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5?4 



ANNALS 



ATO \'(r'*d» 



TRANSACTIONS 



or THE 



BRITISH HOMCEOPAI 
SOCIETY, 



AND OF THE 



VOL IV. 

(POBLISBBO BT ACTHORITT OF THE SOCIBTT.) 




LONDON : 

LEATH AND CO., 5. ST. PAUL'S CHUECH 
And 9, VERB STREET, OXFORD STREI 

1864. 



PREFATORY NOTICE. 



The completion of the Third Volume of " The Amials/' 
demands but few prefatory remarks. 

The Editing Committee have the satisfaction of con- 
gratulating the Society on the steady success of the 
publication, as evinced in the growing favour with which 
its numbers are welcomed, both at home and abroad — 
favour which proves the soundness of the principles 
on which the work was commenced, and to which the 
Editing Committee have strictly adhered. 

The present volume, it is believed, will, in every res- 
pect, bear favourable comparison with its predecessors. 
This is due to the laudable zeal which has prompted the 
production of so many valuable essays ; to the useful in- 
formation, and free expression of opinion, contained in the 
discussions ; and to the more extended form in which the 
latter are reported. The Society is indebted to one of 
its Corresponding Members for an interesting com- 
munication, on a new medicine, which appears in the 
latter pages of this volume. 



vi Prefatory Notice, 

Limited space has rendered it impossible for the- 
Editing Committee to publish all the materials at their 
disposal. In making their selection, they have been 
guided, chiefly, by the practical character of the papers, 
and by the amoimt of interest they excited, when read 
before the Societ3\ 

In conclusion, the Editing Committee Avish to express 
their gratification, at the increasing usefulness and pros- 
perit}' of the London Homceopathic Hospital, whiclv 
whilst it dispenses the blessings of Homoeopathy to large 
munbers of the poor, continues also to afford to Medical 
Inquu'ers, an opportunity of witnessing the practical 
application of the principles propoimded by Hahnemann^ 

Frederic Foster Quix. 
John Rutherfurd Russell^ 
Stephen Yeldham. 
Hugh CA^rEROx. 



CONTENTS. 



Prefidorj Notice to the Third Volame of the Annals. 

No. xni. 

80C1ETT. 

FAOE. 

1. Is the Doctrine of lufinitessimals Consistent with Reason and Experience ? 

By Dr. Samnel Cockbnm ...... I 

2. Discussion (in which Dr. Hale, Dr. Metcalfe, Dr. Eiddj Dr. Drnry, Dr. 

Wyld, Dr. Rnssell, and Dr. Chapman took part) . . • .29 

3. Addressof the President, Dr. Qmn, at the Annnal Assembly of 1863 . 4» 

4. Unpablished Letters of Hahnemann • . • . .61 

HOSPITAL. 

5. Concluding Lecture on Rhenmatism — On the Dose and the Alternation of 

Medicines. By Dr. Russell ...... 72 

6. Case of Ovariotomy ...••.. 91 

No. xiy. 



1. The Positive Services of the School of Hahnemann, Exemplified in the 

Treatment of Acute Inflammatory Disease. By John Ozanne, M.D. . 97 

2. Discussion (in which Mr. Ycldham,Dr. Hughes^ Dr. Russell, Dr. Chapman. 

Dr. Chepmell, and Dr. Qnin took part) . . . . .113 

3. On Some Afifections of the Knee-Joint. By Dr. Ransford . .128 

4. Discussion (in which Dr. Drury, Dr. Russell, and Mr. Yeldham took part) . U I 
6, Retrospect of 1862 . . . . . , .144 

6. Some Unpublished Letters of Hahnemann . . . . IGo 

HOSriTAL. 

7. On some Morbid Affections of the Nervous System. Lecture I.— Epilepsy. 

By Dr. Russell . . . . . . . .164 

8. Cases treated with High Dilutions. By S. Yeldham, Esq., Surgeon to the 

Hospital ......... 183 

9. Cases by William V. Drury, M.D., M.R.LA., Physician Accoucheur to the 

Hospital .... , • • 18S 



vi Confnih. 



No. XV. 



8i»(IHT. 



1. A Case of Kxtra Uterine Gestatiou. L>y Mr. I.«eadam . .193 

2. DiscDSfioD (in which Mr. Cameron, Dr. Drary, and Dr. Qnin took part) SOS 

3. On some Morbid Affections of the Ear. By Charles Cotmore, E«q., 

M.R.C.L.,&L.M.,Eng. ....... sio 

4. Discussion (in which Dr. Drurj, Mr. Yeldhaui, and Mr. Cameron took 

part) ......:.. 236 

5. A Case of Hsmatnria and Albnminoria after Scarlatina Miliaria. Bj Dr. 

Trinks ......... 228 

6. Discussion (in which Mr. Teldham, Dr. Wjld (of London), Dr. Hughes, 

Dr. Drury, Dr. Wilde Cof Winchester), and Mr. Cameron took part) 241 

7. Cases of Opthalmia, with Opacity of the Cornea. By. Dr. Ozanne 246 

8. Some Unpublished Letters of Hahnemann .... 254 



9. On some Morbid Affections of the Nerroos System. Lecture IL — Epilepsy. 

By Dr. Russell ,. ^ - . . . . . 258 

10. Cases Treated with High Dilutions. By S. Yeldham, Esq., Snrgeon to the 

Hospital ......... 283 

No. XVI. 



1 . Observations on the Physiolo^iuai aud Therapeutic Effects of Alcohol. By 

Alfred C. Pope, M.RO.S. 286 

2. Discussion (in which Mr. Cameron, Mr. F. H. Smith, Dr. Dmry, Dr. Ru8«ell, 

Mr. Yeldham, and Mr. Pope took part) . . . . .310 

3. Case of Gangrena Senilis. The last illness of Archbishop Whately. By 

Dr. Scriven ........ 318 

4. Discussion (in which Mr. Yeldham, Dr. Kidd, Dr. Morgan, Mr. Buck, Dr. 

Russell, and Dr. Chapman took part) ..... 329 

5. Observations on a Few Local Anaesthetics. By Dr. Eugene Cronin . 333 

6. Discussion (in which Dr. Wyld, Mr. Cntmore, Dr. Drury, Dr. Russell, and 

Mr. Cameron took part) ...... 339 

HOSPITAL. 

7. Lecture on Asthma, by Dr. Russell ..... 342 

8. Cases Treated with High Dilutions. By S. Yeldham, Esq., Surgeon to the 

Hospital . , , . . . . . . 362 

AFPEl^DlX. 

Fourteenth Annual Report of the London Uomoeopathtc Hospital . .371 



Contents. vii 

No. XVII. 

•OdBTT. PAOB. 

1. On the Alternations of Medicines. ByDr. Drjsdale . .871 

2. Discnssion (in which the President (Dr. Qnin), Mr. Yeldham, Dr. Metcalf, 

Mr. Reynolds, Dr. Chepmell, Dr. Dmry, Mr. J. Harmer Smith, Dr. Hale, 

Dr. Russell, Dr. Drysdale, and Dr. Chapman took part) . . . 384 

3. Notei on the Symptoms of Cerebral Disease. By Dr. Black . . 404 

4. Diacaesion (in which Dr. Drury, Dr. Wyld, Dr. Hughes, Dr. Eidd, Mr. J, 

Harmer.Smith, Dr. Russell, Dr. Black, and Dr. Chapman took part) • 424 

5. On Diabetes Mellitus. By Dr. Neaiby . . . . .432 

6. Discussion (in which Mr. Buck, Dr. Watson, Dr. Hamiltooi and Dr. 

Neatby took part) ....... 455 

7. Resolutions of the Society in regard to holding Profesaional Intercourse 

with Unqualified Practitioners ...... 453 



8. Cases Treated with High Dilutions. By S. Yeldham, Esq., Surgeon to the 

Hospital ........ 460 

No. XV lU. 

fiOGIBTT. 

O-, 1. OnAlbWnuria. By Dr. Gibbs Blake ..... 487 
' 2. Discussion (in which Dr. Drury, Dr. Bayes, Mr. Leadam, Dr. Ransford, 

Mr. Theobald, and Dr. Russell took part) .... 485 

3. A Few Remarks on the Action of Hydrastis Canadensis in Cancer. By 

Dr. Brtyes. ........ 489 

4. Discussion (in which Dr. Drury, Dr. Hamilton, Dr. Metcalfe, Mr. Reynolds, 

and Dr. Hall took part) ....... AOO 

5. Remarks on Recent Cases of Poisoning by Calabar Beans. By. Mr. J. 

Harmer Smith ........ 602 

6. Observations on the Cactus Grandiflorus. ByDr. Rubini . . 508 

7. Discussion (in which Dr. Russell and Dr. Yeldham took part) . . 512 

HOSPITAL. 

8. Lecture on Asthma. By Dr. Russell • . . . . .511 

9. Cases Treated with Low Dilutions. Bj S. Yeldham, Esq., Surgeon to the 

Hospital ......... 533 

Index to the Third Volume . . . . . . .543 



genitals af Ij^t Somlg* 



IS THE DOCTRINE OF INFINITESIMALS CONSISTENT 
WITH EEASON AND EXPEEIENCE ? 

By Dk. Samuel Cockburn. 

Mr. Chairman and Gentlemen, — ^Next to the law of Cure, 
the subject of Dose occupies the most important position in 
the practice of Homoeopathy. In regard to the law we are all 
united, and herein lies our strength — therein lies our power. 
In regard to the dose we are sadly disunited, and herein 
lies our weakness — ^weakness within, deficiency of power 
without. 

I confess that I have found great difficulty in knowing how 
to face this subject. At one time it has assumed the appear- 
ance of an immense giant, whose vast proportions, armed cap-a- 
pie, struck awe to one*s heart, and defied any attempt at attack. 
At other times it has assumed the appearance of a phantom, 
to fight with which would be like a man fighting with his own 
shadow. Giant or phantom, let us face it. 

In order to take a comprehensive, and at the same time, a 
clear and definite view of the subject, I shall divide it into 
eight short heads ; — 

I. The Origin and Tendency of Infinitesimals. 
II. Infinitesimals not Demanded by the Bequirements of 
our Organization. 

III. Why they Cure, and Why they Cause Aggravations. 

IV. Tested and Found Wanting. 

V. The Cause of Disunion, and an Obstacle to our Progress. 
VI. The Doctrine of Infinitesimals is Unscientific : 

1. Because Incomprehensible. 
VOL m. 1 



2 Is the Doctriiu of InfinitesimaU 

2. Because Impracticable. 

3. Because Uncertain. 

VII. The Doctrine of Infinitesimals is opposed to and sub- 
versive of Homoeopathy. 
VIII. The Doctrine involves an Absurdity. 
[As this paper is somewhat too long, I shall be obliged to 
omit some portions of it] 

I. — ^The Origin and Tendency of Infinitesimals. 

Hahnemann is silent as to the causes which led him to the 
introduction of infinitesimals. Why he did so, therefore, can 
only be inferred from collateral evidence. What led him to 
the discovery of Homoeopathy, and the evidences of its truth, 
are given with openness and candour. What led him to the 
introduction of infinitesimals, he kept a secret. The difference 
between Homoeopathy and the old method of practice was not 
so great as that subsisting between the infinitesimal doses 
which he invented and those used in ordinary practice. 
Homoeopathy was known before, and had been practised in a 
limited form for ages ; but infinitesimal doses, such as those in- 
vented by Hahnemann, and practised by some of his followers, 
were never heard of before — ^never had any existence. It 
is currently admitted that he was led to diminish his doses on 
account of the aggravations which were sometimes observed 
to follow their use. This reason has very generally been 
received — and naturally enough — though no one has ever 
alleged that these doses failed to effect cures. But to avoid 
aggravations could not be the reason for the introduction of 
infinitesimals. We can understand how a large dose should 
give place to a small one, if the former appeared to act too 
powerfully — how half-a-grain should be given in place of a 
whole grain, or a quarter in place of a half, and so on ; but 
we can see no relationship whatever between any degree of 
aggravation ever recorded, and the infinitesimal dilution of 
the drug frequently used oow. And then you wiU observe 



Consistent with Reason and Experience f 3 

that it was not in all the cases, not even in the majority of the 
cases, that any unpleasant aggravations were produced by the 
large doses : it was only in a few of them, in which monstrous 
doses of powerful drugs were^given, that anything of the kind 
was observed ; but the infinitesimal invention applied to every 
kind of medicines, whether aggravations had ever been observed 
by their use or no. And then Hahnemann, as well as many who 
bear his name, afl&rm that aggravations happen more frequently 
under the use of infinitesimals than by the use of large doses, 
thus stultifying the original reason assigned for their introduc- 
tion. I therefore cannot believe that this had anything to do 
with the origin of these doses. There are only two alterna- 
tives — either that Hahnemann was not led to the introduction 
of infinitesimals fipom the fear of causing aggravations, but for 
some other reason; or that the introduction has proved a 
failure, — for aggravations occur more frequently under the use 
of infinitesimals than by the use of large doses. 

As is well known, Hahnemann, after discovering the Homoeo- 
pathic law, established its truth by a record of facts drawn from 
the experience of Allopathic practitioners, who, of course, had 
effected their cures by the use of large doses. His faith in the 
truth, therefore, and consequently in the superiority of Homoeo- 
pathy over Allopathy, was based on results obtained by the 
use of such doses. And when he commenced to follow the 
law in his own practice, he not only had no intention of 
giving doses different from those generally given by Allopaths, 
but daily experience with such doses confirmed and estab- 
lished his faith in their success. Small and infinitesimal 
doses were then never dreamt of. For nine years he practised 
Homoeopathy with the large doses of crude drugs used by Allo- 
paths, and by these obtained cures which for rapidity and 
beauty have never been surpassed. His success then was 
the making of Homoeopathy. Every year's experience with these 
doses gave fresh proofs that Homeopathy was true ; and every 
year raised him in public estimation as a successful practi- 



4 Is the Doctrine of Infinxtenmah 

tioner. In 1799, his fame and reputation ran so high as to 
attract the notice and arouse the jealousy of the medical 
authorities in Wolfenbiittle, where he then resideil. And as 
Halinemann's practice of dispensing his own medicines was a 
direct violation of a national law, which nia<le it ini[)erative on 
every medical practitioner to have his medicines prepared and 
dispensed by an apothecary, an action was raised against him 
by the apothecaries, whose privileges he had infringed upon. 
The result of this was, that Hahnemann was debarred from 
practising. All who have studied the nature of the struggle 
between the great Medical Eeformer and the apothecaries, must 
have observed that, to a very considerable extent, Hahnemann's 
feelings got the better of his judgment. As an intelligent 
man, Hahnemann must have felt that his case with the apothe- 
caries was a hopeless one. They had the strong arm of the 
law on their side ; he had none. How, at this period, he rea- 
soned on the subject, we know not ; but the very next year 
after this attack upon him by the apothecaries, we have the 
first introduction of the infinitesimals. We have not the gradual 
diminution in the size of the dose which we would naturally 
have expected to find in the development of a new practical 
fact, but the sudden and unlooked-for introduction of infinitesi- 
mals. And he on more than one occasion afterwards pointed 
to these infinitesimals as a triumph over the apothecaries, whose 
services in future would not be required by medical practitioners, 
and whose trade would therefore be ruined. Under cover of 
these infinitesimals, he endeavoured to evade the law ; and some 
years after that brought out his famous manifesto in defence of 
his position, in which, by a species of special pleading which 
no one can approve of, he endeavoured to show that the law 
did not and could not apply to his peculiar kind of medical 
practice. 

Looking at these facts, I think we have veiy strong evi- 
dence to suspect that the persecution referred to had something, 
if not everything, to do in originating the infinitesimal doses. 



Consistent with Reason and Experience f 5 

II. — Infinitesimals not Dbmandkd by the Kbquieembnts 
OF ouB Organism. 

In every condition, in every circumstance of human exist- 
ence, in savage equally as in civilized life, the body can appro- 
priate for its support and growth only those substances which 
in their constitution correspond to itself. Qualitative resem- 
blance is an absolute necessity ; every departure from this frus- 
trates the ends of nutrition and growth. But while qualitative 
resemblance is so imperative, absolute quantitative relationship 
is not so. Man is so constituted that, provided he gets what 
is in its nature suitable, it is not necessary that he should 
take it in such a quantity that it shall not by one grain, or by 
one fraction of a grain, be above or below a certain given 
standard. He lives, grows, and thrives on quantities and 
proportions varying to a very considerable and, in some in- 
stances to a very great extent. Were this not the case, and 
if every fraction of a grain either in our bread, salt, or beef, 
were to be followed by loss or suffering, what would our lives 
be ? We cannot, could not by any means, know exactly to a 
grain how much we need, and no more ; and if this is so, how much 
less could we know to the hundredth, thousandth, or millionth 
part of a grain the exact quantity we need ? God has so formed 
our bodies, that we don't need to know this ; — ^practically, such 
knowledge would be of no use. That man would be recognised 
as a madman who should attempt to regulate his food by the 
grain ; much more so, were he to estimate it by miUionths or 
billionths. 

The cure of disease can only be effected by a remedy having 
a certain definite relationship to the disease. Whatever the 
form, whatever the condition, — ^be it plant, mineral, or metal, — 
this qualitative relationship is imperative. This qualitative rela- 
tionship discovered and established by Hahnemann, we recognise 
by the teim Homoepathy. In all ages of the world — ^in every con- 
dition of human existence, civilized and savage — througkow^* viSi 



6 Is the Doctrine of Infinitesimals 

the reigns of diflTerent and opposing medical theories and systems, 
cures have been eCTected in accordance with this qualitative rela- 
tionship, and by quantities varying as much as we find to obtain 
in the quantities of food used by different individuals. Our pre- 
sent knowledge of the history of medicine has brought this con- 
sjiicuously to light. Large doses have cured, and do still cure. 
Small doses have cured, and do still cura A man may take too 
much of the right kind of food, and an abnormal and uncom- 
fortable condition of obesity ensue ; or he may take a great deal 
too much, and die from gluttony ; or, again, he may take too 
little, and the energy and strength of the system become im- 
poverished ; or, he may take a great deal too little, and die fipom 
starvation. But between death from gluttony and death from 
starvation there is a wide range of degrees, and the right and 
the i)roi)er are easily found by the great majority of mankind. 
But that the right and the proper are comprised within limits 
so marked, tliat the passing of which on the one side or the 
other must entail suffering or loss, is not true. In the best of 
health, our frxxl, in quantity, varies within certain conservative 
limits, wliich have a considerable range every day, and that 
variation has no effect upon us. The constitution of our bodies 
is wondorfiiUy and beautifully adapted to this. 

And just so in disease — a patient may take too much of the 
riglit kind of medicine, and thereby produce disturbing drug 
syniptoiriH; or he may take a great deal too much, and die in 
coriH(jquorice ; or, again, he may take too little, and the disease, 
unolKjckod, may extend its ravages in the system; or he may 
tak(i far too little, and die from the disettse. But between death 
from drug jioisoning and death from too little medicine there 
is u wi(l(j lunge of quantities, within which range we are sure 
in (jflciciiiig a cure, and within which we are quite as certain of 
doing no liann. Infinitesimal quantities of the right kind of 
food are bcjyond our capacities to appreciate, and unnecessary. 
IrifinitcHinial qiuintitics of medicine are also beyond our capa- 
cities to appreciate, and in the cure of disease are qidte un- 



Consistent with Reason and Experience t « 

necessary. The body, to live and grow, must have food ; dis- 
ease, to be cured, must have medicine. To say that exactly so 
many grains or so many drachms or ounces ought to be taken, 
and no more, would be no more absurd than to say that the 
billionth or trillionth of a grain was the only right quantity 
to cure. The speculative theory which would defend the one 
figment would equally apply in defence of the other phantom. 
Let us be men guided by the real and the true. Science deals 
with the known and knowable. 

III. — ^Why they Cube, and Why they cause Aggravations. 

It would be absurd to deny that aggravations, and aggrava- 
tions of a very violent description, have taken place during the 
use of infinitesimal doses. Authenticated facts of this kind, 
from a variety of sources, place the subject beyond all doubt. 
But, seeing that, comparatively speaking, large doses of the 
same medicine used in similar diseases do not produce the 
aggravations which are assigned to the infinitesimals, it is 
evident that there must be some special reason to account for 
the fact. It is not difficult to understand how the fourth 
of a grain produces less effect than a whole grain, and how the 
fiftieth part produces stUl less ; but that the ten thousandth 
part of a grain, or a billionth part, should produce a greater 
effect than the whole grain, cannot be understood without the 
introduction of some special reason to account for the fact. 
How do infinitesimals produce aggravations? Some years 
ago I more than once met with patients who complained sadly 
of having been much disturbed by the medicines they were 
taking, the symptoms of their complaint having been much 
aggravated, and who declared that they could not possibly con- 
tinue to use it on account of its over-powerful action. This 
annoyed and puzzled me for a long time, more especially as 
the medicines then used were in infinitesimal doses from the 
6th to the 12th potency, and sometimes higher. The fact 



5 Is the Dortrinf of InfinittMmaU 

:i..\: ctl.ers had often met with similar cases did not in any 
irjTv-r Iv^son the difficulty. Tu sjiite of my own exj^erionce 
az.: ::..;: of many others, the farts set'ined to me to involve a 
:::.:rA.l:::i..a. and I resolved on tryin;^ s«jme exi>eriment« in 
:r.'.-.r :■: J.v:emiine their meaning. To one patient who com- 
^*.i::.v.l loudly of his mahuly having l»een aggravate<l, and 
ii^ r:>>:\: strong fears that the honueoj^athic medicine was too 
r«."3-rr:j.l, I gave powders of pure sugar of milk, and the aggra- 
Ti::::ij weiv quite as strongly nuirked as Wfore. To another, 
L ifni.CT. who complainetl of Ixiing much disturbed by the 
n-i'i:.!::* I gave pure water, with a few droi>s of spirit of wine 
ii. ::. i::I s::ll the aggravations continueil. In two or three 
:•:! fr -.'i^s I loUoweii the s;une plan, and with the same results, 
iLf £.c:-:T'.v;i:£oas Knng ijuite as much under the sugar of milk 
ijil >\ :t:: .*: wine as under the globules. These facts forced 
n-: :.' .vz.lnde that the aggravations were not pnxluced by 
:!-■ ^'.V::>s a: all. but aiv>$e from a cause witliin the patient 
l:r-:5rl; — hii a subjective origin. I ivmeml^r two of these 
ri>-^ :u yA:t:.",:lAr. the patient* having left me altogether, de- 
^jiTLT^ :h^y ivul.i &>: stand the tiwitment 

Sur..^' li?;:- 1 hive me: with similar cases^ and have followed 
±r -:i:,:>-> ry^\>K:e plan to that ivferrevl ta In place of giving 
x-rr: --:i:~> rvce::iL«vi d^v^es. or puiv sugar of milk. I have 
Ti^cr LZ ,-i::j.v, or in ;^>iuo C5is<>s gradually, come down to 
x.i^zr:jLl :rSi,':-.-ciAl di\i^^ of the uuxli^ino which was found to 
.-sii-s: -.1- i^riV3i:va. and in all suoh oas^>s 1 have found the 
Acr^ -i~.-3: T,' >rtjfca^ ray:a:Y. 1 n<\\i no: ciil^rp? on this^ 

Yrn -J:*:>s*f rv\^ ^r.T!« of ex^^vriiuoutcv 1 a:u ^viiviuced that 
iZ, *c^ '"i-.\irs A.vzrt*j:i: vixxTti;^: t!:e use of ir,t::u:e??™ils^ which 
ijv r : ri^jLTsI 5fTwroc2::^;rri:* \>f iho o.:si<\-Uk\ r.::v>AvkTxi >y che 
-r-=L:=-=u~ ij^ yzr.xriL-rt; ?>f jci iv,iprt>*3Uon v/,Av:e vn: :he iiiagi- 

Z-Zi- > i:? i T^. «a\£ ^wiilN thN>*i* who tlrs: s.v:t:<' r:n%ier 
:l=l-i-. -!.::_-■. T^scir^is::: iit'^'s? r>;>5 the faiutxx:^: id^ o: wbai 
^:=rrj.'TiiL'i^\: ^srs^he^ >yn5«s». either a* iv^yxU their iubenrnt 



Consistent vnth Reason and Eocperience t 9 

properties or their strength. The name of the remedy and the 
name of the potency make him in reality no wiser. In this 
condition of ignorance it is natural that certain individuals 
should expect to experience some imdefined kind of effect im- 
mediately on taking a dose of those mysteriously powerful 
drugs, of which probably they have heard some strange stories. 
And further, it is not only natural, but it is certain, that the 
impression thus formed on their imagination will manifest 
itself in the direction of the morbid condition imder which the 
patient is suffering, and that it will manifest itself either as a 
special aggravation, or as a modification of the existing malady. 
It is also quite certain that an alleviation of the complaint 
may be produced in the same way, and it may even happen 
that a curative result takes place after the previous aggrava- 
tion. Sudden and strong mental impressions have often pro- 
duced very serious diseases, and even death, and they have 
also often produced miraculous cures. This is admitted by alL 
That the aggravations in the cases referred to did actually 
arise from an influence having a subjective origin cannot be 
doubted, seeing that the aggravation ceased so soon as a suffi- 
cient quantity of drug was taken to produce a real drug action. 
As the excited imagination has the power of impressing itself 
on the existing disease, and thereby producing aggravation ; so 
the drug has the power of impressing its action on the sensitive 
sphere, quite independent of the imagination, and thereby the 
patient becomes conscious merely of a slight drug action — so 
slight, indeed, as may merely suffice to counteract the effect of 
the imagination and alleviate the malady. 

Those who wish to cure disease by acting on the imagination 
will find the 30 th or any higher potency a most suitable dose, 
there being no fear of such doses interfering in any way with 
either biological or magnetic influences. But those who believe 
that drugs, when properly given, have the power of curing all 
curable diseases, should see to it that in the treatment of dis- 
ease they are really using drugs, and not mere names. 



10 Is th€ Doctrine of InJiniiesimaU 

IV. — Tested and Found Waitting. 

Hahnemann recommended globule doses of the SOth attenu- 
ation as being the most highly curative potency and dose of 
the drug. True, ho substituted olfaction in place of the 
globule in his latter years ; but as this part of Ilahnemannism is 
not formally represented in our day, we need not consider it. 
Many have gone far beyond their teacher in the potentizing pro- 
cess, the 200th being frequently used by soma Some choose the 
high potencies ; some choose the low ; and some, again, with an 
accommodating profession of extreme liberality, choose all — 
high and low, low and high, up and down, down and up, — 
guided by what ? Yes, by what ? Will anyone tell me why 
he chooses the SOth in place of the 29tli or 28th ; or why he 
chooses the 60th in place of the Gist, or the 12th in place of 
the 13 th, and so on ? What is his guide in choosing these ? 
It cannot be experience, for most of the intermediate potencies 
he has never tried, and in all likelihood never will try. Do 
we call our friends over the way routinists? What is the 
choice of the SOth potency but the highest embodiment of 
routinism ? 

There appears to me but one way of fairly and conclusively 
testing the worth of these infinitesimals, and that is, to try 
them in such cases as shall leave no doubt as to the effect of 
the treatment upon the disease. Some complaints are very 
capricious in their course and development, paroxysms of pain 
coming on suddenly without any intimation, and often going 
off as suddenly — old troublesome symptoms reappearing under 
influences which we cannot always understand — abnormal con- 
ditions, changes of mode of living, changes of weather, 
atmospheric changes, &c., remaining away for years, or re- 
turning in some new form. It is clear that it would not be 
fair to test these doses in such complaints, because there might 
be room to doubt whether the dose given really had anything 
to do with the change that took place during its use. There 



Consistent with Reason and Experience f 11 

are some complaints, however, the natural course and history 
of which we know so well that we can be certain as to the 
effect of the treatment. I shall refer to one or two of these. 

Thus, in hooping cough, Hahnemann recommends one 
globule of the 30th potency of Drosera, which he says 
will cure the malady in seven or eight days. like all of you, 
I have had many opportunities of testing the truth of 
Hahnemann's assertion on this point, and I have no hesitation 
in saying that even in very simple uncomplicated cases, I have 
not observed the slightest effect from the use of globules of 
the 30th potency of Drosera, even after trying it for a longer 
period than seven or eight days. I have also consulted many 
authorities on the treatment of this complaint, and the whole 
weight of testimony is dead against the eflftcacy of globules of 
the 30 th potency. Drop doses of the 1st cent, of Drosera I 
have often seen do good, though no one now trusts to this 
medicine as the specific for every kind of hooping cough. 
Hahnemann's reconmiendation of the 30th potency, and his 
assertion about curing it in seven or eight days, can only be 
looked upon as the offspring of his theory, and is very much 
of a piece with the monstrously exaggerated statement he 
makes about one drop of the 1 5th potency being sufficient to 
endanger the life of a child. Hooping cough in a mUd form 
disappears of itself, but globules of the 30th potency of 
Drosera have no effect upon it. 

In the treatment of itch, also, Hahnemann says that one 
globule of the 30th potency of sulphur is sufficient to effect a 
cure. Hahnemann's method has been tried times without 
number, and found a failure. Now, itch, whether of recent or 
longstanding, cannot be cured by globules of the 30th potency 
of sulphur. The testimony of the profession is clear and ex- 
plicit on this subject ; and it is highly questionable if Hahne- 
mann himself ever did any good by it, or even tried it. We 
have it on the testimony of Dr. Hartmann that Hahnemann 
did not abide by the treatment he recommended to others. Iil 



1 2 I A thf Dortrinf of InJinUesimaU 

181G, t\v«Mily-six ywirs nftor the discoveiy of HomcDopathr, 
nii«l sixt<*(>ii yoiirs at'trr tlie iiiv(*iition of infinitesimals. Dr. 
Ilartiiiaiiirs bpitlirr Applied to Hahnoinann for the cure of 
itch. IlaliiH'inann, of course, nrniiniiriidod sulphur, but not 
one ^'Iiilmlo of the 3()th jMitiMuy — no, hut the 1st decimal, and 
tliat lint in ;^h)hu1o doses, hut as nnuh as would cover the 
])oiiil of a iKMiknifo; and not onro a fortnight, but three times 
a (hiy. And, besides that, sulpliur ointment was to be rubbed 
into the joints every ni^ht. This eminently rational treatment 
was ]»erfe<'tly suc(;e8sful ; Hartniann's bnjther was cured, and 
enjoyed perft^ct health afterwanls. This one fact upsets all 
Hahnemann's theorisings alxjut the cure of itch by four globules 
of the 30tli potency. 

In s}^hilitic diseases, Hahnemann asserts that one globule 
of the 30 th potency of mercury is sufticient for the cure. I 
need scarcely say that this assertion has been disproved. 
Evidence from every part of the world testifies that the 30th 
potency of mercury has no effect on this disease; and the 
practice, if followed out, would, to a certainty, be productive 
of the most dire and destructive consequences. 

Then in cholera, the universal voice of the profession is 
against globules of the 30th potency. Even Hahnemann's 
treatment of this disease with camphor, was heroic when com- 
pared to that of all other Homceopathists now-a-days. Large 
quantities of the saturated tincture were given internally ; the 
same was given as an enema, and also rubbed largely all over 
the body. Why in this disease should the potentizing theory 
not hold good ? — ^why, if the curative power of the camphor 
is more highly developed by the potentizing process, why not 
use the drug in its most highly curative form in this highly 
dangerous disease ? It is in rapid and dangerous diseases that 
we require the highest resources of the medical art. Why, 
if potentized drugs are best, do we not give the 30th potency 
of camphor? In this case theory has failed to crush and 
rule over the good sense of Hahnemann and that of his 



Consistent with Reason and Experience i 13 

followers ; and it is a blessing to the world that such has been 
the case. 

Is there any reason, in the nature of the case, why the 30th 
potency should not be given ? Let us see. 

First, in regard to the disease : 

(a.) It cannot be because of the danger and fatality of the 
disease, because there are many other dangerous and fatal dis- 
eases in which the 30th potency is given. According to 
Hahnemann's theory, the severity of the complaint does 
not regulate the potency, were it the case that the danger 
and urgency of the disease is to be the guide, as to the strength 
of the dose; it would be an amusing application of the 
Eule of Three to find out what degree of severity or danger 
any particular disease would require to have to be treated by 
the 30th potency, that of another being given which required 
drop doses of the saturated tincture. Such a disease would 
certainly be very highly attenuated. 

(6.) It cannot be because the disease is one which runs a 
very rapid course ; for we do not find this principle at all 
acknowledged or acted upon by strict Hahnemannians. Diseases 
running their course in a few days receiving the same 30 th 
potency which is applied to others extending over months or 
years. 

Second, in regard to the drug : 

(a.) It cannot be because camphor has a short period of 
action in the body ; for this would account for the frequency 
of repetition, but not for the strength. 

(6.) It cannot be because the drug has a feeble or slight action 
on the system; for camphor has a powerful action and in 
strong doses produces alarming and fatal results ; an action 
more powerful than carbo. calc. cam. silic, &c., which are 
given in the 30th potency. Why then not be consistent, and 
follow out the potentizing theory in this case? I look to 
potentisers to give the answer. 

I might here refer to gonorrhoea, but no one who knows 



14 h the Doctrine, of InfiniUsimaU 

aiivtliint; of the trimtmoiit of Ruch complaints imagine that 
^luhiilis of tlio 3(»tli iM»tt'iicy have any effect at alL If then 
^Inhiilrs of tlio 3()th potciu'V of the tnio carative remedy 
art* fouinl to he iuo|M>r:itivc in those complaints mentioned, what 
coiK-lii.sion are we to come to ? Hahnemann says the 30th 
potcnry is the most hi^'lily cunitivc in all diseases, but what 
he says in ref^^nl to the general use of the 30th potency has 
no more evi<If'ncc to su])iKirt it than what ho says in regard 
to its special eflicacy in hooping cough, itch, and syphilis. 
But the testimony of facts jimves that the 30th potency has 
no effect in these s])C('ial com])laints, and we are therefore 
warranted in concluding that it lias no effect in general use — 
no effect in any. 

V. — ^The Cause of Disunion, and an Obstacle to our 

PUOGRESS. 

Homoeopathy, as a principle, can be demonstrated — ^proved to 
be true ; and when fairly examined, it has commanded the assent 
of every intelligent mind. The most that any of its bitterest 
opponents have ever ventured on saying is, that while true in 
principle, it is not of universal application. A large and prac- 
tical knowledge of it, however, leads to the conclusion that it is 
universally applicable in its own sphere. As a general truth, 
harmonising with the highest exercise of reason, and also 
with the results of experience, it is designed to be univer- 
sally acknowledged. In this we look for unity — a unity 
quite consistent with very considerable diversity in the special 
individual apprehensions we may have of it. It is, perhaps, 
impossible for any two minds to look at or apprehend 
any one truth in every aspect of it exactly in the same 
way. Being universal in application, we look upon it as being 
designed to become universally practised. Absolute unity in 
practice we know cannot be ; but there is a unity of practice as 
well as a unity of principle quite consistent with very con- 
siderable difference in detail We look forward to and strive 



ConrnterU with Reaso'n and Experience f 15 

for a universal unity in practice. Far be it ftom me to profess 
such an amount of liberalism as would recognise one kind of 
practice just as good as another, or that two opposite kinds of 
practice can ever possibly be true. There can be only one 
law of healing, and only one true mode of practica Of all 
the systems of the past, no one has ever been based on a prin- 
ciple of universal application; no one has ever harmonised 
the relationship between drugs and disease ; no one has ever 
had the character of perfection in principle, progressive 
development in application, and catholicity in spirit. When 
properly understood, Homoeopathy delivers from the bondage 
and thraldom of all theories and dogmas, and gives the indi- 
vidual practitioner a key and a guide to imlock every diffi- 
culty — to cure disease with safety and certainty, if faith- 
fully followed. But while it does this, it involves a higher 
weight of individual responsibility than any other system ever 
did. No one can ever be a true Homoeopathist who is guided 
by the opinion of, or follows in the footsteps of, another. 
The law must be his only guide — individual right and privi- 
lege in choosing ; individual responsibility in faithfully acting ; 
no casting blame on leaders or teachers. Along with this indi- 
viduality of choice and universality of application, we look for 
unity of practice, and we ought to hav^ it. In the choice — 
in the selection of a drug for a special disease, we have 
something like unity ; thanks to the definiteness and clearness 
of the law for this. And this is a great matter ; but, in the 
dose of the remedy, in its application, alas ! alas ! what have 
we ? Unity ? E"o ; but the wildest confusion,' the most ex- 
treme discord. In the application of the Homoeopathic law, 
we have now a monstrosity of diversity such as never was 
heard of, never conceived of — a diversity and a confusion 
which baffles the mind to grasp. One practitioner gives a 
drop of medicine, another gives a tenth part; one gives the 
hundredth part, another gives the thousandth ; one gives a mil- 
lionth, another gives the billionth; one gives a trilliontb. 



16 Is the Doctrine of Injmitesimals 

another the quadrillionth, and so on and so on without an 
end, to a region requiring a new phraseology — a new lan- 
guage, which corresponds to no conception of our mind, 
and which we cannot understand. What is the value of such 
contradictory experience as this ? What is the meaning of all 
this discord — all this confusion ? There must be error somewhere. 
No wonder our opponents have looked upon Homoeopathy as 
quackery and tomfoolery. Can anyone approve of our present posi- 
tion in this respect ? Can anyone defend it ? Can anyone desire 
it to continue ? Surely not. And if not, what is to be done ? 
The triumphant progress of Homcepathy has been to a great 
extent arrested; and the precious blessings it is capable of dis- 
pensing have been to a great extent shut up from a suffer- 
ing world, and confined to a narrow and limited circle, by the 
extravagant and irrational fancies of infinitesimal potentisers. 
I have unbounded faith in the power of truth reaching the 
hearts and understandings of men, if rightly advocated. The 
opposition to Homoeopathy by the great majority of the pro- 
fession has not been against Homoeopathy proper, but against 
the errors and abuses that have been mixed up with it. Let 
us learn a lesson from the past, and be wise. I am persuaded, 
if Homoeopathy had been rationally practised and wisely advo- 
cated, that instead of hundreds, we would now have been able 
to count our numbers by thousands. We look for this, and we 
ought to accomplish it. 

Hahnemann discovered Homoeopathy, but Hahnemann in- 
vented the doctrine of infinitesimals. There is a limit to all 
human greatness ; there is always a something to mar human 
glory. Hahnemann was not contented to be a discoverer, and 
to be a humble servant and exponent of the truth which he 
discovered, but, unfortunately, he set himseK up as a leader. 
" Unless the physician imitates my method," and, " If phy- 
sicians do not carefully "^practice what I teach, let them not 
boast of being my followers." Such is his language. Homoeo- 
pathy after this lost its catholicity. In place of being a gift 



Consistent wUh Reason and Experience t 17 

from (tocI Himself to a suiSeriiig world, suited for all men and 
all times, it became marred like clay in the hand of the 
potter, and became stamped with the characteristics of the 
man ; and, as a consequence, we have actually a controversy 
between the claims of Hahnemann and Homoeopathy. This 
was his error; here he fell. And how many have fallen here ! 
As a leader, he invented the infinitesimals, and imposed them 
upon his followers, making the adoption of these a test of 
fellowship. Little did Hahnemann dream where this false step 
was to lead to; but the moment the first step was taken, 
HomcBopathy was launched on an ocean without a shore, and 
such it has proved to be. 

On seeing in the practice of others the extravagant lengths 
to which the potentizing theory was being carried by some of 
his followers, Hahnemann, apparently for the first time, saw the 
danger to which it was leading, and exclaimed that " the thing 
must stop somewhere." Stop somewhere ! how could it ? The 
boundary line of science and experience had already been 
crossed, and reason had left the helm ; how then could they 
stop ? Error, like moral evil, never stands stilL Being misled 
by a wild phantom, the very words of him whom they called 
master were imheeded ; from one potency they went to another, 
each new stage of extravagance but preparing them for a higher 
and higher flight, nearer and nearer to the regions of fairyland. 
Is this developing medicine as a science or as a caricature ? 
Is this the way that Homoeopathy is to be raised in the esti- 
mation of intelligent and scientific men ? Is it thus we ex- 
pect to conquer the world ? Verily, no ; it is thus that dis- 
cord and disunion have been sown in our ranks, our influence 
in the world enfeebled, and the day of our final triumph post- 
poned. Let us unite on a rational and scientific basis : thus 
united. Homoeopathy shall move the world ; opposition shall 
quail before its presence ; for it shall then manifest to the public 
and the profession, not only the name, but the power, of the 
true science and art of healing. 

VOL. ni. 1 



18 Is the Doctrine of InfinitemnaU 

VI. — The Doctrine of Infinitesimals is Unscientific — 

1st. Because incomprehensible. 

The use of infinitesimals is destructive to all scientific pre- 
cision in practice. One of the essential elements in every 
science, and without which it cannot be called a science at all, 
is, that in performing any operation or experiment, both the 
quantity and the nature of the materials are really understood. 
Infinitesimal potencies are not imderstood. All potencies 
above the 1 2th are beyond the pale of calculation in so far as 
mental conception is concerned. Whether we look upon the 
potency as the representative of a disembodied force or of finely 
divided atoms, the mind has no power of dealing with them ; 
it is the process alone which is underatood, and it is the intel- 
ligibility of the process that has misled both the practitioner 
and the public. These potencies are spoken about, written 
about, and used in such a familiar way as if we knew tho- 
roughly what we were speaking about and using ; whereas m 
reality no one knows anything about them, neither can he form 
any conception regarding them. As a consequence, where men 
once give themselves up to be led by the unknown and in- 
conceivable in science, degrees of the unknown and inconceiv- 
able are all alike. The tongue can jump with ease from the 
6th to the 12th, from the 30th to the 60th, from the 100th 
to the 200th, from the 500th to the 1000th potency; and it 
is just as easy to speak of and understand the 200th or 2000th 
as to speak of and understand the 30th or 12th. What do 
these figures mean ? what do they represent ? I may be told 
that they represent a particular stage in a process of prepara- 
tion to which the drug has been subjected. Yes, these figures 
represent processes, and nothing more. The profession and the 
public imagined that they represented quantities of the drug, 
but this is not so. 

I do not for a mojient doubt but that every Homoeopathist 
who administers infinitesimals holds that it is not tlie degree 



Consistent with Reason and Experience / 19 

or stage of process that is anything in the matter, but that it 
is the drug, or force, in the particukr fonn or condition repre- 
sented by the degree or process, that is everything. This par- 
ticular condition or form of drug, or force, however, being be- 
yond our capacities to conceive of or apprehend, cannot be the 
subject of intelligent consideration or choice. This being the 
case, one inconceivable or unknown quantity may just as well 
be chosen as another ; but such a choice can have no claim to 
logical or scientific precision. 

In the practice of medicine, the mind perceives abnonnal 
sensations, abnormal functions, and abnormal conditions of 
structure ; it also perceives a more or less striking resemblance 
between the pathogenetic symptoms of the drug and those of 
the disease. In prescribing a remedy, the mind also perceives 
the particular quantity and form in which it is to be used. In 
choosing between different drugs, it is not mere signs or 
symbols which are before the mind — ^it is not a choice between 
A. and B., or between B. and C, but between certain definite 
drugs ; and so in the same way in regard to the dose. The 
choice ought to be made in regard to a certain definite quan- 
tity of material, if material is believed in ; or of degree of force, 
if the idea of force is entertained. But to do this there must 
be a conception in the mind of the quantity or the degree, and 
this quantity or degree is then represented by arithmetical 
figures. It will never do to say that the mind conceives of 
the 12th or the 30th potencies. The 30th potency simply 
represents a stage in a process ; it is the symbol of a stage of 
calclilation — it is not the thing ; it is neither the quantity of 
matter nor the degree of force. The choice of any particular 
process is easy enough, but the choice of any particular 
degree ought to be determined by the previous choice of 
what that degree represents. And as these degrees repre- 
sent what surpasses the powers of the mind either to under- 
stand or conceive of, it follows that we cannot make any intel- 
ligent choice of them at aU ; processes are chosen, not doses. 



i>\ 1$ the Doctrine of Infinitesimals 

ijui ]\ hi unscientific, because impracticable. 

JjL?..v.VAJ-vjiil jxitencies are picpared by the processes of 
\r:.\\.*'k:.\..';:j, &iid succussion. The doctriuc of potentizing assumes, 
Ic. \:j>a jj^^XUiT iij infinitely divisible; 2nd, that in the pro- 
o*«>*h;3* './ trituration and succussion the particles of a definite 
v:.t.:.;.v. of a drug undei^o a certain definite amount of sub- 
c,»^l'-v:-: and 3rd, that the subdivision has no limit — ^it is 



*- » J*:. 



\'i'>.L7Ut dij$puting here the doctrine of the infinite divisi- 
U,Jv.' of iriatt^r, a question of greater practical importance 
zrlv:^>i at ihfi outset — namely, have we the means by which 
yrti cajj ^Jivide matter infinitely? From the nature of the 
<iueJ:tion, I know that no one will say we have. And if we 
hnvh not, then to all intents and purposes it is not infinitely 
diviisiblr^ Lut let us proceed to examine the processes. Firsl^ 
a£ to triturations. 

To prrjjiare the first trituration, 1 gr. of a drug is triturated 
with 99 grs. of sugar of milk for three hours; and as all the 
I^articles both of the sugar of milk and drug are equally tritu- 
rate^l, they must also be equally subdivided, — so that when the 
operation is completed we have 99 times more particles of 
sugar of milk than we have of drug. Absolute perfection in 
this j)roce8S is impracticable; but assuming that perfection were 
attained, wo would have throughout the mass 1 particle of 
drug surrounded by 99 particles of sugar of milk. To prepare 
the second, 1 gr. of the first is added to another 99 grs. of fresh 
sugar of milk. Now, observe that the particles of the 1 gr. were 
originally exactly of the same size as those of the sugar of 
milk, and that it required three hours' rubbing to bring them 
to their present condition. This mixture, then, of the 1 gr. of 
the first trituration and 99 of sugar of milk is triturated for 
another three hours. At the end of this period it is evident 
that the last 99 grains of sugar of milk will be brought into 
exactly the same state of subdivision as the 1 gr. was ; and the 
question arises, does the 1 gr. which was previously triturated 



Consistent with Reason and Experience t 21 

undergo any farther subdivision ? If it does, then we must 
have in the second trituration an irregular mixture of particles 
of different sizes, which is highly improbabla Beason and prac- 
tical experience in the matter would lead us to conclude that 
aU the particles of the second trituration are, when the process is 
carefully conducted, exactly of the same size ; so that the small 
proportion of the drug in the 1 gr. of the first trituration under- 
goes no further subdivision of its particles in No. 2, and the same 
is the case in No. 3, the three hours' trituration merely serving 
to bring up the fresh proportion of sugar of milk to the same 
condition of subdivision as the 1 gr. which was added to it. 
All the particles in the third trituration are of the same size. 
In No. 1 we have 99 particles of sugar of milk for every 1 of 
drug; in No. 2 we have 10,000 particles of sugar of milk for 
every -1 of drug; in No. 3 we have 1,000,000 particles of 
sugar of milk for every 1 particle of drug. The idea that the 
drug is equally divided or spread through the whole sugar of 
milk is utterly impossible, and yet the triturations are spoken 
of as if every particle of sugar of nulk were impregnated with 
or associated with a corresponding particle of drug — a notion 
contrary to reason and fact. 

Then, as regards the succussions, we have the very same«con- 
dition. In the first tincture we have drug and spirit of wine. 
The particles of the drug and the particles of the spirit of wine 
have each a definite size ; and if the tincture is a real tincture, 
and not merely a mixture or suspension, we have the particles 
of the drug and the particles of the spirit of wine both of the 
same size. It is quite impossible to conceive of the particles 
of the drug in this instance being smaller than those of the 
spirit of wine. Making this a starting point, then, we have in 
No. 1, one drop of 6 added to 99 of spirit of wine, and well 
shaken by 10 (some use 60) forcible jerks of the ann. 
What is the result, and what have we ? We have, 1st, 1 drop 
of 6, which, if you please, we shall call drug — one drop of 
this drug, the particles of which are of a defimte size, and 99 



22 Is the Doctrine of Injiniteeinials 

drops of spirit of wine, the particles of which are also exactly 
the same size. This being so, we have 99 particles of spirit of 
wine to every 1 of drug ; by shaking this for any length of time 
you like — 1 minute, 5 minutes, or 60 minutes — what occurs? 
The drug particles and the spirit of wine particles both go 
through the same process; are both subjected to the same 
action ; the effect on the one must be the same as that on the 
other — there can be no difference — so that at the end of the 
process, however long continued, we have 99 times more par- 
ticles of spirit of wine than of drug. If it can be supposed 
that the particles of the spirit of wine may be subdivided by 
the shaking, then it may also be supposed that the particles of 
drug are proportionately subdivided ; but though spirit of wine 
were shaken till doomsday we have no reason to believe that 
its particles are ever altered in size, and certain it is that the 
particles of the drug cannot be subdivided without those of 
the spirit of wine undergoing a similar change, which is con- 
trary to all reason. 

In No. 2 we have 1 drop of No. 1 mixed with another 99 drops 
of fresh spirit of wine, and again well shaken, and the change 
which takes place is the very same as that which took place in 
No. 1. The particles of the spirit of wine are of the very same 
size as those of the 1 drop of No. 1, and no amount of shaking 
can ever alter them. The drug particles are also of the same 
size, so that practically at each new stage of dilution the par- 
ticles of the original drug are rapidly getting fewer and fewer ; 
and as they undergo no further subdivision, they must, in the 
very nature of things, come to an end long, I believe, before 
coming to the 30th potency. 

From all this, I am bound to conclude that the infinite sub- 
division of matter is impracticable, and that we have no reason 
to believe it can be carried up to the 30th potency. 

3. Unscientific, because imcertain. 

Hahnemann recommended the attenuation of drugs to be 
stopped at the 30th degree. Why? Why not carry the 



Consistent vnth Reason and Experience t 23 

process higher and higher, as has been done by some of his 
followers, if it is true that the curative power becomes more 
and more developed the higher we go ? Hahnemann recom- 
mended that the process should be stopped at the 30th potency, 
in order, he says, to secure uniformity in the strength used by 
different practitioners all over the world. Uniformity ! What 
could he mean ? Did he, or does anyone, imagine that two 
different samples of the 30th potency, prepared by two different 
individuals, with every amount of care and nicety, are uni- 
form as regards the number of drug particles, or the amount of 
drug power, they contain ? He must have had strange notions 
of uniformity if he did. Uniformity in potencies is an im- 
possibility, for the following reasons : — 

1st. On account of the essential difference in the propor- 
tion of drug force or active drug power contained in apparently 
the same quantity of two different samples of the same drug. 

2nd. Because of the difference in the precise number of 
molecules in different samples apparently alike. A considerable 
number of particles of a drug have no effect whatever in 
turning the balance in any of the scales in ordinary use ; and 
any difference at all in the number of molecules in the first 
grain of the drug must make a great difference in the 
potencies afterwards. I need not enlarge on these two heads. 

Again, the first dilution of the drug is made by adding 1 
drop of the drug juice to 99 drops of spirit of wine. Now, 
it cannot be doubted that the one drop is intended to represent 
a definite and uniform quantity — that it should contain a defi- 
nite and uniform number of particles; but in pouring out 
drops, I ask, is it at all possible to be sure that you have 
always a drop of exactly the same size — a drop containing 
exactly the same number of particles ? I have been engaged 
in weighing grains and measuring drops for nearly 30 years, 
and I am confident that no one can approach anything near to 
certainty in this matter. Some one might be inclined to say that 
a little difference is neither here nor there ; but a believer in 



24 Is the Doctrine of InfinUmmaU 

potencies cannot with any propriety say that, although practi- 
cally, I liavo no doubt, it makes no diffeTcnee. The difference 
in the size of difTerent drops often amounts to a great deal — ^I 
believe frequently from the tenth to the fifth part of the whole. 
Such a difTerence as this is e([ual to the difference of a con- 
siderable number of potencies — a difference reckoned by 
billions and trillions. From this I am forced to conclude 
that not one of the potencies represents anything approaching 
to a definite quantity, such as the number it bears would lead 
us to expect ; that in most cases the same potency nominally 
will vary to a veiy great extent ; that out of 30 samples, we 
cannot make sure of having any two of them alika We may 
have, in so far as quantity in the original drop is concerned, 
one in reality representing the 20 th, another the 21st, another 
the 22nd, and so on up to the 30tL This cannot be avoided. 
Is this the way to secure uniformity ? Can such a practice 
deserve the name of certainty or of precision. Then, in preparing 
the triturations, besides the constant and unavoidable difference 
in the absolute quantity of the first grain of the drug, there is a 
very considerable quantity of the material which passes off during 
the operation, and especially towards the termination. And 
even allowing that the one grain of the first trituration, when 
again triturated for three hours with a second 99 grs. of sugar 
of milk, should undergo a still further subdivision of its 
particles, it is clear that a very considerable proportion of this 
one grain, from the extreme fineness of its particles, will at 
once begin to escape from the mortar the moment the mixture 
is agitated by the pestle, and that this escape will go on the 
whole time of the three hours' trituration, and thereby cause a 
very considerable loss. All who are practically acquainted 
with the use of the pestle and mortar know this wclL No 
doubt, as the trituration proceeds, the escape takes place from 
the whole mass, including both sugar of Tm'lTr and drug ; but at 
first, and during the earlier part of the process, the chief loss, 
comparatively speaking, must be from the one grain of the first 



Consistent with Reason and Experience t 25 

trituration; and a loss of this kind, to any extent at all, mnst 
tell to a vast extent on the succeeding potencies. 

VII. — ^The Docteine op Infinitesimals Opposed to and Sub- 

VEBSIVE OF HOM(EOPATHY. 

Homoeopathy may be defined to be the curing of a disease 
by a drug which has the power of producing in the healthy 
body an artificial disease similar to the one under which 
the patient suffers. 

In this definition, three elements are introduced : — 

1st. A knowledge of the symptoms of the drug disease. 

2nd. A knowledge of the symptoms of the natural disease. 

3rd. The administering of that very drug which produced 
the artificial disease, the similarity of which to the natural 
disease was the ground of its choice. 

The theory and use of infinitesimals is opposed to this last 
essential element. Let us see how this is so. In all fedmess, 
this last element involves but one meaning — ^namely, that not 
only must the drug used be the same in name as that which 
produced the artificial drug disease, but it must also be 
identical with it in regard to the nature of its mode of action : 
the nature of the force it exerts must be the same. It may 
differ in its form, in its quantity ; but it must not be in any 
sense, or in any essential respect, different from the drug 
proved. It must not only have the same original force which 
the drug proved had, but it must possess no new power which 
the original drug did not possess ; neither must it possess any 
powers, newly developed in it by any process or processes to 
which it may have been subjected, which were not in active 
operation in the original drug, and by virtue of which it 
produced its artificial drug disease. All this is abundantly 
clear, and all this is distinctly contradicted by the theory of 
infinitesimals. 

The doctrine of potentization and dynamization implies that 
drugs possess a deep-seated latent power which cannot be 



:. '•• s-'^Lririot . but T* ^ ^2js 



ii. : !.-. '.':.«! ' :. . * v ^".■. .- fi.:. .:'-] -.\: lai^t.-ri- tLr-.rle* 
li:!\»- fp*.:! ;.:.-■..:- ■' i :'..•:• •-:-:lzi::j f-}^:-:::. Sr-n-r 

l^li-Vi- :]i:.*. t:..- 1.:-:.: ;• ••'■•: :- r-i-r/.y > v->.ji*-lly the lonj- 
«:«jijiiii?M-il j.jr.i-f.*^..^ •., v;., ?. !:.*,- ir:.'* fire su'^-jt-.ted : oti^rs 
JMiiiviii" tii;il !;.•■:..• .- - :..-■ • '.- tr: .1 i..:-J *A ]».'W»'r Jf vek'jied or 
)^roii;.'ljl into act i'.iij 'J;!i:.j ::.- :;:: .'-tliii' j r ":>-55 : and others 
\A'.\\ii\i', i]iut tin.* nattJiL.! u;a:--.:-r of tL'j Jruj! is entu^elT 
silt<.-j<"J in tli« cuujvi of j.ot'.-ijiiziii;:, Liid that the so-called 
*Ji»j;? jjiatcml W;oiiJC'S i:jj]'j'.-L'ijat».-l Ly a liiaguetic pcwer 
'•lij'rlly <l(.-jived 1j-<^iji the j^'.-i-soii of tlif: j^oteiitizer. All these 
tii«o]j.:ft ani on a par; and whi'.h'.-vtr is held to he true, it 
JiijiJy roiilj-adicts t]je cliiof ajid most essential element of 

'iii«: j/i<iat majority of Iloma-opathists believe that the 
|/i'i'<.-a i,f trituration and succussion operates simply by 
Wjwdijij/ tiji' jiartides of the dru;;, so as to make their solution 
"^ii'l^i- 1,: iuid t)ionMj;,di. TJjiH I l>eli*;v(i is all that is accomplished 
*' 'ill tijiii. u r«'quinnl. lint a bidiciver in potencies may also 
•"■ iii- iiJi.d Ui say that thci newly-(h;v«doped power is of the 
-'ii»«. ijjitiji,..^ u,j,i dejMindrt upon th«j samd original i^ower which 

*'""' ^ '*"■■ '*'■'*« «y*iJptoiim. Tni(!, tlic'ir origin may be the 

"■ ■' ■>^'«ill«il^i 4;irrrtivi'. powi'i-H th(»y arc entirely dif- 

I '• i.a hi.-lii i)„jt liny nciw power whatever is 

»."•>• Jiij/j,jj^ i>*'"'«'Marrt, thnn my argument, that 

"'''■"' ■'* *'' *'*»' «|'iiit of llomdiopathy, holds 

'•*"*' V •'■>'.h..u Ihut //i,. ,M,wiT in the drug 

^ . ' ' Z' '^'"'■"•"^ "*• •'»" iH'althy l)ody is ^A« 

^'V »/'/^*^.*. whJMh IU-I.M rumtively on 

// "' *' ''"'''"'■'■'♦ •'»•«« «)iMptoni8 in the 

^" ' ^ nnrnn, *Mi M^ .„r,aivoly in 



Consistent with Reason and Experience 1 27 

the diseased body, then the Homoeopathic principle is sub- 
verted. 

If words have a meaning, there can be no doubt that the 
new curative power said to be developed by the processes of 
trituration and succussion, though naturally inherent in the 
drug, was in a latent and inoperative condition, and could be 
called into active operation only by the potentizing processes. 
But the fact that the drug in its natural condition manifests 
in the healthy body its characteristic disease-producing power, 
proves that this its disease-producing power was not in a latent 
condition, but operative ; and that, therefore, the latent power 
developed by the potentizing process cannot be this disease- 
producing power of the drug, but some other power. I am 
therefore justified in concluding that the new curative power 
developed by the potentizing process is different from the 
disease-producing power of the drug, which is subversive of 
Homoeopathy. 

But if the potentizing processes do not develope any new 
power, what becomes of the potentizing theory ? If the mul- 
tifarious and minute processes recommended by Hahnemann, 
with the sole and avowed purpose of developing a new power 
formerly latent in the drug, fail in developing any such new 
power, then the entire theory and processes of potentization 
becomes a failure. 

If the potentizing theory is given up, then the potentizing 
processes ought to be abandoned ; for these processes were not 
introduced by Hahnemann merely to subdivide the drug, but 
in order to develope the new, often prodigious and over- 
whelming power of the drug. Thorough subdivision of our 
drugs is aU we require, and no mysterious potentizings. The 
disease-producing power of the drug, which it manifests in its 
ordinary subdivided condition, is the alone power which 
cures disease. The-^evelopment of latent powers is a fabri- 
cation. 

Potentizers, to be consistent, ought to institute a new aecu» 



28 Is the Doctrine of I^/initerinuU$ 

of provings with potentized drugs, and be guided in their 
choice of a remedy by such provings ; but until this is done, 
I hold that their present practice of being guided in the 
selection of a remedy nominally by provings obtained by the use 
of drugs whose inner or inmost drug power was latent and in- 
operative, and then applying the drug with this its inmost 
power prodigiously developed, is opposed to one of the cardinal 
elements of Homoeopathy. 

VIII. — ^The Doctrine of Infinitesimals involves ak 
Absurdity. 

The theory of potentizing and spiritualizing assumes that 
the spiritual force of the drug is not only developed in the 
processes of trituration and succussion, but that it is set firee 
from its material embodiment. It is amusing to see how 
fanciful statements of this kind have been accepted and 
credited by men of intelligence, apparently without the slightest 
question. Granting, for the sake of argument, that the drug 
force is &eed £rom its material embodiment, in what form, I 
would ask, does it exist in the sugar of milk ? Is it mixed 
with the latter ; or how is it ? Have we any example of forces 
mixing ; and what are they ? Is it not an established fact that 
forces never mix, but that they always combine i Is it sup- 
posed that the spiritual force formerly resident in the drug 
combines with the sugar of milk, or that it combines with the 
sugar of milk force ? If so, what reason have we to believe 
that this new combination will manifest the same character as 
the drug ? And supposing it has the same character — ^what is 
gained? The spiritual force residing in the new compound 
will require to leave that embodiment before it acts on the 
organism, just in the same way as it would require to separate 
from its natural embodiment — ^the drug. 

In the liquid spiritualization, in what form have we the 
drug force ? Is it simply mixed up with the spirit of wine ; 
or how ? Have we any example of a force being shaken up 



Consistent with Reason and Experience t 29 

and mixed with water or spirit of wine ? Does the drug force 
combine with the spirit of wine ; and, if so, what is the nature 
of the new compound ? Is it drug— or what ? And if a new 
compound, what becomes of the spiritualizing theory ? 

We can act on matter, whether in the solid or liquid state, 
and divide or mix it at pleasure ; but forces cannot be rubbed 
in a mortar, or shaken in a bottla Forces can be evolved 
only by decomposition; and decomposition can only take place 
by the component parts of the substance entering into new 
forms of arrangement — ^new combinations. Look at this sub- 
ject of potentization in any way you like, it certainly does 
appear ridiculous — nay, it is even absurd ; for just see. Is 
it not an extraordinary idea, to talk about rubbing a force out 
of matter ? Is it not equally extraordinary to talk about rubbing 
a force into matter ? But, even supposing that the drug force 
is rubbed out of the drug into the sugar of milk, must it not 
follow that the same rubbing which rubbed the force out of 
the drug material, will also rub the force out of the sugar of 
milk ? If the force, then, is rubbed out of the drug, and also 
nibbed out of the sugar of milk, and consequently is neither in 
the one nor the other, wiU any potentizer teU me where it is ? 

This lengthened and, I am afraid, in some respects tedious 
paper is now finished. I fully expect that where such a variety 
of material has been introduced, and that of a somewhat diffi- 
cult character, deficiencies and errors must have crept in. I 
shall now be glad to see these pointed out and corrected. 

DISCUSSIONS. 

Dr. Hale, while thanking Dr. Cockbum for his paper, which 
gave the Society an opportunity of that full and free discussion 
which the subject demanded, differed in toto from the conclu- 
sions arrived at by Dr. Cockbum. Dr. Hale believed that Dr. 
Cockbum's premises were false and faulty, and that therefore 
his conclusions were also false and faulty. In the first place, 
Dr. Cockbum had tried to prove the analogy between food and 
dmgs — ^an analogy which Dr. Hale entirely denied. Dr. Hal^ 



30 /< th»' Dol/'iM of I Hji nit'. si mats 

*..'.i'. :• :■ •! tii;it frx*<l was pn-ii-nti*! to the system in material 
'j I :.'.•.•.. -■, }m/;iii.-.-, fptiii til.* v«ry iijitiire of its uses, it was 
Ur: '.'i \ii*n t}j*r Tsv-ti'iii in orl«T tn Iwf assiiiiilatftl and deposited 
Hi ;.'..i'» .'i;i! ^j»i;tiititii-i fur thf ;,T'»^»tli and dt-wloimient of the 
\,-,'\ / N'lt -o, )iowiv»r, w»-p' drug's, which are taken into the 
\. '- ::. ii'ft for ^Towth and (l«'V«-liiiniMnt, hut ft»r the purpose of 
\,:'> .'..ir/ 'Jvnariii': ''han;j«-s in th»j or;;ani»Ltinn when disea5e<l 
o' 'I. /i."! -p-'l. Tht'. ari^iiiiHiit fnr th»- n«*ct'?ssity of material doses, 
?/;i ■• : jj/ori an anaIo;.'y which did nut «*xist, was therefore op- 
{,', - i to -t'lt^uct: and jiliihi.'Oiihy. Dr. Ilsde, secondly, entirely 
':■■ ' ;jN-'i from I)r. ^'ockhiirn's s*tut<*nn*nt, tliat the necessities of 
'/::'.:r.i/;iti«iri n;'jiiind tliat drii^js shoiilil not l)e exhibited in in- 
f*:..*i '.mill 'lovrH. Dr. Halt* inaintaimnl that all modem discovery 
hv T;,': iiijcroHfoi*fi, 11h; niiniitii anatomy of the hmnan body, the 
f;i// . of c#:II rh;v*rlopnir;nt and c^ill pathologj', jKjinted the other 
v/ay, nu'\ rl^rarly \trhVi'A that if dnigs arc intended to reach the 
/jjjijiiV: ilriictiire of any rlisoased oryan, they must be brought to 
?:u':li a ;-.taU; of luinutc sulxlivision as will enable them to per- 
iii*:itU: and iutt u])Ou tluj microscopically minute structures com- 
j/o-.iii:' tlif! vttrir>ns or;;aiis. Dr. Hale consideretl the physical 
tit'.':t::Mif*/A of our or;(anization one of the strongest arguments 
in favour of infinite jsinial doses. Dr. Cockburn had introduced 
an ai;MUMr;nt a^^ainst tlitj u«e of infinitesimals, from the uncer- 
tainty u\ii\ unsatJHfactoriiHJHs of so-called medicinal aggravations; 
\fUi ])r. Mal<% wliiKj aj^rf*(iing with Dr. Cockburn that there are 
HjflirjiHiiH atUinding tlu? V(!rifying of aggi'avations, owing to the 
important jiart wliich ofjrtiain ])hy.siological conditions play in the 
I;li<'noni<rna of <liw-a.se; yet, while he blieved that aggravations 
wtr*'. not ivi i'rc<iw,ui as some would wish us to believe, he had 
iii'Vt'i-i^H'UHH fn'<jU(^ntly obsen-ed them occurring from infini- 
t'rMJnjaldoM^jn, anrl had obs(Tved them occurring, moreover, during 
lii;{ i'uvly <-xp( riinrjnts of Ilonimopathy, when the patients were 
not at that iinir; awarcj that they were taking homoeopathic 
rt-iwAu-.i thuH HO far eliminating both in the patients and in 
hirn:'.'-.lf i\u\ mental cause of aggravations. Dr. Cockburn 
donl»l,<'<l tho alIcg(Ml Ijwits of medicinal aggravation from the 
jK'tiori <i\' ip<*dw;uanlia when inhaled in infiuitesimally minute 
(liiruMion in the air; but Dr. Ilale would not occupy the time of 
thn Society \ty (aichjavouring to prove that the accumulated 
weight of evidence in i)roor of such an action of ipecacuanha 
in i'AwUiwi i(IioHyneraci(jH was overwhelming, but instanced a case 
the Hubjeel of whi(jh was a hard-headed allopathic sceptic, in 
whom the minutc^st (piantity of white of egg (which contains 
Hulffhur) in(hic(Hl an attack of acute eczema whenever he partook 
of food (jontaining eggs in any shape. In Dr. Cockbum's paper 
doubts vfiwv. (^xprejssod as to the action of infinitesimals in the 



Consistent with Reason and Experience ? 31 

treatment of syphilis ; "but Dr. Hale had succeeded in curing 
primary Hunterian chancre with Merc. viv. 6th cent., and 
secondary syphilitic ulceration of the throat with Lachesis 5th 
and 6th centesimal. Dr. Cockbum's paper had an apparent 
semblance of logical accuracy in treating the subject ; but Dr. 
Hale considered his logic only apparent, and his deductions both 
illogical and unsound — for instance, one of the arguments dwelt 
upon at some length by Dr. Cockbum was, that the administra- 
tion of infinitesimals was unscientific because their modus ope- 
randi was incomprehensible. Dr. Hale said if this were true 
there would be an end of the practice of medicine : if we were 
to wait, before giving any medicine, until we knew exactly its 
modus operandi, there would be an end to all progress, and 
medicine would be an impossible art. As well might the astro- 
nomer refuse to calculate the motions of the planets, or to accept 
and use the laws of gravity until he had first discovered the 
actual constitution of the sun. What allopath can tell exactly 
the modus operandi of five grains of blue pill? Dr. Hale 
could not follow Dr. Cockbum's argument as to how a grain of 
any substance, with other grains of sugar of milk, conduct 
themselves when saturated in Dr. Cockbum's mortar; but in 
order to prove that matter was rendered visible to the senses up 
to the fifth dilution, he instanced some experiments in spectrum 
analysis made by him in the presence of the Secretary , at a /.JV 
former meeting, in which Nitrate of Strontia and CarhoTUjUe of 
Barytes were rendered perfectly sensible to sight in the 5th cent, 
dilution. A theory of Homoeopathy had been propounded in the 
paper just read, but Dr. Hale was not prepared to accept the 
theory of Homoeopathy upon which Dr. Cockbum based his 
argument. He was not prepared to receive even Hahnemann's 
theory of Homoeopathy. When Hahnemann accumulated facts, 
and from the induction by facts enunciated a laWy he was strong ; 
when he theorised, he was weak. Dr. Hale did not think we 
had yet a satisfactory theory of Homoeopathy. Our duty now 
is to observe phenomena, and build up Homoeopathy by facts. 
This led him to the very climax of Dr. Cockbum's argimient — 
namely, that experience was against the use of infinitesimals. 
If so, Dr. Hale contended, they are indeed a delusion and a snare, 
and thousands of homoeopathic practitioners, and tens of thousands 
of patients, have been for many years dreaming a fantastic dream. 
If this be so, how comes it that most of the early trials, some 
years ago, of the Homoeopathists of any standing were made 
with infinitesimal doses, with attenuations from the 6th to the 
30th, in globules ? Were our convictions of their worth then a 
" delusion and a snare ?" For the first year of Dr. Hale's own 
trials of Homoeopathy, he used little else but globules from. \,W 



32 Is the Doctrim of InfinUesimaU 

6th to the 30th ; but is it a dchision ? Is the Society prepared 
to acco])t Dr. Cockbum's conclusions ? or does the accumulated 
weight of evidence prove it othcm^'ise, and prove it beyond 
doubt and from experience to be otherwise, than Dr. Cockbnm 
would liavc us to believe ? Dr. Hale appealed to the experience 
of every member present to substantiate his conviction as to the 
power and value of infinitesimals. In conclusion, Dr. Hale said : 
it is now-a-days sometimes stated that Homceopathy fails as it 
used not to fail If this be so— and Dr. Hale was not prepared to 
allow that statement to be true ; — he thought that if in any 
cases it were true, the explanation is, that we had departed from 
the teachings of Hahnemann ; that instead of building on the 
sure foundation he laid, we allowed ourselves to become routinists, 
or associated certain properties to certain drugs, and prescribed 
them from some fanci^ relationship to certain organs, and forgot 
or neglected to obey the law of homoeopathy. The failures must 
be laid to the charge of the practitioner, and not to Homoeo- 
pathy. 

Dr. Metcalfe did not purpose entering upon the general sub- 
ject so ably set forth by Dr. Cockbum. He wished only to 
speak in reference to one or two matters that had been dwelt 
upon. In the first place, he was surprised to find Dr. Cockbum 
throwing doubt upon the fact of ipecacuanha producing asth- 
matic sufferings. He knew an instance in point. The gentleman 
with whom he was a pupil was thus aflfected. So sensitive was 
he to the smallest particle of this drug that it was necessary to 
inform him if the stopper of the bottle was removed. He never 
could remain in the surgery during the use of it The mere 
weighing out of a grain never escaped his notica He could 
even tell if it had been used, should he within a short period pass 
through the room ; and he well remembered on one occasion, 
during the trituration of it, that he, sitting in an adjoining room, 
rushed out calling, out " You are using ipecacuanha ! " Attacks of 
sneezing, and a sensation of asthmatic constriction of the chest, 
used to be produced by it. As to the question of the use of high 
potencies of the medicines, he was of opinion that their efficacy 
could not be doubted. Indeed, there were certain medicines 
inert in their crude state, which in the 12th or higher potencies 
I>roduced marked effects. He had seen the value of them in 
tlio n;moval of small encysted tumours of the eyelids, and 
Hubcutancous tumours on the scalp. 

Dr. KiDD : I greatly admire the method Dr. Cockbum has 
purHued in his ingenious and able paper. He started from the 
tru(} point. He began with the history of Hahnemann. In the 
first part of his career, Hahnemann appears truly grand and 
noble. Then, following pure observation and true induction, he 



Consistent with Reason and Experience t 33 

discovered the grandest law of nature, Similia simUibus eurantur. 
Let us recollect that for nine years he practised with minute 
doses — not with infinitesimal During those nine years, in fact, 
he founded the Homoeopathic system. All his teaching afterwards 
was fanciful, and open to uncertainty and doubt, like the suc- 
cessive theories of physicians through thirty centuries. Hahne- 
mann's nature was not able to resist retaliation. He was fiercely 
attacked, and he imwisely retaliated. When retaliation comes 
into play, truth goes out. This was Hahnemann's error. Out of 
contradiction and angry retaliation, he plunged into the doctrine 
of infinitesimals, founded on imagination, not on induction. This 
practice of giving medicines in quantities, so unnecessarily in- 
finitesimal, is the bugbear that deters the majority of medical 
men from joining our ranks. For my part. Upwards of ten years 
ago I separated the truth of the homoeopathic law from the un- 
certain hypothesis of infinitesimal doses, and my success in the 
cure of disease increased tenfold as I followed the natural law of 
cure, Similia similihis eurantur, imtrammelled by the fanciful 
theories of dynamization. As far as Hahnemann followed truth 
I follow Hahnemann, but no farther. I applied the same rule to 
him as to Hippocrates and Harvey. I would follow all that is 
true in the teaching of these great men, but I would not foUow 
their blunders, nor feel bound to reverence their mistakes. It is 
not for us who have cast down the ancient idols of medical wor- 
ship. Authority and Theory — ^who have renounced allegiance to 
fanciful hypotheses, to set up this poor modem idol of Dynami- 
zation, and to fall down and worship Globulism. Along with 
much truth, Hahnemann evolved much error. The theory of in- 
finitesimal doses is a mere fanciful hypothesis, open to numerous ob- 
jections. That error, I for my part have disowned, and do disclaim. 
The truth of the law, Similia similUms eurantur, I firmly believe 
in, as based on induction from the truest observation of facts and 
value as the most faithful guide in the treatment of disease. 
But I refuse to follow Hahnemann into the region of fanciful 
hypothesis. I am a Homoeopathist in principle — not a Hahne- 
mannist, nor a Globulist. Science tells us that there are limits 
to the division of the metallic medicines. Dr. Hale says he de- 
tected the presence of mineral medicine by the spectrum analysis 
at the 5th dilution. If the spectrum cannot detect its presence 
beyond the 5th dilution, why attempt to fancy the presence of 
medicine when even the spectrum cannot detect it ? Surely the 
state of division that the spectrum alone can detect is fine 
enough for all practical purposes, and it is but fair to ask Dr. 
Hale, why do you not rest satisfied with the utmost limits that 
the spectrum analysis can detect ? Why give the 6th or 12th 
dilution, when we know that there is an exquisitely diviH 
VOL. m, ^ 



?, i Is iht Doctrine of Infinitesimals 

?if. ::.''•* :..:.u. in tlir: 5th, and there xnay be nothing in the 12th 
fi., .v^ri ' IM iifl follow truth for its own sake and conmioii 
»> r.-'v . ;:r. I uf»i F^e UA into aliHunliticB out of deferenoe to Hahne- 
rr.;irt.'.V; inuf/wH, I api^^l frr>m Hahnemann fanciful, theoretical, 
st.r».\ '.: /t/.h'ft.y, to Hahnemann vigoroiLS and practical, in his 
l»T,r:.f', 'A'\(*x(i v«;xatioiiH o{i|K)sition caused hiiu to retaliate. 

\y:. \)V.v\ci ff:lt that our thanks were certainly due to Dr. 
(^x.K',.:u for t.hi; 2i:al he Iiad shown in coming such a long 
r:,..Sir.r/: If, uMv\ hi.H jififx^r Init having said that much, he regretted 
V,h\ r.': *j»\\\t\ KLy notliing further in tlic way of praise, as he 
'!;f^%'<'i fr^o alinoHt f;v<;ry word he luul heard. He had unfor- 
iuu'A.U'\-f \^'j.i\ cjiiWt'A fiway curly in the evening, and so missed 
tr>/; Un.t fi^irt ; but from wliat lie heaixl, it appeared to him that 
u»f'. f/i,v:f 'a;ih all f4iii,*i;ulation, which was entirely outweighed by 
f,rif; ■■'.itiuM'' 'Arf:ilw:.'4taljIi.H)icMl fuct, of wliicli there were numbers to 
r^'i•i^/: hr. ^Vy^khimi. The first jxjint to which he would allude 
wa>(, th^; iiovf:l viows stirted by the author on the divisibility of 
ifthr/s. Uf, thought it was conceded that there was no limit 
on t.hiy. \i(:nf\ ; li/iw^jvftr, if Dr. Cockbum would produce the atom 
alr//Jif. v/},jf;h thfjy rlifff-rerl, he (Dr. Drury) would be very happy 
t// ' >ifiiit iha tWWiroAiai" for him. The author was puzzled to 
nnfUir-'.Unfl th^; |K;ft8ibility of bodies becoming incorporated by 
any pn /Hi^:al a/;tion ; yet such tilings did occur. In the arts — 
rKtfUir i/,wf'.rf\il j/ressure — metals could be very intimately 
\Af-jAf'/\ by cli^jmical a/^tion ; new compounds were formed ; and 
(;\oO.(.f.,ly j/rMliic^j/l vr;ry wonderful changes, which were every 
fUiy c-Ac.Uu^^ our fuHtonlHliriient That trituration did develope 
ut.'w [/'/W'-.fH in dni^.H, Wumh was not a shadow of doubt; even on 
a th\i<f\i -/;ai<j Uii.H powfjrwjis demonstrated. Savory & Moore, the 
tUfjm-'XH, of h}w\-HiT(i(ii, were celebrated for their seidlitz pow- 
(if-SH. Now, thougli they used the same ingi'edients as other 
tb^;rrji.Ht?j, yet their morle of operating produced a much better 
artjcifj. Tbey mixf^l their ingredients in quantity in a large 
w^KyJrji }h>x, UHing a shovel for trjssing the salts about till they 
wrjre sufficiently mixfjd. Many other illustrations could be easily 
HfUlucM, without res'irtj'ng Uj the known facts elicited by our 
metb^><ls. As Dr. Cockbuni had lately fallen foul of Mr. Wilson, 
he (Dr. Drury) would mention a case that made a very great im- 
pression upon him when he was new to Homoeopathy, which 
proved more to his mind than any amount of imsupported argu- 
ment. A little child, about two years old, was suffering from 
congestion of the lungs and other mischief. Being only a begin- 
ner at that time. Dr. Drury, in treating this case, had obtained 
the help of another homoeopath. For some days the child 
continued to get worse, and a fatal result threatened. Circum- 
stances occurred that compelled the gentleman in attendance to 



Consistent vnih Reason and Experience t 35 

be absent, and Mr. Wilson's advice was sought On seeing the 
child at seven in the evening, he at once said that it was a 
beautiful Chamomilla case, and would do well ; the respiration 
was then eighty in a minute, with other well-marked symptoms. 
Chamomilla 30 was given. On seeing the child at ten the same 
evening, the respiration had fallen to fifty ; and from that time 
the disease steadily yielded. This case showed the importance 
of making a proper selection, and also that the 30th dilution 
would act as effectually as any other in acute diseasa That the 
Homoeopathic medicines would produce aggravations, was well 
established. He had on different occasions seen the 30th dilution 
of mercury affect the mouth. Probably, in these cases, the mer- 
cury remaining in the system from the former Allopathic abuse 
of the drug was called into play by the Homoeopathic dose, and 
so produced the peculiar action of the drug. That syphilis and 
gonorrhoea might be successfully treated with the 30th dilution, 
there was no doubt. Some years ago, he (Dr. Drury) was attend- 
ing a case of anthrax, of enormous size. There was at the same 
time a venereal sore, to which his attention was called. Nitric 
acid appearing to him to be suitable at the moment for both 
complaints, he gave it in the 30th dilution, and the sore healed 
as quickly as it was possible. He recollected very well attending 
the brother of an editor of an influential journal, sufferii\g from 
gonorrhoea and swelled testicla The brother of the patient said, 
" Well, this is a fair case to try Homoeopathy in, for imagination 
will not cure gonorrhoea and swelled testicle." There was no 
difficulty in treating this case successfully with the 30th dilution. 
Dr. Kidd claimed credit to himseK for picking out the good of 
Hahnemann's system, and rejecting his blunders. It had yet to 
be proved that what Dr. Kidd called blunders, were so ; on the 
contrary. Dr. Eidd appeared to have missed some of the great 
truths established by Hahnemann, and himself deserved the pity 
he was so ready to bestow on the foiinder of Homoeopathy, — as 
by setting up his own opinion in opposition to Hahnemann, he 
committed a fatal error, and lost some of the chief good of Homoeo- 
pathy. He had asked why Dr. Hale, having demonstrated the 
existence of the medicine in the 5th dilution by means of the 
spectrum, had not stopped there. The answer was very simple : 
before ever the spectrum was heard of, Dr. Hale had become 
convinced of the satisfactory action of the higher dilutions, and, 
like a sensible man, had continued to use them. In conclusion, 
he (Dr. Drury) must express his regret if anything had fallen 
from him calculated to wound those from whom he differed ; 
but when great truths were attacked, it was necessary they 
should be defended. 

Dr. Wyld observed that the paper just read had rfoa\3L\»\\. V)aa 



30 /.< (he Ditctrine of InfinitesimaU 

stain]) of gK'at reality. The autluir was thoroughly in earnest, and 
]>n.S(:iitc(l to ud a ^ciml illustration of " tlie fervid genius of the 
Scotcli." He (Dr. WyM) could not mhnit thatthe doctrine of infini- 
ti'.siTiial.s,a.sproixjuniIe(n>y Dr. Ilaliuemann/' was unscientific, be- 
cansf.' incoiiiprelieiisible." Many facta in science were, to the limited 
nature of human thought, quite incomprehensible. The fact that 
soniL' of the fixed stars werc millions of times larger than our 
sun, whilst otlier stars were s<» tli.stant that their light took thou- 
sands of years to reach our earth, \venj scientific facts quite incom- 
prelK'nsible to the human mind. The counter fact that a million 
of intricately organised beings, capable of propagating their race, 
might be all present in a drop of water, was another scientific 
fact lieyond our comprehension. The telescope and the micro- 
scoix? revealed these truths to our sense of vision, and we in 
wrjrrls say, that we know these facts ; still, they were facts tran- 
scending our powers of full comprehension, and were, at least, 
far more inconceivable than the fact that the most violent forms 
of discfase could be controlled by infinitesimal doses of medicine. 
Dr. Cockbum not only denied the reality of the infinitesimal 
dose, but said it was even, if true, still unnecessary. But this 
statement could be at once answered by referring to numerous 
cases of scrofulous caries of the bones being cured by the 12th 
and 30th dilutions of silica, a substance inert in its gross form. 
Anyone who has had an opportunity of judgiug,*must know that 
many cases of disease have been cured by our highest dilutions, 
which remained uncured by allopatliic drugs, and low dilutions 
of liomoeopathic medicines ; although it was true that the con- 
verse was sometimes the case also. Many diseases run a natural 
course, and the sceptic refers all our cures to this cause ; but the 
most unanswerable argument in proof of the actual power of the 
infinitesimal dose seemed to Dr. Wyld to be drawn from the fact 
that constipation of the bowels was frequently produced by our 
remedies when first taken by patients new to Homoeopathic 
practice, and this without any change in their diet or regimen. 
The discovery by Halmemann of the power of the infinitesimal 
dose was deeply interesting and important ; although that great 
genius certainly pushed this and some other doctrines into the 
regions of absurdity, thus greatly retarding the progi'ess of the 
greatest reformation ever effected in medicine. llie doctrine 
might be one contrary to a priori reasoning and probability ; but 
it was a doctrine proved to be true by the daily experience of 
millions of educated and intelligent men and women throughout 
the civilized world. 

Dr. Russell said : While I admire the courage of Dr. Cock- 
bum in coming up to London and boldly throwing down the 
gauntlet in this Society, by aflSrming the astonishing proposition 



Consistent with Reason and Experience ? 37 

that the use of infinitesimal doses of medicine is opposed to 
reason and experience, and should be abandoned from this time, 
I can account for the amount of support his views have received 
only by the iogenuity and literary ability with which he has 
succeeded in supporting them. It would be out of the question 
to attempt at this late hour to follow the author of this paper 
through all the steps of his destructive argument All I shall 
attempt to do is, to point out what I conceive the fundamental 
errors of his process; other speakers have ably discussed the 
errors of detail into which he has fallen. Dr. Cockbum began 
by a historical statement t6 this effect : — Hahnemann's greatest 
success was in the first nine years of his practice — i.e., from 1795 
to 1804 This success was obtained from medicines given in 
massive doses, not in infinitesimal quantities. After he had in- 
vented (to use Dr. Cockbum's own view) his small dose, his suc- 
cess abated ; let us, then, imitate Hahnemann in his better days, 
and not in his worst. I confess I heard this statement with 
perfect astonishment. To me it is perfectly new. I have read 
all that Hahnemann ever published, and I have read and trans- 
lated about sixty letters written to his most intimate friends. I 
have read almost all that his early followers have written, and I 
cannot recall a single expression that warrants such a statement. 
I look upon it as a pure figment ; and how anyone besides the 
author of this paper, who seems to have trusted too much to his 
imagination for his historical facts, should endorse it, is to me 
an almost greater surprise. Not only is it without the shadow of 
support from any authentic record, but it is opposed almost to 
possibility, on Dr. Cockbum's own premises ; for I understand 
that gentleman to avow himself a staunch adherent of the law 
of Homoeopathy, and to maintain that it is only by discovering 
similars that we can successfully treat the sick. Dr. Cockburn 
is a Homoeopathist — ^wishes to be considered such — and objects 
only to the infinitesimal dose. Did it not occur to him that 
during the years which he fixes as being the most successful of 
Hahnemann's useful career, he had not above some eight or ten 
medicines proved ? Does Dr. Cockbum really mean us to be- 
lieve that, with a very few partially known remedies, Hahne- 
mann effected more cures than after he had increased his phar- 
macopoea tenfold by his enormous labour ? If this reaUy were 
so, then indeed the life of the founder of our system — ^the life of 
toil and privation he led for twenty years — ^was all spent in vain. 
But is it so ? On the contrary, the testimony of Hahnemann, 
the evidence of his disciples, the universal belief of aU who had 
an opportunity of becoming acquainted with the facts, — all are 
dead against the wild assumption of Dr. Cockburn. Indeed, it 
seems to me that the strangest tiling about this strange essay i* 



38 Is (he Dmtrine of InJiniUsimaU 

its anaclirfjiiisin. It sliouLl have been published sixty years ago, 
b'fon* tlioro was any accuiiiuhition of experience in regard to Uie 
utility of small dosi'fl. To publish it now is to make upon us no 
less ii tlfinainl than this : " Gt»nth»iiien," Dr. Cockbum virtually 
says, " Voii an; all wnm^ — you are labouring under a delusion 
— the HoiiKi'opathy which has grown up in this century, like 
tliat iiii^'hty tree which spning from a grain of mustard-seed, 
ami which uow spreads its boughs over the whole civilized 
world, lias been wrongly practised. Give up tliis system of prac- 
tice — I will demonstrate to you its insuflBciency — and then" — 
and th»'n what ? Here he leaves us ; we are to put our boxes 
into the fire, and to leave our patients to their fate until Dr. 
Cockhurn excogitates a system of medicine which he can recon- 
cile to his fancy of what ought to be, not to his experience of 
what is. I call his paper an anachronism, and say it should 
have appeared sixty years ago ; but this is not far enough back 
to thrust it ; it ought to have appeared at least two hundred 
years ago, for it is really the paper of a schoolman before the 
time of Lord Bacon. Its fundamental doctrine is, that we are to 
find out by our unassisted reason what ought to be true, and to 
deny everything which does not square with our preconceived 
notions ; we are to deny that there is any virtue in a dose of the 
Cth dilution, because we do not understand how there should be 
any. Such were the systems of philosophy before the time of 
Lord Bacon. They were presumptuous and barren. His system is 
more modest. He tells us to observe phenomena first ; to attempt 
to explain these phenomena afterwards. Hahnemann was his dis- 
cix>l(i ; he was contented to observ^e and to experiment. The 
fruits of his observations and his experiments have grown into a 
system of practice called Homoeopathy. All who practise this 
system, whether they like it or not, are his followers, and to him, 
I may say, we owe everything. While making this acknowledg- 
ment, I do not suppose it can enter into the mind of anyone 
that it is the intention of any rational man to imitate what he 
considers the errors of the great master. Of this, now-a-days, in 
this country, there is little danger ; for, strange to say, it seems 
the fashion for some members of our Homoeopathic body — men 
who owe all their reputation, all their influence, to the fact that 
they adopted the system of medicine discovered sixty years ago 
by Hahnemann, by him alone, and made practical by his 
labours, and by the labours of his disciples — it seems the fashion 
now-a-days to depreciate all his merits, and to exaggerate all his 
faults. To read what some have written, and to listen to what 
some say, one would imagine that we had now grown so wise as 
to be ashamed of calling ourselves the disciples of Hahnemann. 
For my part, I can only say that the shame I feel is, that I am so 



Consistent vnth Reason and Experience t 89 

tmwortliy of so high a distinction ; for to be a disciple of that 
great man implies that one should devote his life to the labour 
of patient investigation into the action of all substances which 
contribute means of curing disease. Hahnemann in his own 
person did more by his life of toil for the relief of humanity 
than all who either helped or followed him in this path. In my 
opinion, it is as impossible to exaggerate his services to medicine 
and the human race as it is for us to equal them ; but there is 
nothing easier than exaggerating the errors into which he fell, 
and really the amount of merit of those who display their inge- 
nuity and bestow their labour in pointing them out, seems to 
me quite infinitesimal. 

Dr. CocKBURN said : Mr. Chairman, at this late hour it* would be 
impossible to reply to each individual objection made to the paper 
read to-night. I shall take up the most important of them. Dr. 
Hale objected to my second position — ^namely, that infinitesimals 
were not demanded by the requirements of the organism. He, 
Dr. Hale, granted that, as regards food, infinitesimals were not re- 
quired for the nourishment and growth of the body ; but he was 
surprised to find in this the nineteenth century that anyone could 
say this in regard to disease. In endeavouring to prove that in- 
finitesimal doses of medicine were required for the cure of disease, 
he. Dr. Hale, unwittingly went on to show, from the microscopical 
structure of our bodies and the theory of cell development, that 
infinitesimals were necessary; but as medicines do not go to form 
part of the structure of the organism, nor take any share in the for- 
mation of organic cells, the infinitesimals required for this purpose 
must be infinitesimal quantities of food — ^the very thing he 
granted was not required. He also stated that the fact of there 
being no analogy between health and disease was fatal to my 
position ; but I had nowhere made any such statement that an 
analogy of this kind existed. I had shown that, in regard to 
health, the food required for the nourishment of the body must 
in its constitution be similar to that of our own bodies ; that 
in disease, the medicine to cure must be one which is capable of 
acting on the body in a way similar to the disease ; and 
that in these respects there was an analogy. Also, that in health 
infinitesimal quantities of food were not required for the nourish- 
ment of the body ; and that in the cure of disease, infinitesimal 
quantities of medicine were not required ; and that in this re- 
spect also there was an analogy. No argument had been ad- 
vanced against these positiona Eeference had been made to the 
wonders revealed by the spectrum analysis, but I can see no 
support which these give to the doctrine of infinitesimals. And 
^bearing in mind the lesson taught by Rutter's magnetoscope, I 
think we ought to be cautious how we attempt to bob>tfcx >\^ ^ 



40 lb Ui€ Dm'trint of IiifinitmrnaU 

doubtful doctrine hy such a novi-lty. While accepting the cor- 
r«M;tii»'h.s of the analysis ciualitatively, I suspect there is an error 
(Hiiiif'ctt'd with tliii caK'ulat ions, which guuu the assumption that 
whi II oiK'piiin of c}iloiid(Mit*s«Mliuni is burnt in a room, the sodium 
i^iwiko. Jiils the itioni. I «^n*ant that it maybe equally diffused 
throiiijhnut tlie atnins]i]icre in the room ; but it cannot fill the 
r<ioni without first nustin*{ the wliole atniosjiheric air present: 
jin<l not only sn, Imt it wuuM n^quin^to oust the whole furniture 
jir< -^i-iit. Tlic (|uantity of atmospheric air in the room, as well 
as all th(r iurnitun*, must i-citn-scnt so much sitace where there is 
IK) cliloride, it ])tMii|r imi»o.s.sible fur any two bodies to exist in 
tli*i saiiK- sj)ace lit tin* sanui time. Fn»m all those experiments, 
\\i)\\c\i:\\ it would a])pear that the chU»ride of sodium exists as a 
con.*,taiit iii;jn*dii!nt in the atmosphere, in a quantity perhaps 
i'.(\\\'A to our Snl or 4th potency, and that many other sub- 
fttaij(;(:.s U-sidcs the chloride are also present. Look at the silica 
conslaiilly tritunited on our footpaths and highwaj'S, driven by 
til' J wiiid:^, and inhaled by everyone — look at the iron, the copper, 
aii'i ilii;ziiic, from the ])euches of a thousand artizans, carried by 
iIkj \,Ti'M'/A'.ii in eveiy direction — ^look at our <lrug mills, chemical 
woilcH, i\r\\\!^ shops, and lalx)ratories, on every side of us, con- 
Htautly prjurin;^ forth large quantities of powerful and deleterious 
iiiat'rj'ial. Wliat effect can globules of the 30th potency have in 
tij'; pKis^-nce of th(;se higher activities? Halmemann never 
ilr*:aiijt of the siMH;tniin analysis ; but taking the drift of his rea- 
bonin;( in coimecticjii with these potencies, there is not a shadow 
ii\' a doubt that he looked upon the use and efficacy of these 
pot^'lK:i'^s as Ixdiig in the highest degree inconsistent and incom- 
patil)l<; will I the \)X<t^iiQ>Q of any disturbing agency in the 
organism at the same time. And on this account he not only 
institiitfjd a most rigorous diet, but insisted on the removal of 
rivt^rytliiiig that could exercise any influence of a drug nature on 
tlio Ixxly. I^ut while he could banish the coffee and the tea, the 
tooth-powder and the perfumery, who could remove the chloride 
of sodium from the atmosphere, or sweep away those other 
nuni(;rous agents, the presence of which is now being revealed 
to us by the sjjectrum analysis? When the facts become more 
matured and numerous, I look to this mode of analysis as being 
liktily to furnish us with a powerful argument against the use of 
th<j inlinitesiinala Dr. Hamilton argued that there was an 
analogy between the infinitesimals and the different miasms, 
and that tlui power of the latter proved the power of the former. 
I can H(U! no analogy here. Anedogy can be predicated only on 
thri'c' grounds — first, analogy in regard to kind; second, analogy 
in ivgard to (piantity ; and third, analogy in regard to power. 
l-'iiMl., in n^gard io kind. As no one has ever succeeded in dis- 



Consistent wUh Reason and Faperience f 41 

-covering the nature of the miasms, we are not warranted in 
assuming that anything else has any analogy to them in kind. 
Second, in regard to quantity. We do not know in what particular 
form the the miasms exist ; but, assuming that they exist in a 
gaseous form, is it not reasonable to suppose that this gaseous 
material is diffused through vast tracts of the atmosphere, and 
that an individual exposed to this, inhales large volumes of it 
at every inspiration ? Is there any analogy in quantity between 
that and the supposed infinitesimal quantity of drug in a 
globule of the 30th potency ? To me there seems to be a great 
contrast. Or, supposing that the miasm exists in the form of solid 
atoms, is it not reasonable to suppose that these are spread over 
immense districts, and that a person exposed to it must inhale 
millions and millions of these ? Is there any analogy between 
that and the quantity of drug supposed to exist in a liliputian 
globule of the 30th potency 1 There seems to me to be a pro- 
digious contrast. Third, in regard to power. Is there any 
analogy between the power of the pestilence that walketh by 
noonday and that spreadeth abroad its terrors by night ; that 
makes our homes desolate, and fills our graveyards with 
blackened corpses — ^any analogy between that and a globule of 
the 30th potency ? The very idea is absurd. My friend Dr. 
Eussell has made a very full and elaborate defence of the doctrine 
of infinitesimals on the general ground of experience. This 
appears to me to be the stronghold of the doctrine ; but what 
does it mean ? Is it meant that experience proves the efficacy 
of all the potencies in all diseases ? No. Is it meant that ex- 
perience proves the efficacy of ail the potencies in some diseases? 
No : for many of the potencies have never been tried. Is it 
meant that experience proves the efficacy of some of the poten- 
cies in all diseases ? No. I take it, therefore, that it must mean 
that experience proves the efficacy of a limited number of the 
potencies, not amounting to a fourth of the whole, in a limited 
number of diseases. But this is something very different from 
that which is implied in the general objection. And then, even 
though it had assumed this modified form, I should have sought 
to know what it was that led to the choice of the special potency 
in the special case : why it was that thirty was chosen in place 
of twenty-nine or thirty-one ; why sixty was riosen in place of 
sixty-one or fifty-nine; why, in a word, any one particular 
potency was chosen in place of the one immediately above or 
immediately below. The answer to this is vital in the case. 
And I know that no one can give any rational, or scientific state- 
ment as to what ought to decide the special choice. This being 
the case, we would require still further to modify the objection, 
which would stand thus : — That experience proves the effic*" 



42 Is the Doctrine of InfinxtmmaU 

a liniitod number of potencies, not amounting perhaps to a 
fourth of the whole, in a limited number of diseases, and that 
unfh.T c()n(iiti(ms and circumstances totally undefined and un- 
dcfiiialjle. I can see no force in an objection like this. But 
it ii])pears to mu we arc on very dangerous ground in making 
our ap]K?al to experience. As Homoeopaths we have always 
felt our superiority over our opponents, and been able not 
only to refute every objection advanced against our system, 
but, without any flattery, I may say we have been able 
to vanquish our opix)nents; and this we have been able to 
do solely on the ground that our mode of practice was based 
on law and consistent with reason. But, in making our 
appeal to experience, we lose our vantage ground, and place 
ourselves on the very same level with every pretender and 
empiric in medicine. Look to our HoUoways and Morrisons, 
our Parrs and our Perrys — ^they all make their appeal to expe- 
rience. I know that experience is the grand test and touchstone 
of every system and every science, but in the doctrine of infi^ 
nitesimals we have no system and no science to which we can 
apply the test. It appears to me that it is not possible that 
experience can prove the efl&cacy of the infinitesimals, and for 
this reasoa You will all agree with me that in every practical 
subject in which a practical test can be applied, it is absolutely 
necessary for the individual applying the test to make himself 
thoroughly acquainted, not only with the nature of the thing to 
be done, and to know that he can do that, but he must also 
make himself thoroughly acquainted with the condition and cir^ 
cumstances on which the success of the experiment depends, 
and act up to these. This is imperative in every science. Why 
is it that we have been obliged to reject the experiments of 
Andral as to the truth of Homceopathy ? Why have we been 
able to refute these ? Not because Andral did not imderstand the 
Homoeopathic formula; not because he knew nothing about 
Homoeopathic remedies ; but simply and solely because the coii- 
ditions and circumstances on which the success of every such ex- 
periment depended were grossly violated in his case. And just so 
here. The conditions and circumstances on which the success 
of the potencies depends being unknown and undefinable, I hold 
that it is impossible to apply a rational experiment in the case ; 
and as no rational experiment can be applied, no one is wiEUV 
ranted in saying that experience proves their efficacy. I shall 
not say what may not be proved by empirical experienca 
Though no rational experiment can be made with the infinitesi- 
mals, we find that they are daily used, and there must be some 
reason for it Infinitesimals can be employed only on three 
grounds : 1st, on the ground of authority ; 2nd, on the ground 



Consistent with Reason and Experience i 43 

oi precedent ; and 3rd, on the ground of empiricism. The 1st 
we have embodied in Hahnemann ; the 2nd in the earlier dis- 
ciples ; and the 3rd in some of the present race of Homoeo- 
pathists. 1st As to the ground of authority. Hahnemann's 
experience has been divided into two sections — ^namely, his 
earlier and later experience ; and from the far greater success of 
the latter over the former, it has been assumed that he was war- 
ranted in dogmatically teaching that the 30th potency was the 
only proper dose always to use. There can be no doubt that 
Hahnemann was successful during the first nine years, when he 
practised Homoeopathy with large doses. He was not ashamed 
of his success then, but from time to time published highly in- 
teresting records of successful cases— cases which he believed 
were calculated not only to prove the truth of Homoeopathy, 
but which were likely to gain converts to the new system. 
To an unprejudiced mind it is rather a suspicious circumstance 
that he should publish no further records after the introduction 
of infinitesimals. But successful as Hdmemann was during 
the first nine years of his experience, we would reasonably 
expect that he should be more successful in his later yearsL 
We would expect at least a twofold increase of success. First, 
we would look for an increase of success, as the number of reme- 
dies increased ; and, second, as he became more fully acquainted 
with the curative powers of the different remedies. And it 
would be an interesting subject of inquiry to find out if Hahne- 
mann's later experience actually came up to this requirement 
I do not deny that it did. But it is assumed by some that we 
have not only this, but that we have a threefold increase of 
success by the introduction of the infinitesimals. It is this 
assumption which I call in question ; not a particle of evidence 
has been adduced to prove the truth of this. That the extensive 
records which he collected for forty-three years after the intro- 
duction of infinitesimals do contain a great amount of material 
which would be of great importance to Homoeopathy, I do not 
doubt ; but that these records refer to diseases more deadly or 
more dangerous in their character — ^that they refer to cures more 
striking and more rapid — or that, in a word, they contain evidence 
more convincing and more demonstrative of the truth of Homoeo- 
pathy than those published in '96 and '98, 1 cannot believe, and, 
considering the importance of the assumption, and inference to 
be drawn from it, I dare not believe without the most unequivocal 
proof. However much anyone may differ from Hahnemann on 
some minor points, no one can for a moment doubt his sincerity, or 
imagine that he would leave one stone unturned that was likely to 
advance the cause he advocated. But to say that he had in his 
possession for upwards of forty years such a mass of material* 



i' • 


...' 


I"* 




t.',: 


i '.\ 


ti''ti 


:.'iji 


lit,'- 


i' ' 


).'■ 





4 i In tht Th^.trxM of Infinittsimah 

^'.f. *:...::.;' t}j;,t. v'Tv fvuh-Tiff' iijirm which the conversioii of the 
ifi! t|j" j.nff-riori to thf; faith auil practice of Hoxnoeo- 
r.;:.:i!v 'Ji|.<rifl<rrl, nii'I tlint yet he withheld the publica- 
t}i;iV i-i «*j*ji'i-*i| to fill I'vjili'iicp. I can look upon Hah- 
I .1 - \f\u*j ;iri hoiif.st man, and reconcile the fact of hia 
!; lijii:.' tli< .<• vtuiiX^ only on the understanding that, as 
' ^:[j' v.- -aIi;.! tli* y r r,ijtaiii»-d, h«* n-ally lx?lieved that their 
J. .'... I'.'iii -Aoul'l [j'jt. In- fi»r tli<: lif-nefit of Homoeopathy. I can 
\'utv\',\f -.w- no ;ii;.'inij'ijt in favour rjf tlie infinitesimals that 
t '.lu \,*' '\ii\Au \vu\\\ Hiiliii'inainr.s later exx)eriencc. Second, as 
f/» W.f '/\',\\ut\ of [in-n-di'iit. Some Ifoniri'opathists are con- 
;t;M.t;v ;,...../. riiii;# tJi;it the f-arlier di^H;ilJ^*s were more successful 
t}i;iji \\\',\t\ now living' are; hut no pniof has been given for this 
u\'.i\Uttu. I \}t'\\i:\i\ it is jMin'ly apocryphal. God forbid that I 
^■.lionl'l ■■.;iy one word (liMpani«(in;4ly of those noble men; we are 
fill intiiWy iu'lebtird to theia I lionour them for their work's 
wik<', aM'i, w' re they now jiresent, would most heartily sympa- 
i\iy\i\ with them in tiie Huffcriui^s and pei*secutions which most of 
th'-jM rriMMt, have unrh'i-^one in tlie defence of the truth. But 
fojfiid that any of uh sliould substitute either a Paul or an 
Apollo:', ill t.hr; jilace of truth itsdf. Tlie assumption that the 
i'iuVM'Y i\m'\\ih*H were more Hncee.ssful than we are, and the infe- 
renri! drawn then^from, I eannot but look upon as an unfortunate 
atU'Mijit, to im|HiHe u|K»n uh tlic: doctrine of individual authority 
in thi* \}\\\v.i\ of I^iw and ilij^dit. Tint I trust that all who know 
whdt, Lnw nnd Hi^dit mc'an, and who feci the moral obligations 
nnd*r whicJi tJii-y lie to thcHo, sliall resist every attempt to 
hav«' iirijiofwd upon them any otlier higher authority. Thiid, as 
to th*' j^, round of (MnpiricJHm. The essential difference between 
llonio(»|»nihy and Alloi)alhy lies here, — ^tliat in Homoeopathy 
ihi'n- \\s a law, by the jrui<hinee of which we cAn, with confidence 
and ccrlainty, eome to a knowled<^M». of tlie tnie curative remedy 
in any curable cane. In Alloi)athy thei'e is no such law; but in 
\\\\\ alificncn of Uuh Mich! an? c.ei'tain rules and guides which we 
nmy I'ornialirtct aH Mm theory of nh vsus in morhu The theory of 
ah it.'iitnin vinrhi, and the law w/nVm smi7/6w5, constitute the 
diHliiM'Mve liadj^i'H of the two o])posing schools. The practical 
applieatiou of the ironinM)])athic law, in so far as the choice of 
the remedy \h concerned, is unity and harmony ; the practical 
applienfion of the Allopatliie theory is disunion and contradic- 
tion. And wo hold that, ho long as tliis false theory is acted on, 
we can have nothing but contradiction and disunion. But aUthis 
rout nidiet ion and all this disunion we attribute not to any want of 
skill, not to any want of knowleilge, not to any want of sincerity 
ow the |Mirt of the individual practitioner, but we trace solely and 
lUnvtly to the inherent llaUacy of the theory. But while the 



Consistent with Reason and Experience 1 45 

Allopath chooses his remedy by the false theoiy of db usm in 
morbi, the Hahnemannian Homoeopath chooses his dose by the 
very same theory ; and all the disunion and all the contradiction 
that prevails in Allopathic practice is thereby introduced into 
the practice of Homoeopathy, and I fear very considerably 
intensified. And it cannot be otherwisa A theory which is in its 
very nature fallacious, can never change its character to ac- 
commodate the particular fancies of any sectary. If observations 
made upon the sick constitute a true and a safe guide in medical 
practice, then let us be honest and say sa If so, we must cease 
finding fault with the Allopath for being guided by this. But 
if these do not constitute a true and a safe guide, then let us be 
consistent and abandon it. The spirit of Homoeopathy demands 
this. Homoeopathy has to do with law, with ascertained natural 
phenomena, and not with empirical experience. In Homoeopathy 
we believed we had found a system which was based upon law 
and consistent with reason. And having done so much and 
suffered so much in behalf of our cause, shall we now introduce 
into our theory and practice the very error against which we 
have so strenuously and so successfully protested ? Are we now 
prepared to confess to the public and the profession that while 
we have a law to guide us in the choice of the true curative 
remedy, we have nothing but empirical experimentation on the 
sick to guide us in their application? Forbid that this ever 
should be so. Hahnemann has taught us the true use of em- 
pirical experience, by making it subservient to the development 
of some grand general principle. He seized hold of the em- 
pirical experience of the past, and made it instrumental in sub- 
stantiating the truth of the discovery he had made. Let us 
follow his example, not by becoming empirics, but by using the 
experience of others, and our own also, in the development of 
some great general principle for the regulation of the dose. 
This is our task. Hahnemann discovered the law which guides 
to the choice of the right kind of medicine ; it is for us to dis- 
cover the law which guides to the choice of the right quantity. 
Let us strive to accomplish this. 

