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01 ?v

THE

KNOWLEDGE OF THE PHYSICIAN,

a Course of lectures

DELIVERED AT THE BOSTON UNIVERSITY SCHOOL OF

MEDICINE, MAY, 1884.

RICHARD. RUCHES, M.D,

BOSTON :
OTIS CLAPP AND SON.

1884.

KLKCTROTYPED AND PRINTED

BY RAND, AVERY, AND COMPANY,

BOSTON, MASS.

r • • • • • • • •

••• • r *

1^'

£^'i

I. T. TALBOT, M.D.,

DEAN

OF THE BOSTON UNIVERSITY SCHOOL OF MEDICINE,

Ci)ts Uolume is IBeHtcateti

BY HIS FRIEND AND SINCERE APPRECIATOR,
THE AUTHOR.

CONTENTS.

. LECTURE I.

THE KNOWLEDGE OF LIFE.

Introduction. — Medicine an art, ministered to by its associated
sciences. — All sciences made up of phenomena, laws and
causes. — The subject of Physiology life. — Life the diffe-
rentia of the vegetable and animal creation. — Not motion,
even spontaneous motion. — Not growth and waste. — Life
consists in assimilation and reproduction. — These essen-
tially one process, and capable of being pei formed by
a single substance. — Protoplasm. — Vitality a property
thereof. — Identical with " Irritability " of Brown. — History
of discovery. — Fletcher, Beale, Drysdale. — The proto-
plasmic doctrine of life a better basis for philosophy
of homoeopathy than that of a " vital force." — Views, of
Hahnemann and Tessier. — Life no entity, but a music
of which organism is instrument. — Living matter seat of
disease and drug-action. — Of illimitable sensitiveness, but
matter still. — We should be dynamists, without being pneu-
matists

LECTURE IL

THE KNOWLEDGE OF HEALTH.

The physician a hygienist as well as a therapeutist. — Hahne-
mann and his school exemplify this. — The physician should
lead the healthy life he inculcates. — Elements of hygiene:

GHfN^^

PAGB

VI CONTENTS.

PAGB

Exercise — Rest — Warmth — Air — Food — Water — Tea
and Coffee — Tobacco — Alcohol 22

LECTURE III.

THE KNOWLEDGE OF DISEASE.

Semeiology, aetiology, pathology. — First alone certain, and there-
fore chosen by Hahnemann as disease-basis of his method.
— Is it sufficient ? — Not so for nosology, prognosis, diag-
nosis. — For drug-therapeutics symptomatology surer, more
thorough, and more effective than pathological inference. —
Carroll Dunham. — Illustration from Fevers, mflammations,
neuroses. — Aid given by pathology. •— The homoeopathic
examination of the patient. — Subjective Symptoms. — Dr.
Russell Reynolds. — Supremacy of Clinical Medicine. —
Sir Andrew Clark •••••• 45

LECTURE IV.

THE KNOWLEDGE OF MEDICINES.

Medicines and Foods. — Modes of discovering medicines • The
empirical — The rational, from action in health. — Hahne-
mann. — S)rmptomatology here also of chief importance. —
Physiology and pathology also of value. — The usus in
morbis. — Characteristics. — Drug-action, unlike disease, can
be studied only in books. — Importance therefore of detailed
records. — The schema available for reference only, not for
study. — Text spoilt by it. — Illustration. — Original narra-
tives must be restored 68

LECTURE V.

PYREXIA AND THE ANTIPYRETICS.

Nature of fever. — Heat-production and heat-radiation. — Hyper-
oxidation main source of febrile heat. — May also occur
from deficient liberation of heat through skin, and from loss
of nervous control over whole process (hyperpyrexia). —
Hectics and intermittents. — Former and present classifica-
tion of fevers. — Antipyretic treatment as ordinarily prac-

^^^^^^^H^

vii

P tiaed. —The antipjrelic remedies of homteopafhy. — I. Aco-

'"=■

LECTURE Vr.

PYREXIA AND THE ANTIPVBETICS Imuli-uid).

II. Belladonna; HyoscyamuB, Stramonium, Agarlcus, VeraHum

viride. — III. Arsenic; Cinchona and Quinine, Lachesis and

* CroUlus. — IV. Btjoniii Rhus, Phosphoric and Muriatic

Adda, Eaplisia

LECTURE VII.

RHEUMATISM AND THE ANTI-RHEUMAllCS.

Rheumatic fever, — Lactic acid its probable nmlrriss morbi ;

hence inapplicable in its treatment. — Alkaline irealmenl. —

— Fibrous rheumatisms.— Anti-rheumatics; L Bryonia;

Aconite, Colchituin, Pulaatilla, Propylamine. — Salicylic

LECTURE VIIL

RHEUMATISM AND THE ANTI-RHEUMATICS (™(««J).

IL Rhus: Dulcamara, Rhododendron (Kalmia, Spigelia). — HI.

1 Cimidfuga; Caulophyllum, Ledum, Rnla, VioU odorala.—

1 IV. Mercuriua ; Kali bichromicum, Phytolacca.— V, Arsenic ;

1 Lactic add. — VI. Sulphur

i6:

LECTURE IX.

CEREBRAL LOCALISATION AND DRUG ACTION.

Histor)- of assignment of function in nervous system to 1830.—

Further progress since then. — The cerebellum. — The sen-

sory and motor paths through cord to brain. — The basal

ganglia.— The cerebrum the sole seat of consciousness. —

Does not act as a vfhole. — Gall and Spurzheim.- The

cerebral convolutions. — Aphasia. — Localisation of specch-

centre.- Electrisation of cortex. — Fritsch. Hiuig. Fcrricr.

Vlll CONTENTS.

PACK

— Localisation of sensations and movements. — Process of
volition. — Ordinarily mechanical. — We have, however, an
inhibitory control over the process. — Hence moral possi-
bilities and responsibilities jgy

LECTURE X.

CEREBRAL LOCALISATION AND DRUG-ACTION (conttnued):

Distribution of cerebral arteries. — Confirmatory of localisations
now established. — De.*«:ending paths from '* psycho-motor
area" undeveloped at birth. — Its gray cells larger than
those of other regions. — Softening of this part only found
to cause hemiplegia. — ** Descending sclerosis." — Its paths.

— Result of cutting-off from trophic centres. — Its results:
loss of power and contracture. — ** Late rigidity." — Con-
tracture variable, hence functional only. — Caused by irrita-
tion of cells of anterior cornua. . — Relation of strychnia
to it. — Can surgery avail itself of cerebral localisation? —
Its aspects in clinical medicine. — Dr. Hughlings Jackson.

— Limited convulsions. " Discharging lesions." — Case. —
The "aura epilcptica." — Carbolic acid in hyperosmia . . 213

LECTURE XL

CEREHRAL LOCALISATION AND DRUG-ACTION {continued).

Locomotor ataxy. — Its variable elements. — Due to irritation of
cells of posterior cornua, and possibly remediable. — Agari-
cn«*, Arsenic, Hclladonna. — Neuralgia. — Aconite, Pella-
clnnna. -^ Migraine.— Ignatia, Nux vomica, Digitalis, Cycla-
nie-n, Iris. — Kpilrpsy. — Particular medicines: Aconite;
litllfldnntia ) Cannabis indica (Nux moschata) ; Cocculus;
(Onliim (C^uliiinc and Salicylic acid) ; Chamomilla, Coffea,
tndinni, Merrurhm ; Santoninc.^ Importance of criticism
in using Mflttria Mcdlra 235

LIXTURE XI I.

tItR V\n\]\iV. or PHARMACODYNAMICS.

Itahncmnnn's " KAatnintiliim of the Mourccs of the common
Materia McdicA.''-^ Miisit l>c )c]>e4tcd from time to time. —

CONTENTS. IX

PACE

General principles. — Action of drugs in health to be asccp
tained, 1st, on animals; 2d, on man. — Knowledge to be
gained by observation and experiment. — Poisoning and
overdosing. — Proving. — Its history and manner. — Hahne-
mann's provings. — The Fragmenta de Viribus. — The Mate-
ria Medica Ptira. — Its elements; ist, Hahnemann's symp-
toms — 2d, those of his fellow-provers — 3d, citations from
authors. — The Chronic Diseases. — Hahnemann's contribu-
tions thereto. — Those of others. — Drs. Sircar and Pope
in vindication of these pathogeneses. — General character of
our Materia Medica. — Wheat and chaff. — ** Clinical symi>
toms" and aggravations. — Wolf and Houat. — Errors of
translation and copying. — Must be thoroughly sifted, traced
to originals, and presented (where possible) in consecutive
narrative. — Re-proving also to be taken in hand. — Conclu-
sion 259

THE

KNOWLEDGE OF THE PHYSICIAN.

THE KNOWLEDGE OF LIFE.

Ladies ■ and Gentlemen, — It is, believe me, with
keen pleasure that I stand here tO-day. American
homceopathy has always enlisted my warm sympa-
thies; but it has been with especial interest that I
have watched the rise and progress of the Boston
University School of Medicine, now in the second
decade of its existence. That such a school should
exist, without distinctive name, pledged to the
method of Hahnemann only by the convictions of
its teachers and the preferences of its pupils, — this
makes actual my ideal of what should be. I would
it were possible in my own country : I am very glad
that it has become so in yours. While, therefore, I
feci it an honour and pleasure to be invited to address
American students, I am particularly gratified that
Boston should be the place in which I am to speak.

2 THE KNOWLEDGE OF LIFE.

In requesting me to deliver this course of lectures,
my friends here have expressed certain wishes as to
the topics of which they should treat. Their main
subject-matter (it is allowed ) should be that to which
I have given the best work of my life, and in the
sphere of which I have made my poor contribution
to our knowledge, viz. Materia Medica and Thera-
peutics. But it has been thought well that discussion
on this head should be preceded by some consider-
ations of a more general nature, bearing on Medicine
as a whole. In deciding what these should be, I have
been determined mainly by the nature of my audience.
You are learners as yet, rather than practitioners :
what you should know concerns you at present more
that what you should do. At the same time, it would
be a superfluous task to seek to augment your actual
knowledge of the topics of medical education. To
go again over ground which you have trodden under
the leadership of such men as adorn this School
would be labour in vain : if you have not learned — or
are not learning — from them the physiology, the
pathology, the pharmacology they teach, you would
not learn it from another. But it has seemed to me
that I might to your advantage draw you back a lit-
tle from your fields of work, and ask you to take with
me a survey of the country at large, — to enquire
what is the knowledge you are seeking, both in itself,
and in relation to the several departments to which it
belongs and the action in which it ends. You are to
practise the art of healing : you are acquiring the
sciences accessory thereto, that you may fulfil your

PHENOMENA.

calling aright. What should you know of all of
these ? what of each ?

Every science — that is, branch of knowledge, s/rieii-
tia from scire — consists of three parts, phenomena,
laws, and causes. You may perhaps be thinking that
phenomena are not peculiar to science, that they are
matters of common observation. And so they are ;
but common observation just differs from skilled, in
that it very imperfectly takes them in. Night after
night the host of stars circle around the pole, and the
moon and planets wander about among them. All
eyes perceive this ; but how few minds take in the de-
tails of their order and march ! how few, for instance,
when poets like Dante and Tennyson indicate the
lime of year by the positions then occupied by the
constellations, can recognise the description and seize
the indication ! He who has studied these and such-
like phenomena has taken the first step towards ac-
quaintance with the science of astronomy. And he
has done more. He has mastered a series of facts
which henceforth are part of the furniture of his
mind, and can be turned to divers uses. Their per-
ception necessarily affords pleasure, xvhich all men
can feel for themselves, and some can, by repro-
duction of its sources, communicate to others. The
poet can so describe the starry heavens, the painter
so depict them, that quite a new sense of their
wonder and beauty is wakened within men. It i.s
thus that fine art lays hold of the knowledge of
phenomena. But useful art employs it no less.
One of the blessings which the Prometheus of

4 THE KNOWLEDGE OF LIFE.

yEschylus claims to have brought to mankind is
that he taught them

" The rising and the setting of the stars."

From observation of these, of the sun*s path among
the stars, of the place of the pole and the phases
of the moon, our progenitors drew a number of
practical applications, to agriculture, to navigation,
to the ordering of life and work, which made the
lights of heaven — long before any real astronomical
science had come into being — of large service to
man, availing "for signs and for seasons, for days
and years.**

I would lay the more stress on the value of knowl-
edge of this kind, as it seems to me to have lost its
place of late, alike in education and in appreciation.
The world has been so fascinated by the discoveries
of the last few centuries that these alone occupy its
thoughts ; and to teach science means to impart
knowledge of laws and causes, with very little refer-
ence to the phenomena which those laws regulate
and for which those causes account. It is the same
tendency as that which dilates on the philosophy of
history, disregarding its facts ; as that which makes
books about great authors widely read, while few
know the original works themselves. We shall see
hereafter how disastrous such procedure has been in
the study of medicine : at present we dwell on it
only in relation to the subject of physical knowledge
in general. Whatever else you learn, inform your-
selves thoroughly as to facfs, — as to all that can be

LAWS AND CAUSR5.

elicited by observation and experiment. Nor takeJ
them only from teachers and books. See, hear, feelj
for yourselves: handle the instruments by whicl
modern observation brings the distant near and the
invisible into view, while at the same time you take
in the great world of motion and sound, of colour and
form, which is open every day to the unaided senses.
Daily experience will warrant this counsel by the
delight and profit it brings.

But while I make thus much of the knowledge of
phenomena — of the e.xercise upon nature of the
perceptive faculties, I would not undervalue that
of the intellectual. Man is made to enquire, to ask
"how?" and "why.'" as well as "what?" The
answer to the two former questions-constitutes what
IS called inductive science — the body of inferences
more or less certain, of theories with stronger or
feebler warranty, which are the rcsidt of thought and
imagination when in the presence of natural facts.
What a crowd of splendid conceptions rises in the
mind when this reference is made! The heliocen-
trism of Copernicus, Kepler's laws of the heavenly
motions, Newton's gravitation, the nebular hypothe-
sis oE Laplace, the undulatory theory of light and
the dynamic of heat, morphological type and evolu-
tionary growth in animated nature, — these are but a
few of the most striking among them. They are all
thoughts rather than observations ; of no necessary
or even demonstrable truth ; open at any time to
reconsideration on adequate challenge; — but, while
they stand, part of the world's richest wealth, lumi-

6 THE KNOWLEDGE OF LIFE.

nous in effect and indispensable to further progress.
Because you are thinkers, and not merely perceivers,
you must enter into these great thinkings of the
giants of scientific discovery : from the vision of
things as they appear you must rise to that which
strives to see them as they are.

These principles apply to knowledge in general :
they characterise no less, of course, that knowledge
which is necessary to the physician. He is, as we
have said, the practitioner of an art ; and he might
carry out his calling by pure empiricism and rule of
thumb. At first he had so to do. But, by degrees,
the life he has to guard and keep in health, the
disease he has to combat, and the drugs he has to
employ, have become the subject each of a science
special to itself. Of these sciences — of physiology,
of pathology, of pharmacology — you have to learn
the phenomena, as ascertained by observation and
experiment ; and no less to possess yourselves of the
noumena, or what are believed to be such — the
laws and causes of their workings as brought into
view by intellectual vision. [I should say that by this
word " noumena " — from voO?, mind — philosophy
designates the reality of things as distinguished from
their appearances. This, however, is a metaphysical
conception, — one of thought rather than fact ; and
I am using the word more in its etymological sense
to distinguish that which the vov's perceives from
that which the senses experience — both these being
(probably) realities.] Let us pass in review to-day
the phenomena and noumena of the first of these

WMAT IS LIFE?

■ rather of that which is the subject of
physiology — of life.

The fundamental characteristic of that human body
for which, as physicians, you will have to care, is
that it is a living organism. The meaning of the
latter term is obvious. It implies that the body is
not simple, as a stone i,s, but complex in form and
structure, its several parts so differentiated as to
constitute distinct mechanisms capable of perform-
ing various functions, and yet all bound together in
unity of existence and (in some measure) of govern-
ment. This it is to be an organism ; but what is it
for such organism to be alive ? A musical instru-
ment, a watch, a printing-machine, answers to the
definition just given: either is — or may be — of
complex structure, having diverse parts subserving
diverse purposes, but neither is living. What do we
mean by characterising the human organism by this
adjective,'

We mean that it belongs to a class of exie;tences,
which includes all other animals and the whole vege-
table kingdom, but excludes the world of earth and
water. In all ages mankind has recognised the dis-
tinctness of this class of beings, and has separated
them off by ascribing to them the possession of a
peculiar quality, which it has called ^017, vita, life.
Plants and animals have life, they are living things, —
this is the language in which mankind expresses a
universal perception. The thought has sometimes
been confused by the use of terms implying vitali
to designate inorganic objects. The poet may indeed
! speak (like Shelley) of

h pardonably sp

nes u

Ilty ^^
eed ^^^1

8 THE KNOWLEDGE OF LIFE.

"The living winds, which flow
Like waves above the living waves below,"

or (like Virgil) oi*'invo sedilia saxo.*' But when
philosophers tell us that minerals ** have a life of their
own," they are employing language which is need-
lessly misleading. Minerals exist, having their own
laws and history ; but we want to describe that which
is peculiar to plants and animals when we say that
they live.

Further consideration establishes what it is to live,
wherein the differentia of living things resides. It is
not that they have a definite form, into which they
inevitably grow, and to which they compel all increase
of their substance ; for this property they enjoy in
common with the lifeless crystal. It is not that they
are the seat of motion. There is no rest anywhere
in nature : if to move were to live, all things would
be alive. The earth and its sister planets are revolv-
ing on their axes, and whirling round the sun ; the
sun itself and its brother luminaries are revolving on
their axes, and circling some central point in space ;
the ether is throbbing with undulations of light and
the air with those of sound ; within the earth, the
ocean is ebbing and flowing upon the shore, the riv-
ers running to the sea, the winds above as restless
as the tides below, the " clouds which far above us
float and pause '* ever resolving themselves and form-
ing anew, heat is radiating and being absorbed, elec-
tricity is producing its attractions and repulsions, its
chemic combinations and decompositions, and — if

VITAL GROWTH.

; to believe its latest

finings — keeping
every atom of matter in as restless a whirl as that
which urges the suns and their worlds. Motion is
not life ; nor does it become so by being spontaneous.
We shall see hereafter that vital motions are not ini-
tiations, but responses : yet, were they otherwise,
that would not make them living, since the total mo-
tion of the universe must — so far as science can
pierce — be thus conceived of. {[ mean, that you
must go outside the universe to find its Mover. In
itself it appears as self-moved,) Nor does life con-
sist in growth and waste. We open our ears and
hear

^^Cvei

The dust of

iry wave upon the cliff, every shower of rain upon
the land, is reducing one part of the earth to enrich
another. In some places the land has risen, in others
it has sunk, within the period of man's existence;
and the whole geologic history before him is one of
continual growth and waste.

While, however, growth by accretion is thus a phys-
ical process, there is a growth which is purely vital,
A granite rock to which chalk has been brought by
rivers has no power of changing calcareous into gran-
itic substance. But the plant and the animal, diverse
as may be the structures of their several organs and
the food supplied to them, can so transform thi.s
food within their bodies that it shall become homo;

lO THE KNOWLEDGE OF LIFE.

neous With themselves, and go to make their wood,
leaf, bone and muscle, and contribute to the texture
of such special organs as the brain and the eye. There
is nothing like this, save in living beings : it is a
purely vital process. And as their growth is not
mere accretion, so the correlative waste in them is
more than separation. Matter is thrown off from the
tissues in lower forms than those in which it exists
there : muscular fibre is eliminated as urea, nervous
substance in the shape of phosphates.

Gr owth b y assimilation is thus the first process
characteristic of lite". And the second is like unto
it, — it is the reproduction of the kind. This is a
power peculiar to plants and animals, and nothing
bearing the remotest resemblance thereto exists in
any but living beings. It also, therefore, is purely
vital, and constitutes an element in life.

Take now the whole life-history of a plant, and we
shall find it comprised in these two processes —
growth by assimilation and reproduction of its kind,
the means for the preservation of the individual and
the perpetuation of the species. All else about it is
physical, common to the world around : these are
peculiar, are vital. Since, then, any property which
does not belong to the vegetable creation cannot be
essential to life as such, we may consider these two
as making up the manifestation of that which we
name vitality. Pressing our analysis farther, we find
the duality resolving itself into unity ; for in the lowest
forms of life generation is no distinctive process, but
a simple fission or gemmation — a portion of the liv-

PROTOPLASM. II

mg mass becoming detached, and then growing by
assimilation into the parent form. (Microscopically,
indeed, reproduction and growth are in all cases
identical, consisting essentially in the cleavage and
duplication of cells ; but I speak of them as they ap-
pear to the common eye.) Now in these primitive
regions, among the dim beginnings of things; another
fact is pressed upon our notice. It is that the essen-
tial functions of life require for their basis none of
the developments seen in the higher plants or ani-
mals. Tracing these down as they slope towards a
fellow, if not a common, root, we come at length to
creatures like the amceba. We have here neither
colour nor (permanent) form ; solidity and structure
alike are absent ; and yet no one can doubt that the
amceba lives. Retracing then outsteps, we find that
as we ascend the scale of being, either along the
vegetable or the animal side of the slope, we always
carry what we may call amceboid matter with us. Be-
hind all shapely form, within all solid envelopes, is
the structureless, transparent, colourless, semi-fluid
substance we have seen floating in the waters. We
call it proloplasm — not a good word, for it is rather
the first to form than the first to be formed. But,
however it be named, it must be conceived of as the
seat, and the only seat, of vitality — this property
being fully manifested when it alone is present.' Of
ourselves we may say, noit omnis vivo: we are not

' " Wherever there is life, froia ils lovrcsl to its hii;hc5
lliere is pttitopUsm ; wlicrevEr there is piotoplaam, Ibere als
russutt ALLtLAR, BHI. AiiSi. Hefarl, i^tj).

12 THE KNOWLEDGE OF LIFE.

alive in every part. The fluids of the body do not
live, any more than water does. Hair, nails, teeth,
bone, are when once formed as lifeless as similar
matter existing elsewhere ; and the same is demon-
strably, though not so obviously, true of cartilage,
fibre, cuticle, and all cell-walls and sheaths. The soft
matter which most of these contain — the contents
of the cell, the pulp of teeth, the marrow of bone —
this lives and forms its envelope ; but the thing
formed, that which has structure, rigidity, colour, has
passed from life to death. As dead, it is continually
decaying, but as continually being replaced by its
indwelling protoplasm, which takes from the food,
reaching it as blood, the material for the purpose.

Life is thus a property belonging to matter in that
peculiar state which we denote by terming it " liv-
ing ; " and such living matter, though everywhere
present in the organism, constitutes but a small part
of the bulk of the frame. The first to promulgate
this doctrine was one whom we of the school of
Hahnemann may fairly claim for our own ; for though
he never practised, and died before homoeopathy be-
came a living thing in his country, he welcomed it
and vindicated its claims to attention. I speak of
Dr. John Fletcher, of Edinburgh. His Rudiments
of Physiology, published between 1835 and 1837,
start from the theory first propounded by Brown in
1780, that life is the result of the action of the
natural stimuli — light, heat, oxygen and so forth —
on the "irritability'* of the tissues. Their capacity
of responding thereto is vitality : their actual re-

FI-ETCHKR AND IllS DISCIPLES.

spouse is vita — life. This view — espoused by all
the great naturalists and physiologists who had
followed, by Bliimenbach, Cuvicr, Bichat, Magcndie,
I'ritchard — is maintained by Fletcher, and opposed to
all theories of a "vital principle," in a series of chap-
ters which, as Dr. Drysdale justly says, " for learning,
wit, close reasoning, and splendour of diction, have
been seldom equalled, and, I venture to say, never sur-
passed in the literature of physiology." But Fletcher
went farther, in perceiving and meeting the difficulty
that much of the organism seemed to be irresponsive
to stimuli. He did so by arguing that it is indeed
no t wholly aliv e ; that its fluids and hard solids have
no more vitality than water or wood. The old phrase
"materia vitEc diffusa" after all expressed the truth;
only it was a "materia" indeed, and nothing serai-
spiritual — a living matter everywhere found where
life is manifested, and constituting the substratum of
its phenomena. That such a matter there must be,
he clearly discerned and irrefragably proved. But he
unfortunately went farther still, and thought he had
found it in the ganglionic nerve-substance. This error
caused his work to be doubtfully received and soon
forgotten. There were two of his pupils, however,
who held his memory dear, and waited for the time
when his discernment would be vindicated. Both
have adorned our rank.s. One was Dr. Rutherford
Russell, a man of no cpmmon power and charm, too
early lost to us. The other I have already
and to name him is sufficient : it was Dr. Dry.sdale.
He had not long to wait. In 1861, Professor Lionel

14 THE KNOWLEDGE OF LIFE.

Beale, of King's College, London, proclaimed as the
result of long-continued microscopical study that the
substance already recognised in plants and the lower
animals, and known as "sarcode" or " protoplasma,**
— that this structureless, transparent, colourless,
semi-fluid stuff, is universally difftlsed throughout the
human organism, and everywhere manifests distinc-
tive vital characters, separating it from the "formed
material '* around. Into this it dies daily, just as the
whole organism dies into its post mortem condition,
when the mainspring of its common existence has
been broken. But, till then, the "germinal matter,*'
while ever perishing at its circumference, is ever re-
newing itself at its centre, converting the pabulum it
takes up into its own living substance, instinct and
quivering with vital motion. All this Beale proved
as a fact which none could gainsay ; but the scientific
world at large was hardly ripe for the theory of life
which followed. Drysdale, on the other hand, pre-
pared by Fletcher, recognised it as that which he had
all along been holding, and saw in protoplasm the
very materia vitce whose existence his master had
demonstrated, but which he had mistakenly identi-
fied. At once, in the British Journal of Homoeopathy^
he commenced a series of papers on the subject, cul-
minating in his separate publications entitled ** Life
and the Equivalence of Force ** and " The Proto-
plasmic Theory of Life.*' ' Here, while others were
hesitating, he boldly grasped and vindicated the doc-
trine ; and he had the gratification in 1879 of hearing

' Published by Bailliere.

PROTOPLASM AND ETHER.

it proclaimed as generally accepted from the Presi-
dential chair of the British Association. Professor
Allman there happily compared the place which pro-
toplasm occupies in the mind of the biologist to that
■which the ether takes in the conceptions of the phy-
sicist. You know that, as sound consists of waves of
air, transmitted from a vibrating body to our percip-
ient organs, so light and heat — to go no farther^
are best understood when regarded as undulations of
some fluid medium. This cannot be the atmosphere,
which extends only some forty miles above the earth's
surface, while heat reaches us from the sun and light
from the most distant of the fixed stars. We have
therefore to assume the existence of an "ether," fill-
ing all idterstellar space, as much finer than air as air
is than water, and in like manner filling its " void and
bare interstices." Protoplasm, as " co-extensive with
the whole of organic nature — every vital act being
referable to some mode or property of it — becomes
to the biologist what the ether is to the physicist ;
only that instead of being a hypothetical conception,
accepted as a reality only from its adequacy in the
explanation of phenomena, it is a tangible and visible
reality, which the chemist may analyse in his labora-
tory, the biologist scrutinise beneath his microscope
and his dissect ing-needle."

I am. I confess, desirous of pressing this concep-
tion upon you, on account of the part it must neces-
sarily play in your thoughts about the system of
Medicine you have adopted. Homosopathy is not a
philosophy, but a method : yet it has a philosophy,

l6 THE KNOWLEDGE OF LIFE.

and it is important that this should be clear and sound,
and in harmony with the best thought of our time.
Hitherto our notions of life have mostly been those
enunciated by Hahnemann. In his student days it
was always assumed to be a principle, distinct from
the organism it animated, — the only question being
whether Stahl should be followed in identifying it
with, or Hoffmann in distinguishing it from, the im-
mortal soul. When, in later life, he began to think
upon the subject for himself, he espoused Hoffmann's
doctrine, though with much more philosophic grasp.
The vital principle with him was no entity, but a
"force," and in conceiving it as such he anticipated
(in 1829) the notion of force now everywhere current.
** The organism " he wrote ( in the edition of the
07'ganoii that year published ) ** is indeed the material
machine to the life, but it is not conceivable with-
out the animation imparted to it by the instinctively
perceiving and regulating vital force, and the vital
force is not conceivable without the organism, conse-
quently the two together constitute a unity, although
in thought our mind separates this unity into two
distinct ideas, for the sake of facilitating the appre-
hension of it.** The "vital force " is thus, with him,
the mode of motion of the living organism.

Through Hahnemann such views of life have gen-
erally gained acceptance in the school which he has
founded. They have, moreover, been reinforced among
us from another and independent centre. In 1849
the distinguished French physician, Tessier, came
over to homoeopathy, and brought with him a brilliant

THE ANIMATING I

band o£ disciples. But lie was more than a physician :
he too was a Master, and taught a complete system
of medical thought. His doctrine of life was that of
the Thomists, the followers of St. Thomas Aquinas.
It is fully set forth in the EUments de Pathologie of
the present coryphaeus of the school. Dr. Jousset —
one of the ornaments o£ our body. We are there
told that the cause of life, of that which makes living
beings distinct from others, is an "animating prin-
ciple," which, existing already in the germ, preserves
it from corruption, fashions the organism into which
it grows and regulates all the functions of the same,
until its final retirement therefrom results in death
and dissolution. This animating principle also, like
Hahnemann's vital force, is said to be so intimately
united with the matter of which it is (in philosophic
language) the "form," that the two are inseparable,
— their union constituting the living being, one and
indivisible. But the Thomist doctrine has the dis-
advantage of lineal descent from that of Aristotle,
and adopts his terminology. The result is that it
speaks of the animating principle of a plant as the
vegetative soul ( ^xVi anima ), and as it uses similar
language regarding the life of man, it seems to iden-
tify his soul with his vital force, and indeed to give
him one at all in no other sense but that in which a
cabbage has one. Moreover, if "anima forma cor-
poris " is to be the canon (and our coii/t-^ns are so
fond of this phrase that for many years it has served
as a motto for their journal, V Art MMkal), — if
the soul is the form of the body, and we go to Aris-

l8 THE KNOWLEDGK OF LIFE.

totle to learn what is meant by "form/* we find him
illustrating it by saying that vision is the form of the
eye. The soul, then, so conceived, has not and can-
not have any existence independent of the body of
which it is the function, — a conclusion tolerable
enough as regards animals and plants, but not to be
readily entertained by man, who " thinks he is not
made to die." It is a conclusion, I should say, which
would be warmly repudiated by the school of which
I speak, which is distinctly Christian in its thought ;
but it is one to which logic must remorselessly lead
them.'

Is such an " animating principle " required to ac-
count for the facts of the case ? It is argued by
Dr. Fr6dault, another worthy inheritor of Tessier's
thoughts, that its existence alone will explain the
growth of the germ into the parental form. But
crystallisation presents similar morphological phe-
nomena, and no '*dme min^rale " is even supposed to
be working here. It is perhaps easier to conceive of
death by calling this its "retirement:" but if it re-
tires, where does it go ? Christian philosophy gives
an at least intelligible account of the future of the
disembodied spirit ; but what can be thought or said
of the separate existence of the bodily life — of the
bodily lives of the million creatures that perish every

* Mr. St. George Mivart, who represents in England the same Catholic
philosophy, would describe the ij/vxri as a " principle of individuation," and
would grant its non-existence apart from the body. But he does not grapple
with the difficulty in relation to man, save by suggesting that in his peculiar
case there may be some interference with the ordinary law ( Brit. Assoc, Re-
port ^ 1879. Biological Section).

LIFE A MUSIC.

"moment ? Is it not much better to conceive of it as
the " splendour and music" which "survive not the
lamp and the lute"? Indeed, this last image, sug-
gested by one of the interlocutors in the Phado as
representing the soul itself, and so casting doubt on
its immortality, may well be applied to our present
subject. Socrates (or Plato for him ) has no diffi-
culty in showing that the soul is more than the har-
mony of the body ; but this is just what life is. It is
a music, of which the organism is the instrument, and ,
the natural stimuli the players, — secondary players
indeed, for the great Musician who out of the diverse
tones they elicit brings pure melody and perfect har-
mony is the Creator and Sustaiiier of all things, of
whom Hahnemann was the constant worshipper, and
whose reverent acknowledgment will I trust be always
a feature of the school which calls him master.

You will observe that in all this I have been say-
ing nothing of the distinctive faculties of man — of
thought, and love, and conscience, and will. I have
spoken only of the life which he has in common with
the beasts that perish, aye, and with the plants of
the field. His higher life may well have for its sub-
stratum some entity of another kind, some substance
which we can only characterise by calling it spiritual.
Hahnemann avoided the dilemma of the Thomists by
distinguishing the vital force from the rational and
immorta] soul. But his conception of life as a
"force," though philosophically tenable, lacks scien-
tific warrant. The forces are affections of matter,
modes of its motion, correlative and interchangeable

J_J

20 THE KNOWLEDGE OF LIFE.

among themselves, and amenable as matter itself to
the law, "omnia mutantur, nil interit." But matter has
other qualities besides these — often casual — affec-
tions : it has inherent properties^ which make it and
its various forms what each essentially is. Accord-
ing to its properties it is influenced by the natural
forces : its chemical affinities determine how it shall
act under chemical attraction, its responsivity to
magnetism makes it advance towards a magnet when
presented to it. Is life, then, a force or a property?
Clearly the latter. Vitality is, as I have said, the
living matter's capability of response to the natural
stimuli ; and the life of each individual is that re-
sponse on its part, conditioned by its own special
constitution. Some of these stimuli — as light and
heat — are themselves forces, and the work done
under their influence is of course an expenditure of
energy equivalent to that which they convey. But
to dead organic matter they appeal in vain, — not
that they are less stimulating, but that it has no
longer the capacity of answering to the prick of the
spur.

The importance of this conception in our philoso-
phy of homoeopathy is that it keeps us clear of meta-
physics, that it enables us to be dynamists without
being spiritists. Hahnemann did not always main-
tain the lucid idea of the vital force whose expression
I have read you from the Organon. He frequently
speaks of it as something distinct from the organism
it inhabits — an archceus regulating its development
and motions. Revolted by the gross humoralism

DYNAMISM NOT PNEUMATISM.

f his day, he retreated beyond solidism into pneu-
matism ; he taught that all disease originated in a
derangement of the vital foree, physical changes
being only secondary. The exciting causes of dis-
ease, especially the infectious principles, must there-
fore be non-material ; and in like manner the drags
which modify it for good must be so attenuated as
to part with their physical envelope, and become
something new and spirit-like. I am not prejudicing
the question of dose : I am rather protesting against
its being prejudged by the assumption that the seat
of medicinal action is an invisible, intangible "force."
Recognise that it is living matter — protoplasm ; and
then you have all that dynamism can desire, without
the need of any such untenable theory as "dynami-
sation." You have matter in its most sensitive,
responsive state, capable of modification by the finest
germs or molecules ; but it is matter still, requiring
its morbific contagia. its sanative medicines, to be —
however minute — material also. This Science also
requires, for (in the natural world) she knows of no
force apart from matter, none that is not resolvable
into the motion originally impressed upon the atoms
of the Universe by their Creator. The amount of
energy contained in and put forth by matter varies
indefinitely, and we avail ourselves of the variations ;
but to think that we can escape from the matter and
retain the energy is a delusive dream. I hope that
no student of iioston University, of the Medical

School which has Conrad Wesselhoeft among its

Professors, will ever dream it.

£^

II.

THE KNOWLEDGE OF HEALTH.

The subject of medical art being the human or-
ganism, there are two things which the physician has
to do for it : he has to preserve it in health, and —
when necessary — to free it from disease. In the
execution of the first of these tasks he is a hygienist,
in the second a therapeutist. It is of the health-pre-
serving duties of the physician that I am to speak to-
day. In allotting no small space to this subject I am
but treading in the footsteps of the master of our
school. It is sometimes ignorantly represented that
Hahnemann was a mere drug-giver, that — as Dr.
Bristowe has said — " for him, preventive medicine,
which deals specially with the causes of disease, and
has been successful only in proportion to its knowl-
edge of them, would have been a mockery and a
snare." So far is this from the truth, that in his first
homoeopathic essay of 1796 Hahnemann speaks of
the removal of causes as the most elevated way which
practical medicine can follow, as a " royal road ; '* and
in his Organoiiy from its first edition in 18 10 to its

last in 1833, he begins by assuming that both to pre-
22

HOMCEOPATHY AND HYGIENE.

vent disease, and to make his curative treatment
unobstructed and permanent, the physician will also
be a hygienist. These precepts are well illustrated
by his own example, as seen in his letters of advice
to patients extant here and there in our literature.
He, indeed, who anticipated Pinel in a rational and
humane treatment of hmatics, was not likely to have
neglected the general management of his sane pa-
tients ; and his writings prior to the time of his special
occupation with his therapeutic method frequently
touch on the subject. In so acting he has been fol-
lowed by his most genuine expositor on American
soil — the late Carroll Dunham ; who, in his "Hoi
opathy the Science of Therapeutics," begins by defin-
ing the sphere and emphasising the importance of
hygiene. In the same spirit have many of the homoe-
opathic physicians of the United States taken active
part in the Public Health Associations of their coun-
try; and one of the foremost European hygienists —
Dr. Mathias Roth — belongs to the homceopathic
body in England.

It could hardly, indeed, be otherwise ; for the
method of Hahnemann in its very nature links itself
with healthy living. Its single, clean, mostly taste-
less and inodorous remedies suggest a regimen equally
simple and pure : the gentleness of its medication
consists only. with a like non-perturbative dietary.
He that dispenses with narcotics and blisters in ill-
ness will hardly abuse stimulants and condiments in
health. The importance we attach to drug-giving
makes us the more anxious to banish all that is medi-

24 THE KNOWLEDGE OF HEALTH.

cinal — that is, poisonous — from our patient's sur-
roundings, and so to secure for him the prime
necessities of health — fresh air, pure water, and
wholesome food. We are thus hygienists in virtue
of our method ; and still more because we are not
homoeopathists only, but physicians, and — ;////// de
humano corpore a nobis alienum piitamus.

Milton has said that a poet's life should itself be a
poem ; and I would apply this saying to the physician.
He who preaches healthy living should himself prac-
tise and illustrate it. With what force can he enjoin
moderation at table if he is a bon vivant ? how can he
warn his patients against nicotinic intoxication if he
smokes all day } And more, — he must see that his
very virtues do not lead him to excess : he must re-
strain himself from the noble folly of overwork, that
he may with greater effect reprove it in others. He
ought to be able to say, — by the observance of the
principles I commend to you I am myself a healthy
man, able to do a full life's work with strength and
joy. Of course there must be exceptions to such a
statement — cases where an unhealthy tendency has
been inherited, or accident has invaded and broken
the constitution. But even here much may be done :
if it could not be, how could we expect patients simi-
larly circumstanced to place themselves in our hands }
When all allowances have been made, it remains true
that the physician should exemplify the ideal he holds
up, and lead as well as point the way to health.

This is the first duty I would lay upon you in con-
nexion with hygiene ; and the next is that you should

EXERCISE. 25

Sre clear conceptions as to its constituent elements.
Hygiene may be defined in brief as man's due care
for himself and proper selection of his environment.
His body needs exercise, rest, warmth, air and food.
The first two it can give itself, and the third it can .
to some extent supply ; but air to breathe and food
to eat come to it from without, and health largely
depends on the quantity and quality in which they
are furnished to it. Let me say a few words on each
of these heads.

I. The recommendation of exercise is a time-
honored function of the physician, and probably in
Hippocratic times it was prescribed with as much
minuteness as medicines are at present. It forms
now as ever a prime necessity of health and adju-
vant to recovery ; and to its hitherto-known varieties
of walking, riding, driving, swimming, and gymnas-
tics, we can add the several kinds of "cycling" and
the " massage." Let us think, however, why it
is that exercise is desirable. It is so because the
more rapidly the effete portions of our organism can
be carried off, and replaced with new matter, the
higher our health and efficiency. E.\ercise promotes
this moulting, by quickening the blood-current and
increasing the secretions ; while the waste thus in-
duced causes appetite — a demand for food to supply
it, and thus deposition of fresh tissue. The enor-
mous quantity of nutriment which can be taken and
digested by the subjects of Dr. Weir Mitchell's treat-
ment, while undergoing vigorous massage, well illus-
trates this point. One s e es^ thsre fu rtr, ■ ufi what class

26 THE KNOWLEDGE OF HEALTH.

of persons exercise should be enjoined. The young
hardly need the admonition, — the problem of per-
petual motion going far towards solution with them ;
and the old sho uld not receive it, for, their power of
repair being feeble, it is unadvisable to precipitate
waste. It is the middle-aged — embracing in this
category all lives from twenty to sixty ; and among
them those of luxurious or studious habits, and those
whose occupations are sedentary. Such persons
may with little exercise strike a sort of secondary
balance — may compensate insufficient outflow with
moderate in-put, and so establish a working equilib-
rium ; but they know little of the sensation of puis-
sant life and the buoyant energy for work which
comes of active exertion and hearty feeding.

2. In the present day, perhaps, rest has to be en-
joined more frequently than exercise. It is an age
of overwork ; and nothing is more common than to
hear, both in public and in private life, that such and
such an one has been ordered by his physicians to ab-
stain entirely from work for a longer or shorter time.
You must of course not shrink from giving such ad-
vice when it is necessary. But on the one hand I
would urge upon you not lightly to lay such an obliga-
tion on your patients ; to put yourself in their place
before you do so, and realise the serious consequences
it involves. I do not know how it is on this side of
the Atlantic ; but on ours it is becoming quite a fash-
ion to "order away " every troublesome case orTwhich
a man is consulted, without considermg what this
means for the sufferer, and instead of taking pains to

REST. 27 1

see whether by medication and wise regulation of life
so revolutionary a change might not be averted. This
I say on the one hand ; and on the other I would com-
mend to you the cultivation of preventive medicine
here. The physician should preach — in season and
out o£ season, he should also practise and exemplify,
the place of rest in life. I have called overwork a
noble folly, and sometimes indeed the adjective has
more truth in it than the substantive. Of one of our
ancient kings — and here the " our " belongs alike to
you and to me, to the Anglo-Saxon race throughout
the world ; of Alfred the Great it is related that he
divided his day into three parts, giving eight hours
to the cares of state, eight to study and writing, and
allowing only the remaining eight for repose, recrea-
tion, exercise and meals. It was perhaps needful for
him so to expend himself, and the nobleness of his
devotion has enshrined him in the reverence of all
succeeding ages ; but it is little wonder that for most
of his life he was racked with painful disease, and
that he died worn out at fifty-two. I advise no one
for lesser cause, and d/oiiiori not for ambition or gain,
to allow so little breathing-space in life for rest and
leisure. To a man in active work eight hours are
none too much for sleep alone ; and if another eight
are allowed for the care of the body and the play of
the lighter faculties I am sure that the work done in
the time which remains wil! be all the better in qual-
ity. It will be this, and it will go on longer. There
will not be the tragedy so often enacted in these days,
of a man in the prime of his powers and usefulness

J J

28 THE KNOWLEDGE OF HEALTH.

more or less suddenly "breaking down," all his ac-
cumulated force and experience lost to the world
because he had not husbanded his strength. This
wisdom must be preached ; and so must that be which
lifts a warning against the feverish haste, the over-
pressure, of our present mode of existence. Men
try to make up for it by taking long holidays ; but
these — even if themselves not spent in hurrying
through foreign sights and sensations — do not make
up for the lack of daily repose. The heart, that tire-
less worker, sets us an example here, for it rests
during a fourth part of every pulsation, and beats at
an almost uniform rate all the day long. Why Should
not we work thus evenly, rest at least thus propor-
tionately.^

3. About tvarmth^ I apprehend the most impor-
tant truth to be that the body makes its own heat,
has its hearth and furnace within itself. How few
people realise that the main use of clothing is to keep
in the caloric which the frame has generated — any
end it may subserve in protecting from draughts of
air being quite subsidiary ! In choosing warm cloth-
ing, therefore, it is not so much quantity or thickness
we have to study, as that the material shall be non-
conductive of heat, and its fit such as to allow space
for a stratum of warm air near the body. And, even
here, it ought to be borne in mind that it is the sen-
sation of warmth we are conserving rather than its
actual existence. Nature has so bountifully provided
for us, that no change in environment makes much
difference in our internal temperature, — cold to the

THE SENSE (

surface only stimulating heat-production, as a fervid
atmosphere is compensated by increased heat-radia-
tion. Thus the normal warmth of the body — that
which is necessary for the due performance of the vital
processes — rarely suffers loss, so long as fuel can be
supplied in food, and combustion kept up by exercise.
Tha t which fluct uates is the sense of warmth, which
is due to the state of the tissue in wilfi^tTthe sensory
nerves of temperature terminate — the skin. If the
cutaneous arterioles are sufficiently open, and the
heart pumps the blood freely through them, we feel
warm, and so are comfortable. Now life without
c omfort is h ardly worth living, and so the sense of
warmth is to be cultivated. Sometimes its absence
is a real morbid condition, and we have medicines to
help us here, — drugs like Asarum and Ledunvwhich
m ake hea lthy persons chilly. But more commonly
the deficiency is a matter ot hygiene, and can be sup-
plied by improving the state of the skin. Foremost
among the measures available here is thai which we
English affectionately call our "morni ng t ub " — the
cold bath taken immediately on rising. 1 speak not
of it now as it conduces to cleanliness, — for this
may be otherwise secured. I am regarding it as a
means of making the skin less sensitive to external
cold, — of approximating the whole surface to the
callousness of the face, which we expose to the coldest
blasts without distress or peril. I am thinking al;
of the glow which follows, and which is so readily
renewed by food, and exercise, and warmth from with'
out. Every man ui woman who can take a cold bath

30 THE KNOWLEDGE OF HEALTH.

in the morning should have it, and will be the happier
and the healthier for it.

But there are cases in which heat-production is
absolutely below the normal standard, and vitality is
lowered in proportion. Here again we may have
a true — that is, primary — morbid condition, and
specific medication may come to our aid. One of the
most interesting things in Dr. Burnett's essay, " N^
trum muriaticum " (which I trust you have all read,
or will read), is the effect of that remedy in promot-
ing the calorifacient^function. Calcar ea ca rbonica
probably has a similar action, though its coldness is
rather felt locally — as in the head or legs — than
generally. But here also the defect is more com-
monly a physiological one, and amenable to hygienic
measures. We have only to think over the sources
of animal heat to see how much may be done by
judicious regimen to increase its production, as by
urging exercise — active or passive, and supplying
readily-oxidised food. At the two extremes of life,
indeed, our aim is somewhat different. In the very
young heat is formed freely enough, but too readily
lost ; and you can hardly be too earnest with mothers
that they should clothe their children warmly, and
not sacrifice health and comfoft to appearances. In
the aged, little can be done for the making of heat :
it is its supply fr om with out to which we must attend.
Warmth toTRe ¥ur^ace, warm air to breathe, are our
adjuvants here ; and especially helpful are hot drinks,
which add positive caloric to the system, and — for
the time at least — inspirit all its functions.

SEWER-CAS.

That the air we breathe should be pure is per-
haps the best-learned lesson of hygienic science. All
educated persons recognise the truth, and nearly all
act up to it so far as supply of oxygen and elimina-
tion of carbonic acid are concerned. But our modern
sanitary arrangements, with all their advantages,
have brought into being a new agent wherewith to
contaminate the atmosphere : I refer to sewer-gas.
I am sure that we cannot be too much on the alert to
detect the possible e.xistenci; of this causa matt ; and
the disconnection of drain-pipes will often do far
more for our patients' health — to say nothing of our
own reputation — than the most carefully selected
medicines. A good instance of the subtle way in
which sewer-gas will act is supplied by our recent
literature. In the Mont/ily Hoinwopatliic Review for
January, 1879, Dr. Edward Madden related a case of
erysipelas occurring in a child of his after vaccina-
tion with calf-lymph. His inference was that the use
of this matter does not secure immunity from such
accidents. In the April number, however, appeared
a letter from Dr. Edward Blake asking Dr. Madden
if he was sure about the state of his drainage, as he
had lately traced a post-vaccination erysipelas to a
fault in this direction. In August Dr. Madden re-
plied, saying that investigation had shown his house
to be "exposed to nearly all the dangers of admit-
ting sewer-gas to which defective arrangements
could conduce." Dr. Blake has indeed made the
subject his own, and supplies another instance of a
member of our body being an earnest hygienist. In

32 THE KNOWLEDGE OF HEALTH.

his brochure entitled " Sewage Poisoning : its causes
and cure," ' he shows how perilous is this taint in the
air to the subject of an operation or the parturient
woman, and traces to its influence many forms of
ill-health, as diphtheritic throats, morning headache
and diarrhoea, unaccountable languor, anorexia, fever-
ishness, and sleeplessness, passing on — especially
in children — to anaemia and glandular suppurations.
To these probably every man's experience would sup-
ply additions, — I, for example, having seen ascarides
in an adult obstinately persist while it was present,
and immediately clear away on its removal. Sewer-
gas cannot of itself initiate a specific disease, but it
both spreads its germs and predisposes to their re-
ception, and then — when the malady has been set
up — tends to make it malignant, and — if the patient
recovers — to retard his convalescence. Whenever
there is an x in the morbid conditions with which
you have to deal — some unknown factor making
everything go badly and defeating your most just
anticipations, there suspect sewer-gas, and look to
the drainage.

