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OF   THE 


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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.  0 

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  0  -.^^  .^•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 

0  12  m 

for  stationery- 

„  Twenty-three       Mem- 

April 10      . .         . .     1  18 

4 

bers'  subscriptions  at 

September  20        ..06 

0 

28.  6d.  (as  per  receipt 

October  8    . .         ..11 

4 

book) 

2  17    6 

„  balance  in  hand,  Octo- 

„ One  fine  at  Is. 

0    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  eotiobite  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  0  ;  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  0  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  0  per  cent. — September  19,  quite 
well ;  liver  unaltered,  sugar  0  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  0  per  cent. — September  29, 
yertigo,  sugar  0  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  0  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  0  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  0  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«« 
0    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 


420  DISCUSSION  ON  HYFEBTBOPHY  OF  THE  PBOSTATE. 

house  at  5  o'clock  one  morning  in  a  state  of  great  distress,  and 
begged  him  to  relieve  him,  which  of  course  he  did.  He  called 
upon  him  again  at  12  o'clock  and  he  was  just  in  the  same  con- 
dition, so  he  tied  a  catheter  in.  As  this  procedure  enabled  the 
patient  to  pass  urine  when  he  required  to  do  so,  there  was  an 
immediate  diminution  in  the  amount  passed,  the  excessive 
secretion  having  been  simply  the  result  of  **  funk."  Dr.  Golds- 
brough  asked  whether  berberis  had  been  used,  because  in 
affections  of  the  urinary  tract  there  were  many  symptoms  in  its 
pathogenesis  to  suggest  its  use.  He  would  add  that  he  found 
lycopodium  of  very  great  use  in  cystitis  in  very  old  people;  and 
there  was  an  old-fashioned  remedy  called  triticum  repens  which 
he  believed  was  often  of  much  benefit,  given  as  an  infusion. 

Mr.  Knox  Shaw  said  his  object  in  opening  the  discussion  was 
to  take  a  broad  survey  of  every  point  likely  to  come  up  and 
needing  discussion.  He  would  like  to  reply  to  several  critics  who 
had  said  that  he  had  confused  two  distinct  troubles  and  that  it  was 
not  clear  as  to  whether  he  was  talking  of  prostatitis  or  of  prostatic 
hypertrophy.  He  would  like  those  critics  to  think  of  this  point. 
They  constantly  saw  retention  of  urine  in  other  cases  besides 
prostatic  trouble.  Men  who  had  had  a  drinking  bout  or  some 
excessive  sexual  excitement,  or  from  some  other  cause,  were 
suddenly  seized  with  acute  retention  of  urine ;  warmth,  rest,  hot 
baths,  aconite,  belladonna,  and  perhaps  the  introduction  of  a 
catheter  once,  would  cure  the  whole  trouble,  and  the  patient 
would  get  perfectly  well  and  have  no  subsequent  difficulty ;  he 
would  probably  be  as  well  in  a  week  or  two  as  ever  before.  There 
was  a  state  of  prostatic  congestion,  he  admitted,  but  there  was  a 
preceding  hypertrophy  of  the  prostate  which,  by  its  action  upon 
the  bladder,  by  its  action  upon  the  kidneys,  perhaps  years  before 
the  onset  of  acute  symptoms,  entirely  altered  the  effect  of  that 
prostatic  congestion,  and  they  had  a  much  more  serious  state  of 
affairs  to  deal  with.  It  was  not  inflammation  alone ;  it  was  a 
congestion  of  an  enlarged  prostate,  and  the  result  would  not  be 
the  same  to  the  patient  if  he  had  simply  the  congestion  and  not 
enlargement  of  the  prostate.  Therefore,  the  two  cases  were  so 
absolutely  mixed  up  one  with  another  and  each  absolutely  de- 
pendent upon  the  other  that  they  could  not  dissociate  them  at  all. 
One  of  the  reasons  given  for  the  diminution  of  the  prostatic 
enlargement  by  orchotomy  was  the  fact  that  there  was  a  cutting 
off  of  the  blood  supply.  Simple  rest  in  bed  would  very  often 
produce  a  great  decrease  in  the  size  of  the  prostate.  The  very 
fact  of  draining  the  bladder  through  the  perineum  would  produce 


DlSCUSSm  OS  HIPEXXBOPHT  OF  THE  PBOSTAZE.  421 

a  most  martefi  dimizmiioa  in  ^he  size  q£  she  pros&ftse,  simpiT  by 
aUowing  the  eongescioa  o£  the  parts  to  sdbside,  acd  many  a  p&uezK 
— and  thai  was  why  Mr.  Regiziali  Harrisoa  vas  so  ssrocg  aa 
adTOcate  ci  the  opoaciDa — who  s:ib:ni*zed  to  penzieal  drainage 
would  aToid  any  sohsequeat  serioos  operacioii,  sach  as  remoTing 
a  portion  of  the  prostate.  He  had  seen  sach  eases  ms  Dr.  Boche 
had  mentiixied  when  the  pasient  absolaaely  refused  to  pass  a 
catheter.  In  those  cases  the  bladder  shoold  be  panccured 
through  the  perineum,  and  the  patient  shoold  go  aboat  with  a 
stop-cock,  when  by  simply  turning  a  tap  he  could  make  water, 
and  keep  himself  conifortable.  Dr.  McLachlan  and  Mr.  Dudley 
Wright  had  adrocated  the  hydrostadc  method  of  washing  oat 
the  bladder.  He  thought  the  beaer  way  was  to  use  the  ordinary 
four-ounce  nozzle  syringe,  the  reason  being  that  unfortunately 
these  patients  had  lost  that  delicate  sense  of  hyper-distension  ol 
the  bladder,  and  therefore  they  might  Terr  easily  OTer-distend 
the  bladder  again  if  they  were  not  very  careful  in  using  anything 
like  hydrostatic  pressure.  With  regard  to  Dr.  McLachlan*s  case, 
in  which  he  asked  him  to  gire  some  suggestion,  he  would  say  it 
was  just  an  ordinary  case ;  they  had  a  hyper-distended  bladder ; 
the  patient  was  reUeyed,  and  for  the  first  week  got  on  swimmingly. 
Then  there  was  acute  cystitis  with  haemorrhage,  following  on  a 
very  flaccid  bladder ;  there  was  a  loss  of  surface ;  in  fact,  in  some 
cases  almost  a  cast  of  the  bladder  would  be  washed  out,  so  that 
he  would  surest  he  should  treat  it  medicinally,  and  wash 
out  the  bladder  occasionally.  He  had  found  strychnine  verv 
useful,  and  Mr.  Dudley  Wright  had  mentioned  nux  Yomica  as 
being  useful. 


422  ABDOMINAL  OPEBATIONS. 

ON  A  PEKIOD  OF  TWENTY-ONE.  MONTHS'  WOEK 
IN  ABDOMINAL  OPEBATIONS— AND  WITH- 
OUT  A  DEATH— IN  THE  GYNAECOLOGICAL 
DEPARTMENT  OF  THE  LONDON  HOMCEO- 
PATHIC  HOSPITAL. 

BY  GEORGE   BURFORD,   M.B. 

Physician  to  the  OyncBCological  Department  of  the  London  Homoeopathic 

Hospital, 

I  HAVE  just  closed  a  period  of  nearly  two  years'  work  in 
abdominal  surgery  in  women  at  the  London  Homoeopathic 
Hospital,  and  with  no  mortality.  In  this  record  I  do  not 
include  the  similar  work  of  my  colleagues,  each  of  whom 
also  has  no  bill  of  mortality  to  present :  I  here  deal  only 
with  my  own  work. 

The  cases  of  abdominal  disease  thus  operated  on  have 
been  of  varied  type,  and  usually  of  complicated  character. 
In  no  case  has  peritonitis  or  hsemorrhage  occurred,  and  the 
recoveries  were  generally  without  incident.  The  ovarioto- 
vvies  numbered  six,  and  these  were  mostly  cases  rendered 
difficult  by  extensive  adhesions.  In  one  instance,  advanced 
necrosis  of  the  cyst-wall  was  present ;  and  in  another, 
influenzal  pleuro- broncho-pneumonia  delayed  the  convales- 
cence. 

The  hysterectomies ,  undertaken  for  large  fibroids,  with 
severe  metrorrhagia,  numbered  three.  These  usually  for- 
midable operations  were  in  each  case  conducted  to  a  success- 
ful issue.  Bemoval  of  the  uterme  adnexa  was  necessary  in 
five  cases  on  account  of  chronic  disease,  and  in  one  instance 
to  control  the  haemorrhage  from  a  bleeding  fibroid.  In  one 
out  of  the  five  cases  both  metrorrhagia  and  constant  and 
acute  pain  were  promptly  subdued  by  the  operation,  after  a 
long  course  of  therapeutic  treatment  in  skilful  hands  had 
proved  unavailing. 

One  case  of  tubercular  peritonitis  was  operated  on  with 
immediate  relief,  but  no  permanent  gain,  the  lung  mischief 
being,  of  course,  quite  uncontrolled  by  the  operation.  Nor 
did  in  this  instance  the  abdominal  lesion  thereafter  remain 
quiescent,  as  is  frequently  the  case. 


TWO   OASES   OF   ABDOMINAL   SEOTION,  423 

The  remaining  operations  require  no  special  comment, 
^nd  the  list,  amomiting  in  all  to  eighteen,  is  thus  complete. 

I  must  call  special  attention  to  the  great  value  afforded 
by  homoeopathic  therapeutics  in  the  preparatory  stadium 
and  in  the  convalescence  of  these  cases.  I  always  prescribe 
arnica  as  a  prophylactic  against  shock  and  haemorrhage, 
commencing  its  use  a  week  before  operation,  and  continuing 
it  a  short  time  after,  when  it  is  replaced  by  belladonna 
s,nA  mercurius  corr.,  these  remedies  in  their  turn  being 
followed  by  lycopodium. 

I  attribute  the  recovery  of  certain  of  these  cases,  which 
were  of  an  exceedingly  unpromising  type,  in  no  minor 
degree  to  the  judicious  use  of  these  and  other  homoeopathic 
remedies  :  and  the  more  my  experience  amplifies,  the  more 
assured  do  I  become  of  the  valuable  and  powerful  aid 
rendered  by  homoeopathy  to  surgical  success. 


TWO   CASES   OF  ABDOMINAL   SECTION.^ 

BY  EDWIN  A.   NEATBY,   M.D. 

Assistant  Physician  for  Diseases  of  Women  to  the  London  Homoeopathic 

Hospital, 

(1)  Mbs.  p.,  aged  45,  had  good  health  as  a  girl,  and  menstrual 
life  began  at  14.  She  had  been  married  twenty-one  years  when 
she  came  under  my  observation  in  October,  1894 ;  had  had  five 
•children,  the  last  eight  years  previously.  Had  one  miscarriage 
between  the  third  and  fourth  children ;  menstruation  lately 
occurred  every  four  weeks,  was  profuse  in  quantity  and  extremely 
painful.  For  nine  years  right  iliac  pain  was  always  present ;  this 
and  "bearing  down"  prevented  her  getting  about.  In  addition 
to  this  pain,  leucorrhoea  and  frequent  painful  micturition  made  life 
-quite  a  burden.  She  slept  badly,  had  no  appetite,  and  suffered 
from  flatulent  distension. 

She  had  been  under  various  specialists  and  medical  practi- 
tioners for  nine  or  ten  years,  with  only  temporary  improvement. 

^  Presented  to  the  Section  of  Surgery  and  Gynaeoology,  June  6, 1895. 


424 


TWO    CASES  OF  ABDOMINAL   SECTION. 


On  examination  the  uterus  was  found  to  be  retroflexed  and 
retroverted;  its  mobility  was  almost  nil.  The  left  ovary  was 
tender  and  adherent  to  the  fundus,  the  right  was  tender  and 
near  the  fundus.  A  band  of  adhesion  tethered  the  uterus  to  the 
sacrum ;  this  band  was  very  tender  and  painful  if  put  upon  the 
stretch.  The  patient  was  under  my  care  for  four  months,  and 
during  this  time  was  in  great  part  confined  to  bed.  She  im- 
proved but  little,  and  was  anxious  that  something  should  be  done. 
The  remaining  history  of  the  case  is  quickly  told  : 
On  February  6  removal  of  the  appendages  was  performed — 
A.C.E.  being  the  anaesthetic  used.     There  was  some  delay  in  its 


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completion  owing  to  the  fact  of  the  right  ovary  being  imprisoned 
beneath  the  fundus  of  the  retroflexed  uterus.  Adhesion  made  it 
difficult  to  replace  the  fundus  and  release  the  ovary ;  beyond  this, 
the  case  presented  no  difficulty  or  unusual  features. 

The  patient  died  on  the  fifth  day — died  in  spite,  as  it  appeared, 
of  every  element  which  usually  makes  for  success. 

The  progress  of  the  case  was  as  follows : — The  patient 
rallied  fairly  well  from  the  operation,  but  throughout  there 
was  an  unusual  amount  of  abdominal  pain. 


TWO   CASES  OF  ABDOMINAL  SECTION.  425 

The  favourable  features  to  which  I  have  alluded  were 
free  discharge  of  fluid  by  the  drain,  becoming  straw-coloured 
after  two  days;  the  appearance  of  urates  in  the  urine  on 
the  third  day ;  haemorrhage  from  the  vagina.  On  the  second 
evening  flatus  began  to  escape  through  the  rectal  tube,  once 
or  twice  very  freely;  the  temperature  never  rose  above 
99-4°. 

The  unfavourable  features  occurred  in  the  spheres  which 
are  chiefly  of  importance. 

The  pulse  rate  steadily  mounted,  becoming  uncoimtable 
before  she  died ;  retching  and  vomiting  of  green  and  offen- 
sive fluid  continued  without  cessation  from  the  time  of 
operation,  and  after  the  second  day  distension  of  the  abdo- 
men set  in  and  increased. 

Irregular  and  catchy  breathing,  which  I  regard  as  a  very 
unfavourable  sign,  developed  about  twelve  hours  before 
death.  I  have  never  seen  a  patient  recover  who  arrived  at 
this  symptom  during  the  unfavourable  progress  of  a  case. 

As  to  the  treatment,  the  usual  rectal  feeding  was  adopted, 
and  arnica,  followed  by  belladonna  and  mercurius  corr.,  in 
the  manner  introduced  by  Dr.  Burford,  were  given.  Apo- 
morphia  failed  to  relieve  the  retching. 

On  account  of  the  unusual  amount  of  pain,  and  against 
my  custom  and  better  judgment,  I  gave  two  hypodermic 
injections  of  morphia,  gr.  J.  On  the  third  and  fourth  days 
aperients  were  given  in  the  shape  of  calomel  in  doses  of 
gr.  v.;  these  proved  ineffective. 

Why  did  the  patient  die  ? — Either  from  peritonitis  pure 
and  simple,  or  from  peritonitis  due  to  a  twist  of  the  bowels, 
or  some  other  cause  of  obstruction.  That  the  latter  was 
the  case  is  the  opinion  arrived  at  by  Dr.  Burford  and  myself, 
when  too  late  to  do  anything. 