Dr. Chapman (in the chair) : We are much indebted to Dr. 
Cockbum for coming such a distance to read his paper to us, and 
the more so as this is his first visit to London. We also con- 
gratulate ourselves on having a man among us of such ability. 
He is a brave and bold man, too, to assert in this Society of 
Homoeopathists that the doctrine of infinitesimals is inconsistent 
with reason and with experience. His mind, it would seem, has 
a greater tendency for metaphysics than for physics. Is the 
doctrine of infinitesimals inconsistent with or opposed to Eeason? 
What Eeason, or the reasoning faculty of what individual, does 



46 h (he Doctrine of InfinitmmaU 

tlio in^'oniuus autlior rcTor to? One man's Reaaon, or what he 
supjioscs to l>e such, diflVrs from another's. The highest Season, 
in its infijiit«^ chanictur, is unapproachable by us. The highest 
reasoning; faculty of any ^ift<Ml human being is far away firom 
th(* (.'oiiiprchcnsion of tlit^ i^reat bulk of mankind. It is a thing 
reiiiott*. like some " brij^ht particuhir star." Who of living men 
has souniltMl the (Io])tlis and shallows of Kant's logic? How 
many or the numerous mathematicians of the world have 
mastVrcrl the subtle analyst^s ^ of Nt^wton and La Place t No 
man has a ri^ht to say — "Sic vcdo, sic juIkjo; stet pro ratione 
voluntfis." — (" I am Sir Oracle, and when I speak let no dog 
bark.") It comes to this, that the doctrine of infinitesimals is 
inconsist(.'nt with the reasoning faculty of the author of this 
essay ; but it is a non sequitur to assume, therefore, that it is 
inconsistent witli pure reason, with pure logic. All that is 
worthy of the name of science moves in the direction of this 
doctrine. The " infinitesimal increments " of Newton, the "atomic 
theory " of Dalton and the advanced chemists, the discoveries of 
the great Dane Oersted in reference to light and electricity — ^the 
wire that flashes a message over half the globe — are iUustia- 
tions of the infinitesimal. The Infinite uses infinitesimals ia the 
creative, conserving, and re-constructing exercise of His autonomy^ 
and autocracy. This doctrine, which Dr. Cockbum laughs to 
scorn, not only pervades with its golden threads all true science, 
but also all nature. You find it in the scents of different 
flowers, in the colours of the shells of the shore, in the infini- 
tesimal difference between the constituents of an active poison 
and a harmless thing, as in the bitter and sweet almond, the 
bitter and sweet cassava. The doctrine of infinitesimals is the 
very key-stone of true philosophy. Dr. Cockbum also laughs to 
scorn the analogy between the atoms that spread plague and 
pestilence, and the atomic doses of medicina There is nothing 
whatever to laugh at, for the fact remains. A single drop of 
water in a part of the brain where no water should be, has 
before this extinguished the brightest faculties of the human 
being. An atom will cause disease, and kiU. It is clear, there- 
fore, that the doctrine of infinitesimals is not inconsistent with 
Eeason. Passing from the higher logic of pure and abstract 
Reason to the "logic of facts," a very inexorable thing, we are 
startled by another thoroughly imwarrantable assertion of Dr. 
Cockbum — ^that experience is without value — ^a dangerous thing 
to appeal to or to rely on. Bacon, who dedicated his great 
works to posterity, observed that Time, which blots out opinions 
and comments (the figments of Dr. Cockbum), confirms and 
establishes experienca Is experience to go for nothing, because 
our estimable and able colleague so wills it 1 Hippocrates has 



Consistent wUh Reason and Experience t 47 

been mentioned. On what does his r^utalion rest ? On his 
admirable clinical observations, as fresh and as valuable to 
those who can avail themselves of them as they were two 
thousand years ago, when Pericles "lightened and thimdered " 
over Greece. On what does the reputation of Sydenham rest ? 
In like way, on his admirable clinical observations. Our 
essajdst has spoken somewhat slightingly, and so irreverently, of 
our founder. Samuel Hahnemann. He says, "Hahnemann 
discovered the law of Homoeopathy, and invented infinitesimals." 
Hahnemann, in point of fact, did not discover the law of Homoeo- 
pathy, nor did he invent infinitesimals. In one of the writings 
attributed to Hippocrates, it is distinctly stated that some 
diseases or disorders are better treated on the doctrine of 
" similars," and others are better treated on the doctrine of " con- 
traries." Suetonius, in his " lives of the Twelve Caesars," stated 
that the Emperor Augustus was unsuccessfully treated ac- 
cording to the law of Similars, and was cured according 
to the law of Contraries. In the introduction to his " Organon," 
Hahnemann accumulates proofs that the law of Similars had been 
more or less recognised through all the cycles of genuine medical 
history. With his prodigous learning and his insatiable in- 
dustry, he collected an immense amount of facts ; he brought 
them all to the test of the law of Similars, and found all were 
included under that law. like a man of true philosophical 
genius, he came to his conclusion, and proclaimed the law of 
Similars as the law of drug-heali'tig. This was quite irrespective 
of dose, and brings us to Dr. Cockbum's charge, that he invented 
infinitesiToals. As infinitesimals have always been, from first to 
last, he could hardly have invented them for his therapeutics. 
Hahnemann attended a patient with severe cholera before the 
irruption of Asiatic cholera from the Delta of the Ganges. Ac- 
cording to his law, he gave her veratrum. She nearly died from 
intense aggravation of her disease. He was a thinking man ; he 
had some experience, and a magnificent reasoning faculty — so 
he reduced his doses, and, by gradual stages, got to his infinitesi- 
mals. The continued reduction was with him a matter of expe- 
riment. Dr. Cockburn has asserted that Hahnemann, during 
his first nine years of practice, while he was supposed to use only 
crude doses — ^not the slightest proof adduced — won his reputa- 
tion, and that it thereafter became " small by degrees, and beau- 
tifully less." Not the slighest proof of this very rash assertion 
has been produced. The fact is quite the other way. Hahne- 
mann never published more than three cases. Dr. Cockburn, 
without saying whether he believed in mesmerism or not, im- 
plied that Hahnemann was a powerful mesmerist The few 
pages which he devotes to this subject in the " Organon " show 
that Hahnemann had not really paid much attention \a^ tcl^^- 



48 Tx the Doctrine of Infinitcsiinah 

iiifrisiii. Dr. Cocklmrn has sneered at aggravations for high 
dilutions. A Live]*|>ool merchant consulted Dr. Chapman. He 
g;iv(; him two or three globules of opium 30. The x>atient did 
not know what he had Uikcn. He canio the next morning, and 
Siiid, '' You gave me o])ium yostenlny, and I suffered the worst 
o]>iiini symptoms/' wliich he gra])hically described. A relation 
of th(; Cliairman was subjc^ct to violent and even terrible tetanic 
conviilsi(;ns at the times of the catamonial period. She despised 
Homoeopathy, and said there was nothing in it He was on a 
visit to her, and sh(i had the forewarning, one night, of one of 
tln*se attacks, and she said to him, " I will try your nonsense." 
She had two or three globules of belladonna 30. She was gene- 
rally confined to her bed-room several days from the conse- 
cpiences of this sort of attack. She had no notice of what had 
been given to her. She, contrary to all expectations, was at the 
breakfast table the next morning, and at once said, "You gave 
me belladonna last niglit. Dr. Baron (the biographer of Jenner) 
gave it to me some years ago, and he told me he gave it to me 
in sncli a dose as he would give to a baby. I was horribly dis- 
tnisscd. The dose you gave me last night produced the same 
results. I would far rather suffer the torture of the tetanic 
misery than that of belladonna. I was seeing the figures of 
naked men all the night long." Tlie lady wheeled about. She 
no longer laughed at Homoeopathy, but she says we use only 
subtle poisons in very concentrated forms. He (the Chairman) 
thought that Dr. Cockburn's argument had entirely failed. 
To use the Cambridge phrases — cadit qicocstio, cadit argv/nun- 
turn. The real fact remains, that the doctrine of infinitesimals 
is thoroughly consistent with reason and with experience. I 
hold, in conclusion, that the dodmiie of infinitesiinaU is tho- 
roughly consistent. Dr. Cockbum's paper, however, will do 
good — has done good — for it shows the gross drug-givers 
that they are dmfting into Allopathy. We have present this 
evening those who use gross doses and those who carry their 
prejudice in the other direction — to only reinote injinitesimals. 
All extravagances perish. We must not relinquish accurate 
observation and large experience for the pursuit of a phantom, 
born of the crude fancies of a metaphysician. The experience of 
HomoDopathists in general during the last sixty years is worth 
infinitely more than crude assertion or idle theory. 

Note by Db. Cookbuhn.— The subject introduced by Dr. Hale is contained in 
one of the portions omitted from this printed report of my paper. The argument, 
however, essentially was this — the Ipecncuan in the illustration I gave was actaally 
present in the attnosphere, and did actually produce drug symptoms; this was sot 
denied. But while this, and aU sncli like cases, proved that very small qnantitiai 
of the material drug did act, no amount of such cases could give any support to 
the idea that the 30lh potency of the same drug had any effect, or, indeed, that it 
contained any of the drug at ful. 



49 



ADDRESS OF THE PEESIDENT, DR. QUIN, 

AT THE 

ANNUAL ASSEMBLY OF 1863. 

Gentlemen, — The British Homoeopathic Society has now 
entered the twentieth year of its existence. During the whole 
of this period I have been honoured by your repeated election 
of me as your President, and until within the last two years I 
have hardly ever been absent from one of the Societ/s 
meetings; latterly, however, from fedling health, I have been able 
to attend but very irregularly, and I have felt great scruples in 
continuing to occupy the chair. Had I listened to my own 
wishes, I would have resigned some time ago, or, at least, have 
begged, when the annual election of the ofl&cers of the Society 
came round, that a more efficient President than myself should 
be chosen. I have refrained, however, from following my own 
inclinations in this respect, at the request of my colleagues in 
ofl&ce, who, in their kind partiality, have repeatedly expressed 
their opinion that the interests and welfare of the Society 
would be best consulted by my abandoning my intention of 
withdrawing from the Presidential chair. I candidly confess that 
I have had less scruples on this point since the election of our 
present most eflBlcient Vice-Presidents, Dr. Chapman and Mr. 
Yeldham. The able manner in which they have presided at 
your meetings, and conducted the affairs of the Society, have 
left nothing to be desired ; and I have seen with pride and 
satisfaction the ability, eloquence, and practical knowledge 
with which our Vice-Presidents have taken part in your dis- 
cussions, and summed up at the close of the debates, as recorded 
in our Annals. To-morrow evening the election of the oflBlcers 
will come on, and I earnestly beg that you will not, from 
feelings of false delicacy, have any hesitation in electing another 
President to succeed me — one who will more efficiently per- 
form the duties of President than I have been able to do of late. 

VOL. ni. 4 



50 Address of the Ptrsident. 

I Hincf^TfAy congratulate you on the increasing number of 
your iii^rmlieTS, and on the increasing utility of your labour& 
TIj'.' aiitiriiifitions and prophecies in which I indulged on the 
i'ii\ frl«';tion of our prt'seiit able and energetic Honorary 
.S<;cr<;lary have l^'On fully fuliillwl. 15y his active influence and 
uir,y*:ixjit:(l industiy, the number of essays and papers have so 
gnratly increased, that the Society is now able to meet t^'ice 
inhV:iA of once every month in the session, — thus your 
Tn';';tings have not only gained in number but in importance 
and usefulness, whilst the publication of the Annals of the 
Hof'/udy are spreading far and near, not only the information 
contained in your practical and theoretical papers, but also that 
contained in the valuable and practical debates which these 
pafy^rs give rise to. We have a flattering and convincing proof 
of thi/j in a letter lately received from Dr. Meyer, editor of the 
JlorruxopaihiscJie Zeitung, and Physician to the Leipsic Homceo- 
pathic Hospital, in which he says, " I have received a copy of 
tlie last number of the Annals, and have already made arrange- 
ments to have one of the papers translated and inserted in my 
journal I will have much pleasure in sending you my 
* Jietrosj>ect of the Year 1862 ' as soon as it is published, and 
shall r;ertainly make favourable mention of the Annals in it 
I have read the last number with great interest, and am 
much pleased with the earnestness of the discussions, but 
I lament that it is so much the custom in your father- 
land t^i give the medicines alternately, consequently making 
exa/.'t oV;s^;rvation very difficult. Could no means be adopted 
to aUjiish this vicious habit?" 

The testimony of so distinguished and learned a physician to 
the utility of the Annals, and your discussions, cannot fail to be 
gratifying to you. I have so often endeavoured to impress upon 
you my opinion of the erroneous practice of alternating medi- 
cin<;s in quick succession, before the sphere of action of any of 
them can have terminated; and I have so often tried to inculcate 
the a/lvantagc of more simplicity of practice and a stricter 



Address of the President. 51 

adhesion to the principles handed down to us by Hahnemann, 
that it is not necessary for me now to say more than that I 
thoroughly agree with Dr. Meyer, and heartily reiterate his 
wish to see this practice abolished in England. 

With regard to the papers read before the Society, I strongly 
recommend to the serious consideration of those members who 
may hereafter write papers, to send a resfwrn^ of them a fortnight 
before they are to be read — ^to lie on the library table, to be 
perused by their fellow-members, before they are discussed. I 
am certain that the debates will, in consequence, increase in in- 
terest and in importance, and reflect more honour on the gentle- 
men who take part in the discussions. In the early days of the 
Society, two copies of every paper were made and circulated among 
the members during the fortnight preceding each meeting. The 
result was most satisfactory with respect to the tone, character, and 
value of the debates. With these preliminary remarks I shall 
now, with your permission, proceed to notice the papers and 
discussions of the session just closed. From the cause stated 
above, I am sorry to say I was not able to attend many of the 
meetings and join in the debates. 

The session began in October, with a paper by Mr. Brisley, 
entitled " On the Advantages of Alternating the Higher 
and Lower Atteniiaiions of Medicines in the Treatment of Causes 
of Chronic Disease*' — a most praiseworthy endeavour to im- 
press upon the attention of the Society one of the principles 
laid down by Hahnemann, but too often forgotten now — that 
we should be extremely careful in the selection of our reme- 
dies when we commence the treatment of any chronic case ; 
and that after we have made our selection, we should not 
capriciously give up one remedy for a new one, until, at least, 
we had satisfied ourselves that the medicine of our choice had 
no beneficial action in the case, either in a high, a moderate, or a 
low dilution. It also illustrated an important fact which I 
have repeatedly mentioned here — ^that if we wish a medicine to 
act beneficially, and for a long time, we shall often act wisely 

4* 



52 Address of the President. 

to prescribe it in various attenuations, ninning the gamuts as it 
\^'cre, from the lower to the higher attenuations, and again 
reversing the order from the higher to the lower, so as to afford 
the organism a choice, so to speak, of every modification of the 
medicinal substance prescribed, and not pall its appetite by the 
constant repetition of it in the same strength and dose. 

Dr. Drury followed with an interesting paper upon some 
cases of sudden and alarming illness, which might, in certain 
circumstances, have given rise to suspicions of poisoning. The 
subject was, and is, one of great imi)ortance in the face of the 
startling evidence given by a great medico-legal authority of 
the great number of cases of poisoning which are undetected. 
It would be well if, following the example of Dr. Drury, a care- 
ful record were made of all the cases of sudden death which 
occur in the hands of every practitioner. We should do some- 
thing to allay the unwise panic, and often unjust suspicions^ 
when such an event takes place ; and by a careful investigation 
of the causes of such dreadful catastrophes, we might do some- 
thing to avert some of them. 

The next paper was by Mr. Harmer Smith, " Upon the JEm- 
ployment of AvjxUiaries " — ^an attempt to lay down certain 
general rules for the guidance of practitioners. As this subject 
was also incidentally handled by Dr. Hilbers, I will reserve 
any observations which suggest themselves till I notice his 
paper. 

I have now to record a most interesting paper **0n the Treat- 
ment of Ovarian Tvmou/rs,'* by Mr. Leadam. Although the 
title was thus general, the paper was apropos of a case of 
ovariotomy. The operation was performed with great skill and 
steadfast coolness by Mr. Ayerst, and after the life of the 
poor woman had been several times despaired of, in conse- 
quence of the violence of the enteritic symptoms, she even- 
* tually recovered. This case is very instructive, both in the 
way of warning and encouragement, and it is highly satis- 
factory to find the uniform and universal testimony of aU 



Address of the President. 53 

who have had opportunities of obBenration, to the skill and 
success of Mr. Ayerst as an operating suigeon. We are now 
no longer dependent upon the caprice of the suigeons of the 
old school, and, as they have thought proper to turn their backs 
upon us, they cannot be surprised if we should now, and in 
future, content ourselves with such aid as is obtainable in the 
increasing experience, skill, and dexterity in operating, of mem- 
bers of our own body. 

Mr. Leadam's practical and instructive paper was followed 
by one of a more ambitious character, from the pen of Dr. 
McGilchrist, of Edinburgh, entitled, " Is DipMheria a Specific 
Disease i '* It is evident that the writer of this essay has been 
long trained in the art of composition. It has the merits and, 
perhaps, some of the demerits of a merely literaiy articla It 
is ingenious and erudite, but the arguments and illustrations 
bear a larger proportion to the positive observations than is 
usual in a paper submitted to our body upon so intensely 
practical a subject as diphtheria. However, such well-written 
essays have a use of their own kind, and it is weU for us that 
in our body we have so great an infusion of literature. 

Dr. Ozanne, of Guernsey, followed with a paper " Upon some 
Cases of OphtJialmia" As he sent it merely to stop a gap 
at a former meeting, and as he was then prevented firom com- 
pleting in time the essay which is to be read to-night, and of 
which the account of the cases I have alluded to evidently 
forms a part, it would be premature, nay, unfair, to make any 
observations upon it beyond the obvious one, to all present, 
that it is sure to be replete with practical information, and give 
evidence of careful investigation. 

The next paper, or rather communication, was by Mr. Daniel 
Smith, in which is narrated an interesting case of fever, which, 
although at one time it appeared likely to have proved fatal, 
by the judicious treatment it received, eventually recovered. 
It is encouraging to young practitioners who may be disposed 
to despair of the recovery of their patients in apparently des- 
perate cases. 



54 AilJnss of the President. 

In the same month, Dr. Marston. of Devizes, read his elabo- 
nitr rssay, " On the Phi/8iolt}ffy ami Patholoffy of the Ganr 
I// inn if St/sfnn of Xirrvs, dnusidered in Especial Melattan to 
IlnttHi'fpfffhic ThrajKuticny It is well that we should have 
sue h sulijrcts ])rou;:ht belore us from time to tima There is, 
un<l<)ul)tc(lh% a ri»k of our becoming so absorbed in the en- 
gi-ossiiig details of the ]^ractico of IIomaK)pathy as to n^- 
Icct vi«*wing the general therapeutic law, which guides us in 
its i-cliitiou to the constantly iluctuating and frequently ad- 
vamiiig sciences of physiohjgy and pathology with wliich it is 
intimately connecteil If, however, we were to shape our practice, 
nut upon the well-established observations recorded in the works 
of Hahnemann and others who have assisted him in ascertaining 
the positive pathogenetic, and therefore curative efiTects, of medi- 
cines, but upon the speculations of physiologists and patholo- 
gists, wc should very soon find that we had returned into the 
delusions from which Hahnemann's genius and industry had de- 
livered us. That a know^ledge of pathology may be, and is, of 
the greatest advantage to the practitioner of homoeopathy, is 
almost a self-evident proposition, and the successful and bril- 
liant career of those who have been celebrated pathologists 
among us is an illustration of the fact, if it require illustration ; 
but it is one thing to enlighten our Homoeopathic practice by 
a profound pathology, and quite another thing to attempt to 
build up a wholly new system of practice on the assimiption of 
the truth of novelties. I, for one, feel myseK called upon to dis- 
claim any participation in such innovations, or approval of the 
novel and immature system of practice arising out of them, which 
is not only subversive of the fundamental propositions and well- 
considered plan propounded by Hahnemann, and successfully 
followed by many thousands of his disciples throughout the 
globe, but fraught with danger to Homoeopathy as a practical 
art, by substituting pathological conjecture for the well -ascer- 
tained facts, the result of oft-repeated experiments, both patho- 
genetic and clinical, extending over a long series of years. Let 
inc not be misunderstood. I am quite alive to the great advan- 



Address of the President, 55 

tage of a sound application of physiology and pathology to 
assist the Homoeopathic practitioner in forming a correct diag- 
nosis of disease, and, in common with the Society, I shall 
always hail with satisfaction all well-directed efforts which 
have for their object the development of Homoeopathy and the 
improvement of our knowledge of the action of medicines, and 
of the indications for their judicious employment in any given 
case; but it is only by long and persevering inquiry, oft- 
repeated and careful experiments, and patient investigation, free 
from all bias or predilection for preconceived theories, that a 
claim to serious attention can be admitted when the doctrines 
and practice taught to us by Hahnemann are sought to be 
departed from and overturned. 

The paper " On Local Anaesthesia," by Dr. Cronin, jun., has 
the merit of being a short and dear statement of his own 
observations and experiments upon a subject of considerable 
and increasing importance ; and it is desirable that he should 
continue his experiments and observations, as they cannot fail 
to increase in interest, and probably be of assistance to us in 
alleviating the sufferings of our patients in cases attended with 
acute pains. 

Dr. Cockbum, of Glasgow, next read his essay, or rather 
treatise — for even, in an abridged form, it deserves from its great 
length the latter appellation — entitled, " 7s the Doctrine of Infini- 
tesimals Consistent with Reason and Experience t " This ques- 
tion he takes upon himseK to answer in the negative. Nothing 
can better demonstrate the liberty of speech we accord to our 
members, than the attentive hearing accorded to the reading of a 
paper, the tendency of which is to overthrow the whole system 
of practice to which our lives have been devoted. The paper has 
many good qualities ; it is a work of mind ; the author has be- 
stowed much labour upon it, and prepared it with great care. Had 
he given as much attention to facts as he did to arguments, he 
would, in all probability, never have written it. It is evidently 
the production of a physician who is isolated ; who has little 



5<) Ailtinss of the Vrfmihnt. 

iiii;iii< nf rniniiiiiniiatioii, little interchange of opinions, with 
lii> t« Il«i\v-|iiii(titiniitr3; anJ ft*\v, if any, op{)ortunities of seeing 
aii'l watrhiiiLj the nsiilts of the practice of men of far longer 
(xjM li. II. f than hiiiisilf in Ilnnidopathy. Hence the narrow 
< in 1.. ill whirh his \'w\\A of tlie action of minute doses of medi- 
( iiif IIP- (iiiitiiuil ; an<l \w. <h»e.s not i>erceive that the circum- 
scrilM-.l n|iiuinns cntrrtain^Ml hy liim are at variance with expe- 
ri<iM«', aii'l that th<* puhlic-ation of thcni cuts the very ground from 
un«l< r liis f»M-t, uj»ou which an* founcU'd the facts which led to 
his rnii version ; for IIoniM-opathy spivad all over the Continent, 
ami i»i«'nc«l into Ch-cai ]»ritain, and diffused itself all over Ame- 
ri< a hy the very infinitesimal dose.s, the belief in the efl&cieneyof 
wliicli, ]\(\ states, is inconsistent witli reason and experienca The 
author must liave felt, as the discussion proceeded which arose 
after the reading of his paper, how even those who most opposed 
his o])inions still respected his honesty of purpose. It is deeply 
to he regretted that he and some who joined in the debate 
have not shown as much consideration for Hahnemann. Let 
young practitioners remember that absence of reverence is no 
sign of greatness of intellect, — quite the reverse. The lower 
we descend in the scale of being, the less of this quality do we 
find ; and the more we ascend, the more do we meet with it 
A mouse, an oyster, a flea, have no reverence for a philosopher ; 
but a philosopher has a reverence for a mouse, an oyster, or a 
flea. It would be a work of supererogation for me to attempt 
a panegyric of Hahnemann in this assembly. His labours to 
increase our knowledge of medicine, his untiring industry, his 
valuable experiments extending over a number of years, his 
great erudition, his genius, are too indelibly impressed upon us ; 
and our gratitude is too deeply rooted in our hearts to require 
that I should dilate upon his merits. 

Let us examine how far the author is borne out by facts in 
the statements he has ventured to make. Dr. Cockbum fixes 
the year 1795 as that in which Hahnemann discovered the 
Homoeopathic law ; and he tells us that his greatest success 



Address of the President 57 

was obtained during the next nine years — ^that is, from 1795 
to 1804 ; that it was his success at this period which gave 
him his renown; and that the reason of this great success was, 
his giving medicines in large doses. Let us see how the histori- 
cal facts square with this hypothesis — for it is nothing more. 
Where was Hahnemann during these nine years ? He spent 
them in the following places: — In 1795, he went to live in 
the small town of Wolfenbeuttel ; soon after, we find him in 
another insignificant place — Konigslutter ; he remained here till 
1799, that is four years only. In the year 1799, when, accord- 
ing to Dr. Cockbum, he was in the blaze of his popularity and 
reputation, he went to Hamburg, but he did not remain there, 
because he had nothing to do ; and the same year he went to 
Altona. He remained there for a very short time, and removed 
to MoUen, in Lauenburg; thence he went to Eulenburg — thence 
to Machern — thence to Dessau — thence to Torgau, where, in 
the year 1806, or two years after the date assigned by Dr. 
Cockbum and those who endorsed his statement, he published 
his first sketch of the Homoeopathic system — " The Medicine of 
Experience^' in an Allopathic Journal So that in these nine 
years, when his success, according to Dr. Cockbum, made him 
so popular, he had lived in nine different places, most of them 
utterly insignificant ! 

Let us now see how far Hahnemann's own testimony and 
practice contradicts the extraordinary statements respecting him 
made by the author of the paper. 

Dr. Stapf was one of his most intimate friends and earliest 
disciples. The letters Hahnemann wrote him were strictly 
confidential. In some of these he directs Stapf how to treat his 
daughter, about whom he was very anxious, and of whom 
Hahnemann was evidently very fond. Can we have a greater 
test of Hahnemann's sincerity than shown in the tenour of these 
directions? Does he recommend massive doses, frequently 
repeated? (see p. 75 of No. VII., March, 1862, of Annals) : — 
" It seems to be doing well now with your dear daughter, yet 



58 A tidress of the PrendetU, 

it will In3 nccossary that tlie Phosphorus should be allowed 
to continue its ofTcct for sixt(»on or eighteen days." This is 
in Si'|)tt'nil>or, 1827. In .January, 1829, he writes (see 
]). 140 of Annals) : — " Altliou^li the winter is unfavourable to 
an anti])soric courso, yet I tliink ]Miss Eliza will continue to 
inij)rove. You have given her a dose of Nux Vomica; but 
should the next catanieuial ])eriod occur at the right time, you 
may pr«;teniiit the dose. You may, however, give her the dose 
of Zincum on the 20th or 21st of January with confidence; 
afterwards we shall see what is to he done." 

His practice was strictly in accordance with his precepts as 
given in the Organon : to select a medicine with the utmost 
care — to give one dose, generally of the 30th dilution, par- 
ticularly when prescribing any of tlie heroic medicines, and not 
to repeat it till it had exhausted its effect, or to dilute it with 
water and distribute the dose in spoonfuls over a given number 
of hours, days, and sometimes weeks. He published no cases 
after he had thoroughly made known his system, except three 
in the Preface to one of the volumes of his Materia Medica 
Pura, and these cases only for the purpose of illustrating his 
method of selecting his remedies. His answer to Fleischmann 
is worthy of record here, as exemplifying the mode in which a 
case ought to be studied, and the appropriate remedy chosen. 
Fleischmann, when yet an imbeliever in Homoeopathy, suffered 
from sciatica, and having exhausted all the ordinary measures for 
obtaining relief in vain, wrote a statement of his case to Hahne- 
mann, who replied to this effect: — "If you study the symptoms 
of such and such medicines as given in my Materia Medica^ 
you will find what will enable you not only to cure yourseU^ 
but others also." Fleischmann did as directed, discovered the 
remedy for his sciatica, and convinced himself of the truth of 
Homoeopathy, and of the trustworthiness of Hahnemann's 
provings. 

The actual time of Hahnemann's European celebrity did not 



Address of the President. 59 

really commence till after the year 1810, when he had pub- 
lished the first edition of his Oiganon ; it went on increasing 
until 1843, when he died. He never went back to laige doses. 
To this fact I myself can vouch. I first studied under Hahne- 
mann in 1826, at Coethen — I again went to him in 1828, and 
again in 1831, still at Coethen. When he removed to France in 
1834, I went there to meet him, and was present at the Great 
Congress of Homoeopathic Physicians assembled in Paris to do 
him honour, and to welcome him to France ; and I repeatedly 
went over to Paris to see him during the remaining years of his 
life. During these years, besides the many instructive con- 
versations I had with him, I had frequent consultations, both 
verbal and by letter, on many cases of interest or of danger, 
and I can bear testimony to his consistent advocacy for 
the emplojTuent of infinitesimal doses, and to the eminent 
success which attended his treatment of the most complicated 
and serious diseases occurring in individuals of every nation and 
of every clime. During the latter years of Hahnemann's sojourn 
in Paris, our colleague, Mr. Hugh Cameron, had similar and 
frequent opportunities of conversing and consulting in some 
most serious cases with Hahnemann, and he will vouch for the 
foregoing facts, and bear similar testimony to me respecting the 
opinions, practice, and great success of Hahnemann's treat- 
ment. 

It is with wonder, sorrow, and astonishment, not unmixed 
with indignation, that we, who had the honour and advantage 
of repeated and intimate communications with our great master, 
and who listened with grateful reverence to the words of 
wisdom and valuable practical precepts that dropped from his 
lips, read and hear the terms in which some who give them- 
selves out as his followers, permit themselves to speak of this 
great and good man, and unblushingly draw upon their imagi- 
nations in giving utterance to the most erroneous and fabulous 
accounts of his opinions and actions, showing an incredible 
ignorance of the maxims and truths contained in his works^ 



60 Address of the Presideni. 

of his conduct throughout his long and honourable career, and 
an iiTcvereuce for the genius, the enidition, and the unwearied 
industry which enabled him to create and establish the system 
of medicine by which they gain their livelihood and hope to rise 
to fame and fortune. One knows not which to admire most, the 
ingratitude or the presumption of such soi-disant disciples of 
Ilahuciiiann. However, this mode of the young to be pre- 
sumptuous and to ignore the wisdom and knowledge of their 
superiors is of all time. Pliny the younger records of the 
youth of his day — " Barum hoc in adolescentibus nostris, nam 
quotusquisque vel aetati alterius vel auctoritate ut minor, cedit/ 
Statim sapiunt ; Statim sciimt omnia ; neminem verentur; imi- 
tantur neminem; atque ipsi sibi exempla sunt !" 

Dr. Cockbum builds a somewhfit ingenious argument, already 
often put forward in Germany and France by our AUopathic 
opponents, against the use of infinitesimal doses, upon the 
assumption that in the course of repeated triturations the 
original medicinal matter will be entirely lost in some portion 
of the preparation, fix)m the impossibility of effecting a suffi- 
ciently fine subdivision of its particles. It is plain, although 
strange, that he has never read Dr. Samuel Brown's admirable 
essay on the theory of small doses. It is equally strange, that 
in the debate which followed the reading of Dr. Cockbum's 
paper, one of the speakers has reiterated the interrogation — 
" Why should we use the 6th dilution, when the spectrum 
analysis shows the substance only as far as the 5th ? Why not 
stop at the point where we know medicine to be ? " It is sur- 
prising that it did not occur to the questioner, in answer to his 
query, that the spectrum analysis, which only discovered 
matter in the 5th dilution the other day, simply verified the 
previous observation made by means of Homoeopathy, that the 
vital test is far superior to any chemical one. In the essay on 
the theory of small doses, above alluded to. Dr. Brown says: — 
" The numerous able works asserting the utility of Homoeopa- 
thic practice, on the ground of sheer experience among the sick. 



Address of the President. 61 

are calculated to impress their opponents with the conviction 
that there is certainly enongh of practical truth in the prin- 
ciple to authorise them to give it a candid trial, since so many 
of their equals, in whatever is scientific and virtuous, are 
ready to stand by both the principle and the practice. Let 
them take the fact of the number and merit of Homoeopathic 
physicians and books as their certificate of right to make ex- 
periments upon their patients, especially since it will only be 
doing nothing at the very worst, and, still more especially, as 
they are well used to the art of prosecuting experimental inves- 
tigations of a far more formidable kind, in connexion with the 
custom of exhibiting sensible doses of the most potent and 
untried of chemicals. Such is one view of the question ; but 
still a theory of small doses is the desideratum. 

The Professor of Mathematics at Prague has endeavoured to 
supply this want according to his habits of thought, his ability, 
and his means. Professor Doppler is not a physician, nor 
yet a Homoeopathic partisan, but simply brings the light of a 
certain physical distinction to bear on the question at issue, 
being ready neither to oppose the prevailing school of medicine, 
nor to abet the followers of Hahnemann, but, having been dis- 
turbed, and probably vexed, by the noise of the imcharitable 
fight around him, being willing to say whatever his own com- 
mimication with science, elsewhere than in medicine, might 

enable him to advance to the point The gist 

of the argmnent he leads out is to the effect, that the question 
of greatness, respecting material operations, is altogether relative 
to the kind of operations investigated. The quantity of caloric 
in the whole world, if it were expressed, and could be condensed 
by some Farraday or Thilorier on a scale of the most deli- 
cate of balances, would not make it kick the beam so sensibly 
as the thinnest breath of air — ^if at all ; yet, that latent heat 
is so magnificent in power, that certain local disturbances of its 
equilibrium are productive of earthquakes and volcanoes ; and 
Newton used to boast, with that quick pleasantry of illustration 



C2 Afifirfss of the PrrMeni. 

which was or chnractoristic of him as his sure induction, that 
if he were the master of fire, he could pock tho planet in a 
nutshell. Electricity, too, is said to l>o imponderable; but tho 
siulrlen ivstoration of the iiit<?rrui)ted balance between such 
quantities of tho subtle thiid as an* contained in opposing 
clouds, theiiisclves so diniiuutive in cum]iarison with the body 
of tho oailli, is the cause of thunderstorm. Nothing created is 
great or little, excojjt comparatively, and in relation to its effects 
and the methoil of oi>eration. Hence, there may arise on the 
very threshold of the inquiry, the preliminary question, whe- 
ther a medicine acts on the frame by virtue of its ponderable 
quantity, or by the extent of its surface wliich is brought in 
contact with the surfaces of the structures on which it re-acts ? 
This query must be ultimately answered by the extensive obser- 
vation of physicians seeking a reply to it ; but to the physicist 
it is plain, that if the latter be the true rationale of the opera- 
tion of medicines (so far as that is physical), the Homoeopathist 
prescribing the deciUionths of grains may, after all, be giving 
greater doses in reality than the Allopathist when he exhibits 
his ounces. So reasons Doppler ; and distinguishing that phy- 
sical superficies of a body which is the simi of the exposed 
surfaces of its exposed particles, he shows that the triturations 
practised by the Homoeopathic pharmaceutist increase the latter 
surface — that is, the surface that shall be brought into reaction 
with the tissues — at a very rapid rate. A cubic inch of brim- 
stone broken into a million of equal pieces, a sand grain each 
in size, is magnified in sensible surface from six square inches 
to more than six square feet. It is calculated in this way 
that, if each trituration of the Homoeopathist diminish his drug 
a hundred times (an extremely moderate allowance, I aver), 
the sensible surface of a single inch of sulphur, or any other 
drug, shall be two square miles at the third trituration ; the 
size of all Austria at the fifth ; of Asia and Africa together at 
the sixth ; and of the sun, with all his planets and their satel- 
lites — at the thousandth ? No, but at the ninth ! 



Address of the President. 63 

The method of trituration is very simple. A grain of the 
drug to be prepared is carefullj rubbed down in 99 grains of 
soluble, insipid, and pure sugar of milk, which is extensively 
made in Switzerland from the residuary whey produced in the 
manufacture of cheese; a grain out of this 100 is triturated 
with other 99 of the sugar of milk ; a grain of this mixture of 
the second dilution is, in its turn, diflfused through 99 grains of 
fresh sugar, so as to produce the third dilution ; and so on to 
the thirtieth, or beyond it. 

In connexion with the trituration of insoluble solids, it has 
been objected, that if, for example, a million of separate parti- 
cles be contained in a grain of the third trituration, and that 
trituration be then diffused through 100 drops of pure water, 
each drop wiU contain 10,000 particles; that one of these 
drops, diffused in 100 of pure water, will give 100 particles 
in each drop; that the next dilution will yield only one 
particle for each drop ; that consequently, in the next grain 
there must be 999 drops of water without a single particle of 
the original metal, or other insoluble body; and that, in fine, 
the higher dilutions of the Homoeopathic practitioner are 
hereby for ever demonstrated to be null and void, at least in 
the case of insoluble substances. This looks very shrewd, 
and even heis an air of the recondite about it. But who 
assured the sagacious amateur that the ^ects of trituration, in 
the way of diffusion, though indefinitely inferior to those of 
true solution, are to be calculated by petty millions of particles ? 
Besides, there is every probability that the diffusion through 
the milk-sugar is, at a certain point, consummated to the degree 
of solution itself by chemical reaction throughout the mass. 
Molten iron solidified has no action whatever on dry air, and 
even when subdivided by filing, does not oxidate itself, without 
the disponent help of water and carbonic acid ; but let it be 
reduced from the state of hydrated peroxide by hydrogen, at a 
temperature not far above the boiling point of water, and no 
sooner is it shaken out of the apparatus in which the opera-. 



04 A tf dress of the President. 

tioii has hoon conducted, than it bursts into combustion. All 
h()(li«s can unite chemically with each other, if the proper cir- 
oumstaiicps he alForded them; and all solid bodies must sufiTer 
mutual reaction, if j»ivscnti*d to one another in fine enough 
(livisinn. This is exactly the* case in the instance under notice. 
The insoluble hocly — say the metal — unites chemically with 
the su^ar, becomes everywhere diffused in a degree of division 
far rcMnoved beyond computation by numbers, and the sac- 
charine; com])ound, probably still insoluble in the true sense of 
tli(; tc^ni, rapidly passes through the closest filter, and remains 
sus])en(led invisibly among the particles of the solution. This 
is surely tlie reverse of incredible to the chemical analyst. 
In a word, let such dilettanti as found objections on their own 
limitation of mechanical subdivision, and on their own in- 
ade([uate conception of the nature of particles, remember the 
rigorous calculation of an eminent astronomer of their own day, 
that Encke's comet, vast and wide-spreading as it sweeps 
through the firmament, is composed of an air so attenuated, 
that if, by some transcending force, it were compressed to the 
density of our atmosphere, it might be folded in a walnut, 
and they will never attempt the gratuitous task again." 

The next paper is a valuable one, although rather desultory, 
by Dr. Hilbers, of Brighton, entitled " Ohservations on some 
Qitestiom of Medical Ethics, with Special Reference to so- 
called Homoeopathic Practitioners^ It is written in a liberal 
spirit, and contains much practical matter, interspersed with 
some excellent advice to younger practitioners, which they will 
do well to follow. With respect to the employment of auxiliaries, 
so frankly dealt with by Dr. Hilbers, which was the subject of 
Mr. Harmer Smith's paper, I am decidedly of opinion that it is 
impossible to attempt to lay down rules for their use. Their em- 
ployment must ever be exceptional. It is a matter to be left to 
the conscience of the practitioner, and to his sense of duty to 
his patient — dependent on his consciousness of his own want of 
knowledge of the powers of Homoeopathic remedies, and his 



Address of the President. 66 

inexperience how to select them in exceptional cases, not only 
in the cure, but in the palliation of disease, when the amount 
of pain or suffering is such as to cause the patient, his friends 
and physician, to desire more immediate relief than the pro- 
gress of treatment strictly curative [which aims more at ulti- 
mate results than at immediate effects] will admit of— ^iependent 
sometimes upon the previous habits superinduced in the organ- 
ism by the past Allopathic treatment, which in some cases it is 
more prudent to attempt to antidote, and in others safer 
gradually to wean the patient from, than suddenly to stop- 
dependent sometimes upon the state of mind and prejudices of 
the patient and Mends, with respect to the action and virtue of 
Homoeopathic medicines, which have not only the original 
disease to combat, but often an endless complication of symp- 
toms produced by a long persistence in the use of drugs in 
large doses— dependent sometimes upon the practitioner's Allo- 
pathic experience of by-gone days, of the palliative virtue of 
means which will give temporary relief to pain or suffering, and 
cause but a short and slight interruption to the curative treat- 
ment sought for by the administration of Homoeopathic reme- 
dies. It would be utterly useless to seek to establish a prin- 
ciple to guide us in such exceptional cases. 

My experience fully bears out the opinions expressed by 
Dr. Hilbers, that the tendency to the employment of auxilia- 
ries exists more in the practice of those practitioners who 
give large doses of medicines, often in the more crude and 
material form, than in those who habitually prescribe infini- 
tesimal doses. I have perhaps better and more frequent 
opportunities than most other Homoeopathic physicians of 
forming a correct judgment upon this point. From the fact 
of my name having been longest before the public as con- 
nected with Homoeopathy, and from my age^ and position as 
consulting physician, many cases are brought to me which have 
previously been under other Homoeopathic practitioners and in 
the history of the cases and detail of the past treatment given 

VOL. m. 5 



6 6 Address of the President. 

to mo, I have almost invariably found that the resoit to auxi- 
liaries has been much more frequent in the treatment pursued 
by those practitioners who are in the habit of prescribing large 
doses. I have also almost invariably observed that as each 
Iloiuoeopathic practitioner has gained more experience of the 
powers of homoeopathic medicines, he has abandoned the larger 
doses, and approached nearer to the practice of Hahnemann and 
his earlier disciples in prescribing infinitesimal doses ; and I can 
confidently affirm, from all I have observed, that increased suc- 
cess in the treatment of their cases has attended upon the changa 

With respect to the point so creditably and liberally treated 
by Dr. Hilbers, of what ought to be our demeanour and con- 
duct to our medical opponents of the prevailing school, I have 
so often expressed my sentiments in former addresses delivered 
from the chair, and in our debates, that it is unnecessary for 
me to do more than reiterate my advice that we should never 
imitate them in their iUiberality, dogmatism, and uncharitable- 
ness. It is gratifying to reflect that some of the most distin- 
guished amongst our Allopathic fraternity are above the petty 
considerations, the pusillanimity, and the bigotry, that have 
influenced many of their own body, to their own loss much 
more than to ours. But in nothing do I agree with Dr. Hilbers 
more than in his opinion with respect to what should be the con- 
duct of Homoeopathic practitioners towards one another — an 
opinion in complete accordance with the advice I have over and 
over again endeavoured to impress from the chair and in our dis- 
cussions — ^that we should avoid the reprehensible habit in which, 
I am grieved to say, some of our body indulge, much to their 
own loss and discredit, of condemning and speaking slightingly 
to their patients and to the public of the practice and the doses 
prescribed by others, because they differ from their own. 

An -eq^ually suicidal course, and one still more strange, is the 
pretension of some of the so-called Homoeopathic practitioners to 
speak disparagingly of the action of globules — ^nay, to deny 
that they have any action at all ; they at the same time affect 



Address of the President 67 

to hold in contempt those practitioners who prescribe them» — 
whilst, with laughable self-sufficiency, they claim for themselves 
a superiority of intellect in having discarded them, or of never 
using anything but triturations, tinctures, and pilules. Now, it 
is indisputable that the introduction of Homoeopathy over the 
Continent, into England and into America, was mainly if not 
solely eilected by the employment of globules impregnated 
with medicine in the treatment of disease homoeopathically. 
I can answer for my own practice, that for once that I em- 
ploy or have employed tinctures or triturations, I have at least 
prescribed globules sixty times, and my success, I believe, has 
not been behind that of my neighbours, and for many years I 
stood quite alone in England the only Homoeopathic physician. 
Drs. Eomani, Tagliabo, Belluomini, Dunsford, and others, who 
followed some years after me, almost invariably prescribed medi- 
cine in the form of globules. Dr. Constantino Hering, of Phila- 
delphia, who was among the first to' carry Homoeopathy from 
Grermany to America, was, and I believe is, a strict Hahne- 
mannist with respect to his doses. Most of the distinguished 
Homoeopathic physicians known to me in France, Italy, and 
other parts of the Continent, are constantly in the habit of pre- 
scribing globules. And among my friends and colleagues in Great 
Britain I have no hesitation in saying it is my firm and consci- 
entious conviction that those in the most extensive and success- 
ful practice And in the highest repute, prescribe globules. Let me 
not be misunderstood as wishing to convey that either I or they 
confine our prescriptions to medicines in the shape of globules, 
or have tied ourselves up never to employ any other prepara- 
tions ; on the contrary, we are frequently in the habit of pre- 
scribing tinctures, triturations, and pilules, as well as globules, 
in every variety of attenuation from the lowest to the highest, 
according to the more or less susceptibility of our patients to 
the action of the medicines — according to the phases and 
variations that occur during the treatment of our cases, and 
according to the promptings of our judgment and experience. 

5* 



68 A ddress of the President ^ 

I must here also guard myself &om being thought to desize to 
place trammels on the judgment and experience of others in pre- 
fening to prescribe laigo doses only, if they and their patients 
think such practice best It is against their illiberal and un* 
professional conduct only, in running down their colleagues 
who believe in the efficacy of infinitesimal doses, and conse- 
quently prescribe them, that I am contending here. Kow, 
what are globules ? Merely a convenient vehicle or method 
recommended by Hahnemann for prescribing fractions of a 
drop when the whole is not considered necessary to produce 
the desired efiTect, or when it is desired not to give the whole 
drop at once, but to subdivide it into more fractions or smaller 
doses than it would be convenient to do by diluting it in 
water. It is notorious that some of these practitioners who 
proclaim their disbelief in globules, prescribe sometimes 
tinctures in the 3rd, 4th, 5th, and 6th, and even higher 
attenuations ; consequently they avow their belief in the mil- 
lionth and billionth of a drop of the material ding they pre- 
scribe. Well, two or three globules impregnated with the 
1st, 2nd, or 3rd attenuation contains much more of the 
crude or material drug than any drop or number of drops of 
the 4th, 5th, 6th, or any higher attenuation; so that upon 
their own showing, and upon the plea advanced by them 
of what causes the efiQcacy of their fietvourite doses^ theii 
reason for expressing disbelief in the efiQcaoy of medicines 
given in globules as the vehicle, is purely and simply an 
absurdity. 

Another strange idea which has taken hold of some of the 
so-called Homoeopathic practitioners is, that there is little or no 
efficacy in medicines prepared by the centesimal scale adopted and 
recommended by Hahnemann, and which has been in general 
use sincd the commencement of Homoeopathy, they preferring 
the decimal preparations. I remember having a consultation 
with one of these gentlemen^ who on my suggesting a medicine 
which he had not prescribed in the case, readily consented. 



Unpublished Letters of Hahnemann, 69 

but demurred somewhat on my stating the attenuation in 
which I considered it would be most efficacious, and he hoped I 
would not object to his giving a decimal preparation instead, 
as he had for some time ceased to employ any other. On 
inquiring what dilution he proposed, he named the 6th. I 
asked why he preferred that to the one I had suggested, and 
anything more startling and illogical than his reply cannot well 
be imagined ; for, to my astonishment, he said, because it is 
much stronger and more active. Now, as I had recommended 
the 3rd attenuation, which is exactly identical in strength in the 
centesimal scale with the 6th attenuation in the decimal, 
you will understand my surprise. I endeavoured to point this 
out to him, but without success. Such powers of calculation 
are enough to raise the ghost of Cocker ! 

I have now, I believe, touched upon the different matters 
which have engaged the attention of the Society during the 
past session, and have candidly expressed the opinions which 
my forced absence from the Society's meetings prevented my 
doing, whilst summing up, in the course of your debates. 



UNPUBLISHED LETTEES OF HAHNEMANN. 

To Dr. Stapp. 

Koethen, May 5th, 1831. 
Deab Friend and Colleague, 

I must get the horrid chancre dissertation out of the 
house, and so I send it you along with this, as I should have 
done long ago. 

I also send you a very nice guide for patients in search of 
assistance, by the Baron Yon Bonninghausen, in Munster. I 
beg you will send a copy to Dr. Schweikert, for publication in 
lis journal, as I do not know whether he is in Grimma. "WIl^ 



70 UnpubliMhid Letters of Hahn§manjk. 

do yoa say of the article in the 92xid number of Yo88*s 
Journal, by Pn^fossor Schulze. of Berlin, upon the Homceobiotio 
lleiliciiio of ruracelsm ? According to him I haye taken my 
systom out of this man's writings (umntelligible gibberish !), 
but have not rightly understood it. and have confused it in the 
taking. Paraoelsrs understood it better ! From this point no 
one has yet attacked Homoeopathy — it was still to da Do you 
know anything of a Homceopathic physician. Dr. Mayerhofeir> 
of r>remen, who has an immense practice, and is Teiy highly 
esteemed by his patients ? I heard of him &om a friend who 
had liveil for some time in Bremen. 

After you have thoughtfully perused the work upon the 
Katuml Birth, I beg you will return it as soon as yon can, for 
the theologians hero are most anxious to see it. 

I am prevented writing more just now, and so I mnst con- 
clude with my greeting to your dear household. 

Saiiuxl Hahneicann. 

To Dr. Stapf. 

Koethen, August 5ih, 1831. 

Dear Friend and Colleague, 

I send you along with this a globule ot the 30th of Carb. 
An., and I hope it will prove nsefuL I trust that she walks in 
strict obedience to my warning letter. I am greatly pleased to 
hear of the improvement of my beloved Hermann. Next to 
Capsicum, Carb. Anim. is of the greatest service in this epidemic 
of fever. 

I have had Straube, that excellent man and accomplished 
and modest artist, with me frequently, and I have come to like 
him dearly, as well for his own sake as for his convictions in 
favour of our science. 

Preu, in Numbei^, I like mnch, and am obliged to you fop 
lotting mo see his letter. So long as the Allopaths give ns 
false pictures of the cholera, i^resenting it as a combination of 



Unpublished LsUers of Hahnematm. 71 

vomiting and diarrhoea^ it was natural that we unfortunate 
Homoeopaths, at a distance and unable to obsenre for onrselveSy 
should be misled unto the belief of the specific value of 
Veratrum and Arsenicum in the disease; but the true discrip- 
tion given by a Homoeopathist shows that the essential cha- 
racter of the disease is wholly different ; that it is an affection 
of the whole system, which only at its termination assumes the 
form of convulsions and paralysis, accompanied by wateiy 
vomiting and purging only in certain cases; in most cases 
nothing of this takes place-— only rapid death. Here, neither 
Veratrum nor Arsenicum can be expected to do good. Schreter 
writes from Lemberg, that he effected something, but not much, 
by means of Veratrum, and when that did no good Camphor 
was the remedy (he had just got my article upon Camphor). 

I was told within the last two days by an eye-witness that 
when cholera ravaged Odessa, some months ago, the treatment 
pursued there was rubbing the patient over with Camphor, 
which rescued many of them; he himself had treated nine 
patients with Camphor, and all of them recovered. What 
further testimony do we require ? 

The medical authorities in Berlin and Vienna have refused 
to allow my article upon the utUity of Camphor to be pub- 
lished in the JoumaL In Berlin it is to be printed by a book- 
seller, with Stiiler's introduction. I wish you would allow the 
explanations in reference to the dose I have written about this 
introduction of Stiiler's, who makes some malicious observations 
about the size of the dose, to be read at the meeting of the 
10th of August. 

I have also been asked by a Leipsig bookseller to allow binn 
to publish the articla It wiU shortly appear, printed by 
Gluck. He is to sell it for nine gt. gr. I have prepared it in 
an entirely popular form, omitting all scientific details. 

My likeness on steel is not yet ready, else I should gladly 
send it you. I am much pleased at yours. 

Bjominel ha^ managed that article capitally. I trust. that 



*'.*.'ii-? vll *i*-tr '^ 2X1* ^ -P2SS ai lieir i»g. L -^ 
•- V . -_ vr !.:.;_ LA"* "LZiti Liii '.ra=fi "Su- ^/'Jf 



;. .r: -^ .■. v ._iz ^tS^M. ' JL. ^ «i^ iJC 









;^nnals ai tbe ^nspital. 



r;o;;Mj;i>fNG lkcture on laiEOiAnsM.— ox the 

liO.h A NO TMK ALTKKNATIOX OF THE MEDICINE. 
I5y \)\i. Kr;s.SELL. 

(li.MM MKf/, r pr,f.l,poTK!(l Ujo coDsidoratioii of the methods 
n( ii<lfiiihiftl,frin|^ HotiinopHiliic medicines, that I might treat 
Mil iiihjirl. of I.Ik' <Ioh(! with Horiictliiiig like the fuLiess its 
iiii|iMihitM n (l('iiinii(l('(|. And now that I come to fulfil my 
|il''li" , iiiid Id I'lilcr ii|M)n (I ({iH'.st.ion that has caused so much 
iMid mil h \Miiiii diMniMMJon, I frcl tho greatest hesitation and 
it.liii liiiM i> III iiiiliMiii)r ii|M»n Mm t'liHk. It is quite out of my 
|iM'M I In jilvp nvnii Mm lirirfpHt. (uiMinc^ of controversies both 
MiHiiii mid wiMiniil. mil' <i\vu l)od\\ which this question has 
(III Hid , tMiiliiivniMJnrt iMiiidiK^hul with luuch ability on both 
»«iili>< lull iimI> Hlwiiyri wlMk |Mirloot nuukmr and equanimity on 
I'iMiii iildti 

r.i.i.iiii)! Hiitiii Ity liir (ho phmout at toasts lot us attempt 
\s\\\\\ III iinihiiMlHud whu( iho iUOWuIUoh tux> ^vhich have pre- 



Lecture hy Dr. Russell, 73 

vented the some unanimity among the adherents of Hahnemann 
in reference to the proper dose of Homoeopathic medicines as 
happily prevails in regard to the fundamental dogma oh which 
his system is erected, and fix)m which the minor proposition 
that a substance chosen according to the principle expressed 
in the maxim, " SimUtcs similibus curarUur,'' should, to effect 
a cure, be given in a quantity infinitely less than practitioners 
of medicine had been in the habit of employing up to his 
tima To use his own words, as he expresses himself in the 
278th paragraph of the Organon — ^"Here the question arises, 
what is the most suitable degree of minuteness for affording 
certain and gentle relief? — ^how small, in other words, must be 
the dose of each individual medicine (selected according to the 
Homoeopathic principle for a case of disease) in order that it 
shall best effect a cure? . . . Pure experiments, careful 
observation, and accurate experience can alone determine this ; 
and it would be absurd to adduce the large doses of unsuitable 
(Allopathic) medicines of the old system, which do not touch 
the diseased part of the organism homoeopathically, but act 
only on those parts unaffected by disease, in opposition to what 
pure experience pronounces respecting the requisite minuteness 
of the doses for effecting Homoeopathic cures." The question 
is here fairly stated to be one which can be correctly 
answered only by eocperiment, observation^ and experience. 

Let us consider how it happens that we have up to this time 
obtained nothing but confused, evasive, and contradictory replies 
to the interrogations put to this collective oracle. 

At the outset of the inquiry we perceive a fundamental 
distinction between the processes of investigating the question 
of the proper dose of an Allopathic and a Homoeopathic 
medicine. In Allopathic practice the design, as Hahnemann 
states, is, by acting on a healthy organ, to induce a salutary 
change on the part of the body affected with diseasa For 
example, in a case of rheumatic inflammation oi the knees, 
our Allc^athic practitioner might give a purgative, a AtaaMvi 



74 Lecture hy Dr. EusaelL 

or a sudorific, and opiate. If he is asked how he knows what 
quantity of any of these drugs ought to be administered, his 
answer is ready, — " that will depend upon the amount of effect 
required." The effects of the substances he employs have been 
ascertained with greater or less precision by scientific processes. 
It is known to a nicety what quantity of castor oil will operate 
as a purgative, and what quantity of opium is required to pro- 
duce sleep. Making a certain allowance for the disturbing 
action of morbid causes, he selects his dose of medicines 
according to the table put into his hands by the toxicologist 
For an Allopathic practitioner to give the millionth of a drop 
of castor oil to induce purgation, or the billionth of a grain of 
opium to procure sleep would be a manifest absurdity. His 
aim is definite, and the means to attain it equally so. The 
question is not now whether or not purgation be desirable; 
but supposing it to be so, how is it to be obtained ? He can 
graduate his dose so as to produce to considerable nicety the 
amount of the particular action he wishes, because he is acting 
upon the sound part of the frame, according to physiological 
principles established on the secure basis of repeated experi- 
ment. But the position of the Homoeopathic practitioner is 
wholly dijfTerent. The effects he strives to obtain are not 
positive, but negative. For what is a ciire but the n^ation of 
disease? The more perfect the method, the more entirely 
absent is all positive effect. This, then, is his problem — 
" Given thirty different doses, all of which have the power of 
acting curatively upon a diseased organ, while none of them 
produce any appreciable effect upon the sound parts of the 
body — ^how is he to ascertain which one out of the thirty exerts 
a curative power in the strongest degree V* The simplest^ and, 
indeed, the only way to solve this problem is, by a seriies of 
trials of the same medicine in different dilutions administered 
in similar circumstances. But at the very threshold of the 
investigation we encounter the almost insurmountable obstacle 
of contriving experiments which shall meet the requirements of 



Lecture by Dr. Rtusell. 75 

the casa The difficulties that beset the whole class of such 
inquiries are thus expressed by Mr. J. Stuart Mill, in his great 
work upon Logic — " Let the subject of investigation be the 
conditions of health and disease in the human body-— or, for 
greater simplicity, the conditions of recovery from a given dis- 
ease ; and in order to limit the question still more, let it be 
confined in the first instance to this one inquiry, Is, or is not, 
a particular drug — mercury, for example — ^a remedy for that 
disease ? . . . When we devise an experiment to ascer- 
tain the effects of a given agent, there are certain precautions 
which we never, if we can help it, omit. In the first place, we 
introduce the agent into the midst of a set of circumstances 
which we have exactly ascertained. It need hardly be re- 
marked how far this condition is from being realized in any 
case connected with the phenomena of life ; how fiEur we are 
from knowing what are all the circumstances which pre-exist 
in any instance in which mercury is administered to a living 
being. This difficulty, however, though insuperable in most 
cases, may not be so in all; there are sometimes (though I 
should think never in physiology) concurrences of many causes 
in which we yet know accurately what the causes are. But 
when we have got clear of this obstacle, we encounter another 
stUl more serious. In other cases, when we intend to try an 
experiment, we do not reckon it enough that there be no cir- 
cumstances in the case the presence of which is unknown to 
us ; we require also that none of the circumstances which we 
do know shall have effects susceptible of being confounded 
with those of the agent whose properties we wish to study. 
We take the utmost pains to exclude all canises capable of com- 
position with the given cause ; or, if forced to let in any such 
causes, we take care to make them such that we can compute 
and allow for their influence, so that the effect of the given 
cause may, after the subduction of those other effects, be 
apparent as a residual phenomenon. These precautions are 
inapplicable to such cases as we are now considering. . . . 



7 6 Lecture hy Dr. Russell. 

Anything:; like a scientific use of the method of experiment in 
those coinplicatod cases is therefore out of the question. We 
can, in the most favourable cases, only discover by a succession 
of trials, tliat a certain cause is ver}" often followed by a certain 
efreft/' — Mill's "Logic," vol. i. p. 529. I have quoted this 
utt(»rance of inexorable Logic, not that I believe it to be at 
all impossible to establish by a sufficient number of instances. 
that the administration of a certain remedy is followed, by 
virtue of the law of causation, by the cure of certain forms of 
morbid action, but to put us on our guard in dealing with the 
question before us, by exhibiting the category to which the 
problem belongs. It is one of mixed causes. Without under- 
valuing the power of a medicine to effect a cure, yet it is 
obvious that this curative action is only one of several causes 
which bring about the recovery of a patient. The duty of a 
physician is not to make experiments upon the sick entrusted 
to his care, in order to determine with scientific precision the 
exact value of a given remedy ; it is, to employ all the means 
in his power to accomplish the object of his vocation. He 
must, to the utmost of his ability, remove from his patient all 
noxious agencies, and accumulate all salubrious influences about 
him. He must improve his diet, his habits of exercise, or of 
rest ; he must convey hope and confidence if possible into his 
mind ; and in short, he must exhaust all his ingenuity for the 
welfare of the sufferer, just as if he had no medicine to give. 
Into this multitude of healing forces he drops his globula 
Let it not be supposed that I regard the globule so adminis- 
tered as a trifling addition ; on the contrary, I am firmly per- 
suaded that, in most cases, it exerts greater powers in bringing 
about the happy result than aU the other influences put toge- 
ther. Nevertheless, to overlook the other co-operating causes 
of the effect would be as great an error on our part as is the 
mistake of our opponents in ascribing our cures to these causes 
alone. Let us now fairly confront the problem. The question 
-" Here are thirty different doses of the same substance, — 



Leettt/re by Dr. Riissell. 77 

all the thirty possess the power of curing, — ^to ascertain which 
of the thirty possess their power in the highest d^pree?" The 
only conceivable method of setting about the investigation is 
to institute a series of experiments. What are the conditions 
required to give such experiments any scientific value ? It is 
obvious that the physician must begin by selecting thirty cases 
of the same description in every particular; that the cases 
.iQiust be of some complaint which does not tend to a speedy 
spontaneous recovery ; that for each of these cases, the medi- 
cine experimented on is equally well suited; that all the 
persons are placed in exactly similar circumstances as regards 
the other sanative influences ; that they are all equally sensitive, 
naturally, to the action of the particular remedy which is being 
tried ; that the experiment shall be made by the same physician, 
at the same season of the year, surrounded by the same epidemic 
and atmospheric influences ; and that it shall last for several 
weeks, or even months. But one series of such experiments 
could not by any possibility afford any trustworthy results. It 
would require many such series. Now I ask, — ^has this ever 
been attempted, or is it likely that it ever will be ? Common 
sense tells us that the difficulties of performing such experi- 
ments are absolutely insurmoimtable. But till they are over- 
come> I do not see how we can even expect to arrive at a law 
regarding the dose. This can be attained by a process of induc- 
tion alone ; and the only facts available for such induction must 
be obtained by some such process of experimentation as I have 
sketched. All d priori attempts to frame such a law have 
utterly failed. 

The practice of giving medicine in 'extremely minute doses, 
in cases treated homceopathically, rests partly upon reason, 
partly upon experiment. The rationalty of the practice was 
explained sixty years ago by Hahnemann, and with more force 
and clearness, in my opinion, than by any subsequent writer 
on the subject In a letter addressed to Hufeland, and pub- 
lished in his celebrated Journal in the year 1801, Hahnemann 



7 8 Lecture by Dr. Ruuell. 

writes: — "You ask me what eflPect can l-100,000ih part of 
a grain of Belladonna have ? The word can I dialike ; it ia 
apt to lead to misconceptions. Our compendiuxns have alxeady 
decided what medicines can do when given in certain doses; 
and they have told us exactly what we are to use ; they have 
determined these matters with such precision that we might 
look on these volumes as our sacred books, if medical dogmas 
were to be believed as articles of faith. But, thank Heaven, 
this is not the case ; it is well known that our works on 
Materia Medica rest on anjrthing but pure experience — ^that 
they are, in fact, the inanities of our great-grandfathers re- 
peated without examination by their great-grandsons. Let us 
not, then, inquire of these compendiums, but let us ask nature 
what effect has 1-1 00,0 00th of a grain of Belladonna? But 
even in this shape the question is too wide ; it must be put in 
a more definite form for reply, by the addition of the qualifica- 
tions, ubi, quo modo, quando, quibus auxiliis. 

" A hard dry pill of extract of Belladonna produces on a 

P robust, perfectly healthy peasant or labourer usually no effeck 

But from this it by no means follows that a grain of this ex- 

U tract would be a proper or too small a dose for such a man if 

: ; he were ill, or if the grain were dissolved. The most healthy 

)A and robust labourer will be affected with very violent and even 

{;J dangerous symptoms from one grain of the extract of Bella- 

i; donna, if this grain be dissolved in, say, two pounds of water, 

and if he take it in spoonsful within six or eight houis. 

These two pounds will contain about 100,000 drops. Now, if 

one of these drops be mixed with other 2,000 drops of water, 

and twenty drops of this mixture be given every two honis, 

they will produce effects not much less violent if the man to 

whom they are administered be HI. This dose contains about 

one-millionth part of a grain. A few teaspoonfols of this 

., mixture will, I aGBrm, bring to the brink of the grave a person 

seriously ill of a disease to which the action of Belladonna 

II bears a close resemblance. 



Lectu/re ly Dr. Russell. 79 

'"The liard pill of some grains of Belladoxma finds few points 
of contact in the healthy body ; it glides almost nndissolved 
through the intestinal canal, protected by its layer of mucus. 
But it is very different with the same substance when dissolved. 
Let the solution be as weak as it may, on being received into 
the stomach it acts on a much larger surface and excites more 
severe symptoms than the pill which contains a million times 
the amount of medicine is capable of doing." 

In this letter, written more than sixty years ago, we have 
the most explicit statement of the conditions which combine 
to make the administration of medicines in minute doses ob- 
viously rational These conditions are twofold; the first is 
that the substance shall be prepared in such a way as to enable 
it to come in contact with a larger surface of a part of the 
body highly endowed with nervous sensitiveness. This is a 
physiological reason. A healthy man would be poisoned by a 
dose of Belladonna or Opium, if given in solution, which 
would be comparatively innocuous if given in the form of a 
pilL The second condition is pathological, viz., that an organ 
in a morbid state is morbidly alive to morbific agencies — as 
the inflamed eye to intense light, inflamed joints to rough 
movement, &c. 

K Hahnemann had stopped at this point, he might have 
effected what I may call a bloodless revolution in medicine. 
But he did not stop hera A few years after writing the 
passage just quoted, he uttered the astonishing proposition that 
a globule of the decillionth of many substances known to be 
wholly inert in massive doses, had the property of exerting 
an enormous power upon the living organisms when it 
was aflSicted with symptoms of disease similar to those these 
substances produced when they were prepared and administered 
in a certain way. It is obvious that in making such an 
affirmation, Hahnemann left behind all A priori probabilities of 
its truth. The reasoning he employed to render credible that a 
millionth of a grain of Belladonna was more potent than the 



80 I^durt hy Dr. RusmU. 

whole grain, inasmuch aa the former acted on a larger anrbce^ 
is inapplicable in regard to a globule of the 30th dilution of 
calcanM for example, placed upon the tongua Up to a cer- 
tain point, analogy is all in favour of minute doses; beyond 
that j)oint I confess it seems to me that we can derive little, if 
any, support from analogy. 

On what then do we rely if we entertain the belief that a 
globule of the decillionth of a grain of Calcarea is a powerful 
medif.ine ? Simply and exclusively on testimony and our own 
observations. 

Let us consider the evidence in favour of this astonishing 
proposition. The first witness is Hahnemann himseli Is his 
testimony worthy of credit in this matter ? We require of a 
trustwoi-thy witness that he shall be competent in knowledge 
of the subject ; and that he shall be veracious and accurate in 
his statements. Of Hedinemann's acquaintance with the sub- 
ject, and capacity of observing facts in regard to the action of 
the high dilutions of medicine, there is no need to speak. He 
had ample opportunities and undeniable ability for the task. 

I5ut what of his accuracy and trustworthiness as a recounter 
of observations ? If Hahnemann be not accurate and trust- 
wortliy as a critical observer and faithful narrator of his own 
observations and those of others, then the whole feibric of 
Ilomoiopathy rests on an unsound foundation; for be it re- 
membered that nine-tenths at least, if not nineteen-twentieths, 
of the observations upon the actions of medicines which are in 
daily use by Homoeopathists are derived fix>m Hahnemann's 
Materia Medica : and observe what an tmenviable position 
those men occupy who are in the daily habit of employing the 
medicines introduced into practice by Hahnemann, prescribing 
Belladoima, Pulsatilla, Bryonia, &c., not because they them- 
flclvos discovered the virtues of these drugs, but because 
Halmomann has done so, and left directions for their proper 
use, and who, although tacitly acknowledging his trustworthi- 
ness, yet tell us that they have no faith in globules of the high 



Lecture by Dr, Rtissell. 8 1 

dilutions I I could quite understand their position if they 
were to say, We have tried both the low dilutions and the high 
dilutions, and we find the latter of no avaiL But I do not 
find that those who reject Hahnemann's statements in reference 
to the action of the high dilutions have submitted them to a 
careful course of experimentation. On the contrary, it seems 
to me that they act exactly as they blame the opponents of 
the homoeopathic system for acting — ^that is, they deny that 
these doses can act, because it is against their notions of what 
is possible. But who shall say what is possible and what is 
impossible ? Facts alone, facts carefully observed and accu- 
rately reported by witnesses beyond suspicion, can decide such 
a question as this. Hahnemann, as we know, with nothing to 
gain and all to lose by a false step, firmly maintained his 
course, and in cases of the severest illnesses of those most 
dear to him, trusted in his globules of the 30th dilution. Since 
his time a multitude of other observers have borne testimony 
to the efficacy of these extremely minute doses. If we were to 
poU all the homoeopathic practitioners over the globe, and put 
the question to them, " Do you believe that a dose of Calcarea 
of the 30th dilutionhas any power ? " I am convinced that there 
would be an overwhelming majorrt- in favour of the affirma- 
tive. 

All who have earnestly devoted themselves to the study of 
the Materia Medica, and to an experimental verification of 
Hahnemann's original experiments upon himself with the 
medicines it contains, have borne testimony to the wonderful 
fidelity and accuracy of all the statements that rest upon his 
own personal observations. Are we then to throw all these ob- 
servations to the winds, and to begin a reconstruction of this 
great edifice, which looks rather like the growth of ages than 
the effort of one man? Those who propose that we shall, 
hare formed a very faint idea of the difficulties that beset a 
abourer in the path of experiment with medicinal substances ; 
in Iftct, nobody who practises Homoeopathy can serio\x%V 

VOL. in. ?» 



H2 Lecture hy Dr. Russdl, 

liiako >n wilil a ]>roi>osal, for he stultifies his own piactice on 
the vi-ry outset. No; logically there is no alternative: either 
wf iim-t jicecpt the statement of Hahnemann and his followers, 
that ;.'1m1iu1(.'s of the decillionth of a grain of such substances as 
(.'ill' ar»*;i, Carln), Silic«»a, have a most powerful action on the 
di>or<l-iv.l frame of man, or we must reject Hahnemann's 
Mat<']i:i Medica, out of which all the manuals of practice are 
dcri\ <m1. If we are not prepared for the latter altematiYe, what 
\m:()\wr< of the lamentation we so often hear about these high 
dilutions ? If Hahnemann be correct in his statements, then 
he iiifide undoubtedly as great a discovery when he ascertained 
that thf're was me<liciual power in the decillionth of a grain of 
lime or charcoal as was ever made in this region of physics. 
Shall we say this discovery is of no importance — a thing rather 
to be ashamed of because it exposes us, who avow a belief in 
it, to the ridicule of those who despise Hahnemann, his doc- 
trines, and his disciples ? Were we to do so, we should deserve 
the contempt of his opponents, whom we ignobly tried to 
propitiate by denying our master, to avoid the scorn of the 
medical world. 

If on the one hand it is impossible to ascertain by the 
strictly Baconian method of scientific induction the relative 
value of dift'erent doses of the same medicine, and on the other 
hand there is ample evidence for all the various doses ranging 
from the pure tincture up to the decillionth of a drop pos- 
sessing power, more or less, to cure diseases, what is the 
I)ractical conclusion to which we are forced to arrive ? It is 
this. The dose is not to be determined by any geneial law ; 
each individual, each form of disease, each variety of the innu- 
merable conditions, the sum total of which compose a human 
life, has its own appropriate dose. The dose proper for this man 
to-day will bo improper for him to-morrow; the one best suited 
for this woman is not the best for that child ; but all men are 
not to have a different dose from all women and all children. 
Tlui (luostlon of the proper dose is like that of the most suit- 



Lecture by Dr, RusselL 83 

able food. The only answer we can give is, that that is best 
which agrees best with the individual who uses it. In the 
same way we say that dose is best which does its work most 
perfectly. But if we are asked how shall we determine before- 
hand what particular dose to select, our answer is, " It is im- 
possible to give any general rule — ^it depends upon the indi- 
vidual sensitiveness of the patient ; and to be able to form an 
accurate estimate of this, requires the special medical faculty, 
the possession of which, in a greater or less proportion, is the 
grand reason of the difference in the success of one practitioner 
as compared to another. The same kind of rapid perception, 
almost intuition, which enables any physician to form at once 
an accurate judgment of the nature of a case, will enable such 
a man also to form a correct opinion as to the amount of sen- 
sitiveness, and consequently the most appropriate dose. In 
short, it belongs to the unteachable part of the art of medicine, 
not to the teachable sciences which go to form that art. The 
great practical lesson to be leamt from all that has been 
written on the subject I believe to be this : " That man will 
effect most cures, who, besides being duly instructed in the 
action of the medicines, and possessing in greatest measure the 
other qualifications for success, is least bound by any rules in 
regard to the doses he employs — ^who ranges most freely from 
the lowest to the highest, and from the highest to the lowest, 
and is neither deterred from giving a globule of the 30th by 
fear of the incredulous, or of giving a drop of a pure tincture 
out of dread of the purist, and who uses his liberty without 
infringing on that of others. That Hahnemann should have 
desired to promulgate an act of uniformity in our posology is 
natural^ seeing he was expected to do so as the head of the 
largest and most influential school that has arisen since the 
breaking up of the Galenic empire of medicine ; nor do I 
find it strange that in his practice, Hahnemann, who, as a 
flttecesfifol practitioner, was probably never equalled, should by 
tti* few hints he drops in regard to the doses he em^\xyj^. 



84 Lecture by Dr. Russell. 

show that he was iu the habit of employing all doses, from 
drops of the pure tincture to portions of a single globule of the 
30th dilution. 

It was natural that Ilahnemann, as the founder of a school, 
should desire to introduce a certain degree of uniformity into 
the practice of the system he inaugurated, for the obvious 
reason which he liimself gives, that if all used the same dose 
we should be better able to form a correct opinion as to the 
treatment of any case, and be more secure of obtaining the 
same results in a similar circumstance, than if there were a 
great latitude in the amount of medicine employed; and also, 
be it remembered, he fixed upon the 30th dilution to put a 
check to what he regarded as the extravagancies of some of his 
disciples, who soared away into the hundredth and even 
thousandth dilution, and in their devotion to these ghostly 
sublimities were in danger of passing into a state of such mys- 
tification as to forget that the dose was, after all, a matter of 
only secondary importance. 

While Hahnemann claimed for the higher dilutions their 
rightful recognition on the ground of their proved usefulness, 
it was hardly possible for him to avoid framing some hy- 
pothesis to account for the extraordinary development of 
powers which had never been before revealed. The explana- 
tion he advanced of these surprising powers was, that they 
were evoked or engendered by processes of trituration and suc- 
cession, and he termed the result dynamization. We are not 
in the habit of scof&ng at Newton's discovery of the analysis of 
the sun*s light by the prism, because he appended to it an 
hypothesis as to the essential nature of light which is generally 
disallowed ; and it seems to me to argue the opposite of a philo- 
sophical character, for anyone who believes in the discoveries 
of Hahnemann to attempt to hold up his hypothesis to ridicule. 
If we accept his facts, his explanation is at least as good as 
any that has hitherto been proposed. How does it happen, he 
asks, that although the water of this district is highly cal- 



Lecture by Dr. Riusell. 85 

careous, it does not cure diseases for which that substance is 
suitable, and which are cured by Calcarea dynamized by 
trituration ? Here is a question which is yet tmanswered ; and 
surely it is more unphilosophical to reject a fact because its 
discoverer attached an hypothesis to it, than to frame an ex- 
planation in accordance with the general theories of the time 
in which the discoverer lived, which Hahnemann did. That 
there are latent " spiritual " powers in matter was a prevailing 
opinion long before the time of Hahnemann. It is thus ex- 
pressed by Lord Bacon, " Let this be laid for a foimdation, 
which is most sure, that there is in every tangible body a spirit 
or body pneumatical, enclosed and covered with the tangible 
parts." — Sylva Sylvarum, 696. 

For my own part, I am disposed neither to admit nor to deny 
the sufficiency of Hahnemann's hypothesis. It is perhaps as 
good as any other, and merits careful consideration at our hands. 
Still it is only an hypothesis, and does not touch the validity of 
the evidence in favour of his great discoveries — 1st, that the 
trae method of curing diseases is to select a remedy which pro- 
duces in the healthy body symptoms similar to those of the 
patient whom we are treating ; and 2ndly, that a remedy so 
selected has the power of curing even in quantities so minute 
as one decillionth of a grain or drop. 

The second proposition, which we may thus modify, " that 
medicines have the power of curing in so great a variety of 
fractions of a drop or grain that the particular fraction we 
select from the 10th to the decillionth is of comparatively 
secondary consequence," holds true, however, only under the 
conditions that we choose a remedy strictly in accordance with 
the maxim expressed in the first proposition — the Homoeopathic 
formula. If we leave this narrow path traced out by Hahnemann, 
and attempt to discover specifics by any other plan, then the 
whole complexion of the question is at once changed. To 
illustrate my meaning, let me direct your attention to an 
interesting paper which appeared in a recent number of the 



80 Lecture hy Dr. Russdl 

" P.riti-jh Journal of Homoeopathy," by Dr. Eidd, on the treatment 
of lihiijiis tuiuoure of the uterus. Dr. Badd observes, ** The 
hoiiKiopathic treatment of fibrous tumours illustrates the 
r^'O'-ssity we liave to treat diseases not symptomatically, but 
rationally. No m^ lirine is known to cause the production of 
fil»ious tunioiii-s; and although medicines such as Sabina, Secale, 
and Fr-iTiim Muriaticuni, are homaH)patliic to the symptoms 
caused by the tumours, yet their use is only palliative, and in 
no way curative of tlie disease." 

" From the pathogenetic effects of mercur}-, it seems to be 
the nearest homoeopathic specific for the disease. The primary 
patliogenetic effect of mercury is to cause an increase in the 
quantity nf fibrine in the blood; also an increased activity in 
the fibrous structure, and in the fibrous organs, such as the 
woml). In practice I liave found it the most useful remedy in 
the treatment of this disease." Dr. Kidd then mentions that 
he gives from one to three drops of the second decimal dilution 
of CV^rrosive Sublimate two or three times a day, it may be for 
many months. The second decimal dilution is the 100th of a 
gniin, and three drops of that three times a day would make 
lh(i daily quantity of this powerful salt of mercury taken by 
tlu» ])atient about tlie 11th of a drop. In this passage we 
h.'iv(; two statements — the one is that of a fact, and a most im- 
fjortant fact,^coming from a physician known to have had a 
Vi'vy extensive experience — viz., that a given quantity of Cor- 
rosivci Sublimate cures fibrous tumours of the uterus. We 
]iav(; also, in explanation of the fact, the statement that mer- 
cury a(;t8 lioniceoxmthically, having the power to increase the 
fibrin(5 of the blood. While gratefully accepting Dr. Kidd's 
fact as an important addition to our resources, and trusting 
that in the hands of others this remedy may prove as useful 
AH Ik; assures us it has been in his, 1 am compelled absolutely 
to r<yecl his explanation of the method of its curative action, 
for I liiicl all the authorities on the subject describe the action 
of mercury upon the blood as the very reverse of what Dr. Kidd 



Lectu/re hy Dr. RimdL. 87 

aflinns it to ba So feir ttom mercuij piodaciiig an excess of 
fibriiie» it causes a marked reduction in the quantity of that 
ingredient of the blood. Dr. Headland^ in his well-known 
prize essay on the action of medicines, makes the following 
observations in regard to mercury : — " Mercury disintegrates or 
decomposes the blood, and thus wastes the body. This is the 
systemic action of mercuiy, on which too much stress camiot 
be laid. Dr. Wright has analyzed the blood of patients under 
mercurial action. It is materially changed : it contains more 
water, and is more prone to putrefaction, than healthy blood. 
The fibriney albumen, and red globules, are diminished in 
amount." . . . Wibmer, who has collected all the cases of 
mercurial poisoning which had been published at the time he 
prepared his wonderfully elaborate work, mentions, as one of the 
characteristic effects of mercury, " the increase of the fluidity 
and decomposition of the blood," and I can find no authority 
for the statement that mercury at any stage of its operation 
increases the fibrine. If we are constrained to disallow Dr. 
Kidd*s explanation, are we therefore called upon to reject his 
facts, and the practical deduction to be drawn from them ? 
Heaven forbid that we should be possessed of so narrow a 
spirit. No. Let us accept these and all facts which add to our 
power of coping with the multitudinous forms of disease claim- 
ing our efforts to cure or relieve ; but let us arrange such fiacts 
in their proper order, and call them by their proper name. If 
mercury have the power of curing fibrous tumours in virtue of 
its action on the blood, then it is by diminishing the fibrine in 
that fluid. Now, this action is not pathological, but physio- 
logical, and probably chemical ; as such it is removed entirely 
out of the conditions to which the proposition respecting the 
dose of homoeopathic medicines is applicable. To cure in this 
way we must use comparatively large quantities, in order that 
th^y may produce the physiological effect ; we have no right 
to expect any action at all in this method from the minute 
doses usually employed by homoeopathic practitioners. In fact, 



8 S LuUrt bjf Dr. Rusidl. 

« ; h '.irf:i 2lx*: not homceijpathic in any sense. Let this be 
ci;.-/l:. .'!y uii«kT.':too<l, otherwise we shall find that those who 
atv-:;;; * \n r^-jKirat th^^rm, anJ, ignoring this important tsjcXy em- 
pl'iV t;.-: rri*:<Ii^-imr.s in such doses as thev are themselves in the 
h;ii^i^ ot jiroh'jribiri;:, will l^ grit^vously disappointed in the 
Kvjj!*-. I>jt us recognise as a significant sign of the times the 
ri-je of Jt fo nn of sj^ecific therai>eutics entirely different from 
IIoino;o|athy, and likely to have a powerful influence upon 
ui^'Amaik: — Vrneficial as regards Allopathy, to which it will 
naturally ally itself, and in my opinion detrimental to Homoeo- 
patliy, which it will deprive of that purity and certainty so 
remarkably in contrast with the vagueness and uncertainty of 
all other methods hitherto introduced. 

While it may be a cause of legitimate regret to see — as we 
do in Gennany — a large number of men prefer the guidance of 
I'aracf-lsus to that of Hahnemann, in their quest for specific 
renierlies, we are bound to concede that, from their point of 
vi(;w, tli(i massive dose is jjerfectly rational But we cannot 
say HO much of those who adopt the principles of what I think 
Dr. (Jliamhers calls conservative or constructive medicine, and 
aiiempt to carry them out with infinitesimal doses. For exam- 
j)le, tlidHi are some diseases in which it is known that iron 
exists in (l(jficient quantity in the blood. Now, there are two 
plans, both rational, for treating patients so affected. The one 
— the; constinictive — is to administer iron in such a form that 
it can l)(^ assimilated by tlie invalid, and restore by its chemical 
ac-tion the blood to its normal state. That this is possible, 
i/4 proved liy th(j rcjsearches of the chemist. The other 
])lan JM to (liH(}ov(!r medicines which shall enable the organ- 
ism lo appropriate} for itself the iron wliich exists in abundance 
in iirMcJcH of food, if wo adopt the latter plan, then we should 
nmploy infiniU'simal doses; if the former, we must give the 
irnh in tunKihle (juantities. To prescribe it in the billionths 
of a )/niin, is as irrational as it would be to administer the 
tnillionth of a drop of tinoturft of senna to obtain an evacuation 
of tlu' howoU. 



Lecture by Dr. Rutsdl. 89 

I now come to the consideration of the question of the 
administration of two medicines in alternation — a practice 
which may be said to have become usual, and which is often 
adopted even by those who condemn it The short time 
at our disposal will prevent me &om entering with any fulness 
into this division of the subject ; and I shall content myself 
with making a few general observations on the advantages and 
disadvantages of this plan of treatment. 

In the first place, it is so manifestly at variance with the 
doctrines taught by Hahnemann, in regard to the necessity of 
coimteracting one morbid dynamic change, in which he con- 
sidered a disease to consist, by some one other medicinal 
dynamic action, and to his belief of the length of time that a 
single dose of a medicine acted, that he could not possibly 
regard the plan with anything but repugnance fix)m his theore- 
tical point of view. If disease be one and indivisible, and if 
its symptoms be but the mutterings of this evil spirit, and if, 
on the other hand, a medicine act as a whole — ^giving a shock 
to this malignant spirit, as knight charged knight in the 
encounters of chivalry — ^then, with this idea of morbid and 
medicinal action, it was obviously inconsistent to administer 
more than one medicine at a time, or to give a second dose of 
this imtil the effects of the first were exhausted. But Hahne- 
mann, besides being a genuine thinker, a profound excogitator 
of a system derived from certain assumed axioms, was a man of 
great common sense, of large experience, and of practical saga- 
city. And in medicine, as in politics, the most successful 
administrator is he who, although fully recognising the general 
laws which philosophers have propounded, yet adopts his mea- 
sures to the special exigencies of the occasion, even although 
for a time they seem in violation of his most cherished maxims. 
In medicine, the law of humanity is the highest of all laws ; 
and Hahnemann showed by his practice that while recognising 
the general propositions he had laid down in the "Organon," he 
did not allow them to interfere with his freedom of action in 



9 Lecture by Dr. Russell. 

dealing with dangerous disease. In proof of this, we find that 
when he treated a form of typhus fever, in the yeax 1814, he 
administered in alternation Bryonia and Rhus tox. In the 
edition of his Materia Medica published in 1833, he mentions, 
in the introductory observations to Rhus tox, that the only 
remedies which proved effectual were Rhus given in alternation 
(ab wechseld) with Bryonia. Nor does he make any depreca- 
tory observation on the practice So that even when he 
strenuously maintained the theoretical badness of this method 
of procedure, he does not impugn it in an instance in which 
experience proved it to have been useful It is but fair to 
observe, that although he speaks of giving these medicines 
in alternation, yet, in the fuller history of the epidemic, 
he describes the cure as usually effected by a single dose, 
first of the one and then of the other medicine. 

If, however, we reject the notions of Hahnemann, in regard 
to the essential nature of disease, as incompatible with the 
modern pathology which has come into existence since he wrote 
his " Organon " — a pathology not, like that against which he 
inveighs, founded upon conjecture, but the fruit of extensive 
and accurate observation on the results of morbid changes, and 
of careful inference therefrom as to the nature of the actions 
which produced these organic alterations in the body — are we 
therefore justified in also rejecting his practical advice, never to 
give but one medicine at a time, and never to give a second 
until the operation of the first has wholly exhausted itseK? 
There still remains another serious objection to the administra- 
tion of medicines in alternation, and that is, that it introduces 
such an element of confusion into the problem of what did 
good in any particular case as in some degree to vitiate the 
scientific value of the result we obtain. If, in a case of acute 
rheumatism, I prescribe Aconite and Bryonia alternately, and 
the patient recover, how shall I determine whether the cure 
were due to the action of the one or of the other, or of a 
tertium quid compounded of both ? That this is a most 



Case of Ovariotomy. 91 

serious objection must be admitted; and the conclusion I am 
disposed to come'to is, that when we adopt the system of alter- 
nation it should be done always under protest. The paramount 
duty of the physician being to cure, he is bound to employ the 
measures which seem to him best suited for the particular case 
under treatment. All other considerations are secondary to 
this irrevocable^ and immutable obligation. 



CASE OF OVAEIOTOMY. 

Operation performed by Mr. Ayerst. Eeported by 
Mr. EoBiNSON, House Surgeon. 

Harriet Foster. Aged 24. Servant. Unmarried. On May 
6th, 1862, was received as an out-patient under Mr. Leadam, 
for Ovarian Tumour of left side, which she first noticed 
eighteen months previously. Fluctuation was then indistinct. 
She gradually enlarged, fluctuation becoming more diffused and 
distinct, and continued as an out-patient until Nov. 24., when 
she was admitted into the Hospital She then measured 36-^ 
inches in circumference, one inch below the umbilicus. 

Tapping was not had recourse to, as she was considered a fair 
subject for the major operation. She complained of a feeling of 
great weight in the abdomen, more particularly when walking • 
dragging pain round the hips ; much flatulence ; sensation of 
hot water passing down the back ; giddiness, dimness of sight, 
and headache ; excessive sour eructations ; shooting pain in the 
hypogastrium. Bowels regular, but each action is followed 
by much pain, as from piles. Catamenia always regular, but 
attended with great pain. There was occasional hysteria. 

From this date (Nov. 24) to Dec. 30, the general health 
gradually improved, and it was now decided to remove the 
tumour, for which purpose she was placed under Mr. Ayerst. 



92 Case of Ovariotomy, 

At 9 a.in. the patient was put under chlorofonn, and an inci- 
sion made to the extent of 4^ inches, in the median line — from an 
incli ])f»low the umbilicus to an inch above the pubes. The tumour 
was brought forward, and the separate cysts of which it was 
composed were tapped with the ovariotomy trocat. Some (the 
larger cysts) contained a dark-brown-coloured fluid of a grumous 
consistence ; others (the smaller ones) contained a thin straw- 
coloured fluid. The total quantity of fluid that came from the 
abdomen was about two gallons — an ordinary stable bucket- 
full. The size of the mass being thus much diminished, and 
there being no adhesions, it was with little difficulty pulled 
forward. A clamp was applied to the pedicle, and a ligature 
an inch lower down. The tumour was then removed by a 
single stroke of the bistoury. The clamp was left outside, and 
the edges of the wound were brought together by means of 
large harelip needles and twisted sutures. The wound was 
dressed with lint soaked in a calendula lotion. 

Within the envelope of the ovary were found numerous 
small but distinctly-formed cysts, varying in size from a pea 
to a hen's egg, and containing a pale straw-coloured fluid. 

1 1 a.m. — Patient complains of feeling cold and numb in the 
lower extremities ; slight numbness also in right arm. Great 
tympanitic distension in umbilical region. Pulse 84. 

Ordered beef tea and weak brandy and water. Temperature 
of the room, 65**— 70° Ft. 

R. Am. \ \ 4t« horis. 

1 p.m. — Pulse 112. Body quite warm and comfortable; 
numbness gone ; tympanitis continues ; sharp pain at seat of 
wound,* and slight nausea. Several ounces of urine were drawn 
off. This was done, not because she had any retention, but to 
prevent unnecessary motion of the patient. 

6'20 p.m. — Pulse 120. Stabbing pain in hypogastrium ; 
passed a littje urine involuntarily ; less tympanitis. 

R. Aeon. 3 gtt. j. h. s. s. 



Case of Ovariotomy. 93 

Dec. 31, 10*30 a.m. — Nausea; vomited a small quantity of 
very acrid fluid. Pulse 112. 

Jan. Ist^ 1863, 9 a.m. — Pulse 120. Feels dull and low ; 
complains of feeling bilious ; conjunctiv» yellow. 

R. Merc. sol. \ i 2'^d» horis. 

Jan. 2nd, 4 a.m. — ^Pulse 130. Excessive clammy perspira- 
tion. Palms of hands alternately burning hot and cold ; feeling 
of sinking. 

Jan. 3rd, 9 a.m. — Pulse 120. Has had some hours' sleep; ' 
violent retching during the night ; stomach rejects food. 

12 Noon. — Constant hiccough; stomach rejects everything; 
tongue dry and brown ; feels cold, but no well-marked rigour. 
Pulse 110. 

R. Ipec. \ \ 2°^« horis. 

4 p.m. — ^Foecal vomiting to the extent of at least two pints; 
extreme chilliness and prostration ; cold clammy sweat all over 
body. 

R. Ars. 3 gtt. j. 2»<^« horis, and after each attack of 
vomiting. 

8 p.m. — Pulse 136. Feeble; foecal vomiting continues; 
extremities more warm. 

R. Plumb, carb. 1 gr. iij. o. h. s. 

11-30. p.m. — Pulse 130. Almost imperceptible; seems 
much prostrated. Vomiting has been much more frequent j 
excessive jactitation. 

R. Tinct. Bell. gtt. iij., in Enema. 
R. Bell. \ \ tertiis horis. 
Jan. 4th, 9 a.m. — Foecal vomiting less frequent. * 
Jan. 4th, 6 p.m. — Seems getting worse every hour. 
Jan. 4th, 11 p.m. — Pulse 150 ; quite thread-like. 

R. Op. j. gtt. j., 0. h. s. 
Jan. 5th, 6 a.m. — Decidedly better; slept for an hour 
during night. 



94 Com of Ovariotomy, 

Jan. 5th, 11 a.m. — Pulse 144; considerable foecal vomit- 
ing, but less abdominal tenderness. 

Jan. 5th, 5*30 p.m. — Clamp removed by Mr. Ayerst; she 
is now almost pulseless ; eyes within last two hours have sunk 
in lier liead ; constant retching and hiccough ; cold sweats. 
Ordered cliampagne, hot brandy, and beef tea. 
R. Ars. J J 0. h. s. 
Cataplasm to abdomen. Enema. 
Jan. 5 th, 9 p.m. — Seems rapidly sinking ; is scarcely able 
to hiccough ; is unconscious of what is going on around her ; 
extremities cold ; tossing about in bed. 

Jan. 6 th, 9 a.m. — Decided reaction ; her extremities have 
become warmer ; slight glow on cheeks ; tongue less brown and 
hard. Wound dressed, and pedicle ligature removed. Continue 
Arsen. 

Jan. 6th, 10*30 p.m. — Continues to rally; no foecal vomit- 
ing for twenty-four hours. 

Jan. 6th, 12 Midnight. — Pulse 150; very small; extreme 
restlessness ; frequent and distressing hiccough ; slight bilious, 
but not foecal vomiting ; feels ineffectual urgings to stool. 
R. 01. Eecini, ^gs. 
Sp. Terebenth, gtt. x. 5- 
Pro Enemate. 
Jan. 7th, 9 a.m. — Had several (five or six) evacuations of 
hard scybala ; skin warm and perspiring ; has some swelling 
of parotid glands ; she fancies she caught cold from the door 
being left open. 

R. Ars. \ \ 4*^ horis. 

Jan. 8 th, 9 a.m. — ^Pulse 112 ; glandular swelling has in- 
creased so much that she cannot open her mouth ; otherwise 
continues to improve. 

Jan. 8th, 9*30 p.m. — ^A profuse discharge of brownish- 
coloured fluid has suddenly taken place from the lower part of 
the wound ; about a pint came away at one gush ; she had 



Case of Ovariotomy. 95 

no pain with it, or warning of its approach ; it had a slightly 
foecal odour. 

Be. Aeon. L s. 8. (2 doses). 

Jan. 9th, 9 a.m. — Pulse 146 ; half a pint of brownish 
foecal-looking matter escaped from the wound during the night ; 
she has had no sleep ; abdomen much decreased in size ; face, 
gums, and mouth, painfal and swollen. 

Jan. 9th, 9 p.m. — ^Pulse 128 ; bowels opened tolerably 
freely about mid-day ; loose watery stool ; a great deal of brown 
fluid came from wound; the wound gapes at lower part; 
mouth very sore and troublesome; has great difficulty in 
swallowing. 

R. Aeon. I I 2""^ horis (3 doses). 

Jan. 10th, 9 a.m. — Pulse 116, full; bowels slightly moved; 
intestinal discharge from wound ; has had no sleep ; mouth 
very troublesome; the needles and ligatures were removed, 
and the edges of the wound brought together with adhesive 
plaster ; takes a good deal of nourishment. 

Jan. 16th. — From last report to this date the symptoms con- 
tinue much the same, but indicate gradual improvement ; dis- 
charge from wound decreases ; bowels act naturally ; appetite 
improves, and diet consists of good nourishing food, such as 
chops, beef tea, stout, wine, &c. The glandular swellings, how- 
ever, increase, and go on to suppuration. An abscess pointing 
behind left ear was opened by Dr. Ayerst. Has profuse dis- 
chai^ from ears. 

Jan. 20th. — ^Vespere ; trifling discharge from wound all day ; 
pudendum inflamed, from excoriating nature of the discharge; 
bowels acted three times ; no pain in abdomen. 

Diet consists of beef tea, chicken broth, arrowroot, and port 
wina 

Jan. 22nd. — Has had troublesome cough last night, and feels 
low and weak. 

Be. Hep. SuL 1 ^ 4*^ horis. 

Jan, 23rd. — Slept tolerably well ; two natural motions \ but 



96 Case of Ovariotomy. 

little discharge from wound ; it heals rapidly at upper part ; 
complains of plilegm in chest ; tongue much cleaner, but dry, 
and slightly aphthous ; glandular swellings much diminished ; 
immense discharge from both ears. 

Continue Hep. Sul. 

Feb. 4th. — From 23rd of January to this date she gradually 
improves, when the report is as follows : — Bowels acted largely 
last night ; discharge from the wound for the last three or 
four days has been much less ; skin soft and cool ; tongue 
still slightly aphthous; wound, healed up to one inch; a 
conical piece of cork, covered with lint, soaked in calendula 
. lotion, was applied to the wound. 

Continue Hep. Sul. 
Vespere Aeon. (1 dose). 

Feb. 7th. — ^Pulse 115; looks much better, and feels so; 
discharge from left ear quite ceased, and from right nearly so ; 
bowels acted once ; plug removed to be cleaned and re-applied. 
Since its application the stools have been doubled in quantity, 
and much more natural in appearance. She enjoys much com- 
fort from the plug. Yesterday, sat up from 12 to 4 o'clock. 

Feb. 13th. — Had a good night's rest; no discharge from 
the wound of any kind; cough easier; tongue clear, and 
quite free from aphthae ; appetite good ; sits up daily. 

From this date she went on steadily improving, and was dis- 
charged on the 27th, cured. 

N.B. — Additional information in regard to this interesting 
subject will be found in a paper by Mr. Leadam, published in 
"the second volume of the " Annals." 



^nitals af i^t ^atxtiri. 



THE POSITIVE SERVICES OF THE SCHOOL OF 
HAHNEMANN, EXEMPLIFIED IN THE TREATMENT 
OF ACUTE INFLAMMATORY DISEASE. 

By JOHN OZANNE, M.D., Guernsey. 

Gentlemen, — In the summer of 1860, a remarkable scene 
occurred at one of the sittings of the Imperial Academy of 
Medicine, at Paris. 

In the course of a speech, M. Malgaigne used these words : — 
" Alas for the Medicine of the present day ! It forgets to 
study disease, and looks to pathological anatomy alone for its 
indications ! Without being aware of it, its therapeutics are 
nothing more than a jumble of contradictions, the produce of 
the theories of all ages. Hence it has come at last to such a 
point, as to number, in one of our hospitals, fewer successes 
than Homoeopathy has achieved." 

Here M. Barth exclaimed, with energy, " That is a falsehood!" 

Numerous and tumultuous protestations to the same effect 
proceeded from other members. 

M. Malgaigne replied, " I hope you are right ; but still my 
statement may be true." 

This Society needs scarcely to be reminded, that the homceo- 
pathic practice here alluded to, was that of one of its corre- 
sponding members, the late Dr. Tessier. 

The state of feeling depicted by the above scene, in an 
assembly numbering among its members the principal hospital 
physicians of Paris, had not arisen without an adequate cause. 
VOL. in. 7 



98 Dr. Oztnnir on the Positive Services 

III tlie yo«ir 1850, Dr. Tessier, a man well and honourably 
known in tlic medical profession; in his earlier days, the 
favouriie pupil and friend of Dupiiytren ; and, subsequently, 
pliy.->ici;in to the hospitals of Paris; published, in a book on 
rii(if//tnni(( and Cholera, the results of his experience of homoe- 
(•pathii! treatment in those diseases, at the Ste, Marguerite 
Hospital. 

These results were of the most satisfactory character, and 
were entirely i)roduced by infinitesimals in the form of globules. 
The worst part of the matter, however, was that they could not 
be denied. Neither could the diagnosis of the disease be called 
in question ; the cases having been drawn up by internes 
whose anti-homceopathic tendencies rendered their testimony 
uninipeacliable in the eyes of the Academicians. 

Although Dr. Tessier's results were far superior in pneu- 
monia to those obtained by a rigid adherence to the favourite 
antiphlogistic treatment of the day, it would not do to admit the 
superiority of Homoeopathy. The new system was too much 
disliked to allow of such an acknowledgment. It was far 
better to throw the w^hole blame on the prevailing method of 
treatment. Therefore M. VaUeix, also one of the physicians 
to the Ste, Marg^ierite Hospital, declared his conviction that 
pneumonia was a disease of much less gravity than was usually 
supposed, and would get well, in general, of itself, if the efforts 
of Nature were not interfered with. Others followed him, and the 
opinion gained ground, that the usual antiphlogistic treatment 
was probably more hurtful than beneficial. 

The same thing occurred at Vienna, but in a higher de- 
gree. The results of Dr. Fleischmann's practice at the Gum- 
pendorf Hospital, by unsettling the usual notions in reference 
to the treatment of inflammation, led many to the extremes of 
scepticism. Among the leaders of the latter school at Vienna, 
I may especially mention Professor Skoda, of the General Hos- 
pital, and Dr. Dietl, of the Wieden (since then removed to 
Crac.ow). 



f>f the School of Hahnemann. 99 

Skill, in Pcuis, medical scepticism has not, I believe, roachi'd 
such a height as either in Germany or in this country. Owiiij^ 
to the number of rival professors, claiming each to l^e the leader 
of a school of his own, and impi*cssin<4 his views on studfjiita 
both as a lecturer and as an examiner, H(»ina>opaihy has (to my 
mind at least) hardly influenced the general tone of mind to 
the extent we might suppose, if w^e judged from the numl>er of 
its professed adherents. The consequence of this state of things 
is, that while, in every-day life, all unite against HouKuopathy; 
in the scientific world, she takes her jJace as one of the rival 
doctrines, attracts less notice, and does not produce the same 
extent of avowed scepticism among her antagonists. Hence, 
her great faith in the one leading principle — similia mnilibiis — 
and in the power of infinitesimals administered in accordance 
with that principle, does not aw^aken in the same degree that 
spirit which can alone arrest her progress — ^the spirit of 
scepticism. 

In Edinburgh, medical scepticism in the ranks of the 
dominant school reigns triumphant, as we shall see presently, 
when we notice a series of cases brought forward by one of the 
professors in the University of that city. In my opinion, the 
great impetus given to Homoeopathy in Edinburgh, more than 
twenty years ago, by Drs. Francis Black and Eutherfurd Russell, 
and subsequently by the conversion of Professor Henderson, 
fully accoimts for the fact. 

In London, the labours of our colleagues and the establish- 
ment and continued existence of our Hospital has produced a 
similar influence on the minds of the most advanced in the 
dominant part of the profession. 

It is painful to think how men of learning, endowed "svith 
every qualification requisite to form a correct estimate of the 
value of the Homoeopathic principle, are prevented from enter- 
ing upon a systematic inquiry into its claims by the ignorance 
and consequent prejudice of the profession at large. An 
inquiry of the kind, undei'taken by some of the leading men in 

* .T».. w 



Km I)i\ Ozanih' on the Posliire Sn-'viccs 

til.' (loiuinaiit. siliool, and systcinatioally earned out, during a 
short iM-riod (»!' years, ^vnuld,^ve cannot doubt, lead to a final settle- 
ment (»r the (p'.cstion al issue Lelwoen the two schools. Tlieiso- 
li.tctl iHorls of individuals are comparatively of little avail in 
coiiv.rt iuL^ opjMMicnts, Ijowover beneficial they may be in confirm- 
iim Ixliivcrs. 1 have felt this most keenly for several years 
]);ist, in tho course of my statistical investigations. As an indi- 
vi(hial in<iuircr,T cannot get access to documents in the possession 
(.r ]>ul)iic hospitals, which a commission invested with authority 
by the dominant school could easily procure ; nor, had I all the 
most conchisivti facts in my x>ossossion, could I obtain thehear- 
ini;- which would be readily awarded to public commissioners. 

r>ut since we cannot command on the part of our antagonists 
the atlonlion which our system deserv^es, we must needs be 
content to plod on, working with what materials may fall 
witliin our reach, and addressing ourselves to those who are 
suiiieiently devoid of prejudice to give us an impartial hearing. 
I'lie vital question of the day as regards the Hahneman- 
nian doctrines and as propounded by our adversaries — ^by the 
Forl^eses, the Balfours, the Bennetts, the Simpsons, the 
Gairdners — is this : — Are the cures observed in patients under 
homceopathic rule to be ascribed to nature or to art ? or, in 
other words, are the successes obtained by that mode of practice 
2WHitive, or negative ? While we assert their positive character, 
our adversaries declare them to be negative, or simply due to 
the absence of injudicious and injurious treatment. 

I might appeal, if I wished to evade the principal difi&culty, 
to the broad fact that Homoeopathy exists as a distinct, a well- 
established, and a progressive school, represented by a numerous 
and an increasing body of medical men. But such an argu- 
ment would not satisfy the doubts of a thoughtful and tho- 
roughly candid inquirer. The progress of our school through- 
out the civilized nations of the world, and the numerical 
strength of its members, would assuredly be an argument in 
its favour to a considerable extent ; but as the dominant party 
still grftuily 5jwpass us in numbers, it is an argument they are 



of the School of ILihanannn. 



10] 



everyday using agiiinst us, ami wliicli, innsojiucntly, wnuM ]«■ 
of little power in our hands. The stivn^^tli of tlieir i»o>itiuii 
consists also in their holding most of tlio public in.-jtilutioiis 
which give influence and authority io the nuulital profrssifni, 
and not in their scientific right to lji»M them. X«*\vrtlji-h-ss, 
as they have tlux)ughout made use of th«*.s<' advantai^'fs, wiih thr 
determiaation to crush us if possibU*, and as th<»v Iiavo not suc- 
ceeded, it will afford some presumptive evitleiici; of the vitality 
of the truths which Homa^opathy cmhi-sici-s to take a glainc at 
the statistics of our adherents in different parts of tlie world. 

A. — ^The present position and devilojMnont of the; houMo- 
pathic school 

According to Catellan*s " Annuaire irom<uoi)athi(iue ** for thr 
present year, the accuracy and trustworthiness of wliich we havi* 
every reason touphold,^^ the number of medical men i)nutisin[^ 
Homoeopathy in various parts of the world amounts : — 



In North America 




to 


1G55 (No information sinci* 


„ the West Indies 




» 


32 the war.) 


„ South America 




>» 


131 


„ the British Isles 




i> 


283 


„ Belgiiun 




>> 


40 


„ Spain 




» 


192 


„ Italy 




» 


lOG 


„ the Netherlands 




»> 


14 


„ Portugal 




» 


57 


„ Eussia 




» 


vr> 


„ Switzerland 




»> 


37 


„ Parts of Asia 




yy 


4^ 


From these various 


„ Denmark, Norw^ay, 


Sweden 


>» 


14 


]>ai*ts no precise in- 


„ Moldo-VaUachia, Turkey 


a 


5 


-forniati(m could he 


„ Poland 




» 


21 


obtained by ^lessrs. 


„ Various other places 


» 


9. 


Catelhm, freres. 


„ France 




» 


441 


„ Grermany 




yy 


554 




Total 




3761 





• There are, of course, here as in all works of the kind, a small 
number of errors; but this does not affect its general testimony. 



102 Dr. Ozanne on the Positive Services 

Xoto. — In those tables the United Kingdom figures for an 
incivaso of 78 practitioners over the preceding list published 
in 18G0. 

As th<* total in 18G0 was 3G15, these tables show an increase 
of 14G. 

In viewing these tables, and allowing for errors, for changes of 
residence, for the continued insertion of the names of persons de- 
ceased, we cannot help being struck by the largenumber of medical 
men who have adopted and put into practice the system of Hahne- 
mann. Indeed, the fact that the new school carries it out uniformly, 
in different parts of the world, among peoples distant from each 
other, speaking different languages, pix)fessing different religions, 
and often hostile to, or in actual warfare with one another ; that 
it increases notwithstanding its opposition to all previously es- 
tablished notions ; and that it could not exist as a body of prac- 
titioners, if millions of people did not adhere to it, even when 
in peril of their lives, speaks most strongly in favour of the 
benefits conferred by its instrumentality. 

In the face of evidence of that kind, how paltry is the 
opposition, how miserable the pettifogging of our statistical 
adversaries ! Need we, with such facts, be liable to the impu- 
tation that we are attempting to build up the homoeopathic 
edifice upon a fictitious foundation ! Nevertheless, let us glance 
briefly at the scientific aspect of the question. 

B. — The statistical evidence supporting the positive ser- 
vices of the homoeopathic school, in the treatment of acute 

diseases. 

Long ago we heard it stated by Balfour, Forbes, Routh, Ben- 
nett, Simpson, Gairdner, and others, that whatever favourable 
results were observed under homoeopathic treatment, were due, 
not to any virtue our medication possessed, — for it was asserted 
to be positively wortliless, but to the fact that pneumonia, left 
to itself, nearly always got weU. This has been dinned over 



of the School of Hahyuinann, 103 

and over again into our ears. First we heard of Dietl, who, at 
the Wieden Hospital, lost only 7i per cent, of his cases ; and 
then of Bennett, whose success was something most startling, 
having been obtained at the Edinburgh Royal Infimiary, where 
anything like error or deceit was impossible ; even setting aside 
the oft told tale, that regular practitioners could never have 
any wish to deceive ! More recently stiU, we heard of a paper 
read before a Medical Society at Edinburgh, containing a large 
series of cases, treated by a method all but dietetic, and yet 
presenting results of the most admirable description. These re- 
sults having since then been published in Dr. Bennett's Lectures 
on Inflammation, in the Lancet (May 30, 1863), we are ena- 
bled to ascertain their precise character, and the nature of 
the remedial measures applied. Dr. Bennett's statements 
are so startling, that I cannot forbear transcribing them 
here. 

"My practice is directed to support the strength of the 
economy, never to weaken it in any stage by antiphlogistics ; 
although, if dyspnoea be urgent, cupping or a small bleeding 
may be practised as a palliative, more especially in bronchial 
or cardiac complication. During the febrile excitement, mild 
salines are administered. On the fourth and fifth day, when 
the fever abates, good beef-tea and nutrients are given ; and on 
the pulse becoming soft or weak, from four to eight ounces of 
wine daily. As the period of crisis approaches, slight diuretics 
are given to favour the excretory process. 

