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r: 



€lt %mn\ 



OF THE 



%xi\\5l IniDMptljir iDrirtu 



-'/ / / 



NEW SEBIES 



VOL. III. 



SESSIOISr 1894-1895 



EDITED BY 

KIGHAKD HUGHES, M.D. 



london 
JOHN BALE & SONS 

OXFOBD HOUSE 
86-89, GREAT TITOHPIELD STBEET, OXFORD STREET, W. 

\i 1896. 



CONTENTS. 



Officers and Council. 

list of Presidents. 

Trustees. 

Corresponding Members. 

List of Fellows. 

List of Members. 

Liverpool Branch. 

Local List. 

Members Eesident Abroad. 

Papers and Communications. 

Summary of Pharmacodynamics and Therapeutics. 

Index. 



i 



EXCHANGES. 



Allgemeine Homoopathische Zeitung. 

L'Art Medical. 

The American Homoeopathist. 

The American Institute of Homceopathy, Transactions of. 

The Calcutta Journal of Medicine. 

The Charlotte Medical Journal. 

The Clinique. 

The Hahnemannian Monthly. 

Homoeopathic Journal of Obstetrics. 

The Homoeopathic Physician. 

The Homoeopathic Eecorder. 

The Homoeopathic World. 

The Journal of Ophthalmology, Otology and Laryngology, 

The Journal of Orificial Surgery. 

Journal Beige Homoeopathique. 

The Medical Century. 

Medical Advance. 

Medical Era. 

Medical and Surgical Eecord. 

Minneapolis Homoeopathic Magazine. 

The Monthly Homoeopathic Beview. 

New England Medical Gazette. 

North American Journal of Homoeopathy. 

Pacific Coast Journal of Homoeopathy. 

Bevue Homoeopathique Francaise. 

Bevue Homoeopathique Beige. 

Southern Journal of Homoeopathy. 

Universal Homoeopathic Annual. 

Zeitschrift der Berliner verein Homoopathische Aertz. 



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OFFICERS AND COUNCIL 



OP THE 



Btttisb liomoeopatbtc jSoctetig. 



ELECTED AT 



THE ANNUAL ASSEMBLY, JUNE, 1894. 



President, 
BYRES MOIR, M.D. 

Vice-Presidents . 

GILES F. GOLDSBROUGH, M.D. 
EDWIN A. NEATBY, M.D. 

TreastL7xr, 
J. GALLEY BLACKLEY, M.B. 

Council, 



J. GALIiBYBLACKLE Y,M.B. 

A. C. CLIFTON (Northamp- 
ton). 

R. E. DUDGEON, M.D. 

WASHINGTON EPPS. 

G. F. GOLDSBROUGH, M.D. 

HENRY HARRIS. 



JOHN W. HAYWARD, M.D. 
(Liverpool). 

RICHARD HUGHES, M.D. 
(Brighton). 

E. MADDEN, M.B. (Bromley). 

BYRES MOIR, M.D. 

E. A. NEATBY, M.D. 

C. KNOX SHAW. 



Library Committee, 



J. GALLEY BLACKLEY. 
G. BURFORD. 



R. HUGHES. 
E. A. NEATBY. 



C. KNOX SHAW. 

Librarian, 
E. A. NEATBY, M.D. 

Editor of the Journal, 
RICHARD HUGHES, M.D. 

Secretary, 
C. KNOX SHAW. 



PRESIDEXTS OF THE SOCIETY. 

(FROM ITS FOUNDATION.) 



1844-78 FREDERICK HER\T:Y FOSTER QUIN, M.D. 

1879 ROBERT ELLIS DUDGEON, M.D. 

1880 STEPHEN YELDHAM. 

1881 ALFRED CROSBY POPE, M.D. 
1882-83 WILLIAM VALLANCEY DRURY, M.D. 

1884 DAVID DYCE BROWN, M.D. 

1885 JOHN HAMILTON MACKECHNIE, M.D. 

1886 MATHIAS ROTH, M.D. 

1887 RICHARD HUGHES, M.D. 
1888-89 GEORGE MANN CARFRAE, M.D. 

1890 . ROBERT ELLIS DUDGEON. M.D. 

1891 CHARLES THOMAS KNOX SHAW. 

1892 JOHN GALLEY BLACKLEY, M.B. 

1893 HUGH CAMERON. 

1894 BYRES MOIR, M.D. 



TRUSTEES OF THE SOCIETY. 



ROBERT ELLIS DUDGEON, M.D. 
JOHN GALLEY BLACKLEY, M.B. 



CORRESPONDING MEMBERS. 



ELECTED 

1863 Dr. QUAGLIO, Munich. 

1863 Dr. NOACK, 4, Rue des deux Maisons, Lyons. 

1863 Dr. LADELCI, Rome. 

1870 Dr. IMBERT - GOURBEYRE, Clermont - Ferrand, 

France. 

1875 Dr. LUDLAM, 1823, Michigan Avenue, Chicago. 

1875 Dr. TALBOT, 685, Boylston Street, Boston. 

1875 Dr. ALLEN, New York. 

1875 Dr. S. A. JONES, Ann Arbor, Michigan. 

1876 Dr. LEON SIMON, 5, Rue de la Tour des Dames, Paris. 



1877 Dr. JOUSSET, 241, Boulevard St. Germain, Paris. 

1878 Dr. CLAUDE, Rue Caumartin, Paris. 

1878 MAHENDRA L'AL SIRCAR, M.D., 61, Sankaritola, 

Calcutta. 
1892 Dr. LAMBREGHTS, fils. Rue Stook, Antwerp. 

1892 Dr. BONIFACE SCHMITZ, Rue des Capucines, 

Antwerp. 

1893 Dr. WILLIAM TOD HELMUTH, 299, Madison 

Avenue, New York. 
1893 Dr. MARTINY, Rue d'Arlon 45, Brussels. 
1893 Dr. WINDELBAND, Koniggratzerstr. 88, Berlin. 
1893 Dr. SULZER, Lutzowstr. 88, Berlin. 



FELLOWS OF THE SOCIETY. 



CHARLES HARRISON BLACKLEY. 
JOHN GALLEY BLACKLEY. 
EDWARD THOMAS BLAKE. 
DAVID DYCE BROWN. 
WILLIAM DEANE BUTCHER. 
HUGH CAMERON. 
GEORGE MANN CARFRAE. 
JOHN HENRY CLARKE. 
ARTHUR CROWEN CLIFTON. 
ROBERT THOMAS COOPER. 
JOHN ROBERSON DAY. 
ROBERT ELLIS DUDGEON. 
GILES FORWARD GOLDSBROUGH. 
EDWARD HAMILTON. 
JOHN WILLIAMS HAYWARD. 
RICHARD HUGHES. 
JOHN HAMILTON MACKECHNIE. 
EDWARD MONSON MADDEN. 
BYRES MOIR. 
HERBERT NANKIVELL. 
EDWIN AWDAS NEATBY. 
ALFRED CROSBY POPE. 
CHARLES THOMAS KNOX SHAW. 
GERARD SMITH. 

DUDLEY D'AUVERGNE WRIGHT. 
GEORGE WYLD. 
STEPHEN YELDHAM. 



MEMBEKS OF THE BEITISH HOMCEOPATHIC SOCIETY. 

Founded 1844. 



EXPLANATION OF THE ABBREVIATIONS. 

P.— President. V. -P.— Vice-President. 

T. — Treasurer. L.— Librarian. 

0. — Member of Council. S. — Secretary. 

Those marked thus (*) are Fellows of the Society, and those marked (f) 
are non-resident or retired from practice. 

Members are requested to communicate with the Secretary when correc- 
tions are necessary. 

GENEKAL LIST OE MEMBBES. 

ELECTED 

1892 Abbott, Geokge, M.A., M.D. (Hon. causa) Mass., 

L.E.C.P., L.M.I., L.A.H.Dub., L.E.C.P., L.R.C.S., 
L.M.Edin. ; 11a, Standishgate, Wigan. 

1888 Alexander, Archibald Speirs, M.D., C.M.Glasg. ; Physi- 
cian to the Devon and Cornwall Homoeopathic 
Dispensary and Cottage Hospital ; 6, Sussex Terrace, 
Plymouth. 

1890 Alexander, Samuel Philip, M.D., C.M.Glasg., M.R.C.S. 
Eng. ; Tecumseh House, Kent Eoad, Southsea. 

1893 Arnold, Francis Sorell, B.A., M.B., B.Ch.Oxon., 

M.R.C.S.Eng., L.S.A. ; 332, Oxford Road, Manchester. 



1894 Barrett, John James, M.D. St. And., L.R.C.P.Lond., 
M.R.C.S.Eng. ; 170, Ramsden Road, Balham, S.W. 

1891 Barrow, Roger William, M.D.Brux., L.R.C.P., L.M. 

Edin., M.R.C.S.Eng. ; Physician to the Bristol Homoeo- 
pathic Dispensary ; 3, White Ladies Road, Clifton. 

1868 Belcher, Henry, M.D.Erlang., L.R.C.P.Edin., M.R.C.S. 
Eng. ; Physician to the Sussex County Homoeopathic 
Dispensary ; 28, Cromwell Road, West Brighton. 

1854 tBELL, Vernon, M.D.Edin., L.R.C.S. and L.M.Edin. ; 
Highland Gardens, St. Leonards-on-Sea. 

1892 Bellis, Edward, L.R.C.P., L.R.C.S., L.M.I., L.A.H.Dub. ; 

4, Addison Terrace, Netting Hill, W. 



BIiECTSlD 

1890 Bennett, Henry, L.E.C.P., L.R.C.S., L.M.Edin., L.A.H., 
L.M.Dub. ; 323, HoUoway Road, N. 

1892 Bird, Ashley, M.R.C.S.Eng., L.S.A. ; Culverlands, Stan- 
well Road, Penarth, Glamorganshire. 

1894 Black, Gborqe, M.B., O.M.Edin. ; Greta Bank, Tor- 
quay. 

1871 *Blackley, Charles Harrison, M.D.Brux., M.R.C.S.Eng. ; 

3, Albany Road, Southport. (V.-P. 1881-2, 1886-7.) 

1872 *Blaokley, John Galley {Treasurer), M.B.Lond., M.R.C.S. 

Bng. ; Senior Physician and Physician for Diseases of 
the Skin to the London HomcEopathic Hospital ; 29, 
Devonshire Place, W. (P. 1892. V.-P. 1884, 1891. 
S. 1885-1891.) 

1865 *Blakb, Edward Thomas, M.D.Aberd., M.R.C.S.Eng.; 
Berkeley Mansions, 64, Seymour Street, Hyde Park, 
W. (V.-P. 1887-9.) 

1862 Blake, James Gibbs, M.D.,B.A.Lond., L.S.A. ; Physician 
to the Birmingham Homoeopathic Hospital, Consult- 
ing Physician to the Mason Orphanage ; 23, Waterloo 
Street, Birmingham, and Highfield Gate, Edgbaston. 

1892 Blumberg, Henry d'Arnim, L.R.C.P., L.R.C.S.Edin.^ 
L.F.P.S.Glasg. ; Warley House, Southport. 

1892 Blyth, William Francis, L.R.C.P., L.R.C.S., L.M. 
Edin. ; 97, Approach Road, Victoria Park, N.E. 

1892 Bodman, Francis Henry, M.D.Aberd., M.R.C.S.Eng., 

L.M. ; Physician for Diseases of Women, Bristol 
Homoeopathic Dispensary ; Linden House, Oakland 
Road, Clifton. 
1860 Bradshaw, William, M.D.Aberd., M.R.C.S.Eng., ^j.S.A. ; 
122, Holland Road, W. 

1893 Brooks, Samuel Brewer, M.R.C.S.Eng., L.R.C.P.Edin., 

L.F.P.S.Glasg., L.S.A. ; 25, Peachey Terrace, Mans- 
field Road, Nottingham. 
1892 Brotchie, Theodore Rainy, M.D., C.M.Aberd. ; 102, 
Great Victoria Street, Belfast. 

1871 *Brown, David Dyce, M.A., M.D., C.M.Aberd. ; Consulting 

Physician to the London Homoeopathic Hospital ; 29, 
Seymour Street, Portman Square, W. (P. 188i. 
V.-P. 1883. C. 1892.) 

1872 Bryce, William, M.D.Edin. ; 81, Charlotte Square, 

Edinburgh. 



VI. 

BLBCTBD 

1889 BxjRFORD, George, M.B., C.M.Aberd. ; Physician for 
Diseases of Women, London Homoeopathic Hos- 
pital ; Consulting Physician for Diseases of Women 
to the Homoeopathic Hospital, Tunbridge Wells, and 
to the PhiUips' Menjiorial Hospital, Bromley ; 20, 
Queen Anne Street, Cavendish Square, W. (C. 1892.) 

1879 Burnett, James Compton, M.D.Glasg. ; 2, Finsbury 
Circus, E.C. 

1892 Burns, Alfred Hugh, L.E.C.P.I., L.S.A.Lond. ; Ham- 
slade, Sweyn Eoad, Margate. 

1873 BuRwooD, Thomas Wesley, L.R.C.P., L.M.I. , L.R.C.P., 
L.M.Edin., Physician to the Ealing and West Middle- 
sex Homoeopathic Dispensary ; Strathmore, Florence 
Road, Ealing, W. 

1876 -Butcher, William Deane, M.R.C.S.Eng.; Clydesdale, 
Windsor. (Travelling.) 



1844 '"Cameron, Hugh, M.R.C.S.Eng. ; 62, Redcliffe Square, 
S.W. (P. 1893. V.-P. 1865-6, 1871.) 

1864 ICampbell, Hon. Alan, M.D.Edin.; North Terrace, 
Adelaide, S. Australia. 

1890 Capper, Edmund {President, Liverpool Branch) , M.D., 
C.M.Edin. ; Senior Stipendiary Medical Officer to the 
North Homoeopathic Dispensary ; 2, Newsham Drive, 
Liverpool. 

1892 Capper, Percy, M.B., C.M.Edin.; Honorary Surgeon to 
the Tunbridge Wells Homoeopathic Hospital ; West- 
bourne, 14, Lansdowne Road, Tunbridge Wells. 

1861 "^'Carprae, George Mann, M.D.Edin.; Consulting Physi- 
cian for Diseases of Women, London Homoeopathic 
Hospital ; 4, Hertford Street, Mayfair, W. (P.1888- 
89. V.-P. 1882-3.) 

1879 Cash, Alfred Midgley, M.D., C.M.Edin., M.R.C.S.Eng. ; 
Physician to the Torquay Homoeopathic Dispensary ; 
Surgeon to the Incurable Hospital for Children, 
Babbicombe ; Limefield, Falkland Road, Torquay. 

1892 Cavenagh, John Paul, L.R.C.P., L.R.C.S., L.M.I. ; 57, 
The Tything, Worcester. 

1873 Chalmers, Andrew Crichton, M.D., L.R.C.S.Edin. ; 
305, Glossop Road, Sheffield. 



m m 

Vll. 
SLBCTED 

1877 tCHURCHiLL, Samuel, M.D.Aberd., M.R.O.S,Eng. ; 1, 

Cheriton Terrace, Folkestone. 
1880 *Clabke, John Henry, M.D., C.M.Edin. ; Physician to 

the London Homoeopathic Hospital ; 30, Clarges 

Street, Piccadilly, W., and 3, Newman's Court, 

Comhill, E.G. (V.-P. 1888.) 

1861 -^'CiiiFTON, Arthur Crowen (Council), M.D. (Hon.) New 
York, M.R.CS.Eng. ; Physician to the Northampton 
Homoeopathic Dispensary ; 65, Abington Street, 
Northampton. 

^ 1892 CiiiFTON, Frederick William, M.E.C.S.Eng., L.E.C.P., 

L.M.Edin. ; 356,' Glossop Road, Sheffield. 

1873 Clifton, George, L.R.C.P.Edin., L.M., L.F.P.S.Glasg. ; 
Consulting Physician to the Leicester Homoeopathic 
Dispensary ; 48, London Eoad, and 7, Bowling Green 
Street, Leicester. 

1892 Collins, Charles Phillips, M.D.Clev., M.R.CS.Eng., 
L.R.C.P.Lond. ; Norman Lodge, Leamington. 

1894 CoMPSTON, Edmund Leach, M.B., Ch.B.Vict. ; Craw- 
shawbooth, Manchester. 

1892 tCooK, Edmund Alleyne, Ph.D. Warburg, L.R.C.P., 

L.R.C.S.Edin., L.F.P.S.Glasg.; 88, ColHns Street 
East, Melbourne, Australia. 

1891 tCooK, Henry William James, M.B., B.S.Durh. ; 88, 

Collins Street East, Melbourne, Australia. 
1869 '^Cooper, Robert Thomas, M.A., M.D., M.Ch., T.C.D. ; 
Physician for Diseases of the Ear, London Homoeo- 
pathic Hospital ; 30a, George Street, Hanover Square, 
W. (V.-P. 1889-90.) 

1893 Corbett, Herbert Henry, M.R.CS.Eng. ; 19, Hall Gate, 

Doncaster. 

1892 Cox, Richard Percy, M.D., C.M.Edin. ; 2, Lime Grove, 

Oxford Road, Manchester. 

1890 Cox, William Spencer, M.R.CS.Eng., L.S.A. ; CUnical 
Assistant to the London Homoeopathic Hospital ; 
Physician to the Kensington, Netting Hill and 
Bayswater Homoeopathic Dispensary ; 12, Sheffield 
Gardens, Kensington, W. 

1892 Craig, George Alexander, M.B., CM.Aberd. ; Physician 
to the Birmingham Homoeopathic Hospital ; 63, 
Soho Road, Birmingham. 



• • • 

vm. 

ELECTED 

1892 Cbaiq, John, L.R.C.P.Edin., L.F.P.S.Glasg. ; Shelton 
House, Stoke-upon-Trent. 

1892 Graio, John Smith, M.B., C.M.Aberd. ; 137, Steelhouse 

Lane, Birmingham. 
1862 Cbonin, Eugene Fbancis, M.D. St. And., M.R.C.S.Eng., 

L.S.A ; Old Manor House, Clapham Common, S.W. 

1892 Cboucheb, Alexander Henry, M.D., C.M.Edin. ; Surgeon 
to the Leaf Homoeopathic Cottage Hospital; to the 
Eastbourne Homoeopathic Dispensary; and to the 
Eastbourne Homoeopathic Convalescent Home; 3, 
Iden Villas, South Terrace, Eastbourne. 

1867 Croucher, Alexander Eichard, M.D. St. And., M.R.C.S. 
Eng., L.S.A., L.M. ; Physician to the Hastings and 
St. Leonards Homoeopathic Dispensary ; 26, Grand 
Parade, St. Leonards. 



1893 Davidson, Prederick William, M.R.C.S.Eng., L.R.C.P. 
Lond. ; Liverpool. 

1887 *Day, John Roberson, M.D.Lond., M.R.C.S.Eng., L.R.C.P. 
Lond., L.S.A. ; Assistant Physician and Anaesthetist 
to the London Homoeopathic Hospital; Visiting 
Physician to the Margaret Street Infirmary for 
Consumption ; Hon. Physician to the Kentish Town 
Medical Mission ; 31, Netherall Gardens, Hampstead, 
N.W. 

1892 Deane, Herbert Edward, M.R.C.S.Eng., L.S.A. ; Medical 
Charge of the Hospital for Soldiers' Wives and Children, 
South Camp, Aldershot ; Army Medical Staff, Alder- 
shot. 

1875 +Deck, John Field, M.D. St.And., M.R.C.S.Eng., L.R.C.P. 
Lond. ; Ashfield, Sydney, New South Wales. 

1847 ^Dudgeon, Robebt Ellis {Council), M.D.Edin., L.R.C.S. 
Edin. ; Consulting Physician to the London Homoeo- 
pathic Hospital ; 53, Montagu Square, W. (P. 1879, 
1890. V.-P. 1874-5, 1881. T. 1883-93. S. 1846-48.) 



1893 Eaton, Henby Abnold, M.B., C.M.Edin.; 2, Eldon 
Square, Newcastle-on-Tyne. 



IX. 
ELECTED 

1887 EiiiiiB, John William {Vice-Presidenty Liverpool Branch), 
M.B., Ch.B.Vict., L.E.C.P., L.R.C.S.Edin. ; Honorary 
Medical Officer to the Hahnemann Hospital, Liver- 
pool ; 18, Rodney Street, Liverpool. 

1875 Epps, Washington (Council), L.R.C.P.Edin., M.R.C.S. 
Eng. ; Senior Assistant Physician to the London 
Homoeopathic Hospital; 89, Great Russell Street, 
W.C. 



1889 Eebnie, William Thomas, M.D.Durh., L.R.C.P.Lond., 
M.R.C.S.Eng., L.S.A. ; The Nook, Great Malvern. 

1892 Finlay, John Thomas, L.R.C.P., L.R.C.S., L.M.Edin., 

L.A.H., L.M.Dub. ; Greystone House, Rawtenstall, 
Lancashire. 

1893 Flint, Frederick, M.D., C.M.Aberd., M.R.C.S.Eng. ; 8, 

Ramshill Road, Scarborough. 

1885 Frost, George, L.R.C.P.Lond., M.R.C.S.Eng. ; Surgeon 
to the Hahnemann Convalescent Home ; Ophthalmic 
Surgeon to the Bournemouth Homoeopathic Dispen- 
sary ; Clovelly, Suffolk Road, Bournemouth. 



1881 Gilbert, Sydney, L.R.C.P., L.R.C.S.Edin., L.A.H., L.M. 
Dub. ; Roseneath, Reigate, Surrey. 

1893 tGiLES, Frederick William, M.B.Durh., M.R.C.S.Eng.; 

Hotel Continental, Cannes, France. 
1881 *GoLDSBROUQH, GiLEs FORWARD {Vice-President, C), M.D., 

C.M.Aberd. ; Cedar Lodge, 133, Coldharbour Lane, 

S.E. 

1892 Gordon, John Newlands, M.B., C.M.Aberd. ; Ophthalmic 
Surgeon to the Hahnemann Hospital, Liverpool ; 70, 
Upper Parliament Street, Liverpool. 

1886 Gould, Edward Gardiner, L.R.C.P.I. ; Woodlawn, 
Leigham Court Road, Streatham, S.W. 

1892 Green, Conrad Theodore, M.R.C.S.Eng., L.R.C.P. 
Lond. ; Honorary Medical OflQcer to the Wirral 
Homoeopathic Dispensary; 33, Grange Mount, Bir- 
kenhead. 

1892 Green, Vincent, M.B., C.M.Edin. ; 95, South Street, 
Eastbourne. 



X. 

1876 tGunnwM, Abthub, M.D.Glasg., F.R.C.S.I.. L.M.Dab. ; 4, 
Selkirk Parade, Chehenham. 



1876 Haix, Edoab Athbukg, M.B., C.M.£din. ; PhysiciaD to 
the Sorbiion, Kingston and Norbiton Homoeopathic 
Dispensary ; Laorel Villa, Victoria Boad, Sorbiton. 

1892 HAI.L, Fredeuick, L,R.C.P., L.R.C.S.I., L.M,; Oak 
Hoose, Bacup, Lancashire. 

1847*tHAMiLTON, Edwabd, M.D. St. And. ; 16, CromweD Place, 
8.W. (V.-P. 1865-6, 1878-9. T. 1848-1881.) 

1892 Hamilton, John, L.B.C.P.Edin., L.F.P.S.Glasg. ; 16, 
Eldon Square, Newcastle-on-Tyne. 

1894 Habdy, James Ebexezeb, M.B., C.M.Edin. ; 183, Bath 
Street, Glasgow. 

18/39 Hakpeb, James Peddie, M.D.Edin., L.R.C.S.Edin. ; 43, 
Hertford Street, Mayfair, W. 

1871 Habris, Henby (Council), M.R.C.S.Eng. ; 111, Denmark 
Hill, S.E. 

1878 Hawkes, Alfred Edward, M.D.Brux., L.R.C.P., L.M., 
L.R.C.S.Edin. ; Medical OflBcer to the Hahnemann 
Hospital, Liverpool ; 22, Abercromby Square, Liver- 
pool. (P. 1892. V.-P. 1893. Liverp. Br.) 

1888 Hawkks, Edward John, L.R.C.P., L.R.C.S., L.M.Edin. ; 
4, West Cliff Road, Ramsgate. 

1886 Hayle, Thomas Hahnemann, M.B.Lond. ; 154, Drake 
Street, Rochdale. 

1892 Hayward, Charles Williams, M.D., C.M.Edin., M.R.C.S. 
Eng., L.R.C.P.Lond. ; Assistant Surgeon and Sur- 
geon to the Throat, Nose and Ear Department, 
Hahnemann Hospital, Liverpool ; 117, Grove Street, 
Liverpool. 

1892 Hayward, John Davey, M.D.Lond., M.R.C.S.Eng., 
L.S.A. ; Surgeon to the Hahnemann Hospital, Liver- 
pool ; 16, Prince's Avenue, Liverpool. 

1868 *Hayward, John Williams (Council), M.D. St. And., 
M.R.C.S.Eng., L.S.A. , M.D. (Hon.) New York; Con- 
sulting Physician to the Hahnemann Hospital, Liver- 
pool; 61, Shrewsbury Road, Birkenhead. 



XI. 

ELBCTED 

1885 HiiiBEBs, Hermann Gerhard, B.A.Camb., L.R.C.P., 
L.R.C.S.Bdin., L.F.P.S.Glasg. ; Honorary Physician 
to the Sussex County Homoeopathic Dispensary ; 49, 
Montpelier Eoad, Brighton. 

1887 Hill, William Reed, M.B., G.M.Edin. ; Crouch Street, 
Colchester. 

1861 *HuGHEs, Richard (Editor, C), M.D. (Hon.), L.R.C.P.Edm., 
M.R.C.S.Eng. ; Physician to the Brighton Homoeo- 
pathic Dispensary ; 86, Sill wood Road, Brighton. (P. 
1887. V.-P. 1885-6. S. 1879-84.) 

1892 Huxley, John Charles, M.D., C.M.Aberd. ; 91, Harborne 
Road, Edgbaston, Birmingham. 



1882 Jaqiblski, Victor Apollinaris, M.D.Berlin, M.R.C.P. 
Lond. ; Physician to the Inlirmary for Consumption, 
Margaret Street ; 54, York Terrace, Regent's Park, 

N.W. 

1894 Johnstone, James, B.A., F.R.C.S.Eng., M.B., CM., 
D.P.H.Aberd. ; Senior Clinical Assistant to the Gynas- 
cological Department, London Homoeopathic Hospital ; 
47, Sheen Road, Richmond. 

1887 tJoNEs, David Ogden Roebuck, M.D.Toronto, L.R.C.P. 
Lond. ; 126, Carlton Street, Toronto, Canada. 

1893 Jones, George Reginald, L.R.C.P.Lond., M.R.C.S.Eng., 
House Surgeon to the Homoeopathic Institution, 
Manchester; 143, Lloyd Street, Greenheys, Man- 
chester. 

1866 Jones, James, M.D.Edin., M.R.C.S.Eng., L.R.C.P.Lond., 
41, Castle Street, Reading. 

1881 Jones, Thomas Reginald, L.R.C.P.L, L.M., M.R.C.S. 
Eng. ; Physician to the Wirral Homoeopathic Dis- 
pensary ; 26, Lome Road, Claughton, Birkenhead. 



1886 Kennedy, William Adam, M.B.Durh., L.R.C.P.Lond., 
M.R.C.S.Eng.; {address not communicated). 

1879 Kbr, Claudius Buchanan, M.D.Edin. ; Consulting Physi- 
cian to the Cheltenham Homoeopathic Dispensary ; 
Hadley House, Cheltenham. 



xu. 

ELSCTEO 

1875 tKiTCHiHQ, CflABiiEs Watson, M.B.Lond., M.B.C.S.Eng., 

L.8.A. ; 6, Church Street, Cape Town, S. Africa. 

1872 tKTsiaDOsr, BoaaHTON, L.S.A. ; Sydney, New South Wales. 

1>193 Lambebt, James Budolf Pauii, M.B., C.M.Edin. ; Phy- 
sician to the Walham^Green Homoeopathic Dispensary ; 
Ophthalmic Clinical Assistant to the London Homoeo- 
pathic Hospital ; 11, Sydney Place, Onslow Square, 
South Kensington, S.W. 

1891 LouoH, Geobob John, L.B.C.P.I., L.M. ; Surgeon to the 

Buchanan Cottage Hospital, and Ophthalmic Sui^eon 
• to the Hastings and St. Leonards Homoeopathic Dis- 
pensary ; 35, Wellington Square, Hastings. 

1850 Mackbchmie, John Hamilton, M.D. St. And. ; Physician 
to the Hahnemann Dispensary, Bath; 2, Brunswick 
Place, Julian Boad, Bath. (P. 1885. V.-P. 1872. 
S. 1867-69.) 

1893 MacNish, David, M.A., M.B., C.M.Edin. ; Clinical Assis- 
tant, Throat and Eye Departments London Homoeo- 
pathic Hospital ; . 4, Leinster Square, Bayswater, W. 

1886 McKiLLiAM, BoBEBT, M.D., C.M.Aberd. ; 1, Bennett Park, 
Blackheath, S.E. 

1892 McLachlan, John, M.D., CM.. B.Sc.Edin., F.R.C.S.Eng., 

L.S.A. ; Physician to the Oxford Homoeopathic Dis- 
pensary ; 38, Beaumont Street, Oxford. 

1876 ♦Madden, Edwabd Monson (Council), M.B.Edin., M.R.C.S. 

Eng. ; Physician to the Phillips Memorial Hospital ; 
Burlington House, Bromley, Kent. (V.-P. 1892-98.) 
1892 Mahony, Edwabd, M.B.C.S.Eng., L.S.A. ; Honorary 
Medical Officer to the Hahnemann Hospital, Liver- 
pool ; 30, Huskisson Street, Liverpool. 

1886 Mabsh, Thomas Chables, L.B.C.P.Edin., M.B.C.S.Eng., 
L.M. ; Assistant Physician to the London Homoeo- 
pathic Hospital, and Visiting Physician to the 
Margaret Street Infirmary for Diseases of the Chest 
and Throat ; 66, Fitzroy Street, Fitzroy Square, W, 

1886 Mason, Henby, M.D., C.M.Glasg., M.B.C.S.Eng.; 62, 
London Boad, Leicester. 

1888 tMATTHiAS, William Lloyd, L.B.C.P.Lond., M.B.C.S. 
Eng. ; Sydney, New South Wales. 



« ■ « 

xm. 

ELECTED 

1893 Meek, William Ombler, M.B., C.M.Edin. ; 256, Oxford 
Eoad, Manchester. 

1893 Miller, Bobebt Gibson, M.B., C.M.Glasg. ; 10, Newton 

Place, Glasgow. 
1892 Mitchell, John James, L.R.C.P.Lond., M.R.C.S.Bng.; 

1, Howard Place, Stoke-on-Trent. 

1882 *MoiR, Byres (President), M.D., C.M.Edin. ; Physician 
to the London Homoeopathic Hospital ; 16, Upper 
Wimpole Street, W. (V.-P., 1891, 1892.) 

1892 Mom, Douglas, M.D., C.M.Aberd.; 333, Oxford Road, 
Manchester. 

1889 MoLSON, John Cavendish, L.R.C.P.Lond. ; Assistant 

Physician to the London Homoeopathic Hospital ; 13, 
Lingfield Road, Wimbledon. 

1877 Moore, John Murray, M.D., CM., L.M.Edin., M.R.C.S. 
Eng., M.D. New Zealand; Hon. Medical Officer to 
Hahnemann Hospital, Liverpool ; 51, Canning Street, 
Liverpool. 

1867 Morgan, Samuel, M.D. St. And., M.R.C.S.Eng., L.S.A.; 
Consulting Physician to the Bath Homoeopathic 
Hospital ; Physician to the Bristol Homoeopathic 
Dispensary ; 15, Oakfield Road, Clifton. 

1890 MoRRissoN, Stammers, M.D.Phil., M.R.C.S.Eng., L.R.C.P. 

Lond., L.M.Eng. ; Grafton House, The Pavement, 
Clapham Common, S.W. 

1882 Murray, John, L.R.C.P., L.R.C.S., L.M.Edin. ;• Physician 
to the Folkestone Homoeopathic Dispensary; 15, 
Trinity Gardens, Folkestone. 



1888 Nankivell, Frank, M.D., C.M.Edin., M.R.C.S.Eng.; 60, 
Kirkdale, Sydenham, S.E. 

1888 ''^Nankivell, Herbert, M.D.Edin., M.R.C.S.Eng. ; Phy- 
sician to the Hahnemann Convalescent Home, 
Bournemouth; Penmellyn, Bournemouth. 

1893 Neatby, Andrew Mossforth, L.R.C.P., L.R.C.S.Edin., 
L.F.P.S.Glasg. ; Physician to the Sutton Homoeo- 
pathic Dispensary ; Mulgrave Road, Sutton, Surrey. 



xry. 
I/^^ ^'JizATKT, EDWX3r AwDAS (V^cn-Prssidefit^ Lzbrariam^ 

Aiwiatant Phvacian for Diseases of Women, Loadoa 
Pf6m<KCpftthic Hospital; ITS, Haverstock Hill, 

Phy<iician to the Tnnbn<itje Wells HomcEopathic 

ff/y^pifcal and IHspensary; Belvedere Hoase, Tnn- 

hrid<;(e^WelI?i. 
IftM NfjwKRiey, William Frederick Hoyle, M.D., CM. 

Tnnity College, Toronto, LuS.A.Lond. ; 103, Cazenoye 

Koad, Stoke Newington, N. 
1^(H Nw;Mor.go5, THKOFHiLrs George Husbaxd, MJR.C.SJEng.; 

Out- Door Stipendiary Medical Officer, Hahnemann 

/Ir^pital, Liverpool ; 27, Catherine Street, Liverpoo]. 

iH(i2 }iwjiOhi{f}jif Thoxas Dickinson, M.D., C.M.Edin., 
M.K.C*S.Eng. ; Physician to the Clifton Homceo- 
pathic Dispensary ; 2, White Ladies Boad, Clifton. 

IH^ Noifi.K, Jambs Black, M.B.C.S.Eng., L.B.C.P., L.M.Edin.; 

J 67, Kennington Park Boad, S.E. 
iHlG NouMAM, Okorob, M.B.C.S.Eng., L.S.A. ; Physician to 

tlift Hahnemann Free Dispensary, Bath ; 12, Brock 

Street, Bath. 

IH02 OoKKNOKN, AiiTHUB JoHN, M.B.C.S.Eng.; 25, Begency 

H(|(iaro, Brighton. 
iM)^ OntJt WriiMAM Throphilus, L.B.C.P.Lond., M.B.C.S.Eng.; 

Visiting Surgeon to the Bournemouth HomcBopathic 

DiHpnnsary ; Greenstead, Madeira Boad, Bourne- 

mouth East. 



IHHO Pin(U)TT,JammhColhj, M.B.C.S.Eng., L.B.C.P.,L.M.Bdin.; 
Hurgooti to the Tunbridge Wells Homoeopathic Hos- 
pital and Dispensary; Calverley Parade, Tunbridge 
Wnll«. 

IHOa •Poptt, Am'-umi) Cuohhy, M.D.Phil., M.D. (Hon.) New York, 
M.U.d.H.Mhg. ; Watergate House, Grantham. (P. 
IHHI. V.-P. IH73-4.) 

IM7I) Po\v)>)tit4, AtanuQi) John, M.D.Erlang., M.B.C.S.Eng.; 
Wrnvftttlntono LooH, Anorloy Boad, S.E. 



XV. 
SI^KCTED 

1868 tPitiTCHARD, JosiAH, M.R.C.S.Eug., L.S. A. ; 63, Kichmond 
Eoad, Montpelier, Bristol. 

1893 Pboctob, Peter, M.R.C.S.Eng., L.R.C.P.Edin., L.S.A. ; 
17, Hamilton Square, Birkenhead. 

1884 PuiiLAR, Alfred, M.D., C.M.Edin. ; The Holt, Wimbome 
Eoad, Bournemouth. 

1884 PuRDOM, Thomas Eadib, M.D., C.M.Edin., L.R.C.P., 

L.R.C.S.Edin. ; 25, Park Hill Road, Croydon. 

1893 Ramsbotham, Samuel Henry, M.D.Edin., M.R.C.S.Eng. ; 

Hon. Medical Officer to the Leeds Homoeopathic Dis- 
pensary ; 16, Park Place, Leeds. 
1892 Rban, William Henry, M.R.C.S.Eng., L.S.A. ; 36, 
Vernon Terrace, Brighton. 

1862 Reed, Robert Rhodes, M.D.Clev., M.R.C.S.Eng.; Market 
Square, Lynn Regis, Norfolk. 

1892 Reed, William Cash, M.D., C.M.Edin. ; Physician to the 

Devon and Cornwall Homoeopathic Dispensary and 
Cottage Hospital; 8, Queen Anne Terrace, Plymouth. 

1872 t^EiD, Lestock Holland, M.R.C.S.Eng., L.R.C.P.Lond. ; 
Bowmanville, Ontario, Canada. 

1894 Rendall, John Murly, L.R.C.P., L.R.C.S.Edin., L.F.P.S. 

Glasg. ; Physician to the Edinburgh Homoeopathic 
Dispensary ; 75, Leamington Terrace, Edinburgh. 

1885 Renner, Charles, M.D.Wiirzburg, L.R.C.P.Lond., 

M.RC.S.Eng. ; 186, Marylebone Road, N.W. 

1893 Reynolds, Edward Robebt Bbadlby, M.R.C.S.Eng. ; 

Highcroft, Shepherd's Hill, Highgate, N. 

1894 Richards, George Percy Peel, M.B., C.M.Edin. ; 52, 

Hoghton Street, Southport. 

1892 RoBEBTS, Abthur, M.D. St. And., M.R.C.S.Eng., L.S.A., 

D.P.H. ; Hon. Physician to the Children's Sanatorium, 
Harrogate ; Kingswood House, Princes Square, 
Harrogate. 

1893 Robebts, William Henby, L.R.C.P., L.R.C.S.Edin., 

L.M. ; Physician to the Dublin Homoeopathic Dis- 
pensary ; 63, Lower Mount Street, Dublin. 

1878 Roche, Eleazeb Bibgh, L.R.C.P.Lond., M.R.C.S.Eng., 
L.M. ; Physician to the Norwich Homoeopathic Dis- 
pensary; Hon. Medical Oiiicer to the Orphans' Home, 
Norwich ; and to the Norwich City Mission ; 27, 
Surrey Street, Norwich. 



XVI. 

ELBCTBD 

1892 Roche, William, L.R.C.P.I., L.M., M.R.C.S.Eng. ; 38, 
Berners Street, Ipswich. 

1892 Ross, Alfred, L.R.C.P., L.R.C.S.I., L.M. ; The Elms, 
Vernon Place, Scarborough. 

1891 Ross, William, L.R.C.P., L.R.C.S.I., L.M. ; Physician to 

the Northampton Homoeopathic Dispensary ; 65, 
Abington Street, Northampton. 

1892 RowsE, Edward Leopold, M.D.Brux., L.R.C.P.Lond., 

M.R.C.S.Eng. ; 114, Upper Richmond Road, Putney, 
S.W. 

1880 Sandberg, Arthur Gregory, M.D. (Hon.) Verm., 
L.R.C.P., L.R.C.S., L.M.Edin. ; 151, Brixton HiU, 
S.W. 

1893 Sanders, Horace, L.S.A. ; 77, Camden Road, N.W. 
1892 ScRivEN, George, M.D., B.Ch.Dub., L.M., P.R.G.S.; 

Physician to the Dublin Homoeopathic Dispensary ; 
33, St. Stephen's Green, Dublin. 

1856 ScRivEN, William Barclay Browne, A.B., M.B.Dub., 
M.R.C.S.Eng., L.M. ; Physician to the Dublin 
Homoeopathic Dispensary ; 33, St. Stephen's Green, 
Dublin. 

1885 Shackleton, Henry, A.B., M.B.Dub., M.R.C.S.Eng., 
L.M.R.C.P.I., L.M. ; 12, West Hill, Sydenham, S.E. 

1883 *Shaw, Charles Thomas Knox {Secretary, C), L.R.C.P. 
Lond., M.R.C.S.Eng. ; Surgeon and Ophthalmic Sur- 
geon to tte London Homoeopathic Hospital, and to 
the Buchanan Cottage Hospital, St. Leonards ; Con- 
sulting Ophthalmic Surgeon to the Hastings and St. 
Leonards Homoeopathic Dispensary ; Consulting 
Surgeon to the Tunbridge Wells Homoeopathic 
Hospital ; and to the Phillips Memorial Hospital, 
Bromley ; 19, Upper Wimpole Street, W. (P. 1891, 
V.-P. 1890.) 

1885 Shaw, Frank Herbert, M.R.C.S.Eng. ; Surgeon to the 
Buchanan Cottage Hospital, and to the Hastings and 
St. Leonards Homoeopathic Dispensary ; 33, Warrior 
Square, St. Leonards-on-Sea. 

1888 Simpson, Thomas, M.D. St. And., M.R.C.S.Eng. ; Hon. 
Medical Officer to the Hahnemann Hospital, Liver- 
pool, and to the Bootle Homoeopathic Dispensary ; 
10, Crosby Road, Waterloo, Liverpool. 



XVll. 
ELECTED 

1886 *SinTH, Gerard, M.R.C.S.Bag. ; 37, Gloucester Place, 
Portman Square, W., and Craigholm, Upper Clapton, 

N.E. 

1892 Smith, Robert Gordon, M.B., C.M.Aberd. ; Hon. Medical 

Ofl&cer to the Hahnemann Hospital, Liverpool ; 164, 
Upper Parliament Street, Liverpool. 

1893 SouTHAM, John Binns, M.B.C.S.Eng., L.S.A. ; {address 

not communicated). 

1893 Stagey, Herbert Glebson, M.D.Brux., L.B.C.P., L.M. 
Edin., M.B.C.S.Eng., L.S.A.Lond. ; Honorary Physi- 
cian to the Leeds Homoeopathic Dispensary ; 28, 
Park Square, Leeds. 

1893 StaIjEy, John Christopher George, L.B.C.P.I. ; Physi- 
cian to the Bochdale Convalescent Home ; The 
Mount, St. Anne*s-on-Sea. 

1890 Stancomb, Ernest Henry Murly, M.B., C.M.Edin. 
Westbourne College Place, Southampton. 

1892 Steinthaii, Walter Oliver, L.B.C.P.Lond., M.E.C.S 
Eng., L.S.A. ; 128, Tweedale Street, Bochdale. 

1866 t Stephens, Samuel Sanders, M.B.C.S.Eng. ; Stedcombe 
Manor, Axmonter, Devon. 

1889 Stonham, Thomas George, M.D.Lond., M.B.C.S.Eng. ; 
Elsinore, Alpine Boad, Ventnor. 

1892 Stopford, Bobert, L.B.C.P.I., L.M.; 75, Hoghton Street, 
Southport. 

1887 Storrar, William Morrison, L.B.C.P., L.B.C.S.Edin., 
L.M. ; Senior Physician to the North of England 
Children's Sanatorium, Physician to the Southport 
Hydropathic Hospital ; 15, Hoghton Street, South- 
port. 

1892 Stuart, Peter, L.B.C.P., L.B.C.S.Edin., L.M. ; Assistant 
Physician to the Hahnemann Hospital, Liverpool ; 
36a, Bodney Street, Liverpool. 

1877 Suss-Hahnemann, Erederick Leopold Bobert, M.D 
Leipzig; 14, Highbury Crescent, N. 



1892 Thomas, Bernard {Secretary, Liverpool Branch), M.B., 
C.M.Edin. ; Stipendiary Medical Officer to the Hahne- 
mann Hospital, Liverpool ; 22, Grove Street, Liverpool. 



XVlll. 
ELECTED 

1886 Thomas, Edward John Haynes, L.R.C.P., L.R.C.S.Edin. ; 
Physician to the Chester Free Homoeopathic Dispen- 
sary ; 18, Pepper Street, Chester. 

1891 Thomas, Harold Wstnne, M.R.C.S.Bng., L.R.C.P.Lond. ; 
Resident Medical Officer to the Phillips Memorial 
Hospital, Bromley ; 65, Park Road, Bromley, Kent. 

1893 Thompson, Charles, M.R.C.S.Eng., L.S.A. ; 226, Stamford 
Street, Ashton-under-Lyne. 

1855 tTucKEY, Charles Caulpield, A.B., M.B.Dub., L.R.C.S.I., 
L.M. ; Charleville, Kew. 



1886 Vawdrey,TheophilusGlascott, L.R.C.P.Lond., M.R.C.S. 
Engi ; Stipendiary Medical Officer to the Devon and 
Cornwall Homoeopathic Dispensary; Surgeon to the 
Cottage Hospital ; 4, Buckland Terrace, Plymouth. 



1893 Waddinqton, Charles Edwin, L.R.C.P.Lond., M.R.C.S. 
Eng. ; 2, Marlboro' Road, Manningham, Bradford. 

1862 tWATsoN, Charles George, L.R.C.S., L.R.C.P.I., L.M. ; 
Hobart, Tasmania. 

1858 tWAUQH, J. N., M.D. St. And., M.R.C.S.Eng., L.S.A. ; 
. Brisbane, Queensland. 

1893 Weddell, James Call, M.D., CM., L.M.Edin. ; 2, Carlton 

Terrace, Mowbray Road, Sunderland. 

1894 Wheeler, Charles Edwin, M.D., B.S., B.Sc.Lond. ; 

Resident Medical Officer to the London Homoeopathic 
Hospital ; Great Ormond Street, W.C. 

1861 tWHEELER, Henry, L.R.C.P.Lond., M.R.C.S.Eng. ; 43, 
Alkham Road, Stoke Newington, N. 

1893 Wilde, Frederick George Stanley, L.R.C.P., L.R.C.S., 
L.M.Edin. ; Physician to the Cheltenham Homoeo- 
pathic Dispensary ; Ingleside, Bayshill, Cheltenham. 

1893 Wilde, Herbert, M.B., C.M.Edin., L.R.C.P., L.R.C.S. 
Edin. ; 18, Clifton Terrace, Brighton. 

1893 Wilde, John, L.R.C.P.Edin., M.R.C.S.Eng., L.S.A.; 
Physician to the W^estern-super-Mare Homoeopathic 
Dispensary ; Park House, Weston-super-Mare. 

1891 Wilde, Percy Roberts, M.D., C.M.Aberd. ; Physician to 
the Bath Homoeopathic Hospital ; 23, Circus, Bath. 



XIX. 

ELECTED 

1891 WHiDE, Rowland Stanley, M.B., C.M.Edin. ; Physician 

to the Weston-super-Mare Homoeopathic Dispensary ; 
Park House, Weston-super-Mare. 

1892 Wilkinson, Alfred Geobqe, M.R.C.S.Eng., L.S.A. ; 28, 

Newland, Northampton. 

1892 Wilkinson, Clement John, M.R.C.S.Eng., L.S.A. ; Leh 

House, Windsor. 

1893 Williams, Arthur Llewellbn, L.R.C.P.Edin., L.M. ; 

127, Moss Lane, Manchester. 
1892 Williams, Eubulus, M.D. St. And., M.R.C.S.Eng., L.M., 
L.A.C. ; Physician to Miiller's Orphan Homes; 2, 
Beaufort Road, Clifton. 

1892 Williams, Lemuel Edward, M.R.C.S.Eng.; Surgeon to 
the Skin Department, and Honorary Assistant Medical 
Officer to the Hahnemann Hospital, Honorary Medical 
Officer to the Hahnemann Dispensary, Liverpool ; 62, 
Spellow Lane, Liverpool. 

1892 Wingfield, John, L.R.C.P., L.R.C.S.Edin., L.F.P.S. 

Glasg. ; Honorary Physician to the Birmingham and 
Midland Homoeopathic Hospital; Aubyn House, 
Alcester Road, Moseley, Birmingham. 

1889 WiTHiNSHAw, Charles Wesley, L.R.C.P., L.R.C.S.Edin., 
L.M. ; 3, Earlstoke Villas, Lansdown Road, Clapham, 
S.W. 

1893 WoLSTON, Christopher, B.A.Lond., M.D. St. And., 

M.R.C.S.Eng. ; Summershill, Chislehurst. 

1877 WoLSTON, Walter Thomas Prideaux, M.D.Edin., 
M.R.C.S. ; Physician to the Edinburgh Homoeopathic 
Dispensary ; 46, Charlotte Square, Edinburgh. 

1876 Wood, Henry Thorold, M.R.C.S.Eng.; 86, Seymour 
Street, W. 

1893 Woodgates, Henry, M.D.Glasg., M.R.C.S.Eng. ; Physi- 
cian to the Exeter Homoeopathic Dispensary; Mona 
Lodge, Lyndhurst Road, Exeter. 

1889 ^Wright, Dudley D'Auvergne, L.R.C.P.Lond., M.R.C.S. 

Eng. ; Assistant Surgeon and Surgeon for Diseases of 

the Throat to the London Homoeopathic Hospital; 

32, Wimpole Street, W. 
1854 ^'Wyld, George, M.D.Edin. ; Fieldhead, Wimbledon Park, 

Wimbledon. (V.-P. 1876.) 



1849 *Ybumam, SrsPHEsr, MJLC.S.Eng., Ii.R.C.P.Ediii. ; Con- 
aulfeing Surgeon to the Londoa Homoeopathic Hos- 
pital; Highfield Hoase, St. Nicholas Boad, Upper 
Tooting, S.W. (P. 1S80. V.-P. 1861-64 ; 1877.) 



UYEBPOOL BRANCH. 

Meetings are held at the Hahnemann Hospital, Hope Street, 
Liverpool, on the second Thursday in each month. 

MEMBERS. 

Cafpbb, E. President. Elios, J. W., Vice-PresidenL 

Thomas, B., Secretary, 

Davidson, F. W. Meek, W. O. 

FlNI#AY, J. T. MlTCHELIi, J. J. 

Gordon, J. N. Nicholson, T. G. H. 

Green, C. T. Simpson, T. 

Haix, p. Smith, R. G. 

Hatwabd, C- W. Southam, J. B. 

Haywakd, J. D. Stopford, R. 

Hayward, J. W. Storrar, W. M. 

Hawkes, a. E. Stuart, P. 

Jones, T. R. Thomas, E. J. H. 

Mahony, E. Wilmams, L. E. 



XXI. 



LOCAL LIST. 



Alder shot, 
Deane, H. E. 

Ashton-ufider-Lyiie. 
Thompson, C. 

Axmo7iter, 
Stephens, S. S. 



Bacup. 



Hall, F. 



Bath, 

Mackechnie, J. H. 
Norman, G. 
WUde, P. E. 

Belfast, 
Brotchie, T. E. 

Birkenhead. 

Green, C. T. 
Hay ward, J. W. 
Jones, T. E. 
Proctor, P. 

Birmingham, 

Blake, J. G. 
Craig, G. A. 
Craig, J. S. 
Huxley, J. C. 
Wingfield, J. 

Bournemouth, 

Frost, G. 
Nankivell, H. 
Ord, W. T. 
Pullar, A. 

Bradford {Yorks). 
Waddington, C. E. 



Brighton, 

Belcher, H. 
Hilbers, H. G. 
Hughes, E. 
Ockenden, A. J. 
Eean, W. H. 
Wilde, H. 

Bristol {see Clifton), 
Pritchard, J. 

Bromley^ Kent, 
Madden, E. M. 
Thomas, H. W. 

Cheltenham, 

Guinness, A. 
Ker, G. B. 
Wilde, F. G. S. 

Chester, 
Thomas, E. J. H. 

Chislehurst, 
Wolston, C. 

Clifton, Bristol, 

Barrow, E. W. 
Bodman, F. H. 
Morgan, S. 
Nicholson, T. D. 
Williams, E. 

Colchester, 
Hill, W. E. 

Crawshawbooth, Lanes. 
Compston, Ed. 

Croydon. 
Purdom, T. E. 



XXll. 



Doncaster. 
Corbett, H. H. 

Dublin. 

Roberts, W. H. 
Scriven, G. 
Scriven, W. B. B. 

Ealing, Middlesex. 
Burwood, T. W. 

Eastbourne. 

Croucher, A. H. 
Green, V. 

Edinburgh. 

Bryce, W. 
Rendall, J. M. 
Wolston, W. T. P. 

Exeter. 
Woodgates, H. 

Folkestone. 
Churchill, S. 
Murray, J. 

Glasgow. 

Hardy, J. E. 
Miller, R. G. 

Grantham. 
Pope, A. C. 

Harrogate. 
Roberts, A. 

Hastings, 
Lough, G. J. 



Ipswich. 



Roche, W. 



Kew. 
Tuckey, C. C. 

King's Lynn. 
Reed, R. R. 

Leamington. 
Collins, C. P. 

Leeds. 
Ramsbotham, S. H. 
Stacey, H. G. 

Leicester. 
Clifton, G. 
Mason, H. 

Liverpool. 

Capper, E. 
Davidson, F. W. 
Ellis, J. W. 
Gordon, J. N. 
Hawkes, A. E. 
Hay ward, C. W. 
Hayward, J. D. 
Mahony, E. 
Moore, J. M. 
Nicholson, T. G. H. 
Simpson, T. 
Smith, R. G. 
Stuart, P. 
Thomas, B. 
Williams, L. E. 

London (N.). 
Bennett, H. (Holloway). 
Newbery, W. F. H. (Stoke 

Newington). 
Reynolds, E. R. B. (Highgate). 
Smith, G. (Upper Clapton). 
Siiss-Hahnemann, F. L. R. 

(Highbury). 
Wheeler, H. (Stoke Newington). 



XXlll. 



London {N,E.), 
Blyth, W. F. {Victoria Park), 

London {N,W.). 
Day, J. E. (Hampstead), 
Ja^ielski, V. A. {Begent's 

Park). 
Neatby, E. A. {Hampstead), 
Renner, C. (Marylebone). 
Sanders, H. (Camden Totvn), 

London {S.E.). 

Goldsbrough, G. F. {Camber- 

well). 
Harris, H. {Camherwell). 
McKilliam, E. {Blackheath). 
Nankivell, F. {Sydenham). 
Noble, J. B. (Kenning ton). 
Powell, A. J. (Anerley). 
Shackleton, H. (Sydenham). 

London (S.W.). 

Barrett, J. J. (Balham). 

Cameron, H. (South Kensing- 
ton). 

Cronin, E. F. (Clapham Com- 
mon). 

Gould, E. G. (Streatham). 

Hamilton, E. (South Kensing- 
ton). 

Lambert, J. E. P. (South Ken- 
sington). 

Morrisson, S. (Clapham Com- 
mon), 

Rowse, E. L. (Putney). 

Sandberg, A. G. (Brixton). 

Withinshaw, C. W. (Clap- 
ham), 

Yeldham, S. (Tooting). 

London (E.C.), 

Burnett, J. C. 
Clarke, J. H. 



London (W.). 
Bellis, E. (Notting Hill). 
Blackley, J. G. 
Blake, E. T. 

Bradshaw, W. (Kensington). 
Brown, D. D. 
Burford, G. 
Carfrae, G. M. 
Clarke, J. H. 
Cooper, E. T. 
Cox, W. S. (Kensington). 
Dudgeon, E. E. 
Harper, J. P. 
MacNish, D. (Bayswater), 
Marsh, T. C. 
Moir, B. 
Shaw, C. T. K. 
Smith, G. 
Wood, H. T. 
Wright, D. D'A. 

London (W.C.). 

Epps, W. (Bloomsbury). 
Wheeler, C. E. (Bloomsbury), 

Malvern, 
Fernie, W. T. 

Manchester. 
Arnold, F. S. 
Cox, E. P. 
Jones, G. E. 
Meek, W. O. 
Moir, D. 
Williams, A. L. 

Margate, 
Burns, A. H. 

Nottingham. 
Brooks, S. B. 



XXIV. 



Newcastle, 


St. Leonards-on-Sea, 


Eaton, H. A. 


Bell, V. 


Hamilton, J. 


Croucher, A. E. 




Shaw, F. H . 


Northampton. 


/ 


Clifton, A. C. 


Scarborough. 


Eoss, W. 


Flint, F. 


Wilkinson, A. G. 


Eoss, A. 


Nonoich. 




Eoche, E. B. 


Sheffield. 


/ 


Chalmers, A. C. 


Oxford. 


Clifton, F. W. 


McLachlan, J. 






Southampton. 


Penarth (Glam.). 


Stancomb, E. H. M. 


Bird, A. 






Southport. 


Plymouth. 


Blackley, C. H. 


Alexander, A. S. 


Blumberg, H. d'A. 


Eeed, W. C. 


Eichards, G. P. P. 


Vawdrey, T. G. 


Stopford, E. 




Storrar, W. M. 


Hamsgate. 




Hawkes, E. J. 


Southsea. 




Alexander, S. P. 


Batotenstall (Lanes.), 


^^ ^^B^^ ^^r ^m^^ ^^^m ^^^m ^i*^» ^^ ^^ ■ w^^ w ^■^ ^ 


Finlay, J. T. 


Stoke-on-Trent. 


Beadin^q. 


Craig, J. 


Jones, J. 


Mitchell, J. J. 


Beiqate. 


Sunderland. 


Gilbert, S. 


Weddell, J. C. 


Bichmond {Surrey). 


Surbiton. 


Johnston, J. 


Hall, E: a. 

• 


Bochdale. 


Sutton (Surrey). 


Hayle, T. H. 


Neatby, A. M. 


Steinthal, W. A. 






Torquay. 


St. Anne*s-on-Sea (Lanes.). 


Black, G. 


°^-^-, J. C. G. 


Cash, A. M. 



XXV. 



Tunbridge Wells. 
Capper, P. 
Neild, F. 
Pincott, J. C. 

Ventnor, 
Stonham, T. G. 

Weston-super-Mare, 

Wilde, John. 
Wilde, E. S. 



Wigan (Lanes.). 
Abbott, G. 

Wimbledon. 

Molson, J. C. 
Wyld, G. 

Windsor. 

Butcher, W. D. 
Wilkinson, C. J. 

Worcester. 
Cavenagh, J. P. 



MEMBERS RESIDENT ABROAD. 

Adelaide, New South Wales : Campbell, A. 

Brisbane, Queensland : Waugh, J. N. 

Cannes, France : Giles, F. W. 

Cape Town, South Africa : Kitching, C. W. 

Hobart, Tasmania : Watson, C. G. 

Melbourne, Victoria: Cook, E. A., Cook, H. W. J. 

Ontario, Canada : Reid, L. H. 

Sydney, New South Wales : Deck, J. F., Kyngdon, B., 

Matthias, W. L. 
Toronto f Canada : Jones, D. 0. R. 



JOURNAL 

OP THE 




iritisji InraMpat jir 

No. 1. JANUAEY, 1895. Vol. III. 



All communications and exchanges to be sent to Db. Hughes, 

36, Sillwood Boad, Brighton. 

THE METHOD OF HAHNEMANN AND THE 
HOMOEOPATHY OF TO-DAY : A COMPAEISON. 

PBESIDENTIAIi ADDRESS DELIVERED BEFORE THE LIVERPOOL 
branch/ by EDMUND CAPPER, M.D. 

Senior Stipendiary Medical Officer to the North HomcBopathic Dispensary, 

Liverpool, 

When you so kindly did me the honour to elect me Pre- 
sident of the Liverpool Branch of the British Homoeopathic 
Society, although extremely flattered by your confidence in 
me thereby expressed, it was with much trepidation and 
misgiving that I felt myself moved to accept so grave a 
responsibility. When I look through the list of honoured 
names, ranging through the perspective of the thirty-seven 
sessions during which our Society has existed, of those who 
have previously occupied this chair, I cannot but be over- 
whelmed with a sense of my utter unworthiness to follow 
my predecessors, and doubt as to my capacity to fill the 
position in anything approaching an adequate manner. 
This fact, combined with the consciousness that the post 
usually been entrusted to one of more years and wider 

1 Ootober, 1894. 
VOL. III. — NO. 1. 1 



THE HOMCEOPATHY OP TO-DAY. 



experience than I can lay claim to, makes me feel the 
greatest hesitation in addressing you this evening. Never- 
theless I am convinced that a kindly courtesy will be ex- 
tended towards me, and that whatever deficiencies may be 
manifest in the discharge of my duties, due allowance will 
be made, ascribing them rather to weakness of the flesh 
than to lack of willingness of the spirit. 

The great difficulty which presents itself at the threshold 
is that of finding some subject which may worthily occupy 
our attention, and which may be hoped to bring profit and 
advantage to the great cause in which our sympathies are 
enlisted. The domain of medicine, surgery, and kindred 
sciences is certainly vast, and fresh interests are constantly 
developing under the watchful eye of the zealous student ; 
but able minds and ready pens are likewise equally active 
in coping with new problems, and in throwing the light of 
modem discoveries upon older teachings. In a science to 
which so many earnest and eminently capable men are ever 
devoting themselves, their constant and assiduous toil some- 
what limits the hope of originality. With regard to the 
department in which our own little Society specially in- 
terests itself, there is happily plenty of life among those 
whose labours are more particularly directed to the study of 
homoeopathy in all its aspects, and the ground has been 
traversed over and over again, until frequent reiteration 
somewhat tends to weariness. At the same time, there are 
always new points from which to regard the old familiar 
subject, and when the question with which we are dealing 
relates to so important a matter as the preservation of life 
and the alleviation of suflfering, it can hardly be too fre- 
quently discussed. In the remarks I am about to bring 
forward this evening I feel that I may somewhat lay myself 
open to the accusation of harping on considerations brought 
before the Society on many previous occasions, but this, to 
some extent, it is impossible to avoid. I propose briefly to 
compare the method of Hahnemann with that of modem 
homoeopathy, concluding with an attempt to demonstrate 
the impossibility of amalgamation between the allopatfaic 
and homoeopathic systems of medicine. 



THE HOMCEOPATHY OP TO-DAY. 6 

Since Habnemaoin first published the matured observa- 
tions of years in his " Organon of Eational Medicine " in the 
year 1810, the science of medicine has rapidly advanced. 
In later days, more particularly, the highest intellects have 
been brought to bear on its development, and with ever 
increasing facilities for study, greater perfection of mechani- 
cal means of investigation, together with true devotion on 
the part of its professors, a much clearer light has been 
thrown into many of the dark places than was available to 
the great father of homoeopathy. Without doubt, had he 
lived in the year 1894, his great genius, concentrated upon 
all the resources and discoveries of the present day, would 
probably have led him to a considerably modified presen- 
tation of his views. The great law, of which he was the 
first to recognise the immense significance, would have been 
as true as it then appeared to him ; but he could hardly 
have failed to appreciate the fact that there is much in 
so-called allopathic practice, which compels the most careful 
and serious attention, and rests on a thoroughly scientific 
basis. Doubtless, it is futile to thus speculate upon the 
attitude he might have assumed, since it is impossible to 
say how much of the general treatment of to-day is more 
or less indirectly due to the influence of homoeopathy. That 
such influence is incalculable will be admitted at once by 
anyone v^ith the slightest pretension to impartial judgment, 
who has even casually considered the facts. At the same 
time, I cannot help feeling that the master mind would have 
looked with deep distrust upon the practice of some who to- 
day profess to be his followers, and would regard them in 
the same category as those whom he contemptuously styles 
"bastard homceopathists." 

In the course of a quarter of a century, essentially a 
period of great therapeutic progress, during which his doc- 
trines have been followed by generations of heterogeneous 
exponents, it is impossible but that considerable changes 
must have taken place, either of an advanced or retrograde 
character. Those who follow literally Hahnemann's strictest 
teachings are now, I think I am justified in saying, in a 
small minority; and since he was the first to inculcate a 



4 THE HOMCEOPATHT OF TO-DAY. 

system of practical homoeopathy, it would be little short of 
a miracle were this not the case. The important question 
for us is whether his disciples to-day are advocating and 
practising a more enlightened and successful method of 
treatment than his was ; for if not, we had {sx better adhere 
to the strict lines of conservative orthodox homoeopathy, if I 
may use so paradoxical an expression, as originally laid 
down by him. 

In considering the general method of treatment adopted 
by Hahnemann, it will be unnecessary for practical pur- 
poses to enter into his theories, either as to the nature of 
disease, or as to the modus operandi of the selected remedy. 
In order to compare his ideas with those in vogue at the 
present day it will be convenient to take up the following 
points : — 

I.— The examination of the patient. 
II. — ^The selection of the remedy. 
III. — The administration of one remedy at a time. 
IV. — The dose and its repetition. 

V. — ^Hahnemann's views with regard to local applica- 
tions, and general auxiliaries to treatment. 

J. — The Examination of the Patient. — It may appear 
somewhat irrelevant to deal with this aspect of the subject, 
and so it undoubtedly would be, did it not lead up to at 
least one point of very considerable importance. The 
method of procedure which he advocated in the " individu- 
alising examination of a case of disease " is given at some 
length in the ** Organon."^ It is unnecessary here to enter 
into the details, which are doubtless familiar to all, but it is 
well to bear in mind that this scheme is forniulated to meet 
the exigencies of all forms of disease, tha chronic as well as 
the acute. Whatever other merit the scheme may possess, 
it bears the mark of the careful, painstaking, and conscien- 
tious physician, which Hahnemann was if he were any- 
thing. If it were possible to carry it out in general daily 
practice, we can see how admirably it is adapted to leave 
no point neglected, except it be the family history, to which 

* Hahnemann's ** Organon of Medicine," Sections 83 to 104, Edition 1893. 



k 



THE HOMCEOPATHY OF TO-DAY. 

no particular reference is made, unless we are to under- 
stand that this is included in the general questions as to the 
histoiy of the disease. At the present time some such 
scheme is, at least theoretically, the basis of practice of all 
who follow the heahng art, although its minutisB can only 
be strictly adhered to in institutions where much time and 
attention can be given to each individual case, and where the 
burden of the work is shared by many, as by the students 
in our infirmaries and general hospitals. Brunnow, quoted 
by Ameke,^ informs us that Hahnemann did actually carry 
out the examination of his patients with the exactness 
which he recommends in the " Organon ; " and indeed, his 
entire devotion to his profession, and his immense capacity 
for work, would lead us to conclude that nothing short of 
this w^onld have contented him. He thus often devoted 
hours to the examination of a patient.^ In a letter written 
by Dr. Peschier, of Geneva, in the year 1832, after a visit 
to Hahnemann, he says: "The register of his consultations, 
every day increasing in magnitude, forms at this moment a 
stupendous medical encyclopaedia. We have seen upon one 
of the shelves of Hahnemann's library thirty-six quarto 
volumes of at least 500 pages each, entirely written by 
his own hand.*'^ But in the routine of practice, even did 
time permit, few are gifted with the patience and perseverance 
necessary to carry out a method of such careful detail ; and 
indeed, although in a chronic case too much time can 
hardly be spent in the discovery of the sjrmptoms bearing 
upon it ; in most acute cases, forming the majority of those 
which daily demand attention, anything but an exceedingly 
m.odified application of so elaborate a proceeding would be 
manifestly superfluous. In point of fact, in such cases 
nmch valuable time would thus be wasted, since, with ever 
increasing experience and greater familiarity with the 
jYUiteria medica constantly acquired, a very few minutes in 
unimportant cases frequently suffice to furnish all particu- 

> Ameke's " History of Homoeopathy," p. 167. 

* Ameke's " History of Homoeopathy," p. 113. 

» " liife of Hahnemann," by Thomas Lindsley Bradford, M.D., published 
in the Honueopathic Becorder, vol. ix., p. 377. 



b THE HOMCEOPATHY OF TO-DAY. 

lars necessary for the treatment. Undoubtedly, the nearer 
our practice approaches to work of this careful character, 
the more successful will our results be ; but in daily routine, 
except in its merest outline, it will be found to be quite 
impracticable. For instance, take the daily morning experi- 
ence at one of onr dispensaries, where, as a preliminary to 
the day's work, forty or fifty cases must be prescribed for in 
a limited time. Method and constant practice greatly facili- 
tate the work ; but in most cases, more than the faintest 
attempt in the direction of detailed examination becomes 
manifestly an impossibility. An infant, for example, is 
brought in, not by the mother, but by a kindly interested 
neighbour, whose previous experience has led her to un- 
limited faith in the " homoeopathies.** The doctor is informed 
that the little patient is suffering from diarrhoea, but beyond 
this fact absolutely no information is forthcoming, and the 
character of the motions, their frequency, general accom- 
paniments, and other important symptoms cannot be elicited. 
Consequently, the only means of ascertaining any facts on 
which to prescribe must be furnished by inspection of the 
small atom of humanity in question, whose tender age 
incapacitates him from volunteering any further informa- 
tion than can be imparted through the medium of tears and 
lamentations. 

And here I should like to remark, by the way, that the 
dispensary, as a school for the novice in homoeopathy, is not 
without disadvantage; since the rapidity with which the 
work must be done, and the difi&culty in finding time for 
careful and discriminating examination, has a tendency to 
lead to hasty and slipshod practice, which once acquired is 
not easily shaken off. 

With regard to this part of the subject then, the modern 
homoeopathist endeavours as far as he is able to proceed on 
much the same general lines as did Hahnemann. But one 
very important point is suggested which particularly de- 
mands our attention at the present time. To Hahnemann 
the disease, as far as treatment was concerned, was nothing 
more nor leBs than the " totality of the symptoms " ; and 
thiR view of it may still be accepted, provided that the term 



THE HOMCBOPATHY OP TO-DAY, 7 

be used with sufficient comprehensiveness of meaning, in- 
cluding within its sphere all symptoms, both subjective and 
objective, or in other words, all departures from the normal 
condition of health which any means at our disposal may 
enable us to discover. Lest any confusion of terms might 
arise from the fact that the word ** symptom " is used aUke 
with reference to both those which are of a subjective and 
objective character, it may make clearer the following 
remarks if it is simply understood to be used here in 
relation to the subjective. Such subjective symptoms, 
elicited in the examination of a patient, are nowadays 
deemed far from sufficient, and an increasing attention is 
devoted to the discovery of the anatomical changes to which 
they point, and the definite lesions of the organs implicated, 
thus leading to a more exact diagnosis. With the greatly 
improved facihties for physical examination, the conse- 
quently greater certainty of localising the centres of origin 
of the disease, and a more intelligent interpretation of 
the significance of the facts thus brought to light, a much 
more accurate conception of the deviation from health can 
be ensured, than was hitherto possible. The scientific phy- 
sician can no longer be satisfied until he has discovered, 
as far as the means at his disposal will permit, the actual 
pathological condition which is giving rise to such symp- 
toms of a subjective character as are present in the case 
before him. 

This subject of pathology has been so much to the fore 
of late that it can hardly be dismissed in a few words. For 
some years homceopathists have been reproached with their 
utter indifference to this branch of medical science, and that 
such reproaches should have been to a certain extent 
deserved will be very evident when it is remembered that 
homoeopathy has in past times concerned itself almost en- 
tirely with symptomatical treatment. Since such symp- 
toms must accord with those which have been ascertained 
to be produced by the action of drugs on the healthy 
individual, it is manifest that the provings could not have 
been carried out to the limit of their pathological effect. 
The knowledge acquired from post-mortem examinations in 



8 THE HOMCEOPATHY OF TO-DAY. 

cases of fatal poisoning has always been to a certain extent 
utilised with regard to the study of drug action ; but sjnnp- 
toms in the recorded provings on the living subject have 
had, in prescribing homoeopathically, far the greater impor- 
tance attached to them. But of late years there has been 
a growing desire to place homoeopathy on a more scientific 
and reliable basis than that afforded by mere symptoma- 
tology. The relation of pathology to homoeopathy has been 
a problem of frequent discussion, until at our last two Con- 
gresses it may be said that the whole atmosphere was patho- 
logical. It will be readily granted that in the treatment of 
disease much greater satisfaction is afforded in considering a 
symptom if the anatomical changes of a morbid character, 
which give rise to that symptom, can be definitely ascer- 
tained. It may be reasonably assumed that for every sub- 
jective symptom that exists there must be some anatomical 
change involved; although it might be very difi&cult of 
demonstration to the satisfaction of our nineteenth century 
materialistic propensities. And it is very easy to conceive 
that in the case of only faintly perceptible symptoms an 
infinitesimal variation in the primary cells, or even in the 
protoplasm of the cells themselves, absolutely inaccessible 
to our most delicate means of investigation, might be the 
sole cause of their existence. And since the fundamental 
analysis of an infinity of symptoms must therefore for ever 
remain hidden from our deepest understanding, it is obvious 
that there is a limit beyond which our knowledge of the 
subtle pathological changes, which underlie these outward 
manifestations of disease, cannot proceed. Pathology can, 
therefore, never be of great value to us apart from the 
careful consideration of those subjective symptoms to which 
the primary organic changes give rise. We consequently 
remain absolutely dependent on symptomatology to reveal 
to us indications of the more subtle variations which are 
beyond the scope of our most minute and careful methods 
of investigation. Thus two cases of sore throat may to all 
appearances be objectively absolutely identical, but the 
subjective symptoms complained of by each patient may 
present few features in common. Such instances might be 



THB HOMCEOPATHY OF TO-DAY. » 

qaoted without number, and it is here that a bountiful 
Providence has made up for our deficiencies, since remedies 
have been provided to our hand capable of producing 
apparently similar organic changes, but with a distinctive 
variety of subjective symptoms, although we cannot analyse 
the subtle modifications undoubtedly thereby involved in 
the cellular elements. 

But this by no means demonstrates the futility of patho- 
logical study in its relation to treatment. Every disease, 
with which we are acquainted, presents more or less well- 
known pathological features of a definite character, and in 
the consideration of such features one or several drugs may 
frequently be suggested which tend in their action to bring 
about similar organic changes. Thus we are led to a remedy, 
or a group of remedies, the effects of which fulfil the conditions 
of the simillimum in its more material requirements, but a 
careful discrimination of the subjective symptoms individually 
present still remains necessary, and can alone furnish indica- 
tions of the delicate shades which are essential for the brilliant 
results to which homoeopathy attains. Some very pretty 
examples of the close parallel which may exist between dis- 
tinctive forms of disease and drug symptoms which must 
depend upon definite organic changes, are furnished in the 
paper which constituted our last presidential address, so 
largely quoted by Dr. Galley Blackley at our recent Con- 
gress ; and from this intimate relationship not unfrequently 
to be thus observed between drug effects and disease, one 
of the greatest stimulants to our encouragement may be 
educed ; since in proportion as we become convinced of its 
universal application, the better foundation shall we have 
for the truth of our theory, that for every disease nature has 
provided its counterpart in the sphere of action of some 
particular drug.^ 



* This subject is a wide one, but time does not permit of its more extended 
consideration in this paper. For some of the most recent views, reference 
may be made to the presidential address by Dr.'Hawkes at the Congress of 
1893; to that of Dr. Galley Blackley at the Congress of 1894 ; to an editorial 
in the HonuBopathic Review of September, 1894 ; and to a pamphlet by 
Dr. Pullar, republished this year, on " The Interpretation of the Homoeopathic 
Principle in Belation to Pathology." 



10 THH mXSKEOFATSr OF TD>OA.r. 

Here I -iiioTiid like ro reiizscer a iiuctit ^ro^est against the 
prejudices u Hitimemaiiii wnh reiijird :o aosoioszy. It may 
be nracricailr vaiaeiess in die inad selection )t our remedv, 
but reference rvi a iiseaae mder a iisnncrive title at once 
hrinc^^ ^rfi>re iiir unnds .k jiassfiic _p:oap n :r}'niptonis» which 
will Dtten jeaLtiiv iii4::?^st a ^miiAr jonibmation 1:0 be jbond 
aranns^st; :he symproms jf 3ur jrt^vTnL;^^. 

IT. — T7ie St Jt cVcOPi )r ?iie 3i ^ntnu, — In our ^oui^iderationof 
this pAit II riie aiib]tfci:, wim rhe dnie at jur siisposal, only 
ijfeneral orinciDies can be reierred ro. Eavmi^ obcained bv 
caretiii examination a me ^icrore of :iie aisease, Hahnemann 
teaches chat ciie meaicine most homoeopaducaily correspon- 
dinij is :he mt st ^nirable for aiTnuniscradon: is» zn cact^ the 
specidc reaieitv. For dicse ihseases wicii amnertjus strikbig 
svmiotonis, a iionLLet^oaciiic remedv can more certainlT be 
foand. TTie more stxikinir. sini^ular* micommon, and peculiar 
sii^iis and iym.pcv:ms of iie cai>e of iiseajje are chieify and 
alniast scleiy za be kept in view. d:r ic ii> more particalarly 
these that m.iiat ccrresgond oO very similar ones hi the list 
af svmnti:mji ^:^i tihe m^edicine. in order to constitute that 
medicine the most suitable irr «^&ctij2g a cure. The 
more general sympconLS demand but uttle attention when 
af a va^ie and indennite charaycter. if the v cannot be accu- 
rately described, as sym.p corns of such general nature are 
observed in almost everr disease* and from almost every 

In order to find the drug which is most honiceopathic to 
the disease, the Repertory may be consulted with a view to 
becoming approximately acquainted with the true remedy, 
ai.d the medicines thus generally indicated should be after- 
wards carefully studied out in the Jf.ir<?nVi JZVJaoli. mi til that 
tury^t homceopathically corresponding to the symptoms pre- 
sent is discovered. 

With these directions the homoeopathist of to-day is in 
perfect accord, and we endeaTour to follow exactly the same 
plan as that advocated by Hahnemann. Bat in the compara- 
tive wealth of material at our disposal in the form of provings 
of drags already experimented with, the difficulty and labour 
is immense; and although constant experience somewhat 



THE HOM(EOPATHY OF TO-DAY. 11 

modifies this, and increasing familiarity with the Materia 
Medica greatly facilitates the arrival at the end in view, the 
specific can never be reached by easy paths. This Hahnemann 
freely admitted ; yet we may perhaps assume that the diffi- 
culty was hardly so great to him as it is to us to-day; since 
having himself conducted most of the provings of the then 
known remedies, he must have had a much better personal 
knowledge of the scope of their action. Our Materia Medica 
has, in addition, been greatly enriched by the records of 
constant experiment with drugs hitherto unproved, and 
although our resources in coping with disease are thus 
materially strengthened, the labour of selection is thereby 
greatly increased. Dr. Peschier, in the same letter as above 
quoted, tells us that Hahnemann neither confided in his 
memory nor relied solely on his long experience, but had 
constantly before him the Materia Medica and Eiickert's 
Repertory- From Hahnemann's own writings he would 
lead us to suppose that he himself never prescribed until he 
was certain as it was possible to be, that the drug was the 
nearest simillimum to be found among those then known. 

Many laudable and painstaking efforts have been, and 
still are, constantly made to overcome and simphfy the diffi- 
culties in the search for the simillimum; and the most 
various schemes have been suggested and devised for lighten- 
ing the labours of the busy practitioner in this respect ; but 
in spite of all this, he who expects to find a sinecure in the 
practice of homoeopathy had far better remain in the beaten 
tracks of orthodox medicine, where, though the path may 
be obscured by the shadows of uncertainty, it is infinitely 
less toilsome. 

Hahnemann's criticism of those whose efforts in the 
direction of this careful selection are only of a superficial 
character is quite worthy of a few moments' consideration. 
In the ** Chronic Diseases"^ he remarks: "A physician 
who is not wilUng to take this trouble [that of the study 
of the Materia Medica in relation to a case], but who 
contents himself with the general indications furnished by 

" Chronic Diseases/' vol. i., p. 153. 



12 THS HOM(EOPATHT OF TO-DAY. 

the Bepertories, and who, hy means of these general indica- 
tions, despatches one patient after the other, deserves not 
the name of a true homceopathist. He is a mere quack, 
changing the remedies each moment, until the poor patient 
loses his temper and is obliged to leave this homicidal 
dabbler. It is by such levity as this that true homoeopathy is 
injured." Again in the " Organon " * he says : " But this 
laborious, sometimes very laborious search for, and selection 
of, the homoeopathic remedy most suitable in every respect 
to each morbid state, is an operation which, notwithstanding 
all the laudable books for facilitating it, still demands the 
study of the original sources themselves, and at the same 
time a great amount of circumspection and serious delibera- 
tion, which have their best reward in the consciousness of 
having faithfully discharged our duty. How could this 
laborious, careful task, which alone can render possible the 
most effectual cure pf diseases, please the gentlemen belong- 
ing to the new mongrel sect, who assume the honourable 
name of homoeopathists, and even seem to employ medicines 
in form and appearance homoeopathic, but used by them 
without the slightest dehberation (quidquid in huccam 
venif)^ and who, when the unsuitable remedy does not 
immediately give relief, in place of laying the blame on 
their unpardonable indolence and laxity in performing the 
most important and serious of all human affairs, ascribe it 
to homoeopathy, which they accuse of great imperfection." 
Personally, I must confess to having more than once felt a 
little tenderness of conscience on reading these lines, which 
I fancy may not be wholly unshared by some of my col- 
leagues ; and they are certainly worthy of our most thought- 
ful consideration as a stimulant to more careful work. At 
the same time, if in every case that presents itself for. treat- 
ment such a laborious method were necessary in order to 
arrive at the selection of the suitable remedy, our task 
would assume proportions so gigantic that practice would 
become an impossibility. It is therefore somewhat of a 
consolation to remember that in acute cases, of which the 



I c< 



Otganon," Note to § U9. 



THE HOM(EOPATHY OF TO-DAY. 13 

greater part of our daily work is made up, our knowledge 
of the materia medica will usually readily furnish us with 
the drug most homoeopathic to the symptoms present. 

With regard, therefore, to the selection of the remedy, 
it is impossible that the rules which guide us should differ 
materially from those laid down by Hahnemann ; for other- 
wise we should be out of harmony with one of the essential 
articles of our faith. But in our selection of the remedy 
we should be certainly inclined to place more reliance upon 
it, did we find from the provings that the drug exhibited 
was capable of producing organic changes similar to those 
present in the disease to be treated ; and still more so should 
the records of clinical verification in analogous cases tend to 
the justification of our choice. 

m. — The Administration of one Bemedy at a Tim^. — 
On this point very Uttle need be said, since as we have no 
provings of combinations of drugs, it would be impossible 
to prescribe such combinations with scientific accuracy. 
Professing homoeopathists have been known to administer 
mixtures of two or even more remedies which they consider 
mdicated, but such a proceeding can hardly be indicated as 
homoeopathy. It is needless to dwell upon Hahnemann's 
emphatic teaching with regard to the single remedy. Alter- 
nation of different medicines at more or less frequent 
intervals demands, however, a passing word. On this 
subject Hahnemann says : " Some homoeopathists have 
made the experiment in cases where they deemed one 
remedy suitable for one portion of the symptoms of a case 
of disease, and a second for another portion, of administering 
both remedies at once, or almost at once, but I earnestly 
deprecate such hazardous experiments, that can never be 
necessary, though they sometimes seem to be of use.*'^ In 
other portions of his writings we frequently find him ad- 
vocating alternation, but I think it is always to be under- 
stood that one remedy is to be given for a certain period, 
followed by the second for a similar period, not that the 
remedies should • be given in alternate doses. Although 

" Organon,** edition 1894. Note to § 272. 



14 THE HOMCEOPATHY OF TO-DAY. 

strict Hahnemannians can only regard alternation with 
dubiety on theoretical grounds, nevertheless the frequency 
of its employment by practitioners whose successful results 
testify to the efficacy of their methods, seems to afford 
evidence of its practical value as proved by experience. At 
the same time it must be frankly admitted by its advocates 
that such practice is only due to the difficulty of finding a 
medicine which will satisfactorily cover all the symptoms 
present, and a wider acquaintance with drug symptoma- 
tology will gradually tend towards its elimination. 

rV. — The Dose and its Bepetition. — It will be impossible 
here to enter very fully into a consideration of the various 
opinions that have been promulgated with regard to the 
suitable dose and its repetition. Probably there is no 
branch of the subject of homoeopathy which has given rise 
to more discussion of a controversial nature. Ameke says : 
** History records no instance, books give no example of a 
physician ever having attempted to determine the question 
of the suitable dose with such zealous endeavour as the 
clear-sighted, indefatigable and thoughtful Hahnemann."^ 
But although his conclusions are consequently not lightly 
to be put aside, his experiments can by no means be said 
to have led to any final and satisfactory conclusion. His 
conscientious zeal could never have rested until he had 
settled the point definitely to his own satisfaction ; but in 
spite of the weight that must be placed upon the opinions 
of so earnest and careful an observer, they can be by no 
means regarded as approaching any degree of certainty. 
His later ideas on the subject differ to some extent from 
those which he originally held. At first he advised that a 
single dose of a well selected homoeopathic medicine should 
be allowed fully to expend its action before a new medicine 
is given, or the same one repeated. This dose must be the 
minutest possible "so as to produce the least possible 
commotion in the vital force, and yet sufficient to effect the 
necessary revolution in it.*' On this point he insists most 
emphatically, and in that ultra-dogmatic ' style into which 

* " History of Homoeopathy," p. 127. 



THE HOMOeOPATHT OF TO-DAY. 15 

the overwhelming sense of the importance of his discoveries 
unfortunately not unfrequently betrays him. "It holds 
good," he says, " and will continue to hold good as a 
homoeopathic therapeutic maxim not to be refuted by any 
experience in the world, that the best dose of the properly 
selected remedy is always the very smallest one in one of 
the high potencies (X), as well for chronic as for acute 
diseases, a truth that is the inestimable property of pure 
homoeopathy, &c."^ Hahnemann's tendency, to the end of his 
career, was always in the direction of minimising the dose, 
even olfaction of the high potencies being held by him in 
high esteem as a method of administration. He goes so far 
as to affirm that those who fail to make use of the smallest 
doses of the highest dilutions cannot effect all that homoeo- 
pattiy is capable of doing, and hence have no claim to be its 
adherents.^ 

With regard to the repetition of the dose his later ex- 
periences led him to modify his recommendation that one 
dose should be allowed to expend its action before the ad- 
ministration of another. In studying his teachings on this 
point the difl&culty always arises in my mind as to how any 
observer, however acute his powers, could speak positively 
as to when a remedy definitely ceases to exert any influence. 
He always speaks himself very confidently, but how a 
thoroughly satisfactory demonstration of the fact could be 
effected he leaves unexplained. But putting this aside, his 
later experience led him to the conclusion that although a 
medicine so left to expend its action would ultimately lead 
to recovery, this could be hastened by repetition ; in some 
cases of acute disease where the course is rapid this repeti- 
tion being advantageous up to as often as every five minutes, 
but only until either recovery ensues or the same remedy 
ceases to do good. But he held that our " vital principle " 
does not well admit of the same unaltered dose of medicine 
being given to the patient twice, still less several times in 
succession ; for then, though it may have been chosen ac- 



» " Organon," edition 1893, note to § 246. 
' Ibid., note to § 253. 



16 THE HOMCEOPATHT OF TO-DAT. 

corately homoeopathically it attains the end in view either 
imperfectly or not at all. Hence, he maintains, arise the 
many contradictions of homoeopathists among themselves 
with respect to the repetition of the dose. But if the dose be 
each time changed and modified in its degree of djmamisa- 
tion its advantage is thereby greatly increased, and this 
change of dynamisation he asserted that he obtained by 
shaking up the solution with five or six smart jerks of the 
arm. If the medicine thus still continued to show itself 
active he advised its administration to be persevered with 
in a lower potency. 

In dealing with so complex an organism as the human 
body, it is not to be wondered at that such definite rules 
have not been found invariably to hold good. When we 
consider the manifold varieties of constitution, the different 
degrees of excitability, and the peculiar idiosyncrasies that 
are met with, it would appear highly improbable that any 
absolute law of universal application would be found to 
meet all contingencies. This is borne out by the evidence 
furnished by the fact that the greatest diversity of opinion 
nowadays prevails as to this question of the dose and its 
repetition. Most practitioners must have observed how 
some individuals seem quite unaffected by medicines ad- 
ministered in low dilutions, whilst the higher produce 
rapidly beneficial results, and vice versa ; others appearing 
to be equally susceptible to the actions of medicines in any 
attenuation, ranging from the crude drug itself up to its 
highest potentisations. A certain number of practitioners 
still endeavour to prescribe strictly in accordance with 
Hahnemann's teachings ; but the majority do not confine 
themselves to any particular dose nor know any absolute 
limit to its repetition. Speaking generally, it might per- 
haps be asserted that the higher potencies are much more 
largely used in chronic, and the lower in acute diseases, 
but this can by no means be regarded as the universal plan 
of treatment. On the whole there is a greater tendency in 
the direction of the lower dilutions; and that Hahnemann's 
views with regard to the danger of aggravation are not 
generally considered of vital importance, is demonstrated 



THE HOMCEOFATHY OF TO-DAY. 17 

by the common practice of frequent repetition. And in 
this repetition, the dose and dilution are not necessarily 
altered ; Hahnemann's teachings as to dynamisation by 
succession, as above referred to, being no longer regarded 
by many as worthy of attention. And when an aggravation 
does take place — a point very difficult to demonstrate unless 
absolute confidence can be placed upon one's own powers 
of observation, and the patient's statements may be 
thoroughly relied upon — I think the more common practice 
of the present day would be to give the remedy in a higher 
dilution rather than a lower. 

The question, therefore, remains to a great extent un- 
settled, and the ideas of many with regard to the dose and 
its repetition differ considerably from those of the earlier 
homoeopathists. Observation and experience, however, 
will ^vithout doubt lead ultimately to more definite lines 
of guidance. 

"F. — The attitude of Hahnemann with regard to local 
applications, and auxiliaries to treatment ; and his condem- 
nation of all remedies not prescribed in accordance with the 
law of similars. 

All forms of topical application are looked upon with 
suspicion by Hahnemann. He allows the efficacy of rub- 
bing in cutaneously, in some cases, provided the skin be 
thoroughly free from disease, a solution of the medicine 
which is perfectly homoeopathic to the disease under treat- 
ment ; but qualifies even this by the statement that homoeo- 
pathy never requires this procedure. He felt so strongly 
on the point that the homoeopathic remedy was all-sufficient, 
that having onc^ given the advice " to apply to the back in 
psoric diseases a resinous plaster to cause itching, and to 
employ the finest electrical sparks in paralytic affections," 
he felt it his duty to solemnly retract it, as savouring of 
allopathy.^ ** When the rational physician," he says, ^* has 
chosen the perfectly homoeopathic medicine for the well- 
considered case of disease, he will leave entirely to irrational 
allopathic routine the practice of giving drinks composed 

' Introduction to " Organon,*' fifth edition, 1888. 

VOL. ni. — NO. 2. 2 



1% THZ BDMOirS AZHT Off* TIVTYtT. 

of Other m^oScrriis] £rLr)$32Z3:>^ r»f B^cying compiesses of 
heffjs or f:»irH-::Laii:ici5 wiii Tiur}:»a« j-lfizzts, of injecting 
iLL^dic:a»t*^3 ^T5:t»ers. azii :-f r:ir-rci^ in rris or the other 
ointnieiit/'* Ai rbe Ka.TT>c r:TT>e ii ir^asi m-i be imagined 
that HainemaEJi 015*5: "iiiicnaarjed iLe reiLi'Tal of any mani- 
fettlT in€>cbajiieal ca.:i5e of disaase, Tiiis be c&Hs the causa 
occo^tcw^a'.*^, and insianoES tie 5»^?wiiiir of belladonna 
bem€«, which niTist be exi>ellf»i br the lase of an emetic, 
foreign sub^tanoes in the passar^s, Tesi:!^! calculus, &c. 
To this mu5t be add^ed the corrccifr-n of anv errors in the 
diet or general r^glm^n of the patient, which nii^ht serve 
as deterrents to the recaperatiTe action of the remedial 
agent employed. But apait from sach cases as these, which 
no sane individual coTild think of treating otherwise, the 
suitable remedv, and that al^ne, mav be said to have 
practically formed his sole basis of tiveatment. The idea 
that any medicine should ever be prescribed not in accord- 
ance Ti'ith the law of similars, he absolutelv discountenanced. 
In this department homoeopathic treatment of the 
present day tends to far greater latitude. The widest 
diversity of opinion prevails as to how far auxiliary mea- 
sures are justifiable. There still exists a strict school of 
Hahnemannians, whose implicit faith in the Uteral doctrines 
of our great leader restrains them from any departure from 
his precepts ; but the majority of his followers are inclined 
to act on much broader lines, and to accept that which is 
good from whatever source it may proceed. Thus, in 
accordance with this more liberal spirit, we shall find 
bomceopatbists of to-day who do not hesitate to make a 
judicious use of a multitude of auxiUaries to practice, in 
the form of poultices, eye-lotions, gargles, hypnotics, sooth- 
ing, antiseptically cleansing, or even medicinal injections in 
gonorrhcea, &c,, parasiticides, analgesics, hydrotherapy, 
massage, electricity, and a host of other adjuvants that 
will readily occur to all. In a paper read before this 
Hociety, in session 1888-9, local palliatives in cases of 
pruritus were freely advocated and discussed, which in 

I <• Organon/' edition 1893, note to § 274. 



THE HOMCEOPATHY OP TO-DAY. 19 

itself -will serve to show the greater latitude of opinion 
that prevails in this direction. I am not quite sure that 
the possible efficacy of a blister might not be contemplated, 
and even a leech would hardly be regarded by some with 
the horror which it ought theoretically to inspire in the 
breast of an ardent follower of Hahnemann. 

It will be objected that such retrograde tendencies to 
the paths of allopathy are a very grave admission of weak- 
ness on the part of the physician, since his failure to obtain 
as good results without resorting to such measures is 
merely due to his inability to find the remedy in a drug 
capable of giving rise to similar symptoms. And such an 
objection has certainly strong grounds of validity, since 
reasoning from analogy it might be argued that it appears 
possible, and even probable, that no disease exists for which 
nature does not likewise provide the remedy, and that based 
on the law of similars. Still, even assuming this — and it is 
an assumption which only the most sanguine homoeopathist 
would insist upon — we must bear in mind that we have not 
all the resources of nature in this respect at our command ; 
and whatever the future may have in store for us, we can 
only as yet profess to be acquainted with a small proportion 
of her secrets, and under the circumstances must be content 
to adopt the best means at our disposal. As an illustration, 
let us take a case where we will suppose an anodyne indi- 
cated. Although the carefully selected homoeopathic remedy 
might ultimately attain the end in view, if by resorting to 
cruder methods more rapid temporary means of alleviation 
can be secured while searching for the specific, the homoeo- 
pathist ought not to scruple to avail himself of such methods ; 
for if even a few hours of pain can be thus avoided without 
ultimate detriment to his patient (a case which is not merely 
a hypothetical one), it is no longer a matter of choice, but 
bis plain duty to adopt the means in his power to this end. 
But going even farther than this — and I now begin to feel 
myself on delicate ground — cases may at times occur where 
the most carefully selected homoeopathic medicine is pal- 
pably failing to overcome the disease, and where the 
practitioner's allopathic knowledge suggests to him a 



-Cttuu^i: !«: Wilt 11 jjsr^ ^rumzii^^i insc^ narfecniiet is .Sisit 

jfc trjlt^jt^iis: z?tC»^rrL!T 5ri;j.rtTti i.r z::if i:s rvn -SE^snfri'je issioer 
/''^rt^ T)tr:L ttIi'-ci b^ t^'Ii? :c: ii'TH-iIj Iccthij^ r:arc»fc»fd it? be 

C'>off v. ocjtc iZuTii-rTj. aoi wr-fiT? lie SDize 'Zt ibe ^ifsease 
Wi.^ iir:ti:ii!:sL. TIjct iz.i«rr^2L£r:zed niruirs cf f rrc^ess wfcen 
tbcT Eij^tr 't^i^L iix: tii'c aZIr^rtini's ease ceiii^ created iBriih 
^kS^rcjiZe cf $cCi, aoi ^tjt b:?Eii'Xcrash*5 wioi lie Eieiiicme 
wLiccL h^ ecn.^ic-rr'cd spcci£c. Th*? crciparEscit irt this in- 
flKt£:*/;e .^L-'.Tr'cd so m^rkriilT tn faTvor of iiiie salicvlalte, that 
tb& s^irrj^ tr*£^aii^L:« was ad:ptieti ot inv friend wivh the 
Bio»*t t^uL^ractory resolu. I am not now adTccating salfcylate 
g( stAa as a aniTersal specitic in all cases of acate rheoma- 
ti'sia. Triis aiJecrion has alwavs been to some extent one of 
the h^U^nrAres of homoeopath y. bat the dtifccaltT sometimes 
experienced in discoverinc: a simillimnm does not by any 
means proTe its non-existence. All I wish to point oat is 
that in certain rare cases, where the most carefiil selection 
does not famish as with a perfect remedy, in the interest of 
oar patients we mast not feel boand to confine oorselves to 
homosopathy, if we feel convinced that other means wiU 
proTe more effectaal. 

That a certain amoant of greater liberahty ahoald 
characterise oar treatment is a caase for congiatalation 
rather than for despair, for after all we mast never lose 
sight of the fact that we are physicians first» homodopathists 



THE HOM(EOPATHY OF TO-DAY. 21 

tkfterwards ; and that we shall have a very grave burden upon 
our conscience if we sacrifice the interests of suffering 
humanity to a blind worship of our idol, homoeopathy. A 
great deal is talked of the bigotry of the old school, but a 
charge of a very similar nature might fairly be brought 
against us, did we neglect both theoretically and practically 
to consider the teachings of a more enlightened age, adopt- 
ing any treatment without hesitation, should it prove more 
effectual than our own. We live in a very different time 
from that of Hahnemann, when the best allopathic teaching 
can hardly be sweepingly put aside as unscientific and irra- 
tional. Hahnemann, at a period of comparative therapeutic 
darkness, appears to have been utterly blinded by the brilliancy 
of his own great discovery; and doubtless the heedlessness 
of the profession to the reiterated exposition of a revolution- 
ising law which he knew to be true, together with the in- 
creasing contempt and ridicule to which he found himself 
subjected, drove him into a position of intolerance and 
dogmatism, which nowadays it would be indefensible for us 
to adopt. 

Such are a few of the points wherein the homoeopathic 
practice of to-day may be seen to differ in some measure 
from that of Hahnemann. Other comparisons might be 
made, but the above are sufficient to bring out some of the 
essential features. For example, nothing has been said 
about the importance that is placed, with regard to treat- 
ment, and apart from merely scientific curiosity, upon the 
etiology of disease. To a limited extent Hahnemann may 
be said to have paid some attention to etiology, but this 
hardly advanced beyond the consideration of the constitu- 
tional state. His theory of the dynamic (spiritual) nature 
of disease, which is not perceptible, led him to regard all 
efforts in the direction of its discovery as futile. Neverthe- 
less, the " tolle causam " is, and must ever remain, a point 
to which the scientific physician is bound to direct his 
attention. With the light that latter-day discoveries have 
thrown upon the subject, taking as an isolated example all 
the possibilities developed by the germ theory of disease, 
and the importance played by micro-organisms in its 



22 THE HOMCEOPATHY OF TO-DAY. 

etiology, of which Hahnemann knew nothing, it is impos- 
sible to imagine that such enlightenment could fail to lead 
to applications of practical value. 

Briefly summarising, it will be seen that the principle of 
treatment remains the same. Modern scientific methods, 
and an infinitely more advanced study of morbid anatomy, 
greatly assisted by more perfected facilities for conducting 
our investigations, have directed a far greater amount of 
attention to the domain of pathology. Hahnemann's some- 
what dogmatic teachings in reference to the dose have under- 
gone a tendency to considerable modification ; and although 
the great law of similars is as much as ever the basis of 
treatment, there is a spirit of greater liberality abroad, which 
discountenances a blind intolerance of everything not im- 
mediately within its own particular sphere. 

Eecently it has been somewhat freely asserted that the 
old and the new schools of therapeutics are gradually, but 
perceptibly, merging, and that before many years have 
elapsed an amalgamation will take place, the line of demar- 
cation being entirely obliterated. Such a possibility can 
only be regarded with the greatest misgivings, since it would 
be on the side of homoeopathy that the greatest sacrifices 
would have to be made. But the grim spectre, Pessimism, 
lurks amongst us elsewhere, and the significance of any such 
apprehensions may be somewhat discounted by accrediting 
them to this depressing agency. At the same time the old 
adage, ** no smoke without fire,** has, apart from this con- 
sideration, some shadow of confirmation in this instance ; 
and it is worth our while to search for the spark, and if 
possible to extinguish it. Reviewing the points elicited by 
our comparison between the homoeopathic treatment of to- 
day and that of Hahnemann, it can hardly be maintained 
that any great concessions have been made on our side. A 
natural desire to keep ourselves au courant with the scienti- 
fic spirit of the age and to place our system upon a firmer 
pathological basis can hardly be regarded as a step in the 
direction of allopathy ; whilst a somewhat modified idea of 
the dose, and a greater latitude of opinion with regard to 
general auxiliaries, do not afford very strong evidence of 



THE HOMOEOPATHY OF TO-DAY. 23 

retrograde propensities. To these points it must be added 
that extreme caution on the part of many homoeopathists 
will not permit them to pledge themselves definitely to the 
absolutely universal application of the law of similars, wide 
as they acknowledge it to be ; and that the expediency of 
surgical procedure is taken into consideration much earUer 
than formerly : — and we have enumerated most of the im- 
portant points that might give colour to the assertion that 
we are degenerating. But a glance at old school practice 
will suffice to show that the modifications of the past century 
assume much more striking proportions. How far this is 
due to the influence of homoeopathy is an open question, 
which might lead to warm and unprofitable discussion, but 
need not concern us here. The more heroic methods of 
treatment have yielded to gentler means, and the shedding 
of blood is no longer regarded as essential to the saving of 
life. This part of the subject has been dwelt upon ad nauseam 
and requires no further comment. Nor is it necessary to 
make more than a passing reference to the much greater 
simplicity of the modern prescription, from which to a large 
extent polypharmacy has disappeared, and in which a single 
drug, or at least only one of importance, is not unfrequently 
administered. Comparatively diminutive doses have been 
found to be equally beneficial with those of colossal propor- 
tions erstwhile in vogue ; whilst even portable pocket cases 
of compressed tabloids have made their appearance, strongly 
suggestive of a hint borrowed from the methods of the 
younger school. There is also rather more than a glimmer- 
ing of the perception that the law similia similibus curentur 
is at least partially applicable to the treatment of disease, 
although an apparently ineradicable prejudice, in no small 
measure strengthened by heredity, prefers rather to ascribe 
the kudos of the discovery to Hippocrates than to Hahne- 
mann ; forgetting that had not the latter unearthed it from 
obscurity and brightened it under the influence of the 
sagacity of his transcendent genius, it had still remained 
half buried beneath the accumulated dust of centuries. 

Furthermore, constant gratuitous testimonials to the 
eflScacy of our time-honoured remedies are tacitly accorded 



24 THS HOMCEOPATHT OF TO-DAY. 

and widely endorsed by their wholesale adoption ; although 
at the same time by some mysterious process of ethical 
reasoning, their sponsors are enabled to persuade them^ 
selves of their unquestionable claim to the originality of 
their discovery. 

It must be borne in mind that all these remarks can 
only be regarded as possessing a general bearing, since 
where no definite rule of therapeutic guidance is recognised, 
it becomes almost a case of " tot homines, tot sententia," 
And herein we have struck the key-note which renders 
evident the whole source of the discord. For in the 
absence of such rule of guidance for the apphcation of the 
newly acknowledged remedies to the cure of disease, there 
is no resource but to fall back upon a reckless and indis- 
criminating empiricism, altogether incompatible with the 
fundamental principle of our creed. The old school pre- 
scribing the remedy without any more reason than because 
it has previously proved itself useful in cases of apparently 
approximately similar symptoms will meet with only partial 
success, gradually leading in all probability to its ultimate 
abandonment as untrustworthy ; the new school will never 
place confidence in it, unless a careful comparison between 
the symptoms it is capable of producing on the healthy 
organism, and those of the disease to be treated, satisfies 
them that the parallel between the two meets the require- 
ments of the law upon which constant experience has 
taught them to rely with an almost unlimited credence. 
Until this great law of similars is universally acknowledged 
by the profession, however nearly the old and new systems 
may appear to [approach one another, an actual coalescence 
is absolutely impossible, and can be regarded as nothing 
more than a chimerical phantasm of the imagination. 

Upon every practitioner whose convictions have led 
him boldly to acknowledge his faith in the teachings of 
Hahnemann, an exasperating sense of the injustice of the 
position in which he finds himself thereby placed must 
at times inevitably weigh heavily. Smarting under the 
stigma of the odium medicum, which, although somewhat 
modified in its intense bitterness, is by no means obsolete ; 



THE HOMGBOPATHY OF TO-DAY. 25 

debarred from honourable and lucrative appointments which 
he sees occupied by those whose natural abilities and pro- 
fessional qualifications are in no way superior to his own ; 
and to a hmited extent the victim of social disparagement 
through the misunderstanding or ignorance of a largely 
unsympathetic public, in whose interests he knows himself 
to be in reahty suffering, it is no wonder that he is occa- 
sionally overwhelmed by ardent aspirations for emancipa- 
tion, and an almost irresistible temptation to conceal his 
light under the protecting shadow of a less compromising 
eclecticism. 

But to him whom experience has taught the priceless 
value of homoeopathy, leading him to regard its vitality as 
absolutely inseparable from the highest interests of the 
bodily welfare of mankind, such a compromise is at present 
an impossibility. He cannot hope, however sanguine, for 
the universal recognition in the immediate future of the 
truths which form the basis of his creed ; nor is he on his 
part prepared to make the slightest sacrifice since he sees 
that it must tend in the direction of crudity and empiricism. 
Once let the noble fabric of homoeopathy be tainted with 
this scourge, and it must inevitably ultimately crumble to 
ruins, for all our elaborate provings, the result of the 
unwearied toil and perseverance of generations, will thus 
be necessarily gradually discarded, in proportion as the 
seeds of less careful and discriminating work become dis- 
seminated through the field of general practice. Since any 
flagging or uncertain yielding on his part involves so grave 
a responsibility, to the man of scrupulous conscientiousness 
the open avowal of unswerving faith in his tenets remains 
no longer an act of volition, but becomes a question of 
solemn duty ; and in the noble flame thereby enkindled in 
his breast, all minor obstacles melt into utter insignificance. 

Gentlemen, the fate of homoeopathy rests in the hands 
of the present generation, and we cannot have too magnified 
a sense of the weight of our responsibility. Most of the 
venerable pioneers.who have worn out their harness through 
the more stirring phases of the strife are no longer with us, 
though their laurels have descended upon us. There is a 



26 HOW TO LEABN DBUG PATHOGENESY. 

temporary lull in polemical activity only disturbed by an 
occasional desultory skirmish, while to a great extent the 
salutary stimulus of persecution has ceased to exert an 
active influence to goad us on. We must be ever watchful 
lest we be betrayed into an unheeding condition of apathetic 
indolence, engendered by the comparative ease secured for 
us by the restless and indomitable energy of our fathers. 
We require to cultivate a little more of their spirit of active 
enthusiasm in the work of our hospitals, our dispensaries, 
our general practice, and our societies. Animated by such 
enthusiasm, born of conviction, nurtured by zealous endea- 
vour, and proudly flourishing as its device the oft-repeated, 
but ever pregnant motto, Magna est Veritas^ et prcdvalehit, 
we shall triumphantly march forward, victorious and invin- 
cible ; not vainly aspiring after indefinite aims, but glowing 
in the ardour . of a settled purpose ; ambitious alone of 
proving ourselves worthy of " the oak garland bestowed on 
us by a good conscience, which rewards a thousandfold." 



HOW TO LEAEN DEUG PATHOGENESY.^ 

BY JOHN W. HAYWARD, M.D. 
Consulting Physician to the Hahnemann Hospital^ Liverpool. 

So much has already been said and written, and so well, 
on " How to Learn the Materia Medica^' by such masters 
as Hering, Meyer, Dunham, Hughes, Pope, Wesselhoeft, 
and others,^ that anything more would have been superfluous 
had our materia niedica not undergone reconstruction since 
these essays were published ; and had such classifications of 
its materials as those of Teste, Hering, Hale, Gblston, 
Burt, Farrington, and others not been issued in the 



* Read before the Society, October 4, and before the Liverpool Branch, 
November 8th, 1894. 

* For the List of Essays, see Note d. appended to this paper. 



HOW TO LEARN DRUG PATHOGENE8Y. 27 

meantime.^ Since the publication of the ** Cyclopaedia of 
Drug Pathogenesy," a reconsideration of this matter is 
called for. 

The object of the systematic study of the materia medica 
should, I think, be to acquire a knowledge of the pathological 
and the general symptomatic relationships existing between 
drag diseases and natural diseases, so as to be able to fit these 
together in practice ; in other words, it should be to learn 
the genius and the sphere of the pathogenetic action of 
drugs, which is possible ; rather than to endeavour to 
memorise the whole of minute symptomatology, which is 
not possible. The schema should now be reserved for 
clinical use only ; that is, to be referred to when in search 
of special characteristic symptoms for deciding on the single 
medicine for an individual case. 

To learn the materia medica is a very different thing 
now from what it was when the older members of this society 
began the work; I say, began the work, because they have 
not yet ended it, and, as practitioners, never should. 

A knowledge of the materia medica is one of the most 
important parts of a physician's equipment. There are four 
principal divisions of the professional knowledge essential to 
the medical practitioner, viz., anatomy with physiology, 
surgery, materia medica, and medicine, conventionally so 
called. Anatomy is the foundation of surgery, and materia 
medica, with pathology, is the foundation of medicine. To 
the medical practitioner a knowledge of all of them is equally 
necessary. This necessary knowledge may be acquired in 
one or both of two principal ways, viz., (1) at first hand, or 
(2) at second hand. The second-hand way is from books; 
the first-hand way is from personal observation or contact, 
i.e., by appeal to nature herself. The second-hand way of 
learning anatomy is by reading other men*s descriptions of 
the parts of the body, the position of the muscles, vessels, 
nerves, &c. ; the first-hand plan is that of dissecting the body 
one's self. The second-hand plan of learning operative 
surgery is by reading directions for the different operations ; 

* For the Classifications of Drugs, see Note b. appended to this paper. 



30W TO LSABar QBCG BAZBO^DEBST. 

the first-band plan is rfaac if »ioing die Dp^ations one's sel£ 
So, the second'oand plan 31 minm^ ^ knowied^re of natural 
diseases is by reading die acconniB of other persons' obser- 
vations, and their details of the symptoms : the first-hand 
plan is that by personal observation at the oedside, and the 
practical treatment of cases of illness. The second-hand 
plan of learning the materia medica is by stndying other 
persons' collections and arrangements it the materials — ^the 
ordinary materia medicos, lecrores, condensations, epitomes, 
abridgements, d^.; the firsi^-hand plan is that of proving the 
drugs on one's self^ and studying the original records of 
poisonings, experiments, post-mortems, and provings. 

I need not ask which of these plans wonid be adopted by 
the student or practitioner really in earnest. The student of 
anatomy, or surgery, or medicine, who trusts to books only 
will make but a sorry figure when he comes to apply the 
information he has gained in this way; so the student of 
mat^ia medica who trusts solely to lectures, arrangements, 
condensations, epitomes, or abridgements, will come off very 
indifferently in the use of the materia medica in practice. 
Such information should be obtained at first hand, at the 
fountain head, undiluted and unadulterated. 

When our materia medica existed only in schema form, 
and had to be learnt firom Hahxbicanx's " Materia Medica 
Pura " and '* Chronic Diseases," or from Jahb's " Sympto- 
men Codex;" then to gain an adequate knowledge of the 
pathogenetic effects of the drugs we had to use was indeed 
work, and that not of a pleasant or interesting kind. Now, 
however, since the issuing of the " Cyclopaedia of Drug 
Pathogenesy/' in which records of provings, poisonings, ^W)*^- 
martems and experiments are detailed in the narrative 
form, showing the beginning and the course of the patho- 
genetic action — in which, in fact, drug diseases are described 
as natural diseases are described in other of our treatises — 
we may learn the pathogenetic action of drugs as easily and 
fi^ pleasantly as we learn the pathogenetic action of the 
ftpGcific poisons, measles, scarlatina, small-pox, typhus, 
typhoid, Ac, and we should learn it in the same way. 