I  gladly  take  this  opportunity  of  acknowledging  the  ready, 
self-sacrificing  and  sympathetic  help  accorded  to  me  by  my 
friend  Dr.  Burford  in  what  proved  a  trying  and  disappointing 
case. 

What  lessons  are  to  be  learnt  from  this  case  ? 

Firsts  as  regards  operation.  With  the  wisdom  which 
comes  so  easily  after  the  event,  I  now  wish  I  had  performed 


426  TWO   OABEB  OF  ABDOMINAL  BBOTION. 

vaginal  hysterectomy  and  oophorectomy ;  the  operation 
would  have  been  more  speedily  done,  and  the  result  would, 
I  believe,  have  been  very  different. 

Next,  as  regards  after-treatment.  Had  I  been  more 
hard-hearted  and  refused  to  give  morphia,  and  had  calomel 
or  a  saline  been  given  earlier,  the  patient's  chance  would 
have  been  better,  supposing,  at  least,  that  only  peritonitis 
existed.  Indeed,  the  condition  would  have  been  better  in 
any  case,  and  a  diagnosis  earlier  arrived  at,  making  possible 
an  exploration  for  any  cause  of  intestinal  obstruction. 

Finally,  a  medicine  I  shall  allude  to  later  was  not  made 
use  of.    Experientia  docet. 

(2)  In  1892 — January  2 — H.  M.,  aged  40,  had  an  attack  of  in- 
fluenza which,  on  the  20th,  became  complicated  by  peritonitis. 

Previous  to  this  date  menstruation  had  been  regular  and 
moderate,  but  painful.  It  suddenly  ceased  during  this  illness  and 
did  not  return. 

Constant  abdominal  pain,  chiefly  in  the  right  iliac  region, 
followed  the  peritonitis.  This  was  accompanied  with  obstinate 
constipation,  frequent  retching  and  vomiting,  and  inability  to 
take  more  than  a  few  spoonfuls  of  liquid  food  at  a  time. 

On  one  occasion  a  vaginal  examination,  conducted  with  the 
utmost  gentleness,  caused  vomiting  almost  incessant  for  two  and 
a-half  days. 

For  two  years  and  three-quarters  she  was  under  constant 
medical  supervision,  oftener  in  bed  than  not,  never  able  to  do  full 
work,  and  always  an  anxiety  to  herself  and  friends. 

In  October,  1894,  she  became  worse,  and  after  a  severe  attack 
of  pain  and  vomiting  she  remained  in  bed,  less  able  to  take  food 
than  before,  always  in  pain,  and  steadily  losing  flesh. 

Eemoval  of  the  appendages  was  performed  on  February  9, 
1895.  The  right  ovary,  however,  was  not  found,  in  spite  of  a 
careful  search  by  myself  and  Dr.  Burford,  who  kindly  assisted 
me  in  the  operation.  The  emaciated  and  exhausted  state  of  the 
patient  made  the  result  doubtful  from  the  flrst. 

For  the  flrst  three  or  four  days  she  had  all  the  bad  symptoms 
of  the  previous  case,  and  none  of  the  good  ones. 

The  fluid  from  the  drainage  tube  was  dark  and  scanty,  and 
ceased  on  the  second  day;  neither  urates  nor  vEiginal  hsamor- 
rhage  were  present ;  flatus  did  not  pass  until  the  third  day ;  a 
steady  rise  took  place  in  the  pulse  until  the  fourth  day,  and  in- 
creasing distension  caused  alarm  to  myself  and  distress  to  the 


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428  TWO  CASES   OF  ABDOMINAL   SECTION. 

patient ;  retching  was  practically  incessant.  All  the  symptoms 
of  peritonitis  were  this  time  present.   . 

This  patient  was  operated  on  in  the  same  week  and  at  the 
same  house  as  the  last.  Her  condition  and  this  combination  of 
circumstances  justified  the  patient's  prognostication  that  she 
would  "  never  get  over  it."  We  were  all  prepared  to  see  her  die 
on  the  fourth  or  fifth  day.     She  lived  notwithstanding. 

From  the  fourth  day  she  began  to  mend,  almost  imperceptibly 
at  first,  but  slowly  and  surely. 

The  first  favourable  sign  of  any  importance  was  the  fall  of  the 
pulse-rate,  which  began  definitely  on  the  fourth  day.  Its  maxi- 
mum frequency  was  148. 

Flatus  began  to  pass  more  freely,  and  the  distension  gradually 
lessened.  The  retching  continued  until  the  end  of  the  fifth  day. 
By  the  eighth  day  the  pulse  had  come  down  to  80,  and  the 
patient  was  practically  out  of  danger. 

She  was  out  of  bed  on  the  twelfth  day,  and  walked  across  the 
room  a  week  later.  At  the  present  time  she  takes  a  considerable 
variety  of  food,  and  is  able  to  help  in  the  little  business  which 
she  and  her  sisters  conduct.  Since  her  recovery  from  the  opera- 
tion she  has  not  spent  a  day  in  bed. 

Bemarks  as  to  the  After-treatment, — This  patient  had  no 
opiate  and  no  aperient,  the  latter  not  being  needed.  She 
had  arnica  and  mercurius  corr.  as  usual.  Towards  the  end 
of  the  third  day,  when  the  patient's  condition  and  my 
spirits  were  very  low,  I  gave  crotalus  5x  one  drop  every 
hour,  with  prompt  improvement  in  both.  The  pulse  rate^ 
as  shown  by  the  chart,  speedily  began  to  fall,  and  all  the 
other  symptoms  changed  for  the  better.  Subsequent  diges- 
tive disturbance  was  met  by  various  remedies. 

It  would  be  almost  as  difficult  to  say  why  this  patient 
lived  as  to  tell  why  the  first  patient  died.  I  attribute  her 
recovery  to  the  crotalus. 

That  the  change  for  the  better  in  a  steadily  downward 
course  and  in  an  extremely  dangerous  condition  took  place  a 
few  hours  after  the  beginning  of  the  crotalus  there  is  no 
doubt.  Whether  the  occurrence  was  only  a  coincidence  or 
not  is  more  than  I  can  say.  My  best  thanks  are  due  to  Dr. 
Day  for  his  care  and  skill  in  ansBsthetising,  and  to  my  nurses 
for  their  untiring  devotion  to  the  patients,  and  for  most  of 
the  notes  of  the  progress  of  the  cases. 


DISCUSSION  ON   TWO   OASES  OF   ABDOMINAL   SECTION.  429 

Mr.  Knox  Shaw  thought  that  it  was  very  honourable  and  candid 
of  Dr.  Neatby  to  tell  them  of  his  failures  as  well  as  of  successes.  He 
was  sure  they  learned  as  much,  if  not  more,  from  their  failures  as 
from  a  case  which  ran  an  uneventful  course,  and  had  a  normal 
history.  On  the  surgical  side  they  could  add  to  the  number  of 
abdominal  operations  which  had  been  done  in  a  similar  con- 
secutive period,  and  an  abdominal  operation,  as  he  understood 
it,  differed  only  from  any  other  in  that  the  peritoneum  was 
opened.  They  could  add  fourteen  cases  during  a  similar  period  of 
operative  work,  also  without  a  death.  Those  fourteen  cases  in- 
cluded one  ovariotomy  in  a  woman  of  32,  occurring  in  the  medical 
wards  of  the  hospital,  three  cases  of  appendicitis,  two  in  which  the 
appendix  was  successfully  removed  in  boys  of  8  and  15,  and  one 
in  which  an  appendicular  abscess  was  opened  and  drained  with 
recovery.  Three  abdominal  sections  were  performed,  and  he 
might  say  that,  owing  to  the  crowded  state  of  the  hospital  and  the 
exigencies  of  the  cases,  all  the  fourteen  cases,  except  one,  had 
been  undertaken  in  the  ordinary  operating-room,  and  nursed  in 
the  general  wards.  The  three  operations  just  referred  to  were 
undertaken  mainly  as  explorative  measures.  The  first  was  a  man 
of  42,  who  has  malignant  disease  of  the  peritoneum,  a  diagnosis 
which  was  confirmed  by  the  operation,  and  the  existence  of  pus, 
whi6h  the  peculiar  rise  of  temperature  made  somewhat  probable, 
was  excluded.  The  man  made  a  perfect  recovery,  but  un- 
fortunately died  some  time  afterwards,  of  the  original  malignant 
disease,  outside  the  hospital.  One  woman,  aged  60,  had  had  a 
left  lumbar  colotomy  performed  outside  the  hospital,  but  without 
relief  of  her  symptoms  of  chronic  intestinal  obstruction.  An  ex- 
ploratory laparotomy  revealed  the  fact  that  the  colon  had  been 
opened  below  the  stricture.  A  successful  median  colotomy  was  then 
undertaken.  Another  median  colotomy  was  performed,  after  an  ex- 
ploration, for  chronic  intestinal  obstruction,  due  to  malignant 
disease,  affecting  chiefly  the  pelvic  region.  They  also  had  three  suc- 
cessful cases  in  the  same  period  of  inguinal  colotomy,  all  performed 
for  malignant  disease.  They  had  had  two  cases  of  radical  cure  of 
inguinal  hernia,  in  one  case  a  very  large  portion  of  the  omentum 
had  to  be  removed ;  and  also  a  case  of  umbilical  hernia,  in  which 
a  mass  of  omentum  requiring  numerous  ligatures  was  removed. 
The  points  which  Dr.  Neatby  raised  should  be  well  known  to  all 
workers  at  their  hospital,  because  they  had  been  emphasised  by 
Dr.  Burford.  One  might  delude  oneself  into  an  idea  of  perfect 
safety  if  one  thought  only  of  the  temperature  chart,  and  not  of  the 
pulse  rate.    He  also  felt  very  strongly  that  with  all  that  pure 


430         DISCUSSION   ON   TWO   CASES   OF   ABDOMINAL   SECTION. 

homoeopathic  therapeutics  did  for  them  they  had  to  confess  that, 
in  a  certain  critical  stage  of  abdominal  operation,  there  was 
undoubtedly  nothing  like  some  smart  saline  aperient  or  calomel 
to  produce  rapid  evacuation  of  the  bowels.  In  one  of  his  cases  of 
appendicitis  its  effect  was  most  striking ;  the  boy  was  getting  into 
a  condition  causing  some  anxiety,  but  which  immediately  yielded 
to  a  small  dose  of  calomel.  Dr.  Burford  would  agree  with  him 
that  intestinal  paresis  was  the  bite  noire  of  abdominal  operations. 
He  always  felt  safer  when  the  nurse  could  report  that  flatus  was 
passing. 

Dr.  0.  W.  Haywabd  said  that  in  the  Hahnemann  Hospital 
at  Liverpool,  they  had  better  results  than  in  any  general  hospital, 
taking  their  general  cases  and  their  special  cases.  The  Glasgow 
Western  Infirmary  published  what  they  considered  to  be  an 
extremely  favourable  report,  in  which  they  put  their  death-rate 
at  eleven  per  cent.  In  their  Liverpool  Hospital,  in  which  he 
thought  they  got  as  bad  cases  as  anywhere,  the  death-rate  came 
out  under  seven  per  cent.  They  all  agreed  that  their  excellent 
surgical  results  were  due  in  a  great  measure  to  the  help  afforded 
by  their  therapeutics.  He  was  glad  to  hear  from  Dr.  Neatby  the 
results  of  crotalus  and  congratulated  Dr.  Neatby  on  the  fair  way 
in  which  he  had  brought  forward  a  case  in  which  the  result  was 
unfavourable,  as  well  as  cases  where  it  had  been  favourable.  We 
learn  as  much  from  such  cases  as  from  the  fortunate  ones,  and  he 
wished  that  all  had  the  same  courage  to  include  the  whole  work 
done  in  making  up  statistics. 

Dr.  Goldsbbough  said  that  the  question  as  to  how  medicines 
were  administered  after  an  operation  seemed  to  him  an  important 
one.  It  was  questionable  whether  the  stomach  could  tolerate 
anything,  even  in  the  shape  of  a  drop  of  fluid  other  than  that 
which  flowed  naturally  from  the  mouth.  In  ordinary  medical 
cases  it  was  sometimes  necessary  to  administer  medicine  even  in 
the  old-fashioned  pilule,  or  with  a  little  tincture  placed  on  a  small 
pellet  of  sac,  lac.  In  peritonitis  one  has  long  ceased  to  look  to 
the  temperature  as  an  important  point,  the  pulse  was  evidently 
of  much  greater  importance. 

Dr.  Bubfobd,  in  reply,  said  there  were  very  few  general 
hospitals  in  London  where  the  surgical  results  were  so  good  as 
at  the  Homoeopathic  Hospital,  and  that  in  spite  of  former 
unfavourable  surroundings  to  a  marked  degree.  Considering 
the  record  of  work  that  had  been  presented  that  evening,  he 
felt  he  had  every  reason  to  be  proud  of  the  work  of  his  colleagues 
in  the  gynaecological  department  at  the  hospital. 


NOTES  ON  PATHOIiOOICAI^  SPECIMENS.  431 

Dr.  Neatby,  in  reply,  said  as  a  rale  he  did  not  give  medicine 
for  the  first  twelve  hours,  until  the  vomiting  had  subsided  and  the 
stomach  could  tolerate  it.  At  the  end  of  twelve  hours  some  at 
least  of  the  medicine  was  absorbed,  and  the  rest  was  rather  a 
comfort  to  the  patient,  giving  him  something  to  bring  up  if  there 
was  vomiting.     He  was  very  pleased  with  the  results  of  crotalus. 

Dr.  C.  W.  Haywabd  suggested  that  the  method  of  giviug 
medicines  adopted  by  his  father  might  be  tried  in  such  cases — 
blistering  the  whst  and  then  rubbing  the  medicine  in. 


NOTES  ON  PATHOLOGICAL  SPECIMENS,  CASES, 
(fee,  SHOWN  AT  VARIOUS  MEETINGS. 

Aneurism  of  the  Aorta. 

Dr.  Bybes  Moir,  February,  1895,  showed  a  specimen  of 
aneurism  of  the  abdominal  aorta  just  above  its  division  into  the 
two  common  iliac  arteries.  The  patient,  a  lady,  aged  83,  had 
been  known  to  have  had  the  condition  eight  years.  The  imme- 
diate cause  of  death  was  strangulated  hernia,  from  which  she 
succumbed  twenty-four  hours  after  an  operation  undertaken  for 
its  relief. 

Dr.  Lambebt,  May,  1895,  presented  a  specimen  of  aneurism 
of  the  arch  of  the  aorta,  obtained  from  a  woman,  aged  56,  at  one 
time  a  patient  in  the  London  Homoeopathic  Hospital,  under  Dr. 
Moir,  when  the  aneurism  was  observed  to  have  already  perforated 
the  sternum. 

Considerable  interest  was  attached  to  tbese  two  specimens 
from  the  comparative  rarity  of  aneurism  in  women. 

Dilatation  of  the  Heart. 