"The results of this practice in 105 cases of pneumonia in 
adults consecutively treated by me in the clinical wards of 
the Eoyal Infirmary, during the last fourteen years, are as 
follow : — 

"KTumber of cases, 105. Deaths, 3 ; aU complicated cases — 
one of intestinal ulceration, one of Bright*s disease, and one (a 
drunkard) with delirium tremens and cerebral meningitis. Eatio 
of deaths, 1 in 35 cases. Average age of cases, 3I3 years. 



11)4 Di\ Ozannc on the Positive Services 

Sini^le iincomplioated cases 58; duration averaged ISj days 

J)uul>k'iiiicuinplicatod cases 19; „ „ 20 „ 

('niiij)li(ated cases 17; „ „ ISs „ 

Uiisali>iactoiy cases as to 1 ^ 

ilurtitioii j 

Ociitlis 3 



105 

Sul)j5cciucnt cases, all re- \ 
(.'overed, mentioned in > 10 
a note (loc. cit. p. 600) ) 

Total 115 cases, with only 3 deaths. 

'* Average residence in hospital of 77 uncomplicated cases of 
pneumonia (single and double), was 22^ days. (This is too 
higli: some linger from weakness, from subsequent attacks of 
rheumatism, or skin disease. One remained in a fortnight after 
recovery from having no shoes, &c.) " 

"It has been supposed that in consequence of this compara- 
tively small number of cases, ranging over so long a period as 
fourteen years, the disease is rare in Edinburgh ; but it should 
be explained that the clinical professors are on duty alter- 
nately ; and as regards myself, I have never acted as physician 
to the Infirmary more than one-half the year, and in most 
cases only one-third of the year. Again it has been supposed, 
from the small mortality, that the cases there are unusually 
slight and trivial, or that the disease is not extensive. But it is 
not so. In Edinburgh now, as formerly, many, and especially 
the double cases of pneumonia, have been very severe, with great 
dyspncea and very urgent sjonptoms. I have also frequently 
X)ointed out instances of the pulse being hard and strong in 
vigorous young men, in whom, however, most rapid recoveries 
were invariably observed. It should also be noted that these 
cases were in no way selected, but do not include a few which 
were admitted in extreynis at night, and never seen by the phy- 



of the ScJiool of HahnematifK 1 05 

sician, nor such as were partly treated by other physicians in 
the hospital, and for which treatment I am not responsible." 

I do not wish to cast the least doubt upon the authenticity 
of these cases, nor upon the correctness of the diagnosis. At 
the same time I feel it is not out of place, in the face of the ex- 
traordinary success of Dr. Bennett's dietetic treatment, to point 
out some circumstances which throw a shadow over the picture, 
and which require that we should reserve our conclusions until 
we get full explanations regarding all that has taken place at 
the Eoyal Infirmary. 

1st. A few cases admitted in extremis at night, and never 
seen by the physician, are not included. 

This admission is full of significance. The expression " a few 
cases," when a total of over 115 is under consideration, must 
mean, one would think, 5 or 6, or perhaps 7, or even more. But Dr. 
Bennett would say — It matters not how many, since they never 
came under my observation. Granted, but they must have been 
seen by his clinical clerk, or some other of his assistants, who, faithful 
to the creed of the Professor, would not put the patient under 
the old-fashioned antiphlogistic measures, but would give "good 
beef-tea and nutrients," or perhaps " from four to eight ounces 
of wine ;" in other words, the Professor's own treatment would 
be brought to bear on the moribund. Such cases ought not to 
be excluded ; at any rate, their number ought to be stated, and 
they might thus be made to constitute a separate category. 

This argument acquires additional force, if we take into con- 
sideration the tables of Dr. Fleischmann's Homoeopathic Hos- 
pital, so often quoted in controversial statistics. I quote the fol- 
lowing from the reports for the year 1850 and 1851, printed 
for circidation in Vienna : — 

In 1850 there were 1084 admissions, consisting of cases of 
all kinds ; and besides these, 4 patients brought in dying. 

In 1851 there were 1041 admissions ; and besides these, 
3 patients brought in dying. 



100 hr. (fzannc on the Positive Services 

III bnth yoars, — cases of all kinds, 2125 ; brought in dying, 
7;— totiil, L>i:J2. 

'J'Ih:; putioiila in extronis thus constituted at Dr. Fleischmann's 
l-:3U4tli of the whole numlxjr of cases ; whereas, with Dr. Ben- 
nett, if we put down his morihiuid at 5, which is the least we 
can d's frum his statement, they would constitute l-23rdof the 
whole number. 

fu the Ilomreopathic Hospital, 1 moribund to 304 cases of 
all kinds; at the Eoyal Infirmary, 1 moribund to 23 cases! 
Can these statements of Dr. Bennett's go forth unchallenged ? 

2nd. The cases partly treated by other physicians before Dr. 
Bennett ought to be cited with the results. No one can resist 
the feeling, on reading the whole of the paper, that Dr. Bennett's 
cases gave l)y far the best results ; if so, how could his colleagues 
be so blind and negligent of their duties, as not to perceive the 
advantages of the dietetic treatment, and apply it to the patients 
who fell into their hands ? 

3rd. The average age of the patients, 3I3 years, is a very fa- 
vourable one — much more favourable than in Tessier's cases. 

4th. The number of complicated cases, 3 in 115, is very 
small, if we are to believe the allegations of Dr. Eouth in his 
" Fallacies." 

With these remarks or objections we must take Dr. Bennett's 
cases for what they are worth. I have endeavoured to procure 
the statistics of the Eoyal Infirmary since Dr. Bennett's investi- 
gations began, but have been unable to do so ; therefore I can- 
not compare them with similar cases under the other physicians, 
and under treatment not so purely dietetic. 

Statements such as the above completely unsettle our 
notions in reference to the gravity of pneumonia, when not 
injuriously interfered with by medical art. Yet we must ac- 
cept them, with the reservations I have made, until further facts 
are brought forward to contradict them. 

So far they do not afifect our statistics of pneumonia. The 
course of pneumonia at Vienna and at Paris being very different 



of {lie School of Hahnemann, 107 

from what it appears to be at Edinburgh, we must compare 
allopathic or dietetic results in either of those towns with tlie 
homoeopathic in the same place : thus our statistics will in no 
way be affected by the Edinburgh returns. 

But before I proceed to ascertain the mortality of pneumonia at 
Vienna or at Paris, under simple dietetic treatment. I will call 
the attention of the Society to a singular circumstance, which 
brings me back to the quotation at the head of this paper. 

It would seem that the non-gravity of pneumonia had been 
accepted by many physicians in France ; and among the writers 
on that side of the question, we may mention Dr. Barthez and 
Dr. Bourgeois (of Etampes), besides the late Dr. VaUeix. 

This state of feeling was reflected in the Imperial Academy. 
Hence, the subject proposed for one of the prizes to be com- 
peted for in 1862 was: — "Expectancy in the treatment of 
pneumonia." 

It is remarkable that no essay of a sufficiently conclusive 
kind was sent to the Academy, either from Edinburgh or from 
Vienna, or from the pen of Dr. Barthez ! The prize, therefore, 
was not awarded. 

Under the circumstances, we can hardly believe that all the 
supporters of the spontaneous curability of pneumonia, in nearly 
all cases, are really in good earnest. The suspicion that cases 
are classed and weeded of patients in extremis, so as to support 
a favourite doctrine, naturally arises in our minds. 

In different localities there are medical constitutions, which 
cause much variation in the percentages of deaths in individual 
diseases and on entire populations. 

Professor Christison, in his admirable address to the Associa- 
tion for the Promotion of Social Science, at one of its meetings 
recently held at Edinburgh, stated that in Scotland the average 
mortality on the whole population, for the " seven years ending 
with 1861, was 1 in 48; whereas, in Lower Austria, the 
deaths actually reach 1 in 21\r ^Lancet, Oct. 24, 1863. 

Yienna being in Lower Austria, we should, therefore, ex^^eci 



1 US Dr. Ozanhc on the Positive Services 

tu liiid a lii^'lier perctMitage mortality tl:an in Scotland. Per- 
hajjs thi"- may explain to some extent Dr. Bennett's astonishing 
succM'Ss. 15iit, even here, we were tolil from all sides that 
l.iM.'UiJiniiia left to nature was rarely a fatal disease. 

Dr. Di«.tl, in his book intituled " Der Aderlass in der 
Luuc^ouentziindung," published in 1849, declared his mortality 
among i)atients under simple dietetic treatment to be only 7 
and 4 tenths per cent.; whereas it was 20 and 4 tenths in 
those who were bled, and 20 and 7 tenths in those who were 
placed under a course of tartarised antimony. These assertions 
startled us all when they were first made. But subsequent ex- 
perience (under another physician, I beheve) greatly modified 
the aspect of the matter. 

I c]^uote the follo^ving facts from Dr. Arthur Mitchell's report 
in the Ediiiburgh Medical Journal for November, 1857. The 
moitality of the same hospital, in 1854, when " the treatment 
was symptomatic and exceedingly simple," averaged, in pneu- 
monia, "no less than 20 and 7 tenths per cent." So much for 
the boasted spontaneous recoveries in pneumonia ! 

Professor Skoda, of the General Hospital, Vienna, was said 
to have considerably reduced his mortality in pneumonia by 
discontinuing blood-letting and other active measures, and by 
substituting simple dietetic treatment as the rule. Now, what 
are his results ? 

Dr. ]\Iitchell (loc. cit.) says, in a note : — " During the same 
year, 1854, under Skoda's treatment, out of 53 cases, 31 were 
cured, 8 bettered, and 14 died. Of these the disease lay 13 times 
in the left side, giving 10 cures, 2 deaths, and 1 improvement. 
It occurred on the right side 19 times, and of these 14 were 
cured, 4 bettered, and 1 died. In 12 cases both sides 
were affected, and of these the greater part died. '9 cases were 
complicated with extensive pleuritic exudation, and of these 1 
was fully healed, 2 were bettered, and 6 died." 

During a series of 10 years, ivom. 1847 to 1856, there were 
achiiitted into the General Hospital, of which Skoda's wards 



of tlie School of Hahnaiuuni. 1 ()!♦ 

form apart, 5,909 cases of pneumonia; of those 1439 died. 
One death in 4 and 1 tenth cases, or 24 and 4 tenths deaths 
per cent. 

It seems unaccountable that the simplest possible ti-eatment 
an allopath could devise, should be att<3nded l)y a moi-tality of 
20 or 25 per cent, at Vienna, and by one of less than 
3 per cent, at Edmburgh (even if we put down the gener.il 
mortality at 1 in 27 in Lower Austria, and 1 in 48 in 
Scotland). 

But the allopathic mortality of Vienna is not greater than is 
met with at home under the best alloimthic treatment. In the 
years 1852-3, there were admitted into St. George's Hospital, 
London, 91 cases of pneumonia — the deaths amounted to 30. 
Out of this number, 46 cases were entered as complicated — 
22 of which died. To ascertain the mortality of the uncom- 
plicated cases, we must deduct the complicated cases from the 
total of cases, and the deaths among the complicated from 
the total of deaths (as the deaths in the uncomplicated arc not 
given in the tables). We thus obtain the following residues for 
the uncomplicated cases : — Uncomplicated cases 45 ; deaths 8. 
This gives 1 death in 5 and 6 tenths cases, or 17 and 7 tenths 
per cent. 

A mortality of 1 7 per cent among the uncomplicated cases, 
at St. George's, fully accounts for Skoda's mortality at Vienna. 
But how does it tally with Edinburgh ? Is it that 14 or 15 
per cent, are bled or blistered to death at St. George's ? or is it 
that there has been some mistake in the books at the Eoyal 
Infirmary? 

It is impossible to doubt that our Scottish allopathic friends 
are given to blundering, when they deal with medical statistics ; 
especially if they have before them some disagreeable homceo- 
pathic results which it is urgent to explain away. 

In the British and Foreign Medical Revieiv, for October 
1846, p. 590, Dr. Balfour asserted that Skoda's mortality was 
6 and 6-10th8 per cent. ; and in the next page he informed us 



1 1 \) Dr. Ozannc on the Positive Servicer 

thai Skoda coii-sidiTod 1 in 8 as his nsual proportion of 
deaths. L<*t us see what thcso assertions are worth. 

Al»out thive years ago, Dr. Gallavardin, physician of Lyons 
in France, j»ul>lished a pamphlet, intituled "De TEnseignement 
C'liiii^ue en Alleniagne," containing an account of his visit to 
th(^ niediral schools of the Universities of Vienna, Dresden, 
Cracow, c^'C. 

AiiKjiig other questions he ascertained the results of the 
treatment of Skoda and others in pneumonia. He found that — 

1st. — Those who had observed Skoda's cases during the 
winter of 185-4-5, universally declared that he had lost 1 out 
of every 3 cases of inflammation of the lungs — say 3 3 per cent. 

2nd. — A Vienna physician informed him, that at his ex- 
amination for the doctorate, Skoda avowed that he lost 1 out 
of every 5 of his pneumonia patients — say 20 per cent. 

3rd. — On mentioning this to Dr. Walter, the chief physician 
to the General Hospital of Dresden, and a disciple of Skoda, 
tlie Dresden physician shook his head, and said : " If he only 
loses 20 per cent, of his pneumonia cases, it is that he has been 
very fortunate." 

4th. — The students and physicians who attended the clinique 
of Oppolzer, at the Vienna General Hospital, agreed in esti- 
mating his mortality in pneumonia at 1 in 5 — say 20 per cent. 

It is singular that the results of Oppolzer, who carried out a 
moderate treatment, but quite allopathic, should approximate so 
closely with those of Dietl, of Skoda, and of Walter, who belong 
to the so-called physical school, and have no faith in the ordi- 
nary remedial measures of the allopathic schooL 

These results are of the highest importance, as they clear the 
way for our homoeopathic statistics, so far as Austria is con- 
cerned, and enable the statistician to estimate the positive and 
undeniable curative influence exerted by homoeopathic remedies 
upon acute diseases. 

Let us now inquire into the allopathic mortality in pneu- 
monia at Paris. 



of the School of Hahnemann, 111 

I am sorry to say I cannot procure any statistics of the 
results of simple dietetic treatment. Nor can I give any ex- 
tensive allopathic statistics since those of GrisoUe. They are 
not to be found. It would seem as if our allopathic bretliren 
dread to publish the full statistics of their hospitals. But the 
following admissions, taken from the "Gazette des Hopitaux" 
of Paris, for the 7th Feb., 1863, and from the "Bulletin de la 
Soci^t^ des HSpitaux," and reprinted in the "Art M(5dical," 
April, 1863, are most valuable : — 

" Pneumonia has been frequent and severe ; the cases have 
amounted to 140. of which 61 died — more than one-third. In 
children the mortality was one-half, and in aged persons two- 
thirds." 

Granting that this mortality of 43 per cent, was quite ex- 
ceptional, which must have been the case, enough is left, if we 
deduct the extra-gravity of the cases, to show that pneumonia 
is at Paris, as well as at Vienna, a very serious disease, and one 
frequently terminating fataUy. 

Whatever the " Physical School" in Germany, and the die- 
tetic doctors in the United Kingdom, may say, as an argument 
against ns, the results of homoeopathic treatment, when con- 
trasted with the above, are such as to fill the bosom of every 
honest disciple of Hahnemann with justifiable pride and satis- 
faction. 

The earliest homoeopathic researches of the late Dr. Tessier, 
when he was as yet very inexperienced in the new kind of 
practice, may be safely compared with those of Dr. Bennett. 
Tessier's published cases in his work were 41 in number, with 
3 deaths. 

We have here no mysterious number of patients in extremis^ 
no cases attended by other physicians in the hospital ; all are 
mentioned, and their phenomena recorded in full. And yet 
here we might with more reason plead the mischief of previous 
treatment than Dr. Bennett can do ; for some of Tessier's cases 
had been bled before their admission — a proceeding now recog- 



112 Dr. Ozanne on the Positive Services 

iiisod as injurious. Again, what were the 3 cases terminating 
in (loatli ? 

The first was tliat of a man, 43 years of age, who, after the 
liuvcjlution of February, 1848, had been exposed to difficulties of 
evciT kind, often suffering from want of food, and whose con- 
stitution was broken down when he was seized with pneumonia. 
He was taken to the Hospital on the 6th day of the disease, 
and first seen by Tessier on the morning of the 7th. His case 
was one of double pneumonia, with grey hepatisation of the whole 
of the riglit lung, and purulent effusion in the cavity of the pleura. 

The second was that of a night-man, 60 years of age, who 
had been ill a week when he was brought to the Hospital If 
Dr. Bennett's dietetic treatment had been of any service, this 
man ought to have recovered, for he kept quietly in bed at 
home, abstained from food, and took gum water, until he be- 
came so bad, that he had to be carried to the Hospital 

The tliird case was that of a woman, aged 58, addicted to 
drunkenness, who was brought into the Hospital with delirium, 
and unable to give any account of herself. She had purulent 
infiltration in the upper lobe of the right lung, red hepatisation 
of the middle, and congestion of the lower. 

At Vienna, Dr. Fleischmann admitted in the space of 20 
years, from January, 1835, to January, 1855, no less than 1058 
pneumonia cases into the Gumpendorf Hospital At the latter 
date there remained 6 still under treatment ; we thus have 1052 
cases, with 48 deaths, — or 1 death in nearly 22 cases, or 
4' 5 6 per cent. 

Dr. Wurmb's mortality at the Imperial Homoeopathic Hos- 
pital, Leopoldstadt, Vienna, was for a long series of cases under 
46 per cent. 

These results, contrasted with those we have adduced as the 
true dietetic or allopathic results at Vienna, prove beyond a 
doubt, not only the positive curative power of homoeopathic re- 
medies, but also their immense superiority over all other known 
means of medical treatment. 



of the School of Ifahn^nwvn. 1 1 M 

I think I have proved by undcniahle evidence: — 1st, Tli;it 
under any mode of treatment, pneumonia is always a disease of 
considerable gravity. 2nd, That the superiority of the honuio- 
pathic results over those of any otlier kind of trcatment, not 
excepting the dietetic, is so great, tliat no doubt can (ixist of tlie 
positive curative influence jjossessed by homfoopatliic remedies, 
in the course and termination of the most serious acute diseases. 
3rd, That this positive and beneficial inlluence becomes most 
conspicuous, when all the facts brought in by adverse statis- 
ticians, to confuse the question, are reduced to their proper 
level. 

As a final result of tliis inquir}'- we find that it is not witli- 
out reason, that so large a body of medical men throughout the 
world have adopted Hahnemann's mode of practice, and tliat so 
large a portion of the human race acknowledges its benefits. 

DISCUSSION. 

Mr. Yeldham said, — The great power of Homceopathy in con- 
trolling acute diseases, and its superiority over the allopathic 
plan of treatment, were facts so well established amongst Iloma^)- 
paths, as to require no demon stratioiL Whilst, therefore, Dr. 
Eussell was readiug Dr. Ozanne's paper, he had j(jtted down 
what appeared to him some of the most evident reasons by 
which that superiority might be accounted for. In the first 
place, the seizure of an acute disease was commonly sudden 
and violent, and fell upon persons i)reviously in ordinary 
healthy. The reactiiDn against the morbific impression was 
proportionately violent, and frequently resulted in an attack 
of inflammation of some particular organ — the lungs, the liver, 
the bowels, the throat, &c. This inliammation tended to the 
rapid destruction of the organ ; and if the part attacked was a 
vital part, to the destruction of life also. Now, the ordinary- 
plan of treating these attacks, until a recent date, was almost 
universally by bleeding and other depressing agents. The result 
was exhaustion of the vital power and death : the homoeo- 
pathic plan of treatment, on the contrary, acting in conformity 
with nature's efforts — ^Kke helping like — sustained the i)owers of 
the system, and conducted the inflammation to a healthy issue. 
Another reason might be found in the fact, that the symptoms 
of an acute disease, as well as those of the remedy, were clearly 
and distinctly marked. The relationship between the two was 



1 14 Dr. Ozannc on ihr Po.'iitive Seyn'iers 

<lisiiii( 1, uimI thuru was l»ut little dilliculty in selecting the right 
iviiMtly. Turn now to chronic diseases: — ^Although we might 
\v\'' liistitiit«' advantagi'ously a con)i)arison with the old system 
:is to tla* r«'<uhs of our treatment, the superiority was less 
iii;irk«(l tlian in acute disordei^s ; and lor these reasons, chronic 
«!!•<. 'iis".s wci'<* coTiniKjnly insidious in their accession, and slower 
in tln-ir ]>roLn*»'Ss — so insidious and slow, that the ^mtient often 
did nut iilt«*n«l to them until they had established a firm hold on 
tlif system. Tliou^di ai)j)arently localized in their seat, they 
wcio nlutn hlood diseases — obscure in their origin and nature, 
('nnij)h"cated and indistinct in their symptoms. Under such 
cir(Ministanc(»s, it was manifestly very difficult to apply the 
hninn'ujMiihic law with certainty; and, indeed, in many cases we 
h;nl jit ])rcscnt no renuMlies bearing distinct and unmistakeable 
rclntionshij) to tlie disease. But where the relationship was clear 
and well marked, — as, for example, between chronic stomach 
allections and such a medicine as Nux Vomica, — ^then the result of 
our treatment was all that could be desired. Out of the sphere 
of medicine, moreover, we, as Homceopaths, w^ere compelled to 
resort to tlie same class of auxiliary means as our Allopathic 
brethren, — care in diet, change of air^ change of scene, bathing, 
and tlie like. Although we often cured chronic disorders which 
balllcd the old school, yet, for the foregoing amongst other 
reasons, our superiority was less striking than in the treatment 
of acute disorders. 

Dr. Hughes said, — I fully agree with the author of this 
(nooning's paper as to the inestimable service rendered by the 
sclinol of Hahnemann to the treatment of acute inflammatory 
diseases. The specifics with wdiich Homoeopathy has taught me 
to combat these disorders are to me a source of daily delight 
and thankfulness. I do not, however, rate very highly the value 
of statistics as demonstrative of the success of our treatment in 
this direction. For statistics to prove anything, the phenomena 
whose sequence they classify must be uniform and unvarying ; 
and in comparisons made by statistics, every particular must be 
taken into account, and must be identical on each side. How 
impossible this is in such a subject as the treatment of disease, 
it is easy to conceive. I think it very desirable that, so far as 
statistics go, they should be shown to be favourable to our cause ; 
and therefore, Dr. Ozanne merits our sincere thanks for his past 
and present labours in this field. But I believe that a few well- 
fletailed cases of acute disease, homoeopathically treated (as, for 
instance, those in Mr. Yeldham's book), will do more to enlighten 
the ignorant and convince the gainsaying as to the merits of our 
system than all the statistics in the world. In one particular, 
hr)wever, I fear that zeal for our cause, or imperfect intbrmation, 



itf the SchiMtl nj lln}' iV)ivni ,k . \ \ Ji 

has led Dr. Ozanue to inisunderst.-iinl tin* iM-.niiii; ..f tli.. -t.i!i.:ics 
he lias collected. I ivfor to tlmsr (•!' l>r. MiiL-lifS lliim.-!!. nf 
Edinburgh. Dr. Ozaiiiit' citi*s tin* ims.s nf tliis l":i?1'-i:imii ;is 
instances of expectant or do-noiliin;,' tiiatnu'iit, .ind uliil*- Wini- 
dering at their low rate (►!' iiiortality Z in In."- . suo._.,..t^ t}i;i? 
pneiiiiionia miust he a l<*ss sfiious diM.'ji>«' in KdiiiliU]L:li than in 
Vienna, since Dietl's mortality under ivxinTiant triaiiii«nt was 
ahout 9 per cent. lUit Dr. IJmnctt ]nits Inrtli liis (.(-••> ;•- illus- 
trating, not an exjK'Ctimt, l»ut a .s///7'0/'////'/ ti'-atnun; mT arm.- 
disease. As soon as tlie jnilsj* "^nows ><»rt, wi- ;ri\'- nuiiiiiii-. 
freely, and a moderate allowance of wiiu-. lli- nini-Miv. r cum- 
mences his treatment hy the adniinistratinii nf ^mall tluscs nf 
Tartar Emetic, which we know to 1)«* a true ln'iiKiujiati:!-; 
specific in pulmonary inilaniniati(»n. Dr. ru'mnti', siati-iii-*, 
therefore, give no sujjjjoi-t to t'Xjiectancy ; Init tiny >li«»\v 
the value of a treatment, tlie o|)])osite of Inwrrinu' in a-iit*'! 
disease, especially when conjoined with the admini-tiatinn nf a 
specific homoiopathic to the niorhiil couditinii. In Die-l^ cases 
no drugs were given; hut the i)atient.s were ki-pt uj»oii low tliet. 
A similar i)lan as to suppoil seems to have he«'ii carried out l»y 
neischmann, whose mortality was ahout o jjcrcent. I cann<it, 
moreover, agree with Dr. Ozanne in the eoM and averted ^rjmKMi 
he gives to the expectant school of nK-ilieiue. 1 helieve it is the 
true stepping-stone to Homoiopathy. The ]»]iysician he^^ins hy 
combating with the most heroic moans the disnnlejs of his 
patients, until he finds that the patients themselves too often 
perish in the midst of the conflict. Th(i conii lenci* of inex- 
perience is broken down by failure, and th«,' lesson of humility 
is taught. He acts less, and watches more; he iinds that Nature 
will go on working according to her own hiws, if only he will 
leave her alone, llius he becomes "ex])eetant" in his treat- 
ment, and watches to learn the various modes ol" working of the. 
vis rrvedicatt^: naiurcc. But if he he a true man, he will ikjI 
pause here. Man was not made to watch and to oIkjv blind nature, 
" vi7icit pareundo," indeed, but vinri/. It is so in every otlier art 
based npon science; it must be so in medicine; then Iloma^o- 
pathy comes to him, and holds out a law of healing, obtain(*d from 
a careful observation of the relation of drug-action to disease. 
Acting upon this law, drugs become to him the instruments 
whereby in this, as in every other art, man asserts his mastery 
over nature. This is the history of the progi-ess of many a 
mind; it is the road by which I myself travelled to my present 
sure standing-ground in Homoeopathy. 

Dr. Russell said that he could not"^ refrain from expressing the 
satisfaction which we all felt at once again addressing the Presi- 
dent in the chair. He (the President) had said that it was now 

8* 



1 lit Dr. Uztfn/u un the Positice Services 

aliiKxi twrnty yoars sinro lie had first presided. For his (Dr. 
Ii*ussrir> part hi* saw no reason why he (the President) should 
iii.t .M'.ujiy his |»n'si*nt ]»ost for t lie next twenty years. In regard 
to ihf ]»MjH.T just read, he agreeil with much tliat had fallen from 
1 )r. 1 1 ii-hfs, who indeed had anticipated what he (Dr. Eussell) had 
iiitriidfil to have saiil, and made it unnecessar}' for him to tres- 
]»ass n]»on the time of the Society. He would make but one 
observation, and it was this, if we accept the conclusion of the 
new seimol, as represented hy Dr. llennett, then we must come to 
the painful conclusion that as Humoeox>athy has done no positive 
gnod, the smaller mortality its results display in acute diseases is 
entirely owing to the positive harm of allopathic practice — ^that 
allopathy is a great deal worse than nothing. But if this be so, 
tlH;n the various systems that go under that name, and which 
followed each other in such rapid succession, each new one sub- 
verting its predecessor, can have no claim to our allegiance on the 
ground of authority from age. The practice of medicine as 
]nn'sued hy the expectant school may be good or bad, but it cannot 
claim any authority from its greater antiquity to its self-assumed 
title (»f legitimate medicine. It is as much a usurper of the 
sceptre of Galen as Homoeopathy, or even more so. Homoeopathy 
is, in fact, a much older and more tried system than the allopathy 
of to-day, which dates from some ten years back. In proof of 
this position, he (Dr. Piussell) would refer to the modem opinions 
in regard to bleeding in apoplexy. If for any one particular mode 
of treatment there was an unbroken accumulation of medical 
testimony from the time of Galen to that of Abercromby, it was 
that blood-letting was to be resorted to in cases of congestion of 
the brain and sanguineous apoplexy. Yet what does a very able 
and eminent practitioner of the present day — one of the orna- 
meaits of the many ornaments of our profession — ^Dr. Radclifife 
— say upon this subject ? He (Dr. Eussell) begged to read a 
short passage from Dr. Kadcliffe's work on Congestion of the 
l>rain and Ai)Oi)lexy as one out of numerous illustrations he might 
have scilected : — " Nay, it may even be a question whether blood- 
letting hi\s any advantages at all. No doubt there is enough of 
authority in favour of the lancet, but is there enough of reason? Is 
tlui theory sound ? Is the practice sufficiently encouraging ? These 
are questions Avhich will be answered differently by different per- 
sons, and while many will answer unhesitatingly in the affirmative, 
others will have doubts which will be expressed in acts if not in 
words. If asked, indeed, they may perhaps deny the existence 
of their doubts, or speak as if they had none; but in actual 
practice, the lancet will scarcely be taken out of its case. A great 
change indexed has already taken place, and what the end will be 
it is diflicult to say. In the meantime it would seem to be better 



of the School of Hoh n tm ann. 117 

to err on tlie side of doing too little than on that of dniujr tm* 
much; and on this account, for njy own ]»art, I liave alwav.s 
dispensed with the lancet, or any mode of liluod-luttin;,', in casi-s 
of congestion of the bmin or apoplexy. I liave done this without 
what may seem to be good i-eason ; indeed, I should find it 
difficult to cite any reason, unless such may he found in the 
change which has come over the habits of sncii-ty and the doc- 
trines of the scliools. The habits of society are far more t»'ni- 
perate than they were foiinerly, and the ])eojil--*, in consri^U'iic**, 
would seem to have become less idethoric and less ti>lrrant of 
blood-letting. At any rate, plethora is not a comnn^n cliaracter- 
istic of patients now-a-days. The doctrines of the schools are 
also changed or changing in one most important point. Fornnrly, 
every disease was refeiTcd to inflammation, and the pathoh»^nst 
was unhappy if he did not discover the traces of this lesion alter 
death ; now, many diseases are refeiTed to th(j jirocess which is 
the very reverse of inflammation, — degenemtio.i, — and, instc:i I of 
bleeding, it has been found to be desirable to enricli the bIt)od 
and promote nutrition. Nay, the idea of inflammation its-lf 
would seem to be undergomg a change Ijy which it is beconuMg 
less fiery or inflammatory, and more akin to the i»rocess wijich 
has just been named. At any rate, I have not been able to bring 
my mind to order bleeding in any of these cases ; and, so far as 
I am able to form an opinion upon the practice which has fallen 
to my share up to this time, I have never had occasion to sui)|>o>:e 
that abetter result would have been brought about by a dillur: iit 
line of practice." This is certainly a remarkable statement, (ind 
one which shows how gi'eat a change has taken place in so-called 
orthodoxy. To return to Dr. Ozanne's paper, he (Dr. liussell) 
considered it a most striking statistical analysis, and one well cal- 
culated to excite the attention of all candid minds, and he trusted 
that the learned author would more frequently employ his i>en 
than he had done of late. 

Dr. Chapman was glad that Dr. Ozanne had contriLuted a 
paper, though it was brief, and more suitable for the reading 
with the eye than for the hearing with the ear. Our dis- 
tinguished colleague excelled in many ways : he was a man of 
learning and science, and withal an excellent practitioner ; we 
had no worthier nor better man in our body. Dr. Ozanne had 
been a very diligent student, and for years, in one of the vciy 
best, if not the best, medical schools in the world — that of Paris. 
He there acquired his taste for statistical science, of which he is 
now a master. He pubhshcd in the Homoeopathic Times some 
admirable papers, in which he minutely analysed the facts of 
medical practice in some of the most important diseases of the 
kind called acute. As a man learned in the theories of medi- 



lis l)r. Ozanttc un the Positive Services 

(•iiM-. ln' ji]ipr('ciatt'3 the vast learning, as a philosopher, the 
snl»liiin' ]»hilnsn|)hy, and as a practical man, the admirable 
tlH'r;i|M'Utirs <)!' I lahn«'ijiann. He was about the last man to 
assirt that the; IJaconian or ///^/^^r/ar pi lilosophy was exploded, 
or tliJit iviiablo statistius were without value. He (Dr. Chapman) 
cfjii^idiicl iliat it was far easier to treat acute disease than chroniCy 
acconliii^r tn tlic law and doctrine of Hahnemann. He hoped 
Dr. Ozaiiiie would ])ublish in a se])arate fonn his valuable col- 
l»Mtifm of statistics, showing the superiority of the homcjeopathic 
iinthod to all (jthci-s in the way of drug-healing. Till he 
adopt rl ironi(eo])athy in the year 18-41, through the instrumen- 
tality ni Dr. Partridge, he (Dr. Chapman) was a thorough sceptic 
as to drug tr(.*atment. He belie veil in surgery, but not in medi- 
cine. He had long siniMi anived at the conclusion, so far as 
(h'ug-healiiig is eonctTiied, it must be Homoeopathy or nothing. 
Our President, in his Annual Address, had given us his ad- 
•jnirable ntitone of what has been done during the session about 
to (jlosc!. When he is able to come among us, he makes us feel 
how (i(jnspicuous he is on account of his involuntary absence. 

Dr. CuKr.MKLL, after heartily concurring in the eulogistic 
remarks made by Dr. Chapman, observed that, at this late hour, 
it would not be fair to detain the members of this Society with 
lengthy details of eases in practical illustration of the subject of 
Dr. Ozanne's pai)er. Such cases occurred by hundreds in the 
])racti((». (jf eacli individual member. He woiild, however, claim 
the indulgence of the Society for a concise narration of two cases 
(each in its own way) of a character so exceptional as to merit a 
])ul)lic record. The first he would instance as a most significant 
testimony to tlui rationality of the very hnite creation on the 
subj(M;t of lioma'0])athic therapeutics. He w^ould, in fact, tell 
them what a cat thought of the homoeopathic treatment of 
pneumonia, and how eloquently this "so-called'' irratio7tal 
creature (albcjit it S])okc not) bad expressed its conviction of the 
ellicacy of honueo])athic remedies in serious acute inflammation. 
The second case, or rather terrible cluster of cases — "che nell 
pensier rinuiova la paura" — of which one of his own children 
AN' as the subject, he woidd mention as an instance of recovery 
wJiieh lie bel i(.'-ved to be witliout parallel in the records of medicine, 
evcMi sinec^ the days of Hahnemann. Some ten or twelve years 
a;4() (1 )r. Chepmell continued) he was in the habit of running out 
of town from the Saturday afternoon to the Monday morning, and 
(Mijoying tlie fresh air and change of scene at the country-house 
of a friend, w^henever his professional engagements admitted of a 
little relaxation. On the occasion of one of tbese visits, almost 
the lirst wonis which fell upon his ear were the following, 



of the Hchool of Uahiununin, 1 ID 

addressed by his host, General , to a fieiviiiit : — " J(»h?i, you 

had better shoot the cat, and put tho j)0(»r brute out of it.^ 
misery." The subject of this order, a favouriti* liouso-cat of tin* 
family, lay at full length on a mat in a conna* of tin: i-oom, 
gasping and struggling for breath, to all a])i)eaninct' fast apiu-oacli- 
ing to the term of its "nine lives." It had rt'niained for scvi-ral 
days in this position, if'fusing to (juit tlu^ spot or to tiikt/ food of 
any kind A reprieve was cheerfully grautt-d, on Dr. CIh'Ihu ll's 
volunteering to ascertain whether a less heroic method of tr*at- 
meut might not be pureued to the advantage of all pailies. ( )u 
making an examination of the chest from its dorsid asi)'(t, 
extensive dulness was elicit(?d on jiercussion, on bt)th sidi-s, in a 
nearly equal degree; the vesicular breathing was inaudiijje; and 
the loud hissing tubular ronchiy neJir the base (»f the saxpalrr on 
either side, were singularly marked. In fact, there were the 
Tinmistakeable physical evidences of a very serious case of double 
pne^cmonia, which had gone on unchecked, and was fast ])roceed- 
ing to a fatal issue. Six drops of Phoqyhorus, :3rd dilution, weixi 
forthwith dissolved in six dessei't-s[)OonfuLs of cold water, an I a 
tea-spoonful of the solution prescribed to be administered e\-ery 
hour. Owing to the patient's natural prejudice against cold 
water per se, the admixture of a small poition of milk was at 
first thought of; but as it had already refused even lic^uid food, 
this plan had to be abandoned : consequently, lh(^ administration 
of the remedy presented a serious diiiiculty. In this dilemma it 
occurred to Dr. Chepmell that advantage might be taken of the 
animal's counter-prejudice for cleanliness andcomfoit: accord- 
ingly, the dose was regularly dropped upon its coat, and as regu- 
larly licked up by the patient : — at first, with a view to getting 
rid of the physical discomfort; afterwards (as the sc^qucl of tlui 
case will prove), from a well-grounded conviction of the remiidial 
virtue of the spilt fluid. No sooner had a cou])le of doses be(»u 
thus imbibed than a marked and steady cliangci for the better 
took place; and, after each successive repcitition of the remiuly, 
the oppression of the chest bcjcame less and less intense, so that 
by midnight the danger of suffocation scjcanod no longer immi- 
nent During the remainder of the night a member of the 
Greneral's household, who had taken a great interest in the cas", 
continued the administration of the medicine at intervals of 
about two or three hours. Throughout the next day (Sunday) 
the .improvement continued; the cough was loos(.'r, and the 
breathing less laboured; the animal lu^gan to take li([ui(l food 
in the shape of mUk and water, and to move about a little, 
although still, for the most part, a fixture to its mat. A cor- 
responding improvement had taken j)lace in the physical signs ; 
for, although the dulness on percussion was still extensive, the 



120 Dr, Ozannc on the Positive SerHccs 

intensity of the tuluilar lircatliing had much diminished, and 
soil ciTjiitiint I'alrs ^Vl•lv audible at the extremities of both lungs. 
I'lidcr tlu'st' fsivnurabli' circunistanoes, tlie intervals between the 
dnsi's wen* prolon^^i'd to three and four hours during the day, and 
ii(» niiMlicinr was oxliibited from midnight until the next day. By 
!M(»uday morning, a fui-tlirr and marked improvement had taken 
]»lac('. Tliii animal was beginning to move about more briskly, 
anil had i»artaken of bread and milk. On taking leave of the 
family, Dr. ClieinnoU left a supply of P/w&^t?)^^?'//^, with instruc- 
tions tor its eontinued exhi]»ition, until his return on the follow- 
ing Saturday afternoon. On renewing his visit (on the Saturday) 
liL leiirned from his host that his feline friend had, for the two 
previous days, been roaming about the garden, engaged in its 
favourite i)ursuit of watching the spaiTOWS, and from that time 
had "voluntarily given up the treatment." On asking for an 
explanation of what he mi»ant by the expression " voluntarily 
giving up tlut treatment," the General assured Dr. Chepmell that 
h(^ was not using the phras(»- in a rhetorical sense, and instanced 
as a proof of the oat's wonderful rationality on the subject, the fact 
that, in the course of the i)revious Monday, the young lady who 
had been in the habit of administering the remedy in the manner 
already mentioned, having forgotten her charge, the animal of 
its own accord caine, and, by the pecidiar way in which it 
attracted attention, contrived to remind her of the omission. 
Thereupon, it occurred to her, that she would test pussy's real 
intentions by presenting her with a spoonful of the remedial 
so 1 11 1 i on. The cat, withcnit the slightest hesitation, at once lapped 
up the medicine from the spoon, and then returned to its mat. 
From that time forward until the day when it " voluntarily gave 
up the treatment," as no longer applicable to a state of health, 
the cat having become its own physician, would come of its own 
accord, as if by a tacit agreement (at first, at intervals of four 
or five ; then, as convalescence advanced, of six or seven 
hours), and diink the medicine out of the spoon from the hand 
of its fair mistress, so superior had the feline mind risen to tlie 
prejudices of mere physical instinct. Before quitting liis hos- 
pitable friends. Dr. Chepmell had an opportunity of ascertaining 
the completeness of the cure by a physical examination, to 
which his former patient, who was, in truth, a very gentle and 
tame ci-eature, subnntted with becoming grace. With regard 
to the second case (that of his own child), Dr. Chepmell 
remarked that, although his nerve had never failed him in so 
far as the treatment was concerned, he had at the time no 
heart for scientifically recording all its frightful complications. 
In fact, during u])wards of six months of agonising suspense, 
he hardly dared to believe in the possibility of a favourable 



(if tlvt School of HahmmtiniL 121 

issue, with such fearful rapidity had each Ruccossivc* hlnw 
been struck, hefore the cumuhitivu Kluuks cif ])nMMMliii<r attarks 
could be recovei'cd from l»y the sluiltcnMl ci»nsiituti«iii nl' tin- 
little patient. He would, luiwovrr, j^ivt.* a suiiiniarv of this 
great triumph of the healinf:r art, wliith In* Ih-Ui'VimI to U^ 
without a parallel in the annals nt* iinMlirinr, and l'«»r w liiili 
he would ever be grateful to the nu'iiiur}* nf that ^'icat ami "loiid 
man, whose genius lighted fur all tinu- that tlu-raiM'Utic InMi-on 
by which, in the darkest night of ]»at]i<ilc»gical uncertainty, the 
foundering vessel of mortal life may yet be stifi-ed intu the 
calm channels of convalescenee. About the bi-ginnin^ nf l-'t-hniary 
1861, his daughter, then a imiviously ln-althy chiM i»f r» yrars of 
age, had an attack of continued fever, which, almost from the 
first, assumed a ty|.)hoid form, and which, having seriously en- 
dangered her life, left her, after a duration of between >ix and 
seven weeks, in al>out as unfavourable a eomliiiMn as mnld 
well be imagined for a struggle with any fresh niorbitic inlluenco, 
a very wreck of herself, weak and emaciated to a d«'^M"e(.* that 
would have rendered him anxious for the fulun*, had no n« w 
complication ensued. As a measure of llie virulenct; of the fi.vcr, 
he might instance the hideous disfigurement of the u]»|)(r lip 
(which continued for many months, an<l of which slight ciea- 
trices remain to this day), caused by several extensive fissures 
right through the skin and mucous membrane, consequent ui»on 
the excessive haemon*hagic exudations of the mouth and nostrils, 
at which the child was constantly picking, when the ty]ihoid 
symptoms were at the worst; he might also add the occasional 
suppression of the urine, the troublesome b(?d-sores, and the 
tendency to colliquative diarrhoea, to say nothing of that disposi- 
tion to congestive bronchial cataiTh which afterwards became so 
formidable an element of futm'e danger. In so unsatisfactory 
a manner had convalescence commenced that it occurretl to 1 )r. 
Chepmell, who at the time was attending a case of measles, that 
an attack of this exanthem was only wanting to insure a I'atal 
issue. Within a few days of this unwelcome thought, the eru])- 
tion of measles, ushered in by fever and delirium, mac hi its 
appearance. The eruption, which at first was very full and 
confluent, suddenly struck in on the second day its retrocession 
being immediately followed by symptoms of cerel')ral and pul- 
monary congestion, with coldness of the extremities. After the 
timely exhibition of Cuprum Aceticum and BciUadonna at short 
intervals, the eruption again reappeared, althougli in a less 
satisfactory manner, and simultaneously a suppurative inilamma- 
tion of the eyelids (which for ten days effectually blinded the 
patient) completely relieved the brain, and in a less degree the 
lungs. The exanthem continued to run its course imchecked. 



122 Dr. Ozanne on ttte Positive Services 

and had no sooner faded away than the smouldering mischief] 
the dutat hurst into a flame, and acute Broncho-pneumonia, e: 
tcn.siv(;ly aifecting hoth lungs, in about an equal degree (in whic 
the phniritic membranes became ulthnately involved), ensue* 
0\vin;j[ to the ])rostration of tlie vital powers, only a partial r< 
covcry luul taken place and a tlireateiiing state of sub-acu1 
iiiflannnation had remained behind, when, at the end of anotlu 
fortniglit, by way of climax, the symptoms of whooping-coug 
werii su])eradded. From a once comely child she was now r< 
duc(3d to a mere living skeleton, a tmly hideous and pitiabl 
oljjcct to behold, as though she had put on the withered feature 
of decrepit old age. The moral irritability which accompanie 
this ])hysical dilapidation was not less distressing to witnesi 
Notwithstanding the frightful struggles with the wliooping-cougl 
attended as they often were with imminent danger of suffocatioj 
re])eated day by day and night after night, and the frequer 
rekindling of the acute Broncho-pneiunonic inflammation, on th 
sliglitest unfavoumble atmospheric change, during that tryin 
spring of 18G1, she had rallied sufficiently by the beginning c 
June to justify the risk of her careful removal to the country 
at a short distance from town. Evfm then, he himself had bu 
slender ho])e — ^whilst those of Ids intimate medical friends wh 
had watched the case, as they afterwards confessed, had eve: 
less — of lier idtimate recovery ; for there was still a considei 
able amount of condensation of the pulmonary parenchym 
on both sides; much sub-acute bronchial irritation in bot 
liuigs, and more or less serous effusion in both cavities, moi 
especially in the left : moreover, the emaciation had not bee 
recovered from, she was worn out by hectic fever, and unabl 
to stand from weakness. Under the reviving influence of th 
pure mild atmosphere of Forest Hill and Sydenham (for she W8 
regularly carrietl out into the open air on fine sunny days), sh 
rallied slowly yet steadily, regained her appetite, and the ches 
affection became less urgent ; so that by the beginning < 
8e])t(Mnl)('r, when a change to the sea-side was thought desirabl 
she had gained a little flesh and was able, with assistanc< 
to walk a short distance. After going back to town for 
week, she was taken to Guernsey, where she remained unt 
the end of October. During her stay, she was under the imme 
diate care of her talented uncle. Dr. Ozanne, who successfull 
brought her through two serious relapses of acute Bronchc 
pncjumonia. Although, on her return to London, the aifectio 
of the lungs was still very serious, some ground had been gaine 
by her rijsidence in Guernsey. Tlie whooping-cough was le* 
troubh^sonie, and she had i)icked up a little more flesh. Durin 
the winter of 1861 to 1862, the improvement was remarkabl 



of th€ Sf'hool ttf II, I h I}, f„ ,1 „/,. \ -j; ; 

steady; and, iiotwith.staii(liii*( tMrasimial ilin-at.-niiiL'^ «.!' nn. u.-i 
pulmonic conf;f\stion, tlirn* \vi*r«» in) sfrimis rila|i-i-^. Th,. , |,ii,| 
was, of necessity, almost entirely cnn tin i« I tn tht- limi-.-. takiiii» 
an airing in the curria^^n* cm «'xi«-|»tiiiiial»ly lim- (Ia\-. \\\ ih.. 
end of the winter, however, tin* litll*- |«ali«iil liail r.LMiiJ««l in a 
measure her ijlumimcss and ^^ood l«M.k>: tli** liniL:> w.-n- nnr,. 
more iXTvious to the air; tin* hertir li-vi-r had r.-.i-^.-d ; an>l all 
that remamed of tin* fnrniiilahli' array ^\)i clu-.! >\ inpioni- \\a-< a 
clmmic bi-onchial ratarrli, ehi«*lly eniiiin»d In tli" i-li liniLr. and 
from which the rij^ht was eoniiiarativcly Iiim-. niirin;: lii" -|"ii!ij. 
and summer of 18(3:i sin* was alil«' tn tak'- a lair aiiiMiin! ni 
walking exei^cise on every fine day; and. wiili tin- i\. . |.ii..ii mI 
one or two ]')an)xysnis on first ;4"ttin^' into lu-d at ni-hi an-l nn 
awaking in the morninjr, the cough did not ironlilf ler Inr day^ 
together: her a])[)elite was excellent, an«l ln-r ^'-n'ral ln-al!li ni«»'t 
satisfactor}\ On her return to (luernsiy in lIi-- aulunm. Dr. 
Ozanne was struck with aniazenn-nt at tin* evid»'nr»-s uf li.-i 
recovery; for, when ho had taken leave nf Inr tin.* yi-ar iM-tni-.-, 
he scarcely believed the resolutifjn ol' so mmli or;:ani«.' misc-hii.t 
in the lungs possible to a constitution so sliatl«ivd. II.- tii.-n 
thought that she had only survived that inmnMise ani<»mii of 
acute disease, eventually to become the victim of ]iuhii«»nary 
consumption. A residence of some months on that iMautiluI 
TAncresse Common, where she daily took an amount of ex.Mvis** to 
whichmanyan adult wouM have lK,'en unequal, so coiii|iht»ly re- 
stored her, that from that time all anxi<'ty eeasiMl on In-r aee.nint. 
He might add, that, at the close of that same autumn, <linrily 
after she reached honn», she had an attack of srarlaiin:i. fmni 
which she recovered most satisfactorily, lie would now ;^ivi' an 
abstract of the reuKMlial treatment pursuiMl with su<'h a liajij)y 
result. The ty])hoid f(»ver was chi(?fly treated with Aeonit., iiry.. 
Khus Tox. Cantliaris., r»eHad., rhos])h., IMiosj»h. Acid., Arsen. and 
Sulph.;themeasles,withAcou.,rulsat.,(Jupr. Acet., r>ella<l.,Pho<j»li., 
Bry. and Suljdi. ; the pneumonic inllammaticui and it-; nunn rous 
relapses, with Aeonit., Thosph., Tai-t. Kmet., and Sulph. ; the 
whooping-cough, with I>ellad., I])ecac., He}). Sul])h.,and (.'arb. An. ; 
and the scarlatina with BellaiL AVith the exce])tion of Siilph., 
Arsen., and Carl). An., which were also exhil)ited from time to 
time in the 30th and 20Utli attenuations, when there was exces- 
sive prostration of the vital powers, and of riK»si)h., Tart. Emet., 
Sulpli., and Aeonit, which were also administered in the I»rd, 
4tli, and 5tli decimal attenuations, whiMi i\\it inllammatit»nsof thii 
lungs were very acute, the 3rd cent(^sinlal or <)th decimal were. 
the attenuations prescribed. To rhosi»h. and Tart. Kmetic, abov«; 
all the other remedies (which, nevertludess, fully answered their 



124 Dr, Ozanne on tJie Positive Servicer 

respoctivc imlications), and to single closes of 1 or 2 drops of 
»SuIi)h. 30tli or 200th, did the patient owe her life over and over 
agiiin, when Dr. Chepmell thought that she could not outlive the 
night, whotlier from the intensity of the relapses of acute inflam- 
mation or from the consequent vital prostration. So great was the 
chikl's own appreciation of tlie action of these remedies, that she 
would lierself imerringly suggest their exhibition (aft<3r she had 
got to know their names) from her own feelings. A diet gradually 
proportioned to the powers of assimilation, a cautious use of 
dietetic stimidants (which at no time exceeded 6 teaspoonfuls of 
})ort wine, and 2 claret-glasses of Dublin stout, in the twenty-four 
hours), a teaspoonful of Cod Liver Oil (as soon as the stomach 
couhl boar it), and cliange of air, especially at the sea-side, were 
restorative elements of the highest importance. 

The Pkesidext, in summing up, remarked, that the paper 
read to-night Avas highly interesting and important, and quite 
bore out and justified the remark made by him in an earlier 
part of the evening, in his acUlress from the chair, that a 
paper l)y Dr. Ozamie Avould be sure to be replete with practical 
information, and give evidence of careful investigation. The 
author had already established his reputation as an accurate 
collector and lucid arranger of statistical facts, which, when they 
were honestly dealt with and conscientiously recorded, must 
always carry great weight of evidence to all inquiring and 
earnest minds. He agreed with Mr. Yeldliam in his observa- 
tions about acute diseases, and, indeed, all experienced homoeo- 
pathic i^ractitioners were unanimous in their opinion as to our 
mode of treatment being much more successful in acute diseases 
than in chronic, and that if they wished to carry conviction into 
the mind of an enlightened and experienced physician of the 
prevailing school, they would much prefer showing him their 
treatment of acutely inflammatory cases than those of a less 
urgent nature and acute character; and if the inquirer came 
with an earnest desire to seek the truth, and brought a mind 
unbiassed to the investigation, he coidd not fail to perceive the 
power of Homoeopathy to combat acute disease in its various 
forms. He (Dr. Quin) also agreed with Mr. Yeldham respecting 
the greater difficulty attending the treatment of chronic diseases, 
if it were wished to impress our opponents of the old school 
favourably with respect to the advantages of Homoeopathy ; but 
even here, if the inquirer carried on his researches patiently and 
in good faith, he would find that he had entered on a wide field, 
in which means were at his disposal to treat successfully many 
cases which had previously baffled his attempts to cure by the 
ordinary method. In both schools, it was universally acknow- 
ledged, that chronic diseases were more difficult to cure than 



of the School of Hahneviann, l25 

acute; but wheu an allopathic physician saw the siiccoss- 
fiil treatment of several severe and well-niarkcHl chronic cases hy 
Homoeopathy, it had a greater efTect often upon him than the cure 
of a similar number of acute cases, because he had gi-eater dilU- 
culty in the former than in the latter, to attribute them to a 
spontaneous solution- He (Dr. Quiii) was inclineil to go with 
Dr. Hughes to a certain extent in his strictures on the utility 
of some statistics in proving the superiority of one system of 
treatment over the other, unless the circumstances under which 
both treatments were carried on were exactly identical, and the 
cases similar in gravity ; but these objections fall to the gromid 
when the statistics were gathered from the Hospital practice of 
a physician like Dr. Tessier, who compared the results of his 
own ti-eatment in his own wards under the two different modes 
of treatment — ^the old and the new ; and let it be bonie in mind 
that, at the time of his experiments, he was a most skilful, 
accomplished, and experienced physician in the mode of ti-eat- 
ment of the old school, whilst he was but a recent convert to, 
and inexperienced in, homoeopathic practica Similar value 
attached itself to the statistics of his (Dr. Quin's) friends, the 
late Dr. Mabit, Professor of Pathology and Physician to the 
Hotel Dieu, Bordeaux, and the late Dr. de Horatiis, Professor 
of the University of Naples, and Physician-in-chief to the 
Military Hospital, both of whom had published the results of 
their experiments in both their respective hospitals, in the treat- 
ment of acute cases under both systems. For the same reason 
the results of the treatment of many acute cases recorded by 
Professor Henderson, of Edinburgh, former Physician and Clini- 
cal Professor to the Eoyal Infirmary, were of the greatest interest. 
In aU these instances and in others, which he could quote were 
it necessary, it was not sought to pit the results of the treatment 
of one physician against those of the treatment of another, nor of 
one Hospital against those of another, but of the new mode of 
treatment against that of the old in the hands of the same phy- 
sicians. Here there can be entertained no suspicion of a wish to 
triumph over an opponent or a rival Institution, nor a temptation to 
falsify the results. He (Dr. Quin) fully agreed with the foregoing 
speakers in regarding the Expectant School as the stepping-stone 
to Homoeopathy ; and when one compared the mode of treatment 
practised by allopaths some years ago, with that pursued by them 
at the present day, there could be little doubt that it tended 
more and more towards Expectancy, which he looked upon as the 
high road to Homoeopathy. At one of the Society's meetings many 
years ago, when the debate took a similar course to that which 
it had done to-night, he had referred to an anecdote told of an old 
£riend of his, a distinguished physician and Military Surgeon-in- 
chief of the Austrian Army in Bohemia, Dr. MahrenzeUer^ "wIlo^ 



I 2C) Dr. Oxaiinr on the Positive Sa^vices 

^vll('Tl lie first made his acquaintance, practised at Prague. As 
the anecdote bore upon the point touched upon by several of the 
speakers this evening, he trusted they would not think it irrele- 
vant his again relating it : — ** Dr. Mahrenzeller having passed most 
of his nunlieal career in the Anny, and in great Military Hospi- 
tals, was, what was held in the highest esteem some years ago in 
England, and denominated, an active practitioner, one dealing in 
heroic remedies, in large doses, copious bleedings — in short, in 
violent medicines, both internal and external. When the head- 
quai'ters of the Division of the Army to which he was attached 
was stationed at Prague, he Avas, from the high position which he 
held, much consulted ]>y the townspeople of the wealthier class, 
and his ])ractice extended itself greatly among the civil as well 
as the military ; so much so, that few cases of danger occurred in 
which his advice was not sought. It w^ould seem that the mili- 
tary medical practice, which he introduced into civil life, had 
an}i:hing but a favourable issue in the majority of his cases ; so 
much so, that the churchyard became rather densely peopled, 
and w\as known under the name of Mahrenzeller's Garden. His 
reputation naturally suffered, and his practice gradually dwindled 
aAvay. Shocked and horrified at these melancholy results of his 
heroic mode of treatment, he became disgusted with it and 
himself, and resolved to see w^hat would be the result of leaving 
Nature to herself. This he commenced doing in his hospital, and 
his practice was so much less fatal, that he gradually introduced 
it into his private practice, and he confined his prescriptions to 
bread pills, an occasional mild aperient and diluents. About this 
time the General-in-Chief of the Army, Prince Schwartzenburg, 
w^ho had long been suffering from a painful disorder, from which 
he could obtain little or no relief from the usual means, resolved 
upon consulting Hahnemann, at that time rising into fame, as 
the founder of a new system of medicine. He left Prague accom- 
l)anied by Dr. Mahrenzeller for that purpose. The beneficial 
results attendant upon Hahnemann's advice were such as to 
induce Mahrenzeller to consult him upon a disease from which 
he had himself been suffering for some time. The benefit 
was so marked, that, already in some measure prepared by 
his disappointment at his old mode of practice, and at the less 
unfavourable results of the Expectant, he resolved to study 
Homneopathy, and finally became one of the most distinguished 
homoeopathic physicians in Germany, first at Prague, and then at 
Vienna, w^here his success greatly tended to the spread of the new 
system. It was to him that was entrusted the homoeopathic ex- 
periments ordered by the Emperor, to be made in the great 
Allopathic Military Hospital at Vienna — the Joseph's Academy 
Hospital — ^which experiments were so successfiil,that they resulted 
in the conversion of one of the Commissioners appointed by the 



of thi' SfhiHtl t'f Iluhmnnrini, y2.1 

Government to watch and rop<»rt iip(»n tln'in,— Pn»i'i'ssnr /Inra- 
to-witz. Dr. Mahrenzoller liad in liis own Military Hns]iital. at 
l*rague, full oppoilnnity of watiliiii^' and tlicidin^' n|H»n tin* 
respective merits and advantayt's of tin* tlnv<' nn'tlmds nt* In-at- 
ment inaxiute diseases, ])ractised by liinisi'lf, at tlin'ctiiirm'nl pe- 
riods — ^the AUopatliic, the Expectant, an«l the. iromn-oimthic — and 
the statistics obtained by each mode caused liini t«» <leride upon 
the latter as infinitely the .su])('nor." With rfsjH'ct to the obsrr- 
vations of Dr. liussell, concerninf^ the threat revdbition which has 
taken place of late years in tlie use of the lanci't in inllaniuiatiny 
diseases, and more especially in a])o]»lexy, and to tlie interrstin^ 
quotation from Dr. iiadclifle's work (ju ('nu<:« -st ion of the Uraiii 
and Apoplexy, in which the important aihnission was made on tlie 
inutility, nay harm of bloedin*:; in a])0])lexy, he (Dr. Quiuj recol- 
lected the time when the medical man who abstract«Ml the; 
greatest quantity of blood was looked up to as a hero and a most 
skilfid practitioner, whose footsto])S ought to b(» ibllowe<l and 
imitated ; and even after mc^n began to (lou])t the* ])ropriety of 
the practice, and see the danger of using such large depletions, 
such was the force of example and custom, and such the* tyranny 
of authority, that practitioners resoited often to bleeding, in spite 
of their better judgment, to shelter themselves from the blame 
and obloquy that they were sure to incur, if, on being first call(»d 
to a patient, they neglected co]>ious venesection. It Avas on th(^ 
Continent that this salutar}' revoluticm first commenced, lie (Dr. 
Quin) remembered, as far back as 1829, a circumstance which he 
had mentioned in a former debate (in 1846) just after the deide- 
tory system introduced by Broussais began to lose caste and 
show its baneful effects, so as even to stagger the author of the 
physiological system of treatment, Broussais himself, that Fou- 
quier, the Physician to the Salpetri^re Hospital in Pans, with 
whom he (Dr. Quin) had several consultations at that time, 
Fouquier being a great authority in diseases of congestion anti 
inflammation, — in fact, in all diseases connected with the 
vascular system, — acknowledged that he believed blood-letting 
in apoplexy to be not only of no avail, but positively inju- 
rious. He had put it to the test in the' wards of his 
hospital in the following manner : — The Salpetriere had more 
cases of apoplexy and epilepsy than the other hospitals of Paris, 
and a number of the cases occurred in old veterans. All the 
cases that came into the hospital on Mondays, AVednesdays, and 
Fridays, were put into one ward, and aU those that came in on 
the alternate days were put into another ward ; and Fouquier 
ordered the patients of one ward to be treated according to the 
usual mode hitherto pursued in the Hospital, viz. by venesec- 
tion, cupping, leeching, and other antiphlogistic means, whilst 
the inmates of the other ward were none of them bled or reduced 



1 28 Dr. Rartfiford on sortie Affections of the Knee-Joint, 

by other depletory means, but rather sustained and slightly nou- 
rish(^d : tlu* result was, that he lost considerably fewer patients 
in the latter ward than in the former. The experiments ex- 
tended over several weeks, and ended in Fouquier abandoning 
the practice of blood-letting in such cases. Here, again, we have 
the statistics in the same hospital, under the direction of the 
same ])hysician, treating similar cases by two different modes, 
proving in favour of the one mode over the other, in a manner 
wliich cannot be considered open to suspicion. He (Dr. Quin) 
heartily concurred in the eulogy passed by Dr. Chapman, who 
was always generously alive to the merits of his colleagues, and 
ready to record in his speeches his favourable opinion of their 
labours. The past and present labours of the author were most 
important and praiseworthy ; and he earnestly hoped that Dr. 
Ozaune woidd continue to give to the Society the results of his 
research and experience. The evidence brought by Dr. Chep- 
mell in practical illustration of the paper of his relative, Dr. 
Ozanne, was well worthy of their attention, particularly the for- 
midable and complicated case of his little daughter, of which he 
had given the most minute, circumstantial, and interesting 
details. The history was a harrowing one, and they must aU 
feel the deepest sympathy for the father who witnessed in a 
beloved cliild such a succession of violent diseases occurring 
with such rapidity, and he (Dr. Quin) heartily congratulated 
him on the fortunate escape of the child from such repeated 
imminent periods of danger and its final rescue from the jaws of 
death. Such a case as that, so feelingly told by a parent, ought to 
carry conviction into the most obstinate opponent of our school, 
of the good faith and earnest and conscientious belief of the 
narrator in the blessings conferred on us by the great discoveries 
of Hahnemann. 



ON^ SOME AFFECTIONS OF THE KNEE-JOINT. 
By Dr. Eansford. 
Upwards of thirty years since, when dresser at the Bristol 
Eoyal Infirmaiy, I had under my charge a little girl of stinimous 
habit, about seven years of age, who suffered from what was 
called a white swelling of the knee-joint. It was a case of 
chronic inflammation, originating, probably, in the synovial 
membrane, but in which the other textures had become in- 



Trivei TLe:^ "ins c:'::::r.'r:-:\l ]«axn. wiili u'n'at onlarufinout ol 

tie i::iil "Br]:::!: jres-jiitoi :ho piviiHar whito anjuMiaihT rioiu 
vliiL tie iL^ne -wLito swtllini;" is ul'i.iiiuil. Tlu' nmihiii 
of llr y-iiLZ •«"« VvT}* l::r.:Ti\l : ^xti n^inn «'f tin* liinl* rouiil imt 
l»r ror^r: ::.5 iisu.i! }'.'<:::"ii >va> ilif Iialf-luut tiiif; !h.« ]i.ilirri! 
W-^iTT.-r Lr:::.\ ?!-:-t]'>'.5> : lur luallli was ra|»iil!v f.iiliii;' Sin- 
Lad \K-rii :vr.-.i^:-J with looohrs. tartar niuii*'. niiiinii iit, Mi.i- 
lirTs. krj't oj«en l-y Sabiiio ci-rato ainl all tin- i»llnr Ih-IiIn |.ii.i.| 

appliiincr* cf the Jay. iiiohulinir issui^s anil mMimis. r.irij i.l 

vitli drugs of all sons, aiul giwn in all shaju-v Tlw Sm ■. 

who weK men of emiiuneo, iIooIiUmI. afiiT fiinsuliali«m. tli.ii tin* 
limb must t«e amputatoil. or that tin' rliild \vi»ulil .•.)».■. .IiIn <!h- 
This decision was coimnunioatod \o tlu* iimtlii r. w Im wmiM imi • 
consent to the operation, and ivnii»\ril Inr cliilil \'vu\\\ tin* luiii 
man" to her own eottagi\alu»iit thnv niili's iVum I'li-.d)!. ;hiiiu« 
months aftenvards I was in tlu» ni'i«;Ii!MMirliiMMl o\' Iht iiiuiIm i.j 
house, and called to inquiiv whi'tluT tlir cliilil wmm lixin;- Tn 
my astonishment I found Iior walkin<^ alxuit. in lair Ih-allli. uinl 
the afiected limb not very tlilViM-ent iVnm its jrllnw. I w.n 
informed that a surgoon, practisinj^ in tin* iicij-jilMHuinMMJ, JKid 
done it up verj" caivfully with a variety of plai.lrr.i iimi mni 
ments: and by these moans Ihti j^'irl hail ln-ni rmiil 'lint 
surgeon (so called, for ho was an imh'ri'ii mmI piaciiiioiK-i i hiul 
become familiar with the tivatnu'iil ;uli»plri| liv Mm- lulr Mr 
Scott, of Bromley, Kent, and apply iii;.j il. In Hhm rliilij wa.i 
rewarded with signal success. Tlu* cnse \v:i;* (uk^ ('.Ml«'iilal.«Ml in 
make a lasting impix^ssion upon the iiiiiid of :i .".liidcnl. ui-niik 
tomed to consider the oracular sayin^^s and dnin;':j nl lii.i 
teachers as decisions from which thrro wjis no jippcal. I did 
good to many cases in my pupila^'o u]K)n this prinriph-, :ind 
studied with interest Scott's work, entitled "On |ji(> Tr<:ilhniif. 
of Diseases of the Joints and of Tlrei-s and Ciirnnic Inilaninm 
tion." This work was not favourably niccivr-d hy tlic prof.-.i- 
sion. It was severely criticised, and f«)r reasons which may 
readily be assigned, his reviewers pronounced Mr. Se.oi|.'M 



130 Dr. Ransford on Rome Affections of the Knee- Joint, 

pathological principles to contain nothing new, and his plan of 
treatment, which was fully detailed, was slighted and dis- 
couraged Indeed, the history of this work well illustrates 
professional prejudice. It has been correctly observed, " that 
altliough an accurate description of diseased states, and the dis- 
covery of some phenomena about them not previously recog- 
nised, are hailed by the profession, and confer immediate dis- 
tinction upon the author or observer ; yet remedies, or plans of 
treatment, however effective and valuable, are always received 
very coldly, frequently with perfect indifference, and sometimes, 
nay often (as the members of this Society can testify), meet 
with unsparing and unscrupulous opposition." We could 
produce abundant unimpeachable testimony, that John Scott 
succeeded in curing numbers of surgical cases which had been 
pronounced hopeless by many eminent surgeons of the day. 
In fact, he saved for his patients innumerable limbs which had 
been condemned to amputation. In the few cases which I 
shall have the honour to read this evening, it wiU be seen that 
I have ceased to follow Mr. Scott's mode of practice, because 
we, the professed disciples of Hahnemann, believe ourselves to 
be in possession of a stiU surer guide to the administration and 
application of remedial agents, so far as the Materia Medica is 
concerned; at the same time, although we were never acquainted 
with each other, I should not have considered myself just to 
John Scott's memory had I not given my feeble testimony to 
his skill. Undeterred by opposition or the severity of his 
critics, he continued his practice, and realized by it a large 
fortune. He laid considerable stress on giving the affected 
joint rest, and applying uniform and gentle pressure to it. In 
addition, he bathed the parts with Camphorated Spirits, and 
applied Mercurial Ointment with Camphor. In all injuries 
and diseases of the joints in the slow strumous degeneration 
luhite siveUing (a very vague and comprehensive term), as well 
as in the most violent form of articular inJBammation, perfect 
repose of the affected joint forms a powerful and effectual 



Dr, Hansford on some Affections of the Knee-Joint, 1 81 

curative indication. The means described by Mr. Scott per- 
fectiy secured the quiescence of the joint; but it does more 
than this, — it excites and maintains a gentle warmth and 
action upon the skin over a large surface around and con- 
tiguous to the diseased joint, and thus, by the well-known 
principle of counter-irritation, relieves and subdues the 
inflammatory action in the structures of the joint itself; 
besides which. Mercury is, to a cei*tain extent, homoeo- 
pathic to many of these cases. Sii* Benjamin Brodie's work 
gives information respecting the pathology of diseased joints ; 
but we believe that Mr. Scott's work gives better instructions 
for curing them, so far as Allopathy is concerned. It will not 
be disputed that afifections of the joints are a class of diseases 
which have strong claims on the attention of practitioners, 
since they are of frequent occurrence, are sources of deep 
anxiety to the patients, and for the most part, if neglected and 
maltreated, proceed to an unfavourable teimination. I venture 
to bring forward two or three cases, with the hope that the 
suflBciency and superiority of treatment suggested by the 
homoeopathic law may be apparent. The first case may 
perhaps be termed one of chronic inflammation of the synovial 
membrane, arising from constitutional causes, which, as my 
audience well knows, are often vague and diverse, and into 
which part of the subject too much time would be required for 
me to venture upon ; besides which, such a disquisition would 
perhaps land us in the regions of hypothesis. The subject of 

this case, Henry M , had been an intemperate man ; there 

was likewise reason to suspect a sjrphUitic taint. Eheumatic 
or gouty symptoms presented themselves, arising probably from 
hereditary predisposition, fostered by the patient's habits of 
life and exposure to atmospheric changes. He first consulted 
me in York on August 28, 1855. His age was 31, unmarried ; 
his occnpation groom and valet ; he resided in tlie country, 
within six miles of York. He has an enlargement of the 
left knee-joint, with great pain, which is worse when he walks ; 

9* 



1 ;V2 Dr. Ransford on some Affections of the Knee-Joint 

and lie described the pain as running down to the ankle and up 
to tlie slioiilder. Appetite had. 

IIc'[)ar Sulphuris 6 was ordered. 

Sept. 3. — The joint is smaller; the pain is less; he feels 
hettt^r. Hopar was continued; and a cloth, dipped in a solution 
of Hepar, was ordered to be applied as a compress to the joint. 

Sept. 22. — Much better. The pain is trifling. The joint 
becomes stiff after moving much about. Sulphur was ordered 
internally, and externally as a lotion. Unfortunately, about 
tliis time he was kicked by a horse on the shin of the aflfected 
limb ; the consequence was a contused wound, to which Arnica 
cerate was applied with success ; but after the wound healed 
ulcers appeared on the leg, which ulcers were obstinate. Calendula 
cerate and strapping did some good, but the internal exhibition 
and external application of a solution of SiUcea produced more 
speedy amendment. The knee-joint was comparatively well, 
but the ulcers on the leg were tedious. During the time that 
he was under treatment he took Silicea, Hepar Sulphuris, Sul- 
phur, Graphites, Belladonna, Arsenicum, and Nux Vomica, 
according to indications. He was under my care from August 
28tli, 1855, to March 2nd, 1856; after this I neither saw 
nor heard of him, because he was able to fulfil his duties as a 
servant, until February 16 th, 1857, when he called again upon 
me on account of the appearance of fresh ulcers in the same 
leg : these healed in a month under the use of Silicea, applied 
externally, and taken internally. Fortunately for my patient, 
he did not adopt the recommendation of an hospital surgeon of 
eminence, who, previous to his first application to me, had tried 
upon him the usual orthodox remedies, and concluded by 
recommending amputation of the aflfected limb. 

The details of the next case were sent to me by a clergy- 
man in the north of Ireland, with a request for my opinion 
and advice. I prescribed the external application of Arnica : 
the result was most gratifying. T read, without alteration, the 
account as sent to me in October, 1860 : — 



Dr. Ransford on some Affectiom of the Knee- Joint, 133 

"Elizabeth M'Kenn, aged 19, suffered for several months 
from a swelling in the knee. The pain was excruciating, and 
the leg was greatly inflamed, and swollen to double the natural 
size. Several doctors were consulted — I believe six altogether. 
One recommended 'warm poultices, to cause suppuration;* 
another, scarifyiug and blistering; another said that 'imme- 
diate amputation was the only way to save her life;* another 
said the disease was 'Elephantiasis.' She suffered intense 
pain, could make no use of the swollen limb, and got no sleep 
for a long time. I visited her under these circumstances as a 
clergyman, and by the advice of a physician practising lioma^o- 
pathically, recommended a trial of Arnica. I accordingly gave 
some Arnica, with directions to bathe the knee witli warm 
water, and then apply the lotion, rubbing it for some time 
gently with the hand, and then apply well-saturated linen cloths, 
covering all with oiled silk; the applications to be renewed 
every half-hour. In about two hours a very copious eruption 
of watery pustules appeared, and the pain was greatly abated- 
The applications were continued more than a week, but there 
was no eruption after the first two days. The swelling gradu- 
ally fell, and the pain altogether left the knee-joint, wliich 
seemed to have been the original seat, and settled about half 
way down the leg, where the patient felt what she described 
as ' a drop of water running up and down the inner side of the 
shin bone.' The spot where the pain settled was touched with 
a lancet, and suppurated, and has remained an open sore about 
as large as a fourpenny piece, with a very slight occasional 
discharge at intervals ever since. In other respects the girl is 
quite well. The duration of treatment with Arnica was six 
weeks ; it is now about eight months since the lotion was first 
applied. The lotion used was from 6 to 8 drops of the 
Mother Tincture of Arnica in a wine-glassful of water, a fresh 
mixture being made every time the linen was saturated. She 
was very weak for some time, I believe, from the intense 
sufifering. A doctor says it arose from the dangerous Tiature of 
tiU lotion used. The girl continues well." 



134 Dr. Hansford on some Affections of the Knee-JoirU. 

A few weeks since my correspondent wrote to me, "That 
last Sunday she walked to church, a distance of eight miles, 
there and home again." 

A somewhat similar, although not so severe a case, was that 
of Joseph Neill, eight years of age, who applied at the York 
Homeopathic Dispensary on 12th August, 1851. He was 
apparently in good health, but of a strumous diathesis. The 
left knee is swollen, white and tense, painful when touched or 
moved. Aconite and Arnica were prescribed internally. No 
external application of any kind was ordered. The swelling 
gradually lessened ; Sulphur was then given for two days. On 
the 30th of August, eighteen days after his first appearance 
at the dispensary, the swelling was almost gone; he walked 
much better. 

Sept. 6th. — Improvement continues; joint remains stiff; 
Arnica embrocation was ordered. On the 27th of September 
he was discharged cured. 

The next case was that of John Smallwood, aet. 4 ; likewise a 
dispensary patient in York. He looked delicate, of a strumous 
constitution. The right knee was enlarged, and had been so 
for three months without any obvious cause. Sulphur 30 was 
given for a week, then Calcaric Carb. 30 for 17 days; the swelling 
and pain had both diminished; a compress of cold water covered 
with oiled silk was ordered. 

February' 10th. — The knee is smaller, general health good; 
Iodine 30 was given, and the cold water compress continued. 
On the 4th of March there was no pain in the joint, — he walks 
better. A week afterwards the diseased joint is found to be only 
half an inch' larger in circumference than the other. Calcarea 
30 was resumed, and continued imtil April 7th, when he was 
discharged cured. 

Another and a very simple case was that of Annie Low, set. 14, 
residing' at Penge. She applied at the Sydenham Dispensary 
on the 25th of March, 1862 ; the left knee was very painfid, 
swollen, and evidently contained fluid. She walked with dif- 
ficulty : cloths dipped in a lotion of Arnica^ and covered with 



Dr, Ranrford on sonie Affections of the Knee-^oiiU, 1 35 

oiled Bilk, were ordered ; in less than two weeks there was dimi- 
nution of pain and swelling. On the 8th of April she reported 
herself cured, and ceased to attend 

The next case with which I shall trouble you was that of Ellen 
Bogers, set 18, admitted at the Sydenham Dispensary, on the 
1 8th of April last. She is a fine healthy girl, and states that she 
fell down in December, 1862, and struck her right knee, but 
did not feel any pain in the knee imtil March, 1863 ; she then 
went to St. Mary's Hospital, on the 2nd of April following, as 
an out-patient; she continued going until April 22. During that 
time the tumour of the knee was lanced twice in one week, and 
pus mixed with blood was evacuated on each occasion ; two 
blisters in succession were applied to the swelling after that ; 
subsequently the knee was painted with Iodine. When she came 
to me, the swelling over the patella of the right knee was con- 
siderable and tense, the surface raw; she walked with great 
difficulty, but her general health was good. I ordered Silicea 
Tinct. 6 to be mixed with lard and kept applied to the pait 
aflfected. In four days she walked about freely, and in ten 
days returned to her home in Buckinghamshire. This case 
illustrates, in my humble opinion, the evil results of the 
nimia dUigentia Chirurgici. A less heroic treatment at first, 
with rest, would perhaps have been attended with better results, 
but it affords fresh proof to me of the value of Silicea given 
internally and applied externally. 

And here I may, perhaps, adduce another instance of the value 
of homoeopathic treatment, although not one of diseased joint, 
strictly speaking — ^but a case which Mr. Scott would probably have 
designated Chronic Inflammation. A gentleman, aged 69, resi- 
ding near Barnard Castle, County Durham, wrote to me for ad- 
vice on the 13th August, 1862. I have never seen him, but 
give you the details of his case as I received them, though di- 
vested of much irrelevant matter. In February, 1 8 6 2, he writes : 
** I scratched my left ankle, and produced a wound in it larger 
than a shilling ; my leg was then in places very black. I applied 



136 Dr, Ransford on some Affections of the Knee- Joint 

to the doctor here, to heal it, but he could not, and it discharged a 
little thick white matter — then my foot swelled and puffed up. I 
was advised to drink broom tea, which I did, and do still drink 
it, and wear a bandage from my foot to my knee ; but this was 
all to no purpose, my foot was considered dropsical, and the doc- 
tor ordered me broom tea for it, and frequently applied Caustic 
to the wound, which gave me much pain. Since then my leg 
became full of red spots, like pin points, up to my knee ; and 
these red spots, after some days, became of a scarlet red all over 
my leg and foot, with much hard swelling all over my leg up 
to my knee. My knee and ankle joints are very stiff and scaly ; 
there is also a tremendous itching, which continues at times, 
especially in the night ; the itching is likewise about my arms, 
eyebrows, chin, neck, head, ears, body, and all around my private 
parts, having a yellowish appearance. The wound in my leg is 
not healed up ; it is small — was never very deep." According 
to his own statement, he had lived freely, and took a great deal 
of salt with his food ; since February he has been a total ab- 
stainer. Appetite is good. He is now taking Dr. Eooker*s Pills 
(which I never before heard of) : he formerly applied Tar Oint- 
ment, but now rubs his leg with Holloway's Ointment ; he adds 
a postscript, that he had for thirty years been much troubled with 
rheumatism, and during the last ten years he had been compelled 
to walk with two sticks. For this not very promising state of 
matters, I ordered Belladonna and Arsenicum, to be taken alter- 
nately, and Tinct. Belladonna with water to be applied on a 
cloth, oiled silk to be worn outside the cloth ; the broom tea, 
Eooker's Pills, Holloway's Ointment, were to be inmiediately 
discontinued. In the course of a week he reported himself im- 
proved, the itching and swelling of the limbs had diminished, 
the limbs and joints were stiff from what he described as a hard 
scaly scurf upon them; the urine had increased in quantity, not- 
withstanding the discontinuance of the broom tea ; the scaly 
condition abated, and gave place to healthy skin ; the urine was 
described as having a deep red sediment in it. Ten days after- 



1 38 Dr. Ransford on some Affections of the Knee- Joint, 

pose that medicioe and diet are all that are necessary for the 
treatment of local disorders, and that local remedies are needless. 
We believe that it is by scrupulous attention to, and a proper 
application of the latter, that will make our practice the most 
successful" 

Since writing the foregoing, my friend Dr. Duncan Campbell, 
of South Shields, sent me two very interesting cases : from per- 
sonal acquaintance I can vouch for Dr. Campbell's accuracy 
in diagnosis and description, and have, therefore, much pleasure 
in bringing them before you at this time. The first case 
is that of Mary Wood, aged 18 years : — " She has endured 
with great patience the many torturing means used by allopa- 
thic science. Wood consulted me, for the first time, on the 10th 
October, 1862. Before I could possibly question her, she gave 
me a very fuU and descriptive account of her sufferings ; she 
was leeched, blistered, cauterised, and otherwise very much 
pained, in the vain hope of obtaining a cure. On questioning 
her, she said she never aUed anything in her lifetime before the 
occurrence of the present mishap, which took place in the fol- 
lowing manner: — Coming down stairs very rapidly, and turn- 
ing round on the landing, her left hand got between two of the up- 
rights protecting the stair sides. Although painful at the mo- 
ment, she took no particular notice of the accident till three 
days afterwards ; the wrist .joints got very painful and swollen, 
the part gradually got worse ; the pain she described as unbear- 
able and deep-seated, greatly aggravated by pressure or motion ; 
there was tenderness of the integuments, and a good deal of 
constitutional disturbance. The family surgeon was then called 
in: he ordered leeches and perfect rest, which orders were strictly 
obeyed (a few doses of castor oil were also taken). Thus mat- 
ters went on for nearly a month, but as the inflammation sub- 
sided, a stiffening of the joint ensued. The stiffening went on in- 
creasing, tOl at last the joint was incapable of any kind of mo- 
tion ; she then submitted to a course of blistering, taking at the 
same time some of the so-called alterative medicines (such aa 



Dr. Ransford on some Affections of the Kiiee-Juint. 139 

Iodine, Potass, &c.). These giving no rolief, the actual caut(»ry 
was applied in three parallel lines on the palmar aud dorsal 
aspects of the joint The wounds were kept open for nearly six 
weeks ; they suppurated freely, but no good results followed. 
She got tired of the mode of treatment, and an aunt (a patient 
of mine) got her persuaded to try wliat I could do for her. On ex- 
amining the joint carefully, I found a pci-ceptiWe motion exist- 
ing between the bones composing the wrist-joint pi-ojxir ; pain 
stiU existed on moving it, but the pails were much swollen from 
subcutaneous effusion, — I have no doubt, brought on by the use 
of the actual cautery : this satisfied me that the articulation was 
not so seriously involved as supposed. Her constitution was good, 
and I having diagnosed favourably, began the treatment with 
Arnica lotion, of strength 3i ^o S^ii Aqua Pura, to be rubbed in 
three times a day. I gave her Arnica 3 internally, every four 
hours. For the first week no change was perceptible, but at the 
end of five weeks she was, and felt herself, so much better, that 
she asked leave to discontinue her visits at the surgery. I pre- 
vailed upon her to come once a week for a month longer, which 
she did, and left finally cured. I saw her two months after- 
wards : she was then perfectly well. 

** Remarks. — ^The treatment was not changed during the whole 
time of her attendance. I forgot, however, to mention, that at 
the beginning I applied a long splint, extending from the middle 
of the arm to the extremity of the fingers, thus ensuring com- 
plete rest to the joint involved. Tlie action of the continued 
application of Arnica lotion was, in this case, very obvious, and 
if it had been applied at the first, would have saved the patient 
great pain and trouble." 

Case 2nd. 

" John H , aged 5 years, of a very scrofulous constitution, 

came under my care on the 1 0th of December, 1862. The elbow 
joint of the right upper extremity looked seriously involved. 
Three wounds discharging a thin serous fluid, occupied the pos- 
terior aspect of the joint ; slight motion existed ; the joint was 



140 Dr. Ransford on some Affections of the Knee- Joint. 

much swollen ; the swelling was of that soft, elastic, and colour- 
less nature, so commonly seen in scrofulous affections; the 
muscles of the arm and forearm were perceptibly atrophied ; the 
seiiiiflexeJ seemed the easiest position, and the general appear- 
ance of the little patient seemed to confirm the opinion I first 
formed, — an opinion that this was a case of gelatinous degene- 
ration with necrosis. His appetite was good, his bowels were 
moved regularly, and he did not lose much flesh. The exciting 
cause was supposed to be a fall from his crib three months 
before. Arnica lotion externally, and Silicea 6 gtt. 1 three 
times a day, constituted my treatment for two months; three small 
pieces of necrosed bone came away, the swelling subsided gradu- 
ally, but no return of motion. I then substituted Merc-Sol. 6 
for the Silic, and with obvious benefit. I now applied a semi- 
flexed splint of pasteboard to restrain him from abusing the 
mobility of which the limb was now capable. He took Ol 
Jecor Aselli 5ij morning and night, and now. May 13th, 1863, 
he can take his food with ease ; the joint is somewhat stiffer 
than before, the wounds have all healed up, and he is gaining 
flesh rapidly. I have no doubt but that in a few months more 
the joint will be perfectly restored." 

" Diseases of the joints," says Mr. Listen, *' originate in a 
variety of ways, and in any one of the tissues which enter into 
their formation and composition. These diseases are attributable 
to injury, as sprain or contusion ; but this may have been so 
slight, and so slowly followed by signs or symptoms causing 
alarm, as somehow to be nearly forgotten, the mischief being 
then supposed to arise spontaneously, and altogether through 
some vice in the constitution. Many persons are so slightly 
constituted in these and other respects, that very trifling causes 
operate in deranging the functions and structure of their organs 
and apparatus." 

" I must confess," says Sir Benjamin Brodie, " that in pro- 
portion as I have acquired a more extended experience in my 
profession, I have found more and more reason to believe that 



Dr. Ransford on some Affections of the Knee-Joint 141 

local diseases, in tie strict sense of the tenn, are comparatively 
rare. Local causes may operate, so as to render one organ 
more liable to disease than another ; but everything tends to 
prove, that in a majority of cases there is a morbid condition* 
either of the circulating fluid or of the nervous system, ante- 
cedent to the manifestation of disease lq any particular struc- 
ture, but the constitutional conditions giving rise to, or associated 
with, diseases of the joints, are as various and as different as 
the local phenomena." 

In conclusion, we hope that in the details and results of the 
cases which have now been laid before you, although in an 
imperfect manner, we have demonstrated the value of the 
therapeutic principles, simple and harmonious, with the symp- 
toms presenting themselves. An inestimable boon, which let 
us never forget, we owe to the genius and perseverance of 
Hahnemann. We can afford to disregard the contemptuous 
observation of Sir Benjamin Brodie in the fifth edition of his 
elaborate work on diseases of the joints. It is an observation 
unworthy of his well-earned reputation. In treating of hysteric 
diseases, he enumerates various cases of sudden recovery upon 
the exhibition of some new medicine, or the application of 
some new plaister or liniment, which has therefore obtained, 
though it has not deserved, the credit of the cure. The worthy 
Baronet adds, " that, as might be expected, examples of similar 
cures have been furnished by Mesmerism and Homoeopathy." 

DISCUSSION. 

Dr. Drury regretted that there were so few members present 
to hear the valuable paper with which Dr. Ransford had favoured 
the society. like others of his, it dealt more with practice than 
theory, and useful hints thus thrown out often proved very 
serviceable when similar cases arose. Such hints, however, to 
be turned to good account, should not be allowed to lay the 
foundation of a routine practice, but should rather be made 
available as helps in the selection of the proper homoeopathic 
remedy, or as helps in mechanical or surgical appliances or inter- 
ference common alike to homoeopathy or allopathy. As diseases 
of the knee-joint were not of every day occurrence in the 



142 Dr. RaTisford an sorne Affections of the Knee-Joint 

ordinary run of practices, the opportunity for their study was not 
as groat as many other aibnents. No doubt an interesting dis- 
cussion might be brought about by introducing the treatment of 
scrofula, but that would be travelling out of the legitimate sphere 
of the paper. The disease of the knee that most frequently came 
under his (Dr. Drury's) observation was housemaid's knee ; in 
tliat affection he found Bryonia, Ehus, and SiUcea most valuable 
medicines. In scrofulous affections of the joint many of our 
homoeopathic remedies possessed wonderful power. Amongst 
others, Assafoetida was one well worthy of attention. 

Dr. KussELL said it seemed to him very strange, that the attend- 
ance at our meetings appeared to be the inverse proportion to the 
practical character of the paper announced to be read. The more 
theoretical, the more interesting apparently. Tliis he regretted ; for 
such a paper as has just been read is of the highest importance, and 
might elicit much useful information if fully discussed by those 
who had large experience in this class of aflfections, which gene- 
rally fell to the lot of surgeons. There were three different classes 
of affections of the knee-joint which were apt to be mistaken for 
one another — the scrofulous inflammation of the tissues of the 
joint, the rheumatic inflammation, and what had been called the 
hysterical knee-joint. He had had very well-marked examples 
of each under his care at the same time, and in all of them he 
had succeeded in effecting a cure after the patients had been 
recommended to have amputation performed, at least in the two 
former cases. In the hysterical it might have been, for the case 
had been treated as one of white swelling of the knee-joint. In 
the first case SUicea was the great remedy, and the case resulted 
in anchylosis of the joint, after an illness of fifteen years. In the 
second case of excessively severe rheumatic gonitis, Mercurius 
was the chief medium employed, and the cure was completa 
In the third case, although there was no danger, yet it proved 
tedious and troublesome, and got weU as such cases do, quite 
suddenly and unexpectedly. 

Mr. Yeldham said some of Dr. Hansford's cases referred to 
Synovitis, which he (Mr. Yeldham) considered the most curable 
form of joint disease. The knee was the joint most commonly 
affected, and next to that, perhaps, the wrist. A very interesting 
point in the history of these cases was the rapidity with which 
considerable quantities of synovial fluid often became effused, 
and the almost equal rapidity of its absorption. He had recently 
treated a case of this kind in a lady, who caught cold whilst gar- 
dening, and in whom the left knee-joint became, in a few hours, 
inflamed, painful, and greatly distended with fluctuating fluid. 
Under the influence of rest, cold water, and Aconite and Mercu- 
rius, the fluid was all absorbed in three days. A similar case had 



Dt, Hansford on some Affections of the Knee^oinL 143 

lately been under his care in one of the female wanls upstairs. 
Such cases were very frequent and were satisfactory in their results. 
Perfect rest was very important in joint aff'ections. lie had recently 
discharged a case of synovitis of the wrist, in a young woman 
from the country. Her wrist had been bad for 18 months, but 
she had been aUowed to hang the limb down, and it had not 
been steadied. It was very painful, and filled with fluctuating 
synovia. He (Mr. Yeldham) placed the forearm and hand on a 
splint, applied cold water, and gave Calcarea and Sulphur, and in 
three months she was well. Position was in some cases scarcely 
less important than rest. This was well illustrated in a case 
which was sent into the Hospital about three years since from 
Nice by their colleague Dr. Blest. It was that of a lady's maid, 
who had inflammation of the foot and ankle. She had been unable 
to use the limb for many months previously, and had been treated 
allopathically with leeches, &c. After her admission, she was 
kept in bed in the ordinary recumbent position. This and medi- 
cines did but little good. He (Mr. Yeldham) then had the limb 
placed on an inclined plane, considerably elevated at its distal 
end; the foot thus becoming the highest part of the body. 
Instant amendment followed, and she speedily recovered. In- 
flammation of the ligaments and tendons of joints, arising com- 
monly from sprains, he had often found to be a very troublesome 
complaint ; and he had not, in his practice, generally been so 
fortunate in the recovery of his patients as the author of the paper 
had. He had, at that time, under care a young gentleman who 
had sprained his knee in jumping. He had been under treatment 
a month already, and notwithstanding that he had rested, and 
applied Arnica, and Ehus, and cold water, and taken medicine 
internally, the inflammation still lingered obstinately about the 
joint. Of scrofulous afifections of the joint — a wide field, he 
would not then say anything. Dr. Kussell had alluded to 
aflfections of the joints in hysterical subjects. He (Mr. Yeldham), 
some years since, had under care a very remarkable case of what 
might perhaps be called nervous disease of the hip. It occurred 
on a young lady who had been strictly confined to the recumbent 
posture, on her back, for five years before he saw her. During 
that period, she had never left her bed, nor the horizontal posi- 
tion. The afi'ected limb was kept straight, and was steadied by 
sand-bags, the least motion causing intense pain. The limb was 
shortened, and in other respects looked like genuine hip-joint 
disease. She had been seen, from first to last, by many eminent 
suigeons and physicians, and amongst them, at his (Mr. Yeldham's) 
request, by their President, Dr. Quin. Ultimately, it was deter- 
mined to remove her to the seaside. Her bed was placed in an 
invalid carriage, and she was carried to Brighton. She there 



144 Retrospect of 1862. 

heard of the late Mr. Hamip, the rubber. He took her in han 
At the eud of three months she could walk a mile. She gotpe 
fectly well, has since married, and is now in robust health. I 
should state that there was, in this case, no abscess, and that tl 
patient's general health was tolerably good throughout. This w 
clearly not a case of idceration of the joint : but most probab 
one of chronic iiiflanmiation, or nervous irritation, in the muscl 
and parts sun^oimding the joint. Mr. Yeldham thanked I 
Eansford for Ids very practical paper, and regretted there we 
not more members present to hear it 



EETROSPECT OF 1862. 



Translated from the Allgemeine Horrumpathische Zeitung- 
slightly abridged. By Dr. Meyer, Corresponding Member 
the Society. 
The fifty years* war does not slacken, but maintains itsc 
fresh, and acquires new force. Who knows whether we hi 
not relaxed our efforts and accepted a compromise, as indeed 
sometimes indicated and recommended in whispers among i 
if our opponents were not for ever renewing their challenge 
Who knows whether, satisfied with our Homoeopathy, such as 
was and is, we had not entirely abandoned all progress and t 
effort to increase the productions of our inheritance if we hi 
been permitted to settle in peaceful and friendly relations wi 
our opponents ? Had we done so, it is possible that th 
would openly have acknowledged what they now secret 
borrow from us, and even made the admission that there w 
truth concealed in our doctrines. But could this appare 
felicity have long endured, if each of us had maintained wi 
was most distinctive between us ? Should we not have ma 
to them many little concessions, and, were it even for comp 
ment sake, should we not have admitted that many of th( 
therapeutical principles were not altogether objectionable ? A] 
what would have been the result of this hypocritical reciprocit; 



Retrospect of 1802. 145 

Our opponents might perhaps have learnt something from ns ; 
but, at the very least, we should have introduced impure elo- 
ments into our science, which might have undermined it a 
stability. But the greatest mischief which would have resulted 
from 80 false a fraternisation, would have been the jmralysiiij,' 
influence it would have exerted upon our efforts. We might 
still have laboured, but without the requisite zeal ; we mijjht 
have striven forward, but not with the openness the occasion 
required, and gradually the poison of lukewarmness and indo- 
lence would have penetrated our veins, and Homrjeopathy, in- 
stead of advancing, would have retrograded. 

To begin our retrospect with our litemture : we see how it 
accumulates from month to month, and, if everything wliicli is 
offered to supply the demand is not of great worth and value, 
nevertheless almost every literary effort demonstrates the desire 
of its author to do some real service to our cause. Our journals 
are always full, and manifest that there is no deficiency of an 
earnest power of labour. 

Our book of books is the Materia Medica ; to it belongs the 
first place in the muster-roll. None of his followers have done 
so much for it, and of such noble quality, as the foimder of our 
school He designed the general plan according to which all 
future efforts were directed. To this work every new cycle 
affords its new contribution of material ; the year just passed 
has considerably enriched this department. Among others, we 
have to mention a second proving of Ehus radicans, left 
behind by our deceased colleague, Dr. Joslin, of New York ; a 
proving of Plectranthus fructuosus, by Von Pratobevera ; and 
an arrangement new in our literature of the physiological, pa- 
thological, and therapeutical properties of Gelseminum nitidum, 
by our indefatigable colleague, Constantin Hering. The mani- 
fold and deeply working effects which seem to be peculiar to 
this plant, would well repay the labour of a regular physiolo- 
gical proving. Phosphorus has been proved over again by 
Soige, and the results exhibited in a schema in our monthly 

10 



146 Retrospect of 1862. 

number, which also contained that of sulphur, by Wunnb, ar- 
ranged by Kraehe. In addition to these, Opium has been 
revised by the Austrian Society of Homoeopathic Physicians, 
which is now inviting assistance towards another proving of 
Ledum palustre; while Hoppe has undertaken a proving of 
Chamomilla; and Szontagh, one of Arnica. Fragmentary 
provings of Lycopodium have been contributed by Baum- 
giirtner; and of Veratrum album and Helleborus niger, by 
Lembke. Valuable and welcome as all repetition of provings 
are, yet they are all deficient in the most important atfribute, 
towards which we have akeady, although unfortunately in vain, 
directed attention. The object in repeating a proving is two- 
fold, — the discovery of new powers, and the confirmation of 
symptoms already detected by former provers. But that 
these results may be clearly discerned and become of practical 
utility, it is the duty of those who have undertaken the task to 
indicate clearly and sharply which are the new and which are 
the old and confirmed symptoms. The latter are the most 
important, for such a confirmation of the former symptoms 
establishes their certainty, and would warn off as a " noli me 
tangere " the most rabid erasers and correctors. But if those 
engaged in this work of repeating provings leave this separation 
to the judgment of their readers, the design of their whole 
labour has miscarried, for they will only be laid aside as 
valuable material for future use. If then those who undertake 
this proving over again wish to accomplish some material 
advantage, they should not shun this slight additional trouble, 
which would be their best recompense for their self-devotion. 

Whatds called the purification of our Materia Medica, which 
is said to be so much desired, has been but little attended to. 
Veratrum album alone, which had already been sifted by Gerstel 
has been subjected to the critical examination of the industrious 
Eoth. But here too we miss, with regret, the exposition of the 
final result, — we mean the definite conclusions — what syniptoms 
are to be irrevocably expunged from the Hahnomannian proying, 



Retra9p,rt // IRfii'. 147 

what are to be retained only provisionally, and what ar<' to bo 
regarded as so established that they are never to h(» nn.ddlnl 
with. This determination is as indispensable as we have shown 
it to be in the case of the re-proving of medi<'in<»s, <»thiTwise tin* 
labour bestowed npon such a purgation has ])0<'n ])artiall\' at 
least in vain. At all events such an undertakin<^ is no light 
task, and at all events utterly impracticable for any sin^^'lo i»*r- 
son. We willingly acquiesce in the proposal recently ina<h* by 
Langheinz, that a society should be instituted whicli sh )ul«l 
undertake, by the co-opemtion of its meml)ers, the sifting of our 
Materia Medica. But the primary condition of siu-li an associa- 
tion, from which anything of real use was to be expoct<^d, is not 
the formation of any external fomis of construction, much less 
that there should be set forth a regidar progmmme and a set of 
rales, according to which all citations, and the so-called " o])ser- 
vations of others," should be tested ; but what is wanted is, that 
the pathogenesy arrived at, through the physiological proving, 
should first be taken in hand and thoroughly examined, — and 
this seems to us by far the most important \)tiYt of the umh.T- 
taking. Some kind of programme, however, is rccpiired, tliat 
everyone who wishes to join the association may weigh before- 
hand whether he is competent to fulfil the reciuisitc conditions 
implied in the execution of the task. For nowhere is it more 
necessary to work according to a predetermined arrangement ; 
in nothing could more harm arise from the admission of arbi- 
trary and individual views, than in this work of critical purifi- 
cation. When, however, such a plan is being formed, the first 
requisite of those who undertake the w^ork will be, that they 
regard the thorough sifting of our Materia IVIedica as the most 
important requisition of our science. We may, perhaps, have 
occasion to recur more in extenso to this matter ; at present w(» 
must content ourselves with the expression of this hope, that 
for such an association only those be selected who are known to 
be practical as well as theoretical, and who are thoroughly versed 
in out Materia Medica, and know how to appreciate its gieat 

10* 



1-48 Eetrospect of 1862. 

worth ; but sceptics, or nationalists, as it is the fashion to term 
thorn now-a-tlays, are not adapted to so grave and important a 
task, for in this matter so-called Eeason, as it dealt its strokes, 
niiglit play many a foolish prank and strike out at random. Of 
this we have abundant examples, but at all events we would 
strongly recommend to the attention of those who propose to 
engage in the task, the few but pregnant words spoken by Dr. 
Gross, of Barmen, that hitherto all the attempts at revision of 
provings have consisted chielly in criticising quotations of historical 
or personal grounds, and have dealt with what is external in re- 
ference to the provings tliemselves, or to the persons who were 
engaged in making them, but have neglected to observe the in- 
ternal physiological harmony of the different groups of symptoms. 
Nothing is easier than making erasures, but we openly avow, 
that we should rather retain twenty false symptoms, than see a 
single true and trustworthy one erased : an erroneous symptom 
may mislead us, but to deprive us of a trustworthy symptom is 
to commit an act of robbery upon us and our science. Hence 
it needs the exercise of the greatest prudence and circumspec- 
tion in the choice of means and ways, which are proposed for 
adoption, and in the choice of the men to whose hands we 
commit such sharp-cutting instruments. 

Nor can we report much more progress than in the depart- 
ment we have just referred to in the elaboration of our Materia 
Medica. Among those wliich have appeared in this journal we 
may notice a composition exhibiting the action of Glonoine, and 
a scientific arrangement of the effects of Calcarea and of Aga- 
ricus muscarius, taken from the excellent work of Espanet, 
entitled " Traits m^thodique et pratique de Materia McJdicale 
et de Thdrapeutique," a book we strongly recommend as worthy 
of study by those who are masters of the French language. 

Close upon the territory of the Materia Medica stand the 
observations and experiments in pharmacodynamics. We shall 
begin with the little that has been done in this department by 
homoeopathic physicians. Pemerl gives an account of the 



Rdrmpect of 1862, 149 

action of Atropin, which he employed in the dose of 1-3 2nd 
part of a grain, as a subcutaneous injection in a case of proso- 
palgia. Gallavardin rei)orts upon the efle('ts of l^hosphorua 
upon the nerves of sensation and of motion, upon tlie latter of 
which this medicine exerts a i)amlysing inlhience. Kotli details 
many interesting effects of Curai'o, Nicotine, irEtlur, and 
AlcohoL Severa.1 additional conclusions in regard to Huiti 
Brasiliensis and Cocco are given in tlie letters on Xatnnil 
History which have been published in this journal. l^ahaps 
we ought to include in this list the experiments ma le l)y 
Hoppe with Oil of Turpentine, which he api)lied heated to the 
skin, and produced all the symptoms of a bum. But more 
important than these are the contributions of our allopathic 
brethren to pharmacodynamics, which appi^ared in our nn'nthl} 
part. Most of these were histories of casrs of poisoning. An 
acute case of poisoning with PhospJioincs is detailed by Ehrle 
and Wagner; with Petroleum, by Jelliuek ; with Arseni\ by 
Custer; with StraTnonium, by Flogel, Konty, and Beniliard; 
with Solanum nigrum, by the same authorities; with Chlornft mi, 
by Lamm ; with Upas tieut^, by Mannkopf, who likewise re- 
lates a series of cases of poisoning with Sulphuric Acid, wliicli 
report, besides containing other interesting symptoms produced 
by Sulph^cric Add, makes special mention of its exciting au 
intercostal neuralgia. By experiments, but chiefly upon animal.^, 
the physiological effects of Colchic^tm have been ascertained by 
GoupU; the action of Quassia upon the irritable tissue (irri- 
tablen Grewebe), and oiNatrum muriaticicm, by Hoppe ; of Vcrrr^ 
tnmi mi%de, by Cutler and others ; of Glo7wine, by Demme ; of 
Digitalin, by Stadion (a most valuable work) ; of Caffeine, by 
Biill; of Berherin and Ilicin, by Albers; of Alcolwl, by 
LaUemand, Perrin, and Duroy; and lastly, on the peculiar 
action of the Secale coimutum — a contribution to our pages by 
Theod. Meyer, of Mietau, the substance of which he probably 
obtained from a Eussian journal. 

As yet no inspired prophet has appeared to give us a final 



150 Retrospect of 1862. 

decision upon the contested questions in regard to the dose. 
However, if any one expects that this problem will be solved 
in any such miraculous way, he wiU find himself much mis- 
taken. What is here required is individual effort and indi- 
vidual observation ; any one who shuns these, or believes them 
to be superfluous, is incompetent on this important matter. It 
is only by exact experimentation and persevering and unpreju- 
diced observation, that the reading of this riddle can be obtained, 
while prejudices and prepossessions make the confusion greater. 
Happily, these unhealthy peculiarities disappear more and 
more, and the small party which attempts to stifle the whole 
inquiry by certain phrases, shrivels daily into even smaller 
dimensions. Even they now seek to attach themselves to the 
larger body, aware of the danger to their very existence as a 
party if left wholly isolated. Our science is the sworn foe of 
the materialistic medicine of the present day, and any one who 
admires the latter cannot duly appreciate the former. Smallness 
of dose is one of the essential doctrines and principles of Homoeo- 
pathy, and it is only as to the degree of smallness that there 
can be discussion among us. A previous year has afforded us 
a contribution of both a practical and theoretical character. 
The practical is given in a communication by Eidherr, contain- 
ing a collection of cases of pneumonia, treated by a methodical 
administration of different doses, the conclusion from which 
was, that the most favourable results were obtained from the 
highest — the 30th dilution. The hypothetical reflections and 
objections suggested against this result by Schneider have as 
little weight against the facts as do the four conclusions he 
su))joins succeed in winning our assent. How unwarranted is 
the assumption of Schneider and others, that in acute cases the 
larger doses alone are proper, is demonstrated by Battmann, who 
details a case of Angina membranacea cured by the high 
dilutions; and the cure is so striking, that the action of 
the high potencies of the medicines in this acute disease 
is not attempted to be denied by the leaders of the sceptics. 



Retrospect of 1862. lot 

and only glossed over by an exclamation of siiriiviMo. Aegidi 
also spoke in favour of the high potencies, and att(.>n)i»tcMl to 
explain the nature of their effects by their analo-ry with the 
imponderables. Dr. Grauvogl lias written ui)on the aritlnnetical 
and physical relation of the different dilutions. On tlie otln*r 
side, the deceased Gaspary believed hinis^'lf called to |:ive, for 
the advantage of others, his reflections and experiences u])on 
the doses of the Materia Medica; and in tlicse he makes special 
reference to a conversation with Hahnemann. Eecallinir, how- 
ever, to our minds the well-meaning proverb, "De niortuis nil 
nisi bene," we refrain from passing a judgment upon tlicse 
reflections and experiences of our depai-ted colleague. The 
different views entertained ui)on the question of the dos** which 
were brought before the Vienna Society by its desire, are to be 
found arranged by Eidherr; and lastly, Huber, of Klagcnfurth, 
brought forward proofs (for the most part already cited), derived 
from animate and inanimate nature, of the positive effects of 
infinitesimal quantities. The most important addition, how- 
ever, to this department were the experiments to which Ozanam 
subjected our preparations by means of the spectrum analysis, 
by which he demonstrated the presence of the material, even in 
the higher potencies. It is to be hoped that he will persevere 
with his course of experiments. 

Firmly established as the principles of Homoeopathy are, yet 
we do well to be careful to exhibit in a clearer light how 
entirely rational and consistent with nature are the premisses of 
our system, by a constant reference to the advance of scientific 
investigation and observations in other departments of natural 
science. Towards this, in former years, our greatest contributor 
was Hoppe. Supported upon his well-known vascular theory, 
which was farther elaborated in an article entitled "How 
do the blood-vessels comport themselves in the process of resto- 
ration ?" he treated of the essence and of the limits of Homoeo- 
pathy — of the doctrines of Hahnemann, that the substance 
which produces a disease has the power of curing the same ; 



152 Retrospect of 1862. 

and he strove to establish, in a scientific and highly ingenious 
method, the proper indications afforded by the subjective 
symptoms, and the gradual transition into improvement and 
restoration effected by the medicines. It is certain that this 
vascular theory, the truth of which Hoppe has striven, by 
many experiments, to demonstrate, is calculated to afford con- 
clusions in regard to many physiological and pathological 
processes, and most especially upon the action of homoeopatliic 
medicines and their doses : but to our mind it is, on the one 
hand, too wide, leaving so many ambiguities, and, on the other 
hand, too narrow, while it fails to explain the law of the more 
delicate specific effects in the sphere of the action of the 
medicines. In the meantime, however, our best thanks are 
due to this indefatigable and diligent inquirer, and we hope 
that his exertions and labours will be justly appreciated. In 
the same department we have to mention an article by 
Schneider, of Magdeburg, on the physiology of disease and 
cure. The learned V. Bonninghausen has directed his atten- 
tion, in his solid style, towards the importance of the anamnesis 
in the treatment of diseases, and especially of sycosis. By the 
citation of the medicines which agree with Thuya in the 
symptoms of sycosis, he seeks to enlarge to a considerable 
extent the range of our anti-sycotic remedies. The same 
author presents us with a small work on the indications afforded 
by the aggravation of pain and sensibility induced by move- 
ment or by repose, and thus exhibits the mistake the younger 
Homoeopaths commit when they regard such apparently 
trilling symptoms and distinctions as unworthy of their atten- 
tion. In a separate treatise, entitled " Homoeopathy and Hah- 
nemann," fuU of piety and manly rectitude, Hencke has, in 
logical order, arranged all the doctrines of Hahnemann. Such 
a work as this was the more demanded because the young 
Homoeopathists now-a-days, unfortunately, are unwilling to 
go back to the original sources, and our new guide-books to 
Homoeopathy exhibit the doctrines in a too flashy and super- 



Retrospect of 18r>2. 153 

ficial a style. It is for this reason we wish most emphatically 
to reconunend the work named above. On the primary and 
secondary action of medicines, and on the alternation of 
medicines, Gross, of Barmen, has expressed his opinions. In 
regard to the proposition frequently tliscussed in fonnur years, 
of the rebaptism of Homceopathy, we have this year sucli men 
as Hering, link, and Stem expressing a most unc|iialilied dis- 
approval We, too, exclaim against this anahaptism. 

