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"N 


THE 


MONTHLY  HOMCEOPATHIC  REVIEW. 


Edited  by 


ALFRED    C.    POPE,    M.D., 
D.    DYCE    BBOWN,    M.A.,    M.D., 


AND 


EDWIN    A.    NEATBY,    M.D 


VOL.    XXXV. 


E.  GOULD  &  SON,  59,  MOOBQATE  STREET,  B.C. 

1891. 


siei^z^vw 


^ 


N 


LdN'DOK  : 

■TSAKBR  BB0TUEB8  &  CO.,  "  Till  BISUOPHOATS  PBBS8,*^ 

Bl'IIOrSOATK  WITnoUT,   E.C. 


INDEX. 


A 

PAOK 

Pel^ 279 

^4eomtemC(MG  729 

Ae&itUe  Poisosiiiig,  Alleged  . . . .  34G 
AddrojB  at  the  Britiah  Homoeo- 

patliic  Congreas  by  ICr.  Harris  507 

Alooliol SU 

Alcohol,  Herodity  of 206 

AloohdinD,  iWs^a  in   121 

AixjLLSDEBf  Dr.  A.  S.,  on  the 

Single  Bemedy 441,  d07 

Alternation  of  Bemedies,  by  Dr. 

lffai»l«ii>Jm<A 468 

Amanrons 344 

America,  Notes  from 617,  C78 

Anatomy  in  Boazd  Schools  ....  214 
Anaemia  «• 12o 

Antagonistic  Actions  of  Poisons  d22 

j» ■■  nrwj^waa  •..■••■■■•■•■•.«...«    tx^ 

Antiseptios  in  Disease    736 

Antwerp,  HornGBOpathy  in    677, 

744,  791 

Aphonia 6d0 

ApisMeU\fiea 425 

Do.    FkOTing  by  Dr.  Dudgeon  787 
Aproaezia  in  Children    ........  411 

Ariatol   733 

At'Htea 672 

.  Irsenie 271,  669 

-  irsenic  in  CSancer    120 

.IrMTiiV  in  Cystic  Goitre    277 

^f-MMir<i/Poiiomng   737 

Asthma 120,124,674 

Asthma  Spasmodic,  Dr.  Day  oh  405 
Atypical  Cases,  by  Dr.  Bnrford  772 
Aurttm  Muriatienm    30 


PAOS 

Bath,  Ho8i>ital  Saturday  at. . . .  483 
Bee    Sting,   on  the  Medicinal 

Uses  of ,  by  Dr.  Femio 425 

BEBBiDaE,     Dr.,     A    dinioal 

Case  by 250 

Birmingham  Pirovident  Institute  131 
Blacklet,  Dr.  J.  G.,  on  the 

Irritable  Mucous  Membrane 

of  the  Gouty 2S9 

Blaxb,  Dr.  E.,  on  Staphisagria  361 

Jii«tta  Otientalis 120 

BLuaiBEBQ,  Dr.  and  Mrs 801 

Books,  Now « 71 

BoiV'  Citrate  qf  Magnesia 118 

Bronchial  Glands  Enlarged  ....    35 

Broncho-pneumonia 59 

Bbowh,  D&.  Dtcb 753 

Bryonia 531 

Bryonia  in  M^nidre's  Disease, 

by  Mr.  Wright 189 

BUBFOBD,  Dr.,  on  Ovariotomy  188 

Do.    on PelYic  Diagnosis....  312 

Do.  on  Surgery  and  Homoeo- 
pathy   651 

Do.    on  Atypical  Cases  .> 772 

BuTCHEB,  Mr.  W.  D.,  on  Koch 

and  Pasteur ..••  145 


B. 

Bacterial  Disease    200 

Boldness,  the  Treatment  of 131 

Banquet  to  Major  V .  Morgan  . .  552 
^«ryte  C,  in  Tonsillitis    173 


C. 

<^V(^t'w>inPoBtPartum  Hfftmoirh- 

age 63 

Calcutta     Hahnemann     Anni- 
versary   475 

(^atendnia 205 

Calomrf,  in  Croup   743 

CampJior  in  Urinary  Disease   . .  647 

Cancer,  Arsenic  in 120 

Do.    Latent  Period  of 779 

(■anthari*  in  Puerperal  Mania. .  279 

Cardiac  Dyspnoea    127 

fkrdmut  MariamtSy  Dr.  Dudgeon 

on 164,  277 

Cases  by  Dr.  Lamb 649 


IV 


INDEX. 


llonthly  HomcBopathic 
Beview,  Dec.  1, 1891 , 


PAGE 

Cash,  Dr.,  on  Tachycardia  ....  592 

CataiTh,  Atrophic 125 

Catarrhal  Ophthalmia 650 

Cataract  204,  740 

Chicago,  Medical    284 

r/ilorofmn,  Death  from    133 

Cholera  Infia&ttmi 742 

Chylnrta,  Case  of.  by  Dr.  W.  H. 

Thomas»».»».. 179 

Cirrhosis  of  the  Liver  ........  201 

CLABS35,  Dr.,  Lecture  by 128 

Class,  Sir  A.  and  the  Bev.  C. 

Spurgeon 619 

CiJFTON,Dr.A.C.,ainicalNotes  781 
Clinical  Case,  A 250 

Do.    ^otee  by  Dr.  Clifton   ..  781 

Coceygodtjnia  ^..,.,.,, 786 

Colic,  Aeomte  in 729 

Committee  of  the  House  of  Lords 

on  Metropolitan  Hospitals    ..  476 
Congress,  The  British  Homoeo- 
pathic  358,  415,  421,473,  476,  535 
Congress,  The  International  Ho- 

mcBopathic  209,.  215,  272,  280,  349 

358,  415,  605,  619 

Connecticut,  Practice  in    803 

Constipation 649 

COOPSB,  Dr.,  On  the  Ear  nud 

Scalp 641 

Cifolin  in  Dysentry 117 

Cretinism  Sporadic 413 

Cbosb,    Mr.,    Evidence    before 

Lords'  Committee  on  Hospitals  476 
CaotrcHEB,  Dr.  A.,  onTubercular 

Laryngitis 242 

Croup,  Diphtheritic    743 

Ctfchpadia  of  Drug  Pathogenesy, 

The  Index  to,  by  l>r.  Drysd^le  322 

Do.       do.       Dr.    Hughes  423 

Do.       do.       Dr.  Teldham  563 

Cpehpadiaf  7%«,andit8jEtepertory  461 

CyBt,Ovariau  38 

Do.  Pelvic 37 

Do.  Sero-Sanguineous 33 


D. 

Day.  Dr.,  on  Asthma 405 

Do.        Diphtheria   88 

Do.        The  Supervision  of 
Normal  Parturition    578 


PAOK 

Deaf  and  Dumb,  The  Teaching  of  357 

Deafness,  Ferrum  Pic,  in 12 '> 

Death,  Detection  of    136 

Do.    of  Lady  Ebury 802 

Diabetes  MeUitus 202 

Diabetic  Paralysis. 6>( 

Diagnosis,  Pelvic 312: 

Diphtheria 88,  743 

Diphtheria,  Laryngeal 47C^ 

Diphtheria,  iS(M/.  Jm/.  in 207 

Diphtheritic  Paralysis ^ . . .  412 

Dosage 27^^ 

Doses,  Large  and  Small 359 

Dressing  Lotion   12K 

Drugs,  Double  Action  of 143 

Dbitiocond,  Dr.,  on  Leprosy  . .  268* 
Drtbdale,  Dr.,  on  Obstruction      1 
Do.    on  The  Index,  to  the  Cgch' 

pmlia 322 

Drzewiecke,  Dr.,  on  Phthisis  . .     30 
DiTDOEON,    Dr.,    on     Carduut 

Mariafiut 164 

Do.    on  Lembke's  Provings. .  600 

Do.    on  Lyeopodium 42 

Do.    Presidential  Address   . .  49.*^ 

Do.    Proving  of  Apis   787 

Dumb,  The  Deaf  and.  Teaching 

of 357 

Dysentery,  Creolin  in 117 

Do.    Mercury  in 132 

Dysmenia 27^ 

E. 

Ear  and  Scalp,  Dr.  Cooper  ou  . .  641 
Ears,  Chronic   Catarrh  of   the 

Drum  of  the 739 

Ear  Disease,  Kali  Mur,  in    ....  125 
Ear  Disease,  Pilocarpine  in  ... .   206 

Ear,  Noises  in «...  207 

Ebuby,  Lady,  Death  of 802 

Electrolysis  in  Gynaecology  ....  121 

Elephantiasis    45 

Epithelioma  Laryngis 39 

Ether  Inhaler,  Packard's 213 

Etfculypitts  Oil  in  Ear  Disease  . .  738 
Europhtn   735' 

F. 

Failures  and  Successes   ........  172' 

Taradic    Currents    in    Uterine 
Htemorrhage 63 


MdnftUy 
Beview,  Dec  1,  U 


toic 


INDEX. 


PACE 

Feedmg  Inf antB C93 

Febnib,  Dr.,  on  the  Mcdidnal 

TTaes  of  the  Bee  PoiBon 42o 

^Fnrum  Picrieum  in  Deafness  . .  125 

'Fever  in  New  Bom  Children   ..  471 

Fladi  and  Milk  Supply 217 

Food^Foune 137 


G. 

Gairdner,  Dr.,  on  Old  and  New 

Bemedies 808 

GalTiino-Caateiy  in    Enlarged 

TonsOs   ! 729 

Gangrene,  Dr.  Hayward,  on  107  266 

Gastric  Uloer   767 

Glands,  Bronchial  Enlarged  . .  36 
Glands,  Thoracic  Enlarged     . .    40 

Glottic  Spasm 738 

Goifa:^,  Cystic ••••  277 

Do.  Exophthalmic  ....  207,  277 
Gont  52 

Do.    Therapeutics  of     781 

Gonty  Subject,  Mucous  Mem- 

hraneofthe 289 

Gull,  Sir  W 623 

Gums,  Bed  Lines  on  the    127 

GynsBCology,  Electrolysis  in    . .  121 


H. 

Hsematoma  Pelvic 772 

HnmoptysiB    27G,  414 

Hsemorxhage  after  Tracheotomy  673 

Hsmonhage,  Nasal  341 

Heemorrhage,  Bectal 127 

HflBmorrhoids 181,  780 

BUhnkicann      Anniyersary      in 

Calcutta 475 

HAHinDCANiT  Dinner 333 

HijaKKXANN  Publishing  Soc.  470, 769 
Habbtb,  Mr.,  Congress  Address  607 
Hatwabd,     Dr.    C.    W.,     on 

Gangrene 107,266 

Hatwaxd,    Dr.     J.     D.,     on 

Bheumatic  Fever 643 


I*.V(iK 

Headache  from  H^'peropia   ....    61 

Heredity,  Alcoholic    208> 

Hernia,  Badical  Cure  of    34 

Homatropia 61 

Homoeopath  ^  What  is  a 62G 

HomcBopathic  Association,  The 

Oxford   366,  419' 

Do.  Congress,  The  British  368, 

416,  421,  478,  47(5^ 
Do.      do.     The  International 
209, 216, 272, 280, 349, 368, 606, 619 
Do.  Convelescent  Home, 

Bournemouth    282 

Do.  do.  Eastbourne  36:i^ 

Do.      Directorj- 764,  810 

Do.  Dispensary,  Croydon ....  419 
Do.         do.         Oxford    ....  282^ 

Do.         do.         Sussex 211 

Do.      Hospital,  Cleveland    . .  863 

Do.  do.      Devon 211 

Do.  do.      Loudon      68, 

128,  476, 661.,  688,  762,  801 
Do.       do.  Philadelphia    420- 

Do,       do.     Tunbridgo  Wells  282 
Do.  Society,  The  British     32, 

333,  493,  661,  799- 
Do.  Therapeutics,  Surgery  and  661 
Homccopathy  in  Antwerp  677, 

744    791 
Do.  Belgian  Senate,  The  675- 

Do.  Boston 129 

Do.  Brussels 12S 

Do.  Influenza    619* 

Do.  Oxfonl    28:J- 

Do.  Russia 681 

Honours,  State 600' 

Hospital  Saturday  at  Batli  ....  48:1 
Hospitals,  Lords'  Committee  on  476 
HnoHSS,    Dr.,    on    First   and 

Second-Hand   27 

Human  Milk 124 

HuBXDALL,  Mr.,  on  FIosIl  and 

Milk  Supply 217 

Hydatids,  Uterine 463,  81 1 

Hyo»eyamH4  in  Neurosis  of  the 

Larynx  411 

I/ffpcncum  in  Pain 1 19- 

Hyperpp'exia  6-1:^ 

Hypnolisni    264 

Hysteria 1'2(>' 

Hysterical  Paralysis   31V 


VI 


INDEX. 


Monthly  HonuBopathic 
R«Tiew,  Dec.  1,  IWl. 


I. 

r.vriE 

Infancy,  Stomach  iu  741 

Infant  Feeding *  *  c93 

Influenza   57,  420,  0I6,  619 

Intermittent  Fever 120 

Iodide  of  Potassium 605,  G88 

Iodine ^  ]  j<j 

Iod<tf(trin  Emulsion 413 

K. 

JiitU  Jfur.  in  Ear  Disease 1 25 

KnjaUmey  The 520 

Ki*ea*ote  m  Vomiting 202 

Koch  and  Paotbub,  Discoveries 
of  as  Illustrating  the  Law  of 
Similars,  hy  Mi-.  W.  Butcher    145 
Koch's  Lymph  68,  115, 139, 193, 

211.  074 

L. 

Labour,  Induction  of  Prematui-e    02 

Itac1ie$%M 573 

liAiCB,  Dr.,  Bryonia  30  iu  Rheu- 
matism by  631 

Lamb,  Dr.,  Cases  by  649 

Laryngeal  Diphtheria    470 

Do.         Neoplasms    j)4i 

Do.         Phthisis (J7 

Do.         Stenosis 06 

Larynx,  Disease  of  the 72 

Do.      Epithelioma 39 

Do.      Neurosis  of  the    411 

Do.     Tuberculosis  of  the 2a5 

Legacy,  A 025 

L£3CBEE*s  Provings    600 

Leprosy,  Dr.  Drummoud  on 268 

LiEBEAULT,  Dr.,  Testimonial  to  488 
LiEBBBicH's  Remedy  in  Tuber- 
culosis  284 

L'uimr  Carnis 136 

Locomotor  Ataxy    132 

Limibago   , , , 732 

Lycopodium , 42 

McKechnie,  Dr.,  on  Haemor- 
rhoids    181 

Madden,  Di*.,  Our  Failures  and 
Successes   172 

Manual  of  Therapeutics,  lutro- 
duction 721 


PAOK 

Maxillary  Sinus,  Scraping  the. .  674 
Medical  Practice  iu  Connecticut  803 

Meniere's  Disease    189 

Menstruation  and  Suckling  ....  743 

Menthol  in  Ear  Disease 738 

Mercunue 573 

Mercuric  Cf/anide  176,  743 

Mercurials  in  Dysentery   132 

Milk  Supply 217 

Do.  Unboiled    284 

Do.      Tubercular     Infection 

through 744 

MooBE,     Dr.     M.,     on    New 

Zeahind    ft29,  708 

Do.    Hydatids,  Uterine  .  .468,  4li 

MooBE,  The  late  Dr 130 

MoBOAN,  Major  Vaughan  662,  617 

Morphia  Habit 121 

MoBBissox,  Dr.,  on  Pneumonia    95 

N. 

Xankivell,  Dr.  F.,  on  Arsenio  271 

Kaphthalin   073 

Nasal  Diseases 278 

Nasal  Epilepsy 65 

Nasal  Polypi 411 

Naso-pharjmgeal  Growths 411 

Natural  Immunity 68 

Needles 590,  766 

Nephro-lithotomy 201 

Neuralgia 688 

Neuritis 33 

New  Zealand 629,  708 

Nicotine  Psycliosis 803 

NUric  Acid 472 

Notes  and  Comments 49 

Nose,  Foreign  Body  in  the  ....  207 

O. 
Obituabies  : 

Oronin,  Mr.  A 287 

Lilienthal,  Dr.  (New  York) . .  809 

Love,  Dr.  (Paris)    488 

Marsden,  Dr 215 

Millin,Mr 625 

Moore,  Dr.  J 140 

Morgan,  Dr.  W 660 

Roth.Dr 764,  805 

Sawyei-,  Di*.  (Monroe) 488 

Smith,  Dr.  (Cliicago) 487 


If nnthly  HoMCBonathic 
Bvftow.  Doc.  1.  iSn. 


INDEX. 


Vll 


PACK 

Obstrnction,  Case  of 1 

Obfltmetion,  Intestmal 559 

Ovuiotomy,  On 188,  531 

P. 

Papfllomft 12o 

Farataloid 51 

PBrtmition   578 

Asnjhra  121 

Pasteur  and  Koch,  DiflcoTeries  of  145 

Pehric  IHagnoais 312 

PteitypUitis 208 

Pfraxide  of  Jfydniffen    118 

PhaimaoeatiGal  Society  of  Tas- 
mania  285 

Fhaiynx,  Disease  of 73 

PhoBph^ric  Acid 179 

Pho9phwru»    343 

Phoiphonts  in  Rickets  117 

Phtliisia,  ^tfftfiit  in 30 

filoearpine 277 

P«^0«ar/»tiM  in  Ear  Diseases  ....  206 

Pneumonia 95 

Pneumonia  in  Children 123 

Pneumonia,   Ptroxide   of   St/' 

drogenin    118 

Poisons,  Antagonistic  Action  of  628 
Pope,    Dr.,  on   Serpent  VenofH 

301,  373 

Popular  Medical  Monthly 358 

Porro's  Operation 122 

Post-Graduate  Lectures  50,  69, 

211,415 

Potency  and  Dilution 422 

PzRsentation  to  Dr.  Blumberg. .  801 
Presidential   Address    by    Di'. 

Dudgeon   493 

Pboctob,  Dr.,  on  the  Cydopiedia 

of  Drug  Pathogenesy 461 

Pruritus  YulvBe    278 

Puerperal  Mania **....  279 

Qmimne  Amaurosis 344 

B. 

Bectal  Haemorrhage   • 127 

Befraction,  Errors  of 60 

Bemedies,  New  and  Old   398 


PAOX 

Remedy,  llie  Single 441 

Repertory,  The  Brittish 287 

Repertory,  The  British,  Intro- 
duction to 382" 

Reports,  London  HomoBopathic 

Hospital 762 

Respiration,  Artificial  ....  471,  507 
Rest  in  Tetanus 111> 

Reviews  : 

A  CyclopaMlia  of  Drug  Patho- 
genesy      I9fl^ 

Annual  of  Unirersal  Medical 

Sciences 275,  734 

B<mninghau8en*8  Therapeutic 

Pocket  Book lOfv 

Decline  of  Manhood,  Small . .  113. 
Electricity     in     Diseases    of 

Women,  Massey li'2 

Gedichte  Ton  Gk>ttfried  Rahl  66» 
GyiitBoology,  Southwiok    ....  274 

Heredity,  Shoemaker 40O 

Homoeopathic  Directory  ....  668- 
Materia  Medica,  Fanington..  110 
Medical  Symbolism,  Sozinsky  46^ 
Nervous  System,  Edinger. ...  798 
On  Consumption, Burnett....  197 

On  Epilepsy,  Hare $4 

On  Diphtheria,  Thomas 465> 

On  Diseases  of  the  Eye,  Angell  409 

On  Fever,  Hare  532 

Principles  of  Surgery,  Senn . .  196- 
Report  on  Influenza,  Parsons  666 

Text  Book  of  Hygiene  604 

The  Daughter's  Health,  Capp  19» 
The  Dog  Owner's  Annual  91,  113 
The   Drug    Proving   of    the 

Future    603- 

The  HomcBopathic  Treatment 

of  Alcoholism,  GhJUvardin  lia 
The  Medical  Annual,  Wilde. .  382 
Woman's  Health,  Rentoul   . .  195- 

Bheumatio  Fever    648 

Rheumatism 531 

Rhinitis 66,  341 

Rhinoscopy 73g 

Rickets 117 

Riiij^'orm 124 


Till 


INDEX. 


Monthly  HonuBopatbic 
Review,  Dec.  1, 1890. 


S. 

•    PAUE 

Sale  of  Work,  London  Homooo- 

pathic  Hoppital    801 

Sarcoma  of  the  Brcaat 34 

.Sarooma,  ITteride '  62 

Sciatica 784 

Sclerosis,  Insular   So,  64 

Sepsin 211 

»Sephun  Xasi,  Perforated 66 

Serpent  Venvtn   301,873 

Shaw,  Mr.,  on  Elephantiasis  . .  45 
Shaw,  Mr.,  on  Iodide  of  Pottuts,  565 
Smith,  Mr.  G. ,  on  Infant  Feeding  693 

Sodium  Iodide 207 

Spastic  Paralysis '>5 

Spubqeon,  Bev.  C 618 

Stammering  and  Earache 58 

i^tammering  Nasal  Disease  341,  674 
Staphifagria^  Dr.  E.  Blake  on. .    61 

Stomach,  Ulcer  of 651 

Stomach,  Washing  of     744 

Stone  Throwing 130 

Stonhax,  Dr.,  on  Thuja -^ 

Suckling  and  Menstruation  ....  743 

Surgery  and  Therapeutics 651 

Syi>hilis,  Tertiary 555 

T. 

Taohycai-dia 592 

Tetanus 119 

Therapeutic  Notes  hy  Dr.  Clifton  781 
Therapeutics,  Sir  W.   GuU  and  623 

Thei-apeutics,  Manual  of 721 

Therapeutics,  Rational 620 

Therapeutic  Be-disooveries..  53,  69 

Thoxas,  Dr.  on  Chyluria 179 

Do.    on  Gastric  Ulcer  757 

Thoracic  Glands  Enlarged    ....    40 
Thobnlet,  Dr.,  on  Camphor  . .  647 

Thvja 277 

TAr{/a  in  Eczema 48 

Tobacco  Poisoning 804 

Toe  Nails,  In-growing 690 

Tongue,  Dryness  of  the 277 

Tongue,  Suppuration  of  the. ...    57 

Tonsillitis 66,  783 

Tonsils,  Hypertrophied  125, 207,  720 


PAUE 

Tonsils,  Mycosis  of  the 341 

Tubercle  Bacilli,    Examination 

for 70 

' Tubercle,  Infection  through. . . .  744 

Tuberculin    212,280 

Tuberculosis 284 

TucKEY,  Dr.,  on  Transfer  Treat- 
ment and  Sc^gestion 264 

U. 

Ulcer  of  Stomach  ....  119,  651,  757 

Vranium  Xitras 119 

Urinary  Cfilculi   118 

Urticaria  Vretu 27 

Uterine  Haemorrhage 68 

Uterine  Hydatids    453 

Uterine  Inversion 32 

V. 

Vaccinia  and  Variola 283 

Varicocele 331 

Varicose  Ulcer , , . ,    56 

Vaseline  and  Lard 689 

Venesection  671 

Veratrum  V.    207 

Vomiting,  iiMfin/' in    119 

Vomiting,  Kreoeote  in 202 

Vulva,  Pruritus  of 63 

W. 

Western  Counties,  Therapeutic 

Society,  The 468,800 

Wilde,  Dr.  S.,  on  Aconite  in 

CoUc   , 729 

Wildungeu    688 

WiLKiXBON,  Mr.,  on  A  Curious 

Reflex 331 

Whooping  Cough  and  Blindness  414 
Wright,  Mr.  D.,  on  Bryonia  .,  189 

Do.        do.    Diseases  of    the 

Pharynx  and  Larynx    73 

Do.        do.    Enlarged  Tonsils 
and  the  Galyano-Cautery  729 

X. 

XttHthoxyltan    , , ,  279 


iSSSIrJ^TSSu^  A  CASE  OF  OBSTRUCTWHr-- 


^ li 


/ 


THE    MONTS^W  MQ 

HOMCEOPATHIC    REVIEW. 


•:o: 


A   CASE   OP   OBSTEUCTION,   WITH   COMMENTS 
ON  THE  SYDENHAM-THOMAS  TREATMENT. 

By  J.  Drysdalb,  M.D. 

Miss  L.,  a  lady  about  50,  residing  at  Eastbourne,  \vho 
had  not  previously  been  liable  to  constipation,  sent  for 
Dr.  Croucher  of  that  place  on  the  9th  of  February,  1890, 
complaining  of  "  a  chill  on  the  liver,"  and  remained  in 
bed  till  the  14th.  She  complained  of  headache,  sickness 
and  general  tenderness  of  the  abdomen  ;  there  were  also 
anorexia  and  constipation ;  temp.  101°,  and  tongue  coated. 
She  improved  under  bry.  Ix  and  vierc.  sol.  3x.  On  the 
13th  February  she  had  further  improved,  and  the  bowel  a 
were  said  to  have  acted  fairly.  She  then  got  arsen.  8x 
and  strych.'phoB,  3x.  But  on  the  27th  February 
Dr.  Croucher  was  again  called  in,  and  found  her  suffer- 
ing from  colic,  vomiting  and  coated  tongue.  She  got 
relief  from  colocynthis,  mere.  d.  and  irisin,  and  the  bowels 
were  "  moved  slightly  "  by  an  enema,  after  castor  oil  by 
the  mouth  had  been  vomited.  From  that  time  there  was 
no  motion  till  the  28th  of  March.  The  motion  on  the 
28th  of  February  was  quite  inadequate,  and  as  it  was  the 
only  one  which  had  taken  place  for  a  week  or  ten  days 
before  we  may  consider  that  the  obstruction  lasted  in  all 
about  five  weeks. 

On  the  1st  of  March  the  patient  went  to  St.  Leonards, 
and  had  to  go  to  bed  on  arrival,  and  remain  there  with 
constipation,  colic  and  vomiting  till  4th  March,  when 
Dr.  Croucher  senior  was  called  in.     He  found  severe 

Vol.  85,  No  1.  B 


2  A  CASE  OF  OBSTBUCTION.  *'SSSw?^?ifi»i! 

colic  and  persistent  complete  constipation,  for  which  he 
gave  an  enema  of  gruel,  oUve  oil  and  glycerine  through 
the  long  tube.  This  produced  vomiting,  but  no  reUef  to 
the  bowels.  She  continued  to  have  straining  discharges 
of  blood  and  mucus  from  the  rectum,  with  colic  and 
vomiting.  On  the  6th  of  March  a  dose  of  castor  oil  by 
the  mouth  produced  no  effect  on  the  bowels,  but  the  colic 
was  relieved  by  colocynth  and  carb.  veg.  During  the 
latter  days  of  Dr.  Groucher's  attendance  he  gave  opium  1 
diXidLplwrnh.  acet.  1  in  alternation,  and  once  or  twice  a  small 
nut-like  piece  of  apparently  fsecal  matter  was  passed.  She 
continued  much  in  the  same  state  with  complete  constipa- 
tion, small  straining  discharge  of  blood  and  mucus,  disten- 
sion of  abdomen,  colic  and  occasional  vomiting  till  the  22nd 
of  March,  when  she  was  removed  to  the  house  of  a  rela- 
tive in  Liverpool  and  bore  the  journey  pretty  well.  Soon 
afterwards  the  above  previous  history  of  the  case  was 
kindly  sent  to  me  by  Drs.  Croucher,  of  Eastbourne  and 
St.  Leonards.  I  saw  her  on  the  22nd  March,  and  found 
the  symptoms  as  above,  noting  in  addition  that  there 
was  little  tenderness  of  the  abdomen  ;  temp.  101^,  pulse 
90 ;  some  portions  dull  on  percussion  in  the  left  iliac 
region  and  in  the  track  of  the  colon ;  the  tongue  and 
breath  were  foul ;  there  was  much  gurgling,  and  much  tym- 
panitic swelling  of  the  abdomen,  flattened  above  the  navel, 
indicating  that  the  seat  of  the  disease  was  in  the  large  intes- 
tine. I  gave  chiefly  atropin  3x  alternated  with  veratrum 
album  1  every  two  hours  for  the  next  three  days.  Then  an 
enema  of  oil  and  glycerine  was  given  but  without  any 
effect  except  that  of  provoking  vomiting  and  increase  of 
colic.  On  reviewing  the  whole  case,  I  now  came  to  the 
conclusion  that  there  was  no  evidence  of  complete  occlu- 
sion from  mechanical  cause,  nor  enteritis,  nor  intussus- 
ception, but  that  the  obstruction  depended  on  functional 
defect  of  the  action  of  the  colon  with  probably  a  partial 
amount  of  volvulus  at  the  sigmoid  flexure.  So  I 
determined  to  carry  out  rigidly  Dr.  0.  Thomas's  plan  of 
avoidance  of  all  attempts  to  move  the  bowels  forcibly 
even  by  enemata,  and  also  to  restrict  the  diet  to  purely 
fluid  articles,  avoiding  even  milk.  Under  this  regimen 
and  homoeopathicaUy  chosen  medicines  the  symptoms 
remained  very  mild ;  the  pains  and  vomiting  were  not 
frequent  or  urgent,  and  though  some  of  the  vomited 
matters  were  offensive  we  could   not  say  they  were 


/ 


lK^rJ^STi8Ml^  A  CASE  OF  OBBTBUCTION.  ,  3 

distinctly  fascal.    There  were  also  intervals  of  refreshing 
sleep.      The  medicine  now   (25th  March)   chosen  was 
plumbum  aceticum  1,  as  it  seemed  to  suit  best  hoinoeo- 
pathically,  corresponding  as  it  did  to  the  constipation, 
irregular  swellings,  gurglings  and  colic.    For  the  first 
twelve  hours  it  was  alternated  every  two  hours  with 
morphium  aceticum,  1,  which  was  also  homoeopathically 
indicated  as  tending  to  restore  the  healthy  sensibiUty  of 
the  diseased  parts  to  their  natural  stimuli.    After  that 
nux  vomica  1  was  alternated  with  the  plumbum.    I  was 
not  then  aware  that  Dr.  Groucher  had  already  given 
plumbum  with  the  result  that  some  small  knots  of  faBces 
were  passed.    The  same  happened  now  and  some  flatus 
was  passed.    At  this  stage  (35th  day  of  obstruction)  a 
a  consultation  with  Dr.  Alexander  being  suggested,  I 
was  glad  to  agree,  not  that  I  thought  things  were  doing 
badly,  but  on  general  grounds,  that  if  there  should  arise 
any  necessity  for  operation  the  question  ought  not  to  be 
delayed  till  too  late  for  the  best  chances  of  success. 
After  a  careful  examination,  and  hearing  the  previous 
history  of   the    case.    Dr.    Alexander    considered    the 
abdomen  enlarged  but  not  tensely  distended,  the  outline 
flattened  centrally,  that  agreeing  with  Thomas's  test  of 
the  seat  of  obstruction  in  the  colon.     The  coils  of  the 
large  intestine  could  be  felt  filled  with  hardened  masses. 
The  rectum  was  empty  and  collapsed,  and  the  absence  of 
'' ballooning  of  the  rectum,*'  as  well  as  the  passage  of 
some  flatus  described  by  the  patient,  went  against  the 
idea  of  organic  stricture.     The  roof  of  the  rectum  was 
pressed  down  by  a  heavy  mass,  apparently  the  loaded 
sigmoid.    For  these  reasons  Dr.  Alexander  considered 
it  not  a  case  requiring  operation.    He  recommended  a 
large  simple  enema  to  be  given  next  day.      The  bowels, 
however,  began  to  act  spontaneously  that  same  night, 
and  frequent  large  semi-fluid  stools,  intermixed  with 
scybala,  were  discharged  for  the  next  three  or  four  days, 
with  relief  to  all  the  symptoms  of  obstruction,  though 
not  complete  restoration  to  health,  as  the  chronic  state 
of  the  bowel  and  the  liver  will  require  medical  care  for 
some  time. 

This  is  not  given  as  a  case  in  any  way  remarkable  for 
character  or  severity — in  fact  it  was  scarcely  a  fuUy- 
developed  case,  as  ileus  was  not  distinctly  present.  I 
oonsider,  however,  that  the  patient  was  for  two  or  three 

B— 2 


> 


I 

4  A  CASE  OF  OBSTRUCTION.   "MrfftST^ 

* 

weeks  on  the  verge  of  ileus  and  probable  fatal  collapse, 
which  were  only  averted  by  the  negative  influence  of 
avoidance  of  coarse  diet  and  purgatives  combined  with 
the  positive  action  of  homoeopathically  chosen  medicines. 
It  was  a  case  of  simple  obstruction,  and  therefore  suitable 
as  a  basis  for  discussion  of  the  Sydenham-Thomas  treat- 
ment, but  without  the  large  doses  of  opium. 

The  principles  of  the  non-medicinal  management  were 
those  laid  down  by  Dr.  H.  0.  Thomas,  who  has  long 
been  in  the  first  rank  of  British  surgeons,  owing  to  the 
application  of  his  original  and  inventive  genius  to  the 
mechanical  treatment  of  joint  diseases,  and  they  are  set 
forth  in  his  work  on  "  Intestinal  Disease  and  Obstruc- 
tion," (London:  H.  K.  Lewis).  As  this  work  appears  to 
be  hardly  as  well  known  to  the  homoeopathic  school  as  I 
think  it  ought  to  be,  it  may  be  of  service  to  give  here  an 
abstract  of  the  above  principles,  which  are  applicable  in 
both  schools  of  medicine,  and  then  discuss  the  question 
whether  sedative  doses  of  morphia  may  not  be 
occasionally  with  advantage  adopted  as  an  auxiliary  to 
the  homoeopathic  treatment  of  this  disease.  Dr.  Thomas' 
book  may  be  described  as  a  work  recalling  the  attention 
of  the  profession  to  the  principles  of  Sydenham  for  the 
treatment  of  obstruction.  These  are,  shortly,  avoidance 
of  all  purgatives  or  means  of  forcibly  moving  the  bowels ; 
a  fluid  diet ;  and  the  use  of  sedative  doses  of  opium.  In 
spite  of  the  authority  of  Sydenham,  these  principles  have 
never^  been  generally  and  fully  carried  out,  and  the 
suffering  and  mortality  from  the  disease  in  the  allopathic 
school  are  still  little  less  than  in  the  time  of  Hippocrates. 
It  is  therefore  necessary  that  they  should  be  re-asserted 
more  rigidly  and  more  in  detail,  and  this  is  what  is 
admirably  done  in  Dr.  Thomas's  book. 

**  By  intestinal  obstruction,"  says  Dr.  Thomas  (p.  49), 
"  I  mean  any  condition  of  the  intestine,  its  surroundings 
or  contents,  which  retards  or  completely  arrests  in  their 
progress  towards  the  rectum  the  matters  contained 
within^  the  gut.  For  the  purpose  of  discussion,  these 
conditions  may  be  divided  into  two  classes,  viz., 
obstructions  caused  by  disordered  function  and  those 
arising  from  mechanical  agency.  In  the  first  class  I 
include^  enteritis,  peritonitis,  typhlitis  and  perityphlitis, 
ulceration,  perforation,  painter's  colic,  paraplegia,  the 
intestinal  lesion  of  typhoid  fever  and  Asiatic  cholera. 


MSa^Jj^Ti^i^^  A  CASE  OF  OBSTRUCTION. 


In  the  second  class  I  place  hernia,  stricture,  intus- 
susceptions, volvulus,  strangulation  from  adventitious 
bands,  or  by  rents  in  the  mesentery,  tumours,  gall-stones 
and  loaded  rectum."  If  we  exclude  hernia  and  loaded 
rectum,  of  which  the  diagnosis  is  not  difficult  and  the 
treatment  obvious,  we  have  a  clinical  entity  dependent 
on  a  variety  of  pathological  states,  which  all  have,  in 
common,  obstruction  as  the  dominant  symptom ;  and,  as 
remarked  by  Dr.  Thomas,  "all  forms  of  obstruction, 
sooner  or  later,  develop  signs  akin  in  detail.'*  For  this 
reason  he  maintains  that  differential  diagnosis  of  the 
exact  nature  of  the  obstruction,  though  no  doubt  most 
desirable,  is  not  essential  for  successful  treatment.  "  No 
matter  what  may  have  been  the  cause  of  the  disease,  the 
treatment  (dietetic  and  therapeutical)  at  the  commence- 
ment is  similar  for  all  forms."  As  a  matter  of  fact,  the 
exact  diflferential  diagnosis  cannot  be  made  in  many 
cases,  and  so  long  as  this  difficulty  exists,  "necessity 
compels  us  to  pursue  a  course  of  symptomatic  treat- 
ment.*' We  come  now  to  the  details  of  the  general 
management  and  the  treatment  of  the  symptoms.  The 
persistent  constipation  is  naturally  the  most  prominent 
symptom,  and  except  in  the  early  stage  of  intussuscep- 
tion and  in  loaded  rectum,  in  which  there  is  a  false 
diarrhcea,  it  is  of  course  easy  to  recognise.  At  the  early 
stage,  however,  there  is  a  difficulty  in  distinguishing  it 
from  the  constipation  attending  gastric  and  bowel 
derangements  which  are  so  common.  In  fact,  Dr. 
Thomas  considers  them  to  differ  only  in  a  degree,  for  he 
says,  "  Costiveness,  constipation,  or  the  retardation  in 
progress  of  the  intestinal  contents  is  an  infinitesimal 
degree  of  obstruction ;  this  is  my  opinion  '*  (p.  83).  And 
he  considers  that  the  true  principles  of  curing  common 
constipations  are  applicable  to  obstructions  generally. 
We  are  generally  not  long  left  in  doubt  whether  we  have 
an  obstruction  or  common  constipation  to  deal  with ; 
and,  if  the  former,  now  comes  in  the  first  point  in  the 
Sydenham-Thomas  management,  viz.,  "that  it  should 
simply  be  let  alone."  The  rational  treatment  of 
obstruction  necessitates  that  some  of  the  symptoms 
should  be  prescribed  for ;  but  constipation  is  one  that 
requires  no  direct  interference  with.  Constipation  is  a 
sign  which,  beyond  all  others,  distracts  the  physician, 
and  which  is  liable  to  lead  him  astray  in  the  direction 


6  A  CASE  OF  OBSTRtJCTION.  ^"^^JjwfSST^nSl! 

of  active  interference,  where  he  is  certain  to  be  followed 
by  the  patient's  friends,  who  consult  together  and  soon 
conclude  that  this  symptom  is  the  cause  of  all  the 
patient's  suffering,  and  must  be  grappled  with,  and 
even  at  some  hazard  treated  first  and  foremost.  These 
amateur,  but  not  the  less  emphatic  opinions,  in  many 
cases  goad  the  physician,  despite  his  doubts  and  better 
knowledge,  to  permit  the  administration  of  a  purgative 
or  some  vile  concoction  in  the  form  of  an  enema.  This 
treatment  much  intensifies  the  disease  and  increases 
the  evils  previously  present ;  but  such  aggravation  is 
taken  as  evidence  of  retrogression  of  the  disease  rather 
than  of  questionable  treatment,  and  the  malapraxis  is 
repeated  until  the  patient  either  recovers,  despite  the 
well  meant  but  injurious  meddling  of  those  around  him, 
or  perhaps  even  until  he  prematurely  succumbs  (p.  65). 
It  is  true  that  Sydenham  emphatically  condemned  pur- 
gatives and  clysters  in  pronounced  obstructions  ;  but  he 
was  hardly  so  decided  as  Thomas  in  prohibiting  all 
forcible  means  of  moving  the  bowels,  and  in  fact  all 
direct  treatment  of  the  constipation  in  all  stages  of  ob- 
struction. This  is  probably  the  reason  why  Sydenham's 
advice  has  produced  no  more  decided  effect  on  the 
current  treatment,  for  though  in  most  handbooks  pur- 
gatives are  now  condemned  in  fully  pronounced  ob- 
struction, yet  at  the  earlier  and  later  stages  they  are 
still  recommended,  and  fatal  results  are  the  frequent 
consequence.  And  notwithstanding  the  condemnation 
of  purgatives  by  Sydenham,  Brinton  and  Inman,  Dr. 
Thomas  still  feels  it  necessary  to  say,  **  my  experience 
has  taught  me  that  their  protest  against  the  employ- 
ment of  purgatives  requires  renewing  and  extending  to 
the  point  of  insisting  on  the  total  omission  of  purgatives 
in  the  treatment  of  all  classes  and  degrees  of  obstruc- 
tion" (p.  101).  And  again,  **  the  treatment  by  pur- 
gatives of  the  cases  I  have  placed  in  the  first  class  has 
made  the  rate  of  mortality  in  these  as  high  as  in  those 
of  the  second  class  "  (p.  103).  This  prohibition  he  applies 
equally  to  enemata,  and  the  danger  from  them  is  the 
greater,  inasmuch  that  it  is  insidious,  for  it  is  generally 
supposed  that  they  can  do  no  harm.  This  is  not  the 
case,  for  they  excite  injurious  peristaltic  action  throughout 
the  whole  intestine,  and  if  they  reach  up  to  the  diseased 
or  inflamed  part  fatal  collapse  is  likely  to  happen.    Most 


SS!!?STSf^  A  CASE  OF  OBSTRUCTION.  7 

of  UB  have  seen  the  aggravation  of  yomiting  and  pain 
induced  by  even  the  mildest  injection  given,  probably 
against  our  better  judgment,  at  the  solicitations  of 
anxious  friends.  The  same  prohibition  is  extended  by 
Thomas  to  nutritive  enemata  which  cannot  be  introduced 
in  this  disease  in  quantity  to  do  any  good  as  food, 
without  exciting  hurtful  irritation.  **  Even  a  momentary 
exploration  of  the  rectum  by  the  finger  may  become  a 
serious  matter."     (p.  144). 

In  short,  the  bowels  must  be  let  alone,  and  the  consti- 
pation will,  with  a  suitable  diet,  yield  of  itself.  Even 
after  it  has  yielded  the  same  care  must  be  continued  for 
a  time,  as  it  is  liable  to  recur  as  secondary  constipation, 
for  which  the  same  care  and  management  is  required  as 
for  the  primary.  *^  The  period  of  persistent  constipation 
in  well-managed  cases  may  vary  from  five  to  fifty  days, 
but  about  thirty-six  days  would,  in  my  opinion,  be  close 
to  a  correct  average."  (p.  65).  The  next  point  is  the 
restriction  of  diet.  Dr.  Thomas  had  observed  that  in 
cases  of  severe  fractures  when  it  is  of  the  utmost 
consequence  that  the  patient  should  be  moved  as  little 
as  possible,  the  system  could  best  tolerate  prolonged 
constipation  under  a  fluid  diet  without  milk.  After  the 
fracture  is  set  he  puts  the  patient  on  a  diet  of  tea, 
biscuit  and  butter,  flesh  broth  thickened  with  arrowroot, 
sago  or  rice,  then  arrowroot  and  water  with  wine  or 
brandy,  but  no  milk.  He  then  adds, ''  I  also  inform  the 
patient  that  I  desire  that  the  bowels  should  remain 
undisturbed  one  month  if  possible,  but  in  these  cases  I 
have  never  been  able  to  prolong  the  constipation  beyond 
the  third  week,  even  when  an  evening  opiate  has  been 
taken  to  ease  the  pain  of  the  injured  limb."  (p.  87). 
Here  we  have  a  mode  of  diet  under  which  constipation 
can  be  comfortably  borne,  and  terminates  spontaneously 
well  within  its  average  duration  in  obstruction.  Accord- 
ingly the  diet  in  obstruction*  prescribed  by  Dr.  Thomas 
is  as  follows :  *'  arrowroot,  sago,  ground  rice  cooked 
with  water,  with  the  addition  of  brandy  or  wine 
and  nutmeg,  with  sugar,  salt  and  butter ;  pea, 
lentil  or  bean  flour  cooked  with  water  then  carefully 


*  Might  we  not  lake  the  hint  and  apply  the  same  dietetic  plan  to  the 
treatment  of  thoee  inretexate  oaaea  of  constipation  which  we  find 
diilUmlt  to  core  homoeopathioaUj  nnder  ordinary  mixed  diets  7 


8  A  CASE  OF  OBSTRUCTION.  ^E^Jwf  jSJTmS! 

Btrained,  when  butter,  salt  and  a  little  pepper  are 
added.  For  a  change,  I  permit  any  of  the  flesh 
broths,  these  being  administered  in  small  quan- 
tities, as  seldom  as  the  thirst  and  hunger  of  the 
patient  will  permit.  All  solids  and  milk  should  be 
prohibited.  The  latter  I  firmly  believe  may  cause  quite 
as  much  harm  as  any  solids.  Even  with  this  limited 
diet  it  is  better  to  underfeed  than  to  push  the  supply, 
inasmuch  as  the  sufferer  cannot  within  the  time  we  are 
to  expect  resolution  succumb  from  lack  of  alimenta- 
tion."    (p.  90). 

The  nursing  of  the  patient  should  at  the  same  time 
be  attended  to.  "  He  should  be  instructed  to  confine 
himself  to  the  horizontal  position,  and  advised  to  lie 
a  few  hours  on  the  right  and  then  to  change  to  the  left 
side.  The  upper  and  lower  limbs  should  be  kept  warm, 
and  the  shoulders  and  chest  covered,  while  the  abdomen 
ought  to  remain  exposed,  and  the  foot  of  the  bed  be 
elevated  ten  inches  by  blocks  under  the  feet,  so  as  to 
diminish  fluid  pressure  and  lessen  its  tendency  to  flow 
towards  the  locality  of  obstruction  ;  this  elevation  also 
makes  the  vomiting  less  frequent  but  more  copious; 
cases  are  also  given  where  it  produced  speedy  and 
marked  relief  of  the  pain.  When  the  sufferer  is  asleep 
he  should  never  be  wakened  to  take  either  food .  or 
medicine." 

"  The  selection  of  a  suitable  diet  for  the  patient  is  all 
important  in  the  treatment  of  obstruction,  and  is  in 
most  cases  of  much  greater  assistance  to  recovery  than 
any  medicinal  or  surgical  aid.  It  is  my  opinion  that  of 
these  three  items  medicine  is  the  least  in  value."  (p.  91). 
Care  must  be  taken  also  not  to  relax  the  strictness  of 

« 

the  diet  too  soon  after  amelioration  has  begun. 

Finally,  as  a  reason  for  the  above  strict  diet,  Thomas 
and  Sydenham  both  remind  us,  that  without  it  you 
cannot  put  in  force  their  great  medicinal  remedy,  viz. : 
opium.  For  if  the  diet  is  coarse,  including  solids  and 
milk,  under  full  doses  of  opiunif  the  sensibility  of  the 
abdominal  organs  is  so  blunted  that  sufficiency  of  such 
food  may  be  swallowed  to  induce  serious  or  fatal 
symptoms.  *^  The  use  of  opium  in  combination  with  an 
unsuitable  quality  of  food  is  the  worst  form  of  mal- 
practice in  these  diseases."     (p.  235.) 


tSSSS^SSTuuS^  A  CASE  OP  OBSTRUCTION.  9 

The  third  point  is  the  administration  of  medicines. 
These  may  be  divided  into  stimulant  and  sedative.  The 
local  stimulants  in  the  form  of  the  various  aperient 
drugs  have  all  already  been  condemned  and  are  set  aside : 
those  described  as  neurotic,  chiefly  tobacco,  strychnia  and 
belladonna,  'which  act  through  the  splanchnic  nerves, 
and  excite  the  muscular  coat  of  the  healthy  part  of  the 
intestine,  are  equally  to  be  condemned  with  purgatives. 
Belladonna,  or  atropin,  however,  has  a  real  and  beneficial 
sphere  of  action  as  a  stimulant,  which,  according  to 
Thomas  it  is,  and  never  anything  else  in  medicinal  dose ; 
this  is  in  the  stage  or  state  of  collapse,  if  that  should 
unfortunately  threaten  or  come  on,  and  is  characterioed 
by  a  harmonious  depression  of  both  the  pulse  and  the 
temperature,  i.e.,  there  is  a  slow,  nearly  imperceptible 
pulse,  with  low  temperature.  On  the  other  hand, 
collapse  with  discord  between  pulse  and  temperature — 
low  temperature  and  quick  pulse — indicates  operative 
interference.  In  the  former  case  it  should  be  given 
subcutaneously  in  the  form  of  liquor  atropue  first  3  drops, 
then  in  twenty  minutes,  if  reaction  fails,  a  second  dose 
of  five  drops.  If  this  also  fails  after  half  an  hour,  a  dose 
of  10  drops  may  be  ventured  on."  If  we  except  the 
condition  of  collapse,  the  employment  of  belladonna, 
or  any  other  neurotic  stimulant  in  the  treatment  of 
intestinal  obstruction  is  as  wrong  in  theory  as  the  use  of 
local  stimulants,  i.e.,  purgatives — though  in  practice  it 
is  not  nearly  so  injurious  as  the  latter.  There  remains 
now  only  the  sedatives,  and  of  these  only  opium  and 
alcohol  Thomas  considers  useful  in  practice.  Alcohol, 
he  insists,  is  never  anything  but  a  narcotic,  but  as  he 
counsels  only  a  quite  subordinate  employment  of  it,  and 
that  on  the  ordinary  clinical  indications,  the  theory  does 
not  matter ;  and  we  may  consider  at  once  that  the  sole 
drug  to  which  he  trusts  in  almost  all,  or  all  cases,  is 
opium,  and  generally  in  the  form  of  the  subcutaneous 
injection  of  liquor  morphia  sidphatia,  4  grains  to  the 
ounce  of  water.  ''In  very  mild  cases,  and  when  the 
vomiting  is  almost  absent,  it  may  be  given  by  the  mouth 
in  15  to  20  minim  doses,  three  to  four  times  a  day  in 
proportion  to  the  discomfort  felt  by  the  patient.  Some 
cases  may  require  none,  or  only  an  occasional  dose,  but 
should  the  vomiting  be  too  frequent,  then  the  remedy 
requires  administering  by  the  skin,  in  doses  sufficient  to 


10  A  CASE  OF  OBSTRUCTION,  "'b^!^???!^! 

ease  pain,  and  control  the  vomiting,  reducing  it,  if 
possible,  to  once  or  twice  in  24  honrs.  At  the  outset  of  the 
disease  this  ought  to  be  aimed  at  by  the  use  of  the 
ordinary  hypodermic  doses  of  the  alkaloid,  commencing 
with  10  minims,  repeated  as  signs  of  its  action  wear 
away,  and  the  dose  should  gradually  be  increased  up  to 
^  or  even  f  grain  of  morph.  sulph.  if  preceding  doses 
show  no  controlling  effect.  In  one  case  in  which  the 
largest  of  these  doses  was  reached,  the  total  quantity  of 
morphia  consumed  amounted  to  45  grains,  and  the  treat- 
ment lasted  32  days.  On  the  21st  day  collapse  came 
on.  For  this  liq,  atropia  was  injected  sub-cutaneously 
twice,  and  the  patient  was  soon  after  visited  by  Dr. 
Thomas  and  Mr,  Eushton  Parker  prepared  to  operate. 
But  the  reaction  proceeded  so  favourably  that  they 
deemed  it  unnecessary,  and  the  case  went  on  under  the 
previous  treatment  to  a  successful  issue  on  the  S2nd 
day.  The  effects  that  follow  the  giving  of  opium  during 
the  treatment  of  gut-obstructions  are  the  following,  viz. : 
the  tongue  becomes  more  moist,  the  thirst  less,  the  tem- 
perature falls,  the  pulse  is  reduced  in  rate  and  enlarged 
in  volume,  the  pain  is  eased,  and  the  vomiting  dimi- 
nished. .  .  As  soon  as  the  temperature  is  observed 
to  approach  the  normal  condition,  or  to  fall  below  it, 
then  sedatives  ought  to  be  withheld,  as  collapse  may  be 
near,  for  should  this  come  on  while  the  patient  was 
much  charged  with  either  opium  or  alcohol,  his  chance 
of  reaction  would  be  very  poor.*'  (P.  121).  Thus, 
according  to  Thomas  and  Sydenham,  if  in  addition  to 
the  negative  conditions  of  abstinence  from  purgatives 
and  from  coarse  and  solid  diet,  we  add  the  full  sedative 
action  of  opium  suppressing  pain  and  peristalsis  and 
thus  moderating  the  vomiting,  and  by  "  its  paralysing  or 
inhibitory  action  on  the  vaso-motor  centres,  enlarging 
the  area  of  blood  diffusion  and  thus  diminishing  the 
pressure  upon  the  diseased  structures,"  then  the  patient 
is  put  into  the  most  favourable  position  for  natural 
recovery  from  the  various  pathological  states  lying  at 
the  root  of  obstruction.  And  when  we  come  to  thiak  of 
it,  the  powers  of  natural  recovery  are  very  great  when 
given  full  play  to  by  complete  physiological  rest.  Not 
only  all  the  diseased  states  in  the  first  class  can  be  and 
have  been  recovered  from,  but  even  many  of  those  in 
the  second  class,   where    actual  mechanical  occlusion 


B^^iUS^''  A  CASE  OP  OBSTRUCTION.  11 

more  or  less  exists.  For  example,  we  know  that  cases 
of  intassusception  have  recovered  natnrally,  either  by 
disentanglement  through  peristalsis,  or  by  throwing  off 
the  invaginated  portion  and  adhesion  of  the  intestinal 
walls ;  and  not  only  this,  bat  on  reviewing  the  statistics 
of  gastrotomy  in  this  disease,  Thomas  contends  against 
Ashnrst,  Bryant  and  Hutchinson  that  the  fatality  among 
the  operated  cases  is  greater  than  those  left  to  nature  with 
theabove  medical  management.  Infact Thomas  concludes 
that  **  of  the  mechanical  class  of  obstructions  intussuscep* 
tion  is  the  most  amenable  to  treatment  by  medicine  and 
other  therapeutic  means,"  (p.  79)  and  finally  states  that  he 
has  never  met  with  valid  evidence  that  any  case  of  intus- 
susception requires  gastrotomy  and  correction  by 
manipulation,  (p.  162).  Gases  of  volvulus  are  also 
known  to  have  been  resolved  by  natural  action.  There 
remain  other  forms  of  mechanical  occlusion  such  as 
stricture,  strangulation  from  adventitious  bands,  &c.» 
which  we  can  hardly  suppose  capable  of  resolution  and 
therefore  require  recourse  to  surgical  operation.  Never- 
theless, from  the  analogy  of  the  action  of  cat-gut  on  the 
arteries,  and  from  the  experiments  of  Sales-Girons,  who 
ligatured  the  gut  in  dogs  which  recovered  with  pervious 
lumen,  we  can  suppose  this  may  at  times  be  possible, 
and  cases  are  given  by  Fagge  and  Brinton  in  which  there 
is  good  reason  to  believe  it  has  actually  happened. 
Therefore,  it  is  well  to  give  sufficient  time  to  nature  and 
to  be  guided  in  the  decision  to  operate  more  by  the  state 
of  the  patient  than  by  any  presumed  differential  diag- 
nosis which  is  never  certain.  Thomas  lays  it  down  that 
if  the  primary  treatment  has  been  proper,  it  is  highly 
improbable  that  operation  will  be  required  earlier  than 
the  third  day  or  later  than  the  third  week ;  except  in 
malignant  disease,  tumours  and  concretions,  which  may 
need  operation  after  a  long  period.  In  the  majority  of 
instances  the  period  for  operating  will  be  indicated  about 
the  seventh  day  and  only  in  very  rare  occasions  will 
symptoms  pointing  to  the  necessity  for  an  operation 
appear  much  earlier  or  later  than  the  seventh  day. 
{p.160). 

The  surgical  procedures  other  than  gastrotomy  (and  of 
course  that  for  hernia  when  present)  allowed  by  Thomas 
are  paracentesis  of  the  gut  to  relieve  tympany  and 
possibly  inflation  in  the  early  stage  of  intussusception. 


12  A  CASE  OF  OBSTBUCTIOX. 


i^ten. 


Paracentesis  is'not  anfreqnently  required  and  gives  great 
relief,  it  is  indicated  more  by  the  tension  of  the  ab- 
dominal walls  than  the  amount  of  gaseoos  swelling,  care 
mnst  be  taken  that  only  air  is  evacuated,  for  if  fluid 
comes  there  is  danger  of  its  oozing  into  the  peritoneum, 
and  setting  up  fatal  inflammation.  For  this  reason 
Thomas  considers  *'  the  practice  of  trocaring  the  in- 
testine to  reheve  distension  from  Uquid  is  attended  with 
more  risk  than  would  be  incurred  by  the  performance 
of  gastro-enterotomy "  (p.  189).  "For  the  safe  per- 
formance of  paracentesis  the  centre  of  the  area  of 
resonance  should  be  selected  for  puncture,  and  a  trocar 
of  small  diameter  but  of  extra  length  should  be  used, 
not  shorter  than  4  inches,  that  it  may  remain  well  in 
the  nearly  always  perturbed  intestine.  It  is  not  ad- 
visable to  let  the  canula  remain  long  in  the  intestine, 
not  longer  than  5  to  15  minutes,  as  delay  in  withdraw- 
ing tends  to  make  the  puncture  patent.  In  withdra^\'ing 
the  canula  or  hollow  trocar  the  thumb  should  be  placed 
over  the  external  orifice,  to  make  sure  that  the  contents 
of  the  tube  do  not  drop  into  the  peritoneum"  (p.  131). 
Cases  are  given  in  which  trocaring  was  used  with  good 
effect  every  second  day,  or  even  four  or  five  times  a  day, 
and  in  one  case  forty  times  in  aU  during  the  illness.  To 
inflation  Thomas  gives  only  a  doubtful  and  qualified  assent 
in  some  cases  of  intussusception  in  the  very  early  stage. 
The  passing  of  the  long  tube ;  enemata,  simple  or  medi- 
cated or  nutritive ;  throwing  in  of  effervescing  salts ; 
kneading  and  inversion;  counter-irritations;  metallic 
mercury  and  other  rough  and  desperate  expedients  are 
utterly  condemned  by  Thomas. 

Such  are  what  we  must  consider  the  most  advanced 
principles  of  treatment  of  this  disease  in  the  allopathic 
school,  and  it  will  be,  I  think,  interesting  and  instructive 
to  compare  them  wich  those  of  the  homoeopathic  school. 
In  the  first  place  we  notice  here  as  elsewhere  even  in  the 
medicinal  part  of  the  treatment,  the  entire  absence  of 
any  direct  curative  action  on  the  diseased  parts  them- 
selves, which  are  left  to  recover  or  perish  as  nature 
pleases  without  any  help  from  the  physician,  except  the 
negative  one  of  removing  hindrances.  That  is  much, 
certainly,  but  is  it  really  all  that  art  can  do  ?  We  think 
not.  As  regards  the  non-medicinal  negative  treatment 
the  same  rules  apply  to  both  the  homoeopathic  and 


^^Jfj^TSf^*"  ^  <^^SE  OF  OBSTRUCTION.  IB 

allopathic  methods,  and  as  respects  the  first  article  in 
the  Sydenham-Thomas  code  we  may  notice  that  the 
strict  homoeopathic  treatment  ahready  involves  abstinence 
from  purgatives  and  forcible  attempts  to  move  the 
bowels,  and  it  is  only  when  the  practitioner  thinks  he  is 
called  upon  to  deviate  from  homoeopathic  practice,  that 
errors  on  this  point  can  arise.  So  I  hope  the  experience 
above  detailed  will  convince  our  school  that  it  is  an 
error  to  give  purgatives  in  any  form,  and  will  encourage 
us  to  resist  the  solicitations  of  anxious  friends.  This  is 
often  extremely  difficult,  and  Thomas  relates  several 
instances  in  which  he  himself  was  turned  off  and  roundly 
scolded  for  ignorance  and  incapacity  in  leaving  thi 
bowels  unopened  for  even  a  week.  The  second  article 
of  the  code,  viz.,  abstinence  from  solid  food  and  milk,  is 
no  necessary  part  of  the  homoeopathic  method,  but  is,  of 
course,  quite  compatible  with  it,  and  I  have  no  hesitation 
in  saying  that  we  ought  to  adopt  it  in  its  integrity  as 
one  of  the  most  important  aids  to  success. 

In  these  two  articles  both  schools  are  thus  on  a  par, 
both  negative,  but  in  the  third  article,  viz.,  the  use  of 
medicine,  they  differ  widely,  for  the  homoeopathic  method 
aims  to  act  positively  and  curatively  on  the  diseased 
part  and  that  alone,  whereas  it  is  admitted  by  Thomas 
that  the  sedative  doses  of  opium  are  not  expected  to  act 
on  the  diseased  parts  of  the  intestine  but  solely  on  the 
healthy  parts  of  the  nerve  and  muscular  organs  of  the 
intestinal  canal  which  are  over  acting.  In  health,  in 
full  dose,  opiates  stop  secretion  and  peristaltic  movements 
and  blunt  the  sensibility  of  the  bowels  ;  and  in  obstruc- 
tion by  the  same  action  we  may  for  a  time  stop  pain  and 
peristaltic  action  and  vomiting,  restlessness  and  fever, 
although  no  directly  curative  action  may  have  taken 
place  on  the  proximate  cause  of  the  obstructions.  By 
the  stoppage  of  the  pain,  vomiting  and  violent  peristaltic 
movements,  physiological  rest  is  given,  and  thus  a  great 
help  to  the  natural  process  of  cure,  although  indirect 
and  negative,  yet  still  one  not  to  be  forgotten  if  other 
modes  fail,  and  one  which  taken  in  connection  with  the 
other  two  articles  has  made  the  Sydenham-Thomas 
method  more  successful  than  any  other  allopathic  plan. 
But  we  cannot  of  course  allow  that  it  supersedes  the 
homoeopathic  mode,  and  I  do  not  doubt  that  if  we  rigidly 
adopt  the  two  first  articles  and  then  treat  homoeopathi* 


14  A  CASE  OP  OBSTBUCnON*  ^^tS&^SaaHu^S^. 

cally,  our  success  vhll  surpass  that  of  Thomas.  If  we 
look  at  the  functional  causes  of  obstruction  we  find  they 
all  belong  to  pathological  states  such  as  inflammation^ 
swelling,  spasm,  local  paralysis^  &c.y  which  we  daily  treat 
homceopathically  with  remarkable  success.  In  particular 
our  success  in  typhlitis  with  aconite ,  beUadonnaf  anenir- 
cum ;  in  enteritis  with  the  same  and  colocynth,  bryoma^ 
&c. ;  in  spasms  and  colic  with  cohcynthisy  plumbum^  beUa- 
donna  and  bryonia  is  remarkable.  Even  in  the  second 
class,  where  there  is  mechanical  occlusion,  the  direct 
specific  treatment  has  a  margin  in  which  it  is  applicable, 
for  there  is  generally  present  some  inflammation  or 
swelling  which  aggravates  the  mechanical  defect  to  the 
point  of  obstruction.  The  margin  here  is,  however, 
narrower  before  we  may  be  compelled  to  fall  back  upon 
opiates  or  operation.  On  the  whole,  therefore,  we 
have  every  encouragement  to  start  hopefully  with  the 
homoeopathic  treatment  in  cases  of  obstruction, 
but  there  are  certain  difficulties  raised  by  the  success 
of  full  sedative  doses  of  morphia  in  a  disease 
in  which  that  medicine  is  itself  homceopathically 
indicated,  which  require  discussion,  as  well  as  the 
question  how  far  and  when  we  may  take  advantage  of 
the  full  sedative  dose  as  sen  auxiliary  to  homoeopathic 
treatment.  In  the  first  place  let  us  steadily  keep  in 
mind  the  existence  of  cases  in  which  faecal  vomiting, 
constipation  and  deaths  occur,  while  at  the  poH  mortem 
the  whole  intestinal  canal  is  found  quite  pervious,  and 
free  from  not  only  the  mechanical  obstructions  consti- 
tuting the  second  class,  but  even  from  the  more  obvious 
lesions  constituting  the  first  or  functional  class.  This  is 
remarkable,  and  gives  a  certain  element  of  mystery  to 
this  disease.  At  the  same  time  it  encourages  us  to  hope 
that  if  the  mystery  is  penetrated  we  may  not  only 
explain  these  cases,  but  find  a  morbid  state  more  or  less 
present  in  all  cases,  and  which  may  also  be  an  object  of 
specific  treatment.  Let  us  call  to  mind  the  anatomy  of 
the  parts  affected.*  The  muscvlar  coaU  of  the  intestine 
consist  of  an  internal  circular,  and  of  an  external 
longitudinal  layer  of  involuntary  muscle,  the  former 
being  much  thicker  and  stronger  than  the  latter. 
The    nerves  of   the    small   intestine    come    from  the 

*  Chiefly  from  HoKindrick*s  Phynology,  vol.  it 


JK^^jSTS^  a  case  of  obstruction.  15 

SQperior    mesenteric    plexus,    formed    from    branches 
of    the    pneomo-gastric    nerve,    the    semi-lunar    gan- 
glion and  the  cceliac  plexus ;    while  the  large  intestine 
is  supplied  by  branches  of  the  inferior  mesenteric  and 
hypogastric  plexuses.     The  numerous  nerve  filaments, 
consisting  chiefly  of  non-medullated  fibres,  form  a  net- 
work under  the  serous  coat,  then  penetrate  the  longi- 
tudinal layer  of  muscular  fibres,  and  spread  out  so  as  to 
form  a  plexus  between  the  muscular  layers,  which  is 
called  Auerbach's  plexus.    From  this  plexus  numerous 
non-medullated  fibres  issue,  some  of  which  terminate  in 
the  muscular  fibres  while    others    pass  through    the 
circular  muscular  coat,  and  form  another  and  more 
delicate  plexus  in  the  submucous  coat  called  Meissner's 
plexus.    From  this  fibres  pass  to  the  glands.    As  peris- 
taltic movements  and  probably  secretion  occur  readUy  on 
stimulation    after  a    portion  of  the  bowel    has  been 
severed    from    its    nervous  connections,    it  is  evident 
that    these    movements   are    regulated  by   ganglionic 
centres    in    the    wall    of    the    bowel    itself.      Besides 
these  the  bowel   is   also  influenced  by   four  other  sets 
of  fibres  reaching  it  from  the  above  sources,  viz.,  (1) 
inhibitory,  (2)  motor,  (8)  vaso-motor  to  the  blood-vessels, 
and  (4)  sensory.    It  has  been  found  that  stimulation  of 
the  vagus  increases,  whilst  stimulation  of  the  splanchnic 
arrests  the  movements.     The  vagus  may  therefore  be 
regarded  as  a  motor  nerve  for  reinforcing  the  activity  of 
the  ganghonic  centres,  and  the  splanchnic  as  containing 
inhibitory  fibres  for  restraining  and  controlling  these 
centres.    Intestinal  movements  may  also  be  influenced 
by  impressions  coming  from  the  higher  nervous  centres, 
as  is    seen    from  the  '^ yearning  of   the    bowels"  in 
emotional  excitement  and  the  constipation  which  attends 
apoplexy  and  many  nervous  afi^ections  from  interruption 
of   the    constant    stimulus  conveyed  from  the  brain. 
Conversely  through  those  nerve  filaments  is  conveyed  the 
stimulus  causing  pain,  vomiting  and  coUapse  on  sympa- 
thetic symptoms  of  the  present  disease  of  the  bowels,  as 
well  as  the  numerous    remote  disorders  arising  from 
irritation  in  the  bowels.    ''  The  movements  of  the  small 
intestine  consist  of  regular  and  successive  contractions 
from  above  downwards,  by  which  the  caUbre  of  the  tube 
is  diminished,  and  also  contractions  in  the  direction  of 
the  long  axis  of  the  tube,  which  shortens  the  length  of  a 


16  A  CASE  OF  OBSTBUCnOK. 


,  Jn.  u  im. 


small  portion  of  it,  and  when  energetic,  move  a  loop  of 
intestine  as  a  whole.  The  circular  contractions  are  dae 
to  the  actions  of  the  circular  fibres,  whilst  the  others 
depend  on  shortening  of  bundles  of  the  longitudinal 
fibres.  When  carefnUy  watched  in  animals  recently  dead, 
it  is  easy  to  observe  that  both  sets  of  fibres  in  a  segment 
may  act  at  the  same  time,  so  as  to  produce  a  peculiar 
twisting  movement.  Such  movements  are  termed 
peristaSicy  and  by  them  the  chyme  is  slowly  propelled 
along  the  intestine.  The  rate  of  movement  is  about 
10  mm.  per  second.'*     (McEendrick,  p.  104). 

From  this  we  learn  that  peristalsis  is  a  complicated 
operation  requiring  the  delicate  adjustment  of  two  sets 
of  muscular  fibres  under  the  influence  of  several  nervous 
centres,  near  and  remote.  In  this  it  resembles  numerous 
functions  such  as  swallowing,  speaking,  the  rhythmical 
actions  of  the  heart,  and  others  requiring  co-ordinated 
muscular  contractions  and  relaxations.  Here  the  inter- 
ruption of  the  rhythmical  contractions  would  produce 
practically  obstruction,  although  there  was  no  mechanical 
occlusion  or  even  narrowing  of  the  gut  at  any  part.  A 
variety  of  muscular  disturbances  may  conceivably  pro- 
duce this  effect,  for  example,  considering  that  the 
intestines  are  crowded  into  a  small  space  and  the  coils 
twisted  in  every  direction,  the  mere  failure  of  action  of 
the  longitudinal  fibres  in  adjusting  the  bowel  to  the  effect 
of  the  propulsive  action  of  the  circular  fibres  must  pro- 
duce obstruction  and  possibly  kinks  or  volvulus.  If,  then, 
the  mass  of  contents  continue  to  increase  by  injudicious 
feeding,  or  still  worse  by  purgative  medicines,  the 
circular  fibres  continue  to  act  more  and  more  forcibly, 
with  pain,  spasm  and  irregularity,  till  finally  the 
peristalsis  is  inverted  and  we  have  the  distinctive  state 
of  ileus.  Thus  mere  perversion  of  the  rhythmical  con- 
tractions may  be  sufficient  to  cause  ileus  and  explain  the 
mysterious  element  which  constitutes  some  forms  of 
this  disease  and  more  or  less  complicates  all  forms  of 
obstruction.  We  have  thus  perverted  rhythmical 
muscular  action  as  a  pathological  element  in  addition  to 
those  already  enumerated  requiring  direct  specific  treat* 
ment.  Such  according  to  the  homoeopathic  law  we 
must,  of  course,  look  for  by  drugs  causing  perverted 
rhythm  in  the  healthy  body  ;  and  that  such  should 
exist  is  no  more  surprising  than  we  should  find  that 


JSSSij£!TSS^  ^  CAM  OF  OBSTBUOTIOK.  17 

hdladonna,  leaving  untoaohed  the  circular  fibres  of  the 
iris,  stimalates  the  radial  fibres  and  thus  dilates 
the  papil,  while  physoMtigma  acts  precisely  in  a 
contrary  manner.  So,  doubtless,  many  drugs  act 
on  the  circular  and  longitudinal  fibres  of  the  intes- 
tines, although  experimental  research  has  not  yet 
enabled  us  to  classify  them  so  exactly  as  in  l^e  case  of 
the  iris.  Any  way,  guided  by  tiie  anfdogy  of  the  symptoms 
in  individual  cases  several  drugs  have  been  found  homoeo- 
pathically  curative  in  actual  ileus,  more  especially 
plumbum,  alum,  opium,  nux  vomica,  dc,  apparently  from 
direct  curative  action  on  the  element  of  perverted 
muscular  rhythm.  Here,  however,  experience  is  still 
defective  in  the  homoeopathic  school,  and  practitioners 
should  not  confine  themselves  to  the  small  circle  of 
medicines  enumerated  in  the  text  books,  but  should 
consider  the  whole  Materia  Medica  open  to  the  choice  of 
the  drug  which  corresponds  most  closely  to  the  symptoms 
of  perverted  rhythm,  whether  it  had  previously  cured  a 
similar  case  or  not.  Probably  among  the  astringents 
and  the  more  powerful  irritants  may  be  found  many 
medicines  homodopathically  suited  to  this  element  of  the 
disease.  I  have  no  doubt  that  a  sufficiently  large 
number  of  cases  treated  strictly  homoeopathically  will 
show  a  more  favourable  average  of  recoveries  and  a 
shorter  duration  of  the  disease  than  Dr.  Thomas's ;  and 
in  fewer  cases  will  the  question  of  sedatives  or  operation 
need  to  be  raised  ;  but  still  we  must  be  prepared  for  that 
arising  in  a  certain  number  of  cases,  and  if  under  the 
best  chosen  homoeopathic  specific  medicine  the  pain  and 
vomiting  from  reversed  peristaltic  action  continue  and 
collapse  threatens,  then  we  ought  not  to  hesitate  to 
inject  \  gr.  doses  of  morphia  subcutaneously.  Having 
once  decided  on  this,  the  further  question  now  arises 
whether  the  homoeopathic  treatment  should  be  continued 
when  the  patient  is  under  the  influence  of  full  sedative 
doses  of  morphia  ?  This  is  a  question  which  is  appro- 
piate  for  discussion  in  a  meeting  like  this,  and  any 
agreement  come  to  will  be  comforting,  and  will  strengthen 
the  hands  of  practitioners  for  the  future  in  dealing  with 
this  distressing  disease.  There  is  no  doubt  that  the 
quenching  of  pain  and  disordered  movements  and 
vomiting  by  this  full  sedative  dose  must  for  the  time 
deprive  us  of  signs  of  disease,  which  are  valuable  for  the 
VoL  35,  No.  1.  c 


18  A  CASE  OP  OBSTRUCTION,  *^J,fSS?ifi^? 

choice  of  the  homoeopathio  remedy ;  neyertbeless  I  am 
inclined  to  think  that  the  full  dose  of  the  sedative,  once 
or  twice  in  the  24  hoorSi  should  not  preclude  the  con- 
tinuance of  homoeopathic  treatment  during  the  rest  of 
the  time  on  the  best  indications  we  can  obtain,  im- 
perfect though  they  may  be.  Chance  has  also  furnished 
me  with  some  experimental  evidence  on  this  point,  for 
having  been  called  in  to  cases  of  obstruction  and  allied 
abdominal  inflammation,  which  were  already  under 
treatment  with  opiate  subcutaneous  injections,  I  have 
found  the  case  to  progress  favourably,  though  the  in- 
jections were  continued  at  lengthened  intervals.  Of 
course  the  danger  must  be  guarded  against  of  yielding 
too  readily  to  the  seductive  mfluence  of  such  a  powerful 
means  of  speedy  though  transient  relief. 

There  remains  the  difficulty,  how  is  it  that  opitcm  can 
be  used  not  only  without  injury  but  even  with  benefit 
in  full  doses  in  a  disease  to  which  it  is  in  its  broad 
features  so  homoeopathic,  while  at  the  same  time,  we 
know  it  to  be  curative,  homoeopathically,  in  the  usual 
small  dose.  If  we  look  closely  into  the  practice  of 
Dr.  Thomas  and  the  allopathic  school  generally,  rather 
than  into  their  theories,  we  shall,  I  think,  get  some 
inkling  into  the  explanation  of  this  difficulty.  Dr. 
Thomas  is  an  uncompromising  allopath  at  heart,  and  in 
words,  and  lays  it  down  almost  dogmatically  that  opium 
can  act  only  as  a  sedative,  and  entirely  denies  or  ignores 
the  double  and  opposite  action  of  medicines  as  displayed 
in  every  homoeopathic  cure,  and  in  large  and  small 
doses  on  the  healthy  body,  and  in  the  same  doses  which 
at  different  stages  display  the  double  and  opposite 
action,  and,  in  short,  the  whole  world  of  therapeutic 
possibilities,  which  lies  in  the  more  delicate  actions  of 
medicine  inside,  as  it  were,  of  the  full  physiological 
action.  According  to  him,  the  opium  can  have  no  effect 
at  all,  except  in  full  sedative  dose,  and  then  it  simply 
acts,  not  as  a  direct  remedy  for  any  symptom  or  part  of 
the  disease,  but  as  a  means  of  coarsely  quenching  all 
the  nervous  activities  of  the  abdominal  organs,  in  the 
hope  that  the  enforced  functional  rest  thus  given 
will  allow  the  diseased  organs  to  right  themselves. 
In  like  manner  Dr.  Thomas  denies  in  toto  any  sedative 
or  antispasmodic  action  of  belladonna  or  atropine,  and 
lays  it  down  that  it  always  acts  only  as  a  stimulant,  and 


^4 


SSSI'jSTJS^*  a  case  op  obstbuction.  19 


Benew,  Jan.  l,  1801. 


for  this  reason  should  never  be  given  except  in  the  state 
of  collapse.    This  is  not  in  accordance  with  the  resalts 
of  experiment,  for  "  Salvioli  found  that'  nicotine  caused 
violent  intestinal  contractions  and  narrowing  of   the 
blood  vessels,  while  opium  and  atropine  produced  the 
reverse/'*      Dr.  Thomas  is  sensible  of  the  difficulties 
which  the  facts  of  pharmacology  oppose  to  his  dictum 
of  the  single  action  of  drugs,  and  explains  it  by  treating 
as  toxical — in  contra-distinction  to  physiological — those 
effects  which  do  not  agree  to  his  principle.     But  it  is 
obvious  that  will  not  apply  to  the  above  experiment, 
nor  can  it  reaUy  be  upheld  otherwise  ;    and  neither  he 
nor  anyone  else  will  ever  understand  or  explain  the 
direct  therapeutic  action   of   drugs    without    acknow- 
ledging the    double    and    opposite    action    of    small 
and  large    doses    in   homoeopathic    cures.       On    Dr. 
Thomas's   principles    doses  of  j^  to  ^  of   morphia, 
or  one  or  two  drops  of  tincture  of  opium,  can  be  of  no 
possible  use.    Such  doses  are  not  sedatives  in  any  sense 
of  the  word,  and  it  is  simply  another  example  of  the 
innomerable  errors  committed  by  putting  words    for 
ideas  to  speak  of  them  as  such.    Nevertheless,  in  Dr. 
Thomas's  own  cases,  we  find  a  number  of  examples  where 
he  gives  the  opium  in  fractional  doses,  such  as  1  to  4 
drops  of  tincture  of  opium,  and  benefit  is  reported  long 
before  the  quantity  could  have  amounted  to  a  sedative 
dose.    So,  in  fact,  a  large  part  of  the  allopathic  treatment 
of  abdominal  inflammations  and  obstructions  is  really 
homoeopathic  after  all,  and  when  we  add  to  that  the 
speedy  toleration  acquired  for  opium,  no  doubt  many  of 
the  full  doses  of  that  drug  have  thus  become  relatively 
small  enough  to  cure  homoeopathically.    There  will  thus 
remain  only  a  certain  proportion  in  which  the  coarse 
sedative  action  is  required,  and  in  many  of  these,  as 
above  said,  we  may  find  it  necessary  to  adopt  the  same 
proceeding.     So  the  apparent  difficulty  of  reconciling 
Thomas's  practice  with    our  theory  is  not   so  great 
after  aU. 

I  conclude  with  a  summary  of  the  principles  which 

ought  to  guide  our  treatment  in  this  distressing  malady. 

1st. — ^As  soon  as  we  decide  that  the  cure  before  us 

is  one  of  obstruction  and  not  common  constipation,  the 

*  See  Hennann'fl  JSseperimefUdl  Pharmacology,  p.  189. 

c— 2 


20  A  CASE  OF  OBBTBUCnON.   ''pSSL^jSf?^ 


Bartow,  Jaa.  1,  un. 


first  two  articles  of  the  Sydenbam-Thomas  code  should 
at  once  be  put  in  force  by  the  prohibition  of  all  purgatives 
and  forcible  means  of  moving  the  bowels  and  the  rigid 
diet,  excluding  all  soUds  and  milk ;  also  the  raising  the 
foot  of  the  bed,  and  other  precautions  in  nursing. 
2nd.  Then  begin  homoeopathic  treatment,  choosing  the 
medicines  strictly  according  to  the  symptoms  of  the 
patient,  and  not  being  tied  down  too  rigidly  to  a  routine 
circle  of  medicines  previously  found  curative  in  the 
disease.  During  this  stage  the  trocar  may  be  used  when 
indicated  for  the  surgical  reUef  of  the  distension. 
8rd.  If  now,  after  a  reasonable  time,  the  main  symptoms, 
especially  the  pains  and  vomiting,  fail  to  be  relieved, 
and  become  more  violent,  then  we  should  adopt  the 
method  of  full  sedative  doses  of  morphia  injected 
subcutaneously  once  or  twice,  or  oftener,  in  the  twenty- 
four  hours,  continuing  at  the  same  time  the  homoeopathic 
treatment.  4th.  If,  after  a  further  reasonable  time — ^to 
be  determined  by  the  general  state  of  the  case — ^no  relief 
is  obtained,  then  operation  should  be  taken  into  con- 
sideration. 

I  should  like  now  co  be  allowed  to  ask  Dr.  Thomas  a 
question,  How  is  it  that  he  has  ears  to  hear  the  voice  of 
Sydenham  who,  being  dead  ahready  two  hundred  years, 
yet  speaketh,  and  still  is  totally  deaf  to  the  voices  of 
ten  thousand  fully  qualified  practitioners  now  living,  who 
assert  on  the  evidence  of  a  life-long  experience  that  the 
primary  full  physiological  action  of  medicines  is  not  the 
only  one  which  can  be  used  therapeutically  in  this  and 
the  majority  of  diseases,  and  that  within  this,  i.e.,  in 
doses  too  small  to  produce  the  primary  action,  there  lies 
a  whole  world  of  therapeutic  activity  in  which,  in  fact, 
the  homoeopathic  school  exists?  We  are  not  all 
Sydenhams  certainly.  We  do  not  even  claim  that  there 
is  any  Sydenham  among  us  now  hving,  but  we  do  make 
the  claim  that  Hahnemann  surpassed  him  in  originality 
aod  genius,  and  that  the  discovery  of  the  homoeopathic 
law  of  specifics  was  of  immeasurably  greater  importance 
to  medicine  than  anything  done  by  Sydenham.  It  is 
true  that  Hahnemann  had  the  defects  of  his  qualities, 
and  by  pushing  the  reduction  of  the  dose  to  an 
extravagant  degree — as  when  he  proposed  the  80th 
dilution  as  the  normal  dose — ^he  well  nigh  reduced  the 
practical  value  of  his  discovery  to  a   nullity.      But 


£SSfrjS!Ti8w!*'  A  CASE  OP  OBSTRUCTION.  21 

Sydenham  had  his  vagaries  too,  and  could  by  no  means 
shake  himself  free  from  the  superstitions  and  nostrum- 
mongering  which  encumbered  medicine  then  perhaps 
even  more  than  now.  For  instance,  in  this  very  disease, 
he  recommends  with  equal  urgency  and  faith  to  those 
measures  Thomas  thinks  so  sensible,  the  application  of 
a  live  kitten  to  the  stomach  of  the  patient,  and  is  very 
particular  that  it  should  not  be  removed  till  the  vomiting 
stops  !  Thomas  condones  this  piece  of  folly.  Why  can  he 
not  extend  the  same  charity  to  Hahnemann,  whose 
errors,  if  such  there  be,  are  only  exaggerations  in  defence 
of  truly  scientific  principles  ? 

Discussion. 

The  PBEsmEMT  said  they  were  very  much  obliged  to  Dr. 
Drysdale  for  this  very  admirable  paper,  and  for  the  length  at 
wluch  he  had  treated  the  question. 

Dr.  Hughes  asked  Dr.  Drysdale  whether  he  suggested  that 
in  cases  of  ordinary  constipation  they  should  adopt  the  same 
methods  as  he  recommended  in  cases  of  obstruction.  It 
seemed  to  >^iTn  that  the  cases  stood  upon  diametrically  oppo- 
site grounds.  In  cases  of  obstruction  they  did  not  want  to  do 
anything  to  stimulate  the  intestines  to  work.  They  wanted  to 
leave  that  to  rest,  while  they  subdued  inflammation,  restored 
power,  and  left  nature  to  help  on  natural  action  of  the  bowels. 
But  in  ordinary  constipation  they  wanted  to  do  just  the  oppo- 
site. They  needed  to  supply  a  natural  stimulus  to  the  bowels 
of  which  it  was  deficient,  and  the  treatment  of  intestinal 
obstmction  and  constipation  should  therefore  be  entirely 
different. 

Mr.  Knox  Shaw  said  there  were  two  or  three  points  in  the 
paper  to  which  he  would  in  particular  like  to  refer.  He  was 
sorry  they  did  not  hear  the  case  described  (hear,  hear), 
because  that  would  have  helped  them  a  little  in  forming  some 
idea  as  to  the  exact  form  of  obstruction  to  which  he  was 
referring,  cases  of  obstruction  being  so  varied.  The  case  to 
which  Dr.  Drysdale  more  particularly  alluded  he  thought  they 
ought  to  class  more  under  the  head  of  chronic  obstruction, 
it  made  all  the  difference  in  the  world  whether  they  were 
called  upon  to  treat  a  case  of  chronic  obstruction  or  a  case  of 
aeate  obstruction.  If  they  treated  a  case  of  acute  obstruction, 
and  waited  86  days  for  the  bowels  to  act,  the  patient  would 
be  dead  and  buried  long  before  that  period  had  arrived.    He 


22  A  CASE  OF  OBSTRUCTION.  "fSl^^Hf^! 

conld  not  support  the  view  which  Dr.  Drysdale  encouraged, 
that  enemata    were    vile    concoctions    (Dr.    Dyce    Brown: 
Hear,  hear),  because  it  seemed  to  him  that  an  immense 
deal     could    be    done    by    a    judicious    and    proper    use 
of  enemata.      (Hear,  hear).      Those  who  treated  intestinal 
obstruction,  he  might  point  out,  ranked  themselves  on  two 
sides.     The  one  side  was  led  by  Mr.  Jonathan  Hutchinson 
and  the  other  was  led,  perhaps,  by  Mr.  Frederick  Treves. 
Mr.  Hutchinson  was  a  strong  advocate  for  deferring  operative 
treatment  and  trying   all  other  measures — measures  which 
sounded  almost  ridiccdous.     In  a  paper  he  wrote,  published 
in  his  very  interesting  Archives  of  Surgery,  he  told  them  how 
by  calling  in  four  policemen  they  might  take  the  patient,  shake 
him  well  up,  twist  him  and  turn  him,  pummel  his  abdomen, 
administer  copious  enemata  of  warm  water,  &c.,  and  that 
they  would  be  more  likely  to  cure  him  in  this  way.     Mr. 
Treves  took  the  other  side,  and  thought  that  when  they  had 
once  concluded    that  the    constipation    was   due    to   some 
mechanical  obstruction,  it  was  their  duty  there  and  then  to 
operate.      This  question  of  operation  was  passed  over  by 
Dr.  Drysdale  a  little  too  hastily  he  thought,  for  he  was  sure 
that  with  modem  treatment  operative  measures  could  now  be 
undertaken  with  so  very  Httle  danger  to  the  patient  that  a 
physician  was  almost  morally  bound  to  advise  his  patient  to 
submit  to  an  operation  if  he  saw  that  the  disease  did  not  yield 
within  a  very  short  time.     It  was  quite  clear  that  if  an 
operation  was  to  be  successful  it  must  be  done  before  the 
patient  got  into  a  state  of  collapse,  or  became  too  seriously  ill 
to  bear  it.     Nowadays  an  exploratory  incision  2  or  8  inches 
in  extent,  could  safely  be  made  into  the  abdominal  cavity. 
This  would  admit  two  or  three  fingers,  which  in  the  case  of  an 
ordinary  patient  under  an  anassthetic,  would  enable  them  to 
explore  nearly  the  whole  of  the  abdominal  cavity.     So  much 
could  be  gathered  from  it,  and  if  the  case  did  happen  to  be  one 
of  obstruction  from  any  mechanical  cause,  they  were  then  so 
easily  able  to  relieve  the  patient,  that  he  felt  convinced  that 
the  question  of   an  early  operation  was  a  question  which 
should  be  considered  very  carefully  indeed.    He  felt  that  great 
responsibility  rested  upon  a   man  who  allowed  his  patient 
to    drag    on    and    on    in    the    )iope    that    something    was 
going  to  turn  up,  till  he  had  really  passed  the  period  when 
aid  which  might  have  been  given  him  by  a  well-planned 
surgical  operation  would  be  of  service.     With  regard  to  the 
treatment  of  these  cases  by  opium,  there  was  no  doubt  what- 
ever that  opium  did  immensely  reHeve  the  patient,  but  it 
complicated  matters  as  regards  the  treatment.     (Hear,  hear^ 
and  applause).     First  of  all  he  was  himself  very  strongly  of 


£3S?jSIT^S^  a  case  of  OBSTRtTOTION.  28 

opimon  thai  it  hampered  the  remedies  ihej  might  be  using* 
but  what  was  more  important  than  anything,  it  allowed  the 
patifflit  to  drift  into  a  dangerous  condition  without  their  being 
reaUy  aware  of  it.  (Hear,  hear).  It  so  mastered  the 
symptoms — it  stopped  the  vomiting  and  it  arrested  tiie  pain, 
bat  it  allowed  the  disease  to  go  on  so  Heut  that  when  ti^ey  were 
(H^led  npon,  as  they  might  be  to  perform  some  surgical 
operation,  they  might  find  that  the  intestine  would  be 
raptured,  or  was  in  such  a  state  of  necrosis  as  to  need  some 
operation  as  severe  as  re-seotion  or  the  formation  of  an 
artificial  anus.  He  had  seen  that  only  quite  lately  in  a  case 
which  he  published  in  the  Monthly  HomoBopathic  Review,  as  to 
whidi  Dr.  Gilbert  would  bear  him  out  in  saying  how  difficult 
it  was  for  them  to  decide  whether  the  patient  should  be 
operated  on  or  not,  because  the  symptoms  were  so  masked  by 
an  opiate  which  he  (Dr.  Gilbert)  felt  it  his  imperative  dutv  to 
give  the  patient,  so  great  was  his  agony.  In  this  case,  when 
he  saw  him,  with  Dr.  Gilbert,  the  question  of  an  operation 
had  really  almost  passed  out  of  their  minds  because  the 
patient  had  so  improved.  They  did  operate,  and  he  felt  sure 
from  the  subsequent  history  of  the  case  that  the  improvement 
was  purely  false.  It  was  simply  due  to  the  man's  pain  being 
relieved,  and  the  vomiting  being  stopped.  The  obstruction 
was  not  relieved  the  least  bit  in  the  world.  They  should  be 
very  careful  before  they  resorted  to  anything  like  enemata. 
(Applause). 

Dr.  DroK  Bbown  sympathised  very  much  indeed  with  the 
^e^s  expressed  by  Mr.  Knox  Shaw.  There  was  one  point  in 
Dr.  Drysdale's  paper  which  it  was  important  to  notice.  He 
qpoted  firom  Dr.  Thomas,  and  approved  of  his  opinion  that  it 
did  not  matter  very  much  what  the  diagnosis  of  the  cause  was, 
that  they  could  not  make  a  diagnosis  in  many  cases,  and  it 
did  not  matter  very  much  in  the  treatment.  Mr.  Enox  Shaw 
seemed  to  think  that  it  mattered  a  great  deal.  If  it  was 
simply  faecal  obstruction  they  could  go  on  having  want  of 
action  in  the  bowels  for  a  number  of  days  withoiit  much  risk 
to  the  patient,  but  if  it  was  a  case  of  twisting  of  the  gut  or 
any  other  form  of  obstruction  than  simply  fsecal  accumulation, 
they  might  lose  the  patient  without  prompt  action.  In  cases 
whroh  he  believed  were  not  fsecal,  but  something  more,  he 
should  say  the  proper  course  would  be  to  have  an  operation 
as  soon  as  they  found  that  ordinary  measures  fedled  to  afford 
idief.  In  cases  of  simple  fsBcal  obstruction  they  could  with 
aafety  wait  for  a  considerable  time,  and  use  other  measures, 
which  were  often  successfal.  He  quite  agreed  with  Mr.  Enox 
Shaw  also  as  to  the  ^ue  of  enemata.    He  had  frequently 


24  A  CASE  OF  OBSTRUCTION.  ^SSw^S^i^ 

seen  seTere  eases  relieTed  by  the  persisient  use  of  large  hot- 
water  injectioiis.  Not  only  was  no  bann  done,  but  a  vast 
amount  of  good  ;  the  water  bringing  away  little  by  little  until 
at  last  the  whole  mass  came  away.  He  was  speaking  now  of 
fsBcal  obstruction. 

Dr.  Haywabd  thought  Dr.  Dyce  Brown  had  shown  that  he 
was  unfamiliar  with  Dr.  Thomas's  book.  Dr.  Thomas  went 
over  the  whole  question,  and  with  him  it  was  not  mere  guess- 
work or  matter  of  opinion.  He  had  gone  over  the  whole 
literature  of  the  subject,  surgical  and  medical,  and  had 
arrayed  the  facts  of  operative  interference  in  opposition  to  the 
facts  that  he  himself  and  others  had  accumulated  when  the 
operation  had  been  deferred,  so  that  those  who  were  not 
familiar  with  his  book  might  not  be  sufficiently  well  able  to 
criticise  his  views.  Dr.  Thomas  had  shown  that  the  results 
were  infinitely  superior  under  the  treatment  of  leaving  alone 
and  using  opiates  and  weak  diet. 

Dr.  Edwabd  Maddbk  :  What  is  the  date  of  his  book  ? 

Dr.  Dbtsdalx  :  Three  or  four  years  ago. 

Dr.  Maddsn  said  the  advances  in  abdominsl  surgery  were 
so  entirely  of  recent  date  that  to  compare  the  results  of  that 
date  with  abdominal  section  was  quite  beside  the  question. 

Dr.  Dbtsdalb  :  I  think  you  are  quite  mistaken  there.  He 
knows  all  about  it. 

Dr.  Madden  said  the  best  surgeons  in  regard  to  abdominal 
complaints  told  them  that  an  explanatory  incision  was  abso- 
lutely without  danger,  and  he  believed  that  Lawson  Tait  and 
other  men  who  were  constantly  doing  it  had  not  had  a  single 
death  where  they  had  resorted  to  exploratory  incision.  There- 
fore when  they  met  with  a  serious  case  of  obstruction,  and  life 
was  threatened,  and  they  could  not  otherwise  decide  the  cause, 
he  should  certainly  say  that  the  abdomen  should  be  opened 
for  the  purpose.  He  rose,  however,  chiefly  to  thank  Dr.  Drys- 
dale  for  calling  their  attention  to  this  work,  and  the  part  which 
he  felt  he  should  personally  gain  most  from  was  the  special 
diet.  That  was  new  to  him,  not  having  read  the  book,  and 
it  ought  to  be  a  great  help  to  them  in  treating  chronic  consti- 
pation and  the  milder  forms  of  obstruction  which  did  not  oal 
imperatively  for  immediate  operation. 

Dr.  Neild  said  he  felt  personally  very  much  indebted  to 
Dr.  Drysdale  for  his  paper,  which  he  had  felt  to  be  one  of 
very  great  interest.  One  point  that  particularly  struck  him 
was  that  referred  to  by  Mr.  Enox  Shaw,  with  regard  to  the 
difference  between  acute  and  chronic  obstruction.    Mr.  Knox- 


SSSTjSna***'  A  CASE  OF  OBBTBUCTION.  25 


SvTiev.  Jan.  1,  UOl. 


SWb  experience  bad  of  course  been  very  much  greater  than 
hie,  and  in  every  way  superior,  but  he  took  it  that  with  this 
treatment  they  might  frequently  convert  an  acute  case  into  a 
chronic  ease,  with  much  greater  probability  of  ultimate 
success.  In  one  case  of  intestinal  obstruction  tbat  he  had, 
the  patient  went  on  for  a  matter  of  some  months,  although 
the  case  was  several  times  acute  and  approaching  collapse. 
He  went  on  in  a  chronic  way  for  three  weeks,  and  then  every 
now  and  again  acute  obstruction  would  be  set  up,  with  all  the 
signs  of  acute  mischief.  But  in  that  case  he  thought 
hdladonna  did  the  most  good  for  the  patient.  At  the  end  of 
three  weeks  they  had  action.  They  might  possibly  be 
deceived  as  to  the  fadcal  action,  because,  as  had  already  been 
pointed  out  by  one  of  the  speakers,  the  faeces  were  not  only 
an  excretion,  but  sometimes  a  secretion.  In  the  case  to 
which  he  referred  there  was  a  secretion  of  fsBces  below  the 
obstruction,  which  on  more  than  one  occasion  made  them 
think  they  were  actually  getting  faeces  through  when  it  was 
not  the  case.  He  could  scrape  it  with  his  finger  nail  from 
the  intestine.  With  regard  to  the  question  of  constipation, 
it  was  perfectly  marvellous  how  long  patients  might  be  left 
with  aiuEety  so  long  as  no  serious  symptoms  arose.  He  was 
called  to  a  case  when  there  had  been  no  action  for  a  month, 
and  the  sister  of  the  patient,  an  intelligent  woman,  told  him 
she  herself  had  gone  for  two  months  and  had  not  told  her 
mother  anything  about  it  until  she  had  been  a  month  without 
the  bowels  being  opened,  and  no  symptoms  arose.  So  that  it 
was  a  great  encouragement  to  them  as  homoeopaths  to  stand 
oat  against  the  practice  of  giving  purgatives,  and  he  hoped  it 
would  be  a  help  to  them  in  doing  so.  One  other  case  was  a 
curious  one.  He  once  had  under  his  care  an  old  man,  who 
was  in  a  state  of  vegetation,  but  as  a  matter  of  fact  his 
bowels  were  only  opened  about  four  times  a  year.  He  had 
no  symptoms,  no  difficulty,  and  he  (the  speaker)  took  no 
action  whatever.  There  was  large  evacuation  at  the  end  of 
about  thirteen  weeks.  So  &r  as  he  knew,  no  bad  results 
followed. 

Dr.  PoFE  drew  attention  to  the  immense  usefulness  of 
leUadonna  in  the  very  beginning  of  the  illness.  (Hear,  hear.) 
He  thought  they  were  very  apt  to  lose  time  by  giving  other 
medicines.  Belladonna  seemed  to  him  to  cover  completely 
the  acute  pain  which  characterised  the  commencement  of 
^ese  attacks,  and  he  beheved  that  many  a  case  might  be 
aaved  from  going  on  to  actual  obstruction  by  trusting  to  that 
medieine.  With  regard  to  operation.  Mr.  Enox-Shaw  had 
stated  that  an  exploratory  incision  was  perfectly  safe,  and 


26  A.  CASE  OF  OBSTRUCTION.  "^^^fSK^MM! 

that  a  large  number  of  cases  had  reoovered.  But  it  struok 
him  very  forcibly  that  it  depended  upon  the  time  which  had 
elapsed  from  the  first  symptoms  to  that  when  the  operation 
was  performed.  (Hear,  hear.)  The  longer  the  operation  was 
deferred,  the  greater  must  neoessarily  be  the  danger  attending 
it.  Therefore,  after  medicine  had  had  a  thoroughly  fair 
chance,  he  could  not  help  thinking  that,  in  the  present  state 
of  abdominal  surgery — ^which,  to  his  mind,  was  one  of  the 
most  remarkable  features  in  the  advance  of  surgery  at  the 
present  day — ^they  ought  to  avail  themselves  of  ifcs  aid  without 
further  delay.  He  knew  of  a  case  which  occurred  recently 
where  the  operation  had  been  delayed  for,  he  believed,  a  week, 
and  was  absolutely  fatal  within  a  very  few  hours.  So  that 
whether  the  operation  was  successful  or  not  was  largely  a 
question  of  time.  He  had  not  seen  Dr.  Thomas'  book,  and 
therefore  he  did  not  know  whether  the  question  of  time  had 
been  taken  into  consideration.  (Dr.  Drysdale  :  Yes.)  But  if 
it  had  not,  the  inferences  deduced  were  not  so  valuable  as 
they  otherwise  would  be. 

Dr.  Hawkes  pointed  out  that  Dr.  Thomas  was  a  man  who 
thought  and  resbd  a  good  deal,  and  of  whom  it  might  almost 
be  said  that  they  knew  his  mind  from  week  to  week.  The 
speaker  referred  to  a  case  in  which  injections  had  been  used, 
and  eventually  the  bowels  moved  under  the  influence  not  of  a 
dose  of  opium,  but  of  corrosive  sublimate  and  so  on.  In  this 
months  Review  there  was  a  reference  to  intussusception.  A 
little  while  ago  the  advice  was  to  cut  down.  Now  Uie  advice 
was  to  wait.  The  speaker  also  alluded  to  another  case  where 
injection  was  certainly  of  the  greatest  service.  Air  and  water 
were  both  injected  in  large  quantities,  and  the  intussusception 
yielded  at  once. 

Dr.  Dbtsdale  then  replied  upon  the  discussion.  He  said 
of  course  they  all  agreed  that  the  operation  was  a  thing  to  be 
kept  in  view,  and  as  he  always  said  to  be  done  in  good  time. 
The  last  time  he  attended  a  case  of  obstruction  he  sent  for 
Dr.  Thomas,  and  he  would  not  operate  on  the  day  that  he 
(the  speaker)  thought  it  was  necessary,  but  put  it  off  longer, 
and  the  patient  died.  He  thought  if  he  had  taken  it  in  time 
life  might  have  been  saved.  But  Mr.  Knox  Shaw  was  rather 
mistaken  when  he  thought  Dr.  Thomas  was  not  up  to  date  in 
these  matters.  Surgeons  were  apt  to  be  too  soon  rather  than 
too  late.  It  was  better  to  do  what  they  could  by  medicine, 
but  try  not  to  wait  too  long.  That  was  the  grand  difficulty. 
(Hear,  hear).  They  were  tdl  agreed  as  to  the  desirability  of 
an  operation  at  the  earliest  possible  time  when  it  was  neces- 
sary. 


FIBBT'HiND  AND  SECOND-HAND. 


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80  AUBUM  MUR.  IN  PHTHISIS.   *'SJJg;rf jS^lfJaM? 

AURUM  MUR.  IN   PHTHISIS.^ 
By  Dr.  Joseph  Drzewiecxi. 

Late  Ordinary  Phjsidan  in  the  Universitj  Clinic  of  the 
Holy  GhoBt  Hospital,  WarsaWf  Poland. 

On  perusing  the  Cyclopadia  of  Drug  Pathogenesyy  edited 
by  Drs.  Richard  Hughes  and  J.  P.  Dake,  my  attention 
was  drawn  to  the  similarity  of  the  symptoms  which 
aurum  muriaticum  produces  on  the  healthy  organism 
with  those  of  phthisis.  The  symptoms  are  the 
following : — 

"  It  occasions  a  specific  fever,  more  or  less  violent 
(p.  510) ;  the  pulse  is  more  frequent,  and  then  follows 
profuse  and  long-lasting  perspiration,  or  a  great  flow  of 
urine,  or  diarrhoea.  The  perspirations  have  been  known 
80  severe  that  the  mattress  was  wet  through  ;  they  have 
at  times  an  alkaline  odour,  at  times  they  are  very  foetid. 
According  to  Gozzi  the  perspirations  are  decidedly  worse 
at  night  (p.  511). 

*'  It  occasions  great  heat  in  cheeks  and  ears  (p.  502), 
and  produces  a  cough  which  is  more  pronounced  and  is 
accompanied  with  heat  in  larynx,  and  expectoration, 
white  and  blood-streaked,  or  yellow  and  thick  ;  speech  is 
difficult,  and  voice  hoarse  and  stridulous.  With  chest 
and  heart  symptoms  there  is  sense  of  suffocation  at 
night  (p.  498). 

*^  Experiments  on  animals. — After  injection  of  4  centi- 
grammes of  the  chloride  of  gold  to  strong  dog,  the 
respiration  was  difficult  and  noisy,  there  was  sighing, 
suffocation,  and  vomiting  of  a  very  small  quantity  of 
white  matter  floating  in  foam.  At  each  expiration 
it  made  a  very  loud  noise.  Post-mortem  examination 
showed  the  lungs  livid,  excepting  a  few  small  patches 
which  were  rose-coloured;  the  lung  tissue  was  dense, 
hepatized,  gorged  with  blood,  and  non-crepitant.  Placed 
in  water  they  sank,  and  only  the  rose-coloured  patches 
floated  and  were  slightly  crepitant "  (p.  511).  Here  is 
a  more  or  less  similar  portrait  of  phthisis  !  As  far  as 
I  know  aurum  muriaticum  has  not  been  hitherto  used  in 


*Read    by  Dr.  Clarke  before   the  Britisli  Homoeopatliic  Society, 
December  4th,  1890. 


SS^j^TSlf"**  AURUM  MUK.  IN  PHTHISIS.  81 


Bevieir,  Jan.  1, 1891. 


phthisiB.  I  have  used  it  in  my  private  practice,  and  the 
following  are  the  results : — 

Aurum  muriaticwm  given  to  the  patients  every  three 
hours  in  doses  of  gr.  ^^  within  five  days  produced  a 
very  visible  effect — the  temperature  fell,  perspiration  and 
cough  diminished,  and  after  two  weeks  some  undoubted 
amelioration  could  be  detected  by  physical  examination. 

Out  of  eleven  patients  treated  with  aur.  mur,  five 
recovered  after  five  weeks'  treatment  without  interrupting 
their  daily  occupations ;  these  patients  were  in  the  first 
stage  of  phthisis.  Two  with  a  very  advanced  tubercular 
process  in  the  lungs,  who  remained  in  bed  the  greater 
part  of  the  day,  after  two  months*  treatment  improved 
considerably  and  are  still  under  my  care ;  the  daily 
temperature  now  is  normal,  only  the  evening  temperature 
is  BometimeB  slightly  raised,  perspirations  ceased, 
appetite  increased,  and  general  aspect  improved  :  cough, 
although  slight,  remained.  Four  patients  died,  but  they 
were  in  extremis^  and  had  been  given  up  by  their  own 
doctors. 

After  the  above  observations  I  venture  to  say  that 
phthisis  in  the  beginning  stage  can  undoubtedly  be  cured 
with  awrum  muriaticum ;  where,  however,  the  tubercular 
process  has  already  produced  great  devastation,  although 
it  arrests  the  process,  yet  the  effects  of  it  remain. 

Betuming  to  aur.  mur.  once  more  I  must  add  that  this 
remedy  should  be  used  with  caution,  and  not  longer  than 
five  days  together,  after  which  a  pause  of  two  or  three 
days  must  be  made.  In  one  case  which  I  observed  a 
few  days  ago,  after  three  days'  application  of  the  chloride 
of  gold,  the  patient  had  shortness  of  breath  (dyspnoea) 
and  sleeplessness,  but  the  temperature  was  greatly  dimin- 
ished, which  makes  me  suppose  that  the  patient  w€U9 
intoxicated  by  gold.  I  interrupted  its  further  use,  and 
next  day  dyspnoea  and  sleeplessness  disappeared,  and  the 
temperature  did  not  rise.  Seeing  such  beneficial  effects 
from  aur.  mur.  on  the  patient,  I  prescribed  it  in  8x  dilution, 
five  drops  every  three  hours,  and  the  patient  could  not 
deep  during  the  night,  had  shortness  of  breath,  and  fear 
of  death.  In  this  manner  I  was  obliged  to  stop  the 
farther  application  of  aur.  mur.,  and  only  6x  dilution 
was  well  supported  by  the  patient. 

This  fact  I  state  in  order  to  show  how  cautious  we  must 
be  in  the  exhibition  of  this  drug ;  in  one  case  2x  dilution 


32  A  CUNICAI.  EYE5INO.     "^E^foK^TiaS! 

produces  good  effects,  in  the    other  the    8x  dilation 
occasions  symptoms  of  intoxication. 

As  mercury  in  syphilis  arrests  the  farther  growth  of 
gummjtta  and  effects  their  absorption,  so  gold  acts  in 
the  same  way  on  tubercle.  Perhaps  platina  or  palladium, 
which  belong  to  the  same  group  as  gold,  might  prove 
still  more  efficacious  in  phthisis. 

It  is  a  pity  that  the  pathogenesy  of  these  drugs  has 
not  yet  been  fully  explored.  That  platina  may  be  useful 
in  phthisis,  I  base  upon  the  publication  of  a  manu- 
facturer of  plate- works  in  Vienna,  who  states  that  the 
health  '  of  his  workman  affected  with  phthisis  was 
ameliorated  in  spite  of  non-hygienic  conditions,  if  they 
were  a  longer  time  employed  in  the  galvanoplastio 
section.  He  ascribes  the  beneficial  effect  to  the  vapour 
of  prussic  acid  ;  I  suppose  that  the  improvement  of  the 
health  of  the  patients  must  be  ascribed  to  the  action  of 
gold  or  platina,  and  probably  there  are  in  Eoch's  remedy, 
which  many  suppose  to  be  lymph,  preparates  of  gold  or 
platina, 

Warsaw,  November  24, 1890. 
87,  Erakowskie  Przedmiescie. 


BRITISH   HOMCEOPATHIC    SOCIETT. 

CuNiGAii  EvBNiNa,  Dbo.  4th,  1890. 

Inversion  of  Uterus. 

Db.  Cabfrae  reported  a  case  of  the  above  con- 
dition, and  showed  the  patient.  He  said : — This  case  I 
look  upon  as  being  both  interesting  and  instructive. 
Interesting  because  of  its  rarity,  and  instructive  on  that 
account  as  well  as  because  it  may  be  looked  on  as  a 
typical  case,  presenting  all  the  symptoms  one  generally 
fmds  in  such  cases.  In  all  probability  the  mischief  dates 
from  the  last  confinement,  two  years  ago,  when  the 
patient  had  an  instrumental  delivery.  Since  then  she 
has  never  been  well,  has  had  copious  menstrual  periods 
lasting  ten  days,  and  causing  great  prostration,  as  well 
as  sickness  or  diarrhoea. 

On  examination  a  body,  which  felt  extremely  like  a 
large  polypus,  was  felt,  as  recorded  in  the  notes  of  the 
ease,  but  with  this  peculiarity — it  was  attached  all  round 
the  cervix.    I  may  add  here  that  bi-manual  examination 


i^^'SSrnS^      A  CLINICAL  EVENING.  83 


wa8  very  difficult  on  account  of  the  spasmodic  rigidity  of 
abdominal  muscles. 

Dr.  Burford  also  casually,  as  it  were,  examined  and 
found  a  growth  protruding  into  vagina. 

Some  time  after,  as  the  notes  record,  we  had  the 
patient  ansBsthetized,  and  could  then  make  a  thorough 
bi-manual  examination.  Then  we  found  the  charac- 
teristic absence  of  the  uterine  body.  We  found,  more- 
over, the  absolute  impossibility  of  getting  the  sound  to 
pass  beyond  a  very  short  distance  into  the  cervical 
cavity.  One  finger  in  rectum  and  a  sound  in  bladder 
confirmed  this  fact,  and  we  came  to  the  conclusion  that 
we  had  to  do  with  a  case  of  inversion  of  the  uterus. 

After  the  patient  had  recovered  from  the  effects  of 
this  ordeal,  we  again  had  her  aneesthetized,  and  attempted 
to  reduce  the  displacement,  but  without  success.  We 
then  applied  Lawson  Tait's  repositor  with  complete 
success.  The  patient  is  now  perfectly  cured  so  far  as 
the  inversion  is  concerned.  It  will  take  some  time  before 
her  general  health  is  restored. 

The  moral  attached  to  this  case  is,  in  all  cases  where 
there  is  a  growth  in  the  vaginal  canal  be  careful  to 
ascertain  ibS  exact  nature.  Such  cases  as  this  under 
consideration  have  frequently  been  mistaken  for  polypus 
and  the  uterus  has  been  amputated,  almost  always  with 
a  fatal  result.  Even  such  an  astute  and  experienced 
gynscologiBt  as  Lawson  Tait  records  a  case  in  which  he 
made  this  mistake.  But,  inasmuch,  as  it  was  com- 
plicated with  epithelioma,  the  treatment  was  the  best 
that  could  be  adopted,  and  the  result  perfectly  satis- 
factory.   The  patient  recovered. 

SerO'Sanguineous  Cyst. 

Mr.  Enox  Shaw  showed  a  little  boy,  aged  nineteen 
months,  then  a  patient  in  the  hospital,  suffering  from 
a  large  tumour  in  the  right  axilla.  When  six  months 
old  a  tumour  was  first  noticed  under  the  arm,  which 
very  slowly  increased  in  size  until  Midsummer  last,  when 
the  increase  became  very  rapid.  On  admission  the  tumour 
vas  the  size  of  a  cocoa-nut  and  occupied  the  right  axilla, 
reaching  from  the  level  of  the  nipple  to  above  the 
clavicle.  It  was  soft,  semi-fiuctuating,  freely  movable, 
non-adherent  to  the  skin,  and  became  tense  when  the 

VoL  33,  No.  1.  D 


34  A  CLINICAL  EVENIHG.     ''SS^fSST^l! 

child  cried.  There  were  some  enlarged  vems  oyer  the 
surface,  and  when  tense  it  had  a  bluish  colour.  Pressure 
was  first  applied  but  did  no  good.  It  was  then  tapped 
and  some  ounces  of  blood-stained  serum  removed,  but 
the  tumour  did  not  materially  diminish.  Tapping  was 
repeated  without  much  benefit,  so  the  patient  was  now 
being  treated  with  electrolysis.  Three  applications  had 
already  been  made,  of  ten  minutes  each,  passing  50 
milli-amperes  through  the  tumour.  A  very  marked 
change  had  taken  place,  the  tumour  having  considerably 
diminished  and  having  become  much  harder.  The  last 
application  was  accompanied  with  considerable  reaction. 
The  treatment  was  now  interrupted  as  the  child  had 
had  an  attack  of  measles.  Further  electrolytic  treatment 
would  be  undertaken.  Mr.  Knox  Shaw  considered  the 
tumour  to  be'  a  sero-sanguineous  cyst  arising  from  the 
degeneration  of  a  blood  nsBvus.  Photographs  of  the 
child  taken  by  Mr.  W.  S.  Cox  on  its  admission  were 
exhibited. 

Sarcoma  of  Breast. 

Mr.  Enox  Shaw  also  presented  a  woman,  aged  55, 
whose  left  breast  he  had  removed  in  September  last  for 
a  very  large  fungating  sarcoma  of  two  years'  standing. 
Two  capital  photographs  showing  the  condition  of  the 
breast  on  admission,  taken  by  Mr.  Cox,  were  exhibited 
with  the  patient.  Though  seemingly  a  most  unfavourable 
case  for  operation,  it  had  been  undertaken  at  the  earnest 
solicitation  of  the  patient  and  her  medical  attendant.  Dr. 
Buck,  vrith  a  most  satisfactory  result.  The  patient  was 
freed  from  a  loathsome,  offensive  mass  and  had  now  a 
sound  cicatrix.  A  very  small  gland  was  enlarged  in  the 
axilla,  and  this  was  to  be  removed  at  once,  some  axillary 
glands  having  been  removed  at  the  time  of  the  operation. 

Radical  Cure  of  Hernia. 

Mr.  Enox  Shaw  exhibited  another  patient,  a  woman, 
aged  49,  upon  whom,  sixteen  days  previously,  he  had  per- 
formed a  radical  cure  for  an  irreducible  femoral  hernia. 
The  contents  of  the  sac  were  entirely  omentum,  some  of 
which  was  firmly  adherent.  The  omentum  was  ligatured 
and  removed,  a  plug  being  left  to  fill  tiie  hernial  opening. 
The  operation  had  followed  a  perfectly  aseptic  course, 
and  the  wound  healed  under  one  dressing. 


S^fjSiyaf^    A  CLINICAL  EVENING, 85 

Insular  Sclerosis  without  Tremors. 

Dr.  Edwin  A.  Neatby  showed  a  case  of  insular  sclerosis, 
in  which  the  stress  of  the  disease  had  fallen  on  the 
lower  part  of  the  spinal  cord  and  on  the  cerebrum. 

Fredk.  B.,  8Bt.  81,  complained  of  weakness  of  legs. 

History. — Thinks  he  had  convulsions  as  a  child 
(teething?).  When  18  or  19  years  of  age  had  a  series 
of  convulsiYe  seizures  of  the  left  side,  drawing  head  to 
one  side,  and  affecting  arm,  hand  and  leg.  These 
attacks  extended  over  a  period  of  12  months.  They  then 
ceased.  No  history  of  syphilis.  About  three  or  four 
years  ago  had  a  fright,  and  after  this  he  was  unable  to 
follow  his  occupation  as  an  omnibus  conductor. 

Present  condition. — Reflexes. — ^Enee  jerks  both  exagge- 
rated, especially  the  left.  Ankle  clonus  present  on  both 
sides,  more  on  the  right.  The  superficial  reflexes  are  all 
absent. 

The  tactile  sensibility  is  slightly  diminished  in  both 
feet.  General  diminished  sensibility  to  heat  and  cold, 
especially  the  inner  part  of  right  foot  and  on  great  toe. 
Here  he  calls  hot,  cold.  Says  usually  that  the  tests  are 
neither  hot  nor  cold.  No  rhythmical  tremors  of  hands 
or  arms.  No  urinary  or  pronounced  sexual  disturbance 
(both  testes  are  undescended,  they  can  both  be  felt  in  the 
inguinal  canals) ;  slow  and  interrupted  utterance ;  in- 
voluntary laughter ;  weakness  of  hands  ;  spastic  gait ; 
nystagmus.  Pupillary  reaction  diminished,  both  to 
light  and  during  acconmiodation. 

Pallor  of  left  optic  disc.  Can  only  read  for  a  few 
moments  at  a  time. 

Memory  poor,  except  for  recent  events. 

Electrical  reaction. — Greneral  diminished  response  to 
both  galvanism  and  faradism  in  muscles  of  fingers,  fore- 
arms, and  in  ant.  tibiales ;  no  qualitative  change. 

EnUvrgement  of  Bronchial  Glands  (probably  syphilitic)  with 

Chronic  Dyspnoea. 

Dr.  Gallet  Blaceley  showed  a  patient  at  present  an 
inmate  of  the  hospital,  where  the  provisional  diagnosis 
had  been  as  above,  rather  with  the  view  of  eliciting  the 
opinion  of  members  present,  for  a  satisfactory  diagnosis 

D— 2 


86  A  CLDnCAL  EYEKIKO.     '"bSSt^STTmS! 


in  soch  cases  is  frequently  a  matter  of  considerable  diffi- 
culty.   The  notes  of  the  case  were  briefly  as  follows : — 

'*  Emmanuel  J.,  aged  56,  gunsmith,  has  used  brace  and 
bit  a  great  deal  pressed  very  hard  i^ainst  epigastrium. 
No  fihngs  or  great  amount  of  dust  in  his  work.  Father 
had  asthma ;  mother  lirer  disease ;  no  history  of 
phthisis  in  family.  Had  chancre  at  thirty  with  secon- 
dary symptoms.  Smokes  a  little.  First  complained  ten 
years  ago  of  suffocation  whilst  talking  to  a  customer; 
this  happened  twice  within  half-^m-hour,  and  after  it 
he  noticed  his  breathing  permanently  affected;  used 
to  sing  and  did  for  eighteen  months  afterwards,  at  end  of 
which  time  he  had  to  give  it  up  altogether,  finding  his 
breathing  noisy  and  laboured  whether  at  work  or  rest. 
Seven  years  ago,  feeling  incapable  of  doing  work,  came 
as  an  out-patient  to  this  hospital,  when  his  breathing 
was  extremely  noisy,  and  had  a  very  loud  cough,  with 
yellow  expectoration.  Took  him  into  the  wards  and 
sent  him  out  at  end  of  14  days  to  go  to  a  convalescent 
home  at  sea-side,  where  he  remained  three  months,  at 
end  of  which  he  could  walk  twelve  miles^  Has  been 
working  pretty  steadily  since  this  time,  and  has  noticed 
nothing  very  unusual  except  that  breathing  has  slightly 
improved,  and  he  has  seen  for  last  four  years  at  times 
pinky  expectoration.  Six  weeks  ago,  when  coughing, 
was  seized  with  considerable  hsemoptysis,  which  went  on 
steadily  for  four  weeks,  generally  very  dark.  Came  to 
me  a  fortnight  ago,  presenting  following  symptoms : — 
Yoice  better  than  when  last  seen,  five  years  ago.  Breath- 
ing audible  at  some  distance  and  stridulous. 

**  Chest  measures  28|^  round :  right  side  14^  in. ;  ante- 
riorly, sinking  below  clavicle  and  in  intercostal  spaces ; 
expansion  very  deficient,  vocal  fremitus  ditto,  percussion 
note  beginning  at  median  line  is  dull  for  three  incbes 
externally  and  down  to  ensiform  cartilage.  Heart  sounds 
heard  very  plainly  over  this  dull  area,  but  no  adventitious 
sounds.  Inspiratory  sounds  exaggerated,  expiration 
prolonged;  over  middle  line,  at  epistemal  notch  and 
external  to  it  breath  sounds  tubular  and  much  exag- 
gerated (stridulous).  Behind,  dulness  over  suprascapular 
fossa  along  vertebral  border  of  scapula  and  slightly  below 
tip.  A  few  sonorous  moist  rhonchi  heard  posteriorly 
and  laterally,  otherwise  normal.  Left  side  of  chest 
measures  14  in.  round,  somewhat  barrel-shaped,  per- 


ggjSTaff^    A  CLIKICAL  EVENING. 37 

CQssion  note  tympaxiitic  especially  along  anterior  border ; 
saperficial  cardiac  dnlness  almost  obliterated.  Heart's 
apex  beats  1  in.  below  and  1  in.  inside  nipple  line. 

"  Laryngoscopic  examination  shows  epiglottis  tilted 
backwards  partially  obstructing  view  of  cords,  has  a 
few  dilated  capillaries  upon  it ;  mucous  membrane  cover- 
ing arytenoids  red  and  swollen  ;  cords  slightly  more  pink 
than  normal,  left  one  moves  much  more  freely  than 
right ;  immediately  behind  and  below  right  cord  is  a  small 
smooth  swelling  about  the  size  of  a  horse-bean,  encroach- 
ing slightly  upon  the  lumen  of  the  air  tube.  A  full-sized 
oesophageal  bougie  passes  without  difficulty. 

"  Sputa  nummular,  flesh  coloured  (consisting  of  blood 
and  pus  intimately  mingled),  with  some  frothy  mucus. 

"  Microscopic  examination  of  sputa  for  yellow  elastic 
long  fibres,  and  tubercle  bacilli,  gave  negative  results." 

Dr.  Blackley  said,  that  in  attempting  a  diagnosis  there 
were  several  different  conditions  that  naturally  suggested 
themselves  as  being  possibly  present:  (1)  aneurysm  (this 
had  been  diagnosed  by  one  medical  man  some  years  ago» 
but  no  distinct  evidences  of  it  remained) ;  (2)  displace- 
ment of  the  heart  following  pleurisy ;  (3)  phthisis,  due 
to  his  occupation ;  (4)  scrofulous,  malignant  or  syphilitic 
deposit  in  the  bronchial  glands.  On  the  whole  he  leaned 
to  the  last  supposition. 

Pelvic  Cyst. 

Dr.  Btjbfobd  showed  a  patient  sent  into  hospital  by  Dr. 
Edwin  Neatby,  'under  whose  care  she  had  been  for  a  short 
time  prior  to  admission.  The  patient  had  been  variously 
ailing  for  some  three  months,  her  troubles  culminating 
in  a  severe  attack  of  pelvic  inflammation  with  a  high 
degree  of  pyrexia.  Under  the  care  of  an  allopathic 
specialist,  aspiration  was,  according  to  the  history,  per- 
formed through  the  vagina,  and  some  quantity  of 
sanguineous  fluid  withdrawn.  She  transferred  herself 
to  the  care  of  Dr.  Neatby,  who  detected  a» pelvic  tumour 
concurrent  with  evidences  of  pelvi-peritonitis.  He  pre- 
scribed beUadon7ia  80,  under  which  the  inflammation 
subsided,  and  then  advised  her  removal  to  hospital.  On 
her  admission  a  large  cystic  swelling,  originating  in  the 
pelvis,  occupied  nearly  the  whole  of  the  left  iliac  fossa, 
and  recent  plastic  exudation  into  Douglas'  pouch  was 
found.    The  temperature  was  of  the  hectic  type.    The 


38  A  CUHIGAI.  EYEKING.    ""^ft^^jST^fiai! 

cyst  was  diagnosed  as  par-OTarian,  and  the  patient  con- 
&ied  to  bed  and  treated  with  hepar  Mulph.,  and  hot 
doaches  locally  to  remove  the  plastic  eflPosion.  Under 
this  regime  daily  progress  was  made.  The  temperature 
soon  fell  to  normal,  and  the  patient's  general  condition 
steadily  improved.  After  about  a  fortnight  thus  spent 
in  hospital  the  cyst  was  found  to  have  disappeared,  but 
curiously  without  the  least  consciousness  on  the  part  of 
the  patient.  No  fresh  symptom  was  evoked,  and  no 
hindrance  offered  to  the  continuity  of  convalescence. 
The  patient  left  hospital  with  health  fairly  regained,  and 
with  but  scanty  evidence  of  the  previous  pelvic  lesion. 

Dr.  Burford  held  that  the  cyst  had  slowly  leaked  into 
the  peritoneum,  thus  discharging  itself  of  its  contents, 
which  in  broad  ligament  cysts  are  usuaUy  innocuous; 
and  that  the  local  inflammation,  peripheral  to  the  cyst, 
had  undergone  absorption  under  the  treatment  detailed. 

Ovarian  Cyst. 

Dr.  Burford  also  showed  a  large  ovarian  cyst, 
which  he  had  removed  that  morning  from  a  patient 
sent  into  hospital  by  Dr.  Hughes.  The  history  of  the 
growth  was  that  some  six  months  ago  the  catamenia 
suddenly  stopped,  and  had  not  since  returned.  No  sign 
of  increase  in  size  was  detected  by  the  patient  until  about 
a  month  before  admission  into  hospital,  when  she  was 
seen  by  Dr.  Hughes,  who  detected  the  neoplasm  and 
advised  its  removal.  A  fortnight  before  operation 
Dr.  Burford  examined  her,  and  dm'ing  the  fourteen  days 
prior  to  its  removal  the  cyst  nearly  doubled  in  size,  its 
upper  limit  reaching  nearly  to  the  ensiform  cartilage. 
On  December  4th  the  cyst  was  removed.  Some  parietal 
adhesions  were  broken  down,  but  there  were  no  visceral 
ones.  Some  gallons  of  thick  turbid  fluid  were  evacuated 
by  the  trocar,  and  the  solid  elements  of  the  cyst  removed 
in  the  usual  way. 

Neuritis  (/) 

Mr.  W.  S.  Cox  showed  a  case  under  the  care  of  Dr. 
BoBERsoN  Day,  who  was  unavoidably  absent.  The 
patient,  a  woman,  aet.  45,  had  for  some  months  past 
complained  of  weakness  in  the  lower  extremities  and 
inability  to  go  up  or  down  stairs  without  helping  herself 
with  her  arms,  also  difficulty  in  going  up  or  down  an 
incline,  and  inability  to  rise  from  the  sitting  posture. 


Sl^riSlTS^*    A  CLINICAL  EVENING.  89 


The  right  calf  was  half  an  inch  larger  in  circumference 
than  the  left.  On  May  14th,  1890,  the  knee  jerks  were 
difficult  to  obtain,  especially  on  left  side,  but  the  pupils 
reacted  to  light  and  accommodation.  There  was  no  stag- 
gering gait.  Dr.  Boberson  Day  requested  the  opinion  of 
members  present  as  to  the  diagnosis  of  the  case.  He 
considered  it  one  of  peripheral  neuritis. 

Epitlielioma  of  Larynx. 
Mr.  W.  S.  Cox  showed  a  larynx  obtained  from  a 
patient  admitted  under  the  care  of  Mr.  Enox  Shaw  for 
epithelioma  of  the  left  vocal  cord.  The  disease  had 
existed  nine  months,  and  was  most  easily  demonstrable 
by  the  laryngoscope.  Very  urgent  dyspnoea  having  set 
in  the  patient  was  tracheotomised,  but  he  died  four  days 
sabsequently  from  pneumonia. 

Hysterical  Paralysis  0J 

Dr.  Cavendish  Molson  sent  for  exhibition  a  patient  of 
whose  case  the  following  are  the  notes : — 

Mrs.  C.  S.,  8Bt.  50  ?  Eight  children,  one  miscarriage. 
About  four  years  ago  patient  was  seized  with  severe 
pains  in  her  head,  accompanied  by  dimness  of  sight  and 
constant  desircto  lie  down ;  18  months  since  she  became 
decidedly  worse,  and  a  httle  later  lost  the  power  of  loco- 
motion and  of  articulation,  and  became  unable  to  feed 
herself. 

During  her  illness  she  was  seen,  at  intervals,  by  four 
medical  men,  who  all  agreed  that  patient  could  not 
recover ;  the  last  authority  limiting  the  duration  of  her 
life  to  a  few  "  weeks,"  or  "  months.'* 

By  the  advice  of  a  friend  she  was  induced  to  "  try  " 
homoeopathy,  and  was  brought  from  her  bed  (where  she 
had  been  for  months)  to  the  out-patient  department  of 
our  hospital.  On  this  day,  Tuesday,  July  29th,  her 
symptoms  were  as  follows : — 

Viz. :  1.  Dimness  of  sight.  2.  Vacuity  of  mind ; 
lack-lustre  expression  of  countenance.  8.  Inability  to 
stand,  except  by  holding  on  to  something  for  support. 
4.  Inability  to  articulate,  the  attempt  to  speak  being 
followed  by  an  incoherent  noise.  6.  Profuse  ptyalism, 
the  saliva  pouring  from  the  mouth  in  a  continuous 
stream.  6.  Loss  of  prehensile  power,  and  great  difficulty 
in  deglutition.  7.  Epileptic  (?)  fits  (four  months). 
Symptoms  3  and  4  had  been  present  for  twelve  months. 


40  A  CLINICAL  EVENING.    ^^Sl^^SSTf^^. 


Berlew,  Jan.  1, 1801. 


Treatment:  5^  tincU  cicuta  tirosa  Ix,  tine,  ignatia 
amara  Ix,  gtt.  5,  8  hor.  alt. 

Result:  July  SO.  Vision  improved.  Mind  clearer. 
July  81.  Spoke,  ate,  walked  a  little,  and  felt  generally 
better.  August  8rd.  So  much  improved  that  patient 
was  able  to  ride  on  the  outside  of  an  omnibus.  From 
this  date  onwards  the  convalescence  was  unbroken,  and 
patient  was  discharged  **  cured  "  on  8rd  Dec.,  no  change 
having  been  made  in  the  treatment.  From  other  obser- 
vations Dr.  Molson  attributed  the  improvement  to  the 
cietita  rather  than  to  ignatia. 

Pressure  Dyspnoea. 

Dr.  Mont  showed  a  boy  who  had  a  disorder  of 
breathing.  He  might  be  called  a  "roarer."  The 
condition  had  lasted  four  years,  with  short  intervals  in 
sunamer.  There  was  a  strong  syphilitic  history,  and 
evidence  of  increase  of  size  in  the  thoracic  glands 
exciting  pressure  on  the  trachea.  The  child  was  much 
emaciated,  and  had  a  deep  hollow  in  the  epigastrium. 

Discussion. 

db.  moib*s  case  of  0b8tbucted  bbeatmno. 

Dr.  Clarke  agreed  with  Dr.  Moir  in  supposing  that  the 
pecuUar  breathing  was  caused  by  pressure  of  enlarged  glands, 
and  he  thought  probably  the  thymus  was  chiefly  at  fault. 

Mr.  Wright  mentioned  another  case  which  had  occurred  in 
the  hospital  about  a  year  ago.  That  case  recovered  under 
mere,  hiniod.  There  was  a  strong  syphihtic  history.  In 
Dr.  Moir*s  case  the  enlargement  of  the  thymus  was  not  so 
clear.  The  bronchial  glands  were  often  affected  in  these 
cases.  There  was  some  enlargement  of  the  thymus,  which 
passed  round  the  trachea. 

Mr.  Bhaw  asked  Dr.  Talbot  to  show  a  Packard's  Infialer. 

Dr.  Talbot,  of  Boston,  showed  the  working  of  the  appa- 
ratus, a  specimen  of  which  he  presented  to  the  hospital. 

MR.    SHAW's   CASE    OP   TUMOUR. 

Mr.  Shaw  said,  in  answer  to  Dr.  Moir,  he  thought  it  a  case 
of  sero-sanguineous  nsevoid  cyst,  the  distension  being  due  to 
its  venous  character. 

Mr.  Wright  said  Mr.  Owen  had  described  cases  of  cystic 
hygroma  of  the  neck  which  were  similar  to  this  case.  Only 
these  were  lymphatic.  They  were  better  left  alone,  as  they 
disappeared  in  time,  and  if  meddled  with  got  erysipelas. 


iS^J^Ti^^     ^  CLINICAL  EVENING.  41 


DB.   MOLSON's   case   OF   PABALT8IS. 

Dr.  Edwin  A.  Neatby  said  it  was  probably  hysterical,  but 
there  was  quite  a  possibility  that  some  organic  disease  might 
declare  itself.  Transitory  slight  paralyses  and  other 
neuroses  were  often  the  precursors  of  disseminated  sclerosis. 
They  did  not,  however,  usually  last  so  long  as  the  symptoms 
had  done  in  this  case,  before  disappearing. 

Dr.  Moi£  thought  it  might  be  an  instance  of  cure  by  sug- 
gestion. 


I  DR.    EDWIN    A.    NEATBY* S   CASE. 


Dr.  Neatbt  said,  in  reply  to  Mr.  Wright  and  Dr.  Moir,  the 
disease  had  been  coming  on  three  years — much  more  rapidly 
last  ten  months.  He  had  never  had  syphilis.  He  had  not 
seen  similar  eye  symptoms  in  this  disease  before,  but  almost 
any  combinations  of  symptoms  might  exist,  depending  on  the 
situation  of  the  sclerosed  patches. 


DB.   BLACKLET's   CASE. 


Dr.  MoiB  thought  there  was  no  doubt  about  there  being  a 
tnmour  present,  either  a  gumma  or  mahgnant.  He  advised 
large  doses  of  iodide  of  potamum. 

Dr.  BukCKLET  said  it  was  too  slow  for  a  maUgnant  growth. 
He  thought  it  was  possible  there  was  affection  of  bronchial 
glands  He  had  been  apparently  well  and  at  work  for  five 
years,  and  had  only  returned  to  Dr.  Blackley  a  fortnight  ago, 
80  there  had  been  httle  time  to  observe  treatment.  The  man 
was  now  on  plwiibum  ;  he  had  not  had  iodide  of  poUisdum, 

Mr.  Wbioht  thought  there  were  probably  diseased  bronchial 
glands. 

Mr.  Shaw  suggested  aneurysm. 

Dr.  BuLCKi£T  said  that  had  been  diagnosed  by  one  of  the 
medical  men  who  saw  him  years  ago. 

Dr.  MoiB  said  he  had  seen  a  case  of  aneurysm  in  which 
rapture  took  place,  no  symptoms  of  dyspnoea  having  been 
present. 

DB.   BUBFOBD's   case   OF   TUMOUB. 

Mr.  Shaw  thought  the  case  showed  the  possibility  of  filing 
into  error.  If  apia  had  been  given,  all  would  have  said  apis 
had  cured  the  tumomr. 

Dr.  Clabke  suggested  that  liepar  was  the  indicated  remedy, 
and  had  cured. 

Dr.  Bubfobd  said  the  liepar  was  indicated  by  the  tendency 
to  suppuration,  fever,  and  hectic.  Also  liepar  had  done  so 
splendidly  in  another  case  he  had  had  on  hand  at  Surbiton. 


42  LYCOPODIUM  SYMPTOMS.     ^^^f^"?J^! 

ON    CERTAIN    ALLEGED    LYCOPODIUM 

SYMPTOMS. 

By  R.  E.  DuDOBON,  M.D. 

In  the  Monthly  Homoeopathic  Revietv  for  November,  1890, 
Dr.  HugheB  directs  attention  to  Dr.  Mossa's  discovery 
that  the  symptoms  82  and  85  of  lycopodium  in  the  CAr. 
Krankh.  (2nd  Edit.)  bear  a  striking  resemblance  to  those 
observed  in  a  case  related  by  Dr.  Gross  in  the  7th  vol.  of 
the  Archiv.  The  symptoms  as  given  by  Hahnemann 
are  as  follows  :  S.  82.  "  He  can  talk  appropriately  upon 
higher,  even  abstract  subjects,  but  is  confused  about 
common  things ;  for  instajice,  he  says  '  plums '  when 
he  ought  to  say  *  pears.'  "  S.  85.  "  He  cannot  read,  be- 
cause he  mistakes  and  confounds  the  letters ;  he  sees 
them  and  can  copy  them,  but  cannot  remember  their 
meaning ;  he  knows,  for  instance,  that  Z  is  the  last  letter 
of  the  alphabet,  but  has  forgotten  what  it  is  called ;  he 
can  write  what  he  will,  writes  the  proper  letters,  but 
cannot  himself  read  what  he  has  written." 

Dr.  Gross's  case  is  as  follows : — 

"A  clergyman  of  over  50  years  of  age  who  was 
certainly  psoric  but  on  the  whole  healthy,  had  an 
encysted  tumour  on  his  head  the  size  of  a  pigeon's  egg» 
I  cannot  now  tell  how  long  he  had  had  it.  He  at  length 
had  it  enucleated.  From  this  time  he  began  to  ail.  At 
first  he  had  various  rheumatic  ailments  and  easily  caught 
cold,  though  for  many  years  he  had  daily  taken  exercise 
in  the  open  air,  and  lived  more  in  the  air  than  in  the 
room,  consequently  he  was  habituated  to  the  influence 
of  the  weather.  He  was  now  frequently  troubled  with 
fluent  or  stuffed  coryza,  and  was  still  worse  when  that 
ceased.  He  became  hard  of  hearing  in  one  ear.  This 
was  with  great  difficulty  removed  by  ordinary  homoeo- 
pathic remedies,  but  thereafter  he  was  attacked  by  a 
very  peculiar  affliction.  He  could  7iot  add  up  the  smallest 
SUTHS,  saw  mostly  only  the  fuilf  of  objects,  and  suddenly  lost 
completely  the  power  of  reading,  He  saw  the  letters  aU 
right  but  could  not  name  them,  and  confused  them  tvith  one 
another,  thus,  e.g.,  he  knew  that  Z  is  the  last  letter  of  the 
alphabet,  but  had  completely  forgotten  its  meaning,  he  could 
write  properly  ^consequently  could  distinguish  tlie  letters 
when  writing  J  but  could  not  read  his  own  trriting.  He  had 
forgotten  the  names  of  ordinary  objects  about  him,  whilst 


S^^jSTSSl^*  lycopodium  symptoms.  43 

he  could  talk  appropriately  even  upon  abstract  subjects^ 
This  carious  state  was  much  improved  by  antipsoric 
remedies,  he  learnt  to  see  correctly,  to  calculate,  and  to 
give  ordinary  things  their  right  names,  but  though  he 
learnt  again  to  read  it  is  still  difficult  for  him,  and  he 
can  only  pronounce  a  word  slowly  like  a  beginner. 
The  hardness  of  hearing  of  one  ear  has  returned  later  on,. 
and  it  is  to  be  feared  that  sooner  or  later  8ome  serious 
disease  will  be  developed  in  him." — Archiv,  vii  3, 12, 1828. 

The  lycopodium  symptoms  given  by  Hahnemann^ 
quoted  above,  appeared  in  the  first  edition  of  the  Chr. 
Krankh.,  which  was  pubUshed  in  1828.  This  edition 
was  noticed  in  the  second  number  of  the  seventh  vol.  of 
the  Archiv,  and  was  therefore  published  some  months 
before  Gross's  case.  The  article  in  which  Gross  gives  his 
case  is  entitled  Medicinische  Lesefrilchte,  and  is  a  collec- 
tion of  gleanings  from  allopathic  periodicals  and  works. 
Among  these  he  gives  a  case  from  Rusfs  Magazin,  in 
which  the  extirpation  of  a  fatty  tumour  was  foUowed  by 
a  series  of  morbid  symptoms.  Ajrropos  to  this  he 
mentions  several  cases  tbat  had  come  under  his  own 
observation,  where  the  removal  of  tumours  was  apparently 
the  cause  of  serious  derangements  of  the  health,  among 
others  the  case  detailed  above. 

The  symptoms  given  by  Hahnemann  as  the  effects  of 
lycopodium  and  those  of  Gross's  patient  are  too  strikingly 
alike  to  admit  of  a  doubt  that  they  refer  to  the  same 
case.  How,  then,  does  it  happen  that  Hahnemann  gives 
them  as  symptoms,  caused  by  lycopodium  '!■  Gross  says 
they  were  the  consequence  of  the  removal  of  an  encysted 
tumour  on  the  patient's  head,  and  though  he  says  these 
symptoms  were  improved — not  cured  completely — by 
antipsoric  remedies,  he  does  not  say  that  lycopodium 
was  one  of  the  remedies  used.  Dr.  Hughes,  misled  by 
Mossa,  says  that  lycopodium  was  one  of  the  antipsoric 
medicines  administered.  It  might  have  been;  for 
though  it  is  obvious  that  Gross's  case  must  have  been 
observed  before  the  appearance  of  the  vol.  of  the  Chr. 
Krankh.,  in  which  lycopodium  appeared — ^perhaps  years 
before — still,  we  know  from  Hahnemann's  letters  that  he 
communicated  many  of  the  pathogeneses  of  his  anti- 
psoric medicines  to  his  faithful  henchmen,  Stapf  and 
Gross,  a  considerable  time  before  the  pubhcation  of  the 
work  in  which  they  appeared.    But  it  is  impossible  to 


44  LYCOPODIUM  SYMPTOMS.      "'?SSji?1Kr?!^! 


Baview,  Jsn  1, 1801^ 


imagine  that  if  Gross  had  been  aware  that  lycopodium 
had  produced  symptoms  so  exactly  resembling  those  of 
his  patient,  he  would  not  have  called  attention  to  this 
remarkable  similarity,  and  at  the  least  have  mentioned 
lycopodium  as  one  of  the  antipsorics  he  had  employed  in 
the  case.  As  Hahnemann  originally  printed  these 
lycopodium  symptoms  in  brackets,  that  shows  that  he 
was  doubtful  of  their  authenticity  as  symptoms  of 
lycopodium.  We  must,  I  think,  infer  that  Gross  had,  in 
his  correspondence  with  Hahnemann,  communicated  to 
him  these  curious  symptoms,  and  he  possibly  mentioned 
that  lycopodium  was  one  of  the  antipsorics  administered 
which  improved  the  patient's  state.  Hahnemann, 
perhaps,  believed  that  the  improvement  was  chiefly  or 
entirely  attributable  to  lycopodium^  and  therefore  included 
these  phenomena  among  the  symptoms  of  that  drug, 
but  enclosed  them  in  brackets  to  indicate  that  there  was 
considerable  doubt  in  his  own  mind  as  to  their  being 
really  lycopodium  symptoms.  That  the  brackets  were 
removed  in  the  second  edition  is  no  proof  that  Hahne- 
mann had  observed  these  symptoms  as  pathogenetic 
effects  of  this  drug,  for  we  know  that  his  later  medicines 
were  not  proved  on  the  healthy,  and  a  comparison  of  his 
several  works  shows  that  all  the  bracketed  symptoms  of 
the  earlier  versions  of  his  medicines,  by  whomsoever 
observed,  were  reproduced  in  the  last  edition  of  the 
Chr.  Krankh.  without  brackets.  In  short,  there  are  no 
bracketed  symptoms  in  this,  his  latest  work,  so  that  no 
inference  can  be  drawn  from  the  non-appearance  of  the 
brackets  there  that  the  symptoms,  which  were  at  first 
considered  doubtful,  have  been  proved  to  be  real  by 
fresh  provings. 

The  history  of  these  alleged  lycopodium  symptoms 
would  suffice  of  itself  to  throw  a  doubt  on  most  or  all  of 
the  symptoms  recorded  by  Hahnemann  himself  which 
appear  only  in  the  Chr.  Krankh.  But  as  we  know  that 
these  symptoms  were  not  obtained  by  proving  the 
medicines,  but  were  only  observed  in  patients  either  as 
appearing  after  the  administration  of  a  dose  of  a  high 
dilution  or  as  disappearing  after  the  administration  of 
such  a  dose,  they  ought  evidently  to  be  all  bracketed, 
and  Dr.  Hughes  is  quite  right  to  exclude  them  from  the 
Jjidex  he  is  going  to  issue  with  the  last  vol.  of  his  great 
Cyclopadia. 


2SS!fj2nrSl!^       ON  ELEPHANTIASIS.  45 

ON   ELEPHANTIASIS. 

Communicated  by  Mr.  Knox- Shaw. 

At  the  June  meeting  of  the  British  Homoeopathic  Society 
a  case  of  elephantiasis  was  shown  by  the  writer,  and 
discussion  \vss  invited  as  to  treatment.  A  report  of  the 
proceedings  in  the  Homceopathic  World  for  July,  led 
Dr.  Th.  van  den  Heuvel,  of  Kimberley,  Cape  Colony,  to 
eommunicate  with  me,  giving  a  case  of  his  own  and 
suggestions  as  to  the  treatment  he  had  found  most 
osefal.  The  following  epitome  may  be  of  interest  to  the 
readers  of  the  Revieiv. 

Formerly  when  in  Zanzibar,  Central  Africa  and  the 
Congo,  Dr.  van  den  Heuvel  often  met  with  hypertrophied 
legs  amongst  the  Arabs  and  negroes,  and  had  obtained 
good  results,  chiefly  in  relieving  the  pain,  from  pulsatiUa, 
hamamelis,  and  when  there  were  acute  symptoms,  apis 
mel. ;  these  drugs  being  used  externally  also,  combined 
with  glycerine.  He  has  had  no  experience  of  hydrocotyle 
asiatica,  but  is  now  trying  it  in  a  case  of  elephantoid 
swelling  of  the  face,  such  as  one  sees  in  the  early  stage 
of  leprosy.  His  former  cases  were  rather  acute  and 
more  allied  to  *^  acute  varicosis  or  lymphangitis,  with 
infiltration  of  the  legs."  Hence  he  considers  the  good 
results  obtained  from  Pulsatilla  and  hamamelis.  But  in 
chronic  cases  these  medicines  seem  to  be  inactive. 

Mrs.  E.,  aged  about  SO,  multipara,  suffered  two  years 
ago  from  a  fever,  probably  of  a  typhoid  character,  which 
kept  her  in  bed  a  long  time,  and  was  followed  by  great 
weakness.  Since  that  time  her  legs  have  been  swollen 
and  painful.  This  condition  occasionally  disappeared 
aad  then  recurred,  until  at  the  time  of  examination  the 
legs  had  become  permanently  enlarged. 

Both  legs,  but  chiefly  the  left,  were  very  swollen  and 
pale.  There  was  no  external  varicosis,  the  skin  appeared 
to  be  normal  in  structure,  colourless  and  relaxed,  and  did 
not  pit  on  pressure.  Underneath  the  skin  were  a  great 
number  of  tumours,  from  the  size  of  a  pea  to  that  of  half 
a  wabint,  irregular,  spongy,  and  painful  to  the  touch. 
They  were  scattered  all  over  without  any  connection 
with  the  veins.  There  was  a  considerable  enlargement 
of  the  whole  leg,  chiefly  around  the  calf,  the  skin  having 


46  ON  ELEPHANTIASIS.     ^a^lw^jSiTlSl? 

a  baggy  appearance,  hanging  over  the  ankles.  Similar 
indurations  were  also  noticed  above  the  knee,  and  in  the 
middle  part  of  the  thigh,  along  the  coarse  of  the 
saphenous  vein.  On  the  foot  the  swelling  was  more  of 
the  nature  of  an  oedema.  Nowhere  was  there  any  sign 
of  inflammation.  There  was  a  sensation  of  heaviness 
and  pain  in  walking,  and  when  the  legs  rested  upon  the 
ground,  this,  however,  disappeared  when  lying  down. 
The  patient  was  constipated  and  suffered  from  pains 
around  the  sacrum  and  pubes,  periodical  sickness, 
leucorrhoea,  heaviness,  oppression  and  headache.  She 
was  pale  and  anaemic  though  rather  stout. 

Dr.  Heuvel  diagnosed  the  case  as  one  of  elephantiasis, 
and  prescribed  acid,  fluoric,  and  kali  mur.^  one  powder  in 
water,  alternately  once  a  day.  On  June  3rd  he  noted 
that  the  legs  were  less  swollen,  and  that  the  colour  had 
returned  to  a  certain  degree ;  the  tumours  were  softer  and 
less  large.  On  August  2nd,  the  patient  wrote  that  she 
was  much  improved ;  that  the  tumours  were  nearly  aU 
gone,  but  that  she  still  felt  weak  in  her  legs,  and  could 
not  walk  long.  She  still  complained  of  constipation  and 
pain  in  her  back.  She  was  then  ordered  ac.  fluor.  only 
once  a  day. 

"  Such,"  says  Dr.  Van  den  Heuvel,  "  is  the  result 
obtained  in  three  months'  time.  I  cannot  judge  de  visuy 
as  the  patient  is  living  at  a  distance.  But  how  did  I 
come  to  the  selection  of  ac.  fluor.  and  kali  mur.  ?  In 
looking  through  a  codex  of  symptoms  it  would  be  diffi- 
cult probably  to  find  the  pathogenesis  of  a  drug  similar 
to  the  symptoms  of  the  patient.  We  find  under  acid, 
fluor.  *  obstinate  varicose  veins,  and  pains  in  the  legs.' 
But  in  the  case  quoted,  there  is  not  exactly  a  varicose 
state  of  the  veins  ;  the  increase  in  the  size  of  the  leg  is 
caused  by  an  infiltration  of  the  sub-cutaneous  tissue,  the 
skin  being,  unaffected,  but  pale  and  stretched.  In  some 
places  it  is  warty  and  indurated,  a  condition  different 
from  pure  varicosis. 

I  had  thus  to  take  pathology  as  my  guide,  and  found 
that  the  predominant  factor  in  the  production  of  the 
swelling  was  fibrin,  which  had  exuded  from  the  walls  of 
the  vascular  cavities,  either  venous  or  lymphatic,  and 
was  possibly  due  to  the  semi-paralysis  of  the  vaso-motor 
orves,  and  want  of  contractility  of  the  elastic  fibres." 


S^^^^rSSf*"       ON  ELEPHANTIASIS.  47 


Beview.  Jan.  1«  1891. 


Thus  the  indication  was  to  absorb  the  fibrin  into  the  cir- 
€TiIation,  and  to  prevent  farther  exudation.  To  obtain 
such  a  result,  Schiissler  gives  hints  worthy  of  trial ;  he 
says:  **  Calcarea  fltiorica  (physiologico-ehemical  data). 
On  the  ground  of  therapeutical  experience,  I  assume  that 
it  is  also  a  constituent  of  elastic  fibre,  and  that  the  proper 
fanetions  of  these  is  adjusted  by  this  salt.  Elastic  fibres 
are  found  in  the  epidermis,  in  the  connective  tissue  and 
in  the  vascular  walls.  A  disturbance  of  the  equilibrium 
of  the  molecules  of  fluor.  causes  a  continued  dilatation  or 
chronically  relaxed  condition  of  the  implicated  fibres.  If 
the  elastic  fibre  of  any  portion  of  the  vessels  of  the  con- 
nective tissue  or  of  the  lymphatic  system  has  arrived  at 
such  a  condition  of  relaxation,  the  absorption  of  the  solid 
exudation  in  such  a  part  cannot  take  place.  In  conse- 
quence induration  of  the  part  sets  in.  When  the  elastic 
fibre  of  the  blood  vessels  suffer  a  disturbance  of  the  mole- 
cules of  Jbior.,  such  pathological  enlargement  takes  place, 
and  makes  its  appearance  as  haemoiThoidal  tumours, 
varicose  veins  and  vascular  tumours." 

About  kali  mur.y  Schiissler  says  that  this  ''  salt  stands 
in  a  chemical  relation  to  fibrin;  disturbances  in  its 
molecular  action  causes  fibrinous  exudations.    General 

action. — Kali  mur.  answers  in fibrinous  exudations 

in  the  interstitial  connective  tissue,  infiltrated  inflam- 
mations, &c.y  &c."  "  Could  we  find  a  better  simile  than 
jbwr.  acid  or  kali  mur.  to  these  cases  of  elephantiasis. 
This  similarity  prompted  me  to  give  those  medicines  a 
trial,  and  not  finding  any  keynote,  I  alternated  them  in 
my  first  prescription,  but  gave  only  ac,  fluor.  in  the 
sabeequent  powders." 

[In  the  present  state  of  our  knowledge,  or  rather  of  our 
ignorance,  of  the  physiologico-ehemical  changes  taking  place 
m  the  living  cells,  whether  healthy  or  diseased,  of  the  human 
body,  it  is  not  necessary  to  criticise,  still  less  would  it  be  safe 
to  finally  accept  the  theory  which  guided  Dr.  van  den  Heuvel 
to  the  use  of  fltioric  acid  and  kali  mur.  While  awaiting 
confirmation  or  correction  of  Schiissler's  theory,  the  practical 
physieian,  however,  will  gladly  make  use  of  the  clinical  fEusts 
related  above,  until  the  advance  of  our  knowledge  of  drugs 
and  diseases  enables  us  to  prescribe  with  the  confidence  of 
science  instead  of  with  the  uncertainty  of  empiricism  or  of 
improved  theory. — ^Eds.  M^  H.  R] 


48  THUJA  IN  ECZEMA.        "^iL=?5?Tt£f* 


Beview,  Jan.  1,  laoi. 


THUJA  IN  ECZEMA  FOLLOWING  VACCINATION. 

By  T.  G,  Stonham,  M.D.,  Lond. 

In  December,  1888,  F.  D.,  aged  nine,  was  brought  to 
me  with  an  eczematous  eruption  on  the  right  temple 
extending  backwards  in  the  hair  to  a  little  behind  and 
above  the  ear,  and  forwards  almost  to  the  eyelids,  the 
surface  being  moist  and  red,  and  forming  with  the  secre- 
tion thin  glutinous  scales.     The  eyelids  of  both  eyes 
were  also  affected  along  the  margins,  small,  dry  crusts, 
which  were  very  difficult  of  removal,  collecting  along  the 
roots  of  the  lashes.      The  mother  stated  that  the  erup- 
tion had  existed  for  eight  years,  and  came  on  immediately 
after  vaccination,  and  that  notwithstanding  much  medi- 
cal treatment  it  got  no  better.     The  health  was  good 
with  the  exception  of  the  eruption.      Thuja  30  three 
times  a  day  was  prescribed.    A  fortnight  afterwards 
there  was  marked  improvement  of  the  eyelids,  and  some 
change  for  the  better  in  the  patch  on  the  temple.     The 
medicine  was  continued.    For  some  weeks  improvement 
went  on  but  very  slowly.    A  change  to  thuja  <f>  then 
caused  an  aggravation,  which  subsided  again  on  resuming 
the  30th  dilution.    The  mother  being  dissatisfied  because 
the  case  was  not  progressing  faster  I  yielded  to  her 
importunities  to  give  an  external  application,  and  pre- 
scribed a  mercurial  ointment,  the  thnja  30  to  be  con- 
tinued as  well.    In  another  fortnight  the  mother  returned 
delighted — ^the  eczema  had  disappeared.    Treatment  was 
suspended.    A  week  after  a  message  came  requesting 
me  to  see  the  child  as  it  was  very  ill.    I  found  him 
suffering  from  a  patch  of  pneumonia  in  the  right  lung 
behind  in  the  region  of  the  scapula,  and  with  a  tempera- 
ture of  104°  F.    After  a  course  of  treatment  by  bryonia, 
phosjihorus  and  sulphur  the  pneumonic  patch  entirely 
disappeared,  and  he  seemed  perfectly  well  again,  but 
before  many  days  had  passed  was  brought  to  me  again 
suffering  from  a  reappearance  of  the  eczema.    The  old 
patch  on  the  temple  and  the  crusts  on  the  eyelids  had 
returned  as  bad  as  ever.     The  mother  was  very  disap- 
pointed, but  I  pointed  out  to  her  that  the  complaint  had 
been  going  on  for  eight  years  and  must  of  necessitj  be 
deeply  rooted;    that  we  had  proved  the  futility  and 
danger  of  seeking  to  cure  it  by  external  appUcation,  and 
that  if  she  would  be  content  to  persevere  with  internal 


mSi^SaTtS^  notes  and  commeots.  49 

medicaments  alone  for  a  safBcient  period  I  thought  I 
could  promise  an  ultimate  complete  cure.  She  consented 
k)  try  and  I  again  put  him  on  thuja  30,  five  drops 
night  and  morning,  and  kept  him  on  it  without  chang:e. 
Improvement  soon  set  in,  and  was  continuous,  so  that  in 
nine  weeks  after  recommencing  the  treatment  the  skin 
was  perfectly  clean.  The  medicine  was  continued  for 
three  weeks  more  and  then  left  off.  He  has  been  in 
perfect  health  with  no  return  of  the  eruption  ever  since — 
a  period  of  sixteen  months. 

Yentnor,  I.  W. 


NOTES   AND    COMMENTS. 


It  is  not  oub  custom  to  publish  a  retrospect  of  the 
year's  progress,  but  on  this  occasion  there  are  one  or  two 
points  which  call  for  remark.  First,  respecting  our 
Review.  Our  present  issue  is  the  first  number  of  the 
85th  year  of  the  Monthly  Homoeopathic  Review — a  fairly 
respectable  age  for  a  journal  representing  teaching  and 
practice  so  long  declared  to  be  moribund.  The  Review 
first  appeared  as  a  periodical  of  about  48  pages;  at 
present  72  pages  are  sometimes  inadequate  for  the 
matter  at  our  disposal. 

We  remind  our  readers  of  a  new  feature  in  the  Review, 
mtroduced  in  1889  in  order  that  they  may  more 
frequently  be  contributors  thereto.  The  section  for 
"Clinical  and  Therapeutical  Notes"  was  opened  to 
receive  short  notices  which  our  correspondents  might 
think  unworthy  to  be  styled  "  articles."  During  the 
past  year,  under  the  title  of  **  Periscope,"  a  number  of 
extracts  from  contemporary  medical  literature  in  its 
various  branches  were  given,  several  enthusiastic  and 
capable  observers  co-operating  in  this  work.  It  is 
mtended  to  continue  the  Periscope,  and  to  present  in  its 

Vol.  35,  Ko.  1.  B 


50 


NOTES  AND  COMMENTS.    *^S^fto??ttw! 


pages  a  stunmary  of  what  is  newest,  most  interesting 
and  most  important  in  connection  with  medical  science. 
In  the  present  year  also  we  shall  make  '*  Notes  and 
Conunents  "  as  may  be  necessary,  on  current  topics  of 
interest  to  the  practitioners  of  homoeopathy  and  the 
profession  at  large. 


^HE  PRAcncB  of  holding  courses  of  post-graduate 
lectures,  chiefly  of  a  clinical  nature,  has  of  recent  years 
become  so  general  that  the  introduction  of  the  custom 
at, the  London  Homoeopathic  Hospital  will  create  no 
^Q^prise.  The  success  of  such  lectures  is  due  to  the 
act  that  they  meet  (to  use  a  stereotyped  phrase)  **  a 
felt  need.*'  In  Germany  and  Paris,  and  in  America, 
such  lectures  or  classes  are  especially  well  attended. 
The  explanation  of  the  *'  felt  need  "  is  obvious ;  it  is 
also  two-fold.  The  exigencies  of  professional  work — 
out-giving— limit  the  opportunities  for  regular  reading 
and  study — in-taking.  The  routine  of  practice  seldom 
provides  the  supply  of  material  which  is  collected  within 
the  walls  of  a  good  hospital. 

Post-graduate  courses  to  meet  the  end  for  which  they 
are  established  should  be  eminently  practical  and 
clinical.  The  didactic  lecture  has  its  place  in  the 
theatres  of  our  medical  schools;  the  theoretical  and 
speculative  at  the  learned  societies.  We  hope  and 
believe  that  the  lecturers  whose  names  we  announced  in 
our  last  will  bear  these  facts  in  mind.  When  we  speak 
of  the  practical  element,  it  will  be  understood  that,  when 
medicinal  treatment  is  in  question,  we,  as  debtors  to 
Hahnemann,  shall  expect  sound  homoeopathy  to  occupy 
at  least  the  front  rank.  We  wish  the  lecturers  every 
success. 


2SSSrjST3Sf?^    NOTES  AND  COMMENTS.  51 

No  iNFOBicATioN  has,  as  yetf  been  presented  to  the 
profession  respecting  the  natnre  of  "  paratoloid,"  If 
Professor  Eoch's  experiments  are  still  so  incomplete  that 
he  cannot  yet  make  knoim  its  composition  or  mode  of 
preparation,  it  follows  that  it  was  onscientific,  premature 
mi  imprudent  in  so  serious  a  matter,  to  publish  any 
Btatement  whatever  respecting  the  new  treatment.  Until 
it  IB  capable  of  being  carried  out  and  thoroughly  tested 
from  the  beginning  by  the  profession  generally,  it 
cannot  win  the  confidence  it  may  deserve.  We  greatly 
regret  that  Sir  Joseph  Lister  should  have  seen  fit  to 
arouse  further  curiosity  respecting  other  experiments  of 
Koch's  on  "  two  virulent  infective  diseases,"  on  which 
Eoch  himself  had  preserved  a  judicious  silence. 

The  mind  of  the  Lancet  Special  Commissioner  has 
been  greatly  exercised  lest  medical  men  should  delude 
themselves  with  the  idea  that  so  dangerous  a  remedy 
wiDeverbe  "available  for  general  practice."  Indeed, 
the  smallness  of  the  dose  required  seems  to  have  greatly 
disturbed  that  gentleman,  who  fears  the  average  prac- 
titioner will  be  unable  to  measure  so  minute  a  quantity 
as  the  1,000th  part  of  a  milligramme.  In  judging  of 
the  virulence  of  the  remedy  he  forgets  that  to  act  as  a 
poison  a  much  larger  quantity  than  xi^tju  S^-  ^  required ; 
in  considering  the  minuteness  of  the  dose  he  must  be 
tmaware  that  much  smaller  quantities  of  matter  are 
every  day  producing  striking  effects  in  the  hands  of 
careful  men — ^men,  too,  who  find  no  difGiculty  in 
measuring  ^^  milligramme. 

During  the  trial  of  this  treatment  it  is  advisable  that 
no  theory  of  its  action  should  be  allowed  to  bias  the 
mind  for  or  against  it.  Eoch's  own  explanation  is 
dearly  inadequate ;  to  destroy  the  tissue  in  which  the 
tuberek  bacilli  flourish  is  but  to  throw  them  into  a 


62  NOTES  AND  COMMBNTS.  **  r^^jS^^mSl 

sarroanding  zone  of  tissae,  and  bo  aggravate  the  evil. 
If  the  fluid  cannot  either  kill  the  bacilli  directly  and 
entirely,  or  atill  better,  ao  modify  the  soil  in  which  they 
lire  and  fructify  that  they  starve,  it  will  grieyonsly 
disappoint  the  public  and  the  profession. 


Although  the  rKNECESSARY  extension  and  complica- 
tion of  medical  terminology  is  to  be  deprecated,  yet  the 
advance  of  knowledge  cannot  fail  from  time  to  time  to 
make  some  modification  requisite.  Increasing  know- 
ledge may  enable  us,  firstly,  to  distinguish  things  which 
differ,  or  secondly  to  class  together  allied  conditions 
which  superficial  differences  have  caused  to  be  dissociated 
in  our  minds.  Gout  has  dwelt  in  our  midst  for  centuries 
a  veritable  hydra-headed  monster,  and  we  have,  as  yet, 
found  no  Hercules  to  lay  it  low.  When  one  of  its 
"heads"  has  been  attacked  it  has,  like  the  hydra, 
speedily  developed  another — ^and  perhaps  a  more  for- 
midable one.  One  chief  reason  of  this  (discarding 
metaphor)  is  that  different  pathological  processes  have 
been  grouped  together  under  the  one  name  of  gout.  It 
has  become  evident  that  gout  is  not  a  homogeneous 
entity,  "  but  only,"  in  the  wordff  of  Sir  William  Boberts, 
"  a  loose  bundle  of  morbid  tendencies."  {Lancet^  Nov. 
29,  p.  1,162).  To  enable  us  to  reduce  to  order  this 
"loose  bundle,"  Sir  William  has  proposed  to  dignify 
with  a  specific  name  the  condition  which  serves  to  link 
clinically  and  pathologically  many  so-called  "gouty" 
manifestations.  Uratic  precipitation  is  to  be  denomi- 
nated "  Uratosis."  Uratosis  will  thus  rank  as  a  process 
or  condition  by  itself  on  a  par  with  albuminuria  and 
glycosuria.  Albuminuria  has  long  been  known  to  be  a 
feature  of  many  diseases  other  than  Bright's  disease ; 
glycosuria  has  more  recently  been  deposed  from  being  a 


SSS^jSTwJ?*'  notes  and  comments.  53 

synonym  of  diabetes.  Uratosis  may  be  shown  to  belong 
to  other  conditions  than  one — which  we  now  call  gouty. 
Chronic  plumbism  produces  sympioms  overlapping  those 
of  goat,  and  is  accordiugly  spoken  of  as  a  cause  of 
"gout."  This  may  be  so,  or  it  may  not ;  it  may  become 
evident,  if  it  is  not  so  already,  that  lead  poisoning  is  a 
condition  per  scy  with  the  phenomena  of  diseased  kidney 
and  uratosis  common  to  it  and  to  gout.  On  the  other 
hand,  many  anomalous  symptoms  of  gout  may  ultimately 
be  demonstrated  to  be  due  to  uratosis.  In  any  case  the 
term  may  be  of  use  in  more  clearly  defining  our  ideas. 
In  passing  we  may  remark  that  the  difficulty  in  medici- 
nally treating  cases  wrongly  grouped  together  does  not 
occur  where  Hahnemann's  rule,  "  let  likes  be  treated  by 
likes,"  is  followed. 


Onb  op  the  features  of  the  day  is  the  "  discovery  " 
by  the  old  school  of  homoeopathic  medicines.  Burroughs, 
Wellcome  &  Co.,  send  us  "  New  Therapeutic  Notes,"  in 
which  we  find  that  (1.)  Veratrum  viride  as  an  antipyretic 
has  been  "  discovered,"  and  used  by  Drs.  A.  T.  Hudson, 
&c.  (see  page  69).  Next,  calcium  sulphide  (our  old 
friend  hepar  stdph.),  has  been  "  discovered  "as  of  great 
Yalue  in  ovarian  and  fallopian  inflammations  with  forma- 
tion of  pus.  In  bronchial  catarrh  it  is  also  recommended 
(see  page  69). 

In  December,  1889,  we  commented  at  some  length 
upon  an  article  in  the  Therapeutic  Gazette,  recommending 
rhm  tox.  in  chronic  rheumatism  in  small  doses  of  a  1  in 
10  tincture.  Dr.Aulde  accepted  priority  in  "  introducing" 
this  drug  into  practice.  But  another  correspondent 
pointed  out  that  it  was  already  in  use  amongst  homoeo- 
paths, and  that  he  had  read  of  it  in  Philip's  Materia 
Medica  and  Therapeutics. 


54  REVIEWB.  ""S^^STTiM 


BeTiflfw,  Jftn.  1, 1801 


Doubtless  patients  will  here  and  there  benefit  by  the 
adoption  of  these  homoeopathic  remedies  by  the  old 
school.  We  cannot,  however,  view  with  satisfaction 
such  empirical  practice,  and  look  forward  to  the  time 
when  oar  brethren  will  regard  it  as  more  honourable 
boldly  to  test  the  principle  underlying  the  administration 
of  such  remedies  as  these,  than  to  use  a  few  stolen 
therapeutic  "  tips." 


REVIEWS. 

Kpilepsy ;  Its  Patholofjy  and  Treatment, — ^Being  an  essay  to 
which  was  awarded  a  prize  of  4,000  francs  by  the  Acad. 
Boy.  de  M^decine  de  Belgique.  Dec.  81st,  1889.  By 
HoBART  Amory  Hare,  M.D.,  B.Sc.  Philadelphia  and 
London  :  F.  A.  Davis,  1890. 

This  volume  of  228  pages  forms  the  7th  of  the  Physicians' 
and  Students'  Beady  Beference  Series,  and  as  the  title  page 
and  preface  inform  us  was  deemed  worthy,  by  the  Belgian 
Academy  of  Medicine,  of  a  prize  of  4,000  francs.  It  famishes 
the  reader  with  information  on  all  that  is  known,  and  on  a 
good  deal  of  what  is  believed  by  a  variety  of  authorities  about 
epilepsy.  The  subject  is  fully  and  intelligently  dealt  with ; 
views  and  statements  are  presented  with  fairness,  and  are 
usually  submitted  to  fair  and  judicious  criticism. 

After  briefly  reviewing  the  history  of  epilepsy,  the  author 
describes  a  model  attack,  and  then  dwells  on  the  individual 
symptoms  in  detail ;  statistics  are  given  of  their  frequency, 
relative  importance,  &c.  With  the  majority  of  the  author's 
views  we  are  in  agreement ;  for  instance,  when  he  states  that 
•*  impairment  of  mental  power  "  (in  long-standing  cases  we 
presume)  '*is  the  rule  rather  than  the  exception."  Never- 
theless we  are  not  quite  sure  that  statistics,  if  forthcoming, 
would  not  support  Reynolds  when  he  affirms  that  ^' (jreat 
mental  impairment  is  the  exception."  Tiiat  grave  deteriora- 
tion often  exists  is  true,  but  of  those  in  whom  epilepsy  exists 
before  insanity,  we  believe  the  proportion  of  cases  of  great 
impairment  not  to  be  a  large  one.  We  remember,  however, 
that  here,  as  elsewhere,  "  great "  is  a  relative  term. 

Following  the  sections  descriptive  of  the  symptoms  comes  a 
series  of  sections  treating  of  separate  varieties  of  epilepsy, 
e»g,f  psychic  epilepsy,  syphilitic,  Jacksonian,  noctumsJ,  post- 


2!SS?j2TSB*^  reviews.  55 


SBviev,  J«a.  1,  ISM. 


htmiplegia,  reflex  epQepsj,  etc.,  etc.     These  Tarieties  are 
fallj,  rdiably  and  equally  dealt  with. 

With  this  classification,  howeyer,  we  cannot  feel  much 
astisfftction.  Syphilitic  epilepsy  does  not  deserve  to  rank  as 
a  separate  variety,  and  discussion  of  the  causal  relationship  of 
syphilis  to  epilepsy  under  the  heading  etiology  would  have 
been  more  orderly.  **  Jaoksonian  epilepsy  "  is  not  epilepsy 
at  all  as  we  understand  the  term.  To  have  given  Jack- 
sonian  epilepsy  a  place  at  all  in  this  volume,  the  words 
*'  and  convulsive  seizures  "  should  have  been  added  to  the 
title,  which  of  course  would  have  given  the  work  a  wider 
scope  than  was  intended.  The  essential  difference  between 
epilepsy  proper— -due,  according  to  Hughlings  Jackson,  to 
an  explosive  or  discharging  lesion  of  some  of  the  cells  of  the 
"  highest  level "  centres — and  epileptiform  seizures,  ''  middle 
level "  fits,  does  not  seem  to  be  clearly  appreciated  by  the 
writer,  or  he  would  hardly  class  together  petit-maJ  and 
nocturnal  epilepsy  along  with  post-hemiplegic  and  Jacksonian 
epilepsy,  as  varieties  of  the  same  disease. 

When  treating  of  the  etiology  of  symptoms  and  of  the 
pathology  of  epilepsy,  we  notice  that  the  author  attempts  no 
explanation  of  the  loss  of  consciousness  or  mental  confusion, 
which  is  an  essential  part  of  the  disease,  whether  the  attacks 
are  of  the  major  or  minor  variety.  Nor  have  we  yet  met  with 
any  satisfEustory  explanation.  Loss  of  ''  consciousness  '*  is  a 
negative  condition — an  absence  of  functioning  on  the  part  of 
certain  receptive  (sensory)  centres — **  highest  level."  Were 
diese  centres  over-functioning  (as  is  the  case  in  the  '*  ex- 
plosion" of  certain  unstable  cells,  in  convulsions)  we  should 
expect  disorderly  or  contentious  acts  of  ''cerebration" — of 
the  mind.  This,  indeed,  occurs  in  some  cases  which  are  evi- 
dently due  to  a  '*  discharging  lesion  "  in  the  highest  centres. 
{Lancet,  August  9thy  1890. — Such  a  case  was  recently  reported 
by  Dr.  S.  Taylor,  under  the  title  **  Intelleotual  Aura."  Here 
the  so-called  "aura"  constituted  the  attack — characterised  by 
a  pecuhar  idea  striking  the  patient  and  being  followed  by  a 
rash  of  disconnected  thoughts  through  the  mind).  Did 
the  loss  of  consciousness  develop  late  in  the  attack — 
as  is  the  case  in  some  severe  epileptiform  seizures  which 
spread  to  the  whole  body,  it  would  be  a  possible  explanation 
that  some  inhibitory  influence  passed  from  the  cells  inducing 
the  fit,  along  fibres  communicating  with  the  sensory  cells. 
Why  on  the  other  hand  such  impression  should  be  a  negative 
(inhibitory)  and  not  an  exciting  influence  is  not  evident.  We 
should  like  to  see  this  question  worked  out. 

When  considering  the  condition  of  the  reflexes  (p.  82)  p.fter 
an  epileptic  fit,  the  author  brings  out  a  valuable  point  not 


56 CLKICAL   NOTES.         "ffir^ST^tSS! 

suffidexitly  dwelt  upon — ^viz,,  that  by  observing  the  lelative 
condition  of  the  reflexes  and  the  secondary  deviation  of  the 
eyes  (in  cases  where  the  onset  and  progress  of  the  fit  has  not 
been  witnessed)  it  may  be  possible  to  decide  which  side  of  the 
brain  is  diseased.  Why,  however,  Dr.  Hare  should  add 
"  especially  if  the  first  movements  of  the  fit  are  also  noted," 
we  do  not  understand ;  observation  of  the  first  movements 
would  be  a  fax  more  reliable  guide  than  the  after  condition  of 
the  reflexes. 

In  a  few  minor  (?)  points  we  should  join  issue  with  the 
author— -€.<7.,  where  he  attributes  to  acquired  syphilis  a  large 
share  in  the  causation  of  epilepsy  proper.  That  inherited 
syphilis  plays  such  a  part  is  unquestionable ;  and  that  the 
tertiary  lesions  of  syphilis  induce  epileptiform  seizures  is,  of 
course,  universally  acknowledged.  Most  English  medical 
men  are  content  with  the  action  of  the  iodide  of  potamwii 
upon  gummata,  but  Dr.  Hare  considers  it  *'too  slow,"  and 
discards  it  for  mercury. 


CLINICAL   AND   THERAPEUTIC    NOTES. 


Varicose  Ulcer  of  Leg, — A  laundress,  ©t.  40,  consulted  me 
in  February  about  an  ulcer  on  her  leg,  of  about  eight  years' 
standing,  and  her  case  illustrates  very  neatly  the  actions  of 
two  very  useful  drugs.  Her  body  was  covered  with  a  rash, 
irritable  and  sore,  and  I  noticed  that  her  eye-lids  particularly 
were  raw  looking  and  irritable ;  this  had  l)een  going  on  some 
eight  weeks ;  and  then  the  entire  left  leg  from  about  two-and- 
a-half  inches  below  the  knee  to  the  ankle  became  swollen  and 
erythematous,  and  an  oval-shaped,  deep,  varicose  ulcer  with 
swollen  surroundings  occupied  the  inner  side  of  leg  above 
malleolus ;  in  size,  half  an  inch  by  a  quarter. 

Until  the  diffused  cellulitis  came  she  had  been  able  to  work 
very  fedrly,  aided  by  an  elastic  stocking ;  now  she  is  quite 
unable  to  kneel  or  engage  in  the  various  duties  of  the  laundry. 
Two  years  ago  she  had  a  miscarriage  with  floodings,  and  has 
since  suffered  firom  back-ache.  Bowels  act  regularly,  but  is 
always  hungry  and  ficdnt. 

Noticing  the  very  irritable  condition  of  the  skin  of  her  face, 
I  gave  her  camphor  bromide  8rd  dec.  5  grs.  to  2  drachms  of 
water,  5  drops  thrice  daily,  and  when  seen  a  week  afterwards 
the  change  in  her  appearance  was  really  astonishing ;  the  eye- 
lids and  face  were  no  longer  swollen,  and  the  size  of  the  wound 
had  gone  down  one  half,  while  the  erythema  of  leg  had  quite 
left  except  round  the  sore.  I  ordered  for  the  succeeding  week 
one  dose  of  the  same  remedy  every  second  day,  and  by  the 


It^SmS!?^  CLINICAL   NOTES.  57 


Itoview,  J«n.  1,  IWl. 


€Xid  of  this  time  my  impression  was  that  there  was  no  farther 
progress,  although  the  first  improvement  was  well  maintained. 
She  could  now  kneel  well  when  at  work,  and  felt  maoh  better 
than  at  first. 

My  experience  of  camph.  bromide  led  me  to  infer  that  no 
additional  benefit  woald  accrne  from  its  repetition,  and  I 
therefore  changed  it  for  kali  hydriodicum  80,  2  pilules  thrice 
daily,  and  when  I  saw  her  three  weeks  afterwards  the  result- 
ing change  was  in  every  way  striking ;  there  was  no  erythema 
of  the  leg,  the  wound  was  about  the  size  of  a  pea,  she  looked 
well,  felt  weU,  and  had  no  occasion  for  an  elastic  stocking, 
although  she  still  continued  the  hard  work  of  the  laundry. 
The  results  of  the  use  of  kali  hydriod.  80  in  this  instance  leads 
me  to  believe  that  it  deserves  more  frequent  employment ;  it 
acts  with  an  energy  and  thoroughness  in  the  dilutions  that, 
in  some  instances,  for  outstrips  the  power  of  its  more  material 
preparations. — ^Bobt.  T.  Goopbr,  M.D. 

Suppurative  Infiammation  of  tJie  Tongtw, — A  young  man, 
aged  21,  was  sent  into  the  Liverpool  Hahnemann  Hospital 
sofiiering  from  pain  in  the  fauces  with  inability  to  open  the 
mouth  or  protrude  the  tongue.  The  tongue  was  thickened, 
especially  posteriorly,  and  was  hard  and  covered  with  a  thick 
white  coating.  It  was  quite  fixed,  and  almost  entirely  blocked  the 
fftuces,  swallowing  even  of  water  being  extremely  difficult,  and 
nothing  but  fluids  could  be  attempted.  The  patient  was  given 
apu  mell,  8  for  twenty-four  hours,  which  was  then  changed  to 
mercurius  soL  8,  there  being  much  salivation.  This  condition 
lasted  for  two  days  longer,  when  reUef  was  obtained  by  the 
escape  of  pus,  although  evidence  of  its  presence  could  not  be 
found  previously.  Hepar  sulph.  8  was  now  substituted,  and  the 
patient  steadily  improved  and  left  hospital  in  about  a  week. 
The  place  of  exit  of  the  pus  could  not  be  seen  even  with  a 
kuyngoscopic  mirror,  but  the  depression  could  be  felt  near  the 
base  of  the  left  anterior  pillar.  The  patient  ascribed  it  to 
sleeping  with  his  bedroom  window  open ;  other  causes,  syphi- 
lis, etc.,  were  denied.  C.  W.  Hayward,  M,D. 

Return  of  Influenza, — On  December  2nd  I  was  called  to 
attend  a  gentleman  suffering  from  influenza.  He  has  just 
returned  from  a  trip  to  South  America,  but  does  not  know  of 
any  cases  of  influenza  having  occurred  where  he  has  been. 

His  chief  symptoms  have  been  extreme  prostration,  with 
a  weak  intermittent  pulse,  pains  in  the  back  and  limbs, 
delirium  at  night  and  sleeplessness  with  great  restlessness. 
Temp,  did  not  rise  above  102.4°  F.  and  latterly  has  been  sub- 
normal. The  chief  remedies  have  been  Con,  and  Bry. 
alternately,  at  first,  then  Ar9efiictan  and  Bell,  at  night. 


68  PBBI800PE.  *2S2L^2??^ 


Beriew,  Jan.  1, 1891. 


A  serious  outbreak  of  influenza  is  reported  in  Hungary, 
and  I  hear  of  cases  in  the  practice  of  other  doctors.  Are  we 
likely  to  have  a  repetition  of  last  winter  ? — J.  Bobebson  Day, 
M.D.,  Lond. 

Stammering  and  Ear-ache,  de. — ^In  NoYember,  1888,  B.  M.» 
a  little  girl  four  years  of  age,  was  brought  to  me,  complaining 
of  deafiiess  in  left  ear,  ear-ache  and  pain  on  pressure  on  and 
round  the  external  ear.  There  was  no  otorrhcsa.  She  had 
also  a  hard  dry  cough,  worse  in  the  morning ;  not  during  the 
day.  I  was  told  that  she  had  taken  to  stammering  since  the 
ear-ache,  &c.,  came  on.  The  mother  attributed  the 
symptoms  to  "  a  cold."  Pule.  6,  two  drops,  three  times  a  day 
was  prescribed. 

The  next  report  was  that  patient  was  quite  well,  and  had 
lost  all  her  symptoms  within  a  week.  On  the  4th  of 
February,  1889,  she  came  again  to  me.  Both  ears  were 
discharging  a  ttiin  watery  fluid.  There  was  much  pain, 
worse  at  night.  Also  a  dry  night  cough.  She  again  began 
to  stammer  when  the  ears  got  bad.  The  same  prescription 
was  given  with  favourable  results. — E.  A.  N. 

PERISCOPE. 


MEDICINE. 

Death  Afteb  Tbeathent  with  Koch*s  Lticph. — The  Berliner 
Klinieche  Wochenscrift  (Dec.  10, 1890),  gives  the  following  par- 
ticulars of  this  case.  Of  the  case  of  death  after  injection  of 
Eoch*s  lymph  already  reported  in  the  daily  press  information 
has  been  obtained  from  Innsbruck.  On  Wednesday,  the 
8rd  December,  the  first  injections  made  in  that  city  were  on 
five  persons  at  the  hospital.  One  of  these  was  a  girl,  16  years 
of  age,  affected  severely  with  lupus.  A  dose  of  2  milligrams 
was  used.  In  all  the  five  cases  the  reaction  came  on  quickly 
in  the  usual  manner,  but  in  the  girVs  case  the  temperature 
went  on  increasing  to  41.5  degrees  (centigrade) ;  the  pulse 
very  frequent ;  coma,  collapse ;  death  occurred  exactly  thirty- 
six  hours  after  the  injection.  A  post-mortetn  was  made  by 
Professor  Pommer  twelve  hours  after  death,  and  disseminated 
lobular  pneumonia  of  both  lungs  and  acute  cedema  of  the  brain 
were  found  to  be  the  causes  of  death. 

On  Natubal  Immunity. — ^M.  Arlonig  {Archivee  ds  MSdecine 
ExperimentaUj  Tome  11.,  p.  89}  thinks  that  immunity  to 
infectious  disease  depends  on  the  inaptitude  of  the  organism 
to  feel  the  effects  of  the  amorphous  products  secreted  by 
microbes.  The  virus  of  pleuro-pneumonia  causes  rapid  death 
if  injected  into  the  conjunctiva  of  the  ox,  slight  effects  if  a 


Sg^jSySff^  PBBISCOPE, 69 

goat  be  the  subject,  and  no  effeot  on  a  dog  or  a  rabbit.  Other 
TixTises  behaye  differently.  The  natnrid  immonity  of  each 
animal  depends  npon  a  certain  state  of  the  elements  of  the 
body^  which  cannot  be  microscopically  distinguished.  In 
acquired  immnnity  probably  the  elements  of  the  body  have 
become  accustomed  to  the  presence  of  the  soluble  products 
secreted  by  the  microbes. 

EsTBiFEUkTOUs  Bbongho-Pneumonia. — M.  Mosny  {Archives 
de  Medecins  Experimentale,  T.  11.,  p.  272)  records  the  following 
case.  A  housemaid,  aged  87,  after  nursing  her  employer  who 
was  seriously  ill  with  erysipelas  of  the  head  and  &ce,  was 
suddenly  seized  with  violent  pain  in  the  right  side.  She  went 
to  bed,  had  a  restless  night,  the  following  morning  had  an 
inteuse  and  prolonged  rigor,  and  was  admitted  that  evening 
into  the  hospital,  La  Piti^,  under  Prof.  Brouardel.  Ausculation 
showed  lobular  pneumonia  of  the  base  of  the  right  lung.  She 
died  the  next  day,  and  the  condition  of  lung  was  confirmed  by 
a  post-mortem  examination.  Microscopic  examination  showed 
the  presence  of  the  streptococcus  of  erysipelas  and  no  other 
micrococcus.  The  cultivation  showed  that  the  streptococcus 
was  that  of  erysipelas,  and  inoculation  of  the  cultivated 
microbe  produced  erysipelas  only  when  introduced  into  the 
ears  of  rabbits.  M.  Mosny  considers  that  it  was  a  case  of 
prunitive  erysipelas  of  the  lung. — J.  Gibbs-Blake. 

SURGERY  AND  OPHTHALMOLOGY. 

Aneubysm  :  Its  Cubs  by  Inducd^o  thb  Fobuation  of  White 
Thbombi  Ynmis  the  Sac. — By  Wm.  Macewen,  M.D.,  Glasgow* 
Dr.  Macewen  delivered  a  very  interesting  address  on  this 
subject  to  the  Midland  Medical  Society.  He  first  discussed 
the  relative  value  of  the  cure  of  aneurysm  by  the  formation 
of  red  and  white  thrombi.  The  former  being  induced  when 
an  aneurysm  is  cured  by  causing  coagulation  of  its  contents 
by  the  introduction  of  some  foreign  body  into  the  sac ;  the 
latter  when  the  operation  of  ligature  is  performed.  He 
maintained  that  the  red  thrombus  was  not  the  best  mealis  of 
cure,  it  was  softer  and  thus  was  more  liable  to  the  production 
of  emboli :  it  was  more  liable  to  yellow  softening,  and  so  to 
cause  septic  contamination  ;  and  finally  the  red  thrombus  did 
not  produce  so  permanent  an  occlusion  of  the  vessel.  The 
white  thrombus  is  gradually  formed  into  fibrous  tissue,  which 
by  its  vascularisation  becomes  blended  with  the  vessel  wall, 
^is  ultimately  shrinks,  but  to  a  much  less  extent  than  the 
led  thrombus.  Irritation  of  the  wall  of  an  aneurysm  excites 
an  arrest  and  segregation  of  the  leucocytes  in  the  blood 
stream.  Thus  the  thrombus  formed  by  acting  on  the  con- 
tents of  an  aneurysmal  sac  is  different  from  one  induced  by 


60  PBM8C0PE.  "^5^"32?7r^ 


Eeriev,  Jan.  1,  U01. 


acting  on  the  walls.    Dr.  Macewen  employs  a  fine,  smooUi, 
cylindrical    needle,    sufficiently    strong    to    penetrate    the 
aneurysmal  sac,  and  long  enough  to  reach  across  it.      The 
skin  of  the  patient  is  rendered  carefully  aseptic,  and  the  pin 
is  passed  into  the  sac  until  it  reaches  Uie  opposite  side.     It 
should  he  allowed  to  scratch  the  inner  wall  hy  the  force  of  the 
hlood  current  or  should  be  gently  moved.     After  one  spot  has 
thus  been  acted  upon  for  ten  minutes  the  pin,  without  being 
removed,  can  be  made  to  attack  another  part  of  the  sac,  and 
so  on  until  the  greater  part  of  it  has  been  acted  upon.     The 
needle  may  have  to  remain  in  the  sac  24  to  36  hours,  but 
should  not  exceed  48.      In  a  very  large  aneurysm   several 
needles  may  be  employed  at  one  time.      They  generally  are 
required  to  be  re-applied  at  intervals  of  a  week.     No  anaas- 
thetic  is  necessary,  as  little  pain  is  caused.      Occasionally  it 
may  be  weeks  before  thickening  of  the  coats  can  be  made  out. 
The  address  is  illustrated  by  four  cases,  an  innominate,  a 
subclavian,   an    abdominal    aortic,   and    an    external    iliac 
aneurysm.     Two  were  absolutely  cured,  one  was  so  much 
better  that  the  patient  refused  further  treatment,  and  resumed 
his  work,  and  was  well  two  and  a  half  years  after  the  treat- 
ment had  begun.      One  died  of  asphyxia  after  a  month's 
treatment,  with  the  aneurysm  two-thirds  cured.     The  address 
is  concluded  by  the  following  warning : — "  I  trust  that  this 
form  of  treatment  will  not  be  indiscriminately  employed  upon 
every  case  of  large  aneurysm,  especially  upon  those  which  are 
beyond  hope,  otherwise  the  method  will  become  discredited. 
The  very  simplicity  of  the  treatment,  the  fiEtciUty  with  which 
it  may  be  carried  out,  without  even  the  use  of  an  anaesthetic^ 
and  with  a  comparatively  limited   anatomical    knowledge* 
makes  this  word  of  caution  necessary.*' — Brit.  Med,  Jour,, 
Nov.,  1890. 

Ebbors  of  Refbaction. — The  increasing  importance  that  ia 
attached  to  the  diagnosis  and  treatment  of  errors  of  refraction 
and  anomalous  actions  of  the  ocular  muscles,  is  shown  by  the 
fact  that  in  the  last  number  of  the  Journal  of  Ophthalmology, 
Otology  ami  Laryngology,  seven  out  of  the  eight  articles  devoted 
to  ophthalmology  concern  the  above  subjects. 

Hydrohroniide  of  Hyoscyamine, — Dr.  Macbide  sums  up  an 
article  on  the  power  of  this  drug  in  rapidly  overcoming  spasm 
of  accommodation,  as  follows: — A  solution  of  hydrobrotnide  of 
hynscy amine  of  the  strength  of  1  per  cent,  acts  as  a  powerful  agent 
in  paralysing  the  ciliary  muscle,  even  when  in  a  state  of  spasm ; 
a  single  instillation  is  enough ;  paralysis  is  complete  in  from 
eighteen  to  thirty  minutes  ;  the  effects  pass  off  in  from  three 
to  five  days ;  it  gives  rise  to  no  disagreeable  symptoms  in 
children  and  young  adults,  and  with  careful  use  is  safe  even 


t:s^srrs^       periscope.  61 


BeirUw,JaB.l,18Bl. 


in  the  old,  where,  of  coarse,  it  would  seldom,  if  ever,  be 
reqniied  to  be  used  for  spasm  of  the  accommodation.  It  ap- 
pears to  be  the  most  powerful  of  all  the  mydriatics,  oue 
instillation  doing  as  well  as  repeated  instillations  of  atropia 
nUpkaU,  and  instead  of  requiring  from  ten  days  to  three  weeks 
to  pass  off,  the  effects  pass  off  in  five  days  at  the  longest. — 
(Joum.  qfO.  O.  d  L.,  Oct.,  1890). 

Momatropine, — '*  It  has  been  well  established  ih?Xhomatropine 
is  a  trustworthy  mydriatic  if  properly  employed,  having  the  great 
advantage  that  its  action  upon  the  ciUary  muscle  is  sufficiently 
pronounced  to  permit  an  accurate  determination  of  the 
refraction  error,  while  its  effect  is  so  transitory  that  the 
patient  is  but  little  inconvenienced."  So  writes  Dr.  Schweiuitz 
in  the  Ophthalmic  Review  for  December.  But  he  records  a 
ease  to  show  that  though  the  average  period  of  recovery  is 
about  24  hours,  yet  in  exceptional  instances  the  effect  upon 
the  ciliary  muscle  is  prolonged  beyond  the  period  usually 
given,  and  the  statement  of  the  possibihty  of  such  anomalous 
action  should  be  made  to  the  patient  to  whom  the  drug  is 
given. 

HxADACHS  Besultino  FROM  HYPEROPIA,  accompauicd  by 
muscular  insufficiency. — ^Dr.  A.  B.  Norton,  New  York,  details 
at  length  a  case  of  a  hyperope  whose  symptoms  continued  in 
spite  c^  the  most  careful  correction  of  his  refraction  error  by 
competent  ocuHsts.  Avoiding  technical  details,  the  examina- 
tion showed  a  latent  divergent  strabismus,  which  was 
remedied  by  exercises  with  prisms.  Upon  this  case  Dr. 
Norton  remarks : — First :  We  find  a  case  which  would  be 
generally  considered  by  all  oculists,  at  the  time  his  eyes  were 
first  troubUng  him,  as  reqtiiring  glasses,  and  the  gradual 
increase  in  their  strength  as  was  followed  would  have  probably 
been  the  treatment  of  nearly  all,  and  yet  we  find  the  eyes 
steadily  growing  worse  from  their  use.  Second  :  It  demon- 
strates the  necessity  of  examining  the  muscular  condition, 
both  wiUi  and  without  the  glasses,  which  correct  the  refrac- 
tive error,  and  that  the  treatment  should  depend  upon  the 
condition  existing  when  the  eyes  are  prepared  for  work,  that 
is,  with  the  glasses  they  are  to  use.  Third :  It  exemplifies 
the  permanent  reUef  found  after  a  course  of  training  of  the 
ocalu:  muscles,  together  with  the  steady  reduction  in  the 
strength  of  the  glasses  used. — Jour,  of  O.  O.  d  L.,  Oct.,  1890. 

Dr.  Keeler,  Syracuse,  reports  a  similar  case  under  the 
title  *' Headache  of  ten  years  standing,  together  with 
hyperopia,  astigmatism  and  esophoria;  a  cure."  Hero  no 
progress  was  meAe  until  Dr.  Keeler  had  tested  and  found 
muscular  insnfficienoy.  Systematic  exercise  with  pnsms 
resulted  in  a  cure. 


62  PERISCOPE.  "tSSL^S?!?^ 


Beview,  J«a.-1, 1881. 


GYNAECOLOGY. 

Bebi<in  Conobbss — Fifth  SimNo. 
Sabcoma  of  Utbrus. — Professor  Ealienbach  (Halle)  gave 
Lis  experience  of  sarcoma  uteri.  He  showed  seven  instances 
of  complete  removal  of  the  uterus  for  this  lesion,  in  four  of 
whom  the  affection  located  itself  in  the  cervical  mucous 
membrane.  Of  the  patients,  two  had  succumbed  within 
seven  months  of  the  operation,  the  remainder  were  hitherto 
free  from  recurrence,  some  for  a  period  of  2^  years.  In 
another  case  of  a  girl  15  years  old,  recurrence  leading  to 
death  took  place  in  a  year  and  a-half.  In  a  ninth  case,  not 
operated  on,  the  patient  had  been  previously  deHvered  of  a 
very  large  myxoma  of  the  chorion,  and  Ealtenbach  drew 
attention  to  another  recorded  instance  of  this  concomitancy. 

Prematube  Induction  of  Labour.  —  Professor  Parvin 
(Philadelphia)  read  a  paper  on  the  Indications  for  the  Premature 
Induction  of  Labour,  These  were  (1)  Uncontrollable  vomiting. 
Out  of  ten  cases,  the  mother  recovered  eight  times ;  in  five 
instances  a  living  child  was  delivered.  (2)  Lesions  of  the 
kidneys.  (8)  Lesions  of  the  heart.  (4)  Lesions  of  the  lungs, 
4,g,,  capillary  bronchitis,  pneumonia,  oedema,  phthisis ;  of  ten 
mothers  thus  affected,  six  recovered.  (5)  Nemral  lesions,  e,y,, 
eclampsia,  meningitis ;  of  nine  mothers,  six  recovered ;  of 
ten  children,  one  was  bom  dead.  (6)  Acute  infectious  fevers. 
(7)  Abnormal  conditions  of  the  pelvis;  this  was  the  most 
frequent  indication.  Among  988  cases  of  premature  induction 
of  labour,  870  were  undertaken  from  this  cause. 

Professor  Macan  (Dublin)  maintained  that  the  risks  of 
premature  induction  had  been  considerably  diminished  by 
antisepsis,  even  almost  to  vanishing.  Difficulties  occurred  in 
those  cases  where  the  interests  of  mother  and  child  were 
opposed,  e.g.y  in  contracted  pelves.  The  better  that  early 
operation  here  is  for  the  mother,  the  more  dangerous  it  is  for 
the  child.  GaBsarian  section  should  only  be  resorted  to  after 
a  full  representation  of  the  alternative  procedures  to  the 
mother.  Methods  of  induction  that  caused  bleeding  were  to 
be  avoided,  because  blood  in  a  protracted  case  would  decom- 
pose, and  so  lead  to  secondary  infection.  The  best  method 
seemed  to  him  to  be  the  introduction  of  bougies  and  after- 
wards of  Barnes'  bags. 

Dr.  Galderini  (Parma)  supported  the  following  propositions. 
(1).  In  the  child's  interests  must  premature  induction  be 
effected  in  rickety  pelves,  when  the  conjugatavera  is  less  than 
7.5  centimetres.  (2).  In  narrow  but  not  rickety  pelves,  with 
careful  antiseptic  measures  premature  induction  may  be 
effected  with  a  conjugata  vera  up  to  8.5  centimetres.  (8). 
Phe  mortahty  of  the  children  thus  bom  alive  can  be  materially 


SaS^jSTST'  PERISCOPE. 63 

lessened  by  proper  precautions.  (4.)  Antiseptic  procedures, 
have,  in  lesions  whicli  complicate  pregnancy,  exercised  a 
decided  influence  on  the  success  of  the  operation.  (5).  The 
best  method  for  its  performance  consists  in  the  use  of  hot 
douches  through  a  Ferguson's  speculum,  and  the  introduction 
of  a  bougie  up  to  the  fondas  uteri. 