Drtig diseases should, I think, be studied in the same 



HOW TO LEASN DBUQ FATHOGENESY. 29 

way as natural diseases. Now the best way to gain a know- 
ledge of natural diseases is to study them at the bedside, 
and to read accounts of case after case of the disease — read 
case after case in succession : so the best way to gain a 
knowledge of drug diseases is to prove (or reprove) the drugs 
ourselves and on our relations and friends, and to read the 
accounts of case after case of poisoning, experiment and 
proving — read proving after proving in succession. In no 
other way can this knowledge be so thoroughly and so 
pleasantly acquired. Anyone, therefore, who wishes to learn 
the homoeopathic materia medica should select a drug with 
a well defined and perhaps a limited sphere of action, such 
as cantharis ; or a polychrest, such as a^onitum, belladonna, 
or phosphorus, and prove (or reprove) it upon himself and 
his friends,^ if possible ; and in addition he should read it 
over, first of all in Pereiba, or Phillips, or Christison or 
Taylor, or some other work on toxicology ; and of course 
in Hughes's "Pharmacodynamics." After this he should 
take up the Cyclopaedia and read over first the poison- 
ings, experiments and results of post-mortem examinations ; 
and lastly, he should read over the provings — the provings 
should be read last. He must do this more than once, and 
he should do the first reading somewhat aimlessly, as if for 
mere amusement, as Dr. Guernsey says, "in an easy chair, 
with his pipe in his mouth ; *' then he should read all over 
again, but this time carefully and somewhat seriously, noting 
the most striking or oft-occurring effects, and the parts or 
organs most affected ; the order in which they are affected ; 
and the kind of morbid effect produced in them ; then he 
should write out his own individual opinion of the special 
disease-producing power of the particular drug, and the 
nosological forms of disease its effects resemble or indicate. 
He should then read the experiments, poisonings and 
provings over again carefully, and make himself thoroughly 
master of the peculiarities of the drug action, noting care- 
fully the character of the symptoms, the conditions under 



* At least make a short experimental proving : see Wesselhoeft's paper 
p. 155. 



30 HOW TO LKJLRX DBC6 PATH06ENEST. 

which ihev ooeur, aiu) iho <vHc>.^mitamts connected with each 
symptom. 

HAviuj; pnxvtHUHl in this tray and thus far he will have 
r.i:t:uned a fair kninvUnlco of the pathology of the particnlar 
druij. and will In* able to pw^dioate, in a general way, the 
oIass oi diseases lo whioh it will be homoeopathic, and he will 
have mentally pisicMU-holed it for nse in such cases. He 
sl.< •uld then take up another dru^j — an analogous one ^ — and 
study it in the same way ; suppose the first drag was aco- 
mtitm, he should next lake up such a drug as baptisia, or 
bnjoiiiii : if it was hrSiiuLnn^^ he should next take up such 
a drujj as A*/«v>vj/.iw><,<, or stramonium : if it was cantharis, 
then tipis, if /»/>tv.<^>fe<>r**j?, then a serpent venom ; and so on, 
always selecting a somewhat similarly acting drug.^ By 
this metluHl of study he will pun an insight into the phy- 
siology and jwtholoj^y^ of drug diseases, and acquire (not a 
mechanical hul> a scientific knowledge of drug pathogenesy. 
Having so studiinl some dor.en or more of the most impor- 
tant drug>i given in the Cycloivanlia, he should read over 
the same drugs in Haunkmaxx's '' Materia Medica" and 
** (^hroi\io Diseases ** if lhei\\ and again note carefully the 
uh)st characteristic symptonis and the conditions and con- 
comiiftuts^ If he has a fair memory for words he will, by 
thin tinus have ivtaintnl nmny symptoms in his mind, and 
will hav« hcconte ahvady a tolerable symptomatologist : but 
at thi«i Htage he need not make much eflFort to memorise the 
symptoms themselves as such ; his endeavour should rather 
bo to comprehei\d and (\illy appreciate the genius and the 
sphere of action — the fon^i ft ori^o mnli — of the action of 
each drug/ its special oUvtive affinities, and the specific 
character of its action ; whether, for instance, it acts prin- 
cipally on the nervous or the vascular system, or whether it 
is febrigenic, like ttconitunt, or tissue irritant, like kali hi- 
chfvmicum ; if febvigenic, whether its fever is inflammatory, 
like that of acofiitnm ; or nervous, like that of hyoscyamus ; 



* For analogous drugs s«e Not« x. appended to this paper. 

• Tho living morbid process, not pathological anatomy. 
See Mcyor*8 paper^ p. 445. 



HOW TO LEAKN DBUG PATHOGENESY. 31 

if tissue irritant, what tissues especially it irritates ; and if 
its irritation is acute and tends to run on to inflammation, 
like that of bryoniay belladonna, phosphorus, &c., and if so, 
what parts especially it inflames, whether the serous mem- 
branes, like bryonia, cantharis, &c., or the mucous, like 
belladonna, euphrasia, &c. ; or the tendinous structures, like 
rhtis; or the lungs, like phosphorus, and so on ; or if its irri- 
tation, instead of being acute, is of a slow character tending 
to the production of effusions, hypertrophies, atrophies, 
indurations, degenerations, &c., and so on.^ 

The whole materia medica should be studied in this way 
80 that the genius and the sphere of the pathogenetic action 
of drugs may be fully comprehended and mentally defined, 
and the student be made capable of writing out the patho- 
logy of drug diseases as easily and truthfully as that of 
natural diseases. When he can do this he will be fit to 
attempt homoeopathic practice, and he will then find the 
medicinal treatment of patients to be a pleasant, interesting 
and successful occupation. With this general pathological 
knowledge of drugs and diseases, immediately on a patient's 
complainings being detailed to him, one, two or three 
medicines will present themselves to his mind ; he should 
then think over the patient's symptoms, and selecting the 
fundamental ones, i.e., those indicative of the origin of the 
disturbance, and those peculiar to the individual patient, he 
should appeal to the schema, or the pathogenesy itself by 
means of the schema, and in it find the medicine in which 
these same symptoms are fundamental, idiopathic, or more 
distinctly marked than in any other. He will then be able 
to prescribe the medicine really homoeopathic to the case 
itself— to the individual patient. Say it is a case of pneu- 
monia ; immediately tartarus emeticus, or phosphorus, or 
bryonia, or some similar medicine will occur to his mind, 
and then, by the peculiar symptoms, such as the pain, or 
the absence of pain, or the kind of cough or expectoration 
or respiration, or some other characteristic symptom pre- 
sent — to be sought for in the pathogenesis by means of the 

' A reading of it in Ringer*s " Manual of Therapeutics" (if there) would be 
wi excellent finish to the study of each medicine, (twelfth edition). 



82 HOW TO UUUMI DRUG PATHOQEKB8Y. 

nck^mA, i>[^)wltvrys ^>r uu)<^x — the mdiTidoal medicine may 
W {iot\\\MA\ a\<'A^\'x\va>^s JM>d $t> be prescribed with the 
u;n>.>M wx.:,vvsv ^i^.3 wiaisiwtiv^ffiu *Di with certainty as 
to \ )v v>w ., ,>. tl'^h^^ :^wvYmA :$i^^xjc "he TMerred and used for 
;i.cv ♦,' i.vtN V ^%i*iW»^*>^ «t£ &uiisiuTr*. «cir 5:r sach purpose 
,xi»> i xj>x villi -tvTv )v mtutt iw :jujii]«:5 re $Ts«eniatic study 
H^ ^l. ^ '^v' /v*'»^i»---^i« n^<>^nft«^ ^Utf T>«c:ics£»ar^ material 
* V >4Uvh kiivi V ^ >»uumii^i'»i»x. • iitf nr^Jcna that to be 

><uiu fKti» 's^ t'-:. ^►.ut ", ¥t**i:^' -<tL:;r**5C i?r learning 

;iu>, ''vvi'' V "^^' ' ^"^ - >> - t "•*^* t'^-^ s:^ ':tr no the one 

vOs'SK^»i V ^ »>.^..-u^^'> '• •♦><5.\ ■♦'- t3 '.7SitC<:-i Tipon both 

•^♦v/fr v;- *> ' -;;'^ ' ***<.*'^ -^r^t-^ ij^i ^ xrrt'^^ori use of 

.•v ^(.'tt '^Ki.y ••* *4 '^ '» 't^*-. -r*:^-!*.-'* =-%c^t ing patho- 

. ... .-vy >v ••»«.>i"?^ •'••;>^ ii ♦•:><.. •> :^diiv and his 

.«.'■ »vii^ '^^♦.h'; ♦-c ''t "i^ iT ..r^.'^ -r- :uced on him- 

vau .'•'.. -' , -^I'L^ -.^ IT ':^- '•> ^ me efGacts on 

v<. iiHY %«.., .4.:»'->^ "^ "^.'^.i. idvocate the 



* 1 v_ '* ^* 



w^» . • tV "isV*. ' ^*> 



v.. »^ V • • •> 



f-a ^:re find him 

, ,^ *^v. "t- »T- . >c^:w Doses/* in 

,. X , V, ^^ - ^-.. •'. r ' Vaat organs 

, ^ , <v . . -^ • -^i r niodifies in 

,^ ,. V ^>--- -- . T . .:r::bs- or excites^ 

^ . .^ ^5. ? x-l:.:! -uid digestive 

, ,^ - • ^% tn? iisposition^ 

. . ^ .■ ^5:v --,:• :::H ^hat modi- 

•a .• low long its 

- •.^i^rii powerless, 

-IV :^ jr less dis- 

•»t: :>4: .^pended 

^ : - .-^ ■ i/ 2u::*G» Wes- 

" > ... >v > -^rttaiof all 

' - V '5^ »., X xi'.v.:^e iud help- 

^ - - -.v -*^t --->< '^o^fj, >i;v.u>d vW rfiat of 

-u.i uc»4i Jt iiuu^ii. vuc^tni >v txhose of 






v'".*. 



-«.»** 




DISCUSSION ON DBUG PATHOGENSSY. 33 

Meyer and Wbssblhobft, then the others in the order of 
their publication. 

Since Hahnemann's time the number of our medicines 
and their pathogenesies have been much increased ; they are 
now so numerous and extensive that a general knowledge 
of their disease relationships is all that can be borne in 
mind and made use of in the every-day work of the busy 
general practitioner! With this general knowledge he treats 
ordinary acute diseases, and he only resorts to minute 
symptomatology in consulting-room work, and with ano- 
malous and chronic cases. Nor, indeed, is more necessary, 
for with a good knowledge of the Cyclopcedia the practi- 
tioner may with confidence undertake the treatment of 
acute and definite morbid states, and with, in addition, 
appeals to the schema, by means of a good repertory, he 
may, without hesitation, attack any chronic disease, or 
anomalous or rare morbid state that may turn up to him, 
whether as a general practitioner or as a specialist. By 
acting in this way, whilst practising symptomatically he will 
avoid the fault of mere mechanical symptom-covering and 
of mere key-note empiricism, as well as that of mere speci- 
ficking, and whilst submitting to the exigencies of practice 
he will conform to the dictates of a scientific profession. 



Dr. Ord said with regard to first studying the CyclopaBdia he 
thought they must consider the objects for which they were 
working, and especially the position of those whom they were 
advising in their studies. For instance, in America where there 
were schools in which homoeopathy was taught, he did not think 
they should begin by putting the provings of the Cyclopaedia 
in the hands of students in the early days of their materia medica 
lectures ; they would be better appreciated later on. But the 
importance of the study was actually as great to physicians as 
that of anatomy was to the surgeon. Free licence should, how- 
ever, be given as to the order in which the drugs were studied ; 
it would greatly confuse some minds to read belladonna, 
itramonvuM and hyoscyamus in succession. He had heard of a 
man who read a drug up in the materia medica every night 
before going to bed. If they all did that, they would get on 
very much better with their cases. There was a very difficult 
voii. ni. — ^No, 1. 3 



34 DISCUBSIOM ON DBUO PATH06ENE8T. 

point which required a little elucidation. They were rightly 
advised to try and form a mental picture of the action of each 
remedy, but if a drug such as bryonia were taken, with a very 
wide sphere of action, and they also looked at two or three 
conditions in which bryonia was frequently useful, such as 
pneumonia, rheumatic fever, or liver congestion, each one of 
these was a more or less distinct disease with its own particular 
symptoms ; how were they to form a single picture in their 
minds to include all three? Inasmuch as no prover ever ex- 
perienced all those symptoms together, he thought they should 
look upon the action of bryonia and other polychrests in such 
cases as distinct, each requiring the mental conception of a 
separate drug-picture. In the case of disease they did so, as, 
for instance, in pneumonia they could each tell exactly the stage 
and the special symptoms which would call for bryonia, or for 
phosphorus, or for sulphur, and that remark also applied to con- 
gestion of the liver and rheumatic fever. Therefore, he thought 
that a little application of organopathy adapted to the study of 
such a polychrest as bryonia was advantageous in practice, and 
would help one in getting a correct idea, not of its one sphere 
of action, but rather of its many spheres of action, each depend- 
ing upon that organ which was specially affected. 

Dr. Galley Blaoeley said he was very agreeably dis- 
appointed with the paper, peculiarly so after having taken a 
somewhat similar subject as the groundwork of his address at 
the last Congress, and he was very glad to find that Dr. Hayward 
was climbing down a little from the attitude he had hitherto 
assumed. With the greater part of the paper he most cordially 
agreed, and most of all with regard to the schema. He felt more 
and more persuaded that the schema should be left to the very 
last. It was the last Court of Appeal, and they should not need 
to appeal to it except in anomalous cases, new diseases, and so 
on. He joined issue, however, with Dr. Hayward with regard 
to the study of proving. It was manifestly quite impossible to 
prove all the drugs either upon themselves or upon their friends, 
but what they should try and do, after having studied physiology 
and pathology, was to grasp the principles of drug-proving. 
That was best done in class and not individually. He was quite 
opposed to Dr. Hayward in thinking that they should begin 
making drug-provings before they did the reading. The principles 
of drug-proving needed to be studied in much the same way as 
was done nowadays in respect of the elements of physiology. 
These, as they well knew, were quite a different thing to what 



DISCUSSION ON DBUG FATHOGENESY. 35 

was the case five-and-twenty years ago. Now the first principles 
of physiology, zoology and botany were studied conjointly as 
formiiig parts of the broad science of life, now called biology ; 
and it was in the light of this broad biological spirit that they 
ought to approach the subject of drug-proving. Having done 
that they should read the Cyclopaedia. Then if they had the 
time, and obliging friends who would kindly offer themselves as 
subjects, well and good ; but to most of them it was quite im- 
possible to attempt anything like even an exhaustive proving of 
a dozen medicines, let alone six hundred. 

Dr. Dudgeon thought they must look upon the paper as a 
counsel of perfection. He did not think any person in practice 
could carry it out to the extent that Dr. Hay ward had mentioned. 
In fact, he doubted whether he had not omitted the very impor- 
tant part necessary for practice, viz., the experience of others 
with regard to medicines. It was from the icsus in morhis to a 
great extent that they were guided to the selection of the 
medicines chosen for different diseases. It was hardly possible 
to find more than mere hints of pneumonia, rheumatic fever, or 
congestion of the liver in the pathogenesis of bryonia, but the 
cUnical experience of many practitioners had changed the hints 
there given into indications for these diseases. But life would 
not be long enough to study the materia medica in the way that 
Dr. Hayward had advised. 

Dr. Hughes said he could not quite follow Dr. Dudgeon in 
regarding Dr. Hay ward's advice as so many ** counsels of perfec- 
tion," to be admired from a respectful distance but not to be 
followed. They must, of course, have ideals higher than they 
could quite attain to, if they wished to attain to anything worthy 
at all; but it was really not so difl&cult. He could not agree 
with Dr. Ord that students in college were not to follow Dr. 
Hayward's mode of study. It was the practice of some of the 
professors in America to present the effects of the different 
drugs to their students as detached symptoms and not in the 
form of connected narratives. He thought that was very 
puzzling and very often very misleading to the student's mind. 
The student did not, as Dr. Hayward expressed it, get the genius 
and sphere of action of the drug in his mind ; he got only a 
number of detached symptoms strung on a thread, and he became 
a mere symptom discoverer. Every student should be shown 
Hahnemann's ** Materia Medica Pura " and the detailed narra- 
tives of the *' CyclopaBdia of Drug Pathogenesy," and should be 
encouraged to possess himself of those books. First-hand 



36 DISCUSSION ON DRUG PATHOQBNBSY. 

knowledge in all matters was of the utmost value. As regarded 
the schema, he would go even further than Dr. Hayward and 
Dr. Blackley. He hoped the time would very soon come when 
the schema would be abolished altogether from the materia medica 
to find its true plsice in the Eepertory. The schema of Hahne- 
mann was an attempt to combine in one the materia medica and 
the Repertory ; it was an arrangement of the materia medica in 
such a way as to make its symptoms easily found, but by putting 
the materia medica into index form the text was spoiled. We now 
had the text in its true and native form, and with a schematic 
index all would be complete. 

Dr. GoLDSBROUGH Said he was to a certain extent a living 
witness of Dr. Hay ward'§ plan having been carried out, because 
prior to the publication of the CyclopsBdia, it was really the plan 
he had adopted in studying the materia medica. If there were 
any counsels of perfection in it, we were indebted to Dr. Hughes 
for them ; they were the same as he had taught as lecturer on 
materia medica at the London School of Homoeopathy seventeen 
years ago. 

Dr. Christopher Wolston remarked that the question had 
come forcibly before his mind, as to how far the various provings 
of medicines recorded in our books of reference were reliable. 
He must state that for himself he had no confidence in the 
effects said to be produced by drugs proved in dilutions from 
the 6th to 30th. Many of the provings accredited and made by 
Hahnemann, as recorded in his ** Materia Medica Pura," were^ 
he believed, made with the 30fch dilution. Such provings for him 
were valueless. He felt persuaded that many of the patho- 
genetic effects we are called upon to study had no existence 
save in the imaginations of those that recorded them. Some 
present would doubtless remember a controversy that took place 
some years ago in one of our journals as to the reliability of the 
symptom of a hair on the tongue, said to have been produced 
by the 200fch of natrum muriaticum. If he was to study materia 
medica according to the exhaustive plan of Dr. Hayward, he 
must first be assured that he was studying the actual and un- 
doubted effects of medicines. He had found for himself, in some 
provings that he had made, that if he sat quietly down to wait 
for symptoms and watch for them, he perceived or fancied he 
experienced symptoms floating about in his system that had no 
real existence, because when he went about his work or was 
occupied with other things, these symptoms did not occur, or at 
least they did not arrest his attention, while those that did were 



DISCUSSION ON DBUG FATHOGBNBST. 37 

comparatively few but well marked and continuous. He believed 
the manufacture of symptoms was only equalled by the manipu- 
lation of symptoms, and one process was as valuable as the other. 
He believed the great want, as to our materia medica, was an 
aaihentic record of facts and real symptoms produced by drugs 
an the human system, in place of many recorded symptoms that 
were purely imaginative, and having no real existence were only 
misleading, not to speak of the valuable time lost in studying 
them. 

Dr. Pope regarded the paper as presenting an ideal method of 
studying the materia medica rather than describing a plan which 
was absolutely necessary, or, indeed, possible to everybody. It 
was not necessary, for instance, for an intelligent or practically 
useful knowledge of materia medica that every student of it should 
become a prover. He thought that it would be far better for the 
student or practitioner of the homoeopathic method of therapeu- 
tics, prior to reading the Cyclopsedia, to read the articles in Dr. 
Hughes's *' Pharmacodynamics," or in Farrington's ** Clinical 
Materia Medica," and then to go to the Cyclopaedia. He would 
by 80 doing be able to study the Cyclopaedia with some idea of 
the sphere of action of the drug that the facts it contained led up 
to. And the clinical indications which he had gleaned from 
Hughes and Farrington would become more surely fixed in his 
mind. He had often heard it said medicines should be studied 
alphabetically, but that had always appeared to him to be too 
mechanical and artificial to be satisfactory. Some years ago, 
when lecturing on materia medica, he had endeavoured to divide 
the drugs into classes, taking together such drugs . as were con- 
spicuous in their action upon the nervous system in one group, 
such drugs as were conspicuous by their action on the gastric 
system in another, and so on ; and having gone through one set, 
before commencing to discourse upon another, to carefully com- 
pare the drugs which had been already gone through, pointing 
out their differentiae. For instance, taking the narcotic drugs, 
belladonna, hyoscyamus, stramonium, opium, &c., before pro- 
ceeding to the next set he compared the action of each drug, one 
with another; for example, taking head symptoms, the head- 
aches that were produced by each and the forms of delirium pro- 
duced by each, and so on. He had found that plan to be a 
most useful one to himself. A lecture of this kind was published 
in the Homcdopathic Beview for 1881. Dr. Dudgeon had referred 
to the ustis in morbis as a ground work of drug selection, and had 
said that from the study of bryonia they would never get a case 



38 DISCUSSION ON DBUG PATHOQBNEST. 

of pneumonia or rheumatism. If he (Dr. Pope) remembered 
rightly, in the Austrian provings of bryonia they had a most 
distinct case of pneumonia, and an equally striking illustration 
of its action in producing rheumatism. With regard to the 
scliema, however valuable the Cyclopaedia might be, and however 
useful the essays on individual drugs might be, when they came 
to practice and to decide between the relative advantages of three 
or four drugs, in order to do so rapidly they wanted both the 
Bepertory and the schema. These latter were the complement of 
the former. Without the CyclopsBdia and the essay they could 
not so efficiently use the schema and the Bepertory, while these 
again were the reference books to the former. 

Dr. Hayward, in reply, thanked the members for the manner 
in which they had received and discussed the paper. He felt he 
had little to reply to, for Dr. Hughes's remarks had met most 
of the criticisms. He agreed with Dr. Hughes that the Cyclo- 
psadia was not uninteresting reading. Dr. Hughes had read it 
through twice, he had himself read it all through once, and some 
parts several times. He was sure Dr. Blackley would be in- 
terested in reading the papers of Drs. Guernsey and Wesselhoeft. 
He agreed with Dr. Pope that for study the medicines should be 
taken up in classes, and, notwithstanding Dr. Ord's remarks, he 
contended that these should be of analogous drugs. The symp- 
toms of analogous drugs were an aid to memory whieh those of 
dissimilarly acting drugs were not. 

Discussion at the Liverpool Branch, 

Dr. Blaoklet, senr., eigreed with the method proposed by Dr. 
Hayward. He referred to a plan which he had recommended in 
the London Homoeopathic Hospital Reports of using the Gyclo- 
pasdia by making colours express the different symptoms. His 
idea was that you should get a thorough knowledge of a drug 
in the same manner as you would of an individual ; as you would 
notice the gait, features and characteristics of an individual, so 
by continued observation and familiarity you would get to know 
a drug. He thought you should constantly read over the Cyclo- 
paddia, and that you should group the drugs and compare them 
as Dr. Hayward suggested, and it was much easier to remember 
drugs in this way than alone. 

Dr. Hawkbs would like to suggest that just as composite 
photographs could be taken, so by putting the provings together 
wo might, so to speak, make a composite photograph of a drug in 
schema form. Busy practitioners could not be expected to do 



X>X80TJSS10K ON DBUG PATHOGBNEST. 39 

this for all tlie d.iru.gs in the Cyclopaedia, but a very little time a 
day would. sixfGice to do one or two. He had seen Dr. Blackley's 
arrangement y 'bixt it seemed to him rather complicated. 

Dx. rrs.o^s:AS a*greed with Dr. Hayward^s method of learning 
the Cyclopaedia., but for a beginner Hughes's "Pharmaco- 
dynamics*' 'would, be a better introduction. 

Dr. Jo:nss believed in making notes as you read and using 
them ^wbeu possible. The Gyclopssdia was rather puzzling and 
like a big dictionary, and the only way in actual practice was to 
use the ** Cyplier Eepertory." He mentioned a case in point. 
In tbe matter of learning the materia medica, the old school had 
tbe advantage of us. 

Dr. 'Wii-iaiAMS said he had been pleased with Dr. Hay ward's 
paper because, so far as he knew, it was the first attempt that 
bad been made to adopt a fixed plan of learning the materia 
medica from the Cyclopsedia. We observe first the nature, next 
the duration, and lastly the varying character according to the 
particular case. 

Dr. Mahony agreed especially with self-proving of drugs ; 
by doing so on himself he had become more familiar with their 
action. As regards kinds of symptoms that are most useful in 
treatment ; vre do not want the toxicological effects but the finer 
symptoms. There are four things we want for practical purposes : 
(1) locality ; (2) symptom ; (3) conditions ; (4) concomitants. 
Ge had a different mark for each of these in his GyclopsBdia, and 
thus by looking down the page you could see at a glance the 
symptom you wanted. This was a similar method to that 
employed by Dr. Blackley. 

Dr. Chas. Hayward thought the most useful hint in the 
paper was that you should group medicines into families, accord- 
ing to their action. What is wanted to make the Gyclopsedia a 
more useful book for practice, is an index. He did not agree 
with Dr. Mahony, that it was not the toxicological symptoms 
which are wanted, as he regarded these as of great importance 
in determining the use of a drug. He did not agree with pre- 
scribing on key-note symptoms, and neglecting the pathology. 
He thought the Cyclopsedia offered a better means of study 
than the schema form. 

Dr. GoBDON Smith said he considered an intimate knowledge 
of materia medica most important to the homoeopathic physician. 
He did not think you could prescribe one method of learning the 
materia medica that would suit everybody. While studying the 
vujtieria medica one could not help comparing the drugs together. 



40 DISCUSSIOH OH DBUG PATHOGENEBY. 

He advised repeated study of the CyclopsBdia, noting down the 
important symptoms. He always preferred to prescribe on a 
pathological basis, but quoted Carroll Dunham, who said in con- 
tradiction to this that you must get the symptoms that are 
peculiar to a drug. 

Dr. ElijIS agreed with Dr. Ghas. Hayward in his remarks 
about prescribing. He objected to cases being reported with 
only the peculiar symptoms mentioned. He believed in making 
notes of the essential or useful parts of the Gyclopssdia, and 
boiling them down as one does at college. You should compare 
the symptoms usually attributed to a drug with those in the 
GyclopsBdia, and if they are not recorded put a line through 
them. 

Dr. Meek said his difficulty in studying the provings was that 
different wording was used for the same symptom by different 
persons. 

Dr. Simpson, while expressing his appreciation of the paper, 
said that some of our confr^reSf as Kent and Skinner, had given us 
some hints and characteristics which were very useful, as kali 
carb. for slow getting up after confinement, bromine for laryngeal 
diphtheria, &c. With the Gyclopaedia and the digest in Eaue, he 
could manage very well. 

Dr. E. Gappeb said the subject was interesting and useful to 
all. The Gyclopsedia must be studied as a stern necessity. He 
agreed with grouping the drugs according to the sphere of action ; 
an index on this plan would be very useful. If everyone knew 
Hughes well the Gyclopsedia would be better understood, because 
the former gives a fair idea of the scope of most drugs. Dr. 
Blackley's plan was valuable to the individual who made it. 

Dr. Haywabd, in his reply, said the materia medica should be 
BO studied that the practitioner may meet his work with the same 
kind of knowledge of the drugs he has to use as of the disease he 
has to treat. 

NOTES. 

Note A, page 6. — As to '* analogous drugs," it must be borne in mind that 
though this analogy may in some instances extend to the symptoms generally, 
as in the case of fever and tissue irritant symptoms, it is mostly topical, like 
that between hyoscyatnus and stramonium on the brain, that between bella- 
donna and Phytolacca on the throat, that between tartarus emeticus and 
phosphorus on the lungs, and so on ; also that the topical action of one drug 
may resemble that of another on more than one part or organ, as, for 
instance, that of tartarus emeticus on both lungs and stomach somewhat 
resembles that of phosphorus^ and that of mercurius corrosivus on both 
stomach and rectum somewhat resembles that of arsenicum on these parts. 



DISCUSSION ON DBUO PATHOGENESY. 41 

Note B, page 1.— Teste : see Teste's ** Materia Medioa ; " Hebino : see 
British Journal of Homoeopathy, ii., 264 ; Hale : see Hale's ** New Bemedies ; " 
GsLSTON : see British Journal of Homosopathy, xvii., 681 ; Buet : see Burt's 
"Materia Medica ; " FABBiNaTON : see Farrington's " Materia Medioa." 

Note c, page 8. — See Dunham's ** HomoBopathy the Science of Therapeu- 
tics," page 40. 

Note D, pages 1 and 8. — List of Essays. As early as 1837 — six years 
before Hahnemann's death — that materia medica veteran, Dr. Gonstantinb 
HsBiNa, one of Hahneicakn's immediate followers and personal friends, then 
living in Philadelphia, in the introduction to his German essay on '' Serpent 
Venoms," enters very fully into directions as to how the materia medica should 
be learnt. A translation of this essay was given in the British Journal of 
Homceopathy, vol ii., p. 250. 

In 1852 Dr. Meyeb, another of Hahnemann's immediate disciples, took 
up the same subject in a very learned paper in the Hom^jeop, Vierteljahrschrift, 
i., 259. A translation of this essay was given in the North American Journal 
of Homoeopathy, ii., 438. 

In 1862 Dr. Gabboll Dunham, of New York, a real master in materia 
medica, published a very exhaustive paper on the subject in the Am>eriean 
Eomoeopathic Betnew, This was afterwards reprinted as the opening chapter 
in his " Homodopathy the Science of Therapeutics," see p. 30. 

In 1864 Dr. Pope read before the Northern Homceopathic Medical Asso- 
ciation a very elaborate paper on this subject. This was published in the 
Monthly Homoeopathic Beview, viii., 674. 

In 1870^Dr. H. B. Madden read a very masterly paper on the subject 
before the Homoeopathic Congress at Birmingham. This was published in 
the Monthly Homoeopathic Beview, xiv., 665. 

In 1879 our English master in m^iteria medica, Dr. Huqhes, at that time 
lecturer on materia medica at the London School of Homoaopathy, made this 
same subject the purpose of his introductory lecture. This^was published in 
the Monthly Hom^oeopathic Beview, xxiii., 841. 

In 1881, Dr. Pope, then senior editor of the Beview and lecturer on 
materia medica at the London School of Homoeopathy, returned to the 
subject in a veiy practical lecture, which was published in the Monthly 
Homceopathic Beview, xxv., 204. 

In 1887, Dr. G. Wesselhoeft, professor of Pathology and Therapeutics in 
the University of Boston, addressed himself to the same question in a most 
thorough manner. This dissertation was published in the New England 
Medical Gazette, xxii., 152, 209, 263. 

In 1893, Dr. G. H. Blacklet took up the subject in the December issue 
of the London Homceopathic Hospital Beports, iii., 1. 

In 1894, Dr. Joseph G. Guebnsey, of Philadelphia, took up the subject 
in a very masterly manner in a paper in the Hahnemannian Monthly, xxix., 
235. 

Ibid., Dr. Seibebt, Easton, U.S.A., attacks the same subject in the same 
journal, p. 321. 



42 ON ACUTE HEPATITIS. 

Ibid.f Dr. Hughes returns to the subject in a paper read before the 
American Institute of Homoeopathy.* This also was published in the 
Hahnemannian Monthly, xxix., 412. 

Ibid.f The American Institute of Homoeopathy took the subject up for its 
1894 meeting : its materia'medica section collected the opinions of 31 of the 
members of the Institute. These were published separately, illustrated with 
portraits of 31 of the writers, under the editorship of Dr. Fbane Kraft, 
chairman of the section. 



ON ACUTE HEPATITIS.^ 

BY D. DYCE BROWN, M.A., M.D. 
Consulting Physician to the London Homoeopathic Hospital. 

I OWE you a word of explanation for bringing before you 
some remarks on such a comparatively rare disease as acute 
hepatitis — at least rare in this country. But the fact is, 
that this paper is one part of what was intended to be a 
series of short papers on ** Liver Disease." The different 
sections were mapped out by Dr. Goldsbrough, the Secre- 
tary of the Section, and arranged at a meeting of the 
Committee of the Section in July; and I had no idea, till I 
saw the business card of to-night*s meeting, that this plan 
was not to be carried out. On inquiry. Dr. Goldsbrough tells 
me that from twenty-five of our colleagues, who were asked 
to contribute, no reply had been received, while others who 
did reply made excuses and failed to help, with the excep- 
tion of Dr. C. Wolston, who gives us a paper on ** WeiFs 
Disease,*' though whether this is a specially liver disease 
will be elucidated in his paper and in the discussion. I was 
told to keep strictly to the limits of my instructions, namely, 
to treat of acute hepatitis only. My paper was thus prepared, 
and that it takes up such a limited range is, you will see, not 
my fault. You will, therefore, kindly look upon it as only 
the opening paper of a series on liver disease in general — a 
head with no tail. 

' Under the Title of *< The Best Method of Studying and Teaching Materia 
Medica." 

^ Bead before the Society, November 1, 1894. 



ON ACUTE HEPATITI8. 43 

Acute hepatitis, though a frequent and fatal disease in 
warm climates, often going on to abscess, is comparatively 
rarely seen in this cpuntry, since tropical heat, which we do 
not have, seems to be one of the chief exciting causes of it. 
We must first exclude from discussion what is known as 
congestion of the liver, which is of passive character, and 
the result of venous engorgement of the organ, produced 
by various causes. Acute hepatitis is an active inflamma- 
tion of the substance of the organ, the capillaries of the 
hepatic artery being supposed to be primarily involved. 
The disease is sometimes divided into : (1) peri-hepatitis, in 
which the investing membrane of the Uver and the super- 
ficial part of the organ are involved ; and (2) hepatitis, in 
which the whole substance of the liver is inflamed. But 
this distinction is not a real one, only one of degree and 
situation. 

The cause of hepatitis, as seen in this country, is either 
a chill from exposure, or some poison, such as influenza, 
analogous to the malaria of tropical climates, which is, with 
heat, a frequent exciting cause. Of the three cases I shall 
speak of, which occurred within the last two years, one was 
certainly traceable to influenza, the second was suspected to 
be so, though not certainly, while the third may have been 
so also. At a post-mortem examination, the liver is softened, 
loaded with blood, and sometimes having a granular appear- 
ance. It sometimes is infiltrated with serum, or lymph ; Eind 
when the disease goes on to abscess, pus is found in larger 
or smaller quantities. If there is peri-hepatitis the liver may 
become adherent to the diaphragm or to neighbouring 
tissues. The disease terminates (1) in resolution, (2) in 
abscess, and (3) occasionally in a chronically enlarged state, 
this latter being more frequent in hot climates. The sjrmp- 
toms are well marked, and I need hardly take up your 
time with them in detail. There is usually a shiver to 
commence with, followed by rapid pulse and high tempera- 
ture, headache, loss of appetite, vomiting, coated tongue, 
thirst, and dryness of the mouth. Constipation or diarrhoea 
may be, either of them, present. There is more or less 
acute pain. When peri-hepatitis is present, there is sharp 



cxtuing pain gcdng tliioiigfa to the back, and in taking a 
ceej^ breath ; while if the substance of the li¥er is the seat 
<jt the mischief, the pain may be more of a dull, heavy, 
pressiTe weaght, preventing the patient lying on the left 
side. The liv^: is yery tender to tonch, and yeiy soon 
eialairges to a marked degree; there may also be a dry, 
harking coufjti. If the inflammation goes on to abscess, we 
have renewed shiveriugs, fever of the hectic type, and 
general prostration* There is often httle or no janndice. 
The stools are pale, and the urine loaded vnth lithates. 
As to the diffisrential diagnosis, there can be little difficulty. 
The fever, pain and tenderness of the hver exclude mere 
engorgement of a passive type. There may be a mistake 
made between it and pleurisy or pnemnonia, bat the stetho- 
scopic signs ought soon to remove any doubt. The sharp, 
severe pain might suggest gall-stone, especially at first, but 
this, again, is negatived by the fever and the local tender- 
ness, while a day or two will remove any possible doubt on 
this score. 

The prognosis in this country is generally favourable, 
while in hot climates it is otherwise. It usually, in this 
country, ends in resolution, though occasionally abscess 
occurs. 

Treatment. — The ^ medicines which wiU be required, 
according to circumstances, are aconite, baptisia, bella- 
donna, bryonia, mercurius, hepar sulph., and after a time, 
lycopodium, nux vomica and nitric acid. If abscess occurs, 
phosphorus, silica and calcarea, and hepar. 

(1) Aconite. — This is the medicine, |)ar excellence, that we 
should give at the very commencement of the attack, and it 
should be persevered with for twenty-four or forty-eight 
hours, given frequently, either alone every hour, or alternated 
with one of the other medicines I have named. Besides its 
infinite value in acute sthenic fever, and in the early stage 
of acute inflammations of all organs — on which I need not 
dilate before a homceopathic society — we find in the provings 
interesting symptoms referable to the liver which justify our 
selection of it. Thus : '' pressive pain, as from weight, in 
the hypochondria;*' "feeling of violent constriction in the 






O:^^ AOUTB HEPATITIS. 45 

hypochondriai ; *' ** sexiBation of anxiety there ; " " stitches 
in the liver a.ncL "bo^wels as with needles ; " " continued con- 
striction, espeoicblly in the right hypochondrium, hindering a 
deep breatli ; " * * siiitcTies in the hepatic region, hindering a 
deep breatb. ; " * * ^pressure in the hepatic region, obstructing 
respiratiom , folio v^od by pinching belly-ache above the navel ; " 
"violent jerks iri tile bepatic region, taking away the breath ; '* 
" constrictive ;pa.iix in the region of the gall-bladder, prevent- 
ing respir action , on sitting." I would advise the Ix dilution, 
one or tv/o dro"ps. 

(2) 'Bcuptisitx,. This naturally comes in for notice after 

aconite. Tlie fever of baptisia is not that of aconite, but 
more approa.clies, as you are aware, the typhoid type — alto- 
gether leas stlienic. Still, it not unfrequently happens in 
practice tbat, ^wben aconite has seemed to be indicated, and 
it iaila to produce the expected result, a change to baptisia has 
9i magical effect in bringing down the fever, and checking 
turtber miscbief . So, if I found aconite after twenty-four 
or forty-eigbt hours, at the outside, fail, I should give 
baptisia ior tT?venty-four hours alone, or rather in alternation 
ivitb another remedy more local in action. But it is 
interesting to notice in the provings, as with aconite, certain 
marked local symptoms referable to the liver. Thus : " pains 
in liver ; " *' dull pain in right hypochondrium ; " " the pain 
extends from the right lateral ligament to the gall-bladder ; 
it is almost impossible to walk, it makes the pain so severe 
in tbe region of the gall-bladder ; " '* suffered constantly and 
severely all day with pain in the liver and stomach ; " ** dull 
pain in liver ; " " soreness in the region of the liver ; " " con- 
staxit dull pain in the region of the gall-bladder, very severe 
on walking." I generally use the Ix dilution in doses of 
three drops. 

Having selected first what I may call our anti-febrile 
medicine, the question next comes to us, shall we select 
(3) bryonia or (4) mercurius, as these are the two medicines 
tbat stand in the fore-front, and the choice lies between them. 
It v^rould be quite out of place to go over, in this Society, the 
liver-provings of bryonia; its action on the liver and its 
investing membrane is a household word in homoeopathy. 



46 

All I need do, in aiding our choice of it, is to keep in Tiew 
the characteiistic shaurp cottinc^ pain in the region of the 
liyer, going through to the back, which it produces, along 
with the tenderness on pressure, and the general uneasiness 
felt in the firer ; also if there were present the troublesome 
dry cough which ofken accompanies hepatitis, so much the 
more would it be indicated. It would therefore be chosen 
in preference to mercurius, if such pains were prominently 
present, from the existence of peri-hepatitis. After the first 
few hours, then, of aconite alone, I should, in such a case, 
give bryonia Ix, 2 or 3 drops, in alternation with aconite. 
Then for mercurius, the other leading medicine, the choice 
would be determined by the comparative absence of acute 
cutting pain, while instead, there was present a heavy dull 
aching uneasiness, a decided fulness, found on palpation, with 
tenderness on pressure, indicating involvement of the whole 
liver substance, thickly coated yellow tongue, bad taste, 
offensive breath, and vomiting of food or bile, with diarrhoea. 
That mercurius has a specific action on the liver is one of 
the few points on which there is universal agreement in both 
schools of medicine, and it has for generations and up till to- 
day firmly held its place as a remedy of superlative value in 
inflammation of the Uver, as well as in the milder conges- 
tions and chronic diseases of this organ. Some years ago a 
Committee of investigation was conducted by Dr. Hughes 
Bennett, of Edinburgh, and subsequently by Dr. Eutherford, 
also of Edinburgh, on the action of mercurius on the liver. 
These experiments were said to show that the old beliefs as 
to the cholagogue action of mercurius were erroneous, as the 
bile was found to be diminished, instead of increased. This, 
however, showed an action of some definite kind on the liver. 
But on analysing these experiments carefully, one sees that 
at the first, with one or two, or small, doses, the bile was in- 
creased, while it was only after large purgative doses were 
given that the bile was diminished in quantity. Along with 
this diminution the liver was found engorged and the duode- 
num inflamed. This only shows how correct is the law of 
Himilars, that small doses cause the stimulation of the organ, 
while large and repeated doses set up congestion and inflam- 



ON ACUTE HEPATITIS. 47 

mation, and so diminish to marked degree the excretion or 
secretion of the bile. Again, in cases of poisoning by mer- 
enrius, the liver has been fomid inflamed and engorged. 
There can be no doubt, then, that mercmius is thoroughly 
homoeopathic to congestion and inflammation of the liver. 
It accordingly ranks with bryonia as our chief medicine in 
acute hepatitis. Having selected it, then, in preference to 
bryonia, I would give tangible doses, as 4-5 grs. of the 3rd 
decimal trituration of mercurius sol. or dulcis, or even one 
or two grains of the 2x trituration. 

After the time for aconite or baptisia is over, and if the 
case is not yielding to them, it is, I think, good practice, 
though not perhaps theoretically correct, to give bryonia 
and mercurius in alternation, more especially if the general, 
symptoms leave one a little in doubt as to which of the two 
is most indicated. 

(5) I mentioned belladonna among our remedies. The 
indications for it are not that belladonna has a specific action 
on the liver, but from our knowledge of its value in all acute 
inflammations, when there is fulness of pulse, flushed face, 
dry skin, and marked restlessness at night, or even by day. 
It is of great value as an intercurrent or alternative remedy 
when these symptoms are present. I would prescribe it in 
the 1st decimal dilution. Next in importance is (6) hepar 
sulpli., and this I consider a remedy pf first-class position, 
after mercurius and bryonia have done their work, and when 
the patient is over the acute stage, or again, when the 
mercurius and bryonia have failed to check the progress of 
the inflammation. 

Hepar is not so much thought of as a liver remedy as it 
should be, while those who know it as such look on it as 
more useful in chronic affections of the organ. In the 
provings we find marked uneasiness, sense of pressure, and 
sharp stitching pains in the liver, as indicating its action 
on that organ. But besides this, we have to remember the 
remarkable power which homoeopaths have always known it 
to have of checking inflammation that seems to be going on 
to suppuration, while on the other hand, if suppuration has 
once set in, of promoting the maturation of the abscess. 



4.^ ^iw M^vn smBvrsTm. 

^ ' ..- I . . . '-^U <i«,HlW<;' p/V^iir which ITATinprfiar^^ 

i-ul , r -i ..\x^4. 11^ ium iM.'knowIedged by the aIL:casie&. snee 
^i ",j • r (.>>.t >V4i4< |>ubliHhed. And h^« wyr--^ iiz be hs 
' tj lii 4r u(«^ luipatitiN. When the case goes ca iii::mToaz> 
u |> uui \kt\ A)«^ nfmid of abscess, hepar comes in. and 
' '... ^....' !» A» i« mA^ioally in stopping fnrth^ inflammaiory 
< i; ;. h^\k \w\\\u\\\^ aKhiIi a resolution. One of my cases 
'r'..i ,!.;.!»* ii!»»Mr<iK>* 5*r«* powiwr. It would be still farther 
''••i/« .» . «i. ,. \ )^'( K»*k«.'»s wt*ctj ^wcy coetTTe, t^idency to piles 
t'^ >•,) i'^^li ('thj wKMMtuutil (ii»4iecDS£0£i. I give it in the 

I 'K v..., i.^HviU ' *iuMitiimtid« tycopooium, I perhi^ 

\ './ ' »^'*' '»'U,iva;» >iiK'id I :uix apeakioa: ooJy of acute 
ii j.. . ..^ ». '. v>. u X .\ uuc :uti worsit is^ o^er, when acate 

. ... I,. . u* ♦ .'^>v,^iv\i, uuL \>t* wish to testoiw the liver to 
II .' I. ^i . KK-»,huick r*it; special mfieadons for it 

I., . N^. i ix»t.'\N 'I ..uu I rict:»i rioc lie uiore duHi aomply name 

i), .,, m' f ^r.iiv:';. t^i rat' Liver, AoiominaL <diistension, 

!m , ',. |m\- .^^^>i. liic' uL-iiit3 loaded -^visa 'ichates, a white- 

,,! I |..n Ml.' l-l^l 110 Aj;p«3CitJe. 

\m, s^'iiiiv^i :iiid mriic acid I only n^Mne, as bi^ig, Kke 
1^. .J. . Immh. u'MK\lios rlia; couit; in after ail :ttnu(ie' »rition has 
.ill rti I, LM I i''K' uiiu is to restore the we^kenaji. eegorged 
., ,,» I . \\ ilih. They are of i^reat value here, bcitt I need 
H ,1 >v I 1,' NvHU' time by ^ving their indicadeoSw K. again, 
,1,... , ,lw liu's itself, the remedies to be used aie those 
1 1,., I .u. .i» wvll kuowu to have power over the sapcsarative 
J. 1, \i/. . lu i>ar, phosphorus, silica and calcareaL 

•|'li. dirt should, I need hardly say, in the acute stage be 
.1 Ml . li:.;litr^t, luilk being par excellence the fixd. As to 
I,, , II. il .ijiphiatiuna, there is no doubt of their great assist- 
.,,.. |\iiiltiiu<.s and hot fomentations in the acute stage, 
,, I ,ili.< iwdnU tepid compresses till recovery results. K 
, I , . I ....,,. I y iM slow, and the Uver diminishes in size slowly, 
, , ..iii|.i> >.» ul uitiio or acetic acid is often beneficial. * 

nli'iitM tlio case go on to abscess, the pus may evacuate 

II Hi. I.I.I iuilly, or into the bowel, or into the lung, all of 

lii>.li iiHiiliii ui'o considered, on the whole, favourable to 

,.,.!, v\ lull) if it evacuates into the peritoneal cavity, the 




ON ACUTE HEPATITIS. » 49 

result is fatal. As to operative proceedings, the consensus 
of opinion is that opening the abscess is not desirable, if 
it can be avoided, the mortality after it being great. If it 
has to be done, it is best done with the aspirator. 

I shall now give three cases that have occurred within 
the last two years : — 

Case J. is the most acute case I have ever seen. Mr. 
A. B., aged 55, came to me in May, 1893, with symptoms 
of influenza, though slight. I ordered him to bed, which 
he thougbt hardly necessary. He was well in a week, and 
came to me to report himself as quite well on the 28th. His 
usual health was excellent, and he was a rather abstemious 
man. On May 31 he went out to dinner, walked home, and 
went to bed feeling quite well. He slept well through the 
nighty and got up as usual next morning to take his bath. 
Suddenly an exceedingly severe pain came on in the region 
of the Uver, making him feel faint, and he went back at 
once to bed. He sent for me, and I saw him very soon. 
The pain was very acute in the hepatic region ; there was no 
enlargement and no tenderness, and his temperature was 
sub-normal. I put it down as a case of gall-stone, but 
when I saw him in the afternoon, though the pain was 
lessened, the temperature had risen to 101**. In the 
evening it was over 102**, and there was decided tender- 
ness over the liver region. I prescribed aconite Ix every 
hoar, and hot fomentations. Next day, after having slept 
badly, his temperature was as high ; the pain was bad, 
though much mitigated from what it was the day before. 
The liver was distinctly enlarged, and very tender. I then 
gave him bryonia Ix alternately with the aconite. On the 
next day, June 3, there was no improvement. He felt 
sick, but there was no vomiting. The liver was markedly 
larger, and tender ; the bowels had acted, and the urine was 
simply high-coloured. From this time till June 15 there 
was no improvement, save that the pain became slight, 
except on movement of any kind in bed, and he could 
not lie on his left side. The liver had now enlarged to 
below the level of the umbilicus, extending to the splenic 
z^on, and was very hard and tender. Aconite faiUng, 

VOL. ni. — NO. 1. 4 



U\ Oir ACUTB HEPATITIS. 

\ hfi/t ^iv^ri baptiiiiAy belladonna, bryonia and mercurins 
K/il ;u, ^fr 0. On that day Dr. Kidd saw him with 
lAft \u ci>niiultation. The temperature then was about 
If)!' in ^^^^^ morning, rising to 102^** in the evening. Dr. 
Kid/i KmI nothing fresh to suggest, but to go on with 
hryontA und rnorcurius. He saw him with me again on 
W\^ 17th, whon matters were in ^tatu, gtco. The bowels 
Mit^sd With onoum; pale in colour. The hardness of the liver 
W4M m groat that I feared there was something malignant 
f$t this bottom of the oase» while Dr. Eidd was afraid rather 
of ahH(M)MM. There was profuse perspiration at night, and 
h^t UniU for Home days. Ou the ISth I left oflf the mer- 
iJUtiiii* and bryonia, aiid g*ve bepar sulph. 3x, 5 grs. every 
two hi>urM, and WlUdonna at night, which latter he had been 
haNin^ for Hon^e day$. There w^as at this time no jaundice, 
an^l tho uvino w*$ hi^h-vvlv^ured only. The effect was 
.>htu^Ht UhH,4;iv*al, The i:ext d^i> ifrer beginning the hepar 
I ho ti'UijH vhUux" oanu^ 3,^4"::: *.* ?V^ ia the morning, and at 
mxr.i \M\*v^\ \\v<o to lA^-^^ K,* '^^its. eai^er in all ways, no 
pH«M o\vsnM xv^, r.v^x -v .> i^!vi ^^a x^'itciifja^ the liver. Dr. 
K\* ' VHA ' " >r ^ w * :"..•: .::ue ^>tr ::2ie 20th. The state 
• »- Yivv »^«^ vv v^. ^s.Nv'*. V*. tr:v? :cmperacure was normal 
., .1 *.v . .. , ^v. .. \ .>5^ „c Mi-hc to 99-i'. Dr. Eidd 

V • N .V • ^:^r:s5< ^^5W> :>teadv and uninter- 
\ s— V o*» ^...^ 't:.:>a Luiii to sleep soundly, 

lis liver became gradu- 

V AcKs sov>u able to lie on his 

•<. t \ iv diminished and then 

: * Avui-s:iuur» and then for 

v ^-uuuejs* in. the Kver 

V «. £ 'uivt come down to 

** tv »05>, and hardly at 



'V .«. 



■ V \ ». 



• «* 



lipiuiued of nothing, 



When hv- /.Lurn »" ^~'^'' ^ -^^-vv'-n -v.^tvi u|^ ijti every way. 

''^und t,ijo ejni^, . '^'^^^m ;u«r. u .vitxv. u ^ ^ yort himself, and 

^reatriien^, . .»"^'*'^^**au u -k> 'i^tii v<viu(j»Ieiiely gone. In 

^^^ vuiarLiiL'ji vlw^ 'ic^^twr awtid belladonna 



I 



^^^•^ V. '^-^ » ** .♦ iikPiiiined of nothincr. 



». .! \> ;;^ \;;^ is v^. V .. u I uly ^^ to Lland- j 



ON ACUTE HEPATITIS. 51 

for some time, I left off the latter and substitated nux, 
and finally gave him nitric acid Ix, 3 drops, for about ten 
days before he left London. I stated that during the worst 
time there was no jaundice. As he began to get better a 
distinct yellow tinge appeared on the conjunctiva and the 
skin, but only slightly, and it soon disappeared. I have little 
doubt that the influenza was the real cause of the hepatitis. 
Case H. — This patient was myself. In November, 1892, 
I began to feel sharp boring pain at the pit of the stomach. 
I made little of it, and thought it would pass off, as I was 
eating and sleeping well. In two or three days, however, it 
became worse, and nearly constant, keeping me from sleep 
at night, though always relieved by eating, which I did with 
a certain relish. One afternoon, the pain after lunch came 
on so severely, chiefly felt at the epigastrium, that after 
going out in the carriage I came home, drank hot water, 
and went out again, though not relieved. Just after leaving 
a patient's house I became violently sick, and vomited the 
hot water I had previously drunk. I then went home and 
went to bed, and had a hot fomentation. That night the 
pain w^as so sharp, constant, and boring that I could not 
sleep or lie in any easy position. Next morning, feeling a 
little easier, I ate a good breakfast, which I felt better for, 
and as there was a consultation at the hospital that day, I 
went to it. There Dr. Byres Moir remarked that I was 
looking ill, and on telling him what I had been feeling, he 
made me lie down on the sofa, found my liver extremely 
tender, and enlarged to about two inches below the ribs, and 
my temperature 101°. So little can doctors manage them- 
selves, that I had not even felt my liver or taken my 
temperature. Of course, I was ordered to bed, had hot 
fomentations and aconite. The temperature soon came 
down in the morning, but rose after mid-day for three days 
to about 101"*, the liver enlarging still more to about three 
inches below the ribs. I lost the acute pain after two days, 
had only tenderness on pressure, but could not lie on my 
left side, or even easily on my back for the sense of dragging 
weight. Mr. Knox Shaw also kindly came to see me with 
Dr. Byres Moir. After aconite had been stopped I took 



62 ON ACUTE HBPATITIS. 

bryonia and mercurias. Then, as the symptoms became 
most pecaliar, as I shall presently state, china was given; 
and finally nitric acid. After a week in bed I was allowed 
to get up, the temperature then being normal at night, and 
the liver having gone very much down in size, being 
felt only about an inch below the ribs, with no pain, but 
only uneasinoBS on pressure. At the end of another week 
the liver was normal in size, and I was quite well and able 
for active work. The symptoms during the week I was in 
bed and for tlio next week were so peculiar that I was at a 
loss to account for them, as were also Dr. Moir and Mr. 
Shaw. I liad an excellent appetite — in fact a craving for 
food ; if I wnnt beyond two hours I felt the craving posi- 
tively painful, and a severe occipito-frontal headache came 
on, which was at once removed by food or tea. I enjoyed 
iny pipo all through, and had not a trace of jaundice. The 
bowels at^ttul naturally, the stools being pale in colour, 
while the urino all through was profuse and clear, with not 
a trace of lithatoa — not being even of high colour. On falUng 
asleep about U pan., after having had food, I would wake 
about 1 a.m, soaked in perspiration, passing a profuse 
quantity of urine, and with a splitting occipito-frontal head- 
aolia, Milk and biscuit relieved this and I slept again, to 
wake in the stune state, while as soon as I could get the 
maids to give me breakfast I ate heartily, and my headache 
vanished. The temperature fell in the morning to 96°, but 
rose each day soon after mid-day till it finally ceased to rise. 
The perspirations, the profuse urination, the headache 
always relieved by food and tea, and the craving appetite, 
continued till I was quite well. It was only on talking it 
over some time ago with Dr. Blackley, that he suggested 
that there must have been influenza as the cause, as the 
only way that these pecuhar neurotic symptoms, along with 
the hepatitis, could be accounted for. And I am inclined to 
think he was right. 

Caae III. — Miss X., aged 75. For a week before the 

acute attack came on she was out of sorts, though not 

feverish, and nothing indicating influenza. On the morn- 

of June 30, 1894, I was telegraphed for, and when I 



ON ACUTE HEPATITIS. 53 

came I found Miss X. complaining of acute pain below the 
right ribs. She had been vomiting ; there was no tender- 
ness but frequent desire for micturition and pain in passing 
urine, with uneasiness all along the line of the ureter. I 
put it down as a case of renal calculus and treated her 
accordingly. In the evening she was easier of the acute 
pain, but the temperature had risen to over lOl**. Next day 
the renal symptoms were much less, and she had passed 
some gravel, but the pain, more distinctly in the hepatic 
region, was still bad ; sickness occasionally ; some tender- 
ness and fulness over the liver, the temperature still high. 
I gave aconite and bryonia. This case was very unsatis- 
&ctory in improvement, resembling Case I. The tempera- 
ture kept up and rose to over 102** at night, the liver 
enlarged, the tenderness very marked, and the pain more 
or less severe, of a sharp cutting character, at times varied 
by a dull ache. Aconite, bryonia, belladonna, baptisia and 
mercurius had at least a slow effect, as for fully a fortnight 
the symptoms remained much the same, high temperature, 
enlargement of liver increasing till it was fully three inches 
below the ribs. It had become very hard, especially in 
centre part. After the third week improvement showed 
itself in the falling of the temperature to 99** in morning 
and going up to 100° at night, with general amelioration of 
symptoms, the liver, however, remaining large and hard. 
But now jaundice showed itself, the eyes and skin becoming 
very yellow, the stools were white and the lirine of the 
olive-green colour characteristic of jaundice. There was 
great dislike of food, troublesome nausea, perspirations at 
night and even during the day on falling asleep, with 
marked emaciation. Looking at the patient's age, the 
protracted state of the case, the hectic symptoms, the 
nausea, &c., and the loss of flesh, a very red dry tongue, 
with aphthse on it, and the hardness of the centre part of 
the enlarged liver, I felt sure I had malignant disease to 
deal with. I put her then on hepar and hydrastis Ix. By 
the beginning of August the temperature had fallen to 
normal in the morning and rising again at night to 100°. 
The other symptoms in statu quo, 1 felt confirmed in my 



li\ Av»,^v..^: J*s r.vA.ii Vk«»«r i:tti» cua!J2t:. excerr ^ar ioa: ipiie 
i.iAt,x. j.«'.,ii vvu>vi-j . «&i^c tutr uaua»ea. w&a TTinn: iesg. tea: tfaee 
j.v.4j.tiA,i iA ...' ^. v^z-J. ts-*- i:^er wab Kill harj. iboop- lomud 
li.c i< i*iiA i-^wt ty/fu-/ mJL.c Uss* tenaer. I tnec Jiac xx ^ 
u\\;i\ t»'i Uv^ X,., .A-v^ fcz-C it-l: Ler ii. charjf^ ciXhr.'Macniah, 
\v..(' f i.i...sAC i-'.A //-,<./:-' .i*»-*. w:tL Tanatians acocnmnj: td 
t Ml <ii..h:»s.A^^ K,4 ^4^',v.:*. i^^o-jjr^iian- anc mercmra^. ^Bjr 
til i.M.i i.f 0.^.^ ^«.w4«* '//, ^<-ji'-iuber 24. I lomui matfios 
\\*i ku li.i .^ ^^->.,» 7 «*.c ^x^f-c-v* uud all ^^nt. tiit agpeiise 
\\»t> L.i.^ y,'^^ ^••^<« vr*c» s-c*;^:.^: !air':T. tht: perspiiHiuiiK 
wiic n ..^».\->. u.^ UMfj.<r**tv«*: i»"a* lioniial ni^t and ctoy* 
i.c < . ..i;.v .^.<.*^c. <L«.#(<i.M»(y tK<: Lfc^diHftfe. o: tilt liver baR 
Uii.. *^i -.^^ .^•c.j ffr 0f»/4u<-t »^«, t lilt ffiifarpffTnmn liaa 
4 -^ u' . ^ ... I ::w*. y».»o oi4<> i'f I/*: t;j - ^ii€ haE now com- 

..| .. .A ;. <. *.^?<, iju.,,»rt4 Hcj^K to L*tf i»*teii only one of 
.t^.... .<^,^,k,5 f |»«»vo <it «^tr<irijjf bclj-sf iir«w •faai ii» 

I'**- •! >».«^ ^.»,i:j*,»f Ml MM 11»«» h^t'r aci pr^ 



(.« I .•«>ti>>r* 



|N JMiMinnu Mm «1i£!i.nt5i» Mini l'i>Mn>t tbfi subject of this 
|m|« » \m lorn ilu^ iiv»mh«'in «>| <ho Hviiihh Homoeopathic 
^•'•^<\. I nf. onrp ri<fl<o <)m< 1 hnvo ni>tbing original with 
xvlH»h <o rlniin iboiv «H<'nhi>n. 1 atu merely responding 
\o <|)M i!nifniioii of iho (\>inn"ii<iro of the ** Section of 
M» M» H<l MiMlii'ino mifl iVfholojjy " i«^ supply, in connection 
v^,»Uj Mm' pin])|tM»f, of *Mjivov l>i«onwo/' inf^M'mation regarding 



I 



wbil'b dibbasb. 55 

"Weil's New Infectious DiseaBe." All I pretend to do 
is to compile and epitomise what has been observed and 
written by others on this sabject, adding some very brief 
saggestions of my own as to the medicines which, on the 
homoeopathic principle, are, I believe, specially indicated 
for the treatment of this disease. 



In 1886, in the Deutsch Arch., xxxix., p. 209, a Q-ennan 
physician of the name of Weil described an acute infectious 
disease, characterised by fever and jaundice, commencing 
suddenly without prodroma by rigors, running a short 
severe course, and terminating usually in recovery. The 
constant and distinctive sjmiptoms were fever, headache. 



56 weil's disease. 

gastric disturbances with diarrhoea, early jaundice, and 
muscular pains, especially in the calves of the legs. The 
liver and spleen were generally swollen, the former being 
tender on pressure. The fever ran a typical course, lasting 
usually from eight to ten days ; now and then a relapse 
occurred, the attendant symptoms being less severe.^ The 
urine contained bile pigments ; in some cases there was 
nephritis. In one or two cases erythema was observed. 
About the same time Wagner described two such cases, 
and, in common with Weil, regarded the disease as a 
peculiar and abortive form of typhoid fever. 

The disease was also observed and discussed by other 
German physicians, notably Goldsmidt, Aufrecht, Both and 
Haas, giving a total of about twenty cases. Following 
them, in 1888, Dr. Fielder, in the Deutsch Archiv, f, Klin, 
Med.y vol. xlii., drew very general attention to this disease. 
After a critical study of the cases recorded by Weil and 
others, he reports twelve cases of the disease which he had 
observed himself during the past eleven years, but which 
he had been hitherto unable to classify. His paper is ably 
condensed in the May number of the American Int&r- 
national Journal of Medical Science of the same year, and 
this is, as far as I can find, the first appearance in English 
literature of any account of WeiFs disease. 

The British Medical Journal, May 12, 1888, called the 
attention of British practitioners to Weil's disease, pre- 
facing the discussion of it, based upon Dr. Fielder's paper, 
by remarking upon the undesirability of calling diseases 
after the names of the men who may have first observed 
or described them, and stating that ** as part of a system 
of nomenclature it is very faulty." 

In the June number of The Practitioner, and in the 
Edinburgh Medical Journal of this same year, accounts of 
Weil's disease, apparently drawn from the same source, may 
also be found, and I do not think I can do better, for the 
purpose that this paper has in view, than give in full the 

' By the kindness of Dr. J. G. Blackley, who took them from the Deutsch 
Arch.f which I could not myself consult, I am able to append temperature 
charts oiE two of WeiPs cases shewing the typical curve, and the character of 
the relapse that occurred in one case. 



Weil's disease. 57 

condensed report of DrJ Fielder's article, as given in the 
International Journal of Medical Science , to which I have 
already referred. 

" Dr. Fielder does not believe that Weil's disease is an 
abortive form of typhoid with icterus, as Weil has suggested, 
since in aoa experience of over 5,000 cases of typhoid fever he 
has never seen a case, beginning with severe general 
s3rniptoins and chill, develop icterus, with swelhng and 
tenderness of the liver on the second or third day, and then 
on the eighth or tenth day be completely free from fever and 
nearly convalescent. He further emphasises, as distinguish- 
ing it from typhoid, the pains in muscles, especially in the 
calves, the typical temperature curve, the absence of catarrh 
of the lungs, and various other symptoms. 

" After an extended discussion he draws the following 
conclusions from his own observations : 

** (1) The disease first described bj'^ Weil in 1886 is an 
acute infectious or toxic affection, which has nothing in 
common with typhoid fever or any other disease. It is a 
morbus sui generis. 

" (2) The disease begins quite suddenly, without pro- 
dromal symptoms, and often with a chill. 

•* (3) Symptoms always present are fever, headache, evi- 
dence of gastric disturbance, jaundice, and muscular pains, 
especially in the calves. 

** (4) The fever has a typical curve, and lasts eight or ten 
days ; sometimes after the fall of temperature, which occurs 
by lysis or steps, a relapse of the fever is seen. The pulse 
at first frequent later on becomes subnormal. 

** (5) The spleen and liver are commonly swollen, but not 
always, and the latter is often tender on pressure. 

** (6) Nephritis is often observed in the course of the 
disease. 

** (7) Herpes and erythema at times occur. 

*' (8) The disease has in general a favourable prognosis 
and termination. 

" (9) It attacks chiefly the male sex at the prime of life, 
previously in good health, and develops during the hot 
season of the year. 



68 weil'b dibbase. 

'' (10) The cause of the disease is still unknown, though 
the circumstance that out of twelve male patients nine were 
butchers makes it probable that butchers are more especially 
liable than other persons to be attacked by the agencies that 
produce the affection." 

Dr. Nauwark, in the Milnch. Woch., No. 35, of 1888, 
gives short notes of a case of Weil's disease, as he considers 
it, that came under his notice in the summer of 1888. It 
was the case of a butcher, aged 63. After feeling generally 
ill, with great weakness, fever, and pains in the calves for a 
couple of days, he became slightly yellow on July 31, and 
by August 2 was quite icteric. On August 4 he was very 
drowsy, icterus very marked, pains in the lower extremities 
very severe, especially ia the calves of the legs, but not 
increased by pressure. Pulse 89, rather small, and the 
heart's action weak, with a systolic murmur. The tongue 
coated, except at the margins. Liver dulness was increased, 
with tenderness on pressure, which appeared to be more 
superficial than deep. The spleen was not apparently 
enlarged. The analysis of the urine on the sixth day of 
illness gave one-quarter per cent, of albumen, and micro- 
scopic examination showed shrunken red blood corpuscles, 
isolated epithelium, and here and there cylinders of hyalin. 
The temperature was not noted. By August 10 he was up 
out of bed, and the icterus passing off. He was still very 
weak, and the pains in the limbs, though still present, 
were much less severe, and sleep and muscular power were 
returning. 

Commenting on this and another similar case. Dr. Her- 
mann, in the Vienna Clinical Lectures, as reported in the 
Medical P7*e$$ and Circular of October, 1890» remarks : " On 
carefully looking over the literature on this subject I find 
several such cases. Prominent amongst these is one 
recorded by Albert Mathieu in 1884 under the title of 
' Typhus Hepatique Benin.' In the Bevtie de Mededne, vi., 
1886, page 633, this case is fully described. It is one of a 
young man, aged 23, a joiner, and the details given of the 
symptoms agree in every particular with Weil's disease. 
Landoazye considers such cases belong to the typhus form 



WBIL*B DI8BA8B. 59 

of disease, of which a large class of different varieties are 
bound up together in clinical history, but differ in their 
etiology. If the virus expended its force on an individual 
oi^an, as the liver, it is possible to connect the group in a 
simple category. Dr. Haas, of Prague, who bas reported 
ten sucb cases, considers the disease to be an abortive, 
bilious, enteric affection. In spite of these opinions, when a 
typical case is before us there is plausible reason to separate 
Weil's disease as a separate affection. Nauwark, who has 
made a pathological enquiry, admits that there exists a want 
of anatomical facts. Whatever special worth may be 
attached to these observations, we may conclude by repeat- 
ing the circnmstances, that, though there is a close connec- 
tion to be observed with enteric fever, the anatomical 
connection cannot be proved." 

In England very few cases of Weil's disease have been 
observed, or at least recorded, and the first I have been able 
to discover is in the Lancet of November 30, 1889. Dr. E. 
H. Young there gives in detail the following really typical 
case: — 

" At 7 a.m. on May 14 I was sent for to see T. H., aged 
20, who was said to have had a ' stroke.' On reaching the 
house at 8.30, his friends gave me the following history : — 
Patient always enjoyed the best of health, and has had no 
severe illness at any time. On May 10 he returned from his 
annual Yeomanry training at Barnstaple, being then perfectly 
well. On Sunday, 12th, he took his food with his usual 
appetite, and in the evening he walked to chapel, four miles 
away. When returning home he * suddenly shivered,' 
severe headache came on, with aching pains in the legs, the 
latter being so severe that he thought he should never be 
able to reach home, and was obUged to take frequent rests by 
the way. He went straight to bed and slept well through 
the night. The next morning (the 13th) he got up some- 
what later than usual, but no sooner was he downstairs than 
he sat in a chair and became drowsy and stupid. When 
roused he said his head ached, that he felt sick and had pains 
in the calves of his legs. He would not take any food. He 
was helped back to bed. Three aperient pills were given him 



60 weil's disease. 

and his head bathed with cold water. Throughout the day 
the drowsiness increased. When spoken to he replied briefly 
and said the headache, nausea, and pain in legs continued. 
He refused food of all kinds. Towards evening he became 
more unconscious, was delirious and answered questions 
incoherently. He had passed no urine since 6 p.m. on the 
previous day. On the 14th, at 3 p.m., his bowels were re- 
lieved, motions rather pale and semi-liquid ; a small quan- 
tity of water they thought was passed also at this time. 

" At 8.30 a.m., when I first saw the patient, a tall, well- 
made, muscular young man, his condition was as follows :— 
Lying in bed on his back, eyes closed, and he took no notice 
of my entry. Features blurred, cheeks rather dusky, and 
his skin slightly yellow. When roused he replied in mono- 
syllables, and often incorrectly ; complained of pain in the 
stomach and in the region of the liver, and of soreness in 
his legs. There was tenderness on pressure over the liver 
and spleen, especially the former. No marked alteration in 
hepatic or splenic dulness. Tongue covered with thick, 
moist, yellow fur. Byes injected, pupils equal, but rather 
dilated, and responding sluggishly to light. No paralysis or 
oedema. Temperature 101*4°; pulse regular, full and 104 per 
minute. Eespirations 12 per minute. There was marked 
prostration of strength. 

" I ordered complete abstention from food, hot poultices 
over the liver, and gave a powder of calomel and compound 
jalap, followed by a sulphate of soda mixture. 

** At 2 p.m. I was again sent for, as the patient was said to 
be worse. On arriving at 3 p.m. I found that after I left 
this morning he had complained of severe abdominal pain, 
which was relieved on his passing a motion, which was 
liquid and of a tarry colour. His general condition 
remains the same, except that he is perspiring freely, and 
the pulse is more relaxed. Ophthalmoscopic examination 
(for which the lids had to be held up) showed the discs were 
clear and healthy, but the veins rather full. A small 
quantity of urine had been passed, which was tinged with 
bile, clear when passed, but speedily becoming turbid and 
highly acid. It contained no albumen, and microscopically 



— — ^ 



WEIL*S DIBEABB. 61 

it showed a large quantity of uric acid crystals, amorphous 
urates and some oval colourless plates, but no blood or 
casts. 

" May 15, 11 a/m, — The report was that he had remained in 
much the same condition of stupor as when I saw him 
yesterday afternoon, becoming deUrious at night. At 4 
a.m. he seemed to be sleeping quietly, and on awaking at 8 
a.m. said he felt better. His aspect this morning is dis- 
tinctly brighter, but tendency to stupor still marked. He 
is not so dusky about the cheeks, and the veins of the eyes 
are less full. His skin has a more distinctly jaundiced 
colour. He still complains of pain in his legs, but says his 
head is now only * funny.' No appetite and refuses all food. 
Temperature 102*4° ; pulse 72. His bowels have been 
opened twice since yesterday, the motions liquid and of tarry 
colour. He has also passed six ounces of urine of the same 
character as before. 

" May 16, 3 ^.m. — The patient has passed a good night 
and had no delirium. He is brighter and talks with his 
friends. Pupils widely dilated. Bowels opened once, 
motion still tarry and liquid ; has passed nearly a pint of 
urine. He still has tenderness on pressure over the liver, 
but no other pain. Tongue cleaving. Jaundice about the 
same as yesterday. Temperature, 100*2° ; pulse 58, regular 
and good. 

" May 18, 3^.m. — Patient has been going on well since 
last note. Tongue cleaner. Appetite still bad. Jaundice 
diminishing. Motions normal. No tenderness now over 
the liver. Temperature 98*4° ;. pulse 46, regular and firm. 

" The patient went on well after this. He sat up for an 
hour on the 19th, but felt very shaky. He rapidly con- 
valesced, and quickly regained appetite and strength.*' 

Although no albumen, blood, or casts were actually de- 
tected in the urine, there can be no doubt, Dr. Young 
observes, that from the fact of so httle urine being secreted 
in forty-eight hours, the kidneys were seriously affected by 
the disease. 

From the London Medical Becord of November 20, 1890, 
reviewing a paper of Dr. Weiss's on Weil's disease in the 



62 WBIIi'S DISBABE. 

Wien. Med, Wochensh. xi., 1890, it would appear that a 
severe and fatal form of this disease has been prevalent in 
Egjrpt, Syria, and the Balkan Provinces. Twelve cases are 
reported. Five of them, however, would seem to have been 
modified forms of relapsing fever, or typhus biliosus, 
occurring in sufferers from malaria. The other seven cases, 
of which four were rapidly fatal, have all the distinctive 
feature of Weil's disease in a very acute form. In all these 
cases the course and symptoms of the attack, as well as the 
post-mortem appearances, were so strikingly alike that one 
description will serve for all. " It set in suddenly with 
rigors, headache, vomiting, fever, and pain in back and 
limbs ; jaundice appeared variously between the second and 
fifth days. The jaundice was soon followed by marked en- 
largement of the liver, spleen and inguinal glands. The 
urine was scanty and high-coloured, albuminous or bloody, 
there was bilious or bloody diarrhoea, the breath extremely 
offensive, and the liver and spleen tender. Death occurred 
on the ninth or tenth day, in all four cases, preceded by low 
delirium and coma. Post-mx)rtem examination in all these 
cases showed general icterus, fatty degeneration of heart 
and liver, haemorrhagic pachy-meningitis, the liver deeply 
stained with bile, with dull swelling of the parenchyma, 
and acute interstitial hemorrhagic nephritis, and internal 
haemorrhages in various organs." 

The latest notice of WeiFs disease that I have been able 
to find occurs is in the epitome of current medical literature, 
given in the British Medical Journal of February 24, 1894, 
and taken from the Berlin. Klinik, February, 1894. ** Dr. 
Freyhan there discusses this subject after relating the 
following typical case : — ^A man, aged 32, was suddenly 
seized with shivering, fever, headache, followed by semi- 
coma ; on the next day jaundice was noticed. On admission 
the tongue was dry and coated. The temperature 38*9° C, 
and the pulse 100. The urine was dark in colour, contained 
bile pigment, a little albumen, and some hyaline casts. The 
liver and spleen both enlarged and tender. The stools were 
loose and passed unconsciously. Severe pains in the calves 
were noted. The fever terminated by lysis in a few days, 



wbil's disbabb. 63 

the other symptoms disappearing at the same time, the 
pains in the calves continuing to the last." 

Commenting generally on this disease, '* Men," says Dr. 
Freyhan, " are more often attacked than women. Some- 
times relapses occur, the former symptoms re-appearing, 
but rarely in such a severe form. The pulse rate is usually 
high, but during convalescence it is infrequent or sub- 
normal, probably owing to the presence of bile constituents 
in the blood. Severe cerebral symptoms are rarely absent ; 
early jaundice is the most constant symptom. The hepatic 
enlargement is not always present, the spleen being often 
affected. The nephritis is to be looked upon as toxic in 
nature, as in other infective processes. Muscular pains, 
especially in the calves, probably due to myositis, are almost 
always present. The prognosis is usually good. Neither 
morbid anatomy nor bacteriology has as yet given definite 
and distinctive information as to the exact nature of the 
disease. It may be difi&cult to distinguish it from enteric 
fever in the first few days, and it has been looked upon as 
abortive enteric fever with jaundice, but the typical lesions 
of the former have never been found. The resemblance to 
acute yellow atrophy is quite superficial, and it differs from 
septicaemia in several ways. From infective jaundice the 
difi&culties of diagnosis may be great. The author then 
refers to the infective theory of simple jaundice with special 
reference to epidemics, but he does not believe that a single 
cause can account for all such cases. Those believing ex- 
clusively in the infective origin of jaundice look upon Weil's 
disease as only a severe form of this affection. The clinical 
picture of catarrhal jaundice is very different from that of 
Weil's disease. The relation of Weil's disease to typhus 
bihosus, endemic in Egypt, is then discussed. Some have 
looked upon it as a sporadic form of this disease. Only the 
discovery of the specific agent will settle the question." 

Other up-to-date descriptions and comments on Weil's 
disease can be read in Osier's ** Principles of Medicine " 
and Musser's "Medical Diagnosis," but Dr. Freyhan's 
is the most complete and exhaustive, as well as the most 
recent. 



64: WSIL'S DI8BABB. 

As the main object of this paper has been to give in- 
formation regarding Weil's disease, and to gather together 
the descriptions and discussions of this disease that have 
from time to time appeared in different medical publications 
during the last six or seven years, thus giving them a per- 
manent place in the annals of our Society for comparison 
and reference, I have left myself but little space to devote 
to the question of treatment ; my remarks, therefore, as to 
this will be very brief. 

In the reports of cases of this disease that I have been 
able to compare, treatment, save in two^ instances, is not 
referred to, so that as to this part of my subject I have 
little to relate. In one case "cognac mixture and cold 
baths,*' followed on the next day by "two-grain doses of 
quinine " is jnentioned, and in the other Dr. Young states : 
"I ordered complete abstention from food, hot poultices 
over the liver, and gave a powder of calomel and compound 
jalap, followed by a sulphate of soda mixture," as to which, 
in his remarks on his case, he naively suggests that : " The 
rapid recovery of this patient was probably not influenced 
by the treatment pursued." 

However, interesting as it might have been to learn a 
little more of how our allopathic confreres treated their 
cases, as disciples of Hahnemann we need not very much 
regret the omission, as with the clear and graphic descrip- 
tions of Weil's disease that they have given us, we have 
only to consult our " Cyclopaedia of Drug Pathogenesy " to 
know with certainty how to treat it, and that, too, with 
the confidence, that " the rapid recovery " of our patients 
will undoubtedly be greatly "influenced by the treatment 
pursued." 

The most complete drug picture of Weil's disease that 
I have myself been able to discover, taking it up alone from 
the side of subjective and objective symptoms, is found 
under chelidonium majus. 



* I avail myself again of information kindly supplied by Dr. J. G. Blackley, 
to state that Weil treated most of his cases with acid. mur. dil. in two drop 
doses. The homoeopathicity of this drug and the smallness of the dose used 
wiU strike most. 



Weil's disease. 65 

It has the initial rigors, followed by fever and muscular 
pains, notably in the calves; the early onset of severe 
nervous symptoms characterised by headache, drowsiness, 
and great prostration of strength ; the yellow skin ; tender- 
ness and pain, with swollen feeling in the region of the liver. 
Dull pain in the left hypochondrium, pointing to some affec- 
tion of the spleen. Gastro-enteric sjnnptoms, with bilious 
diarrhoea, sometimes bloody. Benal symptoms, with dark- 
coloured urine containing mucous epithelium, urinary 
cylinders, and reddish flocculent sediment, indicating ne- 
phritic congestion and possibly commencing nephritis. 
Lastly, the duration of the action of chelidonium, about 
ten days, tallies with that of Weil's disease ; but it lacks 
the deep features of structural change, supplied by post- 
mortem examination. 

Taking this disease up from the side of pathology and 
morbid anatomy, the drug that comes prominently to the 
front, before all others, is phosphorus. Its effects upon the 
tissues of the brain, liver, spleen, heart, and kidneys, with 
the hsemorrhage it causes in various internal organs, corre- 
spond minutely and strikingly with the appearances pre- 
sented at post-mortem examinations of Weil's disease. 
Together with these structural changes it has many of the 
objective and subjective symptoms observed in the course 
of an attack of this disease. 

Regarding it in the Kght of an abortive, or peculiar form 
of typhoid fever, baptisia comes to one's mind, and if it 
have any relation to relapsing typhus, we must not forget 
bryonia, and the success achieved by Hahnemann and Kidd, 
who both used it in epidemics of this species of fever. 

liooking to the aetiology of Weil's disease, which, though 
still rather doubtful, points pretty clearly and primarily to a 
degenerative change in the blood, produced by the introduc- 
tion into the system of a poison of a specific nature derived 
from decaying animal matter, the prevalence of the disease 
amongst butchers being strongly in favour of this view, 
rrotalus must not be overlooked. 



VOL. in. — NO. 1. 



66 DISCUSSION ON "ACUTE HEPATITIS*' AND "WEIL's DISEASE." 



Discussion on Dr. Dyce Brown's paper on "Acute Hepatitis " 
AND Dr. Christopher Wolston's on " Weil's Disease." 

Dr. Hughes said the impression made upon his mind hy 
listening to the cases which Dr. Wolston had quoted was that 
there was no such definite entity as Weil's disease. Some of 
them, he was strongly inclined to think, were instances of trichi- 
nosis. He had thought that before he had heard of the prevalence 
of the malady amongst butchers. Some cases he considered 
were of acute diffuse inflammation of the liver, some possibly of 
phosphorus poisoning, and some might be, as had been suggested, 
abortive forms of typhoid. Some of the cases in his opinion 
came under the category of the protean forms of influenza, of 
which they had seen so many of late years. He doubted very 
much whether further research would . establish any definite 
entity due to a specific poison in Weil's disease. The study of 
the drugs which Dr. Wolston had given in the treatment of the 
disease was an excellent specimen of what the clinical study of 
the materia medica should be. Dr. Wolston just took the real 
effects of the drug, both as shown on the healthy and as obtained 
by post-mortem examination, in such a way as to make them feel 
they were on sure ground. If Dr. Dyce Brown would allow him 
to say so, he had not the same feeling as to the symptomatology 
which he had brought before them. He would ask him, for 
instance, whether the symptoms that he mentioned as indicating 
the action of baptisia on the liver were taken from several 
provers, or whether they were simply copied from Allen's " Ency- 
clopaedia " without reference to their source. His (Dr. Hughes') 
impression was that they all rested on one prover. Dr. Burt, and 
it was a curious thing that every medicine Dr. Burt proved gave 
him bad pains in the liver and gall-bladder ; so he did not think 
much stress could be laid on the liver symptoms derived from 
Dr. Burt's proving. His (Dr. Hughes') belief was that baptisia 
had no action at all on the liver, and could not be depended 
upon in any affection of that organ, whether the fever indicating 
it was present or not, because the fever of hepatitis must be 
sympathetic of the local inflammation. He thought Dr. Dyce 
Brown's cases were excellent, well observed and described, and 
full of interest and instruction ; but in the earlier part of his 
paper, he (Dr. Hughes) felt there was something of the text- 
book character, and that the indications as to drugs were hardly 
the result of his valuable experience, but were just copied from 



DISCUSSION ON '* ACUTE HEPATITIS*' AND *'WEIL's DISEASE." 67 

those which were given in books they knew pretty well. With 
r^ard to what Dr. Dyce Brown had said about mercurius, he 
quite agreed with him as to its applicability to liver disease, but 
did he derive his statement that in the experiments of Buther- 
ford and Hughes-Bennett small doses of mercury caused an 
excessive flow of bile, and large doses the reverse, from any recent 
investigation of the experiments in question ? or was it Dr. Dyce 
Brown's recollection of what he had read many years ago when 
the experiments were made ? He remembered Dr. Dyce Brown 
making a similar statement a good many years ago, which he 
(Dr. Hughes) ventured to contravene ; and on reading over the 
experiments at that time they bore to him a very different com- 
plexion. He would be glad to know if Dr. Dyce Brown had in- 
vestigated them again. His (Dr. Hughes') impression was that 
in quite small doses when no evacuation was present mercury 
checked the formation of bile, and that its action was always to 
diminish the secretion. There might be an increased flow of bile 
by reflex stimulation of the gall-bladder, but the actual secretion 
of bile in Hughes-Bennett's experiments (and also in Scott's) was 
uniformly diminished by the direct and primary action of small 
doses of mercury on the liver. It was a curious thing, that 
while Dr. Dyce Brown had told them so much of the indications 
for aconite, bryonia, mercurius and baptisia in acute inflamma- 
tion of the liver, in all the three cases he had brought before them 
those medicines were remarkable only for their inaction. The 
disease went on in spite of them all. He thought they must 
look further afield for the best medicines, and that the one most 
promising in these cases had been mentioned by Dr. Wolston — 
that was chelidonium. There was no medicine that had such a 
potent action on the liver, and its use had received considerable 
clinical confirmation. It was a medicine he (Dr. Hughes) could 
always depend upon in well-marked cases of acute congestion 
of the liver. He had never seen such true inflammatory cases 
as Dr. Dyce Brown had described, but he had seen approaches 
to them, and, like Dr. Dyce Brown, had experienced these in his 
own person, and he had always found chelidonium was the 
medicine which touched the liver most effectually in those cases. 
Dr. Edward Blake quite agreed with Dr. Dyce Brown that 
of late years infiuenza was amongst the commonest causes of 
hepatitis, itself probably never a primary disorder. The liver 
bearing towards the portal circulation the same relationship as 
the lymphatic glands do to the lymph system, it may be said 
to stand between man and death. For as the spleen wages 



68 DI8CT7S8ION ON " ACUTE HEPATms" AKD "WEHi's DISEASE. 



>» 



war with the pathogenic micro-organisms introduced from with- 
out, so the liver interposes a barrier between gastro-intestinal 
toxines and the general circulation. If the liver win the battle, 
after an invasion of influenza, and successfuUy negotiate the 
intra-and extra-bacillary toxines, there is no icterus; but if the 
hepatic lobules succumb, then we have an attack of jaundice. 
Tenderness and rise of temperature do not serve to distin- 
guish hepatitis from gall-stones ; they are found present in both 
conditions. Dr. Blake entirely endorsed what was said of 
aconite. It is certainly the remedy for congested Hver. When 
another remedy is used in alternation with it, probably it is the 
aconite alone that does the work. In aconite we have also the 
medicine par excellence for jaundice, even when that condition 
occurs without rise of temperature. In the case of adults, if 
aconite fail he gives mere. cor. in the acute type, and afterwards 
hepar. In the jaundice of children, podophyllum, the rhizome 
not the resin, acts well in the higher dilutions. This drug should 
never be given strong during childhood. Anstie induced sharp 
enteritis in dogs and rats, with extensive ulceration of the lower 
part of the duodenum, by means of the resin, podophyllin. 
Dr. Blake had seen only one example of hepatic abscess which 
had commenced in this country. It occurred in the person of a 
sanitary inspector, who, whilst exploring a sewer, was bitten by 
a rat. Abscess of the liver supervened, from which the man 
recovered. With regard to this case there is a point of extreme 
interest. There exists in India a disease called '' jurra," which 
is very fatal to horses. The animal dies stricken with acute 
hepatitis, and in the blood is found a minute nucleated protozoon, 
fusiform in shape, endowed with the power of very active move- 
ment, depending on a long flagellum. The only quadruped in 
this country that forms the host of a 'similar organism is the 
sewer rat. With regard to Dr. Dyce Brown's own case, with a 
group of symptoms such as bulimia, enuresis, hyperidrosis, and 
occipito-frontal headache, surely the indicated remedy was 
iodium. Turning to Dr. Wolston's paper, its title indicated an 
infectious disease ; probably infective was the adjective intended 
to be used. Weil's disorder presents many points of contact with 
beri berif a disease of undoubtedly infective nature. Dr. Blake 
had just seen a typical example, with oedema of the cellular tissue 
over the subcutaneous bones, with tenderness of the leg muscles 
and with local areas of skin anaesthesia. Various parsesthesise 
were present. Beri beri occurs afresh under insanitary condi- 
tioDS ; it is autochthonous, and it dies a natural death when 



DISCUSSION ON "ACUTE HBFATITIS'* AND '' WEIL'B DISEASE /' 69 

the patient has hygienic surroundings. It is undoubtedly a 
septic neuritis. The appearance, in Europe, of these tropical 
forms of disease may be due to the use of tinned meats, and to 
the importation of foreign cattle. 

Dr. GaijIiEy BlaceiiET, unhke some speakers, thought Weil's 
disease was undoubtedly a disease sui geTieris, and he did not 
at all agree with Dr. Hughes' suggestion that it might be 
trichinosis, or several other things. He was bound to confess 
that until he read the syllabus of Dr. Wolston's paper he knew 
absolutely nothing about the subject, but he had in the meantime 
taken the trouble to look up a few of the cases recorded in the 
medical journals of the last seven or eight years, including 
Weil's original paper published in the Deutsches Archiv fil/r 
klinische Medicin of 1886, and perhaps Dr. Wolston would not 
mind if he read the shortest possible resume of Weil's conclu- 
sions, for it was very interesting to see that those conclusions 
had not been materially called in question by any of the ob- 
servers since then. He found, for instance, that the maximum 
temperature was reached on the second to the fourth day, and 
that the fever was gone on the seventh to the eleventh day. 
There was a relapse after a period of one to seven days, and 
this second attack lasted six days. There were cerebral symp- 
toms, headache, vertigo, restless dreams, delirium, tendency to 
somnolence and great feebleness ; enlargement of spleen, liver 
enlarged and tender, and, very constantly, nephritis ; the 
defervescence was by steps, the pulse following the tempera- 
ture, the tongue was coated and dry, and there was vomiting 
and diarrhoea. He was so interested that he went to the 
fountain head and looked up W^eil's temperature charts, which 
he copied. The medical treatment which Weil adopted was 
very interesting. Three of his cases were treated by dilute 
muriatic acid — that is, our muriatic acid first decimal, two-drop 
-doses every two hours. Another case was treated by bicar- 
bonate of soda in five-grain doses. It appeared to be pretty well 
established that Weil's disease was fairly common, and one felt 
naturally tempted to ask one's self the question whether many 
of the cases recorded in homceopathic literature as examples of 
the jugulation of typhoid fever by means of medicines, might not 
have been, after all, cases of the type that Weil had precision- 
ised. As regards treatment there was no doubt that, in the 
severe form, the medicine Dr. Wolston had hit upon was the 
right one, viz., chelidonium. In the less severe cases he (Dr. 
Blackley) was bound to say that baptisia was the medicine that 



70 DISCUSSION ON ** ACUTE HEPATITIS" AND *'WEIL's DISEASE." 

occurred to him first of all when he read WeiFs cases. Baptisia 
had undoubtedly very many of the symptoms recorded by Weil 
and other men, in spite of what Dr. Hughes had said about Dr. 
Burt, because it was a fact that in several of the provings pain 
in the region of the liver and hypochondrium was present. It 
was wonderful how very near the symptoms of baptisia came to 
the symptoms recorded by Dr. Wolston and other observers, 
and that was one reason that made him (Dr. Blackley) suggest 
that they might have been giving credit to baptisia for aborting 
typhoid when it did not deserve it at all, as it was not typhoid 
but Weil's disease. It would certainly be an enormous help if 
observers would take the trouble to make careful notes of the 
cases of continued fever they got in private practice. Periodi- 
cally one saw a large number of cases of a so-called gastric type. 
Time was when we were in the habit of thinking that the term 
" gastric fever '* was only a euphuism for " typhoid fever," made 
use of in order not to alarm the friends, but many of those cases 
of the gastric type, if carefully recorded, he felt quite sure would 
turn out to be of a definite character, and probably they would 
not be materially influenced by baptisia or any other djrug. 

Dr. GoLDSBBOUGH thought it was an advantage to have had 
acute hepatitis and Weil's disease brought into relationship with 
each other. He would like to have heard from Dr. Dyce Brown 
a little more as to the pathological, or perhaps he ought to say 
anatomical characters of acute hepatitis ; because in his opinion 
it was not so rare a disease as indicated in the text-books. There 
were cases which could be defined as circumscribed inflammation 
of the liver ; and although he could not himself give any informa- 
tion on the subject, he had a case some years ago which puzzled 
him very much, and which he could only set down as acute cir- 
cumscribed hepatitis followed by abscess. The patient was a 
man of 53, and was taken with severe rigors, followed by a rise of 
temperature, in the early part of his illness, to about 101°. The 
temperature dropped in the course of two days. He had no pain 
localised in the liver, but a general malaise and aching of the 
limbs, associated with a chill. As soon as the temperature 
dropped to about 99° jaundice supervened. That lasted three or 
four days, and then, as it seemed, he got perfectly well. In the 
course of a few months he had another similar, but more severe, 
attack, and got over that quite well. He had two further attacks 
gradually becoming more severe. He (Dr. Goldsbrough) could 
not find out any precise lesion of the liver nor diagnose any chronic 
abscess of the liver. Bye-and-bye the patient had an attack from 



DISOUSSION ON " A.OUTE HEPATITIS " AND **WBIL*S DI8BASB." 71 

which he did not recover. It began with rigors, temperature rose 
to 103°, and pursued a fluctuating course, sometimes dropping to 
normal and then again in a day or two going up *to 103° or 104°. 
Jaundice supervened. The condition gradually became worse, 
the liver enlarged, and he (Dr. Goldsbrough) believed that an 
abscess formed which eventually burst into the abdominal cavity, 
and the patient died. There was no post-mortem. Dr. Golds- 
brough thought they might have cases of that kind without being 
able to diagnose a general hepatitis. The case he mentioned had 
some resemblance, at any rate in the early attacks, to Weil's 
disease, although it was not a case of that disease. There was 
no history of syphilis, of malarial poisoning, or of influenza. He 
(Dr. Goldsbrough) agreed with what had been said about medi- 
cines, particularly chelidonium, in cases that might be called 
active hypersemia of the liver; for example, where there was 
chill, followed by fever, with tenderness in the region of the 
liver — ^jaundice might or might not be present. Aconite to begin 
with, followed by chelidonium and hepar sulphuris, would clear 
up the case. 

Mr. Gebabd Smith asked Dr. Wolston if the urine had been 
chemically tested in Weil's disease, and what was called the dark 
colour proved to be bile. He had come across, whilst traveUing 
up the Nile, a good many cases of fever with dark urine, apart 
from cases of hsBmaturia, but the darkness was due to haemoglobin 
and not to bile. As described by Dr. Wolston the cases seemed 
to him (Mr. Smith) very much like those of hsemoglobinuric fever 
which were so prevalent on the Congo and, in a much milder 
form, on the Nile in some of the dirty villages. 

Dr. BiiACEiiEY stated that Weil tested for bile acid and bile 
pigment, and found both. 

The Pbesident (Dr. Byres Moir) said he had been astonished 
that none of the surgeons had rushed to the front when Dr. Dyce 
Brown declared against an operation for an abscess of the liver. 
He would be strongly in favour of an operation, not exploring 
with the needle, but an exploratory incision. With regard to 
Weil's disease he would compare it with acute infectious pneu- 
monia. There was no question that there was a form of pneu- 
monia resembling that disease very much. He was astonished 
that Dr. Hughes, knowing what ^German work is, should suggest 
that some of the cases were trichinosis. With regard to Dr. 
Blackley's remarks as to typhoid fever, jaundice was not seen in 
that disease while it appeared in Weil's disease. 

Dr. Dyce Bbown said that with regard to Dr. Hughes' critical 



72 DIBCUSSIOM OV '< AOUTE HEPATITIS " AND " WEIL's DISEASE." 

remarks on the paper, that the first half looked too much as if it 
were taken from a text-hook and not from original ohserva- 
tions : he (Dr. Brown) admitted that. The paper was not his 
choice. In giving a short description, as an introduction to the 
series of papers, there was no opening for original work on a 
disease which was infrequent in this country, and it was neces- 
sary merely to summarise what was generally known. Dr. 
Hughes asked whether the symptoms of haptisia quoted were all 
by one prover, and taken from Allen's ** Encyclopaedia/' Those 
symptoms were taken from Allen. He (Dr. Brown) did not look 
up the references to see if they were all from one prover or not. 
He thought they were reliable. Dr. Hughes had also asked if 
any recent analysis had been made by Dr. Brown of the mercury 
experiments referred to. He (Dr. Brown) was well aware 
that Dr. Hughes and himself did not agree on certain points in 
the action of mercury and some other drugs. Dr. Hughes' 
arguments, written at the time when Dr. Brown made this 
analysis to show that he was wrong, had not convinced him at 
all, and so he deemed it unnecessary to go through afresh analysis, 
considering that his conclusions were correct. Dr. Blake had 
asked if there was rigor in the severe case. There was not at 
first, except the cold, collapsed feeling which came on with the 
severe pain. There was no absolute rigor. In the middle of the 
illness, when the fever was at its height, there was one night a 
slight rigor, which led to nothing. It did not seem to produce 
any symptom one way or another, and was not repeated. In 
his own illness he did not select his own medicines, but left it in 
the hands of his medical attendants. 

Dr. WoLSTON, in replying, said that he had had no personal 
experience in Weil's disease, but from carefully comparing the 
observations of others he was decidedly of the opinion that it was 
a disease sui getieris. He was greatly surprised at Dr. Hughes' 
suggestion, based upon the mere circumstance that it was preva- 
lent among butchers, that the oases given were cases of trichinosis, 
lie failed to see any sort of likeness between Weil's disease and 
trichinosis* He did not think that the idea of trichinosis had 
occurred to any of the gentlemen who had observed cases like 
Woirs disease, or if it had then they would not have overlooked 
oxaminatiou of the muscles to find the trichina itself. Dr. Blake 
had given it as his opinion that the casea described were merely 
(onus ot opideunc influenza, but he failed to see any evidence 
oonuootiug Woirs disease and influenza* They did not find such 
ny utptoms as Weil described in the course of epidemics of influenza. 



DBUG SYMPTOMS OF THE EYB AND BAR. 73 

The only point of likeness was infectiousness. Infective pneu- 
monia had also been mentioned, but when they came to symptom- 
atology and pathological changes, he did not think there was any 
similarity between that disease and Weil's disease. He (Dr. 
Wolston) was obliged to Dr. Blackley for the notes from the 
German of some of Weil's own cases that he had given, and the 
information that Weil had treated many of his cases with 
muriatic acid ; not being a German scholar himself he had not 
been able to go, as he had done, to the fountain head. 



A COMPAEISON OF THE DEUG SYMPTOMS OP 
THE EYE AND EAE : THEIE ANALOGIES 
AND PEACTICAL IMPOETANCE.^ 

BY W. THEOPHILUS ORD, M.R.O.S.ENG., L.R.C.P.LOND. 

We must all of us, when studying materia medica in the 
CyclopaBdia and elsewhere, have been struck by the number 
of symptoms recorded that, though suggestive of various 
morbid states, have so far received no clinical application. 
As an example I may mention constipation, which has been 
produced as a primary or secondary effect by nearly every 
drag in use, but how few of these do we attempt to utilise 
when treating the condition in daily practice ? 

Very much the same may be said of the ear-symptoms 
with which so many remedies supply us. It is true that 
compared with eye-symptoms produced by the same drugs, 
those of the ear are often scanty and vague, hence some of 
them seem to have been neglected. This fact and the 
obvious difficulty of rightly interpreting ear-symptoms, 
pathologically as well as clinically, has suggested to me the 
idea of studying them in the light afforded by eye-symptoms 
produced by the same drugs. If a reliable analogy could be 
shown to exist between the two, we might hope from this 

* Read before the Society, October 4, 1894. 



74 DBUa SYMPTOMS OF THE EYE AND EAB. 

to obtain fuller indications for use in ear diseases and 
certain forms of deafness, than the unaided study of ear 
sjrmptoms alone have so far provided us with. 

There is doubtless an anatomical reason for a paucity of 
ear-symptoms and a plethora of eye indications being ob- 
served, although pathological conditions of similar intensity 
may be at work in both organs, whether in a drug disease 
or a morbid process. Protected by its position far inside 
the bones of the head, the mechanism of hearing requires 
no such sensitiveness as the photophobia of inflammatory 
eye affections, nor such symptoms as lachrymation, ciliary 
neuralgias and other troubles which in eye disease serve the 
useful purpose of preventing permanent injury to sight by 
prohibiting attempts at using the functionally impaired 
organ. The high development of the superficial sensory 
nerves of the cornea and conjunctiva has happily for us no 
corresponding arrangement in the nerve supply of our 
organs of hearing. Hence, far greater mischief must be 
progressing in the ear to give us symptoms as evident as 
trivial lesions may produce in the eye. There is, never- 
theless, as I hope to show, a valuable analogy between the 
kind and variety, though not in the intensity, of symptoms 
produced by the same drugs on both organs, so much so that 
we may sometimes practically supplement the one by the 
other. This has been hinted at before by Dr. Lilienthal in 
his ** Homoeopathic Therapeutics*' (second edition, p. 391). 

To commence with, an undoubted analogy exists be- 
tween those parts which perform similar functions in both 
eyes and ears. The cornea and membrana tympani, which 
first receive and transmit the vibrations of the ether and 
air respectively, are evidently homologous. The middle ear 
with its chain of ossicles and their controlling muscles, 
conveying and modifying sounds transmitted through the 
membrane, may compare with the anterior chamber of 
the eye and the iris, which regulates the amount of light 
admitted and conveys it to the lens. The fenestra ovalis 
and, in a sense, the stapes and incus of the ear perform 
similar functions to the lens of the eye with its suspen- 
sory ligament and muscle. The highly specialised termina- 



DBUa SYMPTOMS OF THE ETE AND BAB. 75 

tions of the optic nerve in the retina, and of the auditory 
nerve, portio mollis, in the labyrinth are functionally com- 
parable, as also are the vitreous humour and the fluid of the 
labyrinth which bathe their respective surfaces. 

May v^e not expect, then, to find that the same remedies 
will similarly affect analogous parts in both organs, and if 
this is so, will not the subjective, and probably the objective, 
symptoms produced by them be similarly comparable ? An 
examination of the pathogenetic action of one or two well- 
knov^n drugs on eye and ear alike, will supply the best 
answer to this query. Let us begin, for example, with 
belladonna. 

Omitting its action on the conjunctiva, to which mem- 
brane there seems no corresponding part in the ear, bella- 
donna causes partial blindness and deafness. The cornea 
is clouded, traversed by capillaries as in pannus and 
keratitis, and similarly the ear-drum is thickened and in- 
flamed, often with visibly pulsating vessels, as met with in 
acute otitis. In provings of belladonna further mischief 
has not actually been produced, but if such inflammations 
continue, we know that an extension to the anterior 
chamber of the eye will result, producing sometimes ulcera- 
tion of cornea, hypopion, iritis and anterior staphyloma. 
In the ear we have similarly the middle chamber involved, 
inflammation of its mucous membrane, formation of pus, 
perforation of the drum-head with discharge and often 
chronic ulceration estabUshed, all of which ear-symptoms 
except the last seem to have been proved effects of the drug. 
The subjective eye and ear symptoms of belladonna, as 
given in the " Materia Medica Pura " and the CyclopaBdia 
provings, also exhibit a striking likeness. In both are 
experienced the four symptoms of inflammation — heat, 
swelling, redness and pain. Pains are sudden, shooting, 
sticking, in both eyes and ears, and also as if the organs were 

in both cases being alternately torn out and pressed into the 
head. Photophobia corresponds to sensitiveness to loud 
sounds. Foggy sight, as if a mist were before the eyes, 
answers to deafness, as if a skin were drawn over ears. 
Deceptions of sight, such as red vision, flashes, flickering 



76 DRUG SYMPTOMS OF THB BYB AND EAR. 

lights, &c., compare with humming, ringing, and roaring 
noises in the ears. The red, protruding, glistening eyes of 
belladonna are exactly matched by the red, congested, bulg- 
ing, shiny, tympanic membrane, which, though perhaps not 
seen in any prover of the drug, has been familiar to most of 
us in the acute otitis recently so frequent after influenza, 
and in which belladonna usually proved curative. If one of 
Hahnemann's symptoms — purulent discharge from ear for 
twenty days — is reliable, the drug must, in this case at le9.st, 
have caused perforation of the drum-head. 

To take another example :— In hepar sulphuris we have 
a drug invaluable in suppurative diseases of both eye and 
ear, marked also by striking resemblances between the 
pathogenetic symptoms. There being no very complete 
provings recorded in the Cyclopsedia I will avail myself of 
the Hahnemannic symptoms as arranged in Dr. Allen's 
handbook. There we see that hepar causes inflammation 
and swelling of the eyelids with purulent, sticky mucus, the 
external ear also is red and hot with itching and increased 
secretion of wax. There are sticking pains in both organs, 
worse in eyes on moving them, and worse in ears by blowing 
nose. Crackling noises, as from electric sparks, and whist- 
ling in ears, are produced by blowing the nose, that is, by 
forcibly sending air up the Eustachian tubes, which points to 
the presence of increased mucus in the middle ear^ corre- 
sponding, perhaps, to the sticky mucus with lachrjmaation 
from eyes. This has been known to go on to suppuration 
with purulent discharge from the ears, and though in the 
eye no prover has, of course, pressed the drug so far as to 
develop pus in the anterior chamber, the value of hepar in 
hypopion is nevertheless well known to us. We also find 
under hepar that vision is dim by candle-light, and similarly 
in the ears murmuring noises are heard in the evening after 
lying down till sleep, with throbbing. Flickering vision 
seems to answer to roaring sounds. 

One more brief drug study in this connection will, I trust, 
be of interest, and assist our conclusions. 

Silica is a remedy with a very well defined action on 
ulcerations of both cornea and tympanic membrane. In the 



DBUa SYMPTOMS OF THE E7B AND BAR. 77 

former it is used for sloughing ulcers with a tendency to 
perforate » and having no red vessels running up to them — 
that is, when caused hy non-inflammatory states, such as 
struma and impaired nutrition. Houghton, in his " Lectures 
on Clinical Otology," recommends silica when the tympanum 
is perforated and irregular, secretion of pus scanty, the ulcers 
are deep and covered with scabs. He adds: ''It has been 
our view that more repairs of the membrane occur under 
the use of this remedy in chronic disease than under any 
other single remedy." 

In the CyclopeBdia -we find several examples of eye and 
ear being simultaneously affected by siUca. Prover No. 11 
experienced " pains in forehead and above eyelids increased 
by opening eyes," ** pain in eyes as if they were drawn out," 
also " tearing pains spread over temple with stitch in left 
ear, shooting pain in left ear ; " " for two or three days hard- 
ness of hearing in left ear, occasional tinnitus and persistent 
coryza." Prover No. 15 records " sudden dart of pain 
through left eye," and ** tinnitus aurium," and again, " cutting 
feehng in right eye, stitches in left ear." No. 17 had " both 
eyes agglutinated with mucus, hearing of both ears stopped 
for a short time." Others mention dimness of vision and 
hardness of hearing. It is interesting that several of these 
provers give the eye and ear symptoms together, as if these 
sensations were associated in their minds. By adding to these 
the Hahnemannian symptoms we obtain a still closer resem- 
blance. Swelling and inflammation round eyes with lachry- 
mation correspond to the same condition of the outer ear, 
with discharge of much thin wax. Also an ulcer on the 
cornea is recorded, and from mention of various thin dis- 
charges from ears we may conclude that perforation of the 
drum must also have occurred. The symptom — "photo- 
phobia in evening, a mist about a light with red and green 
halo " — may correspond to " sensitiveness to loud sounds, 
singing in ears in evening and sound of a bell at night." 

Surely we may conclude that such a similarity of symp- 
toms in the case of these three drugs can hardly be accounted 
for by their known general action alone. There are several 
other features in this analogy that may justify such a con- 



78 DRUG SYMPTOMS OF THB EYE AND EAB. 

elusion. In the ease of belladonna, impaired vision and 
hearing may be due to congestion of the optic and auditory 
nerves respectively, as well as to retarded conduction of 
sight and sound to the retina and labyrinth. May not the 
dilated iris and paralysed accommodation, producing dimness 
of sight, compare with impeded movement of the tympanic 
membrane and ossicles from a similar spasm of their accom- 
modating muscles, the levator tympani and stapedius, as well 
as to inflammatory thickening of the mucous lining of the 
middle ear? 

You will notice that I have contrasted hallucinations of 
sight, flashes of light, flickering, &c., with tinnitus aurium. 
The causes of each seem to be strictly analogous. If we 
close our eyelids and tap the eye-ball gently and rhythmi- 
cally with the finger, after a few moments each tap will be 
seen to apparently cause a flash of light. This explains the 
production of tinnitus aurium. Sounds which previously 
were correctly transmitted, now find the conducting appa- 
ratus unable to vibrate in unison with them, and thus their 
finer characteristics are lost, but producing instead a con- 
strained, though rhythmical, movement of the thickened 
tympanum and inflamed ossicles, they give rise to hum- 
ming, roaring and other fictitious noises. It is probable 
also that currents set up in the fluids — mucus or pus — 
which in congested states distend the middle ear, are other 
factors in the production of these sounds. In many cases 
the auditory neive is at fault in addition to, or even in- 
dependently of, such causes; hence the production of 
illusions of sight and sound by drugs that cause optic 
neuritis and corresponding nerve deafness, as I shall pre- 
sently show. 

The comparison of photophobia to sensitiveness to sound 
can only be justified when the former exists without any 
conjunctivitis. It is interesting to observe of the thirty- 
three remedies which, in Dr. Hayward's recently published 
Ear chapter of the '* Cipher Kepertory,'* are said to have 
produced improved or sensitive hearing, or sensitiveness to 
noise and music, that twenty-six of them also cause photo- 
phobia. Of the remainder, five have symptoms similar 



DBUa SYMPTOMS OF THE ETE AND EAB. 79 

to photophobia, such as sensitiveness to light, inability to 
keep eyes open, inflammation, &c., and the remaining 
two are almost miknown and unproved. Again, may not 
increased secretion of wax in ears have some analogy to 
lachrymation ? Dr. Hajrward gives us eleven drugs causing 
this, of which nine also produce lachrymation. In the 
repertory in Houghton's " CKnical Otology *' I have found 
that of thirty-eight remedies which are there said to cause 
free discharge of wax, no less than thirty-three produce 
lachrymation also, and of the remainder four are but little 
known or used, the only important exception being berberis. 
Before proceeding to apply the principles I have sug- 
gested to the elucidation of some lesser known remedies, 
there are two common conditions, one in each organ, which 
appear to be peculiar and will not help us. The first is 
conjunctivitis. The conjunctiva belongs strictly to the 
respiratory tract, being a prolongation of its upper mem- 
brane through the nose. We find, therefore, that drugs 
inflaming it belong chiefly to the respiratory sphere, such 
as aconite, euphrasia, arsenic, iodine, &c. There seems to 
be no analogous portion of the ear, though in certain forms 
of middle ear catarrh we have an analogous condition, and 
one in which the same drugs are useful. Hence symptoms 
due obviously to affections of the conjunctiva alone must 
generally be discarded in comparison with ear disease. 

That condition of the ear which seems unrepresented in 
eye disease is the form of chronic middle ear catarrh which 
is usually kept up by morbid states of the posterior nares 
and pharynx, or, in children, of the tonsils. Thus are 
caused constant extensions of catarrhal inflammations up 
the Eustachian tubes, and so the ear trouble is maintained. 
Although it is such a common cause of deafness this seems 
to be, strictly speaking, a naso-pharyngeal disease of which 
the former trouble is only an extension. The impossibility 
of curing the aural catarrh until other parts are restored to 
their normal state and no more colds are caught, well known 
to all who treat such cases, confirms this view, and explains 
why no analogous condition of the eye is met with. We 
find too that the remedies most useful in chronic middle 



80 DBUG BI^MPTOMS OF THE BTE AND EAB. 

ear catarrh of this tjrpe, such as hydrastis, nitric acid, nux, 
and also chlorides and iodides, have a special aJB&nity for the 
gastric or respiratory tracts, and, except by extension of 
inflammation from nose to conjunctivae, do not exhibit 
any specific action on the mechanism of sight. It is 
possible, however, that post-catarrhal deafness may have 
some more analogous condition in the eye, and perhaps 
when caused by impaired movement from adhesions of the 
drum-head and ossicles it might compare with the results 
of iritis and chronic defects of accommodation. 

I now endeavour to apply these principles to the study of 
certain drugs, which, though well known and often used in 
ophthalmic work, have not hitherto received much attention 
by aurists. And this I attempt not at all as a specialist, a 
position to which I have no pretensions, but simply as a 
student of the materia medica. Having had the misfortune 
to suffer slightly from middle ear catarrh myself, I have be- 
come, perhaps, specially interested in such conditions. The 
first remedy I ask you to consider in the light of these 
suggestions is zincum. 