Let us now dii-ect our attention to the practical departments 
of our science. The first work we here encounter is Kiickert's 
important collection of cases, entitled " Clinical Experiences," 
the first volume of which appeared in the year 1854, and which 
arrived at a provisional conclusion in the fourth volume recently 
published ; whUe the publication of the supplement is only 
retarded by external obstacles. In the meantime, materials 
continue to accumulate, and the year that has just passed is not 
less rich in published records of clinical observations than its 
predecessors. We shall not attempt the particular enumeration 
of each of these, because the task would be too laborious, and 
the space required beyond what we could spare ; so we must 
limit our observations to those narratives of cases and commu- 
nications which are of special importance for the therapeutics of 
certain diseases. Among these, Gerson's experience upon the 
treatment of prosopalgia was most instructive. Unfortunately, 
this excellent work is hitherto incomplete. Schweikert published 
his observations on Cynanche cellularis Maligna, against which 
he recommended anthraxin as the most efficacious remedy. 
Sigmann wrote upon the therapeutics of Leucorrhcea, and 
pointed out the necessity of a local examination. Freytag 
treated of Amblyopia in its pathological and therapeutical 
aspect. Bartl reports upon the treatment of Ophthalmia in 
general and of Egystian in particular, likewise of epilepsy from 
his previous hospital experience. Stern has written upon the 
therapeutics of syphilis ; Clotar MUller, on Migrane ; Quaglio, 



154 Retrospect of 1862. 

upon Laryngismus stridulus and croup ; Buchner, aphoristically 
on the therapeutics of affections of the diaphragm of Bright's 
disease and uraemia ; Boyer, on his treatment of metrorhagia ; 
Kidd, upon fibrous tumours of the uterus ; Mclimmont, upon 
pelvic cellulitis, against which dangerous disease he recommends 
next to Aconite, Veratrum viride. Besides, Kraizell conmiuni- 
cates some successful cases of typhus fever ; and Hirsch describes 
his experience in the treatment of pauaritum, and writes on the 
prophylaxis and cure of abdominal hernias (unterleib Hemien). 
The discussion which took place at the annual congress of the 
Central Association turned upon whooping-cough, asthma thy- 
micum, and epilepsy. Finally, Bruchner drew a parallel be- 
tween the allopathic and homoeopathic treatment of symptoms 
of depression and paralysis, while Bresslauer recommended a 
judicious employment of the water-cure to Homoeopathists in 
certain cases. We have also to mention, as of especial 
worth, a treatise by Proll, entitled "Experiences and Studies on 
Gastein,'* which exhibits the subject from various homoeopathic 
points of view. But one of the most gratifying publications in 
this province was the commencement of a work on homoeo- 
pathic therapeutics, by Bahr, which supplies a long felt want, 
and upon the contents of which we have already expressed our 
opinion. The treatise of Kafka upon the same subject will fall 
to be considered in the retrospect of next year. The following 
is a catalogue of the certain medicines which have been recom- 
mended against certain diseases : — Phosphorus against Icterus 
7)ialignus, by Schaedler and Eavel ; Apis against Morbus 
Brightii and scarlatina, by Teller ; Arnica in poisoning from 
adder's bite, by Kirsten ; Argentum nitricum against chorea, 
by Gross, of Eegensburg; Bryonia as an external application in 
arthritis and rheumatism, by the deceased Perrutz; Glonoine 
against certain forms of brain affections, by Kaeseman and Ganz ; 
Mercurius iodatus against diphtheritic sore-throat in scarlet'fever, 
by Kirsch, jun.; Mercurius corrosives against an epidemic 
dysentery by Ellinger ; Phospholeinum against impotence and 



Retrospect of 1862. 155 

bashfolness in youth, by Altschul ;* Ledum palustre against 
-whooping-cough — a popular remedy in Kussia — by Lembke; 
the differential diagnosis between opium and glauber-solts in 
lead-colic is shown by Gross, of Barmen ; and against incipient 
tabes dorsalis, the rubbing in of the lumbar portion of the spinal 
marrow and brain of a pig ;t besides Gelseminum scmpervi- 
vens against apoplexy, by Hall ; Eumex crispus against lavi/n- 
geal catarrh, by Joslin; Agaricus muscarius against chorea, 
by Clifton and Bloede; Kalmia latifolia against rheumatism, 
by Fretsch ; and Sarcenia purpurea for the rapid cure of small- 
pox, and the avoidance of its scai*s. 

The following articles are rather of pathological than of 
therapeutical interest : — A treatise on the Asthma of IMsoners, 
by Marschall ; an attempt at a more precise demonstration of 
the causes of spasmodic dyspnoea of children and adults; an 
article by Freytag, and an essay by Bohler, upon the recog- 
nition of the existence of Trichia; and one, by Mayerhofer, 
upon angina diphtheritica. Perhaps we should include, in 
this list, an article upon the Mischief of Vaccination, by 
Graham. 

We will not repeat our old complaint that we obtain but 
little from our clinical institutions. Much as this is to be 
regretted, yet at present there seems little prosi)ect of improve- 
ment, for the cause lies in insufficient remuneration of the 
physicians and their assistants. Tlic Praxis axtrca must be 
sought outside the hospital, and thus much is allowed to go to 

* The German text is Impotenz wul Blodigkeit dor Kinder, 
and the literal rendering would be " impotence and bashfulness of 
children." What this means is beyond the conception of the 
translator. 

t Again, we are afraid to trust our senses and reproduce the 
text verbatim et litteratim — Die verriebene portio lumbalis der 
MedtUla spinalis und cerdyt*i Porci gegen beginnende Ruckenmarh- 
Schwind'sucht: it may mean triturations of the spinal marrow 
and brain of a pig, and not that this is to be rubbed in. It pro- 
bably does not much signify what it means. — Tr. 



156 Retrospect of 1862. 

waste within our institutions which, if it could be published, 
would be of good service to our science. So we must content 
ourselves with the little afforded us by our hospitals in the 
year 1862. We have first to mention the continuation of the 
report of the hospital at Gyongyos, by Homer, which contains 
much that is interesting. Then we have, from the industrious 
Eidlierr, a small selection of clinical cases from the Homoeo- 
pathic Hospital in the Leopoldstadt, at Vienna, and the annual 
statistics of that institution; we have likewise a statistical 
report on the hospital at Munich, founded and conducted by 
Buchner and Quaglio ; and, finally, we have the annual report 
on the results of the Leipzig Dispensary, which Clot. Mutter 
subjoined to the treatise on migrim of which mention has 
already been made. 

When we have mentioned that our domestic homoeopathic 
literature has been enriched by a most useful work from the 
pen of Altschul, entitled " Eules for diet and prophylaxis for 
ofi&cers and their horses," Kkewise by Grauvogl, and by a 
second edition of Gullen's " Eepresentation of Homoeopathy," 
we shall have completed our survey of the scientific contri- 
butions received by Homoeopathy in the year that is past. 
This survey would, however, have been much more extensive 
had we not been compelled to confine it to our own literature, 
and thus to exclude the contributions of the foreign periodical 
press, some of which have been translated into German, as, for ex- 
ample, the excellent treatise of Veterinary medicine by Pemisal 
Yet, from what we have detailed, every reader will perceive 
that our little circle of colleagues have not been idle, but 
with much diligence have laboured at the development of our 
glorious science. 

A further proof of this is to be found in the establishment 
of two new homoeopathic periodicals: the one edited by Eidherr, 
entitled " Zeitschrift des Vereins horn. CErzte (Esterreichs," and 
the other, " Journal du Dispensaire Hahnemann de Bruxelles," 
by Mourcmans. Both these journals are, doubtless, welcome 



RetTos^pect 0/ 186 2. 157 

to our reading colleagues. We likewise take tliis opportunity 
to make mention of a periodical publication comnuMict'd in 
1861, imder the title, Annals of the British Ilunueoitathic 
Society, and of the London Homoeopathic 11 Oi^j) it al. This journal, 
which, besides containing reports of tlie tninsactions of tlie 
Society and showing the activity of the London Ilonicoopatliic 
Hospital, possesses other points of interest, affords especially a 
brilliant proof of the earnestness and scientific sjarit wln'cli 
pervades both the Society and the Hospital. In the foi-mor 
there are very full and often most instructive discussions u])on 
the essays read before the meetings ; while, in the latter, besides 
the treatment of the cases admitted, lectures of a pathological 
and therapeutical character are delivered, and thus no pains are 
spared to extend a knowledge of Homceopathy, and to attract 
both young and old physicians. And this devotion is shown 
not to be in vain by the rapid increase of Homceopathists in 
England from year to year, and by the futile attempts made 
by some of the licensing bodies (especially those of Ireland) to 
induce those who are entering the profession to bind themselves 
never, in their whole future career, to tamper with the great 
medical abomination. " E pur se muove ! " we exclaim to these 
petrifying institutions. In France, too, the voice of the de- 
fenders of our science becomes every day louder, and we have 
in view especially the writings of Gallavardin, who, in his work 
entitled " Experiences sur les Malades des Hopitaux instituds 
par TAcaddmie de Mddecine," condemns the tendency of the 
allopathic hospitals, and the frivolity with which, in a country 
so boastful of its civilization, hospital patients are regarded as 
the material for bold experiments. Although such exposures 
may be received by the mass of the profession only with a 
scornful laugh, yet the repetition of truth makes some impres- 
sion on the conscience. Lympha cavat lapidem non forte sed 
80&pe cadendo. 

We have also to notice more activity among the Homceopathists 
of Switzerland, as is shown by their congress at Alten, and their 



158 Retrospect of IQ&2. 

resolution to constitute a society for proving medicines. From 
far distant lands, too, we hear of the greater spread of the doc- 
trines of Hahnemann. From the Colony of Blumenan, in South 
Brazils, we received a report from Friedenreich of the increasing 
adhesion to Homoeopathy in that country. He likewise, in the 
most handsome way, presented to the congress some tinctures 
made from Brazilian plants, and a preparation of Trigonocepha- 
lus jararaca. While from Chili, Garcia Fernandez sends us an 
account of the extension of our system, from Smyrna we hear 
of its progress, by the pen of Cricca ; and among many other 
sources of intelligence, showing the strong hold it has got in 
Melbourne, we may mention the reports of V. Eochlitz. 

If we now survey our own German fatherland, we have not 
so much to tell of the increased extension, of the elevation or 
the augmented reputation which our science has here obtained. 
Before there is much improvement, the prevailing school of 
medicine must work itself clearer of its present gross material- 
ism ; perhaps, however, the day is not so distant, when the 
physicians will again learn to think. In this period of expecta- 
tion we must not let our hands hang idly by our side, but we should 
carefuUy watch all the movements of our antagonists with a 
careful eye, so as to parry with the requisite adroitness every 
attack from whatever side it may come. We have to thank 
this watchfulness and tact for converting into a triumph for our 
cause the movement in Prussia against freedom in dispensing 
medicines. The result of their aggression is that a ministerial order 
has been issued enlarging instead of abridging our liberty in this 
matter. The association for establishing a homoeopathic hospi- 
tal in Berlin has made good progress, and besides the regular 
subscriptions, has been enriched by some handsome benefactions. 
The project has our best wishes for its success. There is some 
mitigation of the repressive enactments against Homoeopathy in 
Bavaria, under the regime of the present more liberal govern- 
ment. 

To the credit of the Bavarian homoeopathic physicians, let us 



Retro^ct of 1862. inji 

record that out of their private means they have contributoil a 
fand, out of which the assistants at Buchnor's Hospital may l»e 
paid a salary. In other respects there is little change in Ger- 
many, and when Frolitz asks, " How goes the time in tlie king- 
dom of legitimate state medicine ?" we might reply, it is liigli 
time for it to begin to reform itself, lest the people should them- 
selves undertake the task : for already the matter is being taken 
in hand by the Social Science Association (volkswii-thschaftliche 
Verein), which has secured greater freedom for physicians, and 
has done away with their dependence upon the apothecaries 
(chemists). Thus Homoeopathy leads the van in the march of 
external liberation. Let us stand shoulder to shoulder and en- 
dure the toil and the struggle. What we cannot achieve by indi- 
vidual effort, must be done by associative strength ; and it was 
a happy idea of our Central Society of Homoeopathic Physicians, 
to send delegates both to the Congress of Naturalists at Carlsbad, 
and the Congress of Social Science, at Weimar. Fischer, of 
Weingarten, Forges, and Hoppe have, with much tact and ani- 
mation, fulfilled this mission. We would express both to these 
colleagues and to the Central Association, our thanks for the steps 
they took on this occasion, and also our wish that the partici- 
pation in the meetings of the two cliief German Societies — the 
" Central Vereiu," and the " Vereinigung der Homoop. (Erzte 
Bheinlands und Westphaliens" — may steadily increase. 

Let us erect a stone to the memory of our deceased ! Alas, 
the number, in relation to the period that has elapsed, is dis- 
proportionately large and lamentable, of loyal and laborious 
men who have been removed from among us. In Germany 
we "have to mourn Von Benniger, Degen, Glass, Hartz, Carl 
Haubold, Perutz, Vincenz Vrecka, who by his efforts on 
behalf of his poorer colleagues has raised his own monimient, 
and Eitter Hofrath Schwarze ; in England, Atkin and Homer, 
of Hull, and Eogers, of London ; in France, the learned Tessier ; 
in Italy, Treppi, Director of the Academy of Homoeopathy at 
Palanno (he was murdered in the open street); in Belgium, Bron, 



160 Some UnjruUished Letters of Hahnemann, 

of Brussels; in Switzerland, Gsell, of St. Gall; in Spain, 
Aloiizo y Pardo, of Madrid ; and in America, the industrious 
provor and accomplished and much loved physician, Dr Joslin, 
of New York, and Eeichelm, of Philadelphia. 

And that we may not close with sadness, we shall turn once 
more from those who are gone to those who still remain, and 
enumerate the names of the men who, to their own honour and 
to the honour of Homoeopathy, have received distinctions and 
decorations. To this number belong Fleischmann, of Vienna, 
who has received the additional order of the Prussian Crown 
(den Preuss. Kronorden); Wank, Physician to the Staff, who has 
received the Archducal Hessian Ritter Kreuz of the first class ; 
Gunther of Langensalza, who has obtained a Prussian Order of 
Merit (Verdienst-Medaille) ; Weber, Physician, to the Queen of 
Hanover, who is appointed Superior Member of the Medical 
Council ; and Stens, of Bonn, who has been named a Member 
of the Sanitary Council of Prussia. 

In conclusion, we may be permitted to refer to the fact, that 
in the year 1862 this journal completed the thirtieth yesiT of 
its existence. May it continue to enjoy the favour and good 
wishes of its readers and fellow- workers ! 



SOME UNPUBLISHED LETTEES OF HAHNEMANN. 

To Dr. Staff. 

KoetJien, August 18th, 1829. 

Dear Colleague, 

I can bear much joy and much grief, but I was quite 
overcome by the surprise I got from so many and so strong 
demonstrations of the kindness and love of my disciples and 
friends, which overwhelmed me, on the 18th of August. And 
now, as I come gradually to myself, and examine one by one 



Some Unpublished Letters of Ilahnrnwnn. 1 fi I 

the gifts bestowed on me by so many kind hearts, I am more 
and more astonished at their magnificence and olo<^iinco, and 
the amount of thought and trouble they must liave cost. 1 
have not deser\^ed them: they are the fruits of ;;enerosity, allV-^- 
tion, and exaggerated gratitude. I know how to vahio their 
worth. I beg that you will communicate my feeble expres- 
sions of thanks to the donors, and retain yourself a ^syowt 
share. 

Now for business. Along with this I send you a lettor 
from good Dr. Hering, and I must request you to enclose tli<^ 
accompanying answer when you write to him, as I liare no 
opportunity; it contains some of the new anti-proric medicines, 
— Alumina, Causticu/ni, Natrum if., Kali, and Conivm. 

I also send you an article fi*om our friend Schmit, in wliich, 
by his desire, I have dropped an observation liere and there. 
For a first publication (so far as I know, ho has not printed 
anything yet) it is done in excellent style. I gave him the 
material for it here, and compelled him, in sjnte of his mo- 
desty, to put it together. We will urge him to give some- 
thing more to the world. God grant it may go well with him 
in Lucca ! 

With regard to Colonel Bock, at least he did me good service, 
for he went from here to Halle, at his own expense, to see 
Professor Schweickert, and made him promise to print my 
article, and send a copy of it to Bnmswick, which accordingly 
was done, with a letter requiring three florins as the cost of 
the printing, otherwise it could not appear. I leave you to 
judge of this conduct, as also of the introduction which the 
Halle gentlemen have thought proper to put before my article, 
the expenses of wliich Bock had also to pay. They seem to have 
considered my article as an offence wliich required justification 
at their hands, and save themselves with diplomatic particu^ 
larity of expression, as if what I had written the publisher did 
not wish laid at his door. AVhat rudeness and vituperation ! 

I send it to you, and recjuest its return ; but I am afraiil 

VOL. m. U 



162 Some UTvpvhlished Letters of Hahnemann. 

that, although they have swallowed the Coloners three florins, 
they will yet not put the thing into the journal, and tlius tlie 
whole design will be frustrated. 

I beg of you, as soon as you see the article in the journal, 
to inform me at once by post, that I may begin the printing 
of the fourth part of the Chronic Diseases : before that I shall 
not stir a step. 

Ah ! how wearisome and hard it is, and how beset with 
obstacles, to bring truth into the world, and overcome preju- 
dice ! If the good did not itself repay the doer by the sense 
of approval from above, and out of the depths of his own con- 
science, then good would remain undone. With warmest greet- 
ings to Eumond, Gross, Franz, and Gerstorflf, I remain. 

Yours most truly, 

Samuel Hahnemann. 

As I am sending you a packet, I enclose the newspaper 
which gives an account of our fete. I do not know where the 
editor got it : not one word did he get from me. I wish the 
authorship of that article of mine to be strictly concealed, 
otherwise it would be immediately attacked, and its contents 
would never be fairly judged. 

To Dr. Hering. 

Koethen, Sept. 13th, 1833. 
My dear, good Hering, 

I wish you joy of being in the land of freedom, where 
unhindered you can work all the good that is in your heart ; 
there you are in your element. To stimulate your zeal for 
our beneficent art would be to pour oil upon fire. You 
ratlier require to be held back that you may not injure yourself 
and reminded of the care due to your health, which is dear to 
all true friends of Homoeopathy. 

When you get Kopp's book and the Algem. Horn. Zeitimg, 
you will read with regret with what revolting impiidence a 
mixture of aUopathic impotence with superficial Homoeopathy 



Some Unpublished Letters of Halinnnann. 1<'»3 

has b^on to be made» and placed above the pure Homoeopathy, 
which is clamoured against as imperfect and insufficient for 

the cure of diseases. In Leipsic, ^^tis the hea<l 

of that sect, and almost all the members of the Homoeopathic 
Society there belonged to it. Twice in successive years 1 had 
warned them privately in a paternal and strongly woixled 
pastoral letter, but they continued to carry on their monstrous 
system, and they would undoubtedly have polluted the Horac^o- 
pathic Hospital which was being erected with this horror, if 1 
had not broken a stick over their heads in the Leipsic paper. 
Then they called out that I wished to limit their freedom of 
independent action, and that I was wrong in fearing tliiit they 
would practise otherwise than purely homoeopathically in tlip 
hospital, and that it was to be public, as a matter of course. 
But they only ventured to publish in various homoeopathic 

journals 's explanation, that it was his plan to 

practise allopathically to a certain extent, which would have 
been a scandal to all the world, and brought our science to 
suspicion and reproach, if I had not launched my thunderbolt 
upon them. A certain Dr. Kutschman advanced to their de- 
fence, whom I drove home ; then followed and 

, who audaciously maintained that bleeding, leeching, 

&c., were indispensable to cure, according to their experience. 
I could have answered, but I did not like, that their deficient 
homoeopathic knowledge was not the- standard of the full 
powers of the system ; that they left many uncured and sent 
them to their grave, whom a true homoeopatliic treatment would 
have rescued. The whole Leipsic Society threatened me with 
open enmity ; however, I let them proclaim their false teaching, 
which they called eclecticism, in the Algem. Horn, Zeitunff, and 
thus they drew upon themselves a public stigma in the eyes of 
all the true disciples of Homoeopathy. In the meantime, in 
the 5th edition of the " Organon," I have done full credit to 
this movement. This scandal caused me, however, much dis- 
tiefls. 



164 Lecture by Dr. Russell 

On the 10th of August I had some 20 of the best disciples 
with me. Bonninghausen was among them, and they all came 
to the unanimous conclusion, that a true Homoeopathist, besides 
giving a simple and carefully selected medicine for a disease 
ascertained with care, would also avoid all palliatives and every- 
thing that would weaken the patient, as well as all external 
stimulation by irritants. God help you in your good efforts, and 

Believe me, yours truly, 

Samuel Hahnemann. 



ON SOME MOEBID AFFECTIONS OF THE NEEVOUS 
SYSTEM.— BY DR EUSSELL. 

Lectuke I. — Epilepsy. 
Gentlemen, 

On looking over the- tables of the diseases treated in this 
Hospital during the last year, I was struck with the small number 
of recoveries entered under the heading "Diseases of the Spinal 
Marrow and Nerves." Out of 27 cases only 2 are returned as 
cured, 1 were much improved, and 8 left very much as they 
entered. The list includes cases of hemiplegia, hysteria, spinal 
irritation, cerebral affections, spinal disease, mental derangement, 
and partial paralysis. It does not embrace epilepsy, as epileptic 
persons are generally able to attend among the out-patients. 
If it had, the statistical returns might have been somewhat 
improved. As these at present stand, we perceive that the 
diseases of the nervous system are really the most formidable 
class we encounter in our practice, and unfortunately this class 
is probably greatly on the increase in this country, and in every 
country where there is a perpetual struggle for existence on the 
part, not only of the working population — whose firataies, when 



an EpUtpsy, 165 

they give way, generally suffer from rheumatism or bronchitis — 
but also equally or more on the pai-t of the upper classes, who 
live by their brain and nervous system, and wlio, besides tlie 
constant strain under which the strongest often succumb, are 
exposed to sudden vicissitudes of fortune. 

I propose to confine my obsef\'ations in tliis lecture to tlie 
subject of Epilepsy. 

It is calculated (Sieveking, p. 80) that tliere are alx)ut 
56,000 epileptic persons in England. Most, if not all of them, 
are under medical care : thus it happens that all practitioners 
of any reputation have almost always one or more cases of 
this disease under treatment. Now, when we consider the 
extreme severity and the long duration of the complaint, the 
distress and anxiety it causes to the relatives of the patient, 
the obscurity and perplexity of its pathology, and the uncer- 
tainty in regard to the proper method of tieating it, we need 
not be surprised that it should be a favourite subject for dis- 
quisition by medical authors, and its literature should be very 
extensivCj It would be out of place here to enter upon an ex- 
amination of what has been written even recently by many 
able and justly celebrated men; but I shall freely use the 
information their works supply, while endeavouring to afford 
the material for a satisfactory reply to the questions which are 
pretty sure to be asked of us when an epileptic patient is pro- 
posed to be placed under our care. 

The first question which we are pretty sure to be asked is, 
" What are the chances of the patient's recovery ? " From what ? 
The term epilepsy represents a very complex and varied series 
of phenomena, and we must, before giving an opinion, ascertain 
the kind of epilepsy with which the person is afflicted. Tliere 
are two very distinct forms ; the one called in the language of 
science epilepsia gravior, the other epilepsia mitior, spoken of by 
French and some English writers as le grand and le petit mal, and 
familiarly .described by one of the out-patients of this Hospital, 
as *' 1m fits and his starts'' Of the true epileptic fit, or falling 



166 Lecture hy Dr, Russell 

sickness, there is no need to give a description. When once 
seen it is impossible to forget. It is not likely to be mistaken 
for anything else, or anything else for it. Sometimes there is 
a difficulty in discriminating between certain forms of hysteri- 
cal convulsions and epilepsy. I believe, however, that a careful 
history of the case will almost always enable us to decide. As 
a general rule hysteria may be safely considered as a peripheral 
affection of spinal and other nerves, while epilepsy is a central 
affection of those parts of the nervous system which are included 
in the encephalon — i. e., the brain proper, the cerebellum, and 
the meduUa oblongata. It is very rarely that we find the 
mind affected in hysteria ; at the same time I have met with 
cases where there was temporary aberration of reason, along with 
violent clonic convulsions, attended with unconsciousness and 
ending with sleep, and yet which were undoubtedly shown by 
the course they took, and the previous history of the patient's 
complaints, to be of a hysterical kind and not to be epilepsy. 
Some writers lay much stress upon the state of the pupil 
as a diagnostic sign: I have no great faith in this. It is diffi- 
cult to get a good view of the upturned eye of a person 
rolHng on the ground and struggling violently, and I have ob- 
served the pupils in hysteria dilate just as much as they are 
said to do in epilepsy. The attacks of epilepsia mitior present 
a great variety ; sometimes they are simply what the term im- 
plies — fits of a kind similar in their character, but much slighter 
in degree than the regular fits, lasting it may be for one or two 
minutes ; sometimes they appear like what might be described 
as a transient blush of the brain (as it were) : there is a momen- 
tary suspension of consciousness, and the slightest possible 
tremor of the hands, and it is over. But there is another form 
bearing an exact resemblance to natural somnambulism, or to 
tlie condition of persons in that curious state known by the 
absurd name of electro-biology, which seems nothing more than 
somnambulism artificially produced. I had for some time under 
my care a patient afflicted with true epileptic fits, who was. 



on Epilepsy. 167 

besides, subject to these attacks of somnambulism in the day- 
time. On one occasion she called upon me at the usual hour 
for receiving patients, and took her place in the waiting-room. 
When she was told by my servant that I was disengaged, she 
rose and walked into my consulting room, sat down, and 
answered questions quite coherently, although her manner was 
somewhat strange and absent. However, I had no idea she was 
unconscious till she suddenly started, and declared she? had 
dropped a piece of money : this she had ceilainly not done in 
my presence, and her purse was in her hand. It was a clasp 
purse and shut. On looking in the waiting-room, the nnjney 
was found on the floor. Immediately after dropping it she had 
passed into the state — a kind of sleep — her actions were no 
longer influenced by direct volition, but probably by the obscure 
dream-memory : by this impulse she walked into my room and 
took her seat, and she answered questions as some persons do 
when asleep. The condition is a most curious and interesting 
one, and well worthy of attentive consideration by psychologists. 
It is wonderful to find a person who is imdoubtedly in a state 
of unconsciousness, and not responsible for her words or actions, 
returning coherent replies to the questions put to her. Tlie 
knowledge of this condition may throw doubts upon the legal 
and moral responsibility of women in some cases of child murder. 
At all events, it is well that we should be acquainted with the 
fact, that persons may move and talk as if they were awake 
and rational, while all the time they are in a profound uncon- 
sciousness, and this suddenly and in the day-time; and in 
circiimstances where the absence of their natural intelligen(»(3 
would not for a moment be suspected by any one unacquainted 
with their habits, or the nature of the malady under which they 
laboured. 

On the frequency and rarity of these intermediate attacks, 
and their lightness or severity, the prognosis of any case of 
epilepsy in a considerable degree depends. It seems to be gene- 
rally admitted, that the frequent recurrence of these slight 



168 Lecture by Dr, Russell 

attacks is more unfavourable as regards the cliances of recovery, 
than the severity or even the frequency of the regular fits. 

If the epileptic patient be under puberty, and especially if 
of the female sex, much is hoped for from the change that 
attends the attainment of that condition. This is a popular 
belief — I fear it is a popular fallacy. That epilepsy often 
occurs at that age for the first time is undoubted, and quite 
in accordance with what we should expect ; for, according to the 
Latin adage, Coitus brevis epilepsia est ; and sexual excitement of 
any kind produces a violent perturbation of the nervous system 
and brings the muscular combinations more directly under the 
influence of the motions and less under the control of the 
will — thus favouring all convulsive actions. But any reason, 
except the deceitful one, that what we wish that we believe, 
there is for expecting an existing epilepsy to be removed by 
the setting in of puberty, I never could see, and I confess my 
own experience is dead against it. On this point I find myseK 
at variance with one of our very few systematic writers — I 
mean Dr. Laurie. In his well-known and very popular work, 
he says : " When the disease occurs before the age of puberty y or 
when purely sympathetic (which, by the bye, epilepsy never is), 
it is generally curable without much difficulty by means of 
homoeopathic remedies." If Dr. Laurie's conviction of the 
early curability of those cases of epilepsy which appear about 
the eighth year, or from that to the tweKth, be derived from 
a sufl&ciently large number of cures, he would lay the profession 
under a serious obligation by publishing the details of their 
treatment, as in this matter his experience is opposed to con- 
current medical testimony, and is in accordance with universal 
popular belief. 

In connexion with the influence of the development of 
puberty, we may glance at the allied question of what is likely 
to be the effect of marriage upon a person affected with epilepsy. 
We know that hysteria is often cured by marriage, and that on 
the whole we are safe in expressing an opinion, that the fact of 



on Epilepsy. 1G9 

a woman being hysterical is no banier to her marriage. Can 
we say so much of epileptics ? This most important question 
has been fully discussed by many able writers. (See Sicvekiiig, 
p. 140.) It presents itself in various aspects to our attcntiun. 
First, in the simply medical point of view, thus : whether is it 
safer for a man affected witli epilepsy to undergo marriage and 
its consequence, or to abstain ? That some cases of epilepsy 
have had their origin in consequence of marriage is a well- 
known fact. On the other hand, it is athrmed by many credible 
authorities, that similar results have followed from enforced 
abstinence. A curious case of the latter description once came 
under my own notice. It was as follows : — A gentleman of 
about twenty-four or twenty-five years of age had his leg dis- 
located at the hip-joint. The dislocation was not reduced, and 
the head of the femur had to make a new socket for itself in 
the ilium. To enable it to do so, the patient was obliged to Lie 
constantly on his back ; otherwise he was in the enjoyment of 
a fair share of health, of a most agreeable disposition, highly 
cultivated, an only son, and of high worldly expectations. In 
this situation he became attached and en^xiged to a lady ; and 
the only hindrance to the match being the state of the limb, he 
impatiently waited the time when he should be able to stand 
and walk, even with crutches. He so far recovered as to do so. 
The marriage-day was fixed, and the guests were invited; 
among them one of the most influential noblemen in England, 
kinsman of the bride. A death in her high circle of relations 
obliged the postponement of the ceremony for ten days. Two 
days before that interval had elapsed the surgeon in attendance 
(along with myself) on the case was sent for in great haste. On 
arriving at the house he found the gentleman in a severe true 
fit of epilepsy, in which he expired. There was no post Tnortcm 
examination, but I had no reason to suspect any other cause of 
death. There was no previous indication of any affection of 
the heart. The particulars of the last fatal struggle were fully 
detailed to me at the time by the surgeon, who enjoys a high 
reputation,. and who gave it me as his opinion that the death 



170 Lecture by Dr, Russell 

was owing to an epileptic seizure, brought on by the prospect 
of his approaching marriage, and the excitement and restraint 
of his sexual desires. As a youth he had been of a very 
amorous disposition, and his accident had prevented him from 
indulging it. 

Admitting the facts of this case and the inference, they 
may be interpreted either for or against the prudence of 
matrimony in the circumstances. It is quite possible that, 
had this gentleman married on the day he first intended, he 
might have escaped his melancholy fate. At the same time, it 
is quite possible that the latent epileptic forces which slum- 
bered in his brain might have been called out into equally fatal 
energy by the consummation of the marriage act, and have 
made his end even more tragical Thus, we are compelled to 
leave the question as to the propriety of the marriage of an 
epileptic person for the decision of the parties chiefly interested. 
All we can say is — it may do good, and it may do harm, and 
it may do neither good nor harm. But, beyond this, if we 
enter upon the general expediency of the step, we have no 
difficulty in coming to a conclusion against it, especially if the 
epileptic be a woman. On this point, we have a clear voice of 
warning, furnished by statistics; for we find that out of 110 
epileptic persons there were 31, or nearly one-third, who had 
epileptic parents, or near relatives, and (what is still more con- 
clusive) 14 epileptic women gave birth to 58 children. Of 
these 58 so born, 37 had died under 14 years of age, and 
almost every one of these 37 had died of some convulsive 
disease. With such facts before us, it may be our duty to 
warn any epileptic who asks our advice on the question of 
marriage, of the dreadful consequences he is likely to entail 
upon his offspring — if the marriage be fruitful. If, however, 
from the age of the parties, or any other cause, there is no 
chance of offspring, this would materially modify our opinion 
as to the expediency of the^'step. When we are asked to give 
our opinion as to the probable course and termination of a case 
of epilepsy, it is likely that we shall be pressed to say whether 



on Epilepsy, 171 

there is great danger of its destroying the mind, and, un this 
point, we should be well prepared to give exact information. 
The prevailing belief, both popular and professional, is, that 
epilepsy is very apt to end in idiocy, or some other form of 
insanity. Now, there is no doubt of the close connexion of the 
two conditions; but Dr. Badcliffe ver}" pertinently observes 
that epilepsy as often begins as ends in madness, — that is, the 
condition of the brain which induces the latter condition favours 
the development of the former, and thus we are apt to be 
misled and to take too unfavourable a view of the prospects of 
an epileptic patient. The fact is, that the subjects of epilepsy 
fell into the hands of what are popularly called the mad- 
doctors. They found their epileptic patients going on from bad 
to worse till they became perfect idiots, and this they ascribed 
to the epileptic attacks, whereas the chances are that the fits of 
these poor creatures were owing to the causes of their fatuity. 
A more careful study of the matter has led to a different 
conclusion, and the result is, that we have one of the most 
recent writers on Epilepsy giving as the result of his induction, 
that " the duration of epilepsy is per se without influence upon 
the mental condition of the epileptic." (Russell Reynolds, 
p. 173.) So far as my own experience goes, it entirely con- 
firms this opinion. I have had the opportunity of observing a 
considerable number of epileptics, as I happened to have had 
one or two veiy striking recoveries in my practice a good many 
years ago, and, in consequence, there was quite a msh of this 
class of patients. At that time, I had the impression that there 
was a progressive deteriomtion of the powera of the mind as a 
rule ; tut I have not found it so. I have watched a good many 
of these 'patients, and, I am sorry to say, I have not, in many 
of them, seen improvement. Still, although the fits have been 
as' frequent and as severe as they ever were, yet the mind, if it 
has not developed, has not retrograded. However, I have 
seldom observed the natural development to go on. Epilepsy 
seems to blight its powers of growth, to arrest the mind in the 



172 Lecture by Dr. Russell 

state it was in, hut frequently to do no more. Out of 64 cases 
of t7^e epilepsy observed by Dr. Eeynolds, in 24, or above 38 
per cent., the intellect was wholly unimpaired ; in 20, or above 
32 per cent., there was only slightly impaired memory for 
recent events ; in 9, or about 1 5 per cent., the apprehension, 
as well as the memory, was impaired ; and in 9 there were 
general confusion of ideas, amounting to imbecility. If the 
whole number — 64 — be too small to permit us to accept of 
the propositions exhibited by these figures as altogether trust- 
worthy, they are large enough to prevent our accepting the 
general notion that epilepsy, if imchecked, passes, as a rule, into 
mental imbecility. In quoting the tables, I emphasized the 
true prefixed to the word epilepsy ; for, probably, one main 
cause of what seems to have been an erroneous impression in 
regard to the effect of epilepsy upon the mind was confoimding 
this disease with cases of epileptiform affections depending 
upon tumours of the brain — in which disease, along with the 
most dreadful convulsions, we have utter prostration of the 
mental powers. 

Another favourite fallacy is, that much may be done by 
attending to the general health. Now, this requires special 
attention, if there be any such derangement of the health as 
is or may be an exciting cause of the paroxysms — e, g. 
intestinal worms — then we may reasonably hope that, with 
their removal, there will be a cessation of the fits. But even 
here, we must not be too sanguine. We must remember that 
" fits," entirely caused by worms or by teething, are not 
epilepsy ; that they are merely peripheral irritation, exciting an 
action on a comparatively healthy central nervous system ; 
which action subsides when this irritation ceases. But in- 
testinal worms may be present in a person predisposed to 
epilepsy, and be the exciting cause of the first attack. If this 
be the case, we have no reason to expect to effect a cure of the 
epilepsy by merely removing the wormsf. Any excitement may 
rouse the latent epileptic condition into active manifestation. 



on Epilepsy. 17»^ 

For example : " I have seen," says Van Swieten, *' a very 
healthy girl of ten years of age, bom of sound parents, who 
never had epilepsy, rendered epileptic for several years, and tlie 
first time she was seized was upon having her soles tickled by 
some girls who were at play with her, some of them holding 
her fast upon the floor to prevent her avoiding the intolerable 
sensation.'* Now, as school-girls have tickled school-girls, and 
school-boys school-boys, from time immemorial, and this is 
the only case on record of such tickling having given rise to 
epilepsy, we may unhesitatingly conclude that although, in one 
sense, the tickling caused the epilepsy, yet it would not have 
done so had not all the materials for explosion been ready 
to ignite upon the application to them of ani/ spark ; and that, 
if instead of being tickled this girl had eaten too many raw apples, 
or any other indigestible food, or if worms had been generated 
in her intestines, she would equally have had her epilepsy. 
It is too late now to attempt to comfort her companions, who, 
from the way the case is told, must have gone down to their 
graves a century ago, with this sin upon their conscience ; but 
it is not too late to point out the absurdity of promoting a 
mere accidental exciting cause into a primary agent in the 
production of this disease. And if we, on finding that a 
paroxysm of epilepsy was first caused in any given case by 
worms, at once jump at the conclusion that all we have to do 
is to remove the worms, we shall commit a grave error, and 
may give rise to unwarrantable hopes and bitter disappoint- 
ment. While, on the one hand, we cannot always give security 
against the recurrence of the fits of epilepsy, by removing the 
exciting cause which originally induced the paroxysms — as, for 
example, irritation of the gums from teething— on the other 
hand, the attacks of the disease may be held in abeyance for 
an indefinite length of time by arresting the propagation of the 
irritation from the circumference to the centre. Dr. Brown- 
S^uard, in his treatise on Epilepsy, quotes from Odier a strik- 
ing case in point. A man had frequent cramps in the little 



1 74 Lecture hy Dr, Russell 

finger of his left hand. The contractions went on increasing in 
extent and frequency ; they by degrees extended to the fore- 
arm, the arm and the shoulder, always beginning in the little 
finger. At last they arrived at the head, and then true fits of 
epilepsy, with loss of consciousness, took place. By means of 
two peculiar ligatures round the arm and the fore-arm, and 
which the man could tie easily, when ie felt contraction of 
the little finger, the attacks were prevented at every threaten- 
ing for two or three years. Unfortunately, one day, he ate 
and drank too much, and being intoxicated he forgot the liga- 
ture, when the initial cramp appeared, and then he had a 
violent fit. From this time the ligature had no more influence 
over the fits ; they became very frequent, and always began in 
the little finger. Paralysis came on, and the patient died in 
coma. On examining the head of this patient, an enormous 
tumour was found in the left side of the brain, below a place 
where the cranium had been wounded long before. "This 
case," adds Dr. Brown-S^quard, " and the facts observed in my 
animals," (i. e. the animals on which he had experimented,) 
" positively show that the apparent outside origin of epileptic 
fits, does not prove that there is not an organic cause in the 
nervous centres." A somewhat similar case is related by Dr. 
Eeynolds, who once witnessed and himself arrested the invasion 
of the epileptic force. " The attacks," he writes, " are always 
preceded by a stabbing pain in the lower part of the belly of 
the left biceps muscle, on the inner side especially. The pain 
is not in the skin, but deeper, and seems to go through the 
arm. If this joint is immediately grasped, so as to press both 
skin and muscle against the bone, the pain ceases in a few 
seconds, and nothing more occurs. If pressure is not exerted 
directly, the biceps contracts and draws up the fore-aim, and 
it requires firmer grasping and drawing up of the fore-arm to 
prevent the attack. The pressure must be exerted on the 
biceps ; the effect is not produced by directing it upon the 
trunks of the nerves, or upon the blood-vessels. Once, while 



oti Ejnhpny, 17"» 

a fit was arrested with my own hand, I ohservod both radial 
and ulnar arteries to be still pulsating. There in no doubt 
about the fact that this pressure does, in some way or otlicr, 
arrest the attacks; it effects more than a relief of pain, which 
might or might not run on into a paroxysm. This I had occa- 
sion to establish once by an attack coming on while I was 
talking to the patient. He said, ' Here it comes/ and Ids face 
betrayed great horror ; his respiration ceased, and his pupils 
dilated widely. I grasped the arm firmly, and the natund 
expression of face returned, the pupils contracted, the face 
flushed, perspiration broke out, and nothing more occurred. 
He did not lose his consciousness. The fits when, as he ex- 
presses it, 'they get past the arm,' are fully developed jm- 
roxysmjs of epilepsia gravior." (Op. cit., p. 94.) 

These two very instructive cases demonstrate the possibility 
of keeping even the worst class of cases of epilepsy in a state 
of abeyance, if we can discover what gives the initiative to the 
paroxysm, and cut this off, so that it does not get into the inte- 
rior, as it were. We gather too, from these histories, the lesson 
of the necessity of a very careful investigation of all the steps 
of the process of the complex series of phenonena called "a fit;" 
and if we see our way, either by mechanical contrivances or by 
medicine, to get hold of the first link in the chain, then we 
become masters of the situation, and may, without imprudence, 
hold out a fair hope of averting the dreadful consequences that 
follow, if the evil is not arrested at its origin. 

I had lately under my charge a patient suffering under 
epilepsia gravior, the first symptom in whose case was a fulness 
of the veins of the back of the neck. I never had myself an 
opportunity of observing this, but it was described to me by the 
mother of the patient, a person of education and intelligence, 
and she informed me that the only treatment that had done her 
daughter any good, during the sixteen years under which she 
had suflFered from the disease, was a course of medical rubbing 
by Mr. Beveridge, of Edinburgh. In this case we may presume 



176 Lecture by Dr, R%issell 

that the exciting cause of the attack was venous congestion of 
the brain. We know from the experiments of Sir Astley Cooper, 
that interfering with the proper circulation within the head 
will produce convulsions. These experiments are so important, 
that it may be as well to advert more fully to them. He states 
that, having tied the carotid arteries of a rabbit, respiration 
was somewhat quickened, and the heart's action increased, but 
no other effect produced. In five minutes the vertebral arteries 
were compressed with the thumb, the trachea being completely 
excluded. Respiration almost directly stopped, convulsive 
struggles succeeded, the animal lost consciousness, and appeared 
dead ; the pressure was removed, and it recovered with a con- 
vulsive inspiration. It lay upon its side, making violent convul- 
sive efforts, breathed laboriously, and its heart beat rapidly ; in 
two hours it had recovered, but its inspiration was laborious. 
The vertebrals were compressed a second time, respiration stopped, 
then succeeded convulsive struggles, loss of motion, and apparent 
death : when let loose its natural functions returned with a loud 
inspiration, and with breathing excessively laboured. In four 
hours it was moving about and ate some greens. In five hours 
the vertebral arteries were compressed a third time, and with the 
same effect, — in seven hours it was cleaning its face with its 
paws. In nine hours the vertebral arteries were compressed for 
the fourth time, and with the same effect upon the respiration ; 
after thirteen hours it was lively. In twenty-four hours the 
vertebrals were compressed for the fifth time, with the same 
result, viz. : suspended respiration, convulsions, loss of motion, 
and unconsciousness. After forty-eight hours, for the sixth 
time, the same results were obtained by pressure. Thus it 
appears, if the carotids are tied, that simple compression of the 
vertebrals puts an entire stop to the functions of the brain. 
The experiment was reversed, the vertebrals tied, and the carotids 
compressed, with similar results. Tieing the vertebrals caused 
the breathing to become laborious, the animal's right ear fell, 
and the right fore-leg was partially paralysed ; in five hours it 



OH EpilejWf. 177 

ran about. The following day, when the carotids were com- 
pressed, it fell on its side, losing all sensation and volition, and 
recovered on withdrawal of pressure. Tlie same results were 
repeatedly obtained. When both vertebral and carotid aiteries 
were tied at the same tiinc, the animal breatlicd no more ; but 
there were thirteen to fourteen con\Tilsive contractions of tlie 
diaphragm, and convulsions of the hinder extremities, and tlic 
animal ceased to exist. (Guy's Hospital Reports, vol. i. p. 457. 
Sieveking, op. cit., p. 196.) 

Although these experiments by no means prove tliat venous 
cerebral congestion, or a defective supply of arterial blood, is the 
cause of epilepsy, yet they establish, beyond a doubt, that such 
a condition of the brain excites convulsions ; and if the person 
in whom this congestion takes place be of an epileptic habit, then 
there can be no question that in sucli a person it will give rise 
to true epileptic paroxysms, and that, upon the relief of the 
congestion, the immunity from attacks will in a great measure 
depend. In giving an opinion as to the danger to life, our at- 
tention should be directed to the state of the tongue — if this 
presents marks of having been bitten, it is affirmed by Schroder 
van der Kolk that there is less risk of a fatal termination of 
the disease. Tlie reason he assigns is this. The most danger 
to life is from violent irritation of the par vagimi. Now he 
found that in patients who had habitually bitten their tongue, 
the capillary vessels in the course of the hypoglossal nucleus 
in the medulla oblongata were of a greater i^roportional size as 
compared with those in the track of the par vagum, than in 
epileptic patients who had been in the habit of biting their 
tongue. The opinions of this celebrated anatomist upon this 
point, which seem to have been suggested by his observations 
on the morbid structure, have received confirmation from the ex- 
perience of practical observers, and we may accept them as so far 
established, and assign to the presence or absence of this symp- 
tom a place among the facts on which we form a judgment of 
the probability of a sudden fatal termination of any given case. 
YOU m. 12 



178 Lecture by Dr. Russell 

It may be well here to enter somewhat more fully into the 
pathology of epilepsy, as undoubtedly the subject has been 
more successfully investigated in recent times ; and if we have 
not arrived at a solution of all the difficulties, we have at all 
events received some useful hints for the direction of our cura- 
tive efforts. 

Dr. Schroder van der Kolk regards the medulla oblongata as 
the centre of general reflex actions, and, of course, as the starting 
point of epileptic and other convulsive diseases. He considers 
that, however remote the seat of the primary irritation may be, 
that in the medulla oblongata is the mine which is always fired 
wherever the train be led from. Hence, he has directed his 
special attention to the investigation of the minute morbid 
anatomy of this portion of the nervous system. The general 
results of his observations are, that in all dissections of the 
medulla oblongata in epileptics, whether or not death took 
place during a fit, he met with great redness and vascular 
tension in the fourth ventricle penetrating into the medulla 
oblongata, sometimes to a considerable depth. Transverse 
sections through the whole medulla oblongata, from beneath 
the jpons varolii to the inferior extremity of the corpora olivaria, 
exhibited the part in the vicinity of the fourth ventricle of a 
much darker colour, usually containing some more distended 
vessels, which then ran either in the course of the roots of the 
hypoglossus into the corpora olivaria, or in the course of the 
vagus, and accessory or in both. Where the degree of redness 
was slighter, it was commonly confined to the posterior half of 
the medulla ; in most cases, however, this hypersemia extended 
into the corpora olivaria, which were often furnished with 
large blood-vessels. Thus, also in the raph^, dilated blood- 
vessels were almost always visible. After Schroder van der 
Kolk had discovered the close connexion between the corpora 
olivaria and the hypoglossus nucleus, he found dilated blood- 
vessels exactly in this course in the first epileptic patient^ 
whose brain he subjected to a microscopic examination. On 



on Epilepsy. 179 

measuring the width of the vessels under the microscope, the 
widest vessels in the course of the hypoglossiis were found to 
amount to 0.230^** (two hundred and thii-ty tliousundth) part 
of a miUem^tre ; in the corpus olivare, to 0.305 niillcmetre ; 
in the vagus, to 0.152 millom6tre. lie connected tliis pre})on- 
derance of the diameter of the capillaries in the course of the 
hypoglossus over that of the vessels in the track of the vagus, 
with the fact that the patient had invariably bitten his ton^^ue 
in the fits. On the other hand, he discovered that in a patient 
who had never bitten his tongue, but in whom the respiration 
was generally disturbed, the vessels in the course of the vagus 
were much larger than those in the course of the hypoglossus- 
Hence, the inference we have just noticed, that inasmuch as 
the functions presided over by the vagus are of more import- 
ance to life than those under the direction of the hyi)oglossus, 
so there is the greater risk in propoiiion as the former, and 
lesser risk in proportion as the latter, are those chiefly affected 
in any given case of epilepsy. However, it by no means fol- 
lows, as an absolute rule, that in cases in which the h^^^oglossus 
is much affected, the vagus is comparatively little so; they may 
both be equally largely diseased, and in such a case, of course, 
the biting of the tongue would give no security ; the respiration 
would stiU be in as much danger of being seriously affected, 
and compromising the life of the patient. 

The extreme difference between the diameter of the blood- 
vessels of the hypoglossus in a healthy subject, and an epi- 
leptic, is as 0.306 to 0.096, i. e. as the 306*-^ part of a thou- 
sandth of a millemfetre to the 96*^ part of a thousand ; in the 
vagus, as the 0.237 is to 0.111. Upon such infinitesimal dif- 
ferences depend health with all its enjoyments, and epilepsy 
with all its privations and miseries ! If this slight dilatation of 
the capillary vessels were in a part exposed to view, — the eye, 
for example, — how easily would they be controlled by applying 
to the part some remedial agent, whose specific operation took 
.effect upon these vessels. Could we succeed in discovering 
Bome substance, whose action upon the vessels of the medulla 

1?-* 



180 



Lectwre by Dr. Russell 



oblongata is equally determinate, we might then indulge the 
hope of curing epilepsy, as we do iritis. 

Before entering upon the consideration of how we are to do 
so, and what substances hold out the best prospect of being 
useful, it will be well to give the analysis of the pathological 
changes in a fit of epilepsy, as these have been suggested by Dr. 
Brown-Sdquard. These he has arranged in such a way as to 
give a tabular view of what he considers to be the causes of 
the various phenomena observed in a paroxysm of epilepsy. 



1. Excitation of certain parts 
of the excito-motory side of 
the nervous system, i. e., any 
irritation by tickling, worms, 
&c. 

2. Contraction of the blood- 
vessels of the face. 

3. Contraction of the blood- 
vessels of the brain proper. 



4. Extension of the excitation 
of the excito-motory side 
of the nervous system. 

5. Tonic contraction of the 
laryngeal and of the expi- 
ratory muscles. 

6. Farther extension of the 
excitation of the excito- 
motory side of the nervous 
system. 

7. Loss of consciousness and 
tonic contractionof thetrunk 
and limbs. 

8. Laryngismus trachaeismus, 
and the fixed state of ex- 
piration of the chest. 



1. The effect of this is con- 
traction of the blood-vessels 
of the brain proper, and of 
the face, and tonic spasm of 
some of the muscles of the 
eye and face. 

2. Paleness of the fiace. 

3. Loss of consciousness and 
accumulation of blood in 
the base of the encephalon 
and in the spinal cord. 

4. Tonic contraction of the 
laryngeal, the cervical and 
the expiratory muscles. 
Laryngismus trachseismus. 

5. Cry. 



6. Tonic contraction extending 
to most of the muscles of 
the trunk and limbs. 

7. FalL 



8. InauflGicient oxygenation of 
the blood, and general ob- 
atadd to the mtraaoe of 



on EpUepty, 



181 



9. Insufficient oxygenation of 
the blood, and many causes 
of the little oxygen absorbed, 
and detention of the venous 
blood in the nervous centres. 

10. Asphyxia, and perhaps a 
mechanical excitation of the 
base of the encephalon. 



venous blood into the chest, 
and special obstacle to the 
return from the head and 
spinal canaL 
Asphyxia. 



10. Clonic convulsions every- 
where; of the bladder, of 
the uterus, erection, ejacu- 
lation, increase of many se- 
cretions, efforts at inspira- 
tion. 
Cessation of the fit, coma 



11 



or fatigue, headache, sleep. 



11. Exhaustion of nervous 
power generally, and of re- 
flex excitability particularly, 
except for respiration. Ee- 
tum of regular inspirations 
and expirations. 

It may be well after this very ingenious analysis of an 
epUeptic seizure, as explained by Dr. Brown-S^quard, to con- 
sider how the same phenomena are explained by Professor 
Schroder van der Kolk. " I think," he says, "we have suflacient 
reason to conclude that the first cause of epilepsy consists in 
an exalted sensibility and excitability of the medulla oblongata, 
rendering the latter liable to discharge itself, on the application 
of several irritants, which excite it in involuntary reflex move- 
ments. The irritation may either be external (irritation of the 
trigeminus), an irritated condition of the brain, or, as is still 
more frequent, it may proceed from irritants in the intestines. 
Acidity, a torpid state of the bowels, &c., are among the 
most common causes ; in adults there may be irritation of the 
intestines, particularly of the mucous membranes, constipation 
and enlaigement of the colon connected therewith ; but above 
all onanism, which acts so very much on the medulla oblongata, 
and moat be r^arded as a very frequent cause of epilepsy. 



182 Lecture by Dr. Russell on Epilepsy, 

Amenorrhoea, chlorosis, plethora of the uterus, hysteria, &c., are 
also to be enumerated. 

" In the commencement, there is stiU only exalted sensibility. 
If this can be removed or moderated, the epilepsy gives way 
of itself, especially if the sensibility (i. e., over-sensitiveness) is 
not renewed by remote causes. But if the disease has already 
lasted long, organic vascular dilatation (as before described) 
takes place in the meduUa oblongata, the consequence of this 
being that too great a supply of blood is detained there, and the 
ganglionic groups are too strongly irritated, too quickly over- 
charged. Every attack then becomes a renewed cause of a 
subsequent attack, as the vascular dilatation is promoted afresh 
by every fit. Lastly, increased exudation of albumen ensues 
from the now constantly distended vessels, whose walls at the 
same time become thickened, producing increased hardness 
of the medulla, subsequently passing into fatty degeneration 
and softening, thus rendering the patient incurable." 

Although, as we perceive, these two eminent pathologists do 
not entirely agree as to all the causes of epilepsy, yet there is a 
considerable correspondence in their views as to the different 
steps of the process which constitute a paroxysm ; and we may 
fairly assume that, if we have not arrived at the whole truth, 
we are at all events approaching the solution of what has 
been long regarded as one of the most inscrutable maladies 
which afflict our race, called of old the morhus sacer, as being 
a direct manifestation of demoniac power, and requiring nothing 
short of miraculous intervention to deliver its miserable sub- 
ject from the mysterious and malignant influence which held 
it in possession. Now that the mystery is so far solved, we 
may hope that more enlightened therapeutics may enable us 
to achieve greater triumphs over this terrible malady ; but I 
must reserve for my next lecture a consideration of this part 
of the subject. 



183 

CASES TREATED WITH HIGH DILUTIONS. 
By S. Teldham, Esq., Surgeon to the Hospital 
The question of the positive and comparative efficacy of the 
high dilutions of medicines has for some time occupied a good 
deal of the attention of liomoeopatliic practitionei-s. Any- 
thing tending, in however slight a degree, to the solution of 
this question, cannot fail to interest the profession. Clearly, it 
can only be solved by the careful obsen^ation and publication of 
clinical facts ; and it is manifest, for reasons which need not 
be particularised, that no place is so well calculated for eliciting 
those facts as the wards of a hospital. Actuig under this con- 
viction, the writer has commenced a course of exijeriments with 
the patients under his care in the Hospital. The plan adoptedi 
thus far, has been to conmience with the 200th dilution, and to 
continue it as long as the welfare of the patients seems to 
justify such a course — i. e. until that dilution has had a fair 
trial, and has failed in producing the expected results. The 
200th dilution has been selected as being a fair medium stage 
in the scale of high dilutions, and because it would seem to be 
the one much relied on by those who use the high potencies. 

The writer is anxious, in this matter, to hold the place of an 
impartial inquirer ; and, in order that he may not influence tlie 
opinions of others, he purposely withholds his own impressions 
and restricts himself, for the present, simply to a detail of the 
cases as they are recorded by the house surgeon. 

The first batch of cases is now presented to the reader, 
and, if this inquiry is continued, others will, from time to time, 
be published. 

It should be stated that the medicines employed are pre- 
pared by Messrs. Leath and Boss, the Chemists to the Hospital. 

Case 1. 

Sore Throat — Anna Stevens, aged 14, admitted October 

Ist, discharged October 18th. Of a strumous constitution. 

Two years ago caught cold, had sore throat, and has been 

affected with it ever since. The tonsils are very much enlarged^ 



184 Cases treated with High Dilutions. 

evidently chronically so — they nearly meet and fill the isthmus 
faucium, and greatly impede deglutition. She has a very 
peculiar blowing or barking cough — or rather, a spasmodic 
expiration, which seems to be associated with the state of the 
throat. Her general health is good. The house surgeon pre- 
scribed Acom'te 3 and Mercurius 3 alternately every second hour. 

From the 3rd, on which day I visited her, until the 7th, she 
had Saccharum lactis. At the latter date she is reported as 
having less inflanmiation of the tonsils, and as having lost the 
peculiar expiration above described ; but she complains of pain 
in the abdomen and has no appetite. 

Pulsatilla 200, a drop ter die. 

Oct. 9. — The pain continues, and is of a shooting kind. 
Mercurius Corrosiv. 200, a drop ter die. 

Oct. 12. — The pain in the abdomen has disappeared, but she 
complains again of the pain in the throat. 

Hepar Sulphuris 200 : ter die. 

Oct. 14. — A recurrence of pain in the abdomen, with sour 
taste in the mouth of a morning. 

Mercurius Corrosiv. 200 : ter die. 

Oct. 16. — No pain. Feels quite well. 

Case 2. 

George Carle, aged 37, rheumatism. Admitted October 7; 
discharged October 19. 

On admission says : — He got wet a fortnight ago on going to 
work, and worked in his wet clothes all day. In the evening he 
was seized with pain across the shoulders, and in all his limbs. 
Since then he has been getting gradually worse ; he has now 
pain in all the joints, but more especially in the ankles and the 
great toes : these joints are swollen, tender to the touch, and 
painful on movement. He has profuse perspirations. Pulse 
86, skin cool; tongue clean; bowels rather costive. Sleep 
much disturbed by the pains in his joints, which are worse at 
night. Heart sounds, normal. 

Aconite 200, a drop every four hours. 



By Mr, YMham. 185 

Oct. 5th. — Better, except in the feet, ^vhere the pains are 

woise. 

Continue Aconite 200. 

Oct. Vth. — ^Is worse; pains in feet more acute. Had a 
sleepless night Pulse 90. 

Bryonia 200, a drop every three hours. 
Oct. 9tL — Feels better. Pain almost gone from the right 
foot, and is now confined to the dorsum of the left foot, which 
is tender and swollen ; skin cool. Pulse 80. 
Continue Bryonia 200. 
Oct. 12th. — Pain in left foot easier, except when attempting 
to put it to the ground. No pain last night. 
Continue Bryonia 200. 
Oct. 16th. — Much better in every respect. Is up and dressed, 
and can stand without much difficulty. 

Continue Bryonia 200. 
Oct. 19tL — ^Well. Discharged. 

Case 3. 
Mary Foot, aged 40, sore throat. Admitted October 2 ; dis- 
charged October 20. 

In April had rheumatic fever, and has not felt well since. 
On Sunday fortnight was seized with cold in the head, from 
sitting in a draught. Two days after she was laid up with 
bronchitis, and has been ill with it since. 

On admission, she complains of aching all over ; cough of a 
fotiguing character all day, with dyspnoea ; dull aching pain 
between the shoulders ; throat sore ; tonsils inflamed, swollen, 
and ulcerated ; deglutition painful ; pulse quick ; no appetite ; 
thirsty ; respiratory sounds normal. 

Aconite 200, a drop every four hours. 
Oct. 4th. — Pulse 100; had sleepless night, from pain in 
throat ; cough looser ; less pain between shoulders. 
Continue Aconite 200. 
Oct. 5th. — Pulse 90; restless night; tongue foul; tonsils 
free of ulceration, but stiU red and inflamed. 

Belladonna 200, a drop every four hours. 



186 CoMS treated with High Dilutions, 

Oct. 7th. — Had rather better night ; to-day throat more 
painful, and deglutition more difficult. 

Hepar Sulphuris 200, every four hours. 
Oct. 9th. — Throat better ; less pain after swallowing. 

Continue. 
Oct. 12th. — Much better; throat well; has pain from 
epigastrium to back ; worse after food ; tongue white. 
Pulsatilla 200, a drop ter die. 
Oct. 14th. — Pain greatly mitigated, felt only occasionally. 

Continue. 
Oct. 19th. — Well, as regards the foregoing attack; has 
swollen knees from chronic rheumatism. 

Ehus Tox 200, ter die. 

Oct. 25th. — Discharged well; with the exception of the 
knee pains. 

Case 4. 

Edward Dunn, aged 4 7, impetigo. Admitted October 5th ; 
discharged October 25th. 

About a month since an eruption appeared on the outer 
side of the right arm, and on both feet and legs. It is of an 
impetiginous character, scabby, mealy, rough, red, and raised 
on an inflamed base ; it itches. 

Ehus Tox, 200, ter die. 
Oct. 13th. — The scabs cleared off the arm. The eruption 
looks much better, and itches less. 

Continue. 
Oct. 19tL — Continues to improve; arm almost well; feet a 
little swollen. 

Continue. 
Oct. 26th. — Has been progressing favourably, but to-day 
there is a little more roughness and redness on the arm. The 
other parts that were affected are quite well. 
Sulphur 200, ter die. 
Oct. 28th. — ^Discharged cured. 



By Mr, Yeldliam, 1S7 

Case 5. 
Jane Bonnar, aged 52, gastric irritation. Admitted Octo- 
ber 22nd ; discharged November lOtli. 

Was in Marylebone Infinuary for bronchitis for six montlis. 
She left in May. Since then has been badly housed and fed. 
Three weeks ago was seized witli pain in stoniacli, and vomiting, 
which has continued ever since. Slie vomits cventhinj' alK)ut 
a (j[Tiarter of an hour after taking it ; the ejected matter being 
sour and bitter, and green looking. Has great pain in tlie 
stomach after taking food, and the epigastrium is very tender 
to touch. Anorexia ; thirst violent ; headache woi-se at night ; 
has a little cough ; bowels costive. 

Since the vomiting commenced she has been living in a 

house where the sewers were open, and painting was going on. 

Tinct. Aconite 200, ter die. 

Oct. 26th. — Has not vomited since beginning the medicine. 

Exquisite tenderness in cardiac region on pressure ; pulse 

hard and incompressible. 

Continue Aconite 200. 
Oct. 3 0th. — ^The previous symptoms have disappeared. There 
is catching pain under the lower ribs of the left side, shooting 
up the breast ; worse in breathing and movement. 
Bryonia 200, a drop every four hours. 
Nov. 2nd. — ^Well, except weak ; takes and enjoys food. 
Nov. 4th. — Saccharum lactis. 
Nov. 10th. — Discharged cured. 

Case 6. 
Jane Staines, aged 50, hepatic irritation. Single, a cook. 
Admitted October 22nd; discharged November 4th. 

Thirteen days ago was seized with vomiting. Her ejecta 
were composed of " blood and matter." Some hours after the 
vomiting, was seized with pain in the region of the liver, which 
has continued ever since. 

On admission, complains of dull pain in right hypochon- 
dricun, worse after movement. If she moves, has sharp, shoot- 
ing pain through the side ; headache ; pain in temples ; heavi^ 



188 Cases hy Dr. Drury, 

ness over the eyes ; appetite fair ; tongue slightly coated ; 
bowels have been kept open by purgatives. Probably had 
calomel from her medical attendant. The mouth feels sore ; is 
blistered, and there is a slight mercurial foetor ; very weak and 
prostrated; pulse 84; skin cooL On percussion, the liver 
does not seem enlarged, but is tender on pressure ; stools are 
generally dark-coloured; has large, foul, chronic ulcers on 
both legs. Twenty years ago had jaundice. 
Bryonia 200, a drop ter die. 

Oct. 26th. — Much the same. 

Aconite 200, ter die. 

Oct. 28th. — Better altogether; pain in side much better, 
but still there. 
Continue Aconite 200. The ulcers on the leg to be poulticed. 

Oct. 30th. — ^Altogether much better; no tenderness on 
pressure in region of the liver ; tongue clean ; no thirst ; pulse 
normal. 

Nov. 2. — Continues to improve ; general health pretty good ; 
ulcers healing well. 

Saccharum lactis. 

Nov. 4th. — Quite well, except the legs, which are granu- 
lating healthily and rapidly. Wishes to go home. Dis- 
charged. 



CASES BY WILLIAM V. DEUEY, M.D., M.E.LA. 
Physician Accoucheue to the Hospital. 

Case 1. 

Dysmenorrhcea, — J. F., a servant, aged 24, admitted as out- 
patient July 12, 1863. 

Has been out of health for the last three months ; menstrua- 
tion returns every five or six weeks. The quantity is large, and 
is passed in clots ; suffers during the period from bearing down 
pain ; complains also of pain in head, with pressure in eyes ; 
also pain below ribs, increased by stooping, believed to be 
flatulent. 



CaSMhyDr.Ih'ury, 189 

Sepia 30 in solution twice a day for three days; 
then to stop three days, and repeat. 
July 26tL — Feels better, but still feels the pain below ribs. 

China 6-30, I twice a day. 
Aug. 1 Bth. — Called to report liei'self well. 

Case 2. 
Change of Lift, — Louisa D., age 44, admitted as out-patient 
June 28th, 1859. Complains of violent pains in back of 
head. Vertigo aggravated by movement. This is of daily occur- 
zence: the pain in head is a heavy bruised pain. Menstniation 
stops for two or three months : about a month ago menses were 
present ; they had continued on and ofif for five or six weeks. 
Lachesis 6-30, \ twice a day ; Pulv. ij. 
July 5th. — ^Much better, slight giddiness, but weight in back 
of head and neck is nearly gone. 

Lachesis 6-30, \ twice a day ; Pulv. ij. 
Omit medicine if better. 
July 12th. — Omitted medicine when she felt better, but re- 
sumed it again, as there was some return of headache ; and 
again obtained relief. 

Continue Lachesis. 
July 26th. — Is now generally better, had omitted the medi- 
cine for four days, but resumed it again on feeling some return 
of headache. 

To continue Lachesis if any return of symptoms. 
Case 3. 
Headaches, Jkc; scanty menstruation. — C. M., age 36. Mar- 
ried, has two children; youngest 12. Admitted as out-patient 
July 5, 1859. Suffers from headache before and during men- 
struation ; there is vomiting and pain at the period. Suffers 
from debility. Complains of pain under left ribs. Constipa- 
tion. Menstruation scanty, often absent. 

Pulsatilla 6-30, J twice a day; 
stop three days ; repeat twice. 
July 26th. — Burning pain over eyes. Sour risings. Beating 
in head. Bloated feeling after food. 



190 Cases ly Dr. Drury, 

China 6-30, 9 3 a day. Pulv. iij ; discontinue if better. 
Aug. 16th. — At first much relieved, but on stopping me- 
dicine some return of symptoms. 

Eept. China. 
Sept. 13th. — Improving. 

Phos. Acid 7-20, \ 3 a day. Pulv. ij. 

To be followed by China. 

Case 4. 

Cerebral disturbance. Convulsions. — Eachael S , aged one 

year and six months, admitted as out-patient July 19, 1859. 
Five or six weeks ago had convulsions ; during fit, and while 
it is threatening, right hand is contracted. Cheeks flush, then 
get pale, child trembles. 

BeU. 6-30,j3aday. 
July 26th. — Nights very restless; screams out suddenly at 
night ; sleeps with eyes partially open. 

Bell. 6-30, I 3 a day. Pulv.ij. 
Aug. 9. — Much better;, perspires very much about head; 
:jontinues to get thin. 

Acid Phos. 30, J three times a day, six days. 
Aug. 30th. — Child is all but well; is still, however, weak. 
Calc. Carb. 30, J three times a day. 

Case 5. 

Diarrhoea after food. — ^Amelia H , age 1, admitted as 

out-patient July 26, 1859. 

A weak and sickly-looking child ; has had diarrhoea for three 
weeks; has had thrush for nine days; evacuations are dark 
green, and are generally passed after taking food, which also seems 
to produce pain. 

Ferrum 6-30, \ every four hours. Pulv. y. 
This was followed by Calcarea Carb. 6-30, i 3 a day. Some 
more Ferrum was given. 

Aug. 2nd. — Improving; takes her food well; has pain in 
stomach at night. 

Gale. Garb. 6-30, J 3 a day. 



Cases hy Dr. Drury. J 91 

Aug. 9th. — Much better, but Iiad some diarrlura throuyli the 
week; the evacuations have been sour, grei*iii.sli antl white ; hist 
two rather better. 

Cham. 30, thrco times ii <lay. 
Aug. 16th. — Improving. Takes her fond well; but bowels 
still show a tendency to act after taking it. 

Ferrum 30, three times a day. 
Aug. 30th. — Child is reported well ; looks vciy much better; 
is getting fatter and stronger. 

Case G. 
Eczema. — Eliza T., age 68, admitted as out-patient July 
26th, 1859. Has suflfered more or less for years from ill 
health, but for last three months has suflered much from an 
erythematous patch of about ten inches in length on left leg. 
There is much itching. There are also red patches on fingers, 
with purulent vesicular eruptions. She has herself taken 
Shus, Aeon, and Belladonna. She has a wet rag on leg. 
Phos. 6-30, 6 twice a day. Continue. 
Aug. 9. — Eather better, forefinger of right hand is bright 
red and suppurating over knuckle. The itching varies. 
Continue Phos. 30, twice a day. 
Aug. 23rd. — Improving. 

Continue Phos. ; but to stop every alternate three days. 
Sept. 13th. — Improving, but has a few spots on the right leg : 
the eruption seems to get more round left leg. 

Continue Phos. 
Oct. 4tL — Improving, still much itching, stiU uses the 

wet rag to leg. 

Continue Phos. 
Oct. 25th. — Continues to improve steadily. 

Case 7. 
Ba/iMda, — ^Louisa W., age 28. Admitted as out-patient 
July 5, 1859. States that about six months ago she noticed 
a swelling in mouth between tongue and lower jaw. Continuing 



192 Cases hy Dr. Ih^ry, 

to increase in size, she sought allopathic advice. The tumour 
was opened and burned with caustic, without effecting a cure. 
It is now about the size of a small walnut. Her health has 
been moderately good, except for some leucorrhoea, attended 
with smarting ; and that she suffers from pain the first day of 
menstruation. 

Carbo Vegetabilis 2-30 daily for six days ; stop three ; 
then repeat. 
July 12th. — She comes sooner than expected, as she says 
the swelling is larger, and she feels sick, and trembles. 
Aut. Crud. 6-30, \ 3 a day. 
This was followed by Carbo AnimaKs 2-30, four doses. 
July 26 th. — Swelling has increased in size. 

Mercurius 6-30, J 3 a day. 
This treatment was continued till September 13, without any 
apparent change ; but as she was suffering from pain during 
menstruation, she was given Pulsatilla 30. 
After this she had Thuja, Ehus, and then Mercurius 4-200, 

3 daily ; stop three days and repeat. 
Nov. 22nd. — Eanula smaller, nausea, wheezing breathing, 
soreness in chest, and hoarseness. 

Hep. Sulph. 9-30, /o 3 a day; Pulv. ij. 
Nov. 29th. — Chest better, but is suffering from headache. 

Kahnia 30. 
March 13th. — ^The tumour has continued to decrease in 
size, and is now about the size of a pea. 

The attendance at the Hospital had ceased from November 
to the following March ; but the improvement that appeared to 
have commenced under Mercurius 200, steadily continued, and 
by April 24th all trace of ranula was gone. 

These cases have been selected more from their being some 
of the earliest in the case-book, than from any special interest 
attaching to them ; they are rather imperfect in detail, as the 
notes were taken more for the sake of reference to the medi- 
cines given, than with a view to their publication. 



A CASE OF EXTRA-UTEBINE GEST^\ riOX. 

Bt Mr. Leadam. 

Mb. Pbesident, 

I bring the following case before tlie British Ilomojo- 
pathic Society, in the hope that it may be considei-ed worthy of 
being recorded in its transactions, as one of those rare casos 
which give additional interest to the study of gestation, as well 
in its abnormal as its normal progress. Such cases are instances 
of the natural history of disease, and are at all times instruc- 
tive, if not remediable. They are aids to diagnosis in other 
obscure and diflBlcult cases, and indicate the eflforts nature in- 
stinctively makes to restore the equilibrium of the natural 
processes, when accident or injury has disturbed them. Again, 
they excite a great amount of reflection upon the means 
which it might be possible to adopt in similar cases, with the 
hope of releasing the mother and the child. The members of 
the Society will, I am sure, not be slow to appreciate any 
advantage which the recording of such a case may bring. 

I esteem it a fortunate circumstance, that in a case of such 
rare occurrence, and of such an abnormal and complicated 
character, I should have the testimony of two highly-respected 
members of this Society, as to the correctness of the descrip- 
tion I have given of the case. The lady was a patient of the 
President's, to whom she was known from her earliest child- 
hood, and also to Mr. Cameron, who, at various periods had 
attended her when Dr. Quin was ill or absent from home. 
Mr. Cameron was also present with the eminent physician- 
accoucheur, and professor of obstetrics, and his son, who had 

VOL. ni. 13 



194 Mr, Leadam on Extra-Uterine Gestation. 

been several times consulted at the post-mortem examination, 
which was performed by Mr. Eobinson, at that time house sur- 
geon to this Hospital. My professional services were engaged 
by Dr. Quin for the period of accouchement; but several 
unusual symptoms showing themselves before the time of 
parturition, Dr. Quin became desirous that an examination 
should take place, and he finally associated me with himself 
in the conduct of the case, and I had thus the advantage of 
his counsel and co-operation in the treatment of this interesting 
case, in which the most complicated disturbances arose at 
different times, in various organs, from excessive sympathetic 
irritation during the progress of the latter months of the gesta- 
tion. The following history wiU show the progress of the case. 

H. M., aged 32, had been for some time in indifferent health 
previous to July, 1862, the catamenia then appeared, and ter- 
minated on the 12th of that montL At the end of July, she 
thought herself pregnant from the similarity of her sensations 
to those at the commencement of former pregnancies. Had been 
married eight years, and had several miscarriages, and once a six 
months pregnancy, five years ago. On the 10th of August, the 
catamenia were due, but did not appear. About this time, when 
driving a pair of ponies in the country, they took fright, ran 
away, and although the pony-carriage was dragged into a ditch, 
she was not thrown out, but shaken about and frightened. A 
slight haemorrhage occurred per vaginam, for which she was 
confined to the sofa. Early in December quickening was 
said to be felt, and occasionally, after that, for two months, 
gentle but distinct movement was noticed. Before this, how- 
ever, attacks of flatulent colic were experienced. In conse- 
quence of the troublesome persistence of these, she came up 
to London, in order to be under the care of Dr. Quin, and as 
an occasional flow per vaginam took place, she was confined to 
the sofa. 

On January 27, I first saw the patient with Mr. Cameron, 
and made the following report : — " The patient is in constant 



Mr. Leadamon Extra-Uterine Gestation 195 

dread of miscarriage, haa occasional flow per vnginam on 
any exertion or incautious movcmcut innw tlic sufii. Has 
repeated attacks of flatulent colic. Eats mcII. The ahdu- 
men is enlarged to rather less than its usual size at this 
period of pr^nancy, but the eulargeinent is not central and 
ovoid as it should be, but chiefly on the left side, extend- 
ing to the umbilicus, beyond which, to the right side there is 
nnnsnal resonance. The patient thinks she fuels occasionally 
slight foetal movement, but it is very gentle. The nioveniont 
is not perceptible to any other person. The bowels are kept 
open by a teaspoonful of castor oil taken every other day. 
The evacuations are large." In Felmiary the same conditions 
existed, but there was increase of size; some tenderness on 
firm pressure, and slight movement was felt by the medical 
attendant but only once. I thought I had discovered a sub- 
dued placental briiit once or twice thi'ough the stethescope, 
but the foetal heart was not distinguished. Dr. Quin having 
charge of the case, asked me to see her again in March, when 
some sanguinolent discharge per vaginam took place, of 
a grumous character, and which continued for a week. It 
appeared to result from a sudden impulsive movement in rising 
to greet a visitor. At this period unduly large evacuations 
were passing from the bowels, of a normal consistence and 
appearance. The abdomen ceased to enlarge, but flatulent dis- 
tress increased ; the urine was loaded with lateritious deposit ; 
the appetite variable ; there was midue hardness of the abdo- 
men, and the outline of a fcetus was diagnosed once or twice 
when the colon was less distended with air, wliich at other times 
obscured it The entire colon seemed enormously distended with 
air, and its transverse portion was very tender. There were 
frequent eructations, and the appolito n)oro fanciful. At the 
end of this month the alvine evacuations continued wonderfully 
large in quantity, but not at all of the nature of diarrlicea. 

April 3rA — Good Friday. — Eat some salt fish which dis- 
agreed, and produced a violent attack of flatulent colic. The 

13* 



196 Mr, Leddam on Extra-UteHne Oestation. 

stomach contiilued in a state of great irritability for three 
weeks, with great general distress from colics, sleeplessness and 
febrile exacerbations at night, for which aconite was given. 

The treatment for the foregoing conditions was according to 
the symptoms. Niuc Vomica for the flatulency; Pulsatilla, 
Belladonna^ HyoscyamuSy Yeratrwm, Sdhina, Con/mm, for the 
grumons discharge and pain in the left ovarian region, &c. 

On the 10th of April, one of the physician-accoucheurs 
formerly referred to, saw the patient, and gave his opinion, that 
however great the sufferings were from these sympathetic symp- 
toms, it would be better to wait the normal period of pregnancy 
without interference. There was, at that time, a grumous, dark, 
and occasionally red discharge per vaginam on and off for two or 
three weeks. The symptoms of gastric irritation continued, as 
well as the tenderness of abdomen, of the left side chiefly, and 
the tympanitic distention, flatulent colics, &c. The urine was 
often deep coloured and turbid, loaded with a brick-dust sedi- 
ment. Solid food was refused; chicken panada and soups 
with seltzer water and champagne formed the chief diet. 

On the 7th of May, the full time of pregnancy had expired. 
A careful exploration of the uterus was made. The os uteri 
was found very high up, but by great effort it was reached, and 
found patulous and relaxed, but the inner os closed. The sound, 
carefully used entered the uterus, but on attempting to turn it 
a resistance was felt. The attempt was inunediately discontinued. 
There was at this time milk in the breasts, which by pressure 
appeared at the nipples. On the 9th of May, the other 
physician-accoucheur saw the case. After a careful examination, 
he declined to give a positive opinion till after another visit. 

On the 11th of May, he saw the patient again with me. 
At this time it was distressing to her to lie on either side : it 
always produced an attack of flatulent colic. The case was 
very dark, no one could say what was the real state of things ; 
there were symptoms of pregnancy, but no child could be 
felt in the uterus. Air in the intestines seemed to predominate, 
yet there was a solid mass beneath the air occupying the left 



Mr, Leadam on Extra-Uterine Oestation. 197 

side of the abdomen. The countenance ^ras mucli fallen away 
and exhibited great distress — general attenuation. She wixs 
unable to bear more than just to be earned from the bed to the 
80& Sickness was now frequent, the bowels irregular, and a 
persistent febrile condition. 

After this examination, on the next day there was an accession 
of inflammatory fever — ^the skin burning hot Incn*asod thirst 
and tenderness of the abdomen; the hands burning, pulse 120. 
Exacerbations at night, sleeplessness and a diarrhoea set in 
of blacky offensive, at times sanguinolent, and putrescent evacua- 
tions. This lasted a fortnight, during which great exhaustion 
occnnedy and the evacuations appeared mixed with albuminous 
and membranous fibres, but so intermingled and so offensive 
that the nurse would not separate them. I saw them at times, 
but could not well get hold of the matters by the pieces of stick 
which I used. At the end of a fortnight, about four inches of 
a cord-like tubular structure was passed, as weU as a buucli of 
firinge-like matter. These were washed and taken to St. George's 
Hospital Museum, and there submitted to the microscope, 
and declared to he intestinal cast and a mass of hlood vessels. 
After this, the evacuations became more natural, of a pale brown 
colour, and the diarrhoea ceased. One teaspoonful of castor oil 
was given, with a view to the expulsion of any more of the 
membranous matters there might be, and of some of the air 
from the intestines. It caused sickness and increased exhaus- 
tion, but brought nothing abnormal away. 

It was at this time suggested by me that the tubular portion 
which had come away was a part of the umbilical cord, and the 
fiinge-like tissue a part of foetal placenta, and that an ulceration 
of the intestine had occurred in connection with the cyst through 
which these had passed. This opinion was not coincided with 
by the phymcian-accoucheur who attended along with me, 
for he thought she must have died long ago if such had been 
the casa After this the abdomen diminished in size, much 
air having passed, as well as liquid evacuations. Ten days 



198 Mr, Lecidam on Extra-Uterine Gestation. 

after, the nurse observed sometliing protruding at the anus 
after evacuation, which receded into the bowel again. The finger 
was passed into the rectum as high up as possible, but it could 
not be found. In two days more a long piece of the same tubular 
structure was passed, resembling umbilical cord. The physician- 
accoucher visited the patient, but did not agree in this view. It 
was thought now that some fluctuation was felt in the abdomen, 
but it was indistinct. At times the tumour could be felt more 
defined and hard in the left side, but at other times it was obscured 
by the tympanitic distension. After this the symptoms became 
more and more grave, the vomitings more incessant, gradual ex- 
haustion set in, but no diarrhoea; there was sleeplessness and 
distress, and death happened on the 17th of June, two months 
after the full term of gestation was completed. The case was 
watched throughout by Dr. Quin, and was seen at times by Mr. 
Cameron at the early stages. 

Post'Mortem Examination. — Great emaciation of the face and 
extremities. The abdominal parietes, however, contained thick 
layers of adipose tissue. On making a crucial incision at the 
umbilicus some pus was observed in the fossa and beneath it. 
(During life the nurse had observed a mattery discharge from 
the umbilicus.) On raising the peritoneal flaps of the left side 
we found the body of a female child, packed very close in a 
curvilinear form, with the head lying upwards and outwards, 
the back towards the left outline of the mother, just at the 
crista ilei. It was of the size of an average foetus of six or 
seven months, and lay in a sac formed by thickened peritoneum 
and amnion united, aU matted in with the abdominal parietes. 
The foetus was covered by the usual caseous deposit ; on lifting 
it up from this bed, the umbilical cord was found broken, but 
resting at the aperture of a large ulcerated opening in the sigmoid 
flexure of the colon. It corresponded with the portions of 
tubular structure which had passed fmm the bowels. The foetus 
was in a state of white putrescence, very offensive, but firm, 
and tightly compressed, of a drab colour, the limbs indented 



Mr. Leadam an ExtrorUttriiu Oestatim, 199 

one with the other. Through the ulcerated opening in the bo\i'el 
fSoeculent matter had entered the sac, the edges of the opening 
were thickened. The sac was adherent to the intestines on its 
posterior aspect, and the odour was highly putrescent. The 
foetal placenta would seem to have been adherent to the in- 
teatineB, and decomposing to have caused inflammation and 
ulceration into the bowel, through which it and the portions of 
cord first found had exit, and thus accounting for the putrescent 
diarrhoea. On raising the foetus in order to remove it, no attach- 
ment existed. There was no fluid in the sac, for, on the day of 
death a quantity had issued per rectum and saturated the bed. 
The uterus was a little larger than normal and of a dark purplish 
colour. The fallopian tube was identified at its junction with 
the uterus, but terminated in the thickened tissue matted 
together. The foetus was taken to St. George's Hospital, but 
was thought too putrescent for any further examination, and was 
thrown away before Hospital visit next morning. 

The preceding case appears to differ from the greater number 
of cases of extra uterine gestation which are recorded, in the 
fiEulure of any natural effort to get rid of the foetus, or to pre- 
serve it from putrescence. It will have been observed in the 
course of the history that the sympathetic irritation induced in 
the mother was evoked at an early date, and that what might 
be called the conservative effort to dislodge it from its abnormal 
position took place posteriorly, or in the bowel, and therefore at 
a point which, whilst of necessity it must prove fatal to the 
mother, equally precluded the possibility of any surgical assist- 
ance. The ulcerative process which took place in the intestines 
of course admitted the intestinal gases into the sac, and to this 
cause alone is attributable the putrescency of the foetus, which 
so long as it was encased and hermetically sealed in the cyst 
would remain for any length of time free from septic influ- 
ences. There are many cases of this accident scattered through 
the transactions of the difierent medical societies, but in the 
44th voL of the " Medico-Chicurgical Transactions " is to be 



200 Mr, Leadam on Extra-Uterine Gestation. 

found a very interesting account of one case upon which Mr. 
Adams, of the London Hospital, operated with success in con- 
junction with Dr. Kamsbotham, and some part of its details will 
I doubt not be interesting to the Society. 

In the Museum of the Eoyal College of Surgeons there are 
only five specimens of extra-uterine foetation, and from these 
and others recorded it would appear that the fallopian tube is 
usually the seat of the accident, and not the ovary. 

One of these is the case alluded to which occurred in 1860. 
A patieut was taken into the London Hospital under Dr. 
Eamsbotham, with a large abdominal swelling, which Dr. Rams- 
botham and Mr. Adams considered to be an extra-uterine foetus. 

" M. S., set. 28, of fair complexion and middle height, and with 
all the appearances ofgood health, had been married eight years. 
She had always menstruated at regular periods, but had never 
been pregnant before. In January, 1859, she menstruated very 
profusely, and very scantily in February. From March until 
May she was subject to occasional attacks of severe cramp-like 
pains, which were confined to the right side of the abdomen, 
extending from the pelvis to the hypochondrium;- she felt very 
sick, but rarely vomited ; she had no distinct morning sickness 
at any time. After February her menstrual secretion stopped, 
and she dated the commencement of her pregnancy from the 
early part of this month. In June she first felt the move- 
ments of a child, and her breasts perceptibly enlarged. This 
condition continued, and after some time she observed milk 
escaping from both breasts, more particularly the left, and the 
veins of the left leg and thigh became varicose. 

" She continued in good health, her abdomen increased in size, 
and she distinctly felt the movements of the child until the 
30 th, a day or two prior to which she had a heavy fall, which 
was followed by soreness and cramp down to her knees. She 
considered herself in the ninth month of pregnancy, and ex- 
pected her confinement in the early part of November. She 
was visited by Mr. Williams, surgeon, of Plaistov, Essex. On 



Mr. Leadam an Extra-Uimru Oestation, 201 

the 30th of October she leceiyed a severe mental shock from 
her sistei'a death At this time she ceased entirely to feel the 
moyements of the child, and a week after this she began to feel 
sleepy, tired, and worn, and suffered from a sense of stifihess in 
her limbs, but had no distinct pains like uterine pains. A 
discharge took place from the vagina, and blood varying in 
colour &om dark to pink, and pieces of flesh-like substances, 
entirely inoflfensive in odour, were expelled in gushes. She 
reckoned her time of gestation to have terminated at the be- 
ginnlng of November. From this time she gradually diminished 
in siza 

"In January, 1860, she remained in much the same state. 
In February, menstruation recommenced, and it has continued 
r^^larly ever since, varying in quantities, and usually ex- 
pelled in gushes. The milk remained in her breasts until 
March Latterly she had become much thinner. On ex- 
amination a hard oval tumour was felt, particularly on the 
right side of the abdomen, extending from above the umbilicus 
to the right side of the symphisis pubis. There was a re- 
markable prominence in the tumour, which was quite irre- 
znoveable, and very unlike any swelling from a fibrous tumour 
connected with the uterus. The hand could be easily passed 
around the greater part of it, and the abdominal parietes could 
be made to glide over its anterior surface. There was a feeling 
of irregularity about it ; but the individual portions of a foetus 
could not be recognised distinctly, for there was a good deal of 
subcutaneous fet in the walls of the abdomen. There was no 
pain on pressure. The uterus was found by examination per 
vaginam, to be rather higher than usual, but there was no 
evidence of disease in it. She was able to perform her usual 
domestic duties, and expressed herself very anxious for the 
removal of the tumour. There could be little or no doubt as 
to the precise nature of the case ; so Dr. Eamsbotham and Mr. 
Adams agreed that the operation of gastrotomy should be per- 
formed, but thought it prudent to allow six months from the 



202 Mr, Leadam on Extra-Uterine CfestaOon. 

end of what was supposed to be the natural term of gestation 
to elapse. She was therefore re-admitted in May, and being 
then in perfect health, and fully alive to the risk of the opera- 
tion, it was performed by Mr. Adams on the 31st. 

I avoid the minute details of the operation. " On opening 
the peritoneum (five inches in length), the surface of the 
tumour presented a glistening aspect, and was only slightly ad- 
herent at the part. The cyst, which was four lines in thickness 
and very firm, was opened, and a pint of a greenish-yellow 
transparent fluid escaped, with yellowish flakes of vemix caseosa 
and some hairs. As soon as the cyst was opened, a loop of 
the funis protruded. The cyst was divided on the finger, to 
the extent of the opening in the abdomen, and the funis being 
returned, and a portion of the rectus muscle divided trans- 
versely, I felt the head and body of a foetus, with its head 
uppermost, and its face towards the spine. I introduced my 
hand and seized -an arm, which I pushed back, and then had 
no difficulty, owing to its limp state, in extracting the foetus 
by the breech. The funis was divided so as to leave about 
two inches outside the incision. On traction by the remaining 
part of the funis, it was clearly ascertained that the placenta 
was firmly adherent, and, under the advice of Dr. Eamsbotham 
no attempts were made to remove it. A piece of omentum 
which had escaped through the opening was cut away, and 
some rather large arteries, as well as some vessels in the cut 
edges of the cyst, were secured. I carefully sponged out aD 
the fluid from the cyst, the walls of which collapsed, especially 
on the left side. Firm adhesions seemed to keep the right side 
in contact with the abdominal walls. The edges of tho wound 
were carefully brought together by interrupted sutures, carried 
only through the integument and subjacent fSat, and all the 
parts were kept in apposition by careful strapping, padding with 
cotton wool and an elastic bandage. After the operation she 
became extremely fidnt, but was restored by brandy. She went 
on uninterruptedly well. The funis, which on its first appear- 



Mr. Leadam on Extra-Utrine Oestatian, 203 

ance daring the operation, was thick and oedematons, shrivelled 
np, and was altogether lost sight of on the fifth day after the 
operation ; no doubt it escaped among the discharges. There 
remained for some time a small fistulous opening with ex- 
uberant granulations, &c. 

" With respect to the child : — ^The length of the child was two 
feet, the weight was four pounds three ounces. The urachus 
and umbilical vessels were open. The child was a female well 
developed. The cuticle peeled off in large flakes ; there was 
no offensive odour. The head was well covered with fine, long, 
and light brown hair ; the nails were long and well developed. 
The parietal bones were slightly displaced, and overlapped by 
the occipital and frontal bones. Both comiae were opaque, the 
eyes shrunk. No vitreous humour was found. 

" No opportunity was afforded in this case of proving the 
precise situation of the extra-uterine foetus. Whether it was 
developed in the walls of the uterus or in the abdominal cavity 
by attachment of the ovum to the peritoneal surface of the 
intestines, could not be made out." 

The second specimen in the College Museum is that of a 
woman aged thirty-six (having one child), who in the fourth 
month of pregnancy was reaping in a com field, and carrying a 
heavy burden, when she fainted, and was carried home ; faint- 
ness, but little pain ensued, and she died the next day. The 
middle portion of the left fallopian tube was dUated into an 
oval cyst filled with coagulated blood. In the anterior wall is 
a ragged opening, through which the foetus had burst, and had 
escaped, and is seen falling through into the pelvis, which was 
found full of blood coagulated. The uterus was enlarged as in 
the early stages of pregnancy, and was said to have had, when 
recent, a deciduous membrane ; the os uteri was closed by a 
gelatinous exudation. 

The third case shows the right fallopian tube dilated into a 
BBC, about one inch and a-half in diameter near to its extremity, 
and opened, to show a small foetus (six or eight weeks) budding. 



204 Mr, Leadam on Extra-Uterine Oestation. 

the face distinct, and the extremities just evolving. There is 
no increased vascularity in the uterus. 

The fourth case is the section of a full-sized foetus, which 
after arriving at maturity, had been retained over fifty-two years 
in utero, enclosed in a sac, which had become ossified. The 
foetus was roUed up and compressed into a firm globular mass. 
The parts of the foetus which lay external or towards the sur- 
face of the cyst, became absorbed down to the bone, while the 
muscles, &c., situated towards the interior, were soft and natural 
After aU these years the limbs were partially unfolded, and 
there were no signs of decomposition. 

The fifth case is that of a condensed and ossified foetus, which 
had been retained in the abdomen fourteen years beyond the 
ordinary period of gestation. It was in a museum in Ham- 
burg before it was brought to the College of Surgeons. 

The foetus is almost completely developed, but compressed 
and dried, so that little more than the bones remain to indicate 
its previous form. It is reduced to a flattened irregular mass, 
about four inches long, by from two to three inches wide. 

The foetus was removed by operation, as was believed, from 
the fallopian tube. The patient recovered, and lived a long 
time after in Hamburg. 

Dr. Wm. Campbell, of Edinburgh, in a memoir on extra- 
uterine gestation, published in 1843, details nineteen cases in 
which the foetus remained in the abdomen of the mother during 
a period varying from two to fifty-six years, and he refers to 
several cases in which the mothers so circumstanced conceived 
once; two cases in which the mothers bore two children, four 
cases in which three children were bom, two instances of five 
birtlis, and one case where the mother gave birth to six children, 
whilst an extra-uterine foetus remained in the abdomen. 

However, he remarks, that " except in some rare cases, sooner 
or later, in consequence of many causes, which may or may not 
bo obvious, inflammation arises in the adjoining organs, in- 
volving the envelope of the foetus." In those cases which have 



Mr, Leadam on Extra-Uteriiu Oestatian. 205 

remained innocent for so long a time, nature converts the cyst 
contaimng the foetus into a material not readily acted on, which 
constitutes a permanent covering, ossification of the cyst takes 
plaxse, or the foetus undergoes a sort of petrifaction, by which it 
is converted into cartilage or bone, and is materially reduced in 
voluma 

Numerous instances are on record where the foetus has been 
got rid of by ulceration into the vagina, rectum, colon, bladder, 
as well as by abscess, opening externally, either at the umbilicus 
or some other part, of the abdominal walls. 

It is most probable that in all such cases, the decomposition 
and subsequent disintegration of the foetus have preceded the 
efforts of nature to evacuate the contents of the cyst; for 
when the foetus has been extracted entire, however long a period 
m&j have elapsed after the termination of natural gestation, no 
decided evidences of putrefaction have been found. In a case 
quoted by Dr. Eamsbotham (in his " Principles and Practice of 
Obstetric Surgeiy "), where a foetus was removed by incision, 
which had evidently remained eight years in the abdomen of 
the mother, it was in " an astonishing state of preservation." 
(The case is given in the Medico-Chirurgical Review for 1834.) 
A fistulous opening was formed at the umbilicus, which was 
enlarged, and the foetus removed. In another case referred to 
by Mr. Adams, the patient declined an operation at the very 
time when surgical interference was called for, and she died, 
worn out by diarrhoea and hectic. 

DISCUSSION. 

Mr. Cameron. — ^The lady whose melancholy case Mr. Leadam 
has so well described, was well known to me for many years, and 
I frequently attended her when Dr. Quin (her physician from 
her childhood) was ill or out of town. I was called to see her 
on the 14th January, 1863, and continued in attendance during 
the remainder of that month, during his absence in the country, 
where he was detained by illness. Before he left London he had 
arranged with the patient and her friends, that Mr. Leadam was 



206 Mr. Leadam on Extra-Uterine Gestation. 

to attend her in her accouchement, and, as some puzzling and 
anomalous symptoms connected ifith her pregnancy showed 
themselves, I obtained her consent to my having a consultation 
with that gentleman, and accordingly we met on the 27th Janu- 
ary. Two days afterwards. Dr. Quin returned to London, and I 
ceased my attendance. From my interest in the patient and in 
the case, I was able afterwards through conversations with Dr. 
Quin and other friends, to watch the progress of the illness pretty 
accurately, and from having been present with other medical 
men at the post-mortem examination, I am in a position to bear 
full testimony to the correctness of Mr. Leadam's report of the 
case. 

Dr. Druey had listened with much interest to the details of 
Mr. Leadam's well reported and instructive case, one of a class 
of cases more frequently heard of than seen, as from their great 
rarity they were unknown to many practitioners except from 
books ; Dr. Drury's own knowledge being gathered from such 
sources he felt a hesitation about saying anything, but being ap- 
pealed to by the President, he availed himseK of the opportunity 
of thanking Mr. Leadam for having so faithfully preserved the 
history of the case. He at the same time conamended the judg- 
ment of the gentlemen in attendance that led them during the 
life of the patient to form an opinion as to the nature of the case 
which was afterwards borne out by post-mortem appearances. 
In this particular case the question of obtaining relief by operative 
interference may not have arisen, but in these days of bold and 
successful operations, the medical attendant should always be alive 
to the chances of saving life afforded by a timely and well-planned 
operation. It unfortunately too often happened that the golden 
opportunity was lost by a hesitancy about operating even where 
such a step was inevitable if life was to be saved. At times 
also this was deferred without sufficient reason, till the patient's 
strengtli was so much reduced that the hopes of success were much 
diminished. A case had arisen last year in Allopathic practice 
that caused much controversy, but which helped to illustrate the 
point that he. Dr. Drury, alluded to, it was that of a medical 
man at Tunbridge Wells, suffering from obstruction of the in- 
testinal canal, some of those who saw the case wished to practice 
Amusset's operation, but others objected because there still some 
small amount of foeces passed, so that there was not total obstruc- 
tion; the non-interference men carried their point, and the patient 
died ; now, in this case, had an operation been performed life 
might have been prolonged for a year or two. In the cases im- 
mediately imder consideration, even when their true nature was 
recognized, no rule could be laid down for interference, as from 
their known terminations the point could only be settled on the 



Mr, Leadam on Extra-Uterine Gestation, 207 

merits of each particular case. It sometimes happened where 
extra^uterine foetationhad taken place that the immediate danger 
passed over, and subsequent pregnancies tenuinating naturally 
and favourably took placa A case occurred in the practice of Dr. 
M. W. MiiUer, of Hohenweihr, where a hernial tumour was found 
to increase in size as pregnancy went on, and which was ulti- 
mately opened, the cmld and placenta being extracted, but 
imliappily the patient sank from internal haemorrhage. Writers 
generieJly classified extra-uterine foetation imder three heads, 
ovarian, tubular, and interstitial, the tubular being the most 
frequent In Mr. Leadam's case the mischief would appear to 
have been connected with the ovary; it was a question how 
txr the early history of the case threw a probable light on the 
cause of the evil, for from the state of health, &c., prior to preg- 
nancy, the pathological change most probably then took place, 
pr^nancy being prevented following the ordinary course by what 
nad existed for some time. Dr. Campbell had collected some 
valuable statistics of this accident, showing that the foetus might 
be retained without destroying life for a period varying from 
months to many years. The nope of the foetus being expelled 
either through the abdominal parieties or through the bowels, 
was necessanly uncertain, but happening sufficiently often to give 
hope when such an action was set up that it might terminate favour- 
ably. The passing a portion of the umbilical cord was a first 
effort in the present case towards a removal by the bpwels. Not 
liaving experience of his own to relate Dr. Drury would not 
trespass longer on the time of the Society. 

The President, in bearing full testimony to the accuracy and 
exactitude of the description of the sad, but extremely rare case 
just read to the Society by Mr. Leadam, said, that the subject of 
it, from her infancy up to the period of her marriage had, in all 
the illnesses incidental to cluldhood and youth, been treated 
Homoeopathically. On her marriage she removed from London, 
and resided abroad for some years, and afterwards in the country, 
and there being no Homoeopathic practitioner in the neighbour- 
hood, she was generally treated Allopatliically, except occasionally, 
while in London. Although several times pregnant, no child 
was bom alive, — ^miscarriages each time having taken place early, 
with one exception, about three years ago, when the child was 
six months old. About a year and a-half before her last 
pregnancy, of which they had just heard the history, she had a 
very dangerous attack of diptheria ; this was followed a short 
time after by ulceration of the womb, which was treated locally 
by injections and cauterization, and internally by alteratives and 
tonics, by the Allopathic physician-accoucheur then in attend- 



208 Mr, Leadam on Extra-Uterine Oestation. 

ance. To this succeeded ulceration of the rectum, which assumed 
so serious a character, that an eminent surgeon was associated 
with the above gentleman in the treatment of the case. Her 
health deteriorated greatly, she became much emaciated, she 
imderwent great pain and discomfort from the local treatment 
pursued, which brought on two severe attacks of erysipelas, which 
aggravated greatly the pains in the rectum. A highly nervous, 
excitable, and irritable state supervened, accompanied by symp- 
toms of a hectic character, and inability to move, sit upright, or 
stand without suffering or violent paroxysms of pain in the 
rectum. Her own family became alarmed and interfered, and her 
earnest wish to return to the treatment she had been accustomed 
to from her childhood, was acceded to by her husband and his 
family, and he (Dr. Quin) was sent for. Under the action oi Aconite 
Belladonna, Arsenicum,^ vxVomica, Ignatia,BJid Hepar Sulphuris, 
with occasional doses of Chamomilla, Coffea and Hyoscyamus, all 
the painful and distressing symptoms gradually disappeared, the 
fever abated, the appetite and sleep were restored, and the power, 
of moving without provoking pain or bringing on a relapse 
returned. She was able to walk, and take long drives into the 
country, and drive over the stones in town without bringing on 
pain, which she had not been able to do for months. She was 
sent into the country for change of air, to assist in restoring her 
strength and recovering her flesh. Just at this period, before she 
had recovered the full tone of her former good health and pre- 
vious healthy constitution, she unfortimately became again 
pregnant. He had entered much more at length into these 
details than he would have done, because he baew the early 
history of the case, and because he was of opinion that the 
accident mentioned by Mr. Leadam, or rather shock which her sys- 
tem had received from being ran away with in her pony carriage 
had nothing to do with the extra-uterine foetation. This he believed 
must have occurred within the first ten or fourteen days of her 
pregnancy, which state of pregnancy had been communicated to 
him by letter a considerable time before the ponies ran away 
with her. He thought it was more probable that the reduced 
state of her health from the long and severe suffering and illness 
she had experienced from the disease in the womb and in the 
rectum, had contributed to the misfortune which had terminated 
in death. From the very earliest period of gestation, threatening 
symptoms set in. On the 14th of September, the medical prac- 
titioner in the country where she was staying, reported to him 
(Dr. Quin) as follows. " I first saw her on the 9th, when she com- 
plained of pain and a sensation of weight about the pubis and 



Mr. Leadam on Eoctra-Uterine Oestation, 209 

acarum ; there was a rather brownish-coloured discharge from the 
vagina^ which she mentioned had occurred at intervals during the 
pievioos week or ten daya This discharge had not at all the ap- 
pearance of the catamenia,but resembles that which frequently pre- 
cedes an abortion. These symptoms had, on the 12tli, in a great 
measore subsided, by perfect rest on the sofa and small doses of 
Hyosyamus. When on the 13th, she was seized with severe 
pain in the muscles of the chest and abilomen, accompanied 
with occasional vomiting, great thirst, and great distention from 
wind. The discharge from the vagina is nearly gone, but there 
is still a sensation of great weight at the lower part of the 
abdomen. You are aware that it is now more than nine weeks 
since there was a discharge of a decidedly catamcnial charac- 
ter." These symptoms, he learnt from subsequent reports wliich 
were sent to him (Dr. Quin), frequently recurred, accompanied by 
much pain and discomfort in the left side in the ovarian region, 
notwithstanding she was kept as much as possible in the re- 
cumbent posture. Every exertion and attempt to move pro- 
voked a recurrence in a violent form of these painful and dis- 
tressing attacka Towards the beginning of December, 1862, 
she was brought to town to be under his (Dr. Quin's) imme- 
diate care and treatment until the time for parturition ap- 
proached. Subsequently the suspicious and anomalous symptoms 
differing from those usual in natural and healthy gestation, made 
me desirous of associating Mr. Leadam with me in the treatment 
of this complicated, and at that time, obscure case, earlier than 
in ordinary circumstances would have been necessary ; and it is 
but justice to him to state that after making the requisite local 
examinations, his diagnosis of the case from the time that the 
usual period for parturition had elapsed, and even for some time 
before, was justified by the subsequent events and by the post 
mortem examination. As may easily be imagined, in such a 
complicated state of organic disease as latterly existed, the sym- 
pathetic irritation of the nervous system and disturbance of the 
digestive organs became more distressing, and the pains at times 
were dreadfully acute, whilst the treatment and conduct of the 
case increased in difl&culty. The patience of the poor sufferer was 
most touching, and greater than could be supposed possible by 
any one who had not witnessed it. In all her acute sufferings and 
distress she never lost confidence in Homoeopathy, and even 
up to the last she resisted every attempt at persuasion to have 
recourse to Allopathic treatment, which some well-meaning 
friends, who ignorant of the real nature of her state, and dis- 
posed to attribute her danger to the want of efficacy of 
Homoeopathy, had endeavoured to induce her to do. With re-. 
VOL. in. 14 



210 Mr. Cutmore on sorne Morbid Affections of the Ear, 

spect to the observations of Dr. Drury in relation to an opera- 
tion in this case, it was the opinion of all the medical men 
who had seen the patient, that such an attempt was inadmis- 
Bable, and could only have increased her sufferings and ac- 
celerated the fatal issue. The autopsia proved how correct 
was this conduct of her medical advisers, seeing the adhesions 
that had taken place and the ulceration communicating from the 
sac formed in the fallopian tube or left oviary through the peri- 
toneum to the sigmoid flexure. In the earlier part of these 
observations, he (Dr. Quin) had stated his disbelief that the 
shock of the pony carriage — ^being landed in a ditch — ^had 
anything to do with the extra-uterine fcetation, and he was 
disposed to agree with Dr. Drury, that mental causes and 
deteriorated health were more likely to lead to such abnormal 
cases of conception than physical shocks or accidents. Fortu- 
nately such cases as the one brought under the consideration of 
the Society this evening are very rare, this is sufl&ciently proved 
by the few instances on record collected from various countries 
and extending over a very long period of time. 



ON" SOME MOEBID AFFECTION'S OF THE EAR. 
By Charles Cutmore, Esq., M.RC.S. & L.M. Eng. 

Gentlemen, 

Before I speak of the general treatment, I will describe 
the Anatomy and Pathology of the Internal Ear, merely with 
the view of facilitating and simplifying the mode of treatment 
of the morbid structures connected with the organ of hearing. 
It is to be regretted that our Materia Medica is so barren 
in objective symptoms, relating to diseases of the ear, of which 
the great majority only can be diagnosed. The diseases of that 
organ principally arise from an altered state of their natural 
structures, and are only recognised by the eye, ear, and touch, 
whilst the subjective symptoms express pain, pressure, fulness 
and noises in the ears, arising from a disordered state of the 
portia-mollis, chorda tympani, anoemia, or congestion of the 



Mr, ChUmore on some Morbid Affections of the Ear. 211 

vessels supplying those parts, upon which very little reliance 
can be placed in regard to their efiicient treatment ; the diag- 
noslB must then really rest upon those objective and more 
trustworthy symptoms. The various diseases of the ear are 
generally devoid of any symptoms for the surgeon's guidance of 
treatment, and depend in many instances u^KDn morbific changes 
which are only curable by constitutional treatment, while 
others are relieved by the local application of remedies to the 
Yaiious structures. 

I shall first mention some alterations of the structures which 
are liable to become diseased, or altered from the normal state, 
and produce deafness : — 

1st. The diseases of the ceruminous glands. 

2nd. Acute and chronic inflammation of the dermoid meatus 
which generally terminates in polypus. 

3rd. Polypus. 

4th. Exostosis of the external meatus. 

5tL Diseases of the membrana tympani. 

6th. Obstruction of the eustachian tube. 

7th. Diseases of the cavity of the tympanum. 

8th. Disease of the mastoid-ceUs. 

9tL Nervous deafness. 

The Ceruminous glands are about the size of millet seeds, 
placed exteriorly to the dermoid meatus, in the interstices of a 
reticulated membrane; the cerumen they secrete is useful in 
keeping the canal of the meatus and the membrana tympani in 
a state of moisture, necessary for health, and to transmit 
sonorous sounds. On examining the ear when in a healthy 
condition, you will find a ceruminous circle, consisting of fine 
hairs, covered by a sort of glutinous dew; but in a diseased 
state of those glands it is absent, and presents an accumulation 
of hardened wax, which fiUs up the meatus, causing pressure 
upon the membrana tympani, and giving rise to deafness, 
vertigo, noises in the head, and very often producing s}Tnptoms, 
in highly-nervous persons, similar to pressure on the brain, from 

14* 



212 Mr, Cutmore on some Morbid Affections of the Eixo'. 

the hardened mass pressing upon the ossicles through the 
membrana tympani against the contents of the vestibule. 