Calderini  farther  gave  a  comparative  table  of  the  various 
procedures  in  Italy  for  contracted  pelves,  from  which  it 
appeared  that  the  mortality  of  the  mother  rose  from  turning, 
through  symphysiotomy,  forceps,  perforation  up  to  CsBsarian 
section  by  Porro,  and  finally  by  Sanger.  The  mortality  of 
the  child  at  birth  proceeded  graduaUy  from  the  section  by 
Sanger,  through  section  by  Porro,  symphysiotomy,  forceps, 
and  finally  version,  in  premature  induction.  Turning  is  thus 
the  most  fatal  for  the  child. 

Dr.  Dohm  (Eonigsberg)  gave  as  statistics  in  271  cases  of 
premature  induction,  treated  antiseptically,  60  per  cent,  of 
living  children  bom.  In  171  labours  at  term  in  contracted 
pelves,  20  per  cent,  of  children  were  bom  aUve.  The  maternal 
mortality  in  818  cases  of  premature  induction  amounted  to 
5  per  cent.  The  maternal  mortality  in  215  cases  of  perfora- 
tion was  12.  Leopold,  in  GaBsarian  section,  lost  8  per  c^t. 
of  the  mothers,  and  saved  87  per  cent,  of  the  children.  Com- 
pare with  this  the  60  per  cent,  of  living  children  gained  by 
premature  induction. 

Vdlvab  Prumtus.— ;Dr.  Hardy  contributes  to  the  Clinique 
a  case  of  vulvar  pruritus  in  an  old  lady,  that  had  troubled  the 
patient  for  over  twenty  years.  It  was  post-climacteric^ 
occurring  paroxysmally,  only  being  relieved  by  applications  of 
eold  water.  The  topical  use  of  peroxide  of  hydrogen,  at  first 
diluted,  and  afterwards  pure,  prolonged  the  intervals,  and 
finally  suppressed  the  attaicks. 

Faradic  Gubbbnts  nr  UTEBms  HiKMOBBHAGss. — ^Dr.  Boa 
gives  his  experience  concerning  the  use  of  the  interrupted 
current  in  uterine  bleeding.  Applied  for  ten  minutes,  the 
negative  poll  to  the  cervix,  and  the  positive  to  the  fundus  uteri 
over  the  pubes,  hadmorrhage  is  arrested  ;  on  recurrence,  repeat 
the  application,  which  may  now  be  quite  external,  t.^.,  the 
negative  pole  to  the  perineum.  The  bleeding  is  arrested,  and 
should  it  recur,  is  more  readily  pulled  up ;  usually  the  effect 
is  permanent. 

[In  post-partum  hemorrhage  this  plan  is  excellent,  and  will 
act  sp^dily  ;  the  uterus  contracts  vigorously,  and  remains  in 
a  tonic  condition  for  some  time. — O.  H.  B.] 

HTPODSBiac  Imjectionb  of  Caffeine  in  Post-pabtum 
HfMOBBHAOE. — A  communicatiou  to  the  Archiv.  d'Obstet,  et 
de  QynkoL  ranks  the  power  of  caffeine  highly,  in  arresting 


64  PEWSCOPE.  "^5^^r?^« 


BsTJew,  Jan.  1»  18R1. 


post-pariom  bsBmorrhage.  The  hypddennic  solution  has  this 
formula :  Benzoate  of  toda  3  parts,  caffeine  two  to  two-and-a- 
half  ptfrts,  water  six  parts.  Inject  about  thirty  minims  of 
the  fluid,  warm  ;  it  may  be  repeated  several  times  during  the 
day  to  avert  collapse,  and  counteract  the  effects  of  anamia. 

G.    H.    BuBFORD> 

NEUROLOGY. 

Diabetic  Pabapleoia. — In  a  clinical  lecture  appearing  in 
the  Arch,  de  Xeurologie  (May,  1890^,  Charcot  states  that  there 
exists  a  paralytic  condition  occumng  during  or  in  connection 
with  true  constitutional  diabetes,  with  characters  peculiar  and 
constant,  such  ad  allow  it  to  be  differentiated  from  other 
forms  of  paralysis  (e.g.,  alcohoUc),  and  which  warrant  its 
being  allotted  a  specific  name.  He  discusses  the  questions 
whether  this  diabetic  paraplegia  is  an  organic  or  dynamic  affec- 
tion, and  of  central  (spinal)  or  peripheral  origin.  Repeated 
autopsies  have  demonstrated  the  organic  integrity  of  the 
spinal  cord.  The  nervous  symptoms  consist  of  "lightning" 
pains  and  other  dyssBsthesise,  of  absence  of  knee-jerk,  of 
Romberg's  symptom,  of  a  peculiar  pseudo-ataxic  gait  (d&marche 
de  stejyper),  due  chiefly  to  paralysis  of  the  extensor  muscles  of 
the  foot  (leg).  The  muscles,  examined  electrically,  shew  the 
'*  reaction  of  degeneration,"  with  general  lessened  response 
to  both  currents.  A  patient,  est.  87,  exhibited  by  the  lecturer^ 
presented  all  these  symptoms,  associated  with  pronounced 
diabetes.  He  suffered  also  from  incontinence  of  urine.  The 
family  history  of  this  patient  was  striking  ;  his  father  was  a 
heavy  drinker,  and  committed  suicide  at  the  age  of  71 ;  his 
mother  was  a  rheumatic  subject ;  of  seven  children  two  were 
insane,  and  the  patient  afflicted  as  described.  He  was  not  an 
alcoholic.  The  patient  improved  considerably  under  a  diabetic 
diet  and  the  use  of  electricity  (drugs  proving  useless),  both  as 
regards  the  polyuria  and  glycosuria  and  the  paralysis. 

The  absence  of  gastric  and  lar3mgeal  crises,  of  tabetic  eye 
symptoms,  and  of  a  truly  ataxic  gait  distinguish  this  condition 
from  tabes  dorsalis.  A  much  closer  alliance  between  this 
affection  and  alcoholic  and  other  toxic  paralyses  exists. 
There  was  less  severe  pain  in  the  case  shown  than  is  usually 
the  case  with  alcoholic  neuritis.  These  cases  were  (appa- 
rently) attributed  by  Charcot  to  peripheral  neuritis. 

Insulab  Sclebosis  (?)  Tbsmob  Abbested  by  an  Attack  of 
Hemiplegia. — Dr.  W.  Smkler  records  a  case  in  which  a  man, 
aged  about  25,  who  had  been  long  working  in  a  silver-plating 
shop,  was  gradually  attacked  with  tremor,  a  voluntaiy 
movement  of  hands,  ceasing  when  at  rest.  This  tremor 
incapacitated  him  from  executing  Ave  movements.  He  had 
no  pain  and  felt  quite  well. 


M:^SSTS^  pebiscope.     66 

This  tremor  oontinned  until  an  attack  of  left  hemiplegia 
-which  rendered  the  left  side  totally  powerless.  Power 
returned  in  the  arm  and  leg  bnt  the  tremor  is  still  absent. 

At  the  time  of  the  report  there  was  coarse  tremor  of  the  right 
hand,  disappearing  when  at  rest,  the  knee-jerk  was  normal 
on  that  side  (and  on  the  left),  the  pupils  unequal ;  but  there 
were  no  other  symptoms  of  disseminated  sclerosis.  While  at 
work  in  the  silver-plating  works,  he  lost  some  of  his  teeth. 
{Possibly  a  case  of  mercurial  tremor?) — Jul.  of  Nerv.  ami 
MerU.  Dis.,  August,  1890. 

Spastic  Pabaltsis. — ^Dr.  Gibney,  ofNewYork,  reconunends 
tenotomy  for  the  deformities  resulting  from  spastic  paralysis. 
He  reports  several  successfully  treated  cases.  Patients  entirely 
unable  to  walk  previously  being  able  to  do  so  after  the 
operation.  While  admitting  that  many  patients  fail  to  get 
the  benefit  alluded  to,  he  believes  that  a  good  proportion  are 
much  helped. — {Ibid.) 

Nasal  Epilepsy. — Schneider  {BerL  Klin.  Woch,,  No.  48, 
1889)  relates  six  cases  of  epilepsy  cured  by  treatment  of  the 
nasal  abnormaUty. 

1.  Male,  set.  14;  no  hereditary  taint;  "fits"  since  five 
jears  of  age,  occurring  nightly,  while  falling  asleep  or  in  sleep. 
Nares  contained  polypoid  swelling.  Asthmatic  breathing 
with  r&les  and  rhonchi  educed  by  touching  inferior  turbinates ; 
fit  followed  in  half-an-hour.  No  fits  or  asthma  since  removal 
of  growths  in  1885. 

2.  F.,  set  24.  Fits  since  puberty.  A  severe  fit  of  sneezing 
brought  on  an  attack,  which  led  to  the  discovery  of  the  nasal 
origin.  Irritation  of  a  spot  on  the  right  inferior  turbinate 
caused  mydriasis  and  ill-feeling.     Eecovery. 

In  two  other  cases  respiratory  difficulty  was  present  as  well 
as  the  convulsive  seizures.  In  these,  operation  removed  both 
affections. 

In  one  case  of  long-standing  epilepsy  the  treatment  failed 
to  cure.    {Brain J  Summer  No.  1890). — Edwin  A.  Neatbt. 

LAEYNGOLOGY,  &c. 

Labtnoeal  Stenosis. — ^Dr.  Dunn  {The  Clinique,  Oct.,  1890), 
in  an  essay  on  laryngeal  stenosis  and  its  surgical  treatment, 
divides  stenosis  of  the  larynx  into  three  classes  according  to 
their  distribution,  viz.,  supra-glottic,  glottic,  and  sub-glottic. 
In  speaking  of  spasmodic  stenosis,  which  belongs  to  the 
second  class,  he  states  that  a  crumb  of  bread  or  drop  of  medi- 
•cament  coining  into  contact  with  the  sensitive  laryngeal 
surface  will  sometimes  produce  a  spasmodic  stenosis  which  is 
&tal,  and  quotes  two  cases  which  occurred  in  London  hos- 
pitals, the  results  of  direct  applications  within  the  larynx. 

VoL  35,  No.  1.  B 


66  PERISCOPE.      "'^ssj'sry^gS! 


ToMsiLLmB. — ^Hudson  reports  several  cases  of  acute  tonsil- 
litis all  successfully  treated  with  veratt-um  viride  and  morplday 
the  attack  being  generally  out  short  within  from  eight  to 
twelve  hours  after  treatment  had  commenced. — New  York 
Med.  Record,  September,  1890. 

BmNiTis,  &c. — ^Parker  (Charleston),  relates  the  case  of  a 
patient  who  suffered  from  atrophic  pharyngitis  and  rhinitis  with 
symptoms  ef  dryness  of  the  throat,  difficult  nasal  respiration  and 
loss  of  the  sense  of  smell.  He  also  had  slight  impairment  of 
vision.  He  was  an  inveterate  smoker  and  accustomed  to  blow 
smoke  through  the  nostrils.  Treatment  consisted  of  entire  ab- 
sence of  smoking,  application  of  electricity  to  the  nasal  mucoua 
membrane  and  ^  grain  of  strychnine  three  times  a  day.  After  a 
month  the  sense  of  smell  returned,  and  the  condition  gradually 
improved.  The  author  states  that,  though  the  sense  of  smeU 
is  primarily  dependent  on  the  olfactory  nerve,  secondary 
conditions  as  a  free  nasal  passage  and  presence  of  moisture 
are  important.  He  further  states  that  anosmia  may  be 
functional  or  organic,  and  that  tobacco  poison  is  capable  of 
producing  either  or  both  of  these  conditions.  When  the 
olfactory  nerve  is  affected  the  anosmia  is  primarily  and  is  on  the 
same  principle  as  tobacco  amaurosis  ;  when  the  secondary  con- 
ditions are  affected  the  anosmia  is  fanctional. — Medical  New$, 

Perfoeation  op  Septum  Caused  by  Dbuos. — Jeoplitz  (New 
York)  reports  that  he  has  seen  perforations  of  the  septum 
narium  similar  to  that  caused  by  chromic  acid,  in  61  per  cent, 
of  workmen  in  an  arseniate  of  copper  manufactory. 

Intubation  fob  Laeyngeal  Stenosis. — Dr.  Cole  (Michigan) 
in  North  Am,  Joum.  Horn.,  Oct.,  1890,  reports  18  cases  of 
diphtheritic  laryngitis  with  suffocative  symptoms  treated  Tvdth 
intubation  of  the  larynx.  Of  these  18  cases,  9  recovered^ 
2  died  from  diphtheritic  toxsemia  and  2  from  broncho- 
pneumonia. The  writer  of  the  paper  states  that  he  i& 
convinced  that  intubation  is  to  be  preferred  to  tracheotomy, 
inasmuch  as  ^1)  it  is  a  more  simple  operation ;  ^2)  the 
laryngeal  tube  is  worn  with  greater  ease  and  comfort  tnan  is 
a  tracheotomy  tube ;  (8)  the  air  which  reaches  the  lungs  is 
heated  and  moist ;  (4)  coughing  and  expectoration  are  much 
easier  and  more  effectual  than  is  possible  with  tracheal  tube ; 
(5)  intubation  does  not  preclude  tracheotomy,  and  the  tube 
maybe  useful  as  a  guide  on  which  to  cut. — Dudley  WKioBnp. 

BAPm  Cube  fob  Tonsillitis. — Dr.  Hudson  (Stocktin,  Cal.) 
relates  {N,  Y,  Medical  Record)  the  history  of  cases  successfully 
treated  with  morphia  and  tincture  of  veratnim  viride.  He  found 
the  attack  of  tonsillitis  was  cut  short  within  from  eight  to 
twelve  hours  after  the  treatment  was  commenced. 

Tbeatment  of  Acute  Tonsillitis. — Dr.  Bidwell  {N.  F. 
Medical  Recoi'd,  July  5th,   1890).      Locally,   poultices    are 


SSSS^STi*^*""  ijotabilia.  67 


fiariev,  Jan.  1, 1891. 


applied  externally,  and  in*  ftdvere,  eases  inhalations  of  steam 
are  used.  Internally,  the  following  prescription  is  said  to  be 
most  Talnable : — 

9  Tinct,gtiaiad,amTn4m.jHncU€hinchona,co.    aa  ji. 

Honey  (strained) ^iii. 

8qX  Bol.  jwtass.  chlorat S^'vi. 

One  teaspoon!^  every  thirty  minutes  to  two  hours,  used  as 
a  gargle,  and  swallowed. 

Aconite  or  veratrum  viride  may  be  added  to  this  formula,  and 
it  may  also  be  used  in  lozenge  form.  The  author  is  fortunate 
in  ha?ing  had  only  one  case,  seen  early,  go  on  to  suppuration 
dvnQg  seven  years  under  the  above  treatment.  He  regards 
eommon  acute  tonsillitis  as  septic,  and  thus  separates  it  from 
the  rheumatic  variety. 

Can  Labvnoeal  PHTmsis  bk  Badigallt  Cxtbed  by  Emdo* 
LucYNGSAii  SuBoiGAii  Tbeaticent  ?  Is  a  qucstion  asked  by 
Heyiing  (Warschan).  A  great  many  of  tiie  patients  suffering 
£ram  laryngeal  phthisis  certainly  die  from  disease  of  the 
longs,  independently  of  the  laryngeal  affection,  and  a  great 
many  of  the  tubercular  affections  of  the  larynx  are  certainly 
mcQzable,  but  we  must  do  the  best  possible  to  diminish  pain 
for  such  patients,  to  prolong  their  lives,  and  to  give  them 
the  chance  of  a  radical  cure.  Upon  these  grounds  laryngeal 
treatment  must  be  reconmiended. 

Of  twenty-eight  patients  described  by  the  author  in  1887, 
twelve  have  died,  of  ten  the  present  condition  is  unknown^ 
and  six  are  still  under  treatment.  Three  of  the  patients  who 
sabseqnently  died  remained  without  recurrence.  Since  thia 
time  ttie  author  has  treated  thirty-seven  cases  by  his  method. 
In  thirty-two  cases  the  ulcers  have  been  cicatrised  for  a 
shorter  or  longer  time.    Five  cases  are  definitely  cured. 

More  than  thirty  authors  have  since  that  time  applied  the 
method,  published  their  results,  or  written  them  in  letters  to 
the  author.  He  showed  a  lady,  forty-eight  years  of  age, 
treated  by  him  in  1886  by  curettement.  The  local  condition 
and  the  general  health  of  the  lady  is  now  very  good.  He 
also  showed  a  specimen,  proving  the  possibility  of  cure  of  the 
severest  form  of  laryngeal  phthisis.  In  another  specimen 
taken  from  a  patient  who  died  from  influenza  pneumonia, 
the  formerly  infiltrated  posterior  wall  was  transformed  into  a 
strong  .cicatrix,  in  which  neither  tubercles  nor  bacilli  could  be 
found  with  the  microscope.  Indications  for  surgical  treat- 
ment are  circumscribed  infiltrations  of  the  posterior  wall, 
infiltration  of  the  ventricular  bands,  ulcers  and  tuberculous 
tumours.  The  author  concludes  that  perfect  cure  is  rarely 
observed,  but  long-lasting  improvement  is  often  obtained 
hj  surgical  treatment. 


68  KOTABIUA.  M«aM7H«»«<,^ 


Beriew,  Jan.  1, 18B2. 


NOTABILIA. 


THE  NEW  LONDON  HOMCEOPATHIC  HOSPITAL. 

Majob  Vauohan  Moboan  has  sent  us  the  following  copy  of  a 
letter  which  he  has  addressed  to  each  homoeopathic  medical 
practitioner  in  India  and  the  Colonies  with  a  view  to  induce 
an  Imperial  support  of  the  scheme  for  rebuilding  the  London 
Homoeopathic  Hospital  on  an  enlarged  and  complete  scale. 
We  quite  coincide  with  Major  Morgan's  view  of  the  importance 
of  the  hospital  in  Oreat  Ormond  St.  as  the  central  homoeo- 
pathic hospital  in  the  empire,  a  view  which  has  hitherto  been 
too  much  lost  sight  of:  and  we  sincerely  hope  that  our 
colleagues  in  India  and  the  Colonies  will,  for  the  credit  of 
homoeopathy  in  their  distant  provinces  and  presidencies,  induce 
their  patients  and  Mends  to  send  substantial  donations  to  this 
large  and  rapidly  developing  scheme.  Nothing  would  tend 
more  to  the  unification  of  homoeopathy  throughout  the  Brittsh 
Empire  than  the  representation  of  fax  distant  supporters  in  a 
large  and  active  hospital  at  the  centre  of  the  Metropolis. 

"  6,  Boltons,  S.W. 
"  London,  December  1st,  1890. 

*'Dear  Sir, — The  London  Homoeopathic  Hospital  may 
fairly  claim  to  be  an  imperial  institution ;  its  doors  are 
open  to  all  the  subjects  of  the  Queen,  and  all  its  advantages 
are  at  the  service  of  our  Indian  and  Colonial  brethren. 

"  Under  these  circumstances,  I  venture  as  its  chairman  and 
treasurer,  to  invite  you  to  support  the  effort  now  being  made 
to  enlarge  its  sphere  of  usefcdness. 

**By  book  post  I  send  you  the  last  annual  report  of  the 
hospital  and  of  our  convalescent  home  at  Eastbourne,  together 
with  the  appeal  to  and  response  from  the  residents  in  the 
United  Kingdom  on  behalf  of  our  new  building  fund. 

''Our  present  scheme  contemplates  an  expenditure  of 
£80,000,  of  which  £24,000  is  promised ;  but  if  £50,000  could 
be  raised,  we  should  be  in  a  position  to  secure  the  whole  block 
of  buildings — half  of  which  we  now  occupy — and  be  thus 
enabled  to  give  the  Hospital  the  great  advantage  of  a  site  with 
three  frontages,  besides  providing  for  future  developments,  and 
^ving  this  the  central  Homoeopathic  Hospital  a  structure 
worthy  of  Homoeopathy.  Hoping  to  hear  from  you  that  you 
will  induce  your  fnendis  and  patients  to  help  us  with  donations 
for  this  great  scheme,  as  the  medical  men  in  England  have 
•done. 

"  Very  truly  yours, 

William  Vauohan  Morgan, 

Major," 


SSS^jSTSS?^'  notabuja.  69 


Baviev,  Jan.  1, 1881 


POSTGBADUATE  LECTURES  AT  THE  LONDON 
HOMCEOPATHIC  HOSPITAL. 

AoooBDiNG  to  the  promise  made  in  our  last  issue,  we  give 
below  the  fall  sjUahus  of  the  course  of  lectures  to  be  given  by 
various  members  of  the  staff  during  the  ensuing  three  months. 
The  lectures,  which  will  be  open  to  all  qualified  medical  men 
on  presentation  of  their  cards,  will  be  delivered  in  the  Board 
room  of  the  hospital,  Great  Ormond  Street,  on  Fridays,  at 
5  p.m.,  commencing  on  Friday,  Jan.  16Ui,  1891. 

-  Stllabus. 

Jan.  16th,  1891. — **  On  the  Peculiar  Features  of  Hie  Hamceo- 
patkic  Materia  Medica.'*     By  J.  H.  Clarke,  M.D. 

Jan.  28rd.— "  The  Organonr    By  J.  H.  Clabke,  M.D. 

Feb.  6th. — *'  Modem  Methods  of  Precm<m  in  Pelvic  Diagnosis: 
^Hth  Clinical  Cases."     By  Geo.  H.  Bubfobd,  M.B. 

Feb.  18th. — **  Differential  Diagnosis ,  Prognosis j  and  Treat- 
meiu  of  Abdominal  Tumours:  with  Clinical  Cases."     By  Geo. 

H.  BUBFORD,  M.B. 

Feb.  20th. — "  On  the  Treatment  of  some  of  the  Commoner 
Diseases  of  the  IjU7igs,  mth  Clinical  Cases,"  By  J.  Galley 
Blacklet,  M.B.  Lond. 

Feb.  27th. — The  same  continued. 

March  6th. — *'The  Diagnosis  of  Errors  of  Refraction  and 
Anomalous  Action  of  Hie  Ocular  Muscles."  By  Mr.  C.  Enox 
Bhaw. 

March  18th. — "  Adenoid  Vegetations  of  the  Naso- Pharynx." 
By  Mr.  C.  Knox  Shaw. 

EE-DISCOVERIES. 
The  following  excerpts  from  a  circular  advertising  new  drugs 
may  be  taken  as  the  *' straws"  that  show  '*  which  way  the 
wind  is  blowing  "  : — 

**  Veratrum  Vtride. — A.  T.  Hudson,  M.D.,  in  the  Medical 
Beeard,  relates  particulars  of  several  cases  of  tonsillitis 
SQCcessfolly  treated  by  minim  doses  of  veratrum  viride.  Three 
or  four  doses  were  generally  sufficient  to  stop  the  congestion, 
produce  sweating,  and  afford  permanent  rehef.  One  patient 
bad  suffered  from  the  disease  three  former  times,  and  on  each 
occasion  the  treatment  with  veratrum  viride  successfully 
terminated  the  illness  in  from  three  to  five  days.  The 
simplicity  of  treatment,  and  the  promptness  of  relief,  are 
sufficient  reasons  for  emphasizing  the  value  of  veratrum 
viride  in  tonsillitis. 

'*  Sir  Morell  Mackenzie  recommends  small  doses  of  aconite 
frequently  repeated  as  an  anti-pyretic  {Diseases  9f  the  Throat 
and  Nose,  vol.  1)." 

«  ♦  4e  ♦  ♦  « 

Calc.  sulphide. — "  A  writer  in  the  Therapeutic  Gazette,  May, 


70  NOTABiuA.  '''SS^^^^i::!!!!^. 


1890,  ooDsideni  fiiTOiixably  the  emploTment  of  ealeium  tulphids  in 
a  large  variety  of  cases,  more  especially  in  the  treatment  of 
ovarian  and  uterine  affections.  The  drag  is  said  to  be  chiefly 
effective  in  preventing  the  formation  of  pus.  Frequentlyy 
dif^lao^nents  of  the  ntems  are  attended  with  o^^rian  pain, 
which,  if  not  attended  to,  will  result  in  salpingitis  and 
nmnerons  other  ills,  that  are  rehevedonly  after  resort  to 
the  knife.  The  anthor  says:— •  I  have  been  fortunate  in 
qaite  a  number  of  instances  in  overcoming  this  chronic 
ailment  by  suitable  local  treatment,  and  the  exhibition  of 
calcium  mdphide^  in  doses  of  ^th  grain,  at  intervals,  so  that 
five  '  Tabloids,*  each  containing  this  amount,  are  taken  daily. 
Those  who  have  doubts  about  these  statements,  can  easily 
settle  the  matter  to  their  own  satisfaction  in  the  course  of  a 
few  days,  by  selecting  from  among  their  patients  some  poor, 
bedridden  woman,  who  has  been  half  invalid  for  months,  or 
possibly  years.  Arguments  of  this  kind  are  the  most  con- 
vincing  Chronic  uterine  catarrh  may  be  success- 
fully treated  in  the  same  manner,'  "  etc. 

"  Bronchial  catarrh,  acute,  subacute  or  chronic,  is  always 
benefited  by  the  use  of  calcium  sulphide.  In  the  acute  stage, 
when  the  cough  is  severe,  the  dose  mentioned  should  be 
given  every  hour,  combined  with  a  minute  dose  of  morphia 
^  gr.  <  Tabloid ' ;  by  this  treatment  the  author  considers 
mudii  better  results  may  be  obtained  than  by  the  admioistra- 
tion  of  nauseating  mixtures, 

"  In  all  cases  where  there  appears  to  be  a  tendency  toward 
suppuration,  the  employment  of  calcium  nUpMde .  .  .  .  • 
is  highly  commended.  *A  succession  of  common  boils, 
scrofulous  and  other  abscesses,  are  made  to  mature,  and  the 
expulsion  of  the  pus  is  favoured  by  the  use  of  sulphides' 
(Barthoiow.)  Very  remarkable  results  were  obtained  by  the 
employment  of  calcium  sulphide  in  small  doses  in  the  treat- 
ment of  furunculosis  (Ringer)." 

TO  EXAMINE  TUBERCLE  BACILLI  IN  SPUTUM. 

The  following  is  an  easy  and  reliable  method  of  examining  for 
tubercle  baciUi.  Take  two  cover-glasses  thoroughly  cleaned 
by  having  been  previously  immersed  in  strong  nitric  add, 
washed  in  water  and  then  in  methylated  spirits  and  dried.  On 
one  of  them  smear  a  small  quantity  of  the  sputum  suspected 
to  contain  the  bacilli,  press  the  other  cover-glass  against  it, 
and  wipe  away  any  superfluous  sputum  which  may  appear  at 
the  edges  of  the  glass  with  blotting  paper.  The  glasses  may 
now  be  separated,  and  each  will  be  covered  on  one  side  with 
a  film  of  sputum.  Pass  the  glasses  several  times  through  the 
flame  of  a  spirit  lamp  in  order  to  dij  tlie  film  and  coagulate 


SSS'^rra?*       notabilu.  71 


Beviev,  Jan.  1,  18B1. 


the  albumen.  They  may  now  be  allowed  to  remain  in  one  of 
the  staining  fluids  mentioned  below,  floating  face  downwards  for 
from  five  minutes  to  half  an  hour  according  to  the  strength  and 
temperature  of  the  fluid.  They  should  next  be  removed, 
shaken  in  distilled  water  for  a  minute  or  two,  and  then  (in  the 
case  of  using  fuchsiu  or  methyl  aniline  violet)  placed  in  a 
1  in  4  solution  of  nitric  add.  Bemove  them  from  this  in  half 
a  minute,  and  then  transfer  to  distilled  water,  wash  thoroughly, 
and  dry  and  mount  in  Canada  balsam  dissolved  in  benzole 
and  turpentine. 

Staifu :  Fucfinn, — Erlich's  stain  is  made  by  taking  5  parts 
of  pore  aniline  and  100  parts  of  distilled  water.  These  are 
well  shaken  and  then  filter^.  A  saturated  solution  of  fuchsin 
is  then  added  until  precipitation  occurs.  Methyl  violet  is 
prepared  in  the  same  way  as  the  fuchsin.  Perhaps  the  best 
staui  is  CHhbes*  double  stain,  which  is  made  of  magenta  and 
methyl  blue.  The  process  of  staining  is  the  same  as  above, 
only  instead  of  washing  in  nitric  acid,  methylated  spirit  is 
used  until  all  the  stain  has  apparently  disappeared ;  then  dry 
and  mount.  The  lenses  needed  are  eye-piece  No.  8 ;  ob- 
jectives i  or  ^  (English) ;  No.  7  (Hartnack) ;  or  glass  D. 
(Zeiss).  The  stains  may  be  obtained  ready  prepared  from 
microscope  makers. 

NEW  BOOKS. 
We  notice  that  The  Medical  Annual  (edited  by  Dr.  Percy 
Wilde)  for  1891  will  be  ready  this  month.  This  periodicid 
continues  to  grow  in  size,  and  can  now  boast  of  a  circulation 
of  over  10,000  copies.  From  the  synopsis  of  contents  this 
issue  promises  to  be  more  than  usually  valuable  and 
interesting.    (Publisher  :  Wright,  Bristol). 

A  new  edition  oiNeaWs  Medical  Digest  is  to  be  published  in 
a  few  months.  This  work  is  well  known  to  all  medical  men 
engaged  in  literary  work,  but  is  not  intended  to  be  useful  only 
to  them.  Much  help  may  be  derived  by  the  practitioner 
from  reference  to  it  when  studying  anv  new  subject  or 
difficult  case.  Names  of  subscribers  should  be  forwarded  to 
Dr.  Neale,  Boundary  Boad,  N.W.  Were  a  supplement  to  this 
work  issued  every  six  months,  and  a  new  edition  every  Ave 
years,  its  value  would  be  greatly  enhanced.  Moreover  it  is 
time  that  the  contents  of  homoeopathic  joumcds  should  And  a 
place  in  its  pages. 

The  Anntud  0/  the  Umveival  Medical  Sciences  for  1890  is 
now  pubUished.  It  was  somewhat  late  in  its  appearance  on 
account  of  the  iUness  of  many  of  the  editors  from  influenza. 
It  is  continued  on  the  lines  of  previous  years,  and  is  an 
encydopsedio  work.    (P.  A.  Davis,  Bemers  Street,  W.) 


72  OORRE8POKDE5T8.       ""TSSw^SSTT^ 


DaTis'  Visitinff  Lut  (Bemera  Street,  W.),  is  an  exceptionally 
portable  and  handy  litUe  book,  adapted  for  any  month  or  year. 
It  has  the  usual  pages  for  notes,  caish  aeconnts,  &e. 

NOTICES  TO  CORRESPONDENTS, 

%*  We  emmmti  mmdertdke  to  rttum  rejecUd  wtantueripts. 

Authors  and  CoiiTitiKUTOBS  reoeiTiii^  prooCs  are  requesfced  to  correct 
and  zetnm  the  aune  as  early  as  posBlfaie  to  I>r.  Rdwik  A.  Neatbt. 

We  are  asked  to  stste  that  Mr.  S.  J.  Lbwis  of  Newington  Oansewa j, 
S.E^  has  opened  a  HomcBopatliic  FhrnnoMoy  at  285,  Queen's  Road,  New 
Cross  Gate,  S.E. 

Mr.  DuBLKT  WsiGHT  has  oommenoed  practioe  at  21,  Leinster 
Square,  W. 

Communications,  &c.,  receiyed  from  Dr.  MoBRisON,  Dr.  J.  Galley 
Blacklet.  Dr.  Bchpord.  Dr.  Day,  Dr.  Dudgeox,  Mr.  Knox-Shaw, 
Mr.  Weight,  Mr.  Cross,  Mr.  S.  J.  Ellis  (London)  ;  Dr.  McKechnie 
(Bath)  ;  Dr.  Nicholson  (Clifton) ;  Dr.  Stoxham  (Yentnor) :  Dr.  J. 
OiBBS  Blake  (Birmingham)  ;  Dr.  Hughes  (Brighton)  ;  Dr.  W. 
Talbot  (with  endoenre). 

BOOKS    RECEIVED, 

A  Clinical  Materia^  Medica.  By  the  late  K  A.  Farrington,  M.D. 
Second  edition.  Philadelphia  :  F.  £.  Boericke.  \%m.—PrinetpJet  of 
Surgery.  By  N.  Senn,  MJD.,  PhJ>.,  Milwaukee.  WiiL,  Philadelphia  and 
London  :  P.  A.  Davis.  1990.— ffn-edity.  Health  and  Personal  Beavty, 
By  John  Y.  Shoemaker,  AJL,  M.D.  Philadelphia  and  London :  F.  A. 
Davis.  ISW.—Electrieity  in  the  Diseases  of  Women,  By  G.  Betton 
Massey,  M.D.  Second  edition.  Philadelphia  and  London  :  F.  A.  Davis. 
1690,— Twelre  Lectures  on  the  Structure  of  the  Central  Nervous  SystenK 
By  Dr.  Ludwig  Edinger,  Frankfort-on-ihe-Main.  Translated  by  Willis 
Hail  Yidson,  M.D.,  S.  Paul,  Minn.  Philadelphia  and  London  :  F.  A. 
Davis.  1890.— T»^  Medical  Bulletin  Visiting  List,  or  Physician's  Call 
Jleeord.  New  Edition.  Philadelphia  and  London  :  F.  A.  Davis.  1890. 
— Transactions  of  the  Fourteenth  Annual  Session  of  the  Calif omia  State 
Homceopathic  Medical  Society,  held  May,  1890.  YoL  i  San  Fran- 
cisco:  Joseph  Winterbum  &  Co.  1890. — HonuBopathie  Wot  Id,  Dec. 
London. — Chemist  and  Druggist,  Dec.  London. — Magazine  of  Phar- 
macy, Dec.  London. — Beauty  and  Fashion,  Nov.  29tlL  London : 
Sheppard  &  St.  John. — Report  of  the  Melbourne  Honicfopathic  Hospital, 
1890. — North  American  Journal  of  Homoeopathy,  Nov.  New  York. — 
American  Homeeopathist.  Nov.  New  York. — New  Yorh  Medical  Times, 
Dec,— Medical  Record,  Nov.  and  Dec.,  1890.  New  York.— The  Chiro- 
nian,  Nov.  New  York. — Helmuth  House  Report.  (Fourth  series). 
New  York. —  Hahncmannian  Monthly,  Nov.  Philadelphia.  —  The 
Clinique.  Nov.  Chicago. — The  Medical  Adtance,  Nov.  Ann  Arbor. 
— The  California  Homosopath.  Nov.  San  Francisco. — The  Medical  and 
Surgical  Record,  Nov.  Omaha. — H  Policlinico,  8th  and  23rd  Nov. 
Turin. — Pop.  Zeitsehrift  fur  Homoopathie,  Dec.  Leipzig. — Allgcm, 
Horn.  Zeitung.    Dec    Leipzig. — Rivista  Omiopatica.    Nov.    Borne. 

Papers,  Dispensary  Beporta,  and  Books  for  Review  to  be  sent  to  Dr.  Popk,  19, 
Watorgate,  Orantham,  linoolnshire ;  Dr.  D.  Drcs  Baowx,  29,  Seymour  Street,  Port- 
man  Sqnaie,  W.;  or  to  Dr.  Edwix  A  Nbatbt,  161,  HaTsrstook  IDll,  N.W.  Advertise- 
ments and  Business  coounimications  to  be  sent  to  Messrs.  £.  GfouLD  &  Sov,  69, 
Koorvftte  Street,  E.C. 


^^y^*"  PHABTNOITIS  AND  LABYNOITIS.  78 


THE    MONTHLY 


HOMOEOPATHIC    REVIEW. 


•:o:- 


SOME  OP  THE  COMMONER  DISEASES  OP  THE 

PHAEYNX  AND  LARYNX.* 

By  Mr.  Dudley  Wright. 

I  SHALL  not  try  to  deal  in  any  great  detail  with  the  sub- 
jects I  have  chosen  for  to-night's  paper,  as  our  time  i» 
too  short,  and  for  this  reason  I  must  ask  you  to  make 
allowances  for  the  **  sketchy  *'  character  of  this  essay.  I 
hoped,  moreover,  to  have  brought  before  you  patients 
suffering  from  the  various  diseases  of  which  I  shall  treat, 
bat  in  this  I  have  been  disappointed,  and  will  therefore 
try  in  part  to  make  up  for  this  loss  }ff  a  few  coloured 
illustrations  taken  from  patients  who  from  time  to  time 
have  presented  themselves  for  treatment  at  this  hospital. 

For  various  reasons  I  shall  not  enter  into  a  discussion 
upon  acute  catarrh  of  the  naso-pharyngeal  tract,  but, 
passing  this  over,  will  commence  with  the  extremel}' 
and  often  intractable  disease — chronic  naso-pharyngitis. 

This  disease  may  be  present  in  one  or  both  of  two 
forms :  The  first  consisting  of  a  more  or  less  uniform 
redness  of  the  mucous  membrane  with,  perhaps,  slight 
swelling;  the  second,  to  which  the  name  pharyngitis 
granulosa  is  given  is  characterised  by  the  presence  of  the 
so-called  granular  bodies  in  various  parts  of  the  pha- 

*Bead  bef<Mre  the  British  HomcBOi^athfo  Society,  Jan.  1, 1891. 
Vol.  85.  No.  2.  O 


74         PHARYNGITIS  AND   LARYNGITIS.    ^"^^^SSH^Iml 

ryngeal  tract.  They  vary  in  size  from  a  pin's  head  to  a 
split  pea  or  even  larger,  and  are  situated  by  far  the  most 
commonly  in  the  pars  oralis. 

According  to  Saalfield  and  Both  these  bodies  are  due 
to  "  a  circumscribed  proliferation  of  the  lymphoid  tissue 
around  the  duct  opening  of  a  mucous  gland/'  and  most 
observers  are  agreed  that  their  presence  is  a  manifesta- 
tion of  the  evil  effects  produced  by  irritation  of  one  form 
or  another  applied  to  the  mucous  membrane  of  the  pha- 
ryngeal tract. 

The  most  common  of  these  irritants,  according  to 
Lennox  Browne,  is  the  improper  use  of  the  voice,  in  which 
he  would  include  not  only  improper  voice  production,  but 
also  over-exertion  of  the  voice  or  straining,  an  act 
entirely  controlled  by  the  pharynx.  That  this  is  really 
a  common  factor  is  demonstrated  by  the  very  frequent 
occurrence  of  the  disease  in  clergymen  and  public 
speakers,  from  which  fact  it  has  obtained  the  name  of 
''  clergyman's  sore  throat."  Other  important  causes  are 
excessive  smoking,  especially  if  expectoration  be  fre- 
quently carried  out  during  the  act,  and  alcoholic  excess. 
One  form  of  the  disease,  which  according  to  most  English 
observers  is  uncommon  in  this  country,  is  that  in  which 
the  granulations  are  grouped  more  particularly  at  the 
sides  of  the  pharynx.  To  this  the  name  lateral  hyper- 
trophic pharyngitis  has  been  given.  In  such  cases  in- 
spection shows  an  irregular  and  elongated  swelling  of  the 
mucous  membrane  behind  each  posterior  pillar  of  the 
fauces  springing  forward  and  inwards  and  coming  very 
prominently  into  view  when  the  patient  is  made  to  say 
'^  a."  This  condition,  though  as  before  said  compara- 
tively rare  in  England,  is  by  no  means  uncommon  in 
parts  of  the  Continent,  and  in  the  clinics  in  Vienna  one 
could  find  it  present  to  a  greater  or  less  degree  in  nearly 
half  the  cases  of  chronic  pharyngitis. 

This  form  is  of  importance,  inasmuch  as  the  granula- 
tions, being  in  close  proximity  to  the  opening  of  the 
Eustachian  tubes,  are  more  likely  to  obstruct  the  free 
passage  of  air  into  the  middle  ear  and  lead  to  ordinary 
*^  throat  dea&iess"  and  other  consequences  of  Eustachian 
blocking,  than  the  form  in  which  the  granulations  are 
situated  more  in  the  middle  line  of  the  pharynx. 

A  common  symptom  in  these  cases  is  a  ''  sticking  " 
pain  running  up  in  one  or  both  ears. 


^f^fnSi!^''    PHABYNGITIS   AND   LABYNGITIS.  75 


If  the  granular  pharynx  is  not  carefully  treated 
atrophy  of  the  mucous  membrane  is  very  apt  to  ensue, 
and  we  then  have  the  atrophic  form  of  pharyngitis  in 
which  there  is  a  loss  of  epithelium,  atrophy  of  the 
glandular  tissue,  and  thus  a  diminution  or  complete 
absence  of  secretion,  the  mucous  membrane  becoming 
diy  and  glazed. 

In  the  vault  of  the  pharynx  is  situated  the  mass  of 
Ipnphoid  tissue  called  after  Luschka,  who  first  accu- 
rately described  it,  Luschka's  tonsil.  This  organ  pos- 
sesses numerous  crypts,  similar  to  those  of  the  faucial 
tonsils,  though  larger,  running  into  its  substance. 

It  is  the  hypertrophy  of  this  pharyngeal  tonsil  which 
forms  the  adenoid  vegetations  so  commonly  met  with  in 
children  from  the  age  of  six  years  upwards. 

Besides  this,  another  form  of  disease  is  liable  to  be 
prodaced  by  certain  alterations  in  its  structure. 

Yon  will  see  in  the  illustration  that  at  about  its  centre 
is  sitoated  a  crypt  which  is  somewhat  deeper  and  larger 
than  the  rest,  and  which  has  been  called  the  bursa 
pharyngea.  This  crypt  is  liable  to  be  attacked  by  a 
form  of  chronic  inflammation  which  causes  it  to  be  the 
seat  of  a  stringy  muco-purulent  discharge  which,  issuing 
from  its  mouth,  may  appear  trickling  down  the  posterior 
pharyngeal  wall  behind  the  uvula.  This  process  may  of 
course  occur  in  any  of  the  other  crypts,  but  its  effects  are 
moch  more  noticeable  and  possibly  more  common  in  the 
larger  central  one.  This  disease  was  first  described  by 
Tomwald,  of  Dantzig,  and  has  been  called  bursitis  or 
catarrh  of  Luschka's  pouch. 

In  order  to  make  a  certain  diagnosis  posterior  rhinos- 
copic  examination  is  necessary,  and  the  discharge  may 
sometimes  be  seen  issuing  from  the  mouth  of  the  crypt. 
I  have  not  yet  myself  had  an  opportunity  of  seeing  one 
of  these  cases,  but  it  should  always  be  looked  for  in 
patients  suffering  from  a  chronic  discharge  from  the 
posterior  nares.  In  some  cases  examination  of  this 
region  may  be  assisted  by  some  form  of  uvula  retractor, 
one  of  which  I  pass  round.  They  are  not  often  needful 
for  examination  purposes,  but  may  be  found  useful  when 
it  is  desirable  to  apply  remedies  locally. 

With  regard  to  the  treatment  of  chronic  catarrh  we 
have  many  remedies  from  which  to  make  a  selection. 
Por  those  cases  attended  with  a  scanty  secretion  and 


76  PHARYNGITIS   AND   LARYNGITIS.   ^^iL^ST??^'' 


Beriew,  Feb.  2, 18BU 


constant  hawking,  especially  when  this  occurs  in  the 
morning  soon  after  waking,  7inx  vomica  will  generally 
give  prompt  relief.  When  the  granular  condition  is 
marked,  saiiguinaria  taken  internally,  or  as  I  prefer  it, 
locally  with  glycerine  or  in  a  warm  spray,  is  as  good  a 
remedy  as  one  could  wish. 

Phytolacca  is  useful  in  those  cases  of  chronic  sore 
throat  increased  by  exposure  to  cold  winds,  with  pains 
commencing  in  the  throat,  extending  downwards,  and 
exciting  a  paroxysmal  cough  with  thick  mucus. 

Bichromate  of  potash  is  chiefly  indicated  in  those  forms 
attended  with  considerable  muco-purulent  discharge  and 
involvement  of  the  nasal  mucous  membrane,  and  should 
be  of  use  in  the  disease  described  by  Tomwald.  One 
other  form  of  medication  I  have  found  useful,  especially 
in  chronic  catarrh  left  after  repeated  acute  attacks,  is 
the  inhalation  of  camphor  mixed  with  sulphuric  ether y  in 
the  proportion  of  10  of  camphor  to  100  of  ether. 

Some  forms  of  pharyngitis  are  marked  by  the  presence 
of  enlarged  and  tortuous  veins  beneath  the  mucous  mem- 
brane, and  often  by  a  varicose  condition  of  the  veins  at 
the  root  of  the  tongue.  In  these  cases  puUatiUa  is  the 
indicated  remedy,  though  it  is  often  necessary  to  destroy 
the  varix  by  means  of  the  galvano  cautery.  Pulsatilla 
is  more  particularly  indicated  in  those  cases  of  long 
standing  pharyngitis  accompanied  by  a  characteristic 
train  of  mental  and  gastric  symptoms. 

Chronic  laryngitis  is  one  of  the  most  common  forms 
of  laryngeal  disorders  with  which  one  meets.  In  it  one 
founds  a  more  or  less  equally  distributed  injection  of  the 
mucous  membrane  of  the  larynx,  with  or  without 
involvement  of  the  true  vocal  cords.  The  redness  and 
swelling  is,  as  a  rule,  most  marked  when  the  tissues  are 
loose  in  texture  as  over  the  ventricular  bands  and  ary- 
epiglottic  folds :  but  the  epiglottis  may  become  intensely 
injected,  especially  in  those  cases  due  to  alcoholic  excess. 
Bands  of  mucus  may  be  seen  stretching  from  cord  to 
cord,  which,  breaking  when  the  cords  are  widely  separated 
as  in  taking  a  deep  breath,  leave  an  appearance  of 
crenation  of  the  free  borders.  Often,  also,  will  be 
found  a  want  of  the  power  of  approximation  of  the  cords 
in  their  central  parts,  owing  to  weakness  of  that  portion 
of  the  thyro-arytenoidens  muscle,  which  exercises  a 
control  over  the  tension  of  the  cords,  and  at  the  same 


SS^P^STSfJ^*    PHARYNGITIS   AND   LARYNGITIS.  77 


Itiisv,  Feb.  S,  18»1. 


time  a  certain  jerkiness  in  their  movements  may  be 
noticed.  As  in  the  pharynx,  so  in  the  larynx,  though  to 
a  lesser  degree,  the  glandular  Ijrmphoid  tissue  may 
become  enlarged,  forming  the  so-called  follicular  laryn- 
gitis. 

Erosions  of  the  mucous  membrane  may  be  present, 
though  true  ulceration  seldom  if  ever  occurs.  When 
the  loss  of  epithelium  takes  place  on  the  vocal  cords,  an 
absence  of  the  characteristic  sheen  will  be  noticed  on  the 
damaged  parts.  The  treatment  of  chronic  larjoigitis  is 
very  much  the  same  as  for  chronic  pharyngitis,  but  I 
may  mention  iodine  as  a  drug  to  be  used  in  the  follicular 
form. 

It  musty  however,  never  be  forgotten  that  both  chronic 
pharyngeal  and  laryngeal  catarrh  are  as  often  as  not 
complicated  with  some  form  of  nasal  stenosis,  and  may 
really  be  the  result  of  the  stenosis.  Any  form  of  treat- 
ment, then,  is  useless  until  we  remove  the  exciting 
ouise  from  the  nose.  So  long  as  the  stenosis  exists, 
the  patient  will  breathe  through  the  mouth,  and  this 
will  invariably  keep  up  the  irritation. 

Before  passing  on  to  the  specific  forms  of  inflamma- 
tion, I  should  like  to  mention  a  case  of  a  rather  anomalous 
character  which  was  under  the  care  of  Mr.  Shaw  in  the 
hospil^  last  year.  A  female  child,  age  5  years,  who 
had  previously  been  operated  on  for  post  nasal  adenoids, 
was  admitted  with  a  sore  throat,  which  had  been  coming 
on  for  the  last  four  days,  general  weakness  with  a  tempera- 
ture of  101^.  Examination  showed  the  fauces  to  be  much 
injected  and  the  tonsils  enlarged  (this  was  old-standing 
trouble).  On  the  lower  half  of  the  uvula  was  situated  a 
dmnb-bell-shaped  bleb,  the  remainder  of  the  uvula  being 
of  an  intensely  red  colour.  On  the  upper  part  of  the 
right  anterior  pillar  of  the  fauces  were  two  other  blebs, 
with  a  surrounding  zone  of  hypereBmia. 

The  posterior  pharyngeal  wall  was  deeply  injected  and 
the  tongue  coated  On  the  second  day  after  admission 
a  rash,  somewhat  similar  to  that  of  scarlet  fever,  was 
noticed  on  the  arms  and  shoulders,  and  at  the  same  time 
the  skin  was  hot  and  dry,  but  by  the  evening  the  rash 
had  gone  and  the  skin  was  moist.  By  the  fourth  day 
the  temperature  was  normal,  and  the  blebs  had  nearly 
Appeared,  but  at  this  time  what  appeared  to  be  pom- 
pholyx  formed  on  the  outer  side  of  the  terminal  phalanx 


78  PHARYNGITIS  AND   LARYNGITIS.    ^"^^^^SV^. 


Benew,  Feb.  %  1801. 


of  the  right  index  finger.  The  child,  however,  went  on 
well  and  was  soon  sent  down  to  the  Eastbourne  Con- 
valescent Home. 

She  received  bell,  whilst  the  acute  stage  lasted,  and  at 
the  end  rhvs  tox.  The  illustration  was  taken  on  her 
admission.  From  the  faucial  appearances  I  should  be 
inclined  to  class  this  under  the  head  of  herpes  of  the 
pharynx,  the  attack  somewhat  corresponding  to  those 
cases  in  which  a  rise  of  temperature  is  followed  by  no 
other  symptoms  than  herpes  of  the  lips. 

Cases  of  syphilis  of  the  pharynx  are  unfortunately 
common  enough  in  both  its  secondary  and  tertiary  forms, 
and  in  hospital  work  one  is  constantly  meeting  with 
patients  who  present  various  features  of  this  affection. 
They  are  generally  the  most  satisfactory  cases  we  have 
to  treat,  and  the  results  are  very  encouraging. 

Cases  of  primary  chancre  of  the  pharynx  or  oro- 
pharynx would  hardly  come  under  the  heading  of  this 
paper,  so  I  propose  to  deal  only  with  the  two  other  forms 
of  the  disease. 

The  throat  manifestations  of  the  secondary  stage  are 
of  the  same  nature  as  those  of  the  skin. 

A  more  or  less  symmetrical  hypersemia  of  the  mucous 
membrane  of  the  fauces  and  velun,  together  with  a  slight 
amount  of  swelling  owing  to  serous  infiltration  of  the 
submucosa  is  to  be  seen.  The  swelling  is  of  course  most 
marked  where  the  tissues  are  loose,  and  hence  the  uvula 
may  be  considerably  swollen  and  its  edge  have  a  peculiar 
semi-transparent  look  owing  to  the  oedema.  The  pos- 
terior pharyngeal  wall  is  not  so  often  attacked  by  the 
inflammation,  though  the  naso-pharynx  may  become 
involved  together  with  the  lining  of  the  Eustachian  tube. 
Mucous  tubercles  may  be  present,  corresponding  to  the 
papular  eruption  of  the  skin,  and  on  them  "  plaques  "  of 
exudation  may  form,  but  in  many  cases  these  plaques 
are  not  due  so  much  to  an  exudation  as  to  the  heaping 
up  of  sodden  scaly  epithelium. 

The  illustration  is  taken  from  a  typical  case  of 
secondary  syphilitic  sore  throat  in  a  man,  aged  21  years, 
who  was  first  seen  here  by  me  last  May.  He  had  a 
hard  chancre  in  January  and  the  sore  throat  came  on  at 
the  end  of  February.  When  seen  he  was  decidedly 
anaemic  and  tlie  forehoad  and  upper  part  of  the  chest 
was  covorod  with  u  thick  macular  and  papalo-squamous 


K^^!t^Sl^   PHABYNGITIS  AND   LARYNGITIS.  79 

eraption,  which  had  been  present  for  two  months.  Ton 
will  see  that  on  the  right  tonsil  and  anterior  palatine 
fold  is  a  "  plaque  "  of  a  horse-shoe  shape,  and  on  the 
left  side  is  a  more  irregular  shaped  one.  The  mucous 
membrane  around  them  is  much  congested  and  there  is 
slight  cedema  of  the  uvula.  There  was  an  enlarged 
miindurated  gland  at  the  left  angle  of  the  jaw.  The 
hearing  power  was  only  in  contact  with  the  watch  in  the 
right  ear  and  ^  in  the  left  ear.  He  had  preyiously  been 
treated  at  the  North- West  London  Hospital.  I  ordered 
him  nierc.  sol.  3x  mv.  t.d.s.  and  ung,  hydrarg.  ammoniatia, 
vith  lanoline  and  glycerine  in  equal  parts  for  the 
eruption.  In  a  month  the  rash  on  the  arms  and  body 
and  the  sore  throat  had  quite  gone,  but  there  were  still 
a  few  maculsB  left  on  the  forehead. 

The  symmetry  of  the  erythematous  or  papular 
eruptions  of  the  throat  are  very  characteristic,  and 
Jonathan  Hutchinson  has  given  to  it  the  name  of 
"Dutch  garden  symmetry." 

In  the  secondary  form  of  the  disease  true  ulceration 
very  rarely  takes  place.  The  plaques  may  be  mistaken 
for  ulcers,  but  careful  inspection  will  prevent  this  error. 
A  certain  amount  of  erosion  of  the  mucous  membrane 
may  occur,  but  ulceration  is  practically  limited  to  the 
tertiary  stage  and  is  then  the  result  of  breaking  down  of 
gommata. 

Secondary  syphilis  may  assert  itself  in  the  larynx  in 
very  much  the  same  form  as  it  does  in  the  pharynx, 
though  it  is  less  frequent  and  its  manifestations  do  not 
show  the  same  tendency  to  symmetrical  arrangement  as 
in  the  latter  seat.  Another  important  feature  about 
laryngeal  involvement  is  that  it  does  not  show  itself  as 
a  rule  till  a  much  later  period  than  the  pharyngeal 
form,  indeed,  it  is  generally  only  first  present  when  the 
latter  trouble  has  nearly  or  quite  subsided. 

If  mucous  tubercles  are  present  they  generally  occur 
in  the  epiglottis,  and  in  the  larynx  the  same  rule  holds 
good  with  regard  to  true  ulceration  being  rare  in  the 
secondary  stage. 

The  voice  is  more  markedly  affected  in  cases  of  specific 
than  of  simple  laryngitis.  Periods  in  which  the  voice  is 
quite  lost  are  not  uncommon,  and  are  chiefly  dependent 
on  atmospheric  disturbances,  and  when  the  voice  is 


80  PHABTNG1TI8  AND   LARYKGITIfl.    ^BS£i?SS!?iflM: 

restored  it  is  almost  always  husky  for  a  considerable 
period  and  may  become  permanently  so. 

The  treatment  of  the  various  conditions  of  secondary 
syphilis  are  eminently  satisfactory.  Perchlaride  of 
mercury  saits  most  cases,  and  I  have  not  seen  a  case 
which  did  not  obtain  benefit  from  it.  For  the  pharyn- 
gitis a  gargle  of  1  in  20  nitric  acid  solution  is  highly 
beneficial.  I  know  of  nothing  which  so  qoickly  removes 
the  discomfort  occasioned  by  the  hyperemia.  The  same 
or  a  little  weaker  lotion  may  be  applied  locally  to  the 
laryngeal  mncoas  membranes  by  means  of  the  laryngeal 
brush,  or  better,  a  probe  covered  with  cotton  wool.  The 
patient  must  avoid  eating  anything  which  may  act  as  an 
irritant  to  the  inflamed  parts,  such  as  curries  or  mustard, 
&c.,  and  he  should  take  great  care  that  the  teeth  and 
cavity  of  the  mouth  are  always  kept  clean. 

We  have  seen  that  the  pharyngeal  and  laryngeal 
lesions  of  secondary  syphilis  are  similar  in  their 
pathology  to  those  found  on  other  parts  of  the  body, 
and  we  find  that  the  same  order  of  things  obtains  wi^ 
regard  to  the  tertiary  stage.  We  have  the  same  gum- 
matous deposit,  the  same  loss  of  tissue  or  ulceration 
brought  about  by  changes  taking  place  in  the  walls  of 
the  vessels  supplying  the  gummata,  and  the  same 
tendency  to  heal  up  under  suitable  remedies.  The  soft 
palate  and  uvula  is  the  most  frequent  seat  in  the 
pharynx  for  gummatous  deposits,  and  it  is  here  that  the 
disease  leaves  the  clearest  traces  of  its  past  existence. 
A  more  or  less  localised  hypersemia  and  swelling  of  the 
part  attacked  is  to  be  first  noticed ;  death  of  tissue  soon 
follows,  and  an  ulcer  forms  which  is  generally  covered 
with  a  tough  yellowish  slough,  the  remains  of  the 
necrosed  tissue.  If  this  slough  be  removed,  the  ulcer 
will  be  seen  to  be  of  a  considerable  depth,  with  under* 
mined  edges,  and  the  mucous  membrane  in  the  vicinity 
of  an  int^sely  red  colour.  The  discharge  which  comes 
away  mingles  with  the  saliva  and  renders  that  secretion 
offensive  and  highly  septic  The  glands  at  the  angle  of 
the  jaw  will,  moreover,  be  increased  in  size. 

If  there  is  a  gumma  at  the  root  of  the  uvula  the 
blood  supply  of  that  appendix  may  become  cut  off,  and 
true  gangrene  of  the  uvula  residts;  this  I  have  seen 
happen  in  a  very  severe  case.  In  other  cases  the  gumma 
is  situated  in  the  substance  of  the  uvula  itself,  and  the 


^t^^t^S^    PHABTOGITI8  AND   LARYNGITIS.  81 


Rmkm,  Aib.  %  laBl. 


olceration  which  follows  results  in  its  complete  dis- 
appearance. The  soft  palate  may  become  perforated, 
and  the  loss  of  tissue  over  the  hard  palate  may  cause 
necrosis  of  the  bone  and  exfoliation. 

Under  treatment  the  healing  process  soon  commences, 
ihe  sloughs  disappear  and  the  ulcers  look  healthier  and 
gradually  diminish  in  size.  Cicatrisation  now  takes 
place,  and  if  the  ulceration  has  been  at  all  severe,  and 
there  has  been  much  loss  of  tissue,  considerable  de- 
formity will  result.  The  first  illustration  was  taken  from 
a  female,  aBt.  52,  admitted  to  hospital  for  severe  syphi- 
litic ulceration  of  the  soft  palate.  Two  perforations  can 
be  seen,  the  uvula  having  entirely  disappeared,  and  on 
the  left  side  a  bridge  'Of  tissue  running  up  from  the 
anterior  pillar  of  the  fauces  stretches  across  one  perfora- 
tion. The  second  illustration  was  taken  from  a  girl  aged 
18  years,  who  acquired  syphilis  at  15  years.  In  this  case 
the  uvula  has  quite,  and  the  velum  almost  entirely 
ulcerated  away,  and  there  is  a  considerable  amount  of 
scarring  of  the  posterior  pharyngeal  wall. 

Tertiary  syphilis  of  the  larynx  may  follow  on  a  case  of 
tertiary  syphilitic  pharyngitis,  but  should  this  be  the  case 
its  ravages  seldom  extend  below  the  epiglottis.  It  occurs, 
as  a  role,  as  a  very  late  manifestation  of  the  disease,  and 
often  not  until  some  10  or  15  years  after  the  primary 
stage.  The  gummatous  deposit  breaks  down  and  a  typi- 
cal syphilitic  ulcer  is  the  result.  These  ulcers  may  be 
pi^esent  in  the  epiglottis — ^which  is  most  commonly  the 
case — on  the  vocal  cords  or  on  the  inter-arytenoid  space. 
When  on  the  epiglottis,  the  ulcer  may  be  very  readily 
Been,  and  its  edges  often  acquire  a  peculiar  mouse-nibbled 
contour,  which  is  very  characteristic.  The  process  of 
cicatrisation  of  these  ulcers  is  often  attended  with  a 
good  deal  of  contraction,  and  this  may  lead  to  stenosis 
of  the  larynx  of  extremely  troublesome  character. 
Bming  the  process  of  ulceration  the  cartilages  of  the 
larynx  may  become  attacked,  and  pieces  may  from  time 
to  time  be  discharged. 

Acute  oedema  may  occur  during  the  progress  of  the 
case,  and  such  an  accident  often  calls  for  the  prompt 
performance  of  tracheotomy. 

The  treatment  of  tertiary  syphilis  is,  as  a  rule,  very 
satisfactory  so  long  as  we  only  have  to  deal  with 
nlceratiouy  but  the  after-effects  produced  by  cicatrisation 


82  PHARYNGITIS   AND   LARYNGITIS.   "^^^^SfSflSl! 

are  always  very  troublesome.  The  ulcerative  process  is 
in  most  cases  entirely  stopped  by  the  internal  adminis* 
tration  of  iodide  of  potash  in  3  to  6  grain  doses. 

Mr.  Jonathan  Hutchinson  has  given  us  a  very  good 
example  of  the  homoeopathicity  of  this  drug  in  Vol. 
No.  1  of  his  admirable  Archives  of  Surgery,  where  a  case 
of  iodide  of  potassium  poisoning  with  the  production  of 
numerous  gummatous  like  growths,  and  which  were 
indeed  mistaken  for  such,  is  well  illustrated.    Should 
the  iodide  fail,   we  fall    back  upon  nitric  acid,   both 
internally  and  as  a  mouth  wash.    Any  good  antiseptic 
mouth  wash  may  be  used — ^preferably  permanganate  of 
potash — and  after  the  sloughs  have  been  removed  the 
ulcers  may  with  advantage  be  painted  with  a  1  per  cent. 
solution  of  iodine  in  glycerine. 

During  'the  ulcerative  stages  of  tertiary  syphilitic 
laryngitis,  the  same  treatment  may  be  adopted,  but 
when  cicatrisation  has  ended  and  stenosis  is  left,  surgical 
treatment  is  necessary. 

Schrotter,  of  Vienna,  in  these  cases  performs  a  pre- 
liminary tracheotomy,  and  by  means  of  hollow  tubes'  of 
gradually  increasing  dimensions,  dilates  the  stricture  by 
passing  the  instruments  from  above.  The  tubes  axe 
retained  in  position  for  from  15  to  80  minutes.  I  have 
seen  two  cases  of  post-diphtheritic  stenosis  in  his  cUnique 
treated  by  this  method  with  very  good  success. 

Whistler  uses  a  dilator  and  knife  combined,  by  which 
the  stricture  is  at  the  same  time  incised  and  dilated,  and 
he  does  not  perform  a  preliminary  tracheotomy.  In 
spite,  however,  of  the  most  painstaking  treatment,  the 
results  are  unfortunately  very  discouraging,  from  the 
very  great  tendency  for  the  stricture  to  become  tight 
again. 

A  deposit  of  tubercle  in  the  larynx  may  take  place 
during  the  course  of  chronic  pulmonary  tuberculosis,  or 
as  post-mortem  examination  has  proved,  without  the 
primary  affections  in  the  lungs. 

The  first  pathognomonic  signs  of  laryngeal  tubercle 
are  often  preceded  by  a  marked  anaemia  of  the  mucous 
membrane.  The  white  cords  do  not  stand  out  with 
their  usual  distinctness  against  the  other  coloured 
portions  of  the  larynx.  Marked  pallor  of  the  mucous 
membrane  is,  then,  always  a  suspicious  sign,  and  more 

lecially  so  if  to  this  be  added  a  certain  amount  of 


i£l£JriS°n8w?**  PHARYNGITIS  AND   LARYNGITIS.  83 

aphonia  and  imperfect  adduction  of  the  vocal  cords. 
These  symptoms  in  delicate  women  with  menstrual 
dislorbance  are  by  no  means  uncommon  precursors  of 
larpgeal  tubercle. 

Swelling  of  the  parts  in  which  the  deposit  of  tubercle 
has  taken  place  is  the  next  change.  This  is  the  first 
characteristic  of  tubercular  disease  of  these  parts.  It 
is  generally  localised  to  one  particular  spot,  especially 
the  inter-arytenoid  space  or  the  coverings  of  the 
arytenoids. 

The  tumefaction  is  due  to  a  tuberculous  infiltration  of 
the  sub-mucous  tissues,  and  is  not  to  be  confounded 
with  the  swelling  due  to  oedema  which  sometimes 
occurs  during  the  course  of  tubercular  laryngitis  owing 
to  perichondritic  changes. 

When  the  deposit  is  over  the  arytenoid  cartilages  the 
swelling  is  very  characteristic,  the  two  pyriform  bodies 
standing  out  prominently,  with  their  larger  ends  meet- 
ing in  the  middle  line  and  the  other  ends  tapering 
outwards.  The  epiglottis  and  the  ary-epiglottic  folds 
may  be  likewise  affected,  and  in  the  sketch  taken  from  a 
patient,  kindly  sent  to  me  by  Dr.  Cooper,  you  will  see  a 
good  example  of  tubercular  infiltration  of  the  right  half 
of  the  epiglottis  and  the  covering  of  the  right  arytenoid 
cartilage.  In  this  case  there  is  considerable  hypersemia 
of  the  affected  areas  which  is  not  usual,  the  colour,  as  a 
rule,  being  described  as  "  muddy  "  or  greyish,  with  a 
few  dilated  vessels  crossing  over  the  swelling.  In  the 
above  case  there  is  also  some  commencing  ulceration  of 
the  inner  edge  of  the  swollen  epiglottis  and  of  the  right 
ventricular  band,  with  hyper»mia  of  the  right  vocal 
cord.  The  patient's  age  is  26,  and  he  has  slight 
evidences  of  phthisis  at  the  right  apex. 

The  swollen  parts  may  attain  an  enormous  size  before 
ulcerating,  but  sooner  or  later  the  mucous  membrane 
gives  way  and  small  ulcers  form,  which  by  confluence 
form  larger  ulcerated  areas. 

About  this  time,  or  even  sooner,  paralysis  of  one  or 
both  cords  may  appear,  and  this  is  due  either  to  direct 
impediment  to  their  movements  ovnng  to  the  swollen 
condition  of  the  parts,  or  to  pressure  on  some  part  of 
the  recurrent  laryngeal  nerve,  the  right  nerve  being 
more  conunonly  involved  than  the  left  owing  to  its 
anatomical  relations. 


84  PHARYNGITIS   AND   LARYNGITIS.    *^52JL^ST2^ 


Beriew,  Feb.  S,  18B1. 


One  meets  occasionally  with  cases  in  which  there  is  no 
marked  swelling  of  the  arytenoids  or  epiglottis,  bat  in 
which  there  are  present  on  the  posterior  wall  of  the 
larynx  some  polypoid  excrescences.  These,  at  first 
sight,  are  apt  to  mislead,  but  careful  examination  will 
probably  prove  them  to  be  the  upper  indurated  border 
of  a  tubercular  ulceration,  which  is  limited  to  that  part, 
the  ulceration  itself  not  beingy  visible,  owing  to  its 
irregular  upper  edge  which,  proj^ting  forward,  appears 
as  the  polypoid  excrescences  and  thus  obstructs  the  view. 
In  process  of  time  the  ulceration  may  be  seen  creeping 
on  to  one  or  the  other  vocal  cord  or  ventricular  band 
and  the  diagnosis  becomes  no  longer  doubtful. 

It  is  necessary  to  say  a  few  words  on  the  subjective 
symptoms  of  this  disease,  as  their  presence  not  only  aids 
us  in  treatment  but  also  in  diagnosis  and  prognosis. 

The  voice  is  usually  early  affected,  becoming  weak  and 
often  quite  aphonic.  In  syphilis  true  aphonia  does 
not  often  occur,  the  voice  being  only  hoarse. 

Respiration  is  not  often  embarrassed,  though  often 
more  frequent  than  natural,  owing  to  the  condition  of 
the  lungfl.  Stenotic  suffocation  is  not  so  common  as 
in  syphilis. 

Cotufh  and  expectorations  are  much  dependent  upon 
the  condition  of  the  lungs ;  and  hcemorrhages^  apart 
from  a  pulmonary  origin,  are  rare,  whereas  in  cancer  and 
syphilis  they  are  fairly  common. 

Pain  is  present  when  there  is  much  cough,  and 
especially  when  the  epiglottis  is  involved,  as  every  par- 
ticle of  food  irritates  the  tender  surface.  Fain  is  a  rare 
symptom  in  syphilis. 

The  prognosis  is  usually  unfavourable,  especially  when 
the  epiglottis  or  pharyngeal  aspect  of  the  larynx  is 
involved,  for,  owing  to  the  painful  deglutition,  sufficient 
nourishment  is  not  easily  taken,  and  the  patient's  end  is 
rapidly  hurried  on  by  starvation. 

When  the  disease  is  confined  to  the  intra-laryngeal 
portion  we  may  have  hopes  of  arresting  its  course. 

In  treatment  the  two  chief  drugs  we  have  to  rely  upon 
are  iodide  of  arsenic  and  iodide  of  mercury.  Dr.Beebe  in  the 
Journal  of  Ophtlialmology,  Otology  and  Laryngology,  for 
October,  1890,  reports  three  cases  of  this  disease  in 
rather  an  advanced  state,  receiving  great  benefit  from 
the  former  drug,  and  fermm  phosph.^  combined  with 


£S?lS!?3w^  PHABYNGITIS  AND   LARYNGITIS.  85 


local  treatment  of  the  ulcerated  areas,  with  20  and 
SO  per  cent,  solutions  of  lactic  acid^  iodoform  powder 
being  afterwards  dusted  on. 

Bichromate,  of  potash  would  be  indicated  when  there  is 
much  ulceration  and  chondritic  change. 

To  relieve  the  cough,  which  is  often  a  very  trouble- 
some symptom,  inhalations  of  conium  are  useful, 
li  Sod<e  carhonatis  exsiccaUe        ...     gr.  xx. 

Aqiue  (140°  F.) fl.  j  xx. 

Solve  et  adde — 

Sued  Conii        ...         ...         ...     fl.  5ii. 

The  vapour  should  be  inhaled  once  or  twice  a  day. 

(The  above  is  from  the  Throat  Hospital  Pharmacopoeia,) 

In  many  cases  codd  in  J  gr.  doses,  with  a  drachm 
of  glycerincy  will  be  found  to  give  great  relief  to  the 
eongb. 

A  twenty  per  cent,  solution  of  lactic  acid  applied  to  the 
nicers  is  a  very  favourite  remedy,  and  in  some  cases  has 
caused  them  to  heal  up  rapidly.  A  form  of  treatment 
which  has  been  lately  advocated,  and  I  myself  can  testify 
to  the  relief  sometimes  given  to  the  patient  from  cough 
and  pain,  is  the  injection  into  the  larynx  of  a  20  per 
eent.  solution  of  menthol  in  olive  oil.  Many  patients 
treated  by  this  method  express  great  relief,  and  often  the 
emaciation  is  arrested  and  weight  regained. 

It  yet  remains  to  be  seen  whether  Dr.  Koch's  method 
of  treatment  is  to  be  relied  upon  in  laryngeal  tubercle. 

Discussion. 

Dr.  Blake  had  pointed  out  fifteen  years  ago  that  follicular 
phaiTngitis  was  often  associated  with  emphysema,  and  tricuspid 
insufficiency.  Dissenting  ministers  were  less  hable  to  it 
than  Church  clergymen.  Mr.  Spurgeon  said  it  was  because 
Dissenters  did  not  intone.  Dr.  Blake  did  not  agree  with  this. 
He  attributed  it  to  the  fact  that  AngHcans  were  often  athletes, 
and  subject  to  emphysema.  Much  more  attention  was  given 
to  the  subject  of  naso-pharyngeal  neoplasms  by  Americans 
than  by  oUiers.  He  mentioned  the  best  instruments  for 
removing  adenoids,  the  most  popular  being  Lowenberg's  for- 
ceps and  Gottstein's  ring-knife.  Dr.  Blake  had  adopted  the 
suigical  treatment  some  years  ago,  and  found  it  much  better 
than  medicinal.  He  noticed  that  laryngeal  symptoms  disap- 
peared when  the  pharynx  was  treated.  Osteo-arthritic  patients, 
especially  pallid  and  anaemic,  were  liable  to  sore  throat. 
They  have  pain  on  swallowing.    It  is  myalgia  of  pharyngeal 


86  PHARYNGITIS   AND    LARYNGITIS.   ^°^*ii!L^ST2^JS*' 


Review,  Feb.  3, 1861. 


muscles,  and  disappears  under  acUm  racemosa.  There  is 
nothing  to  see  on  looking  at  the  pharynx.  He  sterilised  the 
nose  before  examining,  with  a  spray  of  boric  acid  and  cocaine 
(5  per  cent.)  in  camphor  water.  Dr.  Blake  showed  and  illus- 
trated the  use  of  a  new  nasal  sound  he  had  devised.  He  gave 
the  3x  trituration  of  imrc.  cor.  in  secondary  syphilis,  the  first 
centesimal  in  primary  syphilis.  The  80  c.  was  excellent  in 
syphilis  of  the  newly  bom.  He  mentioned  a  case  of  tertiary 
syphilis  of  a  peculiar  kind.  The  wife  of  an  officer  suffered 
from  great  pain  in  left  arm  and  attacks  of  dyspnoaa,  hoarse- 
ness, and  marked  cyanosis.  She  had  been  thought  to  have 
adhesion  of  the  pericardium  to  the  heart.  Mr.  Millican  and 
Dr.  Blake  had  diagnosed  a  gummatous  mass  in  the  mediastinum 
pressing  on  the  phrenic  and  recurrent  laryngeal,  and  this  was 
confirmed  by  a  post  mortem  examination.  In  reference  to 
ioilide  of  poUissium,  he  mentioned  a  case  in  which  cerebral 
syphilis  was  diagnosed,  and  massive  doses  of  iodide  of  potassium 
administered.  The  patient  became  worse  at  once,  developed 
dementia  and  local  dropsies,  and  was  sent  to  an  asylum  where 
he  soon  died.  His  brain  was  found  perfectly  healthy.  There 
was  no  syphilis.  The  patient  died  of  iodide  of  patussium. 
The  case  was  really  one  of  old  sunstroke  occurring  in  a 
guardsman ;  it  had  been  steadily  improving  under  Uwliesis  6, 
when  unfortunately  the  aid  of  a  distinguished  neurologist,  who 
evidently  himself  suffered  from  another  form  of  syphilis  on 
the  brain,  was  sought  with  the  disastrous  result  that  has  been 
described ! 

Dr.  HuoHEs  was  glad  to  see  young  members  taking  up 
specialities,  but  he  hoped  Mr.  Wright  would  not,  in  his  zesu 
for  surgical  measures,  forget  the  better  way.  There  was  a 
danger  lest  the  enthusiasm  for  the  one  should  swallow  up 
something  better.  The  two  were  not  incompatible,  but  the 
methods  were  very  different.  The  old  school  method  was 
analytic;  the  homoeopathic  was  synthetic.  We  do  hear  of 
morbid  growths  melting  away  under  drugs.  Our  first 
enthusiasm  should  be  reserved  for  the  homoeopathic  treatment. 
We  must  go  to  our  Materia  Medica — work  that  thoroughly 
before  going  to  the  other. 

Dr.  Clabks  was  much  interested  in  Mr.  Wright's  excellent 
paper,  and  he  was  glad  to  find  he  was  devoting  himself 
to  this  special  study,  In  his  own  experience  in  the  treatment 
of  chronic  pharyngitis  he  had  not  found  local  applications 
necessary.  In  one  case,  in  which  the  catarrh  had  ksted  for 
years,  tne  patient  having  to  clear  away  a  greenish-yellow 
leathery  secretion  several  times  a  day,  miplmr,  bfcopodiuni, 
arrfentum  nitricumf  and  cisttis,  given  according  to  the  patient's 
symptoms,  general  and  local,  entirely  relieved  the  condition. 


iSSSfpSrSi?*''  PHABYNGITIS   AND   LABYNOITIS.  87 

Cistus  was  given  becanse  the  patient  complained  of  a  "  spongy  " 
feeling  in  the  throat,  cistus  producing  a  feeling  of  softness.  The 
relief  was  immediate.  The  patient  also  suffered  from  granular 
inflammation  of  the  eyelids,  and  every  night  she  used  to 
bathe  the  eyes  with  a  zinc  lotion  in  order  to  get  rehef  .  This 
condition  was  entirely  removed  at  the  same  time  as  the  throat 
symptoms.  In  reference  to  "  antiseptic  washes "  recom- 
mended for  the  mouth  and  throat  by  Mr.  Wright,  he  would 
ranind  him  that  the  mouth  absorbed  very  rapidly,  and 
everything  applied  locally  to  the  mouth  was  at  once  absorbed 
into  the  system.  He  had  seen  a  case  of  severe  poisoning  by 
brnix  used  for  a  long  time  as  a  mouth-wash  for  a  child.  There 
was  ulceration  outside  the  mouth  as  well  as  inside,  and  the 
characteristics  of  borax,  '*  aggravated  by  downward  motion," 
was  most  marked.  The  child  screamed  whenever  the  nurse 
attempted  to  put  it  down.  He  thoroughly  endorsed  Dr. 
Hnghes'  remarks  that  our  Materia  Medica  should  be  our  first 
enthusiasm.  Homoeopaths  should  be  fully  abreast  of  the 
allopaths  in  all  surgical  methods,  but  they  should  be  homceo- 
paths  first  and  surgeons  afterwards. 

Mr.  Knox  Shaw  thought  Mr.  Wright's  paper  an  excellent 
combination  of  modem  surgery,  with  bunts  for  the  best 
medicinal  treatment.  There  were,  however,  some  remedies  he 
bad  not  mentioned.  Hydrastis  was  one.  Chronic  post-nasal 
catarrh  he  had  seen  relieved  by  this,  and  the  local  application 
dhfdraais  with  glycerine  was  of  great  service.  He  had  found 
edcarea  phos,  very  useful  in  adenoid  disease.  Some  patients, 
on  whom  it  had  not  been  convenient  to  operate  at  the  time, 
materially  improved  under  calcarea  phos.  But  he  thought 
operation  should  not  be  delayed  too  long.  A  vapour  of 
ehloride  of  ammoninm  had  been  useful,  applied  to  the  nose  and 
pharynx.  With  many  a  patient  with  chronic  hoarseness, 
improvement,  would  not  take  place  till  the  pharynx  was  seen 
to.  JVttric  acul  Ix  was  useful  in  syphilitic  ulceration,  as  well 
as  mercury.  He  had  long  considered  what  was  the  relation 
between  iodide  of  potash  and  tertiary  syphilis.  Mr.  Wright 
had  asserted,  on  Mr.  Hutchinson's  case,  that  it  was  a  homoeo- 
pathic relation,  and  if  so,  this  cleared  away  a  difficulty. 
Mr.  Hutchinson  had  given  good  illustration  of  homoeopathic 
action  in  showing  the  power  of  arsenic  to  cause  cancer,  which, 
tt  homoeopaths  biew,  it  had  also  cured. 

Dr.  Mom  said  if  homoeopathy  is  to  make  progress,  homoeo- 
paths must  be  on  a  level  with  the  men  of  the  old  school  who 
^u:e  domg  good  work  in  special  diseases,  and  of  this  homoeopaths 
0Q|^  to  avail  tiiemselves. 

Dr.  Dm)OEOK  (in  the  chair)  said  his  own  experience  did  not 
giTohim  mudi  information  about  the  smrgicai  diseases  of  the 


S8  NOTES   ON   0IPHTHKRIA.  ""tSSJflSfjMS! 

throat.  He  had  found  all  those  Mr.  Wright  meationed  weie 
fairly  amenahle  to  homoBopathic  remedies.  He  had  had 
several  cases  of  the  glazed  pharynx  so  &r  improved  that  all 
the  discomfort  had  heen  taken  away  by  a  long  course  of 
homoeopathic  remedies.  He  considered  the  use  of  iodide  of 
jwtfi^ium  in  tertiary  syphilis  was  hom<B'>pathic,  but  it  did  not 
do  very  well  in  mfinitesimal  quantities.  In  one  case  of 
ulceration  of  the  pharynx  healing  took  place  under  five  grain 
doses  very  rapidly.  Another  case  of  chronic  affection  of 
tonsils  in  a  lady  of  50,  phtftoUicca  cured  rapidly,  though  befdte 
taking  it  she  never  could  experience  cold  or  damp  weather 
without  the  greatest  inconvenience.  Such  cases  made  him 
less  anxious  to  resort  to  surgical  measures.  Medicines  had 
this  advantage,  that  if  successful  they  remove  tendencies  which 
surgical  measures  do  not  do. 

Mr.  Enox  Shaw  said  he  had  omitted  to  mention  one  point — 
the  intense  difficulty  of  swallowing  in  patients  suffering  from 
laryngeal  phthisis.  He  referred  to  a  method  of  feeding  these 
patients  which  has  been  of  great  service  to  many.  They 
should  lie  on  a  sofa  the  face  down  with  the  head  hanging 
over  and  turned  to  one  side,  the  food  (being  liquid)  is  sudced 
up  and  passes  along  the  back  of  the  pharynx  and  by  the  side 
of  the  epiglottis. 

Mr.  Wbight  (in  reply)  thanked  the  members  for  the  manner 
in  which  the  paper  was  received.  The  glazed  pharynx  was 
not  amenable  to  surgical  means.  It  was  only  by  getting 
drugs  strictly  homoeopathic  that  any  impression  can  be  made 
on  it.  He  did  not  think  the  laryngeal  affection  was  always 
reflex  as  Dr.  Blake  suggested ;  it  might  be  by  extension  of 
the  diseased  action,  or  from  the  cold  air  breathed  through  the 
mouth,  the  nose  being  stopped.  Cocaine  should  be  avoided 
as  an  application  to  relieve  the  pain  in  tubercular  laryngitis ; 
and  for  anaesthetic  purposes  it  was  better  used  on  a  plug  of 
cotton  wool  than  as  a  spray. 

NOTES    ON    DIPHTHERIA,  WITH    CASES. 
By  J.  BoBERsoN  Day,  M.D.  Lend. 

Assistant  Physician  and  Anesthetist  to  the  London  Homoeopatfaio  Hos* 
pital;  Visiting  Physician  to  Margaret  Street  Infirmary  for  Ckinsmnption. 

Perhaps  there  is  no  disease  which  is  more  interesting 
to  the  physician  than  diphtheria.  The  subtle  way  in 
which  it  often  appears ;  the  great  difficulty  there  must 
always  be  in  a  certain  number  of  cases,  where  there  are 
no  pronounced  symptoms  or  lesions,  in  distinguishing  it 


SSSUfjSTSfi!**  N0TB8  ON   DIPHTHERU.  89 

from  a  siinple  case  of  tonsinitifl ;  the  uncertainty  of  the 
coarse  it  rons — at  one  time  lining  the  fauces  and 
nasal  passages  with  false  membrane,  and  speedily 
cansmg  death  from  exhaustion  or  by  asphyxia,  at 
another  time  the  local  lesions  being  so  slight  as  to  be 
unrecognised,  but  the  subsequent  paralysis  so  marked 
and  grave  as  to  lead  to  death — ^all  these  points  will  ever 
lead  the  cautious  physician  to  give  a  guarded  diagnosis, 
and  when  there  is  no  doubt  as  to  the  nature  of  the 
disease,  a  cautious  prognosis,  even  in  the  cases  appa* 
rently  most  simple. 

Li  many  points  diphtheria  is  comparable  to  enterio 
fever,  in  the  way  in  which  it  is  conveyed  by  contaminated 
milk  or  water  or  by  bad  drains ;  the  way  in  which  both, 
though  contagious  diseases,  can  be  safely  nursed  in  the 
general  wards  of  a  hospital,  provided  sufficient  air  be 
allowed  ;  and  lastly  the  uncertainty  of  the  course  which 
each  win  run,  death  threatening  in  so  many  ways. 

The  following  cases  show  in  a  remarkable  way  this, 
eccentric  nature  of  the  disease  : — 

Alice  P.,  aged  5;  father  a  cab-driver.  Mother  brought- 
her  to  the  Kentish  Town  Medical  Mission  on  Sept.  19th, 
1889,  saying  she  had  fits,  and  turned  black  in  the  face, 
and  foamed  at  the  mouth.  The  attack  first  came  on 
four  days  ago,  on  Sunday,  when  she  had  two  fits,  and 
was  insensible  till  mid-day  on  Monday.  On  looking  into 
mouth,  throat  was  seen  to  be  ulcerated.  Merc.  soL,  1 
gr.  j.,  3  h. 

Sept.  26. — Throat  much  better,  repeat. 

Oct.  2. — Paralysis  of  soft  palate,  and  fluids  regurgitate 
through  the  nose.    China  ^  gtt.  ij  ter. 

Oct.  10.— Repeat. 

Oct.  17. — Nasal  twang  when  she  speaks  very  marked, 
and  fluids  still  return  through  the  nose.  The  knee 
jerks  are  absent.  Very  weak  and  shaky  on  her  legs* 
Mother  notices  she  holds  books  nearer  her  eyes  than 
before.  Has  some  bronchial  rales  in  chest.  Ipecac. 
Ix  gtt.  j.  8  hr,  OL  Morrh.  5  j.  bis.  die. 

Oct.  28. — Paralysis  in  legs  increasing.  Admitted  into 
the  London  Homoeopathic  Hospital  under  the  care  of 
Dr.  GaUey  Blackley,  to  whose  courtesy  I  am  indebted 
for  permission  to  publish  the  following  notes. 

Family  and  personal  history. — ^Had  measles  and  whoop* 
ing  cough,  never  had  chicken  pox.    Father  alive  and 

Vd.  J6,  No.  2.  H 


90  NOTES   ON   DIPHTHERIA.   ^"^^^^^^S^^^. 

healthy.  Mother  suffers  from  a  tumour  in  her  throat, 
and  underwent  five  operations  for  it.  Seven  brothers, 
all  healthy  now,  but  some  had  diphtheria. 

Present  iUness  came  on  about  one  week  ago.  Mother 
noticed  that  there  was  weakness  of  both  legs,  so  that  the 
patient  could  not  walk  about.  Had  a  cough  about  three 
weeks  ago,  which  has  continued  up  to  the  present  time. 
The  inability  to  swallow  has  been  present  about  a 
fortnight.  Everything  she  takes  (liquid)  comes  through 
the  nose.  Never  complained  of  the  eye-sight  being 
affected. 

On  admusion. — ^Eather  pale,  unheathy-looking  child. 
P.  144,  regular  in  force  but  not  in  rhythm.  Slight  weak- 
ness of  legs.  Knee  jerk  absent.  Plantar  reflexes 
diminished,  especially  on  the  left  side.  Neck  muscles 
seem  very  weak.  No  apparent  weakness  of  arms.  The 
soft  palate  does  not  move,  but  there  is  no  irregularity  of 
the  sides.    Tonsils  large.    Tongue  whitish  grey  fur. 

Lungs. — Slight  dulness  of  the  left  apex  in  front  and 
weak  breathing,  with  some  coarse  bubbling  and 
crepitant  rales.  There  are  some  coarse  crepitant  rales 
at  the  left  base,  but  elsewhere  only  sonorous  rales. 

Heart  appears  to  be  normal ;  sounds  good.  Pupils 
react  well  to  accommodation  and  to  light. 

Oct.  24. — T.  98.2  last  night ;  97.6  this  morning,  and 
slight  difficulty  in  swallowing,  but  fluids  do  not  regurgi- 
tate. Abdominal  respiration  is  less  than  normal.  The 
pectorals  and  trapezius  respond  well  to  stimulation ;  the 
serratus  magnus  and  obUqui  do  not.  Gelsem,  Ix  gtt.  j, 
4  tis  horis.    Milk  diet. 

Oct.  25. — Temp,  normal  last  night.  99.2  this  morn- 
ing. Coughs  a  great  deal.  Large  quantity  of  mucus 
rattling  in  throat.  Breathing  a  great  deal  by  the  extra- 
ordinary muscles  of  respiration.  Diaphragm  appears  to 
be  acting  badly.  During  the  night  patient  seemed  to  be 
collapsed  and  became  blue  in  the  face  in  patches.  Steam 
kettle  was  put  on  and  patient  appeared  to  rally.  This 
morning  she  is  a  little  easier  and  lies  on  the  left  side. 
Bell.  <l>  gtt.  ij,  2  hrs.  About  1  p.m.  patient  became  col- 
lapsed again,  the  face  becoming  blue  in  patches  and 
breathing  weak.  She  became  progressively  weaker. 
Given  food  by  enemata  of  about  a  teacupful  every  second 
hour  of  milk  and  egg  and  two  tea-spoonfuls  of  brandy. 
At  3  p.m.  the  child  was  evidently  dying.  Pulse  was  184, 


£riS^^^§^  NOTES   OP   DIPHTHERIA.  91 

Tery  fluttering,  and  respirations  60.  Digitalin  j^  gr. 
was  given  hypodermically,  but  its  good  effects  in  making 
the  pulse  stronger  and  more  regular  only  lasted  half-an- 
hour.  The  blueness  passed  off  shortly  before  it  was 
given,  and  did  not  return.  The  child  died  in  spite  of  all 
treatment  at  about  6.80  p.m. 

Post  Mori.  Exam. — About  22  hours  after  death ;  post 
mortem  rigidity  fairly  marked.  Tonsils,  pharynx  and 
larynx  appeared  to  be  normal.  There  was  sUght 
tracheitis  and  the  tubes  contained  a  large  quantity  of 
clear  mucus. 

Lungs, — Emphysematous  in  parts.  No  collapse. 
Crepitant  all  over.  No  pneumonic  consolidation.  There 
was  some  bronchitis  of  the  larger  tubes,  but  the  capillary 
tabes  were  free,  and  were  not  clogged  up  with  purulent 
or  mucoid  material.  There  was  no  pleurisy  and  no 
adhesions.    No  fluid  in  pleural  cavity. 

Heart, — Bight  auricle,  some  loose  red  clots  in  it. 
Bight  ventricle  flaccid  and  empty.  Left  auricle  full  of 
wiute  non-adherent  blood  clots.  Left  ventricle  very 
firmly  contracted  and  empty.  About  1  drachm  of  fluid 
in  the  pericardial  sac.  All  the  valves  appeared  healthy 
with  the  exception  of  the  aortic,  which  was  redder  than 
natural.    The  heart  muscle  appeared  normal. 

Liver,  spleen  and  kidneys  normal.  Bladder  full  of 
pale  urine.  Brain  and  cord  not  examined.  The  blood 
in  the  veins  was  fluid  and  dark  coloured. 

Percy  P.,  aged  3,  was  first  brought  to  me  on  October 
10, 1889.  He  is  brother  to  the  above  patient,  and  has 
had  a  similar  throat  and  coughed  ''  like  a  dog,"  and  his 
grandmother  said  it  "sounded  like  croup."  Nothing 
can  be  seen  now  in  the  throat,  but  from  the  history  con- 
dude  that  he  has  had  a  mild  attack  of  diphtheria,  so  gave 
him  mere,  soL  1,  gr.  j,  8  h. 

Oct.  17. — Tonsils  not  enlarged.  Knee  jerk  almost 
absent.  Nothing  the  matter  with  his  general  health. 
Eats  and  drinks  anything  well.    Bepeat  mere.  soL 

Oct.  28. — Knee  jerk  present  to-day  on  both  sides ; 
mother  said  his  breath  still  smells,  as  when  he  was  first 
attacked,  and  sometimes  he  cannot  swallow.  The  glands 
at  the  angle  of  the  jaw  on  the  left  side  are  increased. 
Bepet.,  ter  die. 

Oct.  81. — Slight  bronchial  catarrh.  01.  morrhiue,  5j. 
bis  die  p.c.  and  ipecac.,  Ix  gtt.  j,  3  hrs. 

H— 2 


92  NOTES   ON   DIPHTHERIA.    ^f^fiTSwM! 

Nov.  7. — Much  better.    Bepeat. 

Dec.  12.— Quite  well.    Knee  jerks  present. 

William  P.,  aged  9  ;  another  brother;  brought  to  me 
Oct.  17,  1889.  Throat  bad  four  days  ago.  Now  the 
tonsils  are  enlarged.  No  false  membrane.  Glands  at 
the  angle  of  the  jaw  on  the  left  side  are  enlarged.  Both 
knee  jerks  are  absent,    mere.  sol.  1,  gr.  j.  ter  die. 

Oct.  24. — Sjiee  jerks  still  absent ;  throat  nil.    Bepeat. 

Oct.  81. — Knee  jerks  still  absent,  but  he  is  much 
better.     01.  morrh.  5ij.  bis  die. 

Nov.  7. — ^Knee  jerks  returning  faintly.    Bepeat  ol.  rn. 

Dec.  12. — ^Both  knee  jerks  present.    Quite  well. 

Charles  P — ,  aged  12 ;  another  brother.  His  mother 
asked  me  to  see  him,  saying  he  was  going  weak 
in  his  legs,  like  his  sister  Alice  did.  I  went  to  see  him 
and  found  the  left  leg  rotated  inwards,  with,  apparently, 
no  power  to  rotate  it  out.  There  was  no  pain  in  move- 
ment in  hip-joint  or  elsewhere.  It  seemed  to  be  due  to 
a  localised  paralysis  of  the  external  rotators  of  the 
femur.  Bemembering  the  family  history,  I  suspected  it 
was  another  case  of  post-diphtheric  paralysis,  so  at  once 
admitted  him  to  the  London  Homoeopathic  Hospital 
under  Dr.  Galley  Blackley. 

The  following  notes  were  made  by  the  house  surgeon^ 
Mr.  Cox : — 

Patient  admitted  for  persistent  rotation  inwards  of  the 
left  leg  and  foot. 

Previous  health. — ^Had  measles  when  an  infant.  Has 
always  been  pretty  strong  up  to  present  time;  could 
always  walk  well,  and  legs  were  quite  straight. 

Present  illness. — This  boy  seemed  to  escape  the  attack 
of  diphtheria  which  affected  the  other  children.  About 
the  second  week  in  April  he  was  walking  with  his  grand- 
mother when  she  noticed  his  foot  seemed  to  turn  inwards, 
and  he  began  to  drag  it.  Once  or  twice  he  said  it  ached, 
and  caused  him  to  cry,  but  he  did  not  seem  to  have 
much  pain.  There  was  never  any  difference  noticed  in 
the  temperature  of  the  two  limbs.  The  leg  seemed  to 
get  weaker.  He  was  taken  to  Dr.  Day  about  a  week 
ago,  and  he  was  sent  in  here  on  May  17.  He  has 
always  taken  food  well.  Bowels  regular.  Has  lost  flesh 
a  little  lately;  no  difficulty  in  swallowing;  no  other 
symptoms  noticed  by  the  mother. 


SS^'p^^a*^*  NOTES   ON   DIPHTHERIA.  93 


Benew,  Feb.  2, 1891. 


On  admission. — Fairly  healthy  boy,  fair  complexion. 
Heart  normal ;  area  of  the  liver,  apex  beat  4th  space 
^  in.  internal  to  nipple ;  lungs  quite  healthy ;  tongue 
fairly  clean. 

There  is  marked  inversion  of  the  left  leg,  so  that  the 
toes  of  the  left  foot  point  to  the  right  side.  There 
appears  to  be  no  wasting  of  the  limb  muscles,  and  not 
any  coldness  of  the  limbs  ;  knee  jerks  normal ;  no  ankle 
donas ;  pupils  re-act  perfectly  to  light  and  to  accommo- 
dation. 

Fau<;es  examined. — Granular  condition  of  fauces,  but 
no  paresis  of  palate  muscles.  Sleeps  well.  BowcIb 
acted  once,  greenish,  relaxed  stool. 

May  19. — To-day  the  leg  has  got  back  to  its  normal 
position  and  the  patient  walks  about  quite  well. 
May  22.— Still  quite  well. 

Remarks. — There  are  many  interesting  features  in  the 
above  cases.  The  disease  was  so  slight  in  Alice  P.  as  to 
be  at  first  unrecognised,  until  the  palate  became 
paralysed ;  then  followed  paralytic  symptoms  of  undue 
gravity  out  of  all  proportion  to  the  primary  attack,  and 
«nhninating  in  death  by  syncope. 

Percy  and  Wm.  P.  had  the  disease  so  slightly,  that 
but  for  the  sister's  attack  it  might  readily  have  been  over- 
looked altogether.  These  two  boys  had  the  knee  jerk 
first  diminished,  then  absent,  and  this  in  doubtful  cases 
is  likely  to  be  a  symptom  of  great  value  as  regards  a 
correct  diagnosis. 

It  is  to  be  regretted  that  no  examination  of  the  urine 
^as  made. 

The  last  case  of  Chas.  P.,  although  it  at  first  simulated 
post-diphtheritic  paralysis,  especially  happening  in  a 
&mily  where  there  had  been  diphtheria,  was  evidently  a 
ease  of  neuromimesis,  which  although  more  common  in 
girls  about  this  age  is  not  unknown  in  boys.  I  subse- 
quently learned  that  he  had  been  previously  admitted 
into  the  North  West  London  Hospital  for  the  same  com- 
plaint, and  in  a  short  time  discharged  quite  weU  and 
walking  properly ;  this  relapse  is  again  strong  evidence  of 
its  hysteroid  nature. 

The  following  case  from  the  Brit.  Med.  Joum.,  read  in 
connection  with  the  foregoing,  is  instructive. 

A.  B.,  8Bt«  41,  had  been  engaged  uninterruptedly  as 
charge-nurse  in  diphtheria  wards  for  eighteen  months. 


94  NOTES   ON   DIPHTHEBIA.   ^arfj^^gtSJ! 

March  81,  noticed  to  have  paroxysmal  convergent  stra- 
bismus of  both  eyes.  Advised  to  go  off  duty,  but  refused 
to.  Paroxysms  increased,  and  then  lost  power  over 
hands,  and  at  same  time  slight  anaesthesia  of  palate. 
Throat  quite  clear,  and  urine  had  a  heavy  trace  of 
albumen.  Patient  warded  on  16th,  as  squinting  increased 
and  legs  began  to  drag. 

Being  pressed,  she  acknowledged  having  had  sore 
throat  six  weeks  before,  but  considered  it  only  a  simple 
sore  throat.  Also  confessed  she  had  seen  two  very 
minute  patches,  one  on  each  tonsil.  At  same  time 
there  had  been  headache,  shivering  and  vomiting,  but 
she  did  not  complain,  and  continued  her  ward  work. 

March  19.— HyperaBsthesia  of  forearms ;  urine  small 
in  quantity,  contained  more  albumen.  Two  days  later, 
numbness  in  legs  and  a  feeling  "  as  if  wool  were  between 
the  fingers  and  palms  of  hands."  Loss  of  power  in  legs 
and  arms  more  and  more  marked,  and  on  24th  complete 
loss  of  sensation  in  lower  limbs  and  partial  in  arms. 

Pupils  much  contracted  and  power  of  accommodation 
greatly  impaired.  Knee  reflexes  absent.  Temp,  persis- 
tently subnormal,  95.4°  to  98°,  average  96.8°.  Pulse 
kept  very  smaU.  Several  attacks  of  syncope.  Patient 
had  bad  nights  and  slept  little.  Motor  paralysis  became 
extreme,  and  on  March  25  galvanism  commenced.  By 
80th  motor  power  improved,  but  ansBsthesia  persisted. 
Urine  now  free  from  albumen.  April  6th,  reaction  of 
pupils  began  to  improve,  and  on  12th  squint  practically 
disappeared.  Still  absolute  anaesthesia  of  arms.  On 
20th,  able  to  sit  up,  but  could  not  stand.  Vision,  which 
had  been  again  much  impaired  for  some  days,  began  to 
improve.  On  25th,  knee  jerk  normal  and  patient  could 
read  for  a  short  time,  after  which  letters  ran  together. 
She  was  still  unable  to  stand.  On  30th,  could  take  a 
step  or  two  with  assistance,  and  May  7,  with  cruches, 
could  walk  some  yards.  Sight  not  clear.  Sensation 
almost  normal  over  body.  From  this  date  she  rapidly 
improved,  left  leg  dragging  a  little  when  she  left  for 
sea-side.  May  21. 

Treatment  consisted  in  free  stimulation,  owing  to 
threatened  cardiac  failure  and  administration  of  iron 
and  quinine. 

Nttherhall  Gardens,  Hampstead. 


U^J^nX^  CROUPOUS   PNEUMONIA.  95 

CROUPOUS    PNEUMONIA. 

By  S.  MoBBissoN,  M.D. 

Thib  form  of  inflammation  of  the  Imigs  is  one  of  the 
diseases  which  has  been  better  defined  and  better  ander- 
stood  of  recent  years.  In  severe  cases  the  cough,  fever- 
ishness,  debilitating  perspirations  and  emaciation  bear 
such  a  strong  resemblance  to  phthisis  puhnonalis  that 
the  detection  of  the  micrococcus  of  pneumonia,  the 
absence  of  the  tubercle  bacillus,  or  the  want  of  evidence 
of  the  deposit  of  tubercle  form  the  chief  distinguishing 
eharactenstics.  We  have  long  known  that  catarrhal 
pneumonia  is  a  frequent  precursor  of  phthisis,  but  the 
liability  of  croupous  pneumonia  to  run  into  the  more 
&tal  disease  has  been  less  generally  recognised. 

For  pathological  purposes  it  is  convenient  to  divide 
the  course  of  this  disease  into  three  stages, — 

1.  Invasion, 

2.  Hepatization, 
8.    Degeneration. 

Invasion  is  commonly  ushered  in  by  symptoms  of  a 
severe  chill,  as  with  the  catarrhal  form.  Inflammatory 
action  leads  to  an  engorgement  of  lung  structure.  This 
usually  occurs  in  a  portion  of  one  lung  only,  the  right 
long  being  more  frequently  attacked  than  the  left,  and 
the  lower  lobe  in  preference  to  the  upper.  Herein  it  is 
the  opposite  of  primary  phthisis.  But  the  exceptions 
are  numerous.  This  is  the  stage  of  engorgement,  with 
rapid  infiltration,  the  portion  of  lung  affected  becoming 
consolidated,  losing  elasticity,  and  giving  a  dull  sound 
on  percussion.  To  a  quick  pulse  and  high  fever  temper- 
ature are  added  a  distressing  cough,  with  panting  respira- 
tion, fever  blisters  on  the  lips  and  crepitation.  The 
presence  of  these  fever  blisters,  the  absence  of  abdominal 
symptoms,  and  the  physical  signs  distinguish  it  from 
typhoid  fever ;  though  the  more  grave  form  is  often  called 
^hoid  pneumonia.  As  mischief  progresses  the  second 
stage  develops,  that  of 

Hepatization. — Infiltration  having  become  more  or 
less  complete  sero- plastic  exudations  form  in  the  air 
cells,  and  in  the  meshes  of  these  exudations  are  numer- 
ous red  and  white  blood  corpuscles,  the  presence  of  the 
former  being  due  to  the  rupture  of  capillary  vessels. 
The  structures  involved  became  darker,  heavier,  less 


96  CROUPOUS  PNEUMONU.  "S,fF*??Ww! 

crepitant  and  friable,  and  the  expectoration  has  the 
chcuracteristic  rust  colour.  No  doubt  the  expression 
hepatized  originated  from  the  liver-like  appearance  of 
the  affected  lung  structure.  But  this  stage  is  completed 
by  the  fibrinous  material  and  the  red  corpuscles  being 
replaced  by  embryonic  and  epithelial  cells,  the  products 
of  emigration  and  local  proliferation.  Some  authors 
divide  this  process  into  two  stages,  that  of  red  and  grey 
hepatization,  an  unnecessary  sub-division,  as  the  grey 
form  is  merely  the  commencement  of  the  degenerative 
process.  Passing  on  to  the  third  stage,  it  has  been 
found  that  these  more  recent  elements  undergo  fatty 
transformation,  and  this  constitutes  actual 

Degeneration. — The  broken  down  products  are  either 
expectorated,  absorbed,  or  form  an  abscess.  Expectora- 
tion becomes  pus-like,  and  should  an  abscess  form  it 
may  become  putrid,  sometimes  with  gangrenous  exhala- 
tions. These  three  processes  may  run  their  course  con- 
currently, even  in  the  one  lung.  While  one  patch  or  a 
section  of  one  patch  is  undergoing  hepatization  or 
degeneration  an  adjacent  patch  or  section  of  a  patch 
may  be  commencing  the  inflammatory^  process  of  invasion. 
Another  important  factor  is  the  frequency  with  which 
metastasis  occurs.  I  have  had  under  my  care  a  young 
married  lady  in  whom  the  disease  came  on  insidiously. 
It  was  three  weeks  after  the  chill  when  I  was  called  in. 
Hepatization  existed  over  the  lower  lobe  of  the  right 
lung,  cough  was  persistent  and  distressing,  with  semi- 
purulent  expectoration,  soreness  over  the  affected  portion, 
evening  exacerbations  of  feverishness,  hydrose  on  the 
lips,  and  debihtating  night  perspirations.  Although  the 
symptoms  were  grave  for  another  four  weeks,  the  pulse 
did  not  exceed  88  (except  during  attacks  of  palpitation) , 
nor  did  the  temperature  rise  beyond  88°  C.  (100.4  F.) . 
The  family  history  is  phthisical.  Three  weeks  after 
commencing  treatment  an  ague  fit  occurred.  Similar 
attacks  recurred,  of  the  tertian  type,  and  enquiry  elicited 
that  she  had  a  series  of  attacks  some  eight  years 
previously,  when  living  in  Pimlico.  Arsen.  8,  followed 
by  sidphur  80,  relieved  her  of  this  unwelcome  complica- 
tion. Prior  to  these  attacks  of  ague  the  pulmonary 
congestion  transferred  itself  from  the  lower  lobe  of  the 
right  lung  to  the  lower  lobe  of  the  left.  Subsequently 
it  was  transferred  to  the  left  subscapular  region,  from 


SS!Jf^°!?w^  CROUPOUS   PNEUMONIA. 


97 


thence  it  again  invaded  the  lower  lobe  of  the  left  lung, 
then  it  again  took  up  a  temporary  residence  in  its  old 
quarters  at  the  base  of  the  right  long,  then  in  the 
upper  lobe  of  the  left  long,  and  so  on.  Lycopodium  12 
and  80y  sulphur  80,  aconite  8  and  80,  spongia  1,  bryonia  8 
and  matrix  tincturcy  and  quassine  in  centigramme  granules 
helped  her,  but  the  chief  honors  of  the  second  stage 
belonged  to  lycopodium  and  sulphur. 

Other  names  for  this  disease  are  fibrinous  and  lobar 
pneumonia,  which  are  pathologically  more  accurate  than 
the  fanciful  designation  of  croupous.  Both  this  and  the 
catarrhal  form  are  popularly  known  as  lung  fever.  Here, 
again,  is  an  imaginary  distinction,  in  that  simple 
congestive  pneumonia  should  be  termed  catarrhal,  as 
opposed  to  the  localized  form.  Both  are  catarrhal,  but 
croupous  pneumonia  is  more  common  in  the  adult, 
catarrhal  in  infancy  and  old  age.  Localized  pleurisy  is 
almost  certain  to  accompany  a  severe  attack,  and  rheu- 
matic achings  in  the  limbs  are  common.  Where  further 
lung  mischief  threatens  the  rust-coloured  expectoration, 
due  to  the  presence  of  blood  from  the  digested  portions, 
may  be  replaced  by  the  admixture  of  bright  blood  from 
freshly-ruptured  capillaries,  with  the  lumpy  or  tenacious 
mucus,  which  is  an  indication  for  the  consideration  of 
hyoscyamusy  in  medium  or  high  potencies 

DuoNosis  is  important,  because  of  the  future  liabilities. 
In  the  catarrhal  form  where  fatal  results  occur  the 
patients  die  from  the  mechanical  effects  of  the  congestion. 
One  lung,  or  both  lungs,  may  become  so  completely 
occluded  that  an  efficient  aeration  of  the  blood  is  rendered 
impossible,  and  the  patient  dies  asphyxiated.  In  the 
croupous  variety  death  is  more  frequently  due  to  a  failure 
of  vital  power,  consequent  on  the  exhausting  nature  of 
the  disease.  Supposing  a  case  of  the  catarrhal  and  of 
the  croupous  kind  well  marked,  the  one  usually  occurs 
in  childhood  or  old  age,  is  more  or  less  associated  with 
bronchitis,  and  the  fever  runs  a  sthenic  course ;  the 
other  occxurs  in  adult  life,  is  associated  with  pleurisy, 
and  the  sthenic  febrile  symptoms  of  the  early  stage  give 
place  to  the  asthenic  symptoms  of  a  debilitated  constitu- 
tion. Catarrhal  pneumonia  runs  a  fairly  straightforward, 
though  dangerous,  course  ;  but  the  croupous  form  is 
uncertain  and  treacherous,  both  as  to  relapses  and  dura- 
tion.   The  usual  time  for  a  single  acute  attack  to  last  is 


98  CROUPOUS   PNEUMONIA.   ^nSSr^iSf^Ww! 


from  14  to  25  days,  but  the  chronic  form,  igrhich  meajis 
a  saccesBion  of  inTasions  mth  only  partial  recoveries 
between,  may  continue  for  months  or  years. 

In  the  early  stage  of  a  severe  onslaught  the  evening 
temperature  may  reach  40°  C.  to  40.56°  C.  (104°  F-  to 
105^  F.),  with  a  morning  faU  of  0.5  C.  (0.9  F.)  to  1.90  C- 
(2.7  F.) ;  a  pulse  of  100  to  110,  and  respirations  of  40  to 
50  (Baue) — as  a  rule  the  pulse  rate  is  below  that  of  the 
respiration.  MobiUty  of  the  chest  walls  is  decreased, 
vocal  fremitus  is  increased,  and  crepitation  becomes 
well  marked.  The  cough  is  frequent  and  distressing. 
The  frothy  mucus  is  soon  replaced  by  the  rust- 
coloured  expectoration.  This  stage  usually  lasts  from 
two  to  five  days,  and  is  characterised  by  the  concurrence 
of  high  febrile  symptoms,  with  dulness  and  crepitation. 

The  second  stage  shows  increased  dulness,  broncho- 
phony and  pectoriloquy  are  heard,  and  the  soreness  of 
congestion  becomes  complicated  by  pleuritic  pains.  The 
cough  becomes  deeper,  is  more  paroxysmal,  and  recura 
at  longer  intervals ;  while  the  lumpy  expectoration 
assumes  a  lighter  colour,  and  may  be  tinged  with  arterial 
spots  or  streaks.  This  stage  continues  from  five  to 
eight  days. 

After  this  comes  the  third  stage,  in  which  degenera- 
tion leads  to  the  expectoration  of  broken  down  material, 
and  to  resolution  and  recovery ;  or  to  the  formation  of 
an  abscess,  possibly  with  gangrene ;  or  to  tubercular 
infiltration,  with  the  usual  consumptive  symptoms ;  or 
to  death  from  exhaustion.  The  pulse  and  temperature 
fall  rapidly,  and  where  the  result  is  favourable  the  chest 
sounds  become  tympanitic ;  respiration  becomes  easier, 
and  mobility  returns.  The  duration  of  this  stage  is  from 
seven  to  fourteen  days.  Wliere  the  result  is  unfavourable 
the  affected  structures  become  (edematous,  or  serous 
infiltration  occurs,  and  the  expectoration  becomes  more 
purulent,  or  tenacious  and  &othy,  and  the  duration  of 
the  illness  very  uncertain. 

Beside  these  symptoms  of  the  various  stages  are  those 
of  the  general  run  of  febrile  diseases,  such  as  thirst, 
restlessness,  nausea,  headache,  anorexia,  furred  tongue^ 
irritability,  turbidity  of  urine,  and  a  dryness  of  skin, 
followed  by  profuse  clammy  perspirations. 

Pbognosis  is  usually  favourable,  but  requires  to  be 
guarded,  because  of  the  treacherous  character  of  the 


SriSS^^hTS^**   CROUPOUS   PNEUMONIA.  99 


Berieir.  Feb.  2, 1891. 


disease.  I  passed  through  all  these  stages,  including  a 
gangrenous  abscess,  upwards  of  sixteen  years  ago,  and 
ean  speak  from  personcJ  experience.  Very  few  who  have 
that  complication  live  to  tell  the  tale.  The  results  in 
my  own  case  show  that  patients  should  not  be  content 
with  a  partial  recovery,  but  should  make  special  sacri- 
fices to  obtain  a  restoration  to  thorough  health.  If  the 
germs  of  the  disease  linger  in  the  injured  lung  a  recur- 
rence of  illness  is  extremely  probable,  the  slightest  chill 
stirring  up  fresh  mischief.  Catarrhal  pneumonia  is 
more  immediately  fatal ;  under  the  old  treatment  it  was 
discounted  at  twenty  five  to  fifty  per  cent.,  but 
the  croupous  form  may  wear  the  sufferer  out  by 
the  repetition  of  the  attacks.  Here  is  a  case  in  point  in 
which  this  would  have  occurred  but  for  timelj^  help.  On 
the  2nd  of  November,  Mrs.  P.,  of  Dover,  consulted  me, 
stating  that  six  years  previously,  as  the  result  of  chill, 
severe  aching  pains  came  in  all  the  limbs,  with  soreness 
in  the  chest,  "  a  dreadful  cough,"  and  heavy  night  per- 
spirations. Never  entirely  lost  the  cough,  and  has  been 
under  medical  care,  at  frequent  intervals,  ever  since,  but 
does  not  know  what  the  disease  really  is.  Thinks  she 
has  recently  been  treated  for  bronchitis,  but  her  own 
feelings  are  that  she  is  running  into  consumption.  Has 
always  suflfered  from  inaction  of  the  liver.  The  previous 
April  had  a  large  tumour  removed  from  the  left  shoulder ; 
a  few  days  after  an  artery  burst,  and  she  had  a  narrow 
escape  of  bleeding  to  death.  Her  chest  symptoms  returned 
in  an  aggravated  form  in  September  of  last  year 
(1890).  Questions  elicited  that  she  had  a  violent, 
spasmodic  cough  (**  like  whooping  cough  ") ;  ^  with 
greenish,  semi-pm-ulent  expectoration,*  catching  pains  in 
the  lower  lobe  of  the  right  lung,  and  debilitating  night 
perspirations.  There  was  great  dyspncea,  emaciation, 
and  furred  tongue.  Examination  revealed  a  tender, 
crepitating,  consolidated  patch  near  the  centre  of  the 
right  lung,  and  another  in  the  sub-clavicular  region  of 
the  left  lung,  with  loose  bronchial  rattling  over  both 
lungs.  Pulse  88;  temp.  39.60°  C.  (100  F.)  The 
indications  of  active  mischief,  with  the  soreness  and 
greenish  expectoration,  led  me  to  select  pho8»  12,  to 
he  taken  every  three  or  four  hours,  with  an  occasional 
doee  of  drosera  ^  for  the  spasmodic  cough.  Linseed 
poultices  were  ordered.     On  the   16th  November  the 


100  CROUPOUS   PNEUMONIA.    ^'S^l^^^^!^^. 

general  Bymptoms  remained  about  the  same,  with  aching 
pains  in  the  right  subscapular  and  right  lower  axillary 
regions ,  and  dropsical  swelling  of  the  feet  and  ankles. 
The  perspirations  were  clammy,  yet  with  general  feelings 
of  heat.    Evidently  the  phosphorus  stage  had  passed, 
BO  lycopodium  12  was  selected,  with  bryonm  <^  to  replace 
drosera.    Cod  liver  oil  was  ordered.    By  December  7th 
improvement  was  very  marked.    Bespiration  was  easier, 
cough  and  expectoration  and  the  perspirations  had  almost 
ceased.    Pulse  84 ;  temp.  37.10  0.  (98.8°  F.) ;  resp.  28. 
Lycop.  80  was  prescribed.     She  happened  to  come^to 
London  on  a  raw,  snowy  day,  which  brought  a  return  of 
bronchial  U'ritation.     This  was  relieved  by  antinu  tart. 
dx.     On  December  28rd  she  was  out  of  doors  and  caught 
a  chill,  which  resulted  in  a  sharp  attack  of  epidemic 
influenza,   with    soreness    through   the   centre  of  the 
left  lung.      This  was  relieved  by  arsen.  8  and  phos.  8. 
Early  in  February  she  wrote  that  her  old  cough  had 
practically  gone,  and  she  was  feeling  fairly  well.     On 
the  5th  of  May  she  wrote  for  medicine  to  relieve  a  fresh 
cold.    I  did  not  hear  from  her  again  till  August  11th, 
when,  in  reply  to  enquiries,  she  answered — "  I  have 
been  away  for  change  of  air.     Am  pleased  to  say  that  I 
am  very  much  better,  and  have  lost  my  cough."     Such 
a  report  is  almost  as  satisfactory  as  a  personal  inspection, 
for  intelligent  patients  can  record  their  own  feelings. 

An  unsatisfactory  element  in  this  disease  is  the 
rapidity  and  frequency  with  which  mischief  transfers 
itself  from  one  part  of  the  lung  to  another.  Just  as  a 
patient  seems  on  the  point  of  making  satisfactory 
progress  a  relapse  takes  place.  Unless  patients  and 
friends  are  warned  of  this  liability  they  are  apt  to  con- 
sider the  most  careful  treatment  inefficient,  when,  in 
fact,  that  very  care  is  lessening  the  severity  of  the 
onslaughts,  lengthening  the  intervals,  and  bringbig 
about  an  ultimate  recovery,  which  would  not  be  possible 
were  the  disease  left  to  run  its  natural  course.  Where 
fatal  results  ensue,  which,  happily,  under  improved 
methods  of  treatment  have  become  far  more  exceptional, 
these  usually  take  place  in  viciously  acute  attacks,  from 
the  third  to  the  eighth  day,  or  up  to  the  twenty-third 
day ;  and  in  the  more  chronic  forms  from  two  months 
jto  two  or  five  years,  the  latter  usually  being  where 
'sical  symptoms  supervene. 


SSS^S'^'^SS"*   CROUPOUS   PNEUMONIA.  101 


B«viev,Fd>.8, 1891 


T&EATXENT  should  be  sustaining  with  perfect  rest  and 
freedom    from  noise,  strong  light,  dust,  and  sudden 
changes  of  temperature.    Patients  should  be  guarded 
from  the  influences  of  strong  east  winds,  as  well  as 
from  the  incursions  of  cold  and  damp.     Sensitiveness 
to  light    is    sometimes   equalled   by  sensitiveness    to 
noise.     During   the    crisis  stage  of   my  own    illness 
I  could  hear  the  ordinary  conversation  of  the  kitchen, 
which  was  three  floors  below.    Talking,  also,  is  trying 
to  the  patient,  whether  as  a  principal  or  a  listener. 
The  lungs  and  brain  want  rest.      Linseed    poultices 
properly  applied   are    very  soothing    to  painful  parts. 
Not  the  doughy  structures  of  the  crude  attendant,  but 
the  moist,  lightly-mixed,  and  decent-sized  applications 
of  the    skilled    nurse.      These  can   be    covered    with 
bleached  lining-wadding  larger  than  the  poultice,  and 
bound  closely  on.    A  couple  of  safety  pins  through  the 
Hndervest  or  nightdress  will  prevent  the  slipping  down, 
and  a  well-applied  poultice  should  keep  warm  all  night. 
The  skin  should  be  wiped  dry,  or  sponged  and  wiped  on 
its  removal,  and  a  layer  of  fresh  wool,  or  silk,  or  flannel 
applied.    Irritants  to  the  skin,  such  as  iodine,  bUstering 
fluids,  and  croton  oil  should  be  looked  upon  as  the  relics  of 
a  bygone  age.    The  hydropathic  pack  is  almost  equal  to 
poultices,  provided  care  is  taken  not  to  chill  the  patient. 
In  applying  it  on  a  larger  scale,  as  the  wet  sheet  pack, 
it  is  used  to  reduce  the  fever  temperature.    Aconite  Ix 
to  3x,  repeated  every  quarter-hour  to  every  hour,  will 
regiilate  the  temperature  with  equal  certainty.    Ventila- 
tion of  the  room  is  essential,  but  the  temperature  should 
be  carefully  regulated;  in  cold  weather  15.20^  C.  (60°  F.) 
to  17.60°  C.  (64°  F.)  being  the  standard.    But  at  any 
season  of  the  year  great  care  should  be  taken  to  avoid 
sudden  changes,  especially  to  a  colder  temperature.  Tepid 
spongings  are  very  grateful  to  the  patient,  especially  with  a 
tablespoonful  of  strong  white  vinegar  or  dilute  acetic  acid 
added  to  the  quart  of  water.      Mentioning  this  reminds 
me  of  another  febrile  disease,  scarlet  fever,  in  which  these 
spongings  not  only  soothe  the  patient,  but  greatly  lessen 
the  risks  of  infection.    The  body  should  be  completely 
covered,  but  not  too  thickly.    Woollen  and  silk  garments 
are  excellent.    Heavy  counterpanes  should  be  cast  off ; 
blankets  only  are  far  superior.    The  latter  are  warm, 
light  and  porous.    Use  twill  sheetings  in  preference  to 


102  CROUPOUS   PNEUMONIA,   "^"j,^ 

linen,  no  matter  how  fine  and  elegant  the  latter  may  be. 
Diet  must  be  regnlated,  but  Bomewhat  in  accordance 
to  the  tastcB  of  the  patient.  And  here  I  should  add  a 
plea  for  coffee  for  breakfast,  as  more  eustaining  than  any 
amount  of  sloppy  tea.  If  it  interferes  with  the  action  of 
certain  medicines,  so  much  the  worse  for  the  medicines. 
Either  very  high  or  very  low  potencies  repeated  every 
hour  to  every  three  hours  will  overcome  that  difficulty, 
if  selected  in  accordance  with  the  rule  of  simtlia.  Cocoa 
makes  a  palatable  and  nourishing  beverage,  but  does  not 
suit  every  digestion.  Tea  should  be  used  in  moderation. 
Kolatina  and  Kola  chocolate  are  coming  into  favour,  and 
are  very  useful  in  conditions  of  debility.  Milk,  barley 
water,  toast  water,  black  currant  tea,  tamarind  water, 
bome-made  lemonade,  efTerveacing  Salutaris  water,  and 
other  simple  drinks  may  be  used  to  supplement  our 
natural  beverage.  Foods  should  be  appetising  and 
noui-ishing.  Light,  plainmeats,  suchaspoultry,game(not 
high),  fish,  and  mutton,  with  beef  tea,  broth,  and  well- 
prepared  extracts  of  meat,  form  a  euflBcient  variety 
during  actual  illness,  together  with  milk  foods,  light 
puddings,  fruits,  and  the  lighter  vegetables.  Bread  is 
an  important  article,  whether  taken  plain  or  as  toast. 
Milk  loaves  and  brown  bread  made  from  fine  meal  (not  ttie 
usual  whole  meal  bread),  with  germ  bread,  frame  food 
bread,  and  the  white  and  wheat  meal  aerated  bread  make 
palatable  changes  from  the  ordinary  bread  in  common 
use.  Many  bakers  still  use  alum,  with  something  else 
to  back  it  up,  as  a  means  of  improving  the  appearance  of 
indifferent  flour.  Really  good  flour  does  not  requu-e  any 
adjunct  of  that  kind.  The  general  principle  of  diet 
should  be  to  have  everything  of  good  quality,  well 
cooked,  and  nicely  ser\-ed  at  the  proper  times.  Under 
these  conditions  the  simplest  foods  are  palatable. 

The  proper  selection  of  medicines  is  of  great  im- 
Many  doctorsadopt  the  "expectant"  method, 
ana  careful  nursing,  dieting,  and  cod  liver  oil, 
ring  the  specific  action  of  medicines.  Some 
rs  since  I  was  called  in  to  meet  a  neighbouring 
er,  who  carried  these  ideas  out  to  the  letter  in 
)f  double  pneumonia.  It  was  the  second 
3  attack  from  which  the  young  man  had 
vithin  three  years.  His  condition  was  very 
.     The  only  alteration  in  treatment  was  the 


bSS^mImwiI^''  croupous  pneumonia.  103 

snbstitation  of  lycopodium  12  for  the  simple  mixture  he 
was  taking.  From  that  time  he  improved,  and  gradu- 
ally  reeoyered.  He  has  since  had  a  recurrence,  but 
haying  remoyed  to  another  district  I  did  not  see  him, 
and  so  cannot  giye  details.  Dosimetric  practitioners  are 
attempting  the  jugulation  of  febrile  diseases  by  the  ad- 
ministration of  aconitine,  digitalinef  and  veratrine,  and 
with  a  fair  amount  of  success.  Whether  patients  always 
giye  them  credit  for  the  success  is  another  matter. 
There  is  a  certain  amount  of  risk  with  this  process.  In 
a  case  of  typhoid  fever  seven  granules  of  aconitine,  one 
granule  every  hour,  nearly  jugulated  the  patient.  The 
temperature  fell  from  89.40°  C.  (103°  P.),  to  86.5°  C. 
(96°  F.),  and  recovery  was  retarded  by  the  formation  of 
abscesses.  Since  then  I  have  used  the  first  centesimal 
trituration  of  aconitine  for  the  reduction  of  temperature, 
one  grain  in  water  every  hour  for  four  or  five  doses,  and 
with  satisfactory  results. 

As  an  item  of  personal  observation  and  experience  a 
few  medicines  come  well  to  the  front.  It  appears  to  me 
that  lycopodium  and  sulphur  are  to  croupous  pneumonia 
what  aconite  and  phosphorus  are  to  the  catarrhal  form, 
our  sheet  anchors.  But  the  range  of  selection  is  large, 
though  the  following  are  the  chief  drugs  for  ordinary 
xwe: — 

Aconiium  napeUus,  Ix  to  80,  for  general  febrile 
symptoms,  with  high  temperature ;  dry,  hot  skin :  ex- 
treme thirst ;  hydroae  on  the  lips  ;  evening  exacerbations 
and  nocturnal  restlessness. 

Antimonium  tartaricum,  3x  trituration,  for  the  later 
bronchial  symptoms ;  with  loose,  mucous  expectoration  ; 
or  difficulty  in  expectorating  ;  with  oedema  of  the  lungs  ; 
and  especially  in  elderly  people. 

Arnica  montana,  Ix  to  8x  for  pain  and  soreness,  with 
Imnpy,  prune-juice  expectoration. 

Arsenicum  aUmm,  8x  to  80  for  general  catarrhal 
symptoms,  with  wheezing  respiration;  burning  pains 
(especially  in  the  right  lung; ;  periodical  exacerbations, 
eepeciaJly  from  1  to  8  a.m. ;  with  dryness  of  the  tongue, 
puehing  of  the  lips,  and  a  frequent  desire  for  drinks  in 
small  quantities ;  and  vital  prostration. 

Bryonia  alba,  matrix  tincture  to  80,  for  bronchial  and 
pleuritic  complications,  with  exudations,  with  free  ex- 


104  CROUPOUS  PNEUMONIA.   ^^^^iL°S5?*??2f 


Beriew.  Feb.  2, 1801. 


pectoratioiiy  or  the  stitch  pains  and  dry  spasmodic  cough 
of  pleurisy,  with  rheumatic  tendencies. 

Calcarea  carbonica,  8x  trituration  to  30,  in  scrofulous 
patients,  with  enlarged  glands,  clammy  perspirations, 
especially  of  the  hands  and  feet,  with  thick  yellow  or 
putrid  morning  expectoration,  and  phthisical  tendencies. 

Calcium  hypophosphite,  3x  trituration,  in  tendencies  to 
abscess,  to  lessen  the  formation  of  pus. 

Carbo  vegetablis,  8x  trituration  to  30,  for  gangrenous 
exhalations,  and  in  collapse,  with  blueness  of  the  skin 
and  coldness  of  the  extremities. 

ChaviomUla  vulgaris,  matrix  tincture,  20  to  40  drops 
in  a  wineglass  of  hot  water  at  bedtime  to  arrest  debili- 
tating perspirations  and  to  induce  sleep. 

Digitaline,  first  centesimal  trituration,  one  grain  to  a 
tablespoonful  of  water  every  16  to  80  minutes  for  four  to 
six  doses,  to  relieve  distressing  palpitation ;  with  inter* 
mi t tent  pulse. 

Drosera  rotundifolia,  matrix  tincture,  for  a  free  expec- 
toration of  pure  blood,  whether  bright  or  clotted ; 
especially  if  with  a  hard,  spasmodic  cough ;  increased  by 
liquids. 

Gelsemium  sempervirens,  Ix  to  3x,  for  passive  conges- 
tion, with  great  drowsiness ;  slow  pulse  ;  stitches  in  the 
right  chest ;  and  dry  cough ;  with  spasm  of  the  glottis. 

Hepar  mlphuris,  3x  to  30,  for  hectic  fever,  with  a  dry, 
barking  cough,  and  rattling  breathing  during  sleep. 

Hyoscyamtcs  niger,  3x  to  30,  for  spasmodic  night  cough, 
excited  by  a  tickling  in  the  throat  (also  lachesis) ;  with 
expectoration  tinged  with  blood,  and  as  hyoscyaminef  9x 
trituration,  for  typhoid  symptoms,  with  nocturnal  de- 
lirium. 

Lachnantes  tinctoria,  matrix  tincture,  for  stitch  pains 
in  the  right  chest ;  cough  worse  in  bed  after  sleeping, 
with  bloody  expectoration,  and  with  phthisical  ten- 
dencies. 

Lycopodium  clavatwn,  12  to  SO,  during  the  second  and 
third  stages.  Loose  cough,  with  lumpy  expectoration, 
purulent,  foetid,  saltish,  yellow,  greenish,  or  with  blood, 
copious  on  waking,  and  during  the  early  evening;  night 
cough,  with  lumpy  expectoration,  or  which  does  not  wake 
from  sleep ;  dyspnoea  on  the  slightest  exertion ;  sighing 
'<ispiration ;  dilatations  of  the  alse  nasi ;  and  flatulent 


SiS^'lSTSi!***    CROOTOUS   PNEUMONIA.  106 

dygpepsia,  with  epigastric  constriction,  and  irregular 
action  of  the  bowels. 

Magnesia  Carb.,  12  or  80,  for  a  harsh,  straining  cough, 
which  brings  neuralgic  shootings  up  the  cranial  nerves, 
with  scanty  expectoration,  and  especially  in  the  gouty 
diathesis. 

Phasplwrus^  4x  to  80,  in  the  stages  of  invasion  and 
hepatisation ;  with  hacking,  or  hollow  cough  ;  expecto- 
ration frothy  and  streaked  with  bright  blood  ;  or  rust- 
ooloured,  purulent  expectoration,  with  soreness  in  the 
longs ;  cough  excited  by  talking,  movement,  and  a  change 
to  colder  air ;  cough  worse  before  midnight,  from  drink- 
ing, and  on  lying  on  the  left  side. 

Spongia^  1  to  80,  for  a  hoarse,  barking,  laryngeal 
ooogh ;  worse  before  midnight,  from  cold  air,  dry,  cold 
winds,  and  talking ;  with  whitish  or  frothy  mucus  and 
partial  aphonia. 

Sulphur,  12  to  80,  for  a  short,  dry,  constant  cough, 
or  with  greenish,  purulent,  sweetish  or  saltish  expec- 
toration, ^th  stitches  and  soreness,  through  to  the  left 
scapula  in  pneumonia  of  the  left  upper  lobe,  especially 
in  die  later  stages,  and  as  an  intercurrent  remedy,  when 
carefully-selected  medicines  fail  to  give  relief. 

Other  medicines  should  not  be  overlooked,  such  as 
apis  meL  for  dropsical  effusions ;  iodine  for  the  early 
stage,  with  extensive  hepatisation;  lachesis,  for  irri- 
tating throat  cough,  worse  on  lying  down,  with  great 
dyspnoea;  nierc.  sol.,  for  bilious  complications;  opium, 
for  the  typhoid  condition,  with  flushings  followed  by 
hot  sweat,  and  mental  hallucinations ;  and  Pulsatilla,  for 
semi-lateral  (left  sidel  perspirations,  with  rapid  respi- 
ration, and  gastric  troubles.  Qtuissvie  has  been 
referred  to.  The  medicinal  properties  are  those  of  a 
corrective  of  atonic  dyspepsia,  with  thickly-coated  tongue 
and  loss  of  appetite.  In  this  condition  it  can  be  ad- 
nunistered  without  interfering  with  the  action  of  specific 
medicines,  just  as  cod-liver  oU  may  be  given  during  an 
ordinary  course  of  treatment,  or  it  may  be  given  three 
or  four  times  a  day,  without  affecting  the  action  of 
remedies  suited  to  the  nightly  aggravation  of  cough. 
The  administration  may  either  be  as  granules,  two  or  three 
for  each  dose,  or  as  the  third  decimal  trituration  of  the 
extract,  five  grains  to  two-thirds  of  a  wine  glass  of  water, 
flavoured  with  lemon. 

Vol  33,  No.  2.  I 


106  CB0UP0U8  PNEUMONU.   "SJSL^SS'?'^ 


Be?iew,  Feb.  2,  IflBl. 


Certain  yapours  and  inhalations  are  of  service.  CaV- 
cium  periodate  (periostatej  is  coming  into  favour,  in 
germ  diseases,  with  the  advanced  section  of  ordinary 
practitioners,  both  for  administration  and  inhalation. 
The  former  is  by  grain  doses,  made  into  pills,  and  the 
latter  by  the  vaporiser,  in  the  proportion  of  one  grain 
to  1,000,  or  to  5,000,  of  distilled  water.  The  germ- 
destroying  power  is  said  to  reach  1  in  5,000.  This 
sounds  very  like  the  children's  idea  of  putting  salt  on 
the  bird's  tail,  but  we  know  that  both  iodine  and  calcium 
possess  remedial  powers  far  beyond  those  of  mere 
chemical  effects.  Another  substance,  decidedly  efficacious, 
is  creolin  (Jeyes').  Thirty  to  sixty  drops  in  water,  in  a 
small  vaporising  lamp,  or  in  a  bronchitis  kettle,  will  soon 
diffuse  its  odour  through  the  room  ;  cleansing  the 
atmosphere,  and  easing  the  expectoration  of  tenacious 
mucus.  Or  a  few  drops  may  be  put  into  an  ordinary  jug 
or  inhaler.  A  third  substance  is  eucalyptus,  an  excellent 
purifier,  but  much  over-praised  for  its  supposed  medicinal 
value.  A  few  drops  of  this  will  suffice,  used  as  directed 
for  creolin,  or  by  means  of  a  respirator.  HyoscyamuSf 
20  to  80  drops,  is  particularly  efficacious  where  bronchial 
symptoms  predominate,  especially  if  with  low,  muttering 
delirium.  Kreoiote  and  carbolic  acid  have,  of  course, 
their  advocates.  I  prefer  creoUn,  as  being  more  effi- 
cacious and  non-poisonous.  2]erebene  and  pinol  are  of 
use  in  soothing  the  patient,  and  in  promoting  expectora- 
tion. Whichever  is  selected  it  should  be  used  strictly  in 
moderation,  so  that  the  atmosphere  of  the  room  may 
not  be  disagreeable  to  either  the  patient  or  attendants. 

Change  of  air,  especially  where  the  surroundmgs  are 
unfavourable,  is  of  great  benefit ;  but  too  much  reliance 
may  be  placed  upon  the  mere  change.  Home  comforts 
should  not  be  entirely  sacrificed,  neither  should  medical 
care  be  neglected.  Good  nursing  does  a  great  deal,  but 
the  chronic  forms,  and  the  onset  of  broncho-pneumonia, 
are  often  very  insidious.  In  some  cases  the  patient  has 
been  thought  to  be  suffering  only  from  ordinary  catarrh, 
with  debility,  where  the  stethoscope  would  at  once  reveal 
the  crepitant  rale,  and  percussion  show  the  dulness  of 
hepatisation.  ^  Where  the  effects  of  a  chill  do  not  readily 
pass  away,  it  is  well  to  have  attention  early,  rather  than 
risk  the  dangers  and  expense  of  a  prolonged  illness. 

26,  Harley  Street,  W. 


SSS^Srae?^  ON  GANGRENE.  107 


Beriev,  Kb.  8, 1891. 


ON  IDIOPATHIC  SYMMETEICAL  GANGRENE. 

By  C.  W.  Haywabd,  M.D.,  CM. 

{Contintiedfrom  Vol.  xxxv,,  page  618.) 

Other  cases  of  this  disease  have  been  reported,  but 
cannot  be  inclnded  here,  as  they  would  extend  this 
akeady  lengthy  series  beyond  all  reasonable  or  manag- 
able  proportions.  I  have  thought  it  necessary  to  quote 
at  some  length  the  above  series  of  cases,  in  order  that 
we  may  have  before  us  sufficient  material  from  which  to 
form  opinions  as  to  how  the  clinical  facts  observed 
correspond  with  the  observations  and  theories  which 
have  been  made  in  connection  with  this  disease. 

The  symptoms  of  the  disease  as  originally  described 
are  the  occurrence  of  discoloured  or  black  patches  on 
the  body,  arranged  symmetrically.  These  patches  are 
generally  preceded  by  ischaemia,  and  occur  especially 
at  the  ends  of  the  fingers  or  toes ;  also  on  the  ears  and 
tip  of  the  nose,  etc.  These  patches-  may  be  transitory, 
and  may  recover  without  gangrene  occurring.  In 
Case  V.  there  were  over  twenty  attacks,  in  only  one  of 
which  did  any  gangrene  take  place.  The  discolouration 
may  not  pass  off,  but  may  be  followed  by  gangrene — 
usuially  superficial — involving  the  skin  and  tips  of  the 
toes  or  fingers ;  but  in  the  first  of  these  cases  it  was 
more  extensive — as  also  in  Case  III.  In  Gases  XII  and 
Xm  it  was  far  more  extensive,  while  in  Case  II  both 
legs  became  gangrenous  as  well  as  the  greater  part  of 
the  face. 

Pain  is  usually  a  marked  symptom;  in  Gases  III 
and  ly  it  was  especially  marked,  as  also  in  Gase  YIII 
of  Raynaud's  series,  but  in  Gase  I  it  seemed  to  be  very 
slight,  and  in  Case  YIII  it  is  stated  that  there  was  no 
pain. 

Let  us  see  how  the  facts  stated  in  the  above  series  of 
cases  agree  with  the  theories  of  Baynaud. 

Predispoiing  Causes. — ^It  affects  especially  the  female 
sex.  In  Raynaud's  first  series  of  cases  he  cited  twenty 
cases  in  females  and  five  in  males.  In  his  next  series 
(contained  in  his  New  Researcltes,  New  Syden.  Soc.f 
Vol.  cxxi.)  there  were  two  females  and  four  males.  In 
the  fifteen  cases  reported  above  there  were  twelve  females 
and  three  males. 

1—2 


108 ON   QANGBENE,  '^S^fgTglS! 

Age. — ^Raynaud's  cases  occurred,  in  the  great  majority, 
between  18  and  80  years,  the  average  being  25  years, 
and  the  youngest  case  he  had  seen  was  at  8  years ;  but 
the  first  case  here  occurred  in  a  child  aged  1  year 
7  months — the  youngest  I  have  found  on  record ;  the 
second  case,  although  occurring  at  18  months  being  not 
so  typical.  Nothing  of  importance  can  be  deduced  from 
the  temperament,  constitution,  or  previous  ilhiesses,  in 
the  above  cases — as  also  was  the  case  in  Raynaud's 
cases. 

Nor  does  occupation  or  heredity  seem  to  have  played 
an^  part  in  its  production,  although  the  winter  and 
spring  seem  in  the  majority  of  cases  to  have  been  most 
favourable  to  its  development. 

Exciting  Causes. — Usually  exposure,  generally  to 
cold — ^but  often  an  unappreciable  degree — as  in  Case  V ; 
but  in  Case  I  it  rather  seemed  to  be  after  exposure  to 
the  sun  than  to  cold. 

Baynaud  mentions  that  the  condition  may  be  caused 
by  emotion,  and  this  is  confirmed  by  Case  X,  which  I 
think  confirms  the  theory  of  nervous  origin  of  the  disease^ 

As  to  Arteritis, — There  was  no  evidence  of  this  in  any 
of  the  cases,  while  in  Case  I  the  arteries  were  found  to- 
be  healthy  (see  microscopical  specimens) ;  also  in  Case 
in  the  arteries  were  examined  and  found  to  be  healthy. 

It  is  interesting  to  notice  that  it  is  distinctly  stated  in 
Case  Y,  that  the  discolouration  did  not  disappear  on 
pressure,  as  it  is  described  by  Baynaud  as  invariably 
doing. 

In  Case  lY  there  is  a  deficient  condition  of  the 
circulation  of  the  limb — similar  to  the  condition  observed 
in  Cases  XVin  and  XXII  of  Raynaud.  This  condition^ 
however,  certainly  did  not  cause — but  may  have  con- 
tributed towards — the  attacks. 

Although  Raynaud  in  his  second  series  of  cases 
describes  a  case  in  which  a  state  of  contraction  of  the 
retinal  arteries  was  observed  (Netv  Researches,  Case  I, 
pp.  155-160),  and  assumes  that  this  is  a  visible  proof 
that  the  arterioles  are  in  a  state  of  spasm  generally — ^it 
has  not  previously  been  demonstrated  absolutely  that 
the  arterioles  in  the  affected  limbs  are  contracted.  That 
such  is  the  case  is  absolutely  demonstrated  by  referring 
to  microscopical  specimen  viii,  from  Case  I,  the  thicken* 

J  of  the  middle  coat  being  physiological  and  not 


SS^STflE?^  ON  aANaBENE.  109 


BflvteVy  IM>.  2(  Iwl* 


pathological,  and  dae  to  a  contraction,  as  shown  by  the 
iQcreased  folding  of  the  internal  coat  (see  also  accom- 
panying drawing  of  artery). 

!  EmboUsm. — There  are  no  symptoms  at  all  pointing  to 

I        this  condition. 

Ergotism,  can  in  all  the  above  cases  be  absolutely 

I        excluded. 

I  As  to  the  condition  of  the  blood  more  evidence  is 

required.     In  Case  III,  the  condition  of  the  blood  was 

I        good,  the   corpuscles   numbering  4,800,000  per  cubic 

i  millimetre,  and  also  in  cases  reported  by  Dr.  Barlow 
(appendix  to  RaynaticCs  Cases  op.  cit.)  the  state  of  the 
blood  will  not  account  for  the  condition ;  nor  does  the 
examination  of  the  blood  in  Cases  XII  and  XIV  reveal 
any  important  change. 

Nervous  influences. — That  gangrene  may  be  caused  by 
nervous  influences  is  a  well-demonstrated  fact,  as 
gangrene  occurs  after  injuries  of  nerves. 

Inritation  of  nerves  may  produce  gangrene  of  the  parts 
supplied  by  these  nerves;  we  get  stimulation  of  the 
excito-motor  function,  and  spasm  of  the  vessels.  The 
spasm  of  the  arterioles  may  give  way  and  recovery  occur, 
or  it  may  persist  and  cause  gangrene.  Stimulus  of  the 
nerve  produces  spasm  of  the  arteries — as  proved  by 
Baynaud's  experiments  {New  Researches  op.  cit.)  That 
peripheral  neurites  can  produce  gangrene  seems  to  have 
been  proved  by  the  experiments  of  Pitres  and  Yaillard 
Gazette  de  Midecine  de  Paris,  1887).  They  produced, 
neuritis  by  means  of  hypodermic  injections  of  sulphuric 
ether.  Cutaneous  anssthesia,  disorders  of  motility,  and 
even  serious  trophic  lesions  were  observed  to  follow  such 
injectionB,  and  the  experimental  researches  of  Amoyau 
and  ^vat  proved  that  the  mechanism  of  these  lesions 
was  a  neuritis. 

When  an  injection  of  half  a  cubic  centimetre  of 
sulphuric  ether  was  made  deeply  into  the  cellular  tissue 
separating  the  muscles  on  the  back  of  the  thigh  of  a 
guinea-pig,  paralysis  of  sensation  and  motion  resulted 
in  the  parts  of  the  limb  below  the  level  of  the  injection. 
Generc^y  the  anaesthesia  occupied  the  two  outer  toes, 
and  the  outer  aspect  of  the  leg.  After  a  few  days  these 
phenomena  may  be  accompanied  by  cedematous  swelling 
of  the  foot,  ulceration  of  the  toes,  and  tarsus,  falling  off 
of  the  nails,  etc. 


110  HEVIEWB.  "1S^i?S5£'?1^ 


Beview,  Feb.  2, 18B1. 


The  anaesthesia  and  the  paralysis  are  manifested 
immediately  after  the  injection,  and  in  a  short  time 
they  reach  their  fullest  extent,  and  when  developed,  may 
persist  for  several  weeks  or  months.  Pitres  and  Vaillard, 
on  histological  examination,  fomid  the  nerve  above  the 
level  of  the  lesion  normal ;  below  there  was  Wallerian 
degeneration.  Also  in  Case  III,  the  neuritis  seems  to 
have  been  demonstrated  as  the  cause,  as  it  is  stated  by 
Dr.  Affleck,  that  the  appearances  in  the  nerve  were  so 
striking  and  unmistakable  as  to  preclude  the  theory 
that  they  were  secondary  to  the  state  of  the  foot.  Also 
severe  neuritis  is  found  in  Case  I  (see  specimens  VI 
and  VII). 

(To  be  continued.) 

REVIEWS. 


A  Clinical  Materia  Medica.  Being  a  course  of  lectures  delivered 
at  the  Hahnemann  Medical  College,  of  Philadelphia,  by 
the  late  E.  A.  Fab&tsqtok,  M.D.     Edited  by   Clarence 
Bartlett,  M.D.,  and  revised  by  8.  Lilienthal,  M.D.,  with  a 
memorial  sketch  of  the  author  by  Aug.  Eomdoerfer,  M.D. 
Second   edition.     Philadelphia:    Halmemann  Publishing 
House.    1890. 
Tms  volume  was  published  from  shorthand  reports  of  Professor 
Farrington*s  lectures  and  from  his  own  manuscript.     The 
first  edition  bears  the  date  October,  1887,  and  the  appeanmce 
of  a  second  in  so  short  a  time  bears  testimony  to  the  appre- 
ciation it  has  met  with.   In  1888  we  fully  noticed  the  pecidiar 
features  and  advantages  of  this  work,  but  so  highly  do  we 
think  of  it  that  we  have  much   pleasure   in  again  calling 
attention  to  Dr.  Farrington's  book. 

As  we  pointed  out  before,  the  author  possessed  in  an 
unusual  degree  the  facility  for  imparting  the  knowledge  he 
had  accumulated  by  careful  study.  His  descriptions  of  the 
general  action  of  the  drugs  is  lucid  and  accurate,  but  a  special 
feature  in  the  book  is  the  comparisons  he  institutes  between 
the  drug  under  consideration  and  drugs  of  use  in  allied  con< 
ditions.  '<  It  is  in  his  power  of  differentiation,  which  nothing 
but  an  extensive  and  intimate  knowledge  of  drug  symptoma- 
tology and  a  wide  clinical  experience  can  give,  that  the 
excellence  and  practical  utility  of  Dr.  Farrington's  book 
appear  so  striking." 

Many  drugs  which  are  known  theoretically  to  be  of  value 
in  certain  conditions  are  practically  very  little  used.  Such  a 
remedy  is  colchicum.    Dr.  Farrington's  work,  carefdlly  an 


^tS^iSTS^  BBVIEW8.  Ill 


reguiaslj  studied,  would  bring  nuu^  of  these  into  use  at  the 
ftppropriaie  moment.     We  make  some  quotations  from  the 
leetuie  on  cokhkum  by  way  of  illustration.    Its  symptoms  are 
inanged  under  four  headings :  Under  (1)  that  of  typhoid 
eonditions  and  debility,  we  read  :  *<  We  find  it  indicated  in 
debility,  particularly  in  debility  following  loss  of  sleep ;  for 
instance,  when  one  does  not  retire  as  early  as  usual  in  the 
evening,  so  that  he  is  deprived  of  a  portion  of  his  accustomed 
sleep,  and  he  awakens  the  next  morning  feeling  tired  and 
languid,  he  can  hardly  drag  one   leg  after  the  other,  the 
appetite  is  gone,  bad  taste  in  the  mouth,  and  nausea  are 
present.     The  debiUty,  then,  starts   from,  or  involves,  the 
digestion  as  a  result  of  loss  of  sleep.    You  can  see  how  close 
this  comes  to  the  ntu  vomica  condition.    The  debility,  how- 
erer,  is  greater  even  than  that  of  ntco?  vomica.    There  seems 
at  times  to  be  a  dishke  of  all  food;    the   odour  of   food 
cooking  makes  the  patient  feel  sick ;  he  becomes  irritable ; 
every  htde  external  impression  annoys  him ;  here  it  is  pre- 
cisely like  nux  vomica,^'    .    .    .    *'  "fhe  position  of  colchicum 
in  typhoid  fever  is  between  arsenicum  and  cinchona.    First, 
we  find  that  the  patient's  intellect  is  beclouded.    Although  his 
mind  is  befogged,  he  still  answers  your  questions  correctly, 
showing  you  that  he  is  not  in,  a  complete  stupor.    Unless 
questioned  concerning    it  he  says  nothing  about  his  con- 
dition, which    does  not  seem   dangerous  to  him.     There 
is   not    that    fearfulness,    that    dread    of    death,    which 
characterises    some    drugs    indicated    in    typhoid    fevers. 
The  pupils  are  widely  dilated  and  very  imperfectly  sensitive 
to  light.     There  is  a  cold  sweat  on  the  forehead ;  here  you 
will  at  once  note  a  resemblance  to  reratrum  album.    When  the 
patient  attempts  to  raise  the  head  from  the  pillow,  it  falls 
back  again  and  the  mouth  opens  wide,    You  thus  see  how 
weak  are  the  muscles  in  the  colchicum  case.    The  face  has  a 
cadaverous  appearance.    The  features  are  sharp  and  pointed, 
the  nose  looks  as  though  it  had  been  pinched  or  tightly 
squeezed,  and  the  nostrils  are  dry  or  even  black.    The  tongue 
is  heavy  and  stiff,  and  is  protruded    with   difficulty.      In 
extreme  cases  it  is  bluish,  particularly  at  the  base.     There  is 
almost  complete  loss  of  speech,  and  the  breath  is  cold.    There 
are  often  nausea  and  vomiting,  the  latter  being  attended  with 
considerable  retching    .    .    .    restlessness  and  cramp    .    .    . 
body  hot  while  the  extremities  are  cold    .    .    .    tympanitis 
•   •   .    stools  watery  and  frequent  and  escape  involuntarily. 
These  are  the  symptoms  which    lead  you  to  colchicum  in 
typhoid  states    .    .    .    Colchicum    .    .    .    combines  the  rest- 
leBsuess    and    debility  of   arsenic    with    the    tympany    of 
^mcAona."    .    .    .    ''  Carho  reg.  is  allied  to  colch.  in  the  cold- 


112  BBVIEWB.  "igS^^SrgSia! 

ness  of  the  breath,  in  the  tympany  and  the  great  prostration/* 
•  .  .  But  **the  watery  stool  is  not  so  characteristic  of 
4saiiH),  veg.f  the  discharges  being  either  absent,  or,  if  presentt 
dark  brown  and  horribly  offensive."  Under  (2)  Abdominal 
symptoms,  the  lectnre  goes  on  to  differentiate  between 
4!afUhari8,  fnercuriui  and  colchictun ;  under  (8)  Fibrous  tissues, 
it  defines  its  position  in  gout  and  rheumatism,"  and  under 
(4)  *<  Chest,'*  its  sphere  in  endocarditis,  pericarditis,  &c. 

For  a  study  of  treatment  from  the  side  of  the  disease,  a 
very  useful  and  complete  clinical  index  is  supplied. 

We  repeat  what  we  said  before: — "It  is  a  book  which 
should  not  merely  be  in  the  hbrary  of  every  physician,  bnt 
which  should  have  a  permanent  position  on  his  study  table  ; 
out  of  which  a  lecture  might  be  advantageously  read  every 
day  by  the  most  experienced  amongst  us,  one  by  the  light  of 
which  cases  may  be  studied  more  usefully,  perhaps,  than  by 
any  other  on  the  same  subject, 

Elechicitij  in  the  Diseases  of  Women.     By  G.  Betton  Massbt^ 

M.D.  London  :  P.  A.  Davis,  1890. 
Tms  manual  appears  as  the  fifth  in  the  "  Physicians'  and 
Students'  Beady  Beference  Series,"  and  is  a  compact  volume 
of  some  280  pp.  The  views  and  experience  of  the  author 
are  given  with  terseness  and  lucidity,  and  the  sphere  of 
electrical  treatment  in  pelvic  lesions  is  delimited  very  com- 
prehensively. Though  not  ranking  as  a  classical  treatise, 
the  vein  of  practical  apphcation  runs  throughout ;  procedure 
is  mainly  limited  to  the  safe  lines  laid  down  by  ApostoH'  and 
others,  and  cases  are  freely  cited  showing  the  value  of  the 
technique  in  given  instances. 

Electrolysis  for  uterine  fibroids  naturally  is  treated  at  greatest 
length,  though  this  chapter  is  mainly  a  rechaufS  of  the  views 
of  others,  supplemented  by  cases  in  one  of  which,  at  least, 
the  diagnosis  was  obviously  inexact. 

Little  is  added  to  the  knowledge  already  at  the  service  of 
the  profession,  and  the  occasional  risks  of  the  procedure  are 
pa|S8ed  over  as  non-existent.  Thus  on  pp.  122-8,  a  case 
originally  reported  by  the  reviewer,  the  latter  can  authorita- 
tively deny  the  statement  that  "a  necrotic  process  was 
threatened  before "  electrolysis.  The  electro-puncture  of 
fibroids,  an  always  dangerous  and  sometimes  f&tal  method,  is 
described  and  recommended.  Besides,  to  speak  of  ''  the 
chance  of  reproduction  of  fibroids "  as  "  by  no  means  as 
great  as  in  ovarian  tumours  "  is  in  direct  contravention  to  all 
experience. 

The  electrical  treatment  of  subinvolution,  parametritis, 
metrorrhagia,  and  pelvic  pain  is  described,  though  scaroely  at 


SrirSS^  BKVIEWU.  nil 


Bivlew,  Peb.  S,  Ifin. 


length;  and  extta-uterine  pr^inaney  is  still  deemed  fitting 
for  eleetrolysiB.  After  Tait's  declaration  that  the  placenta 
continnes  to  grow  after  the  electric  foeticide,  this  method 
mast  be  mled  out  of  court. 

The  chief  feature  in  this  Tolnme  is  the  description,  with 
namerous  diagrams,  of  the  electric  armamentum,  and  the 
Talne,  from  the  author's  experience,  of  different  combinations 
and  selections.  This  is  very  well  done,  and  will  be  nsefol 
both  to  pre-  and  post-graduates,  however  well-informed  and 
skilfuL 


T^  DecUne  of  Mcmlwod:  Its  Catusn  ;  tfte  best  'ineatw  of  Prevent" 
ing  tJietr  l^ffecU,  and  bringing  abcmt  a  Bestoration  to  Health, 
By  A1.TIN  A.  SifAiiL,  A.M.,  M.D.  Fourth  edition,  revised 
and  enlarged.    Chicago :  Oross  &  Delbridge.    1690. 

Tms  little  book  is  intended  for  the  public,  and  has  evidently 
become  popular,  for  it  has  reached  a  fourth  edition.  The  tone 
of  the  book  is  good ;  no  unnecessary  detail  is  indulged  in. 
Soond  advice,  both  hygienic  and  medicinal,  is  given  in  its 
pages. 


The  Dog  Owner^s  Annual  for  1891.  London:  Dean  &  Son, 
Fleet  Street,  E.G. 

The  annual  before  us  is  replete  with  much  that  is  of  interest 
and  importance  to  all  lovers  of  man's  faithful  friend,  the  dog. 
It  is  rendered  especially  interesting  to  us  by  a  well-writt^ 
and  usefril  article  on  distemper  by  Mr.  Thomas  Moore.  The 
vuious  phases  of  the  disease  are  clearly  described,  and  the 
lumioBopathic  indications  for  remedies  in  its  treatment  fully 
pointed  out,  while  the  general  management  of  the  dog, 
Buffeiing  from  this  disease,  is  equally  well  treated  of.  There 
is,  however,  one  form  in  which  we  have  seen  distemper 
manifest  itself  on  several  occasions  to  which  Mr.  Moore  does 
not  allude  :  it  is  that  where  the  central  inflammation  occupies 
the  spinal  cord,  the  animal  being  paralysed  in  its  hind 
quarters  and  limbs.  Ou^  case  of  this  kind  occurred  to  ns 
some  years  ago,  in  a  dandy  dinmont  puppy,  about  four 
months  old,  in  which  plumbum  carbonicwni  given  frequently  in 
the  8rd  decimal  trituraticm  was  followed  by  rapid  recovery. 

Tlw  HomaopaUiic  Treatment  of  Alcoholism.  By  Doctor  Galla- 
VABDnv,  of  Lyons,  France.  Translated  by  Irenaeus  D. 
Foulon,  A.M.,  M.D.  Philadelphia :  Hahnemann  Publish- 
ing House.     1890. 

^s  fear  the  question  of  the  management  of  alcoholism,  acute 
or  chronic,  whether  viewed  from  a  medical  or  social  stand- 


114  REVIEWS.        "sssi'fflryjs? 


Beview,  Feb.  %  IflBl. 


point,  will  not  find  its  solution  in  this  little  volome.  Still, 
any  genuine  contribution  to  the  consideration  of  so  difficult 
and  important  a  subject  merits  attention.  Dr.  Gallavardin  is 
evidently  an  enthusiast,  and  is  a  very  firm  beheyer  in  the 
power  of  homoeopathically  selected  remedies ;  in  this  he  has 
our  entire  sympathy.  He  affirms  that  he  has  used  with  sac* 
cess  the  following  remedies  for  drunkenness : — Ntus  r.,  laeh.f 
caitst,,  sidph.f  calc,  carb.,  hepar,,  ars.^  mere,  viv,,  petroL^  opUinh 
staph. J  caniumt  puis,  and  mof/nes,  carb.  This  is  a  positive  state- 
ment of  value  as  far  as  it  goes.  But  we  are  bound  to  say  that 
the  indications  the  author  gives  for  each  particular  remedy 
are  far  from  satisfeustory.  Had  he  simply  stated  that  he  gave 
these  drugs  in  accordance  with  the  indications  of  the  Materia 
Medica,  instead  of  selecting  the  few  symptoms  he  mentions  as 
guides,  his  position  would  have  been  unassailable.  Moreover 
we  fear  that  readers  of  this  book  will  be  disappointed  when 
they  find  that  many  of  the  cures  claimed  were  performed 
without  the  doctor  having  once  seen  his  patients,  and  with  a 
few  globules  of  a  high  dilution  given  in  a  single  dose  in  the 
ordinary  alcoholic  beverage  of  the  drinker.  We  confess  that 
without  more  evidence  of  the  nature  of  the  cases  and  the  cures 
than  the  author's  reports  afford,  we  shall  regretfully  regard  them 
with  considerable  want  of  confidence.  It  is  an  unfortunate 
habit  with  some  writers  to  make  bare  statements  which  do 
not  permit  of  others  forming  a  judgment  of  them.  Were 
observers  infallible,  such  bare  statements  would  have  a  value 
which  they  can  never  possess  while  liability  to  error  remains. 
An  illustration  of  such  statement  is  the  following:  "A  married 
man  was  accustomed  to  drink  as  high  as  80  glasses  of  absinth. 
After  a  dose  of  cawtticum  200th,  taken  without  his  knowing  it, 
he  felt  such  a  repulsion  for  absinth,  and  even  for  wine,  that 
not  only  he  did  not  drink  any  more  of  it,  but  he  could  not 
even  remain  in  the  presence  of  persons  who  were  drinking  the 
stuff.*'  Such  reporting  will  tend  to  discourage  others  from 
experimenting  on  truly  homoeopathic  lines  in  these  cases,  and 
it  is  consequently  to  be  deplored.  StiU  the  one  fact  remains 
(for  such  we  believe  it  to  be)  that  the  author  has  apparently 
cured  many  cases  of  confirmed  inebriety,  and  this  should 
encourage  others  to  follow  on  in  the  footsteps  of  Hahnemann 
and  Hering,  and  they  will  in  due  time  reap  no  less  a  reward 
than  they  did. 


NoTABiLB. — ^The  fears  expremed  in  oar  last  issue,  and  oonfirmed  by 
TioteBatx  Vizchow's  eacaminatiooos,  that  new  foci  of  disease  may  be 
created  by  the  disturbance  of  the  bacilli,  receive  additional  support  by 
the  fact  that  after  injection  with  Koch's  lymph,  bacilli  have  been  found 
in  the  blood.  The  blood  of  nine  patients  was  examined,  in  an  oases  with 
positive  results.  It  is  too  early  to  gauge  the  importance  of  thisdisoovery 


b^iSTSS^  notes  and  comments.  116 


NOTES   AND   COMMENTS. 


The  sbcrbt  of  the  Berlin  consumption  cure  has  at 
length  been  divulged.    All  our  readers  and  all  the  world 
now  know  that  the  agent  is  a  "  glycerine  extract  from 
pore  cultivations  of  the  tubercle  bacilli."     It  should 
therefore  be  possible  within  a  short  time  to  obtain  sup- 
plies of  the  fluid  prepared  in  English  laboratories.    The 
next  desideratum  is  to  determine  as  early  as  possible  the 
Talae  of  the  remedy.    Are  we  any  nearer  attaining  this 
end  than  a  month  ago?    We  think  so;  the  reported 
cases  show  clearly  that  in  some  instances  unquestionable 
benefit  has  followed  the  treatment.    The  permanence  of 
the  benefit  only  time  can  prove.    It  is,  apparently,  not 
less  true  that  harm  has  resulted  from   the  injections* 
The  determination  then  of  what  cases  are  suitable  for 
and  what  cases  are  unsuited  to  the  treatment  by  Eoch's- 
method  remains  to  be  made.    If  Dr.  Eoch's  meiliod  only 
is  pursued  it  appears  probable  that  his  remedy  will  fall 
into  entire  discredit,  as  other    remedies    have  fallen 
through  indiscriminate  use.    As  in  the  instances  we 
allade  to,  it  will  probably  be  left  for  homoeopathists  to 
elucidate  the  exact  sphere  of  usefulness  of  the  virus. 
They  win  not  be  afraid  to  reduce  the  dose,  to  the  3rd,  6th 
or  12th  attenuation,  or  stiU  higher,  if  necessary,  in  order 
to  avoid,  at  any  rate,  the  serious  aggravations  which 
have  already  been  produced.  Moreover  the  precise  effects 
of  the  poison  will,  we  hope,  ere  long  be  ascertained  by 
testing  it,  in  dilution,  on  the  healthy  subject.    We  shall 
then,  at  once,  have  determined  its  sphere  of  action.   Such 
proving  has  already  been  undertaken  to  some  extent  in  the 
case  of  the  analogous  substance  in  use  under  the  name  of 
tuhercuJinum.  Bespecting  the  mode  of  action  of  the  remedy 
nothing  satisfactory  can  as  yet  be  reported.    The  dose 


116  NOTES  AND  COMMENTS.    ^^^wflSf^wK! 

in  which  the  poison  has  been  administered  so  far  has 
been  sufficient  to  destroy  more  or  less  completely  the 
diseased  tissue  in  which  the  bacilli  have  flourished.  This 
destruction  has  been  accompanied  with  inflammatory 
action  which,  in  some  instances,  has  not  been  limited  to 
the  actually  tubercular  tissue.  That  the  injections  have 
also,  apparently,  either  roused  into  activity  dormant  foci, 
or  have  created  fresh  centres  of  disease,  cannot  be  denied. 
Some  doubt  has  recently  been  thrown  on  the  specificity 
of  the  remedy.  It  is  suggested  that  the  poison  may  have 
done  nothing  more  than  attack  and  destroy  tissues  of 
lowered  vitality.  For  not  only  have  admittedly  tuber- 
cular tissues  been  attacked,  but  it  is  stated  that 
leprous  tissues  have  also  been  similarly  affected. 
The  effects  of  the  poison  on  lupus  may  not  be 
cited  as  evidence  of  its  affinity  for  tubercle  until  the 
precise  relationship  of  lupus  and  tubercle  is  more 
satisfactorily  determined  than  at  present.  What  is  now 
urgently  needed  is  a  series  of  carefully-conducted  experi- 
ments with  much  smaller  doses  than  have  at  present 
been  employed — doses  small  enough  to  avoid  any  violent 
local  destruction  of  tissue,  small  enough  to  avoid  the 
''  reaction  '*  or  aggravation  brought  about  hitherto,  and 
apparently  regarded  as  essential.  Should  it  be  proved 
that  this  *'  reaction  "  and  the  tissue  destruction  which  it 
indicates  are  essential  to  the  success  of  the  treatment, 
there  is  no  doubt  that  its  days  are  numbered,  in  so  for, 
at  least,  as  internal  lesions  are  concerned. 


It  should  be  bemembeeed  that,  though  perhaps  not 
novel,  Professor  Koch's  discovery  may  still  be  original. 

In  our  December  number  we  gave  reasons  for 
believing  that  the  remedy  might  be  a  homoeopathic  one, 
and  no  reasons  for  altering  this  belief  have  arisen.    But 


SS^STS^  PBBI800PB.  117 


BBviev,  N>.  2,  lan. 


while  we  cannot  accord  to  Dr.  Eooh  the  credit  of 
novelty,  it  is  bat  fair  to  allow  that  to  him  we  owe  the 
preparation  of  what  ought  to  take  a  place  as  a  definite 
and  standard  agent.  The  idea  of  the  adoption  of  the 
actnal  products  of  disease  as  remedies  is  an  unpleasant 
one ;  but  this  is  not  the  worst.  These  products  must 
vary  indefinitely,  and  consequently  be  uncertain  as  well 
as  nasty.  This  will,  to  a  large  extent  at  least,  be 
obviated  by  the  use  of  Eoch's  fluid.  The  details  of  its 
preparation  we  have  yet  to  learn. 


PERISCOPE. 


MATERIA  MEDICA  AND  THERAPEUTICS. 

Phosphorus  in  the  Treatment  of  Rickets. — For  the  past 
two  years  Dr.  Mandelstamn,  of  Kazan,  in  Russia,  has  been 
using  phospiwrm  in  small  doses  in  the  treatment  of  rickets, 
and  during  that  time  he  has  administered  the  drug  to  two 
hundred  and  fourteen  patients  of  different  ages  suffering  from 
the  various  forms  of  the  disease.  He  concludes  as  follows  : 
Clinical  observations  perfectly  justify  the  employment  of 
phosphorm  in  rickets.  Phosphorus  acts  better,  more  quietly 
and  more  surely  than  any  other  drugs.  The  administration 
of  the  drug  for  a  long  time  in  small  doses  is  well  borne  by 
children  and  does  not  produce  any  ulterior  effects.  Phos- 
phorus  acts  favourably,  especially  in  cases  of  symptoms 
depending  upon  the  rickety  diathesis.  Under  the  influence  of 
phosphorus,  in  the  great  majority  of  cases,  the  development 
of  the  disease  is  arrested.  The  dose  was  1  centigramme  (8-20 
gr.)  to  1,000  grammes  (1  qt.)  of  cod  liver  oil,  1  dessert  spoon- 
ftd  once  or  twice  a  day. — New  York  Medical  Times,  Aug.,  1890. 

Cbeolin  Injections  in  Dysentery. — Dr.  Sosovski  {Lancet, 
Aug.  8, 1880)  has  found  large  enemata  of  dilute  creolin  very 
Qsefol  in  dysentery.  He  employed  a  one-half  per  cent,  solu- 
tion injected  into  the  bowel  twice,  or  sometimes  three  or  four 
times  daily,  the  quantity  used  for  each  enema  being  generally 
about  five  pints.  The  patients  did  not  experience  any  burning 
sensation  or  abdominal  pain.  The  treatment  was  employed 
in  sixteen  cases,  not  one  of  which  proved  fatal,  although  a 
ecmsiderable  number  of  patients  succumbed  to  the  disease 
daring  the  same  epidemic.  In  two  cases  the  disease  was 
airested  after  the  second  enema,  in  nine  cases  the  bloody 


118 PKBIBOOPK.  "'S^SS!?^ 

Bioolfl  ceased  on  the  third  day,  in  two  cases  on  the  fifth  day, 
in  one  on  the  sixth,  and  in  one  on  the  ninth.  In  addition  to 
these,  two  children  nnder  a  year  old  were  treated  snccessfnlly 
foy  means  of  creoUn  enemata.  Again,  another  Bnasian 
physician,  Dr.  Eolokoloff,  has  nsed  a  1  per  cent,  solution  in  a 
nnmher  of  cases  of  adoltis  with  complete  success. — Xew  York 
Medical  Times,  Aug.  1890. 

BoBO-CiTRATB  OF  Maokksul  IN  Uboiabt  Caixiuli. — ^Dr.  N. 
Perez  (Albawj  Med.  Annals,  Sept.  1889)  refers  to  the  case  of  a 
boy,  four  years  old,  having  a  large  calculus  in  his  bladder. 
Before  performing  an  operation  he  tried  the  application  of  the 
horo'citrate  of  magjiesia,  of  which  he  gave  fifteen  grains 
dissolved  in  an  ounce  of  syrup,  one  to  three  tablespoonfuls 
every  day.  After  three  days  of  this  treatment  a  good  deal  of 
white  sediment  appeared  among  the  mucus  in  the  urine, 
which  continued  about  one  month,  the  other  phenomena  dis- 
appearing.— New  York  Medical  Times,  Aug.,  1890. 

Peboxide  of  Hydbooen  m  the  Tbeatment  of  Pneumonia. — 
Dr.  J.  L.  Greene,  of  Ck>lorado,  writes  to  the  Medical  Record 
that  a  year  ago  he  conceived  the  idea  that  peroxide  of  hydro- 
gen might  be  useful  in  treating  congestive  and  croupous 
pneumonias  prevalent  in  the  Bocky  Mountain  region.    Out  of 
twenty-three  cases  treated  by  him  since  that  time  there  have 
been  twenty-two  recoveries  and  one  death.    The  death  was  in 
the  case  of  a  puny  infant  eleven  weeks  old  and  so  far  gone 
when  first  seen  that  any  treatment  whatever  could  avail  but 
little.    These  cases  comprised  some  with  double  pneumonia, 
some  persons  of  robust  habit,  some  with  constitutions  im- 
paired by  long  intemperate  use  of  alcoholic  liquors,  and  several 
children  ranging  in  age  torn  three  months  to  three  years. 
The  main  treatment  has  been  the  internal  use  of  peroAde  of 
hydrogen,  though  he  has  used  any  rational  measures  that  were 
indicated  to  meet  complications,  or  unusual  conditions  arising 
in  any  case.    The  dose  mentioned,  says  the  author,  in  the 
rather  scanty  literature  on  the  subject,  as  applicable  to  other 
classes  of  cases — a  teaspoonful  three  times  a  day — ^is  far  too 
light  for  pneumonia.    In  the  high  line,  or  congestive  form, 
common  enough  at  high  altitudes,  the  patient  would  exhansi 
the  effect  of  the  first  dose,  and  die  from  apnea  before  the 
second  would  be  due.    He  often  gives  one-fourth  to  one-half 
a  teaspoonful,  well  diluted  with  water,  once  in  five  or  ten 
minutes  for  an  hour  or  more,  with  good  results.    In  acute 
lobar  pneumonia  he  usually  gives  half  a  teaspoonful,  diluted, 
every  hour,  with  benefit,  even  when  no  emergent  conditions 
exist,  and  continues  it  till  after  the  crisis  occurs. — Neic  York 
Med.  Times,  August. 


SSSU^ST^*"*  PBBI8C0PB.  119 


,  Feb.  i.  vm. 


Htfericum  in  Paik. — Deprecating  the  nse  of  morphia  in 
fraigieal  cases,  Gilchrist  says  {N(nthwestem  Journal  of  Hom,)^ 
hjperieum  absolutely  prevents  pain  in  any  kind  of  operation 
which  is  painfdl  in  natore.  It  makes  no  dififerenoe  in  what 
fonn  you  administer  it,  whether  in  the  tincture,  the  thirtieth, 
or  two-hundredth,  the  result  is  the  same.  I  know  that  many 
think  where  there  is  any  mechanical  obstruction  it  is  necessary 
to  give  an  anodyne. — /ZvW. 

BisT  m  THE  Tbeatmbnt  of  Tetanus. — We  are  told  by 
Chambers'  Journal  that  Prof.  Benzi,  of  Naples,  has  treated 
sacoessMly  several  cases  of  tetanus,  by  absolute  rest  for  the 
patient.  This  absolute  rest  does  not  mean  simple  release 
from  labour,  but  includes  rest  for  the  several  senses  as  well  as 
for  the  body.  The  ears  of  the  patient  are  closed  with  wax, 
the  room  is  darkened,  and  the  floor  is  heavily  carpeted. 
Every  fifteen  minutes  the  nurse  enters  with  a  shaded  lantern 
to  attend  to  his  wants,  and  to  administer  food  such  as  eggs, 
milk  and  other  fluids.  Nothing  solid  or  requiring  any  attempt 
to  masticate  is  given.  Sedatives  are  administered  as  required 
to  relieve  pain.  It  is  said  this  treatment  shortens  but  little, 
if  any,  the  length  of  the  disease,  but  it  lessens  the  force  of  the 
paroxysms,  which  gradually  cease  altogether. — IbUL 

TJbanium  Nitbicuu  in  Ulceration  of  the  Stoicach. — Dr. 
Gorham  {Medical  Era,  July,  1890)  relates  the  following  case 
in  proof  of  the  great  value  of  this  drag  in  gastric  ulcer : — 
*'  Mrs.  A  was  prostrate  in  bed,  too  weak  to  stand,  emaciated, 
pulse  weak  and  rapid  (180  per  minute),  face  pale,  with  distress 
marked  in  every  line,  and  suffering  constant  pain  in  the 
stomach,  which  was  greatly  aggravated  by  the  least  food  or 
liqmd  swallowed.  Nothing  had  been  retained  by  the  stomach 
daring  the  previous  ten  days.  8he  vomited  frequently  mucus 
mixed  with  blood,  and  occasionally  the  regular  '<  coffee-ground  '* 
Tomit.  She  seemed  in  imminent  danger  of  dying  from 
eihanstion.  There  were  also  dark,  tarry-looking  stools,  indi- 
eating  hemorrhage  of  the  stomach.  There  was  marked 
seDsitiveness  over  the  region  of  the  pylorus,  and  pressure 
caused  pain,  but  no  hardness  or  thickening  could  be  detected  ; 
the  skin  was  pale,  anssmic,  and  about  normal  temperature. 
After  a  variety  of  treatment,  homceopathic  and  allopathic, 
wm.  nit.  2  x.  was  administered.  The  pain,  which  had  been 
agonising,  was  greatly  relieved,  in  a  few  hours  the  vomiting 
lenened,  and  the  patient  had  four  hours  of  quiet  sleep  the 
&8t  night.  She  went  on  to  complete  recovery,  and  had  no 
letom  of  the  trouble  at  the  end  of  a  year." 

Iodine  in  Vomitino. — V  Union  Med.,   Dec.   10th,   records 
^  experience  of  M.  Darthier  in  nineteen  cases  of  vomiting. 


120 PEM8C0PE.  ''l^fSSrg^! 

in  which  iodine  was  used,  eleyen  of  the  patients  being  tuber- 
cular subjects;  he  found  that  it  is  of  more  value  in  the 
vomiting  of  early  phthisis  than  in  that  of  the  later  stages 
of  this  disease.  At  the  same  time  he  gives  instances  of 
advanced  cases  with  obstinate  vomiting  where  the  symptom 
was  largely  controlled  by  the  drug.  Amongst  other  oases  he 
gives  one  of  bronchial  dilatation  (subsequently  fiEttal  from 
aoute  tuberculosis)  in  a  female*  who  for  three  weeks  had 
regularly  vomited  after  every  meal.  From  the  date  of  com- 
mencement of  the  use  of  the  drug  she  ceased  to  vomit,  and  after 
a  week's  treatment,  which  was  not  productive  of  any  signs  of 
iodism,  was  completely  cured  of  the  symptom.  Apart  from 
phthisical  vomiting,  M.  Darthier  finds  it  useful  in  alcoholic  gas- 
tritis, in  ulcer  of  the  stomach,  and  in  the  vomifing  of  pregnancj 
and  chlorosis,  instances  of  which  are  recorded.  He  says  that 
the  majority  of  patients  t&ke  the  iodine  with  pleasure ;  it  often 
produces  an  agreeable  sense  of  warmth  in  the  stomach,  lasting 
from  five  to  twenty  minutes.  The  dose  is  ten  drops,  dissolved 
in  125  grammes  of  water,  taken  in  three  portions,  immediately 
after  meals.  In  a  certain  number  of  cases,  symptoms  ot 
iodism  are  produced,  chiefly  coryza ;  but  a  good  many 
patients  do  not  experience  any  such  inconvenience  from  it. 

Intermittent  Fever. — ^Dr.  Stout,  of  Jacksonville,  reports 
several  cases  of  intermittent  fever  cured  without  quinine 
— ^in  one  case  after  quinine  given  ''by  bathing"  had  failed. 
Nux  vomica  was  one  of  the  remedies  used,  as  indicated 
by  a  '*  congested  type,  face  and  fingers  blue,  feeling  of  suiFoca- 
tion,  &c.,  followed  by  high  fever  with  deliriuip."  Residence 
at  the  sea-side  brought  back  the  fever  in  one  case,  but  nau 
mur.f  indicated  by  the  hydroa  on  the  lips,  at  once  acted,  and 
prevented  another  chill. — Souiliem  Journal  of  Homaopatkyy 
Nov.,  1890. 

Arsenic  in  £prrHELioBCA. — ^Dr.  Green,  of  Little  Bock, 
reports  a  case  of  epithelioma  of  penis  of  several  months*^ 
standing.  The  disease  began  in  the  prepuce,  and  the  patient 
had  been  subjected  to  a  thorough  course  of  anti-syphilitio 
treatment.  It  recurred  in  the  scar  a  year  after  excision.  Under 
the  influence  oiarsenicum  2x  trit.  locally,  and  8x  trit.  internally, 
the  patient  entirely  recovered  within  two  months. — {Ibid). 

Blatta  Orientalis  in  Asthma. — ^Dr.  Bay,  of  Calcutta, 
relates  an  anecdote  of  an  old  asthmatic  who  happened  to 
drink  a  cup  of  tea  into  which  an  Indian  cockroach  had  fedlen. 
After  taking  this  tea  he  found  himself  much  better,  and 
instituted  an  enquiry  as  to  its  cause,  with  the  above  result. 
Subsequent  experimentation  by  Dr.  Bay,  with  Srd  dec.  trit. 
and  solution  in  alcohol,  led  hun  to  say  that  <'  in  many  cases 


lt:^v!STJ^  PERISCOPE-  121 


Beviev,Feb.S,l»l. 


it  aeted  almost  specificftUj ;  that  is,  the  whole  trouble  cleared 
away  within  a  forbiight  or  so  without  recurrence.*'— Horn. 
Recorder,  November,  1890. 

Passiflora.  ni  Tms  Alcohol  and  Mobphia  Habit. — Mr.  D. 
had  suffered  from  delirium  tremens,  and  when  he  began  to 
improTe  the  old  cravings  for  liquor  and  morphine  returned. 
He  came  under  Dr.  Dunleig*s  care  for  piles  which  caused  hlrn 
great  suffering  and  led  to  the  use  of  alcohol  by  day  and 
morphine  at  night.  Dr.  D.  stopped  these  drugs,  but  the 
patient  lay  awake  at  night  calling  for  his  sleeping  draught 
imtil  he  was  bordering  on  a  state  of  insanity.  Passiflora  <^ 
was  given  in  doses  of  a  teaspoonful.  He  at  once  b^fan  to 
improve,  and  soon  lost  his  craving  for  the  drugs  mentioned. 
Dr.  D.  has  used  passiflora  with  success  in  other  cases  of 
insomnia  and  gets  most  benefit  where  there  is  ''  great  bodily 
exhaustion."  He  proposes  to  prove  the  drug  upon  himself. — 
Horn.  Recorder,  November,  1890. 

GYNAECOLOGY. 

Intebnational  Medical  Gongbess,  Beblin. 

[Concluded,) 
Stibject :  Electrolysis  in  Gynacology. 

Dr.  Apostou  (Paris)  said  that  the  use  of  electricity  ex- 
tended to  cases  of  endometritis  and  metritis,  to  fibroids, 
peri-aterine  inflammations,  diseases  of  the  appendages,  ameno- 
rrhosa,  dysmenorrhoea  and  h»morrhages.  The  use  of  the 
constant  current  raised  the  temperature  of  the  tissues  between 
the  poles,  and  so  caused  an  acceleration  of  circulation  and  an 
increased  absorption  process.  The  positive  pole  causes  the 
destruction  of  microbes.  The  intra-uterine  use  of  the  current 
was  important ;  the  therapeutic  vogue  of  electricity  depending 
on  the  rise  in  local  temperature  and  the  ensuing  circulatory 
drunage,  together  with  the  polar  and  inter-polar  action. 
Vaginal  galvano-puncture  Apostoli  uses  only  a  few  millimetres 
deep,  by  a  fine  trocar,  which  is  isolated  and  antisepticised  up 
to  the  point.  In  912  patients  Apostoli  has  administered  the 
earrent  11,499  times.  Three  of  these  patients  have  died ;  one 
in  consequence  of  too  deep  a  puncture,  going  into  the  peri- 
toneal cavity ;  the  second  case  was  one  of  probable  purulent 
salpingitis ;  the  third  one  of  ovarian  cyst.  Thirty  of  the 
patients  later  became  pregnant. 

Db.  Cutteb  (New  YorkT  described  his  method  of  electrolysis 
which  was  practised  in  America  before  Apostoli.  He  stated 
that  it  lessened  the  tumour,  and  relieved  the  pains  and  bleed- 
ing.   Among  50  cases  tabulated  by  Cutter,  eleven  cases  of 

Vol.  35.  No.  2.  K 


122  PERISCOPE.  "•SSSJ'SEH!^" 


fi«yiew,  Feb.  2, 1801. 


fibroma  were  completely  healed  by  electricity ;  the  growth  was 
retarded  in  25,  three  were  reheved,  seven  were  mirelieved, 
and  four  had  died.  The  methods  used  in  America  were  partly 
Apostoli's,  partly  the  old  method. 

Db.  Zweifel  (Leipsic)  said  that  the  use  of  the  current 
between  175-200  milliamp^res  was  very  painful ;  he  opposed 
the  galvano-puncture.  The  simple  intra-uterine  method  is  in 
all  cases  entirely  free  from  risk,  where  acute  inflammation  is 
absent.  The  myomata  become  smaller ;  but  after  the  cessa- 
tion of  the  treatment  the  growth  again  increases,  excepting  in 
older  patients,  when  the  diminution  is  permanent.  The  posi- 
tive pole  quells  the  bleeding ;  the  negative  pole  seems,  at  least 
at  first,  rather  to  increase  it.  The  subjective  condition  of  the 
patients  is  as  a  rule  remarkably  benefited. 

Dr.  Gombaboff  (Moscow)  stated  that  in  cases  of  interstitial 
and  submucous  myomata  the  intra-uterine  pole  must  be  used, 
but  in  subserous  fibroids  the  galvano-puncture.  Electricity  gives 
the  best  results  in  non-degenerated  and  isolated  myomata, 
bleeding  and  pain  being  usually  reheved.  Faradisation 
obviated  the  pain  in  inflammation  of  the  womb  and  ap- 
pendages. In  carcinoma  the  pains  can  be  relieved  by  a 
current  of  1,000  milliampdres  in  less  than  five  minutes.  In 
500  cases  so  treated  no  accident  has  occurred.  In  very  strong 
currents  it  is  necessary  to  use  chloroform  now  and  again. 
Galvano-puncture  causes  isolated,  non-degenerated  myomata 
to  lessen,  or  to  vanish,  as  has  been  proven  by  ensuing  lapa- 
rotomy. In  one  case  of  extra-uterine  pregnancy  after  15 
punctures,  a  complete  disorganisation  of  the  placenta  and 
foetus  of  six  months  was  caused,  laparotomy  afterwards  being 
performed.  Twenty  cases  of  the  same  lesion  up  to  the  third 
month  were  in  this  way  completely  cured.  The  daily  use  of 
faradisation  for  from  15-80  minutes  had  the  best  results  in 
pruritus,  vaginismus,  dyspareunia  and  dysuna. 

Geobge  Bubfobd. 

PoBBo*s  Opebation. — ^Mr.  Lawson  Tait  shewed,  at  the 
Birmingham  Branch  of  the  British  Medical  Association,  a 
patient  in  whom  he  had  amputated  the  pregnant  uterus  with 
the  result  of  sa\ing  both  mother  and  child.  In  this  case 
Gaasarian  section  hsid  been  done  for  the  woman's  first  labour 
after  the  child  had  been  eviscerated,  and  three  subsequent 
premature  labours  had  been  induced.  The  patient  made  an 
easy  recovery  from  the  operation,  and  asserted  that  she  had 
suffered  far  less  pain  and  discomfort  than  in  any  one  of  the 
previous  four  operations.  It  was  exactly  six  weeks  since  the 
operation,  and  the  patient  was  in  perfect  health  and  able  to 
do  all  her  domestic  work,  including  heavy  washing.  The 
child  was  very  healthy  and  growing  well.    This  was  the 


sss^5nr?sf*^      periscope.  123 


seventh  case  in  whicli  Mr.  Tait  had  operated.  All  had 
recovered  except  one,  in  which  the  operation  was  done  for 
cancer,  and  in  that  case  the  patient  succumbed  to  the  progress 
of  the  disease,  the  child  being  still  alive. — Birmbujliam  Medical 
Etrievc,  December. 


DISEASES  OF  CHILDBEN. 

Apbosexu.  m  CHnj>BEN. — ^Aprosexia  is  derived  from  the 
Greek,  and  means  heedlessness,  and  is  a  name  given  to  a 
condition  in  children  where  there  is  a  marked  want  of  the 
capacity  for  attention  dependent  on  adenoid  growths  in 
the  naso-pharynx,  and  often  associated  with  deafiiess.  This 
condition  was  first  pointed  out  by  Professor  Guye,  of 
Amsterdam,  in  1887.  The  deafness  when  occurring  is  due  to 
the  growths  occluding  the  orifice  of  the  eustachian  tube.  The 
heedlessness  is  thought  to  be  ovnng  to  a  congestion  of  the 
venous  and  lymphatic  systems  in  the  anterior  lobes  of  the 
brain,  caused  by  a  blockage  in  the  lymphatics  in  the  pharynx 
!md  nose,  with  which  those  in  the  forepart  of  the  brain  are  in 
commnnication,  this  blockage  being  due  to  the  presence  of  the 
adenoid  growths  in  the  increased  fibrous  connecting-tissue 
associated  with  them.  A  support  to  this  theory  is  afforded 
by  Ferrier  experiments  on  monkeys  in  which  he  found  that 
extirpation  of  the  pre-frontal  lobes  of  the  brain  was  followed 
by  a  marked  impairment  of  the  faculties  of  attention  and 
observation. — Neic  York  Medical  Record,  Nov.  29th,  1890. 

Pneuiionia  in  Children. — Dr.  Stowell  read  before  the 
Academy  of  Medicine,  New  York,  a  study  of  100  cases  of 
pneumonia  occurring  in  his  practice  in  children  under  10  years 
of  age.  Of  these  80  were  of  the  croupous  form,  and  the  rest 
catarrhal.  Seventeen  cases  proved  fatal ;  three  of  these  were 
lobar  cases,  two  of  them  being  double,  five  were  lobular  cases 
following  rubeola,  and  five  were  lobular  following  complicat- 
ing pertussis,  this  last  being  an  extremely  fatal  admixture  of 
diseases,  only  two  out  of  seven  recovering.  As  grave  symp- 
toms in  pneumonia  cases  he  mentions  (a)  intermittent  pulse, 
(b)  profiise  and  early  sweating,  (c)  urine  pale  in  colour  before 
the  crisis  has  taken  place,  (d)  profuse  and  persistent  diarrhoea, 
(e)latedelirium,(f)  the  co-existence  of  pneumonia  in  both  lungs 
specially  in  fat  children,  (g)  and  pneumonia  beginning  as 
simple  collapse  of  the  lung  without  bronchitis.  Cerebral 
symptoms,  which  he  considered  as  of  slight  import,  he 
noticed  to  be  much  more  frequent  when  the  apices  were 
attacked.  He  quotes  various  percentages  of  mortality  from 
Cerent  authors,  which  amount  gener^y  from  10  to  20  per 
<^t.  with  the  remarkable  exception  of  Laennec,  who  had 

K— 2 


1 0A  T>i?DTartnT>i7  Monthly  Hoi&a»o|ittbie 

1  ^TC  PERISCOPE .  Hmvimw.  Pftb. «.  1»1. 


Beview,  Feb.  S,  1891. 


a  mortality  of  only  8  per  cent.,  and  who  treated  all  his  cases 
with  tartar  emetic. 

Dr.  Stoweirs  own  mortality  was  17  per  cent.,  he  aimed  a.t 
no  specific  treatment,  hut  only  to  make  his  patients  as 
comfortable  as  possible,  and  to  aid,  by  ordinary  means, 
a  speedy  and  favourable  termination,  belieying  with  Ziemssen 
that  "  nature  cures,  and  the  only  duty  of  the  physician  is 
to  maintain  life  until  the  cure  is  effected." — Xew  York  MediceU 
Record,  Nov.  1,  1890. 

Treatment  of  Binowobm. — S.  J.  Y.  Simpson,  of  Missouri, 
recommends  the  following  treatment  for  ringworm  : — First 
cut  the  hair  short  and  wash  the  scalp  well  with  green  soap, 
and  then  apply  with  a  camel-hair  brush  a  solution  of  corrosive 
subhmate  in  collodion  of  the  proportion  of  2  grains  to  the 
ounce.  He  claims  for  it  four  advantages,  viz.,  (1)  The  corro- 
sive sublimate  destroys  the  fungi ;  (2)  the  ether  of  the  collodion 
penetrates  to  the  root  of  the  hair,  conveying  the  corrosive 
sublimate  to  the  roots  of  the  disease  ;  (8)  the  film  formed  by 
the  collodion  shuts  off  the  supply  of  oiygen  to  the  fungi,  and 
thus  helps  to  destroy  them ;  (4)  the  film  also  prevents  the 
hairs  from  flying  about  through  the  atmosphere,  and  carrying 
the  germs  to  other  persons.  He  states  that  he  has  treated  a 
large  number  of  cases  with  this  solution  with  excellent 
results. — Medical  Reprints,  September  16. 

Pathological  Variations  in  Human  Milk. — S.  Botch,  of 
Boston,  gives,  in  a  paper  published  in  the  Archives  of  Pediatrics 
for  November,  the  results  of  analysis  of  normal  and  patho- 
logical milk  in  the  human  subject.  He  shows  that  when  the 
infant  is  thriving  the  relative  proportions  of  the  solids  to  each 
other  and  to  the  water  vary  only  within  narrow  Hmits.  When 
the  intervals  between  the  nursings  are  too  long  the  proportion 
of  water  is  too  great,  and  when  they  are  too  short  the  propor- 
tion of  solid  is  increased.  Diet  and  exercise  caused  marked 
effects  on  the  composition  of  the  milk.  A  sedentary  life  with 
abundance  of  rich  mixed  food  increased  the  ratio  of  the  total 
solids  to  the  water,  the  increase  being  due  to  a  larger  propor- 
tion of  albuminoids  and  fats,  while  the  sugar  was  little,  if  at 
all,  affected.  As  a  general  rule  the  amount  of  fat  may  be 
increased  by  increasing  the  quantity  of  meat  in  the  diet,  and 
the  albumen  may  be  decreased  by  moderate  exercise.  An 
excess  of  albuminoids  in  the  milk  is  apt  to  produce  digestive 
disturbances  in  the  child,  and  therefore  the  nursing  mother 
should  take  a  fair  amount  of  exercise. 

Asthma  of  Miller.  —  For  this  complaint  (so-called) 
Dr.  E.  M.  Hale  has  used  a  tincture  of  dlphium  (Bosinweed) 
with  success.  It  is  also  useful  for  asthmatic  cough,  and 
closely  resembles  tui-pene,  terebenc  and  lobelia  in  its  action. — 
I]om,  Recorder,  November.  T.  G.  Stonham,  M.D. 


ISf^St^  PERISCOPE.  12rt 


OTOLOGY,  &c. 

Ejjd  MuBiATicuM  IN  Ear  Diseases. — E.  H.  Linnell,  M.D., 
in  Joum<d  Ophth,,  Otolofiy  and  Lari/ngolofftj,  Oct.,  1889,  finds 
kali  mui\  of  use  iu  ''subacute  catarrhal  and  proliferous 
inflammation  of  middle  ear  with  granular  pharyngitis ; 
letracted  membrana  tympani ;  adhesions  and  inspissated 
secretions  in  tympani ;  sequelsB  of  suppurative  cases  ;  closure 
of  Eustachian  tube  and  stuffy  sensation ;  tinnitus,  like  a 
swarm  of  bees;  atrophied  condition  of  the  meatus,  and 
pallor  of  mucous  membrane."  These  conclusions  are  drawn 
from  a  series  of  oases  treated  with  kali  vmr,,  other  forms  of 
ear  disease  were  not  benefited. 

EnoLoaT  of  ATSopmc  Gatasbh. — E.  L.  Mann,  M.D.  (ibid) 
considers  that  in  atrophic  catarrh  a  retention  of  secretion  is 
always  the  real  cause.  Mucus  shut  up  behind  nasal  hyper- 
trophies, or  in  any  way  retained,  leads  to  a  maceration  of  the 
epithelium,  and,  finally,  to  its  destruction ;  the  ciHas  being 
lost;  the  mouths  of  the  glands  blocked  up  and  secretion 
oontinuing  causing  dilatation  of  duct,  with  pressure  of 
snrroanding  structures  and  consequent  atrophy.  Hence 
perfect  cleiuiliness  is  the  first  requisite  in  treatment,  and  all 
secretions  should  be  got  rid  of.  After  cleansing  some  oily 
substance  should  be  used  to  lubricate  and  protect  the 
membrane. 

Febbum  Picricum  in  Deafness. — B.  T.  Cooper,  M.D.,  gives 
a  case  of  deafness  in  both  ears  cured  by  ferrum  2>icruum,  the 
symptoms  being  headache,  when  tired,  across  the  forehead 
and  eyeballs  ;  deafiiess  worse  in  damp  weather  and  in  easterly 
winds;  skin  of  a  chronically  jaundiced  colour  ;  hearing  only 
^  inches  right  ear,  and  1  inch  left  ear.  Ferr.  pic.  8rd  dec, 
seven  drops  to  i  oz.  of  water,  and  five  drops  of  this  daily. 
He  adds  that  the  indication  was  the  hepatic  complication  and 
the  overpowering  effect  of  fatigue.  Hahnemann  Monthly, 
Nov.,  1890. 

AiuEMiA  and  Intra-nasal  Operations. — Dr.  Holbrook 
Cnrtis,  of  New  York,  considers  that  all  cases  of  nasal 
stenosis  are  accompanied  by  ansemia;  and  after  operation 
he  finds  that  there  is  a  constant  increase  in  the  oxyhiemoglobin 
contained  in  the  blood. — International  Journal  of  Surqery, 
Feb.,  1890. 

Relation    between    Hypertbophy   of   pharyngeal   tonsil 

AXD      recurring       PAPILLOMA      OF      CHILDREN. Mr.     LounOX 

Browne  reported  a  case  at  the  November  meeting  of  the 
British  Laryngological  and  Bhinological  Association,  which 
shows  some  connection  between  these  two  diseases.    The 


126  PEBiscoPE.         "'^L?Sr?tSI' 


Beriefw,  Feb.  2,  ISOl. 


child  was  six  and  a-half  years,  and  had  warty  growths  in  the 
larynx,  which  were  removed  under  chloroform  in  three 
sittings.  Fourteen  days  after  the  last  operation  the  voice 
was  reported  as  getting  more  husky,  and  on  examination  the 
cords  were  found  highly  inflamed.  Besides  this  she  had  fits 
of  crying  and  night  frights.  A  large  mass  of  adenoids  was 
found,  and  these,  together  with  part  of  the  tonsils,  were 
removed,  and  in  six  weeks  the  child  was  in  perfect  health. 
The  post  nasal  adenoids  in  these  cases  are  supposed  to  act  by 
producing  mouth-breathing,  and  thus  chronic  laryngeal 
catarrh  which,  all  observers  are  agreed  upon,  is  an  important 
factor  in  the  production  of  non-malignant  growths  of  the 
larynx.  D.  Wbioht. 


NEUROLOGY. 

Hysteria. — At  the  Birmingham  and  Midland  Counties 
Branch  of  the  British  Medical  Association  (November,  1890), 
Dr.  Saundly  read  a  paper  on  the  treatment  of  hysteria.  He 
defined  the  disease  as  an  exaggerated  demand  for  sympathy, 
leading  to  the  gradual  abandonment  of  the  care  of  the  body 
and  the  control  of  functions.  The  cure  must  be  a  **  self- 
cure.*'  The  essential  element  in  treatment  is  isolation  from 
human  sympathy.  Massage,  forced  feeding,  &c.,  occupy  a 
secondary  place.  At  the  same  meeting  Dr.  Douglas  related 
two  cases  of  hysterical  paralysis. 

Case  I. — A.  F.,  aged  80.  As  a  girl  often  ailing.  At  17 
diphtheria,  followed  by  great  weakness  of  mind  and  body. 
At  18  febrile  attack,  lasting  six  weeks,  with  paralysis  of 
bladder  and  almost  complete  paraplegia,  the  latter  lasting 
18  years.  Treatment  did  little  good  until  she  was  removed 
from  home  in  December,  1889,  and  treated  by  massage, 
faradism,  and  forced  feeding.  In  six  months  was  able,  with 
assistance,  to  get  about  with  crutches.  In  nine  months 
could  walk  short  distance  without  help,  and  was  still 
improving. 