The air we breathe must be pure, and it must be
suited to any weakness — any vulnerability which
may exist in our constitutions. In health " man is
man, and master of his fate :'* he can subdue to his
purposes the greatest extremes of climate as he can
the beast of the field, the fowl of the air, and what-
soever passeth through the paths of the seas. But
let his system once give way at any point, and his

* Spon ; i6 Charing Cross, London, and 446 Broome Street, New York.

CI-TMATE. 33_

mastery is over: «oh viiicit, now, scd faremtdo. He
must find the spot of earth best suited to his pars
minoris rcsistetitia, if the rest of his frame is to
flourish unimpaired. This choice of climate fre-
quently fails to the physician to determine, and we
must be prepared to advise alike with sound princi-
ples and with knowledge of their practical applica-
tion. There is nothing in which we need so specially
to individualise as this. The total which we call
ciimate is the product of several factors, — latitude,
exposure, elevation, soil, water, all go to make it up ;
and it is the whole which we must estimate and fit.
Nothing is more instructive than the maps of the
British Islands which Dr. Haviland has framed,
showing by diverse colouring the tracts more or less
favourable to the development of consumption and
cancer. Inductive generalisation can perhaps estab-
lish some common features here — defective flow of
air in the one case, saturation of soil in the other ; but
for the present the individual facts are our most im-
portant knowledge. Again, what is more significant
than the fact elicited by Dr. Chambers, that in Italy
chronic degenerative maladies like Bright's disease
play a very small part among the causes of mortality
compared with Great Britain ? Residence there, when
practicable, is obviously the best resource for those
so afflicted. The value of mountain-air, though cold,
for phthisical subjects is another fact of the same
order. You doubtless have, in the vast e.\tent of
your States, an England and an Italy; a Riviera or
Madeira for your delicate-chested, a Davos for your

34 THE KNOWLEDGE OF HEALTH.

true consumptives. Study them individually, as we
have had to study the health-resorts of Europe ; and
you will have in climate a most potent agent at your
command.

5. We come now to the important subject of food^
and with this must occupy ourselves for the remain-
der of the present lecture.

Why must we eat } That nature prompts us so
to do by the calls of appetite, and sternly punishes
any failure to attend to her admonitions, is obvious
enough : but what does science say on the subject ?
for what end or ends do we take food } This ques-
tion is (I think) best answered by the old comparison
of the body to a steam-engine, whose fire is vitality,
and which needs fuel that it may perform work. The
human engine differs indeed from its mechanical
type that it has, at one stage of its existence, to
grow, and throughout its continuance to repair its
own waste. For these purposes food is required as
substance, to make the tissues which need augment-
ing or replenishing ; and until lately this (with the
supply of heat) was looked upon as its sole office.
Now, however, we have come to see that in the adult
body there is not much waste ; that its floating cap-
ital is small in proportion to its actual assets. If,
then, repair were the sole use of food when supply
for growth was no longer needed, the demand for it
would be very small. But the doctrine of force in
modern science has taught us that for all work done
energy must be expended, and so — if the work is to
continue in doing — must be renewed. For its sup-

FOOD THE FUEL OF LTFE.

351

ply the main source is the aliment. I doubt not that 1
this is (mostly, for there are exceptions) assimilated
before it is oxidised — that it is its own substance
which the animal steam-engine burns, and not di- .
rectly the coal. But so rapid is the conversion, sod
unstable the product, that the pabulum may fairly I
be regarded as the fuel for the flame, and the imme- f
diate source of the motive-power of the body.

" The human body " says Hermann, " like that of tvery other 1
anima.1, is 2n organism in which, by the chemical changes of]
its constituent parts, potential is converted into kiHetic energy, f
. . . These chemical changes depend on the presence, within ^
the organism, of energj'-yielding substances. . - . Every a
the organism must diminish, to a corresponding extent, the
energj'-yielding store which it contains, . , , It is, therefore,
essential, in order that the organism should continue to e.xist,
that it be continuously supplied with oxygen and oxidisable
substances. The latter are called the organic constituents of
food."

He goes on to show that the inorganic elements of
our diet, besides any mechanical (e.g. solvent) uses
they subserve, supply the waste of the same substances
which form part of the body ; but do not furnish it
with energy.

Even stated thus, it appears that food is the fuel
for the flame of life. But we may go farther when
we regard those dialytic processes which are not
oxidations, and in which aliments are decomposed
immediately without previous assimiiation. What
occurs when sugar — or, what ultimately comes
same thing, starch — is ingested.' It is convt

les to the ^^J

36 THE KNOWLEDGE OF HEALTH.

into lactic acid, a substance of much lower equivalent
value ; and thus energy is directly evolved A sim-
ilar thing happens with fats, where — mainly under
the influence of the pancreatic juice — the stearine (or
what corresponds to it) is broken up into stearic acid
and glycerine ; and this prior to assimilation. Here
are liberations of force occurring in the food itself ;
and when we consider how large a part is played in
our ordinary diet by sugar, starch and fat, the con-
ception of it as fuel becomes yet more strictly war-
ranted.

An important practical conclusion, moreover, fol-
lows in respect to the quality of our food. Of old,
when our whole body was supposed to be in a state
of continual flux, and the main use of food was con-
ceived to be the laying down of tissue, it was natural
to look upon flesh as flesh's best repairer. The earlier
achievements of organic chemistry favored the same
result, for in all physical exertion great waste of mus-
cular tissue was supposed to occur, which meat diet
alone could replace. But, as Dr. Pavy justly says,'
" the information which has been obtained during the
last few years has completely revolutionised some of
the cardinal scientific notions formerly entertained "
on this subject. It is now ascertained that the most
active and prolonged muscular exercise causes little
increase in the excretion of urea, and therefore as
little loss of nitrogen ; while the capacities of herbiv-
orous animals and insects find ready parallels in the
human race. "The inhabitants of mountainous dis-

' Treatise on Food and Dietetics. 1874.

Animal food.

tricts prefer to take fat and sugar as provisions when
they have arduous journeys to perform (Hermann) ;
and Dr. Anna Kingsforcl ' has well shown that a great
deal of the most vigorous work of the world is done
by men in whose diet flesh plays little or no part.

Shall we, then, follow her to her conclusion that
we should all be vegetarians ? I think not. I quite
acknowledge that man is essentially a frugivorous
and graminivorous animal ; and that on fruit, pulse,
and cereals, with milk and water to drink, he may
keep himself in health and vigour. But man is some-
thing more than an animal ; and as he has gone be-
yond his simian fellows (I will not say ancestors) in
learning to cook his food, so has he in widening the
range of his diet. He has done for himself what he
does for his domestic animals, teaching dogs and cats
to live on bread and milk, which their wild brothers
— wolves and tigers — would starve rather than touch.
The Biblical tradition of permission to eat flesh hav-
to Noah after the Deluge, —
ig been a vegetarian,' suggests
advance on his part, suited to
change of environment ; and such it assuredly is,
for in cold and damp climates animal food can rarely
be dispensed with. Chemistry witnesses to its use-
fulness, for it shows a certain amount of nitrogen
as necessary to be supplied in the diet ; and meat gives
us this in smaller compass than any other food, and
with greater relish. There is, moreover, a stimulant

ing first been given
primitive man havir
such aliment as an

Lond., Kegjn Paul.

ood, and I

timulant J

38 THE KNOWLEDGE OF HEALTH.

quality about meat — especially roast meat — which
no other food can supply. The vegetarians object to
this, saying that it gives to man some of the ferocity
of the carnivora. But a slight infusion of their char-
acteristic nature is possibly not without benefit to the
human stock, doing for it what the blending of Nor-
man with Saxon did for the Englishman.

But while I cannot endorse or practise, in its
entirety, the vegetarian regimen, I do so far agree
with its advocates that flesh should be the exception,
instead of the rule, in human dietary. The three meat
meals a day, so favoured in my country (I do not
know how it is with you), are alike wasteful and inju-
rious. Wasteful, because animal food — fish, flesh,
or fowl — is the most costly of our aliments ; and
injurious, because less force can be made out of it in
proportion to its bulk than out of any other article
of diet, and the residual substance goes to burden
the liver with the formation and the kidneys with the
elimination of urea to an extent quite beyond their
powers. Hence — unless the most vigorous out-door
exercise counteract the evil — there comes lithaemia,
azoturia, and gout, if not organic disease itself. I
am of course speaking of the lean of meat : the fat
occupies a different place, and its ingestion need be
limited only by the powers of digestion. Bacon or
eggs thus suggest themselves as the most suitable
adjunct to breakfast, and cheese to lunch or supper,
where we do not care to make thesre purely vegetable
meals, confining the consumption of lean meat to
dinner only.

sum up the leading principles of diet
thus: —

a. The growing child requires food for the supply
of substance, and cannot have too much, if he can
digest it. Milk, oat- and wheat-meal, sugar and fruits
are his main subsistence until he begins to learn, and
then meat should be added.

b. The adult requires a certain small amount of
nitrogenous food to repair waste, and this he can
best get in meat. But his main requirement is force
for work, which can be derived from carbo-hydrates
and hydro-carbons — starches, sugars and fats — with
less expenditure than from any other source. The ■
Irishman gets these in his potatoes and buttermilk, ]
the Hindoo in his rice and ghee ; and either needs
only a small proportion of meat or pulse to raise him
to full vigour.

So far as to what we should eat ; and now as to
what our drink should be. First of all I would say
that few people drink enough water. They forget
that this element constitutes at least two-thirds —
some say four-fifths — of our frame, so that it is a
veritable food, especially as no part of us is being
more constantly given off. Your plucky compatriot.
Dr. Tanner, lately interested the whole civilised
world by showing how a man could live for forty
days on water alone ; and he was only illustrating
thereby to an unusual degree a recognised scientific
truth. Water is further a diluent and solvent, and
as such plays a most important part in the system,
— all whose processes languish without it, A pure

.J_^

40 THE KNOWLEDGE OF HEALTH.

water-supply is the prime necessity of every habita-
tion, — not only as excluding germs of disease, .but
as encouraging the free imbibition of the fluid. The
cautions sometimes given against it are mere fancies.
You are told that you must not drink of the moun-
tain streams while pedestrianising in Switzerland : I
have more than once done so copiously with perfect
impunity. I was warned when I visited your Phila-
delphia in the "heated term'* of 1876 that I had
better not make too much use of ice-water; but I
should be sorry to say how many gallons my thirsty
lips disposed of with nothing but refreshment.

And now what shall we say to the tea, coffee and
cocoa we drink warm at some of our meals ? The
cocoa we may dismiss as little more than a liquid
food — one, indeed, of the utmost value, but not
concerning us here. Tea and coffee occupy an iden-
tical place, save that the latter is a little more heat-
ing. Both diminish waste of tissue, both stimulate
the nervous centres. They are therefore admirably
adapted to circumstances involving much exposure
or fatigue ; and we can well understand how the
Arctic voyager prizes them, and what store the Peru-
vian mountaineer sets on his analogous coca. But,
per contray they seem less suitable to normal condi-
tions and healthy bodies ; and, though we may not
condemn coffee so strongly as Hahnemann did, or
anathematise tea with the Dean of Bangor, I think
there can be no doubt of their frequent abuse. I
would keep them entirely away from the young ; and
if adults must use them, would have them ordinarily

TEA, COFFEE, AND TOBACCO. 4I

rade too weak to produce any appreciable effect,
increasing strength only according to need. Even
then we must beware of being lulled to false security
by their potent action. They check waste of tissue,
and so far are useful as temporary conservators ; but
we must remember that the material thus retained
is partially effete, and that true health lies in its
removal and replacement. By their gentle stimula-
tion they take off the sense of fatigue ; but this
sense is nature's cry for repose, and if it is hushed
up instead of its appeal being granted, a nemesis
will sooner or later follow,

I may here speak of tobacco, which, though not
taken through the digestive organs, yet behaves in
the system like tea and coffee, so far as the tissues
are concerned. It thus partakes of their advantages
and of the objections to them ; and, like them, should
be used — if at al! — in the strictest moderation. We
do not drink tea and coffee all day, but so — 1 fear —
do many smoke tobacco. If you ask them why they
thus act, they will tell you that they enjoy the sooth-
ing effect on the nervous system. Tobacco differs
indeed from the substances I have just mentioned in
being a sedative here, not a stimulant. It depresses
from the first, and its ultimate action is prostration
and paralysis ; while tea and coffee, carried to excess,
over-excite. Well : if the brain and nerves are tem-
porarily disturbed, and want quieting, I would not
grudge the solace which a pipe can bestow. But
surely this does not occur to all men every day, and
several times in a day, as would be inferred from the

d-I

42 THE KNOWLEDGE OF HEALTH.

practice of most smokers. To induce sedation with-
out cause is — to speak plainly — a slight self-poison-
ing ; and those who incur it should realise what they
are doing.

Last, of alcohol. I have nothing to say here on
the moral aspect of "drinking** — of its peril of in-
ducing intoxication, which we all agree to condemn.
Nor would I speak of the usefulness of alcohol as a
medicine, which we all — or nearly all — agree in ac-
knowledging. The question is as to its place in
health. Is it a food ? The advocates of total absti-
nence maintain the contrary, and base their denial
on the experiments of Lallemand, Duroy and Perrin,
which seemed to prove that it is entirely eliminated
by the emunctories. But they ignore the counter-
experiments of Anstie and Dupre, which — after
"some fourteen years of almost unintermittent work"
— have established the fact that a non-intoxicating
dose of alcohol is almost entirely consumed within
the body,* and that within a very short time. Oxi-
dation is the only conceivable mode of its destruc-
tion, and this implies the liberation of force, which,
as it does not appear as heat — alcohol actually lower-
ing the temperature, must become working energy.
Alcohol therefore is certainly a force-producing food ;
and many instances are on record of life being sus-
tained almost wholly upon it for months and even
years. It is thus, probably, that it acts as a "stimu-
lant," for its medicinal influence is quite in the oppo-
site direction. The earliest manifestation of its in-

* See Practitionerf xiii. 1 5.

fluence is flushing of the surface and quickening of
the heart's action ; precisely parallel to that produced
by the inhalation of nitrite of amyl, and like that
associated with diminished arterial tension and fall
of internal temperature (despite the illusive sense of
warmth caused by the glow on the skin), and so
pretty certainly owning a similar causation, viz. : vaso-
motor paralysis. The further progress of its action
is to depress the other parts of the nervous system,
beginning with the centres of speech and motion,
and ending with those of consciousness. It is also
an irritant to all tissues with which it comes in con-
tact, either locally or by absorption ; and shares
with tea, coffee, and tobacco the power of check-
ing waste of substance. These undesirable col-
lateral effects spoil it for a food under ordinary
circumstances, though it may be made such for
special times — as during exhausting diseases. A
healthy man may drink a tumbler of light beer or
a glass of pure wine at his dinner with impunity.
But if he take the stronger, fortified wines and malt
liquors, and the spirits, and in such quantity as to
feel appreciable effects from them, he is inflicting on
himself the worst of slow poisoning. He is dimin-
ishing his resistance to cold and his production of
nervous energy : he is fretting stomach, liver, kid-
neys, brain, into" smouldering irritation ; and he is
stori ng effete tissue which will break down under the
least provocation, as seen in brewers' draymen when
they come into hospital from illness or accident.
The conclusion must be that the use of alcoholic

44 THE KNOWLEDGE OF HEALTH.

drinks in health is a custom more honoured in the
breach than in the observance. It is, for most peo-
ple, entirely unnecessary ; and, when practised, should
be so on the most limited scale. A man should be
independent of it ; and, that he may be so, should be
brought up without it. Let the dietary of the young
be non-alcoholic, if you love them ; and then, as they
grow up, you may pretty safely leave them to do as
they like.

I fear I may have wearied you, ladies and gentle-
men, with these details, but their introduction was
my only mode of doing justice to the subject. They
are not taken merely from books ; but represent the
matured results of nearly thirty years' study and
observation of their phenomena. I cannot but in-
dulge the hope that they may be helpful to my
younger hearers, in enhancing — for their own bene-
fit and their patients' — their knowledge of health.

THE KNOWLEDGE OF DISEASE.

The physician is a hygienist, but he is above all
things a healer. His "high and sole mission"a3
Hahnemann states at the outset of the Orgauon "is
to restore the sick to health — to cure, as we term
it." In this pursuit he has to deal with disease, as
the subject of his operations, and with drugs, as the
chief instruments with which he works. The greater
part of your medical UEe, whether as students or as
practitioners, will have to be spent in acquiring and
applying the knowledge of these two. It cannot,
therefore, be without profit that wc should spend
some time in considering what such knowledge
should be — in what proportion it should deal with
the phenomena, the laws, and the causes, which we
have seen to be the elements of all knowing.

I suppose that all lecturers on the Practice of Phy-
sic begin the account of particular diseases by de-
scribing their clinical features. " Every now and
then," as my former teacher at King's College — Dr.
George Budd — used to say, "we meet with" cases

46 THE KNOWLEDGE OF DISEASE.

presenting such and such groups of phenomena and
sensations. He would then give the name by which
the malady thus constituted is styled, and would pro-
ceed to relate how it came about, and wherein it
essentially consisted, so far as these points were
known. But observe the difference involved in this
"so far.'* The etiology and pathology of the disease
were more or less uncertain, and our conception of
them was liable to vary as new facts came into our
view. But its clinical features remained. They
were those which perchance Sydenham, or even Hip-
pocrates, had described as graphically as any modern
physician : they, amid all shiftings of conception
about them, were permanent and sure.

Now when Hahnemann proposed as the law of
cure similia similibns curciitnr^ "let likes be treated
by likes,*' and had to define the elements of the com-
parison thus implied, he took these features as the
disease-basis of his method. Simplicity and certainty
were his aims in practical medicine. He could not
conceive that the obstacles to them were insurmount-
able ; ' and he felt sure — in his profound Theism —
that "as the wise and beneficent Creator has per-
mitted those innumerable states of the human body
differing from health, which we term disease, He
must at the same time have revealed to us a distinct
mode whereby we may obtain a knowledge of diseases,
that shall suffice to enable us to employ the remedies

' I refer to his essay published in Hufeland's Journal in 1797, entitled " Are
the Obstacles to Simplicity and Certainty in Practical Medicine insurmount-
able ? " (Lesser Writings, p. 358.)

HAHNEMANN S

capable of sulxiuing them, ... if He did not mean
to leave His children helpless, or to require of them
what was beyond their power." This "distinct
mode" was, he considered, the clinical. He was in-
deed far from refusing the aid of Ectiology, to such
extent as it was available. In the Orgation he points
out that it is obviously part of the physician's duty
to ascertain the presence or incidence of any exciting
causes of disease, that he may remove them now and
ensure their avoidance in future. It is also desirable,
according to his teaching, to discover the past causes
• — both predisposing and exciting — of the patient's
morbid condition, as certain medicines are found spe-
cially suitable when disease has originated in certain
ways — A rnica wh en from injuries, R hus a nd Dulca- ,'
ma ra when from dam p, and so forth. Pathology,
however, Hahnemann absolutely rejected for thera-
peutic purposes. It was in his day far more a matter
of guess-work than it is now ; and was too much of a
quicksand for a sure foundation to be laid in it. But
he went farther, and maintained that a knowledge of
the essential nature of disease was both unattainable
and useless. His views on this subject are best ex-
pressed in § 5 and 6 of the fourth edition of the Or-
ganoH. " It may be conceived " he there writes " that
every disease implies a change in the interior of the
human organism. But this change can only be in-
fcrre/i hy the understanding, and that in a dim, mis-
leading manner, from the morbid signs present. It
is in itself unknowable, and perhaps in no way with-
out illusion can the nature of the internal invisible

OF DISEASE.

change be apprehended. The invisible morbid a
ation in the interior, and the outward change of (
(lition noticeable by our senses (the totality of t
symptoms), together constitute, to the gaze of 1
Almighty Creator, that which we call disease. But
the sum of the symptoms is the only side of the mal-
ady accessible to the physician, the only one observ-
able by him, and the principal thing which he can
learn from the patient and employ for his benefit."
The side of disease which pathology explores was
thu.s to Hahnemann its tionmenon in the strict sense
of the word, — recognised metaphysically as existent,
but taken no practical account of; for all purposes
but those of thought represented by the phenomena.
The "totality of the symptoms" is, to the thera-
peutist, the disease.

Is this position tenable ? Most persons would at
once answer in the negative ; but they would do so,
I think, without regard to the end set before us in
thus limiting our apprehension of disease. If we
were dealing with it as an object of science, a branch
of natural history, it is certain that .symptomatology
would be an insufficient basis for our knowledge.
No one has better shewn this than Liebermeister,
in his Introduction to the section on Infectious Dis-
eases in Ziemssen's Cyclopsdia. The basing unities
of disease on symptoms gave us such pathological
entities as hydrops, icterus, apoplexy, and the like ;
and "from this symptomatic stand-point quotidian
fever was a different malady from the tertian or the
quartan form, while on the other hand ascites and

CLASSIFICATION AND PROGNOSIS.

tympanites were only different forms of the same
disease." He goes on to argue that the most scien-
tific — because most real — rule of classification must
refer to causes, must be etiological. The quotidian
and quartan types of fever are one, because they
both originate from malaria : they are to be differ-
entiated from pysemic febrile attacks, though these
may have a similar rhythm and similar symptoms,
but are to have grouped with them other malarial
affections which differ greatly in symptoms, such as
malarial neuralgia, malarial diarrhcea, malarial ca-
chexia. " The lightest form of varioloid is regarded
as essentially identical with the most severe form
of variola : on the other hand, vaccinia and varicella
are separated from it. . . . The simplest diarrhcea,
arising from the poison of Asiatic cholera, is to be
ascribed to this disease : on the other hand, a very
severe and deadly cholera morbus is to be marked
as another malady."

Nor is it for classification only that such scien-
tific knowledge of morbid states can be turned to
account. It avails for prognosis. That we are able
to distinguish true typhus from other forms of con-
tinued fever, and that we know its natural history,
enables us to affirm that if the patient passes the
nadir of his prostration between the fourteenth and
seventeenth day, and then displays an upward ten-
dency, he will pretty certainly recover. It avails for
the general management of the patient. To recog-
nise relapsing fever as present leads to a care being
taken after the first apparent recovery which would

50 THE KNOWLEDGE OF DISEASE.

Otherwise be needless, but which here materially
influences the course of the second paroxysm : it
also suggests the use of antiseptics during the inter-
val for the possible prevention of the recurrence, as
was carried out so successfully by Dr. Dyce Brown
in Aberdeen.' It avails, again, for estimating the
influence of treatment. Of old, every chancre which
disappeared without secondaries supervening went
to the credit of the mercury that was given, or to
the demonstration of its needlessness if it had been
omitted. We now know that the soft chancre —
which occurs by far the more frequently of the two
— has no such significance, and is naturally without
scqicclcB.

Now if medicine were an applied science only, it
would be with such knowledge and its utilisation
entirely that we should be concerned. But it is the
merit of homoeopathy that in it medicine assumes its
true place in being an art — the art of healing. The
physician is not primarily a cultivator of science : he
is a craftsman, the practiser of an art, and skill
rather than knowledge is his qualification. His art,
indeed, like all others, has its associated sciences.
Physiology and pathology are to it what chemistry
is to agriculture, and astronomy to navigation. So
far as they bring real knowledge, the more versed
the physician is in them the better for himself and
for those in whose aid he works. But he was before
they had their being, and his art should have a life
of its own independent of the nourishment they

' Sec Brit. Journ. of Ilum.y xxxi. 355.

bring. They must, being progressive, consist largely
of uncertaintitfs — working hypotheses and imper-
fect generalisations, destined ere long to be super-
seded by more authentic conceptions. Medicine
should not vary with their fluctuations, or hold its
maxims at the mercy of their support. While grate-
ful for the aid they bring, it should go on its own
separate way and fulfil its distinctive mission. The
method of Hahnemann enables it to do this, by tak-
ing the clinical aspect of disease as its working
basis. Pathological knowledge has little to do with
drug-selection so determined. It has taught us —
for instance — to recognise enteric fever as specifi-
cally distinct from typhus, and for many purposes
this differentiation is highly important. But the
indications for its homceopathic remedies were just
as plain when it was classed merely as "typhus ab-
dominalis," and were as well given of old by Wolf
and Trinks as they now are by Jousset and Panelli.

Again, if our aim be the ascertainment of the
particular organ affected in a given case, symptoma-
tology is certainly insufficient. Not, indeed, because
it is to be distinguished from physical diagnosis, and
has to do with "rational" signs only. The phe-
nomena perceivable only by a 'scope or speculum,
the sounds elicited only by percussion and ausculta-
tion, are as truly symptoms as is a dilated pupil or
a wheezing respiration. Not thus, but because to
ascertain the seat of disease we have to bring in t
aid of morbid anatomy. Thi.s is the science of lesions,
while clinical medicine takes account of maladies —

1 the J

— ^^^1

52 THE KNOWLEDGE OF DISEASE.

which, in the words of Tessier, are "constituted by
an assemblage of symptoms and lesions undergoing
a definite evolution." The one speaks of hepatisa-
tion of the lung, the other of pneumonia ; the one
of herpes, the other of shingles. Now the lesion —
save where, as in the last instance, it is on the
surface — is a thing inferred on!y, not perceived
or experienced ; and hence is not strictly included
within the range of the knowledge of disease re-
quired by the homoeopathic method, which — again
to quote Tessier — is one of "positive indications."
To many minds, accustomed to make physical diag-
nosis their chief aim as physicians, this is a very
unacceptable feature of our practice. But let us
look at the matter dispassionately. What do you
gain by inferring, from certain signs, that a given
group of symptoms means the presence of inflamma-
tion of the air-cells proper, as distinguished from the
bronchial mucous membrane or the pleura? Some-
thing, it may be, for prognosis : you know better
what the patient has to expect, and both he and you
feel more security from being able to follow the mor-
bid process as it were with your mind's eye through
all its stages. In other cases, as where the digestive
organs are affected, a knowledge of the precise seat
of the malady aids you in general management ; you
can order such food only to be taken as will give the
affected portion rest — farinaceous diet where the
stomach, animal where the duodenum is involved.
In neither instance, however, have you gained any-
thing as regards positive treatment, especially if you

ORGANOPATHY, 53

are going to conduct this by similar remedies. Your
medicine must indeed act on the same parts as those
affected by the disease, and in the same manner.
But, if it produce a like group of symptoms, the
inference is that it does so. As Hahnemann wrote
in the Organon (§ 148) — "A medicinal substance
which has the power and the tendency to produce
symptoms the most similar possible to the disease to \
be cured, given in a suitable dose affects those very
parts and pbinlii in the orgartiSm hitherto suffering
from the natural disease." It is from the phenomena
that, in diagnosis, you infer the noumena : quite as
surely, in treatment, if drug and disease have the
same phenomena, it may be concluded that their
noumena are also identical. You are indeed in this
■way more certain of your aim ; for your diagnosis
may be wrong, as the autopsy not uncommonly
proves, but your compai'ison of symptoms — if intelli-
gent and painstaking — cannot err of the mark.
And further, — it must be remembered that our
object is to select, not a simile only, but the siniil-
limipu — the medicine whose action on the healthy
corresjMnds to the particular case in its individuality,
in the finer features and more minute ramifications
of the malady here presented. Identity of lesion is
insufficient for this: "we want" as Dr. Drysdale
has said "a pathological simile far more exact and
qualitatively like than that afforded by mere coarse
morbid anatomy, which is common to all cases alike.'"
We get this by fitting together the variety of phe-
nomena manifested in disease and in drug-action, by

54 THE KNOWLEDGE OF DISEASE.

** covering'' the one with the other. We may not
be able to explain why certain symptoms are present
in certain cases : but we must believe that each has
its proximate cause, and that the combination of such
causes constitutes the individual malady from which
the patient is suffering, and to which our drug must
be fitted.

For drug-therapeutics on the homoeopathic princi-
ple, therefore, symptomatology may justly supersede
diagnosis, as being in many cases surer and in all
more thorough. It gives us this further advantage,
that it often enables us to attack maladies in their
forming stage, before they have developed such le-
sions as physical signs can manifest. The totality of
symptoms is intended to be a curative indication, and
if disease is to be cured it should be taken as early
as possible, before such results have occurred as be-
come the subjects of morbid anatomy post mortem^
or even of pathology during life. In such early stages
maladies are recognisable by rational signs alone, and
mainly by symptoms of a subjective nature. This
point has been forcibly made by Carroll Dunham, in
his essay entitled **The Relation of Pathology to
Therapeutics ; " and I would take the opportunity of
commending the writings of this "beloved physician"
(by no name less tender can those who knew him
speak of him) to your most earnest attention. His
lucid style is but an index to the clearness of his
thought ; and in him Hahnemann finds an expositor
who knows how to reconcile him to science and ex-
pound him in reason without sacrificing an iota of

55 '

|essential principles. In the essay I have men-
tioned he shews, that as physiology takes cognizance,
not of life, but of the results of life, so that with
which pathology is concerned is the result of the
abnormal and perverted life which we caU disease.
The products of disease pathology sees, hears, or
infers : it knows nothing of disease itself. Hence,
to base therapeutics upon pathology alone is to make
the former merely palliative — a pumping out a leak-
ing ship instead of stopping the leak. It may be
said that wc do not know where the leak ^the pri-
mary disturbance — is, and that if we knew we could
not reach it to stop it. But by the proving of medi-
cines we obtain agents which shew their power to
cause similar inundations, and therefore, presumably,
similar breaches, which — upon the principle simiiia
sii!ii7i6iis — it is the hypothesis that they can repair.
If, then, the comparison between the results of dis-
ease and of drug-influence be thoroughly and accu-
rately made, the parallelism of action must reach also
to that which originates either. "And here" Dr.
Dunham writes " I cannot refrain from rendering
homage to the wonderful prevision of genius by
which, in an age when pathology, as we understand
it, was unknown, Samuel Hahnemann anticipated all
that we have said, and all that the most advanced
thinkers of our day have taught, respecting the scope
and influence of Pathology in relation to Therapeu-
tics. The symptoms of the urinary organs in con-
nexion with the discharge of morbid urine would at
one time have been regarded a? the proper subject

56 THE KNOWLEDGE OF DISEASE.

of treatment. But Pathology has now taught us
to trace these symptoms back to the kidneys, and be-
yond the kidneys to the blood, and beyond the blood
to the nutrition and the destruction of all the organ-
ised tissues. As Dr. Carpienter remarks — * When,
for example, the urine presents a particular sediment,
our enquiries arc directed not so much to the sedi-
ment itself, as to the constitutional state which
causes an undue amount of the substance in ques-
tion to be carried off by the urinary excretion, or
which prevents it from being (as usual) dissolved in
the fluid.' To confine the attention, therefore, in
prescribing for a given case, to the immediate organ
the perversion of whose functions is most obviously
pointed out by the prominent symptoms, is to disre-
gard the clearest indications of Pathology. We must
analyse these obvious symptoms, and must include
their remotest elements in our indications. Nay,
these remotest elements— the constitutional disturb-
ances, for instance, of which Carpenter speaks — are
even more important indications for treatment than
the more obvious and objective symptoms. But
how can we analyse these more obvious symptoms,
and ascertain those 'constitutional disturbances ' in
which they have their origin ? In no other way than
by a study of the functions of the entire organism —
1 what way and to what extent they are performed
I in an abnormal manner. And this brings us at once
L to that rule on which Hahnemann so strongly in-
sisted, that the entire organism of the patient should
be examined in every possible way, and that the

THE FEVERS. 57

'totality of symptoms ' should be made the basis o£
the prescription ; nay, that the constitutional, gen-
eral symptoms are often more conclusive as to the
proper treatment than the more obvious local symp-
toms. The grand old master reached at a single
bound the same conclusions to which the labors of
a half century of able pathologists have at last, with
infinite research, brought the medical profession."

All this time we have been dealing with general
principles ; but let us look at speciaHornis of disease,
and see whether or no the Hahnemannian mode of
regarding them is sufficient for their treatment.

I. Thcftvers constitute a group which plays a large
part in daily practice. They are maladies in which
morbid increase of temperature exists prior or out of
proportion to any local inflammation which may be
present. The theory of this state is still a moot
one. According to some pathologists it depends iipon
excessive heat-production ; according to others, upon
deficient heat- radiation ; while yet another class (with
whom I venture to think the truth resides) believe
that both factors operate in the process. Rut what-
ever be the genesis of fever, it remains a positive
fact, a clinical entity, with which we have to deal.
Upon the homceopathic principle, we have to treat it
with drugs capable of producing fever. How they
do so, we may not know ; but our ignorance of the
process matters little if we are sure about the result.
"An infinitesimal quantity of atropia — a mere atom/
— writes Dr. Harley, "as soon as it enters
blood, originates an action which is closely allied

s the ^J

58 THE KNOWLEDGE OF DISEASE.

if it be not identical with, that which induces the cir-
culatory and nervous phenomena accompanying ente-
ric or typhus fever/* This is sufficient ; and as soon
as we learnt it to be a fact, from Hahnemann's prov-
ings of Belladonna (made, I may add, before Dr. Har-
ley was heard of), yet minuter quantities of Atropia
(in the form of the juice of its mother-plant) became
in our hands trusted remedies for these very fevers.
Again (for here there is no question of lesions) the
classification of fevers of which we have already
spoken, so necessary for science and so valuable for
general purposes, has but the smallest influence upon
drug-selection. The old divisions of synocha, syno-
chus and typhus (the last with its " nervosus ** and
"putridus*'), worthless as they are from a scientific
point of view, are much more useful for our practice
than those of typhus, typhoid, relapsing and epheme-
ral. They denote the h'^id of fever with which we
have to do, its quality and mode of life ; and to us it
is all-important that our drugs, next to being really
febrigenic, should correspond in their action to the
kind of fever present. They can hardly set up a
whole typhoid, in its complete evolution ; but the
febrile state they developc is certainly either a syno-
cha, a synochus, a typhus nervosus versatilis or stu-
pidus, or a typhus putridus ; and if we find these
states existing, in the essential fevers, the exanthe-
mata, or elsewhere, in them we shall have our reme-
dial means.

2. After fevers, the most important group of dis-
eases consists of the inflammations. To the pathology

THE NEUROSES.

of this morbid process many pages are devoted at the
comraencement of every treatise on medicine or sur-
gery. Whether, after all that has been said, we
know much about it in its essence, may well be
doubted ; but, even if we do, of what avail is our
knowledge for treatment — at any rate for medicinal
treatment ? The old phenomenal signs, dolor, calor,
rubor, turgor, still for all practical purposes constitute
inflammation, when externally manifested ; and when
it is internal, and so invisible, the facts which lead
us to infer its presence and seat are no less of the
symptomatic order, as I have already argued. To
treat inflammation homosopathically, it is only neces-
sary to find a drug capable of setting it up, at the
same spot and in the same manner, as evidenced by
the symptoms.

3. The Jiciiroscs, of which I would in the third
place speak, are still — as Liebermeister says — symp-
tomatic groups. Their unity is one neither of cause
nor of (known) lesion : it is clinical only, It is of
much interest to know what is the seat and process
of the epileptic paroxysm ; but our choice of anti-
epileptic remedies must be determined mainly by
the power they have of inducing similar paroxysms
in the healthy subject, explain it or not as we can.
In like manner is it with chorea and tetanus and hys-
teria : no conceivable knowledge we can gain as to
their intimate nature would make us better able
to fit homceopathic remedies to them than we should
be if we possessed their symptomatic analogues in
drugs.

60 THE KNOWLEDGE OF DISEASE.

It thus appears that, of the three elements i
have seen to exist in all knowledge — phenomena,
laws, and causes, it is the first which, for positive
therapeutic action, chiefly concern us in disease.
Not that the other two are worthless to us, even for
this end. Our laws here are classifications — the
recognition in morbid states of genera, species and
varieties analogous to those of animated nature.
These enable us to form groups of remedies asso-
ciated with them, instead of having to wander
through the whole Materia Medica for each pre.
scription: they also give a continuity to medicinal
treatment, without which the i/si/s in morbis were
of no avail. Hahnemann led the way here, by con-
stantly insisting on the existence of fixed and defi-
nite types of disease, to which standing remedies
should be applied ; and by giving us his group of
"antipsorics." I fear, however, that he must be
considered as having rejected all enquiry into causes
— I mean proximate causes, the noumena of the
phenomena — in this sphere. In so doing we need
' not follow him. His ground for taking symptoms

I as the element of parallelism between disease and

I, drug-action was that they only were surely known.

\ In his day this was true, and his selection of them

was most prudent. But to maintain that they only
I were knowable was unwarrantably to bar the ad-

jl vance of science. His stricter followers have acted

l[ on the dictum, and have looked askance on the posi-

tive pathology of the present day, with its physical
diagnosis and post-viortem confirmations. They are

PATHOLOGICAL SIMILARITIES,

always a decade or more behindhand in their recog-
nition of such distinctions as those between typhus
and typhoid, between chancre and chancroid, and in
their use of such means as auscultation and ther-
mometry. Now this is altogether wrong. An infer-
ence from symptoms, if sure, is as good a basis for
treatment as symptoms themselves. This sureness
is assumed in the prognosis given and the general
management instituted: why should it not be also
for purposes of drug-selection ? By proceeding upon
it we secure another route to the simile we desider-
ate. \Vc use symptoms to reach it, because they
are its most certain expression ; but, if it can be
otherwise attained, the alternative access may often
be useful. Morbid lesions sometimes occur almost,
if not quite, without symptoms, as for instance
caries of the vertebrae, and senile pneumonia. To
attempt to "cover" these from the results of the
proving of drugs would be futile. But to.xicology
and experiments on animals here come to our aid,
and give us in Phosphorus a substance capable of
inflaming alike the cancellous structure of bone and
the pulmonary air-cells ; so that with it we can com-
bat these diseases, however latent and expression-
less they may be. There is indeed something
fascinating about similarities of this kind ; and an
eminent English homceopathist. Dr. Sharp, has pro-
posed (following in the footsteps of Paracelsus and
Rademacher) to make seat of action instead of
symptoms the basis of our method, which accord-
ingly he would call "organopathy." That remedies

62 THE KNOWLEDGE OF DISEASE.

SO led to may prove effectual is undoubted : we have
a good example of them in the Ceanothus Ameri-
canus, which, though never proved on the healthy,
and only known to "act upon '* the spleen, has been
found strikingly effective in enlargements and other
disorders of this organ. But we should never, if
possible, rest content with identity of seat between
disease and drug : we should aim also at making their
kind of action the same, and this can only be done
by securing similarity in their symptoms. In this
way we elevate the simile to a simillimum, and pro-
portionately enhance its energy in cure.

We thus come back to the phenomena as our
mainstay in practice : for therapeutic purposes, the
totality of symptoms constitutes the disease. As a
result of this view, the examination of patients by
the homcDeopathic prescriber is far more minute than
that ordinarily practised. He can hardly, indeed,
inspect and explore for himself more thoroughly
than does the well-trained practitioner of to-day;
but he listens to and questions the sick person with
greater patience and more painstaking complete-
ness. His object is not merely to find out to what
recognised malady his patient's troubles are to be
ascribed : for such end but few symptoms are neces-
sary, and the rest can be left. He has to get at
their totality, that he may cover them with a medi-
cine capable of producing them on the healthy sub-
ject ; and in pursuit of this aim he must not account
any detail superfluous. It has been objected that we
should come off badly upon such a method with Mrs.

SUBJECTIVE SVMl'TOMS.

Nickleby for a patient. But happily Mrs. Nicklebys
are exceptions ; and when we do meet them common
sense must deal with them accordingly. Of counse,
proportion must be observed; and any thing we
htoii) to be merely incidental may be omitted. Our
colours must be mixed, like Opie's, " with brains.
Sir." But if we only think a detail unimportant,
our wisdom will be to give the patient the benefit
of the doubt, and insert it in our picture.

In this way we are led to that greater regard for
subjective symptoms in favour of which Dr. Russell
Reynolds so eloquently pleaded before the British
Medical Association in 1874.

" Is it not coming to Ihls " lie protested " that but little atten-
tion is often paid to the accounts which patients give of them-
selves, Iheir ideas, emotions, feelings, and physical sensations?
These are things which we cannot weigh in our most guarded
balances; measure by our finest scales; split up by our cruci-
bles ; or describe in any terms save those which are peculiar to
themselves, and which we cannot decompose. These symptoms
are often disregarded and set a.';ide : and the patient, whose story
of disease is made of them, is thought fanciful, hypochondriacal,
hj'sterical, nervous, or unreal ; because, forsooth, we have physi-
cally examined thorax, abdomen, limbs, and excretions, and have
found in them nothing wrong; because we have looked at the
retiniE, examined the limbs electrically, traced on paper the
beatings of the pulse, weighed the patient and not found him
wanting. Still he is miserable, in spite of placebo and assurance
that there is nothing organically wrong! There may be in him
a consciousness of a deep unrest ; or of a failing power, which
he feels, but which we cannot see; or of a something worse

Hwn or heart; a want of the feeUng of Intellectual grasp, which

J_J

64 THE KNOWLEDGE OF DISEASE.

he may call failure of memory, but which memory — when we
test it — seems free from fault; a want of the sense of capacity
for physical exertion, which seems, when we see him walk or
run, to be a mere delusive notion, for he can do either well or
easily to our eyes and those of others ; and so he is called ner-
vous, and told to do this or that, and disregard these warnings
which come to him from the very centre of his life. And let
me ask whether or no it has not again and again happened in
the course of such a history as that which I have only faintly
sketched, that some terrible catastrophe has occurred ? Do we
not see minds gradually breaking down while we say there is
no organic change in the brain? hearts suddenly ceasing to do
their work, when after careful auscultation we have said there
was nought to fear? Suicide or sudden death sometimes dis-
turbs the calm surface of our scientific prognosis of no evil:
we may be startled, and may then see all that we ought to have
seen before. But when the ripples that such unforeseen events
have occasioned on that smooth surface have subsided, we go
on as we have already done, and still pay but little attention to
what the patient feels, and delight ourselves in the precision of
our knowledge with regard to physical conditions of which he
may know nothing and may care still less. No one can appreci-
ate more highly than I do the value of precise observation, but
I do not believe that minute, delicate, and precise observation is
limited to a class of facts which can be counted, measured, or
weighed. No one can see more distinctly than I do the wrong
conclusions at which a ])hysician may arrive by accepting as
true the interi)retations which fanciful patients may offer of their
symptoms; but I am sure, that if we pay no heed to these mis-
taken notions of a suffering man, we lose our clue to the com-
prehension of the real nature of his malady. Morbid sensations
and wrong notions are integral i)arts of the disease we have to
study as a whole, and we arc bound to interpret their value for
ourselves ; but we can ill atiford to set them aside, when we are
as yet but in the dawn of scientific pathology, and are endeav-
ouring to clear away the obstacles that hide the truths we hope
hereafter to see more clearly about the mystery of disordered

THE TOTALITY OF SVMfTOMS. G'j

lite. Tlie value of such symptoms may he sliglil in some kinds
of disease, when compared with that of those phenomerja which
may be directly observed; but we are bound to remember that
there are many affections of which they furnish the earliest indi-
cation, and there are not a few of which the)' are throughout the

In the light of this, which is but one among the
many advantages of Hahnemann's mode of observ-
ing disease, I think we may make claim for it as be-
ing, not only the one safe thing for his own time,
but also a mode of procedure most important in
itself, and never to be left behind. It needs espe-
cially to be emphasised at the present day. It is
with us as before the Reformation, when the Bible
was used by the Church only as a rule of faith — a
source whence were to be inferred the doctrines and
practices obligatory on her children. What Luther
and his fellows did was — as Dr. Robertson Smith
has well shewn — to recover the Book itself, in the
totality of its thoughts and words, as a means of
grace to each individual soul. The fruitful results
thus achieved in the spiritual sphere will be par-
alleled in the medical as the clinical study of disease
is allowed its due preponderance, and is made the
direct road to therapeutics. Of this reformation
Hahnemann was the preacher in his day ; and his
voice must ever be echoed by his disciples when they
see the profession straying into the alluring, but less
practical, by-paths of pathological speculation.

In support of thus acting, they can now cite the
words of another acknowledged leader in Englit^h

66 THE KNOWLEDGE OF DISEASE.

medicine, Sir Andrew Clark. In his Presidential
Address at the Clinical Society of London in 1883,
this distinguished physician said : * —

" Another great work of our Society has been, and continues
to be, the gradual unfolding of the exact relations which morbid
anatomy and, incidentally, experimental pathology should hold
to clinical medicine. These two chief servants of our art,
excited and carried away by their marvellous successes, and
assuming a joint sovereignty over our art, look down with conde-
scending superiority upon clinical medicine, ridicule her claims
to supremacy, scoff at her empirical distinctions, reproach her
with being unscientific, and strive to torture her into a slavish
subjection to their theories. But the true relation is not this 5
it is, indeed, the converse of it. For the structural change is not
disease, it is not co-extensive with disease ; and even in those
cases where the alliance appears the closest, the statical or
anatomical alteration is but one of other effects of physiological
forces, which, acting under unphysiological conditions, consti-
tute by this new departure the essential and true disease. For
disease in its primary condition and intimate nature is in strict
language dynamic ; it precedes, underlies, evolves, determines,
embraces, transcends, and rules the anatomical state. It may
consist of mere changes in the relations of parts, of re-arrange-
ments of atomic groupings, of recurring cycles of vicious chemi-
cal substitutions and exchanges, of new conditions in the evolu-
tion and distribution of nerve force, and any or all of them may
be invisible to the eye, inseparable from life, and undiscemible
in death. Undoubtedly the appearance of a structural alteration
in the course of disease introduces a new order of events, sets in
action new combinations of forces, and creates disturbances
which must be reckoned with, even as mechanical accidents of
the pathological processes. ^^\x\. always behind the statical lies
the dynamic condition; underneath the structural forms are the
active changes which give them birth, and stretching far beyond

' Lancet^ Feb. 3, 1883.

SUPREMACY OF CLINTCAL MEDICINE. 6/

the limits of pathological anatomy, and pervaded by the actions
and interactions of multitudinous forces, there is a region teem-
ing with manifold forms of disease unconnected with structura4
change and demanding the investigation which it would abun-
dantly reward. It is in this mysterious and fertile region of
dynamic pathogenesis that we come face to face with the primi-
tive manifestations of disease, and learn how much knowledge
from various sources is needed to understand it aright; it is
here that we see how, without help from physics, chemistry, and
biology, collecting, converging, and meeting in a common light,
no single problem in disease can be completely solved ; it is
here that we are made to comprehend how the nature of a path-
ological product cannot be determined by its structural char-
acter, but by the life-history of the processes of which it is only
a partial expression ; it is here that we observe how, in thera-
peutic experiments, the laws of the race are conditioned and
even traversed by the laws of the individual ^ and it is here
that we discover how clinical medicine is to become a science,
and how she is already, beyond question, at once the mother
and the mistress of all the medical arts."

IV.

THE KNOWLEDGE OF MEDICINES.

At our last meeting we spoke of the knowledge of
disease. We saw that the phenomena we call "clin-
ical " — the symptoms of maladies, subjective and
objective, rational and jDhysical, in their connexion,
conditions, and order of evolution — form the most
important object of our study. They do more than
enable nosology to classify their sum and pathology
to diagnose their seat : they directly avail, under the
guidance of the method of Hahnemann, for the choice
of their remedies. Nosology aids in this, by group
ing drugs around definite morbid species, and pathol-
ogy by utilising their local affinities ; but both need
completing by symptomatology to determine finally
the one medicine which shall be the similliimun of the
disorder we have to treat. We heard .some of
the ripest medical thinkers of our time bearing wit-
ness indirectly to the validity of this mode of pro-
cedure, recognising the dynamic origin of disease,
the importance of subjective symptoms as indicating
its beginnings, and the necessity of taking all symp-
toms into account if we arc to arrive at a true con-

FOODS AND MEDICINES. 69

ccption of a case. The inference is that to the clini- ,
ca] study of disease, as made possible by hospital and '
dispensary, you should devote your chief attention.
Learn, indeed, all that pathology, which is the science
of disease, can tell you about it in its various forms;
but use the iight of such knowledge, not so much to
gaze upon in scientific interest, as to illumine your
perception of the actual features of that with which
you have to do.

Our subject to-day is the knowledge of medicines,
which are the tools of the healing art, as disease is
the material on which it works. What are medicines ?
I do not know that any better definition of them can
be given than that which was put forth by Hahne-
mann in 1805. in the preface to his Fragmcuta de
viribns mcdicamcntorum fositivis: — "Quie corpus
mere nutriunt, Aiiincnta, quas vero saniim hominis
statum ( vel parvA quantitate ingest^ ) in ajgrotum —
ideoque et a^grotum in sanum — mutare valent, Mcdi-
cameiita appellantur." My only difference with him
would be that I shoidd place the corollary foremost,
and define a medicine as a substance which has the
power of changing sickness into health, and there-
fore — on the principle nil prodcsl quod nan liBiUtur
idem — of altering health to sickness.