The value of zinc in catarrhal conjunctivitis, ophthalmia 
and inflammations, especially of the inner canthus, is 
known to us all. Its homoeopathic relation to these condi- 
tions gives success to many an allopathic eye wash. But it 
is from its use in pterygium, and its affinity for circum- 
scribed corneal inflammations, that I think we may gain 
help in ear disease. These inflammations seem to be 
specially characterised by burning, smarting, itching, and 
tickling, also by lachrymation and photophobia, with red- 
ness of conjunctivae and cloudy vision. We might then ex- 
pect that the condition of ear induced by the drug would give 
us symptoms of inflammation of the membrane, and, per- 
haps, of the middle ear, with similar characteristics. And 
this, indeed, is the case so far as has been observed, accord- 
ing to the Cyclopaedia provings. "Wax is increased, hearing 
is dull and impeded, beating of pulse is distinct and causes 
roaring, there is a discharge, that may also be purulent. 
Other provers mention burning, and tickling not better by 
rubbing, and a feeling on putting finger in ear as if fleas 



DBUG SYSTEMS OF THB BYB AND BAB. 81 

were jumping about in it. Various noises and stitches 
are also described. Is not this, I may ask, a picture of 
the subjective symptoms experienced in sub-acute otitis, 
especially that form left after an imperfect recovery from 
an acute attack of inflammation ? Numbers of these oases 
were going about after influenza, and I greatly regret my 
attention had not then been called to the drug at the time 
the epidemic was so prevalent. On examining the ears of 
such patients you would find a condition strikingly similar 
to that observed in the eyes of the provers — the external 
meatus somewhat congested, the drum red and thickened, 
with visibly dilated capillaries forming patches on it, and 
increased secretion of wax. These cases are distinguished 
from the more acute inflammations in which belladonna is 
useful, by the generally less violent nature of the symptoms, 
pains are less, throbbing less, tinnitus less, but especially by 
increase of secretion of wax, there being generally dryness of 
the meatus under belladonna, and also by internal itching 
and tickling in the ear. I have often observed in these con- 
ditions patients boring into their ears as if to relieve the itch- 
ing, and perhaps the sensation *' as of fleas jumping about in 
them," might gratify the thirst for key-notes with which 
some of our colleagues over the water are said to be afflicted. 
A remedy which has received little attention from aurists, 
and yet which a consideration of its eye symptoms suggests 
as likely to be of value, is clematis erecta. This drug has a 
very well defined action on the iris, seeming to stand midway 
between the effects of a s}rphilitic taint on the one hand, and 
a rheumatic diathesis on the other. Its general indications, 
such as hard and painful swellings of glands, orchitis, and 
herpetic eruptions in rheumatic subjects, are well known. 
The violent toothache, transiently relieved by cold and 
aggravated by heat, and other symptoms closely resembling 
those of mercurius are important. The value of mercurius 
dulcis in middle ear catarrh is well known ; and from the 
similarity of the indications for clematis and its effect in 
iritis, we may look for its probable usefulness in a similar 
condition of the tympanum. A closer examination of its 
eye and ear symptoms may help to make this more evident. 
VOL. ni. — ^No. 1. 6 



82 DBUa SYSTEMS OF THE EYE AND EAB. 

In the CyclopaBdia, prover No. 2 records " impaired hear- 
ing '* as one of the first symptoms noticed. Next day it was 
assopiated with singing in left ear, dry nose, and pain in a 
carious molar. Pains in teeth increased, with sense of 
elongation and sweUing of gums, which was reheved by 
mere. sol. Prover 3 experienced drawing pain and occa- 
sional singing in ear, with swelling of glands of neck and 
salivation. Others describe heat and burning pain of 
external ears, congestions of head with headache, noises in 
ears, and various catarrhal symptoms. The eye symptoms 
are too well known to require repetition in full; Those that 
have been clinically proved as most reliable are pressing 
pain, photophobia, heat and burning, with special sensitive- 
ness to cold air, contracted pupils and dim vision. These 
conditions run chiefly in syphihtic or rheumatic persons, 
when cold and exposure has induced another attack of iritis. 
It is probable that clematis might prove useful in similar 
subjects with dry catarrh of the membrana tympani and 
middle ear, chiefly, perhaps, when the condition is not con- 
nected with nasal or pharyngeal troubles, and there is no 
discharge of mucus down the Eustachian tubes into the 
throat. This would give us burning heat in ears, with sen- 
sitiveness to cold air and only slight impairment of hearing. 
Such conditions, when the result of recent exposure, and 
especially if associated with the characteristic tooth symp- 
toms of the drug, would certainly call for clematis. 

We may now consider those more obscure causes of 
deafness which arise in the inner ear, and seem somewhat 
allied to bUndness from affections of the retina and optic 
nerve. This correspondence has been observed by Dr. 
Houghton in his valuable ** Lectures on Clinical Otology.'* 
In the chapter on inflammation of the internal ear he speaks 
of " those cases of hypersesthesia, in which the person is 
excessively sensitive to simple noises," and says, ** these are 
analogous to those sjonptoms of the optic nerve in diseased 
conditions when the patient has illusions of colour." He 
goes on to point out that these symptoms are not necessarily 
due to organic changes in the auditory nerve, although such 
lesions are often present. Following this is given a very 



DBUO SYSTEMS OF THE ETB AND EAB. 83 

interesting example of the value of a practical recognition of 
this analogy, which I venture to reproduce. A girl, aged 21 
years, found her sight going, and a year after failure of hear- 
ing occurred, with constant tinnitus and persistent head- 
aches. Dr. Houghton observes: ** The same morbid process 
which progressed two years in the optic tract had now un- 
doubtedly commenced its ravages in the auditory trunk. . . 
The case was clearly an idiopathic disease. The remedy 
which arrested the neuritis was spigelia. Under this drug, 
not only w^as the optic neuritis arrested, but also the vertigo 
which occurred usually on raising the head after waking in 
the morning, when the bed seemed to revolve horizontally, 
ceased, the tinnitus was reduced to a minimum, and," Dr. 
Houghton adds, " everything indicates the arrest of the 
morbid process which threatened to abolish both functions.'* 
Under the ear symptoms of spigelia there is one observation 
worth repeating ; it is, " sudden buzzing and cracking before 
ears, extending into forehead, better by holding hands over 
eyes, v^th wave-like pulsation in them." Without going 
farther into the well-known symptoms of spigelia, I may 
suggest its probable utility in obscure forms of deafness 
when any of the characteristic eye and head indications are 
present. Some of the middle ear s)maLptoms, which are 
numerous, and the posterior nasal catarrh induced, suggest 
also its possible similarity to otitis with catarrh of the 
tympanic cavity. 

Dr. Dyce Brown's admirable study of tabacum, in the 
lately issued volume of London Homoeopathic Hospital 
Beports, shows that we have clearly been guilty of neglect- 
ing the drug. This is especially true of its eye and ear 
symptoms. In my practice recently, a case of partial blind- 
ness in a strumous and rheumatic lady, which had been 
diagnosed by a well-known Birmingham oculist as " choroi- 
ditis disseminata, with small scattered atrophic patches," 
was greatly benefited both in general health as well as the 
eye pains, distressing flashes of light being also reheved by 
tabacum, which covered all the symptoms. The very clear 
characteristics of the drug may guide us in its selection 
in ear cases. Unfortunately, the changes in the internal ear 



84 DBUG SYSTEMS OF THB EYE AND EAR. 

corresponding to atrophy of the optic nerve with congestion 
remain almost miknown to us, but here Hahnemann's 
method of comparing subjective symptoms once more proves 
its value compared with the helplessness of modern path- 
ology when unenlightened by the law of similars, and we 
can, with a probability of accuracy, describe the conditions 
when a drug may safely be prescribed, independently of our 
knowledge of the actual pathological condition. 

Dr. Brown points out the action of tobacco on the 
cerebro-spinal nervous system. Here it first causes excita- 
tion ynth some congestion, then long-lasting depression, 
which may be followed by organic degenerative changes. 
In the eye, the results of this process appear in atrophy of 
the disc, blindness, and a long list of subjective sensations. 
The ear symptoms recorded suggest similar changes in the 
auditory tract. We have first, sensitiveness to loud sounds, 
almost amounting to hjrpersBsthesia, with noises humming 
and ringing in ears ; this is followed by gradual duhiess of 
hearing, during which the noises and dislike to music and 
loud talking continue. Such would occur in nervous, 
hypochondriacal, depressed people, subject to dyspepsia 
and palpitation, usually with pale, sallow complexions, 
spare habit and loss of sexual power. Dulness of hearing 
arising in this way with tinnitus aurium in such persons, 
especially if associated vdth occasional vertigo resembling 
Meniere's disease, and unconnected vdth any middle ear 
trouble, we might surely expect to relieve by tabacum. 

In Macnaughton Jones's recent book on ** Subjective 
Noises in the Head and Ears," due notice is taken of the 
presence of uric acid, gouty, rheumatic and S3rphilitic con- 
ditions as causing tinnitus aurium. In addition to these 
there is one allied state often overlooked as a factor in the 
production of tinnitus ; Irefer to so-called bilious conditions, 
when bile and effete matters, that have escaped the vigilance 
of a sluggish congested liver, circulate in the blood. This 
may explain why nearly all drugs acting specially on the 
liver, have tinnitus and various subjective noises prominent 
in their ear symptoms, and also cloudy sight, vdth specks 
and musc8B volitantes floating before the eyes. This is true 



DBUO SYSTEMS OF THE EYE AND £AB. 85 

of bryonia, mercurius, and others, but especially of cheli- 
donium. Morfe than any other remedy does this drug cause 
hepatic congestion and engorgement, with over secretion of 
bile, which escapes either as bilious diarrhoea or vomit, or, 
entering the blood, produces jaundice, yellow conjunctivBB 
and skin, bilious headaches, cloudiness of vision with black 
specks before eyes, and lastly, ringing, singing and other 
noises in ears, with difficult hearing. In an old lady I 
recently attended for a complication of disorders, in which 
Uver symptoms were prominent, cheUdonium rapidly cured 
her long-standing tinnitus and deafness, which local treat- 
ment to ears had always failed to relieve ; bilious symptoms 
disappeared at the same time. Belief was procured for six- 
teen months, when mental worry caused a slight return of 
the same condition. She is now taking chelidonium again 
with success. 

Probably there is no symptom so little understood and yet 
80 interesting in connection with disorders of vision and of 
the internal ear as vertigo. It is doubtful whether vertigo, 
which by the way occurs in the pathogenesy of nearly every 
drug we have, is ever caused apart from circulatory or nerve 
disturbance in the semi-circular canals of the labyrinth, 
which it seems can never be excluded as a necessary factor 
in its production. Eoughly speaking, drugs may be divided 
into three classes according to the manner in which they 
produce vertigo. We have first those in which it is secondary 
to some gastric disturbance, in which a gastric symptom 
always precedes its production. Secondly, those which 
disturb the circulation primarily, such as aconite, digitalis, 
glonoin, &c. ; with these also vertigo occurs as a secondary 
effect. Lastly, we have those in which vertigo is often the 
first symptom recorded, produced by immediate action of the 
drug on the nerve centres. The same remedies cause also 
dimness of vision, and usually deafness or tinnitus aurium 
occurs coincidently. We find that some of the drugs coming 
nnder this head are those that experience has proved to be 
of special value in Meniere's disease. They are quinine, 
salicylate of soda, gelsemium, conium, and cicuta. From a 
<;omparison of their eye and ear symptoms I would add that 



86 DBUG SYSTEMS OF THE EYE AND EAB. 

probably hyoscyamus, stramonium, physostigma, ergot and 
possibly santonine might be found useful in the same condi- 
tions, when vertigo, deafness and disturbance of vision with 
headache are present. Of these latter, two have proved 
specially valuable in treating the vertigo of locomotor ataxia, 
which I believe to be the purest example of simple nerve 
vertigo that we have ; these are ergot and stramonium. Of 
quinine and salicylate nothing need be said. Dr. Houghton 
gives a case of Meniere's disease cured by gelsemium, and 
our colleague, Dr. Cooper, in his book on " Diseases of the 
Ear," gives conium and cicuta as also useful. 

I could wish that experience justified me in taking up 
Dr. Ellis's challenge with regard to the use of carbon disul- 
phide in eye and ear diseases, the special application of which 
in peripheral neuritis he so skilfully indicated just a year ago 
in his paper *" On the Value of lesser known Drugs.*' From 
a materia medica standpoint I may venture on a few 
remarks. The symptoms produced by carbon disulphide 
seem to be largely a combination of those of its component 
remedies plus an enormously increased power over the 
nervous system. This has been shown in the production of 
true peripheral neuritis with its resulting paralysis, anaes- 
thesia, and other symptoms, which seem much the same as 
those we are familiar with from lead and alcohol poisoning. 
The eye symptoms of carbon disulphide show an unmis- 
takable optic neuritis, and the deafness produced probably 
comes from a similar condition of the auditory nerve. In 
this respect we may expect it to be useful in pure nerve 
deafness, with or without tinnitus, but chiefly in elderly 
people with dryness of the meatus, — for the action of the 
carbon seems more local and to predominate over the more 
general symptoms due to the sulphur, so far as I can inter- 
pret its pathogenesy. This occurring with optic neuritis or 
any signs of similar nerve lesions elsewhere would be an 
additional indication for its use. But I think the chief 
sphere for carbon disulphide may be found in chronia 
catarrhs of the middle ear. A comparison of the numerous 
eye symptoms, confirmed by the ear indications, renders this 
very probable. Time forbids my examining them in detail. 



DRUG SYSTEMS OF THE ETE AND EAB. 87 

Dr. Houghton recommends carbo veg. when there is granular 
pharyngitis, with itching and heat deep in the ear and 
meatus, causing an inclination to swallow. These condi- 
tions occur generally with proliferous, non-suppurative 
inflammation of the middle ear, with retracted dry tympanic 
membrane and easily dilated Eustachian tubes. Those symp- 
toms in the pathogenesy of carbon disulphide, which I have 
referred to, seem to suggest the same local condition but 
modified by the sulphur diathesis. Hence this would indi- 
cate the special value of the drug in strumous or arthritic 
persons, the former when early in life with disposition to 
catarrhs and the well-known sulphur characteristics, and 
the latter later on when arthritic and skin affections have 
replaced the former state or are further modified by gouty 
poison. Here too the carbon element may show itself by 
deficient venous circulation, coldness and blueness of extre- 
mities and short breath on exertion. 

In all these conditions the neurotic symptoms of carbon 
bisulphide are closely allied to those produced by plumbum. 
Probably optic neuritis, which has been known to yield to 
the use of lead, in suitable cases might be arrested by the 
former drug. I also suggest that in plumbum we may 
find a remedy for similar nerve deafness to that produced by 
carbon disulphide, tabacum and spigelia, when the arthritic 
symptoms and anaemia indicate its own closer similarity. 

This is the last drug I propose to consider this evening. 
Perhaps the views put forward may appear crude and 
uncorroborated, but if they serve to suggest ideas that 
others may take advantage of, and perhaps develop with 
greater skill and precision than I have attained, this paper 
will not have been prepared in vain. 

Some apology may be due from the paucity of clinical 
cases I have brought forward, but it is probably safer to 
leave those who will not be likely to magnify my ducks 

• _ 

luto swans to confirm these suggestions in practice. I am, 
however, testing them as opportunities occur, so far with 
encouragement and success. 



88 IH8CU8SIOH OH DBUO 8TBTBM8 OF THB ETB AND BAB. 

Dr. HuoHBS said that some years ago he had done a little 
pioneering work in the same field, and had written a paper on 
the "Homologies of Eye and Ear/' which appeared in the 
Homaopathie Beview for 1868, suggesting similar correspondences 
to those which Dr. Ord had now pat forward, doubtless from 
entirely fresh thinking. Dr. Ord had indeed developed the subject 
much further than he (Dr. Hughes) had done ; but he would like 
him to look that paper up. He did not quite agree with Dr. Ord 
about the homolc^y of the conjunctiva. Dr. Ord had very justly 
said that the conjunctiva was a prolongation of the respiratory 
mucous membrane, but so was the lining of the middle ear, and 
he (Dr. Hughes) ventured to think that the homologous parts 
were the conjunctiva on the one side and the middle ear on the 
other ; that though they somewhat differed in their anatomical 
relations, yet physiologically and in response to drugs they were 
identical, and the same medicines would be found to act on their 
morbid states. 

Mr. DuDiiET Wbight thought Dr. Ord had made out a very fair 
analogy between the different parts of the eye and the ear ; but 
the only prmciple on which he had made that analogy was 
either their function or their position. Of course, it was found 
that one part of the eye received impressions, and another part of 
it transmitted them ; and one part of the ear received impressions 
and another part of it transmitted the impressions ; but when the 
matter was studied more closely, it was found that there was a 
very great difference between the various parts of the transmitt- 
ing and receiving apparatus in the two different organs, and he 
did not think they could really, so far as symptomatology was con- 
cerned, carry out the train of relationship between the two. Dr. 
Ord had stated there was no part in the ear corresponding with 
the conjunctiva in the eye. As Dr. Hughes had said, the middle 
ear most decidedly did correspond with that. It was simply a 
prolongation of the respiratory mucous membrane ; at any rate, 
with the mucous membrane that lined the nose, the pharyngeal 
cavity, and the tracheal cavity. Another matter which he 
thought Dr. Ord had overlooked was that the lens, although corre- 
sponding with the drum membrane and ossicles in its functions, 
was altogether different from it in its development. For instance, 
they knew that the lens was originally formed from the epiblast of 
the body of the embryo, and the only part of the ear which corre- 
sponded with this structure, so far as embryology was concerned, 
was the labyrinth. That, too, was formed by an involution of the 
epiblast, which in time got vacuolated and formed the sac which 



DISCUSSION ON DBUG BTSTEMS OF THB BTB AND EAB. 89 

eventnally produced the semi-circular canals and the nuclei of 
the utricle, the saccule, and the cochlea. So that so far as the 
relationships which Dr. Ord had mentioned were concerned, he 
(Mr. Wright) did not think they ought to act upon them for 
guidance in choosing remedies. The only true way in which 
the similarity between the two could be taken was in micro- 
scopical investigation. If one structure was found in the eye 
corresponding with another structure in the ear — for instance, 
the nervous structure of the eye with the nervous structure 
of the ear, the glands of the eye with the mucous glands of the 
ear, the lining membrane of the tympanum with the lining of 
the conjunctiva, the fibrous tissue of one organ with the fibrous 
tissue of the other — and it was found that those particular parts 
were affected by a particular drug, then they had a proper basis 
on which to prescribe. With regard to the nerve deafness which 
Dr. Ord had spoken of, very much had to be learnt. Unfortu- 
nately, they were not in a position yet to tell precisely in any given 
case of internal ear disease when the nerve itself was affected, and 
when simply different parts or contents of the labyrinth were the 
structures primarily involved. We know certain causes will bring 
about a haemorrhage in the inner ear ; the labyrinthine fluid will 
be displaced by blood, and in those cases the symptoms produced 
will be exactly the same as those produced by a lesion of the 
nerve trunk itself. In one case the treatment ought to be com- 
pletely different from the other ; and yet, prescribing on symptoms 
alone, there was nothing to guide them as to the part affected, 
and which drug they ought to choose. Bather they should try to 
ascertain the differenfc effects the drugs had upon the inner ear, 
to find out which caused degeneration of the nerve substance 
pure and simple, which caused haemorrhage, and which caused 
different diseases of the labyrinth structures, and then upon that 
basis only should they prescribe them. There were one or two 
remedies which Dr. Ord had not mentioned. In the Monthly 
HomcRopathic Beview of March 2, 1891, he (Mr. Wright) had 
recorded a case in which very marked and long standing Meniere's 
symptoms, in a patient suffering from middle ear disease, had 
yielded to a few doses of bryonia alba. He had seen the patient 
since that, and there had never been any return of the symptoms. 
Another remedy he had not seen mentioned by homoeopathists 
was pilocarpine, which the allopaths were using very much in 
labyrinthine troubles. When there was reason to suspect hsemor- 
rhage or any trouble with the inner ear, pilocarpine was used with 
very good results indeed. Allopaths pushed it until its physio- 



90 DISCUSSION ON DRUG SYSTEMS OF THE EYE AND EAR. 

logical action was produced — ^profuse perspiration, and even faint- 
ness ; but he thought homoeopathists should try to find out what 
were the effects of pilocarpine on the structures of the ear and the 
eye. He thought aurum was a remedy in chronic conditions of 
the middle ear and internal ear, from which they might expect 
to get a great deal of benefit. 

Dr. Dudgeon thought that Dr. Ord's paper, like all analogies, 
had little practical value, for they could not say because a medicine 
acted upon the eye, that it would consequently act upon the ear. 
No doubt many of the medicines did act both upon the eye and upon 
the ear, but the parts of the eye and the ear were not analogous. 
Dr. Ord compared the membrane of the tympanum with the cornea, 
but they were perfectly different. The membrana tympani 
• was really a membrane attached to a muscle, and there was a 
muscular movement connected with it which was not found in 
the cornea. It must not be inferred from the action of a medicine 
upon the eye that it would act upon the ear. In practice it was 
necessary to study the action of medicines on each individual 
organ, and that they acted on other organs having a fanciful 
analogy would not help the practitioner as far as he was aware. 
Dr. Ord's paper was ingenious and interesting, and showed much 
thought and study, but its practical value was not commensurate 
with the pains expended upon it. 

Dr. Hayward thought the tendency of the action of medicines, 
both in pathogenesy and cure, was along the line of structure 
rather than that of the functional use of parts. A great part of 
our practice in ear diseases is in connection with the middle ear, 
which is lined with mucous membrane continued through the 
Eustachian tube, as the mucous membrane — the conjunctiva — of 
the eye is in connection with that of the nose ; hence the spread- 
ing of catarrhal conditions. He could not, therefore, agree with 
Dr. Dudgeon that these parallelisms between the eye and the 
ear were of no great use in practice ; he believed they afforded 
many useful hints. 

Dr. Ord, in reply, said that Dr. Hayward had summed up the 
position in words that exactly expressed his (Dr. Ord's) feeling 
as to the analogies which he had endeavoured to point out, 
namely, that they were parallelisms which did give hints that 
might be valuable in treatment. He did not claim much more 
than that. He had in his paper carefully avoided reference to 
anatomical or developmental analogies, which were of little help 
in materia medica. Nearly all the symptoms that had been 
produced by drugs were from functional disorder, and it was 



DISCUSSION ON DRUG SYSTEMS OF THE EYE AND EAB. 91 

especially in elucidation of those symptoms, produced by func- 
tional derangements, followed in due course, no doubt, by patho- 
logical changes, that he had endeavoured to establish such an 
analogy, and suggest its probable value in practice. In the case 
of the three drugs, belladonna, hepar, and silica, to which many 
others might be added, he had noticed that not one of those who 
differed from his analogy on anatomical grounds had found fault 
with the conclusions he drew from the consideration of those 
drag symptoms, i.6., that parts which performed similar functions 
were similarly affected by each of them. In this respect there 
was an extraordinary agreement between them, and he thought 
it might be utilised. But the analogy failed if applied on purely 
anatomical grounds, or from a study of embryology ; this would 
not help them and was outside the scope of his suggestions. 
With regard to what Mr. Dudley Wright said, he (Dr. Ord) 
quite agreed with all he said, so far as his facts were concerned, 
only in the application of them they were looking at things from 
a different standpoint. Mr. Wright was taking the pathological 
and anatomical side, and he (Dr. Ord) was taking the materia 
medica and functional side, which for his purpose were the most 
important. This enabled him to utilise the subjective symptoms, 
which were all of value when genuine. He did not agree that 
middle ear troubles and conjunctivitis were comparable; on 
purely anatomical grounds they might be, but functionally they 
were not, and the remedies acting on the former were chiefly of 
the gastric sphere, the mucous membrane being prolonged from 
the pharynx and cesophagus, rather than from the respiratory 
tract. The subject was a difficult one. 



92 LIVERPOOL BBANOH MEETINGS. 



LIVEBPOOL BBANOH MEETINGS. 
Annual Bepobt, 

Thirty-seventh Seseion, presented on October 12, 1894. 

It is once more my pleasant duty to briefly review the work of 
another successful session. The usual eight monthly meetings 
have been held, and the following papers have been read and 
discussed : — 

1893.— Oc^. 12: Presidential Address by Dr. John W. Ellis, on 
" The Value of Some of the lesser-known Drugs, in the Treatment 
of Diseases of the Nervous System." Nov. 9: "Notes on a 
Case of Villous Growths in the Bladder," by Dr. J. D. Hayward ; 
and a paper on '* The Duties of the Physician," by Dr. Simpson. 
Dec. 9: Paper on *' Anaemia (Chlorosis)," by Dr. Davidson. 

1894. — Jan. 11 : *' The Presentations of our Materia Medica,** by 
Dr. J. W, Hayward. Feb, 8: '* Ghosts, in the Light of Modern 
Science," by Dr. C. Theodore Green. Mar. 8: ** Diagnostic 
Hints in Ophthalmic Work," by Dr. Gordon. Apr. 11 : Clinical 
Evening. May 10: " Lochial Pyrexia," by Dr. Hawkes. 

In addition to the above papers, many cases of interest have 
been brought before the society, and a number of pathological 
specimens exhibited. 

The following is a complete list of the fellows and members of 
the Liverpool Branch: — Fellow, Dr. Hayward, senr. ; Members, 
Dr. Hawkes, Dr. Mahony, Dr. J. D. Hayward, Dr, C. W. 
Hayward, Dr. Jones, Dr. Gordon Smith, Dr. Gordon, Dr. Stuart, 
Dr. Williams, Dr. Simpson, Dr. Capper, Dr. Green, Dr. Ellis, Dr. 
Thomas, Dr. Davidson, Dr. Finlay, Dr. Mitchell, Dr. Stopford, 
Dr. Storrar, Dr. Hall, Dr. Haynes Thomas, Dr. Meek, Dr. 
Southam, namely, 24 in all. As was anticipated, the membership 
has been largely increased by the joining of the branch by mem- 
bers of the British Homoeopathic Society in neighbouring towns ; 
nine new members have thus been added this Session. 

The ofl&cers elected for Session 1894-5 were : — President, Dr. 
Capper ; Vice-President, Dr; EUis ; Secretary and Treasurer, Dr. 
Bernard Thomas; Bepresentative on the Council of the Society, 
Dr. J. W. Hayward. • 



IiIVERPOOL BBANOH MBSTIKaS. 



93 



A local subscription of 2s. 6d. per member was voted to defray 
the expenses of the branch. 

The cash account shows a balance in hand of 5s. 8|d. 

On the whole I am happy to be able to report the continued 
and increasing prosperity of the society. 

I am. Gentlemen, 

Yours faithfully, 

Edmund Gappeb, Hon. Sec. 



BALANCE SHEET, 1898-94. 



Dr, 



Cr. 





£ s, d. 


1894. & 8. 


d. 


To balance in hand, Octo- 




By payment to G. Ellams • 




ber, 1893 


12 m 


for stationery- 




„ Twenty-three Mem- 




April 10 . . . . 1 18 


4 


bers' subscriptions at 




September 20 ..06 





28. 6d. (as per receipt 




October 8 . . ..11 


4 


book) 


2 17 6 


„ balance in hand, Octo- 




„ One fine at Is. 


10 


ber, 1894 . . ..05 

£S 11 


^ 


■ 


£3 11 44 


Jt 



Audited and found correct^ 

B. GoBDOK Smith. 
John D. Hatwabu. 



94 SOCIETY NEWS. 



SOCIETY NEWS. 

At the opening meeting of the Liverpool Branch of the 
Society, the Secretary presented the Annual Eeport of the 
session 1893-94 (see page 92), which shows the Branch to he in 
a flourishing and active condition. 



At the second meeting of the session in London, the Presi- 
dent (Dr. Byres Moir) and Dr. Hughes referred to the death of 
Dr. L6on Simon, the oldest corresponding member of the Society, 
who died on September 16th, 1894. A vote of condolence and 
sympathy with the family was unanimously passed. 



Dr. Hughes, in seconding the vote of condolence, said it was 
known to most of them that the late Dr. L6on Simon was one of 
a family who had done the utmost service to the cause of 
homoeopathy in France. His father was one of Hahnemann's 
original disciples. Dr. L6on Simon's son, Dr. Vincent L^on 
Simon, whom many of the members would remember having seen 
at the Congress in 1881, showed every sign of worthily succeed- 
ing his father. Dr. L6on Simon died in his Tlst or 72 nd year. 
He had been for many years the practical head of the more 
strictly Hahnemannian school in Paris, as distinguished from the 
more liberal school, of which Tessier in his lifetime, and Dr. 
Jousset afterwards, were the leaders ; but although the differences 
between them led to the formation of separate hospitals, and, for 
a long time, separate societies, he (Dr. Hughes) did not think 
there was any unfriendly feeling. He had had the pleasure of 
meeting Dr. L6on Simon at the Congresses held in Paris in 1878 
and again in 1889, and having been brought officially as well as 
personally into contact with him, he had found him as courteous 
a gentleman as he was an accomplished physician. 



At the November meeting of the Liverpool Branch, Mr. T. G. 
H. Nicholson, M.E.C.S.Eng., 27, Catherine Street, Liverpool, was 
elected a member of the Branch. 



By the death, from apoplexy, after a few days' illness, of Dr. J. 
'^ Dake, American homoeopathy has lost one of its pillars, and 



SOCIETY NEWS. 95 

this Society a valued corresponding member. Bom in 1827, 
graduating at the Hahnemann Medical College of Philadelphia, 
and practising first at Pittsburg, then at Nashville in Tennessee, he 
has always been among the foremost in the defence and advance- 
ment of our system. President of the American Institute of 
Homoeopathy in 1857, he has ever been one of its most active 
and honoured members. Lecturer on Materia Medica at his 
alma mater in 1855-6, he has since assiduously cultivated this 
field ; and it was through him that the attention of the Institute 
was so drawn to the need of a trustworthy drug-pathogenesy that 
it was led to join hands with our own Society in getting one con- 
stracted. He has brought up five sons to our branch of the pro- 
fession — four of whom survive him ; and bequeaths to them a 
worthy example, to his colleagues a treasured memory. 

At the December meetings of the Society, both in London and 
Liverpool, expression was given by resolution to the loss Homooo- 
pathy and the Society had sustained by his death. 



96 SUHMABT. 



SUMMAEY OF PHAEMACODYNAMICS AND 

THERAPEUTICS. 



"OATHEB UP THE FBAOMENTS, THAT NOTHING BE LOST. 



>9 



September — November, 1894. 



PHARHACODTNAHICB. 

Acidam carbolicam. — A case of poisoning by this substance 
is communicated by Dr. Ensey to the North American Journal of 
HonuBopdthy for October. The symptoms during life were those 
of pure coma, precisely simulating poisoning by opium. At the 
autopsy, ** the remote effects seemed to be entirely centred in 
the brain and spinal cord. The vessels of the dura mater and 
pia mater were turgid with dark fluid blood. On section, the 
brain substance itself dripped blood. There was excessive serous 
effusion into cavities of skull and spinal canal." 

Aoonite in pneumonia. — *' Some years ago I made a trial of 
aconite, and for a long time I treated every case of acute pneu- 
monia that I met in this way : one drop of the tincture was given 
every ten minutes for an hour, and then the same dose was given 
every hour for twenty-four hours. By this means I succeeded, 
certainly, in controlhng temperature ; but I failed to observe any 
control of the disease. All I could claim was that I had intro- 
duced irregularities into the temperature charts — an exploit that 
I have no ambition to repeat." — Raven, Practitioner, July. 

Ammonium caFbonicum. — Epistaxis occurring every morn- 
ing for a week, after washing face, was checked in two days by 
the 6x dil. of ammonium carbonicum three times a day. — North 
Amer. Joum, of Horn., September, p. 595. 

Dr. Gallavardin, who makes a specialty of mental perver- 
sities, recommends ammonium carbonicum, 30th and higher, for 
uncleanliness ; and this not only in demented patients, but in 
those otherwise enjoying good health. — Horn. World, November. 



SUMMABT. 97 

AnaoaFdimn. — Dr. Swift reports a case of gastralgia coming 
on as the stomach emptied itself, which he treated with anacar- 
dium. It cured, hut as it did so produced general itching and 
an eruption resembling that of rhus poisoning. — Med, Century^ 
September 1, p. 412. 

A student, being forgetful, took anacardium Ix in pellets. 
After ten days he became more forgetful, could not remember his 
own name, had double vision, and complained of being so very 
weak that he could scarcely walk. On his hands, especially the 
index and middle fingers, there appeared a papular eruption, 
which terminated in vesicles filled with a very sticky fluid. The 
eruption was characterised by an intense itching, burning and 
smarting, aggravated by scratching at night. His fingers were 
very much swollen, and the pain at times was unbearable. 
Heat also aggravated the condition. Grindelia robusta was 
given, and relieved the annoying symptoms and cured the erup- 
tion. — Eahn. Monthly, September, p. 608. 

Apocynum. — Dr. Gliski has been experimenting on frogs 
and rabbits with the root of this plant. He finds it to act on 
the heart and arteries similarly to digitalis, and uses it medici- 
naUj accordingly. — Horn. World, October, p. 466. 

Aranea diadema. — Dr. E. D. Ayers, who practises in a 
malarial district of Arkansas, speaks of the ** algid '* form of 
intermittent as in his hands yielding promptly to aranea in 
medium potency, while quinine produced absolutely no effect. — 
Medical Century, October 1, p. 461. 

Amenioam. — A case of multiple neuritis is recorded in 
UOmiojpatia in Italia for 1894, where, after failure of old school 
treatment, arsenicum was given on account of the burning 
character of the pains, their nocturnal aggravation, and their 
amelioration by movement. Increasing doses were administered, 
up to a milligramme per diem. Improvement was rapid and 
continued; but as the symptoms of neuritis went off, another 
series developed — those of ataxia, with a great distinctness of 
Bomberg's sign. From these patient recovered slowly under 
secale and alumina. — Hahn. Monthly, November, p. 750. 

I>r. Gentry finds this drug effective in curing the tobacco 
habit. — Horn. World, September, p. 387. 

ArBenicum bromatum. — ^Dr. A. M. Gushing, asking ''Who 
has ever been satisfied with the results of sulphur, Pulsatilla, &c., 
in the acne of young people ?" and replying, " Not I," goes on to 

veil. ni. — NO. 1. 7 



98 SUMMABY. 

Bay, '' but I have been with the 4x of the bromide of arsenic. 
Try it, and make yourself and your patient happy." — Hahn, 
Monthly f October, p. 160 of appendix. 

AsafoBtida in Dyspncaa. — A recurring dyspnoea, after lasting 
three weeks, and resisting for another week ignatia and arseni- 
cum, was removed in twenty-four hours by asafoetida 2. It was 
connected with flatulence. — N. Am. Journ. of Horn,, September, 
p. 596. 

Belladonna. — A case of poisoning from the application of 
a belladonna plaster is related in the HomcBopathic World of 
October. It presents the special features of numbness of hands 
and feet, all objects seeming streaked with alternate lines of 
black and white, and pronounced tendon reflexes. 

Caloarea silioata. — Under this name, Dr. J. T. Boyd has 
introduced a new remedy into our pharmacopoeia. It is a mixture 
of our calcarea ostrearum and " rock crystal." He gives it in 
degenerations analogous to those undergone by sheep fed on grass 
grown on soil lacking these ingredients. He gives cases of 
incipient phthisis, stricture — ^presumably malignant — of the 
rectum, and profound nervous debiUty, where its action in 5-10 
gr. doses of the lOx trit. seems to have been marvellously effec- 
tive. — N. Am. Journ. of Hom., November. 

Camphor. — Dr. Emery relates four involuntary provings of 
this substance. The first was from chewing. Vertigo, tendency 
to unconsciousness, with feeling as if he would die, with pale face, 
formed the main symptoms ; and they recurred next day on his 
thinking about it again. In the second, eating a piece the size of 
a marble induced epileptiform convulsions,, lasting some twenty 
minutes, with wandering and hysterical excitement of mind. The 
third subject, a man, took a teaspoonful ; and vertigo was soon 
followed by syncope, lasting ten minutes — head hot, feet cold. On 
recovery, memory did not return for four hours ; and for some 
time distant objects were but dimly discerned. The same dose, 
taken by another man, caused severe cramp in stomach that 
night, with cold sweat on face and abdomen, pulse hardly percep- 
tible. Some febrile reaction followed. — Amer. Homosopathist, 
November 15. 

Cannabis indioa. — Yet further experiences of the action of 
this drug, when taken in the form of haschisch, are contained in 
the EomoBopathic World of September and October. 



8UMMABY. 99 

Canlophyllam. — This medicine has been somewhat neglected 
of late. Dr. J. S. Ayers writes to the North American Journal of 
SonuBopathy for November, notifying his unabated confidence in 
it in dysmenorrhoea, threatened abortion, and inflammatory rheu- 
matism of hands and feet. 

Causticam. — There is yet another aspect of this curious pre- 
paration. " Eecent investigations," says Dr. Allen, '' at Columbia 
College in New York, have shown that this ' tinctura acris sine 
kali ' is really aldehyde." — North American Journal of Homoeo- 
pathy, October, p. 603. 

Goffea in Insomnia. — Those who have praised coffea in sleep- 
lessness have generally recommended it in the medium or higher 
dilntions. Dr. Harvey Dale, however, found it effective in a case 
where, morphia having been given for a few nights after an 
operation for scirrhus mammae, persistent insomnia set in on its 
being discontinued. ** Some three or four weeks after the opera- 
tion she consulted the writer. At that time her general health 
was in every way as good as could be expected under the cir- 
cumstances, but the sleeplessness was obstinate. After careful 
questioning she was given coffea cruda, to be taken before 
retiring. Some months later she returned for some more of the 
medicine, saying that she seldom needed it now, but when she 
used it a single dose was, and had been since the first, effectual.'' 
— Amer. HomoRopathist, November 15, p. 367. 

Coniom. — A " Women's International Provers' Association " 
was founded at the Chicago Congress, and it made its first report 
at the Denver meeting of the American Institute last year. 
Goninm was the drug selected for proving : it was taken in the 
30x, 3x, Ix and d. " The provings," says the N. Engl. Med. 
Gazette (October), " were more interesting as a promise of future 
work by women, than for any additional symptoms obtained. 
The two symptoms sharply emphasised by the majority of 
provers, regardless of attenuation, were ' dull occipital headache 
on rising in morning and continuing through day,' and * dull ache 
in lumbar and sacral region.' Depression, vertigo on rising, 
soreness of eyeballs with orbital pain, coHc with loose stools, 
much aching and trembling of limbs, were also accented." 

Olonoin. — Dr. F. H. Pritchard states that a one per cent, 
solution of nitro-glycerine, in drop doses, is a prompt antidote 
to the disagreeable effects occasionally resulting from the injec- 
tion of cocaine into the skin or gums. — Hahn. Monthly, September. 



100 SUMICABY. 

HelodemUL — ** Quite a nmnber of those who read the 
proving' of heloderma horridum shrugged their shoulders and 
cried, ' too sensational' Among them was a young clerk in the 
employ of Boericke and Tafel. He laughed at the whole thing* 
and in a spirit of bravado took six doses of the 6th dil. On the 
second night he awoke with a cold sensation creeping down hia 
body and legs, and found himself in a very cold and clammy 
sweat. This lasted all the remainder of the night, and he was 
unable to go to sleep again ; by morning the disagreeable experi- 
ence began to pass off, and he felt no more of it." — Horn, Be- 
corder, October. 

HepaF Bolphuris in OtorFhosa. — Dr. Cooper states his Ex- 
perience to be that hepar only permanently benefits otorrhoea 
when this dates from scarlatina. Further^ that while the lower 
dilutions best control the discharge, any coincident impairment 
of hearing yields more surely to the 30th. — Horn, World, 
November. 

Hydroootyle. — The clinical observations from Dr. Audouit's 
monograph on this drug are translated in the September number 
of the HonuBopathio Becorder^ and form very interesting reading. 

HypePioum. — A re-proving of this drug is said to have bemi 
made by students of the Homoeopathic Department of Iowa 
University, and to be reported in the Bulletin thereof by Pro- 
fessor George Royal. — Pacific Coast Journal of HonuBopathyy 
November* 

Ipeoaouanha in Stpumous Ophthalmia.— Dr. Boyle, in a 

paper on the treatment of the principal external diseases of the 
eye* npDaks of ipecacuanha as one of the best remedies in phlyc- 
tenular keratitis in ohildreUi with redness, photophobia, and 
laKslirymatlon. "It acts/* he says, "where you would think 
eoutum would be the remedy, bat conium has disappointed me so 
that t do imt thitik of using it any more in these cases." — North 
i4m<!ifitVtH JoHrHul c^ Hom^»opathyy September, p. 557. 

Kail lodatulll% — Di\ Nicholson oommunicates a series of cases 
ot bt^)i\t^httls and bi^>nehitic asthma in which iodide of potassium, 
tkl d-A \/{\%i\\ itv^t^es^ »t^ms to have a<^ted much more rapidly than 
^)XV \m\^\ \\\p\\M\\^K lie adduces evidence of its homosopathicity 
to tl\^ hwnlvid i>i>uditiott» — Monlh)^ H^mu JR^^iwr, September. 



^ 8^ ty)lv iv ot l>Hi« ^<>uwal> p. d^. 






SUMMABY. 101 

Kali phosphoricum. — ^Dr. Emily L. Hill relates three oases 
favonring Schiissler's contention that kali phosphoricum is " the 
great nerve-tissue salt." Two were of neurasthenia ; one of night- 
terrors, following on exhaustion after severe diarrhoea. The 2x 
and dx triturations were used. — Hahn. Monthly, October. 

Kftlifii^. — Dr. Allen relates a case of post-diphtheritic 
paralysis, in which the heart failed, pulse going down to 38, face 
pale and pinched, cold extremities. Digitalis helped at first, then 
lost its power; but kalmia 6 "was like magic, acting instantly 
and holding him — no slipping back this time, and before morn- 
ing the danger was over." — Amer. Homosopathist, November 15, 
p. 370. 

Lemna minor. — In this plant — the common duckweed — Dr. 
Cooper's " arborivital medicine" seems to have pulled out a 
plum. Its action is on the nasal mucous membrane ; and 
polypus, ozsena, chronic catarrh and simple thickening are con- 
ditions which have yielded to its remedial influence. Drs. Clarke 
and Burnett send corroborative cases ; but it is curious to note 
that the single doses of the mother tincture on which Dr. Cooper 
lays so much stress find no place in their reports — the 3x 
several times daily being the prescription they both affect. — 
Hahn. Monthly, October. 

Lyoopodium in Diphtheria. — The so-called '' Hahneman- 
nian" school among us (better called "empirical") have long 
maintained as a special indication for lycopodium in diphtheria 
that the deposit is limited to or begins on the right tonsil. In a 
discussion on the subject, at the New York Homoeopathic 
Materia Medica Society, Dr. Deschere, giving the indications for 
lycopodium, said *' the affection may or may not have started on 
the right side of the throat or in the nostrils; it is, however, 
generally worse on the right side." Another speaker said, three 
of the worst cases ever seen by him were worse on left side of 
throat, but were cured by lycopodium. — Amer. Joum, of Horn., 
October, pp. 77-79 of appendix. 

Mangannm in Coryza. — Dr. Winterburn relates two cases in 
which a chronic coryza, in one of three months', in the other of 
seven years' standing, speedily yielded to manganum 200 (Dun- 
ham). — N, Amer, Joum, of Horn., October, p. 660. 

Hercnry in Syphilis. — Among the many points of dissimi- 
larity between mercury and syphilis, Dr. Allen specifies this, that 
mercury, if it affects the bones, chooses the long ones, while, 



102 BUMMABY. 

syphilis attacks by preference the flat ones. — Amer. Homaopathisty 
November 1. 

Natrum muriaticum.— Dr. George Herring sends from this 
country some notes on this medicine to the HomoBopathic Be- 
corder for September. He uses it mainly in the 1st trit., and 
finds it in this form almost infallible for stopping a cold com- 
mencing with sneezing. It seems, however, to have the disad- 
vantage of inducing occasional pathogenetic effects, as cardiac or 
epigastric pain, cerebral discomfort, toothache, irritation of 
rectum, and nightmare. He relates a remarkable case of post- 
partum dementia recovering under it — mainly in the 3rd trit. 

Nux Yomioa. — Dr. George Herring relates, in the November 
number of the Monthly Horn. Review , a proving of nux vomica 
made by rubbing a few drops of the mother tincture into the 
palms. 

Phosphorus. — Dr. Gartier propounds a smooth red tongue as 
especially indicating phosphorus. This is on the authority of 
Dr. Heermann ; but he has personally verified it. — L*Art Medical, 
October. 

Quinine in Intermittents. — Dr. Datta believes that when 
quinine is exactly indicated, homoeopathically, in intermittents, 
it will do better work in infinitesimal than in substantial doses. 
He relates a case characterised by well-marked stages and exact 
periodicity (chill at three p.m. daily), by great pain in the dorsal 
vertebrsB during the chill and tenderness there in all the stages. 
After nine days of fruitless allopathic administration of the drug, 
two doses of the 6th dil. were given in the interval, and the 
patient never had another paroxysm. — Indian Horn, Beview^ 
vol iv.. No. 12. 

Senecio. — A proving of the " aureus *' variety of this plant is 
reported by Dr. Julia Washburn in the Southern Journal of 
Homeopathy for November (the only number that has reached 
us this quarter). Four ladies took part in it, using small but 
appreciable doses. One had nothing but an intense sleepiness : 
the other three felt the uterine action of the drug. The cata- 
menia came on earlier and more freely, leucorrhoea occurred, and 
dysmenorrhoea was relieved. 

Sepia. — Dr. Jousset's experience with sepia is unique: **This 
drug,*' he writes, ** of which I make great use, gives me excellent 
results, provided it is continued for some time, and in strong 



I 



SUMMABY. 103 

doses — ^ten centigrammes (about 1| grains) of the Ix trit. twice 
daily." — L*Art Medical, September, p. 218. 

Silica. — (1) M. T., aged 12, a scrofulous, emaciated child. For 
six months has suffered from inflammation of the left knee-joint. 
The swelling declined after violent febrile inflammation, leaving the 
knee nearly fixed in flexed position. After injection of iodoform, 
violent pains ; resection was advised. On the inner side of the 
joint, spongy swelling. The extremity cold and atrophied. Pre- 
Bcribed silica 6. After eight days the joint was free from pain 
BO that passive movements could be made. After four weeks the 
swelling gone. General streugth improved. The child is still 
under treatment. Thuja, causticum and phosphorus'were given. 
The joint still remains strongly flexed, but the child can get 
about with a stick and is stronger; the joint is painless. — 
Stifft, Allg, h. Ztg.y cxxix., 164. 

(2) E. K., aged 10. For four months has had swelling, tension, 
and difficulty of moving the left knee-joint. The disease com- 
menced vdth pain on moving the limb ; no febrile symptoms. On 
the inner side of the joint a spongy swelling. Similar though less 
severe affection of right joint. Appetite good, lungs sound, but 
relapsing scrofulous conjunctivitis. In the last month repeated 
injections of iodoform were made, which always caused pain for 
several days. Prescribed silica 6. On leaving the hospital after 
six weeks' treatment the swelling was almost gone, the child 
could walk a little. Eyes well. After two months the swelling 
had quite disappeared. The joint still somewhat enlarged but 
without pain, and can be used. Prescription : Calc. iod. 3 and 
phosph. 5. Next month the joint the same. Appearance healthy, 
can walk without assistance. — Ibid, 

(3) O. M., aged 19. Of six children, three healthy, the two 
eldest and the youngest; three affected in the same manner. 
Parents healthy. When three years old, this otherwise healthy 
child got symmetrical swelling of the toe-joints going on to 
necrosis and exfoliation of the peripheral parts. The same 
process was gradually developed in the hands, so that most of 
the phalanges of the toes and Angers were absent. Exarticula- 
tion of some of the phalanges did not arrest the disease. When 
brought to the hospital there was a large spongy swelling of right 
inner ankle, the left heel was ulcerated. Silica 6, later 10, in 
six weeks healed up the ulceration and reduced the swelling. 
General health good. Patient left the hospital and walked in 
felt shoes. After this thuja, phosphorus and arsenicum were 
given. The patient is still under treatment, but better. — Ibid, 



104 BUMMABY. 

(4) Mrs. W. E., aged 54. A thin woman belonging to the 
working class. General rheumatico-gouty affection. On the 
dorsal aspect of wrist spongy granulative swelling, painless ;' joint 
swollen and stiff. In her youth she had been scrofulous, later on 
had frequently suffered from rheumatism. Prescription : silica 6 
and thuja 3. After four weeks the swelling nearly gone, the 
joint can be used. Cold feeling and weakness of hand continued, 
but were improved by causticum 6, so that three weeks later the 
patient could leave off treatment. — Ibid, 

(5) Mrs. F., aged 50. In previous years had suffered often from 
rheumatic affections. Last autumn got stiffness of right wrist 
with spongy swelling of surrounding parts, which had got well. 
In the spring of this year (1894) painfulness of left foot and 
inability to walk. General swelling of dorsum, first spongy, then 
redness and heat at one part. An incision was made there ; 
thereafter a fistulous opening remained, and an excreting eczema 
spread all over the foot. Injections of iodoform were ordered. 
She then came into our hospital. Silica 6 and externally saturnine 
lotion, whereupon the eczema rapidly disappeared. The fistula 
closed up, but broke out again twice with redness and swelUng, 
and discharged white flocculent stuff and serum. It then healed 
up permanently. Subsequently she got phosph. 5 and thuja 3, 
and was dismissed cured and remained so. — Ibid., p. 165. 

Spi^elia. — A good paper on this remedy was read by Dr. T. 
H. Hudson, at the Denver meeting of the American Institute. 
In relation to prosopalgia, he compares it with belladonna, many 
of the symptoms of which are present, but all in less intensity 
save the pain, and this is " characterised by intolerance as much as 
by actual suffering.*' The left side is generally the one affected. 
He gives two cases, in one of which the 3x, in the other the 30x 
was the dilution used. In the discussion which followed, many 
others bore testimony to the value of this medicine, and Dr. 
Monroe mentioned aggravation in the middle of the day as 
characteristic of it. — Amer. HonuBopathist, September 1. 

Strophanthus. — A new use has been found for this drug ; it 
provokes a nausea attended with special disgust for alcohol, and 
so aids in the treatment of dipsomania. Seven-drop doses of the 
tincture sufl&ce for this purpose.— -Horn. Becorder, October, p. 
510. 

Strychnia. — A case of poisoning by this drug is recorded in 
the Birmingham Medical Beview for May. Signs of nephritis, 
uraemia, and ascending motor paralysis appeared during life : but 



8UMMABY. * 105 

after deatli — which occurred in four days, with dyspncea and 
cyanosis — tlie kidneys were simply injected deeply and congested, 
while the spinal cord showed no evidence of any lesion. — Hahn. 
Monthly J September, p. 593. 

Dr. J. A. Young conmiends this drug as not unfrequently 
curative of reducible hernia, and relates a case in point. Doses 
of gr. l-30th to 1-lOOth were taken three times a day, and 
gradual cure took place in six months. — Med, Centwry, 
October 15. 

Symphytum. — Dr. H. G. Allen calls attention to this remedy 
as freq^uently appHcable after injuries where arnica would be pre- 
BcribecL in vain. It is in injuries of the globe of the eye, and 
where bone or periosteum are affected, that it seems specially 
indicated ; its pains are pricking, sticking, and jagging. — Med. 
Century, October 15. 

Thlaspl in Metrorrha^a. — Dr. H. Mason records a case of 
uterine haemorrhage, following upon a miscarriage, in which, 
after not medicines only but operative procedures had failed, 
thlaspi bursa pastoris cured. There were two special points of 
interest about the case — one that the plant was given in infusion, 
half a pound of the dried herb being added to a quart of boiling 
water, of which a wine-glassful was taken three times a day ; the 
other that a too long continuance of the remedy seemed to cause 
a recxurence of the haemorrhage, for the latter quickly ceased 
on the discontinuance of the former. — Monthly Horn. Review, 
September. 

Uranium. — In our last number (p. 490), we mentioned the 
proving of uranium nitrate lately carried out by the New York 
Homceopathic Materia Medica Society. Some of the more 
detailed reports of the experiments we then desiderated are 
furnished in the North American Journal of Homoeopathy for 
November (p. 715). As yet only a resume of the symptomatology 
of the experiments (nine in number) is given, but the day-books 
of the provers are to be published in the Transactions of the New 
York State HomoBopathic Society for 1894. 

Tiola odorata. — Dr. Cooper gives the later history of the 
case of chronic choroiditis, with periodical headaches, referred to 
at p. 363 of our second volume as greatly benefited by occasional 
single doses of viola odorata 0, The extracts from the patient's 
letters, now supplied to us, are very satisfactory, and show that 
a complete and lasting cure has been effected. — Hahn, Monthly, 
October. 



106 SUMMARY. 



THERAPEUTICS. 

Albuminuria. — Dr. O. H. Hall reports two cases, and refers 
to others, in which albuminuric anasarca, occurring pretty early 
in pregnancy, after resisting ordinary remedies, cleared away 
speedily under the use of ergot (he does not say in what form or 
strength). — Minneapolis Horn. Magazine^ November. 

Barlow's disease. — Under this heading. Dr. Martin Deschere 
relates two cases of the infantile scurvy brought before the Society 
by Dr. Gibbs Blake, in November, 1893. [Dr. Deschere writes : — 
" To my knowledge there is no record of scurvy in rickets 
throughout the entire homoeopathic literature." He will find the 
paper referred to, with the discussion following it, at p. 27 of the 
second volume of this Journal.] Change of diet here also 
proved curative, though medicines were given at the same time. 
— Hahn, Monthly, October. 

Another article on this disease, with three cases, is con- 
tributed to the North American Journal of Homoeopathy for 
October, by Dr. Van Baun. 

Chblera Infantum. — A second number of the Medical 
Century — that for September 16 — is devoted to the summer 
diarrhoea of children ; and again contains much useful matter 
in the direction of hygiene and general management, as well as 
in that of medication. The contents of these two numbers alone 
would make the year's journal worth subscribing for. 

In the number for October 15, Dr. E. Cartwright has a 
supplementary article on the therapeutics of this disease, in 
which he speaks of the great value of zincum bromatum 6x in 
the anaemic coma or spurious hydrocephalus often left behind. 

Colio. — Eanee had long been suffering from intense colic 

pain almost daily. I was called to see her on July 9 last. 
She said that for the last three years the pain was giving her 
trouble every day from 1 to 4 p.m. She could not describe 
its nature, but said that it was intense, that it was impossible 
for her to suffer any longer. She was so irritable and peevish 
that I could get no further description from her. I at once 
decided to administer chamomilla 30. The effect was magical. 
Two doses every half hour took away the pain altogether, and it 
has not since returned. 



SUMMABT. 107 

Patient had all along been under treatment by an allopathic 
physician or a kaviraj. Injection of morphia would reUeve her 
pain, but for a few days only. — B. N. Banerjee, Calcutta 
Joum. of Med. ^ October. 

Cutaneous Diseases. — ^Dr. Westover pleads for local para- 
siticide treatment of these affections, when owning a microbic 
origin, and gives a good account of their various forms.^ [It is 
a pity that he, or the editor, has allowed his paper to be dis* 
figured with such solecisms as ** schizomy cites," " a chorion," 
"ciromata" (for ** circinata"), and *'ager ager "(for "agar- 
agar "). — Ed.] — Hahn. Monthly , September. 

An interesting series of cases of skin disease is related by 
Dr. Halbert in the Cliniqtce for September. They illustrate the 
value of hydrocotyle in acne, mezereum in eczema, antimonium 
tartaricum in pemphigus, and arsenicum in icthyosis. Local 
applications are judiciously used in conjunction with remedies, 
the only novel one being ** tumenol," a substance ** found in the 
distillate of a bituminous mineral from the Messel mine in 
Germany." 

Cystospasm. — Dr. D. G. Wilcox relates a case of what seems 
a pure neurotic cystospasm, causing distressing dysuria. Belief 
of the bladder was required every 30 — 60 minutes, and the 
patient bad slept on a bed-pan for thirteen years. Periodical 
daily paroxysms of pain " would rack her poor body for two, 
three, or four hours at a time until life was really not worth the 
living." Nothing was found on examination but tenderness and 
congestion of urethra. Magnesia phosphorica was given without 
effect ; but cinchonidia sulphate, four grains every four hours, 
made a strong impression, and the improvement was maintained 
by regular dilatation of urethra and anus. ^'In less than three 
months the patient was sent home, not cured, but in comparative 
comfort, and the improvement is still progressing with an occa- 
sional use of the sound." — Horn. Joum, of Obstetrics^ September. 

Diphtheria. — Dr. Eoux* report of his treatment of this 
disease by the serum of horses rendered (by inoculation) immune 
against it is given at length in L'Art Medical for October. It 
seems to have reduced by one-half the usual mortality under 
old-school treatment. As it is to be tried in the Hdpital St. 

' Dr. Arcularius, in the October number of the same journal, suggests 
that these are more numerous than is ordinarily supposed, and that many 
chronic local eczemas belong to them. 



1kwmcic«1£:5c medjcaacn aSso. as pncsaed ibesre in the past. 

In a Imer pociaoQ of the sacae c^mhrr, j«K EDcxe sarisfartary 
oesGits ai« mponed, maiiJr iracs the local i^plieaikm of 
l^jeerii^e eo&tamisg e ot i obite ss^cirsaae in the proportion of 
1 pan to 20 or 30. 



— Tbis diapaap., as an aottimnal epEdemie of no 
smafl znUHJsitT. is unknown to ns here : bet for oar readers in 
leas farosred parts of the world we note some TahiaUe rmnarks 
on its treatment br the Editor of the Jledical Cem^ry m its 
omnber of October 1. He finds fernun phosphoricmn more 
freqnentl J indicated than aconite in the initial stage, and bryonia 
or eolehicom playing a part for which the mercuries are some- 
times less appropriately pat forward. 

DymneoorrbaUL — ^I>r. J. E. Daily, in an article on the place of 
electricity in gynaecology, says of dysmenorrhoea that, *' whether 
it be neuralgic or obstractive, membranons or OTarian, it will 
disappear before the ase of electricity like the dew before the 
rising son." — Horn, Joum. of Obstetrics^ &c.. May. 

Ennresifl. — Dr. J. P. Gobbe thinks that this trooble often 
results from an irritating quality of the urine (which is dark and 
loaded), this itself being traceable to digestive disturbance. In 
such cases the patient can generally control the bladder during 
the day, though at night the urine escapes. He finds Pulsatilla 
the best remedy in such cases, and relates an instance in which 
the 3x dil. did everything that could be desired. — Clinique, 
November, p. 542. 

Dr. Worthington has come, after an experience of some years, 
to almost absolute dependence on rhus aromatica in this com- 
plaint. It has to be given, however, in ten-drop doses of the 
mother tincture. — Horn. Recorder, September. 

Epilepsy. — Dr. W. M. Butler gives an interesting study of 
some of the remedies foimd useful in this disease. His best 
results have been obtained from cuprum and hydrocyanic acid. 
Of the former, he says that he has not been able to define its 
exact indications; but that several cases, apparently hopeless, 
which had been for years under allopathic medication, he has 
promptly and permanently cured with it. Nor has it been less 
efficacious in recent cases, though for these he generally prefers 



8UMMABT. 109 

hydrocyanic acid. '' We have found it exceedingly BatiBfactory, 
and have permanently cured several cases through its agency. 
In some instances,, where we have ultimately had complete 
success, we have found that it did not at first check the convul- 
sions, but rendered them much milder and shortened their 
length, the patient retaining partial consciousness during the 
seizure.*' The lower dilutions are recommen^^. — North Ameri- 
can Journal of Homoeopathy, September. ^ 

Goaty Teeth. — Dr. Burchard describes the gouty affection of 
the teeth as a pericementitis. He points out that '' the pulp of 
the tooth is not its tactile portion, but rather that of special 
sense, the thermal," and that ''thermal changes are about the 
only cause of response in the healthy pulp. The tactile sense 
resides in the tooth's periosteum, the pericementum." Hence, 
when the teeth are sensitive to concussion or pressure, the 
pericementum is affected, while sensitiveness to cold or hot 
water in the cavity of a tooth would point to disease of the pulp. 
The Hahriemannian Monthly for September, from which we take 
the above, justly remarks : — '' Here we have an excellent oppor- 
tunity to distinguish and scientifically to interpret the symptoms 
of our materia medica" 

Influenza. — Litten considers spontaneous arterial thrombosis 
after influenza to be identical with Yirchow's ''marantic throm- 
bosis." It is probably due, according to Leyden, to the breaJdng up 
of leucocytes, which develop in the blood during the fever. They 
break up into the so-called " blood plates." These, by adhering 
to the arterial walls, c^use coagulation, and thus form an arterial 
thrombus. Heintz has shown that in arsenical poisoning 
arterial and venous thromboses originate from the breaking up of 
white blood cells and their transformation into blood-plates. 
Phosphorus and chlorate of potash poisoning give rise to similar 
conditions. — Althaus, Lancet, July 9. 

Melaucholia. — Dr. Craig records a case of melancholia in a 
young lady, where the head symptoms were those of glonoin. A 
drop of the Ist dil. three times a day not only relieved the head 
(and promoted the scanty catamenial fiow), but restored cheerful- 
ness. — Monthly Horn, Beview, September. 

MeningHis, Tubercular. — Dr. G. M. Gale has an article ou 
this disease in the September number of the Hahnemannian 
Monthly, which we mention mainly to caution our readers against 



110 SUMMARY. 

its too couleur de rose assertions. ** Under homoeopathic treat-* 
ment," the author writes, " we can report many cases of recovery 
in genuine tubercular meningitis " ! He fortunately antidotes 
his own poison by going on to say in the next paragraph, '' Treat- 
ment of this disease is unsatisfactory to say the least." Later 
on, however, he tells us that ** Dr. J. Compton Burnett, in his 
work on * Tuberculosis,' reports many cases of genuine tuber- 
cular meningitis cured with his tuberculinum in the 30th and 
200th potency." We need not say that Dr. Burnett, with all his 
enthusiasm, has made no such claims. 

Myelitis. — Dr. Simpson relates a case of paraplegia so 
diagnosed, in which lathyrus 3, *5 drops night and morning, 
proved curative. — Monthly Horn. Beview, October. 

Ophthalmia Oonorphoica. — B. P., aged 35, commenced treat- 
ment September 7, 1892. Severe blennorrhoea of eyes as a 
consequence of gonorrhoeal infection. Vascular injection round 
cornea. It b^gan j&ve days ago. Prescription : Mer. praec. rub. 3 
and diligent cleansing of the eyes with warm water. Next day 
improvement. On October 10 completely cured. The last 14 
days, on account of hypertrophic conjunctival catarrh, he got 
thuja alternately with the mere, prsBcip. — Stifft, Allg. h, Ztg,, 
cxxix., 166. 

Ophthalmia Scrofalosa. — W. M., aged 3. Began treatment 
October 27. Merc, prsecip. rub. 3 every three hours. In a 
week photophobia and profuse secretion relieved; the cornea, 
formerly ulcerated and dim, cleared. The swelling of conjunctiva 
slowly declined. Thuja 3 followed by calc. iod. completed the 
cure by Dec. 1. — Ibid. 

Several cases, imperfectly described, of conjunctivitis phlyc- 
tenulosa were cured by aur. mur. natron. 3 and ipecacuanha 3. 

Pertussis. — Dr. Gartier relates cases verifying indications for 
unusual remedies in this malady — ambra when the paroxysms 
are accompanied by eructations, mercurius corrosivus when they 
occur in pairs. [The former indication is pathogenetic, the latter 
clinical only. — Ed.] — L*Art Medical, October. 

Phlebitis. — When the pain of this malady is of a burning 
character, Dr. Gartier finds arsenic as therapeutically active as 
it is symptomatically indicated. — Ibid. 



8UMMABY. Ill 

PlithifiULS. — Dr. G. M. Soger writes very practically in the 
October number of the Homoeopathic Physician on ** The Pallia- 
tive Treatment of Pulmonary Tuberculosis." China (high) for the 
fever, calcarea carbonica (200) and polyporus (3x) for the night 
sweats (the latter where hepatic symptoms and intermittent 
pyrexia co-exist), geranium. (0) for the hsemoptysis, and coccus 
cacti for vomiting with the cough, are the medicines on which he 
lays most stress. The diarrhoea he recognises as very intract- 
able. " For undigested stools," he writes, ** china heads all 
others, and may be useful. When cheesy masses are present 
calcarea phosphorica is ' more serviceable than iodine or thuja. 
In black watery stools, having the odour of rotten eggs, with 
urinary symptoms, asclepias tuberosa has done magnificent work 
for me." 

Pruritus yuIysb. — Dr. E. E. Snyder relates a chronic and 
distressing case of pruritus vulvae, in which ** black wash " gave 
almost immediate relief. It is in the less sensitive cases that 
he finds this the most suitable appUcation ; in others infusion 
of tobacco or diluted oil of peppermint answers better.— Horn. 
Joum. of Obstetrics, September, p. 402. 

Torticollis. — Dr. C. T. Swan relates a case of spasmodic 
wry-neck of three years' standing, cured in a month by correcting 
refractive errors of vision, which were of a high degree, with 
glasses, and muscular errors by tenotomy. — Cliniqtie, October, 
p. 488. 

Trachoma. — Dr. W. Spencer calls attention to the inert or 
violent character of most of the remedial measures adopted for 
granular lids, but has had excellent results from massage with 
boric acid. The eye is thoroughly ansBsthetised with a solution 
of cocaine ; powdered boric acid is then dusted over the everted 
lids, and friction is made with the finger, firm pressure being 
employed. Very little reaction follows, and the treatment can 
be repeated daily. —Hahn, Monthly, October. 

Typhoid FeYer. — The number of the Medical Century for 
October 1 is devoted to typhoid and its treatment, and contains 
many valuable things. Especially good is Dr. Conrad Wessel- 
hoeft's paper on the ''general treatment." The indications for 
medicines are excellent. 

The subject is continued in the number for November 1, in the 



112 SUMICABT. 

shape of supplementary papers and the report of a meeting of 
the Homoeopathic Medical Society of Chicago. Dr. Dewey's 
comparisons between twelve leading typhoid remedies are par- 
ticularly valuable. One practitioner only mentions pyrogenium, 
but he ** would not be without it for fevers of a high degree and 
a poisoned condition of the system." " I gave it/' he writes, 
*' to one of my friends, a ' regular/ and he said it worked to a 
charm, and wanted to know what it was and where he could 
get it." 

[Note. — On page 488 of our last number, we mentioned that 
the beneficial effects of plumbum in a case of interstitial nephritis 
reported some time ago by Dr. S. A. Jones had not proved 
permanent. We quoted this information from Dr. Searle ; but 
Dr. Jones wishes us to state that it was he himself who furnished 
it to the former physician. — ^Ed.] 



JOURNAL 

OF THE 




%tml iHMaiiirttiir 

No. 2. APRIL, 1895. Vol. IH. 



All communications and exchanges to be sent to Db. Hughes, 

36, Sillwood Boadj Brighton, 



COBEECTIVE POSTUEES IN LATERAL 
CURVATURE OF THE SPINE.^ 

BY GERABD SMITH, M.B.C.S. 

The treatment of curable cases of lateral curvature of 
the spine by the more modern method of gymnastic exercises, 
has not yet gained the complete confidence of the profession, 
because it is as yet so much an affair of unscientific 
routine; the mistake has been made of attempting to 
apply to an abnormal condition a fixed routine or system 
of exercises which are classed in Sweden, the land of 
their origin, as ** pedagoguic gymnastics," meaning a system 
fitted to use in the physical education of the normal child. 
'Any fixed system presupposes that the conditions dealt 
with are alike, and there is only one condition in which 
children may be said to be alike, that is to say, the normal 
condition. 

I wish to indicate by an example, the general line upon 
which this faulty conception of the gymnastic treatment 

■ Presented to the Surgical Section, December 6, 1894. 

VOL. in. — ^No. 2. 8 



114 LATEBAL CUBVATUBE OF THE SPINE. 

must be set right, and I cannot see why this Society should 
not take the first place in establishing the treatment upon 
scientific lines in England (in Sweden this has been partly 
accomphshed already). 

For the purpose of demonstration, I will take the most 
common form of scoliosis, the case in which there is one 
curve, involving chiefly the dorsal vertebrae, with the con- 
vexity towards the right, and the usual accompaniment of 
rotation of the ribs backwards on that side ; a drawing of 
such a patient is represented in fig 1. 

In every case, the diagnosis, prognosis, and treatment 
must be made as if the patient before us was not one of a 
class, but an individual case, to be treated on its own 
merits; I will imagine a series of cases of this deformity, 
each one more severe and permanent than the last. 

The first corrective test applied would be the very 
obvious one of making the child assume as upright a carriage 
as possible, with the shoulders well braced back, and with 
no manual aid from the surgeon. If such an effort succeed 
even for a few seconds in correcting the curvature, the child 
may be treated by the mere general " Swedish movements," 
which are apparently assumed by most of the public and 
many of the profession, to constitute all that is needed for 
all cases, and very probably the cure of the case would be 
accomphshed in a few months. 

But, if this mere effort to stand straight be not successful 
in restoring the spine to its normal position (and this would 
frequently occur) some more detailed attention as to cor- 
rective action of the muscles must be paid. Fig 2 (after 
B. Both) shows a position which is well known. It is the 
first elementary corrective posture, and it appears to satisfy 
some surgeons as being the only test available as a corrective 
position. I may remind you that the latissimus dorsi and 
the lower portion of the trapezius overlap at their powerful 
attachment nearly opposite the most concave point of the 
curvature on the left side; and the forcible raising of the 
left arm by means of the deltoid, pulls upon the two muscles 
I have mentioned, rendering them tense, and passively the 
means of correcting the deviation, along with the vigorous 



LATERAL CUBTATUBE OF THE SPINE. 115 

bilateral contraction of the erector spinae which results from 
the posture. 

A careless observation might suggest that the exercises 
to be founded upon this corrective posture are to be those 
whicli strengthen the acting muscles, but in this case it is 
seen that the deltoid, which produces the result, has no 
attachment to the spine, and no amount of strengthening 
that muscle could produce permanent e£fect. We need to 
exercise the latissimus dorsi, the lower portion of the 
trapezius, and the lower erectors, by movements of the left 
ann downwards and backwards, and flexings and extensions 
of the spine. 

The correction in a case which would be put right 
temporarily by this posture could be produced without the 
contraction of any muscle ; for if the child were merely 
suspended by the left arm by the surgeon, the correction 
would appear. 

The next grade in severity would be that in which only 
a partial correction of the lateral deviation was produced by 
this position, and more muscles must be brought into 
action for diagnosis and treatment. This is best accom- 
plished by the surgeon holding the patient's hands whilst in 
the indicated position, and the patient making efforts to 
carry the left arm downwards and forwards across the face, 
and the right arm directly backwards, the surgeon resisting 
those movements. Such efforts result in the contraction of 
the left pectorals and serratus magnus, and the right rhom- 
boids, the combined effect being to pull upon the spinous 
processes to which the right rhomboids are attached, and 
thus to pull the rotated vertebrae towards the convexity of 
the curvature, whilst the left pectorals and serratus magnus 
pull the sternum towards the left, these movements being 
those which will correct the rotation, if it can be corrected 
by voluntary effort. Added to these efforts on the part of 
the patient, it is useful to direct that the left leg be advanced, 
the surgeon resisting the movement with his foot ; this con- 
tracts the left psoas muscle pulling upon the lumbar part of 
the concavity. If these combined movements result in partial 
or complete temporary correction, the exercises to be used 



116 LATERAL CURTATUBE OF THE SPINE. 

are founded upon the information elicited by the test, being 
obviously those exercises which carry the right arm forwards 
and the left backwards, which flex the left thigh, and these 
will of course be varied with the erector movements and the 
use of the movement of the latissimus dorsi and lower 
trapezius. 

Taking now a further degree of severity, which cannot 
be corrected by any of the former postures, we should need 
to bring to bear more active force upon the spine, because 
we are dealing with contracted ligaments upon the con- 
cavity of the curvature. We wish to attempt the unfolding 
of the curvature, by carrying the lumbar vertebrsB towards 
the right, and the upper dorsal vertebrae in the same direction, 
and to do this we must elevate the right side of the pelvis, 
lower the right shoulder, and raise and carry towards the 
right the left shoulder. In practice I do this by means of 
the posture seen in fig. 3, and if, when the patient makes 
vigorous traction upon his hands when in this posture, the 
curve is partially or entirely straightened, I prescribe the 
posture itself as an exercise, with the movement occasion- 
ally as indicated in fig. 4, where the patient has the arms 
fixed at right angles on a light wand, and making a long 
forward (partially sideways) stride on to a bench with the 
right foot, he attempts to touch the raised foot with the 
end of the pole ; if this be too severe, the pole may simply 
be held in the hands overhead. It will be understood, of 
course, that all the former exercises mentioned are added to 
this special prescription. 

The posture of fig. 3 may, however, be insuflScient to 
correct, and there may be added to it the active pressure of 
the surgeon's hands upon the convex aspect of the curve 
(that is to say, the right ribs, and the left side of the 
pelvis) ; quite severe deformities will be thus corrected, and 
I may say that personally I attach the greatest value to 
these active manual pressures by the surgeon, and that 
practically we may put very considerable force upon the 
spine without fear, so long as the absence of caries is abso- 
lutely certain. We are quite accustomed to bring to bear 
very great force in correcting some cases of deformities of 



""^^^^ 





1r 



LATERAL CUBTATUBB OF THE SPINE. 117 

the feet, and experience proves that this may be done with 
safety, and I have made very frequent use of a similar 
though more gradual force in the treatment of scoliosis with 
marked benefit to the patients. 

I have under my care at the present time a young lady 
who has a most severe scoliosis, and who, under this ap- 
plication of manual force, with other indicated exercises, is 
improving so markedly that the gentleman who is also 
treating her by means of a spinal appUance, writes to me 
to say that she " runs away from the appliance " ; the im- 
provement from the exercises and counter pressure is more 
rapid than the periodical alterations to the appliance can 
keep up with. 

I give an illustration in fig. 5 of Zander's orthopaedic 
chair, which explains itself. Personally I am not in favour 
of these cumbrous and terrifying appliances ; they save 
work for the surgeon, but they have not the appreciative 
touch of the surgeon's hands, and it is easy to overstrain a 
delicate patient by their use. The case in this drawing 
(after Legrange) is one of sigmoid curvature, which is con- 
verted into the single form by tilting the seat as seen in the 
dravring, vrhilst the counter pressure and fixation of the 
shoulders are accompUshed mechanically. 

In addition to the exercising of the pectorals, serratus 
magnus and rhomboids upon opposite sides which I have 
described as corrective of rotation, it is necessary to apply 
more forcible movements for the correction of this very 
obstinate part of most cases of scohosis ; the counter pressure 
of the surgeon's hand upon the prominent ribs behind, as 
the patient rises from the stooping position, is a very well- 
known movement, and has its uses. Very considerable 
twisting strain may be brought to bear also by the surgeon 
upon the rotated thorax, especially when the patient is sus- 
pended by the arms from a horizontal bar; suspension 
separates partially the articular facets between the vertebrse, 
and permits more direct force to bear upon the connecting 
ligaments by the surgeon, the opposing influence of the body 
weight being removed. 

Suspension is often recommended as corrective, and 



118 



LATBHAL CUBTATUSE OF THE SPINE. 



possibly the passive stretching of contracted ligaments may 
be of valae; bat even in those cases where suspension, 
partial by the arms only, or completely by arms and neck. 






Pig. 7. 

Traoings across the baok from side to side, over the spinous process of th& 
eighth dorsal vertebra; girl, age 17. Tracing No. 1 (the top), July 24. No. 2, 
September 4. No. 8, December 8. The spinous process comes more into 
normal prominence as improvement takes place ; its real position laterally 
is better seen when rotation has been corrected. 




Fig. 8. 

Traoings from a girl, age 15, a case of rotation only. First tracing at 
oommenoement of treatment by rotation movements only, October 20. 
Second tracing on December 8. 

totally corrects the deformity at the moment, it cannot be 
said to give any indications for treatment. Since in suspen- 
sion all the normal weight and conditions are removed, the 



liATESAIi OTTBVATUBE OF THB SPINE. 119 

correction brought about by it cannot be maintained for a 
moment by the natural efforts. 

Fig. 6 gives an illustration of the second part of a com- 
bined movement, of which fig. 4, if the wand be omitted 
and the high step changed for the level, may be taken as 
the first part. I have devised the exercise and found it of 
great benefit in correcting rotation; the child is made to 
keep the feet fixed in the position first taken by the forward 
stride ; and in the second part of the movement is encour- 
aged to try and touch the backward foot with the originally 
forward arm. This is a movement which exercises the 
muscles which directly correct rotation of the thorax, and 
the erector muscles of the side opposite to the backward 
rotation. The stooping movement must be performed 
slowly, in order to use the erector of the side which is 
uppermost to restrain the movement downwards. 

Of course, in the case of left rotation, the first stride is 
made forwards with the left foot, and the twist of the thorax 
is in the opposite direction to that indicated in the 
drawing. 

It will be understood that all the drawings except figs. 
1 and 5 are taken from healthy subjects, it being difficult for 
a deformed child to pose in such positions for an artist to 
catch the details of the posture. 

The following tracings are from two cases in my note 
book, both still under my treatment ; the tracings are taken 
in the usual way with a strip of metal moulded over the 
back from one side to the other. In these cases I have 
taken them over the most marked part of the deformity, 
just below the angles of the scapulsB. Figs. 7 and 8 explain 
themselves, and are good examples of the effects of a course 
of carefully selected rotation exercises. 

I hope that I have been able to prove that there is a 
great difference between mere routine Swedish exercises or 
caliBthenic drill, and genuine orthopaedic gymnastics. 



lao 



CHRONIC irEBCUBIAL POISONING IN ITS RE- 
LATION TO VARIOUS FORMS OF CERE- 
BRO-SPINAIi DISEASE.^ 

BY J. McLACHLA:^, iLD^ F.R.C^. 

Specific Action of Mercury. — In the stomach mercurials 
are said to combine with the chloride of sodimn of the 
secretions, and, no matter whateTer their original form may 
be, are converted into a doable chloride of sodium and 
mercory, which farther unites with the albominous juices 
to form a complex molecule of mercury, sodium chloride, and 
albumen. In this form it enters the blood freely, but once 
there this complex molecule is decomposed by combination 
with oxygen and albumen, an oxy-albuminate of mercury 
being the result. Mercury, however, quickly leaves the blood 
and enters the tissues, where it is apt to remain almost in- 
definitely, being excreted with comparative slowness, especi- 
ally when the kidneys are diseased — ^this being, as you 
know, an important contra-indication for its use in allopathic 
practice. Mercury has been found in every organ of the 
body, but most abundantly in the hver. It is a remarkable 
fact, however, that (so far as I know, at least) no definite 
anatomical change has ever been demonstrated in the 
viscera, such as the vessels, liver, or nervous system, even 
in casos of chronic poisoning by this metal. In this respect 
it differs very markedly from lead^ silver , antimony and 
d/rseniG, "Whilst, therefore, the specific action of mercury 
10 unquestionable, its mode of action (i.e., what it does and 
how it does it) is still obscure. Our friends in the other 
Mcliool got over the diflSculty by calling it an " alterative " — 
A word that has never had an exact application, and there- 
forn (Idfios oorroct definition ; all that can be said is that it 
pt'odiuum an alteration. This " alterative" action is chiefly 



I Pi'OMQuiod tiu tho Maiterla Medioa and Therapeutio Section, Jan. 3, 1895. 



CHBONIC MEBCUBIAL POISONING. 121 

exhibited in " granulation-tissue *' growths, such as we see 
in simple inflammations and syphilitic growths. 
I propose first of all to direct your attention to 

I. — ^MuiiTiPLB Cerbbbo- Spinal Sclebosis. 

This disease has various other names, as ** Disseminated 
Sclerosis," '* Insular Sclerosis,*' " Multilocular Sclerosis.*' 
It is also sometimes called " Charcot's Disease," as he was 
one of the first to identify and characterise the disease. 

Nature and Mtiology, — It is a disease produced by the 
development of patches of sclerosis of varying size and 
shape throughout the spinal cord and brain. The sites 
affected with special frequency are the lateral columns of 
the cord, the medulla and pons. Charcot divided the 
disease into cerebral, spinal, and cerebrospinal forms. 
Among its exciting causes exposure to wet and cold would 
seem to take the first rank. 

Anatomical Characters, — The patches of sclerosis are 
due to hyperplastic overgrowths of the neuroglia, which 
naturally exists around and between the nerve elements, but 
are not dependent on previous degeneration of the nerve 
fibres, as in the case of the " secondary degeneration " that 
follows apoplexy. There, fatty degeneration and atrophy of 
the nerve fibres are the first events, and these changes are 
followed by hyperplasia of the neuroglia, but in cerebro- 
spinal sclerosis it is hyperplasia first and then atrophy of 
the nerve elements. The patches vary in size and position. 
They may involve the lateral, anterior, or the posterior columns 
of the cord, or even the grey matter. As the patches grow 
they press upon and constrict the nerve fibres and cause 
their partial atrophy. The nerve fibres, however, do not 
whoUy disappear ; it is the white substance of Schwann 
that disappears, whilst the axis-cylinders, or a considerable 
number of them, persist. The walls of the blood vessels 
are generally greatly thickened, especially the outer coat, 
but the process is apt to extend inwards and involve the 
middle or even the inner coat. It is more than probable 
that prohferation also takes place from the inner surface of 
the intima, or inner coat, resembling "obliterative end- 



122 CHBONIC MBBCUBIAL POISONING. 

arteritis/' and this may occasionally lead to thrombosis. It 
is rare to find bands of " secondary degeneration** in con- 
nection with these patches of primary sclerosis, probably 
because the bulk of the axis-cylinders persist, so that the 
parts below (or above in the case of the posterior and parts 
of the lateral columns) are not absolutely cut off from their 
" trophic centres.** 

Symptoms. — In going over the symptoms I will only refer 
to such as find their counter-part, more or less perfectly, in 
the CyclopaBdia. The symptoms necessarily vary according to 
the situation and extent of the patches, for as Charcot states, 
the affection is a " poly-morphous *' one. In some cases the 
sclerotic patches may, for a time, be wholly or chiefly con- 
fined to the posterior columns, when the symptoms will very 
closely resemble, or be identical with, those of locomotor 
ataxy. In other cases the lateral columns are chiefly in- 
volved, and the symptoms resemble those of "spastic** 
paralysis. 

The usual symptoms are — ^A slowly ensuing paresis of 
the lower extremities, beginning first in one limb, and 
then after a time involving the other ; sensation is scarcely 
at all affected in the early stage of the disease, nothing 
more than a temporary numbness being complained of in 
the majority of cases. One of the most typical signs of 
the disease is the marked trembling or shaking of the 
muscles during attempts at voluntary motion or speech. 
The movements cease during sleep and when the parts are 
at rest, though in the later stages the tremors show a 
tendency to become constant, but are always aggravated 
on exertion. The movements may in some cases resemble 
paralysis agitans, in others chorea. Charcot supposes that 
the tremor is due to irregular conduction through the axis- 
cylinders, which are lying naked in the midst of the sclerosed 
tissue. Exposure to cold or irritation of the skin in various 
ways will often suffice to initiate this general tremor. The 
classic test is to make the patient raise a glass of water to his 
lips. In doing this he manages to preserve the main direc- 
tion of the movement, and the glass reaches the lips, but it 
is forcibly jerked against the teeth, and the contents are 



CHRONIC MERGUBIAL POISONING. 123 

thrown over the patient's face and neck. This test is re- 
garded as almost pathognomonic of this disease. 

The speech assumes a staccato character ; it is hesitating 
and measured, the patient drawhng out syllable by syllable 
(scanning speech.) The gait is usually of the spastic variety, 
but sometimes closely resembles that of locoitiotor ataxy. 
There is often marked vertigo, and in the later stages, as 
the cerebrum becomes more and more affected, the memory 
fiuls. At this stage, too, epileptiform attacks are particularly 
apt to occur from time to time. 

Symptoms from Cyclopcedia. — In 30a we read : " They 
complain of weakness of the legs, which increases more and 
more, and renders walking and standing difficult ; they can 
no longer work as before, their hands and legs come into a 
state of moderate paresis." Also : " Attacks of vertigo, 
. . feehng of * gone to sleep,* numbness, formication 
in hands, not so often of legs. . . . Every emotion, 
every muscular effort, brings on trembling, staggering, pal- 
pitation and imperfect speech. The paresis of the arms and 
legs may become so great as to compel the patient to give 
up his work." , 

306. ** It is generally the hands and arms over which the 
control of the will is lost, and which tremble and twitch at 
the least exertion or emotion. . . . Sometimes the 
legs are first affected with great weakness, and when an 
effort is made to walk or even to stand, there comes on 
staggering and falling down. . . . The gait of those 
still able to walk is laboured, and the feet wide apart as in 
people with tabes dorsahs. Many cannot drink because they 
spill all the Uquid in the glass before they can get it to their 
mouth." ... One side of the body is occasionally 
more strongly affected than the other. . . . The 
convulsions rarely continue during sleep. . . The 

convulsions are always of the clonic form. . . Vertigo 
is very frequent." 

326. "When at rest there is.no tremor, but it comes 
with the slightest psychical excitation." 

33a. ..." The memory so affected that he could 
not remember the names of his nearest acquaintance." 



124 OHBONIC MEBCURIAL POISONING. 

336. "At times the spasms would cease; but any 
part which he attempted to move would immediately become 
affected. If he attempted to raise his foot it began to tremble 
and fell down again. If he wanted to drink, instead of 
carrying the glass to his mouth, he put it to the ear, nose, or 
forehead ; so that his comrades laughingly said he could not 
find his mouth. If another held the glass he could drink 
easily. A cold draught, the touch of a cold hand, and the 
unexpected entrance of anyone into his room instantly pro- 
voked spasms. The muscles of the left side were more 
affected than those of the right.'' 

40c. " Thus a patient attacked with them (the tremors), 
wishing to bend his arm, cannot accomplish this at once — 
two or three little jerks will draw back the forearm and 
cause a tremor. In bad cases the sufferers cannot get a cup 
of liquid to their mouths without upsetting it." 

47. " Certain subjects have experienced symptoms ana- 
logous to those of the petit mal. . . . They may be 
accompanied by loss of consciousness ; the patients then fall 
suddenly, and remain some time on the ground." 

At this point I would like, in passing, to direct your 
attention to : — 

(1) Endarteritis obliterans. 

(2) The pathological changes produced by the syphilitic 
poison. But whether these" throw any light upon the 
pathological changes that one would think ottght to be pro- 
duced by chronic mercurial poisoning I leave you to judge. 

(1) Endarteritis obliterans occurs : — 
(a) In syphilis. 

(6) In the healing of wounds. 

(c) In the vessels of the kidney in Bright's disease. 
In endarteritis obliterans the endothelium of the intima 
proliferates all round the circumference of the vessel and 
thus narrows its lumen. The chief changes occur internal 
to the elastic lamina, though the other coats are also more or 
less thickened. A change somewhat similar is observed in 
the blood vessels of the cord in or near the sclerotic patches. 

(2) Syphilis. — This is regarded as a specific infective in- 
flammation characterised by the production of a special form 



CHRONIC MEBCURIAIi POIBONINa. 125 

of granulation tissue. The tissue thus produced consists 
of:— 

(1) Many small, round cells. 

(2) A few large multinucleated cells. 

(3) A delicate reticulum of new fibrous tissue. 

(4) Newly-formed blood vessels. 

So far, in fact, as the microscope can reveal, it just 
resembles ordinary granulation tissue. It may be laid down 
in two forms : — 

(a) As a diffuse infiltration. 

(b) As a circumscribed mass — a " gumma." 

In the other school, mercury is supposed to exert a 
special influence over the inflammatory process (being re- 
garded as a powerful ** antiphlogistic") and other conditions, 
such as syphilis, that are characterised by a growth of small 
round cells. In such conditions it is said to exert its so- 
called " antiphlogistic action." 

II. — Chorea. 

In this disease there is not actual loss of command over 
the muscles, but voluntary movements are interfered with 
by the super-addition of involuntary movements. There is 
a loss of control over the motor apparatus, with movements 
excessive in point of number and extent but wanting in 
vigour and precision, hence it has been called " delirium of 
the sensori-motor ganglia." 

Pathological Anatomy. — The seat of the disturbance is 
said to be the corptis striatum, but the exact pathological 
changes are doubtful. Much has been said about '' dilatations 
of the minute arteries" and "capillary emboHsms." Be 
that as it may, however, one thing is pretty certain, that in 
almost all fatal cases of chorea there is endocarditis with 
deposits of beads of lymph on the mitral or aortic valves, or 
both, whether a murmur have been audible during life or not. 
Here I would remind* you of the high place mercury holds 
in the "old school" as a "deobstruent," i.e., an agent to 
procure the disintegration and absorption of exudation, e,g,, 
in iritis. Where there is effusion of lymph, in visible beads, 
on the margin of the iris, when mercurials are given internally, 



126 CHBONIC M£BCUBIAIi P0I80NIKQ. • 

the lymph speedily disappears. The late Professor Spence 
nsed to say one could almost see it disappearing. 

Symptoms. — ^The child may be perfectly quiet when lying 
down, and for a short time even when sitting or standing, 
if not conscious of being under observation. Emotions 
increase the movements, e.g.y when the child is irritated 
or out of temper. If the patient be told to do anything, the 
movements will be multiplied and exaggerated in the muscles 
employed ; though the movements occur apart from as well 
as vnth voluntary efforts. There is diminished reflex action 
on tickhng, and ordinary sensation seems less acute. Some- 
times the muscles of the feice and neck are specially affected, 
so that it may require two or three persons to feed the 
patient. The movements cease during sleep. The left side 
of the face and the upper limbs are frequently first affected ; 
it usually begins in the face and sometimes does not affect any 
other part of the body. In the extremities the movements 
are chiefly those of pronation and supination, i.e,, twisting 
movements rather than flexion and extension, in this respect 
differing from paralysis a^itans. The gait is slow, shuffling, 
and uneven ; the power of co-ordination is deficient, and he 
can v^th difficulty walk in a straight line. 

Symptoms from the Cyclopcedia. — 30a. " Often there is a 
psychical irritability which makes persons, not usually shy, 
confused on being looked at ; sometimes very skilful work- 
men cannot go on v^ith their work when looked at. . . . 
Slight tvntching of the muscles of the face is an early 
symptom, especially about the comers of the mouth, the 
fingers begin to tremble when spread out, also the tongue 
when protruded, the letters become tremulous if one looks 
at him when he is writing. . . . Their movements be- 
come hurried, every little trifle, even being looked at or the 
dread of being observed, makes them excited and confused, 
and robs them of the use of their muscles. . . . The 
facial muscles twitch, they are unable to do their work, or 
even to write if others are observing them, the fingers and 
hands tremble." 

306. ** They (the muscles) certainly obey the impulse of 
the will by contracting, but these contractions are not such 



CHBONIC MBBCUIOAL POISONING. 127 

as the patient desires. They begin to tremble and twitch 
and set other muscles agoing in the same way, and the 
will loses all power over these muscles. ... It is 
generally the hands and arms over which the control of the 
will is lost. . . . One side of the body is occasionally 
more strongly affected than the other. . . . The convul- 
sions rarely continue during sleep and are always of the 
chnic form.*' 31a. "Four times tremor attained such an 
intensity that he had to be fed." 32a. " In the summer of 
1858 she was in the hospital, and for sixteen weeks at home, 
obliged to be fed." 32&. " Careful examination of tactile 
sense with the callipers shows decided diminution of sensi- 
bility." 336. " The reporter saw that it was a spasm, not 
resembling tetanus, hydrophobia or hysteria, but rather 
chorea. The head, arms and fingers, especially of the left 
side, were in incessant spasmodic motion. The corners of 
the mouth were retracted; the eyebrows wrinkled; the 
nostrils dilated. . . . The muscles of the left side were 
more affected than those of the right." 

III. — Paealysis Agitans. 

In this disease the tremors of the limbs occur indepen- 
dently of muscular exertion, and are of a clonic character. 

Anatomical Changes. — The anatomical changes are 
doubtful and inconstant, though sclerotic patches and de- 
generative changes are sometimes found. It is regarded as 
a disease of the brain, with a lessened conductivity of the 
fibres of the pyramidal tract, and therefore the impulses 
from the cortex pass intermittently. 

Symptoms, — Occasional tremors in a hand, thumb or 
foot, gradually increasing in frequency, duration and severity, 
and slowly spreading to other parts. When fully developed, 
moral emotions and voluntary movements augment them. 
The head and neck usually remain unaffected. Associated 
with the tremor is a peculiar rigidity of the muscles, and 
sometimes a cramp-like pain. The flexor muscles are 
specially affected, and the tremors consist of movements of 
flexion and extension, and not twisting movements such as 
are met with in chorea. The tremors cease during sleep. 



128 CHBONIO MEBClTBIAIi POISONING. 

and may at first be arrested by voluntary effort. Speech is 
jerky and slow, and tbe tongae is tremulous. Thrt gait is 
peculiar. Tbere is an inability to maintain equilibrium 
when walking is attempted. There is some dij£culty in 
rising from a seat ; and, before he starts off wal]dng, he 
probably hesitates a little as though for the purpose of 
balancing himself. Then, with the body bent forwards, he 
sets out in pursuit of his own centre of gravity ("festinant 
gait "), as if he were endeavouring to pass from a walking 
to a running pace. He is irritable and fidgety, and suffers 
from a painful sense of heat referred to the epigastrium and 
back, or he may be much troubled with " flushes of heat.** 
In regard to " old school *' treatment, I would jusii remind 
you that the late Professor Charcot recommended the use 
of the vibrating chair — a kind of rude homoeopathy, I 
suppose. 

Symptoms from the Cyclopadia. — I do not intend to quote 
sentences verbatim from the Cyclopsedia showing the resem- 
blance between paralysis agitans and the tremors of chronic 
mercurial poisoning. The resemblance is more a general one, 
to get a proper idea of which one needs to read the various 
sections right through. In regard to the gait there is a cer- 
tain resemblance between the " dancing trot " of chronic 
mercurial poisoning and the ** festinant gait '* of paralysis 
agitans. The tremors in paralysis agitans, it is true, occur 
tjrpically when the patient is at rest, nevertheless, in the 
later stages of the disease voluntary effort augments them. 
In other respects the general resemblance between the 
tremors of mercurial poisoning and those of paralysis agitans 
is marked ; and I do not think our law demands that the 
symptoms should be identical, but it does demand that there 
shall be as great a resemblance as possible. 

IV. — Locomotor Ataxy. 

Etiology. — It has often seemed strange to me that 
syphilis should play such a prominent part in its causation. 
This disease is supposed to account for at least one-half the 
cases, and Erb goes so far as to state that nine-tenths have 
a syphilitic origin. In thinking over this question I could not 



CHRONIC MEBCUBIAIi POISONING. 129 

help wondering whether it was the disease itself (syphilis) or 
its treatment (the excessive use of mercury) that deserved 
the most blame. This led me to turn to the Cyclopaedia to 
see whether chronic mercurial poisoning had produced 
symptoms resembling locomotor ataxy, and I was dehghted 
(if I nciay say so) to find that it had. The same reason is 
also a sufficient explanation for the almost universal use of 
iodide of potassium in the treatment of locomotor ataxy 
among our friends of the other school. 

Anatomical Changes, — ^An increase in the connective 
tissue (sclerosis) of the posterior root zones (postero-external 
tract: fasciculus of Burdach) finally spreading to and 
involving the postero-internal tract (fasciculus of Goll) as 
well. It begins in the lumbar region and ascends. Pari 
'passu, with the increase of connective tissue, there is a 
corresponding atrophy of the nerve elements. 

Symptoms. — The most common and characteristic symp- 
tom is the ataxy. There is, in the early stage, a difficulty in 
standing, especially when the eyes are closed (" Eomberg's 
symptom "). There is a difficulty in fine movements, such as 
buttoning the coat ; and when a stick is used he wraps a 
handkerchief round the handle in order to increase the sur- 
face of contact, this being required by the numbness of the 
hand. Then we have the "lightning pains,'* especially felt 
when the weather is damp ; also numbness, tingling, feeling 
of needles and pins, and "girdle sensations" in various 
parts of the body and extremities, especially the legs. There 
is a delay in the transmission of sensory impulses ; loss of 
the patellar reflex ; and a group of eye symptoms, among 
which we would specially note, paralysis (often temporary) 
of the third nerve, and the " Argyll-Eobertson pupil,*' i.e., 
loss of reaction of the pupil to light while it still continues 
to act with accommodation. Further, we have various 
'* crises," with vasomotor and trophic changes such as local 
sweatings, changes in the teeth and nails, leading to partial 
decay or total loss, and finally " Charcot's joint disease." 

I ought to have mentioned the sense of something soft 
under the feet (" furry sensation "), and the inability to walk 
in a straight hne, especially if he raise his eyes from the 
VOL. m. — NO. 2. 9 



130 CHRONIC MBBCUBIAL POISONING. 

gronnd or close them, with diflSicnlty in turning, which he 
does in a shuffling and uncertain manner. Then, again, 
there is the analgesia, and in a less pronounced form ances- 
thesia, very often present during the initial stages of the 
disease, occurring usually in localised areas or patches, 
which are surrounded by healthy skin. Analgesia is by far 
the most common impairment of sensation, and, as the case 
advances, it may extend so as to affect, in addition to the 
lower extremities, the trunk, upper extremities, and even the 
regions supplied by the fifth pair of nerves. Diminution, 
too, of the mtiscular sense is seldom absent, so that the 
patient is unable to recognise the position of his legs, unless 
he can see them. The temperature sense is frequently 
affected also. 

In passing, I would point out an interesting fact. In 
December, 1858, in the American HovKBopathic Beview, a 
paper by Boenninghausen is published, giving in great detail 
a case of tahes dorsalis cured by aluminium metallicum ; he 
also refers (without giving details) to three other cases cured 
by the same medicine. Now it is a curious coincidence that 
Professor Gowers, writing in 1894, on the treatment of tabes 
dorsalis, says ** The writer has lately found chloride of 
aluminium very useful." I wonder where he got the " tip." 

Symptoms from the Gyclopcedia. — 306. " The patients 
cannot grasp or use small objects. . . . The gait of 
those still able to walk is laboured, and the feet wide apart 
as in people with tabes dorsalis. . . . Formication and 
numb feeling in the hands, and even sometimes in the legs. 
Anaesthesia tactus and analgesia are sometimes observed." 
41. ** He had violent pains in the lower part of his back, was 
always trembhng, generally constipated, and could not make 
water freely. He had been impotent the whole twelve 
months. He complained further of shooting pains in his 
legs, could not feel the ground, and had a sensation of his 
feet being twenty times the size they really were." 42. 
'* Some time afterwards he felt very weak, particularly in the 
legs, and by-and-bye he became unable to walk straight. 
He complains of violent pains in the lower part of his back, 
and abnormal sensation in his legs, feeling as if bound tightly 



GHBONIO MEBOUBIAIJ POISONINQ. 131 

with an iron belt across the abdomen. . . Very slow re- 
action of the iris to light; nearly continual discharge of 
semen." 43. " Very marked analgesia on the dorsal aspect 
of both forearms, also a little on right chest and both 
temples." 44. " Six weeks ago he had felt creeping in soles, 
which soon reached legs and thighs, sensibility in these 
parts becoming very obtuse ; he felt as if walking on paste- 
board. . . . There has been for three months much 
diaphoresis, but exclusively on the right side. ... If made 
to walk, he advances uncertainly ; it is an effort to lift his 
feet, but he does not actually drag them. With closed eyes 
he staggers, and sways to the right side. . . . SensibiUty of 
surface varies in different regions, but is generally dimin- 
ished, especially on right side. There is complete anaesthesia 
on right side from malleoU to umbilicus, also over right arm 
save on its internal border, on inner and posterior aspect of 
left leg, and on lower half of anterior surface of left thigh. 
There is complete analgesia of right arm, right side of 
abdomen and both thighs save upper anterior surface of left. 
To cold both legs are insensible, right thigh, right half of 
trunk and right arm. ... In the right eye the conjunc- 
tiva is insensible, sight indistinct, pupils dilated." 45. " In 
the lower extremities, painful shootings through length of 
limbs (not in the joints)." 46. "The author has seen a 
well-marked case of locomotor ataxy, characterised by pains, 
ocular disorders, spermatorrhoea, 'plantar anaesthesia, and 
inco-ordination of muscular acts, result from the inhalation 
of mercurial fumes." 

I do not think that the various ** crises " are represented 
in the symptoms given in the Cyclopaedia, unless the feeling 
of tightness and pressure in the chest which occurs so often, 
and the occasional asthmatic attacks, be of that nature. 

V. — Friedreich's Disease. 

Synonyms, — " Hereditary Ataxy " ; " Postero-lateral 
Sclerosis " ; " Diffuse Sclerosis of the Spinal Cord and 
Bulb." 

Nature. — It SQems to stand between locomotor ataxy 
and "disseminated sclerosis," having important alliances 



132 CHBONIC MEBCUBIAL POISONING. 

with each, though for the most part the alliance is closer 
between it and disseminated sclerosis than between it and 
locomotor ataxy. 

The gait is misteady and uncertain rather than a dis- 
tinctly ataxic gait. The legs are often placed ynde apart, 
and the walk is not unlike that of a drunken man. The 
tremors are exaggerated when the patient executes any 
movement, but, on the other hand, cease when he is com- 
pletely at rest in the recumbent position. The speech is 
hesitating and thick. 

It is unnecessary to repeat the symptoms from the 
Cyclopaedia bearing on this disease, as they have already 
been given in the sections on " Disseminated Sclerosis " and 
" Locomotor Ataxy." 

VI. — Mental Diseases. 

It is possible that mercury would be useful in various 
mental disorders. In speaking of " Disseminated Sclerosis,** 
I should have mentioned that towards the end of that 
disease a subacute maniacal condition may supervene ; or 
the patient may develop " delusions of grandeur " precisely 
similar to those met with in general paralysis of the insane. 
In other cases persons suffering from this disease may lapse 
into a profoundly melancholic condition. 

In the cases given in the Cyclopaedia we may notice 
occasional wandering of mind, but more especially in 306, 
where we read: "As darkness comes on, the patient often 
has hallucinations of vision, which may last almost all 
night. He sees people about his bed, they touch him, lie 
down beside him or upon him like a nightmare ; all sorts of 
known or unknown people move about his room, pass his 
bed ; horrible figures, demons, dead people, monsters come 
and go. All this occurs when his eyes are open. These 
things inspire the patient with terror and horror. The 
patients are often subject to causeless anxiety that makes it 
impossible for them to be left alone day or night : they 
scream with terror, weep and lament, try to get out of the 
bed or room and flee away. Sometimes there is complete 
deUrium and aberration of intellect even persisting during 
the day.'* 



CHBONIC MEBCUBIAL POISONING. 133 

VII. — ^Neuralgia. 

In regard to neuralgia, mercury would seem to have 
some specific relation, probably in virtue of its action on 
the coverings of the nerves, rather than on the nerve fibrils 
themselves, though of course one cannot be quite certain as 
to the part actually affected. 

Symptoms from the Cyclopcedia, — In 31a we find ** Tear- 
ing pains in extremities, specially the upper." In 37a, out 
of a total of 107 cases given, 27 suffered from ** neuralgia." 
In 376, out of 18 cases, we find that two suffered from 
neuralgia and three from ischialgia. In 37c we read : *' Neu- 
ralgias are very frequent, under the form of gastralgia, 
ischialgia, and neuralgia of the fifth pair." In 48, ** After 
this process (i.e., salivation) she began to suffer frightfully 
from neuralgic pains in both arms and legs. . . . When- 
ever she took cold, or* was over-fatigued or depressed from 
any bodily or mental cause, she was certain to experience a 
recurrence of the pains. At the time of her application to 
me she was suffering from an attack of more than ordinary 
severity, and which had lasted a long time without shovnng 
any signs of yielding. She apparently could not find words 
to express the acuteness of her sufferings. All along the 
course of the sciatic nerve in the thigh, all down the course 
of the middle cutaneous and long saphenous branches of 
the anterior crural, in the musculo-spiral, radial and ulnar 
nerves ; and also, in a more generalised way, in the gastroc- 
nemii, in the soles of the feet, and in the palms of the 
hands, the pains were of a tearing character, which she 
described as resembling * iron teeth ' tearing the flesh. 
The pains recurred many times daily." 

In addition to the above I might refer to the shooting 
and other pains mentioned in the section on " Locomotor 
Ataxy," as well as the " bone pains " so frequently found in 
the various sections of the Cyclopaedia. I may here quote 
a short paragraph from Carroll Dunham : ** By virtue of the 
special cause, the neurilemma being attacked, true neuralgia 
occurs (prosopalgia mercurialis), especially when single 
nerve-twigs are involved. The pain is drawing and tearing, 
attacks generally but a single nerve; often changes its 



184 CHBONIC MEBGUBUL POISONmO. 

location, but sometimes retains its seat for months; is 
aggravated by hygrometric changes, and by changes of 
temperature. The left side is the most powerfully 
aflfected." 

I would now like to ask the question, " How are we to 
know, with a reasonable amount of certainty, the special 
cases of the foregoing diseases where mercury is the indi- 
cated (i.e., the simZZimMW, or most like) remedy?" It is 
all very well to write a paper on the subject, but quite 
another thing to face the question in actual daily practice. 
The question is important, too, in another direction, because 
whatever affects our practice will affect our pocket — a very 
tender spot with some of us. Were .mercury the only 
remedy ever likely to be needed in the diseases I have 
named, then the question would be comparatively easy to 
answer. In that case we would simply have to make sure 
of our diagnosis in the ordinaiy or allopathic sense. I need 
not tell you, however, that mercury is not the only medicine 
likely to be needed ; indeed, judging from clinical records, it 
does not seem to be used at all scarcely in some of these 
diseases. 

No two faces are alike, no two handwritings are the 
same, and no two cases of disease are identical, even when 
called by the same name and owning the same pathological 
anatomy, inasmuch as the 'patient always differs, and it is 
patients we have to deal with, not with diseases. How then 
are we to choose ? It would hardly be scientific to adopt 
the plan ** you pays your money and you takes your choice '* ; 
nor do I think it would be legal to " toss " for it ; and the 
law is very stringent at the present time on the subject of 
"games of chance," else we might try to guess. 

Whenever we admit that two or more medicines may be 
applicable for any given diseased condition, then, so far as 
the choice of the medicine is concerned, mere diagnosis and 
mere pathological anatomy must take back seats. The 
pathological changes in locomotor ataxy, whatever the cause 
or origin of the disease may be, or however the symptoms 
may differ in individual cases, are essentially and always the 
same — viz., increase of the connective tissue in the posterior 



CHBONIG MEBCUBIAIi POISONINO. 1S5 

columns of the cord ; indeed, without this it would not be 
locomotor ataxy. Microscopical observations can give us 
no indications when to choose this remedy or that, and 
besides we are not likely to meet with patients self-sacri- 
ficing enough to give us a section of their spinal cords in 
order to aid us in our diagnosis. 

The only possible scientific way out of the difficulty, it 
seems to me, is to follow the rule laid down by Hahnemann 
in paragraph 153 of the " Organon." " In this search for a 
homoeopathic specific remedy, that is to say, in this com- 
parison of the collective symptoms of the natural disease 
with the lists of symptoms of known medicines, in order to 
find among these an artificial morbific agent corresponding 
by similarity to the disease to be cured, the more striking, 
singular, uncommon, and peculiar (characteristic) signs and 
symptoms of the case of disease are chiefly and almost solely 
to be kept in view ; for it is Tnore particularly these that 
very similar ones in the list of symptoms of the selected medi- 
cine must correspond to, in order to constitute it the most 
suitable for effecting the cure." 

If the symptoms, or combination of symptoms, that 
distinguish any given medicine from all other medicines, 
and the symptoms or combinations of symptoms character- 
istic of any given patient, fit well, then I believe we may 
expect, with a reasonable amount of certainty, to cure. The 
indications for the use of any drug are derived, I believe, not 
so much from a knowledge of the particular tissues it may 
affect and how it affects them, but upon the general constitu- 
tional symptoms with their conditions and concomitants. 

I will now attempt to name a few of the symptoms that 
are regarded as more or less characteristic of mercurius. 

Cases requiring this drug, are usually characterised by 
erethism, very rarely by torpor; the patient is restless, and 
is constantly changing from place to place. He is slow in 
answering questions, and the memory is weak. 

It is said to be specially applicable to persons with light 
hair and blue eyes. 

In regard to the eye I would point out the aggravation of 
its symptoms by the heat, but especially by the glare of fire. 



136 CHBOmC MKBCUBIAIi POISONING. 

MercuriuB seems to be related very specially to the nose ; 
swelling and pain of the nasal bones. It is mnch in request 
for " dirty-nosed children." Note its epistaxis : it is worse 
at night, the blood is light in colour, and hangs in clots from 
the nose, Uke icicles. 

The face is earthy-coloured and pnflfy, or yellow. It has 
a special affinity for the two ends of the alimentary canal, 
i.e. 9 mouth and rectum. When I first was converted to 
homoeopathy I had a special friend, and the strenuous efforts 
we made to master the materia medica would have excited 
your profoundest admiration. This friend was a poet, and 
he was in the habit of making use of his gift in order to 
impress the leading fiEicts of the materia medica upon our 
minds. For example, in reference to mercurius he wrote : — 

'* M'ciuius fact I would relate 
Though moath is moiat, the thirst is great." 

Note the profuse, foetid ptyalism, with a coppery or 
metallic taste, the aphthae, ulcers or even sloughing of the 
cheek, the swollen, flabby, pale or yellow-coated tongue, 
showing the imprint of the teeth. Speech stammering, or 
difficult on account of trembling of the mouth or tongue. 
Note the decay of the teeth, also the fact that the gums 
recede, leaving the fangs bare ; the toothache with swelled 
face, this swelling being hard and pale ; the spongy bleeding 
gums, with a vivid red line, specially at the roots of the 
incisor teeth. Then again, we have the slimy, bloody stools, 
with great tenesmus during and after, followed by chilliness 
and a "never-get-done" feeling; the more blood the more 
is mercurius indicated, and it is rarely indicated where there 
is no slime. 

It has a peculiar cough ; it is dry and fatiguing, and two 
paroxysms succeed each other closely, and are separated 
from the next by a period of perfect rest ; it is worse at 
night, and the patient is unable to lie on the right side. 

Profuse perspiration attends nearly every complaint, but 
does not relieve, and may even increase the sufferings. It is 
easily provoked, oily, sour, giving a yellow tinge to the 
linen. Sweat during sleep. 



DISCUSSION ON CHBONIC MEBCUBIAL POISONING. 137 

Grlandnlar swelling, with or without suppuration, but 
especially if the suppuration be too profuse note ; its marked 
aflSnity for the salivary glands, also the inguinal, which may 
swell every time the patient gets his feet wet or takes cold. 

"Wlien discharges from mucous membranes contain pus 
(e.g., from the bowel, kidney, or uterus) as in pyaemia and 
puerperal fever {puerperal metritis) . 

Conditions of Aggravation, — By cold, and at night, just 
after, or as soon as he becomes warm in bed (especially the 
bone pains) ; though the rest in bed relieves, yet the heat of 
the bed aggravates. There is also aggravation by damp 
rainy -weather, by exposure to currents of air, especially in 
the evening and in the autumn with its warm days and cold, 
damp nights. The Cyclopaedia gives : — '* These tophi, with 
swelling and sensitiveness of periosteum, are the cause of 
violent pains, especially at night, in the warmth of the bed, 
in cold, damp weather, and in a thunderstorm, but par- 
ticularly at the first snow-fall.'* Patients are said to be 
worse when lying on the right side, and remember in con- 
nection with this how mercury, in its action, has a preference 
for tlie left side. 

In conclusion, I would remind you of the very important 
trio, often so perplexingly alike in their symptomatology, 
viz., hepar, mercurius and nitric acid. 