Case  II. — M.  E.  W.,  aged  21.  As  a  young  girl  had  good 
health.  At  12  years  became  weak  and  irritable.  At  18  years 
had  catalepsy,  with  loss  of  consciousness  about  8  weeks, 
followed  shortly  by  violent  hysteria ;  was  afterwards  helpless 
and  was  also  speechless  (except  at  times  to  mother  in  scarcely 
audible  whispers)  until  July,  1890.  June,  1890,  admitted  to 
hospital  and  treated  by  seclusion,  tonics,  faradism,  massage, 
and  exercises  in  reading  aloud.  In  four  weeks  able  to  talk  and 
walk.  Still  continues  to  improve. — IJirw.  Med.  Ber.,  Dec., 
1890. 


S^^rSX^  PERISCOPE.  127 


MEDICINE. 

Gabdug  Dyspn(ea. — ^Dr.  E.  M.  Hale,  writing  on  the  above, 
in  the  Southern  Journal  of  HomcBopathy  (October),  reoommenda 
reratrmn  viride  to  reduce  arterial  tension.  •*  Nitrite  of  amy  I 
should  only  be  given  in  desperate  oases,  when  the  face  is 
deadly  pale,  and  like  the  hands  and  feet,  cold  and  covered 
with  cold  sweat,  while  the  pulse  is  almost  extinguished." 
A  few  inhalations  restore  the  pulse.  For  the  purpose  of 
mitigating  future  attacks  aurum  iodid.  and  attr.  mur,  not.  are 
lecommended ;  in  the  2x  trituration  these  remedies  also  act  as 
diuretics.  The  alternation  of  atropine  8x,  with  strychnia  2x, 
three  or  four  hours  apart  is  said  often  to  give  long-lasting  relief. 

To  allay  the  nervousness  attending  dyspnoea,  coffaa^ 
KUteUarin,  monobromide  of  camphor,  mmbtU  and  chamomilla,  and 
especially  chloroform.  Quebracho  ^  (gtt  5-10),  or  the  alkaloid 
aspido-gpermine  2x  (gr.  2-5)  is  the  best  remedy  Dr.  Hale  has 
used  for  continuous  dyspnoea,  aggravated  by  the  slightest 
exercise,  and  rendering  active  exercise  impossible.  Anhalonium 
is  invaluable  in  the  dyspnoea  of  fatty  degeneration. 

The  Bed  Line  alono  the  Gums. — Dr.  Snader,  of  Phila- 
delphia, has  written  a  paper  *'  to  disestablish  the  red  line  "  as 
a  diagnostic  mark  of  phthisis.  In  the  course  of  observations 
on  the  point  in  question  he  concluded  that  it  might  be 
ascribed  (1)  to  improper  care  of  the  teeth ;  (2)  to  an  idiosyn- 
cratic tendency  to  the  excessive  accumulation  of  dental  debris, 
either  in  the  form  of  tartar  or  the  deposit  of  salt  from  the 
saliva;  or  (8)  to  great  general  or  local  connective  tissue* 
relaxation  and  want  of  tone,  &c.,  due  to  mercury,  scurvy, 
&c.  He  has  noticed  an  ephemeral  red  line  in  the  mouths  of 
etuldren  after  eating  fruit. — Horn,  Recorder,  November. 

HiEMOBRHAOE  FBOM  THE  Rectum. — Dr.  Louiso  Laimin 
records  two  cases  of  this  condition. 

Case  I. — A  multipara,  set.  45,  suffered  from  rectal  hsemorr- 
hage  five  years.  It  was  painless,  but  preceded  by  colicy 
pain  about  the  r^on  of  the  umbilicus.  The  blood  was  bright- 
red  and  fluid,  and  considerable  in  quantity.  She  first  received 
heU.,  ipecac.,  china,  phos.  and  hamamelie,  but  with  no  good 
r^ult.  She  was  idso  seen  by  Dr.  H.  M.  Dearborn  who  found 
only  one  small  spot  of  ulceration  in  the  rectum,  but  it  had  no 
bleeding  point.  There  wa«  no  sign  of  hsemorrhoids,  fissure 
of  fistcda.  She  was  next  given  erigeron.  The  hsemorrhage 
persisting,  lachesU  80  was  administered.  The  only  indications 
were: — Chiefly  worse  on  waking  and  late  in  the  afternoon,  and 
the  feeling  that  the  clothing  around  the  waist  must  be  worn 
very  loose  to  be  comfortable ;  also  scantiness  of  menses,  which 


128  NOTABiLiA.         "S!S£:^T?^ 


were  regular  and  dark  in   colour.      The  hiemorrhage  90on 
ceased  and  the  patient  left  the  hospital  well. 

Case  II. — ^A  married  woman  with  a  history  of  bleeding  from 
the  rectum  very  similar  in  detail  to  that  of  the  first ;  it  was 
of  twelve  years'  standing.  Nothing  abnormal  locally  except 
a  bluish  congested  appearance  of  the  rectum.  She,  too,  was 
ordered  lachetis  80  every  two  hours.  The  hamorrhage  re- 
curred twice  during  the  next  week  and  then  ceased,  and  had 
not  returned  three  months  later. — Nortf^  Amer,  Jaw.  of 
Homceopathy,  Sept.,  1690. 

A  SooTmNO  Dressimo. — ^Dr.  Green  (Little  Bock,  Ark.) 
recommends  the  following  as  a  soothing  application  after 
operations  upon  the  mucous  membrane  of  the  nose  or  nasal 
fossae :  Carbolic  acid,  gr.  ii. ;  tr.  caUnduUB,  gtt.  xxx. ; 
lanoUHf  5vii. ;  almond  oil,  5i. 

Antidote  in  Cocaine  Poisoning. — To  overcome  the  depressed 
cardiac  action  that  is  sometimes  induced  by  the  local  applica- 
tion of  cocaine^  Dr.  Green  (Little  Rock)  advises  digitalim  in 
^  grain  dose,  and  hyoscyamine  in  ^^  grain  dose  to  promptly 
reUeve  the  nervous  symptoms. — Joum,  of  OphtJiaL,  Otol,,  and 
LaryngoL,  July,  1890. 


NOTABILIA. 


LECTURES  AT  THE  LONDON   HOMCEOPATHIC 

HOSPITAL. 

The  introductory  lecture  to  the  post-graduate  course  at  the 
London  Homoeopathic  Hospital  was  delivered  by  Dr. 
J.  H.  Clarke,  on  Friday,  16th  ult.  In  some  pre£fttCry 
remarks  he  stated  that  he  preferred  the  out-patient  depart- 
ment to  the  wards  for  teaching  and  testing  purposes.  The 
lecture  was  entitled  The  Peculiar  Features  of  Uie  Hmnaopathic 
Materia  Medica,  which  Materia  Medica  forms  the  peculiar 
feature  of  homoeopathy.  In  other  branches,  said  the  lecturer, 
the  two  schools  are  alike.  After  briefly  sketching  the  way 
in  which  Hahnemann  arrived  at  the  rule  of  similars,  Dr.  Clarke 
pointed  out  that  the  expression  Materia  Medica  was  an  un- 
fortunate one— what  Hahnemann  termed  the  Materia  Medica 
was  not  the  medicinal  substances  themselves,  nor  a  descrip- 
tion of  their  botanical,  chemical,  physical  and  physiological 
properties,  but  (ideally)  a  record  of  the  pure  effects  of  drugs 
on  the  healthy  body.  He  would  have  preferred  the  use  of 
such  a  term  as  drug  symptomatology  or  semeiology. 

The  peculiar  features  were  1st,  the  plain  statement  of  the 
effects  of  drugs  on  the  body  ;  2nd,  the  ascertaining  of  these 


SSi^FSySSr  SOTABItlA. 129 

effects  by  iestmg  the  drugs  (in  various  doses)  on  the  healthy 
subject — by  "provings;"  8rd,  the  Hahnemannian  *<  schema,'* 
or  arrangement  of  the  symptoms  into  anatomical  groups  for 
reference.  An  appendage  to  the  Materia  Medica  was  the 
repertory  or  symptom  index.  The  repertory  might  be  called 
the  "road  and  street  map  of  the  Materia  Medica  country." 

Dr.  Clarke  invited  all  medical  practitioners  and  any  medi- 
cal students  who  had  the  leisure  and  courage  to  test  homoeo- 
pathy for  themselves,  by  attending  the  hospital  regularly  for 
an  adequate  period. 

The  remaining  lectures  will  be  given  at  5  p.m.  in  the 
Board  Boom  of  tibe  Hospital : — 

Feb.  6th. — Modem  Methods  of  Precision  in  Pelvic  Diatom  : 
WUk  Clinical  Cases.    By  G.  H.  Burford,  M.B. 

Feb.  18th. — Differential  Diagnosis^  Prognosis  and  Treatment 
cf  Abdominal  Tumours ;  With  Clinical  Cases.  By  G.  H.  Bur- 
ford,  M.B. 

Feb.  20th  and  27th. — On  Hu  Treatment  of  some  of  the  Com- 
moner  Diseases  of  the  Lungs ;  With  Clinical  Cases.  By  J.  Galley 
Blackley,  M.B.,  Lond. 

March  6th. — The  Diagnosis  of  Errors  of  Effraction  and 
Anomalous  Action  of  the  Ocular  Muscles.     By  Mr.  Knox  Shaw. 

March  18th. — Adenoid  Vegetation  of  tlie  Naso-Pharymv.  By 
Mr.  Ejiox  Shaw. 

FIFTY  YEAB8  OF  HOM(EOPATHY  IN  BOSTON,  U.S.A. 

The  homcBopathic  physicians  of  Boston  celebrated  the  jubilee, 
or  as  they  term  it,  "  semi-centennial "  of  the  introduction  of 
homoeopathy  into  their  city.  A  banquet  at  the  Hotel  Yendome 
was  held  on  the  2drd  ult.  in  honour  of  the  occasion.  The 
Mowing  extract  from  the  circular  of  invitation  issued  by  the 
committee  gives  a  succinct  but  noteworthy  record  of  progress 
during  these  fifty  years : — 

"In  December,  1840,  three  physicians  assembled  in  thid 
Tidnity,  and  formed  the  homoeopathic  fraternity.  As  its 
numbers  increased,  and  its  circle  widened,  it  was  called  the 
Massachusetts  Homoeopathic  Fraternity.  Later  it  received  the 
name  of  the  Massachusetts  Homoeopathic  Medical  Society, 
and  in  1856  it  was  incorporated  by  the  Legislature  of  the 
State.  It  is  fifty  years  the  present  December  since  this 
beginning  of  the  Society,  and  it  seems  fitting  that  its  semi- 
centennial anniversary  should  be  marked  in  an  appropriate 
manner.  When  we  consider  that  within  a  few  years  the  State 
bas  established  a  homceopathic  insane  hospital  at  West- 
boronghy  which  contains  over  five  hundred  patients ;  that 
it  bas  in  the  last  year  given  $120,000  for  the  enlargement  of 
ovr  Massachusetts   Homoeopathic  Hospital;    that  a  single 


130  NOTABILU.  "C5;W??SS! 

legacy  has  this  year  been  given,  exceeding  in  amount 
$150,000,  and  which  will  be  used  for  the  support  of  the 
hospital ;  that  the  city  has  contributed  a  large  site  of  land  on 
which  to  erect  a  homoeopathic  dispensary,  and  that  generous 
donations  have  been  given  therefor ;  that  five  hospitals  have 
been  established  in  various  cities  in  the  State,  in  which 
homoeopathic  and  allopathic  treatment  are  equally  provided ; 
that  a  medical  school  has  been  established  in  connection  with 
Boston  University,  which  has  proved  very  successful,  and  has 
added  large  numbers  of  well-educated  physicians  to  our 
ranks  ;  we  have  many  causes  for  gratitude  and  rejoicing." 

THE    LATE    DR,    MOORE    AND    THE  LIVERPOOL 
HOMCEOPATHIC  MEDICO-CHIRURGICAL  SOCIETY. 

At  a  recent  meeting  the  above  society  adopted  the  following 
resolution : — 

'*  We,  the  members  of  the  Homoeopathic  Medico-Chirurgical 
Society  of  Liverpool,  beg  to  express  our  heartfelt  condolence 
with  Mrs.  Moore,  and  the  family,  on  the  recent  removal  by 
the  hand  of  death,  of  our  colleague,  Dr.  John  Moore.  Dr. 
Moore  was  a  distinguished  representative  of  the  class  of  medi- 
cal converts  to  whom,  perhaps,  more  than  any  other,  are  due 
the  development  and  spread  of  homoeopathy.  For  he  was 
already  a  highly  esteemed  and  successful  general  practitioner 
when  the  claims  of  homoeopathy  came  under  his  attention. 
When  convinced  of  the  fundamental  truth  of  the  homoeopathic 
principle,  he  was  impelled  by  his  conscience,  rooted  in  trae 
Christian  faith,  to  carry  out  openly  and  avowedly  the  principle 
as  far  as  applicable  in  practice,  in  spite  of  persecution  by  the 
medical  men  on  one  hand,  and  the  ignorant  solicitations  of 
his  patients  for  their  old-fashioned  palliatives  on  the  other. 
With  his  scrupulous  conscientiousness  and  otherwise  high 
moral  and  religious  character,  and  with  a  practical  experience 
already  ripe,  he  occupied  an  important  position  among  us,  in 
working  out  the  difficult  question  of  fixing  how  far  allopathic 
auxiliaries  are  to  be  admitted  in  a  practice  predominately 
homoeopathic. 

''  For  these  reasons,  besides  the  personal  esteem  and  affec- 
tion in  which  he  was  held  by  us  all,  we  feel  our  loss  to  be  very 
great ;  and  all  hope  and  trust,  for  the  sake  of  our  cause,  that 
numerous  converts  of  the  same  high  character  will,  ere  long, 
again  be  added  to  our  ranks." 

"  STONE-THROWING." 
The  Hainaopathic  Journal  of  Obstetrics,  July  1890,  complains 
that  it  is  often  quoted  without  the  sectarian  adjective  in  its 
title,  leading  to  mistakes  of  identity.    The  same  issue  of  the 


^t^^^rrST"  NOTABILIA.  181 


M&fim,tA.t,h»l, 


said  periodical  styles  our  Renew  (we  presume  it  is  ours,  for  it 
refers  to  an  article  originally  appearing  in  our  pages)  HonueO' 
patkic  Medical  Review.  "  Dwellers  in  glass  houses  should  not 
throw  stones."  Our  American  contemporaries  also  occa- 
sionally quote  from  our  pages  as  from  the  British  HomoBo- 
pailiic  Review,  no  such  paper  existing.  The  title  we  have  used 
for  84  years  is  on  the  cover  and  at  the  head  of  every  page. 

BIBIUNGHAM    MALE    ADULT    PROVIDENT 

INSTITUTION. 
The  49th  report  of  this  active  and  flourishing  institution  is 
JQst  issued.  Progress  in  every  department  is  noted.  A  truly 
benevolent  and  non-pauperising  institution,  its  good  manage- 
ment renders  it  extremely  popular  in  Birmingham.  It  has 
grown  steadily  and  rapidly  since  its  formation.  On  its  medi- 
cal staff,  one  of  the  consulting  physicians  and  two  of  the 
surgeons  are  homoeopathists. 

THE  TREATMENT  OF  BALDNESS. 
The  treatment  recommended  by  Lassar,  of  Berlin,  for 
alopecia  pityrodes  and  alopecia  areata  has  been  attended  with 
some  brilliant  results.  According  to  Dr.  Graetzer's  article 
in  the  Therapeutisclie  MonatsHchri/t,  but  few  cases  resist  the 
treatment,  and  after  a  few  apphcations  the  downy  sprouts  may 
be  seen.  The  following  procedure  is  to  be  repeated  daily : 
1.  The  scalp  should  be  lathered  well  with  a  strong  tar  soap 
for  ten  minutes.  2.  This  lather  is  to  be  removed  with 
lake-warm  water,  followed  by  colder  water  in  abundance ; 
then  the  scalp  is  to  be  dried.  8.  A  solution  of  biihloride  of 
mercury,  1  to  900,  the  menstruum,  being  equal  parts  of  water, 
fjlyceriTie  and  cologne  or  alcohol,  is  to  be  rubbed  on.  4.  The 
scalp  is  then  rubbed  dry  with  a  solution  containing 
^tta-naphthol,  1  part,  and  absolute  alcoJwl,  200  parts.  6.  The 
final  step  in  the  process  is  an  anointing  of  the  scalp  with  an 
ongaent  containing  two  parts  of  salicylic  acid,  three  parts  of 
timiire  of  benzoin,  and  100  parts  of  neat's  foot  oil.  This  treat- 
ment should  be  persisted  in  for  a  period  of  six  weeks  or 
longer.  Lassar  is  reported  to  have  treated  a  thousand  cases 
in  the  manner  described.  .  .  .  The  parasitic  theory  of 
the  causation  of  hair-fall  as  advocated  by  Unna  and  Sehlen, 
has  its  support  in  those  not  infrequent  cases  where  the  trouble 
seems  to  be  referable  to  the  use  of  unclean  utensils  by  the 
barber.  In  this  class  of  cases  Lassar*s  treatment  will  find  its 
indications  and  successes  more  frequently  than  in  that  other, 
neurotic,  class  described  by  Michelson  and  Shiitz  as  occurring 
in  young  persons  who  have  a  **  nervous  "  history  or  have  met 
^th  a  traumatism  affecting  the  head  and  brain. — Mnl.  Era^ 
%,  1890. 


132  NOTABiLiA.       ^?:^^?sr?iS! 


MERCURIAL  TREATMENT  OF  DYSENTERY. 

Dr.   Lemoine   has  had  an  opportunity  to  treat  102  cases  of 
dysentery  in  the  miKtary  hospital  of  Oran.    Fifty-four  were 
treated  with  subhmate  clysters,  being  those  who  could  not 
take  calomel  owing  to  some  disturbance  of  the  stomach. 
Twenty-one  used  calomel,  with  a  beginning  dose  of  1  gramme 
followed  in  the  next  two  or  three  days  by  smaller  doses ;   11 
were  treated  with  ipecacuanha ;  and  16  in  the  beginning  with 
ipecacuanha,  and  later  with  mercury.    No  deaths  were  noted, 
and  ordinarily  1  gramme  of  calomel  was  sufficient  to  check 
the  slimy  and  bloody  stools.    In  28  of  the  cases,  the  favourable 
results    were    immediate.    The  clysters,  consisting  of  200 
grammes  of  a  five  per  cent,  solution,  were  commonly  retained 
about  ten  minutes,  and  worked  rapid  improvement  in  the 
tenesmus  and  slimy  discharges.    In  some  cases,  owing  to  the 
sensitiveness  of  the  anus,  it  had  to  be  painted  with  a  solution 
of  cocaine.      In    many   cases    the    calomel  was    given  in 
connection  with  the  clysters.    Poisonous  symptoms  were  not 
noted  in  any  case.    The  author  refers  the  favourable  action 
of  mercury  in  these  cases  to  its  antiseptic  power.— Netr  York 
Medical  Record,  Oct.  18. 

FAILURE   OF  THE   SUSPENSION    TREATMENT   OF 

LOCOMOTOR  ATAXY. 
Thebe  are  signs  in  the  air  that  the  suspension  treatment  of 
progressive  locomotor  ataxy,  respecting  the  beneficial  result  of 
which  we  have  heard  so  much  during  the  last  year  or  two,  is 
likely  to  follow  Bergeon*s  recto-insuffiation  treatment  and 
ApostoH's  electrical  treatment  for  uterine  fibroids.  The  ease 
with  which  trained  observers  become  convinced  of  the  value 
of  a  meithod  which  subsequent  experience  shows  to  be  idle,  if 
not  injurious,  is  really  marvellous,  and  points  to  certain  defects 
in  the  constitution  of  the  individual  mind.  The  great  point, 
to  begin  with,  is  to  estabUsh  indubitably  the  nature  of  the 
disease  which  it  is  proposed  to  cure,  and  this  is  often  not 
possible,  or,  if  possible,  is  rarely  accomplished.  Both  operator 
and  subject,  moreover,  seem  to  be  hypnotized  by  the  concen- 
tration of  the  attention  on  a  given  object,  and  the  result  is  an 
amehoration  which,  in  the  hands  of  less  enthusiastic  observers, 
is  frequently  conspicuous  by  its  absence.  These  medico-his- 
torical facts  should  teach  us  to  show  a  becoming  diffidence  in 
placing  too  implicit  confidence  in  new  remedies.  Who  will 
venture  to  assert  that  a  time  will  not  come  when  the  pana- 
ceal  quaUties  of  antipyrin  will  have  sunk  into  oblivion  (though 
not  without  having  made  the  fortunes  of  a  number  of  specu- 
lators), crushed  by  the  pretensions  of  new  derivatives  from 
other  series  at  present  unknown  to  the  chemical  and  thera- 
peutic world. — Hospital  Gazette. 


f^^mS^  NOTABILU.  133 


Beriev,  fleb.  2, 1801. 


DEATH  FBOM  CHLOROFORM. 

The  question  of  ansdsthetics  will  always  be  the  order  of  the 
day,  inasmuch  as  a  truly  scientific  and  reliable  anaesthetic  has 
not  been  found.  At  the  present  time  there  are  few  surgeons 
that  it  does  not  deeply  interest.  Many  are  the  records  of 
secidenta  whi<di  are  known,  and  more  still,  perhaps,  are  the 
onpnblished  cases. 

The  following  is  a  report  of  a  case  of  death  by  chloroform 
that  happened  in  circumstances  which  are  like  those  present 
in  all  cases,  that  is  to  say  the  accident  was  unforeseen 
and  nnexplained.     Two  points,  nevertheless,  are  important  to 


In  the  first  place,  the  patient  had  already  been  chloroformed 
Beveral  times,  and  notably  a  month  previously ;  then  the 
anesthetic  employed  was  chloroform  mixed  with  the  fourth  of 
ethjlio  alcohol,  according  to  the  formula  of  B^gnault.  Now 
many  surgeons,  on  the  authority  of  English  surgeons,  notably 
Spencer  Wells,  consider  this  chloroform  (mixture)  perfectly 
hannless. 

Having  said  this,  let  us  state  in  a  few  words  the  previous 
fllnesaof  the  patient  and  his  condition  at  the  time  of  anaasthe- 
tisation,  then  will  follow  the  phenomena  before  death,  and 
lastly  the  results  of  the  autopsy. 

P.  B.,  a  cook,  set  49,  admitted  to  THdpital  Tenon, 
Deoember  18th,  1889,  complained  of  a  cachectic  illness, 
presentiQg  numerous  local  manifestations  of  tuberculosis.  He 
had  ahready  undergone  an  operation,  when  eight  or  nine  of 
the  right  ribs  were  scraped  for  tubercular  osteitis.  In  August, 
1889,  he  had  had  the  left  fore-arm  amputated  for  a  white 
swelling  of  the  wrist.  Aftier  admission,  December  18th,  1889, 
he  had  been  chloroformed  January  9th,  1890,  and  undergone 
resection  of  the  outer  extremity  of  the  right  clavicle,  as  before 
for  a  tubercular  lesion.  February  18th  he  was  about  to  be 
operated  on  for  a  chronic  abscess,  situated  in  the  lumbar 
region,  on  the  left  side.  In  spite  of  being  so  emaciated  and 
cachectic  in  appearance  he  seemed  very  well  able  to  undergo 
an  operation  of  this  nature  and  to  take  chloroform ;  for  he 
coughed  very  little  and  presented  no  signs  of  advanced 
pulmonary  disease. 

Feb.  18.  Patient  was  given  chloroform  ^mixture)  at  9.36. 
It  was  administered  according  to  the  clinical  method  em- 
pbyed  in  the  hospitals,  by  means  of  a  folded  towel 
(oompresse)  rolled  into  a  cone,  into  the  hollow  of  which  a  few 
drops  of  chlorofonn  were  poured  from  time  to  time,  and  it  was 
kept  applied  over  the  mouth  and  nose  of  the  patient  lying  on 
his  back.  It  is  a  method  both  contimiom,  since  the  intervals 
daring  which  the  cone  is  raised  to  renew  the  chloroform  are 


1 Q J,  ^riT  AUTT  T  A  Monthly  Hotnaeopatluc 


Ho'ieir,  Feb.  2, 1861. 


very  short,  and  intermittent^  since  these  intervals  permit  the 
patient  to  take  each  time  one  or  two  inspirations  of  pare  air. 

At  the  commencement  of  the  ausesthetic  the  patient  did 
not  attract  any  special  attention  heyond  a  slight  injection  of 
the  face  and  upper  part  of  the  body — a  red  colouration  which 
existed  only  in  places;  the  other  parts  remained  pale  and 
formed  irregular  T&ches. 

These  differences  of  colour  were  especially  marked  on  a 
level  with  the  forehead  and  the  forepart  of  the  head,  which 
was  bald.  But  they  were  present  before  the  administration 
of  the  chloroform. 

During  the  first  minutes  of  giving  the  chloroform  the 
breathing  was  regular,  the  pulse  a  little  accelerated,  the  con- 
junctival reflex  present  by  fits  and  starts,  and  the  patient 
began  to  enter  the  stage  of  excitement ;  he  pronounced  some 
unintelligible  words,  and  at  tlie  moment  when  the  cone  was 
raised  to  renew  the  chloroform  he  turned  his  head  to  the  left 
side  to  spit  a  mouthful  of  hquid  muco-pus.  Durmg  this  first 
period,  which  scarcely  lasted  more  than  three  or  four  minutes, 
the  cone  was  replenished  three  times.  At  this  moment,  the 
operation  being  situated  on  the  dorsal  region,  the  patient  was 
turned  by  assistants,  first  on  his  left  side,  then  turned  back 
again  on  his  right  side. 

During  these  movements  the  patient  was  at  the  height  of 
the  stage  of  excitation  ;  he  sat  almost  upright,  but  was 
restrained  by  assistajits. 

At  the  moment  when  the  patient  was  turned  on  his  right 
side,  and  put  almost  flat  on  his  belly,  there  appeared  a  con- 
traction of  all  the  muscles,  especially  the  muscles  of  the 
thorax  and  abdomen.  The  respiration  suddenly  ceased  without 
any  r&les  or  rattling  in  the  throat  previously  calling  attention 
and  showing  closure  of  the  glottis.  The  eyeUds,  which  pre- 
viously remained  closed,  now  were  wide  open,  and  the  pupils 
widely  dilated ;  conjunctival  reflex  was  abolished.  A  dusky 
colouration  of  the  face  and  the  upper  part  of  the  body 
appeared  ;  the  veins  were  distended.  Inmiediately  the  tongue 
was  seized  and  drawn  forwards,  and  artificial  respiration 
commenced. 

The  movements  imparted  to  the  arms  prevented  the  state  of 
the  heart  and  of  the  pulse  being  observed.  The  finger,  intro- 
duced with  difficulty  to  the  back  of  the  pharynx,  owing  to  the 
contraction  of  the  jaws,  kept  the  entrance  to  the  respiratory 
passages  open,  into  which  the  air  entered  mechanically  by  the 
movements  of  artificial  respiration.  The  pharyngeal  reflex 
existed  at  this  time,  the  jaws  were  kept  open  with  difficulty 
by  a  cork,  but  the  spontaneous  movements  of  respiration  were 
very  feeble. 


SS£!^5rr!!5?*  NOTABILIA.  185 


Berieir,  Feb.  2, 1891. 


Artificial  respiration  was  continued,  and  hypodermic  injec- 
tions of  ether  given  to  the  patient.  Besides  this,  the  two  poles 
of  the  battery  were  placed  on  the  chest,  in  the  epigastric  and 
precardial  region ;  the  *'  hammer  of  Mayor,"  applied  ahnost  at 
the  temperature  of  boiling  water,  only  produced  a  slight  red- 
ness, and  no  vesication  (about  a  quarter  of  an  hour  after  the 
oecarrence  of  the  accident) ;  two  gallons  of  oxygen  were  in- 
haled and  etiter  repeatedly  injected  (5  syringes  of  1  c.c.  alto- 
^ther]. 

Artificial  respiration  had  been  practised  for  10^  hours,  with 
two  or  three  intervals,  the  patient  showed  some  signs  of  spon- 
taneous respiratory  movements  but  at  the  end  of  almost  an 
hour,  during  which  artificial  respiration  was  carried  on  with- 
out intermission,  and  after  exhausting  every  means  of  resusci- 
tation, and  even  while  the  air  continued  to  enter  the  chest 
mechanically,  the  patient  grew  colder  and  colder  and  he  had 
to  be  left. 

At  the  post-morten  made  at  the  Morgue  by  Dr.  Descoats 
nothing  worth  noting  was  discovered  either  in  the  brain  or 
abdomen.  But  on  opening  the  thorax  important  lesions  were 
found.  The  five  or  six  upper  ribs  were  abnormally  moveable 
<m  the  vertebral  column  and  subluxated.  The  anterior  sur- 
face of  the  head  and  neck  of  these  ribs,  as  well  as  the  corres- 
ponding vertebral  bodies  were  denuded ;  the  periosteum,  the 
inter -vertebral  discs,  and  inter -vertebral  hgaments  were 
ahnost  completely  destroyed  for  a  distance  of  about  20  cm. 
&om  the  fourth  dorsal  vertebra  to  the  second  lumbar.  Up 
to  the  same  height  was  an  encysted  sac  of  pus  which  pressed 
upon  the  organs  of  the  mediastinum,  pressing  the  heart 
forward,  and  the  aorta  towards  the  left.  This  immense 
ehionic  abscess  was  closed  -below,  but  presented  pouches 
above  which  insinuated  themselves  between  the  ribs  by  the 
side  of  the  vertebrsa  and  had  a  communication  with  the 
muscular  structure  of  the  back. 

Whilst  dissecting  the  muscles  of  the  back  a  fistulous  tract 
was  found  communicating  with  the  pre-vertebral  sac,  measur- 
ing 18  cm.,  and  extending  from  the  8rd  dorsal  vertebra  to 
to  the  lumbar  abscess  sac  on  which  the  operation  was  about 
to  be  performed. 

This  sac  measured  inside  20  cm*  long  and  12  broad,  and 
was  filled  with  pus. 

There  existed  then  two  enormous  sacs ;  one  pre-vertebral  in 
the  dorsal  region,  the  other,  retro-vertebral  in  the  lumbar 
legion,  and  descending  to  the  sacrum.  Then  two  pouches 
communicated  by  a  fistulous  tract  which  ascended  behind  to 
the  upper  portion  of  the  dorsal  region. 

The  thoracic  viscera  being  examined,  the  larynx,  trachea 


186  NOTABILIA.  ^'SS^?Sr?^^ 


Reriew,  F^b.  %  18B1. 


and  bronchi  were  found  to  contain  liquid  seoretion.  The 
whole  of  the  right  long  was  bound  down  by  biae  membrane^ 
which  caused  it  to  adhere  closely  to  the  thoracic  walls. 

The  same  adhesions  existed  on  the  side  of  the  left  lung, 
but  they  were  less  complete,  and  occupied  only  the  lower 
two-thirds.  Both  the  lungs  were  very  congested  and  engorged 
with  bronchial  secretion,  but  they  only  contained  few  tuber- 
cular manifestations,  no  cavities  nor  pneumonic  or  apoplectio 
patches.  The  heart,  pushed  slightly  forwards  and  to  the  left, 
was  normal  in  size.  No  false  membrane  nor  fluid  was  found 
in  the  pericardial  cavity.  Some  milky  patches  were  found  on 
the  surface  of  the  right  ventricle  in  front  and  behind.  The 
cavities  of  the  heart  contained  black  fluid  blood ;  the  left 
ventricle  was  in  a  state  intermediate  between  systole  and 
diastole.  The  auriculo- ventricular  orifices  were  healthy.  The 
aorta  showed  some  atheromatous  patches.  The  state  of  the 
walls  and  of  the  interior  of  the  pulmonary  artery  was  not 
mentioned. — Archives  Generales  de  MSdecine. 

DETECTION  OF  DEATH. 

Some  years  ago  the  French  Academy  of  Science  offered  and 
awarded  a  prize  of  40,000  francs — ^as  a  stimulus  to  investi- 
gation — ^for  a  certain  and  easy  mode  of  detecting  somatic 
death ;  the  prize  was  awarded  to  a  physician,  who  revealed 
the  fact  that  the  phenomenon  known  as  *'  scarlet  space 
between  the  fingers  when  held  to  the  light'*  immediately 
ceases  when  life  is  absolutely  extinct. — Med.  Era,  July,  1890. 

"LIQUOB    CARNIS." 

Gaffyn's  Liquob  Cabnis  is  an  uncooked  meat  juice,  light 
brown,  and  semi-transparent  in  appearance,  and  devoid  of 
the  suggestive  look  and  taste  of  blood  which  some  liquid  foods 
of  this  class  possess.  It  has  a  decidedly  sweet  taste,  being 
preserved  with  glycerine.  It  has  been  proved  by  experiment 
that  a  considerable  proportion  of  glycerine  interferes  with 
digestion,  hard-boiled  egg  remaining  undigested  by  pepsin  for 
an  indefinite  period  in  the  presence  of  glycerine.  We  are  not 
aware,  however,  if  the  same  is  true  of  serum  albumin,  and 
believe  Liquor  Camis  to  be  an  easily-digested  food.  After 
exposure  to  the  air  for  several  days  the  juice  beeomes  turbid ; 
on  heating  it  becomes  almost  soUd  from  the  coagulation  of 
the  albumin  which  is  present  in  great  plenty.  The  report 
issued  with  this  preparation  relates  some  experiments  in  which 
the  Liquor  Camis  was  injected  into  the  peritoneal  cavity  of 
the  stomach  of  living  animals.  It  was  found  on  examining 
these  cavities  a  short  time  afterwards  that  the  fluid  was 
entirely  absorbed,  or  had  almost  disappeared,  no  trace  of 


^tS^^TSS^  NOTABILU.  137 


BfTieir,  Alb.  S,  1891. 


imtation  haying  been  set  up.  Gate's  Liqnor  Gamis  appears 
to  possess  the  essentials  of  highly  natritious  and  easily- 
aasunilable  food. 

The  new  directions  issued  with  this  uncooked  food,  which 
allow  of  its  admixture  with  hot  fluids,  or  even  of  its  being 
cooked^  raise  an  important  question,  viz.,  whether  or  not  this 
treatment  interferes  with  the  digestibility  of  such  foods.  In 
tiie  first  place  it  must  be  remembered  that  to  produce  coagula- 
tion of  the  albumin  a  temperature  much  below  boiling-point 
irill  suffice.  We  find,  on  heating  the  Liquor  Gamis  with 
twice  its  bulk  of  water  in  a  test-tube,  that  at  a  temperature 
of  about  55«  G.  (1S0<»  F.)  a  definite  but  light  finely  divided 
precipitate  occurs.  This  temperature  is  more  than  that  at 
which  *<  hot "  fluids  are  ordinarily  taken,  and  is,  of  course, 
ocmsiderably  more  than  the  temperature  of  the  stomach. 
This  would  indicate  that,  if  previously  diluted  with  water,  the 
admixture  with  fluids  at  a  temperature  for  drinking  does  not 
in  any  way  interfere  with  the  digestibility  of  the  food,  its 
albnmin  remaining  uncoagulated.  On  the  other  hand,  the 
adds  of  the  stomach  produce  coagulation  before  the  albumin 
is  changed  into  peptone.  Further  experimentation  would  be 
required  to  determine  if  the  coagulum  produced  by  the 
combined  action  of  heat  and  dilute  acids  is  more  difficult  of 
peptonisation  than  is  that  produced  by  the  stomach-acids 
alone.  At  present,  therefore,  it  is  safer  not  to  administer 
at  a  temperature  sufficiently  high  to  coagulate  the  albumin. 

"  FRAME  FOOD." 

HoBT  of  the  new  food  preparations  brought  before  the  public 
and  seeking  the  approval  of  the  profession  are  derived  from 
an  animal  source.  "  Frame  Food  '*  has  a  vegetable  origin, 
and,  it  is  stated,  is  made  from  "the  brown  husky  outer 
coT^nng  of  wheat,  which  is  separated  from  wheat  flour.'*  By 
this  means,  as  is  well  known,  much  of  the  salts,  largely 
phosphate,  and  of  the  albuminoids  is  lost.  Efforts  have 
been  made  to  replace  this  by  manufEu^turing  "brown"  or 
''whole-meal"  bread,  but  with  only  imperfect  success. 
Many  people  cannot  take  these  forms  of  bread,  and  they  are 
especiidly  often  distasteful  to  children,  who  most  need  them. 
Moreover,  the  amount  of  nourishment  which  the  system  can 
extract  &om  the  bran  of  brown  bread  or  from  whole-meal  is 
uncertain,  and  probably  varies  a^good  deal  with  different 
niethods  of  preparing  the  flour  and  of  cooking  the  bread. 
Frame  Food  then  is  designed  to  supply  the  nourishment 
found  in  wheat,  but  absent  from  ordinary  white  bread,  in 
proper  quantity  and  in  a  pleasant  form.  How  much  depends 
on  good  feedmg,  and  especially  how  much  depends  on  a 

ToL  33,  Na  2.  L 


188 KOTABim.  'g^flS'^iSir 

proper  supply  of  phosphates  for  growing  children  we  need 
not  stop  to  point  out  here. 

''  Frame  Food  "  is  made  in  the  form  of  a  powder,  termed 
t^e  "Extract/'  which  can  conveniently  and  pleasantly  be 
mixed  with  bread,  cakes,  puddings,  porridge,  coffee,  &c.  The 
same  manufacturers  supply  a  Jelly  made  of  <'  Frame  Food 
Extract,"  to  which  sugar  is  added  while  the  Extract  is  in  a 
liquid  form  and  boiled  down  to  a  jelly.  A  little  fruit  acid  is 
added  to  flavour.  This  is  fairly  palatable  and  may  be  used 
as  a  jam.  Frame  Food  Porridge  is  a  cooked  wheaten  food 
with  added  "  Extract." 

Our  analysis,  given  below,  which  corresponds  approxi- 
mately with  other  analyses  of  the  same  substance,  shows 
that  the  *'  Extract  *'  contains  more  nitrogenous  material  and 
salts  than  ordinary  flour,  and  that  the  starch  is  largely 
changed  into  sugar. 

We  beUeve  *•  Frame  Food  "  to  be  a  valuable  article  of  diet,, 
and  a  genuine  addition  to  our  armamentarium. 

We  find  the  "  Extract "  to  consist  of : — 


Moisture 

...    8.74  per  cent. 

v./ JLX         •••          •••          ■••          ••• 

...     1.60        „ 

Sugar  and  Dextrine. . . 

...  61.00 

Starch.  &c 

...  12.47 

♦Albuminoids     

...  14.87 

Cellulose 

...  none. 

Mineral  Matter  (Ash) 

...  11.32 

100.00 


*  ContaiDing  Nitrogen. 

Eight  per  cent,  of  the  Mineral  Matter  is  soluble  in  water,, 
and  contains  much  phosphates  and  potash. 

PRINCESS  HENRIETTA  AND  THE  LATE  PRINCE 

BALDWIN  OF  BELGIUM. 

The  Princess  Henrietta  of  Flanders,  the  eldest  of  the  three 
daughters  of  the  Count  and  Countess  of  Flanders,  has  recently 
had  a  serious  illness,  in  which  her  life  was  despaired  of,  but 
is  now  pronounced  to  be  out  of  danger.  History  repeata 
itself,  and  The  TKor/J  states : — 

"  Although  the  matter  has  been  to  a  great  extent  kept  secret, 
a  battle  between  homoeopathy  and  allopathy  has  raged  over 
the  sick  bed  of  Princess  Henrietta  of  Flanders  precisely  similar 
to  that  which  occurred  at  the  coinmencement  of  Lord  Bea- 
consfield's  fatal  illness.      Her  mother,  who  is  an  ardent 


itSiil^TS^  NOTABILIA, 139 

homoeopathist,  called  in  Dr.  Martiny,  the  bead  of  that  school 
of  medicine,  and  all  the  eminent  orthodox  physicians  declined 
to  meet  him  in  consultation.  The  attitude  they  assumed 
necessitated  the  summoning  of  a  provincial  practitioner  by 
telegraph,  and  has  given  a  wonderful  opportunity  to  a  yoiing 
and  able  military  doctor,  who  considers  obedience  the  fiiri^ 
duty  of  his  calling." 

Later  information  enables  us  to  state  on  the  highest 
authority  that  the  following  are  the  facts  relating  to  the 
illness  of  the  Princess  Henriette  de  Flandres. 

For  some  years  past  Dr.  Martiny,  of  Brussels,  has  been  the 
ordinary  medical  attendant  of  the  family  of  the  Comte  de 
Flandres,  and  in  that  capacity  the  Princess  Henriette  has  on 
several  occasions  been  under  his  care.  Some  weeks  ago  the 
Princess  took  cold,  which  rapidly  developed  into  broncho- 
pneumonia affecting  both  lungs.  Seeing  the  dangerous 
condition  of  his  patient,  Dr.  Martiny  requested  a  consultation 
\dth  another  homoeopathic  physician.  This  the  family 
declined,  [preferring  that  Dr.  Martiny  should  continue  the 
treatment,  and  that  a  physician  occupying  a  public  position 
should  watch  the  course  of  the  case  with  him.  Accordingly 
Dr.  Hayoit,  one  of  the  Professors  in  the  University  of  Louvain, 
and  Dr.  Melis,  an  army  surgeon,  joined  him  in  attendance  on 
the  Princess,  subsequently  Dr.  Hegar,  of  Brussels,  was  called 
in.  The  allopaths  being  now  in  a  substantiar  majority, 
insisted  on  the  use  of  allopathic  measures.  Dr.  Martiny, 
instead  of  retiring,  remained  to  watch  the  progress  of  events. 
Under  the  altered  treatment  Her  Boyal  Highness  grew  rapidly 
worse.  The  respirations  were  now  60,  the  temperature  40.5 
(Gent.)  and  pulse  150.  Dr.  Martiny,  seeing  his  patient  goingfrom 
bad  to  worse,  now  proposed- the  use  of  tartar  emetic  as  the 
most  homoeopathic  remedy  to  her  condition,  in  a  dose 
oonesponding  to  the. first,  decimal  trituration.  Improvement 
commenced  at  once  and  has  continued.  Her  Boyal  Highness 
being  now  convalescent. 

Prince  Baudouin,  who  had  no  confidence  in  homceopathy, 
was  throughout  the  course  of  his  fatal  illness — ^pleuro- 
pnemnonia  and  renal  hsemorrhage — ^under  allopathic  treatment. 

IS  DR.  KOCH'S  DISCOVERY  ORIGINAL  ? 

In  The  St.  Jameses  Gazette  of  21st  ult.,  there  appeared  the 
following: — 

"  The  famous  Berlin  consumption  cure  has  already  gone 
ihtOQgh  the  phases  of  being  first  blindly  believed  in  and  then 

L— 2 


140  OBITUABY.  ^"^^^Sr?^ 


Beview,  Feb.  S,  UM. 


Tehemently  attacked.  Now  people  are  beginning  to  say  that 
whether  it  is  *  true '  or  not,  it  is  not '  new.*  Messrs.  E.  Gould 
and  Son,  of  Moorgate  Street,  write  to  us  as  follows : — 

'  It  may  interest  many  of  your  readers  to  loam  that  a  prepa- 
ration, prescribed  by  homoeopathic  physicians  in  the  treatment 
of  consumption,  and  which  contains  the  identical  substance 
used  by  Professor  Koch,  has  been  dispensed  by  us  for  many 
years  past  under  the  name  of  Tuberculinum.  The  method  of 
its  preservation  has,  however,  differed  from  Dr.  Eoch's,  inas- 
much as  the  tubercle  bacillus  and  its  productions  have  been 
ground  down  in  the  first  instance  with  sugar  of  milk  and 
bottled  in  the  dry  form.  Some  ten  years  ago  Dr.  Drysdale, 
of  Liverpool,  introduced  sepsin — the  production  of  certain 
bacilli  which  cause  the  putrefaction  of  muscle — as  a  remedy  in 
the  treatment  of  typhoid  cases.  This  body  has  physiological 
and  chemical  characters  resembling  very  closely  those  de- 
scribed by  Dr.  Koch  as  belonging  to  his  preparation,  and  it 
has  been  found  that  a  66  per  cent,  solution  of  glycerine  sug- 
gested by  Dr.  Drysdale  has  successfully  preserved  this  sub- 
stance for  years.  In  our  judgment,  therefore,  Dr.  Koch  has 
made  an  improvement  on  the  old  method  of  preserving  tuber- 
culinum  by  extracting  it  with  glycerine  solution.  The 
homoeopathic  Materia  Medica  contains  many  remedies  of  the 
same  class,  which  are  designated  as  '  nosodes.'  " 


OBITUARY. 


DR.  JOHN    MOORE. 

It  is  with  deep  regret  that  we  announce  the  death  of  Dr.  John 
Moore,  of  Liverpool,  at  the  age  of  77.  One  among  the 
earliest  members  of  the  profession  to  acknowledge  the  truth  of 
homoeopathy  in  this  country,  he  has  ever  been  a  careful  and 
skilful  practitioner  of  medicine,  and  for  40  years  an  earnest 
advocate  of  homoeopathy.  As  a  medical  man,  he  was  a  typi- 
cal specimen  of  the  best  class  of  the  British  general  practi- 
tioner. Thoroughly  well  informed  on  professional  topics, 
taking  the  deepest  interest  in  the  welfare  of  his  patients,  and 
full  of  sympatliy  with  them  in  suffering,  he  was  at  once  their 
highly  competent  medical  adviser  and  warm-hearted  friend. 
Hence  his  popularity  with  all  classes  was  great,  and  his  pro- 
fessional success  considerable. 

John  Moore  was  bom  in  1818  at  Kilraughts,  Go.  Antrim,  in 
the  North  of  Ireland,  and  obtained  his  general  education  at  the 
Belfrist  academy.     Selecting  the  medical  profession  as  his 


£;gilrJ^TS?^°  OBITUABY. 141 

vocatioii  ia  life,  he  was  in  1827  apprenticed  to  a  surgeon- 
apothecary  iu  Bermondsey.  From  thence  he  passed  to  Guy's 
Hospital,  at  the  time  when  Sir  Astley  Cooper  was  the  surgical 
laminary  of  that  institution.  He  was  admitted  a  Licentiate 
of  the  Society  of  Apothecaries  in  1884,  and  a  memher  of  the 
Collie  of  Surgeons  in  1885.  He  immediately  settled  in 
practice  in  Liverpool,  being  induced  to  do  so  by  an  old  family 
Mend,  Dr.  Hamilton,  of  Great  George  Square  in  that  city. 

In  the  year  1848,  the  subject  of  homoeopathy  was  intro- 
duced to  his  notice,  and  he  made  a  careful  experimental  study 
of  it  xmder  the  direction  of  the  late  Drs.  Chapman  and 
Hilbers.  In  1849  he  openly  declared  his  confidence  in  it,  and 
during  that  year,  joined  the  staff  of  the  Liverpool  Homoeo- 
pathic Dispensary.  Cholera  shortly  afterwards  made  its 
appearance  in  Liverpool,  and  he,  with  other  members  of  the 
8^  of  the  Dispensary,  worked  asi^iduously  in  a  well  sustained 
effort  to  check  its  ravages,  an  effort  which  was  crowned  with 
a  success  that  was  in  the  highest  degree  gratifying. 

In  1859,  Dr.  Moore  took  an  active  part  in  the  debate  at  the 
Liverpool  Medical  Institution,  when  the  majority  of  the  mem- 
bers enacted  a  new  bye-law,  prohibiting  any  medical  man 
being  admitted  a  member  thereof,  who  practised  homoeopathy, 
a  law  which,  to  the  disgrace  of  the  institution,  still  remains 
on  its  statutes.  In  the  course  of  his  speech  on  that  occasion. 
Dr.  Moore  said : — 

I  entered  this  institution  about  28  years  ago,  and  every- 
thing went  '*  pleasant  as  a  marriage  bell,"  until  this  horrid 
thief,  homoeopathy,  came  across  my  path — that  was  in  1847. 
It  met  me,  or  racier  I  met  it,  through  Dr.  Chapman  ;  I  ridi- 
eoled  it  then  as  much  as  you  possibly  can  do  now.  Dr. 
Chapman,  however,  said  that  if  I  tested  the  medicines  I 
shodd  alter  my  opinion.  I  tested  them  steadily  and  regularly 
for  12  months  in  my  own  house.  I  afierwards  joined  the 
Homoeopathic  Dispensary,  and  attended  there  for  some  time 
before  I  announced  my  views  to  the  world,  and  in  1850  I 
published  a  pamphlet,  in  which  I  distinctly  stated  my  changed 
^ws,  and  I  have  never  yet  seen  any  reason  to  change  the 
opinions  I  then  published,  or  to  deviate  one  iota  from  the 
principles  of  Hahnemann.  In  the  matter  of  dose  I  give  just 
as  much  as  I  believe  to  be  necessary,  often  a  grain  or  two 
gndns,  or  a  drop  or  two  of  the  tincture,  as  the  case  may  be. 

"Dr.  TumbuU  has  said  that  we  give  the  same  medicines 
that  you  do.  xou  all  practise  on  the  homoeopathic  principles 
sometimes,  and  I  beheve  that  all  diseases,  when  cured  at  all, 
are  cured  on  that  principle.  If  homoeopathy  is  a  delusion  it 
is  a  very  troublesome  one,  one  which  has  cost  me  much 
labour,  much  pain  and  self-denial,  and  many  a  cold  shoulder 


1 AO  AT^TTTT  A  T>  V  Monthly  HunuBopstlilB 

J.*ia  OBITUAltY.  B^riew.  Feb.  s.  laoi. 


Beriew,  Feb.  2, 18B1. 


from  my  old  friends  in  the  profession.  But  I  really  tliink 
that  at  any  rate  it  must  be  something  more  than  a  delusion  to 
have  stood  the  test,  as  it  has  with  me,  of  upwards  of  ten 
years,  daily  and  hourly  practising  on  that  principle,  and  upon 
no  other,  except  in  incurable  cases,  where  I  adopt  palUatives. 

*•  In  1887  I  listened,  in  Liverpool,  to  Dr.  Lardner,  when 
that  gentleman,  with  far  more  clearness  than  has  been  manl- 
fested  by  Dr.  TumbuU  on  the  present  occasion,  proved  the 
impossibiUty  of  crossing  the  Atlantic  by  steam.  In  1888 
three  steamers  crossed  the  Atlantic.  So  much,  therefore,  for 
reasoning,  demonstration  and  argument  upon  principles  of 
scientific  truth.  Patient  experimental  research  is  the  only 
mode  of  deciding  this  great  question ;  it  is  not  to  be  put  down 
by  persecution  or  tyranny. 

''  Dr.  Abercrombie  has  pointed  out  the  responsibility  resting 
on  medical  men  in  regard  to  every  great  truth,  namely,  that 
there  is  guilt  in  ignorance  if  knowledge  is  within  their  reach, 
and  that  there  is  guilt  in  that  hardness  of  heart  which  hinders 
them  from  the  reception  of  truth." 

In  1870  he  obtained  the  license  of  the  Boyal  College  of 
Physicians  of  Edinburgh,  and  a  Uttle  later,  the  Homoeopathic 
Medical  College  of  Missouri  conferred  upon  him  the  degree  of 
M.D.  {Iionoru  causa).  In  1888  Dr.  Moore  was  the  president 
of  the  British  Homceopathic  Congress  held  at  Matlock  Bath, 
when  he  opened  the  proceedings  with  an  admirable  address, 
entitled,  **  A  Bird's  Eye  View  of  Hovtaopathy  tn  Oreat  Britain^ 
tcith  special  reference  to  the  Jiostility  of  the  medical  profession^** 

In  addition  to  the  pamphlet  already  mentioned,  HomceopatJiy 
Briefly  Explained,  Dr.  Moore  has  published,  at  various  times, 
many  useful  and  practical  essays  on  medical  and  surgical 
subjects,  both  in  the  British  Journal  of  HomoeopatJiy  and  in 
our  Review. 

Though  his  health  has  for  several  years  been  impaired  by 
cardiac  valvular  disease,  he  continued  in  active  general 
practice  until  a  year  ago,  when  he  retired  in  favour  of  Us  son. 
Dr.  Murray  Moore,  who,  twelve  months  previously,  had 
returned  from  New  Zealand.  On  leaving  Liverpool  he  went 
to  reside  at  West  Eirby,  Cheshire,  where,  after  an  illness  of 
two  months,  due  to  gouty  endocarditis,  he  died  on  the 
8rd  ult. 

Dr.  Moore  was  well-known  in  Liverpool,  not  only  as  a 
successful  practitioner  of  medicine,  but  as  an  active  worker 
in  connection  with  the  congregation  of  George  Street  Chapel, 
with  whose  evangelistic  efforts  he  had  been  intimately 
associated  during  the  last  forty  years. 

The  funeral,  which  took  place  at  the  Necropohs,  Liverpool, 
on  a  bitterly  cold  day  in  January,  testified  to  the  esteem  in 


2S^7pST?S^      coebespondence.  143 


Bmi&w,  Eeb.  S,  18B1. 


which  our  deceased  colleague  was  held  by  those  among  whom 
he  had  lived  dnring  so  long  a  period  of  time.  Hundreds  of 
persons  assembled  at  his  grave  side  anxious  to  pay  the  last 
tribute  of  respect  to  one  they  had  so  much  loved  and  revered. 
In  addition  to  this  large  assembly  of  personal  friends,  were 
two  deputations,  one  representing  the  committee  of  the 
Hahnemann  Hospital,  and  the  other  the  George  Street  Con- 
gregational Church.  The  medical  profession  was  represented 
by  all  who  practise  homoeopathically  in  Liverpool,  together 
with  a  great  number  of  those  who  must  be  reckoned  amongst 
its  opponents. 

Dr.  Moore  leaves  a  widow,  six  sons  and  four  daughters,  all 
of  whom  are  occupying  honourable  positions  in  different  parts 
of  the  world. 

In  conclusion,  we  may  truly  say  that  by  the  death  of 
Dr.  Moore,  all  who  have  known  him  will  £eel  that  they  have 
lost  a  true  friend,  an  excellent  practitioner  of  medicine,  a 
thorough  homceopathist,  and  a  most  honourable  member  of 
007  profession. 

CORRESPONDENCE. 


THE  DUAL  ACTION  OF  DRUGS. 
To  the  Editors  of  the  **  Monthly  Homceopathic  BemewJ'* 

GxKTLEMEN, — Dr.  Drysdalc,  in  the  paper  read  before  the 
British  Homoeopathic  Congress,  and  which  is  reported  in  the 
Janimry  number  of  the  Review,  speaks  of  the  contrary  action 
of  medicines  in  large  and  small  doses,  and  says,  *'  neither  he 
(Dr.  Thomas)  nor  any  one  else  will  ever  understand  or 
explain  the  direct  therapeutic  action  of  drugs  without 
admowledging  the  double  and  opposite  action  of  small  and 
laige  doses  in  homoeopathic  cures." 

I  had  thought  that  this  feust  of  the  opposite  actions  of 
certain  doses  was  disputed  very  vehemently  by  many  homoeo* 
paths,  indeed.  Dr.  Dirsdale  himself,  in  criticism  of  Dr. 
Sharp's  Leamington  address  in  1878,  very  strongly  condemned 
this  idea  as  feJse,  and  denied  it  as  a  **  law  faiCt  *' ;  it  would 
seem  that  further  experience  has  caused  him  to  give  the 
weight  of  his  authority  in  a  different  sense. 

This  is  a  point  of  great  importance,  which  the  British 
Homoeopathic  Society  should  take  up  and  investigate ;  if  it 
be  a  '*  law  fact/'  as  I  am  persuaded  it  is,  to  neglect  it  is 
sorely  very  dangerous,  for  it  would  lead  us  out  from  the  crude 
dogma  of  similars,  into  the  presence  of  an  explanatory  law. 

Yours  obediently, 

GERAED  SMITH. 


144  COBBESPONDENTS.       ^^l^?STSlr 


Seriev,  Feb.  i,  IWL. 


NOTICES  TO   CORRESPONDENTS. 

*,*  We  cannot  undertake  to  return  rejected  mannterijU. 

AUTHOBS  and  Contbibutobs  reoeiTing  proofs  are  reqneeted  to  conect 
and  return  the  same  as  early  as  possible  to  Dr.  Edwin  A  NeJiTBT. 

XiGE. — In  reference  to  oar  announoement  in  December  that  Madame 
Meyhofveb  is  prepared  to  introdaoe  a  saocessor  to  her  late  hnsband'ff 

Eractioe,  it  is  perhaps  right  also  to  inform  intending  applicants  that 
»r.  Qowixo  MiDDLBTON  is  already  in  homoBopathio  practice  at  Nioe, 
in  charge  of  the  VUla  Arson  Sanatorium, 

A  Review  of  Dr.  Bi7BNBTT*8  new  book  on  Gonsiimption  is  unayoidablj 
postponed. 

Commnnications,  &o.,  receiyed  from  Dr.  J.  M.  Moobb  (Liverpool)  ; 
Dr.  MoBBiasoN,  Dr.  Bubfobd,  Mr.  Knox  Shaw,  Mr.  D.  Wbiqht,  Mr. 
Wybobn  (London) ;  Dr.  Stonham  (Yentnor) ;  Dr.  Huqhes  (Brighton). 


BOOKS    RECEIVED. 


The  Daughter  :  Her  Health,  Mueation  and  Wedloeh.  By  William 
M.  Capp,  M.D.  Philadelphia  and  London :  F.  A.  Davis,  pnblisher. 
l^^l.-^ Oedichte  von  Gottfried  KahZ.  Leipsig.  Yerlag  von  Albert 
Moller.  \%^\,—Homaopathy  and  Blood4etting.  By  W.  B.  Clarke,  M.D. 
Indianapolis,  Ind. — Five  yearf  experience  in  the  Cure  of  Consumption 
by  its  own  Virus,  presumably  on  a  line  with  the  method  of  ICoeK 
lUnstrated  by  Fifty  Gases  by  J.  C.  Burnett,  M.D.  London  :  HomoM>* 
pathic  Publishing  Company.— Homoeopathic  League  Tracts,  Na  32, 
The  Revolution  in  Medieine,  London  :  Bale  &  ^nA.-^Quatre  ans  dans 
un  Dispensaire  d'JSnfants  par  le  J).  I,  Love,  Paris :  G.  SteinthaL — 
The  HomoBopathie  World.  iKmdon.  Jan. — The  Chemist  and  Drufoist,. 
London.  Jan.— TA^  Monthly  Magazine  of  Pharmacy,  London.  Jan. 
-^The  North  American  Journal  of  Homwopaihy,  "Sew  York.  Dec. — 
The  American  Homaopathist.  New  York.  Dec. — The  New  York  Medical 
Times,  Jan. — The  2^  York  Medical  Record,  Dec.  and  Jan. — The 
Chironian,  New  York.  Dec.  —  The  California  Homesopath.  San 
Francisco.  Dea  — >  The  New  England  Medical  Gazette.  Boston. 
Jan. — The  Hahnemannian  MotUhly.  Philadelphia.  Dec.  and  Jan* 
—7^  Homceopathie  Recorder,  Philadelphia.  Nov. — The  Homeeo* 
pathic  Physician.  Philadelphia.  Jan. — The  Clinijue*  Chicago.  Dea 
— The  Medical  Era.  Chicago.  Dec.  —  Birmingham  Age-Herttld, 
Birmingham,  Ala.  Novemtor  15th,  1890. — Bibliothegve  Homcso* 
pathique.  Paris. — Bib.  OH^ral  .de  Therapeutique,  Paris.  Jan. — 
Journal  de  Medeeine  de  Paris,  Jan.  18th. — Rctue  Hom.  Beige, 
Brussels.  Oct.  and  Nov. — U  Union  Homceopathigue,  Antwerp.  Oct. 
— Id  HomcBOfathie  Populaire,  Paris.  January. — La  Reforma  Mediea. 
August.  Mexico. — La  Midecine  Hypodermique,  Paris.  December^ 
1890. — Allgem,  Hom.Zeitung.  Leipdg.  JnnL-^opulare  Zeitschrift  fiir 
Homoopathie.  Leipng.  Jan. — II  Pdielinico,  Turin.  Dec. — Oatzetta 
Medica  Di  Torino,  Jan. — Homaeopdthisch  Maandblad,  Jan. — Rimsta 
Omiopatica,    Bome.     Nov.  and  Dec. 

Fapeta,  Dispemary  Beporis,  and  Books  for  Boriefw  to  be  aent  to  Dr.  Pops,  19» 
Watagate,  Grantham,  linoolnabire ;  Dr.  D.  Dyox  Bbowic,  S9,  Sejrmoar  Street,  Port- 
man  Scpiare,  W.;  <v  to  Dr.  Edwitt  A.  Nsatbt,  181, Baventodc  ITiil,  K.W.  AdTtrtlw- 
iBMiti  and  BoaineM  oonmumioationa  to  be  aent  to  Mombih.  B.  Oouu»  ft  8o«»  M» 
Mooigate  Street,  E.C. 


SSS'Jrrffi?*     KOCH   AND   PA8TEUB.  145 


tumm,  Mtx.  %  IWI. 


THE    MONTHLY 


HOMCEOPATHIC    REVIEW 


■:o:- 


THE  EECENT  DISCOVERIES  OF  KOCH  AND 
PASTEUR  AS  ILLUSTRATING  THE  LAW  OP 
SIMILARS.* 

By  Mb.  W.  Deane  Butcher. 

I  HAVE  chosen  as  a  subject  worthy  of  the  Society's 
attention  "  the  Recent  Discoveries  of  Pasteur  and  Koch 
as  Illustrating  the  Law  of  Similars,"  but  herein  I 
labour  under  two  disadvantages.  The  subject  is  one  so 
new,  80  open  to  debate,  and  the  time  for  preparation  so 
limited,  that  I  have  been  tempted  to  throw  on  the  mem- 
bere  of  the  Society  the  task  for  which  I  felt  myself 
unequal.  You  will  see  in  the  notice  that  the  question  I 
put  before  you  this  evening  is  merely  **  matter  for  dis- 
cussion" rather  than  a  fully  matured  and  elaborated 
paper. 

In  my  previous  paper,  '*  The  Recent  Discoveries  in 
Physical  Science  as  Illustrating  the  Law  of  Similars,"  I 
endeavoured  to  perform  a  humble,  but,  perhaps,  useful 
task,  viz.,  to  ascertain  whether  our  school,  the  liberal 
school  of  medicine,  was  in  touch  with,  and  abreast  of^ 
^e  most  recent  development  of  other  sciences ;  and 
whether  our  theory  of  pharmacodynamics  was  in  accord- 

*  Bead  at  the  British  Homceopathic  Society,  Feb.  6th,  1891. 
Vol.  85,  No.  3.  M 


n 


146  KOCH   AND    PASTEUR.      ^S^/w^C^Sh 


ance  with  the  interpretation  of  the  laws  which  govern 
the  phenomena  of  molecular  physics. 

As  you  may  remember,  I  endeavoured  to  prove  that 
the  law  of  similars  was  a  universal  law  of  molecular 
motion,  governing  all  physical  phenomena — a  rule  not 
only  of  pharmacodynamics,  but  of  physics. 

To-night  I  purpose  to  review  the  discoveries  associated 
with  the  names  of  the  two  great  bacteriologists,  and 
trace  the  influence  of  their  investigations  on  the  modem 
conception  of  the  law  of  similars. 

First  let  me  sketch  as  briefly  as  possible  the  researches 
of  the  great  French  savant. 

Pasteur  was  born  in  1822,  and  up  to  1847  he  studied 
ishemistry.  At  that  date  his  narrow  conception  of 
strictly  chemical  qualities  associated  with  differences  of 
<;hemical  composition  were  troubled  by  the  observation 
of  the  German  mineralogist,  Misterlich,  on  the  optical 
differences  in  two  substances  of  the  same  composition, 
"viz.,  the  para-tartrate  and  the  bi-tartrate  of  soda  and 
^ammonium. 

His  researches  on  the  tartrates  led  him  to  the  study 
of  fermentation,  which  resulted  in  his  world-renowned 
treatise  on  that  subject.  .     „ 

'*  He  who  can  explain  the  nature  of  fermentation, 
said  Eobert  Boyle,  "will  give  an  explanation  of  the 
morbid  processes  of  fever  and  other  diseases,"  and  it  is 
to  the  great  exponent  of  fermentation  that  we  are 
indebted  for  the  modern  methods  of  research,  and  that 
scientific  use  of  the  imagination  which  has  created  a  new 
^ra  in  the  study  of  disease.  The  study  of  disease  taken 
up  from  a  new  quarter — not  by  a  healer  but  by  an 
experimenter — by  an  enquirer  trained  in  the  rigorous 
methods  of  chemistry  and  physic,  was  destined  to  yi^l" 
great  results.  , 

'*A11  that  Uves  must  die,"  says  Pasteur,  "  and  all  dead 
matter  must  be  disintegrated  by  the  action  of  hvu^S 
matter."  Fermentation  is  this  disintegration  of  naa*^^ 
that  Ims  lived,  by  matter  that  is  living,  this  shaking  to 
pieces  of  organised  but  dead  material  by  the  action  oi 
life. 

Pasteur  was  the  first  to  point  out  that  putrefaction, 
like  fermentation,  had  its  origin  in  a  living  ferment. 

In  opposition  to  Liebig  he  showed  that  the  phenonien* 


eSSSTSTS?''      KOCH   AND   PASTEUR.  147 

^f  putrefaction  were  due  to  the    presence    of   living 
organisms  which  he  called  Vibrios. 

The  question  of  spontaneous  generation  next  took  his 
attention. 

Hitherto  all  the  world  had  been  of  the  opinion 
of  Aristotle  that  **  Every  dry  body  becoming  moist 
engendereth  animals,"  and  of  Van  Helmont,  who  says, 
•'*Itsufficeth  to  place  a  dirty  shirt  in  an  open  bottle 
containing  grains  of  corn.  The  ferment  of  the  shirt, 
modified  by  the  odour  of  corn,  engendereth  a  transmu- 
tation of  cheese  into  mice  in  2D  or  more  days.  This 
have  I  myself  seen,"  says  he,  *'  the  mice  being  fully 
grown  both  male  and  female."  In  opposition  to  such 
ideas  which  were  supported  by  both  Buffon  and  Pouchet, 
Pasteur  showed  conclusively  that  there  was  no  such 
thing  as  spontaneous  generation,  that  omne  vivum  ex  ovo 
was  the  one  rule  of  nature  which  admitted  of  no 
exception. 

In  this  connection  he  invented  the  method  of  steriliza- 
tion, without  which  modern  Bacteriology  would  be 
impossible. 

We  next  find  the  French  Government  deputing 
Pasteur  to  inquire  into  the  silkworm  disease,  that  had 
created  such  havoc  in  the  silk  industry  of  the  South  of 
France.  The  cause  of  this  disease,  Pebrine,  was  found 
to  be  certain  corpuscles  everywhere  present  in  diseased 
worms. 

By  a  microscopic  examination  of  the  egg-bearing 
moth,  and  the  destruction  of  all  diseased  eggs,  he  intro- 
•dnced  an  improvement  in  silk  culture  valued  at  many 
milliards  of  &ancs. 

Bat  it  is  his  subsequent  studies  of  septicaemia  and 
charbon,  of  anthrax,  fowl  cholera,  and  hydrophobia, 
with  which  we  are  most  interested. 

It  was  in  March,  1865,  that  Lister,  inspired  by  the 
teaching  of  Pasteur,  performed  his  first  great  operation 
under  antiseptic  treatment,  and  it  was  the  work  on  the 
fermentation  of  milk  that  suggested  to  Lister  the  method 
which  has  revolutionised  surgery. 

In  his  studies  on  chicken  cholera,  Pasteur  first  pub- 
lished his  method  of  pure  cultivations  of  bacteria. 

The  germs  are  sown  in  nutrient  broths  or  jellies  under 
^fluch  conditions  that  only  pure  air  is  admitted  to  them. 

M— 2 


Monthly  Horoopopatbio 


148  KOCH   AND   PASTEUR.     T.S^l.lSlSl'SrTSl! 


Under  favourable  circumstances  the  organisms  wiir 
live  for  years.  If  these  cultures,  however,  are  exposed 
to  lower  temperatures,  the  germs  gradually  lose  their 
virulence  and  their  power  of  reproducing  disease. 

A  fowl  was  inoculated  with  the  weakened  or  attenuated 
virus.  It  became  slightly  indisposed,  but  soon  recovered^ 
If  it  was  then  inoculated  with  the  strong  virus  it  escaped 
unhurt,  although  a  fowl  unprotected  by  vaccination 
would  be  killed  by  a  smaller  dose.  This  was  a  true 
vaccination  phenomenon. 

The  success  of  this  treatment  was  shown  by  the  fact 
that,  by  inoculating  fowls  with  the  attenuated  virus, 
Pasteur  has  succeeded  in  reducing  the  death-rate  of  the 
poultry  yards  over  a  large  area  of  France  from  10  per 
cent,  to  1  per  cent. 

Pasteur  next  turned  his  attention  to  anthrax,  a  disease 
well  known  in  the  East,  and  there  regarded  as  the  du^ect 
descendant  of  one  of  the  plagues  of  Egypt.  Here  also 
his  method  of  an  attenuated  virus  was  successful,  and  a 
second  contagious  disease  was  brought  under  control. 

The  bacillus  anthracis  was  isolated  by  a  young 
physician  of  Breslau,  Dr.  Koch. 

Koch,  moreover,  showed  that  under  certain  conditions- 
the  bacillus  breaks  up  into  spores,  which  have  the  power 
of  resisting  a  degree  of  heat  which  would  prove  fatal  to 
the  bacillus  itself.  He  further  succeeded  in  making 
artificial  cultures  of  the  germ  in  nutrient  jellies  and 
broths. 

The  greater  resisting  powers  of  the  spores  to  heat  had 
not  escaped  the  attention  of  Pasteur,  who  was  also  work- 
ing at  the  bacterium  of  anthrax,  and  in  connection  with 
this  we  read  of  an  experiment  which  gives  a  wonderful 
insight  into  his  inductive  method  of  reasoning. 

It  is  a  well  known  fact  that,  although  anthrax  passes 
readily  from  one  kind  of  animal  to  another,  from  quad- 
ruped to  man  and  back  again,  it  never  attacks  birds.. 
Experiment  had  shown  that  a  temperature  of  44°  C. 
is  prohibitive  to  the  multipUcation  of  the  germ ;  now 
birds  have  the  warmest  blood  of  all  vertebrates,  the- 
temperature  of  their  circulating  medium  being  as  high 
as  42°  C.  The  bacillus,  then,  when  in  the  body  of  a. 
fowl,  is  at  a  temperature  closely  bordering  on  the  pro- 
hibitive one,  and  further,  being  an  serobiotic  microbe,  it 
is  handicapped  by  having  to  wrest  its  oxygen  from  the 


B^^T^"     KOCH  AND   PASTEUR.  149 

Uood  corpascles.    Under  these  circumstances  it  does  not 
thrive,  and  the  fowl  escapes  a  terrible  disease. 

Now  Pasteur  said  to  himself,  "  If  the  above  reasoning  be 
true,  and  we  take  a  fowl  and  keep  it  under  such  conditions 
that  the  temperature  of  its  blood  is  lowered,  it  ought 
when  inoculated  to  take  the  disease.'*  He  therefore 
lowered  the  temperature  of  a  fowl  to  37°  C.  or  38^  C.  by 
placing  its  feet  in  cold  water,  and  then  inoculated  it. 
Within  24  hours  it  had  died  of  anthrax.  He  corroborated 
this  experiment  by  chilling  another  fowl,  inoculating  it 
«id  allowing  the  fever  to  come  to  a  head.  Then  he 
hurried  it  into  a  warm  chamber  and  restored  its  normal 
^mperature  by  wrapping  it  in  cotton  wool.  In  a  few 
hours  the  returning  heat  got  the  better  of  the  bacillus, 
and  the  fowl  was  soon  restored  to  perfect  health. 

Pasteur  applied  his  discoveries  of  attenuated  virus 
also  in  this  disease,  and  with  such  success  that  a  million 
sheep  and  100,000  oxen  have  been  vaccinated  for  anthrax, 
and  the  insurance  companies  of  Prance  insist  on 
vaccination  before  they  will  insure  cattle. 

Such  is  the  man  who  has  spent  the  last  nine  years  in 
the  study  of  hydrophobia  or  rabies,  and  in  an  endeavour 
to  find  a  means  for  its  cure. 

In  this  disease  the  virus  appears  to  attack  the  nerve 
<5entre8,  and  to  be  reproduced  more  especially  in  the 
nieduUa  oblongata. 

Pasteur  experimented  for  years  until  he  was  able  to 
reproduce  the  disease  with  certainty  by  inoculation, 
although  he  was  mot  able  to  isolate  the  bacillus.  Babbits 
inoculated  with  the  virus  showed  a  definite  latent  period 
of  incubation  of  seven  days  duration. 

As  the  poison  has  not  been  isolated,  Pasteur  makes 
^ose  of  a  trituration  of  the  spinal  cord  itself. 

By  heating  this  for  14  days  at  25°  C.  the  bacteria,  if 
imy,  or  at  all  events  the  disease-producing  cells,  are 
killed.  A  small  quantity  of  the  poison  remains  unaltered, 
and  this  is  used  as  a  vaccine. 

An  animal  may  be  injected  with  a  virus  from  a  14  day 
old  cord,  then  with  one  12  days  old,  &c.,  till  the  full 
strength  of  the  fresh  cord  vaccine  can  be  borne. 

A  dog  thus  protected  is  perfectly  impervious  to  the 
bite  of  a  mad  dog,  bite  he  never  so  madly,  as  has  been 
Foved  over  and  over  again. 


150  KOCH   AND   PASTEUR.     "Si'iSL^rr?^^!* 


Review,  Mar.  2, 1891. 


But  a  still  further  advantage  is  gained.  The  bite  of  a^ 
mad  dog  would  take  some  days,  or  weeks,  or  months, 
before  it  would  become  strong  enough,  by  recruitment 
in  the  blood,  to  poison  the  brain. 

It  has  to  take  two  days  at  least  to  form  the  poison, 
and  seven  days,  the  period  of  incubation,  for  the  poison, 
to  act. 

If,  now,  the  poison  be  injected  ready  made,  there  is 
an  interval  of  nine  days  during  which  the  protective 
power  of  the  artificial  virus  may  act,  and  these  small 
doses  of  the  poison  gradually  inure  the  nervous  system 
to  its  presence.  This,  and  perhaps  variola,  are  the  only 
diseases  in  which  treatment  by  vaccination  has  been 
attempted  in  the  human  subject. 

The  explanation  of  the  modus  operandi  is  not  easy  r 
but  in  the  case  of  hydrophobia  there  appears  to  be  what 
we  may  term  a  Mithradatic  effect,  Le.,  the  nervous 
system  is  strengthened  and  hardened  against  the  impact 
of  a  nervous  excitant,  by  mere  use  and  wont  of  a  gradu-^ 
ally  increasing  dose  of  the  new  poison,  whereby  a  con- 
dition of  tolerance  is  obtained. 

We  shall  see  in  the  discoveries  of  Pasteur's  successor 
a  still  nearer  approach  to  homoeopathic  methods  and 
modes  of  thought. 

Chapter  II. — Koch. 

We  can  but  briefly  review  the  career  of  Pasteur's 
compeer — the  great  German  bacteriologist,  Koch — whose 
name  we  have  already  met  in  connection  with  Pasteur's 
study  of  anthrax. 

He  was  brought  into  prominent  notice  by  his  discovery 
of  the  bacillus  anthracis,  and  more  recently  by  his 
supposed  discovery  of  the  comma  bacillus  of  cholera.. 
Although  it  is  disputed  by  English  authorities,  this 
organism  is  universally  accepted  in  Germany  to  be  the 
true  cause  of  cholera.  His  latest  discovery,  the  bacillus 
of  tubercle,  led  the  way  to  the  so-called  Koch  cure^ 
which  excited  for  a  time  a  degree  of  enthufiiasm  un- 
paralleled in  the  history  of  scientific  discovery. 

Associated  with  broncho-pneumonia,  with  phthisis,  iu 
scrofulous  glands,  in  the  skin  of  lupus,  in  the  pus  of 
scrofulous  joints,  and  lastly  in  the  expectoration  and 
even  the  breath  of    phthisical  patients,   Koch  demonr 


£ssr5nri8^  ^^^h  and  pasteur.  151 

skated  the  presence  of  a  minute  organism,  the  so-called 
bacillus  tuberculosis.  Whether  the  bacillus  causes  the 
tubercle,  or  whether  the  tubercular  diathesis  generates 
or  fiacilitates  the  growth  of  the  bacillus,  is  a  question 
much  debated  and  still  unsettled. 

I  need  not  detain  you  with  a  description  of  the  bacillus 
tuberculosis,  a  rough  diagram  of  which  I  have  here^ 
and  a  slide  of  which  you  will  find  under  the  microscope, 
kindly  lent  by  my  friend  Dr.  Shuldham.  I  think  that 
the  balance  of  proof  supports  our  belief  in  the  existence 
of  a  true  bacillary  phthisis  in  which  the  introduction  of 
the  bacillus  plays  the  part  of  the  vera  causa. 

The  following  are  Koch's  postulates  or  conditions  of 
proof,  which  must  be  satisfied  before  we  can  say  any 
particular  organism  is  the  actual  causa  camans  of  a^ 
specific  disease. 

1.  The  organism  must  be  found  in  every  animal  dead 
or  suffering  from  the  disease. 

2.  From  this  animal  the  organism  must  be  cultivated 
through  successive  generations  on  nutritious  media  out- 
side the  body. 

3.  After  going  through  many  generations,  or  culture 
series,  the  cultivated  organism  must  produce  the  disease 
afresh  with  all  its  characteristic  symptoms  on  inoculat- 
ing healthy  animals. 

4.  In  these  experimental  animals,  before  or  after 
death,  the  organism  must  be  found,  and  fresh  cultures- 
established  therefrom. 

Koch  maintains  that  each  of  these  conditions  of  proof 
has  been  abundantly  manifested  in  the  case  of  tubeccle. 

If  tubercle  be  then  caused  by  the  invasion  of  patho- 
genetic bacilli,  and  if  they  are  capable  of  causing  all  the 
symptoms  of  tubercular  disease  by  their  mere  presence 
in  the  body,  we  might  naturally  expect  that  a  bacteri- 
ologist would  follow  the  example  of  Pasteur,  and  seek 
for  the  method  of  cure  by  exhibiting  an  attenuated  virus 
of  the  disease,  as  was  done  in  anthrax  in  chicken  cholera 
and  in  hydrophobia. 

Such  we  find  to  be  the  case,  for  when,  after  some 
delay,  Koch  revealed  the  constitution  and  preparation  of 
his  remedy,  we  found  it  was  in  fact  a  product  of  the 
bacillary  growth.  It  is  interesting  to  follow  the  steps  of 
the  experiments  which  led  up  to  Koch's  discovery,  and 
vhich  were  related  at  the  last  International  Congress  at 


152  KOCH   AND   PASTEUR.      ^SS^^S??^ 


Review,  Har.  2, 1891. 


Berlin,  where  I  heard  from  Koch's  own  Ups  the 
assurance  that  he  had  discovered  an  agent  which,  at  all 
events  in  the  laboratory  and  in  the  guinea  pig — the 
corpus  vile  of  the  experiment — ^had  arrested  the  progress 
of  tuberculosis. 

Long  ere  this  Koch  had  isolated  the  bacillus,  and  had 
cultivated  it  on  sterilised  blood  serum  outside  the  body. 
The  bacilli  were  sown  in  this  medium  and  produced 
their  like,  generation  after  generation,  as  surely  as 
seed  produces  wheat.  A  pure  sterilised  medium — pure 
air  and  a  suitable  temperature — was  all  that  was 
required  to  procure  a  so-called  pure  cultivation  of 
hacillus  tuberculosis. 

A  tube  of  sterilised  blood  serum  was  inoculated  with  a 
platinum  needle  dipped  in  the  cultivation.  Islands  of 
the  bacillary  growth  spread  over  the  surface  till  the 
whole  mass  became  infected. 

If  now  a  Pravaz  syringe  was  filled  with  this  infected 
gelatine  and  injected  under  the  skin  of  a  guinea  pig,  the 
animal  became  tuberculous.  In  about  six  weeks  the 
whole  body  was  infested  with  tubercle. 

Now  Koch  took  two  animals,  No.  1  healthy,  No.  2 
which  had  been  rendered  thus  tuberculous. 

If  No.  1,  the  healthy  animal,  was  inoculated  with  a 
syringe  full  of  the  pure  cultivation  of  bacillus,  the 
wound  did  not  heal  except  superficially. 

In  ten  days  a  hard  nodule  appeared,  which  broke  down 
into  an  ulcerating  sore,  getting  deeper  and  deeper,  till 
the  animal  died. 

If  No.  2,  the  tuberculous  animal,  was  inoculated  with 
the  pure  cultivation  of  the  tubercle  bacillus,  quite  a 
different  condition  of  things  resulted.  The  wound 
healed  with  a  viscid  secretion.  No  nodule  was  formed, 
but  a  shallow  ulcer  which  healed  rapidly  without  infect- 
ing the  lymphatic  glands.  These  phenomena  occurred 
whether  the  injection  was  made  with  living  bacilli  or 
with  a  solution  of  dead  bacilli,  and  this,  whether  the 
microbes  were  killed  by  heat,  by  cold,  or  by  chemical 
means.  This  proved  conclusively  that  the  poisonous 
results  were  not  due  to  a  growth  of  living  bacilli. 

While  the  local  symptoms  thus  differed,  there  was  a 
corresponding  difference  in  the  general  condition. ' 

Comparatively  small  doses  of  the  dead  bacilli,  tritu- 
rated in   water,   killed  tuberculous  animals  in  a  few 


rSSH^^T?^     KOCH   AND   PASTEUR. 


153 


hours,   whereas    it    merely  rendered   healthy  animals 
tnberculons. 

If,  however,  the  dose  was  not  large  enough  to  kill  the 
tuberculous  animal,  if  the  bacilli  were  diluted  still  further, 
the  inoculated  animal  survived  and  began  to  improve. 

If  the  injections  of  minute  doses  were  continued  every 
two  days,  the  local  ulcer  healed  (which  it  never  did 
otherwise),  the  swollen  lymphatic  glands  diminished  in 
size,  and  the  nutrition  was  improved.  The  animal  was 
saved.  The  bacillary  poison  which  was  fatal  to  the 
healthy  was  a  cure  to  the  diseased  animal.  This,  surely, 
is  similia  similibus  with  a  vengeance. 

Bat  one  disadvantage  remained.  Koch  found  that 
there  adhered  to  the  dead  bacilli,  with  great  tenacity,  a 
poison  whose  peculiar  property  it  was  to  set  up  local 
suppuration. 

To  get  rid  of  this  substance  he  dissolved  out  the  active 
principle  with  glycerine,  and  thus  produced  a  pure 
glycerine  solution  of  the  specific  poison,  untainted  with 
dead  bacilli  and  free  from  the  substance  which  excited 
suppuration. 

Koch's  lymph,  then,  is  a  glycerine  extract  from  a  pure 
cultivation  of  the  tubercle  bacillus.  The  active  principle 
<^  be  procured  as  a  colourless  dry  material,  of  which  the 
ordinary  lymph  contains  only  about  -j^  of  one  per  cent. 

Further  on  we  shall  find  the  dose  to  be  infinitesimal 
as  the  remedy  is  homoeopathic. 

As  might  be  expected,  Koch's  explanation  of  the  rrwdtis 
operandi  is  not  wholly  satisfactory.  It  is  too  mechanical 
to  satisfy  those  who  have  learned  to  look  for  a  wider  and 
deeper  generalisation  of  pharmacodynamic  action. 
^  The  action  of  the  lymph  according  to  his  theory  is  a 
Naeh-impfung,  or  after-poisoning,  in  which  the  bacillus 
is  killed  by  an  excess  of  its  own  poisonous  excreta. 

The  substance  thus  isolated  is,  according  to  Koch, 
that  particular  product  of  the  bacillary  growth  which 
sets  up  in  the  surrounding  tissue  the  phenomena  of 
tubercular  caseation. 

We  may  study  its  action — 

1st.  Locally  on  the  tubercle. 

2nd.  Grenerally  on  the  system. 

I.  The  local  theory. 

We  have  in  lupus  or  phthisis  numbers  of  points  in- 
vaded by  living  bacilli,  and  each  colony  is  surrounded 


154  KOCH   AND   PASTEUR.     ^SSiL^iSIf?^^* 


Review,  Mar.  2. 1891. 


by  a  softened  and  neutral  zone  in  which  there  are  but 
few  invaders,  but  which  is  already  infiltrated  with  the 
poison  the  result  of  the  life  processes  of  the  bacilli. 

If  to  the  nutrient  fluid,  i.e.,  the  blood,  some  of  this 
poison  be  added,  the  inflaming  and  softening  processes^ 
going  on  in  this  area  are  quickened  and  the  bacilli  are 
killed  by  the  excess  of  a  poison  similar  to  their  own 
excretion. 

Still  further  the  process  of  caseation  is  set  up,  since 
the  tubercle  bacilli  produce  a  poison  which  in  a  certain 
state  of  concentration  kills  the  tissue  around  it,  and 
causes  it  to  pass  into  the  condition  called  by  the  Germans 
the  coagulation-necrosis  of  Weigert. 

This  necrosis  may  extend  to  only  a  part  of  the  cell, 
the  remainder  of  which  in  that  case,  with  further 
growth,  becomes  a  so-called  giant  cell. 

This  process  is  not  confined  to  tubercle,  but  seems  to 
be  Nature's  universal  method  of  setting  a  bound  to 
bacillary  inroads. 

Here  is  a  rough  diagram  of  the  ordinary  caries  disease 
in  teeth. 

A  is  the  area  of  bacillary  infection.  On  examination 
microscopically  thousands  of  bacilli  will  be  found  crowd* 
ing  the  field,  but  around  the  infected  area  is  another 
lightly  shaded  area  (b)  which  is  softened,  infiltrated  with 
the  morbid  products  of  caries,  but  not  as  yet  invaded 
with  bacilli. 

It  is  as  though  Nature,  to  whom  nothing  is  great  or 
small,  who  cares  for  bacilli  as  she  does  for  men,  had 
carefully  prepared  around  each  colony  of  bacUli  a 
neutral  zone — an  area  of  political  influence  as  it  were — 
into  which  any  enterprising  bacillus  might  emigrate  at 
its  will. 

At  all  events,  this  neutral  territory  is  destined  ere 
long  to  be  over-run  by  the  present  inhabitants  of  a  or  by 
their  descendants. 

This  diagram  might  serve  as  well  for  a  tubercle,  and 
illustrate  the  phases  of  tubercular  invasion. 

Like  all  over-crowded  communities,  the  inhabitants  of 
A  will  be  poisoned  by  the  products  of  their  own  retro- 
grade metamorphosis,  the  bacilli  secreting  a  poison 
which,  from  their  point  of  view,  is  destined  to  set  up  a 
modified  and  gentle  solubility  in  adjacent  territory,  but 


^SI^v^TSS?^     KOCH   AND    PASTEUR.  155 


JBeriew,  Mu-.  2, 1891. 


which,  under  certain  circumstances,  becomes  most  fatal 
to  themselves. 

Just  as  the  Black  Hole  of  Calcutta  was  poisonous  to- 
its  inmates  from  the  mere  presence  of  carbonic  acid  and 
other  death  dealing  exhalations  of  lungs  and  skin,  so  all 
living  beings  excrete  products  of  metamorphosis  which 
in  too  great  concentration  is  fatal  to  themselves. 

Fermentation,  for  instance,  is  a  process  so  like  bacillary 
disease  that  it  may  be  taken  as  its  type. 

Fermentation  is  the  growth  of  yeast ;  alcohol  the- 
excretion  of  yeast.  When  the  alcohol  reaches  a  certain 
strength,  it  destroys  its  progenitor,  for,  as  you  well  know, 
alcohol,  the  result  of  fermentation,  is  the  very  best 
preventive  and  preservative  against  it. 

To  return  to  the  lymph.  In  health  in  large  doses  it 
injures  certain  tissue  elements,  especially  the  white 
blood  cells.  In  very  small  doses  it  produces  extensive 
eell-necrosis  in  every  spot  where  bacilli  are  vegetating. 

That  the  remedy  has  a  very  general  and  serious 
influence  on  the  bacilli  themselves,  none  can  doubt,  who 
have  made  a  microscopical  examination  of  sputa  or 
tissue  after  the  Koch  treatment. 

On  the  table  you  will  see  slides  which  show  this  very 
clearly.  In  the  second  slide  you  will  see  symptoms  of 
degeneracy  in  the  cell  debris — ^the  uncertain  outline — 
and  the  crescent  and  dumb-bell  shaped  hacilli,  the 
result  of  Koch's  treatment. 

Fever,  as  you  know,  is  the  first  and  most  noticeable 
symptom  after  injection.  In  this  respect  Koch  has  given 
to  us  an  agent  of  great  potency.  Indeed  the  Koch 
lymph  is  the  most  certain  fever-producer  known.  A 
rise  of  temperature  from  98°  to  104°  is  not  uncommon 
in  six  hours,  preceded  by  a  rigor,  accompanied  in  certain 
cases  by  rash,  nausea,  drowsiness,  and  other  symptoms^ 
of  profound  general  iiervous  poisoning. 

It  would  be  an  interesting  study  to  inquire  what  part 
this  rise  of  temperature  takes  in  the  so-called  Koch  cure 

When  studying  the  effects  of  antipyrine,  quinine^  and 
the  many  agents  for  reducing  fever,  so  carefully  worked 
out  on  the  Continent,  it  has  often  occurred  to  me  to- 
^sh  for  an  agent  which  could  produce  at  will,  a  certain, 
nioderate  and  easily-controlled  rise  of  temperature  in 
the  blood,  instead  of  the  reduction  of  temperature  so* 
^versally  desiderated. 


156  KOCH   AND   PASTEUR.      "^J^^^S? 


It  would  seem  thai  fever  is  exactly  Nature's  mode  of 
chemically  destroying  the  bacillary  invaders  of  the  blood, 
and  of  neutralising  the  poison  they  set  free. 

For  what  does  a  chemist  do  if  he  wishes  to  sterilise  a 
liquid  which  will  not  bear  a  high  temperature?  He 
heats  it  to  as  high  a  temperature  as  the  liquid  will  bear 
without  decomposition.  Further,  if  a  temperature,  say, 
of  108°  will  destroy  the  bacteria,  we  know  that  their 
spores  will  not  be  destroyed,  being  more  resistant  to 
heat  they  need  time  to  develop.  In  their  turn  they  need 
heating  to  arrest  or  destroy  them.  Hence  the  phe- 
nomena of  intermittent  fever. 

1.  Infection.  Invasion  of  bacilli  from  marshy  ground, 
«&c. 

2.  A  period  of  quiescence. 

3.  The  bacteria  grow — ^increase  in  numbers. 

4.  They  secrete  their  appropriate  poison. 

5.  The  poison  acts  on  the  nervous  system,  causing 
depression,  rigor,  &c, 

6.  The  nervous  system  reacts,  fever  sets  in,  the  blood 
is  heated,  the  bacillary  activity  subsides,  they  degenerate. 

7.  One,  two,  or  three  days  intervene,  till  spores  have 
time  to  develop,  secrete  poison  anew,  and  the  old  vicious 
round  begins  again. 

It  may  be  that  in  Koch's  lymph  we  have  ready  to  our 
hand  such  an  agent  for  securing  a  rise  of  temperature, 
.at  least,  for  cases  of  tubercular  origin. 

If  it  be  true  that  the  nightly  rise  of  temperature  in 
phthisis  is  indeed  nature's  effort  to  throw  off  the  disease, 
to  destroy  the  invader,  then  we  may  hope  that  in  early 
cases,  by  imitating,  we  may  aid  nature's  efforts — when 
the  resisting  powers  are  strong,  when  fever  would  not  be 
fatal,  an  artificial  fever  may  disorganise  the  bacteria. 
At  the  same  time,  experience  has  already  shown  us 
abundantly  the  extreme  danger  of  lighting  up  at  the 
same  moment  the  slumbering  fires  or  foci  of  infection. 

Dose, 

I  have  said  that  the  dose  of  Koch's  lymph  was  as 
infinitesimal  as  the  action  was  homoeopathic. 

The  lymph  as  it  issues  from  Koch's  laboratory  at  the 
Hygienic  Institute  of  Berlin  is  a  straw-coloured  liquid 
containing,  according  to  his  own  estimate  only  a  trace  of 
:the  septic  poison — a  fraction  of  one  per  cent.    Hence 


S^^M.fTK?**'     KOCH   AND   PASTEUR.  157 


Befviev,  Mar.  2, 1881. 


this  would  in  onr  nomenclature  be  a  Sx  solution.  A 
10  per  cent,  solution  of  this  is  used  for  injection,  thus 
reducing  the  strength  to  the  fourth  decimal  dilution. 

Now  the  smallestquantity  of  this  dilution  which  has  pro- 
duced in  Koch's  hands  a  definite  reaction  is  .001  gramme 
or  1,000th  of  this  dilute  solution ;  so  that  according  to 
these  somewhat  rough  experiments,  the  human  organism 
reacts  with  certainty  to  the  1,000th  of  1,000th,  or 
one  millionth  of  a  cubic  centimetre  of  the  poison. 

There  is  no  doubt  that  it  might  usefully  be  used  in 
still  smaller  doses,  if  submitted  to  careful  proving  and 
experiment  by  members  of  our  own  school. 

We  may  hope  for  great  results  when  we  are  able  to 
mtroduce  the  remedy  into  the  body  by  nature's  own 
method  of  inhalation — and  this  gradation  step  by 
step,  cautiously  and  continuously — and  for  dose  we 
may  also  imitate  nature's  methods  when  we  can  estimate 
accurately  the  dose  of  bacterial  poison  absorbed  while 
sleeping  for  a  single  night  in  a  marshy  hollow.  For 
this  is  the  dose  which  sets  up  a  like  disease,  and  the^ 
curative  dose  must  be  at  any  rate  less  than  this. 

Perhaps  some  of  our  members  can  give  us  tho 
results  of  practical  experience  of  treatment  with  iso- 
pathic  remedies  or  nosodes,  of  which  Koch's  fluid  is  the 
last  and  most  potent. 

I  have  here  a  list  of  more  than  100  so-called  iso- 
pathic  medicines,  including  sepsin,  tubercnlinuvi,  pyrogen, 
anthracin,  rariolin,  scarlatinin,  sypldlinum,  showing  that 
the  idea  of  curing  disease  by  the  exhibition  of  their 
products  is  a  very  old  one. 

Among  these  Dr.  Drysdale's  tiiberculinum  anticipated 
some  ten  years  ago  not  only  the  remedy  re-discovered 
by  Koch,  but  the  appropriate  vehicle  glycerine. 

So  that  just  as  the  method  and  the  dose  are  in  accord- 
ance with  our  tenets,  so  apparently  did  the  idea  emanate 
from  our  despised  school. 

I  can  only  speak  personally  of  the  effects  of  pyrogen 
or  pyrexiny  the  sepsin  of  beef,  manufactured  by  Mr. 
Wybom,  which  has  appeared  to  me  to  be  of  undoubted 
efficacy  in  cases  of  puerperal  fever,  pyeemia  and  the 
like. 

In  conclusion,  I  feel  I  have  but  touched  one  wing  of  a 
subjecc  of  so  vast  and  growing  an  importance  that  na 


158  KOCH    AND    PASTEUR.     ^^L^SH^St 


Beview.  Mar.  S,  1»1. 


medical  man,  and  no  school  of  scientific  medicine  can 
:aflford  to  neglect  it. 

Whether  I  have  proved  my  thesis  that  these  researches 
have  an  intimate  bearing  on  the  doctrine  of  similars 
I  must  leave  to  you  to  decide  who  have  listened  so  long 
■and  so  patiently  to-night. 

At  all  events,  I  think  we  may  fairly  take  as  proved, 
that  the  researches  of  Pasteur  do  support  the  doctrines 
of  our  school. 

1.  They  illustrate  the  efficacy  of  vaccination  both  as  a 
•cure  as  well  as  a  preventative — a  doctrine  which  some 
of  us  hold  in  the  case  of  variola  as  a  necessary  result  of 
the  law  of  similars. 

2.  They  illustrate  the  use  of  animal  poisons,  which 
have  always  been  favourite  remedies  with  us,  e.g.^  apiSf 
Xachesis,  &c.,  while  neglected  by  other  therapeutists. 

3.  They  illustrate  once  agam  the  doctrine  that  great 
results  invariably  spring  from  small  causes.  Indeed, 
the  preparation  of  the  rabies  remedies  and  the  pure 
^cultivations,  both  in  magnitude,  in  mode  of  dilution  and 
preparation,  and  even  in  nomenclature,  are  homoeopathic. 

4.  They  confirm  our  belief  in  the  selective  power  of 
remedies  on  certain  organs  and  tissues. 

5.  They  corroborate  our  guiding  rule  that  the  search 
for  a  cure  is  the  search  for  a  similimum. 

My  task  is  even  easier  when  we  turn  to  Koch's 
•studies. 

Indeed,  his  first  paper,  as  reported  in  the  Times, 
might  well  have  been  written  by  a  "  Liberal." 

1.  His  dose  is  infinitesimal. 

2.  His  remedy  acts  fiercely  on  a  diseased  organism, 
feebly  or  not  at  all  on  a  healthy  body. 

3.  The  doctrines  of  medicinal  exacerbation  and 
medicinal  tolerance,  both  receive  support- 

4.  In  short,  he  has  proved  in  his  laboratory  in  Berlin, 
in  1890,  what  Hahnemann,  with  the  prescience  of  genius, 
asserted  50  years  before- 


'  Similia  Siviilihus  Curantur,'' 


Discussion. 


Dr.  Hughes  quite  agreed  with  Mr.  Butcher  that  the  action 
jof  Koch's  fluid  was  apparmtbj  homoeopathic  to  the  disease 
(tubercular  phthisis)  it  was  designed  to  cure.  When  we  went 
below  the  surface,  however,  the  case  was  not  so  clear.    Koch's 


X52^i2?T^,'"*     KOCH   AND   PASTEUR.  159 


Beview,  Xkr.  8,  1881. 


acconnt  of  the  process  was  that  the  bacilli  poison  the  proto- 
plasm on  which  they  feed,  making  it  unfit  for  their  pabulum, 
and  that  his  fluid  does  this  more  rapidly  and  on  a  larger 
-scale,  so  starving  them  out.  Naturally  therefore  the  two 
agents  produce  similar  s3rmptoms — ^fever,  cough,  &c.,  but 
since  he  could  not  think  of  drugs  as  acting  in  this  way,  he 
was  unable  to  claim  any  curative  effects  obtained  by  Koch's 
floid  as  examples  of  the  law  of  similars.  Neither  could  he 
make  such  claim  for  Pasteur*s  treatment,  real  or  imaginary, 
in  their  efficacy.  A  patient  protected  by  them  is  like  one  who 
has  already  had  an  attack  of  the  disease  to  be  guarded  against, 
and  this  he  considered  was  also  the  probable  account  to  be 
given  of  the  power  of  vaccination.  On  the  other  hand,  in 
respect  of  the  minute  quantities  required,  Koch's  treatment 
was  a  valuable  testimony  to  one  feature  of  homoeopathy.  In 
this  matter  he  (Dr.  Hughes)  had  long  ago  said  that  science 
was  fighting  our  battle,  and  that  we  might  wait  for  her  to 
^in  the  victory  for  us.  He  asked  Mr.  Butcher  if  omne  vivum 
tx  QTo  should  not  be  omne  Hvum  e  vivo,  as  eggs  were  not 
always  required  for  the  process. 

Dr.  Dyce  Browk  said  Mr.  Butcher's  papers  were  always 
deeply  interesting  and  instructive.  Dr.  Dyce  Brown  elicited 
from  Mr.  Butcher  that  the  virus  was  taken  from  guinea-pigs, 
though  the  original  came  from  the  human  subject.  He 
thought  in  this  case  the  treatment  was  and  is  homoeopathic. 
If  it  is  direct  from  the  human  subject  he  could  not  consider  it 
homoeopathic ;  unless  the  simple  attenuation  of  the  virus  so 
altered  it  as  to  produce  something  different  from  the  original. 
He  considered  the  Koch  treatment  was  similar  to  the  hydro- 
phobia treatment  of  Pasteur  and  vaccination.  The  agent  is 
altered  by  being  passed  through  different  animals.  He  con- 
sidered vaccinia  and  variola  two  entirely  distinct  diseases. 
Cows  would  not  take  variola.  If  infected  with  the  poison, 
vaccinia  results,  not  variola.  Pasteur  does  not  use  hydro- 
phobic virus  from  the  dog,  but  from  the  rabbit.  Babbit  rabies 
is  different  from  dog  rabies.  The  two  are  not  identical,  but 
like.    A  tertium  quid  is  proved. 

Dr.  Madden  said  the  question  of  the  use  of  nosodes  as 
homoeopathic  remedies  was  always  interesting.  He  had  tried 
j»fro(jen  in  one  case  of  typhoid  and  two  of  puerperal  fever.  He 
found  no  result.  He  considered  it  proved  that  Koch's  remedy 
did  produce  effects,  and  some  of  them  satisfactory.  In 
reference  to  Dr.  Hughes'  remarks,  he  said  that  the  strong 
fluid  did  produce  effects  on  the  healthy.  In  one  of  Koch's 
eases  the  guinea-pig  was  cured  by  a  smaller  injection  of  what 
had  before  given  it  tubercle.  He  asked  if  the  discussion  was 
not  trenching  on  the  explanation  of  the  homoeopathic  action 


160  KOCH   AND   PASTEUR-      ^^J.^^S!'?^. 


of  remedies  as  stated  by  Hahnemann.  Were  not  the  symp- 
toms produced  the  result  of  the  organism  reacting  against  the 
poison  ? 

Dr.  E.  6.  EocHE  (of  Norwich)  said  he  had  been  struck  as 
Mr.  Butcher  had  with  the  thought  that  Pasteur  and  Koch 
had  hit  upon  the  idea  of  cure  by  similars.  He  agreed  with 
Dr.  Dyce  Brown  that  the  passage  of  ihe  poison  through  other 
animals  did  produce  a  tertium  quid.  He  found  intelligent  men 
much  more  open  to  conviction  as  to  the  power  of  the  infini- 
tesimal since  they  had  become  aware  of  the  minute  quantitiea 
of  Koch's  fluid  which  produce  such  powerful  effects. 

Dr.  Carfkae  wished  to  intensify  Dr.  Dyce  Brown'&criticism 
of  Dr.  Hughes'  remarks.  He  thought  vaccination  was  a 
strong  illustration  of  the  law  of  similars.  Dr.  Hughes  admits 
the  fact  that  Koch's  fluid  produced  all  the  symptoms  of 
tuberculosis,  but  objects  to  its  being  homoeopathic,  because  of 
the  supposed  mode  of  action.  The  one  is  a  fact  admitted  by 
Dr.  Hughes  the  other  a  theory  which  is  generally  accepted 
but  may  turn  out  to  be  quite  wrong.  But  right  or  wrong  the 
theory  must  give  way  to  the  fact. 

Dr.  MoiB  was  deeply  interested  in  Mr.  Butcher's  paper.  He 
thought  Koch's  methods  were  decidedly  homoBopathic ;  but 
the  results  were  nothing  to  be  proud  of  at  present.  Neither 
did  he  think  Pasteur's  results  were  so  very  certain.  H& 
thought  much  more  might  be  done  by  prevention. 

Dr.  BuRFORD  felt  great  indebtedness  to  Mr.  Butcher  for 
working  out  the  scientific  side  of  homoeopathy.  The  paper 
was  fertile  in  ideas.  If  Dr.  Dyce  Brown's  idea  of  a  tertium 
quid  was  right,  he  thought  Pasteur  and  Koch  were  decidedly 
homoeopathic.  Either  it  was  or  was  not  homoeopathic.  If 
not,  we  must  be  content  to  be  swallowed  up  by  something 
else.  It  is  not  so  much  the  living  bodies  as  the  never  varying 
chemical  products  of  the  orgajiisms  that  produce  the  efi'ects. 
The  pabulum  in  wliich  they  are  found  is  important,  and  makes 
all  the  difference  to  the  properties  of  the  cultures.  It  is  not 
so  much  the  hving  organism  as  its  excretion,  called  ptomaines, 
that  is  the  efficient  agent.  It  is  the  careful  study  of  ptomaines 
that  now  devolves  upon  us.  In  septic  peritonitis  after  opera- 
tion, the  deaths  are  due  to  poisoning,  and  this  not  so  much  by 
the  organisms  as  by  their  environment.  Another  point  which 
is  of  interest  is  the  theory  of  inheritance.  Tendency  to 
tubercle  is  inherited.  It  is  open  to  question  if  the  Kochian 
results  of  immunity  are  also  heritable.  In  regard  to  Mr. 
Butcher's  theory  of  self-hmitation  the  question  is — ^Is  the 
pabulum  present  on  which  the  germs  can  thrive  ?  On 
Mr.  Butcher's  theory  it  would  not  be  right  to  interfere  with 
abscesses,  &c.,  until  they  had  killed  all  the  germs. 


^flUy  HomcBopjaiic     g^^g   ^j^jj   PASTEUR.  161 


Seriew,  Mar.  2, 1801. 


Dr.  Galley  Blacklet  said  he  had  taken  considerable 
interest  for  years  past  in  the  system  of  protective  inoculations 
as  practised  by  Pasteur  and  others,  but  had  come  to  the  con- 
elusion,  at  least,  in  so  far  as  concerned  the  inoculations  with 
fluids  still  containing  bacilli,  that  they  were  in  no  way  allied 
to  homoeopathy.  The  successive  cultivations  of  a  bacillus  did 
not  at  all  resemble  the  dilutions  of  a  drug,  for  as  a  matter  of 
fieust  the  number  of  the  bacilli  might  increase  to  an  unlimited 
extent,  although  their  virulence  gradually  diminished  and 
they  could  be  tolerated  when  injected  into  the  system  of  the 
animal  whom  it  was  desired  to  protect,  as  in  the  case  of 
anthrax,  or  cure,  as  in  the  case  of  rabies.  Dr.  Dyce  Brown 
had  spoken  as  if  the  tubercuhsation  of  an  animal  by  Koch  had 
been  accomplished  with  the  so-called  lymph :  this,  it  need 
hardly  be  said,  was  not  the  case.  The  tuberculisation  was 
performed  either  by  feeding  the  animals  on  tuberculous 
material  or  by  means  of  injections  containing  bacilli.  It  was 
curative  effects  alone  that  were  claimed  for  the  finished  pro- 
duct known  as  Eoch*s  fluid.  In  claiming  Koch^s  liquid  as  a 
homoeopathic  specific  it  should  not  be  forgotten  that  it  did 
not  at  all  fulfil  the  conditions  laid  down  by  Drysdale  in  his 
definition  of  a  specific,  viz. : — that  its  whole  physiological 
action  should  be  absorbed  into  its  therapeutic  effects.  Reply- 
ing to  Dr.  Hughes*  suggestion  that  the  fever  produced  by 
Koch's  injections  was  probably  that  of  destruction,  he  said 
this  could  not  be  maintained ;  the  fever  was  undoubtedly 
primary :  he  had  seen  a  dose  of  half  a  milligramme  injected 
into  a  child  with  strumous  dactylitis  ;  within  eight  hours  the 
temperature  rose  to  105.5  and  was  down  again  next  morning 
below  100 ;  all  that  there  was  to  show  in  the  way  of  local 
trouble  being  that  the  diseased  finger  joint  was  swollen  to 
double  its  size  but  in  no  sense  destroyed.  Whatever  might 
be  in  store  for  the  fluid  as  a  remedial  agent  there  could  be  no 
doubt  that  in  cases  of  lupus  it  had  produced  effects  such  as 
no  other  remedy,  either  external  or  internal,  had  ever  produced 
in  the  same  space  of  time. 

Dr.  Clabks  said  he  would  not  retail  to  members  the  three 
last  leading  articles  of  the  Uomceopathic  WorUl,  They  had 
doubtless  been  read  already.  He  fully  agreed  with  Mr. 
Butcher  that  the  treatments  of  Pasteur  and  Koch,  in  so  far  as 
^ey  were  curative,  were  homoeopathic.  In  reference  to 
Dr.  Hughes*  remarks,  he  would  say  that  drugs  had  a  lofty 
scorn  for  explanations.  K  a  substance  which  had  the  power 
of  producing  certain  symptoms  could  also  cure  these  when 
otherwise  brought  about,  that  substance  acted  homoeo- 
pathically,  no  matter  what  the  explanation.  He  had  used 
^fotodis  and  he  found  them  very  effective  agents.    He  agreed 

Vol  36,  No.  S.  N 


162  KOCH    AND   PASTEUR-     ^SSS^^X°^'!«i! 

with  Hahuemann  that  the  method  of  preparation  did  so  alter 
them  as  to  make  them  not  identical  but  similar.  He  could 
not  endorse  all  the  methods  and  doctrines  of  Pasteur  and 
Koch,  nor  did  he  rate  them  at  so  high  a  figure  as  Mr.  Butcher, 
but  they  had  certainly  brought  the  doctrine  of  nosodes  to  the 
front,  and  it  would  have  to  be  dealt  with  by  homoeopaths. 
He  had  used  tuberculmwn,  the  nosode  used  by  Dr.  Burnett, 
and  with  very  good  results.  He  had  also  used  pyrogen  lately, 
with  good  effect,  in  a  case  of  debihty  after  typhoid. 

Dr.  BuEwooD  thought  the  profession,  as  well  as  the  public, 
were  losing  their  heads  in  connection  with  this  matter.  We 
had  all  heard  of  the  **  grape  cure,"  and  the  '*  milk  cure,"  and 
other  cures ;  the  term  "  cure  "  here  really  meant  treatment, 
and  the  Eoch  treatment  at  present  had  certainly  not  been  a 
**  cure  "  in  the  proper  acceptation  of  that  term.  He  would 
like  the  Koch  treatment  to  be  tried  in  the  early  months  of 
childhood  for  the  prevention  of  tubercle,  as  vaccination  was 
employed  for  the  prevention  of  smaU-pox.  It  might  interest 
the  Society  to  Imow  that  one  of  the  earliest  patients,  he 
beUeved  the  third  inoculated  in  London,  was  his  patient,  a 
lady,  and  had  been  under  his  care  for  twenty  years ;  during 
this  period,  off  and  on,  slie  had  been  subject  to  lupus  in  the 
face ;  as  soon  as  it  began  to  appear  she  would  have  the  usual, 
homoeopathic  remedies,  the  condition  gradually  improving  and 
the  face  for  two  or  three  years  remaining  tolerably  well.  Then 
another  outburst,  and  so  on.  The  last  attack  or  relapse  no 
kind  of  treatment  seemed  of  any  use  for,  so  Dr.  B.  suggested  con- 
sulting an  eminent  specialist,  who  said  in  six  months  he  would 
cure  it.  At  the  end  of  three  months  the  lupus  was  worse 
than  ever.  She  then  saw  Mr.  J.  H.,  who  confirmed  the  diag- 
nosis and  advised  a  line  of  treatment,  wishing  to  see  the 
patient  in  six  weeks  ;  at  the  end  of  that  time,  the  face  being 
no  better,  he  advised  that  the  Koch  treatment  should  be  tried 
at  once,  and  on  the  next  day  she  had  the  first  inoculation  by 
Dr.  H. ;  she  had  eight  injections,  with  the  usual  reactionary 
fever.  Strangely,  however,  the  face  trouble  was  not  affected 
in  the  shghtest  degree,  but  instead  an  old  slumbering  pulmo- 
nary trouble  which  had  been  quiet  thirty  years  was  roused 
into  activity  with  most  distressing  cough,  &c.,  &c.,  and  now,, 
after  eight  weeks  residence  in  a  surgical  home,  the  patient  has 
to  return  to  the  country  with  her  face  as  bad  as  ever,  and  her 
lung  much  worse.     So  much  for  the  Koch  cure  in  this  case. 

Dr.  Dudgeon  thought  before  we  claim  anything  as  homoeo- 
pathic we  should  first  ask,  Is  it  successful  ?  In  reference  to 
Pasteur's  inoculation  for  hydrophobia  there  was  a  long  list 
of  fatalities  ;  the  death  rate  from  hydrophobia  since  he  began 
his  inoculations  had  been  raised  in  France  instead  of  being: 


^t^v^T'S^     KOCH   AND    PASTEUR.  16S 


.  lUr.  s.  isn. 


lowered.  Besides,  Pasteur  did  not  claim  to  cure  hydrophobia, 
bat  only  to  prevent  it.  Homoeopathy  was  a  method  of  curing 
not  preventing  disease,  hence  Pasteur's  inoculations  had 
noUimg  to  do  with  homoeopathy.  Dr.  Carfrae  said  he  would 
give  up  homoeopathy  if  he  was  convinced  that  vaccination, 
was  not  truly  homoeopathic,  but  as  vaccination  was  the  pro- 
duction of  a  disease  in  a  person  in  order  to  prevent  another 
disease  attacking  him,  it  was  not  homoeopathy  at  all,  so  he 
feared  Dr.  Carfi^  would  have  to  renounce  his  allegiance  to 
Hahnemann.  Coming  to  Koch,  not  a  single  authentic  case 
of  cure  had  yet  been  recorded.  Yirchow  had  shown  that  the 
inoculations  instead  of  killing  the  bacilli  multiplied  them 
and  set  up  infection  pneumonia.  It  had  also  been  shown 
that  m  patients  under  the  Koch  treatment  bacilli  existed  in 
the  blood  where  they  had  never  been  found  before.  In  thir- 
teen  cases  of  death  from  two-and-a-half  to  forty-seven  years,, 
dying  in  from  eighteen  hours  up  to  thirty  days  after  Koch's 
injections,  examined  by  Dr.  Hansemann,  the  diseases  were  of 
very  great  gravity,  mostly  disseminated  tubercle ;  and  this 
happened  not  only  in  the  advanced,  but  also  in  the  early 
cases.  We  should  not  be  in  a  hurry  to  claim  any  treatment 
as  homoeopathic  until  it  had  first  been  proved  curative. 
Homceopathy  is  a  curative  system  ;  Koch's  has,  as  yet,  only 
proved  a  killing  system. 

Mr.  BuTCHEB,  in  reply,  said  he  simply  followed  Koch  up  to 
his  laboratory  experiments.  He  expressly  guarded  himself 
against  saying  anything  about  his  ''  cure "  as  applied  to 
haman  beings.  He  did  not  endorse  fully  Koch's  experiments 
on  hnman  beings  with  a  destructive  poison.  He  was  not 
speaking  in  a  limited  sense  of  what  anyone  may  consider  to 
be  homoeopathy,  but  of  the  law  of  similars — the  interference 
of  vibrations  more  or  less  like.  Scientifically  there  can  be  no 
other  demonstration  of  the  homoeopathic  law.  Take  Koch's 
fluid  and  call  it  K.  It  is  formed  and  fashioned  by  animal 
liie,  just  as  aconite  is  formed  by  vegetable  life.  He  took  it 
there  was  no  difference  between  re-arrangement  of  atoms  by 
physical,  vegetable  or  animal  forces.  If  you  take  the  Ix 
dilution  of  **  K  "  you  have  a  certain  aiTangement  of  atoms, 
and  it  makes  no  difference  whether  this  is  brought  about 
chemically  or  by  means  of  animal  or  vegetable  life.  Sugar, 
^hich  was  once  thought  impossible  to  make,  has  been  formed 
in  the  laboratory  only  the  other  day.  Mr.  Butcher  takes  the 
floid  of  Koch  from  Koch's  hands  as  an  entity.  By  similarity 
Mr.  Butcher  means  equality  of  vibrations.  He  had  seen 
improvement  in  lupus  cases,  but  he  referred  to  discoveries 
made  in  the  laboratory  in  his  comparisons  with  homoeopathy* 
He  was  not  referring  to  cures. 

N— 2 


164  CARDUU8   MARIANUS.     "SSil^Cf?^ 


Review,  Mar.  S,  1881. 


CAEDUUS    MAEIANUS. 

By  E.  E.  Dudgeon,  M.D. 

This  plant,  which  was  such  a  favourite  with  Eademacher, 
who  found  it  an  excellent  remedy  for  acute  and  chronic 
affections  of  the  liver,  gall-stones,  gastralgia,  hsemoptysis, 
haBmatemesis,  metrorrhagia,  &c.,  has  not  received  so 
much  attention  from  homoeopathic  practitioners  as  it 
deserves.  In  1882  Dr.  Windelband,  of  Berlin,  wrote  an 
article  in  the  Berlifier  Zeitschrifty  in  which  he  related  the 
marvellous  results  that  he  had  obtained  from  its  employ- 
ment in  varicose  ulcers,  of  which  he  had  many  cases  in 
the  practice  of  the  Homceopathic  Dispensary  of  Berlin. 
He  says :  *'  The  forms  that  came  under  our  treatment 
were  chiefly  fully  developed  ulcers  of  bluish  or  brownish 
red  colour,  with  ichorous  discoloured  granulations,  and 
usually  surrounded  by  broi;\Tiish-coloured  dilated  veins, 
with  jagged,  cfeUous  borders,  easily  bleeding,  and  caused 
by  a  blow,  the  bursting  of  a  varix,  following  eczema, 
rarely  consequent  on  inflammation  of  the  connective  tissue, 
most  frequently  caused  by  scratching  an  eczematous 
skin.  The  pains  were  usually  moderate ;  sometimes  the 
patients  complained  of  burning  in  and  around  the  ulcer. 
The  most  tiresome  symptom  was  the  constant  itching, 
which  was  worst  when  the  ulcer  was  commencing  to  heal." 
He  had  been  favoured  with  large  numbers  of  such  cases, 
both  at  the  dispensary  and  in  private  practice,  and  had 
had  little  or  no  success  with  many  homoeopathic  reme- 
dies, such  as  carbo  veg.,  beUad.,  rhus.y  pids.f  hanianielis, 
graph,  sulph.,  cBc.  He  was  led  to  the  knowledge  of  the 
healing  powers  of  carduus  in  such  ulcers  in  this  way :  A 
labouring  woman  of  middle  age,  who  had  had  six  children, 
and  had  to  do  a  great  deal  of  housework,  came  under 
his  care  for  inflammation  of  the  liver,  which  left  a  chronic 
-swelling  of  that  organ.  After  trying  many  homoeopathic 
remedies  in  vain,  he  at  last  resolved  to  try  Bademacher's 
remedy.  He  gave  the  drug  in  a  decoction  of  the  seeds 
as  Eademacher  first  directed.  The  liver  disease  rapidly 
improved  under  this  remedy,  and  he  was  surprised  to 
find  that  some  "colossal"  varicose  ulcers,  with  which 
the  patient  had  been  tormented  for  five  or  six  years,  were 
completely  healed  in  a  few  weeks  without  any  external 
mtment  except  the  occasional  and  irregular  employ- 
mt  of  a  simple  bandage.    This  case  led  him  to  employ 


S^rSrrS^''      CABDUUS   MARIANU8.  16& 

the  fiame  medicine  in  tincture  of  the  seeds  in  his  dis- 
pensary practice,  and  it  proved  so  successful  that  of  lOft 
cases  of  varicose  ulcers  of  the  legs  of  all  varieties  of 
degree  145  were  completely  cured  by  carduns  alone^ 
though  the  patients,  who  were  mostly  women  of  the 
lowest  class,  continued  to  go  about  their  work.  The  only 
external  application  was  an  ordinary  flannel  bandage,, 
and  when  there  was  much  burning  or  itching  a 
wet  compress  or  an  oiled  rag.  As  these  chronic 
varicose  ulcers  are  usually  of  a  most  intractable  nature, 
a  veritable  opprobrium  medicinse  even  under  homoeo- 
pathy, and  with  prolonged  rest  on  the  part  of  the  patient,, 
it  is  interesting  to  all  practitioners  to  know  the  success 
that  has  attended  their  treatment  by  carduxis  marianus. 
Dr.  Windelband  gave  the  tincture  of  the  seeds  in 
the  first  dilution  or  mother  tincture,  five  drops  three 
times  a  day.  I  may  observe  that  the  tincture  or  decoc- 
tion of  the  seeds  was  what  was  used  by  Bademacher  and 
Windelband,  and  by  Eeil  and  Buchmann  in  their  not 
very  satisfactory  provings.  The  British  Homoeopathic 
Phannacopoeia  directs  that  the  tincture  should  be  made 
from  the  root  and  seeds,  but  as  there  is  no  evidence  that 
any  medicinal  virtue  is  contained  in  the  root  it  should 
certainly  not  be  used  in  preparing  the  tincture. 

In  the  Berliner  Zeitschrift  of  August  last,  Dr.  Kunze 
has  an  article  on  carduus  mananusy  which  gives  us  a 
father  insight  into  its  medicinal  powers.  After  remarking 
that  in  the  latest  works  on  Materia  Medica  of  the  allo- 
pathic school  no  mention  is  made  of  this  drug,  and  that 
it  has  rarely  been  used  even  in  the  homoeopathic  school, 
he  says : — 

"  The  chief  spheres  of  action  of  c.  mar.  are  diseases  of 
the  liver,  bile  and  spleen,  and  various  affections  caused 
by  derangements  of  this  organ,  such  as  asthma,  cough, 
pleurodynia  and  local  rheumatism,  especially  of  the 
intercostal  muscles,  diaphragm  and  abdominal  muscles ; 
also  gastric  ailments,  digestive  disturbances,  gastro- 
intestinal catarrh.  It  has  a  marked  effect  on  the  venous 
Bj'stem,  especially  when  the  affection  of  the  vessels  is 
owing  to  hyper »mic  state  of  the  liver  and  obstructive 
congestion  of  the  portal  vessels,  but  it  seems  also  to 
have  a  specific  relation  to  the  venous  system  unconnected 
^th  any  affection  of  the  abdominal  organs.  Epistaxis, 
metrorrhagia,  hsemorrhoidal  flux,  haemoptysis  and  bflpmo- 


166  CAKDUCS   MABIANU8.      "S2^=2STSi! 


Renew,  Mar.  2, 1881. 


temesis,  as  also  various  ulcers  of  the  legs,  have  frequently 
been  cured  by  e,  mar. 

"  The  first  and  chief  indication  oicard.  inar.  is  hyper»- 
mia  of  the  liver,  of  the  biliary  apparatus,  and  of  the 
portal  system,  and  jaundice.  It  is  suitable  for  both  the 
acute  and  chronic  forms  of  hepatic  hypersemia.  The 
symptoms  that  chiefly  indicate  its  employment  are: 
more  or  less  distension  and  tenderness  of  the  right 
hy^chondrium  with  pressive,  throbbing  or  shooting 
pain  on  right  side  of  abdomen,  below  short  ribs  through 
to  spine,  also  extending  through  chest  to  right  shoulder. 
Clinical  experience  has  taught  that  in  liver  affections 
with  great  tenderness,  but  without  swelling  of  liver  or 
stoppage  of  bile,  cardans  is  superior  to  other  remedies. 
There  is  present  an  inclination  to  take  a  deep  breath, 
but  the  pains  are  aggravated  by  that  and  by  movement. 
In  very  acute  cases  this  hepatic  hyperaemia  assumes  the 
form  of  a  bilious  fever  or  so-called  acute  hepatitis,  or 
as  typhlitis,  or  with  an  array  of  symptoms  resembling 
peritonitis  puerperalis,  or  as  cough  with  stitch  in  the 
side  (false  pleurisy). 

"  This  chronic  hepatic  hyperaemia  is  often  attended  by 
chronic  pleurodynia  in  either  hypochondrium,  pain  in 
csecal  region  accompanied  by  emaciation,  dirty  yellow 
complexion  or  hectic  fever ;  sometimes  hsemorrhages 
ensue,  epistaxis,  haemoptysis  or  haematemesis,  metror- 
rhagia, sciatica  and  intercostal  myalgia.  A  common 
complication  is  icterus  and  gastro-intestinal  catarrh. 
Indications  for  card,  mar.  are  dull  headache,  especially 
in  forehead  or  temples,  confusion  of  head  and  vertigo, 
epistaxis,  bitter,  pasty,  flat  taste,  eructations,  heartburn, 
white  tongue,  especially  when  it  is  white  in  the  centre 
and  red  at  tip  or  sides,  or  only  white  on  one  side,  at  the 
same  time  vomiting  of  a  sour  green  fluid.  The  stools 
3je  at  first  generally  brown  and  of  firm  consistence, 
normal,  neither  constipation  nor  diarrhoea,  later  they 
become  bright  yellow,  pappy,  and  diarrhoeic.  The  urine 
is  at  first  bright  yellow,  then  brownish  tinted,  alkaline 
or  acid,  with  a  glittering  scum  and  cloudy  sediment. 
The  gastro-intestinal  catarrh  is  sub-acute;  there  are 
sometimes  attacks  of  gastralgia,  the  pains  being  con- 
ractive;  at  this  climax  vomiting,  cold  rising  from 
precordium  to  throat,  ending  with  a  feeling  of  spasmodic 
constriction  in  throat.      I  may  mention  that  card,  is 


S^^inTiSi"'      CARDUUS   MARIANUS.  167 

sometimes  useful  in  the  vomiting  of  pregnant  women,  or 
such  that  occurs  in  the  morning  before  meals,  is  watery 
and  tasteless.  Some  recommend  it  in  gall-stone  colic, 
but  I  cannot  do  so. 

**  Melancholy  as  a  consequence  of  hepatic  disease  is 
cured  by  card,  in  suitable  cases.  There  is  rarely  absent 
a  cough,  which  is  sometimes  dry,  sometimes  with 
expectoration  of  mucus,  streaked  with  blood  or  san- 
guineous. In  the  morning  thick  yellow  sputa,  aiid 
eipectoration  with  difficulty,  there  are  at  the  same  time 
stitches  in  the  side  and  evening  fever.  The  patients 
complain  of  dyspnoea. 

"Here  is  a  specimen  of  a  cure  of  hepatic  hyperemia. 
A  woman,  aged  45,  of  greyish-yellow  complexion,  who 
had  been  subject  for  several  years  to  hepatic  colic,  had 
been  suffering  for  a  week  from  her  periodical  pains. 
They  commence  in  the  middle  of  the  abdomen  and 
extend  thence  to  the  scrobiculus  cordis  and  right 
hypochondrium  where  they  remain.  The  precordium 
was  80  sensitive  to  the  slightest  touch  that  she  cried  out, 
and  thorough  examination  was  impossible.  An  hour 
later,  before  she  had  taken  any  medicine,  she  got  an 
attack  of  colic  with  very  little  vomiting,  great  dyspnoea, 
feeling  of  suffocation  and  great  exhaustion.  This  attack 
went  off  in  the  afternoon  without  medicine,  and  then 
there  ensued  chill  and  heat.  When  carefully  examined 
next  day,  the  whole  right  hypochondrium  was  found  to 
be  distended  and  extremely  painful,  with  febrile 
symptoms,  so  that  hepatitis  might  almost  have  been 
suspected.  Tongue  loaded,  rather  pasty ;  urine  reddish- 
yellow,  turbid,  scanty  and  strongly  alkaline.  The 
patient  got  tinct.  card.  inar.  10  to  15  drops  five  times  a 
day.  Next  day  much  better,  completely  cured  after 
three  days." 

Dr.  Kunze  points  out  the  similarity  of  the  above 
symptoms  to  those  obtained  by  Reil  in  his  proving  of  the 
drug,  which  may  be  read  in  the  second  vol.  of  the 
Cyclopedia  ofDnig  Pathogenesy. 

"hi acute  or  saib-acute  gastro-intestinal  catarrh  card. 
w«r.  given  in  doses  of  several  drops  of  the  tincture 
^veral  times  a  day,  is  so  very  useful  that  the  slighter 
<»8e8  are  removed  in  two  days,  the  severer  ones  in 
five  to  seven  days.  Even  chronic  cases  are  cured  in  a 
relatively  short  time. 


n 


168  CABDUUS   MARIANU&-      ^gSSg^f^^J^SS! 

*'  A  woman,  aged  64,  had  been  suflFering  for  two  years 
from  anorexia,  persistent  nausea,  frequent  vomiting  of 
food,  of  which  she  could  only  eat  the  lightest  kinds, 
pains  in  precordium  and  right  hypochondrium.  The 
last  few  months  she  had,  in  the  evening,  palpitation  of 
the  heart,  chill  lasting  quarter-of-an-hour,  spasmodic 
drawing  in  calves  and  hands  and  numbness  of  fingers. 
Tongue  moderately  furred,  steel  grey,  taste  bitter,  urine 
acid,  bright  yellow,  cloudy  ;  headache.  After  taking  for 
two  days  some  remedies  which  had  no  good  eifect  she 
got  tijicL  card,  mar.  Next  day  the  evening  attack  did 
not  come  on  and  she  felt  better  generally-  Some 
haemoptysis  occurred,  but  that  she  had  often  had.  After 
taking  the  medicine  for  fourteen  days  all  her  symptoms 
disappeared. 

"In  spasms  of  the  stomach  carduus  is  superior  to 
most  of  the  usual  remedies.  If  the  pains  are  contrac- 
iive,  if  vomiting  occurs  at  the  climax,  if  there  is  cold 
rising  from  the  precordium  to  the  throat,  combined  with 
feeling  of  spasmodic  constriction,  if  there  is  pressive^ 
shooting  pain  in  the  right  side  of  abdomen  spreading 
to  the  back  or  shoulder,  one  may  rely  on  seeing  good 
results  from  cardmis. 

'*  Chronic  hypersemia  of  the  spleen,  and  its  attendant 
affections  are  not  insusceptible  to  the  action  of  carduus. 
It  removes  the  following  symptoms  which  may  be  due 
to  the  spleen :  chronic  pleurodynia  in  left  hypochon- 
drium, hfematemesis,  ague  and  intermittent  neuralgia. 
I  have  seen  sequelae  of  malarious  and  typhoid  fever 
repeatedly  yield  to  this  medicine. 

"  A  widow,  60  years  old,  who  had  been  ailing  for  10 
years,  complained  of  loss  of  appetite,  bitter  taste,  con- 
stipation, tension  or  pain  in  precordium  and  liver.  A 
few  days  ago  she  got  a  feeling  of  hot  undulation  in 
precordium,  with  anxious  oppression,  followed  a  few 
hours  later  by  a  black,  tar-like  stool  mixed  with  blood. 
She  now  felt  not  only  pains  in  the  liver,  for  which  she 
had  been  latterly  taking  quaesia  without  effect,  but  also 
pressure  and  shooting  in  the  region  of  the  spleen,  ^hich 
was  swollen  and  tense.  Card.  mar.  was  prescribed. 
Next  day  the  liver  pains  had  completely  gone,  but  the 
spleen  remained  tender  to  pressure  ;  on  the  2nd  or  3rd 
day  she  lost  blood  by  stool,  but  10  days  after  taking  the 
arduus  there  was  no  more  swelling  or  tenderness  of  the 


iKiSTS^''      CABDUUS   MABIANUS.  169^ 

spleen,  and  the  patient  felt  better  than  she  had  done  for 
years,  while  continuing  to  take  the  medicine. 

"  In  former  days  carduus  was  given  for  ague.  Tourne- 
fort  relates  the  following  case :  A  young  woman,  aged 
25,  complained  for  a  week  of  violent  pains,  which  began 
at  the  right  ear,  passed  through  the  temple  down  to  face 
and  neck,  did  not  invade  the  left  side  and  recurred  two 
or  three  times  a  day  ;  pain  in  both  sides,  especially  in 
the  middle.  Every  day  about  3  p.m.,  she  has  an  ague 
fit,  with  chill,  heat  and  sweat,  lasting  from  1  to  2  hours. 
She  is  weary,  lies  in  bed,  has  no  appetite,  bitter  taste, 
tongue  thinly  furred,  deep  yellow  urine,  with  glittering 
scum  and  cloudy  sediment.  For  the  last  six  months 
the  menses  have  come  on  every  fortnight,  lasting  three 
days  and  generally  pale  coloured.  In  the  interval  she 
has  continual  leucorrhoea.  On  account  of  her  anaemia 
she  got  iron,  and  for  the  gastric  malarious  symptoms 
carduus  mar.  at  the  same  time.  The  ague  and  periodical 
neuralgia  disappeared  in  a  few  days,  and  in  three  weeks 
the  leucorrhoea  and  anomalous  menstruation  were  cured, 

"  Numerous  cases  have  occurred  where  card.  mar.  has 
cured  pains  in  the  hepatic  or  splenic  region  accompanied 
by  haemoptysis  or  expectoration  of  viscid,  lumpy  mucus, 
and  evening  fever.  Even  phthisis  pituitosa  and  slight 
or  severe  bronchial  catarrhs  have  been  cured  by  it. 

'*  A  man,  aged  62,  had  suffered  for  six  months  from 
cough  with  copious  purulent  expectoration  in  enormous 
masses,  and  for  the  last  14  days  had,  in  addition,  hectic 
fever.  He  complained  of  shooting  in  the  left  side  and 
pains  in  the  chest ;  the  left  lobe  of  liver  was  painful  to 
pressure  and  swollen,  the  tongue  coated  yellow.  No 
appetite.  Prescribed  tinct.  card.  mar.  In  three  days  the 
shooting  pain  was  gone,  the  liver  free  from  pain.  After 
four  weeks  the  expectoration  had  quite  ceased.  Ferr.  acet. 
was  given  simultaneously  for  the  anaemia,  and  the 
patient  was  quite  cured. 

"  Hasmorrhage  from  the  lungs  connected  with  hepatic 
disease  is  curable  by  no  other  medicine  so  readily  as  by 
card.  Diar.  It  is  also  of  great  use  in  haemoptysis 
dependent  on  disease  of  spleen,  with  swelling  and  shoot- 
ing in  that  organ  and  relief  by  lying  on  left  side.  Acute 
and  chronic  sore  throats,  and  chronic  asthma  when 
connected  with  hepatic  or  splenic  derangements  yield 
to  this  remedy. 


170  CARDUUS   MARIANUS.       ^S^X^Sf?^S? 


Beview,  Mar.  2, 1881. 


"  An  emaciated  man  of  40,  with  a  yellowish  grey  com- 
plexion, had  suflFered  for  several  years  from  asthma  with 
severe  cough  with  more  or  less  expectoration  of  thick 
sputa.  His  general  health  was  pretty  good.  Ausculta- 
tion revealed  sibilant  and  mucous  rales,  the  right  hypo- 
chondrium  was  swollen  and  painful.  The  left  lobe  of 
the  liver  was  most  sensitive  and  felt  hard.  Moderate 
pressure  immediately  caused  difficulty  of  breathing  and 
•cough.  He  was  never  free  from  asthma,  the  breathing 
always  panting  and  the  voice  hoarse.  Any  exertion 
increased  the  dyspncea.  At  night  the  asthma  was  not 
so  tiresome  as  the  cough,  which  only  towards  morning 
became  loose.  As  the  affection  evidently  depended  on 
•disease  of  the  liver,  card,  mar.  was  given.  In  a  week 
the  patient  felt  better,  and  after  a  fortnight  the  asthma 
and  cough  were  gone.  The  patient  now  left  off  the 
medicine,  but  as  his  chronic  liver  malady  was  not  quite 
well,  the  asthma  and  cough  returned.  He  resumed  the 
medicine,  and  after  going  on  with  it  for  a  considerable 
time  he  was  quite  cured. 

"I  have  already  said  that  card.  mar.  is  a  valuable 
remedy  in  various  hsemorrhages ;  certain  it  is  when  these 
depend  on  affections  of  liver  or  spleen  carduus  is  very 
eflBcacious,  but  it  would  seem  also  to  be  a  good  remedy 
ioT  haemorrhages  independent  of  disease  of  those  organs. 
Professor  Rapp  says  it  is,  next  to  hryonia,  the  best  remedy 
for  the  habitual  epistaxis  of  young  persons  having  a 
psoric  origin.  I  have  already  given  examples  of  its 
power  over  hsemoptysis,  hsBmatemesis  and  passage  of 
blood  by  stool.  But  it  is  also  decidedly  useful  in 
metrorrhagia.  This  is  often  not  an  idiopathic  affection 
of  the  uterus,  but  dependent  on  disease  of  the  liver, 
spleen  (or  kidneys).  In  real  affections  of  the  liver  and 
spleen  we  are  not  always  able  to  find  an  actual 
enlargement  of  or  severe  pain  in  these  organs.  The 
previous  occurrence  of  typhoid,  intermittent  fever,  icterus 
or  pneumonia  may  lead  us  to  infer  the  existence  of  some 
alteration  in  the  liver  or  spleen.  This  inference  is 
strengthened  by  the  presence  of  digestive  derangements, 
disposition  to  diarrhoea  or  constipation,  bitter  taste, 
coated  tongue,  yellow  colour  of  temples  and  corners  of 
the  mouth,  muddy  urine,  light-coloured  stools,  satiety 
after  very  little  food,  sensitiveness  of  the  hepatic  region 
.to  pressure.     In  affections  of  the  spleen  or  liver  a 


^S^J'^T^''       CARDUUS   MARIANtJS.  171 

peculiar  complexion  resembling  ansemia.  In  a  former 
paper  I  mentioned  the  good  effects  of  large  doses  of  hirsa 
pastoris  in  metrorrhagia,  but  that  card.  mar.  is  a  valuable 
remedy  the  following  case  will  show : — 

"A  young  married  lady,  aged  27,  who  had  already 
had  two  children,  had  suffered  for  eight  years  from 
frequent  attacks  of  metrorrhagia,  coming  on  at  menstrual 
period.  The  haemorrhage  lasts  twelve  to  fourteen  days, 
and  then  leucorrhoea  ensues.  She  suffers  from  costive 
Wels,  is  emaciated,  yellow  about  temples  and  corners 
of  mouth,  bitter  taste,  and  is  very  irritable.  Her  last 
child  is  6  years  old.  Various  gynaecologists  have 
examined  her,  and  declare  there  is  no  idiopathic  uterine 
affection,  but  the  liver  is  not  swollen.  For  the  last  six 
months  she  had  suffered  from  periodic  hemicrania. 
She  has  undergone  much  treatment  at  the  hands  of 
celebrated  physicians  in  various  places,  but  without  any 
good  result.  The  yellow  colour  of  the  temples  and  the 
digestive  symptoms  point  to  an  affection  of  the  liver ; 
h»morrhages  attendant  on  liver  disease  demand  cardnus 
"«ar.  She  began  to  take  the  tincture  on  the  sixth  day 
of  the  discharge.  After  a  few  doses  the  discharge 
decreased,  and  after  two  days  stopped  completely,  and 
no  leucorrhoea  followed.  On  continuing  the  medicine 
the  next  period  was  much  less,  and  lasted  only  five  days. 
The  lady  recovered  her  health,  her  complexion  became 
normal,  and  her  bowels  regular.  After  a  few  months 
she  declared  that  the  *  miraculous  drops '  had  cured 
her.- 

Dr.  Kunze  then  alludes  to  Dr.  Windelband's  experience 
of  the  eflScacy  of  card.  mar.  in  varicose  ulcers,  mentioned 
ahove,  and  he  then  goes  on : — 

"It  is  a  specific  in  local  muscular  rheumatisms 
dependent  on  liver  disease.  This  rheumatism  only 
J^ttacks  the  abdominal  muscles.  It  sometimes  spreads 
to  the  hip  and  the  thigh,  and  even  down  to  the  ankles, 
aod  there  are  often  pains  under  the  short  ribs  and  in 
the  sacrum. 

"A  married  lady,  aged  34,  who  had  been  confined 
four  weeks  previously,  during  her  convalescence  got  an 
affection  of  the  peritoneum,  with  tearing,  shooting  paid 
on  both  sides  of  abdomen,  sometimes  concentrated  in 
the  centre  of  the  abdomen,  where  it  gave  her  much  pain 
•<^n  taking  a  deep  breath.     Card.  mar.  in  three  days 


172    OUB  FAILURES  AND  SUCCESSES.  "SS^"^f?^^» 


Beriew.  B£ar.  S,  1691. 


completely  removed  this  rheumatic  affection  of  the 
abdominal  muscles. 

"These  abdominal  pains  accompanying  liver  affec- 
tions may  be  so  violent  as  to  make  us  suspect  peritonitis,, 
but  their  rapid  cure  by  card.  mar.  shows  that  this  was 
not  the  case. 

"A  widow,  aged  30,  of  greyish  yellow  complexion, 
complained  of  continued  severe  pains  in  the  centre  of 
the  abdomen,  especially  severe  in  the  right  mesogastric 
region.  On  pressure,  or  on  the  slightest  touch  of  this 
part,  which  was  hard  and  distended,  the  pain  was  very 
violent.  Loss  of  appetite,  tongue  slightly  coated, 
considerable  fever.  After  taking  card.  mar.  for  three 
days  all  the  symptoms  disappeared. 

**  The  following  case  will  show  its  power  in  rheumatic 
affections  of  sacrum,  hip  and  thigh :  A  woman,  six 
months  pregnant,  complained  of  violent  pains  in  the 
right  hip,  which  extended  to  the  middle  of  the  thigh 
and  ran  down  to  the  ankle.'  Along  with  them  was 
violent  sacral  pain.  She  can  only  crawl  along,  limping 
and  dragging  her  leg.  The  pains  are  particularly 
violent  on  rising  from  a  seat  and  become  gradually 
slighter  on  walking.  Under  the  right  short  ribs  she 
feels  a  slight  tenderness  on  pressure,  but  no  pain.  After 
a  week  of  tinct.  card.  mar.  she  was  completely  cured  of 
her  rheumatic  ailment." 

I  have  frequently  employed  with  advantage  the 
tincture  of  card.  mar.  in  cases  of  congestion  of  the  liver, 
but  from  Drs.  Kunze's  and  Windelband's  observations  it 
seems  to  have  a  much  more  extensive  sphere  of  action 
than  it  has  hitherto  been  credited  with,  except  by 
Eademacher,  to  whom  indeed  medicine  is  chiefly  indebted 
for  a  knowledge  of  its  therapeutic  virtues. 

THE  NECESSITY  OF  RECORDING  OUR  FAILURES 
AS  WELL  AS  OUR  SUCCESSES.* 

AS  ILLUSTRATED  BY  THE  TREATMENT  OF  E^TiARGED 
TONSILS  WITH  BARYTA  CARBONICA, 

By  E.  M.  Madden,  M.B.,  Edin. 

Mr.  President  and  Gentlemen, — The  mere  title  of  my 
paper  is  almost  suflScient  to  ensure  my  object  in  bringing 
it  forward  at  this  meeting,  namely,  to  open  a  discussion 

*Read  at  the  British  Homoeopathic  Congress,  1890. 


SSSS'STT^"*  oub  failures  and  successes.      173 


Bevkv.likr.  2. 18D1. 


which  I  hope  may  be  of  practical  use,  for  I  take  it  we 
shall  all  agree  that  it  is  as  necessary  and  useful  to  dis- 
card fallacies  and  avoid  disappointment  as  it  is  to  add 
to  the  list  of  therapeutic  truths  and  strengthen  our  con- 
fidence in  the  power  of  medicine  to  give  relief. 

It  is  a  truism  as  old  as  human  thought  that  we  each 
individually  learn  as  much  by  our  failures  as  our  suc- 
cesses, and  we  must  all  have  made  frequent  notes  of 
methods  of  practice  lauded  as  useful,  if  not  infallible, 
which  in  our  hands  have  proved  practically  worthless, 
and  which  we  have  long  ceased  to  try. 

In  how  few  cases,  however,  do  we  feel  it  to  be,  as  I 
maintain  it  is,  our  duty  to  publish  the  results  of  our 
experiences  for  the  benefit  of  others  and  the  advance- 
ment of  onr  art  by  the  elimination  of  error ;  or  it  may 
well  be,  in  some  cases,  for  the  benefit  of  ourselves,  by 
learning  from  others  wherein  we  had  failed  in  the  right 
application  of  the  treatment  or  the  proper  selection  of 
cases  for  its  exhibition  ? 

Into  which  of  these  divisions  the  particular  instance 
I  am  bringing  forward  will  eventually  fall,  must  remain 
for  those  who  follow  me  to  decide. 

When  I  first  entered  upon  the  study  of  homoeopathy 
I  had  the  inestimable  privilege  of  doing  so  under  the 
personal  guidance  of  Dr.  Hughes,  the  author  of  by  far 
the  best  treatises  on  homoeopathic  Materia  Medica  and 
therapeutics,  at  least  in  our  own  language,  and,  as  we 
are  all  glad  to  swear  in  verba  magistrif  and  to  regard 
them  as  all  but  infallible,  I  am  delighted  to  be  able 
to  follow  his  lead  in  this  direction,  as  I  have  with  the 
greatest  satisfaction  and  confidence  in  almost  every  other ; 
and  can  only  regret  that  I  did  not  from  the  first  accept 
his  dictum  instead  of  laboriously  and  painfully  proving 
it  for  myself. 

Why  baryta  carb.  was  ever  expected  to  cure  chronic 
amygdahtis  it  is  somewhat  difficult  to  see.  The  symp- 
toms in  its  proving,  in  Allen's  Encyclopedia,  which  refer 
to  the  throat,  seem  to  be  all  taken  from  Hahnemann's 
Chronic  Diseases^  but  they  point  very  much  more  to  a 
condition  of  acute  inflammation  than  of  chronic  hyper- 
trophy, while  there  is  a  mrfrked  absence  of  throat  symp- 
toms in  the  new  Cyclopiedia  of  Drug  Pathogenesy,  which 
leaves  one  in  doubt  (in  the  absence  of  the  promised 
<^tici8ms  on  the  Hahnemannian  provings)  whether  such 


174        OUR  FAILURES  AND  SUCCESSES.   ^S!SL^iS??f?^^ 


Beview,  Biar.  2^  IBH. 


i> 


symptoms  may  not  have  been  observed  in  sick  persons 
while  taking  the  medicine,  or  that  they  were  noted  in 
ordinary  provers  after  taking  a  few  doses  of  a  high  dilu- 
tion. Several  of  the  symptoms,  too,  while  evidently 
those  of  some  acute  angina,  are  marked  as  being 
observed  after  18,  28,  and  in  one  case  89  days  ! 

As  these  recorded  symptoms  may  not  be  quite  fresh  in 
your  memories,  perhaps  you  will  pardon  me  if  I  quote  a 
few  of  the  most  important :  ^'  After  chilliness,  and  heat, 
and  bruised  feeling  in  all  the  limbs,  an  inflammation  of 
the  throat  with  swelling  of  the  palate  and  tonsils  which 
suppurate,  and  on  account  of  which  he  cannot  open  the 
jaws,  neither  speak  nor  swallow,  with  dark  brown  urine 
and  loss  of  sleep."  *'  Attacks  of  choking  in  the  throat 
after  dinner,  when  sitting  and  writing,  with  sensation  as 
if  the  thyroid  gland  were  pressed  inward,  which  thereby 
impedes  respiration."  ''  Sticking  in  the  throat  worse 
when  swallowing,  with  dryness,  in  the  evening. 
*'  Smarting  pain  in  the  throat  when  swallowing,  though 
most  on  empty  swallowing;  therewith  the  throat  is 
painful  externally  on  both  sides  to  the  touch."  "  Raw- 
ness and  smarting  in  the  throat  after  a  night-sweat, 
more  painful  on  empty  swallowing  than  when  swallowing 
food."     **  Swelling  of  the  sub-maxillary  gland." 

I  suggest  then,  in  the  first  place,  that  such  provings 
of  bar.  carb.  as  we  have  from  Hahnemann,  even  if  we 
admit  them  as  genuine,  would  lead  us  to  expect  it  to  be 
of  use  in  acute  tonsillitis,  but  not  in  chronic  hypertrophy. 

In  practice,  too,  this  is  just  what  I  have  found,  viz., 
that  in  a  certain  number  of  cases  of  acute  angina  with 
threatened  quinsy,  bai-yta  carb.  has  appeared  to  have 
the  power  to  abort  it,  and  a  speedy  recovery  has  tfJjen 
place  in  from  two  to  four  days  without  pus  having 
formed  at  all. 

These  cases,  however,  have  been  comparatively  few  in 
my  own  practice,  certainly  not  more  than  one  in  four, 
still  in  these  few  it  has  appeared  to  be  well  marked. 

On  the  other  hand  in  not  a  single  case  of  chronic 
hypertrophy  have  I  ever  been  able  to  trace  the  slightest 
effect  from  it. 

I  am  not  going  to  wearv  you  with  details  of  cases,  nor 
is  this  the  place  to  publish  them,  but  I  will  simply  state 
that  I  have  tried  it  in  very  many  cases,  at  least  50  if  not 
more ;  I  have  persevered  steadily  with  it  for  from  two  to 


SS^SJTiSS?^  our  failures  and  successes.      ITS* 


JLenew,  Mar.  %,  1891 


three  months,  giving  it  in  all  dilutions  from  8x  up  to 
12c,  but  with  such  uniformly  negative  results  that  I 
have  now  quite  given  it  up  in  despair. 

More  than  tMs,  I  have  aske<l  several  colleagues  for 
their  experience,  and  find  it  to  have  been  precisely  the 
same  as  my  own;  and  if,  after  further  comparing  of 
notes  with  those  who  hear  and  those  who  may  read  this 
paper,  it  proves  that  the  general  experience  of  our  body 
is  to  the  same  effect,  I  would  ask,  has  not  the  time  come 
when  this  should  be  pubUcly  acknowledged  ?  and  should 
not  banfta  carb,  be  henceforth  excluded  from  the  hst  of 
medicines  one  should  consult  in  treating  a  case  of 
chronic  enlargement  of  the  tonsils  ? 

I  hope  that  in  the  discussion  which  may  follow,  we 
shall  not  be  led  off  on  the  one  hand  into  the  considera- 
tion of  the  causes  proximal  or  remote  of  the  condition  of 
hypertrophy  in  the  tonsils,  nor  on  the  other  into  the 
comparative  merits  of  the  various  other  remedies  recom* 
mended  for  its  treatment,  as  these  questions,  though  full 
of  interest  in  themselves,  are  outside  the  scope  of  my 
paper.    I  have  introduced  this  instance  merely  as  a 
striking  example  of  the  necessity  for  putting  on  record 
our  failures  with  equal  faithfulness  to  that  with  which 
we  are  most  of  us  ready  to  report  any  striking  cures.. 
Here  we  have  a  case  of  constantly  recurring  disease,  of 
easQy  recognised  symptoms,  and  in  every  text-book  I 
have  seen  this  medicine  occupies  a  prominent  place 
among  those  which  should  be  given ;  whereas  there  iS' 
good  reason  to  beUeve  that  its  use  will  only  cause  a. 
waste  of  valuable  time,  disappointment,  and  not  im- 
possibly, in  the  patient  at  least,  a  loss  of  faith  in  the 
system  in  accordance  to  which  it  is  supposed  to  be 
prescribed  (though  really,  as  I  have  shown,  it  has  very 
Uttle,  if  any,  right  to  this  claim) — all  which  results  are 
dae  to  the  silence  of  those  of  us  who,  having  fairly  tried 
it,  have  proved  to  our  own  satisfaction  that  it  is  useless,, 
and  have  neglected  to  sound  a  warning  note  to  save 
others  from  a  similar  pit-fall. 

We  had  recently  an  example  of  the  value  of  a  public 
confession  of  faUure,  when  Dr.  Goldsborough  read  a 
paper  before  the  British  Homoeopathic  Society  on 
Diphtheria,  and  stated  that  he  had  given  a  somewhat 
extensive  trial  to  mere,  cyan.^  and  had  rarely,  if  ever^ 
fonnd  it  of  any  service.    In  the  course  of  the  discussion 


176        OUR  FAILURES  AND  SUCCESSES.    ^S?£l°^SJT?SJ* 


Review,  Mar.  2, 1891. 


^hich  followed  it  was  pointed  out  that  Dr.  Goldsborough 
had  used  only  the  3x  dilution,  whereas  Dr.  Villers,  to 
whose  report  of  its  use  we  are  indebted  for  its  introduc- 
tion into  this  country,  never  gave  it  lower  than  the  6c, 
tuid  found  its  eflficacy  apparently  increased  by  going  still 
higher  up  the  scale.  Following  this  hint  Dr.  Golds- 
"borough  was  afterwards  able  to  report  that  when  he 
gave  it  in  the  6c  or  higher  dilutions  he  had  been  most 
Ratified,  and  thought  it  the  most  useful  medicine  we 
possess  for  this  terribly  serious  complaint.  I  may 
perhaps  add  that  I  also  had  been  trying  it  in  the  lower 
dilutions  with  very  little  if  any  success,  and  that  it  was 
after  reading  this  discussion  I  again  tried  it  in  the  6c 
ivith  such  success  that  I  am  now  never  without  some  in 
my  pocket  case  and  have  great  confidence  in  it. 

Possibly  some  such  light  may  be  thrown  upon  the 
<;au8e  of  my  failure  to  cure  enlarged  tonsils  with  bar.  c. 
I  notice,  for  example,  that  Dr.  Hughes,  who,  in  hie 
^earlier  edition  had  merely  said  he  had  never  seen  any 
benefit  follow  its  administration  ;  in  his  later  one  says 
it  may  be  found  useful  in  those  cases  which  are  the  result 
of  repeated  attacks  of  an  acute  inflammation.  If  this 
is  so  I  should  suppose  that  these  cases  must  be  very  few, 
and  certainly,  so  far  as  my  experience  goes,  sufferers 
from  frequent  attacks  of  quinsy — and  there  are  many 
such — do  not,  as  a  rule,  have  hypertrophied  tonsils,  and 
those  whose  tonsils  are  hypertrophied,  though  very 
liable  to  all  kinds  of  superficial  anginas,  from  a  simple 
catarrh  up  to  a  severe  follicular  ulceration,  are  very 
rarely  attacked  by  a  true  quinsy ;  and  so  far  as  acute 
attacks  are  concerned,  it  is  undoubtedly  in  the  true 
quinsy,  and  not  in  superficial  inflammation,  that  bar.  c. 
has  proved  itself  curative. 

I  am  fully  conscious  that  my  paper  is  very  slender 
both  in  matter  and  construction,  and  quite  inadequate 
to  the  importance  of  the  meeting  at  which  it  is  to  be 
read,  but  I  have  endeavoured  to  be  concise,  to  stick  to 
the  point,  and,  if  possible,  make  my  point,  which,  though 
a  small  one,  is,  I  think,  an  important  one  in  principle ; 
and  if  it  leads  to  practical  results  in  other  directions 
and  in  abler  hands,  it  will  have  fully  answered  the 
purpose  with  which  I  have  introduced  it,  and  you  will 
feel,  I  hope,  that  your  time  has  not  been  altogether 
wasted  in  listening  to  it. 


i^^SST^^    OUB  FAILURES  AND  SUCCESSES.        177 


Bivkfv,  Mtt.  2,  ISBl. 


Discussion. 

The  Prbsident  remarked  that  the  question  Dr.  Madden  had 
considered  was  a  very  important  one.  He  would  Uke  to  make 
a  few  remarks*  but  time  was  getting  on,  and  he  would  defer 
them  for  the  present. 

Dr.  Clarke  said  they  were  very  much  indebted  to  Dr.  Mad- 
den for  bringing  this  question  before  them.  What  he  would 
like  to  point  out  was  that  if  a  failure  wad  to  be  of  any  service 
they  must  have  all  the  notes  of  the  case.  If  the  faUure  was 
to  teach  them  anything  they  must  take  notes  of  the  case»  so 
as  to  be  able  to  follow  it  all  through  and  find  out  where  their 
mistake  was.  The  mistake,  he  thought,  was  in  giving  bari/ta 
carh.  for  enlarged  tonsils.  If  they  did  that  they  would 
probably  never  do  any  good.  But  if  they  gave  hanjUi  carh,  to 
a  patient  whose  whole  condition  corresponded  to  ban/ta  curb, 
they  would  cure  the  tonsils  as  well.  At  least,  such  had  been 
his  experience.  He  had  used  it,  he  beheved,  more  in  acute 
cases  than  in  chronic,  but  he  had  seen  it  given  in  chronic 
eases  too.  He  would  like  to  have  the  notes  af  Dr.  Madden's 
cases,  with  all  the  symptoms  written  out. 

Dr.  Nankivell  thought  banjUi  carh,  was  a  medicine  which 
in  chronic  cases  of  enlargement  of  the  tonsils  was  certainly 
disappointing.  He  had  very  seldom  used  it  absolutely  alone, 
so  that  he  could  not  say  whether  local  treatment  had  not  had 
something  to  do  with  the  improvement  of  the  tonsils  while 
the  harifta  carb,  had  been  given.  But  he  had  found  it  useful 
after  cases  of  acute  quinsy.  They  know  perfectly  well  that 
acute  quinsy  was  very  apt  indeed  to  recur  when  it  had  once 
been  set  up.  So  far  as  he  could  recollect,  he  did  not  think  he 
had  had  a  case  of  recurrence  of  quinsy  since  he  had  begun  to 
use  baryta  carb.  directly  convalescence  was  established.  That 
practically  was  all  he  had  to  say  on  the  matter. 

Dr.  Hatwabd  said  he  was  very  pleased  indeed  with  Dr. 
Madden's  paper,  but  somewhat  disappointed  for  all  that,  for 
this  reason,  that  he  was  quite  under  the  impression  Dr. 
Hughes  had  taught  him  that  it  was  in  acute  tonsillitis  that 
W^  carh.  was  indicated,  and  not  in  chronic. 

Dr.  ^Iadden  :  I  said  so. 

Dr.  Hatwabd  said  he  thought  Dr.  Madden  had  been  taking 
the  treatment  of  chronic  from  those  directions.  All  he  had 
to  say  was  that  his  experience  quite  corresponded  with  that  of 
Dr.  Hughes. 

Dr.  PuLLAB  said  he  had  used  baryta  carb,  with  great  success 
and  nsed  it  very  frequently,  mostly  in  acute  oases,  where  the 
sphere  of  the  medicine  as  defined  by  Dr.  Hughes  exactly 
corresponded.    But  he  had  also  used  it  even  in  chronic  cases 

Vol  33,  No.  8.  o 


178        OUR  FAILURES  AND  SUCCESSES.   ^p^.^SJ*?^^ 


with  a  fair  measare  of  success.  He  did  not,  however,  think 
that  it  was  nearly  so  satisf^tory  in  these  cases.  Calcarea 
vhospJwrica  was  the  medicine  he  had  found  of  much  greater 
value  in  chronic  cases,  and  iodine. 

Dr.  Pope  said  that  with  regard  to  chronic  tonsillitis  there 
was  a  remark  of  Dr.  Carroll  Dunham's  well  worth  remember- 
ing. You  have,  he  said,  enlarged  tonsils,  it  is  true,  but  you 
have  in  addition  to  that  a  state  of  general  ill-health  more  or 
less  ;  and  when  asked  what  to  give  for  chronic  tonsilUtis,  he 
said  something  to  this  effect :  ''  Don't  look  at  the  tonsils,  but 
look  at  the  patient."  (Hear,  hear.)  He  advised  them  to 
prescribe  for  the  symptoms  of  ill-health  which  the  patient 
exhibited,  and  then  felt  assured  that  the  tonsils  would 
diminish  in  size.  Baryta  was  not  a  specific  for  chronic 
enlargement  of  the  tonsils,  unquestionably.  With  regard  to 
the  dose  of  cyanide  of  mei'cury  in  diphtheria,  and  the  absolute: 
necessity  which  some  would  seem  to  think  existed  for  giving 
it  in  a  more  or  less  high  dilution,  he  would  like  to  remind  the 
Congress  of  the  large  series  of  cases  treated  by  Dr.  Sellden,  a 
district  medical  officer  for  some  part  of  Sweden,  where 
diphtheria  was  exceedingly  rife,  where  the  mortality  had  been 
something  like  50  to  60  per  cent,  as  a  rule,  and  where,  when 
the  use  of  njanide  of  mercury  came  into  vogue,  it  was  reduced 
he  believed  to  three  or  four  per  cent.  He  did  not  use  a  sixth 
dilution,  but  on  the  contrary,  if  he  recollected  rightly,  the-, 
dose  was  something  equal  to  the  second  or  third  decimal  of 
their  scale.  In  St.  Petersburgh  Dr.  Erichsen  said  he  used 
cyanide  of  mercury  in  a  dose  like  the  SOOth,  400th  or  500th  of 
a  grain,  or  something  of  that  kind,  and  had  had  very  success- 
ful results.  So  he  did  not  think  that  Dr.  Goldsborough's 
failure  in  this  case  was  altogether  due  to  his  having  given  a 
moderately  sized  dose  of  cyanide,  but  that  he  had  got  hold  of 
some  particular  case  to  which  the  cyanide  of  mercury  was  not 
strictly  homoeopathic.  (Hear,  hear.)  They  were  all  very 
much  obliged  to  Dr.  Madden  for  bringing  this  subject  before 
tiiem,  and  his  paper  would  be  extremely  useful  in  showing  up 
a  medicine  which  had  obtained  credit  through  having  been 
copied  from  one  book  to  another,  without  having  really 
deserved  it. 

Dr.  Hawkes  said  he  was  much  obliged,  with  the  rest,  for 
Dr.  Madden's  paper,  but  he  did  not  so  read  Dr.  Hughes.  He 
took  it  that  he  warned  him  years  ago  that  it  would  not  have 
much  effect  in  chronic  tonsillitis.  Further  than  that,  he 
could  bring  the  same  charge  against  nearly  every  medicine  as 
regards  enlarged  tonsils.  He  had  been  very  unsuccessful  with 
medicines  in  the  case  of  enlarged  tonsils,  and  he  was  now 
following  very  much  the  advice  of  a  surgical  friend,  who 


£SS^iSff?S^     Oase  of  chyluria.  170 


BsTiew,  Mar.  S,  18B1. 


declared  that  there  was  no  harm  in  removing  them  if  thej 
were  absolutely  obstructive. 

Dr.  Dtce  Bbown  :  I  certainly  agree  with  Dr.  Madden  in  not 
having  found  ban/ta  carbonica  of  much  use  in  chronic  enlarge- 
ment of  the  tonsils,  but  in  certain  cases,  properly  indicated,  it 
is  of  very  great  value. 

The  PBEsmsNT  said  he  had  had  some  little  experience  in 
cases  of  enlarged  tonsils,  and  he  had  given  baryta  carb.  in  all 
dilations  from  the  second  decimal  up  to  the  sixth,  and  he 
believed  even  up  to  the  twelfth,  but  with  him  it  had  been  a 
very  unsatisfactory  drug  indeed.  He  was  speaking  of  cases 
of  pure  chronic  enlargement.  At  the  same  time  he  was  not 
prepared  to  say  that  if  he  had  carried  out  his  treatment  with 
bigher  diffusions  he  might  not  occasionally  have  met  with 
more  success.  But  it  had  been  a  very  unsatisfactory  mode  of 
treatment,  and  in  earlier  days  he  had  found  in  very  extremely 
ehronie  cases  the  guillotine  the  speediest  and  most  satisfactory 
ftgent,  after  trying  medicinal  treatment  for  a  length  of  time. 
He  now  occasionadly  saw  some  of  his  cases  where  an  opera- 
tion bad  been  performed  many  years  ago,  and  bad  been 
attended  with  the  greatest  possible  success,  and  satisfaction 
on  the  part  of  the  patient.  He  did  not  know  a  more  unsatis- 
&ctory  series  of  cases  than  these  cases  of  enlarged  tonsils. 
At  least,  that  was  his  experience,  and  it  was  a  tolerably  wide 
one.  But  not  only  in  these  particular  cas^s,  but  in  all,  it  was 
very  important  and  it  would  be  very  advantageous  if  they 
eooldonly  make  up  their  minds  to  have  the  moral  courage  in 
fatnre  to  acknowledge  their  failures  as  well  as  their  successes 

Dr.  Madden,  in  reply,  said  he  could  only  thank  them  very 
mnch  indeed  for  the  kmd  way  in  which  they  bad  received  and 
criticised  his  paper.  Time  would  not  permit  him  to  further 
enlarge  upon  the  subject,  but  he  hoped  that  future  editions 
of  their  text  books  would,  when  treating  of  tonsillitis,  strike 
ont  this  medicine,  or  state  that  it  was  only  very  rarely  useful^ 
snd  that  in  the  majority  of  cases  its  results  were  apt  to  be 
disappointing  rather  than  beneficial.     (Applause). 

PHILLIPS    MEMORIAL    HOMCEOPATHIC   HOS- 
PITAL, BROMLEY. 

C(ue  of  Chyluria  in  a  child  17  months^   cured   hy 

Phosphoric  Acid. 

BtH.  Wynne  Thomas,  L.R.C.P.,  Lend.,  M.R.C.S.,  Eng. 

The  following  interesting  case  seems  worth  recording. 
While  attend^g  the  child's  brother  for  bronchitis,  the 

0—2 


180  CASE   OF   CHYLURIA.      ^'^J^fiSSS^l! 

mother  drew  my  attention  to  this  patient,  Baying  that 
he  was  always  wanting  to  drink  water,  and  that  instead 
of  growing  he  seemed  to  be  getting  smaller. 

Fred.  L.,  age  17  months.  Father  a  coachman,  for 
some  years  in  this  neighbourhood. 

Dec.  10,  1889.  Child  is  small  and  thin,  looks  weakly. 
For  the  last  foar  months  has  been  suffering  from 
frequency  of  micturition,  and  passes  milky  urine.  Is 
always  hungry  and  very  thirsty,  but  never  seems 
satisfied.  Sleeps  well,  and  otherwise  seems  pretty  well. 
Has  never  had  any  previous  illness,  never  suiSered  fi'om 
worms. 

Urine  looks  Uke  milk.  Specific  gravity  varies  from 
1012-1020.  Acid.  On  boiling  a  slight  increase  in 
<3loud,  which  is  not  affected  by  the  addition  of  acetic 
acid.  Under  the  microscope  are  seen  numerous  brilliant 
oil  globules  varying  in  size.  After  standing  two  hours 
a  creamy  layer  rises  to  the  surface,  which  by  about 
twenty-four  hours  has  fallen  to  the  bottom.  On  shaking 
with  ether  an  opalescent  jelly  rises  to  surface.  This 
milkiness  has  been  increasing  up  to  the  present  time ;  is 
very  marked  early  in  the  morning  before  breakfast;  is 
least  noticeable  before  dinner,  and  most  marked  again 
about  two  hours  after  dinner ;  but  is  never  absent.  I 
prescribed  for  him  acid  plws.  8  x.  m.  iij,  three  times  a  day. 

Dec.  20. — Urine  is  much  the  same;  child  seems 
stronger.    Bepeat  medicine. 

Jan.  3,  1890. — Urine  is  much  better ;  patient  is  less 
thirsty ;  micturition  less  frequent.    Bepeat. 

Jan.  10. — Urine  has  gradually  improved  and  for  the 
last  three  days  has  been  quite  clear.  To  continue  medi- 
eine  for  three  weeks. 

Dec.  1st,  1890. — ^I  saw  the  child  to-day.  He  is  growing 
fast,  looks  much  healthier,  and  his  mother  says  that 
there  has  been  no  return  of  the  urinary  trouble. 

Dr.  £.  M.  Madden  also  saw  the  case  with  me  and 
-confirmed  the  diagnosis. 


SriSt^STiS^        O^  HiEMOBRHOIDS.  181 

ON    H^MOKRHOIDS.* 
By  Db.  McKechnie. 

Mb.  President  and  Gentlemen, — ^When  asked  by  our 
indefatigable  secretary  if  I  would  read  a  paper,  and  what 
its  subject  would  be,  I  chose  that  of  haemorrhoids,  not 
because  I  expected  to  bring  any  special  acumen  to  the 
subject,  or  that  I  could  expect  to  teach  you  anything 
new  in  the  pathology  or  therapeutics  of  piles,  but  that 
it  is  a  convenient  peg  on  which  to  hang  a  discussion,, 
that  so  Uttle  seems  to  be  said  about  it  in  modem  days  by 
physicians  who  seem  inclined  to  leave  the  matter  wholly 
to  one  remedy, /erruw,  whether  calidum  or  frigidum,  or 
both,  and  that  I  am  desirous  to  enter  my  feeble  protest 
against  this  indiscriminate  use  of  the  knife  in  such 
cases,  and  am  afraid  that  amongst  our  own  colleagues 
there  is  too  great  a  tendency  to  relegate  the  treatment 
of  piles  to  the  surgeon.  Of  course,  in  this,  as  in  many 
other  matters,  we  are  not  masters  of  the  field,  and  are 
subject  to  many  influences,  direct  and  indirect,  but 
especially  that  of  our  colleagues  of  the  old  school,  who, 
in  their  agnosticism  as  to  the  valae  of  drugs,  have 
nothing  to  fsAl  back  upon  in  the  treatment  of  piles,  but 
the  reUef  to  be  obtained  in  the  removal  of  the  damaged 
part. 

We  too,  on  our  part,  are  many  of  us  wanting  in  that 
faith  in  drug  influence  which  should  enable  us  firmly  to 
withstand  the  entreaties  of  patient  and  friend,  by 
promising  that  time  and  perseverance  will  do  what  is 
wanted  without  mutilation.  We  are  also  much  influenced 
by  the  influx  into  our  number  of  many  new  and  younger 
practitioners,  and  glad  we  are  to  welcome  them ;  but  they 
are  new  from  the  schools,  necessarily  more  or  less  under 
school  influence,  with  some  tincture  of  the  aforesaid 
agnosticism,  and  knowing  the  value  of  similars  but 
imperfectly,  while  they  are  able  in  the  use  of  the  knife, 
and  in  the  ardour  of  youth  leaning  strongly  to  the  faith 
in  thmgs  seen  and  tangible. 

Hence,  patients  coming  to  us  under  the  influence  of 
this  distressing  malady  of  piles,  requiring,  as  it  some- 


*  BMd  at  Bath  before  the  Western  Coanties  Therapeutical  Society. 


182  ON  HiEMORRHOIDS.      "S^jmSTmS! 

times  does,  prolonged  and  patient  treatment  of  Tarious 
kinds,  are  often  unable  or  imwilling  to  give  the  time, 
trouble,  and  patience  needful  .to  work  out  a  real  cure, 
and  desire,  especially  now  that  aneasthetics  and  anti- 
septics are  to  the  fore,  the  speedy  riddance  of  their  pain- 
ful and  disgusting  encumbrances. 

Now,  I  am  anxious  to  say  a  few  words  in  the  hope  of 
staying  the  tide  which  is  carrying  many  of  us  towards 
surgery  rather  than  homoeopathy  in  this  connection, 
and  I  think  we  should  keep  constantly  before  us  the  fact 
•that  we  are  advocates  of  the  principle  of  similars,  that 
every  case  which  is  operated  on  under  our  care  is  more  or 
less  a  slur  on  that  principle,  which  notwithstanding  is 
capable,  in  almost  every  case,  of  effecting  a  cure-  Of 
course  a  great  difficulty  in  bad  cases  is  the  need  for  time 
and  careful  nursing.  Every  case  must,  of  course,  be 
decided  on  its  own  merits.  One  cannot  make  any 
absolute  rule,  but  it  is  for  us  to  keep  before  the  patient 
and  his  friends  the  fact  that  drug  influence,  with  time 
and  perseverance,  can  cure  ! 

Our  method  of  treating  a  case  of   piles  must    be 
largely  modified  by  the  conditions  which  brought  about 
the  attack,  and  the  extent  of  the  mischief  done.     It  is 
scarcely  needful  for  me  to  say  anything  here  about  the 
influence  of  occupation  in  this  matter.    Whenever  a  case 
of  piles  comes  under  our  care,  we  may  be  pretty  sure 
that  stasis  and  distension  have  been  going  on  for  long 
before  we  were  applied  to,  and  indeed  for  long  before 
the  patient  himself  became  conscious  of  any  embarrass- 
ment ;  BO  that  even  if  he  now  seeks  one's  aid  he  has 
been  first  trying  some  treatment  of  his  own,   or  his 
neighbours,  and  putting  off  the  application  to  his  doctor 
as  long  as  might  be;  but  that  now  some    error  of 
diet  or  drink,  some  chill  adding  to  the  embarrassment 
of  the  circulation,  or  a  purge  which,  while  softening  the 
stool  and  stirring  up  the  muscular  coat  to  action,  has 
brought  about  additional  congestion  of  the  haemorrhoidal 
plexuses,  and  while  swelling  yet  further  the  superior 
plexus  has  irritated  the  sphincter  and   hindered  the 
lower  plexus  from  returning  its  current  to  the  superior, 
the  mucous  membrane    thus  becoming    irritated  and 
congested,  and  thereby  the  arteries  dilated,  and  I  think 
oh  taking  the  whole  pathological  condition  in  view,  one 
will    scarcely    wonder    at   the    distress    and    suffering 


iKStJfiSJTSS?**     ON   HJBMORRHOIDB.        .  188 

^tnessed  in  a  case  of  inflamed  piles,  and  one's  first 
thought  shonld  be  how  to  give  relief,  to  free  the  occluded 
Tains,  and  though  it  may  seem  most  scientific  to  try  and 
relieve  at  the  nether  end,  yet  so  much  is  to  be  done 
and  so  much  more    promptly  at    the    locus    in    quo^ 
and  that   by  heat  and  moisture  combined,  either  by 
steaming,  by  fomentation,  or    by  the    hot    hip*bath, 
any  of  them  well  applied,  but  especially  the  first,  will 
give  great    relief,  and    enable    the    patient    generally 
to  return  the  obtruded  swelling  through  the  sphincter. 
There  are  two  points  in  this  connection  however.    I  am 
constantly  surprised  to  find  that  medical  men  do  not 
sufficiently  attempt  to  teach  their  patients :   The  first 
being  the  instructing  them  in  the  endeavour  to  return 
the  protruded  mass,  the  need  to  bear  down  as  if  in 
defecation — ^to  relax  the  sphincter,  in  fact — while  the 
tomid  mass  is  being  gently  and  equably  pressed  up ;  and, 
second,  the  value  of  some  grease  to  lubricate  the  mass 
at  the  time.    Once  get  it  within  the  sphincter  the  stran- 
gulation is  over  for  the  time,  there  is  a  certain  relief 
afforded,  and  the  patient  begins  to  feel  that  something  is 
being  done.     In  cases  of  fluent  piles,  however,  it  may  be 
better  to  use  a  warm  moist  sponge  as  a  medium  for 
niaking  the  needful  pressure. 

It  may  be  well,  then,  to  consider  the  need  or  the 
advisability  of  relieving  the  bowels,  and  to  find  out  if 
the  rectum  is  loaded  with  hardened  fsBces  or  not. 

In  many  cases  it  is  worth  while,  and  I  have  a  great 
liking,  when  needful,  for  the  'pulv.  glycyrrh.  co,  (Prussian 
preparation),  which  I  think  better  than  an  enema, 
although  it  takes  12  hours  to  get  an  action ;  but  the 
means  employed  should  depend  rather  on  the  habits  of 
the  patient,  his  fears  and  prejudices,  what  should  be 
done,  and  before  all,  on  the  state  of  the  faecal  masses 
themselves. 

If  the  enema  is  used  in  a  case  of  inflamed  piles,  I 
think  thin  warm  gruel,  with  a  plentiful  admixture  of 
olive  oil,  is  the  best. 

Then  comes  the  consideration  of  the  real  drug  treat- 
ment of  the  case,  and  I  think  one  should  at  once 
administer  aconite  or  belladonna ,  or  perhaps  give  them 
alternately,  being  guided  very  much  in  this  matter  by 
the  indications  given  by  the  thermometer,  general  febrile 
conditions  being  the  predominant  indication  for  aconite^ 


184  .      ON   H^JMORRHOIDS,      ^SSJl.^S!!'?^ 

and  local  inflammation  and  active  congestion  for  bella- 
donna. In  children  with  inflamed  piles  I  always  take 
chamomiUa  well  into  consideration. 

The  dietary,  of  course,  should  be  very  carefully 
managed,  and  should  generally  be  but  slightly  azotised, 
not  fatty  nor  alcoholized — leaving  the  patient  but  little 
else  than  farinaceous,  vegetable  and  fruity  foods — ^all 
spices  should  be  avoided,  as  they  undoubtedly  tend  to 
irritate  the  part  affected.  This  leads  one  to  the  con- 
sideration of  one  medicine,  viz.,  capsicum^  which  I 
have  found  of  use  in  inflammatory  piles,  with  frequent 
small  mucous  stool,  and  intense  tenesmus  after  it. 
Caimcum  seems  to  be  of  use  in  fluent  as  well  as  blind 
piles,  but  the  bleeding  when  it  occurs  in  such  a  state  is 
rather  a  general  oozing  than  a  haemorrhage  from  the 
varices  themselves. 

With  these  means  we  shall  not  long  have  to  treat  a 
case  of  inflamed  piles  before  the  great  pain  and 
inflammatory  state  is  so  far  subdued  that  the  patient  can 
be  moving  about,  and  able  to  perform  his  duties  more 
or  less  freely,  and  then  comes  the  question  of  further 
treatment,  and  a  really  curative  method  should  be  put 
in  operation. 

Perhaps  the  most  important  considerations  are  now 
the  sex  of  the  patient  and  the  habit  of  the  bowels.  K 
constipation  is  habitual,  if  there  is  a  feeling  of  obstruction 
or  of  dryness,  if  the  stools  are  dry  and  hard  and  in 
largish  masses,  either  smooth  or  of  agglutinated  scybala, 
one  may  think  of  cesculus,  and  especially  if  there  is  a 
dull  aching  pain  over  the  lumbo-sacral  region.  Before 
ascvlus  was  brought  well  before  the  profession  as  a 
remedy  in  hsemorrhoids  with  constipation,  one  was  in 
the  habit  of  looking  principally  to  ntuc  vomica  and  sulphur , 
one  or  both  in  such  cases,  but  everyone  seems  to  think 
ascnltis  has  almost  superseded  them  in  such  cases. 

Let  me  say  here,  that  for  many  years  I  have  made  a 
BtroDg  point  in  chronic  or  habitual  hemorrhoids,  of 
getting  my  patients  to  adopt  the  practice  of  emptying 
the  rectum  at  night,  before  going  to  bed,  rather  than  the 
usual  one  of  doing  so  in  the  morning.  The  disturbed 
part  has  the  time  of  the  night's  rest  to  recover  itself,  and 
the  patient  is  much  more  likely  to  be  able  to  go  about 
his  duties  next  day.  It  is  often  difficult  to  estabUsh  the 
habit,  for  the  bowels  are  apt  to  relapse  into  their  old 


iWiSrS?^      ON   HiEMOKBHOIDS.  185 


established  method,  will  not  go  at  night,  and  will  go  in 
the  morning,  bat  the  patient  should  be  encouraged  to< 
persevere  for  the  gain  is  great. 

After  asculus  I  scarcely  think  there  is  a  better  remedy 
than  Pulsatilla,  whether  for  acute  or  chronic,  whether 
fluent  or  dry,  whether  in  male  or  female.  Its  marked 
influence  on  the  venous  system,  its  still  more  marked 
influence  on  the  digestive  functions  and  on  the  mucou& 
membranes,  wherever  they  may  be,  should  point  to  pul- 
tatiUa  as  a  medicine  bringing  about  a  group  of  symptoms 
very  closely  similar  to  that  we  find  in  piles  ;  of  course 
where  the  special  temperament  or  constitution  is  pecu- 
liarly marked  we  may  look  for  the  more  striking  effect, 
but  there  can  be  no  doubt  that  puhatiUa  suits  many 
eases  even  amongst  men. 

It  is  by  no  means  only  the  female  sex  that  is  to  be 
influenced  by  this  potent  drug.  Wherever  passive  con- 
gestions, and  especially  where  there  is  tendency  to* 
cbronic  catarrhal  conditions,  Pulsatilla  should  be  taken 
into  consideration.  Even  constipation  is  not  absolutely 
a  centra-indication;  but  when  one  has  haemorrhoids, 
dyspepsia,  catarrhal  tendency,  varicosis  elsewhere  than 
the  rectum,  dysmenorrhcea  or  spammenorrhoea,  it  ought 
to  suggest  itself  to  one  before  almost  any  other  drug  in 
our  Materia  Medica. 

Sulphur  covers  so  much  the  same  lines  as  jmhatilla  as 
to  call  for  consideration  in  such  cases,  but  the  points  in 
which  it  is  more  distinguishable  from  it  are  the  presence 
of  constipation  and  of  severe  itching  about  the  anus. 

Sulphur  comes  in  alternately  with  (esculus  or  with  nux 
vomica  in  a  large  number  of  cases  where  there  is  consti- 
pation ;  two  or  three  days  of  the  one  and  two  or  three 
days  of  the  other  I  find  a  convenient  arrangement. 

Nux  is  called  for  most  among  men,  especially  those 
who  are  given  to  the  use  of  alcohol.  (People  who  are 
subject  to  piles  should,  as  a  general  rule,  become 
abstainers).  The  constipation  of  nux  is  accompanied  by 
a  feeling  as  though  the  bowel  would  not  or  could  not 
empty  itself,  and  often  there  is  frequent  and  ineffectual 
urging  to  stool.  What  does  come  is  hard  and  dry,  with 
pressure  on  the  sacrum,  and  often  burning  feeling  about 
the  whole  region.  The  stools  are  not  wanting  in  bile,, 
although  the  liver  and  its  portal  circulation  are  most 
affected  by  it.    The  piles  are  large  and  blind. 


186  ON  HAEMORRHOIDS.      "g^fS??^ 

CoUinsonia  is  a  medicine  of  very  great  value  in  piles, 
and  especially  in  those  females  who  have  inertia  of  the 
rectum  and  general  congestive  tendency  in  the  pelvis ; 
it  is  especially  valuable  to  pregnant  women  si]Uffering 
from  piles,  and  in  the  piles  one  finds,  so  often  in 
parturient  women.  Pruritus  here  also  is  a  very 
•characteristic  symptom.  Flatulence,  colic,  tenesmus 
are  additional  indications  for  it. 

While  talking  of  pelvic  congestion  as  a  cause  of  piles, 
one  must  hardly  forget  the  classical  remedy  for  such  a 
state,  though  at  the  same  time  I  may  say  that  I  have 
not  used  it  of  late  years,  collinsonia  having  with  me 
taken  its  place.  I  mean  aloes,  which  produces  a  general 
abdominal  and  specially  a  pelvic  congestion,  there  is  very 
marked  burning  in  the  anus  and  tenesmus,  often  with 
faintnesSf  and  the  bladder  is  often  irritated. 

I  have  already  spoken  of  such  cases  of  fluent 
haemorrhoids  as  are  largely  to  be  benefited  by  pulsatiUa, 
but  though  this  last  remedy  is  probably  that  of  the 
largest  range  in  piles,  yet  there  are  cases  in  which  one 
would  prefer  employing  hanianielis,  viz.,  such  as  present 
the  fluent  character  in  the  most  marked  degree.  Its 
wonderful  influence  on  the  venous  system  suggests  it  as 
a  most  valuable  remedy,  and  experience  carries  out  our 
expectation.  It  is  especially  in  the  fluent  piles  with 
-copious  bleeding,  which  it  will  speedily  modify  and  arrest, 
and  that  without  the  fear  one  has  been  accustomed  to 
hold  of  **  the  arrest  of  the  haemorrhoidal  flux." 

The  less  fluent  forms,  if  associated  with  varicosities, 
or  any  indications  of  venous  troubles,  may  make 
hamamclis  worthy  of  precedence  before  pulsatiUa,  whQe 
the  catarrhal  state  of  the  mucous  membrane  may  give 
Pulsatilla  the  precedence. 

My  time  is  running  short,  but  there  is  one  medicine, 
viz.,  muriatic  acid,  I  must  mention  which  I  have  found 
often  of  very  great  value,  and  it  is  especially  among 
people  who  are  advanced  in  years,  and  whose  piles 
continue  to  trouble  them.  The  piles  are  large  and 
painful,  very  tender,  and  suggest  that  ulceration  has 
taken  or  is  likely  to  take  place. 

In  such  cases  there  is  a  general  adynamia,  and 
commonly  an  offensive  odour  of  the  breath  or  other 
secretions  are  present. 


S!S!^5r?^?Sf*      ON  HiEMOBRHOIDS.  187 


Hengw.Mu.^imi. 


When  biBmorrhoidshave  gone  on  bo  far,  and  have  been 
80  frequently  renewed  that  the  various  layers  of  the 
reetom  and  anus  become  thickened,  while  the  tumours 
themselves,  the  varices  create  irregularities,  where 
ulcers  are  very  likely  to  be  developed,  which,  from  their 
position  take  peculiar  forms,  as  in  so-called  anal 
fissure.  If  any  condition,  consequent  on  piles,  will 
justify  the  use  of  the  knife  it  would  be  there  ;  but  I  am 
sure  that,  in  these  cases,  if  the  patient  can  and  will  give 
the  time,  the  attention  and  the  nursing  that  such  a 
case  requires,  we  may  do  perfectly  well  without 
the  metal. 

The  great  requirement  is  the  careful  and  continual 
cleansing  of  the  rectum,  which  must  be  effected  with  as 
little  disturbance  of  the  part  as  possible,  almost  absolute 
rest  being  needed  by  the  patient.  Calendula  as  a  local 
application  is  most  useful,  and  I  have  heard  hydrastit 
equally  vaunted. 

The  bowels  must  be  kept  in  a  soluble  condition,  if 
possible,  by  means  of  appropriate  diet,  e.g.,  fruit, 
tamarinds,  &c.  I  am  quite  inclined  to  think  that  cocaine 
in  a  weak  solution  is  not  only  justifiable  but  of  great 
use  in  such  cases. 

I  have  used  ignatia,  cbbcvIub,  graphites,  and  many  other 
medicines  with  more  or  less  success,  but  I  have  derived 
most  benefit  from  the  two  latter.  I  can  say  that  I  have 
cured  a  good  many  cases  of  fistula  in  and  without  the 
knife ;  in  fact,  I  consider  this  much  more  tractable  than 
the  affection  I  last  spoke  of,  but  it  requires  rest  for  its 
treatment  and  careful  nursing  ajid  syringing. 

The  remedies  I  have  used  have  been  sUicea  almost 
exclusively,  and  calcarea  a  little  as  internal  remedies,  and 
calendula  and  hydrastis  as  local  applications. 

I  have  at  present  temporarily  under  my  care  a  patient 
vho  was  cured  of  fistula  by  our  colleague  A.  C.  Clifton 
fiome  good  many  years  ago — about  fifty — and  who 
remains  cured  still. 

There  are  many  other  medicines  which  have  been 
employed,  some  that  I  have  myself  formed  some  estimate 
of>  but  I  will  not  keep  you  longer  at  this  time,  but  hope 
to  hear  some  of  the  results  of  your  practice  in  this 
Action. 


188 OVABIOTOMY,  ^^fiSrg^! 

OVAEIOTOMY  AT  THE  LONDON  HOMCEOPATHIC 

HOSPITAL, 

By  6.  H.  BuRFOBD,  M.B. 

ABsistont  Physician  to  the  Oynsoologioal  Department. 

In  the  later  half  of  November  last,  Dr.  Hughes  asked 
me  to  receive  into  the  hospital  a  patient  suffering  from 
a  large  ovarian  cyst.  In  due  time  the  girl  came  up  to 
town  and  was  placed  under  my  care.  The  abdomen  was 
considerably  distended  and  rapidly  increasing  in  size, 
she  had  recently  suffered  some  acute  abdominal  pain^ 
and  her  general  distress  was  such  that  she  expressed  a 
very  emphatic  desire  for  operative  relief. 

A  consultation  was  held  at  the  hospital,  at  which,  in 
view  of  the  character  of  the  case,  there  were  present  the 
consulting  staff.  Dr.  Dudgeon,  Dr.  Dyce  Brown  and 
Dr.  Yeldham,  as  well  as  the  physicians  and  surgeon 
serving  on  the  active  staflF.  The  recorded  opinion  was 
unanimously  for  prompt  operative  treatment,  and  the 
diagnosis  that  of  ovarian  multilocular  cyst. 

On  Thursday,  December  4th,  I  completed  an  ovariotomy 
on  this  patient,  with  the  assistance  of  Mr.  Knox- 
Shaw.  At  the  operation  there  were  present  Dr.  Hughes, 
Dr.  Dudgeon,  Dr.  Roche,  of  Norwich,  Drs.  Blackley, 
Moir  and  Carfrae  and  Mr.  Wright.  The  usual  median 
incision  was  made,  the  peritoneal  cavity  opened,  and  the 
fluid  contents  of  the  cyst  discharged  through  a  Wells 
trocar.  Nearly  a  half  of  the  tumour  consisted  of  solid 
adenomatous  growths,  and  to  allow  the  removal  of  the 
cyst  the  incision  was  somewhat  extended,  parietal 
adhesions  broken  down,  and  the  whole  mass  delivered 
from  the  abdomen.  The  pedicle  was  deligated  by  three 
interlacing  ligatures,  the  abdomen  flushed  with  warm 
boro-glyceride  solution  and  a  glass  drainage  tube 
inserted.  Under  Dr.  Day's  ansesthetisation,  there  was 
no  vomiting  nor  straining  during  the  operation. 

The  convalescence  was  good  and  devoid  of  any  symptom 
of  gravity.  Some  troublesome  intestinal  distention  after 
the  first  week,  and  some  dysuria,  ultimately  yielding  to 
canthnris,  gave  the  most  trouble;  while  a  few  days 
before  leaving  the  hospital  a  carbuncle  made  its  appear- 
ance over  the  sacrum. 

A  fortnight  ago  the  patient  wrote  to  me  expressing  the 
great  gratification  of  herself  and  her  friends  at  the 


-Mb^jmrn^of^  BRYONIA   ALBA.  189 


Berieir,  Mtf .  2, 18»1. 


immonity  from  suffering  she  now  enjoyed.  I  also  have 
recently  received  the  assurances  of  Dr.  Hughes  as  to  her 
general  health  and  progress. 

In  the  history  of  this  case  three  notable  points  demand 
■special  attention. 

First,  complete  amenorrhoea  existed  for  six  consecutive 
months  prior  to  operation.  The  patient  menstruated 
regularly  up  to  May  last,  since  which  time  no  period 
had  come  on.  This  symptom  of  amenorrhcea  con- 
comitant with  an  ovarian  cystoma  is  by  no  means 
usual.  Mr.  Ejiowsley  Thornton  stated  a  short  time  ago 
that  menstrual  excess,  under  these  conditions,  was  the 
rule.    Here  is  an  instance  of  exactly  the  reverse. 

Secondly,  this  growth  was  peculiar  in  its  rapidity  of 
•formation.  The  first  appearance  of  distension  was 
noticed  by  the  patient  only  some  two  or  three  months 
heiore  admission ;  and  during  the  last  month  the  cyst 
had  nearly  doubled  in  size.  The  solid  elements  weighed 
«ome  seven  pounds,  and  the  fluid  removed  was  nearly  a 
gallon.  The  rapidity  of  increase  suggested  to  one  of  the 
'Consultants  the  idea  of  malignancy — a  state  of  matters 
fortunately  not  verified  by  examination. 

Thirdly,  the  dysuria,  a  late  and  frequent  symptom, 
vanished  in  Dr.  Hughes*  hands  under  the  use  of  can- 
Iharis  B.  While  in  the  hospital  canthatis  3x  had  been 
prescribed  with  only  moderate  benefit.  I  am  assured  by 
Br.  Hughes  that  cantharia  is  very  liable  to  aggravate  if 
^ven  in  low  dilution.  In  this  instance  the  progress 
under  8x  was  certainly  not  nearly  so  manifest  as  that 
made  while  taking  the  8. 

20,  Queen  Anne  Street, 

Cavendish  Square,  W, 


THE  ACTION  OP  BRYONIA  ALBA  IN  MENIERE'S 

DISEASE. 

By  Mr.  Dudlby  Wright. 

AjBsistftnt-Siirgeon  to  the  London  HomGeopftthic  Hoepital. 

I  AH  able,  through  the  kindness  of  Dr.  Byres  Moir,  under 
^hose  care  the  patient  formerly  was,  to  report  the 
following  case,  which  may  be  of  interest,  inasmuch  as  he 
has  now  for  six  months  been  free  of  a  disease  which  for 


190  .BBYONIA  ALBA.  "SSSl^S"?^ 


Beview,  Mar.  2, 1801. 


a  considerable  time  totally  preyented  him  from  following 
his  occupation. 

Bichard  B.,  a  butler,  aged  88  years,  first  consulted 
Dr.  Moir  on  December  14th,  1889,  complaining  of 
giddiness,  buzzing  and  other  noises  in  the  ears,  chronic 
constipation  and  occasional  attacks  of  vomiting.  He 
said  that  he  had  been  subject  to  these  attacks  for  over  a 
year,  and  that  in  the  last  year  he  had  lost  twelve  pounds 
in  weight.  There  was  deafness  in  the  left  ear,  the 
patient  being  only  able  to  hear  a  watch  on  contact.  H& 
at  first  received  hydrastis,  but  as  that  did  not  improve 
matters,  on  December  80th  salicylate  of  soda  was  given 
and  continued  for  five  weeks,  with  the  effect  of  con- 
siderably relieving  the  attacks  of  giddiness  and  vomiting, 
but  in  no  way  altering  the  constipation.  The  attacks^ 
however,  returned  with  increased  severity  at  the  end  of 
February,  1890,  and  continued  on  into  March,  on  the 
22nd  of  which  month  he  was  admitted  into  the  hospital. 
Previous  to  this  cocculus,  tabaewm  and  sulphur  had  been 
used,  but  without  effect.  On  admission  I  obtained  the 
following  history  from  him  (March  22nd,  1890).  Up  to 
about  two  years  ago  he  had  always  enjoyed  good  healthy 
but  had  always  been  liable  to  constipation.  He  had 
never  had  gout  or  jaundice.  Family  history  only  shows 
that  there  is  rheumatism  on  his  father's  side.  The 
present  illness  came  on  in  the  summer  of  1888.  It 
commenced  with  a  sudden  attack  of  giddiness,  vomiting 
and  cold  sweating,  which  came  on  without  any  warning' 
whilst  at  his  ordinary  occupation.  The  attack  lasted 
about  half-a-day  and  left  behind  it  great  prostration  and 
headache.    It  was  not  followed  by  jaundice. 

About  two  or  three  days  after  this  he  woke  up  one 
morning  and  found  that  he  was  deaf  in  the  left  ear,  and 
thinking  it  might  be  due  to  the  eaj:  being  "  stopped  up,"* 
he  put  His  finger  into  the  ear  to  clear  it  out.  This 
immediately  brought  on  a  severe  attack  of  giddiness  and 
faintness  which  lasted  the  greater  part  of  the  day. 

At  this  time  he  first  noticed  a  loud  hissing  sound  in 
the  left  ear^  like  a  steam  engine,  and  this  has  lasted  up 
to  the  present  time  (date  of  admission).  Gonstipatiou 
still  present. 

During  the  first  year  the  attacks  would  come  on  about 
every  four  months,  and  if  he  was  standing  when  an 
attack  came  on  he  would  occasionally  fall  dovni,  bat 


J&SyjggTlSr  BBYONIA   ALBA. 191 

dnnng  the  last  year  the  attacks  have  been  much  more 
frequent  and  of  much  greater  severity,  and  if  standing 
when  the  attack  appeared  he  would  always  fall.  During: 
the  attack  he  has  never  lost  consciousness,  never  bitten 
his  tongue,  or  passed  his  urine  or  faeces  involuntarily. 

Withm  the  last  few  months  he  has  always  noticed  that 
the  attacks  have  been  preceded  by  a  copious  flow  of  thick 
saliva. 

The  patient  was  a  sallow  complexioned  man  of  fairly 
good  build.  The  arteries  seemed  in  good  condition, 
pulse  52  per  minute,  fairly  full  and  quite  regular,  and 
the  tongue  was  clean  though  pale  and  flabby.  Exami- 
nation  of  the  heart,  lungs  and  abdominal  viscera  gave 
negative  results.  The  throat  and  fauces  were  normal, 
there  was  a  decayed  upper  left  bicuspid.  Hearing 
power  in  the  right  ear  was  very  good,  being  able  to  hear 
a  watch  at  8^  feet,  and  there  was  good  bone  conduction. 
On  the  left  side  the  watch  could  only  be  heard  at 
4  inches,  and  bone  conduction  both  for  watch  and  tuning 
fork  was  deficient,  though  not  abolished.  The  high  notes 
of  the  piano  were  heard  best.  Beyond  a  slight  retraction, 
of  the  posterior  and  upper  segment  of  the  left  membrana 
tympani  nothing  abnormal  was  noticed.  The  patient 
says  that  formerly  he  had  been  advised  to  perform  Val- 
salva's method  of  inflation  of  the  middle  ear,  but  that 
he  dreaded  doing  it  as  it  brought  on  the  giddiness.  The 
patient  further  stated  that  he  had  always  eaten  well,  but 
was  not  much  of  a  drinker,  and  that  he  thought  he  was< 
"a  very  bilious  man." 

Cocaine  hydrochlar.  8  irij-  t-d.s.  was  ordered,  and  he 
was  put  on  fish  diet.  The  former  was  in  four  days 
changed  to  soda  salicylatis  gr.  iii.  t.d.s. 