Dr.  Douglas  Smith  showed,  at  the  Liverpool  branch,  February, 
1895,  a  heart  removed  from  a  man,  aged  62,  which  was  greatly 
enlarged.  The  left  side  of  the  heart  was  dilated  ;  the  left  ventricle 
hypertrophied ;  aortic  and  mitral  orifices  somewhat  dilated,  but 
the  valves  competent.  The  right  side  of  the  heart  was  very 
greatly  dilated  and  its  walls  very  thin.  The  tricuspid  orifice 
was  enormously  dilated,  the  auricle  and  ventricle  being  prac- 
tically one  cavity,  with  no  constriction  between  them,  this 
accounting  for  the  absence  of  murmur  during  life.  The  pleural 
cavities  contained  forty  ounces  of  clear  watery  fluid. 


432  NOTES   ON   PATHOLOGIGAIi    SPECIMENS. 

The  most  peculiar  feature  during  life  was  the  entire  absence 
of  a  murmur  in  any  cardiac  area,  despite  many  marked  cardiac 
symptoms  and  signs,  e.g,,  distinct  dicrotic  pulsation  in  both 
internal  jugular  veins,  great  degree  of  cyanosis,  dyspnoea, 
anasarca,  and  dropsy  of  serous  cavities. 

Diffuse  Infiltrating  Carcinoma  of  Stomach. 

Dr.  MacNish,  May,  1895,  showed  an  indurated  and  contracted 
stomach  obtained  from  a  man  aged  83.  The  specimen  repre- 
sented that  class  of  diffuse  infiltrating  carcinoma  of  the  stomach 
with  much  stroma,  known  as  the  india-rubber  bottle  stomach. 

Chronic  Enlargement  of  the  Liver. 

Dr.  Bernard  Thomas  brought  before  the  Liverpool  Branch, 
January,  1895,  a  girl,  aged  14,  whom  he  had  brought  before  the 
Society  in  October,  1893  (Journal,  vol.  ii.,  p.  44).  She  had  since 
been  under  treatment,  and  showed  some  degree  of  improvement. 
She  then  was  somewhat  emaciated,  and  had  obstructive  jaundice 
and  pains  radiating  from  the  gall-bladder ;  the  liver  was  also 
enlarged,  reaching  nearly  to  the  umbilicus.  Now,  the  general 
condition  was  much  improved ;  there  was  complete  absence  of 
jaundice,  the  pains  were  less  frequent,  and  the  swelling  had  de- 
creased in  size.  The  swelling  was  not  uniform,  and  was  greater 
in  the  epigastric  region.  The  treatment  adopted  was  berberis 
in  two-drop  doses,  three  times  a  day. 

Perforating  Typhoid  Ulcer. 

Dr.  Douglas  Smith,  Liverpool  Branch,  February,  1895, 
showed  a  portion  of  the  small  intestine  removed  from  a  youth, 
aged  19,  presenting  numerous  deep  ulcers  and  many  congested 
and  inflamed  Peyer's  glands.  Near  the  ileo-caBcal  valve  in  the 
ileum  was  a  large,  ragged  mass  of  hsemorrhagic  ulcers,  evidently 
the  source  of  the  ante-mortem  haemorrhage.  One  of  these  had 
perforated  into  the  peritoneum  and  set  up  a  purulent  peri- 
tonitis. The  peritoneum  was  intensely  congested,  and  the 
peritoneal  cavity  full  of  stinking  pus.  The  mesenteric  glands 
and  spleen  were  somewhat  enlarged. 

The  patient  had  had  a  severe  attack  of  typhoid  fever,  and  had 
had  copious  hsamorrhage  from  the  bowel  twelve  days  before  death. 
Violent  spasmodic  abdominal  pain  occurred  four  days  before 
death ;  and  there  was  abundant  hsBmatemesis  (coffee  grounds) 
during  the  last  day. 


NOTES  ON  PATHOLOGICAIi  SPECIMENS*  433 

Benal  Gcdcidus :  NepkrO'Lithotomy, 

Mr.  Dudley  Weight  exhibited,  November,  1894,  a  calcnlus 
removed  from  the  left  kidney  of  a  woman  who  had  been  in  the 
h.ospital  some  months  with  pyo-nephritis  and  enlarged  kidney. 
The  kidney  had  been  opened  and  explored  for  stone,  unsuccess- 
fully on  two  occasions.  Drainage  failing  to  relieve,  and  the 
patient's  strength  failing,  nephrectomy  was  proposed.  In  en- 
deavouring to  pass  a  Hgature  around  the  pedicle,  the  ureter  was 
felt  to  be  distended  with  some  hard  substance,  and  on  opening 
the  pelvis  a  calculus  was  discovered  sending  a  long  pyramidal 
process  into  the  ureter,  completely  blocking  up  its  lumen.  The 
stone  was  removed  and  the  kidney  replaced.  The  patient  made 
eventually  a  perfect  recovery. 

AdenO'Sarcoma  of  Palate. 

Mr.  Dudley  Wright  showed,  February,  1895,  a  cast  taken 
from  a  female  patient,  aged  50,  who  had  suffered  from  a  small 
growth  in  the  palate  for  twenty  years.  It  had  lately  grown  con- 
siderably, and  caused  some  pain  and  discharged  slightly.  The 
tumour  was  about  the  size  of  a  bantam's  egg.  It  was  removed 
under  an  anaesthetic  ;  the  haemorrhage  was  considerable  from  the 
posterior  palatine  artery,  which  had  to  be  plugged  in  its  bony 
canal. 

Mr.  Johnstone  reported  that  the  growth  consisted  in  the  main 
of  adenomatous  tissue,  but  that  in  one  part  sarcomatous  infiltra- 
tion was  commencing. 

Ovarian  Cysts, 

Dr.  BuRFORD  exhibited,  February,  1895,  an  ovarian  cyst 
successfully  removed  by  abdominal  section  from  a  patient,  aged 
38.  The  pedicle  was  extremely  short.  Convalescence  was  prac- 
tically uninterrupted. 

Dr.  BuRFORD  also  showed,  March,  1895,  a  large  ovarian  multi- 
locular  cyst,  from  a  single  woman,  aged  43.  The  cyst  was  very 
adherent,  and  had  undergone  necrosis  in  large  areas ;  the  bases 
of  both  lungs  were  oedematous,  and  the  temperature  preceding 
the  operation  was  101°.  The  patient  made  an  excellent  recovery 
and  has  since  resumed  her  work. 

Adenoma  of  the  Ovary. 

Dr.  BuRFORD,  in  October,  1894,  showed  an  adenoma  of  the 
ovary,  successfully  removed  by  abdominal  section  from  a  patient 
aged  25.      A  considerable  quantity  of  ascitic  fluid   co-existed. 


434  NOTBB  ON  PATHOLOGIOAL  BPEOIMENS. 

The  patient  made  a  good  recovery,  and  has  since  been  in  excel- 
lent health.  Accompanying  the  specimens  was  a  microscopical 
section  of  the  tumom:,  prepared  by  Mr.  Johnstone. 

Dermoid  Cyst  of  the  Ova/ry.  ^^ 

Dr.  Edwin  Nbatby  presented,  December,  1894,  a  specimen 
which  he  had  removed  from  a  patient,  aged  32,  who  had  been 
under  observation  for  a  few  months  on  account  of  an  abdominal 
tumour,  which  was  diagnosed  to  be  an  ovarian  cyst.  She  had 
suffered  only  from  some  slight  constant  pain  of  a  dull,  aching 
character  at  the  monthly  period  down  both  thighs.  The  cata- 
menia  were  moderate.  There  was  no  pain  at  other  time.  She 
had  no  family.  The  medicines  which  had  been  administered 
were  kali  brom.  and  aurum  brom.  On  account  of  the  steady 
growth  of  the  tumour  operation  was  advised  and  was  performed, 
November  9,  1894.  The  cyst,  which  affected  the  left  ovary,  was 
found  to  contain  bone,  hair,  and  cholesterine.  The  convalescence 
was  in  every  way  satisfactory. 

Dr.  BuRPOBD  showed,  June,  1895,  a  specimen  of  suppurating 
dermoid  cyst  of  the  left  ovary,  together  with  commencing  cystic 
degeneration  of  the  righb  ovary,  removed  from  a  patient  aged 
38.  An  almost  unbroken  convalescence  followed,  and  the  pre- 
vious symptoms  of  distress  practically  ceased. 

Myomata  of  the  Uterus. 

Dr.  BuRFORD  showed,  January,  1895,  a  cystic  myoma  of  the 
uterus  successfully  removed  by  abdominal  hysterectomy  from  a 
married  woman  a  little  over  40  years  of  age.  She  made  an 
unbroken  recovery,  and  has  since  been  actively  engaged  in  her 
ordinary  avocations. 

Dr.  BuRFORD  presented,  June,  1895,  another  cystic  myoma  of 
the  uterus,  removed  by  supra-vaginal  hysterectomy  from  a  single 
woman.    A  very  good  recovery  ensued. 

Microscopical  Specimens  of  Solid  Ovarian  Tumours, 

Mr.  Johnstone  showed,  under  the  microscope,  two  specimens 
of  solid  ovarian  tumours  which,  when  contrasted,  had  special 
interest  from  the  fact  that,  though  on  cursory  examination  they 
both  appeared  to  be  sarcomata,  on  a  more  careful  examination 
one  proved  to  be  a  myoma  in  which  the  fibres  were  short,  fat, 
and  spindle-shaped  like  those  of  a  spindle-celled  sarcoma,  which 
the  other  was.  Both  were  sections  of  specimens  removed  by 
abdominal  operation  by  Dr.  Burford. 


CASES  IIiIiUSTBATIYE  OF  DBUQ  ACTION.  435 

CASES  ILLUSTEATIVB  OF  DEUG  ACTION.* 

BY  E.   MAHONT,   M.B.C.S» 

Zinc  and  Alumina^ 

In  a  middle-aged  gentleman  retching  and  vomiting,  hiccough 
relieved  by  vomiting,  one  dose  of  zincum  30  promptly  relieved. 
The  same  patient  a  few  days  later,  the  following  symptoms : 
sullen,  low-spirited  look,  cheeks  red  as  copper,  heartburn,  acrid 
eructations,  nausea,  with  inclination  to  vomit,  which  made  him  con- 
stantly  insert  a  tooth-brush  handle  into  back  of  pharynx,  on  looking 
at  food  already  satisfied,  smoking  is  disagreeable  to  him  though  he 
is  very  fond  of  it  usv/illy,  ptosis  of  right  upper  eye-lid,  drowsi- 
ness, uneasy  sleep  with  dreams,  turning  from  one  side  to  the  other, 
cold  air  very  disagreeable  especially  to  the  feet,  no  evacuation  of 
either  faces  or  urine  (as  is  usual  in  these  attacks).  He  is,  when 
in  health,  very  fond  of  vegetables,  and  enjoys  walking  in  the 
open  air  and  the  warmth  of  the  stove.  For  the  italicised  symp- 
toms in  particular  he  received  alumina  30  one  dose,  which  was 
followed  by  marked  relief,  practically  annihilation  of  his  troubles 
for  one  week,  when  costiveness  with  inability  to  pass  urine  and 
anorexia  returned,  and  he  received  alumina  2,000  one  dose, 
which  was  followed  by  a  large  natural  stool  within  three  hours, 
and  has  had  a  daily  evacuation  and  freedom  from  dyspeptic 
troubles  to  date,  sixteen  days. 

Caladium. 

A  middle-aged  lady,  suffering  from  chronic  eczema  of  joints 
and  goitre,  with  tendency  to  glandular  enlargements,  presented 
the  peculiarity  that  when  the  rash  disappeared  the  throat  and 
chest  were  worse,  and  vice  versa.  Eight  doses  of  caladium  200 
in  water,  one  night  and  morning  produced  marked  relief. 

Crotalus  Horridus, 

A  retired  army  captain,  who  had  sunstroke  in  India,  and  had 
previously  benefited  by  hydrophobinum,  complained  of  weakness 
in  eyes  since  wet  weather,  tendency  to  dribbling  from  bladder,  with 
flaccidity  of  sexual  organs.  He  received  several  doses  of  crotalus 
200,  and  after  taking  one  dose  was  made  very  nervous  and  ex- 
citable for  fourteen  days,  had  a  very  red,  rough  tongue,  and  found 
his  hands  very  sore  and  bleeding ;  took  no  more. 

*  Bead  before  the  Liverpool  Branch,  February,  1896, 
j  VOL.  III. — NO.  4.  30 


436  mitiirr  or  oo-wAco^ 


REPORT  OF  THE  OODEGDL 

Is  presenting  their  Annnal  Beport  the  Cc-im-rfL  as  they 
anticipated,  are  not  able  to  acnoimce  so  large  an  increase  in 
Mernberftfaip  of  the  Society  as  they  were  on  the  two  prerioiis 
occa^ionn  of  their  Beport. 

During  the  Session  two  Members  hare  been  elected  to 
the  Fellowship,  and  three  new  Members  have  joined  the 
Society. 

^J*he  Society  has  to  deplore  the  loss  by  death  of  two  of 
itH  Members  and  two  of  its  Corresponding  Members.  Mr. 
Henry  Harris  was  a  valued  Member  of  the  Comidl  and  an 
earrjest  participator  in  the  work  of  the  Society  since  his 
election  in  1871.  Dr.  Charles  Canlfield  Tuckey,  who  had 
been  a  Member  since  1855,  was,  owing  to  his  retirement 
from  active  practice,  less  well-known  to  the  present  Mem- 
bers. Dr.  J.  P.  Dake  and  Dr.  Leon  Simon,  Corresponding 
Members,  were  well  known  and  respected  beyond  their  own 
country. 

The  Council  are  satisfied  that  the  new  departure  in- 
augurated this  Session,  in  the  devolution  of  the  work  of  the 
Society  to  sections,  has  answered  well.  The  meetings  have 
been  well  attended,  and  the  material  supplied  for  their  con- 
sideration abundant.  No  less  than  twenty-five  papers  have 
been  read  at  the  eleven  meetings  held  during  the  Session, 
and  the  discussions  following  the  papers  have  been  most 
interesting. 

The  Council,  after  due  consideration,  have  decided  to 
commence  instead  of  close  the  Session  with  the  Presiden- 
tial Address,  and  hope  by  this  means  to  make  the  Address 
of  the  nature  of  a  Hahnemannian  oration. 

Next  month  will  see  the  opening  of  the  new  LondoA 
HomoDopathic  Hospital,  and  the  Council  hope  to  make 
arrangements  for  the  meetings  of  the  Society  to  be  held 
next  Session  in  the  Board  Boom  of  the  new  hospital. 


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438  SOCIETY    NEWS. 


80C1ETT  NEWS. 

At  the  last  meeting  of  the  Liverpool  Branch  of  the  Society, 
the  following  office-hearers  for  1895-6  were  elected : — 

President,  Dr.  J.  W.  Hayward. 
Vice-President,  Dr.  Edmund  Capper. 
Bepresentative  on  the  Council,  Dr.  J.  W.  Hayward. 


The  Council  has  re-appointed  Dr.   Hughes,  Editor  of  the 
Journal,  and  Mr.  C.  Knox  Shaw,  Honorary  Secretary. 