Dr. Hughes said he agreed with the author with regard to the 
homoeopathicity of mercury to chorea and paralysis agitans, but 
with regard to affections like multiple sclerosis and locomotor 
ataxy, and, so far as they knew anything about it, Friedreich's 
disease, he must accept the doctrine, as the French say, avec 
riserves. Sclerosis, whether occurring in the primary chancre of 
syphilis or in some of its later manifestations, seemed to him 
beyond the range of mercury, and any good that it did must be by 
its antipathic action. He did not believe in the homoeopathicity 
of mercury to the hard chancre. It cured the soft chancre, but 
if it removed a hard one it must be by exerting its antipathic 
influence upon it, and so with regard to the sclerotic changes 
which occurred, whether in syphilitic subjects or others. The 
case quoted from Bartholow was, he thought, the only one which 
developed any of the symptoms of locomotor ataxy in such com- 



188 DISCUSSION ON CHBONIC MEBCUBIAL POISONING. 

bination as to lead one to believe that the sclerotic change in the 
posterior columns had occurred; and standing alone, valuable 
as it was, it needed confirmation. He had understood Dr. 
McLachlan to say that in the treatment of locomotor ataxy by 
the old school, iodide of potassium played a large part, and to 
suggest that that might indicate that it was really a chronic 
mercurial poisoning. His (Dr. Hughes') impression was that 
anti-syphilitic treatment had been found of no avail, and had been* 
practically abandoned, in the treatment of locomotor ataxy. The 
best results published were those obtained by Wunderlich, and 
those who had imitated him, with nitrate of silver. If iodide of 
potassium had been used it had been unsuccessful, and so they 
could not argue from the beneficial effects of this drug. As 
regarded the mental disease, he quite accepted what had been 
said, and also with regard to neuralgia, but he did not see why 
they should suppose the mercury acted upon the neurilemma 
rather than upon the substance of the nerve itself. That which 
had been said with reference to the neuralgia-producing power of 
mercury seemed to him to indicate neuritis. He thought they 
could recognise neuritis in many of the mineral poisons, especially 
in arsenic. He now came to what was really the most practical 
point in the paper, apart from the valuable researches on the 
pathological relations of mercury to morbid states — ^were they to 
choose mercury in the treatment of those diseases because the 
pathological change it was capable of causing was present, or 
were they preferably to be guided by the presence or the absence 
of certain other so-called characteristic symptoms of the drug ? 
He should answer that question according to what they found. 
For instance, suppose there were three drugs — mercury, phos- 
phorus and arsenic — all of which were capable of producing 
identical pathological changes in the spinal cord, and the patient 
came to them with those changes, and it was a question between 
those three drugs, and suppose that patient had some of the con- 
stitutional symptoms of mercury and not of phosphorus and 
arsenic, he quite agreed with Dr. McLachlan that they should 
choose mercury in preference to the others ; but he could not quite 
agree that if such symptoms were absent, therefore they should not 
prescribe mercury. Their presence added to the indications for 
the drug, but their absence would not forbid its use. The author 
told them that they had to treat patients and not diseases — 
he could not always accept that as a guiding rule. There were 
cases in which they had to treat the patient, but there were 
also cases in which they had to treat the disease. For instance, 



DISCUSSION ON OHBONIC MBBCUBIAL POISONING. 139 

a man, liitlierto in good health, took a chill, which brought on a 
feverisli attack. Now, the kind of feverish condition he was in, 
wlietlier lie was restless, agitated, distressed and anxious, or 
cahxL a-iid passive and dull, was very important in choosing his 
remedy. There, they treated the patient rather than the disease. 
But ^v^Iien a man got pneumonia, it mattered little or nothing 
whetlier lie was cross or patient, with regard to treatment — 
very little indeed in comparison with the actual change which 
had taiken place in his lung and the stage of the pneumonia 
whicli ^was present. It was not that the man was ill and 
therefore had pneumonia, but that he had pneumonia and there- 
fore ^waiS ill, and the great thing to do was to cure his pneu- 
monia. W^hen they had done that any crossness he had would 
very soon pass away. He thought their friends who called 
themselves Hahnemannians went to an extreme in which Hah- 
aemann himself would never have followed them. He (Dr. 
Soglies) read at the International Congress of 1881 a paper upon 
individnalisation, and he brought a number of extracts from 
Hahnemann's writings to show he was by no means the indi- 
vidaaliser he was so often supposed to be, but recognised the 
definite types of disease as strongly as any pathologist could do, 
and chose his remedies with reference to those types. He did 
not deny that there were many cases in which the general con- 
dition of the patient was the most important thing, but he did 
niaintain that there were many others in which it was not his 
condition as a whole, but that of the particular part a»ffected. 
Therefore he must maintain that it was so with reference to 
those chronic diseases of the nervous system. The subject of 
paralysis agitans or chorea or anything else might have any 
mental state they liked, might have perspirations or no perspira- 
tions, giving relief or otherwise, but if mercury was truly homcBo- 
pathic to the condition of his spinal cord, or whatever might be 
the nervous centre affected, he maintained, according to the 
principles of homoeopathy, that mercury would do him more 
good than any other medicine, unless they could get one which 
acted still more decidedly upon those parts and in the same 
manner. It was the local symptoms, the topical symptoms, 
that were here the important ones. He admitted it was a 
matter open to difference of opinion. It was the most important 
question they could discuss in connection with that subject. 
With regard to the relation of mercury to locomotor ataxy, and 
multiple cerebro-spinal sclerosis, he based his objections to itd 
homoeopathicity not only upon the nature of the pathological 



140 DISCUSSION ON CHBONIC HEBGUBIAL POISONING. 

change, bat because he did not think that they had in the 
pathogenesis of mercury any of the definite symptoms of either 
of those diseases. The difficulty of carrying a glass of water to 
the mouth was not peculiar to cerebro-spinal sclerosis — it was 
met with in chorea, if not in paralysis agitans — and the bending 
over of the body in walking which Dr. McLachlan had referred 
to — it was more than that, it was a hurried walk, as the word for 
it (festination) implied — ^had not (he thought) been observed in 
chronic mercurial poisoning. Again, he did not think the 
peculiar symptom of difficulty of standing with the eyes shut 
had been noticed, except in that one case of Bartholow's, 
which was so striking that it was hardly credible. He should 
want two or three cases at least before he could accept that. 
He would ask Dr. McLachlan to consider these points : — ^That of 
the true homoeopathicity of mercury to locomotor ataxy and 
multiple cerebro-spinal sclerosis ; whether its neuralgia was not a 
neuritis ; and whether the '* characteristic " mercurial symptoms, 
although valuable when present as indications, availed as contra- 
indications when absent. 

Dr. CiiiFTON said that with regard to the points which Dr. 
Hughes had raised, first, as to how far mercury met the patho- 
logical conditions which had been alluded to, and, secondly,whether 
the choice of a medicine for any given disease should be from a 
pathological or a symptomatic standpoint, he (Dr. Clifton) would 
say but very little, inasmuch as he knew comparatively nothing 
of scientific pathology, and moreover because his practice had 
been based mainly upon the study of minute symptomatology, 
supported to some extent by such sidelights as he could get from 
any source bearing upon the nature and course of the disease 
which he had to treat. At the same time, he admitted that 
merely symptomatic treatment, apart from pathology, was not 
satisfactory, and that so far as possible both should be combined. 
He believed the study of minute symptomatology led up to a 
correct pathology, and that pathological knowledge also led to a 
better interpretation of symptoms, in relation to what were 
essential or non-essential symptoms. 

Dr. BoBEBSON Day mentioned an interesting case illustrating 
mercurial poisoning, which was quite a pathogenesis of the drug. 
It only, so to speak, showed one side of the poisoning. The 
patient was employed in filling mercurial thermometers and was 
constantly exposed to the fumes of mercury, which attacked him 
through his nervous system. He had no such thing as salivation 
or ulceration of the gums, or any of those symptoms which are 



DISCUSSION ON CHBONIO MEBCURIAL POISONING. 141 

generally obtained from mercury, but all the symptoms were 
referable to the nervous system. He had most marked tremor, 
emaciation, and from being a strong and robust young man, 
became a nervous, tremulous being. Any noise alarmed him ; 
he started even when spoken to, and was utterly incapacitated for 
all the ordinary avocations of life. It appeared an interesting 
case in this respect, that it might possibly throw light upon some 
of the cases that one meets with where although the drug is used 
which seems best to cover the symptoms, yet the curative results 
anticipated are not obtained. In the case of the man he had 
cited, supposing he had come suffering from ulceration of the 
gums, and symptoms which would ordinarily indicate mercury, 
representing that side of mercurial poisoning, and mercury was 
prescribed, might it not be unsuccessful ? But supposing he came 
with the nervous symptoms and tremor, the mercury would 
suit the symptoms of tremor, and in that respect would probably 
cure him. That might explain some of the cases of failure, 
which seemed inexplicable in other ways. 

Dr. GoLDSBBOUGH Said that the author had told them that if 
they were to understand the action of mercury they must make a 
very thorough study of its pathogenesis. But after all, the veri- 
fication of the value of the remedy in disease was the practical 
point for those who had to deal with the diseases mentioned. 
He had only one little fact to mention in relation to the various 
groups of diseases which were detailed in Dr. McLachlan's list, 
and that was as to the temporary help a dilution of mercurius 
solubilis affords in paralysis agitans. He had had under observa- 
tion four well-marked cases, three of which he had watched to the 
end of their lives. He had not been able to do them any perma- 
nent good, but the aching and stiffness in the muscles of the 
neck, together with the tremor, had been repeatedly relieved by 
mercnrius solubilis of the twelfth and thirtieth dilutions. He 
was treating a case now, and had been for some two years, of 
what he believed would eventually turn out to be a pronounced 
case of paralysis agitans, where there was a marked dragging 
sensation in the nape of the neck, with a difficulty to keep the 
head still. There was a slight tremor of the head, but in no 
other part of the body, and he regarded that as a case pf incipient 
paralysis agitans. The only medicine which would do that patient 
any good was mercurius solubilis 30. He gave her that for some 
weeks, and then it seemed to lose its effect, but after an interval 
on repeating the prescription more relief was obtained. As to 
whether they were always able to find characteristic symptoms 



I 

142 DISCUSSION ON OHBONIO MBECUBIAL POISONING. 

in any giyen case, he (Dr. Goldsbrough) thought they ought 
always to be able to find them, because it was a pre-supposition 
that if the characteristic symptoms of one drug were absent there 
^would be some of another drug which was indicated from a 
generalised point of view. If they took Dr. Hughes' illustration 
of arsenic, phosphorus and mercury, they were all three indicated 
from a generalised or pathological point of view. The presump- 
tion would be that one of those three would be indicated from 
the specialised point of view ; and if they were not satisfied that 
any one of those drugs was indicated from the specialised point 
of view, surely there must be some other drug, or some other 
group of drugs, which ought to be brought into consideration in 
that view. In his opinion they ought not to be satisfied until they 
found a drug which corresponded all along the line. He asked 
them not to think that he aorgued from the symptomatological 
point of view only, but he wished to emphasise the fsict that they 
ought to seek for the drug, and expect to find it, which would 
occupy the whole field. He only wished they had more real 
facts in the treatment of the diseases which Dr. McLachlan had 
brought before them. It was so difficult in general practice to 
fix one's attention on a certain group of diseases or cases and 
follow them out to their proper scientific conclusions. 

Dr. Dudgeon would have preferred Dr. McLachlan to have 
mentioned cases where mercurius had cured those diseases of 
which they found such accurate likenesses in the Gyclopsadia. 
He had never seen any record of cases where mercury had cured 
locomotor ataxy ; and looking at the symptoms of mercury as 
detailed in such collections as Ziemssen's GyclopaBdia, where he 
gave a resume of the effects upon workmen, it appeared to him 
that not locomotor ataxy but more what is called general 
paralysis was the affection that was represented in the patho- 
logical or toxic effects of chronic poisoning by mercury. But in 
the absence of illustrative cases of the cure of the diseases 
mentioned by mercury it was very well that, they should be 
reminded that mercury did present pictures of these diseases. 
He was surprised to hear that Dr. Hughes considered mercury 
was not homoeopathic to hard chancre, and that it was homoeo- 
pathically indicated in soft chancre. His own experience was 
exactly the reverse of that. He found mercury curative of 
hard chancre, and he had seen a good many cases of soft chancre 
where mercury did no good, but appeared to do a great deal of 
harm. He could not agree with Dr. Hughes in thinking that the 
action of mercury in hard chancre was antipathic ; he thought it 



DISCUSSION ON CSaBONIC MEBCUBIAL POISONING. 148 

was truly homoeopathic to syphilis, both primary and secondary. 
They knew, for instance, that the symptoms of mercury had 
stmck several allopathic writers, notably Dr. Graves, of Dublin, 
as being almost an exact represenl/ation of syphilis, and if so then 
surely they must say that mercury was homoeopathic to syphilis, 
and the most characteristic feature of syphilis was the hard 
primary chancre. 

Dr. Hughes wished to explain that it was not a question of 
experience but one of pathogenesy. He would ask his colleagues 
to consider whether mercury had ever produced anything like a 
hard chancre in a healthy subject ; whether on the contrary it did 
not produce ulcerations which corresponded very closely to soft 
chancre. As to the matter of practical experience he had said 
that he quite believed that mercury did promote the disappear- 
ance of a hard chancre, but he beHeved it did so by its antipathic 
action and not by its homceopathic, and therefore it was that 
it was always given even by homoeopathists in semi-substantial 
doses. Even a man like Jahr went down to the first trituration 
for the treatment of primary syphilis. 

Dr. McLachlan, in reply, said that Dr. Hughes was quite 
right "with, regard to iodide of potassium, as it had not been 
successful ; it used to be always given, but in the latest medical 
works they would find it was put down as being absolutely use- 
less in locomotor ataxy. In every case he tried to get the exact 
pathological changes, but at the same time he did not found his 
treatment upon that exclusively, unless, of course, he had nothing 
else to go on. He endeavoured to put the symptomatology and 
the pathological anatomy together ; the only thing was that he 
put symptomatology first in importance. He mentioned a case 
of pleurisy where the patient had got on beautifully with bryonia. 
She Iiad a high temperature and a short respiration, and she 
could only lie upon the painful side. He thought that this was as 
clear a case of indicating bryonia as one could possibly find. He 
gave bryonia 30, with great relief. He mentioned another case, 
near Oxford, where the symptoms were similar, except that the 
girl could not He upon her painful side. That surely must mean 
something, but he could not tell what. He remembered reading 
that belladonna in such cases was more likely to be of use than 
bryonia, and he had prescribed belladonna, with a direct and 
satisfactory result. 

Dr. Hughes : Was that the only symptom present ? 

Dr. McLachlan: No; she had the flushed face, and was 
probably tubercular as well, and further, bryonia had been tried 



144 POLTPUS OF THE EAB. 

before I was sent for, but was found to be useless. With regard 
to sclerosis versus liquefaction he could not say, because there 
had been no pathological changes observed in chronic mercurial 
poisoning. He remembered a case at Edinburgh where two 
workmen put a pot of mercury on the top of the stove in the 
room where they were sleeping, and the next morning they were 
both suffering from mercurial poisoning — one had the nervous 
symptoms purely, the other had salivation, and none of the 
nervous symptoms at all. In such a case there could not be 
time for profound pathological changes to take place. 



POLYPUS OF THE EAE.' 

BY ROBERT T. COOPER, M.D. 
Physician for Diseases of th£ Ear^ London HomoBopathic Hospital, 

Polypus of the ear presents some difficulties of treatment, 
when, as this did, it protrudes from the meatus and obstructs 
the entire lumen of the external auditory passage. In the case 
from which this was removed the man had been operated 
upon four years ago by one of the foremost aural surgeons 
in London. The man described the operation as having 
been performed with the ordinary snare, presumably Wilde's 
snare, and as having given him a great deal of pain, followed 
by excessive haemorrhage. Besides this, the patient had 
been operated upon previously by three general practitioners, 
and for some two or three years had been treated by two 
prominent homoeopathic colleagues as well as by the Mattei 
remedies — in fact, the polj^us had existed for ten years 
without apparently having been once completely removed. 
So considerably had he suffered from operations, so great * 
had been the haemorrhage and pain on the last occasion that 
he trembled at the idea of my undertaking to remove it. 
As, however, I had seen a very large number of these cases 
from time to time, and had never found any inconvenience 

' Specimen shown, together with the forceps employed in its removal, 
December 6, 1894. 



POLYPUS OF THE EAB. 145 

to arise ^when the operation was properly performed, I did 
not hesitate to remove it, and to the surprise of the patient 
got it srwB.y at once, without anaesthetics, the pain and 
hsBmorrbage being in fact quite trivial. The reason for 
being able to accomplish this result so easily arose from the 
fact tlnat instead of using a snare, I employed a specially- 
constructed polypus-forceps, of which this is a pattern. It 
is made for me by Wright & Sons, of 108, New Bond 
Street, and possesses the advantage of being able to grasp 
the polypus by its slightly beaked extremity, •without any 
fear of slipping ; and, so long as the blades of the forceps 
are strong enough, without any danger of their over-riding, 
while a slight twisting movement is being given to the 
elongated growth. It is to this torsion effected upon the 
polypus that I attribute the comparative freedom from 
haemorrhage after the operation, the supplying vessels being 
thereby constricted. The polypus seems to give way at its 
most constricted part, which is where it emerges from the 
middle ear, at the perforation in the tympanal membrane. 
I have seen . many cases where extreme loss of hearing 
resulted from this operation in the hands of good aurists, and 
consider it likely that this often results from the destruction 
of middle ear tissue through the forcible pulling required for 
the removal of the growth when the snare is employed. 

It seems to me unaccountable how Wilde's snare (and 
its modifications) has held its sway, and with what unani- 
mous approval it has been received ; the slope downwards 
of the inner half of the external auditory meatus renders it 
difl&cult, if not impossible, to constrict the polypus with the 
wire noose sufficiently close to the tympanal membrane for 
ef&cient removal, while the twisting movement, so easily 
given with the forceps, is liable to break the wire in use 
with the snare. 

In the forceps shown. No. 1 has a single limiting bar. 
No, 2 has double bars ; the former I have had in use many 
years, but the latter modification is, I consider, an improve- 
ment, as it guards still more against over-riding of the ends 
of the blades. 

It goes without saying that when a growth entirely fills 

veil. III. — NO. 2. 10 



146 TUBEBcn^nrs cebticai^ glastsm. 

op the mesknB, snd psoinides 80 as to constitate a de^^ 
£nrmity, besides depnYing the patient of all power to hear 
outside sounds, the indicaitionH for removal are imqiies- 
tionable. 

While, therefore, my endeaToor, as a role, is to avoid all 
kinds of operations npon the ear, I am forced to admit the 
occasional necessity for this one. 



TUBEBCULOUS CEBVICAIj GLANDS.^ 

BY D. MAGHISH, MJ>. 

As this is a disease which every medical practitioner — 
homoeopath or allopath — ^is called upon to treat in general 
practice, I take the liberty of bringing to yoor notice the 
system of treatment adopted in a series of cases in the 
London Homoeopathic Hospital. As a rule, every one has 
his own routine system of dealing with this disease, and a 
discussion on the various methods will be of general interest. 
Before doing so I will prefeu^ the discussion by a few remarks 
on the Aetiology of the disease. 

Our cold, raw climate, our populous and crowded cities, 
our large manufacturing centres, the habits and vices of 
the people, tend to foster the strumous diathesis. In this 
country there are abundant facilities for its study in its 
many and varied manifestations. 

Struma, scrofola, 'tuberculosis, are now considered iden- 
tical terms. The condition has been defined as a chronic 
and infectious parasitic disease, produced by a tangible 
organic contagium. The bacillus of tuberculosis has been 
definitely and clearly demonstrated. There is some differ- 
ence of degree but not of kind between the virus of scrofula 
and tubercle. 

A strumous gland is a tuberculous gland. The primitive 
lesion is hyperplasia of the gland tissue. In this diathesis 

* Presented to the Surgical Section, December 6, 1894. 



TUBEBOULOUB OBBVIOAL GLANDS. 147 

we observe nsuaUy a defective condition of the general 
health, a tendency to various forms of inflammatory change. 
This change manifests itself in lymphatic glands, cancellous 
bone, skin, synovial and mucous membranes. Scrofulous 
gland disease is rarely associated with phthisis. Scrofu- 
lous bone disease is often associated with phthisis. Scrofu- 
lous patients often die of phthisis. Phthisical patients 
rarely contract scrofula. It is a condition inherited. The 
seed is inherited in congenital syphilis ; in scrofula it is the 
pecnliarity of the soil. In tuberculosis there is a general 
infection of the system which localises itself in some of the 
tissues named. In syphilis there is a local affection which 
afterwards becomes general. 

There is no affection more dependent on external condi- 
tions. The chronic inflammatory changes are very much 
what they are allowed to become. Judicious treatment can 
prevent its local development and recurrence, can modify its 
course. It is a process chronic in its nature, tedious, prone 
to relapse, but ever amenable to treatment. The scrofulous 
youngster often develops into a strong and healthy adult. 

Scrofulous disease usually begins near the centre of the 
gland. There is rapid cell proliferation, defective power of 
organisation. Giant cells are seldom observed. The in- 
flammatory process tends to spread by local extension, and 
is very prone to caseous degeneration. 

Of all tissues the lymphatic is the most embryonic, the 
least differentiated or organised. It is also the most plastic, 
and endowed with the most potentiality. Lymphatic glands 
do not enlarge spontaneously. There must be some antece- 
dent lesion. The primitive lesions are inflammatory. The 
inflammation is usually due to some irritant, e,g,, injury, 
and so the parts affected are those most directly subject to 
this irritant. The inflammatory condition may be simple or 
tuberculous. These two forms of inflammation or lymph- 
adenitis are well differentiated. The strumous variety is 
characterised by a greater amount of inflammation, by 
obstinacy, intractability, and pertinacity after inflammation 
has been set up. Strumous glands will inflame on much 
less provocation than ordinary healthy glands. When once 



148 TUBEBOULOUB GEBVIGAL GLANDS. 

inflamed they remain inflamed for a longer time. Ordinary 
non-tuberculous glands when inflamed will resolve, suppu- 
rate, or organise in much shorter time. They rarely undergo 
the "cheesy** change so characteristic of tuberculous glands. 
In the strumous diathesis there is more vulnerabiUty. There 
is a defective power of resistance to external influences. This 
is usually accompanied by a defective power of growth and 
development. 

Lymphatic vessels, lymphatic plasma, as well as the 
general anatomical relations of the cervical glands, are so 
well known that it is unnecessary to make any further 
mention of them. 

With these few preliminary remarks I will now discuss 
the treatment adopted, and afterwards the relative values of 
surgical and medicinal aids. 

Ordinary Course, — The gland — rarely only one — in- 
creases in size. This may be with or without pain. It 
feels hard at first — movable — swells up. There is in acute 
cases fever, limitation of movements of jaw, neck and head, 
feeling of fluctuation, often appearance of red lines over 
swelling. Sometimes earache occurs. Skin becomes dusky 
red — then dull blue. There may be crepitus. Skin may 
become adherent, and burrowing of the pus. The gland gives 
away ultimately in the centre. There is a shell of adenoid 
tissue lining the capsule — inside a homogeneous, greasy, 
caseous mass. Earely there is oedema of larynx. In one 
case under treatment, woman aged 32 (July 16, 1894) with 
a suppurating specific swelling, the patient died suddenly 
from this condition of oedema. In another case a retro- 
pharjnigeal abscess formed. This was opened externally, and 
the patient, a young lad, made a good recovery. The scar 
resulting is usually permanent. 

Of the 100 cases occurring in Mr. Dudley Wright's 
Out-patient Department of the London Homoeopathic 
Hospital the average age of the patient has been 16 years. 
The ages have varied from 12 months to 75 years. In a con- 
siderable number of the cases the proximate cause has not 
been noted, and the results of the treatment have not been 
stated. Still, we may infer that at least in 50 per cent, non- 



TUBEBCULOUB CEBVICAIi GLANDS. 149 

return of the patient signifies a cure. Hospital patients are 
not the class of patients who do one most credit in the 
treatment of this disease. Their poverty, environments, 
difficulty in obtaining suitable nourishment, their exposure 
to all sorts of weather, militate very much against them. In 
patients situated in a superior position of life the usual 
remedies are much more efficacious. 

Koughly, we may divide the cases into two classes : (1) 
Where the disease is acute. (2) Where chronic. As the 
latter class comprises the greater number of those under 
treatment, with these alone I will now concern myself. 

(1) Simple Chronic TubercuUncs Enlargement of the 
Glands. — Here the application of glycerine and ext. bellad. 
locally, especially if any irritation, with internal remedies as 
calcarea iod. 3, arsen. iod. 3, has been very efficacious. Ung. 
iodoform has also been used locally with good results, es- 
pecially if the glycerine and bell. appHcation has proved 
ineffectual. The ung. iodoform has been applied twice daily. 
In a large number of cases this form of treatment has 
failed. The glands have gone on to suppuration. 

(2) Suppurative Lymphatic Glands. — ^Here still ung. iodof . 
has been locally applied; and hepar sulph. 3x, sihca 3x, 
silica sol. 3x used. When suppuration has been inevitable, 
hep. sulph. 3x has been efficacious, followed by silica 3x 
where other glands also show signs of suppuration. There 
has been the usual scar, but in many cases the results have 
been very favourable. 

Still, this treatment has also failed in many cases. 
Where there has been general glandular cervical infiltration 
tuberculinum has been used. In two cases — which I need 
not detail — the results were most satisfactory. There was 
at once a great improvement locally, and the patients volun- 
tarily reported themselves as feeling ever so much better in 
health. This conditipn was maintained. In two cases the 
patients never returned. In two cases there was no im- 
provement after prolonged use of tuberculinum, and the other 
remedies were again resorted to. 

There is still a large number of the patients xmder treat- 
ment ; it is surprising how they persist with homoeopathic 



150 TUBBBCULOUB OEBYICAL GLANDS. 

treatment month after month — a state of matters most 
unusual under allopathic treatment. 

In a large number of cases the condition of the teeth has 
demanded attention. Until carious teeth are removed or 
cured, our treatment is ineffectual. In infants, how often do 
we find that the dental condition is the proximate cause of 
the local glandular development of the tubercular diathesis. 
Strumous children, as we all know, usually suffer from 
dental caries, and it is very important that good dental skill 
be secured for them at once. Among the poor hospital 
patients this is very difficult to obtain. 

Surgical Treatment, — Here there is considerable differ- 
ence of opinion. One side state that this form of treatment 
is unnecessary. As good results, if not better locally, are 
obtained by medicinal treatment alone. The advantages of 
surgical treatment are outweighed by its disadvantages. Its 
disadvantages are : — (1) Shock to the system. (2) Danger of 
metastasis of the disease. (3) Bisk of locally spreading the 
disease. (4) The frequent necessity for its re-application. 
(5) Danger of closing a natural outlet of the disease in cases 
where there is suppuration. They allege that, in the case 
of patients suffering from tuberculous glands, so long as 
these glands remain uninjured and are subjected to no 
stimulation, and so long as the nutrition of the patients 
keeps fairly good, the patients remain as a rule compara- 
tively free from puhnonary phthisis and other forms of 
tuberculosis. By operative treatment, the knife and Volk- 
man's spoon, there is no doubt the amount of disfigurement, 
a most important factor in the treatment, is lessened, but at 
what risks? Often by the danger of disseminating the 
disease to some more vulnerable part of the system. The 
suppurating gland is said to be an outlet for the disease. 
It is an issue of most material importance to the patient 
when it is allowed to heal up under medicinal treatment. 
It is said we rarely find any recurrence of the disease in any 
other part of the body. Surgery is stated to cure the local 
condition but ultimately to kill the patient. Operative treat- 
ment is too often the precursor of a fatal recurrence of the 
disease, in some more vital organ, as the brain or lungs. 



DISOUSBIOM ON TUBBBOUIiOUB OBBVICAL GLANDS. 151 

The diathesis is said to localise itself in a gland or series of 
glands y and the less irritation applied to these the better for 
the patient. 

Tlie advantages of surgical treatment may be stated as : 
(1) Hiessening the amomit of disfigurement. (2) Also the 
time of local treatment. (3) The removal of a local source of 
infection and irritation ; and (4) Strengthening the patient's 
general condition. 

In the race of life scars on the neck militate against the 
patient's career. Patients as a rule will endure an extra 
amount of suffering if by such means the amount of dis- 
figurement can be lessened. Of course, along with surgical 
treatment, constitutional treatment is indispensable, and 
there is no doubt by suitable homoeopathic remedies the 
results in the hands of our homoeopathic surgeons have been 
so far satisfactory. 

There are cases where, after surgical treatment has been 
adopted, a fatal recurrence has ensued. But are they the 
rule ? The surgeons say they are the exception. The 
surgeons of the London Homoeopathic Hospital have had 
abundant facihties for contrasting the results of the different 
systems of treatment, and to them on this point we must 
necessarily look for guidance. This difference of opinion 
about surgical treatment is not confined to the Homoeopathic 
School. The Allopathic School has its advocates and 
supporters of each system. 

There are many and important points in this disease 
which I have not considered it necessary at this time 
to bring to your notice. In a short paper like this it 
has been impossible to do so. In the discussion, which I 
hope will follow, the different members of the Society will 
be able to bring out any points of saUent interest which I 
have considered it at present unnecessary to trouble you 
with. 



Mr. Knox Shaw said those who had operated on a good many 
cases of tuberculous glands could have but one opinion, viz., that 
it was almost impossible for any medicines to have any influence 
upon them after a very early stage. He could quite understand 



152 DISCUSSION ON TUBERCULOUS CBBYICAL GLANDS. 

how medicinal influence might help the gland when it was in a 
state of irritation, when its normal tissue was simply hypertrophied, 
hut when they came to the state of caseation and pus, which was 
arrived at very early in the course of the disease, he did not see 
that medicines could do any material good to the glandular con- 
dition. After having operated upon a very large numher of cases, 
he failed to see that surgery did any harm to the patient hy 
removing a source of irritation, and he was inclined to think that 
the expression of opinion that tuberculous glands were the 
natural outlet for some evil humour was returning to the 
pathology of a very ancient date. He felt that surgeons, and 
even physicians, should begin to treat surgical tuberculosis as 
they would treat a malignant disease, and that they should never 
rest until they had eradicated its foci as fully as possible. He 
believed that the damage done to a patient by having left in his 
body bags of caseous and purulent material, as they might be con- 
sidered, and which became sources of auto-inoculation, was very 
great — they were not an outlet for the humour in the body, but a 
humour in the body which was poisoning the patient. With regard 
to local applications, when the glands were in their early stage 
of enlargement, the less they were irritated by applications the 
better. As an instance of what he meant by treating surgical 
tuberculosis as if it were a malignant disease, he would mention 
the case of a young man who might be said to have been rescued 
from tuberculosis by persistent and active surgical measure. 
Many years ago he began to suffer with enlarged cervical glands. 
Various glands were removed on a great many occasions, amongst 
them some axillary glands. Finally, the tuberculosis attacked 
one of his testicles, and it was removed. The patient was now 
going about to all intents and purposes practically well, simply 
because his tuberculous disease was treated as if it were a 
malignant disease. Mr# Knox Shaw said he knew the question 
had been raised that if the glands were removed it predisposed 
the patient to an attack of tuberculosis elsewhere. His own 
experience did not confirm this view. 

Dr. Dyce Bkown said one point that Dr. MacNish had 
brought forward with regard to the surgical treatment of these 
cases, was that the scar left was so much smaller. He (Dr. 
Brown) had seen several cases where the mark was not one to 
be proud of. 

Mr. Knox Shaw : Taken too late. 

Dr. Dyce Brown said that the question really was whether 
the gland which was to be removed was the source of disease to 



DISCUSSION ON TUBEBCULOUS CEBVICAL GLANDS. 153 

the patient or whether it was merely the outcome of constitu- 
tional affection. If it were the latter he could not see wherein 
consisted the good in removing the gland. He could quite under- 
stand that a gland in a had state might be a focus of disease, but 
BtiU iie could not see that removing it really put the patient in 
other than a temporarily better condition, merely removing the 
immediate source of the infection, while the constitutional con- 
dition continued. To consider a case a cure until the results for 
a very considerable time afterwards were seen was a fallacious 
way of looking at it. There might noti be an immediate out- 
break of any disease, but it might occur later on in a more vital 
organ. Sis own feelings were against the surgical view of the 
case, and he thought they would do more good by trying to 
prevent suppuration and get the glands to disappear, which they 
very often did. If they failed to do that, they should let them 
heaJ hy the use of internal treatment. That was the most 
scientific mode of treatment, in his opinion, though the other 
looked the more brilliant for the time being. 

Mr. Dudley Wright said he thought he owed a certain 
amount of apology to the Society for the fact that whilst work- 
ing with him Dr. MacNish had not yet been able to make up his 
mind whether surgical treatment was advisable or not. He (Mr. 
Wright) had very soon made up his mind on the subject. He 
had seen very many cases in which operation had not been done, 
and disastrous results had occurred which might have been pre- 
vented by operation. He thought that the sooner they operated 
in those cases the better. The chief reason why those hundred 
cases were not all operated upon was that there were not enough 
beds to put them into. In a certain percentage general medicinal 
treatment did seem to succeed, even in those cases which they 
thought were not very suitable for that form of treatment. He 
remembered one case of a blind boy who had enormously large 
glands in the parotid region. Thinking it was not a case suitable 
for surgical treatment, he treated him with silica solubilis, and he 
was glad to say those glands were now reduced to about a quarter 
the size, in fact they were scarcely perceptible. There was no 
sign of fluctuation about them, but at the same time he was much 
surprised at the very good result which came from that remedy. 
In other cases he found silica solubilis to suit the patients better 
than ordinary sihca, which had previously been given to them. 
Dr. MacNish mentioned hepar as being very useful in glands 
which were beginning to caseate or suppurate. His experience 
was that the glands always commenced suppurating, and broke 



l&i DISCUSSION ON TUBEBOULOUB CEBYICAL GLANDS. 

through the skin, when the hepar was given, which, in some ways, 
he thought was a good thing if they were not going to operate. 
With regard to meningitis coming on after operation, he had seen 
one case where the patient had enormous glands on hoth sides of 
the neck; they were removed from one side, and ahout three 
weeks afterwards the girl suddenly developed tuberculous menin- 
gitis and died. The peculiarity of the case was that on the left 
side, which had not been touched by the operation, the whole of 
the swelling had disappeared. He put the meningitis down, not 
to the operation, but possibly to the fact that one of those 
caseating glands had ruptured into one of the contiguous veins 
and caused a dissemination of the tuberculous matter over the 
system, and thus set up the meningitis. That was the only case 
he had seen in which after operation a bad result hsid followed. 
He had tried tuberculine in many cases, but was at present unable 
to state definitely the effect. What Dr. Dyce Brown had said 
with regard to local treatment, and the possibility of tuberculous 
caseating glands being a source of infection to the system, might 
be all very true, but although there might be a general state 
which produced these local manifestations, should they for that 
reason withhold local measures? Should they, for instance, 
neglect to treat advanced tuberculous disease in a joint, because 
in spite of removing it or removing a focus of disease there was a 
possibility of the child in after years becoming attacked by tuber- 
culous meningitis or tuberculosis in other parts of the body ? He 
thought it was all the more reason why they should remove that 
focus, and thereby enable the patient to get about in the fresh 
air, and thus get into the best possible condition to prevent the 
onset of any further complication later on. 

Dr. Cash Eebd said that the treatment was summed up 
mainly, so far as his experience in the West of England went, 
in two methods, one surgical and one purely a matter of environ- 
ment. The first was the removal of all the teeth which were in 
any way carious, and secondly, beyond that perhaps in efficacy, 
the unsurpassed air of Dartmoor, he might almost say, which had 
an extraordinary effect in toning the system in such a way that 
not only the glands appeared to melt away, as it were, but pari 
passu with that, the system became wonderfully invigorated. He 
had seen many cases from time to time, which had been in a very 
serious condition, so far benefited that there had been a return to, 
what one might almost call, ideal health. The air of Dartmoor — 
the higher and dryer the better, and he had almost said the colder 
the better — had also a very remarkable effect in certain stages of 
phthisis. 



DISCUSSION ON TUBBBCULOUS CEBVICAL GLANDS. 155 

Dr. GoiiBSBBOUOH entered a protest against the physician and 
surgeon parting company in the treatment of tuberculous glands, 
because supposing cases were handed over to the surgeon and 
tuberculosis appeared in an internal organ subsequently, the sur- 
geon -w^ould not reckon the final result as part of the results of 
sui^cal treatment. They should be very careful in speaking 
about results of different kinds of treatment. The results of 
surgical treatment proper would end with the immediate effect of 
the operation on the patient. If tuberculosis was a constitutional 
state, and it would issue in the tuberculous glands, for his part he 
could not see any objection to the removal of a gland, provided 
they iTvere certain that the process so far had stopped there. But 
if the process was going on, and deposits were still taking place 
in the gland, it seemed to him that if they removed the gland 
they removed a source whereby the constitution might be reliev- 
ing itself. Truly, it might relieve itself in another gland, but 
very great caution would be required before deciding to remove a 
gland or a group of glands, under the use of homoeopathic medi- 
cines. Supposing they had a case of tuberculous glands which 
they were not sure were not continuing to enlarge, it seemed to 
him it would be wrong to perform an operation for their removal, 
but if they placed a patient under homoeopathic treatment, such 
as giving the iodide of lime or iodide of mercury, his general 
experience had been that those means would hasten the process 
of suppuration, and as soon as they were certain suppuration had 
taken place surgical treatment might be adopted. He could not 
see the wisdom of allowing any pus or bBoken-down caseous 
material to remain in the neck or anywhere else if it could be 
found. He remembered two cases in his own experience where 
consequent on sudden resolution of the glandular swelling the 
patient had developed phthisis. In one case there had been 
suppuration of several glands, and they had been treated as 
rapidly as possible, surgically, but notwithstanding that the 
patient developed very rapid phthisis. In the other case the 
glands disappeared after painting with iodine, and the patient 
developed phthisis immediately. 

Dr. BiiASB said that when they had the glands in the neck 
superficial to the sterno-mastoid they could not be due to carious 
teeth. When the glands began under the sterno-mastoid, when 
it was more deeply seated, they might be carious, syphilitic, tuber- 
cular or cancerous. He knew of a case of a large bunch of glands 
under the right jaw, which had began under the sterno-mastoid, 
which had withstood ten years' homoeopathic treatment with the 



156 DISCUSSION ON TUBBRCUIiOUS CXBYICAIi GLANDS. 

yiew of their being stramons in character, whilst they disappeared 
immediately on the removal of carious teeth. In the other case, 
which came from the Cambridge fens, the man haid a similar 
bimch of glands, apparently in same position, but they had com- 
menced more superficially than the stemo-mastoid ; under sulphide 
of calcium they entirely disappeared without being removed 
surgically ; they had been there some two or three years. If the 
glands do not rotate with the head they cannot be dental. 

Dr. Hughes said he quite admitted the temptation to a surgeon 
— and to a physician also — ^to get rid of a bunch of unsightly 
glands by simply an incision and a clearing away, but sufficient 
evidence had been adduced to show that the glands might be, at 
some stage of their history at any rate, resolved by medical treat- 
ment. Mr. Dudley Wright's case of the use of silica solubilis 
was a very striking one. The records in the last two numbers of 
the Lancet showed, from the effects of some barium waters, what 
internal treatment in old school ways might do, and Dr. Gash 
Beed's experience of Dartmoor air proved that simple hygiene had 
some power here ; so that these enlarged glands were not extra- 
vital things that one must lop away as mere excrescences — they 
were still amenable to the ordinary laws of hygiene and medica- 
tion, and might diminish to a minimum or disappear altogether. 
That being the case, they ought to repress their natural inclina- 
tion to sweep them away with the knife and try to treat them by 
the other method. As far as was known, they were not of local 
origin, they did not begin with a mechanical injury, but came on 
insidiously from within, and surely it was more reasonable to 
attack them from within. They came on under unfavourable 
conditions (as regards the patient) in respect of environment and 
80 on, and surely it was more suitable to attack them and remove 
them by making the environment unfavourable to themselves. 
In reading Watson's lectures, he had been very much struck with 
one remark, viz., that one very seldom saw in phthisical adults 
any scars on the neck. Children who had scrofulous glands very 
seldom became the subjects of phthisis in after life. Someone 
had said they often grew up very healthy children; and Dr. 
Qoldsbrough had adduced some parallel cases in the way of 
phthisis. In Mr. Dudley Wright's case of the supervention of 
head mischief, it seemed much more likely to him, the glands on 
the left side being so much enlarged, and then disappearing, while 
the tubercular meningitis was set up, that it was what used to be 
oalled metastasis. When a part had become extra-vital, having 
and flows, no rises and falls and vital changes, and not 



DISCUSSION ON TUBERCULOUS CEBYICAL GLANDS. 157 

amenable to ordinary influences, then of course there was nothing 
for it but operation, but as long as it was vital, as long as it had 
any organic connection with the health of the system at large, 
they should use the means which homoeopathy and hygiene gave 
them, and try to cure it from within. 

Dr. Neatby thought the difference of opinion that existed 
between the speakers might be explained by the fact that all 
enlarged glands were not tuberculous. The glands which so 
speedily went away in the air of Dartmoor, or which were re- 
moved by the extraction of carious teeth, were in all probability 
not tuberculous cases. He had had some little experience of 
children, and thought that where they had definite evidence, 
apart from the glands, that there was a distinct tuberculous 
condition, the sooner they were removed the better. One single 
point was powerful evidence in favour of that view, viz., that 
when they had persisted in medical treatment and had failed, and 
had decided that the glands must be removed, they almost 
invariably found other glands which they thought were practically 
healthy, or sufficiently sound, to leave either a caseating mass, 
or, as Mr. Shaw had said, a bag of pus. 

The President (Dr. Byres Moir) said the question of diagnosis, 
to which Dr. Neatby had referred, was a very grave one. A good 
many of the cases which had been mentioned could not, he 
thought, be considered tuberculous. With regard to metastasis, 
they had had two cases lately in the hospital — one was that 
which Mr. Wright had mentioned, in which it was certainly a 
question as to whether it was metastasis or from the rupture of 
the gland. Shortly afterwards a child was admitted under Mr. 
Shaw with extensive surgical tuberculosis. The knee-joint was 
disorganised, and the question came, was amputation of the leg 
justifiable? After consultation it was decided that they had 
hetter not interfere, and four days afterwards meningitis came 
on and the child died. If that leg had been removed, the 
meningitis would have undoubtedly been set down to the 
operation. 



158 MAJOB BPILBPBY AND ITS 1!BBATMENT. 



MAJOE EPILEPSY AND ITS TEEATMENT.^ 

BY BEBNABB THOMAS, M.B., CM. 

Thb difficulty of choosiDg a subject which shall prove of 
interest to this Society, must be my excuse for writing a 
paper about such a familisur subject as epilepsy. Al- 
though the name is so widely known, even to the general 
public, when we consider what has been ascertained of the 
pathological processes and the essential nature of epilepsy, 
we find that there is much that is obscure, much that is 
theoretical and little that we can admit as actual scientific 
truth. So much is this the case that I should hesitate to 
introduce a subject which may, perhaps, seem to place me 
among the prophets, if I did not feel convinced that my 
efforts will be regarded, in greater part, as a means of ob- 
taining knowledge both by the preparation of a paper and 
from the discussion of a subject in which I feel a good deal 
of interest. I may here remark that my attention was es- 
pecially caUed to this disease by reatog in the British 
Medical Journal about some experiments with absinth, 
showing the striking resemblance of the action of this 
poison to epilepsy, and on this account I was induced — 
though the idea is not new — ^to test the homoeopathic utility 
of the drug by direct experiment ; but more about this 
presently. 

There are some diseases which are peculiar in that they 
consist of attacks of sickness separated by intervals of days, 
months, or even years of comparative good health. Such 
are, for instance : — 

Paroxysmal hsemoglobinuria, angina pectoris, migraine, 
hysteria, epilepsy, &c. But in most of these the attack is 
precipitated by some exciting cause ; it is only, in fact, the 
dormant tendency which is re-awakened. Now we can 
hardly believe this to be so in epilepsy. As a rule, an 

^ Bead before the Liverpool Branch, December 13, 1894. 



MAJOB EFIIiEPBT AND ITS TBBATMENT. . 169 

epileptic will have his seizures after certain, though some- 
what indefinite, intervals, in spite of the absence of any 
appreciable exciting cause. In women, however, it is not 
onasnal to find the paroxysm coincident with some portion 
of the menstrual function, which may be considered to 
determine the precise time of the attack. 

Epilepsy is a paroxysmal disease, and as everyone 
knows, has been called by Dr. Fagge a paroxysmal neurosis ; 
and other non-febrile nervous disorders occurring in fits, as 
paroxysmal aphasia, amaurosis, paralyses, or involuntary 
movements, either co-ordinated or irregular, have no doubt 
an affinity to this disease. The essential feature of epilepsy 
is that it consists of attacks of sudden loss of consciousness 
with or without convulsions. These may be either of the 
major {haut mat) or the minor kind (petit mat). The 
latter, although possessed of great interest, will not be 
Gonsidered in this paper. 

Major epilepsy consists of the attack and the interval 
between the attacks. The paroxysm itself may be con- 
veniently divided into four stages, some of which, however, 
may be absent. 

L Premonitory symptoms. 

n. Unconsciousness and tonic convulsions. 

m. Unconsciousness and clonic convulsions. 

IV. The stage preceding recovery. 

I. Premonitory Symptoms, — Judging from my own ex- 
perience the aura is more usually absent than present before 
the actual seizure. When it occurs, at a varying time 
before the fit, the patient has a warning that the attack is 
coming on. One patient told me that, about a quarter of 
an hour before the paroxysm, she felt a loss of power in the 
nght side (motor aura) ; another had a sensation of a wave 
passing up the back of the head, shortly before the attack 
sensory aura) ; while a third felt queer usually the day 
preceding the fit, ** he went all of a shake and rubbed his 
bands as if he were cold," due, no doubt, to a spasmodic 
contraction of the arterioles (vasomotor aura). These are 
instances of the more usual forms of these premonitory 
symptoms. I mention them because I have personally 



160 MAJOR EPIIiEPBY AND ITS TREATMENT. 

observed them : the more fantastic varieties can be referred 
to elsewhere. Briefly, among the more common symptoms 
which precede an attack we find : (1) changes of temper ; (2) 
contraction of vessels of feet or hands, producing a diminu- 
tion of temperature ; (3) spasmodic state of some of the 
muscles ; (4) optical illusions of sight. Besides these, there 
may be illusions of the other senses or a vague sense of 
dread which the patient is unable to properly describe. 

II. After the aura the patient suddenly becomes un- 
conscious, and falls down, if he be standing, sometimes 
uttering a peculiar cry or groan. The epileptic cry is pro- 
duced by the convulsive contraction of some of the muscles 
of the larynx and the expiratory muscles of thorax and 
abdomen. The fall, as Brown-Sequard points out, may be 
either paralytic or convulsive, the patient being thrown vio- 
lently forwards. Tonic contractions more often begin in 
the muscles of the face, to be soon followed by the muscles 
of the other parts of the body ; the teeth become firmly 
clenched, the back slightly arched, the legs extended and 
the head drawn back or, in some cases, rotated to one side ; 
this rotation, it is noticed, is more frequent when cerehral 
lesion is present. The face may at first be pallid, but the 
stoppage of respiration from fixation of the chest soon 
renders it cj^anotic. The stage of tonic contractions lasts 
about half a minute and quickly passes into that of clonic 
spasms. 

III. The third stage usually lasts from one to three 
minutes, but when it is prolonged to six or more minutes 
we may strongly suspect the attack to he due to some organic 
disease of the brain. It is peculiar to notice that the clonic 
convulsions begin in the face or upper part of the body and 
spread downwards in regular order. It is at this stage that 
the tongue is so often bitten and that measures have to be 
adopted to prevent the patient from injuring himself. 

In the following case this stage was unusually prolonged. 

Case 1. — Thomas A., aged 5 years. Has had fits ever since 
he was three years old, at intervals of several months. Present 
seizure began on the morning of December 2, 1892. The mother 
attributed the fits to a flogging at school — this might possibly be 



MAJOR EPIIiEPSY AND ITS TREATMENT. 161 

the case — at any rate, when there is one, it is as well to blame 
the cat. The boy was perfectly still and unconscious when I first 
saw him, but soon went off into convulsions. First clonic spasms 
of the left side of the face, the left side of the mouth, left orbicu- 
laris oculi and muscles adjacent, then the flexors of the left 
hand, followed by the muscles of the arm, the elevators of the 
scapula and muscles of the trunk. At this stage cough and 
hiccough supervened, and saliva began to trickle from the mouth. 
The convulsions becoming stronger and stronger, the correspond- 
ing muscles of the right side now became affected, then the left 
leg, until all the muscles of the body were involved. The com- 
plete paroxysm lasted over twenty minutes, and was followed by 
a brief period of about a minute, after which a similar attack took 
place. Although measures were adopted to attempt to check 
these severe paroxysms they were futile, and the fit ran its 
course. But oddly enough the patient seemed to be little the 
worse for the attack when it was over. Two days after he came 
to the dispensary complaining of pain over the right parietal 
bone, near which there was a cicatrix, said to be due to an injury 
during a former attack. There was convergent strabismus of the 
left eye, and a slight dragging of the left foot when walking. 
The intellect was not of the brightest, but beyond this there was 
no special mental symptom. Nearly seven months afterwards I 
was informed that he had a seizure of a similar nature. 

This case is not intended to serve as an example of 
idiopathic epilepsy. In many ways it is atypical and seems 
to be an instance of organic brain disease. 

IV. The clonic stage is followed by a short interval 
of unconsciousness without spasm, and then the patient 
sometimes rather suddenly, but, as a rule, after a heavy 
sleep, with more or less stertorous breathing, recovers from 
the attack. During the seizure the urine may be voided or 
feces passed unconsciously, and in men there may be an 
emission of semen. Shortly after the fit, according to 
Growers, the reflexes are mostly absent and then for a time 
the deep reflexes are increased. Transitory paralysis is 
more common, according to Brown-Sequard, than is gene- 
rally supposed, and he also remarks that it is due to 
inhibition and not to exhaustion of the nervous centres, 
because loss of power of the muscles may occur even after a 

VOL. HI. — NO. 2. 11 



162 MAJOB BPILBFBY AND ITS TBBATMJSNT. 

slight attack. On examining the urine we may find traces 
of albumen or sugar ; the rupture of small vessels may give 
rise to petechiee or more serious haemorrhage; vomiting 
may also occur soon after a fit. The patient suffers from 
his attack both mentally and physically, feeling dazed and 
bruised. But sometimes the mind is very much disturbed 
and there may even be delirium of a violent kind. 

The Interval between the Paroxysms, — The health 
between the attacks is often indifferent, but there is nothing 
that is characteristic, and when the fits are separated by 
long intervals of time it is often very good. In all cases, 
however, which have gone on for some time and where 
there are frequent attacks — in those cases, in short, where 
there has been excessive wear and tear of the brain tissues, 
there is a condition of mental deterioration and sometimes 
imbecility developed. A few fits only may produce this 
condition in children. 

There seems to be universal agreement that epilepsy 
more commonly begins in childhood. Gowers declares that 
seventy-five per cent, of cases occur at this period. Brown- 
Sequard says that epilepsy which begins above the age of 
twenty-five is more common in females, below that age in 
males. Heredity is a cause of the disease in two different 
ways— either directly from epileptics, when the disease 
usually, but not invariably, shows itself before puberty, or 
from neurotic or alcoholic parents. 

Other possible causes of this disease are anaemia, syphilis, 
rheumatism, diabetes, masturbation, puberty and certain 
obscure alterations of brain nutrition following on or the 
result of fevers. It is a very common experience to find 
that epilepsy is said by patients to originate from emotional 
causes, but I believe these only determine the paroxysm in 
an epileptic subject. Finally, it is of interest to us, as 
homoeopaths, to remember that certain poisons, as oxide of 
carbon, carbonic acid, lead, absinth and alcohol may pro- 
duce an epileptic condition. 

Such, in brief, is the eetiology. I do not know that it 
helps us very much in the consideration of the essential 
nature of the disease. The pathology offers, one would 



MAJOR EPILEPBT AND ITS TBBATMEKT. 163 

think, a more hopeful field of inquiry, but in cases of idio- 
pathic epilepsy there is comparatively little information to 
be obtained. The post-mortem changes in those who have 
died during a fit consist in congestion of the internal vis- 
cera; an appearance which is also present in death from 
infantile convulsions. Hamilton says that the brain imme- 
diately after death is extremely anaemic, but that some time 
afterwards it contains more blood than usual. I do not 
know whether this statement has been verified. 

In old cases of epilepsy there is thickening of the bones 
of the skull and membranes. Hamilton reports a hardened 
.state of the medulla due to an increase of fibrous tissue, and 
Zeigler notes that there are sometimes found nodules of grey 
matter in the white parts of the brain. 

In cases of epilepsy where the determining cause is 
more easily found, we have either a lesion of the brain, 
spinal cord, the membranes or the periosteum of the cranium. 
Finally, in some cases there may be a peripheric lesion 
elsewhere. When cerebral disease exists, any part of the 
brain may give rise to epilepsy ; but the cortex, according 
to Brown-Sequard, outside the motor areas is the most 
productive of this disease. In order of frequency he finds, 
first the frontal, next the occipital, and lastly the parietal 
and temporo-sphenoidal lobes are the more usual regions 
affected. 

It is of interest to note the relation that the experiments 
on animals have to this subject. The stimulation of a guinea- 
pig*8 brain by an electrode placed on the cortex may pro- 
duce an attack identical with epilepsy. Various observers, 
including Hughlings Jackson, Ferrier and Landois, have 
noticed that stimulation of the motor areas produced spasms, 
sometimes so violent as to simulate an attack of epilepsy. 
The inflammation so produced developed in time an epi- 
leptic condition which was hereditary. Stimulation of the 
sub-cortical white matter also produces epileptiform spasms, 
but in this case they take place on the same side of the 
body, not, as in the preceding, on the opposite side. ** If 
the motor areas are extirpated, epilepsy is absent from those 
muscles controlled by that area, and separation during an 
Attack cuts it short." 



164 MAJOB EPILEPSY AND ITS TREATMENT. 

Brown-Sequard showed that guinea-pigs could be ren- 
dered epileptic by various procedures, as hemisection of the 
spinal cord, section or pinching of the sciatic nerve, &c. 
In course of time there formed on the same side of the head 
and face, on the skin of the inferior border of the lower jaw, 
or on part of the skin of the nape of the neck, an " epilep- 
togenic zone." Tapping this area produced at first reflex 
spasms, but, in about six weeks fits which assumed the true 
character of epilepsy. Westphal, by tapping the head of a 
guinea-pig, produced a similar condition. Earely, through 
injury of the fifth cranial or the sciatic nerve, this same 
condition has been produced in man. I must apologise for 
so largely quoting from authorities in this manner, but it is 
merely to establish the fact that, on the whole, there is 
more evidence for regarding the cortex of the brain as the 
seat of the disturbance, although other views are held by 
some good observers. When I say the seat of the disturb- 
ance, I do not mean that it is from these that the cerebral 
storm, which ultimately culminates in a fit, is of necessity 
initiated. I believe that the condition produced is one of 
irritation, and that it may be excited directly by the cortex 
or reflexly by some other part of the brain or periphery. 
The facts that the convulsions spread uniformly and show 
such a close similarity to experimental epilepsy from 
irritation of the cortex, and also that the disease may be 
associated with insanity, seem to support this view of the 
case. Further, the experiments relating to the formation 
of an epileptogenic zone show that a morbid condition of 
the brain may be produced by reflex irritation, and the 
stimulation of a peripheral zone may give rise to an epi- 
leptic seizure, and we notice that this area is the same as 
that from which the spasms commence. 

From the consideration of the seat of the disturbance we 
turn next to the actual change which takes place. This is 
usually believed to be a condition of anaemia, the result of a 
vasomotor spasm, which inhibits the action of the cerebral 
centres. This is actually what takes place in the experiments 
on animals, but there are some difficulties in the way of this 
explanation. For instance, it is hard to understand the 




MAJOR EPILEPSY AND ITS TREATMENT. 166 

rationale of Alexander's operation of tying the vertebral 
arteries for epilepsy, or the stoppage of a paroxysm by 
pressure on the carotids. 

These theories, even if they fully described what takes 
place during a seizure, are yet unsatisfactory and incomplete 
and do not cover the whole ground of the question of the 
essential nature of the disease. In one sense they are as 
incomplete a pathology of epilepsy as it would be to say that 
gout was a disease consisting of a deposit of urates in 
the joint of the big toe. Those forms of epilepsy which 
depend on cerebral disease are, perhaps, more easy to under- 
stand in this respect because there is a source of irritation 
which, thanks to experiments, we are not surprised to find 
should produce epileptic paroxysms. But how about the 
large number of cases of idiopathic epilepsy where no known 
lesions exist, and where, except in advanced cases, there are 
no means of determining whether a particular brain is 
epileptic or not ? I must confess that we have here a very 
difficult problem, and one which, so far as I know, has never 
been answered satisfactorily. UrsBinic convulsions exhibit a 
certain resemblance to epilepsy, and much more so do those 
convulsions produced by certain vegetable poisons which 
I shall mention further on. Again, chronic poisoning by 
lead and alcohol sometimes develop an epileptic condition. 
Taking these facts into consideration, is it not possible that 
epilepsy is due to some toxine? We might even suppose 
that this product is elaborated by the blood or tissues and 
only causes a fit when it has accumulated in suflicient 
amount, and that during an attack it is either altered, elimi- 
nated or destroyed. 

Before mentioning the treatment I wish to make a few 
remarks about the diagnosis. When we see a person in an 
actual attack we have to discriminate between cerebral 
epilepsy, idiopathic and hystero-epilepsy. 

Taking the last of these first, we note that here the con- 
dition is more one of disordered consciousness than loss oi 
consciousness, and there are often hysterical symptoms 
before and after the fit. The patient usually avoids injuring 
herself, and the tongue is rarely bitten so that it bleeds. 



166 MAJOB EPILEPSY AND ITS TBEATMENT. 

The convulsions do not always occur in the same order as in 
true epilepsy, there is no stupor afterwards, and, finally,, 
pressure on the ovaries has the effect of either increasing or 
cutting short the paroxysm. 

In the cerebral disease there is more usually an aura, 
either referred sensation or cramps. I have already re~ 
marked that the head may be rotated to one side and that 
the clonic stage is sometimes of long duration. Convulsions, 
may take place without loss of consciousness, and they may 
be semi-lateral or may differ in intensity at the two sides. 
Apart from the character of the seizure other symptoma 
may lead us to suspect that a cerebral lesion exists. 

In some cases the attacks of epilepsy only occur at night, 
and the seizures might, on this account, be passed over. But 
certain symptoms may arouse our suspicion, such as a bitten 
tongue, a morning headache, nocturnal enuresis, or a bruised 
and sore feeling on waking. 

Little need be said about the treatment of the paroxysm. 
Everyone recognises that the only thing that can be done is 
to prevent the patient from doing himself an injury. Pres- 
sure on the carotids has been advocated by some, but it 
seems to me rather a severe proceeding. It is the treat- 
ment of the patient during the interval that is the more 
important consideration. 

The routine treatment by large doses of bromide is not 
very satisfactory. It prevents attacks by its sedative action, 
lowering the tone of the nervous and intellectual functions, 
and, if pushed, producing a condition of bromism, making 
the mind dull and lethargic, reducing the strength of the 
muscles and lowering the activity of the circulation. In 
short, it sometimes produces a condition a little worse than 
occasional seizures. Treatment of this kind is a confession 
of our inability to grapple with the disease, and I only regret 
that when other means fail and the seizures are frequent we 
may, for a time, be driven to use it as a dernier ressort, but, 
alas I not with the certainty that the paroxysms will be 
prevented. But, as homoeopaths, we should first try whether 
our own system of therapeutics, which has done yeoman's 
service in many difficult cases, can offer any advantage over 
established method of bromide drugging. 



MAJOR EPILEPSY AND ITS TREATMENT. 167 

Certain drugs produce a condition resembling an epileptic 
seizure, and we therefore expect to find them useful in the 
treatment of this disease. 

Belladonna. — The convulsions produced by this drug 
have a greater resemblance to the other forms of convulsions 
than to epilepsy. One case is mentioned in the poisonings 
by this drug in the Cyclopsedia, where the condition is de- 
scribed as epileptiform, but on reading it over we find that 
delirium accompanied the convulsions. Incidentally I may 
remark that potassium bromide prevented attacks, while 
atropine increased the excitability of the motor area, in 
experimental epilepsy. 

Artemisia absinthium, — The epilepsy produced by this 
plant is a true one in every respect. There may be either a 
proper fit like major epilepsy, or a sudden loss of conscious- 
ness resembling the petit mal. The epilepsy of absinth is 
characterised by the number of fits in a short time, that of 
alcohol by the reverse. In the British Medical Journal for 
November 28, 1893, we read, " The action of this drug 
(absinth) has been investigated by Marce, Magnan, and 
Professors Horsley and Gotch, and these observers have 
shown the striking resemblance between the fits produced 
by absinth and those seen in idiopathic epilepsy. In the 
absinth fit there are twitchings of the muscles of the face 
and ears which are immediately followed by tonic and clonic 
spasms of the limbs and trunk muscles ; there is salivation, 
the urine is often voided, cries are frequent, and finally a 
state of unconsciousness may supervene ; there is a succes- 
sion of these fits." 

Cicuta virosa. — ^In the poisonings we read of an epileptic 
condition being produced which is characterised by much 
contortion of the limbs and face. 

(Enanthe crocata. — The convulsions as described in the 
Cyclopsedia do not so closely simulate epilepsy as the two 
preceding. The fit is more prolonged than is the case in idio- 
pathic epilepsy. Some of the principal features seem to be : 
marked trismus, mania, and afterwards vomiting and heavy 
sleep. I should suggest that it might prove of service in 
cases of cerebral disease. 



168 MAJOB EPILEPSY AND ITS TBEATMENT. 

Lead poisoning exhibits, besides many other nervous 
symptoms, saturnine epilepsy, which differs in no respect 
from idiopathic epilepsy, except that the sopor, which follows 
it, is a coma which may last for several days. 

Spasms and convulsions produced by other medicines do 
not seem to have the same character as epilepsy. For 
example, zinc and copper, although both produce clonic 
contractions, do not give rise to the state of unconsciousness 
which is so marked a feature of an epileptic fit. At the 
same time, certain medicines are cUnically useful in some 
cases, and we may regard them as going, perhaps, one step 
towards a full paroxysm. These medicines are agaricus, 
amyl nitrite, argent, nit., camphor, cocculus, cuprum, hyos- 
cyamus, nux, strychnia and zinc. 

Constitutional treatment in epilepsy is often of itself 
beneficial and, therefore, we find that such medicines as 
calcarea, Pulsatilla, arsenicum, mercurius, &c., often give us 
good results when prescribed alone. I have often adopted 
the plan of giving one of these alternately with the more 
specific remedy and with good results. 

The following cases show the result of the treatment with 
absinth. 

Case 2. — William G., aged 14, has had epilepsy for two years. 
The paroxysms are very frequent now, two a week or more. 
On March 17 he was given absinth 3x and mercurius sol. 3 every 
three hours in alternation. He went twenty-five days without a 
paroxysm, then nineteen days. The dilution was then changed 
to the 6th centesimal; the intervals were now eleven and five 
days. A lower dilution (3x) was again administered, and the 
result was that he had fourteen days' interval, but after this, 
although the medicine was continued in the same potency, the 
intervals became progressively shorter. Absinth 1 was now given, 
and he had an interval of twenty days without any seizure, but at 
the end of that time he had several fits. 

Case 3. — Elizabeth K., aged 22, had a convulsion when 18 
months old ; when 7 a fit from fright ; the next at 14. Fits 
are now very frequent, usually two or three a week. She 
experiences a feeling of loss of power in the right side about a 
quarter of an hour before the paroxysm. May 4, she was given 
calcarea carb. 3, absinth 3x every three hours aUernately, and 



DISCUSSION ON EPILEPSY AND ITS TBEATMBNT. 169 

absinth 3x when she feels a fit coming on. On May 16, no actual 
attack ; has twice experienced the aura. Absinth was taken 
immediately, and no attack supervened. She had four fits on 
May 29, an interval of twenty-five days. She had two fits on 
June 21, an interval of twenty-one days. 

Before concluding my paper I should like to remark 
that absinth has been in some cases disappointing, but in 
others it has lengthened the interval, and more especially 
when used low — Ix to 3x. Calcarea has often proved of 
benefit, especially if the patient has symptoms which 
would otherwise lead us to prescribe that drug. Zincum 
mur. 3x was the means of lengthening the interval from a 
week to a fortnight in one case where the paroxysms only 
occurred at night. In another case of epilepsy or hystero- 
epilepsy, where, in a young girl of 12, the paroxysms 
occurred almost regularly every month, cuprum acet. 3x and 
ignatia 1 succeeded where other remedies had failed, and for 
five months, at least, there was no return. But here, from 
the character of the seizures, I strongly suspect, in spite of 
the early age, that they were of hysterical origin. 

There arfe other medicines which will be found useful in 
the treatment of epilepsy. I have only mentioned a few of 
which I have practical experience. 



Dr. Douglas Smith said that as there was practically nothing 
known of the pathology of epilepsy we were obliged to treat 
symptoms alone. He asked what would be the best medicine to 
give in a case of epilepsy when the seizures occurred every one or 
two months, at night, and the patient did not know that he had 
them. 

Dr. Hay WARD thought if we could determine the cause of the 
seizm-e the disease was not epilepsy. In idiopathic epilepsy the 
convulsions were due to a deep-seated disease of the cortex, 
which we do not understand. The treatment of the interval 
must be therefore symptomatic, and the medicines used need not 
be those which produced convulsions. He referred to a paper in the 
British Journal of Homoeopathy , 1868, by Dr. Drysdale, in which 
he said that it was the dormant disease and not the paroxysm on 
which we should base our treatment. The patient should be 
studied in the interval and the deviation from health noticed. 



170 DISCUSSION ON EPILEPSY AND ITS TREATMENT. 

By a study of these minute symptoms we might more reasonahly 

hope to attain success. It was the condition underlying the 

disease which we should treat. Dr. Hay ward was quite in 

agreement with these views. He next referred to a paper by Dr. 

Chapman, in which he said that he had cured seven cases of 

idiopathic epilepsy by homoeopathic medicines. He thought the 

essential nature of epilepsy was loss of consciousness. 

Dr. Davidson had found potencies from 6 to 12 to be most 

useful. 

Dr. Hawkes would like to hear reports of cases cured by 

homceopathic medicines, as he considered the treatment of this 

disease was not very satisfactory. He had tried several 

medicines, both spasmodic and antipsoric, he had tried medicinea 

which were used for the effects of fright where the iits seemed to 

originate from that cause, and he had also chosen medicines 

according to the direction of the aura, but had been disappointed 

in the results. He mentioned a case of a man in whom the 

presence of hiccough had lead him tojprescribe hydrocyanic acid, 

and with some benefit. He also mentioned a case which had 

been cured by Dr. Ferrier, no doubt with large doses of bromides. 

Dr. DuFFUS thought it extraordinary that this disease, which 
had been recognised so long, had not yet been satisfactorily 
treated. He had never seen anything of any use except bromides 
and chloral. In the status epilepticus he recommended 5ss. of 
chloral in jii. of starch as an enema. He mentioned epileptic 
colonies, and thought that they offered the best solution of 
treatment. He referred to a case of a dairyman who had come 
under his charge, who had mental symptoms and frequent 
fits. The use of bromides cured the mental symptoms and 
materially lengthened the interval. 

Dr. Nevin agreed with Dr. Hayward that a distinction must 
be made between eclampsia and epilepsy. He mentioned a case 
of eclampsia of pregnancy in which blood-letting had been of 
great benefit. In nocturnal epilepsy he had tried all the homceo- 
pathic medicines without benefit, but he had found large doses of 
borax useful. He recommended Dr. Douglas Smith to try this 
in the case he mentioned. He did not think Dr. Thomas could 
claim any good results icom. the use of absinth, as the patients 
were practically the same before as after treatment. He referred 
to a case of Jacksonian epilepsy where belladonna and bromides 
in material doses had produced improvement. He believed that 
in giving chloral the whole benefit depended on the liberation of 
chloroform. 



DISCUSSION ON EPILEPSY AND ITS TREATMENT. 171 

Dr. WiLiiiAMS had prescribed cyanide of potassium and hydro- 
cyanic acid with benefit. The condition to look for was reflex 
irritation ; by discovering this cause and treating it we might 
obtain a good result. He mentioned a case of epilepsy where 
there was. dysmenorrhoea : by treating this condition a good 
result was obtained. 

Dr. GoBDON Smith said the case mentioned by Dr. Williams 
was one of reflex epilepsy and not cerebral epilepsy. He referred 
to an analogous case where the irritation was a heavy supper, 
and this was the cause of two seizures at different times. 

Dr. Gbeen had tried a prescription of Dr. Alexander's of 
borax and bromides, but without very good results. He had also 
tried bromide of strontium, but could not give a glowing account 
of its use. Hypnotism had not proved very successful in his 
hands, but in one case^ where there was extreme sickness and 
headache before and after the attack, suggestion had cured these 
symptoms but not the paroxysms. 

Dr. Mahony said the chronic miasms, psora, syphilis, and 
sycosis, should be borne in mind in the treatment of epilepsy. 
There were sometimes medicinal causes which he beheved pro- 
duced a great deal of disturbed vitality. He agreed with Dr. 
Drysdale's paper that minute symptoms were most important, 
and he thought it an error to repeat the medicine too frequently. 
. He said that true epilepsy was always marked by unconscious- 
ness. 

Dr. John Haywabd said that in some cases of petit mal there 
was not loss of consciousness. The surgical treatment was very 
hopeless. He believed that Dr. Alexander had abandoned tying 
the vertebrals. As far as surgical treatment was concerned, the 
best, in his opinion, would be castration of the males, as the 
disease was sometimes hereditary. He endorsed Dr. Neviu's 
remarks about blood-letting in the status epilepticus. In his 
student days in the hospital he and others had done it with 
marked benefit, but no doubt some of the cases were eclampsia. 
He was disappointed with the use of belladonna. He thought 
something could be done in the treatment of the paroxysm. He 
had used glonoin, placing it on the tongue of the patient, and 
had obtained good results by these means. Perhaps it acted 
antipathically, overcoming the spasm of the blood vessels. With 
regard to the treatment of the interval, our eflbrts should be 
directed to the treatment of the susceptible condition which pro- 
duced epilepsy. He mentioned the fact that epilepsy occurred in 
animals, in cats and dogs. He did not think we could draw any 
conclusions from the cases mentioned in the paper. 



172 NOCTUBNAL ENURESIS IN CHILDKEN. 

The President (Dr. Capper) remarked that the discussion had 
been a good one. He agreed with Dr. John Hay ward about the 
treatment of the paroxysm, and mentioned hypodermic adminis- 
tration of nitro-glycerine. Petersen, for purposes of treatment, 
distinguished two kinds of paroxysms : (1) those in whom the 
face was pale, (2) those in whom the face was congested and 
turgid. He recommended for the former warm wet compresses 
to the face and genitals and rubbing, and for the latter cold wet 
compresses to the same parts and beating of the feet. He men- 
tioned, also, the hydrobromate of hyoscy amine. The borax 
treatment was best combined with bromide of sodium. The dis- 
advantage of this last mode of treatment was that it might 
produce gastric disturbance, disease of the gums, diarrhoea, and 
skin diseases. 

Dr. Thomas, in his reply, thanked the members for the good 
discussion that had followed on his paper. He said that he only 
used bromides as a palhative when other means failed. He 
thought unconsciousness always accompanied attacks of epilepsy, 
even if of the minor kind, though in these cases it was so 
transitory that it was apt to be overlooked. 



NOCTUENAL ENUKESIS IN CHILDKEN.^ 

BY H. WYNNE THOMAS, M.R.C.S., L.R.C.P. 
Besident Medical Officer to the Phillies Memorial Hospital, Bromley, 

I HAVE taken for my subject this evening ** Enuresis iu 
Children,'* and shall limit my remarks to nocturnal enuresis. 

This complaint is frequently met with in children of all 
ages and, at times, also in adults ; it is often most trouble- 
some and intractable ; it is a great trial to the poor sufferer, 
being frequently the cause of sundry whippings and other 
forms of chastisement, and as the patient grows older is a 
great drawback to him, handicapping him heavily in all 
walks of life. Enuresis may date from birth, or may^ be 
acquired later in life. In the latter case its first occurrence 
has usually been attributed to fright, but it is a popular 

' Presented to the Surgical Section, December 6, 1894. 



NOCTURNAL ENUKEBIS IN CHILDBBN. 173 

impression that all nervous derangements are excited by 
some shock to the nervous system, and too much import- 
ance must not be attached to this explanation. 

In cases where it is not due to manifest weakness of 
mind or pure laziness of body, and where no disordered 
condition is present to which incontinence can be attributed, 
we may sometimes be able by careful examination to detect 
some cause of irritation that requires removal, and the first 
great point is satisfactorily to make out the diagnosis, for 
unless this be' done, all treatment is simply empirical, and 
I wish strongly to impress upon you the necessity of a 
physical examination in all cases. 

First of all, examine the external genitals — a small 
meatus itself may be the cause of the trouble. As is well 
known, the external meatus is the narrowest part of the 
urethra, and it is not an uncommon belief that as long as 
there is a hole it suffices for micturition ; this, however, is 
erroneous. If the relation of the calibre of the external 
orifice to the general urethra be disproportionate, the result 
is that the urine cannot escape as fast as it ought to do, and 
irritation is set up in the peripheral extremity of the nerves, 
which disturbs the vesical centre. For instance, if a boy 
of 12 have a meatus which will only admit of a catheter 
No. 3 and be suffering from enuresis, we ought to at once 
suspect that the local obstruction is the cause of the trouble 
and enlarge the orifice and pass a bougie No. 10 or 11. 
Cases of nocturnal enuresis have been cured by this means 
alone. 

Make sure that the foreskin is not too long and can be 
easily retracted, and that it does not conceal any irritating 
secretion, as this is a very frequent cause of reflex troubles, 
in boys. I have been frequently struck by the fact that in a 
large number of boys the foreskin has been more or less 
adherent, and in almost all the cases in which I have had 
to perform circumcision I have found some adhesions 
present. In girls also the clitoris is sometimes found ad- 
herent to the small labia and must be freed. 

Inquire of the mother if the patient be troubled with 
threadworms, as these are another cause, for when at night 



174 NOCTUBKAIi ENURESIS IN CHILDREN. 

the child is quiet asleep they emerge from the anus, and are 
found in the folds of the genitals, and in girls creep into the 
vulva. If no external cause can be discovered, remember 
the possibility of a small stone being impacted in the urethra. 
Though not a common cause, this has been so before now. 
If the stone have only just entered the internal meatus it 
will be firmly and accurately embraced by the sphincter, so 
that no urine can escape ; if, however, the stone advances 
half an inch further, it may lodge and still allow the urine 
to pass by. It might be thought at first that if a calculus 
be impacted in a boy's urethra it would give rise to great 
pain and discomfort, but this is not so as long as the stone 
allows the urine to pass by ; in fact, Teevan says he has 
known patients who have had impacted calculi in their 
urethra for years without being aware of it, so little dis- 
comfort was there caused. 

Stone in the bladder is found more frequently in the 
children of the poor, and therefore more likely to occur in 
hospital than private patients. I have twice had small boys 
brought to me with calculi projecting from the urethra and 
retained by the meatus. In one case the opening had to be 
enlarged before the stone was removed. In other cases, 
again, the urine, on testing, will be found to be too acid in 
reaction, and will throw down crystals of uric acid, and it 
seems to me that this will be rather likely to be aggravated 
than diminished by limiting the quantity of fluid in the 
child's diet. In other cases, owing to causes which are not 
easy to explain, there seems to be an excessive irritability of 
the bladder. Under normal conditions the bladder is closed 
by the sphincter vesicae, whose office it is to resist the 
action of the muscular coat of the bladder ; if necessary the 
involuntary action of the sphincter can be enforced by the 
exercise of the will, and in many cases of incontinence, the 
irritability of the muscular coat being exaggerated, and the 
resistance of the sphincter being relatively deficient when 
the will power is withdrawn in sleep, as soon as a quantity 
of urine collects in the bladder micturition takes place. In 
these cases there is, I think, as a rule, increased* frequency 
of micturition during the daytime. At first sight, micturi- 



NOCTURNAL ENUBESI8 IN OHILDBEN. 175 

tion seems to be purely a voluntary act, but this is not 
altogether so ; experiments have been made in dogs of 
completely dividing the spinal cord, but as long as the lower 
dorsal and lumbar part is left micturition will go on as a 
purely reflex action. In such cases there can be no act of 
volition. When, under these circumstances, the bladder 
becomes full (and otherwise the act fails), slight stimulation, 
as sponging the anus or slight pressure on the abdomen, 
will cause the act to take place. The same has been ob- 
served in man in cases of paralysis from injury or disease as 
long as the lower part of the cord is left intact. The 
centre for this reflex act seems to be in that part of the 
cord corresponding to the twelfth dorsal or first lumbar 
vertebra. 

What happens when a child or man falls asleep we do 
not know ; all we do know is that the child loses conscious- 
ness, and that sensibility is very much blunted ; for instance, 
a sound v^hich would attract the attention while awake 
produces no effect on the brain when asleep, but if the 
sound be gradually increased in intensity, after a time it will 
cause the sleeper to awake. Children sleep much more 
soxmdly than adults, and require more of a stimulus to 
awake them, and this may account for nocturnal enuresis 
being so much more common in children than adults ; also 
as children grow up to manhood and womanhood and their 
sleep becomes less sound, micturition during sleep frequently 
disappears of itself, quite independently of any treatment. 
Judging of the depth of sleep by the intensity of the noise 
required to wake the sleeper*, it may be concluded that, in- 
creasing very rapidly at first, it reaches its maximum within 
the first hour, and from then diminishes at first rapidly but 
afterwards more slowly until the sleeper wakes ; and I have 
noticed that most of the children that I have had to treat 
for this trouble have wetted the bed during the first hour 
or two after going to sleep, and, in cases where the nurse 
has taken the child up on going herself to bed, that mic- 
turition has already taken place, although care was taken 
that the bladder was emptied before the child was put to 
bed, so that it cannot be from the bladder being fully 



176 N0CTX7BNAL ENUBESIS IN CHILDREN. 

distended. The same thing occurs occasionally in children 
-when an artificial sleep is produced by chloroform, especially 
if the anaesthetic be pushed, and this is still more likely to 
happen if an operation is to be done about the genitals. 
There is one other condition which is at times the cause of 
nocturnal enuresis. I mean epilepsy. When attacks come 
on during sleep, enuresis often occurs ; in fact, an epileptic 
will know that he or she has had a seizure during sleep 
solely by finding that they have passed water in the bed 
during the night. I have an epileptic patient under my 
care now, 17 years of age, who has been subject to fits 
since 3 years old, who frequently has fits during sleep, and 
until four years ago frequently wetted the bed in conse- 
quence, but has not done so since ; but whether this is due 
to her increasing years or that the fits are less severe I am 
not sure. As to treatment, it is impossible to lay down a 
plan of treatment for general adoption, and the peculiarities 
of the case and habits must be considered in each case. 
Eemoval of the apparent cause, however, by no means 
always cures the malady, and these are the cases which tax 
the surgeon's and physician's skill. In some cases, cer- 
tainly, medicines do cure the trouble, but the difi&culty is to 
find the homoBopathic drug — there are usually so few symp- 
toms to compare. The child seems in excellent health, but 
is liable to this accident ; or he simply sleeps too soundly. 
What is the remedy we are to select ? for the list of medi- 
cines which have cured, or have been credited with the cure, 
of this complaint is a long one. Foremost among remedies 
is belladonna, which has been used successfully in all 
strengths from 200 down to ; it is truly homoeopathic, for 
we find that symptoms produced under belladonna are fre- 
quency of micturition, involuntary discharge of contents of 
bladder and rectum, involuntary discharge of urine during 
sleep. Dr. Hughes, in his ** Pharmacodynamics," says that 
belladonna paralyses the nerve endings, both sensory and 
motor, and, if pushed, will paralyse the bladder itself. This 
drug is the one relied on by the old school, who push it until 
it produces physiological symptoms. Pulsatilla is another 
remedy most useful in girls. Causticum, verbascum, equi- 



NOCTUBNAL ENURESIS IN CHIIiDBEN. 177 

setnin, gelsemium, and plantago all produce increased fre- 
quency of micturition, and have been used successfully. 
Lycopodium and thlaspi are especially indicated if crystals 
of uric acid are thrown down in the urine and also if 
threadworms are present. In addition to the medicinal 
treatment, the child should be sponged with cold water 
every morning and vigorous friction applied with a rough 
towel ; should the child be delicate the water should be 
tepid instead of cold ; begin with water at 90°, and as the 
child grows accustomed to it, gradually lower it to 60**. Also, 
if the child sleeps very soundly, a night-light should be kept 
burning in the room. 

After first trying medicines, pass a gum elastic catheter 
as large as possible every day for a time. I have sometimes 
found this has been the means of curing cases which have 
resisted medicines and electricity. In two cases I at first 
had great difficulty in passing a catheter, but after a few 
days it went in quite easily. If the trouble still goes on 
galvanism should be tried ; a large flat electrode connected 
with the negative pole of a battery should be well wetted 
with salt water and applied to the spine over the last dorsal 
vertebra, while a small electrode connected with the positive 
pole is applied to the perineum. A current will always take 
the shortest route possible to complete the circuit, and when 
the terminals are thus placed the sphincter and nerve-supply 
is included in 'the circuit. This treatment should be per- 
severed in daily for a quarter of an hour. It is necessary to 
include a galvanometer in the circuit that we may know 
the strength of current being used, as batteries are so 
variable in their behaviour, and the resistance offered by the 
skin, &c., is so different in individuals, and in the same 
individuals at different times, that without it* we are in great 
doubt, especially with children, who are so easily frightened. 
As to the amount of current actually passing, two to three 
nailliamperes are enough to begin with, but the current may 
gradually be increased in a few days to eight or ten, never 
commencing stronger than two, and always gradually dimi- 
nishing the current to two before breaking the connection. 
In some cases I have found faradism to be more successful, 

VOL. III. — NO. 2. 12 



178 DISCUSSION ON NOOTUBNAL BMUBBSIS IN CHILDREN. 

especially if applied by means of a silver catheter in the 
urethra. In a girl of 19 I applied faradism by means of a 
metal terminal to the neck of the bladder through the 
vagina. She was quite cured at the end of a fortnight's 
treatment of this troublesome affection, which had lasted 
for months. 

I hope I have suggested some points of interest to some 
of you, and now I trust that in return you will give some of 
your individual experiences, that in future we may be able 
better to treat this troublesome affection. 



Dr. Dyce Bbown said the subject was an extremely interest- 
ing one, because in so many cases which they came across there 
was very little to be found in the way of symptoms except the 
one prominent feature, so that it was an excellent form of disease 
for showing the effects of therapeutics. These cases were very 
often obstinate if not properly treated. But in those cases where 
there was scarcely anything else but the one condition, if one 
went carefully into points of health, something was generally found 
wrong, the principal thing being a weakness of general nerve 
power which had produced the inability to retain the urine. The 
patients generally got abnormally tired easily. The remedies 
which he had found most effective were three — sulphur, bella- 
donna, and ignatia, the last suitable where the patient was of 
a markedly nervous temperament. The tepid hip-bath was a 
great aid to therapeutic means, the patient sitting in water of a 
temperature of 85° for ten minutes. It answered the purpose of 
a bracing cold bath as far as the parts were concerned, and ten 
minutes of that was valuable not only for the nerves about the 
bladder, but for the whole nervous system. Secondly, it should 
be seen that the patient did not take too much physical exercise ; 
walking should be confi^ned to the minimum, and the patient 
should lie down after each walk for at least half an. hour before 
the midday meal, and for an hour in the afternoon. 

Dr. Hughes said that his experience had been singularly 
confirmatory of what Dr. Dyce Brown had said, only he gave 
the 30th dilution of sulphur. He had been disappointed with 
ordinary remedies. 

Dr. Blake asked the author to state in his reply whether he 
had observed any connection between enuresis and peculiar con- 
ditions of the throat generally. The smallness of the meatus was 
the result of a slow shrinkage action from hypertrophic urethritis 



DISCUSSION ON NOCTURNAL ENURESIS IN CHILDREN. 179 

due to the retention of a few drops of urine after each micturition, 
or owing to a long or adherent foreskin. He would strongly sug- 
gest that electric endoscopy should be carried out, because there 
might be a small calculus which could hardly be detected if it 
were pocketed in the urethra itself ; there might be a polypus, a 
diaphragni, or a stone in the bladder. The patient was not so 
much afraid of the electric knife as of an ordinary knife. 
I Haemorrhage does not occur unless the knife be made white hot. 
Yet there was apt to be much more shrinkage after the electric 
knife than after Eeginald Harrison's triangular meatotomy knife, 
the bleeding from which readily yields to hazeline apphed on 
lint, well pushed home to prevent premature healing. Dr. Blake 
then described a curious case of nocturnal enuresis in a boy 
whose symptoms had dated from scarlet fever six months before. 
There had been fits of minor epilepsy, occurring about each hour. 
The boy had a night cough, bad temper, and he was very untruth- 
ful. He had elongated prepuce, with adhesion to the glans, and 
a stenotic meatus. Circumcision and slitting were followed by 
purely negative results. He was then put under hellebore 12, 
and he improved a little. After hypnotism he went four days 
without a fit, and he ceased to wet the bed. The hypnotism 
was repeated once a week, the boy always became cataleptic. 
After about twelve hypnotisings the whole group of symptoms 
passed away, and the boy remained quite well for four years. 
He has just had another attack of epilepsy. Dr. Blake generally 
used ferrum muriaticum in third decimal dilution, and often 
inter-currently with other medicines. With regard to. the con- 
tinuous current, if more than one milliamp^re be used with boys, 
it is better to employ the accumulator and to reverse the current 
about every minute to prevent sloughing. 

Mr. Gerard Smith said he had known several cases in which 
nocturnal enuresis had been treated by electricity. Galvanism 
gave no result at all, but faradism was remarkably successful. 

Dr. Morrison said he had frequently found equisetum of very 
great service in cases where there was no special mechanical 
cause, in 1 to 7 drop doses. 

Dr. Cash Beed said that the treatment of nocturnal enu- 
resis had, in his experience, resolved itself into the treatment of 
abnormal somnolence. He had tried hard to combat that, more 
especially by the homoeopathic exhibition of opium, but without 
the slightest effect. The cases with which he had had to deal 
had been singularly unsuccessful under ordinary methods of 
treatment. They wanted to combat that kind of coma in which 
*ll reflex power of retention was abolished. 



180 DEEP BREATHING. 

Dr. E. B. BocHE thought that, in the case of deep sleep, the^ 
passage of water generally occurred when the patient lay upon 
the back, and suggested the fixing of a large cotton-reel rolled in 
a silk handkerchief across the loins, the flanges placed on each 
side of the spinal processes, which would effectually awake the 
patient if turning over on the back during sleep. He had found 
in young and delicate children very good results from the use of 
phosphate of iron, and also advised the cessation of meat diet in 
younger children. 

Dr. Bybeb Moir (Chairman) agreed with the last speaker as 
to nervous, delicate children. Dr. Dyce Brown had given a 
very good description of the uric acid diathesis found in children. 

Dr. Thomas, in reply, said he had not noticed whether the 
throats of the children had been affected in enuresis or not. 
He had found galvanism very good in several cases, but not 
in all. 



DEEP BREATHING.^ 

BY SURGEON-MAJOR H. E. DEANB, 
Army Medical Staff, Aldershot. 

There are certain points in the subject of developnaent 
of the chest and deep breathing which I venture to think are 
worthy of review, iteration and consideration of old facts 
being often fraught with benefit to ourselves and others. It 
is in view of the extension of chest development to medical 
practice and of showing the method of deep breathing that I 
have ventured to write this paper. 

We can all call to mind the pathetic way in which 
patients, especially of the feminine gender, juvenile and more 
or less adult, have, in answer to a request to localise a pain 
in the chest, placed their hands in the neighbourhood of the 
umbilicus — whereat the young student of medicine smiled ! 
However, they had a truer and, perhaps, instinctive con- 
ception of what is meant by the chest, than others who look 

* Presented to the Section of Medicine and Pathology, February 7, 1895. 



DEBP BREATHLNO. 181 

upon the chest as heing a something behind the upper part 
of the sternum, which can be expanded or blown, or levered 
out like a bivalve, the shape of an emphysematous chest 
being in some minds especially the type of beauty and im- 
pressiveness, whereas when such shape is not due to pad- 
ding, we know it to be the most useless of chests. 

In speaking of the chest let us consider what it really is 
we deal with ; we have first the bony and cartilaginous 
walls, including a large portion of the spinal column, on the 
integrity of which and on the maintenance of the proper 
curves and the relation of those curves to one another and 
the rest of the skeleton, depends the integrity of the re- 
mainder of the chest walls. We have the muscular boundary 
and the contents of the chest, and — the disposition of the 
diaphragm, the largest muscle in the body, being borne in 
mind — it will be seen that the chest contents consist of not 
only lungs and heart, with their respective closed serous sacs 
and large blood vessels, arterial and venous, but also impor- 
tant organs of nutrition, excretion and digestion, in fact, 
«very organ which is in close proximity to the diaphragm 
above and below, and which organs are acted upon by the 
varying movements of the diaphragm, not only by the 
direct pressure but by alteration in blood pressure during 
respiratory movements. So when we talk of the chest we 
mean a great deal, and I emphasise this, because it is the 
first important fact necessary to impress upon instructors of 
physical training who are concerned in this subject of deep 
breathing, and who cannot carry it out till they rightly 
understand what the chest is, and that the most important 
organ and most easily affected by slight cause is the heart, 
which, it seems to me, in the lay mind never enters into a 
conception of the chest. Before going further, let me briefly 
run over a few essential points in the construction of the 
chest. The upper opening is inextensile, small, and of very 
uniform dimensions, the lower opening large, expansile, and 
varying in size in the individual to a greater extent than the 
upper. Where the ribs are longest, most curved and most 
obliquely placed, there is the freest movement and the 
greatest consequent increase in the capacity of the chest. 



182 DEEP BREATHING. 

These ribs are from the fifth to the ninth. About these- 
facts there is no manner or shadow of doubt, but when we 
come to the mechanism of respiration, then there are 
ahnost as many views as there are illustrious men to pro- 
pound them, and where one eminent authority says that 
expansion of the chest begins above and spreads downwards, 
and another says it begins below and spreads upwards, what 
are you to do? What I have been doing is trying to get out 
of Nature herself what she does, doubtless what everyone 
else has done, and different views have been based on different 
interpretations of what Nature said, or, rather, of the manner 
in which she said it. Now, deep breathing has been brought 
into notice for various reasons. It is a very powerful force 
we are dealing with, and it is a force that cannot be 
brought into action by everyone without tuition as to the 
application of the force. A man or recruit asked in an 
ordinary way to take a deep breath and expand his chest, 
makes a gasp, shrugs up his shoulders, draws in his abdo- 
men and tries to force his chest out — with the result that 
very little difference indeed is made in dimension ; inental 
influence, with an anxiety to appear as big as possible, caus- 
ing a diversion of the proper application of the force. Now, 
it seems to me very clear that in order to breathe deeply, 
we must increase or exaggerate Nature's movements in the 
order in which they occur, and observation of what actually 
occurs in respiration leads one to think that the text-book 
physiological expositions are chiefly myths, which have been 
perpetuating themselves. I have observed the quiet respira- 
tion of women lying in bed during the puerperium, and I 
have been surprised to find that the diaphragm was moving 
freely ; and though there was more movement of the lower 
costal arch than in most men, it was not sufiicient to justify 
a separate classification of costal — the upper part of the 
chest was not moving much more than in men. We cannot 
take the style of breathing necessitated by dress as justify- 
ing a separate type of respiration and proceed to act upon 
it. Well, I have observed men and women and new-born 
infants— and in ordinary quiet respiration the chief and in 
most men the only movement visible is that due to descent 



DEEP BREATHING. 183 

and ascent of the diaphragm — and on a deeper inspiration, 
the lower costal arch expands chiefly laterally, and the 
expanding movement spreads upwards and ends in elevation 
of the upper part of the costal arch — the last part to move 
being the first rib, so that instead of the fixing of the first 
rib by the scalenus anticus forming the fixed point for the 
expansion of the chest, that fixed point is provided by the 
lumbar origin of the diaphragm. Now, to increase the 
depth of the breathing, I think the indication is clear to 
develop the action of the diaphragm, which does not exert 
its full respiratory power in quiet breathing. On further 
descent of the diaphragm, it becomes unfolded from the 
inner sides of the ribs, and would pull those ribs inwards 
were those ribs not kept out by the organs covered by them ; 
indeed, it does do so to a slight extent. Now, when the 
diaphragm has become unfolded, it cannot descend any more, 
and then it comes into action in another way — it partially 
ascends and then helps to expand those ribs to which it is 
attached ; during the descent, at first presumably, the bases 
of the lungs in contact with it become filled, and during 
the partial ascent of it, accompanied by expansion of 
the lower ribs, the thick lateral parts of the bases become 
filled. The movement of expansion then extends up- 
wards, the lateral expansion being less marked at the 
upper part of the chest where elevation is most marked. 
The greatest amount of expansion takes place about three 
and a half inches below the nipple over the seventh and 
eighth ribs — the chest measurement taken over the latis- 
simus dorsi and pectoralis muscles in a very muscular man 
particularly being no chest measurement at all, and I have 
seen very imposing pseudo chest expansions obtained in that 
way. Now, I maintain that to expand the lungs to the 
fullest extent we must follow Nature, and then the much- 
abused apices will get the air in them changed, the air in 
the lungs being changed by diffusion, this diffusion con- 
stantly going on between the apices and bases. It was 
mooted at one time that tubercle attacked the apices on 
account of their disuse, and a costal type of breathing ad- 
vocated in consequence rather than abdominal. This theory 



184 DEBP BBBATHma. 

has been abandoned by the profession generally, and I think 
its advocates must have overlooked the fact that, as women 
are supposed to breathe chiefly with the upper part of the 
chest, their apices ought not to have shown such a predi- 
lection to tubercular deposit. Besides, a costal type of 
breathing to the more or less exclusion of the diaphragm 
necessitates shallow breathing, which cannot be good for 
apices or any other part. 

Now, suppose the advisability of deep breathing being 
decided on for whatever reason, say for the purpose of in- 
creasing measurement, pure and simple. The first thing is 
the position in which to do it. Now, the first position in 
which a man can learn to get the utmost out of his dia- 
phragm and to gain control over it, is by lying flat on his 
back. And amongst others for this reason, that the rectus 
abdominis is slackened, and because the spinal column and 
chest are in proper relationship, and cannot be distorted. 

Very well then, lay the subject flat on his back, arms by 
the sides, and do not let him arch his back off the ground. 
Now, get him to breathe naturally and quietly through his 
nose and without any constraint. Then get him to prolong 
the descent of the diaphragm, and it will help him to grasp 
the idea by placing his hand lightly on his abdomen and 
letting his hand rise as the diaphragm descends. It must 
be impressed upon him that during this time there must be 
no action of the abdominal muscles, and on the appearance 
of any such, let him expire at once and go on again till he 
can get his diaphragm down without any contraction of his 
rectus. A very short time will suffice to let him appreciate 
how to use his diaphragm. Then get him to increase the 
inspiratory effort still more so as to expand the lower ribs, 
and when the diaphragm is seen to be stretched out, let him 
expire. Then get him to draw the deepest possible inspira- 
tion, without shrugging his shoulders, not too slowly, and 
expire also not too slowly. During this exercise no other 
muscles than those immediately controlling respiration are 
to be used, and herein is one advantage of putting the man 
flat on his back ; not only are the chest walls in their proper 
relationship to the spine, but he is unable to give a false 



DEEP BBBATHIKQ. 185 

idea of chest expansion by various contortions, and con- 
tracting bulk of muscles. This exercise on the ground can 
be performed after the first week or so by raising the arms 
above the head, the elevation commencing when the descent 
of the diaphragm is completed. The arms are brought 
down again during expiration. Now, out of this recumbent 
posture, what is the position in which not only can ordinary 
respiration be best carried on, but the utmost expansion ob- 
tained ? There is only one word necessary — erect. I may 
seem to be deaUng with very elementary facts, but a mis- 
apprehension of this upright position of man is attended with 
harmful consequences, and I am anxious to point out how 
important it is that this training of the chest should be 
under the supervision of those who thoroughly understand 
this point. First of all, how a man should stand. To be 
perfectly balanced a man stands flat on his feet, the weight 
being distributed equally over the arches of the feet ; the 
knee and hip joints are extended, and the head at a right 
angle with the spine, the feet at right angles with the legs, 
the shoulders drawn back, but not forcibly so, and the arms 
allowed to hang naturally. In this erect position the line 
through the centre of gravity of the body passes from the 
occipito-atlantean joint, cuts the points of junction of the 
different spinal curves, and passes through a line joining the 
centres of the hip joints, slightly behind one joining the 
knee joints, and strikes the ground just in front of the 
ankle joints. In this position a line dropped from the 
occiput just touches the heels, and a line from the most 
prominent part of the trunk in front falls within the feet. 
There is just that amount of muscular contraction which is 
necessary to a living muscle and which is not perceptible to 
the man, to keep the body at that erect position — the main- 
tenance of man's erect position, by provision of nature, 
depending less on muscular action than anything. No part 
of the body wants to be forced out, pulled in, shoved here or 
shoved there ; nature has not built our bodies as tailors 
make our coats, and if any asymmetrical individual requires 
his skeleton to be straight it is a matter of slow and gradual 
process, bringing requisite muscles to bear in the required 



186 DEEP BREATHING. 

direction and so on — ^but suddenly to try and shove, pull, 
and dress a man into his proper position is likely to be 
attended with evil consequences. Well, having got the man 
to stand so that his skeleton and contained organs bear 
their proper relation to one another, let him go through the 
same exercises, though he will have more difificulty at first 
with the diaphragm owing to the tonic resistance of the 
abdominal muscles, and some men will get a larger expan- 
sion lying down and others standing up, the reason of 
which is not quite clear to me. At the end of inspiration 
— ^the deepest possible inspiration — ^the shoulders may be 
raised so as to help to elevate the two upper ribs. The 
best way to begin is to lean slightly forwards from the 
hips, and as inspiration proceeds straighten the spine again, 
taking care not to hyper-extend it, as that produces an 
involuntary expiration. To emphasise this upright position 
of man and its importance, let me briefly consider the 
position of the soldier, called the ^' position of attention " 
— and it is worth considering, because in sending patients 
perhaps to a gymnasium, the instructor may possibly be 
imbued with the ideas derived from this position. The 
position is thus described in the drill-book : " The arms 
should hang easily from the shoulder, elbows to the rear, 
slightly bent, the hand partially closed, the backs of the 
fingers touching the thigh lightly, thumb close to the fore- 
finger, the hips rather drawn back, and the breast ad- 
vanced, but without constraint. The body should be straight 
and inclining forward, so that the weight of it may bear 
principally on the fore part of the feet ; the head erect, but 
not thrown back, the chin slightly drawn in." To read over 
this anomalous position strange contradictions are apparent, 
but I cannot stop to go in detail into the anomalies of this 
position which upsets the whole graceful balance of the body 
without any compensatory benefit, and results, often, in a 
grotesqueness of attitude, as it would involve a consideration 
of the soldier's pack, which is placed with an utter disregard 
to the centre of gravity of the body and the requirements of 
the man's skeleton, and entails needless, and very often 
mischievous inconveniences ; and the inconveniences of this 



DEEP BBEATHING. 187 

position and the method of carrying the kit have been de- 
scribed to me by many men in different regiments at home 
and abroad in almost identical terms : but these details do 
not concern me here now. One justification for throwing 
the weight on to the fore part of the feet is that the weight 
of the pack behind can be balanced ; and another that the 
man shall not stand on his heels ! The absurdity of thinking 
you can carry a weight by getting on to the fore part of the 
feet will be so evident I need not say more. I have had it 
reiaarked to me that this was all very well as regards the 
human being, but that it did not apply to the soldier ! It 
doubly applies to the soldier, as his efficiency as such 
depends on details, and from an aesthetic point of view, alone, 
no one can improve on a well-made man standing in Nature's 
position of uprightness. I can only here consider the posi- 
tion with reference to the chest. Now, in the service, ** the 
hips to be dra^/^n back " (which, really, is unintelligible) is 
invariably interpreted by " draw in the stomach.** This, com- 
bined vrith an advanced chest, and a belt round the waist 
necessarily tight to keep the pack in its place, most effec- 
tually stops diaphragmatic breathing, which becomes shallow 
at the outset. The chest being advanced, and having to 
be kept so, is in a state of semi-dilation ; air not entering 
freely, the air already in the lungs has to become rarefied to 
keep the vacuum filled ; and now, what about the heart, 
which obeys every movement of the chest, being as delicately 
suspended and as readily susceptible of every change of 
movement as the uterus in the pelvis? Its walls are dis- 
tended by the vacuum attempted to be formed by the pleurae 
as much as the air cells are. The position, starting with 
the chest advanced, creates a partial vacuum which has to 
be filled, then respiration becomes shallow and interrupted, 
and, consequently, the even flow of blood to and from the 
heart is interfered with — free venous circulation depending 
entirely upon free, unfettered respiration. Now, the soldier's 
heart has been described in various armies, and is well known 
in ours — and one factor in its production is this position, 
with its necessary interference with free respiration ; and to 
endeavour to prove its share in the causation, mind you, an 



188 



DBBP BREATHINa. 



easily preventable one, of the soldier's irritable and excitable 
heart, I have made some observations on the subject. I 
counted the heart beats accurately in a sitting or easy up- 
right posture, and then got men to stand strictly to atten- 
tion for three minutes — some in marching order and some 
not — and none of the men had under a year's service. All, 
except a few men, showed a marked increase in the pulse 
rate, in some cases the rhythm being irregular, and the 
heart took from quarter to half an hour to resume its former 
rate. I found the same thing, though much less marked, in 
some gymnastic instructors, who stood at attention for three 
minutes without any encumbrances about the chest. These 
are some of the heart rates : — 

60 per minute increased to 84 per minute, increase 24 
100 ,, „ 120 



68 


84 


16 


100 


108 


8 


84 

> 


104 


„ 10 


84 


116 


32 


96 


108 


12 


92 


112 


20 



I found a difficulty in getting observations in some men, 
because their hearts were so irregular and irritable that it 
was useless to try and see the effect of any posture ; the 
mere fact of the man standing up in one case setting the 
heart beating at 150 a minute. The condition of such 
hearts under the mental influence of trying to avoid re- 
marks from superiors on parade for inspection or other 
duties, added to the atrocious physical conditions, may be 
imagined. These few observations will emphasise my point 
of insisting on free and unfettered breathing on account of 
the heart being so easily affected by respiration. I have 
been able to practically demonstrate the efficacy of the 
simple method of breathing I have just advocated in three 
men, whom I have picked out to show that this method 
of deep breathing will produce an increase in the chest 
capacity even in men by whose training ajid physique one 
would have presumed the chest to have reached its fall 



DEEP BREATHING. 189 

development. The men were T. Williams, the light-weight 
champion of Australia, who has trained for and fought 
thirty-three fights; T. Bmrrows, light-weight champion 
wrestler and champion club-swinger of Australia, who holds 
the world's record for swinging clubs for twenty-four con- 
secutive hours, and an all-roand athlete as well, in addition 
to being a boxing instructor ; and Staff-Sergeant Paterson, 
Army Gymnastic Staff, a prominent figure at the E. M. 
Tournaments at Islington. Now, this description is enough 
to show the physical work those men have done and which 
depended on a due rhythmical relationship between heart 
and lungs. Sergeant Paterson, previously to my taking him 
in hand, had been practising deep breathing as well. 

The experiment with Williams was broken into by a 
contest in the prize ring, so he only practised for about 
three weeks, but there has been suiBicient gain to prove my 
point. 

On January 8, Williams' chest measured, lying down, 
3^ inches below nipple, 32|-35| inches. 

On February 5, 32i-36i inches. 

On January 8, Burrows' chest iheasured, lying down, 
3^ inches below nipple, 33|-37 inches. 

On February 5, 33f-37J inches. 

On January 15, Paterson measured, lying down, 34^-39^ 
inches ; and standing up, at 3^ inches below nipple, 34J-38f 
inches. 

On February 6, 34^-394 inches lying, 33i-39i inches 
standing. 

This man can also show a measurement round his chest 
(not a chest measurement, however) which shows a differ- 
ence of ten inches between minimum and maximum, taken 
over the latissimus dorsi and pectoralis. 

Now, we have here first of all a powerful means of ex- 
panding the chest, and if it will expand chests of men in 
such high physical training as these men are, in so short a 
time, we have no doubt what would be the effect on a young 
growing chest. Young people of both sexes can here, under 
intelligent advice, get their hearts and lungs into such a 
condition as to be able to bear the muscular work of a gym- 



190 DEEP BREATHING. 

nasium. To put a youngster of poor physique, narrow 
chest or an asymmetrical skeleton into a gymnasium as 
such, is calculated to do more harm than good, unless he be 
under skilled supervision, which is in many cases not the 
fact. The exercises on apparatus in the undeveloped state of 
the muscles can only be done by fixation of the chest walls, 
and the resulting figures in boys can be seen at any public 
school competition. We know that for the chest to be 
symmetrical the curves of the spine must be normal, and in 
this deep breathing performed lying down we have a means 
by which, undoubtedly, a lateral curvature in its incipient 
stage may be helped to correction ; this I have done in prac- 
tice ; the ribs which became distorted by the spine being 
made an auxiliary to the strengthening of the spine again. 

Mr. Christopher Heath recommends breathing deeply 
when holding on to a rope high enough to ensure the 
patient being on tip-toe. The greatest movement of the 
ribs cannot possibly be got in that position, though, of 
course, the position helps to straighten the spine. 

I need not enter into the physiology of breathing, but I 
would suggest that in the powerful suction action of the 
chest, which accounts for all the venous circulation, we 
have an adjunct in treating various conditions. 

Every medical man is familiar with instances of men 
whose hearts run away from nervousness on occasions of 
public speaking, and who have steadied their hearts by a 
few deep breaths. This acts not only through a nervine in- 
fluence, but mechanically, by duly filling the heart for each 
beat. And in various morbid cardiac conditions this deep 
breathing may act in the same way. Again, when the cir- 
culation is rapid and the brain excited and sleep will not 
come, some will be familiar with the fact that a few deeper 
breaths quiet the circulation at once and bring sleep by 
depleting the brain. Burrows, one day, during these ex- 
periments, volunteered the statement that he felt much 
clearer and brighter after doing his deep breathing in the 
morning, and in cases of congestive headaches, irritable 
hearts, congestion of abdominal organs, it seems to me that 
here we have a powerful mechanical aid to the relief of the 



DISCUSSION ON DEEP BREATHING. 191 

circulation of such congested organs. Asthma, again, is a 
condition which lends itself to treatment in this way. I 
have not yet had sufficient opportunity for making any 
extensive ohservations in this direction in organic diseases. 

I may have seemed to be treating of a simple and self- 
evident subject, but when so much is talked about physical 
education, which after all concerns the weak rather than the 
strong, and when such weaklings are sent to gymnasia, and 
when wre know that among the laity the chest is, and must 
necessarily be, a closed book, and that the chest, in its 
extended definition, is the most important consideration, I 
think the profession do not always raise their voice in this 
matter as they should, and impart some necessary instruc- 
tion to those whom it may concern. The muscularly strong 
in a gymnasium are taken more interest in, whereas the 
weakly one, who wants real physical education, is apt to be 
overlooked and, of course, finding himself " oat of it," gets 
disheartened and drops work altogether : and if all in- 
structors were enabled to understand how to set to work 
and what they wanted to aim at and how the chest worked, 
they would have a greater and keener interest in their work 
and would also take an interest in watching the gradual 
development of the weaklings. 



Dr. Edward Blake had taken great interest in the subject for 
over five-and-twenty years. He had made it a practice to record 
the duration of inspiration in every case that came to him. The 
adult average intake is only four seconds. It was usually possible 
to increase that to forty seconds. Amongst his worst breathers 
had been military men. Mr. Deane's observations on the im- 
portance of teaching a child how to breathe before placing it in 
a gymnasium were excellent. Dr. Blake's plan of teaching the 
art of breathing to men is to let the patient lie and stand alter- 
nately. The subject is instructed to spread out the fingers, laid 
flat on the lower ribs, and to press them firmly backwards, at 
the same time flexing the head and bending the upper portion of 
the spine forwards, whilst he blows out quickly through the 
puckered lips. The fingers are then enlaced behind the neck, in 
order to give fixed points for using the scaleni, the sterno-capital 
group, the subclavii, the pectorales and the other muscles of 



192 DISOUBBION ON DEEP BBBATHING. 

extraordinary inspiration. The mouth is closed and the head is 
slowly extended with the shoulders thrown back, as the patient 
breathes in through the nostrils only. It is strictly enjoined that 
inspiration cannot be too slow. The breath is now held as long 
as possible and is afterwards sent out through a small opening 
in the lips ; this is done rather quickly, in order to increase the 
elasticity of the chest-walls. It is now well known that arterial 
tension is more affected by the respiratory play than by the con- 
dition of the ventricles. Dr. Blake had seen all the symptoms of 
mitral incompetency disappear in a fortnight under systematic 
lung-instruction. The cyanosis, the laboured breathing and the 
dry and irritating cough had all gone. A course of lachesis 
stereotyped the improvement, so that after a lapse of six years 
there was no recurrence of the troublesome results of defective 
compensation. Dr. Blake considered that lung education was of 
especial importance in the gouty group of disorders, including 
glycosuria. Here oxidation is deficient, chromocytes usually 
plentiful, whilst the lymphocytes are relatively scanty. The 
latter enter the circulation about two hours after a meal by way 
of the thoracic duct, and nothing stimulates the sluggish upward 
current of the mixed chyle and lymph like long breaths. That 
tubercle bacilli collect at the pulmonary apex because that is the 
least mobile portion of the lung, is a very simple explanation 
founded on a very fascinating theory. But, as Mr. Deane has 
shown, it must be received with reserve. There is another reason 
for viewing this notion with distrust. Women and children use 
the apex freely and are especially prone to tuberculosis ; whilst 
middle-aged and gouty men, who do not employ the apex, enjoy 
a remarkable immunity from tubercular phthisis. Another im- 
portant use of long breaths is involved in the physiological treat- 
ment of ordinary flat-foot, so often found to co-exist with varicose 
OBdema. The patient reclines supine, having the hips raised and 
the knees bent. Now a long expiration is ordered, and at the 
same time the masseur firmly and slowly presses the two femoral 
veins along their whole course towards the abdomen. This is 
repeated half-a-dozen times, then the patient is turned on the 
face, one knee is bent at right angles, and all the vessels of that 
side are emptied by firm, slow, circular pressure directed towards 
the heart. Vaseline of hamamelis may be used as a lubricant. 

Mr. Gerabd Smith thought that the author of the paper had 
done great service in dispelling the illusion which was very com- 
mon with regard to the actual practice of respiratory movements. 
Almost up to the present day gymnastic teachers had been 



DISCUSSION ON DEEP BREATHING. 193 

satisfied to go through with their pupils certain arm movements 
with the idea of raising the rihs. It was only quite recently that 
they had better information as to how breathing exercises should 
be carried out. The effect of arm exercises on the chest was, of 
eoarsei quite secondary and very indirect ; the mere raising of the 
ribs being insufficient because it was beginning at the wrong side 
altogether. They had really to enlarge the contents of the 
cavity rather than to enlarge the cavity first, so that the contents 
should fill it up. No amount of muscular effort could drag the 
nbs up if the lungs inside them were collapsed or weak and not 
expanded, whereas they had plenty of proof in daily practice that 
a lung which was larger would raise the ribs and maintain them 
in their position. For instance, in the case of emphysema, a lung 
which was abnormally large could produce a large chest measure- 
ment, though that was an unhealthy one; but by natural breathing 
with the abdominal muscles alone the lungs could be expanded, 
and then the chest followed suit. The problem was to amplify 
the respirations to the greatest possible extent. The amplitude 
and frequency of respirations were in direct ratio to the need of 
oxygen, and that again was in direct ratio to the amount of 
muscular work done by any muscles in the body in a certain 
time. He had always been accustomed in practical work (deal- 
ing chiefly with children), to put them through exercises which 
meant the use of the larger muscles for a time before commencing 
breathing exercises, in order to create the sense of need of 
oxygen, the muscles of the thigh being the most useful. There was 
DO exercise which more increased chest measurement than run- 
ning— running for boys, and skipping for girls. Very often the 
um naovements would do a great deal if combined with abdo- 
minal breathing. Soldiers stood too much upon their toes, whilst 
ciyihans went to the other extreme, standing too much upon their 
beels, the result being that they slacken all their abdominal 
muscles, so that many men who were not fat became so by letting 
everything slacken in that way. Such people would get a great 
deal of good from standing upon their toes. 