Now on what ground is any substance to be reck-
oned a medicine? and how is it to be ascertained
what are the morbid conditions and processes it can
favourably modify .' There are but two ways by which
to arrive at such conclusions, the empirical anJ the
rational.

70 TilE KNOWLEDGE OF MEDICINES.

I. Many, perhaps most, of the ordinary remctHS
uses of drugs have been stumbled upon by chance.
It has generally been "the common man" (as Hah-
nemann calls him ), sometimes even the still lower
brute, that has discovered them ; and the professional
healer has taken the hint and adopted the practice.
After this manner has been gained bark as a remedy
for ague, burnt sponge for goitre, arnica for the effects
of falls and strains, graphites for tetters, sulphur for
the itch. Nor less empirically, though among the
practitioners of medicine, has arisen the use of mer-
cury and iodide of potassium in syphilis, of bismuth
in gastralgia, of arsenic in psoriasis. Theories of the
modus operandi of such remedies have often been
subsequently framed ; but it is certain that their ori-
ginal adoption grew out of no such theories, but was
an accidental discovery.

Now it would be the height of unwisdom to neglect
information from this source, A remedy is a remedy,
however come at, and whether conforming or not to
any laws of action we may suppose to prevail. Ex-
perience is the test even of medicines rationally ascer-
tained to be such : it is but beginning the process a lit-
tle lower down when experience itself discovers them.
But on the other hand it is obvious that the empir-
ical method is a very uncertain one, and affords no
guarantee of further additions to onr remedial wealth.
Indeed it is no method at all, but mere guess-work
and chance picking-up. It is only hopelessness as
to rational therapeutics which can lead writers like
Wilks and Druitt to make empiricism a matter for
' ' ' 'OH and a standard of advance.

^^H RATIONAL MEDICINE-SEEKING. ^[

^^^; There are certain pseudo-rational modes of dis-
covering remedies which have brought undeserved
slight on those tndy bearing the name. Such are
the doctrine of " signatures " and much of the iatro-
mechanical and iatro-chemical theory of former and
later times. When a real medicine has been gained
by these means — as chelidonium in disorders of the
liver and euphrasia in those of the eye, as iron in
an33mia and muriatic acid for low fevers — it has been
by coincidence, not from induction : the result is
practically empirical The truly rational method is
that which infers the place and power of a drag in
disease from its behaviour in health. Every such
substance, on being introduced into the animal organ-
ism, causes certain disturbances, certain changes.
Each has its proper series of effects ; each selects
certain organs and tissues, or certain tracts and re-
gions, of the body, and there sets up phenomena of
a definite kind. This is the only source of informa-
tion which is surely and indefinitely fruitfu!. If from
observing the pathogenetic effects of a substance we
can conclude {subject to the teachings of experienca)
as to its therapeutic virtues, we have but to experi-
ment with fresh poisons in order to gain as many
additional remedies.

It is (as you know) the glory of Hahnemann that
he perceived the sujireme value of this mode of dis-
covering medicines, that he earnestly preached and
diligently practised it. By so doing, and by discov-
ering — in siiuilia similibus — the link between path-
ogenetics and therapeutics in the lattor's highest

72 THE KNOWLEDGE OF MEDICINES.

form, he opened the way on which we are now ad-
vancing, and made jwssible every triumph we can
obtain. I am not relating to you the history, or
vindicating to you the truth, of Homoeopathy; I
assume that you know the one and recognise the
other, and therefore I assume your concurrence with
me in the proposition that our knowledge of drugs
must be largely concerned with their physiological
action. Their effects on the healthy body form the
parallel to the phenomena of disease : here, as there,
we must know these phenomena themselves, and
what we can of their laws and causes.

And here again the phenomena, in their totality,
are those which claim our most earnest attention.
The clinical study of disease must have its comple-
ment in the acquaintance we make with medicines.
The law of similars teaches us this, for to obey it we
must have wholes to compare with wholes. In the
ordinary practice men aim at knowing what drugs
can do, that in disease they may induce such effects
with them, when they judge it desirable. In old days,
accordingly, they cared only to learn whether a given
one could purj^e, or puke, or sweat, that they might
class it as cathartic, emetic, or sudorific ; and now
they correspondingly limit their investigations to the
question whether it is an excitant or depressant of
certain nerve-tracts. For such purposes dumb crea-
tures suffice ; and hecatombs of these unfortunates
are now annually sacrificed in enquiries as to drug-
action. The differences of result, and therefore of
opinion, are endless ; and the gain is proportionately

IIOMCEOPATHIC PKOVIKGS,

small. We, on the other hand, have wanted the
whole picture of the effects of drugs for comparison '
with the phenomena of disease, and have gone to
work accordingly. As it is human disease to which
we need similia, and as this is largely made up of
subjective symptoms, it is on the human subject that
we experiment; and'we faithfully record the whole
series of morbid changes which occur after the in-
gestion of a drug. We test the effect of single full
doses, to get analogues of acute disease ; and of long-
continued small ones, that chronic maladies may find
their antitypes. Thus our pathogenetic knowledge,
when truly obtained and registered, is like a picture-
gallery, in which the discerning eye may perceive
the lineaments of all morbid conditions known or
likely to occur, Our provings minister to medicine
as an art : they are synthetic and sensuous, full of
colour and detail. Those of the other camp are
rather analytic, appealing to the reason ; and are
available only so far as morbid processes are scientifi-
cally understood. The record of the one recalls the
graphic pictures of Hippocrates and Sydenham and
Watson, to whose ever-fresh lineaments the mind
returns with pleasure, wearied with the merely intel-
lectual refinements of modern nosography. The work
of the physiological laboratory goes hand in hand
with that of the dead-house : the Hahnemannic phar-
macology and pathology alike move in the region of
life.

This is the first truth about the matter. To read
a good proving in detail — like the Austrian of

74 THE KXOWXEDGE OF MEDICINES.

Aconite — is like going through a series of clinical
cases illustrative of the varieties of a particular dis-
ease. But this comparison of itself suggests that a
further step is necessar)'. In recording such cases,
a physician would do so by way of basis for a discus-
sion of the disease in question, of its causes, its
nature, and its treatment. For ourselves too we
have seen that the clinical aspect is not the only one
in which we should regard the ills to which flesh is
heir. From pathology — the science of disease —
its phenomena are always illuminated, and some-
times even rendered transparent so that through
them we can see the noumena. Pharmacology
should seek a stand-point no less advanced. Prov-
ings correspond with our studies at the bedside or
in the prescribing room ; but as to interpret these
we go to the dead-house, so to the study of prov-
ings we must add — when possible — that of poi-
sonings and of experiments on animals, that the
lesions wrought by drugs may be positively ascer-
tained. But yet our work is not done. We must
use these facts also as materials for inductive gener-
alisation ; we must seek to connect, classify, and
interpret them, to ascertain their laws, to trace them
to their causes. In proportion as we do so, we make
our pharmacology a worthy mate for the pathology
which is growing into maturity beside it. In neither
do we content ourselves with generalisations alone :
the clinical history of diseases and the detailed prov-
ings of drugs must ever form the basis of our knowl-
edge, be the superstructure what it may. But while

PUVSIOLOGICAL INTERPRETATION.

5 employ another figure) these constitute our text,
we shouid reaci it with the help of a commentary
which may ilUmiinate it by the best available lights.
There are some who think they are best following
Hahnemann by shutting their eyes and ears to all
that has been learned since his time; by recognising
nothing ih disease but the patient's sensations and
obvious appearances, and nothing in drug-action but
a scattered heap of symptoms of like kind. We
should not go to the other extreme, and ignore any
aid which may thus be gained in practice. But we
should regard the human body, whether idiopathi-
cally or medicinally disordered, as one of whose
order we are not wholly ignorant — as a sphere in
which we are to some degree at home, and where
we may speak and act as no mere strangers. In
studying the Materia Medica we are to be more
than syniptom-memorisers, in applying it more than
symptom-coverers. We are clcri and not laid here,
and we fall short of our vantage-ground if we work
mechanically only.

Let me illustrate. Dr. Jousset, in his recently-
published Traied dc la Matihr Mi'iiicalc, describes
the action of Digitalis on the heart. He tells us that
in the form of poisoning he calls foiidroyautc, the
pulse is small, uncountable, sometimes completely
absent, and the heart-beats precipitate and hardly
perceptible, with irregularity as recovery ensues ;
that in the less severe variety he designates progres-
sive the pulse is at first strong and hurried without
irregularity, beating 120 to 140 in a minute;

^'ithout ^m
and ^^1

*]& THE KNOWLEDGE OF MEDICINES.

that when the effect is less pernicious, this rapidity
is succeeded by slowness, which from small doses
occurs at once. Again, in summing-up this part of
the drug's action, he states that strong doses "par-
alyse the heart and the arteries after hav'ng excited
them," while still larger doses paralyse from the first ;
and that, of feeble doses, " strong and retarded car-
diac impulse is the primitive, feeble and accelerated
the secondary, effect." All this is true and useful
enough, but what does it mean ? The heart is a hol-
low muscle, contracting rhythmically under the influ-
ence of the ganglia embedded in its substance, and
regulated by the opposing influences of the pneu-
mogastric and sympathetic fibres coming to it from
the central nervous system. What is meant by its
being " paralysed " ? Is it the cardiac muscle itself
that is incapable of responding to the nervous im-
pulses, or the nervous centres which have no power
to send forth their commands } Is the alteration of
the heart's pulsation due to inhibitory or accelerat-
ing influences transmitted to it from above, or to
some change in the organ itself } These are ques-
tions of no mere speculative interest : on their
decision depends our view of the use of the drug as
a remedy. If it paralyses the cardiac nerves only,
it cannot strengthen and tone up a dilated ventricle
by its homoeopathic action. If it retards the heart
otherwise than through the vagi, slow pulse is no
indication for it when induced by their inhibitory
influence. Traube has actually ascertained that
they are the channels through which Digitalis re-

THE uses IN MORRIS. 77

larcis the heart, and Claude Bernard found the drug
In be a direct muscle-poison. That the atiident
shoulc! know this gives him a precious clue through
the mazes of the phenomena displayed, and shews
him where the drug is truly homceopathic, i.e. where
the pulse is simply slow, or where the cardiac muscle
is of feeble vitality.

The physiological effects of drugs, with their in-
terpretation, form thus the chief material of that
knowledge of medicines about which we are enquir-
ing to-day. But there is another and only iess im-
portant field to be worked : I refer to the iisiis in
viorbis, the therapeutic experience gained with the
substances we employ in practice. I have already
urged that a medicine — medkameutum — is one
which has shewn its power medicare, to heal : it
would be such did we know nothing of its power to
hurt. And conversely, though the pathogenetic
effects of a drug, when ascertained, are our most
trustworthy source for eliciting its curative powers,
they are not necessarily conterminous with these.
They may fall short of them, through inadequacy of
provings and absence of poisonings ; or they may
outrun them, from the multitude of trivial sensa-
tions the drug may elicit without definite character
or localisation. Of the former alternative we have
an instance in Ilamamelis: how slight is its patho-
genesis compared with the frequent use wc make of
it! For the latter we have examples ready to hand
in Ptelea trifoliata, in Fagopyrum cscul
in one of the few provings we in luiglnnd

1 nana \

n, and J

I have \

[tE KNOWLEDGK OF MEDtCtNES.

achieved — that of Cotyledon unihiliciis. These drugs
have been freely and fully submitted to experi-
ment : their pathogeneses in Allen's Enc)'clopatUa
contain 965, S36, and 253 symptoms respectively:
but who uses them — at any rate the two last — in
practice ? The therapeutic virtues of a drug must
therefore be studied on their own merits ; and, when
they are of very definite character or on any thing
like an extensive scale, had best (I think) be taken
first. The pathogenetic effects can follow ; and these
will throw light on the clinical results which have
been obtained, will give them precision and not
uncommonly expansion.

I need not say that in so doing you will avoid the
vicious practice of the old-school writers on Materia
Medica, who as a rule carefully abstain from connect-
ing the physiological and therapeutic actions of the
drugs they treat of. Of old, I imagine, they did this
from indifference and scepticism (which last Stills
has plainly avowed) : but now the utmost charity
cannot acquit writers like Ringer, Phillips and Bar-
tholow of deliberately adopting this course that the
frequent testimony their practice bears to homteop-
athy may not appear. You, of course, will hail such
testimony rather than shut your eyes to it. But
let me urge you not in your turn to be lacking in
candour when the evidence points the other way.
This caution is not needless. Here is a patient in
the agonies of angina pectoris. His heart is as it
compressed, his breathing almost impossible :
his face is deadly pale, his surface cold, his pulse

small and contracted. Your old-school colleague
steps forward, and, taught by Dr. Lauder Brunton,
applies to his nostrils a few drops of the nitrite of
aniyl. In less than a minute his face begins to flush,
he warms up, he breathes freely, and the intolerable
breast-pang is gone. This is beautiful practice; but
is it homceopathy ? Nay: for let a healthy man
inspire the same substance, and the effect will be,
not the pallor and coldness and constriction, but the
flush — the dilatation of the imprisoned arteries —
which delivered the sufferer. In all common sense
and justice, therefore, this action ought to be as-
cribed to the second of those three 7nadi operandi
of medicines described by Hahnemann : it is enan-
tiopathic, antipathic, affording all the speedy palli-
ation characteristic of such remedies while open to
all their disqualifications and reproaches. I have
nevertheless been grieved to sec more than one
communication to our journals which, on the strength
of some incidental phenomena in disease and drug,
have claimed the action of amy] in angina for the
law of similars. My colleague Dr. E. M. Hale would
go farther still; and by his theory of "secondary
homceopathicity" would catch every application of
the physiological action of drugs in the Hahne-
mannic net. I admire his enthusiasm ; but I deplore
the effects of such teaching. It leads, I fear, to a
great deal of very eclectic practice; and it lays us
open to just retaliation on the part of our confreres o£
the other camp. We say to them, — you are taking
our similar remedies, small dose and all, and refusing

THE KNOWLEDGE OF MEDICINES.

to acknowledge the law under which they act, using
them empirically, or explaining away their apjjarent
homcEopathicity. Thej' will say in return, — you are
taking our contrary remedies, full dose and alJ, under
a plea which to us at least is transparently futile:
and I do not see how we can repel the allegation.

You will not hesitate, therefore, to give credit to
anti-jiathy when you meet with it ; nor will you
ignore any other curative applications of drugs be-
cause they seem to lie outside the homoeopathic
method. Whether you should employ them must
depend upon other considerations, which you will
learn from your teachers : just now. however, this is
not a practical question for you. Putting these
aside, you will find in your therapeutic studies of
medicines abundant esamplcs of true homeopathic
action, and will enrich your knowledge of them
accordingly. You will also learn here another thing
which pathogenesy alone could not teach you : I
refer to what are known as the "characteristic symp-
toms " of our remedies. A great deal too much has
indeed been made of these features : conditions have
been dealt with independent of the things condi-
tioned ; adjectives have been treated as more impor-
tant than their substantives ; and, so long as disease
and drug strike the same " key-note," it has been reck-
oned indifferent whether or not they play the same
tune, — with what results in discord it is not difficult
to imagine. But, on the other hand, given your sub-
stantive, an adjective peculiarly belonging to it is
often of value in suggesting it and — in case of need

CHARACTERISTIC SYMPTOMS. 8l

— distinguishing it from others of its kind. Hahne-
mann initiated such characteristics when he recom-
mentied Aconite to be given in inflammations when
"with thirst and rapid pulse, an anxious impatience,
an unappeasable restlessness and an agonised tossing
about are conjoined." Experience has abundantly
confirmed the indication : Dr. Dunham has shewn
its coherence with the pathological condition to
which the drug is suitable, and Dr. Guern.sey has
under its guidance extended the range of Aconite
into regions which might otherwise have seemed
foreign to it. The aggravation of liryonia pains by
motion and those of Rhus in rest ; the early morn-
ing waking of the Nux vomica patient, the evening
exacerbation of Pulsatilla sufferings, the intolerable-
nes5 of those of Chamomilla — these are other well-
known and well-tried characteristics which we owe
to the master. Later experience has added others
quite as trustworthy — the aggravations of Rhus
symptoms on change to wet weather, of Rhododen-
dron symptoms at the approach of storms, of Lache-
sis symptoms after sleep; the relief of the Coffea
toothache by cold water held in the mouth, the
nausea of Colchicum at the smell of food, the sensi-
tiveness of the Hepar patient, and so forth. Dr.
Claude has lately shewn us, by a series of well-
selected ca-ses, how important an indication is what
he calls the rhythm of medicines, — as the tendency
of Lycopodium attacks to supervene from 4 to 8
P.M. and of those of Belladonna to come on somewhat
later. Dr. Hawkcs (of Chicago) has in Hkc manner

82 THE KNOWLEDGE OF MEDICINES.

illustrated the unfailing way in which a certain group
of symptoms — vertex headaches, with heat there,
burning in the soles of the feet in bed, hot flushes,
and *' gone, empty feeling " about an hour before the
midday meal — characterises a patient in whose ail-
ments Sulphur will be beneficial. I might continue
such an enumeration ad infinitinn ; but the point I
desire to make is that all — or nearly all — this
knowledge is gained from the usits in morbisy and
would not be learned from a study of pathogenesy
alone. You must therefore cultivate this field as-
siduously if you would fill in the outline of your
acquaintance with the medicines you are to use.

So far I have been speaking as if disease and
drug-action constituted a precisely parallel series of
phenomena. There is an important difference be-
tween them, however, which perhaps has already
occurred to your minds. Disease is ever with us.
Though it is not exactly producible at will, its origi-
nating germs, or its predisposing and exciting causes
of a general character, are so widely diffused, that
no one need go through his student days without
having seen one or more cases of at least its ordinary
forms. In exhorting you therefore to study disease
clinically, with pathology as the lamp to illuminate
the field, an intelligible and practicable task is being
assigned. With drug-disease it is otherwise. This
is to some extent producible at will, but the will is
(naturally) lacking ; and we can only study it in the
records left us by those who have been — voluntarily
or involuntarily — the subjects of medicinal action.

RECORDS OF DRUG DISEASE, 83

This is a serious drawback ; and the only compensa-
tion for it would be that the records in question were
as full and clear and life-like as possible. Suppose
the student were debarred from studying disease at
the bedside or in the dispensary. He would value the
more the teachings from the chair of the Theory
and Practice of Physic ; but he would feel that, after
all, what he got there introduced him to maladies
only in their typical, somewhat abstract and ideal,
forms. He would crave for lectures and books con-
taining detailed narratives of cases, so selected as to
illustrate the various forms and varieties in which
disease is liable to occur. But suppose that, instead
of such materia!, a volume (or ten volumes) were
put into his hands in which, under the head of each
malady, there was given a list of all the symptoms
which had been observed in the several instances of
its occurrence, — these being divorced from their
connexion and sequence, and re-arranged under the
headings of the part or function of the body to which
they seemed to belong. Would he not reject with
loathing this stotie offered him instead of bread.'
would he not clamour for the clinical records, fresh
from nature's mint, of which some cruel technicality
had gone out of its way to deprive him .'

You will have anticipated me in feeling that this
is the unhappy position in which you are actually
placed in respect of the Materia Medica. 1 know
your teacher of that subject too well to doubt that
he gives you, in the most instructive way, all the
information regarding it which is communicable in

THE KNOWT-EDCE OF MEDICINES.

lectures. But, after all, he has only introduced the
medicines to you : he has done for their pathogenesy
what the Professor of " Theory and Practice " does for
disease. Where, then — as you cannot study drug-
maladies in life — are the clinical cases, the detailed
provings and poisonings of individuals ? They mostly
exist, — though Hahnemann is said to have been un-
kind enough to destroy the day-books of his provers :
they exist, — but scattered through interminable vol-
umes, often sealed up in a foreign tongue, sometimes
still only in manuscript. The writer of a monograph
on any drug has the utmost difficulty in getting to-
gether all the necessary materials, as a certain Club
in this city found when they began the labours
which resulted in their charming little volume on
Gelsemium:' but what is the student of all drugs
to do? He may make the most of such books as
those of Hempel and Burt, or as that Manual of
Pliannacodyiiamics of my own which the authorities
of this school have honoured me by admitting among
their text-books. But these, after all, occupy only
the same ground as the lectures he hears, and must
be read in connexion therewith. Both one and the
other are introductions : but what is it to which you
are introduced > Whether in Hahnemann himself,
in Allen, or in Hering, it is that unhappy jumble of"
symptoms whose inadequacy to instruct has been
already seen in the parallel instance of disease.
What, then, are you to do.'. As matters stand at

: Olis CUipp ai

THE SCHEMA FOR REFERENCE ONLY, S$ '

present I would advise you, for all d priori knowl-
edge of medicines, to content yourselves witti the
general view given in your lectures and text -books,
with the broad features of their physiological action
eked out with the fullest possible acquaintance with
■ what they have done and are likely to do in the
way of therapeutics. Their minute symptomatology
it is hopeless to memorise, but no less perilous to
abridge : let it stand as it is, with such discrimina-
tion as you can supply, and use it a posteriori only.
Whenever an unusual symptom or combination of
symptoms meets you, whenever a case "hangs fire"
under the ordinary remedies, hunt up the phenomena
by means of a repertory, which is just an index to
the Materia Medica. If you find them there, if their
source (so far as known) is trustworthy, if the drug
to which they are ascribed is otherwise suitable to
the case, give it, nothing doubting. You will some-
times miss your mark, but quite as often you will hit
it; and in this way you will turn to profit a symp-
tomatology which otherwise is only a barren and
trackless wilderness.

I believe it would be a great deliverance to the
student, and also to the would-be convert, of homce-
opathy if it were distinctly understood that our
symptomen-codices were not meant to be studied.
The endeavour so to use them has turned back many
an enquirer in disgust : as it is said to be ominous
that our English Marriage Service begins with
"Dearly beloved" and ends with "amazement," so
is the schema reficctcd in the mind of its peruser.

WLEDGE OF MEDICIN'ES.

who begins with " vertigo " ancJ ends with "rage."
Hahnemann certainly intended his for no such pur-
pose : it is demonstrable that the i posteriori use of
them was the only one he contemplated, and that it
was in view thereof that he published his provings
in this form. Let us hold his works in all honour.
Let us give them adequate translation into our own
tongue, as we in England have lately done with the
Materia Medica Fitra, as I hope America will speed-
ily do with the Chronic Diseases. But let us use
them aright ; not exhibiting them to outsiders as a
specimen of what Materia Medica should be, not
breaking our own or our pupils' hearts by vain at-
tempts to learn from them what medicines can do.
For this purpose his prefaces and notes are often of
the utmost value, for he wrote them from a knowl-
edge of the detailed provings. But the catalogues of
symptoms into which he cut up the latter he made for
reference, and for reference only should they be used.
Again let me illustrate. In 1847 Dr. Molin, of
Paris, published the following experiment made on
himself with Tartar emetic.

" Being in a good stale of health, my pulse 64, I took at 8
A.M., tasting, five milligranimes of larlnr emetic in water. This
dose was repeated for five dajs without perceptible effect. The
sixth day I felt nothing until about 4 p.m. The respiration
then appeared to me a little less free. Feeling no further effects,
and my appetite continuing good, I took about 9 r.M. a dose of
one centigramme. The night was passed in a restless nianner.
and [he sleep interrupted by a fatiguing heat; I felt necessitated
to drink several times, the respiration was slightly impeded ; on
■^^'"gi general uneasiness, weariness similar to what follows a

PROVING OF TARTAR EMETIC. Sj

febrile fit, the moulh clammy. At S a.m. I took one centi-
gramme. No appetite: a simple soup for breakfast without reV
ish. All the day I was in the same state. AItouI s p.m. greater
uneasiness, especially about the epigastric region: nausea; de-
sire to vomit but without result; respiration more impeded;
short dry cough, pretty frequent ; great thirst ; heat in the head ;
white tongue ; drinks appear always loo sweet ; clammy mouth ;
♦wo loose evacuations during the day ; palpitation of the heart;
ised feeling and general weariness, compelling me to go to
at eight o'clock. The eat applied to the chest gave evidence
,6( nothing abnormal, except that the respiration appeared much
feo rough. At ij P.M. 1 took 5 milligrammes. Agitated sleep,
difficult respiration, feeling of pressure on the chest during sleep.
Al s A.M. I was awakened by a violent rigor, it lasted twenty
minutes, and was followed by heat; the pulse, which liad been
little affected during the two previous days, increased to 78, was
full and strong: skin hoi: face red; thirst urgent; heat in the
head; pretty strong palpitation of the heart; slight burning at
the stomach, — fulness, and inclination to vomit; respiration
very much impeded ; feeling of pressure and constriction of the
chest ; cough frequent, and a little moister ; on auscultation, the
respiration appeared rougher than on the previous evening, and
deep inspiration was accompanied by slight pain under the left
nipple. Night very agitated; nightmare; disagreeable dreams.
I felt much the same in the morning as 1 had the previous day,
but deemed it advisable not to carry the experiment farther.
During the subsequent dajs the following symptoms occurred ;
— the tenth day. no stool; towards evening, pulse 72; respira-
tion somewhat less difficult; cough the same; hardly anv pain
in the side; great thirst; a good deal of uneasiness: no incline
tion to vomit; night a little less restless. The eleventh day, a
little less roughness of breathing on auscultation; cessation of
the pain; pulse neariy normal; skin still hot; thirst less; uneasi-
ness diminished ; appetite in part returned ; respiration still
obstructed; cough a little less; the night more tranquil. Twelfth
day. appetite; breathing nearly free; the cough continues;
scarcely any thirst ; tranquil night. The symptoms continued

THE KNOWLEDGE OF MEDfCrNES.

to dimmisli the subsequent days, so that by the eighteenth there
remained no trace of indisposition, except slight cough, which
persisted some lime longer."

Now it is quite ctear that in this proving o£ Tartar
emetic Dr. Molin developed in himself an incipient
pneumonia; anci the rest of the symptoms (save per-
haps those of the gastro-intestinal organs) were syri-
tiroinata of that affection. Read in their connexion
and sequence, they are easily understood a.right ; but
imagine them cut up for the schema. Imagination
is necessary here ; as — very fortunately — Dr. Allen
overlooked Dr. Molm's experiments when compiling
the pathogenesis of Antimomum tartaricum for the
first volume of his Encyclopedia, and so has reserved
them for the appendi-t in the tenth volume, where he
gives them in detail as recorded. But the picture is
not difficult to construct. The rigor, heat, full pulse,
and thirst, would appear in the " Fever" section, and
would seem to shew that Tartar emetic was capable
of exciting primary pyrexia, and this indeed — seeing
that there was fever also on the previous night — of
an intermittent character. The agitated nights, with
their troubled dreamings, would be classed under
"Sleep," and would suggest that the drug had power
directly to disturb this function of the brain ; while
the palpitations would mislead similarly as to its
action on the heart. The respiratory affection would
itself he dismembered ; for cough is always, in our
schemas, found under the head of "Larj-nx," while
the rest of the symptoms would be referred to the
chest.

PROVISOS TO 1

Sail! I not truly then that our pathogeneses, in the
'Hahnemannian arrangement, are not intended for
study ? Their unity is deliberately broken up, that
they may become an index rather than a text ; and they
must be used accordingly, for reference and not for
consecutive reatiing. To a great extent, as we have
seen, the sacrifice is made in vain ; for the separate
symptoms divorced from their context arc often unin-
telligible and even delusive. All that is required
would have been given by a short repertory affixed to
each pathogenesis, or group of pathogeneses, shew-
ing where — if anywhere — individual symptoms might
be found. In this way the peculiar sensation of the
sweet taste of drinks, experienced by Dr. Molin,
might have been noted ; and might have led to a mi-
nute adaptation of the drug. Hahnemann did some-
thing of the kind for the pathogeneses of his Frng--
menta de Viribus, but he had already adopted for these
schema-form. It is too late for any alteration in
'hat we have from him : but it is not too late to stop
any presentation of new provings in this shape. I
had hoped, until I saw the Transactions of the Amer-
ican Institute of Homceopathy for 1881-2, that no one
would now inflict such a wrong upon us. It seenjs,
however, that some of those who call themselves
"Hahnemannian" feel bound to reproduce, with
Chinese accuracy, the defects as well as the merits
of their eponym. Their vicious procedure will call
down its own punishment ; for in the Materia Medica
of the future such contributions, if admitted at all,
will pretty certainly receive the comparative discred-
ing o£ smaller type.

.11, j

KNOWLEDGE OF MEDICINES.

Of this Materia Medica, on which the hearts and
hopes of many of us are now set, I shall have to
speak to you in the concluding lecture of this course.
I shall then endeavour to shew you how you may
have to your hand records of drug-action answering
to the clinical aspect of disease, which you may study
with equal interest and instruction. In the mean
time, as I have said, — make the best use you can of
your introductions, and of such detailed provings
and poisonings as you can pick up from books or
journals. But do one thing more. I have said that
the student of disease, if put off with an artificial
symptomatology, would clamour for the natural records
of which he had been deprived. I want you also to
clamour. If what I have said on the subject has
commended itself to your minds : if on hearing such
a narrative as that of Dr. Molin's you have thought
O si sic omnia ! let your voice be heard, and sic omnia
will be. I am pleading for the constitution of an
entire Materia Medica in that form ; and this largely
in the interest of the students a thousand of whom
annually fill the Homceopathic Colleges of America.
If they will back my plea they will convert it into a
demand ; and the supply will assuredly follow.

PYREXIA AND THE ANTIPYRETICS.

We have enquired what should be our knowledge
of disease and our knowledge of medicines, and have
arrived at certain definite conclusions thereupon.
From what I know of my friends, the Professors of
Practice of Medicine and of Materia Medica in this
School, I have no doubt of being in agreement with
them as to what you should learn in these departments,
and as to how j-our knowledge should be acquired.
I am no less sure that, under their guidance, you are
becoming as thoroughly acquainted with disease and
with drug-action as it is possible for students to be.
I have nothing to add to what they teach you. I pro-
pose rather, on most of the remaining occasions of
my addressing you, to occupy your attention with a
series of topics intermediate between the spheres in
which their instructions move. I propose to study
cert3.in ffrvK/s of medicines — groups formed naturally
out of relationships to morbid states or actions on
the same parts of the body ; and to institute such
comparisons between the .several members of the
groups as shall bring out their individualities, and

: ANTIPYRETICS.

thus ensure their accurate adaptation to the disorders
they have to remedy. Fever and rheumatism are the
morbid states I shall utilise for the purpose ; while
for action on the .same part of the body I shall study
the cerebral symptoms of a number of drugs in the
light of the researches on cerebral localisation which
have excited so much interest of late.

Our subject to-day, then, will be the group of drugs
which, from the control they have shewn themselves
capable of exercising over the febrile process, may
be called antipyretics. Before approaching them,
let us dwell for a time on the process itself, and as-
certain what is known of its inner nature and of the
manner of its occurrence.

That fever, pyrexia, consists essentially in increased
temperature of the body appears from its name, which
in both Greek and Latin points to combustion or
glowing heat (impcTO'i, from Tup, fire ; febris, from fcr-
vco, I glow). Wc shall see presently that something
more than heat of body is required to constitute the
clinical entity we call fever ; but, though there may
be hotter blood (as ascertained by the thermometer)
without fever, there cannot be fever without hotter
blood. Now this organism of ours is so nicely ad-
justed, both in its inner relations and in its re-actions
with the environment, that the temperature of our
bodies is at all times arid under all circumstances
almost uniformly the same. Whether we shiver at
the poles or swelter within the tropics, whether we
glow with e.\ertion or feel the chilliness of sedentary
and indoor life, the thermometer in our armpits tells

HEAT FORMAXrON AKD RADIATION.

the same tale, and marks 98.4° of Fahrenheit's scale,
37° o£ the centigrade, as our normal heat. There
are, of course, oscillations about this fixed point,
according to time of day, meals, exercise, and so forth ;
but they observe very narrow limits, rarely transcend-
ing two degrees (up and down) of the one scale or
one of the other. This uniformity is secured by a
due compensation between the production of heat
and its loss. When production is stimulated — as by
external warmth or physical e.vertion — the perspir-
ing skin {with its twenty-eight miles of tubing) allows
a freer radiation : when heat-formation, in coldness
or quietude, is small, the dry surface and contracted
cutaneous arterioles restrain the loss of what there
is.

It would seem, therefore, that for fever to exist one
or both of these compensating functions must be dis-
ordered. There must be cither increased production
of heat, or diminished loss, or the two must coincide.
Both of the first two alternatives have had their ad-
vocates. As regards diminished loss, — restriction
of heat-radiation may undoubtedly cause elevation of
internal temperature, as has been ascertained experi-
mentally during exposure of the skin to cold air or
water; but the increase is too moderate to attain of
itself the febrile height. I think, however, that it
may be sufficient to set going, in vulnerable tissues,
the excessive heat-production which the opposite
theory requires; and I apprehend that this is the
rationale of the simple fever which results from a
chill. While in yourcountry In the summer of 1S76,

94 PYREXIA AND THE ANTIPYRETICS.

and sitting in the usual perspiration which the "heated
term *' of that year developed, I went out on a piazza
to see a thunderstorm advancing over the country.
The strong blast of wind which so often heralds such
a storm swept down upon me, and closed my open
pores with irresistible force. The next day I felt that
I had "caught cold," and in two days more coryza
had developed itself, and I had a temperature of 102°.
This fever was out of all proportion to the local
symptoms, which were quite moderate. It had been
forming, I apprehend, ever since my chill ; and its
starting-point was the check to heat-radiation which
then occurred.

I would thus explain " catarrhal fever " by dimin-
ished loss of heat as its primary cause ; but I have
already said sufficient to shew that increased heat-
production must also be set up to constitute the fully
developed malady. Without it true febrile tempera-
tures cannot be attained ; and that it is present in
fever is shewn by the enhanced tissue-waste manifest
therein. Excess of urea in the urine precedes rise
of temperature and outlasts its decline, and ranges
from li to 3 times the amount of its proportion in
health. What does this mean — there being no
change in food to account for it — but increased
oxidation ? and, if Wagner be right in saying that
"the essential sources of heat in the organism are
rhemical processes, based upon oxidation," then any
excess in this action implies the production of an
abnormal quantity of caloric. Nor would the case
be altered if the protoplasmic doctrine of life were

HYPEROXIDATION. 95

to lead us — as some think it does — to refer heat-
production to the direct metabolic action of the liv-
ing matter. Excess of tissue-waste must still imply
increased metabolism of tissue, and with this must
come increased evolution of heat

To hyperoxidation, then (this conception being
provisionally maintained), we must look as the main
source of the undue heat present in the febrile
state. In catarrhal fever, it is probably secondary
to disorder of the apparatus which permits of heat-
radiation ; and in fevers dependent upon local inflam-
mations (including those of hectic type) the tissue-
destruction may be limited to the seat of mischief.
But in the essential, toxcemic fevers — in typhu-S
typhoid, variola, scarlatina, and their congeners — I
take it that we have hyperoxidation of the blood, or
the tissues, or both, as the primary factor of the
morbid process. The virus of their contagion, when
imparted to a susceptible subject, acts as a spark to
the combustible elements, and the mischief slowly
or quickly spreads. These fevers are thus more pro-
longed than those of catarrhal origin, — the latter
subsiding on the supervention of perspiration, which
liberates the retained heat and so removes a main
factor of the whole trouble.

But there is yet another possible source of increase
of temperature ; and that is the nervous system. I
do not mean so much that portion of it which, from
its influencing the calibre of the arteries through
their muscular coats, is called vaso-motoi: This, of
course, is largely concerned in the heat-regulating

96 PYREXIA AND THE ANTIPYRETICS.

function of the surface, in which the blood-vessels
play so important a part. At one time their con-
traction, constituting the cold stage, and their sub-
sequent dilatation, which forms the hot stage, of
fever, was supposed to be of the essence of the
process. But it is now known that the chill may be
altogether absent, so that the hot stage is no mere
re-active dilatation of the superficial vessels ; and, on
the other hand, when the chill does occur, it is found
to be an evidence that the temperature has already
risen. Its only causal influence can be some amount
of heat-retention when it is prolonged. Again, after
paralysis of the vaso-motor nervous system by de-
struction of the principal centre, no fever is induced
unless the animal be placed in a hot room. He is
unduly sensitive to his environment, but is not other-
wise febrile : indeed, if the temperature be low, he
will die of cold. But experiment seems to shew that
there are heat-centres in the spinal cord independent
of the vaso-motor nerves, and that their injury is
capable of setting up a great increase of the bodily
heat. Sir Benjamin Brodie found that at the end of
forty-two hours after crushing the lower part of the
cervical enlargement of an animal's cord, the tem-
perature (centigrade) was 43.9 — the norm being, as
you know, 37.0; and Billroth, Simon and Naunyn
have seen corresponding effects from injuries of this
kind in the human subject. Mr. Tealc, of Leeds,
reported a remarkable case to the Lancet in 1875, in
which the temperature continued above 108° for some
weeks, sometimes rising to 122° and over. This, too.

NEKVOUS ELEMKNT OF FEVERS.

was one in which injury to the spine had occurred.
I have mentioned these facts, though I do not think
they have much bearing on ordinary fever, — Mr.
Teale's patient, for instance, having no very marked
febrile symptoms ; but they possibly account for the
occasional supervention of that hyper-pyre.\ia which
has frequently been noted of late, and which puts
the patient in such peril. Even for this, however,
we must have two factors — some pyrogenous mat-
ter in blood or tissues, and collapse of the heat-
controlling nervous centres; for Mr. Teale's patient,
in whom the latter element presumably existed,
survived through weeks of a temperature which,
e.g., in acute rheumatism would kill in twenty-four
hours.

There are two other types o£ fever for which also
we may look in this direction; viz,, the hectic and
the intermittent. Either is marked by a scries of
paroxysms made up of more or less chill, heat, and
sweat, usually occurring in this sequence, and having
a rapid rise and fall of the temperature of the blood
as their basis, — the rise being here as elsewhere
accompanied by increased excretion of urea. In
hectic, we have a local infective process (as tuber-
culisation of the lungs) where suppuration is going
on ; and any continuous pyrexia which is present
may be explained as is that of the fever symptomatic
of inflammation of any part. For periodica! paro.v-
ysms of the kind, however, we must invoke the
agency of the nervous system ; for we can hardly
suppose, as some have done, that the pyrogcnic

PYREXIA AND THE ANTIPYREXrcS.

matter accumulates and discharges itself with such
rhythmical regularity as seen, for instance, in the
diurnal pyrexia of phthisis. The malarious fevers
may be similarly regarded. Here, too, the exciting
cause is probably of a substantive character, i.e., it
consists of an abundance of low forms of vegetable
life ; but here too, I think, we must look to the
nervous system as the source of the paro.xysms. It
may be that thus is explained the fact so often
noted, that it is easier, with the attenuated remedies
of homosopathy, to cure chronic intermittents than
acute ones. The latter have the cause still present
and in operation ; the former consist rather in a mor-
bid habitude of the nervous centres, which a strong
mental impression will often remove as effectually as
an appropriate drug.

From the nature of fever we may now pass to the
forms under which it is manifested. The classifica-
tion generally accepted in the last century was that
an outline of which you see on the board.

"Symptomatic" fever was that obviously depend-
ent on some local inflammation ; and, if continuous,
n simply as "inflammatory," while, if it

CLASSlFICATrON OF FEVERS. 99

occurred in a succession of daily paroxysms, it was
called " hectic," " Idiopathic " fevers were those
apparently of primary origin ; and' these too were
divided according as their phenomena were "inter-
mittent," "remittent," or "continued." Continued
fevers were further subdivided on the basis of the
character of their symptoms. If these were of the
simple and sthenic kind familiar in inflammatory
fever, the term "synocha" was used to designate
the patient's illness. If of a somewhat lower type,
"synochus" was substituted as their designation;
leaving "typhus " for the well-marked "low fever,"
and adding " nervosus " or " putridus " as the stress
of the disease seemed to fall on the nervous centres
or on the blood. The "versatilis" and "stupidus"
further qualifying the typhus nervosus need no ex-
planation.

Such a classification is obviously unsuited for
nosology, when once the essential nature of certain
fevers, and their dependence upon definite miasms
or contagions, is recognised. The distinction of
symptomatic and idiopathic pyrexia still indeed holds
good, and pyaemia and septicasmia find appropriate
place as varieties of hectic. But intermittcnts and
remittents are now classed together as malarious ;
while continued fevers are recognised as occurring
under the four forms of ephemera, relapsing fever,
typhus, and typhoid, to which some would add a
"common continued fever" — the Jih're synoque of
the French, the "gastric fever" of popular English
speech. Thus we get the second schema presented

1 to u;

J-J

PYREXIA AND THE ANTIPYI

Idiopathic . . .

Typhcid.

Now, speaking generally, there is a tolerable coin-
cidence between the apparent and the real types.
Ephemeral fever is synochal in character ; relapsing
and gastric fevers would of old have been called syn-
ochus ; while t>'phus and typhoid conimonly present
the characters of the typhus putridus and nervosus
respectively. But, while this is so, we must not let
the ancient distinctions be swallowed up in the mod-
ern, as though wholly obsolete. While the latter are
all-important for prognosis of the course and probable
termination of fevers, and for their general manage-
ment, the former still hold good for therapeutic pur-
poses. They arc symptomatic, and therefore lend
themselves with great appropriateness to a method
of drug-selection like ours whicii uses symptoms as
its materials. They also enable us to embrace such
fevers as the catarrhal and rheumatic, and that ac-
companying the contagious exanthemata, which- —
though not finding place in the usual classifications
— are no less genuine clinical facts. The same may
be said of those recognised varieties of our commoo

REATMENT OF FKVERS.

continued fevers which are now referred to the
"tyjihoict" or "gastric" category. Trousseau gives
them as "mucous," "bilious," "inflammatory," "ady-
namic," "piitriti," "ataxic" and "malignant." Our
own Trinks, to whom we owe a valuable study of
"abdominal typhus" (i.e. typhoid) in its drug-rela-
tions,' describes it as occurring under the forms
" simplex, " " biliosus, " " pituitosus, " " putridus, "
"ncrvosus versatilis " and " nervosus stupidus." While
the essential fever thus manifesting itself may be
one and indivisible, the various forms under which it
appears are no less realities, and require a suitable
adjustment of our drug-remedies, as they do of those
of a more general kind.

Coming now to the treatment of fevers, it is first
of all necessary to recognise that pyrexia, as such, is
an evil state, fraught with untold injury to its sub-
ject. We know how twenty-four hours of it, in its
simple catarrhal form, will weaken a strong man ; and
after the three weeks of it in typhoid Liebermeister
well describes the body of the convalescent as " emer-
ging like a wreck from a storm ; on the one hand,
having to throw overboard ruined parts and clear the
deck, on the other, to restore sails and rudder." It is
most desirable, therefore,' to abate its severity and — if
possible — shorten its duration. Inordinary practice
I this is aimed at by cold baths, or by drugs like qui-

I nine and salicylic acid. ,It is a rough, crude treat-

I tnent, directed — as Dr. Cretin has justly pointed out

r — against one element only in fever, viz. ; the high

TIPVRETICS.

temperature ; but, nevertheless, it seems to be better
than expectancy. Sassetzky, of St. Petersburg, has
lately instituted a special enquiry into its merits, with
very favourable results. He found that invariably
the cold bath diminished the elimination of nitrogen,
and that a similar but far less marked diminution oc-
curred in the cases treated by quinine and the sali-
cylate of soda. The quantity of urine was increased
by each method, but to the largest extent by the bath.
The assimilation of the solid and nitrogenous constit-
uents of milk was improved under the bath treatment,
as shewn by the very marked diminution in the f^cal
elimination of nitrogen ; and the same fact was also
noticed, to a less degree, under the other methods.
The quantity of water ingested was diminished, and
also the loss of water by the lungs and skin, except
under the salicylate, when the cutaneous loss was in-
creased. These are results which shew that, dur-
ing the febrile state, the patient is in a far better
condition under the antipyretic treatment than with-
out it. It is for us to demonstrate that we can, by
non-perturbative internal medication, do as well as or
better than our old-schooi colleagues ; and spare
patients the distress of cold bathing and the injury
of the necessarily large doses of quinine and the
salicylates. Comparative studies on a large scale are
the only means of prm'i'ig that we can do so ; but in
the mean time we can study our available means, and
see what are at least their positive virtues.

We turn accordingly to our antipyretic medicines,
which we may reckon as fifteen in number, viz. ; —

ACONITE.

AciHiim mtiriaticu

n. Cinchona (and Quinine)

Acidum iphosphor

cum. Crotalus (and Lachesis)

Aconite.

Gtlsemium.

Agaricas.

Hjoscjamus.

Arsenicum.

Rhus.

Baptisia.

Stramonium,

Belladonna.

Veratrum vmde.

Lrjonia.

They must be considered in their relation to the
febrile process itself, and to the kinds and shapes in
which it has come before us. And this we shall best
do by taking certain representative medicines, and
counting them as types, under whose headings the
others may find their appropriate place. Such typical
drugs are Aconite, Belladonna, Arsenic, and Bryonia.
I. The historj' of Aconite as an antipyretic is the
history of homceopathy. What was known of it up
to 1805 had led to its use in a few chronic affections
only. In that year Hahnemann published his Frag-
mcuta de Viribus, which contained — among others —
a pathogenesis of this plant. It shewed its power of
producing a series of paroxysms of alternate chill
and heat, "repeated two, three, or four times before
the whole efTect ceased, which it did in from eight to
sixteen hours." In 1811, republishing this pathogen-
esis (with additions) in the first volume of his Ma-
tiria Mcdica Pitra, he prefixed .some remarks pointing
to the above-named features of its action as promis-
ing usefulness from it in acute diseases. Of what
kind these should be he had not then perceived. But
somewhat later, while treating some inflammatory

I04 PYREXIA AND THE ANTIPYRETICS.

disorders he was led to the employment of Aconite
from the similarity of some of the concomitant symp-
toms with some in its pathogenesis, and he found its
administration followed by a great diminution in the
frequency of the pulse, and a cessation of the febrile
state. He followed up this hint; and in 1822 was
able to proclaim it the one sufficient remedy for states
against which the whole antiphlogistic apparatus of
that day (and you know how heroic this was) was
considered necessary — the "pure inflammatory fe-
vers." It has continued to be so reckoned ever since
in the school which he founded, and has of late won
no small acceptance in the ranks of those who (at
least outwardly) reject his method.

Remembering this history, we turn over one of the
latest treatises on Materia Medica and Therapeutics
to see what is said on the subject. Dr. Bartholow,
in 1877, writes: — **The monopoly by homoeopathic
practitioners of the use of aconite has roused a preju-
dice against it, which has discouraged its employment.
Aconite is, however, an antagonist to the fever-pro-
cess ; it is not applicable in accordance with the so-
called law of similars. It is used by these quacks
because it is a powerful agent which will produce
manifest effects in small doses, that may easily be dis-
guised." One hardly knows whether most to smile
at the ignorance or sigh at the insolence of this
statement. That Hahnemann was the discoverer of
the antipyretic power of Aconite, and that he arrived
at it by working with the law of similars, is manifest
from the facts of the case ; that he required for its

ACONITE. 105

exercise no doses which needed disguising, however
easy, appears from his recommendation (in 1833) of
the 24th dilution as sufficient for the purpose. Tliat
Dr. BarCholow's own l^nowledge of this use of the
drug is Hnealiy derived from him is also readily de-
monstrable. His immediate inspirer is evidently —
from his quotations — Dr. Sydney Ringer; and
whence did he learn it ,' In January, iS6g, he wrote
a paper on Aconite in the Lanctt, which begins —
"Of all the drugs we possess, there are certainly
none more valuable than aconite. Its virtues by
most persons are only beginning to be appreciated,
but it is not difficult to foresee that in a short time
it will be most extensively employed in the diseases
immediately to be noticed." And these are, inflam-
mation and its accompanying fever. Dr. Ringer im-
plies that he is making a new departure in the em-
ployment of the medicine, and the silence of the
Materia Medicas of the day substantiates the assump-
tion. He is equally silent as to the source of his
fresh knowledge; but the homccopathic history of
the drug fills up the gap he has left. I venture to
think that my own attempt to make our Materia
Medica intelligible and interesting to outsiders had
some share in this result ; for my Manual of Phaf
macodynamics first appeared in the summer of 1867,
and of course contained the statements which, eigh-
teen months later, Dr. Ringer so emphatically war-
ranted.