The  members  forming  the  various  Sections  are  as  follows  : — 

Matebia  Mbdioa  and  Therapeutics. 

Chairman,  Dr.  Hughes  ;    Secretary,    Dr.  Epps ;    Drs.   Dyce= 
Brown,  Ord,  and  Lambert. 

Medicine  and  Pathology. 

Chairman,  Dr.  Galley  Blackley ;  Secretary,  Dr.  Byres  Moir ; 
Drs.  Day,  Goldsbrough,  and  Dyce  Brown. 

SUBGEKY  AND    GyN2EC0L0GY. 

Chairman,  Dr.   Burford ;    Secretary,    Mr.    Dudley  Wright ; 
Mr.  Johnstone,  Dr.  Neatby,  and  Mr.  Gerard  Smith. 


SUMMARY.  43^ 


SUMMAEY  OP  PHARMACODYNAMICS  AND 

THEEAPEUTICS, 


-"*  GATHER  UP  THE   FRAGMENTS,   THAT   NOTHING  BE  LOST.*' 


June — ^August,  1895. 


PHARMACODYNAMICS. 

Aoidam  benzoioam. — Dr.  Ord  reports  four  cases  of  gout  in 
various  forms,  where  benzoic  acid,  given  on  the  indication  of  the 
strong  smell  of  the  urine,  proved  efficacious.  The  Ix  solution 
seems  to  have  been  used. — Monthly  Horn,  Review,  June. 

Adonis. — In  The  Clinique  for  August  Dr.  Burt  has  put  to- 
gether a  number  of  useful  scraps  of  information  regarding  this 
drug,  which  should  be  noted  for  reference.  Dr.  Genius  gives  a 
good  case  illustrating  its  value  in  cardiac  dropsy  (p.  410). 

Dr.  Kessler  has  found  the  tincture,  in  ten-drop  doses,  effective 
in  reducing  obesity  in  his  own  person.  He  considers  that  as  a 
•diuretic  it  acts  directly  on  the  renal  epithelium,  as  it  produces 
this  effect  even  where  there  is  fatty  degeneration  of  the  heart, 
and  where,  accordingly,  the  action  of  a  **  cardiac  tonic'*  can 
hardly  be  exerted. — L  Art  Medical,  August,  p.  148. 

Antitoxin. — ^The  frequent  and  large  use  of  this  substance  as 
e,  remedy  for  diphtheria  is  accompanied  with  so  many  **  acci- 
dents ''as  to  be  fast  making  for  it  a  pathogenesis  of  its  own. 
Among  other  cases  reported,  two  assistant  physicians  at  the 
Hospital  of  the  Holy  Ghost,  at  Frankfort,  had  it  administered  to 
themselves — one  for  a  mild  attack  of  diphtheria,  the  other  for 
prophylaxis.  They  were  attacked  with  urticaria,  exceedingly 
high  temperature,  muscular  and  arthritic  pains,  loss  of  appetite, 
and  great  weakness,  from  which  they  were  a  long  time  in  re- 
covering.— The  Clinique,  August. 

Apocynum. — A  fuller  account  of  Dr.  Glinski's  observations 
on  apocynum  than  we  previously  cited  (see  p.  97  of  this  volume) 


440  SUMMABY. 

is  given  in  the  Monthly  HonuBopathic  Beview  for  August,  p.  461. 
Its  power  of  diminishing  the  area  of  dulness  in  cardiac  dilatation 
is  noteworthy. 

Arsenioum. — The  homcsopathicity  of  arsenic  to  cholera  wa<s 
once  denied  among  us,  on  the  ground  (mainly)  that  the  thirst 
characteristic  of  the  drug  (** drinks  little  and  often'*)  was  quite 
different  from  that  of  the  disease.  Dr.  Amrita  Lai  Sircar 
records  a  case  in  which  the  thirst  for  large  quantities  of  water 
was  insatiable,  but  where  arsenic  was  brilliantly  effective.  "  I 
gave  a  dose  of  the  6th  exactly  at  midnight,  and  within  ten 
minutes  he  fell  asleep.  I  kept  watch  over  him  till  1.30  a.m.^ 
up  to  which  time  he  did  not  even  move  his  limbs.  Next 
morning  I  saw  the  man,  and  found  him  doing  well  in  every 
respect.  He  was  quiet,  free  from  restlessness  and  the  thirst 
which  had  troubled  him  so  much.  The  prostration  was  nearly 
gone.  He  had  slept  the  whole,  night." — Calcutta  Jour,  of  Medi- 
cine, May. 

[In  the  June  number  the  Editor  has  an  interesting  discussion 
on  *'  The  Thirst  of  Arsenic.'*— Ed.] 

Dr.  Selfridge  had  a  case  of  ovarian  cyst  in  which  he  thought 
arsenicum  the  indicated  remedy.  He  does  not  say  why,  and  the 
only  associated  symptom  he  mentions  is  emaciation.  However^ 
the  6x  trit.  was  administered  every  four  hours.  **  In  three  weeks 
the  size  had  perceptibly  diminished,  and  in  three  months  every 
vestige  of  the  tumour  had  disappeared.'* — Pacific  Coast  Joum.  of 
Eom.y  August. 

Arsenicum  iodatnm.— -Dr.  Kroener  presents  the  results  of 
his  experience  with  this  drug  during  the  past  year.  He  prefers 
a  solution,  as  more  stable  than  the  triturations,  making  a  2nd 
dec.  with-  absolute  alcohol  and  a  little  ether.  He  employs  it  ta 
hasten  absorption  of  exudates,  citing  numerous  cases  of  pleurisy 
with  effusion  and  fibrinous  and  catarrhal  pneumonia,  as  well  as 
of  tuberculous  peritonitis,  where  excellent  results  were  obtained. 
In  incipient  phthisis,  and  even  in  more  advanced  stages,  he  has 
found  it  answer  well,  and  in  asthma  he  speaks  highly  of  it. — 
Hahn,  Mmithly,  July,  p.  496. 

[Some  of  his  cases  we  have  already  given  at  p.  201  of  this- 
volume.] 

Atropine. — A  solution  of  the  sulphate,  4  gr.  to  the  oz.,. 
dropped  into  the  eye  of  a  baby  of  a  month  old,  twice  caused  fever^ 


8UMMABY.  441 

the  temperature  rising  to  104*5'*  and  107*2^  on  the  two  occasions 
respectively. — Monthly  Horn,  Bev.,  August,  p.  465. 

Auram. — ^This  drug  has  not  heen  mentioned  of  late  with 
regard  to  scrofulous  ophthalmia.  Dr.  Dahlke  relates  a  severe 
case  in  which  the  ordinary  remedies  had  done  little.  Finally, 
led  by  the  symptom  that  whenever  the  child  was  worse  it  seemed 
to  have  congestion  of  blood  to  the  head,  he  gave  aurum  muria- 
ticum  6x,  three  times  a  day,  and  rapid  improvement,  with 
following  cure,  resulted. — Pop,  Zeitschr.,  Nos.  7  and  8,  1895. 

Azadirachta  indioa. — This  plant,  indigenous  to  and  of  high 
native  repute  in  India,  has  recently  been  proved  there.  The 
symptoms  most  characteristic  of  it  seem  to  be :  constant  bitter 
taste  in  mouth  and  throat;  sense  of  fulness  in  abdomen;  and 
burning,  glowing  heat  in  face,  palms,  and  soles,  recurring  every 
afternoon.  Guided  by  these  symptoms,  it  has  been  given  in 
malarious  fevers  and  other  morbid  states  with  considerable 
success. — Hahn.  Monthly ^  July. 

Baptisia. — Dr.  A.  P.  Macdonald  writes  to  The  Clinique  for 
August  to  communicate  a  lengthened  experience  with  baptisia  in 
malignant  scarlatina.  In  his  first  case,  ailanthus,  lachesis,  ar- 
senicum,  and  arum  triphyllum  had  been  given  in  vain. 

Berberis. — ^An  obstinate  eczema  of  the  right  hand,  of  five 
years'  duration,  cleared  rapidly  away  when  an  accompanying 
(and  preceding)  pain  in  the  right  side  was  attacked  by  berberis 
2x  and  Ix. — Med,  Century,  June  15. 

Blatta. — ^Dr.  Bradford,  who  is  doing  so  much  useful  biblio- 
graphical work  just  now,  gives  us  in  the  Hahnemannian  Monthly 
for  July  a  collection  of  observations  relative  to  the  Eussian  or 
Indian  cockroach — blatta  orientalis.  Dropsy,  in  the  old  school, 
asthma,  among  homoBopathists,  are  the  affections  in  which  it  has 
gained  its  repute ;  and  it  seems  to  have  indubitable  energy.  An 
active  principle  has  been  isolated,  and  named  **  antihydropin." 

Borax. — ^Dr.  F.  H.  Pritchard  discusses  the  suitability  and 
homoeopathicity  of  borax  to  thrush  in  the  Hahnemannian  Monthly 
for  August.  As  to  the  latter,  he  comes  to  a  negative  conclusion, 
and  for  the  former,  relates  a  case  which  recovered  far  more 
rapidly  when  boracic  acid,  eight  grains  to  the  ounce,  was  used  as 
the  local  application. 


4^ 


>■ — Thft  mgestum  of  puwilecei  eg^-AeUs  by  the  tea- 
spormfirf.  tio  the  orBawmiaL  powor  of  whidEi  izl  csmeer  atleniioii  was 
drawn  some  dme  ago,  has  berai  faanii  bj  Dr.  Gmbe  wonderfolly 
mtaatawR  ot  she  g.f^iHr?tI  iffialtth  of  trovo  (ii&beitzcs»  thoagb  makiiig 
fittle  arao  imiJusiiBioii  upon  thgr  diaeaae^  Li  a  ithird  case  he  tried 
faar  granny  daily  of  a  mfrirtirg  of  seven  pans  o£  carbonate  and 
one  of  phospha&e  of  lime,  winh  qmiT^^y  resoIoSy  positiTe  and  nega- 
tive.— HaJoL.  M'yntkly^  AizstEsc»  p.  ooO. 

A  case  of  mnatanti  cbillineaB^  wink  extreme  sensimeness  to 
drm^hlg>.  of  stx  years*^  stauidmg^  after  the  £ulxxre  of  natmm 
mnriarirnm  and  araoea  diadema^  reoovered  under  the  daily  nse 
ci  lime-water  as  a  drink. — Ham.  World,  August,  p.  351. 


. — ^Dr.  Sybel  speaks  rery  highly  of  the 
fiuoride  of  Ume  in  the  treatzneat  of  mdolent  and  long-lasting 
enlargemoits  of  the  eenrical  lymphatic  glands^  especially  where 
induration  is  prononneed.  He  gires  mainly  the  5r  trit. — Hahn. 
Mamthli/,  July,  p.  493.    [See  p.  312  of  this  Tolnme.] 

Dr.  Majmndar  eends  a  case  of  (apparently)  exostosis  of  the 
antrnm,  which  entirely  disappeared  under  the  persistent  nse  of 
the  12th  diL  ci  this  medicine. — Hom^  Worlds  March. 

Cannabis  aatnrm. — "In  parenehymatons  keratitis,"  writes 
Dr.  Chas.  G.  Boyle,  "  where  the  cornea  is  opaqne  and  very  yas- 
cnlar,  1  consider  it  the  remedy  ahoTe  all  others.  Bedness,  pain  and 
photophobia  are  not  so  marked  as  with  anram,  bnt  the  vascular 
condition  of  the  cornea  is  more  so." — Med^  Century^  Angost  15. 

Canfliafia. — ^Dr.  Frendenberg  has  reported  to  the  Berlin 
Medical  Society  that  he  has  long  employed  cantharidine  inter- 
nally in  the  treatment  of  cystitis,  and  with  the  best  results.  He 
employs  a  solution  of  1  part  to  100,000  (answering  to  our  5x  dil.). 
In  fifty-three  patients  so  treated  he  had  only  five  failures; 
and  these  were  grave  chronic  cases,  which  had  shown  themselves 
rebellious  to  all  other  therapeutic  measures. — L'Art  Medical,  July. 

Capsioum. — "  A  girl  came  to  the  dispensary  with  profuse 
purulent  otorrhoea,  and  some  swelling,  redness  and  tenderness  in 
the  mastoid  region.  I  sent  her  at  once  into  the  hospital  and 
ordered  hydrogen  peroxide  and  poultices  locally,  with  capsicimi 
internally,  expecting  to  operate  the  next  day.  She  improved  so 
rapidly  that  no  operation  was  necessary,  and  she  made  a  good 
recovery." — Moffat,  N.  Am,  Jour,  of  Horn.,  July,  App.,  p.  50. 


^UMKABY,  4A:3 

Cinnabar. — Dr.  Chas.  E.  Boyle  writes: — ''This  remedy  I 
have  prescribed  wherever  I  have  found  its  characteristic  pain 
around  the  eye,  and  it  seldom  fails  to  relieve  the  patient,  no 
matter  what  the  trouble  is.  I  have  used  it  in  keratitis,  in 
kerato-iritis,  and  iritis  itself ;  also  in  glaucoma.  I  consider  it 
almost  a  specific  for  gummata  of  the  iris  and  syphilitic  iritis ;  I 
have  cured  the  iritis  and  absorbed  the  gumma  in  little  over  a 
week's  time  in  some  cases." — Med,  Century,  August  15. 

Cooonlas. — Dr.  Searle  records  a  case  of  the  general  paresis 
which  calls  for  this  remedy.  It  came  from  nervous  *'  breakdown." 
Patient  was  somewhat  emaciated,  countenance  haggard,  flushing 
easily ;  he  was  distrustful,  and  his  mind  was  confused ;  articula- 
tion was  thick,  sleep  broken  and  unrefreshing,  gait  staggering, 
legs  clumsy  and  weak ;  joints  felt  stiff.  The  bodily  functions 
generally  were  performed  well.  All  symptoms  were  alleviated 
by  eating  and  by  conversation.  Under  cocculus  3  the  patient  (a 
merchant)  made  an  excellent  recovery. — Horn.  Becorder,  August. 

Coffea. — Hahnemann  is  not  alone  in  tracing  to  the  abuses  of 
coffee  many  of  the  ills  which  affect  the  human  frame.  MM.  de 
la  Tourelle  and  Gagne  have  recently  brought  before  the  Soci6t6 
M6dicale  des  Hopitaux  des  Paris  a  memoir  on  chronic  intoxication 
by  coffee,  as  symptoms  of  which  they  enumerate  many  digestive 
and  nervous  disorders.  Dr.  Marc  Jousset  promises  to  reproduce 
these  in  a  complete  monograph  on  **  Cafeisme,"  which  will  shortly 
appear  from  his  pen. — L'Art  Medical,  August. 

Pruritus  (it  is  not  said  of  what  seat)  is,  according  to  Brown- 
S6quard,  often  caused  by  the  free  use  of  coffee. — Amer,  HonmO' 
pathist,  July  15. 