The treatment in such cases is simple. I will relate one of 
many that have come under my care. 

Case. 

Abraham Shilling, aged 63, fisherman at Dover. For many 
years had suffered with deafness, also vertigo and violent noises 
in the head and ears (nearly depriving him of his livelihood on 
account of his deafness). Examined the meatus with the 
speculum and discovered a hard, black-looking mass, which on 
being touched caused great pain in the head ; he also expressed 
that he had not been able to lie on the affected side for years 
without feeling distressed ; the hearing distance of the watch was 
contact. Syringed the meatus with warm soda-water, which 
brought away a hardened mass of cerumen and epidermis, 
leaving the meatus absorbed, red, and granulated ; touched the 
meatus with a solution of Arg. nit. gr. x aquse 5, with a 
camel-hair brush ; the hearing distance increased three feet (that 
being the normal standard), and the whole of the unpleasant 
symptoms left him. 

There is another disease which affects the ceruminous glands, 
viz., a deficiency of wax. This generally happens to persons 
disposed to rheumatism and of a gouty diathesis, chlorotic 
females, and those suffering from long continuous discharges, 
viz., leucorrhoea, haemorrhoids, &c. ; also, the disease arises from 
a diseased condition of the throat and tonsils^ which occurs in 
a scrofulous diathesis. 

The treatment here, must be entirely constitutional, and 
vary with the peculiar idyosyncrasies of the patient, so as to 
restore a healthy secretion of the glands. 

I have foTmd Spongia an excellent remedy where there is a 
total deficiency of wax. I will now pass on to another disease 
of a more serious nature, viz., acute and chronic inflammation 
of the dermoid meatus. This membrane is subject to inflamma- 
tion from many causes, such as the accidental introduction of 



Mr, Outmore an some Morbid Affections of the Ear. 213 

any foreign body, an accumulation of cerumen, the ap])li- 
cation of cold or heat, arising especially from a sudden 
change of temperature in the weather, or any debilitating ill- 
ness. The symptoms of the inflammation are similar to those 
which attack any other part of the body, added to a sensation 
of fullness and uneasiness in the meatus, inci-eascd by a 
pressure on the external ear, causing singing, throbbing, and 
acute pain, the pulse becoming accelerated with great restless- 
ness and anxiety. Should the affection advance, the dermis 
becomes tumefied, so as to considerably diminish the calibre of 
the meatus; the pain continues to increase, and in a short 
time a copious discharge suddenly takes place, followed by 
immediate relief ; upon removing the secretion with a syringe, 
the BurfSace of the tumefied meatus is seen to be of a deep red 
colour, and the epidermis entirely denuded, secreting a muco- 
purulent fluid. 

The treatment in this stage should be hot fomentations, or 
an evaporating lotion applied to the meatus on cotton wool, or 
a poultice with a few drops of tincture on its surface, of the 
same medicine as prescribed intemaUy, but of a lower dilution, 
such as Aeon, Bell., Puis., or Mer. v., and to syringe the meatus 
three or four times a day with warm water, medicated witli the 
same remedy as taken internally, so as to be absorbed by the 
denuded surfaces of the meatus. Should the above symptoms 
be allowed to remain, or the patient not present himself for 
treatment until the chronic stage is developed, many of tlie 
important structures of the ear, are, to a certain extent, injured 
by hypertrophy of the dermoid meatus, which causes a narrow- 
ing of the external orifice ; should the hypertrophy extend to 
the dermoid layer of the membrana tympani, the power of 
hearing is much impeded, and very often lost. Sometimes in 
the chronic stage, the symptoms take on the catarrhal, espe- 
cially in those persons of a scrofulous diathesis, with glan- 
dular enlargement, and who are exposed to a low, damp, or 
moist atmosphere. 



214 Mr. Cutmore on some Morbid AffeetioTis of the Ear. 

The distinguishing point between chronic inflammation and 
catarrhal, is the peculiar character of the discharge from the 
latter being of a very muco-purulent form and of a very- 
offensive kind. When the disease has remained some time, the 
mucous membrane of the tympanic cavity is apt to be impli- 
cated, and deafness of a more serious kind is the result ; how- 
ever, it must be remembered, that catarrh of the dermoid 
meatus, and of the dermoid layer of the membrana tympani, 
frequently is a symptom of ii^ritation witliin the tympanic 
cavity, and the external symptoms cease so soon as the inter- 
nal irritation is relieved, by bringing the mucous membranes of 
the throat, tonsils, and eustachiah-tube into a healthy state 
with the remedies I shall hereafter mention. 

In treating chronic diseases of the ear, and especially those 
which arise from a debilitated constitution, the treatment should 
be directed towards reinstating the general tone of health, prior 
to the application of local remedies, which, according to ex- 
perience, are necessary for the restoration of the diseased 
structures. In chronic discharges of the ear of a purulent 
kind, I find that Bell., Mer. s., Puis., and Sulph., to answer well ; 
if of a syphilitic character. Nit. ac., Mer. rub., Aur. m., Hep. 
Sulp. ; and if caries of the ossicles and mastoid cells, Aur. mu., 
Sili. Cal, Assaf. The meatus must be first syringed with warm 
water, previously medicated with ten drops of a low dilution 
of the remedy as prescribed internally, or applied to the 
meatus on cotton-wool, each medicine given according to the 
pathogenesis of the diseased state; in conjunction with the 
above, it is of paramount importance to use every means to 
invigorate the health, by abundant exercise in the open air in 
the country, or by the sea-side ; sponging the body daily with 
tepid salt water ; a simple, nutritious, but not a stimulating 
diet, and, above all, sleeping in a cool, well-ventilated apart- 
ment, aided by those Homoeopathic remedies, that will place the 
digestive organs in a healthy condition^ to digest those aliments 
which will nourish and invigorate the body. 



Mr, Outmore on some Morbid Affections of the Ear. 215 

There is another method of treatment which I prefer in 
those cases wliere there is much hypertrophy of the dermoid 
meatus with large granulated surfaces, which discharge a 
muco-puTulent fluid, or a continual exfoliation of the epidermis, 
from chronic congestion of the dermoid meatus; first, to 
syringe the ear with warm water in which a little carbonate of 
soda has been dissolved, and then ai)ply to the external meatus 
a solution of Arg. nit. gra. ij, aqute 3ij, with a camel-hair brush 
twice a day. This remedy seems to act like a charm, by re- 
lieving the congestion of the capillaries of the dennoid meatus, 
and membrana tympani, especially in chronic cases, which have 
defied all other treatment. 

I wiU now give an illustration of a case of chronic in- 
flammation of the dermoid meatus, with treatment. 

Henry CrapneU, aged 9, Dover, June 5tli, 1860. Deaf six 
years from scarlatina, previously treated by several surgeons. 
Had a very offensive discharge from the right ear of a muco- 
purulent kind. Left ear healthy. Examined the meatus ex- 
temus and syringed ; the dermoid layer of the meatus being 
much denuded and congested with granular surfaces, the mem- 
brana tympani opaque and soddened. Health good. Hearing 
distance of the right ear, of the watch, contact. Syringed the 
ear with warm water in which a little soda was dissolved, and gave 
Sulp. Prescribed BeU. 6 gL x. Lotion the same as medicine. 

June 12th. — Discharge less. Tongue coated. Hearing dis- 
tance, right ear, three inches. 

Eepeat the medicine. 

June 18. — ^Discharge the same. 

Pencilled the meatus with Arg. nit. gr. v. aquas ^ ; Mer. cor. 
vi. gL X., to be taken internally. 

June 25. — ^Discharge less. Hearing distance of right ear 
seven inches. 

Mer. cor. 

June 2 &:— Discharge the same. Hearing distance of right 
ear, eight and a-half inches. 



216 Mr, Cutmore on some Morbid Affections of the Ear. 

Mer. cor., with lotion of ditto, pencilled the meatus extemus 
with Arg. nit. 

July 4. — Discharge thick and more healthy. Hearing dis- 
tance of right ear, eleven inches, pencilled the meatus externus, 
and continued the medicine. 

July 12. — ^Discharge nearly ceased. Hearing distance of 
right ear, eighteen inches. Applied Arg. nit. to the surface of 
the meatus extemus. 

BeU. 6 gL x., with lotion. 

July 20. — ^Discharge the same. Hearing distance of right 
ear two feet. 

Applied Arg. nit. as before. Sulph. 6 gL x. 

July 29. — Discharge ceased. Hearing distance of right ear 
three feet. Pencilled the meatus extemus with Arg. nit. 
Hep. sulp. 6 gL X. 

August 3. — -Cured. Hearing distance of right ear, three 
feet, normal distance. 

In the above case there was hypertrophy and congestion of 
the meatus extemus, with discharge of an obstinate character, 
and had I used only the internal remedies, without stimulating 
the surfaces of the meatus, probably it would have taken a 
much, longer time to have eradicated. 

If this disease of the dermoid meatus be allowed to remain 
in a chronic state any length of time, polypi is generally de- 
veloped from the granular surfewes ; sometimes, however, they 
arise from chronic inflammation of the tympanum, or from 
obstruction of the eustachian tube, but mostly from the dis- 
eased surfaces of the dermoid layer, and at other times from 
the membrana tympanum ; when the growth is large, a sen- 
sation of fulness is felt in the ear, and not unfrequently a sen- 
sation of heaviness, vertigo, and confusion in the head. These 
cerebral symptoms often cause alarm. 

The pressure of the polypus on the exterior surfaces of the 
membrana tympani and chain of ossicles, causes tension of the 
fluid in the vestibule. 



Mr. Cutmcre on some Morbid Affections of the Ear. 217 

There are two kinds of polypi The fibro-plastic, or gela- 
tinoiis, and the cellular^ or vascular polypus. 

The fibro-plastic, or gelatinous polypus, generally grows from 
the ceruminous glands, and sometimes from other parts of the 
dermoid layer of the meatus, springing from a single root or 
peduncle, of a pale, fleshy colour, insensible to the touch, and 
grows slowly, frequently accompanied by otorrhoea, the discharge 
diminishing as the growth of the polypus advances. 

The treatment is simple, merely removing it, when large, 
with a pair of ring forceps, seizing it as near to the root as 
possible, and giving it a twisting movement ; having done thus, 
means must be employed to eradicate its recurrence, which is 
of frequent annoyance. The treatment I have hitherto used 
has been successful, viz., pencilling the dermoid meatus daily 
with a solution of Arg. nit. gr. v. aqudB ^ ^^^ its removal, 
and attending to the general health, with those remedies pre- 
viously mentioned in the treatment of the meatus extemus. 

This fibroid-pla-stic, or gelatinous poljrpus, is generally of a 
purely local character, merely springing from the excoriated and 
diseased surfaces of the dermoid meatus. 

Case illustrating the fibroid-plastic or gelatinous polypus, 
with the treatment. 

Miss E — B — aged 20. At three years of age had scarlet 
fever ; since that time had a constant discharge from both ears 
of a purulent kind, the health remaining very good ; the dis- 
charge was not particularly noticed, the medical attendant in- 
forming the parents that it was healthy, and not to stop the 
dischaige on any account. At 16 years of age, a substance 
was observed in the external meatus of the left ear ; their medi- 
cal man termed it a polypus, and removed it without any treat- 
ment In the course of a year another grew, which was removed 
in the same way, and a third, which was removed also, besides 
several small ones, which turned black and dropped off. 

March 13th, 1861. — Came under treatment. 



218 Mr. Cutmore on some Morbid Affections of the Ear, 

I observed a fibro-plastic or gelatinous polypus, from the left 
ear, extending outside the external meatus to about the size of 
a walnut, the right and left meatus secreting at the same time 
a muco-purulent pus ; the polypus was insensible to touch, and 
of a fleshy kind. Syringed the surfaces of both meatus with 
warm water, in which some carbonate of soda had been dis- 
solved, pencilled the surfaces of the meatus with Arg. nit. gr. v. 
aquse ^ with a camel-hair brush ; hearing distance of the watch of 
the right ear, half-an-inch. Hearing of left ear entirely gone. 
Prescribed Mer. sol. 6 gL x. 

March 14th. — ^Extracted the polypus from the meatus, with 
a pair of ring forceps, giving it the twisting movement ; much 
venous haemorrhage followed ; examined the meatus, and found 
the surfaces very granulated and tumefied, the membrana 
tympani being absorbed and perforated where the polypus had 
grown. The ossicles intact. Syringed the meatus with Arnica 
lotion and cold water ; directed it to be syringed thrice daily. 
Prescribed BelL 6 gl. x. 

March 15th. — Hearing distance of left ear had increased 
four inches; continued the syringing with Arnica lotion. 
Prescribed Am. 6 gl. x. 

March 16th. — Hearing distance of left ear had increased six 
inches, and discharged a thin flakey pus. Syringed with warm 
water. Pencilled the meatus with Arg. nit. 
Prescribed Mer. soL 6 gl. x. 

March 18th. — Hearing distance of left ear the same. Dis- 
charge less. 

Eepeated Arg. nit. Prescribed Mer. sol. 6 gL x. 

March 20. — Hearing distance of left ear seven inches. 
Syringed and pencilled with Arg. nit. Bowels constipated, with 
pains in the head. 

Prescribed Nux. v. 2 gL x. 

March 22. — Hearing distance of left ear the same. Still 
discharging. Syringed with wann water and applied a piece 



Mr Cutmore on some Morbid Affections of the Ear. 219 

of cotton-wool steeped in Arg. nit. gr. v. aquae ^ to the orifice of 
the membrana tympani, and allowed it to remain. 
Prescribed Sulp. 6 gl. x. 
March 25. — Hearing distance of left ear the same, right ear 
two inches. Discharge ceased in both ears. Syringed both 
the meatus extemus with warm water, and pencilled with Arg. 
nit. Examined the meatus with the speculum, and found the 
membrana tympani hypertrophied, concave and white, and the 
surfaces less vascular. 

Prescribed Calc. 6 gl. x. 
March 27. — Hearing distance of left ear the same, right ear 
two and a-half inches. Pencilled both the meatus with Arg. nit. 
Membrana tympani looking healthy. 

Prescribed Calc. 6 gl. x. 

April 2. — Hearing distance of right and left ear the same. 

Membrana tympani looking still more healthy. At church on 

Sunday, heard the preacher for the first time since ten years. 

Prescribed Mer. soL 6 gl. x. 

April 5. — ^The same. 

Cal. 6 gL X. 
April 10. — ^The same. 

Prescribed Sulp. 6 gl. x. 
April 1 5. — Hearing distance of left ear the same ; both the 
extemus meatus and membrana tympani looking healthy. 
Applied an artificial tympanum to the left ear. 
Prescribed Sac. lac. 
April 18. — Hearing distance of left ear much improved with 
the artificial tympanum. Hearing distance of right ear five 
inches. Left : The hearing restored so far as the disorganiza- 
tion of the ear would permit, and no recurrence of tumours. 
The Cellular or Vascular Polypus. 
This afiection is of a fungoid or cancerous growth, and arises 
firom a low cachectic state of the constitution, poisoned either 
by scarlatina, measles, or some exhaustive disease. It consists 
of vascular granulations, growing frequently with a broad base 



220 Mr, Cuimore on some morbid Affections of the Ear. 

from the membrana tympani, or dermoid layer of the meatus, 
of a red, raspberry hue, extremely sensitive, bleeds on the 
slightest touch, owing to its great vascularity, and grows 
rapidly, often discharging a foetid kind of pus. The treatment 
of this kind of polypus is somewhat different to the former, if 
large, and causing cerebral disturbance, it must be removed 
with the ring forceps, and the constitution reinstated by reme- 
dies, suited, according to the peculiar dyscrasia of the patient. 

The following medicines may be consulted with great ad- 
vantage in this class of polypus, arising, as it generally does, 
from a low state of the constitution ; — Sulp., CaL, Mer. s., Mer. 
ru., Ars., Nit. acL, Phos., Sepia., SiL, Hep., Staph., Lach., Rhus- 
tox., Aci. sulp. 

The meatus must be syringed twice a day with warm water, 
containing a few drops of the Ist or 2nd dilution of the indi- 
catiQg internal remedy. 

I have generally used from the 6th, 12 th, and 30th dilution 
in tinctures. 

When the discharge is of a foetid kind, no application is 
better adapted than an injection of Chlorate of Potash, gr. xx 
Aqu, 5 X., syringing once or twice a day as the case may re- 
quire. If the granulations are large and flabby, syringe the 
meatus with Nit. aci 3 ij- ^ ^ half-pint of water, or if pre- 
ferred, a calendula lotion, 3 iij. ad ^ ij. is a very good injection. 

Exostosis. 

Exostosis, or osseous tumours, of the meatus externus, is a 
disease which frequently occurs in the middle period of life to 
those persons of a rheumatic or arthritic diathesis, or those who 
may be termed free livers, taking much stimulating food. 

The development of the tumour is slow, and frequently un- 
attended with any symptoms calculated to attract the attention 
of the patient. When from a cold, or a sudden change in the 
weather, causing an accumulation of cerumen in the meatus, the 
aperture becomes closed, deafness is complained of, and relief is 
sought; sometimes the growth of the tumour produces a feeliiig 



Mr, Cutmore on some Morbid Aj^ectians of the Ear. 221 

of distencdon in the ear, and a weight in the side affected. The 
semiology of the disease may be confounded with polypus, or 
hypertrophy of the dermoid meatus, but on an inspection with 
the speculum, it soon disappears, for the polypus is of a dark 
colour, and moistened with a discharge, very often of a foetid 
kind, whereas, the osseous tumour is white, hard, and dry ; how- 
ever, should there be any doubt, it would be removed by the 
use of the probe. Very frequently there is a collection of hypertro- 
phied epidermis, and on relieving the meatus of this the hearing 
is much improved. The osseous growth is affected by the 
application of the Tincture of Iodine on a camel-hair brush to 
the internal surface of the meatus extemus; also, I have found 
great assistance in this affection of the ear, from passing a con- 
tinuous current of galvanism through the tumour to cause its 
absorption, and attending to the rheumatic and gouty dia- 
thesis by internal remedies, such as Caust., CaL, SiL, Ant. cm., 
Clem., Aur. m., Phos., Ass., Euta., Kali, bi. Hep., Sulp., lod., 
Colo., Cocc, Ehodo., in dilutions varying according to the tem- 
perament and peculiarities of the patient, from the 3rd, 6th, to 
the 30th dilution. 

Membrana Tympaot. 

We now come to another structure in the ear, which is im- 
portant to keep in a healthy condition, and to restore when it 
becomes altered by disease, viz., the membrana tympani I will, 
en passant describe the different layers of that membrane, in order 
to facilitate the diagnosis of various alterations which take 
place in that important membrane, as they give rise to many 
difi&culties in the treatment of deafuess. 

The membrana tympani is composed of four layers, viz. : — 
epidermic, dermoid, fibroid layer, and mucous. 

The fibroid layer is composed of two laminas, one of radiating, 
and the other of circular fibres, which are attached to the pro- 
cessus longus of the malleus, keeping tense the membrana tym- 
pani with the aid of the ligament of the tensor tympani muscle, 
necessary for the acute state of hearing ; the mucus layer lines 



222 Mr. Cutmore on some Morbid Affections of the Ear. 

the tympanic cavity and covers the whole. The various diseases 
which attack the membrana tympani are acute and chronic in- 
flammation, the latter running into catarrh and ulceration, hy- 
pertrophy, relaxation and perforation. 

The four first of the diseases above-mentioned, have been 
spoken of separately with their treatment, in the dermoid layer 
of the meatus extemus, the dermoid layer of the membrana 
tympani being continuous with that membrane. 

Hypertrophy of the membrana tympani considerably interferes 
with the usefulness of the organ of hearing, by destroying its 
elasticity and impeding the sonorous undulations from passing 
through to the vestibule, therefore, it behoves the surgeon to 
use those means and remedies that will alter and avert such 
consequences, and to keep the membrana tympani in a healthy 
state. The best means that I can at present deduce from my 
experience, is to pencil the membrana tympani with Arg. nit. 
3 gs. aquae ^ L with a camel-hair brush twice a week, with the 
proviso that there is not any abrasion, previously syringing the 
meatus with warm water, also, by the application of a most 
useful therapeutic agent for the absorption of fluid and hyper- 
trophy, viz., galvanism ; I generally place the positive pole on 
the upper part of the cervical vertebrae, and the negative pole 
over the mastoid process, and sometimes introduce it into the 
external meatus, stimulating the membrani tympani, eustachian 
tube and the contents of the labjTinth. 

Eelaxation of the Membrana Tympaih. 

This disease is a frequent cause of deafness in debilitated 
and scrofulous constitutions, also in those persons who sufier 
from chronic catarrh of the nasal passages, the mucous mem- 
bane being in connexion with the fauces, is generally in a re- 
laxed state also. 

Upon examination, the membrana tympani will generally 
be found opaque, concave, and frequently hypertrophied, the 
bright spot elongated, and the manubrium of the malleus 
standing out prominently. 



Mr. Cutmore on some Morbid Affections of the Ear. 223 

The result of these objective symptoms is deficiency of hear- 
ing, with a sensation of fullness in the head, and a feeling as . 
if one spoke thickly. 

The diagnosis of this disease is not at all difficult ; by 
directing the patient to hold his nose while inhaUng his breath* 
and to forcibly expire with the closed mouth, so as to force the 
air through the eustachian tube, will cause the membrana 
tympani to become tense and natural, and produce an ameliora- 
tion of all unpleasant symptoms. In this aflfection the remedies 
are mostly of a constitutional kind ; where permanent benefit 
is derived from attending to the general tone of health, as 
already observed, in treating chronic diseases of the external 
meatus, with those medicines which have a long range of action 
on the system and mucous surfaces. Dul., Puis., Carb., Nux. v., 
LacL, Cal, Sili., Mer. s., Sulp. If much hypertrophy of the 
membrana tympani, the use of the Arg. nit., as before-mentioned 
will be of use, in thinning and toning the fibres, aided by 
galvanism, if obstinate. 

Perforation. 

The next aflfection of the membrana tympani that I shall 
allude to will be perforation. The usual cause of perforation 
of the membrana tympani, is catarrh of the mucous mem- 
brane of the tympanic cavity, and not the result of ulceration, 
as is generally supposed, but from that membrane secreting 
too abundantly, and the natural orifice of the eustachian tube 
being nearly closed by viscid mucus, is unable to carry it 
away through the fauces, and the absorption of the membrana 
tympani, is the result of the pressure of the viscid mucous 
inside the tympanic cavity ; it generally arises from scarlatina, 
measles, or chronic catarrh of the fauces. 

Perforation of the membrana tympani is not always attended 
with total loss of hearing, except when there is much hyper- 
trophy, or relaxation of that membrane, when the power of 
hearing becomes greatly diminished. The treatment is simple. 
Bedace the hypertrophy by applying Arg. nit., similar to that 



224 Mr, Cuimore on some Morbid Affections of the Ear. 

spoken of in hypertrophy of the external meatus. When the 
membrane becomes more healthy, apply a piece of moist cotton- 
wool to the orifice, by means of the speculum, and with a pair 
of fine plyers, or an artificial membrana tympani made of 
India-rubber, so as to confine the vibrations of the air in the 
tympanic cavity, and to concentrate it on the labyrintL The 
diagnosis of this affection is easy; desire the patient to hold 
his nose, and blow with his mouth closed, if the membrana 
tympani is not pervious, you will audibly hear an escape 
of air making a hissing noise through the external meatus, or 
upon examining the ear with a speculum during his blowing, 
you will perceive the edges of the opening expand. 

The Eustachian Tubk 

This is another important structure connected with the 
organ of hearing, and should there be any alteration from its 
natural state, deafness ensues ; it is frequently over-looked by 
surgeons when searching for the cause of deafness, thinking 
that the meatus and membrana tympani, ought only to be the 
objects of their attention. 

The especial use of the eustachian tube when in a healthy 
state, is to allow ingress of air to the tympanic cavity, and 
egress of mucus from it ; when mucus is too abundantly secreted, 
these natural functions are impeded, either from hypertrophy, 
congestion of the mucous membrane of the tube, or closed by an 
abnormal quantity of mucous, so that deafness ensues; there- 
fore it is necessary that the canal should be kept pervious, and 
a constant interchange of air in the cavity of the tympanum. 

The frequent cause of obstruction of the ^eustachian tube 
arises then from chronic congestion, and hypertrophy of its 
mucous membrane at the faucial orifice, and sometimes from 
an accumulation of secretion from its lining membrane of the 
t3rmpanic cavity; it generally arises from chronic catarrh of 
the nasal passages and fauces, with enlargement of the tonsils, 
occuring in persons of a scrofulous diathesis. 



Mr. Cutmore on some Morbid Affections of the Ear. 225 

This kind of deafness usually happens suddenly, upon taking 
cold or an exposure to the night air, and very often disappears 
as suddenly, with a loud crack in the ears, and an improve- 
ment of the hearing, which is of short duration. 

Upon examining the membrana tympani with a speculum, it 
will be seen to be very concave and opaque, frequently drawn 
inwards, so as to approach the stapes ; the concavity of the 
membrana tympani is often a diagnostic sign of the eustachian 
tube being impervious, arising either from chronic congestion, 
hypertrophy, or an accumulation of viscid mucus, but the true 
method of ascertaining the state of the eustachian tube is by 
the otoscope, an instrument of great value in diagnosing 
diseases of the ear; this instrument is an elastic tube, about 
eighteen inches in length, and each end tipped with ebony, one 
end is inserted into the ear of the surgeon, and the other end 
into that of the patient, who must swallow a little saliva, his 
nose and mouth being closed ; if then the eustachian tube be 
pervious, at the moment of swallowing he will feel a sensation 
of fulness in the ears, and the surgeon will hear distinctly a 
crackling sound produced by a slight movement of the mem- 
brana tympani outwards ; if the crackling is not heard, however 
faint, there is certain to be an obstruction of the eustachian 
tube, especially if the membrana tympani is concave. 

In treating of these diseases of the eustachian tube and 
fences, I may state that they principally arise from a cachectic 
state of the constitution, brought into activity by scarlatina^ 
measles, residing in a damp locality, or exposure to a cold; moist, 
atmosphere; such causes must be removed, and the' patient 
placed in as favourable a position as possible for recovery; 
also hygienic means must be resorted to as mentioned in the 
treatment for chronic inflanmiation of the meatus, with the 
following addition: a cold compress placed around the throat and 
neck on going to bed, and in the morning to bathe the throat and 
neck with cold salt water, and rub it afterwards with a coarse 
towel until a glow is produced, adding the administration of some 

VOL. in. 15 



226 Mr, Cuimore on some Morbid Affections of the Ear, 

of the following medicines — I have generally found them 
Homoeopathic to the subjective symptoms of the diseases which 
attack the eustachian tube and throat, each medicine prescribed 
according to its correspondence with the diseased state of the 
patient — ^Ammon. caust., Calc, lodi., Merc, ioda., Mer. s.. Nit. 
acid, Kal. car., Kali, hydriodi. Con., Kreas., Lach., Phos., Grap. 
Caust., Nat. mur.. Puis., Sili., Dulc, 

DISCUSSION. 

Db. Djrury, while thanking the author for his paper, felt that 
the thanks of the Society were also due to Mr. Cameron, for the 
excellent manner in which he had read it : good reading always 
helping to place an author on better terms with his audience. 
It was to be regretted that Homoepathic literature was deficient 
in diseases of the ear, and he. Dr. Drury, was glad to find 
that Mr. Cutmore was giving his attention to this matter, as it 
was always desirable that specialities should be in the hands of 
respectable practitioners. Though some able and upright men 
amoDgst the Allopaths had selected this department for their 
particular attention, there was no doubt that aural surgery had 
not been as well represented as it might in the profession, so that 
is required all the weight of a Toynbee or a Harvey to raise it 
again in public estimation. When such stories were current as 
that of " the watch trick," it was most desirable to see men of 
standing trustiug to their own skill and integrity to raise them 
above any such suspicion. What he spoke of as the watch trick, 
was simply the using a loud ticking stop watch, by which the 
first day, as close to the ear as possible nothing could be heard, 
while on the second visit, the loud tick showed the patient how 
much he had improved. Knavery of this sort had possibly 
frightened some men from being associated in the same depart- 
ment with such charlatans. Mr. Cutmore's paper was very in- 
teresting and gave some valuable information. It was much to be 
regrettecf that Mr. Cutmore had not given the indications for the 
medicines, or that he had not trusted more to them and less 
to what might be termed Allopathic auxiliaries. If in remo- 
delling his paper he would rectify this error and give his reasons 
for using certain drugs, and the effects that he could fairly trace 
to them, it would much enhance its value. 

Mr. Yeldham said Mr. Cutmore had adhered rather loosely 
to the title of his paper, inasmuch as the most important and in- 
teresting of all the affections of the ear, viz., deafness arising 



Mr, Cutmore on some Morbid Affections of the Ear. 227 

from disease of the auditory nerve, were scarcely alluded to. He 
certainly did expect that in a paper of so comprehensive a title,* 
these cases would not have been omitted. Mr. Cutmore's paper 
was interesting as far as it went, in the description of ordinaiy 
affections of the external ear and passages. Mr. Outmore's 
treatment of these he thought was somewhat meagre, and by no 
means noveL The accumulation of hardened wax in the ear 
was a fertile source of temporary deafness. He, Mr. Yeldham, 
was constantly meeting with cases in which relief was afforded 
in a few minutes by carefully syringing the ear. This operation 
must be done thoroughly to be effectual, and even then in some 
cases it failed to remove the obstruction. Some time ago, a 
gentleman came to him for deafness which had existed in one 
ear for years, and which had been ineffectually treated. On 
examining the ear, he, Mr. Yeldham, was satisfied that it 
arose from mechanical obstruction. The syringe failed to 
remove it. He then introduced a fine hooked instrument, like 
a crochet needle, and extracted a hard substance like a bullet. 
The cure was, of course, instantaneous. The patient then 
recollected that two years before he had introduced a piece 
of paper into his ear, which he had never removed, and this 
formed the nucleus around which the wax had hardened. Mr. 
Cutmore's description of inflammation of the meatus audetorus 
extemus did not appear to be very distinct. He, Mr. Yeldham, 
had not often met with it excepting in young scrofulous subjects, 
being either idiopathic, or the result of scarlatina, and the best 
remedies were those which best combated the scrofulous diathesis 
— Calcar, Hepar, Sulph., Pulsatilla, Phosphorus, and cod liver 
oil — a weak Arnica-lotion he had found to be the best local ap- 
plication. Mr. Cutmore had omitted to mention a very fertile 
source of obstructed hearing, viz., eczema of the external ear and 
passage. This disease, which often attacked those parts, thickened 
the Iming membranes, and caused, sometimes permanently, an 
almost complete occlusion of the external canaL Mr. Cutmore 
had spoken of osseous tumour and of polypus as frequent 
diseases. In his, Mr. Yeldham's, experience, they were by no 
means common. He had seen only one case of polypus for some 
years past, and hardly recollected a case of deafness from osseous 
tumour. The passing into the eustachean tube of the catheter, 
which required some dexterity, was, in some cases, doubtless, 
a useful operation, as it is performed by aurists. His old 
friend, the late Mr. Pelcher, had passed it for him, Mr. Yeldham, 
many years ago, for deafness, and afforded relief for a few hours 
by expelling a globule of air ; but the relief was very transitory. 

* The original title was more ambitious than the present one. 

15* 



228 A Case of Hcematuria and 

The deafness returned and remained for months, imtil one day, 
whilst he was ascending a high hill, it went off with a loud bang, 
and never returned. He, Mr. Yeldham, did not agree with one 
of the speakers who had preceded him in recommending Mr. 
Cutmore to make diseases of the ear a " speciality." He believed 
these diseases were well understood by most medical men, besides 
which the Homeopathic body was at present too small to admit, 
without disadvantage, of being cut up into specialities. 

Mr. Cameron. — ^I cannot agree with the objections which have 
been so generally made this evening against the preponderating 
importance which Mr. Cutmore has given to the surgical over 
the Homoeopathic treatment of diseases of the ear, for I believe 
that in this class of ailments, purely medical treatment, whether 
Allopathic or Homoeopathic, is seldom of much direct use. When 
the aurist has directed his attention to the improvement of the 
general health of his patient, or, in cases of acute pain, admi- 
nistered his sedative ; or attacked, upon general principles, rheu- 
matic or gouty inflammation among the small bones of the internal 
ear, or their articulations, he has pretty well exhausted hisresources 
of a purely medical kind. The surgical treatment of the ear, if often 
not more successful, is at least not so limited in its applications, and 
I think Mr. Cutmore had no choice left him in his endeavour to 
present us with a comprehensive view of the diseases of the ear 
and their treatment, but draw our chief attention to their surgery. 
I am afraid, however, that even this is not a very successful field 
of practice, and that patients, from sad experience, have made 
up their minds to be satisfied with a " safe ** aurist, without ex- 
pecting any great things from him in the way of cure in very 
many cases. I had ample opportunities two years ago, of wit- 
nessing the practice of Dr. Kramer, of Berlin, perhaps the most 
eminent aurist in Europe, and was then painfully impressed with 
the slender modicum of success which attended his skilful 
attempts to relieve the patients whom I had persuaded to 
consult him. 



A CASE OF HiEMATUEIA AND ALBUMINURIA AFTER 
SCARLATINA MILLARIA. 

By Dr. Thinks, Corresponding Member of the Society. 

[From the Neue Zeitschrifb der Homoeopathischen Kilimk.] 

Antoine de S os, aged 15, of a feeble and strongly de- 
veloped scrofulous constitution, of high mental endowments 



AUmminuria after Scarlatina Miliaria, 229 

and a nervous temperament, had suffered from many serious 
attacks of disease at different periods of his life. In his tenth 
year he had inflammation of the whole of the right lung, which, 
never being entirely cured, left it in a state of camification as high 
as the fourth rib, and it was only above this point that the respira- 
tory murmur was audible. Two years later he suffered from abdo- 
minal typhus, which, according to the statement of his mother, 
who was minutely informed of the facts by the physicians of 
Warschau who were in attendance, induced an attack of albu- 
minuria. In the preceding autumn he had caught cold and was 
laid up by a laryngeal and bronchial catarrh, which was cured 
by a course of the Kieselbrunnen of Ems. 

He passed the comparatively mild winter of 1862-68 in 
perfect bodily comfort, till the 25th of February, when he was 
suddenly seized with headache, vomiting, and slight sore throat. 
Having then been called in, I prepared his parents for the appear- 
ance of scarlet fever, as I had seen the same premonitory symptoms 
in many children; and so it proved to be, for the eruption showed 
itself the following night. The scarlet fever ran a very mild 
course, there was very moderate fever from first to last ; the 
sore throat was but slight likewise during the first three days ; 
there occurred, however, a most unpleasant nervous restlessness, 
which lasted day and night, making sleep impossible, and causing 
lively images and slight delirium for the two first days. The 
rash was not much developed, it spread as a miliary eruption 
from the upper to the lower portions of the body, excited un- 
pleasant itching, paled as early as the fourth day, and at the 
same time the sore throat disappeared, and the fever from this 
time rapidly diminished. 

Under the administration of Aconite in the 2nd decimal dilu- 
tion, at the rate of three drops every three hours in water, and 
a couple of doses of three drops of coffea, 1st dilution, to allay 
the nervous restlessness, the scarlet fever ran its course without 
any further remarkable symptom. The exfoliation of the cuticle 
began upon the face and neck on the seventh day, and somewhat 



230 A Case of Hcematuria and 

later on the other parts of the body. On the tenth day, on 
account of the increased appetite of the patient, he was 
allowed meat and broth, and all his functions were performed 
with perfect regularity. He was kept in bed and felt perfectly 
well until the sixteenth day, on the early morning of which his 
mother observed swelling of the face and of both hands, and 
showed me on my visit that there was albumen in the urine, 
for before 1 got to the house, indeed whenever she noticed 
the swelling, she had boiled some of the water, and the amount 
of the albumen was very considerable. The urine reddened 
litmus paper. Taught by former experience, I was in no hurry 
in prescribing a medicine, for I had frequently observed that 
blood appeared after the administration of HeUeborous niger. I 
had formerly ascribed this appearance to the t/OO powerful action 
of this remedy, and I wished to observe whether the same 
symptom would appear without the use of any medicine what- 
ever. The result justified my suspicions, for next day I found 
blood in the urine, and this rapidly increased in quantity during 
the following days without the use of any medicine ; so that 
the whole urine, which was not inconsiderable in quantity, was 
of quite a blood-red appearance. There was no increase of 
thirst. The secretion of urine in respect to its amount seemed 
at the same time much increased ; it also showed the same con- 
siderable quantity of albumen when being boiled. The swel- 
ling of the face and hands did not increase, and this anasarca 
did not extend itself to other parts of the body, as rapidly hap- 
pens in cases of this description. 

Looking upon this hsematuria as an active hypersemia of the 
kidneys I did not wish to take energetic measures to subdue it. 
However, the marked retardation and compressability of the 
pulse, the increased feebleness of the action of the heart, the 
anaemic murmur in the ventricles, the paleness of the face and 
lips of the gums and tongue, informed me that a state of 
anaemia was being established, notwithstanding that the appetite 
continued good and that the digestive functions including defe- 



Albuminuria after Scarlatina Miliaria. 231 

cation went on with regularity. Sleep, too, remained undisturbed, 
althougli the patient was not strengthened by it. 

On the 6th day of the attack the urine contained a very 
large quantity of blood, which fell to the bottom of the vessel, 
and also a large quantity of albumen ; it had lost all the proper 
urinous smell, and was passed in considerable quantity, the 
oedema of the face and hands was gone, but the other symptoms 
continued to run their own course. Having in view chiefly 
the necessity of arresting the progress of the anaemia and 
nephritic haemorrhage, I ordered the patient 3 drops of the 1st 
decimal dilution of China every four hours, and to take a 
nourishing but at the same time easily digested diet, consisting 
of slightly roasted white meat and broth. 

In two days after the administration of the China, the 
quantity of albumen in the urine decreased, and this diminution 
continued to advance each day, while on the other hand the 
quantity of blood in the urine was only slightly affected, and 
it was not till after the albumen had entirely disappeared, and 
the quantity of the urine had sensibly lessened, that the blood 
very gradually and slowly disappeared. After the entire dis- 
appearance of the blood, the urine passed during the night de- 
posited a large quantity of reddish crystals, which were 
recognised as those of cystecin when viewed under the micro- 
scope. After a few days, they, too, entirely disappeared, and 
the patient rapidly advanced to a perfect sense of health both 
of body and mind. 

China in this case first cured the albuminuria within a few 
days, then the nephritic haemorrhage, and then the anaemia this 
occasioned. The further development of the general dropsy was 
visibly checked likewise by this remedy, so that the organism 
was spared the effect of absorbing the serous effusion in the 
subcutaneous cellular tissue. Should other practitioners find 
China of use in similar cases, the sphere of action of this 
remedy, otherwise so valuable, will have received an important 
eztention. 



232 A Case of HcematvHa and 

In severe cases of scarlet fever, I have always found that the 
kidneys, as well as the brain, were affected from the beginning, 
although sometimes in a slight, at other times in a severe 
degree. Either diabetes insipidus without any albumen oc- 
curred, or the opposite condition was present, and along with a 
diminished secretion, the urine, on being boiled, exhibited traces 
of albumen. This particular direction of the scarlet fever poison 
towards the kidneys explains the frequent appearance of albu- 
minuria and hsematuria as consequences of an attack of scarlet 
fever, both of these affections being uncommon in other exan- 
themata. Neither errors of diet nor exposure to cold give rise 
nor are the cause of this albuminuria, but the chief cause is this 
sole and only one, that the scarlet fever poison has not been 
fully eliminated from the system, and this it is that produces 
this peculiar affection of the kidneys in such cases. It is 
chiefly in persons of a highly-scrofulous constitution in whom 
this sequela occurs during the process of desquamation. 

In the case just related I was induced to prescribe China on 
account of the rapid development of the anaemia, also from the 
character of the haemorrhage, for I had not before observed that 
this medicine exerted so decided an action in checking albu- 
minous urine. The result was the more surprising to me, as I 
had not found the least diminution in the quantity of albumen 
produced by the administration for a long time of the Sulphate 
of quinine in the instance of a patient of sixty years of age, 
whose case was one of idiopathic albuminuria. In cases of 
simple albuminuria after scarlet fever, with serous infiltration 
of the subcutaneous cellular tissue of the face, the limbs and 
the whole body, but without consentaneous hsematuria, Helle- 
borus niger has always proved suflBicient, and I never have had 
occasion to employ Arsenicum ; the Hellebore alone has always 
sufficed to cure the affection. 

As the therapeutics of scarlet fever gradually becomes more 
and more perfect, both in reference to the treatment of the 
disease itself and of its complications and consequences, we may 



A Case of Paratyphlitis, 233 

indulge the hope that in the course of time we shall discover 
the appropriate remedies for the cerebral aflfections, for the most 
part &Ltal, by the general or partial paralysis of the brain — 
affections generally incident to children under five years of age, 
and manifestiQg themselves with the development of the attack 
of scarlet fever, and which also, although much more rarely, are met 
-with in adults ; and that we shall likewise discover the proper 
remedies for the diptheritic affection of the mucous membrane 
of the nose, palate, and fauces, such as commonly attacks very 
scrofulous children under ten years of age, and often goes on to 
a rapidly fetal termination in a condition of stupor. 

Agaiost the cerebral poisoning by scarlet fever, the medicines 
hitherto known and employed which act upon the brain, are 
quite insufficient, and, we see without power to avert the ap- 
proaching paralysis of that organ. Indeed there is hardly time 
for the efforts of the physician to be effectual, for within four 
or five days the sad termination takes place. It is probable 
that in the diptheritic condition of the mucous membranes, 
Bromine would prove of more service than Mercury or Arsenic, 
which have hitherto been tried in vain. 

A Case of Paratyphlitis. 

Miss A. Zeidler, 16 years of age, of a scrofulous constitution, 
with the exception of measles and scarlet fever, and sHght 
catarrhs from catching cold, had always enjoyed good health ; 
the catamenia also had appeared without any difficulties at the 
age of 14, and had always recurred at the right time and with- 
out irregularity of any kind. 

On the 29 th of May of this year (1863), I was sent for by 
the mother of this girl to see her. She had suffered for several 
days from severe pains in the right side of the abdomen, with 
obstinate constipation. I found the patient in bed, and on a 
close examination, I discovered a broad hard tumour in the 
right iliac fossa, extending down to the region of the uterus, 
and above over the junction of the colon and ileum. The 



234 A Case of Hcematuria and 

tumour was very painful on external pressure ; in breadth it 
was equal to the palm of the hand ; faecal masses could be 
distinguished below the surface, and between this and them 
a harder substance could be felt. Pressing upon this impac- 
tion, gave the patient stabbing and pressing pains. The ab- 
dominal parietes were considerably elevated by this tumour, as 
was seen by comparing them with the corresponding region on 
the left side. Three days previously the bowels had been freely 
evacuated by a soap enema, since then there had been no pas- 
sage of either faeces or flatus ; the intestinal canal consequently 
contained much flatus. The whole of the rest of the abdomen 
was entirely free from pain. The tongue was slightly coated 
with white ; there was neither thirst nor appetite, nor was there 
any eructation of wind, nausea, or vomiting. The taste was 
somewhat insipid (fade) wersh (scottice) ; the pulse 70, not 
hard, the head was free ; the sleep disturbed in consequence of 
the pain ; the urine clear and pure, and of acid reaction. 

I now got the following report as to the origin of this attack. 
The catamenia had appeared six days previously at the right 
time, and unattended with any pain, and had continued quite 
regularly for two days ; on the third the patient had chilled her 
feet, and the catamenia began to be interrupted, and in the 
course of the same forenoon entirely ceased. In the afternoon 
of that day the patient had experienced lively pain deep down 
on the right side ; and as this had not subsided on the fourth, 
and there had been no stool, her mother had given her an 
cjioma of soap and water, which had the effect of emptying the 
bowels of hard faeces, but without producing any mitigation of 
her siifferings. To the time of my visit the only remedies em- 
ployed had been some cups of St. Germain tea, with the view 
of moving the bowels and relieving the pain; but no such 
effect had followed; the steady increase in the pain had at last 
induced her mother to seek my aid. 

In consequence of the arrest of the catamenia by the patient 
having got a chill in her feet, an inflammatoxy action had been 



A Case of Paratyphlitis. 235 

excited, which, extending firom the cellular tissne to the broad 
legament of the uterus and ovarium, had advanced bo as to 
involve part of the colon and ileum and the processus vermi- 
formis ; and thus a case of paratyphlitis had resulted For the 
tumour was not occasioned by the impacted faeces alone, as the 
infiltration of the tissues and there tumification were palpable 
beneath and beside this fiecal mass, and the retention of the 
fiseces was to be regarded only as a necessary consequence of 
this inflammatory process. Such was the diagnosis, and it was 
confirmed by the further progress of the case. 

Such being the condition of affairs, it behoved that energetic 
measures should be at once adopted to arrest the progress of 
this inflammatory condition already far advanced, to avert a 
disastrous issue in sphacelus, and perforation or suppuration 
and adhesion of the different portions of intestines to one 
another, or to the neighbouring tissues. Accordingly, the 
patient was ordered 3 drops of the 2nd decimal dilution of 
Belladonna every three hours in a little water, and warm oat- 
meal porridge — ^poultices were applied to the abdomen; for drink, 
water which had been boiled and allowed to cool, as the fresh 
spring water produced eructation. 

On the 30th of May I found the condition of the patient 
altogether unchanged; the pain and the configuration of the 
tumefaction were exactly what they had been, the pulse was 
unaltered, and so was the urine. The patient had had Uttle 
sleep in consequence of the continuous pain. 

May 31. — No change in the condition of the patient, which 
was exactly what it had been on the previous day. No dimi- 
nution of the pain or swelling, no discharge of feeces or of 
flatus. Sleep very restless, pulse somewhat more excited — 85 
beats in the minute. Tongue somewhat more thickly coated ; 
dryness of the mouth and more longing for drink. 

June 1. — The pain in the undiminished swelling increased 
during the night, and as in ordinary cases of enteritis became 
more severe at intervals, and of the character of colic; no flatus 



236 A Case of Paratyphlitis. 

or faeces passed; the urine is become thick, and the pulse risen 
to above 100. The patient was altogether unable to sleep. 
The thirst had increased, the tongue had become more thickly 
coated. An enema of water and oil was administered without 
any result. Notwithstanding all this, no change was made in 
the medicine. 

June 2. — The patient had had no sleep all night in conse- 
quence of the recurrence at very short intervals of the colicky 
pain in the right inguinal region, and this had produced the 
greatest restlessness. The swelling, imdiminished in size, had 
become excessively tender, so that the poultices required to be 
made very thin. The thirst as well as the eructation were 
much increased ; the severe paroxysms of pain were attended 
with nausea; no faeces or flatus passed; the urine was very 
thick and deposited a brick-dust sediment, its surface was 
covered with an non-iridescent film, and it was very pungent ; 
stni it had an acid reaction. Pulse 110 ; temperature much 
increased. 

By the increase of aU the morbid symptoms the insufllciency 
of the medication was manifest, and the question remained 
whether the insufficiency was to be ascribed to the medicine 
being given in too small and in too infrequent doses, or to its 
not having been rightly selected. My experience justified the 
choice of the medicine, which had never played me false in the 
worst cases of the most advanced enteritis; and I was compelled 
to ascribe its failure in this case to its not being given with 
sufl&cient frequency, and to the doses not being sufficiently 
large. There was no time to lose, and not to do so by pre- 
scribing another medicine which was not so suitable for the 
case, I resolved to increase the dose of this one and to give 
it more frequently. The patient had from this time five drops 
of the 2nd decimal dilution of Belladonna in water every two 
hours. The poultices were continued. 

June 3. — Before midnight even, a diminution of the con- 
tinued and colicky pains in the swelling and its vicinity took 



A Case of Paratyphlitis. 237 

place. Towards morning, for the first time for long, there was 
passage of flatus. The excessive tenderness of the hard 
swelling had much lessened. In the afternoon, without the 
use of any artificial aid, some yellow and not very hard faeces 
were passed. The eructation and nausea were absent. The 
thirst was still great ; the pulse fallen to 95 ; the temperature 
of the skin was reduced. The urine as before; no change 
was made in the treatment. 

June 4. — ^The patient had slept with some interruption, not- 
withstanding the recurrence at longer intervals of the colicky 
pain ; in the state of the swelling, which was as hard as ever, 
there was no change, although in the early morning faeces of 
the natural form had been passed in abundance ; they were not 
hard, and no. artificial assistance was given; much flatus, 
attended with great relief, was also passed. The tongue was 
cleaner, there was no more eructation, the thirst was lessened, 
the pulse was 90; the urine thidk, without the film, and 
with the red sediment. The skin was of natural temperature. 
The medicine was now given every three hours. 

June 5. — ^The colicky pains have entirely subsided, but the 
swelling, which still retains its old form, is still very tender to 
the toucL After midnight a copious discharge of faeces of a 
natural form, preceded by an emission of flatus, occurred spon- 
taneously. The tongue is now almost clean, the thirst very 
moderate, the pulse 85, the temperature natural, the urine re- 
mained clear, and had an acid reaction. The medicine was 
now given every four hours. 

June 6. — ^The patient had slept the whole night calmly, felt 
better in consequence, and desired some food. The tumour, 
which has greatly diminished both in height and breadth^ was 
still very painfully sensitive. It was easy to perceive that the 
focal accumulation had been removed, but deep down a hard 
oval body could be distinguished ; there was no fluid effusion 
round this, for the percussion tone was quite clear but quite 
" empty" over this body. Pulse 80 ; urine clear. On this 



238 A Case of Paratyphlitis. 

morning also there was a slight alvine evacuation. The medi- 
cine was given only every six hours. 

June 7. — ^The swelling could still be distinguished lying 
deep backwards, as an oval, hard, painful, body. The appetite 
was strong, and was allowed to be satisfied ; the stool was of 
natural figure, and very copious. Pulse, urine, sleep, were all 
natural ; the strength returned ; the medicine was given only 
night and morning. 

After six days I could discover only the faintest trace of the 
tumour. All the other functions were normally discharged, 
there was a daily and sufficient stool, and the patient felt 
herself again quite strong. The medicine was however per- 
severed in night and morning. 

After other five days every trace of the tumour had entirely 
disappeared, and so all farther medication was given up. In 
due time the catamenia made their appearance and ran their 
nominal course. 

I may now be allowed to add some observations to the nar- 
rative of the cure of this severe disease. The reputation and 
success of Hahnemann and Homoeopathy were begun and 
grounded by the splendid early cures made of very severe 
diseases, acute as well as chronic. All these brilliant cures 
were made with large, often very large, powerful medicines, 
given in often-repeated doses. The physiological provings, too, 
which are contained in the first volume of the " Materia Medica 
Pura," were for the most part begun and carried through 
with very large doses, as I learned from the communications 
of Hornburg, Franz and others. I was acquainted with a 
Dr. Anton, a relative of the psychologist Heinroth, who had 
also proved medicines for Hahnemann, but who had got them 
in such strong doses that they made him seriously ill, and 
frightened him from Homoeopathy altogether. 

Probably Hahnemann himself was induced by a similar ex- 
perience in the proving of medicines, as well as by the occasional 
pathogenetic effects produced upon patients by the administra- 



A Case of Paraiyphlitis, 239 

tion of strong doses of medicines, to dilute the medicines, in order 
to prevent this medicinal action in patients. From this period 
Homoeopathy entered into a new phase. Hahnemann appeared to 
have been thoroughly penetrated by the dread of too powerful 
effects from the medicines in disease, and this fear pushed him to 
the opposite extreme. This dread beclouded his otherwise sober 
and keen powers of observation ; every aggravation of disease 
that occurred after the administration of a medicine he attributed 
without further proof to the effects of the medicine taken, and 
it was this dread which led him to promulgate the dogma that 
the most minute dose was sufficient to cure the severest disease, 
and ultimately induced him to announce the theory of poten- 
tizatipn, a theory destitute of all foundation upon facts. It was 
necessity alone which compelled Hahnemann from time to time to 
lid himself of this fear of the too powerful effects of drugs ; as 
for example, when he found it necessary to administer Camphor, 
both externally and internally, in strong doses, in cases of the 
prevailing epidemic of Asiatic cholera. 

Hahnemann's sphere of practice had in the course of time 
become so peculiarly constituted, that he was withdrawn from 
the direct inspection and observation of all acute diseases. In 
Leipsig, as well as at Koethen, he saw only patients who were 
able to go to him, and these were for the most part the sufferers 
from chronic diseases. It was probably this fact which gave 
him so strong a preference for this class of patients, — a pre- 
ference which carried him so far that he gave both myself and 
my deceased colleague, Dr. Wolf, the advice to decline under- 
taking the treatment of acute cases ! In this way, all acute 
cases had to a certain extent become strange to him, and had 
been kept entirely out of his sight, and this necessarily induced 
in him a certain one-sidedness. In chronic diseases he had 
gone so far as to have noted down each particular symptom 
which made its appearance in a patient, it might be weeks 
after the administration of a medicine, and these notes com- 
posed the greater part of the materials out of which the 



240 A Case of Paratyphlitis, 

provings of the so-called antipsoric medicines were derived. 
Hence the efforts of my respected friends Dr. Eoth and Dr. 
Langheinz, of Darmstadt, are not only worthy of the highest 
praise and fullest recognition, but the work in which they are 
engaged is of the most urgent kind, — for the purification of 
the Materia Medica is a work of absolute necessity. 

It is now, however, full time that the dogma just referred 
to should be struck out of the Organon, and that the potenti- 
zation theory should be given up as a part of the doctrine 
of medicinal action, — ^being, as it is, in direct antagonism to 
all experience. I have said even to Hahnemann's face, and 
demonstrated to himself the fact, that it is not possible to 
potentize into more powerful efficacy upon the animal economy, 
wine and alcohol, by the addition of water, and that both these 
substances must, according to his own definition of what 
medicines are, be reckoned sucL He never replied to this 
representation. 

The foregoing narrative of the cure of so serious a disease, 
affords us a fact of important consequence. It demonstrates 
that the operation of a well-chosen medicine in small doses, 
repeated at considerable intervals, is often insuf&cient to cure, 
but that by increasing the strength of the dose and repeating it 
more frequently, the intensity of the disease may be broken and 
overpowered, and its cure achieved. 

Note. Langheinz, whose name is but little known in this 
country, published an article in the recent number of the 
" Vierteljahrshrift " upon Opium. He states that out of 518 
symptoms to which the references gave him access no less than 
210 ought to be struck out. He shows the symptoms of Matthaei, 
Machart, Hunter, Eademacher were observed principally in 
persons suffering from iUness, also those by Young, and the pre- 
parations he employed were not pure, that Schillhammer's opium 
was combined with crocus, iEplis with rhubarb ; also Miiller 
and Stutz employed mixtures, while those of Friend, Bergius, 
Murray, Geofifroy, EttmiiUer, WiUis, and Haller were merely such 
hypothetical symptoms as are found in the manuals. Buoff's 
symptoms are utterly worthless. 



A Case of Paratyphlitis, 241 

I could bring forward likewise other cures of acute and 
chronic diseases to confirm these facts, and I will do so if God 
should grant me a longer life. I wished, however, by the com- 
munication of the one experience, to make my Mends observant 
of this — that we must resolve to leave the path which Hahne- 
mann has hitherto marked out, that we must make up our 
minds to accommodate the dose of the medicine to the degree 
of intensity of the disease we treat, that we must abandon as 
an error that a small or the smallest dose is sufBicient for the 
cure of every — even the severest of diseases. This is demanded, 
as well on account of suffering humanity, as because it is a 
fancy equally destructive to science, and one which undermines 
the strength and power of the Homoeopathic system of medi- 
cine, and deprives it of its full value and recognition. 

DISCUSSION. 

Me. Teldham said, — ^Albuminuria, it was now well ascertained, 
since it had become the custom to analyze the urine, was by no 
means a rare occurrence, and probably it was much more common 
than was even now imagined. The most frequent cause of it 
was beyond a doubt, a previous attack of scarlet fever. It was 
generally said to bear a close relation to the severity of the skin 
diseasa It might be so ; but the rule had large exceptions — of 
this he was perfectly satisfied from his own experience. Nor 
did he think that exposure to cold, and errors in diet after scar- 
latina, had much to do with inducing albuminuria. He had 
treated many cases in which every precaution in these respects 
was taken, and yet dropsy had occurred. He believed the great 
predisposing cause to be a peculiar delicate scrofulous constitu- 
tion. Not long ago he had a whole family of children under 
care with mild scarlet fever who, under his own strict injunctions, 
were taken the greatest care of, to prevent chill or improper 
feeding, because he anticipated, from the temperament of the 
children, that dropsy would follow, and his prediction proved 
but too true. They were all pale-faced, delicate children, and 
all had anasarca. He would not dwell on the treatment of albu- 
minuria after scarlatina ; on that they were pretty well agreed. 
In Aconite, Arsenic, Hellebore, Cantharis, and Terebinth, they 
possessed very powerful and generally successful remedies. 
When albuminuria occurred as the result of Bright's disease, 
it was very questionable whether any treatment would succeed. 

VOL, ni. 16 



242 A Case of Albumimcria and 

He thought Dr. Trinks' selection of China very interesting. He, 
Mr. Yeldham, regarded that medicine, in low dilutions, as a most 
important medicine in many cases of atonic inflammation. He 
believed that it excited the contractility of the capillary vessels, 
pathogenically on the healthy body, curatively in disease — Whence 
its relation to ague — hence its power in averting haemorrhage — 
hence its curative action in inflammation, which consisted in 
dilatation of the capillaries. He thought they were much indebted 
to Dr. Trinks for the examples he had given of the good effects of 
low dilutions, as they were also indebted to those gentlemen, who, 
on the other hand, exemplified the effects of the high dilutions. 
All this went to confirm the opinion which he believed was en- 
tertained and acted upon by the soundest practitioners of 
Homceopathy, viz., that all the dilutions of medicines were curative 
in certain cases, and that he was wisest who restricted himself 
to no particular dilution, but availed himself, as circumstances 
might require, of all of them. 

Dr. Wyld (of London), did not think that much was to be 
learned from the case of albuminuria following scarlatina which 
had been just read. This was a very common affection, and very 
easily cured inthegreatmajority of cases. Dr. Wyld had had two 
cases of chronic albuminuria under his care, accompanied by 
general anasarca. These cases had lasted for years, but no treat- 
ment seemed much to reduce the amount of albumen in the 
urine, although the swelling and anasarca had nearly disappeared 
in the one case under grain doses of the black-oxide of iron, and 
in the other case during a month's residence in the country. In 
this second case the dropsical swellings had returned, and on one 
occasion the patient became comatose for two days, but recovered 
under Opium 3 and Arsen. 3. Apis appeared to do most good 
in one of the cases. Both cases resulted probably from degeneration 
of the kidneys, although neither casts nor blood discs have been 
observed in the urine. Dr. Wyld would be glad to know if any 
gentleman present had ever succeeded in curing chronic albumin- 
uria, the result apparently of kidney disease. Arsenicum was 
probably our best remedy, but in both the cases referred to it 
had failed to do much good. With regard to the case called 
paratypJditis, it did not appear very clearly made out There 
appeared to have been the presence of a tumour without any in- 
flammatory action to begin with, and secondly the tumour was 
felt as " an oval moveable tumour.'' Was it a phantom tumour, 
or was it a moveable kidney? The cure being effected by Bella- 
donna might to some extent point to an hysterical origin. Dr. 
Wyld had seen an hysterical tumour which perfectly simulated 
a hard fibrous tumour, but which always melted away when the 
patient was placed under chloroform, and re-formed as the 
influence of that drug subsided. 



A Case of Paratyphlitis. 243 

Dr. Hughes said — I heartily join in the admiration generally 
expressed for this and all other practical papers by Dr. Trinks. 
I agree with him, that the renal affection is not an accident in- 
cident to the convalescence from scarlet fever, but is of the essence 
of the malady. But I think we should draw an incorrect in- 
ference from his narrative, if we concluded that the China exercised 
any direct curative influence upon the congested kidneys. There 
is no evidence that China is a specific irritant of the renal paren- 
chyma, like Terebinthis, Cantharis, Arsenicum, and Mercurius 
Corrosivus ; and it can never take the place of either of these 
remedies in the treatment of nephritis. Its value in the case 
before us seems to me purely dependent on its well-known power 
of antidoting the bad effects of loss of blood, from which Dr. 
Trinks' patient was plainly suffering when he saw her. I have 
no doubt that he acted wisely in treating this serious general 
effect of the local mischief, and leaving the latter to right itself ; 
but it is important that we should understand this to be the true 
rationale of his successful treatment. I have not met with the 
paralysis of the brain in scarlatina, of which Dr. Trinks speaks 
so despairingly ; but the experience of Dr. Elb of Dresden, and 
others, would seem to prove that we have in Zinc a very potent 
remedy for such a condition. The diphtheritic complication I 
have found almost universal in severe cases; and, except in 
malignant forms of the disease, have much confidence in the 
Biniodide of Mercury for its removal With regard to the 
■ second case, I cannot agree with Dr. Wyld, in the doubt he has 
raised as to the diagnosis. I think the inflammatory nature of 
the disease very plain ; but regret that Dr. Trinks seems to have 
left out of sight in his treatment the evident implication of the 
peritoneum in this process. I cannot but think that, had he 
recognized this, he would have found much help from Mercimus 
Corrosivus in the management of the caso.. I look upon this 
medicine as almost infallible when in inflammation of any of the 
abdominal organs, the peritoneal covering becomes implicated in 
the morbid process. I well remember a case of ovaritis in which the 
y]i Corrosidfe Sublimate — ^the first medicine administered-^-removed 
/ in a few hours the sharp, cutting pain of serous inflammation, 
and left behind the dull, sickening misery characteristic of 
ovarian congestion, — which in its turn yielded beautifully to the 
steady use of Pulsatilla. I am compelled, moreover, to question 
the Homoeopathicity of Belladonna to a malady of this nature, 
and to doubt very strongly whether it contributed much towards 
the recovery of this patient. Dr. Trinks tells us that he per- 
severed with the drug, because in the worst cases of enteritis in 
the highest stage, it had never refused him its aid. But surely, 
upon fir, Trinks' own showing, this was no case of enteritis,— 

10^ 



244 A Case of AlhuminuHa and 

by which I suppose he means, as we do in England, inflammation 
of the intestinal mucous membrane. And the history of the case 
seems to show the disease progressing, imchecked, to its acme, 
and then as steadily declining. I cannot think that the mere 
increase of two drops in dose, and diminution of one hour 
in the intervals between the doses, had anything to do with the 
turn of the malady. 

Dr. Drury regretted very much to find that instead of that 
harmony and brotherhood that ought to exist in the Homoeopathic 
body, tliore was every day becoming more prominent a spirit of 
opposition and disbelief — what one gentleman asserted, was 
contradicted by some one else, and much good was lost by a 
wholesale condemnation of those who differed, without any at- 
tempt being made to extract what reaUy was valuable, from a 
dislike to the individual, or to the particular school to which he 
belonged. On the present occasion, there was a paper by Dr. 
Trinks, that really might have been dispensed with. It came as 
a flat contradiction to what had been so well and so completely 
stated by the President. Indeed, the address aUuded to, so com- 
pletely answered tliis paper by anticipation, that had it fallen 
undor the notice of the learned foreigner, whose cases had just 
been narrated, the Society might have been spared hearing a 
repetition of eiTors that had been so ably refuted by Dr. Quin. 
In the tli^t case that had been read, he. Dr. Drury, could give 
no credit to the China beyond the good it very likely produced 
by being given after Haemorrhaga In cerebral affections he had 
a vtny high opinion of Hyoscyamus, and had used it freely with 
groat success. A very interesting case that just came into his 
mind — that of a little child w^ho suffered from several derange- 
ments of vision, preventing her reading, following diphtheria, — 
the double vision and other symptoms disappeared under the use 
of Hyoscyamus. In the case where Belladonna was given, it ap- 
peared to be indicated by the tumour, but if instead of giving 
stronger doses, a higher potency had been given, a better result 
might have been obtained. While using other medicines 
when indicated for ovaritis, he, Dr. Drury, had the highest 
opinion of the action of Conium. 

Dr. Wilde (of Winchester), — I have recently seen a good deal 
of scarlet fever in Winchester. In most of the cases, very severe 
throat affections occurred, and in a great number hsematuria with 
anasarca. I found that where Belladonna had not been used at 
the outset of the disease, in consequence of my not seeing the 
cases earlier, that medicine was very useful in alternation with 
Arsenicum, during the nightly fever, delirium, and restlessness ^ 
which accompanies the anasar^ous condition. I had one very |(^ 
interesting case of paralysis after scarlet fever, occumng in a 



A C<x8e of Paratyphlitu. 245 

cliild two years of age. After the patient had passed well 
through the rash and a severe throat affection, and seemed to be 
rallying from the attack, 1 was sent for suddenly to see the child. 
On arriving at the house, I found the little patient lying in the 
lap of his mother, in a semi-comatose state, with dilated pupils, 
and perfect loss of motion of the left arm and leg, with great dis- 
tension and fullness of the veins of the scalp, and much heat 
about the head. Belladonna was administered, but with ap- 
parently no good effect. I then tried Zincmn Met, which com- 
pletely removed the paralysis, and the child recovered after three 
or four days. 

Me. Cameron. It is with great deference to so eminent and 
and experienced a physician as Dr. Trinks that I venture to call 
in question the value which he sets upon the directly curative 
effects of China in the cure of albuminuria and hsematuria. Not- 
withstanding his authority, I own that I am very sceptical as to 
the great importance of any one remedy in the treatment of 
symptoms like these, which so often depend upon many and very 
different pathological conditions. We know very well that albu- 
minuria and haematuria are symptoms that may often arise 
simply from a morbid state of the digestive or other organs, un- 
connected with any structural lesion, temporary in their duration, 
and that will disappear without any special treatment, while 
again in other instances they denote the most incurable and 
deadly structural diseases. Owing chiefly to the serious nature of 
albuminuria in Bright's disease, and to the rather sweeping gene- 
ralizations of that and some other eminent writers, a degree of 
importance has become associated with the smallest appearance 
of this symptom in any case, which it does not always deserve. 
In some patients, for instance, albuminuria is readily produced 
by a dose of Calomel or other preparation of Mercury. Some 
people experience it after a full meal, and lose all trace of it next 
day. I know a gentleman, in fair average health, who has had it 
for more than twenty years. Another gentleman, who goes 
through a great amount of mental and bodily work, has been 
subject to albuminuria at intervals for many years, and regards 
an attack of it as rather curative, as he feels better after than 
before it. In short, there seems to be no reason to question the 
opinion of many Pathologists who maintain that this appearance 
may often depend entirely on errors of digestion of a very simple 
and unimportant kind, and that in these cases the symptom is 
owing to the mode in which the pabulum is presented to the 
kidneys for secretion. The same general remarks apply to 
hematuria — ^it is often unconnected with any local disease, arising 
in such cases from a generally morbid condition of the system, 
and disappearing when that condition has been removed. It 



246 Cases of Ophthalmia, 

frequently occurs, withoutanylesioii,in purpura, scurvy, sinall-po3t, 
typhus and other low forms of disease, and, in these cases, takes 
its departure without any other treatment except the general one 
employed for the removal of the adynamic condition of the sys- 
tem. Although these and other similar arguments cause me to 
doubt the directly curative action of China in the interesting case 
reported by Dr. Trinks, I am very far from calling in question the 
perfect propriety of his treatment, as I believe that in the ex- 
hausted state, and hsemorrhagic tendency of the patient, it was the 
most appropriate remedy that could be used. I am, however, 
equally persuaded that it acted by relieving the generally 
adynamic condition of the patient, and not by any immediate 
Homoeopathic or specific influence over the kidneys, just as it 
does in cases of scurvy, purpura, or typhus, accompanied with 
haematuria in removing this symptom. I cannot sit down without 
expressing my regret that Dr. Eussell has been called away before 
the reading of this paper. Had he been present he woidd have 
explained to us what amount of importance was to be attached 
to the observations of Dr. Trinks in regard to the practice and 
opinions of Hahnemann at different periods of his career, obser- 
vations which he believed to be entirely at variance with those 
of other credible witnesses ; and he feared that unless they were 
now met with a distinct contradiction, they would be admitted 
unchallenged in future into the History of Homoeopathy. 



CASES OF OPHTHALMIA, WITH OPACITY OF THE 

COENEA. 

By Dr. Ozanne. 
The following cases are doubly interesting to the Homoeo- 
pathic practitioner, inasmuch as they show the power of his 
remedies in effecting a cure where the ordinary or classical 
treatment had previously failed. 

Case l. — Mary Anne Duffy, a very interesting little girl, 3 
years old, was brought to the Homoeopathic Dispensary on the 
14th September, 1860. About five or six weeks previously she 
had an attack of measles. At first she was under the care of 
one of the parish surgeons, but subsequently was trans- 
ferred to that of his colleague. Before the measles had 
subsided one of her eyes became inflamed. The case was 



with Opacity of the Cornea, 247 

treated most carefully in the usual way ; leeches were applied 
twice, the child was blistered, the eye was fomented with 
decoction of poppies ; and subsequently the eye was touched 
every day with a small brush soaked in some medicated solu- 
tion In addition to these measures internal remedies were 
at the same time administered. 

Notwithstanding this careful treatment, the appearance of 
the eye, when I first saw it, was most alarming. The whole 
of the eye-ball seemed much swollen, the conjunctiva injected 
red and swollen ; the cornea was opaque, as if painted over 
with a thick coating of starch, and appeared to me to be, as I 
noted down at the time, ** disorganized." The child had quite 
lost her appetite, and had much fallen off in flesh. 

My prognosis was in this state of things, of the most dis- 
couraging character, for I must confess I looked upon the eye 
as irrevocably lost. 

Aconitum 1, six drops in three ounces of water, a teaspoonful 
every two hours. 

Sept. 15. — Much pain. No change in the appearance of 
the eye. 

Belladonna 1, 6 drops to two ounces of water, a teaspoonful 
every three hours. 

Sept. 17. — ^The pain diminished. Less swelling and less 
redness. 

Merc. cor. 2. 
Sept. 19. — Pain much relieved. 

Eepeat Merc. cor. 
Sept 21. — Still some redness of the conjunctiva; the pain 
much better. 

Aconitum for three days, six dix)ps to three ounces of water, a 

desert spoonful three times a day. 

Sept. 24. The eye generally much improved; the signs of 

inflammation disappearing. The cornea much improved, the 

ulcerations healing, and its general opacity less. 

Repeat Aconitum. 



248 Cases of Ophthalmia, 

Sept. 26. — ^Much the same. 
Merc. cor. for five days, six drops to three ounces of water, a 
desert spoonful for three days. 
Sept. 29. — General improvement continued. Cornea be- 
coming more transparent. 

Belladonna for three days, six drops to three ounces of water. 
Oct 2. — Much the same. 

Merc. cor. for five days. 

Oct. 5. — ^Diarrhoea, many watery motions since the previous 
day. 

Veratrum albm. 2, six drops to three ounces of water, a 
teaspoonftd every two hours. 
Oct. 6. — Bowels quite well, eye better, cornea healthier and 
gaining in transparency. 

Merc. cor. for five days. 
Oct 9. — The child had taken cold, had a cough, and redness 
of the lids of the good eye. Cornea getting clearer. 
Aconitum for fivei days, six drops to three ounces of water, a 
teaspoonful four times a day. 
Oct. 13. — Improving. 

Belladonna, for three days. 
Oct. 16. — Eye much improved; the opacity had so far 
diminished that I could see the whole outline of the pupiL 
Merc. cor. for five days. 
Oct. 19. — Cornea getting more and more transparent, the 
inner half being alone opalescent The eye appeared to be 
more of its natural size. 

Bepeat Mer. cor. 
The child remained under treatment until the 10th Dec, 
taking in succession Camabis Sativa 1, Aurum m. 3, Belladonna 
4, Camabis Sativa 1, and Merc. cor. for five days and six days; 
at the end of which course the eye was completely restored 
to its original state. 

The above notes are transcribed almost word for word from 
the case as drawn out at the time ; they are necessarily very 



with Opacity of the Cornea. 249 

incomplete, but nevertheless suffice to show that the ordinary 
treatment had most signally failed in every respect. It had 
failed to relieve the pain, had failed to remove the inflamma- 
tion, and had failed to avert the serious consequences which 
result from badly-treated cases of ophthalmia, when these are 
severe. 

Quite recently I have had a case in every respect similar to 

the above, in a little girl aged 20 months, AdaE ^ but 

having been fiK)m the first under Homoeopathic treatment, the 
results have been far different. By means of Aconitum 1, and 
subsequently Belladonna 1, and Merc. soL, 2 dec., trit., the in- 
flammation and its e£fects have been removed in a very short 
time without any damage whatever to the cornea. 

I may safely say that the case of Mary Anne Dufiy was one 
of the worst that could be imagined, and yet the result was all 
that could be wished for. 

Case 2. — Sarah Cameron, aged 11, daughter of a sergeant quar- 
tered at Fort George, had been from three to four weeks imder 
the treatment of the Surgeon to the Eoyal Artillery. Collyria 
externally, and powders internally, had been regularly ad- 
ministered. 

On 29th September, 1862, the lids of both eyes were red 
and swollen, the conjunctiva much injected. The left eye worse 
than the right. 

Aconitum 1, 10 drops to 4 ounces of water, a teaspoonful every 
two or three hours. 

Oct. 1. — Both eyes much better. 

Belladonna 3, 12 drops to 4 ounces of water. 

Oct 3. — ^The improvement continued. Two patches of red- 
ness in the globe of the left eye ; some excoriation of the edges 
of the eye-lids. 
Merc. cor. for 4 days, to be followed by Merc. soL five times a day. 

Oct. 6. — Improving. 

Eepeat the same. 

Oct 10. — ^Much better, excepting some photophobia. 
Belladonna for four days. 



250 Cases of Ophthalmia, 

Oct. 13. — Still a little injection of the eyes. This appears 
to be kept up by exposure to strong currents of air, the Fort 
being in a very high and exposed situation. 
Merc. cor. for six days. 

Oct. 20. — Much better. 

Bepeat the same. 

Oct. 29. — Eight eye much inflamed (a most decided relapse). 
Aconitum 1, 8 drops to 4 ounces of water; a teaspoonful every 

three hours. 

Nov. 1. — Eyes better. I now detected a small ulceration in 

the comer of the right eye. Whether it existed previously or 

not I could not feel sure, as untU now I could not make so 

thorough an examination of the cornea as I could have wished 

Mer. cor. 2, 10 drops to 4 ounces of water. 

From this date the medicines given were Mer. cor. 3 and 5, 
Aconitum for 3 days for another relapse on the 29th November, 
and SUicea 5. On the 26th December the eyes were perfectly 
well. 

Since then Sulphur 5, 2, and 12 have been prescribed for a 
herpetic eruption on the occiput. 

This case, although not a severe one, is interesting on account 
of the failure of the Allopathic treatment, and of the manifest 
improvement which soon took place under the new treatment; 
and the final cure in the most unfavourable season of the year 
and under unfavourable circumstances. 

Case 3. — A. — , a delicate young woman, aged 16, was 
brought to me on 28th November, 1862. 

She had been affected with ophthalmia over nine weeks. At 
first there was very much pain, photophobia and lachrymation. 
She was at once placed under the care of an Allopathic surgeon, 
who, in addition to a course of medicine internally, applied 
blisters on the temples, and subsequently instilled caustic solu- 
tion into the eye. 

When I first saw her, there was so much pain in the eyes 
and photophobia, that it was impossible to ascertain the state 



with Opacity of the Cornea, 251 

of the comea of either eye. She informed me that at first 
" everything before her eyes looked like fire," then everything 
became quite dark. For about a week she could see the light 
of day, but as if through a thick cloud. 

Belladonna for 2 days, 12 drops to 6 ounces of water, a dessert- 
spoonful every four hours. 
Dec. 1. — Her mother reports that she cotdd open her eyes a 
little yesterday, and bears the light of the candle better. 
Shooting pain in the nose. 

Bepeat Belladonna for 2 days. 
Dec. 5. — ^A cold and cough. Eyes much the same they say, 
but bears the light better, and can open the eyes better. 
Belladonna for 5 days, 12 drops to 6 ounces of water, a dessert- 
spoonful every four hours. 
Dec. 9. — I saw her this day and was able to examine her 
eyes carefully, as she was able to open them. I found the 
comea in each eye quite opaque. She was able to see the 
shadows of objects, but could discern nothing. 
Mer. cor. 2, 6 drops in 8 spoonfuls of water, a spoonful 
every four hours. 
Dec. 11. — StiU a cough. Sight improving. Last evening 
could see her own fingers, but they appeared very dark in 
colour, and much larger than naturaL 

Mer. cor. 2, 12 drops to 6 ounces of water, a dessert-spoon- 
ful every four hours. 
Dec. 15. — Sight continues to improve, and the comea is 
getting clear. White objects appear yellow to her, and brown 
seem to be black. Some toothache since the 13th. 
Aconitum for 1 day, 8 drops to 4 ounces of water ; a dessert- 
spoonful every two hours. 
Dec. 18. — ^Toothache better. She can see smaller objects. 

Mer. cor. 2, 12 drops to 6 ounces of water, 
Dec. 20. — I called to see her, and found the right comea 



262 Cases of Ophthalmia, 

still very opaque, but the left more transparent, especially at its 
upper part. 

Eepeat the Mer. cor. 
Dec. 22. — Much the same. 
Silicea 5, 12 drops to 6 ounces of water; a dessert-spoonful 
four times a day. 
Dec. 26. — The sight continues to improve. She is now able 
to see objects and to recognize them, though not distinctly 
Bepeat Silicea 5. 
Dec. 30. — Continues to improve. 

Merc. cor. five times a day, as before. 
Jan. 5. — ^The improvement continues ; she is now able to see 
a little with the right eye. 

Silicea 5. 
Jan. 9. — Improving. 

Mer. cor., four times a day. 
Jan. 13. — Improving. 

Silicea 5. 
Jan. 21. — ^Mer. cor., five or six times a day. 
Jan. 26. — ^The right eye is getting on as well as the left. 
Her mother says that she can see wonderfully better, having been 
able to discern her face, and to read aU the letters on a placard 
in the street. 

Silicea 18 ; 6 drops to 6 ounces of water; a dessert-spoonful 
four times a day. 
Jan. 30. — ^A slight cold, with slight vascular injection of 
the right eye. 

Belladonna, for three days. 
Feb. 6. — Much the same. 

Mer. cor., for six days. 
Feb. 10. — ^Eyes keep improving. 

Gale, acet 12. 
Feb. 16.— Going on welL 

Bepeat the Calc. acet. 



with Opacity of the Cornea. 253 

Although not completely recovered this case is one of the most 
interesting I have met with for a long time. The cornea of 
the left eye is very nearly transparent throughout, and that of the 
right eye in a fair way towards a complete cura The patient 
can now distinguish the lines o£ impression in an ordinary book^ 
but cannot distinguish the letters. 

The gentleman who attended her at first called soon after I 
commenced the treatment, tasted the medicine she was taking, 
and declaring that there was nothing in it ; at the same time he 
announced that he would become a believer in Homoeopathy 
if the patient ever recovered her sight by means of it. 
Whether he ftdfilled or not his announcement it matters but 
little, at any rate, this is certain, that notwithstanding his skill, 
neither the pain nor the photophobia were relieved by the 
orthodox measures he employed, but that an improvement began 
soon after the commencement of the Homoeopathic course, and 
has progressed up to this time in a surprisingly rapid manner. 

On looking over the medicines prescribed in these cases I find 
that Aconitum, Belladonna, and Mercurius Corrosivus have been 
those almost exclusively employed. In one case Cannabis sativa, 
and in two Silicea. 

I have the greatest confidence in the low dilutions of the three 
first of these medicines in the acute cases of disease of the 
cornea, followed by ulceration and subsequently by opacity, 
but experience has taught me the value of higher dilutions of 
Mercurus corros., and of SUicea in the more chronic forms. The 
latter medicines I prefer usually at the 12th, 18th, and 30th 
attenuations. 

In cases of ophthalmia of a more violent type, with more 
inflammatory irritation, and in strong constitutions, I generally 
use the lowest dilutions of Aconite with Belladonna, and Mercu- 
rius solubilis in preference to the corrosive sublimate. The 
solubilis is conveniently administered on the 2nd or 3rd decimal 
attenuations ; th^ dose a grain twice or three times a day 
generally alternated with Belladonna. 



254 



SOME UNPUBLISHED LETTEES OF HAHNEMANK 

To Dr. Stapf. 

Koethen, August 5th, 1830. 

Dear Friend and Colleague, 

The accompanying communication is for the meeting of 
the 10th of August. May I request that it should be read 
slowly, and that you will give in the coming Archiv, -a report 
of the Congress along with this paper of mine, which is thus 
at your service ? 

Will you also, after this essay, lay before the meeting this 
anonymous communication, which, I think, wOl be of use? 
there will be those present who will understand the meaning 
of it. Joking apart, the homoeopathic physician must at last 
come to this, that he gives only the needful medicine without 
any vehicle ; in that way he wiU evade aU attempts of the 
criminal jurisdiction to hinder his dispensing his own medi- 
cines. Yours, 

Samxtel Hahnemann. 

It would be well to remind the meeting that, in treating 
all cases, we should as far as possible ascertain what allo- 
pathic medicines the patients have taken in large doses, such 
as sulphur, carbonate of soda, that they may avoid them. 

To Dr. Stapf. 

Koethen, Dec. 27th, 1830. 
Dear Friend and Colleague, 

I send you with this one globule of Natrum, M. 30th, 
for Miss Eliza, and one globule of Calcarea, 30th, for Miss Mary, 
who, however, has not given me a sufficiently minute account 
of her symptoms. I want to know about the headache last 



Unpublished Letters of Hahnemann, 255 

week, the sleeping of the limbs and the whole side, the sore 
throat, the hsemoptysfe, and cough, as well as the swelling 
of the glands, and the cold feet. The next time she writes, I 
beg she will be more particular ; however, on the whole I am 
pleased with both. 

Dr. E. Aegidi was the one whom I also preferred for the 
Princess. I thank you for having obtained the situation for 
him. 

It certainly has a bad appearance, that the unequivocal testir 
mony in the journals of the marvellous efficacy of Homoeopathy 
(especially Veratrum) in the cholera has not found entrance into 
the ears and eyes of the rulers, particularly Nickolus ; but there 
is no doubt that it must ultimately do so. The great and infi- 
nitely good Spirit, who cares for the fate of the lowest insect, 
will, with mighty hand, in the stillness of His power, without 
our being able to see how all co-operates for the end, take 
advantage of the great opportunity which so directly affects the 
welfare of those smitten by illness, hitherto so sadly neglected. 
The present system of medicine is really a disgraceful patch- 
work. Eead, for example, how Hasper, the nephew of Kreysig, 
in Leipsic, in the face of the Homoeopathists, teaches that the 
cholera should be treated with blood-letting to 30 ozs., with 
leeches, and 3 or 4 drachms of Calomel ; grounding this mur- 
derous recommendation upon theory, and what he calls the 
experience of the best physicians — ^that is, the English. Is it 
not enough to rouse into an outbreak the rage of the Homoeo- 
pathists ? I should like if Attomyr were a man who would 
raise a powerful voice against the allopathic murders, for the 
reviews of allopathic stuff which have hitherto appeared in your 
Archiv, seem to me to be done with too lenient, mild, and gentle 
a hand, to shake out of their security the obdurate and scanda- 
lous blockheads. For such a case, the cautious, timid stroking 
of our homoeopathic reviewers won't do ; they look as if they 
were going to attack a fly. Can it be worse with us than that 
we shoxQd be deprived of our natural rights as citizens, and shall 



256 Unpvhlished Letters of HahnemanrL 

we not scream into their ears the^ wrongs they do, and pursue 
the murderous host with stabs of our only weapon, the pen. 
They must learn to be afraid of having their malpractice attacked 
by us ; they must tremble before us, otherwise we shall make 
nothing of it, and our immense superiority will not be recog- 
nised ; otherwise we shall not be honoured, nor wiU they be 
brought into the public contempt and abhorrence which 
they so richly deserve. I must beg of our fellow-workmen 
to rouse them better for the work, to kindle their zeal, 
to bring into clearer light the advantage of our heavenly 
art, by more vigorous defence and attack, and to expose 
the miserable nakedness of these men-slayers. Were I but 
thirty years younger, I would alone engage them, and none 
should escape my deadly strokes, I would not stop till I 
had silenced every one of their miserable organs. Now, I 
ought to think how I can leave this duty to abler disciples. 
After I have finished my 76th year, I am no longer able to 
enter the ring. I have, I believe, with immense efforts, placed 
my science upon pillars which can never be overthrown. But 
to drive the haughty and slanderous intruders out of the temple 
of -^sculapius with scorpion scourges, less will not suffice — 
ought not to be laid upon me. Would to Gk)d a man should 
arise with a head, a heart, and powerful arm, who would devote 
his Ufe to this second and important work as I did to the first 
— ^the establishment of Homoeopathy ! Give my greeting to 
Attomyr. 

I send you along with this the Hungarian translation of 
the "Organon" and the first part of my " Materia Medica." 
For GuiUon's good wishes, thanks from my whole souL 

Up let us raise our head. If we do not conquer and beat to 
the ground our and mankind's enemies, the fault is ours ; even 
now, when all is movement, and every ear and eye upon the 
stretch, it is the time to begin and carry something through. 
My spirit is with you. 

Samuel Hahnemann. 



Unpunished Letters of Hahnemann. 257 

To Dr. Staff. 

Koetlien, Feb, 3rd, 183L 

Dear Friend and Colleague, 

Make your promise good, and use the delightful railway 
to give me the pleasure of a visit ; but remember you must 
bring our friend Eummel along with you. 

So you will not wear the splendid ring ? Are there not true 
friends, who are far removed from envy, and who rejoice heartily 
and truly with you over the happy circumstance ? Would it 
be well to deprive such friends of such a pleasure, and not to 
show them this gem in which they had a share. I feel that I am 
such a friend to you, for a gift to you is a pleasure to me ; and 
you may trust that there are many of the same sentiment. So 
you must put on your ring when you go to visit a true friend, 
that you may rejoice him with it. And yet the letter the 
Duke wrote with it, is worth double the value of the jewel ; 
but this excites no envy in your friend, but gives him as much 
gratification as if the letter were addressed to himself. So you 
may know how to act in such a case — and you will put on 
your ring for the sake of your friend. I send you ^gidi's 
letter. I found it necessary to show it to the princess, and I 
have done him good service by so doing ; for the prince imme- 
diately appointed him to a Hussar regiment, then vacant, under 
General Von Wiebel, which I have communicated to ^gidi. I 
am very glad of this piece of good luck ; for besides such a 
post in so populous a town, under the protection of its ruler, 
he may carry on his homoeopathic practice without let or hin- 
drance fix)m any man — preparing and distributing his medicines 
as he pleases. If this is not incredible good fortune for a 
homoeopath, I know not what is. He will also enjoy the favour 
of the princess, although I continue to be physician to her. 

I have only had time within these few hours to look at the 
new number of the Archiv, which you were kind enough to 
send me. The article of Miiller, the only one I have read, 

17 



258 Lecture by Dr. Russell on Epilepsy, 

speaks of me in such a tone, that I must shortly write him a 
letter of acknowledgment. Thus must we step out, imless we 
are to be prepared to be trodden to pieces. He has won great 
creat credit to himself by this article. Do you know anything 

of ? I hear nothing. Hermann, of Petersburg, who had 

to do with his family, writes to me without being asked, that 
he is a pitiable shaking reed. I do not know how better I 
can say it. Hermann has just married my neice, the youngest 
daughter of Trinius, of the Academy. 

Yours, Samuel Hahnemann. 



^ /»r LECTUEE ON EPILEPSY.— Lecture II. 

By De. RusslELL. 
Gentlemen, 

I propose in this lecture to confine my observations to 
the treatment of Epilepsy. The success hitherto obtained 
by the most careful and scientific practitioners, accord- 
ing to the old school-method, has been very xmsatisfactory. 
Out of 115 cases of chronic convulsive diseases treated by 
Dr. Reynolds, all of which in common parlance would have 
been entitled Epilepsy, and had been treated as such for many 
years, 21, or 18 per cent, were cured. Of these, however 
only 80 were true Epilepsy, and the number of recoveries out 
of these 80 were only 8, or 10 per cent. Out of 191 cases 
treated in this Hospital, 38 are reported as cured, or 20 per 
cent. But as these cases are chiefly among the out-patients 
there is always considerable uncertainty in regard to the re- 
sults in a disease which may be long dormant without being 
radically cured. And under the head Epilepsy, it is not iln- 
probable that other forms of convulsive diseases may have 
been included, as in Dr. Reynolds's first list. There is no 



Lecture by Dr. Russell on Epilepsy, 259 

great difference in the results, judging by these tables of the 
old and new system. At all events, whether we excel our 
neighbours or not, we have no ground to boast. So long as we 
have to record the mortifying fact, that four-fifths of the epi- 
leptic patients who have been treated by us have not been 
cured; and if any one can discover more certain indications 
for the remedies most commonly used, or suggest any means 
not hitherto employed, and which hold out any prospect of 
advantage, he will be hailed as a benefactor of his kind. 

In considering the treatment of EpUepsy, the subject na- 
turally divides itself into general rules for the guidance of 
patients, so that they may be fortified against the consequences 
of the disease, and the special indications for the administra- 
tion of remedies. 

In regard to the first, or the general management of epileptic 
patients, there is a great difference of opinion as to the proper 
food; one party strongly advocating a low diet, excluding 
animal food and forbidding all stimulants ; while another party 
insists upon what is called a generous fare and a liberal allow- 
ance of wine. Those who adopt the latter view, argue that we 
are apt to be deceived into the erroneous idea of spasms being a 
manifestation of excessive nervous force ; while, on the contrary, 
their presence invariably indicates an enfeebled condition of the 
nervous system ; — that we meet with them as consequences of 
loss of blood and of impaired vigour generally, and that the 
restlessness of a nervous patient is not from too much, but 
from, too little life. Especially it is pointed out, that the 
scanty vitality of epUeptics is betrayed by the general coldness 
of the extremities, and the small, quick, and jerking pulse. 
And that it is in consequence of this low condition of what 
we may call the power of the Anima, that persons afflicted 
with Epilepsy become subject to cosmical influence. That, in 
fact, they approach the life of plants as they recede from that 
of man. " The plant," says Dr. Eadcliife [Epilepsy and other 
Conytdsive Affections. By Charles Bland Eadcliffe, M.D. 2nd 



260 Lecture hy Dr, Russell on Epilepsy, 

ed., 1858, p. 142], " exhibits plainer and more numerous evi- 
dences of periodicity than the animal ; and it does this, I argue, 
because it has less of the innate life which enables man and the 
higher animals to be partially independent of the sun and other 
vivifying influences which act upon them from without ; and 
hence it follows (this among other reasons) that the man who 
exhibits more evidences of periodicity than he ought to do, 
has been shorn of some of that innate life which is the badge 
of destinction between him and the plant." Whether or not the 
want of the power of the Anima brings the epileptic under the 
influence of the moon, has been keenly debated, and some of 
our most recent and most scientific writers declare themselves 
on the side of the moon. " Although here and there," observes 
Eomberg [vol. ii. p., 205], "doubts have been raised against 
this view, the accurate observations of others have estabhshed 
its correctness." Among these observers a prominent place is 
always given to Dr. Mead, who, in the following words, de- 
scribes a celebrated case of lunar influence. " No greater con- 
sent in such cases was, perhaps, ever observed than what I saw 
many years since, in a child about five years old, in which the 
convulsions were so strong and frequent, that life was almost 
despaired of. . . . The girl, who was of a lusty, full habit of 
body, continued well for a few days, but was, at full moon, 
again seized with a most violent fit ; after which the disease 
kept its period constant and regular with the tides. She lay 
always speechless during the whole time of flood, and recovered 
upon the ebb. The father, who lived by the Thames side, and 
tiid business upon the river, observed these returns to be so 
punctual, that not only coming home, he knew how the child 
was before he saw it; but in the night has risen to his 
employ, being warned by her cries, when coming out of the fit, 
of the turning of the water. This continued fourteen days — 
that is, to the next change of the moon." This case is gene- 
rally quoted as demonstrative proof of the moon's power. 
Perhaps it would be more correct to accept it as evidence of 



Lecture by Dr, Russell on Epilepsy, 261 

general cosmical influence, for it may have been, that it was not 
any direct effect of the moon upon the nervous system of this 
child, but of the ebbing and flowing of the waters of the 
Thames^ We now know that it is held by some of our highest 
authorities, that the molten lava which underlies the habitable 
crust of the globe — ^the waters of fire under the earth — flow 
and ebb in their outlets — the volcanoes, just as the waters of 
the ocean above the earth, swell and retire in obedience to 
tidal laws. 

How much we are all under cosmical influences, is every 
now and then shown, when an earthquake happens, or a 
new epidemic sweeps over a tract of a country, cutting down, 
as with a scythe, all who have not enough of vital power in 
them to resist its fatal force. The weak perish, but all, even 
the strongest are affected. The most sensitive are aware of it 
at the greatest distance. A curious illustration of this is men- 
tioned in Eckermann's Conversations with the Poet Goethe, 
who, although one of the most sensitive, was, at the same time, 
one of the most robust of men — a great example of that rare 
nature, which, like our own Shakespeare, felt everything, and 
was subdued by nothing. One night Goethe rang for his ser- 
vant about midnight ; when the servant went he found that 
Goethe had moved his bed to the window and was gazing upon 
the heavens. Goethe asked him if he had seen nothing re- 
markable in the sky ; on receiving an answer in the negative, 
he desired the man to enquire of the watchmen if they had. 
They had not. On his servant's return he found his master 
still in the same position, and he made this remarkable an- 
noimcement: "Listen," said Goethe, "this is an important mo- 
ment, there is now an earthquake, or one just going to take 
place." Next day he mentioned at Court (Weimar) his con- 
viction, and the duke believed he was right, from his know- 
ledge of Goethe's character. Some weeks afterwards the in- 
telligence arrived at Weimar that upon that night the great 
earthquake had taken place at Messina, which had overthrown 



262 Lecture hy Dr. Russell on Epilepsy. 

a great part of that city. Here we have an example of an 
impressionable man perceiving a telluric influence unfelt by his 
fellows. He perceived it, but merely as a sensation, from 
which he drew his inferences ; for his nervous system was in a 
state of health. But if it had been in an epileptic condition, 
would this impression not have most Kkely given rise to a fit ? 
We have positive proof afforded by the experiments of Dr. 
Brown-S^quard, that, while on the one hand an injury of the 
centre of the nervous system is a predisposing cause of Epil- 
epsy, that on the other hand the exciting cause is an impres- 
sion on the extremities of the nerves in communication with 
this morbid centre, and that so long as this part of the peri- 
phery is not affected, the Epilepsy may slumber' for almost any 
length of time. 

The most important general indications in the treatment of 
Epilepsy are discovering how, in each case, the strength of 
the patient can be best sustained. Some thrive best on a 
nearly purely animal diet; some on a merely vegetable one; 
others on a mixture of the two. We must find out by careful 
investigation, which agrees best, and that we must order. The 
same rule holds good as regards stimulants ; to some they are 
injurious, to some beneficial, and to others indifferent. The great 
error seems to be, laying down any general rule for Epileptic 
patients. There is, and can be, no such rule. Each case must 
be treated on its own merits, and diet should be as specific as 
treatment. It is a consequence of 'this vague generalization, 
that it is the fashion to order iron, and^^so called tonics, in 
Epilepsy. The pmctice, although recommended by so high an 
authority as Dr. Watson, is emphatically condemned by Dr. 
Brown-S^quard. The action of iron on the brain he considers 
injurious. The same rule, or rather the same latitude and 
absence of rule, which directs us best in i-egard to diet, would 
be good in respect of exercise, and indeed of every one of the 
conditions of healtL In a case of Epilepsy, we must carefully 
examine into all the habits of the patient, and insist upon the 



Lecture ly Br, Rtossell on Epilepsy, 263 

avoidence of everything which can either damage or enfeeble 
the general health, and tend to give special animation to any 
exciting cause of a paroxysm. Above all things, we should 
have the patient avoid all sources of irritation of the surface of 
the body, being taught by physiology how the sensitiveness 
of the peripheral nerves is exalted by the epileptic condition ; 
and it is rational to expect benefit from soothing ablution with 
cold or hot water, and the application of soap or oil to the 
surface of the body. The effect of soap-water — a common ex- 
pedient in the water-cure establishments — in relieving an over- 
sensitive condition of the skin, is most marked, and may be of 
great use in the treatment of Epilepsy. What an Epileptic 
wants is strength within and hardness without. The great 
source of inward strength is food and exercise, and of outward, 
hardening friction and proper baths. If we can discover any 
particular spot where the aura (if there is an aura) takes its 
rise, we may be tempted to try the effect of a local anaesthetic 
upon it. The best is probably that recommended by Dr. 
Brown-S^quard, and consists of half-a-grain of Sulphate of 
Morphia, and one-sixtieth of Sulphate of Atropia, and a minim 
of dilute Sulphuric Acid in fifteen minims of water. This is 
to be injected under the skin of the part where the aura origi- 
nates. 

It is now clearly established that weakness of a muscle, or 
set of muscles, predisposes it to be affected with spasmodic 
action. Dr. Brown-S^quard, in a lecture recently delivered in 
this neighbourhood, and reported in the Medical Times and 
Qaaette of March 28th, observed that "of two muscles, one 
atrophied and one healthy, the former will respond to a cer- 
tain stimulant, while the latter will not ; a weak person will 
jump or start on hearing a noise, which produces no effect upon 
a strong one." This he attributes not to " weakness of nerves," 
as it. is called, but to the weakness of the muscles. Epileptics 
are usually very weak, often partially paralysed ; their reflex 
excitability is augmented, while their voluntary muscular 



264 Lecture hi/ Dr, Russell on Epilepsy. 

power is diminishei Here, then, we have one of the most 
important of the general indications for ti^atment — yiz., the 
adoption of means to increase the voluntary power of the 
muscles. Nothing is better for this than gentle drilling, or a 
course of what is called medical gymnastics. I have known 
cases of Epilepsy very much benefited by the treatment 
known by the name of " the Movement Cure." 

To sum-up, an epileptic patient should be nourished with 
the greatest care, so as to bring the whole body into the highest 
condition, but especial attention should be paid to the develop- 
ment of the muscular system, and this should be exercised in 
such a way as to improve the control over the limbs. Thus, 
dancing, marching, and all movements which tend to curb the 
loose shambling gait of the epileptic, are of importance to his 
cure. Besides, great care sHbtild be bestowed in bringing the 
skin into a healthy state, by baths and by friction, 'so as to 
allay all morbid sensitiveness, which is apt to be the starting 
point of the train of mischief, which ends in a paroxysm. 
These are the obvious suggestions made by common sense upon 
the facts ascertained by modem physiology, in regard to the 
causes of EpUepsy ; at the same time it is right that we should 
bear in mind that we ^hall often meet with epileptics who 
are in perfect bodily health, and well developed. Dr. Eeynolds 
lays down as inferences from a large series of observations : — 

That Epilepsy is not incompatible with perfect physical 
health. 

That it is the exception, not the rule, to find serious impair- 
ment of the organic constitution. 

That the co-existence of Epilepsy with extremely robust 
health, is more common than the converse. 

How far Dr. Eeynold's observations justify such sweeping con- 
clusions I cannot say, but certainly several of the cases that have 
come under my own treatment have been persoHS in whom I 
never should have suspected any infirmity of any kind, judg- 
ing from their appearance.; and in this class of patients we 



Lecture hy Dr. Russell on Epilepsy, 265 

cannot expect to do miicli good by any general, dietetic, or 
regeninal management, and must confine our expectations to 
producing a change in the system of the patient by a st.eady 
course of medical treatment. 

The treatment of Epilepsy by medicines naturally divides 
itself into those which are best adapted to arrest the first 
stage, and those which tend to mitigate the paroxysms, and 
prolong the interval between the attacks. 

There seems no doubt that the first stage of an epileptic 
seizure may be arrested, just as the first stage of Cholera is, by 
Camphor. I have witnessed this in Cholera. I once saw a 
little girl of about eight years of age literally take Cholera. 
She was in a room where there were two patients in a state of 
collapse. She suddenly gave a slight cry, and on looking at 
her face I saw the immistakeable, but indescribable change, 
which indicates the invasion of Cholera. This is a well-known 
fact in regard to Cholera. In the instance referred to, I im- 
mediately gave the patient a dose of Camphor which I had in 
my hand. The effect was instantaneous. I watched th^ life 
returning into the face, which before had been the countenance 
of a corpse. It came back slowly and steadily, the pulse was 
extremely rapid and small ; it increased in volume, and abated in 
speed, and" in about ten minutes the danger of death was passed. 
The same rapid arrest of an epileptic paroxysm is sometimes 
effected. " Once," says Dr. Eeynolds, " when I was talking to 
an epileptic; and observing his eye, a fit commenced ; the eyes 
rolled upwards, and to one side, and the pupils dilated. He 
had, however, after this dilatation sufficient power to say, " I am 
going to be ill," but not till then did the distortion begin. 
This attack was stopped by Chloroform. Similar attacks in 
other patients have been arrested by placing Ammonia near 
the nostrils. But neither Ammonia, or Chloroform or anything 
else, has the slightest effect after the first moment of the 
paroxysm. 

This first stage of Epilepsy is probably caused by contrac- 



266 Lecture h/ Dr. Russell on Epilepsy, 

tion of the blood vessels of the brain proper, and of the face, 
and tonic spasm of the muscles of the eye and face. The effect 
of Ammonia and Chloroform upon this spasm is very much 
like that of the smoke of Strammonium upon the asthmatic 
spasm, and immediate relief is the consequence. Considering 
that upon the arrest of this first stage so much depends, and 
that in some respects it is so easily managed, it seems singular 
that it should so seldom be effected. The reason is, that this 
stage is so very short, lasting not above a few seconds, and 
that even these few seconds have somewhat deprived the 
epileptic person of his power of thought and action. It is 
just possible that there may have been real virtue in some of 
the amulets that were so highly prized even by the least super- 
stitious of the ancient physicians in the treatment of Epilepsy. 
Possibly certain substances worn round the neck, so as to give 
off their fragrant or pungent particles in the immediate neigh- 
bourhood of the extremities of the branches of the nerves that 
supply the lips and nostrils may have had a good effect in 
arresting the first stage of Epilepsy; and it may be worth 
while to try the effect of a bag of Camphor suspended round 
the neck, such as it was the custom for persons exposed to Cholera 
contagion, to wear. 

If, however, our efforts to arrest the first stage fail — and for 
my own part, I have never seen them succeed — then we must 
address ourselves to the task of discovering some medicines 
which so act upon the seat of the disease as to restore it to 
a normal condition, that is, which have the power of reducing 
to their natural calibre the capillaries of the spinal chord and 
brain, and thus of removing that preternatural excitability, 
on which it now seems pretty certain that EpUepsy depends. 

On entering upon this the most important and most diflficul* 
portion of our task, it is well that we should clearly perceive 
on what the difficulty depends. It arises in a great measure 
from the conflicting testimony in regard to the efficacy of par- 



Lecture by Dr. Russell on Epilepsy, 267 

ticular substances, a difficulty always great in medicine, but un- 
usually so in a disease like Epilepsy, which is so uncertain in 
its course as to baffle the most careful efforts of the least 
unbiassed to arrive at positive evidence in regard to the 
utility of any given drug. When we read the works of recent 
writers we are struck with the acumen they display in their 
critical demolition of the statements of their predecessors and 
contemporaries. For example. Dr. Eadcliflfe analises Trouseau's 
cases cured by Belladonna, and reduces the number to 20 out 
of the 150 patients treated. From Dr. Eadclifife we expect 
some statement of his own success which shall be unassailable 
by the process he brings to bear upon Trouseau. Dr. Eadclifife 
is an advocate for the employment of Naphtha, Musk, and 
Castor, and we eagerly look for the proofs of his confidence. 
What does he give us ? "I think, he says, also, I can point to 
at least a score of cases in which the fits have not only been 
lessened in severity by being deprived of their most ominous 
character — Coma; but where the intervals between the fits 
have become so lengthened out as to aflford good ground for 
supposing that the fatal habit may be altogether broken by a 
continuance of the same method." If Trouseau, instead of a 
detailed account of all the 150 cases which he had treated 
with Belladonna, had said he thought he could point to some 
scores of patients who had been benefited by this remedy, how 
mercilessly would Dr. Eadclifife have commented upon the dif- 
ference of Trouseau's thoughts or impressions, and the pos- 
sitive testimony demanded by science before she can adopt the 
conclusion that Belladonna was the real instrument of cure ! 

I do not make these observations to discredit Dr. Eadclifife, 
for whose labours I entertain the highest respect, but to show 
how miich easier it is to attack the positions of another than 
to place one's own so as to secure them from being taken 
by a similar assault. 

What we observe in regard to the therapeutics of Epilepsy 
is one of two courses, either an empirical confidence in certain 



268 Lecture hy Dr. Riissell on Epilepsy, 

remedies without a corresponding pathological collateral security, 
or conjectural measures derived from inferences drawn from 
pathological speculations, and as yet unsubstantiated by the suc- 
cessful adaptation of these hypothesis into actual practice. 

Nor are these obscuring conditions peculiar to either the old 
or the new school of medicine. For example — on the occasion 
of a paper being read before the Medico-Chirurgical Society, 
Sir Charles Locock (the President) remarked that in Epilepsy, 
in which the paroxysm had a tendency to assume a periodic 
character connected with menstruation, he had been led to try 
the Bromide of Potassium, by an observation made by a German 
physician that this medicine produced temporary impotence. 

Sir Charles stated that he had treated fourteen or fifteen 
cases of Epilepsy presenting this peculiarity with Bromide 
of Potassium, and that he had only failed to give relief in one 
case ; and that one of the cases so cured had lasted nine years. 
[Medico Chirurgical Transactions for 1857.] 

T call this an example of an empirical cure ; for we cannot 
admit, that because a German physician observed impotency to 
follow the administration of Bromide of Potassium, that therefore 
this substance was specifically adapted for the treatment of what 
may be called Catamenial Epilepsy. However, as an empiri- 
cal remedy it may be worthy of our attention, and the fact 
that so accurate an observer as Sir C. Locock testifies to its 
utility, is certainly a strong recommendation to examine its 
claims by the light of our therapeutic law. As yet we have 
not such a proving of the Bromide of Potassium as to enable us 
to put it to this test. Other examples of purely empirical reme- 
dies resorted to largely by the practitioners of the old school of 
medicine (which affects such pharisaical contempt for the means 
it so frequently condescends to employ, are the following: — . 

Viscus Quercinus, or Mistletoe, [On Epilepsy and the use 
of Viscus Quercinus, by Henry Eraser, M.D.] Cotyledon Um- 
bilicus, and Indigo. 

Of Viscus Quercinus, Dr. Eraser reports that out of 11 



Lecture ly Dr. Russell on Epilepsy, 269 

cases of Epilepsy which he treated with this substance 9 were 
cured, one was moribund and one died. 

Indigo was employed in Epilepsy first by Dr. Ideler, of 
Berlin, and subsequently by Dr. Eodrigues (Eevue Medicale, 
April, 1855). It is rather remarkable that although Indigo is a 
remedy introduced into the Homoeopathic therapeutics, it should 
not be included in the list of medicines which Dr. Laurie gives 
as suitable for the treatment of the various forms of the 
disease — although this list embraces no less than 46 of our me- 
dicines. Certainly the chapter on Epilepsy in Laurie's " Elements 
of the Homoeopathic practice of Physic," must impress our old 
school medical colleagues with the enviable richness of our re- 
sources ; and at the same time excite a wholesome respect in 
the minds of laymen for any human intelligence which knows 
how to use as arms of precision nearly half a hundred dif- 
ferent weapons. 

Cotyledon umbilicus, like the two former substances, has its 
admirers and defenders. It, too, has been " proved" by one of 
our body. But the proving has not induced its reception as 
one of the accredited Homoeopathic remedies. 

I have now given illustrations of the empirical remedies 
recommended by high authorities in the old school, — simply on 
the ground of their approved usefulness. If this were ad- 
mitted, then we should not cavil at the absence of a satisfac- 
tory explanation of their mode of operations. But unfortunately 
there is not one of the specifics in vogue for the treatment of 
Epilepsy, that has not a much larger number of deniers than 
of believers, and as the number of such specifics is so numer- 
ous, that their bare enumeration would fill a respectable vo- 
lume, it is clearly hopeless to attempt by the simple empirical 
method of experiment, unguided by theory, to determine 
whether any of them have really the virtues with which they 
have been accredited. Nor is there better chance of success, if 
we pursue the opposite method, and, if having accepted the 
pathological doctrines now in fashion as the basis of our treat- 



270 Lecture hy Dr. Ru$sell on Epilepsy, 

ment, we administer medicines in obedience to them alone ; 
for the whole history of medicine, if it shows anything, proves 
this — that every age supposed it had arrived at the long- 
coveted knowledge of the real and essential cause of disease. 
Now it is a poison, formerly it was a spasm, and against the 
spasm an anti-spasmodic was prescribed, and after the world 
had been on the strength of this doctrine swallowing anti- 
spasmodics for a quarter of a century, up rose some clever, 
bold man, who denied with such force, and argued with such 
cogency, against the notion of a spasm having anything to do 
with the matter — that the world voted itself in the wrong, and 
gave up taking any more anti-spasmodics. There seems a 
danger of our falling again into this error. The observations of 
anatomists and physiologists in regard to Epilepsy are very 
important, and their speculations as to its cause very ingenious, 
and possibly true. But let us remember that there is no theory 
which lias yet been universally received by all physiologists, 
and that the most approved at present has not stood the test 
of twenty years ; while on the other hand the symptoms of 
Epilepsy have been carefully noted for as many centuries, and 
if we acknowledge the sufficiency of our therapeutic maxim 
as a guide in other diseases, there is no reason why we should 
discard it here. Let us, then, not be led astray from the study 
of the symptoms of Epilepsy into the speculative region of the 
cause of these symptoms. At the same time let us carefully 
arrange these symptoms, so as show at once both their natural 
sequence and their comparative importance, and then try 
whether we can exhibit any medicinal actions having a similar 
sequence, producing similar results, and if so, whether the sub- 
stances that do so ever cure Epilepsy. 