On  March  29th,  a  week  after  admission,  he  had  the 
first  attack  whilst  in  the  hospital.  At  11.30  a.m. 
giddiness  suddenly  came  on  and  lasted  about  half-an- 
hour.  The  things  in  the  room  appeared  to  be  going 
round  him,  travelling  from  right  to  left  whilst  he  kept 
still,  he  shut  his  eyes  but  this  did  not  relieve  him. 
There  was  no  vomiting  but  great  nausea,  and  he  said 
that  he  thinks  he  would  have  vomited  had  he  moved  at 
all.  The  attack  was  immediately  preceded  by  the  flow 
of  sticky  saliva,  but  there  were  no  auditory  aurse  or 
sensations  beyond  the  constant  hissing  in  the  left  ear.. 
The  following  night  at  12  o'clock  he  had  another  attack 


192  BRYONIA  ALBA.  "Sl'SlL^^r??^!' 


Review,  3£u-.  2, 18B1. 


which  came  on  after  dreaming  heavily.  He  awoke  up 
and  felt  the  saliva  flowing,  and  this  was  followed  by 
exactly  the  same  symptoms  as  above  described,  the 
whole  attack  lasting  an  hour  and  a  quarter.  The  next 
night  there  was  another  attack  lasting  about  an  hour, 
.and  he  was  ordered  ghnoin  2x,  pil.  2,  to  be  taken  if  he  felt 
an  attack  coming  on.  About  four  days  after  he  had  a 
flow  of  saliva  and  he  immediately  took  the  pilules  and 
Jio  giddiness  or  nausea  followed.  The  good  effects, 
however,  were  not  produced  a  second  time.  Nux  vomica 
8x,  sulphur  and  opium  1,  together  with  a  pint  of  hot 
water  at  bed-time,  were  all  tried  but  failed  to  stop  the 
.attacks  and  relieve  the  constipation.  The  patient  was 
discharged  on  May  1st,  and  sent  to  Folkestone  for  a 
fortnight,  where  he  had  five  or  six  attacks,  and  this  sort 
of  thing  continued  on  into  July,  when  he  came  back  as 
out-patient  to  the  hospital,  when  amongst  other 
•complaints  he  said  that  he  always  noticed  that  the 
giddiness  came  on  if  he  suddenly  got  up  from  the 
.sitting  or  lying  posture.  Upon  this  symptom,  combined 
with  the  man*s  general  condition  and  the  constipation, 
I  prescribed  bryonia  Ix,  2  pilules  to  be  taken  every  three 
hours,  and  to  be  carried  about  him  to  take  before  he  felt 
.an  attack  coming  on. 

The  same  day  he  returned  to  Bamsgate  where  he  had 
been  staying  for  two  weeks,  and  he  began  taking  the 
medicine  regularly.  In  two  days  he  felt  an  attack 
^coming  on  whilst  out  walking,  immediately  he  took  two 
pilules  and  it  was  stopped ;  a  few  days  later  the  same 
thing  occurred,  and  smce  then  up  to  the  present  time 
.(Jan.  12,  1891)  he  has  not  had  a  single  attack  of  vertigo. 
The  bowels,  moreover,  soon  after  taking  the  bryonia 
.commenced  to  act  regularly,  and  have  done  so  up  to  the 
jpresent.  The  medicine  was  continued  for  one  month. 
Examination  now  shows  that  th^  hearing  power  in  the 
right  ear  is  3^  ft. ;  left  ear,  15  inches.  Bone  conduction 
.as  good  as  before  on  the  right  side,  not  quite  so  good  on 
the  left  as  on  the  right,  but  very  much  better  than 
before.     No  change  in  the  membrane  of  either  ear. 

The  above,  I  think,  is  a  fairly  typical  case  of  Meniere's 
disease,  or  labyrinthine  vertigo.  That  some  labyrinthine 
^change  was  present  is  sufficiently  shown  by  the  impaired 
bone  conduction  on  the  diseased  side,  and  apart  from  the 
constipation  there  were  no  other  derangements  likely  to 


SS^mSJTS?**"  notes  and  comments.  193 


Sarlev.lfar.  S,  1S91. 


have  caased  the  vertigo  by  reflex  action.  The  most 
remarkable  thing  about  the  case  is  the  ready  way  in 
which  it  responded  to  the  hryonia,  and  it  is  for  this 
reason  I  bring  the  case  forward.  The  patient  himself 
thoroughly  believes  that  it  was  this  remedy  which  has 
cured  him,  and  I  am  very  much  inclined  to  the  same 
belief.  I  should  much  like  to  know  of  any  other  cases 
treated  by  similar  means  with  success  or  failure. 

21,  Leinster  Square,  W. 

NOTES   AND    COMMENTS. 


In  an  AMXTSiNa  note,  the  British  Medical  Journal  (Feb. 
7th)  complains  that  "  the  homoeopaths  claim  to  have 
anticipated  Koch  "  in  his  new  treatment  of  phthisis. 
The  qnestion  of  priorities  does  not  interest  us  much,  and 
we  gladly  leave  others  to  fight  it  out.  The  broad  fact 
remains  that  for  several  years  a  few  medical  men  in 
England  and  America  have  used  a  preparation  of  tubercle 
bacilli  in  selected  cases  of  phthisis.  That  this  prepara- 
tion (tuberctdinum)  was  merely  an  attenuation  of  phthisi- 
cal sputuni  is,  we  believe,  true.  But,  provided  the 
presence  of  tubercle  bacilli  be  proved  (and  the  products 
of  their  existence  granted)  it  appears  to  us  not  to  be  very 
wide  of  the  mark  to  state  that  the  old  tuherculinum  is  an 
agent  analogous  to  Koch's  fluid.  The  chief  difference — 
m  principle,  not,  of  course,  in  the  mode  of  preparation — 
is  that  Koch's  remedy  is  apparently  the  more  homoeo- 
pathic of  the  two.  It,  at  least,  is  modified  by  being 
passed  through  the  guinea-pig  (and  by  cultivation?) 
while  it  is  less  clear  that  the  attenuation  of  the  virus 
does,  strictly  speaking,  modify  it.  If  the  tvhercidinum 
be  only  a  dilution  of  the  actual  "  poison "  of  phthisis 
(l>acilli  and  products),  then,  as  was  pointed  out  in  the 
discussion  at  the  last  meeting  of  the  British  Homoeopathic 
Society,  its  use  is  isopathy  and  not  homoeopathy,  unless 
the  extreme  dilution  really  renders  it  a  **  tertium  quid." 

ToL  35,  No.  S.  P 


1 


194  NOTES  AND  COMMENTS.    ^SS^l^TSHm! 

We  are  much  more  interested  in  the  question  whether 
the  action  of  Koch's  fluid  be  homoeopathic  or  not.  This 
we  must  still  regard  as  suh  jvdice.  If  the  substance  will 
produce  in  the  healthy  human  subject  a  condition  closely 
resembling  that  which  we  call  pulmonary  phthisis,  or 
consumption,  or  will  produce  a  condition  closely  resem- 
bhng  any  stage  thereof ;  if  this  same  substance  will  also 
cure  that  condition  (phthisis)  otherwise  acquired,  or  a 
stage  of  that  condition  (phthisis)  similar  to  the  stage  it 
will  bring  about  in  the  healthy — then  and  only  then  does 
the  substance  act  homceopathically — or,  in  other  words, 
then  and  only  then  is  it  a  homoeopathic  remedy. 
(Homoeopathic  tuberculimuUf  however,  we  are  bound  to 
Bay,  does  fulfil  these  conditions).  And  we  need  hardly 
«ay  that  under  these  circumstances  the  remedy  is  homoeo- 
pathic by  whomsoever  it  be  discovered,  prepared  or  pres- 
cribed. In  our  December  issue  we  gave  reasons  for  believing 
that  Koch's  fluid  might  prove  to  be  a  homoeopathic 
remedy  for  phthisis.  Little  or  no  additional  information 
bearing  on  the  question  has  been  brought  to  light,  either 
from  the  pathogenetic  or  the  clinical  side.  Pending  the 
further  testing  of  the  disease-producing  power  of  the 
fluid  on  the  healthy  subject,  we  suggest  that  our  canfreres 
should  work,  though  it  be  to  some  extent  in  the  dark,  from 
the  clinical  side,  by  using  the  fluid  in  doses  not  likely  to 
produce  aggravations  and  carefully  recording  the  results 
(if  any). 

We  presume  that  the  British  Medical  Journal  speaks 
of  the  ^^  seer  eta''  of  homoeopathy  and  of  the  "esoteric 
mysteries  "  of  the  system,  because  it  desires  that  the 
truths  of  homoeopathy  may  long  remain  hidden  from  the 
knowledge^of  the  profession.  We  cannot  but  think  this 
attitude  altogether  out  of  keeping  with  the  scientific 
apirit  of  tho  times  and  of  the  Journal  itself  in  most  other 


|tottlyH«n«opjtiii«  BEVIEW8.  195 


Betitfv,  Mmr.  S,  1891. 


matters.  Homoeopathy  has  no  secrets  any  more  than 
has  the  BritUh  Medical  Journal  or  the  Boyal  College  of 
Physicians.  Bat  it  were  surely  wiser  to  put  its  claims 
frankly,  openly  and  unbiassedly  to  the  test  than  to 
throw  over  it  a  mantle  of  darkness.  Homoeopathy  has 
tilways  courted  unprejudiced  examination  and  the  test  of 
experience ;  if  it  be  a  false  system,  then  the  sooner  it  is 
exposed  and  done  away  with  the  better ;  if  it  be  a  true 
one,  the  sooner  its  truths  are  acknowledged  and  profited 
l)y,  the  better  for  all  concerned. 

We  can  hardly  be  responsible  for  the  list  of  delicacies 
to  which  Professor  Eeyburn  and  his  New  York 
'''homoeopathic  drug  vendor"  treat  the  readers  of  our 
<Jontemporary ! 


REVIEW8- 


Tke  Diifmty  of  Woman's  Healthy  and  Uie  Nemesis  of  its  neglect. 
By  BoBEBT  Bsm  Reivtoul,  Doctor  of  Medicine.  London  : 
J.  &  A.  Chorchill.     1890.    A  pamphlet  for  women  and 

girls. 
The  Daughter  :    Her  Health,   Education  and    Wedlock.      By 

WmuAM  M.  Capp,  M.D.    Philadelphia  and  London:    F. 

A.  Davis.     1891.     Homely  suggestions  for  mothers  and 

daughters. 
Both  these  popular  httle  works  have  for  their  object  the 
instruction  of  woman  respecting  the  physiology  and  care  of 
their  own  pelvic  organs  and  of  their  general  health.  The 
aathors  of  both  works  hold  that  "the  ignorance  concerning 
the  simplest  matters  of  personal  and  household  hygiene  and 
physiology  is  often  most  surprising"  (Capp),  and  it  is,  we 
may  add,  truly  lamentable.  The  first  mentioned  work  is 
divided  into  five  chapters,  and  treats  of  menstruation  and  its 
domestic  and  hygienic  management,  of  the  fitness  of  woman 
fcr  "  continuous  work,"  and  of  "  who  should  marry."  We 
hftve  not  space  for  quotations,  but  may  summarise  Dr. 
Bentoul's  most  important  advice  as  follows : — 1st.  During  the 
fiist  few  months  of  menstrual  Ufe  the  studies  and  active 
exertions  of  a  girl  should  be  stopped.  2nd.  That  at  each  monthly 
period  study  and  exertion  should  be  less  than  usual,  and  that 
Bxoesfiive    exertion   such   as   dancing,  tennis,  &c.,  should 


196  KEViEws.  "SS!'Z,=ffi?7?2lr 


Beriew,  ICar.  2, 18011 


especially  be  avoided.  8rd.  That  woman  is  consequently  not 
constructed  to  undergo  "continuous  work."  4th.  That 
"  selection,"  from  the  health  point  of  view,  should  obtain  in 
the  choice  of  a  partner  in  life,  and  that  such  selection  is  not 
only  wise  but  that  its  neglect  is  "  an  offence  (p.  184)  against 
all  the  laws  of  morahty,  honour  and  health."  Respecting  the 
practicability  of  some  of  these  views,  we  leave  our  readers  to 
judge  after  perusing  them  in  extenso  in  Dr.  Bentoul's 
interesting  pamphlet. 

Dr.  Capp's  little  book  of  140  pages  deals  with  topics  con- 
cerning "  the  infant,  the  child,  the  girl,  the  wife,"  besides 
giving  a  chapter  entitled  **  general  suggestions  upon  health." 
Its  sphere  is  thus  more  extended  than  the  work  of  Dr.  Ren> 
toul.  The  advice  given  respecting  the  management  of  infants 
is  in  the  main  sound,  and  such  as  English  medical  men  would 
approve.  The  imwisdom  of  much  cradle  rocking  and  of  walk- 
ing the  room  with  fretful  babies  is  alluded  to,  as  also  that  of 
loading  the  air  which  they  breathe  with  perfumes.  One  point, 
which  is  entirely  un-English,  is  the  statement  that  a  complete 
bath  is  rarely  desirable  for  infants  in  the  early  days  of  life. 
Local  cleansing  only  is  recommended.  We  have  seen  thi» 
stated  in  other  American  works.  That  the  washing  of  in£ELnts 
which  EngUsh  nurses  and  mothers  are  accustomed  to  may  not 
be  essential  to  a  moderate  amount  of  health  and  comfort  is 
proved  by  this  American  custom,  and  still  more  so  by  that  of 
the  Chinese,  who  do  not  wash  their  infants  for  many  months. 
That  the  skin  must  act  better  for  thorough  and  regular  clean- 
sing is,  on  the  other  hand,  indisputable.  The  author  recom- 
mends that  children  be  not  taught  the  letters  of  the  alphabet 
until  about  nine  years  of  age,  and  states  that  children  taught 
from  that  age  by  good  teachers  rank  the  same  at  12  years  of 
age  as  children  who  have  begun  study  much  earlier.  Our 
own  experience  would  agree  with  this,  provided  that  good  use 
have  been  made  of  the  early  years  to  build  up  the  health  of  the 
child.  We  may  say,  without  endorsing  every  detail  in  these 
interesting  Uttle  works,  that  our  readers  may  safely  recommend 
and  introduce  to  young  wives,  and  to  mothers  for  their 
daughters,  either  of  them,  according  as  their  personal  require- 
ments or  those  of  their  children  are  in  question. 


Principles  of  Surrfm/,    By  N.  Senn,  M.D.     Philadelphia  and 
London  :  F.  A.  Davis.     1890. 

Dr.  Senn,  whose  labours  in  the  field  of  intestinal  surgery  in 
America  has  given  him  a  European  reputation,  has  presented 
to  the  profession  a  new  book  with  the  above  title.  Much  of 
the  practice  of  surgery  remains  unchanged,  but  even  modem 
text  books  are  out  of  date  with  regard  to*  the  latest  develop- 


^^SS^T^^  REVIEWS.  197 


B«Tiew,  Ifar.  2, 1801. 


ments  of  the  science  of  the  art,  such  rapid  strides  having 
been  made,  especially  in  bacteriology.  Senn  has  therefore 
eDdeavoored  **  to  connect  the  modem  science  of  bacteriology 
more  intimately  with  the  etiology  and  pathology  of  surgical 
affections."  The  earher  chapters  are  devoted  to  the  ground 
vork  of  surgery,  repair  and  inflammation,  but  even  here 
the  development  of  bacteriology  necessitates  some  change 
in  modem  surgical  nomenclature.  Senn  draws  a  distinct 
difference  between  regeneration,  which  is  a  plastic  aseptic 
inffammatory  process  and  inflammation,  which  is  always 
caused  by  the  presence  of  one  or  more  kinds  of  pathogenetic 
microbes.  He  is  an  adherent  of  MetschnikofPs  theory  of 
phagocytosis,  and  illustrates  a  phagocyte  in  the  process  of 
devonring  an  anthrax  bacillus.  This  doctrine  has  met  with 
considerable  opposition,  and  will  need  further  confirmation 
before  it  can  be  generally  accepted,  but  it  is  important  to  see 
that  Senn  favours  the  theory.  The  chapter  on  Pathogenetic 
Bacteria  is  very  interesting  and  important,  especially  as  it 
attempts,  and  ably  too,  to  throw  light  on  many  points  difficult 
of  explanation,  with  regard  to  the  causation  of  some  of  the 
morbific  processes  by  bacteria.  The  questions  are  treated 
imder  the  heads,  "  Bacteria  outside  the  body ; "  *'  Presence  of 
pathogenetic  bacteria  in  the  healthy  body ;  "  '<  Localisation  of 
bacteria,"  &c.  Surgical  diseases  of  bacteriological  origin  are 
very  folly  discussed,  their  etiology  being  very  carefully  gone 
into.  The  book  is  exceedingly  interesting,  and  though  written 
from  the  point  of  view  of  an  enthusiastic  bacteriologist,  con- 
tains much  that  must  carry  conviction  to  the  most  sceptical. 
Medicinal  therapeutics  naturally  plays  a  small  part  in  the 
book ;  but  we  noticed  that  he  condemns  calcium  sulphide  as 
useless  in  influencing  suppuration  ;  this  is  probably  because 
its  efficacy  would  not  square  with  the  bacteriological  origin  of 
suppuration. 

Fire  Years'  Expeiience  in  the  Xeiv  Cure  of  Consumption  hy  its 

men  Tints,    Illustrated  by  fifty-four  cases.     By  J.  Compton 

Burnett,  M.D.    London :   The  Homoeopathic  Publishing 

Company.    1890. 

Dr.  Burnett's  treatises  are  always  original,  interesting  and 

instructive.    This  one  is  especially  so,  and  its  interest  and 

value  are  enhanced  by  its  appearance  at  a  time  when  Koch's 

new  remedy  for  tuberculosis  is  creating  such  a  furore.     Dr. 

Burnett  has  been  employing  this  same  remedy,  prepared 

differently,  however,  for  five  years,  with  the  results  he  here 

records.    Any  real  advance  in  the  therapeutics  of  precision  is 

sore  to  be  on  homoeopathic  lines,  and  here  we  have  Koch's 

**  discovery  "  anticipated  by  the  school  which  is  tabooed  by  the 


198  BEviEWfl.  ""SiSSL^Sf?^? 


Berierr,  Max.  S,  1881.. 


**  orthodox  "  old  school,  although  when  brought  out  with  a 
flourish  of  trumpets  by  a  well-known  '<  allopath/'  Dr.  Eocb» 
the  medical  world  rushes  into  it  madly. 

Dr.  Burnett  uses  a  preparation  of  tuberculous  matter  in. 
which  the  microscope  has  revealed  the  presence  of  bacilli.. 
This  is  diluted  in  the  usual  homoeopathic  method  to  the- 
dOth  centesimal,  the  100th  and  200th  dilutions,  and  the  doses 
are  given  at  infrequent  intervals,  usually  every  six  or  ten; 
days. 

Koch,  who  injects  his  remedy  subcutaneously  in  small  but 
still  comparatively  tangible  doses,  maintains  that  it  is  inert 
if  taken  by  the  mouth,  while  Dr.  Burnett  proves  that  when 
much  more  highly  diluted  it  is  efficacious  to  a  remarkable 
degree  when  given  by  the  mouth,  and,  as  we  have  said,  at 
infrequent  intervals.  The  two  statements  are  quite  com- 
patible. It  is  well-known  that  the  poisons  of  deadly  serpents 
are  innocuous  when  swallowed,  and  yet  the  medical  experience 
of  homoeopaths  is  that  these  same  poisons,  ladiesU,  crotalus 
and  naja  are  medicines  of  inunense  value  when  given  by  the 
mouth  in  "  high  "  dilutions. 

Next,  is  ''  tubercuLinum  "  (we  note  that  Koch  proposes  to  call 
his  remedy  *'  tuberadin  '')  or  as  Dr.  Burnett  proposes  to  call 
it  **  bacillinimiy'*  homoeopathic  or  isopathic  ?  It  looks  at 
first  sight  to  be  isopathic.  But  it  is  quite  possible  that  the 
extreme  amount  of  dilution  may  so  alter  the  virus  as  to 
practically  make  it  no  longer  an  ide}n  but  a  nmiU.  At  all 
events  in  a  strong  dose  it  produces  symptoms  similar  to  those 
that  Dr.  Burnett  shows  that  it  cures.  We  may  therefore 
consider  it  homoeopathic  and  not  isopathic. 

Another  point  of  interest  is  that  while  Eoch*s  doses  in- 
variably produce  severe  febrile  disturbance,  and  dangerous  or 
'>ven  fatal  aggravation  of  the  patient's  state,  the  dOth  and 
100th  dilutions  do  not  in  the  least  aggravate  or  cause  any 
disturbance.  In  one  of  Dr.  Burnett's  cases,  however,  it  is 
right  to  notice  that  he  states  that  a  slight  increase  in  the 
symptoms  preceded  the  amelioration,  and  in  another  case,  a 
lady  stated  that  the  remedy  "  tried  her  very  much." 

Now  for  the  results. 

Koch  has  been  successfal  in  only  a  limited  sphere  of 
tubercle,  viz.,  in  lupus,  and  even  then  not  uniformly,  while 
in  consumption  the  results  are  too  few  to  judge  of,  and  those 
recorded  have  not  been  brilliant. 

Dr.  Burnett,  on  the  other  hand,  gives  54  cases,  some  of 
undoubted  phthisis,  others  of  "  consumptiveness,"  and  others 
of  other  forms  of  scrofulous  or  tubercular  disease,  many 
of  them  completely  cured,  while  others  were  markedly 
ameliorated,  the  case  being  finished  up  by  other  homoeopathic- 


^S^S^T^^  KEVIEW8.  199 


;  Mar.  2, 1891. 


remedies.  Both  Eoch  and  Burnett  find  that  in  advanced 
phthisis  the  remedy  £ails,  and,  although  there  is  no  evidence* 
that  the  infinitesimal  doses  hasten  the  fatal  end,  there  is 
ample  evidence  that  Koch's  larger  doses  do  so.  It  seems  evi- 
dent that  if  Eoch  and  his  followers  wish  to  obtain  better 
results  the  dose  must  be  very  largely  diluted.  Dr.  Burnett's 
cases  are  extremely  instructive  on  this  point.  He  used  the 
80th  largely.  >iow  he  states  that  he  rarely  goes  below  the 
100th,  and  gives  it  only  at  intervals  of  about  a  week.  And 
eertainly  his  success  is  remarkable.  We  forbear  to  quote 
cases,  some  of  them,  of  course,  better  than  others,  for  want  of 
space,  but  we  regret  this  the  less,  as  it  is  desirable  that  the 
cases  be  read  all  through.  One  thus  gets  a  much  better  idea 
of  the  scope  of  the  remedy  in  different  forms  of  disease  than 
by  perusing  a  single  case  or  two.  A  strong  and  interesting 
point  in  these  cases  is,  that  Dr.  Burnett  is  able  to  record 
permanent  cures,  the  interval  of  time  that  has  elapsed  since 
the  treatment  of  most  of  them  being  sufficient  for  the  purpose. 
We  strongly  advise  our  confrPren  to  procure  and  read  one  of 
the  most  original  and  instructive  little  works  that  has  appeared 
for  many  years  past. 

A   Cyelopadia    of   Drug   Pathogenesy.      Edited  by   Bichabd 

Hughes,  M.D.,  and  J.  P.  Dake,  M.D.     Part  xiv.     Sulphur 

—Valeriana.      London :    E.   Gould  &  Son.      New  York : 

Boericke  &  Tafel.     1891. 

Wk  have  much  pleasure  in  mentioning  the  appearance  of  the 

fourteenth  part  of  the  Cyclopaedia  of  Drug  Patliogenesy,   now 

80  near  its  completion.      In  this  number  i  s  completed  the 

paihogenesy  of  Sulphur,    It  also  contains  a  full  description  of 

the  following  important  drugs — Tabaeuw,  Terehinthirui,  Thuja 

and  Vraniurn.      Of  these,  after  Sulphur,  Tahacum  seems  the 

most  interesting,  and  is  fertile  in  useful  suggestions. 

The  editors  again  make  appeal  for  contributions  to  the 
Appendix,  which  may  be  sent  to  Dr.  Hughes,  Brighton,  Eng., 
or  to  Dr.  Dake,  Nashville,  Tenn.,  U.S.A. 


Banninghausen's  Therapeutic  Pocket  Book  for  Homoeopaths  to 
UM  at  tJie  bedside  and  in  tlie  study  of  the  Materia  Medica.  A 
new  American  edition  by  Dr.  Timothy  Field  Allen. 
Philadelphia :  The  Hahnemann  Publishing  House.     1891. 

Most  of  our  readers  are  familiar  with  this  work,  and  all 
fihoTild  become  acquainted  with  it  who  do  not  already  know 
it.  It  may  truly  be  called  a  repertory  of  cliaracteristics, 
^ere  are  seven  sections.  The  first  includes  mind  and 
intellect;  the  2nd,  ''  parts  of  the  body  and  organs  "  ;  the  drd^ 


200  PERISCOPE.  "SS&^5???^ 


Beriew,  liar.  S,  1»1. 


<'  all  the  sensations  and  complaints  "  ;  the  4th,  "  sleep  and 
dreams  "  ;  the  5th,  **  fever  "  ;  the  6th,  "  conditions,  or  aggra- 
vations and  amehorations  '* ;  7th,  '*  relationships." 

The  ''pocket  book"  does  not  profess  to  be  a  complete  and 
detailed  repertory,  and  is  consequently  of  most  use  to  those 
already  famihar  with  the  symptomatology  of  the  Materia 
Medica.  For  instance,  nnder  Music  (in  the  6th  section)  all 
the  drugs  which  have  sympioms  aggravated  by  music  are 
given — a  list  of  some  24.  The  symptom  itself  must  be 
sought  for  in  sections  1,  2  or  8 ;  the  aggravation  is  found  in 
the  6th.  It  will  not  always  follow  that  the  symptom  and 
the  condition  have  previously  been  associated  either 
pathogenetically  or  clinically.  But  it  is  believed  that 
a  truly  characteristic  '*  condition  "  runs  through  the  whole 
of  the  symptoms  of  a  drug.  That  this  is  often  the 
case  is  undoubtedly  true  ;  but  it  is  equally  true 
that  it  is  not  always  so.  Consequently  the  warning  of 
Dr.  Allen's  preface  must  not  be  overlooked.  **It  must 
be  borne  in  mind  constantly  that  it  (the  '  pocket  book ') 
is  intended  only  as  a  guide  to  the  proper  remedy,  and  in  no 
way  should  be  used  to  supersede  the  Materia  Medica"  This 
is  and  always  must  be  true  of  any  repertory  or  index.  It  is 
also  to  be  borne  in  mind  thai,  although  from  the  pen  of 
Boenninghausen,  the  repertory  can  only  be  as  good  as  its 
sources  are  reliable.  Of  tlie  reliability  of  these  sources 
differences  of  opinion  exist.  Many  other  symptoms  than 
absolutely  pathogenetic  ones  are  included  in  the  index.  With 
this  warning  (which  of  course  applies  equally  to  all  other 
repertories  hitherto  published)  we  feel  sure  most  of  our 
readers  could  use  this  work  with  advantage.  Its  regular  use 
could  not  fail  to  ensure  a  more  thorough  knowledge  of  the 
characteristic  features  of  the  Materia  Medica, 

Dr.  Allen  has  enlarged  the  book  by  the  addition  of  many 
new  remedies.  His  wide  experience  in  the  study  of  the 
Materia  Medica  is  well  known. 

The  *'  pocket-book"  is  printed  on  well  rolled  paper,  with  clear 
type,  and  it  is  portable  (4 J  in.  by  6f  in.  by  f  m.),  and  well 
bound  in  morocco. 

PERISCOPE, 

MEDICINE. 

Notes  on  Bacterial  Diseases. — The  refractory  state  of  the 
body  to  a  second  attack  of  measles,  scarlet  fever,  small  pox, 
is  well-known. 

The  frog  and  fowl  enjoy  immunity  from  bacillus  anthrads, 
which  is  fatal  to  man  and  larger  animals,  such  as  sheep  an^ 


i£^£frfSS*'         PEW8C0PE.  201 


Vienew,  Knr.  2,  1891. 


oxen ;  bnt  the  interesting  point  is,  if  the  temperature  of  the  frog 
1)8  rused  and  that  of  the  fowl  be  lowered,  they  are  both  rendered 
iiable  to  anthrax  (Pasteur). 

This  refractory  state  can  be  produced  by  innocnlation  of  an 
allied  disease  {e.g.,  vaccinia  in  case  of  small  pox),  or  of  the 
disease  itself,  modified  by  passage  through  another  animal. 

The  refractory  state  is  produced  by  innocnlation  of  a  virus, 
modified  by  cultivation  outside  the  body.  Tressant  and 
Chaaveau  found  that  by  heating  cultivations  of  the  bacillus 
anthracis  rapidly  to  a  comparatively  high  temperature,  they 
at  the  same  time  attenuated  its  virulence. 

Again,  this  refractory  state  can  be  produced  by  introducing 
into  the  system  definite  chemical  products,  resulting  from  the 
action  of  pathogenic  organisms  on  cultivation  media. 

Micro-organisms  generate  products  which  are  deadly  to 
themselves  and  capable  of  arresting  their  growth,  a  fact  long 
kiown  in  connection  with  fermentation  organisms. 

Filtered  chicken  cholera  bouillon  (containing  no  organisms), 
when  innoculated,  produces  the  disease.  The  lymphs  or 
vaccines  used  by  Pasteur  owe  their  value  to  certain  definite 
albomoses  which  they  contain. — Dr.  S.  Del^pine,  on  Bacterial 
Diseases,  Lancet. 

Fatty  HypERTKOpfflc  Cibbhosis  op  the  Liveb. — M.  Charles 
Luzat  {Archives  de  Medecine  Experimentale,  Tome  11.,  p.  282), 
gives  a  case  of  the  above,  which  was  observed  in  the  Hdpital 
Saint-Antoine,  under  the  care  of  Professor  Hoyem.  The 
symptoms  had  existed  about  four  years,  but  the  acute  symp- 
toms had  lasted  about  two  months,  and  were  jaundice  and 
abdominal  pain,  of  greatest  intensity  at  the  epigastrium,  with 
vomiting  about  two  hours  after  food.  There  was  no  black 
colour  of  vomited  matter.  The  vomiting  was  only  immedi- 
ately preceded  by  nausea  and  relieved  him  at  once.  For  a 
month  before  he  came  into  hospital  the  vomited  matters  were 
black,  and  the  stools  were  loose  and  black.  He  was  a  man- 
cook,  84  years  old,  who  had  drunk  a  great  deal,  four  litres  a 
day  some  days. 

During  life,  cancer  of  stomach  was  suspected  and  he  was 
brought  to  the  hospital  on  account  of  copious  hfiematemesis 
with  melsena.  He  died  in  a  state  of  stupor  the  day  after  he 
was  admitted  into  the  hospital.  After  death  the  stomach  was 
found  dilated,  and  there  was  no  tumour  nor  ulcer. 

The  Uver  was  found  projecting  below  the  false  ribs,  cirrh- 
osed,  and  with  a  number  of  vegetations  on  its  under  surface. 

The  microscopic  examination  of  these  vegetations  showed 
that  they  were  points  of  fatty  hepatic  tissue  which  had  resisted 
fibroid  infiltration,  but  no  reason  why  is  given.  A  very  com- 
jplete  histological  examination  of  the  liver  was  made. 


202  PERISCOPE.  "^l^^S^T^ 


On  the  Changes  in  Pebiphebic  Nebtes  in  Diabetes 
MellituS)  is  the  title  of  a  paper  by  Dr.  Anch^,  of  Bordeaux, 
in  the  Archives  de  Mhdecine  FsxpMmentale,  Tome  II.,  p.  685^ 
A  number  of  cases  are  cited,  and  the  following  conclusions  are 
drawn.  It  has  been  proved  that  peripheral  neuritis  is- 
developed  in  the  course  of  diabetes  without  any  other  apparent 
cause,  and  that  the  symptoms  are  not  uncommon.  The 
symptoms  affect  the  motor  and  sensory  nerves,  the  nutrition 
and  the  vaso-motor  system.  The  picture  is  often  like  that  of 
alcohohc  neuritis,  for  which  it  is  likely  to  be  mistaken  unless 
the  urine  is  examined  for  sugar.  The  pathogenesis  of  the- 
symptoms  is  not  to  be  exclusively  attributed  to  the  irritating 
action  of  the  sugar  on  the  peripheral  nerves.  The  symptoms 
are  probably  due  to  many  causes,  anhydsBmia,  acetonsemia, 
the  derangement  of  general  nutrition  which  affects  the  nerves 
as  well  as  other  tissues,  and  perhaps  the  action  of  chemical 
substances,  at  present  ill-defined,  which  circulate  in  the  blood 
of  diabetic  patients. 

On  the  Tbeathent  of  Excessive  Vomiting  by  Ebeosote.. 
Dr.  Peter  Kaatzer  {Berl.  Klin.  Wochenschn/t,  Dec.  29th,  1890, 
p.  1227)  gives  a  case  in  which  kreosote^  prescribed  for  phthisis, 
had  the  effect  of  checking  very  troublesome  vomiting  in  a 
pregnant  woman.  Dr.  Kaatzer  attributes  the  effect  to  the 
destruction  of  tubercular  bacilli  in  the  stomach.  [This 
explanation  a-la-mode  is  not  in  accordance  with  the  homceo- 
pathic  use  of  kreosote  in  cases  of  vomiting,  as  one-thousandth 
part  of  a  drop  of  kreosote  would  not  be  likely  to  kill  many 
bacilli.]  J.  Gibes  Bulks. 

SURGERY. 

A  Case  of  Nephbolithotomy  (following  Nephbectomt)  for 
Total  Suppbession  of  Ubine  Lasting  Five  Days  ;  Complete 
Recoveby  AND  Good  Health  Five  YitABs  aftebthb  Opebatiom. — 
Mr.  Clement  Lucas  read  the  notes  of  this  case  before  the 
January  meeting  of  the  Royal  Medical  and  Chirurgical  Society.. 
This  case  was  mentioned  by  the  medical  journals  at  the  date 
of  the  operation,  in  1885,  as  a  case  of  exceptional  interest, 
but  the  author  had  delayed  publishing  it  until  sufficient  time 
had  elapsed  for  a  judgment  to  be  formed  as  to  the  permanence 
of  the  cure.  The  patient  was  still  enjoying  the  best  of  health 
and  freedom  from  pain,  discomfort  and  hsematuria,  which,  for 
seventeen  years  before  her  right  kidney  was  removed,  were- 
almost  constantly  present.  The  operation  for  total  suppression 
of  urine  was  one  that  the  author  had  long  considered  justifi- 
able, and  he  had  on  more  than  one  occasion  previously  pub- 
licly advocated  its  performance.    The  patient  had  been  under 


iESS'£TS£?*  pebiscope.  20a 


,]ar.i,]fi»l. 


the  care  of  Mr.  F.  D.  Atkuw,  of  Sutton,  Surrey,  to  whom 
much  eredit  was  due,  hoth  for  the  original  diagnosis  and  for 
the  promptitude  with  which  he  acted  when  the  total  suppres- 
sion occurred.  F.  F.,  aged  87,  was  first  admitted  into  .Guy's 
Hospital  on  June  22nd,  1885.  There  was  a  strong  fanuly 
history  of  consumption.  For  seventeen  years  she  had  suf- 
fered from  hfematuria  at  intervals,  and  for  nine  or  ten  years 
this  had  heen  accompanied  hy  pain  on  the  nght  side  of  the 
abdomen,  and  for  seven  years  a  tumour,  diagnosed  as  a  float- 
ing kidney,  had  been  felt  on  that  side.  On  July  14th  the  right, 
kidney  was  removed  by  lumbar  incision.  It  was  a  mere  shell 
containing  masses  of  stone  and  weighing  21  ounces.  The  wound 
healed  completely,  and  she  left  the  hospital  convalescent  on 
Aug.  10th,  just  within  a  month  of  the  operation.  All  went  well 
for  three  months.  She  had  returned  to  her  household  duties^ 
vas  tree  from  pain  and  haematuria,  and  much  satisfied  with 
the  result  of  the  operation.  On  Sunday,  October  24th,  1885^ 
ska  was  suddenly  seized,  between  7  and  8  a.m.,  with  agonising 
podn  in  the  back  and  left  loin.  The  pain  passed  through  the 
l»in  to  the  front  of  the  abdomen  and  groin.  About  eight 
o'clock  she  passed  a  little  urine,  but  from  that  time  all 
secretion  stopped.  Vomiting  commenced  about  half-past 
eight  on  the  same  morning,  and  was  continued  at  intervals 
&nd  whenever  anything  was  taken.  Mr.  Atkins  was  called  to- 
see  her  and  found  the  bladder  empty.  Vomiting  and  anuria 
continued  throughout  Sunday,  Monday  and  Tuesday.  On' 
Tuesday  Mr.  Lucas  met  Mr.  Atkins  in  consultation  and 
advised  operation.  The  symptoms  continued  without 
cKsation  on  Wednesday,  when  she  was  brought  to  London,, 
but  Mr.  Lucas's  medical  colleagues  still  advised  him  to 
postpone  operation  until  a  further  trial  had  been  given  to- 
diuretics,  and  in  deference  to  their  opinion  he  waited  another 
day.  On  Thursday  afternoon,  the  fifth  day  of  anuria,  the 
patient  became  drowsy  and  weaker,  so  that  it  was  difficult  to 
rouse  her  to  obtain  answers  to  questions. 

Her  pulse  was  weak,  her  temperature  99°,  and  she  had 
become  less  sensitive  to  pain  and  indifferent  to  what  was 
passing  around  her.  Ether  was  given,  and  Mr.  Lucas  cut. 
down  on  her  remaining  kidney  and  discovered  a  conical  stone 
acting  as  a  ball-valve  to  the  top  of  the  ureter.  The  stone 
was  rather  more  than  three-quarters  of  an  inch  in  length  and 
from  three-eights  to  five-eights  in  diameter.  Urine  began  to 
drip  away  out  of  the  wound  as  soon  as  the  pelvis  of  the  - 
Udney  was  opened,  but  the  pelvis  was  not  found  much 
dilated.  For  twelve  days  all  urine  was  passed  by  the 
wound  in  the  bin.  Then  an  ounce  and  a  half  was 
passed  with  great  pain  from  the  bladder,  and  the  quantity 


•204  PERISCOPE.  "SSJ^^iSjrS!" 


Brnew«  Msr.  2, 18B1. 


.gradually  increased.  After  the  nineteentli  day  all  urine 
was  passed  naturally.  The  wound  ran  an  aseptic  course,  and 
the  patient's  temperature  scarcely  rose  above  normal. 
Healing  was  complete  ten  weeks  after  the  operation.  During 
<the  last  five  years  she  has  been  employed  in  household 
'  duties  and  has  enjoyed  good  health.  The  patient  was  exhibited, 
together  with  her  right  kidney,  which  was  excised,  and  the 
stone  removed  from  the  left  ladney  for  total  suppression  of 
urine. — Lancet ,  January  17th,  1891. 

OPHTHALMOLOGY. 

On  some  PoniTS  in  the  Development  op  Catabact. — A 
paper  with  this  title  was  read,  and  a  discussion  followed,  at 
the  December  meeting  of  the  Ophthalmological  Society. 
The  points  raised  are  of  considerable  importance  with  regard 
to  the  possible  arrest  of  the  development  of  cataract  by 
medicine.  Mr.  W.  A.  Brailey,  the  author,  stated  that, 
excluding  the  congenital  and  zonular  cataract,  and  also  those 
secondary  to  local  or  general  diseases — such  as  glaucoma, 
iritis,  or  diabetes — seven  per  cent,  of  the  total  cases  seen  in 
private  practice  were  found  to  have  some  degree  of  opacity  of 
the  lens ;  but  in  only  one  on  the  average  out  of  these  seven, 
was  the  cataract  sufficiently  advanced  to  justify  operation. 
From  the  records  of  all  his  patients  with  immature  cataract 
that  had  been  re-examined  within  the  last  two  years,  it  was 
foimd  that  45  per  cent,  of  them  remained  absolutely 
unchanged  for  the  worse ;  the  interval  between  examination 
and  re-examination  varying  between  three  months  and  eight 
years.  Four  other  cases  were  slightly  better  as  regards 
vision,  thus  making  58  per  cent,  in  which  the  sight  had  not 
deteriorated.  Twenty- three  per  cent,  had  become  decidedly 
worse,  inclusive  of  four  cases  (13  per  cent.)  in  which  the 
cataract  was  sufficiently  advanced  to  justify  removal  under 
ordinary  circumstances.  The  slight  improvement  of  vision 
in  18  per  cent,  of  the  cases  was  attributed  to  the  hygienic 
measures  adopted  with  regard  to  the  use  of  the  eyes.  It  was 
observed  that  the  cataracts,  which  had  remained  stationary, 
were  mainly  of  the  cortical  variety ;  whereas  those  getting 
'  slowly  and  steadily  worse  were  chiefly  nuclear. 

The  President  (Mr.  Power)  said  .  .  the  rate  of  development 

•  of  cataract  varied  much  in  different  individuals,  and  probably 

depended  in  part  on  constitutional  causes,  but  in  some  cases 

:the  progress  appeared  to  be  delayed  by  hygienic  precautions, 

such  as  rest  for  the  eyes  and  attention  to  the  general  health. 

He  was  unaware  of  the  condition  ever  actually  disappearing 

:  spontaneously. 


£^r£??°S^  PERISCOPE.  205' 


Dr.  W.  J.  Collins  mentioned  the  case  of  a  woman  in  whom 
cataract  had  been  diagnosed  by  Sir  William  Bowman  25  years 
previously  and  a  sketch  made.  The  cataract  was  still 
immature. 

Mr.  McHardy  said  that  evidence  was  wanting  that  much 
use  of  the  eyes  hastened  the  maturation  of  cataract,  and  that 
he  advised  patients  to  make  free  use  of  what  vision  remained. — 
OpJuhalmic  lieview,  Jan.,  1891. 

Calenduia  as  a  Dbbssing. — Some  time  ago,  during  one  of 
the  discussions  at  the  British  Homoeopathic  Society,  Dr. 
Hughes  deplored  the  substitution  of  direct  antiseptics  in  the 
dressing  of  wounds  instead  of  the  use  of  such  old  vulneries  as 
calendula.  Objection  was,  however,  raised,  that  good  as 
calendula  undoubtedly  was,  that  it  was  impossible*  by  its  use 
to  ensure  that  strict  antisepsis  which  is  so  necessary  for  the 
rapid  healing  of  wounds.  This  difficulty  is  now  being  overcome 
in  the  surgical  wards  of  the  London  Homoeopathic  Hospital 
by  the  use  of  the  following  ointment : — Tr,  calendula^  5  i. ; 
oi.  eucalypt.,  5  i. ;  lanolini,  3  i.  This  makes  an  excellent 
dressing  for  granulating  surfaces,  ulcers,  and  such  similar 
wounds,  the  surface  rapidly  healing.  The  granulations  in 
some  cases  are  apt  to  become  too  exuberant,  when  a  dry 
dressing  of  boracis  lint  should  be  applied  for  a  few  days.  A 
nice  ointment  may  also  be  made  by  using  5  i.  of  boroglyceride 
60  per  cent,  instead  of  the  ewalyptus, 

0.  Knox  Shaw. 


LARYNGOLOGY,  Etc. 

Labtnoeai.  Affections  (Lupus  and  Tuberculosis)  Tbeated 
BY  Koch's  Method.— Dr.  Michael  (Hamburg)  gives  a  very 
eomplete  account  of  his  own  experiments  and  collected 
records  of  cases  treated  by  this  method.  The  whole  matter 
is  summed  up  in  the  first  part  of  his  paper  which  we  give  in 
his  own  words : — *•  The  great  discovery  of  Robert  Koch  is 
already  well  known  to  all  readers  of  this  journal  (Journal  of 
Lanjnffology)  from  the  numerous  pubhcations  wluch  have 
appeared  in  the  daily  and  medical  journals.  It  is,  there- 
fore, not  necessary  to  dwell  on  the  great  importance  of 
the  new  treatment  so  far  as  laryngology  is  concerned;. 
it  is  now  time  to  collect  as  completely  as  possible  the 
experiences  of  different  observers  upon  the  efficacy,  the 
dangers  and  the  limits  of  the  new  treatment.  Only  by 
experiments  can  be  answered  those  important  questions  which 
concern  laryngology,  and  are  the  most  interesting  for  the- 
moment.  These  are ;  (1)  Can  a  certam  diagnosis  be  made  by 
the  medicament  ?    (2)  Is  the  new  treatment  a  true  specific- 


206  PERISCOPE.  "S£^^fS;r?S]! 


for  laryngeal  phthisis  and  lupus  ?    (8)  Must  it  he  combined 
for  this  purpose  with  a  local  treatment  ?     (4)  Is  the  swelling 
produced  by  the  local  reaction  so  great  that  tracheotomy  often 
or  ever  is  called  for  ?    Having  had  occasion  to  observe  just 
lately  nearly  thirty  cases  treated  by  this  method,  I  would 
^answer  these  questions  in  the  following  manner :  (1)  Laryn- 
geal tuberculosis  and  lupus  laryngis  in  all  cases  are  influenced 
by  the  lymph  in  a  similar  manner,  which  remains  inefficacious 
an  other  diseases,  so  that  a  certain  diagnosis  can  be  made 
from  the  local  and  general  reaction.     (2)  It  may  be  said, 
though  with  the  greatest  reserve  and  scepticism,  that  the 
i;reatment  has  an  influence  on  the  local  state,  and  that  this 
influence  is  a  favourable  one.    It  is  not  yet  time  to  say  if  a 
complete  and  durable  cure  can  be  obtained.     (8)  The  limits 
•of  the  power  and  effect  of  the  method  are  not  yet  known ;  it 
is,  therefore,  not  yet  the  time  to  combine  with  it  any  local 
treatment.     (4)  In  spite  of  great  degrees  of  swelling  in  the 
majority  of  cases  (in  all  which  I  saw  myself)  no  stenosis  has 
:arisen  during  the  period  of  reaction,  nor  has  any  existing 
stenosis  been  increased.    I  have  formed  the  impression  that 
the  direction  of  the  swelling  of  the  tissue  is  a  vertical  one. 
In  some  cases  it  was  possible  to  see>  during  the  reaction  period 
more  of  the  larynx  than   before.     It  will  not,  therefore, 
usually  be  necessary  to  perform  tracheotomy,  but  it  will  be 
judicious  to  place  the  patients  under  medical  observation,  and 
to  have  all  prepared  for  operation  in   case  of  unfortunate 
exceptions." 

The  writer  then  quotes  other  observers — ^Dr.  Hertel's  notes 
of  eighteen  cases  in  the  clinic  of  Prof.  Gerhardt ;  Dr.  Lublinski ; 
Dr.  Grabower  (two  cases) ;  Profs.  Fraenkel  (seven  cases) ; 
Bergmann  (five  cases) ;  Schuitzler  (twenty-five  cases) ;  and 
'Others — in  all  of  which  reaction  was  observed,  in  two  tubercular 
growths  were  spontaneously  removed,  but  all  observers  agree 
that  it  is  too  soon  yet  to  record  any  complete  cure. 


Injection  op  Pilocarpine  in  Aural  Affections. — Dr.  Adam 
Politzer,  Vienna  (in  Lancet,  Jan.  8,  1891),  gives  results  of 
treatment  of  various  ear  troubles  with  pilocarpine,  which  he 
uses  in  a  two  per  cent,  solution  of  the  muricUed  pilocarpine^ 
2  drops  being  injected  subcutaneously,  or  6  to  8  drops  through 
the  Eustachian  catheter  into  the  cavum  tympani.  The  treat- 
ment is  chiefly  indicated  in  labyrinthine  lesions,  and  seldom, 
^f  ever,  in  middle  ear  troubles.  Hence  the  indications  for  its 
use  are  air  conduction  of  tuning  fork  sounds  better  on  the 
^diseased  side  than  bone  conduction ;  low  notes  better  perceived 
hy  air  conduction  than  high  ones ;  and,  lastly,  other  symptoms 


^S^lrfST"  PBBI8C0PE.  207 


Beriew,  Mar.  2, 1891. 


pointing  to  implication  of  the  labyrinth,  as  giddiness,  total 
inability  to  hear  the  watch  through  the  head  bones.  It  is 
ooBtra-indicated  when  in  extreme  deafness  the  bone  conduction 
is  better  than  that  through  air,  and  the  low  tones  are  hardly, 
if  at  all,  heard  through  air,  whilst  the  high  tones  are  very  well 
beard,  these  symptoms  pointing  to  middle  ear  trouble.  If  no 
benefit  results  after  15  injections  they  should  be  discontinued. 
Any  unpleasant  symptoms,  e.g.,  faintness,  too  free  diaphoresis, 
and  salivation  may  be  coxmteracted  by  a  1  in  400  solution  of 
atropine  sulpli.  The  only  condition  of  middle-ear  trouble  in 
which  it  can  be  used  with  benefit  is  that  in  which  there  is 
slight  swelling  of  the  mucous  membrane  and  shght  secretion 
of  mucus.  Here  the  Eustachian  injections  combined  with 
Politzerisation  may  be  of  use ;  but  it  must  never  be  used  in 
dry  or  sclerotic  catarrh. 

Foreign  Body  Completely  Occluding  Bight  Nasal  Passage 
FOR  Thirtekn  Years. — H.  B.  Davies  {Lancet,  Nov.  16,  1890) 
reports  a  case  of  the  above,  in  which  he  removed  the  obstruc- 
tion, which  consisted  of  "  mortary  **  dJbrie  and  gravel,  this 
having  obtained  entry  18  years  previously. 

Yeratrum  VmmE  for  Exophthalmic  Goitre. — {Jowmal  of 
Menial  Diseases,)  Patient  est.  85.  Very  prominent  exoph- 
ihaJmos,  aneemia,  and  much  debilitated,  thyroid  much  enlarged 
mdi  mind  deranged.  Yeratnim  viride  given  in  d-drop  doses 
night  and  morning,  to  be  gradually  increased  to  the  utmost 
limit  of  tolerance.  At  the  expiration  of  12  months  from  the 
beginning  of  treatment  (the  disease  having  lasted  12  years) 
the  symptoms  had  entirely  disappeared,  and  there  has  been 
no  relapse  since. 

Iodide  of  Sodium  in  Diphtheria  and  Membranous  Laryn- 
•oins. — Dr.  Jackson  {OniaJia  Clinic)  recommends  the  above 
very  strongly.   He  gives  it  in  5  to  10  gr.  doses  every  three  hours. 

Galvano-Puncture  of  Hypbrtrophied  Tonsils. — Dr.  Kellog 
{New  York  Medical  Times,  November,  1890),  prefers  galvano- 
puncture  to  amputation  by  means  of  the  guillotine.  He 
seldom  finds  it  necessary  to  apply  cocaine,  and  the  results  are 
much  more  satisfactory.  Its  only  drawback  is  that  the  whole 
treatment  cannot  be  carried  out  at  one  sitting,  but  requires 
the  attendance  of  the  patient  once  a  week  for  several  weeks. 

HuMMiKO  Noises  in  the  Ears  of  Nervous  Origin. — 
Jonathan  Hutchinson  {Archives,  October,  1889)  describes  a 
peculiar  form  of  noises  in  the  ears  met  with  even  in  young 
people.  It  is  unattended  by  any  dea&ess,  but  may  in  time 
lead  to  failure  in  hearing.  It  is  made  worse  by  drinking  tea 
and  cofifee,  and  relieved  by  drinking  wine,  and  hence  the 
symptom  is  worse  after  breakfast  and  relieved  after  dinner. 
If  tea  or  coffee  be  taken  after  the  wine  the  symptom  does  not 


208  PERISCOPE.  ^^JL^^S^rSt. 


Review,  Mar.  %  1»1. 


appear.     It  is  always  symmetrical  and  appears  to  be  closely 
filled  to  the  deafness  produced  by  quinine. — D.  Wright. 

DISEASES  OF  CHILDREN. 

Alcoholic    Heredity    in    Diseases    of     Childrbn. — In  a 
paper  read  before  the  North  American  Medical  Association, 
Dr.  T.  D.  Crother  brought  forward  a  number  of  cases  in 
which  diseases  in  children  were  modified  by  the  existence  of 
an  hereditary  alcoholic  tendency.      Many   of   the  children 
showed  a  marked  liking  for  alcohoHc  drinks  and  medicines ; 
the  administration  of  medicines  in  the  form  of  tinctures  at 
once  developing  a  strong  craving.    In  addition  to  whatever 
other  disease  they  suifered  from  there  was  always  neuras- 
thenia and  defective  control  of   the  brain   centres    which 
manifested  themselves  in  various  different  ways.     In  some- 
there  was  an  abnormal  hypersBsthesia  of    the  senses,  the 
children  being  much  disturbed  by  noises,  and  by  change  of  light 
and  surroundings ;  in  some  various  skin  disorders  and  nutrient 
troubles  were  prominent;    in  others  there  was  precocious 
development  of  brain  and  nerve  force,  the  brain  being  extra- 
ordinarily receptive,  but  at  the  same  time  instable  ;  there  was 
a  tendency  to  sudden  liberation  of  nerve  energies,  whether  in 
violent  passion,  or  in  work,  play  or  study,  to  be  followed  by 
extreme  prostration.     The  general  principles  which  should 
govern  the  treatment  are  :  1.  The  avoidance  of  any  form  of 
alcohol  and  of  narcotics  of  all  kind.     2.  The  pathological 
tendency  is  to  become  alcohol  takers  and  meat  eaters,  hence 
the  diet  should  always  be  non- stimulating  and  farinaceous,, 
and  the  meals  should  be  regular ;  the  use  of  tea  and  coffee 
should  also  be  prohibited  or  restricted.     8.  Careful  attention 
to  hygienic  surroundings.     4.  Every  kind  of  extreme  should 
be  guarded  eigainst,  and  especially  should  there  be  no  undue 
forcing  of  the  mental  faculties. — Medical  EeprinU,  Dec.  15th, 
1890. 

Perityphlitis  in    Children. — Dr.  J.   Lewis   Smith,  in  a 
paper  on  collected  cases  of  perityphlitis  in  children,  asserto 
that  in  49  fatal  cases  perforation  took  place  in  87,  and  con- 
cludes that  in  most  cases  of  perityphlitis  perforation  of  the- 
appendix  is  the  proximate  cause.     The  foreign  bodies  in  the 
appendix,  whether  impacted  fsecal  matter  or  other  hard  bodies, 
by  their  pressure  cause  necrosis  of  the  epithelium,  the  intes- 
tinal microbes  invade  the  exposed  subepithelial  tissue,  septic 
inflammation  is  set  up  which  extends  through  the  coats  of  the 
appendix  and  invades  the  peritoneum,  and  perforation  takes- 
place  through  the  softened  wall.    An  abscess  then  forms  out- 
side which  is  usually  localised,  but  in  some  cases  the  perfora- 
tion sets  up  diffuse  peritonitis,  and  if  left  to  themselves  the 


f^^ST^^  NOTABILIA.  209 


Berinr,  lEor.  2, 1891. 


localised  abscesses  most  usuallj  burst  into  the  peritoneum 
with  the  same  result  which  is  usually  fatal.  Favourable  results 
usually  occurred  if  the  pus  evacuated  through  the  abdominal 
wall  or  into  the  rectum  or  csecum.  The  greatest  fatality  occurred 
in  children  under  six  years  of  age,  eleven  out  of  twelve  of  whom 
died.  Treatment  is  directed  first  to  the  prevention  of  suppura- 
tion ;  for  this  end  the  bowels  are  kept  at  rest,  an  icebag  applied 
oyer  the  caecum  and  an  aqueous  extract  of  opium  given  every 
two  hours ;  the  use  of  laxatives  is  avoided.  If  in  spite  of  thia 
treatment  an  abscess  forms  laparotomy  is  performed,  the 
abscess  cavity  thoroughly  washed  out,  and,  if  possible,  th& 
diseased  appendix  is  removed.  The  use  of  the  exploratory 
needle  for  the  purpose  of  diagnosis  is  strongly  condemned  as 
being  likely  to  carry  infection  from  the  abscess  to  healthy 
peritoneum  traversed  by  the  needle  on  its  withdrawal. — Netir 
York  Medical  Becord,  Dec.  9th,  1890. 


NOTABILIA. 


INTERNATIONAL  HOMCEOPATHIC   CONGRESS. 
We  are  requested  to  insert  the  following  circular  : — 

**  The  organization  and  executive  management  of  the  Fourth 
Quinquennial  International  Homoeopathic  Congress  has  been 
placed  in  charge  of  a  committee,  consisting  of  the  executive 
committee,  and  eight  other  members,  of  the  American 
Institute  of  Homoeopathy." 

"  The  time  appointed  for  the  Congress  to  meet  is  June,. 
1691;  and  the  place  selected  is  Atlantic  City,  N.  J." 

"  In  carrying  out  the  duties  placed  upon  them,  the  committee 
desire  to  make  such  arrangements  as  will  be  most  acceptable 
to  those  who  will  participate  in  this  Congress,  and  will  best 
serve  the  interests  of  homoeopathy,  and  contribute  to  the 
progress  of  medical  science  throughout  the  world.  They  hope 
that  every  physician  will  give  to  it  his  most  active  efforts  and 
strongest  influence  ;  and  that  our  ablest  men  will  contribute 
their  best  thoughts,  either  in  written  essays  or  in  personal 
discussion  on  the  topics  selected.  The  time  of  this  session 
will  be  necessarily  so  limited  that  many  important  subjects 
cannot  be  properly  considered ;  yet  the  committee  desire  to 
select  those  which  will  prove  to  be  of  greatest  service  to 
the  profession,  and  to  have  them  presented  by  those  most 
competent  to  the  task ;  to  this  end  they  ask  suggestions  fromi 
those  interested." 

'<  The  usual  five  days  session  of  the  American  Institute  of 
Homoeopathy  will  give  place  to  this  Congress.  The  Institute 
will  assemble,  however,  on  the  day  preceding  the  Congress  for 
the  transaction  of  necessary  business.  The  plan  now  pro- 
posed is  that  the  Institute  shall  hold  its  session  on  Tuesday^ 

VoL  35,  No.  3.  Q 


210  NOTABILIA.  ^S'^'^iSJ'STS? 


Beview.  Mar.  2, 1801. 


June  16th,  1891 ;  the  Congress  will  assemble  Wednesday, 
June  17th,  and  continue  one  week,  namely,  Wednesday, 
Thursday,  Friday,  Saturday  morning  (with  rest  Saturday 
Afternoon  and  Sunday),  Monday  and  Tuesday ;  closing  on 
Tuesday,  June  28rd." 

ORGANISATION. 

''  The  Congress  wiU  accept  as  members  all  homceopathic 
physicians,  in  good  standing  in  recognised  Homoeopathic 
Medical  Societies;  and  from  places  where  such  societies  do 
not  exist,  physicians  with  suitable  credentials.  Delegates 
will  be  received  from  any  and  all  homoeopathic  institutions, 
and  will  be  expected  to  prepare  reports  of  them.  Visitors 
will  be  admitted,  whether  physicians  or  laymen,  who  may  be 
interested  in  the  subject  of  homoeopathy." 

**  The  officers  of  the  Congress  will  include  representatives 
from  all  the  important  Homoeopathic  Medical  Societies ;  and 
the  committee  request  that  the  names  of  the  president  and 
recording  secretary  of  such  societies  be  forwarded  to  them 
before  May  1st,  1891." 

SUBJECTS    FOR    CONSIDERATION. 

"  The  Congress  will  secure  statistics  of  the  present  status 
•of  homoeopathy  and  its  progress  in  the  last  five  years,  as  far 
as  possible  from  all  parts  of  the  world.  This  will  include  the 
number  of  its  practitioners,  its  institutions,  national  societies, 
^tate  societies,  local  societies  and  clubs,  general  hospitals, 
special  hospitals,  infirmaries  and  dispensaries,  colleges  and 
medical  schools,  training  schools  for  nurses,  and  medical 
journals.  Their  scope,  organisation,  government,  how  to  be 
conducted,  methods  of  support,  form  of  reports,  and  various 
matters  of  importance  to  each  kind  of  institution,  will  be 
carefully  considered.  Essays  and  discussions  will  be  prepared 
on  the  materia  medica,  homoeopathic  therapeutics  in  surgery, 
and  in  special  forms  of  disease,  such  as  insanity,  disease  of 
the  nervous  system,  of  women,  of  children,  of  the  chest, 
throat,  eye  and  ear,  alimentary  tract,  kidneys,  &c." 

**  In  arranging  these  many  subjects  to  the  best  advantage, 
the  committee  ask  your  suggestions  and  assistance.  All  com- 
munications may  be  sent  to  the  chairman,  T.  Y.  Kinne,  M.D-i 
Paterson,  N.J.,  or  to  the  secretary,  Pemberton  Dudley,  M.Dm 
Cor.  Fifteenth  and  Master  Streets,  Philadelphia." 

**  By  order  of  the  joint  committee  the  chairman  and  secretary 
are  under  instructions  to  make  up  and  submit  to  the  otber 
members  of  the  committee  a  list  of  subjects,  and  of  writers 
and  debaters,  to  be  appointed,  at  as  early  a  day  as  possible 
this  duty  will  be  performed,  and  in  due  time,  thereafter, 
another  circular  will  be  issued,  embracing  a  programme  for 
*he  Congress." 


POST-GBADUATE   LECTURES. 

PuBiNG  the  past  month  lectures  (as  announced)  have  been 
dehvered  by  Drs.  Burford  and  J.  Galley  Blackley.  These 
have  been  of  an  extremely  practical  nature,  and  we  hope  to 
publish  remtnls  of  some  of  them  at  a  later  date.  The 
present  series  will  be  concluded  by  the  following  lectures  by 
Mr.  Knox  Shaw  : — 

March  6th. — **  The  Diagnosis  of  errors  of  Refraction  and 
Anomalous  Action  of  the  Ocular  Muscles." 

March  13th. — **  Adenoid  Vegetations  of  the  Naso-Pharynx." 

DEVON  AND  CORNWALL  HOM(EOPATHIC  COTTAGE 
HOSPITAL  AND  DISPENSARY. 

The  annual  meeting  of  the  supporters  of  this  Charity  was 
held  on  the  5th  ult.,  the  Mayor  presiding.  The  medical  staff 
was  represented  by  Drs.  Cash  Reed  and  Alexander.  The 
report  stated  that  the  finances  were  in  a  more  satisfactory 
condition  than  last  year,  and  that  the  committee  were  looking 
for  more  suitable  premises,  the  in-patient  accommodation 
being  too  small.  Total  attendances  at  dispensary  8,479 ; 
visits  paid  8,939.  The  attendances  were  rather  smaller  than 
the  previous  year,  owing  to  the  absence  of  any  epidemic 
such  as  occurred  last  year.  The  medical  officer's  report 
stated  that  ''  compulsory  notification  had  done  much  to 
stamp  out  zymotic  disorders.** 

SUSSEX  HOMCEOPATHIC  DISPENSARY. 

The  annual  meeting  of  this  dispensary  was  held  in  the  Town 
Hall  at  Brighton  on  the  8rd  ult.  The  report  acknowledged 
a  generous  gift  from  the  Earl  of  Dysart  with  a  promise  of 
forther  help.  The  balance  sheet  showed  a  small  balance  in 
hand,  both  in  the  general  fund  and  in  the  building  fund. 
Inconvenience  had  been  caused  by  the  temporary  premises 
rendered  necessary  by  the  alterations,  but  the  committee  hoped 
in  the  course  of  a  few  weeks  to  return  to  their  own  building. 
The  record  of  work  done  compared  favourably  with  previous 
years.    Dr.  Hughes,  Dr.  Belcher  and  others  were  present. 

DR.  DRYSDALE  AND  DR.  KOCH. 

Bepebrino  to  the  introduction  and  use  of  sepsiji  or  ptfrofjen  by 
Dr.  Drysdale,  the  Lirerpool  Daily  Courier  (28th  Jan.)  says : — 
'*  Our  townsman,  Dr.  Drysdale,  makes  no  claim  to  have 
anticipated  Dr.  Koch's  method  for  the  treatment  of  consump- 
tion. But  Dr.  Drysdale  was  the  first  to  make  use  of  the 
poison  of  bacteria  as  a  therapeutic  agent.  This  was  made 
faiown  Ir  a  pamphlet  published  in  London  by  Bailliere,  Tin- 


1 


010  xfrkTAT>TrTA  Monthly  HomoBopatMc 

-fll^  NOT AB ILIA.  Hpvinr.  Mar.  2. 1»U 


Kevicw,  Mar.  2, 1»U 


dall,  and  Cox  in  1880,  entitled  Pyrogen,  The  rationale  of  the 
plan  is  briefly  as  follows: — It  is  well  known  that  what  is- 
called  blood  poisoning  is  produced  by  the  growth  of  bacteim 
in  the  tissues  and  the  blood.  The  researches  of  numerous- 
bacteriologists,  among  whom  Koch  has  a  distinguished  placer 
have  established  the  fact  that  the  multiplication  of  the  bac- 
teria and  the  poisonous  effects  they  produce  on  the  system 
have  a  double  and  separable  origin,  viz.,  that  the  multiplica- 
tion of  the  bacteria  takes  place  by  the  ordinary  laws  of 
animalcular  growth,  while  the  poisoning  is  produced  by  a 
secretion  from  those  same  bacteria.  Now,  if  it  is  possible  to* 
use  this  poisonous  secretion  as  a  medicinal  agent,  it  is  plain 
it  must  be  separated  from  the  self -multiplying  microbe  from 
which  it  has  its  origin  ;  otherwise  there  would  be  no  means  of 
regulating  the  dose  which  would  be  thus  always  unlimited,, 
and  would  tend  simply  to  hasten  death  rather  than  have  any 
curative  effect.  The  most  obvious  means  is  therefore  to  kill 
the  bacteria  by  the  agency  of  alcohol  or  heat,  or  in  other  ways* 
We  thus  get  rid  of  the  self-reproductive  element,  and  can 
study  the  poison  and  regulate  the  dose  of  it  like  any  other 
common  chemical  agent.  The  bacterial  poison  here  spoken  of 
is  called  sepsiVy  and,  when  injected  into  the  veins  of  dogs,  i* 
found  to  produce  violent  fever,  from  which  the  animal  recovers 
perfectly  in  a  day  or  two  if  the  quantity  of  poison  used  was  not 
too  great.  On  the  homoeopathic  law  of  similars  this  sepsin 
ought  to  be  a  remedy  for  the  fever  that  attends  blood  poison- 
ing and  allied  morbid  states.  On  these  principles  sepsm  was< 
prepared  by  Dr.  Drysdale  and  Mr.  Paterson,  of  the  Borax. 
Works,  and  has  been  frequently  used  as  a  reqiedy  since.  The- 
mode  of  preparation  may  be  briefly  described  as  destroying  the^ 
bacteria  by  heat  or  alcohol,  and  then  dissolving  the  sepsin  in 
distilled  water,  and  adding  66  per  cent,  of  glycerine.  This* 
forms  an  amber-coloured  fluid  similar  to  that  described  by 
Koch.  The  above  is,  no  doubt,  a  similar  process  to  that  used 
by  Koch,  but  of  far  less  importance,  as  he  has  discovered  the 
mode  of  applying  it  in  the  case  of  the  specific  bacillus  which 
is  the  exciting  cause  of  tubercular  consumption  and  scrofola,. 
whereas  Dr.  Drysdale's  process  applies  to  the  much  more 
restricted  sphere  of  the  fever  of  blood  poisoning  and  typhoid." 

NAME   OF  KOCH'S  FLUID. 

••  The  new  supply  of  Koch's  lymph  is  sent  out  in  bottles> 
labelled  *  Tuberculin,  Dr.  Libbertz,'  so  that,  after  having  had 
all  sorts  of  names,  such  as  '  Kochin,'  '  Koch's  fluid,'  etc.^ 
bestowed  on  it  by  amateur  godfathers,  the  lymph  may  now  be 
considered  officially  christened ;  not  that  the  name  itself  is* 


new— in  No.  1,571  of  the  IlritiKh  Malkal  Jtnivnat,  on  page 
299,  a  honueopathic  '  remedy '  ia  spoken  of — a  dilution  of 
pttthiaical  Bputnm,  which  is  called  '  tubercalinnm.' " — Brituh 
iUdital  Journal,  Feb.  14tL. 

HeiT  Lntze  has  devised  a  method  of  diepensing  single  doses 
Dl  lubrrcuiin,  properly  diluted  for  use,  in  sealed  phials. 

PACKARDS  ETHER  INHALER. 
This  inhaler  was  invented  soma  sis  years  ago  by  Dr.  Horace 
Packard,  of  Boston,  U.S.A.    It  has  been  in  use  in  several 
large  hospitals,  and  by  practitioners  in  private  practice  since 
ihst  date,  with  most  satis&ctory  results. 


It  consists  of  a  metal  cup,  shaped  somewhat  like  an  hour- 
glass, or  two  cones  placed  eml  to  end.  In  addition  there  is  a 
«loth  bag  about  6  by  10  inches,  into  which  is  slipped  a  piece 
-of  perforated  card-board  to  give  siiffneHS  and  at  the  same  time 


214  NOTABILIA.  "S^!j.?SS??^Si* 


Review,  Mar.  2,  IfflU 


to  allow  air  to  pass  through.  This  bag  is  then  folded  round 
the  lower  half  of  the  ether  cup  and  secured  by  safety-pins 
forming  a  conical  cap,  which  fits  accurately  over  the  nose  and 
mouth.  The  ether  is  poured  into  the  cup,  the  lid  is  closed  to 
prevent  external  evaporation,  the  ether  runs  down  into  the 
lower  part  and  escapes  by  fine  slits  in  the  edge  drop  by  drop 
on  to  the  inner  folds  of  the  bag.  When  a  patient  is  to  be 
etherised,  the  anaBsthetic  should  be  used  very  sparingly  atjirst 
in  drop  doses,  in  order  that  the  lungs  and  trachea  may  become 
accustomed  to  their  new  conditions,  thus  avoiding  choking, 
coughing  and  gagging.  If  this  precaution  be  taken,  the  cone 
need  not  be  removed  until  ansBsthesia  is  complete;  in  the 
convulsive  stage,  the  symptoms  of  distress,  alarming  to  a 
novice,  pass  away  within  a  few  seconds  if  the  ether  be  pushed, 
but  linger  if  the  cone  be  removed  under  a  mistaken  desire  to 
give  the  patient  air.  During  the  operation,  the  cone  may  be 
held  two  or  three  inches  from  the  face. 

The  advantages  of  the  Packard  inhaler  are  its  simplicity, 
cleanliness  and  cheapness,  together  with  ease  in  administra- 
tion of  the  anaesthetic.  The  patient  is  not  forced  to  breathe 
the  same  air  over  and  over  again. 

THE   DRINK  BILL  FOB  1890. 

We  quote  from  the  iMncet  the  following  paragraph,  the 
importance  of  which  will  be  so  obvious  to  every  reader,  and 
especially  to  every  medical  man,  that  it  needs  no  comment. 

**  It  is  appalling  to  find  that  the  Drmk  Bill  of  1890 
amounts  to  £189,495,470,  an  increase  of  £7,282,194  over  the 
sum  of  the  previous  year — all  common-sense  and  medical 
science  notwithstanding.  It  is  said  to  be  equal  to  one-twelfth 
of  the  estimated  income  of  all  persons,  to  one-fifth  of  the 
National  Debt,  and  to  be  eight  times  more  than  the  income  of 
all  the  Christian  churches.  It  is  not  our  business  to  moralise 
on  this  expenditure.  To  us  it  means  so  much  cirrhosis, 
Bright's  disease,  gout,  rheumatism,  insanity,  &c.,  disabling 
employment,  taking  the  pleasure  out  of  the  life  of  families- 
and  bread  out  of  the  mouths  of  children.  The  Drink  Bill  for 
last  year  is  larger  than  for  any  year  but  that  of  1878,  when  it 
was  more  than  142  millions  of  pounds." 


"  BOARD  "  SCHOLARS  AND  ANATOMY. 

**  Doctors  are  sometimes  astonished  to  find  what  Board 
Schools  are  doing  for  the  rising  generation.  Not  long  ago  a 
dirty  little  urchin  was  brought  into  one  of  the  hospitals 
crying,  *  I  have  fractured  my  radius  ! '  An  examination 
proved  that  he  was  right." — Charity,  Jan.  15th. 


^tS^S^TS^^'  OBITUAKY.  215 


,  Mat.  S.  1891. 


OBITUARY. 

DR.  J.  L.  MARSDEN. 

We  regret  to  have  to  announce  the  death  at  Clive  Yale^ 
Hastings,  on  February  6th,  of  Dr.  Marsden,  M.D.,  M.R.C.S., 
in  his  76th  year. 

Jambs  Loftus  Mabsden  studied  in  Edinburgh  under  Liston,. 
graduating  M.D.  and  L.R.G.S.  Edin.  in  1887.  He  then  went 
to  Exeter.  While  practising  there  a  medical  friend  who  was 
visiting  him  cured  him  in  twenty-four  hours,  with  globules,, 
of  a  form  of  catarrh  that  usually  lasted  a  fortnight.  He  then 
took  this  firiend  to  see  several  patients,  and  the  results  led 
Br.  Marsden  to  try  homoeopathic  medicines  on  his  own 
account.  This  was  at  first  done  quietly,  in  connection  with 
his  large  dispensary  practice.  In  1850  he  went  to  Vienna 
and  Paris,  partly  on  account  of  health  and  partly  to  study  the 
homoeopathic  treatment  at  the  fountain  head.  After  this  he 
settled  in  Malvern,  acquiring  a  large  and  lucrative  practice^ 
and  remained  there  20  years.  From  Malvern  he  removed  to 
Grosvenor  Street,  where  he  practised  for  some  nine  years. 
He  was  then  seized  with  paralysis,  and  as  mitral  disease 
existed  he  became  incapacitated.  Two  other  paralytic  attacks 
followed  at  long  intervals,  and  severe  attacks  of  bronchitis  were 
added.  The  loss  of  his  only  son,  by  drowning,  and  heavy 
money  losses,  proved  a  great  shock  to  him ;  although  he  never 
murmured,  the  brightness  of  his  hfe  was  gone.  He  was 
twice  married,  and  leaves  a  widow  and  a  daughter.  In 
1856  he  published  an  interesting  book,  Notes  on  Homoeopathj/^ 
now  unfortunately  out  of  print. 

CORRESPONDENCE, 

To  the  Editore  oftJie  "  Monthly  Homoeopathic  Review.'' 

INTERNATIONAL    HOMCEOPATHIC    CONVENTION. 

Gentlemen, — Allow  me  to  direct  the  attention  of  your 
readers  to  the  approaching  fourth  quinquennial  International 
Homoeopathic  Convention,  the  circular  of  which  appears  in 
your  present  issue.  I  continue  to  receive  from  over  the  water 
favourable  accounts  of  the  preparations  that  are  being  made, 
and  the  committee  of  management  have  every  reason  to  expect 
a  large  and  profitable  gathering.  I  hope  that  some  of  our 
colleagues  here  are  thinking  of  being  present ;  and  that  others 
will  have  contributions  to  make  to  the  material  for  discussion. 
I  shall  be  pleased  to  act  as  intermediary  in  announcing 
sach  intentions  or  forwarding  such  communications. 

Yours  very  faithfully, 

Richard  Huohes, 
Brighton,  Feb.  20,  1891.  Permanent  Secretary. 


216  CORRESPONDENTS.       ""^^^ffi^tSl! 

NOTICES  TO   CORRESPONDENTS. 

*•*  ^^^  cannot  undertake  to  return  rejected  manuscripts, 

AUTHOBS  and  Contributors  receiving  proofs  are  requested  to  correct 
and  retnrn  the  same  as  early  as  possible  to  Dr.  Edwin  A  Neatby. 

We  are  requested  to  state  that  Mr.  Reid,  formerly  of  Kent  Boad, 
Southsea,  has  retired  from  practice,  and  is  now  living  at  Bowmanville, 
Ontario.  Dr.  S.  P.  Alexander,  his  partner,  has  succeeded  him  in 
practice. 

Mr.  Knox -Shaw  has  removed  from  St.  Leonards-on-Sea  to  19, 
Upper  Wimpole  Street,  London. 

We  are  asked  to  state  that  Mr.  W.  Ackland  (from  Messrs.  E.  GouiJ) 
and  Son)  has  purchased  the  old-established  business  of  Mr.  T.  Casely. 
46,  Camden  Road,  N.W. 

Communications,  &c.,  have  been  received  from  Dr.  Bereidge,  Dr. 
BuRPORD,  Dr.  Dudgeon,  Mr.  Knox-Shaw,  Mr.  Dudley  Wright 
(London);  Dr.  Hu«HE8  (Brighton);  Dr.  Butcher  (Windsor);  Dr. 
S.  P.  Alexander  (Southssa) ;  Dr.  C.  W.  Hayward  (Liverpool). 


BOOKS    RECEIVED. 


A  Practwal  Manual  of  Gyntrcolofiy.    By  G.  R.  Southwick,  M.D.. 
AssiBtant  Professor  of  Obstetrics  in  the  Boston  University  School  of 
Medicine,  L.  M.  Rot.  Hospital,  Dublin.    Boston  :  Otis  Clapp.     1891. — 
JBopnnimjhausni'g  TJierapcutio  Pocket  Book  for  JToviwopathh  Phy«i- 
cianit.    By  Dr.  Timothy  Field  Allen.    Philadelphia  :  The  Hahnemann 
Publishing  House.    18J>1. — .4  Cijriopfpdiaof  Dru4f  Pathogctiesif.   Edited 
by  Richard  Hughes,  M.D.,  J.  P.  Dake,  M.D.    Part  xiv.    Snipkvr — 
Valeriana.    London  :  E.  Gould  ^^  Son.    New  York  :  Boericke  &  Tafel. 
1891. — Thr    irotno't'puthic    World.     Feb.     London. — Tlie   Chemist   and 
Dru/jgixt.     Feb.     London. —  Thr  Monthly  Magazine  of  Pharmtwy,    Feb. 
London. —  The  Snnduy  Smtinrl.  Feb.  1.  Indianapolis. — ^' The  CIiildrrR*4t 
Home." — Mcthodixr  itcrorder  SupplcmfitT.   Jan.  15. — BcUrfu  Concerning 
Materia  Mrdira.     By  Charles  Mohr,  M.D.     Philadelphia. —  ^l  Xotc  on 
the  ProhahJp   Discovery  of  Snake-Bitc  and    Cholera' Cure.      By   the 
Municipal  Commissioner  of  Baroda. — The  Xew  York  Medical  Timt-s. 
Feb. — The  Xorth  Amrriean  Journal  of  Ilomeeopathy.    Feb.    New  York. 
— The   American  How oeopat hist.     Feb.    New  York. — The  Xew    York 
Medical  lircord.     Jan.  and  Feb. — The    Chironian,      Jan.  6th,   20th, 
Feb.   2nd.     New  York. — Tite  Ilovurnpathic  Physician.    Feb.    Phila- 
delphia.— The  Uomacopathic  Recorder.   Feb.   Philadelphia. — Tlic  Medi- 
cal Era.     Jan.  and  Feb.     Chicasro. — The  Medical  Advance.      Dec.  and 
Jan.    Chicago. — The  Southern  Journal  of  Homoeopathy.    Deo.  and  Jan. 
New  Orleans. — The  Ctilifomian  Homceopath.    Jan.    San  Francisco. — 
Schedule  of  Misstmri  Inxtitut*'-  of  Uomceopathy.     1891. — The  Medical 
and  Surgical  liecord.    Jan.    Omaha. — Gazetta  Medica  di  Torino.  Jan. 
25th,  Feb.  5th,  lSih.—TJie  Homa:opathic  Envoy.  Vol.  i.,  March,  1890-91. 
Lancaster  and  Philadelphia.     E.  P.  Anstruty.    1891. — The  Xew  B^me- 
dies.    Jan.     Gross  iN:  Dellndge.    Chicago. — Bitue  Horn.  Beige.    Feb. 
Brussels. — Bull.    General  de    Therapeutique.      Feb.      Paris. — Allgem. 
Horn.    Zeitung.    Feb.     Leipzi<r. — Leipziger    PopuUire    Zeitschrift  f&r 
Honwopathie.     Feb. —  Uomtvopathisch  Maandhlad.    Feb. 

PapcTH,  Dispensary  IteportA,  and  Books  for  Review  to  be  sent  to  Dr.  Fopb,  19, 
"Watergate,  Chrantham,  Lincolnshire ;  Dr.  D.  Dvck  Browx,  39,  Seymonr  Street,  I^Qlrt- 
man  Square,  TV.;  or  to  Dr.  Enwix  A.  Neatby,  161,  Haveratock  TTill,  N.W.  Advertiae- 
xncnts  and  Businewi  commtinicatitina  to  be  lent  to  Meaars.  £.  OoDU>  &  Sok,  SO, 
Hoorgate  Street,  K.C. 


tSS^^ST^   0^  FLESH  AND  MILK  SUPPLY.    217 


THE    MONTHLY 


HOMCEOPATHIC    REVIEW 


■:o:- 


OUR  PUBLIC  FLESH  AND  MILK   SUPPLY  IN 
RELATION  TO  HYGIENE.* 

By  J.  S-  HuRNDALL,  M.R.C.V.S. 

Thb  inTitation  to  read  a  paper  before  jour  Society  was 
aeeepted  by  me  rather  as  a  compliment  to  that  branch 
of  medicine  of  which  I  am  a  member  of  the  mere  rank 
and  file  than  to  myself  as  an  indiyidual,  and  at  the  same 
time  a  coorteoos  advance  on  your  part,  as  I  believe,  to 
institute  a  closer  union  between  the  two  branches  of  the 
profession;  and  I  use  the  term  ''the  profession" 
advisedly,  meaning  to  convey  the  idea,  that  practically 
I  look  upon  the  work  of  the  medical  practitioner  and  the 
veterinarian  as  one;  certainly  the  pathology  of  the 
human  subject  and  the  lower  animals  is  to  all  intents 
and  purposes  one,  notwithstanding  the  fact  that  we  find 
forms  of  disease  peculiar  to  one  class  of  animal  from 
which  all  other  classes  have  so  far  seemed  to  be  exempt ; 
again,  there  is  a  remarkable  one-ness  in  our  therapeu- 
tics ;  the  remedies,  which  after  obtaining  a  full  list  of  the 
totality  of  the  symptoms  you  rely  upon,  I  find  equally 
applicable  under  like  circumstances;  furthermore,  coming 
nearer  home  to  the  subject  of  this  paper,  are  not  the 

*Bead  before  the  British  Homoeopathic  Society »  March  5th,  1891 . 
VoL  So,  No.  4.  B 


218  OUR  FLESH  AND  MILK  SUPPLY.    ^^^.A^S^fm! 

sanitary  laws  which  you  observe  and  desire  to  see  carried 
out  for  the  better  health  of  your  patients  as  applicable 
to  the  lower  animals  ?  In  claiming  for  my  own  pro- 
fession so  close  and  intimate  an  alliance  with  your  own, 
I  hope  I  shall  not  be  esteemed  too  familiar ;  for  my 
object  in  appearing  in  your  midst  to-night  is  not  to 
breed  contempt,  but,  if  possible,  to  cement  a  closer  bond 
of  friendship  between  your  confreres  and  my  own, 
between  you,  gentlemen,  and  myself. 

I  have  selected  the  subject  of  Health  because  there 
we  meet  on  common  ground;  it  is,  I  am  well  aware, 
your  practice  at  these  meetings  to  discuss  subjects  of 
vast  importance  affecting  the  action  of  drugs  on  the 
principles  laid  down  by  the  revered  Hahnemann ;  and 
those  of  you  who  know  me  best  are  well  aware  that  there 
is  no  more  loyal  follower  of  that  great  man  than  myself; 
moreover  I  revel  in  the  study  of  therapeutics ;  the  study 
of  micro-organisms,  fascinating  though  it  no  doubt  is, 
does  not,  to  me,  compare  in  interest  with  therapeutics ; 
but,  had  I  offered  for  your  consideration  some  of  my  own 
poor  thoughts,  based  it  may  even  be  on  experience, 
respecting  the  pathogenetic  and  therapeutic  actions  of 
one  or  more  drugs  on  one  or  more  different  animals,  it  is 
just  possible  I  might  have  succeeded  in  interesting  you  ; 
it  would  not,  however,  have  been  even  a  step  in  the 
direction  I  have  indicated  as  being  one  of  the  reasons  of 
your  flattering  invitation  to  me  to  appear  in  your  midst 
this  evening ;  it  would  have  been  a  subject  of  no  interest 
whatever  outside  this  room,  or,  at  all  events,  outside  the 
number  of  the  profession  who  follow  the  principles  of 
Hahnemann. 

In  point  of  fact,  I  am,  by  your  permission,  proposing 
to  reverse  the  order  of  things  ;  instead  of  discussing  how 
to  cure  some  form  of  disease,  I  propose  to  ask  you  to 
consider  how  best  to  prevent  disease,  so  far  as  that  is 
possible  by  protecting  people  from  the  risks  they  now 
daily  incur  by  taking  into  their  systems  in  the  form  of 
nutriment  deleterious  substances  only  too  well  calculated 
to  undermine  health  and  sow  the  seeds  of  various  patho- 
logical conditions,  some  of  which  are  curable  and  some, 
so  far  as  is  known  at  present,  which  can,  alas,  only  be 
described  as  incurable. 

No  doubt  it  is  against  the  interest  of  the  practitioner 
to  encourage  the  observance  of  sanitary  laws,  and  to 


B^^flVWM^'*  ^^»  FLESH  AND  MILK  SUPPLY.    219 


adopt  prophylactic  measures,  that  is,  so  far  as  the 
annual  income  is  concerned.  I  have  often  heard  this 
assertion  combatted ;  and  glib  and  plausible  arguments 
have  been  advanced  affirming  that  the  public  gladly  pays 
for  advice  that  the  scientific  man  can  offer  on  hygiene. 
Does  it  ?  Possibly  in  a  few  isolated  cases  !  Some  great 
man,  with  his  pockets  already  well  lined,  and  a  mighty 
good  balance  at  his  bankers,  will  perhaps  receive  a 
handsome  fee  for  advice  on  some  important  sanitary 
problem  affecting  either  a  whole  parish  or  the  palatial 
residence  of  a  member  of  the  peerage ;  but  how  about  the 
straggling  practitioner  ?  Will  it  pay  him  best  to  urge 
the  adoption  of  measures  to  prevent  diphtheria  and 
scarlatina  or  to  have  plenty  of  cases,  attend  them 
assiduously  and  make  some  splendid  cures ;  a  few  losses 
by  death  only  serve  to  intensify  the  value  of  the  cures, 
and  to  prove  what  a  clever  man  he  is ! 

Again,  as  to  the  veterinary  surgeon.  Which  pays 
best,  to  advise  measures  to  hinder  the  spread  of  an 
epidemic  like  influenza,  or  to  allow  it  to  take  its  course 
and  have  plenty  of  cases  to  attend,  to  be  followed  by 
good  bold  accounts  at  quarter-day  ? 

1  submit  to  you,  gentlemen,  it  does  not  take  long  to 
answer  these  queries ! 

Happily,  however,  for  the  public  weal,  there  are  those 
in  our  professions  who,  conscientiously  desirous  of 
serving  faithfully  their  day  and  generation,  put  on  one 
^de  all  personal  interests,  cheerfully  and  gladly  advoca- 
ting measures  that  tend  to  save  this  already  too 
suffering  world  from  unnecessary  pain,  and  this  often 
Against  strong  opposition  on  the  part  of  that  portion  of 
the  public  entrusted  with  its  purse  strings.  Such  being 
the  case,  I  anticipate  that  the  subject  I  have  ventured  to 
sabmit  to  you  this  evening  is  one  that  will  commend 
itself  to  your  judgment  and  approval ;  and  imperfect 
though  I^faiow  my  effort  will  be,  I  sincerely  trust  it  will 
in  some  measure  serve  to  arouse  in  your  minds  an 
awakening  interest  that  will  stimulate  each  one,  accord- 
ing to  the  measure  of  his  influence,  to  do  what  within 
bim  lies  to  promote  the  establishment  of  such  improve- 
ments and  provisions  in  connection  with  the  distribution 
of  flesh  and  milk  as  the  urgency  of  the  circumstances 
^^arrant  us  in  demanding  of  local  authorities. 


E— 2 


220     OUR  FLESH  AND  MILK  SUPPLY.  ^^^^J^?m. 

In  the  public  interest  it  is  of  the  first  importance  that 
flesh  consumed  as  food  should  be  wholesome ;  and  not 
only  wholesome,  but  nutritious.  On  whom  does  the 
public  mainly  rely  for  guarantee  of  good  faith  in  this 
respect?  Unfortunately  the  public  has  no  practical 
knowledge  of  what  is  sound  flesh  and  what  is  not ;  it 
must  therefore  trust  to  some  one ;  and  that  some  one  is 
generally  the  butcher.  No  doubt  a  very  respectable 
following  of  this  trade  consists  of  honest  upright  men; 
but  is  the  majority  so,  think  you?  I  put  it  to  you; 
assuming  that  you  were  all  absolutely  poor  men  with 
only  a  few  pence  in  your  pocket  to  spend  on  the  article 
of  flesh,  and  with  the  pangs  of  hunger  gnawing  at  your 
stomach,  would  you  care  to  purchase  all  and  everything 
that  the  majority  of  butchers  tell  you  in  their  usually 
hilarious,  jovial  style  of  description,  is  good  meat?  I 
trow  not !  Furthermore,  let  us  for  the  nonce  assume 
that  every  butcher  is  an  unimpeachably  honest  man» 
who  would  not  for  worlds  deceive  the  public  by  selling 
diseased  flesh  nor  offer  horse  beef  in  lieu  of  that  of  the 
ox ;  may  not  the  butcher  himself  be  imposed  upon  for 
lack  of  that  knowledge  which  none  but  the  y®^^^^^^ 
surgeon  possesses  ?  Personally,  I  am  firmly  impressed 
with  the  conviction  that  he  can  and  frequently  is  so 
imposed  upon.  And  the  matter  is  not  rendered  any 
more  satisfactory,  as  regards  the  protection  of  the  pubuc 
interests,  by  imposing  the  responsibility  VLipon  the 
medical  officer  of  health  to  decide  what  is  and  what  is  not 
healthy,  or  on  the  other  hand  diseased  flesh,  and  whether 
or  not  it  is  fit  for  consumption.  I  consider  that  those 
gentlemen  who  hold  public  appointments  as  medical  officers 
of  health  deserve  a  great  deal  of  sympathy.  Probably,  ui 
the  majority  of  instances,  the  appointment  is  a  vaJuabie 
one,  and  one  that  it  is  desirable  to  secure.  In  view  o 
the  large  number  of  applicants  for  such  public  appomt- 
ments,  it  would  not  do  for  the  candidates  to  open  up  * 
preliminary  discussion  with  the  local  authority  in  p^"^^ 
to  point  out  that  they  were  not  qualified  for  c^^*^  • 
the  duties  which  the  authority  in  its  wisdom  included  ^ 
the  work  required  of  its  officers.  That  would  be  by  i^ 
too  risky  a  procedure,  lest  the  coveted  prize  should  siip 
from  the  grasp ;  and  so  it  comes  to  pass  that  i^^ 
gentlemen  are,  nolens  volens,  compelled  to  undei^^^ 
responsibilities,  to  discriminate  upon  which  they  have 


iSS^A^rSSil*"  OUR  FLESH  AND  MILK  SUPPLY.    221 

had  no  E^ial  training,  and  for  which  they  poBsess  no 
qualifications  whatever.  I  reiterate,  they  deserve  a  grea 
deal  of  sympathy  ;  but  only  up  to  a  certain  point  is  this 
sympathy  deserved,  and  that  point  is  when  they  have 
served  the  ofiice  long  enough  to  discover  their  own  un- 
fitness for  these  duties,  when,  I  contend,  the  local 
aathority  should  be  apprised  of  the  mistake ;  but 
experience  serves  to  show  that  medical  officers  of  health 
are  intensely  human,  and  rather  than  make  such  an 
admission  as  these  circumstances  would  require,  the 
duties  of  meat  inspecting  are  carried  out  as  best  they 
may  under  existing  conditions. 

I  submit,  gentlemen,  that  so  important  is  the  subject 

hi  meat  inspection,  that  not  only  ought  every  carcase, 

[whether  of  the  ox,  sheep  or  pig,  to  be  carefully  examined, 

[but  the  examination  or  inspection  should  be  invariably 

conducted  by  a  member  of  the  Royal  College  of  Veteri- 

uary  Surgeons,  who  by  special  qualification,  experience 

I  and  character,  is  fitted  for  and  officially  elected  to  the 

position  of  Public  Inspector ;  and  that  none  but  veteri- 

luuy  surgeons  should  be  eUgible  as  candidates  for  the 

appointment.      Moreover  it  is  most  desirable  that  all 

private  slaughter  houses  should  be  abolished  with  a  view 

I  to  the  thorough  and  complete  fulfilment  of  the  inspector's 

duties ;  this  of  course  refers  to  large  towns  and  districts 

where  public  abattoirs  could  be  established,  concerning 

which  no    theoretical  sophistries  could    be    advanced 

against  location  and  public  convenience ;  in  isolated 

country  districts,  where  population  is  not   sufficiently 

1^^  large  to  warrant  an  expenditure  of  money  out  of  local 

funds  such  as  would  be  requisite  to  provide  a  public 

abattoir,  it  should  only  be  legal  for  butchers  or  meat 

purveyors  to  obtain  their  stock  from  the   dead  meat 

Diarket,  which  should  be  duly  certified  by  the  inspector 

as  fit  for  food  before  it  could  be  allowed  to  be  taken  from 

the  market. 

I  am  desirous  of  impressing  upon  the  minds  of  gentle- 
nicn  present  how  important  it  is,  in  view  of  the  public 
I  well-being  and  general  health,  that  legislation  of  a  very 
M  radical  character  should  be  effected  ;  but  before  there  is 
:  the  slightest  hope  of  arousing  an  active  interest  in  the 
I  subject  to  an  extent  sufficient  to  overcome  all  the  red- 
r  tapeism  that  will  have  to  be  confronted  in  order  to  make 
I-  anything  like  a  practical  advance  in  the  direction  I  have 


222    OUR  FLESH  AND  MILK  SUPPLY.  ^SSS^.^^fl^! 

briefly  suggested,  some  measure  mast  be  devised  to 
educate  the  public  to  protect  itself,  and  I  know  of  no 
better  means  than  that  of  first  convincing  the  medical 
profession  of  the  importance  that  attaches  to  this  subject, 
and  relying  upon  its  active  co-operation  in  promulgating 
the  teaching.  But  here  comes  in  a  difficulty.  Tour 
profession  reads  that  Klein  is  of  opinion  that  a  scarlatinal 
epidemic  was  due  to  infection  from  cows  themsehes, 
while  members  of  my  own  profession  say  no.  The 
infection  certainly  may  possibly  have  been  conveyed 
from  some  other  source  through  the  medium  of  the  milk, 
but  it  had  nothing  whatever  to  do  with  the  cows.  It  is 
quite  natiural  that  many  of  you  should  attach  more  im- 
portance to  Klein's  opinion  than  to  that  of  the  veterinarv 
profession,  provided  you  do  not  think  for  yourselves,  and 
this  may  result  in  a  want  of  unanimity  of  action.  Dr. 
Klein's  conclusions  were,  in  my  judgment,  altogether 
unwarranted  and  extremely  unfortunate ;  their  consider- 
ation certainly  will  come  in  more  appropriately  in  that 
portion  of  my  paper  which  refers  to  milk,  but  I  mention 
it  here  in  passing  as  a  proof  of  the  danger  that  is  likely 
to  arise  if  even  such  an  authority  as  Dr.  Klein  meddles 
in  investigations  for  which  he  has  bad  no  special 
training,  more  especially  on  account  of  the  weight 
attaching  in  the  lay  mind  to  any  opinion  he  may 
advance  on  this  and  kindred  subjects ;  indeed,  I  am  of 
opinion  that  Dr.  Klein  is  in  no  small  degree  responsible 
for  any  delay  that  may  for  a  time  take  place  in  promul- 
gating sanitary  legislation.  No  doubt  the  doctor 
himself,  many  members  of  your  profession,  and  tnat 
portion  of  the  public  which  interests  itself  in  the  subject, 
axe  of  opinion  that  he  has  done  very  much  to  foster 
wholesome  sanitary  legislation.  I  am  sorry  to  say  ^ 
think  very  differently. 

It  may  be  objected  that  the  investigation  which  I  refer 
to,  as  conducted  by  Dr.  Klein,  had  nothing  whatever  to 
do  with  meat  inspection ;  and  I  admit  that  directly  it 
had  not ;  on  the  other  hand,  it  was  a  function  properly 
devolving  upon  a  veterinary  surgeon  having  specia 
reference  to  the  communicability  of  disease  between  man 
and  animals,  for  which  reason  I  felt  justified  in  com- 
menting upon  it  at  this  stage  of  my  paper.  I.  *7® 
already  expressed  the  opinion  that  it  is  dangerous  in  tne 
public  interest  for  members  of  the  medical  profession  to 


iS^r^StMS?"*  OUR  FLESH  AND  MILK  SUPPLY.    223 


assume  responsibilities  in  connection  with  oar  flesh  and 
milk  sapply  for  which  they  have  had  no  training,  and  I 
quote  this  instance  of  Dr.  Klein's  experience  as  evidence 
in  support  of  my  argument.  I  shall  now  revert  back  to 
the  consideration  of  various  abnormal  conditions  which 
present  themselves  in  connection  with  the  flesh  of  differ- 
ent auimalfl  used  for  food,  including  of  course  a  resume 
of  the  diseases  of  which  animals  may  be  the  subjects, 
and  which  in  my  judgment  render  the  carcases  unfit  for 
consumption,  with  a  view  to  show  how  necessary  it  is 
that  systematic  inspection  should  be  instituted. 

hi  determining  whether  flesh  should  be  passed  as 
healthy  and  fit  for  consumption,  there  are  many  points 
which  have  to  be  borne  in  mind  ;  they  may  be  taken  in 
the  following  order :  colour,  odour,  moisture,  texture  and 
firmness  as  the  leading  features  for  consideration  ;  theso 
again  may  be  subdivided  according  to  the  many  varia- 
tions which  frequently  present  themselves ;  for  instance 
as  regards  the  colour,  flesh  may  be  extremely  pallid,  due 
in  one  case  to  the  character  of  the  food  upon  which  the 
animal  has  been  fed,  and  at  another  time  to  a  develop- 
ment of  disease  such  as  dropsy;  from  this  it  will  be 
observed  that  a  practical  acquaintance  with  pathology  is 
essential  if  an  inspector  is  to  perform  his  duties  properly. 

Again,  the  colour  may  be  of  a  yellow  tinge ;  this  may 
be  due  to  food  or  a  diseased  condition  of  the  Uver. 

Other  hues,  such  as  magenta,  scarlet,  mahogany, 
brown,  green,  and  even  black  are  observed  in  animal 
flesh,  each  of  which  indicates  its  own  peculiar  condition, 
and  has  to  be  taken  into  consideration  when  determining 
the  fitness  or  otherwise  of  such  flesh  for  human  food. 
The  odour  of  flesh  is  best  determined  upon  immediately 
after  slaughter,  as  it  is  then  most  readily  detected  ;  fer- 
mentation, decomposition,  food,  drugs  or  some  patho- 
logical development  each  in  its  turn,  may  be  responsible 
(or  any  deviation  from  the  normal  odour,  as  also  is  the 
age  of  the  animal. 

hi  forming  a  judgment  as  to  the  moisture  one  has  to 
bear  in  mind  how  long  the  animal  has  been  slaughtered ; 
the  state  of  the  atmosphere,  whether  damp  or  dry,  to 
which  the  carcase  is  exposed ;  the  age  of  the  animal  and 
its  general  condition,  and  the  extent  to  which  it  was  bled 
when  slaughtered. 


224    OUR  FLESH  AND  MILK  SUPPLY.  ^SSS^!WJ^. 

These  are  but  a  few  of  the  more  important  points  tliat 
the  experienced  inspector  has  to  bear  in  mind  in  {be 
performance  of  his  duties,  though  they  by  no  means 
represent  the  full  complement  of  knowledge  he  ought  to 
possess ;  I  leave  it  to  you,  gentlemen,  to  say  whether  you 
are  of  opinion  that  a  medical  officer  of  health  is  qualified 
to  undertake  duties  of  this  character.  But  after  all  the 
inspector's  chief  functions  are  to  decide  whether  the  flesh 
of  animals  which  have  been  the  subjects  of  some  definite 
form  of  disease  is  or  is  not  fit  for  human  consumption. 
Various  opinions  are  held  upon  this  point,  I  very  much 
regret  to  say,  even  by  veterinary  surgeons,  but  I  should 
obviate  any  difficulty  arising  out  of  differences  of  opinion 
thereupon  by  making  it  compulsory  that  the  carcases  of 
all  animals  which  have  suffered  from  any  of  the  follow- 
ing forms  of  disease  should  be  condemned :  viz.,  py»mia, 
septicemia,  anthrax,  hog  cholera,  small  pox,  trichinosis, 
hydatid  disease,  dropsy,  tuberculosis,  and  parturient 
fever.  Professor  Walley,  Principal  of  the  Eoyal  (Dick^s) 
Veterinary  College,  Edinburgh,  than  whom  there  is  no 
one  (whether  veterinary,  medical  or  lay)  better  qualified 
to  offer  an  opinion  upon  the  subject  now  under  considera- 
tion, in  his  appendix  to  The  Four  Bovine  Scourges,  states, 
when  considering  what  is  marketable  and  unmarketable 
meat  as  follows : — 

"About  this  question,  as  about  all  others  connected 
with  this  subject,  a  vast  difference  in  opinion  exists ;  and 
it  cannot  be  answered  without  including  in  its  discussion 
the  third  question  also."  The  third  question  referred  to 
by  the  Professor  is  as  follows :  "Is  the  inspection  of 
meat,  as  a  rule,  in  proper  hands  ?  "  He  then  proceeds 
to  say :  "  In  the  very  great  majority  of  instances  in- 
spectors of  meat  look  only  at  the  bare  carcase,  and  that, 
too,  after  it  has  been  dressed  and  hung  up  for  a  period 
of  twenty-four  or  forty-eight  hours ;  and  not  infrequently 
even  after  it  has  been  quartered.  If  the  flesh  is  tolerably 
firm,  dry,  devoid  of  unpleasant  odour  or  flavour,  is  not 
much  altered  in  its  normal  colour,  and  the  carcase  sets, 
it  is  passed  as  marketable  and  fit  for  food.  If  the  reverse 
of  these  conditions  obtains,  it  is  rejected,  though  in  soine 
districts  ^cd  is  condemned  which  would  be  passed  in 
others.  Thus  one  inspector  would  reject  a  carcase  which 
was  dark  in  colour,  even  though  otherwise  all  righ*; 
while  another  would  pass  it  without  hesitation. 


IS^SS?^^    O™  FLESH  AND  MILK  SUPPLY.         225 

-* — 

''We  shall  see  the  same  divergencies  in  opinion  when 
we  consider  the  second  question — ^viz.,  *  What  is  innocu- 
ous, what  nocuous  ? ' — and  I  think  that  much  might  be 
gained  if  the  Legislature — ^by  aid  of  competent  authorities 
—would  authoritatively  settle  the  question  as  to  what 
should  be  considered  fit  for  food  and  what  unfit.  It  should 
decide  too,  independently  of  particular  diseased  condi- 
tions, primarily,  between  two  principles  for  the  guidance 
of  inspectors.  These  are  (a)  Is  the  inspector  to  take  into 
consideration  collateral  circumstances  ?  (b)  Is  he  simply 
to  be  guided  by  the  condition  and  appearance  of  the 
carcase  after  it  has  been  divested  of  all  organs  and 
appendages  and  prepared  in  the  usual  way  for  sale  ?  " 

Probably  no  single  individual  has  given  more  careful 
or  dispassionate  consideration  to  the  subject  of  meat 
inspection  than  has  Professor  Walley,  and  personally  I 
lool  to  him  as  a  leading  authority,  whose  opinion  is 
deserving  of  the  most  respectful  attention.  In  thus 
quoting  from  the  Professor's  work,  which  treats  very 
fully  of  this  subject,  it  is  my  aim  to  draw  your  attention 
to  the  fact,  that  while  individually  I  claim  to  hold  very 
strong  views  upon  the  urgency  of  legislation  for  the 
better  protection  of  the  public  health,  where  it  is  affected 
by  the  flesh  and  milk  supply,  I  am  by  no  means  an 
isolated  advocate  of  such.  Professor  Walley  has  both  in 
season  and  out  of  season  done  very  much  to  try  and 
arouse  the  authorities  to  a  sense  of  their  duty,  and  has 
been  an  earnest  and  conscientious  worker  in  this 
direction  for  the  public  weal.  I  thought  it  would  be 
mteresting  to  you  gentlemen  who  represent  an  important 
section  of  the  medical  faculty  to  learn  that  there  is 
among  the  veterinary  profession  a  goodly  muster  who 
recognise  the  importance  of  assisting  your  profession  in 
its  efforts  to  inaugurate  prophylactic  measures  for  the 
better  protection  of  your  patients  against  the  ravages  of 
devastating  disease,  and  I  hope  to  convince  you  that  a 
systematic  practice  of  inspection  is  a  most  important 
step  in  this  direction. 

My  opinion  is  that  the  inspection  of  meat  is  a  question 
that  has  not  yet  had  that  consideration  and  attention 
&om  sanitarians  that  its  importance  demands,  and 
I  hope  to  so  fully  arouse  your  interest  in  the  subject 
that  henceforward  you  will  one  and  all  bring  your 
influence  to  bear  upon  it  and    that  you  will    never 


226  OUR  FLESH  AND  MILK  SUPPLY.    ^^^.^'SS?^ 


Beview,  April  1,1881. 


allow  an  opportunity  to  pass  of  awakening  influential 
clients  and  the  public  generally  to  the  fact  that  steps 
are  urgently  required  for  prompt  legislation,  and  by  tlus 
means  it  is  to  be  hoped  that  pressure  may  be  brought 
upon  Parliament  with  a  view  to  the  speedy  adoption  of 
some  enUghtened  measure.  According  to  Professor 
Walley  the  inspection  of  meat  has  for  the  most  part  been 
carried  on  hitherto  in  a  very  perfunctory  fashion,  and  by 
men  whose  general  training  has  not  in  any  way  fitted  them 
for  the  office.  It  might  seem  from  what  one  hears  and 
sees  that  any  person  (no  matter  what  his  previous  occu- 
pation) is  qualified  to  act  as  a  meat  inspector.  Thus  we 
hear  of  retired  tradesmen,  such  as  shoemakers,  of  super- 
intendents in  the  employ  of  public  companies,  of  gate- 
keepers of  slaughter-houses  and  other  persons  in  a 
similar  position  being  employed  not  only  as  meat 
inspectors,  but  also  as  superintendents  of  slaughter- 
houses, and  probably  there  is  not  one  in  a  hundred  of 
these  who  has  received  any  scientific  or  practical  train- 
ing to  fit  him  for  the  office." 

Professor  Walley  also  goes  on  to  say :  **  Again  we  find 
that  legislation  affecting  the  subject  is  of  a  very  divme 
and  unsatisfactory  character — various  regulations  having 
only  local  effect  being  in  force  in  different  parts  of  the 
country  :  and  further,  that  in  many  districts  slaughter- 
houses are  private  property  and  not  under  the  supervision 
of  any  official,  competent  or  otherwise."  After  hearing 
this  statement,  which  is  from  the  pen  of  one  whose 
experience  of  the  subject  is  second  to  none  in  the  king- 
dom, I  would  ask  what  are  your  feelings  about  the  risks 
you  run  in  your  own  persons  without  considering  your 
clients  at  all  ?  When  questions  such  as  these  are  crying 
aloud  for  interference,  and  being  treated  as  though  they 
did  not  exist,  there  is  nothing  like  bringing  the  matter 
home  to  the  individual,  hence  I  put  it  to  you  so  fax  as 
regards  yourselves. 

But  to  make  it  more  impressive  I  propose  to  deal  with 
one  form  of  diseased  meat,  which  comes  into  the  naarket 
daily  in  vast  quantities,  about  which  various  opinions 
are  held  as  to  its  nocuity,  I  refer  to  the  flesh  of  aniiiift}s 
affected  with  tuberculosis.  I  think  if  I  deal  with  tb^ 
one  form,  of  what  I  believe  to  be  dangerously  risky  foou, 
it  will  suffice  without  going  into  details  of  the  many  other 
forms  of  nocuous  flesh  that  is  only  too  often  palmed  on 


sS^!S!ST^  0^»  FLESH  AND  MILK  SUPPLY.  227 

npon  an  unsuspecting  public ;  about  these  your  acquaint- 
ance with  pathology  will  enable  you  to  <fi:aw  your  own 
inferences  as  to  dangers  which  are  imminent,  and  you 
will  no  doubt  be  able  to  appreciate  the  responsibility 
lying  at  the  door  of  those  whose  eyes  are  open  to  such 
startling  facts.  Without  making  any  attempt  to  define 
the  pathological  characteristics  of  tubercle — for  before  an 
audience  like  the  present  such  an  effort  would  be  super- 
fluous— ^I  ask  your  consideration  of  the  question  of  the 
use  of  the  flesh  of  tuberculous  animals  for  human  food ; 
and  I  may  as  well  state  at  once,  in  order  to  obviate  the 
necessity  of  repeated  reference  to  my  authorities,  that  I 
am  indebted  mainly  to  Professor  Walley's  work  on  Meat 
Inspection,  and  to  the  Journal  of  Comparative  Pathology 
and  TherapeuticSy  edited  by  Professor  McFadyean, 
Lecturer  on  Anatomy  at  the  Koyal  (Dick's)  Veterinary 
College,  for  evidence  and  cases  in  support  of  the  line  of 
argument  I  propose  to  rely  upon.  There  is  very  little 
doubt  that  tons  upon  tons  of  flesh  belonging  to  animals 
which  are  the  subject  of  a  tubercular  diathesis  are  con- 
sumed, and  that  without  any  apparent  injury  to  the 
consumers ;  but  inasmuch  as  it  has  been  proved  that 
phthisis  may  be  introduced  into  the  human  system  by 
consuming  tubercular  flesh,  I  contend  that  the  risk  is  far 
too  serious  to  be  incurred  with  impunity,  and  that  there- 
fore no  carcase  affected  with  tubercular  lesions  should  be 
passed  for  human  food.  Professor  Walley  very  perti- 
nently remarks  that  ''  it  may  be  argued  that  there  is  no 
direct  proof  of  the  transmission  of  tubercle  from  animals 
to  man  by  the  consumption  of  flesh ;  such  proof,  it  need 
scarcely  be  said,  cannot  for  manifest  reasons  be  obtained, 
but  the  mass  of  indirect  proof  in  favour  of  such  suppo- 
sition is  enormous,  and  if  our  arguments  against  the  use 
of  such  flesh  are  based  only  upon  analogies  and  deduc- 
tions they  are  suflScient  to  warrant  us,  in  view  of  the 
great  gravity  of  the  question,  in  prohibiting  the  sale  of 
tuberculous  flesh  for  human  consumption.  Very  recently 
a  most  striking  example  of  the  effects  of  consuming  the 
flesh  of  a  tuberculous  animal  has  been  brought  to  light 
by  a  French  physician  in  the  case  of  a  young  woman  who 
rapidly  became  consumptive  as  the  result  of  devouring 
the  imperfectly  cooked  bodies  of  tuberculous  fowls." 

Professor  McFadyean  has  translated  from  a  paper  read 
by  M.  Arloing  at  the  recent  International  Congress  held 


228    OUB  FLESH  AND  MILK  SUPPLY.  *b^, aS^u^IS! 

in  Paris  the  following  among  other  experiments  to  show 
the  nocuity  of  tuberculous  flesh : — 

"Let  us  at  the  outset  prove  very  clearly  the  nocuity 
of  the  flesh  coming  from  tuberculous  animals.  That  has 
been  demonstrated  by  two  varieties  of  experiment.  1. 
The  ingestion  of  the  flesh  of  tuberculous  animals  having 
all  the  appearances  of  healthy  flesh.  2.  The  inoculation 
of  the  juice  extracted  from  such  flesh.  Of  the  first  kind 
we  shall  content  ourselves  with  citing  a  few.  Those  of 
Gerlach  and  of  Johne  with  the  raw  flesh  from  animals 
attacked  with  tuberculosis  8  or  22.5  per  cent,  became 
tuberculous,  and  of  46  subjects  fed  in  the  same  manner 
by  Johne  18.1  per  cent,  contracted  the  disease,  M.  Peuch 
caused  two  young  pigs  to  consume  5  kilogrammes  of  raw 
flesh  without  bone  in  ten  days.  At  the  end  of  two  and 
three  months  these  animals  presented  discrete  glandular 
tuberculosis.  Thus  the  passage  of  suspected  flesh  into 
the  digestive  tube  can  communicate  tuberculosis.  More- 
over, M.M.  Straus  and  A.  Wurtz  have  shown  in  some 
experiments,  in  vitro,  that  the  virulence  of  Koch's  bacilli 
is  with  difficulty  destroyed  by  the  gastric  juice.  "  The 
cooking  to  which  food  is  submitted  can  diminish  the 
danger,  but  it  is  impossible  to  rely  on  that  for  the 
destruction  of  the  virulence.  In  fact  to  obtain  this  result 
all  the  virulent  particles  would  require  to  be  heated  to 
over  70°  C.  for  half  an  hour.  But  in  practice  this 
temperature  is  not  always  uniformly  attained  and  main- 
tained throughout  the  whole  thickness  of  the  masses  of 
flesh  submitted  to  the  cooking.  Let  us  add,  to  complete 
the  information  on  the  role  that  may  be  attributed  to 
cooking,  that  in  62  experiments  in  which  Johne  ad- 
ministered notoriously  tuberculous  flesh,  after  having 
submitted  it  to  cooking  in  boiling  water  for  ten  to  fifteen 
minutes,  35.5  per  cent,  of  the  animals  were  infected." 

From  the  same  source  we  learn  that  a  series  of 
experiments  were  performed  by  M.M.  Nocaxd,  Chauveau, 
Arloing,  Galtier,  Peuch  and  Veyssiere  to  test  the  effecr 
of  inoculation  with  the  juice  of  meat  of  tuberculous 
animals:  first  impressions  concerning  the  expected 
results  of  such  experiments  would  probably  favour  the 
idea  that  these  would  be  more  decisive  than  by  ingestion 
into  the  digestive  canal ;  such,  however,  did  not  prove  to 
be  the  case,  and  one  reason  assigned  for  this  is  that  the 
virulent  bacilli  are  very  irregularly  distributed  among 


SS^^STSm?"  our  flesh  and  milk  supply.   229 

the  moscles,  and  that  in  many  portions  from  which  the 
juice  for  inoculation  purposes  might  be  expressed  the 
virulent  bacilli  may  frequently  be  absent.  These  gentle- 
men made  47  experiments,  employing  187  animals,  18 
of  which  became  tuberculous,  which  gives  a  proportion 
9.4  per  cent,  that  were  infected  by  inoculation,  while  the 
average  number  of  animals  infected  in  Gerlach  and 
Johne's  experiments  by  ingestion  amounted  to  17.8  per 
eent.  Such  results  as  these,  whatever  may  be  their 
effect  upon  your  minds,  fill  me  with  concern,  and  serve 
to  convince  me  that  ordinary  prudence  dictates  that 
effective  measures  should,  from  a  sanitary  point  of  view, 
be  taken  to  prevent  the  consumption  of  tuberculous 
flesh.  I  do  not  mean  to  infer  that  bovine  tuberculosis 
is  alcne  responsible  for  the  spread  of  the  disease  among 
hnman  subjects,  but  that  it  is  due  to  this  source  either 
through  the  ingestion  of  flesh  or  milk  in  a  very  large 
degree  I  am  fuUy  persuaded  ;  hence  the  importance,  in 
my  opinion,  of  early  legislation  to  ensure  a  proper 
system  of  inspection  of  all  carcases,  and  the  inclusion 
of  tuberculosis  in  the  schedule  of  the  Contagious 
Diseases  (Animals)  Act.  It  is  not  improbable  that 
some  of  the  more  sceptical  among  your  number  may  be 
disposed  to  raise  a  doubt  as  to  the  probabiUty  of  risk 
of  infection  on  account  of  the  power  of  resistance 
against  infection  on  the  part  of  the  human  subject,  and 
the  consequent  minimum  of  risk  in  consuming  tubercu- 
lous flesh.  I  have  met  with  many  such  sceptics,  men 
who  are  never  satisfied  with  anything  short  of  direct 
proof  before  they  accept  anything ;  but  when  I  think  of 
the  large  mortality  due  to  tuberculosis,  I  confess  to 
feeling  that  if  we  err  at  all  it  should  rather  be  on  the 
side  of  sacrifice  than  of  caution.  In  a  report  of  the 
Committee  of  the  North  of  Ireland  Branch  of  the 
British  Medical  Association,  held  in  Belfast  in  December, 
1889,  which  appears  in  the  Journal  of  Comparative 
Pathology  and  Therapeutics,  it  is  stated  that  ''  In  man 
10  to  14  per  cent,  of  all  deaths  are  due  to  tuberculosis. 
150,000  it  has  been  said  die  annually  in  the  British  Isles 
of  consumption."  Such  a  statement  as  this,  I  contend, 
is  sufficiently  serious  to  make  the  most  careless  ponder. 
The  same  report  in  dealing  with  the  infection  of  man 
from  the  lower  animals  states  :  *^  The  probability  of  the 
transmission  of  the  disease  from  animal  to  man  rests  on 


230    OUR  FLESH  AND  MILK  SUPPLY.  ^'S^.  A^W. 

the  following  points:  (1)  The  disease  is  the  same  in 
man  and  animal;  (2)  Man  is  very  susceptible  to  the 
disease;  (8)  Animals,  which  are  much  less  sasceptible 
than  man,  become  affected  by  experimental  inhalation, 
ingestion  and  inoculation.  It  is,  therefore,  a  fair  deduc- 
tion that  man  may  become  affected  by  the  same  methods. 
Practically,  it  might  be  said,  it  must  be  by  one  or  other 
of  these  methods,  although  not  experimentally." 

For  my  own  part  I  cannot  see  that  any  other  deduction 
can  be  drawn  from  experience  ;  the  wholesale  condemna- 
tion of  affected  carcases  seems  to  present  a  serious 
difficulty  in  the  minds  of  some  to  anything  like  effective 
legislation  on  account  of  the  heavy  pecuniary  loss  that 
would  be  inflicted  on  individual  owners  of  cattle,  so 
large  a  proportion  of  the  bovine  population  being  in 
greater  or  less  degree  the  subjects  of  this  fell  disease ; 
but  surely,  gentlemen,  you  will  not  allow  such  an 
insidious  objection  to  influence  you  against  appealing 
for  legal  protection  against  a  disease  so  cruel  and 
destructive  as  tuberculosis.  The  loss  must  be  borne  by 
someone  ;  the  question  is  who  ?  It  certainly  does  not 
seem  fair  that  individuals  should  be  ruined  for  the 
coimtry's  good,  hence,  theoretically,  the  responsibility 
seems  to  devolve  upon  ths  country :  but  this  is  no  part  of  the 
present  argument ;  the  conditions  are  so  urgent,  and  of 
themselves  call  so  loudly  from  a  moral  standpoint  for  effec- 
tive reparation  that  it  does  not  do  to  stop  to  think  of 
consequences,  at  all  events  in  the  present  instance ;  the 
effective  method  of  dealing  with  that  side  of  the  question 
must  be  left  to  financiers  and  political  economists,  who 
can  no  doubt  easily  find  a  way  out  of  the  difficulty,  and 
that  without  imposing^  any  unfair  burden  upon  the  indi- 
vidual.  Tuberculosis  is  only  one  form  of  disease,  albeit 
the  most  terrible,  that  the  public  has  a  right  to  be  pro- 
tected against.  I  have  already  enumerated  a  number 
which,  in  point  of  fact,  does  not  include  all,  and  I 
reiterate  the  statement  that  public  slaughter-houses,  sub- 
ject to  official  inspection,  are  a  sine  qua  rum  to  the  health 
of  the  nation,  and  the  compulsory  inspection  of  every 
carcase  of  whatsoever  animal  that  is  killed  for  human 
consumption,  conducted  on  fixed  lines  and  rules,  is 
positively  necessary  ;  and  I  further  assert  that  until 
these  are  legalised  by  statute  we  have  no  protection 
whatever  against  the  spread  of  disease  through  the 


SS?A^!STE^  OUB  FLEBH  AND  MILK  SUPPLY.    231 


Beriew.ApKil  1,1801. 


medinm  of  flesh  used  for  the  support  of  life.  I  am  con- 
scious that  I  have  but  inadequately  expressed  such  ideas, 
on  this  important  subject,  as  I  desired  to  convey ;  my 
object  has  been  to  show  that  for  the  better  protection  of 
the  public  health  sanitary  legislation  is  imperative,  and, 
whereas  the  medical  faculty  is  the  natural  conserver  of 
health,  I  hope  I  have  not  failed  in  showing  you  that 
legislation  is  not  only  necessary  but  well  within  the 
compass  of  possibihty,  provided  active  measures  are 
taken  to  ensure  it ;  and  I  know  of  no  body  of  men  better 
able  to  force  on  such  measures  than  is  the  medical  pro- 
fession. 

I  must  now  pass  on  to  that  portion  of  my  subject 
which  refers  to  milk  consumption.  Many  are  the  perils 
which  beset  the  national  health  from  the  use  of  this 
most  simple  and  natural  article  of  diet,  and  whereas 
children  and  invalids  who,  in  all  probability,  are  consti- 
tutionally more  susceptible  of  disease  than  are  healthy 
and  full-grown  persons,  rely  in  a  very  large  measure 
upon  milk  for  support  and  nutriment,  it  becomes  a 
matter  of  the  first  importance  that  the  public  supply 
from  all  sources  should  be  subjected  to  such  critical 
supervision  as  to  render  it,  humanly  speaking,  practically 
impossible  for  milk  to  serve  as  a  disseminator  of  disease 
m  itself,  or  as  a  factor  in  the  dissemination  of  disease 
from  other  sources.  There  is  at  the  present  time  in 
force  a  Dairies,  Cow-sheds  and  Milk  Shops  Order,  which 
is  supposed  to  be  enforced  by  district  local  authorities ; 
it  is,  however,  practically,  and  to  all  intents  and  purposes, 
a  dead  letter.  Were  it  enforced  and  carried  out  in  its 
mtegrity  there  would  not  be  much  to  desire  beyond 
such  improvements  from  time  to  time  as  experience 
is  almost  certain  to  suggest.  The  reason  why  it  is 
not  properly  enforced  is  probably  that  suitable  persons 
folly  empowered  have  not  yet  been  appointed.  I 
therefore  satisfy  myself  in  the  present  instance  by 
reminding  you  that,  whereas  suitable  measures  are  in 
force  they  are  nevertheless  not  carried  out  efficiently, 
and  I  pass  on  to  show  how  important  it  is  that 
Bystematic  efficacy  should  be  imparted  to  existing 
legislation.  I  have  already  shown  you  that  the  bovines 
are  terribly  responsible  for  the  spread  of  disease,  and  the 
poor  cow  is  deservedly  made  accountable  for  very  much; 
but  there  are  members  of  the  medical  profession  who 


232    OUB  FLESH  AND  MILK  SUPPLY.  ^^S^^aS^X^. 

would  put  more  upon  her  than  she  really  deserves.  I 
refer  of  course,  for  illustration  of  this,  to  the  investiga- 
tions made  by  Mr.  Power  and  Dr.  Klein,  which  were 
included  in  the  Annual  Eeport  of  the  Local  Government 
Board,  1885-86.  As  the  result  of  his  investigation,  Mr. 
Power  was  led  to  believe  that  the  milk  from  the  Hendon 
cows  did  not  become  infected  through  introduction  from 
human  scarlatina,  but  that  the  infection  was  due  to  a 
diseased  condition  of  the  cows  themselves ;  and  Dr. 
Elein,  who  investigated  the  '  ailment  among  these 
Hendon  cows,  seems  to  have  arrived  at  similar  con- 
clusions. Since  that  time  Dr.  Klein,  presumably  in 
support  of  his  first  theory,  has  stated  that  he  has 
ascertained  that  a  micro-coccus  is  present  in  the  blood 
of  persons  suffering  from  scarlatina  identical  morphologi- 
cally with  the  organism  he  obtained  from  the  Hendon 
cows. 

Professor  J.  Wortley  Axe,  of  the  Eoyal  Veterinary 
College,  who  also  acted  at  the  time  as  Consulting 
Veterinary  Surgeon  to  the  British  Dairy  Farmers'  Asso- 
ciation, also  made  an  independent  investigation  of  this 
notable  Hendon  outbreak.  He  found  that  said  outbreak 
was  nothing  more  than  an  easily  recognised  and  well- 
known  eruption  confined  to  the  teats  of  the  cow  only. 
The  subjects  of  the  eruption  show  no  constitutional  signs 
of  disease,  as  the  appetite  remains  unimpaired,  the  flow 
of  milk  continues  undiminished,  and  the  internal  body 
temperature  is  normal.  The  eruption  is  essentially  con- 
tagious and  capable  of  transmission  from  one  animal  to 
another  by  the  hands  of  the  milkers,  and  the  disease 
may  be  communicated  to  a  person  milking  if  he  has  an 
abrasion  or  cut  on  the  hands.  The  disease  is  of 
common  occurrence  all  over  the  country,  and  easily 
recognised  by  stock  owners. 

Professor  Axe  traced  the  origin  of  this  outbreak  to 
three  cows  purchased  out  of  a  herd  of  30  or  40,  and  dis- 
covered that  they  had  this  eruption  before  they  were 
introduced  to  the  Hendon  herd.  Their  milk  was  con- 
sumed in  the  place  they  came  from,  but  no  one 
developed  scarlatina  there.  Other  cows  of  this  herd 
were  sold  to  various  dairymen  in  and  around  London, 
but  no  cases  of  scarlatina  could  be  traced  to  the  dairies 
into  which  these  cows  had  been  brought.  It  only 
appeared  among  customers  of  the  one  dairy  at  Hendon. 


^SSSi^SSn^  ^^^  FLESH.  AND  MILK  SUPPLY.     233 


After  closely  examining  the  whole  of  the  circumstances 
from  start  to  finish,  Professor  Axe  winds  up  his  report 
as  follows : — 

"  Reviewing  the  facts  stated  above,  I  am  of  opinion 
that  the  disease  which  prevailed  in  the  several  herds 
referred  to  above,  had  a  common  origin,  being  in  all 
directly  or  indirectly  derived  from  the  Derby  cows.  Five 
dairies  were  thus  infected,  but  coincident  scarlatina  was 
Dnknown  in  the  customers  of  four  of  them,  and  the 
inference  becomes  irresistible  that  the  London  epidemic, 
which  has  been  imputed  to  the  fifth,  had  its  origin  in 
some  obscure  source  connected  with  the  dairy  by 
channels  which  enquiry  has  failed  to  reveal."  Professor 
McFadyean  who,  like  Professor  Axe,  is  a  recognised 
authority  upon  veterinary  pathology,  makes  this  case, 
together  with  another  similar  one  that  took  place  in 
Dundee,  the  subject  of  withering  sarcasm  in  an  editorial 
article  in  the  Journal  of  Pathology  for  September,  1889. 
He  taunts  the  medical  practitioner  or  officer  of  health 
for  so  readily  falling  back  upon  a  teat  eruption  of  the 
cow  as  the  source  of  a  scarlatina  epidemic,  because  such 
a  line  of  reasoning  is  simple,  and  makes  no  special 
demand  upon  the  investigating  capabilities,  while  to 
trace  the  contagion  to  a  human  source  would  involve 
considerable  time  and  trouble.  It  certainly  does  strike 
one  that  before  gentlemen  occupying  the  social  and 
professional  positions  of  Mr.  Power  and  Dr.  Klein  pro- 
mulgated such  theories  as  they  did  concerning  the  origin 
of  this  scarlatina  epidemic  they  would  have  not  detracted 
from  their  own  dignity  had  they  first  consulted  with 
recognised  veterinary  pathologists,  if  for  no  other  reason 
than  the  desirability  of  sparing  the  public  an  altogether 
unwarrantable .  scare,  and  the  infliction  upon  the  dairy- 
man's trade  of  an  unfair  and  damaging  imputation.  I 
believe  I  shall  be  quite  within  bounds  if  I  state  that  not 
a  member  of  the  veterinary  profession  throughout  the 
United  Kingdom  would  support  the  theory  of  Mr.  Power 
and  Dr.  Klein ;  but  when,  as  in  the  case  of  Dr.  Anderson, 
of  Dundee,  a  member  of  the  medical  profession,  who  is 
also  medical  officer  of  health,  ascribes  an  outbreak  of 
typhoid  fever  to  an  eruption  on  cows'  teats,  we  pass  from 
the  sublime  to  the  ridiculous.  There  are  those  who 
think  the  medical  profession  has  gone  crazy  on  the  sub- 
ject  of   micro-organisms    and  their    influence  in  the 

Vol.  35,  No.  4.  s 


234    OUR  FLESH  AND  MILK  SUPPLY.  ^e^,^^i!^! 

development  of  disease ;  and  certainly  the  importance 
"which  Dr.  Klein  seems  to  attach  to  his  discovery  of  tiie 
micrococcus  before-mentioned  will  not  be  without  its 
effects  upon  the  minds  of  such  persons. 

Wherever  micro-organisms  peculiar  to  infectioofl 
disease  are  present,  there  is  no  doubt  that  milk  is  a 
peculiarly  attractive  vehicle  for  their  transmission,  and 
it  thus  becomes  a  factor  in  the  dissemination  of  disease; 
it  may  be  extremely  difl&cult  to  trace  the  origin  to  its 
source;  through  this  medium  it  is  probable*  many  epi- 
demics are  estabUshed ;  the  specific  disease  is  carried 
from  one  centre  to  another ;  the  cholera  germ,  the 
typhoid  fever  germ,  the  germs  of  small  pox,  scarlet  and 
typhus  fevers  and  diphtheria  may  and  very  probably 
frequently  are  conveyed  by  milk  from  one  place  to 
another,  but  not  one  of  these,  as  developed  in  the  human 
subject,  can  be  ascribed  to  the  cow  through  her  milk 
the  affections  of  the  cow  which  are  capable  of  trans- 
mission to  the  human  subject  through  the  medium  of 
milk  are  aphthous  fever,  anthrax,  tuberculosis  and 
pyaemia.  I  am  not  aware  that  it  has  been  satisfactorily 
cleared  up  how  in  aphthous  fever  the  virus  declares  itself, 
but  there  seems  to  be  good  reason  to  believe  that  it  |s 
essentially  in  the  quality  of  milk,  and  that  the  latter  is 
not  merely  a  vehicle  for  conveying  the  virus  from  its 
external  manifestations  in  the  cow  ;  when,  however,  ^e 
come  to  consider  how  anthrax  is  conveyed  from  bovines 
to  the  human  subject,  we  have  only  to  remember  that 
the  vegetable  organism  known  as  the  bacillus  antbracis, 
microscopically  examined,  may  always  be  observed  m 
the  milk  of  a  stricken  cow. 

Time  will  not  permit  me  to  refer  more  fully  to  these 
diseases,  as  I  wish  to  draw  your  attention  still  further  to 
tuberculosis.  There  is  no  mistake  about  an  animal 
suffering  from  aphthous  fever  or  anthrax,  but  tuber- 
culosis is  much  more  insidious  in  its  onset  and  develop- 
ment, and  less  easily  recognised.  Fowls,  sheep,  go*t^» 
and  pigs  may  and  frequently  do  fall  victims  to  it,  but 
above  all  other  descriptions  of  animals,  bovines  are  most 
susceptible. 

The  question  we  have  now  to  consider  is  whether  ib^ 
infective  principle  of  tuberculosis  can  be  conveyed  id 
milk.  In  the  case  of  animals  various  experiments  have 
been  made,  which  appear  to  leave  no  reason  for  douM 


I 
I 


fiSSSTiSSlM?*  Ora  FLESH  AND  MILK  SUPPLY.  236 

that  it  can,  and  the  circumstantial  evidence  in  favoor  of 
its  infective  properties  to  the  human  subject  are,  to  my 
mind,  so  strong  that  they  cannot  with  any  show  of 
reason  be  rejected  or  trifled  with.  I  will  deal  with  these 
latter  first  by  quoting  from  Professor  Walley.  He 
says: — 

''  In  1872  I  lost  a  child  in  Edinburgh  under  circum- 
stances which  aUowed  but  of  one  explanation,  viz.,  that 
he  had  contracted  mesenteric  tuberculosis  through  the 
medium  of  milk.  In  a  paper  read  at  the  meeting  of  the 
National  Veterinary  Association,  held  in  London  in  1888, 
Mr,  Cox,  of  the  Army  Veterinary  Department,  related 
the  particulars  of  a  case  which  inevitably  led  to  the 
same  conclusion,  as  did  also  Mr.  Hopkins,  F.B.G.V.S., 
of  Manchester.  Dr.  Fleming  has  also  referred  to  a 
simitar  case  as  occurring  in  the  child  of  a  surgeon  in  the 
United  States,  and  a  short  time  ago  a  case  of  mesenteric 
tabereulosis  by  the  inhibition  of  milk  occurred  in  the 
diild  of  a  well-known  veterinary  oflScer  of  the  Privy 
Council." 

Professor  Axe,  of  the  Boyal  Veterinary  College, 
London,  in  a  pamphlet  entitled  Milk  in  Relation  to  Public 
Healthy  relates  the  following  suggestive  coincidence : — 

"A  few  years  ago  Mr.  Maw,  veterinary  surgeon, 
residing  in  a  north  country  town,  forwarded  to  me,  at 
the  Boyal  Veterinary  College,  the  lungs  of  a  calf  largely 
invaded  with  tubercular  disease.  In  the  summer  of  the 
foUowing  year  I  was  desired  by  him  to  visit  a  cow,  which 
he  stat^  to  be  suffering  &om  chronic  inflammation  of 
the  mammary  gland.  After  a  careful  inspection  of  the 
animal,  I  arrived  at  the  conclusion  that  she  was  the 
subject  of  tuberculosis,  and  that  the  affection  of  the 
gland  was  essentially  of  that  nature.  On  expressing  this 
opinion  I  was  reminded  of  the  calf  whose  lungs  I  had 
examined  in  London  some  time  previously,  and  after- 
wards informed  that  it  was  the  offspring  of  the  cow  in 
question.  While  we  were  conversing  together,  a  Uttle 
boy,  about  eight  or  nine  years  old,  came  into  the  yard 
having  a  handkerchief  tied  round  his  throat.  On 
enquiring  the  reason  of  this  investment,  I  was  referred 
in  explanation  to  swellings  and  ulcerations  of  the  glands 
about  the  throat  and  neck  which  presented  all  the  usual 
indications  of  tubercular  disease.  On  asking  the  boy  if 
he  drank  milk  from  the  cows  on  the  farm,  he  replied 

s— 2 


236    OUR  FLESH  AND  MILK  SUPPLY.  "]S^.%fiIm 

*  yes,'  and  supplemented  the  answer  by  the  statement 
that  he  was  very  fond  of  it." 

From  Dr.  Fleming's  work  entitled  The  Infliience  of 
Heredity  and  Contagian  in  the  Propagation  of  Tuber- 
culosis, I  find  the  following  case  referred  to  as  harag 
previously  been  related  by  Dr.  Stang  of  Amborach  :— 
"  A  boy,  five  years  old,  apparently  strong  in  constitution, 
and  descended  from  healthy  parents,  whose  progenitors 
were  exempt  from  hereditary  disease,  was  attacked  with 
scrofula,  and  died  in  four  weeks  from  miliary  tubercu- 
losis of  the  lungs  and  enormous  hypertrophy  of  the 
mesenteric  glands.  When  making  the  autopsy  it  was 
accidentally  ascertained  that  some  time  before  the 
parents  had  to  destroy  a  cow  which,  according  to  the 
testimony  of  the  veterinary  surgeon,  was  aflfected  with 
pulmonary  phthisis.  The  animal  had  been  a  good  milch 
cow,  and  for  a  long  time  the  boy  had  received  a  quantity 
of  the  milk  inmiediately  after  it  was  drawn."  These 
facts  are,  to  my  mind,  quite  sufficient  to  make  any 
thoughtful  man  pause.  It  is  true  all  the  cases  lack,  in 
a  measure,  that  positive  proof  which  some  minds  demand; 
but  many  a  man  has  been  hanged  on  more  slender  evi- 
dence. I  now  pass  on  to  the  experimental  investiga- 
tions respecting  tuberculous  milk.  I  shall  not  troable 
you  with  the  inoculation  experiments  as  I  prefer  relying 
on  experience  gained  from  ingestion,  and  in  the  first 
place  I  shall  quote  from  the  researches  of  Dr.  Bang, 
Lecturer  at  the  Royal  Veterinary  College,  Copenhagen, 
a  translation  of  which  appears  in  Professor  McFadyean  s 
Journal  of  Pathology :  Dr.  Bang  made  a  series  of  feeding 
experiments  on  eighteen  rabbits  and  eight  pigs ;  t^^ 
animals  received  besides  the  milk  only  vegetable  food, 
and  after  the  milk  was  suspended  water  in  the  plac^  ^^ 
the  milk. 

Some  of  these  animals  received  raw  milk  and  some 
milk  heated  to  various  degrees,  viz.,  60°,  66^  70°,  and 
75°  C.  ^^.. 

Of  those  fed  with  raw  tuberculous  milk  both  rabbits 
and  pigs  were  all  tuberculous  in  a  marked  degree ;  those 
which  partook  of  the  milk  heated  to  60^  and  66®  shoj^ 
slight  traces  of  tuberculosis,  while  those  which  ^*", 
heated  to  70°  and  75°  C,  when  killed  some  time  after  the 
experiment  was  commenced,  gave  no  evidence  of  i^^^' 
tion,  except  two  pigs  which  took  milk  heated  to  70°  9S^^ 


nSS^^i^^   OUR  FLESH  AND  MILK  SUPPLY.    237 

aflierwardB  showed  caseous  and  calcareous  deposits  in 
different  lymphatic  glands  ;  but  Dr.  Bang  was  not  per- 
fectly satisfied  that  these  pigs  were  not  previously 
affected  with  the  disease. 

Professor  Axe,  in  his  before-mentioned  pamphlet, 
remarks  as  follows  : — 

"  My  own  observations  and  experiments  on  the  com- 
monicability  of  tuberculosis  by  the  agency  of  milk  have 
been  very  conclusive,  as  the  following  experiments  will 
show : — (1)  Two  young  pigs  were  fed  almost  exclusively 
on  the  milk  of  a  tuberculous  cow  for  ten  days.  On  the 
twenty-first  day  after  the  last  meal  one  of  them  showed 
slight  indications  of  ill-health,  which  were  marked  by 
dahiess,  a  harsh  dry  skin,  a  frequent  short  cough,  dis- 
charge from  the  nose,  and  a  watery  condition  of  the  eyes. 
On  the  fortieth  day  this  animal  was  destroyed,  and 
examination  after  death  showed  distinct  evidence  of 
tubercle  in  the  lungs,  lymph  glands  and  intestines. 
(2)  Gave  a  negative  result.  Of  three  kittens  fed  with 
milk  from  the  same  cow,  two  developed  generalised 
tuberculosis ;  and  the  result  in  the  third  case  was  nega- 
tive. Additional  testimony  to  the  sometimes  infectious 
property  of  milk  is  afforded  by  Herr  Albert  Schwerte. 
This  gentleman,  in  referring  to  an  outbreak  of  tuber- 
culosis in  a  herd  of  cattle,  states  that  owing  to  the 
prevalence  of  the  disease,  the  milk  of  the  infected  stock 
was  given  to  a  number  of  pigs,  the  result  being  that  they 
were  soon  observed  to  waste  and  give  evidence  of  disease. 
In  a  few  weeks  many  of  them  died,  and  on  being 
examined  after  death  all  the  appearances  and  changes 
characteristic  of  the  disease  were  noticed  in  the  various 
organs  of  the  body.'* 

I  think  the  foregoing  facts  are  quite  sufficiently 
serious  to  convince  almost  anyone  that  something  of  a 
practical  and  definite  character  should  be  done  to  protect 
the  public  against  the  probability  of  infection  by  the 
consumption  of  this  most  useful,  natural,  and  nutritious 
article  of  diet.  It  has  already  been  shown  that,  in 
addition  to  conveying  the  germs  of  certain  diseases  from 
the  animal  which  produced  it  to  man,  it  is  also  a  very 
feady  recipient  and  mechanical  conveyer  of  the  germs  of 
numerous  other  contagious  or  infectious  diseases.  It 
loay  also  become  contaminated  with  all  sorts  of  offensive 
ftnd  hurtful  matter,  through  absence  of  proper  cleanli- 


238    OUR  FLESH  AND  MILK  SUPPLY.  ^iS^J.  A^fljSS! 

ness  on  the  part  of  the  milkers,  so  far  as  regards  their 
own  hands  and  the  state  of  the  cow's  teats ;  in  con- 
sequence of  objectionable  surroundings  in  filthy  sheds, 
which  are  frequently  located  in  districts  of  a  most  loath- 
some character ;  for  want  of  properly  cleaning  the  cans 
in  which  the  milk  is  delivered ;  and  also  suitable 
methods  of  conveyance  when  the  milk  is  brought  from  a 
distance,  so  as  to  preserve  it  from  accumulation  of  dirt 
while  in  transitu. 

Much  greater  care  is  required  on  the  part  of  cow- 
keepers  and  dairymen  than  is  at  present  taken,  in 
consequence  of  the  readiness  with  which  milk  is  affected 
by  the  food  cows  eat,  or  with  medicinal  agents,  or 
foreign  substances  accidentally  passing  in  with  the 
ingesta.  I  remember  when,  during  my  course  of  study 
at  the  B.  V.  C,  I  attended  the  lectures  of  the  late 
Professor  Tuson  on  Chemistry,  how  he  related  an 
instance  of  a  number  of  cows  which  were  pastured  on 
fields  also  used  for  rifle  practice,  how  the  said  cows 
became  the  subjects  of  lead  poisoning,  and  that  distinct 
traces  of  lead  were  found  in  the  lacteal  secretion  as  the 
result  of  simple  chemical  tests.  A  similar  experience 
he  also  related  concerning  some  cows  pastured  on  land 
adjoining  some  lead  works.  From  this  you  will  observe 
that  not  only  is  milk  an  attractive  medium  for  poisonous 
substances  outside  the  body,  but  that  it  will  in  course  of 
secretion  readily  hold  in  solution  from  the  blood 
material  highly  detrimental  to  those  who  thereafter 
partake  of  it.  In  further  proof  of  the  readiness  with 
which  it  partakes  of  the  character  of  food,  to  remind 
you  that  cows  fed  to  excess  on  either  swede  turnips, 
carrots,  or  parsnips,  imparts  a  flavour  most  decided  of 
such  food,  and  the  same  occurs  when  aromatic  drugs 
have  been  used  in  large  medicinal  doses.  In  the  face  of 
such  experience  it  is  not  difficult  to  understand  what 
dangers  attend  its  consumption  if  proper  care  is  not 
taken  to  prevent  the  animals  taking  anything,  either 
accidentally  or  wilfully,  into  the  system  that  might  be 
injurious  to  life. 

To  point  out  all  the  sanitary  and  hygienic  r^qunre- 
ments  peculiar  to  dairy  management  in  detail  wooid 
furnish  material  sufficient  for  a  paper  in  itself.  Already 
my  very  disjointed  remarks  have  been  far  too  Diucn 
drawn  out.      I  must,  therefore,  content  myself  with  the 


bS^jSoTw^  our  flesh  and  milk  supply.   239 

hope  that  in  my  imperfect  attempt  to  interest  you  on  a 
sabject  of  such  vital  importance  to  the  public  health,  I 
shall  at  least  have  succeeded  in  arousing  attention  to  a 
matter  that  calls  aloud  for  prompt  and  effective  legal 
measures. 

Apart  from  these,  no  doubt  the  medical  profession 
could,  if  it  would  only  take  it  up,  set  an  example  of  how 
hygiene  and  sanitation  ought  to  be  brought  to  bear  on 
the  conduct  of  businesses  for  milk  production  and  dis- 
tribution by  taking  pecuniary  interest  in  a  model  dairy 
&nn,  which  should  be  conducted  on  very  strict  lines,  to 
serve  as  an  example  of  how  the  thing  ought  to  be  done ; 
and  if  it  did,  the  profession  wOuld  never  have  cause  to 
regret  it,  for  not  only  would  a  great  philanthropic  work 
be  thus  instituted,  but  a  most  satisfactory  investment 
for  money  would  be  established. 

Discussion. 

Dr.  Mom  thanked  Mr.  Uumdall  for  the  satisfaction  the 
paper  had  given  him.  He  had  often  talked  over  the  matter 
with  Mr.  Humdall,  and  thoroughly  agreed  with  him  as  to  the 
necessity  of  careful  inspection.  He  often  recommended  his 
patients  to  take  the  Jewish  meat,  as  he  believed  it  was 
thoroQghly  well  inspected.  Meat  refused  by  Jewish  butchers 
was  sold  to  and  bought  by  Gentiles.  He  wished  to  ask 
Mr.  Hamdall  about  Jewish  customs,  and  also  as  to  the 
method  of  slaughtering.  He  was  convinced  that  tubercle  was 
spread  by  milk.  The  feeding  of  cows  had  much  to  do  with 
generating  disease.  Many  cows  were  brought  up  from  the 
country  and  kept  in  sheds  without  fresh  air  or  exercise  for 
months,  and  their  milk  must  be  unwholesome.  He  asked 
what  form  the  disease  took  in  the  men  infected  by  the  Hendon 
cows. 

Mr.  Wright  agreed  with  Dr.  Moir  as  to  the  influence  of 
milk  on  children.  He  had  seen  diarrhoea  occur  in  children 
when  the  food  of  cows  was  changed. 

i^r.  Talbot  was  greatly  interested  in  the  paper.  He  said 
Americans  were  much  struck  by  the  open  and  alluring  way  in 
which  meat  was  exposed  for  sale  in  the  streets  in  this 
couniry.  It  might  pick  up  germs  in  that  way.  In  America 
meat  was  not  exposed.  Some  danger  would  perhaps  be 
averted  by  the  adoption  of  the  new  law  of  "  protection  "  in 
the  States.    All  meat  exported  had  to  be  inspected. 

Dr.  Wbioht  (of  America)  had  only  been  in  the  country 
twenty-four  hours,  and  he  had  observed  the  great  amount  of 
meat  exposed  for  sale.     In  America  most  of  it  is  kept  in  ice 


240    OUR  FLESH  AND  MILK  SUPPLY.  ^i^^J^S^. 

chests,  and  only  a  little  exposed.    He  explained  the  meat 
inspection  in  New  York. 

Dr.  Neatbt  asked  if  bacilli  had  been  shown  to  be  present  in 
the  milk  of  tuberculous  cows. 

Dr.  CooFEB  was  exceedingly  well  pleased  to  have  the  sub- 
ject brought  before  the  Society.  Disease  in  cattle  is  dae  in  a 
measure  to  the  neglect  of  vegetation,  which  has  its  effect  on 
animal  life.  Referring  to  the  Hendon  epidemic,  he  had  heard 
that  one  of  the  cows  had  been  taken  to  Wimbledon,  and  tiie 
houses  which  were  more  largely  rented  and  where  most  milk 
was  consumed  were  those  where  most  disease  occurred.  The 
disease  was  probably  due  to  the  milk.  It  was  traced  to  one 
dairy.  He  could  not  speak  for  the  pathology  of  the  question. 
He  would  have  liked  a  little  more  description  of  tubercle  in 
animals.  He  understood  that  the  diagnosis  was  not  alwajs 
quite  clear. 

Dr.  BuRFORD  expressed  his  thanks  to  Mr.  Humdall  for  his 
paper.  Many  lines  of  thought  were  opened.  He  was  glad  he 
had  entered  into  the  imperial  aspect  of  the  question. 
Gradually  everything  was  coming  under  Government  inspec- 
tion, and  meat  and  milk  should  be  inspected  as  well  as  other 
things.  Doubtfully  diseased  animals  should  be  exclnded  &r 
the  sake  of  the  poor,  as  they  would  eat  anything  that  wafl 
called  meat — the  cheapest  they  could  buy.  In  some  diseases 
it  was  easier  to  diagnose  the  disease  from  symptoms  than 
post  niortem^  He  was  not  sure  that  Government  inspection 
was  always  likely  to  be  efficient.  Individual  effort  must  not 
be  neglected.  Milk  could  be  sterilized  by  boiling  and  meat  by 
proper  cooking.  He  alluded  to  the  statement  that  there  is 
a  connection  between  cancer  and  pork-eating.  He  thought  it 
would  be  safest  to  be  vegetarians  for  the  present. 

Dr.  Clarke  mentioned  an  incident  which  might  explain  how 
disease  germs  get  into  milk.  He  had  seen,  outside  a  dairy 
shop,  empty  milk-tins  standing,  and  small  street  boys  climbing 
up  them,  their  dirty  hands  on  the  rims  and  their  dirty  heads 
inside.  If  they  had  any  infectious  disease  about  them  the 
next  delivery  of  milk  would  spread  it  all  round  the  neighboitf- 
hood.  Some  incident  of  this  kind  might  be  the  unexplained 
cause  of  the  epidemic  which  Dr.  Klein  thought  was  traceable 
to  the  cows. 

Dr.  Galley  Blacklet  thought  the  giving  of  raw  flesh  to 
animals  by  way  of  experiment  was  not  very  conclusive.  ^ 
the  cooking  a  chop  or  steak  it  was  surely  much  above  70  t* 
He  quite  agreed  with  Mr.  Hurndall  as  to  the  insufliciency  w 
present  inspection.  As  regards  milk,  a  safe  and  reliable  dism- 
fectant  for  milk  was  a  desideratum.  He  had  tried  severtl 
things,  and  among  others   sulpho-silicate    of  sodium  proved 


SSSf^vS^*"  Ora  FLESH  AND  MILK  SUPPLY.  241 

effective ;  boroglycerids  and  glacialine  are  also  used.  He  agreed 
with  Dr.  Barfurd  that  the  hearty  co-operation  of  scientific 
men  all  round  might  do  much.  We  medical  men  stand 
in  need  of  more  pathological  and  sanitary  training,  He 
mentioned  a  case  of  tapeworm  in  a  gentleman  who  drank 
waters  at  a  foreign  mineral  spring  in  a  field  where  cattle 
grazed. 

Dr.  Dudgeon  (in  the  chair)  thought  Mr.  Hurndall  had 
made  out  a  good  case  for  veterinary  inspection.  Doctors  (he 
spoke  for  himself)  know  nothing  about  animal  diseases,  and 
were  quite  unequal  to  the  post.  The  terrific  picture  of 
diseases  that  may  be  caught  from  animals  almost  made  him 
incline  to  vegetarianism.  He  was  consoling  himself  with  the 
statement  of  foreign  doctora  that  goats  were  immune  from 
phthisis,  but  he  was  sorry  to  hear  from  Mr.  Hurndall  that 
even  goats  might  take  the  disease.  However,  those  who  have 
tasted  goat's  flesh  would  pronounce  it  a  poor  substitute  for 
beef  or  mutton.  Other  diseases  may  be  taken  from  other 
ftnimals.  Trichinosis  is  taken  from  pigs  in  Germany,  where 
{pace  Dr.  Galley  Biackley)  raw  food  is  eaten.  Jews  in 
Gemiany  are  very  subject  to  a  tapeworm  which  is  said  to  be 
taken  firom  fish.  Jews  in  travelling,  when  they  cannot  get 
meat  from,  their  own  butchers,  eat  fish.  It  is  especially  from 
pike  and  carp  that  it  is  caught.  We  may  take  advantage  of 
Koch's  discovery  in  one  way.  As  he  has  found  by  iaoculating 
guinea-pigs  he  makes  them  immune  from  tuberculosis,  so  if 
we  inocalate  our  children  with  his  fluid,  when  they  grow  up 
to  years  of  discretion  (or  indiscretion)  they  will  be  able  to 
eat  tuberculous  meat  without  fear !  Then  there  is  another 
disease  that  may  be  taken  from  animals.  A  lady  whom  he 
attended  had  serpiginous  ulcers  in  her  mouth  at  a  time  when 
the  foot-and-mouth  disease  was  rife.  She  had  nothing  wrong 
with  her  feet.  When  she  boiled  all  the  milk  she  took  (and 
she  drank  a  good  deal)  she  soon  got  well  of  the  ulcers. 

Mr.  HuBNDALL  (in  reply)  said,  in  reference  to  Jews' 
Blaoghteringy  that  bleeding  does  not  get  rid  of  pathological 
diseases.  Jews  are  very  particular.  They  refuse  the  carcass 
of  any  animal  which  shows  any  sign  of  disease.  The  feeding 
of  animals  does  make  much  difference  in  the  milk.  He  had 
no  doubt  Dr.  Moir  was  correct  in  attributing  the  diarrhoea  in 
his  case  to  the  feeding  of  the  cows.  The  men  inoculated  from 
the  Hendon  cows  showed  elongated  ulcers,  exactly  like  those 
on  the  cows'  teats.  Beferring  to  the  use  of  ice  chests,  he  said 
housewives  did  not  like  meat  that  had  been  in  ice,  as  it  made 
it  uncertain  in  the  cooking.  Tubercle  bacilli  are  found  in 
izulk  in  large  numbers.  Dr.  Cooper  was  right  in  his  state- 
nients  about  vegetation.    He  blamed  landlords  for  not  seeing 


242  TUBEBCULAR  LARYNGITIS.    ^B^^l.^S^iIm 

to  this.  He  was  glad  Dr.  Cooper  had  spoken  strongly  on  the 
Hendon  investigation.  All  the  milk  infected  did  come  from 
one  dairy ;  but  the  point  was  that  no  scarlatina  occurred  from 
the  forty  other  cows  sent  to  other  dairies.  Dr.  Cooper  asked 
about  the  detection  of  tubercle.  There  are  many  cows  found 
tuberculous  post  mortem^  when  there  is  nothing  to  show  it 
during  life.  Tuberculous  cows  could  be  fattened.  Bacilli  are 
found  more  in  the  organs  than  in  the  flesh.  It  is  only  when 
far  gone  that  the  flesh  is  affected.  Dr.  Burford  had  said  (h&t 
milk  might  be  boiled,  but  he  did  not  think  boiled  milk  was 
very  palatable.  He  thought  rich  people  required  protectmg 
as  much  as  the  poor.  Regarding  veal,  he  thought  on  the 
Continent  calves  were  not  slaughtered  at  so  early  an  age  as 
with  us.  The  tape-worm  in  Dr.  Blackley's  case  probably 
came  from  the  excreta  of  a  dog.  Tuberculosis  is  foond 
among  cows  of  the  short-horn  breed  more  than  any  other 
breed,  while  the  Ayrshire  breed  are  almost,  if  not  entirely, 
&ee  from  the  disease.  The  reason  generally  assigned  for  its 
prevalence  among  short-horns  is  that  the  most  noted  and 
fashionable  sires  were  tainted  with  tuberculosis,  and  so 
handed  down  the  seeds  of  the  disease  from  generation  to 
generation. 

A  CASE  OP  TUBERCULAE  LARYNGITIS:  TRACHE- 
OTOMY PERFORMED,  FOLLOWED  BY  CESSA- 
TION OP  THE  DISEASE. 

By  Alexander  H.  Croucher,  M.D.  &  CM.,  Edin. 

I  have  called  this  case  one  of  tubercular  laryngitis,  and 
I  think  the  account  which  I  append  of  the  morbid  pro- 
cesses which  occurred  during  the  progress  of  the  disease 
will  justify  me  in  so  classifying  it ;  it  seems  to  be  one  in 
which  the  primary  seat  of  the  disease  was  in  the  pharynx, 
in  fact  commencing  as  a  tubercular  pharyngitis  it  ended 
in  a  tubercular  laryngitis. 

The  interest  of  the  case  centres  in  the  fact  that  a  cure 
seemei  to  have  been  brought  about  by  the  operation  of 
tracheotomy,  which  no  doubt  in  allowing  the  diseased 
larynx  rest,  by  diverting  the  air  from  pursuing  its  natural 
course  through  the  larynx,  has  brought  vU  medkatru 
natura  to  the  front,  with  a  cure  resulting  thereby. 

Tubercular  manifestation  in  the  pharynx  is  much  naore 
rarely  seen  than  in  the  larynx.  Guttman  and  Gublinski 
are  of  opinion  that  one  per  cent,  of  tuberculous  patients 
have  the  disease  in  the  palate  and  pharynx,  whust 


M^ri^J^TS^    TUBEKCULAR  LARYNGITIS.       24S 

another  observer  notes  only  one  case  occurring  in  the 
pharynx  out  of  1,817  cases  of  general  tuberculosis. 

According  to  Dr.  Lennox  Browne,  Heinze  states  "that 
among  4,486  consecutive  autopsies  made  at  the  Patho- 
logical Institute  of  Leipzig,  pulmonary  phthisis  was  the 
cause  of  death  in  1,226  instances,  and  of  these  51.8  per 
cent,  had  ulcerations  in  the  larynx ; "  and  he  further  says 
"  that  ulcerations  were  never  found  with  tuberculosis  of 
other  organs  when  the  lungs  were  intact.*' 

The  proportion  of  males  to  females  affected  by  this 
disease  is  said  to  be  about  three  to  two.  The  onset  of 
pharyngeal  tuberculosis  generally  occurs  late  in  the 
coarse  of  pulmonary  phthisis ;  this  case  here  narrated 
Beems  to  be  one  of  the  exceptions  to  the  general  rule, 
occurring  as  it  did  without  obvious  lung  trouble. 

Dr.  Lennox  Browne,  in  his  work  on  The  Throat  and 
Nose  and  their  Diseases,  mentions  two  cases  of  tubercular 
pharyngitis  occurring  two  and  three  years  previously  to 
any  puhnonary  disease  showing  itself.  This  author  says, 
in  speaking;  of  tubercular  pharyngitis,  '*  its  occurrence  as 
a  primary  manifestation  of  the  tubercular  diathesis  is  at 
least  doubtful,  but  still  as  possible  as  that  of  tubercular 
laryngitis.  All  arguments  to  this  effect  are  met  by  the 
fact  that  no  case  is  recorded  of  a  patient  dying  with 
either  disease  in  which  the  lungs  are  found  healthy,  and 
in  this  connection  we  can  but  admit  that  the  ear  is  less 
likely  than  the  eye  to  detect  early  manifestations.  My 
own  belief  is  in  accord  with  that  of  Schech,  who  has  been 
forced  to  the  conclusion  that  the  pharynx  is  only  appa- 
rently attacked  primarily ;  in  other  words,  that  prior  to 
the  outbreak  of  pharyngeal  tuberculosis,  tubercular 
deposits  exist  in  other  organs,  although  the  fact  cannot 
always  be  demonstrated." 

This  case  is  one  in  which  the  contention  above 
mentioned  can  only  be  definitely  settled  by  a  necropsy, 
which  it  ifl  to  be  hoped  may  be  long  deferred,  as  seems 
very  likely. 

In  discussing  the  advisabDity  of  tracheotomy  in 
tuberculous  laryngitis.  Dr.  Lennox  Browne  says :  **  I  am 
not  at  all  prepared  to  admit  that  absolute  rest  of  the 
larynx  is  likely  to  follow  tracheotomy  on  a  tuberculous 
patient  whatever  the  stage.  On  the  contrary,  in  no 
disease  is  a  tube  so  ill-borne  or  so  liable  to  set  up 
increased  inflammatory  irritation  and  ulceration.    More- 


244  TUBEKCULAR   LABYNGITIS.      ^^S^^^^h^- 

over,  in  no  disease  is  more  likely  to  occur  the  untoward 
risk  of  what  we  may  call  collapse  of  the  larynx — a  not 
unfrequent  result  of  tracheotomy,  which  was  first  pointed 
out  by  Listen,  and  has  since  been  insisted  on  by 
Whistler.  Nor  can  I  agree  that  the  larynx  can  be  more 
eflfectively  treated  by  topical  measures  after  tracheotomy 
than  before,  for  on  account  of  the  disposition  to  collapse 
just  mentioned  the  larynx  is  almost  invariably  far  more 
difficult  to  examine,  as  also  to  be  treated  internally, 
after  a  tracheotomy  tube  has  been  introduced." 

"  I  must,  therefore,  with  all  respect  to  the  many  able 
laryngologists  who  advocate  tracheotomy  in  tubercular 
laryngitis,  offer  my  uncompromising  opposition  thereto, 
hardly  excepting  cases  of  urgent  dyspnoea,  in  which 
it  is  considered  as  permissible  by  Solis-Cohen,  Morell 
Mackenzie,  and  Erishaber.  I  certainly  would  not 
perform  it  except  at  the  request  of  the  patient  or  his 
friends,  and  not  even  then  without  very  plainly  stating 
that,  although  death  by  actual  suffocation  might  be 
thereby  averted,  life  would  hardly  be  prolonged,  and 
that  only  at  some  considerable  expense  of  suffering  and 
lingering  distress." 

I  am  not  in  a  position  to  combat  these  argmnents, 
and  will  merely  relate  now  the  following  case  as  showing 
that  in  this,  as  in  other  diseases,  no  inviolable  rule  as  to 
treatment  can  be  laid  down.  The  ultimate  result  of  this 
case  still  remains  one  which  the  future  only  will  reveal, 
but  as  it  is  now  fifteen  months  since  tracheotomy  was 
performed,  the  prognosis  may  at  any  rate  be  considered 
favourable,  as  the  patient's  general  health  is  now 
excellent  and  the  local  trouble  nil. 

Wm.  B.,  8Bt.  13,  an  intelligent  lad,  came  under  mj 
care  at  the  Eastbourne  Homoeopathic  Dispensary  on 
August  28th,  1888.  By  occupation  he  was  an  errand 
boy.  Patient  complained  of  sore  throat,  which  he  said 
had  commenced  in  the  previous  March,  producing 
gradually  difficulty  and  pain  in  swallowing,  with  great 
accumulation  of  mucus  in  the  throat,  also  much  hacking 
cough.  All  these  symptoms,  with  loss  of  flesh,  were 
increasing,  and  he  applied  for  relief. 

History. — At  the  present  time  patient's  mother  iB 
suffering  from  advanced  carcinoma  uteri ;  there  is  |jo 
ascertainable  history  of  phthisis  in  any  members  of  the 
family ;  he  has  one  brother  and  two  sisters  who  appeft^ 


bH^SSTiS^    tubebcular  lakyngitis.  245 

to  be  enjoying  good  health ;  he  has  always  been  able  to 
get  sufficient  food,  and  daring  the  day  time,  at  any  rate, 
had  the  opportunity  of  getting  plenty  of  fresh  air  when 
following  his  occupation,  which  also  necessarily  exposed 
lum  to  the  vicissitudes  of  our  climate.  His  previous 
health  has  been  fair  since  he  got  through  the  first  three 
years  of  his  existence  ;  he  was  a  delicate  baby,  and  was 
daring  that  period  rickety,  his  legs  having  been  crooked, 
his  head  large,  and  the  fontanelles  late  in  closing. 

When  seen  on  August  28th,  1888,  the  following  was 
the  lad's  condition :  he  was  rather  short  for  his  age,  his 
muscular  development  below  the  average,  and  the 
muBcIes  flabby ;  he  was  thin  in  all  parts  except  his  face, 
which  was  of  the  square  type.  The  whole  head  was 
large,  the  forehead  protuberant  from  excessive  ossifica- 
tion of  the  centres  of  the  frontal  bone,  the  vertex 
flattened,  and  what  had  been  the  site  of  the  anterior 
fontanelle  presented  a  depression ;  there  was  considerable 
expansion  at  the  eminences  of  the  parietal  bones,  the 
teeth  were  in  fairly  good  condition,  and  evidenced  no 
signs  of  notching,  as  described  by  Hutchinson.  The  face 
was  pale  and  pasty  looking,  and  patient  complained  of 
general  weakness  and  languor  with  perspiration  on  the 
least  exertion. 

The  tongae  was  fairly  clean,  appetite  good,  there  was 
odynphagia,  but  not  dysphagia ;  bowels  acted  regularly, 
there  was  no  vomiting. 

On  examining  the  throat,  which  was  a  very  difficult 
matter  (as  the  use  of  a  spatula,  or  introduction  of  any 
Kke  instrunaent  into  the  throat  invariably  brought  on 
retching  and  coughing),  the  following  was  seen :    The 
mucous  membrane  lining  the  buccal  cavity  was  pale  in 
colour,  at  the  back  part  of  the  throat  was  a  great  accu- 
mulation of  tenacious  yellowish-white  mucus,  coating  the 
tonsils,  palate,  and  posterior  pharyngeal  wall ;  on  getting 
rid  of  this  secretion  by  rinsing  the  mouth,  the  parts  at 
the  back  of  the  throat  were  seen  to  be  of  an  angry  red 
colour,  the  tonsils  enlarged  and  ulcerated,  the  palate 
especially  at  its  posterior  border  thickened  and  nodular, 
the  uvula  enlarged  and  apparently  somewhat  (edematous, 
the  pharyngeal  wall  irregularly  swollen,  raw  looking,  and 
coated  with  secretion  as  described  above.     The  voice  was 
thick  in  character,  but  not  hoarse.    Examination  of  the 
heart  and  lungs  revealed  nothing  abnormal  beyond  the 


246  TUBERCULAR    LARYNGITIS.     ^SSS^.^S^ii^! 

heart's  action  being  rapid.  The  conformation  of  the 
chest  was  good,  there  being  no  narrowing.  In  the 
mornings  the  efforts  to  get  rid  of  the  accumulation  of 
secretion  caused  hawking  and  retching. 

Perspirations  at  night  were  present  and  the  tempera- 
ture was  raised. 

Patient  was  given  iodide  of  arsenic  8x  nt  iy.  t.d.,  oleum 
inorrhuoe  5  i  nocte  maneque,  and  told  to  gargle  his 
throat  with  salt  and  water.  He  was  not  very  skilful  in 
doing  this,  and  never  managed  it  well  on  account  of  the 
retching  caused  thereby.  He  was  ordered  increased 
nourishment,  extra  milk,  eggs,  and  beef-tea. 

Sept.  18th. — Much  the  same  condition.  To  gargle 
with  iodine  and  water,  5  drops  of  the  B.  P.  tincture  to 
half-a-tumblerful  of  warm  water.  His  weight  at  this 
time  was  5  st.  6  lb. 

Oct.  2nd. — ^Reports  having  lost  2  lbs.  in  weight,  but 
feels  better  in  himself.  Cough  is  troublesome,  of  a 
hacking,  irritating  character. 

Oct.  9th. — KaL  bichrom.  2x  nx  i.  t.d. 

Oct.  16th. — ^Eep.  kali,  bich.,  and  sulphur  8x  ni  iv.  to  be 
given  morning  and  night  in  addition. 

Oct.  30th. — Potass  chlor.  given  internally  and  as  a 
gargle. 

Nov.  18th. — Syrup  hypoph.  co.  (Fellows),  half-a- 
teaspoonf ul  in  water  three  times  a  day,  and  throat  to  be 
painted  with  glyceriiie  of  alum  night  and  morning.  No 
improvement  noticed  in  the  condition  of  the  throat. 

Dec.  6th. — Glycerine  of  Hydrastis  l-6th  ordered  for 
painting  the  throat. 

Dec.  12th. — The  uvula  appears  to  be  partially  eaten 
away  ;  the  part  remaining  is  thickened  annularly.  All 
the  food  now  taken  is  soft  in  character  on  account  of  the 
severe  pain  caused  in  swallowing.  All  meat  is  minced 
prior  to  swallowing  it.  Maltine  ordered.  Mercur. 
biniod.  8x  grs.  v.  t.d.     Discharge  more  purulent. 

Jan.  8rd,  1889. — ^As  regards  the  uvula,  non  est 
inventus.    Merc,  bifiiod.  and  glycerin  hydrastis  repeated. 

On  the  next  day  patient  left  Eastbourne  and  went 
away  to  Brenchley  for  five  weeks'  country  change  of  air. 

Feb.  19th. — Has  returned  from  the  country,  and 
says  his  appetite  has  improved,  and  that  he  has  rather 
less  pain  in  swallowing,  has  rather  a  healthier  appear- 
ance.    The  throat  looks  in  much  the  same  ulcerated 


iS^fiSflirS^   TUBEBCULAR  LARYNGITIS.  247 

eonditioiiy  quajitities  of  tenacious  yellow  mucous  hanging 
around,  which  is  now  tinged  with  blood.  The  odour  of 
the  breath  is  unpleasant,  but  there  is  no  fcetor,  nor  has 
there  been  any  during  the  course  of  the  illness.  The 
cough  is  very  troublesome  and  the  voice  hoarse.  The 
lymphatic  glands  of  the  neck  are  slightly  enlarged. 

In  the  early  part  of  March  patient  was  admitted  into 
St.  George's  Hospital,  London,  and  remained  there  till 
Jane  5th,  when  he  went  to  a  convalescent  home  at 
Wimbledon.  During  all  this  time  he  had  been  losing 
ground  rather  than  gaining.  Dyspnoea  gradually  became 
worse,  and  while  at  Wimbledon  he  lost  his  voice.  He 
was  re-admitted  into  St.  George's  about  the  middle  of 
July,  and  returned  to  Eastbourne  in  the  beginning  of 
August. 

Twice  daring  his  stay  in  St.  George's  Hospital  (on 
account  of  the  dyspncea)  instruments  were  got  together 
for  the  performance  of  tracheotomy,  but  the  urgent 
symptoms  passed  away  and  the  operation  was  not  done. 
Treatment  there  consisted  in  sprays,  inhalations,  and 
applications  appUed  to  the  larynx  by  a  brush.  For  the 
odynphagia  he  sucked  cocaine  lozenges.  While  in  the 
hospital  be  was  said  to  have  had  congestive  symptoms 
in  the  right  infraclavicular  region. 

The  surgeon  under  whose  care  Wm.  B.  was  while  in 
St.  George's  Hospital,  has  courteously  given  me  a 
description  of  the  laryngoscopic  appearances  as  ob- 
servable in  March,  1889,  which  I  append  :  **  Arytsenoids 
and  ventricular  bands  and  epiglottis  irregularly  thickened, 
presenting  a  nodular  appearance.  A  few  days  later, 
laryngoscopic  examination  under  cocaine,  ventricular 
bands  irregularly  thickened,  arytaenoids  in  similar  con- 
dition, only  the  anterior  half  of  the  left  vocal  cord  visible, 
rest  of  it  hidden  by  the  swoUen  ventricular  band.  Left 
vocal  cord  paralysed  in  the  cadaveric  position,  on  the 
right  side  the  vocal  cord  can  be  seen  iq  phonation 
appearing  from  beneath  the  nodular  masses  on  the  ven- 
tncular  band." 

On  August  7th,  1889,  Wm.  B.  again  came  under  my 
care.  His  general  appearance  had  much  altered  for  the 
worse  since  I  saw  him  five  months  before ;  he  was 
emaciated,  his  eyes  sunken,  the  expression  anxious,  skin 
hot  and  dry,  and  pulse  rapid.  Dyspnoea  was  great,  he 
could  walk  with  great  difficulty,  tongue  foul,  great  accu- 


248  TUBERCULAB    LARYNGITIS.    "^S^.^Smot! 

mulation  of  muco-pus  about  the  fauces.  The  veins  on 
chest  numerous  and  distended,  cough  violent,  and  noc- 
turnal sweats  present ;  altogether  he  was  in  a  distressing 
condition.  There  was  marked  cyanosis  increased  on  the 
least  exertion,  the  power  of  vocalisation  was  reduced  to 
a  whisper.  With  all  his  sufferings  he  never  murmured^ 
His  mother  told  me  that  at  times  she  thought  he  could 
not  live  another  minute,  the  breathing  was  so  bad  at 
times,  and  that  his  nights  were  awful.  I  told  the  mother 
to  send  for  me  when  a  very  bad  attack  came  on,  as 
something  might  be  done. 

On  August  9th,  about  9  p.m.,  I  received  an  urgent 
message  to  come  at  once  as  Wm.  B.  was  dying.  I  went 
to  the  patient's  home,  and  found  him  lying  on  a  couch 
struggling  for  breath,  with  his  mother  fanning  him. 
The  dyspnoea  came  on  in  paroxysms,  and  during  the 
intervals  patient  lapsed  into  a  semi-conscious  condition, 
the  breathing,  though  quick,  becoming  very  shallow. 
The  skin  was  livid,  with  a  cold  damp  sweat  thereon,  the 
extremities  cold.  The  parents  having  acquiesced  that 
the  windpipe  should  be  opened,  I  procured  a  fly  and  took 
the  lad  to  the  Leaf  Homoeopathic  Cottage  Hospital,  and 
with  the  assistance  of  Dr.  Walther  performed  the  high 
operation  of  tracheotomy.  Cocaine  was  injected  into  the 
skin  over  the  upper  part  of  the  trachea,  and  Dr.  Walther 
administered  chloroform.  There  was  very  little  difficulty 
in  the  operation,  and  that  only  caused  by  the  struggling 
movements  in  the  efforts  to  breathe.  After  the  trachea 
was  opened  the  relief  was  immediate,  the  long-drawn 
inspirations  showing  (if  I  may  use  the  expression)  how 
hungry  the  respiratory  centres  were  for  a  larger  supply 
of  oxygen  than  had  been  doled  out  to  them.  Scarcely 
any  blood  was  lost.  For  several  days  following  the  lad 
was  in  a  critical  condition  from  weakness  and  prostra- 
tion, but  the  unceasing  care  and  attention  of  our  matron 
brought  him  through. 

On  August  10th  the  temperature  was  101°  P.,  and  for 
the  succeeding  month  varied  from  99°  F.  to  100°  P. 
The  pulse  on  August  10th  was  140  beats  per  minute,  and 
varied  from  100  to  120  for  the  next  three  weeks,  when  it 
fell  to  80  and  remained  thereabouts.  The  expectoration, 
which  was  excessive  for  a  week  and  required  constant 
removal,  gradually  diminished,  and  from  being  purulent 
and  bloody  became  mucoid  and  clear. 


r 


£S^53T!aSf"    TUBEBCULAB   LABYNGITIS.  249 

In  the  first  inBtance  a  bivalve  tracheotomy  tabe  was 
used,  bnt  as  this  caused  irritation,  and  some  discomfort 
on  swallowing,  a  Durham's  tube  was  introduced  on 
August  22nd,  and  retained  with  perfect  comfort,  and 
maeh  less  cough  followed  its  introduction.  Aconite, 
phosphorous,  and  arsen.  iod.  were  the  medicines  used 
after  the  operation. 

Patient  was  discharged  on  September  7th,  his  general 
appearance  having  wonderfully  improved. 

During  the  early  part  of  this  year  patient  was  re- 
admitted fort  strumous  ophthalmia  of  right  eye,  which 
was  rather  intractable ;  he  was,  however,  cured  in  a 
month. 

In  June  of  this  year  (1890)  the  cervical  glands  were 
enlarged  on  the  right  side,  and  he  looked  ill.  About  this 
time,  however,  he  got  some  light  work  to  do,  and  with  it 
good  food,  and  in  a  short  time  he  again  put  on  flesh, 
and  has  reoaained  well  since.  He  is  able  to  be  out  in  all 
weathers,  and  can  run  a  short  distance  without  getting 
very  much  out  of  breath. 

The  tube  is  removed  and  cleaned  once  in  three  or 
four  months,  but  he  is  unable  to  do  without  it.  I 
examined  the  patient  on  October  28th,  1890,  and  then 
found  him  in  the  following  condition : — ^Voice  hoarse  and 
husky,  but  more  distinct  than  four  months  ago ;  no  pain 
in  throat  on  speaking  nor  on  swallowing. 

Breathing  only  slightly  embarrassed  on  exertion. 
Occasional  cough,  but  only  a  little  clear  mucus  is  got 
rid  of ;  has  had  some  severe  colds  in  the  head  lately,  but 
no  chest  trouble ;  no  blood  has  been  seen  in  the  expec- 
toration for  nine  months. 

Patient  has  to  chew  his  food  carefully,  and  swallow 
both  solids  and  fluids  slowly,  or  else  sometimes  a  little 
passes  into  the  larynx  and  causes  choking.  He  has 
found  that  hot  liquids  excite  a  little  cough  from  setting 
up  a  tickling  sensation. 

There  is  no  dulness  in  the  chest,  and  the  veins  on  the 
surface  are  only  slightly  visible.  The  cervical  glands  are 
a  little  swollen.    His  weight  is  six  stones,  nine  pounds. 

Examination  of  the  throat  shows  a  small  nipple-like 
elevation  where  the  uvula  was  originally  placed,  the 
mucous  membrane  is  of  normal  colour,  the  interval 
l)etween  the  posterior  pillars  of  the  fauces  is  narrowed, 

Vol  35,  No.  4.  T 


250  A   CLINICAL   CASE.        ^^H^^XS?^ 


Beriew,  Apnl  1,  IBSL 


apparently  from  contraction  ;  there  are  no  irregularities 
of  the  surface  to  be  seen. 

With  the  laryngoscope  the  vocal  cords  are  seen  to 
move,  the  right  with  more  freedom  than  the  left  one.  In 
the  inter-arytsenoid  fissure,  nearer  to  the  right  than  the 
left  vocal  cord,  is  a  small  nodule  of  whitish  colour  ;  the 
epiglottis  looks  shrunken,  and  has  lost  much  of  its  sub* 
stance,  so  that  its  efficiency  as  a  valve  is  partly  lost 
The  little  secretion  that  is  seen  is  simply  mucus.  The 
mucous  membrane  looks  normal  in  colour.  Beyond 
removing  and  cleaning  the  tube  occasionally,  no  treat* 
ment  is  going  on  at  present,  but  I  have  advised  him  to 
begin  cod's  liver  oil  now  that  the  weather  is  colder. 

The  stenosed  condition  remaining  in  the  larynx  is,  I 
apprehend,  incurable. 

Eastbourne,  November  6th,  1890. 

A  CLINICAL  CASE. 
By  E.  W.  Berridge,  M.D., 

Member  and  Corresponding  Secretary  of  the  International 

Hahnemannian  Ansociation. 

Case  of  Gleet  cured  by  Natr,  Mur.,  Cantlu,  Rhns.f  Merc. 

1870,  Oct.  6th. — Mr.  0.,  aged  23,  consulted  me  for  a 
chronic  gleet.  He  had  gonorrhoea  two  years  previously ; 
it  was  treated  allopathically,  but  a  gleet  remained.  He 
then  used  injections,  which  stopped  the  gleet  for  three 
or  four  days  only.  Afterwards  he  used  stronger  injec- 
tions, consisting  of  nitrate  of  silver ;  these  caused  great 
pain,  chordee,  and  the  formation  in  the  urethra  of  three 
lumps,  which  subsequently  became  one.  He  then  used 
a  catheter  daily  for  six  weeks,  after  which  the  lump 
disappeared.  Since  then  he  has  had  gleet  at  times^ 
sometimes  lasting  three  months  at  a  time.  Inguinal 
glands  hard  and  enlarged  ever  since  the  gonorrhoea. 
Has  only  bad  gonorrhoea  once,  and  never  syphilis.  His 
present  symptoms  are:  slight  milky  discharge  from 
urethra  since  July;  uncontrollable  urging  to  urinate 
every  two  or  three  hours  for  last  three  days  (this  first 
appeared  after  the  nitrate  of  silver  injection,  and  then 
came  on  every  half  hour  for  six  weeks) ;  urinates  only  a 
little  at  a  time  ;  slight  uneasiness  at  end  of  urethra  on 


J^^ST^        A  CLINICAL   CASE.  251 

walking ;  itching  in  urethra  daring  urination ;  if  he 
attempts  to  hold  the  nrine  all  the  muscles  of  the  body 
feel  teiisey  and  relax  again  when  the  urine  is  passed ; 
when  the  urging  comes  on  he  cannot  retain  the  urine 
more  than  three  or  four  seconds;  has  to  rise  eyery 
night  to  urinate ;  drinking  alcohol  increases  the  gleet ; 
ingoinal  glands  hard  and  enlarged ;  injections  of  arrow- 
root  stop  the  discharge  temporarily,  but  increase  the 
itching. 

Diagnoiis  of  the  Remedy. 

Itching  in  urethra  during  urination.  Awbr.j  graph., 
b/cop.y  niezeTy  natr.  mur.y  nux  vom.,  oleum  an.y  petrol., 
tanap.y  thuja. 

Frequent  urging,  with  scanty  discharge  of  urine. 
Jiatr.  mur.y  nux  vom.y  oleum  an.,  petrol.^  sarsap. ;  and 
many  others  which  have  not  the  former  symptom. 

Urethral  pain  on  walking.  Aeon.,  alum.,  heliad., 
lerh.,  chelid.j  ignat.,  mere,  corr.,  mezer.,  natr.  mur., 
strych.,  thuja. 

White  discharge  from  urethra.  Canth.,  caps.,  cinnab., 
copaib.y  cupr.  ars.,  ferr.,  kali  c,  kobalt.,  laches.,  mere, 
natr.  mur.,  nitr.  ac.,  petrosel.,  puis.,  sep.,  sulph.,  tradesc, 
tkuja.,  zinc.  Milky  discharge  is  so  described  imder 
copaib.,  kali  c,  natr.  mur.,  petros.,  sep. 

This  reduces  the  list  of  remedies  to  natr.  mur.,  which 
also  has  the  nocturnal  urination  and  swelling  of  inguinal 
glands,  though  the  hardness  has  not  yet  been  recorded 
under  that  remedy.  The  tension  of  the  muscles  on 
attempting  to  retain  the  urine  is  a  very  characteristic 
symptom,  but  is  not  as  yet  to  be  found  in  the  Materia 
Medica.  Natr.  mur.  is  also  the  great  antidote  to  crude 
doses  of  nitrate  of  silver. 

I  prescribed  one  dose  of  natr.  mur.  1  m.  (Jenichen), 
and  ordered  him  to  abstain  strictly  absque  Baccho  et 
yenere,  which,  however,  he  did  not  do. 

Oct.  ISth. — Improved  next  day.  Uneasiness,  itching, 
and  tension  all  gone  ;  less  discharge  and  urgency ;  has 
only  once  had  to  rise  at  night  to  urinate ;  can  hold  urine 
easily  for  four  hours ;  glands  unchanged ;  can  now  drink 
sherry  and  porter  without  increasing  the  gleet. 

Oct.  22nd. — Discharge  the  same  ;  urging  nearly  gone, 
but  increased  by  beer  or  wine  ;  has  not  had  to  rise  to 
urmate.    Since  taking  the  medicine  stool  more  scanty 

T— 2 


■^ 


252  A   CLINICAL   CASE.        ^?^^ISSi?m. 


Beviflw,  April  1,1811. 


than  usnal  (pathogenetic  action  of  natr.  mur.)  -;  gluids 
smaller,  no  pain  therein,  even  on  violent  exercise; 
alcohol  increases  the  gleet,  but  to  a  less  extent  than 
before. 

Oct.  Slst. — Urging  less,  not  increased  by  wine,  stool 
as  at  last  report ;  glands  in  left  groin  are  smaller,  in 
right,  natural ;  can  easily  hold  urine  six  hours ;  disoharge 
for  last  three  days  rather  increased  and  more  sticky ; 
when  urinating  smarting  in  urethra,  about  an  inch 
from  extremity ;  for  a  few  days  stream  of  urine  has  been 
double. 

As  the  improvement  seemed  to  have  nearly  ceased, 
and  new  and  important  symptoms  had  arisen,  a  new 
remedy  had  to  be  selected. 

Diagnosis  of  the  Remedy. 

Stream  double.  Argent,  nitr.y  cannab.,  canth.,  petrol^ 
rhvs.y  thuja. 

Discharge  viscid.  Canth. ^  kali,  bichr.,  mezer,  natr, 
mur.,  selen.y  thuja. 

This  reduces  the  list  to  canth.  and  thuja.  Both  of 
these  have  smarting  in  urethra  during  urination. 
The  present  symptoms  giving  no  further  clue  to  the 
remedy,  I  examined  those  which  had  previously  existed. 
Both  remedies  had  swelling  of  urethra,  but  only  under 
canth.  is  recorded,  776,  "  urethra  swollen  internally, 
the  urethral  swelling  of  thuja  being  situated  at  the  ex- 
tremity. (See  symptoms  1620,  1622.)  I  therefore 
prescribed  one  dose  of  cantharis  1  m.  (Jenichen). 

Nov.  11th. — No  urging  ;  left  inguinal  glands  rather 
painful  on  moving  ;  discharge  has  been  much  better,  but 
is  now  increased  from  indulgence  in  ale,  wine  and  toba^ ; 
smarting  less  severe  and  less  often ;  stream  not  so  often 
double. 

Nov.  19th. — Smarting  less ;  stream  double  at  tirn^s ; 
no  pain  in  groin ;  discharge  much  more  watery ;  feels  a 
hard  swelling  in  urethra.  Here  was  an  old  symptoDi 
returning,  coincidently  with  an  improvement  in  the 
more  recent  symptoms.  Usually  this  is  a  sign  that  the 
remedy  is  attackmg  the  disease  at  its  deepest  roots,  and 
ought  therefore  to  be  allowed  to  act  without  interference 
of  any  kind ;  but  in  this  case  I  concluded  that  it  ^^ 
due  to  his  dietetic  indiscretions,  and  that  an  appropna*^ 
remedy  should  be  selected  at  once,  more  especially  as 


fSSS^SSTSS^        A  OLDaCAL   CASE, 263 

canthy  being  neither  antipsoric,  antisyphilitic,  nor  anti- 
qrooticy  IB  a  remedy  of  comparatively  short  and  saperficial 
action. 

Diagnosis  of  the  Remedy. 

Swelling  of  interior  of  urethra.  Canth.,  led.,  mere, 
nitr.  ac.  rhus.  Stream  doable;  canth.  rhus.  (and  the 
four  others  already  quoted,  which  have  not  the  swelling) . 

As  eanth,  had  just  been  prescribed,  rhtis.  remained  the 
only  simillimum,  and  I  gave  one  dose  of  rhtts.  tox.  2  m. 
(Jenichen). 

Nov.  26th. — Oh  20th  and  21st  discharge  increased 
(had  drunk  spiced  ale) ;  since  then  much  less,  and  has 
ceased  entirely  at  times.  No  smarting  since  21st; 
stream  not  double ;  pain  at  times  in  groin  on  walking ; 
during  last  week  has  smoked  and  taken  more  wine  than 
usual,  but  nevertheless  is  better. 

Dec.  8rd. — Discharge  unchanged ;  does  not  feel  the 
lump ;  stream  double  for  the  last  week ;  for  a  few  days 
smarting  in  the  urethra  near  the  glans  on  beginning  to 
urinate ;  three  days  ago  penis  felt  very  hot  to  the  touch, 
but  not  subjectively.  Here  were  two  new  symptoms, 
and  as  the  discharge  persisted  and  the  double  stream 
had  recurred,  it  showed  that  the  last  remedy  had  com- 
pleted its  work,  and  could  do  no  more. 

Diagnosis  of  the  Remedy. 

Heat  of  penis.  Aur.  sulph,,  beU.j  canth.,  caust.,  cocc.  c, 
^phr.,ferr.,jacar.,  mere,  jnezer.^plat.  mur.fVhus.  v.,  sepia. 

Urethral  pain  on  commencing  to  urinate.  Arsen., 
conn.,  canth.*  caust.,  clem.,  daphn.  ind.,ferr.,  iris,  vierc., 
it^c.  sol.,  natr.  ars.,  plumb.,  prun.  sp.,  secal.  (Smarting 
on  commencing  to  urinate  is  only  under  plumA.  and 
seed.). 

This  eliminates  all  except  canth.,  caust.,ferr.,  mere.,  of 
which  eantk.  had  already  been  giveu,  and  of  the  remain- 
ing three  only  m>erc.  has  the  swelling  in  urethra,  which 
formerly  was  an  important  feature  of  the  case.  I  gave 
one  dose  of  m^rc.  v.  200  (Lehrmann). 

Bee.  10th. — ^Discharge  has  ceased  at  times ;  is  no  worse 
to-day,  in  spite  of  drinking  all  kinds  of  wines  last  night, 
andcUuicing  from  9  p.m.  to  4  a.m.;  the  smarting  ceased, 
but  returned  to-day,  lasting  nearly  all  the  time  of  urina- 

*  In  mother  oaee  of  gonorrhoea,  I  oured  a  scalding  pain  in  urethra, 
imr  root  of  penis,  on  beginning  to  urinate,  with  one  dose  of  cantkaris 
Im.    (Jenichen.) 


254 A  CLINICAL   CASE,        '^j^,^^5g?lS^ 

tion  (probably  the  result  of  "mixing  his  liquors "); 
stream  not  double;  stifiness  in  groins  at  times  when 
walking  fast. 

Dec.  17th. — Discharge  less,  ceases  at  times  ;  smarting 
less  ;  stream  double  at  times  if  bladder  is  not  full ; 
groins  unchanged ;  still  some  swelling  of  glands. 

Dec.  29th. — Discharge  very  slight  ;  no  smarting ; 
stream  not  so  double  ;  groins  better. 

Patient  now  considered  himself  suflScientlv  cured  to 
cease  consultation,  and  so  did  not  return.  I  did  not  see 
him  till  Nov.  11th,  1881,  when  he  consulted  me  for 
gravel.  He  then  informed  me  that  the  old  symptoms 
soon  ceased  entirely,  without  further  treatment,  and 
never  returned. 

Comments. 

(1).  This  case  shows  the  evil  effect  of  injections,  so 
frequently  resorted  to  by  unscientific  physicians.  These 
8oi-disant  pathological  prescribers  are  really  ignorant  of 
true  pathology,  or  they  would  recognise  the  fact,  dis- 
covered by  Hahnemann,  afterwards  further  elaborated 
by  Boenninghausen  and  Kent,  and  now  admitted  by  some 
of  the  more  advanced  of  the  allopathic  school,  that  this 
disease  is  not  always  a  merely  local  inflammation,  but 
an  external  manifestation  of  a  deep-seated  and  long- 
lasting  miasm  or  diathesis,  to  which  Hahnemann  gave 
the  generic  name  of  sycosis.  This  being  so,  how  can 
local  treatment  cure  ?  It  may  sometimes,  by  virtue  of 
a  crude  homoeopathicity  to  the  local  condition,  relieve 
the  more  acute  suffering,  but  it  leaves  behind  trouble- 
some chronic  symptoms ;  and  what  is  worse  it  frequently 
causes  a  complete  suppression  of  the  disease,  resulting 
in  a  metastasis  to  more  internal  and  vital  organs,  thereby 
infecting  the  entire  system,  and  producing  a  condition 
of  ill-health,  which,  unless  the  strictest  homceopathic 
treatment  be  resorted  to  in  time,  continues  during  the 
lifetime  of  the  patient,  terminating  in  a  painful  death. 
My  experience  in  the  treatment  of  both  gonorrhoea  ana 
syphilis  has  been  that  the  disease  is  very  easily  cured 
homoeopathically,  provided  it  has  not  been  suppressed 
or  complicated  by  improper  treatment.  In  these  cases 
it  is  far  more  difficult  to  cure,  and  a  long  period  must 
often  elapse  before  the  combined  effects  of  the  disease 
and  the  doctor  can  be  removed  and  the  patient  restored 
to  perfect  health.    It  can,  however,  be  done  with  care 


S^SnT^*'        A   OLINIOAIi   CASE.  255 


,  April  1. 18B1. 


and  patience ;  and  in  these  cases  the  improvement  in 
the  health  of  the  patient  is  generally  accompanied  by 
a  temporary  return  of  the  suppressed  symptoms,  which 
in  turn  disappear  permanently  under  the  action  of  the 
homoeopathic  remedy,  which  finally  eradicates  the 
disease  root  and  branch. 

(2.)  The  value  of  what  Boenninghausen  called  the 
Anamnesis,  or  the  past  condition  of  the  patient,  is  shown 
by  this  case.  It  sometimes  happens  that  two  or  more 
medicines  seem  equally  indicated  by  the  present  symp- 
toms. In  such  cases  we  should  carefully  examine  the 
past  ^mptoms,  and  also  the  hereditary  pre-dispositions ; 
these  will  then  decide  the  choice.  Hahnemann's  grand 
doctrine  of  the  treatment  of  chronic  diseases,  which  he 
divided  into  the  three  well-known  genera  of  psora,  syphi- 
lis, and  sycosis,  is  simply  in  its  essence  the  doctrine  of 
Anamnesis.  In  order  to  eradicate  a  chronic  disease  we 
must  select  a  remedy  corresponding  not  only  to  the 
present  but  also  to  the  past  condition  of  the  patient ;  in 
other  words,  the  totaUty  of  the  symptoms  must  be  those 
of  the  entire  constitutional  condition  from  first  to  last. 
Hence  the  remedies  which  alone  can  permanently  eradi- 
cate chronic  disease  must  be  those  which  have  a  long- 
lasting  and  deep-seated  action  like  that  of  the  morbid 
process  to  which,  under  the  law  of  similia,  they  are 
opposed. 

3.  The  question  has  frequently  been  raised  to  what 
extent  the  curative  action  of  our  remedies  is  hindered  by 
dietetic  and  similar  transgressions.  Hahnemann,  in  his 
Organoiiy  lays  down  strict  rules  of  diet  in  order  to  avoid 
interference  with  the  medicinal  treatment ;  but  it  must 
not  be  overlooked  that  at  the  time  he  wrote  thus  he 
chiefly  used  the  30th  potency.  It  is  conceivable  that  the 
much  higher  potencies  which  have  been  prepared  since 
then,  some  of  which  Hahnemann  used  in  his  later  years, 
may  not  be  so  easily  thwarted  in  their  action.  On  this 
subject  I  may  say  that  I  have  from  the  first  used  the 
highest  potencies  almost  exclusively,  and  I  have  never 
found  their  curative  action  hindered  in  this  manner, 
though  I  take  Hahnemann's  word  for  it  that  such  rigid 
niles  are  necessary  where  the  30th  (and  perhaps  the 
SWHh)  potencies  are  used.  The  only  rules  of  diet  and 
regimen  that  I  find  needful  are  that  the  patient  should 
abstain  from  whatever  disagrees  with  him  or  tends  to 


256  ON   GANGBENE.  ^^S^^^^T^. 


Bevifiw,  April  1, 1»1. 


aggravate  the  disease.  In  the  above  case  the  patient 
more  than  once  caused  a  relapse  by  indulgence  of  alcohol 
(the  very  worst  thing  he  could  have  taken),  bat  the 
homoeopathic  remedy  acted  in  spite  of  all.  Perhaps  still 
higher  potencies  would  have  prevented  the  aggravation 
from  alcohol  altogether. 

(4.)  Lastly,  I  would  call  attention  to  the  antidotal 
power  of  natr,  mur.  to  the  effects  of  crude  nitrate  of  silver. 
This  latter  remedy  is  often  used  most  unscientifically, 
not  only  as  an  injection  to  dry  up  a  discharge,  but  as  a 
caustic  application  to  granular  eyelids,  or  for  ulceration 
of  the  OS  uteri.  The  result  is  that  the  disease  is  sup- 
pressed, and  the  last  end  of  that  patient  is  worse  than 
the  first.  In  all  such  cases  natr.  mur.  should  be  first 
studied.  It  will  often  be  found  to  correspond  to  the 
totality  of  the  symptoms,  both  natural  and  medicinal ; 
while  if  it  only  corresponds  to  the  latter,  and  no  remedy 
be  found  applicable  to  the  entire  group,  these  medicinsd 
symptoms  must  be  attacked  first ;  and  thus  the  efiiects 
of  the  poison  having  been  removed,  the  physician  obtains 
a  true  picture  of  the  disease  itself  and  the  selection  of 
remedy  is  facilitated. 

48,  Sussex  Gardens, 

Hyde  Park,  London,  W. 

ON  IDIOPATHIC  SYMMETRICAL  GANGRENE. 

By  C.  W.  Haywaed,  M.D.,  CM. 

^Concluded  from  page  110,  J 

Cases  which  have  an  important  bearing  on  the  relation 
of  peripheral  neuritis  to  this  disease  are  reported  by 
different  observers. 

Mormstein  (quoted  by  Hochenegg,  Ueher  Symmetri^che 
Gangrdn  und  Locale  Asphyxie,  Vienna,  1886,  p.  85)  had 
a  patient,  a  man  aged  51,  for  whom  amputation  of  the 
right  leg  in  the  upper  third  was  performed,  on  account 
of  gangrene  of  the  foot,  which  had  commenced  two 
months  previously.  A  week  after  the  operation  he  died 
with  a  high  temperature.  His  urine  was  natural.  The 
gangrene  had  led  to  the  separation  of  the  first,  second, 
and  fifth  toes,  whilst  the  third  and  fourth  were  isolated ; 
but  the  skin  over  all  the  toes  was  involved  in  the  gan- 
grenous process  as  well  as  that  covering  ijie  heel,  the 


SSS'A^flTJfif*"     ON  GANGBENE.  257 


RavMW,  Apiil  U  lflBl« 


inner  side  of  the  foot  and  the  dorsum.  The  vessels 
generally  of  the  lower  extremity  were  free  from  abnor- 
mal contents,  only  in  the  capillary  vessels  adjacent  to 
the  gangrenous  focus  were  microscopic  hyaline  thrombi 
present.  The  posterior  tibial  artery  showed  many  cal- 
eareous  plates,  but  no  thrombi  adherent  to  them.  The 
posterior  tibial  nerve  was  greatly  thickened  in  its  lower 
part ;  microscopic  investigation  showed  great  wasting  of 
the  myelin  with  collapse  of  Schwann's  sheaths,  and 
chronic  inflammatory  proliferation  of  the  interstitial 
connective  tissue,  especially  in  the  parts  close  to  the 
gangrenous  area.  The  nerves  in  the  left  sound  limb 
showed  similar  changes  to  those  in  the  gangrenous  Umb. 
The  nerve  roots  of  the  lumbar  region  were  only  afifected 
with  neuritis  on  the  right  side.  Brain  and  cord  were 
markedly  anaemic,  and  the  examination  of  the  viscera 
gave  negative  results.  This  case  cannot  be  definitely 
classed  as  Baynaud's  disease,  but  the  double-sided  affec- 
tion of  the  nerves,  more  extensive  on  the  gangrenous 
Bide,  is  very  suggestive. 