Coralliam. — Dr.  Jousset'  has  had  brilliant  results  from  this 
medicine,  in  the  30th  dil.,  in  spasmodic  coughs.  The  absence 
of  vomiting,  he  thinks,  differentiates  it  from  drosera  here. 
Sometimes  the  cough  of  influenza  assumes  this  character,  and 
will  rapidly  yield  to  the  remedy. — L'Art  Medical,  June. 

Cunduran^o. — An  old  farmer  suffered  from  an  ulcer  on  his 
lip.  The  lower  lip  was  deeply  eroded,  with  irregular  edges  sur- 
rounding a  deep  ulcer,  its  base  filled  with  foul,  purulent  matter. 
It  began  with  small  blisters,  which  discharged  and  formed  crusts. 
These  fell  off,  but  always  reappeared,  till  at  length  the  malignant 
ulcer  now  present  was  established.     Cundurango,  2nd  dec,  was 


444  SUMMABY. 

prescribed,  2  drops  three  times  a  day.  After  two  weeks  the  ulcer 
was  gone,  a  thin  crust  only  covering  its  former  seat ;  and  this 
without  further  treatment  was  soon  exchanged  for  healthy  skin. 
— Goullon,  Pop,  Zeitschr,  f.  H,,  xii.,  91. 

Duboisia. — Dr.  de  Montyel  reports  twelve  cases  of  intoxication 
induced  by  this  drug  in  epileptics.  Mental  excitement,  with 
illusions  and  delirium,  convulsions,  partial  sweats,  frequent  and 
copious  micturition,  were  observed ;  the  skin  was  burning,  hot, 
but  pale. — L*Art  Medical,  July,  p.  73. 

Ephedra  vulgaris. — The  Eussian  Vratch  Homoeopathiqiie 
relates  a  proving  of  this  plant,  made  with  a  strong  extract. 
Among  other  symptoms,  some  exophthalmos  was  induced;  and 
Dr.  Mouravow,  who  conducted  the  proving,  recommends  the 
drug  in  Graves's  disease. — Amer,  Homosopathistf  August  1. 

Fabiana  imbricata. — In  this  plant,  commonly  called  '*  pichi," 
Dr.  Eoland  J.  White  thinks  we  have  another  and  a  valuable 
remedy  for  catarrh  of  the  bladder  connected  with  suppurative 
prostatic  conditions.  He  relates  two  satisfactory  cases.  He  gave 
5-10  drops  of  the  Ist  dil.  three  or  four  times  a  day. — Hahn. 
Monthly,  June. 

Ferrum. — Dr.  Younan  tells  how  a  patient  asked  him  to  look 
at  a  bird  of  hers,  which  refused  food  and  seemed  so  weak  that  it 
could  hardly  perch.  Inspection  showed  that  it  was  suffering  from 
ansBmia :  its  back  and  legs,  and  parts  of  the  neck  and  body  stripped 
of  feathers  during  the  process  of  moulting,  were  pale  and  blood- 
less. On  investigation,  its  water-cup  was  found  to  contain  a 
dark  brown  liquid,  and  at  the  bottom  lay  a  rusty  nail.  (Dr.  Marc 
Jousset^  gives  an  account  of  a  discussion  on  the  use  of  iron  in 
chlorosis  lately  held  at  a  German  Congress;  and  pertinently 
draws  attention  to  Nothnagel  and  Eossbach's  confirmation  of 
Hahnemann's  statement,  that  those  living  near  chalybeate  springs 
are  more  frequently  anaemic  than  plethoric). — Calcutta  Journ,  of 
Med,,  May. 

Dr.  Majumdar  finds  preparations  of  this  metal,  chiefly  the 
iodide  and  the  arseniate,  the  best  remedies  for  enlargement  of 
liver  and  spleen  following  intermittent  fever.  He  gives  the  6th 
dil.  of  the  arseniate. — Indian  Horn.  Beview,  July. 

>  L*Art  M4dical,  July. 


BUMMABY.  445 

Graphites. — Dr.  Hirsch  recommends  that  in  cases  of  eczema 
calling  for  this  medicine,  if  the  lower  dilutions  have  proved  in- 
effective the  higher  should  be  tried,  in  rare  doses,  before  changing 
to  another  remedy.  He  relates  two  cures  in  illustration. — Horn. 
Becorder,  July. 

Iodine. — Dr.  H.  E.  Leonard  writes  that  iodine  in  right-sided 
pneumonia  has  been  to  him  one  of  the  few  almost  certainties  in 
the  practice  of  medicine. — Med.  Century,  August. 

Iodoform. — Dr.  Skiles  finds  this  the  best  form  of  iodine  for 
internal  use  in  the  treatment  of  goitre.  He  gives  the  2x  trit.,  a 
tablet  two  or  three  times  a  day.  He  has  only  known  it  fail  once, 
in  a  "  number  of  cases." — The  Glinique,  June,  p.  288. 

Lachesis. — A  paper  by  Dr.  Leonard  in  the  Minneapolis  Homoeo- 
pathic Magazine  gives  some  interesting  details  as  to  the  history 
of  this  preparation.  (We  speak  of  Hering's  original.  In  the 
Monthly  Honiceopathic  Beview  for  September,  Messrs.  Gould  and 
Son  state  that  another  source  of  the  venom  has  been  opened,  and 
that  the  results  have  been  equally  good.) 

In  a  lecture  on  this  drug,  Dr.  Kent  says  : — **  The  most  lovely 
of  all  uses  of  lachesis  is  in  producing  euthanasia.  Where  there  is 
genuine  heart  failure,  it  will  kill,  but  so  placidly,  so  pleasantly, 
without  a  pain  or  discomfort.  The  patient  will  go  to  sleep,  and 
never  wake  up.  When  the  dyspnoea  is  of  the  lungs,  and  there  is 
not  a  true  heart  failure,  there  will  be  a  wonderful  relief." — Medical 
Argus,  June. 

Dr.  Bird  reports  a  case  of  paroxysmal  double  sciatica,  with 
tenderness  and  concomitant  icterus,  occurring  in  a  man  who  had 
worked  much  in  sewers.  Acting  on  this  indication,  lachesis  6 
was  prescribed,  with  brilliant  results.  [While  taking  the  medi- 
cine, he  had  several  times  a  sudden  pain  at  the  back  of  the  neck, 
as  if  he  had  been  struck  there.  Mr.  Frank  Buckland  experienced 
a  similar  sensation  as  the  first  evidence  of  poisoning  with  cobra 
venom.  See  GycL  of  Drug  Pathogenesy,  iii.,  339.] — Monthly 
Horn.  Beview,  April,  p.  187. 

Lemna  minor. — Dr.  T.  L.  Shearer  has  taken  up  this  **  arbori- 
vital "  medicine  of  Dr.  Cooper's,  and  has  employed  it  in  atrophic 
rhinitis  (ozaBua).  '*  Its  action,"  he  says,  "  is  wonderful;  **  but  it 
must  not  be  administered  in  too  low  a  dilution,  as  it  then  causes 
a  sensation  of  intense  dryness  in  pharynx  and  larynx. — Hahn. 
Monthly,  August,  p.  557. 


446  SUMMABY. 

Logo. — ^A  weed  bearing  this  name  has  long  been  known  as 
occurring  in  Mexico,  and  as  having  poisonous  effects  on  animals 
who  eat  it.  Dr.  Gentry  is  now  stationed  in  New  Mexico,  and 
from  his  observations  the  condition  induced  seems  to  simulate 
locomotor  ataxy.  He  has  been  proving  it  on  the  human  subject, 
with  corresponding  results;  and  promises  to  publish  these  ere 
long.  **  Strange  feeling  of  fulness  of  the  eyes,  with  sight  ob- 
scured, so  that  it  appears  that  one  is  looking  through  clear  water, 
which  produces  most  of  the  prismatic  colours,"  is  one  of  the 
symptoms  induced  by  it. — Horn,  Becorder,  August. 

Natram  moriaticam. — Dr.  Louis  A.  Bull  records  a  case  of 
atrophic  rhino-pharyngitis  in  which  the  skin  was  <'  colourless, 
dry,  fishy  in  appearance,  and  profusely  dotted  with  comedones, 
large  and  small."  He  was  reminded,  he  says,  of  Boussingault's 
experiments  in  withholding  salt  from  animals,  and  opined  that 
here  was  a  case  in  which  chloride  of  sodium  was  not  properly 
assimilated.  He  used  it  locally  in  ten  grains  to  the  ounce  solu- 
tion, and  internally  in  dynamised  form,  with  most  satisfactory 
results. — Horn.  Becorder,  August. 

PhosphoFUS. — The  substance  of  one  of  Dr.  T.  F.  Allen's  in- 
structive lectures  on  Materia  Medica  is  given  in  the  North 
American  Journal  of  Homcsopathy  for  June  and  July.  The  pre- 
sence of  hsBmorrhages  in  its  inflammations,  the  absence  of 
nervous  and  circulatory  excitement,  the  aggravating  effect  of  hot 
weather,  the  softness  and  compressibility  of  its  pulse,  the  mentaJ 
apathy  and  indifference,  the  frequent  increase  of  its  symptoms 
between  1  and  5  p.m.,  and  the  sense  of  general  oppression  as 
from  an  external  weight  —all  these  are  brought  out  with  much 
felicity. 

Podophyllum. — Dr.  Midgley  Cash  commends  this  medicine 
(which  he  gives  in  the  3x  dil.)  as  '*  for  all  obstinate  diarrhoeas  in 
unhealthy  children,  on  the  whole  the  most  useful  remedy  we 
possess." — Monthly  Horn,  Beview,  July,  p.  364. 

Pulsatilla. — Dr.  Genius  thinks  that  this  drug  has  been 
neglected  in  the  treatment  of  consumption.  He  relates  one  case 
of  cure  and  mentions  another,  while  five  more  have  been  greatly 
improved.  He  gives  from  the  3rd  to  the  30th  dil. — The  Glinique, 
August. 

Pyrus  malus. — Dr.  Cooper's  last  essay  in  **  Arbori-vital 
Medicine"  treats  of  the   crab-apple    tree— jpyrz^    malus,.   He 


SUMMARY.  447 

relates  a  good  case  of  labyrinthine  vertigo  in  which  it  seems 
to  have  done  much  towards  the  cure  which  was  effected. — Hahn, 
Monthly,  July. 

Sangoinaria.— The  3rd  dil.  of  this  drug,  taken  for  four  to 
five  days,  produced  a  severe  pain  localised  in  a  small  spot  over 
the  upper  portion  of  the  left  parietal  bone.  The  pain  became  so 
violent  that  the  experiment  had  to  be  suspended. — Horn,  World, 
August,  p.  341. 

Silicea. — A  patient  taking  this  drug  for  tinnitus  found  that 
every  dose  produced,  an  hour  after  taking  it,  a  tingling  sensation 
in  the  nose,  extending  through  the  eustachian  tube  into  the 
middle  ear,  as  if  an  air-bladder  was  pushed  through  and  burst. — 
Horn,  Phys.,  June. 

Bolanum  nigrum. — Dr.  Douglass,  of  Danville,  writes  to  com- 
mend the  solanum  nigrum  in  scarlatina,  where  the  eruption  is 
not  uniform  and  diffuse,  but  appears  in  red  or  livid  patches.  It 
takes  the  place  of  belladonna  in  such  cases. — Southern  Joum.  of 
Horn.,  from  Bevue  horn.  Beige,  March. 

Staphisagria. — In  an  article  on  '*  The  Genius  of  Drugs,'*  Dr» 
Korndoerfer  gives  a  graphic  description  of  the  condition  calling 
for  this  little-used  drug,  which  should  be  attentively  studied. — 
Hahn,  Monthly,  August. 

Stellaria  media. — At  p.  362  of  the  second  volume  of  this 
Journal  we  mentioned  Mr.  Kopp's  proving  of  this  plant,  and  the 
action  on  the  joints  it  displayed.  He  now  writes  to  say  that, 
given  on  this  indication,  it  has  displayed  **  wonderful  and  almosi 
miraculous  "  curative  powers  in  the  treatment  of  rheumatism. 
He  advises  the  2x  dilution,  and  a  lotion  of  the  drug  to  the  affected 
joints. — Horn,  World,  June. 

Sulphur.— Dr.  Genius  relates  a  case  of  hemichorea  of  long 
standing,  in  which  the  patient's  general  condition  pointed  so 
strongly  to  sulphur  that  he  gave  it  in  preference  to  any  of  the 
usual  remedies  for  the  disease.  After  a  week  of  the  200th  four 
times  a  day,  progressive  improvement  set  in,  resulting  in  cure 
after  about  five  weeks. — The  Clinique,  August. 

Tabaoum. — Dr.  Genius  contributes  to  The  Clinique  for 
August  two  cases    illustrating  the  power   of  tabacum  30  over 


448  BUMMABT. 

conditions  resembling  those  induced  by  the  abuse  of  the  weed. 
Tremor  and  palpitation  were  prominent  symptoms  in  both  cases, 
and  in  one  had  gone  on  to  angina  pectoris. 

Thlaspi. — Drs.  Jousset  and  Tessier  support,  from  their  expe- 
rience, the  value  of  thlaspi  in  metrorrhagia.  The  former  has 
found  it  act  well  in  "  tisane  "  form. — liArt  Medical,  June. 

Thuja. — A  case  of  general  psoriasis,  of  four  years'  standing, 
in  a  girl  of  ten,  was  traced  to  vaccination,  with  aggravation  by 
over-dosing  with  arsenic.  Thuja  in  the  3rd  and  2nd  dils.  caused 
an  almost  complete  recovery. — Med.  Century,  June  15. 

Some  Belgian  practitioners  have  been  proving  this  drug  on 
themselves.  The  first  and  third  had  small  soft  warts  on  the 
fingers,  the  second  and  third  circular  scaly  spots  on  the  surface. 
Two  cases  are  mentioned  in  which  urethritis  has  been  observed 
from  it. — Ibid,,  p.  274. 

■ 

Tuberculinum.— Dr.  Cartier,  dissatisfied  with  the  results  of 
Koch's  tuberculin,  has  essayed  the  analogous,  but  not  (he  thinks) 
identical  product  derived  from  birds.  He  does  not  give  it  iso- 
pathically  in  true  tuberculous  affections,  but  homoeopathically,  as 
in  grave  bronchitis  and  pneumonia  with  phthisical  tendencies.^ 
He  has  treated  sixteen  cases,  some  of  which  he  relates,  and  with 
no  small  measure  of  success.  He  gives  daily  doses  of  the  100th 
dil.  This  is  after  the  fashion  of  our  own  Burnett,  whose  **  bacil- 
linum "  also  Dr.  Cartier  warmly  appreciates  in  similar  cases. 
He  thinks  it  relieves  the  dyspnoea  more  than  the  cough.  He 
refers  also  to  some  articles  by  Dr.  Mersch  in  the  Journal  Beige 
d'Homaopathie — a  journal  which  does  not  reach  us. — UArt 
Medical,  August. 