That it was the homceopathic method — small dose
and all — which first revealed the antipyretic virtues

I06 PYREXIA AND THE ANTlPVRnTICS.

of Aconite, and that it is homceopathic literature
from which all knowledge of it has been derived, is
thus the plain witness of history. But what of Dr.
Bartholow's further contention, that "Aconite is
an antagonist to the fever-process," that "it is not
applicable in accordance with the so-called law of
similars " ? To answer this question we must ask a
previous one, — what is the "so-called law of simi-
lars"? It is — as Hahnemann always laid it down

— similia similibtts cnrentur, let likes_ be treated by
likes. It assumes nothing about processes or antag-
onisms : it simply requires correspondence — as close
as possible — between the phenomena of disease and
of drug-action. How a remedy, prescribed on such
indications, acts within the organism has always been
left an open question ; and the majority of those who
have thought about it, from Hahnemann himself
downwards, have regarded it as probable that, appar-
ently homeopathic, it is really antipathic to the
essential morbid process. Let it be granted that
Aconite so acts in fever : how does it make against
the claim to it of the method of Hahnemann, unless
it can be shewn that the drug does not cause fever

— is not febrigenic ? Dr. Bartholow might even
deny this, as he is of course ignorant of homceopathic
literature, and does not seem acquainted even with
the experiments of Schroff. The latter would give
him some pretty evident febrile symptoms ; but the
Austrian provings of our own school, from milder
and more repeated doses having been taken, exhibit
the result far better. Here is one of them, which

ACONITE. 107

extract from a monograph on the drug by Dr. Dud-
geon in a forthcoming volume to be issued by the
Hahnemann Pubhshing Society; —

"A. B., a healthy peasant girl, very robust, agcti
22, took on .successive days 5, 10, and 20 drops of
tincture without effect." This was of course the
Hahnemanuian tincture of the whole plant, which is
comparatively a weak one. "On the iSth January
took 30 drops ; confusion of head, feeling of heat in
the evening. 19th. — 40 drops ; after two hours con-
fusion of head, sometimes changing into heavy feel-
ing and pressive pain in crown and forehead ; loath-
ing, nausea, general malaise with painful heaviness in
limbs. After five hours pressive pain in scrobiculus
cordis, dry feeling in mouth, great thir.st, Felt so
unwell, head so confused, giddy, and painful, and
limbs so heavy, that she had to go to bed. Face
hot, hands and feet cold, pulse contracted, hard,
moderately quick. After nine hours, pressive pain
in forehead, face turgid red, eyes sparkling, dry feel-
ing in mouth, tongue moderately moist, slightly
furred, no appetite, great thirst, oppression of chest,
shallow quick breathing, with frequent deep breath-
ing and sighing. No pains, but hcavmess and ful-
ne.ss in chest, an.xiety and palpitation of heart.
Heart's beat strong, pulse fuller than usual, hard
and strong, at same time moderately quick, skin
warm, urine clear and reddish. After twelve hours
heat and restlessness increased, tosses about from
one side to another. In right thorax some pressive
pain. After si.\tcen hours (9 p.m.), more tranquil

io8

PYREXIA AND TilE ANTIPYRETICS.

the last hour, general warm sweat : headache, throat,
and breathing difficulties relieved ; pulse large, soft
and slow. Only confusion of head and perceptible
beating of heart complained of." Next day she was
nearly herself again.

This — which finds several parallels in the Aus-
trian provings — should be sufficient ; or, if any dis-
trust observations on the human subject, they may
be referred to Dr. Mackenzie's experiments on ani-
mals recorded in the Practitioner of iS/S-g. He
found Aconite always to increase the temperature
until asphyxia set in — the thermometer in the ear
of a rabbit rising from two to four degrees Fahren-
heit under its influence. Aconite is undoubtedly
febrigenic ; and that its curative action is homce-
opathic is also shewn by the small doses with which
it may be effected. Hahnemann was content, as we
have seen, with the 24th dilution ; and though most
of us now-a-days prefer to go lower in the scale, yet
who can suppose that the thousandth part of a drop
of the juice can act as an "arterial sedative," while
in such dosage (the 3rd decima!) the drug is most
promptly febrifuge in cases suitable for its adminis-
tration.

And now, what arc these cases .' When Hahne-
mann spoke of the "pure inflammatory fevers" as
its sphere of action, it is obvious that he did not
mean so much the fever symptomatic of local inflam-
mation, as that which from its resemblance thereto
was named "inflammatory," under whatever circum-
stances occurring. For he specifies, as instances <

ver circum- 1
n Stances of

ACONITE. 109

its efficacy, measles, purple-rash, and pleurisy — the
third only having any local affection as its basis.
The Aconite-fever is thus essentially a synocha, and
whenever this type presents itself the drug is indi-
cated. It may occur in the exanthemata, after pass-
ing a catheter, or as the result of cold ; but always
and everywhere Aconite is its great remedy. It is
rarely if ever present in the fevers we call toxrcmic,
as resulting from some morbid poison ; and in the
treatment of these — in typhus, typhoid, variola, and
siich like, Aconite plays but a small part. The same
may be said of such blood-poisonings as septicemia
and pyasmia. As regards the fever symptomatic of
local mischief, — when this is of a character to induce
hectic, Aconite certainly finds no place. But what of
pure inflammations and their accompanying pyrexia?
Hahnemann commended it for these where "with
thirst and rapid pulse, an anxious impatience, an
unapijeasable restlessness and an agonised tossing
about are conjoined," Carroll Dunham has well
shewn that these are the symptoms present when
an inflammation is yet quite incipient. When sub-
stantive local changes have occurred, the tension of
the circulation and nervous system diminishes, and
any subsequent fever is sympathetic only. This
Aconite will not touch : its place, as Teste says, is
" in phlegmasia^ primarily general, and only second-
arily localised;" and in these — I may add — only
before the localisation is complete.

These canons about the relation of Aconite to
inflammatory feycr niay be well illustiated by the

no PYREXIA A\D THE ANTIPYRETICS.

example of pneumonia. The pyrexia of this disease
scc»is quite independent of the phlegmasia: it pre-
cedes any manifestation of the latter by physical
signs, and subsides while these are yet in full pres-
ence. Aconite would therefore appear to be thor-
oughly suited to its incipient stage ; and there are
some, both in our own school and in the other, who
maintain that — given in time — it can abort the
disease. But careful clinicians like Jou.sset and
Kafka warn us against indulging such expectations,
and my own experience is entirely in accord wilh
theirs. The acute pulmonary attack which Aconite
so promptly resolves is congestion, — a condition
which never goes on to croupous exudation, but —
if not arrested — leads to oedema pulmonum and
death. It is very rapid and dangerous, and to have
such a remedy for it as our present drug is a great
cause for thankfulness. But it is not pneumonia.
The rigor with which this malady generally sets in
indicates that the lung is already inflamed, and has
heated the blood up to shivering-point. You may
not yet hear any thing abnormal on auscultation ami
percussion ; but if you will count the respirations,
you will find that they are rapid out of all propor-
tion to the pulse. When this is so, let me urge you
to waste no time in administering Aconite, but to
give Bryonia or Phosphorus, Antimonium tartari-
cum or Iodine, according to the patient's symptoms
and condition. You will under these find pulse and
temperature subside, gradually indeed, but with all
reasonable rapidity, and that from the very fii

while the physical signs diminish aXmast jiari passu.
If twenty-four hours are thrown away in Aconite-
giving, you are more likely to have the sudden de-
fervescence seen in cases left to expectancy {which,
as the late Professor Henderson shewed, is due to
compression of the pulmonary circulation by the
filling up of the air-cells) with slo^y resolution of
the exudation.

Putting all these things together, and remember-

r ing what we have learned to-day concerning pyrexia

in general, it would appear that the sphere of Aco-
nite is the nervous system of the circulation ; and
just so far as a fever belongs to this portion of the
organism, so far can this drug induce it in the healthy
and remove it in the sick. It is antipyretic, not by
diminishing the hyperoxidation on which (ordinarily)
depends excessive heat-production, bnt by regulat-
ing the apparatus provided for heat-liberation. It is
in the fevers brought on by a chill, and in whose
hot and cold stages alike the skin is dry and the cu-
taneous vessels tense, that it displays its greatest
powers. And hence, on the one hand the rapidity,
on the other the short duration, of its action. When
once the tension of the nervous and circulatory sys-
tems has been relaxed, and the pent up heat liberated,

, Aconite has nothing more to do; but this admits of

L being done within a very short time, and Aconite can
do it. We do not continue this remedy for days
together, as with Belladonna and Arsenic. Hahne-
mann's single dose, or the frequent repetitions of the
later practice of most of us, accomplish their work in

> THE ANTIPVKr.TICS.

was e
I action

I profus

I Tin

twenty-four hours at the utmost ; and then, if ncces-
sary, other remedies come in.

The only other antipyretic which can be classed
with Aconite is Gclscmium, for Vcratriim viride —
which some suppose analogous to it — seems to me
to belong rather to the Helladonna group. Of the
reputation with which Gelsemium came to us from
the " Eclectic " school of this country its power over
fevers formed no small part. Dr. Douglass, its earliest
prover, obtained results which shewed its action in
this sphere to be of the homosopathic kind. Experi-
menting on some seventy persons, he found it not
unfrequently to induce, in a few minutes, a marked
depression of pulse, with chilliness especially along
the back, cold extremities, and heat of head and face,
with pressive headache. This was soon followed by
a glow of heat and prickling of the skin, with full
pulse, rising as much above its normal standard as
before depressed below it ; and then came perspira-
tion, sometimes profuse and lasting from twelve to
twenty-four hours. In reply to an objection that
others had not been able to produce these symp-
toms, Dr. Douglass wrote that the degree of chill and
febrile re-action in his subjects bore a very uniform
ratio to the nervous sensitiveness of the patient. In
sotne, where this quality was very marked, " the chill
was equal to a respectable fit of the ague, the re-
action and pain of head corresponding, and the sweat
profuse." '

Thus also must be explained the negative results

Kale. New Remedies. 2iid cd., p. (og.

GELSEMIUW. 113

of Drs, Ringer and Murrell, in their recent provings,
with regard to fever ; though they acknowledge, in
one-third of their observations, a quickening of the
pulse ranging from six to twelve beats in the minute,
and in one experiment a rise of .2° to .4° Fahren-
heit in temperature. The drug is certainly not anti-
pathic to the febrile state, and yet its virtues therein
are largely acknowledged. Dr. Douglass's state-
ments favour the idea that it is in neurotic fevers
that it is likely to find its best employment — in those
which start with heat-confinement, and subside with
heat-liberation. There is a remittent fever often seen
in childhood, but not absent from adults, arising from
various causes, but marked by this, — that the heat
is almost absent in the early part of the day, increases
to\vards evening, and subsides '^vithont perspiration as
the night wears away. Gelsemium is as effective in
this pyrexia as Aconite in its own. Even in the lat-
ter, it may vie with its prototype when, instead of
anxious restlessness and craving thirst, there is rather
a torpid and heavy condition, with a pulse not very
rapid an<l inclined to be full and soft. The Gelsem-
ium fever is a synochus rather than a synocha, —
the main symptoms being those of languor and op-
pression, with dark crimson face, and dull pains in
head, back, and limbs, the head feeling large and
full. On this it acts with much rapidity, speedily
relieving heat, oppression and aching. You may
meet such a pyrexia as the result of a chill, in in-
fluenza, and in the milder exanthemata. It may also
characterise some of the less pronounced malarious

114 PYREXIA AND THE ANTIPYRETICS.

fevers, especially in imperfect convalescence after
the intermittent paroxysms have been broken by
quinine. Whether Dr. Hale's recommendation of it
in hectic can be sustained, I am unable to say.

At our next meeting we will take up the groups
of antipyretics headed by Belladonna, Arsenic and
Bryonia respectively.

PYREXIA AND THE ANTIPYRETICS {continued).

II. In 1838 Dr. Graves, the celebrated clinician of
Dublin, advocated the use of BcUadotina in those
cases of fever with cerebral disorder which are at-
tended with contraction of the pupil. He supposed
that the mydriasis caused by it was due to its action
on the brain, and that a cerebral condition accompa-
nied by myosis must be precisely opposite in character.
Hence, on the principle contraria coutrariis — always
influential with though often repudiated by our old-
school colleagues — he argued that it ought to be
beneficial in such conditions ; and supported his con-
tention by several successful cases. His paper on the
subject may be read in the Dublin yonnial of Med-
ical Science for July in the year mentioned.

We now know that Graves' assumption was incor-
rect ; that Belladonna does not dilate the pupil through
the ocular nerve-centres, but by a peripheral action.
The condition of brain it sets up would he accompanied
with contraction of the pupil, were it not for the
local influence it exerts on the ciliary nerve-termina-
tions in the iris. To idiopathic cerebral states, there-

Ii6

'VKEXIA AND THE ANTII*YUET[CS.

fore, of which niyosis is a feature, it bears the rela-
tion of similarity instead of opposition ; and Graves
was practising homceopathy without knowing it. A
man like I'ereira felt there was something wrong
about the proceeding, and justly argued that — on
accepted principles — Belladonna should be contra-
indicated in febrile and acute inflammatory cases.
This seems to have been the general feeling, and
Belladonna found no place in the treatment of fevers
for another thirty years.

In 1869, however, Dr. John Harlcy published his
Old Vegetable Neurotics, and one of the drugs studied
therein was Belladonna. In regard of its relation to
fever he speaks of "the similarity of the general
phenomena which attend its operation and those
which accompany pneumonia, enteritis, the develop-
ment of pus in any of the tissues or organs of the
body;" and says — "an infinitesimal quantity of atro-
pia — a mere atom — as soon as it enters the blood,
originates an action which is closely allied to, if it be
rot identical with, that which induces the circulatory
and nervous phenomena accompanying meningitis,
enteric, or typhus fevers," These statements are
based on experiments shewing that the drug causes
a decided increase in the force and frequency of the
L circulation, drj'ness of the mouth and tongue, an ele-

I vation of temperature, and an increase of the urinary

I solids. One would have expected that, under these

I circumstances, the presence of fever would have been

I to Dr. Harley, even more certainly than

I Pereira, a conlra-indication for Belladonna.

jeen
just I

ief way. In the therapeutical chapter, the first
four maladies mentioned as under the control of the
remedy are pneumonia, enteric fever, typhus, and
acute nephritis. When we come to enquire how he
could be led into such practice, we find, for the local
inflammations, a theory that the Belladonna dispels
the stasis by its stimulation of the sympathetic fibres,
and consequent narrowing of the capillaries ; but as
regards the fever, whether secondary or primary, a!!
pretence at antipathy is given up. "Two similar
effects," he writes "the one arising from a local irri-
tation, and the other from the presence of belladonna,
like spreading circles on a smooth sheet of water,
interfere with and neutralise each other ; " and again
— " it appears that the stimulant action of belladonna
is converted in great measure in febrile diseases into
a tonic and sedative influence."

This was somewhat bare-faced homceopathy to be
professed by a hospital physician and Gulstonian lec-
turer ; but it is characteristic of the advance of med-
ical thought that no exception was taken to it. I am
not aware that the practice has gained much accept-
ance ; but it is mentioned by all writers on pharma-
cology and therapeutics, and no one objects to it on
the score of its homceopathicity. The febrigenic
power of the remedy is admitted by all ; and Dr. de
Meuriot, in his Etude de la BeUadonne, relates obser-
vations shewing its power to raise the temperature
in dogs from i to 4 degrees of the centigrade scale,
and in man from i to 1^5.

In the school of Hahnemann this property of the

IIB PVREXIA AND THE ANTIPYRETICS.

drug; has long; been recognised and turned to account.
In the first edition of the Rciiie ArzneimittcUchri:
( iSi 1 ) the master g;ave numerous extracts from cases
of poisoning; which shewed fever as resulting from it ;
and the provings of his associates which swell the
pathogenesis in the later editions exhibit many symp-
toms of the same kind. Hahnemann himself, as we
know, was led by the principle of similarity to employ
it in one febrile state as early as 1799, viz. : in scarla-
tina. He does not speak of any other in his subse-
quent writings ; but the obvious application must
have been largely made, for in Hartmann's Practical
Obsen-alious on some of the chief Homaopathic Reme-
dies, published in Germany in 1S39, and translated
here by the late Dr, Okie in 1846, Belladonna is given
a high place in the treatment of many forms of fever.
We have now to enquire what these forms are ; to
what fevers it is suitable. And here our attention
is at once drawn to the marked action of Belladonna
on the nervous centres. It is one of the " narcotics "
of old, of the "neurotics" of present nomenclature:
the sensorium is readily disordered by it, and delirium
is among the most prominent of its poisonous effects.
The inference is that its fever is due to hyper-oxida-
tion of nervous tissue, and this is substantiated by
the fact that it is the phosphates of the urine which
specially shew increase under its influence. Here is
a pathological thought to guide us ; and it will lead
us, as the symptomatic phenomena of the drug led
our predecessors, to fevers of the typhous kind as
especially calling for its use. The "typhus ncrvo-

BELLADONNA.

119

sus" of the old nomenclature is its special sphere,
best when this is also " versatiiis," but not excluded
(as Hartniann has shewn) when it may be called
"stnpidiis." Of the essential fevers now recog-
nised, the typhus and enteric types are those in
which it plays its chief part; and it finds here a
symptom very characteristic of it — the dry tongue.
This is one of the most readily-induced physiological
effects of Belladonna ; and Dr. Harley has shewn it
to be coincident with rise of the pulse, and to be
replaced by a peculiar moisture on its fall. It is
itself, moreover, no mere deficiency of secretion
from inertness of glands or occlusion of blood-
vessels. The parts are dark -red and congested,
and the mouth is hot : we have (again to quote Dr.
Harley) "a condition which exactly resembles that
accompanying the typhus state."

There is another feature of the Belladonna-pyrexia
which suggests the forms of fever to which it is appli-
cable, and this is the rash on the skin so often ob-
served. It is usually compared to that of scarlatina,
and, with the fever itself, the sore-throat, and the
delirium, it makes the drug's action a singularly
dose analogue to the disease You know how this
similarity was turned to account by Hahnemann, in
proposing Belladonna as a prophylactic against scar-
latina; and the success of the practice is vouched
for in quarters far removed from his influence. In
the malady itself, in its ordinary forms, the medicine
should always be given ; though I find it hard to say
.what is the precise amount of control exerted by it.

.d^

YUIiXIA AND THE ANTIPYRETICS,

Much more striking is its action in the initial fever
of variola, where also, every now and then, erythema-
tous and scarlatiniform exanthemata precede the
distinctive pustular inflammation, as Simon and
[ Curschmann have shewn.' Aconite has no influ-
[ ence here ; but Belladonna can produce a decided
abatement of the pyrexia and pains, even before the
pocks come out. This is vouched for by physicians
I of both schools; and I can add my mite of confirma-
f lion to their testimony.

I have no desire, in these lectures, to make any
I pronouncement on the subject of dosage. But I
I must point out that confidence in Belladonna as an
[ antipyretic is most felt and expressed the less atten-
I Tjated the form in which it is given. If you read
I Hartmann's essay (who used it at about the 30th
I potency), you will find it rather coming in to meet
special indications in the course of fevers than to
control the entire pyrexia. Those who give from the
third dilution downwards have learnt to trust in it as
a medicine which gives them real power over the
febrile process. It does not act rapidly, as Aconite
does, — the nature of the fevers to which it is appli-
cable does not allow of this ; but steady persever-
ance with it will give the most gratifying results.

With Belladonna are to be classed its two sister-
drugs — Hyoscyamus and Stramonium, and, more
remotely, Agaricus and Veratrum viride. Let me
say a few words upon each.

I. Hyoscyamus appears to caus^, fever as Bella-

■ Zwnisseii's Cyclo/uJia, Vul. U.

HYOSCVAMUS.

donna does, by setting up hyper-ox id at ion in the
ner\'ous centres. In doses insufficient to dry the
mouth and tongue, it actually lowers the pulse; but
when that full effect of it is obtained, "the pulse"
(writes Dr. Harley, who has experimented on this
"old vegetable neurotic" also) "will generally ex-
perience an acceleration of lo to 20 beats, and be
increased'slightly in force and volume." With this
the face will be flushed and the head oppressed ;
while the urine, if examined, will shew an increase
[:in the urea, the phosphates and the sulphates, as
with Belladonna, but not so marked. A reference
to the "Fever" section of Allen's Encj-ciopctdia yi\\\
manifest general heat of surface as no uncommon
feature of poisoning by the drug.

From Hahnemann onwards, Hyoscyamus has been
esteemed by us a valuable remedy in "cerebral
typhus." To indicate it in preference to Belladonna,
the head symptoms should be those of oppression
rather than of excitement, though there may be
hallucinations or (if the patient is unconscious) inco-
herent mutterings. The curious condition known as
"coma vigil," where the patient is wide awake and
yet insensible to surrounding objects, has been pro-
duced by it and will generally indicate it. In similar
states occurring in other fevers, as the puerperal and
(as I have just lately seen) that of measles, Hyoscy-
amus will give every satisfaction.

2. Of the power of Slraviomum, in poisonous
quantities, to cause fever, we have evidence as good
35 for that of Hyoscyamus; and, its influence on

.i—ri

1 PYREXIA AND THE ANTIPYRETICS.

; nervous system anc! other parts being so very
like that of Hclladonna, its tnodus operandi as febri-
genic may fairly be presumed identical. As com-
pared with the latter, it causes more functional
excitement of the brain, but less active determination
of blood thereto. Its delirium, indeed, approaches
to mania; and on this very account it is less fre-
quently indicated in fevers than the other mydriatics.
Where, however, its more intense nervous erethism
is present ; where there are convulsive movements,
trembling, restlessness, loquacity, emotional agita-
tion, you may substitute it for its congeners with all
confidence.

3. That Agaricus is febrigenic, we are hardly war-
ranted in affirming. Some apparently febrile chilli-
ness was observed by Lembke, in his proving on
himself; and some heat symptoms arc reported by
two of Hahnemann's provers. On the other hand,
the very thorough experimentation of the Austrian
Society failed to develope any thing of the kind.
Roth rested his commendation of it in ataxic typhus
on other grounds. "The uncommon weakness" he
writes "and bruised feeling of the muscles of the
back and lumbar regions, the meteorism, the rum-
bling, the diarrhcea, the prostration of strength, the
stupefaction, the delirium, the small pulse, the trem-
bling motions of the extremities, and many other
symptoms of the central nervous system, exhibit
great similarity to the ataxic forms of typhus fevers.
The indication has been abundantly verified,
this country and in my own : I, too, can bear

both in j

VERATRUM VIRIDE.

123

to its soundness. Tremor, loquacity, restlei
and constant desire to get out of bed, are the indi-
cations for it; while the delirium and unconscious-
ness of Stramonium are absent.

4. Of Veratrtim viride a somewhat .similar account
has to be given. It is not for us to use it as an
arterial sedative : the advocates of coiitraria contrariis
may do their best (or their worst) with it after this
manner. Experimentation on animals shews that
over and above the actions which conduce to this
result it has a direct influence on the nervous cen-
tres, — one of its alkaloids, viridia or jervia, causing
L-Convulsions demonstrated to be of cerebral origin,
lauid post-mortem investigation showing intense capil-
F'lary congestion within the cranium, especially about
the cerebellum and pons. In the human subject
choreiform muscular contortions and paroxysms of
opisthotonos have been observed from over-dosing,
and much pain was felt by the provers in the frontal
region and the neck. It is where, therefore, in fever,
erethistic and hypera;mic conditions of brain and
cord occur that the drug should prove homoeopathi-
.cally useful ; and so it has been. It appears to be
of real value in the incipience of the epidemic cere-
bro-spinai meningitis which sometimes invades your
country, and also to be specially suited to the condi-
I ition of the nervous system and the circulation in the
IJying'in woman. Dr. Ludlam, one of the best of
Four authorities here, speaks of its "wonderful power
; to control and to regulate the vascular movements, to
.equalise the circulation, and, as it were, to stamp out

a local congestion that would almost inevitably result
in inflammation," when occurring in the puerperium,
"It restores the niilk and lochia, when these have
been suddenly suppressed, quiets the nervous per-
turbation, relieves the tympanites and the tenesmus,
whether vesical or rectal, and frequently cuts short
the attack." The tongue-indication Dr. Hale gives
for it ^red-streaked down the centre, with yellow
sides — has been warranted by practice; but the
hard pulse of which he speaks is precisely opposite
to that physiologically produced by the drug.

III. In my last edition of my Phartnacodynamics
I have said the best I can say of Arsenic as an anti-
pyretic. I have traced its history in this capacity,
shewing that only in the malarious fevers has its
remedial power been discovered by the empiricism of
traditional medicine, and that even here its present-
day revival has come from homoeopathic sources ;
while any application of it to the hectic and typhous
forms of fever is homceopathic ab initio. I have
shewn that it is unmistakably febrigenic, — indu-
cing in some persons that peculiar morbid condition
of the nervous centres which shews itself in recur-
ring febrile paroxysms (which are often periodic); in
others, a persistent febrile state which has been seve-
ral times compared to and even mistaken for typhus.
In virtue of the former action, I have claimed for the
law of similars its undoubted power over ague, and
have urged therefrom its usefulness in such hectic
phenomena as characterise tuberculosis and pyaemia.
On the strength of the latter, I have propounded it

ARSENIC. 125

IKe great remedy, not only for typhus itself, but
whenever the well-known " typhoid " symptoms occur
— the prostration, the pallor, the fuliginous tongue
and lips, the (often involuntary) diarrhcea. Whoever
these phenomena appear, I have said, whether in
the continued fevers or the exanthemata, whether
as symptomatic of mortification or as results of blood-
poisoning, Arsenic is our main reliance, and should
be used freely and persistently.

In these doctrines I have only given expression to
the consensus of the homosopathic school. Connect-
ing the facts with our present line of thought, I
think we may say that Arsenic excites fever by act-
ing on both factors of the process, — by disordering
the nervous control over the temperature, and by
increasing heat-production in some portion of the
body. Looking farther in search of this portion, I
think I shall carry you with me in suggesting it to
be the blood. The power of Arsenic to destroy the
life of the circulating fluid has long been inferred
from the phenomena of poisoning by it, and now has
been established by computation of the number of
the corpuscles before and after its influence is set
up, Hyperoxidation of no ordinary degree is here
apparent, and there must be a corresponding rise in
temperature. We take our stand on these facts in
claiming for homcKOpathy the recent employment of
the drug in pernicious anasmia (which, I may note, is
generally accompanied with febrile phenomena) : we
may also use them in interpreting its action as an

126 PYREXIA AND THE ASTIPYRETICS,

antipyretic. It is above everything ioxamia which
indicates it in fever : in proportion as the

" lire of all the blood
Is touched corruptibly"

is its control exerted.

The use of Arsenic in typhoid conditions is a piece
of homceopathic practice which has not yet been —
what shall I say? "the wise convey it call" — not
yet " discovered " by the followers of traditional medi-
cine. Dr. Ringer, however, has made a beginning
of its employment in the hectic type of fever in
which he wii! doubtless find many followers. (He
had been to some extent anticipated in France, as
by Trousseau and Isnard ; but I speak of England.)
"It is stated" he writes in the tenth edition of his
Therapeutics "that arsenic will reduce the tempera-
ture in tuberculosis, and after carefully investigating
this subject, I am inclined to believe so; at least I
have frequently observed a steady and sustained fall
of the thermometer follow the use of arsenic in cases
where the undue temperature had continued un-
changed for a considerable time, and this I have
known happen twice or three times in the same
case on reverting to arsenic after it had been discon-
tinued. The decline generally takes place gradually,
and may begin soon after taking the drug, or the fall
may be postponed for ten or twelve days." The
^ri7(/«rt/ diminution of the pyrexia, here noted, is an
important and valuable feature in the action of our
present drug, and applies equally to the typhoid

CINCHONA. 127

types o{ fever. It produces 110 sudden deferves-
cence, as the cold bath and the large dose of quinine
or digitalis may do. These act on the high tem-
perature solely, leaving its cause untouched ; and
their effects are as evanescent as they arc rapid.
Arsenic goes down to the very furnace where the
preternatural heat is being generated, and there
gradually but permanently extinguishes the fire.

The double action of Arsenic, — corresponding
on the one hand to such fevers as the malarial, the
hectic of phthisis and marasmus, and the pyasmic, on
the other to those of typhoid character, — this, I
say, gives it two kinds of analogues. In the former
sphere, it finds allies in bark and its alkaloids ; in the
latter, in the serpent-poisons.

I. The relation of Cinchona bark to the malarious

Efevers is still a moot one ; and the question has en-
wed on another stage during the last ten years. On
^Ite one side evidence has accumulated in favour of
tnalaria consisting in a contagiiim I'ivum : on the other
; has been proved to he one of the most potent
jrotoplasmic poisons we possess. The inference is
iiatural, that it cures ague by destroying its cause ;

B«hat it checks the multiplication in the blood ol the
germs whose inhalation has caused the mi.schief. If
this be so, the rationale of its action is the same as
that suggested by Hahnemann for the power of cam-
phor over cholera ; and we have an explanation of the
substantial dosage which either remedy seems to
require. Veratrum and Cuprum will play their part
in cholera even in high attenuation, while camjihor

125 PYREXIA AND THE ANTIPYRETICS.

must be given in its primary solution and gains (as
Dr. Riibini has shcwnj by making this a saturated
one. Those who treat intermittents with potencies
seem never to use quinine and rarely its matrix bark,
which Hahnemann maintained to be homoeopathic to
and declared to be specific for any recent malarious
fever occurring in otherwise healthy persons. The
inference is that their dosage is at fault; and that by
using the drug in more appreciable quantities they
would get as good results with it as others claim.

But the analogy extends yet farther. Camphor-
poisoning exhibits cold and collapsed conditions very
like those of cholera : it is therefore truly homoe-
opathic to the condition there present, and may
benefit otherwise than as a germicide, as well as in
similar states occurring inde[ienr!ently of the Asiatic
scourge. And so it is with bark. In the work to
which I have referred I have shewn by numerous
citations from unquestioned sources, that cinchona
and quinine have the power of exciting in the healthy
the febrile paroxysm. Whatever, therefore, they
may do in intermittents by killing the malarial
bacilli, so far as they influence the living tissues it
is in a direction similar to that of the disease, and
thus (as we know) antidotal to it. They may accord-
ingly cure agues — as they often must have done —
without acting as germicides at all ; and they will be
applicable to similar paroxysms not owning malaria
for their source. In this way they take place as anti-
hectics. This is the type of fever liable to be set up
when suppuration is proceeding, or any great drain

THE SERPI

on the system is going on, and this — in hotnce-
opathic practice — is the recognised sphere of our
" China." It is only a step farther when we come to
the pyiemic and septicremic fevers. Quinine may
possibly do something here as a represser of the too
exuberant cell-life which is overwhelming the organ-
ism ; but I am sure that it also acts, in doses too
small for such purposes, as a supporter to the invaded
system. In such cases its combination with Arsenic,
in the form of Cliininum arsenicosum, is a valuable
remedy, — the hxmatic action of the Arsenic rein-
forcing the purely neurotic one of the Cinchona.

2. Here, however, we have come to to.tasmic fe-
vers once more, and to the other branch of arsenical
analogues, the serpent poisons. The use of these
in medicine is peculiar to homceopathy, and consti-
tutes one of its mo.st potent instruments. It should
be so according to the law of similarity, for what is
more quickly fatal, more widely destructive, than
the bite of a venomous snake.' and practice has con-
firmed the inference. In Lachcsis and Crotaliis —
the venoms respectively of the lance-headed viper
and the rattlesnake — we have antidotes to the worst
fevers that afflict humanity ; and the names of those
who have done most to-emphasise their value or sup-
ply materials for their employment, the names of
Hering, Neidhard, Dunham and Hayward, will (I
venture to predict) stand on lasting record.

The phenomena of snake-bites would suggest that
it is in malignant local inflammation.s, with secondary
blood-infection and nervous prostration, that serpent-

I30

PYREXIA AND THE ANTIPYRETICS.

venom would play its part as a remedy ; and this
indeed has proved the great sphere of Lachesis.
Traumatic gangrene, malignant pustule, dissection-
wound, and all cases of pyjemia and septicremia own-
ing a local source, come within its range and respond
to its action. But experiments in inoculation have
shewn that the rattlesnake venom, at any rate, is ca-
pahle of setting up a primary pyrexia, most analogous
to the scourge of your Southern States, the yellow-
fever. The brilliant comparative success which homce-
opathy ha.s always scored in the treatment of this
disease — and never more so than in the last epidemic
— has been largely due to Crotalus. But the analogy
leads us to apply it to purpuric febrile states in gen-
eral, whether occurring primarily and ordinarily, as
in epidemic cerebro-spinal meningitis, or constituting
a distinct variety or occasional form of other maladies,
as scarlatina and variola. Dr. Hayward's monograph
on Crotalus, which will shortly appear, is likely to
give a great impetus to this use of the medicine. He
can say — "for the last ten years the present writer
has used Crotalus in all cases of fever of all kinds
when any thing of a hasmorrhagic or putrescent char-
acter has been exhibited, and with the most prompt
and marked effect in removing the hasmorrhagic
symptoms and checkingthetendency to putrescence."
His two cases of malignant scarlatina (to which even
the Lancet has given in.sertion) well illustrate its
power to rescue from almost imminent dissolution.

IV. We are now well-furnished with medicines
which cause fever by wasting the nervous centres

and the blood ; but we want another set which shall
serve us when the morbid process is seated in the
more lowly-organised tissues, in those of the vegeta-
tive system. The type of such medicines is Bryonia.

The earliest pathogenesis of this drug appeared in
the second vohtme of the first edition of the Materia
Medica Piira, i.e. in 1816, and it contains — especially
in the portion furnished by Hahnemann himself —
some marked fever-symptoms. It is probable that
he had observed these some time previously, for as
early as 1813 he had been led to give Bryonia as one
of the chief remedies in the epidemic fever which
ravaged the army that had fought at Leipsic. On
reading his account of the matter (which you will
find in Dr. Dudgeon's translation of his lesser writ-
ings), you will see that the symptoms which — in
addition to the common febrile ones — led him to its
choice were "shooting (or jerking-t earing) pains in
the head, throat, chest, abdomen &c., which are felt
particularly on moving the part." These express its
action on fibrous, serous and muscular tissues. When
delirium supervened — when, that is, the hyperoxi-
dation involved the nervous centres — Hyoscyamus
had to take its place.

Now it was obvious that if pains increased on move-
ment were to be the characteristic of the Bryonia
fever, it should be above all things a remedy in acute
rheumatism ; and so it has proved to be, as we shall
see in our next lecture. But if, so indicated, it could
control the whole febrile condition present, it must
evidently play some part in the treatment of the

■ 132 PYREXIA AND THE ANTIPYRETICS.

I essential fevers, of which that treated by Hahnemann
I was an instance. It was possibly (as Dr. Russell
I thinks) of the kind now known as " relapsing," though
I, I do not find any mention of relapses as occurring in
I it.' The success he reported with it, and some addi-
I tional symptoms given in the second and third edi-
I tions of his Materia Medica 'Piira, led to its taking
I among his followers a high place among the reme-
K dies for the common endemic "typhus," which was
H generally that which we now call typhoid or enteric
I fever {their "typhus ahdominalis "), but sometimes
p the "synoque" of the French, the "gastric" or
"common continued" fever of our English nomen-
clature. All the representative writers of the first
period of homceopathy — Hartmann, Wolf, Trinks —
L concur in stating that the fever of Hryonia is a syn-
I ochus, often so active as to simulate a synocha, and
I so (wrongiy) to call for Aconite, but liable, if not
checked, to go on to a typhus nervosus. Such a
condition — vascular and nervous erethism, without
much prostration — we often have at the commence-
ment of true typhoid, but still more in the initial
stage of the common continued fevers. To these it is
probable that (as with Baptisia) Trinks' statement
applies that typhus may sometimes be arrested with
Bryonia. The features in them which have led to
the appellation "gastric" are further indicative of
our present medicine ; for such symptoms as coated
tongue, foul and bitter taste, nausea and vomiting.

18,7, <:>

and so forth, — which have not come before us in the
fevers of Aconite, Belladonna, and Arsenic, are
always strong indications for Bryonia. Let head-
ache and other pains be further marked, and a ten-
dency to involvement of the chest appear, and we
have a pyrexia which Bryonia will arrest if arrestable,
and at any rate will modify so favourably as to earn
the patient's grateful thanks.

The allies of Bryonia are Rhus, Phosphoric and
Muriatic acids, and Baptisia.

I. From their first joint appearance in the volume
of the Materia Mcdica Pnra issued in 1816, Bryonia
and Rhus have ever gone together ; and these " great
twin-brethren" have come to our aid in many a
doughty fight. Rhus also had been found to excite
decided febrile symptoms, not merely as sympathetic
with the dermatitis caused by its external application,
but primarily, from ingestion in moderate doses.
Hahnemann accordingly administered it in the fever
I have already mentioned, either after Bryonia, or
from the outset, when the pains were worse during
rest, and when greater prostration was present.
Whatever this fever was, of 183 cases treated by
him in Leipsic not one died ; and so Rhus, like
Bryonia, became a fever-remedy in the homoeopathic
school. Hahnemann himself resorted to them, as
the standard febrifuges, in the consecutive fever of
cholera, apparently recommending their alternation
therein. In the common continued fevers — gastric
and typhoid — the question has generally been which
of these should be given ; and Rhus has been recog-

134 rVREXlA AND THE ANTIPYRETICS.

nised as suitable to an erethistic condition more
adynamic than that of Bryonia, but less so than that
of Arsenic. The first suptrventioa of diarrhoea
upon constipation, of a red upon a coated tongue,
calls for it in gastric fevers ; and in true typhoid may
often indicate it from the first. "Comparing it"
writes Dr. Dunham " with Bryonia and Eupatorium,
we miss at once the whole train of gastro-hepatic
symptoms, the vomiting of bile, soreness and pain
at the pit of the stomach, constriction around the
epigastric zone, fulness and tenderness of the hepatic
region, etc., which indicated those remedies in bil-
ious remittent fevers. On the other hand, we find
Rhus producing some degree of tenderness of the
abdomen, great flatulent distension of the abdomen,
amounting to tympanites, occasional watery or mu-
cous diarrhcea, — symptoms which, though not so
strongly pronounced as similar symptoms are under
Phosphoric acid, yet decidedly resemble the symp-
toms of typhoid fever, and indicate the use of Rhus
in that disease." A red triangle at the tip of the
tongue has recently been said to indicate it here.

2. Phosphoric acid was reckoned by Wurmb and
Caspar, the distinguished clinicians of the Lcopold-
stadt Hospital in Vienna, an analogue of Rhus in
typhoid, corresponding to symptoms of the same
degree of severity, but marked by torpor rather than
erethism. How they came so to use it f cannot tell ;
for there is little indication of fever in its pathogen-
esis, and neither Hahnemann nor any of his ca/^Her
disciples mention it in this connection. Dr. Dun-

MURlATtC ACID. I35

ham, however, as we have seen, seems to think the
indications warranted ; and they are confirmed by
the high value set upon it by the no less eminent
Paris clinician. Dr. Jousset. "Phosphoric acid" he
writes " is, with Muriatic acid, one of the principal
medicines for typhoid fever in its stage of full devel-
opment : abundant diarrhcca with involuntary stools,
paleness of the stools, but most of all intestinal
haemorrhage, indicate the remedy. As concomitant
symptoms we observe epistaxis, bleeding of the
gums, pallor of the face or one cheek red and the
other pale."

3. With Phosphoric goes Muriatic acid ; and, to
ray thinking, outdoes it far in range and energy in
the febrile .sphere. Our employment of it here must
indeed be traced to tradition ; for the fever-symptoms
of Hahnemann's pathogeneses of the drug are quite
insignificant. The tradition took its rise from iatro-
chemistry: the chlorine and the acid were supposed
to neutralise respectively the putrescence and the
alkalescence of the fluids in low febrile states.
That Che action was really dynamic appears from the
high esteem in which it has been held in the homceo-
pathic school, when given in doses far too small to
exert any other kind of influence. The tendency
to ulceration of mucous membrane observed in cases
suitable for it suggests that it is where the hyper-
oxidation of fever affects chiefly this tissue that it
is most applicable ; and it gives it a special relation
to typhoid. Putrescent phenomena, with us as of
old, are always indicative of it ; and it thus fre-

j_J

¥1^6 PYREXIA AND THE ANTIPYRETICS,

■ qucntly finds place in the treatment of malignant
scarlatina and diphtheria.

4. Last, but not least, I have to speak of Baptisia.
The question of the power of this drug to abort true
typhoid is, I think, definitively closed. There are
occasional instances of this fever which spontane-
ously terminate at an early period, and any one who
uses Baptisia much for it will every now and then
meet with such a case. IE he ignores the numerous
examples of the maUdy in which no such result has
followed, he may become an advocate of its abortive
power here. But whenever a succession of cases of
true typhoid has been submitted to the treatment,
the result has always been failure.

There is, however, a fever in which Baptisia is
specific, and whose course it does positively arrest.
This is the "gastric," or common continued fever of
which 1 have already spoken, — a fever which runs
no definite course, but which, under ordinary treat-
ment, mostly puts on a typhnus appearance before
coming to its close. That Baptisia is the Aconite
of this fever, that it can break it up in perspiration
in {at most) two or three days, is a thing of which I
am as certain as of anything in therapeutics. It was
the confusion of this fever with true typhoid which
led to the baseless claims some of us (among whom
I must include myself) have made for the remedy;
but we must not, in the re-action, abandon it alto-
gether. Such a malady is often seen, is sometimes
epidemic, — it constitutes the "colonial fever" of
Australia and the Cape ; and the fame of Baptisia

in the past, and its solid uscfidncss in the future,
lie within the sphere of it.

With Baptisia, as with Muriatic acid, putrescent
phenomena are characteristic ; and fcetor of the
breath and secretions alike indicates it and yields to
its use. It may thus play a part in other fevers
where such a feature is apparent, in scarlatina, in
diphtheria, and above all in variola. Dr. Eiibulus
Williams' experience with it in the last-named, dur-
ing an epidemic occurring in a children's home at
Bristol, was strikingly favourable ; and he especially
notes the absence of the usual offensive effluvia in
the cases treated by it.

We have yet to learn what it is in suppuration
which causes hectic, and it may well be some pro-
cess allied to putrescence. Dr. Mitchell, of Chicago,
has praised Baptisia highly in this fever when occur-
ring in connexion with phthisis ; and I have verified
the indication when the tongue has been moist and
coated, instead of — as in the cases calling for Ar-
senic — red and apt to become dry.

These, ladies and gentlemen, are the leading classes
of our antipyretics, and the drugs that fall within
them. The groups now formed and comparisons
instituted will aid you, I trust, to apprehend more
clearly their genius and sphere of usefulness, and so
to employ them with enhanced precision in the vari-
ous febrile states which come before you. Rightly
used, they will give you — I believe — such control
over fever thiit you will need none of the harsher

.»^

138 PYREXIA AND THE ANTIPYRETICS.

measures of the old school to supplement them. A
temporary exception must be made for the sudden
hyperpyrexia of which I have spoken, where accord-
ing to our present knowledge the cold bath or pack
is indispensable for the saving of the patient's threat-
ened life. Save under these rare circumstances,
however, homoeopathic medication, with ordinary
coolness and quiet, abundant drink, and simple regi-
men, will form the best of antipyretic treatment.

RHEUMATISM AND THE ANTI-RHEUMATICS.

In taking Rheumatism as the second peg on which
to hang a bundle of medicines, I am aware that I am
assuming that to be an entity which pathology refuses
so to recognise. The numerous affections known as
"rheumatic'", ranging from acute polyarthritis to a
simple stiff-neck, have — it is said — neither a com-
mon specific cause nor a single anatomical seat : al-
ready a number of them have been differentiated as
gout, rheumatoid arthritis, myalgia, &c., anr! the re-
mainder hold their place provisionally only. But,
whatever may be said theoretically to such criticism,
it still holds good practically that around the true
"rheumatic fever" which all agree is an "essential"
malady there are groiiped a number of affections more
or less closely allied to it, owning (mostly) the same
atmospheric causation, occupying similar parts, and
— which to us is of most importance — responding
to similar medicines. I maintain that these are as
much entitled to the term "rheumatic" as is the
febrile polyarthritis specially so named, and I shall
include them as varieties of the malady of whose
remedies I have now to speak.

I40 RHEUMATISM AND THE ANTI-RHEUMATICS.

By rheumatism, then, we mean first of all the
acute general form — "rheumatic fever.** As the
name implies, fever is a marked feature here: it
even seems to precede the affection of the joints,
though — as in pneumonia — the appearance may be
deceptive. It is admitted by all to be proportionate
to the number of the joints involved and the inten-
sity of their inflammation. It has the curious feature
of being accompanied almost from the outset by free
perspiration, which, however, affords no relief ; and the
sour odour of the sweat is known to all who have at-
tended a case of the kind. It is in acute rheumatism
that the temperature is most apt to run up to that
menacing height in which it is known as "hyper-
pyrexia." This, however, must not be regarded as an
excessive degree of the true rheumatic fever, which
is an inflammatory one : it is confessedly rather of
neurotic origin, and referable to a collapse of the
heat-controlling centres in the cerebro-spinal system.
The inflammation is primarily situated in the syno-
vial membrane of the joints, — though it may spread
to the neighbouring parts ; and it is characterised by
great instability, suddenly supervening and as sud-
denly departing, the (purely serous) effusion being
as rai^idly poured out and re-absorbed. Certain sec-
ondary inflammations are very apt to occur during
the course of the disease, viz. : peri- and endo- carditis
and pleurisy, less frequently meningitis and pneu-
monia. That the serous membranes should be spe-
cially affected their close alliance with the synovial
would make appropriate ; but it is to be noted that

MATERIE5 MORBl OF RHEUMATIC FEVER.

when inflammation attacks these in the course of
rheumatic fever, it is not fugitive as in the joints,
but takes a firm hoJd, and — especially in the heart
— often leaves lasting results.

The cause of this disorder is in most cases a chill,
less frequently a fright, occurring to persons heated
by exertion ; in either case checking perspiration.
It is reasonably inferred that its phenomena are due
to the retention in the blood of excrementitious
products, capable of setting up local inflammations
and general fever; and that the sweating of the dis-
ease is an eliminative effort, its odour being due to
the acid nature of the malcrics morbi. In the rare
cases in which rheumatic fever developcs spontane-
ously, we may suppose that the same products have
resulted from mal -assimilation or imperfect retro-
grade metamorphosis.

Whether this theory be true or not is of some
therapeutic importance. In the first place, it rules
the application we shall make of Dr. Balthazar Fos.
ter's two observations (confirmed by one of Kuclz's)
that the administration of lactic acid — at any rate
to diabetic patients — is liable to set up acute rheu-
matic arthritis in various places ; while Richardson
and Kauch have found it, in animals, capable of in-
flaming the endocardium. Hy our law, lactic acid
should be a prime remedy for rheumatic fever, if it
were not — as it is by the hypothesis just stated —
the very maUrics morbi. Certainly no reports of
success with it have appeared in homceopathic litera-
ture ; and their absence favours the other alternative.

142 RHEUMATISM AND THE ANTI-RHEUMATICS.

If it be true, the present supplies illustration of the
impossibility of always working with symptomatic
resemblances only, and ignoring pathology.

But then, if lactic acid in quantity be the pyro-
genous and phlogogenous matter of rheumatic fever,
is not chemical antidotal treatment — as by alkalies
— indicated therein ? It is difficult to resist the
inference theoretically, and practically it has been
maintained that not only is the whole duration of the
malady lessened by such treatment, but — which is
more important — the frequency of cardiac complica-
tion is materially abated. The objection to such
treatment lies in its flooding the system with the
necessarily large quantities of alkali required,' — an
evil somewhat mitigated by substituting salts of soda
for those of potash hitherto given, but generally re-
sulting in greater anxmia than is natural during con-
valescence. The total outcome of experience with
alkalies has not hindered our brethren from grasping
eagerly at the prospects held out by salicin and the
salicylates, nor has it stood in the way of trimeth-
ylamine or dethroned colchicum. These last are
remedies which act like our homoeopathic specifics,
striking, as we may suppose, at the cause rather than
neutralising an effect. For, although the starting-
point of rheumatic fever may be the retention of
lactic acid in the blood, from checked perspiration,
its persistence for weeks must imply (as such a
product has no self-multiplying power) a continual

' " No effect can be expected from alkalies unless they are given in very
large doses " {Senator^ loc. cit.).

ALKALIES IN RHEUMATIC FEVER. I43

fresh formation of the inaterics morbi ; and here we
must hypothecate a morbid protoplasmic activity,
by the cessation of which alone can the disease be
radically cured.

In adults, at least, we are therefore warranted in
relying solely on specific measures. In young peo-
ple, viewing the much greater frequency of heart-
affections, and the apparent efficacy of alkalies to
avert them, their administration would be desirable,
were we not capable of achieving as good results
with purely homoeopathic treatment. It would also
appear, moreover, that it is only in comparison with
other perturbative l:reatmcnt — as by blisters, opium,
&c. — that alkalies secure this superior immunity ;
since cases left to nature under good nursing do as
well. I am not sure, however, whether the experi-
ment has been carried out on a sufficiently large
scale, and whether — as with Dietl's in respect of
pneumonia — a greater number of cases might not
alter the averages.

But we must return to our clinical survey. Chronic
articular rheumatism is allied to rheumatic fever by
being not uncommonly its sequela ; and, when it is
of primary occurrence, by its resulting from the same
causes, viz. : continued exposure to cold and damp.
It is more fixed in seat, and leads to greater changes
in the substance of the joints : otherwise, it may be
described as consisting of the local affection of acute
rheumatism without the constitutional disturbance.