Fibres  and  YaiUard  {Archives  de  Physiologic  Normale 
et  PathologiquCy  1885,  p.  106)  narrate  cases. 

The  first   was  a  young  woman,  aged  24,  of  feeble 
intelligence  from  childhood,  but  from  18  began  to  suffer 
from  tremors  and  stiffness  of  limbs,   untU  at  length 
walking  became  impossible,  the  lower  limbs  passed  into 
a  state  of  extreme  contracture  and  the  patient  was  bed- 
ridden and   demented.     After   a   time  the    feet   were 
noticed  to  be  cold,  blue  and  insensitive,  they  gradually 
became  gangrenous ;  the  left  foot  underwent  spontaneous 
amputation    and    the    right    was    all    but    separated. 
Numerous  eschars  appeared  in  various  parts  of  the  body, 
ouudy  of  these  suppurated,  and  the  patient  died  from 
exhaustion.      On  post-mortem  examination  the  tibial 
arteries  were  seen  each  to  terminate  in  a  cicatricial 
cul-de-sac,  which  was  surrounded  by  fleshy  granulations, 
hi  no  part  of  the  arteries  of  the  lower  limbs  were 
adherent  thrombi  found,  only  here  and  there  soft  clots. 
The  aorta  and  its  branches  and  the  veins  of  the  limbs 
generally  were  healthy,   and   the  examination  of  the 
viscera  gave  negative  results.    In  the  nervous  system 
there  was  found  chronic  hydrocephalus  of  the  lateral 
ventricles,  and  some  undue  adhesion  of  the  pia  mater  to 
Qie  cortex  of  the  hemispheres,  and  the  skull  was  greatly 


258  ON  OANGBENE.     '^S^^?!^ 


Itovieir,  April  1,  UH. 


thickened.    There  was  a  slight  diffase  sclerosis  of  the 
dorso-lumbar  part  of  the  cord,  affecting  the  whole  of  tiie 
antero-lateral  columns,  and  the  whole  of  the  posterior 
columns,  except  their  anterior  fifth.    The  spinal  ganglia 
and  nerve  roots,  so  far  as  they  were  examined,  were 
natural.     The  principal   nerve  trunks  were  carefally 
examined  throughout  the  body.      Those  of  the  upper 
limbs  were  normal,  and  the  nerves  of  the  thighs  vere 
also  normal ;  the  anterior  and  posterior  tibial  of  both 
sides  presented  changes  of  varying  extent,  but  which 
were   fairly  symmetrical.     The  changes  consisted  in 
extensive  atrophy  of  nerve  fibres  with  empty  sheaths,  pre- 
senting numerous  nuclei,  and  at  long  intervals,  varicose 
dilatations,  which  contained  masses  of  granular  proto- 
plasm and  drops  of  myelin.    Between  the  fibres  in  many 
places  were  found  abundance  of  leucocytes,  infiltrated 
with  small  granules,  and  having  the  aspect  of  Glu^je's 
corpuscles.     Their  second  case  is  that  of  an  old  woman, 
aged  56,  a  rag  gatherer,  who  had   been  subjected  to 
great  hardships,   and    for    six  months,  along  with  a 
sensation  of  considerable  fatigue,  had   found  that  in 
walking  she  no  longer  felt  the  soil  on  which  she  trod. 
Two  months  before  her  admission  to  hospital,  bullae  formed 
on  the  soles  of  her  feet.  These  she  pricked  and  they  gave  her 
little  trouble.     About  the  same  time  she  began  to  suffer 
from  obstinate  diarrhoea.  Three  days  before  admission  the 
feet  became  swollen,  painful  and  covered  with  reddish 
patches  on  the  dorsal  surface.     Fresh  bullsB  formed  on 
the  feet ;  they  were  perfectly  cold,  and  anaesthesia  on 
the  left  side  extended  up  to  the  ankle,  on  the  right  side 
to  the  middle  of  the  tarsus.  '  The  line  of  separation 
formed  at  this  level  on  both  sides,  but  the  patient  died 
from  exhaustion  and  diarrhoea  before  actual  separation 
had  taken  place.      Post-mortem  examination  showed 
neuritis  of  the  plantar  and  tibial  nerves,  but  the  vessels 
of  the  limbs  were  natural;  and  the  brain,  spinal  cord, 
and  viscera  were  also  natural.    Pitres  and  Vaillard  naeet 
the  objection  that  in  the  above  case  the  neuritis  might 
have  been   consecutive  to  the   gangrenous  process  by 
recording  the  results  of  an  examination  of  peripheral 
nerves  in  a  case  of  gangrene  of  embolic  origin.    The 
nerves  in  the  gangrenous  extremities  were  found  to  be 
normal  throughout. 
They  are  inclined  to  regard  the  peripheral  neuritis 


SSS^A^SrSS?*  ON   OANGRBNB.  269 


Setieir,  April  1, 1891 


in  their  cases  as  the  cause  of  the  gangrene,  and  they 
hold  that  most  of  Raynaud's  cases  of  gangrene  were  of 
like  origin.  Dr,  Wiglesworth  {PatJwl.  Trans.,  1887,  p.  61) 
records  a  case  of  very  extensive  peripheral  neuritis  in  a 
woman,  aged  26,  who  was  the  subject  of  epileptic 
dementia,  and  of  chronic  Bright's  disease,  and  who 
goffered  repeated  attacks  of  spontaneous  gangrene  of 
fingers  and  toes. 

Hochenegg  fUeher  Symmetrische  Gangrdn  und  Locale 
Atphyxie,  Vienna,  1886)  admits  the  soundness  of  the 
conclusions  of  Pitres  and  Yaillard  on  their  own  cases, 
bat  disputes  the  universality  of  their  propositions.  He 
reports  a  case  of  a  man,  aged  51,  who  developed 
gangrene  of  the  left  hand  independently  of  vascular 
eaases.  The  post-mortem  examination  showed  chronic 
hydrocephalus  and  syringomyelia.  Only  a  slight  degree 
of  atrophy  was  found  in  the  peripheral  nerves,  and  was 
held  to  be  secondary  to  the  cord  lesion.  Hochenegg 
maintains  that  the  gangrene  was  caused  by  the  central 
lesion,  but  in  view  of  the  existence  of  the  nerve  changes, 
slight  and  non-inflammatory  though  they  were,  this 
conclusion  seems  hardly  satisfactory.  But  we  find  cases 
of  severe  neuritis  in  which  we  get  no  gangrene,  or  where 
the  gangrene  is  not  proportional  to  the  neuritis  present. 

Haghes,  of  St.  Louis  {Western  Medical  Reporter, 
1887),  relates  two  cases  of  severe  plantar  neuritis.  The 
pain  in  both  cases  was  intense,  being  especially  severe 
at  a  patch  under  the  calcaneo-cuboid  joint,  and  the 
plantar  aspects  of  the  four  inner  toes.  In  the  first  case 
there  was  pallor  of  the  foot  and  toes,  but  no  erythema. 
In  the  second  case  there  was  flushing  of  the  parts. 
Cases  of  severe  peripheral  neuritis  in  which  gangrene 
did  not  follow,  or  where  the  gangrene  was  not  pro- 
portional to  the  neuritis,  are  related  by  MM.  Joffroy  and 
Ch.  Achard  (in  the  second  number  of  Archives  de 
Medecine  Experimentale).  The  first  case  is  one  in  which 
other  conditions  were  associated  with  this  affection.  It 
is  the  record  of  a  case  in  which  well-marked  symptoms, 
as  severe  and  persistent  pain,  followed  by  muscular 
paresis  and  wasting  of  all  the  extremities,  occurred  about 
nine  months  before  the  patient's  death  from  an  attack 
of  cerebral  haemorrhage  and  pneumonia.  Degeneration 
of  nerve  fibres  was  found  in  the  main  nerve  trunks  of 
the  limbs  in  varying  degree,  but  in  all  more  marked  in 


260  ON  OANOBBNB,     ^'SS&'^SST^. 


Be?iew,  April  1,  UU. 


the  peripheral  nerves.  In  addition  there  was  found 
obliterating  arteritis  in  the  neryes^  e.g.9  in  the  sciatic, 
and  it  was  to  the  resulting  loss  of  nutrition  that  the 
neuritis  was  attributed.  Indeed  a  parallel  is  drawn 
between  the  changes  thereby  produced  in  a  nerve  trnnk 
and  those  of  cerebral  softening  from  arterial  thrombo8i& 
It  is  remarked  that  had  the  patient  not  succumbed  to 
pneumonia,  senile  gangrene  would  have  developed  and 
might  have  been  referred  erroneously  to  the  neuritifl, 
whereas  both  conditions  would  have  owned  the  same 
origin,  viz.,  obliterating  arteritis. 

The  next  case  is  a  case  of  tabes,  complicated  with 
cutaneous  gangrene,  in  the  left  great  toe,  bat  with 
neuritic  changes  far  more  marked  in  the  nerves  supply- 
ing some  of  the  other  toes.  Hence  the  writers  do  not 
attribute  the  gangrene  to  the  neuritis,  nor  could  they 
assign  pressure  as  its  cause;  but  refer  the  gangrene 
as  well  as  the  neuritis  to  the  disease  of  the  cord. 

Another  factor  in  the  production  of  peripheral  neuritis 
in  this  case  was  the  presence  of  tuberculosis,  from  the 
effects  of  which  the  patient  died. 

In  the  same  journal  MM.  Dejerine  and  SoUier  relate 
an  interesting  case  dealing  with  the  subject  of  ^*  F^' 
pheral  tabes,"  to  which  M.  Dejerine  had  previously 
drawn  attention.  The  case  was  one  of  a  man  aged  54, 
who  for  fifteen  years  had  suffered  from  inco-ordination 
of  the  lower  limbs,  marked  lightning  pain,  and 
disturbance  of  sensation.  The  patellar  reflex  was, 
however,  present.  This  patient  also  died  of  phthisis. 
The  spinal  cord  and  nerve  roots  were  found  to  be  healthy, 
but  there  was  very  marked  peripheral  neuritis,  especially 
in  the  cutaneous  nerves  of  the  lower  limbs,  less  marked 
in  the  muscular  nerves,  and  slight  in  Uie  cutaneous 
nerves  of  the  hands.  The  sciatic  nerves  were  quite 
normal. 

These  cases  seem  to  oppose  the  theory  that  the  neuri- 
tis causes  the  gangrene,  as  in  the  first  case  the  nenrius 
was  due  to  obliterating  arteritis  in  the  sciatic  nerves,  and 
the  neuritis  was  from  want  of  nutrition  to  the  nerves ;  a 
similar  condition  was  present  in  arteries  in  other  f^xw* 
In  the  second  case  the  neuritis  was  much  worse  in  the 
toes  which  did  not  gangrene,  than  in  the  toe  which  did 
gangrene — ^proving  that  the  gangrene  was  certainly  not 
proportional  to  the  neuritis  present ;  although  the  nea- 


£dS^5StlSS!^  ON    GANGRENE.  261 

ritis  probably  was  an  important  factor  in  its  production. 
The  presence  of  this  neuritis  cannot,  then,  I  think,  be 
said  to  offer  a  satisfactory  explanation  for  the  occurrence 
of  the  gangrene.  It  may,  by  interference  with  the 
trophic  condition  of  the  part,  predispose  to  gangrene ; 
bnt  that  it  is  the  essential  and  only  cause  is,  I  think, 
disproved  by  these  cases.  The  evidence  yet  is  conflicting, 
as  it  has  been  demonstrated  that  peripheral  neuritis  will 
not  of  itself  cause  gangrene — at  least  it  has  been  proved 
that  in  many  cases  it  does  not  do  so ;  while  in  other 
cases  where  gangrene  occurs  peripheral  neuritis  is  the 
only  demonstrated  lesion.  This  agrees  with  the  state- 
ment of  Dr.  Barlow  (appendix  to  Baynaud's  New  Re- 
fearches,  op.  cU.)  that  peripheral  neuritis  alone  vnll 
certainly  not  produce  gangrene. 

The  evidence  certainly  points  to  the  lesion  being  in 
the  nervous  supply  of  the  parts.  That  this  essential 
change  is  not  central  is,  I  think,  proved  by  the  speci- 
mens of  the  pons,  medulla  and  upper  part  of  the  cord, 
which  accompany  these  notes ;  although  a  state  of  irri- 
tation (perhaps  depending  on  some  change  to  be  here- 
after demonstrated)  of  the  cord,  as  suggested  by  Bay- 
nand,  would  produce  the  condition. 

Specimens  vi.  and  vii.  demonstrates  the  presence  of  a 
severe  peripheral  neuritis,  as  was  also  proved  in  Case  III. 
This  would  account  for  the  interference  with  the  circu- 
lation of  the  parts  beyond,  but  not  for  the  state  of 
contraction  of  the  arterioles  generally,  if  this  is  present. 

There  is  some  evidence  to  prove  that  this  spasm  is 
general — as  it  was  observed  in  the  eye  in  Baynaud's 
Case  I,  new  series— -and  also  in  a  general  blanching 
which  occurred  in  Case  Y,  the  eyelids  and  Ups  especially 
showing  it,  previous  to  the  signs  of  local  asphyxia  in  the 
eitremities  manifesting  themselves.  The  spasm  may 
therefore  be  general,  but  the  parts  where  radiation  is 
greatest,  viz. :  fingers,  toes,  ears  and  nose,  are  the  parts 
where  the  condition  produces  the  most  severe  results. 

In  this  spasm  the  venules,  as  well  as  the  arterioles, 
take  part,  producing  the  stage  of  local  syncope  (Baynaud 
op.  cit.).  The  succeeding  stage  of  local  asphyxia  is 
caused  by  the  relaxation,  especially  of  the  venules,  and 
the  blood  stagnates  in  the  venous  trunks. 

H(Bmoglobimma  is  frequently  associated  with  the 
disease. 


262  ON   GANGRENE.  ^^VSSST^. 


Befiew,  April  t  IM* 


Dr.  Barlow  {op.  dt.)  cites  several  cases.  One  by  Mr. 
Hutchinson  (Medical  Times  and  Gazette,  1871,  Vol.  H, 
p.  678)  where  the  urine  became  dark  often  after  exposure 
to  cold.  Dr.  Wilks  {Medical  Times  and  Gazette,  1879, 
Vol.  II,  p.  207)  had  a  case  of  a  boy,  aged  16,  with 
symmetrical  gangrene,  where  the  urine  was  at  different 
times  dark  in  colour  and  gave  the  guaiacum  test 
Granular  casts  and  debris  were  present,  but  on  several 
occasions  no  blood  corpuscles  could  be  found.  At  a 
later  period,  however,  some  blood  corpuscles  were 
present.  Dr.  Southey  {St.  Barthol.  Reports  XVI,  1880, 
p.  15)  gives  the  history  of  a  patient  having  passed  black 
urine  in  some  of  her  attacks,  but  during  her  stay  in 
hospital  with  symmetrical  gangrene,  though  a  trace  of 
albumen  was  present,  there  was  no  record  of  haemo- 
globinuria.  In  a  second  case  by  Dr.  Southey  {op-  fd) 
there  was  for  several  days  a  true  intermittent  haematoria 
caused  by  external  cold  to  the  surface  of  the  body. 
Sometimes  the  blood  was  apparent  by  its  colour  or 
sediment,  but  at  other  times  its  presence  was  only 
detectable  by  the  guaiacum  test.  This  case  was  probably, 
at  times  at  all  events,  one  of  hsBmoglobinuria.  &. 
Barlow  records  a  case  {Transact.  Clin.  Soc.  XVI,  1888, 
p.  179)  where  the  onset  was  marked  by  epigastric  pain 
and  hsemoglobinuria.  The  dark  urine  only  appeared 
once  after  a  given  attack.  It  gave  the  guaiacom  test, 
and  under  the  microscope  pigment  and  oxalates,  but  no 
blood  corpuscles. 

Dr.  Dickinson  had  one  case  {Renal  and  Urinary 
Affections,  Part  III,  1885,  p.  1185)  which  is  important, 
as  the  history  shows  that  the  typical  attacks  of  inter- 
mittent hflBmoglobinuria  were  on  one  occasion  replaced 
by  a  typical  attack  of  the  paroxysmal  local  asphyxia 
affecting  one  hand,  and  unattended  with  the  usual 
urinary  affection. 

Dr.  Druitt  {Medical  Times  and  Gazette,  April  19, 1878) 
in  his  own  case  showed  that  he  suffered  from  ague  and 
also  distinct  attacks  of  heemoglobinuria,  related  to  cold, 
exposure  and  worry.  The  attacks  were  associated  with 
marked  proneness  to  numbness,  tingling  and  blueness  of 
the  extremities,  the  blue  patches  at  times  being  suggestive 
of  imminent  gangrene. 

Dr.  John  Abercrombie  {Archives  of  Pediatrics,  Oct., 
1886),  had  one  case  where  in  certain  attacks  of  local 


iteSSr^SvSf "  ON  OANGBENE.  263 

aBphyzia,  chiefly  affecting  the  hands,  the  child  passed 
urine  of  sp.  gr.  1028,  and  with  ^  albumen.  It  gave  the 
gnaiacam  test,  and  microscopically  oxalates  and  some 
amorphoas  material,  but  no  blood  corpuscles.  Dr. 
Cavafy  (quoted  by  Dr.  Barlow,  op.  cit.),  also  reports  a 
boy,  aged  12,  suffering  from  paroxysmal  hsemoglobinuria 
for  five  years,  and  the  ears  were  noticed  to  be  very 
eyanosed  when  the  boy  was  chilly,  and  ached  as  he  got 
warm.  Subsequently  gangrene  of  both  ears  set  in,  and 
relapsed  several  times  in  successive  winters. 

Dr.  Abercrombie  {op.  cit.)  holds  that  this  is  due  to  the 
same  cause  as  the  Raynaud's  disease,  a.nd  the  presence 
of  bile  sometimes  noticed  (as  in  Case  YIII)  to  spasm  of 
the  hepatic  vessels. 

Hematuria  sometimes  occurs.  In  Dr.  Southey's 
second  case  (quoted  above)  it  was  present  for  some  days. 
It  was  certainly  present  in  Case  I,  the  blood  corpuscles 
being  present  in  large  numbers.  Also  it  was  probably 
present  in  Case  11.  It  was  found  also  in  Case  Y,  and 
occurred  here  in  paroxysmal  form,  the  attacks  always 
alternating  with  the  attacks  of  local  asphyxia,  as  the 
ophthalmic  changes  alternated  with  the  local  asphyxia 
in  Baynaud's  Case  I,  new  series. 

A  hsemorrhagic  tendency  is  noticed  in  many  cases, 
as  in  these  cases  of  hsematuria,  and  also  in  Case  II 
bleeding  occurred  from  the  eyes  and  nose.  In  Case  XY 
there  was  menorrhagia  at  first ;  in  Case  III  the  patient 
coughed  up  blood,  although  no  disease  was  found  in  the 
lungs.  Dr.  Warren  (quoted  in  St,  Bartholomew's  Hospital 
RejKyrts,  1880,  Yol.  XVI,  p.  23)  had  a  case  where  haemorr- 
hage from  the  nose  took  place  "  frequently  for  over  a 
period  of  two  weeks  "  before  the  affection  of  the  fingers 
began. 

The  interference  with  vision  which  is  sometimes 
noticed  (as  in  Case  YIII)  probably  depends  on  spasm  of 
the  opthalmie  vessels,  as  demonstrated  by  Raynaud 
(Case  I,  New  Series). 

Spasm  of  the  arterioles  alone  could  probably  not 
{u»»mit  for  the  condition.  Mr.  Duncan  (quoted  by 
Br.  Affleck)  gives  his  opinion  that  it  could  not  do  so. 

It  is  doubtful  whether  the  stagnation  of  the  blood  in 
the  veins  could  cause  the  gangrene  in  these  cases ;  it 
might  cause  oedema,  but  of  itself  it  could  probably  not 
cause  the  gangrene. 


264     THE  TRANSFEB  TREATMENT.  ^SSSSI^KSm^. 


BciviBir,  AjkH  h  m* 


Eaynaad  says  (op.  dt.^  p.  182),  *^  I  would  say  that  in 
the  present  state  of  our  knowledge,  local  asphyxia  of 
the  extremities  ought  to  be  considered  as  a  neurosifl 
characterised  by  enormous  exaggeration  of  the  excifa)> 
motor  energy  of  the  grey  parts  of  the  spinal  cord,  which 
control  the  vaso-motor  innervation."  "While  allowing  that 
such  a  condition  might  cause  the  symptoms  met  with  in 
this  disease,  we  must  maintain  that  so  far  as  the  evidence 
goes  at  present,  peripheral  neuritis  appears  to  play  a 
more  important  part  in  their  production. 

That  peripheral  neuritis  can  cause  gangrene  has  been 
shown  by  Pitres  and  Vaillard,  probably  owing  to  the 
spasm  produced  in  the  vessels  and  the  interference  with 
the  trophic  condition  of  the  part. 

But  that  peripheral  neuritis  does  not  necessarily  cause 
gangrene,  even  when  severe,  is  proved  by  the  cases  of 
MM.  Joffroy  and  Achard,  and  by  many  cases  of 
peripheral  neuritis,  recorded  by  others,  where  no 
gangrene  occurs. 

All  we  can  yet  state  is  that  in  this  disease  peripheral 
neuritis  has  been  demonstrated,  and  also  spasm  of  the 
arterioles.  It  is  extremely  probable  that  the  cause  of  the 
gangrene  is  to  be  found  in  the  neuritis ;  but  evidence  has 
not  yet  been  collected  which  will  point  out  to  us  the 
cause  of  the  neuritis,  nor  the  exact  relation  of  the 
neuritis  to  the  gangrene,  and  why  gangrene  should  occnr 
in  some  cases  of  neuritis  and  not  in  others. 

These  points  can  only  be  cleared  up  by  ftirther 
evidence,  and  by  further  opportunities  for  observation 
and  research,  as  to  whether  it  is  the  acuteness  of  the 
neurosis,  or  some  special  form  of  neurosis,  which  causes 
the  gangrene  in  cases  of  this  disease. 

THE  "TRANSFEE  TREATMENT"  AND 

SUGGESTION. 

By  C.  Lloyd  Tuckby,  M.D. 

Many  of  the  readers  of  this  Review  will  doubtless  remem- 
ber two  articles  which  appeared  in  Tlie  Fortnightly  Review 
in  July  and  August,  1890,  from  the  pen  of  Dr.  Lays, 
entitled   **  Recent  Discoveries   in   Hypnotism,"  and  a 


SS^SSTiro!**     THE    TRiLNSFER   TREATMENT.  265 

short  account  of  a  visit  to  La  Charit6  Hospital  will 
perhaps  prove  interesting.  Dr.  Luys  described  such 
wonderful  things  that  I  was  impelled  by  curiosity  to 
attend  his  clinique  in  the  course  of  my  autumn  holiday. 
I  was  accompanied  by  a  medical  friend,  and  we  found  no 
difficulty  in  entering  the  ward  and  watching  the  applica- 
tion of  the  "  transfer  "  treatment.  Dr.  Luys  and  his 
assistants  were  most  kind,  and  readily  showed  us  the 
curious  experiments  described  in  The  Foi-tnightly  Review. 
Several  patients  were  undergoing  the  new  treatment,  and 
we  had  the  opportunity  of  watching  their  progress  for 
three  or  four  days,  and  of  questioning  them  as  to  their 
feelings  and  symptoms.  Many  of  them  spoke  with 
enthusiasm  of  the  progress  they  were  making,  and  in  a 
few  cases  it  was  possible  to  note  an  improvement  from 
day  to  day.  The  process  was  simple  enough.  The 
patient  was  directed  to  sit  down  and  grasp  the  hands  of 
a  profoundly  hypnotised  subject,  and  Dr.  Luys  passed  a 
heavy  magnetised  bar  of  steel  up  and  down  both  sitter's 
bodies,  especially  pressing  on  the  cardiac  and  abdominal 
regions.  A  shiver  would  be  seen  to  pass  through  the 
hypnotised  suhject's  frame,  and  he  would  begin  to  com- 
plain of  suflfering  from  the  same  symptoms  as  the 
patient  had  experienced.  The  doctor  questioned  him 
as  to  the  symptoms  and  then  assured  him  that  they 
would  be  cured  and  would  not  return ;  much  in  the  same 
way  as  the  hypnotiser  deals  with  his  patients.  In  the 
meantime  the  patient  looked  on  and  saw  the  transferee 
writhing  in  his  pains,  imitating  his  voice,  gait,  gestures 
and  demeanour  generally,  and  if  he  was  an  imaginative 
person  it  is  quite  likely  that  he  felt  better  from 
witnessing  this  vicarious"  suffering.  When  the  doctor 
thought  it  was  enough,  he  told  the  subject  to  wake  up 
and  to  feel  no  more  pain,  and  as  a  matter  of  fact  he  did 
not  remember  on  waking  what  he  had  gone  through  in 
the  sonmambulic  state,  but  went  away  feeling  apparently 
none  the  worse,  and  gratified  by  a  gratuity  from  the 
patient  whose  disease  he  had  shared.  Dr.  Luys  contends 
that  the  subject  not  only  shares  the  disease  but  partakes 
of  the  personality  of  the  patient,  and  demonstrates  this 
by  showing  how  a  female  recipient  will  assume  a 
masculine  voice  and  carriage  when  sitting  for  a  male 
patient,  and  will  complain  of  the  beard  being  pulled  if 
one  approaches  the  face  too  closely.    It  is  not  a  little 

VoL  as,  No.  4,  u 


266  THE    TRANSFER   TREATMENT.    ^i^^.^^J^! 

surprising  in  this  age  of  science  to  find  a  man  of  Dr. 
Luys'  undoubted  honesty  and  attainments  seriously 
upholding  practice  of  this  kind;  but  the  alleged  discovery 
of  Dr.  Brown- S6quard'8  elixir  of  life  affords  another 
example  of  a  distinguished  physiologist  allowing  himself 
to  be  led  astray  in  his  old  age.  One  is  taken  back  to  the 
time  of  Perkins  and  his  metallic  tractors  to  find  a  parallel 
for  what  is  now  taking  place  in  Paris;  and  be  it 
remembered  that  remarkable  cures  did  follow  the 
application  of  Perkins'  instruments  and  of  the  wooden 
imitations  which  the  physicians  of  Bath  caused  to  be 
tested  in  their  hospital  practice.* 

What  then  is  the  explanation  of  the  results  which 
follow  such  methods  of  treatment  ?  It  is  summed  up 
in  the  word  "  suggestion."  The  imagination  is  pro- 
foundly affected  by  the  hope  and  expectation  of  cure, 
and  this  in  itself  is  sufficient  to  bring  about  a  healthy 
change  in  the  hypochondriacal,  hysterical,  and  malades 
imaginaircs.  But  among  the  patients  we  questioned 
were  some  who  suffered  from  well  defined  organic 
disease ;  one  gentleman  affected  with  aortic  insufficiency 
assured  me  that  since  his  visits  to  Dr.  Luys  he  had 
recovered  his  appetite,  had  slept  well,  and  been  able  to 
walk  uphill  and  upstairs,  whereas  previously  he  had 
been  sleepless,  without  appetite,  and  almost  bedridden. 
A  man  suffering  from  par^ysis  agitans  declared  he  felt 
a  different  being,  but  as  far  as  we  could  see  there  was  no 
lessening  of  his  tremor,  though  the  young  woman  who 
acted  as  his  transfer  reproduced  his  disordered  move- 
ments most  faithfully.  It  is  evident  that  in  nearly  all 
diseases  there  exist  symptoms — often  the  most  painful 
part  of  the  malady  —  of  functional  nervous  origin, 
and  it  is  these  symptoms  which  are  largely  met 
by  hypnotic  suggestion  and  other  treatments  which 
appeal  to  the  imagination  or  the  subconscious  mind. 
I  consider  that  it  is  the  duty  of  a  physician  to 
relieve  suffering  in  any  way,  as  long  as '  it  is  not 
immoral  or  hurtful ;  but  no  one  visiting  La  Charite 
Hospital  could  say  that  the  treatment  by  transfer,  as 
practised  there,  is  free  from  terrible  abuses.     It  is  a  sad 


♦  Vide  Influenzae  of  the  Imoffi nation   in   Health    and   Distate.  by 
Dr.  Hack  Tuke. 


W5SrSS!^  THE  TRANSFEB  TREATMENT.      267 

sight  to  see  to  what  a  deplorable  condition  of  mental 
instability  and  inanity  the  unfortunate  subjects  have 
been  reduced  by  continual  hypnotisation  and  experiments. 
Of  course  the  experiments  carried  out  on  such  subjects, 
and  under  such  hysterical  conditions  as  exist  in  Dr.  Luys's 
<iinique,  are  valueless  from  a  scientific  point  of  view ; 
and  the  phenomena  he  obtains  from  the  action  of  the 
magnet,  different  coloured  balls,  and  with  medicines  at  a 
distance,  have  been  sought  in  vain  by  other  investigators. 
I  have  found  my  subjects  perfectly  insusceptible  to  the 
magnet,  until  I  have  told  them  that  contact  with  it  will 
always  produce  pain  in  the  part  touched,  but  hence- 
forth they  have  always  realised  my  suggestion,  and  com- 
plained bitterly  when  touched  by  it.  When  one  considers 
that  the  personality  of  a  subject  in  the  profounder 
hjqpnotic  states  is  in  complete  abeyance,  and  that  his 
mind  is  a  blank  page,  to  be  written  on  at  the  dictation 
of  the  hypnotiser,  we  see  how  absolutely  necessary  it  is 
to  guard  against  conscious  and  unconscious  simulation, 
and  how  utterly  Dr.  Luys's  experiments  are  wanting  in 
the  only  conditions  which  only  could  render  them  of  any 
value. 

As  hearing  upon  the  above  remarks  I  may  state  that  I 
purposely  asked  Dr.  Luys  if  the  magnet  influenced  all 
somnambulists  in  the  same  way,  and  he  answered  that 
it  did.  If  he  had  been  more  cautious,  and  had  replied 
that  only  some  subjects  were  sensitive,  one  would  have 
been  more  inclined  to  believe  in  the  genuineness  of  his 
results.  The  only  way  of  testing  the  so-called  magnetic 
sense  described  by  Eeichenbach  is  by  the  electro-magnet, 
which  can  be  "  made  "or  '*  unmade  "  instantaneously 
in  a  manner  impossible  for  the  subject  to  guess  by 
ordinary  sensuous  impressions.  The  inquirer  will  find 
in  the  first  volume  of  The  Proceedings  of  the  Society  for 
^^ychical  Research  a  report  of  some  experiments  made 
to  determine  the  existence  of  this  sense.  The  experi- 
ments were  carried  out  under  rigorous  scientific 
conditions,  and  the  result  was  to  quite  prove  that  certain 
persons  do  possess  the  faculty  of  perceiving  certain 
effects  from  the  poles  of  an  electro-magnet  when  in 
action.  But  from  this  to  the  propositions  laid  down  by 
Luys  is  a  very  long  step. 


u— 2 


268         NOTES  ABOUT  LEPROSY.  ^^i^A^STm. 

SUGGESTIVE  NOTES  ABOUT  LEPROSY. 
By  John  Dbummond,  L.E.C.P.,  Edin. ;  M.R.C.S.,  Eng. 

Whilst  acting  as  surgeon-superintendent  on  the  barque 
"  Umvoti,"  during  the  years  1888-89, 1  had  several  cases 
of  leprosy  under  my  charge,  and  I  frequently  saw  a  leprous 
girl  at  the  Durban  depot,  who  had  been  maintained  there 
a  year  at  the  expense  of  general  revenue.  She  mixed 
freely  with  the  other  inmates  of  the  depot,  and  no  restraint 
was  put  upon  her  actions.  Many  were  the  cases  scattered 
about  the  Colony,  and  no  apprehension  of  the  disease 
spreading  to  others  had  then  taken  hold  of  the  public 
mind. 

Some  of  the  cases  brought  under  my  notice  were  of  a 
doubtful  character,  and  as  they  improved  during  the 
voyage,  under  the  treatment  which  I  believed  would  l)e 
useful,  I  think  I  am  justified  in  throwing  them  out  as 
examples  of  old  and  neglected  cases  of  syphilis.  Others, 
however,  were  well  marked  in  type,  and  I  extract  a  brief 
history  of  three  of  these  from  my  official  medical  diary. 

Banau,  a  single  man  aged  48  years,  has  contraction  of 
the  fingers,  with  the  loss  of  the  first  and  second  joints  of 
the  ring  finger  of  the  left  hand,  and  the  loss  of  the  first 
joints  of  the  ring  and  second  finger  of  the  right  hand. 
He  has  little  or  no  sensation  in  the  hands  or  left  foot, 
but  he  is  conscious  when  I  pinch  his  right  foot.  He 
came  to  Natal  in  1878  and  enjoyed  good  health  until  four 
years  ago.  **  I  then  felt  a  numbness  "  he  says  "  in  my 
hands  and  feet,  and  sores  broke  out,  like  blisters,  and 
afterwards  my  fijigers  got  twisted  and  contracted,  and 
some  of  the  sores  seemed  to  eat  into  the  joints,  and 
I  lost  a  part  of  the  fingers  "  (as  already  described).  He 
has  never  suffered  much  pain. 

Boodoo,  a  single  man,  aged  37,  has  been  ten  years  in 
the  Colony.  He  had  never  heard  of  leprosy  in  his 
family,  and  he  is  confident  he  never  suffered  from 
syphilis.  **  Two  years  ago  my  feet  began  to  ache,  with 
a  burning  and  tingling  sensation,  which  kept  me  awake 
at  night,  indeed  I  used  to  get  up  and  put  them  in  cold 
water  to  get  relief.  Afterwards  sores  formed  on  the 
soles  and  rotten  pieces  of  bone  came  away ;  it  was  a 
long  time  before  my  hands  began  to  be  sore."  The 
hands  and  feet  are  now  contracted  into  useless  stumps, 
several  of  the  fingers  and  toes  are  missing,  and  those 


iSSJ^A^STiSr  NOTES  ABOUT   LEPROSY.  269 

which  remain  are  twisted  and  deformed.  A  deep,  dry, 
eroding  ulcer  situated  on  the  outer  side  of  the  ankle 
joint  threatens  eventually  to  sever  the  foot  from  the  leg. 
There  is  complete  loss  of  sensation  in  both  the  hands 
and  the  feet,  so  that  he  suffers  no  pain  and  is  uncon- 
scious when  I  pinch  him.  There  is  not  much  discharge 
from  the  ulcers,  the  granulations  have  a  dry,  glazed 
appearance,  and  the  ichorous  serum  which  stains  the 
dressing  is  devoid  of  foetor.  His  general  health  and 
spirits  are  good,  and  he  takes  his  food  quite  heartily. 
During  the  voyage  I  dressed  the  sores  with  iinguentwm 
raina,  carbolic  acid,  and  oxide  of  zinc,  and  he  took  five 
minims  of  Fowler's  Solution  night  and  morning. 

Sukari  has  lived  six  years  in  the  Mauritius  and  ten 
years  in  Natal,  his  parents  are  living  and  healthy,  and 
he  is  the  only  one  out  of  a  family  of  seven  who  ails 
anything ;  he  never  had  syphilis,  and  always  had  good 
health  until  four  years  ago,  when  he  was  working  on  a 
sugar  estate,  and  often  complained  of  heat  and  tingling 
in  his  feet,  which  made  field  labour  irksome;  after 
standing  all  day  his  pain  at  night  prevented  him 
sleeping,  and  his  feet  seemed  to  swell,  and  felt  as  though 
they  would  burst.  **  My  feet,"  he  said,  "  then  began  to 
get  quite  numb,  and  ulcers  formed  on  my  toes.  I  was 
sent  to  the  hospital  at  Durban,  but  they  got  no  better, 
and  fresh  sores  kept  breaking  out ;  and  as  some  dead 
bone  was  found  Dr.  Bonnar  cut  ofif  half  my  left  foot, 
but  the  wound  has  never  healed,  and  I  lost  two  toes  on 
my  right  foot ;  and  about  six  months  afterwards  my 
hands  began  to  be  bad,  and  fresh  sores  keep  breaking 
out.  The  skin  feels  dead,  and  I  do  not  know  when  you 
pinch  me  without  I  see  you.  I  am  not  ill  of  myself,  and 
am  always  ready  to  eat  my  food." 

The  natives  use  the  Chaulmugra  oil,  which  is  found 
in  the  forests  of  the  Malay  Peninsula  and  in  Southern 
India,  both  externally  and  internally.  They  make  an 
ointment  with  one  part  of  the  oil,  mixed  with  one  of 
yellow  bees'  wax,  and  three  of  mutton  suet.  Two  of  my 
native  dispensers,  who  had  seen  a  fair  amount  of  Indian 
practice,  spoke  highly  of  its  virtues,  and  as  a  local  dressing 
it  may  be  as  suitable  as  anything  else,  as  it  is  aseptic  and 
stimulating.  The  earliest  symptoms  of  the  disease  point 
to  disordered  innervation,  for  prominence  is  given  to 
sensations  of  tingling,  numbness,  and  burning  in  the 


270         NOTES  ABOUT  LEPROSY.  "Srt^^S^^ 

extremities.  These  symptoms  are  followed  by  loss  of 
power  and  of  sensation,  with  contraction  of  the  flexors 
of  the  limbs,  dragging  down  the  toes  and  fingers,  and 
then  nutrition  is  impaired,  and  blisters  form  on  the 
skin,  which  gradually  develop  eroding,  deep  burrowing 
ulceration,  passing  through  joints  and  bones,  and  the 
destruction  which  ensues,  though  much  slower  than,  is 
just  as  certain  as,  that  which  would  follow  in  the 
wake  of  an  arrest  to  the  circulation  through  the  veins 
or  arteries,  as  in  moist  or  dry  gangrene.  These 
symptoms  point  to  arsenic,  and  in  a  recent  number  of  the 
Lavcet  Dr.  Barton,  of  Norwich,  relates  two  instructive 
cases  of  peripheral  neuritis  produced  by  slow  arsenical 
poisoning.*  At  the  recent  meeting  of  the  British 
Medical  Association  at  Birmingham,  Mr.  Jonathan 
Hutchinson  **  referred  to  the  opportunities  offered  in 
connection  with  skin  diseases  for  the  study  of  therapeu- 
tics and  for  observations  on  the  action  of  drugs.  Arsenic 
of  course,  stood  foremost  amongst  those  concerning 
which  we  have  collected  important  and  even  astonishing 
facts.  How  the  drug  acts  we  know  not,  neither  do  we 
know  the  real  nature  of  the  malady  which  we  cure;  It 
may  not  always  cure  it,  but  it  always  changes  it  for  the 
better.  He  who  would  unravel  all  the  mystery  of  howr 
the  bullous  eruption  may  be  cured  and  the  scaly  one 
changed,  how  the  skin  may  be  made  clear  in  one  case 
and  muddy  and  brown  in  another,  how  peripheral 
neuritis  may  be  produced,  to  end  finally,  unless  pre- 
vented, in  some  severe  form  of  paralysis  or  death,  and 
how  in  rare  instances  the  nutrition  of  the  skin  may  be 
so  influenced  that  keratosis,  and  even  cancer,  may  be 
the  result,  will  certainly  find  that  he  has  his  work  cut 
out  tor  many  years.*'  The  speaker  in  this  pregnant  sen- 
tence touches  the  keynote  of  homoeopathic  therapeutics, 
and,  as  in  all  other  diseases,  we  must  look  for 
the  remedy  of  leprosy  amongst  those  drugs  which 
act  within  the  same  pathogenetic  sphere,  and  arsenic 
appears  to  me  more  closely  allied  to  the  incipient 
phenomena  of  this  dreadful  malady  than  any  other  drug 
with  which  I  am  acquainted.  My  opportunities  for 
investigation  were  limited  to  the  voyages  between  Durban 
and  Calcutta,  and  the  cases  were  not  only  confirmed,  but 

•  See  also  M  Horn.  Jietlew,  August,  1890,  p.  483. 


lt:S^A^!uS^  PROVING   OF   ARSENIC.  271 

had  passed  beyond  the  hope  of  cure;  but  I  had  reason  to 
feel  sanguine  that  the  treatment  was  at  least  beneficial, 
althoagh  the  pure  sea  air,  the  generous  diet,  and  the 
entire  rest  which  the  voyage  afforded,  may  have  done 
much  to  restore  the  general  condition  of  the  sufferers. 

Shenstone,  Malvern, 

March,  1891. 

AN  ACCIDENTAL  PROVING  OF  ARSENIC. 
By  Frank  Nankivell,  M.D. 

In  May,  1889,  Mrs.  T.,  »t.  37,  consulted  a  well-known 
London  physician,  and  received  the  following  prescrip- 
tion : — 

I^         Arsen,  alb,  2x     5ij. 

O.      Y.     Xv.  •••  •••  •••  ^al* 

Sig.  Seven  drops  thrice  a  day  after  meals. 
She  was  suffering  from  ovarian  neuralgia,  and  the 
treatment  proved  effectual.  The  medicine  was  taken 
for  about  a  week,  and  seems  to  have  produced  no  bad 
results.  The  neuralgia,  however,  recurred  a  short  time 
ago,  when  she  was  not  in  a  very  satisfactory  condition 
of  general  health,  and  she  obtained  a  fresh  supply  of 
the  medicine,  and  took  it  as  ordered  for  ten  days.  At 
the  end  of  that  time  she  sent  for  me,  and  I  found  her 
in  bed  with  a  hurried,  hard,  rather  small  pulse,  and 
anxious  expression  of  countenance.  There  was  a  con- 
stant feeling  of  uneasiness  in  the  cardiac  region — **  as  if 
there  were  pressure  inside  the  heart,"  the  patient 
described  it — and  frequent  and  rather  severe  attacks  of 
palpitation.  There  was  diarrhoea,  six  motions  having 
been  passed  during  the  day  ;  they  were  preceded 
^1  griping,  and  there  was  a  more  or  less  con- 
stant burning  sensation  referred  to  the  hypogastrium. 
Itching  of  the  lower  lids  had  been  complained  of 
for  two  or  three  days,  but  the  patient  did  not  at 
^e  time  suspect  that  it  was  due  to  the  medicine ; 
for  the  last  day  or  two  itching  was  also  felt  in  various 
parts  of  the  body.  The  state  of  the  eyes  was  peculiar. 
They  were  glazed  and  dull-looking,  and  there  was  some 
dimness  of  the  sight ;  but  there  was  none  of  the  lachry- 
mation  or  "  ferretty  "  appearance  peculiar  to  arsenic. 
Slight  nausea  was  felt  after  each  dose,  but  as  the  dose 


272  NOTES   AND  COMMENTS-    ^ig^.^^^SW. 

was  taken  after  a  meal  it  was  at  first  supposed  to  be  doe 
to  indigestion.  The  state  of  the  tongue,  which  was 
covered  with  a  thin  greyish  coat,  and  the  slightly  metallic 
taste,  was  supposed  to  strengthen  this  theory. 

Much  palpitation  and  cardiac  distress  was  felt  for  a 
week  or  ten  days,  during  which  it  was  necessary  to  keep 
the  patient  absolutely  quiet.  There  was  no  cardiac 
anxiety,  but  a  distressing  feeling  of  pressure  or  disten- 
sion. The  attacks  of  palpitation  seemed  to  be  benefited 
by  aconite  1  x.  On  my  second  visit  I  found  that  there 
had  been  haemorrhage  from  the  vagina,  which,  however, 
was  not  repeated  after  the  first  day ;  this  occurred  just 
midway  between  two  menstrual  epochs,  and  must  have 
been  due  to  the  arsenic.  The  diarrhoea  ceased  at  once 
on  stopping  the  medicine,  and  the  only  symptom  that 
persisted  any  time,  save  of  course  the  cardiac  symptoms 
as  above,  was  the  irritation  of  the  eyelids.  The  amount 
of  arsenic  taken  daily  was  lOJ  drops  of  the  2nd  decimal 
dilution,  or  105  drops  in  all.  This  would  be  equal  to 
126  drops  of  liquor  arsenicalis^  5ii.  of  which  contains 
1  grain  of  potassce  arsejiitis. 

60,  Eirkdale,  Sydenham. 


NOTES   AND    COMMENTS. 


The  International  Homceopathic  Congress. — In  our 
last  number  we  published  the  circular  of  the  Committee 
inviting  co-operation  in  the  work  of  this  important 
gathering  from  our  British  colleagues.  Although  the 
time  at  which  the  meeting  has  unfortunately  been 
arranged  to  be  held  effectually  prevents  any  European 
physician  actively  engaged  in  practice  from  being  present 
at  it — the  responsibility  for  which  rests  entirely  with  the 
American  Institute  of  Homoeopathy— we  may,  by  con- 
tributing to  its  transactions  through  the  General  Secre- 
tary, Dr.  Hughes,  do  somewhat  towards  preventing  it 
being  international  merely  in  name,  and  our  American 
colleagues  from  posing  as  the  sole  representatives  of 
homoeopathy  throughout  the  Universe  ! 


SSS^^STl^  NOTES   AND   COMBiENTS,  273 


We  believe  that  the  preparation  of  a  report  of  the 
History  of  Homoeopathy  in  Great  Britain  has  been 
entmsted  to  a  gentleman  singalarly  competent  to  under- 
take it.  We  therefore  invite  our  medical  brethren  to 
contribute  papers  on  Materia  Medica,  on  the  therapeutics 
of  special  forms  of  disease,  and  in  surgery.  However 
justly  annoyed  we  may  feel  at  having,  by  the  arrange- 
ments of  the  Committee,  been  precluded  from  the  possi- 
bility of  being  present  on  this  very  interesting  occasion, 
we  ought,  in  order  to  fulfil  our  desire  to  promote  the 
interests  of  homoeopathy,  to  do  what  we  can  to  render 
its  proceedings  at  once  useful  and  successful. 

Tlie  Hahnemannian  Monthly  of  March  informs  us  that 
''  The  Fourth  Quinquennial  International  Homoeopathic 
Congress  to  be  held  at  Atlantic  City,  beginning  on  Tues- 
day morning,  June  16th,  1891,  is  an  assured  success.  In 
point  of  numbers  it  will  be  an  overwhelming  success." 
That  the  meeting  will  be  large  we  do  not  doubt,  that  it  will 
be  interesting  and  useful  is  unquestionable,  while  that  it 
will  be  full  of  pleasure  to  all  taking  part  in  it  goes  without 
saying ;  but  that  it  will  be  international  except  in  name 
has,  as  we  have  said,  been  rendered  almost  impossible. 

The  education  of  the  old-school  in  the  common-sense 
of  dosage  is  progressing.  In  the  British  Medical  Journal, 
Feb.  28th,  in  a  review  of  a  new  book  by  Dr.  Stockman, 
of  Edinburgh  University,  on  Materia  Medica,  when 
noticing  the  recent  adoption  of  small  doses  of  sulphur 
in  chronic  bronchitis  and  rheumatism,  the  writer  says : 
"  It  is  probable  that  when  large  doses  of  insoluble  drugs, 
such  as  sulphur  and  the  salts  of  hismuth,  are  administered, 
a  very  small  proportion  is  absorbed  or  exerts  any  remedial 
action,  the  greater  part  being  eliminated,  practically 
unaltered,  with  the  faces."  One  would  have  thought 
that  this  would  have  been  perceived  long  ago. 


9.7/t  T>T?vTi?wa  Monthly  HomoDoprtlde 


Review,  April  1, 1811. 


REVIEWS. 


A  Practical  Manual  of  Gynacology.  By  G.  R.  Southwick, 
M.D.,  Assistant  Professor  of  Obstetrics  in  the  Boston  Uni- 
versity School  of  Medicine ;  L.M.  Rotunda  Hospital,  Dablin. 
Boston,    Otis  Clapp  &  Son.     1891. 

The  strong  point  of  Dr.  Southwick*s  book  is  the  paragraph  on 
internal  or  constitutional  treatment.  The  indications  for 
homoeopathic  remedies  are  given  with  unusual  clearness  and 
fulness,  and  in  many  instances  illustrative  cases  are  quoted. 
The  author  strongly  believes  in  there  being  a  constitutional 
element  in  most  local  conditions,  and  that  it  can  be  largely 
met  by  constitutional  treatment ;  to  this  he  has  consequently 
given  special  attention,  and  with  the  best  results.  Only  a  few 
can  be  speciahsts  in  gynaBcology,  but  every  general  practi- 
tioner meets  with  cases  of  pelvic  derangement  in  the  female 
subject,  which  it  is  either  unnecessary  or  impossible  to  send  to 
the  specialist.  For  such,  the  volume  before  us  is  the  most 
valuable  we  know ;  and  the  specialist  may  often  refer  to  its 
pages  with  advantage,  especially  in  some  of  the  cases  which 
may  be  termed  functional.  The  chapters  for  instance  on 
pruritus  and  dysmenorrhoea  contain  many  fruitful  suggestions. 

The  present  is  the  second  edition  of  Dr.  Southwick's  work. 
It  does  not  claim  to  be  a  complete  treatise,  and  to  maintain 
its  practical  usefulness  omission  has  been  made  of  some  of 
the  rarer  diseases,  as  well  as  of  "  the  discussion  of  various 
theories  current  in  gyneBCology.'* 

The  work  is  well  illustrated,  many  of  the  illustrations  being 
taken  from  Hart  and  Barbour's  work.  Several  of  these  again 
are  modifications  from  Schultze,  whose  writings  on  the  nor- 
mal position  of  the  pelvic  organs  have  revolutionised  our  ideas 
on  this  subject. 

Local  treatment  and  minor  surgery  are  fully  discussed,  and 
all  the  statements  are  clear  and  mostly  rehable.  No  great 
confidence  is  placed  in  local  applications,  though  instructions 
and  indications  for  their  use  are  given. 

A  few  points  we  have  noticed  on  which  the  author  is  at 
variance  with  other  authorities  or  with  our  own  experience. 
For  instance,  we  are  surprised  that  directions  for  the  use  of 
stem  pessaries  should  still  be  issued  ;  the  presence  of  Neisser's 
gonococcus,  if  found  in  the  epithelial  celts,  is  regarded  as  diagnos- 
tic of  gonorrhoea.  The  author,  however,  achnits  that  in  this 
behef  he  has  not  the  support  of  many  other  authorities. 
Chapman's  spinal  hot-water  bags  have  proved  a  failure  in  our 
hands.  The  chapter  on  electricity  in  diseases  of  women  is  a 
moderate  and  judicious  one  ;  extravagant  statements  respect- 


gsa^A^arsr       beviewb. 275 

ing  its  value  in  fibroids  are  not  indulged  in.  Massage  in 
gyniecology  finds  a  place  in  this  edition,  and  this  section  is 
well  written.  We  are  glad  to  see  that  the  character  of 
Dr.  Soathwick's  work  is  so  well  kept  np  in  this  edition. 

Annual  of  tlie  Universal  Medical  Sciences  :  A  Yearly  Beport  of 
the  Progress  of  the  General  Sanitary  Sciences  Throughout  the 
World.  Edited  by  Chas.  B.  Sajous,  M.D.,  and  Seventy 
Associate  Editors,  niastrated  with  chromo-lithographs, 
engravings,  and  maps.  In  5  volumes.  1890.  F.  A.  Davis, 
Philadelphia  and  London. 

Ors  notice  of  this,  the  third  issue  of  The  Annual,  has  been 
unavoidably  delayed.  It  is  impossible  to  do  more  than 
generalise  in  remarking  upon  a  work  of  such  magnitude  and 
comprehensiveness.  "  Nothing  succeeds  like  success,"  and 
the  fact  that  The  Annual  still  exists  is  the  best  proof  of  its 
value  and  usefulness — ^the  best,  at  least,  after  a  personal  test. 
We  may  safely  say  that  everything  of  importance  that  has 
been  written,  spoken,  and  done  in  the  art  and  science  of 
medicine  throughout  the  whole  world  receives  notice  here  in 
its  appropriate  place.  A  glance  at  the  index  will  show  the 
progress  of  the  year  in  any  department,  and  for  detail 
reference  has  only  to  be  made  to  the  body  of  the  work.  For 
illnstrations  of  the  class  of  references  we  will  turn,  as  before, 
to  the  chapter  on  Therapeutics.  A  long  list  of  conditions  in 
irhich  antipyrin  is  given  includes,  besides  pyrexia  and  various 
neuralgias,  asthma,  pertussis,  chorea,  acute  rheumatism, 
hemoptysis  and  other  hsBmorrhages  (locally),  renal  colic,  uric 
acid  diathesis,  sun-stroke,  and  convxdsions.  Its  dangers  are 
illuatrated  by  the  case  of  Tuczek,  previously  referred  to  in 
this  journal  (vol.  88,  p.  669),  in  which  coma,  dyspnoea,  irregular 
cardiac  action,  and  tonic  and  clonic  convulsions  were  caused. 
Several  authors  point  out  that  such  complex  chemical  sub- 
stances as  antipyrin  should  be  given  alone,  as  the  chemical 
composition  is  not  sufficiently  well  known  to  foretell  what 
compounds  with  other  substances  may  be  formed.  The 
active  principles  of  cincho7ia,  for  instance,  are  all  precipitated 
by  antipyrin.  Many  instances  of  the  homoeopathic  use  of 
drngs  and  of  the  use  of  drugs  brought  to  prominence  by 
homcBopathists  are  given,  e,g,f  arsenite  of  copper  in  bowel 
troubles,  barium  chloride  for  varicose  veins  and  aneurism, 
^onia  alba  in  various  haemorrhages,  including  epistaxis, 
cactus  grandijicrus  in  heart  disease,  calcium  sulphide  in 
"spasmodic  and  convulsive  disease,''  chimaphila  as  a  diuretic, 
citutine  in  epilepsy,  cimicifuga  in  neuralgia,  condurangin  in 
carcinoma,  euphratia  in  coryza,  gelsemium  and  veratrum  viride 
as  febrifuges,  hamamelis  in  varices  and  haemorrhoids,  hydrastis 


276  PBMSCOPE.  'S^.'iSSTm 


in  pharyngitis  and  lencorrhoea,  rhm  tox  in  rheumatism.  It  is 
interesting  to  note  that  daring  the  period  covered  by  this,  the 
third  issue  of  Tlie  Annual^  two  authors  are  found  to  write  in 
favour  of  blood-letting  in  a  variety  of  conditions.  We 
may  remark  that  our  own  and  other  homoeopathic 
journals  would  have  furnished  the  Editor  of  the  Thera- 
peutic chapter  with  much  rehable  information  on 
drugs  already  included  in  this  volume  and  on  others  not 
mentioned.  As  so  much  homoeopathy  is  included  in  its 
references  it  would  be  well  to  go  to  the  fountain  head.  We 
have  quoted  from  the  chapter  on  therapeutics  to  show  the 
extent  and  variety  of  information  given,  and  to  show  how  the 
appropriation  of  homoeopathic  remedies  goes  on.  But  to  most 
of  our  readers  the  section  on  general  medicine  and  surgery 
and  on  the  special  departments  Will  be  more  really  useful  than 
the  therapeutic  section.  We  should  state  here,  however,  that 
reference  is  made  to  many  cases  of  poisoning,  which  are  of 
value  to  the  homoeopath. 

We  cannot  too  strongly  urge  our  readers  to  possess  them- 
selves of  the  Antmal  (either  the  present  or  the  forthcoming 
issue).  They  cannot  fail  to  find  it  a  really  profitable  invest- 
ment, especially  if  living  in  the  country  and  away  from  medi- 
cal hbraries. 

PERISCOPE. 

LARYNGOLOGY,  Etc. 

ELsMOPTYSis  IN  Appakently  Healthy  Persons. — Dr.  DaviQ 
Newman  (Glasgow)  reports  five  cases  of  haemoptysis  in 
apparently  healthy  persons.  In  three  which  had  been  under 
observation  for  four  years  haemoptysis  was  suspected  to  be 
from  the  lungs,  but  was  proved  to  be  firom  the  upper  air 
passages.  Li  one,  quoted  as  an  example  of  phthisis  ab 
haemoptoe,  the  blood  was  derived  from  the  upper  air  passages, 
and  inspired  into  the  minute  ramifications  of  the  lung.  I?  * 
fiftli  case  haemorrhage  took  place  occasionally  over  a  penod 
of  fully  three-and-a-half  years,  during  which  the  patient  wa^ 
otherwise  healthy,  and  no  physical  signs  of  pulmonary  disease 
was  discovered  until  within  eight  months  of  death. 

The  author  wishes  to  demonstrate  by  these  cases  that 
haemorrhage  from  the  upper  air  passages  may  easily  be 
mistaken  for  true  haemoptysis,  or  bleeding  from  the  pulmonary 
parenchyma,  and  the  process  by  which  haemorrhage  from  one 
part  may  be  simulated  by  bleeding  from  another  renders  the 
diagnosis  in  certain  cases  very  difficult. 

In  every  case  a  careful  examination  of  all  parts  of  the 
upper  air  passages  for  a  lesion  to  account  for  the  haemorrhage 


SSSf^SrS?"*  PEBI8C0PE, 277 

should  be  made,  and  if  none  be  found  the  case  shotdd  be 
treated  as  one  of  polmonary  disease. — {Jour.  Laryng.  Rhin.) 

Gabduus  Mabianus. — "  Hemorrhage  from  the  lungs  con- 
nected with  hepatic  disease  is  curable  by  no  other  medicine 
so  readily  as  by  card.  mar.  It  is  also  of  great  use  in  hiemop- 
tysis  dependent  on  diseases  of  the  spleen,  with  swelling  and 
footing  in  that  organ,  and  relief  by  lying  on  the  left  side. 
Acute  and  chronic  sore  throats,  and  chronic  asthma  when 
oomiecied  with  hepatic  or  splenic  derangements,  yield  to  fchis 
remedy." — (Dr.  Eunze,  quoted  by  Dr.  Dudgeon,  Monthly 
Horn.  Review^  March,  1891). 

Absenic  in  Cystic  Goitre. — Dr.  Snow  {Brit,  Med.  Jour.) 
speaks  highly  of  arsenic  in  cystic  affections  of  the  thyroid 
gland.  In  one  case  in  which  he  employed  the  drug  the  en- 
largement entirely  disappeared.  In  two  other  cases  the 
improvement  was  very  marked  in  a  short  time,  but  the 
patients  ceased  attending  very  soon  after  the  treatment  was 
beginning  to  show  its  influence. — {Horn.  Review,  March,  1891.) 

C.  W.  Hatward. 

Tincture  op  Thuja  in  Tracheotomy. — Joum.  Med.  de  Pam, 
Dec.,  1890.  The  author  (Dr.  Coculet)  recommends  tinct. 
tkujoi  to  destroy  the  fleshy  vegetations  which  cause  the  irrita- 
tion in  the  region  of  the  canula. 

PmocARpiNE  in  Dryness  of  the.  Tongue. — J.  G.  Blackman, 
Brit.  Med.  Joum.,  June  14th,  1890.  The  author  recommends 
pilocarpin  gr.  ^  ^  in  the  form  of  a  gelatin  lamel,  allowed 
to  dissolve  on  the  tongue,  previously  moistened  with  water. 
A  moderate  flow  of  saliva  is  thereby  produced,  which  lasts  for 
twenty-four  hours. 

Etiology  Prognosis  and  Treatment  op  Exophthalmic 
Goitre. — Gazette  des  H6pitau.v,  Nov.  20th,  1890.  Jaecoud. 
Etiological  factors,  chiefly  mental  emotions,  e.ff.,  shock  or 
prolonged  depression,  and  heredity. 

Prognosis :  Always  serious,  and  disease  ends  fataUy  in  one- 
Ibmih  or  one-fifth  of  all  cases. 

Causes  of  death  :  Marasmus,  due  especially  to  incessant 
cardiac  activity,  and  also  in  a  less  degree  to  digestive  troubles. 
Vomiting,  icterus,  diarrhoea  and  urinary  troubles,  albuminuria, 
glycosuria. 

Treatment :  The  author  advises  iron  for  anaemic  cases,  and 
considers  hydro-therapeutics  and  electricity  of  great  value. 
Warm  douches,  after  a  time  tepid,  and  gradually  diminished 
in  temperature  imtil  cold,  each  being  of  25  to  80  seconds' 
duration  to  begin  with,  and  given  daily.  Tlie  best  form  of 
electricity  is  that  of  weak  continuous  ascending  currents  on 
both  sides  of  the  neck.     Simultaneous  galvanisation  of  pre- 


278  PEMSCOPE.  "^SS!J.%1^' 


Beview,  April  1,.1SB1. 


cordial  region  and  feuradization  of  neck,  as  recommended  by 
Charcot,  is  of  value. 

He  warns  against  the  careless  use  of  ice  over  the  thyroid 
body,  as  there  is  danger  of  inducing  gangrene  of  the  skin 
stretched  over  the  swelling. 

Relation  of  Nasal  Diseases  to  Eye  Tboubles. — Joum.  of 
OphthaLy  Otology  and  Laryngology^  July,  1890.  Dr.  Bissell, 
Rochester,  N.Y.,  in  a  short  but  very  able  article  gives  an 
account  of  our  present  knowledge  of  this  relationsHp.  He 
draws  attention  to  the  fact,  1,  that  *^  the  blood  supply  of  the 
two  organs  is  such  as  to  favour  the  extension  of  trouble  in 
one  to  the  other  "  ;  2,  ''  The  passage  of  inflammatory  con- 
ditions through  the  nasal  duct  is  not  improbable  "  ;  and  8, 
**  That  the  nerve  supply,  both  cerebral  and  sympathetic, 
brings  them  into  very  close  relationship.''  As  example  of 
eye  troubles  traceable  to  abnormal  conditions  within  the  nose, 
he  gives  as  most  frequently  observed  symptoms  classed  under 
the  head  of  asthenopia.  ''  Pain  after  using  the  eyes,  es- 
pecially in  the  morning.  Photophobia  is  a  weak  feeling  in 
the  eyes,  as  if  patient  could  not  keep  the  lids  open ;  worse 
in  the  morning.  Smarting  of  margin  of  the  lids  and  slight 
hyperaemia  of  the  conjunctiva,  passing  off  in  two  or  three 
hours  after  rising."  The  morning  aggravation  is  important, 
and  due  to  pressure  produced  by  the  swelling  of  the  erectile 
tissue  of  the  nose  during  th^  night,  the  nasal  affections  pro- 
ducing this  being  hypertrophies  of  the  turbinates  and  marked 
deviation  of  the  septum,  and  less  frequently  polypi  and 
adenoid  tissue. 

Second  in  point  of  frequency  come  derangements  of  the 
the  lachrymal  apparatus,  either  as  epiphora,  due  to  mere 
excitation  of  the  lachrymal  gland,  the  sac  and  nasal  duct 
being  normal,  or  as  blennorrhoea  of  the  sac  and  stricture  of 
the  nasal  duct,  due  from  direct  extension  of  a  congestion  of 
the  nasal  mucous  membrane  into  the  nasal  duct. 

The  third  group  is  that  of  reflex  circulatory  disturbances, 
such  as  iritis,  conjunctivitis,  keratitis,  &c.  Lennox  Browne 
reports  a  case  of  glaucoma  not  improved  by  iridectory,  but 
cured  by  removing  a  nasal  polypus.  Ziem  reports  six  cases 
of  diminished  vision  with  venous  hyperaemia  of  the  papilla, 
relieved  or  cured  by  treatment  of  the  nasal  condition. 

Dudley  Weight. 

GYNJECOLOGY. 

Pruritus  Vulv«. — Dr.  E.  M.  Hale  reports  cases  of  pruritus 
ani  et  vulvae  cured  by  topical  application  of  menthol.  One 
case,  occurring  during  pregnancy,  gained  complete  relief  from 
one  application  of   menthol  ointment  of   the  strength    of 


Moitflily  HonuBopathie 
Beriew,  April  1, 1801. 


PERISCOPE. 


279 


twenty  grains  to  the  ounce.  Another  case,  after  the  failure 
of  local  dressings  of  borax  and  sulphate  of  soda,  required  a 
aeries  of  six  applications  before  complete  cure  was  effected, 
hi  both,  the  pruritus  did  not  return. 

Graphites  and  Petroleum. — In  chronic  pelvic  lesions  of 
inflammatoiy  origin,  these  two  remedies  are  well  to  the  front. 
In  the  graphites  case  the  skin  is  rough  and  dry  and  marked 
constipation  exists.  The  menstrual  flow  is  lessened  and 
delayed,  leucorrhoea  watery  and  profuse.  Pruritus  also  is 
often  present,  but  precedes  the  periodic  flow. 

Petroleum  relieves  a  pruritus  that  follows  the  period,  being 
eicited  by  the  menstrual  flow.  Here,  again,  the  skin  is 
harsh  and  dry,  but  vesicles  and  pustules  are  frequently 
present ;  the  period  is  anticipated  and  free.  The  leucorrhoea 
also  is  more  viscid  than  in  the  graphites  case. 

In  both  these  types  of  lesion  the  skin  excitation  is  defective, 
and  the  first  step  essential  in  permanent  cure  is  to  take  the 
necessary  measures  to  renew  a  healthy  and  vigorous  tone 
therein. 

Sepia. — In  pruritus  vulvsB,  sepia,  though  often  indicated,  is 
said  merely  to  relieve,  never  to  cure.  Much  more  favourable 
results  are  recorded  from  coUinsonia  in  this  lesion. 

Canthabis  in  Puebperal  Mania. — When  characteristic 
arinary  symptoms  precede  and  accompany  the  attack,  and  the 
&cial  aspect  is  pale,  yellow,  and  wrinkled,  vantharis  may  be 
indicated,  with  such  concomitant  symptoms  as  aggravation  on 
touch,  on  the  sight  of  any  dazzling  object,  bright  eyes,  and 
dilated  pupils. 

Xanthoxylum  in  Dysuenla.  —  A  very  striking  case  is 
recorded  in  the  Horn.  Journal  of  Obstetfics,  of  aggravated 
dysmenia  with  scanty  flow.  The  patient  was  very  restless, 
and  pain  was  ascribed  to  the  region  of  both  flanks  rather  than 
to  the  centre  of  hypogastrium.  The  pain  was  so  acute  tliat 
each  spasm  caused  a  flow  of  tears.  Xanthoxijlum  given  every 
half  hour  caused  complete  disappearance  of  the  pain  after  the 
fourth  dose.  A  week's  medication  before  the  next  ensuing 
period  with  xanthoxylum  caused  an  entirely  painless  period  to 
be  passed,  after  which  the  dysmenia  vanished. 

Opesative  Treatment  of  Pelmc  Abscess. — Wilcox  gives  in 
the  North  American  Journal  details  of  three  cases  which  have 
been  efliectively  dealt  with  by  abdominal  section,  and  which 
illustrate  the  delay  and  danger  incident  to  tapping. 

Case  1  presented  the  signs  and  symptoms  of  suppurating 
hffimatocele.  She  was  seen  when  in  extremis,  and  operation 
inunediately  performed.  An  abscess  sac  in  the  broad  liga- 
ment was  found,  aspirated,  and  the  whole  sac  drawn  out  and 


280 NOTABILU.  "S^^ISS^^ 

treated  like  a  broad  ligament  cyst.  The  patient  made  a  good 
recovery. 

Case  2  was  an  instance  of  post-pnerperal  abscess  which  had 
ruptured  into  the  bladder.  On  operation,  a  doughy  mass  of 
tissue  was  exposed  in  the  pelvis,  and  a  series  of  small  abscesses 
evacuated.  The  mass  of  exudation  lent  itself  to  enucleation, 
the  sinus  leading  into  the  bladder  was  tied,  and  the  operation 
concluded.  This  patient  also  did  very  well  during  convales- 
cence. 

Case  8  belonged  to  the  well  known  type  of  pehic  abscess 
rupturing  into  the  rectum.  The  abscess  sac  had  alternately 
closed  and  discharged  itself  for  a  period  extending  over  five 
years.  On  operation,  the  opening  into  the  sac  was  stitched 
to  the  abdominal  wall,  a  fibroid  present  was  also  removed,  and 
although  the  thinned  rectal  wall  was  torn,  the  opening  has 
spontaneously  healed. 

These  cases  well  illustrate  the  advisability  of  Lawson  Tait's 
method  of  attacking  pelvic  abscess  through  the  abdominal 
walls.  The  abscess  sac  is  thus  treated  on  sound  surgical 
principles,  and  the  wearisome  delays,  the  perpetual  recur- 
rences, and  the  constitutional  demorahsation  due  to  vaginal 
or  rectal  tapping — measures  which  ought  to  be  obsolete — 
totally  avoided.  G.  H.  Bubford. 

NOTABILIA. 

THE  AMERICAN  INSTITUTE  OF  HOMCEOPATHY 
AND  THE  INTERNATIONAL  HOMGSOPATHIC 
CONGRESS. 

We  are  requested  by  Dr.  Hughes  to  insert  the  following : — 
**  The  American  Institute  of  homoeopathy  will  hold  its  forty- 
fourth  annual  session  and  celebrate  its  forty-eighth  anniversary, 
in  conjunction  with  the  fourth  quinquennial  International 
HomoBopathic  Congress  at  Atlantic  City,  N.J.,  beginning 
Tuesday  morning,  June  16th,  1891.  In  accordance  with 
action  taken  at  its  last  session,  the  Institute  will  transact,  as 
far  as  possible,  its  necessary  routine  business  on  that  day, 
and  the  International  Congress  will  assemble  on  the  following 
morning.  The  sessions  of  the  latter  will  occupy  the  morning 
and  afternoon  of  each  day  (Sunday  excepted)  until  Tuesday, 
June  28.  This  arrangement  of  the  business  of  the  Institute 
makes  it  necessary  that  all  the  standing  and  special  com- 
mittees should  have  their  reports  in  readiness  before  the 
opening  of  the  session.  But  it  should  be  noticed  that  all 
scientific  reports  of  committees  and  bureaus  appointed  last 
year  will  be  deferred  until  the  session  of  1892,  thus  giving 
place  to  the  scientific  work  of  the  Congress. 


25^'A^SrSS*  NOTABILIA.  281 


Review,  April  1, 1881. 


"  All  members  of  homoeopathic  medical  societies  will  have 
eqnal  rights  as  members  of  the  Congress,  and  eqaal  privileges 
in  the  transaction  of  its  business  and  in  its  discussions,  under 
such  rules  as  may  be  adopted  for  the  government  thereof. 
The  transactions  will  be  published  by  the  American  Institute 
of  Homoeopathy  and  furnished  to  physicians  on  such  terms  as 
may  be  decided  by  the  executive  committee. 

**  It  is  expected  that  the  proceedings  of  the  Congress  will  be 
€f  the  most  interesting  and  important  character.  While 
general  medicine,  surgery,  obstetrics  and  the  specialities  will 
have  their  place  in  the  discussions,  the  interests  of  homoeo- 
pathy will  furnish  the  main  topics  for  consideration.  It  is 
proposed  that  one  entire  day — '  Materia  Medica  Day  ' — shall 
be  devoted  to  the  subject  of  the  homoeopathic  materia  medica, 
and  the  consideration  of  questions  pertaining  to  its  present 
status  and  its  further  improvement.  Homoeopathic  thera- 
peutics will  also  claim  a  large  share  of  attention,  while  some 
of  the  subjects  upon  which  the  homoeopathic  school  is  known 
to  hold  a  distinctive  position,  will  be  presented  and  considered. 
The  essays  and  addresses  on  all  of  these  subjects  will  be 
presented  by  physicians  carefully  chosen  by  the  committee 
hamg  the  matter  in  charge,  and  the  discussions  will  be 
participated  in  by  some  of  the  physicians  most  distinguished 
in  each  department.  Arrangements  are  in  progress  to  secure 
reports  of  the  condition  and  advancement  of  homoeopathy  in 
aU  the  countries  of  the  civilised  world. 

"  A  word  as  to  the  place  of  meeting.  Atlantic  City,  as  is 
well  known,  extends  for  a  distance  of  two  or  three  miles 
abng  the  sea  coast  of  New  Jersey,  sixty  miles  south-east  of 
Philadelphia,  with  which  it  communicates  by  three  lines  of 
railway  and  scores  of  trains  daily,  most  of  which  make  the 
Stance  in  ninety  minutes.  New  York  and  Baltimore  are 
within  four  or  five  hours*  ride,  while  within  a  radius  of 
400miles  are  nearly  4,000  physicians.  Atlantic  City  has, 
during  'the  season,'  a  larger  patronage  than  any  other  of 
oor  sea-coast  resorts,  her  visitors  coming  from  all  quarters  of 
the  country,  but  chiefly  from  New  York,  Philadelphia, 
Bdtimore,  and  the  West  and  South.  She  has  ample  hotel 
accommodation  for  25,000  guests. 

"  The  United  States  Hotel,  which  will  be  the  headquarters 
of  the  Congress  and  the  place  of  its  meetings,  is  a  new 
stroctare,  located  one  square  from  the  beach  and  within  full 
Tiew  of  the  ocean.  It  has  accommodation  for  800  guests, 
ttnd  the  '  pavilion,*  in  which  the  Congress  will  assemble,  is 
a  large  room  on  the  first  floor  with  a  seating  capacity  for 
800  persons.    The  meeting  of  the  Congress  will  occur  during 

Vol.  33,  No.  4.  X 


n 


282 NOTABiLiA.  '^K^.^;S?gi! 

'  the  season/  but  the  United  States  Hotel  will  be  practically 
at  our  exclusive  disposal. 

**  The  scientific  and  social  features  of  the  meeting,  and  the 
attractions  of  Atlantic  City  as  a  health  and  pleasure  resort, 
render  it  probable  that  this  Congress  will  be  by  &r  the 
largest  gathering  of  homoBopathic  physicians  ever  convened. 
It  is  especially  suggested  that  the  occasion  will  famish  an 
unusual  opportunity  for  our  physicians  to  combine  the  profit 
of  a  scientific  convention  with  the  pleasures  and  benefits  of  a 
vacation,  both  for  themselves  and  their  foanilies.** 

OXFORD  HOMCEOPATHIC  DISPENSAEY. 

The  report  for  1890  shows  this  dispensary  to  be  fioorishmg^ 
and  doing  much  good. 

The  number  of  patients  for  the  year  was  748.  Over  800 
visits  were  paid.  Mortality  2  per  cent.  .  The  physician  is 
Dr.  Ouinness. 

TUNBRIDGE    WELLS    HOMCEOPATHIC    HOSPITAL 

AND  DISPENSARY. 

Wb  have  once  or  twice  lately  noticed  the  new  Homoeopathic 
Hospital  which  was  started  last  year.  It  was  sufficiently 
ready  for  the  reception  of  patients  in  September.  At  present 
the  number  of  beds  is  small,  but  it  is  hoped  that  funds  may 
come  in  to  such  an  amount  as  will  enable  the  Committee  to 
fill  the  vacant  space  with  beds.  From  September  till  the 
end  of  1890,  the  Report  states  that  12  patients  were  admitted 
at  the  Dispensary,  there  were  1,012  patients  treated  during 
the  year,  and  727  visits  were  made  at  patients'  houses.  The 
medical  officers  are  Drs.  Neild  and  Pincott.  Mr.  Tester  is  the 
dental  surgeon. 

THE    HAHNEMANN    CONVALESCENT    HOME   ANI> 
HOMCEOPATHIC   DISPENSARY,   BOURNEMOUTH. 

This  valuable  institution  continues  its  good  work,  and  is,  we 
are  glad  to  see,  in  a  more  satisfactory  financial  condition  than 
last  year.  In  the  Home  147  patients  were  treated,  with  seven 
deaths.  One  of  the  great  advantages  of  this  home  ^,^ 
patients,  if  suitable  oases  and  likely  to  benefit,  are  permitted 
to  remain  for  a  considerable  period  of  time.  Six  months  at 
Bournemouth  (or  even  three)  is  no  small  privilege,  and  may 
save  many  a  life  which  otherwise  would  be  thrown  away.  The 
out-patient  department  grows,  790  visits  having  been  paid 
during  the  year.  The  medical  report  remarks  that  no  patients 
have  yet  been  treated  by  Koch's  method,  no  lymph  being 
obtamable.    But  it  expresses  the  belief  of  the  medical  officers 


Sa^^flg'  NOTABILU, 28a 

ihat  it  acts  on  lines  '*  parallel  to,  though  not  identical  with 
onr  special  therapeutic  law/*  An  experience  of  yeart  at  Isast 
will  be  required  to  determine  its  true  ooratiYe  value.  This  is 
ondoubtedly  a  correct  view,  and  one  which  has  been  largely 
overlooked. 

HOMOEOPATHY  AT  OXFORD. 

Wk  understand  that  some  zealous  (lay)  homoeopaths  of  Oxford 
and  neighbourhood  have  formed  themselyes  iato  an  association^ 
*'for  the  purpose  of  promoting  homoeopathy  in  Oxford, 
Oxfordshire  and  the  adjoining  counties."  A  meeting  was 
held  under  the  presidency  of  the  Mayor,  on  the  10th  ult. 
The  precise  lines  of  action  of  the  ''Oxford  Homoeopathic 
Association  *'  were  to  be  discussed  at  a  subsequent  meeting  of 
the  conmiittee,  but  the  object  was,  it  appeared,  to  be  attained 
by  the  circulation  of  literature,  the  arranging  of  lectures,  &c. 
A**Balliol  man"  had  offered  to  lecture  upon  homoeopathy. 
One  of  the  speakers  suggested  that  the  treatment  of  animals 
would  be  of  use  in  spreading  a  knowledge  of  homoeopathy ; 
another  gentleman  urged  the  Association  to  secure  for  the  city 
the  services  of  a  good  surgeon  acquainted  with  homoeopathy* 
We  doubt  not  that  this  association,  if  carried  on  with  the 
energy  and  prudence  with  which  it  has  commenced,  will  prove 
a  real  boon  to  the  city,  to  poor  and  rich  alike. 

VACCINIA    AND    VABIOLA. 

Ik  the  *^  Weekly  Epitome  of  Current  Medical  Literature  '* 
of  the  British  Medical  Journal,  February  28th,  a  case 
is  recorded  which  is  of  such  importance  that  we  extract  it. 
It  has  been  contended  that  the  **  similarity  "  between  vaccinia 
and  small  pox  fails  in  that  the  former  only  shows,  as  a  rule, 
vesicles  where  the  punctures  have  been  made,  while  the 
ernption  of  the  latter  is  general  over  the  body.  Though  this 
is  generally  true,  yet  a  few  cases  have  been  recorded  sufficient 
to  establish  the  fact  that  the  vaccinia  eruption  may  occur  in  \ 
parts  of  the  body  far  off  from  the  punctures.  Here  is  another 
one. 

*'  Gaucher  {Armales  de  Derm,  et  de  Syph.,  January,  1891) 
brought  before  the  Paris  Dermatological  Society,  on  January 
8th,  1891,  the  case  of  a  child  that  had  been  vaccinated  with 
calf  lymph.  Eight  days  after  the  vaccination  there  were 
three  good  vaccine  pustules  on  each  arm.  On  that  day  the 
pustules  became  excoriated,  the  fever  became  severe,  and  the 
nifimt  refused  to  suck.  On  the  ninth  day  numerous  pimples 
appeared  resembling  vaccine  pustules.  On  the  eleventh  day 
t  general  eruption  was  present  on  nearly  the  whole  body, 
oeeoiring  in  places  where  auto-inoculation  by  rubbing  was 

X— 2 


284  NOTABILU.  "SS2J.Wf!SS! 

not  possible.  Some  of  these  pustules  advanced  to  mnbilicft- 
tion,  others  became  arrested  in  their  evolution.  Whilst  the 
eruption  progressed  the  general  state  grew  worse,  the  InngB 
became  engorged,  and  the  child  died  with  symptoms  of 
asphyxia.  Post-mortem  examination  showed  intense  con- 
gestion of  both  lungs,  without  hepatisation,  spleen  enlarged, 
and  softening  of  the  congested  kidneys.  In  the  liver 
scattered  yellowish  ishuids  of  fatty  degeneration  were  foimd.'* 

MEDICAL  CHICAGO. 
A  cAiiCULATioN  has  just  been  made  of  the  number  of  doctors 
and  medical  institutions  in  Chicago.    It  seems  there  are  in 
that  city  1,621  doctors,  orthodox  and  otherwise;  852 dentists, 
574  druggists,  147  nurses,  27  chemists,  and  18  inicroscopists. 
The  city  is  blessed  with  no  fewer  than  eight  medical  colleges, 
four  of  which  are  regular,  two  homceopathic,  one  "electnc, 
and  one  "  physio-medical."    There  are  besides  three  colleges 
of  midwifery,  five  of  dentistry,  and  two  of  pharmacy,  with  nine 
training  schools  for  nurses.     The  number  of  medical,  dentw, 
and  pharmaceutical  journals  published  in  the  city  is  18. 
There  are  84  hospitals,  19  dispensaries,  three  "  policlinics, 
and  last,  but  not  least,  a  Pasteur  Institute.    In  addition  to 
these,  there  are  28  charitable  and  benevolent  institutions  of  a 
miscellaneous  character. — North  Hants  Journal,  _ 

PROFESSOR    LIEBREICH^S    REMEDY    FOE 

TUBERCULOSIS. 
Canthaiodes  has  long  been  known  to  have  an  action  ^  "\^ 
jespiratory  mucous  membrane ;  but  it  is  only  lately  that  w 
has  been  suggested  that  it  should  be  used  as  a  remedy  lo/ 
tuberculosis.  Liebreich  uses  from  the  l-50th  of  a  deja- 
milligramme  upwards.  The  drug  is  used  subcutaneous^r. 
No  cures  are  reported ;  indeed,  the  report  laid  before  v^e 
Berlin  Medical  Society  on  the  4th  ult.  were  decidedly  un- 
favourable. In  a  recent  lecture  the  Professor  assigned  as  a 
reason  for  the  rare  use  of  cantJutrides  internally  that  l^* 
Gronefeld  (residing  in  England  in  the  17th  century)  was  pr(we- 
cuted  for  thus  administering  it.  Dr.  Gronefeld  nsod  canthari^ 
to  cure  renal  affections.  Liebreich's  method  has,  it  is  ^**^ 
produced  kidney  disease.  The  curative  use  of  the  drag  ^ 
homceopathic ;  the  theoretical  speculative  use  of  it  ^^^^^ 
bring  into  relief  the  value  and  the  **  similarity  "  of  the  oW 
treatment,  if  it  does  nothing  more.  ^^^_____ 

THE  DANGER  OF  UNBOILED  MILK.  ^ 

MiKT  people  have  a  rooted  objection  to  the  taste  of  bon^ 
milk,  and,  as  a  matter  of  fact,  that  liquid  is  generally  d^xD* 
unboiled.     The  public  will,  perhaps,  be  more  incKneo 


w 


SSSSfSsraii*         notabilu.  285 


IfriCT,Aidll,18n. 


depart  from  the  beaten  track  when  they  read  of  the  following 
eaae  broagfat  to  the  notice  of  the  Acad^mie  de  MMeoine  by 
IL  011i7iar»  one  of  the  phygioians  of  the  Hdpital  des  En&ntB 
Iblides.   Clinicians  are  moving  heaven  and  earth  to  exorciae 
the  ogre  taberonloeiB,  and,  in  onr  anxiety  to  discover  an 
antidote  for  the  ravages  of  the  terrible  baciUns,  we  are  apt  to 
iorget  the  old  adage,  "  prevention  is  better  than  cure."     The 
eiM  related  by  M.  OUivier  was  that  of  a  young  lady  aged 
twenty,  whose  frunily  and  personal  health  antecedents  were 
excellent,  but  who  had  the  misfortune  of  being  brought  up  in 
a  Mhool  where,  in  the  space  of  a  few  years,  six  out  of  thirteen 
IprlB  had  &llen  victims  to  tuberculosis,  two  being  cases  of 
tabes  mesenterica.    The  young  lady  succumbed  rapidly  to 
tDbercolous  meningitis.    An  examination  of  the  udder  of  the 
eow,  which  had  for  nine  years  supplied  the  school  with  milk, 
was,  after  death,  found  to  be  the  seat  of  extensive  tuberculous 
lesions.    M.  Mocard  emphasised  the  contention  of  M.  OUivier 
that  unboiled  milk  should  be  banned,  however  healthy  the 
cow  yielding  it  may  appear,  by  relating  how  the  lymphatic 
glands  of  a  calf  in  seemmgly  excellent  condition,  which,  to 
the  great  disappointment  of  its  owner,  had  died  after  a  few 
days'  illness,  had  been  found  stuffed  with  bacilli.     A  short 
tone  afterwards  the  mother  of  this  calf — a  fine  beast,  to  which 
had  been  allotted  numerous  prizes— -died  in  her  turn,  and  the 
udders,  lungs,  and  lympha^c  glands  were  discovered  to  be 
tobercnlous.  The  lesson  taught  by  these  two  interesting  com- 
monications  is  plain :  avoid  unboiled  milk. — Lancet^  March 
7th,  1891. 

THE  PHABMACEUTICAL  SOCIETY  OF  TASMANIA. 

Wk  notice  with  pleasure  the  formation  of  a  Pharmaceutical 
Society  in  Tasmania,  with  head-quartera  at  Hobart. 

As  usual  homoeopaths  take  a  good  place  on  the  Council,  as 
they  do  also  in  Victoria,  where  Mr.  Pleasance  is  a  member ; 
in  New  Zealand,  where  Mr.  Pond  is  one,  and  in  Queensland, 
where  Mr.  Field  is  to  the  front. 

In  Tasmania,  Mr.  H.  T.  Gould,  of  Hobart,  was  elected  at 
the  head  of  the  poll  for  the  Council,  receiving  the  votes  of 
every  member,  and  Mr.  Styant  Browne,  of  Launceston,  was 
retomed  for  his  end  of  the  Colony. 

Mr.  Gould  was  also  appointed  one  of  the  four  (4)  examiners 
and  has  for  some  years  acted  as  honorary  secretary  of  the 
Hobart  Chemists'  Association.  The  Tasmanian  Pharmaceu- 
tical Society  is  working  with  the  Medical  Court,  which  has 
had  control  of  the  examinations  since  1842 ;  in  fact  Tasmania 
in  this  respect  is  well  in  advance  of  any  of  the  other  Colonies 

of  the  mother  country  itself,  as  all  chemists  have  had  to 


286  KOTABILIA.  "S^.^"S!??!S° 


Beview,  April  1, 18S1. 


undergo  an  examination  at  the  hands  of  the  Medioal  Court  of 
Examiners  since  the  date  mentioned  (1842)  or  nearly  half  a 
century  ago.  If  the  medical  men  and  chemists  everywhere 
would  work  together  as  they  do  in  Tasmania,  it  would  be 
much  more  satis&ctory  both  to  the  profession  and  the  trade. 

TUBERCULINE. 

The  following  lines  and  charade  were  written  by  one  of  the 
**  cases "  recently  under  treatment  by  Professor  Koch's 
method,  at  the  ChaJmers  Hospital,  Biuiff,  and  were  com- 
municated by  Dr.  Wm.  Fergusson  to  the  Lanc0t  of 
March  7th,  1891. 

I  feel  this  mundane  sphere's  a  fraud — 

A  gift;  not  worth  the  giving ; 
That  things  are  going  to  the  bad, 

And  life's  not  worth  the  Uving. 

It  is  not  that  the  world  is  false, 

Though  false  it  is  and  vain : 
That  maJces  no  riot  in  my  pulse  ; 

That  brings  my  head  no  pain. 

It  is  not  that  my  love's  unkind. 

Though  that  is  also  true ; 
I  bear  tliat  now  with  equal  mind. 

For  it  is  nothing  new. 

It  is  not  that  I  am  in  debt — 

None  ever  gave  me  credit — 
Nor  am  I  turning  crusty  yet, 

Though  unkind  folks  have  said  it. 

You  ask,  '*  Whence  then  this  clouded  brow — 

This  world  dissatisfoiCtion?" 
I  am  inoculated  now. 

And  this  is  the  *'  Reaction" ! 

Chabade. 

I. 
My  first  lies  at  the  root  of  things, 

With  homely  earth  is  soiled, 
Yet  at  the  festive  board  of  kings 

Is  always  welcome  boiled. 

n. 
My  second  o'er  the  level  green 

Impels  the  polished  ball ; 
Where  '*  cannons  "  rattle  it  is  seen, 

Yet  loves  the  peaceful  "  stall." 


iS^J^STS^  OBITUARY.  287 


Briev,  April  1, 1891. 


m. 

Mj  third  aroond  the  green  earth  lies, 

No  angel  ever  saw  it ; 
'Twas  never  viewed  by  mortal  eyes, 

Yet  men  must  somewhere  draw  it. 

IV. 

When  wasting  sickness  crowns  the  ills 

By  hapless  men  endured, 
My  whole  fresh  strength  and  hope  instUs, 

And  whispers  *'  Be  thou  cured.*' 


OBITUARY. 


h  18  with  extreme  regret  we  announce  the  death,  on  March 
7th,  of  Augustas  Gronin,  L.D.S.I.,  at  his  residence,  26,  Harley 
Street,  Cavendish  Square,  London,  aged  49.  He  had  been  in 
&iiing  health  for  a  considerable  time,  and  retired  from  practice 
October,  1889.  He  held  the  appointment  of  dental  surgeon 
at  the  London  Homoeopathic  Hospital  for  many  years,  and  he 
W&8  also  a  member  of  the  Odontological  Society  and  the  British 
Dental  Association.  All  who  knew  him  must  feel  that  they 
We  lost  a  sincere  and  agreeable  friend. 


CORRESPONDENCE. 


To  the  Editors  of  the  **  Monthly  Homcsopathic  Review,'' 

Gentlemen, — On  p.  200  of  this  month's  Review  in  your 
iiotice  of  Dr.  Allen's  re-issue  of  Bmnninghausen's  Pocket  Book 
jon  remark  that  it  includes  '*  many  other  symptoms  than 
abaolately  pathogenetic  ones,"  and  you  go  on  to  say,  '*  this, 
of  coarse,  applies  equally  to  all  other  repertories  hitherto 
published." 

From  the  way  in  which  the  remarks  are  made  readers  will 
be  apt  to  conclude  that  you  mean  that  other  than  pathogenetic 
Bymptoms  have  been  included  knowingly  and  intentionally 
uito  every  repertory  hitherto  published.  If  this  is  your 
ineaniiig,  I  think  you  will,  on  reflection,  admit  that  your 
assertion  is  not  quite  correct,  for  there  is  at  least  one  honour- 
able, viz.,  the  British  (or  Cypher)  Repertory,  in  which  no 
symptom  has  been  admitted  unless  it  was  thought  to  bear  the 
stamp  of  being  truly  pathogenetic.  And  such  is  the  condition 
on  which  symptoms  are  being  admitted  into  the  forthcoming 


288  CORRESPONDENTS.        ^^SSSL-^SS??^ 


Seriew,  April  1, 1801. 


re-issue  of  the  Throat,  Nose  and  Ears  chapters,  now  in  course 
of  preparation. 

If  jou  will  be  good  enough  to  allow  me  to  reassure  jour 
readers  on  this  matter,  you  will  oblige 

Yours  truly, 

John  W.  Haywaed. 
61,  Shrewsbury  Boad,  Birkenhead. 
March  4th,  1891. 


NOTICES  TO   CORRESPONDENTS. 


%♦  We  cannot  undertake  to  return  rejected  vMniiscrijfti. 

Authors  and  Conteibutobs  reoeiving  proofs  are  requested  to  correct 
and  return  the  same  as  eairly  as  possible  to  Dr.  Edwin  A  NEi^TBT. 
London  Hom(bopathic  Hospital,  Great  Obmond  Steekt, 
Bloombbury.— Hours  of  attendance  :  Medical,  daily,  2.S0 ;  Surgical 
Mondays  and  Thursdays,  2.S0 ;  Diseases  of  Women,  Tuesdays  and 
Fridays,  2.80  ;  Diseases  of  Skin,  Thurdays,  2.80  ;  Diseases  of  the  Eye, 
Thursdays,  2.80;  Diseases  of  the  Ear,  Saturdays,  2.80;  Dentist, 
Mondays,  2.80  ;  Operations,  Mondays,  2. 

Communications,  &o.,  have  been  received  from  Dr.  Bubford,  Mr. 
Wright,  Mr.  Wyborn,  Mr.  Cross,  Mr.  Castellottb  (London); 
Dr.  Hughes  (Brighton) ;  Dr.  Drummond  (Malvern) ;  Mr.  Mabtin 
(Manchester)  ;  Dr.  C.  W.  Hayward  (Liverpool)  ;  Dr.  Thomlby 
(Bolton). 


BOOKS    RECEIVED. 


TheAnnttal  oftJie  f/niversal  Medical  Sciences,  F.  A.  Davis  :  London 
and  Philadelphia.  1890.— 2%«  Ifomatopathic  World,  March.  London. 
—The  ChemUt  and  Druggist,  March.  London.— 2%i?  Monthly  Maga- 
zin^  of  Pharmckoy,  March.  London. — The  North  Afner lean  Journal  of 
Homceopathy,  March.  New  York. — The  American  HomoeopatM- 
Feb.  New  YorV.  — The  New  York  Medical  Times,  March.— ^'• 
Medical  Record.  Feb.  14th,  21st,  28th,  March  7th.  New  York.— 2^^ 
Chironian,  Feb.  New  York.— TAc  Hahnemann  Monthly^  March. 
Philadelphia.— TA^J  New  £}ngland  Medical  Gazette.  March.  Boston. 
-^Thc  ainique,  Feb.  Chicago.— TAc  Medical  Advance,  Feb,  Chicago. 
—The  Medical  Bra,  March.  Chicago.— TAtf  Homoeopathic  Entop 
March.  Lancaster. — Tlie  Southern  Journal  of  Homoeopathy.  Feb. 
New  Orleans.  —  Annual  Heport  Bournemouth  Contaleseent  Bo^f' 
V Homeopathic  Populairc,  March.  Paris. — V  Union  Homceopathi^' 
Jan.  Antwerp. — Allgem,  Horn,  £^eitung.  March.  Leipzig.— /^^i^**^^ 
Zeitsehrift  fiir  Homoopathie.    Feb.,  March.    JjQvpiig.—HomiSopithisek 

Maandhlad,  Feb.,  March.  Gravenhage.— (7tf:rrt<a  Mediea  Di  ^'^• 
Feb.  25th,  Mareh  5th,  15th.— Za  Reforma  Mediea.  Sept,  lo»". 
Mexico. 

Papers,  Dispenmy  Reports,  and  Books  for  Review  to  be  sent  to  D^v^'^ijl 
Wat^i^te,  Grantham,  Lmoolnwhire ;  Dr.  D.  Dyck  Browv,  S9,  Se^onr  Stree^^^ 
man  Sqnare,  W.;  or  to  Dr.  Enwix  A,  Nbatbt,  161,  Haverstock  IQu,  N.W.  ^^^^fsT 
ments  and  Business  eommanications  to  be  sent  to  Messrs.  £.  Oodld  *  Sov>  91* 
Moorgate  Street,  E.G. 


S^^STSIf'"  GOUT.  289 


Berimr.lbr  1,1801. 


THE    MONTHLY 

HOMOEOPATHIC    REVIEW 


•:o:- 


THE  IRRITABLE  MUCOUS  MEMBRANE  OP  THE 

GOUTY  SUBJECT.* 

By  J.  Galley  Blackley,  M.B.,  Lond., 

Senior  Physician  to  the  London  Homceopathic  HospitaL 

6entlb3£bn, — In  looking  oyer  the  voluminous  literature 
of  gout,  it  has  always  appeared  to  me  that  too  much 
space  is  given  up  to  speculations  upon  the  precise  nature 
of  the  disease,  and  too  little  to  its  more  subtle  mani- 
festations. So  far  as  its  commoner  and  more  tangible 
phases  are  concerned,  there  is  no  lack  of  knowledge,  but 
it  is  surprising  how  little  has  really  been  done  to  reduce 
to  something  like  order  the  material  we  possess  in  the 
accounts  of  its  effects  upon  internal  organs,  more  espe- 
cially those  where  the  mucous  membranes  are  chiefly 
inTolved.  It  is  for  this  reason  that  I  have  ventured  to 
choose  as  the  subject  of  my  paper  for  this  evening  the 
irritable  mucous  membrane  as  it  occurs  in  the  gouty 
subject.  There  is  a  common  saying  in  Germany  that 
two  things  are  inevitable  to  mortals  here  below,  **  death 
and  the  third  class  of  the  order  of  the  red  eagle ;  *'  if  for 
"mortals  "  you  substitute  **  medical  men,"  then  I  think 
we  may  say  that  sooner  or  later  the  gouty  patient  with  a 
sensitive  mucous  membrane  is  sure  to  present  himself. 

*Beftd  before  the  British  Homoeopathic  Sooiet j,  April  2nd,  1891. 
Vol.  35,  Ko.  5.  Y 


^^^  GOUT.  Ecnew,  May  1,  lan. 

With  acute  gout  and  with  chronic  gout  so  far  as  it 
affects  the  joints,  or  leads  to  the  well  known  local  deposits 
of  urate  of  soda,  I  do  not  propose  to  deal.  It  is  with  the 
latent,  or  suppressed  form,  that  we  are  concerned  this 
evening ;  in  fact,  with  the  entity  which  goes  for  want  of 
a  better  term  under  the  name  of  the  "  gouty  diathesis," 
and  the  evidences  of  which  are  frequently  seen  only  in 
disturbances  of  the  respiratory,  digestive,  urinary,  or 
cutaneous  systems  or  of  the  brain. 

I. — Respiratory  Sphere. 

In  order  to  give  you  a  connected  idea  of  what  the 
eifects  of  gout  are  upon  the  respiratory  mucous  mem- 
brane, I  will  endeavour  to  draw  a  picture,  from  the 
life,  of  a  patient  whom  I  have  in  my  mind's  eye  at  the 
moment ;  reminding  you  that  the  respiratory  tract  is  a 
continuous  raucous  membrane,  commencing  with  the 
conjunctiva  and  continued  through  lachrymal  ducts, 
nasal  cavities,  pharynx,  larynx,  trachea,  bronchi,  and 
bronchial  tubes  to  the  finest  bronchioles  and  their  termi- 
nal air-cells. 

Case  I. 

Mrs.  T.,  aged  55,  is  a  well-preserved  lady  of  sanguine 
temperament,  German  by  birth,  rather  inclined  to 
cmhonpowt,  with  gouty  antecedents  and  a  history  of 
undoubted  attacks  of  gout,  in  the  shape  of  articular 
gout  (of  which  traces  are  still  evident  in  distorted  finger 
joints),  eczema,  asthma,  deafness,  urate  of  soda  deposits, 
and  passing  of  red  gravel.  The  conjunctivae  are  usually 
slightly  injected,  and  the  lids  somewhat  red  at  the  edges, 
and  she  frequently  complains  of  a  gritty  feeling  under 
the  eyelids  (no  tophi  are  to  be  seen  in  the  conjunctivaej. 
The  nasal  mucous  membrane  is  pale,  somewhat  swollen, 
and  rather  inclined  to  a  dusky  hue ;  coryza  occm-s  on  the 
slightest  provocation,  and  is  generally  accompanied  by 
much  stinging  and  smarting  about  the  posterior  opening 
of  the  naxes ;  the  tongue  is  large,  pale,  covered  with  a 
thin  whitish  coat;  uvula  relaxed,  pale  or  dusky,  not 
pink,  and  showing  dilated  veins.  The  epiglottis  and 
neighbouring  parts  somewhat  turgid  and  injected.  The 
voice  is  usually  rough  and  apt  to  assume  the  aegophonic 
character,  especially  after  exposure  to  damp,  and  this  is 
usually  followed  by  a  loud  barking  or  ringing  cough. 
Breath  sounds  over  cricoid,  trachea  and  bronchi  usualiy 


r 


XaatUjHoauBopatliic  rATTT  9Q1 


fievimr,  May  1, 1891. 


harsh  or  stridulous.  At  the  margins  of  the  lungs  in  front 
and  behind,  are  limited  patches  of  over-resonant  lung,  in- 
dicating slight  emphysema.  Breath-sounds  are  every- 
where somewhat  harsh  and  expiration  prolonged,  and  a 
slight  mucous  rale  is  usually  heard  over  various  parts  of 
the  chest.  As^  regards  the  alimentary  sphere,  primary 
digestion  is  good,  and  the  patient  takes  an  ordinary  diet 
with  whisky  as  a  beverage  (freely  diluted  of  course).  She 
is  frequently  troubled  with  attacks  of  bilious  diarrhoea, 
and  has  some  piles.  The  urine  is  free  from  albumen, 
tut  has  from  time  to  time  contained  sugar.  Uric  acid  is 
nsnally  present  in  quantity  and  is  voided  as  red  gravel. 
This  I  may  remark  is  a  fairly  typical  case,  and  affords  a 
good  idea  of  the  quiescent  stage.  So  far  as  the  urinary 
symptoms  are  concerned,  it  may  be  taken  as  even  more 
characteristic.  The  writer  of  the  article  on  gout  in 
Quain's  Dictionary  of  Medicine,  in  speaking  of  the  con- 
nection existing  between  gout  and  uric  acid,  is  of  opinion 
that  in  chronic  gout,  uric  acid  is  deficient  in  the  secretions 
and  urea  is  steady.  This  is  quite  opposed  to  my  own 
experience,  which  has  been  almost  invariably  that  the 
uric  acid  is  in  excess  whilst  the  daily  excretion  of  urea  is 
diminished ;  this  is,  in  fact,  what  one  would  expect  if  we 
look  upon  urea  as  the  ultimate  product  of  the  oxidation 
of  nitrogenous  waste  material.  In  some  at  least  of  my 
cases  I  have  found  the  percentage  of  urea  in  the  urine 
and  the  total  daily  excretion  to  be  below  the  average, 
whilst  free  uric  acid  has  been  as  constantly  present. 

You  will  doubtless  have  gathered  from  my  description 
that  such  a  patient  is  constantly  in  a  condition  of 
unstable  equilibrium,  and  liable  to  acute  catarrhal 
attacks.  These  may  arise  from  a  variety  of  causes,  cold, 
fetigue,  emanations  from  decaying  vegetable  matter, 
(particularly  mouldy  straw)  &c.  Independently  of  the 
feet  that  these  acute  attacks  differ  but  little  from  those 
seen  in  non-gouty  patients,  to  attempt  anything  like  an 
exhaustive  description  of  them  would  require  a  whole 
evening,  so  I  will  not  attempt  it.  I  may,  perhaps,  be  per- 
luitted,  however,  to  give  you,  firstly,  another  sketch,  from 
the  life,  of  an  acute  respiratory  catarrh  occurring  in  a 
patient  who  at  the  best  is  in  what  I  have  called  a  condi- 
tion of  unstable  equilibrium ;  and  secondly  a  few  points 
of  bterest  relating  to  such  attacks  generally,  more 
especially  in  the  matter  of  treatment. 

y  — 2 


292 GOUT,  ""^^^S!^!!^ 

Case  II. 

Mrs.  X.,  set.  68,  has  suffered  with  occasional  attacks  of 
articular  gout  for  more  than  25  years,  and  has  visited 
nearly  every  foreign  spa  of  any  repute  in  the  treatment  of 
gout.   In  her  ordinary  or  quiescent  condition  she  affords 
an  excellent  example  of  the  class  of  case  I  attempted  to 
describe ;   the  condition  which  may  in  a  few  words  be 
summed  up  as  "irritable  mucous  membrane."     Caught 
a  cold  on  October  5th  whilst  returning  from  Bath,  and 
sent  for  me  on  the  10th.    This  resulted  in  a  prolonged 
sojourn    indoors,  during    which    time,  to   relieve  the 
distressing  night  cough,  I  snipped  off  about  ^^  in.  of 
elongated  uvula.    Bronchial  symptoms  remained  trouble- 
some, and  the  patient,  although  rising  at  11  every  day, 
remained  in  one  room.    Expectoration  was  almost  ml, 
but  coryza  persisted  for  ten  days  ;  ten  or  a  dozen  hand- 
kerchiefs were  used  daily.      Menthol  and  boric  acid 
snuff  so  long  as  used  relieved  this,  but  did  not  cut  it 
short.     The  patient  complained  of  much  pain  behind 
the  sternum,  striking  through  to  left  shoulder-blade,  and 
in  the  left  hypochondrium.     For  this  hryonia  and  kali 
bichromicum  were  used  with  good  effect.     Inhalations  of 
the  oil  ofpumilio  pine,  prepared  according  to  the  Throat 
Hospital  pharmacopoeia,  gave  considerable  relief,  as  did 
also  the  use  of    the    chloride   of  ammonium    inhaler, 
Arsenicum  and  kali  hydriod,  were  given  internally  most 
of  the  time.    The  muscular  pains  in  the  shoulder  spread 
to  the  trapezius  muscle  on  both  sides,  and  in  the  hypo- 
chondrium became  aggravated  to  such  an  extent  that  I 
prescribed  a  course  of  massage  at  the  hands  of  an 
experienced  masseuse.    This  had  been  commenced  less 
than  a  week,  when  one  day  (Jan.  1st,  1891),  after  a  morn- 
ing temperature  of  99^,  the  patient  was  seized  at  4  p.m. 
with  a  rigor,  and  on  my  seeing  her  the  same  evening  I 
found  the  temperature  101°,  skin  hot  and  dry.    Aconite 
was  given.     Next  day  the  afternoon  temperature  had 
risen  to  101*8 ;  slight  perspiration  had  occurred  in  the 
night,  but  the  skin  was  again  dry.    The  attack  rapidly 
developed  into  one  of  lobular  pneumonia,  and  its  further 
progress  will   best  be  understood  by  reference  to  the 
chart  which  I  here  hand  round.    The  patient  made  a 
slow  recovery,  the  attack  of  pneumonia  being  followed 
by  one  of  pustular  eczema,  and  this  in  its  turn  by  one  of 
general  pruritus. 


IS^SniSr"  GOUT.  293 

"  ■  .  ■  .  - 

Coryza  occnrring  in  the  gouty  patient  is  usually  of  the 
variety  called  fluent,  and  may  often  be  cut  short  by  the 
use  of  a  snuff  composed  of  menthol,  boric  acid,  and 
ground  coffee. 

If  in  spite  of  treatment  the  catarrh  should  descend 
still  further,  it  usually  attacks  fauces,  pharynx  and 
larynx  simultaneously.  When  examined  in  a  good 
light  (which  by  the  way  in  gouty  patients  is  frequently 
not  the  easiest  possible  operation  on  account  of  the 
extreme  irritability  of  the  fauces)  we  find  the  mucous 
membrane  everywhere  has  lost  its  pale  and  smooth 
surface,  is  florid  and  uneven  mth  the  surface  capillaries 
very  much  distended,  a  small  vein  along  the  front  of  the 
uvula  being  especially  prominent.  The  epiglottis,  false 
and  even  true  vocal  cords  are  red  and  injected,  and  as 
would  be  expected  the  voice  becomes  raspy  in  con- 
sequence and  the  frequent  cough  is  of  a  noisy  barking 
character.  Acute  laryngitis  is  fortunately  rare,  but  the 
sub-acute  form  is  exceedingly  common  in  gouty  patients. 
The  cough  is  frequently  very  distressing,  especially  in 
the  night,  being  kept  up  by  the  mechanical  irritation  due 
to  the  lengthened  uvula.  This  troublesome  state  of 
matters  may  be  at  once  relieved  by  snipping  off  a  portion 
of  the  pendulous  uvula  by  means  of  a  curved  pair  of 
scissors  after  first  well  spraying  the  uvula  with  a  three 
or  four  per  cent,  solution  of  cocaine. 

Chronic  bronchial  catarrh,  commonly  called  chronic 
bronchitis,  is  of  such  exceeding  frequency,  both  in  the 
out-patient  rooms  and  in  the  wards  of  all  hospitals,  that 
I  will  not  waste  the  time  of  those  present  by  attempting 
to  describe  the  symptoms  of  a  disease  well  knovm  to  all. 
It  will  naturally  be  asked  in  what  respects  cases  of 
chronic  bronchitis  occurring  in  gouty  subjects  differ  from 
the  rank  and  file  of  the  cases  met  with  in  hospital 
practice.  I  will  therefore  enumerate  what  I  consider  to 
be  the  chief  points  of  difference  between  an  average  case 
of  chronic  bronchitis  as  met  with  in  hospitals  and  the 
same  thing  occurring  in  an  undoubtedly  gouty  subject. 

Firstly,  then,  we  have  the  history  of  the  patient,  which 
on  careful  scrutiny  will  usually  furnish  a  record  of  gouty 
troubles  of  a  more  or  less  pronounced  kind,  either  in  the 
shape  of  articular  gout,  of  attacks  of  eczema,  of  asthma, 
of  red  gravel,  or  of  renal  colic,  with  voiding  of  uric  acid 


294 GOUT,  """^l^^ST^i. 

calculi.  In  patients  over  60,  deafness,  if  associated  witt 
the  corresponding  opacity  of  the  membrana  tympaniy 
will  frequently  furnish  a  clue  as  to  the  nature  of  other 
obscure  bronchial  ailments.  In  the  actual  condition  of 
the  patient  we  usually  find  more  or  less  distortion  of 
joints,  especially  of  fingers  and  toes.  If  actual  eczema 
be  not  present,  it  is  exceedingly  common  to  find  an 
irritable  patch  of  skin  on  one  or  both  shins,  generally 
slightly  pigmented,  and  frequently  presenting  marks  of 
cicatrisation  of  an  old  ulcer.  The  urine  as  a  rule  is 
dense  and  hyperacid,  depositing  uric  acid  crystals  when 
an  acid  is  added  to  it.  As  regards  the  bronchial  catarrh 
itself,  it  is  usually  of  the  variety  known  as  catarrh  sec, 
the  amount  of  expectoration  being  sometimes  exceedingly 
small,  differing  completely  in  this  respect  from  the 
humid  variety  as  we  know  it  in  hospital  practice,, 
where  the  quantity  is  generally  enormous,  and  where 
bronchiestasis,  due  to  dilated  bronchi,,  with  night 
sweats  and  clubbing  of  finger-ends  is  so  common*. 
Genuine  attacks  of  spasmodic  asthma  I  look  upon  as 
almost  pathognomonic,  for  these  will  be  found  on  carefuf 
examination  to  alternate  with  other  undoubted  outbursts- 
of  a  gouty  character,  as  eczema,  indigestion,  or  articular 
gout.  Attacks  of  dyspnoea  closely  simulating  asthma, 
(so-called  bronchial  asthma)  are  also  very  commonly 
met  with.  These,  as  was  pointed  out  eighteen  years  ago 
by  my  father,  are  due  not  to  spasm,  but  to  a  temporary 
oedematous  condition  of  the  mucous  lining  of  the  smaller 
bronchial  tubes,  and  culminate  usually  in  copious^ 
expectoration  of  clear  serum-like  fluid.  Emphysema, 
although  commonly  met  with,  usually  occurs  only  to  a 
limited  extent,  and  does  not  actually  endanger  life  as  in 
so  many  of  our  hospital  cases. 

II. — Alimentary  sphere. 

Here  the  gouty  diathesis,  or  poison  if  you  will^ 
makes  its  presence  known  by  disturbances  affecting  partd^ 
of  the  alimentary  mucous  membrane.  It  has  been  urged 
by  some  authors  that  these  are  merely  internal  dis- 
orders occurring  in  gouty  persons  and  differing  in  their 
nature  and  treatment  in  no  respect  from  those  usually 
observed,  or,  in  other  words,  that  they  possess  no  specific 
gouty  character,  but  there  can  be  little  doubt  that  the 


g^^TSST'  oouT.  295 

goaty  diathesis  if  generated  in  a  constitution  too  weak  to 
develop  the  local  affection  in  the  extremities  is  productive 
of  various  disorders  affecting  internal  organs,  most 
frequently  those  of  digestion  and  excretion.  When, 
moreover,  in  connection  with  the  generation  of  the  gouty 
diathesis  the  constitutional  powers  have  been  greatly 
impaired  and  the  functions  of  excretion  weakened, 
nnmerous  internal  disorders  result  whether  the  patient 
may  have  experienced  a  fully  formed  fit  of  gout  or  not. 
It  is  a  common  experience,  at  least  under  homoeopathic 
treatment,  that  patients  who  in  middle  life  have  suffered 
from  attacks  of  articular  gout,  at  a  later  stage  are 
sufferers  only  from  affections  of  the  excretory,  respi- 
ratory, or  alimentary  organs. 

Commencing  with  the  buccal  cavity  and  its  contents, 
we  find  the  lining  membrane  pale,  smooth  and  some- 
what pearly  in  appearance ;  it  presents  distinctly  less 
mievenness  of  surface  than  is  met  with  in  a  young 
healthy  subject.  The  gums  are  apt  to  be  spongy,  and 
are  often  retrocedent,  leading  first  to  exposure  of  the 
neck  of  the  tooth  and  finally  to  loss  of  the  same 
without  caries,  an  affection  perfectly  well  known  to  the 
dentist  under  the  name  of  Bigg's  disease.  For  this 
reason  our  patients  are  not  infrequently  edentulous,  or 
at  best  have  but  the  substitute  provided  by  the  dentist. 

The  tongue  is  large,  smooth,  pale,  not  indented  at  the 
edges,  and  usually  covered  with  a  thin  whitish  coat ;  not 
seldom,  too,  it  is  very  sensitive  to  the  contact  of  acids  or 
spices  from  the  presence  of  cracks  down  the  centre. 

The  patient  constantly  complains  of  dryness  of  the 
mouth,  and  occasipnally  there  is  an  abundant  growth  of 
Leptothrix  buccalis  to  be  found  on  examination  near  the 
hinder  molars.  (This  ought  to  direct  one's  scrutiny 
to  the  urine,  for  it  is  by  no  means  uncommon  to 
find  this  condition  of  mouth  associated  with  temporary 
glycosuria.) 

Little  need  be  said  as  to  the  condition  of  the  soft 
palate,  uvula,  and  pharynx,  except  that  they  too  are 
usually  pervaded  with  the  same  feeling  of  dryness,  a 
eondition  of  things  which  naturally  enough  leads,  even 
after  very  complete  mastication,  to  real  or  fancied 
inability  to  swallow. 

A  condition  of  subacute  oesophagitis,  with  severe  pain 
referred  to  the  cardiac  end  of  the  stomach,  is  by  no 


1 


296  GOUT.  "^;SS:=S5??C! 


Heview,  May  1, 191. 


means  rare  during  the  progress  of  gouty  indigestion. 
The  pain  is  aggravated  by  swallowing,  and  is  produced 
equally  by  liquids  or  solids. 

In  the  stomach  itself  we  have  gastralgia,  usually 
alternating  with  other  symptoms.  The  appetite  is 
usually  fastidious  or  impaired,  but  not  seldom  un- 
naturally keen,  a  symptom  probably  caused  by  the 
condition  of  vascular  erethism  of  mucous  membranes, 
which  is  a  special  feature  of  the  disease,  and  a  symptom 
moreover  which  requires  to  be  studiously  disregarded  by 
the  watchful  physician.  Distension  and  pain  at  the 
epigastrium,  acid  or  acrid  eructations,  nausea  or 
vomiting,  painful  oppression,  flatulence,  palpitation,  with 
mental  depression,  anxiety,  or  hjrpochondriasis.  Tender- 
ness and  fulness  in  the  region  of  the  liver  are  common 
symptoms,  with  constipated  clay-coloured  or  olive-green 
stools,  indicating  lack  of  healthy  bile.  That  the 
functions  of  the  liver  are  often  seriously  interfered  with 
is  also  suflSciently  indicated  by  the  frequent  occurrence 
in  gouty  patients  of  a  certain  type  of  temporary  or  even 
permanent  glycosuria. 

Although  constipation  is  the  rule,  attacks  of  bilious 
or  abilious  diarrhoea  are  frequent  in  individual  cases. 
These  may  be  .preceded  by  severe  pain  in  the  region  of 
the  gall-bladder,  sometimes  amounting  to  true  hepatic 
colic  with  its  usual  concomitants  of  icterus,  bile  in  urine 
and  general  pruritus.  In  patients  habitually  constipated 
haemorrhoids  and  pruritus  ani  are  almost  invariably 
present,  and  the  contractile  power  of  the  large  intestine 
has  usually  been  largely  interfered  with  by  steady  use  of 
aperient  medicines  or  enemata.  The  patient's  anxiety 
on  this  score  is  usually  almost  amusing,  a  period  of 
48  hours  passed  without  a  stool  being  a  sure  prelude 
in  the  patient's  mind  to  an  attack  of  stercoraceous 
vomiting,  and  this  in  spite  of  all  the  cheering  assurances 
of  the  physician  to  the  contrary. 

Our  patient  occasionally  has  attacks  of  true  colic, 
especially  after  exposure  or  after  eating  indigestible 
articles  of  food,  colic  which  reminds  me  always  of  the 
true  lead  colic  I  saw  in  the  wards  of  the  Gumpendorff 
Hospital  in  Vienna  in  1870-71. 

It  will  be  noted  that  all  these  symptoms  may  be  truly 
styled  functional  or  nervous,  very  rarely  inflammatory. 


^gy^THgy^  QOUT.  297 

In  order  to  impress  upon  your  minds  the  most  ordi- 
nary of  these  gastric  and  intestinal  symptoms  in  their 
quiescent  state,  I  will  again  give  you  a  sketch  from  the 
life  of  a  patient  who  even  at  his  best  suffers  either  con- 
stantly or  at  frequent  intervals  from  disturbances  of  the 
alimentary  tract ;  usually  from  catarrh,  frequently  but  by 
no  means  always  associated  with  bronchial  catarrh. 

Case  III. 

Mr.  S.,  aged  72,  of  sariguineo-nervous  temperament, 
tall  and  erect ;  retired  merchant ;  a  Yorkshireman  by 
birth,  but  has  lived  40  years  in  London.  Has  lost  nearly 
all  his  teeth,  all  but  a  very  few  of  the  lower  incisors 
being  replaced  by  artificial  ones.  He  has  been  a  sufferer 
for  many  years  from  gastric  and  bronchial  catarrh  at 
freqnent  intervals,  occasionally  from  eczema,  asthma, 
jaundice,  or  glycosuria,  and  more  rarely  from  slight 
articular  gout.  He  is  at  all  times  extremely  anxious 
about  his  health,  and  when  ill  becomes  positively 
hypochondriacal.  Has  been  treated  homoeopathically 
for  the  last  40  years.  In  his  ordinary  quiescent  con- 
dition his  complexion  is  ruddy  and  he  is  moderately 
stout  (12  stone).  His  tongue  is  large,  not  indented, 
smooth  on  the  surface,  pale  and  covered  with  a  silvery 
fur.  The  fauces  and  pharynx  are  smooth,  bluish,  and 
shownumerous  enlarged  veins.  He  suffers  from  flatulence 
as  a  rule,  and  frequently  from  distension  at  epigastrium 
and  palpitation  (sometimes  very  severe).  The  appetite 
is  usually  keen  and  he  has  an  inordinate  love  for  sweet 
things.  Takes  very  little  wine,  no  beer  or  spirits.  Liver 
nsndly  normal  in  dimension  and  no  fulness  to  be  made 
out  over  the  gall-bladder.  Bowels  usually  regular ;  has 
piles  which  do  not  bleed.  Urine  generally  deposits 
crystals  of  uric  acid  when  allowed  to  stand,  and  after 
the  slightest  cold  a  copious  deposit  of  amorphous  urates. 
8p.  gr.  averages  1022,  and  rarely  rises  above  1028,  even 
vhen  sugar  is  present,  as  happens  occasionally.  Bilious 
diarrhoea  usually  due  to  some  error  in  diet  occurs  some- 
what frequently,  and  the  patient  has  had  one  attack  of 
hepatic  colic  since  I  knew  him,  although  no  gall-stones 
were  passed,  only  inspissated  bile.  Also  several  attacks 
of  bronchitis. 


298  GOUT. 


Honthlj  Homioeopathle 
Beview,  May  1,1891. 


I  have  referred  to  the  occurrence  at  times  of  a 
saccharine  condition  of  the  urine  in  gouty  subjects. 
This  occurs  with  considerable  frequency,  and  should  be 
looked  for  in  all  patients  who  are  the  subjects  of  gouty 
dyspepsia.  Probably  the  reason  why  it  is  so  frequently 
overlooked  is  that  the  amount  of  inconvenience  to  the 
patient  is  so  slight ;  the  urine  is  rarely  increased  in 
quantity  and  but  little  in  specific  gravity,  and  the 
percentage  quantity  of  sugar  is  as  a  rule  small.  With- 
out venturing  upon  speculations  as  to  the  causation  of 
glycosuria,  I  would  merely  mention  as  a  somewhat 
significant  coincidence  that  such  cases  as  I  have  seen 
have  invariably  been  in  dyspeptic  subjects,  and  usually 
such  as  were  liable  to  definite  liver  attacks  in  addition 
to  otljer  gouty  troubles.  This  form  of-  glycosuria  is 
usually,  though  not  invariably,  transient,  a  few  weeks  or 
months  at  most  being  its  usual  duration.  I  have, 
however,  one  patient,  an  old  man  of  75,  who  has  been  a 
sufferer  for  five  years  to  my  knowledge.  It  is  important 
to  be  on  the  qui  vive  for  the  j)robable  occurrence  of  such 
a  symptom,  and  quite  as  important  to  let  the  patient  or 
his  friends  know  of  it  and  of  its  probable  cessation 
within  a  few  weeks,  for  failing  this  it  is  by  no  means 
uncommon  for  the  patient  to  consult  another  medical 
man,  who  pronounces  the  case  to  be  one  of  diabetes^ 
and  suggests  either  a  visit  to  a  well-known  specialist 
or  a  six  weeks'  sojourn  at  Carlsbad,  either  course 
being,  as  I  think,  totally  unnecessary.  It  is,  in  my 
opinion,  precisely  this  class  of  cases  of  temporary 
glycosuria  that  have  earned  for  Carlsbad  a  reputation 
for  the  cure  of  genuine  diabetes,  a  reputation  which  I 
should  be  only  too  glad  to  see  justified  in  practice;  but 
so  far  I  am  bound  to  say  that  all  the  cases  of  undoubted 
diabetes  which  I  have  seen  after  a  sojourn  at  Carlsbad 
have  returned  uncured.  To  commence  with,  I  find 
that  the  symptom  may  be  disregarded  altogether;  I 
have  never  seen  any  ill-effect  from  this  course,  and 
spontaneous  cessation  of  the  saccharine  condition  of  the 
urine  has  always  occurred  within  three  or  four  months, 
except  in  the  single  case  I  have  mentioned  above.  Even 
in  this  last  the  only  troublesome  conditioti  associated 
with  the  glycosuria  is  cataract  in  one  eye,  and  it  is  hai'd 
to  say  that  this  would  not  have  occurred  in  any  case. 


g^B^yogy.  ^pT^  299 

Discussion. 
Dr.  Hughes  said  Dr.  Galley  Blackley's  paper  was  interest- 
ing, and  showed  great  research,  bat  it  did  not  contain  much 
food  for  discussion,  as  he  did  not  go  largely  into  therapeutics. 
He  would  hke  his  opinion  on  a  case  of  an  old  gentleman  who 
had  much  flatulence  with  tenesmus  of  bladder  and  rectum  two 
Lours  after  luncheon,  though  he  had  no  trouble  after  his  other 
meals.  He  had  had  gout,  and  during  the  present  illness  he 
had  had  gouty  grumblings  in  the  toes.  Hot  mustard  foot- 
baths had  removed  the  pains,  but  not  helped  the  intestinal 
tronble.  He  asked  if  our  diagnosis  of  gout  made  any  difference 
in  the  selection  of  remedies  as  distinguished  from  simple 
affections. 

Dr.  Dtce  Brown  thought  the  subject  of  great  interest.  He 
thought  nineteen-twentieths  of  chronic  catarrhal  cases  were 
dependent  on  gouty  diathesis.  We  don't  now  see  so  much 
acute  gout,  but  we  see  the  results.  The  symptoms  vary 
immensely  in  individual  cases.  He  did  not  think  the 
diagnosis  helped  much  in  the  treatment.  He  thought  one 
main  feature  was  getting  the  skin  to  act  by  lamp  or  Turkish 
bath;  also  regulating  the  diet,  which  should  be  light,  not 
comprising  much  meat,  with  fruit  and  vegetables.  Of 
medicines  sulphur,  mere  UnioiL^  or  corrosU^s^  hjcopodium  and 
'nairum  muriaticum  were  the  chief.  His  experience  was  that 
constipation  with  flatulence  was  the  rule,  and  not  diarrhoea, 
as  in  Dr.  Blackley*s  cases.  Cases  where  there  is  uric  acid 
sand  were  the  exception ;  amorphous  urates  were  the  rule. 

Dr.  E.  B.  BocHE  mentioned  a  case  of  alternating  irritable 
hmg  and  eczema ;  all  these  symptoms  were  removed  after 
marriage.  He  believed  the  cause  was  worry,  which  had 
affected  the  liver,  and  in  his  opinion  the  hver  had  much  to  do 
with  gouty  manifestations. 

Dr.  Day  mentioned  a  case  of  frequent  micturition  in  an  old 
gentleman  who  was  gouty.  The  case  proved  intractable  to^ 
remedies. 

Mr.  Dudley  Wright  had  seen  a  case  in  an  elderly  woman 
who  had  constant  calls  to  micturate,  which  nux  and  sulphur 
alternately  relieved.  She  had  weak  irritable  heart  and  some 
oedema.  He  asked  Dr.  Blackley  if  he  had  met  with  gouty 
seborrhea  of  the  external  auditory  meatus?  There  was 
itching  of  the  canal,  which  led  to  scratching,  which  resulted 
in  a  slight  moist  exudation.  This  lasts  some  days,  and  then 
tends  to  disappear.  He  would  like  to  know  what  remedies- 
Dr.  Blackley  had  found  useful  for  it.  He  had  seen  a  patient' 
who  had  cough  from  lung  irritation,  which  condition  was- 
cored  by  keeping  the  feet  warm. 


Mr.  Knox  Shaw  thought  Dr.  Blackley's  paper  afforded 
much  food  for  thought.  He  had  noticed  gouty  diathesis 
affecting  certain  organs  of  the  body.  Mr.  Hutchinflon 
described  the  "  gouty,"  or  **  hot,  irritable  eye,"  and  Mr.  Bhaw 
had  confirmed  his  observation.  Generally  in  the  night,  the 
eye  becomes  painful  and  hot,  and  yet  when  looked  at  there  is 
very  little  to  see.  Here  the  diagnosis  of  gout  was  helpful. 
He  thought  Dr.  Dyce  Brown's  opinion  that  the  diagnosis  was 
not  very  helpful  was  contradicted  by  the  treatment  Dr.  Dyce 
Brown  described.  He  was  often  able  to  pronounce  a  patient 
gouty  by  finding  concretions  of  urate  of  soda  inside  the  con- 
junctiva as  well  as  tophi  in  the  ear.  The  former  cause  much 
irritation,  and  need  removing.  In  his  experience,  when  there 
is  frequent  micturition  not  due  to  enlarged  prostate,  it  is  due 
to  a  highly  acid  condition  of  the  urine.  This  is  reheved  by 
medicines.  There  is  another  point.  He  was  anxious  to  know 
the  relation  between  gout  and  sugar  in  the  urine.  Patients 
came  to  oculists  for  failure  of  vision.  He  had  had  several 
cases  with  haemorrhagic  condition  of  retina.  There  had 
nearly  always  been  sugar.  The  patients  had  not  the  faintest 
idea  that  anything  was  wrong  with  them.  The  sugar  is  not 
permanent,  and  may  disappear  without  relieving  the  condition 
of  the  retina.  He  asked  Dr.  Hughes  to  keep  his  patient 
without  his  lunch. 

Dr.  Dudgeon  (in  the  chair)  regretted  with  Dr.  Hughes  that 
the  paper  was  not  of  a  more  therapeutic  character.  He 
believed  that  much  was  laid  to  the  door  of  gout  which  was 
more  properly  attributable  to  alcohol.  He  had  met  with 
<3ases  which  had  been  called  gout  by  a  number  of  doctors, 
which  were  evidently  due  to  over  indulgence  in  alcohol.  On 
inquiring  into  the  habits  of  a  gouty  gentleman,  the  latter  said : 
"I  take  nothing  gouty;  I  only  take  whisky."  This  Pr- 
Dudgeon  prohibited,  and  he  lost  all  his  *'  gout."  He  had,  on 
the  other  hand,  seen  exquisite  cases  of  gout  in  teetotalers, 
without  even  a  suspicion  of  hereditary  tendency.  A  great 
desideratifm  is  a  real  specific  for  the  gouty  diathesis. 

Dr.  Galley  Blackley  (in  reply)  regretted  that  he  had  not 
Tentured  into  the  region  of  therapeutics.  He  thought  the 
paper  itself  would  afford  ground  for  discussion.  Dr.  Hughes 
case  he  should  certainly  put  down  as  gouty.  He  agreed  with 
Dr.  Dyce  Brown  that  the  taint  is  transmitted.  He  believed 
that  the  diagnosis  of  gout  made  a  distinct  difference  in  ^^ 
treatment.  He  also  thought  we  had  at  least  two  powernu 
specifics  in  gout — mdpliur  and  arsenicum.  These  are  contained 
in  the  springs  recommended  for  gout.  Among  others  UjcopO' 
dium  is  the  most  useful.  He  questioned  Dr.  Dyce  Brown  s 
statement  that  urates  were  always  found ;  that  was  not  his  ex- 


^SS^Tj^""      serpent  venom.  301 

perieDce.  When  there  was  no  catarrh,  there  was  uric  acid ; 
when  catarrh  appeared,  there  were  urates.  He  believed  the 
liver  was  much  involved  in  gout.  An  east  wind  tried  gouty 
patients  much.  Ho  had  frequently  met  with  gouty  seborrhea 
of  the  external  auditory  meatus.  Sulphur  given  internally 
and  applied  as  ointment  cured  this.  He  was  much  interested 
in  the  "  irritable  eye  "  mentioned  by  Mr.  Shaw.  He  had  met 
with  one  marked  case.  He  had  alluded  to  the  gouty  con- 
junctiva in  his  paper.  He  endorsed  Mr.  Shaw's  advice  to 
Dr.  Hughes  about  his  case.  He  agreed  with  Dr.  Dudgeon  that 
most  gouty  patients  would  be  better  without  alcohol  in  any 
shape. 

THE    PHYSIOLOGICAL    ACTION    AND     THEEA- 
PEUTIC  USES  OP   SEEPENT  VENOM. 

By  Alfred  C.  Pope,  M.D. 

It  has  been  the  special  privilege  of  physicians  who 
derive  their  knowledge  of  the  action  of  drugs  from  the 
effects  drugs  have  been  found  to  produce  on  the  human 
body,  and,  for  their  selection  of  a  remedy  for  diseased 
states,  upon  the  principle  of  similia  similibm  curentiir,  to 
introduce  into  medicine,  as  remedial  agents,  the  contents 
of  the  poison  bags  of  several  varieties  of  snakes.  Of 
these  the  chief  are  the  crotalus  liorridtts,  the  lachesis 
tngonocephalus  and  the  riaja  tripudians. 

Between  the  poisonous  effects  of  these  three  varieties, 
there  is  a  very  striking  similarity.  The  nature  of  the 
fundamental  change  produced  by  each  is,  probably,  the 
same,  but  the  degree  of  change,  the  intensity  of  the 
action  of  each  differs.  In  all  three,  it  is  a  more  or  less 
profound  alteration  in  the  constitution  of  the  blood  which 
is  the  cause  of  the  forms  of  disease  they  excite  and 
resemble.  The  crotalusy  however,  is  by  far  the  moat 
intense  and  thorough  hsematic  poison,  the  lachesis  being 
somewhat  less  so,  the  neurotic  symptoms  it  occasions 
are  less  obscured  by  the  violence  of  other  changes,  and 
therefore  appear  more  distinctly  in  the  provings,  and  the 
same  is  true  of  naja.    I  shall  therefore  consider  each 

separately. 

Crotalus, 
The  action  of  the  crotalus  poison  upon  man  and  the 
appUcations  which  may  profitably  be  made  of  this  poison 
in  the  treatment  of  disease  have  been,  perhaps,  more 
thoroughly  studied  than  the  pathogenetic  effects  and 
therapeutic  uses  of  any  other  drug.     This  important 


1 


302  SERPENT   VENOM.         ^""^^SI^^TZ' 


Beviev.MArl.18U. 


work  has  been  performed  by  Dr.  Hayward,  senior,  of 
Liverpool.  His  exhaustive  essay  is  contained  in  the 
first  volume  of  a  work  entitled,  Materia  Medica :  Physio- 
logical avd  Applied,  of  which  it  occupies  280  pages. 
The  Cyclopcedia  of  Drug  Pathogenesy  contains  a  full 
record  of  all  the  most  trustworthy  provings  of,  and  the 
most  characteristic  cases  of  poisoning  with  it,  together 
with  the  details  of  some  sixteen  experiments  by  it  on  the 
lower  animals  and  the  post-mortem  appearances  pre- 
sented by  them. 

It  has  been  denied  that  serpent  venom  when  intro- 
duced into  the  body  by  the  mouth  is  poisonous.  Much 
controversy  has  arisen  on  this  point  and  many  ex- 
periments have  been  performed  to  decide  it.  The 
investigations  of  Sir  Joseph  Fayrer,  Dr.  Eichards  and 
Dr.  Brunton  have,  however,  conclusively  proved  that 
poisoning  does  take  place  by  absorption  of  the  venom 
through  the  mucous  surfaces.  Further,  the  successful 
use  of  serpent  venom  by  homoeopathic  physicians  during 
the  last  fifty  years  is  of  itself  amply  sufficient  testimony 
to  the  power  of  this  animal  poison  to  operate  when 
taken  by  the  mouth. 

The  evidence,  therefore,  on  which  we  rely  to  exhibit 
the  effects  of  the  crotalus,  as  well  as  other  species  of 
venom,  is  partly  such  as  is  afforded  by  provers  who  have 
voluntarily  swallowed  the  poison,  partly  such  as  is 
supplied  in  the  records  of  cases  of  persons  bitten  by  the 
rattlesnake,  and  also  in  experiments  made  upon  the 
lower  animals  with  the  view  of  tracing  the  tissues 
especially  disorganised  by  it. 

When  taken  by  the  mouth,  the  first  symptoms  are 
usually  a  feeling  of  listlessness,  indifference,  stupidity 
and  a  weakness  of  memory.  Then  comes  headache— 
a  dull,  heavy  feeling  in  the  forehead,  with  pressure  upon 
the  eyeballs,  and  a  burning  feeling  in  the  eyes ;  there  is 
some  deafness,  the  ears  feel  hot,  and  as  though  they 
were  stopped  up.  Pains  are  felt  in  the  bones  of  the 
face,  bruised,  tearing  and  drawing,  and  extend  down  the 
neck  to  the  shoulder.  There  is  a  sour,  rancid  taste  in 
the  mouth,  with  pressure  at  the  epigastrium  and  heart- 
burn. A  pressure  is  felt  over  the  umbilical  region,  and 
a,  deep  pain  like  burning  ;  a  stitch  in  the  region  of  the 
spleen,  as  though  one  had  been  running.  As  the  pai^ 
in  the  abdomen  increases,  diarrhoea  sets  in.     Urine  is 


It^J^rX^         SERPENT   VENOM.  303 

increased  in  quantity  and  of  a  dark  colour.  The  voice 
becomes  hoarse  and  weak,  the  larynx  painful  on  pressure. 
Sneezing  is  followed  by  a  stitch  in  the  right  chest,  and 
oyer  the  sternum,  increased  by  pressure  but  not  by  deep 
breathing ;  throbbing  and  bruised  pains  in  the  lateral 
region  of  the  chest,  worse  on  touch  and  movement. 
The  sensation  of  a  bruise  over  the  arms  and  lower 
extremities  in  various  parts  is  repeatedly  felt  by  the 
provers ;  the  limbs  are  tired  and  almost  powerless ; 
cramp  and  coldness  are  also  felt,  and  pains  in  the  knee 
and  other  joints  are  described  as  "  like  gout."  There  is 
great  drowsiness  during  the  experiments,  a  restless 
dreamy  sleep,  from  which  the  experimenter  awakes  in 
the  morning  with  a  bruised  sensation  in  all  his  bones. 

Taken  by  inoculation — for  Dr.  Hayward's  enthusiasm 
in  making  a  complete  research  led  him  to  inoculate 
himself  with  one-sixth  of  a  drop  of  venom — most  of 
these  symptoms  occurred,  but  in  a  much  more  decided 
manner.  When  thus  taken  hypodermically  there  is 
greater  depression ;  the  pulse,  at  first  raised  ten  beats 
above  the  normal,  in  half-an-hour  sinks  ten  below  that 
point,  and  feels  small,  soft,  and  empty,  and  is  very 
easily  compressible.  There  is  a  sinking  sensation  at  the 
epigastrium,  with  a  craving  for  stimulants.  This  is 
particularly  interesting,  as  alcohol  is  regarded  as  the 
most  effective  antidote  to  the  bite  of  a  rattlesnake ;  and 
while  a  human  being  is  under  the  influence  of  the  poison 
it  is  almost  impossible  to  produce  intoxication  with  it. 
As  much  as  three  pints  of  whisky  have  been  given  to  a 
young  lady  17  years  of  age  without  exciting  the  least 
evidence  of  intoxication,  during  her  treatment  for  one  of 
these  bites. 

Vertigo  and  headache — a  sense  of  frontal  congestion — 
were  considerable  and  enduring.  Urine  was  scanty,  of  a 
high  colour,  sp.  gr.  1031.  Boiling  rendered  it  paler  and 
greenish ;  nitric  acid  made  it  a  little  darker,  but  it 
remained  clear.  Another  portion,  to  which  caustic 
potash  was  added,  became  milky,  and,  on  boiling,  a 
darker  green  than  that  acted  on  by  the  nitric  acid. 
Twelve  hours  later  the  urine  became  more  copious  and 
had  a  sp.  gr.  of  1014.  Very  little  exertion  set  the  heart 
beating  rapidly,  and  caused  an  aching  pain  at  the  lower 
angle  of  the  scapula.  The  weakness  of  the  heart  was 
very  considerable,  and  remained  for  some  time. 


304  SEBPENT   VENOM.         ''S^e^fS^Jfrn 

The  joints  were  especially  painful,  stiff  and  aching, 
and  bruised  feelings  in  the  thighs  were  particularlytrying. 

In  the  case  of  a  young  lady  who  submitted  to  the 
same  operation,  giddiness  came  on  in  about  two  boars ; 
she  felt  as  if  the  muscles  of  the  neck  were  too  weak  to 
support  the  head,  and  eventually  she  was  obliged  to  go 
to  bed.  On  waking  the  following  morning,  the  headache 
had  disappeared,  but  she  **  could  not  think,  comprehend, 
or  remember  distinctly." 

Drs.  Humbolt  and  Manzini  inoculated  many  persons 
with  crotalvsYenoui  as  a  prophylactic  against  yellow  fever. 

''The  symptoms  of  the  inoculation  appeared  in  the 
following  order.    At  the  moment  of  inoculation,  there 
was  vertigo  which  soon  passed  away.    There  was  also  a 
nervous  trembling,  which  is  rarer,  but  which  lasts  a 
longer  time.    After  seven  hours,  the  pulse  is  permanently 
modified ;  it  is  either  too  frequent  or  too  slow,  stronger 
or  weaker.    In  eleven  hours,  there  is  febrile  heat.    At 
the  end  of  fourteen  hours,  there  are  headache,  want  of 
appetite  and  thirst.    At  the  end  of  sixteen  hours,  the 
countenance  is  red,  conjunctiva  injected,  epiphora.    The 
swelling  of  the  gums  is  observed  from  the  commence- 
ment.   At  the  expiration  of  eighteen  hours,  pain  is  felt 
in  the  gums,  the  margins  of  which  are  reddened  around 
the  teeth  ;    pain  of   the  salivary  glands,  and  in  the 
direction  of  the  different  branches  of  the  nerves  of  the 
face  and  teeth.    In  nineteen  hours,  there  are  pains 
in  the  lower   jaw  and  in    the  direction  of   the  sub- 
maxillary   nerve,    and    lassitude.      In    twenty   hours, 
bitter  taste,  drowsiness,  coryza  and  oedema  of  the  face. 
In  twenty-two  hours,  a  constrictive  sensation  of  the 
throat,  without  any  visible  alteration  of  the  mucous 
membrane.     In   twenty-three  hours,  yellow  jaundice. 
In  twenty-four  hours,  haemorrhage  of  the  gums.     In 
twenty-eight    hours,    yellowness   of   the  sclerotic  and 
shivering.     In  twenty-nine  hours,  angina   tonsillaris. 
In  thirty-hours,  pain  in  the  region  of  the  kidneys.    In 
thirty-six  hours,  swelling  of  the  eyelids.    In  thirty-eight 
hours,  pain  in  the  muscles  and  joints.    In  forty  hours, 
toothache.    In  seventy-two  hours,  swelling  of  the  lower 
lip.     At  different  hours,   sexual  excitement.     During 
convalescence,  itching  of  the  skin,  cutaneous  eruption  of 
various    kinds." —  Cycl.    Drug.    Path,,    quoting  from 
Newland,  On  Crotahs  HorridiiSy  1868. 


£*t^53TiSS?*        8EBPENT  VENOM.  305 

•  •  • 

As  Dr.  Neidhard  remarks,  **  these  inoculated  people 
reBembled  exactly  sufEierers  from  the  initial  stage  of 
yellow  fever.'' 

As  an  iiliL^tratioh  of  the  effects  of  poisoning  from  the 
bite  of  the  serpent,  the  following  case,  quoted  from  the 
Cydopoedia  of  Drug  Pathogenesyy  is  a  fair  one : — 

"  A  woman,  stepping  on  her  doorstep  with  bare  feet 
on  a  rainy  night  in  October,  was  bitten  on  the  great  toe 
of  the  right  foot.  She  imagined  that  she  had  been 
scratched  by  a  young  cat,  so  that  terror  and  fear  could 
not,  m  this  case,  have  such  influence  as  is  usual  in  cases 
of  anake-bitey  and  could  not  therefore  increase  the  danger, 

"  Immediately  she  had  walked  five  or  six  steps,  she 
.fell  down  as  if  fainting.  She  had  violent  burning  pain 
in  the  leg  of  the  bitten  side,  and  great  swelling  and 
burning  sensation  as  far  up  as  the  thigh.  After  five 
minutes,  there  were  violent  pains  in  the  front  part  of 
the  head.  After  ten  minutes,  violent  vomiting  of  food 
(ihis  lasted  for  several  days  following  each  meal)  •  After 
one  hour,  there  was  dryness  in  the  throat,  with  violent 
thirst,  and  red,  watery,  tearful  eyes.  After  eight  hours, 
there  was  much  cedematous  swelling  of  the  whole  body. 
After  ten  hours,  the  whole  head  and  especially  the  face 
were  much  swollen ;  there  were  also  burning  pains  in 
the  trunk,  lasting  several  days  with  great  sensibility, 
increased  by  touch.  There  were  also  great  oppression  of 
the  chest,  with  evident  inflammation  of  the  lungs  and 
bowels.  Great  languor  and  delirium.  After  ten  hours 
the  swelling  gradually  decreased ;  marble-like  green, 
yellow,  and  bluish  spots  remained,  and  only  departed 
after  the  entire  disappearance  of  the  swelling.  SwelUng 
and  discolouration  extended  to  the  loins  of  the  bitten  side.' 

In  other  cases,  besides  swelling  of  the  limbs,  there 
have  been  blisters  containing  a  yellowish  fluid,  in  others 
vesicles.  In  one  of  these,  a  woman,  bitten  in  the  right 
thmnb,  an  eruption  of  three  or  four  small  vesicles 
accompanied  with  **  bite  "  pain  appeared  on  the  site  of 
the  original  wound  three  months  after  her  recovery.  In 
a  few  days  they  dried  up  and  disappeared,  but  recurred 
eyery  three  months  for  six  or  seven  years ;  during  the 
next  three  or  four  years  they  did  so  at  indefinite  inter-* 
TaU,  but  always  at  longer  periods  than  three  months, 
and  afterwards  for  seven  or  eight  years  (when  the  case 


806  SEBPENT  VENOM,         ^'^S^lfSSfS. 


B«nev,]f«Tl,in. 


was  reported  in  the  American  Medical  Recorder)  there 
was  no  return. 

In  the  case  of  a  man  bitten  in  February  in  his  right 
hand,  after  nine  days  the  hand  and  arm  were  spotted 
like  a  snake  and  continned  so  all  the  sommer.  hi  the 
autamn  his  arm  swelled^  gathered  and  burst,  and  then 
away  went  poison,  spots  and  all.  The  parts  in  the 
immediate  neighbourhood  of  the  wound  not  only  swell 
exceedingly,  but  very  generally  become  gangrenous. 

The  post-mortem  appearances  may  be  represented  by 
the  following  case,  though  they  are  somewhat  spoiled  by 
the  fact  that  the  man  appears  to  have  been  a  dbrnnkard. 
"Much  fluid  blood  followed  on  cutting  into  the  scalp, 
and  still  more  from  the  sinuses  of  the  brain,  perhaps 
nearly  a  pint.  The  arachnoid,  covering  the  hemisphere, 
was  raised  into  vesicles  by  a  deposit  of  serum  beneath, 
giving  it  the  appearance  of  a  blister.  The  veins  of  the 
pia  mater  were  much  injected.  The  brain  substance  was 
also  congested.  There  was  no  extravasation  of  blood. 
There  was  very  little  blood  in  the  heart,  it  having  per- 
haps run  out  from  its  fluidity.  There  were  no  ecchy- 
.moses  in  the  stomach.  The  mucous  coat  of  the  smaD 
intestines  exhibited  patches  of  inflammation  throughout 
its  whole  length  of  a  lively  red  colour,  and  of  variouB 
diameters,  from  6  to  12  or  18  lines,  and  very  close  in 
succession,  especially  in  the  jejunum.  The  liver  was 
somewhat  yellow.  The  muscles  were  brownish  instead  of 
red.  The  bitten  limb  was  tumefied  from  effusion  of  serum 
in  the  cellular  tissue.    The  blood  was  universally  fluid." 

In  another  case  the  liver  had  a  livid  appearibce. 
Dr.  Mitchell  {Researches  upon  the  Venom  of  tlie  Rattle- 
snake,  pp.  94-95)  says  "  Amongst  the  most  constant  and 
curious  lesions  in  cases  of  secondary  poisonings  are  the 
ecchymoses  which  are  found  on  and  in  the  viscera  of  the 
chest  and  belly ;  most  frequently  affecting  the  intestinal 
jsanal,  they  may  and  do  occur  in  any  cavity  and  on  any 
organ  ;  .  .  .  .  this  leakage  of  blood  into  the  serous 
cavities  and  areolar  interspaces  is  plainly  due  to  the  loss 
of  coagulating  power  in  the  blood,  or  to  alterations  in 

the  vascular  tubes  or  to  both It  seemed  to 

me  that,  however  various  the  seat  of  the  affection,  it  was 
in  all  organs  and  tissues  alike  in  its  character.  In  other 
words,  owing  to  the  changes  in  the  blood  or  tissues  or 
both  extravasations  are  met  with  in  the  lungs,  bnuSt 


SSSfiaTrStt?*'        PEBPBNT  VENOM.  807 


Iddneys,  seroas  membranes,  intestines  and  heart.  As  a 
xesiilt,  we  have  functional  derangement  grafted  on  the 
main  stem  of  the  malady,  and  the  aceompanimonts  of 
bloody  seram  in  the  affected  cavities,  bloody  mucas  in 
the  intestiniU  canal,  and  bloody  urine  in  the  bladder." 

As  the  condition  produced  bv  crotdUtM  venom  is  one  of 
true  toziemia,  one  where  the  fibrin  of  the  blood  is  dis- 
solved and  its  corpuscles  necrosed,  so  it  is  in  that  class 
of  disease  of  which  this  state  of  the  blood  is  the 
pathological  ba^is,  that  it  has  been  found  most  useful, 
farther,  it  is  called  for  in  persons  of  a  broken-rdown 
constitution,  persons  whose  health  has  been  ruined  by 
alcoholic  excesses  or  by  malarial  fevers. 

Among  the  various  formidable  diseases  of  this  type 
'with  which  the  physician  is  called  upon  to  deal,  in  one 
part  of  the  world  or  another,  there  is  none  which  is 
calculated  to  inspire  him  with  greater  anxiety  than  is 
the  dreaded  yellow  fever  of  the  Southern  States  of 
America.    In  its  treatment  the  veteran  Dr.  Holcombe, 
of  New  Orleans,    who    is   perhaps    more    thoroughly 
acquainted  with  this  fever  than  any  other  physician^ 
was,  I  believe,  the  earliest  observer  to  note  the  homoeo- 
pathicity  of  crotalus  to  it.    Writing  in  1868 — when  the 
nature  of  the  action  of  crotdlua  was  only  known  roughly 
and  far  less  precisely  than  that  of  lachesis — ^Dr.  Holcombe 
(A\  A.  Journal  of  Horn.,  Vol.  iii.,  p.  498),  after  pointing 
OQt  ihe  value  of  arsenic  in  the  second  stage  of  yellow 
fcyer;:  says : — 

"  in  looking  for  a  complemental  medicine  to  alternate 
with  arsenic,  in  order  to  fill  up  the  morbid  picture,  we 
leep  it  in  view  that  it  must  be  capable,  chemically  or 
otherwise,  of  deteriorating  and  devitahsing  the  blood, 
80  as  to  give  rise  to  hsBmorrhages  and  extravasation, 
and  render  it  unfit  for  the  nutritive  demands  of  the 
i^ervons  system.  No  poisons,  animal,  vegetable  or 
niineral,  do  this  more  uniformly  and  effectually  than  the 
^nms  of  serpents.  With  some  of  these  poisons,  particu» 
hrly  crotalus  and  lachesiSy  we  have  been  made  tolerably 
well  acquainted  through  the  zealous  and  useful  labours 
rf  Dr.  Constantino  Hering.  They  are  remarkably 
^ilar  in  their  action,  like  the  isomorphous  substances 
in  Dr.  Blake's  interesting  experiments.    We  chose  the 

2— a 


308  SERPENT  VENOM.        ^SSSJ^SJifSS: 


lachesis,  and  the  results  were  so  satisfactory  that  crotaba 
was  used  only  tentatively  in  one  or  two  hopeless  cases." 
'  Dr.  Neidhard,  of  Philadelphia,  in  1868,  gave  very 
emphatic  testimony  to  the  usefulness  of  this  drag  in 
yellow  fever,  and  also  in  a  bilious  remittent  of  a  very 
malignant  character  which  he  had  frequently  met  with 
in  the  neighbourhood  of  his  city« 

In  the  elaborate  Beport  of  the  Commission  of  eleven, 
physicians,  who  had  had  considerable  experience  in  the 
.treatment  of  this  fever  during  previous  epidemics,, 
appointed  by  the  American  Institute  of  Homoeopathy  to 
investigate  the  therapeutics  of  the  epidemic  of  1878, 
the  concurrence,  of  opinion  among  those  who  had 
actively  engaged  in  the  treatment  of  cases  of  the  great 
value  of  lacheaia  and  crotalus  in  the  second  stage  was* 
stated  to  be  very  striking. 

In  the  course  of  many  cases  of  epidemic — cerebro- 
spinal meningitis,  purpuric  spots  indicating  the  blood- 
degeneration  which  is  the  basis  of  this  formidable 
.disease,  together  with  great  cerebral  depression  will  be 
better  met  by  crotalus,  than  any  other  medicine,  except 
perhaps  phosphorus. 

In  typhus,  in  its  malignant  or  petechial  form  crotains  will 
probably  be  found  to  influence  the  profound  blood  poison- 
ing  which  exists  more  surely  than  arsenic  or  pJiosphorus^ 

In  puerperal  fever  and  in  pysemia  this  form  of  serpent 
venom  is  oftentimes  clearly  indicated. 
.  In  malignant  pustule,  and  where  glanders  from  the 
horse  has  been  communicated  to  man,  crotalus  is  better 
worthy  of  our  confidence  than  any  other  medicine.  The 
general  condition  of  a  glandered  man  resembles  in 
many  striking  particulars  the  descriptions  we  read  of 
persons  who  have  been  bitten  by  the  rattlesnake. 

Gases  of  variola,  scarlatina  and  measles  in  very  severe 
and  fatal  epidemics  will,  now  and  again,  be  met  with  in 
which  crotalus  may  be  prescribed  with .  some  hope.  In 
variola  the  chief  indication  is  the  purpuric  character  of 
the  eruption  and  hsBmorrhage  from  the  bowels.  In 
scarlatina,  it  is  in  its  most  malignant  form  alone  that 
it  is  likely  to  be  useful.  Dr.  Hayward  records  a  very 
striking  case  of  the  almost  invariably  fatal  form  of  thia 
fever  {Mat.  Med.  Phys.  and  Applied,  vol.  i.,  p.  863),  in 
which  crotahs,  was  very  promptly  remedial.  The  patient 
was  a  girl  of  nine  years  of  age.    Scarlatina  of  the  very 


S3SJ^5ST?S^        SERPENT  VENOM.  8G9 


JUffiew,  May  1«  IWl. 


worst  type  was  appaxent  on  the  5th  of  October,  1870. 
By  the  morning  of  the  7th — 

"  All  the  symptoms  were  worse,  the  throat  way  nearly  closed, 

and  she  breathed  with  difficulty,  with  an  occasional  interruption 

as  though  from  the  swollen  condition  of  the  fauces ;  the  fauces 

iudd  tonsils  appeared  softened,  jelly-Hke  and  as  if  gangrenous, 

aod  the  head  was  thrown  backwards  and  upwards  as  far  as 

possible.    There  was  retching  when  anything  was  given  by 

the  mouth,  even  a  teaspoonful  of  cold  water  would  provoke  it, 

and  the  matter  brought  up  consisted  of  mucus  reddened  with 

the  blood  apparently  oozing  from  the  mucous  membrane,  or 

lesolting  from  the  gangrenous  state  of  the  fauces,  with  som^ 

blood  in  streaks  as  if  forced  out  by  the  retching.      After 

retching  she  always  fell  back  on  the  pillow  moaning,  in  a  very 

weak  and  low  voice,  as  though  dying ;  she  also  sank  down  in 

the  bed  in  a  state  of  stupid  lethargy  Hke  a  dying  typhus 

patient.    The  breathing  was  sighing,  jerky  and  intermittent, 

^d  there  was  a  loose  tickhng  almost  incessant  cough,  as 

•though  from  trickling  of  the  mucus  into  the  larynx;  the 

pulse  could    scarcely  be  felt,  the    rash    was   only    faintly 

visible  and  was  brown  and  rough.     Appreciating  now. the 

Juemorrhagic    character   of  the  attack,  crotalus  was  given 

internally  in  the  4th  attenuation,  a  drop  in  a  teaspoonful  of 

water,    dropped    slowly  into  the    mouth    every    half-hour. 

Cantharis  <f>  was  also  poured  on  the  compress,  which  was 

applied  over  the  tonsils  in  order  to  raise  the  cuticle  with  the 

object  of  applying  crotaltts  to  the  denuded  cutis.     In  the 

altemoon  she  appeared  to  be  dying.    The  cantJiaiis  having 

raised  the  cuticle  around  the  throat,  this  was  removed,  and 

the   wet   compress  was  sprinkled  over  with    crotalus    8rd 

trituration,  this  was  renewed  after  an  hour  and  then  every 

three  hours.    There  was  no  retching  after  the  first  apphcation 

ef  the  crotalus  to  the  denuded  cutis,  not  even  when  beef  juice 

was  administered,  but  the  respiration  and  pulse  remained  the 

same.    In  the  evening  as  I  sat  by  her  bedside,  expecting 

every  moment  to  be  her  last,  I  noticed  that  she  gradually 

b^saine  less  distressed,  and  during  the  night  she  dozed  at 

intervals.    Beal  sleep  followed,  and  her  breathing  gradually 

became  less  hurried  and  irregular,   and    some    degree    of 

conseionsness    was    manifested,  the  eruption  though  dark 

increased,  and  as  the  day  advanced,  brightened  in  colour, 

and  all  the  distressing  symptoms  receded  rapidly.    The  day 

•toilowing  her  i^petite  returned  and  in  a  few  days  she  was 

practically  well. 

In  this  case  the  symptoms  corresponded  closely  to 
those  characteristic  of  crotalus  poisoning;  the  remedial 
.action  of  the  venom  was  rapid  and  well  marked ;  while 


810  SERPENT  VENOM.         ^to£rf£^u«! 

a  severer  test  of  the  power  of  a  medicine  to  control  aa 
apparently  hopeless  condition  could  scarcely  be  applied. 
In  measles  of  the  malignant  type,  especially  when 
hemorrhage  from  the  nose  is  present,  or  purpuric  spots 
are  noticeable,  crotalus  will  doubtless  prove  equally  usefoL 

Some  cases  of  diphtheria,  cases  where  the  degree  of 
prostration  is  greatly  out  of  proportion  to  the  extent  of 
deposit  on  the  tonsils,  where  the  difficulty  in  swallowing 
is  unusually  great,  respiration  much  impaired  and 
lividity  of  the  lips  and  face  is  apparent,  in  such  as  these 
erotakis  is  indicated. 

Erysipelas,  when  it  ocburs  as  the  result  of  septie 
poisoning,  or  in  the  course  of  some  zymotic  disease,  or 
when  idiopathic  it  is  of  a  very  low  typhoid  type,  croialm 
will,  in  many  instances,  be  useful.  It  has  been  given 
with  great  advantage  in  erysipelas  occurring  after  vacci- 
nation. Dr.  Hughes,  in  a  letter  to  Dr.  Hayward, 
informed  him  that  Dr.  Talbot,  the  Professor  of  Surgery 
in  the  Boston  University,  had  told  him  that  in  a  severe 
attack  of  lymphangitis  and  septicsemia  following  a 
dissection  wound  from  which  he  made  a  good  recovery 
he  had  relied  on  crotalus. 

In  the  treatment  of  carbuncle  and  of  traumatic  and 
senile  gangrene,  the  local  and  general  symptoms  of 
crotalus  point  it  out  as  a  medicine  which  is  well  calcu- 
lated to  assist  in  promoting  recovery.  Indeed,  where 
septic  poisoning  is  present  &ere  is,  generally  speaking, 
no  more  useful  remedy  than  crotalus.  Further,  in  cases 
where  septic  poisoning  is  to  be  apprehended— as  in 
genile  gangrene,  where  a  portion  of  the  foot  is  dead  and 
sloughing  is  still  proceeding — a  persistent  use  of  crotalns 
will  materially  aid  in  preventing  absorption  of  the 
discharges  and  consequent  septic  fever. 

In  peritonitis,  when  occurring  as  a  part  of  some 
zymotic  or  septic  disease  and  in  typhlitis  and  peri<> 
typhlitis,  met  with  under  the  same  circumstances,  this 
medicine  will  often  be  required.  Especially  will  it  be 
useful  when  there  is  vomiting  attended  by  much  drowsi- 
ness or  giddiness,  or  if  the  vomited  matters  contain 
much  green  slimy  mucus  or  uncoagulated  blood. 

Where  jaundice  occurs  as  one  of  the  products  of 
general  toxoemia,  crotalus  will  be  called  for,  as  it  will 
also  where,  in  a  similar  condition,  the  kidneys  are  eon- 


£SiJr5??Sn?^         SBHPBHT  VENOM.  311 

gested.  When  this  takes  place,  for  example,  in  the  course 
of  very  malignant  scarlatina,  it  will  be  especially  useful. 

it  is  an  appropriate  medicine  in  general  dropsy,  which, 
in  the  words  of  Dr.  Hayward,  is  '^  not  necessarily  depen- 
dent on  organic  disease  of  any  of  the  great  central 
organs,  but  is  rather  an  expression  of  a  debilitated  or 
softened  state  of  the  capillaries,  or  a  general  breakdown 
of  the  idtal  powers,  and  particularly  if  this  has  resulted 
from  chronic  alcoholism  or  from  septic  or  zymotic  or 
olher  degrading  or  debilitating  disease/'  Op.  cit.,  p.  880. 

The  well-known  h»morrhage*producing  property  of 
erotabis  has  led  to  its  use  in  intra-ocular  haemorrhages. 
**  It  has  appeared  to  hasten  the  absorption  of  extravasa- 
tions into  the  vitreous,  though  more  favourable  results 
have  been  obtained  from  its  use  in  retinal  hsemorrhage. 
It  has  been  of  service  in  the  extravasations  into  the 
retina,  dependent  upon  various  forms  of  retinitis,  but  it 
is  especially  adapted  to  those  eases  which  result  from 
a  degeneration  of  the  vessels,  and  are  non-inflamma- 
iory  in  their  origin.'* — Ophthalmic  Therapeutics  by  G. 
Norton,  M.D.,  2nd  edition,  p.  74. 

While  the  foregoing  formidable  morbid  conditions  con- 
stitute those  in  which  the  power  of  this  venom  is  most 
oonspicuously  exercised  for  good,  there  are  others  of  a 
less  serious  character  in  which  it  is  sometimes  indicated, 
and  has  been  found  useful.    These  I  will  briefly  notice. 

It  is  homceopathic  to  some  headaches,  especially  when 
ooearring  in  persons  in  a  low  state  of  health.  The  pain 
is  duQ  and  aching,  or  throbbing  and  shooting  in  the  left 
forehead.  It  is  associated  with  confusion  and  loss  of 
memory,  and  is  aggravated  by  any  attempt  at  mental 
eiertion.  Headache  with  vertigo,  nausea  and  vomiting 
is  often  present  in  diseases  otherwise  indicating  crotalm. 

There  is  a  laryngeal  tickling  cough  excited  by  any 
pressure  on  the  windpipe,  by  talking  or  taking  a  deep 
breath  in  which  erotahu  is  as  well  indicated  as  lachesia, 
and  which  lachesis  has  repeatedly  cured. 

In  bronchitis,  polmoni^  eoniestion  and  pnemnonia, 
when  either  occurs  in  the  course  of  some  septic  disease, 
crotalug  will  be  useful.  It  may  also  be  expected  to  be  of 
some  service,  when  the  patient  is  one  whose  constitution 
bas  been  deteriorated  by  long-continued  illness  and  in 
whom  gangrene  of  the  lung  appears  to  threaten. 

Further,  Dr.  Hayward  has  found  it   beneficial    in 


312      PRECISION  IN  PELVIC  DIAGNOSIS.  ^Sf"ewfi^?i!wS 

pertussis,  when  there  was  great  debility  and  marked 
cardiac  weakness ;  when  the  attacks  were  followed  by  paffi- 
ness  of  the  face,  epistaxis,  lividity  of  the  lips,  or  when  thoe 
was  a  threatening  of  pulmonary  oedema  or  paralysis. 

In  malignant  disease  Dr.  Hayward  suggests  that 
hypodermic  injection  of  five  minims  of  the  Ist  centesimal 
attenuation  every  few  hours.  In  other  cases  the  Srd  to 
the  6th  centesimal  are  all  sufficient. 

fTo  he  continu^d.J 

MODERN  METHODS  OP  PRECISION  IN  PELTIC 

DIAGNOSIS.* 

By  0.  H.  BuBFOBD,  M.B. 

ABsistant-PhTBioiaii  to  the  Gynaecologioal  Department. 

The  function  of  the  specialist  is  essential,  no  less  in  a 
community  of  letters  than  in  one  of  labour.  Since  the 
age  of  Socrates  the  broad  dogma  of  specialism  has  been 
accepted  all  through  time  ;  and  the  sphere  of  individual 
work  narrowed,  that  its  character  might  have  more  of 
precision.  The  specialist  must  justify  his  existence  by 
contributing  results  obtainable  only  by  concentration; 
though  his  intellectual  range  is  limited,  he  gains  in  mental 
intensity  what  he  loses  in  mental  proportion ;  his  office  is 
contributory  to  the  general  sum  of  human  knowledge. 

,  Now  the  principle  of  devolution  is  nowhere  more 
necessary  than  in  the  study  of  the  phenomena  of  morbid 
states  of  the  human  body.  These  manifestations  are  so 
Protean,  and  withal  always  within  the  sphere  of  ante- 
cedent and  consequent,  that  their  study  is  as  promising 
as  its  sub-division  is  necessary.  The  more  philosophical 
our  conception  of  abnormal  conditions,  and  the  wider  our 
purview  of  the  sphere  of  cause  and  consequence,  the 
more  successful  shall  we  be,  because  the  more  resource- 
ful, in  our  use  of  natural  forces  for  the  renewal  of  health. 
And  within  the  area  of  enquiry,  no  fact  but  has  its 
function,  no  knowledge  but  is  germane  to  the  end  in 
view,  the  restoration  to  the  normal. 

.  The  organs  involved  in  the  perpetuation  of  the  species 
are  in  such  a  condition  of  unstable  equilibrium,  and  fio 
liable  to  the  assaults  of  traumatism,  that  special  study  is 
requisite  for  the  desirable  attainment  of  special  skill  in 
their  treatment  in  disease.    But  in  order  to  gain  a  clear 

*A  Post -Graduate  Lecture  delivered  at  the  London  Hom(eopAUii<' 
Hospital  on  Februaiy  0th,  1891. 


SSS^^^y^ySf^  PRECISION  IN  PELVIC  DIAGNOSIBv     813 


,  Mmj  1, 18B1. 


eoneeption  of  the  abnormal,  we  must  bare  a  vivid  and 
abiding  image  of  the  normal  as  a  foil.  So  I  will  sketch 
the  cluef  details  in  the  background  of  the  normal  con-- 
dition,  that  the  outlines  of  the  unnatural  and  diseased 
maj  stand  out  in  bold  relief. 

On  making  a  vaginal  examination,  search  carefully  for 
the  right  and  left  ischial  spines.  Through  the  spines  the 
pelvic  equator  may  be  drawn.  The  cervix  uteri  is  located 
on  this  line,  exactly  midway  between  its  extremities. 
Thus  if  the  ceryix  be  below  the  equatorial  plane,  there 
may  be  present  prolapse,  cervical  hypertrophy,  or  down- 
ward displacement  due  to  tumour  pressure.  If  the  cervix 
be  nearer  one  or  other  ischial  spine,  we  have  uterine 
displacement,  due  usually  to  contracting  parametritis,  or 
hrosA  ligament  cyst ;  if  above  the  equatorial  plane,  the 
displacement  may  be  due  to  tumour  adhesion,  dragging 
op  the  uterus  in  the  direction  of  growth ;  and  so  on. 

What  is  the  normal  position  of  the  corpus  uteri  ?  Most 
book  diagrams  are  hopelessly  wrong  about  this.  Projec- 
tions have  largely  been  made  from  examinations  after 
death,  or  from  a  sense  of  artistic  fitness ;  and  only  of  late 
years  have  the  painstaking  and  thorough  investigations 
of  Sehultze  shown  that  the  normal  position  of  the  uterus 
is  at  right  angles  to  the  vaginal  long  axis.  The  anterior 
uterine  wall  lies  exactly  apposed  to  the  posterior  bladder 
?all,  the  latter  viscus  being  distended  more  or  less  ;  the 
fondas  uteri  is  found  immediately  behind  the  symphysis^ 
The  long  axis  of  the  uterus  follows  a  line  drawn  from  the 
upper  border  of  the  symphysis  to  the  coccygeal  tip,  the 
line  being  a  little  curved.  And  the  vaginal  end  of  the 
cervix  is  about  2  or  8  cm.  distant  from  the  coccyx. 

This  then  enables  us  to  form  a  clear  conception  of  the 
normal  relative  locus  of  the  cervix  and  the  corpus  uteri. 

Methods  of  Diagnosis. 
For  the  exact  investigation  of  the  lesions  of  the  pelvic 
^era  we  amphfy  our  diagnostic  methods  into  the 
synthetic,  the  graphic,  the  tactile,  the  instrumental;  and 
when  the  diagnosis  has  thus  become  limited  to  a  few 
alternatives,  we  add  thereto  the  special.  These  con- 
secutive procedures  will  now  be  treated  in  detail. 

I. — Thb  Synthetic  Method. 
Hegar    directs   that    we    should    always    commence 
dUgnosis  by  cross-examination,  and  in  this  procedure 
ve  have  various  necessities  to  ccfnsider.     The  necessity 


814"      PRECISION  IN  PELVIC  DIAGNOSIS.  ^"^^^wSu^ 

for  diagnosis  ;  the  necessity  for  prognosis ;  the  necessity 
for  constructing  a  variable  that  shall  resemble  in  its 
essentials  a  constant — the  yariable  being  the  patient's 
condition,  and  the  constant  the  dmg  proving.  Beside 
these  requisites  there  are  larger  issues  upon  Tfhich 
information  is  required.  The  effects  of  heredity ;  the 
mutual  exclusion  of  types  of  disease;  the  secondary 
effects  of  local  lesions  distributed  over  other  organs  and 
tissues  in  the  body.  All  these  lines  of  enquiry,  whose 
results  bear  notably  on  the  condition  of  our  patient 
before  us,  can  only  be  made  fruitful  by  careful  observa- 
tion and  comparison.  To  this  end  we  adopt  a  schema 
broad  enough  to  include  all  essentifids,  and  detailed 
enough  to  comprise  all  the  elements  of  the  case.  Here, 
as  elsewhere,  we  are  utterly  unscientific  where  we  are 
not  methodic.  Subjoined  is  a  copy  of  the  printed  form, 
with  space  for  insertion  of  detail,  that  is  in  use  at  the 
London  Homoeopathic  Hospital. 
Name  :  Age        :  State 

Children        :  Miscarriages        :  Last  Confinement 
hast  Cata. 

Menstruation:  LastCata:  Duration,  Quantity,  Nature: 
Comparison  :  Interval :  Concomitants :  First  Cata :  ut 
supra :  Begular  or  no :  and  since. 

Pain :  During  Period,  Interval,  or  both :  Duration : 
Exact  Days :  Maximum :  Nature,  Locality  and  Radiations : 
Aggravation  and  Amelioration. 

Bladder :  Urging — Day  or  Night,  or  both :  Dysuria. 

Prima  Via : 

Other  Notable  Conditions  : 

Genbral  Conmtion. 

1.  Temperament:  Diathesis:  Condition. 

2.  Previous  History :  Exanthems — ^vaccination. 

8.  General  Aggravation  and  Amelioration  of  Symptoms* 

4.  Eyes. 

5.  Head. 

6.  Heart  and  Circulation. 

7.  Urine. 

8.  General  Symptoms :  Heats  and  Flushes :  Extremities  r 
Fainting  Fits :  Petit  Mai :  Body  Pains,  &c. 

The  immense  importance  of  accurately  transcribing 
all  details  of  a  case  consists  in  this :  that  without  such 
carefully  written  descriptions  no  general  deductions  can 
be  made.    Thus  in  a  recent  tri^  at  the  Law  Courts, 


r 


Bffinr.lfay  1.1891. 


BBBCI810N  IN  PELVIC  DIAGNOSIS.     315 


large  damages  practically  hinged  on  a  correct  answer  to 
tile  qaestion  "  Does  free  bleeding  occur  as  the  earliest 
haunorrhagie  condition  in  carcinoma  uteri?"  The 
response  of  the  specialist  was  made  as  the  outcome  of 
some  years  careful  and  detailed  registration  of  history 
and  symptoms  in  gynecological  cases. 

n. — The  TAcnLE  Method. 

Modem  gynecology  dates  from  ten  years  back,  and 
corresponds  with  the  perfection  of  the  bi-manual  method. 
On  this  point  Lawson  Tait  is  most  emphatic :  '*  The 
(dd-fiishioned  mechanical  school,  the  teaching  of  the 
speculum,  the  sound,  the  caustic  stick  and  the  pessary 
has  been  practically  killed."  Schultze,  the  most  finished 
of  German  diagnosticians,  writes :  **  The  sound  is 
seldom  used  by  us  now  to  find  out  the  position  and 
shape  of  the  uterus,  because  a  much  better  knowledge 
is  obtained  on  these  points  by  bi-manual  palpation.*^ 
For  accuracy  and  ease  in  diagnosis,  the  bi-manual  method 
tea:  surpasses  all  others,  taken  singly  or  collectively. 

For  the  effective  and  profitable  conduction  of  the 
bi-manual,  the  appointments  and  preparations  are :  ^ 

(a)  The  table  or  couch  :  of  sufficient  height  to  obviate 
stooping  on  the  part  of  the  examiner ;  of  sufficient 
hardness  to  allow  free  local  examination  with  ease ;  it 
must  be  approachable  on  both  sides;  it  should  have 
also  two  foot  rests  at  the  end. 

(b)  Complete  unloosening  of  all  garments  down  to 
the  skin ;  the  removal  of  corsets. 

(c)  Empty  rectum  and  bladder. 

Place  the  patient  in  the  dorsal  position,  and  commence  by 

Exa/niifuUion  of  the  abdomen.  Then,  with  the  knees 
well  drawn  up,  still  in  the  dorsal  decubitus,  proceed  to 

Vaginal  examination  with  the  forefinger;  with  the 
other  hand  over  the  symphysis,  the  fundus  can  be 
crowded  down  in  the  pelvis;  and  the  relations  and 
position  of  all  the  pelvic  viscera  determined.  Next,, 
place  the  patient  in  the 

Left;  lateral  position:  The  parametria  and  Douglas^ 
pouch  can  be  stUl  better  explored. 

Rectal  examination  should  always  follow,  as  manjr 
points  can  be  better  and  more  clearly  determined  after 
vaginal  examination.  Inspection  may,  if  necessary, 
be  conducted  for  perineal  tears,  labial  abscess,  urethral 
canmcle,  &c. 


816     PRECISION  IN  PELVIC  DIAGNOSIS.   ^^^Sfl^SJf?^ 


BeTiew,llArl,Un. 


These  procedures  complete  an  ordinary  bi-mannal 
examination.  In  no  instance  is  it  necessary  to  introduce 
the  sound ;  in  few  cases  will  the  speculum  give  more 
information  than  is  obtainable  by  the  tactxvs  eruditus. 

The  following  schema  we  adopt  to  register  the  result 
of  the  tactile  method  of  examination,  supplemented  by 
instrumental  aid  when  necessary. 

Physical  Examination. 
^  Ahdomen :  Contour  :  Parietal  thickness :  Skin :  Ten- 
sion :  Sensitivity:  Abnormal  conditions:  Auscultation: 
Percussion:  Palpation,  deep  and  superficial:  Measure- 
ments, A,  B,  C,  D,  E,  P,  G. 

Pvdenda  and  Perinewm  :  Lab.,  maj.,  min. :  Meatus: 
Cystocele :  Eectocele :  Perineal  Body :  Neoplasm :  Pro- 
<5identia:  Ducts. 

Vagina  with  Portia  V. :  Introitus :  Calibre :  Sensi- 
tivity :  Neoplasm.  Portio  V.  :  Position  :  Direction  : 
Mobility :  Size  :  Laceration :  Hypertrophy :  Atrophy : 
Sclerosis :  Ectropion :  Neoplasm :  Softening. 

Cvl  de  Sacs  :  E. :  L. :  A. :  P. :  Dimensions :  Contents : 
Besistance :  Sensitiveness. 

Bimanual  Examination  :  Uterus  :  Size  :  Position : 
Contour  :  Consistence  :  Deviation  :  Ant.  Segt. :  Post 
Segt. :  Mobility  or  Fixation  :  Fundus  :  Corpus.  Para- 
metria E.  and  L. :  Free :  Eigid  :  Contents  :  Contracted : 
Eesistance  :  Douglas  P. :  Contents  :  Besistance :  Tubes : 
Ovaries. 

Speculum  :  Volsella  :  Dilatation  and  Exploration : 
Curetting:  Microscope. 

Vesical  Exploration :  Bony  Pelvis,  Coccyx,  <fc. : 

Rectal  Exploration :  Diagnosis  : 

Mammce:  Treatment: 

III. — The  Graphic  Method. 
The  results  of  local  examination  should  always  be 
•sketched  as  well  as  described.  For  vividness  as  well  as 
accuracy,  for  a  sound  general  conception  and  correct 
proportion  of  detail,  this  method  is  pre-eminently  a 
method  of  precision.  Lidications  of  site,  of  intimate 
relation,  of  size,  of  form  and  outline,  of  direction  of 
growth — all  these  can  be  represented  much  more 
quickly  and  much  more  accurately  by  drawing  than  by 
description.  Outline  diagrams  are  all  we  need  concern 
ourselves  with,  and  we  will  consider  how  best  to  utilise 
-them.     For  pelvic  purposes  three  planes  of  section  are 


SS?2?j?w^    PBBOISION  IK  PELVIC  DlAONOBIfl.     817 

enough — the  plane  of  the  pelvic  brim,  the  median  antero- 
poBt^ior  pelvic  plane,  and  the  transverse  plane.  These 
three  planes  for  drawing  correspond  respectively  to  con- 
ditions as  fomid  in  the  npright  position,  the  usual  left 
lateral  position,  and  the  position  as  lying  on  the  back. 
To  these  may  be  added  an  outline  abdominal  sketch  for 
delineation  of  tumours,  &c. 


tig.  I.— OatUne  dUgiMii  for  Bkatdhiiig  Site  of  Abdominal  TmnooH,  la>. 


Kg.  2.— FaUoit  Ijing  in  L«f  t  lAteml  Poaition. 


S18      PRECISION  IN  PELVIC  DIAONOSIS.  ^b!^ 


RBifiam,U»jlt 


Fig.  3. — ^Diagram  oorresponding  to  Donal  Decabitni. 
PelTio  Yisoera  to  be  eketohed  in. 


Fig.  4. — ^Diagram  oorresponding  to  Plane  of  Pelvio  Brim. 

These  diagrams  are  prepared  by  Schultze,  and  are 
those  in  use  at  the  Vienna  and  other  great  German 
schools  for  the  same  purpose.  These  four  outline 
diagrams  give  the  condition  of  things  from  all  aspects  of 
examination,  and  together  they  tend  to  that  accuracy  in 
diagnosis,  which  is  the  aim  of  every  practising  gyn»- 
<^ologist. 

IV, — ^The  Instrumental  Method. 

It  is  sometimes  requisite  to  supplement  the  tactile 
method  by  the  use  of  instruments  designed  to  verify  or 


.b^^mS^TiI^  pbeoision  in  pelvic  diagnosis.    819 

amplify  the  information  already  given  by  the  bi-manual. 
The  sense  of  sight  is  thus  requisitioned  by  the  use  of  the 

Speculum. — This  instrument  has  conducted  to  much 
bad  pathology  and  much  ineffective  treatment.  In 
vaginal  lesions,  e.g.^  vaginitis  granulosa,  it  is  very  useful ; 
in  abnormal  cervical  conditions,  e.g.^  a  presenting  poljrpus, 
epitheUomatous  fungosities,  &;c.,  it  also  has  its  vogue ; 
bat  in  all  uterine  lesions  it  is  utterly  useless,  and  very 
often  misleading.  In  cervical  conditions,  too,  let  it  be 
remembered  that  lacerations  in  the  cervix  were  for  many 
years  unnoticed  and  almost  unknown,  consequent  upon 
the  use  of  Ferguson's  speculum,  which  does  not  exhibit 
them  ad  naturam,  ^ 

When  it  is  desirable  to  use  a  speculum,  Ferguson's  is 
ondoabtedly  the  best,  or  the  smaller  Holland's  modifica- 
tion. The  Sims'  duckbill,  or  better,  Heywood  Smith's 
modification  is  most  useful ;  with  this  should  always  go 
Simon's  spoon  for  keeping  up  the  anterior  vaginal  wall. 

Uterine  Dilators. — These  are  of  the  highest  service  for 
aUowing  more  intimate  exploration  of  the  cavum  uteri 
-when  required.  Never  use  such  weapons  as  the  metal 
pronged  dilators  ;  they  are  dangerous  and  unscientific. 
By  far  the  best  and  safest  are  Hegar's  dilators  of  glass 
or  ebonite.  After  use  it  is  well  to  lay  in  the  uterine 
mouth  an  iodoform  pencil ;  if  this  be  done  unpleasant 
after  results  may  with  certainty  be  avoided.  The 
posterior — or  anterior — cervical  lip  must  be  steadied  by 
a  double  hook,  but  never  attempt  with  this  to  draw  the 
uterus  down  if  any  lateral  pelvic  deposit  exist. 

The  Curette  may  then  be  used  to  detach  shreds  of 
membrane,  fungous  granulations,  sloughing  uterine 
tisdue,  &c.,  or  more  guardedly  for  obtaining  small 
quantities  of  neoplasm  for  microscopic  examination. 

The  IntrorUterine  Speculum  is  an  instrument  at 
present  wholly  undeveloped,  but  from  which  ere  long 
sorprisingly  accurate  information  may  be  obtained.  I 
shall  recur  to  this  subject  at  some  future  date. 

The  Sound. — Only  in  the  rarest  cases  is  the  use  of 
this  instrument  necessary.  All  the  information  it  gives 
can  be  secured  with  more  certainty  and  less  risk  by  a 
^efol  bi-manual  examination. 


'320      PKEOISION  IN  PELVIC  DIAaNOSIS.  *^B^Tl£Saim! 

V.^^Spbcial  Methods. 
When  diagnosis '  has  been  narrowed  to  a  few  alter- 
natives certain  special  combinations  of  simple  metboda 
are  necessary  for  the  final  determination  of  the  physical 
condition.  In  the  examples  of  som^  of  the  more 
frequently  recurring  abnormal  conditions,  which  are 
appended,  such  procedure  is  evidenced. 

Eably  Pregnancy. 

The  history  of  one  or  two  periods  missed  is  always 
suggestive;  but  this  requires  to  be  supplemented  by 
Hegar's  sign,  which  in  early  pregnancy,  even  of  one  and 
a-half  months,  is  never  wanting.  ''  The  uterus  in  early 
gestation  loses  its  pear-shaped  outlilne,  and  becomes 
bellied  out  in  its  lower  segment  in  all  the  transverse 
diameters  ;  this  is  most  readily  felt  in  the  anterior  cnl- 
de-sac." 

This  is  an  unfailing  sign  of  early  pregnancy.  I  hare 
demonstrated  it  again  and  again  to  pupils  and  assistants 
in  my  out-patient  clinique,  and  in  every  case  with 
success.  Quite  recently  a  patient  was  sent  to  me  in 
whom  I  diagnosed  early  pregnancy  of  about  two  months* 
She  went  home^  communicated  with  her  local  medical 
attendant,  who  flatly  denied  the  diagnosis.  A  mis- 
carriage at  the  fourth  month  settled  events  even  to  this 
gentleman's  satisfaction. 

n. — ^Uterine  Fibroids. 

Almost  every  pelvic  mass  is  diagnosed  by  the  unskilled 
as  a  uterine  fibroid.  I  have  seen  pelvic  exudation,  preg- 
nancy, mdilignant  disease  of  the  pelvic  organs,  ovarian 
cyst,  pelvic  abscess,  all  in  their  turn  asserted  to  be 
uterine  fibroids  !  That  uterine  fibroids  are  common  is 
beyond  doubt ;  but  that  other  pelvic  lesions  with  solid 
elements  are  also  common  is  not  sufficiently  frequently 
remembered. 

The  synthetic  method  is  essential  here  in  recording 
menorrhagia  or  amenorrhoea,  pain  or  merely  neurotic 
explosions,  a  history  of  previous  pyrexia,  or  an  a-febrile 
course,  a  cachexia,  a  traumatism,  or  a  purulent  gush. 
The  tactile  method  will  shew  an  absence  of  adhesions, 
an  enlarged,  often  nodulated,  uterus,  a  freedom  from 
peritoneal  irritation  or  effusion,  and  a  normal  cervix^ 
The  graphic  method  will'  represent  the  exact  size,  posi- 
tion and  relations  of  the  uterus  for  comparison  in  esti- 


It^SSTSSu"    PBECISIOK  IN  PELVIC  DIAGNOSIS.    321 

mating  progress.  Abdominal  measurements  for  purposes 
of  precision  are  worse  than  useless,  if  used  alone,  to 
determine  size. 

in. — ^Uterine  Carcinoma. 

No  form  of  uterine  lesion  is  heralded  or  accompanied 
bj  80  great  a  diversity  of  symptoms  as  uterine  carcinoma. 
Bleeding  may  be  present  or  absent ;  pain  may  be 
considerable  or  nil;  rectal  and  vesical  symptoms  may 
be  marked  or  wanting ;  and  cachexia  may  be  obvious  or 
of  very  late  development.  Yet  the  synthetic  method  is 
here  of  great  value,  if  only  to  record  the  varying  times 
at  which  the  classical  symptoms  may  make  their 
appearance  in  the  history  of  the  lesion.  The  tactile 
method  is  much  more  serviceable,  but  this  requires  to 
be  used  with  great  care,  for  a  sclerosed  cervix  may  be 
called  a  schirrhus,  or  an  epithelioma  diagnosed  as  a 
benign  papilloma.  In  advanced  cases  there  is  no  room 
for  doubt,  in  early  developments  the  removal  of  a  small 
piece  of  tissue  by  the  curette  for  microscopical 
examination  will  generally  decide  the  question. 

IV. — Prolapsus  Uteri. 

In  minor  degrees  of  prolapsus  the  exact  amount,  or 
even  the  presence,  of  prolapse  requires  careful  con- 
sideration. The  synthesis  will  reveal  some  urging  to 
micturition,  aggravated  during  the  day,  but  relieved  on 
adoption  of  the  horizontal  posture.  The  tactile  method 
irill  always  show,  if  the  patient  strain,  a  commencing 
descent  in  the  anterior  cul-de-sac,  continuing  until  the 
cervix,  and  finally  the  posterior  cul-de-sac  (in  advanced 
eases)  are  thrust  in  the  direction  of  least  resistance, 
toward  the  vaginal  introitus.  The  bulging  of  the 
anterior  cul-de-sac  on  straining  is,  in  however  slight 
degrees  of  prolapsus,  never  absent. 

These  conditions  are  cited  to  show  the  necessity  of 
adopting  the  various  methods  of  diagnosis  in  each 
appropriate  case,  and  the  impossibility  of  accurately 
determining  the  condition  if  all  sources  of  information 
be  not  drawn  upon.  To  become  a  master  in  the  art  of 
diagnosis  requires  incessant  practice,  but  care  and 
discrimination  can  be  evidenced  by  all.  Not  only 
elaborated  method,  but  nou^  is  required  to  give  success 
in  diagnosis,  and  unclassified  experience  is  often  of  no 
avail. 

Vol  85,  No.  6.  2  a 


322  INDEX  TO  THE  CYCLOPiEDIA.   ^b^I^jS^^ 

ON  DE.  HUGHES'  INDEX  TO  THE  CYCLOPEDIA. 

By  J.  Deysdalb,  M.D. 

As  Dr.  Hughes  has  expressed  a  wish  that  his  paper  on 
this  subject  at  p.  658  of  this  Review  for  1890  should 
receive  a  more  full  and  minute  criticism  than  was 
possible  at  the  meeting  of  the  Congress,  I  send  this  con- 
tribution to  the  subject.  Three  different  subjects  were 
discussed  in  the  paper.  The  first  was  whether  the 
symptoms  in  the  Cyclopcedia,  which  are  understood  to  have 
already  gone  through  a  process  of  revision  and  sifting 
such  as  can  be  done  without  actual  reproving,  should  be 
farther  revised  and  sifted  more  thoroughly  by  the  same 
means  before  the  Index  was  made.  On  this  subject  I 
think  we  are  all  practically  agreed  if  we  recognise  the 
fact  that  there  are  two  degrees  of  completeness  of  re- 
vision— one  of  which  can  be  used  at  once  with  the  know- 
ledge at  present  at  our  disposal,  and  the  other  requiring 
reproving  and  exhaustive  study  of  each  medicine.  This 
last  must  necessarily  be  so  slow  that  it  cannot  be  avail- 
able for  our  Index,  but  must  be  dealt  with  first  in  suc- 
cessive volumes  of  Materia  Medica  similar  to  our  Materia 
Medita  Physiological  and  Applied.  On  this  we  are  all 
pretty  well  agreed,  as  I  see  that  Dr.  Hughes,  while 
willing  to  accept  all  help  then  available  from  the  plans 
of  Drs.  Wesselhoeft  and  Sutherland  and  the  discussion 
raised  by  them,  does  not  propose  to  postpone  beginning 
the  Index  till  the  value  of  the  chart  plan  is  finally  settled 
and  the  whole  Materia  Medica  sifted  through  it.  I  think, 
therefore,  we  shall  all  be  glad  to  accept  any  further 
revision  that  Dr.  Hughes  may  find  possible  before 
making  the  Index.  The  second  point  was  whether  the 
Index  should  be  restricted  to  the  Cyclopedia  as  the  name 
impHed.  To  this,  however.  Dr.  Hughes  himself  adds,  as 
is  natural  and  proper,  Hahnemann's  Materia  Mediea, 
and  in  this  we  shall  all  agree.  But  in  addition  I  think 
it  should  be,  if  possible,  so  managed  that  the  Index 
should  include  all  trustworthy  symptoms  from  whatever 
source  up  to  the  day ;  for  there  is  nothing  more  dis- 
heartening to  the  practical  man  in  using  a  book  of  the 
dictionary  kind,  than  the  consciousness  that  something 
is  probably  wanting  in  the  information  afforded  by  it. 
This  reference  to  other  sources  than  the  Pathogenic 


b!S^uSTvb^  index  to  the  cyclopedia.  328 

Cycbpadia  and  Hahnemann  would,  no  doubt,  add  to  the 
•difficulty  which  the  absence  of  the  schema  puts  in  the 
way  of  making  the  index-references,  as  will  be  noticed 
fie^her  on.  This  additional  difficulty  might  be  obviated 
by  incorporating  in  the  appendix  to  the  Cyclopadia  all 
the  newer  fragmentary  trustworthy  symptoms  which 
may  be  deemed  worthy  of  a  place  in  the  Index.  If  all 
this  is  done  the  ''simple  "  index  which  has  so  often  been 
asked  for  will  assume  the  dimensions  of  a  great  work, 
viz.,  the  revision  of  all  the  symptoms  of  our  vast  Materia 
Medica  up  to  the  day,  and  the  invention  of  a  Repertory 
which  will  enable  us  in  the  quickest  and  easiest  manner 
to  match  the  enormous  mass  of  the  natural  symptoms  of 
disease  with  the  almost  equally  enormous  mass  of  symp- 
toms in  our  Materia  Medica.  So  here  we  are  again 
exactly  in  the  same  position  in  which  we  were  nearly  80 
years  ago  when  the  Hahnemann  Publishing  Society 
deputed  a  Committee  to  enquire  into  the  best  mode  of 
making  a  Repertory,  and  the  response  was  the  production 
of  the  British  or  Cypher  Repertory.  For  Dr.  Hughes 
gives  us  to  understand  that  that  plan  will  not  do,  and 
he  does  not  say  that  any  of  the  plans  (chiefly  American) 
that  have  been  invented  since  will  do.  He  will  have  to 
invent  a  new  plan.  There  is  plenty  of  scope  for  improve- 
ment, and  as  we  are  all  deeply  interested  in  the  result  I 
Bend  my  quota  to  help  the  judgment  on  the  past  experience 
in  Repertory  making,  and  the  principles  on  which  such  a 
work  must  be  founded. 

I  am  glad  to  notice  that  in  most  important  points 
Dr.  Hughes  is  in  agreement  with  the  makers  of  the 
Cypher  Repertory.  In  the  first  place  he  prefers  the 
schematic  to  the  alphabetical  order  of  the  Index,  which 
has  been  adopted  by  Allen,  and  in  a  great  many  of  the 
American  local  repertories  which  are  becoming  so 
common  in  the  endeavour  to  supply  the  felt  want  of  a 
complete  Repertory.  The  alphabetical  order  has  an 
appearance  of  simplicity  and  completeness  which  is 
captivating  at  first  sight,  but  we  soon  find  that  owing  to 
the  great  variety  of  synonyms  and  modes  of  expression  for 
what  is  practically  the  same  morbid  state,  it  is  impossible 
to  identify  a  symptom  by  its  conditions  and  concomi- 
tants without  hunting  through  possibly  a  dozen  initial 
letters. 

2  A— 2 


824  INDEX  TO  THE  CYCLOPiEDIA.   ^B^fSE^TMnf 

For  example,  in  Lee's  Repertory y  of  which  Dr.  J.  H. 
Glaxke  says  '4t  is  in  point  of  arrangement  the  best  I 
know,"  we  find  under  the  heading  of  "  Anxiety,  appie- 
hensiye  of  death,"  at  p.  15,  a  Ust  of  88  medicines,  8  of 
which  have  conditions  or  concomitants;   while  cmder 
Fear  of  death,  at  p.  40,  we  have  a  list  of  75  medicines, 
of  which   18  have  conditions  or  concomitants;  while 
again,  under  Death,  fear  of,  at  p.  28,  we  have  another 
list  of  86  medicines,  of  which  11  have  conditions  and 
concomitants.    No  doubt  many  of  the  medicines  appear 
in  two  or  all  three  of  these  lists,  but  many  do  not  appear 
in  all  three,  nor  are  the  conditions  and  concomitants  the 
same  in  the  three  lists  ;  therefore  it  is  plain  that  to  get 
all  the  information  which  this  Repertory  can  afford,  we 
have  to  search  three  widely  separated  lists.     Again, 
under  Obscene,  at  p.  57,  we  find  "  in  speech  Zt7.,  see 
lewdness."     On  turning  to  that  word  at  p.  52  we  find  a 
list  of  14  medicines,  and  one,  viz.  pla.,  specified  in  lewd 
talk ;  while  at  p.  66,  under  speech,  we  find  "  obscene, 
aur.'bel.'Stram.**    Thus,  again,  there  are  three  separate 
places  (and  there  may  be  more)  where  you  must  look 
before  you  get  complete  information  on  one  symptom. 
This  defect  runs  through  all  the  alphabetical  and  verbal 
plans  of  repertory,  and  is  to  my  mind  a  fatal  defect.     I 
would  like  to  know  how  Dr.  J.  H.  Clarke  hkes  to  have  to 
look  under  8  or  4  widely  separated  heads  when  he  wants 
all  the  information  his  [best  of  all]  Repertory  can  give 
on    any    particular    symptoms.      I    conclude  that  all 
repertories  or  indices  on  the    alphabetical    and   con- 
cordance plan  are  unpractical  and  unworkable  onlees 
you  have  unlimited  time  at  command.     On  this  point 
the  Cyj)her  Repertory  committee  have  been  followed  by 
Dr.  Bering,  who  says  at  p.  18  in  his  Analytwal  Thera- 
peutics, Vol.  I. :   "  The  greatest  stress  is  laid  in  the 
following  work  on  the  entire  abolishment  of  th^  alpha- 
betical arrangement     .      .      •      Our  many  repertories 
have  suffered  under  this  most  miserable  of  all  *  orders,^ 
taking  up    our    time    and    wasting    it    by  increasing 
the  difficulties."     The  greatest  care  has  been  taken 
in   the   Cypher  Repertory    to    bring    all  the    varieties 
of  any  symptom  into  one  place  under  its  most  general 
denomination,  and  with  all  the  conditions  and  concomi- 
tants at  the  same  place.    In  fact  an  essential  point  in 
the  Cypher  Repertory  is  that  any  paragraph  or  headiog 


SUSSTm^TTw^'   IN^EX  to  the  CYCLOPiEDIA.  326 

to  which  medicines  belong  most  be  exhaustively  com- 
plete and  contain  every  medicine  which  produces  that 
symptom  in  any  of  its  numerons  varieties.  The  next 
important  principle  to  be  kept  in  mind  in  tracing  the 
resemblance  of  medicinal  to  morbid  symptoms  is  the 
sueceition  of  symptoms.  The  assemblage  and  succession 
of  symptoms  are  the  elements  on  which  diagnosis  is 
founded,  and  of  these  the  succession  is  often  the  more 
important  and  definite.  How  often  have  we  to  tell  our 
patients  to  wait  some  hours  or  days  till  the  succession 
of  the  symptoms  enables  us  to  pronounce  on  the  nature 
of  the  disease  !  Therefore,  in  addition  to  an  Index  of 
the  assemblage  of  the  symptoms  or  elements  of  each 
symptom  on  the  same  plane  as  it  were,  it  is  necessary 
to  have  a  department  indicating  any  succession  of  symp- 
toms or  information  in  a  narrative  form  such  as  is 
represented  in  the  fourth  section  of  the  Cypher  Repertory. 
These  three  principles,  viz.,  the  schematic  order,  and 
not  the  alphabetical ;  the  exhaustive  completeness  of 
each  heading ;  and  the  fourth  section  will,  I  doubt  not, 
be  accepted  from  the  first  by  Dr.  Hughes,  and  these  form 
a  great  if  not  the  chief  part  of  the  merits  of  the  Cypher 
Repertory,  without  taking  the  Cypher  into  account. 
Those  who  are  not  acquainted  witii  the  Cypher  should 
read  Dr.  Nankivell's  paper  on  Repertories  in  the  British 
Journal  of  Homceopathy,  vol.  xxiv.  Dr.  Nankivell  states 
that  "putting  the  Cypher  altogether  aside,  it  [the  Cypher 
Repertory]  still  continues  more  useful  than  any  other 
Repertory,  from  the  very  complete  arrangement  of  its 
parts,  and  its  careful  subdivision  of  all  the  large  head- 
ings, more  especially  the  pains  "  (p.  288).  And  again  : 
"  Thus  far  we  have  examined  the  plan  of  the  Repertory 
apart  from  the  system  of  Cypher,  and  have  found 
that  even  if  the  Cypher  were  blotted  out  from  its 
pages,  it  gives  more  than  any  other  available  English 
Repertory.  For  instance,  let  us  take  the  following 
symptom, '  tension  of  the  abdomen  at  morning  in  bed 
with  dyspnoea  and  anxiety.'  Looking  up  '  tension  '  in 
Qiap.  xiv.,  we  find  a  list  of  44  drugs,  and  on  looking 
into  the  next  column  to  the  condition,  we  find  under 
'morning  in  bed'  only  staph.,  then  on  looking  down 
the  colunm  to  the  list  of  concomitants,  under  '  anxiety ' 
isosehus  and  staph.,  and  under  '  dyspnoea '  arg.  nit^  and 
^jk.    Staph,  is  tJierefore  the  medicine  and  the  only 


826  INDEX  TO  THE  CYCLOPiEDIA.   ^aSfL^SE??^ 


BeTiew.MAylfUn. 


one  which  produces  this  symptom.  Now  this  cannot  be 
done  with  the  common  Jdhr.^  and  if  any  one  doubt  the 
statement  let  him  try  it  "  (p.  285).  I  assume  therefore 
that  when  Dr.  Hughes  comes  to  address  himself  to 
practical  repertory-making  he  will  be  constrained  to 
follow  in  the  footsteps  of  the  Cypher  Repertory  committee 
to  a  large  extent,  and  also  that  he  will  find  it  necessary 
to  make  as  little  change  as  possible  in  Hahnemann's 
schema  to  which  we  are  all  accustomed,  more  especially 
as  any  changes  or  improvements  which  may  be  suggested 
may  all  be  added  as  sub-arrangements  of  the  generalities 
section,  which  comes  in  between  lower  extremities  and 
sleep  or  fever.  Practically  the  real  objection  is  to  the 
cypher  in  repertory  making,  and  Dr.  Hughes  hopes  to  be 
able  to  get  all  the  advantages  of  it  by  simpler  means. 
He  says  (p.  665  of  Mon.  Ham.  Rev.,  1st  Nov.,  1890), 
*'  and  then  the  cypher,  most  ingenious  in  conception,  bat 
alas !  most  abominable  in  effect.  *  Monstrum  horrendum^ 
informej  ingens,  cui  lumen  ademptum.*  It  has  been  a 
spectacle  for  gods  and  men  to  see  the  workers  with  it 
toiling  on  at  their  task,  knowing  that  they  were 
condemning  their  results  to  be  unsaleable  and  unused. 
It  is  surely  time  to  recognise  that  the  world — ^the 
homoeopathic  world,  that  is — ^is  not  worthy  of  it,  and  to 
bury  it  decently  out  of  sight." 