Uranium. — *'  The  administration  of  uranium  seems  to  produce 
striking  results  in  diabetes.  It  causes  first  a  reduction  in  the 
amount  of  urine,  and  subsequently  a  great  fall  in  the  percentage 
of  sugar.  As  the  patients  were  under  constant  conditions  in 
respect  of  diet  and  general  regime,  it  is  fair  to  refer  all  these 
results  to  the  action  of  the  uranium,  for  its  administration  caused 
the  quantity  of  the  urine  and  the  percentage  of  the  sugar  to  fall. 
On  withholding  the  uranium  both  increased  ;  on  giving  it  again, 
both  once  more  fell,  until  in  the  one  case  the  sugar  entirely  disap- 
peared from  the  urine,  and  in  the  other  almost  entirely.** — West, 
Lancet,  August  10,  1895. 

'  '•  Bronohite  suspeote"  he  calls  such  cases. 


SXTMMABT.  449 

la  a  case  of  diabetes,  reported  by  Dr.  Gartier,  this  remedy, 
like  all  the  rest,  was  without  influence  on  the  glycosuria  ;  but  a 
hypertrophic  condition  of  the  liver  was  largely  reduced. — Bevue 
Horn.  Francaise,  May. 

Yanilla. — ^It  has  been  observed  that  the  workwomen  in 
vanilla  suffer  from  various  disorders  of  the  nervous  system  and 
the  circulation.  It  is  now  further  stated  that  the  plant  is  em- 
menagogue  and  aphrodisiac.  The  catamenia  are  prolonged,  and 
degenerate  into  a  haBmorrhage :  even  metritis  has  been  observed. 
— L'Art  Medical,  August. 

Yepatram  Yiride. — Dr.  Cooper  calls  attention  to  the 'uniform 
relief  given  by  the  locaJ  application  of  this  drug  in  inflam- 
matory earache.  Four  drops  of  the  tincture  to  two  drachms 
(or  seven  to  four)  of  glycerine  and  water,  equal  parts,  is  to  be 
instilled  into  the  painful  ear. — Horn,  World,  March. 

YibnFnam. — Some  provings  on  women  with  the  viburnum 
opulus  are  reported  in  the  Pacific  Coast  Journal  of  Honueopathy 
for  August.  They  seem  to  establish  its  homoeopathicity  to 
spasmodic  dysmenorrhoea. 

Zinonm  Yalerianicum. — In  a  valuable  paper  on  ''  The 
Homoeopathic  Treatment  of  GynsBcological  Cases,"  Dr.  Betts 
gives  some  well-marked  indications  for  this  salt.  Eestlessness 
with  nerve-fag  from  ovarian  and  uterine  irritation;  ovaries  ex- 
quisitely tender,  with  localised  (often  burning)  pain;  and  the 
fidgetiness  of  the  feet  characteristic  of  zinc  itself,  will  be  greatly 
benefited  by  the  2nd  or  3rd  trituration. — Hahn.  Monthly,  June. 


THERAPEUTICS. 

Abscess. — Chr.  N.,  aged  23,  tram  driver,  was  admitted  to  the 
Deaconesses*  Institution  on  the  evening  of  October  22,  1894, 
with  a  temperature  in  axilla  of  39-9°.  On  the  20bh  he  had  been 
kicked  by  a  horse  about  the  middle  of  the  inside  of  the  left 
thigh,  which  caused  a  small  skin  wound,  which  was  bandaged  by 
the  surgeon  with  iodoform.  The  skin  over  almost  the  whole  of 
the  inner  aspect  of  the  thigh  was  red,  swollen  hard,  hot,  ex- 
tremely painful  to  the  touch.  Deep  undefined  fluctuation  could 
be  felt.  Therefore,  there  was  inflammation  of  the  cellular  tissue, 
with  probably  commencing  suppuration.  He  got  aeon.  6  and 
arnic.  6,  3  drops  alternately  every  two  hours  ;  the  thigh  was  en- 


450  BUmCABT. 

veloped  in  cold  compresses  frequently  renewed.  Next  morning 
the  temperature  had  declined  to  38*3°,  and  he  felt  hetter.  But 
the  state  of  things  in  the  thigh  was  unaltered.  On  account  of 
severe  headache  next  evening  he  got  bell.  6.  This  did  good  to 
the  head,  but  the  fever  remained,  the  swelling  of  thigh  increased, 
the  fluctuation  was  more  distinct  in  the  middle  of  the  swelling, 
and  the  firm  inflammatory  wall  projected  more  and  more.  On 
the  evening  of  October  25  the  temperature  rose  to  40°,  and  the 
fluctuation  was  very  distinct ;  he  got  hepar  30,  2  drops,  and  on 
the  morning  of  the  26th  an  incision,  5cm.  long,  was  made 
through  the  wound,  extending  through  the  fascia,  whereupon  a 
thick  stream  of  yellow,  inodorous  pus  gushed  out,  to  the  extent 
of  about  100  grammes.  The  compresses  were  continued  till  the 
28th;  his  temperature  had  fallen  to  37' 3°.  The  discharge  of 
pus  is  small,  the  new  wound  is  beginning  to  granulate,  and  the 
patient  feels  well.  But  from  this  time  the  temperature  again 
rose,  and  on  the  evening  of  the  30th  it  reached  38*9° ;  at  the 
same  time,  on  the  outer  aspect  of  the  thigh,  towards  the 
trochanter,  the  skin  is  reddened  to  the  extent  of  half  a  hand ;  it 
feels  hard.  The  flow  of  pus  from  the  large  cavity  is  free,  and 
there  is  no  reason  to  suppose  a  mechanical  retention  of  the  pus. 
So  as  nothing  surgical  could  be  done,  I  fell  back  on  the  specific 
remedy.  Since  the  incision  no  medicine  had  been  given,  and  I 
gave  J  drops  of  mere.  sol.  6.  The  next  morning  the  temperature 
fell  to  37*1° ;  on  the  morning  of  November  1  it  was  only  36° 
and  the  inflammation  was  gone ;  the  wound  was  healing  fast, 
and  the  cure  was  complete  in  a  fortnight,  the  whole  duration  of 
the  treatment  having  been  three  weeks. — Sick,  A.  h.  Z.y  cxxxi., 
p.  22. 

Amaurosis. — Sudden  blindness  is  one  of  the  most  distressing 
things  which  can  occur  to  mortal  man.  There  is  this  comfort, 
however,  that  it  is  sometimes  capable  of  prompt  removal.  Dr. 
Hirsch  long  ago  recorded  two  cases  of  the  kind,  traceable  to  cold, 
in  which  aconite  3  proved  rapidly  curative ;  and  they  are  trans- 
lated in  the  June  No.  of  the  HomoBopathic  Becorder, 

Aneurism. — Dr.  H.  S.  Fuller  communicates  two  cases  of 
aneurism,  in  which  cure  seems  to  have  been  effected  by  homoeo- 
pathic treatment.  Both  were  in  the  neck.  In  one,  occurring  in 
a  boy  of  15,  complete  disappearance  of  the  growth  took  place 
under  calcarea  phosphorica  2x.  In  the  other,  where  the  patient 
was  a  woman  of  45,  calcarea  fluorata  3x,  but  especially  12x  and 
30x,  caused  subsidence  of  the  pains,  which  were  severe,  and  a 


SUMMABY.  451 

shrinkage  of  the  tumour  by  one-half ;  so  that  she  became  able  to 
walk  any  distance  and  attend  to  household  duties. — Pacific  Coast 
Joum.  of  Horn,,  Aug. 

Bromidrosis  pedum. — Besides  the  petroleum  and  silicea 
already  of  repute  in  this  malady,  Dr.  Dearborn  gives  us  another 
remedy  in  thuja.  Led  by  stiffness  of  the  feet,  ulcerative  pain, 
drawing  sensation  in  the  toes,  relief  in  open  air,  aggravation  on 
resting  and  beginning  to  move,  he  gave  the  2x  and  3x  dils.  of 
this  drug,  and  a  permanent  cure  was  the  result. — N.  Amer,  Joum. 
of  Horn. f  Aug.,  p.  508. 

Boms. — In  a  clinical  lecture.  Dr.  Helmuth  says  of  the  man- 
agement of  burns :  ''As  soon  as  the  wound  is  cleaned,  it  is 
washed  thoroughly  with  a  stream  of  cantharides  water,  and  then 
dressed  with  calendula  cerate.  This,  after  long  experience,  I  am 
convinced  is  better  than  the  carbolic  acid,  eucalyptol,  icthyol,  and 
other  of  the  newer  methods  of  treatment." — N.  Amer,  Jouni,  of 
Horn,,  June. 

Cancer. — Dr.  J.  S.  Mitchell,  who  some  years  ago  propounded 
a  plan  of  treatment  of  malignant  sores  by  arsenic,  locally  and 
internally,  comes  forward  in  the  New  England  Medical  Gazette  for 
July  to  state  his  further  experience.  Thirty  per  cent,  of  the  sub- 
jects of  mammary  cancer,  on  whom  a  radical  operation  has  'been 
performed,  survive  the  three-year  limit,  and  hence  are  reckoned  as 
cured.  But  what,  he  asks,  of  the  seventy  per  cent.  ?  On  their 
behalf  he  pleads  for  further  use  of  medicinal  means.  *'  An  expe- 
rience of  143  cases  of  malignant  growths  of  the  mamma  in  tha 
last  six  years  enables  me  to  affirm  with  some  degree  of  positive- 
ness  that  a  persistent  treatment  with  homoeopathic  remedies 
internally  %nd  judicious  topical  application  is  decidedly  of  benefit." 
His  chief  remedies  are  arsenic  for  epithelioma,  conium  for 
scirrhus,  thuja  for  carcinoma.  After  ulceration,  he  sprinkles 
arsenicum  2x  on  the  sore. 

Dr.  Ord  relates  the  history  of  a  case  of  abdominal  papilloma, 
ascertained  to  be  such  by  exploratory  incision.  Singular  im- 
provement set  in  and  was  long  maintained  under  the  action  of 
thuja  Ix ;  though  the  patient  ultimately  relapsed  and  died. — 
Monthly  Horn.  Beview,  Aug. 

Cirrhosis  of  LiYer. — Dr.  Majumdar  communicates  some 
interesting  notes  upon  this  disease  as  occurring  in  children, 
which  it  seems  to  do  with  strange  frequency  in  Calcutta.     No 

VOL.  III. — NO.  4.  31 


492 

eoimeetioii  with  malaria  is  traceable.  He  thinks  it  frequently 
due  to  the  bad  practice  of  persisting  with  milk  diet  daring  the 
febrile  afiCections  of  infancy,  instead  of  sabstituting  sago  water, 
Ac.  The  liver  is  enlarged  at  first,  and  it  is  daring  this  stage 
that  medication — mainly  with  nox  vomica,  lycopodiam,  and  the 
preparations  of  lime — ^is  effective.  When  mnch  indaration  has 
occurred,  and  especially  when  contraction  and  jaundice  have 
set  in,  he  has  found  little  response  to  remedies. — Indian  Horn. 
BevieWf  July. 

Comea,  Ulcer  of. — ^Dr.  A.  B.  Norton  gave  apis  Ix  in  a  case  of 
vascular  ulceration  of  cornea,  led  by  the  great  cedema  of  eyes  and 
lids,  and  the  sharp  stinging  pains  in  the  eyes.  Improvement  was 
apparent  at  once  upon  giving  the  drug,  the  symptoms  rapidly 
disappearing;  and  cure  followed. — N.  Am.  Joum,  of  Hom.f 
August,  p.  509. 

Dandraft — ^A  medical  man,  afi9icted  with  this  trouble,  after 
trying  in  vain  many  measures  for  its  removal,  mixed  an  ounce  of 
sulphur  in  a  quart  of  water,  and  after  frequent  agitation  poured 
off  the  clear  fluid.  With  this  the  head  was  saturated  every 
morning.  In  a  few  weeks  every  trace  of  dandruff  had  dis- 
appeared, and  the  hair  became  soft  and  glossy. — Med.  Argus, 
July. 

Dropsy  of  Pre^ancy. — Dr.  A.  P.  Davis  relates  two  cases  in 
which  small  doses  of  tartar  emetic  had  a  most  rapid  beneficial 
effect  in  abating  the  dropsy  of  pregnancy  and  securing  a  safe 
delivery. — Med.  Century,  August  1. 

Dysentery. — ^We  need  no  confirmation  of  the  value  of  mer- 
curius  corrosivus  in  this  disease,  but  it  is  such  an  exquisite 
instance  of  homceopathicity  that  we  note  a  case  of  Dr.  Jousset's, 
published  in  L'Art  Midical  for  June,  which  well  illustrates  it. 
The  case  was  a  chronic  one,  and  at  his  entry  to  the  H6pital  St. 
Jacques,  on  March  1,  the  man  had  ten  stools  daily.  Under  the 
medicine,  given  in  the  3rd  dilution,  they  underwent  progressive 
diminution,  and  in  a  fortnight  were  formed  and  without  trace  of 
blood. 

Eczema. — Dr.  W.  E.  Taylor  relates  three  cases  in  which  this 
eruption  seemed  to  have  superve^ied  upon  malarial  poisoning. 
In  the  first  two  the  symptoms  were  those  of  the  cachexia,  with 
special  hepatic  involvement,  and  here  mercurius  vivus  3x  to  6x 
effected  a  prompt  cure.    In  the  third,  daily  chills  were  present, 


SUMMABT.  453 

and  eupatorium  perfoliatum  200  sufficed  for  both    ague    and 
eczema. — The  Gliniqtie,  June. 

HydFopericardiam. — A  locomotive  driver,  aged  45,  who  had 
consulted  me  the  beginning  of  last  year,  and  whose  cardiac 
dilatation  had  been  so  ameUorated  by  cactus  6  and  spigelia  30 
that  he  was  able  to  resume  his  duties  in  the  middle  of  this  year, 
came  to  me  on  December  21  with  new  symptoms.  He  could 
only  feel  tolerably  easy  when  at  absolute  rest,  and  with  the  upper 
part  of  his  body  bent  forwards.  Every  movement,  and  particu- 
larly movement  in  a  confined  space,  brought  on  the  most  violent 
dyspnoea.  The  same  occurred  when  he  lay  down,  and  caused  him 
to  be  sleepless.  This  affection  had  come  on  suddenly  after  getting 
his  feet  wet  in  the  snow,  and  his  heart  beat  with  frightful  irregu- 
larity, and  he  had  also  a  sensation  as  though  it  "wallowed." 
Colchicum  seemed  to  be  the  most  indicated  medicine,  though  the 
homoBopathicity  of  it  was  but  slight.  He  got  colch.  30.  Examina- 
tion showed  that  the  case  was  one  of  hydropericardium,  and  the 
fluid  in  the  pericardium  was  not  inconsiderable  in  amount,  for  the 
dull  percussion  sound  extended  beyond  the  right  border  of  the 
sternum.  He  got  a  drop  of  colch.  three  times  a  day.  In  two 
days  he  was  much  relieved,  and  on  the  fifth  day  he  said  he  could  lie 
almost  always,  and  he  only  required  to  raise  himself  up  occasiou- 
ally,  especially  at  night.  A  week  later  he  said  he  could  lie,  sleep 
and  walk,  and  on  January  15,  twenty-four  days  after  the  com- 
mencement of  his  illness,  he  was  able  to  return  to  his  occupation. 
When  I  saw  him  on  the  fifth  day  the  extent  of  dulness  had 
diminished  to  the  normal,  and  only  the  subjective  symptoms 
remained. — Villers,  Arch.f,  Hom.f  iv.,  83. 