In limine, let us observe that any medicine which is to 
affect a radical change in the condition of an Epileptic nervous 
system, and not merely arrest the propagation of the exciting 
cause, must be one endowed with powers of long duration. 
For this reason, I do not believe in the cures of Epilepsy said 



Lecture hy Dr, Russell on Epilepsy, * 271 

to be effected by Musk and Castor, and science demands of 
Dr. Eadcliffe something more exact and definite than his state- 
ment to the effect, that he could point out, at least, a score of 
cases which had been practically cured by these fugitive 
remedies. 

Let us now arrange the symptoms in the order of their oc- 
currence, putting down only the invariable, which we may 
presume to be the essentiaL 

1. Dilatation of the pupil of both eyes. 

This takes place lefore there is any loss of consciousness, and 
is therefore not dependent upon general insensibility. 

2. Paleness of the face. 

3. Twitches of the muscles of the eyes and face. 

4. Loss of consciousness. 

5. Tonic contraction of the laryngeal and expiratory 
muscles. 

6. Cry. 

T. Tonic contractions of the muscles of the trunk and limbs. 

8. FalL 

9; Dark purple hue of the face. 

10. Asphyxia. 

11. Clonic convulsions everywhere. 

12. Coma. 

13. Sleep. 

We have no right, on the Homoeopathic principle, to expect 
any medicine to be effectual in the cure of Epilepsy, unless its 
pathogenesy covers all these symptoms. But this is not 
enough — it must also be capable of inducing a permanent 
derangement of the functions of the brain and other parts of 
the nervous system, as indicated by some impairment of 
memory and apprehension, by a tendency to muscular feeble- 
ness, and by a general habit of slight spasmodic action, repre- 
sented by a the " starts," faintness, momentary arrest of con- 
sciousness, &c, which constitute the most important inter- 
paioxysmal phenomena. We should also like to find, in our 



272 Lecture hy Dr. Russell on Epilepsy. 

medicine, the power of producing somnambulism, which, as we 
have seen, has a strong resemblance with some well-marked 
Epileptic conditions. 

Let us now examine by the proposed tests our Homoeopathic 
medicines. Balladonna fulfils the first condition we have 
laid down as essential It is a medicine of long enduring 
action. On this head Hahnemann observes : — "In the smallest 
imaginable dose, when the symptoms of the disease make 
Belladonna the suitable remedy, it proves curative in the most 
acute cases ; but, on the other hand, it is not less potent even 
in the most chronic cases, and in them the effect of one dose will 
endure for a period of three weeks, or even more." On this 
point I believe that there is no difference in the opinion of ex- 
perienced practitioners of Homoeopathy. Few medicines pro- 
duce more enduring effects upon the animal oeconomy than 
Belladonna. 

1. Of its power to dilate the pupil nothing need be said. 
Belladonna is the mydriatic. 

2 & 3. Paleness of the face, and twitches of the muscles of 
the eyes and face. 

We have these symptoms accurately reproduced in Hahne- 
mann's proving. 

170. Distorted features. 

171. Paleness of the face. 

174. Sudden paleness of the face lasting some time. 

4 & 5. Loss of consciousness, and tonic contraction of the 
lar}^ngeal and expiratory muscles. 

In a case reported by Dr. Gray, of New York, we are told 
" that the patient's manner was apoplectic, respiration anxious, 
and attended with brazen stridulous sound." He afterwards 
speaks of it as a state of " partial coma." The narcotising 
power of Belladonna, and especially of its alcaloid atropine, is 
too well established to require further illustration. What 
makes Belladonna especially suitable for Epilepsy is the mix- 
ture of sjonptoms of stupor and spasms at a stage of the 



Lecture ly Dr. Russell on Epilepsy, 273 

operation of the drug prior to the production of the true coma. 
In this patient of Dr. Gray's, for example, the state of coma 
alternated with paroxysms of uncontrollable tendency to motion 
and rapid automatic movement. Here we have an exact sirrdh 
of the first §tage of Epilepsy before the profound stupor sets in. 
6. Cry. 

Hahnemann has, among the symptoms he collected from 
Greding, recorded the foUoMdng, 1322 : — "With a sudden cry 
he trembles in the hands and feet" 

The fall, the asphyxia, and the violent general convulsions, 
are by no means peculiar to Belladonna. All narcotics which 
have the power of producing a state of true coma, do so by 
causing in some way or other venous, instead of arterial, blood 
to circulate in the brain. After a certain point the symptoms 
are not those of the drug, but those of venous intoxication ; 
and we must be on our guard not to argue from the appearance 
of post'Coma convulsions, among the eflfects of any drug, that 
it therefore possesses, any true spasms-causing power. The ex- 
periments of Sir Astley Cooper abundantly prove that the inter- 
ruption of the flow of arterial blood to the brain is quite 
sufficient to induce violent epileptic-form paroxysms. But the 
condition of the animal so treated is entirely different from 
those in a truly epileptic condition — such as Dr. Brown-S^quard 
induces by injuries of the central parts of the nervous system. 
This is not so with Belladonna, for the more we investigate 
the effects of this drug, the more am I convinced we shall find 
in it the symptoms bearing a close resemblance with all the 
essential ones of Epilepsy ; and if we pass from the observed 
phenomena to their probable causes, I believe that the reason 
why Belladonna produces the image of the natural disease is 
because it has the power both to induce in the central parts of 
the nervous system a morbid congestion ; and, also, to excite in 
the peripheral nerves a morbid supersensitiveness to impres- 
mosiB ; 80 that while on the one hand it predisposes to con- 
Yiilsi<»is by accumulating blood in the spinal cord, medulla 
VOL. hl 18 



274 Lecture hy Dr. Russell on Epilepsy. 

oblongata, and brain ; on the other hand, it facilitates the 
operation of the exciting causes of those convulsions by render- 
ing the surfaces of the body (both the external — the skin, and 
the internal — the mucous membranes), more liable to be offended 
by every irritant. 

The expectations raised by a study of the symptoms pro- 
duced by this wonderful drug, when given as a poison, or to 
ascertain its action in the heathy person, have been fully 
realized by the effects observed of its administration in the 
treatment of epilepsy. 

The curative ef&cacy of Belladonna in epilepsy is attested 
by so many trustworthy observers, that my surprise is that it 
has not won a more general acceptance by thr medical profes- 
sion at large. My own experience in favour of Belladonna is 
that it actually cures this disease even when it presents itself 
in its most formidable character. I may give one or two 
cases in illustration of the grounds of my confidence in this 
medicine. 

A. G. — Oct. 17. — ^A well-grown and intelligent lad became 
subject to epilepsy three years ago. After the first fit there 
was an intermission for two months, then he had two fits ; 
after that they recurred at intervals of every two, three, or 
four months. He consulted me on the 24th of August, 1855, 
he had six fits on the previous day, and one that morning. 
The fits begin with convulsions of the muscles of the face, 
which extend to the arms and legs. He is generally uncon- 
scious for twenty minutes. He was ordered two drops of the 
second dilution of Belladonna three times a day. He took this 
medicine tUl the 1 1th of January, when he had one fit during 
the night. The medicine was continued till the 14th of July, 
and there was no return of a fit. I believe he has kept quite 
free of them ever since. He certainly was so for some years. 
The fits were of the true epileptic character, and in some 
respects bad ; for there was very deep coma, and the length of 
a paroxysm was rather above the average period. He took the 



Lecture by Dr. RvMell on Epilepsy, 275 

medicine for eleven months; and, as the fits came on about 
the age of puberty, and were increasing in severity and numbers 
for three years, the chances of this favourable termination being 
spontaneous are certainly not so great as that they were cured 
by Belladonna. 

Case II. — A fine intelligent boy of 14 years of age came 
under my care upon the l7th of December, 1855. His 
parents stated that he had been subject to convulsions as an 
infant, and from that time he had suffered from strabismus. 
His present malady has lasted for one year. He is affected 
with an unpleasant sensation coming over head and hands 
several times a day, and one or two regular epileptic fits every 
day. His general health is good. On the 31st of December 
he began to take the second dilution of Belladonna three times 
a day, and continued to do so till the end of April During 
the whole of these four months he remained perfectly free from 
aU epileptic symptoms or paroxysms ; and, so far as I know, 
he has been in perfect health ever since. The slight general 
uneasiness this boy complained of is very characteristic of true 
epilepsy, and I have no doubt this case was an example of that 
disease, and that it was radically cured by Belladonna. 

Case III.^A big lad, 19 years of age, of a very dull 
expression of countenance, and an almost idiotic gait and de- 
meanour, was brought to me on the 16th of March, 1856. He 
had been suffering from epilepsy for six years. The fits oc- 
curred two or three times a day, but not every day. He was 
ordered to take a dose of the second dilution of Belladoima 
three times a day. He returned on the 2nd of April, and his 
mother reported that he had had two bad fits the last week. 
The medicine was continued. He remained free of all attacks 
till the 14th of May, on which day he had one fit. On the 
23 rd of July he was brought to me again. His mother as- 
sured me that there was a marked improvement in his general 
intelligence, and that the fits were less frequent and less severe. 
After this I lost sight of the case. 

18* 



276 Lecture hy Dr. Russell on Epilepsy, 

Case IV. — A girl of 14 years of age, of healthy appearance, 
was brought for my advice on the 20th of March, 1857. ronr 
years ago, i. e., when she was ten years old, she had her first 
epileptic fit. It occurred without any assignable cause, and 
was very severe. The fits returned at irregular intervals until 
a year ago, when they began to occur regularly every month. 
They last for about fifteen minutes, and end in sleep. When 
she applied to me she had been free for three weeks, and 
reckoned on one being due on the following week. The second 
dilution of Belladonna was prescribed, a dose to be taken three 
times a day. There was no fit from the 20th of March till the 
22 nd of June, and none between that and the 12th of No- 
vember. Thus, instead of eight fits in eight months, she had 
only two fits, and I believe she kept well from that time. As 
I find no mention made in my notes of the appearance of the 
catamenia, I presume that this change in the constitution had 
not occurred during the treatment, and that the amendment 
was due to the persistent use of Belladonna. 

These four cases occurred when I was practising in Leaming- 
ton, and along with some other striking recoveries or improve- 
ments in similar cases, were so much talked of that I was con- 
sulted by a great many epileptic patients, and have ever since 
had a number of such cases under my care. I must make 
the mortifying confession that although even in apparently 
very bad cases I have been able to effect great improvement, 
yet that in very many I have foimd myself entirely baffled; 
and the tantalising feature of the affair is, that I find I cannot 
pronounce with any confidence as to the probability of the issue 
in any given case. I know of no special indications for the 
use of Belladonna, nor do I know beforehand whether a case 
will get better or worse, or remain stationary. I have been 
disappointed in cases which looked the most promising, and again 
other cases which presented all the worst appearances have 
been the most benefitted. 

The next medicine to which I wish to direct your attention, 
is Hydrocyanic acid. 



Lecture hy Dr, Russell on Epilepsy. 277 

Tn the number of the British Journal of Homeopathy for 
July, 1862, there is an elaborate article by Dr. Madden and 
Dr. Hughes upon the action of Hydrocyanic acid, and especially 
upon its relation to epilepsy. At the end of the article there is 
the following note : — " In the next number of the journal we 
propose to give a series of cases of epilepsy and other diseases 
treated by this drug. If any of our colleagues have had ex- 
• perience with it, or should be led to use it successfully in the 
direction indicated in the above paper, we should be greatly 
obliged if they would communicate to us their observations, 
that we may incorporate them in our series." Having been for 
long much interested in the subject of epilepsy, I have opened 
each of the successive numbers of the journal with great curi- 
osity to read the cases which are here referred to as having 
been treated before July, 1862, with this drug. Up to this 
time, however, they remain unpublished, and in the absence of 
all a posteriori evidence in favour of the power of Hydrocyanic 
Acid to cure epilepsy, we must examine even more critically the 
preofe advanced in the paper just referred to. 

Having already confessed how often I have been baffled in 
all my attempts to effect a cure of epilepsy, I need hardly say 
that I began the perusal of the article with a lively hope of 
finding the authors of it to be right in their belief that Hydro- 
cyanic Acid deserved a place next to Belladonna in the treat- 
ment of this dreadful malady. This hope seemed to me the 
more legitimate inasmuch as we had from the same joint-pen 
received so valuable an article upon the relation of Belladonna 
to this disease — an article which showed that its authors had 
carefully arranged in their preper order, and valued at their 
just proportion, the symptoms which characterise epilepsy. 
However, I must at once confess that the more I studied the 
article the less I was satisfied with the conclusions arrived at 
in it, I wiU state my opinions rather in the form of questions 
than of opposing prepositions. 
. The first I would note is whether there is any evidence of 



278 Lecture by Dr, Russell on Epilepsy, 

Hydrocyanic Acid producing a permanent impression upon the 
nervous system ? To me it seems to act as a very intense and 
very evanescent direct sedative. Let us take, for example, a 
case recorded in the "Eevue Medicale," and quoted by Chris- 
tison and Hempel, as well as by the authors of the article under 
consideration. It is quite a model case, and the substance of 
it is thus given by Drs. Hughes and Madden : — 

" Very soon after swallowing a teaspoonful of the diluted • 
acid, he felt a confusion in his head, and then fell down in- 
sensible as suddenly as if struck by lightning." Let us pause 
to observe that up to this point there had been no convulsions, 
nor any symptoms beaiing any resemblance to epilepsy. And 
this is the rule, not the exception. Thus a case is related in 
" Hufeland's Journal," and quoted by Wibmer and Christison, 
of a man who took a large dose of this poison, and " after stag- 
gering a few steps he sank without a groan (and without a 
struggle) to the ground. A physician who saw him on the 
instant found the pulse gone and the breathing for some time 
imperceptible." To return to the former case, the narrative 
proceeds : — " There was difficult breathing ; small pulse, scarcely 
perceptible at the left wrist ; bloating of the face and neck ; 
dilated and insensible pupils; and lock-jaw. Afterwards he 
had several fits of tetanus, one of them extremely violent. In 
about two hours and a-half he began to recover his intellect, 
and rapidly became sensible." On this we have the following 
comment : — " The epileptiform loss of consciousness, the tetanic 
convulsions, and the spasmodic dyspnoea of Hydrocyanic Acid, 
are well marked in this case." I confess I cannot see the re- 
semblance to epilepsy. It seems to me much more like a 
transient attack of apoplexy ; for let us observe that the con- 
vulsions did not occur at all till after the bloating of the face 
and the insensibility of the pupils demonstrated that narcosis, 
or poisoning of the brain by venous blood, had taken place. It 
was a toxical repetition of Sir A. Cooper's experiments. The 
supply of arterial blood was suddenly cut off from the brain 



Lecture hy Dr, Russell on Epilqpsy. 279 

medulla oblongata, and spinal chord, and the consequences of 
this were insensibility and convulsions. And so little had the 
poison affected the nervous centres in a strictly morbific 
manner, that very soon he began to recover, and so far as we 
know was no more affected by this powerful drug than if he 
had been strangled and restored to life. In fact the symptoms 
are those of strangulation, and as such they bear a close resem- 
blance to the effects of an epileptic seizure, which indeed 
strangles its victim as effectually as if a bow string were 
tightened round his throat. But again I say I see no proof 
of Hydrocyanic Acid acting directly on that part of the nervous 
system which is the seat of epilepsy. We miss entirely the 
early dilatation of the pupil before the establishment of uncon- 
sciousness, which is one of the pathognomonic symptoms of the 
malady. 

Is there any evidence of Hydrocyanic acid exerting a long- 
continued morbific influence ? Are not its effects like those 
of camphor — ^very powerful, but very evanescent ? 

Have we sufficient evidence of its action when given much 
diluted ? I mean, as we are in the habit of prescribing our 
medicines. Will the millionth of a drop produce any effect ? 
We know that a pure stimulant is annihilated by dilution, as 
in the instance of Alcohol. May it not be the same with a pure 
sedative ? These are very important questions to have answered 
before we place our confidence in this remedy, and questions 
which I trust we shall have answered, as well as the produc- 
tion of the promised cases exhibiting the curative efficacy of 
Hydrocyanic Acid in epilepsy. 

Ouprum, either in the form of the triturated metal, or of the 
acetate of copper, is in high favour in the Homoeopathic treat- 
ment of epilepsy; and certaruly it seems to fulfil the conditions 
we require of an anti-epileptic medicine ; for its effects are both 
peripheral and central, and of long endurance. For example, 
Wibmer relates the case of a girl of eighteen years of age who 
was poisoned with a salt of copper, and in whom it produced 



280 Lecture by Dr. RiisseU an Epilepsy. 

convulsions, and then insensibility. Some days afterwards a 
certain amount of paralytic weakness of the arms remained^ 
general disturbance of the whole system followed, and even- 
tually she died. After detailing a number of cases of poisoning 
by the acetate of copper Wibmer concludes with the following 
summary : — 

"Various observations make it probable that copper acts 
upon the brain, and even more upon the spinal chord. We 
meet with headache, often irrational talk, slight deafness, but 
more frequently twitches, trismus, and almost tetanic stiffness 
of the limbs, as consequences of poisoning by this metaL" 

In the proving of Cuprum given to us by Hahnemann 
we find numerous symptoms and groups of symptoms bearing 
a close resemblance to those of a paroxysm of epilepsy. Ifoack 
and Trinks observe that Cuprum " is especially suitable for 
relaxed, irritable, and nervous constitutions, with weakness and 
excessive sensitiveness of the nervous system." 

So far as my own observations go, I must admit that I have 
been disappointed in this remedy in the treatment of epUepsy, 
and I am inclined to think that the action of copper ia rather 
upon the ramifications of the nerves than upon their central 
origin. It is of great use in certain forms of spasms arising 
from which might be caUed circumscribed reflex-action, as in 
some kinds of colic, and choleraic spasms. It is likewise of 
great use in certain forms of oppression of the brain ; but it 
does not seem to act so specifically on the upper part of the 
spinal chord or medulla oblongata ; it does not, like Belladonna^ 
dilate the pupils. In short, although presenting many striking 
features of resemblance in its effects to the symptoms of 
epilepsy, it does not seem to hit the exact likeness, and is per- 
haps more suitable for various kinds of epileptiform convulsions, 
and for general choraic tremors than for true epilepsy. 

I have certainly seen decided benefit from Arsemcum — a 
medicine not nearly so much in vogue among Homoeopathists 
for the cure of epilepsy. That Arsenicum does, however, some- 



Lectv/re hy Dr. Russell on Epilepsy, 281 

times produce a set of symptoms closely resembling those of 
epilepsy is undoubted, and well illustrated in the following 
case: — 

" A girl swallowed a drachm of arsenic, and was in conse- 
quence attacked violently with the usual symptoms of irritation 
in the whole alimentary canaL After a succession of ordinary 
symptoms, a new train gradually appeared. Towards the close 
of the second day she was harrassed with frightful dreams, 
starting from sleep, and a tendency to faint ; with coldness 
along the spine, giddiness, and intolerance of light ; and, on the 
fourth day, with aching of the extremities and tingling of the 
whole skin. This symptom continued till the close of the 
sixth day, when she was suddenly seized with convulsions of 
the left side, foaming at the mouth, and total insensibility. 
The convulsions lasted two hours, the insensibility through the 
whole night iText evening she had another and similar fit ; 
a third, but slighter, occurred on the morning of the tenth; 
another next day at noon ; and they continued to occur occa- 
sionally till the nineteenth day.*' 

The gradual formation of the epileptic condition is curiously 
exhibited here. Over sensitiveness of the periphereal nerves, 
so that there was more than the proper amount of stimulus 
borne inwards to the centre, while, at the same time, an ab- 
normal state of the upper part of the spinal chord was engen- 
dered, in consequence of which there was preternatural tendency 
on its part to be excited. Here we had the train laid by one 
hand, and the match applied by the other. 

It is further to be observed, in regard to Arsenicum, that it 
produces intermittent fever ; and Dr. Brown-S^quard has pointed 
out that the ague, and epileptic conditions of the body are reci- 
procally antagonistic. For these reasons, as well as on the 
grounds of having seen it do good, I am disposed to press this 
medicine on your attention in cases of epilepsy. 

Another medicine, which has seemed to me of unequivocal 
benefit, is Jjfajay and we should expect it to be so from the 



282 Lecture by Dr. Russell on Epilepsy, 

effects it produces when it enters the system in such a way as 
to exert, to its full extent, its morbific influence. In the 
reports of fatal cases from the bite of the cobra di capello we 
have the most characteristic symptoms of epilepsy occurring in 
the proper order of succession. First, there are convulsive 
twitches of various muscles, showing a general agitation of the 
peripheral nerves ; then come insensibility and violent convul- 
sions, with foaming at the mouth. Dilatation of the pupil is 
also sometimes observed at an early stage. Thus from Lachesis 
and Naja we have every reason to expect good results in the 
treatment of epilepsy; and, so far as my experience goes, it 
confirms these expectations. 

From Nitrate of Silver I have never succeeded in obtaining 
any satisfactory results. This may be owing to its popular use 
and even abuse ; for, as it rarely happens to us to be called 
on to treat a case of epilepsy which has not been previously 
under any course of medical treatment, in the majority of our 
cases this remedy has been given, and failed to do good. Dr. 
Gray, of !N'ew York, than whom we have no more trustworthy 
observer, tells us that "Epileptic attacks produced by moral 
causes, e.g., impassioned lay preaching, are promptly and directly 
cured by a few small doses of this medicine." 

Nux Vomica is certainly a most useful medicine in the treat- 
ment of epilepsy ; but rather, as it appears to me, by removing 
the peripheral exciting causes, than by acting on the abnormal 
condition of the nervous centres. However, as I have seen 
undoubted benefit from its action in some obstinate and severe 
cases, we should not deprive ourselves of its use by any specu- 
lative objections as to its inability to produce the cerebral op- 
pression which characterizes epilepsy. 

The same observations hold good of Pulsatilla. 

In thus winnowing out of Dr. Laurie's fifty medicines these 

five or six, I by no means wish to cast a slight upon the others; 

but, as these are clenical lectures, I have confined myself 

exclusively, or nearly so, to giving expression to the result of 



Cases by Mr. Yeldham. 283 

my own personal experience and observation. I only regret 
that it is not more satisfactory ; and I trust that, by and bye, 
we shall have, instead of vaguQ indications and general direc- 
tions for the use of remedies in epilepsy, a collection of well- 
attested cures of this terrible affliction, so that we may discover, 
with some approach to accuracy, what are the peculiar indica- 
tions on which we may rely for giving a preference to one 
remedy rather than to another, in selecting that which is the 
most appropriate to every particular case of the disease, to- 
wards the cure or mitigation of which our remedial efforts are 
directed. 



CASES TEEATED WITH HIGH DILUTIONS, BY MR. 
YELDHAM, M.RC.S., Surgeon to the Hospital. 

Case VTI. — ^Frederick Goodman, aged 16 : admitted No- 
vember 12, 1863 : discharged December 2nd. Result, cured. 

Oastric irritation with headache. — A fortnight ago was seized 
with pain in the head and loins, with tendency to fever. The 
pain in the head has continued ever since. 

Nov. 13th. — He now complains of dull heavy pain in the front 
of the head — ^heis evidently much oppressed by it — ^it causes him 
to stoop, and to move with great caution, and to avoid the light. 
He has neither appetite nor thirst ; tongue dry, and red in the 
centre : white and moist over the rest of its surface, except the 
edges which are clean. Pulse 84 ; skin hot and moist; bowels 
inclined to be relaxed ; urine high coloured. 

Aconite tinct. 200, a drop three times a day. 

Nov. 19 th. — StUl pain in the forehead, at times ; feels weak ; 
tongue slightly coated. 

Nux Vomica 200, three times a day. 

Nov. 23rd. — Head better, though there is still dull pain in 
the forehead. Has pain in the abdomen, after food, as if 
from flatulence. 

Saccharum Lactis. 



284 C(wes hy Mr. Yeldham. 

Nov. 25th. — Head worse yesterday and to-day: astupifying, 
dull, heavy pain ; stomach uncomfortable after food. 

Nux Vomica, first decimal, a drop three times a day. 
Nov. 30th. — Very much better; very slight pain in the fore- 
head ; has slight pain across the epigastrium. 

Continue the Nux Vom., first decimal 
Dec. 2nd. — -Feels quite well. Discharged, cured. 

Case VIII. — ^Ellen Mills, aged 37; single; servant — admit- 
ted November 27th ; discharged, December 21st. Eesult, cured. 

Gastrosis. — ^Three weeks ago felt a pain in the bowels after 
dinner, which has continued up to this time. Now complains 
of constant violent pain, principally in the epigastric region, 
shooting through to the back ; worse after food, and increased 
by pressure. When first seized had sickness and vomiting after 
every meal, but these symptoms have abated within the last 
week. There is no appetite ; thirst, and bad taste in the mouth ; 
bowels act regularly; has headache; skin cool. 

Take Aconite 200, a drop three times a day. 

Nov. 30th. — Much the same. 

Take Belladonna 200, a drop every four hours. 

Dec. 4th. — Continues the same. 

Take Belladonna, first decimal, 3 drops every four hours. 

Dec. 7th. — Considerably better ; pain stUl felt, though in a 
very mitigated degree. 

Continue same medicine. 

Dec. 9th. — More pain across the colon since yesterday 
afternoon, with some frontal headache. 

Saccharum Lactis. 

Dec. 12th. — Very considerably better; pain greatly dimi- 
nished, both after food and at other times. 

Dec. 14th. — Still better, even when sitting up, which 
hitherto has much increased the pain — felt only when lying 
on the left side. 

Saccharum Lactis. 



Cases hy Mr, Yeldham, 285 

Dec. 16th. — ^Much same as at last visit, still some discomfort 
after food. 

Cocculus 200, a drop three times a day. 

Dec. 19th. — Better; sat up yesterday with greater ease than 
before. 

Dec. 21st. — Pain scarcely felt at all; feels sufficiently well 
to go home. Discharged. 

Case IX. — James Rayman, aged 30 ; a labourer — admitted 
November 12, 1863; discharged, December 14. Result, cured. 

Ague, — A stout, muscular man. About three weeks since 
got wet and caught cold ; he coughed for a week and then had 
a shivering fit ; this recurred every second night until four days 
ago, since when he has had the shivering every night. In Oc- 
tober, was working three weeks in the Wolds of Yorkshire, 
where ague prevails. On admission, states that for the last 
four days the shivering has come on about three or four o'clock 
each morning, has lasted for an hour, and has been followed by 
hot stage, which lasts about half an hour, and is succeeded by a 
gentle perspiration. He is always thirsty, but more so during 
the hot stage. Pulse, at eleven a.m., 90. Skin cool; tongue 
coated white ; urine high coloured, and thick ; bowels regular ; 
has slight cough at night. 

Take Arsenicum 200, a drop every four houra. 

Nov. 1 9 th. — Shiveringshave recurred much the same as usual, 
perhaps a little slighter last night ; less heat and sweating ; ex- 
ceedingly thirsty in the night ; pulse 112, weak, ansemic looking 
and feels exceedingly prostrated ; tongue broad, red, and glazed. 
Arsenicum 3rd decimal, a drop every four hours. 

Nov. 21st. — Had shivering on the 20th. Last night had 
copious sweating between twelve and one o'clock, but no 
shivering; slight thirst. 

Nov. 23rd. — ^At noon, on 21st, had a shivering fit which lasted 
an hour and a half. Fever followed, but no sweat. Has had no 
shivering since, but feels giddy, and has a mist before his eyes, 
at times. 

Continue same medicine. 



286 Cases hy Mr. Yeldham. 

Nov. 25th. — For last two nights the shivering has been as 
before, has come on at the usual time, and has been succeeded 
by fever and sweating. 

Chinium Sulphuricum, ^ 5 drops every four liours. 
Nov. 30th. — Continues much the same. 

Chinium Sulphuricum ^ grain every two hours. 
Dec. 2nd. — Shiverings the last two days have come on at six 
in the morning. 

Chinium Sulphuricum ^ grain every two hours. 
Dec. 4th. — Yesterday shivering came on at noon. Feels 
better to-day. 

Continue same medicine. 
Dec. 7th. — No shivering the last two days. 
Dec. 9 th. — Has had no shivering. Improves rapidly. 

Eepeat the same medicine every four hours. 
Dec. 12 th. — No shivering. Well, except a little uneasiness 
in the loins. 

Dec. 14th. — No recurrence of the shiverings. Feels quite 
well, and is discharged. 

CsEA 10. — Jane Amos, aged 21; married; admitted Oct* 
20th, 1863 ; discharged Nov. 18th. Result, relieved. Disease, 
Rheumatism. 

When six years old, and again when ten, had Rheumatic 
fever. Since last attack has enjoyed good health till a fomight 
ago, when she felt pains in head, shoulders, and arms. These 
pains have continued, more or less, since. On admission com- 
plains of pain on motion in back of neck and shoulders. Her 
tongue is clean at edges and in centre, but has two stripes of 
fur ; appetite fair ; bowels regular ; catamenia ditto ; Pulse 110 ; 
skin cool ; sleeps badly ; heart sounds, normal 

Oct. 23. Aconite 200, three times a day. 

Oct. 25th. Worse. Pain has extended to^the other shoulder. 
Bryonia 200, a drop every four honrs. 

Oct. 28 th. Better in herself. Left shoulder painful, like knives 



Cases by Mr. Yeldham, 287 

pricking her, and preventing sleep. Not so thirsty. Tongue 
deeming. 

Continue Bryonia, 200. 

Oct. 30th. Less pain in shoulder, can move it better. 

Nov. 2nd. Flying pains in different parts of body, though 
generally better. 

Pulsatilla 200, a drop every four hours. 

Nov. 5th. Feverish all night and no sleep. Catching pain in 
right side of chest on moving and breathing, and in the region 
of the heart, the sounds of which are healthy. Pulse 120. She 
has had meat diet hitherto, and is now to omit it. 

Take Aconite 2j00, a drop every four hours. 
Nov. 6th. The catching pain in right side continues. 

Bryonia 200, every four hoois. 
Nov. 9th. Had a good deal of pain last night. This morning 
it is felt ia one foot. Feverish. 

Aconite 200, every four hours. 

Nov. 11th. Has pain in the right arm, and in the face and 
teeth ; aching, shooting pains which are worse when the teeth 
are closed. 

Merc. cor. 200, every four hours. 

Nov. 16th. Varioloid looking spots appeared on the body two 
days ago, these are now dying off. She does not progress 
with respect to the rheumatism. Has pains in different parts 
— the right wrist is swollen and painful, fixedly so for three 
days; tongue coated white, pulse quick — 120 — and weak. 
Bryonia 3rd dec. ; three drops every four hours. 

Nov. 18th. General health better — still has flying pains. She 
wishes to leave the hospital, and is to have Bryonia Pilules of 
the 3rd to take three times a day. Further result not known. 

Case 11. James Hubert; age 31 — a shopkeeper. Admitted 

Dec. 3, 1863. Discharged Dec. 23. — Eesult, cured. Disease. 

Bronchitis. — Has been subject to attacks of breathlessness 



288 Cases by Mr. Yeldham. 

for ten years, which seem to be brought on by cold. Has had 
such an attack the last two months. He is breathless, espe- 
cially at night, with a hard cough, and tough greenish expec- 
toration. Has slight pain when he draws a long breath. 
Sibilant rales are heard all over the chest. Pulse 96, small; 
skin cooL Bowels regular; tongue coated. Feels sick and 
thirsty. 

Tine. Nux Vomica 200, three times a day. 
Dec. 9 th. Is easier ; cough looser. Has had a good night. 

Continue medicine. 
Dec. 12th. Breathing was worse last night. Cough dry, and 
expectoration less easily raised. 

Tine. Ipecacuanha 200 ; three times a day. 
Dec. 16th. No better. 

Take Tine. Ipecacuanha, 1st dec. 3 drops every four hours. 
Dec. 19th. "Feels decidedly better since beginning the last 
medicine." Less wheezing, cough easier. 

Continue. 
Dec. 21st. Much better ; but still coughs of a morning. 

Nux Vomica 200, for three days. 
Dec. 23rd. A little cough stiU. 

Discharged. 



g^nnals of i^t S^amt^a. 



OBSEEVATIONS ON THE PHYSIOLOGICAL AND 
THEEAPEUTIC EFFECTS OF ALCOHOL. 

By Alfred C. Pope, 

Mb. President and Gentlemen, — ^The daily consumption 
throughout the world of alcoholic fluids, the deep interest these 
beverages possess for us, as the origin of some forms of disease, 
and the source of the intractable nature of many others, and 
their admitted value as remedial agents, constitute, for the care- 
ful and impartial investigation of their physiological and thera- 
peutic effects, claims, the strength of which no one, I presume, 
wiU feel disposed to question ; the subject is one to which, as 
guardians of the public health, we are bound to accord a patient 
and attentive consideration. In introducing it to you to-night, 
I purpose laying before you a study of the modus operandi of 
alcohol in health, and therefrom shall endeavour to deduce its 
sphere of action in the treatment of disease. 

In attempting to fulfil this intention, I propose to consider. 
First, the symptoms following the use of alcohol in a healthy 
man while fasting and unemployed, the results of experiments 
upon the lower animals instituted with the view of determining 
its characteristic effects, and the modes of death, with the 
morbid appearances ensuing its use in poisonous quantities. 
Secondly, I shall examine, by the light these facts afford, the. 
principal theories propounded to explain its action. And, 
Thirdly, from the same source I shall infer the nature of those 
morbid conditions, in the treatment of which we shall find 
alcohol to prove the most serviceable medicine we can employ. 

By no method can we obtain so clear an insight to the 

VOL. HL 19 



2yo Obscrvatiuits un the Physloloyical and 

actions and uses of any substance as by that which, if not first 
])ioj)»)s«m1 by irabneinann, was by him unquestionably first put 
to any ])ractical use, and subsequently so developed as to pro- 
vide us ^vith a Materia Medica, not only extensive, but easily 
understood and readily available. Chemistry, botany, or the 
empirical use of a presumed remedy in a variety of diseases can 
never provide us with information so reliable as that derivable 
from experiments with it on the healthy body. Amongst those 
of our l^rofession who do not as yet recognize the value of the 
llomu'opatliic law as a therapeutic indicator, this method of re- 
search n^garding the properties of new remedies, and of some 
old ones, is becoming more frequent. We may well congratu- 
late ourselves that it is so, seeing that if persevered in, it must 
l(»ad them — as seventy years ago it led Hahnemann — to see in 
the law of similia similihiis curantur the true guide to the 
select ion of remedies. 

After this manner alcohol has been studied by Dr. Edward 
Smith, of the Brompton Hospital, and to a very slight extent 
by Dr. ('hauibers, of St. Mary's. The latter gentleman has yet 
much to learn in the matter of drug proving ; for when detailing 
some of the results of taking daily an addition of a moderate 
quantity of alcohol to the usual meals, he says, — " On the next 
day, the a])petite for food was observed to be somewhat less 
than usual, and tlie experiment ceased ; for any alteration of 
usual weight, health, feeling, or habits, of course would vitiate 
the r(\sult of an investigation conducted in this form." On the 
contrary, it is a knowledge of the changes in health, weight, 
and feeling arising from the ingestion of a given substance, that 
w^e desiderate ; to obtain it, such experiments are alone under- 
takcjn. 

I)r. Smith, however, w^as less chary of his health and feelings, 
and lias, with the assistance of a friend, furnished the Profession 
with a very valuable proving of alcohol. The symptons re- 
sulting iVom taking a moderate quantity of duly diluted alco- 
hol, of brandy, of gin, rum, whiskey, ale, and porter on an 



Therapeutic Effects of A Icohol 291 

empty stomach, early in the morning, aiv ji" on by him in the 
natnral order of their succession, the duration of their action, 
and with their attendant circumstances. They are recorded in 
the first volume of the Lancet for 1861. 

From this proving we learn that the circulation was the 
function first impressed; and, almost immediately, the brain 
became excited ; shortly afterwards, the spinal cord, the respira- 
tion, and, lastly, the sympathetic system, gave evidence of being 
influenced by the alcohol. " In three minutes after taking the 
spirits and water, the action of the heart was increased, and 
continued so for from thirty to forty minutes. This was at- 
tended by a sense of dryness, heat, and evident fulness of the 
exposed parts of the skin, as the hands and feet, and also a 
general sensation of heat. The skin was as harsh and dry as 
when exposed to an easterly wind. After about twenty to 
forty minutes, tliis sensation of heat gave place to one of cold, 
first felt in the most sensitive parts of the body in reference to 
temperature — ^viz., between the shoulders, and at length, not- 
withstanding the existence of a suitable atmosphere, became 
distressing, and led even to shivering. This was sometimes 50 
marked and occurred so suddenly, that it gave rise to a shock. 
It did not correspond with the temperature of the skin, but it 
was usually co-existent with the cessation of increase of the 
heart's action." 

In these details we have the action of alcohol on the circu- 
lation, and some of the consequences thereof well delineated. 
The heart is at first stimulated to increased activity. The blood 
circtdates in gieater volume, and with more rapidity, carrjang 
with it increased heat to the surface and extremities. As its 
primary influence passes off, the central organ of the circulation 
works less vigorously, abnormal contraction of the capillaries 
follows their previously abnormal dilatation, and the recently- 
acquired warmth of the body gives place to a sensation of cold 
so considerable as to amount to " shock." 

The first indication of the cerebral organization being influ- 

19^ 



292 Observations on the Physiological and 

enced by the alcohol, was felt by Dr. Smith almost coin- 
cideiitly with increased cardiac action, and to the state of the 
circulation it was probably due. "A sensation of fulness at 
the crown and back part of the head, or at the temples, accord- 
ing to the kind of spirit taken," was the first symptom of nervous 
disorder noticed. In from three to seven minutes the mind 
b3came disturbed. In the words of Dr. Smith, — " consciousness, 
the power of fixing the attention, the perception of light, and, we 
believe, of sound also were lessened ; the power of directing and 
co-ordinating the muscles was also lessened, whilst there was 
a very marked continuous purring or thrilling, and not un- 
pleasant sensation passing from above downwards through the 
whole system. Tliis latter symptom was most pronounced in 
from fifteen to forty minutes, and continued without much 
variation during twenty to thirty minutes. After this period 
the whole effect recorded under this head diminished, and 
oftentimes suddenly, as was shown by an increased perception 
of light, as if a veil had fallen from the eyes, and by increased 
consciousness ; but, nevertheless, the last power to be completely 
regained was consciousness." 

Again, the effect of alcohol is manifested in the mental con- 
dition induced. " Eum and some other spirits," says Dr. Smith, 
" made us very hilarious, so much so that my friend was alto- 
gether a king ; but as minutes flew away, so did our joyousness, 
and little by little we lessened our garrulity, and felt less happy, 
until at length, having gone down by degrees, we became silent, 
almost morose, and extremely miserable." 

Through the medium of the nervous system, again, the 
muscular apparatus of the body becomes disordered. "The 
thin layers of the voluntary muscles found about the body 
showed great relaxation. The respiratory muscles acted in a 
gasping manner, so that there was a pumping and quick inspi- 
ratory effort in the earlier, and a feeble expiratory effort in the 
later stage. At aU periods there was a sense of impediment to 
respiration." Though I cite these symptoms here as evidence 



Therapeutic Effects of Alcohol 293 

of the lack of nervous force induced by alcohol, they are but 
partly due to this cause, being probably the more direct result 
of that vitiated, that imperfectly aerated state of the blood to 
which alcohol gives rise. To continue, — " The muscles of the 
limbs were inactive. There was relaxation of the muscles and 
stiffness of the skin of the face, forehead, and upper lip, so that 
the features fell. The state of the muscular system followed the 
commencement of the effect upon the consciousness, and other 
functions of the brain, and also the excited state of the heart. 
In reference to its cessation, the power of co-ordinating the 
muscles was the first regained, whilst the buzzing sensation 
and semi-cataleptic state continued, and the disposition to use 
the muscles was regained the last of alL" 

In the earlier of the symptoms I have detailed, we find a 
diminution in the nervous power of the senses; a partial paraly- 
sis, as it were, of sight and hearing, accompanied by a general 
excitability of the whole nervous system, as remarked in the 
continuous purring and thrilling passing from above downwards. 
We subsequently saw a perversion of nervous energy in the 
mental phenomena evoked. The brain, the medium of the 
mind, was disordered, and evinced its morbid state primarily in 
excitement, and secondarily, in depression. The former de- 
pending on the increased activity of the circulation throughout 
its substance ; the latter arising from the specific action of the 
alcohol upon it, from the depraved condition of the blood. The 
spinal cord, though less powerfully and less permanently affected 
by the alcoholic fluid, is, nevertheless, very strikingly influenced 
by it, as seen in the impaired power, if not altogether of 
moving, at any rate of co-ordinating the action of the muscles. 

In these experiments of Dr. Smith and his friend, we find 
ample evidence of the sphere in which alcohol exhibits its 
peculiar influence. .Physiological and pathological investiga- 
tions point to a similar direction. To some of these researches 
I will refer. 

Dr. Marcet, in the course of a series of experiments detailed 



2'.»4 Observations on the Physiological ami 

but'oro the Hritish Association at its meeting at Aberdeen in 

185'.» (Mailed I Time^ and Gazette, March, 1860), showed that 

fro<^rs into whom he had injected alcohol died more rapidly from 

])()isnn(nis shock, when both the circulation and nervous com- 

nuiiiieations were free than when any mutilation of nervous 

trunks liad been previously practised. Thus demonstrating 

that the nerves themselves are conductors of the alcholic 

])()ison; that the nervous system is influenced in all its parts, 

in its tmcts as well as in its centres. From an ingenious 

comparison between the observed action of alcohol and an 

experiment of M. Claude Bernard's, Dr. Marcet infers the 

nature of the influence of alcohol on the sympathetic system. 

He remarks, at page 13 of his work on "Alcoholic Intoxication," 

" wlien fermented beverages are taken in moderate quantity, it 

is obvious from the increased rapidity of the circulation they 

induce in the membranes with which they come in contact, 

that the alcoliolic fluid exerts a local action on the nerves 

ramifying in those membranes. It is difficult to determine the 

precise seat of this action, but we may surmise that it is 

exerted principally on the sympathetic, this system supplying 

twigs which accompany arteries into their minutest divisions. 

If we now bear in mind the facts revealed to us by Claude 

Bernard, that by cutting a branch of the sympathetic nerve, the 

circulation of the part which is supplied by that nerve is 

greatly increased, and also that this very same increased rate of 

the circulation takes place where alcohol is present in the 

stomach, it is but rational to conclude that alcohol, when first 

absorbed by the minutest blood-vessels, has the property of 

lessening the normal functions of the sympathetic nerves which 

supply those vessels." The same observer has, in the series of 

experiments already alluded to, shown that the shock which has 

been known to follow the sudden imbibition of large quantities 

of raw spirits, is due to their direct action on the extremities 

of the cerebro-spinal nerves. Thus in a frog, in which the 

circulation had been arrested, temporary insensibility was 



Therapeutic Effects of A Icohol. 295 

induced when the hind limbs were immersed in alcohol, while 
in one where the circulation was undisturbed, but the nerves of 
the limbs placed in alcohol severed fi*om their centre, no shock 
occurred. Thus demonstrating that in sudden shock the 
impression is conveyed to the centre solely by the nerves and 
independently of the blood vessels. 

Again, there are certain excretions dependent partly on 
changes in the nervous system, such as the phosphatic salts, 
which are altered under the influence of alcohol. Dr. Chambers 
alleges that they are diminished ; but, as he never carried his 
investigations beyond the primary stage of alcoholism, and as 
there are many observations tending to rebut his conclusion, the 
probability is, that when the deeper action of the spirit comes 
into play, these are largely increased. Some observers have 
remarked a diminution in the amount of ui^ea excreted under 
the influence of alcohol ; others have stated that it is in excess. 
In all likelihood this excretion is not changed in quantity, for 
Dr. Brinton has shown that when diminished in the urine its 
place has appeared to be supplied by the large increase which 
takes place in the ammoniacal constituent of the foeces. The 
channel of excretion, and not the excretion itself, it is that is 
altered. 

While pathogenetic and physiological experiments show the 
power of alcohol over the nervous system, pathological investi- 
gations tend to the same result. 

Dr. Ogston, of Aberdeen, in 1833 detected alcohol in the 
ventricles of the brain of a person who had died in a state of 
intoxication. Dr. Percy was led by a similar observation to a 
more extended series of experiments, the thesis in which they 
were published obtaining an Edinburgh University gold medal. 
He procured alcohol from the brains of intoxicants by distilla- 
tion. And, though he detected it by the same means in the 
liver and the kidney, it was in the brain that he found the 
largest proportion. 

The mode of death from alcohol points to the nervous 



296 Observations on the Physiological and 

system as that upon which its lethal influence has been chiefly 
exerted. 

Death, as I have already noticed, sometimes occurs suddenly 
from nervous shock, after the ingestion of a large quantity of 
spirit. In a dog into whose stomach Dr. Percy injected two 
ounces and a-half of alcohol death was instantaneous. But, speedy 
as was the fatal result in its occurrence, alcohol was found in the 
brain in a quantity equal to that which on previous occasions 
had been yielded when the alcohol had had much longer time 
to accumulate. 

In cases where death supervenes more gradually, the 
symptoms are traceable not merely to nervous derangement, but 
also to deficient aeration of the blood. Coma, convulsions, 
apoplexy, and asphyxia constitute the more prominent features 
in persons dying of alcoholic poisoning. An interesting and 
instructive case of this nature, illustrating alike the rapid 
absorption of alcohol, and the direction of its action is recorded 
by the late Dr. Todd in his "Clinical Lectures on Acute 
Diseases " (p. 44, 1st ed.) A child, three years old, was brought 
into King's College Hospital in a comatose state, having, about 
six hours previously, had about a half-a-quartem (two-and-a-half 
ounces) of gin administered to it. Coma supervened soon after 
the gin was taken ; and when admitted she was still insensible, 
though the pulse was good, the body and extremities warm, 
and the eyes presenting a natural appearance. Emetics — the 
cold douche to the head, a mustard and water bath, slapping 
the feet and posteriors, were tried with the view of arousing 
her, but produced no effect beyond crying and kicking, hit with 
the right leg only. The left arm and leg were paralysed. Three 
hours after admission an epileptic fit occurred, with convulsive 
twitchings of the left side of the body and face. The right 
side shared also in the convulsions, but only to a slight extent. 
About twenty or thirty paroxysms of this character took place 
during the night, the intervals being passed in a comatose 
state. In three more days the patient sank exhausted, the 



Therapmtic Effects of Alcohol 297 

paralysis having continued unaltered, and on one occasion 
only, on the day before her death, did she exhibit any sign of 
consciousness. The brain presented an extreme degree of 
pallor; but, beyond this, there was no abnormal anatomical 
condition, either of its grey or white substance ; neither was 
there any effusion into its cavities, nor any condition by which 
coma could be accounted for by way of pressure. The only other 
alteration observable, beyond the congestion of the lower lobes 
of the lungs, was some degree of fatty degeneration of the 
kidney. The result, in all probability. Dr. Todd remarks, of 
previous mal-nutrition. In this case it will be seen that there 
was no cerebral congestion, no structural lesion to explain the 
severe nervous shock that brought life to a close. The power 
of the brain to create nervous force was simply obliterated, 
more completely so in one hemisphere than in the other. For 
lack of the nervous energy supplied by the brain the patient 
died. 

While the paralysis and nervous irritation exemplified by 
this and similar cases are due, in a very considerable degree, to 
the elective affinity for alcohol possessed by the brain, the 
morbid condition of the blood engendered by the excessive use 
of spirits plays an important part in the production of the con- 
ditions upon- which such disordered states depend. The rapid 
absorption of alcohol by the blood noticed in Dr. Todd's case 
has been remarked upon by all who have studied its action. 
Dr. Percy in his experiments found the darkened arterial blood 
of a dog to yield alcohol in distillation. But not only is it 
thus absorbed, and so conveyed to the brain and other organs 
upon which it exerts its most marked influence, but its pre- 
sence alters the constitution of the blood. Dr. Boecker found 
on comparing the blood of a person who never took alcohol in 
any form with that of one who took daily a certain, but not 
excessive, quantity of brandy, that in the latter the organic 
constituents were deficient ; the proper amount of fibrine as 
compaied with albumen was wanting ; the red clot was more 



298 Observations on the Physiologhdl and 

carbonized, or, at least, blacker than in health. The pale and 
colourless corpuscles were, he observes, in excess. To this 
source probably may be traced the dark colour of the clot 
rather than to its admixture with carbon. The colourless 
corpuscles are simply undeveloped red blood discs. They do 
not become coloured on reacliing the hmgs, and hence the 
blood itself, and consequently the clot formed from it, are dark 
in colour. The experiments of Bourchardat and Sandras are 
confirmed by those of Boiicker. They found the arterial blood 
in a person under the influence of alcohol to have all the 
characters of venous blood — to be evidently unoxidated. In 
commenting upon the investigations of Boecker, Dr. Chambers 
remarks " that the blood is less vitalized, is anemic, and at 
the same time too venous, too much in the condition of the 
portal system ; it retains too much of the efiPete matter, and is 
deficient in new active globules" ("Digestion and its Derange- 
ments," p. 231). 

The observations I have here adduced afford no evidence, I 
may remark in passing, of the decomposition of alcohol within 
the circulation. On the contrary, it was obtained from it by 
distillation by Dr. Percy ; while its dark, carbonized looking 
condition, was due not to its having obtained an excess o 
caj.'bon from an unusual source, but from that which it normallj 
contained, deprived from efiPete matters, not having been elimi 
nated. Dr. Smith's experiments on the influence of alcohol 
on the respiratory process go to confirm the hypothesis. He 
found, he tells us, that the respiration was " disturbed rathei 
than materially altered " (" Philosophical Transactions, 1859") 
The respiratory movements were, he says, in all instances, ex- 
cept where porter was the alcoholic fluid used in experimenting 
diminished in frequency. The carbonic acid excreted by th( 
lungs was diminished when whiskey, brandy, gin, and sherrj 
were taken. When pure alcohol was used, it was increased tc 
nearly one-fifth of a grain per minute, the nonnal amount being 
eight and four-fifths of a grain per minute. With rum, rum and 



Therapeutic Effects of A Icohol. 299 

milk, stout, and ale, it was more decidedly increased. The re- 
sults probably of the large amount of saccharine matter con- 
tained in these compounds. Dr. Prout, in experiments made 
with the same end in view as Dr. Smith's, found that the 
carbonic acid was excreted in diminished quantity, but that 
after the lapse of two or three hours from the time the alcohol 
was taken, it was very considerably increased. 

That the blood contains an excess of carbon, whether de- 
rived from the alcohol, or consisting of that which in the 
usual order of healthy changes ought to have been extruded 
from the system, is certain. This fact is, in some degree, 
illustrated by two symptoms noted by Dr. Smith. He says, 
"the respiratory muscles acted in a gasping manner, so that 
there was a pumping and quick expiratory eflfort in the earlier, 
and a lazy feebler expiratory effort in the later, stages." And 
again he remarks, " at all periods there was a sense of impedi- 
ment to respiration." That such is the condition of the blood 
is still further corroborated by two cases of spasm of the glottis, 
arising from an excessive use of alcohol ; the one is reported 
in the Medico-Cliirurgical Transactions for 1837, and the 
other in the Ediriburgh Medical and Surgical Journal for 1833, 
and both are re-produced in Dr. Marcet's work previously re- 
ferred to (p. 20). The former recovered after tracheotomy; the 
other was fatal In the first, the respiration had a shrill tone 
and was extremely difficult — ^the patient was perfectly comatose. 
Tracheotomy was followed by an immediate cessation of the 
violent efforts of the respiratory muscles, and the subsidence of 
the venous distension around the head and neck. In half an 
hour the breathing was regular. In the second, the post 
mortem appearances showed that " both lungs were congested 
with dark fluid blood ; dark blood was found in the ventricles 
of the heart ; the blood of the veins generally was fluid and 
dark coloured." The symptoms in both cases, and the post 
mortem appearances in one, resembled those in cases of asphyxia, 
from the presence within the circulation of some gaseous poison. 



30 Observations on the Physiological and 

Here, probably, they may be assigned to three causes, the 
common results of alcohol, — First, to deficient innervation giving 
rise to a feeble semi-paralysed state of the muscles of respira- 
tion. Secondly, to the retention within the blood of that carbonic 
acid which ought to have passed off in respiration. And, 
Thirdly, to the " presence of alcohol within the circulation by 
interfering with or checking the action of air in the blood 
within the circulation giving rise to a morbid condition incom- 
patible with the maintenance of life" (Marcet, op. cit, p. 25). 

From the facts I have now laid before you, we may, I think, 
conclude that alcohol has the property, first, of deteriorating the 
quality of the blood ; secondly, from this cause, and also by virtue 
of the affinity which nervous and especially cerebral matter has 
for it, it gives rise to a narcotised state of the brain in par- 
ticular, and of the nervous system in general ; and, thirdly, that 
it is conveyed through the body both in the circulation and 
along the nerves. 

Eeceived into the blood, altering its physical constitution, 
and impairing nervous power, alcohol must influence in a 
greater or less degree every organ of the body ; and we find 
that it does so. 

From the liver alcohol has been distilled where death has 
occurred during intoxication. By its presence in this organ, 
the structure is directly irritated, while its functional activity 
is abnormally increased by the deficient power of the respira- 
tion. The effete matters, which we have seen to be retained 
in the circulation, not being passed off at the lungs, are thrown 
upon the liver. The ultimate result of this physical and 
physiological excitement is undue and irreparable waste of 
tissue. Contraction, therefore, takes place. In other cases, 
where the alcoholic beverage indulged in contains a considerable 
quantity of saccharine matter, fatty degeneration of the struc- 
ture ensues. The accumulation of this morbid material gives 
an appearance of bulk ; the organ is said to be hypertrophied. 
In reality, its size is diminished ; the fat giving to it its ap- 



Therapeutic Effects of A IcohoL 301 

parent enlargement, being in part derived from a change in a 
decay of its natural tissues. 

On the stomach alcohol acts mainly, first, as a topical irri- 
tant ; and, secondly, as a paralyser of its nervous supply. 

Passing unchanged through the kidney, it excites a degree of 
congestion, depending, as in the liver, partly on its irritating 
character, and partly on the excess of functional activity de- 
manded by blood containing alcohoL From the urine of per- 
sons who have recently taken spirits, alcohol has been obtained 
in a more or less notable quantity. 

To one other series of experiments do I wish briefly to allude 
before passing to notice the theories offered to account for the 
mode of action of alcohoL I refer to the investigations of 
Messrs. Lallemand, Perrin, and Duroy, and their recently pub- 
lished counterpart, the experiments of M. Baudot. I have 
already shown that alcohol is deposited in various organs, and 
that it is thrown out from the system through the renal secre- 
tion. Dr. Edward Smith has demonstrated its extrusion 
through the skin. Messrs. Lallemand, Perrin, and Duroy have, 
in an academical prize essay, proved that, in addition to these 
channels of elimination, it is passed off in respiration, and that 
it can be detected in the breath some hours after having been 
drank. By experimenting upon the various products of excre- 
tion, they recovered about 28 per cent, of the alcohol that had 
been taken. Finding no evidence whatever of the conversion 
of the remaining 72 per cent., they conclude that it escaped 
from the economy in a similar manner to that which they 
secured, but that owing to the imperfection of chemical appli- 
ances, the length of time elapsing before the whole of the 
alcohol is extrudefi, and other sources of error in calculation, 
they failed in its detection. These experiments' have lately 
been called in question by M. Baudot in a series of papers 
published in i' Union MMicale. M. Baudot, it appears, failed 
to discover any very appreciable quantity of alcohol either in 
the breath, the perspiration, or the urine, and hence asserts the 



302 Observations on the Physiological and 

conversion, or oxidation of alcohol within the body. M. Perrin 
defends tlie experiments contained in the work of which he 
Avas a joint autlior; endeavours to show why he and his col- 
leagues did not find more of the alcohol taken than they did ; 
adduces a series of arguments to prove that alcohol is not an 
aliment, and points out what he considers its uses and value. 

From tlie observations of Ogston, Percy, and others in this 
country, and the French authors just named, we gather that 
alcohol accumulates in several organs, more particularly in the 
brain and liver; that it remains in the system for a certain 
length of time, this depending probably on the amount taken, 
the circumstances under which it is taken, and the individual 
powers of re-action ; that during its retention it gives rise to 
certain functional changes, producing, according to their in- 
tensity and duration, more or less alteration of structure ; and 
that, ultimately, a great portion, if not the whole, is expelled 
from the organism through its several emunctories. Dr. 
Marcet is of opinion " that a large portion of the alcohol con- 
sumed by habitual drinkers is not at all absorbed by the blood, 
but that, after undergoing certain chemical changes, it is elimi- 
nated through the intestines with the other excreta " (pp. cit, 
p. 1 9). Possibly a considerable portion of that which escaped 
the notice of the French observers may have passed off in this way. 

Such are the principal well ascertained and clearly established 
facts regarding the action of alcohol on the animal economy. 
By the light wliich they afford must we be guided in attempt- 
ing to deteimine the character of this action, and from them 
must we learn when and where the selection of alcohol, as a 
remedy, will best avail us in our efforts to check the advance 
or prevent the occurrence of disease. I believe the details I 
have advanced are perfectly competent for the attainment of 
tliese two ends. For, though nearly all the symptoms observed, 
all the pathological changes noted, and all the results of physio- 
logical investigations that have accrued, either from unusually 
considerable doses of alcohol, or from smaller ones taken under 



Therajpeutic Effects of A IcolioL 303 

somewhat exceptional circumstances, still, as Dr. Edward 
Smith remarks, " the dose only affects the degree and not the 
direction of its influence." As with all drugs, so with alcohol, 
it is with the direction of its action that we are mainly concerned. 

Several theories explanatory of the action of alcohol have 
been advanced. By some it is supposed to be a Food. Those 
who have regarded it in this light have endeavoured to show 
that it affords material for the maintenance of animal heat ; that 
it is the nutrient, par excellence, of nervous matter, and that it 
is a source of the supply of fat. 

Liebig, in his well known work on Animal Chemistry wdiS, I 
believe, the first who assigned to it the property of maintaining 
animal heat. Assuming that, when received into the stomach 
and absorbed by the blood vessels, it was there decomposed into 
its chemical elements, he inferred that the large amount of 
carbon and hydrogen thus supplied united with the oxygen of 
the atmosphere to form carbonic acid gas and water, and that 
this union, or combustion of carbon and hydrogen, gave rise to 
heat. That in fact alcohol was burnt off in the function of 
respiration. This theory, it will be at once obvious, is one purely 
chemical in its basis ; one wliich omits all consideration of the 
physiological action of the spirit. The fallacy of the doctrine 
lies in the assumption that decomposition takes place after the 
fluid has entered the circulation. No such change has ever 
been demonstrated ; while, on the other hand, the experiments 
of Messrs. Lallemand, Perrin, and Duroy, with those of Dr. 
Edward Smith, tend to show that alcohol, so far from being 
decomposed, escapes from the system in its original state. And, 
again, were it a fact that it was resolved into its chemical 
elements, and burnt off at the lungs, the carbonic acid evolved 
during respiration should certainly be in very considerable 
excess over its normal proportions. But Dr. Smith has con- 
clusively proved that no such excess can be detected. Is it, 
howeiver, true ? Does practical observation show that heat is 
developed by means of alcohol? The experience of arctic 



3 04 Observations on the Physiological and 

travellers — so repeatedly quoted as to render specific reference 
unnecessary — has shown that the severe cold of the regions in 
which they sojourned, was better borne, was less felt, when 
spirits were abstained from than when indulged in. Dr. John 
Davy tells us that, both in England and the Barbadoes, he 
found wine to have a positively depressing influence on the 
temperature of the body — a depression which increased in pro- 
portion to the amoimt of stimulant taken. Dr. Edward Smith 
concludes from his investigations that " alcohol does not increase 
the production of heat by its own chemical action, but in- 
directly," by lessening the action of the skin, and thereby 
reducing the loss of heat. Ultimately, however, in its secon- 
dary action " it varies the balance of the circulation at the 
centres and superficies, and interferes with the production of 
heat." These facts appear to me to entirely negative Liebig*s 
theory, and to show that the sense of heat following the use of 
alcohol is similar in many points to that resulting from fever, 
giving place, after its primary action has passed away, to a 
sense of chilliness far more persistent than the previous warmth. 
Secondly, by the late Dr. Todd and others, alcohol has been 
supposed to be a special nutrient of the nervous system. Here, 
again, the basis of the argument is found in its chemical con- 
stitution. " Alcohol is, as you are aware," says Dr. Todd, " a 
hydrocarbon; aud almost all hydrocarbons have a marked 
affinity for the nervous system compared with the other 
structures of the body, and it is upon the nervous centres that 
alcohol exerts its primary influence. At first its action is 
simply to augment nervous power" {op, cit, p. 455). True it 
is that alcohol exerts its primary influence upon the nervous 
system, but this influence is very far removed in its nature from 
that of a nutrient. Dr. Smith remarks that " there is no evi- 
dence that it increases nervous influence, except the action 
upon the heart and the elevation of the spirits be r^arded as 
such ; whilst there is much evidence that it lessens the nervous 
power, as shown by the mind and the muscles." All physio- 



Therapeutic Effects of A IcohoL 305 

logical investigations, all pathological studies tend to show that 
it is deterioration not generation of healthy nervous force that 
results from the affinity of alcohol for cerebral matter. 

The supposition that alcohol loads the blood with fat 
globules, the fact that the chemical composition of alcohol and 
fat are allied to that of nervous structures, and the known 
narcotic property of spirits, have led Dr. Eutherfurd Eussell in 
his very interesting and practically useful Essay on " Diet'* to 
infer the probability of its nourishing and cherishing the ner- 
vous System. In answer to these three reasons on which the 
theory is advanced, it may be urged, — first, that the globules 
seen in the blood which have been supposed to be fatty are, in 
reality, imperfectly formed red corpuscles. The highest stage 
of the blood globule being prevented development by the 
circulation of alcohoL In the second place, the chemical 
likeness existing between fat, alcohol, and brain would be 
fair evidence enough of the power of the two former to sup- 
ply nutriment to the last, if supported by physiological proof 
that the brain was nourished by spirits, wine, or beer, but 
standing alone, imsupported by physiological evidence, it is 
valueless in interpreting the action of alcohoL Thirdly, the 
narcotic effect of alcohol is simply one of its poisonous results. 
During healthy normal sleep the wearied brain is nourished, is 
re-invigorated. But who will contend that the same desirable 
end is attained during the narcotism of alcohol, of opium, or of 
chloroform ? Will sleep so induced avert the " nervous starva- 
tion " which. Dr. EusseU quotes Dr. Buckmll to show, gives 
rise to insanity ? On the contrary, it is the frequent occur- 
rence of the alcoholic and the opiate coma, that in a large 
proportion of instances gives rise to this fearful disease. 

Alcohol does most certainly modify nervous action, but it 
cannot nourish nervous matter, or for more than a very brief 
period elicit nervous power. 

The theory that alcohol is a source of fat appears to have 
taiaea from its hydrocarbonaceous composition, and from the 

20 



306 Observations on the Physiological and 

fact that persons in the habit of indulging largely in beer, 
porter, and some of the richer wines, exhibit a tendency to 
obesity. Such a condition is, however, not necessarily, nor, 
indeed, probably, due to the alcohol they contain, but rather to 
their saccharine elements. Such persons usually live well in 
other respects. The drinker of whiskey and gin, where alcohol 
exists in greater freedom from purely nutrient substances, is a 
thin, spare, and oftentimes prematurely aged-looking person. 
But where fat is deposited, is its presence a manifestation of 
superior vitality ? Certainly not. It exists " not in addition 
to but instead of, the normal tissues " {Carpenter), It is found 
chiefly encumbering the liver, occupying the place of its healthy 
structure, and also in the omentum. The deposition of fat in 
these cases is an instance of fatty degeneration, rather than of 
strong robust health. How rapidly do such subjects succumb 
to acute diseases; especially to those where the blood is 
poisoned by the taint of typhus, small pox, and erysipelas. 
The London publicans, draymen and others, may be large and 
to a great extent — depending, however, on the amount of 
physical exertion they undergo— powerful men ; but they are 
not types of health. 

" Food," liebig remarks in his Letters on Animal Chemistry 
(p. 479, 4th ed.,) ''should exert neither a chemical or peculiar 
action over the healthy frame." Judged by this standard 
alcohol certainly^ is not food. There is no evidence to show 
that it is a supporter of animal heat ; there is none to prove 
that it nourishes the nervous system ; and though some alco- 
holic fluids, by virtue probably of their other contents, do tend 
to an unhealthy accumulation of fat in some parts of the body^ 
there is no reason for attributing to alcohol itself the power of 
adding, by the production of fat, to the nutrition of the tissues. 

By virtue of its power to destroy life alcohol may be justly 
regarded as a poison, and as, in the language of Dr. Taylor, 
'' medicine in a large dose is a poison, and a poison in a small 
dose a medicine ; " it must for all practical purposes be treated 



Therapeutic Effects of Alcohol. 307 

as a medicine. It is an agent capable of producing certain 
morbid conditions, a medicine remedial of disease, and not in 
any way a substance competent to afford pabulum for tlie 
growth of animal tissues. In short, while it fulfils all the re- 
quirements of a medicine of great value, it presents no chara- 
teristic of a food. 

From its primary stimulating action on the circulation, and 
its secondary depressing influence on the nervous system, it 
holds a place in the current Materia Medica as a stimulant- 
narcotic ; and, in accordance with the conditions supposed to 
indicate the necessity for such a dnig, it has generally been 
prescribed. 

More definite explanations of its modus operandi have been 
attempted. Two theories have been made especially prominent ; 
these I will briefly describe. 

Dr. Chambers, Dr. Hammond^ Dr. Ludlam, and others regard 
alcohol as an arrester of metamorphosis. That an arrest of 
the normal waste of tissue takes place in health is, however, 
rendered very improbable by the experiments of Dr. Smith, as 
well as by those other consequences of using alcohol I have 
already detailed. Dr. Chambers draws his conclusions from 
very slight, and for all practical purposes useless, experiments 
of his own, and from a more careful series of observations by 
Dr. Hammond, of the Federal Army, in the American States. 
In all these experiments the supposed arrest of destructive 
metamorphosis was, within a brief period, followed by critical 
evacuations. A result which proves that the changes assumed 
to have been checked, in reality occurred ; but that the debris, 
instead of being cast out of the system in the several excre- 
tions, was retained within the circulation for a time to be cast 
forth when reaction set in. As all the investigations of Dr. 
Chambers were brought to a summary conclusion, when the 
appetite was spoiled, or the usual diet was prevented being 
taken with pleasure, we cannot from them show that these 
changee, besides occurring, were in reality increased ; but the 

20* 



308 OhservoUions on the Physiological and 

observations of others lead us to infer that they were sa 
Healthy metamorphosis requires for its complete performance a 
healthy blood blastema, a healthy state of the nervous system, 
and a normal development of nervous power. These condi- 
tions are absent in a man whose blood is charged with al- 
cohoL Healthy metamorphosis is, therefore, impossible; and 
all lengthened experiments tend to show that the unhealthy 
metamorphosis induced takes the form of an excessive, not of a 
diminished, waste. 

Dr. Beale, (British Medical Journal, October 10th, 1863)* 
holds that " alcohol does not act as a food ; does not nourish 
tissue," as his late distinguished colleague Dr. Todd maintained 
that it did, but that by " altering the consistence and chemical 
properties of fluids and solids," it checks that " increased ac- 
tivity of the vital changes " which he regards as characteristic 
of many morbid processes. Such being those which take place 
in exhausting diseases, where, as in the formation of pus, cancer 
and the granular cells, a large amoimt of pabulum intended for 
the nourishment of healthy tissue is rapidly wasted. There is, 
it will be seen, comparatively little difference between the 
views of Dr. Chambers, and those of Dr. Beale. The latter 
generalises from the effects which he has seen to follow the 
prescription of alcohol in disease; entirely ignoring its action on 
the healthy man. Such a mode of determining the nature of 
drug action must always be unsatisfactory, and very generally 
unsound in its conclusions. 

In health alcohol produces as its specific effect an abnormal 
waste of nervous tissue ; the expenditure of nervous power is 
greater than normal metamorphosis can meet. This, I think, 
the observations and experiments I have laid before you this 
evening fully sustain. Further, all clinical experience teaches 
that the sphere of alcohol in disease is to be found where 
nervous exhaustion, undue waste, or expenditure of nervous 
power are the prominent indications of danger. To such 
morbid states alcohol is therefore manifestly Homoeopathic. 



Therapeutic Effects of Alcohol. 309 

Its mode of action is simply that of all tme, direct, specific 
remedial agents. Nor has this similarity between the symptoms 
arising horn alcohol used in health, with those for the cure of 
which it is so generally prescribed, been altogether overlooked. 
Curiously enough it is in the writings of Dr. Brinton — a 
gentleman who seldom fails to seize an opportunity of sneering 
at Homoeopathy — that we find the Homoeopathicity of the 
action of alcohol most clearly asserted! Discoursing on al* 
coholics in his work on Diseases of the Stomach (p. 378), Dr. 
Brinton remarks, *' in short they are sometimes useftd remedies 
against the very ailments which their abuse (or even their 
moderate use) can otherwise bring about; a statement which," 
and mark the words, ''while it involves no inherent improba- 
hility rests upon an empirical basis such as defies disproof." 

Regarded, then, in what I have endeavoured to prove its 
true light— as a medicine — ^to be used on the same principle 
as all others should be — as a Homoeopathic remedy — we shall 
find the sphere of alcohol in those cases, or rather parts of cases, 
where the indications of danger arise from exhaustion pro- 
ceeding ficom an overstraining of the powers of the nervous 
system. An ordinary fainting fit is a fair type of such. A 
sudden shock or prolonged drain upon this portion of the or- 
ganism gives rise to rapid and extreme waste of nervous force, 
with quickened but depressed circulation. In softening of the 
brain similar special waste is going on ; upon it likewise de- 
pends the exhaustion horn protracted lactation, from long con- 
tinued diarrhoea, ficom hemorrhage, as weU as that witnessed in 
the later stages of fever, where the heart's feeble impulse, and 
the low muttering delirum, with it may be profuse perspirations, 
point to the nervous centres as rapidly giving way. In each 
of these instances, many other might be quoted, alcohol is in- 
dicated as the most probably curative remedy, because it pro- 
duces a condition similar to that to be removed. Let me not, 
however, be misunderstood; I do not say that alcohol is 
Homoeopathic to diarrhoea, and the other diseases named, but 



310 Obaervatioiu on the Physiological and 

that it is so to the consequence of their recent existence — ^to 
the exhaustion they produce. 

Further, it is remedial, so far as a drug can be remedial, to 
that exhaustion which foUo-ws unusual mental or physical 
exertion. It will not, if taken prior to any great effort being 
made, prevent the resulting fatigue ; on the contrary, it will 
tend rather to increase it ; but the labour having been under- 
gone alcohol will, by virtue of its Homoeopathic relationship to 
excessive expenditure of nervous force, remove it more rapidly 
than rest and food alone will do. A man cannot be primed 
for work by brandy, but he may be freed in a very great degree 
from its cost to himself by subsequently taking it. 

DISCUSSION. 

Mr. Cameron, after complimenting the author on the excel- 
lency of his paper, which he considered one of the best that had 
ever been presented to the Society said : — In studying the phy- 
siological and therapeutical phenomena of alcohol, two questions 
prominently demand our attention. 1st. Is alcohol an aliment or 
not ? In other words, is it decomposed in the system, or simply 
absorbed unchanged? 2ndly. Is alcohol a stimulant or an 
anaesthetic ? Early in this century, it was proved by direct ex- 
periment, that alcohol was capable of causing intoxication when 
introduced into the veins or serous sacs of an animal, but Brodit3 
and others soon afterwards ascertained that, although intoxica- 
tion could be produced in this way, the full poisonous eflPects of 
alcohol — the shock to the nervous system which causes death, 
could only be obtained when it was taken into the stomach. 
Hence, they concluded that its full effects were to be referred to 
its action on the extremities of the nerves in its unaltered form. 
At this time all vital actions were explained on chemical prin- 
ciples, and it was therefore asserted that because spirits of wine 
coagulated albumen, it was impossible that alcohol could be ab- 
sorbed into the blood in its original form ; but notwithstanding 
these a Tpriori dicta, Dr. Ogston detected alcohol by its smell in 
the ventricles of the brain, and Dr. Percy soon afterwards found 
it, by the same evidence, in the substance of the brain, and made 
the discovery, afterwards so important, but whose value was not 
then appreciated, that a kind of afiinity existed between alcohol 
and cerebral matter. These gentlemen relied on their sense of 
smell alone in their researches ; but other investigators followed. 



Therapeutic Effects of Alcohol 311 

who discovered pure alcohol in the fluids of animals by chemical 
agents. The authority, however, of Tiedmann, Gmelin, and 
Bouchardat, and others, and more lately that of liebig, who be- 
lieved that alcohol was decomposed in the system for the purpose 
of maintaining animal heat, was arrayed against those who sup- 
ported the views of Percy and Ogston. Duchek, one of Liebig's 
pupils, actually described the several changes undergone by al- 
cohol in its stages towards combustion, becoming Aldehyde, 
then Acetous Acid — ^then Acetic Acid — then Oxalic Acid, and 
finally Carbonic Acid. This brought on the famous controversy 
between Duchek and Masing, in which the latter set aside the 
validity of the experiments of the former, and proved the pre- 
sence of alcohol in the bodies of dogs killed by it, by the effects 
of a stream of air passed over them into a solution of Bichromate 
of Potash and Siiphuric Acid, which is turned into an emerald 
green by the action of alcohoL The French chemists Lalleman, 
Perrin, and Duroy taking up these experiments of Masing, have 
tested the smallest proportions of alcohol in the breath, urine, 
&c., &c., in its unaltered form. In this way proofs of the ex- 
halation of alcohol have been readily obtained by enclosing the 
arm of a man who had drank only one glassful of brandy. In 
short, there can be no doubt, even if we were disposed to dispute 
the evidence of our senses of smell and taste, that the absorp- 
tion of pure unchanged alcohol into the blood is clearly esta- 
blished by chemical tests. This fact, then, answers in the 
negative the first question — Is alcohol an aliment, by proving 
that it passes out of the system, imchanged and undecomposed. 
Is alcohol a stimulant or anaesthetic ? A stimulant is a substance 
which drives on the actions of the nervous system at an in- 
creased speed. Powerful as all the effects of alcohol are, it is very 
doubtful whether it ever acts upon the system in this way. On 
the contrary, its modus operaridi seems to be anaesthetic, as the 
experiments of Dr. Edward Smith prove. He found the primary 
effects of brandy to be "lessened consciousness and lessened 
sensibility to light, sound and touch ; then stiffness, with feel- 
ing of swelling of the skin, particularly of the face, relaxation of 
the dartos and other muscles of the reproductive system, and of 
the sphincter of the bladder, causing that constant micturition 
which those under the influence of alcohol exhibit. The quantity 
of carbonic acid from the lungs, and of urea and sulphates from 
the urine is diminished. The apparent surexcitation of the 
mental faculties and energies which follow the use of alcohol 
could easily be shown to illustrate its anaesthetic nature. It has 
been proved that the addition of a little alcohol to the usual diet 
of a man who previously took none, increased the weight of his 



!412 Observations on the Physiological and 

body half a pound in five days. The use of a similar quantity of 
alcohol with such a diminution of the food as had previously been 
ascoii^ained to be capable of reducing the weight at the rate of a 
(piarter of a pound daily, was found sufficient, not only to arrest 
this diminution, but to add slightly to the weight This is the 
true use of alcohol. It is an anaesthetic — it diminishes the 
metamor])hosis of the tissues — ^it arrests waste. We can thus 
explain the beneficial results of alcohol in continued and other 
low fevers. It docs good, not by directly stimulating and 
i*ousing the vitality and dormant actions of the body, but by ar- 
resting waste, and thus conserving the powers of life until such 
time as the patient can digest and assimilate proper nourishment 
1 cannot conclude without directing the attention of the society 
to the unconscious testimony borne to the Homoeopathic principle 
by T)t. Marcet and the other physicians who have followed him 
in prescribing Oxide of Zinc in Delirium Tremens. This 
medicine causes in the healthy subject, nausea, giddiness, black 
specks before the eyes, rumbling noises in the head, faintings, 
tremblings, &c. These are leading symptoms of Delirium 
Tremens, and for their cure this medicine, in very small doses, is 
now regarded as a specific by our Allopathic brethren. 

Mr. F. H. Smith thought the paper a very able and in- 
teresting one, the only defect was that the therapeutic bear- 
ings of the subject were too slightly passed over. The facts 
and arguments contained in the paper confirmed an opinion he 
had long entertained, that medical men were much to blame, 
inasmuch as for the most part they rather encouraged than 
discouraged the drinking habits of the community. The writer 
of the paper had adduced evidence that the habitual use of 
alcohol lowers the vital powers, induces a carbonized condition 
of the blood, and renders travellers less able to bear fatigue and 
vicissitudes of temperature ; facts which his (Mr. Smith's) ob- 
servations and personal experience enabled him readily to under- 
stand. He did not habitually use alcoholic beverages, and when 
occasionally he took a small quantity, the Gist effect he found 
to be stimulating, the second depressing. He did not, however, 
agi*ee with one of the previous speakers in considering alcohol 
a direct sedative. He thought it bore an analogy rather to 
opium than to hydrocyanic acid in its symptoms. The primary 
effect of a small dose of opium — say a quarter of a grain — ^was 
evidently stimulating ; but when two or three grains were taken 
the secondary or sedative effect was induced so rapidly that the 
primary or stimulating effect was scarcely observable — ^thus 
bearing a close analogy to the .symptoms produced by a large 
dose of alcohol. He believed from many years' observation that 



Therapeutic Effects of A Icohd, 813 

the habitual use of alcoholic drinks was geneially unnecessary, 
and that a proclivity was thereby induced to various forms of 
disease. 

Dr. Drury felt much indebted to Mr. Pope for the interesting 
and instractive paper that had just been read. The difficulty of 
deciding on the primary action of alcohol was very great ; his 
own opinion was that the quantity taken decided the point ; 
a small quantity stimulating, a Is^ei quantity, at first de- 
pressing, afterwards exciting; a very large or poisonous dose 
causing very great depression. It was a valuable remedy, as it 
checked waste of the tissues, increased the animal heat, and in 
cases of exhaustion or syncope, roused vitality by its stimulating 
action. The quantity borne depended on the state of the 
patient Thus, in a case of uterine hoemorrhage, he had given 
a pint of brandy in the space of about two hours, te a lady who 
at other times could not teuch it. Humanly speaking, there 
was no doubt she owed her life to this remedy. In fatty disease 
of the heart small quantities of spirits with water suited better 
than other stimulants. In some forms of dyspepsia a little 
weak brandy and water could often be taken when ale or wine 
disagreed. Though advocating the moderate use of stimulants, 
it would be wrong to avoid expressing a very strong condemna- 
tion of the enormous quantity of ale or beer some men took ; 
it was wasteful and hurtfuL One could not fail being astonished 
at the great quantity some workmen took ; even gentlemen who 
dined in the City, as a rule, felt it necessary to ask for a pint, 
though often half that quantity might be quite sufficient ; the 
accustoming the stomach to take more than it required could not 
but be injurious. Moderation was good in all things, but in 
few more so than in this. Mr. Smith points out the difference 
between the primary and secondary action of opium, which Mr. 
Cameron has rather overlooked. In giving alcohol in illness 
it was of consequence to know when to give it Thus in the 
deliriimi of fever, when some might dread excitement, Dr. 
Stokes, of Dublin, chose that very sjmptom as his indication 
for giving stimulants. Where such a rule as this, founded on 
experience, is laid down, it is a very valuable help. Though 
the amount given must stUl be regulated by the experience 
of the practitioner, and the effect in each case. 

Dr. EusSELL said, — He entirely concurred in the high terms 
of appreciation used by Mr. Cfimeron, whose knowledge of the 
subject made his opinion of great value, in reference to the learn- 
ing and talent displayed by Mr. Pope in the essay they had just 
h^uxL At the same time, he was not altogether convinced that 
the views expressed by Mr. Pope and endorsed by Mr. Cameron, 



314 Observations on the Physiological and 

were quite correct. It seemed to him (Dr. Eussell) that the 
question should be looked at from two distinct points of view, 
first, as one of diet, and then as one of therapeutics. In regard 
to the former, he would prefer deriving general conclusions from 
the immense field of observation which lay open to them in 
history, rather than from the deductions of modem chemists. 
The use of alcohol in some form or other, was coeval with the 
earliest records of the human race. It seemed to him somewhat 
parodoxical to maintain that an article of diet on which mankind 
had thriven for many thousand years, was a poison. Surely such 
a term was misapplied ! surely there must be some fallacy in the 
chemist's view of the question ! He conceived that there was 
this fallacy. The chemist dealt with dead matter, not with 
living ; man to the eye of the chemist was a compound of oxy- 
gen, nitrogen, carbon, phosphorus, sulphur, &c. ; but man to the eye 
of a common observer was something far different ; he was living 
spirit incorporated into a living body, each acting and re-acting 
on the other. Now it may be true that the wine we drink does 
not, as the chemists tell us, form any portion of any tissue of our 
bodies ; nevertheless, it may materially affect the formation of all 
the tissues by exhilarating what in old phraseology were called 
the animal spirits, and inducing what might be called a happier 
nutrition. How different is a meal eaten in silence and sadness, 
to the same meal enjoyed in pleasant society. The judicious and 
moderate use of stimulants may propitiate the digestive powers 
by stimulating them to the proper pitch, and may thus, although 
not themselves nutriments, enable more nutrition to take place. 
At all events, this is a question which must be decided by ob- 
serving the effects of such substances on living men, and can 
never be settled by distilling dead dogs. In regard to the use of 
wine, beer, and spirits medicinally, there is perhaps no greater 
test of the practical tact of a physician, than his management of 
these confessedly dangerous weapons. We have all seen and 
heard of many illustrations of the danger of medical practitioners 
being led away by a crotchet, and either insisting upon total 
abstinence even from food, much more from stimulants, and on 
the other hand, of others following the opposite plan, and stimu- 
lating immensely in all cases. Both extremes are equally 
dangerous. The surest indications for the use of stimulants were 
derived from the state of the pulse. The pulse was not made 
the subject of such refined study as it used to be ; it required a 
highly educated finger to read the pulse aright. We owe much 
to Drs. Stokes and Graves, for their valuable instructions in 
regard to the use of wine in fever, as well as to Dr. Alison and 
others. What they insist on is, that we should ascertain the 



Therapeutic Ejffects of Alcohol. 315 

condition of the heart. It was stiggested by Mr. BL Smith that 
the use of alcoholic liquors induced fatty heart. This may be so 
in some instances, in others, however, the judicious use of stimu- 
lants seems to arrest the progress of this disease, when it arises 
firom insufficient innervation. Besides being guided by the state 
of the pulse, we must narrowly observe the condition of the 
brain. We are apt to be deceived in the symptoms of this organ, 
and to set down to a state of over-action phenomena due to a 
condition of want of nutrition. The delirium of a person in a 
state of starvation resembles that of one intoxicated. In the 
management of incipient puerperal mania, which used to be con- 
sidered as an inflammatory condition requiring depletion and 
abstinence, the modem practice enjoined by Dr. Simpson is free 
stimulation and feeding, — ^and so it is in many other affections. 

Mr. Teldham said, — ^Few subjects associated with medicine 
were of more importance than that which Mr. Pope had brought 
under the notice of the Society in his interesting and able paper. 
In spite, however, of Mr. Pope's arguments, he preferred Leibig's 
explanation of the action of alcohol to emy other he had met 
with. That explanation was, to his mind, thoroughly consistent 
with all the known phenomena of alcohol, both in health and 
disease. It was, in brief, a decoyer of oxygen into the system. 
The affinity between oxygen on the one hand, and carbon and 
hydrogen on the other, was the great motive power in respira- 
tion ; and in alcohol we had a hydro-carbon in the fittest con- 
dition for instantaneous absorption into the circulation. This 
rapid absorption explained some phenomena of its action, which 
else were unaccountable. For, observe, whilst other carbonaceous 
substances — ^fat, oU, &c., had a tissue — ^the adipose— devoted to 
their reception, where, as in a store-house, they were deposited 
untU required for combustion, alcohol had no such depository, 
but was carried directly into the circulation. What followed ? 
This, — ^when it was taken rapidly, and in a large quantity, it 
produced the phenomena of drunkenness. It was poured into 
the system faster than the lungs could bum it ; part of it was 
consumed ; part passed off in the breath unconsumed, imparting 
to it its own odour; whilst another part, circulating in the 
blood unchanged, induced on the biain the symptoms of poisoning 
by carbon. Now, change the conditions; let a man imbibe 
alcohol in equal quantity, but gradually , and he would sit over 
his bottle for hours and hours, without exhibiting any of the 
foregoing symptoms, for the simple reason that he took no more 
alcohol, and no faster, than his system could consume as it was 
taken. The two-bottle man was not, after all, so great a wonder 
as was sometimes supposed ; he did not walk away with all that 
wine under his skin ; he, in fact, carried away but very little — 



316 Observations on the Physiological and 

he had consumed it as he drank it. Again, cold and pure air, 
which contains a large quantity of oxygen, carried off, so to 
speak, the effects of alcohol on the system. Hence, coachmen, 
and cabdrivers, and sailors could take with impunity quantities 
of alcohol, which could not be borne by persons confined in close 
rooms. Apply these considerations to the treatment of ex- 
hausting disease — hoemorrhage, and fevers — and the same prin- 
ciples held good. In both these cases they had loss of power — 
in the one from the loss of vital fluid, in the other from the ces- 
sation of nutrition ; and, in both, beyond the use of medicines, 
the principles of cure were embraced in fresh air, nutrition, and 
alcohol — i. e,, carbon internally in the most convertable form ; 
oxygen externally to combine with it ; and light food to sustain 
the vital powers whilst disease ran its course, and imtil more 
suitable food could be taken and digested. One word as to the 
period of the day when alcohol could be taken with greatest ad- 
vantage. Clearly, as a rule, it should not be taken in the fore 
part of the day. The system was then in the enjoyment of the 
nerve-power generated during rest and sleep, and did not reqtdre 
the stimulation of alcohoL It was then mere surplusage, which 
embarrassed the system. But, later in the day, after the wear 
and tear of the working hours, substantial food was demanded, 
and alcohol would often be indulged in with imj)unity and ad- 
vantage. Unless in exceptional cases, he, Mr. Yeldham, was 
satisfied, from reasoning and observation, that the custom which 
now prevailed with many medical men of ordering alcoholic 
drinks for all hours of the day — for breakfast and luncheon as 
well as dinner — ^was xmscientific and prejudicial It was rarely 
that alcohol, even in healthy persons, could be borne with comfort 
on an empty stomach, or before dinner. These remarks, of 
course, did not apply to fevers and other exhausting diseases, in 
which the administration of alcohol must be determined, both 
as to time and quantity, by the condition of the patient. But, 
even here, its good effects were best displayed when it was given 
in small quantities, rather frequently repeated, and mixed with 
light food : beef tea, chicken broth, arrowroot, and the lika In 
conclusion, Mr. Yeldham thanked Mr. Pope for his excellent 
paper, and for the trouble he had taken in travelling from York 
to read it Such acts of co-operation from their provincial 
brethren were particularly grateful to, and were much valued by, 
the metropolitan members of the Society. 

Mr. Pope said : — I do not purpose, gentlemen, occuping your 
time with any lengthened remarks on the discussion which has 
taken place, but I must tender you my thanks for the flattering 
manner in which you have received the paper I have had the 
honour of reading. Mr. Cameron remarked that Alcohol was 



Therapeutic Effects of Alcohol. 317 

not a real Btiinulant, but a depressor of vital action. This I hold 
to be true of its action in health. In the healthy man^ as I 
have endeavoured to show, it produces general depression, and 
especially is this result observed in the nervous system. But on 
the other hand, by virtue of this action, emd in strict harmony 
with the homoeopathic law, it specifically removes nervous depres- 
sion when existing as a morbid product Because, then, in- 
creased vitality follows its specific action, it may be regarded as 
a stimulant, while in health it is far from being so. Again, it is 
an arrester of metamorphosis only when in disease metamor- 
phosis is proceeding too rapidly, is in reality waste of tissua It 
here restores normal metamorphosis by checking that which is 
abnormal and excessive, the very condition to which it gives rise 
in health. Mr. Harmar Smith aUuded to the responsibility en- 
tailed in prescribing Alcohol in disease. My impression is, that 
our responsibility as practitioners of Medicine consists in our 
ordering such medicines, and such medicines only, as are needful 
for restoration to health ; whatever is needed for this purpose 
must be given, without any regard to the future self-control of 
our patients. If alcohol is needed for the promotion of their 
recovery we ai*e bound to prescribe it, whether when beyond our 
control they will continue to indulge in a palatable but dan- 
gerous drug, though highly valuable remedy, or whether they 
will refrain from it. That is no business of ours. With refer- 
ence to the case mentioned by Dr. Drury, I would observe, that 
in Dr. Smith's experiments the heart's action was found to be 
increased during the first thirty or forty minutes after alcohol 
had been taken, and it may be, that by the frequent and free 
repetition of brandy, this increased action may be kept up for 
some considerable time. Dr. Eussell argued that custom not 
only sanctions the use of alcohol, but proves that it is advan- 
tageous as an article of diet. That because people have in aU 
generations taken more or less alcohol, they must have thriven 
upon it. I confess I cannot see the force of the inferenca As 
well might it be said that arsenic is a food, is productive of 
superior vitality, because the Styrian peasantry have long accus- 
tomed themselves to eating it. Doubtless habit enables a man 
to do with less harm to himself that which, but for the habit, 
would be highly injurious to him. But it by no means follows 
that the habit of taking a drug at regular intervals, which, used 
only occasionally, would be productive of disease, is a desirable 
or health promoting habit, neither can we conclude that it is an 
entirely innocuous one. A substance may be, and is, a poison, 
without tinder all circumstances inducing its poisonous effects. 
Instead of arguing that alcoholic fluids have been constantly 
taken because of their health inspiring properties, it a^^^^^s^ \i^ 



318 Case of Oangrena Senilis, 

me that the secret of their general use is to be found in their 
palatable nature. Good old port, sound beer, brandy punch, &c., 
are all agreeable to the taste, and therefore are freely indulged 
in. When heavy labour, physical or intellectual, has been under- 
gone for some time, and the strength to continue it as long as 
may be required is failing, a dose of brandy may, by its homoeo- 
pathic relationship to the induced waste, check it, and so allow 
of the completion of the work. This power is alluded to 
by one of the Arctic travellers [Mr. Cameron — ^Dr. Hooker.] 
But on the other hand, it cannot produce power anticipatory of 
waste. Mr. Yeldham remarked that alcohol was not specially 
deposited in any organ. It is not so in a decomposed state 
certainly, but in its integrity it finds a nidus in the brain to a 
very considerable extent. It is, it is true exhaled, but not as so 
much carbon and hydrogen ; it passes off from the lungs as it 
entered the stomach, as alcohol. The impunity with which 
more or less alcohol is taken is in proportion to the individual 
power of evolving it The workers in the Staffordshire iron 
founderies, who are constantly in a state of profuse perspiration, 
measure their allowance of beer by the gallon, not the pint. In 
conclusion, I may remark that while much difference of opinion 
evidently prevails as to the modus operaridi of alcohol, we all 
seem to agree as to the class of cases in which it is needed, viz., 
those in which danger arises from nervous prostration. This 
state I believe alcohol produces in health ; to it therefore it is 
Homoeopathic when arising in the ordinary course of diseasa I 
again thank you for the reception you have have accorded to my 
paper, and at the same time take this opportunity of expressing 
the pleasure I have felt in being present here this evening. 



CASE OF GAITGEENA SENILIS. 

The last illness of Archbishop Whateley. 

The public and unconpromising testimony borne by my late 
much lamented patient to the truth of our medical creed, ren- 
ders it imnecessary to apologise for bringing before the Society 
a short notice of the last illness of Archbishop Whateley. One 
of his Grace's most remarkable characteristics was an honest love 
of truth. This in a mind of unbounded capacity, gave rise to a 
strong impulse to investigate every new discovery that came 



Case of Oangrena Senilis. 319 

before him fairly supported. Having rigidly tested it, and 
being once convinced that a subject was based upon truth, he 
became its firm and unflinching advocate. He told me that 
his final decision in favour of Homoeopathy was due to the 
case of a favourite dog, which had been unsuccessfully treated 
for many months by veterinary surgeons, and was cured by Dr. 
Karl Sutton in a fortnight. 

The following memorandum was written about fourteen 
years ago, and speaks for itself. It is copied verbatim from 
the original in his Grace's hand writing, but unfortunately 
bears no date. — " Memorandum : — 

" In case of my being seized with any disorder that de- 
" prives me of speech or reason, my earnest desire is, that none 
" of the ordinary, as they are called. Allopathic practitioners, 
" may be called in ; but that Homoeopathy may be resorted to, 
" if any one can be found to prescribe, and if not, I may be 
" left to nature. And in case of my death, this memorandum 
" may be produced as a vindication of my attendants." 

The following correspondence between a celebrated Allo- 
pathic physician and his Grace, although^ perhaps, known to 
the members of this Society, is of sufficient interest to deserve 
being recorded hera 

''London, 13th June, 1862. 

" My Lord Archbishop, 

" We are informed that the Eoyal College of Surgeons in 
Ireland ordained last August that * no fellow or licentiate of 

* the Eoyal College shall pretend or profess to cure diseases 

* by the deception called Homoeopathy or the practice called 

* Mesmerism, or by any other form of quackery.' * It is also 
hereby ordained that no fellow or licentiate of the College shall 
consult with, meet, advise, direct or assist any person engaged 
in such deceptions or practices, or in any system or practice 
considered derogatory or dishonorable by physicians or sur- 
geons.* Is your Grace aware of this ? 

" I have the honor to remain, 

" Tour very faithful servant, 



320 Case of Oangrena Senilis, 

" My Dear Sir, 

" I was well aware of the detestable act of tyranny you 
refer to. I believe some persons were overawed into taking 
part in it against their own judgment. I have always pro- 
tested against such conduct in all departments of life. You 
may see something to the purpose in my little penny tract on 
'Trades Unions' (to be had at Parker's). In fact, the present 
is one of the Trades Unions. A man has a right to refuse to 
work, except for such wages or under such conditions as he 
himself choose to prescribe, but he has no right to compel 
others to concur with him. If there is any mode of medical 
treatment which he disapproves of, or any system of education 
which he thinks objectionable, he will be likely to keep clear 
of it of his own accord, without any need of compulsion or 
pledges. Those, again, who may think differently, ought not 
to be coerced or bullied. Some persons seem to have a notion 
that there is some connection between persecution and religion, 
but the truth is, it belongs tg human nature. In all depart- 
ments of life you may meet with narrow-minded bigotry, and 
uncharitable party spirit. Long before the outbreak of the 
Eeformation the Nominalists and the Eealists of the logical 
school persecuted each other unmercifully — so have Eoyalists 
and Eepublicans done in many other countries ; and in our 
own country the Trades Unions persecute any one who does 
not submit to their regulations. In Ireland, if any one takes 
a farm in contravention to the rules of the agrarian conspi- 
rators, he is waylaid and murdered ; and if he embraces the 
Protestant faith, his neighbours aU conspire to have no dealings 
with him. The truth is, the majority of mankind have no 
real love of liberty, except that they are glad to have it them- 
selves, and to keep it all to themselves, but they have neither 
spirit enough to stand up firmly for their own rights, nor suf- 
ficient sense of justice to respect the rights of others. They 
will submit to the domineering of a majority of their own 
party, and will join with them in domineering over others. 
In the midst of the disgust and shame which one must feel 
at such proceedings as you have alluded to, it is some conso- 
lation to the advocates of the systems denounced, to see that 
there is something of a testimony borne to them by their ad- 



Case of Oangrena Senilis, 321 

versaries, who dare not trust the cause to the decision of reason 
and experience, but resort to such expedients as might as ably 
be employed for a bad cause as a good one. 

Signed, "R Dublin;' 

In connexion with the above, I may submit to the Society 
the following correspondence : — 

"The Palace^ 2Uh Feb,, 1862, 
"Deae Db. Scriven, 

" The Archbishop's male friends are all very anxious that 
he should allow either Dr. A — , Dr. B — , or Dr. H — to see 
his leg. He thinks it rather worse, but I should hope that is 
only fancy. However, he wishes to satisfy his friends, and 
Miss Whately told him that you had not the least objection to 
his seeing a surgeon, and he has therefore asked me to beg 
you to fix upon which ever you like of these three, and appoint 
an hour to-morrow to meet him here. The Archbishop begs 
me to add, that he has not the least fault to find with your 
treatment of the case. Miss Whately is dining out to-day, 
which is the reason that I am writing. The Archbishop told 
me that I might write in his name in the third person, but I 
thought that I could better explain myself in the first. 

" Believe me, 

** Tours most sincerely, 
«A. S." 

To this I replied that I should be most happy that a surgeon 
should see his Grace, and named Dr. A — , but added, that I 
feared no Dublin surgeon would meet me in consultation. 

" The Palace, Monday Night 
"Dbae Db. Scriven, 

" Many thanks for your kind note, but his Grace cannot 
call in a surgeon. Ycm must do it, or it cannot be done at all. 
He can have no one who will not meet you. If Mr. A. will 
do so, very well ; and his Grace begs me to say that you can 
name any hour to-morrow for your meeting here, only let him 
know beforehand. As I said before, his Grace is perfectly 

21 



322 Ca$e of Oangrena Senilis. - 

satisfied with your treatment, but to please some of his friends 
he will see a surgeon with you — not otherwise. 

" Very sincerely yours, 

"A. S." 

On receipt of the foregoing, I wrote to Dr. A. as follows : — 

"Dr. Scriven presents his compliments to Dr. A., and 
begs to say that he is in attendance on the Archbishop of 
Dublin, who is suffering from a small ulcer on the outer ankle. 
His Grace having been urged by some of his friends to obtain 
the opinion of an eminent surgeon, Dr. Scriven has named 
Dr. A., and would be glad to know at what hour to-morrow it 
would be his convenience to call on his Grace. Enclosed is 
a note which Dr. Scriven has just received from a relative of 
the Archbishop's, at present at the Palace, by which Dr. A will 
perceive that his Grace wishes to continue Homoeopathic treat- 
ment, so far as his general health may require it. 

" 2^th Feb, 1862. " Monday NigUr 

25th Feb., 1862. 
"Mr. A. presents his compliments to Dr. Scriven, and 
reply to his note just received, begs to say, that as his Grace 
the Archbishop of Dublin has decided that he will have no 
surgeon to visit him who will not meet Dr. Scriven in consul- 
tation, Mr. A. regrets that he cannot have the honour of pre- 
scribing for his Grace under circumstances which would be a 
direct violation of a recent "ordinance" of the College of 
Surgeons in Ireland, of which Dr. Scriven is aware." 

" Palace, Tuesday Morning. 
" Deab Db. Scriven, 

" His Grace is so opposed to tyranny in any shape, that 
things must go on as they are, and I have no doubt that it is 
all for the best. 

" Yours sincerely, 

"A. S." 

He was one of the Vice-Presidents of the London Homoeo- 
pathic Hospital, and a liberal contributor to its fimds, as well 
as to those of the Dublin Dispensary. His knowledge of botany 
and natural history was most extensive ; he was also largely 



Case of Gangrena Senilis. 323 

acquainted with the uses of herbs as domestic remedies in 
different countries. This is not the place to recount his Grace's 
literary labours, which are in the possession of the public. 
Without further preface, I shall proceed to give a brief history 
of the illness which removed from his sphere of usefulness this 
truly great and good man at the age of 76. 

On the 2nd July 1863, his Grace the late Archbishop of 
Dublin, sought my advice for a small blackish-looking spot, 
about the size of a fourpenny piece, on the tendo achillis, two 
inches above the os calcis, and more than half an inch above where 
the upper edge of the shoe pressed. It had existed for a fort- 
night before I saw it, and had been poulticed with white lily 
root. There was no appearance Of redness or inflammation 
around it, nor was there any oedema of the foot at this time. 
No mechanical injury of any kind had occurred to which it could 
be attributed ; the pain was described as of a burning kind, 
and at times stabbing " as if a red-hot gimlet were run into it.** 
It may be well to state here, that his Grace had suffered during 
the previous seven years from a paralytic affection, principally 
of the left side, by which the left leg was much enfeebled. 
There was also paralysis agitans of both hands. This infirmity 
had come on gradually without any apparent cause, and slowly 
and steadily increased, interfering very much with the power of 
locomotion, and preventing his taking the amount of exercise 
requisite for health, and to which he had always been accus- 
tomed. Against this his Grace struggled manfully, and persisted 
in taking a daily walk before breakfast and lunch. Of late 
his appetite had not been good, but he partook of animal food 
three times a day, and took a rather large amount of wine and 
other stimulants, including brandy, strong coffee, and snuff. In 
the winter of 1861, I had treated a small but most painfully 
irritable idcer situated below the outer ankle of the other or 
left foot. It yielded to homoeopathic treatment, combined with 
the use of the Turkish bath, which his Grace found most in- 
vigorating and agreeable, and which he continued to t^V^ ^iXiWiis. 

2\* 



324 Com of Oangrena Senilis. 

once every week or ten days, until confined to his country 
residence by the attack now under consideration. 

For the symptoms above detailed, Arsenicum 6 was the 
medicine first prescribed, and cold water dressing to the sore, 
with hot fomentations night and morning. Arsenicum was 
continued for a week without any alleviation, and Arnica 3 was 
given with Arnica lotion locally. No improvement resulted, 
and Secale Cor. 3 was ordered, with a similar result. The 
brownish dry patch spread very gradually, creeping downwards 
and forwards in the direction of the outer ankle. The foot 
became cedomatous, and some swelling appeared in the leg. 
Lachesis was next given, and a poultice of linseed meal and 
barm applied thrice a day, the foot and leg being bathed in hot 
water, when the poultice was removed, and well rubbed and mes- 
merised night and morning. The mesmerism appeared to have 
a temporary effect in soothing pain. By the first week in 
August the sore had extended in the direction of the external 
malleolus, and formed a junction with a similar brown patch 
which made its appearance on the cicatrix of an old ulcer long 
since healed, directly under the ankle. The deeper structures 
were beginning to suffer from the destructive process, and the 
surface of the tendo achillis became exposed, assuming a dirty 
brownish appearance ; there was little or no discharge. There 
being considerable foetor which distressed the patient, a layer of 
very finely powdered peat charcoal was spread on the poultice, 
and Carb. Veg. was given internally. No benefit resulting 
from this change, the poultice was discontinued, and several 
folds of lint moistened with Hydrastis lotion and covered with 
oiled silk was applied, while Hydrastis 3 was given internally. 
The oedema and pain increasing; this was after some days 
abandoned, the poultice resumed, and as there was much redness 
and swelling. Belladonna was given. The redness subsided, but 
the swelling continued, and the destructive process extended 
up the leg to the extent of four or five inches above the os 
calcis and below the outer ankle, while it implicated the whole 



Case of Oangrena Senilis, 325 

structure of the tendon, whicli became a soft pulpy mass of 
brown disorganised fibres, the foetor of which was most offen* 
sive. Various medicines having been given in addition to 
those mentioned, viz., Mercurius, Plumbum, Causticum, and 
China. At the suggestioa of Dr. Blythe, who saw his Grace 
frequently in consultation, it was decided to give the first dilu- 
tion of China, and the first trituration of Ammon. Carb. in 
alternation, and to apply a resinous ointment to the sore. 
After some days, no improvement resulting, the simple poultice 
was resumed, and to relieve the distressing odour, pieces of lint 
wet with a solution of Permanganate of Potash, were placed 
outside the other dressings. Some slight diarrhoea that had set 
in was immediately checked by Arsenicum. The paralytic 
affection to which allusion has been already made, rendered 
every attempt to place the leg in an easy position by means 
of cushions or splints, while the patient lay on his back, utterly 
hopeless. He spent the night lying on the left side, and during 
the day, either sat or lay on a sofa on the right side. Although 
a recumbent position was most desirable, the paralysis gave 
rise to great restlessness, and relief was frequently sought in a sit- 
ting posture. The nocturnal left decubitus produced a large blue 
threatening looking patch on the left trochanter, which I covered 
with Arnica lotion, lint, a pad of wadding, and oiled silk firmly 
secured with adhesive plaister. Slight haemorrhage occurred one 
morning from a small vessel imder the sloughy mass, which 
was quickly repressed by the application of turpentine. Matters 
progressed very gradually, but steadily in this manner till the 
beginning of September. There was little change in the pulse, 
naturally a slow one; the patient slept a good deal, as had 
been his habit in health ; much nourishment was taken in the 
form of strong beef tea, jelly, pounded meats, claret, port wine, 
and brandy. His daUy routine was to get out of bed between 
nine and ten ; after going through his ordinary toilet, which he 
strongly objected to curtail, and being dressed in his usual 
costume, he breakfasted and lay on the sofa. After soma 



32() Case of Omigreiia Senilis. 

rej^ose his leg was dressed, and he transacted business, frequently 
of great importance, and requiring considerable deliberation 
with his secretary, and received liis brotlier diocesans, or any of 
his clergy who came to visit him. He next took an airing in 
the grounds in a Bath chair, and then lay on the sofa, either 
sleeping or listening to reading, always preferring some book 
of a theological or scientific kind. Natural history was a 
favourite subject, and he manifested great interest in the in- 
cidents of the American war, and other leading topics of the 
day. His intellect and memory maintained their power and 
clearness as unclouded as they had ever been. Being very 
averse to relinquish his normal habits, he had himself lifted 
into a wheeled chair, and took his place at the dinner-table. 
In the evening he lay on the sofa, listening to music, which he 
much enjoyed, or played at chess or backgammon. It may 
easily be imagined what a deep interest was taken in his case 
by his numerous friends, and the many prelates and clergy 
who venerated his Grace. Innumerable were the panaceas for 
"sore legs" suggested and urged upon him, not merely by 
letter but pei-sonally, and most pressing were the solicitations 
that he would give up " QiLackery" and have a " regular surgeon.'* 
His reply to these importunities was characteristic and con- 
clusive. Taking an opportunity when a right reverend prelate 
and several minor dignitaries with myself were present, he said : 
" I have very many kind friends, each of whom suggests a 
separate mode of treatment or remedy ; I can make use of but 
one, and having made my selection, must be in a minority." 

Alter frequent consultations with Dr. Blythe, and the an- 
nouncement of our joint opinion, as to the imfavourable nature 
of the case and the probable result, it was determined to 
obtain the advice of Professor Henderson, who having been 
telegraphed for, saw the Archbishop on the 9th of September. 
At this time the sore extended across the back of the foot 
from one malleolus to the other ; the tendo achillis, and all the 
structures down to the bones, were destroyed from the heel six 



Case of Oangrena Senilis, 327 

inches up the leg. The foot was red and cedematous, the calf 
enonnously swollen, of a deep purple red, with two large 
yellow bullae on the centre of the calf, and a black patch had 
appeared on the front of the leg over the tibial muscles. 
There was a large blue patch on each trochanter, surrounded by 
vesicles, a similar spot on the left scapula, and several bluish spots 
on the toes of both feet from pressure against the other limb 
while lying. The pulse had become quick and feeble, the 
tongue dry, and there was occasionally severe pain in the 
ankle and calf of the leg. Such an array of symptoms in a 
broken down constitution at the age of seventy-six, notwith- 
standing the soundings of the heart and lungs, impressed Dr. 
Henderson most unfavourably, and a fatal result was prog- 
nostigated as probable in a week or ten days. He, however, 
recommended a less stimulating diet, claret alone, instead of 
port wine and brandy, and some farinaceous food and beef 
tea. Mercurius 6 was the medicine selected. On the following 
day, the whole leg up to the knee was swollen, tense and 
^^oS7' I enveloped the limb in cotton wadding, covering the 
sloughs with a weak solution of carbolic acid. A water bed 
was procured, and his Grace agreed to forego his usual toilet 
and confine himself to the water bed. The symptoms of 
prostration did not progress, and in a few days, matter of a 
most oflFensive smell and brown colour was evacuated by several 
incisions, a line of demarcation formed at either side of the 
calf and below the popliteal space, and from day to day the 
skin and large muscles of the calf separated piecemeal, leaving 
a clean granulating surface from below the knee to the heel. This 
was all accomplished without haemorrhage or diarrhoea. There 
was a good deal of nocturnal fever and some slight delirium, 
which Belladonna and Hyosciamus relieved. The local change 
was not, however, followed by any improvement in the con- 
stitutional symptoms, and debility very gradually increased 
feam day to day. The black patches on the trochanter re- 
Itained in statu quo, and neither spread, noi didi \\i^ ^^xS^ 



328 Case of Ganjrena Senilis. 

l^afhrT-like sloughs separate. The grannlations on the leg 
amiliiwA florid, and the edges in some places showed an in- 
clinutioii to fonn skin. lu the first week in October the 
t()ii;jti(j beraino drier, deglutition and articulation became more 
(iUi\ iiumi (liilicult, and were only performed by the strong effort 
of a will. Still the intellect remained dominant and nndonded 
iiH v\rr. It wuH a struggle between mind and matter. On 
Mm? (Jill OcAaAh^t, this state of things had so far increased that 
iiii,i<Milfiliini bc'ciiino impossible, yet by a negative or afl&rmatiye 
MJ^jii, liJH (Inuuj was still able to express his wishes to his 
iiilt'ndmiiM. It liad been a frequently expressed wish during 
hi'ullli, wImmi c()nv(u\sing on the subject of dissolution, that he 
mIhiuM not outlive his intellect; and most fully, and it maybe 
mu«l, |ininlully, was that wish accomplished. On the morning 
nf th(» 81 h, at ton minutes to twelve, the struggle quietly 
i'l«»r.tM|. 