Dr.  Hughes  has,  I  have  always  understood,  never 
seriously  tried  to  understand  or  practically  use  the 
Cypher f  or  indeed  any  Repertory^  owing  to  his  distrust  of 
the  minute  symptoms  in  the  Materia  Medica,  preferring 
to  trust  to  a  more  general  correspondence  of  the  drug 
and  the  disease.  Now  I  yield  to  none  in  the  appreciation 
of  the  need  of,  and  the  desire  for,  the  purification  of  the 
doubtful  symptoms,  and  am  proud  to  have  my  name 
associated  with  those  of  the  committee  of  the  Pathogenetic 
Cyclopadia.  Nevertheless  I  recognise  the  necessity  of  a 
rapid  and  easy  mode  of  reference  to  the  minute 
symptoms  of  the  weU-proved  medicines,  as  essential  to 
carrying  out  the  homoeopathic  method  as  Hahnemann 
directed.  Now  I  assert,  in  opposition  to  the  merely 
theoretical  dictum  of  Dr.  Hughes,  that  from  long  ex- 
perience on  my  own  part  and  that  of  many  other 
practitioners,  that  the  Cypher  is  far  the  easiest  and 
quickest  mode  of  finding  in  the  Materia  Medica  and 
matching  in  disease  those  symptoms  compounded  of 


SSSr^yt^*  INDEX  TO  THE  CYCLOPEDIA.  327 

several  elements  as  HahnemaDn  desired  should  be  done. 
I thas  assert  that  the  "horrid  monster"  is  a  creature 
very  easily  tamed  and  made  to  work  in  harness,  while 
the  blindness  spoken  of  really  applies  to  the  critic  and 
the  idle  and  careless  listeners  who  have  never  l;aken  the 
trouble  to  examine  the  matter  for  themselves.  Let  us 
consider  Hahnemann's  model  cases  published  in  the 
M(Ueria  Medica  PurUy  and  opportunely  reprinted  by  Dr. 
Clarke  in  this  same  number  of  the  Monthly  Homoeopathic 
Review  containing  Dr.  Hughes'  paper.  The  second  of 
these  cases  is  one  of  what  we  might  call  gastric  catarrh, 
bat  the  pathological  name  gives  little  or  no  help  in  the 
choice  of  the  remedy.  That  depends  entirely  on  the 
accurate  matching  of  the  eight  symptoms  present  with 
those  in  the  Materia  Medica. 

Let  us  take  the  second  of  the  symptoms  :  ''At  night 
(2  a.m.)  sour  vomiting."  On  this  Hahnemann  remarks 
'*  Stramonium  and  nux  vomica  cause  vomiting  of  sour 
and  sour-smelling  mucus,  but  as  far  as  is  known  not  at 
night;  valerian  and  cocculns  cause  vomiting  at  night, 
but  not  of  sour  stuff."  PtiUatUla',  however,  produces 
soar  vomiting  at  night,  and,  therefore,  as  far  as  this 
symptom  is  concerned^  represents  the  homoeopathic 
nmiie.  From  this  we  learn  that,  in  Hahnemann's 
judgment,  to  get  the  true  homoeopathic  correspondence 
ail  the  elements  of  a  symptom  must  not  only  be  found 
in  the  pathogenesis,  but  they  must  be  found  together  in 
the  same  symptom — that  it  will  not  do  to  have  sour 
vomiting  in  one  symptom  and  night  vomiting  in  another, 
and  then  by  clubbing  these  elements  together  to  imagine 
that  we  can  obtain  the  pathological  simile  of  the  disease 
to  be  cured. 

On  this  point  I  follow  Hahnemann  implicitly,  but  it 
would  lead  us  too  far  from  our  subject  to  enter  on  the 
question  of  the  alleged  pathological  as  contrasted  with 
symptomatic  treatment  which  has  a  kind  of  practical 
bearing,  although  I  consider  it  is  founded  on  an  error, 
and  that  there  is  only  one  treatment  possible,  viz. :  the 
pathological ;  and  the  so-called  symptomatic  is,  or  ought 
to  be,  merely  the  pathological  carried  out  to  a  far  more 
minute  degree  than  the  state  recognised  by  coarse 
morbid  anatomy  alone  to  which  the  word  pathological  is 
usually  applied.  Li  the  present  case,  the  sour  vomiting 
at  night  indicates  a  far  finer  diagnosis  of  the  patho- 


328  INDEX  TO  THE  CYCLOPiBDIA.   '^^/•^S2??m5* 


Beview,  Jfay  1,  ISil. 


logical  state  than  the  statement  that  we  had  to  deal  ^th 
a  gastric  catarrh  in  which  vomiting  and  sourness  ^ere 
present.      And  this  leads  us  to  perceive  the  extreme 
value  of  the  cypher  in  any  repertory  which  aspires  to 
guide  us  to  the  use  of  the  Materia  Medica  in  the  minute 
and  correct  manner  which  Hahnemann  inculcated.    For 
instance,  under  the  heading  "  sour  vomiting  "  we  find 
in  an  ordinary    repertory  28    medicines,    and    under 
"vomiting  at  night "  22  medicines,  but  no  information 
is  given  as  to  which,  if   either,  of   these  have  both 
elements  of  the  symptom,  and  then  farther  if  they  have 
them  in  the  same  pathogenetic  symptom.    Apparently 
the  shortest  process  by  which  this  knowledge  can  be 
obtained  is  to  compare  the  night  list  with  the  sour  list, 
write  out  the  names  of  any  medicines  that  are  found  in 
both,  and  then  refer  to  the  Materia  Medica  in  the  case 
of  each  to  see  if  both  these  qualities  occurred  in  the 
same  symptom.    How  many  busy  practitioners,  profess- 
ing to  follow  Hahnemann,  really  take  all  this  trouble 
which  is  cast  upon  them  by  the  imperfection  of  the 
verbal  system  of  repertories  ?    For  contrast  this  with 
the  cypher  system.    By  it  you  have  merely  to  add  a 
short  symbol  to  the  name  of  the  medicine,  and  thus  all 
its  qualities  can  be  linked  to  all  other  rubrics  to  which 
it  can  belong.    Here,  for  instance,  the  letter  p,  added  to 
the  name  of  the  medicine,  stands  for  sour  vomiting,  so 
by  simply  looking  through  the  shorter  list,  viz.,  "at 
night,"  we  can  see  in  a  second  or  two  that  only  ca-c  and 
pul^  have  this  sign  of  sour  among  a  list  of  22  which 
produced  vomiting  at  night.    When  this  simple  plan  of 
cyphering  is  carried  through  all  the  elements  of  the 
symptoms  it  is  hardly  possible  to  exaggerate  the  boon 
thus  conferred  on  the  practitioner  in  the  facility  thus 
afforded  to  finding  the  exact  correspondence  of  the 
symptoms  such  as  Hahnemann  requires,  or  the  annoy- 
ance daily  and  hourly  experienced  by  those  who  have  to 
depend  on  mere  verbal  repertories,  without  the  facility 
of  linking  the  elements  by  means  of  the  cypher.    For 
instance,  in  the  otherwise  handy  Cough  Repertory  of 
Proctor  and  Simmons,  which  I  often  use  in  the  absence 
of  the  cough  chapter  of  the  Cypher  Repertory ^  we  have 
no  means  of  finding  any  double  or  treble  points  of  corre- 
spondence  of  the  pathogenetic  and  the  morbid  symptoms 
except  the  clumsy  and  time-robbing  one  of  reference  to 


SriS^^JTS?"**  INDEX  TO  THE  CYCLOPEDIA.  329 

i— I mr  ------ M — I r ■  _j  i  -    —     - —     i i    *-      i      i  ■        ■  i  i      i^  a^i    i  ^m  ^■^M_^ 

the  MiUeria  Medica  ten  or  twenty  or  more  times  in 
order  to  obtain  a  piece  of  information  which  might  have 
been  made  obTious  at  a  glance  by  a  proper  construction 
of  the  Repertory.  Look,  for  example,  at  heading  of  sputa 
with  the  cough.  If  we  wish  to  find  the  analogue  of 
**  green  and  viscid  sputa  in  the  morning/'  we  have  to  look 
through  lists  of  87  green,  67  viscid  and  67  in  the  morn- 
ing, and  having  compared  these  and  noted  the  medicines 
which  occur  in  all  the  three  lists,  then  we  must  go 
through  this  last  list  in  the  Materia  Medica  to  see  which 
of  the  drugs  had  all  the  three  elements  in  the  same 
pathogenetic  symptom.  How  many  practitioners,  think 
jOQ,  take  this  trouble,  or  indeed,  have  time  to  do  so? 
And  to  think  that  all  this  waste  of  time  could  be  obvi- 
ated if  the  Repertory-makGrs  would  abandon  the  verbal 
system  and  adopt  the  cypher  plan,  which  has  been  proved 
workable  for  these  many  years  !  In  fact,  no  repertory- 
maker  should  be  otherwise  than  ashamed  to  offer  to  the 
public  a  mere  verbal  repertory  without  the  information 
so  easily  added  by  the  cypher  plan  as  shown  above. 
Farther,  under  many  headings  the  practitioner  should 
be  saved  the  trouble  of  collating  the  compound  elements 
by  having  that  done  to  his  hand.  For  example,  at  page 
818  of  the  Cypher  Repertory  we  have  faa^,  empty,  foul 
and  putrid  eructations,  aco — coc — rap— san — sar — tar. 
Or  again,  iva"""^,  empty,  frequent,  violent  and  loud,  msc. 
Or  again,  at  page  a  45,  we  have  mxu  too  copious  and  late 
menses,  bel — bor  mb — ca-x — can — ^k.hy — mag — ^na-s — 
ni'X.7  sbd  mir.b — tab.  These  lists  give  us  all  the  medi- 
cines in  the  whole  Materia  Medica  which  have  these 
combinations  of  the  elements  of  the  symptoms,  and 
besides  some  additional  information  is  given  respecting 
bor — ^nix — sbd.  It  is  impossible  to  over-estimate  the 
saving  of  time  and  troulile  to  the  practitioner  by  such 
lists.  It  has  been  thought  that  the  comparison  of  the 
headings  in  cypher  to  find  which  medicines  have  elements 
in  common,  would  be  more  difficult  than  if  whole  symp- 
toms were  printed  out  in  full  under  each  heading.  On 
this  point  I  may  refer  to  Dr.  Nankivell's  paper,  page  287 
(British  Journal  of  Homoeopathy ^  vol.  xxiv),  where  he  has 
reprinted  a  heading  in  cypher,  and  at  the  same  time  in 
full,  and  he  finds  that  it  is  much  easier  and  quicker  to 
compare  the  symptoms  in  cypher  than  to  read  through 
the  mass  of  symptoms  printed  in  full.    This  is  indeed 


380  INDEX  TO  THE  CYCLOPEDIA.    ^^f^rfS?^! 

fortunate,  since  to  print  in  full  would  require  48  volames 
the  size  of  Allen's ! 

In  default  of  our  complete  system  a  number  of  local 
Repertories  are  being  now  made  in  America,  and  these 
are,  I  am  sorry  to  say,  nearly  all  on  the  verbal  and  con- 
cordance plan,  which  makes  them  of  little  value,  and 
besides  they  mostly  admit  symptoms  ah  usu  in  morbig 
often  from  questionable  sources.  Now  the  power  and 
the  will  to  make  a  repertory  is  given  to  few,  so  we 
must  look  to  America,  with  its  numerous  homoeopathic 
graduates,  for  those  exceptional  few  who  are  able  and 
willing  to  make  repertories,  and  I  wish  that  our  Cypher 
Repertory  should  be  brought  forward  and  made  known 
to  the  young  men  by  the  professors  of  Materia  Medica, 
in  the  hope  that  workers  may  come  forward  and  finish 
it.  When  we  remember  that  only  500  copies  were  printed 
of  each  part,  and  that  some  parts  are  now  out  of  print, 
we  can  see  that  very  few  among  the  10,000  American 
practitioners  can  have  even  seen  it.  But  if  it  is  properly 
explained  I  have  great  hopes  that  some  workers  on  it 
may  come  forward. 

At  the  Bournemouth  Congress,  in  1890,  Dr.  Hughes 
held  up  the  Cypher  system  to  ridicule  and  abhorrence, 
confident  apparently  in  his  power  to  devise  a  simpler 
mode  of  indexing  the  Materia  Medica,  and  his  word  was 
hopefully  received  by  those  present  who  knew  nothing  of 
the  Cypher  Repertory,  while  those  who  were  experts  with 
it  were  more  doubtful,  though  willing  to  wait  and  see* 
With  these  I  should  be  very  glad  to  welcome  a  simpler 
plan  from  Dr.  Hughes  which  would  equal  the  efficiency 
of  the  Cypher  system,  but  I  have  not  much  hope,  and 
cannot  refrain  from  reminding  him  of  the  words  of  the 
king  of  Israel,  '^  Let  not  him  that  girdeth  on  his  harness 
boast  himself  as  he  that  putieth  it  off."  I  need  not 
recapitulate  in  detail  all  the  difficulties  he  will  have  to 
encounter,  but  may  here  describe  the  one  alluded  to  at 
the  beginning  of  this  paper,  viz.,  the  difficulty  of  quota- 
tion of  the  Patlwlogical  Cyclopadia  from  the  want  of  the 
schema.  In  the  ordinary  schematic  arrangement  of  the 
medicines  the  Repertory-iJiakeT  has  merely  to  give  the 
name  of  the  medicine  and  it  can  easily  be  found  in  the 
Materia  Medica.  Not  so  with  the  Pathological  Cyclopadia, 
for  here  a  long  uncouth  abbreviation  of  the  book  and 
page,  and  probably  line,  will  need  to  be  given  even  if  no 


bSS^mLTHSm?*^      ^   CURIOUS    REFLEX.  331 

^^^— — ^P— ■»^— ■  ■  ■         I  ■  ^^^— ^^1^.^   I        I  ^1  ■  ■  —  ■  ■■!■   ■      ^^^^■■  ■■  I     II—      ■ 

such  information  as  our  Cypher  conveys  is  given,  and  the 
book  will  already  present  the  repulsive  appearance  to  the 
eaaoal  reader  whi^h  is  the  real  objection  of  saperficial 
persons  to  the  Cypher  Repertory ;  and  if  the  information 
of  the  Cypher  is  added,  just  think  of  the  disgust  of 
Dr.  Hughes  when  he  finds  he  is  chastising  his  hopeful 
adherents  with  scorpions  instead  of  whips ! 


A  CUEIOUS  REFLEX. 

By  Clement  J.  Wilkinson,  M.fi.C.S.,  &c. 

E.  B.,  aged  82,  of  athletic  habit,  came  to  me  in  March 
to  complain  that  he  had  ''  wet  his  bed  "  the  previous 
night.  He  had  noticed  frequency  of  micturition  for  a. 
few  days  and  had  a  small  linear  bruise  on  the  abdomen. 
His  urine,  which  was  clear,  neutral,  of  specific  gravity 
1.020,  containing  neither  albumen  nor  sugar,  suggested 
little.  I  found  that  the  abdominal  muscles  presented 
by  their  development  something  of  that  chess-board 
appearance  so  common  in  statuary  and  so  rare  in  life  ; 
the  linear  bruise  corresponded  with  the  attachment  of 
the  middle  fleshy  fibres  of  the  right  external  oblique  to 
their  aponeurosis.  Extending  this  line  downward,  I 
fonnd  tenderness  in  the  contents  of  the  inguinal  canal 
where  they  rest  on  the  pubes.  Lower  down  again  was  a 
large  varicocele.  The  superficial  veins  of  the  right  leg 
were  also  varicose. 

I  elicited  that  the  bruise  dated  from  some  practice  in 
"circling"  on  the  horizontal  bar  a  few  days  before,  and 
the  inji^  to  the  varicocele  was  evidently  due  t^  the 
same  cause. 

The  treatment  consisted  of  an  efficient  suspensory 
bandage  and  the  nightly  use  of  a  cold  compress  over  the 
bladder.  The  incontinence  did  not  recur,  but  the  tender- 
ness of  the  dilated  veins  lasted  for  some  days. 

The  diflfering  destination  of  the  vesico-prostatic  and 
the  spermatic  plaxus  (the  first  emptying  into  the  internaf 
iliac  vein,  and  the  latter  reaching  the  inferior  vena  cava) 
makes  the  mechanism  of  this  reflex  somewhat  obscure. 

Bolton-le-Moors. 


832  REVIEWS.  "?!S&-^Kf?^ 


Review,  May  1,  IWl. 


REVIEWS. 


The  Medical  Annual  and  PraetUioner^s  Index:  A  Work  oj 
Reference  for  Medical  Practitioners  by  Nuvierous  Contributors* 
1890  and  1891.  Bristol :  John  Wright  &  Co.  London : 
Simpkin,  Marshall  &  Co. 

The  first  thing  which  strikes  the  reader  on  opening  these 
volumes  is  the  goodly  array  of  eminent  names  in  the  list  of 
contributors.  Most  of  them  are  well  known  British  professors 
and  practitioners,  some  metropolitan  and  some  provindal, 
who  have  made  themselves  a  name  in  the  department  for 
which  they  are  responsible  in  the  Medical  Annual,  On  turning 
to  the  body  of  the  work  it  will  be  found  that  the  respective 
articles  or  abstracts  are  written  with  that  ability  and  judg- 
ment which  we  should  expect  of  the  authors. 

As  most  of  our  readers  know,  these  annual  volumes  include 
a  "  Dictionary  of  New  Eemedies  "  and  a  re»ume  (with  references) 
to  the  most  important  advances  in  all  departments  of  the 
medical  sciences. 

Each  volume  is  divided  into  three  ''  Parts,"  (a)  New  Reme- 
dies ;  (/})  New  Treatment ;  and  (7)  Miscellaneous.  The  sub- 
jects in  each  section  or  *<  Part "  are  given  alphabetically,  and 
a  good  general  index  is  also  furnished. 

In  the  1890  volume  an  important  chapter  on  thermo- 
therapeutics,  or  hydropathy,  as  it  used  to  be  called,  is 
contributed  by  Dr.  Percy  Wilde.  Much  ignorance  prevails  in 
the  profession  about  the  action  of  varying  temperatures 
(applied  usually  by  means  of  water),  and  this  even  amongst 
that  branch  of  the  profession  which  claimed  the  late  Dr.  QcvXij 
as  one  of  its  adherents.  The  simple  principles  which  should 
guide  to  a  scientific  use  of  thermo-therapeutics  are  clearly  and 
concisely  laid  down  by  the  writer,  and  many  valuable  hints 
given  as  to  when  this  useful  form  of  treatment  may  be  em- 
ployed. In  our  opinion  this  section  alone  is  worth  the  cost 
of  the  whole  book. 

Another  important  chapter  is  that  summarising  the  recent 
advances  in  cerebral  localisation  and  surgery ;  this  is  written 
by  Mr.  Elam,  of  the  Cancer  Hospital,  and  is  divided  into  five 
parts.  These  are  (1)  cranio-cerebral  topography  (including 
the  important  and  now  well-known  observations  of  Anderson 
and  Makins) ;  (2)  traumatisms  ;  (3)  cerebral  abscess ;  (4)  the 
surgical  treatment  of  epilepsy ;  and  (5)  of  cerebral  tumours. 

The  mixture  of  remedies  in  some  of  the  chapters  is  very 
noticeable.  In  the  article  of  the  treatment  of  dysmenorrhoea, 
we  have  side  by  side  aconite^  actaa,  aietris,  puLsatillay  caulo' 
phyUum^  nux  vonuca^  belladonna^  viburnum,  and  liq*  ammonia 
^ceUitis,  opium,  cJdoral,  iodide  of  potassium,  bromides,  antipyrinm 


2SSI^55T?SJ"*^  MEBTIKG8.  33& 


Bfviev,  May  1, 1»1. 


Very  scanty  directions  are  given  as  to  when  any  of  these 
drags  should  be  used,  beyond  stating  the  *'  form  '*  to  which 
they  are  suited— oyarian  or  uterine. 

The  miscellaneous  section  contains  an  interesting  chapter 
on  "  Sanitary  Science,"  including  drainage,  yentilation,  disin- 
faction,  etc.  It  is  illustrated  by  good  diagrams,  indeed  this  is 
true  of  all  the  chapters  where  they  would  be  useful. 

A  list  of  books  published  during  the  year,  of  new  medical 
or  surgical  appliances,  an  article  on  *'  Life  Assurance,"  a  few 
blank  (but  headed  and  indexed)  pages  for  memoranda,  and  a 
number  of  usefol  and  select  advertisements  conclude  this  most 
useful,  accessible,  and  portable  volume.  It  has  already  lived 
nine  years,  and  has,  we  believe,  the  largest  circulation  of  any 
amiual  medical  publication.  Our  confrere,  Dr.  Percy  Wilde, 
is  the  indefatigable  editor,  and  both  he  and  the  publishers  are 
to  be  congratulated  on  their  work. 


MEETINGS. 


BRITISH    HOMCEOPATHIC  SOCIETY. 

Hahnbicann  Annivebsabt  Dinner. 

The  Annual  Dinner  of  the  British  Homoeopathic  Society 
took  place,  under  the  presidency  of  Dr.  Dudgeon,  on 
April  10th,  the  birthday  of  Hahnemann,  at  the  Criterion, 
Piccadilly  Circus.  There  was  a  fair  gathering  of  members  of 
the  Society  and  guests.  Letters  of  regret  at  inability  to 
attend  had  been  received  from  Dr.  Yeldham,  Dr.  Bradshaw, 
Dr.  Buck,  Dr.  Burwood,  W.  D.  Butcher,  Esq.,  Dr.  Carfrae, 
Dr.  Clarke,  Dr.  Epps,  Dr.  Molson,  Dr.  Morrisson,  Dr.  PuUar, 
Dr.  Sandeberg,  Dr.  Shackleton,  Dr.  Powell,  and  Dr.  Pope. 

After  dinner,  served  in  the  style  usual  at  the  Criterion,  The 
PsBsmENT  rose  to  propose  the  usual  loyal  toasts,  and  said  : — 

Gentlemen, — The  homoeopathists  are  a  very  loyal  section 
of  the  medical  profession,  and  always  commence  such 
proceedings  as  to-night's  with  wishes  for  the  health  of  Her 
Majesty  the  Queen  and  the  Boyal  Family,  although  Her 
Majesty  has  not  yet  called  any  of  us  in,  having  since  the 
retirement  of  Dr.  Jenner  leaned  upon  a  Eeid,  who  has 
led  her  out  to  Grasse,  and  will,  we  hope,  bring  her  back  to 
her  loyal  subjects  in  perfect  health.  The  rest  of  the  Boyal 
Family  are  not,  so  far  as  we  have  yet  heard,  enthusiastic 
homceopathists,  but  we  are  all  delighted  to  think  that, 
irhether  under  allopathy  or  homoeopathy,  they  are  not  at  the 
present  moment  in  need  of  physicians,  so  we  will  drink  their 
health  with  every  loyal  wish. 


334  MEETINGS.  ^'SS^SS^TI^. 


Beriew,  Maj  1,  UBL 


The  toast  having  been  dnly  honoured,  Dr.  Dudgeon  said : — 
Oentlemen,-T-The  present  occasion  is  the  festival  which  we  hold 
every  year  to  the  memory  of  our  illustrious  master,  Samuel 
Halmemann.  I  feel  that  it  is  difficult  for  me  to  say  anything 
new  in  his  praise,  as  his  revered  memory  has  been  so  often 
the  subject  of  toasts  in  previous  festivals  and  before  yourselves. 
Gentlemen,  great  men  are  like  great  mountains,  in  the  fact 
that  the  nearer  you  are  to  them  the  less  you  can  see.  Those 
who  live  in  their  times  are  seldom  in  a  position  to  appreciate 
their  remarkable  qualities,  in  the  same  way  that  the  relative 
height  of  a  mountain  is  lost  to  one  who  is  on  its  side.  To 
the  majority  of  his  contemporaries,  Hahnemann  was  doubtless 
only  a  short  man  with  a  corresponding  temper.  They  may 
have  thought  him  small  in  comparison  with  Galen, 
Hippocrates,  Paracelsus — ^ancient  giants  of  medical  science — 
a  man  who  had  formulated  a  small  system  which  would  soon 
pass  away.  It  is  interesting  to  compare  the  two  systems  of 
John  Brown  and  Samuel  Hahnemann,  (both  originated  at 
about  the  same  time)  and  the  two  methods  of  propaganda. 
The  partisans  of  John  Brown's  system  broke  the  heads  of 
their  opponents,  so  that  a  regiment  of  Hanoverian  Dragoons 
had  to  protect  those  who  disagreed  with  them.  You  know 
that  under  his  system  diseases  were  either  sthenic  or  aBsthenic, 
requiring  depletents  or  stimulants  accordingly.  The  first 
among  the  stimulants  was  of  course  alcohol,  afterwards 
ammonia  and  camphor.  He  always  began  with  stimulants,  and 
sometimes  never  went  beyond  them.  I  have  a  copy  of  a 
prescription  for  a  hypochondriac,  which,  with  your  permis- 
sion, I  will  read : — 

*'  For  breakfast,  toast  and  rich  soup,  made  on  a  slow  fire ; 
a  walk  before  breakfast,  and  a  good  deal  after  it ;  a  glass  of 
wine  in  the  forenoon, /raw?  tirne  to  tim^  ;  good  broth  or  soup  to 
dinner,  with  meat  of  any  kind  he  hkes,  but  always  the  most 
nourishing ;  several  glasses  of  port  or  punch  to  be  taken  after 
dinner,  till  some  enlivening  effect  is  perceived  from  them,  and 
a  dram  (of  whiskey  ?)  after  everything  heavy ;  one  hour  and 
a-half  after  dinner  another  walk ;  between  tea-time  and 
supper,  a  game  with  cheerful  company  at  cards  or  any  other 
play,  never  too  prolonged ;  a  little  light  reading,  jocose, 
humorous  company,  avoiding  that  of  popular  Presbyterian 
ministers  and  their  admirers,  and  all  hypocrites  and  thieves 
of  every  description  ;  lastly,  the  company  of  amiable,  hand* 
some  and  delightful  young  women,  and  an  enlivening  glass." 
Can  you  wonder  that  a  system  which  offered  prescriptions 
like  that  was  heartily  received  ?  Hahnemann's  system  was 
very  different.  He  was  for  many  years  the  only  homcBO- 
pathist,  and  his  system  was  very  ill  received  indeed,  by  those 


iS^uS^  yEETINQS, 335 

-who  were  accustomed  to  the  traditional  methods  in   the 
medical  world.     Since  his  sjstem  was  promulgated  various 
attempts   have    been   made    by    physicians    to    introduce 
other  systems  :  such  as  bleeding  for  inflammation,  Broussais* 
treatment  of  all  diseases  by  diet  (Broussais,  who  became  a 
convert  to  homoeopathy),  and  many  other  systems  which  have 
been  popular  but  have  not  survived  their  popularity.    We 
have   seen    in    these    last  days    how    the    whole    medical 
profession    has  been   stimulated    to   enthusiasm    over    the 
discoveries  of  Dr.  Koch.     But  Koch  has  gone  out  almost 
before  his  theories  had  come  into  operation.     The  system 
be  promulgated,    of   injection   for    tuberculosis,  has    been 
tried  in   many    cases    and    found    wanting.      There    was 
lecently  the  annunciation  by  Brown  Sequard  that  he  had  dis- 
covered the  elixir  of  life.    Unfortunately,  the  hopes  of  the 
lejavenation  of  old  men  have  proved  fallacious,  and  man  must 
be  content  to  go  down  to  decrepitude  without  the  restoration 
promised.     Homoeopathy  has  progressed  in  a  very  different 
manner.    Its  followers  in  various  parts  of  the  world  may  be 
connted  by  their  12,000  ;  and  there  is  no  chance  of  its  going 
to  the  bad  hke  the  other  systems  described,  and  we  may  con- 
gratulate ourselves  on  having  had  such  a  master  genius  as 
Hahnemann  to  evolve  for  us  a  complete  and  admirable  system. 
He  was,  indeed,   a  great  man  in  many  ways.     Before  he 
discovered  homoeopathy  he  had  laid  down  rules  of  hygiene 
'which  are  now  received  all  over  the  world.    He  was  also 
&miliar  with,  and  practised  to  a  great  extent,  the  water  cure, 
in  a  manner  which  was  ac  the  time  unknown  to  his  country- 
men, and  with  which  in  the  form  of  douches  and  baths  he 
eared  many  chronic  diseases.      Hahnemann  was  also  the 
inaugurator  of  the  rational  treatment  of  insanity  by  gentle- 
ness.   The  year  1792  marked  at  once  the  conmiencement  of 
Hahnemazm's  special  treatment  of  insane  patients  and  the 
introduction  of  Pinei's  system.     Hahnemann  was  also  the  pre- 
carsor  of  those  who  have  introduced  the  microbe  theory  of 
disease.    He  tells  us  that  the  mode  of  propagation  of  cholera 
is  by  the  agency  of  microscopic  animals,  and  his  treatment  by 
ampluor  was  directed  to  the  destruction  of  those  animalculte. 
No  wonder,  then,  that  I  ask  you  to  drink,  as  is  our  custom,  in 
solemn  silence  to  the  memory  of  this  great  man,  and  though 
it  is  not  usual  to  invoke  replies  to  such  a  toast,  we  are 
extremely  glad  to  know  that  the  grandson  of  Samuel  Hahne- 
mann is  here  with  us  to-night.     (Applause.) 
The  toast  was  then  drunk  in  solenm  silence. 
Mr.  Hugh  Cameron  then  rose  to  propose  the  "  Memory  of 
Br.  Qoin,  the  Founder  and  First  President  of  the  British 
Homoeopathic  Society,"  and  said :  On  former  occasions  of  the 


836  MBETiNos.       ^"^s^^surrs^. 


Itoview,  May  1,  UBl. 


Halmemanii  dinner  I  endeavoured  to  illustrate  the  serioTift 
and  earnest  side  of  Dr.  Quints  many-sided  character  by 
giving  you  a  very  imperfect  lustory  of  the  three  great  achieve- 
ments of  his  life — ^the  introduction  of  homoeopathy  into 
England,  the  foundation  of  this  society,  and  of  the  hospital- 
imperishable  monuments  of  his  devotion  to  our  cause,  and  of 
unflinching  courage  in  the  face  of  hostihty  and  opposition, 
such  as  none  but  a  man  of  the  firmest  convictions  could  ha^e 
encountered  and  conquered.  As  we  sit  here,  in  the  calm  and 
peaceful  enjoyment  of  all  the  benefits  that  we  reap  from  the 
successful  working  of  these  beneficent  institutions,  httle  do 
most  of  us  realise  the  strain  of  mind,  the  cares  and  anxieties,, 
and  the  oftien  torture  of  spirit  that  weighed  upon  the  originator 
of  these  blessings  in  his  herculean  task,  without  a  single 
colleague  to  share  his  troubles  or  to  sympathise  with  him  and 
aid  him  by  his  advice.  On  the  introduction  of  homoeopatby, 
more  especially,  Quin  was  assailed  with  such  a  storm  of  rabid 
and  virulent  abuse,  calumny  and  personal  insult,  as  we  in  the 
last  decade  of  the  century  and  in  the  more  tolerant  spirit  of 
our  opponents,  can,  fortunately  for  us,  have  no  idea  of. 
Although  he  knew  perfectly  well  before  he  set  up  the  standard 
of  homoeopathy  in  England  that  he  would  meet  the  most 
determined  opposition,  yet  he  beUeved  that  it  would  be  of 
that  legitimate  and  scientific  kind  which  was  to  be  expected 
from  a  learned  body  of  gentlemen,  and  he  therefore  resolved 
that  he  would  take  no  public  notice  of  any  personal 
attacks  unless  they  affected  his  honour.  But  so  scan- 
dalous had  these  insults  become,  and  so  intolerable  were  lus 
tortures  of  mind  under  these  cruel  inflictions,  that  he  would 
stand  them  no  longer,  and  in  obedience  to  his  own  wounded 
feelings  under  this  incessant  provocation,  and  to  the  code  of 
honour  of  the  time,  the  infringement  of  which  would  have 
branded  him  as  a  coward,  unfit  for  the  society  of  gentlemen, 
he  was  compelled  to  appeal  to  the  logic  of  the  pistol,  and  to 
call  out  to  mortal  combat  the  President  of  the  Boyal  College 
of  Physicians  for  a  most  violent  attack  upon  his  honour  at  a 
meeting  of  a  far-famed  club,  at  the  moment  when  his  name 
was  up  for  the  ballot.  This  learned  physician,  being  firmly 
convinced  that  <*  discretion  was  the  better  part  of  valour,*' 
made  an  ample  apology,  and  there  the  matter  ended,  as  you 
all  know ;  but  perhaps  you  do  not  all  know  that  he  had  no 
intention  whatever  of  making  the  meeting  in  the  field,  if  it 
should  take  place,  a  merely  formal  interchange  of  harmless 
shots,  for  he  was  an  expert  at  his  weapon  as  most  gentlemen 
were  at  that  time,  and  as  Dr.  Paris  was  a  very  large  object, 
more  particularly  in  his  midship  section  and  lateral  develop- 
ment, his  ample  periphery  would  have  presented  to  his  skilM 


SS?27nSi!^  MEETINGS.  '       887 

imtagomurt  a  wide  choice  of  some  non-vital  spot  on  which  to 
leave  his  mark,  and  he  was  folly  detennined  to  take  advantage 
of  that  choice,  for  he  wished  to  demonstrate  to  his  virulent 
assailants  that  he  was  not  a  safe  man  to  provoke  too  mnch. 
Whether  post  Iioc  et  propter  hoo  I  cannot  say,  but  the  fact  is 
thej  dropped  the  personal  element  of  their  attacks  on  him 
from  that  time.  If  the  present  were  an  appropriate  occasion, 
which  it  is  not,  it  would  be  very  gratifying  to  me  to  illustrate  the 
social  side  of  Quin's  character,  which,  unfortunately,  by  its  very 
brilliancy  has  over-shadowed  those  sterling  qualities  of  mind 
which  we  have  just  been  considering,  and,  by  examples  from  his 
own  lips,  to  give  you  some  idea,  however  feeble,  of  that  bright 
wit  for  which  he  was  conspicuous  even  among  wits ;  of  that 
ever-ready  power  of  repartee  that  never  offended;  of  that 
inexhaustible  treasury  of  anecdote  from  which  he  always 
drew  the  one  most  apposite  to  the  subject  in  hand  ;  of  that 
charm  of  conversation  that  fascinated  all  who  came  under  its 
influence  ;  of  that  friendly  and  delicate  faculty  for  banter  and 
'^  chaffing  "  which  always  ''  set  the  table  in  a  roar,"  in  which 
no  one  joined  more  heartily  than  the  object  of  it,  for  by  no 
stretch  of  language  could  he  be  called  the  ''  victim  " ;  and  of 
many  other  points  of  this  social  side  of  his  character.  But  I 
{eel  strongly  that  this  is  not  the  occasion  for  the  introduction 
of  such  a  subject,  and  I  am  sure  you  will  agree  with  me,  as 
any  successful  attempt  to  exhibit  his  marvellous  character  in 
that  light  would  provoke  responsive  rounds  of  joyous  merri- 
ment, and  would  altogether  be  out  of  keeping  with  that  frame 
of  mind  that  should  prevail  in  this  assemblage  while  we 
are  engaged  in  the  solemn  duty  of  offering  our  homage  to  the 
memory  of  the  dead-— our  great  benefactor.  I  will  detain  you 
no  longer,  and  will  conclude  by  asking  you  to  join  me  in 
drinking  to  the  **  Memory  of  Dr.  Quin,  the  Founder  of  the 
British  Homoeopathic  Society,'*  in  silence. 

The  toast  having  been  duly  honoured. 

Dr.  Stan'coub  (Southampton)  then  proposed  "  Success  to 
the  British  Homoeopathic  Society,"  and  said  that  he  did  so  in 
the  place  of  Dr.  Clifton  (Northampton),  and  although  a  youijg 
member  of  the  Society,  he  did  so  with  a  high  sense  of  its  value. 
He  hoped  that  it  would  long  remain  in  its  present  state  of 
prosperity  and  be  able  to  organise  a  propaganda  for  the 
advancement  of  the  principles  of  homoeopathy.  He  was  sorry 
the  proposition  could  not  be  made  by  Dr.  Clifton,  who  was  a 
lover  of  the  Society  in  the  best  sense,  and  a  man  who  always 
spoke  out  his  mind  with  a  freedom  and  frankness  which  never 
gave  offence.  Dr.  Clifton  had  had  the  privilege  of  belonging 
to  the  Society  for  many  years,  and  was  one  of  the  most 
popular  and    valuable    of   the   provincial  members.      The 

YoL  85,  No-  5.  2  B 


838  MEETINGS.  "1S^=SK??^ 


Beriew,  liay  1,  IfllL 


British  Homodopatliic  Society,  as  year  by  year  went  by, 
became  stronger,  its  cause  more  thoroughly  cemented,  and  its 
principles  more  respected. 

The  toast  having  been  honoured  with  enthusiasm. 
Dr.  Cooper  responded  on  behalf  of  the  Society,  and  ex- 
pressed his  pleasure  at  undertaking  so  pleasant  a  task.  It 
afforded  him  an  additional  pleasure,  because  the  gentleman 
who  proposed  the  toast  was  occupying  the  position  in  South- 
ampton which  he  (the  speaker)  had  formerly  occupied.  The 
Society  was  indeed  prospering,  and  its  deliberations  were 
conducted  in  a  scientific  spirit.  There  were  no  such  times  as 
those  described  in  Hudibras — 

"  When  civil  dudgeon  first  grew  high, 
And  men  fell  out,  they  knew  not  why." 

But  under  the  fostering  care  of  Dr.  Blackley  (applause)  the 
work  of  the  Society  was  well  done.  If  there  were  a  more 
continuous  supply  of  observations  and  contributions  from  the 
country  members,  they  would  make  yet  greater  progress  and 
ensure  a  wider  appreciation  of  the  homcBopathic  system.  He 
could  not  sit  down  without  urging  upon  the  Society  that  one 
of  the  main  functions  of  a  medical  society  was  to  express 
disapproval  of  the  practice  by  secret  remedies. 

Mr.  Henry  Harris  then  proposed  the  toast  of  "Homoeo- 
pathic Literature/'  and  said  that  writers  of  papers  on 
homoeopathy  had  the  difficult  task  of  serving  two  masters — ^jn 
endeavouring  to  feed  the  profession  and  supply  the  want  of 
the  public.  The  old  school  journals  had  not  that  difficulty. 
The  Homccojmthic  Beview  and,  still  more,  the  HomctopatJiic 
World  appealed  to  a  wider  public  than  that  of  the  ordinary 
medical  journals.  One  of  the  advantages  of  the  double 
mastership  was  that  the  closeness  of  the  profession  was  being 
gradually  sapped,  and  they  were  more  and  more  taking  the 
public  into  their  confidence.  He  was  reminded  of  another 
class  of  homoeopathic  literature,  which  he  might  term 
literature  ''  under  the  rose."  As  a  student  at  St.  Thomas's 
Hospital,  he  was  a  marked  man  because  of  his  known  homoeo- 
pathic  tendencies.  On  one  occasion  the  house  surgeon 
brought  him  some  articles  in  a  well-known  journal,  by  a 
well-known  man,  and  asked  his  opinion  of  them.  He 
examined  the  compositions  and  remarked,  as  to  the  writer, 
**  He  is  not  far  from  the  Kingdom  of  Heaven.'*  Shortly  after 
the  writer  became  an  avowed  homoeopath,  and  was  with  them 
at  that  moment.  He  had  written  articles  in  both  classes  of 
medical  journals  of  which  no  medical  man  need  be  ashamed. 
He  was  not  quite  satisfied  as  to  the  propaganda  of  homoeo* 
pathy.  He  thought  that  the  Homcecpaifiic  Review  and 
Homceopathic  World,  and  especially  the  Tracts  of  the  Homoeo* 


ssgygyraT'      meetings. 339 

paihio  League,  shotQd  be  more  widely  circulated,  and  that 
bound  volumes  of  the  League  Tracts  and  of  iS/uirpe's  Essays 
shoold  be  presented  to  every  public  library,  so  that  those  who 
wanted  information  on  homoeopathy  need  not  complain  of  a 
dearth  of  it. 
The  toast  having  been  drunk, 

Dr.  BuEFOBD  briefly  replied,  assuming  that  he  had  been 
asled  to  do  so  not  because  he  had  ever  written  a  book,  but 
because  being  an  omnivorous  reader  he  had  read  many. 

Dr.  Gesabd  Smtth  then  proposed  the  toast  of  '*  Homoeo- 
pathic Hospitals  and  Dispensaries,"  which  was  received  with 
enthusiasm. 

Dr.  Maddrn,  replying,  said  there  was  now  hardly  a  town  in 
the  country  which  had  not  its  dispensary  and  sometimes 
bospitaL 

Dr.  Dtce  Bbown  then  proposed  the  ''  Health  of  the 
President,*'  and  said  it  gave  him  extreme  pleasure  to  propose 
the  health  of  their  president  and  friend  Dr.  Dudgeon.  He 
might  well  say  their  friend,  for  he  did  not  know  anyone  who 
bad  not  the  kindest  and  friendliest  words  to  speak  of 
Dr.  Dudgeon.  (Applause.)  His  geniality  and  his  wit  would 
aeeount  for  his  popularity ;  but  they  would  specially  delight 
to  drink  his  health  as  their  senior  and  foremost  man  in  the 
work  of  homoeopathy. 

The  toast  was  drunk  with  the  chorus  **  For  he's  a  jolly 
good  fellow." 

Dr.  Dm>oBON  said  he  was  quite  at  a  loss  to  express  his 
thanks  for  the  kind  manner  in  which  they  had  received 
the  toast. 

Dr.  Blacklet  then  proposed  <'  The  Visitors,"  and  said  that 
at  those  festive  occasions  they  were  fortunate  in  having  the 
presence  of  some  gentlemen  who  were  not  members  of  the 
British  Homoeopathic  Society.  There  was  Mr.  G.  A.  Gross, 
the  indefatigable  and  energetic  secretary-superintendent  of  the 
London  Homoeopathic  Hospital,  who  might  be  able  to  give 
them  interesting  information  concerning  the  progress  of  the 
iond  now  being  raised  to  rebuild  that  institution.  There  was 
also  Dr.  Beith,  whom  they  were  especially  glad  to  welcome 
that  evening.  The  speaker  said  that  20  years  ago,  when  he 
retnmed  £rom  Vienna,  steeped  in  the  agnosticism  of  the 
Vienna  school,  he  settled  in  Liverpool,  and  one  of  the  first 
things  he  heard  was  the  movement  which  was  then  making 
itself  felt  in  the  north  on  the  question  of  homoeopathy.  There 
were  two  physicians  in  the  north  who  were  waging  war  for 
freedom  of  practice.  One  was  Dr.  Dyce  Brown,  the  other 
was  Dr.  Beith.    He  would,  therefore,  in  asking  them  to  drink 

2  b— 2 


840  MEETINGS.  *'S^L°S:??S5' 


Beriew,  Maj  1,  Un. 


the  health  of  the  visitors,  couple  the  names  of  Mr.  O.  A.  Ormb 
and  Dr.  Archibald  Beith. 

The  toast  having  been  honoured  with  the  chorus,  "For 
they  are  jolly  good  fellows," 

Mr.  Cboss  replied  briefly,  and  expressed  the  extreme 
pleasure  it  gave  him  to  be  present  at  that  festival  as  repre- 
senting that  noble  institution,  the  London  Homoeopaihio 
Hospital.  As  Dr.  Blackley  had  named  the  building  fond,  he 
would  simply  quote  the  total  of  the  fund  to  that  date,  which 
was  £25,000.  (Applause.)  There  was  no  doubt  that  in  a 
short  time  the  whole  of  the  £80,000  requisite  would  be  forth- 
coming. But  he  could  not  refer  to  the  building  fund,  or  even 
the  hospital,  without  naming  one  who  wad  conspicuous  that 
evening  by  his  unavoidable  and  much  regretted  absence- 
Major  Vaughan  Morgan.  Ever  since  the  Major  had  taken  an 
interest  in  the  affairs  of  the  hospital,  now  some  fifteen  years, 
the  record  had  been  one  of  uninterrupted  progress  and 
prosperity,  until  now  when  they  had  the  near  prospect  of  a 
building  which  would  not  only  be  a  credit  to  homoeopathy,  but 
perhaps  a  model  to  other  hospitals.  (Applause.)  After 
alluding  to  the  excellent  work  performed  by  the  medical  staff 
of  the  hospital  during  the  past  year,  the  speaker  said  he  would 
no  longer  stand  between  them  and  the  distinguished  man  who 
would  follow  him,  but  would  for  his  own  part  and  on  behalf 
of  other  guests  thank  them  for  the  hearty  manner  in  which 
they  had  responded  to  the  toast. 

Dr.  Abchibald  Eefth  said  he  was  glad  to  have  an  oppor- 
tunity to  acknowledge  this  toast,  though  at  so  late  an  honr. 
Twenty  years  ago  he  had  not  felt  so  much  at  home  among 
his  homoeopathic  brethren  as  he  had  done  that  evening.  He 
felt  specially  happy,  however,  in  the  knowledge  that  some  of 
the  most  respected  members  of  the  Society  were  Scotchmen, 
among  them  Dr.  Dyce  Brown  and  Mr.  Cameron.  For  him- 
self, so  far  as  his  northern  colleagues  were  concerned,  the 
bitterness  of  the  old  fight  was  passed.  The  most  strenuous 
of  his  old  opponents  had  long  since  acknowledged  to  him 
that  if  the  time  came  over  SLgain  he  would  be  treated  very 
differently.  Those  who  persecuted  most  had  passed  away, 
but  one  still  lives  and  apologises  over  and  over  again  for 
the  part  he  took  in  that  far  distant  crusade.  The  speaker 
said  that  he  lived  within  three  miles  of  the  Queen,  but 
her  Majesty  had  never  yet  sent  for  him.  13ut  there 
was  now  no  one  in  Aberdeen  who  would  refuse  to  meet 
him.  It  was  true  he  never  consulted  them,  because  when 
that  was  necessary  there  was  nothing  which  could  lie  done, 
for  the  patient.  But  he  must  confess  that  up  in  the  north 
he  felt  very  lonely  away  from  all  colleagues  who  felt  and 


uS^SSSTSSf  PKBI8C0PE.      341 

ihoaghi  as  he  did ;  and  when  he  was  reminded  that  he  had 
come  into  the  Kingdom  of  Heaven  he  could  not  help  remark- 
ing that  he  fomid  no  one  else  there.  (Laughter).  He 
ewdially  thanked  them  for  himself  and  other  visitors  for  the 
hearty  way  in  which  the  toast  had  been  proposed  and 
honoured. 

The  health  of  the  Hon.  Sec,  Dr.  Galley  Blackley,  was 
then  drunk  amidst  acclamation,  the  company  singing  *'  For 
he's  a  jolly  good  fellow." 

Dr.  BiACKUBT  having  briefly  replied,  the  company  separated. 

PERISCOPE. 


OTOLOGY.  LARYNGOLOGY,  Etc. 

Arrest  of  Nasal  Hshorbhaoe  by  means  of  vert  Hot 
Nasal  Douche. — Dr.  Alvin  {Loire  MedicaU,  Oct.  15,  1890, 
p.  257)  advises  continuous  irrigation  with  water  at  the 
temperature  of  from  180  to  140°  F.  Three  to  five  seconds 
frequently  suffice  to  stop  the  haemorrhage,  the  hsemostatic 
efiect  being  permanent. 

Contributions  to  the  Treatment  of  the  Nose,  Pharynx 
AKD  Labynx. — Dr.  Loevi,  of  Budapesth  {Alk/.  Wiener  Med, 
ZeU,,  No.  44,  1891),  amongst  other  forms  of  treatment  recom- 
mends the  following : — 

In  acute  and  chronic  rhinitis,  20  drops  of  tincture  of  bella- 
donna painted  on  the  nasal  mucous  membrane  daily.  Dimi- 
nution of  the  secretion  follows  on  the  first  application. 

Mycosis  benigna  of  the  tonsil,  the  -  application  of  pure 
chloroform. 

To  laryngeal  neoplasms  he  applies  a  powder  of  equal  parts 
of  alum  and  mlphate  of  zinc.  After  a  few  apphcations  the 
growths  dry  up  and  drop  off. 

The  Connection  between  Staumerino  and  Nasal  Disease. 
—Dr.  Winckler,  Bremen  {Wien,  Med,  Woch,,  No.  48 — 44, 
1890).  The  results  of  the  researches  of  the  author  are  as 
follows : — 

1.  Marked  nasal  disease  is  often  to  be  met  with  in  stutterers. 

2.  Some  anomalies  observed  at  times  in  stutterers  (abnor- 
mal arching  of  the  palate,  mal-development  of  the  chest,  and 
deficiency  of  the  intellect)  may,  in  some  cases,  be  connected 
with  concomitant  nasal  trouble. 

8.  Nasal  affections  can  only  be  regarded  as  the  actual  causb 
of  stammering  in  those  cases  in  which  the  defect  of  the  speech 
manifests  itself  in  the  repetition  of  certain  words  and  syllables, 
without  any  concomitant  spasmodic  movements  or  difficulty 
in  breathing.    Above  all  in  the  connection  most  marked  in 


342  PEMscopE.         *^L=s:^?»:2J' 


Beriew,  Ma7  1,  tBU. 


those  cases  for  which  there  is  incorrect  pronunciation  of 
certain  consonants. 

4.  Although  one  can  only  regard  nasal  affections  as  rarely 
heing  the  immediate  cause  of  stammering,  still  lihey  can 
materially  aggravate  the  malady.  In  all  cases  it  is  necessary 
to  take  them  into  consideration  before  instituting  a  methodic^ 
treatment  of  stammering. 

Phabyngeal  TENEsifus. — Lennox  Browne  {Archr,  IfUgmaL 
de  iMryng,  de  llhin.  et  d^Otologie).  The  term  tenetmitu  is  used 
to  designate  a  symptom  of  which  patients  often  complain  in 
certain  pharyngeal  affections.  It  consists  in  the  constant 
tendency  to  make  efforts  to  coughing  or  "  hawking  "  to  get 
rid  of  some  substance,  real  or  imaginary,  which  seems  to  be 
present  in  the  pharynx.  These  efforts  are  accompanied  by 
uneasiness  or  true  pain,  and  are  followed  by  the  expulsion  of 
some  mucus  which  at  times,  and  more  particularly  on  wakiQg, 
is  coloured  by  a  mixture  of  blood.  The  symptom  is  to  be 
compared  with  that  of  rectal  tenesmus,  and,  indeed,  it  is 
probably  of  the  same  nature,  and  is  often  accompanied  bj 
dilatation  of  the  veins  of  pharynx  which  may  with  propriety 
be  called  <' pharyngeal  hsBmorrhoids.''  It  is  most  frequentlj 
caused  by  enlargements  of  the  lingiial  tonsil  or  by  varixof  the 
veins  at  the  base  of  the  tongue ;  but  the  causes  may  be  classed 
as  follows : — 

{a).  Cases  in  which  a  foreign  body  (fish  bone,  tooth,  &c.)  is 
impacted  in  the  gullet. 

(h).  Cases  in  which  there  is  hypertrophy  of  the  lymphoid 
follicles  ('*  granulations  ")  about  the  isthmus  of  the  fauces  or 
in  the  pharynx  ;  or  a  condition  of  congestion  with  or  without 
enlargement  of  the  thyroid  gland. 

(e)  Those  in  which  there  is  no  digestive  disturbance,  bat 
which  are  essentially  of  a  nervous  character. 

It  is  probable  that  the  nervous  factor  plays  an  accessory 
part  in  all  cases,  the  varicosity  itself  often  arising  from  vaso- 
motor paresis.  At  the  same  time  abuse  of  alcohol  and  tobacco 
may  lead  to  varix  of  the  pharynx  and  so  on  to  tenesmus. 
Paresis  of  the  palate  and  elongated  uvula  may  also  cause 
tenesmus. 

The  author  finally  points  out  the  connection  between 
tenesmus  and  the  sensation  of  a  ball  rising  to  the  throat,  and 
concludes  by  saying:  ''  A  long  experience  has  led  me  to  the 
conviction  that  if  one  puts  aside  those  cases  of  tenesmus  and 
'  globus/  the  result  of  objective  and  cuvative  lesions,  there 
remains  but  a  small  residue  of  those  which  can  be  looked 
upon  as  the  outcome  of  a  neurosis  in  its  proper  sense.  I  am, 
therefore,  of  the  opinion  that  the  term  hysteria  ought  to  be 
abolished,  as  it  only  proves  our  ignorance  of  the  true  cause  of 
the  symptoms."  Dudley  Wright. 


SSSS'£fr?S?*  PERISCOPE.  348 


Bmkm,  Mftj  1,  IflOl. 


MATERIA  MEDICA,  Etc. 

Fatal  Cass  of  Phosphosous  Poibonino. — A  girl,  aged  18, 
yns  admitted  into  Gay's  Hospital  under  Dr.  Goodhart,  on 
January  8rd,  1891,  with  the  history  that  two  days  previously 
she  had  accidentally  eaten  a  large  slice  of  hread  and  hutter 
which  had  been  spread  with  phosphorous  paste  to  kill  black 
beetles.  A  severe  headache  came  on  in  the  evening.  Next 
day  she  remained  in  bed,  complaining  of  gnawing  pains  in 
the  abdomen  and  slight  headache,  but  did  not  appear  ill. 
She  vomited  twice  just  prior  to  admission  a  light  brown 
liquid  smelling  of  '<  match  tops." 

On  admission, — Patient  is  a  big,  decidedly  well-nourished 
girl,  does  not  look  ill,  but  lies  in  bed  in  a  lethargic  condition, 
not  volunteering  any  information  about  herself,  and  answer- 
ing all  questions  in  monosyllables.  Tongue  covered  with  a 
thick  greenish-yellow  fur,  great  thirst,  anorexia,  constipation 
(bowels  not  having  been  opened  since  the  phosphorous  was 
taken).  The  abdomen  soft  and  relaxed,  no  tenderness  in  the 
epigastrium,  but  the  same  gnawing  pain  with  nausea  still 
felt.  The  hepatic  dulness  was  increased,  extending  from  the 
fifth  interspace  to  two  inches  below  margin  of  ribs  in  middle 
line.  Her  breath  smelt  so  strongly  of  phosphorous  that  her 
stomach  was  washed  out  immediately. 

Jan.  24th. — ^Less  pain  last  night,  but  slept  little.  Has 
vomited  after  each  dose  of  her  medicine  (5ss  doses  of 
W.  UrebifUh), 

25th. — Much  better ;  slept  well ;  no  pain  :  no  vomiting ; 
liver  dulness  decreased. 

27th. — ^Liver  dulness  extends  across  to  left  side  of  the 
middle  line  and  for  an  inch  below  the  ribs.  The  spleen  can 
also  be  plainly  felt,  and  there  is  a  slight  primrose  tint  about 
the  forehead  and  abdomen. 

28th. — ^Remained  fairly  well  until  2  a.m.  this  morning, 
when  she  was  suddenly  taken  with  dyspnoea,  and  her  pulse, 
vhich  had  previously  been  good,  became  almost  imperceptible ; 
she  had  also  intense  abdominal  pain.  At  10  a.m.  respirations 
were  52  per  minute :  pulse  126,  only  just  felt  at  the  wrist. 
Uouth  and  gums  spongy  and  bleeding  ;  patient  much  weaker 
sad  continually  calling  out  for  something  to  drink.  Bowels 
well  opened ;  no  melsena.  Passed  a  good  quantity  of  urine 
(Jxiv.  in  12  hours).  Abdomen  very  tender,  especially  in  the 
hepatic  region  ;  the  hver  dulness  does  not  extend  below  the 
ribs.    She  died  at  9  p.m. 

Post'tnortsni  examination, — ^Faint  yellow  tinge  about  oon- 
jonctivs,  fiace,  chest,  and  abdomen. 

Heart. — Few  petechiee  in  the  auricles,  large  vessels  at  base 
and  on  the  endocardium   of  left  yentricle.    Muscle  &tty,  but 


844  PEBIBCOPE.  ^'^I^SS^. 


BerieWfUsj  1,1811. 


not  extremely  so,  less  than  in  a  bad  case  of  ans3mia ;  weight 
8  ozs. 

Kidneys. — Large,  weight  14  oz.,  very  aniemic,  a  few  petedue 
on  the  capsule. 

Stomach, — Distended  with  food  and  black  digested  blood. 
Mucous  membrane  quite  healthy.  The  lower  part  of  the 
small  intestine  contained  a  quantity  of  decomposed  blood,  but 
the  colon  was  free,  containing  clay-coloured  faeces,  free  from 
a  trace  of  bile,  with  no  petecMsB  on  the  mucous  surface,  bat 
a  large  extravasation  of  blood  at  its  mesenteric  attachment 
throughout  on  the  serous  sur£euse. 

Liver. — Weighed  66  ozs.,  which  must  be  considered  laige 
for  a  woman,  firm  and  swollen  rather  than  shrunken, 
extremely  fatty,  but  not  quite  floating  in  water.  In  two  huge 
places  it  was  stained  a  deep  canary  yellow  colour,  but  theie 
was  no  red  mottling.  The  gall-bladder  contained  5ii.  of 
mucus,  but  no  bile,  while  the  ducts  were  empty  and  not 
stained. 

Spleen, — Firm,  but  only  weighed  7  ozs.,  so  was  not  so  large 
as  was  thought  to  be  during  Ufe.  The  right  ovary  was  the 
size  of  a  hen's  egg,  and  consisted  of  one  large  hsemorrhage, 
probably  about  a  week  old,  and  due  to  the  first  effects  of  the 
poison. — Guy's  Hospital  Gazette,  February  28th,  1891. 

—  —        ,  -^ 

OPHTHALMOLOGY. 

On  Quinike  Amaurosis. — W.  G.  A.  Berry,  in  the  O/j/iM.. 
Beview  for  April,  1891,  writes  the  following  review  on  an 
article  by  Barabasheff  in  the  Ve^tnck  OphtalmoL,  January- 
February,  1891 : — "  This  paper  is  a  reprint  of  a  communica- 
tion made  by  the  author  to  the  medici^  section  of  the  Society 
for  Experimental  Sciences,  at  Gharkow.  The  object  of  the 
investigation  was  to  study  the  effect  of  over-doses  of  quinine 
in  perfectly  healthy  people.  For  this  purpose  Barabasheff 
obtained  the  co-operation  of  some  of  his  colleagues,  who  allowed 
themselves  to  be  experimented  on.  He  also  experimented  on 
rabbits  and  dogs. 

Of  six  individuals  who  took  fix)m  40  to  60  grains  of  quininSf 
three  presented  very  definite  symptoms  ;  the  remainmg  three 
were  unaffected,  but  it  was  considered  too  risky  to  administer 
larger  doses  to  these,  as  the  symptoms  in  two  of  the  cases  in 
which  poisoning  took  place  were  sufficiently  alarming.  The 
salt  used  was  mwiate  of  quinine. 

The  value  of  these  experiments  consist  in  the  certainty 
that  all  the  observed  changes  were  produced  purely  by  qtdniner 
and  were  not  due  to  the  co-existence  of  any  disease. 

Barabasheff  divides  the  symptoms  of  poisoning,  as  he  met 
with  them,  into  two  categories,  the  first  of  which  are  already 


known,  while  the  second  have  not  previoasly  been  observedr 
and  therefore  call  for  confirmation. 
To  the  first  category  belong  the  following  symptoms : — 

1.  Acnte  gastritis,  resulting  firom  the  local  action  of  large 
doses  of  qutnine  on  liie  gastric  mncons  membrane. 

2.  Pallor  of  the  face  and  conjunctivce,  giddiness,  sometimes 
hunting,  drowsiness,  ringing  in  the  ears,  ischemia  of  the 
retina. 

8.  Marked  contraction  of  the  retinal  vessels  and  pallor  of 
the  disc. 

4.  Diminution  of  visaal  acuity,  sometimes  amaurosis. 

5.  Concentric  restriction  of  the  field  of  vision. 

The  symptoms  referred  to  in  the  second  category  are : — 

1.  Temporary  increase  of  visual  acuity  (lasting  some 
hours). 

2.  Contraction  of  the  pupil,  lasting  only  a  short  time,  and 
followed  by  moderate  dilatation. 

8.  At  first  quickening  and  afterwards  slowing  of  the  pulse. 

4.  Increase  of  sensibility  in  the  skin,  occurring  after  some 
time,  and  followed  still  later  by  a  diminution  of  sensibility. 

5.  Slight  increase  of  temperature  (0.2 — 0.4  C).  This  is  less 
marked  the  larger  the  dose  taken. 

The  author  explains  that  in  order  to  observe  the  changes- 
which  he  has  referred  to  in  the  second  category,  it  is  neces- 
sary  to  examine  the  individual  soon  after  the  quinine  has  been 
taken. 

Complete  amaurosis  only  occurred  in  one  of  his  cases,  and 
lasted  a  very  short  time.  Its  character,  and  the  fact  that  it 
was  accompanied  by  palpitation  of  the  heart,  were  sufficient 
evidence  that  it  was  due  to  an  abnoimal  state  of  the  vascular 
system.  Restriction  of  the  field  of  vision  occurred  in  two' 
cases;  it  preceded  the  complete  amaurosis  in  the  one  case,- 
^  in  the  other  it  varied  greatly  from  time  to  time,  some- 
times increasing,  sometimes  diminishing,  but  leaving  central 
vision  normal.  In  this  case,  too,  there  were  attacks  of 
palpitation.  The  author  did  not  observe  any  diminution  of 
eorneal  sensibility,  any  red  spots  at  the  macula,  or  any  colour 
blindness,  all  of  which  have  been  described  by  others  in  cases 
of  qtumne  poisoning.  Marked  ischaamia  of  the  retina  occurred 
in  all  cases,  and  in  two  the  pallor  of  the  disc  completely 
resembled  that  found  in  optic  atrophy. 

The  symptoms  caused  by  over-doses  of  quinine  are  therefore, 
in  all  probability,  according  to  BarabashefT,  due  to  poisoning 
of  the  vaso-motor  centres,  tending  to  excessive  constriction  of 
the  peripheral  vessels.  The  continuance  of  the  vascular  con- 
striction  he  considers,  with  Horner,  to  be  due  to  local  changes 
which  are  set  up  (endovaaaUtis  ex  iscJuemia)." 


346  NOTABILU.  ""^^SSrSHt 


Beview,  ICayl,  Un. 


NOTABILIA. 


ALLEGED  ACONITE  POISONING. 

The  following  report  of  an  inquest  on  a  case  of  sudden  death 
occurring  at  Bochdale,  is  taken  from  the  Rochdale  Obserrerm 
We  are  surprised  that  any  intelligent  coroner  should  ha^e 
mistaken  post  for  propter  in  so  simple  a  case. 

The  letter  of  our  confrere.  Dr.  Hajle,  in  reply  to  the 
verdict,  will  explain  itself  and  places  the  matter  in  a  perfectiy 
understandable  light. 

The  coroner's  inquest  was  held  on  the  14th  ult.,  on  the 
body  of  Gertrude  H.,  aged  18  years,  who  died  suddenly 
shortly  after  midnight  on  the  10th. 

James  Thomas  H.  said  the  deceased  was  his  daughter. 
She  had  been  troubled  with  headache  during  the  last  three 
months,  but  not  seriously.  She  had  not  been  seen  by  a 
doctor  until  the  evening  of  her  death,  when  Dr.  Elliott  was 
called  in.  Whenever  she  complained  of  these  headaches  they 
had  given  her  a  couple  of  aconitt*.  pills  every  two,  three  or 
four  hours.  She  never  had  any  of  them  during  the  night. 
Witness  could  not  say  how  often  she  had  had  them,  but  she 
took  some  on  Wednesday  and  Thursday  last.  On  returning 
from  work  on  Saturday  morning  deceased  seemed  restless  but 
went  to  the  cemetery  for  a  walk  in  the  afternoon.  He  next 
saw  her  about  seven  o'clock  in  the  evening,  when  she 
appeared  much  as  usual.  About  nine  o'clock  deceased  went 
to  bed,  and  did  not  get  up  on  the  following  day.  About  noon 
£he  began  to  vomit.  She  drank  some  milk  and  lemonade, 
and  had  several  doses  of  the  pills,  but  had  nothing  to  eat. 
Towards  ten  o'clock  deceased  began  to  change  rapidly  and 
appeared  to  be  sinking,  and  Dr.  Elliott  was  then  sent  for. 
He  came  and  attended  to  the  deceased  until  death.  Witness 
gave  his  daughter  the  pills  because  they  had  previously  done 
him  good,  and  the  family  had  been  used  to  having  them* 
They  used  them  as  a  sort  of  general  remedy  if  they  were 
unwell.  He  did  not  know  what  they  were  composed  of,  but 
he  knew  that  aconite  was  poison.  He  did  not  think  it  could 
do  her  any  harm,  however,  as  it  was  in  such  small  quantities. 
He  had  still  confidence  in  tlie  pills,  and  did  not  think  any 
harm  co\ild  follow  their  use  unless  the  system  was  very  weak, 
as  in  this  case.  Witness  had  had  four  children  and  two  of 
them  were  still  living. 

Dr.  Elliott  said  he  was  rung  up  to  attend  to  the  deceased 
About  half-past  eleven  on  Sunday  night.  He  remained  with 
her  until  she  died  about  a  quarter-past  one  o'clock.  Witness 
saw  the  girl  was  dying.     She  was  quite  pulseless,  and  was 


JbatUylHoiiuMpftihte 
Scnev.Mayl,  IfiBl. 


NOTABILIA. 


847 


eoTored  with  cold  clammy  sweat.  She  had  all  the  symptoms 
of  aconite  poisoning,  and  he  immediately  sent  for  brandy  and 
injected  some  mider  the  skin.  He  then  went  for  Dr.  Heap,  who 
was  indisposed,  for  the  purpose  of  consultation.  Dr.  Hayle 
arriyed  some  time  after  deceased's  death,  and  witness  explained 
the  symptoms  to  him.  If  the  pills  (produced)  were  what 
they  professed  to  be  he  did  not  think  they  would  do  harm 
taken  in  reason.  If  they  were  taken  in  quantities  they  lowered 
the  system  and  produced  collapse.  The  vomiting  during  the 
day  was  the  result  of  what  she  had  drunk.  He  did  not  know 
how  the  pills  were  manufactured,  but  it  seemed  just  possible 
that  too  large  a  dose  of  aconite  had  got  into  one  of  them  by 
accident. 

By  the  Coroner :  At  the  present  I  think  the  aconite  was  the 
piimary  cause  of  death.  I  can  find  nothing  else  to  account 
for  it.  > 

Mary  H.,  mother  of  the  deceased,  said  that  on  the 
Sunday  she  gave  her  daughter  a  full  dose  (two  pills)  every 
two  hours  during  the  afternoon.  That  would  be  ten  pills 
altogether.  She  did  not  think  her  daughter  required  a  doctor 
imtii  she  sent  for  one.  Witness  did  not  think  the  pills  had 
done  the  child  any  harm. 

A  Juryman :  The  directions  on  the  bottle  say  that  only 
half  a  dose  should  be  given  to  a  child.  Have  you  been  in  the 
habit  of  giving  your  children  full  doses  at  a  time  ? — ^Yes. 

The  Coroner:  Then  I  hope  you  will  not  do  it  again, 
Mr8.H. 

Dr.  Hayle  was  here  sent  for,  but  was  unable  to  attend. 

After  summarising  the  evidence  the  coroner  said  that  taking 
into  consideration  the  statements  made  by  Dr.  Elliott  he  had 
no  doubt  that  death  was  due  to  aconite  poisoning,  and  after 
consulting  together  for  some  time  the  jury  returned  a  verdict 
in  accordance  with  that  opinion,  adding  tiiat  the  aconite  was 
administered  by  misadventture. 


THE   DEATH    FROM    ALLEGED   ACONITE  POISONINa. 

To  the  Editor  of  the  Rochdale  Observer. 

Snt, — I  would  be  much  obliged  if  you  would  allow  me  a 
£hort  space  in  your  paper  to  give  a  few  additional  feicts 
relating  to  the  death  of  a  child  from  so-called  **  aconite 
poisoning,'*  which  when  known  will,  I  think,  alter  the  opinion 
of  most  people  as  to  the  cause  of  death.  I  was  very  sorry 
that  I  could  not  be  present  at  the  inquest,  as  I  was  attending 
a  case  that  it  was  impossible  to  leave,  and  I  had  no  notice 
beforehand  that  I  should  be  wanted.  I  obtained  all  the 
symptoms  of  the  child's  illness  from  the  mother  and  father  in 


^ 


848 NOTABiLiA,      ''sss^faygtSi! 

the  presence  of  Dr.  Elliott  an  hour  after  the  child's  death, 
and  wrote  them  down  at  tiie  time.     I  will  mention  the  most 
important,  especially  those  omitted  at  the  inquest.    The  child 
had  a  walk  to  the  cemetery  on  Saturday,  and  came  home 
feeling  chilly.    It  will  he  remembered  that  on  Saturday  there 
was  a  fresh  east  wind  blowing,  with  a  clear  sky  most  of  the 
day,  and  the  thermometer  went  down  to  88  in  the  evening ; 
therefore  there  was  a  warm  sun  and  a  cold  wind.     The 
parents  gave  the  child  some  aconite  (two  pills)  on  Saturday 
evening.     On  Sunday  the  child  did  not  feel  well,  and  about 
noon  complained  of  a  pain  in  the  stomach  and  vomited,  after 
which  she  got  some  more  aconite.     Aconite  at  this  stage  waa 
not  the  right  remedy  to  give,  but  it  was  such  a  smsdl  dose 
(two  pills)  that  I  do  not  tlunk  it  could  do  harm.    She  vomited 
two  or  three  times  during  the  afternoon,  and  was  also  relaxed 
and  complained  of  a  little  pain,  but  when  Dr.  Elliott  saw  her 
she  had  none,  being  nearly  collapsed.      She  had  a  few  more 
doses  of  aconite  during  the  afternoon,  but  she  also  had  some 
home-made  lemonade.      Now  lemonade  and  all  acids  are 
antidotes  to  the  action  of  aconite,  and  as  they  were  distinctly 
homoeopathic  doses,  the  aconite  she  got  during  the  afternoon 
may  be  set  down  as  nothing.    When  Dr.  Elliott  saw  her  she 
was  in  a  state  of  collapse — ^that  is,  the  pulse  was  going  very 
fast  and  was  very  weak,  and  the  hands  and  feet  were  cold  and 
the  child  nearly  insensible.    I  saw  her  soon  after  death,  and 
the  corpse  was  pale,  and  looked  as  if  it  had  died  in  collapse. 
I  took  its  temperature,  and  found  that  it  was  then  102, 
8}  degrees  above  normal.     If  a  child  had  died  from  aroniu 
collapse  the  temperature  would  in  all  probability  have  been 
three  degrees  too  low.     In  death  firom  inflammation  and 
fevers  the  temperature  is  too  high,  and  often  rises  after  death. 
Collapse  may  come  on  in  many  diseases,  such  as  fevers  and 
inflammations,  as  well  as  in  poisoning  firom  aconite,  and  when 
a  person  comes  in  at  the  end,  when  tiie  patient  is  already  in 
collapse,  it  is  often  impossible  to  say  what  has  been  the  cause 
of  that  collapse,  so  the  most  probable  cause  ought  to  be  taken 
as  the  true  cause,  and  not  the  most  improbable.    In  aconite 
poisoning  the  most  common  and  the  characteristic  symptom  is 
tingling  of  the  lips  and  throat,  and  sometimes  of  the  whole 
surface  of  the  body ;  in  this  case  this  was  entirely  absent,  but 
the  symptoms  that  were  common  to  both  inflammation  and 
aconite  were  present,  and  why  aconite  should  have  the  credit 
of  them  and  inflammation  be  ignored  and  not  even  men- 
tioned, I  am  at  a  loss  to  know. 

Now  as  regards  the  dose  of  aconite  that  was  taken.  I  saw 
the  pills  and  ate  one  of  them.  They  were  the  ordinary 
homoeopathic  pilules,  composed  of  ewi^r  of  milk  moistened 


g^^CTg^  NOTABILU. 849 

iviifa  a  dilution  of  aconite.  If  they  had  been  moistened  witk 
the  strongest  tincture  of  <iaynite^  called  the  mother  tincture, 
each  pilule  would  not  contain  more  than  about  one-tenth  of  a 
drop  of  aconite  tincture,  and  as  to  one  pilule  containing  more 
aconite  than  another,  the  idea  is  absurd,  for  by  the  method 
they  are  prepared  it  is  a  physical  impossibility  for  one  pill  to 
ecmtain  more  than  another.  Also  it  is  very  rare  for  these 
pills  to  be  moistened  by  the  strongest  tincture  of  aconite,  and 
by  the  taste  of  the  one  I  ate  I  should  say  those  that  the  child 
bad  were  moistened  by  the  one-tenth  dilution,  each  drop  of 
which  contains  one-tenth  of  a  drop  of  the  mother  tincture,  so 
that  each  pilule  which  the  child  received  would  in  all  proba- 
bility contain  about  one-hundredth  of  a  drop  of  the  mother 
tincture,  and  as  it  had  ten  altogether  the  total  amount  of 
acofdte  she  took  would  be  the  large  amount  of  one-tenth  of  a 
drop  of  the  mother  tincture  of  aconite.  The  smallest  dose 
hitherto  known  to  have  killed  has  been  60  drops  of  the  tine- 
tore.  If,  at  the  inquest,  these  pills  were  suspected  to  be  so 
strong,  why  were  they  not  ordered  to  be  analysed  and  the 
quantity  determined,  and  the  makers  of  them  reprimanded 
&r  sending  out  such  a  dangerous  preparation  ?  Two  pills 
trere  ordered  on  the  bottle  for  a  dose  for  an  adult  and  one  for 
a  child,  because  it  was  enough  to  obtain  the  required  result,, 
but  it  does  not  follow  that  double  the  dose  would  kill. 

If  poisoning  were  suspected  I  think  it  would  have  been  more 
satis&ctory  if  a  post-mortem  had  been  ordered. 

To  sum  up  the  chief  points : — 

1.  The  cause  of  the  illness  seemed  to  be  a  chill. 

2.  The  symptoms  of  the  illness  were  compatible  with 
inflammation  of  the  bowels,  followed  by  collapse,  and  were 
more  like  it  than  aconite  poisoning. 

8.  The  dose  of  aconite  was  too  small  to  kill  even  a  new-bom 
babe. 

4.  The  mother  did  quite  right  to  give  aconite  at  first,  for  it 
CQts  short  many  an  inflammation. 

These  are  the  full  fekcts  of  the  case  without  any  omissions, 
and  I  will  now  leave  the  public  to  judge  what  they  think  was 
the  true  cause  of  death. — ^I  am,  yours  faithfully,  , 

T.  H.  Hayle,  M.B.  (Lond.). 

The  Crescent,  AprU  16th,  1891. 


THE  INTEBNATIONAL  HOMCEOPATHIC  MEDICAL  , 

CONGRESS,  1891. 

FaoH  letters  recently  received  from  the  United  States,  we 
Ibm  that  our  colleagues  over  there  are  exerting  themselves 


850  NOTABILIA.  "S££,=S??S!! 


Beriew,  May  1, 191. 


most  earnestly  in  endeavouring  to  render  the  approaching^ 
Congress  interesting  and  fruitM. 

As  our  readers  are  aware,  the  meetings  will  be  held  in 
Atlantic  City,  New  Jersey,  and  will  commence  on  Wednesday, 
the  17th  of  June,  at  10  o'clock,  and  continue  until  th& 
following  Tuesday. 

Forty  contributions  on  Materia  Medica,  Practical  Medicine, 
and  Surgery  have,  we  are  informed,  been  promised.     Among^ 
the  number.  Dr.  Mack,  the  Professor  of  Materia  Medica  in  the 
University  of  Michigan,  will  furnish  a  paper  on  The  ImWAiiff 
of  Repertories,   and  Dr.  T.  P.  Allen  one  on  Repertories  and 
Inde.res.     These  will  doubtless  supply  valuable  material  for 
the  reflection  of  those  upon  whom  the  arduous  work  of  con- 
structing an  Index  for  the  now  nearly  completed  Pathogenetic 
Cijclopcedia  will  fall.     Dr.  Wesselhoeft,  of  Boston,  is  to  read  a 
paper  on  The  Improvement  of  Our  Present  Symptomatoloffif — a 
topic  on  which  a  great  deal  remains  to  be  said.    Dr.  Ckpp, 
of  Boston,  has  engaged  to  send  an  essay  on  I'he  Pharmacy  of 
Tinctures,   and  Dr.   Sherman,   of   Milwaukee,   one    on  The 
Pharmacy  of  Triturations — ^both  gentlemen  being  well-known 
authorities  on  pharmaceutical  subjects. 

So  far  we  have  only  heard  of  Dr.  Hughes  as  likely  to  be 
present  from  England,  but  with  so  much  to  be  said  on  repertories 
we  should  imagine  that  Dr.  Hayward,  the  champion  of  The 
British  Repertory,  will  find  staying  at  home  almost,  if  not 
quite,  impossible.  The  President-elect  of  the  American 
Listitute  of  Homoeopathy,  when  in  Europe  last  autumn,  was 
promised  the  attendance  of  four  physicians  from  the  conti- 
nent. For  the  information  of  any  amongst  us  who  may  be 
able  to  arrange  for  so  interesting  and  useful  a  holiday  as  a 
visit  to  Atlantic  City  in  June  will  prove,  we  may  state  that 
the  Cunard  steamship  ''  Aurania,"  sailing  from  Liverpool  on 
the  6th  of  June,  will  land  them  at  New  York  in  ample  time 
for  the  meeting,  and  the  "  Umbria,"  leaving  New  York  on 
28th  of  the  same  month,  will  enable  them  to  put  in  appear- 
ance in  Liverpool  on  the  6th  of  July. 

The  following  official  documents  have  been  forwarded  to  us 
for  publication  by  Dr.  Hughes : — 

L^TERNATIONAL   HoKCEOPATmC   CONVENTION. 

Fourth  Quinquennial  Session,  1891. 

As  permanent  Secretary,  I  have  pleasure  in  announcing 
that  the  Fourth  Quinquennial  Meeting*^  of  the  International 
Homoeopathic  Convention  will  be  held  at  Atlantic  City,  New 

*  The  previous  meetings  were  held  at  Philadelphia,  U.S.A.,  in  IS 76  ^ 
London,  England,  1881 ;  Basle,  Switzerland,  188C. 


Sgj^gynff^  NOTABILIA. 351 

Jersey,  U.S.A.,  in  June  of  the  present  year,  commencing  on 
Wednesday,  the  17th,  at  10  a.m.,  and  continuing  its  sessions 
till  Tuesday,  the  28rd.  The  arrangements  and  preparations 
for  the  gathering  and  for  the  publication  of  its  transactions 
have  be^  undertaken  by  the  American  Institute  of  Homoeo- 
pathy, whose  proper  officers  and  committees  will  make  due 
announcement  thereof. 

BicHABD  Hughes. 
Brighton,  England, 

April  14th,  1891. 

ANNOUNCElCEirr. 

The  committee  appointed  to  make  arrangements  for  the 
International  Homoeopathic  Congress,  take  pleasure  in 
announcing  to  the  profession  that  their  work  has  advanced  to 
soch  a  degree  as  to  ensure  a  successful  meeting.  Already 
there  have  been  received  assurances  from  physicians  in 
different  parts  of  the  world  that  papers  and  reports  will  be 
presented,  and  these  papers  are  so  varied  in  character  as  to 
promise  ample  material  for  thought  and  discussion  in  every 
department  and  specialty.  The  committee  voices  the  desire 
of  the  profession  when  it  asks  all  who  are  interested  in 
making  this  Congress  the  best  ever  held  to  come  prepared  fof 
active  duty,  either  by  offering  papers  or  participating  in  the 
debates.  The  investigations  and  experiences  during  the  past 
five  years  should  be  pregnant  with  results  that  cannot  fail  to 
be  of  vital  importance  and  interest  to  the  entire  world.  As 
has  been  already  announced,  the  time  allotted  to  the  sessions 
inJl  be  occupied  in  full  and  free  interchange  of  thought ;  all 
striving  to  Imow  that  which  will  be  productive  of  the  greatest 
professional  and  pubHc  benefit.  While  the  committee  has 
outlined  the  general  conduct  of  the  Congress  and  selected 
from  among  the  many,  some  to  take  charge  of  special  subjects ; 
yet  their  work  is  in  no  sense  to  be  considered  restrictive. 
Necessarily  ignoring  the  pecuUar  features  of  bureau  and 
sectional  work  in  vogue  with  the  American  Institute  of 
Homoeopathv ;  it  is  confidently  expected  that  all  present  will 
give  each  suDJect  the  attention  its  importance  demands.  The 
eommittee  makes  the  following  requests.  That  each  paper 
pr^ented  shall  not  exceed  four  thousand  words;  that  an 
abstract  not  exceeding  one  thousand  words  be  prepared,  such 
abstract  to  be  read  in  case  the  contributions  are  so  numerous 
as  to  preclude  the  reading  of  the  entire  paper  ;  that  all  who 
intend  presenting  papers  shall  send  the  title  to  the  chairman 
or  secretary  of  the  committee  before  April  5th,  so  as  to  ensure 
its  msertion  in  the  published  programme ;  all  abstracts  to  be 
sent  to  the  chairman  before  May  5th,  in  order  that  they  may  be 
sent  to  persons  selected  to  lead  in  their  discussion.     All 


362 NOTABiLiA.       "s^TsygSS: 

statistical  reports  of  societies,  institutions  and  colleges  should 
be  sent  as  soon  as  possible  to  Dr.  T.  Franklin  Smith,  264, 
Lenox  Ave.,  New  York  City.  Dr.  H.  Allen,  chairman  of 
<sommittee  on  railroad  fares,  will  publish  in  the  Amaud 
Circular  and  medical  journals,  fuJl  particulars  regarding 
railroad  rates  and  arrangements.  All  letters  of  inquiry  or 
information  regarding  literary  work  should  be  sent  to 
Theo.  Y.  Einne,  M.D.,  Paterson,  N.J.  The  local  committee 
of  arrangements  at  Atlantic  City  has  for  its  chairman 
Dr.  M.  D.  Youngman,  Atlantic  City,  N.J.,  to  whom  should 
be  addressed  all  letters  and  requests  for  accommodations,  in 
iiccordance  with  directions  in  annexed  circular. 

Theo.  Y.  Kinne,  M.D., 

Cliairnian  Committee  of  ArrangemenU^ 
Fembebton  Dudlet,  M.D.y  Paterson,  N.J. 

Sea'etarii, 
Cor.  15th  and  Master  8ts.,  Philadelphia,  Pa. 
Atlantic  City,  N.  J.  (the  place  where  the  fourth  quinquen- 
nial meeting  of  the  International  Homoeopathic  Congress  will 
be  held),  is  located  on  the  eastern  coast  of  South  Jersey.  The 
city  is  built  on  an  island,  ten  miles  in  length,  and  one  quarter 
of  a  mile  to  two  miles  in  width.  It  is  laid  out  in  squares. 
The  avenues  are  beautifully  gravelled  and  paved,  being  smooth 
and  hard.  The  city  presents  many  fine  and  beautiful  private 
residences,  and  some  of  the  handsomest  and  most  luxuriously 
furnished  hotels  in  the  United  States. 

The  resident  or  permanent  population  is  about  15,000,  but 
during  the  season,  which  is  from  June  1st  to  October  Ist,  the 
number  varies  from  75,000  to  150,000.  There  are  over  500 
registered  hotels  and  boarding  houses.  The  water  supply  is 
from  driven  wells,  one  of  them  1,600  feet  deep.  The  sewerage 
:system  is  in  excellent  condition.  At  night  the  streets  and 
broad  walks  are  brilliantly  lighted  with  arc  lights.  The 
greatest  attraction  of  Atlantic  City  is  its  beach,  which  is 
unequalled.  It  is  formed  entirely  of  white  and  black  quartz 
^tnd  basaltic  sand. 

The  hotel  selected  for  the  sessions  of  the  Congress  is  the 
*"  United  States,*'  situate  on  Pacific  Avenue,  and  running 
from  Maryland  Ave.  to  States  Ave.  This  hotel  is  the  largest 
and  finest  hotel  in  Atlantic  City,  newly  built,  with  all  the 
modem  hotel  conveniences. 

The  rates  will  be  $8.50  and  $4.00  per  day,  according  to 
location  of  rooms. 

The  Committee  of  Local  Arrangements  are  making  prepa- 
rations for  the  entertainment  of  the  guests  during  their  stay  in 
the  city^  which  will  include  vocal  and  instrumental  concerts, 
«xcursiions  to  sea  as  well  as  smooth  water  yachting,  deep  sea 


SSS^^TTS?^*  NOTABILU.  358 


fiMinr,  Hftj  1, 1891 


&hmg,  &0.  There  will  also  be  a  grand  banquet,  tendered  by  the 
manftgement,  and  will  be  free  to  the  members  of  the  Congress 
and  their  friends  who  are  guests  of  the  house.  There  will  be 
BBtablished  in  the  hotel  office  a  "  Bureau  of  Information," 
presided  over  by  a  competent  person,  where  may  be  obtained 
information  concerning  the  city,  its  hotels,  residences,  points 
and  objects  of  interest,  as  well  as  the  program  for  each  day's 
bosiness  and  pleasures. 

It  is  desired  that  all  members  of  the  Congress  and  their 
friends  shall  secure  accommodations  at  the  United  States 
Hotel,  as  in  this  way  the  most  successful  and  satisfactory 
meeting  may  be  assured. 

Application  for  rooms  may  be  made  either  to  the  United 
States  Hotel,  Atlantic  City,  N.J.,  or  to  Dr.  M.  D.  Youngman, 
1618,  Pacific  Ave.,  Atlantic  City,  N.J. 

CLEVELAND  HOMCEOPATHIC  HOSPITAL  COLLEGE. 

At  the  annual  meeting  of  the  above  college  an  entlmsiastic 
gathering  of  alumni  took  place  on  the  24th  of  March  last. 
An  unfortunate  disagreement  among  the  members  of  the 
&eidty  has  resulted  in  the  estabhshment  of  a  new  college  in 
opposition  of  the  '<  old ''  college — *'  the  Cleveland  Homoeo- 
pcUhic  College.'*  This  meeting  expressed  confidence  in  the 
parent  institution.  During  the  evening  the  degrees  were 
conferred  on  the  **  graduating  class,"  which  included  seven 
ineu  and  a  lady.  The  meeting  was  enlivened  by  musical 
performances. 

EA8TB0UENE   HOMCEOPATHIC   CONVALESCENT 
HOME:   ANNUAL   MEETING. 

On  Tuesday,  the  21st  ult.,  the  annual  meeting  of  the  sup- 
porters of  the  above  institution  was  held  at  the  Beception-room 
of  the  Home  in  Enys  Road,  and  there  was  a  large  attendance. 
The  Hon.  Mr.  Justice  Pinhey  presided. 

The  Annual  Bepobt. 
The  annual  report  of  the  board  of  management  expressed 
their  satisfaction  that  since  the  opening  of  the  institution  on 
Battirday,  August  25th,  1888,  not  less  than  400  persons  have 
been  resident.  During  the  twelve  months  reviewed  in  the 
Import,  174  persons  have  been  resident,  including  107  women, 
48  children,  and  24  nurses  of  the  London  Homoeopathic 
Hospital,  for  whose  benefit,  when  invalided,  the  Home  was 
intended,  as  well  as  for  the  convalescent  poor.  To  meet  the 
wishes  of  various  liberal  friends  of  the  Home,  the  board  had 
decided  that,  in  accordance  with  Bule  8,  annual  subscribers  o 
two  guineas  or  donors  of  forty  guineas  should  have  the  privi- 

Vol.  33,  Kg.  5.  2  c 


354  NOTABILU.  "^SS-=SJ??^ 


Bevlew,  May  1, 1881. 


lege  of  one  in-letter  yearly,  the  letter  entitling  a  suitable 
patient  to  stay  at  the  Home  for  three  weeks  absolutely  free 
of  payment  to  the  institution.     The  annual  subscriptions 
amounted,  in  1890,  to  £210  2s.  6d.,  against  £249  10s.  6d.  the 
previous  year,  showing  an  increase  of  £20  12s.   The  donations 
had  been  £71  17s.  lid.,  against  £18  7s.  last  year,  an  increase 
due  to  the  gift  of  £60  early  in  the  year  from  Mrs.  Clifton  Brown« 
No  legacy  had  been  received  during  the  year,  and  consequently 
the  reserve  fund  remained  as  at  the  date  of  the  last  report. 
The  Board  again  asked  the  attention  of  friends  of  the  Home 
to  the  fact  that  there  is  not  yet  an  endowed  bed  or  cot  estab- 
lished in  any  of  its  Wards.     The  Board  acknowledged  the 
kind  consideration  extended  to  the  Home  by  the  Directors  of 
the    London,    Brighton,    and    South    Coast    Bailway,   and 
expressed   their  thanks  to  Dr.  Croucher  for  his  assiduous 
attention  to  patients  who  have  needed  his  care  ;  to  the  Local 
Committee ;    to  Miss   Sutton,  the  Honorary  Secretary ;  to 
Miss  Florence  Lewis,  the  Matron  ;   to  Mr.  Joseph  Gibbs,  of 
Terminus  Boad,  the  Honorary  Chemist,  for  gratuitous  supplies 
of  medicines ;  and  to  the  numerous  friend  who  have  made 
useful  presents  for  the  advantage  of  the  patients.    The  much 
needed  extension  of  the  Home  for  the  reception  of  men  con- 
valescents, the  want  of  which  is  a  serious  loss  to  the  men 
patients  of  the  London  Homoeopathic  Hospital  and  to  others 
who  have  reached  the  stage  of  convalescence  under  homoeo- 
pathic medical  treatment,  had  been  retarded  by  the  necessity 
of  raising  a  large  sum  of  money  to  rebuild  the  Homoeopathic 
Hospital  in  London.     Another  retarding  cause  had  been  the 
illness  of  the  Chairman,  Major  Vaughan  Morgan,  to  whom 
both  the  Hospital  and  the  Home  owe  the  deepest  obligations 
for    generous    help.      The    restoration  of   Major  Yaughan 
Morgan  to  health  was  a  matter  of  sincere  congratulation  to 
the  well-wishers  of  the  Home,  the  Hospital,  and  homoeopathy. 
The  Board  still  looked  forward  to  the  time  when  the  extension 
of  the  Home  for  the  reception  of  men  can  be  brought  under  the 
attention  of  the  subscribers  and  donors  as  a  practical  scheme. 
There  was  no  class  of  patients  for  whom  Homes  of  this  kind 
were  so  necessary  or  so  beneficial  as  men  recovering  from 
severe  illnesses,  and  especially  was  it  desirable  that  there 
should  be  one  under  homoeopathic  auspices  within  easy  reach 
of  London.     The  balance-sheet,  as  appended  to  the  report^ 
showed  the  receipts  from  all  sources  to  have  amounted  to 
£797   5s.  lOd.      The    ordinary    expenditure    amounted    to 
£482  10s.  6d.,  ground  rent  for  1888  and  1889  to  £19  9s.  7d., 
leaving  a  balance  in  favour  of  the  Home  of  £295  5s.  9d. 

A  Becobd  of  Proobkss. 
The  Chaibman,  in  moving  the  adoption  of  the  report,  said 


Jg&Tnff^  NOTABILIA,  366 

it  was  a  pleasing  task  to  do  so,  as  it  was  a  report  of  prosperity 
tnd  progress.  The  support  accorded  the  Home  had  been  in 
excess  of  previons  years,  and  he  congratulated  them  on  the 
prosperity  they  had  met  with.  The  Hospital  in  London  was 
being  rebuilt,  and  now  they  must  give  their  attention  to  the 
Home  at  Eastbourne,  and  make  provision  for  convalescent 
men  as  well  as  women.  Mr.  Boper  seconded  the  resolution, 
and  quite  agreed  with  the  chairman  that  the  hospital  accom- 
inodation  should  be  increased  so  as  to  provide  for  male 
•convalescents  as  well  as  females.  The  report,  with  the 
accounts,  was  adopted. 

Votes  of  Thanks 

having  been  given  to  the  Board  of  Management  in  London 
and  the  local  Committee,  Mr.  Gross  moved  that  the  thanks  of 
the  meeting  be  given  to  Dr.  Walther,  Dr.  Groucher,  to  Miss 
Sutton  (Hon.  Secretary),  Miss  Lewis  (Matron),  and  Mr. 
Oibbs,  the  chemist  of  the  Home.  He  said  that  the  patients 
in  the  Home  were  well  cared  for  and  well  fed.  The  cost  of 
the  management  of  the  Home  was  only  one  shilling  per 
patient  per  week,  and  the  patients  contributed  one-third  of 
irhai  they  cost,  so  that  they  taught  poor  people  to  help  them- 
selves. For  every  guinea  spent  by  any  patient  the  Home 
spent  two  guineas.  The  subscriptions  had  gone  up  con- 
siderably, showing  that  as  the  Home  became  known  it  was 
being  supported.  They  had  a  system  of  <*  free  Jetters,"  by 
which  some  patients  could  be  received  without  payment. 
Letters  from  ex-patients  were  read,  all  expressive  of  their 
satisfaction  at  the  treatment  they  received  while  at  the  Home. 
Mr.  Cox  seconded  the  motion,  which  was  carried  unanimously, 
as  was  also  another  vote  of  thanks  to  the  London  Secretary, 
Mr.  Cross.  The  Chairman  was  thanked  for  presiding,  and 
tea  was  afterwards  served  to  all  present  at  the  meeting. 

Our  readers  will  be  gratified  with  the  prosperous  report 
piesented  to  the  supporters  of  this  useful  institution.  To 
many  patients,  convalescents  from  acute  disease,  whether 
from  the  Metropolitan  Hospital  or  elsewhere,  and  to  others 
suffering  from  overwork,  etc.,  the  Eastbourne  Homoeopathic 
Convalescent  Home  has  been  an  invaluable  boon.  The 
bracing  air  of  Eastbourne,  combined  with  the  care  and  com- 
forts of  the  Home,  give  new  life  to  the  weak  and  the  weary. 
We  heartily  join  with  the  Board  of  Management  in  wishing  that 
the  day  may  be  very  near  when  the  Home  may  be  opened  to  men. 
Should  a  change  of  site  be  possible  so  as  to  lessen  the  dis- 
tance of  the  Home  from  the  sea,  the  usefulness  of  the  Home 
woidd  be  still  further  enhanced. 

2  c— 2 


356  NOTABILIA.  ''^SSS.^SK??^ 


BerJew,  May  1,  IfiU. 


OXFOBD    HOMCEOPATHIC    ASSOCIATION. 

A  LABGBLT  attended  meeting  in  connection  with  the  Oxfoid 
Homoeopathic  Association  was  held  on  the  20th  inst. 

The  Secretary,  the  Rev.  W.  Probyn-Nevins,  read  the 
following  report :  "  The  first  meeting  to  inaugurate  a 
Homoeopathic  Association  for  Oxford  and  Oxfordshire,  with 
the  surrounding  neighbourhood,  was  held  on  the  10th  of 
March,  his  Worship  the  Mayor  of  Oxford  in  the  chair.  It 
was  there  resolved  that  members  should  be  admitted  on 
payment  of  a  minimum  subscription  of  Is.  annually.  A 
preliminary  committee  was  appointed  with  instructions  to 
make  inquiries  and  receive  suggestions  as  to  any  means 
by  which  homoeopathy  may  be  promoted.  With  tins  object 
in  view  they  appointed  twenty  district  secretaries,  asking 
them  to  seek  and  record  homoeopathists  in  their  district. 
From  information  gathered,  and  also  from  remarks  in 
the  pubhc  press,  your  committee  find  there  is  a  large  number 
of  would-be  homoeopathists  waiting  for  medical  aid,  and  who 
would  become  ardent  followers  of  Hahnemann.  Thereupon 
the  first  and  most  important  step  is  to  provide  a  homoeopathic 
surgeon  and  physician  to  settle  in  Oxford.*'  Several  ladies  and 
gentlemen  of  influence  have  kindly  consented  to  act  as  patrons. 

The  Bev.  H.  Barter,  Vice-President  of  the  Association,  in 
the  course  of  an  interesting  address,  said  that  a  strong 
association  like  theirs  was  very  soon  likely  to  influence  the 
public,  so  that  where  there  was  now  only  one  man  pro- 
pounding homoeopathy  there  should  be  a  hundred.  He 
thought  they  would  find  that  the  establishment  of  their 
association  would  be  followed  by  the  starting  of  other  similar 
associations  in  the  country.  He  believed  there  were  a  great 
number  of  doctors  who  were  practically  sceptics  as  to  the  use 
of  drugs.  Doctors  did  not  believe  in  drugs  at  all.  Some- 
times when  he  had  been  speaking  to  a  Dublin  man  of 
considerable  attainments,  his  friend  said  with  a  smile, 
**  Now,  you  don't  really  believe  that  when  any  person  has 
got  scarlet  fever,  or  any  zymotic  disease,  that  any  drag 
will  make  such  a  difl^erence,  do  you  ?  "  He  supposed  many 
homoeopathists  would  say  it  would  make  a  difference,  n 
people  could  once  be  led  to  examine  homoeopathy  they  would 
alter  their  opinion  with  regard  to  it.  It  was  *'  tabooed  "  by 
the  feusulty,  who  thought  that  if  they  looked  to  homoeopathy 
they  would  not  get  a  living.  Mr.  Barter  then  dealt  with 
some  misconceptions  respecting  homoeopathy,  and  cited  some 
instances  in  which  he  had  used  drugs  himself  with  great 
success. 

The  meeting  then  terminated  with  a  vote  of  thanks  to  the 
lecturer. 


S^ajf^TrtST'  NOTABILIA. 367 

With  one  point  in  Mr.  Barter's  excellent  address  all  those 
who  have  had  experience  of  homoeopathy  will  cordially  agree : — 
That  zymotic  diseases  may  he  profoundly  and  strikingly 
inflnenoed  by  drugs  is  unquestionably  true.  If  it  is  im- 
possible to  entirely  abort  them,  the  severity  of  the  case  may 
be  mitigated  and  sequelce  avoided. 

We  do  not  endorse  Mr.  Barter's  opinion  that  members  of 
the  dominant  school  decline  to  investigate  homoBopathy 
because  they  fear  they  would  not  "  get  a  living."  This  may 
be  the  reason  with  a  few  men  established  in  practice,  who 
think  that  a  change  would  be  unwelcome  tc^  their  clientele ; 
but  in  the  majority  of  instances,  especially  with  young  men, 
the  reason  is  that  '*  orthodox  "  practice  is  the  practice  of  the 
men  in  power.  They  feel  that  they  cannot  afford  to  be 
boycotted  by  their  teachers,  their  fellow-students,  or  confreres, 
and  by  the  various  learned  (but  oftentimes  bigoted)  societies. 
Such  boycotting  still  exists,  and  associations  like  the  Oxford 
Homoeopathic  Association  will  be  able  to  do  much  to  remove 
these  prejudices  by  educating  public  opinion.  A  few  of  the 
more  liberal-minded  and  unbiassed  and  independent  of  the  old 
school  may  be  influenced  by  having  the  facts  of  the  case  put 
be&re  them ;  but  the  bulk  will  require  outside  pressure — 
pressure  which  the  public  alone  can  bring  to  bear  upon  them. 

The  last  sentence  quoted  of  the  report  of  the  first  meeting, 
demands,  we  think,  some  qualification.  Oxford  possesses  an 
•able  and  experienced  representative  of  homoeopathy,  who  has 
for  years  done  good  work  there  in  the  dispensary  and  in 
private  practice.  Even  to  seein  to  ignore  Dr.  Guinness  would 
be  an  injustice  and  an  evidence  of  want  of  judgment.  The 
-disadvantage  of  Dr.  Guinness  being  unable,  through  ad- 
vancing years,  to  attend  some  of  the  more  urgent  and  arduous 
calls,  is  more  than  counterbalanced  by  the  value  his  long 
experience  and  ripe  judgment  give  to  his  opinions  and  advice. 
A  junior  colleague,  however,  is  evidently  needed — a  good  all- 
round  man,  who  would  co-operate  witih  Dr.  Guinness,  the 
two  being  mutually  helpfid.  We  wish  the  association  every 
success  in  its  efforts  to  ''  provide  "  such  a  man,  and  we  know 
that  Dr.  Guinness  is  anxious  to  have  a  colleague. 


TEACHING  OF  THE  DEAF  AND  DUMB. 

Mlle.  Louise  Gautier,  a  young  French  lady,  deaf  and  dumb 
from  birth,  has  nevertheless  passed  with  honour  all  the 
examinations  of  the  ^cole  des  Beaux  Arts  in  Paris,  receiving 
iu>t  only  her  diploma  but  an  appointment  as  teacher.  Bhe 
was  taught  by  the  Grosslin  system  both  to  read  the  lips  and 
to  speak,  so  that  her  infirmity,  it  is  said,  is  hardly  noticeable. 


858  CORRESPONDENCE.  ^"j^^w^^. 


THE  ANNUAL  HOMCEOPATHIC  CONGRESS, 

The  Annual  Congress  of  British  Homoeopathic  practitioneis 
will  be  held  this  year  in  London,  on  Thursday  the  9th  of 
July.  This  month  is  selected  instead  of  September  as  hereto- 
fore, as  it  is  important  to  have  this  meeting  during  the 
London  ''season,"  while  in  September  London  is  empty. 
The  9th  of  July  is  fixed  in  order  to  allow  those  who  wish  to 
go  to  the  United  States  to  return  in  time  for  our  Congress. 

It  is  hoped  that  there  will  be  a  large  atttendanoe  of  our 
colleagues,  as  London  affords  attractions  that  no  other  place 
can. 

Full  particulars  will  be  given  in  the  circular  which  will  be 
issued  in  the  beginning  of  June. 


NEW   PERIODICALS. 

Tfte  Poptdar  Medical  Monthly  is  the  title  of  a  new  journal 
published  in  London,  the  first  part  of  which  appeared  last 
month.  Our  new  contemporary  contains  a  Uttle  of  everything 
— everything  at  least  except  homoeopathy.  If  the  editor 
wishes  to  make  the  paper  of  any  real  service  to  the  public  its 
chief  '<  Studies  of  Remedies  "  will  be  from  the  homoeopathic 
standpoint.  Without  tiiis  the  "  MontlUy  **  will  belie  its  title 
of  "  Popular:' 

Messrs.  Frazer  will,  we  understand,  commence  to-day  the 
issue  of  a  new  illustrated  magazine,  The  Lud/jiate  Monthly. 


CORRESPONDENCE. 


INTERNATIONAL    HOMCEOPATHIC    CONVENTION- 

To  the  Editors  of  the  "  Monthly  HomctopaUiic  Review" 

Gentlemen, — ^Permit  me  again  to  direct  attention  to  the 
announcements  relative  to  the  approaching  Convention  which 
appear  in  the  body  of  your  present  number ;  and  also,  this 
time,  to  urge  on  my  colleagues  the  desirableness  of  furnishing 
a  respectable  British  contingent  to  the  gathering.  I  think 
that  you  have  spoken  too  absolutely,  and  from  the  Metropoli- 
tan standpoint  alone,  as  to  the  impossibility  of  getting  away 
at  the  time  appointed.  I  am  a  pretty  busy  practitioner  my- 
self ;  but  though  it  is  inconvenient  enough  to  be  absent  in 
June,  I  find  no  impossibility  in  it,  and  intend  to  be  at  Atlantie- 


SS^SSmTS^     coh^espondence.  359 

Citj.  I  hope  that  aome  others  of  our  men  will  follow  my 
example.  America  sent  us  82  representatives  in  1881.  We» 
with  our  hundreds,  cannot  emulate  them  in  their  thousands  ; 
Imt  surely  our  proportion  should  not  be  lacking. 

I  may  mention  that  I  sail  from  Southampton  on  Saturday, 
Jime  6Uiy  by  the  Hamburg- American  steamer,  '*  Fiirst  Bis- 
marck," which  is  due  at  New  York  on  the  18th  ;  and  shall  be 
pleased  to  hear  of  fellow-voyagers. 

Yours  very  faithfully, 

Richard  Hughes. 


LAB6E  AND  SMALL  DOSES. 
To  t/itf  Editors  of  Hie  *^  Monthly  Homceopathic  Renew, ^' 

OsNTLEMEM, — De  profufulU  clamavi,  but  I  hope  not  too  late, 
hi  your  issue  of  January  ultimo,  page  17,  Dr.  Drysdale  says, 
'*ihat  belladonmt,  leaving  untouched  the  circular  fibres  of  the 
iris,  stimulates  the  radial  fibres  and  thus  dilates  the  pupil, 
wlifle  physottigma  acts  precisely  in  a  contrary  manner." 

Now  Allen's  Encyclopaidia,  under  belladonna,  symptoms  640 
to  649,  gives  "  contraction  of  pupil "  ;  and  under  physostignia 
sjmptoms,  199  to  202,  gives  "  dilatation  of  pupil "  ;  and 
Hahnemann's  Materia  Medica  Pura,  under  belladonna,  symp- 
toms 246  to  250  gives  ''  contraction  of  pupil." 

Dr.  Drysdale  further  says,  on  page  19,  *'  that  neither  he 
(Dr.  Thomas)  nor  anyone  else  will  ever  understand  or  explain 
the  direct  therapeutic  action  of  drugs  without  acknowledging 
the  double  and  opposite  action  of  small  and  large  doses  in 
homoeopathic  cures." 

This  statement  is  the  very  key-stone  of  homoeopathy,  and  is 
seldom  sufficiently  dwelt  upon  by  writers  (see  my  letter  in  the 
HmttopaUde  World  of  April,  1890). 

Again,  Dr.  Drysdale  says :  <*  So  in  fact,  a  large  part  of  the 
allopathic  treatment  of  abdominal  inflammations  and  obstruc- 
tions is  really  homoeopathic,  after  all." 

Is  not  the  reverse  of  this  true  ?  Is  not  rather  the  process 
of  cure  antipathic  while  the  selection  of  the  remedy  only  is 
homcBopathic.  Homoeopathy  and  antipathy  are  conjoint 
factors  in  effecting  a  cure. 

I  am,  &c., 

Wm.  Geo.  Watson,  M.A.,  M.B.,  L.S.A.,  M.R.C.S. 
late  Hoaae  Surgeon  JcPhysioians*  Asaietant,  Univ.  Coll.  Hosp.,  London. 

150,  EUzabeth  Street,  Sydney.  * 

12th  March,  1891. 


360  COEEE8PONDENT8.       "^IIJIL^S??^ 


Be*i«v,  Mar  1,  un. 


NOTICES  TO   CORRESPONDENTS. 


%•  We  camwt  undertake  to  return  rtjeeted  wanH»eript$, 

Authors  and  Contributors  receiving  proofs  are  requested  to  oonect 
and  return  the  same  as  early  as  possible  to  Dr.  Edwin  A.  Nbatbt. 

London  Homcbopathic  Hospital,  Great  Ormond  Stbebt, 
Bloomsbury.— Hours  of  attendance  :  Medical,  In-patients,  9.30  ;  Out- 
INitients,  2.30,  daily ;  Surgrical,  Mondays  and  Thursdays,  2.30  ;  Diseases 
of  Women,  Tuesdays  and  Fridays,  2.30  ;  Diseases  of  Skin,  Thurdays, 
2.30  ;  Diseases  of  the  Eye,  Thursdays,  2.30  ;  Diseases  of  the  Ear,  Satur- 
days, 2.30  ;  Dentist,  Mondays,  2.30  ;  Operations,  Mondays,  2. 

By  a  printer's  error  in  our  last  issue,  Dr.  Thornlet's  name,  of 
Bolton,  was  mis-spelt  Dr.  Thomley. 

Communications,  &o.,  have  been  received  from  Mr.  Knox  Shaw, 
Mr.  G.  A.  Cross,  Mr.  Dudley  Wright  (London)  :  Dr.  Hughes 
(Brighton)  ;  Dr.  Drysdale,  Dr.  C.  W.  Hayward  (Liverpool) ;  Dr. 
Stonham  (Ventnor) ;  Dr.  Percy  Wilde  (Bath) ;  Messrs.  Wright 
AND  Co.  (Bristol). 


BOOKS    RECEIVED. 


The  yfcdlnal  Annual.  Bristol  and  London  :  Wright  &  Co.  1890,  1891. 
— Medical  Symholiiui  in  Cvntiectiof^with  Ifijfforieal  Studies  in  the  Art4 
of  Healing,  and  Ilygwne.  Illustrated  by  Thomas  S.  Sozmskey,  M.D., 
Ph.D.  Philadelphia  and  London :  F.  A.  Davis,  l^'dl. ^Popular  Onidr 
to  Tfomcpopathy.  By  John  Drummond,  L.R.C.P.,  M.E.C.S.  Leith  & 
Boss. — Tlie  Jlomceopathie  World.  London.  April. — The  Chemint  and 
Druggut.  London.  April. — Monthly  Magazine  of  Pharmacy.  London. 
AprlL — The  Aunte**  Journal^  the  Journal  of  the  Poyal  JirittMh  3ttrj«t' 
AsKoriation.     London.     February. — Tlie    Popular    Monthly  Medical, 


April. 

March. — The  Hahnemann  Monthly,  Philadelphia.  April. — Ths  Honuro^ 
pathic  Physician.  Philadelphia. — The  Homasopathie  Itvcorder.  Phila- 
delphia. March. — The  Homasopathie  Journal  of  ObiftHricn.  New  York. 
March. — The  Medical  Era,  Chicago.  April. — Thr  Medical  Advance, 
Chicago.  April. — TJw  diniaue,  Chicago.  March. — The  Southern 
Journal  of  Hmueopathy,  New  Orleans.  April.  —  Th^  California 
HoMceopath.  San  Francisco.  March. — Tim  Indianapoli*  Journal, 
March  25. —  La  Medecine  Hypodermique,  Paris.  March. — Bulletin 
Ghierale  de  Therapentique.  Paris.  April. — llevue  Ilomceopathique 
Beige.  Brussels.  ApriL — Allgem.  Horn.  Zeitung.  Leipzig.  April. — 
Zeipziger  Populdre  Zeitwhrift  fur  Homoopathie.  April. — Oazftta 
Medica  Di  Torino,  Turin.  March,  ApriL — Homwopathi^oh  Maand* 
hlad.    April. 

Fapera,  Dispensary  Reports,  and  Books  for  Bertew  to  be  sent  to  Dr.  Pops,  19, 
Watergate,  Grantham,  lincobuhire ;  Dr.  D.  Dtcb  Browx,  29,  Sermonr  Street,  Port- 
man  Square,  W.;  or  to  Dr.  Bnwix  A.  Nbatby,  161,  Hayerstock  Bill,  N.W.  Advottase- 
ments  and  Business  cotpmunications  to  be  sent  to  Messrs.  £.  Godld  ft  Son,  6B» 
Ifoorgate  Street,  £.0. 


tSS^J^Sr^S^  DELPHINIUM   8TAPHI8AGRIA.  361 


THE    MONTHLY 

HOMOEOPATHIC    REVIEW 


•:o:- 


A  STUDY  OF  DELPHINIUM  STAPHISAGRIA.* 

£y  Edwabd  Blake,  M.D. 

Not  the  most  insignificant  of  those  bays  which  must  for 
eTer  deck  the  brow  of  the  Immortal  Master  is  that  he 
Iftid  bare  a  thousand  unsuspected  virtues  lurking  in 
those  old  simples  of  which  we  talk  so  much,  and,. 
1  fear,  use  too  little. 

You  all  know  that  the  transcendent  genius  of 
Hahnemann,  like  that  of  the  great  Darwin,  wha 
resembles  him  in  so  many  ways — in  modesty  of  manner, 
in  simplicity  of  mind,  in  patience  of  inyestigation  and  in 
an  extraordinary  power  of  minute,  nay  even  microscopic,, 
observation — is  shown  not  so  much  by  the  brilliant 
generalisations  with  which  each  startled  the  quidnuncs 
of  his  day,  as  by  the  amazing  number  of  hard  and 
stubborn  facts,  well  observed  and  well  authenticated,, 
which  these  giants  managed  to  heap  together  into  time« 
defying  scientific  tumuli. 

The  splendid  hypotheses  of  both  have  already  been 
shaped  and  pared  by  the  effects  of  new  observations  and 
of  added  knowledge.  But  the  strict  logic  of  their  facts 
f^nains,  and  must  remain,  as  an  undying  monument^ 

more  persistent  than  the  pyramids  of  Egypt. 

*  — — 

*Bead  before  the  Britisli  Homoeopathic  Society,  May  Ttb^  1891. 
Vol  S3,  No.  6,  2d 


1 


362  DELPHINIUM   BTAPmSAGRIA.    ^^SSrfj^SJilttM! 

That  the  Seer  of  Cothen's  having  contributed  more 
actual  specifics  to  medicine  than  any  known  physician 
before  or  since  his  day,  may  possibly  form  the  popular 
basis  of  esteem  in  a  day  when  few  persons  have  an; 
leisure  to  think,  is  more  than  probable.  To  us  this  is 
not  so ;  to  us  has  been  accorded  the  rare  privilege  of 
knowing  this  unrivalled  mind  in  its  deepest  recesses. 

There  was  a  time  when  the  intellect  of  man  was  so 
large  that  small  matters  could  not  be  contemplated 
without  a  fine  sense  of  scorn ;  now  it  is  but  a  trite  truism 
to  say  that  the  infinitely  great  is  necessarily  based  on 
the  infinitely  little.  If  men  were  weighed  by  the  actual 
practical  benefits  which  they  have  conferred  on  their 
kind,  none  would  hold  his  own  with  this  plain  physician, 
who  first  taught  us  the  way  to  cure  cheaply  and  quickly, 
not  indeed  so  much  those  rare  and  recondite  diseases, 
which  distress  the  rich,  as  those  common,  vulgar 
ailments  which  afflict  ordinary  work-day  humanity. 
Nor  did  Hahnemann,  who  was  ever  actuated  by  the 
pure  spirit  of  research,  think  it  beneath  him  to  test  the 
powers  of  a  common  plant,  the  Larkspur,  chiefly 
connected  in  the  minds  of  men  to  this  very  day  with  a 
loathsome  parasite.  He  stooped  to  this  species  of 
organic  small-tooth-comb,  and  rescuing  it  from  its 
ignoble  alliance,  placed  it  in  the  honourable  post  of  the 
forefront  in  that  great  army  which  he  recruited  to  fight 
the  old  battle  against  disease  and  decay  and  sufi'ering 
and  death.  The  fact  is,  we  axe  not  half  vain  enough  of 
Hahnemann,  and  of  his  work  and  his  powers  ;  familiarity 
has  robbed  them  of  some  of  their  prestige ;  we  are  used 
to  them,  and  we  take  them  too  much  for  granted. 
I^elphiniuvi  is  itself  a  drug  of  which  all  good  homoeopaths 
ought  to  be  very  proud.  As  a  curative  agent  Hahne- 
mann literally  created  it. 

It  was  the  custom  of  Hahnemann  to  introduce  a  fresh 
drug  to  the  notice  of  his  disciples,  and  of  the  profession 
at  large,  by  a  kind  of  little  speech  of  introduction.  Just 
as  we  present  to  each  other  two  distinguished  guests  with 
a  small  verbal  flourish  of  trumpets. 
.  But  in  the  exordium  which  precedes  the  delphinium 
proving,  wq  miss  the  imposing  list  of  Old  School 
authorities  with  which  we  are  familiar  in  Dr.  Dudgeon's 
well-known  translation — a  list  amounting  to  no  less  than 
dS  names  in  the  case  of  opium. 


S^J^StS?**    DELPHINIUM   8TAPHISAGRIA.  363 

Neither  references  nor  quotations  from  traditional 
medicine  are  cited  for  staphisctgria ;  and  for  the  best  of 
all  reasons,  there  were  none  for  Hahnemann  to  cite. 
So  we  do  well  to  call  it  a  Creation  of  the  Master's  Mind. 

We  may  remember  that  staphisagria  was  proved  by 
Hahnemann  himself,  and  by  some  of  his  most  careful  and 
conscientious  coadjutors — Cubitz,  Franz,Gross,Gutmann, 
Hartmann,  Haynel,  Herrmann,  Hornburg,  Kummer, 
LiiiPghammer,  Stapf  and  Teuthorn,  who  recorded  between 
them  no  less  than  721  sjnnptoms,  of  which  200  were 
observed  by  Hahnemann  himself. 

We  are  constrained  to  say  that  of  the  64  drugs 
(omitting  the  three  magnetes)  whose  provings 
Hahnemann  left  as  a  priceless  legacy  to  the  world,  not 
one  has  been  more  thoroughly  worked  out;  and  yet 
staphisagria  has  scarcely  received  fair  treatment  from 
ns,  it  has  been  a  little  ^*  left  out  in  the  cold." 

Let  us  turn  to  the  memorable  words  with  which 
Hahnemann  ushers  into  the  world  this  new  Therapeutic 
Child  of  his. 

''  What  enormous  power  must  not  this  drug  possess ! 
Now,  as  our  new  and  only  healing  art  shows  by 
experience  that  every  drug  is  medicinal  in  proportion  to 
the  energy  of  its  action  on  the  healthy,  and  that  it  only 
overcomes  the  natural  disease  by  virtue  of  its 
pathogenetic  power  provided  it  is  analogous  to  the  latter, 
it  follows  that  a  medicine  can  subdue  the  most  serious 
diseases,  the  more  injuriously  it  acts  on  healthy  human 
beings,  and  that  we  have  only  to  ascertain  exactly  its 
pecidiar  injurious  effects  in  order  to  know  to  what  cura- 
tive purposes  it  may  be  applied  in  the  art  of  restoring 
human  health.  Its  power,  be  it  never  so  energetic,  does 
not  by  any  means  call  for  its  rejection;  nay,  it  makes 
it  all  the  more  valuable ;  for,  on  the  one  hand,  its  power 
of  altering  the  human  health  only  reveals  to  us  all  the 
more  distinctly  and  clearly  the  peculiar  morbid  states 
which  it  can  produce  on  healthy  human  beings,  so  that 
we  may  all  the  more  surely  and  indubitably  discover  the 
cases  of  disease  in  which  it  is  to  be  employed  in 
similarity  (homoeopathically)  and  therefore  curatively; 
whilst,  on  the  other  hand,  its  energy,  be  that  never  so 
great,  may  be  easily  moderated  by  appropriate 
dilution  and  reduction  of  dose,  so  that  it  shall  become 
only  useful  and  not  hurtful,  if  it  be  found  to  correspond 

2d  — 2 


1 


364  DELPHINIUM   STAPHISAGRIA.   '^S^cJ^f^S^UM. 

in  the  greatest  similarity  with  the  sjinptoms  of  the 
disease  which  we  wish  to  cure.  It  is  just  to  the  most 
powerful  medicines  in  the  smallest  doses  that  we  look 
for  the  greatest  curative  virtue  in  the  most  serious 
diseases  of  peculiar  character  for  which  this  and  no 
other  medicine  is  suitable." 

"For  these  unexceptionable  reasons,"  says  Hahne- 
mann, ''  I  anticipated  a  great  treasure  of  curative  action 
in  the  most  peculiar  diseases  from  staphisagria; ;  and  these 
reasons  led  me  to  make  careful  trials  of  it  on  healthy 
subjects,  the  results  of  which  are  recorded  in  the 
following  symptoms.  Thus,  curative  virtues  have  been 
elicited  from  this  medicinal  substance  which  are  of 
infinitely  greater  value  than  its  power  to  kill  lice  (the 
only  medicinal  property  the  ordinary  quackish  medical 
art  knew  it  to  possess),  curative  virtues  which  the 
homoeopathic  practitioner  may  make  use  of  ^th 
marvellous  effect  in  rare  morbid  states,  for  which  there 
is  no  other  remedy  but  this." 

This  is  a  remarkable  utterance  ;  it  is  interesting  as 
being  one  of  the  clearest  and  simplest  of  the  enunciations 
of  the  so-called  law  of  similars. 

A  careful  study  of  the  genius  of  staphisagria,  and  of 
its  alkaloid  delphinine*  reveals  the  interesting  fact 
that  these  drugs  are  especially  called  for  in  the  diseases 
peculiar  to  the  extremes  of  life.  The  fierce  metabolism 
of  infancy,  and  the  perverted  tissue-changes  of  a  second 
childhood,  call  alike  for  such  remedies  as  staplmaffria^ 
baryta  and  their  congeners.  In  their  action  in  the 
domain  of  the  special  senses,  on  the  region  of  the  nape, 
on  the  alimentary  tract,  the  glandular  system,  the 
urinary  apparatus,  and  the  lower  extremities,  they 
present  many  points  of  resemblance. 

Dr.  James  Dore  Blake,  of  Taunton,  a  most  able 
practical  physician,  one  of  the  pioneers  of  homoeopathy ^ 
who  sustained  a  bitter  persecution  for  his  creed  in 
the  earlier  part  of  this  century,  well  known  as  the 
first  prover  and  introducer  of  calendula,  relied  on 
staphisagria  as  his  stock  remedy  for  senile  sciatica. 
He  was  of  course  led  to  select  this  particular  drug  from 
observing  that  not  only  does  staphisagria  cover  the 
constipation  so  often  lying  at  the  root  of  this  form  of 

*  See  Article  Staphisagria,  toI.  iv.  of  Cye.  Drug,  Pathog,  p.  ISl. 


SSSS^^??a?^    DELPHINIUM   STAPHI8AGRIA.  365 


Bvriiv,  Jtme  1,  JBOl. 


neuralgia  in  the  aged,  but  at  the  same  time  it  aids  so 
many  of  the  side  issues,  par  exemple,  the  vesical  troubles 
and  the  nuchal  sorrows  so  frequently  associated  with  it. 

It  was  the  outcome  of  my  study  of  these  sides  of 
st4iphisagria  that  induced  me  to  give  it  a  trial  in  that 
common  but  distressing  result  of  motherhood,  a  pouched 
and  protruding  bladder.  We,  British  doctors,  owe  a  great 
debt  to  the  penetration  of  our  transatlantic  brethren  for 
first  forcing  the  gravity  of  neglected  cystocele  on  our 
notice.  To  them,  too,  will  go  up  the  incense  of  gratitude 
from  myriads  of  mothers  as  yet  unborn,  who  will  reap  the 
benefits  of  American  gynecic  teaching.  For  though  the 
wisest  accoucheur  may,  in  spite  of  a  thorough  maceration 
and  wearying  out  by  means  of  preliminary  dilatation, 
meet  in  his  practice  with  an  acutely  ruptured  perineum, 
only  the  foolish  man  will  leave  it  torn.  He  alone  will 
ruthlessly  condemn  the  poor,  fond,  trusting  creature  re- 
posing on  his  want  of  wisdom  to  the  present  sorrows  of 
reflex  haemorrhage,  scalding  dysuria,  delayed  convales- 
cence, possible  septicemia,  arrested  sub-involution  and 
the  future  worry  of  cystocele,  with  uterine  procidentia  and 
rectal  protrusion. 

All  gynecologists  are  perfectly  familiar  with  the  sad 
group  of  symptoms,  having  as  its  more  pronounced 
features  inability  to  retain  the  water  and  to  discharge 
the  fseces ;  a  detestable  forcing  feeling ;  a  loin  languor ; 
wearisome  aching  in  the  sacral  region  and  from  the 
vertebra  prominens  upwards ;  the  peevish  and  fretful 
or  despondent  mood. 

In  cases  of  prolapsed  bladder,  where  the  unfortunate 
subject  either  could  not  or  would  not  submit  to  the 
radical  operation  for  the  repair  of  the  perineum,  I  have 
been  for  many  years  in  the  habit  of  employing 
9taphisagria  locally  to  the  vesical  tumour,  and  at  the 
same  time  I  like  to  administer  a  high  dilution  of  this 
remedy  internally.  This  latter  I  prefer  doing  when  the 
stomach  is  void.  Topically,  the  drug  is  best  applied  in 
the  form  of  a  saturated  glycerole.  Carefully  carded 
animal  wool  is  a  better  vehicle  for  application  than 
cotton ;  it  retains  its  elasticity  when  wetted. 

The  adjacent  viscera  being  emptied  and  all  tight  waist- 
bands removed,  the  patient  assumes  the  salaam  or 
knee-elbow  posture.  Half-a-dozen  tampons  in  the  form 
of  a  kite-tail  are  introduced  into  the  vagina,  and  packed 


866  DELPHINIUM   STAPHISAGRIA.  ^^JSSSrfj^^m 

well  up  around  the  cervix  during  forced  expiration. 
Unless  the  patient  be  very  silly  or  very  corpulent  she 
soon  learns  to  do  this  for  herself.  The  vagina  should  be 
quite  filled  with  this  wool,  which  is  worn  during  the 
whole  day.  In  bad  cases  it  is  needful  to  support  the 
perineum  in  addition  by  means  of  a  broad  thick 
T-bandage,  the  horizontal  portion  of  which  should  be  at 
least  three  inches  wide  and  should  be  adjusted  to  the 
trunk  just  below  the  hip-  Similarly  the  menstrual  belt, 
for  obvious  anatomic  reasons,  should  never  encircle  the 
body  above  the  iliac  line,  or  it  becomes  a  potent  factor, 
combined  with  a  tight  corset  and  with  heavy  skirts,  in 
adding  prolapsus  of  the  pelvic  contents  at  the  time 
when  the  viscera  are  heaviest. 

I  can  speak  feelingly  of  the  sad  success  of  this  treat- 
ment as  more  than  a  temporary  alleviant,  because,  on 
more  than  one  occasion  women  who  had  decided  to  let 
me  do  perineorrhaphy  for  them  have  so  sensibly  improved 
under  it  that,  to  my  chagrin,  the  operation  has  been 
postponed  siiic  die  ! 

We  will,  before  taking  leave  of  this  valuable  drug, 
glance  a  little  at  the  rest  of  its  many  actions.  Most  of 
them  are  symptoms  quite  at  home  in  the  gynecic  note- 
book. The  sad,  grey  outlool:  of  life ;  the  enfeebled 
memory ;  the  bursting  headache,  itching  scalp  and 
facial  papules ;  the  dilatation  of  the  pupils  preceded 
by  temporary  contraction;  the  inflamed  lids;  irritated 
canthi  point,  like  the  similar  symptoms  in  spigelia, 
to  rheumatic  sclero-conjunctivitis.  Symptoms  120-30 
suggest  choroiditis;  whilst  the  scintillating  scotoma 
pertains  more  to  certain  deep-seated  changes  in  the 
intra-cranial  circulation. 

Tinnitus  is  recorded  by  two  provers. 

Pustulation  has  been  noted  in  the  upper  lips  and 
inside  the  nose.  Also  the  lips  are  ulcerated  on  their 
borders. 

The  submaxillary  symptoms  are  strangely  suggestive 
of  a  drug — ^not  much  allied  to  staplmagria — ^namely, 
mercury.  The  same  observations  hold  good  of  the 
dental  and  gingival  symptoms.  The  typical  toothache 
of  delphinium  is  **  tearing."  The  pathologic  condition 
corresponds  with  periodontitis  atrophica,  so-caUed 
"  receding  gums." 


bSS^JjSJiImSi!^  delphinium  staphisaoria.  867 

Herrmann's  symptom,  '^  when  chewing  he  feels  as  if 
the  teeth  were  pressed  deeper  into  the  gums  "  reminds 
one  of  the  '^ sense  of  elongation  of  the  teeth"  in 
pho9plwrus. 

[Allen's  Index  gives  for  *^  feeling  of  long  teeth/' 
chelid.,  eocculusy  castor  and  petroleum.] 

The  tongue  is  white,  the  palate  sore,  due  apparently 
to  herpes ;   compare  acetic  acid. 

Three  provers  had  ptyalism  {conf.  mercury)  heart- 
bnrn,  eructation,  hiccough,  four  times  nausea ;  and 
actual  vomiting  occurred  twice.  Adipsia  distinguishes 
ttaphisagria  and  rheiim  from  the  "thirst"  of  rhus 
and  the  "  great  thirst "  of  spigelia. 

The  flatulent  colic  of  staphisagria  is  intensified  by 
urinating,  distinguished  from  that  of  rheum,  aggravated 
by  movement. 

Staphisagria  has  constipation  followed  by  diarrhoea ; 
rheum,  diarrhoea  followed  by  costiveness. 

Anal  itching  is  noted  in  two  provers. 

The  urinary  symptoms  are  numerous  and  strongly 
marked ;  they  point  as  distinctly  to  prostatic  troubles  in 
males  as  to  cystocele  in  women.  The  staphisagria 
tamponade  might  be  used  per  rectum  in  the  case  of  males 
for  intractable  prostatic  hypertrophy. 

The  itching  of  the  genitals,  in  both  genders,  recalls 
the  symptoms  induced  by  galipaa  cusparia,  usually 
known  as  angostura  vera. 

Old  people,  we  know,  are  very  prone  to  acute  and 
distressing  but  quite  temporary  strangury.  Very  young 
practitioners  administer  dysuric  remedies  with  no  result. 
Older  doctors  hasten  to  give  a  remedy  for  flatus 
incarcerated  in  the  sigmoid  flexure  or  in  the  rectum  ; 
they  also  direct  that  the  nurse  apply  succussion  to  the 
descending  colon.  I  am  indebted  to  my  friend.  Dr. 
Bichard  Hughes,  for  the  valuable  hint  to  administer 
pulsatiUa  under  these  circumstances.  It  has  not  failed 
me  yet ;  should  it  do  so,  I  shall  certainly  fall  back  on 
staphisagria. 

There  are  nine  coryza  symptoms,  carrying  us  back 
again  in  mind  to  mercury. 

The  twelve  cough  symptoms,  always  aggravated  in  the 
case  of  Dr.  Franz  by  eating  [compare  nux  vomicaX  point 
to  pharyngitis  rather  than  to  laryngitis.    Possibly  some 


368  DELPHINIUM   STAPHISAGRIA.   ^^iJ^fj^SJuS 

are,  like  t  e  ^*  oppression  "  and  "  stitches  "  in  the  chest, 
spinal  in  origin. 

The  nape  and  sacrum  symptoms  we  have  already 
noticed ;  they  are  very  typical  of  ataphisagria. 

The  upper  extremity  symptoms  ought  to  yield  good 
results  in  treating  the  osteo-arthritis  so  common  in  real 
senility  and  in  the  imitation  old  age  of  pelvic  patients. 

Bestless  nights,  disturbed  by  dreams  of  remarkable 
vividness,  are  naturally  followed  by  drowsy  days.  As  in 
stramonium,  the  prover  either  dreams  of  murder  or 
-encounters  some  ferocious  beast. 

The  cerebral  congestion  we  may  therefore  conclude 
is  more  arterial  than  venous. 

The  rigors  are  usually  adipsic,  one  prover  alone 
having  "  great  thirst.'* 

The  cardiac  symptoms,  like  the  perverted  sensations 
in  the  tongue^  resemble  the  action  of  aconite. 

Case. — Staphisagria  in  Left  Deltoid  Mi^algu. 

Mrs.  ,    aged  60,  came  on  July  2nd,  1888,  for 

recurrent  headache  since  early  childhood,  i.e.,  for  more 
than  forty  years. 

The  pain  is  frontal ;  it  corresponds  with  the  distribution 
of  the  two  supraorbital  branches  of  the  fifth  pair. 

Twelve  years  ago,  whilst  nursing,  she  had  a  mental 
shock,  which  greatly  augmented  the  severity  of  the  head- 
aches. This  shock  was  followed  by  temporary  loss  of  the 
senses  of  smell  and  of  taste,  and  by  impairment  of  that 
of  hearing. 

The  double  supraorbital  pain  has  usually  recurred  at 
intervals  of  seven  days. 

The  change  of  life  occuiTed  five  months  ago. 

She  also  suffers  from  attacks  of  acute  spinal  anaemia, 
apparently  depending  on  the  condition  of  her  heart,  and 
associated  with  the  following  symptoms: — ^Pirst  there 
€omes  acute  temporal  pain  ;  this  is  accompanied  by  a 
distressing  sense  of  choking  followed  by  passive 
pharyngitis.  Later  in  the  day  there  are  rigors  and  a 
feeling  of  sickness ;  then  diarrhoea  begins,  and  after- 
ivards  she  becomes  intensely  drowsy.  Usually  there  is 
complete  arrest  of  urine.  Sometimes  she  has  palpitation, 
with  panting  breath.  She  has  been  prone  to  these 
attacks  from  her  girlhood. 

For  the  cold  Bta.ge  vei-atrum  album  in  the  third  decima 


SSSfj^Stw^*    DELPHINIUM   STAPHISAORIA.  869 

dilation  was  recommended,  and  it  gave  marked  relief. 
The  extreme  drowsinesB  was  snccessfuUy  combated  with 
papaver  iomniferum,  thirty  centesimal. 

Inhalations  of  moichus,  matrix  tincture  appeared  to 
relieve  the  dyspnoea,  and  also  the  palpitation,  for  which 
I  afterwards  gave  asafoetida  in  the  twelfth  centesimal  with 
some  advantage. 

Bat  to  Idchesis  is  dae  the  credit  of  curing  this  remark- 
able case.  In  dilutions,  varying  from  6  to  80,  it  swept 
away  the  headache,  aggravated  by  movement  and  by 
noise,  but  even  more  by  light.  Whilst  taking  the 
trigonocephalus  she  also  lost  the  giddiness,  the  noises  in 
the  head,  the  flushing,  dry  mouth  and  throat,  loss 
of  appetite,  epigastric  sinking  and  abdominal  flatus, 
dyspnoea,  tickhng  cough,  and  the  palpitation, 
occarring  both  on  exertion  and  after  excitement. 

Under  the  influence  of  lachcsis  this  patient  enjoyed 
five  months  of  immunity  from  headaches  which  had, 
before  taking  the  remedy,  recurred  once  a  week  for  40 
years.  The  other  attacks,  viz.,  those  of  acute  cerebro- 
Bpinal  ansemia,  had  lasted  during  five-and-twenty  years, 
recurring  at  intervals  of  about  two  months.  Latterly 
they  had  become  much  more  frequent,  leaving  only  three 
weeks  of  freedom  from  the  distressing  disturbance. 

These  also  ceased  to  afiUct  her,  and  she  had  singularly 
good  health  with  one  exception,  which  we  shall  presently 
notice,  during  the  remainder  of  the  year. 

The  only  adjuvants  employed  were  gentle  continuous 
current  to  vagus ;  upward  electro-massage  to  lower 
extremities  and  to  the  respiratory  muscles.  Of  course 
the  patient,  who  respired  very  imperfectly,  was  taught 
to  breathe.  Allowance  have  been  made  for  the  beneficial 
effects  of  these  auxiliary  measures,  the  rest  of  the  credit 
remains  with  the  venom  of  the  Indian  snake. 

This  patient,  on  25th  October,  1890,  again  made  her 
appearance  at  my  rooms,  looking  much  improved  in 
appearance.  She  had  lost  her  look  of  distress  and  had 
pat  on  flesh. 

She  now  complained  of  a  severe  aching  pain  from  the 
left  elbow  to  the  left  shoulder.  This  pain  quite  prevented 
the  use  of  the  left  arm  at  its  upper  part ;  it  grew  worse 
in  bed. 

The  biceps,  the  brachialis  anticus  and  the  deltoid  were 
the  chief  muscles  involved,  all  supplied,  as  you  know, 


n 


370  DELPHINIUM   8TAPHISAGRIA.   ^SJSL^jS??^. 


Beviewt  June  1, 191. 


by  the  musculo-cutaneous  nerve,  the  external  branch  of 
the  outer  cord  of  the  brachial  plexus.  There  was  no 
.  impairment  of  reaction  to  the  various  muscular  stimuli. 
'  The  biceps  and  the  brachialis  anticus  made  a  slow 
recovery  under  baptisia  Ix,  apis  6,  rhits  12  and  sulphur 
SO,  selected  from  subjective  indications. 

The  patient  lived  at  a  considerable  distance.  Owing  to 
this  fact  and  to  the  extreme  inclemency  of  the  weather,  I 
saw  very  little  of  her,  but  she  sent  an  occasional  report. 
Thus  I  heard  that  whilst  the  other  muscles  had  recovered 
their  normal  state,  the  deltoid  hung  fire  and  inflicted  a 
good  deal  of  pain  and  loss  of  rest  till  the  end  of  March. 

I  was  then  preparing  this  drug  as  a  contribution  to 
the  American  Congress,  when  I  was  struck  with  the 
similarity  between  the  whole  group  of  this  worthy 
woman's  symptoms  and  the  complete  pathogenesy  of 
staphisagria. 

So  I  wrote  a  prescription  for  staphisagria  twelfth 
centesimal,  to  be  taken  before  each  meal.  The  same 
remedy  was  given  in  the  first  decimal  dilution  at  bed  time. 

The  deltoid  was  well  rubbed  with  oil  of  stavesacre  twice 
a-day. 

The  last  part  of  the  prescription  had  to  be  suspended 
on  account  of  the  free  appearance,  after  its  use,  of  a  red» 
itching  eruption  resembling  lichen  urticatus. 

The  staphisagria  was  prescribed  on  24th  March  of 
this  year,  the  deltoid  pain  having  persisted  for  nearly  six 
months. 

It  disappeared,  whilst  taking  staphisagria,  in  seven 
days,  and  up  to  the  present  time  it  shows  no  sign  of 
returning. 

Discussion. 

Dr.  BuRFOBD  praised  the  practical  nature  of  Dr.  Blake's 
paper.  Eeferring  to  Dr.  Blake's  mention  of  jnd^tiUa,  he 
recalled  Hahnemann's  note  that  many  of  the  symptoms  of 
Pulsatilla  are  traceable  to  flatulence,  and  disappear  when  the 
flatulence  is  got  rid  of.  Many  symptoms  which  are  useful 
indications  for  a  drug  are  not  found  in  the  provings.  And 
too  much  attention  may  be  paid  to  provings.  The  character- 
istic tongue  of  Pulsatilla  is  a  white  one,  but  this  does  not 
appear  in  all.  J  pis  is  said  to  be  of  great  value  in  nephritis ; 
there  were  no  nephritic  symptoms  in  the  provings.  Clinical 
totalities  and  careful  records  of  cases  were  quite  as  essential 
as  the  provings. 


iSHS^^^t^Snf^  DELPHINIUM   STAPHISAGRIA.  871 

Br.  CooFEB  said  when  he  first  came  to  the  Homoeopathic 
Hospital  staphisagri*%  was  much  more  extensively  used  than 
it  is  now.  He  would  look  upon  it  as  a  remedy  of  great  value 
in  ^ur  diseases.  It  acts  on  teeth  and  alveolar  periosteum,  but 
he  had  never  '<  come  in  upon  "  the  action  of  the  remedy. 
Until  one  has  been  familiarised  with  a  drug  one  does  not  get 
onl  of  it  so  much  as  would  be  expected.  Dr.  Wilson  had  cured 
man  J  cases  of  eye  disease  when  a  symptom  "  heat  in  the 
eyelMLll  so  great  that  it  dims  the  spectacles  "  was  present.  He 
thought  the  history  of  the  drug  might  be  better  known — its 
botanic  and  popular  medical  history.  Staplmafjria^  with  old 
herbalista,  is  spoken  of  as>*  louse-wort."  He  placed  very  httle 
reliance  on  local  applications.  It  was  impossible  to  differentiate 
between  the  action  of  several  drugs — hjdrastisy  staphisagria, 
and  others — ^when  locally  applied. 

Dr.  Febnie  referred  to  the  history  of  the  drug.  He  said 
the  ancients,  Pliny  and  Dioscorides,  used  the  seeds  as  a^ 
purgative.  Pliny  used  the  powdered  seeds  to  the  scalp  to 
destroy  vermin.  He  had  not  read  that  it  caused  any  eruption. 
Dr.  Philips  says  there  are  two  principles — delphinine  and 
*taphi$affrine — ^which  have  different,  and  even  opposite,  action. 
Did  not  the  administration  of  the  entire  drug  entail  the 
counteracting  of  the  one  principle  by  the  other  ?  He  thought 
the  history  of  the  drug  was  pretty  well  known,  and  the  ex- 
planation of  its  names  interesting.  Staphisafjria  implies  a 
wild  vine  or  raisin,  with  reference  to  the  leaf  or  seed  ;  and 
delphiniuvi  likens  the  spurred  rectury  to  a  dolphin.  The  oil 
is  described  in  Martindale's  E.i^ra  PJiannacopaia, 

Dr.  Clarke  had  had  experience  in  many  of  the  uses  of  the 
faig  mentioned  by  Dr.  Blake.  In  a  case  of  prolapsed  bladder 
where  there  was  sensitiveness  of  the  pudenda  as  shown  by 
aggravation  on  sitting  down,  HUiphkatjria  had  given  great 
relief.  He  had  frequent  occasion  to  use  it  in  toothache.  He 
had  pat  on  record  a  case  of  enlarged  tonsils  in  which  the 
symptoms,  stitching  firom  throat  into  ear  on  swallowing,  had 
led  to  its  use,  which  resulted  in  speedy  cure.  Tumours  of  the 
ejelid  had  inflamed  and  disappeared  under  its  use,  and 
exerescence  on  the  gums. 

Dr.  Hughes  was  very  glad  that  there  should  be  a  **  Materia 
Medica  night"  occasionally;  and  to  have  a  drug  brought 
before  us  so  well  proved  and  so  little  used  as  staphisafftia.  Its 
possession  of  such  alkaloids  as  delphinine  and  staphisaffrine 
shows  its  energy ;  and  Dr.  Hughes  thought  that  the  powers  of 
these  substances  gave  us  the  clue  to  the  action  of  the  present 
clnig.  Delphinine  acts  like  aconitine,  inducing  a  numbness 
and  tingling  in  the  extremities,  which,  as  with  its  analogue, 
would  probably  go  on,  if  pushed,  to  neuralgia.    Hence,  the 


872  DELPHINIUM   STAPHIBAGBU.   "^I,°r^rtS! 


Beriew,  June  1, 18BL 


value  of  sUiphUagria  in  neuralgia  of  arms  and  legs.  On  iihe 
other  hand,  ttaphtsagrine  is  an  irritant,  and  the  mother-plant 
is  of  undoubted  value  in  such  a  condition  when  occurring  in 
the  genito-urinary  organs,  especially  when  old  gonorrhoeas 
have  crept  through  the  seminal  ducts  and  into  i£e  prostate. 
His  (Dr.  Hughes*)  own  experience  with  it  had  been  mainly  in 
those  quarters  ;  but  also  as  a  preventive  of  recurrent  styes. 

Mr.  Knox  Shaw  had  been  anxious  to  find  something  to 
relieve  tumours  of  the  lids  without  operation,  and  had  given 
staplmagrin  Ix  to  8  among  other  drugs,  but  he  got  no  results. 
The  natural  cure  is  by  inflammation,  and  he  thought  the  case 
referred  to  by  Dr.  Clarke  was  cured  by  nature  and  not  by 
staphisagria. 

Dr.  Clabke  said  the  tumours  existed  a  long  time,  and  had 
no  tendency  to  inflame  before  8taphis*igria  was  given.  More- 
over, staphisatjna  corresponded  to  the  patient,  and  was, 
in  fact,  the  simillimum. 

Dr.  Dudgeon  (in  the  chair)  had  had  very  little  experience 
of  the  drug.  He  had  used  it  in  toothache  from  recession  of 
the  gum.  The  relief  to  the  pain  was  almost  instantaneons. 
The  old  school  had  not  made  much  use  of  the  drug- 
principally  as  a  destroyer  of  lice.  The  use  of  the  oil  as  a 
stimulating  application  to  indolent  ulcers  had  been  given  up 
as  too  violent.  Eeferring  to  the  symptom,  **  heat  in  the  eyeball 
dimming  the  spectacles,"  he  said  the  dimming  was  produced 
by  sweat  from  the  skin  of  the  face  and  not  by  heat  in  the 
eyeball. 

In  reply,  Dr.  Edward  Blake  agreed  with  Dr.  Burford  that 
the  so-called  tongue  indications  are  often  illusory.  The  same 
drug  in  the  same  dose  causes  a  variety  of  coatings  on  the 
tongue  in  different  persons.  A  given  drug  appears  to  bring 
out  the  special  tendency  of  the  patient  to  a  certain  form  of 
gastric  disturbance. 

With  regard  to  the  adenitis  of  the  eyelid,  Dr.  Blake  treated 
such  cases  according  to  their  cause.  If  irritating  material 
from  the  eyeball,  as  in  the  case  of  strumous  conjimctivitis  bj 
entering  the  meibomian  follicles,  set  up  resulting  disturbance 
there,  then,  of  course,  the  conjunctival  disorder  must  be 
treated. 

If  an  infectious  disease  of  scalp  induced  itching,  and  the 
hand  was  then  applied  to  the  lid,  the  scalp  should  be  attended 
to.  Naturalists  say  that  a  very  minute  beetle,  obtained  from 
dogs,  will  enter  the  lid  follicles  and  set  up  serious  irritation 
there. 

Mercury  administered  internally,  and  at  the  same  time 
applied  locally,   had  cured  the  greatest  number  of  chronic 


Wj^^TSSS^       serpent  venom.  873 

cases,  and  pulsatilla  the  greatest  number  of  acute  cases  in 
Dr.  Blake's  hands. 

Two  speakers  had  doubted  the  specific  effect  of  a  drug 
applied  locally  to  the  vagina.  Why  should  they  do  so  ?  The 
Taginal  tube  is  a  very  absorbent  canal  in  health,  witness  the 
prompt  effect  of  arsenic  introduced  with  criminal  intent. 
Bat  the  real  reply  to  this  difficulty  is,  that  staphisagria  relieves 
whether  it  be  given  in  high  attenuations  or  in  low,  whether  it 
be  applied  topically  or  administered  internally. 

THE    PHYSIOLOGICAL    ACTION    AND    THEEA- 
PEUTIC    USES    OF    SERPENT    VENOM. 

By  Alfred  C.  Pope,  M.D. 
[Continued  from  patje  812.) 

Lachesis. 

The  symptoms  evoked  by  the  bite  of  the  trigonoceplialus 
lachesis  and  the  naja  tripudians  and  those  arising  from 
experiments  which  have  been  made  with  their  venom, 
are  so  similar  to  those  of  the  crotalus  honidua  that  it  is 
mmecessary  to  dwell  upon  them  in  detail.  I  shall, 
therefore,  simply  draw  attention  to  those  conditions  in 
which  the  principle  of  similia  aimilibvs  curentur  points 
to  them  as  remedial,  and  in  which  experience  has 
testified  that  they  are  so. 

For  the  researches  which  have  led  to  the  use  of  lachesis 
as  a  medicine  we  are  indebted  to  the  late  Dr.  Constantine 
Bering,  of  Philadelphia ;  for  our  knowledge  of  the  action 
of  naja  tripudians  to  the  late  Dr.  Butherfurd  Bussell,  of 
London. 

Mental  depression,  great  restlessness,  incapacity  for 
exertion,  forgetfulness,  indifference  to  everything  and 
at  the  same  time  great  talkativeness;  the  subject  of 
poisoning  or  experiment  rapidly  passing  from  one  sub- 
ject to  another,  and  ultimately,  becoming  confused, 
represent  the  mutual  phase  produced  by  lachesis.  These 
syinptoms  have  led  to  its  successful  use  in  cases  of 
melancholia  at  the  climacteric  period,  when  similar  ones 
have  been  present,  and  also  in  mania  marked  by 
excessive  chattering.     (Talcott). 

^  Generally  associated  with  this  mental  depression  and 
irritabQity,  there  is  pain  in  the  left  side  of  the  head. 


874  SERPENT  VENOM.         "SS^^Cf^S!' 


Eeview,  June  1,  Ittl. 


chiefly  over  the  left  frontal  protuberum,  which  feels 
sore  especially  on  pressure.  In  other  cases,  the  pain  is 
throbbing  and  is  chiefly  in  the  left  half  of  the  forehead. 
It  is  worse  on  awaking  in  the  morning  and  when  stoop- 
ing, and  there  are  in  addition  vertigo,  nausea  and  often 
vomitmg  with  considerable  weakness. 

Many  cases  of  sick  headache  are  characterised  by 
such  symptoms  as  these,  and  in  them  lachesia  has  been 
used  with  success.  It  is  also  indicated  in  a  class  of 
cases  which  are  commonly  described  as  cases  of  hemi- 
crania — not  a  very  intelligible  definition  from  a  patho- 
logical point  of  view,  certainly,  but,  still,  one  that  is 
•employed  to  denote  a  one-sided  headache,  generally  met 
with  in  women  of  a  nervous  temperament.  In  the 
Monthly  Hom<eopathic  Review,  vol.  xxix.,  p.  468,  are  two 
such  cases,  reported  by  Dr.  Elb,  of  Dresden,  in  the 
Allgemeine  Horn.  Zeitung,  vol.  cv.,  where  lachesis  was 
rapidly  curative.  One  patient  was  a  widow  lady,  32 
years  of  age,  who  had  suffered  for  eight  years  from 
irregular  attacks  of  hemicrania  (having  eight  or  ten  in  a 
month)  varying  in  duration  from  three  to  four  hours, 
coming  on  suddenly -with  throbbing  over  one  eye  and  in 
the  temple,  together  with  great  nausea  and  vomiting,  at 
first  of  food,  and  then  of  mucus  and  bile.  Lachesis  6x 
was  taken  daily  for  six  months.  One  attack  occurred 
the  day  after  commencing  the  treatment,  but  from  that 
time  not  another.  The  report  was  written  five  years 
after  their  cessation. 

In  another  case — an  unmarried  lady  of  82  years  of  age 
— attacks  of  hemicrania,  accompanied  by  nausea  and 
vomiting  of  mucus  and  bile,  had  occurred  every  eight  or 
nine  days  since  puberty.  Lachesis  6x  was  given,  and  as 
in  the  former  instance,  an  "uncommonly  severe  attack" 
occurred  two  days  afterwards.  The  medicine  was  taken 
regularly  for  six  months.  She  had  "  no  more  attacks, 
nor  any  signs  of  a  return  of  the  headache,''  and  had  had 
none  five  years  afterwards. 

The  symptoms  of  disordered  health  in  the  pharynx 
produced  by  lachesis  are  numerous  and  striking.  There 
is  a  great  deal  of  tenacious  mucus,  exciting  constant 
hawking.  The  throat  feels  dry,  and  is  the  seat  of  a  great 
deal  of  pain  extending  up  to  the  ear,  particularly  on  the 
left  side.  There  is  great  tenderness  externally  all  round 
the  region  of  the  throat,  which  is  rendered  much  worse 


i 


ttwuSJ"*        SERPENT   VENOM.  375 

by  any  pressure.  There  is  also  a  sensation  as  of  a  crumb 
in  the  throat,  provoking  efforts  to  swallow.  The  throat 
is  sore  and,  in  one  instance,  is  described  as  being  ulce- 
rated. Great  difficulty  is  found  in  swallowing,  liquids 
being  more  troublesome  than  solids. 

The  larynx  seems  swollen,  raw  and  scraping.  It 
feels  obstructed  ''as  though  a  plug  were  fixed  there 
winch  moved  up  and  down  with  a  short  cough."  It  is 
painful  to  the  touch.  The  voice  is  hoarse,  becoming 
increasingly  so  with  speaking,  and  there  is  a  sense  of 
accumulated  mucus  which  is  difficult  to  detach.  A  dry, 
tickling  cough  comes  on  late  in  the  evening  and  continues 
often  during  sleep.  "  Troubled  every  evening  from  about 
9  o'clock  with  a  little  fluttering  nervous  cough,  appa- 
rently excited  by  a  tickling  in  the  larynx,  unattended  by 
pain,  expectoration,  or  any  symptom  of  a  cold ;  it  came 
on  at  no  other  time  and  ceased  on  going  to  sleep." 
*|  Every  contact  with  the  open  air  causes  a  violent  tick- 
ling cough  accompanied  by  expectoration  of  mucus ;  it 
lasts  from  five  minutes  to  an  hour." 

Such  are  a  few  of  the  pharyngo-laryngeal  symptoms 
which  arose  in  the  course  of  the  provings  of  lachesis 
recorded  in  Allen's  Encychpadia  of  Pure  Materia  Medica^ 
and  they  hav3  all  been  found  true  indications  for  the 
selection  of  the  medicine  in  practice. 

They  have,  together  with  the  symptoms  of  general 
vital  depression  which  lachesis  in  common  with  crotalus 
gives  rise  to,  led  to  its  successful  employment  in  some 
cases  of  tonsiUitis.  The  throat  looks  congested  rather 
than  inflamed,  and  there  are  on  the  surface  of  the 
swollen  and  somewhat  livid-looking  tonsils,  little  specks 
suggestive  of  commencing  ulceration.  The  uvula  is 
relaxed  as  are  all  the  other  tissues,  and  elongated. 
There  is  a  good  deal  of  pain  which  radiates  towards  the 
ears.  Swallowing  is  difficult  and  there  is  a  constant 
endeavour  to  detach  mucus. 

The  follovring  case  of  chronic  congested,  irritable 
throat,  is  a  very  instructive  illustration  of  the  kind  of 
sore  throat  in  which  lachesis  is  pre-eminently  useful. 
It  is  reported  by  Dr.  Conrad  Wesselhoeft,  originally  in 
the  American  HovwcopaiJiic  Review,  but  may  be  found  in 
The  British  Journal  of  Homoeopathy,  vol.  xxii.,  p.  488. 

"  On  the  27tb  of  October,  1862,  Mr.  T.  consulted  me  on 
account  of  chronic  irritability  of  the  fauces.     The  patient  is 


376  SEBPENT   VENOM.         "SSfi.^f-?!^ 


Beriew.  June  1,  Iftl. 


of  medium  height,  25  years  of  age,  of  a  healthy  fiumly,  of 
fair  complexion,  muscular,  and  accustomed  to  out-door 
exercise  and  horse-back  riding ;  hair  dark,  eyes  blue.  This 
young  man  had  been  affected  for  neaily  a  year  with  an 
irritable  condition  of  the  fauces,  of  which  he  had  taken  but 
little  notice.  Upon  examination  I  found  the  uTula  elongated 
to  such  an  extent  that  in  its  most  contracted  state  it  would 
touch  the  tongue.  The  mucous  membrane  covering  the 
uvula  appeared  hypertrophied  into  an  elongation,  extending 
about  a  quarter  of  an  inch  beyond  the  muscular  structure, 
creating  a  constant  inclination  to  hawk  and  scrape  the  throat, 
thereby  exciting  the  mucous  secretion,  which  in  its  turn 
increased  the  efforts  to  clear  the  throat. 

**  The  fEiuces  appeared  redder  than  in  health,  or  rather  of  a 
purplish  hue  ;  the  tonsils  were  but  sUghtly  enlarged*  The 
patient,  whom  I  had  known  well  for  several  years,  had  become 
visibly  emaciated,  his  countenance  was  pale,  and  wore  an 
anxious,  haggard  expression  ;  night  sleep  was  interrupted, 
appetite  and  strength  were  impaired,  all  of  which  he  attri- 
buted to  the  constant  hacking  and  coughing  produced  by  the 
irritability  of  the  fauces,  now  extending  to  the  larynx  and 
trachea.  Besides  this  I  could  not  discover  any  disease  of  the 
respiratory  organs.  In  addition  to  the  above  symptoms  there 
was  a  feeling  as  if  parts  were  swollen,  some  soreness  on 
swallowing,  and  a  frequent  sensation  as  if  a  crumb  had  got 
lodged  in  the  throat,  which  it  was  impossible  to  remove  by 
coughing.  I  prescribed  lachesis  80,  three  doses  of  a  few 
pellets  each,  one  to  be  taken  every  night  and  morning.  I 
saw  the  patient  again  ten  days  after  he  had  taken  the  medicine. 
Upon  examination  I  found  the  throat  almost  well,  the  purple 
hue  had  nearly  disappeared,  the  uvula  no  longer  touched  the 
tongue  nor  adhered  to  the  sides  of  the  tonsils  as  before ;  the 
hacking  cough  had  subsided.  I  prescribed  two  more  doses  of 
lachesiSf  soon  after  which  the  patient  recovered  completely, 
and  he  has  continued  well  up  to  the  present  time." 

In  speaking  of  erotalm^  1  pointed  out  the  kind  of 
diphtheria  to  which  it  is  homoeopathic.  It  is  in  precisely 
the  same  form  that  lachesxs  has  been  used  with  much 
success.  The  late  Dr.  Carroll  Dunham  {Mat.  Med.  ii. 
250),  in  a  description  of  an  epidemic  of  diphtheria  which 
occurred  on  the  banks  of  the  Hudson  Biver,  near  New 
York,  from  1858-60,  very  accurately  depicts  the  symptoms 
of  the  cases  in  which  lachesis  or  crotalus  is  useful.  He 
says:  "Many  cases  occurred  in  which  the  severity  of 
the  constitutional  symptoms  was  very  much  greater  than 
the  local  manifestations  of  the  disease  in  the  pharynx 


&^TS^        SERPENT   VENOM.  37T 

would  have  led  one  to  anticipate.  In  some  cases  «.  •  «. 
ihe  prostration  of  strength  was  quite  alarming;  the 
poise  became,  in  a  yery  short  time,  slow,  feeble,  and 
compressed ;  a  cold,  clammy  sweat  frequently  covered 
the  forehead,  the  breath  was  foetid,  the  appetite  entirely 
destroyed;  indeed  the  patient  passed  with  alarming 
rapidity  into  a  completely  asthenic  condition.  In  these 
cases— in  all  of  which  the  constitutional  symptoms  thus 
predominated  over  the  local — lachesis  produced  prompt 
and  lasting  improvement,  so  that  very  rarely  was  any 
other  medicine  given  subsequently." 

Spasm  of  the  oesophagus  has  been  effectually  relieved 
by  lachesiit,  an  illustration  of  which  is  recorded  iri 
The  British  Jownal  of  Homoeopathy^  vol.  xxxvi.,  p.  875, 
extracted  from  HirscheVs  ZeitschriH  fur  Homoopatkische 
Klinik, 

The  laryngeal  symptoms  excited  by  lachesia  reflect  very 
accurately  a  dry,  tickling  cough,  the  result  of  consider- 
able irritability  of  the  larynx,  not  unfrequently  met  with 
in  the  course  of  phthisis  pulmonitis  in  nervous  sensitive 
persons,  and  also  during  a  slow  recovery  from  a  catarrhal 
cough.  I  have  found  it  very  promptly  remedial  in  cases 
of  this  kind. 

"There  is,"  writes  Dr.  Bayes,  "a  form  of  cough  in 
which  lachesis  has  proved  almost  invariably  curative,. 
i-e.f  after  a  long,  dry,  wheezing  paroxysm  of  cough> 
suddenly  there  is  a  profuse  expectoration  of  frothy, 
tenacious  mucus,  the  expulsion  of  which  gives  great 
idief."    (Applied  Homoeopathy^  p.  109.) 

Lachem  has  been  prescribed  with  great  advantage  in 
cases  of  which  an  irritable  condition  of  the  heart,  as. 
shown  by  palpitation,  a  pulse  varying  widely  both  in 
frequency  and  quality,  together  with  general  weakness 
ttd  mental  depression  are  prominent  features.  The 
tetion  of  naja  on  the  heart  is,  however,  much  more 
distinct  than  that  of  lachesis,  and  of  late  years  it  has 
wipplanted  it  in  the  treatment  of  disorders  of  this  organ 
to  a  very  large  extent. 

In  that  very  serious  form  of  inflammation  which  is 
met  with  in  and  enveloping  the  coecum  l-achesis  has  been 
fcnnd  of  great  service.  Dr.  Black  {Brit.  Jour^  Honuy 
^ol.  v.,  p.  40],  records  a  well-marked  instance  of  its 
^ne.     In  commenting  upon  it  he  says:     *'In  the 

I  proving  of  lachesis  the  following  symptoms  are  reported  :— 
Vol  35,  Ko.  6.  2  E 


378  SERPENT   VENOM.  ^SSSr^JT^SS! 


inflammation  of  the  intestines,  costivenese,  pain  in  the 
hypogastrium ;  painful  stiffness  from  the  loins  to  the 
sacrum,  pains  extending  down  the  thigh.  Urine  turbid, 
scanty,  with  red  sediment;  strangury.  This  patho- 
genesis, coupled  with  my  experience  of  lacJiesis  in  three 
cases  (one  already  reported,  a  second  one  of  costiveness, 
attended  with  pain  and  swelling  in  the  right  iliac  region, 
and  the  third,  where  lachesis  on  two  occasions  appeared 
to  excite  pain  in  the  lumbar  region  and  hypogasbium), 
confirmed  me  in  my  choice  of  lachesis. '* 

In  no  form  of  disordered  health  has  Ia<:he8i8  been  foond 
more  generally  useful  in  relieving  distress  and  pain  than 
when  given  to  control  many  of  the  symptoms  which 
mark  the  climacteric  period  in  women.  Dr.  Holcombe 
recorded  the  following  illustration  of  the  kind  of  case  in 
which  it  is  useful,  in  the  N,  American  Journal  of 
Homoeopathy y  1865  : — 

'  <<  A  lady,  about  the  change  of  life,  the  principal  of  a  large 
pubHc  school,  exhausted  with  study,  business,  and  domestic 
troubles  of  all  kinds,  applied  to  me  for  something  to  quiet  her 
system  at  night.  She  declared  she  had  not  had  half-a-night's 
rest  for  six  weeks.  Feeling  of  intense  weariness,  worse  in  the 
morning,  palpitation  of  the  heart,  with  throbbing  sensation  in 
different  parts  of  the  body,  confused  thoughts,  jactitation  all 
night,  with  extreme  nervousness,  were  her  chief  complaints. 
She  was  tall,  thin,  very  sallow,  coarse  and  dark  skinned, 
melancholy,  irascible,  of  strong  character  and  profound 
religious  convictions.  There  was  a  metallic  ring  about  the 
heart  and  a  jerking  feel  about  the  arteries.  The  animal 
sphere  of  her  life  appeared  flagged  from  exhausted  excitability, 
and  the  vegetative  sphere  torpid. 

''  I  gave  her  one  drop  of  lacliesis  80  on  sugar,  to  be  taken 
every  night  on  going  to  bed. 

*'  She  took  the  medicine  for  twelve  nights,  and  declared 
herself  astonishingly  relieved,  saying  that  she  had  rested 
better  than  she  had  done  for  months.  This  was  three  months 
ago,  and  she  has  made  no  complaint  since.'' 

In  the  treatment  of  yellow  fever.  Dr.  Davis,  of  Natchez 
— a  physician  of  large  experience — prefers  lachesis  to 
crotaliis.  In  purpura,  in  carbuncle,  in  malignant  pustule, 
and  in  gangrene,  lachesis  has  been  used  with  great  snc- 
cess.  Dr.  Dunham  relates  how  he  contracted  a  dissecting 
wound  during  the  post-mortem  examination  of  a  case  of 
puerperal  peritonitis,  and  says  that  both  the  local  and 


SSiJrjSrSw^        SEBPENT  VENOM.  379 

general  symptoms  were  severe,  while  all  yielded  rapidly 
to  lachesis  12. 

In  gangrene,  Dr.  Franklin,  a  surgeon  in  the  Northern 
army  during  the  civil  war  in  the  United  States,  speaks 
highly  of  the  value  of  lachesis.  He  writes:  "  I  have  used 
this  remedy  in  a  number  of  cases  of  gangrene  following 
wounds,  and  have  never  been  disappointed  in  its  results." 

The  blood  poisoning  of  crotalus  is,  however,  so  much 
more  intense  than  that  of  lachesis  that  in  these  essentially 
malignant  diseases  of  the  blood  I  should  prefer  crotalus. 

Lachesis  has  been  given  successfully  in  almost  every 
Tariety  of  dose  from  the  6th  to  the  SOth  dilution.  Inhere 
is  no  advantage  in  going  higher  than  the  sixth,  and  lower 
cannot  at  present  be  obtained,  owing  to  the  difficulty  of 
procuring  venom. 

Naja. 

In  a  few  conditions,  in  which  both  crotalm  and  lachesis 
appear  to  be  equally  well  indicated,  the  poison  of  the 
cobra  snake — the  naja  tripudians — ^has  proved  to  be  the 
best  preparation  of  serpent  venom  to  prescribe. 

The  headache  in  which  naja  is  especially  useful,  is  a 
deeply-seated  aching,  and  occasionally,  shooting  pain 
commencing  in  the  right  temporal  region  and  involving 
the  eye  of  the  same  side.  Similar  pain,  though  less 
frequently,  appears  in  the  opposite  side.  The  mental 
depression  and  restlessness  which  accompany  this 
headache  are  very  severe. 

In  some  cases  of  tonsillitis,  similar  to  those  referred  to 
when  considering  lachesis,  it  has  been  found  very  useful. 
One  symptom  would  especially  strike  one  as  indicating 
it,  viz.,  the  tenderness  of  the  larynx  to  slight  pressure, 
a  pressure  which  at  once  excites  a  cough.  Mr.  Gillow, 
of  Torquay,  contributes  an  illustration  of  this  to  Dr. 
Batherfurd  Bussell's  paper,  in  which  he  introduced  the 
^a  poison  into  medicine  {BriL  Journ.  of  Horn.,  vol.  xii.) 
The  patient  was  a  lady,  26  years  of  age.  She  had  a 
swollen  right  tonsil,  faucial  redness  and  pain  in  the 
tonsil  as  if  produced  by  needles,  with  incessant  cough. 
During  two  days  she  had  prescribed  mercurius  solubilis 
and  aconite  for  herself  without  much  relief,  and  on 
uending  for  Mr.  Gillow,  complained  of  the  symptoms 
mentioned,  together  with  pain  and  cough  on  pressing  the 
larynx*    He  gave  her  half  a  grain  of  the  first  decimal 

E— 2 


380  SERPENT   VENOM.         ^SSSr^S??S^ 


trituration  of  naja  in  eight  tablespoonfuls  of  water,  one 
spoonful  being  a  dose. 

The  next  day  he  found  that,  after  the  first  dose,  she 
had  felt  relief ;  the  cough  almost  entirely  subsided  that 
night,  the  redness  and  swelling  had  disappeared,  tuid  io 
every  respect  she  felt  perfectly  well.  She  had  previously 
had  simUar  attacks,  for  which  she  had  been  treated 
according  to  the  methods  ordinarily  taught  in  the  schools, 
and  they  had  lasted  several  weeks,  and  had  left  her  mnch 
debilitated.  Some  weeks  after  this  attack  she  bad 
another,  which  was  at  once  arrested  by  naja. 

Naja  has  been  found  useful  in  the  irritable  laryngea 
cough  often  so  troublesome  in  phthisis  ;  here  again  the 
symptoms  tenderness  and  cough  on  pressing  the  larynx 
would,  cateris  paribiis^  suggest  its  use. 

In  some  cases  of  heart  disease,  both  functional  and 
organic,  it  has  been  employed  with  the  greatest  advan- 
tage. It  is  in  its  power  to  regulate  the  nervous  force  of 
the  heart  that  naja  has  obtained  the  greatest  confidence 
in  the  minds  of  physicians. 

In  a  lecture  On  Some  Diseases  of  the  Hearty  delivered 
at  the  London  Homoeopafliic  Hospital  in  1854  (Brit.  Jl 
Horn.,  vol.  xii.),  the  late  Dr.  Butherfurd  Bussell  said: — 

''I  can,  firom  personal  repeated  experience,  testify  to  iha 
great  efficacy  of  the  poison  of  naja  trip.  I  have  now  given  it 
in  several  cases  of  palpitation  of  long  standing  with  the  most 
decided  advantage.  One  was  that  of  a  lady,  about  50  years 
of  age,  who  for  about  a  year  had  been  constantly  distressed 
with  almost  unintermitting  palpitation.  No  organic  disease 
existed,  and  it  was  from  the  other  symptoms  manifestly  an 
example  of  irritable  heart.  I  gave  her  a  dose  of  the  i^th  of 
a  grain  of  the  naja  poison  and  the  relief  was  almost  imme- 
diate, and  the  palpitation  did  not  return  for  about  six  weeks, 
when  it  was  again  reUeved  by  the  same  remedy,  Another 
case  was  that  of  a  dissenting  minister,  who  suffered  severely 
from  this  cause  after  preaching,  and  had  tried,  with  more  or 
less  success,  from  time  to  time,  various  homoeopathic  medi- 
cines. In  this  instance,  too,  the  relief  afforded  by  naja  was 
rapid  and  enduring.  I  have  no  doubt,  from  my  own  experi- 
ments, and  from  these  and  other  similar  fiskcts,  that  the  heart 
symptoms  will  occupy  a  prominent  place  in  the  proving  of 
this  medicine." 

Dr.  Bradshaw,  in  a  paper  on  The  Curative  Action  of 
Snake  Poisons,  read  before  the  British  Homoeopathic 
Society,  and  published  in  the  first  volume  of  The  Annak 


Xoothlf  HomoBopailiio 
Bcfiev,  Jmie  1. 1891. 


SERPENT   VENOM. 


381 


of  the  Society,  gave  the  details  of  a  case  of  angina 
pectoris,  occurring  in  an  exceedingly  delicate,  phthisically 
disposed  woman,  in  which  naja  appears  to  have  been 
earative.  She  consulted  Dr.  Bradshaw  for  a  sharp, 
Acnte  pain  in  the  cardiac  region.  ''I  witnessed,"  he 
says,  '*  several  attacks,  and  as  soon  as  the  distress  had 
gone  off  she  seemed  well,  and  chatted  away  as  usual : 
^e  felt  and  looked  as  if  die  were  going  to  die  during  the 
time  of  the  paroxysm  ;  she  has  been  twice  attacked  in 
the  streets,  and  did  not  dare  to  move  a  step  ;  with  the 
exception  of  these  sudden  attacks  of  acute  pain,  she 
seemed  well ;  the  heart  was  healthy  and  the  lungs 
acted  pretty  well."  He  gave  her  various  medicines, 
and,  amongst  others  lacheais^  without  any  decided  result, 
and  then  prescribed  naja.  The  attacks  were  at  once 
modified,  and  after  some  little  time  she  was  free  from 
them. 

I>r.  Bradshaw,  in  the  same  paper,  stated  that  he  had^ 
daring  the  previous  five  years,  seen  three  or  four  cases 
of  valvular  diseases  of  the  heart,  with  dropsical  effusion, 
in  which  life  was  prolonged  and  suffering  alleviated  by 
the  prescribed  remedies,  and  amongst  them  he  had 
found  naja  one  of  the  most  valuable  and  useful. 

The  aching  pain,  the  stiff  tired  feeling  in  the  nape  of 
the  neck,  and  throughout  the  cervical  and  dorsal  section 
of  the  vertebral  canal,  as  well  as  the  obviously  neurotic 
character  of  many  of  the  conditions  which  naja  relieves, 
would  at  once  suggest  it  as  a  remedy  in  some  cases 
of  spinal  irritation,  especially  in  those  where,  in  addition 
to  tenderness  of  the  spinal  column,  we  have  laryngeal, 
cardiac  and,  it  may  be  added,  ovarian  irritation  or  pain. 
Dr.  Bussell  said  {Annals  of  the  Brit.  Ham.  Soc,  vol.  i.) 
that  he  had  seen  some  striking  cases  of  cure  by  naja  of 
the  state  of  hypersesthesia  known  as  spinal  irritation. 

The  following  cases  reported  by  Dr.  Danforth  in  The 
Transactions  of  the  State  Medical  Homa^opathic  Society  of 
NewYork,  is  a  good  example  of  the  neurotic  conditions  cured 
by  naja.  The  patient  was  a  married  woman,  83  years 
of  age,  who  had  suffered  for  three  years  from  headaches 
and  pain  in  the  cardiac  region;  she  was  very  easily 
eicited,  and  had  had  a  fright  two  years  previously,  in 
consequence  of  which  she  spent  a  few  weeks  in  two 
hospitals,  and  then  returned  home  unrelieved.  When 
Br.  Danforth  saw  her  she  complained  of  pain  in  the  left 


882  BRITISH   REPERTOBY.     ^SSSr^S??m! 

temple,  the  cardiac  and  left  oyarian  regions.  She  sup- 
posed that  she  had  ''  heart  disease/'  but  physical  exami- 
nation revealed  nothing  unusual  in  the  sound  of  the 
heart,  or  in  its  action.  She  had  sharp  stabbing  pains 
in  the  cardiac  region,  great  mental  depression;  the 
countenance  wore  an  anxious  expression  of  sadness ;  she 
was  averse  to  talking.  When  thus  gloomy  the  heart 
symptoms  were  greatly  aggravated.  Fain  in  the  left 
ovary  was  simultaneous  with  the  pam  in  the  heart.  The 
sensation  was  as  though  the  heart  and  ovary  were  being 
drawn  together.  There  were  also  numbness  of  the  head 
and  back  of  the  neck,  momentary  vanishing  of  sight, 
and  great  weariness.  After  trying  many  remedies— 
lachesis  being  one  of  them — ^Dr.  Danforth  prescribed 
naja  6.  Complete  relief  followed,  and  in  a  few  days 
she  was  well. 

She  remained  well  for  a  little  more  than  a  year,  when 
she  experienced  a  slight  return  of  the  heart  symptoms, 
and  naja  again  afforded  her  almost  immediate  relief. 

Pain — cramp  or  shooting  in  character — ^in  the  left 
ovary,  a  neuralgic  pain,  is  often  relieved  by  naja. 

The  third  and  sixth  centesimal  dilutions  are  those 
which  have  generally  been  prescribed,  drop  or  two-drop 
doses  being  given  with  a  frequency  proportioned  to  the 
acuteness  of  the  disorder  to  be  relieved. 

Grantham, 

April  10th,  1891. 

INTRODUCTION    TO    THE    BRITISH 

REPERTORY. 

By  Drs.  Drysdale  and  Atkin. 

[As  a  contribution  to  the  important  discussion  res- 
pecting the  indexing  of  the  Materia  Medica,  we  print  (by 
request)  the  Introduction  to  the  British  Repertory.  The 
nature  and  scope  of  this  work  is  fully  explained  in  the 
Introduction,  which  has  been  so  long  out  of  print  that 
it  will  be  new  to  jnany  of  our  readers. — ^Eds.  M .  H.  R*\ 

Preliminary  Bemarks. 

Since  the  publication  of  the  Materia  Medica  and 
Chronic  Diseases,  by  Hahnemann,  the  number  of 
medicines  proved  and  added  to  our  Materia  Medica  has 


r 


53SffjS?nSf"'     BRITISH   REPERTOBY.  383 

been  more  than  doubled.  We  have  twice  the  number  of 
weapons  to  combat  with  disease  that  the  earlier  homoeo- 
pathic practitioners  possessed,  and  yet,  with  this  advan- 
tage, it  is  believed  by  many  that  our  success  is  inferior 
to  theirs;  audit  must  be  admitted  that  our  practical 
gain  has  not  been  equal  to  the  extension  of  the  Materia 
Medica. 

hi  a  system  of  specifics,  where  substitutes  are  im- 
possible, a  restricted  Materia  Medica  cannot  be  as 
serriceable  as  a  more  extensive  one  equally  well  proved 
and  equally  accessible.  The  greater  practical  success  of 
the  earUer  practitioners  can  only  arise  from  one  of  two 
causes : — 1.  They  had  no  repertories,  and  were  obliged 
to  study  Materia  Medica  closely,  and  thus  became 
thoroughly  acquainted  not  only  with  the  details  of  the 
pathogenesis  of  each  medicine,  but  also  with  its  genius 
and  sphere  of  action.  Their  successors,  it  is  to  be  feared, 
too  often  content  themselves  with  a  cursory  examination 
of  a  repertory,  and  neglect  the  systematic  study  of  the 
Materia  Medica.  2.  The  provings  of  the  new  medicines 
may  be  imperfect  or  incorrect,  and  thus  lead  into  error, 
not  only  by  giving  false  information  respecting  them- 
selves, but  also  by  diverting  attention  from  better  and 
more  accurately  proved  medicines ;  just  as  in  the  story 
of  the  "  Forty  thieves  " — the  mark  on  the  one  house  was 
rendered  useless  by  the  addition  of  a  number  of  similar 
marks  on  the  adjoining  houses. 

The  first  of  these  causes  of  non-success,  of  course, 
cannot  be  affected  or  influenced  by  this  repertory.  For 
its  removal  we  must  have  more  patient  and  industrious 
study  of  the  details  of  pathogenesis,  and  more  self- 
experiment  on  the  effects  of  medical  agents ;  more 
attention  to,  and  more  self-gratulation  on,  the  careful 
adaptation  of  a  medicine  to  disease,  rather  than  on  the 
number  of  patients  prescribed  for. 

In  the  construction  of  this  repertory,  the  second  of 
these  causes  has  been  kept  in  view,  and,  to  a  certain 
extent,  we  hope  counteracted  ;  and  much  care  and  labour 
has  been  expended  in  sifting  the  provings,  retaining  what 
is  trustworthy,  and  rejecting,  without  scruple,  every 
doubtful  or  badly  authenticated  symptom.  The  original 
veil  proved  Hahnemannian,  the  Austrian,  and  some 
other  medicines,  have  been  catalogued  with  rigid  verbal 
accuracy.  In  many  of  the  later  provings,  some  symptoms 


384 BRITISH   REPERTORY.      "^S^^^^j^?^! 

only  have  been  taken,  which  from  internal  or  other 
evidence  aj[)pear  to  be  trustworthy,  and  other  symptoms, 
in  their  plain  and  common  sense  meaning,  stripped  of 
redundancies  and  ununportant  particulars. 

This  must  not  be  considered  as  any  disparagement 
oflfered  to  the  authors  of  these  new  provings,  but  only  as 
intimating  that  these  provings  are  not  yet  sufficiently 
complete  and  well  attested  to  be  admitted  side  by  side, 
and  as  of  the  same  authority  with  the  classic  provings 
of  Hahnemann  and  his  coadjutors.  The  highest  possible 
honour  is  due  to  careful  provers  of  new,  or  re-provers  of 
old  medicines.  They  alone  really  advance  homoeopathy. 
It  is  their  labours  that  will  extend  our  knowledge  of 
medical  action,  and  prepare  the  way  for  a  scientific 
-classification  of  the  Materia  Medica.  The  names  of 
popular  or  successful  practitioners  will  easily  be  forgotten. 
The  self-denying  provers  will  win  for  themselves  a  place 
in  the  temple  of  medicine,  and  their  names  will  descend 
to  posterity,  along  with  those  of  Hahnemann  and  his 
fellow  labourers,  as  benefactors  of  their  race. 

If  on  comparing  this  with  other  repertories  some 
symptoms  be  found  in  them  which  are  not  here,  such 
omissions  can  only  be  shown  to  be  a  defect  by  referring 
to  the  original  provings,  and  demonstrating  that  the 
symptoms  omitted  are  trustworthy. 

Explanation  of  the  Peculiarities  and  Mode  op  Usikg 

THIS  Eepertory. 

L 

In  former  repertories  all  that  has  been  attempted  is 
to  give  a  mere  verbal  index  to  the  Materia  Medica.  In 
this  we  have  sought  to  bring  the  meanings  of  the 
symptoms  prominently  forward,  while  at  the  same  time 
we  have  not  neglected  those  finer  shades  of  difference 
which  are  expressed  by  verbal  distinctions.  This  has 
heen  accomplished  by  modifying  the  alphabetical 
arrangement  thus  far : — Under  the  cardinal  word  of  the 
leading  symptom,  which  is  put  down  in  its  proper 
alphabetical  place,  all  symptoms  which  are  varieties  or 
modifications  of  this  leading  s3rmptom  are  arranged; 
<and  all  the  conditions,  concomitants,  and  other  ways  of 
distinguishing  varieties  of  symptoms,  are  brought 
together,  so  that  at  a  glance  the  particular  symptoms 
sought  for  may  be  discovered,  without  the  waste  of  time 


r 


SSSfjStw^      BRITISH   REPERTORY.  385 

eansed  by  hunting  through  the  letters  of  the  alphabet 
mider  which  any  possible  variety  of  symptoms  might  be 
placed.  The  advantage  of  such  an  arrangement  has 
been  partially  recognised  by  Jahr,  and  he  has  added,  as 
a  supplementy  the  collective  conditions  and  con- 
eomitants  of  head  and  eyes  in  his  second  German 
edition. 

II. — COLLBCTTVB   HeADIMOS. 

A  new  feature  is  the  introduction  of  collective  headings. 
For  example :  In  Chapter  IV.,  Eyes,  Section  1,  there  is 
"Discharge/'  followed  by  its  varieties — "  hardening  eye 
gum,"  "mucous,"  "  purulent,"  "  sealing  lids  together," 
"fine  white  foam,"  and  "gumminess."  In  other 
repertories  there  is  a  vague  general  heading,  such  as  "  dis- 
charge," or  "  heat,"  "  pain,"  &c.,  and  under  these  are 
arranged  those  medicines  only  that  are  indicated  In  the 
Matena  Medica  in  the  same  general  vague  way.  But  in  those 
proyings  which  can  be  best  relied  on  for  accuracy  and 
truth,  few  symptoms  are  indicated  in  such  general  terms 
—they  are  described  more  minutely  and  particularly  with 
conditions  and  concomitants.  The  general  heading  in 
the  older  repertories  thus  did  not  include  the  best 
medicines,  but  only  those  that  were  inaccurately  proved 
or  carelessly  reported.  The  rule  we  have  followed  is, 
first,  to  arrange  under  the  sub-headings  all  the  medicines 
vhich  belong  to  each  of  them,  with  the  varieties, 
adjoncts,  conditions,  and  concomitants  specially  bearing 
on  the  subhead ;  then  we  have  gone  over  all  the  sub- 
headings, and  placed  in  the  collective  heading  all  the 
medicines,  retaining  the  adjuncts  which  refer  to  other 
Bymptoms,  and  omitting  all  that  refer  only  to  their  own 
^ial  sub-heading.  In  the  general  headings  in  the  old 
repertories,  only  medicines  with  uncertain  indications 
^ere placed;  in  this,  the  best,  and  those  with  the  most 
precise  indications,  are  grouped  together. 

III. — Pains. 

The  varieties  of  pain  are  so  numerous  that  had  they 
J^een  placed  in  the  first  part  of  the  section  they  would 
have  confused  the  arrangement,  and  rendered  it  more 
difficult  to  consult.  They  have  been  drafted  off  and 
placed  by  themselves,  with  a  statement  indicating  their 
degree  and  general  characteristics,  and  followed  in  most 
-of  the  chapters  by  their  conditions  and  concomitants. 


386  BRITISH   REPERTORY.       "^S^^^S^S! 


Beriew,  Jime  1,  IttL 


forming  Sections  II.  and  III,  They  are  arranged,  not 
alphabetically,  but  in  classes,  for  the  sake  of  grouping 
together  varieties  that  are  similar  and  closely  related  to 
one  another. 

rV. — Section  IV. — Course  and  Pboobess  of 

Symptoms. 

No  previous  repertory  has  attempted  to  show  the 
course  and  progress  of  symptoms.  This  we  have  done 
in  this  section,  giving  first  an  analysis  as  an  index  to  the 
section,  and  then  arranging  the  medicines  alphabetically, 
with  the  symptoms  produced  by  each  verbatim^  and  this, 
we  believe,  will  prove  one  of  the  most  valuable  and 
practically  useful  parts  of  this  work.  Symptoms  have 
been  hitherto  characterised  by  their  description,  con- 
ditions and  concomitants  alone,  and  no  account  has  been 
given  of  their  course  and  progress,  either  with  regard  to 
their  extension  in  direction,  or  the  sequence  of  the 
events  composing  them,  both  of  which  circumstances  are 
most  important  in  the  diagnosis  of  disease,  and,  there- 
fore, of  equal  value  in  choice  of  a  medicine. 

V. — Section  V. — Peculiar  Symptoms. 

In  arranging  the  symptoms  under  the  four  preceding 
sections,  we  found  there  were  a  few  which  could  not 
fairly  be  included  in  any  of  them — ^peculiar  in  character 
and  important  in  their  relation  to  disease.  These  form 
*'  Section  V. — ^Peculiar  Symptoms ;  "  and,  as  in  the  last 
section,  an  analysis  is  first  given,  and  then  the  medicines 
arranged  alphabetically  with  the  symptoms  verbatim. 

VI. — Section  VI. — Local  Section. 

This  local  or  anatomical  section  is  not  peculiar  to  this 
repertory,  but  is  adapted  from  Riickert,  and  contains  all 
those  symptoms  whose  exact  anatomical  seat  is  defined ; 
for  where  an  organ,  or  part,  is  of  tolerably  circumscribed 
dimension,  the  locality  becomes  the  all-important 
circumstance.  Under  each  region  the  symptoms  and 
pains,  with  their  conditions  and  concomitants,  are 
arranged  according  to  the  plaji  of  the  first  section. 

VIL— The  Cypher. 

This  repertory,  consisting  of  the  six  sections  described 
above,  affords  as  much  information  as  it  has 
^hitherto  been  considered  possible  for  a  repertory  to  give, 


r 


S2S?j^?r!B?**       BRITISH   REPERTORY.  387 


Betiev,  June  1, 1891 


m.,  by  it,  any  medicine  that  has,  or  all  the  medicines 
that  have,  one  single  aspect  or  character  of  the 
symptom  required  can  be  easily  and  quickly  found* 
Bat,  mifortunately,  this  is  very  far  from  supplying  the 
wants  of  the  practitioner,  for  in  many  cases  the  single 
character  or  aspect  is  by  itself  of  little  intrinsic  value, 
the  special  characteristics  of  the  Sjrmptom  being  deter- 
mine by  the  combination  of  the  separate  detailed 
drcomst^cesy  whose  description  constitutes  the  symp* 
toms.  It  is,  tiierefore,  necessary  not  only  to  provide  a 
mode  by  which  one  individual  aspect  may  be  found,  but 
also  give  the  entire  detail  of  the  symptom ;  and  as  it  is 
impossible  to  tell  which  of  its  aspects  a  person  may 
select  in  looking  for  a  symptom,  it  follows  that  under 
eaeh  of  all  the  possible  aspects  the  sjrmptom  must  be 
given  in  detail.  This  necessity  has  been  recognised  by 
the  hard-working  and  indefatigable  Jahr,  to  whom  the 
homoeopathic  public  owe  a  deep  debt  of  gratitude  for 
what  he  has  done  in  devoting  all  his  energies  to  render 
the  Materia  Medica  accessible  to  the  practitioner. 
While  he  recognises  this  as  necessary  for  a 
complete  and  perfect  repertory  Jahr  gives  up 
the  task  as  one  of  insurmountable  difficulty,  for 
he  states  in  the  preface  to  his  German  edition  of 
1848,  he  has  calculated  that,  if  upon  an  average,  only 
four  points  of  view  of  each  symptom  were  given,  the 
Qomber  of  necessary  repetitions  is  so  great,  that  for  a 
repertory  worked  out  on  this  plan,  48  volumes,  the  size 
of  his  thick  octavo,  would  be  required ;  "  and  where," 
he  enquires, "  are  we  to  find  the  author — where  the 
publisher — and  where  the  readers  of  such  a  work?  " 

We  believe  we  have  succeeded  in  overcoming  this 
Realty  ;  and  in  these  two  volumes  we  present 
homoBopathic  practitioners  with  a  work  which  possesses 
bU,  and  more  than  all,  the  advantages  contemplated 
aboTe,  in  a  simple  and  accessible  form.  If  any  are 
disposed  to  grumble  at  the  cost  of  this  work,  caused  by 
the  difficulties  in  the  printing  of  it,  or  at  the  trouble 
required  in  mastering  the  system  adopted,  let  them 
remember  the  calculation  of  Jahr,  and  be  thankful  they 
we  neither  compelled  to  buy,  nor  read  the  48  volumes  to 
which  his  perfect  work  would  extend. 

The  machinery  by  which  we  have  accomplished  this 
^k  is  very  simple.    A  system  of  symbols  or  cyphers 


388  BRITISH   REPBRTORT.       "S^i^^ST?^ 


Review,  Jme  1, 1891. 


has  been  devised  by  which  a  whole  symptom  may  be 
expressed  within  the  compass  of  little  more  than  the 
abbreviations    of    the    medicines    ordinarily    used  in 
repertories.     The  abbreviations  of  the  names  of  the 
medicines  have,  in  the  first  place,  all  been  redaced  to  a 
uniform  system  of  three  letters.    All  symptoms  which 
are  common  to  several  organs  are  represented  by  the 
letters  of  the  alphabet  in  Boman  type,  the  symbolical 
value  of  the  letter  being  the  same  throughout  the  book. 
For  example :   "  a,"  appearance ;  "  b,"  coldness ;  "  n," 
haemorrhage,  &c.    Varieties  of  such  general  characttfs 
are  expressed  by  the  addition  of  a  small  letter  above  the 
line  of  the  letter  indicating  the  group  to  which  the 
varieties  belong,   as   "  a,"   appearance ;  "  a* ,"  bright, 
sparkling ;  *'  a®  ,"  dull,  &c.    Those  aspects  or  characters 
peculiar  to  each  chapter  are  expressed  by  thick  Boman 
or  old  English  letters,  as  "A,"  '*b,"  &c.    It  must  be 
remembered,  therefore,  that  the  symbolical  meaning  of 
these  latter  applies  only  to  the  chapter  tn  which  they  occur. 

The  capital  letters,  when  not  numerals,  are  used  ex- 
clusively for  indicating  the  region  in  which  the  symptom 
occurs,  and  are  generally  placed  before  the  abbreviation 
of  the  name  of  the  symptom.  When  two  regions  are 
indicated  in  the  same  cypher,  the  symptoms  belonging  to 
the  second  region  are  inclosed  within  '  a  bracket,  along 
with  the  capital  letter  indicating  the  region.  Thus,  in 
the  chapter  "  Face,"  M.  stan.  c®  VI^.  [Mx**  i*  ] ,  means 
that  stannum  has  shooting  pain  and  rechiess  of  the  cheek, 
along  with  painful  swelling  in  the  upper  jaw. 

The  Boman  numerals  placed  within  brackets,  thus 
(IV.),  indicate  the  section  referred  to. 

The  pains  have  been  arranged  in  nine  classes,  the 
class  expressed  by  Boman  numerals  ;  the  varieties  of 
each  class  by  Arabic  numerals,  appended  to  the  Boman 
numeral  of  the  class  ;  thus  "  VII.^  "  indicates  the  third 
variety  of  the  seventh  class  of  pain.  The  degree,  locality, 
and  direction  of  a  pain  are  indicated  by  the  numeral  L, 
with  a  common  letter  appended,  as  **  I.*  "  violent,  "  L*  '* 
transient,  &c.  The  conditions  are  marked  by  common 
Arabic  numerals  up  to  180,  arranged  in  series  of  five. 
The  concomitants  are  arranged  according  to  the 
Hahnemannian  scheme,  and  are  expressed  by  Greek 
letters. 


r 


SSi'SS??"^*'       BBITI8H  BBPERTORY.  889 


Renew,  June  1. 18B1. 


When  the  letter  referring  to  an  anatomical  division 
stands  alone  between  square  brackets,  this  implies  that 
the  pain  or  symptom  preceding  A.  also  affects  that  part, 
thus:  (Chap.  V-,  Sect.  VI.,  Div.  A.),  cro.  IV.^  V.«  [M]  " 
will  lesA  :  Crocus — '*  drawing,  cramp-like  pain  in  the 
aoricle  and  meatus  eztemus." 

The  italics  r.  and  I.  always  mean  right  and  left. 
Medicines  are  separated  by  a  stroke  "  — ,"  symptoms  in 
the  same  group  by  periods,  and  groups  of  symptoms  of 
the  same  medicine  by  a  semicolon,  thus  :  (Chap.  lY., 
Sect.  I.) — "  c^  aco. — »th. — opi.  a    ;  a®-  i.  o^- ;  e. 

Tables  of  the  abbreviations  of  the  medicines,  the 
general  symbols,  the  pains,  conditions,  and  concomitants 
are  appended  to  this  Introduction.  Lists  of  the  symbols 
special  to  each  chapter  are  given  at  the  beginning  of  the 
ehapter  in  which  they  are  employed. 

To  show  the  appearance  of  the  symptoms  when  thus 
symbolised,  the  following  are  given,  first  in  full  verbal 
description,  and  then  in  cypher. 

Example  :— 

In  chapter  *' Stomach  " — Conium;  "contractive  pain 
in  the  stomach,  and  sensation  of  coldness  therein,  and  in 
the  back,  wakening  her  out  of  sleep  in  the  morning,"  is 
thus  represented  in  cypher  :  Con.  III.i  b*  8-99.     [b*  o-J . 

In  chapter,  "  Teeth  and  Gums  " — Phosphorus ;  "  con- 
tinued tearing  and  boring  in  one  molar  tooth,  worse  by 
touch  and  chewing,"  appears :  Mo.  Pho.  I.^-  V.*  VI.* 
U-60. 

By  the  use  of  this  system  of  symbols  we  have  thus  a 
method  by  which  the  logical  demand  of  a  perfect 
repertory  might  be  satisfied,  viz.  :  thut  every  symptom 
wight  he  given  ^tw  cypher  J  tinder  every  aspect  in  tvhich  it 
could  possibly  present  itself* 


Vni. — Law  of  Selects, 

After  following  this  method  to  a  certain  extent,  it  was 
found  that  niany  of  the  headings  became  so  overloaded 
as  to  preclude  the  possibility  of  gaining  a  knowledge  of 
their  contents  by  a  rapid  general  glance ;  and  some  of 
them  of  a  more  or  less  collective  character,  because  an 
epitome  in  cypher  of  a  great  part  of  a  chapter.  A 
modification  of  this  method  was,  therefore,  introduced, 
which  has  been  termed  by  the  working  members,  "  The 
liaw  of  Selects."     On  looking  at  any  ordinary  repertory 


390  BRITISH   REPERTORY.       "^'°Zr?S* 


Review,  June  1,  un. 


it  will  be  seen  that  many  simple  symptoms  are  bo 
common  that  they  have  a  list  of  60,  80,  ISO,  or  more, 
medicines  after  them.  A  list  of  such  extent  loses  all 
value  as  a  practical  distinctive  indication.  It  ms, 
therefore,  resolved  that  the  medicines  in  any  list  shoald 
be  limited  to  a  moderate  number,  and  those  medicines 
be  selected  which  seemed  best  entitled  to  the  claiin  of 
producing  the  symptoms  idiopathically,  or  in  a  well- 
marked  manner.  By  adopting  this  plan  of  selection, 
besides  the  advantage  of  relieving  over-loaded  headings, 
another  was  obtained,  viz.,  medicines  of  a  restricted  and 
ivell-defined  sphere  of  action,  such  as  sambuatSy  verbascumf 
lamium,  lobelia,  teii<;ritnn,  &c.,  were  given  their  proper 
prominence  in  their  proper  place,  without  over-loadttng 
the  common  headings — such  as  headache,  bad  taste, 
constipation,  where  they  are  quite  superfluous. 

In  carrying  out  this  plan  of  selection,  it  became 
necessary  to  abandon  the  principle  of  complete  cyphering 
of  the  entire  symptom  in  these  select  headings ;  but  in 
working  out  this  change  of  plan,  the  greatest  possible 
practical  difficulties  were  experienced,  for  the  symptoms 
having  sometimes  to  be  inserted  entire,  at  others 
mutilated,  and  some  symptoms  having  to  appear  at  one 
place,  and  be  omitted  wholly  or  partially  at  others,  great 
confusion  crept  in,  and  the  thread  of  the  meaning  was 
often  totally  lost.  We  may  safely  say,  that  owing  to 
these  difficulties,  every  part  of  the  work  has  had  to  be 
done  over  again,  and  in  many  parts  more  than  once; 
and  the  completion  of  the  whole  work  has  been  retarded 
at  least  three  years. 