Iritis. — An  iritis  occurring  in  a  man  of  32  had  proved  obsti- 
nate, resisting  all  treatment  for  two  or  three  weeks.  The  pupil 
had  been  kept  well  dilated  by  atropine,  yet  the  eye  made  no  im- 
provement, and,  if  anything,  seemed  to  grow  worse.  At  this 
time  the  lids  became  oedematous,  and  profuse  gushes  of  tears 
occurred  on  opening  the  eyes.  There  was  severe  pain  in  and 
around  the  eyes,  worse  at  night  and  in  damp  weather.  Rhus  3x 
was  now  given  with  prompt  relief,  and  cure  was  complete  after 
ten  days. — Norton,  North  Amer,  Journ.  of  Horn.,  August,  p.  510. 

Laryn^smus  stridulas. — Dr.  Ghapin  states  that  in  a  num- 
ber of  cases  he  has  had  he  has  found  that  the  use  of  chlorine 
water,  to  smell,  will  relieve  the  spasm  almost  instantly. — North 
Amer,  Journ.  of  Horn.,  August,  App.,  p.  64. 


454  BUMMABT. 

LeooOFPhoBa. — An  old-school  physician,  Dr.  Slocum,  recom- 
mends the  persistent  use  of  cantharis  in  this  trouhle  occurring 
in  young  unmarried  women,  where  local  examination  is  undesir- 
able. His  dose  is  very  small,  and  strangury  or  other  unpleasant 
symptoms  are  not  produced.  "  The  action  of  the  drug  has  been 
so  uniformly  satisfactory,  that  when  it  fails  such  result  forms 
a  strong  basis  for  suspecting  something  more  than  simple 
hyperoBmiaor  mild  inflammation." — Horn.  Journal  of  OhstetricSy  &c. 

Looomotop  Ataxy. — Dr.  Simpson  contributes  a  case  having 
all  the  features  of  this  disease,  in  which  aluminium  6  relieved  the 
muscular  weakness,  the  formication,  the  numbness  of  the  feet, 
and  the  tottering  gait.  Phosphorus  6  was  then  given  for  some 
time,  at  the  end  of  which  "  the  patient  expressed  himself  free 
from  pain  and  discomfort,  and  strong  to  labour  and  endure." 
— Monthly  Horn,  Beview,  August. 

Meningitis. — Dr.  Bourgeois  reports  to  the  Belgian  Academy 
of  Medicine  some  striking  results  obtained  in  this  affection,  when 
occurring  in  children,  from  minute  doses  of  the  fluoride  of  sodium. 
He  gives  a  milligramme  daily  for  each  year  of  age,  doubling  the 
dose  after  twenty-four  hours  if  improvement  has  not  set  in,  and 
reducing  it  when  decided  amelioration  appears.  He  can  claim 
seven  genuine  cures  out  of  eleven  cases  treated  by  this  medica- 
tion.— UArt  Medical,  August. 

Myxoedema. — In  an  article  on  this  disease.  Dr.  Halbert 
relates  a  case  cured  mainly  by  physical  and  mental  gymnastics. 
Arsenicum,  indeed,  was  given  throughout,  at  first  in  the  3rd  and 
later  in  the  30th  and  200th  potency  ;  but  recovery  seemed  mainly 
due  to  the  systematic  exercise  of  mind  and  body  so  judiciously 
and  persistently  carried  out. — The  Gliniqite,  August. 

OtOFPhoBa. — Dr.  Hengstebeck  reports  the  case  of  a  boy  who, 
after  an  attack  of  scarlet  fever,  was  seized  with  acute  otitis 
media,  which  gradually  became  chronic,  with  continuous  dis- 
charge of  pus.  Calcarea  iodata  3x  was  administered,  and,  after 
cleansing  the  ear,  some  of  the  trituration  was  blown  into  the  ear 
with  an  insufflator.  In  a  few  weeks  the  discharge  had  diminished, 
and  still  later  it  disappeared  entirely. — Hahn.  Monthly,  July,  p.  458. 

Pelvi-pepitonitiB  pueppepalis. — A  primipara,  aged  36,  was 
happily  delivered  of  a  child  beginning  of  January,  and  placenta 
completely  removed.  Two  days  afterwards  had  a  slight  rigor, 
pressure  and  burning  in  stomach,  eructation,  nausea  and  vomiting, 
moderate   thirst,  white-coated   tongue,  abdomen  not  tender    to 


pressoie.  Gold  eompresses  to  abdomen;  ant.  cr.  3  every  four 
hours.  Daring  the  following  days  temperature  rose  to  4(P; 
sensitiyeness  of  abdomen  to  pressure,  especially  in  anterior  ovarian 
region;  increased  signs  of  peritonitis,  distension  of  abdomen, 
fieqaent  bilious  vomiting,  freqaent  (eight  to  ten)  watery  stools 
in  twenty-four  hours,  scanty,  foetid  lochia ;  rapid  emaciation, 
sunken  features,  smaU  poise.  She  complains  Httle,  hands  and 
feet  cool,  tosses  about  on  bed,  cannot  bear  any  bed  clothes. 
She  got  secale  com.  2  every  two  hours,  with  cold  compresses. 
Improvement  gradually  set  in,  the  diarrhcea  became  less,  the 
thirst  abated,  the  sensitiveness  of  abdomen  and  facial  expression 
improved,  appetite  got  better,  sleep  quieter  and  more  prolonged. 
The  distension  of  abdomen  lasted  some  time  longer,  for  which 
she  got  opium  3  every  four  hours.  Towards  the  end  of  the  month 
she  was  convalescent.  For  a  considerable  time  she  took  tepid, 
later,  cold  sitz  baths  until  her  final  recovery. — Groos,  A,  h,  Z,, 
cxxxi.,  p.  11. 

Phlebitis. — Dr.  Elizabeth  Garrett  communicates  a  case  of 
puerperal  phlebitis  making  a  speedy  and  good  recovery  under 
Pulsatilla  3.  The  general  as  well  as  the  local  symptoms  of  the 
drug  were  present. — Horn.  Joum,  of  Obstetrics,  &c.,  May. 

PpilritliB. — In  the  Bevue  Horn.  Frangaise  for  June — July,  Dr. 
Tessier  gives  a  valuable  study  of  pruritus  and  prurigo,  considered 
as  tegumentary  trophoneuroses.  The  internal  medicines  he  has 
found  most  useful  are  the  carbohc,  picric,  and  saUcylic  acids, 
antipyrin,  chloral,  euphorbium,  mezereum,  naphthalin,  opium 
and  especially  morphia,  rumex,  and  vanilla. 

PsoriasiB. — A  cure  of  psoriasis  of  two  years'  standing,  in  a 
girl  of  10,  is  recorded  by  Dr.  Mackechnie.  Cuprum  metallicum 
(dilution  not  stated)  was  the  remedy. — Monthly  Horn.  Review,  May. 

Pyelitis. — J.  F.,  aged  39,  had  intense  pains  in  both  kidneys, 
worse  in  left ;  pain  in  penis  during  urination,  which  occurs  at 
hourly  intervals  or  less ;  chill  recurnng  about  -I  p.m.,  followed 
by  fever  (temperature  103*6^) ;  breathing  short  and  laboured, 
alae  nasi  working  much  ;  much  flatulence ;  thirst  and  prostration : 
general  aching,  worst  in  back  and  head ;  heavily  coated  tongue. 
Urine  was  1015,  acid,  heavily  loaded  with  albumen ;  blood  and 
pus  corpuscles  very  abundant.  All  the  above  symptoms  were 
cleared  away,  temperature  coming  to  normal  in  a  week  and 
staying  there,  under  lycopodium  6. — N,  Am,  Joum,  ofHom.^  June, 
p.  381. 


456  SUMXABT. 

Rheumatio  F^Ter.— Dr.  Lamb,  of  Danedin,  N.  Z.,  who  has 
expressed  his  disappoinUnent  with  the  "orthodox"  homoBO- 
pathio  treatment  of  acute  rheumatism  with  aconite  Ix  and 
bryouia  lx»  has  foand  an  effective  substitute  in  eight-drop  doses 
of  the  mother  tincture  of  the  latter  medicine.  He  relates  three 
oases  in  point. — Monthly  Horn.  Beview,  July. 

Soiatioa. — Dr.  Tooker  records  a  case  which,  after  long- 
continued  treatment  of  all  kinds,  speedily  and  permanently 
recovered  when  sulphur  3x  was  administered.  The  indications 
were  those  given  for  the  drug  in  Lilienthal's  "  Therapeutics/' — 
North  Am^  Joum.  of  Horn.,  June. 

Spiiial  Initation. — ^Dr.  O.  L.  Smith  reports  that  to  relieve 
the  pains  of  spinal  irritation  he  finds  gelsemium,  in  mother  tinc- 
ture, **more  frequently  indicated  and  attended  with  happier 
results  than  almost  any  other  remedy."  Sometimes,  he  adds, 
the  tincture  of  cimicifuga  has  proved  quite  as  efficacious. — The 
Clinique^  July. 

Tetanus. — ^Dr.  SeUridge  relates  two  cases  of  traumatic  tetanus 
which  have  come  under  his  notice.  One  died — treatment  not 
mentioned ;  the  other  recovered  under  nux  vomica  200. — Pacific 
Coast  Joum.  of  Horn*,  June. 

» 

Trismus  necmatOFam. — Dr.  St  Glair  Smith  says  that  cicuta 
has  been  the  remedy  most  successful  in  his  hands  against  this 
dangerous  malady.  He  has  seen  three  cases  treated  vdth  it 
recover. — North  Amer.  Joum.  of  Hom.^  June. 

Yarioose  Uloen. — An  old-standing  case  of  this  kind,  where 
rest  was  impracticable,  is  reported  by  Dr.  Dearborn.  Internal 
treatment,  by  fluoric  acid  3x,  kali  bichromicum  12,  and  phos- 
phorus 12  in  succession,  effected  a  complete  cure. — Med.  Century, 
June  15. 

Variola. — Dr.  Bhaduri  writes  that  quite  a  virulent  epidemic 
of  small-pox  has  raged  at  Calcutta,  and  that  great  success  has 
been  gained  by  homcDopathic  treatment.  '*  We  have  been  able 
to  check  hsemorrhages  in  the  pocks  by  the  exhibition  of  medicines 
like  arsenic,  crotalus,  rhus  tox,  &c.;  and  we  have  made  the 
disease  take  a  milder  type  by  the  use  of  vaccinine.  The  last 
medicine  has  helped  us  more  than  any  other,  and  even  beyond 
our  expectation,  in  this  epidemic." — Indian  Horn.  Beview,  May. 


INDEX 

To  the  Transactions  J  etc.f  of  the  Society. 


FAOB 

Abdominal  Operations,  A  Period  of  Twenty-one  Months'  Work  in :  (G. 

Burford)         ..            ...            ..            ..            ..            ..            ..  422 

Abdominal  Section,  Two  cases  of :  (E.  A.  Neatby)       ..            ..            ..  428 

Acidum  Fluoricum,  its  Action  on  the  Veins :  (W.  Epps)          . .            . .  219 

Actino-mycosis  ?  a  Knotty  case :  (J.  Galley  Blackley)               . .            . .  356 

Aneurism  of  the  Aorta,  Specimens  of             . .            .  •            . .            . ,  481 

Angina  Pectoris,  a  Severe  case  of:  (E.  M.  Madden)    . .            . .            . .  874 

Ankle  Strain :  (E.  Blake)  . .            •  •            . .            • .            . .            . .  264 

Annual  Beport,  Council     . .             . .             . .             .  •             . ,             . ,  486 

Annual  Beport,  Liverpool  Branch  . .            . .            . .            . .            • .  92 

Bacteriology,  the  relation  of,  to  treatment :  (P.  Douglas  Smith)            . .  889 

Balance  Sheet      . .            .  •            . .            . .            • .            . .            . .  487 

Blackley,  J.  Galley :  a  Knotty  case,  ?  Actino-mycosis. .            . .            . .  856 

Blake,  E. :  Ankle  Strain     . .            . .            . .            •  •            . .            . .  264 

Breathing,  Deep :  (H.  E.-Deane)     ..             ..             ..             ..             ..  180 

Burford,  G. :  On  the  Successful  Therapeutic  Treatment  of  a  Case  of 
Ovarian  Tumour,  with  Gteneral  Considerations  on  the  Amenability 

of  these  Neoplasms  to  Drug  Treatment . .             . .             . .             . .  247 

On  a  Period  of  Twenty-one  Months*  Work  in  Abdominal  Opera- 
tions, and  without  a  Death,  in  the  Gynecological  Department  of 
the  London  Homoeopathic  Hospital       . .            • .            . .            . .  422 

Calculus,  Benal :  Specimen  of         . .            . .            . .            . .            . .  488 

Capper,  E. :    The  Method  of  Hahnemann  and  the  Homoeopathy  of 

to-day :  a  Comparison               . .             . .             . .             . .             , ,  l 

Cerebro-spinal  Disease,  Chronic  Mercurial  Poisoning  in  its  Relation  to 

Various  Forms  of:  (J.  McLachlan)         ..             ..             ..             ..  120 

Cooper,  R.  T. :  Polypus  of  the  Ear  . .             . .             . .             . .             . .  144 

Cuprum,  a  Case  of  Severe  Angina  Pectoris  markedly  relieved  by :  (E.  M. 