Mr. Wbight said that for the last twelve months, partly from 
what the author had told him, he had been watching cases in 
which the breathing powers had been small, and where there had 
been need for cultivation of the chest expansion. Especially was 
that the case with those patients who suffered from troubles con- 
nected with the respiratory organs, generally chest and throat 
symptoms, more particularly amongst clergymen who unfortu- 
nately usually suffered most. It was they who really needed those 

VOL. in. — NO. 2. 13 



194 DISCUSSION ON DEEP BBEATHING. 

exercises, and it was unfortunately the case that they were neither 
taught elocution nor the proper method of breathing before going 
into the ministry, with the natural consequence that three-fourths 
of them broke down within a short time of their taking holy 
orders. Even ten minutes* reading was quite enough to bring on 
hoarseness which in a very short time became chronic. Most of 
those cases could be cured solely by those exercises which they 
had seen performed that evening. He noticed from the men who 
had given examples of deep breathing one very important point 
had been apparently overlooked which he had always taken par- 
ticular care to emphasise to his patients, viz., the rule of keeping 
the mouth shut when drawing in a deep breath. He had noticed 
that evening that only one of the three men illustrating the 
breathing exercises had shut his mouth and breathed through his 
nose. To draw in a breath through the mouth was the very 
worst possible thing to do for anyone who complained of dry 
or granulated throat — they should be taught to breathe slowly 
and through the nose. It was not necessary to explain why, on 
account of the dryness of the atmosphere, the moisture was taken 
away from the throat and the mucous membrane became irritated 
and so inflammation and other troubles arose in the throat. 
Another exercise, which Mr. Deane had not mentioned, and which 
he found useful, was to teach patients to draw a deep breath and 
hold it whilst they slowly counted from ten to twenty to them- 
selves mentally, and at the end of that time to expire the air 
slowly, so slowly, in fact, that a flame of a match held in front of 
the mouth hardly wavered at all. That action trained the 
abdominal muscles very well indeed, and made them stronger 
and more steady in their action, which was particularly useful to 
singers. There was one thing to be guarded against. Patients 
frequently when holding their breath in the above exercise did so 
by means of closing the glottis. This was injurious, for it put the 
strain upon the vocal cords which should really have been borne 
by the abdominal muscles. What they should do was to leave 
the glottis open and prevent expiration solely by keeping the 
abdominal and other inspiratory muscles in the inspiratory phase 
of contraction. If patients were taught to do those exercises 
lying down every morning and every night, they would very soon 
find they would be able to speak and read aloud very much better, 
and would go far in correcting the various throat ailments trace- 
able to improper breathing and elocution. 

Dr. Johnstone said that the important bearing of the author's 
paper was on the subject of cardiac and circulatory derangements 



DISCUSSION ON DEEP BREATHING. 196 

and the benefit of deep breathing as an adjunct to their treat- 
ment. From what he had shown them in the way of expanding 
perfectly normal lungs, there was no doubt that excellent results 
might be expected in cases where an over-burdened heart had to 
overcome the resistance of imperfectly working lungs. With 
regard to the question of the prevalence of granular sore throats 
being peculiar among the clergy of the Church of England, he 
might say that in his experience with fifty preachers of a Non- 
conformist persuasion, he found that at least 10 per cent, of them 
suffered similarly to some degree. In its treatment hydrastis 
application and occasional use of the electric cautery he found to 
be most efficacious. 

Surgeon-Major Deane said he had hoped some one would 
have said that the chest expanded from above downwards and 
was disappointed as regards an argument on that account. It 
was no doubt his fault that the men were breathing through their 
months, for not having sufficiently impressed upon them the 
necessity of breathing through the nose ; but these men had only 
been practising such a short time that he did not want to give 
them too much to think about at first. He always made men 
inspire through the nose and expire through the nose and mouth. 
He had seen a book on physical exercises by an American pro- 
fessor wherein it was recommended that exercises should be per- 
formed with the chest kept at full inspiration, which betrayed a 
lamentable ignorance of the chest, and such a book should be 
suppressed. He said it was very undesirable and unnecessary to 
get a man to count while holding the breath, as some people if 
they were told it was advisable to count three, would think at 
once they would do still more good by counting fifty. 



196 MULTIPLB HYDBOCEIiB OF THE COBD. 



A CASE OF MULTIPLE HYDROCELE OF THE: 
COED; SIMULATING A HERNIA.^ 

BY JOHN D. HATWARD, M.D. 
Surgeon to the Hahnemann Hospital^ Liverpool. 

On three recent occasions, when operating for hernia^ 
it has occurred to me to meet with somewhat anomalous 
conditions. In one of these, when trying to relieve a 
strangulated hernia in an elderly man, a patient of Dr. 
Finlay, of Rawtenstall, we found a large, purple, congested 
lymphatic gland lying in front of the hernia. As the 
operation took place on a winter's evening, by candlelight, 
and with defective surroundings, it may be imagined how 
tedious and puzzling the dissection proved before we deter- 
mined upon what the object in the wound was, and removed 
it to find a strangulated and seriously damaged knuckle of 
bowel behind the gland. This patient was not in a hopeful 
condition for recovery, and only lived a day or two after 
operation. 

Almost precisely the same complication occurred in the 
case of a middle-aged woman I operated upon in the Hahne- 
mann Hospital, for symptoms of strangulation ; but in this 
case the gland, bowel and general condition were much less 
seriously affected. The patient did well, a prompt and 
radical cure resulting. In this case only a portion of the 
knuckle of bowel was constricted at the hernial ring. 

In a recent case, to which I now direct your attention, 
the incision for the radical cure of a suspected bubonocele 
revealed a somewhat uncommon condition. 

Charles T., aged 19, was admitted to the Hahnemann 
Hospital on January 29, 1895. He had been in the hospital 
a short time previously suffering from phymosis and severe 
hsemorrhagic balanitis, probably of gonorrhoeal origin. 
Circumcision was performed, and a rather tedious cure 
resulted. At that time the present tumour was noticed 

' Bead before the Liverpool Branch, February, 1895. 



MULTIPLE HYDBOGELE OF THE CORD. 197 

and discussed ; it has become somewhat larger since, and 
patient is anxious for some interference. 

Tlie history of the 'swelling the patient gives is as follows: 

— ^For eight years he has had a swelling in the groin. At first 

this ^was only the size of a hazel-nut, and quite disappeared 

at ni^ht. Gradually it became larger, but by pressing on it, 

or after lying down for a while, it would disappear, all but 

a small soft swelling. During the last twelve months it has 

enlarged, and has not so entirely disappeared underpressure, 

or at night. Several times, so the man says, it has swelled 

np as big as his fist, and caused a sensation of weight and 

dragging. Shortly before his previous visit to the hospital 

it became very large, and burst suddenly into the abdomen. 

Certainly, during the first few days of this stay in the 

hospital the tumour was not noticed, and it appeared to 

-develop during this sojourn. Since his dismissal, however, 

it has become larger and more persistent, but the patient 

states that we have not seen it nearly so large or so tense 

as it has frequently been. 

In the upper portion of the left side of the scrotum, 
extending up to and into the inguinal canal, is a soft, fluctu- 
ating swelling. The tumour is elastic, and rather globular 
in shape, the lower portion beiug larger than the neck. 
Patient declares that the lump still becomes considerably 
smaller during the night's rest in bed. No pain, tenderness, 
or redness. The swelling is freely movable, and is quite 
separate from the testicle, which is apparently normal. The 
tumour presents a distinct impulse on coughing. A little 
firm pressure reduces its size, some of its contents passing 
into the abdomen, but very gradually, and without any 
sudden slip or gurgle. After standing some time, or after 
coughing or straining, the lump is the size of a small orange, 
but may shrink, or be compressed, to the size of a hen's egg. 
Percussion note dull. The superficial scrotal veins of the 
left side were especially large and prominent. 

The patient was anxious for something to be done, so 
preparations were made to insert a trochar ; but the absence 
of translucency and the marked impulse on coughing led to 
the idea that bowel might be present ; so an open operation 



198 MULTIPLE HYDROCELE OF THE ^ORD. 

was preferred, with the intention of performing a radical cure 
should a hernia be present. The tentative diagnosis was a 
hydrocele of the cord, with a hernia behind or into it. 

On January 30, the left side of the scrotum having been 
shaved and an attempt made to render it aseptic, the patient 
was anaesthetised and an incision, about two inches long, was 
made over the upper part of the swelling, extending up to the 
external abdominal ring. Dissection exposed a cyst on the 
front of the cord ; this was incised and about two drachms 
of clear serum evacuated. The upper end of this cyst spread 
up to the external abdominal ring and no doubt communi- 
cated by a fine opening with the peritoneum ; for, during 
the coughing and straining of the early anaesthesia, impulses, 
were obvious and the swelling became larger and more tense. 
Behind the cavity remaining was found another cyst, larger 
and tenser ; this contained about three drachms of serum. 
Next to this, and lower down the cord, a third cyst contain- 
ing about a drachm of fluid was opened; this latter was 
distinct from the tunica vaginalis, though, during its isolation, 
this sac was opened and found exceptionally large but free 
from excess of fluid. In addition to the preceding, one or two 
small cysts were punctured. With the exception of the first 
all the cysts were closed cavities ; they all contained clear 
serum, not tinged with any milkiness or flakes. After the 
emptying of the cysts, a bulky cord remained, consisting 
chiefly of the thickened walls of the evacuated cysts with con- 
nective tissue, a well developed cremaster muscle, a group of 
large spermatic veins, the vas deferens and its artery. The 
group of veins was isolated and tied with catgut ; the vas 
was separated and the rest of the thickened cord was tied 
close up to the external abdominal ring and again just above 
the testis, and removed. Very little blood was lost. Iodo- 
form and wood wool were used for dressing, and arnica 3x 
prescribed. 

The case was evidently one of congenital hydrocele and 
multiple encysted hydrocele of the cord. Had we been able 
to make this diagnosis before operation simpler proceedings 
would have been employed ; but having opened the cyst 
communicating with the peritoneal cavity it was necessary 



MULTIPLE HYDROCELE OF THE COBD. 199 

to occlude the connection, and it was then thought advisable 
to do a more promising further operation than merely to 
puncture the other cysts, with the probability of the re- 
accumulation of the fluid. 

The pathology, of course, is that of accumulations in 
unobliterated portions of the vaginal peritoneal process of the 
testicle. 

After the operation there was abdominal* pain vdth 
pyrexia for two or three days. After this there was con- 
siderable oedema of the scrotum and an inflamed lump at 
the external abdominal ring vdth some fluid in the tunica 
vaginalis. For these and other symptoms during recovery 
ver. vir., mere, corr., bell., bry., apis and pulsatilla were 
prescribed. The patient made a satisfactory recovery and 
soon got about with a suspensory bandage. 

The difficulty in the diagnosis arose from the com- 
plication of cysts which remained persistent, combined 
with a congenital hydrocele of the cord which was variable ; 
it "will appear more excusable to those who examined the 
patient, than to those who merely hear my brief description. 
I exhibit the portion removed, shovdng the emptied cysts. 



200 SUMMAKY. 



SUMMAEY OP PHARMACODYNAMICS AND 

THEEAPEUTICS. 



** GATHER UP THE FRAGMENTS, THAT NOTHING BE LOST." 



December, 1894 — February, 1895. 



PHARMACODYNAMICS. 

Acidnm mupiaticam. — Dr. Cooper follows up his com- 
munication of thirty years ago, which has made some of us use 
muriatic acid with much satisfaction in affections of the tongue, 
with a case in which a hard lump had shown itself there two or 
three days previously, preceded by shooting pains and accom- 
panied by heaviness. After three days of the 12th dil. of the 
acid the unpleasant sensations had gone, and the swelling had 
decreased ; in ten days it was no longer to be felt. — Horn, World, 
January. 

ActSBa. — Dr. C. S. Holton swells the chorus of praise for 
this drug as preventive of undue pain in childbirth. He gives the 
3x dil. four times daily for about three months before the confine- 
ment is expected. — N. Am. Joum, of Horn,, February. 

Apis in Housemaid's Knee. — In a case of this affection, 
occurring, not in a housemaid, but in an expressman who was 
in the habit of Hfting loads upon his knee, arnica proved use- 
less, but apis, given upon the analogy of its action on serous and 
synovial membranes, cured. — Horn, Physician^ February. 

Apocynum in Urethpalgia. — Dr. Midgley Cash reports a case 
where dull pain, like toothache, lasted from one to two hours 
after every act of micturition, and was removed by apocynum 3x. 
— Monthly Horn. Beview, February, p. 72. 

Aranea diadema. — Dr. Sircar relates a case of quotidian 
malarial fever of some standing, in which the cold stage only was 
pronounced. A dose of aranea 6x, given two hours before the 



SUMMART. 201 

expected attack, cured without repetition. The concomitant 
Bymptoms had been met by other remedies, but the daily chill 
still recurred. — Calcutta Joum, of Med,, December. 

Argentum nitricam. — A young lady had been suffering for 
six raonths from symptoms of gastric ulcer. Five months before 
comiiig under homoeopathic treatment she had vomited two 
basinfuls of blood, and had passed blood by the bowels. Argen- 
tmn nitricum 3 every three hours, without any further restriction 
of an already very limited diet, cured her in a week, so that she 
was able to eat fish and poultry. — Horn, World, January, p. 11. 

Arsenicam. — Under the hardly congruous title of '' Arseni- 
cum the liquid catheter," Dr. Harvey Dale relates a case of 
pleurisy with rapid and copious effusion. Paracentesis appeared 
a necessity, but arsenicum 3x trit., two grains every hour, was 
first prescribed. Next day the patient was so much better that 
the aspirator, though brought, was not used ; and recovery ensued 
with gratifying quickness. — Amer. JSommopathist, January 1. 

A case is recorded in which arsenic, taken for chorea, 
developed a multiple neuritis, with paralysis of the extremities 
and the muscles of the trunk, without any gastro-intestinal symp- 
toms being observed. — Hahn, Monthly, December, p. 607. 

The persistent use of this drug removed a giant-celled sarcoma 
of the tibia, on its third recurrence after removal, the inguinal 
glands being hard and enlarged. — Hahn, Monthly, February, p. 
131. 

Arsenicam iodatum. — (a) Pleuritis exudativa. — (1) Pastor 

K., aged 60, had frequently suffered from influenza. Had an 

attack in the winter of 1893-4. According to the report of an 

allopathic physician, this was followed by pneumonia and 

pleurisy. After the cessation of the pneumonia the patient still 

felt weak, coughed frequently, perspired much and complained of 

stitches in the left lung, posteriorly and inferiorly. Percussion 

shows slight dulness, the respiratory sounds are feeble, and rdles 

are heard there. He got sulph. 6 and ars. iod. 3. The morbid 

symptoms diminished rapidly, and in spite of a relapse of 

influenza, in three weeks the condition was quite normal. — 

Kroner, Zeitsch. d. BerL Ver, horn, Aerzte, xiv., 41. 

(2) Mrs. M., aged 25, January 6, complains of scraping in left 
lung posteriorly and inferiorly, aggravated by excitement and 
quick walking. Headache in the morning on rising. Slight 
drowsiness, tickling in the throat, some cough. Physical signs 



202 6UMMABY. 

normal. Ordered bryonia 3, warm fomentations to left side of 
thorax. — January 23. For a week the patient has suffered from 
pains in stomach and down into abdomen ; anorexia, sleeplessness, 
headache, worse in the evening. Cough slighter. She is two 
months pregnant. There is absolute dulness on left side 
posteriorly up to the border of the scapula, anteriorly to the 
clavicle; respiratory sound extinct inferiorly, weak superiorly. 
In the evening, slight fever. Sulph. 6, ars. iod. 3, each three 
times daily. The warm fomentations to be continued. — January 
30. Same state; repeat med. — February 7. The exudation behind 
to the middle of the scapula, in front to second rib. General feel- 
ing, better. Kepeat med. — ^February 19. Dulness only a hand's 
breadth behind. Sulph. 6, apis 3. — March 3. Dulness only two 
fingers' breadth. Sulph. 6, ars. iod. 3. — April 2. Very little 
duhiess behind. Bepeat med. The objective symptoms dis- 
appeared completely in three weeks. She is quite well. — Ibid,, 
41. 

(3) Mrs. E., aged 27, had pleurisy in 1893, which was treated 
by her allopathic doctor with paracentesis in the eighth week of 
the disease, but without good effect. The patient could not 
recover her strength and complained much of dyspnoea. One 
year after the invasion of the disease, examination on May 8, 
1894, showed nearly absolute dulness on the right side, posteriorly 
to the upper border of the scapula, anteriorly to the clavicle. 
Kespiratory sounds weak, inferiorly quite absent. Sulph. 6 and 
ars. iod. 3, each three times a day. — May 29. State the same, 
pains in stom^ich. Eepeat. — June 6. For some days the patient 
has had a very severe cough. She is slightly feverish ; dyspnoea 
causes her to sit up in bed. The cough is spasmodic and is 
caused by persistent tickling in the larynx. No expectoration. 
Phos. every three hours. — June 14. Considerably improved ; 
cough rare, but still hurts the patient. — Eepeat. July 4. 
Cough gone ; patient performs her domestic duties, dyspnoea less, 
appetite and strength good. Objectively, little alteration is 
noticeable. Sulph. and ars. iod. as before. — July 30. Dulness 
clearing off superiorly, respiratory sounds louder. Cough entirely 
gone. Feels well. Same remedies. — September 30. Slight 
improvement of the upper limit of the dulness. No dyspnoea, 
strength constantly improving. — January 7, 1896. Patient did 
not return, as she felt quite well. The dulness had cleared off 
further and the respiratory sounds had become more distinct. 
Still the dulness persisted behind up to the middle of the scapula. 
She got sulph. and ars. iod. alternately. —Ibid,, 43. 



SUMMARY. 203 

(4) Mrs. B., aged 67, had, two years ago, pneumonia and 
pleurisy — probably empyema, on account of which she was 
treated by paracentesis of the right thorax inferiorly and 
posteriorly. But she could not get free of her cough and felt ill 
and wretched. Examination showed dulness to the extent of two 
fingers' breadth on the right thorax, posteriorly and inferiorly. 
Whistling and rhonchus at several parts. No tubercle bacilli in 
the sputa. But as she seemed to me tuberculous, I gave phosp. in 
higher dilutions and ars. iod. 4 in alternation. The obstinate 
cough disappeared in a short time. In the course of a few 
months the dulness had quite disappeared. A second attack of 
cough, in the autumn of 1894, was again successfully treated with 
ars. iod. Unfortunately, when the patient seemed quite well, 
symptoms of softening of the brain appeared, which proved fatal. 
-Ibid,, 43. 

(b) Pneumonia Fibrinosa. — Mrs. N., aged 56, was attacked 
in November, 1893, by fibrinous pneumonia. It was one of those 
central pneumonias which only show distinct symptoms in the 
course of treatment. Though I had formed a correct diagnosis on 
the third day, it was not till the sixth that I could perceive 
distinct dulness. Tubular breathing was only heard over a 
space the size of a hand. On the ninth day an important crisis 
occurred. But neither cough, dulness nor tubular breathing 
declined until the end of the second week. Ars. iod. 4 was 
given; then the change took place rapidly. By the end of the 
third week all the symptoms had disappeared, and under chin, 
arsen. the patient quickly recovered her strength. — Ibid., 44. 

(c) Phthisis Incipiens, — (1) Miss W., aged 60, had haemop- 
tysis eight years ago. Latterly she has had much mucus on the 
chest with short cough and feeling as if the mucus could not get 
loose. Dyspnoea, oppression of chest, pain in left side an- 
teriorly. Aggravation by exercise, especially by exerting herself 
in her domestic work. Weak, bad appetite. Auscultation shows 
resonance in the upper and anterior part of left lung. April 4, 
1893, she got ars. iod. with speedy good effect. She did not 
return, but I frequently see her and am satisfied that she is quite 
well. — Ibid., 47. 

(2) Mrs. M., aged 30, whom I formerly knew as a robust, 
blooming woman, came to see me on January 19, 1894. Since 
the summer of 1893, she has suffered from pain under sternum, 
worse when seated, stitches in both lungs when inspiring and 
when coughing. Cough not very severe, caused by tickling in 



204 SUMMABT. 

throat, generally dry, sometimes with greenish expectoration. 
Appetite bad, variable. Very weak, dyspnoea on going upstairs. 
A suspicious rale at top of left lung. The whole appearance of 
the patient indicated a serious pulmonary affection. She was 
much emaciated and her cheeks had a hectic flush. I gave 
phosph. 30 twice a week, on the other days ars. iod. three times a 
day. The patient did not return. On visiting her subsequently 
she told me that the cough completely left her. She had 
regained her former healthy appearance and felt strong and well. 
—Ibid., 49. 

(3) Mrs. E., aged 60, called me in. She had been treated by 
an allopath for carcinoma ventriculi. She had no appetite, was 
given to vomit her food and was very emaciated. An extremely 
tiresome cough which she also had he treated with large doses 
of morphia. Examination revealed slight dulness in right axilla, 
where she often has stitches, and where rales are audible. Sputa 
contain tubercle bacilli. No sign of carcinoma of stomach. On 
account of the impaired appetite and digestion I gave kreosote 
4, in addition to ars. iod. The cough improved quickly, the 
appetite and strength returned, she increased in weight, and in six 
weeks could be pronounced well. Since then I was called twice 
to see her on account of return of cough, with two attacks of 
haemoptysis which yielded soon to hamamelis. The cough im- 
proved always under ars. iod., and at present nothing abnormal 
can be discovered, but I am unable to say that she is permanently 
cured. — Ibid,, 50. 

(4) Mr. F., aged 45, has had a cough for years, but is 
otherwise well. Four years ago had influenza, since which has 
had constantly increasing shortness of breath. — March 6, scanty, 
clear, viscid expectoration. Appetite bad, emaciation, stools 
rather diarrhcoic. Percussion sound normal throughout. On left 
side posteriorly sharp vesicular respiratory sound. Left lung 
anteriorly and superiorly to third rib, dull rales. Ars. iod. — 
March 22, cough and dyspnoea better, looks stouter. Can walk 
better. Tuberculin 100 once a week, on the other days ars. iod. — 
October 18, has been pretty well during the summer. Looks 
better. Has caught cold and coughs more. Viscid, stringy 
mucus. Ars. iod. and kali bichrom. I see the patient now often 
and he seems all right. — Ibid., 50. 

(d) More advanced Phthisis. — (1) Gustav D., aged 18, delicate 
from childhood ; said to suffer from asthma ; cough severe, with 
much yellow expectoration. For a week face and feet swollen. 
No pain, constant thirst ; ars. 30 once a day. — June 30, 1893, 



BUMMABT. 205 

eigbt days after first consultation, his mother reports that the 
oadema is better, but scrotum much swollen. Urine shows 
mucb. albumen, with cylinders and round cells. Cough rather 
better. Bept.— July 15, considerably improved, oedema only 
on ankles, expectoration and cough rather less, sleeps well, 
aialodorous profuse sweat, urine copious and clear. Bept. — 
September 6, cough returned severely, thick yellow expectora- 
tion; ars. iod. 3 and drosera 1. — December 29, much better and 
can do some work ; ars. iod. — February 9, 1894, patient seen for 
tbe first time. I learn that from his childhood he has been ailing 
and bas been pronounced incurable by several physicians. He 
is very delicate looking, has a pigeon breast and kyphosis of the 
dorsal vertebrae. Percussion sound everywhere dull, diffuse rdles 
and whistling on left side superiorly front and back. Dyspnoea 
after moderate exertion. Ars. iod. and calc. carb. alternately. 
Wbile taking ars. iod. occasionally gets through the summer com- 
fortably. — January 14, 1895, mother reports that he coughs more, 
especially at night, but the dyspnoea is better and he continues 
ars- iod. — Ibid,, 53. 

(2) Miss G., hitherto in good health, got influenza, after which 
had cough and repeated haemoptysis. Brought to me March 5, 
1894. I prescribed hamamelis 1, after which the haemoptysis soon 
ceased. — March 19, hollow barking cough excited by speaking. 
In the morning some yellow expectoration often streaked with 
blood. Appetite good. Pains over chest and back. On right side 
in front and top r^les and slight dulness. Ars. iod., and hamam. ^ 
if there should be haemorrhage. — April 18, no more haemop- 
tysis. Cough worse on leaving off medicine. Weak. B41es on 
right side anteriorly and superiorly as far as third rib. Dros. and 
calc. phos. — May 8, same state. Cough excited by speaking and 
laughing. Phos. and calc. phos. — June 12, no improvement. 
Weak, no appetite, coagh and emaciation increased. Physical 
signs as above. No cough at night. Dros. and calc. phos. — 
August 21, cough as before ; appetite better. Calc. phos. and 
ars. iod. alternately. Mother reports that her daughter is now 
pretty well. — Ibid., 53. 

(3) Miss H., aged 33. Tuberculous for the last eight years. 
Has taken quantities of kreosote and has kept pretty well. 
Liatterly after a chill had fever with severe cough and much 
expectoration, feels very poorly. In right side posteriorly and 
inferiorly dulness for a hand's breadth with rales and tubular 
breathing. — September 15, ars. iod., after which she improved 
quickly. — December 28, the cough returned and she got the same 



206 SUMMABT. 

remedy with good result. She feels now very well, has nothing 
to complain of, thongh of course I do not consider her cored of 
her disease. — Ibid., 54. 

Anun triphyllam. — The use of arum in diphtheria has 
hitherto heen mainly in the hands of those who use the higher 
attenuations. In the Medical Century for January 1, however. 
Dr. Westover writes : " Arum triphyllum Ix dil. in water has 
apparently rescued some desperate cases for me, when the 
nose was excoriated by watery acrid discharge, very irritating 
where it flowed over the upper lip or cheek ; glandular swelling 
excessive ; intense foetor and a general septic condition." 

Belladonna in Amblyopia. — Dr. Lobethal relates a case 
where a lady, from strain of the eyes, had suffered for nine 
months from an appearance as of cobwebs before them, causing 
her vision to be obscured as if by a more or less dense gauze. 
An ocuUst could And and do nothing. Belladonna 3x, repeated 
every forty-eight hours, completely cured her in three weeks. — 
Horn. Becorder, December. 

Dr. Walter M. James emphasises aggravation from jarring of 
the bed as a great indication for the use of belladonna, relating 
cases of prostatitis, inflammation of hip-joint, and gall-stone 
colic where it proved curative on being so selected. — Horn, Physi- 
cian, February. 

Dr. Warner states that he has repeatedly verified the unusual 
symptom "increased on lying down, diminished on standing up," 
in uterine cases. — N. Engl, Med, Gazette, December, p. 606. 

Berberis. — Dr. W. J. Martin gives a good case of renal colic, 
where the patient had been passing urine with brick-dust sedi- 
ment. Berberis 1 caused speedy disappearance of the pain. — 
Hahn, Monthly, December. 

Bromine. — Dr. Deschere has an article on *' Bromine and its 
Compounds " in the February number of the N, Am, Journ, of 
Horn,, which collates much valuable matter. We have made 
some excerpts from it, but note it here for reference. 

Galcarea fluorica.— Dr. E. D. Ayres has much confidence in 
this '* tissue-salt " for removing opacities of the cornea, and re- 
lates in the Medical Century of February 1 two cases in point — 
one of traumatic inflammation, one of trachoma. 



SUMMABT. 207 

Calcarea phosphorioa. — Dr. Traegerhas had very favourable 
results from this salt, in the 2x and 3x triturations, in chronic 
pulmonary cases resembling tuberculosis, with emaciation and 
niglit-s^w^eats. The latter are a special indication for it in other 
forms of disease. He praises it also in chronic hydrocephalus 
and spermatorrhcea, and esteems it superior to iron in chlorosis. — 
Horn. JRecorder, December. 

Camphor. — Dr. Lobethal, from his experience with camphor 
in cholera, considers it effective only when the body retains its 
natural whiteness, however cold the patient may be. In cyanotic 
cases it is useless. He has employed it successfully to rally 
patients from the exhaustion induced by a prolonged continued 
fever or in the resolution of a pneumonia. — Horn. Becorder, 
February. 

Ceanothus. — Under the heading " What I know about 
Ceanothus," Dr. J. A. Whitman relates several cases of splenic 
enlargement, of which a "wave** occurred in his practice (in 
South Carolina) some years ago. In all, ceanothus, in fractional 
doses of the tincture, proved curative. — Medical Century , Feb- 
ruary 15. . 

Cineraria in Cataract. — Dr. A. B. Keene, of Syracuse, N.Y., 
reports decidedly favourable results from the instillation of cine- 
raria maritima, two drops three times a day, in cataract. — 
Horn. Becorder, January. 

Coniam. — Mrs. C, who for several years had enlargement of 
left ovary, with uterine induration and displacement, came com- 
plaining of intense suffering for a week or ten days preceding each 
menstrual period from soreness of the breasts. Under conium 4>, 
one drop three times a day, not only did this soreness entirely 
depart, but the ovary diminished in size and the uterus softened. 
In another case the same guiding symptom led to considerable 
improvement in uterine hjrperplasia with ovarian tenderness. — 
N. American Joum, of Horn., February, p. 123. 

Copaiba. — A case where this drug caused, not only a diffuse 
erythema, but also pemphigoid bullsB on the legs, is extracted 
from the British Medical Journal in the HomcBopathic World for 
February. 

Ferram iodatum. — Dr. Custis depends much on this medi- 
cine, which he gives in the 30th dil., for the feeling of bearing- 



208 SUMMABY. 

down so often complained of by women after child-birth, and 
which, he says, is not always caused by laceration of the peri- 
nsBom. — Horn, Jofwm. of Obstetrics, January 1, p. 89. 

Hyosoyamas. — Dr. Schwenk considers the two most charac- 
teristic symptoms of hyoscyamus in typhoid fever to be trembling 
and twitching of muscles, so that in taking the pulse you feel the 
tendons twitching under your fingers; and illusions during the 
delirium of odd little people gambolling along the foot of the bed, 
or clinging to the frieze of the room, watching the patient and 
terrifying him. — Hahn. Monthly, December. 

Magnesia phosphorica. — '' The symptom," writes Dr. 
Charles H. Evans, " of constant urging to urinate whenever the 
person is standing or walking has been cured so frequently by 
the above-named remedy that it may almost be said to be 
characteristic." — The Clinique, January. 

An Indian contributor to the Horn, World (January) has veri- 
fied the action of this salt in dysmenorrhcea, relating a good case 
in point. He gave the 4:X trit. 

Heroarias cyanatus. — Dr. Grubenmann comes forward as 
another witness to the ef&cacy of mercurius cyanatus in diph- 
theria, of which he relates a formidable case recovering under it. 
Like Dr. Villers, he has found the 30th dil. preferable to the 
12th — 15th, which he formerly used. He thinks we have no 
reason to adopt the ** s6rum-th6rapie." — Bevue Horn. Beige, 
January. 

Hezereum in Periostitis. — In an acute periostitis of the tarsal 
extremity of the tibia, pain and tenderness being great, temp. 
104*5°, pulse 120, the patient a boy of a strumous family, 
mezereum, in Dunham's 200th potency, effected prompt relief 
of pain, and the symptoms speedily subsided. — Horn. Physician, 
February. 

Hyristica sebifera. — Dr. Chancerel relates a case of whitlow, 
in which he verified the experience of the late Dr. Charg6 that 
this plant will relieve when the ordinary remedies fail. He took 
the hint from a symptom furnished by Mure in his Materia 
Medica, Dr. Chancerel used the 12th dil. — Bevue Horn, Frangaise, 
December, p. 412. 

Oojmum canum. — Dr. B. N. Banerjee relates a case of renal 
colic, in which no urine had passed for ten days. Ocymum 6 
was given. Within half an hour the patient began to pass 



SUMMABT. 209 

urine, of which ten pints were discharged daring the day, in the 
course of which, also, a stone ahout the size of a split pea, 
enveloped in shreds of mucous membrane and blood, was voided. 
— Calcutta Joum, of Med., January. 

Phytolaooa, — One of the reasons which has supported the 
use of Phytolacca in corpulence has been the allegation that 
birds which feed on the berries become emaciated. According 
to Dr. !Botzell, natural history refutes this statement, and shows 
that birds which eat the poke berry rather fatten than otherwise 
upon its use. Its fat-reducing power would therefore seem to be 
aut honuBopathums aut nihil, — Hahn. Monthly, December. 

Plantago. — Dr. G. H. Peters sends a short proving of 
plantago major on himself. Neuralgic frontal pains were the 
main symptoms induced ; they prevailed from 12 a.m. to 6 p.m. 
The drug (on two occasions) began to act only three days after 
taking it, but then continued to do so for about five days. — Horn. 
Recorder, February. 

Ptelea trifoliata. — Mr. Frederick Kopp says that this drug 
is "a priceless remedy in the treatment of frontal headaches, 
being in this respect without a rival.*' — Horn. World, February. 

Rhus. — Dr. Geo. Koyal calls attention, as Dr. Helmuth in 
his ** Surgery " had done before him, to the homoeopathicity of 
rhus to septicaemia; and gives two cases, one showing its 
prophylactic, the other its curative, action. — Med. Century, 
February 1. 

Stannum iodatam. — Dr. Youngman has had very favourable 
results from stannum iodatum in chronic pulmonary affections 
simulating phthisis. He gives the 3x trit. It appears to 
reduce especially the profuse secretion and expectoration. — 
Hahn, Monthly, January. 

Stiota. — Dr. A. L. Fisher brings another testimony to the 
value of sticta in coughs. The indication, he writes, is " ex- 
cessive hypersesthesia of the trachea, the least irritation within 
it exciting violent paroxysms of cough that persist until the 
irritant is dislodged." — Medical Current, February. 

¥espa media. — Dr. Menninger sends to the Homoeopathic 
Physician for December an involuntary proving of the fruit 
wasp (** yellow-jacket "). Its subject ate an apple which had 
been ** stung " by the insect. Salivation, nausea, vomiting, 

VOL. ni. — NO. 2. 14 



210 SUIOCABT. 

itching of surface (startiDg from azillsa and popliteal spaces), and 
swelling of mouth and throat, with cough and dyspnoea, were 
the immediate effects. Giddiness came on as he walked to the 
doctor's office, and when there the whole skin was the seat 
of intense urticaria, with oedema of eyelids, lips, and prepuce. 



THERAPEUTICS. 

Aone. — Dr. Deschere writes : — '' One of the prettiest, and, 
at the same time, most striking illustrations of the homoeopathic 
law is the curative action of certain bromides in various forms of 
acne. Potassium bromide rarely fails me in simple acne of the 
face and upper part of the body. The 1st or 2nd dec. dil., or one 
grain of the crude, given three times daily for a week, will 
remove every trace of the eruption, especially in nervous hyper- 
aesthetic females, without reference to puberty." — North Amer. 
Joum. of Horn, f February. 

Bright's Disease.— Dr. Wingfield relates a case of Bright's 
disease, with general dropsy, in a woman of 40, of five years' 
standing. The urine showed one-half albumen. Apis 3x caused 
diuresis and reduced the dropsy, and under arsenicum 3x com- 
plete recovery ensued. — Monthly Horn. Beview, January, p. 17. 

Carbuncle. — Under the heading **What I know about 
Carbuncle," Dr. Houghton relates some disagreeable experiences 
in his own person. He has had much better results from 
tarentula cubensis than from the ordinary remedies, and finds 
the hypophosphite more helpful than the sulphide of lime (our 
*' hepar ") ; locally, he had far more relief from powdered 
Phytolacca root (half a teaspoonful on a poultice) than from any 
more obviously anodyne application. — N. Am. Joum, of Horn., 
December. 

Cirrhosis of Liyer.— Dr. Ord reports a case of typical 
cirrhosis of liver, with some ascites. Under phosphorus 3x, 
followed by arsenicum iodatum Sx, the symptoms all cleared 
away ; and the patient had remained apparently well for eighteen 
months when the report was made. — Monthly Horn, Beview, 
February, p. 74. 

Cysto-spasm. — In a severe and long-lasting case of this 
affection, after dilatation and visual inspection of the bladder had 



8UMMABT. 211 

been practised, the vesical spasm was so much relieved that the 
patient could afterwards control the suffering and the constant 
desire to urinate by drinking freely of very warm water. — The 
Glinique, January. 

Diabetes. — Dr. Stiegele proved that syzygium diminished the 
quantity of sugar in the urine, but had no effect on the general 
health, whilst arsenicum improved the general health without 
diminishing the quantity of sugar. He therefore combined arsen. 
6 with syzyg. 3x as a double medicine and gave it in six cases, 
without change of diet except deprivation of sweets, with the 
following result. 

Case 1. — A farmer, aged 70, has been ill since autumn, 1892. 
April 17, 1893, he got the double remedy 3 times a day, sugar 6 
per cent. — May 13, sugar 2 per cent., general health better. — 
June 5, sugar 0*4 per cent., general health very good. — July 11, 
sugar per cent., quite well. 

Gdse 2.— Man aged 48, swelling of liver for two years, feet 
swollen in the evening, skin blue, gangrene of right sole. — May 17, 
1894, sugar 7 per cent., the double medicine. — June 13, much 
better, ulcer smaller, sugar per cent. — September 19, quite 
well ; liver unaltered, sugar per cent. — January 20, 1894, the 
same. 

Case 3. — Man, had an apoplectic attack in the summer of 1892. 
November 17, sugar 7 per cent., double medicine. — November 25, 
feels better, sugar 4 per cent. — December 30, still better, traces 
of sugar. — March 3, 1894, sugar per cent. — September 29, 
yertigo, sugar per cent. 

Case 4. — Patient aged 66, ill for one year. — September, sugar 
4*75 per cent. Double medicine. — October 2, sugar 0*55 per cent. 
—November 10, sugar 0*4 per cent., later per cent. 

Case 5. — Man, aged 60, ill for six months. — January 4, sugar 
5*5 per cent.; double medicine. — February 14, sugar 0*72 per cent., 
later 0*48 per cent. — May 28, sugar 01 per cent. — October 13, 
traces of sugar, drinks a great deal of beer. 

Case 6. — Man, aged 48. Three months ill. — May 8, 1894, 
sugar 3*4 per cent. Double medicine. — June 28, sugar per 
cent. — September, well, only traces of sugar. — Allg, h. Ztg,, 
cxxix., 178. 

Donner gave syzyg. 6 in several cases without altering diet. 
In one case the sugar was 5*5 per cent. In fourteen days it went 
down to 05 per cent. After leaving off the syzyg., it rose 
again to 1 per cent., but under syzyg., fell to 0*5 per cent. In 
another case the medicine had no effect. — Ibid, 



212 SUMMABY. 

Dr. JouBseii expounds, in UArt Medical of January, the 
theory of the origin of glycosuria in pancreatic inaction rather 
than hepatic over-action. He relates a case treated by the 
liquor pancreaticus, six drops per diem, with a moderately 
restricted diet, in which complete recovery ensued ; and in the 
February number mentions another, as yet incomplete, but in 
which the action of the remedy seems none the less manifest. 

In the same number (January) of this journal, a case is referred 
to in which phosphorus (O'OOl milligramme night and morning) 
proved curative. The malady was obviously of nervous origin. 

In the N. Am, Joum, of Horn, for February, Dr. Deschere 
cites a case of bromism induced by the potassium salt, which 
presented all the symptoms of diabetes ; and one of the idiopathic 
disease in a woman of 68 in which a complete cure was effected 
by the 2nd dil. of the same. 

Diphtheria. — The Medical Century for January 15 is a special 
" Diphtheria number," and is full of practical matter bearing on 
the treatment of this fell disease. Specially valuable are Dr. 
Dewey's ** Twelve Remedies in Diphtheria, with Comparisons,** 
and Dr. Hawkes* " Treatment of Diphtheria.*' The latter is one 
of the ** Hahnemannians,'* but he is not a boaster. " I confess,** 
he writes, '* that I approach a case of true diphtheria, especially 
in a child of from four to eight years of age, with fear and trem- 
bling.** Might we suggest that this partly arises from trusting to 
such unhomcBopathic remedies as, with lachesis, the only three 
he mentions — arsenicum iodatum and lycopodium, and to such 
trivial indications as the commencement of the exudation on 
the right or left tonsil ? 

Glandular Swellings. — (1) A young woman, aged 23, had for 
several years had a collection of swollen glands on the right side 
of her neck causing great disfigurement. She had used many 
different kinds of ointment without effect, and was told that the 
only thing to be done was to have them excised. The tumour 
consisted of several (four or five) indurated lymphatic glands 
aggregated together under the jaw on the right side. With the 
exception of a small gland standing isolated at the edge of the 
tumour, which was red and showed slight fluctuation, threatening 
to burst, the glands were not red and showed no signs of inflam- 
mation, they were not sensitive to touch, but were strikingly 
hard ; the pressure of the tumour on the subjacent veins caused 
frequent congestions in the head. Under hepar 4 and silica 5, a 
powder alternately night and morning, the isolated gland became 



STTMMABT. 213 

ripe for opening after three weeks and discharged a cheesy sub- 
stance. The medicines were continued and after some time it 
healed. The glandular tumour remained unaffected. Calc. fiuor. 
5 trit. was now given, a powder every day. After about three 
weeks of this medicine the tumour showed signs of diminution. 
The medicine was continued for six or eight weeks, and the 
tumour resolved itself into separate glands of the size of hazel- 
nuts, and the disfigurement of the face was quite gone and she 
got married. The treatment lasted from April 24 to the end 
of November. — Sybel, Zeitsch, des Berliner Ver. Horn. Aerzte, 
xiv., 2. 

(2) A strong young man, aged 20, had for four or five years 
a conglomeration of indurated lymphatic glands close under the 
jaw on the right side, causing great facial distortion. One of the 
glands standing aloof from the tumour, of the size of a hazel-nut, 
was red and fluctuating, but the rest of the tumour was hard and 
painless. Silica 5 and kal. chlorat. 5, a powder alternately once 
a day, caused the isolated gland to ripen, and when opened a 
cheesy substance was discharged. He now got calc. fluor. 5 
and kal. chlorat. 5, one powder every day. Under this treatment 
the glandular conglomerate gradually dispersed. The treatment 
occupied sixteen months. — Ibid., 3. 

(3) An unmarried woman, aged 50, had for eight years an 
indurated gland of the size of an egg on the right side of the neck ; 
it was not red and was painless. The patient had for years used 
all sorts of ointments without effect. At last she resolved to try 
homceopathy. Under the use of calc. fluor. 5 trit., a powder at 
first every night and morning, afterwards only once a day, in six 
weeks the gland was completely cured. — Ibid,, 4. 

(4) A child, aged 5, who had for two years numerous indurated 
glands in the neck, was so far benefited by calc. fluor. 5 trit., 
a powder once a day, in six weeks, that the family considered it 
unnecessary to continue the treatment. — Ibid,, 5. 

Goitre. — Dr. Midgley Gash reports a case where iodine, 
locally and internally, seemed rather to irritate, but spongia 3 
cured in two weeks. — Monthly HorruBopathic Beview, February, 

p. 73. 

The isopathy at present reigning in old school medicine has 
taken, in reference to goitre, the curious (but not unprecedented) 
form of treating a diseased organ by its own product or sub- 
Btanoe. Of twelve subjects of this malady who took the thyroid 
pulp in doses of 5 to 10 grammes every two to eight days, nine 



214 SUMMABY. 

were cured or improved, three only showing themselves re- 
fractory. — UArt Medical, January.^ 

Inosituria. — Dr. Crepel communicates to L'Art Medical for 
December a case of this rare form of diabetes, in which it is the 
muscle-sugal:, inosite, that passes by the urine instead of the 
ordinary product of the glycogen of the liver. The same treat- 
ment, however, seems available, for under arsenicum and uranium 
nitricum in alternation the symptoms steadily subsided. 

Heningitis spinalis.— A boy, aged 9, who with the exception 
of an attack of pneumonia two years ago, always enjoyed good 
health, had lately lost his appetite, and on August 12 and 13 
complained of weariness of limbs and vomited once. On the 
14th he was feverish and had to keep his bed. His mother gave 
him a few doses of aconite. When seen on the 15th, he pre- 
sented the following symptoms ; he lies stiff and immovable on 
his back, the nape was stiff and the head thrown back. Face 
sad, anxious expression, eyes bright and fixed. On attempting 
to move the stiff limbs he cried out with pain ; touching his limbs, 
especially the lower extremities, caused pain. Pulse 120, small 
and contracted. Abdomen painful on both sides below navel. 
Pain in the throat, swallowing difficult, could hardly protrude 
the tongue, spoke with difficulty. The previous evening had 
complained of frontal headache, for which his mother had applied 
cold compresses. Eespiration short and superficial, groaned occa- 
sionally from pain; and now and then screamed out, as if a 
sudden pain had shot through his limbs. Thirsty, but could 
swallow little fluid on account of the dysphagia. Could not 
swallow solids, skin felt hot and was covered with warm clammy 
sweat, urine dark red. Diagnosis: spinal meningitis. He got 
bryonia 6x, 2 drops in a tablespoonful of water, at first every three 
hours. In twenty-four hours the abdominal pains and headache 
were relieved ; but his face retained its anxious expression, the 
other symptoms unchanged. He had copious sweat, urine scanty, 
dark red. Had a stool. Though he lay so stiff in bed, at night 
he managed to get out of bed to pass urine without assistance, 
but could not get back without help. On the third day his look 
was not so fixed, his expression less anxious, the stiffness of neck 
diminished. He could swallow better (milk, barley water), but 
he answered questions slowly and with difficulty. The arms 

1 Yet another example of this medication is to be found in the February 
No. — the treatment of malarial cachexia by splenic extract. In two cases 
so dealt with the results were eminently satisfactory. 



SUMMARY. 215 

were more xnobile and not so sensitive to touoh, the lower 
extremities not so stiff; perspiration, especially at night, con- 
tinued profusely. He had slept well the previous night. He 
next got a. dose of mere. 30. — August 21, he was much better, 
the muscnlsir stiffness was nearly gone, but he still avoided 
moving tlie legs. Dysphagia gone, can take more* solid food, 
pulse lOO, sinall, night sweat profuse. He got a dose of china 
30. — Augijist 23, he was well and sat up in bed and could move 
about easily. He soon regained his perfect health. — Goullon, 
Allg, h» 2itg, cxxx., 42. 

Menorpliagia. — In a note on the treatment of this affection, 
Dr. Joiisset places arsenicum facile princeps among its remedies, 
whatever be the exciting cause. He gives it in the 3rd trit. 
throTiglioiit the intervals. — L*Art Medical^ December. 

MetroFPhagia. — Dr. Aldrich reports a case of pelvic distress 
following miscarriage and resulting in metrorrhagia, the dis- 
charge being offensive and acrid. Examination found an enlarged 
uterus, a lacerated cervix, and an endometrium which to the 
sound indicated fungoid degeneration. Creosote 3x cleared up 
all the symptoms in a month, and a proposed curettage was 
definitively abandoned. — Minneapolis Horn, Magazine^ December. 
Dr. Sybel has recorded two cases of a similar kind. In both 
the bad smell of the blood was the great indication for the 
remedy. — Horn, Becorder, December. 

Morbid Growths. — Dr. Stella Perrigo sends two cases en- 
couraging to internal treatment in place of the knife. One was 
an instance of enchondroma (so diagnosed by a surgeon of 
eminence). Similar growths had occurred upon every male child 
bom in the family for several generations, and had been removed 
by operation. This had appeared (on the frontal bone) at 5 
months of age, and at 11 months was the size of a small egg. 
Under sulphur and silica 6 it had disappeared in forty-eight days, 
and has not recurred. The other case was a swelling, the size of 
an orange, involving the right nipple, in a man of 38. It was 
originally traceable to a blow, but since influenza had become 
the seat of lancinating pains, with constitutional irritation ; and 
removal had been urged. The patient was put upon mere. corr. 
6, with a diet of milk and rye bread, and in six weeks the growth 
had entirely subsided. — Minneapolis Horn. Magazine, December. 

A tumour of stony hardness, size of a man's fist, which had 



216 SUMMARY. 

been enlarging for a twelvemonth, beginning at angle of lower 
jaw and extending to lobe of ear, was removed in three weeks by 
silica 6x. — Monthly Horn. Bev.y January, p. 16. 

Nightmare. — Dr. J. E. Mann writes to mention a simple 
remedy which he has found very effectual in preventing night- 
mare. It is to cleanse and rub well the spaces between the toes 
before going to bed. — Med. Century, February 1. 

Oxalaria. — It is stated that Dr. Heermann, of Paris, has had 
remarkable success in oxaJuria from kali sulphuricum. He con- 
siders it almost a specific in this condition. Dr. Allen, who 
mentions this, has ** repeatedly verified the generalisation.*' — N, 
Amer, Journ, of Horn,, February, p. 121. 

Salpingitis. — Dr. Snyder believes that "in a very great 
majority of cases of this disease, if at their beginning, or soon 
after, they have proper homoeopathic remedies with the proper 
auxiliary treatment, they will not reach a stage of development 
demanding operative measures." " I have seen," he writes, '* a 
considerable number of cases treated in this way, without one 
fatal result, and without the need of a surgical operation." He 
finds the vaginal tampon saturated with the glycerole of iodine 
(one part of tincture to four of menstruum) a very valuable 
local application, and administers veratrum viride and other 
medicines, for which he gives indications. — N, Amer, Journ, of 
Horn,, February. 

Syphilis. — (1) A man, the father of several children, had a 
hard chancre with swollen inguinal glands and was cured in 
fourteen days by mere. sol. 6x. After nine months was ascer- 
tained to be quite cured. — Kernler, Allg. h. Ztg., cxxx., 21. 

(2) A waitress, affected with hard chancres, was treated at 
the dispensary with mere. sol. 6x, but as no improvement was 
observed she was taken into hospital and got mere. oxyd. rub. 3, 
with calendula lotion to the ulcers. In three weeks these and 
syphilitic sore throat were completely cured. — Ihid, 

(3) A young widow, who in four weeks after the appearance 
of the ulcers lost forty pounds in weight, became affected with 
such intense headache that she felt inclined to knock her head 
against the wall; sang, can., mere, sol., bell., mere. oxyd. rub. 3x, 
were taken without effect. Sulph. ac, aeon., gelsem., arsenic, 
were then given without relief; mere. oxyd. rub. 1 trit., did some 
good. Then the improvement ceased and her syphilitic sore 



SUMMABY. 217 

throat got worse. Merc. soL 3 did no good to this last symptom ; 
kal. iod. 2x was tried in vain ; nitric acid 3x effected a rapid cure. 
-Ibid. 

(4) A post-office employee, of bloated appearance, had under- 
gone an inunction treatment for fourteen days. The chancre, 
glandular swellings, sore throat, and pains in tibia were rapidly 
cured by nitr. ac. 3 and 2. The cure was completed in three 
weeks by hepar and kali bich. A relapse of the throat affection 
yielded quickly to nitr. ac. — Ibid,, 22. 

(5) A sergeant had hard ulcers on the glans and body of the 
penis. He got mere. oxyd. rub. 2x, with compresses of calendula. 
After fourteen days no improvement ; he then got mere. sol. 6, 
mere. corr. 3, and secale, without benefit. Three months from 
commencement of treatment a specific exanthem of bright red 
colour and sore throat appeared. Coral, rub. 3x and nitr. ac. 2x 
immediately caused improvement. There appeared on his skin 
vesicles which filled themselves with pus, burst and left behind 
a bluish red colour. Lachesis 6 was now given and improvement 
at once set in, and a perfect cure was soon effected. — Ibid. 

(6) A hotel-keeper, who had undergone several inunction treat- 
ments, displayed great anxiety, trembled — especially in stormy 
weather, was pale, anaemic, had once had dropsy, catches 
cold easily — especially in damp weather, has extreme salivation, 
the nose much swollen with small ulcers on its alsB, the 
prepuce is a hard wall. Thuja, natr. sulph., hepar and other 
remedies were of no use. Dulc. 3 caused the salivation to cease. 
After three months he got ars. iod. 3x. This was continued for 
a considerable time. In fourteen days the prepuce became 
normal, and the other symptoms improved. The ars. iod. was 
continued to be given occasionally as a precautionary measure. 
-Ibid. 

(7) A girl of the town had for long had swelling of the right 
labium, and occasionally an exanthem ; lymphatic glands in the 
groin had been several times removed. Nitr. ac. 3 and coral, 
rub. 3 soon cured her. — Ibid. 

(8) A gentleman, who had contracted syphilis eight years 
previously, had been subjected to all sorts of treatment, had 
also been to Aix-la-Chapelle, but could not get rid of a cutaneous 
disease. Coral, rub. 3 did no good, but are. iod. 3x was 
wonderfully successful. — Ibid. 

Thrombosis. — A powerfully built man, aged 56, had been 
operated upon three months ago for fistula. Whilst the wound 
was healing he got pneumonia, which had got well. — July 9, 

VOL. III. — NO. 2. 15 



218 SUMMARY. 

I found the wound of rectum healed. The whole left lower 
extremity from the groin to the foot much swollen. In the 
course of the large femoral vein one can feel a hard thick cord 
that can be traced up into the abdomen. It is very sensitive to 
pressure and the skin over it is red. He cannot move the limb. 
There is some dulness of the right lung inferiorly, sharp vesicular 
respiration, some rales, little cough, feels very weak, complains of 
flatulence and fulness of abdomen. I gave hamajnehs four 
drops in water every three hours, and externally cold compresses 
of hamamelis water. After two days the swelling was less and 
softer. On the 23rd, I was called in haste on account of ex- 
pectoration of pure blood. I found embolism in right lung 
inferiorly with circumscribed dulness. The expectoration con- 
sisted of lumps of bright red blood, there was oppression of 
chest with acute stitches, somnolence, thirst for cold drinks ; he 
lay on his back with head elevated. I gave phosph. 3 every two 
hours and continued the hamamelis morning and evening. In the 
upper third of the femoral vein there was a hard lump the size 
of a walnut. That day the haemoptysis was much better. — August 
2, pulmonary symptoms nearly gone, the dulness has cleared off, 
very little cough, swelling of limb decreased. I discontinued the 
phosph. and gave the hamamelis more frequently. Improve- 
ment went on rapidly, the size of leg was nearly normal, but the 
lump in the upper part of the vein was much the same. — Augast 
28, haemoptysis recurred but without any serious symptoms; in 
lung circumscribed infiltrations were again manifest, constant 
cough with bright red sputa, leg swollen, the lump smaller. 
Phosph. as before. — September 1, felt pretty well, sputa rusty 
coloured. — September 4, no more blood in sputa. I discontinued 
the phosph. — September 14, limb normal in size, a cord is still 
perceptible in the upper third 3 to 4 cm. long with a small lump 
in the middle. He can move the limb very well. Much troubled 
by foetid flatus. Carb. v. 30 once a day and three drops of 
hamamelis once a day. Massage with hamamelis ointment. At 
my last visit on October 5, found the patient very well and 
looking well; he could walk quite well, the left foot swelled a 
little in the evening, appetite excellent but still troubled with 
flatulence, for which he got lycop. 200. — Allg. h, Ztg., cxxx., 10. 




JOURNAL 

OF THE 




No. 3. JULY, 1895. Vol. III. 

All communications and exchanges to be sent to Dr. Hughes. 

36, SillwGod Boadj Brighton, 



ACIDUM FLUOEICUM: ITS ACTION ON THE 
VEINS, WITH CASES OF VAEICOSE VEINS 
AND ULCEES.i 

BY WASHINGTON EPPS, L.R.C.P. 
Senior Assistant Physician, London HomoBopathic Hospital. 

My attention was first directed to the curative action of 
fluoric acid in varicose veins by Dr. Kichard Hughes' 
article on this acid in his ** Pharmacodynamics,'* in which 
he states that his experience with it in all cases of varicosis 
of the legs, such as we often see at the hospital, is very 
favourable. He quotes Dr. Hering as stating that varicose 
veins have shrunk to half their size under its action. 

This was a new idea to me. Previously I had looked upon 
varicose veins as being only amenable to mechanical and 
surgical aids, excepting, perhaps, the slight improvement 
one could occasionally obtain with Pulsatilla and hamamelis 
in recent cases, and with sulphur in the more chronic ones. 
From this time I began giving fluoric acid, and soon found 
that it had a decided curative action in vein diseases. 

' Presented to the Materia Medica and Therapeutic Section, April 4, 1895. 

VOL. in. — NO. 3. 16 



220 ACIDUM FLUORICUM. 

When one turns to the provings of acidum fluoricum in 
the ** Cyclopaedia of Drug Pathogenesy," one is struck with 
the paucity of symptoms bearing on these diseases. In 
fact, at first sight they appear quite insignificant, but on 
deeper study one sees that many of the symptoms can be 
ascribed to a condition of venosity in its earlier stages. 
Possibly, if the provings had been continued for months 
instead of for weeks — for changes in the veins are very slow 
in taking place — we should have had more definite symptoms 
of varicosis. Still, allowing for this slowness of change, we 
have, I think, sufficient indications in the provings to show 
that acidum fluoricum is able to produce a state of venous 
congestion and varicosis, and that, therefore, its curative 
action in these conditions is in accordance with the funda- 
mental law of homoeopathy. 

The above-mentioned paucity of vein symptoms in the 
provings of fluoric acid is, at first sight, a difficulty, but 
if we turn to the pathogenesis of baryta carbonica we shall 
be struck with the same difficulty in respect to the indications 
for the latter drug in arterial diseases, especially in aneurism. 
And yet in this latter disease, aneurism, we frequently ob- 
tain well-marked curative action with baryta carbonica. 
Everyone who has been much about the London Homoeo- 
pathic Hospital, during the last ten years or so, must have 
seen many cases of aneurism in which the good effect of this 
drug has been distinctly noticeable. One case, in particular, 
I would especially mention, of a man with aneurism of the 
abdominal aorta, under Dr. Byres Moir's care, which has 
steadily improved, under this remedy, although the patient 
has continued doing light work, I think, the whole time. 
Anyone who has seen this and similar cases cannot but be 
convinced of the good effect of baryta carbonica, and yet, as 
I have said, the pathogenetic symptoms and indications for 
this drug are very few. The only sjnnptoms of baryta in 
the ** Cyclopaedia of DrugPathogenesy*' I can find which are 
applicable to aneurism are taken from Boehm's experiments 
on animals, in which occur these remarks :^ — " That it does 
not appear improhahle that the muscular coats of the vessels, 

• Ziemmsen's ** Cyclopaedia,** vol. xvii., page 376. 



ACIDUM FLUORICUM. 221 

as well as the heart, are affected by the poison/* and, ** It 
indicates a certain preference of baryta for the tissues com- 
posed of non-striated muscular fibres." 

To return to fluoric acid. In the ** Cyclopaedia'* is a 
proving of this acid by Dr. Hering,^ which gives a more or 
less complete picture of the action of this drug on the human 
body. No experiments are reported on animals. I do not 
intend quoting this proving in extenso, as that vsrould be 
quite unnecessary and most tedious. I shall only make ex- 
cerpts, giving what I consider the principal indications of 
the drug. 

First, the prover, Dr. Hering, smelt the strong tincture, 
and it caused symptoms very like asphyxia, just as smelling 
any other very strong acid would. He felt ** as if he would 
be struck with apoplexy — a kind of determination of blood to 
the head and loss of consciousness.'' Then followed ''sore 
throat, with difficult deglutition." This lasted until the 
next morning, when there was hawking up of much phlegm, 
mixed with some blood. This action on the pharynx and 
throat appears to have been more dynamic and not so much 
the local effect of the acid fumes. 

The same prover next took 60 minims of the 3rd 
dilution of the acid. The interval between the two provings 
is not stated. From the symptoms that immediately fol- 
lowed it seems to have had some local effect, namely, ** sen- 
sation of warmth on the lips and a greasy feeling in the 
Hiouth." One would hardly expect this from the Tshns oi a 
^op of the pure acid. 

In five minutes he noticed ** a headache of the vertex," 
followed in another five minutes by '* nausea and vertigo," 
^d then quickly followed '* painful sensibility of the right 
^pper and then lower jaw." In an hour ** dulness in the 
occiput towards the right, with violent jerkings in the in- 
terior, behind and above the right eyebrow." These 
symptoms appear to show that the drug caused a state of 
congestion of the cerebral veins, followed by reflex symptoms. 

In the evening, some six hours after taking the drug, 
"e noticed ** pains in the right instep followed by slight 

• " Cyclopaedia of Drug Pathogenesy," vol i., page 16. 



222 ACIDUM FLUORICUM. 

numbness of the right thigh, only when crossing the legs ; *' 
a *' sense of fulness in the spermatic veins ; " a ** sensation 
almost like a rush of blood .... first in the forehead, 
afterwards in the upper and lower jaw on the same side 
(right), in lower part of occiput, in bladder and various other 
places." This last was also experienced after taking the 6th 
and 30th dilutions. He also notes ** numbness in the left 
hand." 

On the third and fourth days, " redness of both hands, 
with violent pricking-itching of detached spots, mostly on 
the left side, and on the chest and thigh.*' On the evening of 
this day " the itching affected several old cicatrices, all on the 
left side, followed by redness around their edges, and accom- 
panied here and there with itching vesicles/* 

On the seventh day, ** oppression in the upper part of 
the chest, not relieved by deep breathing.'* 

On the eighth, ninth, and tenth days, ** fulness of fore- 
head," also " difficulty of breathing, seemingly from an 
impediment in the region of the throat and upper chest, 
with pain in the chest below the point of the scapula," 
** numbness in the left leg which went to sleep." Also '* a raw 
feeling in the lower part of the fauces." 

On the thirteenth day, the prover first noticed " several 
small, light carmine-red, round, elevated blood vessels, i-esem- 
bling little flesh warts ; these were very soft and com'pressible, 
and by a strong and steady pressure the blood disappeared, 
but immediately returned again. The largest were the size 
of hemp seed, the smallest ones like millet seeds ; some were 
still smaller, but they were very perceptible as light red 
enlargements of the capillaries, raising up the cuticle. They 
lie below the right nipple and on the opposing surface of the 
right arm. Three weeks later some of the smaller ones had 
disappeared, the larger had become darker, somewhat re- 
sembling nsevi materni, some are larger than before." 
** After three months they were paler; they made their 
appearance and remained without any itching." 

With the fulness of the spermatic cords, there was " an 
easily controlled and gradually diminishing sexual passion, 
and pain in the back, sometimes high up near the shoulder 



AGIDUM FLUOBICUM. 223 

blades^ sometimes deeply seated, as it were in the region of 
the kidneys/' How closely these latter symptoms resemble 
those so commonly seen in varicocele.^ There was also a 
diminution in the excretion of the urine. 

All the above symptoms seem to me to picture a condition 
of venous congestion in various parts of the head, trunk and 
limbs, which we so commonly see in what is called venosity 
or varicosis. 

The symptoms are not very distinct, but taking them as 
a whole and remembering that they were all caused by a 
single dose of the acid, not by several doses, the proving 
gives us many definite symptoms of a general venous con- 
gestion. 

The head symptoms grouped together from all the eight 
provings are more definite, thus : — ** Headache in upper 
forehead and vertex ; slight feeling of nausea and vertigo ; 
dulness towards the occiput; violent jerking pains in the 
interior of the head, behind and above the right eyebrow ; 
painful determination of blood to the forehead ; sensation of 
ringing in the right ear ; whilst sitting, a frequent sensation 
of a general shaking, with a dull pressure and compression 
in the occiput, with continual sensation of numbness in the 
left forearm and hand, which remained during the whole 
forenoon ; contraction of some muscles of the neck, of the 
left side and towards the shoulder.'* Most of the above 
symptoms are from Dr. Hering's proving. Dr. Walter 
Williamson, after taking 20 minims of the 5th dilution, 
immediately felt " a stunning sensation in the head, most in 
front ; and stiffness and soreness in the nucha" ; and on the 
ninth day, " heavy pains in the left half of the head along 
the coronal suture." Three of the other provers had many 
very similar symptoms. 

The chest symptoms are few and insignificant, and were 
noticed on the seventh to ninth days, namely *' pains in 
the larynx ; he often breathed deeply, as if the breast [chest ?] 
within and below was full ; oppression in the upper part of 

' Dr. Alexander Villers in the *• Universal HomcBopathic Annual," 1895, 
page 442, remarks under " Spermatorrhoea/' " I also consider that the diminu- 
tion of enlarged prostate is greatly helped by acidum fiuoricum." 



224 ACIDUM FLUOBIGUM. 

the chest ; difficulty of breathing, seemingly from an impedi- 
ment in the region of the pit of the throat and upper chest." 
These symptoms are somewhat vague but point to pulmonary 
congestion. 

The drug does not appear to have any definite action on 
the rectal veins, but on the spermatic veins there are several 
definite symptoms which should prove of clinical use in 
varicocele. " Sensation of fulness in both spermatic cords '* 
(Hering) and " occasional stitches and drawings through the 
left testicle to the abdominal ring and spermatic cord " 
(Neidhard) ; " sensation of rush of Mood to the bladder"; 
"special warmth in abdomen with pressure towards the 
bladder." Together with these, the before-noted symptoms 
of anaphrodism characteristic of varicocele. 

The skin symptoms, which have been before noticed in 
full, seem to show a very marked action of the acid on the 
tissues of the veins and venules, even to the extent of pro- 
ducing small nsevi, which lasted for three months after the 
drug was taken. 

Now, a few remarks on allied remedies : — Pulsatilla is 
indicated in varicose veins of the limbs, and in varicocele when 
the parts are bluish and cause annoyance by reason of the 
soreness and stinging pains in the veins. One is not guided 
to this remedy so much by the local symptoms as by the sex 
of the patient, the constitutional state, by symptoms of uterine 
or rectal congestion or by irregularities in the catamenia. 
Pulsatilla is*much more frequently indicated in recent cases 
than when the varicosis is of long standing and has existed 
for many months and even years, in which latter cases I do 
not remember ever to have found it of service. 

Hamamelis vies with the last remedy and is to be pre- 
ferred unless the constitutional state indicates pulsatilla. 
Farrington states that varicocele has been cured with 
hamamelis given internally and applied externally at the 
same time, the guiding symptom being a sore feeling due to 
venous congestion. He says that hamamelis may be success- 
fully applied in any condition when the latter symptom is 
present. He has even used it successfully in varicose veins 
on the abdomen, when a ** bruised sore feeling " was a pro- 



ACIDUM FLUOBIGUM. 225 

minent symptom. There is no better external remedy than 
haniamelis in relieving the soreness and burning pain of 
infianxed piles. This is, I feel sure, the common experience 
of all present. Even our friends of the other school have 
discovered this. Ringer^ recommends it in piles, varicocele 
and varicosed veins, not only as checking bleeding, in which 
he says it is " singularly successful and prompt,*' but also in 
varicocele, in which he says ** I have seen one case in which 
during its employment the varicosities entirely and apparently 
permanently disappeared." 

Sulphur is of most use in cases of chronic varicose veins 
of the legs ; in this resembling fluoric acid. It does not 
appear, however, to be of much, if any, use in these cases, 
excepting when the varicose veins are associated with hepatic 
congestion and its concomitant constipation and hflemor- 
rhoids, especially when the latter are of the blind variety. 
Sulphur is of distinct use in this later condition either given 
alone or alternated with nux vomica. 

Another remedy which Farrington says^ has a more or 
less definite action on varicose veins is lycopodium, which 
he states, ** by reason of its effect on the liver, tends to 
produce swelling or enlargement of the veins, particularly 
those which are more or less imperfectly supplied with 
valves ; so we have varices characteristic of lycopodium ; 
varices in the legs, particularly in the right ; varices in the 
genital organs ; the labia are swollen with varicose veins, 
this latter condition occurring during pregnancy." He also 
states that nsevi have been modified by lycopodium, but 
he considers fluoric acid better than any other remedy for 
this purpose. I shall mention further oh two cases in which 
this latter remedy, fluoric acid, appeared to be of service. 

The same author says that lycopodium is also of use in 
erectile tumours, in which there is ** now an increase and 
then a decrease in the amount of blood in them." 

Again he states^ that carbo-vegetabilis may cure varicose 

' " A Hanplbook of Therapeutics," Sidney Ringer, M.D., fourth edition, 
page 292. 

= " A Clinical Materia Medica," by E. A. Farrington, M.D., 1887, page 398. 

' Ibid,, page 440. 



* 



226 ACIDUM FIiUOBICUM. 

veins of the female genital organs, also of the arms and legs, 
when the veins are bluish or livid, looking as though the 
blood had long remained in them. These varicose veins 
have a tendency to ulcerate and form indolent ulcers, and 
are accompanied by burning pain. 

Still another remedy which has a marked curative action 
on varicose veins and ulcers, but which does not appear, 
from the pathogenesis in the ** CyclopaBdia,'* to have any. 
pathogenetic action on the veins, is the carduus marianus. 
Our Lady's thistle ; this remedy must be distinguished from 
the carduus benedictus, the blessed thistle, which has quite 
a different action. 

The carduus marianus is the old Eademacher remedy for 
liver and spleen diseases, and exerts all its action on the 
liver and digestive tract, causing, among other symptoms, 
jaundice with dull headache, bitter taste in the mouth, white 
tongue with red edges, nausea with vomiting of an acid green 
fluid, great distension from flatulence, constipated or bilious 
stools, golden yellow urine, and a feeling of great fulness in 
the hepatic region, but without actual enlargement of the 
liver as shown by percussion. 

Dr. Windelband,^ of Berlin, narrates a .case of enlarged 
and inflamed liver in which he gave carduus marianus in 
decoction. The remedy cured the case completely in a few 
weeks, and in addition entirely cured some varicose veins 
with which the patient, a woman, had been afflicted for 
some five or six years. 

Dr. Windelband afterwards tried the remedy in cases of 
varicose veins, uncomplicated with liver and spleen diseases, 
and he very seldom failed to cure all his cases of varicose 
ulcers with this remedy. He states that he has records of 
196 cases of varicose veins treated with this remedy, of 
which 145 were bona fide cures. The large majority of the 
cases were of many months', and most of them of years', 
standing, in women over thirty years of age, who were either 
multiparsB or suffering from some uterine disorder. He 
afterwards discontinued using the decoction and gave the 
remedy in the Ix or j> tincture, five drops three times a day. 

• Extracted from the Ho7noeopathic Recorder^ 1893, page 127. 

4 



ACIDUM FLUORICUM. 227 

I have given this remedy in a few cases, but with at 
present a very limited curative effect. I have, however, 
quite recently had a case of varicose ulcer, in which this 
remedy was ^ven in the Ix dilution internally, and hazeline 
lotion applied externally, in which the relief was most 
marked in a few days and healing took place rapidly, 
whereas in previous attacks the ulcers had gone on for two 
and three months. Whether the effect was from the carduus 
or from the hazeline I unfortunately cannot say. 

CcLse I. — Varicose Veins of six years* standing. — This 
was one of my first cases of varicose veins treated with fluoric 
acid and was a very severe case. The patient, T. G., aged 
42, was a carpenter, who, besides suffering from greatly en- 
larged veins, was troubled with obesity; this latter was 
partly due to want of exercise — the condition of his left leg 
had prevented him walking and working for several months 
— and partly to inherited predisposition to fat. He was 
5ft. 9iin. high and weighed 17 stone, which is some 70 
pounds above the average weight for his height. 

He had been suffering from varicose veins in his left leg 
for six years ; the left calf was a mass of enlarged veins, 
some as large as an index finger, and extremely painful. 
Otherwise, apart from his excessive amount of adipose 
tissue, he was in robust health. The treatment consisted of 
dieting ; he was taken entirely off potatoes and other roots, 
white bread, puddings, sugar, and beer; and was given 
ac. fluor. 6, and the leg rubbed upwards with hazeline 
ointment. This was begun on November 1, 1889, and con- 
tinued until April 18, when he was discharged cured. The re- 
sult was as follows : — He had lost 20 pounds in weight ; the 
veins had shrunk to a quarter their previous size and gave 
no trouble, and he was able to do a full day's hard work. I 
was, of course, anxious to know if the cure was lasting, so 
recently wrote to him. He replied that he had gone back 
to his 17 stone weight, but in spite of this he has had no 
farther trouble whatever with his legs. This case en- 
couraged me to treat many similar cases in the same way, 
instead of at once handing them on to my friends the 
surgeons, who are marvellously successful in the radical 
cure of these cases. 



228 AGIDUM FLUOKICUM. 

Case II. — Varicose Veins for thirty -five years. — ^W. M., 
aged 52, printer, of medium weight, has suffered from 
varicose veins since he was seventeen. For twenty-seven 
years he has suffered from what he calls eczema, around the 
ankles, in successive outbreaks, and has had frequent attacks 
of varicose ulcers, often lasting for two to three months. 
He was free from the eczema at one time for five to six 
years when working in the open air in Ontario. Patient 
suffered from sleeplessness and constipation, for which he 
had been taking opium 1 and nux Ix. 

The heart sounds were normal and free from bruit, but 
easily accelerated ; apex impulse immediate, 2 inches below 
nipple. The sphygmogram showed a total absence of 
pressure. 

The family history showed a strong disposition to varicose 
veins. The sister, father and grandfather all suffered from 
the same complaint. 

The legs were like bags of veins from the knees down- 
wards, the veins feeling hard like cords, the veins on the 
insides of the thighs and in the groins were also enlarged. 
The chest was free from visible veins. He was in constant 
pain from throbbing in the legs, so much so, that life was 
quite a burden to him. Up to six years before coming under 
treatment patient had done light work, but since then he 
had been working at a lithographer's and had been lifting 
heavy weights. He had worn bandages on his legs con- 
tinuously for thirty years and for the last ten years 
Martin's rubber ones. This will explain the erythematous 
condition of the legs from which he so constantl)'' suffered. 

Below each ankle was an old brown cicatrix from 
previous ulcers. The man came to my clinic first on 
November 5, when I put him on fluoric acid 12. He could 
not then be persuaded to give up his bandages. He was also 
given ignatia for sleeplessness, which was due to nervousness. 

November 12. — The ignatia had acted like a charm and 
he said he had slept better than he had done for two years. 
His legs were much less painful. 

By November 26, after taking the fluoric acid for three 
weeks, he could leave off the rubber bandages for part of the 



ACIDUM FLUOBIGUM. 229 

day. The veins were still improving and looked and felt 
more healthy. Besides taking the fluoric acid he was rub- 
bing the legs upwards every day with simple lanoline 
ointment. 

By December 5, he was wearing water dressing bandages 
only during the latter half of the day. 

On March 8, the veins were very much better, much 
smaller and softer and giving no pain, so that he went, nearly 
all day, without bandages. He is still under treatment. 

The improvement in this case was most marked, and 
I think must be considered due entirely to the action of the 
fluoric acid. 

The case was a very bad one, and certainly a very 
unpromising one, and from wearing bandages for so many 
years the veins had entirely lost their natural support. The 
fluoric acid was given in the 12th and 30th dilution, and no 
external application was used beyond friction with lanoline 
ointment. The man continued at his arduous work the 
whole time he was under treatment. 

Case III, — Varicose Veins of both legs. — Mrs. B., aged 34, 
attended the hospital on February 27, 1891, suffering from 
varicose veins which were very large and very painful. She 
was put on acidum fluoricum 12 and hazeline lotion was 
applied. 

On March 13, the house surgeon ordered ars. 3. 

On April 3, the veins were still very painful. Those 
of the left leg had burst. The fluoric acid was repeated. 

On April 24, the veins on the right leg were very much 
better. Those on the left which had ruptured were still 
very painful. She was then suffering from bad headaches, 
and the catamenia occurred every fourteen days. 

On May 22, the right leg was quite well and the left 
was still painful, but distinctly better, the catamenia re- 
turned only every three weeks. The acidum fluoricum was 
repeated in the 30th dilution. 

On June 12, she attended again, when the left leg 
was very much better. The same remedy was repeated in 
the 30th dilution. 

She attended the hospital some months later, when the 
veins still continued cured. 



230 ACIDUM FLUOBICUM. 

The details in this case are very scanty, but still sufficient 
are given to show the good effects of the acid on the enlarged 
veins. 

Case IV. — Varicose Veins of the legs. — M. K., 48 years, 
single. This woman first attended the hospital for anaemia 
with palpitations. She had also a special form of dys- 
pepsia with constipation, and was troubled with a very 
sore tongue, with a deep semi-circular split in the centre. 
For these troubles she was given natrum mur. 6 and 30, 
which completely cured them. 

She then complained of pains in some varicose veins in 
her legs, which quite prevented her walking, and of varicosity 
of the pharynx. These were so much improved by a course 
of acidum fluoricum that she could walk two miles without 
suffering from fatigue. Nine months later she attended 
again, when the legs still continued cured. 

The remaining cases are of varicose ulcers. 

Case V, — Varicose Ulcer of three years* duration, — This 
patient, Mrs. E., aged 55, a working housekeeper, came 
to me on November 25, 1892, with a large ulcer on the 
outer surface of the left leg. The patient was a broad, 
heavy woman, weighing some 14 to 15 stones. At 
thirty-seven years of age she suffered from rheumatic 
fever, which left her with the left leg larger than the right 
and the veins much distended. She had been suffering for 
the previous three years from a large ulcer on the outer 
surface of the left leg, about two inches above the ankle. 
She had been under treatment more or less for the whole 
three years, six months of which she attended at the 
Stamford Street Hospital for Skin Diseases. 

When first seen by me, there was a large purple, brawny 
patch, the size of the hand, on the outer surface of the leg, 
with numerous large yeins around and spreading upwards 
to the knee and downwards over the dorsum of the foot. 
In the centre of the purple patch was a callous ulcer, half 
the size of the patch and level with the surface. The leg 
was extremely painful, and quite incapacitated the woman 
from work. 

The treatment was ac. fluor. 30 and 12, hazeline lotion, 



ACIDUM FLUOBIOUM. 231 

and a Martin's rubber bandage applied only in the day. 
This was continued until December 23, when the ulcer 
was nearly healed and the induration very much less. The 
internal remedy was then changed to arsenicum 3, and by 
January 10 the ulcer had quite healed, and the leg was 
well. Considering the severity and duration of the case, 
the cure was fairly rapid, namely, 47 days. 

The patient has since consulted me for severe eczema 
auris, from which she is a frequent sufferer. Her leg ha& 
remained perfectly well up to March 22, 1895. The veins 
were then shrunk to almost their normal size, the site of tha 
ulcer was covered with a thin, smooth cicatrix, and the leg 
had given no further trouble. 

Case VI. — Varicose Ulcer of the leg. — This was also a 
very severe case of extensive varicose ulcer of the right leg, 
complicated with extreme varicosis. 

Mrs. E. G., aged 47, living in Essex. She was married 
at 16, but did not begin bearing children until she was 27, 
since which age she has had six, whose ages range from 
twenty to three years, since which time she has not been 
pregnant. The varicose veins began in her first preg- 
nancy over twenty years ago, in her right leg, when fhey 
became so large that they ruptured. Four years ago, 
during her last pregnancy, the veins were tied on the inside 
of her knee. She has been wearing a Martin's rubber 
bandage for the last two years. She suffered much during 
the catamenia, which were very copious and accompanied 
by much pain in the back, and bearing down. During these 
times the legs became almost black, and felt as if they 
would burst. The bowels were very regular. The urine 
was scanty, sp. gr. 1012, acid, and was free from albumen. 

The heart sounds were natural, pulse 84, regular ; she 
suffered much from palpitation and heats and flushes. The 
veins on the chest were varicosed. On examination, the 
organs of the abdomen were found healthy, and per vaginam 
the uterus was found to be somewhat prolapsed but healthy. 
She suffered considerably from leucorrhoea. 

The condition of the legs was as follows : — 

The right leg was very much swollen, somewhat numbed 



232 ACIDUM FLUORICUM. 

and very tender and painful. On the outer side was a large 
ulcer, covered with a dark crust, which was extremely painful. 
The saphena on the inside of the leg and below the knee, 
where it turns into the popliteal space, was very large, the 
size of the little finger. 

The left leg was also oedematous, numbed and the veins 
somewhat varicosed. It throbbed and pained at times. 

She was, October 23, 1894, put on acidum fluoricum 12, 
the ulcer dressed with boracic acid lotion compresses and the 
legs rubbed upwards, daily, with lanoline ointment. The 
legs were kept up as much as possible. 

On October 27 the legs were much better. The oedema 
had almost disappeared. The pain was very much less and 
the patient was feeling very much better in general health. 

On November 18 the legs were still smaller and looked 
better. They were only occasionally painful. 

On November 23 the right leg was still improving, but 
was very painful. It was then only a few days before the 
period, when she always suffered from great pain in her legs, 
and much pain in her head. The crust had come off the 
ulcer. 

On December 11 the leg was still improving. The ulcer 
looked very black and threatened to bleed. The leg was 
very painful at times. Patient was now getting about as 
usual. 

On January 4 the leg was quite healed, the ulcer being 
covered with a sound smooth cicatrix, and the veins were 
much smaller and gave no trouble. The acidum fluoricum 
12 was continued throughout the whole two months' treat- 
ment and appeared to have a marked effect in the cure. 
Nothing could have been more satisfactory than the way the 
oedema disappeared, the veins became smaller and the ulcer 
healed and became covered with a sound smooth cicatrix. 
The case was a very bad one, and I am able to state that the 
cure is still perfect. 

Case VII. — Large Varicose Ulcer of the leg. — Mrs. C. B., 
aged 24, came to me on February 12, 1893, with a large 
varicose ulcer on the leg about the size of the hand, from 
which she had been suffering for the last twelve months. 



ACIDUM FLUORICUM. 233 

The ulcer discharged a great deal and was very painful ; the 
pain was most severe after her first sleep, waking her up 
between twro and three every morning. The veins in this 
leg had ruptured during her last pregnancy. She was put 
on acidum fluoricum 12 and the ulcer dressed with hazeline 
and boracic acid lotion. 

On February 27 the ulcer looked much healthier, it was 
discharging less and was contracting. 

On March 13, one month from the commencement of 
the treatment, the leg was much better, the ulcer was 
healing and the woman was getting good rest at night. 

This case is very imperfect and incomplete, and I am 
very sorry I cannot give the final result of the treatment, 
but the woman did not trouble to attend again. The treat- 
ment of this class of case is very unsatisfactory, as the 
patients will seldom continue attending until quite cured. 
I think, however, it is worth recording, as such marked 
improvement had taken place in four weeks. 

Case VIII. — Varicose Ulcer. — This was a case very like 
the last of varicose veins with a large ulcer. The patient 
was a married woman, aged 33, who had had three children, 
the last eight years previously. She had been attending the 
hospital as a casual patient for some months before she 
came under my care. When first seen by me she had been 
suffering for twelve months from a large oval ulcer 2f by 1^ 
inches, on the inner side of the right leg ; the ulcer was very 
painful and the whole leg was much swollen and the veins 
much distended. 

The left leg was in much the same condition but without 
any ulcer. On account of the oedema present the urine was 
carefully examined and was found to be of a pale straw 
colour, slightly acid, spi. gr. 1004 and free from albumen. 
The treatment adopted was ac. fluor. 12 ; an ointment of 
hazeline in lanoline, applied to the ulcer and rubbed upwards 
into the varicosed and cedematous legs ; and a Martin's rubber 
bandage applied only during the day. 

This treatment Was begun on June 22. The improve- 
ment was immediate ; in a fortnight the legs were better, and 
by August 10 there was so much improvement that the 



234 ACIDUM FLUOBICUM. 

woman stayed away until October 26, when she returned 
with the ulcer broken down again. The ulcer had been quite 
healed and she had taken no further care of her leg. She 
was again put on ac. fluor. but ceased attending in three 
more weeks. 

This brings me to a very important point in the treat- 
ment of these ulcerated legs. The remedies and support 
must be continued for some months after the ulcer has 
quite healed, otherwise the tender cicatrix is sure to break 
down, and the wound become as bad as ever. It is extremely 
difficult to persuade these hard-working women, with their 
many home duties, to spare the time to attend at the hospital 
and continue under treatment. In two of the previous cases 
this was done, and the cure was permanent. 

Other cases in which I have thought that I have seen 
good results, with ac. fluor. given internally, have been two 
cases of naevus of the face in infants, one on the upper lip 
and the other on the upper eyelid. In one the naevus dis- 
appeared, and in the other it ceased to grow and became 
less bright, but whether this was post hoc or propter hoc I 
will not say, as these nsevi frequently do disappear with 
time. Another case in which the acid did good was a case 
of perforating ulcers of the sole in a postman. I showed 
this case at one of our consultation days, and reported it in 
the Beview. In brief, the case was as follows : The man, aged 
39, had been in the post office for twenty years, and had 
always had excellent health. After an attack of influenza a 
gathering like a corn appeared on the sole of his left foot ; 
this he poulticed, and in about a week a very painful, deep, 
circular ulcer formed, about the size of a shilling. Three 
weeks later a second similar ulcer formed by the side of the 
first, then a third, and lastly a fourth, which did not become 
so deep. They had existed for over six months when he 
first came to me, and caused him excruciating pain, especially 
at night, preventing sleep for hours. Under ac. fluor. 6, and 
later arsenicum 3, the foot got quite well in two months. I 
occasionally see him walking about the streets, and can 
report that the foot has remained perfectly well ever since. 
The cause of fche ulcers was not at all clear, there was 



ACIDUM FIiUOBICUM. 235 

neither history of trauma, syphilis, nor diabetes (the urine 
was free from sugar and albumen), and no evidence of nerve 
lesion beyond the ulcers. 

^WTiether the ulcers were of the true perforating kind is 
questionable. The standard authorities say these ulcers are 
always single. I do not remember ever to have seen a 
similar case. 

Another disease in which fluoric acid appears to be of 
use is bronchocele. 

Dr. Woakes gave a series of cases, treated with this 
acid, in the Lancet in 1881. 

He chose fluorine as it was one of the metalloids allied 
to bromine and iodine, which were known to exert an action 
on the thyroid. He gave it in the form of hydro-fluoric 
acid, as being the nearest attainable approach to fluorine. 
He began with 15 minims of the shxs solution in an ounce of 
water for a dose. Two drachms of this solution he found the 
extreme limit of toleration. 

The author reports twenty cases treated with this acid, 
two males and eighteen females, varying in age from fourteen 
to forty-seven years ; the dose of the acid given varied from 
seven to seventy minims, three times a day ; the dura- 
tion of the treatment from three weeks to two years ; with 
the result that seventeen of the cases (85 per cent.) were 
cured. 

These cases are of interest in connection with the 
prevalence of goitre in Derbyshire, and at Gastein, in 
Austria. The goitre in these districts is thought to be due 
to the drinking of the waters which contain fluorides. Dr. 
von Grauvogl drank the Gastein waters, which contain the 
siUco-fluoride of calcium, and found that they caused swelling 
of his thyroid. The deposit thrown down by the Gastein 
waters, triturated, forms the lapis albus, which has been 
found useful in the treatment of uterine scirrhus, scrofulous 
ulcers and diseases of lymphatic glands. 

To conclude. From the extracts I have given from the 
provings of fluoric acid, and the cases I have related, I have 
endeavoured to make out three points. 

First, that fluoric acid has a direct action on the tissues 

VOL. III.— NO. 3. 17 



236 DI6GU8BION ON ACIDUM FLUOBICUM. 

of the veins, causing more or less marked symptoms of 
venosity and varicosis. These, as I have before remarked, 
would possibly have been more definite had the provings 
been continued for a longer period. Second, that the remedy 
has a definite curative action when given medicinally 
in spontaneous corresponding cases; and third, that the 
cases of varicosis that are benefited by the remedy appear to 
me to be always very chronic, not dependent on pressure 
above or on disease of any of the abdominal organs, but 
simply from change in the coats of the veins themselves. 
What the nature of this change is is far from clear, in fact, 
quite conjectural. I will not venture a theory. 

One other point I have also noticed as to dose, — that 
under the 6th the remedy aggravates, and that it acts most 
satisfactorily in the 12th to the 30th dilution. 



Dr. Hughes said that Dr. Epps had brought forward a series 
of cases where spontaneous recovery was inconceivable, and yet 
with very little external help, mainly by the aid of a homoeo- 
pathic remedy in comparatively high dilutions, a most decided 
improvement and an unlooked-for cure had resulted. No paper 
could be better adapted to convince the minds of enquirers from 
the old school as to the potency of homoeopathic remedies, and 
he was very glad Dr. Epps had brought it before the Society. 
Dr. Burnett's first case in his book on ** Diseases of the Veins " 
was that of a rather painful varicose vein occurring in a lamp- 
lighter, a man who had to be on his legs a great deal. Dr. 
Burnett gave him flaoric acid, without enjoining rest and without 
any local support, and yet the man's vein shrank up and the pain 
disappeared. Dr. Hughes recalled one case which turned out very 
successfully, where in addition to the varicosis the whole leg was 
thickened with exudation ; here the action of fluoric acid most 
markedly improved the condition. 

Dr. Blake said that amongst the poor, who, on the one hand, 
were badly nourished and, on the other, exposed to insanitary con- 
ditions, flat-foot was ordinarily seen in connection with varicose 
veins of the lower extremities. Both complaints probably owed 
their origin to a starved and poisoned state of the anterior cornua 
of the spinal cord. In gouty subjects, varicosis was found 
associated with eczema and with oedema. These changes were 
due to endarteritis, to alterations of tension, to toxis in the cord 



DISCUSSION ON ACIDUM FLUORICUM. 237 

and nerves and to blocking of the veins by leucocytes. Even 
when the limb is denuded of its epidermis by old eczema, great 
benefit may be derived from electro-massage combined with the 
ase of hamamelis with cade oil, or else with liquor carbonis 
detergens and vaseline as a lubricant. With regard to the per- 
forating ulcer, in the case of the postman, it appeared to be an 
example of influenzal neuritis, leading to localised neuro-trophic 
necrosis. Similar cases had been recorded by Mr. Jonathan 
Hntchinson as occurring in the course of arsenical neuritis. They 
had been known to drift into epithelioma and to call for amputa- 
tion of the limb. He (Dr. Blake) considered that they were 
similar in nature to the sinuses of tuberculosed children and to 
the ulcer of Charcot's ataxy. With regard to the goitre question, 
there were doubtless a great number of species, and nearly 
every long acting remedy that could inhibit the functions of the 
floor of the fourth ventricle and paralyse the cervical ganglia 
might induce Graves' disease. When the thyroid gland itself was 
primarily invaded a true goitre was the result. Of the four 
principal conditions, myxcedema, saturnism, gout and syphilis, in 
which prolonged high arterial tension was found, two of them very 
often associated with varicosis are gout and syphilis. It could be 
conceived that the constant strain of exaggerated tension must 
produce a sustained pressure on the vasa vasorum. At flrst that 
would have a useful controlling or compensating effect, but 
ultimately it must lead to grave arterial deterioration from 
innutrition. In time there comes an aboUtion of that postural 
change of tension so needful to prevent aneurism on the proximal 
and varicosis in the distal side of the circulation. 

Dr. Madden said that Dr. Schiissler stated that fluoride of 
calcium was found in the elastic tissue of the veins and other 
blood vessels, and therefore concluded that that ought to be 
the remedy when the veins lost their elasticity. The strength he 
recommended was the 4th decimal trituration, and he reported 
many cases which had been benefited by the medicine. He 
could thoroughly confirm Dr. Epps' experience as to the benefit 
of fluoric acid in cases of varicose veins. He himself had had 
several cases which had been successful. He had also had one 
or two very successful cases from the use of carduus in varicose 
ulcers. He had never used carduus unless there was an ulcer, 
but when he had used it in those cases the result had been very 
successful. 

Dr. Dudgeon had had no experience of the effects of fluoric 
acid on varicose ulcers, but some years ago an article in a 



238 DISCUSSION ON ACIDUM FLUOBICUM. 

German periodical led bim to use flaoric acid in cases of cataract. 
He had employed it in several cases of cataract of various kinds^ 
and he had found it very efficacious in removing the opacity, 
where it was not hard and central, but where it was dispersed 
throughout (be substance of the lens. It was now some ten or 
twelve years since a lady came to bim suffering from cataract, 
and, chiefly through the use of fluoride of calcium, she not only 
retains her sight, but it is also improved. He generally used it 
in the 3rd trituration, but sometimes in the 6th dilution. 

Mr. Gerabd Smith said that it was very difficult to get 
fluoric acid in a pure condition, owing to its being kept in glass 
bottles. He would like to know whether Dr. Epps could state 
the best source from which to obtain it. 

Dr. Hughes said that with regard to the preparation of 
fluoric acid, the objection complained of as to the effect of its 
being kept in glass bottles held good with regard to the provings, 
so that at any rate it was the same thing they were using. 

Dr. WoLSTON asked Dr. Epps if he knew that a case of 
whitlow, resulting from the use of fluoric acid, was mentioned 
in Hempel. 

Dr. Epps, in replying, said that he knew of the case mentioned 
in Hempel, resulting from the local application of fluoric acid ; 
it. was almost an exact picture of a very severe whitlow. He (Dr. 
Epps) had had no experience in the treatment of haemorrhoids 
with fluoric acid ; in fact, as he had stated in his paper, it (fluoric 
acid) did not seem to have any action on the veins of the rectum. 
He had not had any experience in the use of fluoride of calcium 
in cases of cataract, as described by Dr. Dudgeon. Dr. Madden 
stated that he had found carduus beneficial in the treatment of 
varicose ulcers. The only cases he (Dr. Epps) had mentioned in 
his paper where he had used carduus were cases of varicose ulcers. 
A few days after the carduus was given, the pain disappeared, and 
the ulcer healed satisfactorily. He had had no experience with 
fluoride of calcium as a remedy for ulcers. He was not sure that 
he agreed with Dr. Blake that in the case of the postman the 
disease was cheiro-pompholyx. He was able to state that the 
case got well very rapidly, but what it was he did not know. He 
quite agreed with Dr. Blake that flat feet very often occurred with 
varicose veins. 



MYXCEDEMA. 239 

MYXCEDEMA.i 

BY J. ROBERSON DAY, M.D.LOND. 
Assistant Physician London Homceopathic Hospital, 

At the Clinical Evening, held on March 2, 1893, I 
showed before the Society a patient who presented well- 
marked symptoms of that interesting and, till lately, little 
understood disease — Myxoedema. I then made a promise at 
some future time to show this patient again, cured, and I 
wish to redeem that promise to-night. If I may be per- 
mitted, I will refer to the Journal of the Society, vol. i., p. 
243, to refresh our memories. 

This photograph, taken before treatment was commenced, 
will recall the appearance the patient then presented. 

On May 5, 1893, she was admitted to the London Homoeo- 
pathic Hospital, and I had the advantage on several occa- 
sions of consulting with my colleague, Dr. Clarke, who, in 
the Homoeopathic World for October, 1892, has recorded a 
case of myxoedema, cured by arsenicum, in high potency. 
Her condition on admission was practically the same as on 
March 2, when I showed her before the Society, and her 
weight lOst. ISJlbs. We gave her at first arsenicum 30, 
4 hrs., and "first diet." In a few days her skin desquamated 
and became softer, and from being harsh and dry began to 
perspire, and on May 24 she was very hot all night. 

I should weary you if I gave the full notes of the case, 
and so I must content myself with extracting only the chief 
points of interest : — 

On June 2, menstruation commenced, and all the symp- 
toms were aggravated, as was usually the case, the eyehds 
being very swollen and the gums bleeding. 

On June 9, the note says, speech showed no improvement 
and is still very thick. The skin is not perspiring at all. 

On June 17, patient was a trifle better. The bowels con- 
tinued constipated. 

' Presented to the Section of General Medicine and Pathology, February 
7, 1895. 



240 MYXCEDEMA. 

On July 7, weight was list, l^lbs., a gain of 21bs. 

On July 16, the period again came on, and was very pro- 
fuse, attended with the usual aggravation of all the symp- 
toms. The temperature was persistently swJ-normal, only 
on three occasions normal, and had been as low as 95'. The 
average was 97". Arsenicum was the chief remedy employed, 
and generally in the 30th dilution. Many others were given 
according to the indications, such as bryonia 30, secale 30, 
tuberculinum 100, nux v. 30, psorinum 30, siHca 3, acid 
nitricum 5, opium 30, china 30, nux mosch. 30, conium 12, 
sabina 12, picric acid 30. 

On July 26, the note says, patient no better ; has gained 
2Jlbs. since admission. Eyes are worse, face is much more 
oedematous. Hands also are thicker. She had now been 
in the hospital eleven weeks and three days, and showed a 
strong objection to remain any longer. I therefore decided 
to adopt the thyroid treatment, and we began by giving her 
a powder of the thyroid extract, equal to one-sixth of the 
gland, daily. 

July 28. — Patient was sick yesterday afternoon, bringing 
up all her dinner. This was followed by an attack of faint- 
ness, pulse thready, very pale. Brandy, 5j. every hour, 
brought her round. About 1 a.m., she had an attack of 
syncope, feeling very faint and giddy. After a dose of 
brandy, she revived in about twenty minutes. She does 
not feel very well this morning, legs ache, and feels giddy 
if she attempts to raise herself in bed. Pulse 72, regular. 
Blood corpuscles, counted by Dr. Gowers' hsemacytometer, 
2,400,000. Feels sick after everything she eats. Tongue 
coated with slightly yellowish white fur. Bowels irregular. 

July 29. — Does not feel very well this morning ; is all 
aches and pains ; all the bones have burning sensations ; 
is feeling warmer ; perspired a little during the night. No 
feeling of faintness, but still feels giddy if she holds her 
head up. Pulse 80, good volume. Skin feels moist and 
clammy, hitherto has always been dry. She feels warmer 
than she has done for years. 

July 31. — Pains in the legs and the lower part of the 
back are worse ; they come on with the slightest movement. 



MTX(EDEMA. 241 

She had two motions yestferday afternoon, white, offensive 
and loose. She feels sick this morning, and is not so warm. 
August 1. — ^Powder was omitted last night, and she was 
free from pain all night ; the joints are getting worse again 
this morning. The face feels as if it was enormously 
s^woUen, but is not actually so. She is much warmer. 

August 2. — Has not so much pain this morning. The 
urine has fallen to 30 ozs. in the last twenty-four hours. 

August 4. — She has no pains about the body. Felt very 
warm last night. Thinks she is smaller in the body ; the 
face shows a decided difference, being smaller. Her head 
aches very much and is giddy when sitting up. 
August 6. — ^Pulse 56 ; feels stiff all over. 
August 8. — Complains of aching and burning in all the 
bones. Powder omitted last night; complains much of 
weakness. 

August 9. — Has lost 4ilbs. 

August 10. — Bowels acted three times in twenty-four 

hours ; no pain or aching ; secretion of urine is diminishing. 

August 11. — Complaining of heat yesterday — it was a 

very hot day. The hair has grown thicker during the last 

fortnight. Pulse 80. 

August 13. — Dose increased ; now takes the equivalent 
to one-fourth of the gland twice daily. 

August 14. — She could not read yesterday on account of 
giddiness. Feels rather sick when the giddiness comes on. 

August 17. — She was up on the couch yesterday for half- 
an-hour. 

August 18. — Dose increased again, now taking the equi- 
valent to one-third of a gland twice a day ; feeling warmer ; 
is much brighter ; face is smaller ; speaks more distinctly, 
and answers questions more promptly. 

August 21. — Has pains all over her ; feels rather giddy. 
August 23. — Giddiness is passing off; is still getting 
thinner ; the fulness under the eyes has quite gone down ; 
complains of feeling very weak. 

August 25. — Continued feeling of weakness. She is 
menstruating, and the loss is much less than usual, and it 
is thirty-seven days since the last period. 



242 MYX(EDBMA. 

August 28. — Period stopped on 26th, and has lasted four 
days. 

September 5. — Almost impaediately after the powder is 
taken she comes over, as she expresses it, all of a burning 
heat. 

September 11. — Is going out ; the powders do not give 
rise to giddiness ; she is feeling much warmer, and speaks 
very well. 

The temperature chart was very instructive ; before the 
thjrroid powders were given the temperature was persistently 
sub-normal, but gradually rose to normal as her condition 
improved under its use. 

The urine at first was largely increased in quantity and 
also its urea increased, showing the thyroid extract was 
increasing the metabolism of the mucoid tissue. In this 
way the patient rapidly lost weight at first, losing 91bs. in 
about a fortnight. 

Present state. — February 28, 1894. She expresses herself 
as feeling quite well now. She eats and drinks well, and has 
no indigestion, which was formerly a great source of trouble 
to her, especially when the disease first began. She can now 
walk for one and a half hours to two hours without resting, 
and is not only able to do all her own house work, but can 
go out and work for others. She sleeps well, and is not so 
drowsy as she was. The menses are quite regular, and the 
quantity is much less than formerly. The speech is quite 
natural, and she is able to swallow anything ; formerly she 
could not swallow dry food, such as bread. Also the gums 
have ceased to bleed, and the teeth are not so loose in the 
head as before. The bowels now act quite regularly. 
Formerly she could not see to sew or read at night ; she 
saw black specks falling; she could not read small print 
at all. The memory also has much improved. She still 
continues to take the thyroid powders, equal to one-sixth of 
a gland twice a week. If she omits this she does not feel 
so well, and would relapse into her former state. I continue 
to see her from time to time, and she keeps perfectly well 
so long as she takes the powders, with which I keep her 
supplied. The powders have been prepared for me from the 



MYXCEDEMA. 243 

fresb sheep's thyroid, by Mr. Allen, chemist, of Kilbum, 
according to the method of Mr. G. White, B.Sc, of St. 
Thomas's Hospital. 

Within the last few years quite a flood of light has 
been thrown upon this hitherto-little-understood organ — the 
thyroid gland, which was formerly relegated to the category 
of ** Ductless Glands." The literature on the subject now 
is voluminous and most interesting reading. Dr. Byrom 
Bramwell tells how his father recognised the disease before 
it had a name. Dr. Ord was the first to give it a name, and 
wrote the most complete description of the disease then 
known. Victor Horsley produced an artificial myxoedema in 
monkeys by removing their thyroids, and this may be said to 
have given the first suggestion to the thyroid treatment so 
much in vogue to-day ; for soon after we find Boccher 
transplanting sheep's thyroids into the myxoedematous sub- 
jects, and subsequently Dr. Murray, of Newcastle, hijecting 
a glycerine extract of the gland. This was quickly followed 
hy feeding the patients with the gland, and by simple steps 
we now use the extract of the gland either as a powder, as 
in my case, or in tablets. 

There are two distinct forms of athyrea — the adult 
form, known as myxoedema , of which my patient is an illus- 
tration, and the congenital form known as cretinism, and 
which may be considered as congenital myxoedema. 

Cretins are much benefited by the thyroid extract treat- 
ment. A female cretin, aged 26, and only 40|- inches high, 
improved greatly, and urea was secreted in large quantity. 

In another case, also a female, 26 years old, marked and 
rapid improvement took place, and from being idiotic she 
became relatively very intelligent, and the menstrual function 
was established, which had hitherto been in abeyance. 

A third case — a boy who had not grown for fourteen years 
— since the treatment had grown 4^ inches. 

A fourth case — a very remarkable one described by Dr. 
Byrom Bramwell — was a female 16 years of age, but only 
29|- inches high. In six months she grew 6^ inches, and 
improved in every respect. 

Many more such cases are recorded, but these will suffice 
our purpose. 



244 IfYXOSDEMA. 

The case I have recorded is a typical illustration of the 
adult form, and the published reports of such cases are now 
very numerous, myxoedema being much more common than 
cretinism. 

But there are many other conditions besides these in 
which the thyroid extract has proved of great value. 
Notably is this the case in skin diseases. Dr. Byrom 
Bramwell speaks well of it in psoriasis, chronic eczema, 
xeroderma, and ichthyosis. Another writer cured a case of 
syphilitic psoriasis, which had resisted all other allopathic 
treatment, but another observer only obtained negative 
results in two cases of psoriasis. Dr. Abraham has reported 
a very favourable result following its use in a case of nearly 
complete alopecia areata, new hair sprouting on all the 
hitherto bald patches. 

Also cases of lupus, lichen planus, and tubercular leprosy 
are reported to have been benefited. 

One correspondent to the British Medical Journal men- 
tions a case of pseudo-hypertrophic paralysis as benefiting ; 
the explanation is less clear in such a case. 

Other Animal Extracts. 

The success of the thyroid treatment in myxoedema has 
suggested the possibility of using other animal extracts in 
certain intractable diseases. Brown-Sequard thought he 
had found " the elixir of life " in the treatment of that most 
intractable of all diseases — old age ! 

Dr. Alexander Eobertson has given extract of sheep's 
brain to melancholic patients with beneficial results, and 
pancreatic feeding — perhaps the most pleasant of all these 
methods — has given some encouragement in the treatment 
of diabetes mellitus — another disease the pathology of which 
is still obscure. Where the pancreas is at fault, most 
benefit is likely to result from this treatment. 

Ovarian extract has been used (I presume in females 
only) for similar troubles for which Brown-Sequard sug- 
gested his testicular extract in the male. 

Extracts have also been prepared from the thymus gland, 
pituitary body and supra-renal capsule. 



PISCUSSION ON MYXCEDEMA. 245 

Hitherto I have spoken of the troubles consequent on 
deficiency of the thyroid gland, but there is one disease 
which is always associated with the reverse condition, and 
in this connection deserves a passing notice. I refer to 
exophthalmic goitre, which Dr. Greenfield, in his Bradshaw 
lecture, suggests may be due to an excessive activity on the 
part of the thyroid gland. This theory is supported by the 
fact that benefit has resulted from the partial removal of 
the hypertrophied gland. Not only has the disease been 
arrested, but a cure has followed, the exophthalmos even 
disappearing, showing that this last symptom cannot be due 
to an excess of orbital fat. 

Eecently the 3x trituration of thyroid extract has been 
given for this disease, and Dr. Epps mentioned, at a recent 
consultation day, a case of his which greatly benefited by 
this treatment. I am now employing it in two cases of 
my own. 

I regret there has been so little homoeopathy in this 
paper, but the fact of having to treat a case of myxoedema 
must be my excuse. 

Dr. Galley Blackley congratulated Dr. Day on being, so far 
as he was aware, the first man of their school who had had the 
opportunity of directly comparing, in the same patient, the re- 
sults of drug treatment of myxoedema and that by thyroid 
extract. The treatment certainly promised well, in a disease 
where the effects obtained from drugs were practically nil. He 
(Dr. Blackley) had lately an opportunity of trying thyroid ex- 
tract in several cases of lupus, elephantiasis, two cases of intract- 
able eczema, and in several cases of psoriasis. The lupus cases 
had been uniformly benefited. The cases of eczema were at first 
very much benefited indeed, but he was sorry to say they were 
now very much in statu qiw. In psoriasis he could not say that 
it had had any effect whatever. He was also treating a case of 
Graves' disease with it, bub it was too soon to say much about it. 

Dr. Edward Blake entered a vigorous protest against the 
ordinary custom of beginning the management of myxoedema 
with full doses of thyroidin. These doses not only expose the 
patient to grave inconvenience and needless suffering, but also, 
where cardiac inhibition is at fault, to actual peril. The fact is 
that one-hundredth of a grain is usually enough to give as a 



246 DISCUSSION ON MYXCEDEMA. 

commencing dose — the most convenient form being a single 
grain tablet of the first centesimal trituration of Burroughs and 
Welcome's preparation. Then, if the effect be not sufficient, it 
is easy to slide slowly up the scale, watching always for sleep- 
lessness as a sign of overdose. But far better than any internal 
method of administration is the inunction suggested and practised 
first by Dr. Blake on June 9, 1894. This is done in the following 
way : — After a very hot bath and thorough drying with hot towels, 
the patient is vigorously rubbed all over towards the heart with 
Brady and Martin's thyroid juice worked up with eight parts of 
lanolin. Dr. Blake would like to draw the attention of the Society 
to a new differentia in the diagnosis of myxoedema. It is that 
the calibre of the arteries does not suffer the ordinary postural 
changes. Owing to sclerosis, resulting from toxic arteritis, no 
alteration in the arterial lumen occurs in any position of the body. 
As far as we know at present, there are but three conditions in 
which this holds good : they are syphilis, myxoedema, and gout, 
with the different forms of interstitial renal degeneration. These 
interesting points have been recently worked out by Dr. George 
Oliver, who has also found, during some researches on Addisonian 
bronzing, that the extract of the adrenals is a most reliable 
cardiac stimulant, even when given in very minute doses. 

Dr. Neild said he had given thyroid extract, with con- 
siderable benefit, in a case of congenital non-development in a 
male. The great point was that the temperature was congenitally 
low — the patient's ordinary temperature being 92° to 93°, or even 
lower. He was developed on his artistic side, being a mere 
child in every other respect. He had been a good deal abroad, 
and was acquainted with all the principal pictures of note, and 
was also musical and very fond of poetry. On account of 
glandular enlargement, he (Dr. Neild) had given thyroid extract 
prepared by Duncan and Flockhart, of Edinburgh, giving half a 
teaspoonful twice or three times a week. The benefit was con- 
siderable. From that time until the patient's death, which took 
place two or three weeks ago, from an attack of broncho- 
pneumonia, they had no trouble with the glands whatever. The 
patient's intelligence with regard to ordinary subjects was simply 
that of a child of nine or ten. He was in no degree idiotic, but he 
took a long time to answer questions. They noticed that after 
taking the thyroid for a time he was able to answer questions a 
little more quickly, and the temperature, instead of averaging 93°, 
went up to an average of 94° or 95°, so that he thought he might 
fairly say that the thyroid did a certain amount of good. 



A CASE OF OVARIAN TUMOUR. 247 



ON THE SUCCESSFUL THEEAPEUTIC TEEAT- 
MENT OF A CASE OF OVAEIAN TUMOUE; 
WITH GENEEAL CONSIDEEATIONS ON THE 
AMENABILITY OF THESE NEOPLASMS TO 
DEUG TEEATMENT.i 

BY GEORGE BURFORD, M.B. 
GyruBcological Physician to the London Homoeopathic Hospital, 

Some years ago I asked one of the most celebrated 
homoeopathic physicians in the world if he had ever seen a 
clear case of ovarian tumour entirely cured by remedies. His 
reply vsras a sorrowful negative. Since then I have in my 
somewhat varied experience seen nothing to induce me to 
hold any different view, until latterly, when, by what the 
Germans call the ** Law of duplication of rare occurrences,'^ 
I have seen two cases of pelvic tumour, presumably ovarian ,^ 
in which cure has been wrought by medicinal means, and 
that means one and the same — bromide of potassium. 

That scepticism as to this possibihty is so common,, 
means that the occurrence is rare ; and that the occurrence is 
rare is obviously due to the neglect of suitable measures, or 
the paucity of suitable cases. I adhere strongly to the latter 
view. If it be charged against us that we neglect therapeutic 
measures, I reply that our course is founded on the inability 
of the careful prescribers in former days — the days of pure 
therapeutics — to produce any braver show of cured cases 
than a fractional percentage. So the canons for solely 
internal treatment lapsed; the pendulum oscillated to the 
other extreme of purely surgical measures; until in the 
fulness of time therapeutic explorers again took up the 
question. What can drugs do for the elimination of tumours? 

Dr. George Clifton, of Leicester, has kindly written the 
following precis of a case I saw with him, and which is a 
striking illustration of the role which the physician, as well 
as the surgeon, has in cases of ovarian tumour : — 

' Presented to the Section of Surgery and Gynaecology, March 7, 1895. 



248 A CASE OF OVARUN TUMOUR. 

** Mrs. M., aged 45, seen on November 8, 1890. After 
lifting furniture, she had severe pain in the left ovarian 
region, shooting down also along the left leg. The pain was 
exactly as if she were going to menstruate. At that time the 
catamenia recurred every three weeks ; with no pain but free 
discharge. She has noticed since the strain that she has 
become larger in the abdomen ; urine is scanty. 

" November 19. — Under apis 1 and macrotin Ix, the pain 
has become much better ; the urine is copious, but she is still 
increasing in size. On examination there is found a large 
cyst of the left ovary. She was then put on bromide of 
potassium, two grains twice daily ; this she continued steadily 
for three months, with varying result. After exertion in 
the spring of 1891, there was noticed a decided increase. 
She was seen by Lawson Tait, who confirmed the diagnosis, 
and advised operation. To this she was averse. She con- 
tinued the medicine with an interval of a month or so until 
June, 1893. During this time Dr. Burford had seen her also 
with me and confirmed the diagnosis, and advised operative 
measures. In the middle of 1893, she reported that she had 
no trouble with the tumour, and no pain, catamenia recurring 
every four or five weeks ; climacteric flushes were frequent, 
but the general health good. On examination, deep in the 
left ovarian region a small hard tumour only the size of a 
Tangerine orange was found. She has continued the same 
remedy at intervals. 