It  was  discovered  at  length  that  the  only  mode  by 
which  the  principle  could  be  maintained  and  confusion 
avoided  was,  that  in  all  select  headings  those  qualities 
only  should  be  added  in  cypher  to  the  medicine  which 
were .  themselves  select.  In  using  the  repertory,  if  a 
symptom  is  sought  for  composed  only  of  qualities  so 
common  that  there  are  more  than  40  medicines  that 
possess  them,  it  is  indifferent  under  which  of  those 
qualities  it  is  sought  for;  it  will  be  found  under 
all  of  them,  and  with  it  all  the  other  good  medicines 
which  possess  those  qualities.  If,  in  addition,  there 
be  some  more  rare  quality,  it  must  be  looked  for 
under  this,  and  the  whole  symptom  will  be  found  there 
entire. 


£S?J^?i!m^       BRITISH   REPERTORY.  391 

It  was  also  found  necessary  to  admit  into  the  select 
headings  all  those  medicines  which  have,  in  addition  to 
the  common  qualities,  another  or  more  characteristic 
symptom  in  the  same  chapter;  for  though  an  un- 
important medicine  may  not  be  worth  putting  into  such 
headings  as  ''  Distension  of  Abdomen/'  or  "  Heat  of 
Abdomen/'  yet  if  it  possess  both  these  qualities  it  may 
be  sufficiently  determinate  to  require  mention. 

When  this  plan  was  perfected,  of  indicating  under 
every  heading  the  whole  detail  of  the  symptoms  each 
medicine  included  in  the  heading  produces,  it  became  a 
question  whether  it  would  not  be  useful  to  add  to  the 
names  of  the  medicines  the  signs  of  all  the  other 
symptoms  which  the  medicine  produced  in  the  organ. 
For  example,  in  chapter  '' Stomach,"  if  aconite  appear 
from  separate  symptoms  under  the  heads  ''  Heat," 
"Pain,"  "Distension,"  "Nausea,"  might  it  not  be 
useful  under  "  Heat "  to  append  aconite^  the  signs  of  the 
other  symptoms  above-mentioned,  and  also  under  the 
other  headings  in  the  same  way  ? 

After  careful  consideration,  it  was  found  that  this 
addition  was  quite  inadmissible,  and  that  the  only  proper 
plan  was  to  adhere  strictly  to  the  Materia  Eedica,  giving 
each  symptom  exactly  as  it  appears  there,  and  never  to 
link  together  any  parts  of  independent  symptoms.  If 
any  other  course  had  been  pursued  the  greatest  confusion 
vcmld  have  been  introduced,  and  such  artificial  groups 
would  have  in  great  measure  destroyed  the  value  of  the 
Materia  Medica. 

Invariably  every  group  appears  in  this  work,  as  it  is 
found  in  the  provmgs.  For  example,  if  aconite  is  found 
with  the  signs  of  the  four  symptoms  mentioned  above, 
it  means  that  these  four  states  occur  in  one  symptom  in 
the  Materia  Medica.  For  a  full  discussion  of  this 
subject  see  the  introduction  to  the  *^  Hahnemann  Materia 
Medica:' 

IX. — Tests  and  Examples. 

Each  chapter,  when  completed,  has  been  subjected  to 
the  following  tests.  A  series  of  symptoms  were  selected 
from  the  Materia  Medica,  written  out  in  full,  and  given 
to  the  compiler  of  the  chapter,  without  the  names  of  the 
medicines  from  whose  pathogenesis  the  symptoms  were 
taken.    He  then  sought  out  the  medicines  from  his 


892  BRITISH   REPEBTORY.       ^^^^SST^^. 


Beview,  June  1,  UU. 


chapter,  and  sent  their  names  to  the  proposer  of  the 
questions.  If  the  answers  were  defective  or  inaccurate, 
the  chapter  was  revised,  the  deficiencies  suppUed,  and 
the  errors  corrected  ;  and  this  process  of  testing  has 
been  repeated  until  the  answers  were  perfectly  correct. 
The  following  are  specimens  of  these  tests,  and  serve  as 
examples  of  the  mode  of  using  the  repertory : — 

1.  Symptoms  of  a  special  kind,  where  the  elements 
are  so  numerous  that  they  are  probably  produced  only 
by  the  medicine  in  question. 

Teeth. — "  Pain  in  several  teeth,  as  if  they  were  loose 
and  about  to  fall  out — the  pain  not  worse  by  chewing." 
Answered  correctly :  Araenwum.  (This  symptom  is 
found  verbatim  under  the  head  of  '^  Looseness,"  and  is 
also  in  Class  IX.  of  Fains.) 

**  By  cold  eating,  not  by  cold  drinking,  drawing  in  a 
hollow  tooth  through  the  temples."  Answered 
correctly  :  Conium.  (This  is  found  under  68,  "  By  cold 
things,"  with  the  adjuncts  Y.^  drawing  pain,  and  I.^  pain 
in  hollow  teeth ;  and  a  reference  to  Section  IV.^  where  it 
is  found  verbatim  under  pains  going  to  temples.) 

Eyes. — "  Feeling  under  left  upper  eyelid  as  if  a 
cutting  body  there." — Mer. 

Ears. — **  Single  sharp  blows  in  the  inner  ear,  like 
earache." — Nx-xk 

^'  By  chewing,  and  pressing  together  the  jaws,  a 
shooting,  drawing  pain  towards  the  inner  ear^  like 
cramp." — Nx-v. 

2.  Sjrmptoms  of  a  general  kind,  where  the  elements 
are  so  few  that  they  are  probably  produced  by  a  number 
of  medicines.  It  is  unnecessary  to  give  examples  of  the 
answers  to  this  test. 

After  each  chapter  was  thus  perfected,  it  was  placed 
in  the  hands  of  a  third  party,  and  a  series  of  symptoms 
given.  The  time  expended  in  searching  out  the 
medicines  was  noted,  and  the  following  are  some  of  the 
results  obtained  ;  thus  proving  that  the  medicine  which 
produces  the  given  symptom  can  be  not  only  easily,  but 
also  very  quickly  found. 

Nose. — **  Pain  as  if  sore  and  ulcerated  round  the 
borders  of  the  nostrils  on  moving  the  nose,  especially  in 
the  evening."    Nx-v.  found  in  half  a  minute* 

'*  Epis taxis  when  coughing."  Mer*  in  quarter  of  a 
minute. 


w 


uS^.^Su'Sn^       BRITISH   REPERTORY.  393 

Eyes. — "  A  smarting  feeling  of  dryness  in  the  inner 
cftnttii,  morning  in  bed." — Nx-v.  in  quarter  of  a  minute. 

**  Pain  in  the  orbits,  at  times  as  if  eyeballs  torn  out, 
at  times  as  if  pressed  into  the  head,  with  frontal  aching. 
BeL  in  one  minute. 

To  illustrate  still  further  the  completeness  of  this 
work,  take  the  following  symptoms : — 

"Hahnemann  Materia  MedicaJ"*  Aconite;  symptoms, 
140. — "Hard  red  swelling  of  right  upper  lid,  with 
feeling  of  tension,  in  the  morning  especially.''  In  cypher 
it  stands  r  aa.  ii.  L.*  VII.*  8. 

On  turning  to  chapter  "  Eyes,"  Section  I.,  Pains,  the 
symptom  is  given  at  length.  In  Section  IL,  Condition  of 
Pains,  8  morning,  it  again  is  given  in  full.  In  Section 
VI.,  Anatomical  Begions,  L.^  Upper  Eyelid,  the  symptom 
appears  in  full  in  each  of  the  following  headings  : — 

aa.  Bedness. 

aa.  S.  Bedness  in  morning. 

ii.  Swelling. 

ii.  8.  Swelling  in  morning. 

VII.*  Tensive  pain. 

VII.  8.  Tensive  pain  in  morning.  This  single  symp- 
tom is  thus  inserted  in  eight  different  headings — that 
is,  in  every  heading  in  which  it  is  possible  anyone  can 
look  for  it. 

Such  are  the  principles  and  plans  on  which  this 
repertory  has  been  constructed  ;  but  it  is  important  to 
remember  that  however  correct  the  principles  and  per- 
fect the  execution  of  this  work,  it  is  still  merely  a 
rq^ertory,  or  guide  to  the  Materia  Medica,  and  ought 
ncTer  to  be  used  by  the  practitioner  independently  of, 
bat  only  in  subordination  to,  the  Materia  Medica.  If  it 
diyerts  him  from  the  study  and  constant  consultation  of 
the  Materia  Medica,  it  will  prove  a  hindrance  to  his  pro- 
gress, and  lead  him  into  error.  Better  for  him,  and 
better  for  his  patients,  that  he  had  never  seen  such  a 
irork. 

This,  no  more  than  any  other  repertory,  can  distin- 
guish primary  from  secondary,  or  characteristic  from 
subordinate  symptoms,  except,  indeed,  in  so  far  as  these 
may  have  formed  an  element  in  admitting  a  medicine 
into  a  select  heading.  It  cannot  supersede  or  take  the 
place  of  the  Materia  Medica,  which  should  always  be 
consulted  before    prescribing.    It  merely  gives    every 

Vd.  35,  No.  6.  2  F 


894  BRITISH   REPERTORY.       "^SJ^^^jSJiImS! 

individual  symptoms  in  its  essential  entirety,  as  it  stands 
in  the  Materia  Medica,  and  affords  the  same  ground  far 
prescribing  as  correspondence  in  one  symptom  does,  but 
no  more ;  and  miless  in  exceptional  cases,  no  one  ought 
to  prescribe  from  one  symptom  alone. 

This  repertory,  containing  only  the  actual  recorded 
facts  in  their  groups  of  conditions  and  concomitants, 
shows  a  vast  discrepancy  still  existing  between  the 
apparently  superabundant  copiousness  of  the  Materia 
Medica,  and  the  infinite  variety  of  detail  which  exists  in 
the  symptomatology  of  .  disease.  The  number  of 
medicines,  which,  even  in  their  most  general  symptoms, 
possess  three  elements  or  more,  hi  common,  is  very 
small.  For  example — ^nausea  is  produced  by  a  great 
number .  of  medicines  ;  nausea  in  the  morning  by  a 
smaller,  though  still  considerable  number;  nausea  in 
the  morning,  accompanied  by  vertigo,  by  very  few.  To 
enter  into  greater  detail,  in  chapter,  "  Throat,"  the 
symptoms  roiighiiess  or  scraping  is  represented  by  about 
60  or  60  medicines.  Roughness^  and  smarting  or 
hurning  pain  is  represented  by  al-s.t  fca-c,  caL,  n<y., 
hy-x.,  iod.,  ipc,  lob,,  mer.,  mez.^  na-m.,  nx-v.y  &c, — ^in 
all,  22  medicines.  But  roughness,  burning^  or  smarting 
pain,  and  sensation  of  a  foreign  body,  has  only  one, 
rhododendron  ;  or  of  three  elements,  roughness,  pain,  aid 
dysphagia,  has  only  col.  and  ox-x. ;  roughness,  pain,  and 
dryness,  only  ipecacuan. 

As  additional  examples,  in  chapter  "  Stomach."— 
Bitter  taste  has  above  60  medicines. 

Bitter  taste  in  the  morning  has  aim.,  am.,  bry.y  cfl-c., 
clia.,  chi.,  dro,,  k-bi.,  lye,  man.,  nic,  ajfs.,  pru.,  puL, 
Sep.,  sil.,  sul. 

Bitter  taste  and  dryness  of  the  mouth  in  the  morning^ 
only  am.  and  man. 

Pain  in  the  stomach,  with  nausea,  has  28  medicines. 

Pain  in  the  stomach  in  the  morning,  87. 

Pain  in  the  stomach  in  the  morning,  with  nausea,  only 
am-c,  ag-n.,  na-m.,  pul. 

Lastly,  dry  retching  has  45  medicines. 

Dry  retching  in  the  morning,  aln,  kre.,  heL,  not.,  wrf.) 

Dry  retching,  with  eructation,  only  ledum.  Symptoms 
consisting  of  three  or  more  elements  occur  very  often  in 
disease,  and  in  these  are  actually  "covered"  by  the 
ajTnptoms  of  the  medicine  selected  much  less  frequently 


SSSilfjSeTwM^*     .BBITISH  BEPERTORY.  896 

than  is  generally  believed.  Many  who  speak  disparagingly 
of  "  symptom  covering "  seem  to  suppose  that  if  a 
medicine  has  all  the  elements  of  a  symptom,  even  though 
separate  or  in  any  connection,  no  matter  what,  yet  by 
stringing  these  together  artificially,  they  produce  the 
homown  of  the  symptom.  This  is  a  grievous  error,  and 
if  such  persons  fail  in  their  treatment  of  disease,  it  is 
neither  a  failure  of  the  homoeopathic  principle  nor  of  the 
plan  of  covering  symptoms. 

It  may  be  quite  true  'that  in  many  instances  the 
elements  of  a  symptom,  such  as  various  conditions  and 
concomitants.,  are  trivial,  vague,  or  purely  subjective,  and 
therefore  of  no  value  as  characteristics  of  the  medicine ; 
bat  often  this  is  far  from  being  so,  and  in  a  very  large 
proportion  of  cases  no  one  is  able  to  pronounce,  a  priori, 
that  any  element  is  absolutely  worthless,  especially 
when  we  remember  what  we  have  learned  as  homoeo- 
pathists  of  the  infinite  variety  in  actual  disease,  and 
the  necessity  of  nice  discrimination  of  the  minutest 
shades  of  difference  for  proper  homoeopathic  treatment. 
Therefore,  though  without  doubt  it  is  absolutely 
necessary,  for  a  practitioner  to  be  successful,  that  he 
possess  a  proper  pathological  knowledge  of  each  case  of 
disease,  and  a  correct  general  idea  of  the  action  of  each 
individual  medicine  ;  yet  if  he  relies  on  this  knowledge 
alone,  he  will  fail  to  cure  a  very  great  number  of  cases, 
in  treating  which  an  unlearned  and  non-professional 
person,  by  painstaking  and  plodding  covering  of  the 
symptoms,  will  be  successful ;  and  this  explains  the 
frequent  and  undeniable  examples  of  brilliant  cures 
effected  by  laymen.  When  a  case  of  disease  with  a 
sufficient  number  of  well-marked  symptoms  occurs,  and 
when  these  are  all  really  and  actually  covered  by  one 
medicine,  it  can  scarcely  fail  to  be  homoeopathic,  and, 
therefore,  curative,  whether  administered  by  a  person 
ifho  thoroughly  understands  the  nature  of  the  case,  or 
one  ignorant  of  pathology — just  as  the  Daguerreotype 
enables  the  artisan  to  take  as  correct  a  likeness  as  a 
professional  artist. 

Hitherto  it  has  been  almost  impossible  for  a  fully 
occupied  practitioner  accurately  to  cover  symptoms,  or 
U)  carry  out  a  perfect  homoeopathic  treatment,  on  account 
of  the  vast  size  of  the  Materia  Medica,  and  the 
imperfect  guides  he  pc^sessed  in  the  ordinary  repertories 

2  P— 2 


896  BRITISH   BEPEBTORY.       "S^'^S??^. 


Beview,  June  1,  IBU. 


We  offer  one  now,  by  means  of  which  those  wishing  to 
piake  use  of  the  minute  shades  of  symptomatic  difference 
can  do  so  with  moderate  labour  and  a  much  shortened 
expenditure  of  time  ;  and  we  hope  that  the  information 
thus  placed  within  the  reach  of  every  practitioner,  guided 
by  enlightened  pathological  knowledge  of  the  character 
oi  disease  and  the  general  action  of  medicines,  will 
increase  the  success  of  our  body  as  relievers  of  human 
sufferings. 

Many  homoeopathists  who  only  take  a  partial  and 
superficial  view  of  this  subject,  disparage  altogether  the 
attempt  to  obtain  minute  correspondence  between  the 
symptoms  of  disease  and  those  recorded  in  the  Materia 
Medica.  Some  rely  on  the  character  of  the  action  of  the 
medicine  in  general,  which  cannot  indeed  be  displayed 
in  the  small  compass  of  one  symptom  ;  others  rely 
chiefly  on  the  exact  position  {locale)  of  the  symptom, 
and  the  anatomical  seat  of  the  specific  action ;  others 
on  the  concomitant  or  sympathetic  symptoms,  and  so 
on,  each  like  the  knight  of  olden  story,  seeing  the  shield 
from  his  own  special  point  of  view,  and  each  maintaining 
that  his  view  is  the  only  correct  and  important  one. 
But,  in  truth,  in  the  vast  variety  of  human  disease,  each 
of  these  is  in  its  turn  and  proper  place  the  chief  point  of 
reliance,  and  a  repertory  of  the  Homoeopathic  Materia 
Medica  must  present  a  faithful  reflex  of  the  semeiology 
of  disease. 

In  some  classes  of  disease  particular  aspects  of 
symptoms  are  of  most  importance.  In  cases,  for 
example,  of  gout,  hysteria,  and  scorbutus,  the  state  of 
the  system  generally  is  more  important  than  the  exact 
description  of  the  local  pain  or  muscular  disturbance. 
In  diseases  of  some  one  organ,  or  even  of  a  particular 
nerve  or  muscle,  the  exact  seat  or  course  of  the  pain,  and 
the  conditions  as  to  rest  and  movement,  are  most  impor- 
tant. In  muscular,  neuralgic,  or  inflammatory  diseases, 
the  nature  and  kind  of  pain  becomes  of  value.  In  all 
these  cases  this  repertory  gives  very  great  facilities  for 
finding  the  best  indicated  medicine  when  any  one  special 
aspect  is  fixed  on  as  the  most  important.  On  turning  to 
it,  .not  only  are  all  the  best  medicines  recorded,  but  to 
each  is  appended  its  subordinate  aspects  as  adjuncts, 
and^  thus,  though  one  may  not  be  found  that  has  all  the 
elements   of    the    symptom,  those  which  possess  th& 


SSi^jSSirS?*"      BRITISH   REPERTORY.  397 


greatest  nnmber  are  at  once  easily  selected.  Though 
the  characteristic  is  to  be  sought  for  according  to  the 
disease,  at  one  time  under  one,  at  another  under 
a  different  aspect,  yet  it  must  be  remembered  that  this 
is  chiefly  of  service  when  the  correspondence  is  imper- 
fect and  we  cannot  find  a  medicine  that  perfectly  covers 
all  the  given  elements.  A  knowledge  of  pathology  is 
then  useful  in  determining  which  element  or  elements 
can  best  be  spared ;  yet  even  in  this  case  the  most  per- 
fect correspondence  that  it  is  possible  to  obtain  should 
be  sought  for,  and  in  fact,  ceteris  paribus,  the  medicine 
that  covers  the  symptoms  best  will  always  be  the  best 
homoeopathic  remedy. 

The  practitioner,  in  consulting  a  Materia  Medica, 
most  employ  his  knowledge  of  disease  as  a  guide  in 
selecting  the  aspect  he  relies  on  as  most  characteristic 
in  each  individual  case,  and  having  selected  it  on  suffi- 
cient grounds,  he  may  neglect  the  others.  In  the 
repertory  the  whole  are  printed  without  taking  into 
consideration  what  use  may  be  made  in  selecting 
from  them  afterwards  ;  therefore,  a  repertory  cannot, 
any  more  than  a  Materia  Medica  be  used  blindly  and 
without  discrimination.  In  some  cases  an  element — ^for 
example,  a  condition — ^may  be  of  importance ;  in  others, 
of  little  or  none.  If,  then,  one  of  these  latter  be 
selected  erroneously,  a  group  of  medicines  is  pointed  out 
having  no  relation  to  the  case  ;  for  this  the  compiler  of 
the  repertory  is  not  to  blame  ;  he  must  give  all,  and  the 
user  must  discriminate. 

The  condition  is  a  very  important  element  if  it  can  be 
relied  on,  but,  unfortunately,  this  is  not  always  the  case ; 
and  in  nothing  is  our  Materia  Medica  more  defective 
than  in  its  lists  of  conditions.  A  single  observation  may 
be  Bofficient  to  determine  a  circumstance  of  a  positive 
character,  but  a  condition  requires  repeated  observations 
to  determine  whether  it  is  not  altogether  fortuitous.  A 
condition  of  a  time  of  day  may  be  entirely  useless  or 
erroneous,  though  the  fact  may  be  stated  quite  correctly. 
For  example — a  pain  occurring  in  the  evening,  the  con- 
dition, evening,  may  be  quite  accidental,  and  should  not 
be  placed  on  record  till  it  has  repeatedly  occurred.  In 
making  this  repertory,  if  the  conditions  could  have  been 
revised,  the  result  would  have  been  most  useful  ;  but  it 
was  impossible,  and  the  blame  of  incorrectness,  if  error 


'398  OLD.  AND   NEW  REMEDIES.    ^SS^.^^;??^ 


is  detected,  must  be  thrown  on  the  Materia  Medica* 
When  the  Materia  Medica  is  perfect,  then,  and  not  before, 
a  perfect  repertory  may  be  formed.  Something  of  value 
has  been  accomplished  in  this  by  strictly  cataloguing 
the  Hahnemannian  and  other  well-proved  medicines,  and 
by  selecting  the  most  marked  features  of  the  others. 

No  practitioner  ought  to  rely  on  his  pathological  or 
practical  acumen  for  selecting  homoeopathic  remedies, 
without  the  trouble  of  covering  the  symptoms ;  for,  as  in 
art,  the  artist  who  relies  on  his  skill  in  seizing  the  salient 
points  of  the  landscape  to  give  a  correct  picture,  will  in 
no  long  time  find  himself  often  excelled  by  the  artisan 
,working  with  the  Daguerreotype,  which  acts  by  infallible 
physical  laws ;  so  in  medicine — the  mere  general  dealer 
in  specifics  will  find  himself  outdone  in  not  a  few  cases 
by  one  who  rigidly  adheres  to  the  natural  therapeutic 
laws. 

By  the  use  of  the  British  Repertory  the  practitioner 
may  put  his  hand  speedily  on  the  very  medicine  or 
medicines  that  produce  the  given  symptom.  The  descrip- 
tion of  the  case  to  be  treated  ought  to  be  carefully  and 
fully  written  out,  and  each  symptom  searched  out  and 
covered  with  the  medicine,  as  Hahnemann  recommends 
in  the  Introduction  to  the  Materia  Medica  Pura ;  but  no 
one  ought  ever  to  prescribe  from  such  a  piecemeal  source 
as  a  repertory,  but  make  the  rule — and,  as  far  as 
possible,  rigidly  adhere  to  it — of  never  giving  a  medicine 
witlumt  first  consulting  the  proving  in  its  totality  in  the 
Materia  Medica^ 

DE.  GAIEDNEE  ON  OLD  AND  NEW   REMEDIES. 

The  Ulster  Medical  Society  in  Belfast  invited  Dr.  W.  T. 
Gairdner,  Professor  of  Medicine  in  the  University  of 
Glasgow,  to  deliver  an  address.  Dr.  Gairdner  complied 
with  their  invitation,  and  the  address  is  printed  in  the 
British  Medical  Journal  of  the  2nd  May.  We  are  not 
informed  if  the  Society  prescribed  the  subject  on  which 
Dr.  Gairdner  was  invited  to  address  them ;  but  probably 
they  knew  that  the  professor  would  choose  to  speak  on 
some  subject  connected  with  therapeutics,  as  that  is  the 
branch  of  medical  knowledge  with  which  he  is  chiefly 
concerned.  The  subject  he  chose  was  ''  On  BemedieSi 
New  and  Old  ^  Errors  and  Fallacies,  with  Suggestions  for 
the  Improvement  of  Therapeutic  Methods.''    Why  the 


SS^fj^Tw^^    OLD   AND   NEW   BEMEDIES.  899 

Ulster  Society  should  have  invited  Dr.  Gairdner  to 
discourse  to  them  on  therapeutics  when  they  had  among 
themselves  such  a  great  authority  on  therapeutics  as 
their  president,  Dr.  Whitla,  is  not  very  apparent. 
Possibly  they  thought  that  as  Dr.  Whitla  had  already 
expressed  a  very  unfavourable  opinion  respecting  the 
value  of  pharmacological  investigations  to  therapeutics. 
Dr.  Gairdner,  who  in  his  address  at  the  British  Medical 
Aflsociation  in  1887,  which  was  fully  reviewed  in  our  Slst 
volume,  had  formed  a  more  favourable  estimate  of  the 
inflaence  of  pharmacology  in  connection  with  thera- 
peutics, might  take  advantage  of  the  opportunity  given 
him  to  restore  the  fallen  prestige  of  pharmacology  as  the 
handmaid  of  therapeutics.  But  if  the  Belfast  Balaks 
imagined  that  the  Glasgow  Balaam  would  bless  pharma- 
cology, they  would  be  greatly  chagrined  to  find  that  if 
he  did  not  curse  it  altogether  he  damned  it  with  faint 
praise.  "  I  am  not,"  he  says,  "  one  of  those  who  would 
seek  to  limit  the  aspirations,  or  in  any  way  restrict  the 
progress  of  pharmacology ;  but  I  cannot  help  noting  that 
in  respect  of  the  increasing  crowd  of  new  remedies  which 
it  is  bringing  to  light  from  the  abounding  wealth  of  new 
chemical  combinations,  it  is  in  the  meantime  rather 
adding  to  than  diminishing  our  difficulties."  In  other 
words,  pharmacology,  in  Dr.  Gairdner's  opinion  in  place 
of  advancing  is  retarding  therapeutics. 

To  those  of  us  who  remember  Dr.  Gairdner's  virulent 
attack  on  homoeopathy  in  the  Edinburgh  Essays  ^  and  in 
his  later  work  on  Medicine  and  Medical  Education^ 
where  he  not  only  calumniated  Hahnemann,  but  accused 
the  leading  authorities  of  the  homoeopathic  system  of 
dishonourable  conduct  and  falsification  of  their  statistics, 
while  claiming  for  the  practice  of  his  own  school  a  truly 
scientific  character,  and  an  infinite  superiority  over  that 
of  the  homoeopathic  school,  it  is  a  great  treat  to  read 
this  address,  in  which  he  shows  most  conclusively  that 
the  teachings  of  orthodox  medicine  are  utterly  unscien- 
tific, and  their  application  to  practice  most  disastrous. 

He  gives  a  short  history  of  the  use  of  mercury  in 
medicine,  showing  how  it  has  alternately  been  lauded  as 
a  panacea  for  almost  all  diseases,  and  denounced  as  '^  no 
remedy  at  all,  but  simply  and  absolutely  a  poison,  and 
the  source  of  almost  all  that  was  most  virulent  and 
disastrous  in  the  diseases  for  the  cure  of  which  it  was' 


400  OLD   AND   NEW   REMEDIES.     ^^& 


Beview,  June  1,  lan. 


employed."  He  farther  says^  ''  It  must  at  least  be 
admitted  that  in  the  endeavour  by  individuals  to  settle 
definitely  the  position  of  any  one  very  largely  employed 
and  very  active  remedy  [m€rcury\  centuries  have 
been  consumed,  not  perhaps  quite  fruitlessly,  but  still 
very  unsatisfactorily,  in  perpetrating  frightful  abuses, 
of  which  all  of  us  are  now  with  good  reason  ashamed, 
and  which  stand  on  record  as  among  the  worst  opprobria 
of  the  healing  art.  In  order  to  reach  even  a  moderately 
safe,  not  to  say  efficient  or  stable,  position  in  the  thera- 
peutic employment  of  this  one  powerful  drug,  we  have 
been  obliged  to  sacrifice,  on  the  altar  of  individual  effort, 
hecatombs  of  victims,  and  to  stumble  along  paiafully 
through  centuries  of  delusion  and  mischievous  blunders, 
not  to  say  quackeries,  in  the  search  for  only  a  few  grains 
of  solid  truth."  It  would  be  difficult  to  match  anything 
in  Hahnemann's  denunciations  of  the  evils  of  allopathie 
medication  with  this  frightful  picture  of  its  results  drawn 
by  the  hand  of  one  of  its  most  authoritative  teachers. 

Dr.  Gairdner  next  gives  the  history  of  antimony  in 
medicine,  which  is  a  worthy  pendant  to  that  of  mer- 
cury, as  it  shows  the  same  unreasonable  enthusiasm 
for  it  as  an  almost  universal  remedy,  and  the  same 
irrational  denunciation  of  it  as  an  absolute  poison. 

This  completes  Dr.  Gairdner's  account  of  oZd  remedies, 
not  a  very  exhaustive  or  satisfactory  account,  and  not 
certainly  one  redounding  to  the  "  stability  "  of  orthodox 
medicine,  which  formed  the  theme  of  Dr.  Gairdner's 
address  in  1887,  already  alluded  to  as  having  been  folly 
criticised  in  our  31st  volume. 

The  7iew  remedies  treated  of  by  the  writer  are  not 
a  whit  more  creditable  to  the  science  of  orthodox  medi- 
cine than  the  old  ones.  We  have  seen  how  he  sneers 
at  the  results  of  pharmacology  as  deluging  therapeutics 
with  new  medicines,  which,  as  Dr.  Whitla  says,  "  pour 
in  upon  us  at  a  rate  which  prevents  that  thorough 
testing  of  their  qualities  and  actions  so  necessary 
before  the  range  of  the  new  weapons  can  be  accurately 
ascertained."  As  an  instance  of  the  uncertain  action 
and  unknown  power  of  such  new  remedies,  experi- 
menting with  which  on  our  patients,  he  remarks,  does 
"far  more  harm  than  good,"  he  gives  this  charming 
little  episode  from  his  experience  or  experimenting: 
"  Some  time  ago,  in  using  for  the  first  time  a  brand-new 


S*SrjSS1?S?*'     OLD  AND  NEW  REMEDIES.  401 

antipyretic  drug,  then  jast  brought  into  notice  by  a  most 
elaborate  and  thoroagh-going  laboratory  investigation, 
I  was  horrified  and  distressed  at  finding  that  the  very 
first  tangible  e£Fect  brought  about  by  it  was  hematuria, 
or  rather  hsematinuria."  So,  apparently,  Dr.  Gairdner 
does  not  refrain  from  experimenting  on  his  patients  with 
new  drugs,  though  he  tells  us  it  is  productive  of  ''far 
more  harm  than  good."  He  might,  at  least,  have  told 
OS  what  the  antipyretic  was  which  caused  this  remark- 
able symptom.  The  knowledge  would  be  useful  to  us, 
though  to  Dr.  Gairdner  and  his  school  of  no  manner  of 
ase  unless  to  warn  them  from  ever  prescribing  it  under 
any  circumstances. 

Dr.  Gairdner  is  naturally  not  very  jocose  in  this 
address;  the  subject  is  much  too  grave,  and  too  sug- 
gestive of  graves,  with  its  "  hecatombs  of  victims,**  for 
joking,  but  he  does  tell  a  good  story  at  the  expense  of 
old -school  methods  of  investigating  the  action  of 
medicines  which  will  bear  repetition.  A  lady,  the  patient 
of  a  "learned  professor'*  in  Scotland,  possibly  in 
Glasgow,  "  finding  in  her  prescription  something 
unwonted  and  as  she  thought '  uncanny  '  (being  possibly 
an  old  bird  in  therapeutical  experiments),  turned  back 
to  get  a  further  explanation  from  the  professor,  who  was 
by  this  time  fully  occupied  with  someone  else.  But  the 
man  at  the  door  was  equal  to  the  occasion.  Taking  the 
prescription  into  his  hand  he  ran  it  over  with  a  practised 
eye,  even  inured  to  Latin  formula  by  long  and  faithful 
service  in  a  medical  man's  house.  He  returned  the 
paper  to  the  lady  and  showed  her  to  the  door  again, 
with  the  remark,  '  Ou  aye,  mem,  it's  a'  right ;  they^re 
fl  'gettin*  tliat,  the  noo'  The  professor  had  been  experi- 
menting all  round,  more  or  less,  with  some  of  the  more 
miwonted  metallic  salts,  salts  of  titanium,  cadmium, 
tellurium,  palladium,  &c.,  most  of  which,  I  believe, 
tamed  out  to  be  '  tonics,'  with  the  exception  of  one, 
which  had  the  awkward  peculiarity  of  causing  the 
patient  to  shed  abroad  such  a  peculiar  and  disagreeable 
perfume  or  stink  (if  you  will  pardon  the  word)  that  it 
bad  to  be  forthwith  abandoned  on  this  account.'* 

This  story,  when  it  got  abroad,  "  did  not  materially 
detract  from  the  world-wide  fame  of  the  learned 
professor."  Very  likely  not;  possibly  it  might  even 
increase  his  reputation  with  his  old  school  colleagues, 


402  OLD   AND   NEW  REMEDIES.     ^T^^jZ^h^' 

showing,  as  it  did,  that  he  had  the  courage  of  his 
opinions,  and  used  his  patients  mainly  as  subjects  for 
testing  the  action  of  new  drugs ;  for  this ''  experimenting 
all  round  "  is  held,  in  some  allopathic  quarters,  to  be 
the  only  scientific  method  of  adding  to  our  therapeutic 
knowledge.  We  know,  of  course,  that  it  is  an  utterly 
wrong  method,  and  was  conclusively  shown  to  be  such  by 
Hahnemann  in  various  articles  and  works  from 
1796  onwards. 

The  only  new  remedy  Dr.  Gairdner  thinks  is  necessary 
to  consider  at  length  is  Koch's  tuberculinum.  The  history 
of  this  new  remedy  is  even  more  strikingly  illustrative  of 
the  fallacy  of  allopathic  methods  than  is  that  of  the 
old  remedies,  mercury  and  antimony,  as  it  has  all  been 
completed  within  a  few  months.  It  has  besides  had  the 
advantage  of  being  the  outcome  of  pharmacological 
experimentation,  which  was  denied  to  the  older 
remedies.  Hatched  in  the  physiological  laboratory, 
which  we  are  repeatedly  assured  is  the  most  scientific 
machine  for  discovering  the  remedial  powerof  drugs,  before 
even  its  nature  was  divulged  it  secured  the  enthusiastic 
adherence  of  medical  men  of  the  highest  repute  all  over 
the  world,  who,  along  with  crowds  of  lesser  medical  lights, 
flocked  to  Berlin  to  obtain  the  precious  life-giving  lymph. 
A  very  short  trial — on  a  very  large  number  of  patients- 
showed  it  to  be  not  only  useless  but  dangerous,  and,  as 
Dr.  Gairdner  expresses  it  in  a  figure  of  speech,  probably 
suggested  to  him  by  a  stormy  passage  from  Glasgow  to 
Belfast,  "  we  are  now  in  the  very  trough  of  a  wave  of 
reaction,  or  rather  of  discouragement,  from  the  hopes 
aiid  expectations  entertained  in  November  last." 

On  the  whole,  to  judge  from  Dr.  Gairdner's  selected 
specimens  of  old  and  new  remedies,  there  does  not  seem 
to  be  much  difference  in  their  respective  histories. 

The  remedies  of  the  "darker  ages,"  viercury  and 
antimony f  held  their  ground  as  panaceas  for  a  longer 
time  than  do  those  of  our  more  enlightened  times ;  so, 
perhaps,  on  that  account  the  new  remedies  are,  on  the 
whole,  less  injurious  than  the  old;  still,  the  modem 
"scientific"  invention  of  "experimenting  all  round" 
must  cause  a  not  inconsiderable  number  of  victims, 
perhaps  not  far  short  of  the  "  hecatombs  "  credited  to 
the  old  remedies. 


SS^.wTJSSi!^''    OLD  AND  NEW  REMEDIES.  40S 


Baftow,  June  1, 1881. 


Dr.  Gairdner's  lagnbrious  picture  of  the  results  of  the 
methods  hitherto  employed  is  brightened  by  his 
"snggestion  for  the  improvement  of  therapeutic 
methods."  The  authorities  of  traditional  medicine, 
however  disparagingly  they  may  talk  of  the  past  and 
the  present  of  therapeutics,  are  always  ready  to 
prophesy  wonderful  things  for  its  future.  Dr.  Gairdnet 
follows  this  time-honoured  and  excellent  plan.  It  is  a 
habit  of  our  Parliament,  when  they  get  into  a  muddle, 
to  appoint  a  committee.  Dr.  Gairdner  has  evidently 
the  parliamentarian  mind.  He  sees  the  muddle  in  which 
his  school  is  floundering  in  respect  to  therapeutics,  so 
the  committee  idea  immediately  occurs  to  him.  Dr. 
Whitla  had  already  proposed  a  committee  ad  hoc,  but 
Dr.  Gairdner  set  about  ''improving"  Dr.  Whitla's 
'' programme,"  and  instead  of  ''one  committee  sitting 
in  London,"  he  suggests  "  twenty,  thirty,  forty,  or  more 
committees  dispersed  over  the  country."  What  these 
committees  are  to  do  is  not  very  apparent ;  perhaps 
they  are  xo  go  on  "  experimenting  all  round  "  with  "  old 
and  new  remedies,''  or  perhaps  they  are  to  limit  their 
experiments  to  the  lower  animals,  and  go  on  multiplying 
ad  infinitum  the  useless  investigations  already  conducted 
on  a  pretty  considerable  scale  by  Dr.  Lauder  Brunton 
and  his  like.  Anyway,  one  can  confidently  prophesy  that 
Dr.  Gairdner*s  committees,  even  if  they  should  be 
formed,  which  is  doubtful,  will  no  more  tend  to  the 
"improvement  of  therapeutic  methods"  than  the 
"  individual  efforts  "  of  past  and  present  investigators. 

Dr.  Gairdner  has  a  wholesome  contempt  for,  or, 
perhaps,  dread  of,  statistics  in  their  application  to 
medical  problems.  Jle  says :  "  No  one,  perhaps,  in  this 
room  has  had  more  occasion  than  I  have  had  to  remark 
on  the  defects  of  the  statistical  method."  In  his 
celebrated  Edinburgh  Essay  ofi  Homcuopathy  he  tried 
that  method  for  the  purpose  of  discrediting  homoeopathy, 
bat  with  small  success,  for  he  had  to  make  a  "  sequel " 
to  the  essay,  in  which  he  "  felt  that  it  was  due  to  his 
readers  to  correct  and  apologise  for  an  error  "  in  the 
statistics  he  had  given  in  his  essay,  whereby  he  had 
flOQght  to  brand  Dr.  Fleischmann  with  deception  and 
fraudulent  statements  respecting  the  diseases  treated 
by  him  in  the  Vienna  Homoeopathic  Hospital.  In  place 
of  statistics   he  quotes  approvingly   some    words    of 


404  OLD   AND   NEW   REMEDIES.    ^^^.^^S?^. 

Dr.  Maclagan,  ''  IndiTidual  observation   (as  opposed  to 
statistics)  is  that  on  which  we  have  to  rely,"  and  be  says, 
under  certain  circumstances,   ''I  should  quite  frankly 
consider  that  individual  effort  is  greatly    superior  to 
collective    effort    in    dealing    with    all     questions    of 
therapeutics."      Then,  what  on  earth  is  the  use  of  his 
"twenty,  thirty,  forty  or  more    committees "  if  the 
statistics  furnished  by  the  **  collective  efforts  "  are  of 
such  paltry  value  compared  with  the  "  go-as-you-please" 
plan  of  individual  effort  ? 

We  cannot  help  giving  a  chuckle  of  gratification  when 
we  read  the  lamentable  confession  of  the  great  defender 
of  allopathy  and  the  implacable  and  virulent  opponent  of 
homoeopathy  that  the  system  he  has  so  long  championed 
and    taught  to  students  is  altogether  unscientific  and 
unsatisfactory.      Our    bitter   and  unscrupulous  oppo- 
nent   is    doing    penance     in    a    white    sheet    before 
our  eyes.    We  wonder  if   the    reflection   ever  occurs 
to    Dr.    Gairdner,    that    in    spite    of   what    he    has 
said  and  done  there  may,  after  all,  be  a  rule  for  our 
guidance  in  the  administration  of  medicines  in  diseases. 
He  told  us  in  1887  that    he    "recoils   instinctively" 
from  the  idea  that  any  "  exclusive  or  single  principle  or 
law  of  the  healing  art  can  be  said  to  exist."     May  it  not 
be  that  his  "  instinctive  recoiling"  is  merely  a  euphuism 
for  irrational  prejudice,  and  may  it  not  be  that  instinct 
is  a  bad  substitute  for  reason  and  observation  in  judging 
of  facts — even  medical  facts  ? 

Had  Dr.  Gairdner,  84  years  ago,  in  place  of  wa>ging 
ineffectual  war  against  the  only  general  therapeutic  rule 
or  **  law  of  the  healing  art,"  supporting  his  futile 
arguments  by  strong  language,  wholesale  falsification  of 
statistics  (for  which  he  found  it  necessary  to  apologise) 
and  unsupported  accusations  of  fraud  and  dishonesty 
against  honourable  and  respected  colleagues  for  which 
he  did  not  think  it  necessary  to  apologise,  had  he  made 
an  impartial  enquiry  into  the  truth  of  homoeopathy,  and 
tested  it  at  the  bedside,  and  adopted  it  as  his  guiding 
rule  of  treatment,  he  would  not  have  needed  to  make  the 
humiliating  admissions  of  the  imperfection  and  insta^ 
bility  of  therapeutics  which  distinguish  this  address. 
Homoeopathists  cannot  reproach  themselves  with  having 
made  "hecatombs  of  victims,"  with  "perpetrating 
frightful  abuses,  of  which  all  of  us  are  now  with  good 


SSSfj^SirSS*  SPASMODIC   ASTHMA.  405 

reason  ashamed/'  with  '^ consuming  centuries"  what- 
ever that  may  mean,  possibly  somethmg  akin  to  setting 
the  Thames  on  fire.  While  allopathy  is,  accordmg  to 
Dr.  Gairdner,  still  floundering  about  in  a  muddle  of 
uncertainty,  looking  for  help  to  such  ignea  fatui  as 
pharmacology,  by  which  is  meant  cruel  and  delusive 
experiments  on  dogs,  cats,  guinea*pigs  and  frogs,  and 
the  appointment  of  innumerable  committees  for  clincial 
investigation,  in  other  words  ''  experimenting  all  round  " 
on  hapless  patients  with  new  drugs  and  chemical 
compounds,  homoeopathy  pursues  the  even  tenor  of  its 
way,  adding  year  after  year  to  its  treasury  of  remedies 
which  its  guiding  rule  enables  it  to  apply  with  certainty 
and  success  to  the  cure  of  disease,  and  to  the  advantage 
of  suffering  humanity. 

SPASMODIC    ASTHMA,    ILLUSTEATED    BY 

CLINICAL    CASES. 

By  J.  BoBERSON  Day,  M.D.  Lond. 

AniBt  Physician  and  Anaesthetist  to  the  Lond.  Homoeopathic  Hospital ; 
Vinting  Physician  to  Maigaiet  Street  Infirmary  for  Consumption. 

This  remarkable  and  interesting  affection  owes  its 
existence  to  a  variety  of  causes.  The  following  cases 
illustrate  the  neurotic,  bronchitic  and  gouty  bronchitie 
forms  of  asthma. 

F.  C,  set.  27,  married.  Has  suffered  from  spasmodic 
asthma  for  12  years.  She  has  tried  all  kinds  of  treatment 
beforehand.  The  attacks  are  very  severe ;  come  on  at 
night  generally,  especially  at  onset  of  menstruation. 
They  continue  throughout  the  year.  Fogs  make  her 
worse.  She  is  thin  and  spare,  and  during  the  attack  can 
only  take  liquid  nourishment,  but  food  seems  to  have  no 
effect  on  the  attacks. 

She  first  came  under  my  notice  on  Sept.  14th,  1887, 
and  I  gave  Ipecac*  Ix  gtt.j.  pil.  Araen.  8x  j.  Alt. 
two  hours. 

Sept.  26th. — Imp.  last  14  days.    Bep. 

Oct.  10th. — ^Has  gone  longer  than  usual  without  an 
attack.  Had  a  threatening  of  an  attack,  which  passed 
off.    Rep. 

Oct.  28rd. — Continues  to  improve  ;  slight  attack  day 
before  yesterday.    Head  bad  now.    Bep. 

Nov.  7th. — Slight  attack  three  days  ago.    Bep. 

Nov.  27th. — Made  worse  by  bad  fogs.    Rep. 


406  SPASMODIC  ASTHMA.        "SS^L^^T?^ 


Beview,  June  1,  IflBl. 


Dec.  5th. — Only  one  slight  attack.    Gets  thinner. 
Dec.  19th. — ^Very  delighted  that  she  has  no  attacks. 
Kep.  PiL  Arsen.  8x  ter. 

Jan.  2nd,  1888. — ^Had  slight  attack  ten  days  ago.  Now 
has  tonsillitis.    Bell.  Ix  gtt.j.  two  hours. 
Jan.  9th. — Throat  well.    Eep.  Arsen,  alb.  8x. 
Jan.  28rd. — No  further  attacks,  but  now  has  odd  feeliog 
in  chest  and  faintness  afterwards.    Ignat.  Ix  gttj.  ter. 

Feb.  6th. — No  asthma  now.  Rep.  Arsen.  8x  ;m7.  j. 
three  hours. 

Feb.  20th. — Another  slight  attack.    Eep. 
Feb.  27. — Torticollis  ;  throat  gets  dry  at  night,  red 
and  inflamed  tonsils  and  uvula.    Bryon.  Ix  gtt.j.  two 
hours  by  day  ;  Beli.  Ix  gtt.j.  every  hour  at  night. 

Mar.    5th. — Slight  attack  of  dyspnoea.     Rep.  Arsen. 
alb.  8x.  pil.  j.  ter. 
Mar.  26th. — One  slight  attack  again.    Rep. 
Apl.  9th. — ^Bad  pain  in  top  of  head,  a  kind  of  numb- 
ness ;  nervous.    Ignat^  Ix  gtt.j.  ter. 

Apl.  23rd. — Head  better.  Threatening  of  dyspnoea, 
with  aching  chest.    Rep.  Arsen. 

July  2nd. — Now  been  without  medicine  some  time. 
Rep.  Seen  again  on  July  9th  and  28rd,  and  Arsm. 
repeated. 

July  80th. — ^Had  a  fright,  and  menses  ceased.  Cham. 
Sept.  19th. — Asthma  returned  five  days  ago.    Eep. 
Arsen. 

Nov.  14th. — Pain  and  aching  in  chest ;  breathing  con- 
tinues good.     Nervous.    Ignat.  Ix  gtt.j.  three  hours. 

Nov.  19th. — Very  bad  breathing.  Rep.  Arsen.  alb. 
8x  gtt.j.  three  hours. 

Nov.  28th. — Improved,  but  cough  very  bad.    Spits 
much  phlegm.    Rep. 
Dec.  81st. — ^Rep. 

Jan.  28th,  1889.— Still  free  from  attacks.  Nux  V. 
Ix  gtt.j.  ter. 

I  saw  her  again  on  Apl.  16th,  1891,  and  her  appear- 
ance is  quite  changed ;  she  is  now  much  more  healthy 
looking,  and  has  gained  much  flesh ;  she  never  has  any 
attacks  now. 

When  asthma  is  associated  with  chronic  bronchitis  and 
emphysema  with  hypertrophy  of  the  right  heart,  less 
satisfac.tory  results  are  obtained,  but  even  here  Arsetiicum 
with  other  remedies  gives  much  relief* 


SSgJfj^rS??'^       SPASMODIC   ASTHMA. ^ 

The  following  case,  which  is  still  under  treatment,  is 
a  good  illastration : — 

J.  H.,  set.  45. 

Bronchitic  asthma. 

May  I2th,  1890. — CJough  for  last  two  or  three  years  in 
Trinter.  Spits  up  yellow  phlegm ;  breath  short ;  phlegm 
difficult  to  bring  up.    Ipecac.  Ix  gtt.j  three  hours. 

May  28th. — Spasmodic  attack  of  short  breath  at  night. 
Arsen.  3x  gr.  j.,  three  hours. 

June  9th. — Very  much  better.    Bep. 

Sept.  17th. — Rep. 

Oct.  8th.— Rep. 

Nov.  19th. — Onset  of  menopause.  Lacheais  6,  three 
hours. 

Dec.  3rd. — Thinks  the  powders  ^i.e.  Arsenicum  J  do 
most  good.    Rep.  Arsen. 

Feb.  4th,  1891.— Much  better.  Rep. 

Feb.  26th. — Amenorrhoea  since  Dec.  8rd.  Now  has 
flushed  again.     Rep.  Lachesis. 

Apl.  22nd. — Still  has  to  take  the  powders,  which  relieve 
her  very  much  indeed.  The  Lachesis  6  gave  her  much 
relief  from  the  flushes,  but  the  Arsen.  relieves  her  breath- 
ing most.  The  short  breathing  seems  to  come  on  all  at 
once.  She  finds  it  is  not  necessary  now  to  sit  upright 
in  bed  at  night  since  she  has  been  under  treatment. 
£ep.  Arsen. 

A  third  case  is  also  instructive.  S.  S.,  set.  about  60,  a 
solicitor,  of  spare  build,  very  active  habits,  but  exceedingly 
irritable  temperament,  has  been  liable  to  winter  cough, 
and  has  an  emphysematous  chest,  with  wide  costal  angle 
and  hjrpertrophy  of  right  side  of  heart  and  is  subject  to 
attacks  of  asthma  coming  on  at  night,  when  he  has 
always  resorted  to  Himrod's  powder,  with  instant 
temporary  relief.  Gold  east  winds  and  fogs  have  always 
made  him  worse,  but  during  the  summer  he  is  fairly 
comfortable,  only  suffering  from  short  breath  on  exertion, 
such  as  climbing  a  hill.  Ipecac.  Ix  gtt.j,  alternated  with 
Arsen.  8x  gr.j.,  at  intervals  of  2  hours  apart,  gave  him 
much  relief.  He  next  developed  a  slight  attack  of 
gout,  when  Nnx.  V.  Ix  and  Sulph.  8x  did  him  much  good. 
Still,  he  found  the  asthmatic  attacks  at  night  trouble 
him  at  times.  I  found  this  yielded  best  to  small  doses 
of  Iodide  of  potash.  Iodide  of  potash  in  large  doses  has 
been  found  to  produce  cough  and  dyspnoea,  and  no  doubt 


408  SPASMODIC  ASTHMA-      *'^lifj^S??3!! 

in  his  case  it  acted  homoeopathically.  Dr.  Hagfaes 
mentions  that  Dr.  Elb  found  Iodine  so  good  in  the 
spasmodic  dyspnoea  of  croup,  and  considers  the  efficacy 
of  Iodide  of  potash  due  to  the  Iodine  it  contains. 

Besides  the  gouty  element  in  this  patient's  case,  there 
is  also  a  strong  tendency  to  insanity  in  the  family. 

Asthmatic  patients  need  most  careful  dieting,  and  as 
they  are  often  spare  and  badly  nourished  their  strength 
must  be  sustained,  and  their  nutrition  improved.  In 
so-called  Peptic  Asthma,  another  well  known  variety,  the 
attacks  are  brought  on  by  unsuitable  food. 

God-liver  oil  is  a  very  valuable  agent  in  improving  the 
constitution,  and  as  the  patient  gains  weight  he  is  better 
able  to  resist  the  attacks. 

This  is  notably  the  case  in  Neuralgia,  with  which 
disease  Asthma  is  closely  related  ;  so  closely  indeed  thai 
neuralgic  patients  sometimes  become  asthmatic,  and 
vice  versa. 

This  is  well  exemplified  in  the  case  of  F.  C,  who, 
when  first  she  came  to  me,  was  miserably  thin  and 
wretched  looking,  but  now  is  in  decidedly  good 
condition. 

Of  all  remedies  Arsenicum  will  be  found  most  generally 
useful  in  these  cases  at  some  stage  or  another,  and  often 
when  persevered  with  for  a  long  time.  No  doubt,  if  these 
patients  came  under  treatment  early  enough,  Arsenicum 
would  be  able  to  cure  them,  but  too  often  asthma  is  only 
a  symptom  of  some  long  confirmed  affection,  which  has 
led  to  the  production  of  a  physical  state  which  the 
sufferer  must  carry  with  him  to  the  end  of  his  life. 

The  following  case,  in  conclusion,  well  illustrates  this 
point: — 

6.  D.,  set.  40.  Carpenter.  Bigid  chest ;  very  little 
movement  during  respiration,  which  is  almost  wholly 
diaphragmatic. 

He  suffers  from  emphysema  and  bronchitis,  and  has 
an  eczematous  rash  about  the  perinsBum. 

During  the  winter  he  was  regularly  attacked  every 
night  with  severe  dyspncea,  which  woke  him  up  at 
4  a.m.     Since  taking  Arsen.  he  has  been  cured  of  this. 

Netherhall  Gardens, 

Hampstead,  N.W., 


SS^j^rrSS?!*'  REVIEWS.  409 


SeHew,  Jimel,  IWl. 


REVIEWS. 


Heredity,  Health  and  Personal  Beauty.      By  J.  V.  8hoemakeb, 
A.M.,  M.D.    F.  A.  Davis,  Philadelphia  and  London.   1890. 

This  is  a  book  written  for  popular  reading  and  from  an 
American  standpoint.  Beginning  with  several  chapters  on 
the  general  laws  of  evolution,  the  author  proceeds  to  the  main 
subject  of  his  book  and  discourses  on  the  beauty  of  the  fair 
sex  and  the  evolution  of  the  American  girl  who  is  destined, 
in  his  opinion,  to  become  the  highest  type  of  beauty  in  the 
world.  That  she  may  the  more  quickly  attain  this  position 
she  is  duly  instructed,  in  many  pages,  in  the  proper  mode  of 
iralkmg,  in  the  care  of  the  skm,  the  use  of  the  bath,  the 
cosmetic  care  and  treatment  of  the  face,  hands,  nails,  and 
hair,  and  finally  advised  on  the  subjects  of  food,  clothing,  and 
ventilation.  Much  of  this  is  pleasantly  written,  interspersed 
with  anecdotes,  and  contains  a  great  deal  of  sound  advice,  but 
we  are  afiraid  that  this  wholesome  feure  will  be  neglected  by 
the  fail  reader  for  the  large  amount  of  information  given 
them  about  hair-dye,  medicated  soaps,  pomades,  brilliantines, 
and  other  preparations  for  the  toilet,  and  which  though  labelled 
"  not  to  be  touched  "  is  displayed  so  prominently  as  to  afford 
a  strong  temptation  to  the  weaker  vessels.  The  first  chapter 
in  the  book  on  evolution  and  the  laws  of  growth  could  well 
have  been  spared.  The  treatment  of  the  subject  is  very 
sketchy,  and  the  arguments  not  always  very  conclusive  ;  the 
wilting  of  this  part  is  also  very  indifferent,  the  sentences  being 
often  so  involved  and  so  badly  arranged  as  to  be  almost  incom- 
prehensible.   This  does  not  apply  to  the  rest  of  the  book. 

The  work  is  nicely  got  up,  the  paper,  printing  and  binding 
being  aU  good. 


A  Treatise  on  Diseases  of  Hie  Eye.     By  Henbt  C.  A.  Anobll, 
M.D.    Otis  Glapp  and  Son,  Boston,  1891. 

When  a  book  has  reached  its  seventh  edition  it  is  evident 
that  it  fills  a  place  in  the  literature  of  the  subject  of  which  it 
treats,  and  criticism  is  somewhat  disarmed.  Nevertheless,  as 
this  book  is  written  for  homoeopathic  physicians  in  general 
practice,  we  scarcely  think  that  it  comes  up  to  the  require- 
ments of  those  seeking  the  best  homoeopathetic  remedies  for 
Bny  special  affection  of  the  eye,  as  certainly  the  weakest  part 
of  the  book  is  its  therapeutics.  Dr.  Angell  (preface  to  the 
sixth  edition)  thinks  that  the  indications  for  the  remedies 
wonld  fiU  too  large  a  portion  of  the  volume  if  they  had  been 

Vol.  35,  Na  5.  2  b 


410  BKVIEWS.  "Sl^"S??^ 


;  Jnae  1,  I9U 


given  ;  but  still  a  good  deal  more  might  have  been  insertedr 
especially  if  some  of  the  rather  lengthily  recorded  cases  had 
been  omitted,  without  seriously  increasing  the  size  of  the 
book,  and  would  have  very  materially  added  to  its  usefulness. 
It  is  annoying  to  find,  after  reading  up  a  certain  disease,  that 
the  indications  for  the  remedy  must  be  looked  for  in  some 
other  volume.  One  expects  from  a  homoeopath  a  greater 
attention  to  therapeutic  details  than  from  the  modem  medical 
sceptic,  especially  as  we  are  convinced  that  so  much  can  be 
done  for  diseases  of  the  eye  by  well-selected  homoeopathic 
remedies.  We  miss  several  well-tried  and  useful  remedies, 
such  as  argent,  niL,  aumm,  actcca^  graphites,  rhus.,  and  tiUca, 
In  the  section  devoted  to  errors  of  refraction  we  notice  that 
Dr.  Angell  still  uses  the  old  notation,  and  not  the  metric 
measurement,  and  that  he  does  not  give  that  preference  to  the 
shadow  test  in  the  estimation  of  errors  of  refr^tion  which  is 
justly  its  due.  Its  use  is  becoming  much  more  general  in 
England,  at  any  rate,  than  the  measurement  by  the  direct 
method,  which  Dr.  Angell  advocates.  The  examiner  is  less 
likely  to  fall  into  error  if  he  reverses  the  order  of  examination 
advised  by  the  author,  and  first  uses  the  ophthalmoscope,  and 
then  proceeds  to  try  with  the  test  glasses.  The  article  on 
muscular  insufficiency,  which  is  partly  contributed  byDr* 
Parke  Lewis,  is  carefully  written,  and  expresses  the  modem 
view  of  the  question.  The  nomenclature  adopted  is  that  of 
Dr.  Stevens,  and  Maddox's  rod  test,  introduced  last  year,  is 
advocated.  We  are  glad  to  find  that  the  writers  take  a 
moderate  view  of  the  necessity  of  tenotomies  in  these  cases^ 
though  they  have  not  found  such  benefit  from  ocular 
gymnastics  as  some  of  their  American  colleagues  appear  to 
to  have  done.  The  description  of  external  diseases  of  the  eye 
is  good  and  full,  and  the  local  and  general  treatment  carefully 
and  explicitly  given.  The  length  of  time  interstitial  keratitis 
drags  its  weary  way  might  have  been  more  strongly 
emphasised,  as  the  general  practitioner  wants  his  confidence 
more  thoroughly  assured  in  these  cases  than  in  almost  any 
other. 

The  chapters  on  the  internal  diseases,  and  also  those  of  the 
eyelids  and  orbit,  will  repay  the  reader*s  attention  to  them* 
This  edition  is,  to  a  great  extent,  remodelled  and  rewritten, 
and  Dr.  Angell  is  more  original  and  does  not  seem  to  have 
availed  himself  so  largely  "  of  the  privilege  of  taking  and 
appropriating  whatever  he  found  desirable  in  the  stimdard 
works  devoted  to  ophthalmology,"  which  distinguished  the 
earliest  editions. 


SS^J!:?rsS"*        PERISCOPE.  411 


8«viev,  June  1, 18B1. 


PERISCOPE. 

LABYNGOLOGY,  RHINOLOGY,  Etc. 

A  SiMPLB  AMD  East  Method  of  Extbactino  Nasal  Polypi. 
— ^Dr.  E.  Kurz,  of  Florence,  zeoommends  the  following  pro- 
oednre,  which  he  has  employed  with  entire  success  in  two 
cases.  After  having  anaesthetised  the  nasal  mucous  membrane 
by  cocaine,  he  introduces  a  Bellocq's  canula,  and  attaches  to 
its  spring,  when  it  enters  the  mouth,  a  stout  thread  of  waxed 
silk,  wil£  which  are  connected,  at  a  certain  distance  apart, 
three  sponges  of  increasing  size.  The  first  should  be  large 
enough,  in  passing  the  posterior  naris,  to  rub  slightly  against 
its  margins.  The  thread  is  then  drawn  forward,  so  that  the 
first  sponge  sweeps  the  nasal  chamber.  The  polypi  are  thus 
detached  and  brought  away  with  the  sponge.  The  remaining 
sponges  are  intended  to  repeat  the  same  manoeuvre,  in  case 
the  first  fiedls  to  accomplish  its  object,  or  to  tampon  the 
posterior  naris,  should  ablation  of  the  polypi  provoke  smart 
hemorrhage.  In  Dr.  Kurz's  two  cases  the  first  sponge 
sufficed  to  detach  the  growth,  and  the  bleeding  was  so  trifling 
that  a  tampon  was  not  needed.  The  operator  merely  cut  the 
thread  and  withdrew  the  two  sponges  through  the  mouth. 
The  writer  suggests  that  the  same  process  might  be  utilized 
&r  the  extraction  of  foreign  bodies  from  the  nose  when  access 
iB  ^BcTdi.— Med.  Bulletin,  March,  1891. 

ADENoro  Tumours  of  the  Naso-Phabynx  of  Children. — 
Chaumier  says  that  the  adenoid  tumours  in  the  naso-pharynx 
of  children  usually  appear  at  about  the  seventh  or  eighth 
year,  and  disappear  about  the  twentieth.  In  some  cases  they 
are  the  cause  of  nightmare.  In  others  they  become  serious 
by  reason  of  causing  loss  of  hearing  and  arrest  of  intellectual 
development.  In  still  other  cases  they  give  rise  to  bronchitic 
sfbctions.  Early  treatment  cannot,  therefore,  be  too  highly 
leeonunended. — Progrh  Med.,  6, 1891. 

Aprosexcia  Nasalis. — Guye,  of  Amsterdam,  called  the 
attention  of  the  profession,  in  1887,  to  a  disturbance  of  cere- 
bral function,  caused  by  some  disease  in  the  nasal  cavities. 
The  patient  is  unable  to  fix  his  attention  on  any  subject.  The 
difficulty  usually  occurs  in  boys,  who  are  thus  unable  to 
master  their  school  exercises.  During  the  past  two  years, 
Leifert  has  treated  seven  cases  of  this  trouble,  all  boys,  ranging 
in  age  from  11  to  17  years,  and  who  complained  of  loss  of 
memory  and  inability  to  study.  By  treating  the  retro-nasal 
difficulties  they  were  all  cured. — MiincJiener  Med.  WocJienschr, 
4, 1891. 

Neurosis  of  the  Larynx  cured  by  Hyoscyamus. — A  young 
lady  of  18  years,  hysterical,  was  a  prey  to  severe  dyspnoea 
with  very  loud  inspiration,  extreme  anguish,  and  menacing 

2  b— 2 


412  PERISCOPE.  "^5SSL=iS??SS' 


Beview,  June  1,  ISBl. 


asphyxia  as  soon  as  she  lay  doiini ;  there  were  complete 
aphonia  and  pain  in  the  larynx  with  impossible  deglutition. 
Laryngoscopic  examination  and  anscoltation  revealed  nothing 
abnormal.  Pressure  over  the  left  ovary  caused  pain,  and 
instantly  produced  an  hysterical  sleep.  Moschus  Ix  trituration 
administered  every  two  hours,  and  in  ten  centig.  doses  pro- 
duced momentary  relief ;  hyoscy,  6th  produced  an  incomplete 
amelioration ;  the  latter  drug  was  later  prescribed  in  the 
mother  tincture,  three  drops  daily,  which  cured  the  laryngeal 
spasm  in  a  few  days. — Reme  Horn.  Beige ^  1890. 

Paralysis  following  Slight  Dxphthebia.  —  Dr.  Gayton 
reports  a  case  (Brit,  Med,  Jour,,  July  19,  1890)  where  a 
woman,  aged  41,  had  an  attack  of  diphtheria  so  light  as  to  be 
considered  a  simple  sore  throat,  but  which  was  followed  by 
complete  paralysis  and  anaesthesia  of  the  arms  and  legs, 
paroxysmal  convergent  strabismus  of  both  eyes,  with  loss 
of  power  of  accommodation,  paralysis  of  palate,  and  attacks 
ofsjmcope.  The  temperature  meanwhile  was  persistently 
subnormal,  ranging  from  95.4*^  to  98°  Fahr.  Treatment 
consisted,  in  free  stimulation  on  account  of  the  threatened 
cardiac  failure,  and  the  free  administration  of  iron  and 
strychnine.     Recovery. 

I)r.  Lennox  Brown  referring  to  this  case  (Brit,  Med,  Jour,, 
July  26,  1890),  writes  that—*'  It  is  interesting  in  that  it 
enforces  the  fact,  well  known  to  specialists,  that  feincial 
diphtheria  in  the  adult  is  frequently  so  slight  that  the 
diagnosis  is  only  confirmed  on  exhibition  of  post-diphtheritie 
neuroses,  and  it  is  this  circumstance  which  renders  it  im- 
portant not  to  lightly  dismiss  the  sore  throats  of  nurses  and 
parents  in  attendance  on  patients  of  tender  age." 

G.  W.  Haywabd. 

SURGERY. 

Aseptic,  Antiseptic  and  Medicinal  Treatbcent  in  surgical 
cases.  At  the  New  York  Medical  College  and  Hospital 
for  Women  '*  all  prescriptions  are  made  with  a  strict  regard  to 
history  of  the  case '  and  <  totality  of  the  symptoms. '  In  traumatic 
cases,  calendula  is  given  for  clean  cut  wounds  ;  arnica  for  con- 
tusions ;  staphysarpia  for  lacerations ;  and  hypericum  for  wounds 
of  the  nerves. 

« In  cases  where  operative  surgery  becomes  a  dire  necessifyr 
this  work  is  performed  under  strictly  aseptic  conditions. 
Under  no  circumstances  are  carbolic  acid,  bidilorides  or  any 
so-called  antiseptics  allowed  to  enter  the  surgical  ward.  The 
surgical  ward  (in  which  operations  are  performed)  is  thoroughly 
cleansed  and  aired  on  day  appointed  for  operation.     All 


SSS'.T^Sf^SS?*  PERISCOPE.  413 


;  June  1,  ISBl. 


instraments  are  washed  in  clean  hot  water,  thoroaghlj  dried 
and  polished.  Perfectly  clean  sponges,  free  from  all  grit,  are 
laid  in  solution  of  calendula  and  hot  water,  from  which  they 
are  taken  and  squeezed  dry  before  applying  to  wash  away 
blood.  Calendula  has  not  only  a  marked  effect  on  the  healing 
process,  but  is  an  efficient  styptic. 

"Perhaps,  while  under  influence  of  the  anaesthetic 
(ether)  or  while  recovering  from  it,  the  pulse  flags,  or  respira- 
tion becomes  feeble,  possibly  wanting.  In  these  cases  the 
bastinado  is  applied  freely,  the  agent  used  being  wooden  back 
of  a  clothes'  brush,  or  sole  of  a  slipper.  The  effect  of  this 
process,  original  with  Dr.  Edmund  Carleton,  Professor  of 
Surgery,  is  instantaneous,  and  needs  only  to  be  seen  to  be 
appreciated. 

'*  After  the  operation  is  finished,  mur  romica  is  administered 
nntil  effects  of  ether  have  disappeared,  and  then  calendula  is 
precribed  until  symptoms  of  some  remedy  are  present.  Simple 
dressings  are  the  rule.  Occasionally  calendula  is  used  in 
cmjunction  with  that  remedy  internally." — Med.  Advance ^ 
November,  1890. 

Iodoform  Emulsion. — The  following  is  the  formula  recom- 
mended by  Mr.  A.  E.  Barker  for  the  treatment  of  large 
abscesses  : — ^Iodoform  in  finely  crystalline  form,  10  part ;  rect. 
spt.,  enough  to  damp  the  iodoform,  placed  in  a  clean  mortar ; 
dist.  water,  20  parts,  stirred  in  gradually  ;  glycerine,  added 
last  by  degrees,  70  parts. — Brit.  Med,  Jour. 

DISEASES  OP  CHILDREN. 

Spobadig  Cbetinism. — In  a  paper  read  before  the  Manchester 
Medical  Society  Dr.  T.  C.  RaHton  brought  forward  the  case  of 
two  children,  one  eleven  years  old  and  the  other  six  years  and 
three  months,  who  exhibited  well  defined  characteristics  of 
cretinism.  The  two  children  were  the  first  and  fourth 
children  respectively  of  healthy  and  temperate  parents,  who  had 
other  perfectly  healthy  children,  and  who  were  not  related  except 
by  marriage,  coming,  in  fact,  from  different  parts  of  England. 
^  infants  they  both  seemed  bright  and  healthy,  but  between 
one  and  two  years  of  age  development  appeared  to  stop  almost 
completely,  and  they  had  remained  in  that  childish  condition 
both  physically  and  mentally  ever  since.  The  stature  of  the 
elder  is  82}  ins.  and  weight  84  lbs.  ;  of  the  younger  the 
statnre  is  88  ins.  and  the  weight  82^  lbs.  The  organs  of  both 
are  healthy,  and  the  thyroid  gland  can  be  felt  in  the  neck  of 
each  as  a  sxnall  firm  and  unsymmetrical  body.  The  anterior 
fontaneUes  are  closed,  but  there  is  some  flattening  of  the 
vertex.    There  are  no  pseudo-lipomata  present.    The  abdomen 


414  PEM8C0PE.  "SS&%??aj! 


Bertow,  June  1,  IflU. 


is  promiBent,  with  a  small  umbilical  hernia  in  each  case. 
The  lips  are  thick  and  everted,  and  in  the  case  of  the  elder 
the  tongue  protrudes  between  them.  The  featiires  are  broad 
and  coarse,  the  skin  hard  and  of  yellow  tinge,  and  the  limbs 
short  and  thick  but  without  any  distortion.  The  tendon  le- 
actions  are  active ;  there  have  been  no  convulsions. 

Dr.  Bailton  takes  exception  to  Dr.  Boumeville^s  list  of 
distinctions  between  sporadic  and  endemic  cretinism  and 
instances  the  above  two  cases  of  sporadic  cretinism  to  show 
that  those  distinctions  cannot  in  all  cases  be  maintained.  He 
claims  that  the  difference  is  one  of  degree  rather  than  of  kind, 
as  both  endemic  and  sporadic  cretinism  depend  upon  the  same 
fundamental  pathological  condition — namely,  loss  of  fmietioa 
of  the  thyroid  gland. — Brit.  Med,  Joum.,  March  28, 1891. 

Blindness  Ocgubbing  n^  Whooping-couoh. — In  a  large  pro- 
portion of  the  cases  of  blindness  recorded  as  suddenly  coming 
on  during  whooping-cough,  the  patient  died.  Dr.  JacoU 
relates  two  cases  both  ending  in  rapid  recovery.  In  the  first 
case,  a  girl  aged  six,  sudden  total  blindness  occurred;  the 
pupils  were  widely  dilated  and  immobile  to  light  or  acconmio- 
dation,  and  there  was  double  optic  neuritis.  Two  days  later 
the  right  eye  could  recognise  large  objects  and  the  pupil 
reacted  and  the  same  was  the  case  with  the  left  eye  after  two 
days  more.  In  six  weeks  vision  of  both  eyes  was  normal,  and 
the  ophthalmoscopic  examination  negative.  In  the  second 
case,  a  boy  aged  eight,  severe  headache  and  vomiting  took 
place,  and  when  four  days  after  he  was  taken  out  of  the  dark 
room  in  which  he  had  been  placed  he  was  found  to  be  quite 
blind ;  but  in  this  case  the  pupils  were  of  medium  size,  reacted 
well  to  light,  and  the  fundus  was  normal.  Two  days  lat^ 
rapid  improvement  set  in,  for  24  hours  he  had  right  hemia- 
anopsia,  but  within  four  days  vision  was  quite  normal.  The 
blindness  is  thought  to  be  due  to  acute  oedema  of  cerebral 
centres.  The  condition  of  the  pupil  in  the  two  above  cases  is 
typical  of  two  classes.  K  the  pupillary  reflex  is  present  the 
lesion  must  be  above  the  corpora  quadrigemina,  and  between 
them  and  the  occipital  lobes,  and  prognosis  as  to  vision  should 
the  patient  survive  is  good.  If  the  pupillary  reflex  is  lost  the 
lesion  must  be  below  the  corpora  quadrigemina,  and  there  may 
be  permanent  loss  of  sight  from  atrophy  of  the  optic  nerve 
following  neuritis. — Netc  York  Med.  Jowti.,  Feb.  28,  1891. 

Fatal  HiKMOPTYSis  n*  Young  Children. — Severe  hemop- 
tysis in  children  is  rare  from  any  cause,  but  occurs  most 
frequently  from  disease  in  the  tracheo-bronchial  glands,  as  in 
two  cases  recorded  by  M.  A.  Aldibert,  which  were  admitted 
into  the  interne  for  tuberculous  consolidation  in  the  lungs. 
Sudden  copious  haemoptysis  proved  fieital  in  each  case.    Oa 


Sl£?!Srr?S?*'  NOTABILIA.  416 


Befiev,  June  1, 1801. 


post  mortem  this  was  found  to  be  due  to  perforation  of  the 
pulmonary  artery,  due  to  tuberculous  arteritis  in  a  portion  of 
the  artery  traversing  a  mass  of  caseous  and  softening  glands 
at  the  root  of  the  lung,  the  bronchus  being  also  involved  in 
the  mass  and  perforated,  so  that  the  blood  found  its  way  from 
the  artery  to  the  bronchus  through  the  abscess  cavity. — 
Benu  Mensuelle  des  Maladies  de  VEnfance,  February,  1891. 

NOTABILIA. 

THE  ANNUAL  HOMCEOPATHIC  CONGRESS. 
The  circular,  with  full  details,  will  soon  be  in  the  hands  of 
members.  The  Congress,  as  we  stated  in  our  last  issue,  is  to 
be  held  in  London,  on  the  9th  of  July.  The  members  of  the 
Britiflh  Homoeopathic  Society  suggest  that  all  their  confrhres 
in  London  and  its  suburbs  who  have  spare  rooms  should 
extend  their  hospitality  to  their  brethren  &om  the  provinces. 
Dr.  Dyce  Brown,  the  Hon.  Sec.,  will  be  glad  to  have  the 
liames  of  those  who  can  receive  guests,  and  also  the  names  of 
those  who  would  wish  to  avail  themselves  of  the  hospitality  of 
their  brethren. 

PBEBIDENT  OP  THE  INTERNATIONAL  CONGRESS. 
We  have  pleasure  in  announcing  that  Dr.  Talbot  (Dean  of 
sad  Professor  of  Surgery  in  the  Boston  University  School  of 
Medicine)  has  been  chosen  by  the  Committee  of  Arrangements 
A8  President  of  the  forthcoming  Convention,  Dr.  Dudgeon 
having  definitely  declined  the  nomination.  The  British 
EomoBopathic  Society  has  chosen  Dr.  Hughes  as  its  delegate 
and  representative  at  the  Congress. 

LONDON  HOMCEOPATHIC  HOSPITAL  POST- 
GRADUATE LECTURES. 
Kb.  Knox  Shaw  delivered  his  lecture  on  March  6th,  on 
^The  Diagnosis  of  Errors  of  Refraction  and  Anomalous 
AetioQ  of  the  Ocular  Muscles."  In  introducing  the  subject 
he  drew  attention  to  its  importance  to  the  generaJ  body  of  the 
profession,  and  expressed  a  hope  that  his  lecture  would  be 
soffieiently  practical,  so  that,  with  due  avoidance  of 
technicahtieB,  interesting  mostly  to  specialists,  it  would 
«naUe  those  present  quickly  and  easily  to  recognise  an  error 
^  r^raction  when  present. 

Touching  briefly  upon  the  land  of  cases  in  which  errors  of 
Infraction  might  be  suspected,  and  advising  the  routine  use  of 
the  ophthalmoscope  in  all  obscure  nervous  cases,  he  proceeded 
to  describe  the  various  methods  in  vogue  for  determining  the 
«Q8tence  of  refractive  errors. 


416  NOTABILIA.  ^^Z 


Beviev,  June  1,  ian< 


For  general  practitioners  he  advised  reliance  upon  the 
ophthakaoscope  alone,  either  by  the  image  test  or  the  shadow 
test.    He  explained  that  when  the  observer  stands  a  metre's 
distance  from  the  patient  and  illmnines  the  fundus  with  the 
ophthalmoscope,  should  he  see  a  picture  of  any  portion  of  the 
retinal  vessels,  an  error  of  refraction  exists.    If  on  moving 
his  head  shghtly  to  one  side  the  vessels  appear  to  move  with 
him,  the  refraction  is  hyperopic,   and  if   in    the  opposite 
direction,  myopic.    No  picture  of  the  retinal  vessels  is  visible 
in  an  emmetropic  eye.    The  shadow  test,  now  so  much  used 
in  the  estimation  as  well  as  the  diagnosis  of  refraction,  was 
described.    The  ophthalmoscope  mirror  (and  the  lecturer's 
remarks  referred   to    a    concave    mirror,  the    one    usnaUj 
employed)  is  used  in  the  same  way  as  the  former  test ;  bat  is 
gently  rotated  on  its  axis,  either  from  side  to  side  or  up  and 
down.    A  shadow,  the  dark  area  surrounding  the  reflected 
cone  of  light,  is  observed  to  come  out  from  behind  the  iris; 
this  indicates    an   error   of  refraction,  and    its    movement 
indicates    the    kind.      If    the    shadow    moves    with    the 
reflected    light,    the    refraction   is    myopic ;     but  if  the 
light  area  moves    one     way,     and   the     shadow    moves 
in  the  opposite  direction,  the  refraction  is  hyperopic.     The 
image  test  and  the  shadow  test  were  practically  demonstrated 
after  the  lecture  upon  patients,  and  by  the  aid  of  FrosVs 
artificial  eye.     To  simplHy  examination  and  to  aid  diagnosiSf 
the  lecturer  recommended  the  use  of  Savory  and  Moore's 
gelatine  discs  of  hydrohromate  of  Jwnuitropirie  and  cocaine.    One 
of  each  is  placed  in  the  eye,  and  in  twenty  minutes  the  pupil 
is  well  dilated,  and  as  the  effect  passes  off  in  a  few  hours, 
the  patient  is  not  inconvenienced. 

The  second  part  of  the  lecture  was  devoted  to  the  question 
of  anomalous  action  of  the  ocular  muscles.  The  extreme  im- 
portance and  absolute  necessity  of  perfect  equiUbrium  of  the 
ocular  muscles  was  insisted  upon.  Diplopia  being  only  avoided 
when  the  image  of  an  object  (seen  by  the  two  eyes)  isfocussed. 
upon  corresponding  portions  of  the  retina.  It  was  pointed 
out  that  much  attention  had  been  given  to  this  subject  latelyi 
especially  in  America,  where  Dr.  Stevens  had  given  the  name 
heterophoria  to  the  general  condition  of  want  of  equilibrium ; 
hyper-, ex-, eso-phoria,  indicating  the  direction  of  the  devia- 
tion. In  England  the  term  generally  used  was  latent 
strabismus,  the  condition  being  due  to  either  excessive  action 
or  insufficient  action  of  some  of  the  recti  muscles.  Manifest 
strabismus  is  easily  recognisable,  but  in  the  class  of  cases 
under  discussion  the  strabismus  is  not  visible  to  the  obsen'er, 
nor  is  the  patient  aware  of  it,  as  he,  in  order  to  avoid  diplopiftr 
exerts  a  considerable  effort  to  excite  the  deficient  muscles> 


tS^Srr^^  NOTABILIA.  417 


Btfiew,  June  1, 1801. 


and  this  over  excitation  leads  to  the  symptoms  of  aching  pain, 
headache,  vertigo,  and  the  other  safferings  complained  of  hj 
him.  Mr.  Knox  Shaw  considered  the  hest  test  for  this 
deficiency,  and  one  easy  of  application,  was  the  glass  rod  test, 
inirodnced  by  Dr.  Maddox  of  Edinburgh.  Any  glass  rod 
would  do,  such  as  a  stirring  rod,  or  even  a  clinical  thermo- 
meter. Messrs.  Carry  &  Paxton,  of  Great  Portland  Street,  W., 
supply  a  smaU  rod  fitted  into  a  suitable  frame.  On  looking 
through  this  rod  at  a  candle  flame  situate  at  1 5  or  20  feet  distant,, 
the  flsone  appears  converted  into  a  long  thin  line  of  light  at 
light  angles  to  the  direction  of  the  rod.  The  two  objects,  the 
eandle  and  the  line  of  light,  are  so  dissimilar,  that  the  natural 
desire  for  the  fusion  of  the  two  images  is  lessened,  and  so  the 
aetoal  state  of  the  equilibrium  of  the  ocular  muscles  is 
demonstrated.  The  glass  rod  being  held  horizontally  before 
the  right  eye,  across  the  pupil,  a  vertical  line  of  light  is 
seen,  which  should,  in  a  normal  condition,  occupy  almost 
exactly  the  same  position  as  the  candle  flame.  Should  it 
however  be  seen  to  the  left  of  the  candle  flame  there  is  crossed 
diplopia,  or  latent  divergence,  but  if  it  appears  to  the  right 
of  the  flame  there  is  a  homonymous  diplopia,  indicating  latent 
eonvergence.  If,  when  the  rod  is  placed  vertically,  the  line  of 
light  is  above  or  below  the  flame,  instead  of  through  it,  there 
is  abnormal  equilibrium  of  the  superior  or  inferior  recti. 

Haddox*s  instrument  for  exactly  measuring  horizontal 
diplopia  was  then  shown  and  explained,  and  the  lecture  con- 
eluded  by  practical  demonstrations  of  the  rod  test  in  muscular 
deficiencies. 


The  last  of  the  post-graduate  lectures  of  the  Winter  Session 
was  delivered  by  Mr.  Knox  Shaw  on  March  18th,  on'*  Adenoid 
Vegetations  of  the  Naso-pharynx."  In  introducing  the 
sa^'ect  the  lecturer  said  that  though  it  was  only  in  recent 
jears  that  much  attention  had  been  given  to  the  subject  yet 
Ciermak  had  suspected  the  disease  80  years  ago,  but  nothing 
was  seriously  written  about  the  condition  till  Meyer's  paper 
appeared  in  1870,  and  that  paper,  as  it  appeared  in  the 
tnmsactions  of  the  Medico-Ghirurgical  Society,  had  left  but 
litUe  more  to  be  said.  Nevertheless,  the  disease  was  not  yet 
well  recognised,  and  many  patients  were  let  go  unrelieved 
with  most  serious  and  disastrous  consequences  to  themselves. 
After  referring  to  the  anatomy  of  the  naso-pharynx  he  went 
<m  to  describe  the  symptoms  by  which  one  was  to  recognise 
the  affection.  The  aspect  was  one  of  vacancy,  with  narrow 
oose,  fallen  expressionless  under-lip,  and  partially  open  mouth. 
The  voice  was  "  dead,"  and  the  patient  spoke  as  if  the  sub- 
ject of  a  cold.    There  was  often  dea&ess  from  obstruction  of 


418  NOTABiLu.  "SSl^r?!S' 


Review,  June  1,  IBtt. 


the  Eustachian  tubes.    The  patients  were  generally  inatten- 
tive.   They  were  loud  snorers  at  night,  and  this  oeeoned 
especially  in  the  young.    When  this  was  the  case  the  deep 
was  restless,  and  the  child  often  cyanosed.    The  throat  wu 
dry  on  waking,  and  the  patient  appeared  unrefreshed  after 
the  night^s  rest.    The  nose  was  generally  '*  stnfpy  '*  and  the 
jsatient  was  a  **  sniffer."    The  nose  bled  sometimes,  and  there 
was  found  a  bloody  discharge  on  the  pillow  on  waking  in  the 
morning.    In  hemoptysis,  without  obvious  disease  of  the 
lungs,    post-nasal    adenoids    might    be    the    cause  of  the 
haamorrhage,  and  should  be  looked  for.    The  disease  was  said 
to  co-exist  with  large  tonsils,  and  attention  was  drawn  to 
Meyer's  observation  that  this  co-existence  was  the  reason  why 
removal  of  the  tonsils  was  so  frequently  not  followed  by  the 
relief  expected,  as  the  principal  cause  of  the  trouble  was  left 
behind.    It  was  also  pointed  out  that  enlarged  tonsils  do  not 
•cause  buccal  respiration.    The  disease,  too,  was  accompanied 
by  many  nervous  symptoms  such  as  headache,  neuralgia, 
laryngismus  stridulus,  a  short  dry  cough,  and  by  a  constant 
hawking.    If  the  disease  goes  on  for  long  unrelieved  the 
patient  becomes  anaemic,  has  a  badly  developed  chest,  and 
becomes  permanently  deaf.    In  children  there  is  much  in- 
attention ;  due,  in  part,  to  the  deafness,  and  in  part  to  the 
inability  to  fix  their  attention,  a  condition  called  aprosexia. 
They  were  often  backward  and  stupid,  and  this  was  said  to 
be  due  to  the  congestion  of  the  venous  and  intracranial 
systems  due  to  the  imperfect  respiration. 

No  known  cause  was  to  be  found,  nor  was  there  any  special 
diathesis,  but  it  was  undoubtedly  more  common  in  damp 
climates.  Mr.  Knox  Shaw  summed  up  the  diagnosis  by 
describing  the  patient  as  *<  a  stuffy-nosed  snorer,  a  mouth* 
breather,  with  a  dead  voice,  a  vacant  expressid(;,  and  some 
deafriess."  ^ 

On  examining  the  pharynx  the  tonsils  would  gef^rally  be 
found  to  be  enlarged,  the  palate  high,  the  soft'  palate 
(edematous,  and  the  pharynx  granular. 

The  posterior  nares  might  be  examined  with  the  rhinosftpic 
mirror,  but  there  was  nothing  so  good  as  the  finger.     Stew- 
ing beside  the  patient,  and  supporting  his  head  with  the  l6 
hand,   the  right  index    finger  should    be    passed    withoutN. 
hesitation  to  the  tonsillar  region  and  by  a  little  rapid  move- 
ment  passed  behind  the  soft  palate  into  the  posterior  nares. 

On  either  side  would  be  felt  the  enlarged  Luschka's  tonsil, 
and  at  the  vault  the  soft  nodular  mass  of  the  adenoids ;  onoe 
felt  they  are  not  likely  to  be  mistaken  for  anything  else.  On 
withdrawal  of  the  finger  it  will  be  found  to  be  smeared  with 
blood,  as  the  growths  are  soft,  vascular,  and  readily  bleedL 


SS5?jS?r5S^*  NOTABILIA.  419 


When  the  yegetatioiiB  are  producing  obvious  symptoms  they 
should  be  removed.  Medicines  have  some  effect  upon  them, 
but  the  oonfiequences  of  neglect  are  so  serious  that  no  one  is 
justified  in  waiting  long  for  what  must  in  these  cases  be  slow 
medicinal  action. 

As  adjuncts  to  surgical  treatment  drugs  are  of  great  value. 
They  will  chiefly  be  selected  according  to  the  necessity  of  the 
case  from  iodide  of  arsenUt  phosphate  of  Urne^  eangmnaria 
and  iodide  of  iron. 

Most  writers  on  the  subject  have  their  favourite  way  of 
^^erating,  but  the  lecturer  preferred  the  use  of  Lowenberg's 
ioieeps,  using  them  with  the  patient  anssthetised.  There 
J^  httle  after  treatment,  beyond  seeing  that  the  patient  got 
into  the  way  of  being  a  nose-breather,  and  correcting  any 
genend  ill-health  that  might  be  present.  The  prognosis  was 
good  if  the  patients  were  treated  early. 

After  the  lecture  a  patient  was  brought  into  the  room  and 
anssthetised  by  Dr.  Day  and  an  opportunity  was  then  given 
to  some  of  those  present  to  examine  the  case  digitally  and  to 
verify  the  diagnosis  of  post-nasal  adenoids.  A  Mason's  gag 
^as  then  introduced  and  the  mouth  fixed  open  whilst  Mr. 
Knox  8haw  removed  the  adenoids  with  Lowenberg's  forceps. 
The  operation  was  accompanied  by  a  good  deal  of  hsBmorrhage 
i^hieh  soon  stopped,  but  it  was  explained  that  this  is  hardly 
ever  the  cause  of  anv  trouble,  if  it  were  it  should  be  arrested 
Dy  cold  douches.  The  patient's  mother  was  told  to  feed  the 
^d  on  Hquid  food  for  a  few  days. 

CSOIDON    HOMOEOPATHIC  DISPENSARY— BEPOBT 

1890. 

The  numbers  have  more  than  doubled  during  the  last  few 
jean. 

Number  of  patients      1,098 

Number  of  attendances 8,718 

(Signed)  T.  E.  Puedom,  M.D.,  CM. 

J.  Delepine,  M.B.,  CM. 

OXFORD  HOMCEOPATHIO  ASSOCIATION. 

In  our  last  issue,  we  noticed  the  rather  extraordinary  course 
adopted  by  this  Association,  in  expressing  their  desire  to  have 
a  homoeopathic  practitioner  in  Oxford,  while  ignoring  the 
cxisteace  of  Dr.  Guinness,  who  has  been  practising  there  for 
I  I  BO  many  years.  We  since  learn  that  Dr.  Guinness  offered  to 
,  f  deliver  a  lecture  on  homoeopathy,  and  that  this  offer  was 
dedmed,  wlule  they  have  arranged  that  a  clergyman  should 


420  NOTABILIA.  "SSSL^jT?^. 


Beriew,  June  1, 19U 


take  this  duty.  We  should  have  thought  that  however  well 
a  clergyman  might  know  the  subject,  he  could  not  speak  with 
the  same  authority  as  one  who  knew  well  the  practice  as  well 
as  the  theory  of  homoeopathy.  Dr.  Guixmess  was  farther 
requested  to  take  his  name  off  the  Association  membership, 
as  the  intention  was  to  make  it  a  purely  lay  association. 
This  position  is  understandable,  but  such  tactics  seem  to  a» 
absurd,  and  not  likely  to  further  the  cause  of  the  Association 
or  of  homoeopathy.  They  haye  called  forth  a  protesting  letter 
in  an  Oxford  newspaper  from  an  allopathic  doctor,  who  signs 
himself ''  Fair-Play,"  and  we  hear  that  at  least  one  member, 
of  position  and  influence  in  Oxford,  has  withdrawn  his  name, 
in  consequence  from  the  Association. 

HAHNEMANN    HOSPITAL,    PHILADELPHIA. 

The  trustees  of  this  hospital,  in  making  a  claim  on  the  State 
Legislature  for  an  **  appropriation  *'  or  grant  of  money  to 
enable  them  to  pay  off  the  debt  existing  upon  it,  present  the 
following  feMsts  as  justifying  them  in  asking  for  $50,000. 

"  The  hospital  has  treated  852,977  out-patients  from  all 
parts  of  the  State.  It  has  treated  7,487  in-patients  from  all 
parts  of  the  State.  It  has  raised  $177,847  for  the  mainte- 
nance of  patients.  It  has  raised  $296,077  for  building  and 
furnishing  the  hospital,  containing  one-hundred-and-twenty- 
flve  beds.  It  has  raised  $146,058  in  endowment  funds  for 
the  perpetual  support  of  the  hospital.  It  has  a  floating 
indebtedness  of  about  $50,000,  incurred  in  the  erection  and 
equipment  of  the  hospital.  It  is  receiving  in  its  accident 
wards  more  emergency  cases,  as  published  in  the  daily  papers, 
than  all  the  other  college  hospitals  of  Philadelphia  combined. 
It  has  received  only  $50,000  bxmL  the  State  of  Pennsylvania 
for  its  building,  while  the  old  school  hospitals  have  received 
$875,000,  and  it  is  proposed  to  appropriate  to  the  youngest  of 
tixe  latter  $70,000  more." — The  Hahnemamdan  MonUdy. 


THE    INFLUENZA. 

The  following  letter  from  the  Standard  is  of  interest : — 

**  Sir, — We  have  now  experienced  enough  of  the  two  epidemics 
of  what  is  called  <'  Influenza  *'  to  enable  us  to  get  at  some 
idea  of  the  best  treatment  of  the  disease,  and  as  it  is  a  subject 
which  appears  to  interest  the  general  public  more  than  it  does 
the  medical  profession  (who  are  unwilling  to  use  anything  bat 
quinine),  it  may  be  useful  to  put  on  record  the  statistics  of  an 
ordinary  family  doctor  using  unorthodox  remedies. 

Excluding  the  mere  panic  oases,  and  those  which  were  only 
bad  colds,  with  sneezing  (the  old-fashioned  English  "in- 


^fJSrS^  NOTABILU.  421 


Barkv,  June  1, 1801. 


£aenza  *'),  and  taking  only  the  undoubted  cases  of  the  epidemic 
modified  '*  dengue  *'  fever,  I  have  had  under  my  care  in  the 
two  epidemics  210  cases  in  which  the  temperature  rose  over  the 
normal,  generally  as  high  as  100  F.,  and  often  to  104  F. ;  in 
a  small  proportion  the  temperature  was  106.  All  the  cases 
have  recovered  ;  in  only  three  was  there  pneumonia,  and  in 
all  but  these  three  cases  the  temperature  fell  to  the  normal 
within  the  twenty-four  hours ;  most  of  the  cases  fell  to 
normal  in  far  less  time.  I  usually  have  found  it  necessary  to 
pay  only  from  two  to  six  visits,  more  than  half  of  these  being 
merely  on  account  of  the  very  great  dread  that  has  been 
voosed  about  the  disease  by  report.  In  every  case  I  have 
relied  upon  the  drug  geUeminnm,  with  a  very  few  doses  of 
aamiu  to  commence  with,  this  being  stopped  at  the  appearance 
of  perspiration. 

If  your  readers  will  look  at  the  results  of  any  cases  in  which 
the  geUeminum  has  been  administered  in  an  overdose  for  the 
sappression  of  neuralgia,  or  cases  where  accidental  poisoning 
fitnn  this  drug  has  occurred,  or  it  has  been  taken  for  experi- 
ment in  health,  they  will  be  struck  by  the  exact  resemblance 
H)f  the  effects  of  the  large  dose  to  the  symptoms  of  this  ''  in- 
fluenza;" the  confasion  of  the  brain,  staggering  walk,  deep- 
seated  pains  in  the  back  and  muscles,  the  severe  frontal  head- 
ache, Uie  loss  of  appetite  and  nausea,  with  yellowish-white 
iiaiied  tongue,  the  restlessness  and  bad  dreams — the  whole 
aecoont  of  the  effects  of  the  drug  are  a  picture  of  this  disease. 

These  facts  drew  my  attention,  and  no  doubt  that  of  many 
others,  to  the  drug  as  the  best  remedy,  and  I  think  that  the 
lesalts  have  proved  that  it  is  the  best  yet  suggested.  The 
only  disadvantage  in  its  use  is  that  it  has  not  the  stamp  of 
rnpectahility  and  orthodoxy  ;  but  I  think  that  its  other  qualities 
may,  perhaps,  outweigh  ttiat  fact. 

I  am,  Sir,  your  obedient  servant, 

General  PBACTmoNER." 

[We  congratulate  "  General  Practitioner  "  on  his  homoeo- 
pattiie  knowledge.  He  is  on  the  right  road,  and  evidently 
flees  that  the  way  to  get  the  right  medicine  for  a  disease  is  to 
select  one,  the  effects  of  a  large  dose  of  which  form  *'  a  picture 
of  the  disease  '*  to  be  treated.  His  remark  about  the  '*  respecta- 
bility and  orthodoxy  *'  of  the  treatment  is  a  "  sop  to  Cerberus." 
He  will  soon  get  over  this  stage  of  development.] 

CHEMISTS   AND   THE  ANNUAL  HOMOEOPATHIC 

CONGRESS. 
Ix  order  to  make  the  Congress  meeting  as  attractive  as 
possible,  it  is  proposed,  among  other  arrangements,  that 
chemists  should  be  invited  to  send  exhibits  of  anything  new 


422  NOTABILU.  "S^^TTSS^ 


Beyiew,  June  l,  im. 


or  interesting.  Dr.  Dyce  Brown,  the  Hon.  Sec.,  would  be 
glad  to  have  an  intimation  from  any  chemists  who  wish  to 
exhibit,  of  their  intention  to  do  so,  before  July  Ist,  as  &U 
exhibits  must  be  sent  by  Tuesday,  July  7th.  The  meeting 
will  be  at  the  HomoBopathic  Hospital,  where  all  exhibits  are 
to  be  sent. 


CAN     WE     INCREASE     THE    POTENCY    OP    THE 
EEMEDY  BY  DILUTING  THE  DRUGf 

[For  the  following  interesting  notes  we  are  indebted  to  Dr. 

Percy  WHde.] 
An  important  fiact  bearing  upon  this  question  has  resulted 
from  some  investigations  into  ihe  principle  of  the  fluorescence 
of  liquid  solutions. 

It  is  understood  that  this  appearance  in  certain  solutions  is 
due  to  the  chemical  rays  of  light  being  rendered  Tisible  by  a 
change  in  their  refrangibility.  The  molecules  suspended  in 
the  liquid  alter  the  conditions  of  the  ray  of  light  so  that  th» 
length  of  the  wave  is  increased,  while  its  velocity  of  imdulatiou 
is  diminished. 

Some  experiments  recorded  in  the  Journal  of  the  Chemical 
Society,  June,  1889,  show  that  the  fluorescence  of  a  Uqnid 
increases  without  limit  as  the  dilution  increases.  In  the  case 
of  the  ammonium  salt  of  fluorescein,  the  fluorescence  of  a 
concentrated  solution  is  zero,  or  at  least  too  small  to  be 
observed.  When  water  was  gradually  added,  the  fluorescence 
first  attained  a  measurable  viJue  for  a  concentration  of  1  in  25, 
and  rapidly  increased  with  further  dilution  until  the  concen- 
tration was  reduced  to  1  in  8,200,  after  which  it  remained 
constant  as  far  as  the  observations  extended,  namely,  to  a 
concentration  of  1  in  6^  millions.  Similar  results  were 
obtained  with  an  alcoholic  solution  of  Magdala  red,  except 
that  it  was  impossible  to  obtain  very  concentrated  solutions  of 
this  substance,  so  that  it  was  impossible  to  observe  the  be^- 
ning  of  the  fluorescence.  This  fact  that  fluorescent  liquids 
lose  the  power  of  fluorescence  when  they  become  sufficiently 
concentrated  suggested  to  another  observer  that  possibly  the 
groups  of  molecules  existing  in  the  solid  salt  are  only  partially 
dissociated  in  the  concentrated  solution,  but  become  more  and 
more  so  with  increasing  dilution,  until  when  the  fluorescence 
is  no  longer  affected  by  further  dilution,  the  dissociation  is 
complete.  This  hypothesis  is  strengthened  by  the  fact  that 
solution  of  florescein  and  eosin  in  water  have  their  fluorescent 
power  increased  by  heat,  the  effect  of  which  would  be  to 
increase  their  solubility,  whilst  on  the  other  hand,  an  alcoholic 


SIS^^STffi?^    COBRBSPONDBNCE.  423 


Bniew,  June  1,  lan. 


solution  of  Magdala  red,  which  is  less  soluble  in  hot  alcohol 
tium  in  cold,  has  its  fluorescent  power  diminished  by  being 
heated.  This  also  explains  the  well-known  fact  that  an 
aquecms  solution  of  Magdala  red,  which  is  more  soluble  in  hot 
water  than  in  cold,  acquires  fluorescent  properties  when  it  is 
heated,  although  it  does  not  possess  them  when  cold. 

These  facts  prove  that  dilution  of  a  soluble  substance  pro- 
duces a  breaking  up  of  clusters  of  molecules,  which,  under 
Qcdinary  circumstances,  would  exist  as  aggregations,  and  it 
does  not  appear  impossible  that  the  separated  molecule  may 
find  its  way  through  the  numerous  barriers  which  are  exposed 
between  the  digestive  canal  and  the  nerve  centre  it  is  designed 
to  influence,  when  the  molecules,  in  their  aggregate  form, 
would  fiul  to  reach  it,  and  be  thrown  back  and  excreted. 
That  in  profound  constitutional  disorders  the  higher  dilutions 
succeed  where  all  other  remedies  have  failed  is  a  fact  recog- 
nised by  all  who  have  employed  them,  and  that  there  is  a  purely 
physical  cause  for  this  beicomes  clearer  as  our  knowledge  of 
the  physics  of  solution  and  the  functions  of  the  human  body 
increase. 


CORRESPONDENCE. 


THE  INDEX   TO  THE  "  CYCLOPAEDIA." 

To  the  Editors  of  the  **  MontJdy  Homceopaihu'  Eevieic.'* 

Gentlemen, — I  am  glad  to  see  discussion  opened,  by  Dr. 
Drysdale's  paper  in  your  current  number,  on  the  plan  for  the 
Index  to  the  Cyclopasdia  of  Drug  Pathogenesy,  laid  by  me 
before  last  year's  Congress.  As  I  hope  that  others  will  take 
pttt  in  it,  I  will  reserve  my  reply  till  several  at  least  have  spoken. 
I  only  write  to  you  now  to  ask  you  to  allow  me  to  repudiate, 
in  the  most  earnest  manner,  the  **  ridicule  and  abhorrence  " 
to  which  Dr.  Drysdale  represents  me  as  holding  up  the  cypher 
system.  It  would  ill  become  me  to  entertain,  still  more  to 
opress,  such  sentiments  towards  a  method  devised  and 
practised  by  some  of  the  best  and  mostesteemed  friends.  What 
I  spoke  of  at  Bournemouth  was  simply  the  impression  made 
by  the  cypher  on  the  readers  for  whom  it  was  intended,  and 
which  had  robbed  the  repertory  it  characterises  of  the  success 
which  is  so  justly  merits. 

I  am,  Gentlemen, 

Yours  very  faithfully, 

BICHABD  HUGHES. 
Biighton,  May  4,  1891. 


424  CORRESPONDENTS.       ^'S'BlL^f?™? 


Beview,  June  1,  UAL 


NOTICES  TO    CORRESPONDENTS. 

London  Homceopathic  Hosfital,  Great  Obmoxd  Strket, 
Bloombbuby. — Hours  of  attendance  :  Medical,  In-patients,  9.30 ;  Out- 
patients, 2.80,  daily ;  Surgical,  Mondays  and  Thursdays,  2.30  ;  DiaesaeB 
of  Women,  Tuesdays  and  Fridays,  2.30  ;  Diseases  of  Skin.  Thuzdays, 
2.80  ;  Diseases  of  the  Eye,  Thursdays,  2.80  ;  Diseases  of  the  Ear,  Satnr- 
^ys,  2.80  ;  Dentist,  Mondlays,  2.30  ;  Operations.  Mondays,  2. 

Dr.  W.  Reed  Hill,  of  Colchester,  attends  Clacton-on-Sea  for  god? 
sultation  at  the  Public  Hall,  every  Tuesday  afternoon. 

Dr.  Thomas,  of  Llandudno,  who  has  hitiierto  confined  his  practice  to 
patients  residing  in  the  Hydropathic  establishment,  has  now  ansnged 
to  extend  it  to  those  outside  who  may  wish  his  services. 

We  are  requested  to  state  that  Mr.  Ctbus  Clifton,  of  Taunton,  u 
removing  to  Hunstanton. 

Communications,  &c.,  have  been  received  from  Dr.  Dudgeon,  Br. 
J.  G.  Blacklby,  Mr.  Enox  Shaw,  Mr.  G.A.  Cboss,  Dr.  Day  (London); 
Dr.  Hughes  (Brighton) ;  Dr.  Stonham  (Ventnor) ;  Dr.  Haywabd, 
Dr.  MUBBAY  MooBE  (Liverpool)  ;  The  Oxford  Homoeopathic  Aasocu- 
tion ;  Mr.  Cybus  Clifton  (Taunton). 

BOOKS    RECEIVED. 

Materia  Medioa  and  Tlwrapeut'wt^  with  especial  rrferenee  to  tiw 
Clinical  Aj)pliralio7b  of  Drugs.    By  John  V.  Shoemaker,  A.M.,  M.D., 
Professor  of  Materia  Medica  and  Diseases  of  the  Skin  in  the  Medioo- 
Chirurgical  College  of  Philadelphia.    Vol.  ii.,  being  an  independent 
volume  upon  drugs.    Philadelphia  and  London :  F.  A.  Davis.    1891.— 
A  Note  for  the  Sueeessful  Treatment  of  Diphtheria^  Jji't:    By  Henry 
Thomas,  M.D.     London :    Kegan    Paul,  &c.      18U1. — A   Treatise  on 
Diseases  of  the  Eye.     Seventh  edition.     By  Henry  0.  Angell,  M.D. 
Boston  :  Otis  Clapp  &  Son.     1891.— T^  Public  Health.    Leprosy  and 
Vaceination.    By  William  Tebb.    London :  E.  W.  Allen.    U^\,—Tke 
Oxford  Xews.    May  13. — TJie  Hovieeopathie  World.    London.    May. 
— The  Cliemist  and  Druggist.  London.    May. — The  Monthly  Magazine 
of  Pharmacy,     London.      May. — The    North    American   Journal  ef 
HomoBopathy.     New  York.      April. — The  New  y^ork  Medical  Timet, 
April  and  May. — 27ie   Chironian,     New  York.     May. — The  Medical 
Record,  New  York.  May  2.^The  New  England  Medical  Oazette.  Bos- 
ton.   April  and  May. — The  JJahnemann  Monthly.    Philadelphia.  April 
and  May. — Tlie  Jlomwopathic  Physician.    Philadelphia.    May.— I1k<? 
Medical  Era,  Chicago.  May. — The  Clin ique,  Chicago.  April. — The  New 
Remedies.    Chicago.    May. — The  Medical  Adeance,    Chicago.    ApriL 
— Tlie  Southern  Journal  of  Homoeopathy,    New  Orleans.     ApriL— T** 
Indiunapolis  News.    February  4. — The  Indianapolis  Journal.  April  6. 
— The  California  Homceopath,     San   Francisco.    February  and  April. 
— La  M(&decine  Hypodei'mique.    Paris.    April. — Betue  Homwopathifite 
Beige.     Brussels.     February. — Bulletin   Ohierale  de  TherapeutiqMt, 
Pans.    May. — Rerue   Homasopathi^ue   Franfaise.    Paris.    April  and 
May. — Allgem.  Ho^n.  Zeitung,    Leipzig.    May. — Fopuldre  Zeitsekrifi 
/iir  Homoo]>athie.  Leipzig.  May. — Rcvista  Omiopatica.    Rome.   Apnl. 
— Oazetta  Medica  Di  Torino,    Turin.    April  and  May. — La  Reforma 
Medica.    Mexico.    February. — Uomasopathisch  Maandblad.    May. 

Papers,  Dispensary  Beports,  and  Books  for  Beview  to  be  sent  to  Dr.  Pops,  lif 
Watogate,  Grantham,  LincohishiTe ;  Dr.  D.  Dycs  Browk,  89,  SOTmoor  StrMfc,  Port- 
man  Square,  W.;  or  to  Dr.  Edwix  A.  Nkatbt,  161,  Haverstodc  Bill,  N.W.  Adnrttse- 
ments  and  Busineas  commimications  to  be  sent  to  Mesas.  E.  Gould  ft  Son,  H^ 
Moorgate  Street,  E.C. 


l£St?J^SM§f?~        BEE   STING   POISON.  425 


THE    MONTHLY 

HOMCEOPATHIC    REVIEW. 


■:o:- 


ON  THE  MEDICINAL  USES  OF  THE  BEE  STING 

POISON.* 

By  W.  T.  Pernie,  M.D, 

Mb.  President  and  Gentlemen, — On  the  occasion  of  our 
Iftst  meeting  here,  Dr.  Galley  Blackley  made  a  playful 
reference  to  me  as  having  awoke,  after  a  three  years' 
slamber,  to  some  sense  of  my  responsibility  towards 
this  Society.  I  ask  your  permission  to  explain  that  it  is 
a  priTilege  of  the  old  to  sleep,  and  that  feeling  myself 
considerably  superannuated  among  so  many  younger 
men  in  the  plentitude  of  their  modern  learning,  I  have 
8at  as  a  disciple  rather  than  as  one  of  the  Patres  Con- 
scripti  at  our  monthly  assemblies  since  I  had  the  honour 
of  becoming  enrolled  amongst  you  three  years  ago. 

Now  in  venturing  to  oflfer  a  paper,  I  beg  you,  solvere 
zenescentem,  to  make  allowances  for  such  lack  of  know- 
ledge as  I  may  display  concerning  the  advanced  tenets 
of  recent  physiology,  whilst  holding  me  excused  for  em- 
ploying the  language  of  a  past  pathology  rather  than 
the  compound  classical  nomenclature  of  to-day's  fin  de 
^ck  attainment. 

Pleading  thus,  I  will  take  as  my  text  a  case  which  I 
attended  as  long  ago  as  in  1858,  and  which  first  brought 
to  my  knowledge  the  potential  uses  of  the  bee-sting  poison 

*  Read  before  the  Britifili  Homoeopathio  Society^  June  4th,  1891. 
ToL  35,  No.  7.  •  2?  H 


426  BEE  STING   POISON.       "*S^"jSh7?^ 


Beriew,  July  1,  IflU. 


as  a  curative  agent  in  disease.  At  that  time  I  was  an 
orthodox  country  practitioner  in  Hampshire,  and  the 
patient  to  whom  I  allude  came  under  my  care  as  an  old 
pensioner,  who  eked  out  his  daily  pittance  by  working  as 
an  agricultural  labourer  on  the  Squire's  estate.  He  was 
about  sixty  years  old,  and  of  rheumatic  tendencies, 
living  in  a  damp  locality  on  the  edge  of  the  New  Forest. 

His  symptoms  in  brief — as  far  as  I  remember  them— 
were  those  of  endocarditis,  becoming  subacute,  with  a 
systolic  murmur,  and  with  embarrassed  action  of  the 
heart  through  dilatation,  but  without  any  marked  hyper- 
trophy. The  kidneys  were  not  implicated  as  shown  by 
any  albuminuria,  and  the  old  soldier  was  a  temperate 
man,  except  for  getting  now  and  then  bemused  in  beer  at 
the  village  tavern  on  a  Saturday  night,  like  many  of  his 
class.  Nevertheless,  I  well  remember  his  urine  at  the 
time  was  scanty  and  high  coloured,  with  copious  lithic 
deposits. 

All  the  symptoms  I  have  recited  gradually  increased, 
together  with  growing  dyspnoea,  and  with  general 
anasarca,  which  became  more  and  more  urgent,  until  at 
length  the  man  took  altogether  to  his  bed,  and  seemed 
doomed  to  sleep  quickly  in  God's  acre  with  his  rustic 
forefathers. 

He  was  treated  with  alkalies,  hydragogue  cathartics, 
and  diuretics,  secundum  artem,  being  also  seen  and  pre- 
scribed for  by  one  and  another  of  my  friendly  confreres 
from  the  adjoining  county  hospital,  where  I  had  been 
lately  the  house  surgeon. 

However,  the  poor  fellow  went  from  bad  to  worse,  and 
became  at  last  so  completely  waterlogged  as  to  lie  an 
enormous  mass  of  shapeless  humanity,  semi-comatose, 
and  ''  babbling  of  green  fields,"  in  a  small  attic  at  the 
top  of  the  narrow,  steep,  cottage  stairs,  down  which  how 
he  might  be  presently  brought  on  the  way  to  his  long 
home  seemed  a  problem  difficult  of  solution. 

It  happened  finally  that,  on  my  visiting  him  in  this 
dire  extremity,  I  found  his  womenfolk  in  the  garden, 
making  a  brew  from  refuse  honeycomb  just  after  taking 
their  bees,  and  I  was  asked  if  some  of  the  reeking 
beverage  might  be  given  to  the  sick  man  in  case  he 
could  drink  it. 

Eeadily  assenting  to  the  use  of  this,  or  any  other  pro- 
posed soUttium^  under  such  desperate  conditions,  I  left 


SSS^jS?fS!f"*        BEE   STING  POISON.  427 


Btfinr.Jiilyl.lsn. 


with  the  fall  asBurance  I  had  seen  the  last  of  my  patient 
in  the  land  of  the  living. 

About  a  week  afterwards,  having  to  ride  past  the 
cottage,  which  was  in  a  remote  part  of  my  distoict,  and 
wondering  that  I  had  not  been  applied  to  as  Begistrar 
of  deaths  to  record  his  decease  (for,  like  George 
Coleman's  *^two  single  gentlemen  rolled  into  one/'  I 
:  was  then  unitedly  the  Poor  Law  Medical  Officer  and  the 
OoTemment  Charon),  I  dismounted,  not  doubting  that  I 
should  find  the  defunct  pensioner  still  awaiting  inter- 
ment, which  had  been  delayed  through  some  casual 
hindrance  in  providing  the  necessary  obolus,  or  in  con- 
Tening  the  distant  relatives ;  but  to  my  intense  surprise, 
on  entering  the  downstairs  dwelling  room,  I  beheld  the 
man  comfortably  discussing  some  broth,  sitting  there, 
restored  to  his  ordinary  proportions,  "  clothed,  and  in 
his  right  mind." 

It  bad  happened  that  shortly  after  beginning  to  drink 
the  bee  beer,  which  he  took  with  avidity,  profuse  watery 
discharges  commenced  from  the  intestinal  and  renal 
oatlets,  which  continued  until  all  the  dropsical  swelling 
had  disappeared,  the  dyspnoea  had  become  relieved,  and 
the  heart  ceased  to  give  him  distress,  or  to  remain  sen- 
sibly disturbed.  In  short,  I  had  no  alternative  but  to 
believe  that  either  the  strange  brew,  or  some  wonderful 
natural  crisis  occurring  just  at  the  time  by  a  singular 
coincidence,  had  brought  back  my  patient  from  the  open 
portals  of  the  grave. 

Finding  the  unlooked-for  improvement  to  continue, 
and  casting  about  in  my  mind  for  an  explanation  of  its 
cause,  I  chanced  to  describe  the  case  and  its  present 
issue  to  my  friend  Dr.  John  Wilde,  now  of  Weston- 
saper-Mare,  but  who  then,  having  the  courage  of  his 
opinions,  avowedly  practised  homoeopathy  as  a  Poor  Law 
Doctor  in  a  district  immediately  adjoining  mine.  He  at 
onee  recognised  the  fact  that  some  bee  sting  virus  con- 
tained in  the  beer,  as  got  from  dead  bees  and  brood 
comb  boiled  up  in  the  brew,  had  acted  specifically  on  the 
cardiac  serous  membranes,  as  well  as  on  the  mucous 
excretory  linings  of  the  sufferer,  and  had  operated 
bomcBopathically  for  his  prompt  and  happy  rescue. 
Dr.  Wilde  further  sent  me  a  pamphlet  whi  ch  had  then 
been  recently  published,  on  ApU  MeUifica ;  or  the  Poison 
of  tlie  Honey  Bee  considered  as  a  Therapeutic  Agent,  by 


42fi  BEE   8TINO   POISON.        "'SSSL"?^?^. 


Beriew,  Jolj  1, 16n, 


C.  W.  Wolff,  M.D.,  of  Berlin,  which  little  book  I  read 
with  deep  interest,  gaining  new  light  from  its  pc^es,  and 
explicit  instruction  about  the  proTings  and  well  ascer- 
tained effects  of  the  remedy  in  question. 

Incidentally  I  may  add  that  the  patient  whose  case  I 
have  been  describing  went  on  uninterruptedly  to  com- 
plete convalescence,  and  was  able  after  a  while  to  resume 
his  work  in  the  fields.  He  retained  his  health  for  the 
five  or  six  more  years  of  my  sojourn  near  him ;  and 
eventually  he  died,  I  believe  of  old  age,  uncomplicated 
by  any  renewed  trouble  of  the  heart  or  any  return  of 
dropsy. 

From  the  small  treatise  of  Dr.  Wolff  I  learnt  that  his 
practical  experience,  based  on  the  provings  of  Dr.  Ber- 
ing, and  attesting  the  faith  of  his  own  grateful  heart 
with  respect  to  the  bee  sting  poison,  showed  the  medicine 
to  be  eminently  curative  for  oedematous  swellings  in 
general,  for  the  higher  grades  of  ophthalmia,  for  inflamed 
states  of  the  tongue,  mouth  and  throat ;  also  by  its 
specific  power  over  the  whole  internal  mucous  membrane 
and  its  appendages. 

Dr.  Wolff  had  likewise  employed  the  api^  very  success- 
fully for  curing  furuncles,  urticaria,  and  erysipelas,  as 
well  as  for  the  typhoid  fever,  which  he  was  emphatically 
persuaded  becomes  engendered  by  the  process  of  vaccina- 
tion. Moreover,  he  had  convinced  himself  that  apis  is  the 
most  sovereign  remedy  for  intermittent  fever,  annihilating 
the  disease  so  radically  that  no  relapses  ever  take  place 
and  no  secondary  symptoms  are  ever  developed. 

For  measles,  scarlet  fever,  panaritia,  spontaneous 
limping,  white  swelling  of  the  knee,  and  dysentery,  Dr, 
Wolff  had  further  found  apis  to  be  an  invaluable  and 
most  trustworthy  weapon  of  defence ;  whilst  he  abun- 
dantly verified  the  necessity  which  others  had  recorded 
for  caution  in  giving  this  medicine  to  pregnant  women, 
though  conversely  he  knew  of  no  drug  endowed  with 
such  reliable  virtues  for  preventing  miscarriage,  par- 
ticularly during  the  first  half  of  gestation. 

His  doses  ranged  fi'om  a  pellet  of  ajris  30  to  a  drop  of 
tincture  of  the  third  strength,  repeated  at  intervals  or 
Bub-divided.  Taken  altogether,  he  had  come  to  regard 
apis  as  the  greatest  polychrest  medicine,  next  to  aconitCr 
which  homoeopathic  pharmacy  can  furnish. 


SrfSJ^jnrf^S^*       BEE   STING    POISON.  429 


Eeriev,  July  1, 1891. 


From  the  first,  while  perusing  all  these  startling 
statements  about  apia,  and  endeavouring  to  receive  them 
with  an  unprejudiced  mind,  one  great  difficulty  beset 
me— that  of  supposing  any  such  animal  poisons  as 
the  virus  of  the  bee  and  cognate  creatures  capable  of 
exercising,  when  swallowed,  any  influence  for  good  or 
for  harm  on  the  human  subject  as  ordinarily  constituted, 
unless  through  some  solution  of  continuity  of  a  mucous 
surface,  so  as  to  allow  of  direct  absorption — or,  unless 
by  acquiring  special  powers  of  stimulatiug  afresh,  when 
fractionally  attenuated,  tissues  impaired  by  disease.  Here 
I  will  cite  two  instances  which  have  happened  recently 
within  our  immediate  observation,  and  which  are 
relevant  to  the  point  I  have  raised. 

A  few  weeks  ago,  at  an  evening  meeting  of  the  Phar- 
maceutical Society,  Surgeon  Parke,  of  the  Stanley 
Expedition,  in  giving  a  detailed  description  of  the  arrow 
poison  employed  by  the  Pigmies  in  Central  Africa,  with 
such  fatal  results,  against  our  men,  narrated  the  fact 
that  of  those  who  were  struck  with  poisoned  arrows  at 
the  battle  of  Uva  Sheba,  all  died  except  Lieutenant 
Stairs,  whose  wound  was  sucked  by  Surgeon  Parke 
himself.  The  ingredients  of  the  poison,  as  far  as  they 
could  be  ascertained,  were  procured  exclusively  from 
vegetable  sources.  I  quote  this  instance  as  exhibiting 
fte  immunity  from  toxication  manifeBted  by  Surgeon 
Parke. 

Per  contra. — On  February  3rd  of  this  year  we  were 
told  in  the  daily  journals  that  Mr.  E.  Bosanquet,  the  son 
of  the  well-known  banker,  was  bitten  by  a  rattlesnake, 
while  shooting  in  Florida.  Mr.  E.  Walker,  who  was 
with  him,  immediately  applied  his  mouth  to  the  wound 
apd  endeavoured  to  suck  out  the  poison.  Then,  having 
tightly  bandaged  the  wounded  leg  of  his  friend,  Mr. 
Walker  raised  and  carried  him  to  Daytona,  where 
Mr.  Bosanquet  died  shortly  after  midnight  in  great 
agony.  Mr.  Walker  also  became  seriously  ill.  He  had 
a  slight  sore  on  the  lip,  and  absorbed  some  of  the  poison 
into  his  system.  An  attack  seized  him  which  resembled 
partial  paralysis,  though  eventually  he  became  better 
and  out  of  danger. 

These  would  appear  to  be  two  typical  cases.  Never- 
theless, I  need  not  say  that  adequate  inquirers  have 
long  since  thrown  a  decisive  light  upon  the  quastio 


480  BEE   STING   POISON.       ^^^wfjoS^! 


vexcsta,  and  have  redeemed  it  from  dispute.  Dr.  Hughes, 
for  example,  has  taught  that  a  serpent  poison  will  act  as 
a  toxicant  when  swallowed,  or  when  applied  to  a  sound 
serous,  or  mucous  membrane,  as  shown  by  Drs.  Brunton 
and  Fayrer.  "  The  idea,"  say  they,  "that  it  will  only 
prove  effective  when  absorbed  through  a  lesion  of  surface 
or  mjected  directly  into  the  blood  is  erroneous." 

Next  I  was  led  to  consider  what  might  be  the  chemical 
composition,  or,  perhaps,  the  organic  character  of  the 
bee  sting  virus  and  of  allied  animal  poisons ;  and  then 
to  wonder  why  any  analogous  toxicant,  such  as,  for 
example,  the  vaccine  lymph,  should  not  act  in  the  same 
potential  way  as  was  claimed  for  this  apis  meUi/leaf  by 
being  swallowed  instead  of  being  introduced  into  the 
absorbent  system  through  a  puncture.  If  fchis  desidera- 
tum could  but  be  accomplished,  many  of  the  objection& 
raised  against  vaccination  would  be  silenced,  and  the 
Hahnemannian  law  of  infinitesimalism  would  be  tri- 
umphantly vindicated. 

In  subsequent  years  it  has  come  about  that  the  Pas- 
teur theory  and  practice  with  regard  to  the  rabid  virus 
of  dogs,  and  of  other  animals,  have  found  a  place  in  esta- 
blished medical  therapeutics ;  and  I  take  these  as  legiti- 
mate subjects  for  speculation  from  the  point  of  view  of 
my  former  and  present  reflections ;  saying  so  ''  with 
bated  breath  and  whispered  humbleness  "  rather  than 
as  laying  the  least  claim  to  be  an  original  thinker  in  the 
matter. 

Dr.  Gooch — who  by  common  consent  now  speaks 
authoritatively  on  these  points — says  "  a  sheep  fed  upon 
potatoes  which  have  been  the  medium  for  the  cultivation 
of  the  anthrax  bacillus,  dies  in  a  few  days.  Similarly 
animals  fed  upon  the  nodules  of  bovine  tuberculosis 
become  tubercular." 

Bollinger  also  has  demonstrated  that  milk  can  prove 
infectious  if  drunk  when  derived  from  cows  suffering 
from  any  form  of  tuberculosis ;  and  these  facts  appear  to 
prove  without  doubt  that  certain  animal  poisons — ^which 
bacteriologists  adopt  as  working  septically  through  living 
microbes  or  through  the  morbific  matter  which  they 
manufacture — can  exert  their  deleterious  influence  on 
the  body  by  being  swallowed,  as  well  as  by  being  injected 
into  the  blood. 

Surely,  therefore,  we  are  justified  in  asking  whether 


bSSS^j^mJwS^     bee  sting  poison.  431 

any  clear  line  of  distinction  and  demarcation  lies  between 
the  bee  sting  poison,  the  serpent  poisons,  the  Taccine 
Tims,  and  the  ultimate  pathogenetic  causes  of  rabies, 
tobereulosiSi  and  the  exanthematous  infective  fevers. 

Dr.  Bristowe,  in  an  address  given  by  him  six  weeks 
ago  on  tuberculosis,  said  :  "  Most  of  us  believe  that  all 
specific  infective  diseases  are  due  to  specific  living  organ- 
isms." He  added  at  the  same  time,  *^  these  septic 
organisms  act  commonly  by  means  of  a  poison  which 
they  discharge,  and  which  is  absorbed  by  the  circulating 
fluids ;  in  which  cases  the  poison  is  soluble,  and  can  be 
obtained  in  solution,  entirely  free  from  bacterial  or  other 
orgamsms,  and  from  putrefactive  taint,  or  tendency." 
This  being  so,  I  would  again  press  the  question  why  such 
a  solution,  when  sufficiently  diluted,  may  not  be  em- 
ployed curatively  as  a  medicine — with  more  precision, 
more  singleness  of  action,  and  better  facilities  for  regu- 
lation of  its  doses — ^not  to  speak  of  the  paramount 
homoeopathic  advantages  thus  secured — than  by  sub- 
cutaneous injection  or  inoculation. 

I  am  by  no  means  unmindful  of  the  effect  produced 
irithin  the  stomach  by  its  secretions  operating  on  living 
microbes  when  swallowed. 

According  to  Drs.  Kurlow  and  Wagner,  who  have 
recently  investigated  the  influence  of  gastric  juice  on 
pathogenic  organisms,  only  the  most  prolific  microbes, 
such  as  tubercle  bacilli,  the  bacilli  of  anthrax,  and 
perhaps  the  staphylococci  can  continue  to  exist  in  the 
normal  gastric  secretion  ;  all  others  being  destroyed  by 
this  powe^ul  germicidal  agent  in  less  than  half  an  horn*. 

But  no  collateral  evidence  is  forthcoming,  of  which  I  am 
aware,  tending  to  prove  that  the  potential  and  toxicating 
solution  eliminated  by  septic  microbes  is  equally  spoiled, 
and  rendered  abortive  by  contact  with  the  gastric  juices. 

As  to  the  chemical  composition  of  the  several  animal 
poisons,  I  learn  that  formic  acid  is  said  to  be  the  basis  of 
apig  meUificay  whilst  bacteria  are  found  on  ana^sis  to 
consist  of  mycoprotein  (a  combination  of  carbon,  hydro- 
gen and  nitrogen,  without  sulphur  or  phosphorus), 
together  with  fat,  ash,  and  undetermined  substances. 

But  Dr.  Gooch  says  "  it  is  a  positive  fact  that  the  inti- 
mate nature  of  the  contagium  mmany  diseases,  such  as 
hydrophobia,  variola,  vaccinia,  scarlet  fever,  and  measles, 
is  at  we  present  day  undetermined,  and  invites  further 


432  BEE   STING  POISON.        ^"SSSUFTSST^. 


Reriev,  Jolj  1,  VBHL 


research.*'  I  am  therefore  again  warranted  in  snppofimg 
that  as  yet  no  ascertained  line  of  separation  exists 
between  the  poisons,  when  fundamentally  considered,  of 
the  bee  sting,  serpents,  rabies,  and  the  infective  febrile 
diseases. 

One  significant  circumstance  can  be  adduced  with 
respect  to  the  bee  sting  poison,  as  placing  it — cateris 
paribus — on  a  level  with  the  attenuated  forms  of  rabies 
virus  employed  by  Pasteur  for  conferring  immunity  on 
his  patients  against  harm  by  the  concentrated  virus.  It 
is  well  known  among  bee  keepers  that  after  being 
repeatedly  stung  throughout  some  weeks,  or  months,  a 
person  who  suffers  acutely  at  first  from  the  assaults  of 
bees  will  become  less  and  less  liable  to  be  affected  there 
by,  and  eventually  altogether  impervious  sensibly  to  tb^ 
poison.  As  far  as  my  personal  experience  in  bee  keepin(( 
for  several  years  has  led  me  to  observe,  this  acquired 
immunity  continues  throughout  a  time  of  cessation  from 
being  stung — during  the  winter  months  until  the  next 
summer — being  thus  differentiated  as  I  believe  from  the 
hardihood  gained  against  tobacco,  arsenic,  and  other 
noxious  toxicants  by  those  who  have  become  inured  to 
them,  and  which  lasts  so  long  only  as  they  are  habituallf 
employed,  and  no  longer.  Notably  as  regards  alcohol,  a 
very  small  dose  of  this  will  serve  to  intoxicate  the  con- 
firmed and  degenerate  drunkard,  though  when  first 
beginning  his  career  of  inebriety  the  same  person  could 
probably  swallow  a  skinful  without  becoming  topheavy 
or  incapable. 

In  speaking  of  the  cultivating  fluids  employed  by 
Pasteur  and  by  other  bacteriologists  for  attenoating 
septic  organisms  and  obtaining  their  potential  solutions, 
Dr.  Gooch  says  great  stress  is  to  be  laid  upon  the  im* 
portance  of  successive  cultivations  of  the  microbes  in 
these  sterilised  liquids,  such  as  nutrient  gelatine  and  the 
like,  through  many  generations,  as  the  objection  that  a 
chemical  virus  may  be  carried  over  from  the  original 
source  is  thus  overcome."  "  And,"  he  goes  on  to  say, 
**  any  hypothetical  chemical  poison  carried  over  from 
one  tube  to  another  would,  after  a  great  number  of  these 
Qji^ivations,  be  diluted  to  such  an  immense  extent  as  to 
"^be  inappreciable,  and  absolutely  inert,"  If  this  were  so, 
the  objection  thus  raised  against  my  view  that  toxication 
by  swallowing  highly  attenuated  pathogenetic  fluids  may 


^tS^SS'i'^S^       BEE   STING  POISON.  433 


Befiew,  July  1, 1881. 


successfully  supersede  cultivated  germ  inoculation  would 
be  insuperable. 

But  our  special  and  incontrovertible  knowledge  of  the 
effects  produced — whether  by  apis  80,  as  the  bee  sting 
poison — or  by  highly  diluted  iMheais,  naja^  crotalus  and 
the  like  as  serpent  poisons,  when  swallowed  medicinally, 
both  refutes  the  allegation  of  Dr.  Gooch,  and  tends  to 
eonfinn  the  analogy  between  these  chemical  viruses  and 
the  toxic  poisons  obtained  in  solution  from  cultivated 
bacteria.  Dr.  Hughes  says  the  curative  action  of  lache- 
sit^  if  worth  anything  at  all,  proves  the  validity  of  the 
infinitesimal  dose.  He  further  directs  attention  to  the 
smgolar  likeness  between  the  symptoms  of  crotalus 
poisoning  and  those  of  yellow  fever,  which  would  now  in 
ail  probability  be  pronounced  of  bacterial  causation. 

In  like  manner,  if  the  principle  for  which  I  contend  is 
a  valid  one,  the  radically  alterative  effects  promised  by 
Dr.  Eoch  and  his  followers  from  inoculation  of  his  fluid 
against  tubercular  phthisis  and  lupus  should  be  brought 
about  as  readily  by  internal  administration  of  this  fluid 
as  by  subcutaneously  injecting  it  in  high  divisions,  such 
as  a  milligramme,  and  without  the  attendant  risk  of  a 
dangerous  shock.  But  the  safety  and  expediency  of 
Dr.  Koch's  whole  proceeding  are  as  yet  so  much  Bubjudice 
and  even  suh  lite,  that  I  refrain  from  dwelling  on  it. 

As  far  as  any  analysis  of  his  tuberctdine  has  been 
made,  it  seems  to  be  purely  chemical,  consisting  of 
peptone,  hemi-albumose,  glycerine,  and  common  salt, 
fiat  it  is  further  stated  that  after  the  primary  bacilli 
from  which  this  liquid  is  elaborated  are  destroyed  by 
heat  or  by  antiseptics  in  any  cultivating  fluid,  spores 
are  left  which  have  a  thick  investing  membrane  of  two 
layers.  These  spores  are  difficult  of  destruction,  and 
can  retain  their  vitality  even  when  desiccated.  No 
stain  will  penetrate  them  until  the  capsule  has  been 
ruptured  or  changed  by  strong  acid;  and  this  may 
certainly  be  accepted  as  an  argument  on  our  side  for 
effective  mechanical  trituration  of  the  tough,  intractable 
spores,  so  as  to  make  their  contents  soluble  for  absorption 
by  mucous  membranes,  just  as  we  pound  up  the 
diminutive  nuts  of  lycopodium,  each  about  ^^th  part  •el. 
-an  inch  in  diameter,  in  an  agate  mortar,  knowing  that 
all  preparations  of  this  drug  which  do  not  involve  a 
<:omplete  fracture  of  its  particles  are  inert.     For  making 


434  BEE    STING  POISON.        ^aJSirfj!S??MML 

even  the  first  decimal  strength  a  trituration  of  the  spores 
for  at  least  two  hours  is  necessary. 

More  and  more  therefore  am  I  led  by  these  several 
arguments  to  advocate  administration  by  the  mouth  of 
potent  toxical  organic  agents  highly  attenuated  and  in  a 
soluble  form,  whether  these  be  classified  as  chemical  or 
septic. 

Reverting  for  a  moment  to  the  vaccine  virus,  and 
quoting  the  recent  dictum  of  Dr.  Bristowe  that  cow-pox 
is  doubtless  small-pox  attenuated  by  passage  through 
the  cow,  I  would  claim  for  the  vaccine  lymph,  whether 
got  from  the  heifer  or  by  transmission  through  the 
human  subject,  an  innocuous  protective  power  of  sure 
action  against  small-pox  by  being  taken  internally,  if 
the  patient  be  at  the  time  of  its  administration  prone  to 
contract  variola.  But  the  toxicant  will  presumedly 
remain  inert  and  abortive  if  no  liability  to  take  small- 
pox on  exposure  to  its  infection  be  then  occupying  the 
patient's  system.  For  which  self  convincing  reason  the 
practice  of  thus  protecting  our  patients,  or  leaving  them 
unscathed  if  then  needing  no  such  protection,  both  as 
infants  by  this  primary  gastric  vaccination,  and  as  adults 
by  the  repeated  process,  should  and  would  strongly  com- 
mend itself  to  public  favour,  if  the  hypothesis  can  only 
be  substantiated. 

Perhaps  you  may  at  once  detect  fatal  flaws  in  my 
mode  of  reasoning,  and  may  suppose  me,  for  lack  of 
sufficient  reading,  or  instruction  upon  a  question  already 
settled  in  a  manner  adverse  to  my  views,  to  resemble  the 
tailor  in  Shakespeare's  play  of  Kmg  John,  whom  Hubert 
saw — 

^*  standing  in  sUppers,  which  his  nimble  haste 
Had  falsely  thrast  upon  oontrazy  feet." 

Or,  in  less  elegant  phraseology,  you  may  accuse  me  of 
having  got  hold  of  the  wrong  sow  by  the  ear.  If  so,  I 
shall  penitently  submit  to  correction  at  your  lenient 
hands. 

Or,  it  may  be,  you  will  say  that  whilst  professing  to 
talk  about  apis  meUifica  as  a  therapeutical  agent,  and 
discoursing  of  its  various  virtues,  I  have  wandered  aim- 
lessly from  the  main  road  of  my  subject  into  barren 
by-paths  of  uninteresting  and  unsound  pathology.  Let 
me  acknowledge,  with  confusion  of  face,  that  I  have  very 
^Htle  to  tell  from  personal  experience  concerning  the 


bUS^SSTS^     »eb  sting  poison.  485 

therapeutic  action  of  the  bee  sting  poison  as  a  drug ;  and 
I  haye  rather  hoped  to  gain  benefit  by  starting  the  sub- 
jeet  and  gleaning  the  experience  of  other  more  busy 
workers  in  the  arena  of  modem  medicine  than  to  furnish 
original  information  on  the  point.  It  happened  felici* 
toasly  to  myself,  several  years  after  my  pensioners^ 
fortunate  episode,  to  prescribe  tincture  of  apis  from  a 
distance  for  a  sweet,  fair-haired  angel  of  a  child,  lying 
alanningly  ill  with  advancing  hydrocephalus,  and  to 
rescue  her  straightway  from  the  danger  which  threatened 
to  quickly  extinguish  her  life.  Beyond  this  illustra* 
tion,  my  aquaintance  with  apis  medicinally  has  been 
restricted  to  the  usual  cases  indicated  by  its  provings 
and  particularized  in  our  text  books.  Under  Dr.  Blake's 
tuition  I  have  learnt  that  the  drug  specially  stimulates 
the  vaso-motor  apparatus,  that  it  causes  shooting  pains 
in  the  occiput,  and  proves  curative  of  septicaemic  urticaria, 
such  as  follows  on  pysemic  absorption. 

Also  a  medical  friend  of  his,  who  took  tincture  of  apis^ 
by  mistake,  experienced  weakness  and  numbness  in  the 
npper  Umbs,  particularly  of  the  ulnar  fingers. 

And  we  were  reminded  at  our  last  meeting  that  Dr.. 
Gibbs  Blake  supplied  a  paper,  some  years  ago,  to  the 
annals  of  our  Society,  on  the  cure  of  albuminuria  by 
api$^  with  detailed  cases. 

Now,  in  conclusion,  let  me  express  a  sincere  hope  I 
have  not  wearied  you  overmuch  by  my  discursive  aberra- 
tions, or  seemed  to  treat  a  serious  subject  in  too  light 
and  trivial  a  style.  You  will  remember  what  Horace 
Bays  in  one  of  his  epistles  about  the  advantages  of 
occasioniJ  levity,  even  in  a  grave  treatise  : 

**  Difloit  enim  dtios,  meminit  qne  libentios  illnd 
Quod  qnis  deridet,  qaam  quod  probat  et  yenerator." 

^  Hen  see  a  joke,  when  to  a  sermon  blind  : 
What  lansrhter  points  dweUa  longest  in  the  mind/' 

Whilst  keenly  alive  to  the  deficiencies  of  my  crude 
paper,  as  compared  with  the  erudite  and  finished  theses 
usually  forthcoming  at  our  monthly  gatherings,  I  would 
pray  you  to  be  mindful  that  the  rough  stick  of  Brutus^ 
cut  by  the  hands  of  a  clown  from  a  Boman  hedge,  con* 
tained  a  rod  of  gold,  and  that,  as  Emerson  pithily  puts 
it,  God  sometimes  hangs  a  heavy  weight  on  one  of  the 
ffiinnest  of  wires. 


436  BEE   STING   POISON.        ^''^SSl'SSrSt 


Beview,  July  1,  UBL 


Discussion. 

Dr.  Hughes,  after  expressing  his  enjoyment  of  Dr.  Fernie's 
paper,  said  that  he  saw  no  reason  why  viruses  should  not  ftct 
by  the  mouth,  though  not  so  potently  as  when  introduoed 
beneath  the  skin  or  into  the  veins.  Vaccinine  had  been  givea 
by  the  mouth  in  small  pox,  and  also  to  effect  vaccination;  in 
both  cases  with  apparently  good  result.  He  doubted,  how- 
•ever,  whether  patients  generaJly  would  consent  to  be  so  vacci- 
nated. Dr.  Hughes  thought  Wolff's  book  a  little  too  enthu- 
siastic, and  many  of  the  supposed  pathogenetic  symptoms- 
taken  from  Hering — on  which  he  bases  his  applications 
Vfj7w,  are  **  clinical  *'  only. 

Dr.  Blake  said  that  Dr.  Burford  was  quite  right  in  his 
observations  at  the  last  meeting ;  there  was  no  evidence  to 
show  that  apis  had  primarily  affected  the  kidney.  Unfortu- 
nately, in  the  cases  where  there  were  renal  symptoms  no 
analysis  of  the  urine  appears  to  have  been  made.  Dr.  Blake 
had  listened  with  peculiar  interest  to  the  contribution  of 
Dr.  Femie.  He  was  much  struck  with  its  cultivated  and 
scholarly  style.  He  said  he  felt  quite  a  paternal  pride 
in  Dr.  Fernie  as  having  stood  sponsor  for  him  at  the  medical 
font.  Dr.  Blake  used  the  animal  poisons  very  largely  in  his 
practice,  he  relied  on  them  in  the  most  grave  and  urgent 
conditions.  There  is  a  strong  family  likeness  between  the 
.animal  poisons  in  their  sphere  of  action ;  even  the  medo^ 
iusts  on  the  skin,  the  heart,  &c.  The  following  proving,  if 
substantiated,  would  go  to  show  its  power  of  profoundly  modi- 
fying the  condition  of  the  intracranial  perivascular  spaces.  In 
the  Lancet  for  last  March,  Dr.  Althaus  says  at  p.  715 :  *'  I 
have  seen  a  case  of  epilepsy  in  a  farmer,  aged  80,  who  had 
been  in  perfect  health  till  he  was  one  day  stung  by  bees.  This 
caused  inflammation  of  the  hand.  He  never  recovered  bis 
health  thoroughly  after  this,  and  nine  months  later  had  his 
first  epileptic  fit  without  any  other  assignable  cause." 

Unfortunately  no  information  is  given  as  to  the  condition 
of  the  urine.  Yet  even  with  this  serious  omission,  the  case  is 
full  of  suggestiveness  to  physicians  without  prejudice.  For 
another  proving  we  are  indebted  to  an  allopathic  doctor.  It 
is  of  especial  value  for  two  reasons  : — 

1.  The  prover  thought  he  had  taken  an  entirely  different 
Jrug,  one  that  in  his  opinion  was  quite  inert. 

2.  He  was  a  sceptical,  cool,  and  clear-headed  person,  with 
the  critical  temperament  well  marked.  This  fragmentary 
proving  is  so  important  and  so  brief,  that  I  wiU  venture  to 
reproduce  the  whole : — 

Feb.  16th,  1887.    Dr. says  :  *«  In  the  morning  I  had  a 

pain  as  though  an  oat  husk  had  stuck  in  the  left  side  of  the 


^?^S^T^i^        BEE    STING   POISON.  437 

]arpa,  external  to  the  aryepiglottic  fold.  Took  about  18* 
minims  of  apis  tnellifica,  thinking  it  was  lacltefda  6.  I  added  a 
quantity  of  water  and  tossed  off  the  mixture.  I  was  then 
galyaniaing  a  patient.  In  about  three  minutes  I  began  to  feel 
Tffiy  strange,  and  the  sensation  increased  so  that  I  had  to  stop 
what  I  was  doing. 

"  I  then  sat  down  and  wrote  these  notes  a«  tlie  symptoms 
arwie. 

"  1.  Feeling  as  of  a  sudden  blow  on  the  occiput.  2.  Swim- 
ming sensation.  8.  Sense  of  constriction  in  throat.  4.  Sttddeti 
dis^pearance  of  pain  in  left  hyoepiglottic  fosse.  5.  Twitching 
of  muscles  and  sHght  trembling.  6.  General  sensation  of 
folness  and  weakness  of  coordinating  power,  especially  in 
bands.  7.  Oppression  at  bottom  of  sternum.  8.  Pain  down 
kft  tdnar  nerve.  9.  Weight  and  tension  at  back  of  neck, 
10.  Dimness  of  sight.  11.  Sense  of  weakness  in  upper  limbs, 
12.  Shght  numbness  of  left  hand,  particularly  of  ulnar 
fingers.  This  subsequently  increased  very  much,  and  amounted 
to  complete  anaesthesia  of  left  ulnar  fingers.  Also  want  of 
power,  with  incomplete  anfiesthesia  of  both  hands.  18.  Irri- 
tability of  bladder,  a  usual  symptom  with  me,  diminished. 

**  You  know  what  a  thorough  disbeliever  I  am  in  most  of 
•the  so-called '  provings." 

Dr.  Femie  had  referred  to  him  as  using  ainum  Hrus  for  auto- 
toxsemia,  or  self-poisoning  with  pus  products.  In  these  cases 
api$  is  indeed  the  *'  king  of  remedies."  It  covers  well  the 
aniBmia,  the  skin  affection  and  the  profound  apathy  of  the 
lymphatic  system. 

The  following  example  was  presented  by  the  wife  of  the 
^conscious  apU  prover. 

Mrs.  — ,  age  87,  suffered  before  marriage  from  endometritis 
and  retroflexion.  Married  10  years.  Had  borne  two  children. 
Becoming  pregnant  again,  life  was  endangered  by  the  extreme 
severity  of  the  vomiting.  It  was  thought  right  to  induce 
artificial  labour.  Pelvic  cellulitis  followed  this  and  the  womb 
became  bound  down  to  the  rectum  by  firm  adhesions  in 
Douglas'  pouch.  She  now  fell  into  a  miserable  condition. 
Low  type  of  recurrent  feverishness,  extreme  prostration  with 
debihtating  sweats  and  persistent  pelvic  pains.  Early  in 
1681  a  distinguished  gynsecologist  was  consisted,  who  opened 
the  abdomen,  and  removed  the  ovaries,  which  were  found  to 
be  in  a  oondition  of  cystic  degeneration.  After  this  the 
patient  was  much  better  for  a  year  when  she  slowly  reverted 
to  her  old  condition.  She  now  began  to  suffer  from  recurrent 
intractable  vomiting,  also  from  itching  of  the  skin,  sleepless- 
ness, profound  mental  misery  and  loss  of  hair.  The  white 
&e6  and  greatly  swollen,  raw  beef  like  tongue,  irritable  throat, 


438  BEE   STING   POISON.        ^'xSSJ^SSTm 


Rflvtow.  Jnlj  1,  IffiL 


poor  appetite  and  torturing  thirst,  flatulence,  abdominal 
folness  and  severe  constipation,  pale  mine,  sp.  gr.  1,005,  the 
iddneys  doing  no  depurating  work,  short  breath,  palpitation, 
loin  pains,  numbness  along  the  ulnar  nerves  were  preseni 
There  existed  also  much  general  dropsy  and  varioosis  of  legs. 
These  symptoms  yielded  to  apis  mellifica  12  centesimal.  Soon 
after  witnessing  tiie  effect  of  the  apis  on  his  wife,  the  husband 
a  specialist  on  the  throat,  was  summoned  one  night  by  a 
neighbouring  practitioner  to  operate  on  a  case  of  cedema 
glottidis.  Before  proceeding  to  perform  tracheotomy,  the 
doctor  bethought  him  of  the  ajns  12.  He  resolved  to  give  it 
a  trial,  and  with  the  satisfieustory  result  that  the  patient  was 
out  of  peril  by  the  morning,  and  the  operation  was  permanently 
postponed.  Apis  is  the  only  remedy  which  Dr.  Blake  bad 
seen  remove  chronic  effusion  between  the  layers  of  the  broad 
ligament.  Mrs.  — ,  aged  28,  had  been  married  two  years.  Ten 
months  ago  was  deUvered  of  a  still-bom  child  at  full  tenn. 
She  has  never  been  well  since.  She  feels  a  lump  in  her  left 
groin,  which  has  been  diagnosed  to  be  many  different  things 
by  many  differing  doctors.  The  senior  surgeon  of  the 
Samaritan  kindly  saw  the  case  with  me,  and  we  agreed  that 
it  was  the  left  broad  ligament  of  the  uterus  greatly  distended 
with  fluid.  As  its  formation  had  not  been  attended  by  rigors 
nor  followed  by  hectic,  and  as  its  disappearance  was  associated 
with  no  h^matin  staining  of  the  skin  or  urine,  we  considered 
that  it  was  probably  serous.  It  was  possibly  a  ruptured  cyst* 
Under  the  bee  poison  this  condition  disappeared  in  four  weeks 
after  10  months'  duration.  The  remedy  was  first  given  in  the 
6th  centesimal  for  one  week,  then  in  the  drd  decimal  dilution. 
Seven  years  have  passed  and  no  recurrence  has  taken  place. 
This  lady  goes  for  long  tricycle  rides  in  the  country — a  fairly 
good  test  to  apply  to  the  parte  once  so  seriously  enfeebled. 

Chronic  pain  in  sacrum  with  oedema.  In  morning  diarrhcBa, 
myalgia  of  the  deltoids,  and  for  that  peculiar  rigidity  of  the 
throat,  indicating  submucous  effusion,  api»  is  invaluable. 
The  typical  headache  appears  to  be  of  the  bursting  occipital 
type,  resembling  in  site  and  action  ite  congener  heUAote, 
relieved  by  pressing  with  the  hands.  Of  profound  interest  is 
the  last  case  recorded  in  that  invaluable  work  The  Cydopadia 
ef  Drug  Pathogenesy  under  apis.  This  goes  to  show  that  bee 
poison  is  the  remedy  for  reflex  eustachian  asthma.  It  also 
makes  it  appear  probable  that  bee  poison  is  volatile. 

Mr.  Wright,  in  speaking  of  the  action  of  apis  m  diphtheria, 
said  that  he  was  disappointed  in  the  resulte  he  had  obtained. 
In  the  case  of  a  man  admitted  into  the  hospital  under  Dr. 
Moir  for  urgent  dyspnoea,  he  examined  the  larynx  and  found 
that  there  was  an  extreme  oedema  of  the  whole   of  the 


iS^^UtS^       BEE   8TIKO  POISON.  439 

sfcraeinies  of  the  upper  aperture  of  the  larynx.  This  was 
the  condition  in  which  apis  was  indicated,  and  it  was  accord- 
ingly given,  but  in  spite  of  it,  two  days  later,  patches  of 
typical  diphtheritic  membrane  developed  on  the  diseased 
puts.  In  many  other  cases  in  children  he  had  found  that 
4rpuhad  no  influence  in  preventing  the  occurrence  of  the 
membrane. 

Dr.  Mont,  speaking  of  the  same  case  as  Mr.  Wright,  said 
he  had  come  to  the  opposite  conclusion,  viz. :  that  the  patient 
was  much  benefited  by  the  apis^  as  it  was  a  case  which  had 
been  sent  in  for  tracheotomy,  and  within  48  hours  the  greater 
part  of  the  oedema  was  gone,  but  he  agreed  with  Mr.  Wright 
that  it  had  no  special  influence  on  the  diphtheritic  membrane. 

All  bee-keepers  seemed  to  get  inoculated  or  indifferent  to 
the  stings  after  a  short  time,  and  he  would  like  to  know  from 
Dr.  Femie  whether  he  suffered  much  from  the  stings  when 
bee-keeping,  and  how  soon  he  became  inoculated.  With 
regard  to  the  administration  of  the  animal  poisons  he  thought 
the  more  exact  methods  by  hypodermic  injections  or  by 
absorption  from  a  blistered  surface,  as  recommended  by 
Dr.  Hayward  for  the  serpent  poisons,  ought  to  be  more 
extensively  tried. 

Mr.  Cox,  speaking  of  Mr.  Wright's  case  of  oedema  of  larynx, 
said  that  he  had  watched  the  case  in  the  hospital  from  its 
commencement.  The  patient  was  admitted  with  intense 
dyspnoea,  and  tracheotomy  appeared  imminent;  under  apis 
the  improvement  was  remarkable — the  oedema  passed  off  and 
respiration  became  easy.  When  able  to  examine  the  larynx 
two  small  patches  of  membrane  were  noted.  The  man  got 
weU,  his  improvement  being  rapid  at  first  and  gradual  after- 
wards. He  had  no  other  medicine  except  aconUe  for  some 
time. 

Mr.  Wbioht  said  that  Dr.  Moir  and  Mr.  Cox  had  misunder- 
stood the  remarks  he  had  made  about  apis  in  Dr.  Moir*s 
patient.  He  contended  that  it  had  not  prevented  the 
membrane  appearing,  which  was  the  case.  The  oedema 
certainly  did  subside,  but  the  question  remained  was  this 
due  to  the  apis  or  the  steam  inhalations  which  the  patient 
was  receiving  as  an  accessory  treatment  ? 

Dr.  CooPEB  joined  in  the  thanks  so  freely  given  to  Dr.  Fer- 
nie  for  his  very  interesting  paper,  and  hoped  that  we  shall  be 
ia^oured  by  an  increased  proportion  of  papers  dealing  with 
drag-action,  as  this,  pre-eminently,  is  the  work  of  the  Society. 
Dr.  Femie  had  mooted  a  question  that  bristled  with  di£B- 
cnlties,  and  one  which  could  not  possibly  be  dealt  with  in  the 
compass  of  a  short  paper,  namely,  the  variations  in  the 


440  BEE    STING  POISON.        *^?iJ?I??S??^f 


Beriew.  Julj  1,  Iflfrl. 


behaviour  of  remedial  agents  when  administered  sobcu- 
taneously  and  by  the  mouth.  Dr.  Cooper  had  used  subcu- 
taneous injections  at  one  time  rather  frequently,  and  he 
considered  he  had  noted  a  marked  difference  in  the  bebaYionr 
of  the  high  dilutions  when  given  subcutaneously  and  by  the 
mouth  ;  he  had  never  seen  the  slightest  characteristic  efect 
follow  a  hypodermic  injection  of  a  high  dilution,  but  very 
marked  effects  had  attended  their  buccal  administration. 

Again,  arnica  acted  with  intense  violence  when  appHed  to  the 
skin  in  persons  sensitive  to  its  action,  but  no  such  violent  result 
had  he  seen  from  it  when  given  by  the  mouth,  and  he  argued 
from  this,  as  well  as  from  many  other  facts,  that  remedial 
agents  differed  very  much  in  the  intensity  of  their  action  in 
accordance  with  the  part  of  the  body  to  which  they  were 
applied.  In  the  treatment  of  deaf  cases,  he  had  often  used 
our  triturations  as  snuffs,  and  he  had  observed  with  some,  a 
very  marked  effect  upon  remote  organs,  while  with  others  ^e 
effect  seemed  limited,  much  more  so  than  when  given  by  the 
mouth,  to  adjoining  organs.  With  ammonium  muriaticum,  fpr 
instance,  its  third  decimal  trituration  is  followed  by  a  feeling 
of  dryness  not  confined  to  the  nasal  mucous  membrane,  but 
extending  very  markedly  to  that  of  the  rectum  and  other 
parts  of  the  intestinal  and  vesical  mucous  tracts.  The  effects 
the  ammonixim  mur,  exerts  is  primarily  a  drying  up  of  the 
fluids  and  consequent  lessened  liquidity  of  the  fseces,  and 
diminution  in  the  quantity  of  urine,  and  this  when  given 
simply  in  the  form  of  snuff.  Coming  to  ajm.  Dr.  Cooper 
insisted,  as  others  had  done,  that  aids  cannot  at  all  be  con- 
sidered as  a  polychrest ;  it  acts  most  satisfactorily  when  indi- 
cated, but  its  indications  do  not  justify  us  in  considering  it  a 
polychrest.  Dr.  Cooper  had  seen  aim  act  in  the  most  magical 
manner  in  throats  attended  with  localised  patches  of  oedema ; 
the  puffy  whitish  submucous  swelling  that  sometimes  occurred 
in  inflamed  throats  disappeared  as  by  command  after  a  dose 
or  two  of  apis.  Dr.  Cooper  was  intensely  interested  by  the 
narration  of  Dr.  Femie*s  initial  case.  He  had  heard  of  it 
many  years  ago  from  his  old  friend  Dr.  John  Wilde,  of  Win- 
chester, now  of  Weston-super-Mare,  and  if  his  memory 
served,  the  drink  concocted  by  the  peasants  from  the  honey- 
comb on  this  occasion  was  termed  in  the  country  '*  hum  "  (to 
this  Dr.  Femie  assented),  and  he  referred  to  it  specially 
because  when  practising  in  Southampton  he  had  been  at  paios 
to  obtain  information  on  the  subject  from  his  dispensazy 
patients,  and  never  succeeded  in  finding  any  who  could  en- 
lighten him  about  it. 

Dr.  DuDOBOM  (in  the  chair)  said  he  had  seen  aim  of  use  in 
ascites,  chemosis,  and  oedema  of  glottis.   Cases  of  rheumatism 


r 


aSS^t^UiS^     THE   SINGLE  BEMEDY.  441 

^^^^■^^^^^^^^^^■^^^^^^■^fc— i-^^i^^^^^"^"^-^^-^^^^^"^^— ^-^i^—^^^B^^^-^^^—^W^™-— •^^^■^•^^■^^-^^^i^B^*— i^^™^-^"^^^— ^^i^"^»»— ^^^^^— ^^» 

had  been  of  late  years  recorded  as  haying  been  cured  by  the 
sting  of  bees  inflicted  Yolontarily  and  involuntarily. 

In  reply  to  the  remarks  made  by  the  several  members. 
Dr.  FsiunE  said :  He  scarcely  could  agree  with  Dr.  Hughes 
that  even  if  advised  by  medical  men  to  swallow  the  vaccine 
lymph  patients  would  object  on  the  score  of  its  being 
repolsive.  In  former  times  persons  willingly  took  as  medicines 
powdered  skuUsi  serpents'  dung,  and  other  such  abominations ; 
▼hflst  to-day,  mysterious  matters  such  as  anti-canceroso, 
anti-scrofuloso,  &c.,  are  unquestioningly  swallowed.  He  would 
aak  if  the  apis  tincture,  which  seemed  to  fail  with  Mr.  Wright, 
was  reliably  prepared  from  infuriated  bees,  according  to  the 
approved  directions  ?  though  the  redted  case  of  the  pensioner 
did  not  seem  to  bear  out  this  necessity. 

Dr.  Cooper  had  kindly  reminded  him  the  brew  which  acted 
80  sncces^ully  in  the  case  adduced,  and  which  Dr.  Cooper 
remembered  hearing  about  at  the  time,  is  called  "hum  "  in 
Hampshire,  and  Dr.  Femie  remarked  that  bee  hum  had  been 
eertamly  proved  anything  but  hum-associated  with  another 
insect,  the  cimex  lecUdarins. 

He  could  not  from  personal  experience  answer  the  query  of 
Dr.  Moir,  whether  being  repeatedly  stung  by  bees  provoked 
the  use  of  bad  language,  with  a  craving  for  whiskey.  In 
reply  to  the  suggestion  by  Dr.  Dudgeon,  that  the  use  of 
bees  designedly  for  stinging  a  gouty  or  rheumatic  limb  may  be 
beneficial.  Dr.  Femie  said  his  gardener,  who  helped  him  in 
attending  to  bees  throughout  several  years,  and  was  often 
stong  by  them,  had  no  attack  of  rheumatism  during  all  that 
time,  though  he  had  frequently  suffered  from  the  malady 
before,  and  has  done  so  again  since. 


THE   SINGLE  EEMEDT  IN    THE  PEACTICE 

OF  MEDICINE.* 

By  a.  Spbibs  Alexamdeb,  M.D. 

Had  we  been  meeting  to  discuss  questions  relating 
to  the  treatment  of  the  sick  in  the  year  1791,  instead  of 
1891,  we  mighty  perhaps,  have  vied  with  each  other,  as 
the  best  evidence  we  could  adduce  of  our  skill  in  the 
science  of  therapeutics,  in  the  effort  to  concoct  the 
most  complex  prescription  possible.  We  might  have 
descanted  learnedly  on  the  vital  importance  of  base, 

^ ■         • — ■ — ^-^ 

*  Bead  before  the  Western  Counties  Therapeutical  Society. 
ToL  35,  Ko.  7.  2  I 


442  THE    SINGLE   REMEDY.      ^^hJJ&t^WSJ! 

• • ■ ■ 

adjuvant,  corrigent,  &c. ;  or  have  exhibited  in  triumph 
some  wonderful  formula  consisting  of  20  or  30  ingredients, 
as  an  infallible  cure  for  some  mysterious  "  humour ; "  or 
-we  might,  perchance,  have  comforted  ourselves  by 
unanimous  denunciations  of  that  arch-heretic  and 
impostor,  Samuel  Hahnemann,  just  at  that  time 
becoming  famous. 

But  the  march  of  medical  civilization  places  us  on  a 
very  different  platform  in  this  year  of  grace,  1891.  Instead 
of  contending  for  the  need  of  complex  prescriptions,  we 
meet  to-night  to  discuss  the  merits  of  the  single  remedy 
in  the  practice  of  medicine  ;  instead  of  pinning  our  faith 
to  the  virtues  of  incomprehensible  mixtures,  some  of 
them  little  better  than  that  of  the  "  witches'  cauldron," 
we  have  learned,  or  are  learning,  to  confide  in  the 
administration  of  one  drug,  and  that  the  similimum,  for 
every  disease,  or  phase  of  disease  ;  and  instead  of 
ridiculing  as  a  visionary,  or  reviUng  as  an  impostor,  him 
who  had  dared  to  depart  from  the  traditions  of  mediaaval 
mysticism,  we  have  learned  to  revere  our  great  master, 
Bamuel  Hahnemann,  as  the  founder  of  rational  medicine, 
as  we  know  it. 

Nor  is  it  among  our  own  ranks  alone  that  the  immense 
advantage  of  simplicity  in  prescribing  is  now  obtaining 
recognition.  There  is  a  growing  tendency  among  the 
more  enlightened  of  our  brethren  of  the  other  school  to 
limit  their  treatment  to  the  exhibition  of  one  drug  at  a 
time.  Practical  evidence  of  this  tendency  is  to  be  found 
in  the  numerous  **  elegant  preparations  "  of  single  drags 
now  in  the  market,  e.g.,  tablets  of  aconite,  bclladonm^ 
calcium  sulphide,  biniodide  of  mercury,  nux  vomica,  anH- 
pyrinCy  stdphonal,  &c.  "  When  we  are  tolerably  certain 
o5f  the  action  of  a  drug,"  says  Dr.  Farquharson,  "  and 
more  especially  when  we  are  making  scientific  observa- 
tions on  its  mode  of  action,  it  is  often  of  great  importance 
that  we  should  not  obscure  its  effects  by  the  addition  of 
any  other  active  substances,  but  order  it  either  simply 
in  distilled  water,  or  merely  combined  with  other  ingre- 
dients for  flavouring  purposes."  One  clause  in  that 
sentence  is  of  the  first  importance  for  us  in  the  con- 
sideration of  the  question  now  before  us.  It  is  this: 
"  and  more  especially  when  we  are  making  scientific 
observations  on  its  mode  of  action."  I  well  remember 
an  anecdote  illustrating  such  observation,  which  I  heard 


S^J^^UiS^      THE   SINGLE   BEMEDY.  443 

when  a  student  from  Dr.  Gairdner.  The  Principal  of  a 
certain  university,  he  told  us,  had  for  years  been  a 
martyr  to  asthma,  and  had  tried  many  methods  of 
treatment  without  avail.  At  length,  a  prescription  was 
given  him  which  alwavs  proved  effectual  in  relieving 
the  paroxysms.  Being  of  an  enquiring  turn  of  mind,  he 
began  to  wonder  which  of  its  numerous  ingredients  was 
the  potent  one  in  relieving  his  malady,  and  so  set  to 
work  to  experiment. ,  Every  time  he  had  the  prescription 
made  up,  he  instructed  the  dispenser  to  omit  one  of  its 
ingredients,  till,  at  last,  the  prescription  was  reduced  to 
one  drug,  which,  taken  alone,  was  as  effectual  as  the 
whole  mixture.  That  drug,  the  Principal  concluded, 
must  be  the  curative  one,  and  continued  thereafter  to 
take  it  without  admixture.  The  particular  drug  was 
iodide  of  potassium. 

Now,  for  us,  as  homoeopathically  prescribing  phy- 
sicians, it  is  of  the  utmost  importance  to  keep  this 
object— the  observation  of  the  mode  of  action  of  single 
remedies — constantly  in  view.  We  ought  to  be  making 
scientific  observations  on  the  action,  if  not  on  the  mode 
of  action,  of  drugs  every  day  of  our  lives.  Their  action 
on  the  healthy  body  has  been  already  given  us  by  many 
able  investigators.  With  us  now  lies  the  duty  of  verify- 
ing in  our  daily  practice  the  corresponding  action  of 
those  drugs  on  the  unhealthy  body. 

In  order  that  we  may  perform  this  duty  e£Siciently, 
what  conditions  must  be  fulfilled  ? 

1°  The  drug  administered  must  be  the  true  similar  to 
the  disease  treated. 

2P  It  must  be  given  alone,  without  admixture,  and 
without  alternation  with  other  drugs. 

8^  It  must  be  given,  if  possible,  in  such  dilution  as 
shall  not  cause  medicinal  aggravation. 

(a)  The  first  of  these  conditions  is  the  most  important, 
as  it  is  the  most  difficult  of  fulfilment.  To  find  the 
siviilimum  is,  for  us,  the  sum  and  substance,  the  uUima 
Thule  of  the  whole  question.  Find  the  similimum  to  a 
given  disease,  and  you  will  infallibly  cure  it,  provided 
the  disease  be  a  curable  one.  I  go  further,  and  assert 
that,  if  we  could  find  the  true  similimum  to  diseases  now 
considered  incurable,  these  would  soon  be  removed  from 
that  category.  Of  such  an  advance  in  therapeutics, 
I  may  instance  the  researches  of  the   renowned  Dr. 

2  1^2 


444  THE   SINGLE   REMEDY.      ^^^^S??S, 

Eochy  whose  treatment  of  certain  forms  of  tubercular 
disease  we  now  know  to  be  founded  on  his  use  of  what 
may  be  regarded  as  the  sirniUmum  of  that  disease. 

For  some  diseasesi  however,  it  may  be  objected,  no 
true  smilimum  has  yet  been  discovered,  and  herein,  it 
seems  to  me,  lies  the  chief  difficulty  in  prescribing  the 
single  remedy.  It  may  be  possible  to  cover  a  part  of  the 
disease,  or  a  phase  of  it,  with  one  drug,  and  thereby  to 
cure  that  part,  or  that  phase.  As  long,  however,  as  the 
whole  of  the  disease  is  not  removed  the  patient  is  not 
cured.  Hence,  it  may  be  necessary  to  take  the  disease 
stage  by  stage,  or  part  by  part. 

The  first  remedy  given  may  cure  a  certain  number  of 
the  symptoms,  but  leave  the  remainder  untouched,  as 
the  latter  were  not  included  in  its  pathogenesis. 

A  second  prescription  is,  therefore,  necessary  to  cover 
these,  or  a  part  of  them,  and  a  third  or  fourth  may  even 
be  required  before  the  whole  disease,  or  rather  the 
patient,  can  be  cured.  The  treatment  of  such  a  case 
may  be  like  the  rungs  of  a  ladder,  all  of  which  lead  to 
the  summit,  but  no  one  of  which,  save  the  last,  is  truly 
the  summit. 

Such  circumstances,  however,  are  by  no  means  the 
rule  in  the  treatment  of  the  sick.  Cases  do  present 
themselves,  and  that  frequently,  for  which  by  a  little 
painstaking  a  true  ^imilimum  may  be  discovered,  and 
when  discovered,  that  single  remedy  will  radically  cure. 

ip)  The  simUimum  having  been  found,  the  second 
requisite  is  that  it  shall  be  given  without  admixture, 
and  without  alternation  with  other  drugs.  The  necessity 
of  the  first  precaution  is  so  self-evident  that  I  need  not 
dwell  on  it.  The  question  of  alternation,  however,  is 
open  to  debate,  though  the  custom  of  giving  two  drags 
in  alternation  is  only  too  common  in  practice.  Suffice  it 
now  to  say,  that  if  the  true  svmiLimum  for  a  given  case 
has  been  found,  alternation  would  be  unreasonable, 
and  fatal  to  scientific  observation  of  its  action.  If  we 
are  to  form  an  accurate  conclusion  as  to  the  effects 
of  our  remedy,  it  must,  of  course,  be  allowed  to  act 
unaided  or  unhindered  by  any  other  drug. 

(y)  Provided  the  remedy  have  been  accurately  chosen, 
the  dilution  is  a  secondary  matter,  and  may  be  left 
to  experience.  The  latter  probably  teaches  most  of 
us  that  it  is  desirable  to  cure  with  the  le'ast  possible 


ItoSSf J^^iTiS?^     THE  SINGLE  BEMEDY.  445 

quantity  of  the  given  drug ;  that  in  some  patients  low, 
and  in  others  high  dilations  may  eaose  medicinal 
aggravations,  and  that,  on  the  whole,  the  medium  and 
hi^er  dilations,  from  the  6th  to  the  80th,  give  the  best 
resnlts,  more  especially  in  diseases  of  a  somewhat 
chronic  character.  In  acute  diseases  I  have  always 
found  the  dilutions  below  the  6th  centesimal  act  well. 

Some  of  our  American  colleagues  go  a  good  deal  farther 
than  this,  and  maintain  that  the  only  true  scientific  rule  is 
to  administer  a  single  dose  of  a  single  drug,  following  up 
with  placebag^  till  the  dose  shall  have  exhausted  itself.  I 
confess  I  have  not  ^et  arrived  at  that  high  pitch  of 
scientific  refinement  m  practice.  I  wll  only  sa^  that  if 
a  single  dose  be  sufficient  to  cure,  the  succeedmg  ones 
need  not  necessarily  aggravate,  for,  the  morbid  process 
having  been  overcome  by  the  first  dose,  and  the  system 
therefore  no  longer  hypersensitive,  the  others  would 
probably  remain  inert,  and  therefore  might  as  well  be 
given  as  plaeeboi^  if  for  no  better  reason^ 

Having  now  shortly  discussed  the  conditions  of  cure 
by  the  single  remedy,  I  proceed  to  offer  a  few  examples 
taken  from  my  daily  practice. 

Case  I. 

Bev.  J.  S.  P.  First  seen,  4th  September,  1888. 
About  a  year  ago,  patient  visited  a  sick  woman,  living 
in  a  very  badly  drained  house.  The  sick  room  had 
apparently  not  been  ventilated  for  weeks,  and  the 
atmosphere  was  so  pestilential  that  the  visitor  felt  almost 
suffocated.  Soon  after,  he  began  to  feel  ill,  was  con- 
stantly drowsy  by  day,  and  slept  too  heavily  at  night. 
An  eruption  then  appeared  all  over  body  and  limbs.  The 
skin  became  bright  red,  and  was  covered  in  patches  with 
dry  silvery  scales.  At  night,  there  was  some  burning 
and  itching. 

Previous  to  this  attack,  patient  had  noticed  a  very 
small  scalv  patch  on  the  extensor  surface  of  each  elbow. 

When  nrst  seen  by  me,  the  patient's  whole  trunk, 
arms,  hands  and  legs  were  covered  with  large  scales,  on 
a  bright  red  base.  The  scales  fell  off  in  flakes  of  the 
size  of  a  shilling.  Some,  he  stated,  occasionallv  accu- 
mulated, and  became  thick  and  hard,  so  that  wnen  the 
limbs  were  bent,  slight  cracks  appeared  in  the  flexures. 
A  papular  eruption  often  appeared  on  face  after  preaching. 


446  THE   SINGLE   REMEDY.     ^^^Sr^SHJ^' 


Had  been  told  he  was  suffering  from  psariasiSf  bat  the 
case  looked  more  like  one  o{  pityriasis  rubra,  1^.  Petrol. 
6,  4  hs. 

18th  Sept.  Writes  that  after  beginning  the  medicine^ 
the  rash  increased.  A  week  later  it  appeared  to  be 
arrested.  Is  now  nearly  gone  from  face,  neck  and  chest, 
and  is  disappearing  more  slowly  from  back  and  legs. 
Sleeps  well,  which  he  had  not  been  able  to  do  for  months 
past.  Appetite  good,  and  can  get  about  comfortably. 
Continue  med. 

6th  Oct.  The  face  and  neck  are  now  entirely  free  from 
the  rash,  and  only  a  little  roughness  remains  on  chest 
and  limbs.    The  latter  is  rapidly  disappearing. 

From  4th  till  27th  Sept.,  patient  lost  4  lbs.  weight, 
but  since  the  latter  date,  has  gained  2^  lbs.  I^ .  Petrol. 
30,  4  hs. 

17th.  Patient  called  to-day.  The  only  trace  of  the 
eruption  remaining  is  a  slight  roughness  here  and  there. 

Ten  days  ago,  a  vesicular  eruption,  covering  an  area 
about  the  size  of  palm  of  hand,  appeared  over  left  hip. 
This  is  now  fading.  General  health  good,  sleeps  weU,. 
and  awakes  refreshed.  Since  27th  September  has  gained 
6  lbs. 

6th  Dec.    Patient  reports  himself  well. 

Since  last  date,  I  have  repeatedly  heard  that  patient 
continues  perfectly  well. 

This  gentleman  had  been  under  allopathic  treatment 
for  a  year,  and  had  taken  quantities  of  arsenic,  only^ 
however,  growing  steadily  worse. 

Case   II. 

Mr.  S.,  seen  July,  1889.  This  patient  had  been  suffer- 
ing for  some  two  or  three  years  from  an  eruption  on  the 
extensor  surface  of  the  right  thumb.  At  the  outset,  his^ 
attention  has  been  attracted  by  some  itching  there,  and, 
on  examining  the  part,  he  noticed  a  fine  miliary  rash 
over  the  surface  mentioned  above.  After  a  time  this 
died  away,  but  subsequently  returned  in  an  increased 
degree.  The  eruption  thus  fluctuated  for  some  months,, 
but  finally  seemed  to  gain  a  firm  hold  and  became 
steadily  worse.  When  seen  by  me,  the  distal  phalanx 
of  the  thumb  was  greatly  swollen,  with  a  deep,  bleeding 
fissure  across  the  joint. 


SS^J^uSn!^''     THE   SINGLE  REMEDY.  447 

The  fissure  gave  great  pain,  and  was  so  aggravated  by 
nsing  the  thumb,  that  the  member  had  become  aknost 
useless. 

To  this  patient  also  petroleum  6  was  given. 

This  he  took  for  two  days,  and  then,  as  the  eruption 
became  much  worse,  stopped  it.  No  more  medicine  was 
taken.  The  aggravation,  evidently  a  medicinal  one, 
soon  passed  away,  the  fissure  healed,  the  rash  gradually 
bded,  and  finally  disappeared  entirely.  Since  then, 
there  has  been  no  return  of  the  trouble,  and  patient  is 
now  in  good  health.  No  local  application  was  made  to 
the  affected  part. 

In  both  these  cases,  the  key-note  "  cracks  or  fissures 
in  bend  of  joints  "  led  to  the  drug  selected. 

Case  III. 

Mrs.  T.,  aet.  48.  First  seen,  6th  September,  1886.  For 
the  last  three  years  patient  has  been  suffering  from  an 
eruption  on  back  of  hands  and  arms.  It  began  on  the 
wrists,  after  a  chill.  The  rash  is  very  scaly,  disposed  in 
small  circles,  running  into  each  other,  with  wide  cracks 
here  and  there,  which  bleed  and  weep  a  little,  and  are  veify 
pamfol.  The  eruption  does  not  itch  much,  but  aches, 
and  "  feels  like  the  sting  of  a  nettle."  Has  some  ecze- 
matous  spots  on  the  scalp,  and  states  that  she  has  at 
times  had  an  eruption  behind  the  ears.  Has  passed 
menopause.    Looks  healthy,  and  is  very  stout. 

The  occurrence  of  the  eruption  behind  the  ears  guided 
to  the  prescription,  graphites  6,  node  maneque. 

Nothing  more  was  seen  of  this  patient  till  Dec.  2nd, 
when  she  returned  and  stated  that,  at  her  former  visit, 
she  had  omitted  to  mention  that  the  inner  surface  of 
both  thighs  resembled  "  raw  beef."  This  was  now  quite 
well.  The  rash  on  the  arms  and  hands  was  almost 
gone,  only  a  few  spots  remaining.  All  the  cracks  had 
healed.  Graphites  12  was  now  given,  and  patient  subse- 
quently sent  word  that  she  was  quite  well.  No  local 
applications  were  used. 

Case  IV. 

Mr.  C,  8Bt.  50-  First  seen,  27th  Sept.,  1890.  This 
patient  presented  a  somewhat  repulsive  appearance,  the 
whole  of  the  upper  lip  being  thickly  covered  by  a  lemon- 
jellow  crust,  broken  down  here  and  there  and  exuding 


448  THE   SINGLE  BEMEDY.     ^IS^&J'SSST^. 


Bevisw,  Jolj  1,  un* 


matter  at  the  edges.  The  eruption  resembled  in  a 
general  way  that  of  "  tinea  capitis/'  but  there  were  no 
cups.  There  was  no  history  of  contagion,  as  from  a 
foul  razor,  nor  could  the  eruption  be  accounted  for  in 
any  way.  It  had  begun  several  weeks  previously,  in 
the  form  of  small  papules  or  vesicles,  the  exudation 
forming  a  crust  which,  after  removal,  quickly  collected 
again. 

Patient  was  directed  to  apply  vaseline  to  the  crust  till 
it  softened  enough  to  be  removed  easily,  and  received 
internally  dctita  viro$a  3x. 

In  a  fortnight  he  returned.  The  crust  was  now  com- 
pletely gone,  the  skin  of  the  upper  lip  looked  healthy, 
with  only  the  remains  of  a  papule  here  and  there,  and 
new  hair  was  growing  rapidly.  The  patient  was  asked 
to  take  the  same  medicine  less  frequently,  and  to  leave 
it  off  gradually.  As  he  lived  at  a  distance  of  some 
twenty  miles  or  more,  he  agreed  to  return  only  if  tiie 
eruption  reappeared,  and  having  heard  nothing  of  him 
since,  I  conclude  that  he  continues  well. 

Under  cicuia  virosa,  Hering  gives  the  following 
symptoms: — Lower  Face — ^Yellow  scurfs  on  the  left 
comer  of  the  mouth,  discharging  yellow  corrosive  fluid, 
may  extend  over  the  lip,  chin  and  cheek. 

Case  V. 

At  the  risk  of  wearying  you,  I  beg  leave  to  present 
you  with  yet  one  more  case  of  skin  disease. 

Mrs.  P.,  8Bt.  73.  First  seen,  10th  October,  1888. 
Complains  of  eruption  on  hands,  arms,  face,  and  back 
of  legs.  The  rash  is  rather  dry,  and  presents  raw 
cracks  here  and  there.  The  eylids  often  crack  at  the 
corners.  I{;  Graph.  12,  4  hrs.  On  Oct.  20th  patient 
was  seen  again,  when  a  considerable  improvement  was 
observed.  The  same  medicine  was  repeated,  but  in  the 
80th  dilution,  and  on  November  Brd  patient  returned 
and  reported  herself  "  quite  well." 

Case  VI. 

Mrs.  M.,  set.  47.  First  seen  2nd  October,  1888.  The 
following  symptoms  were  noted : — 

Pain  after  food,  beginning  in  epigastrium  and  spread- 
ing all  over  chest,  belching  of  flatus,  and  vomiting 
which  relieves  the  pain.  Lips  chapped,  and  tongue  feeb 
scalded.  Bowels  constipated.  Water  thick  and  offensive. 


S^J^rSw?*'     T^^^  BINaLB  BEMEDT.  449 

For  these  symptoms  Natrum  mwr.  80  was  given ;  a  dose 
every  four  hours. 

On  October  16th  patient,  who  lived  at  a  distance, 
im>te  that  she  was  much  better  in  ever^  way.  There 
was  no  pain  now  felt  after  food,  only  a  httle  occasional 
flatolencgr  remaming. 

The  same  treatment  was  continued,  and  on  Nov.  6th 
I  heard  again  that  all  the  discomfort  was  gone,  and 
that,  for  t£ie  first  time  for  many  years,  this  lady  was 
able  to  digest  her  food  naturally. 

Casb  vn. 

Miss  M.  First  seen  28th  December,  1889.  After 
taking  cold  about  a  month  ago,  this  patient  lost  her 
voice,  and  since  then  has  been  able  to  speak  in  a  whisper 
only.  She  has  a  dry  cough,  and  throat  feels  swoUen  and 
painful. 

She  received  antmon.  eauit.  8x,  and  on  January  4th, 
1890,  reported  that  the  voice  returned  three  days  after 
b^inning  the  remedy,  and  had  been  quite  clear  since 
thm. 

A  propos  of  this  case,  I  may  say  that  I  have  used  the 
same  remedy  with  marked  success  in  many  similar 
instances.  The  leading  symptoms  are  inability  to  speak 
above  a  whisper,  with  raw  feeling  in  larynx.  Cauaticum 
is  allied  to  it,  but  di£fers  in  not  necessarily  having  entire 
aphonia,  but  a  rough,  hoarse  voice,  due,  according  to 
Hughes,  to  paresis  of  the  vocal  cords.  For  the  use  of 
cmmon.  caust.  I  am  indebted  to  Farrington. 

Case  Vm. 

Mrs.  H.,  set.  80.  First  seen  7th  Dec,  1888.  This 
lady  was  a  widow,  and  had  never  had  any  family.  For 
fiome  years  she  had  suffered  from  displacement  of  the 
^omb,  for  which  she  had  been  treated  by  a  London 
gynfficdogist,  who  had  inserted  a  pessary.  In  spite  of 
the  mechanical  support  so  obtained,  she  had  never  ceased 
to  suffer  great  pain  and  discomfort,  and  was  almost 
entirely  confined  to  the  sofa. 

Her  chief  symptoms  were  as  follows : — severe  pain  in 
sacrum  and  hips,  going  down  under  surfsuse  of  thighs. 
Oonstant  bearing  down  in  hypogastrium,  and  feeling  as 
though  uterus  were  protruding  from  vagina.  Obstinate 
constipation,  the  bowels  rarely  acting  without  aperients 


460  THE   SINGLE   REMEDY.      ^S^l?S5??t2? 


BevJew,  July  1,  IflBL 


or  enemata.  Urine  thick  and  high-coloured.  All  these 
symptoms  were  greatly  aggravated  at  the  menstnial 
periods,  during  which  patient  described  her  sufferings  as 
excruciating.  The  sum  total  of  the  symptoms  pointed 
clearly  to  sepia^  which  was  accordingly  given  in  the  30th 
dilution.  After  the  next  period,  patient  stated  that  she 
could  not  report  any  improvement,  and  that  indeed  the 
dysmenorrhoea  had  been  rather  worse  than  usual.  Little 
brown  macular  spots  had  appeared  on  her  face,  chest,  &c., 
much  to  her  distress.  Here  was  then  a  clear  case 
of  medicinal  aggravation,  both  in  respect  of  increased 
pain  and  of  the  brown  spots.  Feeling  sure,  however, 
that  sepia  was  the  correct  remedy,  I  prescribed  it  again, 
but  this  time  in  the  200th  dilution. 

In  another  month's  time  the  whole  aspect  of  aSairs 
had  entirely  changed.  During  the  interval  patient  had 
been  almost  free  from  discomfort,  and  had  even  been 
able  to  walk  about  a  little,  while,  to  her  surprise,  the 
period  had  passed  almost  painlessly.  The  same  drug 
was  thereafter  continued  at  intervals,  till,  in  a  few 
months'  time,  this  lady,  who  for  years  had  spent  most 
of  her  time  on  the  sofa,  reported  that  she  was  entirely 
free  from  all  her  old  symptoms,  and  had  taken  a  walk  of 
five  miles. 

On  4th  July,  1889, 1  removed  the  pessary,  which  had 
never  done  any  good  beyond  mechanically  preventing 
retro-version,  and  which  was  never  again  required,  the 
womb  maintaining  its  normal  position  without  artificial 
support.  About  a  year  ago,  this  lady  married  again,  and 
on  17th  January  of  this  year  was  safely  delivered  of  a 
fine  male  child. 

Case  IX. 

In  July,  1889,  a  friend  in  Scotland  wrote  asking  advice 
on  behalf  of  a  boy  suffering  from  "fits."  Prom  the 
particulars  given,  I  concluded  it  was  a  case  of  epilepti- 
form convulsions,  and  prescribed  cicuta  viroia  8x. 

When  in  Scotland  last  summer  (1890)  I  saw  the 
father  of  this  boy,  and  from  him  received  the  following 
particulars: — His  son,  B.M.,  est.  18,  had  been  a  robust 
lad,  and  in  good  health  up  till  June,  1889.  At  that 
time,  after  working  in  the  fields,  he  was  seized  with 
what  were  believed  to  be  epileptic  fits^  The  attacks 
always  occurred  shortly  after  patient  fell  asleep   on 


r 


iSSi^^TtS^     THE   SINGLE   REMEDY.  461 

retiring  for  the  night.  He  awoke  "  suffocating," 
ehoking,  and  gasping  for  breath,  the  whole  body 
"  stretched  oat "  and  rigid,  with  convolsive  twitching  of 
muscles,  and  in  a  state  of  absolute  unconsciousness. 
It  had  not  been  observed  whether  the  convulsions  were 
anilateral  or  bilateral.  The  fits  were  not  preceded  by  & 
cry,  the  tongue  was  not  noticed  to  be  bitten,  nor  was 
there  foaming  at  the  mouth.  After  the  attack,  patient 
slept  profoundly  for  the  remainder  of  the  night.  Six 
fits  had  occurred  during  seven  consecutive  weeks.  The 
boy's  parents  attributed  his  condition  to  exposure  to 
thesun. 

After  the  seventh  attack,  cicuta  vir.  was  given,  a  dose 
thrice  daily,  and  from  that  time  onwards  there  had 
been  no  recurrence  of  the  attacks.  The  boy  is  now 
qmte  well,  and  able  to  work  in  the  fields  all  day  without 
inconvenience. 

Of  cicuta  virosa,  Farrington  says  in  his  Clinical 
Materia  Medica,  page  40Y,  it  '^  produces  congestion  at  the 
"  base  of  the  brain  and  in  the  medulla  oblongata.  At 
"first  the  patient  is  rigid,  with  fixed  staring  eyes, 
"  bluish  face,  and  frothing  at  the  mouth.  Next,  there 
"passes  a  shock,  or  series  of  shocks,  from  the  head 
"through  the  body.  The  patient  is  often  unconscious, 
"  the  jaws  are  locked,  the  patient  bites  the  tongue. 
"  These  spasmodic  symptoms  are  followed  by  profound 
"  exhaustion." 

Case  X. 

Mrs.  B.,  set.  87.  Towards  the  end  of  last  August  thi& 
patient  consulted  me  on  account  of  a  violent  attack  of 
urticaria.  For  the  three  mornings  previous  to  her  visit 
the  rash  had  appeared  the  moment  she  got  out  of  bed.. 
Large,  raised,  white  swellings,  surrounded  by  a  red 
blo^,  suddenly  rose  up  all  over  the  legs,  arms,  chest, 
and  face.  The  irritation  she  described  as  maddening, 
and  she  felt  as  though  stung  all  over  by  nettles.  The- 
rash  remained  out  all  morning,  and  gradually  faded 
without  altogether  disappearing.  Patient  had  been  in  a- 
somewhat  poor  state  of  health  and  highly  nervous  con- 
dition for  some  time,  and  had  gone  away  from  home  for 
change.  The  nervous  debility  may  have  been  a  predis- 
posing cause  of  the  attack,  while  the  exciting  cause  was 
probably  the  circumstance  that  she  had,  while  in  the 


452  THE   SINGLE   BBMBDY.     ^^SSSir^S^fflB! 

country,  been  eating  tinned  tongues.  No  other  caiue 
•could  be  assigned.  Apis  mel.  8x  was  given,  and  no  more 
of  patient  was  seen  tiU  a  few  days  ago,  when  she  called 
and  reported  that  the  day  after  beginning  the  medidne 
the  rash  scarcely  appeared  at  all,  and  that  in  anothar 
day  or  two  she  was  perfectly  well. 

Case  XI. 

E.  S.,  8Bt.  18  months.  Late  in  the  evening  of  Jan.  4Ui 
I  was  called  to  see  this  child,  who  was  said  to  have  had 
a  fit.  This,  however,  was  a  mistake,  as  there  had  been 
no  general  convulsion,  but  the  hands  and  feet  were  in  a 
state  of  tonic  spasm,  and  presented  a  very  peculiar 
appearance.  All  the  proximal  phalanges  of  the  fingers 
and  thumbs  were  strongly  flexed  and  drawn  in  towards 
the  palms,  while  the  distal  phalanges  were  as  strongly 
•extended.  The  hands  themselves  were  pronated.  The 
feet  were  in  a  corresponding  condition,  except  that  the 
whole  of  the  toes  were  flexed  afiid  drawn  in  towards  the 
fiole.  Both  hands  and  feet  were  somewhat  swollen  and 
evidently  tender,  as  the  child  cried  whenever  they,  were 
touched.  The  teeth  were  examined,  but  none  of  thoao 
still  uncut  appeared  very  close  to  the  surface.  Bowels 
were  relaxed.  The  mother  had  given  a  warm  bath,  and 
several  domestic  remedies,  but  without  affording  any 
relief. 

I  accordingly  mixed  some  gels.  semp.  ^,  two  or  three 
drops  in  half  a  tumbler  of  water,  directing  a  teaspoonfol  to 
be  given  every  hour,  a  long  as  the  child  should  be  awake. 
The  child  was  seen  again  next  morning,  and  the  thumbs 
then  found  to  be  relaxed,  and  the  hands  and  feet  conld 
be  touched  without  causing  pain.  The  same  medicine 
was  continued,  and  the  following  day  the  extrenlities 
had  resumed  their  normal  condition,  and  the  child 
seemed  quite  well. 

Under  gelsem.^  Hering  gives  "  convulsions  from  reflex 
irritation ;  spasms  of  one  leg,"  and  also ''  tetanic  spasms.*' 

In  this  case  the  spasm  was  no  doubt  due  to  the  refl^ 
irritation  of  dentition.  Hence  gelsem.  was  homoeopathic 
to  the  condition,  and  therefore  cured. 

Case  XII. 
E.  B.,  set.  22.    On  22nd  Dec,  1890, 1  was  called  late 
in  the  evening  to  see  a  girl  of  22  years  of  age,  who,  I  was 
told,  had  been  ailing  for  some  time  and  had  suddenly 


SSS'SSTw^  HYDATIDIFOBM  MOLSS  OF  UTERUS.  458 

become  very  ill.  I  found  her  in  bed  and  presenting  the 
following  symptoms: — Temp.  104°,  pulse  about  120. 
Tongue  very  dry  and  bright  red.  Frequent  loose 
motions  of  a  dark  colour.  Tenderness  and  gurgling  in 
ri^t  iliac  fossa.  One  rather  doubtful  rose  spot  on 
aMomen.    Much  thirst  and  restlessness. 

All  these  symptoms  pointed  clearly  to  arsenicum^ 
which  was  accordingly  given  in  the  third  decimal 
dilution,  a  dose  every  liour. 

Next  morning  I  saw  the  patient  early,  and  found  the 
temperature  101°,  the  pulse  slower,  the  tongue  moist, 
but  still  red,  the  bowels  relaxed,  the  motions  getting 
lighter  in  colour.    The  same  treatment  was  continued. 

The  following  day  temperature  was  normal,  tongue 
still  red,  motions  less  frequent,  but  decidedly  pea-soupy, 
and  slight  gurgling  still  present  in  right  iliac  fossa. 
From  this  time  onward  there  was  no  rise  of  temperature, 
and  in  another  day  or  two  the  bowels  were  acting  natu- 
rally. Arsenicum  was  the  only  medicine  given,  and  radically 
eured  the  case,  which,  I  have  not  the  slightest  doubt, 
was  one  of  enteric  fever.  The  true  simUimum  having 
been  given,  the  whole  course  of  the  disease  was  at  once 
ent  short,  and  the  patient  cured  in  less  than  a  week. 

HYDATIDIFOEM    MOLES    OP    THE    UTERUS, 
WITH  AN  HiLUSTRATIVE  CASE. 

By  J.  MuBBAY  MooBB,  M.D.,  M.B.G.S. 

Bead  before  Uie  Liyerpool  Homoeopathio  Medical  Society,  May  7th,  1891 , 

As  these  curious  perversions  of  embryonic  structures  are 
not  so  very  common  in  ordinary  practice  as  to  be  un- 
worthy of  note,  I  thought  the  following  case  and 
pathological  specimen  worth  bringing  before  our  Society, 
as  a  basis  for  some  remarks  on  the  nature  of  such 
formations.  As  it  happens,  this  paper  will  not  unsuitably 
follow  that  of  our  gynsBCological  colleague.  Dr.  Hawkes, 
read  at  our  last  (April)  meeting  on  "  Pelvic  Symptoms.'* 
On  the  12th  June,  1890, 1  was  consulted  by  Mrs.  C, 
a  married  lady,  aged  25,  of  spare  frame,  of  nervo-bilious 
temperament  and  active  habits,  and  a  tolerably  healthy 
general  appearance,  for  an  enlargement  of  the  abdomen, 
aeeompanied  with  a  suppression  of  the  menses  which 


464  HYDATIDIPOBM  MOLES  OP  UTERUS.  ^^  b^Jt^iSSTmS! 

could  not  be  accounted  for  by  the  symptoms  of  an 
ordinary  pregnancy. 

Her  story,  gathered  at  several  interviews,  for  she  was 
not  used  to  doctors'  interrogations,  was  as  follows :  She 
had  been  married  in  the  first  week  of  August,  1889. 
Previously  for  some  years  she  had  been  a  school  teacher, 
rather  overworked;  and  had  contracted  hsBmorrhoids 
from  the  long  hours  of  standing  required  by  her  duties, 
and  too  frequent  inattention  to  the  calls  of  nature. 
These  piles  had  for  more  than  two  years  bled  at  intervals, 
and  since  the  beginning  of  these  hasmorrhages  the 
menses  though  regular  had  been  more  scanty  than  before 
that,  and  attended  with  more  pain  during  the  first  two 
days.  Constipation  she  had  been  accustomed  to  relieve 
with  rhubarb  pills.  With  these  exceptions  her  health 
had  been  so  satisfactory  that  up  to  the  date  of  her 
marriage  she  had  never  thought  it  necessary  to  consult 
a  doctor. 

Mrs.  G.'s  mother  is  alive  and  well ;  her  sisters,  all 
living,  are  free  from  scrofulous  or  tuberculous  manifes- 
tations. 

About  one  month  after  her  marriage,  namely,  in  Sep- 
tember, 1889,  the  menses  appeared,  lasting  two  days, 
and  had  not  returned  up  to  the  date  of  her  first  visit  to 
me,  June  12th,  1890.  A  few  days  after  the  September 
menstruation  signs  of  pregnancy  began  to  be  noticed ; 
morning  sickness,  gradual  enlargement  of  the  mamms 
and  mammillse,  elevation  and  enlargement  of  the  uterus, 
and  so  on,  continuing  until  the  end  of  November,  1889, 
when,  without  any  shock  to  the  system,  or  perceptible 
disturbance  of  her  general  health,  these  symptoms  ceased 
to  progress ;  the  mammsB  became  gradually  smaller,  and 
the  abdomen  enlarged  no  further.  Her  mother  and  a 
matronly  friend  who  had  watched  her  with  anxiety, 
expected  a  miscarriage  to  occur,  but  with  the  exception 
of  a  slight  occasional  watery  leucorrhoea,  no  discharge 
from  the  uterus  took  place.  She  would  not  call  in  a 
medical  man,  but  at  length,  in  May,  1890,  about  eight 
months  after  the  commencement  of  her  pregnancy,  she 
heard  of  my  return  to  Liverpool  from  an  old  patient  of 
mine,  and  called  upon  me,  June  12th,  when  I  made  the 
following  observations. 

There  is  no  disease  of  skin,  lungs,  liver,  kidneys, 
spleen,  or  ovaries.  There  is  a  functional,  probably  ansemici 


r 


SS^J^TS?**  HYDATIDIFORM  MOLES  OP  UTERUS.  '  456 

manniir  with  (he  cardaic  sjrstole.  Both  external  and 
internal  haemorrhoids  exist.  Vaginal  and  bi-mannal 
examinations  reveal  the  fact  that  the  uterus  is  enlarged  to 
the  size  of  a  gravid  uterus  at  the  end  of  the  third  month. 
There  is  a  doughy  and  inelastic  feel  about  the  cervix  and 
lower  third  of  the  uterine  parietes,  and  a  small  abrasion 
of  the  OS  uteri,  from  which  there  is  a  slight  muco- 
purulent leucorrhoea,  but  there  is  no  discharge  from 
the  cervix?  It  is  plain  to  palpation  that  the  whole  cavity 
of  the  womb  is  fiUed  up  by  some  soUd  or  semi-solid 
tomour,  the  nature  of  which  cannot  be  pronounced  with 
eertainty  the  while  the  os  uteri  is  closed,  as  at  present. 
No  foetal  heart  sounds  nor  placental  bruit  can  be  heard. 

The  skin  is  paler  than  is  usual  with  Mrs.  G.  in  health, 
in  fact,  there  is  external  evidence  that  her  blood  is  some- 
what hydrsemic,  doubtless  from  the  frequent  loss  of 
blood  at  stool. 

The  plan  of  treatment  I  now  laid  down  for  her  was : 

Ist.  To  heal  the  abrasion  of  the  os. 

2nd.  To  dilate  the  os  and  cervix. 

8rd.  To  excite  the  expulsive  action  of  the  uterus. 

4th.  To  reduce  the  hsBmorrhoids  and  strengthen  the 
general  constitution. 

The  treatment  was  begun  on  June  25th  by  the  appli- 
cation of  hydrastis  lotion  to  the  os  uteri  on  a  sponge. 
The  saccharin  carbonate  of  iron  was  given  as  medicinal 
food  once  a  day,  and  caulophyUum  ^  was  prescribed  as 
the  utero-ovarian  remedy  most  indicated.  By  the  19th 
Jidy  the  abrasion  of  the  os  was  quite  healed.  On  the 
22nd  July  I  was  urgently  summoned  to  her  home  in 
£gremont,  and  found  her  in  the  midst  of  what  resembled 
a  miscarriage,  the  os  partially  open,  clots  and  blood  in 
gashes  of  small  amount  coming  away,  and  severe  con* 
tractive  pains  with  bearing-down.  I  should  mention 
that  on  July  16th  I  had  very  gently  introduced  a  flexible 
Jennison's  sound  through  the  cervix  into  the  os  interum, 
allowing  it  to  remain  there  for  five  minutes.  On  the 
afternoon  of  the  19th  July  she  had  gone  to  a  picnic  and 
danced.  This  combraation  of  circumstances  brought 
<m  the  uterine  expulsive  efforts  of  the  22nd  and  23rd 
July,  to  the  great  satisfaction  of  all  parties  interested ; 
for  early  on  the  morning  of  the  28rd  July,  the  tumour 
came  away  clean,  and  clear,  and  unbroken,  which  had 
been  so  long  retaraed;  namely,  for  a  period  of  eight 


456  HYDATIDIFORM  MOLES  OP  UTEBUS.  ^*]^SJ^STwnl 

months  from  the  cessation  of  visible  growth.  Mrs.  G.  made 
a  rapid  recovery  from  this  iUness,  and  when  able  to 
come  over  to  Liverpool  came  mider  treatment  for  the 
haamorrhoids.  She  gained  in  weight,  in  flesh,  in  colour 
of  skin,  and  in  general  health.  The  catamenia  continued 
regular  from  August  21st,  becoming  normal  as  to 
quantity,  until  October  25th.  Definite  signs  of  pregnancj 
appeared  about  the  end  of  November  of  last  year,  and 
she  has  now  (May  7th)  reached  the  2Srd  w^k  of  her 
second  pregnancy  without  a  morbid  symptom,  and  with 
considerable  improvement  to  her  general  health. 