** Muscular rheumatism " is a good deal discredited
now-a-days ; and, when not of systemic origin (as in

144 RHEUMATISM AND THE ANTI-RHEUMATICS.

scur\'y and metallic poisoning), is set down as either
myalgia or myositis. I cannot think this procedure
wise. The true "myalgia" ought — I think — to
be restricted to muscular pain coming on after too
prolonged, sudden, or great exertion ; while myositis
can hardly be present without tenderness of the in-
flamed muscle, — a symptom of which in the acutest
cases of lumbago there is hardly any trace. The
majority of instances of this malady, of pleurodynia,
and of torticollis, can be traced to the main causes
of rheumatism generally, and may fairly therefore be
considered " rheumatic ** in their nature.

Again, the fibrous tissues throughout the body,
especially the fasciae and nerve-sheaths, are, under
similar circumstances, liable to acute or chronic mor-
bid conditions whose pain, stiffness, and sensitiveness
to atmospheric changes assimilate them to rheumatic
arthritis. They too may therefore be considered
part of our disease-group, and will be found to have
a very defined relation to certain anti-rheumatic
remedies.

To these we now proceed.

I. Bryojiia, of all medicines, comes nearest to
being a typical analogue of rheumatism, in almost
all its forms. It is a specific irritant ; and the parts
it inflames when absorbed into the blood are, not so
much skin and mucous membrane, as serous and
synovial membrane, fibrous tissue, and muscle. It
has excited, especially in one of the heroic Austrian
provers (W. Huber), decided fever; and in several
of them the urine was of febrile character. Hahne-

BRYONIA. 145

mann and Otto Piper have each noticed sour sweat
from it. As regards the joints, a number of the
symptoms of its pathogenesis (see S. 1345, 1425,
1426, 1550 ajid 1551 of Allen's Eticj/ciopcedia) ^\iiiak
of swelling, stiffness and tenderness in them ; and
a very instructive experiment was made on himself
by Dr. Elias Price, of Baltimore, who, after taking
doses of the tincture ranging from 30 to 50 drops,
had — after five days' incubation — a decided attack
of rheumatism of the foot, not entirely passing away
until seven weeks had elapsed. For the muscles,
we have soreness and pain on motion experienced
by the provers in many parts of the body, even to
the production of pleurodynia and lumbago ; and in
an autopsy made on an animal poisoned by it, the
substance of the heart and the muscles of the neck
were found intensely red.

When the rheumatic significance of the patho-
genesis of Bryonia was first noticed, I do not know,
Hahnemann does not intimate it ; but Hartmann,
in 1839, speaks of it as already "a very celebrated
remedy." Curiously enough, popular practice had so
far anticipated its applicability to joint affections as
to give it the name of Gicht-rubc, gout-root. What-
ever it may do for the malady referred to in this
appellation, there is no doubt that in the treatment
of rheumatic affections of all kinds it plays a most
important part. In rheumatic fever, some of us
alternate it with Aconite throughout — Dr. Yeldham
advising the one to be given during the day, the
other at night : some prefer to give Aconite alone

_ u

146 RHEUMATISM AND THE ANTI RHEUMATICS.

until it has done all it can do, and then to put in our
Bryony. There are two indications, however, which
should lead us to administer Bryonia by itself and
at the first. One is pathological : it is when the
disease presents the " synovial *' as distinct from the
"fibrous** form. This distinction was made by
Chambers and Francis Hawkins, and has been en-
dorsed by Watson. In the synovial variety there is
more local swelling and less general fever: as the
name implies, the synovial membranes of the joints
are the seat of the inflammation rather than the
tendons, fasciae, and ligaments round about them ;
and we have seen that it is these chiefly on which
our medicine acts. The other indication is symp-
tomatic : it is where the sensitiveness to movement
so characteristic of the drug is markedly present.
In proportion to its degree not only is Bryonia called
for, but its dosage becomes more attenuated, so that
from the 12th to the i8th, or even higher, it displays
the most brilliant powers, as testified to — inter alia
— by Bayes and Madden. I mention this, because
generally in rheumatic affections the lowest dilutions
seem to do most good. In the complications of
rheumatic fever, Bryonia is quite competent to deal
with the pleurisy and the pneumonia ; but when the
heart becomes affected it yields place to more defi-
nitely cardiac remedies. In chronic articular rheu-
matism Bryonia occupies a sphere which may be
exhibited in the words of Sir Thomas Watson: —
" There are two kinds of chronic rheumatism : one
attended with local heat and swelling, although ,the

147

constitution at large sympathises very little or not at
all with the topical infiamraation ; the other charac-
terized rather by coldness and stiffness of the joints.
In the former of these the pains are increased by
pressure, and by movements of the limbs, and by
external warmth ; the warmth of a bed, for example ;
and there may be even some slight degree of pyrexia
at night. In truth this form of chronic rheumatism
claims a near relationship with the acute, into which
it sometimes passes, and of which it is frequently
the sequel." I may anticipate so far as to say that
the great remedy for the second variety here de-
scribed is Rhus, but for the first Bryonia is specific.
In acute muscular rheumatisms it also plays an im-
portant part, though in severe lumbago I confess I
prefer Aconite. The pain on movement of our medi-
cine is of course present here to a marked degree ;
and in pleurodynia where it is indicated it obliges the
patient to lie on the affected side. For the chronic
fibrous rheumatisms Bryonia can do little. It is to
maladies caused by dry cold, such as that brought
by the east winds of my country, sweeping across
the arid steppes of Russia, and traversing no ocean
of any breadth which can temper their harshness,
that this remedy is appropriate ; while the affections
in question trace their origin rather to cold associ-
ated with damp.

■Bryonia, in its relation to rheumatism, may fairly
be regarded as the head of a group of medicines ;
the other members of which are Aconite, Colchicuni,
Pulsatilla, and the product variously known as "pro-

148 RHEUMATISM AND THE ANTi-RHEUMATlCS.

pylamine" and "trimethylamine." To these we will
now direct our attention.

I. Next to Br}'onia, our great anti-rheumatic is
Aiofiite. Here we have not been, as with the other,
the first to establish its virtues. Stoerck, in 1750,
experimenting on himself with the extract, found it
to cause considerable diaphoresis. He inferred that
it should prove useful in chronic local rheumatisms,
and found it so to be, the improvement generally
setting in with sweating and eruptions on the affected
parts. From this the transition to acute local rheu-
matisms and at length to rheumatic fever was natu-
ral : Tessier (of Lyons), Lombard and Fleming were
its agents, and you will find in Stills several other
testimonies to its value. Nevertheless, the remedy
has not occupied the place which might have been
expected in ordinary practice ; and I agree with Dr.
Phillips that this has resulted mainly from the strong
doses in which it has been given. The aim has been
rapidly to hush up the pain in the joints or to knock
down the fever : this the drug can only do as an
ancesthesiant and arterial sedative, and its effects
when thus given are so unpleasant and even danger-
ous that its use comes to be abandoned.

That so it is appears from the steady favour ac-
corded to it in the school of Hahnemann, where
gentle and unperturbing dosage is practised. We
believe it to be homoeopathic to acute rheumatism,
and use it accordingly — absorbing its whole physio-
logical in its therapeutical action. We conceive that
we have good grounds for so regarding it. In relation

ACONITE, 149

to fever I have brought before you only the neurotic
action of Aconite ; but it must riot be forgotten that
it is also an irritant. You wiHiifeometinie^'ihear it
saitl that Aconite does not causa ^infen^tpation ; and
this is true if the process in parenchymatotis organs
is intended. Hut in post-mortem examinations of
animals poisoned by it decided evidences of inflam-
mation of the pleura and peritoneum have been
found ; and the sensations of some of the provers
point in the same direction. Similar pains, of cut-
ting, shooting and tearing character, were experi-
enced by them in the fibrous tissues generally, the
muscles, and the joints, — those in the last-named
having been observed also in rases of poisoning.
One of SchrofE's provers of the Aconitum camma-
rum experienced them to a high degree. In no case,
however, is there — as with Bryonia — any redness
or swelling.

Having regard to these facts, and to the relation
of Aconite to the synocha present in this disease,
we should say that it ought to be the prime remedy
in the "fibrous rheumatism" of Chambers and
Hawkins, where the peri -articular tissues are mainly
affected and the fever runs highest. This indeed it
is. You must not use it as a neurotic in this in-
stance, and expect it to subdue the fever in twenty-
four hours. It cannot here he!p us by liberating the
arterioles from their contracted state, and promoting
heat-radiation. This is going on abundantly, but
heat-production is on its side so greatly enhanced
that no relief is gained thereby. In rheumatic fever

I50 RHEUMATISM AND THE ANTI-RHEUMATICS.

Aconite is rather antiphlogistic than antipyretic : it
acts on the protoplasm which is being too rapidly
oxidised, and for this time is required.

It is the testimony of all who have trusted to
Aconite in acute rheumatism that under its use the
heart is much less liable to be affected. Should it
be so, however, you need not intermit the use of the
drug ; for its homoeopathicity and activity here have
been abundantly proved. **One of the Austrian
provers had, alternating with his articular suffer-
ings, painful palpitation of the heart and praecordial
anxiety ; and Dr. Jousset says that he has intro-
duced into the circulation of rabbits increasing doses
of the extract, with the invariable result of pro-
ducing lesions of the mitral valve" {PJiarmacody-
namics). If Aconite is actually being taken when
the cardiac complication supervenes, it may be alter-
nated with another heart-medicine, as Spigelia ; but
otherwise it may be given alone, and relied on alone.

In our dosage. Aconite has hardly found place in
the treatment of chronic rheumatism, articular or
fibrous ; and in acute muscular rheumatism it gen-
erally gives way to Bryonia or Cimicifuga. I would
make an exception, however, in the instance of lum-
bago. It caused a real attack of this nature in
Schneller, a physician of the old school who proved
it at Vienna in 1848, and I have always found it
very effective as a remedy. Here, however, as in
rheumatic affections generally, you must not — I
believe — attenuate the drug too far. I seldom rise
above the ist decimal dilution, and generally give
drop-doses of the tincture.

COLCHICUM. 151

2. The second of the analogues of Bryonia is
Colchiann, The repute of this medicine has mainly
been acquired in the treatment of gout ; but Watson
is not the only physician who declares of acute rheu-
matism, that *'the preparations of colchicum have
sometimes an almost magical effect in subduing the
disease." When we enquire how they act, we find
that it is by no indirect process, for it is quite un-
necessary to induce the purgative operation of the
drug : nor is it by any antiphlogistic power, since in
ordinary inflammations — not being gouty or rheu-
matic — it is quite inert. The action is direct and
specific ; and to account for it we can only look to
the physiological effects of the plant. Let us take
a case of poisoning by it, reported in the London
Medical Gazette for 1838-9. A woman, at 33, took
nearly an ounce of the tincture of the seeds one
Thursday at 11 p.m. Symptoms of gastro-enteric
irritation soon supervened ; but among these, about
10 A.M. on the Friday, she felt a numbness of the
feet and hands. "To this succeeded" writes the
reporter " a pricking feeling, as if, so she expressed
it, they had been asleep. All the joints of the
fingers and toes, and also the wrists and ankles,
were very painful, and the toes and fingers were
painfully flexed at times. Pain in the shoulder-joints
succeeded, and, on Saturday, in the hips and loins.
It was also increased in intensity, so that she said
she thought she should go mad. Ultimately, almost
all the bones and joints were affected with pains,
which were of a gnawing, dragging character. Just

152 RHEUMATISM AND THE ANTI-RHEUMATICS.

before these symptoms were at the height, very pro-
fuse sweats came on, and were of a very sour odour.
I may mention, that to the pains in the limbs were
added, on Sunday morning, great stiffness and pain
in the back of the neck and occiput, which was
aggravated by moving the head : there was also a
feeling as of something tightly bound round the
head ; and on moving the tongue, and in swallowing,
she experienced sharp pain about the root of the
tongue. She asked vie if she had not got rheumatic
fever. . . . The pain in the joints continued exceed-
ingly severe long after the vomiting and purging had
ceased : it was still so on Tuesday."

These effects are paralleled at points in several
of the numerous provings which have been made
with the drug, both in the old school and in our
own ; though here perhaps the pains have been felt
more in the muscles than in the articulations. Two
other observers, however (Krahmer and Lindemann),
have noticed the sour sweats so characteristic of
rheumatism ; and in a boy who had eaten portions
of the plant the left elbow and knee-joints were
swollen, hot and painful. The numbness and prick-
ing of the hands and feet observed by Mr. Henderson
(the reporter of the case of poisoning) is interesting,
as it is a well-known effect of Aconite, and we shall
sec it again in Propylamine.

After all this, I am sure that any candid enquirer
would bear me out in claiming for homoeopathy any-
thing that Colchicum can do in rheumatism. Mr.
Henderson very justly observes that the symptoms

PULSATILLA. 153

of his patient would suggest that it was not by its
purgative effects — as then supposed — that the drug
proved remedial, but by its specific action on the
parts affected. We have not used it much, as in
Bryonia we have a remedy so closely resembling it,
and taking its place in that very *' synovial" rheuma-
tism to which it has hitherto been allotted. But the
poisoning I have cited would suggest it as hardly less
applicable to the ** fibrous " form, if another medicine
seems needed after Aconite has spent its force. As
with the two preceding anti-rheumatics, it has shewn
a specific influence on the serous membranes by in-
flaming the pleurae ; and it has displayed remarkable
power in controlling pericarditis when occurring in
the course of rheumatic fever. It should be more
used than it is in muscular rheumatism, especially
torticollis, as it seems to have an elective affinity for
the muscles of the neck. It caused pleurodynia in
several of its provers ; and in a gouty patient of Dr.
Russell's proved strikingly curative of it. Its patho-
genesy bears Teste out in saying that the rheumatic
pains to which it corresponds are generally tearing.
He adds that in warm weather they are principally
felt at the surface of the body : as the air grows cooler
they seem to penetrate the deeper tissues and the
bones.

3. The third drug to which I would draw your at-
tention in this category is Pulsatilla. It is one which
is still peculiar to homoeopathic practice, though our
esteem of it in orchitis has lately received corrobora-
tion from several practitioners of the opposite camp.

RIlEL'MATiSM AND THE ANTI-RHEUMATICS,

Its action on the joints was manifest in Hahnemann's
provitigs of the nigricans species, and appears also in
those which have been made in this coiintrj' with the
Pulsatilla NuttalJiana. In most of the articulations
the pains, however severe, were transient ; but in the
knee, and especially in the feet, they were accompa-
nied by swelling, indicating synovial effusion.

The general action of Pulsatilla would indicate its
use in sub-acute rheumatism, of synovial type, with
little or no fever; where the knees, ankles, or small
joints of the feet and hands are affected ; and when
the articular inflammation shifts readily from place
to place. The temperament and disposition of the
patient will in such rheumatisms generally be found
that characteristic of Pulsatilla, and — when present
— will lend additional force to its indications. Its re-
lation to the digestive organs, moreover, would point
to it as specially applicable when faulty assimilation
rather than chill had evoked the disease. In chronic
articular rheumatism the indications are the same;
and here its " conditions " must be specially regarded,
viz. : that its pains are worse towards evening and at
night, worse also at rest and in a warm room, and
relieved by motion in the open air. These features
of the action of the drug we owe to Hahnemann ; and
they are invaluable in determining its choice. On
tbe fibrous tissues and muscles Pulsatilla has no ac-
tion.

Another relation of this medicine which must be
remembered is that which it bears to the generative
organs in women. There is an ally of rheumatism

^^ Anol

^^^L rem em 1
^^^1 organs

PROPVLAMINK. I55

and gout, specifically distinct (however) from either,
variously known as " rheumatic gout," " nodular rheu-
matism," or (better) "rheumatoid arthritis." When
fully developed, no arthritic disease is more hopeless |
and more disabling: the best chance for its victims i
is to take it in the sub-acute form in which it not un-
commonly begins. Now Dr. Fuller has noted that
"in early life, rheumatic gout is always hereditary o>
c6iincetcd ivith disordered uterine function ;" and I
would add that, in later life, its most frequent sub-
jects are women at the climacteric period. Pulsatilla
finds an obvious sphere of action here; and has more
than once justified its choice.

4. The last drug of our present group is Propyla-
mine. I use this name for the present, as it is that
by which the substance in question is known in com-
merce, under which it was first introduced into medi-
cine, and by which it is designated in homceopathic
literature. It is more properly, however, trimethyla-
mine. Methyl, not propj'I, is its radical, — three
parts of this displacing three parts of the hydrogen
of ammonia, the resulting body being expressed as
CjH,,N, The substance used in medicine is the
propylamine of commerce purified, — this in its turn
being obtained from many animal products, of which
herring-brine is one of the best known and least
unpleasant. It is not pure methylamine — some
ammoniacal salts almost inevitably cleaving to it ;
but the former can be made synthetically, and^
given as a chloride — seems to act much in the same
way as that obtained analytically. As these prod-

156 RHEUMATISM AND THE ANTI-RHEUMATICS.

ucts are little known, I may mention that Propyla-
mine dissolves freely in ether, alcohol, and water;
and that, if you have to give it strong enough to
make it desirable that its disagreeable taste should
be disguised, you may accomplish this to some degree
by adding a little peppermint. The chloride of tri-
methylamine is equally soluble, but inodorous and
not repulsive to the palate.

Propylamine was first introduced into medicine
about 1855, by Awenarius, a Russian physician, who

— after using it in 250 cases of acute rheumatism —
reported it as little less than specific. Giving two
drops only every two hours, he *' frequently saw all the
symptoms of the disease vanish after twelve doses
had been taken." Dujardin-Beaumetz, in France,'
and W. H. Spencer, in England,^ have since reported
results almost equally good ; and the remedy was
just coming into favour when the salicylic treatment

— of which I shall speak immediately — dethroned
and extinguished it, so that it finds no place in the
last edition of Ringer's or of Wood's Therapeutics.

It is not our way so to lose a potent medicine, and
it has never been forgotten in the homoeopathic
school. We have studied it in our usual manner,
i.e. first pathogcnetically, by observation and experi-
ment, and then therapeutically. Observations on
patients treated by it have yielded little definite
result as regards its physiological action. Dujardin-
Beaumetz, however, proved the chloride of trimeth-

* Bull. Gen. lie Ther.^ LXXXIV., 227, 337, 395.

* Practitioner^ Feb. and Mar., 1875.

PROPYLAMINE. 157

ylamine on himself and another healthy person, and
in both the force and frequency of the pulse were
reduced, and the temperature fell nearly or quite
one degree centigrade. One of our own colleagues,
Dr. Chaffee, of Kentland, rejDorted to the Indiana
Institute of Homoeopathy, in 1880, a proving on
himself. "I took" he says "ten drops of propyla-
mine in water. One half hour after taking the same
I experienced a smarting sensation of the tongue
and fauces, with much thirst: there was also a tin-
gling of the fingers, a sensation of numbness to such
an extent that in attempting to pick up any thing it
felt heavy, and I had to use great effort to retain the
article within my grasp. This group of symptoms
passed off at the expiration of three hours. I then
took another dose of ten drops and experienced the
above symptoms intensified, with the addition of
great pain in the wrist joints, also great restlessness,
yet inability to stand upon my feet from the pain
produced in the ankle-joints. I took no more of the
medicine, the tongue became broad and flabby, the
mucous membranes of the buccal cavity were pale,
appetite gone, no desire for anything, became mo-
rose, with great desire to be let alone : the pain in
the joints was made worse by the slightest move-
ment. Twenty-four hours after taking the drug, I
was attacked with diarrhoea : the stools were thin,
watery, and white." '

Several casual experiences with the drug have
been reported in our journals, and one of these may

' U, States A fed. Investigator, June 15, 1880.

158 RHEUMATISM AND THE ANTI-RHEUMATICS.

be cited as worthy to stand beside those from old-
school sources. Dr. Sanborn, of Hampton Falls,
N.H., writes — "In January, 1862, I began to use
Propylamine in rheumatic fever, and have used it
every year since. My whole number of cases has
been about sixty. I begin the treatment with Aco-
nite and Propylamine, giving two drop doses of the
latter four times a day. I have had no case which
lasted more than a week, and generally in three days
my patients can walk about without pain." ' This
very fairly corresponds with the experience of Du-
jardin - Beaumetz and of Spencer. The latter of
these, I should say, notes that the remedy does not
produce such marked and speedy effects in lymphatic
subjects as in those of nervous and sanguine temper-
ament. It is therefore allied to Aconite rather than
to Pulsatilla.

I can thus commend Propylamine to you as having
all the features of a homoeopathic remedy, acting
directly and in small doses. I cannot say the same
of the drug which I have mentioned as having super-
seded it in ordinary practice. I mean salicin, with
its derivatives salicylic acid and the salicylate of
soda. I call these last derivatives of the first, as —
though ordinarily obtained from other sources —
salicylic acid appears to be a product of the breaking
up of salicin in the system, and the action of the two,
physiological and therapeutical, seems to be identi-
cal. Now I do not deny that these substances may
occasionally be homoeopathic to acute rheumatism.

« Medical Call, July, 1882.

SALICYLIC TREATMENT. I 59

Both have been known to induce fever, which,
though of short duration, has been pretty sharp ;
and the salicylate of soda has every now and then,
in the hands of practitioners of our school, done ex-
ceedingly well in doses which the ordinary practice
would deem inert. But I cannot claim for homoe-
opathy the salicylic treatment of rheumatic fever as
a whole. To be of any use — all who employ it affirm
— the dosage must be large, — ten to thirty grains
every two hours or so. When thus administered in
any febrile disease, a considerable reduction of tem-
perature is obtained, and in acute rheumatism the
pain and inflammation of the joints is also greatly
abated. But that the essential malady is not touched
appears from the fact that cardiac and other com-
plications are at least as liable to occur, and that
relapses are decidedly more frequent than when
improvement has resulted from other measures. As
compared with alkaline treatment, for instance, heart-
mischief is nearly twice as frequent, and relapses
occur three times as often.' Still, it might be said,
giving all due weight to these disadvantages, the
benefit obtained is so great, and so unattainable by
other means, that the salicylic treatment should not
be withheld from our patients. But there is yet
another demerit in it. The large dosage required is
an evil which has not been sufficiently considered,
either here or in the analogous instances of the
bromide treatment of epilepsy and the iodide of
syphilis. You cannot introduce these masses of for-

* Lancet^ Sept. 20, 1879.

l6o RHEUMATISM AND THE ANTI-RHEUMATICS.

eign matter into the system without serious injury.
Already men are beginning to trace kidney disease
to the too free use of iodide of potassium, as the
surgeons are finding out that carbolic acid poisons
patients as well as germs, and the aurists are
protesting against the injury done to the ears by
the wholesale quinine-giving now prevalent. That
salicylic acid and its salts are liable to similar re-
proaches is pretty well known. As early as 1877 it
had to be said that " in a considerable proportion of
cases they give rise to disagreeable symptoms, such
as vertigo, headache, tinnitus aurium, and deafness,
nausea and vomiting after every dose, profuse sweat-
ing, great weakness, and occasionally a peculiar
eruption on the skin. More rarely, the symptoms
assume a dangerous complexion, violent delirium,
albuminuria, great prostration, with pallid skin and
feeble pulse, ushering in fatal collapse." ' Since then,
necrosis (in a strumous ^child) of the bones of the
legs and forearm,^ hyper-pyrexia, and haematuria, are
among the disastrous effects observed from this acid.
Salicin is said to be exempt from these reproaches,
but if, as Senator maintains, it is transformed into
salicylic acid in the system, the mischievous agent is
still produced, and — though less manifestly — does
its injurious work.

I think, therefore, that on the whole we shall be
doing most justice to our acute rheumatic patients
if we resist the temptation to hush up their pain and

* Appendix to vol. xvi. of Ziemssen's Cyclo^cedia.

* Lancet f Oct. 27, 1877.

HOMCEOPATHIC TREATMENT. l6l

knock down their fever with salicin and its deriva-
tives. A man must make his choice : he cannot
have every advantage and escape every draw-back.
Under homoeopathic treatment his disease will sub-
side somewhat less rapidly, but no less surely ; and
he will run no risk of being poisoned during its
course, or unduly weakened when he arrives at con-
valescence. If our patients, knowing what as a gen-
eral thing homoeopathy can do in comparison with
ordinary treatment, on this ground seek our aid, we
may very well be content to treat them homoeopathi-
cally. I am sure that in the long run they will bene-
fit thereby ; and that we shall do better by studying
to give precision and effect to our own anti-rheu-
matics, than by hankering after the flesh-pots of
Egypt in the shape of the medication now under
review.

VIII.

RHEUMATISM AND THE ANTI-RHEUMATICS

{continued).

II. At our last meeting, after a review of the phe-
nomena and pathology of rheumatism, in its various
forms, we discussed a group of medicines related to
it as remedies, of which Bryonia was the leading
member, and Aconite, Colchicum, Pulsatilla and
Proi:)ylamine the subsidiaries. We shall begin to-
day with a second group, the type of which is to be
found in a plant very familiar to you in this country
— the R/ucs toxicodendron.

Some ten years ago, there appeared in England
a treatise entitled " Materia Medica and Therapeu-
tics. Vegetable Kingdom. By Charles D. F. Phil-
lips, M.D., F.R.C.S.E." The author was described
as *' Lecturer on Materia Medica at the Medical
School of the Westminster Hospital." On turning
over the pages of this volume (which has since been
reprinted over here) any one could see that it con-
tained a large amount of matter hitherto unfamiliar
in the old school ; and any one acquainted with ho-
moeopathic literature could recognise the source
162

RHUS. 163

from which the new matter had been derived. The
fact was that the writer had been an avowed practi-
tioner of homoeopathy in Manchester for twenty-
years ; but on coming to London found it suit his
views ostensibly to renounce his hitherto connexions.
It was nevertheless the special knowledge he had
acquired as a disciple of Hahnemann which enabled
him to get into metropolitan practice, to obtain his
appointment, and to write and publish his book.

I have made these remarks, because I am going to
quote Dr. Phillips' description of those pathogenetic
effects of Rhus which concern us in our present
study. "Rhus induces pains," he writes, ** appar-
ently of a rheumatic kind, and which are felt not
only in the limbs but in the body, though most es-
pecially about the joints. Pain and stiffness in the
lumbar region are often induced, and to these affec-
tions is often added a sense of numbness in the lower
extremities. The structures most powerfully affected
appear to be the fibrous ones. The pains in ques-
tion are accompanied by a very slight amount of
swelling ; and, singular to say, they become intensi-
fied by rest and warmth."

NowdFvhere did Dr. Phillips get these symptoms ?
His whole description of the effects of Rhus purports
to be taken from cases of poisoning by contact with
or emanations from it, — several instances of which,
he says, he has himself witnessed. But it is a curi-
ous fact that in none of the poisonings collated by
Allen (and he has spared no pains to include all on
record), whether from Rhus toxicodendron or from

164 RHEUMATISM AND THE ANTI-RHEUMATICS.

the venenata species, is there any mention of rheu-
matoid pains being felt. The whole stress of the
plant's influence here seems expended on the skin
and the cellular tissue. In the provings of Hahne-
mann and his associates, however, where the drug
was chiefly taken internally and in moderate doses
of the tincture, tearing pains, and especially sense of
stiffness and aching, in neck, back and extremities,
were frequently observed, with the absence of swell-
ing and the conditions of aggravation noted by Dr.
Phillips. The source of his information is obvious :
and what shall be said of his candour .' what shall be
thought of the reviewers who welcome such a vol-
ume and cast scorn on the authority it implicitly
recognises ?

We, happily, are under no such moratly-benumbing
influences, and can freely and openly use good knowl-
edge wherever we find it. That Rhus can cause
rheumatoid pain and stiffness we first learnt from
Hahnemann's pathogenesis of Rhus to.\icodendron ;
and we have had it confirmed by Dr. Joslin's proving
of Rhus radicans, and those of Kunze, Burt and
others made with Rhus venenata. In these last the
joints, as well as the fibrous tissues, were afWcted —
especially the knees, ankles, feet and hands ; but
there was here also no synovial effusion, as there
was with Bryonia and Pulsatilla. In all cases para-
lytic and numb sensations, with ready trembling, are
present.

The repute of Rhus as an anti-rheumatic is of
purely homoeopathic origin, though its remedial

RHUS. 165

power is now beginning to be discovered in the old
school, and even turned to account in our doses.
At what point this repute originated among us, I
cannot say; for Hahnemann makes no mention of
rheumatism in his preface or notes to the pathogen-
esis in the Materia Mcdica Pura, We have seen,
however, that his main indication for the drug in the
fever of 18 13, in which he so largely and success-
fully used it, was the presence of pains which were
wor^e at rest. This condition of aggravation of the
Rhus sufferings he mentions again with much empha-
sis in the preface referred to ; and the inference
was natural that in rheumatic pains so characterised
it would prove as useful as Bryonia had been in its
way. Obviously, therefore, it would find little place
in rheumatic fever, where the patient generally
dreads the slightest movement. Cases will occur,
however, in which — instead of this feature — rest-
lessness and constant desire to change the position
are present. Here Rhus will tell ; and also in Aco-
nite cases, after this drug has done all it can do, but
" wearing stiffness and aching in the neighbourhood
of the joints '* (Phillips) annoy the patient. In
chronic articular rheumatism it is the remedy for
Watson's second form, where there is " coldness and
stiffness of the joints," and friction and gentle
motion relieve. In association with d?y heat topi-
cally — as from hot bran, salt, or sand — it will
loosen many a stiffened and useless articulation. It
is especially valuable when this affection is chronic
from the outset, when the joints and fibres of persons

l66 RHEUMATISM AND THE ANTI-RHEUMATICS.

advanced in life begin to stiffen and ache, threaten-
ing complete and painful disablement. My own
father, when 73 years old, began to be so afflicted ;
but under the steady use of Rhus, in rare doses of
the higher dilutions, he lost all his troubles of this
kind, and lived to 85 without any return of them.
But its main sphere is found in the local fibrous
rheumatisms of which I have spoken — this name
being due to them from their almost constant origi-
nation in getting wet. It is this, as well as their
seat, which calls for Rhus as a remedy ; for another
point of distinction between it and Bryonia is that
the former (with — as we shall see — Dulcamara)
suits the effects of damp,* the latter (with Aconite)
those of dry cold. It was for this reason that, in
speaking of Bryonia as remedial in the effects of
east winds, I explained that I meant those of my
own country. Those which reach you here in Bos-
ton must bring plenty of Atlantic moisture with
them, and their effects will probably call for Rhus.

Well, then : for rheumatic pain and stiffness trace-
able to damp and increased by it, in tendons, fasciae,
ligaments, Rhus is specific. You cannot better
impress this action of it upon your minds than by
reading a series of cases by one of the early homoe-
opathists, Dr. Bolle, of Dresden, which you will find

* Dr. Hoyne {Clinical TherafettlicSy I., 128) quotes a case of pleurodynia
supposed to depend on cardiac disease. It refused to respond to remedies
until traced to a wetting, when Rhus rapidly disposed of it. This may be
compared with a similar case related by Teste {Mat. Med.y sub voce Aco-
nitum), where exposure to dry cold winds on the Russian plains was found to
have been the exciting cause, and Aconite proved quite as effective.

RHUS. 167

translated from their German original in the twenty-
fifth volume of the British youriial of Homoeopathy.
His conclusions are that Rhus answers to affections,
occurring chiefly in men of strong fibre, occasioned
by taking cold from wetting when the body was in
a state of perspiration and excitement, but also when
no such mental or physical strain had preceded ;
characterised by tension, lameness and stiffness, by
tearing, drawing, bruise- and sprain- like pain in
shoulders, wrist-joint, back, and vastus, and in the
hips, and not unfrequently from those down the
thighs to the feet, with occasional sensation of numb-
ness. The pains had the usual aggravations and
ameliorations, among the latter being dry heat.

With regard to the localities specified by Dr.
Bolle, I would mention that you will often read or
hear of lumbago and sciatica being relieved by Rhus,
although it has no action on muscle or nerve. I
believe it is the lumbar fascia in the first instance,
the fibrous sheath of the sciatic in the other, which
is the seat of the malady ; and here of course Rhus
is quite at home. It is thus well indicated when
lumbago and sciatica occur together — the whole
fibrous tract being affected. I would also remind
you, before leaving this drug, that the indication
"relieved by motion" is not so absolute as that of
"worse at rest." I mean that the patient's first
movement, after repose, may be painful enough : but
he improves as he goes on, while the Bryonia sub-
ject gets worse the longer the motion continues.

The analogues of Rhus in relation to rheumatism
are Dulcamara and Rhododendron.

l68 RHEUMATISM AND THE ANTI-RHEUMATICS.

I. Dulcamara has, since Carr^re recommended it,
found no little employment as an anti-rheumatic ;
though it has now pretty well died out of use, and
Dr. Harley's experiments with it — which seemed to
shew it totally inert — will not favour its revival.
Its use among ourselves is not, I think, lineally
traceable to that which it enjoyed in the old school.
It has rather grown out of a phenomenon noticed by
Carr^re in some of the patients taking it, viz. : that
they were liable to twitching of the eyelids and lips,
and slight convulsive movements of the hands, but
only wJien exposed to cold, damp weather, while exter-
nal warmth readily removed the symptoms. It was
a necessary inference that Dulcamara would be ho-
moeopathically indicated for other affections owning
such causation ; and if so then certainly for some
forms of rheumatism. The inference was further
supported by a considerable array of rheumatoid
pains in Hahnemann's pathogenesis of the drug, and
it has been warranted by experience. The following
case, from the Etudes Therapeutiques of the late Dr.
Petroz, will illustrate its sphere of action :

" A young woman, of a delicate complexion, her skin white,
fine, almost transparent, inhabited a room situated low down,
where the temperature in summer differed from that of out-
doors at least ten degrees " (centigrade).

" In 1833, during the hot season, every time that after mod-
erate exercise she returned to her apartment, she felt an im-
pression which, at first agreeable, finished by being unpleasant.
One day she complained of heaviness in the head, with a feel-
ing of stupidity ; she had, at the end of the day, shaking in her
limbs, some shooting pains in different parts, an extreme fatigue ;

DULCAMAl

169

during the night wakefulness, or an agitated sleep, awaking wiih
fright, dry heat of skin, ebullitions of blood.

" The next day, besides the preceding symptoms, pulse hard,
contracted, no; slight swelling of the articulations of the wrist
— carpus and metacarpus ; sharp pain caused by the least move-
ment; sensation of cold while resting; the articulations of the
feel «

n the s:

"In the morning, at g. Dulcamara 24, three globules. At
noon some painful drawings were felt in the tegs. At two a.
general perspiration took place, without increase of heat, and
lasted all the night, which was more calm.

"The third day the skin was in its normal state; the pulse
was 88 ; touching and movement caused much less pain in the
affected joints. The improvement made progress.

" On the fourth day the patient was near convalescence,
when in the evening she felt violent shooting pains in the right
forearm and wrist, in the right thigh and knee ; there was wake-
fulness and agitation.

"The morning of the fifth day: — frequency, hardness of
pulse; sharp pains in the articulations of the superior and in-
ferior extremities on the right side. The analogy of these symp-
toms with the effects of Dulcamara was too evident not to lead
one to recur to that medicine : it was given in the same dose.
At the end of two hours the skin became moist : the fever was
soon calmed ; the pains decreased progressively, in such a man-
ner as to render movement possible.

" On the seventh day all pains had ceased, and since that
time the health has not been altered."

This is a fair case of incipient rheumatic fever
nipped in the bitd by Diilcamara {which, I should
say, is not without febrigenic power) ; and it is pos-
sible that, had the dose been occasionally repeated
after the first, the recurrence of the fifth day might
not have taken place. You will see that quite a high

170 RHEUMATISM AND THE ANTI-RHEUMATICS.

dilution was sufficient : it is so, in my experience,
with this medicine, and also with Rhus, when either
is indicated. You will see also that the Dulcamara
pains have not the relation to rest and motion of
those of Rhus ; and that the local affection is more
synovial. They correspond in their sub-acute char-
acter, and in their exciting cause.

2. RliododcndroUy the Siberian rose, has a high
native reputation for gout and rheumatism. Its
proving by some of the earlier disciples of Hahne-
mann excited sufficient pains in the muscular and
fibrous tissues to shew that it was homoeopathic to
rheumatic affections of these parts, and it has been
used accordingly with much success in homoeopathic
practice, — here also the attenuations given having
been mostly those from the 12th to the 30th. Rheu-
matism of the cervical and thoracic muscles, and
rheumatic neuralgia of the extremities — arms and
legs, figure most largely among the cases affixed to
the pathogenesis, as originally published in Stapf's
Biitnigc. More lately it has acquired much repute
for " rheumatic face-ache," i.e. pain about the cheek
and jaws induced by a draught. The Rhododendron
pains arc like those of Rhus, in that they are worse
at rest ; but they are relieved at once by movement.
As the /inbitiit of the plant suggests, they have no
special relation to damp ; and they do not indeed re-
cjuiro cold for their exciting cause, though they might
have it ahundantlv there. It is the electric condi-
lion of the atmosphere to which they are especially
soi^silivo; and when you get the feature ** worse

KALMIA. 171

before a storm," you may always think of Rhodo-
dendron.

I am inclined to believe that Rhododendron actu-
ally affects the nerve-substance itself. At any rate,
its relation to rheumatism in the face and extremities
leads me to hang on to it, as a sub-class, two drugs
mainly efficient in the same direction, Kalmia and
Spigelia.

a. In his interesting preface to the proving of
Kalmia in the first volume of the Transactions of
the American Institute, the late Constantine Hering
connects the plant with Rhododendron and with
another anti-rheumatic which will shortly come before
us, the Ledum palustre. ** Rhododendron '* he writes
"thrives in the region of storms and mountains,
and Ledum draws its nourishment from the ponds
of elevated regions, while Kalmia flourishes in the
mists arising from the valleys. All these inhabit
northern climates. They correspond to the great
family of diseases which we comprise under the col-
lective names of rheumatism and gout ; particularly
to that class which belongs to the north, and which
is decidedly distinct from that of the south, and of
the tropics.*' It caused rheumatoid pains in abun-
dance in those who experimented with it. Dr. Bayes
used to esteem it highly in the rheumatic face-ache
of which I have just spoken, and Mr. Clifton con-
firms his estimate from his own experience, adding
that the pain is generally on the right side, and
often goes down the arm, while brachialgia itself of
similar origin will often yield to it. Kalmia affects

RHEUMATISM AND THE ANTI-RHEUMATICS,

the heart much as Digitalis does, especially slowing
its beat ; and the affinity may be utilised when rheu-
matism attacks this organ. We should expect most
from it when the heart simply becomes the seat of
rheumatic pain, without inflammation of the organ
being set up ; but Dr. Dunham relates a case of
endocarditis so completely cured by it that no valvu-
lar murmur remained.

b. Spigelia has a still more decisive action on the
nerves and heart, and also on the eye. In the last-
named organ the painful character of the inflamma-
tion induced in Hahnemann's provers suggests the
"sclerotica and iris as the parts affected, though the
symptoms are not described with sufficient clearness
to make a diagnosis possible. We may certainly
I say, however, that it is "rheumatic ophthalmia"

which the drug causes, and may extend a similar

(conception to its influence on the heart, which is
denoted by great pressure on the chest, shooting
pains through it and down the left arm, and violent
palpitations. Its neuralgia must not be limited to
the rheumatic kind, as it is genuine and wide-reach-
ing; but in practice an origin of this nature has
I always been found a strong indication for it. Its face-

pains are sharper and more shooting than those of
Rhododendron and Kalmia, and — unlike the latter

y— affect rather the left side.
In the eyes and heart, moreover, we must not limit
Spigelia to rheumatic affections. Ciliary neuralgia
of every kind, and angina pectoris when a pure neu-
rosis, come within its range. But the infiainmations

CIMICIFL-GA. 173

it controls in these organs are undoubtedly those of
rheumatic origin. The painful, straight-lined and
\ crimson-hued injection of the eye-balls which we

used to call "sclerotitis" yields rapidly to it, after
Aconite ; and it stands faciU princeps among our
remedies for pericarditis and endocarditis rheumat-
ica. That Fleischinann should have relied upon it
I year after year at the Giimpendorf Hospital in

I Vienna for the cardiac complications of acute rheu-

matism, and should have been able to report 57 suc-
cessive cases with oniy one death, is proof sufficient
of its efficacy.

Ill, I have now to speak of a group of medicines

whose seat and kind of action are "rheumatic," but

which are purely local in their influence. Rhodo-

■ dendron is the link which connects them with the

1 more generally-acting drugs we have left behind us ;

, but their own type is Actasa, or — as you seem here

! to have determined to call it — Cimicifuga race-

mosa.

That Cimicifuga causes pains in various parts of
' the body, and the.se often of some severity, no one

can doubt who reads its pathogenesis. That these
are — to some e-xtent, at least — of rheumatic nature
appears from the interpretation which practice has
given them. The drug is praised by all in acute
, muscular rheumatisms, as pleurodynia, lumbago and

I torticollis — the first-named having been experienced

. more than once by one of the provers. The differ-

ential features of its action here — as compared
with that of Aconite and Brycnia^aro hardly yet

1/4 RHEUMATISM AND THE ANTI-RHEUMATICS.

established. For its influence on local articiila:
rheumatisms, however, we have such indications fron
an unusual source, viz. : from Dr. Ringer. It ij
useful, he says, in rheumatoid arthritis, and in joint
inflammations resembling gonorrhceal rheumatism
but without any history of gonorrhoea, when th<
pains are worse at night and in wet or wind]
weather. The "uterine origin*' which he require:
for the former, if the drug is to act well, reminds ui
of Pulsatilla ; and leads me to say that when paii
and irritability of the womb, whether at the monthb
period or otherwise, appear to be traceable to rheu
matic influences, Cimicifuga is a great remedy fo:
them. I know that present-day pathology woulc
smile at such a conception ; but it was entertainec
on sound data by men like Gooch and Dewees ir
the past, and I think we should lose therapeutically
by abandoning it. That another hollow muscle, th<
heart, can be rheumatic is less disputed ; and whei
it is so, its painfulness being less acute than witl
Spigelia, Cimicifuga gives it great help.

There are four remedies which hang on to Cimi
cifuga in its relation to local articular rheumatisms.

1. Its closest ally is Cmdophyllum^ whose uterine
action is pretty well identical with it. Now thii
plant, when proved by Dr. Burt, developed in hin
pretty sharp pains in the small joints, and those o
the fingers were stiff and red. It has thereupoi
been used with good effect in inflammatory rheuma
tism of the hands, and among its employers is Dr
Ludlam, who has noted its action as being mon
prompt in women than in men so affected.

LEDUM, RUTA, VIOLA ODORATA. 1/5

2. Ledum is one of the old Hahnemannian medi-
cines. Its proving developed marked pain in many
of the joints, and the ankles and feet appear as ac-
tually swollen under its use. It is perhaps better
suited to gout than to rheumatism ; but Pflange, one
of the Rademacherian school in Germany, reports
two good cases of chronic rheumatism of the hip-
joint cured by it. Hahnemann's dictum, that Ledum
will prove suitable only in chronic maladies charac-
terised by coldness and deficiency of animal heat,
points to the non-inflammatory type of rheumatism
as its sphere, like Rhus, and like my next medicine,

3. Ricta, This, too, causes marked pain in the
joints, but goes beyond Ledum (which has shewn
some power of the kind) in involving also the neigh-
bouring bones, probably acting on the periosteum. It
is thus, with the drugs of the Mercurius group to
which I shall immediately come, suited to the form
of rheumatism known as "periosteal ;*' but is some-
times efficacious in the ordinary kind when affecting
the wrist, for which I think it has a special affinity.
You will not forget the uterine influence of this
medicine also.

* 4. Last of our present group in the violet —
Viola odorata. In the slight pathogenesis of this
plant which we have in the Archivy furnished by
Hahnemann, Gross, and Stapf, two of the few symp-
toms of the extremities are ** pressing pain in the
right wrist" and ** drawing pain in the right elbow."
Petroz seems from this slight indication to have been
led to employ it, and Teste says with success, in vari-

^^^V 176 RHEUMATISM AND THE ANTI- RHEUMATICS.

^^^H ous rheumatic affections of the upper limbs. Tes-
^^^H sier then took it up, and pubHshed in the Gazette
^^^B Hommopathique de Paris several cases of inflanima-
^^^^ tory rheumatism which rapidly recovered under this
r medicine in the 12th dilution. In all the ritjht side

L alone was affected, and the wristjoint was always

^^^H the first to experience amelioration. Dr. Kitchen,
^^^H of Philadelphia, translating these cases for an Ameri-
^^^H can journal, adds three of his own, in which cure at
^^^H least as rapid occurred under the ist dihition. In
^^^H one the affection was limited to the right side, but
^^^F in the other two it was bilateral ; and here the curi-
I ous feature appeared, that the left wrist seemed

j entirely insensible to the action of the remedy, so

L that it remained painful and swollen for some days

!' after its fellow had got well, and compelled resort to

* other medicines.'

IV. My next group of anti-rheumatics is a some-
what peculiar one. It consists of three members
only, and its type is Mcrcnrius.
! In the last edition of my Pharmacodynamics I have

spoken (as previously) of the well-known "mercurial
' rheumatism," and have suggested that this is mainly

a periostitis. But 1 have also called attention to the
I profuse and odorous sweats giving no relief, which

characterise rheumatic fever, and which — when oc-
curring otherwise — are always indicative of the
I remedy ; and also to the sallow and red tint of the

I face, with oily perspiration, which Dr. Anstie has

f- remarked as frequently premonitory of it, and which

1 ' S« BrU. Jaarn. of Horn., XXIV., 314.

MT^RCURrUS. 177

no less plainly suggests mercurial prep:irations. I
have accordingly recommendeci Mercurius to be given
in sub-acute forms of the disease, readily relapsing,
where the pains {unlike those of Pulsatilla) do not
shift about much, and are markedly worse at night
— the patient being very sensitive to cold.

I do not think, howeveri that we must lay too
much stress on these symptomatic resemblances, so
as to depend on Mercurius in rheumatic polyarthritis.
Its fever {which no one has described more graphi-
cally than Hahnemann') is very unlike the rheumatic,
as contrasted with which also it has diminution in-
stead of excess of fibrin in the blood. On the other
hand, it shews undoubted power of locally inflaming
the joints. From Huber's very exhaustive treatise
on " Mercury and its preparations," now in the course
of appearing as a supplement to the North Auieriam
yournal of Homeopathy, I extract the following.
"Dietrich thus describes the mercurial arthritis : A
slight stitching, pressing pain in the joints sets in ;
the joint swells up and becomes of a pink or dark
red color. This redness disappears on pressure,
but returns immediately. The swelling is neither
hard nor doughy, and feels hot to the touch. When
at rest and at a low temperature the pain is moder-
ate ; but becomes more severe during motion and in
the heat of the bed (especially from Merc. corr.).
It may end in caries or anchylosis. Wilhelm,
Handschuh, Warbeck de Chateau and Stokes also
speak of a mercurial rheumatism, attacking the knee

■ See PhMrma.iJynamtct, p. 626.

178 RHEUMATISM AND THE ANTI-RHEUMATICS.

and shoulder joint, more rarely the hip-joint, elbow
and carpus ; sometimes in the form of an acute rheu-
matism, leading to hydrarthrosis or to suppuration
of the joint. Richter ascribes especially to the cor-
rosivus the power of causing rheumatitis ; and Kuss-
maul acknowledges that painfulness of the joints
is frequently observed in workers in mercury, but
denies that inflammation or exudation in the joints
follows such occupation. Lendrick, on the contrary,
observed, in consequence of the abuse of mercury,
swelling of the joint with considerable exudation in
its cavity."