Tlio innujMliato termination was to a certain extent un- 
r\luM'l^^(l, noiH^ of tlu3 usual signs of approaching dissolution 
liuvih^ lu^tMi obHiM'vod. It was discovered on my arrival, ten 
iniimlpM iiriprwanlH, that a small vessel in the leg had opened, 
nihl MtiMl('i(»nt ha»nu)rrlia)j[o had taken place to extinguish the 
llu'lNnriMf" lluino that might otherwise have smouldered on for 
niiulhor tNsniity-four hours. 

I''rnnj Iho coiinuoiuunuont the disease had been regarded as 
Monih\ (lani^TtMic, do|MMuhuit on partial or complete obstruction 
of m\\\o (»r tlu^ arlcu'ial branches supplying the limb; an in- 
ilirttiui^t omnlliko haiHlness was detected in the popliteal space, 
but tu>ul(l not 1)0 tracod down the limb. Stethoscopic exami- 
uuliou fiUlod to dirtcovor any disease of the heart or large 
nrtorial truukH, and the lungs were quite sound. In fact, his 
(iraoo frotiuoutly i^emarked that he did not know what a cough 
>vaa. 

To the mechanical origin of the disease one feels inclined 
to attribute the absolute powerlessness of all the remedies 
proscribed, not one of which appeared in any way to impress 



Case of Oangrena Senilis, 329 

the principal malady, although the tendency to diarrhoea, as 
well as the fever and delirium, all yielded to the remedies ad- 
ministered for them. The healthy suppurative process which 
set in subsequent to the visit of Professor Henderson, and the 
total cessation of the spread of the gangrene, were very re- 
markable, and may possibly be attributable to the completion 
of the obliteration of the arteries supplying the calf, and the 
establishment of a collateral circulation, which vitalised the 
deeper layer of muscles and the front of the leg. As no 
anatomical examination of the limb was permitted, this must 
remain a matter of speculation ; but it gave rise to the feeling 
that had this change been brought about at an earlier period, 
before the vital energy had been so lowered, there might have 
been some chance of at least a partial recovery. 

DISCUSSION. 

Mr Teldham rose simply to thank Dr. Scriven for his very 
interesting communication; for, as the Chairman had already 
observed, it was not calculated to elicit much discussion of a 
therapeutic character. Such a communication from a gentleman 
who enjoyed the privilege of frequent intercourse with such a 
man as Dr. Whately, could not fail to be deeply interesting, — 
and Dr. Scriven had ably related what he had observed of the 
closing scene of the great man's life. Dr. Whately's reply to the 
allopathic physician, was a masterpiece of writing — ^too much 
much could not be said in its praise. As regards the medical 
part of the paper, he (Mr. Yeldham) thought Dr. Scriven was a 
little unreasonably disappointed at the failure of his treatment. 
What could he have expected ? Unless they could stop the 
course of time, and reverse the order of nature, they could 
scarcely hope to do much in arresting the progress of Gangrena 
Senilis, which arose from simple failure of vital power from the 
lapse of years. The Archbishop could scarcely be said to have 
ssiiik from disease — ^his was simply a prolonged death — dying at 
the extremities, as an aged tree dies first in its branches. Ex- 
cept by nutrition, and judicious stimulation, they could do but 
little to arrest the death of old age. Therefore, in the present 
case, he would, perhaps, have given the bark and ammonia, 
if he had given them at all, in larger doses, purely as stimulants. 

Dr. KiDD said, that the memorandum written by the Arch- 
bishop, illustrated the largeness of his mind, and the perfect 



iW Case of Gangrena Senilis, 

vouMonoQ he had in the law, " similia simUibtcs.** The case 
was unlortunately oue of those which medical art of any school 
coiilvl not ouiv. The gangrene was caused by obliteration of the 
artt'iit's ; t\\o result of degeneration, which nothing could cure. 
lu surh cast's Dr. Kidd's experience was in favour of keeping 
the ^^'iiugn'uous surface j)erfectly dry — avoiding poultices, fomen- 
tations, ami h)tion3 — the surface dusted with finely pulverized 
ilrv Vv'i:»'tiil>lo charcoal, three or four times a day, and washed 
with wariu si>ft water, not oftener than once or twice in twenty- 
four hours. The limb should be bandaged with a roller of 
l)i>nimctt llaiiuel, which gives a gentle elastic support to the 
iiniil'atit>n. lu sucli cases it is most important to bear in 
luiiul the nuu'lianical cause of the disease, and therefore to pro- 
mi»te tho oiivuhitiou by gentle shampooing of the limb in a 
iliriMtiou upwards, and by raising the leg on an inclined plane, 
avoiviing standing and walking, but keeping the patient fre- 
tiucntly out i>f doors on a reclining couch with the limb raised. 
fhani^o of air to the seashore helps to delay the progress of 
the disease. The medicine which seemed most truly homceo- 
pathie to the cast^ was Secale, and to give the full benefit of the 
law aim ilia similibus to his Grace, this medicine should have 
bet^i given in the first decimal trituration, and the mother 
tincture, as well us in the thinl dilution. Dr. Henderson's advice 
ahvuit vliet was most judicious. Much good is often gained by 
Uvh^ptiuij: a light diet and weaker stimulants. In a weak state 
of health, the stomach and bhn^d became weighed down, so to 
speak, anil oppi^esst^d by too strong nourishment or too strong 
stimulants. Dr. Kiild narrated a case of gastric fever with 
ga:igreni>us \dceration of the legs, in an old lady aged seventy- 
tnght, when^ aggravation invariably followed the use of solid 
fov>.l of any sort, whoivas on clear beef tea and milk and water, 
with a fi'oe use of sherry, the old lady perfectly recovered, to 
tht^ astonishment of her friends, who had a hard task to carry 
out Wus instructions of refusing solid food, which the patient 
asktul for. 

Dr. MoKOAN did not agree with Dr. Scrivens's treatment of 
tlh) cast). No surgeon would have employed the measures he 
adopted. The meilicines best indicated were Secale and Arseni- 
cum. Doubtless, under any treatment, the case must have 
ttMiuinattnl fatiilly. The cause of death was probably ossifica- 
tion of the arteries. He sometimes found even the coronary 
arteries produce death of remote parts. He (Dr. Morgan) 
agrf>tHl in all the treatment suggested by Dr. Kidd. 

Mr. Buck thought all must deeply regret the loss of this 
truly estimable and staunch supporter of our cause ; it was rare 
to tind one who would so boldly and unswervingly persist 



Case of Oangrena Senilis. 331 

against a mighty odds in maintaining and defending this, which 
he felt and knew to be a great and imperishable truth ; fairly 
might we wish his life to have been spared some few years 
longer, to have still given his powerful aid to still the opposition 
with which we are at times assailed. With regard to the treat- 
ment of the case, he did not see that much could be done, but 
agreed with Dr. Eadd as to the treatment of gangrene, by 
supporting the limb, keeping it dry, and giving such patient 
fresh air. Believed Secale to be a most useful remedy; yet 
feared, in the case of the Archbishop, whatever plan had been 
pursued, the result would have been the same. 

Dr. KussELL said, he regretted very much that Dr. Scriven 
was unable to be present. He considered it hardly fair to dis- 
cuss the treatment of a case in the absence of the practitioner 
who treated it ; for in the management of every case there was 
always something more or less peculiar to it, which frequently 
required that the general rules laid down in books as applicable 
to the class to which it belonged should be modified, or even 
altogether reversed. It might not be known to all, that besides 
having an excellent medical education. Dr. Scriven had enjoyed 
the advantage of being an apprentice of the great anatomist and 
excellent surgeon, Mr. Harrison, and had the best opportunities for 
acquiring a thorough knowledge of surgery. This stood him in 
good stead in the present instance, when, owing to the intolerant 
measures of the College of Surgeons of Ireland, he was debarred 
the benefit of the aid of a professed surgeon. The fact that in 
most trying circumstances he succeeded in retaining the fullest 
confiilence of the Archbishop and his family, was the highest 
testimony we could desire, to the tact and judgment both he and 
Dr. Bly the must have displayed ; and we, as a body, may be very 
thankful that we had the advantage of being so well represented 
in Dublin. 

Dr. Chapman (in the chair). — ^The case related by Dr. Scriven 
is one of great interest, personal, however, rather than pro- 
fessional. The illustrious patient deserved all respect from his 
contemporaries, not only on account of his eminent intellectual 
faculties and of his moral excellence, but for his consistent as- 
sertion of his liberty of human thought and of human action, 
for the benefit of mankind, and for the advancement of know- 
ledge and of science in whatever direction. There is no scope 
for discussion on the subject of Senile Oangrena. The oil that 
supports the flickering flame is going out, and soon goes out. It 
cannot be supplied in such cases ; whether it be embolism, or 
arterial obliteration, the result is the same. The practice of Dr 
Scriven has been objected to by one or two, in his treatment of 



332 Case of Oangrena Senilis, 

this case. He is not present to show why he did this or that; 
or why he omitted to do that or this. He had an excellent 
medical and surgical education at Dublin and Edinburgh, and 
partly in London. — ^We doubt not he did his best to alleviate 
wliat lie could not cure ; and the patient and the family were 
thoroughly satisfied with and thankful for his treatment. The 
physician and the patient showed equal moral courage; the 
former had to show patience, and unfailing temper, and con- 
scientious reliance on his own resources ; the latter had to resist 
the impatience of anxious friends, and to die in and for the main- 
tenance of the medical creed, to the practice of which he had 
for many years trusted his own mortal life, and the lives of others 
dearer to him than his own. There is no use in giving cases, 
exemplifying the specific action of such remedies as Arsenicum, 
Bellado7ina, Armonium, Carhonicum, China, Carbo Animalis, 
Carho Vegetahilis, &c., or of the advantages derivable from 
poultices of yeast and charcoal. The Chairman had seen his 
full share of cases of the gangrene of age. He saw a few years 
ago a case of this sort, remarkable from the presentments of the 
affected limb. From the upper part of the thigh to the toes, the 
integuments presented the appearance of half-tanned, of half- 
charred leather. There was, in this case, the same uneasy 
restlessness which is observable in those that go out from 
" Bright's Disease of the Kidney." The best palliative in this 
instance was brandy in small but frequently repeated doses. 
Another case : — A gentleman, not so very old in years, had 
gangrene of several toes of one foot ; he was a plethoric man, 
full of the consciousness of active life. He was told that he 
was to die ; he said " I don't believe it, I don't feel like a dying 
man." The final issue was rapid in this case ; he departed this 
life in a few weeks. In this case, alcohol, frequently repeated, 
but in small quantities, was the chief palliative. There was the 
same restlessness in this case as in the preceding. Yet another 
case : — An old lady, near 80, had gangrene of one of her toes. 
The dead blackness disappeared, but her friends were told the 
case was nevertheless mortal, and she went out Kestlessness in 
this case also was the predominant symptom. We grow old 
while we speak. " Bum loquimur senescimvs" The glory of a 
mortal life fades away ; but in the case of worthies something 
remains. 

" The actions of the just 
Smell sweet, and blossom in the dust, 

From the time he adopted Homoeopathy, to his last breath — a 
period of many years — ^Whately was a staunch HomcBopathist. 
He never wavered ; he gave noble, simple, honest testimony to 
his conviction that Hotnoeopathy was the law of drug healing. 



Observations on afeio Local AncestJietics. 333 

He went out, and was satisfied to go out, under the banner of our 
law of therapeutics. All honour to his memory ! All praise to 
his honesty ! His name will live after him — ought to live so 
long as the English language endures, as a ripe scholar, a pro- 
found reasoner, an exact logician — 

'' Quia desiderio sit pudor aut modus 
Tarn carl capitis ? ** 



OBSEEVATIONS ON A FEW LOCAL AN^aiSTHETICS. 
By Dr. Eugene Cronin. 
I was induced a short time ago to examine the subject of 
local anaesthetics, by seeing the frequency and indiscrimination 
with which Chloroform is now used ; and from having in two 
or three instances witnessed the bad effects produced by it in 
some of the minor operations. Operations which but for the 
nervousness of the patient, might have been performed with 
comparatively little suffering, and which I think but for the 
impatience of the surgeon, would have been rendered sufficiently 
painless by the employment of a local anaesthetic. Every agent 
by which general anaesthesia is induced produces a powerful 
impression upon the system, and may occasion dangerous con- 
sequences when freely and carelessly administered ; and even 
with the greatest care it appears certain that the inhalation of 
Chloroform is in some cases inevitably fatal, and Dr. J. Amott 
has statistically proved that the mortality after operations has 
materially increased since the introduction of Chloroform. 
The title of this communication shows that I have been engaged 
only with some local anaesthetics, for of course there are many 
agents of this nature. My investigations have been confined 
to Chloroform in liquid and vapour, to Chloroform and Acetic 
Acid according to the new form of chloracetisation, to freezing 
mixtures, and lastly to Carbonic Acid Gas. These of course 
can only be expected to act in superficial cases, yet in private 
practice the boon of being freed from the horrors of cold steel, 



334 Observations on a few Local Ancesihctics. 

without encouutering those of the inhalation of Chloroform, is 
no small one. I am inclined to believe these various articles 
do not produce their effects till an action amounting to one of 
revulsion or counter-irritation occurs, since a varying amount of 
irritation in all cases precedes the anaesthesia: I mean by 
counter-irritation the production upon the surface of a powerful 
impression, which seems to be capable of arresting or diverting 
as it were the attention of the system, and thus for a time 
checking or relieving a morbid process. 

It lias frequently been urged that " ancesthetic " is inapplic- 
able and untrue with regard to Chloroform; for my part I could 
never see the force of the argument used against its employment. 
Pit)tessor Hughes Bennett states his argument against the cor- 
rectness of the applicability of the word anaesthetic to Chloro- 
form thus : — " Looking at the meaning of the word anaesthesia 
I find it implies a want of feeling, hence as Chloroform destroys 
the sense of touch by first producing loss of consciousness, the 
term auiosthesia is inapplicable, and is only employed as a 
'* mask to conceal its true action as a stupifying agent." And 
again, in his work on the Principles and Practice of Medicine, 
page 432, he says : "The modem practice of depriving persons 
of coiusoiousuoss in order for a time to destroy sensation, has 
boon very much misunderstood, in consequence of such remedies 
having boon erroneously and unscientifically denominated anaes- 
thotics ; in fact they in no way influence local sense of touch, 
tiioir action is altogether central, and hence the danger which 
ofton attends their action." 

I n answer to Dr. Bennett's argument that the word anaesthetic 
luoauvM a want of feeling, I would say that that translation is 
l^ulially cori-ect, but if we look at the Greek verb di(T0aVo/iac we 
Uuvl that in its strict and true sense it means, "I perceive with 
tho aouHOj*," that the cognate aiadnfris implies " perception by 
tho {ioua^i44»" and the word avntrdritris itseU, means "stupidity," 
with its oovrt^iipouding verb Ayaitrdrirekt " to be senseless," or 
** stui)id." 



Observations on a few Local Ancesthetics, 335 

I shall here give the results of a few experiments tried upon 
myself, accompanied by a few cases : — 

ExperiTrunt 1. — I put about a drachm of Chloroform in a 
wide tube and applied it to my forearm ; after the application 
had been continued for two or three minutes, I experienced 
tingling and slight feeling of heat ; at the expiration of five 
minutes, on removing the tube the cuticle looked of a pale pink, 
the line of pressure from the edges of the tube were very dis- 
tinct, sensibility was in no way disturbed. The tube was im- 
mediately reapplied, and a smart burning sensation was produced 
which increased in severity for about three minutes; the 
sensation then began to diminish and a numb feeling supervened. 
On removing the glass, after fifteen minutes application, the 
cuticle looks pale, and the ring of the tube is surrounded by aa 
erethematous areola ; on pricking the spot with a needle, sen- 
sation was quite absent until the point penetrated the cuticle, 
when a slight amount of sensation became apparent ; no blood 
followed for nearly half a minute : as the numbness passed away 
burning and tingling returned, remaining super-sensitive for 
some hours. 

Experiment 2. — Chloroform Vapour. I applied the mouth 
of a tube containing about 1 drachm of chloroform to my arm, 
holding the lower part of the tube in my hand to induce 
freer evaporation; in five minutes the skin became slightly 
reddened, and I experienced a slight tingling sensation, which 
merged into one of irritation, but never amounted to pain. On 
removing the glass on the expiration of fifteen minutes, sensi- 
bility was decidedly diminshed, though not abrogated ; it speedily 
returned, no unpleasant effect remaining. 

Case 1. — ^In a very distressing case of neuralgia of the 
scalp that came under my notice, lint dipped in chloroform was 
applied to the scalp, the whole carefully covered with oilsilk, 
to hinder too rapid evaporation, this gave entire relief from 
pain, which continued for some hours, allowing the patient to 



33 6 Observations on a few Local AncestheHcs, 

get some refreshing sleep. A slight amount of irritation of 
the skin being the only inconvenience. 

Case 2. — In a case of frontal neuralgia, the application of 
the liquid chloroform gave complete relief in about t^n minutes; 
but in this case, local irritation and diminished common sensi- 
bility resulted. In the same case, on another occasion, the 
vapour of chloroform removed the neuralgia in about fifteen 
minutes, the common sensibility of the part was not at all 
interfered with, nor were there any signs of local irritation. 

Case 3. — I watched a case of carcinoma uteri for some 
time, in which the vapour of chloroform was being used as a 
local application, it being brought into contact with the os by 
means of an elastic tube fastened at one end to a flask con- 
taining fluid chloroform. It generally gave great relief from the 
harrassing pain, but I found that its good effects could not be 
always implicitly relied upon, and I have heard the same 
remarked in other cases similarly treated, the pain being at one 
time removed, in others, only slightly, or not at all relieved. 
For this I know no explanation. 

Experiment 3. — Chloroacetisation. During the early part of 
last year, I noticed that a new mode of producing local anaes- 
thesia, had been brought before the French Academy, by M. 
Toumie, who calls the process " Chloroacetisation," and bases its 
merits on the rapidity with which anaesthesia is produced, and 
the slight inconvenience caused to the patient. I was much 
interested in reading M. Toumi^'s communication, and deter- 
mined to give it a fair trial. The process is as follows : — 1 3 
of glacial acetic acid, and 45 m of chloroform are put into a 
tube, and the mixture applied to the sound skin ; the part to 
be acted upon being marked off" by a piece of diachylon plaster. 
The mixture to be kept at the temperature of the hand. Under 
these circumstances, M. Toumi^ says anaesthesia is to be looked 
for in about flve minutes. I applied a mixture prepared as 
above to the inside of my fore-arm. It immediately caused 
a burning sensation, followed in about twenty seconds by most 



Observations on a few Local AnofHheties. 887 

acute smarting, increasing rapidly to the most excruciating 
pain, and compelling me to remove the tube, and apply cold 
water for relief; the cuticle was reddened and blistered, the 
smarting continued severe afterwards, and the part looked as if 
it had been severely stung by stinging nettles, indeed, the pain 
was very similar to that produced by them. It would have 
been quite impossible to have borne the application of this 
mixture for five minutes, as M. Tourni^ desires. 

Chloroform seems to assist the action of the acetic acid 
severe enough in itself, by favouring its rapid absorption, and 
we know that a solution of Belladonna in chloroform, acts 
with tenfold greater rapidity than an ordinary one. 

Experiment 4. — I next tried the effects of the vapour of the 
acetized chloroform, the which was to produce redness, heat, 
and tingling, in five minutes, which gradually increased up to 
stinging, when I removed the glass. No anaesthesia was 
induced in either of these cases. 

Eocperiment 5. — Ice as a local anaesthetic. 

This method of producing anaesthesia was introduced by Dr. 
J. Amott, and is one of the most successful By making a 
mixture of 2 parts of pounded ice and one of salt in a muslin 
bag, and applying it to the skin, I have in fifteen minutes pro- 
duced the most perfect local insensibility; the skin acquires a 
parchmenty appearance, and becomes hard and homy. 

Case 4. — I have seen this method applied in two instances 
to cases of hernia, one of which occurred in an old woman, 
and was of the femoral variety ; the intestine had been stran- 
gulated in the same way upon a former occasion, and she was 
operated upon while under the influence of Chloroform. The 
patient, though she made a good recovery, suffered from that 
time with almost continual headache. When I first saw the 
case, the taxis had been employed for a considerable time with- 
out any good result, so a bag of ice was placed over the 
tumour, and kept there for five or six hours, hoping that re- 
duction might thus be effected ; after this, the taxis wse «%^\sk 



336 Observations an a fmv Local AncBsthdics. 

tried without success ; a freezing mixture was then applied and 
maintained for about an hour, and the operation for reduction 
was proceeded with, the stricture was divided, the bowel re- 
turned, and a suture introduced, without giving the patient any 
pain ; she made a good recovery. 

Case 5. — ^The other case was that of a man suffering from 
an old inguinal hernia, which became strangulated, the tumour 
was large ; the taxis was tried, and failed, both before and after 
the application of ice ; ice and salt were maintained in contact 
with the tumour for about an hour, and perfect anaesthesia 
being produced, the case was operated upon, and the gut re- 
turned ; no pain was experienced during the operation. 

In this case the patient died three days afterwards, from 
peritonitis, produced by the very severe strangulation of so 
large a portion of gut and omentum. 

Case 6. — A friend of mine had a large number of external 
haemorrhoids removed, insensibility being produced by the use 
of a freezing mixture ; he experienced no pain, and only a few 
drops of blood were lost. I consider in cases requiring opera- 
tion, that ice is, without doubt, the most valuable means for 
inducing local anaesthesia, from its admitting of simple applica- 
tion, and from the very small amount of haemorrhage that oc- 
curs in all cases in which it is employed ; and I think that all 
the following operations might be painlessly performed by this 
method : 

1. The removal of small superficial tumours, embracing 
malignant, cystic, benignant, and other growths. 

2. The operation for the reduction of paraphymosis. 

3. The operation for onychia. 

4. The opening of anthrax, and acute and chronic abcesses, 
when superficial 

5. The operations for the various kinds of hernia. 

6. Excision of external piles. 

Carbonic acid gas, when applied to the healthy akin, pro- 
duces no effect beyond a slight sensation of warmth, but I 



ObservatioTis on a few Local AncestJietics. 339 

have seen very good results from its local application in cases 
of cancer of various parts, especially after the destruction of the 
cutaneous surface; when it, besides relieving the pain, neu- 
tralizes the foefh(i odour, from which the patients suffer almost 
as much as from the pain itself; and it is thus a great boon 
to those about them. 

In three cases of carcinovia nteri, and two of cancer of the 
breast, I have seen it used, without in any case producing un- 
pleasant results, or failing to give reliet 

I would mention that it is better to use sulphuric acid in 
the preparation of carbonic acid gas, for when the hydrochloric 
is employed the gas requires to be washed before being brought 
into contact with excoriated parts, being apt to contain hydro- 
chloric acid in vapour, which may give rise to considerable irri- 
tation and pain. 

DISCUSSION. 

Dr. Wyld thought that practitioners of Homoeopathy were 
apt to neglect the use of local anaesthetics. He had repeatedly 
met with cases of neuralgic pains, which had not yielded to 
carefully chosen Homoeopathic remedies given internally, but 
which had yielded at once, and permanently, to the application 
of chloroform liniment. No doubt it would have been a greater 
proof of skill to have cured such cases by cleverly selected 
medicines. Still, our great object is to relieve pain, and cure 
disease as quickly as is consistent with safety. To heal rapidly 
external eruptions by external applications, is often dangerous ; 
but the healing of neuralgic affections by externally applied 
Anaesthetics, was always a safe process, and frequently a success- 
ful one. 

Mr. Cutmore said — Dr. Cronin's paper upon anaesthetics is a 
very interesting one. As regards chloroform, it is a great boon 
in the practice of midwifery, especially at the point where the 
head is passing over the perinenum, and the anguish is greatest 
also where there is much rigidity of those parts. But I think 
that Homoeopathic remedies are not without their blessings in 
this kind of cases. Gelseminum Semperviren is of that class, 
and if given in drop doses of the 3rd dil. it acts as a power- 
ful relaxor of all mascular fibre, and a calmer of the nervous 
system, which, at those times is a great boon to such patients. 
I have given it for some time, and it has never disappointed me. 

22* 



840 ObuTvationB on a few Local Afuesthitie$. 

There is another medicine which I place great reliance upon, 
that is GonlaEhyllum, and I think it equal to the former, hut its 
action uponttie uterus is generally, where there is a want of 
expulsive power, rather than rigidity of the os uteri. 

Dr. Drury regretted that the author of this paper was not 
present It was always desirable, that those who favoured the 
Society with their opinions should have the opportunity of hear- 
ing what was said, either in the way of censure or praise; 
happily, on this occasion, there was no room to find fault, on the 
contrary, the enquiries of the author showed a large amount of 
careful, steady investigation, resulting in a very interesting 
paper, and gave promise of more extended researches at a future 
day. It appeared as one of the valuable practical results of 
applying cold, with a view to produce local anaesthesia, that 
haemorrhage was controlled by its use, the value of this, in 
many operations was very great, facilitating the operation and 
saving the patient's strength. Dr. Cronin had spoken of Car- 
bonic acid gas as an agent that might be employed with 
advantage. In its condensed form it was valueless, as it acted 
as a powerful escharotic, but applied as a gas it was capable, at 
times, of allaying pain ; it was, of course, in many cases inappli- 
cable, but it had been used, and there was no reason why it 
should not again be employed, if it could be made more manage- 
able. Some gentlemen, it was said, objected to the use of 
local anaesthetics ; unless there was a special reason in any 
particular Jcase, it seemed to him, (Dr. Drury) that in many 
cases their use was very desirabla If prompt and inmiediate 
relief can be obtained by some local means, in no way affecting 
or interfering with the action of our remedies, there could be no 
valid reason for rejecting such aid. If a patient consulted a 
medical man, with painful ulcer of the rectum, though such 
might be cured by Homoeopathic doses, yet if a division of 
the mucous membrane across the ulcer secures a safe and speedy 
cure, why should it not be done ? Mr. Cutmore had spoken 
highly in favour of Gelseminum in labour, the only experience 
he (Dr. Drury) had of it in such cases, was in a case of Mr. 
Cutmore's, where he had given it to prevent abortion, but where 
the patient had aborted notwithstauding. Dr. Drury, should, 
however, say that he saw her after a railway journey, which waa 
not calculated to keep off the threatened mischie£ 

Dr. Eussell said he hoped Dr. Cronin would pursue the line 
of investigation he had entered on. The subject was full of in- 
terest; there could be no doubt, that if for the general narcotism 
produced by Chloroform and similar agents, we could substitute 
merely local insensibility, the gain would be material Dr. 
Hope, professor of Chemistry, in Edinburgh, used to describe 



Observations on afiw Local Anassthetm. 341 

Nitrous-oxide as afifording an elegant debauch. The inhalation of 
Chloroform might be said to be looked upon as innocent intoxi- 
cation. Intoxication it undoubtedly was ; it has all the stages — 
first excitement, next insensibility, and lastly maiatae, and fre- 
quently nausea and vomiting. Chloroform entered the blood, 
and was borne to the brain, on which organ it produced it? intoxi- 
cal effects. And he (Dr. Eussell) had known instances of pa- 
tients suffering from these effects for months. It was, therefore, 
most desirable to substitute for such a general action a merely 
topical one, if such an one subserved the purpose. The only 
case in which he had ever employed a local anaesthetic was that 
of an infant suffering from a large scroftdous abscess of the 
neck. To this he applied a mixture of salt and snow in a silk 
pocket handkerchief, and then made a free incision, and evacua- 
ted about a tea-cupful of pus. It was amusing to observe the 
infant laughing at the very moment the skin — ^which was in- 
flamed and very sensitive — ^was being handled and cut. In all 
similar cases, such, for example, as operating in paronychia, it 
would be easy to employ a f^oiific mixture, and it would avoid 
giving intense^suffering. The employment of this class of 
remedies for minor operations has been ably advocated by Dr. 
Amott and others ; but the subject took a wider range when we 
attempted to apply the same principle to the treatment of those 
spasmodic diseases which began in some irritation of a periphe- 
ral nerve and excited general convulsions. This was the case 
in some instances of epilepsy. If we could deaden the spot at 
the extremity at which the morbid irritation originated, we 
might sometimes prevent it travelling to the centre, and so cut 
short an attack. It is not impossible that even hydrophobia 
might be controlled by some action on the nerves of the throat. 
In short, the command of the incito-motor nerves would be an 
immense gain of therapeutic power in many convulsive diseases, 
and by a diligent study of local anaesthesia, we may ultimately 
attain it. He (Dr. Eussell) was glad to find the subject in the 
hands of one of our members, and he hoped at some future 
occasion Dr. Cronin would give us fuller details of the result 
of his experiments. 

Mr. Cameron remarked, that many years before chloroform 
was heard of. Dr. Toogood Downing (who gained the Jacksonian 
Prize for his Essay on Neuralgia) had invented an instrument 
•which he named the " Aneuralgicon " by means of which he 
was enabled to use anaesthetics of various kinds locally, and 
with decided success in many cases. He employed chiefly 
Belladonna^ Opium, Coniimi, Tobacco, Hyoscyamus, Hops, and 
Lactaca A portion of one or more of these agents was placed 
in -ft imall foinace, which fonned the body of the infttrum^\i\,v!EA: 



342 OhservaHom on a few Local AruesOieties. 

ignited. A stream of air from a pair of small bellows was then 
ilirtHtoil upon it The fames escaped into a hollow cone of 
lh»xiblo mi>tal, under which they were confined, and applied to 
tlu» i>iirt affected. The pain was generally speedily relieved. 
Tho almost unavoidable escape of these powerful fiimes> and ilieir 
inlialatii»u by the patient or those around him formed a serious 
objivtion, according to Mr. Cameron's experience, to the general 
use of this otherwise very convenient little instrument. K this 
drawback could bo overcome, this mode of employing local 
auiiv^tlu'tios ought to become a valuable one, and seemed de- 
siTving of more attention than it ever received from the pro- 
fession. 



%nmh 0f i)^t g0S|jital 



LECTUltE III.— ON ASTHMA. 
By Db. Eussell. 
TiiK triuisition from epilepsy to asthma is natural if we adopt 
a pathological arrangement, and even in the purely practical 
aspect of the two maladies there are so many points of resem- 
blance, that the study of the one makes the comprehension 
of tlio other an easier task. True, the contrast beween epi- 
leptic and asthmatic persons is very great. Among the former 
the majority avo greatly l>elow par in mental power and activity, 
while among the latter the reverse is the rule, and asthma has 
boon described as jpar excellence the complaint of the intellectual 
class. It may be, that the rounded shoulders and stooping 
gait which indicated the man of literature — ^before literature 
took to the rifle — was mistaken for the peculiar formation of 
the chest which is so characteristic of the asthmatic, that the 
accustomed eye can at once recognise the sufferer from this 
complaint the moment he turns his back ; or it may be, that 
the peculiar nervous constitution of the asthmatic is highly 
favourable to the development of intellectual vigour. So far 



Lecture hy Dr. Russell. 343 

as my observations have gone, they quite agree with the popular 
belief. The asthmatics I have known have been persons of 
unusual mental activity and energy. 

So much for the contrast between epilepsy and asthma. The 
resemblance between these two diseases consists in their both 
being affections of the nervous system, of a profound kind, 
connected with its original formation, which gives to it a ten- 
dency to be excited into a peculiar paroxysm giving rise to 
certain sensations on the one hand, and on the other, to 
violent spasms of certain muscles. In asthma as in epilepsy, 
what may be called the head quarters of the disease are in the 
upper part of the spinal chord ; about the origin of the pneu- 
mogastric nerves, and thence it extends along the whole of 
their ramification nerve, giving to all the parts supplied 
by this great source of organic sensibilty a preternatural 
sensitiveness and a tendency to spasm. The morbid centre 
of epilepsy is probably close to that of asthma^ but the 
nerves thence proceeding, by producing a spasm of the throat 
instead of the lungs, give rise to the phenomena of strangula- 
tion. So contiguous, however, are the sources of the two 
morbid currents, that cases are on record of the usual epileptic 
fit being supplanted by an attack of asthma. One striking 
example of this transmutation is thus recorded by Dr. Salter. 

" The case was that of a man of about fifty years of age, 
subject to epilepsy. His fits had certain weU-known premo- 
nitory symptoms, and occurred with tolerable regularity; I 
think about once a fortnight. On one occasion his medical 
attendant was sent for in haste, and found him suffering from 
violent asthma ; the account given by his friends was, that at 
the usual time at which he had expected the fit, he had ex- 
perienced the accustomed premonitoiy symptoms, but instead 
of their being followed, as usual, by the convulsions, this violent 
dyspnoea had come on. Within a few hours the dyspnoea went 
oflF, and left him as well as usual. At the expiration of the 
accustomed interval after this attack, the ordinary premonitory 



344 Lectur$ hy Dr. Russell. 

symptoms and the usual epileptic fit occurred. On several 
occasions (I do not know how many) this was repeated, the 
epileptic seizure being, as it were, supplanted by the asthmatic." 
[Salter on Asthma, p. 44.] 

Let us take the analogy between epilepsy and asthma as 
our chie, and see whither it leads. 

To begin with ; what is revealed by the examination of the 
bodies of those who have died either of the eflfects of these 
diseases, or who, although dying of other maladies, have suffered 
from either of them ? As a rule, in neither has there yet been 
found any constant structural change which can be held as an 
organic cause of the symptoms ; but in both there have been 
occasionally such changes observed, and in both the morbid 
alterations have been in the nervous system. 

That structural change is rare, we state on the high autho- 
rity of Laenec, who says : — " Even at the period at which we 
live, when the eyes of medical men are particularly directed to 
the minute investigation of the anatomical character of diseases, 
I have met with many cases in which it was impossible, after 
the most minute research, to find any organic leison whatever 
to which the asthma could be attributed." So much for the 
rule ; now for the exceptions. In a case of fatal dyspnoea, the 
body of the patient who had thus died was carefully examined 
by the accomplished anatomist Beclard, who foimd, as the only 
possible explanation of death, a tumour on one of the phrenic 
nerves. Parry narrates a case of dyspnoea occurring in fits of 
aggravation, without any symptoms of local pulmonary disease, 
and on dissection he found morbid alterations in the upper 
cervical vertebrae, the result of syphilitic action upon the bones 
of the neck. Lastly, Dr. Gardener relates a case characterized 
during the life of the patient by paroxysms of dyspnoea, and 
the post mortem examination disclosed, as the cause of the 
asthmatic attacks from which he suffered, a neuromatous 
tumour of the par vagum. [Ed. Med. Surg. Joum. 1850.] 

Sir John Forbes makes upon this class of cases the following 



Lecture h/ Dr. RusBtlk 346 

practical observations : — " The influence of spinal irritation in 
producing palpitation and other irregular action of the heart is 
well known; and we apprehend, that many of the chronic 
dyspnoeas and irregular asthmatic affections which we meet 
with in persons who are deformed, arise as frequently from dis- 
turbance of the spinal marrow, produced by the distortion, as 
from disease of the lungs themselves." (Cyclopaedia of Med. 
Asthma.) 

In tracing the analogy and observing the contrast between 
epilepsy and asthma, there is one point of diJBference which 
arrests the attention. It is, that while epilepsy is often fatal, 
asthma may be said never to be the immediate cause of death. 
There are, indeed, one or two instances on record, which perhaps 
ii^ay by some be considered as exceptions to this rule. Guersent 
relates two cases of infants who died of an acute remittent 
dyspnoea, with quick pulse, precordial anxiety, and dry cough, 
and in whose bodies no organic lesion whatever could be found. 
(Diet de Med. Prat., t. iii p. 126.) 

Andral relates the following case : — " A baker of good con- 
stitution, twenty years of age, who had lived in Paris for only 
two months, and who had been affected for the last five or six 
weeks with a slight diarrhoea, presented on the 10th of April 
all the precursory symptoms of measles, — ^redness of the eyes» 
coiyza, hoarseness, and cough. The same state on the three 
following days. On the 14th, the eruption appeared; the 
patient kept his bed. On the 15th, the entire body was 
covered; entered La Charity on the evening of this day. The 
eruption was then confluent, and quite characteristic; pulse 
hard and frequent ; redness of tongue and lips ; violent cough ; 
no other bad symptom. Towards the middle of the night the 
patient felt some oppression ; this increased rapidly ; and on 
the following morning, the 16 th, we found the patient in a 
state of semi-asphyxia ; eyes full and prominent ; face purple ; 
breathing short and very frequent, performed both by the ribs 
and diaphragm ; cough almost constant, some . mucous €;^\\lW\ 



346 Lecture hy Dr. Russell. 

the chest when percussed sounded well in every part; auscul- 
tation caused some mucous rSle to be heard in different places. 
Of the eruption there remained some pale spots just on the 
point of disappearing. The pulse preserved its frequency and 
hardness, and the tongue its redness. This group of symptoms 
seemed to indicate the existence of a pneumonia ; however, 
the pathognomonic signs of this disease were completely 
wanting. Could a simple bronchitis by its extreme acuteness 
or sudden exasperation, give rise to so intense a dyspnoea ? 
Could this inflammation in combination with that of the 
primss viae explain the very severe state into which the 
patient had so suddenly fallen ? Be this as it may, the indi- 
cations to be fulfilled were no longer doubtful The internal 
inflammation must be diminished, and that of the skin recalled.'' 
Andral attempted to effect this after his method, and the result 
was, that under intense suffocation the patient died on the 20th. 
The post-mortem examination revealed no morbid change of the 
parenchyma of the lungs, only intense redness, and some 
croupy exudation of the lining membrane of the bronchial 
tubes. Andral, while on the whole inclining to consider the 
case as one of fatal bronchitis, seems somewhat staggered as to 
its pathology, for he observes : " Those who admit the existence 
of nervous dyspnoea and essential asthmas, might cite this case 
in support of their opinion ; they would say that they had often 
seen the bronchial mucous membrane as intensely inflamed 
without any perceptible dyspnoea resulting fix)m it ; from this 
they would conclude that in the present case, the dyspnoea 
was an essential disease, independent of the inflammation of 
the bronchi" I have quoted this case in full because of its 
pathological interest, both as raising the question as to whether 
this baker died of nervous dyspnoea, and also as a proof of the 
intimate relation between cutaneous and some pulmonary 
affections. 

As the cases referred to and the one quoted are almost the 
ojAy ones recorded of presumed death by asthma, we may as- 



Lecture ly Dr. Russell. 847 

some that in tlfls Instance the exceptions prove the rule, and 
that asthma is never fatal Why not ? If asthma be what it 
is generally represented as being, a spasm of the muscular 
structure which surrounds the extreme ramifications of the 
bronchial tubes just as they loose themselves in the air cells, 
— ^if this be the true pathology of asthma, then the conse- 
quences would manifestly be, that the lung cells would be 
deprived of the supply of air requisite to the maintenance of 
life, and we should have the symptoms of death by strangu- 
lation. For where is the difference to the individual, whether 
he be choked by a ligature round his windpipe— or what is the 
same thing, by spasmodic closure of the glottis, so that no air 
is permitted to enter the tubes and be conveyed along them 
through their subdivisions to the lungs, or whether the air so 
entering be arrested at the extremities of these tubes, and the 
craving of the parched air cells be left unsatisfied ? In the 
former case the patient is suffocated by a wholesale process, and 
in the latter, he is suffocated in detail ; but in both cases he is 
equally suffocated, if by suffocation we understand depriving 
the lungs of the supply of air necessary for life. And what do 
we mean by suffocation ? We mean that the blood passes 
through the lungs without being . there renovated as it should 
be, — ^r^enerated, we might even say, — and that instead of living 
arterial blood, dead venous blood is poured into the left auricle, 
thence into the left ventricle, which in its turn discharges it 
upon the brain, and produces there the effects which Sir A. 
Cooper describes as having been exhibited by the rabbits, whose 
carotid and cervical arteries he had tied, viz., coma, convul- 
sions, and all the after phenomena of epilepsy. But in asthma 
we have as nearly as possible the converse of all this. So far 
fix>m there being coma or unconsciousness, there is quickened 
perception; instead of convulsions, we have absolute stillness 
of every limb and muscle, with one grand exception, the 
mnades of respiration. All these, and none else, are in a 
'Siite of violently exalted action. So that we may, without aja.^ 



348 Leettt/re hy Dr. Russdl. 

conceit of language, call asthma epilepsy of the tespixatory 
apparatus. 

The respiratory apparatus consists of a certain arrangement 
of muscles and of nerves, by which the chest is expanded and 
the lungs inflated. Clearly to understand the phenomena of 
asthma, we must fully comprehend these two sets of apparatus. 
The muscles of the trunk which are brought in aid of the 
common respiratory muscles are thus described by Sir C. Bell : — 
*' If we look upon the frame of the body for the purpose of 
determining what are the muscles best calculated to assist in 
the motions of the chest when there is an increased or excited 
action, we shall have little difficulty in distinguishing them; 
and we shall have as little hesitation in assigning a use to the 
nerves which supply those muscles exclusively. These muscles, 
in effect we see powerfully influenced by deep inspiration, how- 
ever excited. They are the mastoid muscle, the trapezius, the 
serratus magnus, and the diaphragm. They operate in a circle, 
and all would be useless in the act of respiration were one to be 
wanting. The servatus magnus expands the ribs ; but this it does 
only when the scapula, to which it is attached, is fixed ; and unless 
the scapula be fixed, this muscle has no operation in breathing. 
The trapezius fixes the scapula by drawing it backwards and 
upwards. These two muscles must always correspond in action 
in order to expand the chest. Now let us see how the tra- 
pezius influences the operation of the stemo-cleido-mastoideus. 
The mastoid muscle elevates the sternum ; but only when the 
head is fixed, which is done by the action of the trapezius on 
the back of the head and neck. To this train of coimections 
we may join the diaphragm itself, since, without the action of 
the serratus, the margins of the thorax would sink in by the 
action of the diaphragm, and the force of that muscle would be 
consequently lost." 

This description by the masterly pen of Sir C. Bell, exhibits 
at once the peculiar form of the upper part of the back, and 
habitual attitude of the asthmatic His shoulder-bladei haT« 



Lecture hy Dr, Russell, 349 

been so often raised and fixed, to give purchase to his serrati 
muscles, that his shoulders have become permanently round 

So much for the external muscles of respiration. Let us 
now glance at the sketch by the same hand of the nerves 
devoted to associate these muscles in combined action. *' The 
nerves on which the associated actions of voluntary BJid excited 
respiration depend, arise very nearly together. Their origins 
are not in a bimdle or fasciculus, but in a line or series, and 
form a distinct column of the spinal marrow. Behind the 
corpus olivare there is a portion of the medulla which belongs 
neither to the motor nor to the sensitive tracts, and which on 
dissection wiU be found to have more direct connection with 
the corpus restiforme. This fasciculus, or virga, may be traced 
down the spinal marrow between the sulci, which gives rise to 
the anterior and posterior roots of the spinal nerves." 

" From this tract of the medullary matter on the side of the 
medulla oblongata arise in succession from above downwards, 
the portio dura of the seventh nerve, the glosso-pharangeus ; the 
nerve of the par vagum, the nervus ad par vagum accessorius, 
and, as I imagine, the phrenic and external respiratory nerves." 

Thus the principal seat of the power which controls respira- 
tion is within a very narrow compass. Now as epilepsy is 
held by Schroder van der Koch to arise from a morbid con- 
dition of a small portion of the medulla oblongata, so pro- 
bably does asthma, or at least the disposition to asthma, de- 
pend upon a chronic-inflammation (shaU we say?) of a 
contiguous part of this vital structure ; and as the only con- 
ceivable means of a radical cure of epilepsy, is by remedies 
which act upon the origin of the disease, so I believe that we 
shall find that to cure asthma we must look not so much at 
the outward manifestation of the malady, as at its inward 
source. Suppose we are right in this interpretation of the 
pathology of asthma, and that the disease depends upon a 
morbid condition of what for want of a better name, we may 
denominate, after Bell, the respiratory tract ; what should we 



3 50 Lecture hy Dr, Russell 

expect to result from such a condition of the origin of the 
nerves? Let us see what takes place in epilepsy. Here 
we have, in consequence of a similar state of the roots of the 
nerves of common sensation and motion, the following pheno- 
mena. 

Ist. A peculiar morbid sensation — a modification of the 
ordinary sense of feeling, known by the term, av/ra epilqptica- 

2nd. After this peculiar sensation has been borne inward to 
the centre, we have by the law of reflex action, certain twitches 
in the muscles of the face and eye, because the roots of the 
nerves which supply these muscles, have been excited by the 
in-borne impulse known as a sensation. 

What have we in asthma ? 

Suppose the nervtcs vagtcs to be morbid at its root, what 
should we expect to be the phenomena ? Why, that as one of 
its offices is to endow the lungs, not with common sensibility, 
but with the peculiar sensibility which enables them to per- 
ceive the presence of unoxynated blood, and to transmit an 
order, so to speak, for a fresh supply of air, that they may be 
permeated by the vital fluid ; so, when there is a morbid con- 
dition of the pulmonary branch of this nerve, there is, as a 
necessary consequence, a preternatural sensitiveness to the 
natural stimulus, and hence there is a cruel craving for fresh 
air, giving rise to a sense of suffocation." This sense of 
suffocation, when it arrives at the centre of consciousness and 
the origin of motion, immediately calls into the greatest ac- 
tivity the whole muscular apparatus at its disposal, to relieve 
the anguish produced by this intolerable sensation — ^this true 
mimic death — long drawn out — which the asthmatic endures ; 
a sense of suffocation — but not suffocation — ^is the essence of 
asthma, for there is no lack of air in the lungs. Instead of 
there being too little air in them, they are distended almost to 
bursting; but the air does not satisfy the craving. The 
patient sits with his mouth open, gasping like a fish out of 
water. From the mouth and nostrils to the innermost cells of 



Lecture by Dr. Rvssell. 351 

the lungs, there Is no Impediment to the entrance of the vital 
breath ; but it does, so far as his sensatisns go, no good. How 
does this affect the circulation ? The over-distended air-cells 
do not permit a free entrance of blood through their capillary 
vessels: the consequence is, that along with an inordinate 
appetite for, not air, but vivication of the blood — this being 
what we mean when we speak of want of breath — ^there is a 
deficiency in the process by which the venous blood is reno- 
vated. Too small a quantity passes through ; what does pass 
however, undergoes the necessary changes ; it reaches the left 
auricle in a sparing stream, but what gets there is arterial 
living blood, not dead venous blood. This limited supply of 
stimulating blood, excites the heart, which propels it rapidly 
but feebly through the system at large, and up to the brain. 
The pulse is rapid and small in consequence ; the skin shrivelled 
and cold ; the brain clear— often wonderfcdly cleai' — ^but not 
fit for any effort 

If the air instead of entering, as I believe it does, the 
tissue of the lungs, were shut off, as our authorities tell us it 
is, what would be the condition of the blood ? Why, manifestly 
it would be yenous, and we should have venous blood entering 
the left side of the heart, and thence transmitted through the 
brain. Now if for hours this was to go on, how is it possible 
that the person could avoid manifesting the unequivocal sjnoap- 
toms of venous congestion of the brain ? We know what these 
are, — ^we know exactly how long it takes to induce coma and 
convulsions, and yet there is no instance on record of either 
coma or convulsions being induced by attacks of asthma, even 
although of the severest and most enduring kind. 

Among the arguments usually advanced in support of what 
I look upon as the erroneous though prevailing doctrine of 
asthma being a spasm of the entrance of the air-cells, one 
much dwelt on is the instant relief which is given by what 
are considered sedatives. I believe there is here a double 
fidlacy; first, that what is relieved is not a preventing spaam.^ 



352 Lecture by Dr. Russell, 

but an uneasy sensation — anxiety — and that the so-called 
sedatives relieve this either in virtue of their specific action on 
the nerves, by curing the morbid condition of which this is a 
symptom, — as happens when Ipecacuhana and Lobelia do it, or, 
when Chloroform and Opium are the means successfully em- 
ployed, it is in virtue of their primary or stimulating, and not 
their sedative action, that they effect the change. Nothing 
exemplifies this better than the relief given by burning nitre- 
paper, one of the palliatives most frequently efficacious. So 
far from the fumes of the nitric-oxide, which is liberated by 
the combustion of the nitre being of a sedative or soothing 
nature, they are intensely irritating to the air passages, so that 
a person who has riot asthma, if he attempt to breathe this 
vapour, is certain to be attacked with a sense of suffocation and 
a fit of coughing. 

While we regard the essence of asthma to be an exaltation 
of the peculiar or specific sensibility of the pulmonary branch 
of the par vagum, from some morbid condition of that portion 
of the spinal chord whence this nerve springs, as well as a 
morbid state of the other nerves of inspiration depending upon 
something vicious at their roots, so that they convey an un- 
natural stimulus to the muscles they supply, which induces 
them to take on a spasmodic action — just as those of the 
limbs do in epilepsy, we must at the same time remember 
that the functions of the nervus vagus is very complex, and that 
it is not merely a nerve endowing the lungs with their peculiar 
sensitiveness to the presence of venous blood in their capillaries ; 
but also the source of nervous influence to the mucous and 
muscular tissues, which enter into the composition of the rami- 
fications of the bronchial tube and air-cells. 

Now let us inquire into the effect of the enfeeblement of this 
supply of nervous force to the mucous membrane, and the 
muscles of the bronchial tubes — so beautifully delineated by 
Eeisseisen. We know by abundant physiological experiments, 
as well as by pathological conditions, that when any mneous 



On^Asthmn. 353 

membrane is depiiyed of its natural amount of nervous in* 
fluenoe the consequence is, that the capillaries of tiie part so 
maltreated enlarge, and, if the process be of long duration, that 
instead of secreting their natural mucus, they first become dry 
imd then secrete an altered or puriform discharge. This is 
well illustrated in the eye. Such a change takes place in the 
mucous membrane which lines the bronchial tubes and air-cells 
under the influence of the insufficient supply of wholesome 
nerve-force they receive from the morbid par vagum. At firsts 
along with dyspnoea, there is dryness of the membrane, after a 
little time the dryness gives place to an hypersemic condition 
of the parts, and this, the second stage of the quasi-inflamma- 
tory states terminates as all inflammation tends to do, by 
resolution, and a discharge of some secretion from the mucous 
surfftce, — at first slight and viscid and gelatinous, and after- 
wards more or less copious, sometimes extremely so, and very 
watery. Here, then, we see how naturally true nervous asthma 
associates itself with bronchitis. 

Such are the consequences of a depraved condition of the 
mucous membrane incident upon an insufficient supply of 
nervous force. Now what effect has this arrest of wholesome 
nerve-force upon the muscular tissue? Probably it induces, 
in the muscular tissue which surrounds the extreme ramifica- 
tion of the bronchial tubes, a condition analogous to that of 
the voluntary muscles of an epileptic po-son, viz., a tendency 
to assiune spasmodic contractions, combined with weakness 
of their structure. And the result ? Obviously to obstruct 
the passage, into the walls of which they so largely enter, and 
to prevent, sometimes it may be the entrance into, but probably 
more frequently, the exit, of the air out of the terminal cells, at 
whose mouths they are placed. If their spasmodic action pre- 
vent the entrance of the air in sufficient quantity, then we have 
ike symptoms of asthma assuming those of true suffocative 
catarrh, a dangerous, but fortunately a comparatively rare 
£nm of the disease. If, on the other hand, the spasm shata 

1% 



354 Lecture by Dr. Russell 

the door against the exit of the air, the consequences are 
enlargement of the air-cells, or perhaps their rupture, and 
emphysema of the lungs ; and as there is increased difficulty 
in transmitting blood through the lungs when they are in this 
condition, of course to overcome this obstacle greater force is 
required by the heart, and hence, along with emphysema of the 
lungs, we have associated an enlarged heart. But the enlarge- 
ment of the heart does not imply an addition to the strength 
of its walls; on the contrary, along with dilatation of its 
cavities, there is often combined a degeneration of its structure, 
and we thus reach another link of the chain by which the 
asthmatic is in danger of being let down to his grave. 

Emphysema, that is, permanent dilatation of the air-cells of 
the lungs, arising either from their over-distention in conse- 
quence of the difficulty of exit of the air from an obstruction 
in the passages through which it escapes, or from a simple 
over-action of a portion of a lung to compensate for the under- 
action of some contiguous part, in consequence of the latter 
being supplied with a deficient quantity of air, or of its being 
unable to appropriate what we may call the nourishment out of 
its supply, from paralysis of its nerves ; emphysema, implying 
almost as a necessary consequence cardiac disease, is one of 
the most important and dangerous complications of asthma. 
When the heart is much aflfected, the change in its form and 
size can be detected by its pulsations being felt more markedly 
at the scrobiculus cordis. The late Dr. Todd, in speaking of 
this symptom, observes {''Medical Oazette" vol. xlvL p. 1001) : 

" I look upon this sign as one of the most characteristic 
symptoms of asthma; and I consider its presence in every 
case where I suspect asthma, as a clear confirmation of the 
correctness of those suspicions. In accordance with this view, 
one of my first steps in examining a patient whom I suspect 
to be asthmatic, is to apply my finger to the scrobiculus cordis. 
If I find no beating of the heart there, my conclusion is a con- 
tingent negative. But if I find it beating there and not in ita 



On Asthma, 365 

natural position under the nipple, my conclusion is a certain 
aflfirmative." I quote Dr. Todd's expressions, not that I agree 
with them ; for I believe — indeed I am certain — ^that a person 
may have most unequivocal asthma for many years without 
the heart being at all moved out of its natural place ; but I 
quote them because they give a valuable hint, which it is well 
to follow in the examination of all cases of asthma. 

The following narrative of a case treated in this Hospital 
last summer, well illustrates the danger of this complication. 
It is as follows : — 

William Smith, a plumber and painter by trade, applied to 
be admitted as an out-patient on the 1st of January, 1862. 
He stated, that for several years he had been subject to a cough, 
which lasted generally the whole winter. This year it com- 
menced in November, and continued ever since. The cough 
occurred in paroxysms, chiefly in the morning and evening, 
and was attended with little or no expectoration. He had 
diflSculty of breathing with it, and of late occasional sharp pain 
about the region of the sixth rib, on the right side. There 
was nothing in his appearance at this time to indicate any 
unusual risk, and the case seemed like one of the many 
hundreds of winter catarrhs which crowd the out-patients' 
waiting-room. At the period of his admission, he was ordered 
Bryonia, and the pain in the side was reported as being gone 
when he returned. However, on the 22nd of January, there 
was an increase in the cough, and in addition he complained of 
more wheezing, and an uneasy sensation, rather than a positive 
pain over the region of the sternum. On the 6th of February- 
he returned, and stated that the pain or uneasiness was gone, 
but that there was no improvement in the cough or dyspnoea, 
and that he had observed some swelling of his legs. He was 
admitted as an in-patient on the 13th of February. On ad- 
mission, the expression of his countenance was anxious, and 
the skin was suffused with a dark purplish hue ; the respira- 
tion wag hurried, and difficult. There was free expectoration ot 



366 LeeturB hy Dr. RtuselL 

muco-purulent sputa. There was no pain In the chest, except 
such as resulted from the frequency and severity of his fits of 
coughing. The skin was hot ; the pulse 120 ; fall, rather sharp, 
the tongue was clean ; appetite good ; bowels regular* There 
was considerable oedema of both legs. 

His treatment consisted in the administration of Aconite and 
Arsenicum, and his strength was ordered to be sustained by 
appropriate food, and if required he was to have wine. 

All the symptoms became steadily and rapidly worse, and he 
died on the evening of the 19th, having been six days in the 
hospital. 

The result of the post-mortem examination, made by 
Dr. Neatby, who was then house-surgeon, is thus recorded ^ — 

On opening the chest about half-a-pint of serous fluid was 
found in the right pleura, as well as some old adhesions. Both 
lungs were emphysematous. On cutting into the trachea and 
bronchi, the mucous membrane was found congested throughout^ 
and covered by purulent exudation. The smaller bronchial 
tubes were quite filled with this fluid. 

In the pericardium about an ounce of serous fluid was found 
The heart was of dovhle its natural size. The left cavities were 
those chiefly enlarged. The walls of the heart were thin, pale, 
and fatty. There was slight thickening of the mitral valve. The 
tricuspid was normal The liver was found in a state of fatty 
degeneration. The spleen and kidneys were healthy, as also 
were the brain and its membranes. 

What strikes us in considering this case is, not that the man 
died, but that he continued to go about his work till within a 
month of his death. And the important lesson we learn from 
it is, that we should be very cautious not to underrate the 
danger of an attack of bronchitis, when it occurs in a person 
who has long suffered from asthma, or any affection of the 
chest, which predisposed the heart to be enlarged, and where 
emphysema is present. For we are apt to suppose, that if 
any one has been long subject to a winter cough, that there is 



On Asthma. 357 

no great danger In it, and if he consults us for apparently an 
ordinary attack of his familiar enemy, we may very easily 
overlook the fact that his previous illnesses, so tax from enuring 
him to their consequences, have each somewhat driven in the 
mine which at length was destined to sap the walls of his 
citadel of life. Kor is it so easy to determine the state of the 
heart as we are led to suppose from our books. When we put 
our ear to the chest of a patient who has long suffered from 
bronchitic asthma, we hear nothing but a confused sound of 
cooing, and whistling, and hissing, so that it is wholly 
impossible to ascertain whether the heart's action is natural in 
its intensity and lythm. Ab to its position, it may be con- 
siderably displaced, by enlargement, without our being able 
to detect it. For, be it remembered, that the whole cavity of 
the thorax is of unnatural size, and that the emphysematous 
lungs may quite overlap the apex of the heart, and prevent our 
discerning its situation by percussion, while the expansion of 
the parietes of the thorax, and^their unnatural position, prevent 
our accepting them as the landmarks for determining the point 
of impact Although the heart-beat is felt most distinctly 
under the fifth rib, it by no means follows that the heart is not 



I believe, indeed, that we gather as much, or even more 
£rom the general £fymptoms, than we do firam the most adroit 
topical exploration of the chest. 

The symptoms which indicated danger in the case just 
narrated were : — 

1« The expression and colour of the face. In forming an 
^ opinion on a case of dyspnoea, we are much guided by the 
ai^oarance of the patient* There ia a well-marked difference 
between simple anxiety, however intense, and suffocation. The 
difference consists more in the colour of the skin than in the 
expiendou of the features. In some asthmatic dyspnoeas the 
£ace is always pale, in suffocative dyspnoea it is always more or 
loss livid, and whenever we perceive this purple colour of the 



358 Ltcture by Dr, Rusull 

face, and esi)ecially of the lips, we may apprehend more or less 
of danger. Tliere is also a great difference in the expression 
of the eye. In a paroxysm of asthma, however wearied this 
organ appears to be from want of sleep, it never assumes the 
dull torpid appearance which characterizes orthopnoea, and 
suggests the danger of death being at hand. 

2. Then we had here swelling of the legs. This is so 
notoriously a symptom of approaching demger to life, that there 
is no need of pointing it out as such : rather I would suggest 
the propriety of qualif}ing the unfavourable prognosis derived 
from this symptom in certain exceptional cases. (Edema of the 
legs I have met with in cases of chronic bronchitic asthma 
when they assumed an acute character, and I have known 
high medical authorities pronounce a very unfavourable 
judgment on the case in consequence, and yet I have seen the 
patients, on whom sentence of death has been passed by 
competent judges, entirely recover. In such cases the asthma 
has been complicated with gout, and the oedema has been due 
in some way or other, which I do not venture to explain, to the 
gouty action exerted in the feet. The only means I know of 
by which we can discriminate between the oedema, which is the 
precursor of a fatal termination, and that wliich preludes a 
favourable issue, is this : — In the former, along with the progress 
of the oedema, there is a steady, and generally a rapid, aggrava- 
tion of all the unfavourable symptoms, while in the latter 
there is a mitigation of these, coincident with the increase of 
the swelling of the lower extremities. Also we notice, that 
in gouty oedema one foot and leg is generally more affected 
than the other, while in the oedema from organic disease in 
heart or liver both lower extremities are generally pretty 
equally affected. 

3. The pulse was 120 full and rather sharp. There was 
nothing in this rate or quality of the pulse in itself suggestive 
of danger. What gave a bad significance to it was that it was 
not affected by aconite. I always augur unfavourably of an 



On Asthma. 369 

acute disease, when the pulse either continues to rise, or does 
not fall under the steady administration of this medicine. 

It may be useful to contrast with this fatal case one or two 
others which terminated favourably. Of such we have had 
very numerous examples. 

Edward Bristow, a porter by occupation, of 26 years of age, 
was admitted on the lOth of September, 1861. He states 
that from his childhood, he has been subject to attacks of 
dyspnoea. That four years ago he had hemoptysis attended 
with cough, much expectoration, loss of flesh and debility. 

His present attack began some weeks ago, and has been 
steadily increasing ever since. 

On admission his countenance denoted great anxiety (but 
there was no lividity mentioned in the report, and we may 
presume this symptom was not present). There was very urgent 
dyspnoea. He could not lie down on his back. The cough was 
very frequent, and followed by abundant expectoration of glairy 
mucus. Percussion sounds clear. Loud mucous rales were 
heard on ausculation all over the chest. The skin was hot and 
the pulse 120. 

He was ordered Aconite 3 d. dil. gtt. ii. every four hours — to 
be followed by Bryonia 3rd. dil. gtt. ii. The report on 12th 
is : — ^Very much better. Has slept well. Anxiety of coun- 
tenance quite gone. Cough and expectoration both much 
diminished. Continue the Bryonia. 

13th. — Had an attack of dyspnoea this evening, with loud 
wheezing. 

R Arsenicum 3rd. dil. gtt. iL every four hours. 

16th. — Much improved every way. Continue the Arsenicum- 

21st. — Convalescent. He was discharged on the 22nd. 

A recovery from so sharp an attack of bronchitic asthma in 
ten days, with a steady amelioration of all the symptoms after 
twenty-fours' treatment, may surely be considered as indicating 
the curative power of the remedial measures employed. 



360 Lecture by Dr. Rvs&clL 

There is one of the symptoms mentioned in the history of 
the case, on which it may be worth while to ctfer & few 
observations. I mean the previous homoptysis. It will be 
observed that this man had four years before the attack, for 
which he was admitted into this hospital, aU the symptoms 
usually indicative of phthisis pulmonum, viz., cough, hoemop- 
tysis, much expectoration, loss of flesh and weakness. Now, 
1 have met with cases in private practice, in which, from the 
presence of these symptoms, the patient was pronounced to be 
in a consumption, and which afterwards turned out to be cases 
of asthma, and not of phthisis. The differential diagnosis 
of these two very different, and in feet, I believe, reciprocally 
exclusive conditions, is by no means always so easy as books 
would make it appear. It is often necessary to watch a case 
for some time betbre we can positively pronounce upon its 
nature. As a rule the hoemoptysis of phthisis is different 
from that of asthma. The former when not a copious haemorrhage 
from the lungs (and such an event is an exception), consists 
of a slight admixture of blood with the expectoration, a mere 
streak as it is generally called ; in asthma the blood is not 
mixed with the expectoration, it comes up pure, and generally 
florid. It seems to give relief, and is probably a spontaneous 
hcemorrhage by which the hypenoemia of the capillaries is 
relieved. It indicates no permanent structural change in the 
pulmonary tissue. In fact it resembles the pulmonary hcemor- 
rhage which we so frequently see in hysterical patients, especially 
when there is a suppression of the catamenia. I look upon 
hoemoptysis as a good symptom in asthma, but in phthisis it is 
always bad. The asthmatic generally improves rapidly eSter it, 
and is often for a long time free of a paroxy of dyspnoea ; 
it is not in him attended by hectic flushings in the face, or 
wasting night sweats. Whereas, in the consumptive patient, 
hoemoptysis generally is the precursor of an increase of all his 
sufferings — it is the index of a fresh inyasion of his deadly 
tubercles upon some fresh portion of his lungs. I will conclude 



On Asthma. 361 

thia leetnxe with the narrative c^ another oase, wlaeh I find 
entered in the Jontnal of the Hospital as asthma >^ 

Jane Staflford, 24 years of age— -uiunarried-— a domestic 
servant by occupation, was admitted on the &th of December, 
186L 

She stated that on the 26 th of November she began to 
suffer &om pain in all her limbs^ and indisposition. She was 
so unwell as to be obliged to keep her bed. On tiie 28th she 
had an attack of shivenng, which was followed by alternate 
heats and chills* On the following day, the 29th, the dyspnoea 
became much worse, and then she began to cough. The cough 
was slight^ and attended with sharp pain under left maroma. 
She suffered besides from a sense of burning below ibe 
sternum^ 

On admission, the restoration was hurried and attended 
with much difiSoulty. The nostrils dilated at each inspiration. 
Thsre was great wheezing. There was little cough. The 
cough was imattended with any expectoration, and gave no 
itelief. On auscultation sibilant and sonorous rales were 
heard all over the chest. The pulse was 76, weak. The 
toi^e was thinly fhrred. There was much thirst. The 
bowels were confined. The urine natural 

R. Aconite 3rd dil. gtt. j. every four hours. 

Dec. 8th. — Complains of feeling sick; much difficulty of 
breathing, with wheezing ; bowels confined. 

R. N ux. Vom. 3rd dil. Three times a day. 

Dea 9th. — Breathing less difficult; sibilant and sonorous 
rales not so loud. No nausea. Bowels have been relieved. 
S;. Arsenicum, 3rd dil. gtt. j. Three times a day. 

Dec. 13th. — Has slight cough, with scanty mucous expec- 
toration. Dyspnoea occasionally considerable. Still dry sounds 
heard in the chest ; appetite better ; tongue slightly furred. 

Cent. Arsen. 



362 Casa by Mr, Teldham. 

Dec. 20th. — Much better; dyspnoea almost gone; respira- 
tory murmur natural ; only now and then dry wheezing sounds 
are audible ; hardly ever coughs. 

Dec. 24tL — Dismissed, quite welL 

This I look upon as a case of true incipient asthma, rapidly 
arrested. Its history corresponds exactly with that given by 
old sufferers from this complaint. They tell us how very oiten 
in November they begin suddenly to wheeze and feel great 
uneasiness in the chest, attended with slight cough, or none 
at all, and no expectoration ; how this difiSiculty of breathing 
became worse at some particular hour, generally in the early 
morning, and generally established itself into a habit of 
regidar asthmatic paroxysm, of longer or shorter duration; 
and how, after some weeks, there was improvement, and a 
return on exposure to cold or any depressing influence, until 
at length they found themselves fairly enlisted among asth- 
matics. That this would have been the course of this girl's 
case if she had been left to nature, as it is called ; that is, if 
according to the precepts of young physic, we had left ill 
alone, 1 firmly believe, and in my next lecture I will enter 
into a detail of the remedies which I have found most suc- 
cessful in asthma, and the indications for their use. 



CASES TEEATED WITH HIGH DILUTIONS. 
By Mr. Teldham, M.RC.S., Suegeon to the Hospitax. 

Case XII. 
Jane Aldis. Aged 35. A Laimdress. Admitted April 7 — 
1864. April 25th. — Eesult, cured. 



Cases hy Mr, Yeldham. 363 

Chronic Vomiting, Always delicate tiU menstrual period at 
nineteen. Then had better health, married, and had three chil- 
dren. Catamenia stopped for two years after birth of last child ; 
was treated allopathically ; they returned ; got better ; then 
stopped again, and have been irregular ever since, generally 
pale and scanty ; has had leucorrhoea six or eight weeks. For 
about two years has been troubled with vomiting of food ; went 
to consult a herbalist for general debility, and after taking his 
medicine her stomach became so weak that no food was re- 
tained. Took some assafcetida pills ; has been in her present 
state, off and on, ever since. 

Now complains of constant vomiting of aU food, which turns 
acid on her stomach, the ejecta being sour and bitter, and 
coming up a little at a time ; weight, oppression and flatulence 
great after food ; intense heartburn ; relief only by keeping the 
stomach empty ; tongue moist, pallid, and rather enlarged ; 
bowels very costive; clay-coloured evacuations; violent head- 
ache around the forehead ; heavy and dull ; much perspiration 
during sleep, which is very heavy. 

Take Ipecacuanha, 200 ter. die. 
April 11th. — ^Vomiting better ; she has milk diet, having 
previously taken all kinds of food. 

Continue same medicine. 

April 15th. — No vomiting; retains solid food; feels 
stronger, and in "every way much better; disturbed state 
of nervous system in sleep ; depression of spirits when 
awake. 

Take China, 200 ter. die. 

April 18th. — The last-named symptoms relieved; sleeps 
comfortably. 

Continue. 



364 Casu by Mr. Yildhcm. 

April 20th.-— Has taken cold; soBie coughs with paUi in 
chest ; in other respects quito well. 

Bryonia, 200 ter. dia 

April 25th.— -Quite well, and is going out. 

Case XIIL 

John Sp£NC£IU Aged 20. Admitted March 15th, 1864. 
Discharged April 20th, Result, cured. 

Eczema. — States that five months ago, in jumping out of o(ne 
van into another, grazed both legs on the shins ; the sores were 
aggravated by his scratching them. Applied dry rags, and they 
got well in three months. They remained well for a month, 
and then began to itch very much, and both hands and arms 
broke out in the same manner. They have been rapidly getting 
worse. 

On admission, the legs present the following appearance: 
The calves of both legs and front of shins are covered with 
almost continuous patches of scaly, oozing, and pustulous enip- 
tion, resembling a mixture of pustular scabies and eczema. It 
extends more or less from the knee to the foot. There are large 
pustulous, scabby patches on the back part of both thighs ; there 
have been some on the inner side of Hxe thighs and under 
both knees, but these are drying up. No eruption in tiie face. 
On the arms there are large pustulous scabs, principally on the 
outer side, extending down to the hands and between the 
fingers, with small spots resembling the common form of simple 
scabies. The itching is not so great as it has been. Bowels 
regular, tongue coated. Has been using sulphur ointmen for 
three weeks up to this time. 

Take Sulphur, 260 ter. die. 

23rd. Slight amendment ; but the legs have itched much 
the last two nights. 

Sulphur, 3 ter. die. 

25th. Much the same. 

Continue Sulphur, 3rd. 



CoHi by Mr. Yddham. S65 

March 28tlL Both legs still oovei^d with scabby oozing 
eczema. Eaw uk^rationa in some places. Amendment not 
decided. 

Take Arsenicum, 200 ter. die. 

April 20th. Has continued the same medicine uninterrupt- 
edly since the last report (three weeks), and has uninterruptedly 
improved. The legs are free from sores and scabs, the skin is 
quite sound, and only retains the stains of the previous erup- 
tion. The same of other parts. He is discharged, cured. 

Case XIV. 

Elizabeth Ball. Aged 42. Single, a servant Admitted 
Dec. 3rd, 1863. Discharged Dec. 30th. Result, cured. 

Ovaritis. — ^Dec. 4th. — ^Two nights ago was seized with 
violent pain in right iliac fossa, extending to the abdomen and 
extending up to the epigastriuuL The epigastriimi and abdo- 
men still tender to the touch. Cough increases the pain. Very 
tiiirsty, and no appetite. Pulse 100. Copious leucorrhcea. 
Pain and some difficulty in micturition. 

Take Aconite 200, every four hours. 
5th, — Mensturation has set in. Quantity large. 
7th. — No better. Severe pain in right iliac region ex- 
tending to the hip, and painful to move. Pulse 100. 
Take Aconite 3, every 4 hours, 

9th. — Easier altogether, but still has pain over the right 
iliTiTn. 

The same medicine. 
12tL — ^The severe pain in iliac region nearly, but not quite 
gone. 

Same medicine. 

14th. — ^Better constitutionally and with reference to the 
iliac pain, but it is stiU felt on deep pressure. 
Pulsatilla 200 ter. die. 



366 Cases by Mr. YeldhanL 

I6tli. — Has pain and difficulty in micturition. 

Cantharis 200, every 4 hours. 
19th. — Better. Micturition easier. Iliac pain easier. 
The same medicine. 

21st. — Scarcely any pain in micturition. Has a watery 
discharge per vaginam ; at times of a thick mattery nature, 
with pain in utero, felt most when sitting up. 

The same medicine. 

23rd. — Better in all respects. 

Continue. 

26th. — Slight tenderness in iliac region, felt only on a deep 
pressure. On examination, per vaginam, four days ago, slight 
displacement only of the womb was detected. Still has copious 
leucorrhoeal discharge. 

Take Pulsatilla, 200 ter. die. 

30th. — Feels perfectly well, excepting some weakness, and 
some leucorrhoeal discharge, which she has been subject to the 
last four years. 

Discharged. 

Case XV. 

Charlotte Edmunds, aged 30. — Admitted March 5, 1864. 
Discharged May 4. Eesult, cured. 

Pneumonia. — ^A week ago was attacked with violent sick- 
ness, which lasted a day. She also felt a tickling sensation in 
the throat, which ended in a cough, with yellow expectoration. 
Every time she coughed, the pain caught her in the right side 
and under the right blade-bone. 

On admission, feels very weak and faint, and complains of a 
slight barking cough on exposure to the least draught of cold 
air. There is great shortness of breath, and frothy, rusty ex- 



Cases hy Mr. Yddham. 367 

pectoration. The physical signs are, general dullness on per- 
cussion over the right lung ; crepitus large, distinct ; tubular 
respiration over upper part of right scapula, and over the large 
bronchi. Left lung normal. Pulse regular, quick; tongue 
slighly coated and raw-looking. 

Take Bryonia 200, ter die, 

18th. — Feels better. Dyspnoea quite gone. Cough better. 
Expectoration still slightly tinged. Crepitation more circum- 
scribed, and confined to lower scapular region. 

Continue Bryonia 200, ter die, 

21st. — Feels better; expectoration still tinged; physical 
soimds the same. 

Phosphorus 200, ter. die. 

25th. — Pain in right shoulder, cutting her like knives, in deep 
inspiration; cough more troublesome; pulse 100; skin hot; 
physical sounds the same. 

Aconite, 200, a drop, 4 tis. horis. 

28th. — ^The constitutional symptoms described in last report 
have disappeared. The pain round right side still cutting and 
sharp, in deep respiration and coughing ; two nights ago expec- 
torated a considerable quantity of blood ; physical signs same : 
obtuseness, dullness in respiration, tubular sounds, crepitation 
stiU. distinct. 

Bryonia 200, a drop every 4 hours. 

30th. — ^More cough last night; expectoration still deeply 
tinged ; pain piercing chest from front to back on right side. 

Bryonia, 1*., 3 drops every 4 hours. 

April 1st. — Much relieved, cough better, and no tinge ; still 
some pain; the patient noticed a marked and sensible 
improvement on commencing the last medicine. 

Continue. 



368 Cam by Mr. Yeldham. 

6tL Glexiisial amcoidment ; physical signs improyed ; some 
oough at nighl, with very little expootoiatioD. 

11th. — Better; no coogh ; no expeotontian ; physioal signs 
nearly normal 

13th Has caught cold; is feverish, with hot skin and 

quick pulse. 

Aconite, 200, a drop 4 tis. horis. 

15th. — Hfo constitutional distorbanoe; but loose bronchial 
cough, and frothy expectoration. 

Tart Emeticus, 200, a drop, 4 tis. horis. 

22nd. Well; only weak. 

Omit medicine ; remain a few days to regain strength ; 
discharged on the 4th May. Cured. 

Case XVL 

Edward Letchford. Aged 17. Admitted April 6th, 1864. 
Discharged May 17th. Eesult, cured. 

Ulcerations of Leg. Was taken ill on 24th September, 
1863, with stiffness and soreness of right knee. Was treated 
for rheumatism. Three days afterwards the joint commenced 
to swell, and became red and very painful; about ten days 
afterwards an abscess broke in the calf of the leg, which re- 
leived the pain. It discharged much, and he got into a very 
weak sinking state. 

Wa s admitted an in-patient in St. Bartholomew's Hospital, 
on the 15th November, 1863. His health improved. About 
a week afterwards two other places broke out under the knee 
joint, and continued to discharge a great quantity. Linseed 
meal poultices were applied from the beginning during the 
night, and zinc lotion during the day. He took cod-liver oil 
and medicine the whole time. Was discharged from St. Bar- 
tholomew's Hospital on the 25th February, 1864, with the 
wound nearly healed, excepting the large one under the knee 



Cases hy Mr. Yddham. 369 

joint, but was continued an out-patient. About two weeks 
after the wounds opened afresL 

On admission, has a large ulcerated surface over the popliteal 
space, burrowing to a considerable extent under the fold of skin 
formed by the outer ham-string ; it measures about three inches 
in length, and the same in breadth. On the outer side of this 
there is another long shaped wound about four inches in length, 
and an inch across, and another large woimd exists over the 
calf, about three inches by three inches ; and there are other 
smaller ones on different parts of the leg and thigh, giving the 
whole posterior aspect of the limb, from heel to hip, a raw and 
ulcerated appearance. The surface of the ulcers are glazed and 
inactive looking, the edges nearly level with the surrounding 
skin. There is a slight amount of thin unhealthy discharge. 

To have Cod-liver oil. Apply Arnica lotion to the wounds, 
and take Calcarea, 200 ter. die. 

May 11th. — Amendment set in immediately on com- 
mencing the treatment, and has steadily continued. The 
ulcers, except the larger ones, have all healed, and these have 
contracted to so great an extent, as to cause him scarcely any 
trouble, and he wishes to be discharged. He is, however, 
advised to remain, and continue the same treatment, until the 
cure is completed. 

May 27th. — ^Discharged cured. 

Case XVII. 



Dunsford, aged 62, a goldbeater. Admitted, April 

26th, 1864. Discharged, May 23rd. Result, cured. 

Bronchitis and Vomiting. — Has had cold and cough, and 
expectoration of phlegm, for a month. He is now much worse 
in these respects. He wheezes, and coughs violently, espe- 
cially in the night, and brings up a large quantity of phlegm, 
and has shortness of breath. He has no appetite, and his 
toDgae is white and coated. Pulse quick. 

24 



370 Cases hy Mr. Yeldham. 

April 27tli. — ^Take Aconite 200, every four hours. 

April 29th He vomits everything he takes, and did so 

previously. In other respects much the same. 

Tart. Emeticus. 200. A drop every four hours. 
May 2nd. — Scarcely vomits at alL Cough better. 
May 4th.— ^Cough much the same. Vomited once to-day. 
Tart. Emeticus 3 every four hours. 

May 9th. — No vomiting. Cough nearly gone. In all re- 
spects much better. "He thinks the last medicine is doing In'tn 
a great deal of good." 

May 11th. — ^Vomited once, after meat dinner. Tickling 
cough. 

Continua 

May 16th. — No vomiting; iio cough. 

Continue Medicina 

Discharged a few days afterwards-r— cured. 



%mmh ai llj^ ^atut^. 



ON THE ALTEENATION OF MEDICINES. 
By Dr. Drysdale. 

The simple rule of Homoeopathic practice, which enjoins 
that the medicine chosen should be given a one, and continued 
till a change in the symptoms recognised by the physician 
becomes the ground of a change of the medicine, appears al- 
together to exclude the alternation of medicines, or any kind of 
prescription in which two medicines are ordered at the same 
visit. Accordingly, the great majority of systematic writers 
almost uniformly condemn the plan of giving medicines in 
alternation, and some go the length of saying that it is always, 
or almost always, a mere abuse, arising from the ignorance or 
indolence of the practitioner, who tries to make up for his un- 
certainty by the allopathic expedient of increasing his chances 
by what corresponds to mixing several medicines. I am not 
prepared to deny that in many cases, perhaps even the majority, • 
it is a mere abuse ; and I think that, even after all that might 
be said in its favour, it should not be considered as a practice 
standing on an equal footing with the nile of giving one medicine 
at a time, but can be admitted as an exceptional principle only. 
This much is necessary to be said in order to guard against the 
appearance of giving a preference to the plan of alternation, 
when the bulk of this paper will be about the cases in which 
it is allowable, while one sentence must include the much larger 
number in which it is not. 

While these systematic writers condemn tYie ^"Vsiii ot i!L\AT£i^r 



372 On the Alternation of Medicines, 

tion, nearly all practical men, and those very writers themselves, 
adopt it more or less in practice. The great reason of this is, that 
when we try to carry out the simple Homoeopathic rules, we 
are met by the difficulties caused by the complications that 
occur so frequently in actual practice. These are, every man of 
experience will bear me out in saying, much greater than is 
allowed for by the few meagre sentences in which they are 
touched upon by writers. Thus, in Trinks's Introduction to the 
Handbuch, we read, p. xxxi — " There can hardly exist a disease 
which requires the simultaneous exhibition of two or more 
medicines for its cure. The specifically useful medicine can 
always be only one, even when two acute diseases come on at 
the same time in one person {e.g, measles and bronchitis, or 
scarlet fever and malignant angina). The rational physician will 
always be able to cure the disease that most immediately 
threatens life with one medicine, and then cure the other with 
the most suitable medicine." 

Of course, if this can always be done, the question is settled; 
but everyone must feel that it is taking a great deal for granted : 
and cases are met with in which, while we cannot suspend the 
treatment of the main disease for the sake of some subordinate 
symptom or new ailment, yet the total chance of recovery may 
be imperilled by the urgency of some subsidiary symptoms 
(if really complications), such as extreme pain, cough, diarrhoea, 
sleeplessness, &c. In such case, therefore, unless it is maintained 
that the interposition of another medicine absolutely counteracts 
the main treatment, and renders it null and void, we are com- 
pelled to interpose a sufficient number of doses of another 
medicine, to correct symptoms which are not covered by the 
chief medicine, and thus virtually to alternate. This is by no 
means a hypothetical case, but one that must occur frequently. 
In fact, it is rather the exception, in acute diseases, that we can 
find instances where the sphere of action of one medicine is 
plainly indicated, and fully exhausted, before symptoms arise 
indicating some other medicine. If, therefore, we suspend the 



On the Alternation of Medicines, 373 

first medicine in favour of the second at one visit, and go back 
to the first at our next, this becomes, in fact, alternation of 
medicines. And this leads us to the definition of alternation, 
which I take to be the giving a second medicine while the sphere 
of action of the first is still unexhausted. If this be admitted as 
a proper rule for practice, though even as an exceptional one, and 
subordinate to the main rule of single medicines, it is obvious 
it must increase our resources considerably in the treatment of 
acute and complicated diseases, and, therefore, it becomes right 
to enter fully into the subject, and not give it the go-by, as is 
mostly done in systematic treatises on Homoeopathic practice. 
The only essay I can find devoted to the subject is by Dr. Gate, 
of America (Brit. Journal, xii. p. 589), whose arguments in 
favour of a regulated and systematised adoption of the practice 
I concur in to a great extent. 

Let us consider the objections commonly urged against the 
practice of alternation. The first is, that it amounts virtually to 
the same thing as mixing the medicines, which we all know to 
be contrary to the fundamental idea of Homoeopathy. To this 
I demur ; for the real objection to mixing the medicines is, that 
we have no grounds for believing that the mixture of two or 
more medicines will yield a product representing the combined 
virtues of the simple medicines of which it is composed. On the 
contrary, as far as experience goes, mixtures, even when not 
chemical combinations, yield a product very different from the 
component parts, and this even in the coarser symptoms recog- 
nised and used in Allopathic practice — as is seen in Dover's and 
James's powders, and many compound purgative pills. This is, 
no doubt, much more the case in the finer symptoms used by us, 
and in a mixture some of the ingredients would probably either 
not act at aU, or the action of the compound woxild be something 
quite different from the pure symptoms on which we ought to 
lely in prescribing. This is, of course, a fatal objection to the 
use of mixtures in Homoeopathy. But to say that two medicines 
ffYesi Bepaiatelyy at an interval long enough to allow them to 

25* 



374 On thf Alternation of Medidiies. 

take eftect iit all, combine with or counteract each other's efifects 
in the same way as if ^'iven at once, is an assumption of which 
we have as yet no proof, and which, on closer consideration, 
appe.irs somewhat inconsistent with the known laws of the 
action of medicines, and, of course, of disease. On this subject 
I may quote again fmm Dr. Trinks : — 

" ^Medicines that are unsuitable, not chosen on the principle of 
like, and thus not standing in direct relation to the character 
and seat of the disease, either do not act at all on the disease 
in resti-aining or cutting short its natural progress and develop- 
ment, or, if they merely act on the same part of the body as 
the disease, without being essentially similar in their action to 
the disease going on, they suspend the progress and develop- 
ment of the disease only as long as the action of this unsuitable 
medicine lasts, whereupon the disease goes on undisturbed in its 
course. Or, finally, if the medicine chosen has no relation at all 
to the disease, either in its character or seat of action, the 
disease goes on undisturbed ; and if, notwithstanding, the un- 
suitable medicine be gone on with, and in strong doses, we shall 
have, in addition to the disease, the peculiar symptoms of the 
medicine." — (Trinks's Handbuch, p. xxvi.) 

This is spoken of diseases, but it must apply equally to our 
Slateria ^ledica, which is composed of medicinal diseases ; and 
the effect of a second medicine given during the period of 
action of another must depend very much on the relation be- 
tween the two. If Homoeopathic, they may be antidotal ; but 
if Allopathic — i.e., acting in a different sphere — they may not 
interfere with each other, unless, indeed, it is supposed that 
any kind of medicinal action must necessarily interfere with 
and inteiTupt any other — a proposition which no one, and 
above all no Homceopathist, can maintain, who is always 
careful to l>ring forward instances in disease where two or 
more morbid states can co- exist, provided they are sufficiently 
dissimilar, it being one of the gi*eat proofs of the Homoeopathic 
jyrinciple that it is only similar morbid states that cure or 



Oil the Atteiiiaiion of Medidiie^. 375 

extinguish one another. There are, therefore, no a priori phy- 
siological grounds for doubting that two medicines whose 
physiological spheres are sufficiently dissimilar, can display 
their efiFects without interference when given at intervals. Let 
us apply this to the treatment of complications in disease, and 
by this we may cliiefly understand those symptoms or morbid 
states that are not necessarily dependent on one common 
proximate cause, but are connected merely by their happening 
to co-exist in the same individual. After exposure to cold, we 
may be attacked with inflammation of the nasal, tracheal, or 
bronchial mucous membrane, or parenchyma of the lungs, or the 
pleura, or the parietes of the chest, or the liver, or peritonaeum, 
&c., according to the specific susceptibility of the tissues attacked ; 
and each of these diseases may exist separately, and be attended 
with the appropriate essential and sympathetic symptoms of 
the case. In such case, we ought properly to rely on one 
medicine which may be reasonably expected to meet the 
specific susceptibility of the part primarily affected. But, on 
the other hand, from exposure to the same cause, inflammation 
may be set up in several of those tissues at the same time, and 
thus several trains of morbid symptoms set up that have no 
necessary connection except that of occurring in the same 
individual In that case, how can any one medicine be Homoeo- 
pathic to the case which does not show its specific relation to 
all those different tissues in health ? Nor can we say that it 
may be Homoeopathic in relation to the exciting cause, as 
that would be proving a great deal too much, and give us a 
nearly universal medicine if we had one Homoeopathic for all 
the effects of cold. Therefore, unless we are to treat only one 
morbid state, and run the chance of the rest waiting for their 
turn, we are compelled to consider whether we cannot supple- 
ment the action of one medicine by another given in alternation* 
Examples are also given by Dr. Gate, of injuries and accidental 
affections supervening on diseases already existing — such as a 
person suffering from frost-bite of the foot, may s^^Xio^ \cisi^\5^ 



370 On the Alternation of Medicines. 

acid, and set up inflammatiou of the stomacli ; or a person whose 
bladder was inflamed from cantharides might, from a fit of anger, 
get jaundice ; or one with inflamed hmgs from cold, might get 
peritonitis from a wound in the bowels ; and, in short, " more 
than one part of the system may be attacked with disease, and 
with disease, too, var}'ing as widely as the causes that may 
conspire to produce them." Therefore, it appears to me, though 
it was a great thing of Hahnemann to press forward the im- 
portance of looking for the unity of the affection of the whole 
system in the majority of so-called local diseases, yet that must 
not be carried too far, and Hahnemann himself allows for the 
case when a person imder treatment for chronic disease is 
attacked with a new acute disease. 

Now, when a person under treatment for some chronic disease 
gets a bruise, it is plain neither the treatment nor the disease 
prevented the specific phenomena, nor, therefore, should they 
prevent the action of its simile, the Arnica, which probably 
would, therefore, act equally well when applied locally, without 
suspending the treatment. How, indeed, for example, in a case 
of scorbutus, can we expect any local afiection to be cured with 
the bestvselected Homoeopathic local specific, so well if we sus- 
pended the internal dyscrasic treatment? The contrary is 
rather the case ; and this may not only justify internal alternation 
of Homoeopathic remedies for complications, but also the use of 
external Homoeopathic specifics, while continuing the internal 
use of a different Homoeopatliic remedy. As examples, we apply 
Arnica to contused vulva, whUe Aconite is given inwardly 
for milk fever; XJrtica for a burned hand, while Phos. may be 
given inwardly for pneumonia; solution of Nitrate of Silver 
may be applied to scrofulous comeitis and conjunctivitis, while 
Bellad. or Calc. are given inwardly, — all these remedies being 
strictly homoeopathic. 

Dr. Gate also brings forward inflammation of the mucous 

coat of the colon. When it extends to the peritonaeal coat of the 

gut, he gives Merc, corr* in alternation with Sulphur, corre- 



On the Alternation of Medicines. 377 

sponding to their specific action on their different tissues. Also, 
in inflammation of the membranes of the brain, threatening 
effusion, he finds Bryonia alternated with Hellebore more effica- 
cious than either singly. But this is already recognised in 
Homoeopathy, without stepping into the doubtful regions of 
pathology. To quote again from Trinks's excellent summary of 
practical rules in the Handbuch, p. lix. — " It is certainly de- 
monstrated by experience, that a medicine not covering ac- 
curately the morbid symptoms, but only a part, may take away 
that part, leaving the rest untouched, which may then be 
completely removed by another corresponding Homoeopathic 
medicine." On this principle. Dr. Hering cured a liver complaint 
with jaundice, by Euta alternated with Ignatia; Dr. Eimmiel 
recommended the now common alternation of Bellad. and Merc, 
in angina ; Ipec. and Antimon. in gastric disturbances ; Bellad. 
and Qraphites in lupus. But it is unnecessary to give instances, 
as they will be found in every collection of cases, and every 
systematic treatise, even by those who object to the alternation 
on the ground of its frequent abuse. 

With respect to the objection that alternation spoils the 
treatment, by one medicine interfering with and stopping the 
action of the other, that is already to a great extent answered 
in as far as they are dissimilar ; the antidotal relations come 
to be considered presently. But in as far as the giving a mere 
mass of heterogeneous medicines will affect the treatment, it is 
found not so bad as one would expect. No doubt, a con- 
tinuance of violent medicines, like a bad regimen of any kind, 
that pulled down the system, would interfere with the cure 
altogether. But still we have not a few examples where the 
patient has, through ignorance or design, taken, unknown to us, 
large doses of heterogeneous drugs, such as Quinine, or Opium, 
or purgatives, and yet our higher dilutions have taken effect 
notwithstanding. On this subject, Trinks confirms Kampfer's 
lemark, that in chronic diseases which have been long treated 
with excessive doses of Allopathic medicine, 'we oi\«ii feA ^ 



378 O/i the Alter iiaiiu)i of Medicines. 

great susceptibility to the action of the Homoeopathic medi- 
cines, which then frequently display rapid curative powers. 

Also, in acute diseases, Trinks remarks that we often see 
rapid action of our remedies in spite of the previous adminis- 
tration of strong Allopathic doses — as, for example, in croup, after 
Calomel had been used in lai'ge doses. 

Therefore, any evil that may arise from alternation, if too 
frequent or unskilfully done, will . not consist so much in 
spoiling the action of the right specific, if it has been hit upon 
among them, as in the simple loss of time consumed by the 
interposition of useless doses of other medicines. 

The abuse of alternation is only one mode of the abuse of 
medicines, and probably neither the most frequent nor the 
most hurtful. Certainly it is not so bad as the firequent 
changing of the medicines, even if that is done in succession, 
and not alternation. How often does it not happen to us to 
be called in, and find that a string of half-a-dozen medicines 
have been given in succession within so shoil; a time that it 
was quite impossible for any curative effect to have been 
exhibit<2d ? 

The question of alternation is also involved in that of the 
mutual relation of different medicines in their action on the 
susceptibility of the organism. Our real knowledge of the 
action of antidotes is still vague and imperfect. In reasoning 
on the matter, we can at first sight only imagine two kinds of 
antidote — first, those antidotes which simply remove the cause 
by chemically neutralising it, and evacuants wliich hasten the 
expulsion of the actual poison; secondly, various remedies 
which, by our knowledge of the Homoeopathic law, can only be 
other medicines or poisons, in fact, similar to the first. How 
then can camphor, -wine, coffee, &c., be antidotes? It is 
quite evident that if we admit the possibility of antidotes to 
the dynamic effects of medicines other than Homoeopathic, we 
strike at the root of the whole Homoeopathic law and practice. 
If we can get a suljstancc like camphor, that will simply stop 



On the Alternation of Medicines, 379 

the dynamic effects of medicines that have no Homoeopatliic 
relation to itself, why should we not get similar remedies for 
all epidemic and miasmatic diseases ? In that case, what be- 
comes of Homoeopathy, and all our careful provings, if we are 
to go back to the old vague notions of specifics that will simply 
stop diseases, we know not why or wherefore ? We are here 
in a difficulty ; and the only solution I can find for it is, that 
those things, such as camphor, coffee, &c., have no power of 
stopping or curing dynamic action of heterogeneous drugs ; but 
that they act by blunting the susceptibility of the organism to 
all impressions, and therefore they prevent many of the finer 
actions of medicines from taking effect and beginning at all ; 
but when they fail to do that, they have no effect. Now, 
while heterogeneous medicines like the above cannot stop 
dynamic action at all, and only act against it by extinguishing 
the susceptibility in general, the action of similar or Homoeo- 
pathic medicines must be the opposite — t.^., they can stop or 
cure the dynamic action — while their effect on the specific sus- 
ceptibility must be to increase it, for the same reason that in 
natural disease the susceptibiltiy to the Homoeopathic remedy is 
increased, giving ground for the action of our infinitesimal 
doses. 

A singulaily apposite illiistratiou of this is found in the 
physiological action of colours on the retina. By looking in- 
tently for a time on a red surface, the susceptibility of the 
retina becomes exhausted, and the red colour gradually fades 
away ; but, at the same time, the subjective complementary 
colour, green, becomes more and more intense. If the eye be 
now turned on an objective green surface, the green colour is 
at first increased in intensity and then extinguished.* This 
process gives us, by analogy, an example of the production of 
disease — the exaltation of susceptibility to a similar exciting 
cause, and a Homoeopathic cure. Now, the specific suscepti- 

• Arnold. Idiopathische HeilvcvfviAwew, ^* "i^^^^ 



380 On the Alternation of Medicines, 

bility to the action of specific stimuli which constitute our 
medicines is a very delicate thing, and is the basis of the greater 
part of Homoeopathic cures ; that is to say, the specific suscepti- 
bility in contradistinction to general susceptibility. For example, 
the susceptibility of the healthy stomach is almost always pre- 
sent to the nauseant action of Ipecacuanha, and by regulating the 
dose we can always produce it ; while, on the other hand, many 
of the febrile symptoms and other more peculiar actions of 
that drug cannot be produced at will at all in the healthy body, 
and will only appear in a limited number of persons who 
happen to have the susceptibility developed. In disease we 
generally find that the susceptibility to the Homoeopathic re- 
medy is present from the nature of the case, and our great 
object should be to manage the doses and repetitions so that it 
shall not be exhausted before the natural period essential for 
cure. This, unfortunately, however, not unfrequently happens in 
spite of varying the dilutions, or originally having chosen the 
best. In this case the plan has been adopted of interposing 
doses of another remedy as nearly as possible homoeopathic to 
the case. This must, of course, be an antidote ; but, as in the 
case of natural disease, it may tend to revive the susceptibilily 
to the first remedy, and this is, I believe, what usually takes 
place. In fact, in those cases in which it is found advantageous 
to alternate two medicines both homoeopathic to the disease, it 
is seldom that any antidotal action takes place ; but the action 
of the dose of one medicine is being exliausted when the 
second medicine is given, which carries on the case, and revives 
the susceptibility to the first. Bering and others have, how- 
ever, advised us sometimes, when the susceptibility is very dull, 
to give a strong dose of one medicine, followed by a dose of 
the homoeopathic antidote to act as such, and then continue the 
first in the usual small doses. This I have found of service. 
But no doubt the first is the rule, and no antidotal action is 
required, or in fact takes place. Upon this is founded the whole 
cioctnnQ and practice of intermediate remedies, and related and 



On the Alternation of Medicines, 381 

sequential medicines, as laid down by Hahnemann, and which 
I for one believe to be a good guide in practice. No doubt, 
the number of medicines given in handbooks which are related 
to each other, and may be given with advantage after each other, 
is often exaggerated, and too much stress laid on the order of 
sequence ; for, after all, it only amounts to saying that they 
resemble each other in their sphere of action, and therefore 
they are likely to be useful in the same cases, and may support 
each other on the above principle ; but still the choice of each 
must be determined by the symptoms of the case in hand, and 
not merely because it is in such a list. 

Upon these two principles — ^viz., the meeting of complica- 
tions, and the maintaining the susceptibility — j:ests the practice 
of alternation of medicines. And when used with due cir- 
cumspection, it is a practice that has proved useful, and de- 
veloped the powers of Homoeopathy. Numerous examples of 
that may be cited, though it is not always easy to say in each 
case which of these indicatioiis the alternation has fulfilled. 
In the excellent analysis of " Tessier*s Pneumonia Cases," by 
Dr. Bayes, we find several cases that improved rajDidly under 
alternation of Phosphorus with Bryonia, though the latter alone 
was not doing so much good as usual. Whether the action here 
was fix)m meeting some complication, or from acting on the 
susceptibility, or simply from Phosphorus being the right 
medicine, of course are points requiring a large series of ob- 
servations to determine ; but, at any rate, these few cases prove 
that the alternation did no harm to the action of the right 
medicine, if there was only one. Without the use of occa- 
sional alternation and intermediate remedies, we should be 
almost deprived of the help of a large class of serviceable 
medicines in chronic disease, such as Opium in constipation. 
Lobelia, Lactuca, &c., in asthma, CofiFea and Aconite in neu- 
ralgia, &c., &c. A difl&culty with respect to complications also 
arises owing to the imperfection and rudimentary state of evem 
the most modem pathology, which cannot ex\|\amV\v^^^«^^'«L^ 



oS2 Oil the Alternation oj Medicines, 

of the stages of a disease ; whereas, in relation to our remedies, 
we arc compelled to admit that, aud regard the different phases 
as distinct. Thus, in the early stages of pneumonia. Aconite 
is highly useful, while later on in the same disease it is of no 
service whatever. These two states, experience has shown, 
may, as it were, overlap each other, and thus he treated as 
complications, which in fact is done with Aconite and Bryonia 
every day quite successfully. 

But, more than this, may we not push the patholc^cal 
analysis of any ordinaiy case of iUness, or gi*oup of symptoms, 
a great deal further than is usually done ? We are usually 
satisfied to name pleurisy, and consider as one disease all cases 
in which inflammation and effusion occur in the pleura, though 
the group of symptoms observed in different individuals may 
differ very widely — so widely, indeed, that without the aid of 
physical signs we should be unable to recognise the affection of 
the i)leura at all in some of the cases. For these different cases 
the same Homoeopathic remedy cannot be indicated by the law 
of similars, nor is it ; but we have a corresponding variety of 
medicines, which we can apply appropriately while guided by 
the symptoms, though as yet we cannot define the pathological 
cause of those differences. It is quite possible they may 
depend on extension of disease to other local pathological 
centres, and thus be, in fact, more complications than capriciously 
present s}inpathetic symptoms of the one more prominent patho- 
logical state, which is easily recognised. But if this is the case in 
pure cases of easily recognised pathological processes like pleurisy, 
how much more may it not be the case in the ordinary cases of 
disease that we are called on to treat ? In these we can seldom 
trace the whole group of symptoms to a well-defined and known 
pathological process in one organ or tissue alone, but a consi- 
derable amount of complication generally exists, perceptible 
even to our coarser modes of analysis. This is often made 
evident in a striking manner by the effects of our medicines, 
which, as it were, dissect out the finer shades of pathological 



On the Alternatian of Medicines, 383 

states of which the concrete group termed the disease really 
consists. These finer shades at times are shown merely hy one 
or two symptoms apparently unimportant, but which disappear 
permanently under the appropriate medicine, with evident 
improvement of the case. Now, no symptom can exist without 
a proximate cause, nor can it be removed permanently without 
the removal of that proximate cause. It is probable, therefore, 
that each case of disease consists of a greater or less number of 
proximate causes more or less independent, though connected 
by sympathy, and that all of these have their appropriate 
Homoeopathic specific; and this is the reason why, as Hahne- 
mann taught, there are no specifics for diseases, but only for 
the groups of symptoms actually present, and therefore a single 
medicine is seldom sufficient for a case of disease, but several 
must be given in succession, as indicated. Succession of dif- 
ferent specifics is thus a corollary from the Homoeopathic law. 
But it may also quite as well happen that more than one of the 
pathological centres of the concrete disease may be too impor- 
tant to brook delay, and therefore, if there is otherwise no 
counteracting objection, the simultaneous use of two Homoeo- 
pathic medicines in alternation may add greatly to our power of 
controlling disease and perfecting the practice of Homoeopathy, 
This, I believe, does occur not unfrequently in practice ; and by 
the exercise of skill in knowledge of disease, to distinguish the 
points most important to treat first, and in knowledge of the 
mutual relations of medicines, gi*eat benefit may be derived 
from alternation. 

One of the great objections to alternation is that it increases 
so much the difficulty of profiting by clinical experience. 
Systematic writers naturally feel this the most, and put it in 
the foreground ; and to them nothing can be said except that, 
while fully admitting the fact, too much stress has been laid 
on the value of clinical experience. In this I have come more 
and more to the doctrine of Halinemann, who demonatt^t^dt ^^ 
long ago the fallacy of attempting to fin.cl. o\x\. ^i\l^ ^'^^^\^^ 



384 On the Alternation of MediciTua, 

powers of medicines by clinical experience alone. And to those 
who will not hear him, we may point to J. S. Mill's Logic, 
wherein is demonstrated the necessity of knowledge of the 
action of medicines on the healthy body, and the use of 
them according to that knowledge a prioi^, before we can reach 
any degree of exactness in therapeutic experiments. 

Nevertheless, our Homoeopathic literature is full of cases and 
therapeutic directions in which the indications are almost 
entirely clinical, and no efifort is made to find out the exact 
pure symptoms that corresponded to the disease, and the veri- 
fication of which would probably be the only fact of value in 
the history of a successful case. In fact, the longer I practise, 
the more I see the value of Hahnemann's precept — ^viz., to look 
on each case as individual ; and I think we should expect no 
more help from the treatment of one case than a portrait- 
painter expects from the one before in taking a new likeness. 

Finally, the liability to abuse of the practice of alternation ia 
granted to the fullest extent. But it is only to that peculiar class 
of minds w^hich w^ould abolish a good thing because of its 
abuse that this w^ould be an argument for its abandonment ; to 
others it is only an additional motive for self-restraint and cir- 
cumspection. 

DISCUSSION. 