Madden)        ..            ..            ..             ..            ..            ..            ..  874 

Day,  J.  Roberson :  Myxoedema       .  •            . .            . .            . .            . .  289 

Deane,  H.  E. :  Deep  Breathing       . .             . .             . .             . .             . .  180 

Digestion,  Errors  of :  (C.  R.  Niven)               . .             . .             . .             . .  294 

Drug  Action,  Cases  illustrative  of :  (E.  Mahony)         . .             . .             . .  485 

Drug  Pathogenesy,  how  to  learn :  (J.  W.  Hayward)  . .            . .            . .  26 

Dyce  Brown,  D. :  on  Acute  Hepatitis            . .            • .            . .            . .  42 

Ear,  Polypus  of :  (R.  T.  Cooper)      . .            . .            . .            . .            . .  144 

Eczema,  Osmic  Acid :  (J.  Jonnstone)            . .             . .             . .             . .  866 

Enuresis,  Nocturnal  in  Children  :  (H.  Wynne  Thomas)           . .             . .  172 

Epilepsy,  Major,  and  its  Treatment :  (B.  Thomas)      . .             . .             . .  158 

Epps,  W. :  Acidum  Fluoricum,  its  Action  on  the  Veins,  with  Cases  of 

Varicose  Veins  and  Ulcers        . .            . .            . .            . .            . .  219 

Eye  and  Ear,  Comparison  of  the  drug  symptoms  of :  (W.  T.  Ord)          . .  73 


458  INDEX. 

PAGE 

Flnorio  Aoid :  its  Action  on  the  Veins :  (W.  Epps)  . .  . .     219 

GlMids,  Tabercnloas  Cervical :  (D.  BiacNish)  . .  .  •  . .     146 

Hahnemann,  Method  of :  (E.  Capper)          . .            .  •            . .              . .  1 

Hajward,  J.  D.  :  A  Case  of  Multiple  Hydrocele  of  the  Cord  simulating 

a  Hernia        ••            ..            ..            ..            ••            ••              ..  196 

Hayward,  J.  W.  :  How  to  Learn  Drag  Pathogenesy  . .            . .              . .  26 

Hayward,  C.  W.  :  Acute  Periostitis,  with  especial  reference  to  its  graver 

form,  Acute  Necrosis                • .             . .             . .            . .              . .  379 

Heart,  Dilatation  of :  specimen       . .            . .            . .            . .              . .  431 

Hepatitis,  On  Acute :  (D.  Dyce  Brown)        .  •             . .             . .              . .  42 

Homooepathy  of  To-day :  (E.  Capper)           . .            . .            . .              . .  1 

Hydrocele  of  the  Cord :  A  Case  of :  (J.  D.  Hayward) . .            . .              . .  196 

Johnstone,  J. :  Osmic  Acid  Eczema  . .  . .  . .  . .     366 

Kalmia  Latifolia :  (J.  ft.  P.  Lambert)         . .      *      . .  . .  . .     279 

Lambert,  J,  R.  P. :  Kalmia  Latifolia            . .  . .  . .  . .  279 

Lateral  Curvature  of  the  Spine  :  (Gerard  Smith)  . .  . .  . .  113 

Liver,  Chronic  Enlargement  of  :  (case  of)    . .  . .  .  •  .  •  452 

Liverpool  Branch :  Annual  Report               . .  . .  . .  . .  92 

MacNish,  D. :  Tuberculous  Cervical  Glands. .  . .  • .  . .  146 
Madden,  E.  M.  :  Notes  on  a  case  of  Infantile  Scurvy  . .  . .  311 
A  Case  of  Severe  Angina  Pectoris,  with  Oiganic  Heart  Disease, 

markedly  relieved  by  Cuprum  . .  . .  . .  . .  • .  374 

Mahony,  E. :  Cases  Illustrative  of  Drug  Action         . .  . .  . .  436 

McLachlan,  J. :  Chronic  Mercurial  Poisoning  in  its  Relation  to  various 

forms  of  Cerebro-Spinal  Disease  . .  . .  . .  . .  120 

Mercurial  Poisoning :  (J.  McLachlan)  . .  . .  . .  . .  120 

Moir,  Byres  :  Pulse  Tension  :  its  Importance  as  an  Early  Indication  of 

certain  Chronic   Diseases,  and  its  Recognition  by  means  of  the 

Sphygmograph  ..  ..  ..  ..  ..  ..  339 

Myzoedema :  (J.  Roberson  Day)       . .  . .  . .  . .  . .  239 

Neatby,  E  A.  :  Two  Cases  of  Abdominal  Section       . .  . .  . .     423 

Niven,  C.  R.  :  Errors  of  Digestion . .  . .  . .  . .  . .     294 

Ord,  W.  T.  :  A  Comparison  of  the  Drug  Symptoms  of  the  Eye  and  Ear  : 

their  Analogies  and  Practical  Importance            . .  . .  . .  73 

Osmic  Acid  Eczema  :  (J.  Johnstone)             . .             . .  . .  . .  366 

Ovarian  Tumour,  Therapeutic  Treatment  of  ;  (G.  Burford)  . .  . .  247 

Ovarian  Cyst,  Cured  by  Rest  and  Drugs :  (J.  C.  Pincott)  . .  . .  255 

Ovarian  Cysts  :  (Specimens^            . .             . .             . .  . .  . .  433 

Ovary,  Adenoma  of  :  (Specimen)    . .             . .             . .  . .  . .  433 

Ovary,  Dermoid  of :  (Specimen)      . .             . .             . .  . .  . .  434 

Ovarian  Tumours,  Solid :  (Microscopical  Specimen)  . .  . .  . .  434 

Palate,  Adeno-Sarcoma  of  :  (Cast)  . .             . .             . .             . .             . .  433 

Peri-ostitis :  (C.  W.  Hayward)         . .             . .             . .             . .             . .  379 

Pincott,  J.  C.  :  Clinical  Notes  of  a  Case  of  Ovarian  Cyst,  cured  by  Rest 

and  Drugs     ...            ..             ..             ..             ..             ..             ..  255 

Presidential  Address  :  (Byres  Moir)               . .             . .             . .             . .  339 

Presidential  Address,  Liverpool  Branch  :  (E.  Capper)              . .             . .  1 

Prostate,  A  Discussion  on  the  Treatment  of  Hypertrophy  of :  (0.  Knox 

onawi             ..             ..             .«             ..             ..             ««             ..  oV/t/ 

Pulse  Tension :  Presidential  Address :  (Byres  Moir)  . .            . .            . .  339 

Scurvy,  Notes  on  Cases  of  Infantile  :  (E.  M.  Madden)  . .  . .     311 


INDEX.  459 

PAGE 

Shaw,  C.  Knox  :  A  Discussion  on  the  Treatment  of  Hypertrophy  of  the 

Prostate,  together  with  its  Retention  of  Urine  and  Cystitis  . .     399 

Smith,  Gerard  :  Corrective  Postures  in  Lateral  Curvature  of  the  Spine    118 
Smith,  P.  Douglas :  The  Belation  of  Bacteriology  to  Treatment  . .     389 

Society  News   ...  ..  ..  ..  ..  ..       94,320,438 

Spine,  Corrective  Postures  in  Lateral  Curvature  of  :  (Grerard  Smith)  . .     113 
Stomach,  Diffuse  Infiltrating  Carcinoma  of  :   (Specimen)        . .  . .     432 

Summary  of  Pharmacodynamics  and  Therapeutics  . .  96«  200,  322,  439 

Thomas,  B.  :   Major  Epilepsy  and  its  Treatment      ..  ..  ..     158 

Thomas,  H.  Wynne  :  Nocturnal  Enuresis  in  Children  . .  . ,     172 

Typhoid,  Perforating  Ulcer  :  (Specimen)      . .  . .  . .  . .     432 

Uterus,  Myomata  of  :  (Specimen)    . .  . .  . .  . .  . .     434 

Veins,  Action  of  Acidum  Fluoricum  on  :  (W.  Epps)  . .  . .  . .     219 

Weirs  Disease  :  (C.  Wolston)  . .  . .  . .  . .  . .       54 

Wolston,  C.  :  Weil's  Disease  . .  . .  . .  . .  . .       64 


VOL.   III. — NO.   4.  32 


INDEX 


To  Summary  of  Pharmacodynamics  and  Therapeutics. 


>i 


>i 


Abscess 

Aciduin  Beozoicum 
Carboiicum 
Muriaticum 
„      Nitricum  . . 
Aconite 
Acne . . 
Actsea 
Adonis 
Agaricus 
Albuminuria 
Amaurosis  . . 
Ammonium  Carbonicum 
Anacardium 
Anasarca 
Aneurism 
Antipyrin 
Antitoxin 
Apis  . . 
Apocynum  . .         . .     97 
Aranea 

Arbutus  Andrachne 
Arsenicum  .  .97,  201,  210 

„        Bromatum 

„        lodatum 
Arum 

Asafoetida    . . 
Atropine 
Aurum 
Azaridachta 

Baptisia 

Barlow's  Disease 

Baryta 

Belladonna. 

Berberis 

Blatta 

Borax 

Bright's  Disease 

Bromidrosis  Pedum 

Bromine 


PAGE 

..  449 
..     439 

96,  322 
..  200 
217, 322 
..       96 

97,  210 
..  200 
..  439 
..  322 
106,  331 
..  450 
..  96 
..  97 
..  322 
..  450 
..  323 
..     439 

200,323 

200,  332,  439 

97,200 

323 

215,  323,  440 

97 

201,  440 

..     206 

..       98 

..     440 

..     441 

..     441 

..     441 

..     106 

..     323 

98,  206,  323 

206,  441 

441 

441 

332 

451 

206 


Bums 

PAGE 

. .     451 

Calcarea 

324,  442 

„      Fluorata 

324,  442 

„      Phosphorica 

. .     207 

„      Silicata 

. .       98 

Camphor     . . 

98,  207 

Cancer 

332,  451 

Cannabis  Tndica    . . 

98,  324 

,,        Sativa     .. 

. .     442 

Cantharis    . . 

. .     442 

Capsicum    . . 

. .     442 

Carbuncle    . . 

. .     210 

Cataract 

. .     207 

Caulophyllum 

..       99 

Causticum  . . 

. .       99 

Ceanothus  . . 

. .     207 

Chenopodium 

. .     324 

Cholera  Infantum . . 

. .     106 

Choroiditis  . . 

. .     105 

Cimicifuga  .. 

. .     325 

Cinchona     . . 

. .     325 

Cineraria     . . 

. .     207 

Cinnabar     . . 

. .     443 

Cirrhosis  of  Liver. . 

210,  451 

Clematis 

. .     325 

Cocaine 

. .     336 

Cocculus     . . 

. .     443 

Coff  ea          . .         . . 

99,  443 

Colchicum  . .         . . 

. .     326 

Colic . . 

. .     106 

CoUinsonia  . . 

. .     326 

Conium 

. .  99,  207,  326 

Copaiba 

. .     207 

Coprophagia 

. .     332 

Corallinm    . . 

. .     443 

Cornea,  Opacity  of 

. .     206 

,,       Ulcer  of     .. 

. .     462 

Cracked  Nipples    . . 

. .     332 

Crusta  Lactea 

..     330 

Cundurango 

. .     443 

INDEX. 


461 


Cntaneoos  Disease 
Gystosplasm 


PAGE 

..     107 
107, 210 


Dandruff 

Diabetes      ..         ..   211,330, 

Diarrhoea 

Diphtheria  101,107,206,208, 
Dropsy  of  Pregnancy 
Dubbisia 
Dysentery    . . 
I^smenorrhoea      . .    108,  208, 


Eczema 
Enuresis 
Ephedra 
Epilepsy 
Epistaxis     . . 
Erythema  Nodosum 
Euphrasia  . . 


Fabiana 
Ferrum 

„      lodatum 
Filix  Mas    . . 


Gangrsena  Pulmonum 

Glandular  Swellings 

Glonoin 

Goitre 

Gonitis 

Gout . . 

Graphites    . . 

Hamamelis . . 
Heloderma  . . 
Hepar  Sulphuris 
Hydrocotyle 
Hydropericardium 
Hyoscyamus 
Hypericum . . 


Ignatia 

Influenza 

Inosituria 

Iodine 

Iodoform 

Ipecacuanha 

Iritis . . 


Kali  Bichromicum 

„    lodatum 

„    Phosphoricum 
Kalmia 

Lachesis 

Laryngismus  Stridulus 
Ledum        . . 
Lemna 
Leucorrhoea 
Loco . . 


..     452 

333.448 

..     333 

333,337 

..     452 

444 

108,  452 

328,331 

..  452 

108,  333 

..  444 

..  108 

.,  96 

..  334 

..  327 

..  444 
327,  444 
..  208 
..     827 


..     334 

..     212 

99,  109,  327 

213,  334,  446 

..     334 

109,  439 

..     445 

218,  327 
..  100 
100,  328,  336 
100 
453 
208 
100 

328 
109 
214 
334,  445 
445 
100 
453 

328 
100 
101 
101 

445 
453 
328 
101,  445 
454 
446 


Locomotor  Ataxy  . . 

Lupus 

Lycopodium 

Magnesia  Carbonica 
„        Phosphorica 

Manganum . . 

Melancholia 

Meningitis  . . 

„         Spinalis 

Menorrhagia 

Mercurius   • . 

„         Gyanatus 

Metrorrhagia 

Mezereum  . . 

Moschus 

Myelitis 

Myristica     . . 

MyxoBdema 


PAGE 

454 
329 
101 


..  328 
..  206 
..  101 
..  109 
109,  454 
..  214 
215.  336 
..  101 
..  208 
105,  215 
..  208 
..  328 
..  110 
..  208 
..  454 


^aia  <  •         •  •         •  • 
Natrum  Muriaticum 
Nightmare  . . 
Nux  Moschata 
„    Vomica 

Ocimum 
Onosmodium 
Opium 

Ophthaliiiia  Granulosa 
Scrofulosa 


>» 


Otorrhoea    . . 

Oxaluria 

Ozsena 

Pelvi-peritonitis 

Pemphigus  . . 

Periostitis   . . 

Pertussis 

Phlebitis     . . 

Phosphorus 

Phthisis 

Phjrtolacca . . 

Plantago 

Pneumonia.. 

Podophyllum 

Prolapsus  Uteri 

Pruritus 

Psoriasis 

Ptelea 

Pulsatilla 

Pyelitis 

Pyrus  malus 

Quinine 

Rheumatism 
Rhus 

,,    Aromatica 
Rigid  OS 
Robinia 


..  329 
102,  446 
..  97 
..  329 
..     102 

. .  208 
..  329 
..  829 
..  110 

100,  441 
100,  216,  328,  454 
..  216 
..  445 
..  454 
..  336 
..  208 

110,  322 

110,  455 
102,  329,  446 
111,  203,  209 

..  209 
..  209 
96,  336,  445 
..  446 
..  336 

111,  455 
455,  458 

..  209 

108,  329,  446 

336,  455 

..  446 

. .  102 

326,  328,  456 
209,  830 
. .  108 
. .  337 
. .  330 


4G2 


INDEX. 


Salpingitis  . 

Sanguinaria 

Scarlatina 

Sciatica 

Seoale 

Senecio 

Sepia 

SeptiofiBmia. 

Silicea 

Solanum 

Spigelia 

Spinal  Irritation 

Spleen,  Enlarged 

Stannum  lodatum 

Staphisagria 

Stellaria 

Sticta 

Stomach,  Ulcer  of. 

Stramonium 

Strontium   . . 

Strophanthus 

Strychnine  . . 

Sulphur 

Symphytum 

Syphilis 

Syzygium    . . 


PAGE 

216 
447 
337 
456 
106 
102 
102 
330 
103,  447 
447 
104 
456 
207 
209 
447 
447 
209 
201 
•  830 
330 
104 
104 
330,  334,  447 
105 
216 
830 


PAGE 

Tabacum     . .         . .         . .         . .     447 

Tetanus       ..         ..         ..        337,456 

Thlaspi        105,448 

Thrombosis 217 

Thuja  330,448 

Torticollis Ill 

Trachoma Ill 

Trismus  neonatorum       . .         . .     456 

Tuberculinum        448 

Tumours     . .         . .         . .         . .     215 

Typhoid  Fever Ill 

Uranium 105, 448 

Urticaria 323, 326 

Vanilla        449 

Varicose  Ulcers 456 

Variola        456 

Veratrum  Viride 449 

Vespa  209 

Viburnum  . .         . .         . .         331,  449 

Viola  Odorata        105 

Wounds 338 

Zincum       ..         ..         ..         ..331 

„       Valerianicum     ..         ...  449 


CM