Such facts go to warrant the recommendation of
Mercury I have made in my Therapeutics^ viz. : that
it should be given when the inflammation is obsti-
nate in any one joint. They would also suggest it
in a form of acute articular rheumatism which has
not yet come before us — the gonorrhoeal. And this
leads on to another ** rheumatic '* application of our
drug. You may be aware that there are some per-
sons who never contract gonorrhoea without getting,
not rheumatism only, but also iritis, (This is quite
different from the ordinary " gonorrhoeal ophthalmia,"
which is due to some of the virulent matter coming
in contact with the conjunctiva, to which membrane
it is limited, and which attacks one eye only.) Now
the association of Mercury with iritis is quite tradi-
tional, and has descended without break of continuity
into homoeopathic practice. In a paper which you
will find in the tenth volume of the Annals of the
British Homoeopathic Society I have examined into

MERCURIUS.

the matter, I have shewn that the common idea
that iritis is reatiily caused by Mercury is quite
unfounded, — the two authorities usually cited in
favour of it, Graves and Travers, both recognising
in their cases the presence of two other factors of
much greater importance, syphilis, and cold and
damp; while it has never been observed among the
workers in the metal. A single exception made by
Travers to his statement that all his patients were
syphilitics, and an observation of Basedow's in which
an "iritis mercurialis" appeared in a patient being
treated with the drug for hepatitis, were the sole
evidence I could find of the possibility of the dis-
ease being induced by it. Considering, then, the
plastic nature of syphilitic iritis, and the necessity
recognised by the most careful oculists for inducing
to some extent the physiological effects of the drug
if it is to overcome it, I was forced to the conclusion
that it was not horaceopathic thereto. Its reputation
in our school was due, I thought, to its power over
rheumatic iritis, especially when of serous character,
and this variety of the affection it might have cau.sed.
I wrote all this before Ruber's essay had reached
the section on iritis. I find here the usual assump-
tions made, which analysis readily resolves ; but a
few fresh facts are contributed. "Many authors"
we are told " such as Hunter, Bele, Scarpa, Pearson,
Ammon, Werklin, Travers, M. J<Eger and many
others, do not admit the existence of syphilitic iritis,
but ascribe the same to the effects of mercury."
They may have been of this opinion, but if it rested

.^_J

l80 RHEUMATISM AND THE ANTI-RHEUMATICS.

on no better foundation than in Travers* case, their
authority is of little value. If, moreover, supposed
syphilitic iritis were really of mercurial origin, why
did they all treat it with Mercury ? The therapeutic
evidence adduced by Huber goes against his thesis,
as his two clinicians of most weight — Kafka and
Payr — find it necessary, in the syphilitic form of
the malady, to resort to mercurial inunction, as did
Dr. Dudgeon in a case referred to in my paper. But
three fresh observations, besides Basedow's, are given,
which strengthen the evidence for the homoeopathicity
of the drug to some form at least of the disease.
One is rather slight: — ** Cooper, while administer-
ing mercury in a scrofulous affection, observed the
development of iritis." I do not know what Cooper
this may be, nor where his observation is recorded ;
so must let it pass quant nvi valeat. The second is
taken from von Ammon's Zeitschrift fur Opkthal-
inologie : ** In a man and a woman who had taken sub-
limate for chancre, but were not salivated, there
appeared inflammation of the right eye, which in-
volved not only the posterior surface of the cornea,
but also the serous covering of the iris. The pupil
was angular ; the eye very painful, as if too small ;
all the sensations aggravated in bed." Here the
patients had chancre, which might have been syphi-
litic ; but on the other hand the iritis was serous
only, which makes against such an origin. Thirdly,
the "case of Werklin " is mentioned, but no refer-
ence given to it. Dr. Huber states that in this "iritis
appeared together with gummy tumours in a patient

MKRCUKIUS. t8l

who never had syphiUs, and who took calomel with
opium for facial rheumatism. In the list of enumer- i
ated symptoms" he goes on "wc find injected state
of the vessels; pressing, burning pain in the eye;
photophobia; induration of the iris; irregular shape '
of the pupil, and hypopion ; there was violent burn-
ing pain in the supra-orbital region of the forehead;
the sight was nearly gone." As against the sugges-
tion that the iritis, like the face-ache, might have
been rheumatic, he advances the more intense char-
acter and more rapid course of that form of the dis-
ease.

While, then, we want more evidence, and I must
still sum up as against the homceopathicity of Mer-
cury to syphilitic iritis, I think that the case is
strengthened in favour of its having power to cause
this infiammation in some shape ; and I should think
the rheumatic variety of iritis — i.e. that which oc-
curs from cold and damp, or in connexion with gonor-
rhceal rheumatism — the best suited to it, and the
corrosive sublimate the best form in which it can be
given.

I have dwelt somewhat long on this point, but it
is one of importance, and it illustrates the mode of
analytical and critical study of drug-action which you
may often find it advantageous to follow. Merely
saying, in passing, that in what may be called "peri-
osteal rheumatism" — such face-ache, e.g., as results
from draughts of cold and damp air. Mercury —
again best as corrosive sublimate — is very effective,
I pass on to its analogues, which arc Kali bichromi-
cum and Phytolacca.

1 82 RHEUMATISM AND THE ANTI-RHEUMATICS.

I. Of Dr. Drysdale's provings and presentation of
Kali bichromiann I do not like to say too much, as
Dr. Samuel Jones — who is a humourist — says that
it is the only egg of the kind we British have ever
laid, and that we never cease to cackle over it. Well :
it is not quite the only one, and it is a good one ;
but I mention it now (not to cackle, but) just to say
that a revised edition of it is on the point of appear-
ing (with the Aconite and Crotalus of which I have
already spoken), and that, among other things, it will
shew a striking confirmation — from an old-school
source — of the recommendation of the drug in
syphilis which Dr. Drysdale made on the strength of
its pathogenesis in 1852. It is just in the tissues
liable to be affected by both rheumatism and syphilis
— the periosteum and the iris — that the chief part
of Kali bichromicum as an anti-rheumatic is played.
On the periosteum it really exerts a very marked
influence, — manifested not only by pain at certain
spots in the membrane, but by the characteristic
hard swellings of sub-periosteal effusion. These
were seen in the provers on the parietal and maxil-
lary bones, and on the tibia (§§ 136, 499, 1450 of
Allen). Marked tearing pains were also experienced,
especially about the joints, pointing to a similar affec-
tion of the other fibrous tissues ; and one of the
Austrian provers, who took the second trituration,
had *' several bright red spots and streaks on the
white of the left eve," which looks like sclerotic
injection.

Kali bichromicum vies (to say the least) with Mer-

PHYTOLACCA, ARSENrC. 1S3

curius in rheumatic ophthalmia: it is especially suita-
ble to the form known as "catarrho ■rheumatic,"
where the conjunctiva cornea; is involved. Its action
on fibrous tissue has led to its successful use in a
number of local rheumatisms, of th^ chronic and
"cold" variety. In Dr. Drysdale's arrangement of
it you will find cases of lumbago and sciatica, of
rheumatic headache, and of periostitis, which have
been very satisfactorily cured by it. In the first-
named, as with Rhus, I should think the lumbar
fascia and the sheath of the nerve the seat of the
mischief.

2. It was in affections of these parts that the
power of Phytolacca as an anti-rheumatic first ap-
peared ; and a recent case of overdosing by it has
shewn a power on its part of causing periostitis of
the face and forehead. The accompanying symp-
toms in this case suggested syphilis rather than
rheumatism ; so here again we have a drug belong-
ing to the borderland between these two diseases.
Its differential indications have not yet been estab-
lished.

V. The power of Anenic to inflame the serous
membranes might have been anticipated to extend to
their synovial analogues ; and the conclusion has
been substantiated by facts. Dr. Imbert Gourbeyre,
who has made Arsenic an almost life-long study, and
to whom we owe so much knowledge regarding it,
has studied this branch of its action in his "Suites
de I'Empoisonnement Arsenical" lately {1880} pub-
lished in VArt MMical. The articular affections of

I-RIIEUMATICS.

the drug are seen chiefly during convalescence from
acute poisoning by it. They chiefly consist of pains ;
but in several cases swelling has been observed, and
in one at least there was "an intense arthritis of all
the large joints." Dr. Gourbeyre has himself seen
a general articular rheumatism supervene on the
administration of Fowler's solution for eczema; and
that it was due to the medicine appeared from its
recurrence, a year after, on similar treatment being
attempted.

Such facts are not unfamiliar to the ordinary
works on to.vicology, but they have not prevented
old-school physicians from treating chronic articular
affections with Arsenic. Phillips cites Haygarth,
Bardslcy, Christison, Begbie and Fuller (to whom I
may add Etliotson) as warranting its efficacy ; and
adds — "I quite agree that the remedy promises well
in cases where the vital powers are diminished, and
the ends of the bones, the periosteum, capsules, and
ligaments are swollen ; under the continued use of
the drug I have known the joints return to their
natural size." The source of this experience would
lead us, in endeavouring to reproduce it, to use the
drug in the form of the liquor arsenicalis.

I, I have placed Acidmn laclicnm under Arsenic,
because I cannot think that its remarkable power
of inflaming the joints — as observed by Foster —
should remain without utilisation. It cannot be
employed in rheumatic fever, because there in all
probability it is the materies morbi ; but in some
sufa-acute local inflammations of joints, from rheu-

matic causes, it should prove very effective. The
articulations al?ected in his cases were, I should say,
those of the knees, elbows, wrists and hands ; and
they were red, hot, and swollen, as well as painful.

VI. Of Sulphur, which as an anti-rheumatic stands
by itself, I have only to remind you of what 1 have
written about it in my Phannacodynamics. The rep-
utation it enjoys among the common people for their
"rheumatics," carried in their pockets, put under
their pillows, or dusted within their stockings, is
echoed more scientifically but not more convincingly
by the experience gained at sulphureous springs,
such as those of the Pyrenees. Its homceopathicity
is suggested by the minute dosage thus involved ;
and is confirmed by the Austrian provings, where
rheumatoid pains were very frequent, and one experi-
menter, being sceptical as to its influence, tested
it by alternately omitting and resuming the drug,
when he found his pains invariably shewing a corre-
sponding decline or increase. At the same time
you will notice that the dcsage, though minute, is
hardly infinitesimal. Sulphur is not an "anti-
psoric" here, and acts better (I think) in the second
trituration originally recommended by Hahnemann
than in his later 30th,

Such, ladies and gentlemen, is our treasury of
anti-rheumatics, and I think we may feel rich alike
in their number, in the precision of their indications,
and in their tried worth. By our comparative sur-
vey of these and of the anti-pyretics we have, I

1 86 RHEUMATISM AND THE ANTI-RHEUMATICS.

hope, gained some positive knowledge; while we
have also learned lessons as to one mode of study-
ing Materia Medica. Our week has been occupied
with preparation for two of the oldest and common-
est tasks of practical medicine, — the subdual of
fever, the relief of rheumatism. "To-naorrow" —
or rather on Monday —

** To fresh woods and pastures new."

CEREBRAL LOCALISATION AND DRUG ACTION.

The field into which I have now to ask you to
follow me is somewhat different from that which we
have hitherto been surveying. In fever and rheuma-
tism we have taken forms of disease as the sphere of
action of groups of drugs ; and the light which has
illuminated the phenomena we have studied has been
that of pathology. It is now rather an anatomical
region which will constitute our base of unity ; and,
though pathology will play her part farther on, the
lamp we shall take with us all the way will he that
which is lighted by physiology. We have to view
the last and crowning discovery of this science in
regard to the functions of the nervous system, and
to see how far our pharmacology can fit in with it,
and make it fruitful for therapeutic ends.

I say that cerebral localisation is the crown of a
long series of researches into the functions of the
nervous system, and localisation has been the key-
note of all previous attainment in this field. The
first rough survey divided the whole into brain, spinal
cord, and nerves, of which the second was consid-

CEREBRAL LOCALISATION.

i the

I isst

ered simply a bundle of nerves proceeding from the
first, and emerging as the third to be channels along
which the "animal spirits," generated in the brain,
passed into the frame. The first step in differen-
tiation was to recognise the spinal cord as an inde-
pendent centre : this was done, from physiological
and pathological considerations, by Whytt, Unzer,
and Prochaska in the last century, but finally estab-
lished on anatomical grounds by Gall at the begin-
ning of the present. Then came the epoch-making
discovery of Sir Charles Bell (181 1), that the anterior
and posterior roots of the spinal nerves subserved
different purposes, the former being exclusively
motor and efferent, the latter sensitive and afferent.
As the situation of these roots corresponded, roughly,
to a division of the cord into anterior and posterior
cohimns, this was made ; and the former were con-
sidered as conveying motor impulses from the brain,
the latter sensory impressions to it. Then, when
Marshall Hall's researches and writings had revived
the notion of the reflex function of the cord, first
broached by the physiologists of the last century
whose names I have mentioned, its central gray
matter was supposed to be the seat of such autonomy
as it enjoyed. The brain — the contents of the
cranium — next received partition. As the posterior
columns of the cord, through the restiform bodies
of the medulla oblongata, terminated in the cere-
bellum, this seemed to be the sensory centre; while
the cerebrum was that in which ideas and emotions
issued in volitions, which passed through the crura

£M.

SENSATION AND VOLUNTARY MOTION. ISq

cerebri, the anterior pyramids and corresponding
columns of the cord through the motor nerves to
the muscles.

So, speaking generally, things were understood
during the first decades of the present century. The
last fifty years, however, have seen a rapid and steady
progress, which, while substantiating some of these
notions, has revolutionised others, and has pre-
pared the way for the final conception which it is
my present object to elucidate.

The first thing done was the disengagement of the
cerebellum and its spinal connexions from all share
in sensation and voluntary motion. Flourens found
by experiment that its gradual destruction by slicing
had no effect on sensibility or on the power of the
limbs, but that the faculty of harmonious movement,
such as that required for standing, walking, leaping,
and so forth, was iost. He accordingly propounded
the view that the cerebellum was the organ of co-or-
dination of muscular motion. Todd, following him,
maintained that the posterior columns and restiform
bodies were not channels of sensory impressions, but
the medium, whereby the cerebellar influence was
conveyed to the parts specially needing it — the
lower extremities. In support of this view he
pointed out that the columns in question were uni-
form in size throughout the cord until its termination
in the lumbar enlargement and cauda equina; and
that disease in any part of their course caused just
such derangement of harmonised motion as the
hypothesis required.

igO CEREBRAL LOCALISATION.

Now the facts adduced by Fluurens and Todd have
never been disputed ; but their theory, though reign-
ing for a time, has always been beset with difficulties.
The phenomena of disease of the cerebellum have
not lent themselves to it : section of the posterior
columns, through which alone the cerebellum can
communicate with the lower limbs, has been found
to produce no impairment in their motorial power,
simple or harmonised ; and, lastly, obser\'ations which
I shall hereafter bring before you have shewn that
the path of nervous influence along these columns
and their restiform continuations is not from above
downwards, as the theory would require, but the re-
verse — not "pcriphcrad," as the electricians say,
but "ccntrad," Another hypothesis was required
which should embrace these facts as well as those
previously ascertained ; and it has been supplied by
Dr. Ferrier. He maintains the cerebellum to be the
centre of equilibration, the seat of association of
those combined impressions and movements which
result in the preservation of balance under all cir-
cumstances. The impressions which convey the
sense of need of adjustment come through three
channels — the eye and optic tracts, the semicircu-
lar canals of the internal ear with their afferent
nerves, and the paths of tactile sensibility. In these
last the posterior columns find their place, and the
old conception of their function is somewhat reha-
bilitated. For, though it is not along them that
peripheral impressions travel to become conscious
sensations, they do transmit from below upwards those

EQUILIBRATION. IQI

tactile changes in the soles of the feet during stand-
ing or walking which have so much to do with our
due balance. This is well seen in the disease called
locomotor ataxy, in which they arc extensively af-
fected with sclerosis ; where walking is effected by
a series of jerks, and where, if the optical aid to
equilibrium is removed by closing the eyes, the pa-
tient immediately feels as if he would fall and has to
grasp at some support. The effect of these visual
impressions ordinarily only comes thus in aid of the
others ; but it is strikingly seen when perverted by pa-
ralysis of some of the ocular muscles, whether in dis-
ease or from the action of certain drugs, as Gelsemium
and Conium. The part played in equilibration by the
semicircular canals was ascertained experimentally
by Flourcns, and has been confirmed pathologically by
the phenomena of Meniere's disease. It is through
the fibres of the auditory nerve, of course, that their
influence is conveyed ; but in its perversion there is
no necessary impairment of hearing, as there is none
of vision in the corresponding ocular derangement.
Well : the cerebellum being connected with all these
central paths, and receiving their impressions, trans-
mits them pcripherad through the motor paths, with
which it is equally connected by means of its niiddSe
peduncles. Here they are transformed into such
movements as are requisite to preserve or restore the
balance. Through its superior peduncles, moreover,
the cerebellum is connected with the cerebrum, the
seat of consciousness ; and here loss of balance finds
its subjective complement in vertigo, the sense of
giddiness.

192

CF.RKrRAI- LOCALTSA

I have only been able to give you a brief outline
of these interesting facts, of which however you
have probably heard something from your teachers.
But I would strongly advise you to study the fourth
and sixth chapters of Dr. Ferrier's "Functions of
the Brain," in which you will find the whole matter
fully discussed. His conclusion is that "the cere-
bellum would seem to be a complex arrangement of
individually differentiated centres, which in associ-
ated action regulate the various muscular adjustments
necessary to maintain equilibrium of the body ; each
tendency to the displacement of the equilibrium
round a horizontal, vertical or intermediate axis, act-
ing as a stimulus to the special centre which calls
into play the antagonistic or compensatory action."
Accepting this, we may put out of view the cere-
bellum and its spinal connexions in proceeding up-
wards to our goal — the cerebral convolutions.

The next great advance in spinal localisation was
made by one in whom America has at least half a
share — Dr. Brown-Scquard. By his experiments
on the cord, and observations of its diseases and
injuries, he has proved that the conductors of sensi-
tive impressions to the brain run in the gray matter,
while — as was always believed — those which con-
vey motor impulses from it occupy (only to a limited
extent, however, as we shall see) the ant ero -lateral
white columns. He has also ascertained, moreover,
that while the motor tracts cross over to the oppo-
site side — as you know — in the medulla oblongata,
the sensory fibres make their decussation almost im-

^^H and ce
^^^H.«f equ:

mediately upon their entrance into the gray matter.
Disease or injury, therefore, Hmited to one lateral
half of the cord, will cause paralysis of the same
side of the body, but antesthesia of the opposite.
Above the medulla oblongata the cross-action is
complete, so that each crus cerebri which emerges
from the pons Varolii represents the motor and sen-
sory functions of the opposite half of the body.

And here again we have to localise. The crura
cerebri are separable into two divisions — the upper
portion, or tegmentum, and the lower, or pes. In
the upper, it is ascertained, run the sensory fibres;
in the lower, the motor. The tegmentum has at its
termination the ganglionic mass called the optic
thalamus, the pes has the corresponding corpus
striatum, which thus, like capitals of columns, crown
the sensory and motor tracts of the cranio-spinal
axis. Being closely connected, they form the double
key-stone of an arch along which impressions may
be converted into movements without the interven-
tion of the higher centres. They stand thus in the
second of the five circuits which such currents can
traverse. The lowest is constituted by those ac-
tions specially called "reflex " which have the spinal
cord for their centre, and which are seen even when
this is cut off from all communication from above.
The next appears in the automatic functions of the
medulla oblongata — sucking, swallowing, respira-
tion &c. The third belongs to the mesencephalon
and cerebellum : it is illustrated by the mechanism
■■of equilibration, as it has just come before us. The

jA.

CEREBRAL LOCALISATION.

second, as I have said, we have here ; and the first
and highest is that channel for actions requiring
conscious discrimination and voluntary effort which
we are about to consider.

For the basal ganglia — the corpora striata and
thalamt optici — are not, as you know, the topmost
of the nervous centres. From them again radiates
a blended sheaf of white nerve-fibres, that terminate
in the cells constituting the gray matter of the cere-
bral hemispheres, which underlies the whole vault o£
the cranium from forehead to occiput. It has always
been recognised that this is the seat of conscious-
ness, the middle point at which mind touches matter ;
where impressions become sensations and the will
developes itself in action ; and in the force generated
wherein alone (in the present state of being) the in-
tellect finds its means of operation. Nothing chat
has since been ascertained alters this view of the
position of the cerebrum proper. The phenomena
which some have supposed to indicate a sort of con-
sciousness on the part of the spinal cord, even those
which have led Carpenter to designate the automatic
actions of the basal ganglia as seiisori-motor, have
been shewn to require no such assumptions. That
there may be consciousness — the subjective side of
impressions and actions — the integrity and co-opera-
tion of the gray matter of the hemispheres is indis-
pensable.

In respect of the mode of its co-operation, how-
ever, it had hitherto been conceived that the brain
acted as a whole. The sensory nerves coming from

all parts of the frame were integrated in the optic
thalamus, and there — through its connexions with
the cerebrum — the mind as one perceived them,
and translated them into ideas. The influence of
such ideation, or the direct commands of volition,
were in like manner conveyed to the corpus stria-
tum, and thence to the motor nerves of the muscles.
When enquiry was made as to how sensations were
discriminated by the mind, or complex actions exe-
cuted at will, the answer was given by pointing to
the continuously separate fibres of sensory transmis-
sion, and to the associated motor cells of the anterior
cornua of the cord. The former arc telegraphic
wires, each conveying without confusion its own
message: the latter are so many batteries of Leyden
jars connected one with another, the electric force
distributed uniformly over all the united jars, and all
being at the same time uniformly discharged, for
which purpose one conductor alone is nccessarj'.

It is sometimes claimed for the phrenologists that
they anticipated that differentiation of cerebral func-
tion which is now acknowledged. But the concep-
tion of Gall and Spurzheim was of a very diffqfcnt
order. They divided the mind itself into "faculties,"
to each of which they assigned a certain portion (of
pretty uniform size) of the surface of the brain, as-
certaining this by the corresponding elevations or
depressions of the cranium supposed to exist in per-
sons variously endowed. Phrenological science, then
(such as it was), was a compound of psychology (a
very crude one) and craniology; while the art (such

as it was) sliould rather have been called cranioscopy.
But Gall, who was a man of genius, and who first
taught us to examine the brain in a rational way, did
really perceive something which lies at the bottom
of our present views. The convolutions of the cere-
brum, which until quite recently were regarded as
only so many folds designed to give ampler surface in

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a limited space, must — he argued — have a more defi-
nite significance, from the regularity with which they
occur. So evident was this regularity that physiolo-
gists — among whom Gratiolct and Leuret are worthy
of special mention — have named them, and the result
is what you have all learnt in your anatomy classes.

The two great fissures — that of Rolanilo above,
that of Sylvius below — if caused t# meet would
about divide the lateral surface of each hemisphere
into two equal parts. In front of this line is a ver-
tical convolution, called the ascending frontal, and
three horizontal ones — the superior, middle, and in-
fcrior frontal. Behind it is a corresponding perpen-

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lun. Ci. The CDllstctal dairrc. G
marginal nmvolulion. GV. The um:

dicular fold — the ascending parietal, ending above
in the posiero-parictal, and flanked by the angular
gyrus; while below these, reaching to the base of
the hemisphere, are the three temporo-sphcnoidal
convolutions — superior, middle and inferior. These
are all of which — on this surface of the brain — I
need remind you ; though you will not fail to obser\'e
that beyond their range, both in frontal and occipital
regions, there is a projecting portion of brain-sub-

IgS CEREBRAL LOCALISATION.

stance. But I must ask you also to follow me while
I draw as it were the hemispheres asunder, divide
the corpus callosum, and expose the inner surface.
Here, too, are convolutions, biit I need trouble you
with one alone, lying at the base, viz. : the uncinate,
which immediately overlaps the hippocampus major,
and its recurved termination, the "crochet," or sub-
iculum cornu Ammonis. These are the only parts
of the brain which have as yet been differentiated,
and they seem to contain the centres of all the bodily
movements and sensations.

The earliest suggestion of cerebral localisation grew
out of the phenomena of apliasta. There is a form
of paralysis — the giosso-laryngeal of Duchennc, the
old " paralysis of the tongue" — in which the patient
cannot speak because the muscular apparatus of ar-
ticulation has lost its power. But there are circum-
stances of a widely-different nature under which the
faculty of speech may be lost. The tongue and lips
may be freely movable. The integrity of the larynx
appears from the utterance in a natural voice of one
or more words. But with language in genera! the
sufferer has as little power of dealing as a deaf-mute.
He does not necessarily lack ideas, but he has for-
gotten those symbols of our ideas which we call
words. If you shew him a spoon, he recognises it,
and knows its use. But ask him if he knows its
name, and he will shake his head. Ask him if it is a
fork, and he will dissent ; suggest the true name
" spoon," and he will signify approval. The memory
is therefore capable of being aroused. But the faculty

of remembering is permanently impaired ; for repeat
your question as to his knowledge of the name a few
minutes later, and he will again sign a negative.

Nor is it the memory of words only that is lost :
the [wwer of articulating them is also absent. Al-
though you have reminded the patient of the name of
the object before him, he cannot pronounce it after
you. He can perhaps say "yes" or "no," though
he often misplaces them : or he utters in reply to
every question, and spontaneously also, some un-
meaning word, as {in two patients of Trousseau's)
"sapon," "cou-si-si." But no conversation can be
held with him.

This is the typical aphasic, though there are great
varieties in degree in particular instances. Refer-
ring you for these, and for a full discussion of the
subject, to those fascinating Clhiical Lcclnres o£
Trousseau which every practitioner ought to read, I
would say that while aphasia sometimes appears
alone, it is more commonly associated with more or
less hemiplegia. Now, when this latter occurs, it is
almost invariably on the right side of the body, which
implies — as you know — that the lesion is on the left
side of the brain. There, then, for some reason or
other, must be the seat of the faculty of speech.
Now the craniology of the school of Gall had placed
the organ of language in the anterior part of the
brain. In the left frontal lobe, accordingly, the
lesion of aphasia was sought by Dr. Paul Broca, and
was found by him in the posterior extremity of the
inferior frontal convolution on the left side. So

200 CEREBRAL LOCALISATION.

many observations have since confirmed him, and the
few apparent exceptions have been so satisfactorily-
explained, that the localisation has been universally
accepted, and the fold of brain is known as " Broca's
convolution." The occasional limitation of the mis-
chief is explicable by the spot being supplied by
one of the secondary branches of the middle cere-
bral artery — plugging of which by embolism or
thrombosis will cause the symptoms. But why the
faculty of speech should be located at this spot, and
why on one side only of a bilateral organ like the
brain, remained a puzzle as long as the phenomenon
stood alone.

In 1870, however, the step was taken which opened
the whole field of discovery, and has brought us our
present acquisitions. The most fruitful plan by
which nervous function has hitherto been ascer-
tained has been the excitation of the part to be
questioned by electricity. Up to the time I have
mentioned, the few attempts made to electrise the
cerebral surface had failed, and it was supposed to
be insensible to such stimulus, — as it is known to
be to any of a painful character. Now, however, two
German physiologists, Fritsch and Hitzig, "estab-
lished, by a series of valuable experiments on dogs,
that the direct application of the galvanic current
to the surface of the hemispheres in certain regions
caused movements ; and also the more important
fact, that definite muscular contractions were asso-
ciated with irritation of certain circumscribed areas "
(Ferrier). They used a continuous current, availing

THE SEAT OF f

themselves of the stimulus which follows the making
and breaking of the circuit. In 1872, Dr. Ferrit:r —
another ornament of my ahiia mater, King's College,
London — began a series of experiments of the
same kind in which he employed the induced current,
thereby getting more prolonged effects, and (after a
time) using monkeys as his subjects and so having
the closest approximation to the human brain. His
results, which entirely agreed with those of Fritsch
and Hitzig as far as theirs went, were published from
time to time in various places, and at last collected
(in 1876) in the volume I have already mentioned.
At first there were many to dispute the validity of
his conclusions, — it being maintained that the phe-
nomena arose from conduction of the currents to
the basal ganglia. This, however, was readily dis-
proved ; and, since then, normal and pathological
anatomy, clinical medicine and surgery, and even
embryology, have come to his aid ; and the doctrine
as a whole must be considered established, whatever
may be the modification in detail it is destined to
undergo.

What, then, is the doctrine ,' It is that this middle
region of the cerebral hemispheres, lying about the
fissures of Rolando and Sylvius, embracing the con-
volutions I have named to you, and corresponding
roughly to the parietal and squanioso-temporal regions
of the skull, is the ultimate seat of sensation and the
starting-point of volitional impulses. The doctrine
further states, that the several convolutions of this
region are distinct centres, motor or sensory ; per-

202 CEREBRAL LOCALISATION.

sistcnt — SO far as they can be followed — throughout
the animal kingdom ; and each, in the case of the
motor centres, presiding over definite groups of
movements. Let me tell you what these centres
are, and how they have been identified.

I. Let us begin with the hindermost convolution
— the angular gyrus. Electrical stimulation here
causes movements of the eyeballs, sometimes of the
head, and very often contraction of the pupils. It
might be thought that it was a motor centre for the
eyes. But counter-experiments, in which this area
of the brain was destroyed by the actual cautery,
shewed that the movements were only reflex, excited
by subjective visual sensations (such as occur when
the retina is galvanised). The eye on the opposite
side was not paralysed ; but it was blind. Subse-
quent researches have shewn that this blindness is
only temporary, as long as the occipital lobes remain
intact. Such ample provision is even made for this
important sense, that as long as one occipital lobe
or one angular gyrus remains, vision persists to some
degree in both eyes. It is only when all four are
entirely destroyed that total and permanent blind-
ness results.

Some interesting facts relating to hemiopia and
central vision have come out in the course of this
enquiry, and may perhaps — if time will allow —
come before us. At present it must suffice to
remember that the angular gyrus and the neighbour-
ing occipital lobe — corresponding roughly to the
parietal eminence in the skull — are the cortical
visual centres.

HEARING, SMF.LI., AND TASTE. 203

2. On irritation of tlic superior temporo-sphenoidal
convolution in monkeys there is sudden retraction or
pricking up of the opposite ear, wide opening of the
eyes, dilatation of the pupils, and turning of the
head and eyes to the opposite side. These are just
such phenomena as would occur when a loud sound
was made in the ear, as indeed was ascertained by
trial. In the jackal and the rabbit electric stimula-
tion of the homologous spot caused not only the
pricking of the ear, but " the quick start or bound as
to escape from danger, such as might be indicated
by loud or unusual sounds." On the other hand, its
destruction by the cautery caused deafness, — on the
opposite side if made unilaterally, complete if bilat-
eral. Here, then, we have the auditory centre, at
the junction of the parietal and squamOso-teraporal
regions of the cranium.

3. For the sense of smell it was natural to look to
the subiculum comu Ammonis, as the olfactory tract
is very obviously in the lower animals and presuma-
bly in man connected anatomically therewith. As a
matter of fact, irritation at this spot was attended by
a pecuhar torsion of the lip and partial closure of the
nostril on the same side (for the olfactory tracts do
not decussate), such as a powerful or disagreeable
odour would excite. Conversely, localised destruc-
tion here caused diminutien or loss of smell.

4. For similar reasons, the lower part of the mid-
dle temporo-sphenoidal convolution, which is in close
connexion with the subiculum, has been identified
as the seat of taste. The situation of these centres

d-. A

CEREBRAL LOCALISATION.

SO near the base of the skull throws light upon the
loss of taste and smell sometimes following blows on
the vertex or occiput, where — as you know — the
chief damage is often done by coiitre-coup. That of
the olfactory centre, moreover, would explain the
occasional occurrence of anosmia in connexion with
aphasia and right hemiplegia, where the lesion must
be close at hand ; and here, as it should be, the anos-
mia is on the opposite side to the paralysis.

S, Last, the sense of touch has been found situate
in what Dr. Fcrrier calls the "hippocampal region,"
including the hippocampus major and the uncinate
convolution, which it is impossible to separate. It
is a special satisfaction to have so traced the ultimate
seat of tactile impressions to the cortical surface,
for it harmonises with the numerous observations
lately made in France on hemi-anassthesia of cerebral
origin, which has been shewn to result from lesions
independent of the optic thalami, and to be there-
fore explicable only on the supposition of a higher
centre.

The cerebral seat of all our senses has now been
made manifest: the "five gateways of knowledge"
lead to this tract as the throne-room of its palace.
As in the spinal cord, in the crura cerebri, in the
basal ganglia, the sensory lies behind the motor
region : it is as it were the feminine side of the
nervous system, impressible, perceptive, impulsive,
keeping in the rear of the stronger actor, whose
motions nevertheless it plays no small oart in deter-
mining. I pass now to this motor area of the hemi-
spherical substance.

TiTE MOTOR CENTRES.

The motor centres !ie about the fissure of Rolando,
being sitiiate chiefly in the ascending parietal and
frontal convolutions, but including also the postcro-
parietal and the posterior half of the three frontals.
Thus — proceeding from above downwards — elec-
trisation of the postero- parietal lobule causes {in
monkeys) advance of the opposite hind limb, as in
walking; of the adjoining upper portions of the
ascending parietal and frontal, complex movements
of thigh, leg, and foot with — if the electrodes are
pushed a little forward — movements of the tail; a
little lower, it induces retraction with adduction of
the opposite arm ; on the ascending frontal, at its
junction with the superior frontal, extension forward
of arm and hand ; all along the ascending parietal,
prehensile movements of the fingers and wrist ;
while, down the ascending frontal, there are centres
for supination and flexion of the forearm, for the
action of the zygomatics by which the angle of the
mouth is retracted and elevated, and for elevation of
the ala nasi and upper lip. At the inferior extremity
of this convolution, on a level with the posterior ter-
mination of the third frontal convolution (Broca's),
stimulation produces alternate opening and closure
of the mouth, with protrusion and retraction of the
tongue. These last movements are bilateral, all
the others having occurred only on the opposite half
of the body. When, lastly, the posterior half of the
superior and middle frontal convolutions are e.xcited,
the eyes open widely, the pupils dilate, and head
eyes turn towards the opposite side.

206 CEREBRAL LOCALISATION.

For a counter-experiment, let me read you this
from Professor Ferrier. "The right hemisphere of
a monkey had been exposed and subjected to experi-
mentation with' electrical irritation. The part ex-
posed included the ascending parietal, ascending
frontal, and posterior extremities of the frontal con-
volutions. The animal was allowed to recover, for
the purpose of watching the effects of exposure of
the brain. Next day the animal was found perfectly
well. Towards the close of the day following, on
which there were signs of inflammatory irritation
and suppuration, it began to suffer from choreic
spasms of the left angle of the mouth and left arm,
which recurred repeatedly, and rapidly assumed an
epileptiform character, affecting the whole of the left
side of the body. Next day left hemiplegia had be-
come established, the angle of the mouth drawn to
the right, the left cheek-pouch flaccid and distended
with food, which had accumulated outside the dental
arch ; there being almost total paralysis of the left
arm, and partial paralysis of the left leg. On the
day following the paralysis of motion was complete
over the whole of the left side, and continued so till
death, nine days subsequently. Tactile sensation, as
well as sight, hearing, smell and taste, were retained.
On post-mortem examination it was found that the
exposed convolutions were completely softened, but
beyond this the rest of the hemispheres and the basal
ganglia were free from organic injury." Similar re-
sults followed destructive experiments localised in
the special centres ascertained to be such by electri-
sation.

SPEECH. 207

The motor cortical area — the ultimate seat of voli-
tion — has thus been identified : it lies, as throughout
the nervous system, anterior to the sensory tract.
Like that, moreover, it is found to be multiple — to
consist of a number of separate centres, each presid-
ing over a definite movement or group of movements.
How, then, are we to conceive that our will operates?
Has it the faculty of singling out the group of corti-
cal cells of gray matter through which it must act if
it desires to execute a given action ? We are con-
scious, in volition, of no such choice ; nor is it easily
conceivable.

Let us go back to onr original instance of localisa-
tion — the power of speech, and its dependence on
the integrity of the posterior extremity of Broca's
convolution — the third or inferior frontal What
have our experiments in electrisation of the cortex
taught us about it ? Why, this : that stimulation of its
immediate neif;hbourhood excites the movements of
articulation. Now, if we will think of it, we learn to
articulate before we begin to attach any meaning to
words. The baby is taught to say "papa" first of
all, and then to connect the sound with a gigantic
being in coat and trousers, whom it individualises so
little that for some time to come it will address every
male adult by the name. By degrees, as its educa-
tion proceeds, we may conceive two processes as
going on in its sensitive and plastic brain. An
organic nexus is being formed there between sights,
tastes and other sensations and the sounds used to
express the objects arousing them ; and further, each

208 CEREBRAL LOCALISATION.

act of articulation is impressing on the cells which
originate it a material memory — as it were, which —
after a time — is revivable at will or on incitement.
Speech, then, — the power of retaining and recollect-
ing words, and associating them with ideas — is the
subjective side of articulation. Let the centre at
which the movements requisite for the latter have
become organised be damaged, and the faculty itself
is lost : there is no store for recollection to draw upon,
no excitable spot at which the process of retention
can be recommenced. The associations with words
remain, when these are supplied ; for they are regis-
tered on the sensory centres, which — like the sensi-
tised plate of the photographer — receive them for
ever, and recall them in ideas and emotions.

And now we can see why it is on the left side of
the brain that the faculty of speech comes to be
seated. It is so because jt is the result of the mus-
cular actions of articulation. We have seen these to
be performed bilaterally, though the excitation has
been given to one hemisphere only. Potentially,
therefore, the impulse to speech might have pro-
ceeded from either side, and been organised there
accordingly ; but actually, that education of the right
arm which we are taught to practise from our early
days so developes the left half of the brain that the
other lies comparatively idle. We know how difficult
it is, when right hemiplegia has occurred, to get the
left hand to execute the required movements — as in
writing. For those, yet more delicate and complex,
involved in speech the task is so hard as to be iniprac-

SPEECH.

ticable, — at any rate at first. There arc cases on
record, however, in which — though the paralysis per-
sisted — the power of speaking gradually returned;
and here we may fairly conceive the right speech-
centre as taking up the duty.

A crucial test of the .soundness of this explanation
would be afforded by the behaviour of a man natu-
rally left-handed when affected with hemiplegia, for
with him aphasia should accompany it only when on
the left side. Ferrier can refer to three cases in
which this coincidence has been observed. And per-
haps the practical inference is that which our recently
deceased English novelist — Charles Rcade — la-
boured so much to impress, — that we should all en-
deavour to be ambidextrous. Besides the advantages
he urged, we should, if ever the misfortune of a par-
alytic stroke came upon us, have an arm and hand
already educated to do our necessary work ; and, on
whichever side it fell, we should preserve our speech
unimpaired.

The will to speak is thus the revival, from some
sensory excitement, felt or reawakened, of the activ-
ity of the corresponding motor centre, and it thus
inevitably performs itself in speech. We do not
direct the volition to Broca's convolution, which we
should find it hard to do : it is there that it originates,
and when we say we " will," we mean our conscious-
ness of such awaking. But are all our actions, yoii
will ask, thus mechanically organised, so that on sen-
sation, emotion or idea some habitual action necessa-
rily follows ? Not so, or we should not be moral

210 CEREBRAL LOCALISATION.

beings. There are, in many parts of the nervous
system, bundles of fibres whose function we describe
as inhibitory. They are themselves motor in power ;
but their office is — doubtless through their connex-
ions — to restrain such action as would otherwise
result frogi the influence of their fellows. Thus the
pneumogastric — or rather the spinal accessory fibres
which run in it — is the inhibitory nerve of the heart :
stimulate it, and you retard the pulse-rate ; divide it,
and the organ bounds off like a hound slipped from
its leash, and palpitates at breathless speed. Now
of such inhibitory power over our impulses to action
we are certainly conscious, and there is a portion of
the cerebrum as yet unassigned in which probably
the power resides. The frontal lobes, as you will
have already noticed, project beyond the motor as
the occipital lobes beyond the sensory area. Stimu-
lation of neither produces any positive effect, nor does
any very appreciable result follow their destruction.
So far as can be judged, however, in creatures which
have no faculty of expression, the occipital lobes are
the seat of visceral sensations ; while the removal of
the frontal lobes converted rather " bright *' monkeys
into apathetic ones, wanting in the faculty of attentive
and intelligent observation. Now ethical enquirers
have always perceived, when they have thought out
the matter, that our moral responsibility lies in our
faculty of exercising attention. Self-control is the re-
sult of its use. In refusing to act upon mere impulse,
or upon base motives, we are not unimpelled, without
motive. Ideas and emotions — themselves the prod-

THE FRONTAL LOBES. 211

uct of past sensations — still govern us ; but we have
chosen to which of them we will attend — which,
therefore, shall influence our actions. There are two
ways in which, conceivably, we might do this, — one
being by the stimulation of the current of ideas we
wish to encourage, the other by the repression of
those we would refuse. The latter is the more prob-
able alternative ; and if, physiologically, the anterior
part of the brain be an inhibitory centre, then, psy-
chologically, it is our organ of attention. It is that
by which, in obedience to some higher motive, we
check the natural impulses to action. It is the or-
ganic seat of that which is the distinctively human in
us, and accordingly is far more developed in "hoc ani-
mal quem vocamus homo" than in any other. In pro-
portion as its powers are educated, we become men
of discriminative judgment and deliberate choice : the
merely natural becomes less in us, and the moral
more : we

" move upward, working out the brute,
And let the ape and tiger die."

It is not without foundation, then, that common
observation has connected the development of the
frontal lobes, and the expansion of the forehead, with
the large growth of the truly human in man — with
breadth of intellect and moral strength ; while bulk
of the occipital lobes would indicate predominance
of the animal. And one great encouragement which
cerebral physiology gives us is the indefinite capaci-
ties of education it shews our brains to possess.
Happy they who from childhood up have been

212 CEREBRAL LOCALISATION.

trained to be no mere creatures of impulse! But
they who from any cause have missed this early
nurture can do much for themselves to cultivate the
inhibitory faculty, and thereby to conduce to their
own happiness and that of all with whom they have
to do, — to say nothing of higher ends.

It will not have been amiss, ladies and gentlemen,
that this discussion of the psychical should have led
us to the confines of the ethical, and should have
given us a glimpse into the borderland. I am sure
that all your teachers here, much as they desire for
you to be masters of knowledge, are yet more ear-
nest in their wish that you should be loyal servants
of Duty.

CEREBRAL LOCALISATION AND DRUG-ACTION

{continued).

I PROMISED that, at our next meeting, I would
enter into some of the anatomical, pathological, and
clinical facts connected with cerebral localisation,
and so lead on to its connexion with drug-action. I
proceed now to redeem my promise.

I. Let me first remind you of some facts to which,
during your studies in anatomy, your attention must
have been strongly directed, viz. : the distribution of
the arteries of the brain. These are, you will re-
member, the internal carotid and the vertebral.
The internal carotid divides into two main branches
— the anterior and the middle cerebral; while the
basilar artery, which results from the union of the
two vertebrals, becomes double again in the shape of
the two posterior cerebrals. Take now this semi-
diagrammatic view, which our artist has copied from
the Lectures on Cerebral and Spinal Localisation by
Professor Charcot, of Paris, which have lately been
translated for the New Sydenham Society. It ex-
hibits the ramifications of the middle cerebral or

213

214

. LOCALISATION.

Sylvian artery (so cal!e<l from its entering at the Syl-
vian fissure). You will see at a glance that the re-
gion supplied by its anterior branches is just that
which experiment has marked out as the psycho-

^^ motor area (this is our author's name for the motor

t portion of the cortex cerebri) ; that its distribution

I explains why the posterior portion of the three

I frontal convolutions should be functionally different

B from the remainder (which is supplied by the anterior

^ k

THE SYLVIAN ARTERY. 215

cerebral) ; and that aphasia may well exist alone,
since Broca's convolution has a branch to itself.
Let this be plugged by an embolism, and atrophy
of the seat of speech may be the sole lesion, sud-
den aphasia the sole result. This actually occurred
in a case observed by Charcot at the Salpetrierc.

The posterior branches of the artery, you will
observe, reach the angular gyrus and the temporo-
sphenoidal convolutions, which have been ascer-
tained to be the seat of the senses of sight and
hearing, which through the circulation therefore —
as well as (doubtless) through innumerable commis-
sural nerve-fibres — are associated with the motor
centres. But remember that the posterior cerebral,
besides its chief work of supplying the occipital lobes,
sends branches also to the temporo-sphenoidal region,
to the gyrus uncinatus, and to the hippocampus.
As you will remember that there is somewhere in
the occipital lobes a supplementary visual centre,
there are some features here suggesting special pro-
vision for the integrity of regions which are the seat
of our conscious sensations, and thus of our ideas.

2. Again, I must anticipate morbid anatomy so
far as to say that, when the psycho-motor area of
the brain is seriously affected — as with softening,
a peculiar degeneration — a sclerosis — is found to
descend therefrom through certain definite tracts
of the spinal cord. These are the small columns
called (after the first observer of these degenera-
tions) Turck's, which lie immediately beside the
anterior median fissure, and a certain portion of the

2l6 CEREBRAL LOCALISATION.

lateral columns. Such tracts, therefore, must be
regarded as the true prolongations o£ the fibres
coming off from the motor cerebral cells and pro-
ceeding down the crura; the rest of the spinal fibres
being (longitudinally) commissural. Now it is an
interesting fact that these ccrebro-spinal fibres are
latest in development, — that their axis-cylinder
(which you know is the central and essential j>art of
the nerve-fibre) has not acquired its myeline sheath,
and so is not insulated for action, at birth. This is
a.scertained by treating the cord of the newly-born
child with osmic acid, a substance which gives a
black stain to the sheath — the white substance of
Schwann, as we used to call it, but leaves the axis-
cylinder clear. Those parts, I say, which in para-
lysing cerebral lesions are affected with descending
sclerosis, are just the parts which remain clear under
the osmic acid. The true spinal cord of the- infant
is already fully developed, as also his medulla ob-
longata, for these are the seat of the automatic reflex
activities it immediately requires. The fibres which
convey impressions to and from consciousness are
not yet needed. The cerebrum itself is in the same
rudimentary condition, — its m_ain structural details
barely outlined, and the nerve-tubes almost univer-
sally absent. Moreover, in the young of those ani-
mals which are born blind, and which therefore —
like the human infant — are at this time mere reflex
automata, electrical stimulation of the excitable por-
tions of the cortex determines no movements. It
does so in animals which are born with open eyes,

THE GRAY CELLS. 2l7

and the histological development and chemical con-
stitution oE the cerebrum of these creatures differs
little from the condition which obtains in the adult
state.

3. Anatomy can go even farther still — into the
realm of histology, and still find facts confirmatory
of the doctrine of cerebral localisation. It was long
ago noticed (I mentioned it in an account of the
nervous system which I contributed to the British
yonnial of Hommopathy \i\. 1861) that the gray cells
of the anterior cornua of the cord — whence, as you
know, the motor roots of the spinal nerves take
their origin — were considerably larger than those in
the posterior cornua, which are sensitive. Now of
late the cells of the gray matter of the hrain have
been examined microscopically, and similar differ-
ences have been found to obtain. In front of the
fissure of Rolando cells so large as to be called
"giant" are to be found, and they are especially
massed about this sulcus, i.e. in the neighbouring
parts of the ascending parietal and frontal convolu-
tions — the great motor area. Behind this spot, in
the sensory region of the brain, the cells ^ the femi-
nine cells, you will remember I called them — are
markedly smaller, though still superior to those of
the cerebellar hemispheres.

4. I now come to the bearing which pathological
anatomy has upon our present subject, and in this
part of my task am more than elsewhere indebted
to Professor Charcot's lectures.

If the inferences drawn from physiulugical c.vperi-

2l8 CEREBRAL LOCALISATION.

ment are correct, disease — as from softening due
to embolism or thrombosis occluding the anterior
branches of the middle cerebral artery — affecting
the psycho-motor area should cause hemiplegia, even
though the corpora striata remained untouched.
This corollary has been abundantly warranted by
experience. Charcot has recorded all the cases of
ischacmic softening of the cortex of the hemispheres
dying in his wards in the Salpetriere during the last
fifteen years.

" In these cases '' he writes " the lesion presented itself under
the form of yellow softening {plaques jaunes), more or less
extensive in area, involving to a variable depth the subjacent
white matter and occupying the most diverse regions of the
surface of the hemisphere. It is expressly mentioned in all
the observations that the softening had not affected the central
masses — optic thalami, corpora striata, and internal capsule.
My observations may be divided into two groups.

" The first includes the cases in which permanent hemiplegia
had not existed during life, and in which secondary degenera-
tion was found at the autopsy to be absent.

** In all, the convolutions supplied by the Sylvian artery, and
particularly the ascending frontal and parietal, remained intact.
The yellow softening was situated in one of the following re-
gions, viz. ; some part of the sphenoidal lobes, the lobulus quad-
ratus, the cuneus, one or both occipital lobes in their entirety,
some part of the anterior two-thirds of the frontal lobes.

*' In all the cases of the second group there had been, on
the other hand, permanent hemiplegia and well-marked sec-
ondary sclerosis. The feature common to these cases is that
the lesion invariably involved, to a greater or less extent, one
or other of the ascending frontal and parietal convolutions,
principally in their upper half, and often both at the same time.
In addition, the regions nearest to the frontal and parietal con-
volutions were very frequently involved."

"LATERAI, SCLEROSrs. 219

This should be enough. Here is no single case,
which might be exceptional and neutralised by others
of oppnsiite significance ; but a series of observations
in a large special hospital extending over fifteen
years, and all concurring — positively or negatively
— in the same conclusion. The statement made by
Nature in answer to experimental enquiry is volun-
teered by her of her own accord.

Let me now say something of this "descending
sclerosis," which has more than once come before us.
It consists, as I mentioned, in an indurative degen-
eration of those tracts in the spinal cord which are
direct prolongations from the brain — the columns of
Tiirclc and the outer and posterior border of the lat-
eral columns. The former are not cros.sed, and do
not penetrate very far ; the latter are continuous with
the decussating fibres in the anterior pyramids of
the medulla oblongata, and are altogether so much
more important a factor in the matter that the whole
thing is called " lateral sclerosis." This morbid pro-
cess, in its secondary descending form, will follow
any lesion of the motor tract, from the white sub-
stance of the hemispheres downwards, which inter-
rupts the continuity of its fibres. It does not follow
upon hemiplegia consequent on mischief limited to
the corpus striatum ; which appears to shew that this
body is a ganglion ancillary to motor agency, rather
■ than a secondary centre to which the whole tract
converges to radiate forth again.