The President said that, as he should not be able to be 
present during the whole of the discussion upon the interesting 
paper which had just been read, he would, with the permission 
of the Society, deviate from his usual habit of summing up at 
the close of the debate, when he had an opportunity of clearing 
up misconceptions and reconciling the apparently conflicting 
opinions of different speakers, as well as of stating his own 
views on the subject under consideration; instead of following 
this course, he would, on this occasion, open the discussion, for 
were he to be silent, such silence might possibly be misconstrued 
to a want of respect for the learned author, or want of interest 
in the subject. Wishing to guard himself from all such miscon- 
ception, he should now proceed to state briefly his (Dr. Quin's) 
opinions, founded on experience, w4th respect to the matter 
treated of in the paper. It afforded him sincere pleasure to be 



On tJie Alternation of Medicines, 385 

able to bear testimony to the practical and philosophical spirit 
in which the author had dealt with his subject, as also to the 
liberal manner in which he was disposed to deal with opinions 
at variance with his own; with perhaps only one exception, 
which occurred towards the close of the paper. In recalling to 
his memory the impression made upon him by the opinions 
entertained by the author, some seven or eight years ago, at the 
Congress held at Leamington, he (Dr. Quin) was much gratified 
to find that as years rolled over, increased experience had had 
the effect of greatly reconciling and modifying the difference of 
opinion which had existed between them on the subject of 
alternation of medicines— an effect sure to be produced upon a 
mind so constituted and cultivated as that of the author. He (Dr. 
Quin) hailed this with great pleasure, for he was bound candidly to 
state that he was — from conviction founded upon the experience 
of many years — strongly opposed to that mode of practice 
which had for some years prevailed among a number of Homoeo- 
pathic practitioners in England, and had also been inculcated in 
several of the popular books on Homoeopathy — ^viz., of alter- 
nating two or more medicines in quick succession. The author 
reproaches systematic writers with condemning the plan of 
alternating medicines, and then of adopting it themselves, more 
or less, in practice. This — admitting, for argument sake, that 
it is true — does not prove that the plan is good, or that they are 
wrong in pointing out the error of it. Such writers may know 
the right path, and be desirous of making it known to others, 
and still, from diffidence of their own powers, knowledge, or 
skill, may fall into erroneous practice in some cases of difficulty, 
from not having the courage to trust to their having prescribed 
the medicine most homoeopathic to the case. They are conscious 
that, from want of experience, or want of confidence, in their 
selection of the appropriate remedy, they vacillate in their mode 
of treatment, and change or alternate the medicine they are 
prescribing; but this is not a reason for their systemati- 
cally teaching an erroneous practice, or inculcating false 
doctrines, because from one or other of the above causes they 
have been tempted in some particular case or cases to stray from 
the right path. Surely, it is their duty to teach what they believe 
to be the best or true mode of practice, as laid down by the 
founder of our system of medication, and as corroborated by their 
own experience, even although they may feel that in some case, 
or cases, they may have slid from what they consider the true 
faith. Under no circumstances can it be their duty to teach 
error, because they themselves, in some instances, have erred. 
The author also says that nearly all practical m^u vx^Q^\.,\Ci<^^^ 
or less, the plan of alternating medicine m t\i^\x Y^^eNKa^- ^ 



380 Oil thr AUernation of Medicines. 

know not liow or where lie luis an-ived at this knowledge and 
c'Mnc'hision, but it is totally and entirely at variance with my 
cxpL-riifnco. It may hold good with a number of practitioners in 
England, but on the Continent — and my experience is pretty ex- 
tensive, both on account of the number of years I have been 
familiar with the practice of our foreign colleagues, and the 
number of different towns on the Continent with the physicians 
practising in which I have had oral aud\vritten communications 
— the plan of alternation, as practised by some in England, is 
unknown ; and when I have had occasion to mention it, many 
have held up their hands with astonishment, and asked where in 
the works of our masters a justification for such a mode of 
practice could be found. In the address delivered at the 
Annual Assembly of 1863, he (Dr. Quin) quoted a communica- 
tion from that distinguished practitioner and able writer. Dr. 
]\Ieyer, Physician to the Leipsic Homoeopathic Hospital, and 
Editor of the Homceoj)cdhisclie Zcihtng. In speaking of the Annals 
of the Society and Hospital, he says — " I have read the last number 
with great interest, and am much phrased with the earnestness of 
the discussions, but I lament that it is so much the custom in 
your fatherland to give the medicines alternately, consequently 
making exact observations very difficult. Could no means be 
adopted to abolish this vicious habit ?" On the occasion of quoting 
the above opinions of Dr. Meyer, I stated that " The testimony 
of so distinguished and learned a physician to the utility of the 
Annals, and your discussions, cannot fail to be gratifying to you. 
I have so often endeavoured to impress upon you my opinion of 
the erroneous practice of alternating medicines, in quick succes- 
sion, before the si)here of action of any of them can have termi- 
nated ; and I have so often tried to inculcate the advantage of 
more simplicity of practice, and a stricter adhesion to the prin- 
ciples handed down to us by Hahnemann, that it is not necessary 
for me now to say more than that I thoroughly agree with Dr. 
IMeyer, and heartily reiterate his wish to see this practice 
abolished in England.*' To the opinion then expressed by him 
(Dr. Quin), he still adhered most strongly, and, moreover, so far 
from believing that nearly all i^ractical men alternated medicines, 
he felt persuaded — nay, convinced — that if every phyisican on 
the Continent could be polled, that the immense majority would 
reiterate the sentiment and opinions expressed by Dr. Meyer 
upon the subject under discussion. In the same address, in 
speaking of a most praiseworthy paper of Mr. Brisley, he (Dr. 
Quin) had further remarked — ''that we should be extremely 
careful in the selection of our remedies, when we commence 
the treatment of any chronic case, and that after we have made 
our selection we should not capriciously give up one remedy for 



On the Alternation of Medicines. 387 

a new one, until at least we had satisfied ourselves that the 
medicine of our choice had no beneficial action in the case, either 
in a high, a moderate, or a low dilution. His advocacy of a more 
simple mode of treatment, and opposition to the alternating plan 
adopted by so many of the English school of Homoeopathy, were 
not called into existence by the paper of this evening, but were the 
result of many years practice and experience. At the last meeting 
of the Congress held at Leamington some eight years ago, to 
which he had already alluded, the subject of alternation was 
introduced by Dr. Madden, of Brighton, Apropos of some obser- 
vations made by him (Dr. Quin) on the previous evening, respect- 
ing the treatment of some cases which were read to the meeting, 
in which the alternation of two medicines, in rapid succes- 
sion, were prescribed, each being given one after the other re- 
peatedly. This is the alternation to which he was opposed, and 
against which his observations, then, as now, were directed. On 
that occasion, the author of the present paper, in defending the 
practice in certain cases of acute disease, said that he considered 
it had received indirectly the sanction of Hahnemann, in his direc- 
tions for the treatment of purpura milliaria, by the alternating use of 
Aconite and Coffea ; he made, however, at the same time, the 
admission that it should be used with great reserve, as it un- 
doubtedly gave a handle to slip-shod practice, and could only be 
justified by necessity. Another speaker expressed a somewhat 
startling opinion, that alternation of medicines was benefical 
in acute diseases, but quite unnecessary in chronic cases ; whilst 
another member of the Congress quoted cases, in which he said 
he could not trust to one medicine, but always gave two in rapid 
succession. To prove that he (Dr. Quin) was not overstating the 
case, he had only to instance one of the cases quoted, in which 
two medicines had been prescribed in alternation every twenty 
minutes, or a quarter of an hour. Now, in this last case, each of 
the medicines administered had a sphere of action, extending 
over several days, if not weeks ; and to him (Dr. Quin) it 
appeared impossible that the same good result could be expected 
from either of these medicines, thus interfered with in their 
action every fifteen or twenty minutes, even supposing both to 
have been the two most appropriate remedies, as would have arisen 
from one or the other, if it had been allowed to exert its medicinal 
action until it ceased to be beneficial ; and then, and not till 
then, had been followed by the other medicine next in order 
homoeopathic to the case. It is a remarkable fact, and one that 
not only surpiised him, but was a matter of great regret to him, 
that all the members present at that Congress expressed them- 
selves favourably to the practice of the alternating plan theiv %ANVi- 



388 On the Alternation of Medicines, 

cated, with one solitary exception. One practitioner, frankly and 
boldly, in the lace of the majority, supported liis (Dr. Quin's) views, 
and expressed his belief that thebeneficial change which had taken 
])lace in tlie case in rjuestion, was owing to one of the medicines 
alone, and not to the alternation of both, which, in his opinion, 
had retarded, and not advanced the case. Finding himself thus 
i[uasi-isolatod from all his colleagues, he still felt himself bound to 
])rotest against the plan of rapid alternation, as imwise and inju- 
dicious, and one that. in his opinion was likely to interfere with 
and retard the favourable progress of the treatment ; for he was 
])orsua(UHl that the cases of cure narrated would have yielded 
sooner to the action of the remedies selected, if one of them had 
been given alone, and persisted in for some time before having 
recourse to the other. He did not then, nor would he now, advo- 
cate the continuance of one medicine to the exclusion or the advis- 
ability of changing to another, if that other were more Homoeo- 
pathic to the case ; but then, this last remedy ought to be per- 
sisted in, and not changed for the former in a few hours or 
minutes, and then be resorted to again at the lapse of a similar 
number of minutes or hours, and so on, until the termination of the 
case ; or, as often happened, until the practitioner deemed fit to 
prescribe two other medicines in similar alternation. He (Dr. 
Quin) \vas most desirous of impressing upon his colleagues that 
Hahnemann never resorted to this plan of alternation up to the 
day of his death — nay, he was strongly opposed to it. No more 
(lid his first disciples, or his early followers, practice this mode 
of alternation ; and it was through them, and the success of 
their treatment of diseases, that Homoeopathy had spread over 
the world. It w^as a practice, and one of comparatively recent 
date, chiefly adopted in Great Britain, and by some practitioners 
in America, on which country it had been engrafted from Eng- 
land. Comparatively speaking, it was little known, and less 
])ractised, on the Continent. As far as he had had means of 
judging, this plan of alternation had been mostly advocated and 
encouraged by those practitioners who had come over to Homoeo- 
pathy, after having, during a considerable number of years, 
practised AUopatliy, and who found it difficult, after their com- 
plicated prescriptions, to confine themselves to the simpler 
mode of medication enjoined by Hahnemann. These con- 
verts from the old school had frequently a great advantage 
in their superior knowledge of disease and experience of its 
probable course, but they were often much inferior in the 
selection of the proper remedies and in their conduct of a case 
imder humcropathic treatment to those practitioners who had 
commenced their practical career as Honueopathists, and who 



On the Alternation of Medicines, 389 

were not encumbered by the lepren of the old system of prac- ^' 
tice, beyond what they had piiked up in the schools during * 
their curriculum of studies. He (Dr. Quin) had referred at 
greater length than he intended to the Congress at Leamington ; 
and more, perhaps, than the contents and spirit of the paper 
just read, strictly warranted. He had been tempted to do so, 
firstly, because he wished to express his hopes and belief that 
(what he considered to be) a better, more orthodox, and simpler 
mode of practice, was gradually obtaining the ascendancy in the 
minds of practitioners now, than existed then ; and, secondly, 
because he was desirous of stating to them, that struck with the 
state of antagonism in which he found himself placed at 
Leamington on the occasion of the Congress with so many of 
his colleagues, whose opinions he respected, and whose state- 
ments he regarded as faithful and truthful representations of the 
cases which they brought forward in support of their opinions, 
he, on his return home, resolved again to put to the test in a 
variety of cases the mode of alternation which was reported to 
have proved so successful in the cases treated by his colleagues. 
He did this most conscientiously, with a sincere wish to arrive 
at the truth, and an earnest desire to increase his means of 
relieving and curing his patients. The result, then, as before, 
disappointed him. These last experiments, like the former ones, 
mentioned by him in summing up at the close of the discussion 
at the Congress, failed to convince him that the plan of alterna- 
tion, as then advocated and generally pursued, was preferable to 
the simpler mode taught by Hahnemann ; the only disease in 
which he thought he could perceive any advantage in the 
alternation recommended was in some few cases of neuralgia; 
but he thought he could not do better, or express his opinion 
more correctly, even at the risk of repeating himself, than by 
quoting now an extract from his observations on the occa- 
sion of the summing up of the debate: viz., "There had 
been some important cases related by gentlemen whose state- 
ments were entitled to respect. Still, he could not give in to 
the opinion that it is wise or judicious to alternate rapidly. 
Some of the cures related would have followed, he believed, the 
employment of a single one of the medicines, especially as they 
appeared to have been selected with great judgment. His 
opinion continued in favour of keeping to one medicine, not of 
course, to the exclusion of changing that medicine, if tl>e 
necessity for another curative agent were indicated ; as for 
instance, when any violent s3miptoms arose. Halmemann had 
met the question, by allowing the use of what he called inter- 
mediate or between medicines ("zwischen niittiil"\ vJc\\\\\v^ 



390 On the Alternation of Medicines, 

treatment. Had that principle been adopted in the remarkable 
cases that had been mentioned during this discussion, they would 
have known at the close of their treatment to what medicines 
their euros were due. Tlie great point was to ascertain the 
best ni(»(licines to give, and then to steadily continue its em- 
ployment as long as it was found to act beneficially. The early 
Homa*o])athists never alternated ; it was a modem practice. In 
saying that, he did not mean to depreciate laudable attempts to 
advance our knowledge, for we might possibly arrive at an 
improvement upon the practice of Hahnemann. But it ought 
to be bonie in mind, that all the earlier successes of Homoeo- 
pathy had been won without alternations. In his own experi- 
ence as a Homceopathic practitioner, he had certainly not found 
his treatment more successful when he ventured to deviate 
from Hahnemann's rules ; but having read of many successful 
cases of the alternating plan, and being, of course, quite ready 
to adopt it, if any advantage could be gained, he had tried it 
for some time in a number of different cases. His experience 
compelled him to return to the more ordinary practice hitherto 
pursued by him. However, in some cases of neuralgia alone, 
lie found beneficial results from alternating medicines, he had 
not obtained without ; but in these cases, his alternations were 
at much wider intervals than his colleagues here had mentioned 
(the medicines alternated were Aconite and Arsenicum) : but 
looking back on his whole practice, he must say conscientiously, 
he could not see reason sufficient for deviating from his earlier 
method. Every man must be guided by his experience, and 
he (Dr. Quin) must differ from the opinion that seemed prevalent, 
that the rapid alternation of medicine was better than the 
simpler mode of keeping to one medicine, till there was reason 
to be dissatisfied with its action." He (Dr. Quin) still adhered 
to the opinions then expressed, nay he was more convinced by 
the additional experience gained in the intervening eight years, of 
the superiority of the simple method over the complicated one of 
quick alternation. As far as he could recollect, the only time 
Hahnemann, in the numerous volumes and essays published by 
him, speaks of alternating two medicines, occurs in a footnote 
to the preface to "Belladonna," in his Materia MedicaPura; 
wherein, in cautioning physicians against mistaking purpurea 
miliaria (Eothe Friesel) for scarlet fever (Scharlach fieber), and 
employing Belladonna for it, he recommends the alternate use of 
Aconite in the 24th attenuation, and Coffea Cruda in the 3rd ; 
but how widely different is the alternation he recommends from 
the blind and quick mode of alternation which, unhappily, has 
prevailed among so many British practitioners, may be gathered 



On (lie Alternation of Medicines. 391 

from the instructions with which he accompanies his recom- 
mendation. He writes : — " The former (Aconite) given during 
the heat, increasing restlessness and the general extreme 
anxiety ; the latter (Coffea) in the violent pains accompanied 
by great disposition to weep, both in a small fraction of a 
drop for a dose, every twelve, sixteen, or twenty-four hours, 
either the one or the other, according as it is indicated." Now, 
be it remembered, that both Aconite and CofiTea are short-acting 
medicines, exerting their influence duriug a brief number of 
hours only, and that the alternation spoken of by Hahnemanu, 
was only to be had recourse to in the event of certain indica- 
tions specially named by him for each medicine being actually 
present to warrant and motive the change ; and not, even then, 
to be indiscriminately alternated every fifteen or twenty 
minutes, or every one, two, three or four hours, but at intervals 
of twelve, sixteen, or twenty-four hours ; and then, the change 
only to be made, if the symptoms, indicating its propriety, 
showed themselves ; thus, the same medicine might be continued 
for many more than the above number of hours, or even for 
several days, to the exclusion of the other medicine until it 
became indicated. It was worthy of remark, and claimed 
attention from the members of the Society who took interest in 
this question, that in the numerous volumes of the Archil) der 
Homosopathe, edited by Dr. Ernest Stapf, the intimate friend of 
Hahnemann, there occurs not one single case, as far as he (Br. 
Quin) could charge his memory, of disease treated by the Eng- 
lish alternating plan, nor does one occur in the Bibliotheq^ie 
Homceopathiqiie edited by the late Dr. Peschier, of Geneva, nor 
in the Effemeriri Homoeopathica, or other periodicals, edited in 
Italy, nor of any of the numerous periodicals published in 
France, in which, cases and their treatment are narrated in detail, 
did he remember cases treated by the alternating method which 
had become so prevalent in Britain, but which he trusted was now 
on its wane. As corrobative of the truth of the observation, that 
alternation led to a slip-shod mode of treatment, he might mention 
that he had been called into cases where not only two medicines 
were exhibited in alternation every one or two hours, but in one 
instance he had found that his predecessor had prescribed five 
or six medicines in alternation, to be given one after the other, 
in quick succession, of a quarter, half, one, or two hours, not 
according to any special Homoeopathic indications, more or less, 
supervening, but according to the urgency of the symptoms, or to 
the fears of the vaVcillating physician, nmch on the principle said 
to exist amongst the profession in China, where, in a consultation 
on a dangerous case, the prescriptions of the different iglv^j^voSaxv^ 



392 On the Alternation of Medicines, 

called in are mixed together in the same vessel, and administered 
to the patient in the hope that if one medicine did not succeed, 
some other among those prescribed might. He could not agree 
with the author, in his " definition of alternation/' which " he 
takes to be the giving a second medicine while the sphere of action 
of the first is still unexhausted,^* At least, such was not his (Dr. 
Quin's) idea of the alternation practised by so many in England, 
and against which practice he thought it his duty to lift up his 
v'oice whenever the subject came upon the tapis, as wrong in itself, 
and as leading to a routine and slovenly mode of treatment. During 
the progress of a curative treatment, casual acute symptoms might 
and did often arise, demanding palHations. Hahnemann, fore- 
seeing this, had laid down rules for th^ir guidance, by recom- 
mending the administration of intermediate or intercurrent reme- 
dies to meet these accidental symptoms. During the exhibition 
of the palliative remedy, the curative medicine was pro tempore 
suspended, and resumed again as soon as the casual symptoms 
had subsided, or so far diminished as no longer to be of im- 
portance. Thus, in the treatment of a case, it happened to him 
to prescribe against a bad and sleepless night, one or more doses 
of Coffea. Against the supervention of febrile symptoms, Aco- 
nite ; against violent and harrassing cough, Hyoscyamus ; against 
fits of sickness. Ipecacuanha ; against looseness of the bowels, 
Camphor or Chamomilla; but these were all remedies of short 
sphere of action, and were given as palliatives against symptoms 
which, if neglected, might, and generally would, interfere with 
the progress of the curative treatment, more than if this was per- 
sisted in, to the exclusion of the palliative ; which, when it had 
done its duty, was abandoned, and the curative medicine re- 
sumed. It had been asserted by some of the advocates of alterna- 
tion, that this was tantamount to alternating, but an argument 
more fallacious, or less logical, could hardly be imagined. It 
was a mode of treatment not only allowed, but recommended by 
Hahnemann ; and those practitioners, who resorted to it imder 
such authority, particularly when backed by their own expe- 
rience of its usefulness,' could well afford to sit down under the 
unmerited reproach that whilst they comdemned the alternating 
plan of treatment they adopted it themselves in their treat- 
ment ; and he felt assured that if they examined closely into the 
cases quoted, where Eummel, Hering, Peschier,and others had em- 
ployed or recommended alternation, they were more in accordance 
with the practice inculcated by Hahnemann than that which had 
been unfortunately, in his (Dr. Quin's) opinion, adopted by so many 
of their colleagues in Britain. He feared that he had abused 
their time and patience, but he had even now far from exhausted 
the subject and he hoped to have some future opportunity to 



On the A Iternation of Medicines. 393 

resume it. Meanwhile, he must reiterate the expression of liis 
high sense of the liberal and philosophical character of the 
paper, although he could not help considering it as having a 
tendency rather to uphold the exception than establisli the 
principle of the rule. 

Mr. Yeldham said — Eegarded in its strict sense, there would 
be no doubt that the alternation of medicines was opposed to 
the principles of Homoeopathy, and that the excuse for indulging 
in the practice must be sought for elsewhere than in the pages 
of the Organon. The excuse generally urged was success, and it 
was, certainly, a powerful one. Whilst condemning the practice 
in his own mind, and avoiding it as a rule, he was free to confess 
that there were some cases in which the results of the custom 
seemed to warrant its adoption. Tlie painful rheumatic affection 
of the face arising from cold or decayed teeth was one of these. 
For this complaint he prescribed the alternate use of A(^,onite 
and Mercurius corrosivus with almost unfailing success; and, 
seeing this, he had repeatedly administered those medicines 
singly, and had almost as constantly failed in curing the disease. 
But, whatever might be said in favour of alternating medicines at 
long intervals, nothing could excuse the practice which one often 
heard and read of, of giving medicines alternately every hour, 
every half-hour, or at shorter intervals still. This was nothing 
better than the polypharmacy of the old school. To suppose 
that a new action could be set up in the system in so short a 
time, or to believe that the one medicine had left the stomach 
before the other was introduced, was absurd. Better be honest, 
and mix them both in the same bottle, than give medicines in 
that manner, and call it Homoeopathy. If alternated at all, 
clearly, the intervals between the doses should be of considerable 
length. He, Mr. Yeldham, rarely alternated any other medicines 
than Aconite and a second one ; and then, instead of changing 
at each dose, he gave three or four doses of the one in succes- 
sion, and then three or four doses of the other; or, perhaps, 
Aconite during the night, and the other remedy during the day. 
Either of these plans afforded each medicine an opportunity of 
exerting a separate action on the system. But, after all, whilst 
he occasionally resorted to alternation, he felt satisfied that it 
was opposed to true science ; and believing that disease, in the 
great majority of cases, was a single process, he was also satisfied 
that it was most successfully encountered with a single remedy ; 
and that that remedy should be continued until it had been fairly 
tried, or until the disease had assumed such a marked change in 
its character as to demand a change of remedy. It was often 
urged as an excuse for giving two or more medicines, that all 
the symptoms could not be covered by one. Wewe^ \Xv^ ^?osx 



394 On the Alternation of Medicines. 

which the President, Dr. Quin, had described to them on the 
provious evening as prevailing on some parts of the Continent, 
where they lotted out tlie symptoms under different remedies. 
This w^as trifling with disease. So long as the remedy was 
Homoeopathic to the main features of the disease, other, and 
seccmdary, symptoms, which were commonly merely sympathetic, 
might safely he disregarded. It was not often necessary to pre- 
scribe separate remedies for them. They disappeared as the 
disease on which they depended subsided. Dr. Drysdale had 
mentioned the use of Arnica for local injuries occurring to 
patients labouring under other complaints, as illustrating the ne- 
cessity for alternating remedies. He (Mr. Yeldham) did not 
think such cases at all pertinent to the question. As generally 
understood, the word " alternation " meant changing the remedy 
at each dose, and not the provision for accidents, nor the change 
of remedy as the disease changed. Mr. Yeldham thanked Dr. 
Drysdale for his paper, and for favouring the Society with his 
presence during the two evenings' discussion. 

Dr. Metcalf considered that, however desirable it might be 
to treat diseases with one remedy only at a time, in practice it 
would be found that it was not always possible to do so. Sup- 
pose, for instance, your patient residing at some distance, and 
the case one likely, in a very short time, to exhibit symptoms 
different to those then presenting, perhaps, too, a not very intel- 
ligible nurse, — what course must you adopt ? Take, for instance, 
a case of Scarlatina Maligna. It may be that by far the worst 
symptoms are in the throat, and you may be disposed, having 
regard to the malignancy of the symptoms, to rely upon Arsenic 
as the principal remedy. You see, however, in the countenance, 
indications of cerebral mischief coming on. You do not feel at 
all disposed to let go the Arsenic, and yet it is apparent that 
Belladonna may be of service, and, indeed, some symptoms may 
even then point to it. Would you not feel much more easy in 
having left those two medicines to be given alternately than in 
trusting to the nurse's judgment as to omitting one or the other ? 
Undoubtedly you would. Such cases must occur very frequently 
in every practice, and necessitate many, very many, exceptions 
to the rule. 

Mr. Eeynolds said — He must confess that, if administering 
medicines in alternation were an error, it was one he must plead 
guilty to. It was a practice he had long been in the habit of 
pursuing ; it was one which he found successful — so successful 
in its results that he felt no disposition to abandon it, even if he 
were more satisfied than he was with the theoretical objections 
advanced against it. 



/ 



On the Alternation of Medicines. 395 

Dr. Chepmell observed — That the views which Dr. Drysdale 
had laid before the Society so entirely coincided with his own, 
that he had little to add. The admirable examples of cures ef- 
fected by the continuous exhibition of a single remedy, recorded 
in the earlier volumes of The British Journal of Homoeopathy as 
having occurred in Dr. Drysdale's practice, he might adduce as a 
proof that no physician could be better qualified to give an au- 
thoritative opinion on so difficult a subject, prejudiced, as he 
might be said to be, the other way. The alternation of remedies 
was. Dr. Chepmell thought, a practical necessity in many cases, 
e.g., in urgent acute cases, when the patients resided at a distance 
and could not be frequently visited, and even in chronic (he had 
thus successfully treated by correspondence — ^under a scientific 
protest it might be — ^patients living in Australia), for the same 
reason, the treatment had to be based upon the analogy of former 
and stricter experience ; whilst, in some cases, the practice was 
justifiable, in a pathological point of view, for the reasons ad- 
duced by Dr. Drysdale, more especially in those formidable in- 
stances of acute disease, where more than one organic sphere is 
seriously involved in the vital conflict (he had seen measles and 
Q' scarl|tina, both of great intensity, running their course all but 
simuBaneously, the one only having had the start of the other 
by one or two days), and again when the organic susceptibility to 
the same remedial stimulus was being constantly exhausted by 
the intensity of the vital re-action, as in the cases instanced by 
Mr. Yeldham, and of the successful treatment of which he had 
no reason to be ashamed. In conclusion, he remarked that he 
had very little sympathy with those medical sciolists who are 
constantly acting the part of obstructives in distracting the at- 
tention of the studious with their oft-repeated " cuckoo-cry " of 
" infraction of the Homoeopathic law and treason to Hahnemann," 
in respect of this and other kindred subjects. As a matter of 
logic, the Homoeopathic law is in no wise infringed by the 
alternation of remedies : it is a matter which affects the practical 
carrying out of that law, and nothing else. Ahisus non tollit usum. 
Dr. Drukt was extremely anxious to hear Dr. Drysdale's 
paper, as he expected to hear from him the very best arguments 
that could be put forth in defence of the practice of alternation. - 
It was well that the subject was in the hands of so able an ad- 
vocate. But at the very commencement Dr. Drysdale, with a 
candour to which all credit was due, and which alone would be 
expected of him, at once admitted that, in saying what he could 
in favour of the practice, it was more an apology than a defence. 
This was not a new mode of dealing with the question ; it was 
not at aU uncommon for those who adopted it, and who ^\<^^^'^\ 



396 On the Alternation of Medicines. 

its necessity, to admit that, after all, it was to be regretted. Un- 
fortunately, however, not content with its occasional use, some 
men seemed to look upon it as the regular thing, pretty much as 
Allo])aths feel it needful to give purgatives. Certainly to Mr. 
Yeldham belonged the credit of the most rational method of 
giving medicines in alternation, allowing a long interval between 
the changes, also continuing one medicine for some hours. 
Adopting this method, an opportunity was afforded for continu- 
ing a medicine if it was found to be doing good, whereas, by 
giving medicines in rapid alternation, one medicine might be cal- 
culated to do much good, but its action was being continually 
and mischievously interfered with by the intermediate dose of 
the inferior medicine. The President laid down the wise rule to 
select one medicine and give that continuously ; but should 
symptoms arise requiring a change, then to give an intercurrent 
remedy — this being very different from alternation. Thus 
Bryonia might be the regular medicine to be taken, but increase 
of fever taking place at night, a few doses of Aconite might be 
given to allay it. In selecting a remedy, it may happen that, in 
our present state of knowledge, we cannot find one that covers 
the whole group of symptoms ; but if we choose the best, we will 
generally find that all the symptoms wiU improve under it. Mr. 
Yeldham's remarks on this head were very appropriate. Dr. 
Drysdale says that different organs may be affected at the same 
time, and on this ground considers the practice of alternation 
called for. But if the best medicine is chosen, and continued as 
long as good is being got, it wiU be found that practically there 
is no need for alternation. 

Mr. J. Harmar Smith thought that it was one thing in 
exceptional cases to alternate medicines, admitting the neces- 
sity of resorting to such an expedient as a sign of a weak 
and transitional state of matters (as he had understood Dr. 
Metcalfe and other speakers to do), or on the other hand to 
resort to it habitually, and to defend the practice, as if it were 
considered to be the normal and permanent state of homoeo- 
patliic practice. The averment of Dr. Quin, the oldest and one 
of the most successful homoeopathic practitioners in the British 
isles, tliat he never had recourse to the alternation of medicines, 
had afforded him peculiar satisfaction, as proving that the prac- 
tice was not necessary, and might be dispensed with. On the 
other hand, there were some writers in the journals who 
appeared to make a regular practice of alternating remedies, 
without any special or obvious indication, or without thinking 
it necessary to state any reason for their doing so, pro\'ing that 
tliey considered this the normal and proper state of matters. It 



On the Alternation of Medicines, 397 

appeared to him that the tendency of this mode of action was to 
induce a slovenly and routine style of practice (though he was 
far from charging this upon those who adopted it) and a neglect 
of the pathological indications of the case. In pnouinonia, for 
example, a single medicine such as Phosphorous that met the 
pathological state was worth more than a dozen, if they could 
be used, which covered merely minor and subsidiary symptoms. 
And where was the line to be drawn as to the number of 
medicines to be used ? He (Mr. Smith), however, had to confess 
with other speakers, that he was often practically untrue to his 
present principles. In the purity of his first faith in homoeo- 
pathic la,w, he never thought of using more than one medicine 
at a time, but after observing the practice of those with whom 
he was first brought into contact, he slid into the habit of giving 
two or three medicines in alternation. He had, however, learnt 
a better plan, chiefly from intercourse with the members of this 
Society, and he never now resorted to more than one medicine at 
once, except from sheer necessity, although occasionally resorting 
to the use of intercurrent remedies to meet intercurrent 
symptoms. Since acting on this plan his practice had become 
doubly interesting to him, and the assurance that the recoveries 
of his patients were really cures, had never been so frequent 
as now. 

Dr. Hale, although he aoknowledged the necessity for occa- 
sionally alternating medicines under certain circumstances, had 
great objections to the practice, which he considered had the self- 
evident effect of vitiating the results of experience. It was, in 
his opinion — at least he always felt that when he was obliged 
to resort to it in his own practice — a sign of weakness : 
either the case had not been sufficiently individualised, or had 
been hurriedly prescribed for. Dr. Hale contended that it was a 
practice, however necessary in some cases, owing to the imper- 
fection of our knowledge, to be avoided and striven against, as 
much as possible; it led, when employed, other than exception- 
ably, to a loose routine and unsatisfactory practice. Dr. Hale 
urged the necessity of giving one well chosen medicine at a time, 
and of giving that medicine a fair trial before changing to 
another. If we are obliged to give medicines in succession, it is 
well always to have, as it were, one foundation remedy to which 
we should keep, as much as possible ; but he had frequently 
experienced the advantage of giving one or two inticuiTent 
doses of an antisporic, generally in a high dilution, returning after 
a few hours to the foundation drug, which would then often act 
with increased power. This plan he had first adopted some years 
ago, at the suggestion of his friend. Dr. Chepmell ; and he waa 



308 On the Alternation of Medicines. 

glad to hear the learned President (Dr. Quin) advise the same, or 
similar, mode of practice. Dr. Hale instanced a case lately, 
M-hich he thought instructive, as bearing upon the question : — 
A boy, suffering from whooping-cough, was attacked with double 
pneumonia and pleuritic inflammation of one side ; his former 
medical attendant had beengi\Tng him, in alternation and in very 
low dilutions, two well selected medicines, Phosphorus and Tartar 
Emetic, but the pneumonic inflanunation was not yielding, but 
rather on the increase; and the boy's strength failing, under 
these circumstances, Dr. Hale, taking into accoimt the specific 
character of the antecedent disease, whooping cough, was led to 
prescribe Carbo veg., in a high dilution, given alone. A marked 
change for the better was the inmiediate effect, and the boy made 
a rapid recovery, with a short convalescence ; the pneumonia, as 
it were, melted away, apparently under the influence of Carbo 
Veg. 30 ; but might not the pneumonia have been kept up or 
aggravated by a too frequent alternation of two such medicines 
as Phos. and Tartar Emet., given in very low dilutions ? Dr. 
Hale was at issue with Dr. Drysdale, as to his theory of disease. 
Dr. Drysdale appeared to think that several diseases might co- 
exist, and that they must be treated in detail. Dr. Hale was 
inclined to look upon disease as an entity, and that symptoms 
are merely manifestations of that entity ; whatever it may be. 
Dr. Hale, instead of thinking with Dr. Drysdale, that the diffi- 
culties in practice were owing to the imperfection of pathology, 
considered them rather due to the imperfection in our therapeu- 
tical knowledge. He begged, in conclusion, to thank Dr. Drys- 
dale for his paper, which was the result of much thought and of 
great experience. 

Dr. EussELL said — ^he was very glad that a subject requiring 
much knowledge, both of a theoretical and practical kind, had 
been selected by Dr. Drysdale, as the subject of his paper. It 
was, he was aware, quite unnecessary to bear any testimony to 
Dr. Drysdale's profound conscientiousness in the prosecution 
of his duties ; however, he (Dr. Russell) could not deny himself 
the pleasure of testifying, after an intimate acquaintance of 
nearly thirty years, that he knew no one who paid less regard to 
his own convenience and more to the benefit of his patients, 
than Dr. Drysdale. And for his part he was quite convinced, that 
if Dr. Drysdale adopted any one method of treatment in preference 
to others, it must be that he believed that method the best, 
whether it was the easiest or the most difl5cult For his (Dr. 
Russell's) part, he was not at all aware, till last night, what 
Dr. Drysdale's views were, and he found to his great satisfac- 
tion that they coincided very much with those he had expressed 



On the Alteimation of Medicines, 399 

some weeks ago in a lecture which had not been published, as 
follows : — "That two specific morbid actions coidd occur simul- 
taneously in the human body and each pursue its course without 
arresting or modifying that of the other, is a proposition entirely 
at variance with the opinions of the old pathologists who flourished 
before the time of Hahnemann. They held, generally, the doctrine 
taught by Hunter, that no two specific diseases can co-exist in the 
animal economy. On this presumption, Hahnemann founded 
part of his explanation of the curative action of medicine, and 
from this he deduced some of his rules against the administra- 
tion of a second medicine till the period of the operation of a 
previous one had entirely expired. It is of great importance to 
us to know, whether this pathological doctrine be in accordance 
with the larger experience and observation to which we now 
have access. We could hardly have two diseases more specifi- 
cally distinct than typhus and small-pox, yet in the following 
narrative we have a description of the two running their course 
side by side, without either interfering with the other. It 
occurred in the London Fever Hospital, under the care of Dr. 
Buchanan, and is quoted by Dr. Murcheson, at page 209 of his 
work. 'A girl, aged fifteen, was seized on June 1st, 1862, with 
severe pains in the back, vomiting, and loss of appetite, followed 
by an eruption of variolous papules on June Srd. On June 6th, 
she was removed to the Smallpox Hospital, where the symptoms 
ran the usual course of a mild attack of variola, modified by 
vaccination. There were good cow-pock marks on the arm. The 
febrile symptoms, however, did not recede ; and on June llth^ 
a typhus rash made its appearance on the trunk. On Jime 12th, 
she was removed to the Fever Hospital ; and at this date, there 
were a number of dissicating pustules on the face, together with 
a well-marked typhus rash on the chest and abdomen. This rash 
was still distinct on June 18th, but disappeared on the following 
day, and the patient made a good recovery. Several small-pox 
cases had occurred in the next house to that where the girl was 
taken 01, and there was also much typhus in the neighbourhood. 
The girl had also been removed to the Small-pox Hospital in a 
carriage used to convey typhus patients.' This is certainly a 
most interesting case. We cannot question the competence of 
the observers or the substantial accuracy of the statements ; 
and we find that on the 12th of June there was a well-marked 
typhus eruption visible. Now, four days is about the earliest 
period from the time of infection at which so distinct an 
eruption is manifest. This would give the 8th of June as the 
latest date for the reception of the typhus poison. The small- 
pox eruption appeared in its first or papular form on the Srd of 



400 On the Alternation of Medicines, 

June, so that upon the fifth day of the small-pox — ^that is during 
its greatest intensity — she was infectdble, and actually infected, 
by anotlier wholly different, specific, morbid poison. There are 
many instances of a similar kind now on record, and we must 
frame our theories, so that they shall embrace this new category 
of cases. Suppose we encounter a case, and there are such on 
record, of a combination of scarlet fever and of typhus, how are 
we to deal with it ? Are we to engage only one of the two 
destroying agents, and let the other alone tLQ the first be entirely 
subdued? If we believe it is impossible for two medicinal 
actions to proceed pari passu in the animal economy, this 
is the rational course to pursue, and the one recommended by 
Hahnemann. But if two entirely different natural, morbid 
processes, can co-exist in the human body without the one 
afl'ecting the development of the other, what reason is there, 
why tliere may not be two artificial simultaneous series of morbid 
phenomenon, each equally independent of the other ? If scarlet 
fever, or if small-pox, can each run its course, while at the same 
time typhus is doing so likewise, why may not Belladonna and 
Arsenicum each run their course when given in alternation ? I 
confess, for my part, I can see no reason why they should not ; 
and I believe we have now an overwhelming amoimt of evidence 
in favour of giving in a certain class of cases two medicines in 
alternation. The objection usually urged against this method is, 
that it leads to laxity of practice. True, if we give two medi- 
cines instead of one, and let the system take its choice, as it 
were, to which it shall submit— if in a given case, for example, 
we find two medicines pretty nearly indicated, and instead of 
ourselves selecting the one and rejecting the other, we toss them 
both in, tiTisting that the right one only will act, and the other be 
a nonentity, or negative quantity. No one who deals conscien- 
tiously with himself will deliberately approve of so simple a 
method of evading the difficulty of choice. But it is whoUy 
different, if seeing before us two distinct morbid actions which 
we know to be capable of separate and independent progress, 
we arrest the one by its specific antidote, and administer 
another remedy to counteract the other. To prevent the possi- 
bility of being misunderstood in reference to the important 
matter, let me observe that the administration of medicines in 
succession or in alternation, is wholly different from giving such 
medicines combined. What the effects would be of mixing 
Aconite and Bryonia can only be known by a series of experi- 
ments to ascertain the properties of the tertium quid thus 
formed. The most perfect knowledge of the properties of 
Muriatic Acid and of Soda, separately, never could have told us 



On the Alternation of Medicines, 401 

those of common Salt." He would only add, in conclusion, that 
if it be true, that medicines may act simultaneously without 
mutual interference, a new field lies before us for investigation ; 
and if so much has been achieved by the elder branches of the 
house of Hahnemann who restricted their efforts to obtain all 
the results by single medicines, we have a right to expect a great 
expansion of the powers of his system in the hands of the 
younger members of that house, when we shall have ascertained 
— not only the relations of medicines to their respective morbid 
conditions, but their inter-relations to one another, and how 
their various powers may be combined so as to produce the 
greatest effect. The elder branch introduced melody into medi- 
cine, but it may be for the younger branch to arrange the 
melodies, and thus arrive at harmony. 

Dr. Drysdale, in reply, said the discussion fully bore out the 
remark he made at the beginning of the paper, viz., that nearly 
all Homoeopathists object to alternating, but they all, without 
exception, do it in practice, under some name or other. Dr. 
Quin commenced by reprobating the practice, and gave several 
strong examples of malpractice, where a number of medicines 
had been given in a short time, both in alternation and succes- 
sion. No one would deny the evil of such practice ; but it was 
not the use, but the abuse, of alternation, as it was of succession, 
which latter nobody contended was not a proper and orthodox 
practice. Dr. Quin then straightway proceeded to give examples 
from his own practice, where, at the same visit, he gave one 
medicine to be taken every three hours, and left one or two doses 
of another medicine to be given at night ; and then the first 
medicine to be proceeded with till he called again. This was called 
the practice of giving a^zttrischen-mittel,*' or " intermediate remedy,"* 
but, in fact, it had really amounted to alternation, whatever 
name we gave it. The tone of this discussion had been rather 
conventional than addressed to the arguments of the paper, 
which was, perhaps, unavoidable, as more time is required to 
consider the favourable points of a practice which was not 
generally defended. Most speakers stated their objections, and 
made it appear, when they did resort to the practice, as little 
like it in name as possible. Mr. Yeldham, for example, thought 
if we were compelled, as he was at times, to prescribe two medi- 
cines, it was better to give one medicine for several doses in 
succession; and then the other, in the same way ; and then again 
the first. Dr. Drysdale had often done the same, with the idea 
of escaping, as much as possible, from alternation. But now he 
was not sure there was any advantage in it, and probably if the 
two medicines were indicated, it would be better frankly to 



402 Oft the Alternation of Medicine. 

accept the principle of alternation, and give them that way. Dr. 
Metcalfe had brought forward an argument which was unanswer- 
able, viz., the exigencies of a distant and large practice. You 
must, in many cases, leave more than one medicine, either to be 
alternated or interposed, under certain defined conditions. No 
one had touched on this question of reviving susceptibility, 
except Dr. Chepmell, who instanced a plan he had followed from 
the advice of Dr. Curie, viz., interposing a day or two of Sulphur in 
the course of treatment of acute diseases of the chest. No doubt 
tliis was often an excellent plan. The objections by Dr. Hale 
and others, that alternation was more difficult to apply correctly, 
and also rendered clinical experience more difficult to profit by, 
were quite allowed, but that cannot be helped, and we must in 
future look to the clinical experience of hospitals more than that 
of private practice, where so many disturbing causes are at work. 
With Dr. Eussell he quite agreed; and was glad to find they had 
both been working out the same train of thought on the subject 
independently. 

Dr. Chapman (in the chair), congratulated the Society on the 
presence of Dr. Drysdale. His paper on the alternation of medi- 
cines was valuable, as coming from so eminent a man. There is 
no one of our medical sect who has a mind more thoroughly 
philosophical than that of Dr. Drysdale. It is most certain that 
the most satisfactory cures are those made with one drug. It is 
to those the Chairman looks back with most satisfaction in the 
retrospect of his own practice ; but the logic of facts shows 
that, in our present knowledge, we cannot, as a rule, treat diseases, 
whether acute or chronic, with one drug only. Hahnemann him- 
self set his own rule at]defiance,in his proposed treatment of cholera, 
with Camphor, Cuprum, and Veratrum. Who would rely only on 
Camphor ? — ^who on Cuprum, or Veratrum only ? Are Arseni- 
cimi, Carbo Veg., Mercury, Phosphoric Acid, China, never neces- 
sary ? If it be possible to include the whole portraiture of a 
disease, under the whole portraiture of a single drug, let that 
drug only be used. We all know how rare a thing it is to meet 
with such a happy conjunction of the two portraitures. The 
simple truth is that Hahnemann never had the opportunity of 
seeing many cases of acute disease ; and though he was the 
greatest of medical philosophers and reformers, it may be doubted 
whether he was, at any time of his life, a great practical phy- 
sician. There are things that can't be cured. At the long-since 
defunct Hahnemann Hospital a patient presented herself with a 
carious finger. The medical man was to cure it with Lachesis in the 
200th dil. The finger was worse at each visit. Dr. Chapman sug- 
gested amputation of the dead finger. Then the patient went to 



On the Alternation of Medimies, 403 

St. George's Hospital, the amputation was performed, and there 
was, of course, cure. These are the follies of audacious bigotry, and 
medical or surgical superstition. Dr. Eussell has spoken poeti- 
cally and philosophically on this subject True poetry is always 
true philosophy. The architect of the world is called by the 
Greeks, the Poet, the Maker. Melody is made up of discord : 
it is the province of harmony to reconcile them, and to tame 
them down into quietude. Dr. Eussell has justly observed that 
different organs of the body, and different tissues, may be simulta- 
neously affected ; so that different drugs, given in alternation, may 
be necessary to produce harmonious cure. The Chairman is of 
opinion that the expert homoeopathist should be acquainted with * 
the history of medicine, and for the summary of this history we 
are again indebted to Dr. Eussell. He should know whatever is 
or can be known of all therapeutic resources. Wherever we can 
rely on a proved medicine, it is our duty to use it in preference to 
any other not proved, more nostro. The Allopaths have taken 
many a leaf out of our book. When occasion arises, in defect of 
provings, we are justified in making use of their knowledge, 
lake these cases in illustration : — 1. Some fourteen years ago, a 
young lady of about thirty years of age, consulted Dr. Chapman ; 
she had been left an orphan at seventeen, with several brothers 
and sisters to educate, and without means. She had a great faculty 
for drawing, and for teaching it. She was patronised by a 
Duchess, more remarkable for her noble qualities than for her 
rank. The poor girl slaved on ; she contrived to educate her 
brothers and sisters, to provide for them ; but the martyr had 
slaved night and day, and ehe had become subject to such 
attacks as thesa In whatever presence, at home or abroad, 
she was once or twice a week seized with spasms of the heart ; 
she screamed and feinted. The sudden clutch of the heart was 
the thing. Hydrocyanic Acid was prescribed for her, and she 
was speedily and permanently restored to health. — 2. During 
the last invasion of cholera, a Moravian missionary sent for Dr. 
Chapman, to see him ; he had severe choleraic dysentery, with 
the pinched and peculiar features of cholera patients, the whisper- 
ing voice and extreme prostration. Merc. corr. and Colocynth 
were given to him. He had been often asked about any peculiar 
symptoms. On the third day he said he was always faint, 
and had fainted after the tenesmus and strain of the dysen- 
tery. Aloes was then prescribed for him, and after a few doses 
the disease was cured. He is now alive and well in Ireland. 
The physician knew the effect of Aloes from his allopathic expe- 
rience. It is yet no proved drug. — 3. A boy, of about eight 
years of age, had measles. Some five or six others, of a wxxvsY^xovia 



404 Symptoms of Cerebral Diseases. 

family, had the disease mildly. In this hoy's case it was severe. 
He suffei-ed from eczema of his legs almost from his birth. He 
had a great deal of fever throughout ; pneumonia supervened ; 
the surface of the skin, which had been affected with eczema, 
became dry as a chip. Aconite, Bryonia, Phosphorus, had been 
used for the pneumonia, without any decided advantage. The 
physician did not think of Lycopodium, because of the fan-like 
motion of the nostrils ; but he thought of Gum Ammoniacum, 
which he had used as an Allopath, with benefit in such cases. It 
acted like a charm ; the expectoration, which had been suppressed, 
was set free. Two or three days after he was in the dining- 
room, and a week after he was at Scarborough, Touching the 
alternation of medicine. Dr. Drysdale, in reply to objectors, had 
said pithily, but with true Socratic irony — " You all object to it, 
but you all do it." As a matter of course, we are all bound to 
cure our patients as best we may. In this building — ^the Lon- 
don Homoeopathic Hospital — ^where our meetiQgs are held, there 
is abundant opportunity for the medical officers to endeavour, at 
least, to come to some conclusion about the vext questions of our 
practice — such as the dose, the repetition of the dose, and the 
alternation of the medicines. 



NOTES ON THE SYMPTOMS OF CEEEBEAL 
DISEASE. 

By Dk. Black. 

Few passages in the "Organon" of Hahnemann have given 
rise to more hostile criticism than those, where he remarks on 
symptomatology ; e, g., " The disease consists only of the totality 
of its symptoms :" — " The physician needs only to remove the 
totality of the symptoms, in order to cure the disease." 

"Everything of a morbid nature that is curable makes itself 
known to the physician by symptoms of disease;" and in 
connexion with these instructions for investigating, and tracing 
the picture of the disease, are his directions for selecting the 
remedy, — such as "the sum of all the symptoms in each 



Symptoms of Cerebral Diseases, 406 

individual case of disease must be the sole indication, — ^the 
sole guide to direct us in the choice of a curative agent." 

The dogmatic manner in which these theses were expressed 
exposed Hahnemann to attack, and invited the severe and 
harsh criticisms of the defenders of a would-be rational 
medicine. In their eagerness to refute, they overlooked the 
facts, that in these passages Hahnemann expressed only a 
portion of what he practised ; for in the same " Organon," he 
gives full importance to the exciting, and predisposing causes 
of disease, and dwells on the importance of considering the 
physical and moral constitution of the patient. He denounces 
not true pathology, but that tendency to attach too high a 
value to our own mental powers, which leads the physician to 
assume, and speculate on the proximate causes of disease, and 
then to base his therapeutics on what is as little cognizable to 
us as the cause of life itself. He desired to maintain that 
what is really cognizable in disease are the remote and predis- 
posing causes, together with the totality of the symptoms ; the 
connecting link which unites then, the proximate cause, is to 
us inscrutable. Hahnemann's symptomalogical rules have less 
force in the present day than when he commenced his career 
as a reformer. Then medicine was in a very speculative 
stage, and hypothesis was more honoured than simple obser- 
vation. The Methodists and Eationalists were victorious over 
the Empiricists. I use the terms in their original sense, for 
though time has mnch altered their valne, they will ever 
represent constant mental characteristics in Medical Schools. 
In Hahnemann's early days the Eationalists styled their crude 
speculations, pathology ; and the Methodists strove to reduce 
all known diseases within the limits of a natural-history 
arrangement, and to make Nosology the basis of treatment. 
It was to oppose such errors that Hahnemann wrote the theses 
already quoted. Loud was the outcry, " he treats symptoms," 
— " he follows the shadow, and leaves the substance," — " such 
symptoniatology is the grave of science." 



40 6 Stfmptonis of Cerebral Diseases, 

In this Society, I need not dwell on these criticisms; we 
all can readily assent, if not to the words, at least to the spirit 
of Hahnemann's directions, which may be read thns : — ^Disease 
is to be estimated by the totality of the symptoms, or phe- 
nomena, and this picture is the principal guide in selecting a 
remedy. 

As this was an antidote in Hahnemann's days to loose 
speculation, so it is invaluable to us as guarding against a 
routine and slovenly practice. The importance of considering 
the whole plienomena of disease is in no class of cases more 
imperative than in affections of the brain; for here the 
symptoms are often so obscure, or when marked, so common 
to various disorders, that unless carefully connected and 
analysed, errors are sure to arise. 

Think how often such symptoms as headache, vertigo, 
vomiting, various mental changes, loss of power, &c., occur in 
disease, and how frequently they present themselves in our 
Materia Medica; but here, unfortunately, too often disjointed 
from all that makes them valuable. 

In the limits of a paper, it is impossible to consider sys- 
tematically the symptomatology of cerebral disease; I shall 
confine myself to clinical remarks bearing on a few important 
points. 

I commence with a case treated by Dr. Eussell and myself, 
as far back as the year 1843. 

A healthy-looking child, aged 4, was in perfect health 
until the morning of the 4th of July, when he was suddenly 
seized with vomiting. When seen by us, in the afternoon, he 
presented the following symptoms : — constant nausea, with 
repeated vomiting ; tongue clean ; no pain or tenderness in the 
abdomen : he complains of great pain in the head, which is 
very hot, as is also the skin; face flushed; pulse 130, full and 
hard; breathing hurried; no affection of the chest. Aeon, 
was prescribed for ten hours, and then BelL 

Stb. After two doses of Aeon, the skin became moister, and 

i 



Symptoms of Cerebral Diseases, 407 

the vomitings ceased ; little sleep, and very disturbed ; delirium 
during the night; convulsions and startings of the limbs 
face flushed ; eyes fixed, and bright ; he rolls and turns his 
head constantly on the pillow; great heat of the head, and 
severe pain; pulse 110, full; breathing less hurried. Con- 
tinue BelL 

6th. Slept much better; no delirium; no starting of the 
limbs; skin still hot; pulse 100, soft; headache much 
diminished ; bowels opened ; appearance of face natural Eept 
BelL 

VtL The patient is WelL 

In our " Dispensary Eeport," this case Was styled meningitis. 
Our critics — and in those days they were as bitter as they 
were numerous — pronounced it to be clearly a case of 
symptomatic irritation of the brain, owing to improper food in 
the stomach. 

I think th6y were wrong ; Iherd is no pathognomonic sign 
of meningitis ; and in the early stages of its acute form the 
diagnosis must be drawn from the presence of a certain group 
of symptoms, and the absence of others. 

K no improper food have been tak^n, then in a child mor6 
than three years of age, it is improbable that such symptomatic 
cerebral disturbance could be set up without pain, and 
tenderness in the abdomen. There was no question of den- 
tition, the most fruitful cause of symptomatic cerebral disturb- 
ance of children, nor of worms, another fruitful source of 
irritation; no exanthematous fever showed itself, a class of 
affections not imfrequently ushered jn by similar symptoms ; 
so that by this method of exclusion much difficulty is 
temoved; yet, still doubts remain; and for the further cor- 
rectness of diagnosis, the abiKty of the observer must be 
taken into consideration. It is very important in point of 
prognosis and treatment to make the distinction, but bearing 
this in mind, that these sympathetic diseases of the brain in 
early life may, when severe, terminate in cet^iaJi. ftc^^^aafc^ 



408 Symptoms of Cerebral Diseases, 

Were I now to diagnose the case, I would say it was one of 
threatening meningitis, or one of active congestion of the 
brain and its membranes; these two conditions readily pass 
into each other, and require the same treatment. 

When a cliild, apparently well, is attacked with headache, 
fever, vomiting, convulsions, hurried, oppressed breathing, and 
there is an absence of stomach disorder, the ailment may be 
suspected to be inflammation of the brain and its membranes ; 
and if to these supervene constipation, strabismus, or coma, 
alternating with the convulsions, or if the latter be followed 
by loss of power, than there can be no doubt about the nature 
of the disease. As a general rule, lesions of the motive 
power are of more consequence than those affecting the intelli- 
gence. Convulsions, followed by loss of power, are of cerebral 
origin ; and this is a point which almost always distinguishes 
them from the epileptic paroxysms. Besides, the intervals 
between the latter, are those of apparent health, whereas a 
frequent recurrence of the former leaves the patient out of 
health ; and, if persistent, or attended with vomiting, squinting, 
loss of power or intelligence, there are grounds for supposing 
there is tubercular disease of the brain. 

Barthez and Eilliet consider that an attack of meningitis, 
suddenly commencing with convulsions, is indicative of tuber- 
cular disease of the brain. 

I shall now pass on to another class of acute cases affecting 
children ; and where sometimes it is very difl5cult at first to 
determine whether the symptoms are those of irritation of the 
mucus membrane of the digestive canal, or those of hydro- 
cephalus. The following case illustrates the diflSiculty : — 

A strumous child, aged six, suffers for some weeks from a 
more or less constant, dull pain in the head, loss of appetite, 
and flesh; the tongue white in centre, with prominent red 
papilla, and red tip ; occasional vomiting, the bowels generally 
costive, sometimes relaxed ; sleep disturbed, frequent startings 
when asleep ; pulse rarely quick, generally languid and irrit- 
ahle. 



Symptoms of Ctrehral Diseases. 409 

Tliu6 the Case went on for three weeks, the patient getting 
thinner and weaker; and now the symptoms, which before 
were so difficult to diagnose, became more characteristic. There 
is increased irritability, alternating with langour and dnlness; the 
nights more wakefiil ; starting and screaming in her sleep ; the 
pulse begins to quicken, and soon this rapidity alternates with 
slowness, so that at different periods of the day, the pulse 
is varied — now slow, then rapid, weak, and irregular. To 
these is added another symptom — frequent sighing breathing. 
There is now little doubt of the disease being hydrocephalus, 
or tubercular disease of the brain ; soon complete coma sets in, 
and in this state the little patient died ; but about a day pre- 
vious to her death she recovered intelligence for a few hours. 
The autopsy confirmed the diagnosis. This remarkable irregu- 
larity of the pulse, attended by the sighing respiration, may be 
considered as very characteristic of tubercular disease of the 
brain, or hydrocephalus, as it is often called. In isuch a case as 
ROW detailed, had the affection been one of the digestive tube, 
the fever would more probably, after the first week, have shown 
a remittent form, the pulse tolerably quick during the day, and 
becoming rapid in the evening. I recollect a case where the 
t)bservance of this highly irregular pulse was very important m 
^agnosing cerebral disease. A young lady, aged fifteen, in 
the enjoyment of good health, menstruating regularly, and who 
Was able, with care, to pursue her Studies at school, began to 
t5omplain of dull frontal and occipital headache, with no other 
symptoms, except constipation. Belladonna was given for two 
days. On the third day the headache continued, the Skin Was 
cool, the pulse 90. Aconite administered, and tJbntin'iied dui^ing 
the fourth day. Fifth day, still headache, extremely wakeful 
night, followed by distress, stupid look> pupils sluggish ; the 
pulse 45 to 50, and unsteady. The persistence of the head* 
ache, with the peculiar pulse and dull look, at once created 
suspicion of serious disease. As the young lady was at schoo!^ 
and her Mends at a distance, I strongly urged the im^ot^aKL^^ 



410 Symptoms of Cerebral Diiecuee. 

of coDsulting a physician of the Oidinaiy School, as I considdred 
the patient was suffering firom grave cerebral disease, and that 
there were little, or no hopes, of her recovery. A physician, 
now retired from practice, was consulted; he ridiculed my 
opinion, and considered the continuance of the headache as one 
of many signs of the impotence of homoeopathic practice. An 
aperient was rapidly to cure the patient, but neither one nor 
several had any efifect on the constipation or headache. Then 
leeches, cupping, and blisters had no influence in checking a 
rapidly increasing coma ; and in about ten days death closed 
the scene. 

Cases of inflammation of the brain, occurring in young 
people, are sometimes very difficult to diagnose from continued 
fever. I remember two very instructive cases where this diffi- 
culty occurred, but my notes of them are too scanty to afford 
sufiicient data for your discussion. 

From childhood let us pass on to an age when the pro- 
creative powers begin to exercise an important part in the 
economy, and give a special character to various symptoms. 
Our time will not allow of us entering on the influence 
hysteria exerts in simulating serious affections of the brain, 
producing a group of symptoms sometimes difficult to diagnosa 
Passing over the periods from commencing puberty to Woman- 
hood, a time so favourable to functional disturbances of the 
nervous centres, we may briefly consider a group of symptoms 
occurring when the catamenia are ceasing, or have done so. 
Some groups are purely hysterical, but that which I now wish 
to describe closely resemble active congestions of the brain 
— so much so, as frequently to alarm the patient, and create 
fears of apoplexy, palsy, &c. 

The following case gives a fair example : — 

A lady, aged foi-ty-six, has lately ceased to menstruate; 
since then she has complained of general weakness, occasional 
veitigo, frequent flushings of heat, followed by perspiration, 
and attended by fluttering and palpitation of the heart; great 



Symptoms of Cerebral Diseases. 411 

mental irritability. In addition to this, more or less her 
ordinary state, she has occasional attacks of severe headache, 
semilateral and occipital, stiffness of nucha, noise in the ears, 
highly flushed face, vertigo, intolerance of light and noise, great 
mental excitement, amounting sometimes to delirium, or de- 
pression; pulse normal This state is very different from 
active congestive attacks, and it also varies from a similar 
group due to anaemia. In the attack under consideration 
stimulants do no good, rather harm ; and such remedies as 
Aeon. BeU. Fer. give generally no relief; whereas palliation is 
obtained by Puis., Sep., LacL, Graph. Croc. The hip bath, fresh 
air and exercise, with an absence of all stimulants, are great 
assistants in giving relief. 

Let us now turn to a condition of diminished nervous power, 
taiet with principally in young men, and due to over exhaustion 
of the sexual organs. Such patients suffer from general loss of 
strength, with flaccid muscles ; the eye loses its brilliancy, the 
pupils are generally dilated ; they show uncertainty of voice, hesi- 
tation in speech, diflSidence in manner, palpitation of the heart> 
and often have, more or less, flatulent dyspepsia. To these 
general symptoms are added those of functional cerebral dis- 
turbances. The sight becomes weak, the adjusting powers of 
the eye are readily fatigued, often Muscse Volitantes ; in con* 
firmed cases sometimes amaurosis. Headache, generally not 
constant, but readily excited, vertigo, noise in the ears ; rest* 
less and unrefreshing sleep, great depression of spirits ; loss of 
memory and diminished power of mental application. Patients 
in such a state of nervous exhaustion are very liable on slight 
causes — such as indigestion, to have sharp attacks of headache, 
confusion, flushed face, cold extremities, great mental depres- 
sion, embarrassed speech, ringing in the ears, &c. In one case 
I attended, the patient became nearly comatose. The condition 
is very similar to that produced by loss of blood and over 
lactation. 

It is a well established fact, and one showing the im^ov^x^^^ 



412 Symptoms of Cerebral Diseases. 

of considering the whole of the phenomena, and not one or 
more groups of symptoms, that congestion of the brain and 
coma are produced by exciting and by depressing agents. Of 
these causes none are more frequent than general weakness, 
whether due to deficiency of nervous power, to loss of blood, 
or to its impurity> as in gout, kidney diseases, typhus, syphilis. 

I shall briefly report two cases which illustrate this kind of 
cerebral disorder : — 

A gentleman, aged about thirty> stout> but puffy looking, 
with dull eyes and languid gait, consulted me for extreme 
wakefulness. Seven years ago this was the precursor of what 
he says was treated as brain fever. The symptoms returning^ 
he was recommended to leave India. He has now been in 
England for five weeks, but with no benefit. His sight has 
become weak, and his spirits depressed ; he has oppression of 
the chest, coldness and numbness of the hands ; seminal emis- 
sions, about every fourth night. Ign. 1, and Phos. 1, given on 
^alternate days, together with a cold sitz bath, had in six weeks 
a very beneficial effect. He then remained a fortnight without 
' medicine, and again took the medicines. The emissions occur 
now very rarely, and the sleep and general health are restored. 

In India the cause of the head symptoms had been over- 
looked, and the disease maltreated. 

An officer, aged thirty-two, who served eight years in India, 
and suffered much from the climate in the shape of dysentery, 
was attacked, in the latter part of 1860 and commencement of 
1861, with repeated fits of giddiness, accompanied by much 
debility, in consequence of which he was sent to England on 
sick leave. 

He placed himself under hydropathic treatment ; finding no 
benefit to his seminal emissions, which he was now told were 
at the root of his debility and vertigo, he gave up the treat- 
ment ; then followed some tonic and local remedies, with partial 
benefit ; then abandoned all treatment Gradually his health 
improved, so much so as to induce him to prepare to return to 



Symptoms of Cerebral Diseases, 413 

India. About a month before consulting me he suflfered 
from toothache, and had a decayed tooth extracted; shortly- 
after this he was seized with paralysis of the left side of his 
face. His frequent seminal emissions had decreased to once a 
week, and pari passu, the debility and giddiness had dimi- 
nished. His object in consulting me was to ascertain the 
nature of his paralysis, and the prudence of his returning to 
India, seeing that to his old tendencies of debility, diarrhoea, 
and vertigo, were now superadded paralysis* 

The paralysis has existed three weeks, and is unattended by 
pain. When he speaks, and especially on smiling, the face is 
drawn to the right side, the left remaining unmoved; the 
left cheek feels loose ; this is very apparent when he attempts 
to blow or whistle, which he is unable to do. The left eyelid 
droops, and he is unable to close it; and on attempting 
to do so, the eyeball rolls upwards. No paralysis of 
tongue. 

It was quite evident that this was a case of paralysis of the^^ 
portia dura of the 7th pair : this loss of power of the 
orbicularis palpebrarum is very characteristic, and distinguishes ^ 
this form of paralysis from that of the 5th or the 3rd pair 
dependant on cerebral disease. The prognosis was therefore 
favourable; I recommended him to apply for three months' 
more leave, and then to return to India; I told him that> 
before that time, the paralysis ought to disappear, and that 
it had no connexion with his vertigo and weakness. Phos. 1 
was given for the general health. In about five weeks 
he was able to close the left eyelid a little more. The 
general health was much better. Continue Phos. 1. 

In three weeks I again saw him ; the weakness, vertigo, and 
diarrhc3ea were very much better ; the emissions occur once a 
fortnight, and are not followed by exhaustion ; he can close 
the eyelid, and the action of the buccinator is perfect ; but he 
still feels on laughing that there is much more action on the 
right than the left side of the face. Continue Phoa, 



414 Symptoms of Cerebral Diseases. 

He sailed in about a fortnight for India in improved health, 
and continued the Phos. for two months longer. 

The case is interesting, and shows the importance of 
regarding all the symptoms, for on the nerve affected depended 
the prognosis; had the fifth been affected, this coupled with 
the long-continued vertigo, must have given a more serious 
aspect to the case ; for paralysis of the portia dura is very 
rarely indicative of serious mischief unless occurring in con- 
nexion with disease of the temporal bone. 

Tliis palsy of the portia dura is very often produced by 
exposure to cold wind blowing on the face, and thus affords an 
instance of what is called peripheral paralysis. 

I lately attended a case of this kind in a rheumatic l^y, 
who was suffering from acute sciatica ; she had sat for some 
time, during the afternoon, close to a window. In the middle 
of the night she woke with a slight paiu in the left side 
of face, which, on looking at in the glass, she found com- 
pletely paralysed. I was immediately summoned, and was 
able to calm her fears as to the natui^e of the attack. In this 
case, four months elapsed before the face perfectly recovered. 

The subject of paralysis is far too extensive to admit of itd 
being now considered. I shall merely cursorily allude to Bomd 
symptoms bearing on its diagnosis. Paralysis may arise, 
first, from the nerve being destroyed, or its conducting pdwer 
temporarily diminished by such agents as pressure and cold, — 
such poisons as lead, mercury, arsenic, aconite, or from some 
peculiar state of the system — such as hysteria, chorea, diph- 
theria, syphilis, and rheumatism. Second, from diseases of the 
nervous centres, the brain and the spinal cord. 

When we remember the conditions of the brain which are 
embraced in this second division, it cannot be expected that 
similar states are readily found in the pathogenesis of a medi- 
cine ; in fact, in both divisions, we need something more than 
the totality of the symptoms as the indication, we require 
clinical experience, both to guide us in choosing the remedy, 



Symptoms of Cerebral Diseasss. 415 

and very specially in showing us when medicines are una- 
vailing, and impossibilities are not to be expected; for as a 
School, I think, we neglect the natural history of disease. 
Passing over the first division, let us take the second, where 
hemiplegia is dependant on cerebral disease. Here, among 
other symptoms, the condition of the muscular system, espe- 
cially of the arm, may afford assistance in guiding the 
treatment 

K g, — ^Paralysis with relaxed muscles is generally dependant 
on white softening, an atrophic state of the brain, the result 
of malnutrition due to diseased arteries. 

Here medicines cannot be expected to do much ; the treat- 
ment must be principally hygienic. I know of no remedies 
which, as yet, have been proved to have the property of causing, 
for example, atheromatous degeneration of the arteries, or of 
blocking them up with fibrous plugs. 

Age must be borne in mind as the great promoter of this 
change. I think I have found Phos. occasionally very useful 
in giving tone in atrophic conditions of the brain of old 
people ; now, this remedy has a remarkable power of producing 
fatty degeneration in many organs, such as the liver, the 
kidneys, &c., and of exciting hoemorrhagic extravasation in the 
cellular tissue. But nature does so much to restore, in such 
cases, that great caution is required in judging of the success 
of any remedial measure.* 

Again, hemiplegia, with early rigidity of the paralysed 
muscles, arises from some irritation or inflammation of the 
brain; this condition of slight and partial rigidity of 
muscles, is that of most frequent occurrence in the hemiplegia 
caused by an apoplectic clot. The idea, as to its cause, is 
that it depends upon a state of irritation, propagated from 

* As this paper does not profess to embrace the treatment of 
cerebral disease, I do not allude to the medicines usually given 
in paralysis, such as Aeon., Ars., BelL, Dig., Cic, Mer., Plumb., 
Sea, Shii&, Zinc, Ver., LacL, Naja, &c. 



416 Symptoms of Cerebral Diseases, 

the torn part of the brain to the point of implantation of the 
nerves of the affected muscles. "But," you will ask, "why is it 
that in some cases of clot, the hemiplegia is accompanied with 
complete relaxation of muscles, while in other cases rigidity 
exists?" 

The probable answer is this ; "in the cases where there is no 
rigidity, the clot lies in the midst of softened brain, and has 
not encroached upon sound brain; but when rigidity exists, 
the clot has extended beyond the bounds of the white soft- 
ening, and has torn up to a greater, or less extent, or irritated 
the sound brain." * 

In cases where rigidity is complete, there is probably ex- 
tensive intermingeal haemorrhage, or some inflammatory process 
going on, or some irritation, due to some tumour. A more 
serious condition than when the muscles are relaxed. If 
medicines can do anytliing, and this is possible when inflamma- 
tion is the cause, then Aconite is undoubtedly the remedy ; I 
much prefer it in the lowest dilutions. 

This early rigidity is not to be mistaken for a kind which 
occurs later in paralysis ; and follows a relaxed state of tlie 
muscles. It occurs in the course of recovery, and, is 
supposed to be due to an attempt at cicatrization, more or 
less perfect at the seat of the original lesion, whether it be 
simply a white softening or an apoplectic clot, or a red 
softening, with more or less destruction of the brain sub- 
stance, t This gradual shrinking keeps up a slow irritation 
of the surrounding healthy brain ; this is propagated to the 
muscles, and excites in them a corresponding gradual con- 
traction, while, at the same time, their nutrition becomes 
seriously impaired by the want of proper exercise, and the 
general depressing influence of the lesion. 

"Whatever cause paralysis proceeds from, it must be borne in 



* Dr. Todd, " Clinical Lectures onthe Nervous System/' p. 219. 
t Loc, eit,, p. 243. 



Symptmns of Cerebral Diseases, 417 

mind, that nerve tissue never regenerates quickly, and seldom 
completely ; so that any great, or long continued lesion of its 
structure, is not likely to be perfectly removed. 

The conditions causing paralysis will be still better under- 
stood if we pass from a period where the vascular — the nervous 
and muscular systems are in their prime — ^to that stage where the 
general failure of the powers of life disclose the approach of old 
age. Gradually the vital powers have been weakening, organic 
changes slowly creeping on, and mechanical and chemical laws 
gaining a preponderance over vital ones. The increasing belly, 
and the decreasing leg, tell a tale of diminished muscular 
energy, and of the increased liability to adipose degeneration 
and venous congestions. "The shrivelled sinews and the 
bending form, the workmanship of time's strong hand pro- 
claim." Digestion and assimilation languish; the blood has 
less of its elementary parts, and an increase of its fatty and 
aqueous contents. The secretions show changes in diminished 
quantity and quality ; the respiration is less active, the heart 
and arterial system begin to show marked structural degene- 
ration ; the skin becomes dry, and the power to perspire sen- 
sibly diminishes. The procreative faculty declines, and desires 
become extinct. The urine contains less urea, uric acid and 
other salts, than in the prime of life ; it is frequently turbid, 
and readily falls into a state of putrescence. 

In all this withering, condensing, drying process, the brain 
largely partakes. The changes which affect the general vascular 
system, tell peculiarly on the vessels of the brain, in producing 
atheromatous and calcareous degenemtion ; sometimes a fibrous 
blocking up of the arteries, especially of those at the base of 
the brain. The membranes become thickened and opaque, and 
are not unfrequently the seat of ossific aud calcareous deposits. 
The substance of the brain shrinks, loses weight, and the 
serous fluid, which in the healthy man in his prime rarely 
exceeds three ounces, now increases to as much as eight or ten 
oanGec^ almost amounting to chronic hydroce^lasJtoa. ^^^ 



418 Symptoms of Cerebral Diseases, 

such changes in so important an organ, it is not to be won- 
dered at that diseases of the nervous centres, next to respiratory- 
affections, form the most numerous cases in the maladies of old 
people. 

Bearing in mind the anatomical changes which take place in 
the brain of elderly people, it will not be expected that pure 
inflammatory affections are nearly so frequent as in youth ; the 
ailments met with are connected with impaired vitality and 
structural degeneration. Hence, mental decay, vertigo, tremor, 
paralysis, and apoplexy are of much more frequent occurrence 
than inflammation of the brain and its membranes. When the 
latter occurs, it is never idiopathic, as in youth, but is the 
result of some dyscrasia, such as gout, rheumatism, or kidney 
disease. 

As in younger people, so in old, it may be possible now and 
then to diagnose whether the membranes or the substance of 
the brain, or both, are affected ; but these cases are the excep- 
tion, and for most practical purposes they may be considered as 
one disease. 

The following case will illustrate the typhoid appearance 
such inflammation assumes in old people : — 

A lady, aged eighty-one, whose health was much deterio- 
rated by bronchitis and rheumatism, was exposed to much 
anxiety and distress; in a few days these produced their 
baneful effects. She lost her usual cheerfulness, she became 
irritable, wakeful at night, and exhausted during the day. In 
the course of six days there was slight conjunctivitis, dull pain 
in the head, the cheeks flushed, the pulse became very quick 
and feeble, the extremities cold. About the eighth day, 
vomiting and sickness showed themselves, the tongue became 
dry and brown, bowels constipated, intelligence getting duller, 
but occasionally great loquacity, until utterly fatigued ; soon 
there was muttering delirium ; and, at last, on the tenth day, 
complete coma, with slight facial paralysis, appeared. 

The tongue became like brown leather, the abdomen very 



Symptoms of Cerebral Diseases. 4 1 9 

t^TTipanitic ; the motions liquid, offensive ; and passed, as well 
as the urine, unconsciously. Such a state, with slight facial 
paralysis, continued for seven days. Gradually the power to 
swallow returned, the coma decreased, the mouth became 
moister, the tympanitis diminished, the motions were less 
offensive, and the pulse lost a little of its weakness, quickness, 
and irregularity. 

When the coma passed away, there remained paralysis of 
the right leg and arm, with slight rigidity of the muscles. 
By the sixth week I began to entertain hopes of her recovery, 
which before T had utterly abandoned. The power of speech 
was for long impaired; and four months expired before the 
paralysis of the limbs passed away. Her health, considering her 
age, is now very fair. Recovery after such an attack is rarely 
to be expected. The remedies used were Aeon., Bell., Ars., 
Naja. Phos. Ign. ; and in a later period, when prurigo — that 
scourge of old people — retarded her recovery, Rhus, was 
given. 

I will now briefly relate a case where no inflammation 
probably existed, but where a somewhat similar condition was 
due to uroemic poisoning. 

A lady, aged sixty-four, has long suffered from bronchitis, 
which has been worse this last winter and spring. She came 
to Clifton for change of air, and consulted me, April 30, 
1864. She was then able to walk a quarter of a mile to my 
house ; she was emaciated and weak, pulse quick, no appetite, 
tongue glazed and like raw meat, intense t]:i:st, the howels 
regular, loose cough, signs of tubercular disease in apex of 
right lung. The urine, when examined next day, had slight 
acrid reaction, about a pint and half passed in the twenty-four 
hours, sometimes more. Sp. gr. 1.008, albuminous. Tereb. 

May 3. Seen at her lodgings. No change. Cont. Tereb. 

May 7. No change. 

May 11. Signs of drowsiness, cough nearly ceased, urine 
as before, no anasarca. Pulse 84, weak. Cont. Tereb. 



420 Symptoms of Cereh'al Diseases. 

May 12. Wandered during the night, tried to get out of 
bed, passed urine in bed, looks very stupid, cheeks flushed, 
answers slowly and with difficulty when spoken to, tongue 
dry and brown, pupils sluggish, sleeps with one eyelid half 
open, pulse 80 and feeble, bowels costive. Bell. 1. 

May 13. No improvement, refuses to take anything, tosses 
in bed, dislikes being touched, screams loudly, answers no 
question, no cough. Aeon. 1. 

May 14. As no urine had been passed for thirty-six hours, 
I drew off about a large pint. The patient is quite uncon- 
scious, tosses about, and screams loudly ; face pale. She died 
on the morning of the 1 5th. No post mortem. 

In this case I gave, from the first, a very unfavourable 
prognosis, and prepared the friends for a sudden change which 
might come on any day. This commenced on the 11th 
day after seeing her, and was ushered in by drowsiness and 
disappearance of the cough. This subsidence of the cough, on 
the occurrence of head symptoms, was very marked in the case 
just reported of the lady suffering from encephalitis. I have 
noticed it also in the meningitis of tubercular patients. 

This case, from the first, presented symptoms which pre- 
cluded all hope ; putting aside the tubercular disease of lung, 
and the degenerated kidneys, a tongue so glazed and so raw- 
looking, was of itself a symptom of bad augury. 

I may allude to another case in which I was consulted, 
many years ago, by a physician in Bath, now deceased. This 
patient, an old man, had long suffered from bronchitis, but the 
occurrence of obstinate vomiting and headache, led to my being 
called in. On examining the patient, I was struck by his 
anoemic appearance ; his heavy, drowsy look ; his feeble, 
irregular pulse ; his weak and dilated heart. These symptoms, 
together with slight oedema of legs, led me to suspect kidney 
disease ; and this suspicion was confirmed by an examination 
of the urine. It was evident that the patient was beyond the 
reach of medicine ; next day epileptiform convulsions set in, 



Sym/ptams of Cerebral Diseases. 421 

and in twenty-four hours after their appearance he died 
comatose. 

The physician in attendance had carefully watched the case, 
but committed a grave error in diagnosis, because he always 
took the Materia Medica Pura as the standpoint from which 
to examine disease. Head -ache, vomiting and cough, 
with minor symptoms, was the group for which he dili- 
gently searched ; but the heart and urinar}'^ symptoms in Hahne- 
mann's Materia Medica are so imperfectly and so unscien- 
tifically catalogued, that the mistake made in overlooking the 
diseased heart, and the impaired action of the kidneys, is not to 
be wondered at. 

Such errors must occur in the practice of those who me- 
chanically work in this manner, making up pictures of disease 
from the schema of their Materia Medica, instead of first using 
the aids of physiology and pathology, to arrange the patient's 
symptoms in due sequence and connexion. This peculiarity is 
fortunately dying out ; it is an attempt to copy Hahnemann, but 
a poor one, and like all copies it wants the genius of the original ; 
he acquired his knowledge, and acute perception of disease, in 
a different way, and with that knowledge his schema was not 
the quagmire it is to many. 

Vomiting in elderly people ought always to be regarded 
with great suspicion, especially if attended by heaviness, 
vertigo, or syncope. I recollect under-estimating it in two 
cases where it was the forerunner of fatal apoplexy. In both 
these C8S3S — the one an old gentleman, a ton vivant — the other 
a lady of fifty-five — the symptoms occurred in the night, after 
a late and sumptuous dinner. 

We cannot be too much aHve to the importance of the pre* 
monitory symptoms of apoplexy, for the precursors of this 
disease do occasionally admit of relief; but in the attack itself 
the mischief in 95 per cent, of cases is already done; the 
patient is comatose, blood has been efiTused. Our efforts must 
now be turned to prevent further mischief, and to %\vax^ ^.'^^ac«isX» 



422 Symptoms of Cerebral Diseases. 

any symptoms which may result from the irritation or inflam- 
mation of the brain surrounding the clot. 

You may recollect the reply of Hahnemann, when asked by 
an ai-dent pupil — *' AVhat would you do if summoned to a case 
of apoplexy ? " *' Not go," was the brief reply. Why we may 
ask not go ? AVhy was discretion with Hahnemann, in this 
instance, the better part of valour ? Because Hahnemann felt, 
as we all have, that standing by a comatose man, is not the 
fitting place for a therapeutical discussion ; the bystanders look 
on the medical man to restore consciousness. They had no 
doubts in those days as to what must be done ; they had an 
unshaken traditional belief in the lancet ; they entirely coin- 
cided with the good rule of old Dr. Cheyne, " to have every 
patient who was not plainly dying blooded.*' Since these days 
the profession have greatly altered their views of apoplexy, and 
the public have even anticipated them in the change of treat- 
ment, so that now Hahnemann's caution is unnecessary.* 

Active nervous congestion may occasionally be a cause of 
apoplexy, and give a valid excuse for venesection; but the 
extravasation of blood, the congestion, the cerebral softness, are 
the results of impaired vital action tending to disease of the 
cerebral arteries, and thus predisposing to rupture on bodily 
exertion or mental emotion. These deposits, fatty or calcareous, 
impair the arteries of the brain; they become less able to 
support their contents, and the badly nourished cerebral sub- 
stance imperfectly supports the arteries. " There is no single 
cause," says Kokitansky, " that will account for this frequent 
repetition of apoplexy in many individuals, and its simulta- 



* In the discussion arising on this paper. Dr. Eussell gave 
another view of this anecdote ; his version may be the correct 
one, but my informant was the late Mr. Trotman, who saw much 
of Hahnemann, and he frequently related to me this story in the 
light I have given it, and also as bearing on Hahnemann's rule, 
while resident in Paris, not to attend patients at their own 
houses : the answer had a double signification. 



Symptoms of Cerebral Diseases, 423 

neous appearance at several diflferent spots in the brain, but the 
presence of disease of the vessels." 

It is the opinion of Eokitansky, and many of the profession, 
that h3rpertrophy, or hypertrophy with dilation, exerts a great 
influence in causing haemorrhage in the brain ; but this view is 
denied by several able observers, and it is not unlikely it may 
soon be as much modified as the theory of fulness in the 
cerebral cavity being the cause of haemorrhage. 

A patient with dilated and hypertrophied heart and valvu- 
lar disease, dies of apoplexy; a post-mortem examination 
reveals effusion of blood into the substance of the brain, which 
is softened round the clot, and there is extensive disease of the 
arteries of the brain, and of other parts of the body. 

Now, what is the natural order of phenomena in this case ? 
— a peculiar vital change slowly operates on the system, 
deposits take place in the arteries, and on the cardiac valves 
the heart is thus enfeebled, and it has, under this disadvantage, 
to propel blood through vessels which have lost their natuml 
tone, and are more or less obstructed. To meet this the 
heart must act more strongly, and thus gets hypertrophied and 
dilated, as the only way of carrying on the circulation. Eela- 
tively to health, the heart's action is weaker; the apparently 
additional force is a necessity. 

The minute cerebral vessels are not ruptured by over action of 
the heart, but owing to their own diseased state. The vast 
majority of cases occur in persons beyond middle life, and of 
impaired constitutions. It is a mistake to regard the ple- 
thoric, short-necked individual as the sole type of the apo- 
plectic: for the spare, the emaciated and exhausted by disease 
are more liable to its attacks. With the former the attacks 
may be more frequent, but less severe than with the latter ; the 
most rapidly fatal cases often occurring in reduced and anoemic 
persons. 

We have still much to do in bringing up the therapeutics of 
cerefaxal disease to the extent of our knowledg^e o^ *\\.^ \svQr^\^ 



424 Symptoms uf Cerebral Diseases, 

anatomy. There is no class of disease which requires more 
care in the study of its numerous, and often very complex and 
obscure, symptoms ; and in chronic cases of a curable kind, both 
hygienic means, and the long- continued use of one medicine, 
must be persevered with, if benefit is to be attained. 

In our anxiety to give speedy relief, we forget how slowly 
functional disorder operates in producing structural change, and 
how much slower must be the process which is to counteract 
this. 

In the case of a gentleman, aged sixty, with weakened brain 
and bronchitis, depending on adipose degeneration, I have seen, 
after five years of long and steady use of Arsenic, Digitatis, and 
Phosphorus, a very material gain in health and strength. A 
large arcus senilis diminished ; a pulse, felt with extreme diffi- 
culty, now reatlily counted ; and a weak, beating heart, now 
manifesting in its clearer sounds and contraction, a great gain 
in ^dgour. 

But while we strive to make good our therapeutic deficiency, 
we must remember the lesson, hard to learn, and more difficult 
to follow, that nature can do more than the physician, and in 
no diseases more certainly than in chronic affections of the 
brain. 

DISCUSSION. 

Dr. Druuy said, it was about two-and-twenty years since he 
got up in a society in Edinburgh to oppose what his friend Dr. 
lUack then said in favour of Homoeopathy. He was happy on 
the present occasion to be able to rise and express the very great 
pleasure he felt in again meeting Dr. Black, and this time with 
so little difference of opinion between them. He hoped often to 
have the pleasure of meeting Dr. Black in the Society ; and, as the 
president suggested, " always with a paper ;" as coming from him, 
they were sure to be attractive to the members of the Society. 
Unfortunately he had been prevented getting to the meeting till 
part of the paper was read, so that his observations would neces- 
sarily be few. In regard to Baryta Carbonica, it was a medicine 
he had found very serviceable with elderly persons, suiting 
many of the ailments to which they were liable — affec- 



Symptoms of Cerebral Diseases, 425 

tions of the cerebral system, bronchitis, &c., &c. Though Dr. 
Black had spoken of medicines being of use in one form of 
disease, while not so likely to be of use in an opposite state, it 
would be well to bear in mind, that no such rule could be laid 
down, as we found some medicines suiting very opposite states ; 
thus China was of great service in the head affections so like 
congestion, in many of the symptoms depending on debility ; 
while, again, it was a valuable medicine in true apoplexy. He 
(Dr. Drury) could not at all assent to any condemnation of the 
use of repertories as leading to an overlooking of pathology. 
On the contrary, the man well acquainted with pathology knew 
the symptoms to look for. And such a man — not disdaining the 
help that was essential to all who practised Homoeopathy, as it 
ought to be practised — ^would without hesitation consult his 
repertory, and be thankful for the great help he got from it. It 
was not, however, by dealing with an isolated symptom that 
disease was to be treated, the whole group must be studied ; and 
the picture that might be obtained from the Materia Medica 
would often find a faithful representation in disease. Thus a 
recent study of Hypericum Perfoliatum would lead him to the 
conclusion, that much good might be looked for in softening of 
the brain, from this medicine, at least, so far as an arrest of 
symptoms might go. 

Dr. Wyld begged to thank Dr. Black for a profound and 
practical paper on a series of diseases, necessarily often intricate 
and obscure, as being connected with the organs of movement, 
sensation and thought. Dr. Wyld had seen a case, in which the 
only symptom was a gradually increasing somnolency termi- 
nating in death. The post mortem examination revealed an 
abscess filled with green pus, about the size of a wallnut. So 
violent an alteration of structure might have been expected to 
produce more abrupt and violent symptoms. He (Dr. Wyld) had 
some time ago attended a child, six years of age, who fell sud- 
denly into convulsions, and remained insensible for three days, 
after swallowing cherries and their stones, which his nurse gaVe 
him in the street. A remarkable feature of the case was the 
gaping orifice of the child's rectum. This child has again 
recently become liable to fits, which cause him to turn round 
and round, and then fall down insensible. These fits occurred 
several times in a day. In this case, one side of the cerebellum 
was most likely the seat of tubercle. This child, in most of his 
actions and sayings, exhibited disobedience, vindictiveness, and 
cruelty to an insane extent, with occasional intermissions of 
penitence and affection. The case was a most painful one to 
iii^itness. He (Dr. Wyld) knew a gentleman, eighty y<i^\^ <^i ^^ > 
who occasionally, for a few minutes at a time, \o^^ «S\. \sv^\assr3 ^'l 



426 Symptoum of Cerebral Diseases. 

time and space, asking questions as to what day it was, and 
where he was ; should the fit occur in the streets, he is obliged 
to hand his card to some one, in order to be enabled to describe 
where he lives. This gentleman is at other times, and generally 
of a cb.^ar, vigorous, and logical mind. These temporary attacks 
may })ossil)ly depend on local brain congestions, or on local 
brain (exhaustion, as speech and locomotion remain intact. 

Dr. HcGiiKS, after expressing his sense of the great value of 
Dr. Black s paper, especially to the younger members of the 
S(^ciety, remarked that the significance of any symptoms is 
b(»tter api^reciated, if, to its observed connexions and results, its 
]>hysiol()gical inteqiretation be superadded. Thus, the slow 
irregular pulse, and sighing respiration, of such fatal omen in 
cerebral affections, just mean this, that effusion is pressing upon 
the medulla oblongata, and so impairing the nervous centre of 
the all-impoi-tant functions of circulation and respiration. 
Again, in being guided in our prescription by a prominent 
syni])t()m, we may often err, unless that symptom be considered 
in its whole physiological relationship. For instance. Belladonna 
has a very powerful influence upon the brain, and also dilates 
the pupils. We might therefore infer, that one prominent indi- 
cation for the use of Belladonna in cerebral affections would be 
dilated pupil. If we did so, we should be utterly wrong ; for 
in the conditions of cerebral irritation, where Belladonna is so 
j)recious, the pupil is nearly always contracted ; and dilatation of 
the pupils no less betokens a state of exhaustion, or effusion, to 
which the drug is neither Homoeopathic nor curative. The 
solution of the paradox seems to lie in the fact, that the dilation 
of the pupil induced by Belladonna is not symptomatic of its 
influence upon the brain, but a local phenomenon, probably 
induced by excitation of the cervical sympathetic. 

Dr. KiDD commended the practical character of the paper. 
To estimate the value of true symptomatology, it is most 
important to separate the essential, or characteristic, from the 
non-essential symptoms. In tubercular meningitis, one of the 
most constant symptoms in the early stage is obstinate consti- 
pation. AVhen that symptom is associated with irregular pulse, 
headache, restlessness, and irritability, the prognosis is unfavour- 
able. Many of the worst cases of tubercular meningitis come 
on towards the close of gastric fever. When constipation and 
headache set in at the end of that disease, there is cause for 
much anxiety. In nervous, congestive headache of adults, he 
(Dr. Kidd) had found much benefit from the use of Glonoine, 
third decimal dilution, and also from the use of a warm hip 
bath for fifteen or twenty minutes, at bedtime, every second or 
third night In the symptoms, the headache of anoemia, much 



Symptoms of Cerebral Diseases, 427 

resembles the active, inflammatory, congestive headache, but 
small doses of Iron rapidly cure the former, while they only 
aggravate the latter. In the diseases of the brain from atrophy, 
he had found Zinc of much use, and also gentle shampooing 
exercise. In paralysis of the Portio Dura, Faridization, or 
localized Galvanism, is of infinite service and in some cases 
cures in a few days what, medicines unaided, require months to 
cure. In the stupor caused by uraemia, vapour baths are of 
great use. Even when the patient is confined to bed, it is 
possible to bring on a profuse perspiration by putting a large 
piece of quicklime in a blanket, throwing water upon it, and 
putting it under the bedclothes. A most violent ebullition of 
steam arises as the quicklime fuses. In the treatment of 
apoplexy he had found much good from the use of warm, salt 
water injections into the lower bowels — two tablespoonfuls of 
salt in a quart of hot water, repeated every hour or two. Also 
from the application of ice to the head, whilst the feet are 
immersed in hot mustard footbaths. In true cases of san- 
guineous apoplexy, also before effusion has commenced, bleeding 
from the arm might be called for. In progressive paralysis, or 
paralysis of the insane, he had frequently observed, as one of the 
earliest symptoms, an enfeebled action of the orbicular muscles 
of the lip, whereby the articulation of words became imperfect, 
so that the patient could only pronounce about half the word. 
In such cases. Sulphate of Zinc was the only medicine he had 
found beneficial. 

Mr. J. Harmer Smiih said he fully concurred in the views 
expressed by Dr. Kidd on the subject of " Auxiliaries,'' but 
thought Dr. Hughes' remarks hypercritical The term was cor- 
rectly applied to any therapeutic aids adopted by homoeopathic 
practitioners outside the law similia similihus curantur ; and he 
could not see any obscurity or difficulty in such a mode of classi- 
fication. He fuUy agreed in all that had been said in the way 
of eulogium of Dr. Black's paper, which, he thought, the most 
valuable and interesting paper that he had heard since he was a 
member of the Society. He concurred in what had been said as 
to the importance of noticing vomiting as a symptom of brain 
disease. Since first meeting with the statement of Dr. Aber- 
cromby, that vomiting was often the first symptom of cerebral 
disease, he had frequently met with cases confirmatory thereof. 
For example, he had just attended a fatal case in a child, in 
which the first symptom was vomiting, and this alone for some 
days \ the next, dilatation of the pupils ; the next, convulsions ; 
and the next, coma. A much more rare incipient symptom of 
brain disease, was the loss of the memory of words. Dr. Cheynft 
refers to this, and illustrates his remarks Vy ^k^ ^^sft. ^^"^^^ 



428 Symptoms of Cerebral Diseases. 

Spalding, of Berlin, who met with several cases, one of which 
occurred in a lady shortly before she committed suicide. In 
this remarkable affection, the mental faculties are preserved, but 
the memory of words is partially lost ; so that one word is sub- 
stituted for another. He remembered having attended a case 
similar to the one referred to by Dr. Wyld, in which a state of 
complete coma was induced by the patient (a child), having 
eaten a large quantity of fruit ; rapid and perfect relief of the 
sym'ptoms was produced by the action of an emetic of Sulphate 
of Zinc, which he should still think the most appropriate remedy 
under similar circumstances. He had recently cured a case of 
epileptiform of convulsions of some standing, by the use of 
Cicuta Virosa, given in the twelfth dilation. Opisthotonos here 
was one of the leading symptoms ; but there was perfect insensi- 
bility during the paroxysms, proving that the brain participated 
in the morbid state. 

Dr. Russell said — We all know how highly the writings of 
Dr. Black were esteemed on both sides of the Atlantic. His 
reputation for practical sagacity was so great, that any hints 
which he might give for the elucidation of the obscure class of 
diseases he had chosen for his theme, deserved and received the 
utmost consideration from us. The great difficulty in forming a 
correct diagnosis in cases of affection of the brain, lay in the fact, 
that we had no means of exploring the cavity of the skull, as we 
had of the cavities of the body ; we had nothing that corres- 
ponds to the stethescope — no cephaloscope. Hence one great 
source of embarrassment. If a tumour of any considerable 
size existed in the chest or abdomen, much, more in any 
external part, we could distinguish it by either direct touch, 
or by its displacing some organ which could be touched. But 
nothing of this kind was possible in regard to the brain. A man 
was admitted into one of these wards some months ago, with an 
old affection of the hip-joint. On this had supervened excruciat- 
ing neuralgic pains of the leg, taking always the same direction, 
viz., that of the sartorius muscle ; his screams were dreadful. He 
kept the patients awake with him all night ; besides, he was 
deaf. These were all the symptoms. Medicine had no effect ; 
he became delirious, which was ascribed to pain and want of 
sleep, and he died. On examining the head, a hard cartilaginous 
multilocular tumour, about the size of an orange, was found 
embedded in the cerebellum. This was an illustration of the 
important fact, that the most serious organic mischief may exist 
in the brain, and give no pothognomoniac sign. In this class 
of diseases, more than in any other, we require to weigh well the 
whole of the symptoms, to carefully disentangle, if possible, the 
sympathetic from the essential, to ascertain whether the accom- 



Symptoms of Cerebral Diseases. 429 

panying deraugemeuts of the stomach and bowels are cause or 
effect. One of the speakers, this evening, has dwelt upon the 
presence of constipation as a valuable indication for determining 
the presence of meningitis. I have not found it so. In some of 
the best marked instances of that affection, I have seen the con- 
trary condition of the bowels existed. In one of the last cases 
which have fallen under ray notice, the patient, a little girl of 
seven years of age, had been treated for some months for worms, 
and large quantities of tapeworms had been expelled. She then 
suffered from exhausting diarrhoea, and it was not till very near 
the fatal termination that unmistakeable brain disease manifested 
itself. I did not see her till the day before her death ; she was 
then unconscious, convulsed ; the pulse was 140, and she was 
evidently dying. It is too late to enter fully into the many most 
important questions suggested by Dr; Black's paper, which will 
form an important contribution to our scanty practical litera- 
ture. 

Dr. Black, in reply, said the instance of paralysed sphincter 
mentioned by Dr. Wyld reminds me of a case of cerebral in- 
flammation occurring in a young lady of strumous constitution, 
where this sympton was valuable in continuing the diagnosis. 
For about eight days it was difficult to say whether the patient 
was suffering from continued fever or from cerebritis, though the 
probabilities were very much in favour of the latter. About the 
twelfth day, for I speak from memory, the very obstinate consti- 
pation led me to press a more diligent use of enemata. The 
nurse replied, they cannot be given nor retained. I then exa- 
mined the sphincter, and found it quite paralysed. Had the 
disease been typhoid fever, such a condition must have been 
attended by diarrhoea, so that the small doubts previously 
existing were quite removed by the paralysis of the sphincter 
ani : the patient died. In regard to Dr. Kidd's remarks as to 
treatment, I may say I have not entered on this subject, as I 
wished to confine my paper exclusively to the symptoms of 
cerebral disease. I cannot take the same sanguine view as Dr. 
Kidd of the efficacy of hot air baths in ursemic poisoning. 
He must, I think, be considering a very different condition to 
what exists in the cases I have reported. It is not unfrequently 
a valuable remedy in the earlier stages of albuminuria, but one 
which in my experience is utterly useless in such cases as I have 
reported. The symptoms there met with indicate that life cannot 
be long sustained, for a disease of years has at last so degenerated 
the kidneys that they are unable from loss of structure to elimi- 
nate urea. If in kidney disease of some standing we find the 
albumen diminishing, the urine becoming scantier and ot Vs^ 
specilic gravity, and containing no littia^^s, 'v^ Ta.wj \>fc q«^N«2^ 



430 Symptoms of Cerebral Diseases, 

symptoms of nrsemic poisoning are close at hand, and that death 
must ensue. 

Dr. Chapman said, Dr. Black, though yet in the full vigour 
of life, is one of our veterans. Most of our truly eminent 
men were alumni and graduates of Edinburgh. Dr. Black 
was one of the three original editors of the British Homceo- 
pathic Journal, and has all his life been a practical worker. 
We are indebted to him for many valuable contributions to 
Homoeopathic practice He is one of our foremost men, — so 
we are right willing to listen to, or read the results of, his 
excellent practical sense and of his experience. The symp- 
tomatology of brain disease is, of necessity, in many interesting 
cases, very obscure. In the year 1862, Dr. Black attended an 
eminent physician, who was apparently dying from cerebral 
mischief His arms, on being raised and let go, fell like lead. 
There was no speculation in his eyes. Dr. Black passed one of 
his nails over those lack-lustre eyes, and there was no con- 
sciousness. There was also the peculiar cadaverous odour 
emanating from the body, that is sometimes noticed as the 
precursor of deatli. He, nevertheless, recovered ; his brain was 
imtouclied, and he is now alive and active. Early last year. Dr. 
Black visited a patient of Dr. Chapman, who was not considered 
by him to have brain disease. He was a man past sixty ; who, 
without any necessity for it, had begun the business for himself, 
being dissociated from his former partners. His offices had been 
newly painted. Dr. Chapman attributed his symptoms of giddiness, 
&c., to an overwrought brain, to an exhausted nervous system, 
to worry, and to the poison of lead. After he had been a few 
days in Gloucestersliire, he had some sort of epilepti form 
seizure. As he was at some distance from Clifton, Dr. Black 
could not see him with sufficient frequency. He then feU into 
the hands of a sensible allopath, who treated his case gently. 
That gentleman speedily got well, and for anything Dr. Chapman 
knows to the contrary, continues well. The French vivi-sectora 
have proved by their experiments on dogs, that if the corpora 
striata are wounded, the dog or other animal staggers and falls 
forwards. Dr. Chapman had the opportunity a few yeai's ago of 
verifying this statement, in the case of a gentleman who had 
several times in the course of a year staggered and fallen forward, 
and without the loss of consciousness. He performed a very 
long railway journey, went to bed, slept well, and on waking in 
the morning told his wife he felt faint ; she got him a cup of 
chocolate and some toast, ate it, and drank the chocolate, said it 
was very nice, gave a yawn, and died. The corpora striata 
were in a condition of liquid softness. Very often, neither 
scalpel nor microscope ^^n detect brain mischief, where there 



Symptoms of Cerebral Disecuis, 431 

were symptoms of brain disease during life. Dr. Chapman attended 
some years ago a physician, who for several years screamed out 
horribly, unable to resist or control his screaming ; complaining 
of little or no headache. He thought he had a tumour in the 
abdomen. His nervous system was completely prostrated. No 
disease of the abdomen or chest was detected on the post mortem 
examination, but there was atheroma of the circle of Willis. 
One of our chief practitioners, some three or four years ago, saw 
a lady, whose case he pronounced to be hopeless, as there was 
softening of the brain. An allopath was then sent for, who 
refeiTed the head symptoms to dyspepsia, and treated her 
accordingly ; the lady soon recovering, and is now well. These 
few illustrations have been given to show how very difficult it 
is to diagnose with anything like precise accuracy, the condition 
of the brain from the symptoms of supposed cerebral dis- 
turbance. In reference to the use of medicines, it is necessary 
to distinguish between the primary and secondary action. The 
larger dose man, and low dilitutionists, only avail themselves of 
the primary action of drugs. The transcendentalists, who make 
the 30th dilution their starting point, and ascend to the sub- 
limities of 1,000, 20,000, &c., ignore the primary action. The 
really expert physician avails himself both of the primary action 
and the secondary. Dr. Chapman, many years ago, while in 
South America, became subject to " Colonial fever," sometimes 
of the tertian, sometimes of the double quartan type. In the 
spring of 1861, he had to attend the funeral of a near relation. 
He was chilled ; and, a few days after, was seized with his old 
and almost forgotten enemy. He had violent rigors which, in 
an hour, was succeeded by intense heat and quickness of pulse ; 
and then passed in a few hours into the sweating stage. For 
the chill and rigours he availed himself of the primary action of 
Aconite, which he took frequently in a low dilution ; for the 
heat and fever he took Aconite in a higher dilution ; and he 
considered the "sweating stage" to be the natural and favourable 
crisis. He took no other medicine. He has had several such 
attacks since, and has treated himself in the same way ; and 
there has been no attempt on the part of that enemy of becom- 
ing a habit. He recommends to the medical officers of this 
hospital attention to the difference between the primary and 
secondary action of drugs, not on the principle of making expe- 
riments in corpore vile, but of arriving at some wholesome 
deductions, from which a philosophical induction may be 
formed, that we may so arrive at a practical conclusion. 



432 

ON DIABETES MELLITUS. 
By Dr. Neatby. 

The term Diabetes is objectionable, as associating two 
diseases, between which it is at least doubtful whether there is 
any coimexion in their essential nature ; but in the present state 
of the pathology of these disorders, it appears most undesir- 
able to attempt a change of name for either. The terms 
Mellituria and Glycosuria are more objectionable, as not telling 
us as much as " Diabetes Mellitus," and they have the further 
disadvantage of novelty. This disease may have, as Dr. 
Haughton believes, and as cases he brings forward tend, he 
tliinks, to show, an intimate connexion with "Diabetes In- 
sipidus," in which case the similarity of name is an advantage. 
And if this connexion do not exist, the two disorders have at 
least the prominent symptom indicated in common. And, 
lastly, the names are so established, and so weU understood, 
that a new name would require a veiy good reason for its 
adoption. 

Diabetes Mellitus is not at all the rare complaint it was 
formerly supposed to be, nor are its symptoms nearly so con- 
stant. Sugar is found in the urine under a great variety of 
circumstances — sometimes with formidable and even fatal 
symptoms ; at others, with scarcely any constitutional marks of 
its presence. It remains a question, and one well worthy of 
increased and careful investigation, whether there be, as is 
implied by our usual nomenclature and classification, one disease, 
of dilBFerent degrees of severity, or whether there are several dis- 
orders having this one symptom in common. In the present 
state of science, we must go upon the former supposition in 
bringing forward facts, as far as known, and opinions which 
tend to throw light upon the subject. 

There is great variety in the mode of accession of this com- 
plaint. The usual symptoms manifest themselves, in some 



On Diabetes Mellitus. 433 

cases, suddenly and almost simultaneously, as in an acute 
disease; in others they creep on insidiously, giving occasion 
for a classification, sometimes adopted, into acute and chronic 
diabetes. If this division were adopted, there would probably 
be, for every one of the former, a hundred of the latter. In 
some instances the increased flow of urine is the first thing to 
attract attention ; in others, the symptom which annoys most, 
and is complained of earliest, is the urgent thirst ; whilst, in a 
third class of cases, dyspeptic symptoms, with increasing de- 
bility, are for a time the only things which trouble the patient. 
As, however, the thirst, and in a great measure, the debility, 
seem to be dependent upon the unnatural flow, it is desirable 
to describe first those symptoms which seem most essential. 
" Which seem most essential," I say — for it is doubtful whether 
any " symptom " or " sign" is essential to this disorder.* 

There is, then, ordinarily, a largely increased flow of urine — 
so much so, that in many cases it might seem that the patient's 
viscera were undergoing solution, and rapidly flowing away. 
Instead of from one to three pints, which may express in round 
numbers the average quantity of urine daily excreted by 
healthy persons, the quantity in Diabetes may rise to twenty- 
four pints, as in one of Dr. Golden*s cases ; to 52 lbs., as in 
a case of Franks (mentioned by Beale), or even according to 
" writers of credit and veracity" (mentioned by Watson) to 
seventy pints. These latter, are, however, rare and extreme 
cases. But the passing of ten or dozen pints, a quantity not 
at aU uncommon, is surely a most remarkable deviation from 
a healthy condition. The urine is greatly altered also in 
its physical and chemical qualities; it is usually much 
lighter in colour, and of a peculiar odour, which has been 

* Some may object to this, that there is always sugar in the 
urine, or the case would not be one of diabetes. To this, it is 
replied, room is left in the text for the view that Diabetes Melli- 
tns, terminating in Diabetes Insipidus, without alteration of 
other symptoms, is not reaUy changed in character, but that 
TirtaaUy it is the same disease without the sugar as with it. 



434 On Diabetes MMitus. 

variously described. Dr. Watson's comparison is probably 
the most accurate yet given. The odour of the urine, and tlie 
breath of the patient, remind him, he says, of a chamber in 
which apples have been kept. This is often a striking cha- 
racteristic in well marked cases. It was formeriy held, that 
the urates are absent from, or present only in very small 
quantity in, diabetic urine ; and theories have been built upon 
the supposed fact. This has been shown to be a mistake. In 
many instances they are present in quantities larger than is 
normal. That they are not thrown down is only what might 
have been predicted from the quantity of water. When the 
diet is exclusively animal, the urates are not iinfrequently de- 
posited. Dr. Prout considered the deposition of uric acid a 
favourable symptom. It is so as indicating a diminution of 
the quantity of urine voided. 

But the most remarkable and the essential change in the 
quality of the urine is the presence of a more or less consider- 
able quantity of sugar. It cannot now be said, as it used to 
be, that this is a new element introduced into the secretion of 
the kidneys, for it does exist there naturally in an infinitesimal 
amount — at least, so we are taught. In the " Transactions of 
the Chemical Society," April, 1861, is a paper by Dr. Bence 
Jones, in which he records experiments confirmatory of Briickes', 
which showed the presence of sugar in healthy urine. Dr. 
Beale thinks this trace of sugar may be derived from the 
colouring matter of the urine. Further investigation is much 
required. 

The sugar, however, in diabetic urine is not a trace difficult 
of detection. " This singular malady," says Professor Henderson, 
" makes man a very fountain of liquid sugar." And the 
metaphor of this remark becomes very matter-of-fact, when we 
contemplate the enormous quantities of sugar which pass 
through the kidneys in this complaint. One of Dr. Pavy's 
cases yielded, when it came under his observation, from 1^ to 
1^ lbs. in twenty-four hours. Another patient voided about 



On Diabetes MelUtm. 435 

2 lbs. in the same space of time, and on one occasion as much 
as 3^ lbs. Dr. G^rrod gives, as the result of several analyses, 
from half a pound to a pound and three-quarters as the 
quantity eliminated daily. The kind of sugar found in the 
urine is allied to, if not identical with, glucose. Its detection 
is easy, as there are a number of good tests, which it is not 
necessary to describe. Moore's test is a good* one, but not as 
good as Trommer's, a modification of which is equal to all the 
exigencies of medical examination. Albumen interferes with 
the action of this test in its usual form. The fermentation 
test is a very delicate one. Professor Christ ison says he has 
detected, by means of it, one part of diabetic sugar in 1,000 
parts of urine. A rough quantitative analysis may also be made 
with it, as (according to the same authority) every cubic inch 
of carbonic acid gas given off corresponds in round numbers to 
1 grain of sugar. 

Connected with, and dependent upon, the presence of sugar 
in the urine, is another physical quality of a striking character 
— the increased sp. gr. We may place the average density in 
health at about 1*020 — under, rather than over. In diabetes, 
however, it is scarcely ever below 1*025, generally above 
1*030, and sometimes as high as 1*050. The sp. gr. affords 
us a ready and tolerably accurate index of the quantity of 
sugar present. 

Albumen has not unfrequently been detected in diabetic 
urine. Its presence is mentioned in a considerable proportion 
of recorded cases. Dr. Beale refers to an interesting case, in 
which "Dr. Gibb found albumen in the urine in the pelvis of 
one kidney, and sugar in that present in the other, in a case 
of death from cancer of the liver. The urine containing 
albumen had a sp. gr. of 1*015, and that containing sugar a 
sp. gr. of 1*026." Dr. Garrod {Guhtonian LechtreSy 1857) 
considers the presence of albumen accidental. I cannot help 
thinking it more than accidental. The fact just mentioned ; 
the fiewt that albuminous urine may be produced \yj \TtS5t£L\jv^\v 



436 On Diabetes MeUitus. 

of a contiguous portion of the nervous centre to that, irritation 
of which produces saccharine urine ; and the fact of the 
frequent simultaneous occurrence of the two conditions of 
urine, would seem to indicate that a somewhat intimate con- 
nexion does exist. Dr. Glarrod himself has found albumen in 
1 per cent, of diabetic cases — a proportion surely high ; for, 
although albuminous urine is not an unfrequent condition, it is 
certainly not to be found in 10 per cent, of other diseases. 

The thirst is a very urgent symptom, and sometimes com- 
plained of before excessive excretion of urine is noticed. Dr. 
Owen Eees lays great stress upon this point ; and says that, if 
thirst be a prominent symptom among others which point to 
gastric derangement and the like, the urine should be 
examined. He considers that cases are often allowed to run on 
imchecked for want of being by this means discovered early. 
That there should be considerable thirst is only what might be 
anticipated from the quantity of fluid filtered off from the 
blood. It may be looked upon as in part the result of an 
effort of nature to maintain or restore the normal condition of 
the blood. Whether this effort be a well-directed one, may be 
a question. If it were, it should seem that the diabetic ought 
to be allowed suitable fluid ad libitum ; but it has long been 
an established principle, that the quantity of fluid should be 
limited, and rules are laid down for the gradual moderation of 
the quantity of fluid ingesta. Dr. Christison insists strongly 
upon it ; and Dr. Prout, whose practical good sense and whose 
immense experience entitle his opinion to the greatest 
deference, has the following remark : — " Thirst increases by 
indulgence in the use of fluids ; and those who drink most 
invariably suffer most from this distressing symptom." Pro- 
bably the very presence of the sugar in the blood is a cause 
of the thirst. 

The appetite for food, too, is inordinate. Indeed, when the 
disease becomes well marked, the craving for food is quite 
enormous; and though an immense quantity is taken, there 



On Diabetes MelUtus. 437 

temains a sensation of emptiness and sinking at the epigas- 
trium which it is ahnost impossible to appease. 

Notwithstanding the large amount of nourishment taken, 
the patient progressively, and sometimes rapidly, emaciates. 
This is not surprising, considering the great waste which is 
continually going on, and considering also the state of the 
blood, which is so altered as not to minister to healthy 
nutrition. Nor is the emaciation the only feature which at 
once strikes our eye when introduced to a diabetic patient, and 
which depends upon the altered condition of the blood; for 
the general appearance in confirmed cases is strikingly and 
ahnost characteristically changed. He has a haggard, care- 
worn expression, all but sui generis, which suggests to the 
practical physician the nature of his malady. The state of the 
skin may at once confirm the suspicion, for it is usually dry 
and harsh, contrasting with the state of the skin in most 
other diseases characterised by great wasting. 

The faeces, too, are dry, and the bowels, in consequence, con- 
fined ; so that there is no excessive evacuation to account for 
the emaciation, unless we turn to the urine. 

All these symptoms are liable to great variation. Thus, 
emaciation is usual ; but I have known, everyone has known, 
instances of diabetic patients really corpulent. The skin is 
sometimes moist, and even bathed in perspiration. This has 
chiefly been noticed just before a fatal termination. Diarrhoea, 
moreover, occurs in some cases. It was the immediate cause 
of death in one of Dr. Pavy's cases ; and in others, evidently 
hastened the fatal issue. 

There is usually great and increasing debility, pain in the 
loins, aching in the limbs, languor, tremulousness, chilliness ; 
feeble, sometimes unsteady action of the heart, and irritable 
pulse. These are manifestly symptoms of impaired nutrition ; 
as are also dimness of vision (excluding cases of cataract*), and 
loss of virility, which are very common. 

♦ The connexion of cataract with diabetes \a a ^.xJJor^^c^^* ^\iS\- oJl 



438 On Diahttu Mdlitus. 

The tongue is at first covered with a white viscid mucus, but 
usually becomes red and raw-looking ; and later stUl, deep red 
and fissured. The mouth is parched, the gums spongy, and in the 
later stages covered with aphthae. The teeth sometimes become 
brittle and sometimes loose, both of which conditions may arise 
from ilefei^tive nutrition ; and this again, in part, as Dr. Prout 
ob^ierves, in consequence of the gums receding from the teath. 

<Edema of the legs is a very common symptom, especially 
in the later stages; indeed, then, it is certainly almost con- 
stant. But Dr. Garrod, in his Jectures already referred to, does 
not confine even the frequency of this symptom to advanced 
cases. After remarking that it is often slight and overlooked, 
unless specially sought for, he says — "Since my attention was 
directed to its fi-equent occurrence, I have seen no patient in 
whom the urine has been distinctly saccharine when it was 
absent." 

Eeverting for a moTuent to the state of the skin, cutaneous 
eruptions are of frequent occurrenca According to Dr. Front's 
experience, cutaneous eruptions often precede, while affections 
of the sub-cutaneous connective tissue accompany or follow, 
diabetes. Herpes frequently accompanies it; and, according 
to I^r. Garrod, especially when the diuresis is less m