• " She was again seen in August, 1894, when the tumour 
was scarcely perceptible ; the period had occurred only once 
in seven months. She has now got over the climacteric 
change, and is a stronger and healthier woman than for 
years past. My intention was to go into the whole subject 
of ovarian tumours, tracing their origin from several causes 
and then considering their homoeopathic treatment. How 
certain remedies, such as calcarea, phosphorus, sulphur, 
bovista, are called for when there is a hereditary taint, 
strumous or tubercular, as a primary lesion. How certain 
other remedies such as potassium bromide, cannabis sat. 
and ind., and picric acid, are useful in those whose sexual 
apparatus is hypersensitive. Then again, remedies such 



A CASE OP OVARIAN TUMOUR. 249 

as hydrastis, mercurius corr., arsenicum and others where 
there has been probably some absorption of gonorrhoeal or 
septic poison." 

[Dr. Clifton was most regrettably compelled to defer 
dealing with this large subject in ampler detail until some 
future occasion. To this important contribution we look 
forward with much interest.] 

The natural history of tumours, ovarian and other, as 
derived from sufficiently numerous observations, shows 
certain well-defined characters. We note primarily the utter 
insufficiency, in the vast majority, of cases, of the unassisted 
processes of atrophy to effectually compass the resolution of 
new growths. Such pathological products as inflammatory 
exudates and infarcts, the co-ordinating forces of the organ- 
ism can eliminate : but new growths are on a higher plane, 
and involve for their subsidence a quickening of the normal 
powers of elimination, or the introduction of new capacities 
for absorption ; in both cases processes not germane to the 
normal organism, and not easily evoked by therapeutic 
powers. To show the inutility of pessimism, I think I may 
fairly state that there is no known type of tumour or new 
growth which has not in rare and uncommon instances been 
observed to dwindle and disappear; and obversely, in the 
majority of cases, the stream of tendency is decidedly in 
favour of tbeir permanence and development ; pathology then 
affords no absolute criterion as to the potentiality of tumours 
for permanence or resolution. Clinical observation shows us 
that any kind of new growth may atrophy, but that we have 
hitherto been able to evoke atrophic processes in only a small 
percentage of instances. My first thesis, then, is : — 

That new growths involve for their subsidence a quick- 
ening of normal atrophic processes, or the introduction of new 
tendencies to absorption, in both cases processes not germane 
to the particular organism and not easily evoked by therapeutic 

powers. 

There occasionally occurs, in the experience of all, an 
instance of a new growth subsiding owing to a quickening 
of normal atrophic processes. Some years ago, in the 
Hospital for Women, it was my duty to watch a case of 



250 A CASE OF OVABIAN TUMOUR. 

Gvarian tumour, which had been sent in for operation. 
Careful observations were made daily, the case was 
thoroughly investigated, and the diagnosis agreed in by 
all the competent observers who saw the patient. Circum- 
stances necessitated the temporary postponement of oper- 
ation : the patient remained in hospital, awaiting her 
turn, when to the surprise of all it was obvious that the 
tumour was diminishing in size. This process was followed 
for some time, and continued apparently without let or 
hindrance ; the patient was ultimately discharged, so much 
of her tumour having disappeared as to warrant this course. 
I saw her some time afterwards, and the process of atrophy 
was still continuing ; so far as my memory serves me, at 
least three quarters of the mass had already vanished. No 
remedies were given to achieve this result. 

New growths that resolve, owing to the introduction of 
new tendencies to absorption, have occurred in the expe- 
rience of well-accredited observers. Dr. Ed. Madden has 
notified me of a case of cancer of the liver, diagnosed as 
such after abdominal section, by Mr. Lawson Tait. Nothing 
was done ; the abdomen was closed ; a gloomy prognosis 
was given. But to the astonishment of all, of physician 
and surgeon no less than of friends, the patient entirely 
recovered, and all traces of the lesion vanished. Cases of 
this kind I could multiply indefinitely ; and they emphasise 
the postulate that new growths may disappear, owing to the 
introduction of new tendencies to absorption.^ 

My second thesis is : — 

The subsidence of new growths, whether spontaneous or 
determined by treatment, occurs in an ascending series, 
determined conjointly by their pathological nature and the 
idiosyncrasy of the constitution. 

It is regarded as a broad principle of practice by one 
section of the Homoeopathic School, that the pathological 
constitution of new growths goes for nothing, and the idio- 
syncrasies of the individual for everything, both in prognosis 
and treatment. 

* Literature on this subject is rapidly accumulating. See Mr. Tait's own 
cases, and one of Professor Mosetig cited in Tait's " Diseases of Women," 
p. 193 ; also British Medical Journal, 1894, p. 190, 1896, p. 1143, and Lancety 
November 7, 1886. Stokes, British Medical Jcumaly April 20, 1896, may also 
v»o -fAfftrred to. 



AMENABILITY TO THERAPEUTIC TREATMENT OP- 



ABSORPTION CAPACITY OP THE BODY FOR- 



A CASE OF OVABIAN TUMOUB. 251 

This seems to have been derived as an academic deduc- 
tion from a precedent theory of the nature of chronic disease, 
rather than as a constantly verifiable induction from definite 
facts. A scientific view of these facts demonstrates clearly 
that the probabihty of tumour atrophy under treatment is 
directly as the pathological character of the growth, and that 
individual characteristics play but a subsidiary and quaU- 
fying part. 

Let us apply to this statistical question the mathematical 
illustration of the Law of Ascending Series. We find that 
clinical data give us at least four members of a tumour series 
whose capacity for absorption is directly as their rank in this 
series. 

Thus, first, is the class of malignant growths, whose per- 
manent ehmination under treatment is rare and uncommon. 

Next is the class of formed products like dermoid cysts 
or quiescent ectopic gestations, whose capacity for absorp- 
tion under treatment is slightly more than class one. 

Next come small glandular ovarian cysts, whose dis- 
appearance under treatment has been noted again and 
again, and finally small cysts of the broad ligament, or of 
the organ of Rosenmiiller, or pseudo-cystic serous peritonitis, 
which lend themselves more easily than others to permanent 
cure by therapeutic agencies. 

These conditions may be represented by the old methods 
of ordinates and abscissae (see accompanying schemata). 

These I select simply as types ; and the facts are matters 
of every day verification. Pathological growths of the type 
A radically disappear under treatment with the greatest 
rarity ; those of the type B in scarcely greater degree ; 
those of type C in somewhat freer proportion ; while the 
cure of the tjrpe D is no uncommon feat. These, I say, are 
matters of every day verification. 

We may consider this relation in another way, and con- 
. struct a series as indicating the degrees of vital capacity for 
the permanent elimination of new growths.^ 

* Since seeing this schema, my accomplished friend, Mr. Dudley Wright, 
has suggested to me another working h3rpothesis of the same character, hased 
on the differential embryonic sources of tumour elements. But up to the 
present I do not think this view of things has been worked out ; and my 
projections, if arbitrary, have the advantage of ready clinical corroboration. 

voii. ni. — NO. 3. 18 



252 A CASE OF OVABIAN TUMOUB. 

My third thesis is : — 

As tumours are complex structures each tumour constituent 
has its own particular co-efficiefit of absorption. 

Ovarian tumours are, as we know, complex structures, 
and it is probable that each tumour constituent manifests a 
different capacity for elimination — ^in other words, that each 
tumour constituent has its own co-efficient of absorption. 
These growths are, as I have said, complex in their constitu- 
tion ; they contain not only the usual protoplasmic basis, 
but all kinds of differentiated products, the result of the 
vital activity of their epithelial cells. We have to estimate 
thus the absorption capacity of bland albuminous fluid, 
colloid masses, glandular secretions, fat or hair, or teeth or 
bones, as well as the ordinary elements of a blood and 
lymph vascular structure. Speaking generally I am inclined 
to think that readiness in absorption means ease in dis- 
integration, and ease in disintegration implies a correspond- 
ingly rich Ijmaphatic circulation. We know that absorption 
of normal tissues is effected by liquefaction of their con- 
stituents ; and we have every reason to believe that the 
disintegration of tumours is effected in the same way. 
Hence the co-efficient of absorption may be interpreted as 
the co-efficient of easy disintegration, which obviously differs 
for every structure. Crystalloid fluids are more readily 
absorbed than colloid fluids ; epithelial cells more readily 
than bone ; and fat or blood clot more easily than dentine 
or hair. Given the absorption process going on in a tumour, 
its different constituents will disappear at different rates; 
and the slowness of absorption of a tumour, other things 
being equal, is conditioned by the resistance offered by its 
most stubborn constituent. 

Ovarian tumours differ widely in constitution. We have 
the par-ovarian cyst, a simple cyst containing bland, easily 
diffusible fluid. This form of tumour presents the physical 
characters most easy for absorption. Then we have the 
multilocular ovarian cyst, a honey-combed mass of epithe- 
lium which may hold in its different loculi blood, pus, mucus, 
colloid material, or bland, limpid fluid of the ascitic type. 
The difficulties of absorption of such a heterogeneous mass 
are obviously much greater than in the former case. 



A CASE OF OVARIAN TUMOUB. 253 

Next, dermoid cysts of the ovary contain fatty masses, 
hair, teeth, and often bones. The resistance to absorption 
is here greater than in the multilocular and par-ovarian 
types, w^hile in the malignant ovarian tumour the exuberance 
of its structure, the rapidity of its growth, and its highly- 
marked parasitism place it almost outside the range of 
practicable absorption. 

My fourth thesis is : — 

Most tumours present an irreducible minimum, beyond 
which more complete absorption is with difficulty and tardi- 
ness attained, 

A necessary corollary to the foregoing section, and one 
anaply substantiated by clinical facts, is that of an irre- 
ducible minimum with regard to each form of neoplasm. 
The simplest case I can- cite is that of arrested deposit in 
the lung apices, where the encapsuled calcareous nodules, 
discovered in years of senility, are the unabsorbed remnants 
of morbid processes of an earlier date. Another parallel is 
furnished by the electrolysis of uterine fibroids. I have 
never known one of these masses so treated to entirely dis- 
appear : some reduction in size, more or less permanent, 
frequently occurs, but there remains an " irreducible mini- 
mum," proof against further attempts at reduction. So 
with some forms of par-ovarian cyst, that after a single 
tapping do not refill ; the cyst fluid is absent, but the cyst 
waU remains, in whole or in part, so that its identity can 
afterwards be recognised. 

An irreducible minimum, absolute or relative, the major 
or the minor part of its bulk, may be predicated of every 
form of ovarian tumour, except the malignant ones. The 
irreducible minimum is that portion of the tumour which 
remains stationary, which refuses to yield to absorptive 
agencies, or yields so slowly as to require treatment, spread 
out over a much greater time than is usually given to 
therapeutic measures. Of such a nature the remnant in 
Dr. Clifton's case seems to have been ; and instances will 
occur to us all where some remnant, some callosity, some 
encystment remains to indicate the site of an earlier mass 
of much more considerable bulk. 



254 A CASE OF OVABIAN TUMOUR. 

All cases of ovarian tumour do not lend themselves with 
equal promise to therapeutic treatment. They may be 
classed as appertaining to the suitable, the doubtful, and 
the obviously unfit. The exact delimitation can only be 
made in each case on the ground of special judgment and 
experience ; but broadly, it is possible to generahse in each 
typical case. Thus, among the obviously unfit are cysts 
with indications of strangulation; or with a recurrent or 
persistent pyrexia, often indicating necrotic changes; or 
those with indications of numerous and extensive adhesions, 
or dermoid cysts. I believe these latter quite out of the 
reasonable sphere of practicable therapeutics, and their 
liability to suppurate is inherent. I have seen, with Dr. 
Nankivell, a case of suppurating dermoid in a young lady of 
some 21 years who, after agonies, had passed fragments 
of teeth and bones from the bladder, into which they 
had ulcerated. I have seen a patient with an abdominal 
cyst watched and watched until, when operation was decided 
on, nothing could be done with a rotten necrosed cyst wall, 
too disintegrated to remove, and fatal to leave behind. 

Cysts that grow by leaps and bounds, those that set up 
pressure sjrmptoms, whether thoracic or abdominal, those 
of any considerable and incommoding bulk, or those whose 
presence is a bar to the pursuit of a necessary livelihood — 
these also I believe to be improper subjects of protracted 
eliminative therapeutics. 

But those of relatively recent origin, of not more than 
moderate bulk, and with no acute pathological or physical 
complication, I think may be subjected to therapeutic treat- 
ment with some fair prospect of success. I say with a fair 
prospect of success, for in a case recently under my care at 
the London Homoeopathic Hospital a cyst, apparently 
stationary in growth, was subjected to at least six months 
of careful therapeutic treatment without the least avail. On 
operation, the obstinate mass was discovered to be a dermoid, 
a kind of cyst which, as I have just said, I believe to be 
obdurate to treatment. 

I regard also the type of cyst having but a single loculus. 
as more likely to yield to treatment than any multilocular 



A CASE OF OVABIAN GTST. 255 

variety. This view receives a side light from the fact that a 
few of this class of cysts, when tapped, do not refill. 

But I must resolutely protest against that lack of percep- 
tion of the fitness of things which continues a sole reliance 
upon therapeutics when a reasonable trial, both qualitative 
and quantitative, has been given to remedial measures 
without result ; or where, in spite of these, the mass con- 
tinues to enlarge, or where the bodily health suffers, or 
complications are developing, or risks of rupture, or pressure, 
or perforation are being run. Delays here are dangerous, 
and surgery in these cases — I mean surgery reinforced by 
the physician's art — is the more excellent way. 

I do not sound any note of pessimism in speaking of 
therapeutic methods for the efi&cient control of ovarian 
tumours. No fertile discovery was ever yet made in such a 
spirit, and the inspired belief of genius in new worlds to 
conquer is the moving spirit in their efi&cient caption. For 
the elimination of many new growths I believe the thera- 
peutic means now at our disposal are unequal to the task ; 
but we have no warrant to regard the scope of medical work 
in this direction as a closed circle. Both medical history 
and the nature of things warrant the deduction that an 
ampler knowledge of the springs of life will put new growths 
as much under our control as typhoid or myxoedema. To 
this end the impetus of suffering humanity is ever with us ; 
for all mankind, as ever - in the past, regards surgery as a 
hateful incident. 



ClilNICAL NOTES OF A CASE OF OVAEIAN 
CYST, CUBED BY BEST AND DBUGS.^ 

BY J. C. PINCOTT, M.R.G.S. 

The following brief communication, which I trust will 
be of interest, as supplementing Dr. Burford*s paper, is 
based on the notes of a case under my care last year. I 
much regret they were not more fully recorded at the time, 
but I had not then in contemplation their publication. 

> Presented to the Section of Surgery and GynsBcology, March 7, 1895. 



256 A CASE OF OVABIAN CYST. 

On Tuesday, March 13, of last year I was asked to visit 
Mrs. H. as soon as possible. She had just arrived home 
from the seaside, and was said to be suffering from acute 
abdominal pain with diarrhoea and sickness. 

On arrival at the house shortly afterwards I found my 
patient in bed, looking very ill, highly nervous, with drawn 
and anxious expression of face, feeling cold, evidently from 
the journey which she had found most trying. Temperature 
100**, pulse 110 and feeble, constant sickness, bowels relaxed 
and teasing, passing small quantities of urine about every 
fifteen minutes, very restless, tongue dry and furred. On 
examining the abdomen (which she let me do with evident 
fear) I found it tender to pressure, muscles rigid at the lower 
part, just above pubis but a little to the right of the median- 
line, a large, hard swelling, about the size of a firmly 
contracted uterus immediately after a confinement, could be 
easily made out and appeared to be fixed. Seeing her ner- 
vous state I did not make a vaginal examination, but left 
iris Ix and aconite 3x to be taken every two hours alternately ; 
diet : milk or milk and soda water in small quantities, and 
veal broth. To remain in bed, and encouraged her to hold 
the water (urine) as long as possible, hot fomentations to 
ease the pain. 

Previous History, — Family history fairly good; patient 
medium height, thin, aged 52 ; married about twenty years^ 
no family, general health good but never very strong. 
Periods regular, but loses a little too much, especially lately,, 
has not been poorly now for more than two months. She 
has just been spending ten days at St. Leonards to gain 
strength after recovering from an enlarged and inflamed 
breast. During my attendance with the breast trouble she 
was seized one night suddenly with acute pain in the left 
inguinal region which lasted some hours, hot fomentations 
being applied the greater part of the night. When I saw 
her the next morning she was up, free from pain, but would 
not allow me to examine her. She soon got well. 

On Saturday, March 10, after being at St. Leonards 
about a week, she was suddenly seized with pain, like that 
above described (which occurred about six or eight weeks 
before), but being earlier in the evening, a doctor was called 



A CASE OP OVARIAN OYST. 257 

in. On examination he said she had an ante-flexed uterus 
with distension of the bladder which was causing the pain. 
He tried to replace the uterus by pressure with the finger 
but failed ; as he had no catheter with him, he said he 
would call in the morning and draw ofif the water, in the 
meantime to have hot fomentations applied. 

The next morning (Sunday), again failing to replace 
uterus with the finger, he tried to pass a sound but could not 
do so. He then passed a catheter and drew off about half a 
teacupful of urine or less ; he gave instructions for patient 
to remain in bed, and said he would call on the Tuesday, 
replace uterus and insert a pessary. The patient not caring 
to undergo another examination at his hands, came home to 
be under my care. 

March 14. — On calling this morning, patient much 
quieter and rested, had a better night, not so sick ; pulse 
100 ; can hold water four hours and then passes a fair 
quantity, bowels still irritable, abdomen distended and 
painful. Obtaining permission to make vaginal examina- 
tion, can detect a large, hard, rounded swelling high up in 
pelvis, extending rather to right and apparently fixed ; very 
nervous under examination. To have aeon. 3x and colocynth 
3x every three hours alt. Diet, same as before. 

March 15. — About the same as yesterday. 

March 16. — Less sick ; pulse 100. Bowels acted at once, 
can hold water nicely ; abdomen still distended and painful. 
Mercurius corr. 3x every four hours ; temperature normal. 

March 19. — ^Patient not progressing, although easier. 
Dr. Neild kindly came in ; after examination he confirmed 
my opinion as to enlargement of uterus, also that it was not 
ante-flexed, and that there was some deeper cause for the 
symptoms present. We agreed to give mercurius corr. 3x 
and Pulsatilla 3x alternately, and to watch the case care- 
fully, and if no better to consult with Dr. Burford. 

March 20. — Patient much the same. Evening tempera- 
ture 101°. 

March 23. — Patient more restless, abdomen larger ; 
there is a distinct thrill on percussion from above uterus to 
the right inguinal region ; ? is it ovarian trouble ? Evening 
temperature 102°, pulse 120. 



258 A CASE OF OVABIAN CTST. 

March 24. — ^Patient seen by Dr. Burford, who diagnosed 
right ovarian cyst, pushing uterus forward. Abdominal 
measurements : — Circumference at line of umbilicus, 29 
in. ; 2J in. below umbilicus, 31^ in. To be kept in bed 
at perfect rest, fluid diet. Potassium bromide gr. x. t.d.s. 
To be operated on in a few days, the 29th mentioned as 
probable date. 

March 25. — Patient much more comfortable this morn- 
ing, had a good night, no sickness. 

March 28. — Patient still improving; abdomen measured : 
circumference at line of umbilicus, 27 in.; 2f in. below umbili- 
cus, 30 in. 

March 30. — Still improving ; seen by Dr. Burford, who 
decided to postpone operation ; bowels acting nicely once a 
day, occasionally twice ; urine to be measured. To go on 
with the bromide. 

March 31. — Quiet night ; passed one pint and an eighth 
of urine in the twenty-four hours. 

April 7. — Patient still improving. Abdomen reduced to 
about natural size, muscles relaxed, and can easily get 
fingers down behind hard round swelling lying just above 
pubes, of about the size of a cricket ball, but feels to be 
fixed. Moved on to a sofa to-day. 

April 10. — To go into another room on same floor ; to 
take potassium bromide gr. x. twice a day. 

April 30. — Came downstairs to-day, and says she feels 
quite well. 

From this time patient gained strength nicely and has 
never had any recurrence of trouble ; she is out daily for 
long walks and attends to her household duties. I have 
seen her frequently during the last month (February, 1896) 
and she describes herself as quite well. 

The chief points of interest appear to be : (1) The diffi- 
culty in diagnosis in the early stage of the illness. (2) The 
very marked improvement directly the patient commenced 
the bromide of potassium. (3) The great importance of 
giving a full trial to drug action before submitting a patient 
to such a severe operation as the one contemplated. 



DISCUSSION ON " OVABIAN TUMOUB " AND " OVABIAN CYST." 259 



Discussion on Dr. G. Busford's Paper on " Ovarian Tumour," 
Dr. J. C. Prbscott*s Paper on " Ovarian Cyst." 

Dr. Neatby said he thought that the opinions stated in the 
paper represented present day therapeutic feeling very satisfac- 
torily, and a very important and interesting phase of it. At 
one time, according to homoeopathic history, all tumours were 
thought to he curable by globules ; and then, as Dr. Burford had 
remarked, the pendulum swung to quite the other extreme, and 
it was thought, at any rate by surgeons, that no tumours of any 
kind, however innocent they might be, were in the least degree 
amenable to homoeopathic therapeutic measures, if to any drug 
measures at all. Within the last few months, or certainly the 
last year or two, a reaction had again set in. There was an 
accumulation of clinical evidence proving that tumours — at any 
rate innocent new growths — were distinctly influenced by 
homoeopathic and other drug agents. That was seen over and 
over again at the London Homoeopathic Hospital, as well as in 
private practice ; and there was no reason to give up hope with 
regard to that question when it was found, as had all along been 
allowed, that nature could effect a more or less complete cure. 
And if nature had means by which absorption could be effected 
there was no reason to suppose that art might not lend valuable 
assistance. One could assume, as he did, in many instances, 
that a disturbed innervation was at the root of the trouble, 
causing trophic changes. What is disturbed innervation they 
hardly knew, but it was quite possible to suppose that drugs 
could restore the nerve equilibrium, and there was every reason 
to believe they had done so. Not only might drug treatment 
effect that but also other alterative influences, such as an attack 
of inflammation. He would mention a case which would be 
remembered by Dr. Burford, as having been sent to the London 
Homoeopathic Hospital two years ago. He was called to see a 
patient who was suffering from acute pelvic peritonitis, and who 
had a large globular elastic and tense swelling in the left iliac 
region, a tumour which might have been parovarian or ovarian. 
It was about the size of a foetal head at full term. The patient 
was kept under observation for a few weeks, and the inflamma- 
tion subsided very quickly, under the usual remedies, before the 
patient came into the hospital. When the future treatment of 
the case was under consideration it was found almost day by day 
that the swelling was lessening, and within the course of a 



260 DISCUSSION ON " OVARIAN TUMOUR AND *' OVARIAN CYST." 

month, certainly not longer, the tumour had practically dis- 
appeared. He believed Dr. Burford came to the conclusion 
that it was a parovarian cyst, and he (Dr. Neatby) agreed with 
him. That bore out Dr. Burford's ascending series, that the 
broad ligament cysts were those which were most easily 
absorbed, and in which trophic changes were most easily set 
going. Then again, showing the influence of drugs, he might 
mention a case which was still under observation at the 
Homoeopathic Hospital, where a patient who was suffering 
chiefly from fibro-myoma of the uterus also had formerly a 
very distinct ovarian tumour at the same time. During the 
time she was under treatment, some three ye^rs ago, she took 
constitutional remedies, the chief of which were calcarea and 
sepia. He was afraid he could not give the exact reason why 
those medicines were selected, except that they were based on 
the symptomatic treatment of the patient. During that time, 
a period of six or nine months, the ovarian part of- the tumour 
gradually diminished in size, so that within the space of eight 
or nine months the girth of the patient has lessened by five or 
six inches. That afforded a very interesting proof of the 
eliminability, the absorptive possibilities of tumours of that 
kind. He thought they might say that drugs acted in two 
ways, or at least that they might choose them on two grounds, 
either empirical, as it seemed to him bromide of potassium 
was (possibly to act as a nerve ** alterative " or restorer of 
nerve equilibrium), or again more distinctly homoeopathically, 
under which circumstances the whole condition of the patient 
must be taken into consideration, not simply during the few 
weeks or months which preceded the time when the patient 
presented herself for treatment, but during some years. In 
this way they might get under their influence and under the 
influence of the medicines the gradual constitutional and local 
changes which had been going on from month to month, almost 
from year to year, constitutional changes which had produced 
the nerve disturbance. Then ignoring the tumour they might 
have some hope of getting at the root of the matter and of 
bringing about absorption. 

Dr. Pope said that he should have liked to have heard the 
reasons why bromide of potassium was selected, for he could not 
recall to mind any indications which warranted them in using it 
as a remedy in ovarian tumours. It had a paralysing power 
over the sexual organs to a certain extent, but that seemed 
hardly to justify this use of it. Some thirty or forty years ago^ 



DISCUSSION ON '* OVARIAN TUMOUR*' AND " OVARIAN CYST." 261 

a woman, a nurse in the family of the late Dr. Phillips, of 
Manchester, developed an ovarian tumour apparently, and the 
late Dr. Clay was going to operate upon it, but the woman 
objecting. Dr. Phillips undertook to try and relieve her. The 
medicines he gave her were cinchona and hellebore. The case 
was reported in one of the early volumes of the British Journal 
of HomcRopathy, The woman got quite well, and remained 
quite well for twelve or fourteen years. Then the tumour formed 
again. She was then unsuccessfully operated upon. He could 
never understand what induced Dr. Phillips to prescribe cinchona 
or hellebore. In the case of apis, however, there were certain 
symptoms referring to the ovario-uterine sphere, such as cutting 
and drawing pains, with soreness in both ovaries, but chiefly 
in the right. That was a symptom which was frequently re- 
corded. There was further haemorrhage three days after the 
period, in a woman previously quite regular, and in pregnant 
women miscarriage at the second or third month ; and bea;ting 
down pains, with achings, were frequently noticed by provers. 
That showed a distinct action on the ovarian sphere. Then, in 
the second place, they all knew perfectly well the power of the 
apis to produce an excess of serous fluid, and that again would 
suggest it. There was a case mentioned in vol. xxix. of the 
British Journal of HomcBopathy, quoted from the American Ob- 
server, in which a physician at Detroit had arranged to operate 
on a tumour the size of a new-born child's head. Some time 
was to elapse before the operation was to be undergone, and in 
the meantime. Dr. P. H. Hale, of that city, made an infusion of 
ten or twelve living bees in a cupful of hot water, and gave the 
patient a tablespoonful every three or four hours. In a week 
there was an improvement^ and before the day for the operation 
had arrived the tumour had nearly disappeared. Then, again. 
Dr. Craig, of Bedford, in a paper read before their Society, on 
"Specific Medication in Surgery," recorded two cases, where, 
after tapping, apis in the 3rd trituration was given three times 
a day for a considerable time. In the first case, an unmarried 
woman, of 24 years of age, had been ill for about two years, 
and she was tapped, when six quarts of water were with- 
drawn. The apis was resumed, and after giving it for several 
months, the tumour never reappeared. The second case was 
particularly interesting. It was that of a woman, 27 years 
of age, with a left ovarian tumour. She was tapped. She 
had apis for a considerable time, and the tumour entirely dis- 
appeared. She Uved for another six years, and then died of 



262 DIBCUBBION ON " OVABIAN TUMOUB *' AND "OVARIAN CYBT. 



>» 



bronchitis, and a post-mortem examination showed a shriyelled 
cyst, the size of a walnut, attached to the ovary. That was a 
practical demonstration of the actual cure of the disease. Then, 
again, Dr. Percy Wil^, in the Beview for June, 1889, recorded 
two well-marked cases of unilocular ovarian cyst, which Dr. 
Burford agreed was much more readily curable than any other 
variety, and both of those were readily cured by apis given in the 
3rd dilution. At the time of writing those papers, one of the 
patients had remained well for four years, and in the case of the 
other, two years had elapsed, and there was no return. Whatever 
might be said about the bromide of potassium, there was this 
much to be said for it — that it was given in those cases, and 
they recovered. It appeared to him that apis, from the very fact 
of its being, inferentially at least, homoeopathic, and from the 
additional fact of being clinically successful, gave a cystic tumour, 
of a curable variety, a greater chance than any other remedy 
which they knew at present. 

Dr. Dudgeon said that in vol. xxxi. of the British 
Journal of Homoeopathy he had recorded the case of a married 
lady who had passed her climacteric period. After the marriage 
she developed two tumours in her abdomen. The one on the 
right side, corresponding to the right ovary, was about the size of 
a very large orange, extremely hard and not tender except on very 
strong pressure. On the left side there was a similar tumour, but 
a little smaller, also tender on deep pressure. The only symptom 
the lady complained of was dragging down weight, which seemed 
out of proportion to the size of the tumours she had. Some years 
before he had treated her for a tumour in the left breast, which 
yielded after a fortnight to conium 1. He prescribed graphites 
chiefly on account of the analogy of the ovaries with the male 
testicles, for which graphites presented several symptoms in its 
pathogenesis, and also was recorded as having been used 
successfully for disease of these organs. There is one symptom 
in the Chronic Diseases which shows also that graphites has a 
certain action on the ovary, but the action did not seem to be of 
a favourable character in respect to his case. The symptom is : — 
'' The left indurated ovary swells and becomes of a stony hard- 
ness, with violent pains, sometimes on being touched, sometimes 
on merely inspiring or clearing the throat, when the most violent 
stitches occurred so as to put the patient quite beside herself, with 
profuse general perspiration and persistent sleeplessness." She 
took graphites for a year, in the 12th dilution, and under its ad- 
ministration the tumours gradually and entirely disappeared. He 



DISCUSSION ON " OVARIAN TUMOUB " AND *' OVARIAN CYST." 263 

would not undertake to assert positively that it was owing to the 
graphites, for it might have been one of those cases which Dr. 
Burford said would get well by themselves. Still, he thought that 
there was reason to suppose that graphites was homoeopathic in 
that case, certainly more homoeopathic than such a medicine as 
bromide of potassium, respecting which we have no information as 
to its power to produce symptoms of ovarian disturbance. 

Dr. Edward Blake said he had seen a cystic tumour of the 
broad ligament disappear under apis. The case was as follows : — 

Mrs. , aged 28, married nearly two years. Ten months ago 

she was delivered of a still-born child at full term ; she had never 
felt well since. There was a lump in the left inguinal region 
which bad been diagnosed as a hernia. The senior surgeon of 
the '' Samaritan " saw the case with Dr. Blake, and agreed that it 
was a serous cyst in the broad ligament. Apis was given for one 
week, in the 6th centesimal dilution, and afterwards in the Srd 
decimal. No other remedy was given, and in four weeks the 
tumour had entirely disappeared. Ten years have passed and no 
recurrence has taken place. This lady is able to go for long 
tricycle rides in the country — a fairly good test to apply to the 
muscles which pass into the pelvis. He thought there was no 
reason why glandular and myomatous tumours should not be 
cured. Nature removes the thymus after the second year, the 
thyroid in cretinism, whilst a myoma disappears after every 
pregnancy, and there is a physiological cure for mammary adenoma 
after lactation. Unfortunately for the value of evidence, success 
in curing tumours has been in inverse ratio to the possession of 
an intimate acquaintance with pathology and the power of fault- 
less diagnosis. 

Mr. J. C. PiNCOTT, in reply,* said he agreed that the value of the 
use of bromide could not be tested by a single case. The mistake 
of accepting one successful case as a test was often made in the 
reports to the journals. He had been careful to state in his paper 
that the patient appeared to obtain relief and to improve from the 
moment the bromide was commenced. In the case he had men- 
tioned he gave the patient bromide on Dr. Burford' s advice. He 
asked Dr. Burford what there was homoeopathic in the bromide, 
and he said he did not claim such action for the drug, but as the 
patient was to undergo an operation and seeing the nervous con- 
dition she was in, bromide of potassium given as ordered would 
prepare her for the day when the operation was to be performed. 
The patient, however, immediately began to get well ; whether it 
was the drug or not he could not say. Dr. Wolston asked him 



264 ANKLE STRAIN. 

(Mr. Pincott) whether he was sure the tumour had disappeared ? 
When he examined the patient some time after he could get the 
hand well down into the pelvic cavity through the abdominal wall 
and could make out a small swelling ; although there was pain, 
there was never severe peritonitis. When Dr. Burford saw the 
patient the second time, after taking the bromide of potassium 
about a week, the tumour was reduced to the size of a tennis 
ball. 

Dr. BuBFOBD said that they should not run away with the 
idea that nothing but bromide of potassium was given in the cases 
in question. The only reason why it had been used a great deal 
was that it had been found a most useful remedy. With regard 
to apis, he had tried it in several cases, but the result was very 
imsatisfactory. He saw the two cases to which Dr. Neatby 
referred and could confirm what(he said about them. What made 
him (Dr. Burford) use bromide of potassium was in the first place 
Dr. Clifton's case, and then he found that Mr. Lawson Tait was 
fond of using it, particularly for chronic uterine enlargement, and 
after paying a good deal of attention to the history of the drug he 
came to the conclusion that bromide of potassium was a remedy 
in such cases as those under discussion. He believed bromide of 
potassium in small doses to be a remedy of the first rank for 
trophic disturbances of the female generative apparatus. He 
referred his critics to Dr. Hughes, who had given cases in which 
benefit had arisen from the use of bromide. Dr. Hale also 
recommended the use of bromide of potassium in certain cases of 
cognate ovarian troubles, but no reason for its use was assigned. 
There was, therefore, very high authority for the prescription of 
bromide in appropriate cases. 



ANKLE STEAIN.i 
by edwabd blake, m.d. 

Introduction. 

When we think of the robust construction of the joints, 
of their extraordinary strength and the resisting character 
of the materials of which they are built up ; when we remem- 
ber, too, that it is difficult to dislocate the joint of a cadaver, 
and nearly impossible, by any ordinary violence, to break 

' Presented to the Section of Surgery and Gynseoology, March 7, 1895. 



ANEIiB STBAIN. 265 

the bones of the extremities after death, we could be for- 
given if we regarded the articulations as somewhat of the 
nature of fixed quantities ; yet this is by no means the case. 
The fact is, that even the denser forms of tissue, of which 
the joints are composed, undergo extremely rapid removal 
and renewal. Of course this holds good more especially of 
the joints during childhood and during early adult life. 

I will remind you that certain articulations are much 
more active than others. There is, indeed, a very unfair 
division of labour with regard to the articulations of the 
human body. Some joints, as those which unite the ex- 
panded bones of the skull, are always at rest. Some are 
scarcely ever moved. As examples, there may be quoted the 
sterno-clavicular joint in men who earn their living by the 
use of their legs — the intervertebral articulations in soldiers 
and sempstresses, and so on. In vigorous breathers, the 
costo-vertebral joints can never be at peace, whilst the 
temporo-m. axillary joint in the liquorish and the loquacious 
seldom has a holiday excepting during the sleeping hours. 
Then the articulations of the lower extremities in active 
persons have not only movements to execute, but they have 
to sustain the weight of the trunk, and to contribute to 
conveying the body from place to place. Hence these last 
are exposed to peculiar kinds of change. For instance, the 
knee is usually the joint in which, during life, the earliest 
osteo-arthritic changes may be detected. Owing to the 
constant grinding down which takes place in the joints of 
the lower extremities, they soon lose that portion of the 
so-called ** synovial membrane '' which clothes the articular 
facets during foetal life (Toynbee) . 

With regard to the wrongly-styled "secretion" of the 
articular cavities, the synovial fluid and its method of pro- 
duction, I shall have the pleasure of laying before you some 
novel and interesting material. You know that the distin- 
guished anatomist Havers erroneously described the synovial 
fringes as " mucilaginous glands." We have been told as 
students that the synovia is ** secreted" by the synovial 
membrane, but it cannot be a secretion, for there are no 
glands there to secrete it. No doubt a fluid exudes from the 



266 ANKLE 8TBAIN. 

parietal portion of synovial membranes, else the tendon 
sheaths would be dry. Mr. Bland Sntton has made a sug- 
gestion with regard to the synovial fluid which had not been 
published when this paper was written. It is that the 
synovia of exertion is not the same as the synovia of rest. 
The latter is similar to the glairy fluid found in the tendon 
sheaths and in the closed bursas. The fluid found in the 
cavity of a joint after exertion is not produced by the 
pseudo-membrane which clothes the parietes of an articular 
space. That has been absorbed, and its place has been 
taken by the detritus of cartilage,' stroma and cell, crushed 
and ground down between the opposed articular surfaces. 
We can form some conception as to the amount of attrition 
which would be likely to result when a soft and yielding 
material like cartilage is interposed between tWo masses of 
a dense, hard and unyielding substance like bone. Further, 
when we think of the cartilage as exposed not only to the 
pressure exerted by the torso and the upper appendages of 
a burly man, but also to the superadded momentum involved 
in leaping and in running ; supposing these forms of pres- 
sure to be kept up during many consecutive hours, as in a 
day's mountaineering, we cannot then be surprised that the 
cartilages should suffer from considerable disintegration. 
Probably the whole of the cartilage of one of the lower 
joints may be removed and renewed many times in the 
course of one single day in a powerful and vigorous man 
whose body undergoes prolonged and violent exertion. 

Mr. Bland Sutton's view, which occurred to him whilst 
watching the cystic degeneration of certain forms of enchon- 
dromata, supplies the key to many pathological puzzles. It 
is plain that we may, not only with safety but with positive 
advantage, wear away as much cartilage as we like ; always 
provided that fresh cells are ready to rise and replace those 
which perish. But when advancing years, or the degenera- 
tion of disease, rob us of that power of replacement, then 
the joints are in peril of destructive erosion. 

But not only do the softer parts of an articulation 

undergo perpetual change, but the bones themselves are 

*^antly being modified by neuro-trophic influences. 



ANKliB STBAIN. 267 

They are also moulded by pressure and by the traction of 
muscles. Familiar examples of mobility limited by habit 
are furnished by the cervical anchylosis of draught bullocks 
and of pitcher carriers (Bland Sutton). The large and 
mobile sterno-clavicular joints of tlae cobbler, the lion- 
like scapula of the sailor, the arthrodial lumbar articulations 
of the coal-trimmer, and the rugged insertion of the tendo 
Achillis of the professional pedestrian (Arbuthnot Lane), 
supply us with instances of physiological activity increased 
by use. 

It may be remembered that the bones which enter into 
the construction of a true arthrodial joint are not kept in 
position by ligaments as much as by muscular tension 
(Clblland) and by atmospheric pressure. A due recog- 
nition of these two physiological truths readily explains the 
so-called '* spontaneous " luxations. Such displacements 
usually occur in the persons of those whose articular facets 
are not in nice coaptation, or in those in whom the muscles 
cannot or will not exert the needful force to keep up tonic 
equilibrium. 

This brings me to the consideration of a joint specially 
prone to strain and subluxation. I speak of the ankle. 
A full consideration of what has been advanced will make 
us suspect that the topical treatment of the joint itself 
for weak ankle is nothing more nor less than an absurdity. 
It is the nervous system which should engross our attention. 
In the phrase ** nervous system " is, of course, included 
the skeletal muscles, for physiologically they are but the 
expanded end-organs of the motor nerves. 

The ankle joint is peculiar in many ways ; it has to 
carry a greater weight than the knees, yet it is far more 
mobile. Though a true hinge joint, it is also capable, under 
certain conditions, of considerable lateral play. "When 
extended, the front of the foot can be moved by some 
persons through a radius of more than ninety degrees. 
When sharply flexed the ankle is incapable of lateral play. 
A strain of the ankle takes place usually during extreme 
extension. The snap which is sometimes heard is not due 
to the rupture of any anatomical structure, but to atmo- 

VOL. HI. — NO. 3. 19 



268 ANKLE STRAIN. 

spheric causes. It can be imitated with tolerable accuracy 
by applying the moistened tongue firmly to the palate and 
then quickly withdrawing it. It may be a purely subjective 
sensation, like the snap heard by the patient during a 
paroxysm of migraine. But the disastrous results of ankle 
strain are not due to direct violence. The half automatic, 
but tremendous effort put forth by the tibialis anticus, and 
by the peroneus Jongus, is usually the cause of the subse- 
quent distress. It will be observed that the tibialis anticus 
is a flexor of the ankle ; whilst the weaker muscle, the 
peroneus longus, is an extensor. Equilibrium is fairly main- 
tained when both work, because the peroneus acts with 
more mechanical advantage in everting the foot. That the 
peroneus is put to the more severe strain is shown by the 
fact that the pain is more commonly felt near its sheath 
than in the front of the ankle. And this is what we should 
expect, because eversion is more needed than adduction. 

Section I. 
Ankle Strain in Childhood and in Early Adult Life. 

Whilst in healthy adults the foot is chiefly everted by 
the peroneus longus, it so happens that this muscle is often 
undeveloped in childhood, and this is one of the reasons why 
some children are prone to ankle strain. If one watches a 
number of children running out of school, one can see that a 
certain proportion of them run with inturned toes. But 
there are other reasons why children strain the ankle. The 
elaborate co-ordination found in some adults is an acquired 
art, and children have not had time to learn it. Again, the 
movements of childhood are abrupt ; little people are often 
preoccupied. Their attention, too, is easily diverted. These, 
then, are some of the reasons why certain children especially 
may become the subjects of ankle strain. 

The phase of boyhood brings us towards the athletic 
period of life, when the occurrence of strain is possibly 
the most common of all. At this time, an abnormal and 
excessive stress is put upon the locomotor apparatus. The 



AMKLE STRAIN. 269 

chances of strain are artificially multiplied by unfair effort 
involved in such amusements as football, cricket, moun- 
taineering, and flat racing. We have seen that ankle strain 
is not due to the twist of the foot, but to the abrupt and 
powerful effort made to recover. Hence, a muscular man, 
whilst less prone to strain, may yet be more seriously injured 
by the strain than a feeble person. Old and experienced 
hill-climbers learn that they must not try to recover their 
balance ; they wisely give way, and escape unhurt. 

Section II. 
Ankle Strain in Middle Life, 

During the more mature epoch of existence, we encounter 
the slow introduction of a fresh factor into the case. Now 
we have to reckon with the influence of increasing bulk, 
whilst a more sedentary life may lead to enfeebled muscles. 
The injurious influences of under-work and of over-feeding 
may be reinforced by the results of one of the diathetic 
diseases peculiar to middle life. These conditions serve to 
render a strain quite an easy occurrence during the ex- 
ceptional exertion involved in our amusements, which are 
proverbially more fraught with danger than our duties. 
Shooting, hill-cHmbing, tennis playing, and modern fishing, 
which is so largely conducted by wading over loose stones, 
^each has its particular danger. 

Mr. Charles Mansell MouUin has made the ingenious 
suggestion that the well-known ** tennis leg'* is due to the 
rupture of a varicose vein in the deep muscles of the calf. 

Section III. 
Ankle Strain in Old Age. 

In more advanced life, eye changes make it more difi&cult 
to avoid obstacles ; added to this, diathetic degeneration 
passes gradually into senile decay. At this time, vision tends 
to grow more and more defective, and the other special 
senses lose their acuteness ; a general sluggishness and in- 



270 ANKLE STRAIN. 

attention set in. This is misinterpreted as a centric or 
cerebral defect ; probably the brain is not really degenerate^ 
but it lacks the needful stimulus imparted by the perpetual 
imprinting of fresh impressions, reflected from the periphery. 
Not only are the special senses deadened, but a new source 
of peril has come into play. The normal tenderness of the 
plantar surfaces diminishes. Messages are no longer con- 
ducted swiftly and accurately to the motor centres. On the 
exquisite sensitiveness of the sole depend the elaborate feats 
of co-ordination possible in earlier life. As the plantar 
reflexes perish, so perishes the power of arranging the 
muscles to meet a sudden and unlooked-for emergency. Nor 
will all the cautious hebetude of age serve at times to protect 
an old man from the inevitable results of these impaired 
functions. 

Section IV. 
Mechanism of Ankle Strain, 

On twisting the foot inwards, a sharp pain is usuaUy felt 
in the region of the external malleolus. In a few seconds, a 
sense of warmth begins in the peripheral distribution of the 
plantar nerves. The pain in the outer ankle is attributed 
commonly to a strain of the capsular ligament or of the 
middle fasciculus of the external lateral ligament. But these 
are not the structures at fault. The external lateral liga- 
ment can be made out with the greatest ease during life, and 
the pain is not there at all. Both the pain and the subse- 
quent tenderness are in the upper part of the malleolus, just 
in front of the groove for the tendon of the peronei. If we 
follow the successive steps in a strain, we find that they 
occur in the following order : — First the foot turns in, then a 
sudden automatic effort is made to turn it out by means of 
the tibialis anticus and the peroneus longus ; it is then that 
the mischief is done. A violent stress is thrown upon the 
annular ligaments. The ring ligament, which ties back 
the peronei, is sometimes torn through completely. The 
periosteum of the lower and back portion of the external 
malleolus, the front part of the peroneal sheath, and some. 



ANKLE STRAIN. 271 

filaments of the external saphenous nerve are crushed 
violently between the peroneal tendon and the bony groove 
in which it glides. A referred sensation of burning is sent 
to the plantar nerve distribution ; whilst, in acute cases, a 
deadly nausea and vertigo are propagated via the medulla 
oblongata. The burning feeUng in the sole passes away in 
the course of an hour. CEdema then sets in in the neigh- 
bourhood of the external malleolus, and this oedema follows 
the course of the external or short saphenous (communicans 
poplitei), a branch of the internal popliteal, the larger of the 
two terminal forks of the great sciatic. This oedema is due 
to an acute paresis of the yaso-motor nerves, traumatic, of 
course, in origin, but autotoxic in its actual nature, for the 
traumatism acts by arresting the removal of katabolic 
products as well as by inhibiting anabolism. Some of the 
former are active nerve poisons, leading to hyperthermia and 
to clonic spasm of the muscles which act on the ankle joint. 
The action of the special toxines, which act as motor poisons, 
accounts for those twitches which cause such intolerable 
suflfering, by throwing the muscles of the affected limb into 
sudden and violent contraction. 

Section V. 
Pathological Anatomy of Joint Strain. 

We have been taught that the haemorrhage into a joint 
cavity and the extravasation into the surrounding tissues, 
which often complicate a joint injury, are due to the rupture 
of one or more capsular vessels. This accident may un- 
doubtedly happen, but occasionally the effusion of blood 
conunences some hours after the date of injury. There are 
certain reasons why, under such circumstances, the bleeding 
cannot be viewed as the direct result of traumatism. In the 
first place : — 

(a) It comes too late. 

(6) It leaves too early. 

(c) It is absorbed too slowly. 

(d) It is improved by massage. 

(e) It is accompanied or followed by oedema. 



272 ANKLE STRAIN. 

Probably the real explanation of the bleeding is that the 
vasomotor nerves are paralysed by the traumatism. 

A typical example is afforded by 

Casel, — Dela/yedHcemorrhagic Effusion following Injury, 
— The daughter of a medical friend was ascending a mountain 
in the Tyrol. She was seated on the back of a mule, when 
the animal, making a sudden plunge, threw her and then 
trod on the outer side of her leg. The pain that followed 
was intense, but no discoloration occurred until the tenth day 
after the accident^ when a dark bruise made its appearance, 
five inches below the site of the injury. What took place in 
this case was manifestly a traumatism of the trunk of the 
external saphenous nerve. But it is a well-known clinical 
rule that the results of nerve injury are revealed chiefly at 
the periphery. Physiologico-chemical changes, not im- 
mediate mechanical violence, led to the blood effusion. 

Whilst the arterioles are in a paretic condition, serum, 
and even corpuscles, find their way through the walls of the 
finer vessels. Later, the lymphatics become gorged with the 
debris of katabolic material. But these accumulated pro- 
ducts of disassimilation are themselves nerve poisons, and a 
persistent numbness, with a brawny infiltration, shows that 
there is set up a true peripheral neuritis, autotoxic in 
character. This condition is seen to perfection in those who 
are the subjects of gout, Bright's disease, scurvy, myxoedema, 
syphilis or starvation. We are now in a position to under- 
stand the pathological accuracy of the popular expression as 
to gout or rheumatism " setting in " after an injury. 

These points are supported by the observations of Ord, 
who has so carefully worked out the neuro-trophic phenomena 
which underlie the ostensible joint-changes in rheumatic 
gout ; of Emil Pfeiflfer, of Wiesbaden, who has described a 
hypersesthesia in osteo-arthritis preceded by anaesthesia; and 
by Willoughby Wade, of Birmingham, who has demonstrated 
the presence of toxic neuritis in acute gout. 

In connection with this matter it is most interesting that 
Berkabt, in the British MedicalJoumal, February 2, 1895, 
at p. 243, following Ebstbin, " Die Natur u. Behandlung der 
Gicht," 1882, has shown that whereas chronic gout is a 



ANKLE STRAIN. 273 

passive arterio-sclerosis, acute gout is an obstructive 
arteritis, associated with local necrosis, a sort of mortifica- 
tion in miniature. The case is soon complicated with 
autotoxis by means of the degenerated products of sphace- 
lated tissue. The action of these toxines is reinforced by 
the absorption of poisons, produced by the saprophytes 
alw^ays to be found on the foot. These have been described 
by Maggiora, see ** Contributo alio studio dei microfiti della 
j>elle del piede," Giornale delta B, Soc. d'Igiene, 1889. 
The relation of saturnine neuritis to crapulous gout is also 
extremely significant. 

Section VI. 
Treatment. 

Treatment naturally resolves itself into (1) Preventive. 
(2) Curative. 

Preventive Treatment. 

Having assured ourselves that the nerve centres are 
normal, we proceed to the second indication, which is to 
strengthen the muscles which act directly or indirectly on 
the ankle joint. We begin by remembering that the muscles 
grow during legitimate use and conversely that they atrophy 
-whilst at rest. Movement then is essential, but the cardinal 
point is that the movements must be gentle. Systematic 
exercises should be devised to give the most work to those 
muscles which are found in any given case to be the weakest. 
These movements may be first passive, then active, and then 
active and resistant. That is to say, the attendant resists 
and not the patient. Massage as described in Section VII. 
may be employed. The continuous current may be used 
gently and during short sittings. It is as easy to use too 
much electricity as it is to give a patient too much 
champagne, and the results are possibly more serious. 
Half a milliampere is quite enough to use at first. The 
current should never exceed two milliamperes. It is a good 
plan to reverse the current slowly, by means of the com- 
mutator every two minutes. If this be not done, then the 



274 ANKLB STBAIN. 

positive pole should be selected for the patient. The skin of 
a child, and especially of a fair child, sloughs very readily 
under the kathode or negative pole. At a later stage it is 
more convenient to combine the administration of voltaism 
with massage of all kinds, but more especially with deep 
kneading and slow rolling. At a still more advanced stage, 
gentle faradism may either reinforce or replace the use of the 
galvanic current. 

Light boots may be allowed at first in a very bad case. 
Shoes, though less of a solace than boots, are really better 
because the boot teaches the ankle to rely on the artificial 
support afforded by the leather, rather than on the natural 
support given by the muscles. Those who wear sandals, and 
Indians who have loose mocassins, do not suffer from strained 
ankle ; neither do those who have never worn any foot cover- 
ing at all. It was evidently intended that the toes in man 
should spread out like the claw of a bird. Thus the body 
would be balanced by a prehensile foot. The wrench of an 
inturned ankle would then be rendered quite impossible. It 
is not beautiful to turn out the toes in walking, but it renders 
strain less likely to occur. All rigid foot coverings lead to 
unnatural narrowing of the foot and to consequent atrophy 
of the general motor apparatus. As we rise in the scale of 
evolution there is a progressive tendency to atrophy of the 
leg muscles. Man often succeeds in inducing some other 
animal to bear his weight. This, together with the abandon- 
ment of the chase as a means of livelihood, has led to some 
curious results ; amongst them is a tendency of the leg 
muscles to perish. This is well shown by the fact that the 
plantaris, always an unimportant muscle in man, sometimes 
even entirely absent, in the armadillo is larger than the 
gastrocnemius. The plantar fascia and the plantar hgaments 
are viewed by Mr. Bland Sutton as vestigial survivals of what 
were once powerful muscles connected with the plantaris. 
For details see "Ligaments, their Nature and Morphology," 
by Bland Sutton (published by Lewis, 1887), a book of 
extraordinary fascination. . 

All kinds of cycling, but more particularly hill-climbing, 
form a grand method of cure for " weak ankle." The cyclist 



ANKLE STBAIN. 275 

soon finds that a steep hill can be successfully *' negotiated " 
in only one way. It is by sitting well away from his work 
and by placing merely the tips of the toes on the pedals. 
This is capital practice for the small intrinsic muscles of the 
foot, which do the work far better than the larger leg masses. 

Section VII. 
Curative Treatment of Strain, 

"We have reviewed the methods of preventing strain ; we 
will now glance at some of the leading indications for cure. 

(1) If the injury be quite recent, prolonged immersion 
in very hot water removes the results of shock, restores the 
paralysed nerves which control the calibre of the vessels, 
relaxes the spasmodically contracted muscles, aids meta- 
bolism, supports the tissues and greatly relieves pain. 

(2) If reaction has already set in, with erythema, throb- 
bing and effusion, then a good thick compress, with carefully 
applied roller bandages, is more indicated. Mansell Moullin, 
foUovsdng Dacre Fox, strongly insists on the need of making 
the pressure tell on the soft parts by careful packing round 
the bony processes with absorbent cotton pads. Muscle 
ache may be relieved by percussion — Ling's " Tapotement." 

(3) Rest must at first be absolute, with the heel higher 
than the hip, and the whole limb should be carefully and 
evenly supported. Of course the misfortune in these cases 
is that the resting of the foot is begun too late and is con- 
tinued too long. 

(4) Gentle upward rubbing may be practised from the 
first. At the earliest stages very Ught grazing is best. The 
rubbing should of course be towards the heart. It should 
always be slow, progressively growing more firm, but never 
faster. In the case of scorbutic and rickety children, 
massage should be essentially gentle, as the tissues readily 
bruise and the epiphyses even may be detached. 

(6) Weak solution of rhus toxicodendron, applied as a 
compress, is suggested by pain. Any appropriate anodyne 
as cocaine can be introduced by endosmosis, under the posi- 
tive pole of a galvanic battery at any specially tender spot. 



276 ANKLE STBAIN. 

(6) Hamamelis, and heat alternated with extreme cold, 
are indicated by effusions of blood. Their action may be 
aided by keeping the heel elevated and, at a later stage, by 
giving high dilutions of phosphorus, or low potencies of 
muriatic acid. 

(7) For acute oedema and for uncontrollable haemorrhage 
Mansell MouUin recommends firm strapping. This must 
be replaced and tightened every day. This plan secures 
absolute physiological rest, and gives relief by stopping the 
painful starting of muscles whose motor centres and nerve 
supply have been poisoned by products of disassimilation. 

(8) Ichthyol, either pure or diluted with flexile collodion, 
is admirable as a local application for celluhtis or for 
erythema. The latter calls for aconite or belladonjia in- 
ternally ; whilst the former is best combated by apis at 
first and afterwards by mercurius corrosivus. 

(9) Breaches of surface may be carefully cleansed, dried, 
and painted with benzoated or calendulated collodion. 

I will venture to repeat that a word of caution is needful 
as to rest : it is nearly always begun too late and carried on 
too long. Eest should always be promptly commenced but 
not unduly protracted, lest adhesions form. To prevent 
these latter, passive movements, involving the whole possible 
play of the limb in every direction, are viost important. 
They should be undertaken immediately after the disappear- 
ance of acute hypersemia. 

Section VIII. 
Adhesion Breaking, 

Of course this is best done under complete general 
anaesthesia. Automatic muscular resistance, the surgeon's 
greatest enemy, is then abolished. But besides this, a 
valuable element in diagnosis is introduced, for if afterwards 
the joint return to its abnormal condition of rigidity, we 
know we have to deal with a contracture caused by some 
centric or peripheral disease of the nervous system not 
directly connected with the joint itself. It is taken for 
granted that the possibility of active joint disease, connected 



ANKLE STRAIN. 277 

with one of the great diathetic famiUes, has been duly con- 
sidered and carefully eliminated. 

There have been so many distressing accidents with 
chloroform of late, that it is wiser to use gas, which answers 
perfectly well for an ordinary case. The so-called open 
method of anaesthetising is certainly to be avoided. No 
man who elects the open method of giving chloroform 
should expect, in case of death, to receive the support of his 
professional brethren. A proceeding fraught with such 
needless peril is nearly akin to legitimised murder ! 

But generally anaesthesia is not really essential. If the 
surgeon, in any given case, has the least misgiving in order- 
ing deep anaesthesia, it would be better to use cocaine. The 
cocaine is used in the following way : having first given a 
grain of quinine, or a teaspoonful of bark in a Uttle hot 
brandy and water, a few minims of a two per cent, solution of 
cocaine are thrown into the cellular tissue over the course of 
the sensory nerve of the affected side. In five minutes 
the patient will be ready. A few soothing and comforting 
words will add to the safety and success of the proceeding. 

In adhesion-breaking, fortune certainly favours the deter- 
mined man. One sudden and vigorous movement, involving 
the full play of the joint, is far safer than many gentle and 
timorous manipulations. In Mr. Mansell Moullin's little 
book on " Sprains " there are some excellent directions for 
after-treatment. On these I cannot improve. 

Section IX. 

Case 2. 

Angio-n&urptic (Edema from Traumatism, with Secondary 

Ankle Strain, 

The following case serves well to show the pernicious 
results of protracted strain of the muscles which pass the 
ankle. 

Four years ago, my friend Dr. C. sent me a tall and 
powerful woman, of 39 years of age. She had suffered 
during four months from oedema of one leg. There was 
also a sharp pricking pain under the cuboid, especially felt 



278 ANKLE STRAIN. 

in planting the foot. Perhaps because this lady bore a 
decidedly patrician name, these symptoms had been attri- 
buted by her various medical advisers to gout. Por this 
aristocratic malady she had been well treated secundum 
artem, but unfortunately with a conspicuous absence of 
success. The patient was placed in the prone posture and 
in a good light. Under the cuboid bone a very minute dark 
spot was observed. Severe pain was experienced on press- 
ing this part. A small opening was made, and the tissues 
around were firmly depressed. Presently " the murder was 
out.*' A piece of blackened steel protruded and was caught 
by the forceps. A portion of strong carpet needle, measur- 
ing two centimetres in length, was withdrawn. After a 
little firm, slow, upward rubbing, the ankle-oedema departed 
to return no more. This oedema was evidently due to the 
fact that this lady threw her weight as much as possible on 
the internfil cuneiform to relieve the pressure on the cuboid. 
The sural muscles were abnormally contracted during 
exertion, whilst the tibialis anticus, the long extensor of the 
toes, the special stretcher of the big toe and the fibular 
muscles were unnaturally strained. The Ijrmph circulation 
in the intermuscular lymphatic planes was seriously im- 
peded and an angio-neurotic oedema was the result. 

Persistent pain in the heel has puzzled many an able 
practitioner. Of coui'se causation is determined if possible. 
A scrupulous examination of the urine may throw some 
light on the matter by showing the presence of uric acid, 
but it would be rash to assume from such evidence alone 
that uric acid is precipitated in a crystalline form in the 
tissues. If, however, it be found free in the urine, five 
grains of piperazin dissolved in unlimited hot water may be 
cautiously tried daily for a limited time. Afterwards nux 
vomica, nitric acid, lycopodium, bryonia, berberis and other 
remedies for lithiasis can be selected according to the total 
group of symptoms. Firm, deep electro-massage of the 
heel may be practised after prolonged maceration in hot 
water. 

Should these methods fail, there is probably present 
either an adventitious bursa or a subperiosteal effusion. 



EALMIA LATIFOLIA. 279 

Either may be relieved by deep puncture with a sterilised 
needle, the skin of the foot having been first rendered 
aseptic. 

Mr. Knox Shaw said that he was glad to see that Dr. Blake 
was against prolonged rest in the treatment of ankle strain. 
A great many people were left permanently lame and suffered a 
great deal of unnecessary discomfort by prolonged rest. The 
popular idea seemed to be that as long as there was any bruising 
so long ought the Hmb to be kept in a state of perfect rest. Dr. 
Blake preferred rhus locally to arnica, but his (Mr. Shaw's) ex- 
perience had been in the use of arnica. Personally, he had never 
seen any of the disastrous results which were supposed to follow 
the local use of arnica, and he would be glad to know why Dr. 
Blake preferred rhus. He did not consider the erythema of arnica 
a true erysipelas. 

Dr. Dudgeon said that after the first extreme painfulness had 
passed — aided, it might be, by warm fomentations and arnica 
lotion — ^the joint should be moved passively if the patient was 
unable to move it actively. 

Mr. Dudley Wright had seen one or two cases in which the 
use of arnica brought out rash, but it was certainly not erysipelas. 
Another remedy was ruta. He had found it of use both locally 
and internally. 

Dr. Blake said that he preferred rhus for strains and arnica 
for bruises. The distinction, of course, is arbitrary, but arnica 
appears to possess an elective affinity for the skin, muscle, and 
vascular tissue, whilst rhus acts more on connective and fibrous 
tissues. 



KALMIA LATIF0LIA.1 

BY J. B. P. LAMBERT, M.D. 



When I was asked to read a paper before this Society, 
to fill a gap which had unavoidably occurred, a subject was 
suggested for me at the same time— the suggestion being 
occasioned by a paper on the same topic, which appeared 
in the February number of the Homoeopathic World, I 

' Presented to the Materia Medica and Therapeutic Section, April 4, 1895. 






280 KALMIA LATIFOLIA. 

had intended another subject for my first paper before this 
Society, but the short warning given me would not have 
enabled me to do justice to that subject. I shall endeavour 
to make this paper as interesting and practical as possible, 
and shall, therefore, not weary you with long lists of 
symptoms, except such as appear necessary to give a clear 
idea of the action of this useful, but little-used, drug. It is 
my intention, therefore, to bring before you the general 
sphere of action and clinical applications of kalmia, rather 
than a detailed symptomatology. 

Kalmia latifolia, the mountain laurel, belongs to the 
natural order Ericaceae, the same order as ledum and rhodo- 
dendron, and like these two drugs, it may be called a 
rheumatic remedy. 

The most striking points in its pathogenesy are the pains 
which affect all parts of the body, usually of a transient 
character, but sometimes very severe and persistent. They 
usually affect a large part of a limb at once, or several joints, 
and shift their situation rapidly. This last peculiarity is 
most characteristic. In addition to the pains, vertigo and 
dizziness, with or without nausea or impaired vision, occur 
in nearly all the provings. It also has a prominent action 
on the heart. 

We shall now consider its action on the various systems, 
following the order usually adopted in our text-books. 

Turning, then, to the nervous system, which we shall 
consider as a whole, in the first place, we find that kalmia 
acts very prominently, not only on the sensorium and brain, 
but also on the spinal cord and nerves. 

In nearly all the provings we find vertigo and dizziness 
complained of. This symptom is aggravated on stooping, 
and on looking downwards, and sometimes also towards 
noon, and on rising from a seat. It may be accompanied by 
nausea and even vomiting, and by impairment of vision, which 
may amount to almost complete blindness. There is also 
confusion of the brain, causing inability to collect one's 
thoughts, and for study. 

We find, also, that it produces various pains in the head ; 
these have a preference for the right side, and affect chiefly 






EALMIA LATIFOLIA. 281 

the frontal and temporal regions. Occasionally the pain is 
confined to the occiput or vertex, or is strictly one-sided 
(usually right), affecting the occipital and temporal regions. 
Frequently the pain extends from the head down the nape, 
towards the upper dorsal region, or down the sides of the 
neck, or, when it is situated towards the front of the head, 
down into the teeth. 

On the other hand, the pain may originate in the back, 
and pass up over the vertex to the frontal region, but not 
into the eyes. (It will be observed that these pains are very 
like those produced by such drugs as spigelia, ferrum-phos., 
belladonna, and silica. Of these, spigelia usually affects the 
left side, belladonna and silica the right, and ferrum-phos. 
both sides, its headache being of a congestive character.) 
Another important symptom is that the prover often wakes 
with a headache. The above symptoms promise great 
things from kalmia in various forms of headache, even 
migraine, and in supra-orbital and facial neuralgia; and 
clinical experience confirms its value in these affections, as a 
few examples will show. 

On January 21, W. S., aged 54, came to my dispensary 
complaining of a constant headache which he had suffered 
from for many years. He said that for three or four days 
every week it was very bad, and at times so severe that he 
had to shut himself in a room alone, and feared he would go 
out of his mind. He described the pain as ** opening and 
shutting" (which, by the way, does not occur in the provings), 
affecting chiefly the right supra-orbital and temporal regions, 
but sometimes the left side. He said that the eyelids and 
temple sometimes swelled during the severe attacks. He 
seldom woke without a headache, and complained also of 
pains in the joints shifting about, and of a feeling of weakness 
and weariness and occasional giddiness. He is also subject 
to bilious attacks, which occur every three months about. I 
gave him three powders of kalmia 3x, and subsequently 4x 
and 5x. His headache was relieved at once, and he has been 
almost free since taking it. When he leaves it off, the 
headache returns. He has had no other medicine except a 
few doses of sulphur 30 ordered on February 19. I may say 



282 KALMIA LATIFOLIA. 

it was his first trial of homoeopathy, and he is now a firm 
believer in it. 

Experience has shown it to be a valuable remedy in 
headaches of cardiac origin or with cardiac complication. 
There is a case recorded, in the Homceopathische Monats- 
bUitter, by Dr. Proll, of a lad, aged 13, with mitral in- 
sufficiency, who suffered so severely from headache and 
weak memory that he had to leave school. Kalmia, given 
in the 1st, 2nd, and 3rd centesimal dilutions consecutively, 
cured him in about three weeks. 

I have also notes of a case of a man, aged 54, who was 
the subject of tobacco heart (he had been a smoker forty- 
seven years ; since he was 7). He sought advice for right-sided 
temporal neuralgia : pain like pins and needles, induced by 
touch, and on turning the head quickly. He had previously 
been given up by an allopath, and had been nine months 
under a homoeopath without relief. I gave kalmia 3x, which 
rapidly cured his headache and improved hia general con- 
dition and heart, reducing the intermittency of the pulse 
from 1 in 3, to 1 in 8 or 9. 

Facial neuralgia has also been caused and cured by 
kalmia. The pains are transient but severe. 

The next point in connection with the nervous system 
which I have to speak of, is its action on the spinal cord, and 
this I believe to be of great importance. Dr. Dyce Brown, 
in his interesting paper on " Kalmia." published nearly 
twenty years ago, observes that kalmia may be said to act 
almost entirely on the cerebro-spinal nervous system, muscle 
and joints, and most of its symptoms in connection with 
other systems he describes as neurotic. In my opinion he 
has taken too limited a view of its action, and his paper 
gives me the idea of a rather superficial action even on the 
nervous system. In my opinion kalmia has a deep-seated 
action at least on the spinal cord. The cases of poisoning 
in animals point to this very strongly, as the following 
symptoms show. It produces trembling, staggering and 
jerking, followed soon by clonic spasms at intervals of from 
15 to 20 minutes, which increase in severity till they become 
violent convulsions. During the interval the animal appears 



KALMIA LATIFOLIA. 283 

rational, and tries to get up, but in the effort falls into 
another spasm. The eyes turn upwards and become fixed, 
the head is drawn back, the limbs are rigid, the abdomen 
becomes bloated and the bowels loose. If recovery takes 
place the animal is in a state of prostration for a week or 
more, and seldom fully recovers in less than three months, 
during which time it is very weak and nervous, and has a 
tottering, feeble gait. 

The question will naturally be asked, ** Do the provings 
contain symptoms pointing to a similar action?" to which 
I should reply, ** Yes, but they are not definite." For an 
instance, we find in the provings great pain down the back, 
as if the back would break ; pain in localised regions of the 
spine ; then, again, we find pain from the hips to knees and 
knees to feet, described as rending or tearing, which remind 
one of the lightning pains of locomotor ataxy, for which I 
would strongly recommend kalmia to be well tried. I have 
under my care a case of locomotor of fourteen years' stand- 
ing, a man, aged 65, who has been many years under Dr. 
Clarke, who transferred him to me. The patient is quite 
blind and unable to walk at all. When I first saw him he 
was complaining chiefly of sleeplessness due to a constant 
throbbing headache in the left parietal region which had 
lasted two or three months ; also of vertigo and shooting 
pains in his legs, worse in the right, which pains frequently 
shift their position. He had no pain elsewhere. On ac- 
count of these pains and the vertigo, I gave kalmia 3x nxi. 
in half a pint of water, a dessert spoonful three times a day, 
remembering that Carroll Dunham gives as a characteris- 
tic that the pains of kalmia pass through their province 
quickly, and affect a large part of a limb, which descrip- 
tion seemed very applicable to lightning pains. The result 
in this case was a rapid disappearance of the headache, 
sleeplessness and vertigo, and marked relief from the pains 
in his legs. Only once since November last has he had the 
lightning pains, and that after having had no kalmia for 
some weeks- I have provided him with some powders of 
kalmia 200 to take if the pains recur. There has been no 
return of the headache or sleeplessness after four months. 

VOL. ni. — NO. 3. 20 



284 KALMIA LATIFOIiIA. 

In addition to the pains mentioned kabnia produces numb- 
ness and pricking and a sense of coldness in the limbs, and 
also a great sense of weariness and exhaustion, and feeling 
of weakness of the legs, all of which symptoms are common 
in the early stages of such diseases as acute myelitis or 
spastic paraplegia, &c. Dr. Dyce Brown considers that 
kalmia gives a good picture of spinal irritation. I agree so 
far, but, as I said, think that its action tends to go much 
deeper. 

Before passing on to the organs of special sense there is 
one action of kahnia worth remembering, and that is on the 
ulnar nerve, for which it seems to have an affinity, producing 
pain from the little finger along the ulnar side of the arm 
to the elbow, or in the opposite direction. 

We shall now consider its action on the eye. 

Here we find the following characteristic symptoms. 
Stiffness of the muscles of the eyes and lids. Pain as if 
walls of orbit were pressing on the globe. Also sharp stitches 
and burning in the eyes. Pressure on the eyes, with difficulty 
in keeping them open. In addition there are a few symp- 
toms affecting vision, such as glimmering before the eyes 
with nausea and belching, and muscse volitantes, followed 
by nausea ; also impaired vision, amounting almost to 
amaurosis. This symptom accompanied vomiting, and was 
aggravated in the erect posture. These symptoms, together 
with the temporal and supra-orbital pains, suggest its use in 
certain cases of cihary neuralgia, and possibly conjunctivitis, 
while the general pathogenesy would suggest its use also in 
rheumatic eye affections. But when we turn to clinical 
experience we find this drug accredited with beneficial 
effects far beyond these suggestions. Thus Drs. Allen and 
Norton have used it with good results in cases of asthe- 
nopia, especially where there was present a stiff drawing 
sensation of the muscles on moving the eyes. 

Dr. T. F. Allen has reported a case of anterior sclero- 
choroiditis where the vitreous was filled with exudation, 
and there was a glimmering before the eye, specially when 
reading with the other, where kalmia effected a cure. We 
should have liked more particulars of this case, as to the 



EALMIA LATIFOLIA. 285 

time taken, &c. This remark would apply also to the 
following case reported by the same writer, of albuminuric 
retinitis occurring during pregnancy, where kalmia was given 
on account of a characteristic pain in the back, and con- 
tinued a long time, during which the patches in the retina 
gradually became absorbed, and recovery took place. Then 
again Dr. Hunt has reported several cases of rheumatic 
iritis, ^th sharp boring pains and tenderness of the eye, 
where kalmia promptly relieved. We have no details of 
these ; probably atropine was used as well. 

Dr. Boyle has reported a case of tenonitis in which the 
lids -were red and swollen, and there was chemosis and pain on 
movement and pressure, cured by kalmia ; also several cases 
of scleritis, with syphilitic history, where kalmia cured after 
iodide of potash had failed. 

Ijastly, Dr. McMichael has reported a case of supra- 
orbital neuralgia, with ptosis, where the pain extended into 
the eye, but was mostly over the orbit. The condition had 
existed three months. Kalmia Ix relieved in twenty-four 
hours, and cured in ten days, after other remedies had 
failed. These cases show that kalmia deserves an impor- 
tant place among eye remedies ; and in addition to the 
affections mentioned I have yet another suggestion to 
make, and that is its use in tobacco amblyopia. We have 
at present two cases of this affection in Mr. Knox Shaw's 
clinic, at the hospital, taking this remedy. 

The case of headache with tobacco heart, where kalmia 
did much good, first gave me the idea that it might be an 
antidote for tobacco, and the similarity of the action of these 
drugs in poisoning cases confirms this opinion. 

Passing on now to the ear we have not much to say. 
We find a few symptoms such as loud tinnitus (one prover), 
buzzing before the ears, also a darting pain in the ears. 
Dr. Dyce Brown in his paper suggests its use in Meniere's 
disease. Vertigo is certainly a characteristic symptom of 
the drug, and I think the suggestion well worthy of con- 
sideration. 

Of the nose we have still less to say, but we find a few 
symptoms worthy of note, namely : fluent coryza, with 



286 KALMIA LATIFOLIA. 

frequent sneezing and increased sense of smell. Also 
pressing on the bridge of the nose, with frequent sneezing. 
These symptoms are sufficient to indicate its use in nasal 
catarrh. 

We now come to the alimentary system, where we find 
first a few symptoms connected with the mouth and throat, 
such as lips swollen, dry and stiff, dryness of the throat with 
dysphagia. There is also pain on swallowing and throbbing 
in the left tonsil. Irritation in the throat, scratching or 
scraping, occurs very frequently and produces a constant 
desire to cough. We shall have a case of sore throat to 
refer to under another heading. 

Passing now to the stomach and intestines we find 
numerous symptoms. Nausea is very marked and may be 
excessive, and accompanied by impaired vision. Vomiting 
also occurs and frequent retching, but nausea predominates. 
The vomiting may be bilious. Another frequent symptom is 
a warm glowing sensation in the epigastrium, and there is 
also a tearing, gnawing pain in the same region. We come 
next to a symptom of great importance which is very 
characteristic and does not to my knowledge occur with 
any other remedy. It is "pain in the pit of the stomach 
aggravated by bending forward and relieved by sitting erect.** 
(Belladonna comes nearest, producing a pain in the stomach 
compelling the patient to bend backwards.) This symptom 
is a valuable guide to the selection of the remedy, not only 
in cases of gastralgia but also in cardiac affections. 

Dr. A. Clifton, in his excellent little paper on "Kalmia,**in 
the Review for 1877, alludes to a case of gastralgia in which 
the pains were made worse by sitting bent, and yet a feeling 
as if to do so were necessary, and relieved by sitting or stand- 
ing upright, a crampy kind of pain with eructations of 
wind and palpitation, where kalmia had a marked beneficial 
effect after dioscorea had failed. 

It produces also a feeling of contraction in the stomach 
followed by globus or vomiting, also cutting pains in the 
bowels followed by loose stools. It also causes morn- 
ing diarrhoea with much flatus, and ineffectual urging 
between the stools, also great burning in the anus after 



EALMIA LATIFOLIA. 287 

stool. In one case it caused very marked constipation, so 
that the proving had to be discontinued, the stools being 
large and hard and passed with difficulty. Before leaving 
the alimentary system, I should like to recommend the use 
of kalmia in bilious attacks where headache, nausea, and 
vertigo are the prominent symptoms. 

Next, in connection with the urinary system we find only 
a few pathogenetic symptoms, viz., frequency of micturition 
and increased secretion of urine, also sharp pains in the 
lumbar region and frequent desire to pass urine, urine passed 
in small quantities frequently, and feels warm on passing. 
Unfortunately no analysis is recorded. 

Clinical experience, on the other hand, shows a very 
different state of things, for the provings do not promise 
much. 

Dr. Macy has recorded a case of Bright's disease 
(diagnosis confirmed by Carroll Dunham) which kalmia 
cured. It was given on account of severe and persistent 
pains in the limbs. 

Amdt mentions a case of post-scarlatinal nephritis where 
kalmia proved to be the right remedy after hepar, apis, and 
arsenicum had failed. He says, moreover : " I have used it 
in many such cases and it has benefited most of them. I 
now give it in preference to all other remedies in the second 
stage of scarlatinal nephritis, with pains in the extremities or 
back, or irregular paroxysmal pains in different parts, or 
heart complication." We have already referred to a case of 
albuminuric retinitis where it proved serviceable. 

On the sexual organs we find a slight action. The 
symptoms are scanty : we find pain in the testes ; frequent 
erections vnthout desire, in one prover ; no clinical history. 
The female provers noted, menses either too late or too 
early, accompanied by pain in the loins and back and front 
of thighs. Here, again, Arndt speaks emphatically of its 
use, when he says : — " It is our most efficient remedy in 
irregular or suppressed menstruation with albuminuria." 

The respiratory system we may dispatch with a few 
symptoms — tickling in the larynx, cough with expectoration 
of putrid, saltish, unctuous sputum. The most important 



288 EALHIA LATIFOLIA. 

symptom occurred in one poisoning case, viz., a peculiar 
noise on breathing, as from spasm of the glottis. There are 
other symptoms referable to the chest, but they appear to be 
more of cardiac origin. 

We come now to the circulatory system, where kalmiahas 
played a very important part. Large doses exercise a power- 
ful depressing influence on the heart, reducing the strength 
and frequency of the pulse as low as 35 beats per minute. 
This action appears to be more marked where the fresh 
leaves are used. Provers who have taken large doses of the 
tincture have not experienced the same effect. 

We find the following symptoms : — Weak, slow pulse ; 
pulse imperceptible or irregular ; fluttering of the heart, with 
anxiety ; palpitation, with oppressed breathing and anxiety ; 
also dyspnoea, and sticking pain in region of the third and 
fourth left ribs causing dyspnoea. The palpitation is aggra- 
vated by leaning forward and by mental effort, and in this 
connection I must again mention that important symptom — 
**pain in the pit of the stomach, aggravated by bending 
forward and relieved by sitting erect." You will observe, 
from these interesting symptoms, a resemblance to both 
digitalis and spigelia. 

Dr. Hughes, in his valuable text-book, says on this sub- 
ject: — "Much pain is complained of in the region of the 
cervical vertebrsB, which suggests that, like its analogue 
(digitalis), it acts through the medulla oblongata." Gentle- 
men, I am not going to deny that kalmia acts in this way, 
but I must say I fail to see any connection between the 
medulla oblongata and pain in the cervical region. Then, 
Dr. Dyce Brown, in his paper, says : — " Its action on the 
heart is chiefly in the direction of nervous disturbance.'* I 
do not think we are much the wiser for either of these state- 
ments, for there is only one other way in which any drug 
could affect the heart, and that is, by acting on the heart 
muscle itself, for we are not now speaking of pathological 
but physiological action. Now, I do not think that kalmia 
acts directly on the heart muscle as digitalis is capable of 
doing, when all central connection is cut off, for the slow 
pulse of kalmia is a weak pulse, and does not show evidence 



KALMIA LATIFOLU. 289 

of unusually powerful contraction. So we must conclude 
that its action is through the nervous media, but whether it 
acts on the cardio-inhibitory centre, first exciting, and then 
paralysing it, or on the centre for the accelerating fibres, or 
both, or the terminal ends of either of these sets of fibres, 
the provings are, in my opinion, far too scanty to decide ; 
and unless this point is decided, we are not much the wiser. 
It must, therefore, suflice for the present to know that 
it has a powerful action on the heart, and has been used 
clinically, with excellent results, in organic and functional 
cardiac affections, both acute and chronic. We shall now 
review clinical experience in this sphere. Dr. Arthur 
Clifton has found it useful in hypertrophy with dilatation, 
also in aortic stenosis, where there is severe pain and slow 
pulse. Also in a case of fatty degeneration, with attacks of 
angina. Farrington says : — " It is specially useful when 
gout or rheumatism shifts from the joints to the heart, 
especially when the metastasis is due to non-homoeopathic 
applications to the joints.'* He also recommends it in 
hypertrophy. 

Dr. Oscar Hansen has reported a case where it cured the 
following symptoms — pressing on the inner side of the 
sternum relieved by sitting up, with palpitation and fear. 
In this case sitting upright produced a sensation as if some- 
thing fell away from the sternum. 

Carroll Dunham records a very interesting case of a 
little girl of 10 years who had been ill ten days. I will give 
his ov^m brief account : ** When I entered the room her 
attitude, propped up in bed, her anxious expression of face," 
the livid hue of countenance, and the visible, tumultuous, 
and very rapid action of the heart made it evident she was 
suffering from violent acute endocarditis, perhaps also peri- 
carditis. She had just had acute rheumatism ; great weakness 
of limbs, but no pain. I gave kalmia, though her case was 
pronounced hopeless and I had no hope of her. She re- 
covered completely, and to my surprise had no valvular 
murmur." Here was evidently a bad case of endocarditis 
cured by kalmia. 

Amdt speaks highly of kalmia in pericarditis, saying 



290 EALMIA LATIFOLIA. ; 

that it is but little inferior to aconite in the inflammatory 
stage. 

Dr. Clarke recorded a case in last month's World of 
tachycardia with pain. Thyroidin 30 had on previous 
occasions relieved the tachycardia and did so on this 
occasion, but not the pain ; kalmia 200 relieved both, but 
specially modified the pain in a very short time. 

Kalmia is a remedy to be considered in cases of irritable 
heart, and also in cases of functional disturbance due to the 
influence of gout, alcohol, tea, coffee, or tobacco. We have 
already mentioned a tjrpical case of tobacco heart where its 
beneficial action was manifest. 

Lastly, there is one other important class of cases to be 
mentioned — viz., heart failure from diphtheria. In the last 
number of the Journal of this Society a critical case of this 
kind is mentioned, where Dr. Allen gave kalmia 6 with 
magical effect after digitalis had failed. It might also prove 
useful in the general depression with slow pulse which often 
follows influenza. 

We have said enough to prove kalmia a potent remedy 
in cardiac affections, and will now just consider the chief 
indications for its use in these cases. Besides the symp- 
toms already mentioned — slow, weak pulse, or rapid, irregular 
pulse, the palpitation and pain with its peculiar conditions 
of aggravation and amelioration — there are other important 
indications, such as headache or neuralgia, specially right- 
sided, also pain down either arm which may extend to the 
finger-tips and be followed by numbness. Other remedies 
need comparison for this symptom, such as aconite, rhus, 
and cactus. The presence of shifting pains, vertigo and 
nausea, would greatly help in the selection of kalmia. 

We will now consider its symptomatology connected 
with the limbs, skin, fever and sleep, and general symptoms, 
and then its use in general diseases. 

Limbs and Trunk, — ^We have already mentioned many 
symptoms which belong here. The chief characteristic of 
its action is that its pains affect large parts of a limb at 
once, or several joints, and shift their locality frequently. 
There is no swelling or redness of the joints, which dis. 



EALMIA LATIFOLIA. 291 

tinguishes it from colchicum which, according to Wurmb, 
causes " swelling and redness of joints like rheumatic in- 
flammation which easily and quickly changes its location.'* 

The kalmia pains may, however, be persistent and 
severe, especially when situated in the back. 

They may be much aggravated by movement, but some- 
times the opposite is the case. The joints most affected are 
the larger joints^— knee, shoulder, elbow. The region of the 
knee is a favourite site. It also has an affinity for the index 
finger and ulnar nerve. 

On the skin it produces pricking, itching, burning all 
over, and diaphoresis. 

Sleep is restless with unpleasant dreams. Talking or 
walking in sleep is recorded, also great sleepiness by day. 

Kalmia has not much febrile action, but produces cold- 
ness and shivering ; alternate heat and cold ; heat with 
flushed face but normal pulse. Coldness predominates on 
the whole. 

Its general symptoms are very marked, the chief being 
a great sense of fatigue and languor ; a bruised feeling all 
over ; also lassitude and sometimes restlessness. 

Its use in rheumatic affections has been already referred 
to. The cases of rheumatism where it is indicated are chiefly 
subacute or chronic, or cases due to cold. It may also be 
useful in muscular rheumatism. It certainly is not homoeo- 
pathic to acute articular rheumatism with swelling and 
redness of joints, although Dr. Arthur Clifton in his article 
says it is indicated in such cases where the pains shift about. 
He adds: "More especially when the pains begin in the 
upper extremities and are subsequently felt in the lower." 
Farrington says the kalmia rheumatism spreads upwards, 
but, proverbially, " doctors differ," even homoeopaths, alas ! 

There is yet another disease which I must mention, for 
somehow kalmia has apparently acquired a reputation in 
syphilis. You will have noticed that the cases of scleritis 
where it did good were supposed to be of syphilitic origin. 
Dr. A. Clifton mentions a case of chronic sore throat, with 
great dryness and aching pains in the throat, the dryness 
causing frequent cough. The patient not being relieved 



292 DISCUSSION ON KALMIA LATIFOLIA. 

quickly enough under his treatment, went elsewhere and 
was promptly cured by kalmia, which has all the symptoms 
mentioned ; but the only reason given for the choice of the 
drug is that the patient had had syphilis. 



Dr. Hughes said that kalmia was one of the medicines of the 
future. Its proving had been extensive and thorough, and there 
were a good many symptoms, some of which had already been 
utilised in practice, and some of which bad yet to be utilised. 
The paper would induce them to make a more extensive use of 
the remedy. His own experience of the drug had mainly been 
in connection with neuralgic pains about the head and face. The 
indication which had helped him most had been the tendency 
of the pains not to limit themselves to the trigeminal region, but 
to extend also to the nerves of the neck and arm, especially the 
right arm. If you get an attack of right- sided neuralgia of this 
kind, you may certainly give kalmia with benefit. Its action on 
the heart is undoubted, and if you get a slow, weak pulse with 
a neuralgic patient, you feel the drug to be doubly indicated, but 
he did not think they must wait for that. He thought the action 
of kalmia on the heart pointed to an independent influence on the 
pneumogastric nerves, and without any affection of the heart at 
all or alteration of normal pulse they might get a one-sided pain 
about the face and neighbouring parts in which kalmia should be 
curative. That was the only caveat he would lodge against the 
attempt to widen the sphere of the drug and to look for the whole 
manifestation of the drug in that sphere of action in every case 
one met with. 

Dr. Madden said he had been rather struck with the catho- 
licity of the doses in which the kalmia had been found useful — 
from Ix up to 200. The drug evidently seemed to act in any 
dose so long as one did not give too much. For his part, he 
wished they could all use a less range of doses, and he should be 
glad if all who experimented and used drugs homoeopathically 
would limit themselves to the 12th, and not go rambUng into the 
upper regions, which were always so doubtful as to whether it was 
possible to prepare the medicines sufficiently carefully to be 
accurate. Cases, however, were reported where kalmia had been 
used beneficially in the 200th, so that he presumed there was 
some influence in it somehow, and it was interesting to know it 
would act in any strength. 

Dr. GoLDSBBOUOH {in the chair) said he had used kalmia — ^ia 



DISCUSSION ON EALMIA LATIFOLIA. 293 

the region of the nervous system more particularly — for neuralgia 
and also muscular pains. He had thought that kalmia would 
prove a most useful remedy in some cases of influenza — which 
had been suggested by Dr. Lambert — where there was extreme 
muscular ennui and disturbance of the heart's action as well, 
especially if, in addition to that, as was of frequent occurrence, 
there was neuralgia of the trigeminus. It was a similar drug to 
spigelia, but he did not think they met with the muscular 
tiredness in spigelia that was met with in kalmia. 

Dr. Lambebt quite agreed with Dr. Hughes' remarks as to 
the character of the neuralgia. He (Dr. Lambert) did not think 
that the action of kalmia was confined to the fifth nerves — the 
trigemini — because the pains were diffused over the head. It 
might affect any part, and the pains might go down the side of 
the head or down the back. Then, again, the whole sphere of 
action seemed to affect all the nerves in a general way, and not 
just one particular nerve, except in the case of the supra-orbital 
and the ulnar nerve. Kalmia might relieve headaches in any 
part of the head. He had had a case only that week, the son of 
the man who had had a persistent headache for many years. This 
patient complained of neuralgia of the face, which affected both 
sides; he also had an irregular heart, and a good many other 
kalmia symptoms, such as pains in the joints, and biUous attacks. 
He (Dr. Lambert) gave him kalmia on the Monday, and the 
patient was much better that day (Thursday) ; he no longer had 
neuralgia in the face, although previously he had had it for three 
weeks. The dose he gave was a powder of 3x. He had mostly 
used the lower dilutions. With regard to the man who had 
chronic headache, the last time he saw him he gave him the 
200th, because the lower dilutions seemed to be losing their effect. 
As soon as the patient ceased taking the medicine, the headache 
returned. He supposed that most homoeopaths, when they began 
homoeopathy, were a little sceptical about the higher dilutions, 
but if any present that evening had not read Dr. Dunham's 
remarks on the dose, in his ** Science of Therapeutics," he would 
recommend them to do so. He did not hesitate to say that no 
honest man could read those papers and not be convinced of the 
efficacy of high dilutions up to 200. 



294 ERRORS OF DIGESTION. 



EEBOES OF DIGESTION.^ 

BY C. R. NIVEN, M.B., CM. 

The subject I have chosen — that of indigestion — is not 
one that has forced itself upon me because of its simplicity, 
but because of the slight attention paid to it in our student 
days. Because of its great frequency and importance, it is 
one that will well repay the time at our disposal in its con- 
sideration. 

We must remember that all ingested matter for the repair 
and growth of the organism must be considered outside of 
the body until it is absorbed and arrives at the medium of 
distribution — the blood ; and thus it is that the derange- 
ments of digestion must have a chemical or a physiological 
explanation. 

It will conduce to clearness if we contrast that which 
occurs in disease with that which occurs in health. In 
health digestion is rapid, complete and painless, while in 
indigestion it is slow, incomplete and painful. It is not 
necessary that it be slow, incomplete and painful, all at the 
one time, for we may only have one of these to deal with in 
a given case or we may have any combination of them. 

When we say it is slow, we mean that in some part of 
the aUmentary canal the digestive act is not completed by 
the time it ought to be, or by the time the convenience 
of the individual requires it, and this, if continued for some 
time, gives rise to want of natural appetite, and if long 
continued to imperfect nutrition, anaemia, debility, &c. 

When we say it is defective we mean that the food 
does not undergo the changes that it ought to undergo, and 
so it passes through the intestine and is voided, unaltered or 
decomposed, and it is evident here also that the body will 
not be nourished. 

If it be painful, it may vary from the slightest dis- 
comfort to the most terrible agony, although it may at the 
time be rapid and complete, or slow and incomplete. 

* Bead before the Liverpool Branch, March 14, 1895. 



EBBOBS OF DIGESTION. 295 

Clinically we may divide indigestion into three distinct 
stages : — 

(1) Where the appetite is increased. 

(2) Where the appetite is lost. 

(3) Where there is nausea or vomiting. 

It will be well, however, before proceeding further, to 
refresh our minds with the condition of the tongue and 
stomach in healthy digestion and in indigestion, and the 
light the one throws on the other, taking as our guide the 
classical observations of Dr. Beaumont in the case of Alexis 
St. Martin. 

We can see any day of our hfe that a tongue in health is 
pink, slightly rough and moist, and Dr. Beaumont noticed in 
St. Martin that the stomach corresponded, the colour being 
pale pink, velvety, and that it had a slight layer of lubricating 
mucus. On slightly stimulating its surface (for example) by 
the ingesting of food or tickling with a feather, very distinct 
phenomena occurred. The colour heightened and gastric 
juice was secreted, which trickled down its sides. Experi- 
ment shows that this heightening of colour is due to 
increased circul^ition. If, however, he noticed, this stimula- 
tion be excessive — such as roughly rubbing anything over it — 
it gets pale, the blood-vessels contract, and immediately a 
quantity of mucus is secreted, and if the irritation be still 
greater, as is shown by experiment, the animal shows signs of 
nausea and vomits. 

On one occasion Dr. Beaumont noticed that St. Martin 
had a craving appetite, and he found that the tongue had a 
thin white fur upon it, the stomachic walls showed several 
red spots, and also several very tender and very irritable 
abraded patches. The stomachic digestion of his dinner 
was much slower than usual, taking seven instead of about 
four hours. Now, as everyday general practitioners, we often 
come across cases where the appetite is increased, indeed it 
may be craving, and where even the sight of food, or it may 
be a few mouthfuls, satisfies and may even produce nausea. 
Here it is the saliva in the one case, or the one or two mouth- 
fuls in the other, dropping into the stomach, has caused the 
stomach to pass from slight to violent irritation. 



296 ERBOBS OF DIGESTION. 

Two days afterwards the appetite was gone, the tongue 
had a thin yellow coat, the countenance was sallow, and on 
the stomachic walls there were several deep red patches. A 
muslin bag containing some food was introduced into the 
stomach to test the rapidity of digestion, which when drawn 
out was covered with a coat of mucus and yellow bile. Here 
it is to be noted that the sallow countenance points to the 
inflammatory condition having passed up the bile ducts, 
giving rise to that condition we call biliousness. 

The next day the colour of the stomachic walls was a much 
deeper red than naturally, there were also patches of a still 
deeper colour, and there were also abrasions in different 
places. The deeper colour indicates venous congestion and 
evidences that the hepatic circulation is embarrassed. At 
this .time the secretion of gastric juice was very scanty, and 
the digestive act slower as well as less perfect than usual. 

In conditions such as these the gastric juice has rather 
an alkaline reaction, and so it has little digestive power. 
The food therefore will not be converted into chyme, but 
will pass undigested in lumps, and these will irritate the 
intestine and produce diarrhoea, and if the inflammatory 
condition passes on to the duodenum, it will most likely also 
pass by the bile ducts on to the liver causing disturbance of 
its function, evidenced by those signs and symptoms to 
which the term biliousness is given, such as earthy com- 
plexion, yellowish conjunctiva, irritable temper, &c., &c. 

Clinically it is of much importance to be able to tell what 
sort of food it is that produces the indigestion, so as to be 
able to diet our patients correctly, and that cannot be done 
unless we accurately understand the foods necessary for the 
organism and the changes they undergo in the digestive 
act. 

The foods necessary for the daily wear and tear of the 
body and its growth are : — 

(1) Carbo-hydrates. 

(2) Albuminoids. 

(3) Fats. 

(4) Water. 

(5) Various salts. 



EBBOBS OF DIGESTION. 297 

We may divide indigestion into various classes according 
to the food that produces it : and as the alimentary canal 
18 divided into three distinct parts by the pyloric and csecal 
sphincters, we may again divide indigestion into periods 
according as the food mass is in the stomach, intestine or 
colon ; but it would manifestly be wrong to say we have a 
disease of the salivary, stomachic, intestinal or colonic glands, 
as the discomfort felt soon after a meal may be due to distant 
organs, e.g,, uterus, kidneys, lungs, &c. Of the symptoms 
of indigestion such as heartburn, acidity, vomiting, head- 
ache, angina pectoris, pains, including spasms, gripes, weight 
and. wearing pains, waterbrash, diarrhoea, constipation, 
flatulence, piles, &c., it would manifestly be advantageous. 
to speak of them as diseases independent of the causes, but 
the time at my disposal forbids anything being said ; nor will 
it be possible to say anything about treatment. 

As I shall presently have occasion to speak a little fully 
on the digestion and indigestion of starchy, albuminoid and 
fatty articles of diet, I shall at once proceed to the considera- 
tion of the indigestion of water. At first sight, it almost 
appears ridiculous to speak of such a thing, and yet it is of 
very frequent occurrence. 

The assimilation of water is much easier than that of 
any other article of diet, and is by endosmosis and according 
to the mechanical laws of diffusion. Thus, when an animal 
membrane is placed between two fluids of different densities 
a current passes both ways, but quicker from the rarer to 
the denser, and that in direct proportion to the density. 
Secondly, the current is increased in the direction of a 
liquid in motion. Thirdly, the current is also increased in 
the direction from an acid to an alkaline mixture. Fourthly, 
the activity of osmosis increases with the temperature. 
Thus, when we consider the passage of a liquid from the 
stomach or bowels to the blood-vessels, we have the 
greater density of the blood ; its motion and alkalinity and 
the animal warmth will keep up the general activity of the 
osmosis in both directions. Now, whatever gives rise to a 
diminution of any of these conditions, the assimilation is 
retarded, and any excess remains inconveniently long in the 



298 EBROBS OF DIGESTION. 

canal. For example, in chlorosis or anaemia from loss of 
blood, such as is got in piles, there is an infringement of the 
first law. It is comparatively easy to tell it from wind, for 
the noise of wind is worse after exertion, whereas water is 
only on motion, and the sound is a glug-glug. The second 
law is exemplified by valvular disease of the heart, and 
seemingly only when the persons are otherwise healthy, 
as anything that impedes the circulation will impede it, e.g., 
emphysema. We have a perfect exemplification of the 
third law every day before breakfast, when it will be found 
that the urine is of higher specific gravity ; but on breakfast 
being taken, the stomach is roused to acidity, and so a great 
amount of fluid enters the blood-vessels, reducing the specific 
gravity. 

Whatever retards the assimilation of water will also 
retard the salts it has in solution, and we saw that chlorosis 
and anaemiae exemplified the first law* Now, when reading 
Dr. Hughes* *' Pharmacodynamics,'* I was forcibly struck 
with the explanation he gave of the value of iron in chlorosis. 
He calls it a food, and in that he is correct, though to me 
the explanation was new. How often does it happen, 
however, that though we give iron in large or small 
quantities — and there never is a case that we have not to 
give many and many times over the quantity the blood holds 
— very little benefit accrues. Now, the blood has many 
more inorganic things as necessary constituents than iron, 
and the salts of potass and soda are the most important : if 
these also be deficient, it will be necessary to replace them as 
well as the iron, and this would explain the rapid improvement 
so often observed in chlorosis with iron after a preliminary 
course of potass salts, for they not only supply a necessary 
want, but they increase the density of the blood. I am not 
aware that this explanation has ever been given before. 

Blaud*s pills have a great reputation in the treatment 
of chlorosis, and the sulphate of potass that is formed is 
allowed to overcome the constipation the iron produces, 
and the nascent iron carbonate is held to be more easily 
absorbed, but if my explanation be correct, a new light is 
shed upon the fact, and it becomes the truest practice. 



ERROBS OF DIGBBTION. 299 

From a consideration of these facts, it is an easy step to 
the DQore difficult subject of dialysis. 

Graham taught that all bodies may be divisible into two 
great classes, according as to whether they will or not, in 
solution, pass through an animal membrane. Those that 
passed through, he noticed, were crystalline in the solid 
state, and those that did not pass through were not crys- 
talline in the solid state ; and thus his two great divisions 
into crystalline and colloid bodies. Since his time, however, 
a number of departures from his rule have been observed. 
Thus haemoglobin, which is crystalline, will not pass 
through. This, at first sight, seems very strange. But 
crystalline bodies, as a rule, have a low molecular weight, 
while colloid bodies, as a rule, have a great molecular weight. 
Haemoglobin, however, though it is crystalline, has a great 
molecular weight, and thus it would seem that the ability to 
pass through the fine meshes of the animal membrane 
depends on the size of the molecule. That this view is 
correct is confirmed by an observation of Traube, who found 
that a membrane of gelatine tannate would allow barium 
nitrate, with a molecular weight of 130'6, to pass through, 
while it stopped ferrocyanide of potassium, with a molecular 
weight of 211'4. It is necessary to keep this fact in mind 
when we come to deal with the absorption of food, for on it, 
and on the ability of the liver to prevent organic poisons 
passing into the circulation, depends our well-being. 

During mastication — at first sight, a very simple affair — a 
great many things happen. First, the food is mechanically 
subdivided, and so a greater surface is exposed for substances 
soluble in water, and the flavour is thereby increased. It 
also causes a flow of saliva, which will be augmented by the 
increased flavour — the office of which saliva is to convert 
starchy particles into dextrine, and then into malt sugar. 
But the action of mastication does not end here, for it has 
been observed, in a case of gastric fistula with an occluded 
oesophagus, that there is a secretion of gastric juice during 
mastication, so as to be ready for the food when it shall 
reach the stomach. We all know that an organ is active in 
proportion to the amount of blood supplied to it, and this 

VOL. III. — NO. 3. 21 



300 BBBOBB OF DIGESTION. 

we now know happens to the saKvary glands during masti- 
cation, for Marey observed that the current of blood in the 
carotids of a horse while eating was increased three times. 
This is, however, not all sent to the glands ; a part goes to 
the brain, as has been proved by the fontanelles of a child 
rising during suction ; and this increased flow of blood to 
the brain will enable the nervous apparatus that governs and 
co-ordinates the complex act of digestion to be completely 
performed. This increased flow of blood to the brain is still 
further increased by the act of swallowing, for it removes 
the inhibitory action of the vagus, and so the heart works 
quicker. 

The saliva also acts the part of a lubricant and enables 
the food to be swallowed, which after reaching the stomach 
will find already, if the person is not melancholic, and if the 
meal has been savoury, a quantity of gastric juice awaiting it. 
Now the gastric juice is acid, and its first action will be to 
neutralise the alkaline saliva, to digest the albuminous 
envelope of any starch granules that have escaped rupture, 
and the alkaline saliva will in turn cause a further secretion 
of gastric juice. The starch is still further changed into 
dextrine, but it is difl&cult to say whether the further con- 
version into malt sugar goes on or not. Whether it does so 
or not this conversion into dextrine is of immense import- 
ance, for it has been shown by experiment that the stomach 
of an animal which some time before had digested a full meal 
had very little power to digest albumen introduced directly 
into it ; a similar fact was noted in regard to an extract 
made from the stomach itself. The stomach seemed to be 
exhausted by the effort of digesting a full meal several hours 
before, and to be incapable of producing pepsine. If, how- 
ever, certain substances were first introduced into the 
stomach the power to digest albumen was enormously 
increased. These substances, by the experimenter Schiff, 
have been called "peptogens," and the most powerful of 
them he found to be dextrin and soup made from meat. 
That absorption after complete conversion is rapid is shown 
by the fact that it is very difficult to get a trace of sugar in 
the contents of the stomach. The action of the gastric juice 



ERRORS OF DIGESTION. 301 

is confined to the albuminous part of the ingesta, the 
particles of which it causes to swell up and break up into 
simpler molecules by a process of hydration. The first step 
in the process is the combination of the albuminous bodies 
and the hydrochloric acid of the gastric juice to form acid 
albumen, to which is given the name of syntonin. This form 
of albumen is recognised by being soluble in acids, but pre- 
cipitates on neutralization. A further step is now taken in 
the conversion of this syntonin into hemi-albuminose, which 
has a characteristic reaction, as it is precipitated by strong 
nitric acid, but dissolves on heating and reprecipitates on 
cooUng. It differs from ordinary albumen in not being 
precipitated by heat, and in being soluble in either a weak 
acid or a weak alkali. The final step is now taken in the 
conversion of these into true peptones which readily pass 
through animal membranes, thus showing that a great 
change has taken place, for albuminous bodies do not pass 
through. Peptones also differ from other albuminous bodies 
in not being precipitated by heat nor by acids. These 
peptones are very poisonous, for if they be injected into the 
general circulation they produce loss of coagulability of the 
blood, fall of blood pressure and death. This, however, is 
not all that happens, for Brieger has got from an amylic 
alcoholic extract of gastric peptones an alkaloid having an 
action like that of curare, to which he has given the name of 
peptotoxin. The action of this is not (so far as I am aware) 
known, but it at least may explain the bitter taste found in 
artificial digestion. Again, in decomposing albumen a number 
of alkaloids have been obtained which, by Selmi, are termed 
ptomaines, and these, if they happen to pass the liver where 
a great number are formed in certain forms of indigestion, 
may explain the toxflemic conditions that come before us in 
the treatment of indigestion. There also is a partial decom- 
position of fats in the stomach, resulting in the formation of 
a small amount of fatty acids which aid in emulsifying the 
rest. The food after a longer or shorter time passes the 
pylorus, but why this sphincter should relax at definite times 
is not known. Before, however, noticing the changes that 
take place in the intestine it will be well to consider a little 



302 ERRORS OF DIGESTION. 

in detail the conditions that influence adversely the digestion 
in the mouth and in the stomach. 

For thorough subdivision of the food we require a good 
set of teeth and perfect mastication, and for the solution and 
conversion of the starch a sufficiency of saliva, and at the 
proper time. The salivary glands are easily exposed to 
derangement, temporary emotion affecting them tempo- 
rarily, and continued emotion affecting them chronically, 
examples of which are got in the dry mouth of one in great 
fear, such as the coward ; or it may have happened to some 
of us when wishing to say something very nice to some very 
pretty girl, it has been impossible to utter a word because of 
the dry condition of our mouth ; but whether that be or no 
I take it that we have all known some great sorrow, and how 
difficult it has been to swallow a mouthful, even then so long 
does it take to moisten it. Nearly all morbid processes affect 
the fauces and tongue, and thus it is that the digestion 
of starch easily suffers the first, the most completely, and 
the most commonly. But gastric juice is also necessary for 
the digestion of starch, for in the best cooking many starch 
granules escape rupture and in bad cooking most escape 
rupture. But gastric juice is a highly animalised substance, 
and for its production you require good fresh blood ; hence 
if it is deficient because of the condition of the blood, you 
require to make it, and to make blood you require meat 
food. For salivary digestion also you require a sufficiency 
of pleasurable emotion. 

Nearly enough has been said already as to the conditions 
that influence adversely the stomachic digestion. We noted 
that mastication itself, and especially the ingestion of any 
savoury article such as soup, rouses the stomach to activity 
so that when the more solid portions of a meal are taken 
there is a quantity of gastric juice awaiting it ; this con- 
tinues to be secreted, and this secretion is encouraged by the 
simple act of chewing — especially so if any savoury article 
is in the mouth, and this is the reason why cheese and 
sweets are taken after dinner. Suppose, however, the 
stomach is not performing its function properly — and it is 
not my intention at present to take up the causes of indiges- 



BBBOBS OF DIGESTION. 303 

tion, such as eating too little, eating too much, tight lacing, 
solitude, intellectual exertion, abuse of alcohol, tobacco, 
tea, purgatives, &c., for it would seem as if the indigestion 
of albuminoids was less interfered with by external in- 
fluences than carbo-hydrates, but rather is it some con- 
siderable debilitating action on the nervous system which 
begins proteinous indigestion — suppose, I say, the stomach is 
not performing its function properly, as, for instance, when 
the digestion is slower and the gastric juice lessened in 
quantity, alkaline rather than acid, and a great amount of 
mucus thrown out — the normal gastric juice being an anti- 
septic as is seen by putrid meat becoming less so in passing 
through a healthy animal — if it be inactive and less in 
amount, then the albuminoid food will not be digested, and if 
a lot of mucus is thrown out it will prevent the action of 
whatever gastric juice there is. Decomposition is permitted 
with the liberation of gas and development of poisonous 
alkaloids, and when passed on to the intestine if the same 
things exist then the small intestine cannot urge on but 
glides over the sKppery mass, the other foods will ferment, 
the intestines will not be nourished, hence costiveness super- 
venes and the faeces have a hard, lumpy, slimy character. 
It is necessary to remember these facts, for the pancreatic 
juice does not seem to have an antiseptic action ; in arti- 
ficial digestion, though the albuminoids are converted into 
peptones, these in less than a day decompose into leucin, 
tyrosin, indol, &c., but poisonous alkaloids are also generated, 
and here is the danger. 

On reaching the duodenum the partially digested food — 
the chyme — meets the bile and pancreatic juice. The first 
act here will be to neutralize the acidity and render it 
alkahne, stopping the further action of the pepsin and pre- 
cipitating the syntonin. It is to be noted also that the bile 
accumulates in the gall bladder, and it seems to be the acid 
chyme that reflexly causes its ejection ; for an acid injected 
into the duodenum is at once followed by a rush of bile, 
whilst no such effect follows that of an alkaU. 

The pancreatic juice acts on albuminoids, carbo-hydrates 
and fats. It splits the fats up into fatty acids and glycerine 



304 EBBOBS OF DIGESTION. 

and emulsifies them, completes the changes of starch into 
sugar and makes albuminoids crumble away not, like the 
gastric juice, making them swell up. The amount of 
peptones produced, however, does not correspond to the 
amount of proteids acted upon ; other bodies, e.g., leucin, 
tyrosin, &c., are produced. Some of these are fatty bodies, 
whilst others are characterised by their peculiar (faecal) odour, 
e.g., indol. 

If two animal membranes be taken, one wetted with bile 
and the other with water, and oil be made to pass through 
them, the passage of that through the one wetted with bile 
will be very much faster. Thus we see the wetting of the 
intestines with bile enables fats to be absorbed. It also 
emulsifies fats, stimulates the intestine to contraction and 
acts as an antiseptic. 

All through the intestines after this the contents remain 
alkaUne, and the intestinal juice seems to have as its func- 
tion the converting into peptones of albuminoids which had 
been converted into syntonin by the gastric juice, but which 
had not reached the stage of peptones in the stomach before 
passing the pylorus into the duodenum. It should be stated 
here that the glands of Briinner (in the duodenum) are said 
to yield a secretion which in an acid mixture digests fibrin but 
has no effect on carbo-hydrates. Those of Lieberkiihn in the 
rest of the intestine are alleged to have a digestive action on 
proteids, fats and carbo-hydrates. Much work, however, 
requires to be done to accurately understand the changes 
that take place in the intestine. 

No digestion goes on in the great intestine, and the 
matter there is of a distinctly faecal character, and acid in 
reaction. This acidity, however, is due to acid fermentation 
going on in the contents of the great intestine, for the gland- 
ular secretion is alkaline in reaction. This fermentation 
leads to the formation of lactic, butyric, and other acids ; as 
also to the evolution of marsh gas, hydrogen, and sulphuretted 
hydrogen. 

As my definition of indigestion was a defect anterior to 
constructive assimilation, and therefore to the blood, we must 
follow the dissolved food till it reaches and passes the liver, 



£SBOBS OF DIGESTION. 305 

for only then has it entered the circulation — the systemic 
circulation. 

When the soluble portions of the food have passed 
through the intestinal walls into the blood-vessels they will 
be taken up by the red blood corpuscles. The peptones are at 
once changed by dehydration into larger albuminous mole> 
cnles — globulins, and these will be carried to all parts of the 
organism and given off where wanted : part will be arrested 
in the liver and converted into glycogen ; for if peptones 
be injected into the bowel the glycogen in the Kver is 
increased. The sugar also is dehydrated and converted into 
glycogen, and stored thus in the liver ready to be given out 
according to the requirements of the organism. 

While students we were perhaps taught that the office 
of the liver is to secrete bile, and then the characters and 
threefold action of the bile were givea. I need not say, 
however, from what has already been said, that this view is 
entirely erroneous ; for the bile is not so much a secretion as 
an excretion, which in the economy is utilised for certain 
purposes. And here, before going further, I desire to draw 
attention to the fact, as shown by Dr. Green, of Sandown, 
in a case of biliary fistula, that bile is not bitter ; and, indeed, 
jaundiced people very seldom complain of a bitter taste. 
Alkaloids, however, whether vegetable or not, have all, I 
think I am correct in saying, a very bitter taste, and Dr. 
Bence Jones has found in the bile in the liver and other 
organs an alkaloid resembling quinine in many of its rela- 
tions ; and it is to alkaloids such as this, when bitterness is 
associated with bile, that the bitter taste is to be ascribed. 
I said that the liver is not an organ put in the body simply 
for the secretion of bile. Two of its functions we have 
already not^d, namely, the elaboration of peptones and 
sugars into globulins and glycogen. Another function 
equally important is the prevention of organic poisons 
reaching the circulation, or at least only allowing them to 
do so in small quantities at a time so that they may be 
eliminated by the kidneys. Indeed, this sentinel action of 
the liver is necessary for the prevention even of peptones 
and sugar passing into the circulation before being 



306 EBBOBS OF DIGBBTION. 

elaborated into globulins and glycogen, for if they be 
absorbed too rapidly and passed into the circulation with- 
out this elaboration, they may be either very injurious or else 
be eliminated as waste products ; and if we suppose hemi- 
albuminose to be absorbed, we can thus explain glycosuria 
and physiological albuminuria. Indeed, in a great number 
of distinctly healthy people it is possible soon after break- 
fast to get traces of sugar in the urine, evidently from the 
amount of carbo-hydrates taken at that meal. It may be 
noted, further, that Lehmann found that sugar injected into 
the mesenteric veins of a rabbit during digestion did not 
appear in the urine, while in a fasting one it did. This 
points to the liver or portal blood. I do not know that the 
exact steps by which sugar is built up into larger molecules 
is known. These smaller bodies getting entrance into the 
systemic circulation may, as we saw in our remarks on 
dialysis, diffuse through the kidney glomerule while the 
larger ones will not. Physiological albuminuria may be 
of little import, but it may lead to kidney disease, for 
Stokvis has shown that hemi-albuminose, as also egg 
albumin which has a smaller molecule than serum albumin, 
if injected under the skin appears in the urine, while the 
other does not, and if only done once or twice may do no 
harm, but if continued appears to give rise to organic mis- 
chief. As all the venous blood from the stomach and intes- 
tines, except that by the middle and inferior haemorrhoidal 
veins, has to pass through the liver, it is thus that any 
products of imperfect digestion are likely to aflfect the 
hepatic functions and not improbably to derange them. 
The liver is a very elastic organ, as may be seen by the 
experiment of artificial circulation. If the blood pressure 
be increased it greatly expands, and contracts again when 
the pressure is reduced. The blood is seen to flow very 
easily through it sometimes, at others it is slow, the capil- 
laries evidently offering great resistance; this, it would seem, 
depending to a great extent on the quality of the blood pass- 
ing through it. Let us suppose that any person to whom 
the liver belongs permits any indiscretion in eating or drink- 
ing, and that this leads to imperfect digestion, the decom- 



EBBOBS OF DIGESTION* 307 

posed products passing to the liver will cause an obstructed 
flow of blood from the stomach and intestine ; this will give 
rise to venous congestion of them, and, as we saw in the 
first part of our paper, will interfere with digestion in them, 
and thus a vicious circle is estabUshed. 