The explanation of this secondary degeneration is
derived from the phenomena which occur when a

CEREBRAL LOCALISATION,

nerve is separated from its centre. When the mixed
spinal nerves are divided, the peripheral end degen-
erates, both in its centripetal and its centrifugal
fibres. But when it is — as it were — unravelled by
ascending to its roots, a different result is obtained.
When the anterior root is divided, its peripheral
end is still that to wither. The motor centres of
these roots are thus (as we shall see from other facts)
their trophic centres also, viz. : the cells of the ante-
rior cornua of the cord. But divide the posterior
root — which you must needs do before you get to
the ganglion which you know exists upon it, at its
junction with the anterior; divide this root at any
point, and it is the central end which withers — the
peripheral remaining intact. The ganglion, then,
whose presence in my student-days anatomists used
to consider somewhat of an impertinence, is now
shewn to be the trophic centre of the sensory root,
— nay, of the whole sensory nerve; for extirpate it,
and degeneration attacks not only the posterior root,
but all the centripetal fibres of the mixed nerve.

Lesions of continuity of the cerebral motor tract
thus cause degeneration below their seat, because
they cut off the fibres descending therefrom from
their trophic centre, which is the p.s)'cho-motor area
of the cortex. What symptoms do they cause?
Two only, invariably : loss of power and contracture
of the limbs. These are usually and mainly seen on
the opposite side of body to the lesion ; but some-
times or to some extent on the same, — the latter
V'being accounted for by the involvement of the col-

"LATE RIGIDITY. 221

umns of Turck, which — as I have mentioned — are
not crossed. Now this contracture of the limbs is a
phenomenon in every way of great interest. It has
long been l^nown as a symptom of much import in
the prognosis of hemiplegic attacks. "Early rigid-
ity" means little, as it may result merely from irri-
tation, as about a clot; but "late rigidity" — that
which supervenes some months after the "stroke"
— implies that the paralysis is going to be perma-
nent. Dr. Todd ascribed it to cicatrisation of the
brain at the injured spot ; but the descending degen-
eration since discovered is more of a. vera causa, &s
amply accounting for the impossibility of recovery.

The lateral sclerosis, nevertheless, e.vplains only
the paralysis in these cases : but what is the cause of
the contracture.' This, it would seem, must be
something o£ a functional rather than an organic
nature, for this reason, that the rigidity is not uni-
form and constant. It relaxes somewhat during rest
and sleep; it is increased on movement, and espe-
cially by anything like exertion (I mean of course
on the healthy side) ; its appearance may be antici-
pated, or its intensity enhanced, by the administra-
tion of strychnia, while opposite results follow large
doses of bromide of potassium. Now what these
agents increase and diminish respectively is the re-
flex excitability of the spinal cord ; and, looking
farther iti the direction thus suggested, we come
across some very interesting facts. There is a symp-
tom, present in certain kinds of paralysis, absent in
others, to which the Germans have given the

222 CEREBRAL LOCALISATION.

of *' foot-phenomenon *' or "ankle-clonus** — the lat-
ter being its usual designation in England. It is eli-
cited by supporting (as with the hand under the ham)
the paralysed leg, so that it may hang loose and swing.
Then, if the point of the foot be suddenly raised, " a
series of shakes is at once provoked, which collec-
tively constitute a kind of rhythmical movement or
oscillatory trembling more or less regular and per-
sistent *' (Charcot). Now in the healthy subject
this ** spinal trepidation," as the French call it, can-
not be produced, and it is absent in such affections
as locomotor ataxy and infantile spinal paralysis ;
but it is present in all paralyses in which contracture
exists and tends to be established. In hemiplegia of
cerebral origin, it often precedes the " late rigidity '*
by some weeks : it is thus of value for prognostic
purposes, and it further throws light upon the nature
of the symptom it heralds. For it evidently belongs
to the group of phenomena known as "tendon-re-
flexes,*' of which the starting forward of the leg on
striking the patellar tendon is the most familiar ; and
these, as their name implies, are reflex actions. If
the ankle-clonus, then, absent in health, is present
in paralysis with contracture, it implies that in this
condition the reflex excitability of the cord has
undergone enhancement, i.e. (as there are no sensory
phenomena here) that the cells of the anterior cornua
are in an irritable state. What should induce them
to be so } This question is probably to be answered
by considering the destination of the cerebro-spinal
lateral fibres — the "pyramidal tracts," as Charcot

"TENnON-RF.FLRXES." 223

calls them. They progressively diminish in size from
above tiownwartis, are "used up" — as it were — in
the course of their descent. They convey the orders
of the will to the motor nerves, and yet there is de-
monstrably no continuity between them and the ante-
rior roots.' Wliat remains, then, but that they end in
the cells of the anterior cornua, from which the motor
roots emerge? If they do so, then it would seem
that — in descending sclerosis — these cells must
either take on the process of degeneration, or must
oppose it. That they do not ordinarily accept it ap-
pears from the fact that " the muscles of the extremi-
ties on the paralysed side in patients affected with
permanent hemiplegia of cerebral origin present no
Other atrophic changes than those resulting very
slowly from the functional inertia to which these
muscles are condemned " (Charcot). Did the ante-
rior cornuai cells suffer, rapid muscular atrophy
would follow, as indeed occurs in the acute disease
known as anterior poliomyelitis (of which infantile
spinal paralysis is an example) and in the chronic one
we call " wasting palsy " — the " progressive muscular
atrophy " of Duchenne. Sometimes, in ordinary hemi-
plegia, this "amyotrophy" does occur, and the cells
of the anterior cornua have been foimd to have suc-
cumbed ; ' but more commonly, as I say, they resist.
Ifow resistance implies over-action, irritation. Given
ail irritable state of the cells of the anterior cornua,
and you have the exaggeration of reflex activity
shewn in the ankle-clonus, you have the exaggera-

i Sec Chuwl, op. cil., p. agg. » Cliarcol, o/, c-l.. p. aoi-j

224 CEREBRAL LOCALISATION.

tion of the normal muscular tone which appears as
contracture.

The point of special value to us here is that such
a condition is, as Charcot says, "purely dynamic and
corresponds to no appreciable anatomical modifica-
tion." Hence its variability under circumstances ;
and hence (a point I have not yet noted) its occa-
sional diminution and even disappearance in the
course of time. Now all this brings it into the thera-
peutic sphere. We have seen that contracture may
be anticipated or intensified by strychnia so given as
to induce its physiological effects. Hence the warn-
ings of old against using Nux vomica or its alkaloid
in cerebral hemiplegia; but hence, obviously, the
indication for them to us, in our non-physiological
doses. Even in the old school Mr. Charles Hunter
finds that by reducing his dose of hypodermic strych-
nia to the sixtieth or eightieth of a grain he can
remove "the muscular twitchings, spasms, or cramps
of the paralysed parts ;" and these are just the vari-
able element in contracture, and one chief source
of its irksomeness. We cannot (probably) by drug-
treatment alter the sclerosis, and so cannot restore
power ; but it will be no slight help to our patients
if we can further the natural possibilities of mitiga-
tion or subsidence of rigidity. Let me also remind
you that if at any time a sudden accession of wasting
— with loss of electric contractility — should occur
in the paralysed muscles, indicating commencing
degeneration of the cells of the anterior cornua, we
have a hopeful remedy in Plumbum. Lead-palsy is

PLUMBUM IN AMYOTROPHY. 22$

the precise analogue in drug-disease of progressive
muscular atrophy; and even in what may be called
the acute form of that affection — in anterior polio-
myelitis — the drug would seem effective. Dr. Jous-
set has recorded — in his Legons dc Cliniquc M^dicalc^
which Dr. Ludlam has done such good service by
rendering into English — an undoubted case of the
kind, in which Plumbum (in the 30th dilution) ef-
fected a cure.'

All this about "late rigidity" has been somewhat
of a digression ; but I think it warranted by the
frequency with which cerebral hemiplegia will come
before you in practice, and the desirableness of your
knowing all that can be known about it. I return
now to the more direct thread of our discourse ; and
proceed to say something of the clinical aspects of
cerebral localisation.

5. If it be so, that certain spots in the cerebral
cortex are the seat of definite functions, sensory or
motor, ought not the knowledge of them to be of aid
to surgery ? If symptoms of pressure on the brain
exist after an injury, or of localised irritation where
an exostosis or other morbid growth may fairly be
presumed to exist, would not the surgeon be justified
in trephining the skull at the point indicated by the
functional disorder } This question was largely dis-
cussed in Paris during the years immediately follow-
ing the researches of Fritsch, Hitzig, and Ferricr,

* Cuprum, I may add, is ?.notlier medicine wliich lias amyotrophy an.ong
its effects, and also something very hke contracture (see my T/icra/cuius^ i.

236).

226 CEREBRAL LOCALISATION.

especially in 1877, when the French medical journals
were full of it. On the whole, the verdict was in
the negative. In injuries, the old rule of trephining
(if at all) at the seat of the wound seems still to be
the safest ; while, in the case of morbid growths,
the pressure they exert is so diffused as to make it
almost impossible to identify their exact seat. You
know, for instance, how often they cause optic neu-
ritis, without interfering in any obvious way with
the integrity of the optic tracts. All this is true,
but I think that an exception might be made in the
case of presumed exostosis. If troublesome symp-
toms — epileptic or otherwise — were present, and
the history of the case raised a reasonable proba-
bility of such a growth being their cause, I would
strongly advise the application of the trephine at the
spot to which the symptoms pointed. As the dura
mater need not be opened here, the operation would
involve little risk — the usual precautions being
taken ; and sometimes a deliverance otherwise im-
possible might ensue.

6. Of yet more interest, to most of us, are the
phenomena which clinical medicine presents in this
sphere ; and they have the further recommendation
that some of them at least suggested the doctrine
of cerebral localisation before physiological experi- '
ment had established it. I refer to the observations
of Dr. Hughlings Jackson, of London. I wish that
this philosophical physician would do himself the jus-
tice and us the benefit of collecting his scattered
contributions on the subject to journals and transac-

in;

HUCHLrNGS JACKSO>f. 23/

:6 one work. Dr. Ferrier spoke of him as
doing so in 1876; but the promised "Clinical and
Pathological Researches on the Nervous System"
have not yet seen the light. Dr. Jackson was struck
with the unilateral and localised forms sometimes
presented by epileptic convulsions. On the theory of
the disease being resident in the medulla oblongata,
the whole frame should be uniformly convulsed. The
limitation often seen to one side of the body disal-
lowed this conception, at least in such cases, and
compelled that of a direct discharge of nerve-force ;
while again the involvement only of the arm, or leg,
or certain of the facial muscles prevented reference
to the gray matter of the corpus striatum, lesion of
which influences the whole of one side of the body.
Thought was thus inevitably carried up to the hemi-
spheres, and he drew the inference that the convo-
lutions surrounding the striate bodies had a direct
relation to movements, — the convulsive phenomena
being the result of irritative or "discharging" lesions
of the cortex in this region.

In several places he has explained his views about
these " discharging " lesions. He distinguishes them,
by this name, from "paralysing" lesions; they are
to one another as electrisation of the cortex to de-
struction of the same spot in physiological experi-
ment. The discharging lesion, like the former,
causes over-action; not better function, but "insta-
bility " of the gray matter in its neighbourhood, lead-
ing to frequent, involuntary, violent exercises of its
influence. If it be a motor centre, this will result

228 CEREBRAL LOCALISATION.

in localised convulsion ; if a sensory one, in some
subjective manifestations of its form of sensibility.
The first is easy of conception : to illustrate the
second, let me read you the narrative of a case com-
municated by Dr. Gowers to the Lancet of 1879.

*• The patient " who was a man of about 30 " stated
that he was well until two months before he was first
seen, when one morning something seemed very bril-
liant before him, * as if he had a polished plate on his
breast.' He felt giddy, but did not fall ; he sat down,
bathed his head, and was better, but afterwards felt
extreme pain in his eyes, *as if they were bursting.*
Subsequently, he had slight attacks daily, of the
following character: A pain commences in the neck,
goes across the head, comes down between the eyes,
and is felt on each side of the bridge of the nose.
If walking, the road or path seems to get narrower
and narrower, so that he hardly knows where he
is going, and simultaneously his sight fails ; he feels
with a stick to see if he is not getting off the path.
The pain at the top of the head and in the eyes
is something awful, and the eyes seem to throb.
The loss of sight is not complete ; he can only see
just before him, nothing on either side; but he can
generally see better to the right than to the left.
During the three days before he was first seen, at
the commencement of the attacks, as the sight was
going, he had a flickering of light, * like a gold ser-
pent,* in the eye, moving in all directions verj^ fast ;
seen with both eyes, he thought, but more before the
left eye than the right.

"DISCHARGING LESIONS.** 229

"He was treated with bromide and belladonna,
and the attacks ceased, except that once or twice he
had a slight flickering before the eyes. He had,
moreover, several attacks of pain on the top of his
head, coming on suddenly, and he often had pain
at the back of the neck."

After continuing well for five months, this man
had a fall, striking the head. General symptoms of
cerebral disturbance followed, and he died comatose.
At the autopsy, a large tumour was found in the
right occipital region, invading the angular gyrus.
Now this convolution, you will remember, is the
special seat of the sense of sight. The neighbour-
ing tumour acted as a discharging lesion to it and
caused instability of its gray matter. Hence the
paroxysms, so to speak, of subjective visual sensi-
bility — at first exaggerated, later diminished. Ob-
serve, further, the effect of treatment in removing,
almost absolutely, this part of the trouble ; so that
while the tumour remained, it could no longer cause
morbid discharge of the gray cells in its vicinity.
Does not this remind one closely of lateral sclerosis
of the cord and the contracture caused by the irrita-
tion of the anterior cornua .'* Here, as there, the
inference is therapeutically encouraging : part of the
patient's trouble is functional only, and may be re-
moved by medicines. Of those actually used, the
combination spoils the effect for any clinical infer-
ences ; and indeed is ai^ unusually strange one. A
bromide simply dull3 all sensibility, morbid or
healthy; but why Belladonna.^ If this had been

230 CEREBRAL LOCALISATION.

given alone, we should have called the cure a beau-
tiful piece of homoeopathy ; for no drug causes so
much visual hallucination, and this patient's can be
exactly paralleled from its pathogenesis. One of
Hahnemann's provers, Kummer, who evidently ex-
perimented on a very sensitive woman, gives among
her symptoms — "she sees on the ceiling of the
room a white star as large as a plate, and light silver
clouds pass over it from left to right." This oc-
curred several times and in various places. We
should certainly give Belladonna when discharging
lesions affected the visual centres, and might expect
the best results.

I would direct your attention, before leaving this
case, to the seat (or seats) of the pain experienced.
This was evidently connected with the visual excite-
ment, and yet we know that the optic tract itself
has no common sensibility. As this is supplied to
the eyeballs by the fifth nerve, and as it was in them
that the pain was first experienced, we might sup-
pose the commencement of the feeling at the back
of the neck to be connected with the origin of this
nerve at the base of the brain. But why the going
across the head ? and why the subsequent sudden
attacks of pain "at the top of the head".? This I
cannot say ; and the angular gyrus, you are aware,
corresponds rather to the parietal protuberance.
But I remember a case of brain-fag in which I was
consulted, and where one of the symptoms was great
sensibility to light. The patient said that when he
drew up his chamber-blind in the morning, and the

"SENSOKV CONVULSIONS."

sun happened to be shining brightly, a sucldcn pain
struck through his eyes to the top of his head. (I
may mention that this symptom, with the visual sen-
sitiveness in general, disappeared under Niix vomica
30.) Whatever it means, then, I think we may hold
— provisionally at least — that the pain which the
optic tract cannot feel for itself will be referred to
the vertex.

Dr. Hughlings Jackson has described cases of lim-
ited paralysis and convulsion as "the results of ex-
periments made by disease on particular parts of the
nervous system of man." A case of this kind, which
displays a sort of sensory convulsion, is such an ex-
periment, and it is full of instruction. It suggests
the meaning of such as those we often encounter,
where one or more epileptiform attacks occur in a
man to whom they have been hitherto unknown, and
where there is no syphilitic history to suggest exos-
tosis, and then are followed by sudden hemiplegia.
Here some lesion, probably a small aneurism in a
cerebral artery, has first by its irritating presence
caused discharge in its neighbourhood ; and finally,
giving way, has become paralysing to the same spot.
Again, it throws great light upon the "aura epilep-
tica." You know that epileptics frequently experi-
ence, as premonitory to their paro.xysm, a sensation of
some kind, — a sight, a sound, a smell, a taste, or the
"aura" strictly speaking — a feeling as of a breath
of cool air along a limb. In all cases, the sensation
becomes more intense as the fit draws on, and — if its
nature allow — will seem to be approaching the brain.

232 CEKEDRAL LOCALISATIOX.

The aura will ascend the limb, the supposed object
of sight will advance. A patient of mine used to see
a pair of white wings drawing rapidly nearer to her
from the other end of the room, and as they reached
her she lost consciousness, fell, and became con-
vulsed. In the light of what we have learned it is
evident that this means a state of instability of some
sensory centre, leading to recurrent discharges, which
ultimately affect the motor apparatus, but first shew
themselves in the sensations proper to its own en-
dowment.s, — these being, by a well-known law, re-
ferred to the periphery first of all or undergoing a
corresponding increase in intensity. Sometimes, in-
deed, the aura (not then strictly to be so called) is
motor from the outset, and consists in twitching —
say — of a thumb or finger of the arm which is ulti-
mately the main scat of convulsion.

When these aura^ were first studied, the idea of re-
flex action was dominant, and it was su])posed that
something could be done by dividing nerves along
which they seemed to proceed, or forcibly compress-
ing the limb above them. No constant result fol-
lowed these attempts, and we see how it must have
been .so. They were but peripheral expressions of
central irritation. If anything was done, it was by
indirectly modifying this ; and such practice must be
very uncertain. We should have a much surer and
finer road to the affected part if we possessed drugs
which have .shewn themselves capable of arousing
similar subjective sensations. When any such symp-
toms have occurred in pathogcncsy, we should note
them, and may be able to turn them to good account.

CARBOLIC ACID IN HVPEROSMIA. 233

For instance, Carbolic acid has shewn a power of
enhancing the olfactory sensibility. In two of its
provers this occurred from simply smelling at the
acid ; it was associated with the frontal headache of
the drug, and — when it once came on — lasted for
hours. In another it resulted from involuntary ex-
posure to the vapour, and was intense, making the
presence of any odorous matter intolerable. In a
case I have myself observed, a prolonged inhalation
caused all food to smell badly for weeks after. Well :
it was perhaps a small matter that this symptom en-
abled me to remove with the drug a frequently-recur-
ring headache in a lady not subject to such trouble.
There was nothing distinctive about the pain ; but,
she said, whenever it comes, everything seems to
smell too strong. Carbolic acid 12 rapidly and per-
manently checked the attacks. But, on another oc-
casion, a clergyman consulted me with this story.
He had been in fair health till some months previ-
ously, when he had incurred measles. On recovering
from this, everything with any odour had begun to
smell disagreeably to him. This had increased to
such a degree that he could not take adequate food
from the di.sgust it caused him : he had lost many
pounds in weight, and was getting weak. It was not
a case of oza^na, for there was no discharge from the
nostrils, and no offensive odour of the patient's breath
or nasal mucus. I could only conceive that the
morbillous catarrh had in some way affected the ol-
factory nerves ; and I prescribed Carbolic acid. As
he said that he was an old homoeopath ist, and very

234 CEREBRAL LOCALISATION.

sensitive to medicinal action, I gave him the 30th.
At the end of a week he reported improvement ; and
in three weeks time he had lost all his bad smell,
and was enjoying his food like any other man.

Now with this action of Carbolic acicl, thus ob-
served and thus verified, if we had a case of epi-
lepsy in which the premonitory symptom was a
subjective odour, I think we should be justified in
expecting the best results from it.

At our next meeting I shall hope to draw out
more fully the possibilities of drug-action in con-
nexion with the localisation of nervous function.

CEREBRAL LOCALISATION AND DRUG ACTION

{coniinued).

Several times already, in our study of cerebral
localisation in its pathological and clinical aspects,
we have touched upon its connexions with drug-
action. This evening I propose to concentrate your
attention on this branch of the subject. It is that
which especially belongs to us of the homoeopathic
school ; and we are disposed to maintain that it is
at least not inferior in importance to any other. We
frankly acknowledge the industry and acumen with
which the subject at large has been worked out by
our brethren in the other camp ; b^t, save for prog-
nosis, and for an occasional tentative surgical opera-
tion, they must feel that the knowledge gained has
done little for therapeutics — that one great end of
the physician. Let it be ours to emulate their zeal
and to utilise their results by seeking to make them
fruitful in this direction. The law of similars ena-
bles us to do this. We have acquired a better
understanding of a group of morbid phenomena :
let us find parallel facts in the physiological action

235

236 CEREBRAL LOCALISATION.

of drugs, and unlimited possibilities open to us in
the way of benefit.

I. I have spoken of Hughlings Jackson's "dis-
charging lesions " — of those which cause instability
and morbid outbursts of function on the part of the
gray matter in their vicinity ; and have shewn that
this instability, being a purely dynamic disturbance
— an irritation, ought to be under medicinal control.
We have seen two instances of it, — the twitching,
cramps, spasms of paralysed limbs, ultimating in
permanent contracture, which arise from the effect
on the cells of the anterior cornua of lateral sclerosis
of the cord ; and the subjective visual disturbances
resulting from a tumour adjoining the angular gyrus.
In the latter case Belladonna, which would have
been our own remedy, was one of the drugs admin-
istered with good effect : in the former Strychnia,
known to increase the symptoms, and obviously
homoeopathic to them, has already acquired some
repute against them, and in our hands may fairly be
expected to accomplish more.

I. Looking farther in the same direction our atten-
tion may be drawn to the disease known as loco-
motor ataxy — the "tabes dorsalis" of Romberg,
who was the first to describe it. The clinical history
of this spinal affection you have doubtless learned
from your teachers, and I will only go over the
ground again so far as to remind you of a point in
its pathology. It used to be spoken of as a sclerosis
of the posterior columns of the cord. But localisa-
tion has been at work here also, and has shewn that

under this anatomical name there are comprised at
least two distinct tracts of nerve-fibres. The one
pair is immediately contif^uoiis to the posterior me-
dian fissure: they are called the columns of Goll,
The others, known as the columns of Burdach, inter-
vene between those of Goll and the posterior nerve-
roots. It is in these last — the columns of Burdach
— that the sclerosis which lies at the bottom of the
phenomena of locomotor ataxy is primarily seated,
and to these it may be limited.

Now it is well known that, as Hammond says,"
"locomotor ataxia often spontaneously remits in the
severity of its symptoms : indeed, the remission may
at times amount to a complete intermission." This
intermission seems sometimes to have been obtained
to so prolonged a stage as to warrant belief in a cure
by the internal use of nitrate of silver; and of late
has been frequently secured by the process of stretch-
ing the sciatic nerves. It seems hardly conceivable
that, .spontaneously or by such measures of our art, a
degeneration like sclerosis can alter for the better,
however its progress may be checked. There must
therefore be some fluctuating, functional, dynamic,
and therefore modifiable element in the disease. Its
primary manifestations are (I speak of the ordinary
form) in the sensory nerves of the lower extremities,
these being the seat of lightning-like flashes of neu-
ralgic pain — the douktirs fitlgitrautcs of the French,
and of loss of function. By the suspension of reflex
activity thus induced the muscular coordination

■ Diseases «J III! Nirious System, -,\\\ cd., sub mi.

238 CEREBRAL LOCALISATION.

necessary for standing and walking is impaired, and
hence the gait which gives the name " ataxy " to the
disease. These pains and this anaesthesia are ordi-
narily set down to compression of the fibres of the
sensory roots, as they pass through the hardening
columns on their way to the gray matter of the
cord. But, if so, how could there be any variability
in them, any long suspension or permanent removal
of them ? Is it not far more likely that the trouble
lies in the cells of the posterior cornua — the source
of the energy of the sensory roots ? The columns
of Burdach are not made up of long fibres, stretch-
ing all the way up the cord, but of short ones, com-
missural between one segment and another. They
thus arise from and end in these very cells ; and as
we have seen lateral sclerosis irritating the anterior
cornua by a similar connexion, we have a right to
invoke the same agency here.

I would submit, then, that in not too advanced
cases of locomotor ataxy, the symptoms — at any
rate the distressing pains — are due to a dynamic
irritation of the gray cells of the posterior cornua,
and may be amenable to treatment. Later, the cells
submit to the degeneration, and this extends to the
roots, and then nothing is to be done ; but I speak
of an earlier stage. The medicines I would urge for
consideration here are Agaricus, Arsenicum, and
Belladonna.

Agariais developed, in the heroic Austrian prov-
ings, a marked action on the spinal cord ; and among
the symptoms were fugitive neuralgic pains along

AGARICUS IN DOULIitJRS Ftll-GUR ANTES. 239

the spinal nerves. Dr. Dyce Brown, in a valuable
study of the pathogenesis which appeared in the
twentieth volume of the Monthly HoniaofalUic Re-
view, suggested its appropriateness to the pains of
ataxy. I have said that I could not quite follow him
here, as the inflammatory induration which lay at
the basis of these was beyond the range of action
of the drug. They answered rather, I suggested,
to those of what is called "spinal irritation." So
far I was right ; but wc have seen that the doiilatrs
fitlgiiranlcs are just an expression of such irritation,
which intervenes — as it were — between them and
the sclerosis. Dr. Brown's recommendation was
well-founded ; and Dr. Sauer, at a late meeting of
the Silesian Homceopathic Society, spoke of having
seen at least temporary benefit- from the remedy.
You will remember that the neuralgic pains of Agarl-
cus are compared to sharp ice touching the spots, or
cold needles running through the nerves, — in this
contrasted with those of Arsenic, where the imaginary
needles are red-hot.

Turning now to the drug last-named, I would say
that the "myelitis" which has been observed from
it is hardly that of locomotor ataxy, so that it has no
fundamental relation to the disease. The arsenical
paralysis, however, which is generally an epiphe-
nomenon of poisoning by the drug, is always accom-
panied with neuralgic pains and usually with loss of
sensibility, at least to everything but co!d. A similar
exemption of the sense of temperature is often seen
in the anaesthesia of ataxy, which, too, not micom-

240 CEREBRAL LOCALISATION.

monly sets in with burning pains in the soles of the
feet, and " pins and needles " or other forms of
nunibness.

Belladonna I recommend here rather on pathologi-
cal grounds, for I do not feel sure that the group of
symptoms I hav^e adduced in my Pliarmacodytiamics
will bear much weight as parallels. Its tactile anaes-
thesia is certainly not central, like that of the dis-
ease, and it has never — save in one passing instance
— caused neuralgic pain. But the grounds on which
we nevertheless administer it as an anti-neuralgic,
and with brilliant success, hold good here also ; and
I should rely on it actually to preserve the gray cells
from invasion, and so to limit and perhaps starve
out the disease. I certainly think I once made a
cure with it, in an incipient case, giving the ist deci-
mal dilution.

2. We have, I think, another example of a dis-
charging lesion in neuralgia. In this instance there
is not, ordinarily, any substantive growth or change
in the neighbourhood — any tumour or sclerosis — to
set up the discharge : the lesion is the quasi-inflam-
matory state of the gray nucleus of the sensory
nerve in which the pain resides. I assume that the
work done by the late Dr. Anstie in reference to
neuralgia has definitively proved it to be (save of
course when traumatic) of central origin. His small
volume on the subject ' is worth its weight in gold :
it is " hewn from life '* and crammed full of thought.
I differed from my old fellow-student at the time of

* Neuralgia and the diseases that counterfeit it. London, 1871.

its publication (iS/r) in maintaining tliat tlie nuclear
cells and not the posterior roots were the primary
seat of the affection, and that this was inflammatory
rather than purely atrophic : I think that if he had
lived till now he would have acknowledged the sound-
ness of my criticism. But the merit of establishing
the central seat of neuralgia was all his own ; and he
thereby rescued the malady from being a mere ap-
pendage to gout and rheumatism and debility, and
gave it a definite place among the neuroses.

Neuralgia is the manifestation of a discharging le-
sion at the origin of a sensory nerve ; it is, as another
has called it, a nerve-storm. Sometimes its lightning
may come in single flashes, as in the terrible tic-tlou-
loureux — the " epileptiform neuralgia" of Trousseau ;
sometimes in a more continuous sheet of flame, as in
the ordinary type ; sometimes, as in migraine, there
may be a complex variety of lightning, and thunder,
and rain, and wind. But, however it may appear, it
is a storm — an electric outburst. Its peculiarity
stands in its absolute localisation — its confinement
to the nucleus of one sensory nerve on one side of the
body. Why it should make this selective choice, we
cannot say: what moat concerns us is that drugs do
the same thing. "Aconitine" says Schroff "pro-
duces a peculiar feeling of drawing and pressure in
the cheeks, the upper jaw, the forehead — in a word,
in the parts supplied by the trigeminal nerve. This
feeling increases little by little in intensity, and is
transformed at first into a remittent pain which shifts
its place, later into a continued pain of considerable

242 CEREBRAL LOCALISATION.

intensity." Why this result in the trigeminus and
not elsewhere ? The drug, in Schroff' s experiments,
was swallowed, absorbed into the blood, carried about
in the circulation. Its molecules reached the nuclei
of all the sensitive nerves alike : why should that of
the fifth only undergo the morbid change which makes
it the seat of pain ? We know not ; but this we know,
that when the same nerve is the seat of neuralgia, of
such kind as to indicate Acojiite and its alkaloid, they
are as effective to cure as they are to cause it.

We have not the same evidence for the neuralgia-
producing power of Belladonna as we have for that
of Aconite, but its curative action is no less de-
cided. It is by pathological analogy, rather than
by the facial pains experienced by one of Dr. Hale's
provers of Atropia, that we must argue its homoeo-
pathicity. Neuralgia is a quasi-inflammatory condi-
tion of the gray cells at the root of a sensory nerve.
Belladonna sets up a similar morbid process in the
gray matter of the cerebral hemispheres, and there-
fore can only act as a similar here. The small dosage
required bears out the argument ; and here also the
trigeminus is the seat of the neuralgia in the great
majority of the cases it benefits.

In Aconite and Belladonna we thus have two great
remedies for neuralgia affecting the fifth nerve, and
they are types of two classes of analogous remedies.
With Aconite anaesthesia accompanies the pain, with
Belladonna hyperaesthesia. It is hardly likely that an
irritation of sensory cells so similar as in either case
to eventuate in neuralgic pain should in one produce

dimmislied, in the other increased, sensibility: it is
more lilvely, therefore, that these conditions are de-
veloped farther back and higher up than the pain, i.e.
in the sensory centres. However this may be, Arseni-
cum and Platina follow Aconite in having numbness
or actual loss of sensation with their nerve-pain ; while
Chamomilla, China, Nux vomica, and of course Hy-
oscyamus and Stramonium, stand with Belladonna.
Hydrocotyle has caused hypera^sthcsia of the fifth
without pain; while Colocynth, Iris and Spigelia
have developed neuralgic suffering without any other
modification of sensibility.

3. Our drug-action will become yet more cerebral
in its localisation if from the scat of trigeminal neu-
ralgia we pass to that of migniiiie. So much is owing
to the French physicians for their study of this mal-
ady that their form of the Greek hniiicrauia may well
pass current among us, though its old English shape
of "megrim " has much claim to adoption. It is under
this last name that Dr. Robert Livcing has described
it, in one of the best monographs with which I am
acquainted in the whole range of medical literature."

Migraine, in its most common form, is known as
" sick -headache," from two of its most constant and
distressing features. Some persons, for similar rea-
sons, describe it as "blind-headache." Dr. Liveing,
however, studying the malady more Hahnemaiimano,
has been able to construct a complete picture of its
phenomena, seen in full only in the most typical
cases, but so occurring by one, or two, or three as to

■ On Mc^iriKi, uck-hcadaiht, and simc allied tlHorJcrs. Luiiduii, 1S73.

244 CEREBRAL LOCALISATION.

leave no doubt of their coherence one with another
and with the essential disease. "The forms of me-
grim " he sums up " range from the simplest hemi-
cranial pain, transient half-vision, or sick-giddiness,
to cases which present a complex assemblage of phe-
nomena and wide range of sensorial disturbance." In
a well-developed example, the attack is ushered in by
a peculiar disturbance of vision, and culminates in
headache and vomiting ; but during the culmination
there may occur numbness and tingling on one or
other side of the body, and disorder of speech or
thought, and at any time throughout the attack there
may be vertigo, hyperaesthesia and hallucinations of
the other special senses, and emotional disturbance,
especially *' a vague and unaccountable sense of fear."
The face is generally pale and sunken ; the heart is
slow and the pulse contracted.

Dr. Liveing, writing in 1873, was led by the physi-
ology of his day to find the primary seat of this
" nerve-storm " in the optic thalamus. That of ours
would bid us look farther ; and it is significant to
find him noting that when disorder of speech was
present, and numbness and tingling of one arm co-
existed (as it very often did), it was always the right
one. We, I say, should look to the cerebral hemi-
spheres — in their sensory area — as the seat of the
phenomena : we should say that the " storm " began
in the angular gyrus, and thence spread along the
other sensory centres to that of speech, at last be-
coming externalised pain with its sympathetic nau-
sea and vomiting.

IGNATIA. 245

But, hoivcver this may be, our great object is to
utilise the picture thus before us, and find medicines
truly similar to its essential features. Let us take
those of vision as a starting-point. The affection is
a blind spot, most frequently central, but sometimes
assuming the form of hemlopia ; and then almost al-
ways lateral, very rarely superior or inferior. The
blur is dark against a bright ground like the sky,
but luminous on closing the eyes ; and is generally
surrounded with zigzag coruscations, often compared
(in shape) to the bastion-work of a fortress. It
spreads peripherally or laterally, according as it is
central or hemiopic, and the vision clears at the pri-
mary spot as the obscuration widens. Its course is
a brief one, and then comes the headache. It seems
to be bi-lateral in all cases, and to be unconnected
with any change (appreciable by the ophthalmoscbpe)
in the retina.

•In searching for remedies with this clue, we are
first of all led to Igiiatin. Hahnemann observed,
sixteen hours after taking a dose, "a circle of bril-
liant white, glittering zigzags beyond the visual
point when looking at anything, whereby the letters
on which the sight is directed become invisible, but
those at the side are more distinct;" and again he
notes, after thirty hours, "a zigzag and serpentine
white glittering at the side of the visual point, soon
after dinner," In a note, he directs attention to
these symptoms as "very much resembling Hcrz's
so-called spurious vertigo." I cannot trace the ref-
erence; but should think it moat piobablc that Herz

246 CEREBRAL LOCALISATION.

was describing the visual phenomena of migraine,
of which giddiness is often a potent element. Look-
ing then to the other features of drug and disease,
we find that the headaches caused by Ignatia were
frequent and severe, though only once associated
with inclination to vomit ; that difficulty of thinking
and speaking was noted by two of Jorg's provers of
it ; and that hyperaesthesia of the special senses and
emotional disturbance are very characteristic of it.
Ignatia, therefore, would be well indicated for mi-
graine beginning with central blur and coruscations,
and going on to severe pain with such phenomena as
those just mentioned. It would be the more suitable
if the patient were of impressionable temperament ; if
the attacks were specially liable to be provoked by
emotion ; if the pain assumed the form of " clavus ; "
and if the paroxysm passed off with the emission of
a quantity of limpid urine.

Nnx vomica also has produced the visual phe-
nomena which Hahnemann compares to the " vertigo
spuria " of Herz ; ' so that it would seem as if the
Strychnia common to the two were its real exciting
cause. In its pathogenesis, however, though heroi-
cally enough obtained, this symptom has not appeared ;
and our wisdom will be, for the present at least, to
use the matrix drugs. We thus moreover get two
remedies instead of one ; for you know that Nux
vomica and Ignatia have many points of distinction.
The patient whom the former suits is one of different
temperament and habits from those which call for the

* Mat, Med, Pura^ tr. by Dudgeon, S. 145.

DTGITAIJS. 247

latter; anil (remembering how it is indicated for
bra in- workers) it is noteworthy how many men of
high intellectual power — Woolastun, Herschel, Airy,
Lebert, Du Bois Reymond — have furnished narra-
tives of their personal e-xperience with migraine to Dr.
Liveing's book. The Nux vomica migraine would,
from its pathogenesis, have more vertigo about it
than that of Ignatia, as much hyperesthesia, but less
strictly emotional excitement, — if anything of this
kind were disturbed, it would be what we call the
"temper." Errors in diet might well be its exciting
cause; but I do not think that any stress mnst be
laid on vomiting in the course of it, as only once has
the headache of Nux had this concomitant, and then
it came on after dinner, and was sour, — very different
from the way it occurs in migraino.

When first the visual symptoms of migraine were
definitely described in our day, they recalled to sev-
eral the results obtained by Purkinje with Digitalis.
Experimenting on himself on two occasions with the
extract and infusion, he both times noticed much
flickering before the eyes, and on one occasion thus
describes his experiences : — "The figures which the
flickering formed were called flickering roses, because
the form of the rose was the type : in the first ex-
periment there were round spots in the field of
vision, the space circumscribed by four deep oval
lines forming four large convex indentations, and
the waves of light and shade surrounding this exhib-
ited the same form only less indcntated. The flick-
ering figures whicb appeared on the second day, and

248 CEREBRAL LOCALISATION.

which reached their height on the third, were sur-
rounded by curved lines with five indentations, but
more superficial, which were again surrounded by-
enlarging waves of light and shade with superficial
indentations. During the latter days, when the flick-
ering decreased, there were noticed only fragments
with the rose formation on the side, like the small
segment of the larger and more superficially inden-
tated circle." Now one may agree with Dr. Liveing
that the resemblance between these " roses ** and the
** fortification pattern " of migraine is not striking, but
it is near enough to call attention to the drug, and on
looking farther we find in its visual and other symp-
toms a close parallel with the disease. In a patient
of Baker's taking it muscae volitantes were seen be-
fore the eyes on looking at distant objects, which,
when the eyes were covered, became luminous. Dr.
Brunton, when proving Digitaline, saw a large bright
spot advancing before him ; and our own Baehr,
under the same circumstances, had the upper half of
his field of vision covered with a dark cloud. In him,
moreover, a parietal headache set in in the morning,
became worse in the afternoon, and " increased in the
evening to a violent migraine." This was not indeed
an unprecedented occurrence with him, but it was
different from his ordinary attack in that then it was
always at its worst in the morning on rising. Head-
ache, moreover, often severe, is a frequent symptom
of both Digitalis and its alkaloid : vertigo is no less
marked from it ; and its vomiting is of cerebral ori-
gin, slow of coming on, but, when excited, severe

CVCI-AMEN. 349

and long lasting. Remember also the slow pulse of
migraine, and tlie pale face and contracted arteries
— the last being so often a marked feature as to lead
Dii liois Reymond to suppose the disorder a vaso-
motor neurosis ; and you have in forms of it fre-
quently appearing a complete picture of the effects
of Digitalis.

Again, of the Austrian provers of Cyclamen, seven
had more or less obscuration of sight, and four had
flickering before the eyes. One of these, whose
eyes were "weak" and required glasses, had this
symptom — after two doses of the drug — for six
days in the right eye, for three weeks (though less
severely) in the left. It began, too, witfi violent
headache, which lasted unchanged for two days, di-
minished on the third, and disappeared on the fourth.
At one time he speaks of seeing a '"luminous ball"
before the eyes : at another, " with the eyes opened
or closed, he seemed to see at a distance of about
two feet a dark disk, as large as a twogroschcn piece,
which seemed frequently to be pierced by brilliant
lightnings." Vertigo and mental confusion appeared
in the provers, and have been verified by a good
cure. In this case they occurred in a woman at the
climacteric ; and Dr. Eidherr had long before given
us several cases in which the head and eye symptoms
of the drug had co-existed with catamenial derange-
ments such as it causes, and which had yielded to it.
Cyclamen therefore should be useful in migraine
occurring in such subjects and under such circuni--
stances ; and especially where its character was such
as to lead to its being called " blind-headache,"

..i—l

250 CEREBRAL LOCALISATION.

The last medicine I have to mention in connexion
with this malady is the Iris vcrsicoloK I have noth-
ing to add to what I have written of it in the last
edition of my P hannacodynmnics ; but as it was the
" blur before the eyes " preceding a sick-headache
which first led to its employment in true migraine,
it could not be omitted here.

I have made no attempt, in this little study, to
mention all the remedies applicable to migraine. I
know the value in it of Belladonna, Calcarea, Sepia ;
of Sanguinaria, Silica, Stannum, and of Zincum sul-
phuricum. My aim has been simply to show how
the finer pathological study of the present day can
be utilised in our practice, by associating therewith
the knowledge we possess of the physiological action
of drugs. If sick headaches are at all as common
with you as they are on our side of the water, you
will not regret the time spent on the study of some
less common, but not less promising, remedies for
the aid of their victims.

4. Finally, the whole subject of the ** aura epilep-
tica '* must be studied in its relations to drug-action.
There is in Dr. Hammond's Diseases of the Neiiwiis
System a copious list of these, taken from a French
source, and arranged with regard to their apparent
place of origin. No better subject could be taken
for a graduation thesis than a comparison of this list
with the Materia Medica, and an exhibition of the
results. It might fairly tend to make our therapeu-
tics of this obstinate malady more uniformly and
permanently successful.

ACONITE. 2S'

II. I pass iiow from forms of di.sease to individual
medicines, noting any relation their action may have
to the localised functions of the cerebral cortex.

I. Of Aconite I have said enough in relation to
trigeminal neuralgia ; but its anaesthesia yet demands
a word. Liegois and Hottot, as also Ringer and
Mnrrell, have from their e.\periments come to the
conclusion that it produces this effect by acting on
a supra-spinal sensory centre. Hitherto this has
been assumed to be the optic thalamus ; but now
the tactile cortical centre may lay equal claim to
being the seat of its influence. And what lends
support thereto is the marked emotional excitement
characteristic of the drug. Hahnemann's "anxious
impatience, unappeasable restlessness, and agonised
tossing about" will be remembered, and also the
fear of death well known to indicate it in many dis-
orders. Dr. Samiiel Potter relates ' a partial prov-
ing of the drug which will illustrate this. In the
course of the well-known Milwaukee experiments,
he was supplied with ten undistinguished vials, one
of which contained Aconite in the 3rd cent, dilution,
and he was to identify it (if he could) by its distinc-
tive effects. He took frequently re[Teated doses from
one of them, in a short time began to experience agi-
tation, anxiety (wholly causeless) about an absent rela-
tive, and finally such impressionability that the least
thing made him start, work became impossible, and
he had to go to bed. A similar trial of the contents
of the other vials produced no such effects, and he
decided (rightly) on the first as the medicated one.

> Haha. Monthly, Sqil., iSSo.

252 CEREBRAL LOCALISATION.

2. Belladonna plays so large a part in nervous dis-
orders because it induces inflammatory irritation of
the gray matter of the nervous centres. This doc-
trine — which was only a clothing in the language
of modern pathology of a conception universally
current in the school of Hahnemann — has been
supported by the researches of Dr. Harley. He
rejects the terms " narcotic '* and "sedative" hith-
erto in use to describe the neurotic influence of the
drug, and substitutes '* excessive stimulation of the
nerve-centres, attended by increased oxidation " as
accounting for the whole of the phenomena pro-
duced by it. As the hyperaesthesia it causes in the
sensory sphere and its jactitation in the motor are
accompanied by ideational disorder in its delirium,
there seems no doubt of its action being on the cor-
tical centres. I need not remind you of the num-
ber of therapeutic applications -which this action
explains.

With Atropia, the so-called "active principle" of
Belladonna, the inflammatory character of the symp-
toms is much less pronounced, though it is there.
Michea, who gave it largely to epileptics, compares
the symptoms it produces, in cautiously-increased
doses, in the muscles of articulation and of the ex-
tremities, to those which occur in the early stages
of the general paralysis of the insane ; and relates
a case in which the diagnosis between these two
interpretations was difficult.

3. Cannabis Indica — the hemp of Hindustan —
developcs a peculiar resin known as haschisch, which

CANNADIS [NDICA. 253

is eaten or smoked throughout the East (the practice
is not, I have lately read, unknown in the West) for
its narcotic qnalities. The intoxication it induces is
characterised chiefly by (as I have written) "an
intense exaltation, in which all perceptions and con-
ceptions, all sensations and emotions, are exagger-
ated to the utmost degree. Distances seem infinite
and time endless ; pleasure is paradise itself, and any
painful thought or feeling plunges at once into the
depth of misery. Hallucinations of the senses are
common ; and the least suggestion will set going a
train of vivid mental illusions." That the seat of the
drug's action is the cortex cerebri is pretty evident ;
but is confirmed by there often being an accompany-
ing headache, with sensation as of the brain boiling
over, and lifting the crania! arch like the lid of a tea-
kettle. Now you may be aware that in the disease
just mentioned — "general paralysis of the insane"
— one of the earliest mental symptoms is a mor-
bid exaltation of the ideas, leading to notions and
schemes of extravagant grandeur. The lesion seems
to be an inflammation of the gray matter of the hem-
ispheres and of the neighbouring membranes. It is
not certain in which the mischief begins ; but even
were it in the meninges, the cerebral irritation would
be like that which causes contracture in lateral scler-
osis, and might be greatly modified by the remedy.
I would add that Purkinje experienced a simUar exag-
geration of the perceptions of time and distance from
Nux moschata, and that the neurotic effects of this
drug — which have as yet hardly been utilised —

254 CEREBRAL LOCALISATION.

correspond well to a somewhat more advanced stage
of the malady.

4. I did not mention Cocciihts while speaking of
migraine, because it does not cause the visual symp-
tom of the disorder, for which, nevertheless, it is a
leading remedy. The fact is, it covers its motorial
side alone, Cocculus having apparently no action on
the sensory tract of the cranio-spinal axis. It is
therefore indicated when migraine occurs under the
form of ** sick-giddiness " only, and when vertigo and
vomiting (often with slow pulse) form the leading
features of the more fully-developed attack. I have
given in my Phai'inacodynmnics a beautiful cure of
Dr. Black's illustrating its action, which would ap-
pear to be exerted mainly on the cerebellum and its
associated centres, as shewn by the character of the
convulsions excited by its alkaloid picrotoxine. These
are semi-circular and backward movements, and roll-
ings over on the axis of the body, such as have been
observed from experimental injury to the crura cere-
belli (not "cerebri," as misprinted in my book), and
from electrisation of the cerebellum itself.'

5. This, as well as alphabetical order, leads me
here to speak of the influence of Coniiim over the
optical part of the mechanism of equilibration. That
the visual impressions proper for this function may
be conveyed to the cerebellum, it is necessary that
the axis of vision as preserved by the ocular muscles
should be correct. Conium paralyses these, and
hence the giddiness on every fresh adjustment of

* Ferrier, op, cii.y p. 98.

CONIUM. 25s

focus observed by Dr. Harley, and occasionally such
symptoms as those experienced by Dr. Edward Cur-
tis. After taking half a drachm of Squibb's fluid
extract, he could not walk across the room ivith his
ey€S open without giddiness, reeling, and feeling as
if he would vomit ; but directly he closed his eyes
all the symptoms passed off, and he could move
safely.* This explains the benefit obtained in threat-
ened sea-sickness from shutting the eyes, or at any
rate not looking at the swaying boat and waves. In
^ this connexion let me remind you that Quinine and
Salicylic acid exercise a similar influence as regards
the part played in equilibration by the semi-circular
canals of the ear; and that here the pathogenetic
effect has been turned to good account, both reme-
dies having been used with advantage in Meniere's
disease in its curable stage.

6. The emotional erethism ^caused by Chanioinilla
and Coffca (with some other vegetable medicines) on
the one side, and by lodimn and Mercnrius qu the
other, seems referable to action on the sensory region
of the cortex, for in all it coexists with great sensi-
tiveness to pain. With the former it is functional
only, but with the latter (especially with Mercury)
it may be the beginning of organic disease, i.e. of
softening. It is worthy of note that insomnia charac-
terises all. Sleep, whatever be its cause, is certainly
a function of the brain proper : only consciousness
can become unconscious, as only life can die. The
mental condition induced by Iodine and Mercury is

■ Allen, sub voce.

2S6 CEREBRAL LOCALISATION.

little known, and should be studied : it may often
guide us to these profoundly acting drugs at the
commencement of serious brain disease, and arrest
it ere it has gone into substantive change.

7. And now a few words on Santonine, Every-
one knows the xanthopsia — the yellow vision pro-
duced by this drug, and you are probably aware that
in higher degrees of its influence the colouring is
violet. These, however, are visual illusions^ which
disappear with the objects on closing the eyes, and
are due to alterations in the pressure of blood at
some part of the optic tracts. But Santonine pro-
duces also visual hallucinations, seen just as well with
the eyes shut, and independent alike in time, in fre-
quency of occurrence, and in degree, of the illusions.
Dr. Edmund Rose, of Berlin, who has studied these
phenomena very fully, shews that they must be of
cerebral origin ; and points in confirmation to con-
comitant hallucinations of other senses — touch,
sight, taste, not hearing, with the evidently sympa-
thetic vomiting, and the commencement of the con-
vulsions (when they occur in poisoning by it) in the
muscles supplied by the cranial nerves. A fellow-
professor has spoken of experiencing some mental
incoherence from it ; and Dr. Farquharson, of Lon-
don, who tried it on himself, writes — "The best-
marked symptom was a feeling of profound and
most unusual depression, accompanied by so much
irresolution and want of confidence in my own pow-
ers as to render me quite unfit for work of any kind,
'nvariably followed even a single five-grain dose,

#7^1 •

SANTONINE. 25/

and, beginning with dulness and heaviness, ran on into
very much the sort of melancholia which I imagine
jaundice must produce/*

This marked action on the brain ought to be util-
ised.* That it can be appears from some of the eye
cases treated by Drs. Ogston and Dyce Brown, among
which cerebral amblyopia and paralysis of the motor
oculi were greatly benefited, and concomitant head-
aches removed. It evidently acts on the sensory
portion of the cortex cerebri.