I said that the third action of the liver was the preven* 
tion of poisonous bodies passing from the intestine into the 
systemic circulation. We are all aware of the terrible 
consequences of such poisons as that of snakes and curare 
when introduced into the circulation by a wound, and their 
comparative harmlessness when taken into the alimentary 
canal. The explanation that has usually been given is that 
the stomachic secretion destroys them ; this, however, dof;» 
not seem to be the whole truth. The Uver seems to have 
the power of destroying some poisons »uch a« rjicoline ; and 
what happens with the others seems to be thi^, that they 
are immediately absorbed, but separated imme^liately again 
from the portal blood by the secretiiig ti.^Aae of the liver, 
and poured back again with iLe cfle ir.to tr^e iuU^hUnf-.n, thnn, 
completing the circle wLich is enacted a^a.'n and a^ain, and 
preventing them rearrirg the Lean or bTa;n, Some, how- 
ever, do seem to reach the njiterL.ic circulation, biit in 
such small qoantides that the ki-inej^ excrete them ar,d 
prevent their accani:ilaticii. These pci^or^O'i^ s>f/^tance?i, 
however, are no» all rnsrodaced into the iz^Ze^zir^e from with- 
out ; a great many are ^^xjetaczed in ti.e inc^i^tine^ them- 
selves, and that chieiiy in tw j way a. We have alrea^'ly 
noticed that Brieger haa octiained a poiAor.o»i% 3kVKii,WA hcxci 
gastric digestion which he haa named pepiu-^coixiTi, b *t by far 
the ^jeatest amoGnt; of alkaL^ida is prcd;;ce^ cj p'^arefao 
tim set up by bacteria- If proof be a^ked that tr.ey are j4o 
developed it may at once he fitaced that lihej ha^e been 
sepazated from freahly ^rcided arine aiid freshly v >i(ied fapces 
by diatyaSr and then in rahcita have pro^aced ^vere o'^nT^^U 
and death. These poiaoncua prodact^^ are not aii nhe 
^, far di^ vary with the body deccmw'jied, with the 
or fennent atarting' the decomposition, with zae. 
snd with die time the putretaetion haa been 
goiBg GD^ I do not mean to 3ay that all bodies so deveiooed 



■j,t II •"^♦'^m* 



308 EBBOBS OF DIGESTION. 

are poisonous to the organism, as a great many are not. 
There is this very important fact to be noted, that those that 
are produced if separated at once may retain their virulence 
for any length of time, but that when different kinds are 
mixed together or exposed to the continuous action of the 
putrefactive process, they undergo further decomposition 
and become inert. 

As I have already occupied more time than is allowed, 
my further examination of this important subject will be the 
briefest possible, consistent with clearness. I need not 
remind this meeting of the dangerous symptoms that may 
be set up by ** high meat " or tainted fish, and with these 
two examples along with another I shall presently adduce, I 
will be able to illustrate whatever else I have to say. 

Brieger, by sowing bacteria on flesh, obtained a very 
poisonous alkaloid which he called "neurine"; and in the 
same way from fish he obtained *' muscarine.'* Other bodies 
were got, but at present we may neglect them. The great 
value of Brieger's experiments lies in the fact that he 
crystallised these bodies and subjected them to chemical 
analysis, and was not content with getting simply extracts. 
This second body, muscarine, is of interest to us as homoeo- 
paths because it is identical or nearly identical with our old 
friend " agaricus muscarius '* and had never before been 
obtained except from the vegetable source. Now suppose 
either flesh or fish is eaten just before it can be said to be 
tainted, the high temperature of the body will cause the 
putrefactive act that was just beginning to progress rapidly, 
and thus a great amount of these alkaloids may be produced. 
This fact is of the greatest importance, because a person or 
a number of persons may be attacked with gastro-intestinal 
disturbance set up by these poisonous products although 
the part uneaten may still seem sweet. It is perhaps with 
milk that we may oftenest have to do in cases of this kind. 
How many children do we see in summer with violent 
vomiting and diarrhoea, although the mother may tell us 
that the milk the child got was quite sweet and the bottles 
quite clean ; indeed if the milk be examined it may still 
seem sweet though the examination be some hours after- 



EBROBS OF DIGESTION. 309 

wards. It may be the milk was just ** on the turn," and 
although it may remain sweet for some hours longer yet in 
the child's stomach a very poisonous product may be pro- 
duced, the putrefactive action being accelerated by the 
bodily temperature. 

Our other and third example, another very important 
alkaloid named choline (because first obtained from bile), is 
got by boiling bile, or yolk of egg, with baryta. Now choline 
and neurine are closely allied chemically, and choline if 
oxidised by strong nitric acid gives artificial muscarine. 

Muscarine is much stronger than choline and has a 
marked action on the heart of a frog, which choline has not. 
Artificial muscarine is still stronger and has a paralysing 
action on the ends of motor nerves like curare, which 
natural muscarine does not seem to hxtve, or only very 
weakly. The action of these three bodies — neurine, musca- 
rine and choline — is the same. They all produce salivation, 
diarrhoea, vomiting, dyspnoea, paralysis and death. Though 
they all do this it is not in equal degree, for the power of 
neurine is ten, and of artificial muscarine fifty times greater 
than that of choline. They stimulate glandular organs, 
because with salivation there is secretion of tears and moist 
rales in the chest. The dyspnoea is probably due to a 
stimulation of the medulla; or possibly to contraction of 
the pulmonary blood vessels. 

In the dieting of patients we are often met with the 
remark that they cannot take milk or eggs, the reason given 
being that they make them bilious and are binding. Now we 
saw that choline may be got from yolk of eggs, and it has 
been found that in yolk of eggs there is a body, lecithin, from 
which choline may easily be obtained. Milk also contains 
lecithin though in much smaller amount than yolk of eggs. 
The toxic action of choline or muscarine we saw was to 
produce, among other things, diarrhoea. But the objection 
we often meet with in advising a milk diet is that it is 
binding. Between this binding condition and the full toxic 
effects of choline and muscarine there is an immense 
distance, and it may be explained by supposing that in the 
one we have a small amount and in the other a large amount 



310 ERRORS OF DIGESTION. 

of poisonous material produced, or it may be that the ex- 
planation lies in the amount that passes the liver into the 
circulation. 

The face and lungs in poisoning with these bodies are 
pale, but there are other alkaloids (Zuelzer and Sonnenschein 
have obtained such) which have a flushed face, dry mouth, 
dilated pupils, quick pulse — ^indeed an action identical with 
atropine poisoning ; and it is found that atropine is an anti- 
dote if given in time to poisoning by choline, neurine and 
muscarine. It may be that in the alimentary canal, when 
putrefaction is going on, both kinds of alkaloids are 
developed, and these will act as antidotes to one another ; 
but on the other hand it may be that only one kind is 
developed, or developed in excess of the other, and then the 
toxic effects are evidenced. 

Other toxic cases have been seen partaking of the charac- 
ters of both kinds of alkaloids, and it may be that there 
is an alkaloid or alkaloids possessing such, or it may be 
that the poisoning was due to a combination of the two 
kinds of alkaloids ; for though it is true that atropine will 
stop death by poisoning with either choline, neurine or 
muscarine, it is true within certain limits only. If the dose 
of these be great, or if the atropine be not injected early 
enough, the animal will die, and that especially so with 
choline or artificial muscarine, because they cause paralysis 
of the motor ends of the nerves, and atropine itself has this 
action, and thus its exhibition will only increase this action 
of these bodies. 

These, however, are not the only alkaloids that have been 
separated and studied, as the number now is very great and 
the subject is daily widening in its scope, results and teaching. 
The future is full of hope, for from investigations such as 
these much will be learned as to true dieting and other treat- 
ment. Medicine will be the richer, and humanity the better, 
because of the unrecognised labours of those who in the 
realms of research sought for truth. 



CASES OF INFANTILE SCUBVY. 311 



NOTES ON CASES OF INFANTILE SCUEVY.^ 

* BY ED. M. MADDEN, M.B. 
Physician to the Phillips Memorial Hospital^ Bromley, 

K. W. was born on April 15, 1894. Her father had 
strumous disease of the hip as a boy, and her mother, as a 
child, had been a martyr to strumous ophthalmia and 
adenitis. One brother had died at the age of 3 months, 
from tuberculosis, but one sister, the only other child, was 
quite healthy, and is now over 7 years old. 

Her mother had never been able to suckle her, and she 
had been fed from the first upon humanized milk, obtained 
froin the Aylesbury Dairy Co., all attempts to change the 
food being immediately followed by vomiting and diarrhoea. 

On November 17, I was first asked to see this child, I 
being at the time attending her father and sister for attacks 
of epidemic influenza of a mild type. I was told the baby 
had been fretful and out of sorts for some days, and seemed 
to cry as if in pain on any attempt to move her left arm or 
left leg. Her temperature was 100', but besides this pain 
there were no other symptoms discoverable and nothing 
abnormal was to be seen or felt on the affected limbs. She 
was an unusually fine fat baby, and as a rule as happy as 
possible, and up till now had been using her legs strongly, 
and could almost stand alone ; but from this time she was 
quite taken off her legs, and could not even bear them to be 
placed on the ground at all. She continued slightly feverish 
for three days, though never over lOl'S**, and often cried as 
if in sudden pain, and on the 21st a fine red papular rash 
came out all over her face, trunk and arms, like the begin- 
ning of an acute attack of general eczema ; but it never 
went any further and had disappeared in four days. The 
medicines she had during this time were aconite 3 ; and bella- 
donna 3 ; but already — by November 23 — I began to suspect 
scurvy, because of the persistent pain on slight movement of 

» Presented to the Section of Medicine and Pathology, May 2, 1896. 



312 CASES OP INFANTILE SCURVY. 

the legs, and the evident tenderness on pressure, though I 
could detect no swelling over the lower ends of the tibiae, and 
I ordered her to take calcarea phos. 3x every four hours, and 
two teaspoonfuls of orange juice in the day. No change 
taking place the parents could not be persuaded that the 
baby was not suffering from rheumatism, and begged me to 
treat her on this supposition. The next week was con- 
sequently wasted in giving her first bryonia, and afterwards 
rhus tox., and applying hot flannels, &c., to the painful limbs, 
without in any way alleviating her pains, as she seemed to be 
only contented when Ijring perfectly still in bed ; she was now 
evidently losing her appetite and getting to look weak and 
poorly, and had heavy sweats in her head and neck during 
sleep, from which she would frequently wake up screaming. 

As the case was not progressing, and the diagnosis was 
not an absolutely certain one, I asked the parents' leave to 
get their former medical attendant, Mr. H. Harris, of 
Denmark Hill, to see the child with me, which he accord- 
ingly did on December 11, and, after a careful examination 
and consultation he unhesitatingly confirmed my opinion 
that the case was one of infantile scurvy, combined, as it 
so constantly is, with rachitic symptoms, and we agreed to 
give her calcarea carb. 12 lUv. every six hours, and that she 
should have two teaspoonfuls of raw meat juice, as well 
as two of orange juice every day, while continuing the 
humanized milk as her ordinary food. This treatment 
was continued without any change till January 18; she 
took what was given, but showed no liking for the meat 
juice, and positively an aversion to the orange juice, con- 
trary to the usual experience in these cases. All this time, 
too, the child was taken out of doors nearly every day on a 
specially constructed perambulator on which she could lie 
at full length. 

From the very first she began to improve, and by the 
end of a month she seemed almost herself again as regards 
general health ; she had ceased to sweat in her sleep or 
wake with screaming, could bear her limbs to be handled 
freely, and kick them about as she lay on her back, but 
could not bear the least weight on them. I could not believe 



CASES OP INFANTIIiB SCUBVY. 313 

tikSbt the humanized milk was the best food for her, and 
inade one or two efforts to change it for fresh milk, with 
barley water and a little farina of one sort or another, but 
it was no good, everything else invariably set up sickness 
and diarrhoea, and threw her back as to her general health. 
She remained practically in statu quo for another month, 
and meantime had cut three incisor teeth, the cutting of 
eacli of which was accompanied by manifest relapses in her 
health for a few days, with sickness, fretfulness and a dis- 
inclination to move. 

About February 12 she got a cold and again became very 
sick for a time, and refused all her food, but was put right 
again by arsenicum alb. 3x taken for a week, after which 
tbe calcarea carb. was resumed in the 6th dilution. 

On March 12, Frame food was added to her bottles of 
humanized milk and seemed to agree very well, but on March 
21, from no apparent cause, there was a distinct relapse of 
the scorbutic symptoms, and having now cut some teeth the 
gums at their roots were swollen, blue and tender, but not 
ulcerated, while the lower ends of both tibiae were distinctly 
enlarged as well as being very tender to touch, and a small 
patch of herpes came out over the left instep. 

She was again given arsenicum for a week and Frame food 
made with fresh milk and water was tried, but she could not 
digest it. She was, however, able to take alternate bottles 
of humanized milk and Benger's food made with fresh milk, 
and she again made a rapid change for the better, so that by 
March 28 the gums appeared quite healthy, the legs were 
hardly at all tender and the swellings on the tibiae markedly 
reduced. She now returned again to the calcarea carb. 6th, 
and in a few days went to Margate, where she is to stay all 
the summer. On April 9, her mother wrote to me giving the 
following report, which I will quote in her own words : — 
** You will be glad to hear that baby is doing wonderfully 
well on Frame food made with cow's milk and water ; the 
nailk is very rich down here and although I have slightly 
increased the quantity of milk and decreased the water she 
still digests it in every way, and is taking now nothing else. 
I have tried bread and milk, for she has seemed so hungry. 



314 CASES OF DCFANTILE SCUBVY. 

but without success. She has another tooth well through at 
the top, but I fancy the scurvy is showing on her tongue, 
which is discoloured, as the gums were, underneath and 
round the edges. Her legs are about the same as when you 
saw her, tender to the touch in places. She gets a sea- water 
and seaweed bath every day and is very tanned as she lives 
in the open.** She then goes on to tell me that she has 
come across two other children suffering in the same way as 
her own, one aged 20 months and the other 6 months, and 
who had both been brought up on the humanized milk. 

The two points of special interest in this case are the 
fact of its coming on while taking this special food, which 
has always been recommended by the highest authorities as 
the very best substitute for mother's milk, but which it will 
be well to remember in future should be supplemented after 
the first four months by the addition of some raw meat 
juice ; and secondly, the sudden onset of it with a feverish 
attack (possibly influenza), which gave me the very rare 
opportunity of seeing the case from its beginning, though at 
the same time it added considerably to the difficulty of 
making its diagnosis. 

My next case is a doubtful one of either pure struma, or 
struma combined with scurvy. This is a case which some 
of you may remember, as I sent her up to the last consulta- 
tion Friday at the Homoeopathic Hospital, on April 6. 

Edith H., aged 1 year and 10 months, was first seen on 
March 1, 1895. Her father is a respectable mechanic, and 
though small made and thin, has no special weakness that 
I know of ; her mother, however, has, within the last six 
months, developed definite tubercle on the left lung, and she 
dates her decline positively since the birth of this child. 
Two elder children, though not strong, are subject to no 
special ailments. She was only suckled for a very few weeks, 
and then was fed by hand almost entirely on Savory and 
Moore's food, prepared vnth fresh milk, until she was eight 
or nine months old, after which she was given anything the 
others were having. Her teeth were cut in a normal way, 
and are strong and healthy looking. Up till six weeks 
before I saw her she had been a strong, fat, happy child, but 



M 



OASES OF INFANTILE SOUBVY. 315 

about this time there was noticed a swelling in the right ring 
finger, the left little finger, and towards the outer part of the 
right lower eyelid. Although these swellings appeared to 
give her no pain, she graduaUy fell off in her general health. 
lost her appetite, became fretful, and cried if put on her feet, 
as if her legs hurt her (formerly she had been able to walk 
and run quite strongly), though there was no tenderness or 
swelling to be found on the lower Hmbs. The swellings on 
the fingers were fusiform, involving, in each case, the whole 
of tlie middle phalanx, equally distributed all round the bone, 
and making that part of the finger about twice the size of 
the unaffected parts. In the eyelid the swelling was globular, 
about the size of a small marble, freely movable, though it 
was more or less attached to the lower margin of the orbit, 
and the surrounding portions of the lid were puffy and dark 
coloured. All the swellings were quite painless- on mani- 
polation, were hard with an indefinite sense of deep fluctua- 
tion, and the conclusion I came to was that those in the 
fingers, at all events, were periosteal, and I suspect that 
in the eyelid also started from the orbital margin. I also 
thought that most probably the nature of the swelling was 
hsBxaatoma beneath the periosteum, and hence my suspicion 
that the case was allied to infantile scurvy, but the future 
coarse of the case, and the fact of the entire absence of gum 
symptoms, or of the involvement of the long bones of the 
legs, goes, I think, pretty conclusively in favour of a diagnosis 
of simple strum a, though, so far as my experience goes, of a 
very unusual form. I ordered the child to take calcarea carb. 
6th trit. gr. iij. t.d.s., oleum morrhusB 5j. bis die, and to be 
given an orange every day, and a tablespoonful of the fresh 
meat juice as well as her usual mixed diet. I should have 
mentioned before, that she was always very flushed in her 
sleep and had profuse sweat in her head. 

From the beginning of this treatment she improved very 
markedly in her general health, but within the first ten days 
another swelling appeared in the left lower eyelid exactly 
similar to that on the right side. 

On March 27 the swelling in the right lower eyelid broke 
and dischajrged pus mixed with broken down blood clot ; on 
voii. ni. — NO. 3. 22 



316 DISCUSSION ON CASB8 OF INFANTILE SCUBYY. 

the 28th the skin over the swelling in the right ring finger 
broke on its inner aspect, leaving a raw surface but no 
discharge. By this time, however, she had quite recovered 
the use of her legs and had resumed her usual cheerful 
demeanour. 

On April 5 she went to the open consultation, and the 
general opinion seemed to be in favour of a diagnosis of 
struma only, but all agreed as to the treatment being the 
right one in any case. 

Since then the swellings in the lower eyelids have both 
gathered up, broken and discharged almost pure pus, several 
times, as has also the swelling on the ring finger, leaving a 
sinus on the anterior side through which dead bone can be 
plainly felt on probing, and even this gives rise to no pain. I 
have so far been unable to reach bare bone on probing the eye- 
lids, but since the swellings have emptied themselves they 
seem more certainly than ever to start from the orbital ring 
of the upper maxilla on either side. The case is a somewhat 
peculiar one, and I think it was excusable being in doubt at 
first whether the periosteal swellings in the hands, and 
the entire loss of the use of the legs, were not indicative 
of the presence of scurvy, though, for reasons I have already 
given, I am quite of the opinion now that it should be 
considered one of pure struma, or tubercular inflammation 
inherited from her mother. 



Dr. GoiiDSBROUGH said that he knew the family of the first 
case well. He attended the mother, when she was a school girl 
of 14 years of age, with strumous ophthalmia. She had it very 
badly. There was never a worse strumous family than she 
belonged to. During her later girlhood she had adenitis, and 
since, strumous disease of the knee-joint, from which she was 
lame for some considerable time. This was interesting because 
of the occurrence of scurvy in the child along with the family 
history of struma. Before the Aylesbury Dairy Company pre- 
pared " humanized milk," he (Dr. Goldsbrough) was in the habit 
of using a similar preparation recommended by Dr. Franklin in 
the Lancet in 1881. He generally directed the mother to prepare 
it herself, giving her the exact details. As an alternative to the 
use of the humanized milk he suggested the use of cream and 



DISCUSSION ON CASES OF INFANTILE 8CUBVT. 317 

water only. He had noticed in cases where the humanized milk 
could not he tolerated, there heing still too much caseine in it, 
that the use of milk and cream, the cream heing skimmed from 
the milk and not taken hy the separator, in proportions varying 
from one in four to one in ten, was satisfactory. He had used 
that frequently, and found the stomach quite tolerant of it, and 
children fattened upon it. Of course in that case they had no 
destruction of the principles of the milk by the fermenting action 
of the rennet. He had seen the case which Dr. Madden had sent 
up to the hospital the other day, and certainly it appeared to be 
one of genuine struma, and there did not appear to be any evidence 
of scurvy about it. 

Dr. EoBEBSON Day said he had not been convinced that the 
description corresponded to that of the disease known as infantile 
scurvy, as given by Dr. Thos. Barlow. They had not heard yet 
of the condition of the child as to anasmia, nor whether there had 
been hsBmorrhages, and especially with reference to the condition 
of the gums. In the Bradshaw lecture by Dr. Barlow all those 
points were very strongly insisted upon, in fact, it was the ten- 
dency to haemorrhage in a child not necessarily rickety which 
constituted the disease of infantile scurvy. The onset in all cases 
was sudden, and the pain was intensely severe in the lower limbs, 
and there was almost invariably to be made out a thickening and 
swelling which existed (as had been found in those few cases 
where post-mortems had been obtained) beneath the periosteum of 
the tibiaB, consisting of extravasated blood. The upper limbs 
appeared not to be affected, at least only in rare instances. In 
all those cases there had been a most marked absence of the 
fresh food, the absence of the " anti-scorbutic element." Now 
the diet which the child had whose case Dr. Madden had men- 
tioned had no such absence of the '' anti-scorbutic element " in 
the humanized milk of the Aylesbury Dairy Company. They all 
knew what an excellent substitute that was for mothers' milk. 
They had heard from Dr. Goldsbrough that there was a most 
marked history of struma in the family, and he had had an 
opportunity of seeing the other child mentioned at a consultation, 
which was undoubtedly strumous. He was therefore not con- 
vinced from the evidence given that they had before them the 
history of a case of infantile scurvy. Such cases were very rare. 

Dr. Edward Blake said that although there are cases of 
infantile scurvy and rickets, in which no line of demarcation 
could be said to exist between the two disorders; yet, on the 
other hand, typical cases of these diseases are divided by definite 



S18 DISCUSSION ON OASES OF INFANTILE SOUBVT. 

differentia. Hyperidrosis (especially of the head), laryngismus 
stridulus and epiphysial disorders occur in hoth diseases. Bickets, 
first described by Francis Glisson, who was bom in Dorsetshire^ 
in 1696, is essentially a chronic disease, associated with nettle 
rash from dilated stomach. Seldom fatal, having a marked 
geographical distribution, it is rare in the colonies and unknown 
in some of the most destitute continental districts. It is usually 
endemic, possibly a protozoal disease, allied to ague and certain 
forms of carcinoma. Scurvy is a disorder occurring in the chil- 
dren of the well-to-do and is probably on the increase. Its 
occurrence in the offspring of the rich is explained by Gheadle 
and Barlow in two ways : — The children of the wealthy are fed 
much more largely on proprietary food stuffs; whilst the poor 
give their children a mixed diet at a much earlier period than the 
rich do. It might be added that the children of the poor are fed 
from the breast much longer than the children of the wealthy, 
and they are more out of doors. Scurvy is sporadic in the young 
and usually epidemic in adults. It has no special geographical 
distribution. It is worse in winter than in other parts of the 
year. It is an acute disease, running an average course of two 
to four months, often fatal, yielding at once to diet and fresh air» 
Death sometimes results from asthma or from fatty heart. 
A child suffering from rickets is often precocious, but scurvy is 
marked by dulness of intellect. He suggested that in treating 
the disease, the anti-scorbutics should be varied as much as pos- 
sible. Orange, lemon, potato, grape, apple and pear water are 
useful; but above all, watercress juice with raw meat extract 
added to good broth to render them palatable. Watercress is 
curiously rich in earthy salts and contains both phosphorus and 
iron. Yolk of egg is full of ferrated albumin and should be very 
valuable. 

Dr. Madden, in reply, said he was sure he gave the mother the 
right prescription for making humanized milk at home, but 
whether she was successful or not he did not know, at any rate 
the child would not have it except from the bottles made up by 
the Company. What he had spoken of as the classical symptoms 
of scurvy were the symptoms fully developed, and he having got 
the case at the commencement the symptoms never went that 
length. The intense sensitiveness to all motion of the legs, the 
tenderness on touching the lower parts of the limbs, the blueness 
and swelling of the gums, after the teeth had been cut, were 
symptoms quite sufficient, he thought, combined with the general 
condition, to confirm the diagnosis. If Dr. Day had been present 



DISCUSSION ON OASES OF INFANTILE SCUBVY. 319 

nt the paper read by Dr. Gibbs Blake, in November, two years 
previously, he would remember that the case he had described was 
very much worse than his (Dr. Madden's), and was that of a child 
who had been fed upon fresh milk and all the good foods that 
rich parents could provide for it, and he (Dr. Blake) gave them a 
most interesting and leaxned discussion on what constituted the 
anti-scorbutic element of food, and showed that it not uncommonly 
appeared to be lost in fresh milk and other foods which were 
supposed to contain it. It was rather difficult to isolate it, or 
determine its precise chemical constitution, but it certainly was 
not always present in milk, whether fresh from the cow or pre- 
pared in any way such as was given to babies. 



320 SOCIETY NEWS. 



SOCIETY NEWS. 



At the May meeting of the Society the President, Dr. Byres 
Moir, announced the sudden death of a popular and valued 
memher, Mr. Henry Harris, of Camberwell. In moving that a 
vote of condolence be sent to the widow and family, Dr. Galley 
Blackley said he had known Mr. Harris for nearly a quarter of a 
century and had always found him a most enthusiastic homoeo- 
path. Mr. Harris studied with every intention of becoming a 
homoeopath, and his enthusiasm for homoeopathy during his. 
studentship pervaded to some extent some of the students who 
came in contact with him. He (Dr. Blackley) had known one or 
two of Mr. Harris's student friends, and although they did not 
ultimately become homoeopaths, there was very little doubt that,, 
as so often happens, the leaven of homoeopathy was quietly at 
work with them. He had always had the idea that that would 
be the ultimate fate of homoeopathy — it would gradually permeate 
allopathy, the leaven would spread and they would have one 
body corporate. Of Mr. Harris's many-sidedness they already 
knew much, how he could always at their meetings add some- 
thing of a thoroughly practical and valuable nature to the 
discussion, no matter what the subject might be. Here his skill 
as a practised debater stood him in admirable stead. Mr. 
Harris's Presidential Address at the British Homoeopathic Con- 
gress a few years ago still rang in his ears. 



Dr. Goldsbrough, in seconding the resolution, said he did so 
with very pained feelings. He had been associated with Mr. 
Harris in practice for sixteen and a half years, and only one year 
and a quarter of his professional life had he spent by himself. 
He endorsed every word which Dr. Blackley had said. Although 
Mr. Harris had a zeal for homoeopathy which sometimes led him 
farther than some members of the profession were inclined to go, 
still there was no man who had a greater regard for professional 
propriety and etiquette. He (Mr. Harris) thought the best way 
to spread homoeopathy was to appeal to the public as well as to 
the profession. Every member of the Society was not of that 
opinion, but he (Dr. Goldsbrough) would like to add that Mr. 
Harris had helped him in his early years towards the truest 



SOCIETY NEWS. 321 

ideas of professional propriety, and he had learned much from 
him on the broadest ground of ethics in general humanity. He 
seconded the resolution with feelings of much earnestness and 
sympathy. 

At the May meeting Dr. Gibbs Blake was elected a Fellow of 
tlie Society. 



At the June meeting Dr. Washington Epps was elected a 
Fellow of the Society. 

At the same meeting Edward Gerald March, M.B.Brux., 
F.B.G.S.Edin., M.R.CS.Eng., L.R.C.P.Lond., 7, Langhorne Gar- 
dens, Folkestone ; and 

Bertram Wright Nankivell, M.R.CS.Eng., L.R.C.P.Lond., 
154, Drake Street, Rochdale, were elected Members of the 
Society. 



At the annual assembly, June 26th, Frederick Lay ton Orr, 
M-B.Lond., M.R.CS.Eng., L.R.C.P.Lond., London Homoeo- 
pathic Hospital, W.C, was elected a Member of the Society. 



At the annual assembly, June 27th, the following officers 
^were elected : — 

President, Dr. Goldsbrough. 

Vice-Presidents, Dr. Neatby, Dr. Gibbs Blake. 

Treasurer, Dr. Galley Blackley. 

Council, Dr. Goldsbrough, Dr. Neatby, Dr. Gibbs BlaJce, 
Dr. Galley Blackley, Dr. Byres Moir, Dr. Hughes, Dr. Dudgeon, 
Mr. Dudley Wright, Dr. Burford, Dr. Johnstone. 

Section of Materia Medica and Therapeutics, Dr. Hughes, Dr. 
Dyce Brown, Dr. Ord, Dr. Lambert, Dr. Epps. 

Section of Medicine and Pathology, Dr. Byres Moir, Dr. Galley 
Blackley, Dr. Day, Dr. Goldsbrough, Dr. Dyce Brown. 

Section of Surgery and Gynecology, Mr. Dudley Wright, Dr. 
Burford, Dr. Johnstone, Dr. Neatby, Mr. Gerard Smith. 



322 SUMMABY. 



SUMMARY OF PHAEMACODTNAMICS AND 

THERAPEUTICS. 



*' GATHER UP THE FRAGMENTS, THAT NOTHING BE LOST.** 



March— May, 1895.^ 



PHARHACODTNAMICS. 

Aoidum oarbolioum. — Dr. Parenfceau finds this acid, in the 
6th and 12th dilations, nearly always beneficial in eczema of 
the lids. — Bevue Horn. Frangaise, March, p. 97. 

Aoidum nitrioom. — Dr. Alice B. Oondict finds the knife 
rarely necessary in lacerations of the cervix uteri. She nses 
galvanic treatment (negative pole) in the later part of the treat- 
ment, but begins by applying dilute nitric acid. This seems to 
produce '' tiny granulations which catch the ragged edges of the 
lacerations and so draw the flaps together." [The experience of 
Drs. Ludlam and Claude with nitric acid given internally for 
metrorrhagia succeeding parturition or miscarriage suggests a 
dynamic and not merely topical action here. — ^Ed.] — Hahn. 
Monthly, April. 

A^arious. — In an article on the treatment of whooping-cough. 
Dr. Pillsbury relates a case so severe that pulmonary collapse 
was induced during the course of it. After rallying from this, 
the violence of the cough demanded some special remedy, and he 
was led to agaricus by the patient's breaking into profuse sweat 
every time before she commenced to cough. He only found 
under this remedy, indeed, ** sudden spasmodic convulsive cough 
with sweat *';' but this proved sufficiently near, as improvement 
under it was rapid and permanent. — Minneapolis Horn. Mag., 
April. 

^ The British Homoeopathio Journals are unavoidablj omitted this time. 

' This, too, is dinioal only. The only approach to it in the pathogenesis of 
the drug is Allen's S. 1469-—" Coughed violently, and sweated somewhat at 
night."— Ed. 



SUMMARl?. 323 

Antipyrin. — Some ourious instances of the exanthems pro- 
duced by this drug are given in the North American Journal of 
HomcBopathy for March (p. 186). Inflammation, even to vesica- 
tion, in these cases characterised its action on the skin, and even 
sometimes on the mucous membranes. 

The frequent occurrence of urticaria under the influence of 
this drug has been utilised by a Spanish physician, whose observa- ^ 
tion is reported in the Hahnemannian Monthly for May. The 2x 
trit. was used, and the good effect was very rapid. 

Apis. — The numbers of the Homoeopathic Physician from 
March to May contain the editor's recollections of Dr. Lippe's 
lecture on apis. The subject is of course treated symptomatically 
only, and mainly empirically ; but useful hints for practice may 
be gathered from what is recorded. 

Arbutus andrachne. — This, the strawberry-tree of the 
Levant, is Dr. Cooper's latest '* find " in ** arbori- vital medicine." 
He relates cases which show its value in chronic eczema, in 
dysuria, and in lumbago. — Hahn, Monthly ^ April. 

Arsenicam in Renal Dropsy. — Dr. J. F. Irvin was called to a 
youth of 15, who had been treated (allopathically) for two weeks 
for diphtheria. During the second week, dropsy had come on, 
commencing in feet and then invading abdomen and chest. He 
could not lie down for fear of suffocation. There was waxy skin ; 
great thirst for cold water, but little taken at a time; all 
symptoms worse at- night. Urine was of sp. gr. 1,012, and con- 
tained a large proportion of albumen. Arsenicum 30 was given, 
and the patient was discharged in five days cured. — Aw^r. HomasO' 
pathist, December 1, 1894. 

Baryta. — The value of baryta carhonica in hypertrophy of the 
tonsils has been gravely impeached ; but a case published in The 
Glinique for May seems to show that baryta iodata may act 
well upon them. The patient, a boy of 8, had had his tonsils 
enlarged for three years ; but under this drug (how given is not 
specified) they were reduced in two months. 

Belladonna. — On the symptom, " aggravation from jarring of 
the bed," mentioned by Dr. Walter M. James as a great indication 
for belladonna,^ Dr. B. V. Boss writes to say that " aggravation 
from jarring " would express it best, as it matters not whether 
the patient be in bed, or in a chair or carriage. He adds 

* See p. 206 of this Tolume. 



324 8UMMABT. 

** Another characteristic of this remedy, and one of equal value, 
is * pains come and go suddenly.' When these two are present at 
the same time, it is needless to look any farther for a remedy." — 
Horn, Physician, April. 

Dr. Barrows records another of those valuable cases of 
belladonna poisoning in which the symptoms resulted from a 
'plaster applied to the surface. [He thought them indicative of 
stramonium, and suggests that that drug had been combined in 
the plaster with belladonna ; but we see nothing in them which 
belladonna itself might not produce. — Ed.] — The Clinique, 
March. 

Bryonia.— Dr. B. Lippincott writes to corroborate Jahr's com- 
mendation of bryonia as the only medicine that seems to have 
any power to disperse carbuncles. (Curiously enough, he seems 
to use the drug ,in the " crude " form, while Jahr gave the 30th.) 
From his success with it here he was led to try it in whitlow, and 
found equally good results. — Amer, HomoROjpathist, May 1. 

Calcapea fluorata. — A physician of Bogota, S.A., relates a 
case of varicose ulcers of some standing, both on legs and arms. 
Calcarea fluor. 6x was given night and morning, and externally 
was used an infusion of a native plant called cardosanto. In 
fifteen days all the ulcers had healed. [If the internal remedy 
had anything to do with this recovery, it is interesting in view 
of Dr. Washington Epps' experiences as narrated in this number 
of the Journal. — Ed.] — Hahn. Monthly, April. 

In the April number of the Horn, Recorder Dr. Sarah J. Hogan 
communicates a curious experience with this drug. Giving it for 
flatulence troubling a pregnant woman (which it quickly relieved), 
the patient had an unusually easy confinement; and similar 
results have followed in other cases. 

Cannabis indioa. — In a hysterical subject, the main feature 
was a recurrence of *' absences," sometimes as often as three 
times in a morning, and lasting ten minutes. Ignatia did not 
influence them, but cannabis indica 12 caused their complete dis- 
appearance at the end of four days. — JjArt MSdical, April. 

Chenopodiam. — Dr. Yillers relates a case of chronic head- 
ache, characterised by marked aggravation from the noise of 
passing vehicles; other sounds having little effect. Chenopodium 
6, administered upon this indication, not only removed the 
special sensitiveness, but up to the time of the report had com- 
pletely averted the headaches* — Horn, Physician, April. 



SUMMAST. 325 

Cimicifaga. — ^The free local application of the tincture is 
recommended by an old-school physician as giving great relief 
to pain in the eye and photophobia. It should be painted upon 
the lids with a camel's hair brush. — Horn. Recorder, May, p. 228. 

Dr. WiDgfield tells of two cases in which the use of this drug 
seems to have ensured living children at birth. In the first, four 
children had all been born dead, from no discoverable cause, the 
mother never having had a living child ; in the other there had 
heen two dead births and no living one. After the daily adminis- 
tration of the Ix for two months before confinement both mothers 
were delivered of healthy children, which are now alive. — Ibid,, 
April. 

Cinchona. — " It has been discovered," writes the New England 
Medical Gazette (April), ** that the famous tree from the bark of 
which quinine is obtained furnishes no quinine except in malarial 
regions. It is therefore claimed that quinine is a malarial poison, 
drawn from the soil and stored up by this wonderful tree." 

Clematis.-^A young lady, aged 25, a teacher, with a healthy 
family history, who cannot remember having had any serious 
illnesses, has been affected since a child with exuding eruptions 
behind the ear. Gatamenia regular, but retarded, since 15 years of 
age. When 16 there appeared at the menstrual period small vesicles 
betwixt the fingers, and occasionally on the groin, which exuded 
somewhat and formed thin scabs. In the course of the year the 
eruption became more persistent, and not dependent on the period; 
it spread from the fingers to the hands and forearms, from the 
groin to the abdomen and thighs, then it came on the face and at 
last on the chest. When she came to see me she had already 
been under constant medical treatment for eight years, chiefly 
with ointments and once with Baunscheidt's treatment, which 
had caused the skin of the back to look like morocco leather. 
Her face, cheeks, ears and forehead are covered with thin scabs ; 
on washing off these scabs the skin beneath them looks congested. 
Lips dry, the upper eyelids as if covered with powder, the skin 
around the mouth dirty brown. The skin of the body is mostly 
of a dirty brown colour, especially on the neck, the anterior aspect 
of the axilla, the abdomen and the back. On both thighs many 
blue veins. The skin of the fingers is very dry, chapped and 
rough. I gave first sulphur 200, which caused itching, especially 
when she undressed at night. Portions of the skin commenced 
to discharge again, and rough spots the size of a shilling appeared 
on the ball of the thumbs and the left thigh with a fissure through 



326 SUMMABT. 

them. During the next three months I gave graphites and 
mercurius without effect. After taking arsenic 30 for three 
weeks the scahs on the face became fewer ; the dark colour of 
the axilla and around nipple diminished, but the patient became 
ill, emaciated, and complained of great exhaustion during the 
menstrual flux, which had increased in quantity and came too 
soon. I now put her under clematis 12 for two months, and at 
the end of that, time the skin was quite different ; the houghs 
and skin of the first flnger joint were still rough, the neck and the 
flexor aspect of the elbow joint were still rather dirty grey. Owing 
to another affection brought on by hard work for which the girl 
had to be treated, I could hot continue the treatment for six 
weeks, but on resuming the clematis the improvement went on, 
until owing^to exposure to cold some small exuding rhagades re- 
appeared on the fingers and thighs which rapidly yielded to two 
doses of thuja 30 at intervals of fourteen days. Two years have 
now elapsed and the skin has remained perfectly sound. She has 
not gained much flesh, but her skin is so thoroughly restored that 
even the places on her back which had been injured by the 
Baunscheidt treatment have lost their disagreeable appearance. — 
Villers, Arch.f, Horn., iv., 120. 

Colohicum in Rheumatism. — Dr. Colby communicates a very 
favourable experience with colchicum in subacute rheumatism. 
It is of course specially useful in gouty subjects : but even apart 
from this is well indicated when the inflammation attacks chiefly 
the hands and feet ; shows central tenderness on palpation, 
moderate swelling, and a pink blush; causes constant pain, 
increased by motion, during the prevalence of damp east winds, 
and especially before a storm ; and gives the affected members a 
sense of paralytic weakness. He prefers the English ** vinum 
colchici," and thinks that nothing is gained by attenuating it. — 
New Engl, Med, Oaz,, March. 

Collinsonia. — Dr. Jousset is able to concur in the praise 
others have given to this drug as a remedy for constipation. He 
gives the Ix trit. Weight in the rectum, dull pains at the anus, 
are the only differential indications he specifies. — L'Art M^diccU^ 
May. 

Goniam. — A good case of the vertigo suitable for this medicine 
is translated from the Populdre Zeitschrift in the HaJimmannian 
Monthly for May. The attack began like one of Meniere's 
disease, but no tinnitus aurium is mentioned. When seen, the 
patient (a man of 50), had had vertigo for four days, and could 



BUMICABT. 327 

not get np or even torn in bed without bringing it on. Gonium 
3, five drops three times a day, was given, and in twenty-four 
hours he was able to walk unaided. — Hahn. Monthly, May. 

Enphrasia* — A case of paroxysmal coryza, recurring for 
about three hours every morning, and of ten years' standing, was 
cured by euphrasia ^ in three months. — North Am. Joum, of 
Horn., May, p. 310. 

Ferrum. — An old homoeopathic use of ferrum, for vomiting of 
food, has been revived with Schtissler's ferrum phosphoricum. A 
writer in the Populdre Zeitschrift reports seven cases in which 
the 3x trituration acted promptly and lastingly. — Med. Century, 
May 15. 

Filix mas. — The free use which has been of late made of oil 
of male fern as an anthelmintic has revealed poisonous properties 
on its part hitherto unknown. Among its effects blindness has 
been noticed, coming on rapidly with full mydriasis, and going on 
to decoloration of the papillaa and atrophy of the optic nerves. 
" Poulson has recorded thirteen poisonings, of which three were 
fatal. He regards the amorphous form of filicic acid as poisonous, 
and not the crystalline." This acid is readily soluble in castor 
oil. — Hahn, Monthly, May. 

Olonoin. — Dr. Boericke has a good article on this drug in the 
Hahnemannian Monthly for March. He frankly recognises its 
antipathic use as a palliative. His remarks as to its cardiac 
action may well be read in connection with those of Mr. Spencer 
Cox in vol. ii. (p. 69) of this Joubnal. 

Hamamelis. — In an article on the local treatment of burns. 
Dr. H. H. Chase relates a very satisfactory experience ,with the 
fluid extract of witch-hazel in the raw surfaces left by burns. 
Pledges of cotton dipped in it were applied. ** There appeared to 
be sufficient astringency to do away with the fungosities, and some 
portions of the hamamelis dried into the surface of the ulcer ; 
whenever this occurred normal granulations immediately formed 
underneath, and as these became Arm and substantial the 
hamamelis came off, leaving a good, firm new skin which rapidly 
grew in area and thickness. ... In the course of ten days I 
succeeded in completely covering the entire dorsum of a hand 
that was burnt in the Hinckley fire." — Minneapolis Horn, Mag., 
March. 



328 SUMMARY. 

Hepar sulpbaris. — A girl of 20 had suffered from acute otitis, 
and had an otorrhcea. After about a month the discharge had 
ceased ; pain and fever had set in, and there was every indication 
of matter having formed in the mastoid process. Trepanning of 
this seemed inevitable, and was determined on for the next day. 
In the meantime Dr. van Berghe gave hepar sulph. 30x every two 
hours. By 10 a.m. improvement had set in, and the operation 
was first delayed and finally abandoned, as the case cleared 
rapidly up, and that without any evacuation of the pus. — Hahn. 
Monthly, March. 

Ignatia. — Dr. Heber Smith has much confidence in ignatia 
when the excessive use of tobacco is the cause of nervous symp- 
toms. He gives one case in which, besides general '* nervous- 
ness," there was tachycardia and sensation as if the roof was 
falling. — New Engl. Med, Gazette, March. 

Kali biohFomioum. — For four months a man of 40 had had, as 
soon as he swallowed food (not liquids), a tickling in the throat 
exciting a severe cough, which stopped only upon vomiting and 
was succeeded by a watery coryza. Pharyngeal catarrh was noted, 
with stringy mucus hanging from naso-pharynx. Kali bichromi- 
cum 1 was given every two hours. Five days later patient 
reported that he had coughed but twice after eating, and had not 
vomited since taking the medicine. When the case was sent to 
the journal, there had been for three months no return of the 
symptoms. — North Am. Joum. of Horn,, May, p. 311. 

Ledum. — Dr. F. B. Percy writes to rehabilitate ledum as a 
remedy for gout and rheumatism. His own cases belong to the 
latter malady only, and this when seated in the feet ; but show 
that here the Ix dilution will do much to cure. — New Engl, Med. 
Gazette, March. 

Magnesia oarbonica. — Dr. Jousset says that this medicine 
being indicated in dysmenorrhcea when the flow suddenly stops 
at each access of pain, it is suitable for those cases which depend 
on spasmodic atresia of the cervix. " The other symptoms 
which individualise it are anticipating menses, copious flow, and 
blackish colour of the discharge." He gives the 6th to 12th 
dilution. — L'Art Medical, March. 

Moschus is commended by a correspondent of the Horruzo- 
pathic Envoy for nervousness, as when people are coming before 
the public, or children are asked to sing or read before company. — 
Amer, Hormzopathist, May 1. 



329 

Naja in Aathmii^ — A writer in the Medical Advimce states 
that haying heen for fifteen years snhject to severe attacks of 
asthma, he never found a remedy to touch it nntil he tried naja. 
He has since ohtained excellent results hrom it in asthmatic 
attacks beginning with nasal catarrh, as in hay-fever. He has 
always used the 30th dilution. — Amer, Honusopathist, December 1, 
1894. 

Nux mosohata. — Yet another case of nutmeg-poisoning 
appears in the March number of the Pacific Coast Journal of 
HonuBopathy, The symptoms were marked failure of the heart's 
action, requiring strong cardiac stimulants ; great mydriasis ; the 
urine loaded with phosphates, and the lower extremities sweating 
freely. (The two latter symptoms occurred during convales- 
cence.) 

Onosmodium. — A recurrent headache of twelve years' stand- 
ing, of late coming on every other day ; pain beginning in occiput, 
and passing over head into eyes ; increasing and decreasing with 
the day ; relieved by light bandaging — had from onosmodium l.a 
severe aggravation, but subsequently ceased to appear. — North 
Amer. Joum. of Horn,, May, p. 310. 

Opium. — From his experience, the veteran Dr. Teste is led to 
commend opium very highly for the anomalous troubles — failing 
nutrition, nervous depression, flying pains, &c. — which haunt 
some children during the time of rapid growth. He gives it in 
the 6th dilution. — Bevt(£ Horn. Frangaise, March, p. 102. 

Phosphoras. — Some fresh observations as to the health of 
workers with phosphorus have been presented to the French 
Academy of Medicine, and are summarised in L*Art Midical for 
May. Its profound influence on nutrition and sanguification is 
well shown here. 

On a later page of the same number, the internal use of the 
drug is commended as remedial in lupus erythematosus. Some- 
what substantial doses were employed in the cases reported (fifty 
successes in all). 

Palsatilla. — Dr. Jousset would add this medicine to those 
indicated by escape of urine every time the patient coughs. He 
gives a good case in point in UArt Medical for March. The case 
was one of emphysematous bronchitis^ the expectoration being 
very abundant ; and was as a whole much benefited by the 
medicine, given in the 6th dilution. 



330 BUMMABT. 

Rhus in SeptiocBmia. — Dr. C. W. Eaton corroborates the 
favourable testimony of Drs. Helmuth and Boyal ^ to the anti- 
septicamic virtues of rhus. He relates a case of laparotomy in 
which septic peritonitis seemed inevitable, but under rhus all went 
on in perfectly normal order. — Amer. Homosopathist, March 1. 

Robinia. — Dr. Kent finds robinia to act well even when the 
gastric acidity which indicates it is connected with malignant 
disease of the stomach. He relates a case in point. — Hdhn, 
Monthly t May. 

Stramoniiim. — A good observation of poisoning by this plant 
is sent to the New England Medical Gazette for April by Dr. 
J. Emmons Briggs. The clonic spasms were very marked. The 
report is followed by a '^ critical analysis " of the pathogenesis of 
the drug as given in the " Cyclopaedia.'' 

8t]H>ntiam. — The salts of this metal, of which the lactate is a 
favourite, seem to have a diuretic action in renal dropsy, and 
frequently to effect a diminution in the amount of albumen 
excreted. The prolonged administration of the lactate has not 
been found injurious. — L'Art Medical, April. 

Salphur in Crasta laotea. — A male child, 11 months old, had 
been well up to his ninth month, and then with the teething there 
came an eruption on the head, which was at first dry, afterwards 
exuding and spreading all over the forehead and ear, papules 
excreting a yellow matter. Much itching. Sulphur 6 did nothing. 
On January 8 I gave about 1 gr. of sulphur, 1st trit. On Feb- 
ruary 23 his father wrote : ** Your medicine has done wonders. 
The first week the eruption declined, the second week it quite 
disappeared, and now the little fellow is, to our joy, again 
quite well." — GouUon, Zeitsch, der Berl. Ver.j xiv., 149. 

Syzygiam in Diabetes. — Dr. G. H. Viehe communicates 
another cure of diabetes by this new remedy. He says he 
gave "8 or 10 drops three or four times a day," but does not 
mention the dilution thus administered. — Amer, HomoBopathist, 
December 1, 1894. 

Thuja. — Dr. Sarah N. Smith gives two cases, one of ulcer, 
one of vascular tumour, on the hand. Setting down both as 
''sycotic," she gave thuja in Dunham's 200th; and either got 
well in a couple of months. — Horn. Physician, April. 

> See p. 209 of this volume. 



SUMMABY. 331 

Dr. Candy was consulted by a lady who presented a verrucous 
tnmour of the neck attached by a small pedicle. It was of the 
size of one's thumb, and if pulled caused a pain to shoot through 
that side of the head. She suffered occasionally from lancinating 
pains commencing in the growth and radiating into neck and head 
or down into chest. It was impossible to rest on that side. 
Thuja 6 was given internally, and a one- tenth solution of the 
tincture in almond oil applied locally. Affcer a few days the 
groi?7th became flaccid and pale, and after a fortnight it fell off, 
witlxout pain, together with several smaller tumours of the same 
character. The pains also left her. — Hahn. Monthly y March. 

A youth, aged 17, otherwise sound in health, has had for the last 
two years on the left side of the scalp, about posterior edge of the 
parietal bone, a white spot 4 cm. in diameter, somewhat resembling 
a bean and raised about 2 mm. above the surface ; the spot is 
quite insensible, the hair has all disappeared from it, making the 
white elevation very conspicuous. I first gave arsenicum for six 
weeks without any result. Then I prescribed thuja 30, a drop 
every twenty days. In four months he returned and was almost 
cured. The spot was now no bigger than a pin's head, the hair 
had grown completely on it, and in four more weeks the skin 
was quite normal. — Villers, Arch.f. Horn,, iv., 117. 

VibuFniun. — Dr. Jousset writes : '* For several years past we 
have had great success in the most painful dysmenorrhceas with 
this drug. We give the mother tincture, ten to twenty drops in 
200 grammes of water, a spoonful every hour or two.** — L*Art 
MSdical, March. 

Zinonm. — An ansBmic but vigorous woman suffered every ten 
to fourteen days with pressive headache on vertex and forehead, 
sometimes leading to vomiting, but always accompanied with 
amblyopia. Zincum met. 3, once daily, cured in a month. — 
Horn. Becorder, April, p. 153. 



THERAPEUTICS. 

Albaminuria. — In a discussion on this condition in the 
Soci^t^ Fran9aise d'HomoBopathie, several speakers agreed as to 
tuberculin (Koch*s) that it temporarily, but only temporarily, 
improves ; while Dr. Marc Jousset related two cases in which 
kali iodatum, Ist trit., proved curative. — Bevue Horn. Frangaise, 
April. 

VOL. III. — NO. 3. 23 



332 SUMMABT. 

Anasuoa. — A case of this condition, supervening on malarious 
fever, where the patient seemed on the brink of dissolution, is 
recorded in the Indian Homoeopathic Beview of February. 
Arsenicum 30 rallied the patient, and kali bichromicum 6 subdued 
an intercurrent bronchitis. Apocynum Ix was now given, two 
drops thrice daily ; improvement commenced the next day, and 
the last trace of the disease was removed in nine days. 

Bright's Disease. — Dr. Searle publishes in the Hahnemannian 
Monthly for May a series of interesting cases of Bright's disease, 
in which he has had special experience, and no little success. 
The remedies he uses are those generally employed — arsenicum, 
cantharis, &c. ; but he writes : ''In this, as well as in many 
other chronic forms of disease, I have derived inestimable benefit 
from a combination of the milk, rest, and water cures. Indeed 
it is amazing to see what can be accomplished by these alone, 
while, without them, drugs may be set aside as of little use in 
chronic Bright's disease." 

Canoer. — Dr. Cowperthwaite, in a discussion on the treat- 
ment of this disease, said that he had tested a popular remedy, 
with good results. It was the " sheep's sorrel" {rumex acetosella), 
gathered in June and dried on a pewter plate. With the dried 
leaves of this plant, used locally, he had cured eighteen cases of ^< 

epithelioma of the face, having had only three failures to set on 
the other side. — North Amer. Journ. of Horn,, April, App. p. 29. 

Billroth is reported as saying of arsenic in this disease, that 
while in only one instance — a lympho-sarcoma — had he seen 
permanent benefit from its administration, it sometimes retards 
progress and often relieves pain. — Minneapolis Horn, Magazine, "-\ 

April. 

Colio. — In a case of this kind, without diarrhoea, Dr. Jousset 
gave colocynth 0. The pains persisted, and diarrhoea came on. 
Learning now that relief was obtained from sitting with the body 
bent forward, he gave belladonna 6 ; and by next morning the 
colic had disappeared and did not return. — L'Art MSdical, May. 

CopFOphagia. — A child had a craze for eating its own fseces 
or dung lying in the street. Veratrum 2, three times a day, cured : 

it of this propensity in a month. — GouUon, Zeitsch. d, Berl, Ver.f 
xix., 156. 

Craokled Nipples. — ** Schnader finds inunction with glycerine, ^^ 

or tannin with glycerine, the best remedy. He has also found :a 



• •i 



8X7MMABT. 333 

the mucilaginous pulp of oats or barley, cooked twice a day so as 
to be perfectly fresh, and applied freely before nursing, to give 
great relief. It makes the nipple more slippery for the baby. 
The nipples are washed and dried carefully after nursing, and 
exposed freely to the air, which hardens again the homy layer of 
skin softened by the sucking. He has abandoned the use of 
borax, carbolic or other acids, as well as cauterization with blue- 
stone." — Hahn. Monthly, March. 

Diabetes. — Dr. Ludlam, jun., calls attention to alveolar 
periostitis, causing chronic f aceache, as a symptom of glycosuria ; 
and relates a case of the kind treated by his father in which 
nitrate of uranium 3 (probably decimal) effected a complete 
recovery. — The Glimque, March. 

Dr. Dodge relates how, after failure of syzygium, he treated 
a case of this disease with arsenicum 3x ; and then, finding no 
response to this drug, alternated terebinthina 3x with it. 
Immediate improvement set in ; the sugar rapidly disappeared 
from the urine; and, though the patient returned to an un- 
restricted diet, his glycosuria never recurred. The cure had stood 
for ten months when the case was reported. — North Am, Joum, 
of Horn., March. 

Diarrhosa in Children. — Dr. Jousset speaks warmly of 
calcarea acetica and phosphoric acid in the chronic form of 
this complaint, coming on after cholera infantum, in the 
course of dentition, or as an effect of weaning. He gives the 
3rd dilation of each, alternating the two. — L*Art Midical, March. 

Diphtheria. — One of the best reports published as to the 
anti-toxin treatment of diphtheria is that of Dr. W. C. Cutler, 
communicated to the May number of the New England Medical 
Gazette. The series of thirty-one cases he tabulates were treated 
at the " Bufus S. Frost General Hospital" in Chelsea, Massa- 
chusetts. There were four deaths only, of which but one — he 
considers — was part of the ordinary course of the disease, and 
this case was not injected till the fifth day. He notes that the 
mode of disappearance of the membrane under the influence of 
the seram is that it rolls up at its edges, and so peels off; 
whereas under drug treatment it rather softens and breaks away 
piecemeal. 

Enuresis.— Dr. Kraft has in the April 1 number of hin own 
journal, the American HomcBopathist, an interesting paper on tho 
remedies of incontinence of urine. Cina when the urine tnm§ 



334 SUMMABT. 

milky, chamomilla when its irritable mental condition is present, 
causticum in cases resulting from over-strain of the bladder, 
lycopodium in neurasthenia and where there is red sand, and 
staphisagria where there is genital excitement either by thought 
or act — these are the medicines on which he mainly depends ; 
and their indications are graphically presented. 

Erythema nodosum. — Dr. Oscar Hansen reports a case of 
this disease, in which the patient — a woman of 42 — had for 
eighteen years never been free from it save for the three summer 
months. There were shooting pains in the legs having the moda- 
lities of rhus, and causing much restlessness. Ehus venenata was 
given, 5 drops of the 3x three times a day ; and a complete cure 
was effected. — Hahn. Monthly, May. 

Oangrena pnlmonum. — Dr. C. N. Hart, of Denver, sends to 
the Medical Argus for May a case of apparent gangrene of the 
lungs. (Both lower lobes and part of the left upper lobe were 
solid ; and gangrenous lung>tissue was found in the profuse and 
offensive expectoration.) Lycopodium 200 effected prompt im- 
provement, going on to complete recovery. 

Ooitre. — ^Dr. Welch relates three cases which seem to show 
that the inhalation of dry iodine (he does not say how long or 
how often) may greatly aid its internal administration (in the 
3x to 6x dil.) to remove bronchocele. No symptoms of iodism 
appeared. — The Clinique, May. 

Gonitis. — (1) Mrs. Ghr. L., aged 42, tall, dark complexioned, 
stooping gait, consulted me on August 21, 1894, on account of 
pains and swelling of right knee. Some months since she was 
attacked by severe pains and inability to walk. A swelling 
gradually formed, at first with redness of skin, afterwards with- 
out discoloration. The treatment hitherto pursued, ice, massage, 
&c., had no beneficial effect. I found a considerable serous 
effusion in the knee-joint; above the patella the circumference 
was 2| cm. greater than that of the sound leg. Walking was 
very difficult, standing impossible. The general health was in- 
different ; at night she had occasionally violent pains and stitches, 
aggravated by lying under a down quilt ; and she had to get up 
several times in the night to pass water. Bowels acted variously, 
the urine often showed a great sediment of urates. Her suffer- 
ings were increased by damp weather. She had suffered from 
glandular affections as a child. I prescribed sulphur 30, a dose 
every fifth day. On September 23 the report was that the 



general health was mach improved, the Tiolent peins had oeaaed, 
except very rarely at night, the swelling was 1 em. less, bat the 
leg was soon fatigued by walking. I now prescribed solphnr 200, 
a dose once a week. On November 5 she was reported mach 
improyed, hardly any swelling, pain only after standing for a long 
time. Medicine continued. In a letter dated December 20 the 
patient announced that she was quite well, and she has continued 
BO till now. — Wassily, A. k. Z.^ cxxx., 117. 

(2) H. W., a waiter, aged 17, was brought to see me on September 
27. He was a dehcate-looking, pale youth. Three weeks ago he 
had an attack of severe fever ; in the course of one night the right 
knee-joint swelled so much that he could not move it. It was the 
seat of violent pains; the knee measured 4 cm. more than the 
other. Appetite very poor; there was no more fever; every 
movement of the knee was attended by great pain, bowels costive, 
urine with a whitish sediment, sleep restless, great perspiration 
to^v^ards morning, frequent attacks of heat during the day. He 
had formerly suffered from glandular swellings and eruptions, and 
latterly jaundice. I prescribed sulphur 6 a dose twice a day. 
October 12, much improved, the swelling was less by 2 or 2| cm., 
active movements of the leg caused slight pains in the knee-joint. 
Night sweats gone. Prescribed sulphur 30, a dose every other 
night. November 5, the knee was so much better that he could 
walk without a stick ; the swelling was only 1^ cm. larger than 
normal. Hardly any creaking or rubbing could be heard. He 
got a few more doses of sulphur 30 once a week, and by the end of 
the month he was quite well. — UM, 

(3) Mrs. G., aged 68, came under my treatment on July 17, 
1894, for chronic dropsy of the knee-joint. She had been affected 
for about a year, and attributed the disease to a fall on the knee. 
Three months ago the joint was pimctured and washed out, but 
the effusion into the knee joint had recurred, and was now very 
great. She had little or no pain, but damp weather and standing 
for a long time caused aggravation. Her general health was 
tolerably good, only she did not sleep well. After a slight chill 
there was much urging to urinate with scanty discharge; she 
suffered much from cold feet; formerly she had sweaty feet. 
When a girl she was for a long time chlorotic; had also once 
suffered from acute joint rheumatism without any concomitant 
heart affection. I prescribed sulphur 200, a dose for three 
successive nights. August 2, she reported that while taking the 
medicine she was very drowsy every morning ; no alteration in 
the knee. I now prescribed sulphur 3, four drops twice a day. 



336 SUMMARY. 

After a fortnight the swelling began to diminish, and the move- 
ments of the joint were easier. I continued the medicine for 
several weeks, until the knee was no more swollen than the 
sound one. The movements were quite free and painless, there 
was only weakness when she stood for a long time, and slight 
creaking could be heard. I now gave sulphur 200, one dose every 
week, and by December the patient was quite well. — Ibid, 

Menorrhagia. — Dr, Ludlam has had good results from cocaine 
as a hsBmostatic, in such cases as the menorrhagia incident to 
uterine fibroids. He puts about gr. ^^ in half -a- tumblerful of 
water, and of this solution gives teaspoonful doses frequently 
until the flow diminishes. — The Clinique, February. 

Pemphigus. — Dr. Hansen reports a case of pemphigus in a 
man of 37, in which arsenic did nothing but reUeve accompanying 
pain. As he complained of night-sweats, and expectorated much 
mucus, mercurius sol. 1 was given, and a mercurial salve applied 
to ulcers that had formed. In a month he was well. He denied 
syphilis. — Hahn. Monthly, May. 

Pneumonia. — The numbers of the Medical Century for March 
1 and 15 are mainly devoted to the treatment of pneumonia. 
They show that in America as well as in Europe much confidence 
is felt in the homoeopathic treatment of this disease, and that the 
remedies employed there are much the same as those of Fleischman 
and Tessier. 

ProlapsuB uteri. — Dr. Majumdar records three cures of this 
trouble in Indian women by internal medication alone. In the 
first sepia 30, in the second and third lilium tigrinum 3x and 6x, 
were the remedies. Leucorrhoea seems to have been the chief 
indication for the former, co-existent ovarian pain for the 
latter. — Indian HomcBopathic Beview, January. 

Pyelitis. — Dr. Selfridge relates a case of this disease in which 
the pus quite disappeared from the urine under the influence of 
hepar 200. He was led to the remedy by the symptom — ''feeling 
as if a cold wind were blowing about the legs," the patient being 
well covered up in bed, with no draught in the room. [Dr. Sel- 
fridge says : — ** So far as I know there is but one drug in the 
materia medica that has this symptom recorded among its provings, 
and that drug is hepar sulph." It would be well if he would tell 
us in what provings he flnds it. It is not among those collated 
by Allen. Ed.] — Pacific Coast Journal of Homcsopathyt March. 



SUMMABT. 337 

of Os ateri. — In an article on the homoBopathic 
treatment of childbirth Dr. Higbee writes : — ** I have found but 
two remedies having any perceptible influence in promoting dila- 
tation. These are belladonna and gelsemium. Belladonna I use 
internally, and, if necessary, the tincture applied locally to the 
cervix. The indications are entirely different. Belladonna is called 
for -when the cervix is rigid, not having relaxed at all. The indi- 
cations for gelsemium are that the patient is nervous and tired, and 
feels she has not strength enough to go through with the labour. 
Tbe OS and cervix are not rigid. When pains occur, and the pre- 
senting part presses on the internal os, the patient shrinks from 
tbe pain and the uterus may suddenly contract the wrong wa/y^ 
raising the foetus still higher in the uterus. I use in these cases 
tlie tincture, repeating as often as seems best. I never use this 
remedy locally." — Horn. Joum. of Obstetrics, dc, March. 

Scarlatina. — The numbers of the Medical Centwry for May 1 
and 15 are devoted to the treatment of scarlet fever. Tbe old- 
established indications are well sustained by the various writers. 
We note a few novelties. 

(1) Dr. George Boyal, after praising bryonia in caaes of reper- 
cussion of the eruption, notes that in such the urine is apt to be 
suppressed, causing restlessness and irritability, often with 
delirium and carphok^ia, which soon pass on into araemic coma* 
Here, he writes, '' stramonium 3 or 6, given in five^op doses 
every fifteen minutes until the secretion is restored^ ha« several 
times saved life for me." 

(2) Dr. Fisher says that carbolic acid (4tb dilution) has 
rendered him most excellent service in confirmed blood-poi^^ning 
types, with coma, faetor oris, besotted countenance, otorrlKea 
profuse and ofEensive, glandular involvement destructive. 

(3) Our own Dr. Yawdrey legarcb the specific aciic/n of cao' 
tharis (Ix to 3x) in acute nephritis *^ one of the few c^fHAiuiim 
of medicine." 

(4) Dr. A. L. Fisher rdates a ca^e of mippr^imiou of nnu/^ 
with oonvulsimis and subsegpeot dropsy. Cuprum meta)#i/;u/ii 
in a *' moderately high " po<&es:^ h^hiiUedf aud L^^U/nhm in a k/w 
completed, a good retaverj m Una days. 

(5) Dr. B, O- Ayres, ayrrq^a (A a ea*^ ^A d;pht}i/?rjtj/; i^/mi- 
plication, states that Uukhsv^^ ^^Aiz.\\^ furn.^}*^ him mxh i)^ 
most potoit weapon be has a^&l^^^^t 'LyfiXi^rui^ iwM, 

TetaaoUb— In Coc^ (jcr2z:xj Uf/^.%aX tin^ht «m^ ^A Mo^u^j^ 
were treated in tbe iuirj^ii^t vu-h, wWn U^u 4^^^^^, lu t/^ 



388 BUMMABT. 

homoeopathic wards twelve cases also had been treated, but with 
only two deaths. — North Am. Joum. of Horn,, App. p. 28, April. 
[We should be glad to have particulars of these cases. — Ed.] 

A case is reported to the Indian HomoRopathic Beview of March, 
where this disease occurred in an infant in connection with 
umbilical inflammation. Nux vomica 30 was prescribed, with 
speedy relief and complete cure. 

Wounds. — A series of cases of wounds, accidental, operative, 
or experimental, were treated at Iowa University in comparative 
ways. In one class the wounds were united with silk sutures, but 
had no other treatment. In a second and third the usual bi- 
chloride treatment was adopted, or the wounds were dressed with 
iodoform. In the fourth class the homoeopathic vulneraries were 
employed — hypericum at first, calendula afterwards. The follow- 
ing results were obtained : — 1st Class. — Convalescence occurred 
in 11 days; suppuration in 50 per cent.; scar was good in all 
cases. 2nd class. — Convalescence in 9f days ; suppuration in 2 
per cent.; scar good in all. drd class. — Convalescence in 12| 
days ; suppuration in 50 per cent. ; scar good in 70 per cent. 
4th class. — Convalescence in 7f days ; suppuration in 1 per cent.; 
scar good in all. — Minneapolis Horn. Mag., March. 



JOURNAL 

OP THE 




®ritis| Innnpnptjir 

No. 4. OCTOBEE, 1895. Vol. III. 

All communications and exchanges to be sent to Db. Hughes. 

36, Sillwood Boad, Brighton. 



PULSE TENSION: 

Its Importance as an Early Indication of Certain Chronic 
Diseases, and. its Becognition by Means of the 

Sphygmograph. 

Presidential Address 
delivered before the society,^ - 
by byres moir, m.d. 

Physician to the London Homoeopathic Hospital, 

For a certain period the accurate observation of the 
pulse was neglected, more attention than it perhaps quite 
deserved being given to the temperature. In my student 
days a record of the number of the beats was all that was 
thought necessary. For some years now much more atten- 
tion has been given to the pulse, and besides the reference 
in standard books on heart disease, several small mono- 
graphs, especially devoted to the pulse, have appeared; 
the first of these being Dr. Dudgeon's on the sphygmo- 
graph, which, though published more than ten years ago, 
contains a series of tracings which have not since been 
equalled. 

» June 27, 1896. 
VOL. III. — NO. 4. 24 



340 PULSE TENSION. 

Sir William Broadbent's book on the Pulse is well known, 
being an amplification of his Croonian Lectures on the 
Pulse, delivered in 1887. Dr. Ewart, of St. George's Hos- 
pital, is publishing a series of heart studies; the title of 
No. 1, a book of 480 pages, being " The Pulse Sensations, 
a Study in Tactile Sphygmology." It is an exhaustive 
treatise, and the author caJls it an endeavour to bring the 
tactile method ''up to date." The last one is Dr. Oliver's 
*• Pulse Gauging; " the author having invented two ingenious 
instruments, (1) the arteriometer for radial measurement; 
(2) the pulse-pressure gauge. These instruments^ have only 
been such a short time in use that it is too soon yet to 
speak of their value, but the pulse-pressure gauge or sphygmo- 
dynamometer ought to give important observations. 

In this paper I desire to refer to only one condition of 
the pulse, that is, where its tension is increased above the 
normal. 

By arterial tension is meant the blood pressure within 
the artery ; during the ventricular systole it rises, while in 
diastole it falls, but the degree of such rise and fall varies 
greatly under different conditions. 

By means of the sphygmograph we can now recognise 
variations of the tension in a way that it is quite impossible 
to do by the finger alone, and in a series of tracings we have 
a valuable record of the progress of a case during treatment. 
In speaking of the sphygmograph I need not say that I refer 
to Dr. Dudgeon's instrument, which at first was looked upon 
as an interesting toy, but has steadily risen in favour, and is 
now really the only one in general use. So many medical 
men have expressed to me disappointment with regard to 
the results obtained from the use of the sphygmograph, that 
I should like to say a few words on this point. In the first 
place, it is the same as all other instruments, you must get 
accustomed to use it, and whenever there is reason to doubt 
the accuracy of the tracing, several should be taken until 
from uniformity you may be sure of a correct one. 

Next, many doctors whenever, on examining a patient, 

* Shown at the Meeting, and their mode of employment demonstrated. 



PULSE TENSION. 341 

they find a valvalar bruit, expect that a tracing of the pulse 
should give some evidence of this, forgetting that if there 
is compensation no evidence of any change can possibly be 
found in the radial. 

Then the same caution is necessary that is always given 
with regard to counting the pulse — to let any nervousness 
pass away, as it is quite a common thing to get a tracing 
showing tension, and another one immediately after it with- 
out any sign of it. This is not due, however, to any fault 
of the machine, but to the change which has suddenly taken 
place in the character of the pulse — a sudden nervous seizure, 
arising from the use of an unknown instrument, having 
caused relaxation of the arterioles and capillaries and so 
altered the tension, the slow pulse having become a rapid 
nervous one. In renal trouble and other similar conditions 
in which we expect to find tension, it is often absent, 
especially in the later stages, firom atheroma and degenera- 
tive changes in the. myocardium. 

A great improvement to Dudgeon's sphygmograph would 
be a self-registering pen, to do away with the smoked papers. 
An instrument fitted with a pen at the suggestion of Mr. W. 
H. Symons, has been made by Maw, Son & Thompson, but 
I cannot say that it works satisfactorily, and the trouble of 
filling the pen with ink is greater than that of smoking and 
varnishing the paper. 

I am not satisfied about the pressure as applied in 
Dudgeon's sphygmograph, and would like to see it done in 
the same way as in Oliver's pulse gauge, in fact a combi- 
nation of the best qualities of the two might give a very 
perfect instrument. 

I may appear to be dwelling unnecessarily long upon 
some elementary matters, but it is only to make things 
clearer to those who have not yet made much use of the 
sphygmograph. I would draw your attention to fig. 1, a 
normal pulse tracing taken from a young man of 21, a 
member of the Scotch Team of International Football 
Players, and in perfect health. It consists of a line nearly 
vertical — ^the percussion stroke — caused by the contraction 
of the left ventricle forcing the contained volume of blood 



342 



PULSE TENSION. 




Pig. 1. 



into the aorta, and suddenly distending the systemic 
arteries. The height of the first elevation gives a measure 
rather of the suddenness than of the power of the com- 
municated impulse. The relative suddenness can be fairly 
ganged by the acuteness of the angle which the descending 
line makes with the ascending, before the needle is again 
caught and lifted by the current of the blood due to the 
continuing ventricular systole, thus forming the second 
element, the tidal or predicrotic wave. The impulse com- 
municated by the ventricular systole having ceased, the 
needle of the sphygmograph falls by its own inertia, but is 
again caught up to form the dicrotic wave, a notch — the 
so-called aortic notch — of greater or less depth being thus 
formed. Its position marks the instant of complete closure 
of the aortic semilunar valves. The remainder of the trace 
represents the period of the heart's diastole. This is shown 
by the dicrotic wave, followed by a gradually sloping line, 
presenting some slight undulations, called post-dicrotic 
waves, and ending at the base line of the sphygmogram. 

Having satisfied ourselves with regard to the charac- 
teristics of a normal pulse tracing, we eire in a condition to 
consider the tracing of a pulse where the tension is above 
the normal, or high arterial tension. A much better term 
to use is the one suggested by Dr. Sanson, viz., "prolonged 
arterial tension," meaning thereby that the artery is sub- 
jected to a protracted strain from some disturbed correlation 
between the force of the systole of the left ventricle and the 
force of resistance in its own parietes, the best illustration 



PULSE TENSION. 



343 



being the pulse of chronic renal disease, where a hyper- 
trophied and strong left ventricle urges its blood waves 
into arteries whose coats are thickened, contracted, and 
resistant. 

In aortic regurgitation, on the other hand, we have a 
condition in which a sudden blood wave may be so impelled 
into the vessel as to forcibly distend it, even to the point of 
rupture, but during the period of diastole the pressure 
within the artery may be much below the normal ; the 
point of difference being that in one the intra-arterial 
tension is exaggerated and prolonged, in the other it is 
exaggerated and sudden. The absolute amount of blood 
contained in the vessels need not be greater, and may be 
less than normal, but the artery is tightly contracted upon 
its contents, so the pulse may be full, strong and incom- 
pressible, or small and wiry. The onset of the wave is 
gradual : it is felt for an appreciable and relatively long 
period under the finger, and it subsides slowly. The sphyg- 
mographic tracing will have an up stroke with a slight 
inclination forward, a round or flat summit, which may 
descend some considerable distance above the first apex, 
and a gradual decline in which the dicrotic notch is not well 
marked. The breadth of the summit is a measure of the 
first or ascending wave, and the dicrotic notch has a higher 
position than normal. In taking the tracing it is necessary 
to use considerable pressure to get the maximum move- 
ment of the needle. The signs of prolonged tension are, 
therefore : — 

(1) Broad summit ; 

(2) Increased pressure is necessary to develop the maxi- 
mum movement of the needle ; 




Fig. 2. 



344 



PULSE TENSION. 



(3) The dicrotic wave is slightly pronounced, and has a 
higher position than normal. 

Fig. 2 illustrates these points. 

The altitude of the tracing may be considerable or 
Tery slight according to the quantity of the circulating 
blood. If the pulse be full the amplitude may be con- 
siderable; on the other hand, a pulse may be very small 
and thready, and yet manifest over-tension ; and it is in 
these latter cases that a tracing may show that instead of 
a weak pulse we have really a hypertrophied left ventricle 
acting against the obstruction of contracted arteries. 




Fig. 3. 



Fig. 3 is from a girl with marked anaemia and some 
symptoms pointing to myxoedema, the pulse feeling to the 
finger poor and thready, but the tracing closely resembles 
one of renal disease. 

Mahomed proposed as a gauge of prolonged tension that 
a line should be drawn from the apex of the up stroke to the 
bottom of the notch preceding the dicrotic wave. Under 
normal conditions no part of the trace should encroach or 
bulge over this line. If it does so bulge it is an indication 
of abnormal tension. 

Fig. 4 is given to illustrate the opposite condition to pro- 
longed tension. There is a sudden shock, causing a vertical 
up stroke, and almost as sudden a fall, showing that no 
tension is maintained. It is taken from a case of aortio 
regurgitation, and shows in a diagrammatic form the "Water 
Hammer pulse with the emptying of the vessels between 
the beats. 



PULBB TENSION. 



345 




Fig. 4. 

Causes of Pbolongbd Tension. 

1. Hypertrophy of the Left Ventricle. — When the 
arteries are not morbidly thickened, as the result of muscular 
strain. 

2. Constriction of the Arterioles, — The effect of cold to 
the surface is to contract the arterioles, and by imposing a 
barrier to the onward current, to increase the intra-arterial 
pressure. The fatal cramp of swimmers may be brought 
about in this way. In the rigors of fevers, like malaria, the 
arterioles are constricted and tension of the pulse produced. 

3. The most frequent and important cause of prolonged 
tension is resistance in the capillaries due to their contrac- 
tion by the accumulation of excrementitious products in the 
blood. In acute nephritis we have a good instance of this, the 
rise of pressure being noted as soon as the elimination of the 
excrementitious products trom. the blood is interfered with, 
and the tension falls as soon as the kidneys resume their 
normal action. 

The three next figures illustrate this. 

I have to thank Dr. Blackley for being able to show them, 
as they are tracings taken by Dr. Lambert from a case under 
his (Dr. Blackley's) care. It was from the direct evidence 
wfaich they gave of the progress of the case that I was led 
to work more at the subject. A boy of 16 was admitted 



I 



346 



PUL8B TENSION. 



into the London Homoeopathic Hospital with acute ne- 
phritis, the urine containing abundance of albumen and 
tube casts. Fig. 5 was taken on the ninth day of the disease, 
after his admission to the Hospital. Fig. 6 was taken on 
the twelfth day, when there was only a trace of albumen 




Fio. 5. 



J'^^^-H 



Fig. 6, 




Fig. 7. 

and the oedema had nearly disappeared. Fig. 7 was taken 
ten weeks later, when the boy was in a normal condition. 

When we come to chronic renal disease we find the 
typical evidence of over-tension in the arterial system. Here 
we get hypertrophy of the muscular coats of the arteries, 



I 



PULSE TENSION. 347 

general thickening of their walls or arterio-capillary fibrosis, 
and hypertrophy of the left ventricle, this being shown by 
the heaving impulse of the heart, with its apex beat dis- 
placed downward and out ward, the,.accentuated second sound 
in the aortic area and the pulse feeling hard, cord-like, and 
full between the beats. I have not space to dwell long upon 
the nature and causes of these changes — changes which have 
been a matter of constant dispute for fifty years. Bright, 
in recording the various organic changes in a hundred cases 
of renal disease, and referring to the number of cases met 
with without any organic valvular cause for the marked 
hypertrophy affecting the left ventricle, says : ** This natur- 
ally leads us to look for some local cause for the unusual 
efforts to which the heart has been impelled, and the two 
most ready solutions appear to be either that the altered 
quality of the blood affords irregular and unwonted stimulus 
to the organ immediately, or that it so affects the minute 
and capillary circulation as to render greater action neces- 
sary to force the blood through the subdivisions of the 
vascular system." 

Traube regarded the destruction of a large capillary 
area in the kidneys as necessarily causing so much obstruc- 
tion to the circulation that, aided by the imperfect elimina- 
tion of water, the blood pressure in the aortic system must 
rise and cardiac hypertrophy follow. 

Johnson was the first to point out the excessive thicken- 
ing of the muscular walls of the renal arterioles, and con- 
sidered that there was a state of tonic spasm of the whole 
systemic arterioles, which he attributed to stimulation of the 
vaso-motor centre, and regarded the condition as analogous 
to asphjrxia, in which unoxygenated blood, going to the 
brain, stimulates the vaso-motor centre in the medulla, and 
causes contraction of the arterioles throughout the body with 
consequent increase of the arterial blood pressure. 

Gull and Sutton drew attention to the thickening of the 
inner and outer coats, and asserted that the muscular coat 
was atrophied. They regarded these changes as primary 
and essential; the increased blood pressure and cardiac 
hypertrophy as the results of them ; while the kidney disease 



348 FUIiBB TENSION. 

was a mere local expression of a generalised degeneration of 
the arterioles and capillaries, attended by atrophy of 
adjacent tissues. These various theories have now been 
abandoned, and all later yriters have gone back to Bright's 
suggestions, that the changes are due to the action of impure 
bloody either on the heart directly or on the capillaries. A 
great step was taken when Mahomed proved that the rise 
in blood pressure preceded the occurrence of albuminuria; 
here, there is no question of structural change in the heart 
or arterioles ; the sole condition present is that of faulty 
elimination due to the morbid state of the skin. He also 
recorded cases of high arterial tension, sometimes accom- 
panied by albuminuria, in young dyspeptic patients free from 
cardiac hypertrophy. 

Most modern writers — Grainger Stewart, Broadbent, 
Mahomed, and others — regard the obstruction as existing in 
the capillaries, and the cardiac hypertrophy as the conse- 
quence of this impediment to the circulation. The ultimate 
cause of the increased capillary resistance is considered to 
be due to a contraction of the walls from the irritation of 
foreign matters, but requires still further explanation. 

Hamilton has suggested that it may be explained by 
alterations in the specific gravity of the blood sermn ; the 
difference in the specific gravity between the blood plasma 
and the coloured corpuscles giving rise to obstruction by the 
corpuscles having an altered position, and then friction 
against the walls of the vessels retarding their progress. 

The other conditions in which we find prolonged tension 
are — gout, constipation, lead poisoning, anaemia, pregnancy, 
hysteria, migraine, neuralgia, and at the cUmacteric ; I have 
not, so far, found any previous reference to its existence in 
this latter condition. 

Dr. Haig, in his book on " Uric Acid in Causation of 
Disease *' — the most interesting and suggestive work which 
has appeared for some time, and which I would advise all 
who have not already done so to read — considers, and gives 
good reasons for doing so, that excess of uric acid in the 
blood, as the result of imperfect secretion, is the cause 
of the arterio-capillary contraction and increased tension ; 



PULSE TENSION. 349 

and gives to the condition the term ** Uric-acidsemia/' He 
gives a list of diseases as due to this state, including, amongst 
others, migraine, epilepsy, convulsions, hysteria, mental 
depression, asthma, bronchitis, dyspepsia, rheumatism, gout, 
albuminuria, glycosuria and morbus cordis. This seems a 
long list, but in considering the effects of continued increased 
pressure, a gradual sequence in the results can be traced, 
terminating, according to idiosyncrasy and environment, in 
a varied form of disease. 

The pathological effects of prolonged tension on the circu- 
latory system are : — 

(1) Hypertrophy of the muscular coats of arteries and 
fibroid changes. 

(2) Atheroma and degeneration of arteries. Pressure 
within the vessels takes effect on the vasa vasorum in their 
walls, and tends to interfere with the flow of blood along 
them, and thus to cut off the supply of nutriment from' the 
coats of the arteries themselves. This gives rise to a change 
of a strictly degenerative character. Fatty and cretaceous 
deposits are formed in their waUs, and the vessels in 
advanced cases become converted into inelastic tubes, pre- 
senting bulgings and tortuosities and often calcareous 
indurations. Atheroma of the larger arteries and aorta 
follow, and then the valves, from the persistent strain upon 
them, cause, in their turn, hypertrophy and dilatation of 
the heart walls. 

The early symptoms of a general character associated 
with increased tension are migraine or sick headache^ 
depression of spirits, loss of mental power and energy, 
irritability of temper, loss of nerve, with a slow pulse and 
feeUng of chilliness. 

The etiology of these cases, where we find the two con- 
stant factors of increased tension along with deleterious 
products in the blood, seems to be usually a high proportion 
of animal food, and often also of alcohol, associated with 
sedentary habits and a minimum amomit of muscular exer- 
cise; though often a severe illness, an excessive loss of 
blood, or an attack of influenza may seem to be the final 
starting point. 



350 



PUIiSB TENSION. 



When getting together the material for this paper, I had 
not seen Dr. Haig's book, but had been strack with the 
number of cases I was meeting with, usually in persons about 
middle life, in which I found arterial tension revealed by the 
sphygmograph, the majority coming from the better class, 
but still plenty can be found among hospital out-patients. 

Case I. — W., a man of 63, was sent to me by Mr. Wright. 
He was short and stout and complained of constant headaches, 
loss of memory, and inability to attend to his business. His 
urine was free from albumen and sugar. He usually sat in a 
small close room all day, and stated that he had never taken any 
exercise all his life. His appetite was good, and he took a fair 
amount of alcohol. The pulse tracing taken at the time (fig. 8) 
shows very marked tension. 




Pig. 8. 




Fig. 9 



PULSE TENSION. 351 

The treatment ordered was low diet with very little meat ; 
no alcohol ; to be in the fresh air a certain time every day : and 
as I knew he would take no exercise of his own accord, I ordered 
him massage. Under this treatment the symptoms which made 
one fear apoplexy quite disappeared, and when I saw him six 
months later his tracing (fig. 9) showed great improvement, 
though there was still evident a small amount of tension, which 
might be partly due to an influenzal catarrh from which he was 
suffering. 

Case II, y a man of 50, is a very similar one as regards 
causation, but differing in the parts attacked. For some six months 
a small quantity of albumen had been found in the urine, 
always more marked after exercise. He used to be very active, 
but now he cannot walk three miles. He has passed a consider- 
able quantity of oxalates and urates, and sometimes uric acid ; 
the sp. gr. of the urine was 1022, it turned dark with nitric 
acid from bile pigments. Over the pulmonary area there was 
audible a soft bruit with the first sound, and accentuation of 
the second sound over the aortic area (fig. 10). The tongue 
was red and irritable, the liver easily upset, and he complained 
at times of rheumatic pains in shoulders and wrists. He was 
under the care of Dr. Neild of Tunbridge Wells, who some time 
afterwards found sugar in the urine. He dieted him carefully 




Pig. 10. 



on anti-diabetic food, and he is now much better, having lost 
his headaches, and for some time there has been no sugar nor 
albumen. Fig. 11 is a tracing taken a few weeks ago. 



«62 



1»UL8B TENSION 




Fig. 1L 



Case III. (fig. 12). — C, aged 48, is a case of acute gout of 
the big toe. This gentleman confessed to having drunk a bottle 
of champagne for his dinner every night for seven years. After 
the acute attack was over, he reduced his weight by diet and 
exercise by more than a stone, and has been keeping well since. 




Fig, 12. 



Case IV. (fig. 13). — D., a lady aged 48, and weighing 14 stone 
6 pounds, had for some time been losing strength and getting 
very nervous ; there were patches of eczema on her wrists ; she 
had also frequent attacks of diarrhoea. Some ^yq years ago 
sugar was found in the urine ; this disappeared under treatment, 
but it has been noticed at intervals since. She was passing 
urine every two hours. Its sp. gr. was 1042, it contained no 
albumen, but a large quantity of sugar, uric acid and bile 
pigments. She is still under treatment, on strict anti-diabeti6 
food, and is improving steadily ; the urine is now 1028, and con« 
tains only a trace of sugar. 



PULSE TENSION. 



353 




Fig. 13. 

Case V. is a similar one, but the improvement was much more 
rapid, which I attribute to the case being seen at an earlier 
period of the disease. 

B., a lady of 47, complained that she had not been well for 
some months, that she was losing flesh, had great thirst, and 
had become very irritable and nervous. The urine, sp. gr. 
1043, was acid, containing uric acid and urates; no albumen, 
but 4 per cent, of sugar. The quantity passed in twenty-four 
hours was 54 oz. She was put on strict anti-diabetic diet, and 
given acid phos. Ix nxx. t.d.s. The first report was on February 14, 
and on March 2 the urine had a sp. gr. 1020, and there was no 
trace of sugar. The quantity passed was 35 oz., and she had put 
on 3 lbs. in weight. 

At first, whenever the food was changed, more farinaceous 
food being allowed, the sp. gr. went up and sugar appeared, this 
being the case whenever the sp. gr. reached 1025, but for a long 
time now she has been quite well and is able to take ordinary 
diet. 

Case VL — L., aged 48, is a case which I have had under 
observation for some years, and though in some points resemb- 
ling the above, presents many points of interest. The pulse 
tracing (fig. 14) shows well marked tension, but I have never 




FlQ. 14. 



354 PULSE TENSION. 

been able to find sugar or albumen. The heart is hypertrophied, 
the apex beat being well outside the nipple line. The condition 
is evidently in connection with the menopause. The first time 
I saw her was for a large haemorrhage into the choroid ; she was 
at that time suffering from attacks of unconsciousness, only 
lasting a few moments. She has had since several attacks 
evidently pointing to congestion of the brain; on one occasion, 
after hurrying, she suddenly lost control of herself, and began to 
ramble and talk incoherently, and had to be supported to prevent 
falling. On another occasion, while getting up, she fell and struck 
her face, and was found unconscious by her sister, having been 
in that state for half an hour. The last time I saw her, in 
February of this year, she was much better, not having had an 
attack for more than six months. No catamenia had been seen 
for three months. The pulse, however, still shows some tension. 

I have had several cases of increased tension occurring 
about the climacteric period, and in all these the mental 
symptoms have been the most marked. 

The relations of gout, albuminuria and glycosuria are 
very interesting, and it seems probable that they can be 
traced to the same origin, viz., dyspepsia, with resulting 
excess of uric acid in the blood, causing increased tension. 

It is interesting to note the opinions of those who have 
worked specially on this subject. 

Dr. James Anderson considered that gouty arthritis and 
diabetes mellitus are in certain cases merely transformed 
symptoms of the same diathesis, not present at the same 
time, but one taking the place of the other. 

Dr. Latham thought that there was a form of diabetes 
which originated in some error in the metabolism of mus- 
cular tissue. 

Dr. Fagge considered that gout and diabetes were 
due to disorders of hepatic function. 

Dr. Ord believes that general high tension may cause an 
excess of blood in the liver, and so glycosuria. And people 
presenting in a typical form the symptoms of granular con- 
tracting kidney not infrequently have also glycosuria. 

Sir A. Garrod has written on dyspepsia causing an 
excess of uric acid in the blood. 

It has been left to Dr. Haig to give us the most complete 
picture. 



FULSB TENSION. 355 

Treatment, — It is very easy to lay down general rules for 
the treatment of these cases, but much more difficult to get 
them carried out. We need plenty of fresh air and exercise, 
and free action of the skin and bowels, along with a simple 
diet and little or no stimulants — in fact, the ordinary rules 
for a healthy life. But the patients usually suffer from 
lassitude, fits of melancholy, and extreme fatigue after any 
exercise, and there is a complete want of tone about the 
muscles, so that it requires a great deal of patience to make 
them persevere. Hence the advantage of massage as a form 
of exercise to begin with, but it should be followed up by a 
course of Swedish exercises, or active outdoor exercise, to get 
the muscles into trim. 

These cases do not stand cold baths well, and the best 
form of bathing is a warm bath followed by a cold douche. 
Dr. Haig cured himself of periodic headaches due to uric 
acid by giving up nitrogenous food, and it was in conse- 
quence of this that he was led to his investigations. He 
includes fish as being as bad as meat, and advocates a diet 
of fruit, vegetables and vegetable products, with as much 
milk, cheese and eggs as is necessary to keep up a supply of 
urea. There is one point of diet which puzzles me at 
present, viz., that the cases of glycosuria — which, as we 
have seen, arises from the same cause, and is interchangeable 
with albuminuria and gout — seem to need a meat diet with- 
out farinaceous food before any impression can be made 
upon the specific gravity of the urine or in the amount of 
sugar passed. I have seen no harm but good follow from 
its use ; though it seems like adding fuel to the fire. 

With regard to drugs, the old school recommend the 
iodides, mercury in some form, and the salicylates. 

We have many remedies which are most useful, especially 
those which have a direct action upgn the liver. The subject 
is a large one, and I do not intend to enter upon it to-night, 
but we have in bryonia, pulsatilla, mercury, sulphur and lyco- 
podium — to mention no more — drugs upon which we may 
rely, and I expect that when the subject is more freely in- 
vestigated we shall find in lycopodium a medicine which will 
help very much in the elimination of uric acid and urates. 
VOL. III. — NO. 4. 26 



356 A KNOTTY CASE. 

Dr. Dyce Brown, in some of his lectures on the Digestive 
Organs,^ draws attention to the complete picture of gouty 
dyspepsia given by lycopodium, and speaks highly of its use. 
In conclusion, I would only say that the conditions I 
have been considering, though beginning in a slow and what 
appears to be trifling form, in the course of years lead up to 
most serious organic changes. At the first they are purely 
functional disorders, that is, there are no discoverable 
structural changes, and if we can recognise them early 
enough we can often ward off the approaching disease. In 
order to do so more attention must be paid to minor mani- 
festations, and it is to one of these — tension of the pulse 
— that I have desired to draw attention. 



A KNOTTY CASE : ? ACTINOMYCOSIS.^ 

BY J. GALLEY BLACKLEY, M.B.LOND. 
Senior Physician to the London Homoeopathic Hospital, 

Jane Davis was an inmate of the children's ward of 
the London Homoeopathic Hospital from October 24, 1893, 
until the beginning of April, 1894, during which time she 
was to me, and to many of those who saw her, a good deal 
of an enigma. When she left the hospital I was by no means 
satisfied with our provisional diagnosis, which was " pneu- 
monia," nor yet with the more complete diagnosis and 
abstract filled in on the completion of the case, which ran 
as follows : " Probably influenza with pneumonia, bronchitis, 
nephritis, multiple abscesses and long continued diarrhoea, 
ceasing with opening of abscesses and discharge of pus — 
ultimate good recovery.** 

It was only after a lapse of some months, on reading 
over the elaborate notes taken by a late house surgeon. Dr. 
Lambert, that I was struck with the close resemblance 

» Monthly Homoeopathic Review, February, 1894, p. 96. 

* Presented to the Section of Medicine and Pathology, May 2, 1896. 



▲ KNOTTY CASB. 357 

between his record and the symptoms of actinomycosis, the 
" ray-fungus disease," as it occurs in the human subject. 

With a mass of notes extending over a period of nearly 
six months, condensation is by no means easy, but the 
following abstract will, I hope, serve to draw attention to 
the chief phases and symptoms of this interesting case. 

JaneD., aged 13, a schoolgirl, was admitted on Oct. 24, 1893, 
complaining of cough, with pain in the right side of the chest on 
deep inspiration. Except that the child's father was an inmate 
of the hospital at the same time with an attack of subacute 
rheumatism of a low type, the family history presented nothing 
remarkable. The child had always been subject to coughs. The 
attack had begun two days before admission with pain under the 
arm, preceded by shivering and vomiting. On admission, tem- 
perature, pulse, respiration and other physical signs betokened 
an attack of pleurisy in the right infra-axillary region. During 
the next few days the signs of pleurisy disappeared, and those of 
more or less complete lobular pneumonia took their place ; the 
expectoration became profuse, frothy and viscid, the breath 
offensive, and the temperature ranged as high as 104*8°. 

On Oct. 31, without any special symptoms leading one to 
expect anything unusual, the temperature when taken at 1 a.m. 
was found to be 95°, the patient was slightly cyanosed and 
evidently in a state of partial collapse. Four hours later, at 5 
a.m., there was a smart rigor, and the temperature was found to 
have risen during the four hours to 105*4.° Nothing very remark- 
able happened after this extraordinary range of temperature, and 
the phenomenon was not repeated, but the temperature ranged 
persistently high for a whole week. The chest signs were very 
inconstant, varying almost daily, expectoration meanwhile 
increasing. 

On Nov. 8, the temperature began to take on a more distinctly 
hectic type, being subnormal in the morning and high at night. 
Expectoration became copious, muco-purulent and slightly tinged 
with blood. The patient had distinct night sweats, and breath 
was very foul. Dulness was found over both bases as high as 
the angle of the scapula, coarse crepitations, creaky rales, like 
friction sounds, and here and there tubular breathing, causing 
one to think of acute miliary tuberculosis, although there were no 
corresponding signs in front or at the apices. The tongue was 
dry and denuded of epithelium, and the skin dry and harsh. The 
attack at this period was looked upon as one of influenza of the 
remittent type. 



358 A. KNOTTY CASE. 

On Nor. 16 {i.e., twenty-five daya from the commencement of 
the attack) began the second phase of the ailment in the 
appearance of two fluctuating swellings, a small one on the 
acalp and a larger one over the left buttock. Next day both 
were opened, 6 ozs. of app&rently laudable pus being evacuated 
from the gluteal region, and a little thick, ourdy pus from the 



Portion of four honrs' chart of Jane D. 

scalp. Free suppuration continued for several days from the 
larger abscess. On the 21st a third abscess appeared on the 
right arm, and on the 24th a fourth one below the left clavicle ; 
both were saperficial, and on being opened gave vent to some 
ounces of very bright coloured pus. The cough meanwhile was 
very troublesome, and the muco-purulent expectoration exceed- 
ingly copious (two half-pint cupfuls per diem). 



A KNOTTY CASB. 359 

Five days later two fresh abscesses were opened, one on the 
right arm and the other over the left deltoid, the former ones 
haying both closed. 

On November 28, with an evening temperature of 104P, it was 
noted that nearly all the joints were very stiff, and the child 
cried oat on the least movement. She was also seen to be 
wasting rapidly. 

On Dec. 5 (a week later) a diffuse swelling was found in front 
of the right thigh, with some tenderness in Scarpa's triangle. 
The expectoration had meanwhile become distinctly nummular. 
Examination for tubercle bacilli gave a negative result. 

On December 9, a small abscess was opened over the right 
trochanter and a small quantity of very offensive pus was 
evacuated, and on the 12th under anaesthetic my colleague, Mr. 
Shaw, opened an abscess below the deep fascia of the right 
thigh, and 3| ozs. of horribly fcetid pus were evacuated. At 
the lower end of this abscess was a hardened mass of necrotic 
tissue, and after this was cleared away a probe passed freely 5 
inches downwards and 3 inches in an upward direction. During 
the next few days suppuration continued very free and the 
discharge was very foetid. The joints still remained very stiff 
and acutely painful on movement. 

December 16. — The urine on being tested was found to be 
dense, scanty and containing a good deal of albumen (this was 
exactly eight weeks from the date of the initial symptoms). 
A rather copious deposit showed hyaline and granular tube-casts. 

A week later the urine was very scanty (13 ozs. only), but 
free from albumen and casts. Hepatic dulness was found to 
extend three-quarters of an inch below the edge of the right 
hypochondrium. On this day, December 22, the patient expec- 
torated a httle blood. Temperature was very little above 
normal ; right lung quite clear and left nearly so. 

On December 29, the large abscess was still discharging 
freely. Urine 21 ozs., contained a little albumen. 

By January 1, 1894, the temperature was normal night and 
morning ; cough nearly gone and abscess still discharging freely. 
Other notes of same date were : '* Has had slight epistaxis twice 
a day for the last day or two. Urine scanty, high-coloured, acid, 
no albumen ; deposit contains much debris but no distinct casts. 
The patient has been taking food freely for weeks past ; fish, 
chicken, fruit, white wine, whey and cod-liver oil being taken 
greedily.'* On January 3, she was lifted out on to a couch for 
a short time. 



860 A KNOTTY CASE. 

On January 10, began what may be described as the thurd 
phase of this uncommon attack, when diarrhoea, setting in during 
the night of the 9th to 10th, was superadded to other symptoms. 
The abscess was still discharging freely, and the pus very foetid. 

Two days later the notes state that there were ''four stools 
in the twenty-four hours, all very offensive and consisting 
largely of undigested food." 

From this date until the end of the month of January in 
spite of all treatment the diarrhoea continued, the stools varying 
in number from seven to twelve in twenty -four hours ; they were 
liquid, very foetid and occasionally contained a little blood and 
mucus. The lungs were practically clear, and the temperature 
usually normal in the morning and but little raised at night. 
The child was taking food well and could turn herself a little in 
bed. The abscess meanwhile continued to discharge freely. 
At the end of another fortnight (February 13), the number of 
stools was still seven in twenty-four hours. The abscess was 
still discharging freely, but the pus was thicker and yellower 
and less offensive. The patient was still taking food greedily, 
but was emaciated to the last degree, and it was only by the 
unremitting care of sister and nurses that bedsores were avoided ; 
the temperature was practically normal night and morning. 

On February 17, under anaesthetic the abscess was laid open 
throughout its entire length by my colleague, Mr. Shaw, scraped 
with a blunt spoon and stuffed with iodoform gauze. No 
tubercle bacilli were found in the scrapings. 

Ten days later, as the discharge was still excessive and the 
pus again offensive, Mr. Shaw, under A.G.E., again explored the 
wound and found a further large abscess burrowing along the 
back of the thigh and communicating with the former one by 
a pinhole opening. A dependent aperture was made, some 
ounces of very foul pus evacuated, and a large drainage-tube 
passed through the limb from front to back. The immediate 
effect of this and the use of peroxide of hydrogen for syringing 
out the wound was to lessen the amount of discharge and to 
mitigate the diarrhoea. The temperature became normal or 
subnormal. 

Another, and the last, abscess formed above Poupart's liga- 
ment on the right side and was opened on March 13, many 
ounces of pus being evacuated. The diarrhoea still kept up, the 
stools being usually four or five in twenty-four hours ; otherwise 
the patient's condition was distinctly better, the emaciation was 
not progressing, food was well taken and the patient was up 
some hours every day. 



A ENOTTT CASE. 361 

By the end of the month the discharge had become very 
slight. Bowels were still loose (three or four times daily). In 
other respects the child was steadily improving, being up six or 
eight hours daily, and beginning to put on a little flesh. 

April 1. — Taking solid food. Temperature still inclined to 
fluctuate a little. Discharge and diarrhoea very slight. Dis- 
continue medicine. 

April 6. — ^Was taken by the Ward Sister to the Children's 
Home Hospital, High Bamet. Here she remained for three 
months, putting on flesh rapidly all the time, so that on her 
return her weight was at least double what it was when she left 
our hospital. The chest had cleared and urine was free from 
albumen. Extensive matting had evidently taken place amongst^ 
the structures about the right gluteal region, hip and thigh, 
causing the thigh to be permanently slightly flexed on the pelvis. 
There was, however, no shortening or other symptom indicative 
of implication of the joint. Mr. Shaw twice stretched the limb 
under anaesthetic, with some improvement. I saw the girl on 
February 1, 1895 ; she still limped, but less so than before. Her 
chest was normal, except that vocal fremitus was rather less 
marked on the left side posteriorly. The urine was free from 
albumen, and the child well nourished and eating well. This 
state of things has been fully maintained. I saw the child 
yesterday. Her weight is 84: lbs. and the urine is free from 
albumen. 

Were these successive developments — the broncho- 
pneumonia, with its very copious and sometimes foetid 
expectoration, the nephritis, the multiple abscesses with 
the terribly foetid pus, and the intractable diarrhoea, as was 
at first supposed, the sequelse of influenza, or have we 
reasonable grounds for thinking they were evidences of an 
undetected condition of actinomycosis ? I now incline very 
much to the latter supposition, although you will naturally 
object when I admit at once that the most important link 
in the chain of evidence, the presence of the ** ray-fungus," 
is lacking. Yet the symptoms resemble so remarkably those 
of three of the best known forms of actinomycosis, the 
thoracic, the abdominal, and the pyoheemic, that I would like 
to bring these briefly before you. Before enumerating the 
symptoms of these three forins, a word or two is necessary 
as to the pathology of the disease. In the lower animals 



362 A KNOTTY CASE. 

the morbid appearances associated with the presence of 
the ray-fungus generally consist of a more or less solid 
growth composed chiefly of embryonic tissue with the 
actinomyces in the centre. The fungus is generally found 
alone, and not associated with bacilli or microphytes, the 
pyogenic bacilli being conspicuous by their absence. This 
may be accounted for by the fact that the herbivora as a 
class are little susceptible to the invasion of pyogenic 
organisms. In the human subject, on the other hand, it is 
far otherwise. The actinomyces is rarely found alone, but 
is usually accompanied by one or more varieties of pyogenic 
bacilli. The essential lesion consists of a sero-purulent 
sac (derived from a mass of embryonic tissue which has 
become necrotic and purulent) containing the characteristic 
grains, having a great tendency to spread by degrees, or 
to reproduce itself by embolic infarcts in distant organs or 
tissues, or to cause more or less generalised pysemic infection. 
In the lungs peri-bronchic and pneumonic foci cause a 
chronic interstitial inflammation which may extend to the 
pleura, which becomes thickened and contains fluid. The 
mediastinum becomes involved and openings may form on 
the skin, or it may infect the prevertebral tissues, traverse 
the diaphragm and gain the abdomen. 

Very occasionally the disease assumes the form of a 
diffuse mycosic bronchial catarrh, the expectoration being 
foetid and profuse and containing in addition to pus and 
epithelial cells the characteristic grains of actinomycosis. 
Much commoner is the parenchymatous pulmonary form. 
This commences either with acute febrile disturbance 
resembling that of typhoid fever, followed in a few days by 
an attack of pleurisy in one side or the other of the chest, 
or more usually in a more gradual manner by thoracic 
malaise and more or less troublesome dyspnoea. In either 
case the physical signs either reveal the existence of pleuritic 
effusion, or there is dulness, diminished vesicular murmur, 
bronchial or even cavernous breathing mixed with rales. 
If the lesion is near the summit, tuberculosis is usually 
diagnosed; cough, expectoration, haemoptysis and some fever 
seem to confirm this diagnosis : if in the middle of th€ 



A KNOTTT CABB. 363 

lang, one thinks of chronic pneumonia or encysted pleurisy. 
Sooner or later an abscess forms, which either opens on the 
surface of the chest, or burrows along the prevertebral 
cellular tissue in the sheath of the psoas and iliacus, invades 
the abdomen and opens at a point more or less removed 
from the primary focus. If this abscess is opened or para- 
centesis thoracis be performed a purulent, often greenish 
sero-sanguinolent liquid is obtained, containing the charac- 
teristic elements. The expectoration also may yield the 
same evidence. " In this form the infection is spread by 
means of emboli in the subcutaneous and intermuscular 
connective tissue, and in most of the internal viscera. 

In the abdominal form where the intestine is attacked 
extensively, the symptoms are those of enteritis, with 
excessive, intractable diarrhoea. 

A pyaBmic form has also been described when the 
disease terminates by generalisation with the production of 
multiple foci suggesting those of purulent infection. The 
primitive lesion may even have passed unperceived, and the 
malady has every appearance of being a chronic pycemia. 

Altogether I incline to the view that Jane Davis be- 
longed to all these categories ; that the original lesion 
which may have been in the tonsil was overlooked; that 
the lung freed itself from the fungus, so that none was 
detected in the sputa; that the abscesses were caused by 
infarcts and assumed the pysemic character, and that the 
intractable diarrhoea was due to involvement of the mucous 
membrane of the small intestine : and this in spite of the 
dogmatic assertion of Boger that no diagnosis can be con- 
sidered as satisfactory unless the fungus is found. 

It may be suggested that the symptoms at one period 
pointed strongly in the direction of amyloid changes as 
being in progress. The increase in size in the liver, the 
albuminuria, the intractable diarrhoea, occurring in the 
subject of recurring abscesses, with excessive suppuration, 
are certainly suggestive of amyloid change involving the 
intestinal mucous membrane in addition to liver and kid- 
neys. Against this supposition there are several important 
facts to be remembered. Firstly, the age of the patient, 



364 A KNOTTY CASE. 

which is considerably below that of the age most prone to 
amyloid disease (viz., between 20 and 30) ; secondly, the 
iinusually rapid appearance of albuminuria after the 
abscesses began (exactly a calendar month intervened) ; 
lastly, and most important of all, the complete disappear- 
ance of the albuminuria before the patient left the hospital. 
This freedom, moreover, continues to the present day. 

With regard to treatment, you will readily understand 
that the list of drugs used was a formidable one — a bare 
enumeration of them would be wearisome. One point, at 
least, is worthy of mention as tending to confirm Billroth's 
experience that some of his cases of actinomycosis reacted 
to injections of tuberculin in the same manner as cases of 
undoubted tuberculosis. In our patient tuberculinum 6 was 
given on March 16, just as the last abscess was opened, and 
whether post or propter hoc, the fact remains that the 
diarrhoea speedily abated and *the patient improved in 
general condition every day. 



Dr. Lambert said he was sorry that as the case was not 
suspected whilst in the hospital of being actinomycosis, he never 
looked for the fungus. It had always been his impression that 
the case was one of influenza, and there were some points which 
Dr. Blackley had omitted to mention which went against its 
being a case of actinomycosis, among them the fugitive nature 
of many of the symptoms. Some of the abscesses disappeared 
without being opened, only lasting a few days, which did not 
look like actinomycosis. Then, again, the effusion in the right 
pleural cavity completely disappeared in a few days under 
treatment, which also was against its being actinomycosis, for 
Dr. Blackley had informed them that usually the pleural effusion 
went on to the formation of an abscess, which pointed at some 
part more or less remote. Another point in favour of influenza 
was that the pulmonary symptoms altered their character 
frequently from day to day. One day one would find rhonchi all 
over one side of the chest, and none on the other side, and the 
next day the rhonchi had gone to the other side. He had seen 
that in several cases of influenza, and considered it an important 
diagnostic point. The albuminuria only lasted one or two weeks 
at the very outside, and he never thought that it was exactly 
an amyloid change. The diarrhoea, again, presented another 



DISCUSSION ON A KNOTTY CASE. 365 

point, and he thought the whole case was rather in favour of it 
having been of a colliquative nature, because every time an abscess 
was opened, the diarrhoea was better at once, the following night 
or day there was no diarrhoea at all, and they always thought as 
soon as an abscess had been opened that they had an end of the 
diarrhoea. On three or four occasions, after a big abscess had 
been opened, the diarrhoea stopped completely, but it returned 
again shortly as the formation of pus continued, but when the 
last abscess was opened which was a large one, burrowing deep 
into the pelvis, though it was thought to be superficial before 
it was opened, the diarrhoea stopped completely at once, and 
there was no return. He thought these points were rather 
against the case being one of actinomycosis, whatever else it 
might be. 

Mr. Dudley Wbight said that the author had mentioned 
something about the tonsil being possibly the seat of inoculation. 
He should like to ask if any lesion had been found in the tonsil at 
first. 

Dr. BiiACEiiEY said he had not examined the tonsil, but 
had referred to a possible origin there in his summary of the 
symptoms. 

Mr. Knox Shaw said he had never seen a case of actino- 
niycosis, and though he was intimately connected with the case 
under discussion, he had been quite astonished to hear that 
evening that that was the ''knotty case." The great difficulty 
that he saw in accepting the diagnosis was that none of them 
had seen the ray-fungus, and of course that was essential to a 
correct diagnosis. The symptoms which he had seen, and for 
which he was asked to open the abscesses, might be accounted 
for by a sub-pyaemic condition into which patients with influenza 
sometimes drifted. 

Dr. Dxtdqeon thought that as the fungus was not quite a 
microscopic object, but could be seen by the naked eye, it was 
very improbable, if the disease had been actinomycosis, that an 
inspection, not necessarily microscopic, of the pus would have 
failed to discover those small but not altogether microscopic 
objects. 

Dr. Galley Blackley, in reply, said the patient's father was 
a builder's labourer, and had worked in the same place for twenty 
or thirty years, but did not come in contact with horses at all so 
far as he knew. The tonsil was mentioned, as it had been found 
a frequent seat of infection in the human subject. With regard 
to the frequency of the occurrence of the disease in the human 



366 OBMIO ACID ECZEMA. 

subject, the latest monograph on the subject was by a German, 
who gave a series of sixty-seven cases, so that it must be fairly 
common. The tonsil appeared to be the means of ingress, and 
very frequently the disease appeared to be conveyed by the barbs 
or little spines about the various kinds of grain. The fungus was 
especially interesting in the fact that it seemed to have two 
different states of existence, one in animals and another in 
vegetables; and it would invade the grains of wheat and oats, 
and many cases in the human subject had been acquired by 
getting the little barbs of these into the tonsil or into the mucous 
membrane of the mouth. He believed cases were on record 
where it had been quite undetected there, and had spread into 
the lung, and thence into the mediastinum. In this patient the 
lung cleared comparatively early in the progress of the case, and 
although there was copious expectoration for a while afterwards, 
it was astonishing how very quickly the lung trouble disappeared. 
Dr. Lambert's suggestion was a very reasonable one, namely, 
that the whole of the symptoms exhibited by this remarkable 
case furnished one of the thousand . and one phases of the 
*' hydra-headed monster " influenza. 



OSMIC ACID ECZEMA.1 

BY JAMES JOHNSTONE, M.B., F.R.C.S. 

Assistant Surgeon, London Homoeopathic Hospital, 

In these days of specialism, when specialities are ever 
overlapping one another, and spheres of influence, or rather 
of interest, are not exactly delimited, one may be pardoned 
for introducing into the Surgical and Gynaecological section of 
this Society, a subject such as eczema, which has rival claims 
for its hand on the part of both physician and surgeon. 

Probably this case in some of its aspects might have 
been more suitable for discussion in the section for Materia 
Medica and Therapeutics, but I trust that in other aspects it 
may be sufficiently surgical to warrant its discussion here. 

' Presented to the Surgical Section, June 6, 1895. 



OSMIO ACID ECZEMA. 367 

The history of Osmium and its compound, osmic acid, 
is a particularly interesting one, sometimes almost verging 
on the romantic. The metal osmium belongs to the plati- 
num group, which also includes rhodium, ruthenium, 
iridium, palladium, and rubidium. These metals are all 
found in nature associated in certain ores in various pro- 
portions. Native platinum contains osmium. Another ore, 
osmiridium, a hard crystalline native substance, much used 
in the pointing of pens, contains osmium and iridium with 
rhodium, ruthenium and platinum in smaller quantities. 
Of these metals the most abundant and most useful com- 
mercially is platinum. Associated, with it osmium was 
first discovered at the beginning of the century, and for the 
first seventy years of the century had not attracted much 
attention. Its properties generally were known, and it had 
been proved by such observers as Stokes, Hering, Bojanus 
and Brauell, of whose provings a detailed account is given 
in the '* CyclopsBdia of Drug Pathogenesy.** 

The metal itself is one of the hardest of the platinum 
group, and is not fusible at the highest obtainable tempera- 
ture. Its compound with oxygen, which interests us most, 
is osmic tetroxide, OSO4, otherwise known as hyperosmic 
or perosmic acid. This substance, made from the metal 
by oxydising it at a high temperature in a stream of oxygen 
gas, is crystalline, softening like wax at a moderate heat, 
melts at a lower temperature than wax, sublimes easily and 
is slowly soluble in 50 parts of water. It is extremely 
irritable to all living tissues, as is unfortunately too well 
exemplified by the suffering of those who have handled it 
during its manufacture. 

In 1872 an International Commission was appointed to 
deal with the question of standard weights and measures. 
It was necessary that the standard measures be made in 
some material which would be as little as possible affected 
by surrounding chemical and cUmatic influences. This was 
particularly necessary in the case of the standard metre 
measure. The material chosen by the Commission was an 
alloy, consisting of 90 parts of platinum and 10 parts of 
iridium. The reason for the choice lay in the fact that such 



368 OSMIC ACID BCZEMA. 

an alloy was discovered by Professor Deville to be the least 
subject to those variations in dimension which result from 
changes in temperature. In order to supply each of the 
Governments represented on the Commission, a large num- 
ber of standard bars were required and the total mass of 
metal necessary was 250 kilos or about 562^ lbs. The 225 
kilos of pure platinum requisite for this alloy were supplied to 
the French chemists and metallurgists, who had been charged 
with the work of preparation, by an Englishman, Mr. 
Matthey, of the firm of Johnson, Matthey & Co., refiners, 
of Hatton Garden. Unstinted praise has been accorded to 
this gentleman by the Commission and the French Academy 
of Sciences, for the absolutely indisp.ensable assistance he 
gave. It was in the manufacture of these 225 kilos of 
platinum at Hatton Garden that a striking case of osmium 
poisoning took place. The victim was Mr. John Berry. 
His history and the symptoms produced by the poisoning 
have been fully detailed by Dr. Galley Blackley in the 
Monthly Homceopathic Beview for 1884, vol. xxviii., page 170. 
For the last twenty-three years this patient has been sub- 
ject to the influence of the fumes at intervals of not more 
than a month or less. The chief symptoms have been 
painful and acute conjunctivitis, drowsiness, heats and 
chills, dyspnoea, irritative bronchitis, eczema and nephritis, 
with albuminuria and haematuria. The eczema has existed 
to a greater or less extent, depending on the amount of 
exposure to the fumes, during all these years. The other 
effects have troubled him less, though all very severely for 
short periods.^ At present it affects the hands and forearms 
only, but has spread to other parts of the body, arms, 
shoulders, face and neck at various periods. 

The case, however, to which I wish to draw attention 
more particularly is that of a French metallurgist, who 
began his unfortunate experience with osmium when 
engaged, about the same time as Mr. Berry was first 
affected, in the manufacture of the 25 kilos of iridium 
necessary to make up the platinum alloy. This iridium at 

* The patient was presented to the meeting and his eczematous condition 
inspected. 



OSMIC ACID ECZEMA. 369 

the first attempt was prepared by Messrs. Deville and 
Debray at the Ecole Normal, of Paris. Iridium is usually 
extracted from the refuse resulting from the smelting of 
platinum. To provide the necessary 25 kilos of iridium 
more raw material was required than could be obtained in 
Paris or London. The want was supplied by the Eussian 
Government, for then as now the bulk of platinum comes 
from the Ural mountains, and refining of platinum was 
carried on in St. Petersburg on a large scale. In a paper 
read before the Academy of Sciences, 1874, General Moran 
describes how the iridium was extracted pure from the refuse 
by the chemists, Deville and Debray, with the assistance of 
their head practical chemist, Mons. Clement (Gomptes 
rendus, 1874). These three workers were all more or less 
affected. Mons. Deville suffered from asthmatical attacks 
with dyspnoea and severe thoracic pain. Mons. Debray 
suffered from conjunctivitis, and Mons. Clement from a 
variety of symptoms. It is his case of which I wish to give 
a few notes. After many years' service he has now retired 
and is at present on a visit to London. I had hoped to be 
able to introduce him to the Society, but I was unable to 
persuade him to come. The eczematous condition in his 
case is almost identical with that of Mr. Berry. 

Mons. J. Clement's cUnical history is as follows : — On 
the evening of the day on which he was exposed to the 
fumes he felt his eyes itchy and afterwards sore with burning 
sensations, photophobia, a halo or aureola round the flame 
of a candle or lamp, and lachrymation for two or three 
minutes, ceasing for fifteen to thirty minutes, to return 
again. He was unable to fix the eyes on an object for any 
length of time without sense of fatigue. There was no 
apparent affect on the optic centres or nerve. On first and 
several subsequent days he felt cold and hot alternately; 
the chill often amounted to shivering ; perspiration ensued ; 
he slept indifferently the same night and subsequent sleep 
was heavy, interrupted by violent starts and nightmares; 
next day he could not eat, he had no appetite and thinks 
that the sense of taste was affected. Frequently there was 
present a feeling of nausea in the morning, sometimes with 
vomiting of glairy gastric juice on rising. 



870 OBMIC ACID ECZEMA. 

On the second day and subsequently, were experienced 
cramps and heat in left chest and region of stomach, without 
difficulty of breathing but with cough and profuse expec- 
toration, clear and frothy at first, changing subsequently 
to green. On one occasion last year he had a more severe 
attack of bronchitis as a distinct result of exposure to 
the fumes. He has had occasional colic, occasional diar- 
rhoea, but never any blood ; he never had any renal trouble. 
Eczema first attacked him twenty-three years ago, and 
appeared about three to four days after beginning to work in 
the fumes. Now exacerbations of eczema ensue after one 
to two days* exposure. The eczema begins with a severe 
itching of the skin of the hands and wrists ; soon raised red 
papules appear with swelling of the entire dermis and a 
certain amount of weeping. This latter is never sufficient 
to form absolute crusts. The tops of the papules become 
broken, probably by the scratching, and a blood-stained scab 
forms. The lesion may heal and disappear under favourable 
circumstances, but usually becomes persistent by rubbing 
and scratching. The rash, at first confined to the dorsum 
of the hands and the wrists, occasionally spreads up the 
forearm, and on one occasion, five years ago, affected the 
upper-arm, shoulder, shoulder blade, back, neck and face, 
except the bearded portion. The itching is always worst at 
night and weeps more after rubbing. All the symptoms, 
including eczema, disappear after ceasing to work in osmium 
for fourteen days. The skin becomes quite smooth and soft 
again. While under the influence of the metal, he must 
follow a regular life. The slightest excess in food or drink 
increases the symptoms, the digestion is impaired and 
delicate; he cannot take coffee or red wine. He has been 
working slightly for the last few days with osmium and the 
eczema is present on the hands and wrists, otherwise he is 
in good health. For some years various precautions have 
been taken to protect the workers from the fumes, with the 
result that the conjunctivitis and respiratory troubles are 
lessened, while the eczema is not so intense. 

When Mons. Clement was first attacked in 1874, while 
engaged on the iridium ingot, one of his operatives was so 



OSMIO ACID EOZEMA. 371 

aflfected by bronchial symptoms as to be incapacitated for 
work. He entered the hospital of the Pitie under Vulpian, 
and eight days after admission died of advanced pneumonia 
with gangrene of the lung. He suffered also from intestinal 
hasmorrhage, albuminuria and severe cephalalgia. The case 
is fully reported by Mons. Eaymond in the Comptes Bendus 
of Soc. de Biologic, 1874, and there is a short summary in the 
" Cyclopaedia of Drug Pathogenesy." 

Such were some of the experiences of those who worked 
at the metal for the standard metre. The subsequent story 
of the alloy, of the ineffectual attempts of the French metal- 
lurgists to obtain a perfectly homogeneous mass, and of the 
ultimate successful completion of the work on the premises 
of Messrs. Johnson and Matthey in Hatton Garden, cannot 
be told here in all its interesting detail. 

In summarising the effects of osmic acid we find pro- 
duced conjunctivitis, sleepiness, startings in sleep, night- 
mare, shivering, heats, nausea, colic, want of appetite, 
diarrhoea, melsena, neuralgias, dyspnoea, cough, expectora- 
tion, bronchitis, eczema. 

Of other metals which produce eczema the most striking 
example is Arsenic, which has produced all kinds of erup- 
tions from a simple erythema to vesicles and shingles. The 
poisonings from arsenic have usually taken place by the 
mouth, accounting probably for the generalised nature of 
the eruptions. In many respects arsenic and osmium are 
allied; chemically they are both of such a nature as to agree 
in some respects with the metals, and in others with the 
non-metals. The behaviour of osmic tetroxide and the 
oxide of arsenic in having acid properties is somewhat 
remarkable. 

EuTHENiUM, another of the rare metals of the platinum 
group, and met with when refining the commoner members 
of the group, produces, when present as its volatile oxide, 
symptoms, including eczema, very like those of osmium. 
Its most remarkable character is the overpowering smell, 
which is said by the workers in chemical odours to surpass 
all others in its intensity and disagreeableness. It has the 
unfortunate property of clinging to clothing, and even after 
VOL. III. — NO. 4. 26 



372 OSMIO ACID ECZEMA. 

a garment has been well aired for several days it is not freed 
from the taint. The cases of poisoning by this metal are so 
rare that no details of importance are to hand. Mr. Berry 
can testify to its olfactory effects. 

Two other metals, Manganum and Selenium, are patho- 
genetically related to Osmium, not so much in their effects 
on the skin as in the respiratory changes produced after 
their administration. 

Therapeutic Uses of Osmium, — I have not been able so far 
to lay hands on any outstanding example of the successful 
therapeutic use of the metal according to homoeopathic 
principle. It has been used by allopaths, principally in 
the form of subcutaneous injections for such diseases as 
epilepsy, neuralgias, rheumatism, sarcoma and other 
tumours, sciatica, &c., but without any marked success. 
Epilepsy and neuralgia have benefited in some cases. As 
neuralgia is. one of the special pathogenetic symptoms of 
osmium it would be interesting to know what led to its 
therapeutic use in this way. May it have been another of 
those cases where consciously or unconsciously our guiding 
rule has been applied by a member of the old school in the 
cure of disease ? 

In the paucity of actual recorded results from the homoeo- 
pathic use of osmium one can only suggest some conditions 
where it might prove useful. Those which seem most pro- 
minent are : (1) eczema, with pruritus, weeping, non-pus- 
tular ; (2) acute conjunctivitis ; (3) irritative bronchitis and 
pneumonia ; (4) measles ; (5) influenza. 

No doubt some members of the Society have used the 
drug in practice, and I for one would be glad to know to 
what extent, and in what conditions osmium answers to the 
therapeutic rule of similia similibus curentur. 



Dr. Galley Blacklby was exceedingly interested to find 
that the symptoms which were present in the case of Mr. Berry 
and the other patient whom he had had an opportunity of seeing 
were practically confirmed in the case of the French observer and 
also in that of the patient who died. If he remembered aright 
there was retinitis in Mr. Berry's case when he saw him eleven 
years ago. With regard to the therapeutic uses of the drug, he 



osiao Aom eozbma. 373 

had used it a few times in eczema ; he thought the drug wanted 
steady and continuous use over a large series of cases before one 
could say much about it. He had also given it in one or two 
cases of nephritis. There also the same remark applied. The 
patients got well, but everyone knew that acute nephritis, 
especially where there was hasmaturia, was a disease that had 
a natural tendency towards recovery. He had not used it in the 
later stages of nephritis, in cirrhotic, or enlarged white kidneys, 
as it did not seem to him to be indicated. He had also injected 
it for sciatica, but it did not do the shghtest good. 

Dr. Hughes wished to ask Mr. Johnstone whether he thought 
that upon the homoeopathic principle such effects of osmium as 
he had described — the conjunctivitis, bronchitis, eczema — ^were 
really indications for the homoeopathic use of the drug. It seemed 
to him before they could be that, they must prove that they were 
capable of being developed otherwise than by local application ; 
if a patient swallowing osmium should get those affections then 
they were specific, then they could give the patient the drug with 
every belief that it would go to its mark by affinity, but he 
doubted whether they could do that merely from local effects. 

Dr. Ord mentioned that in Allen's " Handbook of Materia 
Medina " it was stated that osmium had both caused and cured 
glaucoma. In a case of his own, a man came to him having been 
told by an old-school surgeon that he was in danger of losing his 
eye. The symptoms were apparently those of incipient glaucoma, 
with impairment of vision, pain, prismatic colours around lights, 
intra-ocular tension and sluggish reaction of pupil. The symp- 
toms were aU relieved by osmium 3x, and the patient considered 
himself cured. 

Dr. GoLDSBROUGH Said Mr. Johnstone's account of osmium 
suggested a train of symptoms which were very often asso- 
ciated with gout — they got asthmatic breathing and conjunc- 
tivitis and eczema all together, or alternately, and he won- 
dered whether in those conditions they might find a remedy in 
addition to arsenic and one or two other remedies they were in 
the habit of using. He should like to ask Dr. Hughes why he 
would enter a caveat about the action of osmic acid. Surely it 
had some specific effect on the peripheral nerves when it set up 
that permanent irritation which was found in the patients 
affected by it. It seemed to him to be characteristic in its effects, 
not merely a local irritation which would pass away quickly if 
the subject were taken away from the influence of the drug. 

Mr. Johnstone, in reply, thought that the suggestion of Dr. 



374 A CASE OF BEVEBE ANGINA. 

Hughes was a very important one. There was no douht that 
many of the symptoms produced by osmium were such as would 
be produced by an externally irritative chemical. There was^ 
however, one symptom, that of albuminuria, which showed that 
the osmium must have gained entrance into the system before it 
could produce the effects which it did. Also, although one might 
be inclined to think that the eczema on the hands was there 
because those were the parts most exposed, still he beheved that 
there was some influence on the peripheral nerves which pro- 
duced or helped to produce the eczema. 



A CASE OF SEVEEE ANGINA PECTOEIS WITH 
OKGANIC HEAET DISEASE, MAEKEDLY 
EELIEVED BY CUPEUM.^ 

BY E. M. MADDEN, M.B. 
Physidom to the Phillips Memorial Hospital, Bromley, 

When I was asked by our worthy Secretary to the 
General Medicine and Pathology Section to bring forward 
some cases for comment and discussion, I looked through 
my notes in search of such as I thought would be of the 
greatest practical interest ; and I was anxious, if I could, to 
find some having a direct bearing upon questions which had 
already proved interesting and instructive at recent meetings 
of this Society. This, I am glad to say, I have been fortunate 
enough to be able to do, at least in respect to the first two 
cases I propose to read to you, as within the last two years 
we have had papers on " Angina Pectoris " by Dr. Croucher^ 
and on " Scurvy as it Affects Infants," by Dr. Gibbs Blake, 
both of which were of exceptional interest and practical 
value. 

My first case is one of angina pectoris, the history of 
which is as follows : — 

^ Presented to the Section of General Medicine and Pathology, May, 1895. 



A CASE OF SEYEBB ANGINA, 875 

Miss C, aged 47, first came to my house to consult me on 
January 15, 1894. I had made her acquamtance during the 
previous six years, as the devoted attendant upon an .elderly 
maiden cousin of hers, who was under my care all that time 
suffering from paralysis agitans, and who had died in the previous 
April. During all this period, so far as I know, Miss 0. never 
took any holiday, hut waited, single handed, upon her cousin 
night and day ; and as the old lady was absolutely helpless and 
nearly rigid, from tonic spasms of all her flexor muscles, this 
was no light task looking at it from a purely muscular stand- 
point, and when to that is added the frequently disturbed nights, 
and the constant anxiety and responsibility of her position, with- 
out intermission for so prolonged a time, it constitutes a strain 
calculated to leave its mark upon the strongest constitution. 
Through it all, however, she had shown no outward signs of its 
aifecting her health, and was always cheerful and had a good 
colour, though she has since confessed that during the last two 
years of her nursing she not unfrequently had severe palpitation, 
at times accompanied by prsBcordial pain, when lifting or carrying 
the invalid. She was a tall, large framed and well developed 
woman, and might easily have passed for ten years younger than 
her true age. 

She had had no catamenia since the preceding September, but 
then was flooded and felt very ill for the time, and she is inclined 
to date her present condition as starting from that period. The 
immediate cause, as I learned at a later period, of the onset of 
angina in a serious form was one day when she overheard an 
acquaintance making some disparaging and as she thought un- 
true remarks about a friend of her own, which she resented and 
which led on to "words," after which she had a very violent 
attack of palpitation and pain in her chest and nearly fainted. 

When she came to see me she had walked nearly a mile 
from her own house. She complained of frequent attacks of 
distressing palpitation, accompanied by an acute pain at the 
heart, "as if it were constricted by a tight cord," the pain ex- 
tending down the left arm. On examination the pulse was 150, 
but regular, there was violent visible pulsation all over the 
cardiac area, and the transverse cardiac dulness was over 3^ 
inches. Auscultation gave normal sounds at the base, but a 
loud whistling mitral systolic bruit at the apex, and for some 
distance all round it. 

I of course told her to go home and keep quite quiet, and 
prescribed cactus 2x niv. every two hours, and Burroughs & 



376 A CASE OF SEVERE ANGINA. 

Wellcome's trinitrine tablets, each contaming gr. ^hv ^^ nitro- 
glycerine, one to be taken when required for an attack of pain, 
but never more than one in an hour. 

I saw her at her home on the second day, January 17, and 
found the first night had been very much better, but last night 
very bad again, so that she had walked about her room the 
greater part of the night ; the attacks seemed always more inclined 
to come on when lying down, and there was a disposition for them 
to be worse about 10 p.m. Her pulse this day was 120. Treat- 
ment continued. 

On the 19th, she reported having had two more very bad 
nights, and that going upstairs always brought on an attack, so 
I advised her to keep to her own room. The trinitrine always 
relieved an attack immediately, but did not seem at all to 
prevent their recurrence. 

On January 23, her condition remaining very much the same, 
and still having many attacks at night, obliging her to walk her 
room, I changed the cactus 2x to Ix, but with no better result, 
as 1 found on the 29th that she had taken no less than seven 
trinitrine tablets during the previous liight, still with invariable 
immediate temporary relief and with no headache or vertigo. I 
now discontinued the cactus and gave infusion of digitalis, 5j. every 
four hours, for a week, but with no relief to her symptoms, while 
on the contrary the medicine had during the last day or two made 
her feel very sick, and she had a profuse watery diarrhoea and 
was feeling altogether very low and ill, and had not been able 
to lie down at all for the last two nights. I now, therefore 
(February 4), gave arsenicum album 3x and veratrimi album Ix 
every two hours in alternation. In two days the diarrhoea had 
ceased, but she had now oedema of both legs as high as the knees. 
The heart symptoms were no better, the pulse kept up to 120, and 
she was still obliged to pass the nights sitting up in her chair. 
Her urine on examination had sp. gr. 1015, and contained phos- 
phates, but no trace of albumen. 

I now gave her aconite 3x and lycopus 2x, nxv. every 
alternate two hours, and continued this for four days. I may 
here say that the trinitrine tablets were continued as a palliative 
throughout the whole of her treatment, and she frequently said 
she did not think she could have lived without them. 

By February 10, the oedema was considerably less, and she 
was again able to lie down, though not for long, the pulse was 
110, and the angina was inclined to shift, not always coming in 
the heart, but the same pain starting in the left shoulder or 



• A OABE OF SEVERE ANGIKA. 377 

interscapular region and extending thence down the left arm. 
This day I gave her lycopus 2x and spigelia <^ and four days later 
lachesis 4c and lycopus 2x. Her general condition continuing 
practically unaltered though varying from day to day, and the 
Gbdema never leaving the feet though gradually coming lower 
down the legs, she took on an average three tablets each night 
now, and did not often require one by day. 

On February 20, she was given lycopus Ix nxv. every three 
hours, alone, with apparent benefit, though many fluctuations, 
occasionally going through a night without any attack, on others 
having from two to six, some very violent, others moderate. 
The lycopus was continued up to April 12, but on March 15 she 
had a return of catamenia (after six months' absence) with great 
pain, for which she took belladonna <^ in alternation. On April 
12, the oedema had practically left the legs and was only occa- 
sional and slight in the feet, but the angina was not by any 
means gone, and was very easily brought on by any exertion or 
excitement. 

On April 12, she began to take spigelia 2x irtv. every three 
hours, and continued this for a fortnight, at the end of which 
time the report was that she was able to go up and down stairs 
now, and the pain was less severe in the left arm, but still came 
on acutely at the heart, so that she took 2 to 5 tablets every night. 

On April 26, I gave her cuprum acet. 3x irtv. three times a 
day, and at the end of a week her nightly record of tablets was, 
4, 2, 2, 2, 2, 1, 0. She v/as feeling much stronger and getting 
out most days. At the end of the second week she was not so 
well, having required 2, 3, or 4 tablets on each of the last four 
nights. I now altered the strength of the medicine and gave her 
cuprum acet. 2x nxiij. every four hours, and from that day she 
never looked back ; during the first week she took 1 tablet each 
night for the first four nights, and none after that ; during the 
next fortnight she only took 2 tablets all told, and we then dis- 
continued treatment, and there has been no occasion to resume 
it since. Her heart continued to beat about 100 to the minute 
and the mitral bruit never disappeared, but she said she felt 
quite as well as she had ever done during the last four or five 
years. I ought to mention that the catamenia returned again 
in April, May and June, always with considerable dysmenorrhoea, 
though always relieved by belladonna <p. Since June of last year 
I have not seen her, but I had quite intended to call and see her in 
order to give her further history up to the present time ; however, 
on my return from a short Easter holiday, I found among my 



378 A CASE OF SEYEBB ANGINA. 

letters waiting for me a card announcing Miss G*s. marriage to 
the brother of the old lady to whom she had been such a devoted 
nurse, so I have no doubt she is at the present time enjoying 
her honeymoon. 

It may be reasonably open to question whether the re- 
establishment of her menses had anything to do with the 
departure of her neurosis, but as she is of the full age when 
the menopause is the natural condition, I am not myself 
inclined to credit that with the cure. It is also to be noted 
that the relief was coincident with the onset of summer, 
and this, no doubt, was in her favour ; but I cannot myself 
doubt, nor did she at the time, that the cuprum was the 
really active agent in finally dismissing the angina, which 
had lasted for so many months, and which at one time 
really threatened her life. 

As to my reason for choosing cuprum, I cannot claim 
that it was the result of any cajreful study of the materia 
medica, or comparison between the pathogenetic effects of 
the medicine and the symptoms of my patient, but it so 
happened that just at this time Dr. Croucher read his paper 
on angina, and it will be remembered that Dr. Hughes 
spoke very highly of the efficacy of cuprum, and also gave 
the opinions of the late Drs. Bayes and Holland strongly 
in its favour. The power of cuprum to cause muscular 
spasms and cramps is well known, though the heart 
muscles are not the seat of its special selection, and these 
attacks are usually accompanied by quick, small, thready 
pul^e, exactly such as would' be most certainly relieved by 
nitro-glycerine. 

Dr. Hughes said Dr. Madden's choice of cuprum in the 
case he had reported bore out his own experience. It was very 
difficult to say what was the exact pathology of angina pectoris, 
but he apprehended that the cases in which cuprum benefited 
were cases in which it assumed the spasmodic form. The attack 
might sometimes be due to embarrassment of the heart's action, 
it might be neuralgic, it might be spasmodic ; but he suspected 
that the cases in which cuprum benefited were the pure spasmodic 
cases. It was difficult to distinguish them, and therefore their 
treatment must be somewhat tentative. In cases where the 



ACUTE PERIOSTITIS. 379 

attacks seemed to be purely connected with embarrassment of 
the heart's action from valvular disease, he was generally in the 
habit of giving naja. Where the pain was of the more distinctly 
neuralgic character, he thought arsenic was the prime remedy. 

Dr. Blake thought that recent observations on angina tend to 
show that the causes of angina are outside the heart. The pain 
could not be in the heart, because that organ has no sensory 
supply* It is needful, then, to seek for a successful remedy 
amongst those medicines which do not act upon the heart at all. 

Dr. Lambert said that it had been shown recently in some 
experiments of Boy and Adami, of Cambridge, that one of the 
chief causes of dilatation of the heart was some obstruction to 
the flow of blood in the arterioles and the capillaries, and, there- 
fore, the remedy might act as an anti-spasmodic in that way, not 
on the heart, but on the smaller arterioles, and the action might, 
therefore, be purely homoeopathic. 

Dr. Madden, in reply, said he was sorry not to be able to 
answer the question as to the alteration in the pulse tension after 
and before cuprum. He thought that an attack of angina was 
accompanied, in such a case as he had mentioned, with contrac- 
tion, probably entirely of nervous origin, of the arterioles, and 
that the condition of the pulse and arteries during an attack of 
spasm caused by cuprum was the same ; the pulse became very 
small and contracted, and therefore he thought that it was 
truly homoeopathic to that condition. That was also the way in 
which glonoin relieved (by causing dilatation of the arteries), not 
from its directly affecting the heart as such. 



ACUTE PEEIOSTITIS: WITH ESPECIAL 
EEFEEENCE TO ITS GEAVEE FOEM— ACUTE 

NECEOSIS.i 

BY 0. W. HAYWARD, M.D. 
Assistant Surgeon, Hahnemann Hospital^ Liverpool, 

Before introducing the subject of acute periostitis for 
your discussion, allow me to express the great pleasure I 
have in being present amongst you this evening. The occa- 
sions are far too wide apart on which we in the provinces 

^ Presented to the Surgical Section, June 6, 1896, 



880 ACUTE FEBIOSTITIS. 

have the opportunity of meeting and fraternising with the 
members of the main body of our Society. We should all 
be the better could we more frequently meet, and could 
the staffs of our different hospitals and dispensaries be able 
sociably to discuss cases of interest and gather information 
from each other's experience and observation. 

It is in the hope of gathering the fruits of your experi- 
ence, while I trust also contributing to the general store, 
that I have ventured to prepare a few notes on acute perios- 
titis ; and I think that after mentioning the various forms 
of this disease, I shall best present the subject by narrating 
a case which illustrates its most grave form. I shall not be 
able to advance anything new, but I hold that the history of 
this case proves the superiority of surgery combined with 
our scientific therapeutics over the surgery as practised by 
the old school. 

In a short communication like this it is impossible to 
go into the aetiology and pathology of this disease. We 
must content ourselves with merely noting three forms of 
acute periostitis : — (1) Simple Acute Periostitis ; (2) Acute 
Suppurative Periostitis ; (3) Acute Infective Periostitis, or, 
Acute Necrosis. 

(1) Acute periostitis occurs after an injury — as a kick. 
There is swelling, heat, pain and active inflammation of the 
periosteum. This may resolve and the parts return to the 
normal. Or it may pass into the second form and suppura- 
tion — localised — occur. Very often it passes into a more 
chronic form and assumes an osteoplastic character, ending 
in the formation of a node, or thickening. 

(2) The second form is that in which acute periostitis is 
accompanied by, or leads to, the formation of pus. In this 
form the pus is localised and does not tend to burrow and 
strip the periosteum from the bone. When the pus is 
evacuated it usually heals without further trouble, although 
sometimes there may be a superficial necrosis. 

(3) Acute necrosis is perhaps the best term to apply to 
the third and most grave variety of acute periostitis. It 
usually occurs in young people, generally in boys. There is 
generally a history of scrofula or bad state of health, and it 



ACUTB PERIOSTITIS. 381 

sometimes occurs after acute specific fevers. There is 
sometimes an injury to start with, but very often no such 
history is found. The onset is sudden, and there is difficulty 
at first in localising the disturbance, and a diagnosis of acute 
rheumatism may be made. The pus rapidly burrows and 
strips the periosteum from the entire bone and extending to 
the epiphyses affects the growing tissue, thus separating 
the diaphysis, which may be found lying quite loose in the 
distended and thickened periosteum. If the pus is evacuated 
early the necrosis may be limited; but in any case the 
condition is grave and the prognosis must be guarded. 

The case I intend bringing forward is not a recent one, 
as it occurred so long ago as 1892, but we have had some 
recent cases in the hospital, and so this subject occurred to 
me as one good for discussion, and the present case is the 
best I could present in detail. 

I was called to see B. G., aged 14, on Thursday, April 28, 1892, 
when he was complaining of a bad headache and pain in his left 
ankle. He had had a bad cold for a day or two owing to having 
had this foot wet with a hose pipe while watering the garden and 
not changing his stocking. No further history could be obtained ; 
there was no injury, he had not knocked his foot in any way, and 
he had often had pain in the foot previously at intervals. The 
urine contained abundant urates, and the foot became swollen. 
His pulse kept 80 per minute. He improved for a day or two, 
but afterwards became worse, and the temperature reached 
102° F., and there was also considerable bronchitis present. The 
condition of the leg was somewhat masked owing to the fact 
that his mother, in trying to relieve the pain early in the illness, 
had applied turpentine fomentations so energetically as to pro- 
duce intense general redness and a large blister just above the 
ankle. 

On May 6 he seemed better in himself — pulse 92, temperature 
99.40 — Yyui there was evidence of fluctuation above and to the 
inner side of the ankle. I opened this at once and let out two 
to three ounces of dark pus. 

On May 8 a consultation was held with Dr. Eobert Jones^ 
and I removed the patient to hospital and opened the front of 
the leg by means of two incisions, reaching the greater part of 
the length of the leg and going through the periosteum which 
was stripped from the bone and greatly thickened. The tem- 
perature after the operation was 101*8° F. 



382 



AGUTB PSUIOSTins. 



May 9.— Temperature 100° F. 

On the 11th, temperature 103° F.; a small patch of dulness in 
the right lung at the back and crepitations at the bases. The 
leg looked fair and was discharging freely. 

The temperature varied between 103° and 99° {vide accom- 
panying chart), and on May 14 the ankle swelled and was painful, 
but the condition of the lung was improving. 

On May 15 another consultation was held, but notwithstand- 
ing the bad condition of the patient, the consulting surgeon would 
not agree to amputation. I therefore made an incision over the 
dorsum of the foot, and carried the tube from the periosteum 
through to the back to get, if possible, still more free drainage. 
Under chloroform lateral motion was found at the ankle. 






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On Ma^ 16 a rigor oocuired in the monung and another in 
the afternoon, !DNnperataie 104^ F* 

On the 17th I a^n sent for the consultant to get him to 
confinn uie in my desire to r»noTe the leg, and on seetog the 
oondition of the patient he readily oonsented, but stated that he 
hud no elianoe of reoovery, sitying be hjwi neTer seen a patient 
** ^ to piec^es ^* so rapidly, the boy^s pulse b^ng 140 and very 
u-eak^ aiui his teinper^uT^ lOS^S^' F. 

At 4 p^nis he ^ribs earned into the op«radng theatre, and my 
oevll^tji^)^ kindly assi^ing, although they one and aU declined all 
WjjvjvM-j^ibility in th^ oase^ as thoy expected the padent to die on 
iX\^ tAMe> I a^npiitAted the thigh thresh the oondyles. Ether 
had to l^ inj^o*ed t>onoe during th^* opeom^ion, whkh was per- 
fon^i^sJ wtpialy ai^d >9nih a^ little loss of blood as possible. He 
WMi ^viU to b^i wthoat a*iy accident, a;nd a;t 11-15 p.m. his 
tempei'atxn^ >os'a;s i^<^^" F. I ordered him to have an injection of 



ACUTE FBBIOSTITIB. 388 

one drachm of brandy with some hot water into the rectum 
every hour ; also three meat suppositories and the whites of two 
^gs during the night. He rallied, and at 7 a.m. his temperature 
was 103-2° F., and at 11 a.m. 102° F. and he seemed better. The 
stxmip was dressed in the afternoon, when it looked excellent, 
the solution injected through the tube returning as clear as it 
went in. After the operation I gave him arsenicum 3 every hour. 

On May 28 I put him on crotalus 6. The stump did not unite 
nicely, and the edge of the anterior flap sloughed, leaving the 
wound open but healthy-looking. Crotalus was continued, and 
although still in a very precarious state, he made good progress. 

On the 27th I changed the medicine and gave liquor arsenicalis 
TTti. every three hours. He improved rapidly, and on June 1 got 
out of bed for the first time. The wound closed up nicely, and 
on June 14 I placed three grafts from my forearm on the granu- 
lating surface. He continued to improve, and on June 19 went 
home with the stump nearly healed. He was ordered calcarea 
phosphorica 3x. It took several weeks for the complete formation 
of epithelium, but he soon got an excellent stump, the cicatrix 
entirely behind the bone, and he could bear any amount of pres- 
sure or knocks on the end of the bone. His general health 
improved, and he was healthier and stouter than ever before. 
He was fitted with a wooden leg with a joint which he could 
bend by releasing a spring when sitting down, and in a few 
weeks after his return home I saw him riding a safety bicycle, 
and he said that he could easily do ten miles. 

I think that the good result in this case was certainly due 
to the therapeutic treatment which was combined with the 
surgical. The terrible condition to which the patient was 
reduced at the time of operation, and the undoubted pyaemia 
from which he suffered, would, I am sure, under surgery 
alone have been fatal. The effect of the crotalus was most 
marked. 

Such an experience confirms me in my conviction that 
we who believe in the law of siviilia similibus curentur 
should in nowise hold back from devoting our best energies 
to surgery and all other extra-therapeutic methods of curing 
disease — such as electricity, massage, hydropathy, climato- 
logy, &c. We are possessed of a system of therapeutics of 
which we are justly proud and in which we have entire 
confidence. We cannot be victims to the despair which 



384 ACUTB FEBIOSTITIS. 

permeates the old school — despair bred by the frequent 
impotency for good, and the common potency for evil of 
their therapeutic practice — one cannot call it a " system " 
when there is no guiding thread in all its intricate mazes. 
We, having this confidence and this guiding thread, cannot 
become subject to the panic which causes the old school to 
rush aimlessly to extremes in these directions, outstripping 
the good and often doing harm. Therefore it behoves us, 
while holding confidently to our therapeutics, in all ways to 
cultivate these branches of the medical art, and we shall 
prove in each and all of them — as we have already done in 
therapeutics — that those who hold this guiding rule in what 
must ever constitute the main treatment of disease, can in 
every branch of treatment attain results which are impossible 
to the old school. 

In this way shall we best help on our cause, and do the 
most for suffering humanity. I am delighted to find that 
our Society no longer neglects eitra-therapeutic subjects. 
Let it rather encourage in every way the carrying of our 
principles into every branch of treatment, and in so doing 
we shall restrain the excesses of each, as we have done in 
medicine. We have been too long stifled by shutting out 
fresh currents of thought and breathing too much the one 
atmosphere. I trust that in the new London Homoeopathic 
Hospital we shall prove that our treatment is superior to 
other hospitals, not only in medical cases, but in each and 
every branch of the healing art. 



Mr. Knox Shaw thought acute infective periostitis was often 
mistaken in its early stages for some more trivial affection, such 
as rheumatism, and it was a disease in which delay to rightly 
interpret the symptoms and introduce surgical methods was 
almost of necessity fatal to the patient. He knew of several cases 
where the natural dislike to the knife which existed in the breast 
of some, both medical men and patients, had led to a most disas- 
trous and fatal termination. There was really no time to wait 
to see what medicines would do ; unless the tension of the bone 
was relieved by a free incision through the periosteum, necrosis 
would rapidly follow, with the very speedy onset of pyaemia. 

Dr. Dyge Bbown mentioned aurum as a medicine which he 



ACUTE PEBIOSTTTIS. 385 

bad found of great value in the treatment of periostitis. It 
answered very well in ordinary dilutions, i.e., the 3rd decimal, 
and he had also used it in the 12th and 15th dilutions with very 
great success. 

Mr. Dudley Weight endorsed Mr. Knox Shaw's remarks, 
but with regard to what had fallen from Dr. Dyce Brown he did 
not quite gather whether the case referred to was one of acute 
infective periostitis which formed the immediate subject of the 
paper, or one of the simple form of periostitis. He doubted 
whether in every case of acute infective periostitis one could say at 
w^hat moment necrosis first occurred. The disease progressed so 
rapidly that, before they were aware of it, some separation of the 
periosteum from the underlying bone had taken place, and the 
necrosis had to a certain extent taken place already. There was 
no doubt that the more simple form was curable by medicines 
alone, whereas many were convinced that the other was abso- 
lutely incurable even in its earliest stage by any treatment other 
than surgical. Perhaps Dr. Dyce Brown would explain to which 
form he referred. 

Dr. Dyce Brown said he referred to ordinary acute periostitis. 

Dr. Wilkinson asked Dr. Hayward to state whether he had 
found any separation at the epiphysis. He believed there was a 
much greater chance of absorption and consequent pysBmia from 
the separated epiphysial surface. 

Dr. Hughes said he should be glad if Mr. Dudley Wright 
would explain how they were to distinguish between simple cases 
in which medicines might be of value, and those hyper-acute 
cases in which they were of no avail and where the surgeon 
should be immediately called in. In his early practice he had had 
two cases of acute necrosis, both young girls. One was distinctly 
scrofulous, and some years afterwards died from tubercle in the 
brain ; but at that time she had acute necrosis of the tibia, and 
under medicinal and ordinary local treatment, without any use of 
the knife, she had made a very good recovery. In the other case 
the bones of the foot were affected, and the patient nearly died, 
no doubt for want of surgical aid. At that time he was so 
enamoured of drug therapeutics that the thought of surgery did 
not readily occur to his mind. However, the patient did not die, 
and subsequently, though an abscess formed, it was opened, and 
everything went on quite satisfactorily. Since then he had seen two 
well-marked cases of acute periostitis of the tibia, which however 
subsided by the use, not of aurum, but of mezereum. At present 
he thought they could not distinguish between cases, as suggested 



886 ACUTB PEBIOSTITIB. 

by Mr. Wright, and they should therefore begin the treatment 
hopefolly with medicinal measures, trusting that surgery would 
not be necessary. 

Mr. Johnstone was also inclined to think that the distinction 
between the two kinds of periostitis did not exist, that it was 
merely a question of the extent to which the lesion had gone and 
of its rate of progress. In the early stage of periostitis they had 
first the inflammation of the periosteum. That was accompanied 
by the exudation of a certain amount of lymph between the 
periosteum and the bone, raising up the former. Up to that stage 
it was curable by means of medicine and rest, principally rest. 
But if the micro-organisms of sepsis got into the body either 
through a superficial wound or by some other means of access to 
the blood, and caused a suppurative change in the locally effused 
lymph, then they had the conditions under which necrosis might 
be expected, and under such conditions the knife ought certainly 
to be employed. It would be a mistake, however, to employ the 
knife in a case where the periosteum was only slightly inflamed 
and congested. With rest and the use of such remedies as had 
been suggested, those minor cases would do very well. He men- 
tioned the case of a lady which had occurred during the last three 
weeks. She had grazed her shin on entering a railway carriage 
a week before he first saw her. When examined, the skin cover- 
ing the anterior aspect of the tibia was in an inflamed condition 
with much tenderness and cedema of the underlying fascia and 
periosteum. It was evident that the case was on the verge of 
suppurative periostitis. Absolute rest in bed with the use of mer- 
curius corrosivus was ordered. The critical stage of pus formation 
was arrested, the exuded lymph gradually resolved, and with some 
thickening of the periosteum the recovery was complete. Another 
few hours might have sufliced to place the case beyond therapeutic 
aid alone. 

Dr. Dudgeon did not know whether Dr. Charles Hayward, in 
the case he had brought before them, wished them to look upon 
it as a cure of acute necrosis, because it seemed to him an odd 
sort of cure. He had treated a case of acute necrosis in a young 
lad of 13 or 14. The first appearance of the disease was in the 
distal joint of his right forefinger. It appeared like an ordinary 
whitlow, but terminated by the loss of the whole of the phalanx. 
Some time afterwards the boy was suddenly seized with acute 
necrosis of the right tibia. About two-thirds of the bone was 
necrosed and had to come away, but the case did very well, the 
healing process went on satisfactorily, and the leg remained 



ACUTE PERIOSTITIS. 387 

a very useful limb. There was no necessity for amputation in 
that case, the ordinary homceopathic remedies acting very well. 
Another case was that of a gentleman upwards of 60 years of 
age, who had acute necrosis in the lower jaw. The disease 
resembled those cases of " fossy jaw " caused by poisoning by 
phosphorus in the manufacture of matches. 

Dr. Galley Blaceley said that most members must have 
seen cases of acute necrosis occurring after infectious diseases, 
especiaUy after typhoid fever. He called to mind one (treated 
allopajihically) where the shaft of the femur was extensively in- 
vplved : delay was incurred in making the necessary incisions, 
and extensive burrowing of pus under the periosteum of the 
femur was the result. After this, a considerable amount of 
exfoliation took place, and the patient escaped with his life, but 
with a couple of sinuses burrowing deep into the right thigh. 
From these small sequestra continued to come away, and he died 
at the end of four years of amyloid kidney trouble. Concerning 
the question asked by Dr. Wilkinson about the involvement of 
the epiphysis, he (the speaker) would like to say that in such 
cases as he had seen of pyasmia resulting from suppurative 
myelitis, it was the marrow of the shaft that was primarily in- 
volved ; and, in fact, it was not uncommon for one to see the 
whole of the diaphysis of a long bone become necrosed and 
come away and the epiphyses remain sound. They might, in 
fact, lift out the shaft of the bone from its periosteal bed and take 
it away. He had seen such a case where the whole of the 
humerus came away in one piece, and the epiphyses remained 
intact. Whilst in Vienna he saw several post-mortems on cases 
of acute septicaemia from inflammation of the marrow, and it 
was invariably the marrow of the shaft and not that of the 
epiphyses that was the fons et origo mali. 

Mr. Cox asked whether Dr. Hayward had thought of re- 
moving the bone before the question of operation came on. 

Dr. E. B. EocHE said it was very difficult indeed to say that 
the two forms of disease mentioned were distinct and different. 
Most cases exemplified the point emphasized by the cases given 
by Dr. Hughes and Dr. Dudgeon — viz., that it depended very 
largely on the individuality of the patient, rather than on any 
specific character of the disease. The same inflammation arising 
in one patient would, because of the constitutional condition 
present, rush on to a foudroyant periostitis, whilst in another it 
would run a mild and easily-controlled course. Mr. Johnstone 
mentioned the micro-organisms introduced into the system — ^no 

VOL. III. — NO. 4. 27 



388 ACUTE PERIOSTITIS 

doubt he would include in similar action those injurious organisms 
already present in the system in those cases of already evidenced 
ill-health, whether depending on tuberculosis, syphilis, or other 
constitutional disease. 

Mr. Wright, in reply to Dr. Hughes, said that the whole 
question of diagnosing the different conditions of periostitis un- 
fortunately hung upon the identification of the micro-organisms 
concerned. Unfortunately they were not able clinically to dis- 
tinguish those, but he conceived that the fact that acute infective 
periostitis usually occurred in children, and rapidly led to 
stripping up of the periosteum and death of the bone — in fact, 
was an excessively acute disease, was one which might be of 
considerable help to them. After the suggestions which Drs. 
Hughes and Dyce Brown had thrown out, he thought they might 
be inclined in future to give some cases the benefit of the doubt 
and see what medicines could do, but he should not be inclined 
to wait long. 

Dr. Hayward, in reply, said the difficulty in the discussion 
had reaUy been that most of the members who had spoken had 
been considering not the third form of acute periostitis, or acute 
necrosis, but the first form of simple periostitis. Mr. Johnstone's 
case was a case of simple acute periostitis, which came under the 
first heading. There was an injury — as a kick on the shin — 
pain, heat and swelling of the periosteum and surrounding tissues. 
He did not think in that case there was any danger whatever of 
suppuration, and certainly no danger of the third form of acute 
necrosis. He also doubted Dr. Dudgeon's case at the end of the 
terminal phalanx of the finger, and he certainly would rule out 
of court the case of necrosis of the jaw. He thought they were 
simply cases of the same disease under different phases in 
different constitutions. In some cases in the adult or in healthy 
constitutions they got the first form, in another case they might 
get the second form of simple suppurative periostitis, Le.y they 
got the lymph poured out, stripping the periosteum locally from 
the bone ; then the lymph became pus ; but if the pus was 
evacuated early, they did not get necrosis even of the part from 
which the periosteum had been stripped. As a rule, they got a 
slight necrosis, more or less lengthy, but certainly not always 
corresponding to the extent of the suppuration. He agreed that 
perhaps he might have diagnosed his case earlier, but he offered 
as an excuse that he was handicapped by the presence of a large 
superficial redness over the lower end of the leg, and a large 
blister right over the place where the suppuration occurred. 



THE BELATION OF BAOTEBIOLOGY TO TBEATMENT. 389 

The suppuration only showed at the side of the blister, and he 
had opened it immediately. He had not found any separation of 
the shaft from the epiphysis. He did not look upon it, as Dr. 
Dudgeon had suggested, as cured acute necrosis, but as cured 
patient, which he thought was very much more important. In a 
case of acute necrosis, he contended that nobody was competent 
to treat who was not competent to use the knife, unless he 
called in somebody who could and who should decide when it 
ought to be used. Crotalus 6 he had found very useful, not 
for the periostitis but for the pyaemia. His patient undoubtedly 
suffered from decided pyaemia. He was delirious most of his 
time, and he (Dr. Hayward) was very much pleased with the 
effect of the crotalus. As to whether there was any chance 
of incising the bone instead of amputating, possibly if the leg 
had been opened earlier it might have been saved, but he 
thought, under any circumstances, they would have had to 
look forward to a very long suppuration, and probably would 
have had a similar case to that patient mentioned who died of 
lardaceous disease. 



THE EELATION OF BACTEEIOLOGY TO 

TKEATMENT.i 

BY P. DOUGLAS SMITH, M.B. 
Resident Medical Officer^ Hahnemann Hospital, Liverpool, 

The number of able investigators is on the increase, 
methods of research are being greatly improved, and know- 
ledge of the science of bacteriology is being rapidly ad- 
vanced. This being the case, the question of the relation 
of bacteriology to treatment cannot fail to grow in import- 
ance, and in the near future to compel our attention to a 
much greater extent than at present. 

The bacterial nature of many diseases has now practically 
ceased to be a mere theory, and has justly come; to be 
regarded as a fact — a fact, moreover, which year by year 
becomes capable of wider and wider application. The study 

* Bead before the Liverpool Branch, May, 1895. 



890 THB BELATION OF BACTEBIOLOGY TO TREATMENT. 

of this science has been undertaken by men in themselves 
so well qualified and deserving of confidence, by methods so 
careful and so eminently scientific, and with results so con- 
clusive, that we have no alternative but to accept these 
results as correct. 

Before a particular microbe can be assumed to be the 
actual exciting cause of a disease (1) it must be found in the 
affected tissues or elsewhere in the body of the diseased 
person ; (2) it must be isolated and cultivated artificially ; 
(3) the artificial culture must be proved to reproduce the 
disease ; and (4) the organism must be again discovered in 
the body of the inoculated host. "When the organism is 
thus described as the cause of a disease, it does not at all 
preclude the idea of a constitutional or predisposing cause. 

The tubercle bacillus is the cause of pulmonary phthisis, 
while at the same time we know well that there is such a 
thing as the tuberculous constitution, which, apart from 
actual disease, and apart from the bacillus in question, is 
handed down from parent to child. We have all probably 
breathed countless hosts of tubercle bacilli, while none of 
us, I hope, have contracted the disease, for the simple 
reason that we have not that hereditary susceptibility which 
is called the tuberculous constitution. 

Speaking of germinal diseases generally, it is accepted 
that the microbes themselves have no direct injurious action 
whatever upon the system. It has, however, been definitely 
ascertained that, by their action upon the juices and tissues 
of the body, they give rise to the formation of many different 
kinds of chemical compounds. If the organisms be taken 
from the body and cultivated upon some nutrient medium 
such as blood serum, nutrient gelatine, &c., it is found that 
here also these chemical substances are formed. Of these, 
some appear to be harmless, while others are in an intense 
degree poisonous to the system, and are, in fact, the real 
immediate cause of the various phenomena of disease. 
Different kinds of organisms of disease act in very different 
ways. 

The organisms may be purely local and the symptoms 
mainly local, as in acute abscess. 



THE BBLATION OF BACTERIOLOGY TO TREATMENT. 391 

The organisms may be local and the symptoms may be 
general, as in tetanus and diphtheria. 

The organisms may pervade the whole of the body and 
the symptoms be general, as in septicaemia. 

Whatever the method of action of the disease germ, a 
reaction on the part of the human organism is always pro- 
voked, and a contest ensues between the vital forces on the 
one hand, and the disease forces on the other. 

It has been discovered — has, in fact, been seen, and the 
process watched — that the white corpuscles of the blood 
have the power of destroying the germs of disease by de- 
vouring them, but that the disease germs have also the 
power of destroying the leucocytes, probably by means of 
the poisons which they secrete. 

On the foregoing and other facts of bacteriology many 
methods of treatment — medical and surgical — have been 
based. Of these, perhaps the most familiar is the anti- 
septic method introduced by Lister, the principles and prac- 
tice of which are so well known to us all. It could never be 
a beau-ideal of treatment on account of its universally 
admitted drawbacks. All the chemical substances in use as 
antiseptics, of which the oldest and best is carbolic acid, are 
far more destructive to cells of the human body than to the 
noxious microbes, and are irritating to the skin as well as 
to the deeper tissues. It cannot, however, be doubted that 
antisepsis has revolutionised modern surgery, arfd has made 
possible things that could not be attempted before its intro- 
duction. To open into the knee-joint, for instance, was 
practically manslaughter before Lister brought it within the 
sphere of practical surgery. So fatal was this under the 
old system that when Lister first operated on the knee-joint 
in London, there were those who had determined to prose- 
cute him for manslaughter if the case had proved fatal. 
The event justified him, however, and his patient made a 
good recovery. 

In preparing the skin of a patient for operation, one's 
object is that it may be perfectly steriUsed, but even with 
the most careful and thorough application of antiseptics, 
this cannot be assured. In twenty-one operation cases 





'"'■^ Tll« MKiMTIOJf or 

;;;;;""v .•M...rim«„u.d opon. i. ^^^ ~ j;;^ 

""""••■•« ""ly in H,.w.n i - "t"'-^- ^•=^''= 

■' , i*"ven cases, tnc eret -,» 

"'•;•■ ' '^< .1... <^uZVo J^z\^ r ^^"^ '^ ^ 

»""" Hit .tihMi,,.,.. ^ "^ '^^'^^ ^y s:iae^,«^^ 

"" -M - H .: ^t^^^f^fr^ -orl.:^St 

:r'' ' ( <-''vu:LJtyZm^^^^^ 

I""'"" <•'•!• I..Miiu.,m,iU,i„ J ,. P'f «^' ^* " neither anti- 
VniHm Mini,... *""' '"^^ to do with chemical pio- 

"»"'" ""muuui ««u«H -t., r Iv^ f- .^^^« ^^'Jd seem 

fl>«"*^Ha. but m m\ to tvaatS ''°* treatment of the 

Attajui)tH hava also bee,, „m(?« . . 
'UathocI beyo„d the domain of Ztrv ? J"^ *^^ *°*^««P«« 
u,te«ti«al antiaepaia. aa n tv^L , '"^ *^' *^''"''*^°^ 
dn-eotion of antiaepaia i,; the Soo^ "''''' "°^ "^ '^^ 

Ant,aeptiQ treatment of ent^rin f 



:-IO»T TV? TKSArKCST. S^ 



^vrhile tbeT ares' 

'would kill ibe xciiieiii lin^ c»ri:rr renIrrbLC iis rl.x>i lo auiv 
appreciable exicm aniiieTiir. W'e i:» nci r^^uire suob 
things as ibese, bsTin^ iii'£c:*i::€s. c:i jiiitiseriic in tbo 
usual sense of tbe w:ri- wbi/n sczirbrw or ciber cause the 
offensive micrzoes lo ^e^ Thus a d>se cf laobesis will 
abort an axilLaiy acsoess res:ilnn^ i^:-2i a disft«?cting wouiivl. 
tbongh we knew such acsoess to be swamiin^: with niiorv^tvs 
of a virulei:! nar^re. In treaimeni of disease we sball all, 
I suppose, agree tbat tbe be nroecratbic law answers just as 
well whether tbe disease be of a bacterial nature or not. 
The question of accessory antiseptic nietbods we bad before 
us a sbort time ago, wben we were discussing dipbtberia. 

Of far greater interest to us as bomo^patbic physicians 
is the treatment of disease by preparations of tbe products 
of pathogenic microbes- Tbis would seem to be a very 
hopeful source from wbicb to enrich our pbarmacopo&ia, not 
tbat it is desirable to increase tbe number of drugs, but tbis 
group of drugs would seem likely to occupy a very definite 
place of their own. It is a comparatively simple matter 
to filter pure cultures of patbogenic bacteria, so as to got 
rid of aU trace of tbe germs themselves and isolate their 
chemical products. 

This has been done and tbese products bave been provod 
to produce the symptoms of tbe disease. Tbe same may bo 
done with a watery extract of spleen or other organ or tissue 
of a patient dead of the disease. Tbus tbe diphthoritic 
poison prepared in tbis way produces all tbe symptoms of 
diphtheria, including a paralysis of the same nature and with 
the same pathology as true diphtheritic paralysis. 

It has also been shown that these toxins, when injoctod 
into susceptible animals in small doses, are capable of con- 
ferring upon the animal so treated immunity to the disoaRO, 
such artificial immunity being of varying degree ami 
duration. 

This has been proved to be the case in many baotorial 
diseases, and would probably hold good for many more, if 



394 THB BBLATION OF BACTEBIOLOGY TO TREATMENT. 

not for all. But possibly the same principle would hold 
good when applied to diseases other than bacterial. 

The nature or cause of this immunity is not known, but 
it is supposed to be due to the formation in the blood of a 
substance antagonistic to the disease poison, to which the 
name of " antitoxin " has been given. But there is an 
obvious indication that these poisons should be used for 
the cure of the diseases to which they belong, and we are 
familiar with such treatment in our nosodes. 

The antitoxins above referred to have also recently been 
employed in the treatment of such diseases as diphtheria, 
tetanus, and pneumonia. 

An animal is rendered immune by the method above 
mentioned, and serum obtained from it, either by venesec- 
tion or by blistering. The same end is attained if one takes 
the serum of a patient convalescent from a disease. 

Whichever way it is obtained the serum is supposed to 
have in it a substance — the antitoxin already referred to. 
As to the nature of the supposed antitoxin, — the suggestion 
is a reasonable one on the face of it, that the serum is 
merely a dilute preparation of the disease poison ; but on 
inquiring further this does not seem to be the case. If 
equal quantities of the antitoxic serum and the toxins of 
any disease be injected into an animal the effect is nil, 
whereas if a like quantity of the toxin alone were injected 
it would be rapidly fatal, so that the antitoxic serum appears 
to antidote the toxin. 

Whatever be its nature this antitoxic serum has been 
used in disease, and in some cases apparently with marked 
success. Results, however, are not constant, which is what 
we would have expected. In pneumonia, for instance, the 
effect is wonderful sometimes, a critical fall of temperature 
being at once induced, and followed by rapid convalescence, 
while in apparently similar cases the effect is absolutely nil. 
In the " Year Book of Treatment *' for 1895 the author thus 
comments on these variable results : " These discrepancies 
cannot be reconciled. That they were due to causes in- 
herent in the persons of those injected, essential variations 
in diseased processes, or subtle radical differences in constitu- 



saro: ^7 rnkTSSBaoi^M^ v^ rmjinticcts $^ 



tion, and j::(t i»? ^zItt ,ccEjinDrc: re ib? s^r^r:*,. i?^ vwx^\ ^x 
the fiurt that di5cfs:.i resijs i:Z':TPivi lie ;;:>^ oi 5>>^ $*i^^^ 



ss 



The amtcr aZsc caci5:rs 12s as iv* ?ie $ox:tw of ih^ 
semin, remarking thai ser^r^ taken frviu reyV.nv.c^ jvj^U^uu 
can produce nepbiiiis when in'cci^d inio the w;r,* \\f \\x^^^ 
T?hich lemad^ alsois nc-i w:;h:>at its thejRiix^xiUO ^i^^uilW^MUV^ 

It is pretty evident that some cases aiv ^v;U^Mo Kni" Oua 
treatment and some are not, though wh^t doionuuu\^ lhi« 
snitahility or otherwise has not yet been asivri^uutHL 

In diphtheria the death-rate of cases un^\or antitx^xio 
treatment is much less than that nudor onlinary alK^p^tUio 
treatment, but the treatment in this disojvso should bo o\\nw 
menced early if it is to be of any uso at all* *V\\\\^ \\\ }\ 
series of cases recorded, of six treated from the rtrst tirty M 
recovered ; of 66 treated from the second day, two \\\k^\\ i 
while in cases where treatment did not conmu>iuHv till ihrt 
third day, the mortality was 53*5 por cent. Tlio pivlluH 
genesy of diphtheria antitoxin, as far as rtHU)nlo(l, Hoomw to 
point to diphtheria. 

In connection with these methods of tnialiuntit It In 
interesting to observe that a bacillus of (^uuuir liaM Innm 
alleged to be found Qyy Schenerlen) in Hcirrhoim oanMiiniim ol* 
the breast. This has been isolated, and cultivated, ati<l tliM 
pure culture has been injected into the rniunnun of bitfliiiM, 
where it has produced hard epithelial tiunoiH'N, Othiu' 
observers have also adduced evidence to hIiow that imu'.i-^r i« 
a bacterial disease, though nothing can l)e h^M to l/tt \iins^''i\ 
in this direction yet. At least we should aW \m\ with j//y 
any drug that would aftsist \XH in th'? tr^Jit/zi'rot of mnr^tif^ 
and it is at least possible that mu^M /Iru^/ may (/'$ foiin4 Ut ai 
preparation of the jjrodiict^ oliUh ha/ulUii^, or h, f^n ffutuiv^h 
from the tumour itf>elf, or from th<; k^:rntt of fti f/u.U* ai 
suffering from cancer or jf^iA^^nA i//;//;w.'p t'/ * 4h',i f HfifU 
cially by toxins* 

"With regard to tb^?v^ r/>?t/^vil^ '/ in-^yu./ lA ih*f<. U M 
presait a vatt a>v.iow;t oi oryt/;'^//./; vy/..'./. ft^*>^X i/< - ^/v/^>) 
up before a lAtivivi^torv v/ v;-^;r<tJ-'; ^s? ;/;/., 'a'-.o/. 'A t' < a. x^-./y 
be made. 



396 THE RELATION OF BACTERIOLOGY TO TREATMENT. 

It would be of great interest to see the matter taken in 
hand and a full pathogenesy of such drugs obtained from 
experiments upon animals and provings upon healthy 
persons. They could then be prescribed with accuracy, and 
would probably prove of great value to us in the treatment 
of many formidable diseases. 

There is only one point more to which I would like to 
refer, and it is in connection with diagnosis. In some 
germinal diseases, if the diagnosis be once established, it 
may serve as an indication for treatment, medicinal, dietetic 
and hygienic. 

A diagnosis, for instance, of pulmonary phthisis might 
help us to the selection of a remedy, and indicate a change 
of air and regulation of diet. As an aid to this diagnosis in 
difficult cases, the presence of the tubercle bacillus in the 
sputa is often valuable. In regard to diphtheria also there 
is a growing conviction that a final diagnosis of the disease, 
before paralysis sets in, is impossible without detection of 
the bacillus of Klebs, and facts seem strongly to support 
this view. There tbre throat affections with formation of a 
tough membrane exactly as in diphtheria, and with consti- 
tutional symptoms of a similar nature, but which are not 
accompanied by the presence of the specific microbe. 

The presence or absence of this bacillus is found to 
correspond with a very striking difference in the clinical 
course and mortality of the disease. In the membranous 
angina without the bacillus of Klebs the mortality is small 
indeed, in fact scarcely appreciable, while true diphtheria in 
which the bacillus is found has a very high death -rate. 

Of all cases diagnosed as diphtheria without examina- 
tion of the membrane for bacteria, about one-sixth to one- 
third have not the bacillus and are not diphtheria at all. 

It is probable that patients with these pseudo-diphtheritic 
sore throats often contract true diphtheria and die through 
being confined in the same ward or room with diphtheria 
patients. If this be so the indication is obvious that a 
bacterial examination should always be resorted to and thus 
grave error avoided. 

I would venture to submit the conclusion that we owe a 



THE BEIiATION OF BACTEBIOIiOGY TO TKEATMBNT. 397 

vast amount to bacteriology, and that this science has a very 
important relation to the treatment of disease ; also that it 
behoves us, as scientific physicians, not to be behindhand, 
but to be in earnest to secure the benefits promised to us 
and to humanity through us by such methods of scientific 
research. 

'So fact concerning disease could possibly be beneath the 
notice of a homoeopathic physician. 



Dr. Hawees said there were often difficulties in the way of 
bacteriological examination. A suspicious evacuation might 
enable us to determine whether a case were typhoid or not, but 
in the case of diphtheria there is more difficulty in finding the 
bacillus. He referred to Burnett's bacillinum, and said he had 
seen good results from Koch's tuberculinum 6, which he had got 
potentised. He would like to know the bearing of these on 
homoeopathic treatment. 

Dr. Hayward questioned whether recent advances in bacteri- 
ology had done a great deal for therapeutics. He remembered 
when nearly all fevers were regarded as fatal, while some other 
germ-diseases were regarded as curable. It was thought that 
the latter should be left to nature, but nature may be assisted by 
treatment. Dr. Smith stated that if the toxin and antitoxin 
were given together they neutralised each other. This was no 
proof that the action was antipathic ; the same result would 
follow if equivalent doses of opium and atropine were adminis- 
tered. The toxins and antitoxins were preventive, and ought 
therefore to be indicated in treatment. In reference to the treat- 
mept of enteric fever, the germs are found in the stool and on 
the mucous membrane of the intestines ; hence he counselled 
the use of material doses of sulphur, which had an antiseptic and 
laxative action. 

Dr. Nevin said that in surgical treatment good results were 
obtained from weak as well as strong antiseptics, and water 
alone had been used by some. Two bacteria had been described 
in pneumonia, one of which was encapsulated, the other not. 
Perhaps the presence or absence of one of these might explain 
the different results of the antitoxin treatment. Milk in typhoid 
is probably non-irritating, but if curdled in clots it must irritate 
the mucous membrane : farinaceous food, being digestible by 
the saliva and pancreatic juice, had been tried, but it had caused 
a rise of temperature. Putrefaction was influenced by tempera- 



398 THE RELATION OF BACTEBIOIiOQY TO TBEATMENT. 

tare, moisture and other factors, and if these vary we may get 
different alkaloids — e.g,, maize in summer produces a narcotic 
and paralysing ptomaine ; in winter another alkaloid with a 
base having a tetanising action. Dr. Nevin at some length 
discussed the relation of the syphilitic poison to locomotor 
ataxy, saying that myelitis had been produced experimentally 
by many bacilli {e.g., nerve sequelflB of diphtheria, which Sidney 
Martin and others had shown to be due to a soluble toxin). 
Locomotor ataxy occurred years after the secondary symptoms, 
but this might be due to some poison long dormant in the 
system, or that it only inflicts some permanent but not obvious 
change in the nervous centres, rendering them liable to degenera* 
tion under slight causes and because of the molecular and 
nutritive changes that attend old age. 

Dr. Thomas said that with regard to the relation of bacteri- 
ology to treatment, the most striking advances had been made in 
prophylaxis. 

Dr. Gordon said the important fact for us to ascertain was 
the part microbes played in disease, and antidote that. Bac- 
teriology had aided diagnosis materially : this was important. 

Dr. John Hayward remarked that the antagonistic effect of 
one bacillus on another had not been referred to. He had seen 
a case of lupus which had been beneflted by an attack of 
erysipelas. Dr. Kevin's suggestions were valuable ; Mr. Eushton 
Parker attributed some of the symptoms in typhoid to milk diet. 
With regard to the antitoxin treatment, he thought if the toxin 
and antitoxin could be injected together without result the action 
was not homoeopathic. 

Dr. Mahony thought the fact that the toxins and antitoxins 
could be given together was because they were similar but not 
identical. He believed that the bacilli were not the cause but 
the effect of disease. Pasteur had failed in his treatment because 
he used one remedy, a nosode, for different cases. 

Dr. Capper (the President) said we had to treat the combina- 
tion of symptoms in accordance with the homoeopathic law and 
not the bacteria. 

Dr. Smith, in his reply, did not wish to contend that diph- 
theria was a local disease, but that the bacilli were local. In the 
treatment of pneumonia by serum, the production of a crisis on 
the second day proved a cure. The suggestion to treat cancer by 
serum was as homoeopathic as in the treatment of other diseases 
by nosodes. As to the part that bacteria play in the production 
of disease, he mentioned that the introduction of tubercle bacilli 
was in some cases followed by phthisis. 



TREATMENT OF HTPERTBOPHY OP THE PROSTATE. 399 

A DISCUSSION ON THE TEEATMENT OF HYPEE- 
TEOPHY OF THE PEOSTATE, TOGETHEE 
WITH ITS EETENTION OF UEINE AND 
CYSTITIS.^ 

OPENED BY C. KNOX SHAW, 
Surgeon to the London Homoeopathic Hospital* 

In the practice of medicine and surgery we are accus- 
tomed to see revivals of interest in various diseases : the 
brain, the ovary, the kidney, the gall-bladder, the appendix 
vermiformis, have been, and to some extent still are, centres 
of attraction. Lately, owing to the proposal of a new 
operation, orchectomy or orchotomy, as it is variously called, 
for the rehef of obstructive prostatic hypertrophy, interest 
has been revived in the treatment of this affection. The 
Council of this Society, anxious to test and see what is 
good in the old, before rushing to the adoption of new and 
partially tried measures, decided to elicit the opinion and 
experience of its members on the treatment of a disease 
that must come under the notice of every man who has been 
even a short time in practice. We sadly want to cultivate a 
calm and dispassionate power of discrimination in these days 
of medical fads and crazes. The members of this Society 
are often called faddists, but I venture to assert that our 
" fad " has lasted longer and has better stood the test of 
experience than some of the marvellous cures of meteoric 
brilliancy that have illumined the medical sky in recent 
years. I did not realise, when I responded to the invitation 
of the Council to open this discussion, how difficult it would 
be to compress all that can be said on so vast a subject 
within a short compass. I am, therefore, only going to out- 
line the points most needing consideration, leaving to others 
to fill up the gaps from their experience. 

No share of the kudos attending a brilliant operation 
falls to the doctor who skilfully pilots a patient through the 
dangers and pitfalls of the disorders attendant upon an ob- 

1 June 26, 1896. 



400 TREATMENT OP HYPBRTBOPHY OP THE PROSTATE. 

structive enlargement of the prostate; and yet I would 
maintain that as much judgment, care and attention are 
required in the management of these cases as are lavished 
on much less serious conditions. 

Before we proceed to discuss treatment we ought clearly 
to understand exactly what it is we are going to treat. I 
cannot enter into the physiology of the prostate, but would 
like to draw attention to the modern view that the prostate 
is not an organ of urination, but is primarily a sexual organ 
supporting the urethra and secreting a viscid fluid connected 
with the preservation of the spermatozoa. Further, it is 
maintained by some, and with apparent reason, that the 
prostate and uterus are not homologous structures, a point 
which is of some interest when we come to consider treat- 
ment. We are so apt to look upon prostatic hypertrophy as 
essentially an affection of old age, that it is worth recalling 
to mind that cases have been observed as early as forty 
years of age. We must also consider what cases need 
treatment, for there are, I should say, at least 60 per cent, 
of the cases of prostatic enlargement that need no special 
attention. 

We must consider for a moment the symptoms that 
indicate enlargement of the prostate requiring medical super- 
vision. A patient complains of irritable bladder, with in- 
creased frequency of micturition both by day and night ; 
this is accompanied with a sense of weight and discomfort 
in the perineum ; there is some difficulty in commencing to 
urinate, and there is a noticeable decrease in the expulsive 
power of the bladder. In this condition the patient is very 
liable from exposure to cold, or imbibition of alcohol, to pros- 
tatic congestion with perhaps haemorrhage into the bladder, 
or to sudden and complete retention of urine. 

At this period, though there may be residual urine from 
the bladder gradually losing its tone, there is rarely cystitis. 
Meeting with these symptoms we may suspect prostatic 
hypertrophy, and proceed to examine the patient per rectum. 
In the majority of cases we shall find evidence of the hyper- 
trophy in the rectum, but we must also recollect that that 
portion of the prostate palpated from the rectum is no sure 



c? KZFXKEBa?ar or tkk v^ossxsx^ ^ 



> -Vi 



guide to tbe rn^rTj acii amoGnii of ^he ciirar-Ti^nril ^rcvii 
of the cr^azL. I wms iniai smck wiii siiis rc£ni wbar 
examining, scci* jfne snce, & ii:i::z.C€r cf sf^cimec^i in ^i* 
Museum cf ihs CcZIege cf S^ir^rcs^ Tbe fr^'iitfcicj >:£ 

prostate, cr it eat ie d:ie to izcDeased ly^ral secc^ccc: 
excited leSexrr ex cackrarari tressiie fr:ci the CTer-^wjui^ 
bladder. If we ±id Iimrii nrfne cf Icar sreciz:^ i^riTi^T jjni 
with a ssincriiziil r^acenia*^ cf zltea we sr:::ili sc^rirCa ^iis 
conditicn. Tris is tiie sta^^ when drriz trea^rnem shccji 
be of service, ani I w^nt to leam frziz. mer^^cers cf iiiis 
SocietT wiieii:£fr thex can c5ar aziT eTiirII.^^ on^ this rc£nx. 

• — - -U. 

Hospital SGTgec zs r^relj see patienis a^ ihis reri :«i. :izii I r:i~ci 
regret that I f^^ gire t^i iiide perscrjil izif:miA:i:ii m xhi> 
pomt. Before I enifrelj deTi^ed mj^elf *o ST«rch\I ^ssrrrk ind 
thns saw the cases earlier than I Jo n3 w, I rresorihei f:5r ^his 
eadT condition vari::i5 remedies, such as icdiie cf rcsisi. 
iodide of mercarr, ic«i:ie of arsenic. fcTirastis a^^i ah.~^a: 
but I cannot say that I saw any direct and pcsidve r^e^cuis 
follow their use. I haxe, however, derived marked i>erie£t 
in the state of passive conzesdcn to which hyrer:rrcrhied 
prostates are Kahle from beUadcnna and the icviide cf mer- 
cury administered alternately. Bat what I want to lir:i i$ 
a drug having a direct action npon the dLRise ^laniiljar 
growth which is the caose of the enlargement. There are 
other drags said to be of considerable benedt. of whici I 
expect to hear something in the discussion. 

Suppose we find, in spite of treatment and the hy- 
gienic advice that will have been given to avoid chilU and 
excess of stimulants, and to take care that the cl:^dier is 
regularly emptied, the patient's symptoms increase : w\e 
must not heedlessly rash into catheierism. b^it arrroach 5he 
operation with considerable caution. I wo;iId reoci:im.end 
that first the urine be examined, and if there aie anv siir^is 
of renal degeneration, or even urine of low srecidc cravisv^ 
that the operation of passing the catheter be perfcrmed ta 
the patient's home, and that he be kept warm in t>rd for the 
rest of the day. It is imperative that the caiheier he 
scrupulously clean, and it is best that it should be of a dC'it 



402 TREATMENT OF HYPEBTBOPHY OF THE PROSTATE. 

kind. Instrnment makers sell a capital little instrament 
for sterilising the catheter by means of steam. 

If we are testing for residual nrine, and that is a special 
point at this juncture, the patient must be made to urinate 
before the catheter is passed, and as soon as the catheter 
passes into the bladder, note should be taken of the force 
with which the urine is expelled from it, as this is a gauge 
of the propulsive power of the bladder, and indicates the 
likelihood or otherwise of the patient gaining later on 
vesical control. If the residuum is considerable, the period 
of rest should be longer. If we find but little or no residual 
urine, and the urine itself is normal, and the patient has 
the power of voluntary micturition, there is no need to 
introduce him to catheter life at once. In these cases I have 
found the bougie a ventre, introduced by Mr. Reginald 
Harrison, of service : it seems by its double dilatation to 
keep the waterway through the prostatic urethra. Before 
proceeding to pass a catheter it will be well to expose the 
abdomen and percuss out the bladder, for this will often 
reveal the fact of its hyper-distension ; it is remarkable to 
what an extent the bladder will slowly and painlessly dis- 
tend without the patient being aware of it. Mr. Johnstone, 
who has recently successfully brought a patient through his 
catheter crisis, will, I have no doubt, allude to a very in- 
teresting case I saw in consultation with him — a case which 
illustrates many of the points to which I am referring. 
Whether we are called to see a case of over-distended 
bladder, with the patient still passing urine, or to a 
case of sudden retention, our treatment should be the same, 
with perhaps some mechanical difference in the catheter 
manipulation. 

I think every patient should be fully informed of the 
risks and dangers attending catheter life, and also his posi- 
tion if left unrelieved. Years ago, in my early medical life, 
for want of doing this, I earned the unenviable reputation 
of having killed a patient by passing a catheter. It was one 
of those cases of slow hjrper-distension of the bladder, the 
patient all the while going about his work ; then incontinence 
followed, and the doctor was summoned. Catheterism was 



TREATMENT OP HYPERTROPHY OF THE PROSTATE. 403 

Bpoken of as a slight measure ; it was rapidly followed by 
cystitis and the death of the patient. 

En passant, incontinence of urine in an adult male 
should always make us suspect prostatic hypertrophy. I 
was able to demonstrate with the cystoscope at the hos- 
pital a few months ago an interesting case of this nature, 
and to show not only the reticulated and h3rpertrophied 
walls of the bladder, but also the enlarged prostatic lobe 
which was the cause of the condition. 

First, then, having put the patient to bed, a new india- 
rubber catheter. No. 10, should be chosen and carefully 
sterilised. This may be done by soaking it in carbolic acid 
(1 — 20) and then washing it in boiled water. If there is any 
suspicion as to its asepticity from previous use, then the 
steam catheter steriliser should be used. Only about half 
the urine should be withdrawn, the subsidence of the bladder 
being watched by the hand on the abdomen or by per- 
cussion. Eapid withdrawal of all the urine may cause 
sudden syncope, or most probably considerable intra- vesical 
hflBmorrhage. Before the catheter is withdrawn it is well to 
inject into the bladder, and leave there, two or three ounces 
of warm boro-glyceride solution or a solution of perchloride 
of mercury, 1 — 10,000. There may be cases in which it is 
impossible, owing to swollen and congested states of the 
parts, or to some peculiar disposition of the prostatic hjrper- 
trophy, to pass a catheter, or its attempt is attended with 
excruciating pain. Warmth, rest, and suitable treatment 
vnll do much for these cases, and enable a catheter ulti- 
mately to be passed, if we can only tide over a short time, 
and for this purpose I can confidently recommend supra- 
pubic aspiration of the bladder. I have on occasions re- 
peated this more than twenty times on the same patient 
without any harmful effect following. 

After you have supervised the catheter treatment a little 
while, the patient can be taught to manage his own bladder, 
but he must be duly impressed with the extreme importance 
of care and cleanliness, or he will be certain to get into 
trouble. He must not do as a patient once did in my 
consulting room. I was examining his eyes when he was 
VOL. III. — NO. 4. 28 



404 TREATMENT OP HYPBBTROPHY OF THE PROSTATE. 

suddenly seized with severe vesical tenesmus, and urgently 
begged a porringer ; to xay horror, he produced a very dirty- 
looking catheter from his pocket, wet it by passing it 
between his lips, and promptly passed it into the bladder. 
Needless to say, on enquiry, I found him suffering from 
painful and troublesome prostatic cystitis. 

There may be some difficulty in passing a soft catheter, 
then one should try a coude, or a gum elastic catheter with 
a suitable curve given to it by means of the stilette, or 
lastly, one may have to have recourse to the silver prostatic 
catheter, but which, unless used with the greatest care and 
gentleness, may turn out to be a very dangerous weapon. 

Here I may remind you of a little tip with regard to the 
catheter management of these cases. Great assistance is 
often giving in passing the catheter by introducing the 
index finger of the left hand into the rectum. When the 
catheter reaches the neck of the bladder it encounters a soft 
but resisting obstruction ; the tip of the catheter should then 
be gently raised by the left index finger, at the same time as 
the distal extremity of the catheter is depressed by the right 
hand, and in many cases it will gently glide into the bladder. 

Notwithstanding all our care, there are some cases that 
will do badly ; we can recognise some of them at once. 
One morning, going round Bayes Ward, our then resident 
medical officer took me to see a case of prostatic retention 
he had admitted since my last visit. His management of 
the case had been most judicious, but .after hearing the 
history of the case and examining the patient, on leaving 
the bed I expressed the opinion, rather to the surprise of 
the resident medical officer, that the man would die — a 
prognosis unfortunately only too soon verified. Mr. Hurry 
Fenwick so well describes the patient to whom I refer that 
I cannot do better than give his words: " A patient, about 
60 years of age, with anaemic lips, with a face of leaden hue, 
with short breath, capricious appetite, and morning nausea 
or retching — a patient who is feeble in his work, failing in 
his bodily vigour, forgetful in his business, and drowsy over 
his occupation." In these cases and in others not quite so 
advanced, the patient is probably ursemiq from backward 



TBEATMENT OF HYPEBTBOPHY OF THE PBOSTATE. 405 

pressure upon his kidneys, and there is also often some 
co-existent cystitis. 

We may be fortunate enough to steer our patient through 
his catheter life without any accident, but not unfrequently 
within a few day^ of our first using the catheter, the con- 
dition known as catheter fever supervenes; the patient 
becomes feverish, the tongue dries, he loses his appetite, 
the urine becomes turbid, contains mucus and pus, and later 
on becomes ammoniacal, whilst urination becomes frequent 
and painful. If the kidneys had previously become seriously 
affected, death may soon follow, or after a period of serious 
illness the patient may drift into all the pains and discom- 
forts of a chronic cystitis. Here we can render valuable 
therapeutic assistance, in addition to local measures. 

First, as to local measures : the urine must be regularly 
withdrawn and the bladder washed out with either boracic 
acid, boro-glyceride, acidulated sulphate of quinine, or per- 
chloride of mercury. With regard to the latter, it should 
not be begun stronger than 1 — 20,000, the strength being 
increased as the patient shows tolerance to its use. Many 
other drugs have been used, but these seem the most useful. 
There are various means at our disposal for washing out the 
bladder ; as a matter of general routine I prefer to use a soft 
catheter and a four [to six ounce rubber bottle with a stop- 
cock ; using tepid water for the first two or three injec- 
tions and then one of the above solutions, allowing the 
solution to remain a few moments in the bladder before 
permitting it to escape. The stop-cock prevents the entry 
of air into the bladder. I have not found tying a catheter 
into the bladder very serviceable, and avoid it whenever 
possible. In the acute stage of cystitis I do not think that 
we can do better than begin with aconite or belladonna 
alternately with cantharis. I have over and over again seen 
great relief follow their use. At this period the bladder is 
too sensitive to wash out. The patient will derive great 
relief from the use of hot hip baths, their frequency depend- 
ing upon the severity of the case. If there is much urinary 
tenesmus, especially at night, I can cordially endorse 
Helmuth*s suggestion of ten drop-doses of Tr, hyoscyamus 



406 TBBATMENT OF HTPBBTBOPHT OF THE PBOBTATE. 

(f> given in a wine-glass of hot water every three or four 
hours. When the acute stage is passed and the bladder 
contains ropy mucus, I have found copaiba, pulsatilla, and 
chimaphila helpful. I have also used, Ynth apparent benefit, 
ten-drop doses of pichi. During the attack the patient 
should at first be in bed and then rest on the sofa a good 
deal, and avoid all stimulants, drinking freely of bland 
drinks, such as thin barley water. When the urine is 
ammoniacal I have sometimes added twenty grains of 
boracic acid to each pint of the barley water. I have also 
used, with the greatest benefit to the patient, both in acute 
and chronic cases, the old-ifashioned remedy of decoctum 
triticum repens, giving a pint to a pint and a half a day. 

The above measures will, in a great many cases, render 
the patient comfortable and enable him to get about and 
enjoy life. But there are some cases where the chronic 
cystitis appears intractable. Of course I am presuming that 
the question of the existence of a calculus has been decided 
in the negative. There is frequent and painful micturition, 
day and night ; the patient's rest is destroyed, and he ia 
evidently going downhill. We have next to consider what 
we have now to offer the patient. Here the treatment 
becomes almost purely surgical. 

We may drain the bladder through the perineum (Har- 
rison), or drain it supra-pubically (Thompson); we may 
attempt to remove the offending portion of the prostate 
through the perineum or urethra (Bottini, Mercier); we 
may attack the prostate through the bladder, supra-pubically 
(McGill, Mansell MouUin), or we may endeavour to reduce 
the size of the prostate by removing the testicles (White). 

Perineal drainage has its uses, though it is not a radical 
cure. In certain cases, where the cystitis is too severe to 
warrant a supra-pubic cystotomy, it gives relief, and cer- 
tainly allows the congested prostate to subside, and so 
makes a subsequent prostatectomy a less serious under- 
taking. 

Prostatectomy through a perineal or urethral route does 
not commend itself to me. 

The present store of accumulated evidence shows that 



TBEATMENT OF HYFESTBOPHY OF THB PBOSTATS. 407 

supra-pubic prostatectomy is a justifiable, practical, and 
curative operation, and with improved technique and a 
proper selection of cases its mortality need not be very 
great. The operation is often put off too late, and is per- 
formed upon a most unsatisfactory class of patients. This 
is not the place nor time to enter into the surgical details 
of the operation ; we want to discuss it as a justifiable mode 
of treatment in certain cases. 

I think it is too early to pronounce an opinion upon the 
operation of castration for the reUef of prostatic obstructive 
hypertrophy. This operation is based on the analogy be- 
tween uterine fibro-myomata and prostatic overgrowth : the 
analogy, though advanced by able men, is not yet proven, I 
think. From the evidence offered us it seems fairly clear 
that castration has the effect of preventing the development 
of the normal prostate, as shown in eunuchs, young people 
who have been castrated for disease, and in castrated animals, 
but the effect follows when the testicles and prostate are in 
a state of great functional activity. We have yet to see 
that the same effect follows when both organs are in a state 
of sexual decadence. I do not think gynaecological surgeons 
would expect to see a marked diminution in the size of a 
uterine fibro-myoma follow the removal of the ovaries in a 
woman aged 60. 

Certainly many cases have been already published of 
apparent success following the operation, but in some of 
them sufficient time has not elapsed since the operation to 
form a correct opinion ; and evidence is slowly accumulating 
that the operation is not quite so simple a matter as was at 
first supposed. Unfortunately there is too much tendency 
to publish the successful and leave untold the unsuccessful 
cases, and thereby an incorrect judgment of an important 
operation is easily formed. At present I would prefer to 
have an open mind on the question, but this I have already 
learned by personal observation, that it is not an operation 
likely to commend itself to the patient unless he has very 
great assurances that a very marked benefit will follow its 
employment. 



408 DISCUSSION ON HYPERTBOPHY OP THE PROSTATE. 

Dr. E. B. EocHE (Norwich) said that from the point of view 
of private practice he had been surprised, in reviewing the 
matter, at the very few cases that came under actual active 
treatment. It had been said that about 34 per cent, of males of 
60 years of age and upwards had some prostatic mischief, but if 
that were so it was a remarkable fact that during his experience 
of twenty years as a general practitioner, he had known only 
about seven or eight cases requiring active treatment, the more 
so as he had, through previous circumstances, got a name for 
taking surgery and cases of that sort. With regard to medicines, 
he had previously noted down exactly those which Mr. Knox 
Shaw had found useful — coUinsonia, belladonna, cantharis and 
aconite. As a practical point he would mention the accident of 
hasmorrhage. Those who were not used to passing instruments 
did so with a certain amount of trepidation, and that was a bad 
thing. It was very important that the patient should see that 
the doctor had confidence, as any nervousness on the part of the 
surgeon was sure to communicate itself to the patient, and thus 
set up difficulties which need not exist. He had often passed a 
catheter with great ease, allowing the urethra as it were to eat 
up the instrument, but still, when he had drawn off the water 
there was some little hsBmorrhage following. With the greatest 
care, when the prostate was in that high state of congestion, 
bleeding would take J)lace from the mere touch of the catheter 
on the congested surface. If, as he had sometimes seen, the 
bladder became two-thirds full of blood-clot, the doctor's patience 
and ingenuity was taxed, but by the use of the syringe and dis- 
infectants, and washing the bladder out, the bladder could be 
cleared. With regard to the question of residual urine, one 
should turn the patient on his side, or even quite over, almost on 
his face, to empty the pouch that lay below and behind the 
prostate, and might take that urine separately from the other, 
by drawing off until they were sure they were getting to the 
bottom, and then try to get that urine separate from the rest. 
It might be done with a little care and attention. As to the 
question of percussing out the bladder, it was important to 
remember the way in which in old people the bladder settled 
down into the pelvis, and there was much more distension than 
one had any conception of, even in percussing out above the 
pubes, and one might be very much deceived if one was not 
aware of that. Examining by the rectum would often give 
knowledge of a much larger cyst filled with urine than would be 
gathered from percussion on the abdomen. Some persons would 



TisBEZF US ±" ^Hag-arpy^ ir ^tt sus^sizk. ^^ 



fakrvf^ Sd iciiss eluilll mc 2**: ■a.Ti£r"r fcric snsr w«c^ ^^srr 

a p^»"^^-*i^ - TT^TT-^iJ- filling Iti: TTShrt* T.Ttfc; ^VTit^ Xll£ .SlJjr JbJiiSCTnil- 




riHT €iizizu=&. inzzfzig cci=aL::5cci for 

eoold be e:::itl£*iai_ '*^»j:j=ir5r izisrs: ■■-*$ & grZjfraZ tr^'.iirjgcr^g:! of 
the pgogajg-, i:rrzzAaf=Zj ibsrs -^as ^rCcsTiLlly ^e&sa c»b5tra^x:cc 
and xhev miisi le assuli -»--ui iiisiiriizLi: lo xhe c::r^:iiristtzijes of 
the case. T^-nfc =:>r>iiiZj£s L=r hii fi:zLi cz ibe rscss c»i m>»& 
aconite in the ae:ne SLi^e- azii cLziiLizis he h&i fccnii of great 
benefit in Ix dLl:mi^ ^■^ulici aziy ik£:paT^i:~n- ILr. Ee^ir^d 
Hnrnsfm ad-nsed ihe ^sse of fari^aT--^. twi he Tssed larcer dos^ets 
than Ix. He iiad aZsa ssai cdliz^cnia, azil, of ocKirse, bella- 
donna. 

Dr. I>ui>&£OS sail thai the siit^ect ar.r.c :ii^cei for discus^on 
washypertrcpby of theprosiaic- b:it Mr. Rtidx Shaw had included 
prostatitis in his paper. B:ii prostatitis a&d hypertrophy of the 
prostate were qnite di^€:rent niseases — the nrst was a disease o£ 
early manhood, the latter of old age, and was not usually or 
necessarily attended, or caused, by icdammation. He had had 
very little experience of prostatitis, but he had seen a good many 
cases of the other. Tney raried Tery much in their character and 
in their symptonts. Tnere was hypertrophy of the prostate, 
causing no symptoms at all except obstruetion of the dow of 
urine more or less complete. He had seen a case where the 
hypertrophy was very small, and yet the obstruction was very 
great ; but as Sir Henry Thompson had pointed out, a very slight 
hypertrophy of the middle lobe of the prostate would often produce 
complete obstruction of the urine. That could be easily under* 
stood, because in the middle lobe any little elevation of the caput 
gallinaginis would act as a valve and prevent the urine from 
passing. Then there were other affections which sometimeii 
accompanied hypertrophy of the prostate, such as gleoty dia* 
charge, which did not come from the mucous membraue of the 



410 DISCUSSION ON HTPBBTBOPHT OF THE PROSTATE. 

urethra, but which he thought was caused by a secretion of pus 
into the sinus pocularis of the prostate gland, or perhaps from the 
seminal vesicles. Sometimes the gleety discharge was very con- 
siderable, but if they made a careful examination they would find 
that the water might be drawn off from the bladder perfectly clear, 
and it was only in the last drops on the withdrawal of the cathe- 
ter that they would find a purulent secretion. Sometimes a 
purulent discharge would be noticed when there was complete 
obstruction of the passage of the urine ; the efforts made by the 
patient to relieve himself would bring out a few drops of purulent 
matter. He imagined that came from the sources he had 
already mentioned ; it was evidently not from the bladder. There 
was manifest sympathy between the testicles and the prostate 
gland. He had had cases of prostatic enlargement where there 
was periodical or occasional orchitis of a very severe description, 
and other cases he had seen where the testicle only swelled con- 
siderably, but without pain or other signs of inflammation, show- 
ing the sympathy of the testicle with the prostate. As the 
seminal ducts enter the urethra through the prostate gland just at 
the mouth of the sinus pocularis, any affection of that part of the 
prostate gland may very readily be communicated through the 
seminal ducts to the testicle. It was upon that sympathy of the 
testicles with the prostate gland that he believed the success that 
had attended castration in enlarged prostate was owing. Hyper- 
trophy of the prostate gland was not often a dangerous disease, 
but sometimes it was. Sometimes, in spite of all one could do, 
the prostate would suppurate to a very great extent throughout 
its substance, and, in fact, become a mere abscess, which was a 
very dangerous condition of things, and might cause the death of 
the patient. With regard to the means for relieving hypertrophy 
of the prostate, it was very dangerous to allow the patient, where 
there was inability to empty the bladder completely by natural 
efforts, to remain without having his bladder periodically emptied. 
If the obstruction was complete, the patient must empty the 
bladder as often as was required, with the catheter. The kind 
of catheter used was a matter of some importance. If the urethra 
was free from any stricture, the soft catheter which Mr. Knox 
Shaw had shown would be quite sufl&cient, and the patient could 
use it himself without any danger or difficulty : but if, as was very 
often the case, there was a stricture along with the prostatic 
disease, it might happen that in attempting to introduce the soft 
catheter it doubled up upon itself, and would not enter the 
bladder. In that case, another catheter must be selected. The 



UaCUSSlQlS QBT RIPnOBIffSX OF TBS FBOSTAXM^ 411 



catheter which he had foand <^ mosfi use in soeh cases was the 
hlack robber catheter, wit:k probe-pointed end. That passed 
readily throng the strictmre and enabled tihe patient to draw off 
his urine with much greater facility thiui if he used the catheter 
without that probe point. As for medicines, those mentioned by 
lir. Knox Shaw and by Dr. Boche were those suitable for prosta- 
titis, and not fat hypertrophy of the prostate. As far as his 
experience went, belladonna seemed to hare no effect on hyper- 
trophy of the prostate. He had tried all the recommended 
medicines for hypertrophy of the prostate, bat he had never sue- 
ceeded in sati^yiog himself that any medicine with which they 
were aoqnainted had a speci&c action npon that most intractable 
affection. He had tried sabal in the form of tinctnre, and also in 
its combination with santal oil, called sanmetto ; bat in spite of 
the wonderful testimonials published respecting its efficacy in 
prostatic disease, he had not seen any effect from it. Thnja, 
argentnm nitricom, salphor, and nitric acid, all seemed some- 
times to be of nse, bat he coald not say he had succeeded in 
curing hypertroj^y of the prostate with medicines ; so the patient 
had to content himself with the mechanical relief a catheter 
afforded. If he did that, and did not allow his urine to remain 
longer in his bladder than was comfortable to himself, he might 
pass a very tolerable existence, even though his hypertrophied 
prostate caused complete obstruction to the natural process of 
micturition. 

Dr. BocHS (Eastbourne) said he had found apis in three 
cases to be of Tery great practical service. He agreed with his 
brother as to the remarkably few cases of a serious nature which 
came under one's observation in general practice. He had never 
had anything but the most gratifying results from the use of very 
soft catheters; he should like to say how true he believed was 
the suggestion that they must be used boldly. Haemorrhage 
was an important matter ; he had seen one or two cases where it 
was considerable, and he supposed some patients would always 
have hsBmorrhage under certain circumstances, but he did not 
know that he had ever seen a case where any serious danger had 
accompanied it. The number of really intractable, troublesome 
cases requiring operation which he had seen were very few 
indeed. 

Dr. McLachIiAN said he always used No. 8 soft catheter* 
With regard to washing out, he thought that the best way was 
simply by gravity. When the soft catheter was in the bladder, 
an india-rubber tube and a little funnel should be attached to it ; 



412 DISCUSSION ON HYPERTEOPHY OP THE PROSTATE^ 

the fluid could then be run in, gently, of course, until the patient 
felt he wanted to make water, and then the fluid should be 
allowed to run out again. He believed in washing out the 
bladder that the quantity of the fluid used was of more im- 
portance than the kind of antiseptic employed. In regard to 
drugs, they could not get one drug which would act on every 
hypertrophied prostate ; there were many in the materia medica 
which ought to be useful whether they were or not, such as 
Pulsatilla, apis and secale. The allopathic explanation given of 
the action of secale was that it acted upon the non-striped 
muscle. Digitalis was another that ought to be useful ; so also 
thuja, cyclamen, causticum, lycopodium, copaiba, zinc, agnus- 
castus, alumina, hepar, and sulphuric acid, all of which medicines 
give indications of action on the prostate. Primary catheter 
fever might arise from a ** nerve storm " merely ; then a second 
form might take place a few days afterwards from other causes, 
some septic changes, perhaps, in the bladder. For catheter fever 
due to the ** nerve storm," nothing equalled aconite. For a soft 
catheter the red rubber of Hutchinson was the best. He would 
ask Mr. Shaw whether the steam would not be apt to melt the 
catheter. 

Mr. Knox Shaw said that not only did he use steam, but in 
some cases even boiled the catheter, without injury. 

Dr. MacLachlan mentioned the case of an old gentleman of 
74, complaining that he wanted to make water too frequently at 
night, and in trying to do so erection of the penis came on and 
prevented it. On looking at the materia medica there was only 
one remedy, viz., digitalinum, that had that symptom. He had 
not any digitalinum, so he used digitalis. A short time after 
that the patient had complete retention for forty-eight hours. He 
used the soft catheter and drew off part of the water, then gave 
him a few hours' rest, and then drew off some more. The 
ordinary-sized chamber-pot was pretty well filled. He gave him 
aconite beforehand and there was no trouble at all, and the next 
morning he taught him to pass the soft catheter himself. About 
ten days after that there was a most profuse haemorrhage. He 
did not know why it came on. Gantharis seemed to be a most 
useful medicine there. At present the patient was doing well, 
and was taking an occasional dose of cantharis. The power to 
pass water voluntarily returned in two weeks, since when be has 
not again used the catheter. 

Dr. Dycb Brown said that castration could only be justified 
by experience. The theory was all very well, but only ex- 



DISCUSSION ON HYPERTBOPHY OP THE PROSTATE. 413 

perience of a large number of cases could make it justifiable in 
practice. One interesting point mentioned by Mr. Knox Shaw 
was that one might find hypertrophy occurring at a much earlier 
age than was generally supposed. He saw a gentleman the other 
day who was only 41, and on examining his rectum he found the 
prostate was enormously large and tender. As to treatment, he 
agreed with Dr. Dudgeon that if they simply had an enlarged 
prostate depending upon age, without any symptoms of irritation, 
pain, tenderness, or any other symptoms further than just what 
might be produced by an enlarged prostate, he did not think that 
medicines had much effect. The cases where they got benefit 
from medicinal treatment were those where there was a certain 
amount of prostatitis or congestion, with tenderness from catching 
cold. It was in these cases where they found the benefit of 
medicines, and it was in these cases also where they found that 
the prostate seemed to be reduced in size. The medicines which 
he had found most successful were chiefly belladonna, cantharis, 
and Pulsatilla, the principal medicine being belladonna. After 
the patient was better and had got over the acute stage, and 
there was very little irritation, then nitric acid was of very good 
value, and the local use of the sitz bath was an exceedingly im- 
'portant part of the treatment. He thought they could do a good 
deal with those medicines, but they could not be expected to work 
miracles. They could not be expected to reduce the enlargement 
depending upon elderly age where there were no symptoms of 
active or passive congestion in the parts. 

Dr. J. W. Hayward said he thought that Mr. Knox Shaw 
had included two points without definitely distinguishing between 
them. In practice there were two conditions, viz., hypertrophy 
of the prostate, and inflammation of the prostate. The most 
prevalent troubles in ordinary practice were not so much from the 
hypertrophy, as from the inflammatory attacks. A man might 
have hypertrophy and not trouble himself much about it, but 
when he got a chill he had to call the doctor in, not for hyper- 
trophy of the prostate, but for an attack of congestion or inflam- 
mation of the prostate. The plan which he had found most 
advantageous was to let him sit in hot water, and then probably 
he will pass urine into the bath. By the help of aconite and 
cantharis, most of those cases would not require a catheter at all, 
and the evidence which had been given that passing a catheter 
produced bleeding, however carefully it was done, showed that it 
was really a congested condition. As to the strength of these 
solutions of corrosive sublimate and others, for washing out the 



414 DISCUSSION ON HTFEBTB0FH7 OF THB PBOSTATE. 

bladder, the absorption from the bladder being very rapid, they 
must remember that patting them into the bladder is almost like 
taking medicines internally, and they must be careful not to use 
their solutions too strong. For internal medication he had 
never had occasion himself to use cantharis stronger than 3. 
Aconite 1 and cantharis 3 were quite sufficient ; and he had had 
very little trouble with these cases afterwards. Then as to the 
chronic treatment, they should not forget their old remedies, 
hepar and silica. 

Dr. Hughes felt that the criticisms which three speakers had 
put forward upon the mingling of congestive and inflammatory 
conditions of the prostate with simple hypertrophy were well 
founded. Perhaps Mr. Knox Shaw would say, and very justly, 
that they were mingled in practice, and so far he would agree 
with him. It was rare for them to see a case of pure hypertrophy 
without occasional or permanent congestion or inflammation con- 
nected with it. But if they were to separate them, he agreed that 
they could not expect any medicines to exert an influence upon 
pure hypertrophy of the prostate. It was a different thing from 
oedema occurring in a lymphatic gland or tonsil. When they got 
hypertrophy of the prostate it was a mere proliferation of glandu- 
lar fibrous and muscular tissues, and medicines would not touch 
it. It was extra- vital. The case then became one for the surgeon, 
and upon the good advice he gave, and the help he rendered, the 
patient's comfort and life depended. He quite agreed as to the 
power of medicines in modifying inflammatory conditions of the 
prostate, and he wished to emphasise what had been said about 
the value of pulsatilla. That was the medicine which had helped 
him most. It covered that marked feature of prostatic trouble, 
the increased frequency of passing water at night. The patients 
had to pass more water at night than when they were standing 
about in the day-time. He had often noticed that in prostatic 
trouble, and it made one think of pulsatilla directly. Pulsatilla 
having such a powerful action upon the sexual organs, both in the 
male and female subject, was naturally applicable here, the pros- 
tate being, as Mr. Knox Shaw had said, part of the sexual rather 
than the urinary system. The only medicine recommended for 
simple enlargement of the prostate which had been said to be 
sometimes successful was iodide of sulphur. From a paper 
published a good many years ago, it appeared that this drug, 
given in the 8rd decimal trituration, had had a real power in 
apparently reducing the size, and certainly the bladder troubles 
incidental to the increased size. ''Sanmetto*' did not seem to 



DI8CU8SI0K ON HTFEBTBOPHT OF THE PBOSTATB. 415 

have borne out the very warm praise giyen to it by the advertise- 
ments, but there had been many instances where it had been of 
use. He was sorprised to learn that Dr. £. B. Boche had used 
cantharis in the Ix. That was one of the few drags which he had 
seen cause real homceopathic aggravation. Dr. Bahr strongly 
recommended never to go below 3x. The cases where Ix conld be 
given mnst be of a torpid character, where the condition did not 
respond readily to medicinal action. With regard to haemorrhage, 
he suspected that haemorrhage from the urinary passages came 
more frequently from the prostate than was commonly supposed. 
He had seen one or two cases in which attacks of haemorrhage 
were distinctly traceable to congested prostate, and that must be 
taken into account in dealing with the subject. 

Mr. DxjDiiET Weight said that inflammation and congestion 
were not quite the same things. In early adult age, and up to 
middle age, all the veins which ran in the bladder wall and 
which conveyed generally towards the prostate were very well 
fitted with valves. These valves acted as a rule perfectly, but in 
old age they began, for various reasons, to give way, and the 
veins themselves became tortuous, and, the part being in a very 
dependent position, congestion occurred and there was a liability 
to thrombosis. It was that venous congestion which was the 
cause of the symptoms in the majority of the cases. In many 
cases it was not inflammation at all, but a venous congestion 
which led to the obstruction and which sent their patients to 
them with the complaint that they could not pass water. Those 
cases might be dealt with very well by the hot bath, but unfor- 
tunately the various remedies which had been indicated did not 
always succeed, and it was in those cases where they had to be 
careful not to allow accumulation of urine to go on to such an extent 
that the bladder was stretched beyond the power of regaining its 
usual elasticity. The bladder in elderly people had not the same 
power of contracting as in younger men, and a state of atony 
was easily induced. The subject of atony was a very important 
one. They got a certain amount of weakness of the bladder 
shown by the fact that the flow of urine of those prostatic cases 
was extremely feeble. In certain cases of enlarged prostate they 
saw a form of incontinence of urine. If the prostate were en- 
larged in all its directions, occasionally the passage was actually 
made wider than was natural, the sphincter of the urethra was 
not able to close the outlet of the bladder and the consequence 
was that incontinence of urine took place as pointed oUt by 
Eenwick. They might do much to restore the healthy tone of 



416 DISCUSSION ON HYPEBTBOPHT OF THE PROSTATE. 

the bladder, not only by medicinal treatment, but also by means 
of bladder calisthenics. When they passed the catheter into the 
bladder they might allow the stream to go out and then suddenly 
close the end of the catheter, by which means a certain amount 
of reflex action was caused, and the bladder was made to con- 
tract. There was another way, viz., when washing out the 
bladder to insert an ordinary catheter and attach an india-rubber 
tube and then a glass funnel to the top of that and allow the 
water to flow into the bladder, and wait till the patient experi- 
enced the feeling of full bladder. By putting the patient on 
his back and allowing him to try to pass water they would be 
able to gauge the amount of the action of the bladder itself. 
Of course it was necessary to see that the action was not 
altogether diaphragmatic, but by getting the patient to try 
and pass water, they were able not only to gauge the amount 
of the action of the bladder, but also do what was called 
dumb-bell exercise for the bladder. He endorsed what had 
been said about aconite. He knew several cases in which 
the history of passing the catheter had brought on attacks of 
rigors, and in which aconite being administered had prevented 
their recurrence. He would hesitate to operate in any case 
where there was any amount of arterial degeneration or any ad- 
vanced disease of the kidney. Still he would not allow ordinary 
congestion, which was always present, to deter him from passing 
a catheter if he thought by doing so he might save that hyper- 
distension of the bladder and prevent the patient getting very 
serious complication of trouble, which was already quite serious 
enough. 

Mr. Johnstone said that Mr. Shaw had referred to a case 
which they had seen together in consultation about the end of 
January. The case illustrated, in many ways, the principal 
points which they had been discussing. He would briefly run 
over the notes of the case. The gentleman was 75 years of age ; 
the father of a large grown-up family. He first noticed two or 
three years ago frequency of micturition, particularly at night. 
Latterly he had to rise every half-hour during the night, and 
could not retain water for more than three hours (and more often for 
less) during the day. The urine had always been perfectly clear, 
and proved to be normal microscopically and chemically. The 
quantity passed at any time did not exceed a tumblerful. He 
never at any time complained of pain. In addition to the 
increasing discomfort of frequency of micturition, the patient had 
been falling off in health for six or nine months ; suffered from 



BISCUSBIOK ON HTPEBTBOPHY OF THE PROSTATE. 417 

considerable loss of appetite and a general feeling of weakness and 
inability for his usual amount of exercise. There was present an 
accentuated arcus senilis in both eyes, and a marked atheromatous 
condition of the arterial system. During the last two or three 
years he had several attacks of hsematuria, for which he had been 
attended by Dr. Cook. At the end of January of this year the 
patient consulted him with regard to the frequency of micturition, 
most marked at night. He had been worse since a cold caught 
in a snow-storm« On examination of the bladder he found the 
whole of the pelvis filled up with a firm, tumour-like mass, the 
bladder being enormously distended, reaching almost as high as 
the umbilicus. The patient had morning nausea, very little sleep, 
and no appetite. Mr. Knox Shaw was asked to see him in con- 
sultation. The diagnosis was that of hyper-distended bladder due 
to enlarged prostate. The treatment indicated was that of careful 
catheterisation. In doing this, some difficulty was experienced. 
Soft catheters, French and gum elastic, with and without stilette, 
were tried without avail. Then coud6 catheters were given a fair 
trial, but without success. The only resource was in the use of a 
metal catheter. A No. 8, silver, with the point well curved, was 
successfully introduced on depressing the handle well, so as to ride 
the point over an eminence on the lower or posterior wall of the 
prostatic urethra. It was quite evident that they had to deal with 
a large third or middle lobe of the prostate, bulging from behind 
forward, overlapping and compressing the vesical end of the 
urethra, and acting like a valve. There was a good deal of 
hasmorrhage in passing the catheter, recurring at each instrumen- 
tation. He ultimately got to No. 10 English, having begun with 
No. 6. After a week he tried to use a soft catheter, and was able 
to introduce a No. 5 coud^ with a little difficulty, and after that a 
6 and 7. The silver catheter was discontinued, and a coud6 alone 
was used. Haemorrhage still occurred occasionally, and appeared 
to proceed from a particular spot on the prostatic urethral wall 
which bled at the slightest touch. The residual urine was not 
drawn off all at once, but a little more each day. At the end of 
about a week it was found that the residual urine measured 46 ozs. 
The catheter was passed daily at 7 p.m. This ensured a perfect 
night's rest till 6 a.m. next day, by which time the residual pocket 
was again full, and the surplus was passed every two to three 
hours. For over a fortnight no ill effects followed the daily use of 
the catheter till, on one occasion, the haBmorrhage was very pro- 
fuse, a large quantity found its way into the residual pocket, 
and by its presence favoured the onset of septic changes. In spite 



418 DISCUSSION ON HYPEBTBOPHY OF THE PBOSTATE. 

of the greatest care these ensued, and a smart cystitis was the 
result. Micturition occurred every few minutes, accompanied by 
supra-pubic pain. This condition, however, was overcome by 
washing out the bladder with a solution of perchloride of mercury, 
1 in 2,000 to 3,000. The funnel and rubber tube apparatus was 
used. The urine once more became acid, but with a certain 
amount of pus present. The perchloride solution, even in weaker 
strength, seemed to irritate, and various other media were tried 
such as quinine, sanitas, boracic acid, and ultimately izal, which 
proved to be the most satisfactory. The patient's health began to 
improve ; the nausea disappeared, appetite became excellent, and 
strength improved, sleep became undisturbed, and now he is able 
to take a three or four mile walk without discomfort. The amount 
of residual urine has decreased by 10 ozs., and is still on the wane. 
The remedies which had been used in the course of the case, 
according to prevailing symptoms, were arsenicum, cantharis, 
hamamelis, silica, and hepar ; the two latter more particularly 
with the object of reducing the pyuria still persisting. 

Dr. Newbeby said he had found arnica of very great use in 
connection with passing the catheter to avoid the rigors which 
had been referred to, and anything like catheter fever. In a case 
which he had seen with Mr. Gerard Smith, two or three years 
ago, the bladder was distended up to the umbilicus, and they had 
very serious fears as to what the result would be in connection 
with passing the catheter. They used arnica 1st decimal, and 
there was no rise of temperature, no rigor, and no haBmorrhage, 
and everything went on most satisfactorily. 

Dr. Neatby said that Mr. Knox Shaw had raised an im- 
portant point in speaking of castration, as to whether it was any 
use to castrate when the testicles were already in a state of com- 
parative inactivity. He had seen a case where the testicles were 
atrophied from two or three severe attacks of epididymitis, where 
the prostate remained as large as ever. Therefore it was obvious 
that the mere physiological atrophy of the testicle did not neces- 
sarily cause reduction of the prostate. On the other hand, he 
had seen an old man who had had his testicles removed for some 
local disease, where the operation was followed by entire disap- 
pearance of the prostate. He had been told by a well-known 
writer on this subject, that in the space of two months' time a 
large prostate was rendered practically impalpable after excision 
of the testes, and he was extremely surprised at the rapidity 
with which that had taken place. It was evidently due to some 
reflex action through the nerve endings which were damaged by 



DISCUSSION ON HYPEBTBOPHY OF THE PBOSTATE. 419 

the actual operation itself and which did not take place from the 
natural atrophy. Some reference had heen made to age with 
respect to operations. His own opinion, from what he had seen, 
was that age was no bar, provided that the general health of the 
patient was good, and his organs were fairly sound. A gentleman 
who had been under his care was operated on (prostatectomy) at 
the age of 83, and he had lived for eight or ten years afterwards, 
well and able to get about. He (Dr. Neatby) recommended Mr. 
Johnstone to try lycopodium in the 2x to 3x dilution. He had 
tried that more than once in cystitis, connected with enlarged 
prostate, which was not, however, sufficient to cause obstruction, 
Bi-manual examination had been referred to and that was very 
important, as they got a more clear idea as to the size and shape 
of the prostate. 

Dr. GoiiDSBBOUOH mentioned three cases which illustrated 
some of the points brought up in the paper. A gentleman who 
was suffering from cystitis and retention of urine from hyper- 
trophy of the prostate — a patient of Mr. Harris's in his early 
years — ^where he attempted to pass a catheter and where also he 
(Dr. Goldsbrough) also attempted, . and both failed, they were 
obliged to seek the aid of a surgeon of the old school. He 
passed the catheter with remarkable facility by the following 
method : He placed the patient dehberately across the bed, his 
face in front of the operator. The finger was put into the rectum 
and the catheter directed in a vertical line to the body of the 
patient, and that seemed to be the secret of the manoeuvre. It 
struck him (Dr. Goldsbrough) at the time as a hint worthy 
of consideration. The next case illustrated one or two pioints 
with regard to the use of drugs. A man, 75 years of age, had 
never had any difficulty, and did not know that he had any en- 
larged prostate until he was suddenly pulled up by not being 
able to pass water ; the patient was a broken down old man, 
suffering from venous stasis in many parts of his body, particu- 
larly in his hands and feet. He had a double scrotal hernia, and 
was of a very nervous temperament. He passed a catheter and 
drew off a considerable quantity of very dark urine mixed with 
blackish blood. He gave him hamamelis and kept him in bed. 
The patient passed water for several days himself, but there was 
no further condition like the first. The urine next day was much 
lighter in colour and almost normal. The other was a patient 
with an enlarged prostate which was a cause of trouble at in- 
tervals. Directly he had any difficulty he began to secrete an 
enormous quantity of limpid urine. The patient came to his 

VOL. III. — ^No. 4. 29