As this will be the last time we shall study individ-
ual drugs together, I will ask your attention to one
feature in our mode of proceeding which I think wor-
thy of notice. It has been very common of late to
hear it said that drugs ** have " such and such symp-
toms, or that we find these *' under them ; " without
any heed being taken as to how the drugs got the
symptoms, or how the symptoms came under the
drugs. Now this practice may be convenient, for
brevity's sake ; — but I venture to object to it as peril-
ous. Had we a pure and sound Materia Medica, it
might be indulged in ; but in our present confusion
of genuine and imaginary, of pathogenetic and clini-
cal, of real experience and wholly supposititious infer-
ences, it is most unsafe. Our only security lies in
ascertaining the source of any asserted drug-action

• Dr. Heber Smith, who was present at this lecture, afterwards infonueci
me that he had obtained striking and peimancnt benefit from Sant<jnine in a
case of recurring occipital headaches of much severity, accompanied by
visual hallucmations us of red fire-balls movnig about. He gave the 2x
trituration.

258 CEREBRAL LOCALISATION.

wc wish to Utilise, and — if we are writing for or
teaching others — in stating it. To do so may often
involve periphrasis ; but this is one of the cases in
which the shortest cut is the longest way. To make
sure of our ground before we stand on it is the
wisest course to follow when we are threading a
morass.

And so we are brought back to the state of our
Materia Mcdica, and the need of reform therein,
which was broached in our fourth lecture. In the
next and concluding one I purpose taking up the sub-
ject anew, and shewing more in detail what is our
present position, and what our prospects and means
of remedy.

XII.

THE FUTURE OF PHARMACODYNAMICS.

As an introduction to the third volume of his Ma-
teria Mcdica Pnra {\^\. ed. 1816, 2nd ed. 1825), Hahne-
mann prefixed " An examination of the sources of the
common Materia Medica." In this scathing criticism
he passes in review the current methods of arriving
at the knowledge of the value of medicines, and ex-
poses their utter inefficiency. He discusses the as-
cription of general therapeutic virtues, as when drugs
are styled resolvent, tonic, and so forth ; the infer-
ence from sensible properties, as those of the bitters
and aromatics, or from chemical qualities ; and the
usns in morbis, shewing conclusions from this source
to be vitiated by polypharmacy and lack of individ-
ualisation. Such sources, he concluded, were turbid,
and a Materia Medica drawn from them was unwor-
thy of confidence. It was full of error and falsehood ;
and " error in the most serious and important of all
earthly vocations, the healing of the sick, must have
the most grievous consequences;" while "falsehood
here is the greatest of crimes, being nothing less

than high treason against humanity."

259

26o THE FUTURE OF PHARMACODYNAMICS.

These were strong words, but they criily expressed
what Hahnemann sincerely felt. Nor had he con
fined himself to feeling, or to shewing the worthless-
ness of the existing material. He had learned and
taught the more excellent way of arriving at the
knowledge of medicines, viz. : by ascertaining their
action on the healthy body ; and he had made some
progress in such ascertainment, and in communicat-
ing its results to the profession. Before he died, he
had published ten volumes containing pathogeneses
of drugs — six of the Materia Medica Puray four of
the Chronic Diseases. The impetus he gave to the
work of proving drugs has continued to this day
among his own disciples, and has spread even among
the followers of traditional medicine, so that his ten
small octavos, with their ninety three mecjicines, have
expanded into the ten large ones of Allen, with their
seven hundred. Our quantity of material is unques-
tionable, — but it is necessary that we keep strict
watch over its quality : ever and anon, if we would
follow Hahnemann, we must institute an "examina-
tion into the sources of the common Materia Medica.*'

The mastcr^s way of proceeding, in his day, was to
plunge at once into criticism. In ours, we shall do
more wisely to begin by laying down principles,
which shall serve us hereafter as standards for judg-
ment. Assuming, then, that the best way of learn-
ing the action of medicines is the investigation of
their effects in health, we have two classes of organ-
isms on which these can be ascertained — the lower
animals, and man himself.

EXl'EKIMENTS ON ANIMALS, 26[

I. There was a time when the corpus vile of brutes
was thoiLght the only ground on which ^rf cxpcruHen-
tuui : and even now it plays by Ear the largest part
in the jiharmacological research of the profession
at large. If this were sound practice, Hahnemann
woidd be somewhat discredited ; for he, recognising
that it was available, deliberately rejected it. Hut
have his arguments against its adequacy ever been
answered t The first is that the effects of drugs are
different on them and on us, and different as between
themselves. " A pig can swallow a large quantity of
nux vomica without injury, and yet men have been
killed with fifteen grains A dog bore an ounce of
the fresh leaves, flowers and seeds of monkshood :
what man would not have died of such a dose?
Horses eat it, when dried, without injury. Yew
leaves, though so fatal to man, fatten some of our
domestic animals. . , . The stomach of a wolf poi-
soned by monkshood was found inflamed, but not
that of a large and a small cat, ]X)isoncd by the same
substance." Thus Hahnemann, and similar facts have
come to light in later times, among which I may
mention the impunity with which the rabbit may be
fed for days upon belladonna leaves. The argument
from them has been urged afresh in the forty-first
volume of the British Journal of Homaopathy, and
shewn to be borne out by the contradictory results
of recent ]>harmacological research on animals.
. The second objection is yet more destructive: it
5 that we cannot obtain subjective symptoms from
dumb creatures, and we have seen how important

262 THE FUTURE OF PHARMACODYNAMICS.

these are in the knowledge — for curative purposes
— of disease, and therefore also of drugs. We may
point this objection by the instance of Aconite. In
experiments on animals, loss of sensibility of the
surface is often noted : hence the drug is supposed
to be an anaesthetic, and suited for employment in
neuralgia and other simple pains, for which it must be
given in physiological doses, or — when the affected
parts can be reached — applied locally. But con-
sult human poisonings, or, still better, provings, and
another tale is told. While the surface may be in-
sensible to external impressions, it is not so to the
patient's own consciousness It is an ancesthesia do-
lorosa from which he is suffering, and one which — as
we have seeji in Schroff's provers — may develope
into actual neuralgic pain, to which therefore Aconite
is truly homoeopathic, and which it will cure by inter-
nal administration and in non perturbing dosage.

These objections arc surely fatal to any exclusive
or even predominant reliance on exjxM-iments upon
animals, for ascertaining the properties of drugs.
But on the other hand they have a place, which
Hahnemann was ready to acknowledge (thirty years
before Majendie began their systematic institution),
and which the provings of his school, when thorough,
have always given them. Besides the induction of
the more violent effects of the drugs, and the ascer-
tainment at will — by autopsies — of the lesions they
set up, we can learn upon these subjects the result of
their long continued employment in doses sufficient
to change without killing. In this way Wegner has

POISOxMXGS. 263

discovered the power of Phosphorus to induce a plas-
tic irritation of periosteum and of the interstitial tis-
sue of the stomach and liver, and Kugene Curie has
shewn Bryonia capable of exciting pseudo-membra-
nous deposit and Drosera that of tubercle. Again,
experiments on animals lend themselves to analysis
and interpretation. Dr. Lauder Brunton has well
shewn how in this way the rapid circulation of Atro-
pia has been proved to be due to paresis of the termi-
nal extremities of the vagi in the heart ; and the
opposite effect of Digitalis has been demonstrated
to result from stimulation of the same inhibitory
fibres at their origin. It is not always that here le
jen vaut la chandelle — that we take much by our
knowledge ; but, assuming it to be worth having, it
is certainly from experiments on animals that we
must obtain it.

ir Such experiments, then, being of subsidiary
value only, we turn to the action of drugs on the
human body as the main source of our knowledge of
them. This knowledge must be gained in pharma-
cology, as in all other sciences, by observation and
by experiment.

I. Observation, in the present instance, has for its
field poisoning of healthy and over-dosing of sick per-
sons ; and each of these sub-divisions requires sepa-
rate discussion.

a. Poisoning is obviously limited to the comixira-
tively small class of drugs sufficiently virulent to
produce such effects. Here, however, it is of great
value. It supplies the more violent disturbances and

264 THE FUTURE OF PHARMACODYNAMICS.

the post inoricm changes induced by medicinal sub-
stances better (because more surely) than experi-
ments on animals can do : it aids us greatly in arriv-
ing at the lesions they can produce, and in obtaining
correspondence of seat between drug-action and dis-
ease. Records of poisonings and works on toxicol-
ogy have therefore been always largely employed,
from Hahnemann downwards, in the construction of
our pathogeneses; and nothing can be said against
this source of knowledge save that it is, as it were,
illegitimate. Poisonings are the product of crime or
of carelessness, and in the progress of society should
become more and more rare; so that we may not
lean too confidently upon them as materials of future
information.

b. Over-dosing may also be said to be a remediable
error ; but as long as traditional medicine is prac-
tised it will be liable to occur again and again, as it
has occurred in the past. The object of both anti-
pathic and alloeopathic medication being to induce the
physiological actions of drugs, these are continually
being observed ; while even in ** alterative " treatment
the ponderable doses deemed necessary, and the oc-
casionally quick susceptibilities of patients, determine
the eliciting of collateral effects. The older treatises
on Materia Medica draw largely on such observations,
partly for knowledge as to pathogenetic action, and
partly for warning against excessive dosage. The
obvious weakness of effects so obtained is the uncer-
tainty which belongs to them, owing to their exhib-
iter being already the subject of disease. Of course,

if this be of a dufinite and limited character, ;
sisting with fair general health ; and if all symptoms
conceivably resulting from it, or occupying the same
seat, are excluded, and likewise all phenomena pre-
viously observed in or by the patient during his ill-
ness, — then pathogenetic effects may be taken from
the sick almost as safely as from healthy persons.
Some of our best records of the symptoms produced
by atropia, as those of Grandi, Micht^a, and Lussana,
have been in this manner obtained ; and without it
we should know next to nothing of the physiological
action of the bromide and iodide of potassium and of
salicylic acid.

2. We come now to experiment, which here, as in
other departments of research, should be our princi-
pal resource. Very little use, however, had been
made of it up to the time of Hahnemann. Haller's
insight had perceived its need ; and he had written
— "It is upon the healthy body first that the medi-
cine, free from any foreign admixture, is to be tested ;
its taste and odour to be ascertained, and then, small
doses being swallowed, their effects to be fully noted,
how the pulse behaves, how the temperature, how
the breathing, how the excretions." Hut his words
had fallen on barren ground ; for there is no trace of
any connexion between them and the few provings
which were extant at the end of the last century,
Stoerck (1750-1760} had swallowed a few doses of ac-
onite, conium, and colchicum, — merely, however, to
ascertain whether and how far they could be admin-
istered with impunity. Alexander {1768) had tested

266 THE FUTURE OF PHARMACODYNAMICS.

on his own person castor, saffron, nitre and camphor;
but here again as much to try whether these sub-
stances had any activity at all (which question in the
case of the first two he was led to answer in the neg-
ative) as to discover their "doses and effects'* if
really operative. Grimm (1767), Crumpe (1793) and
Bard (1755) had made some experiments with opium,
Coste and Willemet (1778) some with asarum, and
Wasserbcrg one with belladonna. These were the
only forerunners of Hahnemann ; and how few and
feeble were their efforts! He, on the other hand,
once persuaded of the necessity for therapeutics of
drug-provings on the healthy human body, proceeded
to institute them on the most extensive scale, and to
publish his results.

Before we go on to estimate the worth of these, let
us consider how a proving should be conducted. It
should secure healthy persons as its subjects, or such
as, from the limited seat and known symptoms of any
malady they might have, are practically so. They
should either have some medical knowledge them-
selves, or should be interrogated by a superintending
physician. They should be free from the action of
any disturbing causes, mental or bodily. Since acute
disease is generally induced by single potent causes
— a chill, a shock, a morbid poison, &c., and chronic
disease by a succession of slighter ones, the medicine
to be tested should be taken both in single full doses,
and at another time in small ones repeated more or
less frequently until some effect is obtained. To
avoid the influence of expectant attention, the

THE FRAGMENTA DE VIKIBUS 26j

prover should not know what drug he is taking.
Penally, that mere natural oscillations in health
should not be set down to the medicines, the prover
should note any symptoms observed in himself for
some days previous to beginning his experiments.
This last refinement must not be expected of Hahne-
mann, however much its absence may vitiate his re-
sults. It was not till 1871 that Dr Hamilton shewed
us * how many slight deviations from the norm will
occur in a man presumably healthy who records his
own daily feelings and donigs ; nor till 1877 that your
own Professor C Wesselhoeft exhibited the effect of
combining herewith the influence of expectant atten-
tion.^ Putting this aside for the moment, let us en-
quire how far the provings published by Hahnemann
come up to the standard we have erected. Parts of
what I now have to say have already seen the light
in divers places ; but I think it well to bring the facts
and considerations relating to the subject in one focus
to-day, that, knowing what pharmacodynamics has
for you in the present, you may follow me in the at-
tempt to state Its needs for the future.

I. Hahnemann's first publication (1805) ^^'^s his
Fragment a dc viribits vicdicaDicntorum posit iv is. It
was written, as its name implies, in Latin, and con-
tained pathogeneses of twenty-seven drugs. As its
contents were subsequently incorporated with the
larger works — mainly with the Materia Mediea Pura^
I will only say of them that the symptoms referable

* Drit. Journ of Noj/i., x\'\\.. 565.

* Trans. Amer Inst, of Horn., 1S77.

268 THE FUTURE OF PHARMACODYNAMICS.

to provings appear to have been the results of single
full doses of the several drugs, and that Hahnemann
speaks of them as having been noted ** in a careful
and sceptical manner/*

2. The Rciiic Arziicimittcllchre^ better known by its
Latin name of Materia Medic a Piira^ began to be
issued, in successive volumes, in 1811, and the first
edition was completed in 1821.^ In 1822 a '* second,
augmented edition '* began to appear, and ran on in
like manner until 1827. In 1830 and 1833 respec
lively the first and second volumes entered a third
edition, which, however, went no farther. Our trans
lation of the work thus contains the medicines of the
first two volumes in their third, of the other four in
their second revision. The dates of these are im-
portant to bear in mind, as they correspond to epochs
of Hahnemann's life, and afford a clue to the manner
in which the symptom lists were obtained.

The first edition of the Materia Medica Pnra con
taincd sixty-one medicines, besides the magnet (of
which the less said the better, though the numerous
citations from authors ' shew that Hahnemann was
not alone in supposing it to be capable of disordering
the healthy functions). In the second edition, three
more — Ambra, Carbo animal is and vegctabilis —
were added to the sixth volume (1827) ; and, in the
third, Causticum was omitted from the second vol-
ume. The total is thus sixty three. The patho-
geneses are made up of three elements, each of which
must be examined separately.

' In the second edition, 195 (out of 861 j.

iiaiint.makn's symptoms. 269

a. The first are the synijitoms voucheti for by
Hahneniaiii) himself, and which, until the third edi-
tion, occupied a separate list, — the symptoms of fel-
low-provers and the extracts from medical literature
appearing together in a second as "Observations of
Others." Those of the Fragmciita de viribiis were
elicited, Hahnemann tells us, by experiments made on
his own person and on that of others whom he knew
to be perfectly healthy — probably members of his
family We may reasonably so account of the
symptoms furnished by him to the first edition of
the Materia Medial Pura ; and, as they had probably
been obtained during the six years intervening be-
tween the two publications, we may suppose these
likewise to be the effects of single full doses.

The same cannot be said, however, of the addi-
tions made by him to the second and third editions.
Even for those of the earlier volumes, it is hardly
likely that he had instituted fresh experiments with
the same drugs on himself or his family ; and those
made on his disciples — including his son Friedrich
— are separately given. There is reason to think,
therefore, that he had already ■begun his undoubted
later practice of noting fresh symptoms appearing
in patients after drugs had been given them, and
ascribing these to the medicines they were taking.
During this period, i.e. from 1811 onwards, he was
using attenuated remedies pretty freely, so that
many of the symptoms thus obtained must have
appeared while these were being administerccl

We shall see immediately what grave objections

270 THE FUTURE OF PHARMACODYNAMICS.

lie against this mode of eliciting the supposed patho-
genetic effects of drugs. Its large use by Hahne-
mann vitiates the symptoms supplied by him even
to the Materia Mcdica Piwa, It would be a boon
if any one would have the patience to go through
our present English version with the first edition of
the original, and mark all symptoms belonging to it,
which then we might count on as genuine. Until
any have been so identified, we cannot be sure of
their not belonging to a different category.

b. In the volumes from the second (1816) onwards,
Hahnemann was able to follow up his own symptoms
with a number obtained by fellow provers, of whom
thirty-seven in all co-operated with him during the
progress of the work. They were disciples of his
who had gathered round him during his brilliant
career at Leipsic, and whom he had enlisted in the
task of proving. From his own account he appears
to have taken every precaution that they, and any
others on whom they might experiment, should be
in good health and under normal circumstances ; and
that the influence of any disturbing causes should
be eliminated by omitting, or at least bracketing as
dubious, symptoms then occurring. Dr. Hering
also tells us how carefully he examined his provers
on receiving their day-books, so as to ensure fulness
and accuracy. As regards the manner of proceed-
ing, it would seem that insoluble substances were
proved in the first trituration (centesimal of course),
and vegetable drugs in the mother-tincture — re-
peated small doses being taken until some effect was

CITATIONS FROM AUTHORS. 2/1

procluccd. An exception must be made for the three
new medicines of the second edition of the sixth
volume — Ambra, Carbo animalis and vegetabiUs, —
where, certainly in the case of the iast, and probably
in that of the first two, the third trituration was
employed.

I think, then, that — all deductions being made
for physiological oscillations and the influence of
expectant attention — the symptoms of Hahnemann's
fellow-provers in the Materia Mcdica Pnra may be
accepted as substantially genuine and trustworthy.

c. We come now to symptoms taken from authors,
which are absent from only thirteen of the pathogene-
ses, and with which the remainder are so abundantly
supplied as to raise the total to over four thousand,
about one-twelfth of the whole. These symptoms
are either general statements of writers on Materia
Medica, or observations of poisoning or over-dosing.
The first may stand for what they are worth ; but,
considering the uncritical character of most of their
enunciators, they need confirmation before having
much weight leant on them. Observations of poi-
soning are always valuable, provided the causa is vcra^
the subject healthy, and the influence of the anti-
dotal treatment allowed for. I make the first two
stipulations, because Hahnemann has included in his
pathogenesis of Cannabis sativa a number of symp-
toms observed in workers in hemp, including such
trifles as cataract, enlarged liver, ascites, cystople-
gia, incurvation of the spine, pneumonia, and mania.
Neither by the reporters, nor (I imagine) by any

272 THE FUTURE OF PHARMACODYNAMICS.

Other person in the world, were or would these per-
fectly natural disorders be ascribed to the very mild
noxa of the hemp which surrounded their subjects.

I am sorry to say that this is too faithful a speci-
men of the manner in which Hahnemann has gone
to work with medical literature. He takes a case
or series of cases treated by a drug, and sets down
as many as he pleases of the symptoms noted as
occurring in the patient from day to day as effects
of the same, without regard to the disease which is
being treated or other causes which may have been
operative. In my Soujres of tJic HoinoeopatJiic Ma-
teria Mcdica^ the substance of which is reproduced
in the second and third lectures of the fourth edition
of my P Jiarmacodynaviics, I have exhibited many
instances of this mode of proceeding, and have
shewn its disastrous results. I cannot reproduce
them here : I can only give the gross results of an
investigation in which I have consulted every author
and examined every symptom quoted by Hahne-
mann, both in the Materia Medica Pura and in the
CJironic Diseases, so far as those have been accessible
to me and these traceable. I regret to have to say
that m^ny hundreds of these citations, consisting of
symptoms observed in patients, have no more right to
be ascribed to the drugs they were taking than had
the diseases I have just enumerated to be set down
to the hemp in which their subjects were working.

I have shewn (in the same place) by extracts from
his writings that Hahnemann was not insensible to
the risk he was running in drawing from such im-

THE CHRONIC DISEASES.

pure sources ; but that the exagfferated notions he
entertained of the potency of drugs led him to set
down all the sufferings, accidents, and changes of
health occurring in patients as solely derived from
the medicines they were taking. He himself, in-
deed, describes such symptoms as "corroborative"
only; but they have taken their place in his patho-
geneses side by side with the others, and thence have
been transferred to manuals and repertories with
their distinguishing references omitted. Nor is it of
much avail to publish corrections, as has been done
in Allen's Encyclopaedia and in Dudgeon's transla-
tion of the Materia Medica Pura. " Rage during
the menses" is still quoted as an effect of Aconite,
though it has been shewn that the subject was a
maniac; and so of a Jiost of equally untrustworthy
symptoms.

3. Hahnemann's third and last collection of patho-
geneses constitutes (with the introductory essay) the
work entitled Die chrouisehcn Kraukhcitcn, "Chronic
Diseases." The first edition consisted of three vol-
umes published in 1828, and a fourth in 1830. The
second and third of these contained fifteen medicines,
all new; the fourth, with two new ones, presented
enlarged symptom-lists of five which had already ap-
peared in the Materia Medica Pura. The second
edition appeared in successive parts between 1S35 and
1839. Besides the twenty-two medicines of the first
edition it contains twenty-five others. Twelve of
these had already appeared in the Materia Medica
Pura, and the rest (with few c.-cccptions) in the Fni^-

274 THE FUTURE OF PHARMACODYNAMICS.

vieiita or in Stap['i» journal, the ArcJiiv ; but nearly all
have large additions. For all Hahnemann acknowl-
edges contributions from fellow-observers, and for
many cites symptoms from the extant literature of
his day.

Of these last I have nothing to say different fiom
what has come before us relative to them when oc-
curring in the former work. I have only to speak,
then, of Hahnemann's own contributions, and of those
of his associates.

a. The pathogeneses contained in the two volumes
issued in 1828 appear without a word of explanation
as to how the symptoms were obtained, and the
names of no fellow-observers are mentioned. The
absence of any co-operation on the part of others is
further to be inferred from what we are told of the
first announcement of the work. After six years of
solitude at Coethen (to which he had been driven from
Leipsic in 1821) Hahnemann ** summoned thither his
two oldest and most esteemed disciples, Drs. Stapf
and Gross, and communicated to them his theory of
the origin of chronic diseases, and his discovery of a
coinplctcly neiv scries of inedicaments for their cure,'*
So writes Dr. Dudgeon. That he should now first
reveal these new remedies, and in the following year
should publish copious lists of their pathogenetic
effects, confirms the inference to be drawn from h\s
position and from his silence as to fellow-observers.
He was himself between seventy and eighty years
old, and it is hardly likely that he did anything in
the way of proving upon his own person, as indeed

HAHNEMANN S CONTRIBUTIONS. 275

he makes no mention of having done. Wc are com-
pelled to the conclusion that he drew these symptoms
from the sufferers from chronic disease who flocked
to his retreat to avail themselves of his treatment.

The prefatory notices to the several medicines
still further substantiate this view, and throw some
light on the doses with which the symptoms were ob-
tained. He recommends almost all the medicines to
be given in the dilutions from the i8th to the 30th ;
and repeatedly makes some such remark as this —
*' For some time past I have given the 6th, 9th, and
I2th potencies, but found their effects too violent."
I infer, therefore, that it is these "violent effects " of
the dilutions from the sixth to the tweltth, experi-
enced by the sufferers from chronic disease who took
them, which make up the unexplained pathogeneses
of 1828. Of those of 1830-1839, Hahnemann's con-
tributions — often large — must be explained in the
same manner, save that the 30th dilution must have
been their most frequent (supposed) eliciter, as in
1829 Hahnemann had laid this down as the one form
in which all remedies should be given. I must except,
however, from this description such symptoms as be-
long to previous provings in which he had taken part,
as those of Cuprum and Mczcreum from the Frag-
vicntay and those of Anacardium and Platina from the
ArcJiiv.

It thus appears that (with few exceptions) Hahne-
mann's contributions to the pathogeneses of the
Chrouic Diseases are (supposed) effects of attenua-
tions from the sixth to the thirtieth, observed in sick

276 THE FUTURE OF PHARMACODYNAMICS.

persons taking them as medicines. As to their ori.
gin from infinitesimal quantities I have nothing to
say at present. The subject is a large and difficult
one, and demands a lecture to itself, which I have
given to it m my book. This only must be affirmed,
that there can here be no idea of overdosing in the
ordmary sense of the word. The real question is —
can we trust Hahnemann's discrimination in the mat-
ter of symptoms taken from the sick ? Our studies
among his citations from authors supply the answer.
We saw him there, as it were, at work among pa-
tients ; and found that his eager desire for symptoms,
and his over-estimation of the activity of drugs, had
led him in numerous instances to put down as path,
ogenetic effects phenomena which were obviously
those of the disease or of occasional causes. We can
have no confidence, but rather the reverse, that he
has not followed the same course in his observations
on his own patients Hence (in the first edition of
the Chronic Diseases) the thousand symptoms of Cal-
carea and Phosphorus and the twelve hundred of
Sepia — all derived from sick persons during (prob-
ably) the six or seven years of the Coethen period.
The re proving of the last medicine by the American
Institute, in which thirty healthy persons took part,
only yielded 517 symptoms as its result. Hence,
too, the increase of the symptom-list of Sulphur, from
1,041 in 1830 to 1,969 in 1839. The additions are
nearly all Hahnemann's, who certainly was not a
provcr at this time, but was (on the ground of the
psora-theory) increasingly a sulphur giver to the sick.

HAHNEMANN S ASSOCIATES. 2/7

b. Hahnemann's associates in supplying the path-
ogeneses of the second edition of the Chronic Diseases
were of various kinds. Some of them were published
books, as the Aj-zueimittcllehre of Hartlaub and Trinks
and the Matcrialicn of Jorg. Some were the men
whose work with him in earlier and better times he
reproduced in these pages But over and above
these, he acknowledges as fellow-provers for the pres-
ent work a band of later disciples; and these, it must
be believed, made all their experiments with globules
of the 30th dilution. In the edition of the Organoit
published in 1833 Hahnemann recommends all prov-
ings to be made therewith, as yielding the best re-
sults ; and from the preface to Nat rum muriaticum.
in the Chronic Diseases volume of 1830 we find that,
in the case of the three persons who contributed
symptoms to it, the practice had already been begun.
We may fairly extend the inference to all provings
subsequently made.

Here, too, I have no desire to prejudge the ques-
tion of the pathogenetic activity of infinitesimals,
though certainly any reasonable faith in it is put to
a severe strain. I only wish that you should know
with what you have to deal. I could further wish
that the development of their symptoms herewith was
the worst thing I had to say of Hahnemann's new
associates. But I fear that the demoralising influ-
ence of his practice among the sick had begun to
lead them also in the same direction. One offender
here there certainly was — one in many other respects
entitled to sincere honour, Constantiae Hering. His

278 THE FUTURE OF PHARMACODYNAMICS.

first and (T think) only appearance as one of Hahne-
mann's associates is in the pathogenesis of Arsenicum,
given as a sort of appendix to the fifth part of the
second edition of the Chronic Diseases ; and all his
symptoms were avowedly obtained from leprous pa-
tients taking the drug, of course in the 30th dilution.
Read them over, as translated from the original in
the Archiv in the nineteenth volume of the British
yoiirnal of Homosopathy (p. 633), and I am sure you
will agree that they are to be rejected. Wahle is
another of the present band of disciples who seems,
from internal evidence, to have sinned in this way,
and his symptoms must be received with a good deal
pf suspicion.

The view of the pathogeneses of the Chronic Dis-
eases now put before you was published some ten
years ago, and has re -appeared in more than one form
since. Until quite lately it has received no chal-
lenge. Two champions have now advanced to do
battle on behalf of the work, — Dr. Sircar, of India,
and Dr Pope, of England. The former, in a recent
number of his excellent Calcntta yonrnal of Medi-
cine, objects that Hahnemann expressly states that
he learnt the *'antipsoric " character of certain
substances by experimentation on the healthy. This
is so ; but the statement in question is taken from
the introduction to the second edition, which in-
cludes — as I have shewn — many medicines of the
past and the results of many fresh provings. My
contention that the symptoms were taken from the
sick applies only to Hahnemann's personal and fresh

E S VINDICATION.

279

contributions to the pathogeneses, which neverthe-
less make up their great bulk. Dr. Pope," while
allowing his inability to traverse my allegations, re.
fuses my conclusions on two grounds, — the viola-
tion of his own canons of which Hahnemann would
have been guilty had he acted as I describe, and the
verification of the symptoms of the work by clinical
experience. To the first I reply, that inconsistency
is too common in human nature for its improbability
to outweigh the evidence I have brought forward.
To the second, that (i) ! have already admitted that
the second edition, which is that in our hands, con
tains many symptoms perfectly trustworthy, and (2)
that too much stress must not be laid on clinical ver-
ification, here and there, of such extensive symptom-
lists. Since those of each polychrest contain nearly
every [Wssible variation from health, any success ob-
tained with these drugs would find reflection at some
point of their course. Again, had the curative ap-
plication of these remedies been drawn solely from
their pathogeneses, it ought to be somewhat commen-
surate with the range of these ; whereas Natrum mu-
riaticum, with its 1,345 symptoms, has become an
important remedy; while Natrum carbonicum, with its
i,oSo, IS almost unused, and many similar anomalies
might be presented. The fact is, our use of these
medicines is largely traditional and empirical (the
application, for instance, of Natrum muriaticum to in-
termittents), and has little relation to their catalogues
()f symptoms.

280 THE FUTURE OF PHARMACODYNAMICS.

1 have spent much time over these pathogeneses
of Hahnemann's, partly from the large space and pre-
rogative position they occupy in our Materia Medica,
and partly from the typical picture they present of
the rest of its material. Much of this is thoroughly
good, — as good as the provings and poisonings of
the Fragmenta and the first edition of the Materia
Medica Pura ; and, in its original form, is far better
presented. In this description I include the prov-
ings of Jorg, Martin, Schneller, Schroff, Harley and
Ringer in the old school, and of the Austrian So-
ciety, of many later Germans, of a few French and
English, and of perhaps a majority of the numerous
American workers, in our own. On the other hand,
Hahnemann's later domgs have given the impetus to
much work which must be pronounced as thoroughly
bad. Following his example, many symptom-lists
have been published as belonging to medicines, with-
out the least explanation of the manner in which
they were obtained.: the Archiv, and Hartlaub and
Trinks* AnnaUn and Arzncimittellehre^ are full of
them ; and Petroz in France and Hering here gave
a number more. The observation of symptoms in
the sick became quite common ; and these patients
afforded yet another opjxjrtunity for supplying the
Materia Medica with symptoms. Aggravations of
their existing troubles occurred from time to time
during treatment, and were of course ascribed to
the energy of the medicines they were taking ; and
these were, not without countenance from Hahne-
mann, set down among the symptoms of the drug.

I abl

I be!

Roth quotes one such instance from the Chronic
Diseases under Colocynth, and says that he has fre-
quently found the same proceeding resorted to else-
where. UuC the imitators of the master's weaknesses
have quite outdone him as regards the utilisation of
the sick for enriching the Symptomerk Codex, When
in a prover some existing deviation from health dis-
appeared during the action of a drug, Hahnemann
recorded it, adding '" Heihvirkung" (curative effect).
Only in the instance of lodium has he done this with
definite maladies (as goitre and enlarged glands)
treated with the medicine. But his disciples have
seized upon the proceeding and carried it to lengths
from which he would have shrunk aghast. They
have freely admitted "clinical symptoms" ("that
abominable fallacy" as Dr. Allen justly terms it
'• which has poisoned the fountains of our Materia
Mcdica from Hahnemann to the present time") into
our pathogenetic lists, cutting up the cases which
have recovered under the action of a remedy into
their component parts, and sowing these in the appro-
priate plots of the schema. They at first (as in
Jahr's '■ Manual") denoted such symptoms by a sign
(° or ') ; but soon grew careless about affixing it, and
at last {as in Lippe's " Text-book" and Hering's
"Condensed Materia Medica" and "Guiding Symp-
toms") avowedly omitted it altogether.

When, side by side with those proceedings, there
went on an increase of attenuation up to unimagin-
able limits, and a corresponding gobemouchcric of
belief in the energy of these wonderful potencies.

282 THE FUTURE OF PHARMACODYNAMICS.

the evil grew ever greater. It culminated in two con-
summate flowers. One was Wolf's "proving'* (!) of
Thuja, where he took a single globule of Jenichen's
i,oooth potency (i.e. about Hahnemann's 40th),' and
recorded every deviation which occurred in his health
for the next two years (including an attack of small-
pox) as the result of this violent dose. The other is
Houat's Nouvclles Donn^eSy where almost every ill
to which flesh is heir is ascribed (among others) to
those potent poisons, Robinia pseudo-acacia, Cubeba
officinalis, and Piper nigrum.* To such deliberate
vitiations as I have now depicted are to be added
those incidental to time and use — the havoc wrought
by imperfect translation and re-translation, the errors
of repeated copying, and such like. The result is
(I do not hesitate to say it) that our Materia Medica
is an Augean stable almost as foul as was the com-
mon one when Hahnemann exposed its condition,
and set himself to the Herculean task of its puri-
fication. When we add thereto the unfortunate
schematic arrangement on which I have already
commented, its evil state becomes yet more appar-
ent. It is, in great part, what some one caustically
styled Jahr's Manual^ " nonsense made difficult."

What, then, is to be done } First of all, we must
winnow the many grains of wheat which are scat-
tered through the mass of chaff which lies before
us. In pietas to Hahnemann, his work should (as I
have said) be translated as he has left it, with such

* See Brit.Journ. of Iloin.^ Jan. 1881, art. '* Dilutions."
^ Jtici.^ vol. XXV ii., 137, and xxxviii., 4.

I '

THE MATERIA MEDICA OF THE FUTURE.

editing as any similar books would receive. Eng-
land has done this for the Materia Mcilica Ptirn, antl
she looks to America to do it for the Chivuic Dis-
eases. When we have these volumes as they should
be presented, let them stand on their own merits.
Let us leave the symptoms of Hahnemann and his
associates, so far as they are only accessible there ;
and proceed to deal with the more manageable mate-
rial which lies outside it. Let this be thoroughly
sifted, — without scepticism, indeed, but without
credulity; and let what remains be presented in the
most accurate, concise, and instructive form, — repe-
titions being avoided, redundancies pruned, and all
provings given, where possible, in consecutive order,
as related by the experimenters. The student will
then have the text of his medical bible, and will have
it in genuine and intelligible form. Genuine, —
because all versions and copies will be traced back
to their ultimate original, and verified, corrected, or
reproduced therefrom ; because all clinical symptoms
and (supposed) medicinal aggravations will be ex-
cluded, and phenomena observed in patients taking
drugs accepted only on amply sufficient evidence ;
because provings themselves will be rigidly scruti-
nised, and not admitted — at least in any complete-
ness or full-sized type — unless their source and
method seem free from objection. And intelligible,
because all observations and experiments will be
related in detail, or in sufficient summary, so as to
preserve the- order of cvoUition of the drug-effects.
We shall then have a series of individual pictures of

284 THE FUTURE OF PHARMACODYNAMICS.

the morbid conditions induced by our medicines, and
— so far as they go — shall only have to fit them to
idiopathic disease, on the immortal principle similia
similibns^ to have the homoeopathic method at our
full disposal.

But then will open before us another task, that
of re-proving and fresh experiment. The very ex-
hibition of our extant material will shew many a gap
to be filled up, many a deficiency to be made good.
And further, we ought to improve upon what we
have. With our better knowledge of the natural
history of health, and of the influence of expectant
attention, to obviate self-deception ; with our in-
creased command of modes and instruments of pre-
cision ; with our enhanced acquaintance with the
order we are to disturb and the disorder we desire
to simulate, we ought to make provings greatly
superior to those even of Watzke and his fellows.
For the means of making them I would only say, Cir-
cumspice. Dr. Dake ' calls for Provers* Colleges ;
but in the Homoeopathic Schools of America you
already have a dozen of such. Let the Materia
Medica classes of these, under their respective Pro-
fessors, prove each year a single drug ; and we shall
soon have a body of experimentation of which we
may be proud.

This, however, is the work of to-morrow. That of

> The work which this physician has done in exposing the deficiencies of
our existing Materia Medica, and shewing the way to improvement, will always
entitle his name to honour (see Transactions of Amer. Inst, of Homoeopathy
for 1857, 1873, 1874, and ot World's Hom. Convention of 1876),

CONCLUSION. 285

to-day is the garnering up of our existing wealth,
and the making it immediately available. To this
task, feeling its urgency, but knowing its magnitude,
I have purposed (God willing) to devote the remainder
of my literary life. I have obtained for it the assent
and support of the British Homoeopathic Society ;
and I have come over here as its delegate to seek the
co-operation of the American Institute of Homoeopa-
thy. The invitation which, on my way, has diverted
my steps to Boston has brought me many gratifica-
tions. But I shall be best rewarded for any trouble
I have taken if I can secure for my proposals the
advocacy of those who have listened to me here, —
of students, and professors, and physicians in gen-
eral. Believe me that you will thereby be helping
forward a work which will give us quite a new aspect
in the eyes of the profession at large; which will
make acceptance of homoeopathy far readier, its
study more easy, its practice more delightful and
successful ; and so will redound to the advantage of
that common humanity for which each man should
live, and in losing his individual life for which he
most surely finds it.

INDEX.

Acidnni carholicum in hyperosmia, 233.

lacticum in rheumatism, 141, 184.

vniriaticuni in fever, 135.

phosphor icum in fever, 134.

salicylicuniy in rheumatism, 158; in Meniere's disease, 255.

Aconite, indications for in inflammation, 81, 109; Hahnemann on, 104;
liartholow on, 104; Ringer on, 105; febrigenic power of, 107;
action in fevers, 108; in pneumonia, 110; anti-rheumatic, 148; in
rheumatism affecting heart, 150; in lumbago, 150; in neuralgia,
242; action on cerebral cortex, 251.

Aconitifiey in neuralgia, 241.

Aj^ariiiis, in fever, 122; in locomotor ataxy, 238.

Air, need of pure, 31.

Alcohol, 42.

Alexander, provings by, 265.

Alkalies in rheumatic fever, 142.

Ambidexterity, 209.

Amyotrophic paralyses, 223, 224.

Angina pectoris, 78.

Ankle-clonus, 222.

Anstie, on neuralgia, 240.

Antipathy, 79.

Antipyretic treatment, loi.

Aphasia, 197.

Arsenic, as antipyretic, 124; in pernicious anaemia, 125; as anti-
rheumatic, 183; in locomotor ataxy, 239; in neuralgia, 243.

A tropin, action of, 252.

Attention, power and seat of, 210.

Baptisiciy in fever, 136.

]>ARriioLo\v, on Aconite, 104.

Uath. the cold, 29.

Kkale, researches on protoplasm by, 13.

Bell, Sir C, discovery of, 188.

287

288 INDEX.

Belladonna^ time of occurrence of svinptoms of, 8r ; action on pupil,
115; febrigenic |X)wer, 116; place in fevers 118; in scarlatina,
119; in variola, 120; action on visual centres, 230; in locomotor
ataxy, 240 ; m neuralgia, 242 ; action on cerebral cortex, 252.

Tii.AKE, K., on sewer-gas, 31.

lIui.LE, on Rhus, 167.

liKoCA, on scat of sj^eech, 199.

Brown-Sequard, on sensory paths in cord, 192.

liRUNToN, louder, on amyl nitrite in angina pectoris, 79; on action
of Atropia on heart, 263.

Bryonia^ aggravation of symptoms by motion, 81 ; in fevers, 131 ; in
rheumatism, 144.

13uRr, Physiological Materia Medica, 84; proving of Caulophyllum,
174.

Calcarea^ in deficient calorifaction, 30.

Camphor^ relation to cholera, 127.

Cannabis Iiidica^ in general paralysis of insane, 252.

Caulophyllum^ in rheumatism, 174.

Ceanot/iuSy action on s])leen, 62.

Cerebellum, function of, 189.

Cerebral localisation and trephining, 225.

Cerebro-spinal tract, 215.

Cerebrum, sole seat of consciousness, 194, convolutions of, 196;

electrisation of, 200; cortical sensory and motor centres in, 203;

frontal lobes of, 210; arteries of, 213; histology of, 217; results

of softening in, 218.
Chaffee, proving of Propylamine, 157.
Chamomilla^ hyperaesthesia of, 81, 243, 255.
Characteristics, 80.
Charcot, 213, &c.

Cliina^ as antii)yretic, 127; in neuralgia, 243.
Chiiiinum arsenicosum^ in pyaemia and septicaemia, 129.
*' Chronic Diseases," the, 273.
Cimicifui^a^ in rheumatism, 173.
Clark, Sir Andrew, on clinical medicine, 06.
Ci.AUDK, on rhythm of medicines, 81.
Climate, ^i^

Clinical medicine, 66, 69.
Clinical symptoms, 2S1.
CocculuSj in migraine, 254.
Cocoa, 40.

Coffee^ as beverage, 40; as medicine, 81, 255.
Colcliicum^ characteristic symptom of, 81 ; in rheumatism, 151.
Colocyutlty in neuralgia, 243.

Columns of Hurdach, 237; of Goll, 237; of Turck, 215.
ConiunZj action on eyes, 254.
Crotalus^ as antipyretic, 129.
Cuprum^ in amyotrophic paralysis, 225 (note).
Cyclamen^ in migraine, 249.

INDEX. 289

Pake, on the Materia Medica, 284 (and note).

Descending sclerosis, 216, 219.

Diagnosis, 51.

Dii^italis^ action on heart, 75; in migraine, 247.

Discharging lesions, 227.

Drug-experiments on animals, 26r.

Drysdai-K, on protoplasmic doctrine of life, 14; definition of specific

action, 53; on Kali hichromicum, 182.
Diilrnindray in rheumatism, 168
Dunham, Carroll, on hygiene, 23; on totality of symptoms, 54; on

Aconite in inflammations, 109; on Rhus in fevers, 134; on Kalniia

in endocarditis, 172.
Dyce Brown, on agaricus in locomotor ataxy, 239.

Kmi)iricism, 70.

Kpilepsy followed by paralysis, 231.
Epileptic aura, 231, 250.
Exercise, 25.

Eerrier, on the cerebellum, 190; on the cerebrum, 201.

Eever, nature of, 57, 92; kinds of, 58, 98; catarrhal, 94, 113; cerebro-
spinal, 123, 130, gastric, 99, 132, 136; hectic, 97, 124, 128, 137;
inflammatory, 108; intermittent, 97, 124, 127; relapsing, 49, 132;
remittent, 113; rheumatic, 140, 145, 148, 151, 154, 156, 165, 169,
176; typhoid, 119, 125, 132, 134, 135; typhus, 119, 121, 122, 125;
yellow, 130.

Fletcher, doctrine of life, 12.

Flourens, on function of cerebellum, 189.

Food, 34.

" Fragmenta de Viribus," the, r65.

Fritsch and Hitzig, experiments on brain, 200.

Gai.l, on the brain, 188, 196.
Gcheiniitniy as antipyretic, 112.
GowFRS, case by, 228.
Graves, on Belladonna, 115.

Hahnemann, doctrine of life, 16, 20; a hygienist, 22; chooses symp-
toms for disease-basis of his method, 46; scientific value of his
"totality of symptoms,** 55; relation to pathology, 60; definition
of medicines, 69; founder of experimental pharmacology, 71;
characteristics by, 81; on Aconite, 103; on Bryonia, 131; on
Rhus, r33, 164; on Ledum, 175; on Materia Medica of his day,
259; contributions to Materia Medica Pura^ 2(^\ citations from
authors, 271 ; contributions to Chronic Diseases^ 274.

IIaller, on need of drug-provings, 265.

Hamilton, on physiological oscillations, 267.

Barley, on Belladonna, 116; on Hyoscyamus, 121.

Havward, on Crotalus, 129, 130.

llEMi'EL, "Materia Medica," 84.

290 INDEX.

Henderson, Prof., on pneumonia, in.

Hepar^ sensitiveness of patient, 81.

Hering, on Kalmia, 171 ; Arsenic symptoms by, 278.

Homoeopathy, provings of, 72; Materia Medica of, 83, 28a

HoUAT, provings of, 282.

HuBER, on Mercury, 177, 179.

Hydrocotyle^ in trigeminal hypersesthesia, 243.

Hygiene, 25.

HyoscyavtiiSy as antipyretic, 120; in neuralgia, 243.

Hyperpyrexia, 96, 138, 140.

Igiiatia^ in migraine, 245.

Imbert-Gourbeyre, on Arsenic, 183.

Inflammation, 58.

I odium y 255.

Iris, neuralgia of, 243 ; in migraine, 25a

{ACKSON, Hughlings, on cerebral pathology, 226.
oussET, on life, 17; on Digitalis, 75; on Phosphoric acid, 135; cure
of anterior poliomyelitis by Plumbum, 224.

Kali hichromicum, in rheumatism, 182.
Kalviia^ in rheumatism, 171.
Kitchen, on Viola odorata, 176.

Lachesis, characteristic of, 81; in Fevers, 129.

Late rigidity, 221.

Ledum, in coldness, 29; in rheumatism, 175.

Life, 7.

LiVEiNG, on migraine, 243.

Locomotor ataxy, 236.

LuDLAM, on Veratrum viride, 123; on Caulophyllum, 174.

Lycopodiumy characteristic of, 81.

Marshall Hall, 188.
i' Materia Medica Pura," the, 268.
Medicine an art, qo.
Medicines, definition of, 69.

Alercurius, in rheumatism, 176; action on cerebrum, 255.
Migraine, 243.

Mitchell, on Baptisia, 137.
MoLiN, proving of Tartar emetic, 86.

A^atrum muriaticum, in deficient calorifaction, 30.

Neuralgia, 240.

Neuroses, the, 59.

Nitrite of amy I, in angina pectoris, 79.

Nosology, 48.

Niix mosihata, 253.

Nux vomica, in hemiplegia, 224 ; in neuralgia, 243 ; in migraine, 246,

INDEX. 291

OrganopathVt 61.
Overdosing, 264.

Paralysis, general, of insane, 252, 253.

Pathology, 60.

Pt'troz^ on Dulcamara, 168.

" Pharmacodynamics, Manual of," 84.

Phillips, "Materia Medica/* 162; on Arsenic in chronic rheumatism,

184.
Phrenology, 195.
Phytolacca^ in rheumatism, 183.
Platina^ in neuralgia, 243.
Plumlmm^ in amyotrophic paralyses, 224.
Pneumonia, treatment of, 1 10.
Poisoning, 263.

Pope, on pathogeneses of Chronic Disecues, 279.
Potter, proving of Aconite, 249.
Price, proving of Bryonia, 145.
Propylamine^ in rheumatism, 155.
Protoplasm, 11.
Proving, 265, 266.

Pulsattlla^ characteristics of, 81 ; in rheumatism, 139.
Pyaemia, 99, 129.

Quinine, in malarious fevers, 127; in Meniere's disease, 255.

Re-proving, 284.

Rest, 26.

Reynolds, Russell, on subjective symptoms, 63.

Rheumatism, 139.

Phododetidrojiy characteristic of, 81 ; in rheumatism, 170.

Phiis, characteristics of, 81 ; in fever, 183; in rheumatism, 162.

Ringer, on Aconite, 105; on Arsenic, 125.

Roth, on Agaricus, 122.

jR/ila^ in rheumatism, 175.

Salicifty in rheumatism, 158.

SantoHiiie^ cerebral action, 256.

Scarlatina, 119, 130.

Schroff, on Aconitine, 241.

Septicaemia, 99, 129.

Sewcr-gas, 31.

Sircar, on pathogeneses of Chronic Diseases, 278.

Speech, seat of, 199; acquirement of, 207.

Spi^relia, in rheumatism, 172; in neuralgia, 243.

Stramonium^ in fever, 121 ; in neuralgia, 243.

Strychnia, in hemiplegia, 224, 236.

Subjective symptoms, 62.

Sulphur, characteristics of, 82; in rheumatism, 185.

Symptomatology, 54.

292 INDEX.

Tartar emeticy proving of, 86.

Tea, 40.

Tendon-reflexes, 223.

Tessier, doctrine of life, 16; definition of maladies, 52; on Viola

odorata, 176.
Teste, on Aconite, 109; on Colchicum, 153.
Tobacco, 4r.

Todd, on the cerebellum, 189; on late rigidity, 221,
Trophic centres of nerve^fibres, 220.

Variola, 120.

Vegetarianism, 37.

Veratruvi viride^ as antipyretic, 123.

Viola odorata^ in rheumatism, 175.

Vital force, 16.

Volition, process of, 207.

Warmth, 28.

Water, 39.

Wesselhoept, C, 2t, 267.

Wolf, proving of Thuja, 282.

WuRMB and Caspar, on Phosphoric acid, 134.

LANE MEDICAL LIBRARY

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H91 The knowledge of the

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