This  tumour  which  I  now  pass  round,  when  first 
passed,  resembled  exactly  a  cast  of  the  inside  of  a  gravid 
uterus  at  the  tenth  or  twelfth  week. 

Its  weight  was  5  oz.  and  it  measured  6^  in.  in  length 
by  5}  ins.  in  circumference,  tapering  down  to  2  ins.  at 
the  lower  (the  narrower)  end. 

Its  colour  was  dark-red  originally,  now  made  rather 
paler  by  the  transudation  of  blood  into  the  surrounding 
preBervitive  medium,  which  is  pore  glycerine:  but  it! 
form  and  size  are  practically  unaltered.  Shortly  after 
this  mole  came  away,  I  made  a  vertical  incision  throngh 
its  whole  length,  and  found  no  trace  of  embryo  or  an 
embryonic  cavity,  but  confirmed  the  diagnosis  of  Dr. 
Hawkes  that  it  was  a  hydatidiform  mole,  by  revealing 
the  peculiar  cysts,  graphically  described  by  Grooch  as 
^*  like  white  currants  floating  in  red  currant  juice."  There 
is  a  firm  hematoma  inside  the  narrow  end  of  the  mole. 
Externally,  the  surface  of  the  mole  is  reticulated,  but 
displays  no  roots,  tendrils,  or  processes.  This  has  been 
a  most  fortunate  feature  for  the  patient's  safe  deliveiy, 
for  sometimes  the  chorionic  villi,  thus  transformed,  as  I 
shall  shortly  explain,  burrow  into  the  walls  of  the  uterus, 
and  cause  serious  hemorrhage  and  even  septicaemia, 
after  the  surgeon  has  been  obliged  to  scrape  the  mole 
piecemeal,  out  of  the  uterus.  If  any  portion  of  a  "  true  "^ 
mole,  such  as  this  is,  be  left  behind  in  the  uterus,  it  may 
be  the  nucleus  of  the  formation  of  a  ''false  "  mole. 

In  searching  gynecological  literature  for  an  explana- 
tion of  these  formations,  I  find  that  nearly  aU  writers 
agree  that  the  "true"  uterine  vesicular  or  hydatid-, 
like  mole  consists  of  a  degeneration  of  the  vilU  of  the 
chorion,  accompanied  by  the  death,  decay,  and  absorp- 
tion of  the  embryo.    The  characteristic  contents  of  this 


SiriSlr^rS?*''  hydatidiporm  moles  of  uterus.  457 


land  of  mole  consists  of  numerous  pedunculated  grape  or 
currant-like  cysts,  separated  from  each  other  by  semi- 
fluid, or  by  coagulated  blood,  but  held  together  at  the 
basis  of  their  stalks  by  a  fibrous  network  resembling  that 
of  the  normal  placenta. 

True  hydatids  of  the  uterus  are  rare,  but  may  occur. 
Originating  in  the  liver,  they  may  burst  into  the 
abdomen,  and  penetrate  through  the  uterine  walls  into 
its  cavity,  or  into  the  vagina.  The  hydatid  is  a  closed 
sac,  containing  one  or  two  more  sacs  inside,  and  the 
microscope  reveals  the  "hooklets  "  ot  the  Echinococcus  in 
each  of  them.  Of  such  a  nature  was  the  case  of  the  Maori 
widow  (quoted  in  my  paper  of  last  session  on  **  Clinical 
Experiences  in  New  Zealand),  from  whom  I  removed  per 
vaginam  in  September,  1881,  a  long  coil  of  these  para- 
sitic cysts,  the  nature  of  which  had  been  mistaken  by  a 
previous  medical  attendant  for  "cancer.'*  Mrs.  W. 
made  a  rapid  and  complete  recovery,  and  for  seven  years 
afterwards  (when  I  quitted  the  colony)  to  my  certain 
knowledge,  had  no  recurrence  of  them.  Hydatids  of 
liver,  lungs,  and  stomach  are  not  infrequent  among  the 
Maoris,  but  among  the  settlers  they  are  much  rarer 
than  among  the  Australian  colonists. 

The  morbid  process  of  degeneration  of  the  ovum, 
which  forms  the  true  vesicular  mole,  commences, 
Spiegelberg  states,  in  an  abundant  proliferation  of  the 
yflli  of  the  chorion-sac,  followed  by  hypertrophy  of  the 
internal  mucoid  matrix  of  each  individual  villus,  the 
cells  and  nuclei  of  its  epithelium  increasing  pari  passu 
with  the  intercellular  fluid  produced  by  the  breaking 
down  and  liquefaction  of  many  cells — a  process  which 
swells  out  many  of  the  villi  into  bladders  resembling 
currants  or  grapes. 

The  fluid  in  these  cysts  has  been  analysed  by 
Gscheidlen,  who  finds  in  it  albumen,  mucin,  phosphates 
and  other  inorganic  salts ;  leucin  and  tyrosin  in  small 
quantities ;  but  no  trace  of  fibrinogenous  substances,  of 
paralbumen,  or  of  sugar.  By  this  negative  feature  the 
molar  cystic  fluid  is  distinguished  from  the  composition 
of  the  amniotic  fluid,  which  otherwise  resembles  it. 
Usually  the. patient  has  an  oozing  of  watery  serous  fluid 
from  the  vagina  during  the  period  of  retention  of  the 
mole,  but  Mrs.  C.  had  no  symptom  like  this,  and  it  was 
plam  fi:om  the  appearance  of  the  mole,  when  passed. 

Vol  35,  No.  7,  2  k 


458  HYDATIDIFORM  MOLES  OF  UTERUS.  ^b^^J^TSl 

that  none  of  the  cysts  had  burst.  This  mole  is  of  smAll 
size  compared  to  some  which  have  attained  the  weight 
of  8  lbs.,  and  the  size  of  a  foetal  head  at  full  term  of 
delivery. 

In  the  case  of  twin  pregnancy,  it  is  interesting  to  note 
that  one  of  the  impregnated  human  ova  may  undergo 
this  cystic  degeneration,  while  the  other  may  proceed  to 
full  development.  It  is  stated  that  the  celebrated 
anatomist  Beclard  was  the  living  child  of  an  event  of  this 
kind.  No  case  is  on  record  of  complete  absorption  and 
disappearance  of  a  mole  within  the  uterus  ;  it  most  be 
passed  through  the  os  tUeri,  or  brought  away  in  the 
mode  least  likely  to  injure  the  tissues,  or  exhaust  the 
patient.  In  this  instance  the  compact  nature  of  the 
mole  (comparatively)  and  the  normal  state  of  the  con- 
tractile fibrilla  of  the  uterus  rendered  its  expulsion  easy. 

The  point  as  yet  unsettled  in  the  pathology  of  these 
moles  is  whether  the  degeneration  of  the  chorionic  villi 
is  initiated  by  the  death  and  decay  of  the  embryo,  or  is 
caused  by  a  morbid  state  of  the  blood  supplied  to  the 
uterine  decidiui,  which  involves  the  subsequent  destrac- 
tion  of  the  foetus.  Leishman  states  that  the  period 
within  which  the  degeneration  of  the  chorionic  villi  may 
originate,  does  not  extend,  probably,  beyond  the  tenth 
week  of  embryonic  life — that  being  the  most  active 
period  in  the  growth  and  multiplication  of  these  villi. 
Later  on,  when  blood-vessels  have  occupied  the  bulk  of 
the  villi,  this  kind  of  degeneration  seems  incapable  of 
formation — although  at  any  period  of  intra-utexine  life 
the  foDtus  may  perish,  and  various  degenerations  of  a 
part,  or  of  the  whole  of  the  uterine  contents  may  occur. 
If,  for  instance,  the  molar  degeneration  sets  in  after  the 
placenta  has  fully  formed,  the  foetal  cavity  remains 
distinct  in  the  tumour.  In  this  case  there  was  no  trace  of 
either  foetus,  or  foetal  cavity.  It  is,  therefore,  probable 
that  the  molar  degeneration  began  in  this  case  about  the 
tenth  or  eleventh  week  of  embryonic  life,  as  the  arrest 
of  development  was  noticeable  from  external  appearances 
at  the  end  of  November,  1889. 

The  actual  pathological  cause,  or  causes,  of  these  molar 
transformations  have  not  yet  been  ascertained.  If,  as 
Spiegelberg  maintains,  the  seat  of  the  earliest  morbid 
change  is  in  the  allantois,  which  forms  the  primitive 
channel  of  nutrition  between  the  embryo  and  the  mother, 


SSSfwSrrSSl?^  hydatidifobm  moles  op  utebus.  469 

^e  mnsi  ascribe  the  cause  to  some  dyscrasia  in  the 
maternal  system,  such  as  syphilis,  scrofula,  or  anaemia. 
A  woman  who  for  years  had  suffered  from  membranous 
dysmenorrhoea  might  be  liable  to  molar  developments 
of  this  kind.  Again,  there  may  be  such  a  chroDically 
morbid  state  of  the  menstrual  discharge  as  to  cause  in 
all  the  ova  liberated  at  the  period  a  Imbility  to  organic 
decay.  After  impregnation,  in  fact,  the  sperm-cell 
{fpermatozoon)  may  be  healthy,  while  the  germ-cell 
(ovum)  is  unhealthy,  though  responsive  to  the  vital 
stimalus  of  the  former.  As  Mr.  C,  the  husband  of  my 
patient,  is  a  perfectly  healthy  man,  I  believe  that  it  is  in 
Mrs.  G.*s  h^th,  previous  to  her  marriage,  that  the 
eskuse  must  be  sought.  For  more  than  two  years  before 
I  saw  her,  her  blood  had  been  in  a  hydremic  condition, 
and  the  menses  had  been  defective  in  quantity  and  in 
eoloor.  Mental  overwork  had  also  been  added  to  bodily 
&tigue,  and  insufficient  appetite  for  food  during  her 
teaching  years.  It  seems  to  me  that  there  was  scarcely 
enough  vis  vita  in  her  first  embryo  to  bring  it  on  to 
complete  development. 

Bat  a  happier  fate,  I  trust,  is  in  store  for  the  expectant 
mother,  who  now  (May  7)  has  reached  her  twenty-third 
week  of  pregnancy,  as  I  have  stated.  As  there  is  a 
strong  tendency  for  molar  abortions  of  various  kinds  to 
lecor  successively  in  the  same  person,  it  is  our  duty,  I 
conceive,  as  scientific  homoeopathic  practitioners,  to 
endeavour  to  prevent  such  recurrences  in  a  patient  who 
has  once  suffered,  by  constitutional  anti-psoric  treatment 
during  their  next  pregnancy ,  very  much  on  the  lines  indi- 
cated by  my  friend.  Dr.  Burnett,  in  his  Prevention  of 
pefect,  Deformity  and  Disease^  dtc.  If  and  when  we  are 
informed  that  our  patient  is  pregnant,  it  is  our  duty  to 
request  her  to  consult  us  once  a  month  (or  oftener,  as 
need  may  arise)  so  as  to  report  her  exact  state  of  health 
and  the  effect  of  such  constitutional  remedies  as  we  think 
fit  to  prescribe. 

My  chief  object  in  recording  and  commenting  upon 
this  case  has  been  to  indicate  to  my  colleagues  of  this 
Society  the  possibility  of  so  managing  the  treatment  of  a 
subsequent  pregnancy  as  to  tide  the  foptus  safely  over  the 
dangerous  period  of  its  first  three  months  of  intra-uterine 
life,  and  prevent  the  recurrence  of  a  vesicular  mole. 

2k  — 2 


460    CYCLOPiBDIA  AND  ITS  REPERTORY.  ^^B^Slrfj^owS 

THE  CYCLOPEDIA  AND  ITS  REPEETORY. 

In  continuance  of  the  discassion  on  this  subject,  as  desired 
by  Drs.  Drysdale  and  Hughes,  I  would  ask  permissioa 
to  express  a  few  thoughts  that  occur  to  me  in  considering 
the  matter,  and  in  the  first  place,  we  naturally  come  upon 
the  CyclopcediUf  being  as  it  is  the  basis  upon  which  the 
Repertory,  whatever  form  that  may  take,  has  to  be  con- 
structed.   As  the  Cyclopadia  is  nearing  its  completion, 
it  may  not  be  amiss  to  take  it  in  review  and  consider 
whether  it  has  succeeded  in  fulfilling  the  hopes  that 
were  formed  at  its  inception ;  and  if  not,  where  it  has 
failed.    In  the  first  place,  praise  unqualified  must  be 
given  to  the  workers  for  the  rapidity  with  which  the 
numbers  have  been  placed  in  our  hands.    It  is  quite  a 
matter  of  surprise  as  well  as  gratification  that  the  origi- 
nal records  have  been  so  hunted  up,  and  condensed,  and 
turned  off  from  the  press,  that  we  get  the  desired  volumes 
without  having  to  wait  impatiently  half  a  lifetime  for 
th.em.      Credit   to  this  extent    must    undoubtedly  be 
awarded  to  the  editors.    In  the  second  place,  it  appears 
to  me  unquestionable    that  the  narrative    form  is  a 
success.    For  myself,  it  has  for  the  first  time  rendered 
our    provings    readable    and    intelligible,    and    placed 
them  on  parallel  lines  with  the  diseases  we  have  to 
treat,  and  one  cannot  doubt  that  the  scientific  appli- 
cation of  the  law  of  similars  will  be  facilitated,  and  the 
development  of  medicine  advanced  one  important  step. 
If  we  had  no  new  Repertory  to  come  the  Cyclopadia 
would  serve  a  useful  purpose  to  all  students  of  drag 
action,  and  it  may  be  safe  to  predict  that  no  record  of 
drug  proving  will  hereafter  have  any  chance  of  accept- 
ance unless  it  appears  in  this  form.      Without  any 
hesitation  it  may  be  safely  said  that  this  element  of  the 
work  will  give  complete  satisfaction.    But  at  this  point 
we  gain  some  insight  into  the  advantages  of  the  Schema 
for  purposes  of  reference,   as  Dr.  Hughes  points  out. 
Whilst  the  narrative  gives  us  what  we  require  for  the 
proper  understanding  of  a  proving,  it  is  not  so  easy  of 
reference,  and  therefore  a  i^epeito/^  is  essential  to  enable 
us  to  obtain  any  special  information  we    may  seek. 
Consequently,  Dr.  Hughes  asks  whether  it  is  desirable 
for  this  purpose  to  have  the  Cyclop(edia  dissected  and 
thrown    into    Schema.    It    seems   to  my    mind   not 


1 


SS^J^^nSi?**  CYCLOPJEDIA  InD  ITS  REPERTORY.    461 

very  essential,  for  a  parallel  case  occurs  in  the 
reyised  version  of  the  New  Testament,  in  which, 
for  purposes  of  reference,  chapter  and  verse  are  indicated 
by  marginal  nombers,  and  the  narrative  suffers  no  dis- 
continuity. In  some  sunilar  way  the  symptoms  may 
irith  equal  ease  be  picked  out  and  numbered  in  the  course 
of  each  proving.  Turning  now  to  another  aspect  of  the 
Cyelopadiay  we  notice  that  if  it  sins  at  all  it  is  in  the  way 
of  omission.  What  are  we  to  say  of  the  exclusion  of  so 
many  medicines  that  found  a  place  in  ''  Allen  "  ?  The 
Cyciopadia  has  admitted  only  the  half  of  them,  and  this 
wholesale  massacre  seems  really  to  call  for  a  judicial 
enquiry.  Dr.  Murray  Moore  called  attention  to  this 
alaiming  fact  some  tune  ago,  and  it  must  have  struck 
most  of  us  who  have  followed  the  course  of  the  Cyclopadia, 
Dr.  Hughes  showed  that,  allowing  for  change  of  place  in 
Bome  cases,  the  others  were  excluded  by  the  rules  upon 
which  the  work  was  conducted,  and,  no  doubt,  he  will 
be  able  to  justify  every  instance  of  exclusion  by  reference 
to  the  rules.  If.  however,  these  rules  are  so  framed  as 
to  exclude  good  matter  it  may  be  well  to  re-consider  their 
effect  before  going  any  further  with  the  Repertory.  It 
was  with  some  surprise  that  I  read  Dr.  Hayward's 
answer  to  Dr.  Simpson  last  month,  where  he  pro- 
poses for  the  Cypher  Repertory^  that  the  Cyclop€edia 
fihall  be  the  source  from  which  future  compilers  shall 
draw  their  supplies,  and  with  a  light  heart  he  throws 
oyerboard  half  the  medicinal  cargo  he  had  previously 
carried.  He  says  the  Cyclopaedia,  ''  contains  all  the 
reliable  material  of  Allen's  Encyclopcediay  along  with 
the  other  material  that  has  been  provided  since  the 
publication  of  that  great  work."  If,  however,  that  work 
included  material,  half  of  which  is  believed  to  be  worth- 
leas,  its  greatness  must  have  consisted  in  its  bigness, 
following  that  idea  out,  what,  according  to  Dr.  Hayward, 
mast  be  the  value  of  the  back  numbers  of  the  Cypher 
Repertory,  which  were  based  upon  Jahr  and  Alien  ? 
Leaving  the  Cypher  Repertory  for  the  present,  let  us  ask 
the  simple  question,  does  the  Cyclopadia  contain  all  the 
reliable  material  of  Allen  ?  for  upon  the  satisfactory 
answer  to  that  question  will  depend  the  confidence  we 
shall  be  able  to  place  in  the  Cyclopredia  as  presenting 
fairly  all  that  is  positively  known  of  drug  action  on  the 
healthy  body. 


1 


■  ,  I 

462    CYCLOP-EDU  AND  ITS  REPERTORY,  ^j^^i^^l^. 

In  the  first  vol.  of  the  Cyclopadia  we  have  over 
20  medicines  missing,  and  this  appears  to  be  the  case 
with  every  succeeding  volume.  Amongst  titie  omissions 
in  vol.  i.  may  be  mentioned  accdyphuy  calendula, 
and  bals.  pent — ^the  two  former,  singularly  enough, 
being  referred  to  in  this  month's  World  as  acting 
curatively,  the  former,  as  reported  by  Dr.  Heath, 
curing  a  case  of  haemoptysis  within  its  accredited 
sphere,  and  the  calendula  being  employed  by  Dr.  Cooper 
in  ear  disease  with  beneficial  results.  Now,  it  is 
likely  that  acalypha  came  athwart  the  bows  of  Boles 
2  and  6  and  foundered  at  once,  but  what  calendula 
has  done  to  share  the  same  fate  does  not  clearly  appear, 
for  in  Allen  it  is  vouched  for  by  two  observers,  and  in 
one  of  the  cases  the  proving  was  made  by  a  tablespoonfol 
of  the  tincture — a  substantial  dose  enough.  Then  the 
proving  of  bale,  peru  by  Dr.  Lembke  was  made  with 
repeated  doses  of  15  to  SO  drops  of  the  drug,  and  the 
results  have  the  appearance  of  genuineness,  and 
are  suggestive  of  the  relations  of  this  medicine 
to  benzoic  ac,  one  of  its  important  constituents. 
This,  presumably,  was  omitted  because  of  its  occurring  in 
only  a  single  prover.  But  a  single  witness  may  speak 
the  truth,  and  when  the  statement  made  bears  all  the 
appearance  of  genuineness,  it  is  only  the  rigorous 
application  of  the  law  that  would  exclude  it.  The  rules 
of  the  Cyclopedia  may  be  appealed  to  by  the  editors,  and 
then  the  important  question  arises,  seeing  what  is  the 
effect  of  this  rigorous  application  of  the  rules,  will  the 
profession  be  satisfied  with  the  result  ?  It  is  the  desire 
of  all  that  the  truth  be  spoken,  but  we  want  the  whole 
truth  as  far  as  we  can  get  it.  Sometimes  we  find  in 
actual  life  that  the  adoption  of  a  line  of  conduct  leads  to 
results  graver  than  were  anticipated,  and  it  is  a  part  of 
wisdom  to  consider  in  this  instance  whether  the  facts 
justify  any  re-C(»i8ideration  of  the  mode  of  procedure, 
and  to  rectify  an^  mistake  before  the  last  step  is  taken* 
In  excluding  provings  solely  with  high  potencies,  the 
rules  were  well  framed,  but  with  regard  to  the  exclusion 
of  provings  with  material  doses  by  single  observers,  the 
utmost  latitude  should  be  allowed. 

No  attempt  is  made  here  to  enumerate  the  heavy  dedac- 

tion  from  the  list  of  medicines  hitherto  regarded  as  reli- 

but  on  turning  over  the  pages  of  the  Cycbpadia 


r 


u!SiJ^TiS»^  cycLOP-aa)iA  and  its  rbpbbtory,  463^ 

and  comparing  mth  Allen,  every  one  mast  be  alarmed 
at  the  disappearance  of  so  many  familiar  names.  Before 
the  book  is  finally  closed,  and  the  Repertory  begun,  I  would 
call  attention  to.  this  important  fact,  and  ask  those  who 
moant  guard  over  the  homoeopathic  treasury  to  see  that 
in  the  transfer  now  being  made  from  the  old  to  the  new 
version  no  valuables  are  permitted  to  fall  through,  and 
that  the  missing  items  are  only  those  not  worth  retain- 
ing. The  merits  of  the  Cyclopcedia  are  so  obvious  that 
a  oanger  of  this  kind  is  apt  to  be  overlooked,  and  the 
enror  recognised  only  when  it  is  too  late. 

In  the  second  place,  comes  the  question  of  the  Reper- 
tonfj  and  after  ail  that  has  been  said  on  the  subject  one 
ironld  have  thought  that  opinion  had  definitely  shaped 
itself.  Perhaps  it  has,  and  only  requires  to  be  expressed. 
At  any  rate,  we  have  Dr.  Hughes,  on  the  one  side, 
(^posed  to  the  Cypher  plan,  and  Dr.  Drysdale,  with  his 
old  admiration  for  it,  advocating  it,  and  bringing  it 
forward  and  expatiating  on  its  many  excellencies  as  he 
has  done  any  time  for  the  last  80  years.  But  it  seems 
to  me  that  the  court  before  which  this  case  must  be  tried 
has  changed.  Originally,  the  case  had  to  be  tried  by 
argument,  in  which  the  merits  and  demerits  were 
advanced  and  balanced  one  against  the  other,  and  the 
eonclusion  arrived  at  according  to  the  weight  of  evidence 
on  one  side  or  the  other.  Dr.  Drysdale,  in  the  June 
Review y  repeats  this  process,  and  brings  before  our  notice 
the  original  preface  to  the  Cypher  Repertory,  and  calls 
upon  us  to  discuss  the  matter  de  novo,  and  on  the  old 
argumentative  lines.  It  seems  to  me,  however,  that  the 
court  before  which  we  have  now  to  try  the  case  is  not  the 
court  of  argument,  but  that  of  experience.  When  an 
institution  h^s  been  in  existence  for  the  space  of  a  gene- 
ration, ^e  have  other  means  of  judging  it  than  were 
possessed  by  the  founders.  We  have  the  experience  of 
the  practical  working  of  it.  If  we  find  that  it  is  in  general 
ose  for  the  purpose  for  which  it  was  intended,  we  pro- 
nounce it  a  success.  But  if,  on  the  other  hand,  it  is  not 
made  use  of  generally,  but  is  practically  abandoned, 
except  by  a  devoted  few,  then  we  say  that,  however  per- 
fect theoretically,  it  has  proved  its  unsuitaVihty  for  the 
people  it  was  intended  for,  and  is  not  a  success.  Tried 
by  this  practical  test,  what  is  the  position  of  the  Cypher 
Repertory  ?  Is  it  generally  used,  or  are  other  Bepertories 


464    CYCLOPEDIA  AND  ITS  REPERTORY.  **^i^f  j^iy  i,  im. 

found  in  its  place  ?  Of  the  nomerous  ones  compiled  sinee 
the  Cyjyher  was  started,  not  one  has  adopted  that  method, 
and  the  Cypher  Repertory  itself  was  not  received  in 
America  with  favour.  To  all  its  perfections  on  paper, 
there  is  but  one  practical  reply — ^it  does  not  meet  with 
general  approval.  This  being  the  case  with  those 
numbers  of  the  Repertory  that  have  appeared,  what 
hope  is  there  that  any  different  fate  awaits  the 
Cyclopcedia  Repertory  if  cast  on  the  same  lines? 
The  modem  reader  makes  a  dead  set  against  the  Cypher 
in  these  days  of  lucid  typography,  and  whatever  excel- 
lent qualities  may  lie  concealed  in  a  book,  it  will  fail  to 
command  success  if  it  requires  a  troublesome  deciphering, 
and  if  the  eye  is  offended  by  the  difficulty  of  picking  out 
a  word  from  its  bristling  surroundings  of  algebraical 
and  other  signs.  So  far  as  one  can  gather  the  sentiment 
of  the  profession  towards  the  Cypher  Repertory^  it  is  pre- 
cisely that  expressed  by  Talleyrand  regarding  the  lady : 
"  She  is  insupportable — but  that  is  her  only  fault." 
The  advantages  of  the  Cypher  are  conceded.  It  does  all 
that  its  advocates  claim  for  it — but  it  is  not  used. 
Argument  is  wasted  in  a  case  of  the  kind.  Dr.  Drysdale 
has  probably  used  the  Repertory  so  much  that  his  visual 
perceptive  powers  are  trained  to  see  only  what  he  wante 
to  see,  and  so  it  might  be  with  others  if  they  would  only 
submit  to  the  necessary  discipline,  but,  as  a  matter  of 
fact,  they  will  not,  and  because  one  sensibility  is  offended 
a  barrier  is  raised  against  what  would  else  prove  a  helpful 
work.  If  the  medicines  were  printed  in  block  letters  so 
as  to  stand  out  distinctly,  and  the  Cypher  relegated  to  a 
backward  position,  artistically,  the  eye  would  more  easily 
detect  what  is  wanted  from  amongst  the  accompanying 
signs,  but  perhaps  then  the  Cypher  might  be  less  legible, 
and  a  new  difficulty  would  be  created  in  place  of  the  old.  At 
present,  with  the  knowledge  we  have  of  this  plan,  I  am 
distinctly  in  favour  of  aboUshing  the  Cypher  in  the  new 
Repertory,  whilst  retaining  all  the  other  arrangements 
of  classij&cation  and  order.  Dr.  Drysdale  shows  that 
the  Repertory  without  the  Cypher  is  workable,  though  in 
a  roundabout  way,  and  Dr.  Nankivell  agrees  that  it 
would  also  gijve  us  more  information  than  any  other,  and 
it  is  in  the  highest  degree  probable  that  the  extra  time 
required  in  its  consultation  would  be  amply  compensated 
by  the  power  of  understanding  what  we  are  looking  at, 
and  without  the  aid  of  a  key. 


Si5^iS?nr°  BEVIEWB. 466 

If  it  may  be  permitted  for  an  outsider  to  offer  a 
suggestion  as  to  the  future  of  the  Cypher  Repertory  ^  I 
'would  say  that  it  should  continue  on  its  old  lines,  keeping 
Allen  for  its  basis,  and  so  preserve  its  consistency.  It 
will  necessarily  be  slow  in  its  progress ;  but  if  it  resembles 
some  great  cathedral  that  takes  centuries  to  raise  it,  and 
that  embodies  the  varying  architectural  styles  of 
successive  periods,  it  will  end  in  being  a  composite  and 
nondescript  structure,  lacking  in  the  essential  element 
of  unity  of  plan  which  should  attach  to  every  great 
work. 

P.  Proctor,  L.E.C.P. 

Birkenhead. 


REVIEWS. 


A  Note  for  the  Successful  Treatment  of  DipMieria,  also  of  the 
Coryza  and  Malignant  Sore  Throat  of  Scarlatina.  By  Henby 
Thomas,  M.D., Llandudno.  London:  EeganPaal&Go.,IB91. 
Li  this  practical  and  interesting  pamphlet,  Dr.  Thomas  advo- 
cates the  use  of  liq.  amnion,  fort,  in  diphtheria.  He  gives 
2  drop  doses,  well  diluted,  for  adults,  and  i  a  drop  to  1  drop 
for  children.  He  gives  several  good  cases  where  success 
followed  this  treatment.  He  states  that  since  1884  he  has 
treated  "more  than  150  decided  and  severe  cases  of  this 
disease,  and  has  steadily  used  this  remedy  only,  and  with 
success.*'  In  the  malignant  sore  throat  of  scarlet  fever,  he 
advocates  the  use  of  the  diluted  hydro-chloric  amd  of  the  B.P. 
This  treatment  of  diphtheria  is  worth  keeping  in  view  in 
had  eases,  when  other  more  usual  methods  are  not  producing 
^miendment. 


^Mical  Symbolism.    By  Dr.  T.  8.  Sozinsket,  Philadelphia 

and  London :  F.  A.  Davis.  1891. 
This  little  work  claims  attention  to  matters  which  are  in 
leality  sound  and  serious,  though  light  brains  may  esteem 
them  as  foolish  toys.  It  begins  by  explaining  that  the  serpent 
is  the  most  important  of  medical  symbols  as  originated  by  the 
Oreeks.  JEsculapius,  their  god  of  medicine,  was  on  feimiliar 
terms  with  the  serpent,  and  sometimes  assumed  the  serpentine 
fonn.  A  long  time  afterwards  the  Romans,  who  disregarded 
the  art  of  medicine,  being  attacked  by  a  pestilence,  sent  to 
Oreece  for  iEsculapius  and  his  serpent,  which  they  also 
^opted.  The  Epidaurian  Grove,  wherein  this  deity  and  his 
^miliar  dwelt,  became  a  famous  sanitary  retreat  to  which 


Aaa  -ovxmpxxra  MontUy  Hamoeoprtiilc 


Beview,  July  1,  Un. 


multitudes  of  invalids  flooked  from  all  parts  of  Greece ;  and 
it  may  be  reasonably  taken  as  the  prototype  of  modem  popular 
health  resorts.  In  all  probabihty  the  mild  sea  air,  and  the 
pure  climatic  influences  associated  with  the  three  hundred  and 
twenty  asclepia,  or  temples  of  health,  which  subsequently 
sprang  up  throughout  Greece  and  her  Colonies,  had  more  to 
do  than  serpentine  virtues  with  the  many  cures  which  were 
effected  therein.  At  Cos  the  asclepion  was  conducted  by 
Hippocrates,  who  gave  to  the  world  an  imperishable  legacy  of 
medical  knowledge  which  still  constitutes  the  main  body  of 
our  healing  science. 

Much  research  has  been  evidently  spent  by  the  author  of 
Medical  Symbolism  on  the  records  of  the  Asdepiades  and  their 
methods  of  practice ;  also  on  the  mythological  history  of 
iBsculapius.  He  shows  that  the  bacterium — now  interpreted 
as  a  disease-germ — was  primarily  the  staff  of  JEsculapius,  and 
of  special  significance  when  enwreathed  by  the  serpent.  Some 
old  writers  supposed  it  to  symbolise  the  phallus  as  an  emblem 
of  universal  fertility.  The  knots  were  expressive  of  difficulties 
in  the  art  and  practice  of  medicine.  Two  serpents  were  some- 
times represented  about  the  staff,  male  and  female,  in  an 
amatory  mood.  These  have  been  since  adopted  on  the  title 
page  of  medical  books,  with  the  words  circumscribed  around 
them,  Irrupta  tenet  copula — Literis  Medicina.  Furthermore 
prudence  was  symbohsed  by  the  serpent  as  something  very 
requisite  in  the  physician.  Several  other  explanations  are 
likewise  suggested  of  the  fact  that  the  serpent  has  been  asso- 
ciated with  medicine  from  very  early  times.  Among  these 
are  mentioned  the  '*  preposterous  and  numerous  uses  to  which 
the  venom  is  put  by  homoeopathic  doctors." 

All  the  interesting  lore  afforded  in  this  treatise  respecting 
the  staff  and  serpent  of  ^sculapius  bears  thoughtfully  on  the 
idolatrous  tree  and  serpent  worship  prevalent  in  the  pre- 
historic ages  of  Babylonian  civiHsation.  A  protest  of  pnmitiTe 
Jehovah  worshippers  against  this  superstitious  cult  has  been 
thought  to  underlie  the  prohibition  said  to  be  given  in  Eden 
to  our  first  parents  against  eating  the  fruit  of  the  tree  of 
knowledge,  and  of  the  tree  of  life. 

Among  the  ancients  a  serpent  in  the  form  of  a  circle 
symbohsed  eternity.  Other  attributes  of  ^sculapius  were, 
our  author  tells  us,  the  laurel  wreath,  interpreted  as  rays  of 
light ;  a  bunch  of  herbs ;  a  bowl,  indicative  of  medical  potions; 
a  scroll — ^the  Telesphorus,  a  small  boyish  figure,  representing 
the  aninia  medica  ;  a  dog,  showing  fidehty  and  watchfulness ; 
a  cock,  always  on  the  alert ;  and  a  goat,  in  token  of 
reproductive  power.  Again,  the  pinecone  was  accredited  with 
remedial    properties    which    it    conferred,    or    typified,  for 


S^j?iS?'S^^  BEViEws.  467 


.Jnlyl,  isei. 


exorcising  evil  spirits  from  the  sick.  Hygeia  is  next  noticed 
as  the  goddess  of  health,  who  was  represented  as  a  blooming 
gill,  with  a  serpent  twined  around  her  left  arm,  and  feeding 
oat  of  a  chalice  held  in  her  right  hand,  llie  reader  is  par- 
ticularly asked  to  observe  that  the  divinities  specially 
interested  in  the  preservation  of  health  among  the  Greeks- 
vere  all  females. 

Medical  amulets  and  talismans  come  finally  under 
consideration,  of  which  the  former  were  worn  about  th& 
peiBon,  whilst  the  latter  were  astrological  charms  due 
at  first  to  the  Ohaldeans.  The  lion  rampant  symboUsed 
rode  health.  Leo  erectu»  verum  signum  aanitatis  pratendit. 
The  phallus  was  a  charm  placed  on  houses  in 
Pompeii  with  the  inscription  hie  habitat  felieitas.  Our 
symbol  of  modem  use  at  the  head  of  a  prescription, 
and  which  is  commonly  thought  to  stand  for  recipe^. 
iras  from  time  immemorial  the  monogram  of  Jupiter, 
king  of  the  planets  and  the  father  of  life.  Amulets 
ware  for  the  most  part  gems  engraved  with  images  of  the 
things  feared,  such  as  the  golden  emerods  and  mice  spoken  of 
m  the  Bible.  Certain  numerals  also  had  remarkable  properties 
accorded  to  them,  such  as  the  number  seven^  three  of  the 
triangle,  and  four  of  the  square ;  a  renmant  of  this  old  belief 
in  the  relation  of  seven  to  health  is  the  still  prevalent  notion 
that  the  seventh  son  of  the  seventh  son  is  possessed  of  peculiar 
healing  powers.  The  colour  red  was  thought  to  protect 
against  pestilences,  whence  has  been  derived  a  belief  yei 
dominant  in  the  virtues  of  red  flannel.  '*  Touch  pieces  '* 
were  golden  eagles  or  coins  issued  by  Henry  the  Seventh  io 
persons  touched  for  the  evil.  But  this  practice  was  resorted 
to  in  Palestine,  and  obtained  in  Greece  three  centuries  before 
our  era. 

The  pestle  and  mortar  were  formerly  used  as  a  sign  ex- 
clogively  by  apothecaries,  one  of  whom  was  the  Bishop  of 
London,  in  the  time  of  King  Henry.  The  barbers  and  surgeons' 
pole  still  seen  in  some  of  our  streets  bore  of  old  on  its  top  a 
brass  basin,  with  a  semicircular  gap  in  one  side  to  protect 
the  dothes  of  the  patient.  Yellow  was  the  characteristically 
medical  colour  in  past  times  ;  and  in  the  days  of  Charles  tho 
Second  English  doctors  visited  their  patients  sitting  sideways  on 
horseback.  The  gold-headed  cane  was  then  indispensable  for  & 
physician  of  any  pretensions,  being  always  held  to  his  nose^hen 
he  approached  a  sick  person  so  that  the  volatile  fames  from  the 
fffanonia  which  it  held  might  protect  the  doctor  from  noxious 
exhalations.  Until  less  than  a  century  ago  the  dress  of  a 
debtor  was  remarkable,  consisting  of  a  well  powdered  three- 
tailed  wig,  a  silk  coat,  breeches,  stockings,  buckled  shoes  and 


468  MEETINGS.  »^SJ&55S??^ 


Beview,  July  1,  IflO. 


lace  ruffles ;  also,  as  indicative  of  his  mystic  endowments,  he 
wore  a  ring  on  the  third  finger  of  his  right  hand  to  imitate 
the  signet  of  Solomon,  and  the  ring  of  Gyges,  the  skilfiil 
shepherd  of  Lydia.  A  strange  mathematical  figure  named 
the  pentacle,  and  esteemed  for  driving  away  the  devil  and  all 
witches,  has  been  viewed  as  a  symbol  of  health  ever  since  the 
building  of  the  Pyramids.  Its  angles  contain  in  a  sort  of 
rebus  the  name  of  Hygeia,  the  celebrated  daughter  of 
^sculapius. 

Altogether  the  small  book  now  under  our  review  is  a  mine 
in  petto  of  scholarly  and  ingenious  facts  about  medical 
symbols  ancient  and  modem,  therefore  we  gladly  conmioDd 
its  close  perusal  to  such  of  our  readers  as  take  pleasure  in 
studying  the  subject. 

MEETINGS. 

WESTERN  COUNTIES  THERAPEUTICAL   SOCIETY. 

Meetino  held  at  2,  White  Ladies  Road,  Clifton,  on  Febmary 
18th,  1891. 

Present : — Dr.  A.  S.  Alexander,  of  Plymouth ;  Dr.  8.  P. 
Alexander,  of  Southsea  ;  Dr.  A.  M.  Cash,  of  Torquay ;  Dr8.6. 
Norman  and  P.  Wilde,  of  Bath  ;  Drs.  Eubulus  WilHams,  S. 
Morgan,  F.  H.  Bodman  and  T.  D.  Nicholson,  of  CUfton. 

Dr.  A.  S.  Alexander  read  a  paper  on  *'  The  Single  Remedy 
in  the  Practice  of  Medicine." 

After  this  was  concluded,  Dr«  S.  P.  Alexander  read  a  short 
paper  on  the  same  subject,  the  former  of  which  we  print 
^n  page  441. 

The  following  remarks,  contribued  by  Dr.  Mackechnie,  of 
Bath,  who  was  unavoidably  absent,  was  then  read  by  the 
Secretary. 

''  With  regard  to  the  necessity  or  advisability  of  observing 
the  rule  laid  down  in  the  17^d  section  of  the  Orgawm^  I 
should  say  that  I  accept  it,  with  reservations,  and  did  time 
And  space,  and  other  terrestrial  limitations  not  hold  one  down 
to  more  practical,  if  looser,  methods,  would  be  glad  to  work 
out  my  cases  to  find  the  similimum  between  the  pathology  of 
the  disorder  and  the  pathogenesis  of  the  drug,  but  want  of  time 
on  the  part  of  the  practitioner,  and  of  intelligence  and  obserra- 
tion  on  the  part  of  the  patient  in  noting  and  detailing  his 
symptoms,  make  it  difficult  to  carry  it  fully  into  practice.  I 
have  come  to  this  conclusion  by  practical  experience,  and  in 
spite  of  opposite  prejudices  and  impressions  from  the  men 
under  whom  I  studied  homoepathy,  many  of  them  themselves 
pupils  of  the  Great  Master,  and  many  of  whom  set  themselves 
ito  treat  disease  with  single  doses  of  a  single  remedy,  in  single 


£5Sf^?ST!Sf^  MEETiNas.  469 


,  July  1, 1891 


globales  or  less  of  a  SOth  dilution,  repeated,  perhaps,  in  a 
week  or  a  fortnight.  Doubtless,  wonderful  cases  of  cure 
ooeorred,  which  it  would  be  almost  impossible  to  attribute  to 
anything  else  than  this  minute  single  remedy,  but  time  was 
frequency  insufficient,  fiulure  often  occurred,  the  cases  of 
acute  disorder  were  comparatively  few,  but  I  think  we  may  all 
be  agreed  that  homoeopathy  has  not  lost  by  the  occasional 
use  of  alternated  remedies,  and  of  comparatively  large 
doses,  more  frequently  repeated,  as  the  labours  of  Madden  and 
Hughes,  Drysdale,  Dudgeon,  and  others  have  brought  out 
more  clearly  the  relations  between  pathogenetic  and  patho- 
k)gic  conditions  and  the  preferability  of  these  latter  over  a 
mere  symptom  covering  method. 

"  I  am  sure  that  there  is  often  a  great  saving  of  time,  and 
therefore  of  suffering,  in  the  alternation  of  remedies,  especially 
when  one  has,  as  frequently  happens  in  our  dispensary  here, 
to  see  50  or  60  patients  in  a  morning,  and  can  say  that  I 
think  the  results  obtained  is  anything  but  unsatisfactory." 
A  discussion  followed. 

Dr.  Bodman  thought  that  when  two  remedies  were  given 
at  the  same  time  they  should  be  such  as  do  not  act  on  the 
same  tract. 

Dr.  Cash  said  in  reference  to  the  urticaria  case,  that  we 
should,  in  choosing  a  remedy,  pay  attention  to  concomitant 
symptoms,  and  especially  to  the  cause.  He  had  cured  nettle- 
rash  quickly  with  ajyis  mel,  in  one  of  his  children,  when  a 
severe  and  general  attack  had  followed  the  handling  of  some 
plant.  On  the  other  hand,  he  had  seen  apis  fail,  though  the 
pain  was  of  the  well-marked  stinging  character,  and  the  rash 
typical,  but  the  cause  had  been  gastric.  In  this  case  pulsatillu 
was  of  marked  benefit.  As  to  the  use  of  the  single  remedy, 
he  thought  it  was  to  be  applied  specially  in  chronic  ailments, 
and,  above  all,  in  skin  diseases,  where  we  find  constitutional 
flaws  at  the  root  of  the  whole  trouble,  as  psora,  tubercle, 
scrofula,  syphilis,  &c.  Then  the  appropriate  single  remedy 
would  gradually  umravel  the  whole  of  the  symptoms.  But  in 
acute  diseases,  when  change  was  rapid  and  many  things  had 
to  be  done  at  once,  he  thought  we  should  more  often  by  the 
use  of  two  remedies  in  alternation  do  best  for  our  patients. 

Dr.  Wilde  remarked  on  the  case  related  by  Dr.  Alexander, 
of  cure  by  bryonia  after  aggravation  by  rhus^  that  the  two 
medicines  were  sometimes  both  indicated,  the  former  acting 
on  the  synovial  membrane,  and  the  latter  on  the  white 
connective  tissues,  the  symptoms  of  one  being  masked  by  the 
other. 

He  recommended  sulphur  80  in  all  chronic  skin  diseases^ 
and  especially  in  lupus. 


470  PEBiscoPE.  ""^^^Sr?^. 


Beview,  Jvkf  1,  UU. 


Dr.  Nicholson  said  the  question  had  not  yet  been  My 
answered  whether  medicines  assist  or  antagonise  one  ano&er 
if  given  at  the  same  time,  that  is,  supposing  their  physiological 
symptoms  are  not  antagonistic.  Common  experience  replies 
that  drugs  acting  on  the  same  organ  often  help  one  anoUier, 
-e.g.,  mix  vomica,  assists  the  action  of  aloes  or  podophyllum  as  a 
purgative.  But  in  small  doses  and  homceopathic  dilutions  the 
reply  is  not  unanimous.  Nevertheless,  the  general  experience 
shows  that  aconite  and  belladonna  often  help  one  anodier,  and 
niLc  with  mlphur  in  alternation,  and  the  combination  of 
viercuriui  and  ^^^L— drugs  acting  in  the  same  direction, 
whose  single  action  is  inadequate  to  cure  the  symptoms. 
These  tonics  help  one  another  greatly  e,g,,ferrum  t-.,  qum.,fen» 
c,  strychn.,  &c.  He  had  frequently  found  ac,  phosph.  and 
strychn,  of  great  service  in  aged  people,  and  ac,  phosph,  and 
ignatin  in  younger  persons,  either  together  or  in  alternation, 
where  both  medicines  seemed  indicated.  In  chronic  disease 
he  thought  all  the  followers  of  Hahnemann  agreed  to  give  one 
drug  at  a  time,  but  then  they  could  not  afford  to  neglect 
adjuvants  as  mustard,  heat  and  cold,  alcohol,  diet,  &c.,  and 
these  all  had  a  share  in  the  cure. 

He  related  a  case  showing  the  action  of  two  medicines  whose 
physiological  action  is  opposite,  yet  acting  in  harmony 
together.  The  case  was  one  of  retention  of  urine  in  a  horse, 
where  it  was  hardly  possible  to  choose  the  homceopathie 
remedy.  Stnjclinitu  and  hyoscyamine  were  given  together,  one 
to  combat  the  paralysis,  and  the  other  the  spasm,  and  with 
the  happiest  result,  for  two  doses  of  one  milligram  gave  some 
relief,  and  the  trouble  promptly  and  entirely  disappeared  after 
the  tenth  dose. 

After  some  farther  discussion. 

Dr.  Cash  read  a  paper  on  "  Tachycardia,"  which  also  elicited 
critical  remarks.  This  paper  and  that  of  Dr.  S.  P.  Alexander 
will  appear  in  a  subsequent  issue. 


PERISCOPE. 

DISEASES  OP  CHILDEEN. 

Intubation  in  Laryngeal  Diphtheria. — Dr.  Julius  Schwalbe, 
of  Berlin,  writes  a  paper  on  the  above  subject.  After  referring  to 
the  dreadfully  small  percentage  of  successes  after  tracheotomy 
in  children  with  laryngeal  diphtheria,  he  gives  a  history  of  the 
introduction  of  intubation  and  a  description  of  O'Dwyer's 
instruments.  He  then  narrates  ten  cases  of  his  own  of  laryngeal 
diphtheria,  in  which  intubation  was  practised.  Of  these,  all 
died  but  one,  death  occurring  at  various  periods  from  the 
second  to  nineteenth  day.  The  cause  of  death  was  pneumonia 


SriSyj^MSSy^  PEBISCOPE. 471 

in  five  cases,  purulent  bronchitis  in  two  cases,  fibrinous 
bronchitis  in  one,  and  capillary  bronchitis  in  one  case.  The 
only  recovery  was  in  a  boy,  aged  8,  in  which  tnbage  was  under- 
taken earlier  than  tracheotomy  is  usually  performed.  The 
iiathor  of  the  paper  thinks  that  intubation  is  not  likely  to 
improve  the  statistics  of  diphtheria.  In  nine  cases  examined 
post  mortem  there  were  five  instances  of  pressure  sores,  partly 
in  the  trachea  and  partly  in  the  larynx.  Other  dangers  are 
the  possibility  of  the  tube  being  brought  up  by  coughing  or 
vomiting  in  the  absence  of  a  skilled  attendant  to  reintroduce 
it,  the  ^placement  of  membrane  during  the  introduction  of 
the  tube,  and  the  formation  in  the  trachea  of  larger  masses  of 
membrane  than  can  possibly  be  expectorated  through  the 
tube. — Deutsche  Medicinische  Wochenschrift,  April  2,  1891. 

Schxjlzb's  Method  of  Artificial  Bbspibation. — In  a  paper 
<m  a  life-saving  method,  in  still  births.  Dr.  Lusk  describes 
Scholze's  method  of  artificial  respiration  in  the  following 
maimer : — "  The  child  is  grasped  in  such  a  way  that  the 
operator's  thumbs  rest  on  the  anterior  thoracic  wall,  the  index 
fingers  are  in  the  axilla,and  the  three  others  are  placed  diagonally 
across  the  back ;  the  operator  then  allows  the  child  to  hang 
down  at  arms  length,  &ce  upwards,  between  the  knees.  In 
this  position  the  capacity  of  the  chest  is  at  its  maximum,  for. 
the  pectoral  muscles  draw  the  upper  ribs  upwards,  the 
abdominal  muscles  draw  the  lower  ribs  down,  and  the  weight 
of  the  liver  pulls  down  the  diaphragm.  The  child  is  next 
swimg  upward  until  the  operator's  arms  are  nearly  horizontal. 
The  swing  is  then  stopped,  the  head  falls  downwards,  the 
hmbar  spine  also  is  flexed,  and  the  lower  limbs  fall  towards 
the  operator  until  the  whole  weight  of  the  child  rests  on  his 
thumbs.  In  this  way  the  chest  and  abdomen  are  compressed, 
the  diaphragm  is  forced  upwards,  and  an  efficient  expiration 
results." — American  Jouituil  of  Medical  Sciences,  February, 
1891. 

Tbeatmeht  of  Fever  »  Newborn  GmLDREN. — ^Dr.  Julius 
Eross  has  published  some  observations  on  the  treatment  of 
fever  in  newborn  children.  In  the  obstetric  and  gynaacological 
department  of  the  university  of  Buda  Pesth,  he  found  that  of 
956  children  no  fewer  than  481  sufifered  firom  pyrexia  during 
the  first  10  days  of  life.  The  fever  in  the  majority  of  the 
cases  was  due  either  to  gastro-intestinal  derangements,  or  to 
inflammation  originating  in  connection  with  the  separation  of 
the  umbilical  cord.  After  experimenting  with  antipyrin  and 
with  chinin,  he  tried  lukewarm  baths,  which  gave  much  more 
satisfactory  results.  A  bath  for  10  minutes  of  from  98^  to 
95^  F.  caused  a  very  considerable  and  rapid  lowering  of 


472  NOTABIMA.  ^"S^'SSSr^. 


Renew,  July  1,1m. 


temperature,  amounting  on  the  average  to  5^^  F.  The  M 
continued  for  half  an  hour  to  an  hour  after  removal  from  the 
bath.  Dr.  Eross  did  not  observe  symptoms  of  collapse  in  any 
of  his  cases,  but  in  order  to  avoid  this  he  recommends  that 
the  bath  should  not  last  longer  than  five  minutes.  The  effect 
of  the  baths  on  the  general  condition  was  very  satisfiictoiy, 
restlessness,  whining,  sleeplessness,  and  the  symptoms  of 
apathy  and  indisposition  to  suck  disappeared ;  the  poise  and 
respiration  fell,  and  the  child  slept  for  an  hour  or  two,  and  on 
waking  took  the  breast  better.  After  a  few  hours  the  pyrexia 
is  re-established,  but  Dr.  Eross  believes  that  by  taking 
advantage  of  the  improved  condition  for  nourishing  the  child 
during  the  apyrexial  periods  much  benefit  is  obtained. — Britidt 
Medical  Jourmil,  March  7,  1S91. 

T.  G.  SroNHAMy  M.D,  London. 

LARYNGOLOGY,  Etc. 

Nitric  Acm. — Patholoffical  Indications. — Chronic  catarrhr 
syphilitic  ozcsna,  eruption  of  herpes,  or  excrescence  (warts)  on 
the  tip  of  nose  and  on  the  alte.  Bedness  of  the  tip ;  polypus ; 
ulcers. 

Clinical, — Fluent  coryza  with  obstruction  of  the  nose  ;  the 
mucus  is  discharged  only  through  the  posterior  nares. 
Coryza,  with  hoarseness.  The  nasal  discharge  easily  becomes 
foetid  and  yellow,  with  complete  obstruction  of  the  nasal 
passages,  or  sometimes  with  dropping  of  water  from  the 
nostrils.     Warts  on  the  tip  of  the  nose. 

CJiaracteristic  are  the  stitches  in  the  nose,  as  from  splinters, 
when  touching  it  {Anfejitum  nitr,) ;  the  eruptions  in  the  alie 
of  the  nose,  with  itching ;  redness  of  the  tip ;  a  syphilitic 
diathesis,  with  abuse  of  mercury ;  sweaty  feet,  and  aphonia, 
with  coryza. 

— -  -    —  -       -  _      _  ■    

NOTABILIA- 

ANNUAL  HOMCEOPATHIC   CONGRESS. 
The  following  circular  letter  has  been  issued  by  the  Secretary 
of    the  Congress    to    all    known   British    practitioners   of 
homoeopathy  : — 

"  29,  Seymour  Street, 

Portmau  Square,  W., 
June,  1891. 
Deab  Sir, — The  Annual  Congress  of  Homoeopathic  Prac- 
titioners will  be  held  this  year  in  London,  at  the  Homoeopathic 
Hospital,  Great  Ormond  Street,  W.C.  (the  use  of  rooms  in 
which  has  been  kindly  granted  by  the  Board  of  Management)^ 
on  Thursday,  July  9th,  at  10  a.m.  punctually. 


^^TXf'  NOTABILU. 473 

The  business  of  the  Congress  will  be  opened  by  an  address 
I       from  the  President,  Mr.  Heksy  Habbis,  of  London,  entitled 
''After  Twenty  Years,  and  Twenty  Years  After." 

Any  strangers,  ladies  and  gentlemen,  who  may  desire  to 
hear  the  President's  address,  will  be  welcome. 

After  this  a  short  interval  will  allow  the  Hon.  Treasurer  io 
receive  subscriptions. 

A  paper  will  then  be  read  by  Mr.  Knox  Shaw,  of  London, 
entitled  **  Ohservatums  on  the  Action  of  Iodide  of  Potasduvi  in 
Tertiary  Syphilis'*  Discussion  is  invited  on  this  and  the  other 
papers. 

.  As  Mr.  Enox  Shaw's  paper  will  be  short  it  is  expected  that 
ihere  will  be  time  before  luncheon  for  a  paper  by  Dr.  Bubford, 
of  London,  on  "  TJie  Reciprocal  Relations  between  Surgery  and 
Uonuxopathic  Therapeutics  as  Exemplified  in  Pelvic  Lesions,** 

The  Congress  will  adjourn  for  luncheon  at  1  o'clock.  At 
luncheon,  which  will  be  served  in  the  Holbom  Restaurant, 
the  members  of  Congress  will  be  the  guests  of  the  British 
Homoeopathic  Society. 

At  2  o'clock  the  Congress  will  re-assemble,  and  receive  the 
leport  of  the  Hahnemann  Publishmg  Society,  proceed  to 
select  the  place  of  meeting  for  the  next  year,  elect  officers, 
and  transact  any  other  business  which  may  be  necessary. 

A  paper  will  then  be  read  by  Dr.  Bobebson  Day,  of  London, 
on  "  The  Supervision  of  Normal  Parturition,** 

Lastly,  a  paper  will  be  read  by  Dr.  Mubbay  Moobb,  of 
Liverpool,  entitled  "  Notes  on  the  Climatology  aiul  Prevalent 
Diseases  of  New  Zealand.** 

The  members  and  their  friends,  ladies  as  well  as  gentlemen, 
^1  dine  together  at  the  Holbom  Restaurant,  at  7  p.m. 

A  paper  had  been  promised  by  Dr.  Beith,  of  Aberdeen,  but, 
owing  to  illness.  Dr.  Beith  has,  we  regret  to  say,  been  unable 
to  prepare  his  paper.  This  has  necessitated  a  re-arrange- 
ment of  the  programme  of  papers,  and  has,  in  consequence, 
necessarily  delayed  the  issue  of  this  circular. 

A  precis  of  the  papers  is  enclosed,  in  accordance  with  a  new 
Tule  of  Congress. 

A  meeting  of  the  Hahnemann  Publishing  Society  will  be 
held  at  the  Hospital  at  9.80  on  the  morning  of  July  9th. 

On  Wednesday  evening,  July  8th,  the  annual  meeting  of 
the  British  Homoeopathic  Society  will  be  held  at  the  Hospital 
>t  8  p.m.  This  day  has  been  fixed  in  order  to  allow  of 
members  from  the  provinces  being  present. 

On  Wednesday,  July  8th,  at  2.80  p.m.,  it  is  expected  that 
there  will  be  operations  in  the  hospital,  Drs.  Carfrae  and 
Botford,  Mr.  Enox  Shaw,  and  Mr.  Dudley  Wright  having 
kindly  agreed  to  arrange  this  day  for  the  purpose.  All  members 

Vd.  35,  Kg.  7.  2  L 


474  NOTABILIA.  "S^'^S??^?. 


Beviev,  Joly  1.  un. 


of  Congress,  who  may  be  able  to  be  present,  are  invited.  The 
list  of  operations  will  be  posted  np  at  the  hospital  in  the 
morning.  After  the  operations  the  physicians  will  be  happy 
to  show  to  the  members  cases  of  interest  in  th6  wards. 

On  Wednesday  evening  and  on  G'hnrsday  Dr.  Boberson  Day 
will  exhibit  his  anaasthetic  apparatus  and  microscopical  speci- 
mens of  interest.  It  is  also  expected  that  the  homoeopathic 
chemists  will  exhibit  new  and  interesting  specimens,  and 
Messrs.  James  and  Go.  will  furnish  the  lavatoiy  with 
**  Dermatos  "  soap. 

The  subscription  to  the  Congress  will  be  lOs.,  which 
includes  the  dinner  ticket.  The  dinner  ticket  alone  will  be  78.6d. 

In  order  to  obtain  the  presence  of  as  large  a  nombw  of 
members  as  possible,  the  British  Homoeopathic  Society 
suggest  that  all  members  of  Congress  living  in  London  and 
the  suburbs,  having  a  spare  room,  should  invite  their 
provincial  colleagues  to  be  their  guests  at  this  time.  If  those 
who  do  not  personally  invite  friends,  but  are  willing  to  receive 
one  or  more  guests,  will  kindly  communicate  with  me,  I  shall 
be  much  obliged.  Also  if  members  from  the  provinces,  not 
personally  invited  by  their  friends,  but  who  would  accept 
hospitality,  will  communicate  with  me,  I  shall  be  happy  to 
arrange  for  them,  as  far  as  possible. 

If  you  know  any  colleague  who  has  not  received  a  circular, 
kindly  let  me  know. 

The  enclosed  post-card  is  to  be  filled  up  and  posted  as  soon 
as  possible,  but  not  later  than  July  1st. 

I  am.  Dear  Sir, 

Yours  faithfully, 

D.  Dtoe  Bbown. 

Hon,  See, 

Pb&cis  of  Pafbbs. 

Mr.  Enox  Shaw's  Paper. 

The  question  discussed  is  whether  in  the  light  of  later  in* 
vestigations  and  observations,  it  is  possible  to  ascribe  a 
homceopathic  action  to  the  influence  of  iodide  o/potamtm  in 
Tertiary  Syphilis. 

Dr.  Burfobd's  Paper. 

1.  Surgery  antecedent  to  homosopathy. 

2.  The  influence  of  homoeopathy  on  surgical  procedure. 
8.  Modem  surgery  independently  of  homoeopathy. 

4.  The  limits  of  homoeopathy  in  surgical  cases. 

5.  The  hmits  of  surgical  work  in  homoeopathic  practioe. 

6.  Special  application  of  conclusions  to  pelvic  lesions: 
with  illustrations. 


w 


£!£S^rf?f1SSJ^  NOTABILIA.  476 


BcTiew.Jiilyl,  lan. 


Dr.  BoBEBsoN  Day's  Paper. 

Progress  in  obstetrics  pari  jmwu  with  that  in  other 
^tepartments  of  medicine. 

Preparation  of  patient  beforehand  by  medicinal  treatment. 

Bequisites  for  antiseptic  nnrsing^  and  mles  for  monthly 
Burses. 

Dilatation  of  the  or  nteri — ^treatment. 

Dilatation  of  the  ostium  yaginae — treatment. 

Management  of  the  uterus  during  third  stage. 

Subsequent  treatment  of  patient. 

Dr.  Moobb's  Paper. 

Misapprehensions  of  consulting  specialists  regarding  the 
Australian  and  New  Zealand  Climates. — Sir  A.  Gkrke's  state- 
meut. — General  character  of  the  New  Zealand  climate 
(rainfidl,  temperature,  winds,  &c.) — Best  time  for  invalids  to 
teach  the  Colony. — Four  climatic  zones. — Special  features  of 
Zone  IV.,  with  its  mineral  springs. — Imported  diseases 
benefitted  or  contra-indicated  by  the  New  ZesJand  climate. — 
Effect  on  the  writer's  own  health.  — Diseases  prevalent  in  town 
and  country. — Some  cases  of  special  interest  (mania, 
cataract,  hydatids  of  uterus). — Longevity  in  New  Zealand. 
This  colony  is  one  of  the  healthiest  countries  in  the  world. 


THE  HAHNEMANN  ANNIVEESABY  IN   CALCUTTA. 

When  we  in  London  were  commemorating  the  anniversary  of 
Hahnemann's  birth,  at  a  dinner  on  April  10th,  it  is  gratifying 
to  know  that  the  same  event  was  being  celebrated  at  Calcutta. 
Dr.  Soshi  'Bhusan  Midcerji  has  kbdly  sent  us  a  very  in- 
teresting account  of  the  anniversary  meeting  on  April  10th. 
The  Honourable  Dr.  Sircar  was  the  president,  but  owing  to 
illness,  he  was  prevented  being  present,  and  the  chair  was 
taken  by  Dr.  M.  M.  Bose,  the  Vice-President.  The  medical 
profession  was  present  in  large  numbers,  and  the  attendance 
altogether  amounted  to  nearly  200.  A  paper  was  read  by  Dr. 
Soshi  Bhusan  Mukerji,  the  Hon.  Assistant  Secretary,  on  the 
"  Life  and  Works  of  Samuel  Hahnemann."  A  proposal  was 
nuide  to  start  a  homoeopathic  hospital  in  Calcutta,  but  it  was 
considered  that  that  meeting  was  not  the  proper  place  to 
biing  this  subject  forward. 

We  congratulate  our  Calcutta  colleagues  on  their  public 
spirit  and  their  enthusiasm  for  the  cause  of  homoepathy,  and 
we  wish  them  all  success  in  the  proposal  to  foxmd  a  homoeo- 
pathic hospital.  We  shall  look  next  year  for  a  report  of  the 
next  anniversary  meeting. 

2l— 2 


476  NOTABILU.  "S^^SfPSf 


Beview,  JnlfLian. 


HAHNEMANN  PUBLISHING  SOCIETY. 

The  Genbral  Meeting  of  this  Society  will  be  held  at  the  Lon- 
don Homoeopathic  Hospital  on  July  9th,  at  9  o'clock  a.m* 
punctually,  and  not  at  9.80  as  stated  in  the  Congress  circular. 
Gentlemen  having  any  reports  or  communications  to  make 
to  the  Society  will  please  send  them  to  Dr.  Hayward,  61, 
Shrewsbury  Road,  Birkenhead,  Cheshire. 

THE  CONGRESS. 
The  Hon.  Secretary  particularly  requests  that  all  post-cards 
not  already  returned  to  him  should  be  sent  at  once.  An 
ovaioiiomy  will  be  performed  by  Dr.  Burford,  at  the  hospital, 
at  2.80  p.m.  punctually,  on  Wednesday,  the  8th.  The 
Annual  Meeting  of  the  British  Homoeopathic  Socioty  will  be 
at  seven  o*clock  for  private  business,  and  the  President  will 
deliver  his  Address  at  eight.  The  Hahnemann  Publishing 
Society  will  meet  at  9  a.m.  on  Thursday,  and  not  at  9.80,  as 
contained  in  the  circular.  Accommodation  will  be  provided 
at  the  Hospital  for  dressing  for  dinner  for  those  who  live  in 
the  suburbs,  and  who  have  not  time  to  return  to  their  homes. 

SELECT  COMMITTEE  OF  LORDS  ON  METRO- 
POLITAN  HOSPITALS,  Etc. 
On  the  4th  ult.,  Mr.  G.  A.  Cross  gave  evidence  before  the 
Select  Committee  respecting  the  London  Homoeopathic  Hos- 
pital. There  were  present — ^Earl  Spencer,  Earl  Cathcart, 
Earl  of  Eimberley,  Lord  Zouche  of  Haryngworth,  Lord  Saye 
and  Sele,  Lord  Sandhurst.  Lord  Sudeley  (Earl  of  Arran),  Lord 
Monkswell  and  Lord  Thring.  The  Lord  Sandhurst,  in  the  chair, 
'  Mr.  George  Alfred  Cross  was  called  in ;  and,  having  been 
sworn,  was  examined,  as  follows : — 

Chairman. — You  are  the  secretary  of  the  London  Homceo- 
pathic  Hospital  in  Great  Ormond  Street,  are  you  not  ? — ^Yeft. 

When  was  that  founded  ? — ^It  was  founded  in  1849. 

How  many  beds  have  you  ? — We  have  a  capacity  of  90 
beds  ;  that  is  the  utmost  capacity. 

What  is  your  working  average  ? — About  66  beds. 

Do  you  not  employ  the  remainder  of  the  beds  for  want  of 

imds  ? — Partly  for  that  reason,  and  partly  because  if  really 

we  filled  90  beds  we  should  have  no  room  for  our  nursing 

staff,  which  is  a  very  large  one,  and  is  largely  used  for  private 

nursing. 

How  is  your  hospital  managed  ? — ^It  is  managed  by  a  board 
of  managers  and  a  weekly  committee. 

The  weekly  committee  are  the  administrative  body  then? 
— Practically,  but  the  actual  administrative  power  is  wholly  in 
the  hands  of  the  board  of  management. 


r 


B^SSlSSnX^  NOTABILIA, 477 

Is  yoniB  a  free  hospital  ? — ^Yes,  except  that  we  get  recom- 
mendations, in  some  cases,  from  sabseribers. 

Have  you  a  large  oat-patient  department  ? — We  see  about 
10,000  out-patients  in  the  year.  Some  of  them  would  be 
repetitions ;  the  same  patient,  I  mean,  would  be  calculated 
twice  oyer  by  the  expiration  of  the  ticket. 

Do  you  mean  that  the  attendances  number  about  10,000  ? 
— ^No,  the  attendances  number  about  80,000. 
I  Then  the  fresh  cases  are  10,000  ? — We  give  our  out-patients 

a  ticket  which  entitles  them  to  advice  and  medicine  for  a 
month  ;  at  the  end  of  a  month  they  must  renew  that  ticket, 
and  when  they  so  renew  it  they  are  counted  as  new  patients. 

Do  you  make  any  inquiry  into  the  circumstances  of  the 
patients  ?  We  have  an  arrangement  by  which  our  dispenser 
checks  the  patients  as  they  come  in.  We  have  a  lady 
dispenser,  and  she  makes  any  inquiry  she  thinks  fit ;  and  our 
m^cal  men  are  also  urged  by  the  board  to  stop  any  pi^tient 
who  gives  any  sign  of  being  able  to  pay  for  medical  attendance, 
and  to  refer  the  case  back  for  inquiry.  Ultimately  it  may  be 
referred  to  me. 

In  the  absence  of  the  board,  have  you  entire  power  in  the 
hospital  ? — ^I  have. 

Have  you  plans  of  the  drains  of  your  hospital  ? — Yes. 

Which  yon  keep  up  to  date  ? — Yes ;  we  have  renewed  the 
drainage  of  the  hospital,  perhaps  five  years  ago  ;  we  renewed 
it  entirely  from  be^nning  to  end,  so  that  our  drainage  is  on 
the  latest  system. 

Will  you  tell  me  whence  you  derive  your  income  ? — ^We 
derive  it,  in  the  first  place,  fix>m  a  certain  amount  of  invested 
fonds.  We  get  perhaps,  altogether,  £800  or  JS900  from 
invested  funds ;  we  get  £1,000  from  subscriptions ;  an  average 
of  perhaps  £400  from  donations ;  we  get  £250  from  the  Hos- 
pital Sunday  Fund,  and  from  £80  to  £100  from  the  Hospital 
Saturday  Fund ;  we  get  about  £400  from  out-patients'  fees 
(they  pay  a  shilhng  for  a  monthly  ticket) ;  and  we  get  legacies. 
It  is  a  little  difficult  to  fix  the  average  of  the  legacies,  but  I 
should  think  the  average  is  about  £1,500  or  £2,000  a  year. 
Of  course,  those  legacies  are  very  variable.  This  year,  we  did 
not  even  have  £500.  The  legacies,  I  may  say,  have  increased 
considerably  within  the  last  ten  years. 

Do  you  appeal  to  the  pubhc  9 — Yes,  constantly. 

And  do  you  have  the  usual  festival  dinner  ? — We  have  no 
festival  dinner. 

Mot  a  triennial  occasion  ? — No ;  we  are  organising  one  at 
the  present  moment,  but  that  is  of  an  entirely  special  character. 

Why  are  you  taking  that  step  this  year  ? — Because  we  are 
about  to  rebuild  our  hospital.    We  have  appealed  for  a  sum  of 


Lk.. 


478  NOTABILU.  "^SSlL^jS???^ 


Bertew,  July  1,  isn. 


£80,000,  of  which  we  have  now  over  £27,000 ;  and  as  we  do 
not  propose  to  commence  building  till  we  have  the  whole  of 
the  money  actually  promised,  a  great  efifbrt  is  being  made  to 
get  together  the  whole  of  the  remaining  £8,000. 

How  long  have  you  been  collecting  that  £27,000? — Since 
this  time  last  year.  One  lady  gave  us  £10,000 ;  our  treasoier 
and  chairman  gave  £2,000 ;  his  wife  gave  us  £1,000  ;  two  other 
Mends  have  given  us  £2,000  each  ;  and  the  rest  we  have  made 
up  in  general  donations.  May  I  say  that  we  have  an  income 
from  the  nursing  fimd,  for  the  nurses  sent  out,  of  £1,667* 
This  last  year  it  has  been  £1,800. 

Does  that  go  to  the  funds  of  the  hospital  ? — ^It  goes  to  the 
funds  of  the  hospital,  less  the  expenses,  so  far  as  we  can  cal- 
culate them,  of  the  nursing  staff;  so  that  we  may  take  it  that 
we  get  £650  as  an  average. 

Do  you  give  any  pensions  to  your  nurses  ? — ^We  have  no 
pensions.  The  matter  is  at  the  present  moment  under  the 
consideration  of  the  board.  Acting  on  the  advice  of  a  com- 
mittee which  sat  at  our  hospital  last  year  to  go  into  all 
questions  of  our  nursing  arrangements,  the  board  are  nov 
considering  the  desirabiUty  of  instituting  a  pension  fund  at 
the  hospital. 

Have  you  any  land  belonging  to  your  hospital? — None 
whatever,  except  the  land  we  are  built  on. 

Is  your  hospital  freehold  ? — ^It  is  freehold. 

Have  you  any  house  property  besides  the  hospital  ? — ^None 
whatever. 

Then,  as  regards  the  food  of  the  patients  and  the  nurses, 
who  makes  the  contracts  ? — The  house  committee. 

Is  a  public  tender  invited  ? — ^No  ;  we  do  not  take  public 
tenders. 

Then,  how  do  you  select  your  tradesmen  ? — ^We  get  the 
most  reasonable  tradesmen  that  we  can  find,  perhaps  two  or 
three  of  them,  to  send  in  tenders* 

Do  you  think  that  by  that  means  you  get  the  best  and 
cheapest  food  ? — ^I  think  that  our  tenders  are  the  lowest  of 
any  hospital,  and  I  think  that  our  quality  is  equal  to  any. 

Have  you  had  any  opportunity  of  comparing  the  prices  paid 
by  your  hospital  with  those  paid  by  other  hospitals  ? — ^Tes. 

Do  you  ever  have  complaints  tram  your  patients  as  to  the 
quality  of  the  food  or  the  cooking  ? — Very  rarely  indeed. 

What  course  is  pursued  if  a  complsont  is  made  ? — ^It  i» 
reported  to  the  house  committee. 

The  house  committee  might  not  be  sitting ;  what  would  be 
done  in  that  case  ? — ^In  that  case  I  should  deal  with  it  myself 
instantly. 


r 


ssss'jSrrs^      notabh,ia-  479 


Beriev,  July  1. 18B1. 


Before  this  house  committee  that  sits  once  a  week  are  all 
the  small  accomits  laid  7 — Not  before  the  house  committee.  A 
member  of  the  board  of  management  is  appointed  by  the 
board  to  go  through  every  detail  of  the  account,  both  the 
income  and  the  expenditure,  before  the  statement  is  made  to 
the  board,  and  cheques  are  submitted  to  the  board  to  be  signed. 
All  the  small  accounts  are  laid  before  this  board  once 
monthly. 

And  that  your  governors  think  to  be  sufficiently  frequent  ? — 
Of  course  the  audit  does  not  end  there ;  the  whole  accoimts  go 
into  the  hands  of  pubhc  chartered  auditors  at  the  end  of  the  year. 

What  assistance  have  you  in  your  office? — I  have  one 
clerk,  and  within  the  last  few  months  I  have  had  a  junior 
dark,  a  boy. 

Have  you  got  a  hospital  steward  ? — ^No. 

Then  who  is  responsible  for  the  taking  in  and  receiving  of 
the  food  ? — Our  housekeeper  is  responsible  to  me  for  that. 

Then  as  regards  your  medical  staff,  what  number  have  you  ? 
— ^We  have  16  members  on  the  medical  staff,  including  the 
consulting  physicians  and  consulting  surgeon. 

And  what  is  the  limit  of  age  to  which  those  gentlemen 
occupy  that  position  ?    There  is  no  limit  fixed. 

Have  you  any  resident  medical  officer? — Two,  appointed 
for  six  months. 

Are  they  salaried  officers  ? — ^Yes.  The  senior  gets  a  salary 
at  the  rate  of  £100  a  year,  and  the  junior  at  the  rate  of  £40 
a  year,  and  board  and  lodging  of  course. 

Earl  Spencer, — ^Is  yours  the  only  homoeopathic  hospital  in 
London  7 — Yes,  in  London. 

Do  the  patients  come  to  you  a  longer  distance  than  usual 
on  account  of  yours  being  a  homoeopathic  hospital  ? — I  may 
say,  yes  ;  we  have  them  from  the  provinces. 

You  mean  as  out-patients  7 — ^As  out-patients.  Of  course 
oar  in-patients  are  constantly  coming  from  the  country. 

Are  there  any  homoeopathic  hospitals  in  the  country  7 — 
There  is  one  in  Liverpool,  one  in  Birmingham,  another  in 
Bath,  one  in  Bournemouth,  and  others  in  ifastings,  East- 
bourne, and  Bromley. 

Are  you  in  connection  with  them  in  any  way  7 — ^Not  with 
them.  We  have  a  convalescent  home  at  Eastbourne,  of  which 
I  am  the  secretary. 

Do  you  think  that  the  qualifications  of  your  medical  men 
are  different  from  those  usual  in  other  hospitals  in  London  7 — 
Not  in  any  sense,  except  that  they  claim  to  have  gone  a  step 
beyond  the  ordinary  curriculum  of  medical  education,  and  to 
have  acquired  a  special  principle  of  therapeutics. 

You  said  that  there  was  an  extra  qualification  in  your 


480  NOTABILIA.  ''SSSL^a??^* 


Beview.Jiilyl,18n. 


medical  men  to  those  of  other  hospitals,  on  account  of  jour 
being  a  homoeopathic  hospital ;  is  there  any  examination  or 
test  for  that  ? — Not  that  I  am  aware  of.  I  ought  not  to 
have  said  "  qualification/*  I  mean  there  is  no  diploma  givea 
in  consequence  of  it. 

After  explanations  respecting  the  functions  of  the  medical 
council  of  the  hospitfd,  and  the  medical  school,  the  witness 
stated  that  under  a  law  of  the  hospital  all  legacies  over  60 
guineas  are  funded. 

Lord  Monksicell,  by  a  series  of  questions,  elicited  the 
opinion  that  the  advice  given  to  the  out-patients  is  veiy 
largely  gratuitous,  that  is  to  say,  they  only  pay  about  one- 
twentieth  part  of  the  cost  of  their  treaianent. 

Then  with  regard  to  these  tenders,  you  say  that  you  employ 
the  most  reasonable  tradesmen  in  the  neighbourhood ;  how  do 
you  find  out  who  are  the  most  reasonable  tradesmea  in  the 
neighbourhood? — Personally,  I  find  out  by  consulting  witix 
my  colleagues,  the  secretaries  of  other  hospitals,  what  they 
pay ;  I  feel  that  if  I  get  the  supplies  at  a  hospital  of  the  size 
of  ours  at  the  same  price  that  they  have  them  for  at  much 

larger  hospitals,  I  have  reason  to  be  satisfied 

We  make  it  a  principle  to  secure  quality  before  price  ;  at  the 
same  time  we  have,  I  think,  about  the  lowest  prices  of  any 
hospital  in  London.  If  the  quality  of  the  service  continues 
we  have  no  wish  to  change. 

But  my  question  rather  was,  when  you  are  inclined  to  be 
dissatisfied  with  a  tradesman,  and  when  you  think  it  your 
duty  to  ask  other  tradesmen  to  tender,  what  steps  do  you  take 
with  a  view  to  finding  out  that  the  tradesmen  who  wish  to 
tender  are  the  best  tradesmen  ? — In  the  case  of  milk,  for 
instance,  some  years  ago  we  had  occasion  to  complain,  and  I 
sent  to  a  hospital  of  considerable  size  near,  and  asked  the 
secretary  the  name  of  their  contractor,  and  the  prices ;  and 
I  then  went  to  that  man  and  some  others,  and  eventually  we 
chose  that  man  at  the  price  at  which  he  served  the  larger 
hospital. 

Earl  of  Kimherley. — Could  you  tell  us  what  price  you  are 
paying  now  for  mutton  ? — We  pay  7d.  all  round,  for  the  best 
joints. 

All  round,  in  beef  and  mutton  ? — All  round,  in  beef  and 
mutton,  for  the  best  joints. 

Chairman. — The  shilling  is  generally  cheerfully  paid,  you 
say  ? — It  is. 

Are  your  patients  of  the  poorer  class  ? — ^I  do  not  think  our 
patients  are  of  the  most  absolutely  destitute  class  as  compared 
wiih  some  of  the  other  hospitals,  but,  of  course,  they  are  a 
very  poor  class;  and  within  the  last  few  years  they  have 


£S?i?!rf3Sf^  NOTABIUA.  481 


Bninr,JiiIyl,]»l. 


fleemed  to  me  to  be  yet  poorer ;  we  seem  to  have  had  a  lower 
class  of  people  in  the  monetary  scale  coming  to  the  hospital 
than  in  former  years. 

Earl  Cathcart. — ^The  financial  poll  that  you  seem  to  have 
over  all  other  hospitals  is  in  the  small  use  of  drags ;  what  do 
joa  pay  for  dmgs  ? — ^We  are  supplied  gratuitously  with  the 
ixmioeopathic  drugs  by  Messrs.  Gould  and  Son,  of  Moorgate 
Street. 

Th^  cost  nothing  ? — The  homoeopathic  drugs  cost  nothing. 
Certain  appliances  and  external  applications  which  we  are 
obliged  to  make  cost  us  as  much  as  they  would  cost  any  other 
hoe^tal  at  the  wholesale  dealers. 

With  regard  to  your  medical  school,  you  mention  one  in 
jonr  various  documents  ? — I  perhaps  ought  to  say  that  we 
have  hardly  a  medical  school  in  the  ordinary  sense  of  the 
term ;  as  a  &ct  our  medical  men  only  profess  to  teach  two 
snbjects,  therapeutics  and  materia  medica;  all  the  rest,  if 
taught,  would  be  the  same  as  those  taught  in  the  ordinary 
schools. 

Lord  Thring* — ^Do  you  consider  that  your  hospital  really 
and  truly  supplies  all  the  homcBopathic  necessities  of  London ; 
in  other  wordis  is  it  large  enough  for  London  ? — I  think  not ; 
bnt  it  has  been  the  wish  of  our  board  to  considerably  enlarge 
the  sphere  and  the  work  of  our  hospital. 

And  you  think  it  would  be  capable  of  enlargement  if  you 
had  more  money  ? — ^I  think  there  is  no  doubt  about  that. 
At  the  present  moment  we  are  obliged  to  reduce  the  number 
of  patients  because  our  income  last  year  was  not  equal  to  our 
expenditure. 

Your  financial  position  is  particularly  strong,  you  fund  all 
yoor  legacies  ;  is  tiiat  owing  to  an  original  rule  or  because  you 
do  not  like  to  risk  any  deficit  ? — It  is  actually  part  of  an 
original  law  of  the  hospital,  that  all  sums  over  50  guineas 
shall  be  invested,  and  the  interest  only  be  made  available  for 
cnrrent  expenditure. 

You  are  aware  that  other  hospitals  speculate  more,  so  to 
speak ;  use  their  legacies  for  current  expenditure,  and  trust  to 
the  pubUc  for  makmg  up  the  deficit  ? — ^I  am  sorry  to  say  I  am 
avare  of  that. 

But  you  consider  that  your  position  is  stronger  by  funding 
yopr  property  in  the  way  you  do  ? — Not  only  stronger,  but  I 
think  it  is  sounder  in  every  way  as  a  financial  principle. 

Supposing  other  homoeopathic  hospitals  were  set  up  in 
London,  do  you  think  that  they  would  injure  you  at  all,  or  do  you 
think  that  London  could  supply  both  ? — ^My  experience  hardly 
enables  me  to  answer,  but  I  should  think  there  are  plenty  of 
people  to  supply  both. 


482  NOTABiLU.  "SiSJSrjS!!! 


Beviev,  Jvly  U  iBtL 


Do  you  adhere  striotly  to  the  old  homoeopathio  system  of 
globules,  or  have  yoa  modified  it  at  all  ? — ^We  mostly  use 
tinctures  at  the  hospital,  and  triturations,  and  what  ve  call 
pilules. 

You  do  adhere  to  such  very  minute  doses  ? — Some  of  the 
doctors  do. 

Chairman. — ^Are  your  subscribers  mostly  large  or  smsll 
subscribers? — I  am  sorry  to  say  they  are  mostly  small 
subscribers ;  as  we  lose  subscribers  of  10  guineas,  we  do  not 
replace  them  to  the  same  amount ;  we  have  to  get,  perhi^, 
five  new  subscribers  of  two  guineas.  The  tendency  seems 
to  be  not  to  subscribe  but  to  make  donations. 

Do  you  receive  any  commission  on  subscriptions  ? — ^None 
whatever. 

Does  anybody  connected  with  the  hospital  receive  any 
commission  ? — No. 

You  have  no  collector  ? — ^My  clerk  performs  the  work  of 
the  collector,  and  his  remuneration  is  included  in  his  salary. 

Have  you  any  chaplain  in  connection  with  your  hospital?— 
We  have. 

Is  he  a  salaried  officer  ? — ^He  gets  a  small  stipend. 

Does  he  live  in  tiie  hospital  ? — No. 

Have  you  any  female  clinical  clerks  ? — ^No. 

Lord  Thring. — Your  cases  are  principally  medical,  not 
surgical,  are  they  not  ? — ^We  have  had  a  very  large  inciease 
in  surgical  work  within  the  last  two  years. 

And  by  "  surgical  work,*'  do  you  mean  that  yon  perfonnthe 
ordinary  surgical  operations  ? — Yes,  of  every  land. 

And  then  as  to  your  nursing ;  I  quite  understand  that  your 
medical  system  is  cheaper,  on  account  of  the  drugs,  but  is 
your  system  of  nursing  for  any  reason  cheaper  than  tbe 
ordinary  hospital  nursing? — I  should  be  disposed  to  think 
tl^at  our  nursing  arrangements  are  rather  more  expensive  than 
the  ordinary  hospital  nursing.  Our  nurses  are  very  weU 
looked  after  in  every  way. 

Earl  Spencer. —  Do  your  patients  remain  longer  in  yonr 
hospital  on  an  average  than  the  patients  in  an  ordinary  hos- 
pital ? — I  think  rather  leas ;  as  far  as  I  have  been  able  to  see 
^m  the  Hospital  Sunday  Fund  returns,  rather  less.  They 
stay  with  us  about  27  days  on  the  average. 

Do  you  consider  that  your  treatment  would  reUeve  the 
patients  in  a  shorter  time  ? — ^We  are  strongly  of  that  opinion. 

Chairman. — ^Is  there  anything  else  you  wish  to  say?-— I 
have  taken  a  great  deal  of  interest  in  the  question  of  the 
rating  of  charities. 

What  are  you  assessed  at  ? — At  iS225  a  year ;  with  oar 
nursing  institute  it  is  now  £825  a  year. 


SSSS'JKrSSf^  NOTABIUA.  48» 


Sevtoir,  Jv*j  1. 1891. 


And  what  do  you  pay  on  that  ? — ^We  pay  on  that  about  £80 
a  year.  The  question  I  was  referring  to  was  the  whole  ques- 
tion of  the  rating  of  charities,  as  to  whioh  I  have  taken  some 
Teiy  active  steps  in  the  last  few  years. 

With  what  view  ? — With  the  view  of  securing  the  exemption 
of  hospitals  entirely  from  rating.  Until  the  year  1865  the 
hospitals  all  over  the  kingdom  were  entirely  exempt  from  any 
ntes  whatever ;  but  since  then,  by  reason  of  a  decision  that 
iras  given  in  Uie  House  of  Lords  on  the  case  of  the  Mersey 
Docks  and  Harbour  Board,  such  action  has  been  taken  that 
the  hospitals  are  now  obliged  to  pay  rates.  1  am  very 
strongly  of  opinion,  after  loolang  carefuUy  at  all  the  cases  and 
BQflh  Acts  as  have  been  referred  to,  that  there  is  actually  no 
warranty  for  it  at  all,  in  any  cases  decided. 

Earl  of  Kimberley, — Is  your  contention  then  that  charitable 
institutions  ought  to  have  a  subvention  from  the  rates  ? — That 
they  should  be  exempted. 

Of  course  it  is  exactly  the  same  thing  as  regards  the  rates 
whether  they  are  exempted  from  the  payment  of  a  certain 
Bom  in  rates,  or  whether  they  receive  a  subvention  to  that 
amount  from  the  rates  ? — In  my  opinion  it  is  not  exactly  the 
same  thing.  If  the  State  subsidised  the  hospitals  in  any  way, 
there  is  no  doubt  the  State  would  be  perfectly  entitled  to  claim 
a  share  in  the  management  of  them. 

But  do  they  not  subsidise  them  ?  What  difference  is  there 
whether  I  give  you  £5  or  exempt  you  from  paying  £5. — As  far 
as  the  money  is  concerned  there  is  no  difference,  but  the 
prindple  of  action  ia  entirely  different. 

[In  a  Mihseguent  issus  we  hope  to  give  the  evidence  of  tJie 
CJuiirman  and  Matron  of  tlie  Hospital,} 

HOSPITAL  SATDRDAY  AT  BATH. 

It  seems  that  at  Bath,  Hospital  Saturday  is  not  a  thing  got 
19  by  an  outside  committee,  as  in  London,  and  in  which  all 
hospitals  participate,  but  it  has  hitherto  been  got  up  by  the 
"  Bioyal  United  Hospital ''  for  themselves.  The  Committee  of 
the  Uomceopathic  Hospital  resolved  this  year  to  act,  if 
possible,  in  connection  with  that  of  the  other  hospitals,  and 
have  a  general  collection,  to  be  divided  in  certain  proportions. 
Communications  were  opened  with  the  authorities  of  the 
Boyal  United  Hospital,  but  their  overtures  were  refused* 
This  being  the  case,  the  Committee  of  the  Homoeopathic 
Hosj^tal  resolved  to  act  for  themselves.  It  would  not  have 
done  to  select  an  earlier  Saturday  than  that  chosen  by  the 
Boyal  United  Hospital  as  they  might  be  charged  with  taking 


484  NOTABILU.  "bSS^^jS??^ 


Beriew,*  July  1.  un. 


an  unfair  advantage  of  their  old-school  friends,  and  it  would 
clearly  not  have  done  to  select  a  later  day.  It  was  resolved 
therefore  that  the  tables  and  boxes  in  the  street  should  beaei 
up  on  the  same  day  as  those  of  the  Boyal  United  Hospital 
In  case  of  any  mistake  they  were  clearly  marked  with  the 
name  of  the  Homoeopathic  Hospital,  the  colours  being  blue 
and  white,  while  red  was  the  colour  of  the  Boyal  United 
Hospital.  It  was  a  fair  contest,  and  no  one  could  give  to 
either  side  under  a  mistake.  Many  homoeopaths  gave  to  the 
Boyal  United  Hospital  boxes,  and  the  compliment  was 
returned  by  the  feust  that  several  allopathic  doctors  contri- 
buted to  the  Homoeopathic  Hospital  boxes,  and  a  general 
friendly  feeling  was  manifested  on  both  sides.  It  was  clearly 
an  appeal  to  the  public,  and  the  result  was  most  satisfactory. 
The  Boyal  United  Hospital  netted  more  than  they  had  ever 
done  before,  while  the  Homoeopathic  boxes  yielded  £181. 
Thus  the  one  hospital  was  actually  better  instead  of  h&ng 
worse,  and  the  other  got  a  handsome  sum,  and  a  marked 
recognition  by  the  public  of  the  value  of  the  Homoeopathic 
Hospital.  We  congratulate  our  colleagues  in  Bath  on  their 
public  spirit,  and  on  their  success.  We  print  the  correspon- 
dence which  appeared  in  the  Bath  daily  papers. 

1.  Letter  from  the  President  of  the  Boyal  United  Hospital. 

HOSPITAL   SATURDAY. 

The  Boyal  United  and  HoMCEOPATmc  Hospitals. 

To  tJie  Editor  of  the  "  Bath  Herald.'* 

'<  Snt, — It  has  been  officially  intimated  to  this  committee  that 
-the  Homoeopathic  Hospital  intend  to  compete  with  us  in  our 
street  collection  next  Saturday. 

"  It  is  not  my  intention  to  enter  into  a  correspondence  with 
the  Committee  of  the  Homoeopathic  Hospital,  but  I  beg  to  be 
allowed  to  lay  the  facts  before  the  public  by  means  of  your 
columns.  The  Boyal  United  Hospitiskl  contains  120  free  beds, 
and  is  the  ojily  hospital  in  Bath  for  accidents.  Hence  its  claim 
on  the  working  classes.  Our  Committee  organised  the  Boyal 
United  Hospital  Saturday  Fund,  not  as  in  London,  where 
the  fund  is  worked  by  an  outside  committee,  and  the  proceeds 
divided  among  many  hospitals,  but  as  their  own  appeal  to 
the  working  classes,  and  right  well  have  they  been  supported. 

"  We  have  this  year  again  obtained  the  sanction  of  his 
Worship  the  Mayor-''*  and  made  all  preparations  to  hold  our 
x^oUection  on  Saturday  next,  when  the  authorities  of  the 

*  The  Mayor,  on  being  applied  to,  stated  that  he  had  no  power  to  gire 
«r  ref  OBe  permisBion. 


Xnlhljr  HontaopaHite 
Btfitv,  July  1,  IflU. 


NOTABILIA. 


485 


HonuBopathic  Hospital  ask  us  to  give  them  a  share  of  the 
collection,  or  threaten  to  open  rival  collecting  stations  at  th& 
tame  Uim.  I  do  not  deny  the  right  of  the  Homceopathic 
Hospital  to  have  their  own  collection  at  any  time  they  fix, 
but  to  make  use  of  our  organisation  and  advertisements,  and 
80  to  secure  much  money  that  was  intended  for  us,  does  not 
appear  fidr  nor  honourable.  Many  contributors  will  be  unable 
to  distinguish  between  rival  collectors.''' 

"  I  am,  sir,  faithfully  yours, 

''Edwabd  Handlxy, 
**  President  Boyal  United  Hospital. 
"  Bath,  May  25th,  1891." 

[The  above  appeared  in  our  Special  Edition  last  evening.] 

2.  Letter  from  the  Chairman  of  the  Homoeopathic  Hospital 
Committee.  The  writer,  Mr.  Hammond,  has  been  twice 
Mayor,  and  is  a  former  President  of  the  Boyal  United 
Hospital,  and  is  a  J.P.  for  the  City  and  County. 

"HOSPITAL  SATURDAY." 
To  Hie  Editor  of  the  ««  Bath  Daily  Chronicle:  " 

"  8m, — ^I  had  not  intended  troubling  the  Press  with  a 
letter  on  the  subject  of  Hospital  Saturday,  but  I  feel  bound, 
as  Chairman  of  the  Homoeopathic  Hospital  Committee,  to 
repudiate  in  the  strongest  terms  that  neither  in  intention  nor 
in  the  line  of  conduct  it  has  thought  fit  to  pursue  has  there 
been  anything  '  unfEur '  or  dishonourable." 

"  When  the  subject  of  Hospital  Saturday  was  first  men- 
tioned at  a  meeting  of  the  Homoeopathic  Hospital  Committee 
the  unanimous  feeMng  was  to  act  in  unison  with  the  Hoyal 
United  Hospital  Committee,  and  to  find  a  modus  vivmdi 
whereby  we  might  act  unitedly.  Our  Secretary  went  to  the 
Secretary  of  the  Boyal  United  Hospital  and  was  some  time 
trying  to  effect  amalgamation,  and  it  was  only  when  the 
Committee  found  that  such  was  impossible  it  elected  to  act 
nngly. 

'*  No  other  way  could  be  devised  than  the  one  adopted  and 
which  is  in  use  on  similar  occasions.  We  could  not  have  two 
Hospital  Saturdays — if  we  had  had  one  in  advance  of  the 
B.U.H.  we  should  have  been  found  fault  with  for  taking  the 
wind  out  of  their  sails,  if  after,  we  should  not  have  pleased 
the  public. 

"  I  may  add  that  great  dissatisfaction  was  expressed  on  the 
part  of  our  friends  last  year  that  out  of  the  proceeds  of  the 


*The  coUeotmg  boxes  and  tables  of  the  Homceopathic  Hospital 
irtre  clearly  marked  with  its  name.  Tiie  oolonrs,  bine  and  white, 
bong  used  mstead  of  red,  the  oclonr  of  the  Royal  United  Hospital. 


486  NOTABILIA.  "^S^^'S??aS' 


Beriew,  July  1,  IflH. 


day  the  Homoeopathic  Hospital  did  not  get  a  proportionate 
amount  though  all  subscribed,  I  had  no  idea  it  was  neoessazy 
to  obtain  the  sanction  of  Hie  Worship  the  Mayor  to  having  a 
Hospital  Saturday,  otherwise  I  ^ould  not  have  beioi 
apparently  so  discourteous  as  not  to  follow  the  example  of  the 
President  of  the  B.U.H. 

I  may  further  add  that  my  Committee  would,  in  case  of  an 
amalgamated  effort,  have  been  glad  to  pay  its  proportion  of 
the  attendant  expenses. 

I  have  no  prejudices  in  the  matter.  I  subscribe  to  all  the 
Hospitals  and  Dispensaries  in  the  town  and  served  on  the 
managing  committees  of  each  up  to  yesterday. 

"  Anthony  Hammond, 
*'  Chairman  Homoeopathic  Hospital  Committee." 

8.  Letter  from  Dr.  Percy  Wilde. 
4.  Statement  of  the  result. 

To   the  Editor  of  the  "  Bath  Daily  Chrotdcle." 

"  Snt, — The  value  of  the  services  rendered  by  the  Boyal 
United  Hospital  are  fully  recognised  by  the  supporters  of  the 
Homoeopathic  Hospital,  and  this  has  been  amply  proved  by 
their  contributions  to  its  funds,  and  the  readiness  with  whicn 
they  have  assisted  in  promoting  bazaars  and  entertainments 
for  its  benefit. 

'*  I  should  be  very  sorry  if  the  unfortunate  tone  of  Mr. 
Handley's  letter  should  serve  to  alienate  any  amount  of 
public  sympathy  from  the  Institution  over  which  he  presides. 
Nothing  could  have  been  more  courteous  than  the  commnni- 
cations  addressed  by  the  Committee  of  the  Homoeopathic 
Hospital  to  that  of  the  Boyal  United,  in  the  hope  that  in 
Bath  we  might  have  a  "  Hospital  Saturday  "  on  the  same 
lines  as  in  other  places.  Mr.  Handley's  announcement  of 
his  intention  not  to  **  enter  into  correspondence  with  the  Com- 
mittee of  the  Homoeopathic  Hospital "  will  explain  why  a 
separate  collection  vnll  be  made  this  year,  the  same  day  being 
chosen  simply  as  a  matter  of  public  convenience.  It  is  not 
out  of  any  desire  to  minimise  the  claims  of  the  Koyal  United 
Hospital,  but  simply  with  a  view  to  accuracy,  that  I  fed  it 
my  duty  to  point  out  that  accidents  are  not  refused  admission 
to  the  Homoeopathic  Hospital,  and  that  it  is  the  only  hospital 
in  Bath  from  which  the  poor  are  visited  at  their  own  homes 
in  all  parts  of  the  city. 

"  Percy  Wiu)e,  M.D." 

EE8ULT. 

Bath  Hospital  Satubday. 

Hospital  Saturday  was  held  last  week,  when  the  friends  of 
the  Homoeopathic  Hospital  entered  the  field  as  wdl  as  the 


SSSfj^rSw!*'  OBITUABT,  487 


Boyal  United  Hospital.  The  total  cniin  oolleoted  was  £454 
158.  4id.,  against  £294  ITs.  2d.  in  1889,  and  £807 
148.  0)d.  in  1890.  Of  the  £454,  the  Boyal  United  Hospital 
got  £822  188.  2|d.,  and  the  HonuBopathic  Institution  £181 
178.  ^. 


OBITUARY. 


DS.  D.  B.  SMITH,  OF  CmCAGO, 

AND 

DB.  A.  J.  8AWYEB,  OF  MONROE,  MICH. 

OcB  American  colleagues  have  recently  had  to  deplore  the 
loss  of  two  of  the  pioneers  of  homoeopathy  amongst  them,  in 
the  persons  of  Dr.  D.  S«  Smith,  of  Chicago,  and  Dr.  Sawyer, 
of  Monroe,  Mich. 

DkYJD  S.  Smith  was  bom  at  Oamden,  New  Jersey,  April 
28th,  1816.  He  studied  medicine  at  the  Jefferson  Medical 
Goll^,  Philadelphia,  where  he  took  his  M.D.  degree  in  1886. 
He  immedLately  proceeded  to  and  settled  in  practice  at  Chicago, 
at  that  time  little  more  than  an  Indian  trading  post.  Throe 
jeans  before  Dr.  Smith  arrived  in  Chicago  there  were  but  85 
houses  outside  Fort  Dearborn!  Early  in  his  career,  his 
attention  was  drawn  to  homceopathy ;  and,  after  several  years 
of  enquiry  and  experiment,  he  oonmienced  to  openly  practice 
homoeopathically  in  1848,  being  the  first  to  do  so  west  of  the 
gzeat  lakes.  At  this  time  the  population  of  Chicago  had 
grown  to  7,000  ;  in  a  few  years,  he  found  himself  with  several 
professional  colleagues  around  him,  and  he  then  took  the  first 
steps  to  found  the  Hahnemann  Medical  College  and  Hospital. 
The  Charter  granted  to  the  College  by  the  Legislature  in 
1854-5,  was  drawn  up,  under  his  direction,  in  the  office  of 
ibtaham  Lincoln,  afterwards  President  of  the  United  States, 
at  that  time  practising  as  an  attorney  in  Chicago.  Dr.  Smith 
hecame  the  first  President  of  the  College  in  1860,  and  occupied 
that  position  until  1871,  when  he  was  succeeded  by  the  late 
Dr.  Small.  Again,  on  the  decease  of  Dr.  Small,  he  was  elected 
Prosident,  and  remained  so  until  the  hoar  of  his  death. 

Dr.  Smith  joined  the  American  Institute  of  Homoeopathy  in 
1846,  in  which  he  leaves  only  eight  members  senior  to  him- 
self. In  1857  he  was  appointed  Secretary,  and  in  the  follow- 
ing year  President  of  the  Institute. 

During  his  career,  Dr.  Smith  has  rendered  valuable  service 
to  his  profession  and  to  homoeopathy  in  the  United  States.  Full 
of  energy  and  enthusiasm  he  was  ever  ready  to  take  an  active 
and  prominent  part  in  every  good  work  having  for  its  objeot 


488  COBBESPONDENCE.       "S^fSS??S«! 

the  fortberanee  of  scientifio  iherepeutics.  He  died  on  the  29th 
of  April,  the  day  after  he  had  attained  his  75th  birthday,  beloved 
and  esteemed  by  every  member  of  bis  profession  in  Chicago, 
and  gratefully  regarded  by  a  large  circle  of  friends  and  patients. 

Alfred  Isaac  Sawtbb  was  bom  at  Lyme,  Obio^  Oetober 
dlst,  1828.  He  adopted  medicine  as  his  profession,  and 
studied  at  the  Western  College  of  Homoeopathy,  at  Cleveland, 
graduating  there  in  1854.  In  1857  he  settled  in  Monroe, 
Michigan,  where  he  remained  until  his  death. 

Dr.  Sawyer's  claim  to  distinction  and  to  the  gratitude  of  all 
homoeopathists  rests  on  the  unwearying  zeal  with  which  he 
devoted  himself,  during  a  series  of  years,  to  securing  the 
the  teaching  of  homcoopathy  withm  the  University  of 
Michigan.  To  this  great  achievement  we  drew  attention 
when  announcing  Dr.  Sawyer's  unanimous  election  as 
President  of  the  American  Institute  of  Homoeopathy,  at  the 
conclusion  of  the  1889  meeting.  This  position  a  painfal 
and  acute  illness  prevented  him  occupying,  and  on  his  recoveiy 
he  retired  from  practice.  Some  months  ago  he  had  an  attack 
of  cerebral  baBmorrbage ;  from  this  also  he  more  or  less 
recovered,  when  on  the  7th  of  May  another  attack  occurred, 
and  death  followed  within  half-an-hour. 

DR.  JAMES  LOVE,  PARIS.  77"? 

The  death  of  this  very  fashionable  homoeopathic  physician  is 
announced  as  having  occurred  at  his  residence,  Paris,  on  the 
8rd  ult.,  in  the  76th  year  of  his  age. 

Dr.  Love,  who  occupied  in  Paris  a  somewhat  similar 
position  to  that  filled  by  the  late  Dr.  Qnin  in  London,  was  the 
beloved  and  trusted  adviser  of  a  large  circle  of  aristocratic 
patients.  During  the  cholera  of  1849  he  rendered  conspicuous 
services  to  the  poor  of  Paris.  His  skOl  as  a  diplomatist  was 
recognised  and  used  on  more  than  one  occasion  by  the 
Emperor  Napoleon ;  just  as  that  of  our  own  colleague  was  bj 
the  ministry  of  which  Lord  Palmerston  was  once  a  member. 
During  1868  the  Empress  Eugenie  was  a  patient  of  Dr.  Love's. 
Dr.  Love's  high  artistic  skill  brought  him  into  contact  with  a 
number  of  operatic  and  dramatic  artists  as  well  as  painters, 
and  among  them  he  had  a  large  and  most  appreciative 
clientele.  He  had  practised  homoeopathy  in  Paris  for  50  years. 

CORRESPONDENCE. 

PRESENTATION    OF    A    TESTIMONIAL   TO 

DR.  Lli:BAULT,  OF  NANCY. 
To  ilie  Editors  of  Hie  "  Monthly  Homceopathic  Eeriew." 
GsNTLEBcsN, — ^Dt.  Li^bault,  of  Nancy,  who  enjoys  the  distinc- 
tion of  having  been  the  first  to  apply  hypnotic  suggestion  m 


SS^^Sw?^?**'        CORRESPONDENCE.  489 


,  J11I7 1,  laei. 


the  treatment  of  disease,  is  one  of  the  most  modest  and  single- 
minded  of  men.  Twenty-five  years  ago  he  abandoned  a 
lucratiTe  general  practice  in  order  to  devote  himself  to  the 
development  of  this  treatment.  Since  that  time  he  has 
treated  gratuitously  more  than  10,000  of  the  poor.  He  did 
80  gratuitonsly,  partly  in  order  to  obtain  patients  to  whom  he 
codd  apply  this  treatment,  and  partly  to  avoid  being  regarded 
as  a  charlatan  endeavouring  to  obtain  fees  from  the  public  by 
deceiving  them.  Many  of  his  colleagues  and  friends  pitied 
him,  and  regarded  him  as  a  lunatic,  because  he  thus  acted  so 
disinterestedly.  Several  years  ago  I  published  some  biographi- 
cal notes  of  the  doctor,  which  will  be  found  in  the  MorUhhj 
Homaojmtliic  liecinv,  vol.  xxxiii.,  p.  40.  In  1866  he  pubHshed 
his  work,  **  Du  Saintneil,  et  deg  etata  anahffue»,  considerh  sur- 
tout  au  point  de  nie  de  V action  du  Moral  mr  le  Physique,**  Very 
little  attention  was  paid  to  the  subject,  and  for  many  years  his 
book  remained  on  the  shelves  of  the  publishers ;  when  about 
1884,  Professor  Bemheim's  attention  was  drawn  to  Liebault's 
treatment  by  a  poor  woman,  who  was  cured  by  him  by 
hypnotic  suggestion  after  having  been  treated  unsuccessfully  in 
the  Professor's  clirdque.  I  am  told  that  it  is  due  to  this  case 
that  Professor  Bemheim's  attention  was  drawn  to  Li^bault's 
treatment,  and  after  deriving  instruction  from  him,  he  at  once 
began  to  experiment  in  his  own  cliniqm,  and,  having  convinced 
himself  of  the  important  curative  effects  to  be  derived  from 
hypnotism,  he,  two  years  later,  published  the  first  edition  of 
his  well-known  book  De  la  Suggestion  et  de  sen  Applicatunui  a  la 
Thirapeutique.  It  was  a  most  courageous  step  for  Dr.  Bernheim, 
as  a  professor,  to  adopt  Li^bault's  treatment,  and  to  teach  it 
publicly  to  his  pupils.  He  set  a  glorious  example  to  that 
majority  of  clinical  professors  who  condemn  any  new  or 
onorthodox  treatment  without  taking  the  trouble  to  examine 
it.  From  the  time  that  Bernheim  began  to  advocate  hypnotic 
suggestion,  LiSbault  became  more  and  more  widely  known. 
French  and  foreign  medical  men  visited  them  both,  and  ever 
found  them  ready  to  communicate  what  they  knew,  and  to 
show  the  practical  results  of  their  treatment.  Mons.  Li^gois,  a 
professor  of  law  at  Nancy,  studied  the  effects  of  hypnotism  from 
a  legal  point  of  view  at  the  same  time.  These  three  gentle- 
men may  be  regarded  as  the  fathers  of  the  School  of  Nancy, 
while  the  members  of  the  School  of  Paris,  under  Charcot, 
were  engaged  in  the  physiological  study  of  the  effects  of 
suggestion  on  hysterical  persons  of  both  sexes. 

As  Dr.  Li^bault's  treatment  is  now  well  known  011  both  sides 
of  the  Atlantic,  and  in  the  Colonies,  he  resolved  to  retire  from 
active  practice,  and  the  occasion  was  taken  advantage  of  by 
Dr.  Lloyd  Tuckey,  whom  I  persuaded  to  study  hypnotism,  to 

Vol.  35,  Xo.  7.  2  M 


490  CORRESPONDENCE.       ^uS^J!^Zm. 

suggest  to  Dr.  Li^bault's  many  admirers  and  pupils  the 
presentation  of  a  testimonial  to  bim.  Dr.  Tuckey's  movement 
was  warmly  approved  of,  and  no  less  than  14  nations  are 
represented  by  subscribers  to  the  testimonial.  This  consisted  of 
a  beautiful  bronze  statue  of  David,  by  a  French  artist,  together 
with  an  album  containing  photographic  portraits  of  the  sub* 
scribers.  A  balance  of  several  hundred  francs  was,  according 
to  Dr.  Liebault's  wish,  applied  to  the  commencement  of  a 
fund,  the  interest  of  which  is  to  be  given  as  a  prize  for  the 
study  of  any  practical  question  on  the  subject  of  hypnotism. 

The  presentation  was  made  on  the  25th  of  May,  at  a  dinner 
given  in  honour  of  Dr.  Liebault.  Dr.  Dumont-Pallier,  one  of 
the  physicians  of  the  H6tel  Dieu,  Paris,  Dr.  van  Renterghen,  who 
presides  over  a  private  cUniqtie  for  hypnotism  in  Amsterdam, 
and  Dr.  Berillon,  the  Editor  of  the  lievue  de  VHypnoHtme^  eaeh 
addressed  the  guest  of  tlie  evening,  referring  to  liis  modesty, 
unselfishness,  perseverance,  kindness,  and  philanthropy, 
when  I  was  called  upon  to  say  a  few  words.  In  doing  so,  1 
alluded  to  the  great  readiness  Dr.  Liebault  had  always  shoim 
to  communicate  the  result  of  his  researches  to  others,  and  I 
thanked  him  in  the  name  of  English  speaking  medical  men  in 
all  parts  of  the  world  for  what  he  had  taught  us,  and  I  also 
dwelt  on  tlie  value  of  the  work  done  by  Professor  Bemheim 
and  M.  Li^gois. 

In  responding.  Dr.  Liebault,  who  was  very  much  touched 
by  the  manifestation  of  kindly  feeling  towards  him,  said  that 
"  Professor  Liegois,  who  had  recently  confirmed  the  rapid 
development  of  psycho-physiology,  has  frequently  told  me  that 
I  am  a  happy  man  !  This  is  true.  I  could  not  fail  to  be  so 
when  so  many  adhesions  were  being  received  to  this  almost 
new  science.  And  then  to-day,  gentlemen,  when  looking  at 
this  beautiful  work  of  art,  and  listening  to  the  addresses  whieh 
have  been  made  in  my  honour,  I  am  more  than  a  happy  man. 
Especially  so  when  I  see  here  to-day  Dr.  Dumont-PaUier— 
one  of  the  masters  of  French  medical  science — joining  in  this 
expression  of  sympathy  with  me  at  this  social  gathering.  I 
thank  him  most  heartily  for  his  presence  here,  and  all  those 
who  have  worked  with  me,  either  by  making  experiments  or, 
as  Dr.  Renterghen  has  done,  by  opening  cliniques  for  the 
practice  of  hypnotic  suggestion,  all  of  whom  have  contributed 
to  the  progress  of  our  knowledge  of  the  doctrine  of  suggestion. 
My  thanks  are  particularly  due  to  Dr.  Mathias  Both,  who 
was  one  of  the  first  to  appreciate  the  importance  of  the 
principles  I  have  taught,  and  who  it  was  who  induced  his 
countryman,  Dr.  Charles  Lloyd  Tuckey,  to  investigate  them, 
the  colleague  who  has  been  the  devoted  promoter  of  the 


IS^^ta^        C0RBE8P0NDBNCE.  491 

International  subscription,  the  final  result  of  wbiob  is  our 
gathering  here  this  evening.  My  warmest  thanks  are  also 
due  to  Dr.  Dumont-Pallier,  under  whose  patronage  the 
Reme  de  rHyjmotisme  has  been  established,  and  to  Dr. 
Berillon,  its  chief  editor,  whose  great  and  important  services 
in  conducting  this  journal  have  been  most  conspicuous. 
Most  gratefully  do  I  at  the  same  time  thank  Professor 
Bemheim,  who,  though  through  his  official  position  he 
incurred  many  a  risk  in  doing  so,  was  the  first  to  tender  me 
bis  right  hand  and  to  encourage  me  in  my  work.  Professors 
Lidgois  and  Beaumis,  each  in  his  speciality,  has  done  much 
much  to  help  me,  and  most  warmly  do  I  acknowledge  this 
great  kindness. 

**  And  now,  gentlemen,  it  is  my  turn  to  raise  my  glass  and 
drmk  to  your  health,  and  that  of  all  your  friends  in  various 
countries,  who  have  been  so  kind  as  to  present  me  with  this 
testimonial  of  their  regard  and  sympathy.  I  drink  to  your 
success  in  the  future  because  there  is  still  much  to  be  dis- 
covered in  the  large  field  in  which  we  have  only  begun  to 
work;  I  drink  to  the  opening  of  a  new  scientific  era  in 
therapeutics ! 

"  Gentlemen,  I  cannot  sit  down  without  once  more  repeat- 
ing how  proud  and  grateful  I  am  that  men  who  are  among  the 
most  distinguished  in  science  have  come  here  horn  all  parts 
to  offer  me  their  congratulations,  a  brotherly  demonstration 
vhich  I  appreciate  more  than  all  beside.'* 

Thus  ended  a  pleasant  meeting  due  to  the  initiative  of  our 
^Ueague,  Dr.  Charles  Lloyd  Tuckey,  to  whom,  he  not  being 
able  to  be  present,  a  brotherly  message  was  sent  by  telegraph. 

I  have  only  to  add  that  on  the  morning  of  the  25th  of  May 
Professor  Bemheim  received  the  foreign  and  other  friends  of 
Br.  Li^bault  in  his  cliniqtu,  explaining  to  them  the  treatment 
by  suggestion  at  the  bedside,  and  demonstrating  its  import- 
ance in  both  acute  and  chronic  disease. 

I  cannot  conclude  without  earnestly  recommending  my 
homoeopathic  colleagues  to  make  themselves  practically 
acquainted  with  the  treatment  by  suggestion ;  doing  so  will 
enable  them  to  cure  many  disorders  which  do  not  yield  to  the 
ordinary  medicinal  treatment  of  either  the  old  or  new  school. 

I  am,  Gentlemen, 

Yours  truly, 
Divonne,  France,  M.  Both. 

June  1st,  1891. 

2  If— 2 


492  eORRESPONDENTB.        *";^'L=?S??^* 


Beview,  July  1,  IWl. 


NOTICES  TO   CORRESPONDENTS. 


*^*  We  cannot  ntuJertake  to  rttnrn  rejected  manuscript. 

Authors  and  Contbibutoes  receiving  proofs  are  requested  to  correct 
and  return  the  same  as  early  as  possible  to  Dr.  Edwin  A.  Neatby. 

London  Homceopathic  Hospital,  Great  Obmond  Street, 
Bloomsbury. — Hours  of  attendance  :  Medical,  In-i>atients,  9.80  ;  Out- 
patients, 2.30,  daily ;  Surgical,  Mondays  and  Thursdays,  2.30  :  Dinaees 
of  Women,  Tuesdays  and  Fridays,  2.30  ;  Diseases  of  Skin,  Thardays  . 
2.30  ;  Diseases  of  the  Eye,  Thursdays,  2.30  ;  Diseases  of  the  Ear,  Satur- 
days, 2.30  ;  Dentist,  Mondays,  2.30  ;  Operations,  Mondays,  2. 

Dr.  Abbott,  recently  of  Exeter,  and  formerly  of  Wigan,  at  the 
earnest  request  of  his  numerous  Lancashire  friends,  has  returned 
North,  and  has  now  taken  up  his  residence  in  Winckley  Square,  Pres- 
ton. Dr.  R.  A.  Bremner,  of  London,  has  succeeded  him  at  Exeter. 

Errata. — In  Dr.  Hughes'  letter,  page  423,  last  issue,  for  *'  some  of 
the  best  friends/'  read  "  some  of  my  best  friends,"  and  also  for  **whidi 
is  so  justly,"  '•  which  if  so  justly." 

Communicauons.  &c..  have  been  received  from  Mr.  Wyborn,  Dr. 
Hughes  (Brighton)  ;  Dr.  Blake,  Dr.  Fernie,  Mr.  Cross  (London) ; 
Dr.  Hayward,  Dr.  A.  Hayward,  Dr.  Proctor  (Liverpool);  Dr. 
Butcher  (Windsor) ;  Dr.  Brazol  (St.  Petersburgh) ;  Dr.  Percy 
Wilde  (Bath). 

BOOKS    RECEIVED. 


-I  Cyclopfedla  of  Dnnj  Pathujencsy.  Part  xv.  Edited  by  Dre. 
Hughes  and  Dake.  London  and  Xew  York.  1891. — Howwoputhlc 
Lcugur  Tracts.  No.  35.  The  Txvo  Ways  in,  Jfrdwine,  London :  Bale 
and  Sons.  Titchfield  Street.  Hw  Jfowcsopathic  World,  London.  June. 
— Medical  Jieprintu,  London.  June. — The  Chemist  and  Druggist, 
London.  June. — The  Monthly  Magazine  of  Pharmacy,  London.  June. 
— (^ireulary  Miller  Stuart  Co.  Liverpool. — The  Korth  American  Journal 
of  Homaopathy,  New  York.  May. — The  Medical  Jieview,  New  York. 
May  and  June. — The  Awerican  Homoeopath  ist.  New  York.  May. — 
The  Netc  York  Medical  Times,  May  and  June. — The  New  England 
Medical  Oazctta,  Boston.  June. — The  Hahnemaun  Monthly,  Phila* 
delphia.  June.— T^^*  Medical  Era,  Chicago.  June.— ^r*  Cliuipw. 
Chicago.  May.  The  Medical  Ad-cance,  Chicago.  May. — The  Medical 
Argux.  Minneapolis.  March. — TJte  College  Argvs.  Cleveland.  April* 
— The  Medical  and  Surgical  Record,  Omaha.  May. —  The  Stmthem 
Journal  of  Iloma'opaihy,  New  Orleans.  May. — The  Hamwopathic 
PhyKiei4in.  Philadelphia.  June. — The  Indianapolis  Sentinel.  MayH. 
lU'tue  Iloma'opathique  Beige.  Brussels.  March.— ZViiic»»  Jlttnueo- 
pathiqne.  Antwerp.  April — Allgem,  How.  Xeitung,  Leipzig.  June. 
-^Populiire  Zeitschrift  fur  Homoopathie,  Leipzig.  Jvake,—jRirisfa 
Omiopatica.  Rome.  May. — Gazetta  Medica  J)i  Torino.  Turin.  May 
and  June. — Jai  Ilrforma  Medica,  Mexico.  March  and  April. — UomasO' 
juUhisch  Maandhlad.  June. — Jivll.  Gen.  de  Tli^rapeutigue,  Paris.  June. 

Papen,  Dispensary  Reportji,  and  Book§  for  Review  to  be  sent  to  Dr.  l\>rB,  19, 
Watergate,  Grantham,  Lincolnithire ;  Dr.  D.  Dyck  Browk,  29,  Reymonr  Street,  Port- 
man  Square,  W.;  or  to  Dr.  Edwin  A.  Nratbt,  161,  Haventock  Iliil,  N.W.  AdrertMe- 
iDent«  and  Buainem  communicatinna  to  be  sent  to  Messrs.  £.  Ooitld  ft  Soir,  S9t 
Moorgate  Street,  £.C. 


JSta^jS^oSJ?^  rBSBtDKKTlAIj  ADDBEB8.  498 


THE    MONTHLY 

HOMCEOPATHIC    REVIEW. 


■:o:- 


BRITISH  HOMCEOPATHIC  SOCIETY. 

PBB8n>BNTIAL  AdDRBSS  AT  THE  ClOSB  OF  SESSION  1890-91, 

By  R.  E.  Dudgeon,  M.D.* 

Gentlemen, — ^At  the  close  of  each  session  it  is  customary 
for  the  President  to  deliver  an  address  by  way  of  winding 
up  the  business  of  the  year,  and  as  Presidents  should,  of 
all  men,  be  especially  guided  by  precedents,  I  willingly 
eonform  to  the  time-honoured  custom. 

It  is,  I  find,  usual  to  give  a  resume  of  the  work  we 
have  done  during  the  nine  months  occupied  by  the 
meetings  of  the  Society.  Criticism  of  that  work  by  the 
President  would  be  supererogatory  and  impertinent,  as 
the  papers  that  have  been  read  and  the  cases  that  have 
been  presented  have  already  been  adequately  discussed 
in  full  meeting. 

The  initial  meeting  of  the  session  was  opened  by  a 
paper  from  Dr.  Clarke,  who,  abandoning  for  a  while  his 
onerous  labours  as  the  homoeopathic  Atlas,  sustaining  on 
his  unaided  shoulders  the  whole  Homoeopathic  World, 
kindly  undertook  to  direct  us  in  the  true  way  and  to  warn 
OS  against  straying  into  a  false  way  in  the  practice  of  our 
special  therapeutics.  His  paper  was  entitled  **  The  Two 
Paths  in  Homoeopathy."  The  title  recalls  to  my  memory 
that  of  a  story  which  used  to  delight  and  instruct  my 

*  Delirered  July  8th,  1891. 
Vol  35,  No.  8.  2  N 


494  PRESIDENTIAL  ADDRESS.  ""SiSL^l 


Benew,  Aug.  1*  IflU. 


childhood.  It  bore  the  name  of  "  The  Lofty  and  the 
Lowly  Paths."  I  do  not  remember  more  about  this 
interesting  nursery  tale  than  that  the  bad  boy,  who  chose 
the  high  path,  came  to  grief,  whereas  the  good  boy,  who 
kept  to  the  low  road,  got  on  all  right.  In  Dr.  Clarke's 
paper,  on  the  contrary,  the  high  path  is  apparently  the 
one  that  meets  his  approbation,  though  it  is  beset  with 
difficulties  ;  whilst  the  other  path — evidently  a  low  one 
as  he  speaks  disparagingly  of  it  as  ''  the  road  which  takes 
the  downward  direction," — though  easy  and  flower- 
bestrewn,  is,  he  seems  to  think,  "  the  primrose  way  to 
the  everlasting  bonfLre.*"  Dr.  Clarke's  high  and  low 
paths  have,  of  course,  nothing  to  do  with  high  and  low 
potencies. 

Dr.  Clarke  gave  us  a  shock  by  evoking  from  its  tomb 
the  long  buried  doctrine  of  a  vital  principle  or  life  force, 
which  has  at  various  periods  haunted  medicine  under 
the  names  of  Psyche,  ArchsBUs,  Seele,  Lebenskraft,  &6« 
We  hoped  it  had  been  finally  laid  to  rest  some  50  years 
ago.  Ghosts  of  ordinary  material  bodies  are  gruesome 
things,  but  when  the  ghost  of  such  an  immaterial  im- 
palpable  thing  as  a  vital  principle  '*  revisits  thus  the 
glimpses  of  the.  moon"  we  cannot  help  feeling  that  it  is 
something  extra  uncanny.  Hahnemann  resuscitated  the 
doctrine  in  the  last  edition  of  the  Organon^  evidently 
because  it  fitted  so  nicely  on  to  his  hypothesis  of  the 
dematerialisation  of  medicines  and  the  liberation  of  their 
medicinal  powers  from  their  connection  with  the  drug 
substance  by  means  of  his  pharmaceutical  processes; 
but  as  it  is  only  a  theory  incapable  of  proof  or  disproof, 
it  may  be  held  as  a  pious  opinion  or  rejected  without 
detriment  to  the  stability  of  the  homoeopathic  therapeutic 
rule,  which  got  on  very  well  before  Hahnemann,  in  the 
last  decade  of  his  life,  allied  it  with  the  even  then  mori- 
b^und  doctrine  of  an  omnipotent  and  omnipresent  vital 
principle.  Had  Burns  been  a  doctor  living  in  these 
times,  we  might  fancy  him  addressing  an  ode  to  this 
troublesome  immateriality  in  the  style  of  his  address  to 
another  evil  spirit  whose  name  I  forbear  to  mention  to 
ears  polite : — 

O  you,  wbaterer  title  like  ye, 
Archaetu,  vital  force  or  Psyohe, 
What  maks  oor  Clarke  sae  fidgin-fykie 

To  ca*  ye  back  t 
Has  modern  science  failed  to  strike  ye 

A  mortal  whack  ] 


F 


SXS^^Sat^^    PRESIDENTIAL   ADDRESS.  495 

Bnt  I  need  not  pnrBue  the  subject  farther.  An  annual 
address  is  hardly  a  fitting  occasion  for  the  consideration 
of  SQch  a  lofty  theme. 

At  the  second  meeting  of  the  session,  in  November, 
Dr.  Cook  gave  ns  a  maiden  paper,  '*  On  Therapeutics  as 
«D  Applied  Science."  With  much  ingenuity  and  learn- 
ing he  showed  the  plausibility  and  probability  of  the 
homoBopathic  system  by  analogies  &om  other  departments 
of  science.  There  can  be  no  doubt  that  such  a  mode  of 
treating  the  subject  is  well  adapted  to  recommend 
homoBopathy  to  all  unprejudiced  minds,  and  though  it 
cannot  supersede  the  direct  proof  sLfforded  by  the  suc- 
cessful results  of  practice,  it  is  eminently  fitted  to  remove 
the  prejudices  of  scientific  men  and  dispose  them  to  take 
a  favourable  view  of  the  claims  of  homoeopathy  to  be 
the  true  science  of  therapeutics. 

The  third  meeting  in  December  was  devoted  to  the 
exhibition  of  a  large  number  of  interesting  cases,  medical 
and  surgical,  by  Dr.  Garfrae,  Mr.  Knox  Shaw,  Dr.  Moir, 
Dr.  Neatby,  Dr.  Cox,  Dr.  Blackley,  and  Dr.  Burford. 

Dr.  Dudley  Wright  occupied  the  attention  of  the 
Society  at  its  fourth  meeting  in  January  with  an  admi- 
rable paper  "  On  Some  of  the  Common  Diseases  of  the 
Pharynx  and  Larynx."  These  diseases  were  chronic 
pharyngitis  and  laryngitis,  post  nasal  catarrh  or  Torn  wald's 
disease,  syphilitic  pharyngitis  and  laryngitis,  tubercular 
pharyngitis  and  laryngitis,  and  new  growths  of  the  air- 
passages.  In  truth,  a  goodly  list  of  diseases,  any  one  of 
which  might  almost  have  sufficed  to  occupy  an  evening. 
Of  each  of  them  we  might  say  with  Hamlet :  **  Ay,  madam, 
it  is  common,"  but  for  all  its  commonness  its  cure  is  by 
no  means  so  commonly  understood  as  not  to  need  a  con- 
siderable amount  of  light  being  thrown  on  it.  And  it 
mnst  be  acknowledged  that  the  author  of  the  paper,  and 
iBany  of  those  who  took  part  in  the  discussion  it  evoked, 
8Qcceeded  in  throwing  a  great  deal  of  light  on  the  thera- 
peatics  of  the  diseases  treated  of. 

The  fifth  meeting  in  February  was  devoted  to  the 
reading  of  a  paper  by  Mr.  Butieher,  entitled  "  The  Recent 
Disco7eries  of  Eoch  atid  Pasteur  as  illustrating  the  Law 
of  Similars."  Mr.  Butcher  is  eminently  fitted  for  the 
treatment  of  such  a  subject  from  his  great  scientific 
acquirements  and  his  highly  original  intellect.  He  was 
likewise  speciiJly  qualified  for  giving  a  good  account  of 

3  m— 2 


496  PRESIDENTIAL   ADDRESS.  ^S^JL^SHT^ 


Beriew,  Aag,  1,  IflU. 


Koch's  method^  as  he  had  learned  in  Berlin  itself  much 
about  it.  But  he  did  not  touch ^  upon  the  subject  of  the 
success  or  otherwise  of  Koch's  treatment  of  human 
beings.  He  only  referred  to  his  laboratory  experiments 
^  illustrating  the  law  of  similars.  Of  course  his  paper 
was  calculated  to  create  a  lively  discussion,  for  we  have 
amongst  us  not  only  some  who  are  believers  in  Pastenr 
and  Kochy  but  some  who  think  that  both  these  eminent 
9avanU  have  gone  on  quite  a  wrong  method  in  their 
search  for  a  cure  for  hydrophobia  and  phthisis.  Some 
great  man  is  reported  to  have  said  anything  can  be 
proved  by  figures,  and  this  is  conspicuously  the  case  with 
regard  especially  to  Pasteur's  anti-rabic  inoculations,  for 
while  his  partisans,  such  as  Sir  J.  Paget  and  Sir  J. 
Lister,  show  by  figures  that  his  injections  have  saved  the 
lives  of  many  persons  who  otherwise  would  have  died  of 
hydrophobia  (the  former  puts  the  number  at  900,  the 
latter  at  12,000  in  four  years!)  his  opponents,  like 
Drs.  Lutaud  and  Peter^  prove  equally  convincin^y  by 
^gures  that  his  injections  so  far  from  having  prevented 
hydrophobia  have  spread  it,  and  thus  have  been  instm- 
mental  in  causing  the  deaths  of  many  who  otherwise 
would  never  have  had  the  disease.  Another  great  man 
has  said  nothing  is  so  fallacious  as  figures — except  facts ; 
^o  what  are  we  to  believe  ?  *'  Who  shall  decide  when 
doctors  disagree  ?  " 

The  results  of  the  anti-tubercular  injections  of  Koch 
are  not  so  uncertain.  It  is  now  generally  admitted  that 
the  whole  business  is  a  lamentable  fiasco — ^that  none 
have  been  cured  but  many  killed  by  it.  The  Koch  episode 
does  not  redound  greatly  to  the  credit  of  the  medical 
profession.  The  first  announcement  of  the  so-called 
discovery  caused  an  invasion  of  the  capital  of  Prussia  by 
doctors  from  all  parts  of  the  world.  It  was  a  most  un- 
dignified scamper — a  kind  of  "  devil  take  the  hindmost"— 
all  eager  to  be  the  first  to  obtain  a  drop  of  the  precious 
lymph,  whose  composition  was  then  utterly  unknoivn« 
The  report  that  enough  lymph  for  a  thousand  inoculations 
could  be  had  for  26  shillings,  and  that  the  doctors  of 
Berlin  were  cha.rging  from  £6  to  £1Q  for  each  inoculation, 
was  enough  to  make  the  mouths  water  of  the  thousands 
of  practitioners  who  were  half-starving  on  half-crown 
fees.  When  the  grand  smash  came,  the  disappointment 
of  the  credulous  lymph-seekers  must  have  been  aggravated 


SJS^iSTSS**    PBBBIDBNTIAL  ADDRESS.  497 

by  the  discredit  they  had  bronght  on  an  honourable 
profession  by  their  indecent  haste  to  employ  a  secret 
nostrum — an  altogether  unprofessional  proceeding  which 
the  chief  exponents  of  medical  ethics  had  frequently 
condemned  in  the  most  explicit  terms. 

Incidentally  I  may  remark  that  Koch's  idea  of  curing 
tuberculosis  by  its  own  virus  was  anticipated  long  ago  by 
bomoBopathy,  the  very  name  Eoch  gives  to  the  prepared 
idras,  "  tuberculinum,"  being  that  given  many  years 
fiince  by  Swan  to  his  similar  preparation.  The  homoeo- 
pathic idea  passing  through  the  allopathic  brain  was 
mined  in  the  transit,  and  tuberctdinum^  which,  employed 
after  the  method  of  Hahnemann  has  only  benefited 
patients,  when  used  according  to  the  directions  of  Eoch 
has  hurried  many  victims  into  a  premature  grave.  One 
of  onr  members,  Dr.  Burnett,  has  published  a  book,  in 
which  he  shows  how  helpful  tvherctdinum  is  when 
rationally  employed. 

The  sixth  meeting  in  March  was  pleasantly  and 
profitably  spent  in  listening  to  an  interesting  paper  by 
onr  esteemed  veterinary  colleague,  Mr.  Hurndall,  on 
"'Our  Public  Flesh  and  Milk  Supply  in  Relation  to 
Hygiene."  The  author,  though  not  a  member  of  the 
Society,  is  a  welcome  visitor,  and  last  year  favoured  us 
with  his  experience  on  the  homoeopathic  treatment  of 
influenza  in  the  special  subjects  of  his  clientele,  viz. : — 
horses.  It  is  very  satisfactory  to  us  to  find  that  horses 
are  very  amenable  to  homoeopathic  treatment,  and  we 
are  glad  to  know  that  our  system  is  practised  with 
excellent  results  by  such  a  skilful  and  scientific  veteri- 
nary surgeon  as  Mr.  Hurndall.  Speaking  for  myself, 
I  have  a  special  fondness  for  veterinary  practice,  for  I  was 
once  very  near  being  a  miUtary  veterinary  surgeon.  It 
happened  in  this  way:  Some  thirty  years  ago,  being 
seized  with  the  desire  to  become  acquainted  with  the  art 
of  war,  I  entered  the  military  service  of  her  most 
gracious  Majesty  in  the  reserve  forces.  I  may  mention 
that  I  served  for  nearly  twenty  years  in  the  ranks,  but 
that  my  wish  to  witness  real  warfare  was  not  gratified, 
as  during  all  that  long  period  this  country  was  never 
once  invaded  by  a  hostile  army,  and  you  are  doubtless 
aware  that  the  reserve  forces  are  not  sent  on  foreign 
service.     I  cannot  say  that  my  military  career  was 


498  PRESIDENTIAL   ADDRESS.   ^S^fASjniwM^ 

altogether  bloodless,  for  on  one  of  our  field-days  a 
spectator  was  shot  through  the  body  by  a  ramrod  which 
had  been  carelessly  left  in  a  rifle.  But  as  the  victim 
was  only  a  clergyman  and  therefore  a  pacific  non-com- 
batant, the  catastrophe  could  not  be  fairly  regarded  as 
an  incident  of  real  warfare.  The  colonel  of  my  regiment 
one  day  told  me  that  he  thought  what  he  was  pleased  to 
term  my  talents  were  wasted  in  the  rank  and  file  of  the 
regiment,  and  he  asked  me  if  I  would  not  like  to  be  one 
of  the  regimental  doctors.  I  at  once  replied  no,  my 
object  in  joining  the  army  was  the  slaughter,  not  the 
cure,  of  my  fellow  creatures ;  of  the  latter  I  had  quite 
enough  in  my  civil  capacity.  He  then  asked  me  if  I 
would  not  accept  a  commission  as  an  officer  of  some 
sort.  I  replied  that  if  I  quitted  the  ranks  I  would  only 
exchange  my  present  status  for  that  of  veterinary 
surgeon.  He  asked  me  what  I  knew  about  horses'  diseases. 
I  replied,  nothing  at  all,  but  that  did  not  signify,  for 
if  I  were  appointed  to  the  post  of  veterinary  surgeon  I 
would  adopt  the  stamping-out  plan  which  had  been  so 
successfully  enforced  by  the  Government  in  the  case  of 
the  cattle  plague ;  and  when  a  horse  seemed  ill  and  unfit 
for  work  I  would  order  it  to  be  slaughtered  and  a  sound 
one  procured.  The  colonel  seemed  struck  by  the  sim- 
plicity and  efficacy  of  my  plan,  but  regretted  that,  as  ours 
was  an  infantry  regiment,  and  there  were  only  three 
hDrses  in  the  regiment — his  own,  the  major's  and  the 
adjutant's— it  seemed  hardly  worth  while  creating  a 
special  surgeon  for  such  a  small  clientele.  I  could  not 
agree  vrith  him  there,  as  the  number  did  not  matter 
when  the  whole  efficiency  of  the  regiment  in  the  face  of 
the  enemy  might  be  endangered  by  the  disablement  of 
the  charger  of  any  one  of  those  important  officers.  Such 
an  accident  could  not  happen  in  a  dragoon  regiment,  as 
any  officer  whose  horse  was  disabled  could  be  supplied 
with  another  from  the  ranks,  therefore  the  fewer  the 
horses  in  a  regiment  the  greater  the  need  of  an  official  to 
see  to  their  efficiency.  My  arguments  did  not  move  the 
colonel  to  adopt  my  suggestion.  I  have  often  noticed 
that  colonels  are  mdisposed  to  introduce  any  novelty  or 
reform,  however  excellent,  into  their  regiment  unless  it 
has  origmated  in  their  own  brain. 

This  little  bit  of  military  autobiography  will  enable 
you  to  understand  the  interest  I  feel  in  veterinary  sub- 


SSSr^rrSS?^  pbesidentul  address.  499 

jects,  and  how  thoroagbly  pleased  I  was  to  listen  to  the 
experience  of  our  able  veterinarian,  Mr.  Hurndall. 

The  chief  object  of  his  paper  was  to  show  that  there 
could  be  no  safety  for  the  consumers  of  butcher's  meat 
unless  the  body  of  every  ox  was,  as  it  were,  sat  upon  by 
a  veterinary  coroner,  and  a  verdict  of  "died  from  non- 
natural  causes ''  returned.  This  is  similar  to  the  Jewish 
plan  with  regard  to  their  "  Kosher  "  meat,  and  as  we 
are  apparently  about  to  be  deluged  with  an  immense 
importation  of  wandering  Jews  from  Russia,  we  may  in 
coarse  of  time  become  so  Hebrewised  as  to  adopt  their 
peculiar  custom  in  regard  to  meat-inspection. 

At  our  meeting  in  April  we  were  favoured  with  an 
excellent  paper  by  our  worth v  honorary  secretary.  Dr. 
Blackley,  on  **  The  Irritable  Mucous  Membrane  of  the 
Gouty  Subject,"  which  was  fully  up  to  date  in  erudition 
and  practical  value.  I  have  often  observed  that  patients 
seem  to  derive  considerable  comfort  from  the  doctor's 
assurance  that  their  complaints  are  due  to  gout  in  their 
system.  Probably  their  satisfaction  is  owing  to  their 
belief,  originally  started  by  Lord  Chesterfield,  I  believe, 
that  gout  is  a  highly  respectable  disease.  When  heredi- 
tary it  shows  a  sort  of  aristocratic  strain  in  the  blood,  of 
which  every  well-regulated  mind  ought  to  feel  proud. 
The  consciousness  of  the  gentility  of  the  disease  may 
tend  to  mitigate  its  anguish,  even  though  the  victim 
may  find  that  Ovid  was  right  when  he  says  : 

Tollere  nodosam  nesoit  medicina  podagram. 

At  our  May  meeting  Dr.  Blake  gave  us  a  luminous  and 
interesting  paper,  entitled  ''A  Study  of  Delphinium 
Staphisagria."  Though  the  drug  has  been  known  to 
the  faculty  from  the  very  earliest  times,  little  use  has 
been  made  of  it  by  the  old  school,  except  as  an  applica- 
tion to  the  head,  in  order  to  destroy  that  loathsome 
vermin  which  Burns  apostrophizes  as  an 

Ugly,  creepin',  blnstit  wonner. 
Detested,  shunned  bj  saint  and  sinner. 

On  the  other  hand,  Hahnemann  discovered  in  it  great 
therapeutic  virtues,  which  were  all  set  forth  by  Dr.  Blake, 
whose  observations  will  materially  help  to  precisionise 
its  sphere  of  therapeutic  utility. 

At  our  last  meeting  in  June,  Dr.  Fernie  improved  the 
shining  hour  by  discoursing  on  the  therapeutic  vktues 


600  PRESIDENTIAL  ADDRESS.    ^i£S&^2??2S! 


B«Tiew,  Aug.  1,  Ifin. 


of  the  busy  bee.  His  paper,  besides  being  replete  mih 
practical  wisdom,  was  witty  and  humorous,  and  while 
it  instructed  it  amused  his  audience,  and  elicited  a 
general  wish  that  the  author  would  soon  gratify  us  with 
another  paper.  Had  Dr.  Watts  been  still  alive  to  hear 
Dr.  Fernie's  paper  he  might  have  added  a  verse  in  his 
celebrated  poem  about  that  exemplary  insect,  the  bee» 
something  in  this  style : 

How  artfully  she  stores  her  tail 

With  yeiiom,  strong  and  sure, 
Adapted  to  a  two-fold  nse^ 

To  poison  and  to  core. 

Casting  a  retrospective  glance  on  the  session  just 
terminated,  I  think  I  may  say  that  it  has  been  a  very 
satisfactory  one.  We  have  had  excellent  papers  read 
and  instructive  discussions.  We  have  had  many 
interesting  cases  of  rare  disease  exhibited,  and  we  hare 
had  fair  average  attendances  of  members.  We  have 
increased  the  number  of  our  members  by  the  election  of 
six  new  ones. 

We  have  to  regret  the  loss  of  two  of  our  oldest 
members  by  death :  Mr.  Ayerst,  of  London,  who  though 
he  remained  a  member  of  the  Society  to  the  last,  did 
not  attend  our  meetings  of  late  years,  and  Dr.  Moore,  of 
Liverpool,  who  during  his  rare  visits  to  London  occa- 
sionally delighted  us  with  his  genial  presence. 

Indirectly  connected  with  the  Society  we  have  had  a 
series  of  post-graduate  lectm'es  delivered  by  some  of  oar 
members  belonging  to  the  staff  of  the  hospital.  These 
lectures  have  been  most  interesting  and  instructive,  and 
have  been  much  appreciated  by  the  audiences.  It  is  to 
be  hoped  this  excellent  plan  will  be  continued  in  future 
years. 

As  the  British  Homoeopathic  Society  is  intimately 
connected  with  the  London  Homoeopathic  Hospital,  aU 
that  concerns  this  institution  interests  ue  in  the  highest 
degree.  Accordingly  we  have  viewed  with  feelings  of 
the  warmest  sympathy  the  amazingly  successful  enorts 
made  by  the  board  of  management  of  the  hospital,  headed 
by  their  indefatigable,  energetic  and  liberal  chairman, 
Major  Vaughan  Morgan,  to  collect  funds  for  rebuilding, 
with  all  the  scientific  improvements  required  by  modem 
sanitation  and  hygiene,  the  hospital  which  we  feel  has 
hitherto  but  inadequately  supplied  the  wants  of  the 


iSStlTiSTB^    J^BEBIBBNTIAL  ADDRESS.  501 

patients  who  have  flocked  to  it.  Now  that  the  large  sum 
of  i^,000  has  been  collected  there  need  be  no  delay  in 
commencing  the  work  of  rebuilding,  and  perhaps  before 
om:  next  annual  meeting  we  may  have  the  pleasure  of 
assembling  in  the  hall  of  a  handsome  and  commodious 
new  hospital,  which  will  increase  the  reputation  and 
extend  the  knowledge  of  homoeopathy. 

I  cannot  leave  the  subject  of  the  hospital  without 
aDnding  to  the  great  progress  that  has  been  made  in  the 
surgical  department.  There  can  be  no  doubt  that  during 
the  last  decade  inunense  advances  have  been  made  in 
operative  surgery,  more  especially  in  that  of  the  abdo- 
men, and  that  many  cases  which  formeHy  would  have 
perished  from  lack  of  operative  help  are  now  saved  by 
the  surgeon's  skill.  As  we  have  a  surgical  department 
in  the  hospital,  it  would  be  shameful  if  the  surgery  were 
not  quite  up  to  date.  We  are  proud  to  know  that, 
thanks  to  the  perfect  skill  of  our  surgeons,  that  reproach 
cannot  be  applied  to  our  hospital.  I  do  not  hesitate  to 
say  that  operations  as  skilfully  performed  and  as  wonder* 
folly  successful  as  those  in  any  of  the  existing  hospitals 
may  be  witnessed  in  the  London  Homoeopathic  Hospital. 

Since  we  parted  in  June  last  year  there  has  been  but 
little  mention  of  homoeopathy  in  the  old  school  periodi- 
cals. Our  old  adversary,  "  R.  B.  C,"  alias  Mr.  Robert 
Bmdenell  Carter,  distinguished  himself  by  reporting  to 
the  Ophthalmological  Society  the  outrageous  conduct  of 
one  of  the  members  who  actually  ''  submitted  to  consult 
^th  a  homceopath,"  and  proposing  that  the  Society 
should  pass  a  resolution  to  the  effect  that  ''it  is  inex- 
pedient and  improper  for  its  members  to  engage  in 
professional  consultations  with  avowed  homoeopaths,  or 
with  persons  holding  o£Sce  in  homoeopathic  institutions." 
The  Ophthalmological  Society  would  have  nothing  to 
do  with  Mr.  Carter's  resolution,  whereupon  Mr.  Carter 
indited  an  acrimonious  letter  to  the  Lancet  in  which  he 
loaded  with  equal  abuse  homoeopaths  and  the  majority 
of  the  members  of  the  Society,  and  loftily  announced 
bis  resignation  of  the  membership  of  the  Society.  Of 
course  Mr.  Carter's  letter  was  duly  answered,  and  a 
very  pretty  quarrel  was  kept  up  for  a  few  weeks  in  the 
eolnnms  of  the  Lancet.  Except  this  little  fight  there 
has  been  nothing  stirring  in  the  homoeopathic  contro* 


602  PRESIDBNTIAL   ADDRESS.   ^SSilJr^ASruSu 

yerBial  sphere.  It  is  to  be  hoped  that  it  may  not  be 
long  before  some  new  assailant  of  homoeopathy  enters 
the  list  and  gives  our  school  the  opportunity  of  having 
a  fair  stand  up  fight  for  the  cause  of  scientific  thera- 
peutics. A  young  truth  always  flourishes  amid  the  din 
of  controversy.  The  palm  of  victory  is  not  to  be  had 
without  the  dust  of  strife — -palma  non  sine  pulvere, 

A  characteristic  attempt  at  boycotting  was  enacted  at 
Bath  on  the  occasion  of  Hospital  Saturday.  It  appears 
that  hitherto  the  collection  on  that  day  was  in  some  way 
monopolised  by  the  Boyal  United  Hospital  and  w&s 
managed  by  the  committee  of  that  hospital.  The  com- 
mittee of  the  Homoeopathic  Hospital  considered  this 
unfair,  and  thought  that  the  collection  should,  as  in 
other  places,  be  made  for  all  the  hospitals  of  the  place, 
including  their  own.  They  accordingly  proposed  to  the 
committee  of  the  allopathic  hospital  that  the  collection 
should  be  a  general  one  ;  the  proceeds  to  be  afterwards 
divided  among  the  lidspitals  proportionally.  The  allo- 
pathic committee  scornfully  refused  to  *'  enter  into  cor- 
respondence with  "  the  homoeopathic  committee,  so  the 
latter  instituted  a  separate  collection  for  tb^ir  own 
hospital,  which  was  so  far  successful  that  they  got 
upwards  of  £130.  For  my  own  part,  I  think  the 
homoeopaths  acted  perfectly  right,  and  I  should  always 
approve  of  an  energetic  resistance  being  offered  to  all 
such  attempts  to  treat  us  otherwise  than  on  a  footing  of 
perfect  equality.  If  we  allow  ourselves  to  be  sat  on  ve 
shall  certainly  be  squashed. 

In  the  old  school  nothing  of  permanent  importance  to 
medicine  has  occurred.  Of  course,  a  good  many  new 
antipyretics  and  hypnotics  have  been  introduced,  but  as 
the  same  thing  has  occurred  frequently  during  the  last 
decade,  and  the  novelties  after  a  short,  trial  are  discarded 
for  some  still  newer  remedies  of  the  same  class,  we  need 
not  trouble  ourselves  much  about  them. 

Each  remedy  as  it  is  introduced  is'  said  to  be,  like 
Eeatings'  insect  powder,  *^  perfectly  harmless  to  animal 
life,"  but  it  invariably  happens  after  a  longer  or  shorter 
trial  that  some  of  those  who  have  employed  it,  write  to 
the  medical  periodicals  to  complain  of  its  poisonous 
action  on  their  patients.  The  most  amusing  incident  in 
the  old  school  is  the  tragi-comic  drama  enacted  in  Berlin 


Sl!S?'5?rS^*     PRESIDENTIAL   ADDBE88.  503. 

in  eonnection  with  the  Eoch  cure  of  tabercolosis,  to  which 
I  have  ahready  alluded. 

The  hopes  raised  in  the  breasts  of  the  aged  by 
Dr.  Brown-Sequard's  announcement  that  he  had  dis- 
covered the  true  elixir  vitaB  have  alas  !  not  been  realised* 
This  is  to  me  personally  a  f^reat  disappointment,  as  I 
had  looked  forward  to  renewing  my  youth  at  this  new 
fountain  of  jouvence,  when  I  might  have  roused  your 
enthusiasm  by  a  lively,  vigorous  and  youthful  address, 
in  place  of  wearying  you  with  the  vapid  babblings  of 
senility. 

I  was  just  about  to  write  that  nothing  more  of  a  new 
and  original  character  had  appeared  in  connection  with 
old  physic,  when  I  received  by  post  a  work  entitled,. 
"Bhyming  and  Mnemonic  Key  to  Materia  Medica." 
In  this  the  author,  who  modestly  conceals  his  name, 
endeavours  to  fix  on  the  memory  by  means  of  rhymes 
and  puns  the  rather  dry  facts  of  drug  compounding.. 
Sometimes  he  contents  himself  with  the  mere  enumeration 
of  the*  constituents  of  the  compounds '  ef  the  official 
pharmacopoeia,  as  thus: — 

^  Linimentun  Aeoniti — 

Take  aconite-root  and  rectifi^  spirit,  parte  twenty, 
And  eamphar  one  part,  yon  see  it  is  plenty." 

But  he  usually  includes  a  bit  of  therapeutical  infor- 
mation in  his  rhyme : — 

*'  Plumhi  aretast  oprnm,  confection  of  roses 

Makes  a  pill,  which  if  taken,  stops  bleeding  from  noses/' 

*'  tSulph.  magnesia  one  oance  and  nnieil.  awyluw^ 
With  one  onnce  olive  oil  to  act  on  the  rectum/' 

"  Gnm  arable  in  powder,  syrup,  cinnamon  and  chalk 
This  mistora  cretce,  diarrhoeas  will  balk." 

These  are  perhaps  the  most  favourable  specimens  of 
the  author's  work.  In  many  of  the  couplets  the  metre 
and  rhyme  are  both  conspicuous  by  their  absence,  as  for 
instance : — 

'*  Calontel,  80  grains,  one  ounce  axungia 
Prescribed  much  it  is  for  scrotal  eczema." 

The  idea  appeared  to  me  to  be  good,  though  the- 
execution  certainly  leaves  something  to  be  desired.  Why 
not  utilise  it  for  the  purpose  of  impressing  the  homoeo- 
pathic therapeutics  on  the  mind  ?  I  remember  when  I 
was  a  student  a  certain  teacher  of  anatomy  in  Edinburgh 
was  credited  with  having  invented  a  whole  system  of 


604  PRESIDENTIAL  ADDRESS;   ''S^^ITSn! 

nmemonic  rhymes  for  the  purpose  of  teaching  his  class 
students  anatomy.  I  can  only  recall  one  specimen  of 
this  curious  industry.  In  order  to  enable  the  student  to 
remember  the  relative  position  of  larynx  and  pharynx 
(called  in  Scotland  laarynx  and  phaarynx)  this  elegant 
•couplet  was  to  be  learned  by  heart : — 

'*  The  laaiynz  lies  beneath  the  skixi, 
The  jphaarifnjs  lies /ar  in." 

Some  of  US  remember  how  our  distinguished  colleague, 
Dr.  Tod  Helmuth,  at  the  dinner  of  the  International 
Homoeopathic  Congress  in  1881,  delighted  us  by  reciting 
a  poem  of  his  own  composition,  in  which  he  gave  a  sort 
of  history  of  surgery  and  its  chief  operations.  He  showed 
that  operative  surgery  was  a  very  ancient  art,  the  earliest 
recorded  example  of  it  being  the  enucleation  of  Adam's 
rib.  An  Italian  of  the  name  of  Guaneiali  in  1840  pub* 
lished  a  poem  in  Latin  hexameters  all  about  Hahnemami 
and  his  medicines ;  but  he  rather  limited  himself  to  giving 
a  poetical  account  of  the  pathogenetic  effects  of  the 
chief  homoeopathic  medicines,  and  as  he  chose  to  write 
in  Latin  the  circle  of  his  readers  was  limited. 

I  thought  that  something  might  be  done  in  the  style 
of  the  Rhyming  Mnemonic  Key  to  impress  on  the  un* 
learned  reader's  mind  the  salient  facts  of  homoeopathic 
therapeutics.  I  remembered  how  the  succession  of  kings, 
from  William  the  Conqueror  downwards,  and  some  of  tibe 
striking  facts  of  English  history,  had  been  engraved  on 
my  memory  by  the  rhymes  learnt  in  the  nursery,  setting 
forth  how — 

''  Norman  Willy,  the  Gonqneior,  long  did  reign, 
Red  Billy,  his  son,  by  an  arrow  was  elain. 
Henry  the  Fint  was  a  scholar  bright. 
And  Stephen  was  f oroed  for  his  orown  to  fight." 

And  SO  on.  If  a  serious  subject  like  history  could  be 
legitimately  taught  in  rhyming  couplets,  why  not  that 
equally  serious  subject,  medicine  ? 

I  forthwith  set  to  work  to  try  and  get  the  idea  put  into 
execution.  Among  my  friends  I  have  one  who  is  what 
I  may  call  a  spiritualistic  poet.  Under  the  inspiration 
of  spirits  he  will  reel  you  off  any  quantity  of  rhymes  on 
any  given  subject.  So  I  interviewed  him,  told  him  what 
I  wanted,  put  a  copy  of  Dr.  Clarke's  Prescriber  into  his 
hand  and  a  glass  of  Glenlivat  into  his  slot,  and  so  set 
him  going.    In  a  short  time  he  produced  a  sheet  fall  of 


SShS^J^TSbi!^  fbesidentiaii  addbess.  605 

ocmpletsy  wherein  a  namber  of  our  medicines  and  their 
therapeutic  ases  are  set  forth  in  alphabetical  order  as 
foQows: — 

If  inflammation  holds  you  tight 
YoqH  loose  its  grip  with  Aconite j 

For  erysipelas,  on  my  honour, 
There's  nought  can  equal  Belladonna. 

When  ilatnlenoe  mutable  is 
Take  Carbo  regetabUis, 

When  onr  heart's  aotion  seems  to  fail  us, 
We  take  a  dose  of  Digitalis, 

JBuphrtuiaf  anglieU  Eyehright 
Is  good  for  clearing  up  dim  sight. 

A  tapeworm  in  a  lad  or  lass 
Is  quiokly  kiUed  by  FUim  mas. 

Psoriasis  an  ugly  sight  is, 

It's  been  cured  often  by  OraphUrs. 

To  keep  your  boils  from  going  deeper 
Take  every  night  and  morning  Hepar. 

To  one  by  sorrow  who's  emaoia- 
Ted,  the  safe  cure  is  Ignatia, 

For  sweats  exoessive  Jahorandi 
Is  of  all  med'oines  the  most  handy. 

Lest  toothache  tease  you  you  should  note 
The  remedy  is  Xreasnte. 

To  give  a  gout-racked  person  Ledum 
Is  vastly  better  than  to  bleed  him. 

A  cure  for  bilious  trouble  is 
Mereurius  solubilis. 

Take  for  disordered  stomach  a 
Pilule  of  Xum  vomica. 

If  drowsiness  you  overcome 
Then  take  a  dose  of  Opium, 

From  Pentland  Firth  to  Boephoms 
Pneumonia's  cure  is  Phosph-orus. 

If  grave  disease  has  made  you  pine 
A  grand  restorative's  Quinine. 

If  suffering  from  fumnculus 
Your  remedy's  Banuneulus. 

If  thread  worms  make  your  baby  whine 
Give  him  a  dose  of  Santonine. 

When  wheezy  mucus  clogs  the  chest 
Tartar  emetic  is  the  best. 

If  you're  attacked  by  diabetes 
Uranium  helps — see  E.  Blake's  treatise. 

Its  full  and  copious  proving  stamps 
Veratrum  as  the  cure  for  cramps. 

Water  applied,  both  cold  and  hot, 
Oozee  of  diseases  a  great  lot. 


■606 PEESIDENTIAL  ADDBE88.     '^S^.a.^.i.mi. 

When  maidens'  menses  painful  oome 
Then  doee  them  with  Xanthttxylum, 

Whene'er  yon  feel  down  on  your  Inck,  a 
Bemedy  you'll  find  in  Ywtea, 

The  suffering 8  from  excess  of  drink — 
Easperto  crcac — ^yield  to  Zirie, 

When  I  objected  that  the  poetry  was  hardly  np  to  the 
high  standard  I  anticipated,  the  author  replied :  What 
could  you  expect  from  a  single  glass  of  whisky  ?  If  it 
had  been  a  bottle  the  lines  would  have  had  more  spirit 
in  them.  You  can't  get  more  out  of  a  vessel  than  yon 
put  in  it — and  so  forth.  ^  I  only  give  this  specimen  by 
way  of  a  hint  to  others  who  may  be  disposed  to  adopt 
this  method  of  popularising  homceopathy.  Now  that 
the  aJlopaths  have  taken  to  the  poetical  plan,  we  may 
follow  their  example  and  show  them  that  homoeopathic 
therapeutics  is  quite  as  susceptible  of  poetic  treatment 
as  their  pharmacopoeia.  The  Rhyming  Repertory  of 
Rational  Remedies  would  be  as  good  a  title  as  that  of 
the  allopathic  work  I  have  introduced  to  your  notice. 
The  historical  nursery  rhymes,  of  which  I  gave  you 
a  specimen,  were,  if  I  remember  aright,  set  to  a  lively 
tune,  and  though  lively  music  might  seem  hardly  suited 
to  such  a  grave  subject  as  medicine,  there  might  not  be 
the  same  objection  to  inJK)ning  the  Rliyming  Repertory 
if  it  were  considered  advisable  to  give  a  public  reading 
of  it.  But,  perhaps,  I  had  better  avoid  any  allusion  to 
ecclesiastical  forms,  lest  it  might  suggest  to  some  of  yoa 
to  propose  reading  the  Commination  Service  for  my 
benefit — or  the  reverse. 

Gentlemen,  we  have  well  earned  our  holiday,  and  I 
trust  we  may  all  enjoy  it.  But  I  must  remind  you  that 
to-morrow  the  Annual  Congress,  which  is  something 
quite  apart  from  our  Society,  is  to  meet  in  this  room, 
and  I  hope  it  may  be  largely  patronised  by  our  members, 
one  of  whom,  our  excellent  friend,  Mr.  Harris,  is  to 
occupy  to  presidential  chair.  I  am  sure  all  you,  and 
many  others,  will  give  him  their  cordial  support. 

Thanking  you  for  the  patience  with  which  you  have 
listened  to  my  address,  which  I  wish  for  your  sakes  had 
been  better  worth  listening  to,  I  bid  you  farewell  until 
October  next,  when  I  trust  we  shall  again  assemble  like 
giants  refreshed  by  our  holiday,  prepared  to  develop  our 
scientific  therapeutics  and  extend  the  knowledge  of  the 
beneficent  system  of  Hahnemann — vrbi  et  orbi. 


bSSS^T^TSi!^*  after  twenty  years.  507 


THE  ANNUAL  HOMCEOPATHIC  CONGRESS. 


AFTER  TWENTY  YEARS  AND  TWENTY  YEARS  AFTER.* 

By  Henry  Harris,  M.B.G.S. 

Colleagues,  Ladies  and  Gentlemen, — ^It  was  certainly 
not  on  account  of  any  fitness  on  my  part  to  fill  such  an 
office  that  my  colleagues  at  Bournemouth  did  me  the  great 
honour  of  placmg  me  in  this  position  to-day,  and  rather 
I  would  say  (and  I  say  this  as  an  encouragement  to  the 
more  modest  ones  amongst  us),  it  was  an  illustration  of 
the  proverb,  *'  All  things  come  round  to  him  who  will 
bat  wait ; "  and,  almost  for  the  first  time,  you  will  have 
from  this  chair,  the  views,  not  of  a  field-marshal,  not  of 
a  general,  not  even  of  an  officer,  but  of  one  of  the  rank 
and  file  of  the  medical  profession.  So,  in  speaking  to 
jou  to-day  in  the  capacity  of  President  of  the  Congress, 
I  would,  in  the  first  place,  guard  myself  from  misconcep- 
tion, that  in  so  doing  I  am  in  any  way  a  representative 
or  mouthpiece  of  the  homoeopathic  body.  The  views  I 
lay  before  you  to-day,  I,  and  I  only,  am  responsible  for. 

It  will  be  within  the  recollection  of  many  of  you  that, 
as  long  since  as  1850,  the  custom  of  ^holding  Congresses 
of  the  practitioners  of  homoeopathy  has  obtained  in  this 
country.  The  custom  continued  annually  until  the  year 
1856,  and  then  fell  into  desuetude.  It  was  revived  in  the 
year  1870,  and,  with  two  exceptions — or,  perhaps,  I  should 
say  three — consequent  on  the  meetings  of  the  Inter- 
national Convention,  it  has  since  been  continued  year  by 
year. 

It  is  not  my  purpose  to  dwell  at  any  great  length, 
either  upon  the  addresses  which  have  been  deUvered  at 
these  Congresses,  or  upon  the  men  by  whom  they  were 
delivered. 

Suffice  it  to  say  that  among  the  latter  have  been  all, 
or  nearly  all,  the  most  prominent  practitioners  of 
homoeopathy  in  the  British  Islands,  and  hence  I  feel 
strongly  the  sentiment  of  the  old  writer,  **  What  shall  a 
man  say  who  cometh  after  a  king  ?  *' 

In  1879,  Dr.  Hughes,  at  the  Malvern  Congress, 
armnged  the  addresses  which  had  preceded  his  under 

*  Being  the  Presidential  addrees  deUvered  in  London,  Jolj  9tb,  1891. 


608  APTEB   TWENTY   YEAB8.   ^iSSSJr^SMf^ 


two  heads :  The  Scientific,  and  the  Politics  of  homoeo- 
pathy. 

This  arrangement,  admirable  at  the  time,  has  con- 
tinued equally  applicable  until  now.  By  the  addresses, 
classed  under  the  head  Scientific,  it  has  been  proved, 
first,  that  the  homoeopathic  law  is  scientifically  true; 
secondly,  that  it  is  in  agreement  with,  and  enables  as  to 
utilise  to  their  full  extent,  all  additions  to  our  knowledge 
of  physiology,  pathology,  and  therapeutics ;  thirdly,  that 
in&iitesimal  doses  of  drugs  have  a  curative  action  in 
disease ;  fourthly,  that  by  the  practical  working  of  the 
homcBopathic  law,  diseases  are  more  quickly,  safely,  and 
pleasantly  cured  than  by  any  other  known  method  of 
therapeutics. 

Under  the  heading  of  Politics  of  homoeopathy  the 
addresses  have  shown : 

First,  that  the  reception  of  homoeopathy  bv  the  old 
school  of  medicine  has,  from  the  very  first,  been  mtolerant 
aind  unjust ;  that  its  practitioners  have  been  boycotted, 
persecuted,  and  deprived,  as  far  as  possible,  of  all  pro- 
fessional privileges  and  emoluments. 

Secondly,  that  the  attitude  of  the  homoeopathic  body 
has  been  (in  this  country,  at  any  rate)  characterised  by 
a  strict  observance  of  the  laws  of  medical  etiquette,  and 
by  continued  efforts  for  reunion,  at  the  sacrifice  of  every- 
thing but  fundamentals. 

TUrdly,  that  the  influence  of  homoeopathy  on  the 
general  practice  of  medicine  has  helped  the  discrediting 
and  abandoning  of  the  grosser  forms  of  treatment. 

Fourthly,  that  the  remedies  introduced  by  the  homoeo- 
paths have  been,  and  still  are,  constantly  (without 
acknowledgment  of  the  source  from  whence  they  are 
tdiken)  appropriated  by  the  so-called  orthodox  school  of 
medicine. 

I  have  thus  four  propositions  under  each  headifig 
which  I  shall  take  as*  proven,  and  should  any  one  feel 
aggrieved  by  this  course,  my  reply  is  that  I  am  not 
to-day  a  missionary,  but  that  I  am  speaking  to  those 
who  are  heart  and  soul  convinced  of  the  truth  of 
homoeopathy,  and  of  its  benefits  to  the  human  race. . 
•  What,  then,  after  twenty  years,  is  .  the  position  of 
homoeopathy  in  this  country  ?  What  signs  are  there  of 
the  triumph  of  its  principles,  the  spread  of  its  methods 
ef  practice? 


SSS^^ITS?^     AFTER  TWENTY  YEAB8.  509 

A  question  that  is  constantly  asked  by  our  patients.is. 
Does  homoeopathy  increase  ?  Daring  the  last  few  years, 
when  that  question  has  been  asked  me,  I  have  felt  con- 
iriderable  difficulty  in  giving  the  positive  assunmce  I 
could  wish.  "  If  I  might,  with  comprehensive  view, 
survey  mankind  from  China  to  Peru,"  I  could  always 
satisfactorily  reply  to  my  questioner  ;  but  when  I  know 
the  meaning  of  the  question  is  limited  to  the  condition 
of  homoeopathy  here,  I  speak  with  some  fear  that  my 
questioner  may  compel  me  to  give  reasons  for  my  reply. 

hi  what  direction  can  we  fairly  look  for  evidences  of 
growth? 

Taking  first  the  attitude  of  the  profession  to  homoeo- 
pathy. At  various  times  during  the  past  twenty  years, 
upon  the  slightest  appearance  of  an  increase  of  toleration 
and  liberality  on  the  part  of  the  allopaths,  an  optimistic 
cry  has  gone  up  from  the  writers  of  the  homoeopathic 
school  that  the  dark  days  had  passed,  the  injustice  to 
which  we  had  been  subjected  was  about  to  be  acknow- 
ledged, and  the  homoeopath  was  to  be  received  into  the 
fold  of  orthodox  medicine. 

Even  in  the  year  1870,  a  writer  in  the  British  Journal 
of  Homoeopathy  expressed  the  belief  '*  that  the  time  was 
not  far  distant  when  there  will  cease  to  be  homoeo- 
pathists  and  allopathists  ;  but  all  will  be  one  fraternity, 
jomed  together  by  one  common  aim,  mutually  respecting 
one  another  in  their  common  labours,  for  the  weal  of 
suffering  humanity." 

Four  years  later  a  distinguished  writer  wrote,  "  The 
boundary  line  between  the  homoeopathic  and  orthodox 
practice  is  daily  becoming  less  distinct."  And  five  years 
later,  in  1879,  another  writer,  equally  distinguished, 
expresses  himself  in  these  words,  "  For  our  children  we 
may  safely  anticipate  the  time  when  the  name  homoeo- 
patiby  shall  no  longer  denote  a  persecuted  sect,  but  a 
&ith  and  practice  recognised  universally  as  legitimate, 
and  largely  as  truth,  when  the  antagonisms  of  to-day 
shall  cease  to  separate  between  brethren." 

I  might  go  on  quoting  year  by  year  similar  sentiments, 
bat  I  will  come  to  more  recent  times,  and  bring  to  your 
memory  the  admirable  address  of  Dr.  Dyce  Brown  in 
1888,  wherein  he  brings  before  you  certain  evidences  of 
this  growth  of  toleration.  Amongst  others  he  mentions 
the  fcict  that  Dr.  Percy  Wilde  had  been  invited  to  read 

Vol  35,  No.  8.  2  0 


610  AFTEB  TWENTY  YEARS.     ^n^JwfS^^^ 

a  paper  before  the  local  branch  of  the  British  Medical 
Association  on  a  subject  involving  the  question  of  the 
relation  between  the  two  schools,  in  the  discussion  of 
which  most  liberal  feeling  was  shown.  That  I  also  was 
invited  by  a  local  Medical  Society  to  address  them  on 
the  subject  of  homoeopathy.  What  Dr.  Wilde's  after 
experience  has  been  I  know  not,  but  mine  was  this,  that 
though  my  paper  was  well  received  and  fairly  discussed, 
the  president  was  quietly  informed  by  several  members 
of  the  Society  that  they  would  resign  their  membership 
if  the  subject  of  homcBopathy  were  again  introduced.  I 
mention  these  two  cases  as  illustrating  this  hopeful  view, 
for  on  them  Dr.  Dyce  Brown  mainly  founds  his  state- 
ment that  **  all  round  we  are  frequently  finding  evidence 
of  the  direction  in  which  the  tide  is  flowing  in  favour  of 
freedom  in  medicine,"  and  Dr.  Pope,  at  the  last  meeting 
of  the  Congress,  gave,  as  illustrating  the  same  progress 
of  toleration,  that  our  old  enemy,  The  Lancet^  had 
inserted  a  letter  from  a  homoeopath,  repelling  a  slander 
made  in  their  columns,  and  that  was,  as  Dr.  Pope  said, 
something  distinctly  new. 

I  have  also  noticed  that  this  same  journal.  The  Lancet^ 
now  utilises  the  advertising  columns  of  the  Monthly 
Homoeopathic  Review,  but  against  these  recent  evidences 
of  gi'owth  may  be  placed  the  fact  that,  in  the  College  of 
Physicians,  there  is  now  a  library  rule  that  books  on 
homoeopathy  shall  not  be  placed  on  the  table  of  the 
reading  room. 

I  confess  that  I  cannot  share  these  optimistic  views 
which  I  have  quoted. 

I  am  unable  to  recognise  any  radical  change  in  the 
attitude  of  the  bulk  of  the  profession  towards  the 
followers  of  Hahnemann. 

It  may  be  that  the  virulence  of  language,  like  the 
*^  damns  "  of  conversation,  has  had  its  day;  it  may  be 
that  the  outward,  active  persecution  is  less  manifest, 
that  recognising  the  old  truth  ''that  a  persecuted  faith 
always  grows,"  the  profession,  acting  on  the  advice  of 
Dr.  Bristowe,  has  ceased  openly  to  assail  us,  but,  con- 
spiracy of  silence  and  contemptuous  indifference  have 
taken  the  place  of  the  open  warfare,  and  the  innuendo 
that  of  the  curse. 

To  look  in  this  direction  for  signs  of  progress,  willi  I 
feel  sure,  be  unavailing. 


SSSS^JSTTS?**  afteb  twenty  yeabs.  611 


In  the  medical  hierarchy,  as  in  all  other  bodies  of  that 
type,  true  reform  will  only  come  firom  without. 

In  discussing  this  first  head  of  the  attitude  of  the 
profession  to  homoeopathy,  I  have  also  indicated 
sufficiently  that  the  attitude  of  homoeopathy  towards 
the  profession  has  continued  to  conform  to  that  rigid 
-observance  of  medical  etiquette  laid  down  in  the  second 
proposition. 

We  may  now  pass  on  to  consider  the  modifying  action 
of  homoeopathy  on  the  practice  of  medicine  at  large. 

As  to  the  first  part  of  such  action,  the  discrediting  of 
the  more  violent  methods  of  practice  (though  it  is  true 
bleeding,  blistering,  emetics  and  violent  purgatives  still 
exist,  and  occasionally  make  efforts  once  more  to  become 
fashionable) ,  on  the  whole  we  may  say  that  healing  by 
torture  is  almost  extinct.  As  to  the  question  of  the 
adoption  of  our  remedies.  Each  year  continues  to  add 
its  testimony  to  the  growth  of  the  practice,  and  acting 
on  the  advice  of  a  previous  president,  I  would  be  quite 
<}OQtent  to  view  such  practice  in  a  benevolent  spirit,  if 
Hahnemann's  advice  were  taken,  ''If  you  imitate, 
imitate  correctly." 

Bat  when  we  come  to  consider  this  as  one  of  the 
evidences  of  the  growth  of  homoeopathy,  I  am  not  quite 
as  well  satisfied. 

For  what  does  this  absorption  mean  ? 

Is  it  a  real  taking  in  and  digesting  of  the  guiding  law  ? 
Or  is  it  simply  an  empirical  use  of  remedies  used  in  our 
school  ?  Were  it  the  first,  the  result  of  such  absorption 
voald  be  a  permanent  alteration  in  the  general  practice 
of  medicine,  and  would  be,  perhaps,  the  ideal  to  which 
we  might  aspire.  But,  meanwhile,  it  would  necessarily 
have  manifested  itself  by  converts  coming  to  our  ranks, 
not  as  single  spies,  but  in  whole  battalions,  for  the 
conviction  of  a  great  truth  would  have  overridden  all 
the  worldly  advantages  pertaining  to  orthodoxy.  But  I 
am  afraid  that  this  adoption  is  simply,  as  has  been  often 
stated,  a  mere  empirical  use  of  the  remedies,  not  likely 
to  advance,  but  rather  to  hinder,  the  cause  of  true 
homoeopathy. 

And  here  I  can  do  no  less  than  bear  an  enthusiastic 
tribute  to  the  immense  work  done  by  members  of  our 
school  towards  the  building  up  of  a  reliable  iiuiteria 
iiiedica,  and  the  furnishing  us  with  the  best  means  of 

2  0—2 


512  AFTER  TWENTY  YEARS.     ^^^^SS^T^ 

utilising  that  work.  As  Dr.  Hughes,  iq  1879,  was 
enabled  to  congratulate  the  homoeopathic  body  on  the 
completion  of  AUen's  Encyclopadiay  so  I,  in  18i91,  may, 
I  think,  fairly  congratulate  Dr.  Hughes  and  his  co- 
workers on  the  completion  of  the  Cyclopedia  of  Drug 
PathogeneaiSy  a  work  of  which  any  era  of  medicid 
history  might  be  proud,  a  work  which,  when  supple- 
mented by  its  appropriate  repertory,  must  for  many 
years  to  come  be  the  chief  source  to  which  the  homoeo- 
pathic student  will  look  for  guidance. 

As  we  have  already  considered  the  bearing  on  the 
progress  of  homoeopathy  of  the  attitude  of  the  dominant 
school,  as  well  as  the  results  already  attained  by  the 
empirical  adoption  by  allopaths  of  homoeopathic  remedies, 
let  us  now  turn  for  evidence  to  that  which  would  perhaps 
occupy  the  first  place  in  the  mind  of  the  outside  observer. 
I  mean  the  number  of  avowed  practitioners.  According 
to  a  homoeopathic  directory  published  in  1853,  there 
were  in  the  British  islands  178  qualified  practitioners  of 
homoeopathy.  In  1868,  fifteen  years  later,  there  were 
258,  which  number  gradually  increased  till  1874,  when 
there  were  278,  but  in  1890  the  latest  directory  available, 
256  names  only  appear  in  the  list. 

Consequently  we  are  face  to  face  with  these  facts : — 

First,  that  the  attitude  of  the  profession  towards 
homoeopathy  and  homoeopaths,  though  superficially 
altered,  is  not  materially  changed. 

Second,  that  the  appropriation  by  the  profession  of 
our  remedies  is  not  accompanied  by  the  absorption  of 
our  law,  and  its  effects  are  therefore  not  likely  to  be 
permanent. 

Third,  that  whilst  during  the  earlier  years  of  homcBO- 
pathy,  the  number  of  its  avowed  practitioners  steadily 
increased,  they  are  now  fewer  than  they  were  20  years 
ago.  Of  this  last  fact,  we  have  had  various  explanations ; 
but,  explain  how  we  will,  the  fact  remains.  j 

In  1874,  Dr.  Dudgeon,  in  the  address  from  which  I 
have  already  quoted,  told  his  hearers  that  '^  they  were 
not  to  look  for,  or  expect,  any  great  increase  of  the! 
number  of  the  avowed  followers  of  Hahnemann,  but) 
must  rest  content  with  the  assurance  that  the  principles^ 
of  homoeopathic  therapeutics  were  being  largely  adopted  i 
and  acted  on  by  nominal  adherents  of  the  old  school." 


^^^TSn^     ^TBR  TWENTY  YEARS.  613 

In  Btriking  contrast  we  have  the  direct  progress  of 
homoeopathy  in  the  United  States.  In  this  same  address^ 
Br.  Dadgeon  explains  the  reason  of  this  difference,  and 
attributes  it  a^aongst  other  things  to  the  fact  '*  that  we 
are  an  eminently  conservative  race,  and  to  the  concilia- 
tory and  non-aggressive  spirit  in  which  homceopathy  has 
always  been  advocated  by  its  professional  adherents  in 
this  country."  He  goes  on  to  say:  "While  the  new 
eonverts  of  the  United  States  come  out  of  the  old  ranks 
in  an  ostentatious  manner,  and  enrol  themselves  openly 
among  the  adherents  of  the  new  school,  our  new  converts 
remain  in  the  old  ranks,  and  are  careful  to  avoid  an 
^n  alliance,  with  what  is  still  denounced  as  a  heresy. 
'file  Bingers,  Harleys,  Wilks,  Thorogoods  and  Bumeses 
of  America  fill  chairs  in  the  homoeopathic  colleges ;  herci 
they  stick  to  the  old  craft,  and  are  rewarded  by  professor- 
ships, and  the  applause  of  orthodox  journalists." 

But  Dr.  Dudgeon  is  bound  to  confess  that,  at  that 
time,  the  nnmber  of  homoeopathic  practitioners  in  the 
United  States,  was  at  least  ten  times  that  of  the  number 
in  this  country.  This  disproportion  has  continued  to 
increase,  for  we  were  told  at  our  last  Congress  that  there 
were  at  least  14,000  practitioners  of  homoeopathy  in  the 
United  States,  and  from  a  return  I  have  recently  read, 
ont  of  the  total  number  of  87,487  students  who  have 
during  the  past  ten  years  graduated  in  medicine  in  the 
Unit^  States,  8,878,  equal  to  more  than  one-tenth  of 
the  whole  number,  graduated  at  homoeopathic  colleges. 

To  counterbalance  this  disproportionate  increase  in 
the  number  of  practitioners,  we  ought,  before  we  endorse 
the  difference  in  policy,  have  some  evidence  that  we  have 
gained  in  other  directions. 

But  from  what  I  can  understand,  the  attitude  of  the 
dominant  part  of  the  profession  towards  homoeopathy  is 
at  least  no  worse  than  in  this  country,  and  the  tendency 
to  use  oar  remedies  is  quite  as  great  there  as  here. 
Clonsequently,  on  the  three  grounds — the  modifying  of 
the  attitude  of  the  profession,  the  modifying  of  the 
general  practice  of  medicine,  and  the  direct  increase  in 
die  number  of  practitioners — the  balance  of  evidence  is 
strongly  in  favour  of  the  policy  which  has  been  pursued 
in  America.  But  in  what  does  this  difference  of  policy 
consiBt?  It  is,  I  believe,  simply  the  question  of  the 
relative  importance,  in  the  two  countries,  attached  to 


614  AFTER   TWENTY  YEARS.     ^^^.^^^ 

the  duty  owed  to  the  profession,  and  the  duty  owed  to 
the  public.  On  this  point  the  whole  matter  hinges.  Li 
America  they  may  not  have  paid  as  much  respect  to  the 
traditions  of  the  profession  as  they  might  have  done. 
It  may  be,  they  have  occasionally  been  led  into  regrettable 
extravagances  and  have  failed  to  preserve  that  intense 
respectability  on  which  we  so  much  pride  ourselves. 
But  the  results  obtained  would  justify  worse  means  than 
any  they  have  employed.  And  at  the  present  time  tiie 
homoeopathic  body  in  that  country  is  in  a  position  to 
command  respect,  and  to  influence  the  national  policy 
t^ith  regard  to  the  future  of  medicine. 

In  fields  other  than  that  of  medicine,  take  that  of 
politics  for  example,  we  are  not  content  to  be  told  that 
our  opponents  are  colom*ed  by  our  principles,  and  axe 
stealing  our  measures.  Before  we  accept  the  dictum 
that  our  cause  is  progressing,  we  require  to  see  aa 
increased  number  of  voters  at  the  poll,  an  increased 
number  of  representatives  in  the  House.  I  do  not 
believe  the  public  will  accept  as  satisfactory,  any  evidence 
of  the  growth  of  homoeopathy,  which  does  not  show  an 
increase  in  the  number  of  practitioners.  For  myself, 
I  am  not  content  with  this  lateral  development,  nor  am 
t  content  to  wait  much  longer,  with  baited  breath  and 
bended  knee,  for  an  invitation  to  return  to  the  ranks  of 
orthodox  medicine. 

Still,  perhaps,  in  this  opinion  I  may  be  singular,  and 
others  may  think  that  the  influence  and  teaching  of 
homoeopathy  have  so  thoroughly  and  permanently 
changed  the  general  practice  of  medicine,  that  its 
proglress  is  of  little  consequence,  and  that  there  is  little 
left  worth  fighting  for.  They  may  tell  me  that  during 
the  past  twenty  years,  medical  science  has  made  great 
strides — that  our  knowledge  of  the  causes  and  natural 
history  of  disease  has  so  increased  that  preventive 
medicine  has  become  a  perfect  art,  that  by  enforcements 
of  the  state  of  the  laws  of  hygiene  on  the  community, 
the  ravages  of  zymotic  diseases  have  been  greatly 
reduced,  and  the  public  health  generally  raised  to  a 
higher  standpoint  than  it  ever  before  occupied.  With 
all  this  I  agree — for  by  reference  to  the  Begistrar- 
General*8  Returns,  I  find  in  1869  the  deaths  from 
zymotic  disease  amounted  to  4,174  in  every  million. 


r 


SSSJ^JSTSmw^*   after  twenty  yeabs.  516 

whilst  in  1889  they  were  bat  2,184 ;  a  little  more  than 
half. 

A  great  improvement  surely,  mainly  due,  no  doubt,  to 
the  improvements  that  have  taken  place  in  sanitation 
and  preventive  medicine. 

If  it  should  be  said,  however,  that  some  at  least  of 
this  great  gain  is  owing  to  improved  medical  treatment, 
I  would  retort  that  if  so,  through  its  lateral  development, 
homoeopathy  may  fairly  lay  claim  to  a  share  of  the 
credit. 

But  though  in  1889  the  death-rate  from  scarlet-fever 
was  onl^  281  per  million,  as  against  1,244  in  1869 ; 
though  m  enteric  fever  it  was  but  173  as  against  890 ; 
in  whooping  cough  421  as  against  498  ;  in  measles  508 
as  against  464;  yet,  notwithstanding,  this  death  rate 
means  that  from  scarlet  fever  there  were  6,698  deaths  ; 
from  enteric  fever  5,011  deaths ;  from  whooping  cough 
12,225  deaths  ;  and  from  measles  14,782  deaths. 

I  know  not  how  these  figures  will  appear  to  you,  but 
they  seem  to  me  to  show  that  there  is  still  ample  neces- 
sity for  the  growth,  direct  or  laterally,  of  homceopathy. 

By  a  curious  coincidence,  in  the  21st  year  of  the 
renewal  of  our  annual  Congress,  I  have  just  completed 
my  21st  year  of  medical  practice,  and  with  this  death 
roll  in  my  mind,  it  struck  me  that  it  would  be  interesting 
to  review  the  army  of  martyrs  who  have  fallen  at  my 
hands. 

I  find  that  during  the  21  years  that  I  have  been  in 
practice,  I  have  certified  as  to  the  cause  of  death  in  810 
instances. 

The  number  of  cases  of  the  diseases  of  which  I  have 
placed  the  statistics  before  you  is : — 

Scarlet  Fever  8 

Enteric  Fever  8 

Diphtheria  4 

Whooping  Cough    18 
Measles  2 

Total— 80 
Whilst  preparing  this  address  I  have  received  a  letter 
from  a  well-known  colleague,  who  commenced  practice 
the  same  year  as  myself,  in  which  he  says :  ''  During  21 
years'  practice  I  have  not  lost  a  case  of  scarlet  fever, 
measles,  enteric  fever,  small  pox,  croup,  or  erysipelas. 


616  AFTER  TWENTY  YEARS.     ^SSSK 


B0¥iew,  Avg.  U  Ifltt* 


and  less  than  half  a  dozen  cases  of  diphtheria  out  of 
many  hundreds.  I  am  not  writing  this  boastfully  or 
egotistically,  but  with  a  pardonable  pride  that  onr 
homoeopathic  law  has  worked  oat  such  brilliant  results.'* 

I  take  these  records  to  be  no  better,  and  perhaps  no 
worse,  than  that  of  other  practitioners  of  homoeopathy ; 
but  when  I  see  that  in  London  alone,  since  the  Ist  of 
January  this  year,  there  have  been  265  deaths  from 
scarlet  fever,  846  from  measles,  and  1,225  from  whooping 
cough,  I  am  tempted  to  ask  myself  how  many  of  these 
lives  would  have  been  saved  had  the  general  practice  of 
medicine  in  this  country  been  based  on  the  benign  law 
of  similia  similibus  curentur. 

There  is  another  point  which  has  been  brought  very 
prominently  before  us  during  the  last  two  years,  and 
that  is,  the  great  advantage  the  homoeopath  has  over 
his  allopathic  brother  when  called  upon  to  treat  a  new 
disease. 

For  him,  it  is  not  necessary  to  wait  to  find  out  the 
exact  origin  or  pathology  of  the  disease  before  he  begins 
to  treat  his  patient.  The  adaptability  of  homoeopathy 
in  these  cases  is  an  old  tale,  dating  as  far  back  as  the 
founder  of  the  system.  Ton  have  all  heard  or  read  how 
Hahnemann  was  enabled  to  prescribe  for  cholera  from 
the  symptoms  before  he  had  seen  a  case  of  the  disease. 

In  the  recent  epidemics  of  what  has  been  caUed 
influenza  (which,  though  perhaps  not  a  new  disease,  was 
practically  a  new  experience  to  a  large  part  of  our  living 
medical  men) ,  the  homoeopath  was  enabled  at  once  to 
set  to  work  to  cure  his  patients. 

I  thought  it  would  be  interesting  to  members  of  this 
Oongress  to  hear  something  of  the  experience  of  the 
homoeopathic  practitioner  in  this  field.  With  this  end  in 
view  I  sent  a  circular  to  all  whose  names  appeared  in  the 
Horrweopathic  Directory  in  1889. 

I  fear  that  some  of  my  coUeagues  may  have  been  over- 
looked, but  if  so,  I  must  ask  them  to  accept  as  my  apology 
that  I  had  no  more  recent  record  to  rely  upon. 

To  my  circular  I  received  more  than  100  repUes,  and 
I  am  thus  enabled  to  place  before  you  the  following 
facts : — Out  of  the  total  number  20  had  kept  no  record 
of  the  number  of  their  cases,  but  stated,  in  most  in* 
stances,  that  they  had  attended  a  large  number.  The 
mortality  in  1890  of  these  20  practitioners  was  1  caee 


SSSSSTiSSTS^     AFTBR  TWBKTY  YEARS.  517 

only ;  in  1891,  6  cases ;  total  mortality  6.  From  82  men 
I  had  replies  giving  me  particulars  both  as  to  number  of 
cases  as  i^ell  as  the  mortality  in  both  years.  In  1890 
the  total  of  cases  was  6,889,  and  the  mortality  17.  In 
1891  the  total  number  of  cases  was  8,146,  and  the  mor- 
tality 56.  So  that,  taking  the  two  years  together,  we 
find  a  total  of  cases  14,986,  with  a  mortality  of  78,  or  at 
the  rate  of  one  death  to  every  205  cases  ;  and,  of  these 
losses,  15  are  stated  to  have  been  over  70  years  of  age. 
These  statistics  bear  out  the  general  idea  that  the  mor- 
tality of  the  present  year  is  greater  than  in  1890 — for  we 
find  that  whilst  in  1890  the  rate  was  1  in  402  cases,  this 
year  it  has  been  1  in  146. 

Forty-eight  practitioners  report  on  over  100  cases, 
and  58  were  fortunate  enough  to  treat  6,982  without  a 
death. 

From  two  of  our  older  colleagues  I  had  protests  against 
these  epidemics  being  called  influenza  ;  and  one  of  our 
most  promising  young  ones  expressed  his  opinion  that 
they  partook  much  more  of  the  nature  of  "  Dengue." 

Some  correspondents  were  kind  enough  to  send  me 
particulars  of  the  treatment  employed,  but  as  my  facts 
on  this  head  are  not  numerous,  I  do  not  intend  to  go 
into  that  part  of  the  subject,  only  remarking,  in  passing, 
that  six  or  eight  remedies  would  cover  nearly  all  their 
recommendations. 

There  was  a  curious  exception,  however.  One  prac- 
titioner sent  his  return,  but  did  not  wiah  his  figures 
inserted,  as  he  did  not  think  they  wonld  give  a  fair 
indication  of  the  results  of  homoeopathic  treatment. 
For,  he  said,  I  have  used  whatever  I  thought  would  do 
good.  Amongst  other  things,  antipyriney  antifehriney 
4piftitn^,  James^  powder,  carbonate  of  ammonia,  &c.  I 
agreed  with  this  gentleman,  and  excluded  his  figures. 
Perhaps  he  is  one  of  the  fruits  of  the  lateral  development 
of  homoeopathy. 

It  is  stated  in  the  text  books  that,  with  influenza, 
though  the  rate  of  mortality  is  small,  owing  to  its  wide 
distribution,  its  effect  on  the  death  rate  is  greater  than 
that  of  cholera.  The  latter  part  of  this  statement  is  fully 
borne  out  by  the  fact  that  between  the  first  week  of 
January  and  the  second  week  in  June,  influenza  killed 
exactly  2,000  persons  in  London,  and  probably  may  also 


518  AJ-TBR  TWENTY  TEAB8.     ^^gSriS^.^S^^w*! 

be  credited  with  the  increased  mortality  from  bronchitiB. 
aad  pneamonia  during  the  same  period.  For  whilst  in 
the  first  three  montha  of  the  year,  when  influenza  was 
scarcely  present,  the  mortality  from  these  diseases  did 
not  greatly  exceed  the  average  daring  the  month  of 
May  and  the  first  two  weeks  in  June,  when  inflaensa 
was  at  its  highest  point  (having  in  that  time  caused 
1,909  deaths),  we  find  from  bronchitis  there  were  1,919 
deaths,  and  from  pneumonia  1,187.  In  each  case  more 
than  double  the  average.  So  that  those  three  diseases, 
in.  six  weeks,  killed  in  London  5,015  persons. 

It  has  been  said  that  anything  can  be  proved  by 
statistics,  a  statement  generally  made  by  the  persons  they, 
tell  against ;  but  as  I  have  nat  any  reliable  information 
as  to  the  mortality  under  allopathic  treatment,  I  leave 
these  figures  to  tell  their  own  tale,  simply  remarking,  if 
the  allopathic  percentage  is  as  good  as  ours,  the  distri- 
bution of  the  disease  must  have  been  wide  indeed  to 
account  for  so  large  a  mortality. 

In  this  matter  of  collection  of  statistics,  a  useful  work 
would  be  done  if  the  British  Homoeopathic  Society 
would  take  up  the  question,  obtain  from  its  members  a 
return  of  all  cases  of  zymotic  disease  occurring  in  their 
practice,  with  the  mortality  ensuing.  If  these  results 
were  published  annually  as  the  record  of  the  experience 
of  the  members  of  that  society,  they  would  form  a 
standing  protest  against  the  ordinary  mortality  from 
these  diseases.  I  am  aware  that  a  scheme  somewhat  on 
these  lines  was  set  on  foot  by  the  Monthly  Homoeopathic 
lieviewy  but  from  what  I  could  gather  the  idea  was  to 
gain  scientific  information  for  the  use  of  the  profession. 
What  I  suggest  is  for  use  more  as  an  argument  for  the 
conversion  of  the  public. 

And  now  I  would  have  you  think  out  what  importance 
the  facts,  which  may  be  deduced  from  the  figures  I  have 
laid  before  you,  have  for  the  community. 

If  it  is  a  true  inference  that  in  most  diseases  the  use 
of  drugs  on  the  principle  of  similia  8imilibu9  curentur 
diminishes  to  a  certain  extent  the  mortality;  if,  in 
addition  to  that,  it  shortens  the  time  of  illness  and 
convalescence,  it  is  surely  a  matter  of  grave  importance 
that  those  adviantages  should  be  secured  to  the  largest 
degree  possible. 


M^XtS^rSn^     AFTEB  TWENTY'  YEARS.  619 

And  I  wish  for  a  abort  time  to  forget  that  we  are  medi- 
cal men,  and  look  at  these  facts  as  citizens.  Every  human 
Hfe  lost  before  it  has  contribated  its  quota  to  the  general 
well-beingy  is  so  much 'wasted  effort ;  and  it  is  not  merely 
this  waste  of  life,  and  the  loss  of  the  results  those  lives 
would  have  produced  had  they  been  prolonged ;  but 
there  is  also  the  infinitely  larger  quantity  of  damaged 
lives,  which  just  survive  after  long  periods  of  illness^ 
many  never  able  again  to  take  their  full  part  in  life's 
struggle,  Therefore  it  is  a  matter  not  concerning  the 
profession  alone,  but  of  the  greatest  importance,  that 
homceopathy  should  continue  to  increase ;  and  in 
discussing  the  means  to  be  adopted  for  renewing  ita 
growth,  we  must  not  be  guided  only  by  our  duty  to  the 
profession,  but  must  distinctly  remember  we  owe  a  larger 
dnty  to  our  fellow  citizens.  It  is  in  view  of  this  greater 
duty  that  I  urge  upon  you  to  see  that  nothing  is  wanting 
on  your  part  to  help  its  promulgation. 

I  shall  plead  in  vain  unless  you  are  convinced  that  in 
the  law  of  similars  there  rests  a  power  to  control  these 
lavages  of  disease  ;  that  it  is  not  simply  a  slight  thing 
to  be  used  now  and  then,  but  one  which  (with  few 
exceptions,  and  those  mostly  owing  to  our  owu 
incomplete  knowledge)  should  be  the  controlling  and 
directing  influence  of  our  practice. 

To  the  older  practitioners  this  was  distinctly  so,  and 
continues  moie  or  less  the  case  amongst  them  to  the 
present  day  ;  but  I  am  afraid  there  are  some  dilettante 
practitioners  who  fail  to  recognise  the  seriousness  of  thia 
matter;  who  consider  the  spread  of  homoeopathy  a 
small  incident  and  not  the  main  object  of  their  life's 
work. 

In  the  earlier  days  of  homoeopathy  its  progress  waa 
much  more  rapid  than  it  has  been  of  late  years,  owing, 
I  believe,  to  the  more  active  propagandism  which 
characterised  that  time.  Most  of  the  earlier  practitioners 
who  had  accepted  the  doctrine  of  Hahnemann  were 
animated  by  the  spirit  and  the  desire  expressed  in  the 
words,  ''It  is  our  wish  to  extend  the  knowledge  of 
homoeopathy  from  city  to  town,  and  from  town  to  village. 
We  wish  our  doctrine  to  reach  alike  the  palace  and  the 
lordly  hall,  the  mansion  of  the  rich,  the  modest  home 
of  the  tradesman  or  mechanic,  and  the  cottage  of  the 


520  AFTER  TWENTY  YEARS.     ^S±l^%??!2d! 


Befiew,Ai«.l«Utt. 


poor.  We  call  upon  all  to  look  to  the  diffusion  of 
homoeopathy  as  the  thing  to  be  effected.  Whatever  maj 
be  a  hindrance  to  this  must  be  overcome,  passed  by,  or 
leaped  over.  In  a  battle,  whether  by  sea  or  land,  all 
personal  feelings  are  merged  in  the  contest,  the  victory 
is  the  thing  looked  at.  If  this  be  the  case  in  a  quarrel 
between  princes  or  states,  when  war  is  the  result  of  folly 
or  madness,  or  some  base  passion,  how  much  more  does 
it  apply  to  those  who  contend  for  what  they  believe  to 
be  a  great  truth." 

It  was  in  this  spirit  that  Curie  lectured,  that  John 
Epps  lectured  and  wrote.  It  was  in  this  spirit  that  the 
•earlier  tract  literature  was  written  and  given  to  the 
world.  Men  at  that  time  did  not  limit  their  appeals  to 
the  profession,  and  as  a  consequence,  conversions  were 
numerous,  and  it  required  no  arguments  to  show  that 
progress  was  made. 

It  may  be  somewhat  a  cant  phrase  to  speak  of  the 
^*  spirit  of  the  age,"  but  no  one  can  be  observant  of  the 
things  passing  around  him  without  being  convinced  that 
there  is  a  spirit  of  unrest  and  change  pervading  all 
sections  of  society  and  all  forms  of  thought.  Old  well- 
-established beliefs  are  being  re-tested,  old  institutions 
reformed  in  all  directions,  and  perhaps  the  most  difficult 
thing  of  all,  old  conventionalities  of  society  are  being 
disregarded  and  swept  away.  This  spirit  has  invaded 
the  sacred  precincts  of  the  learned  professions,  and  the 
intolerance  of  the  public  of  class  privileges  is  getting  day 
by  day  more  and  more  pronounced. 

With  the  spread  of  public  education — whether  in 
theology,  or  law,  or  physic — its  professors  find  their 
superiority  no  longer  admitted  without  question.  The 
magic  letters  after  a  man's  name  have  lost  their  charm, 
iind  even  the  golden-headed  cane,  or  the  white  necker- 
chief, fail  to  inspire  reverence.  The  priest,  the  lawyer, 
or  the  doctor,  must  now  retain  his  superiority  by  greater 
knowledge,  or  not  at  all.  I  am  not  prepared  to  say  that 
this  change  is  all  for  the  better.  A  little  knowledge,  we 
are  told,  is  a  dangerous  thing,  and  many  a  proverb 
■describes  in  unflattering  terms  the  man  who  attempts  to 
be  his  own  professional  adviser.  But  that  this  is  the 
-condition  of  things,  and  that  it  will  go  on  increasing,  I 
3.m  convinced.    And  what  I  now  ask  is.  How  can  we 


SSSf  A^tlS^      APTBB  TWENTY  YBAR8.  621 

Qtilise  this  spirit  for  oar  great  work  ?  In  other  words^ 
How  can  we  make  the  pablic  and  the  profession 
eo- workers  ? 

When  the  weapons  of  abuse  and  vulgar  railings  were 
found  useless  in  the  hands  of  our  opponents,  they  re- 
placed them  with  the  more  subtle  and  cruel  innuendo ; 
unable  to  deny,  or  disprove,  the  claims  of  homoBopathy, 
they  launched  against  its  practitioners  the  charge  that 
they  were  guilty  of  a  breach  of  professional  etiquette ;  that 
they  owed  their  successes  in  practice  to  the  fact  that  they 
assumed  the  distinctive  title  of  homoeopath ;  that,  in 
short,  they  were  trading  on  a  name.  The  charge  was 
false,  but  like  many  other  false  charges  it  wrought 
woeful  mischief.  For,  as  I  have  already  pointed  out, 
there  has  always  been  amongst  our  men  a  longing  for 
union,  a  desire  so  strong  that  it  has  almost  become 
morbid,  that  there  should  cease  to  be  two  camps  in 
medicine.  Consequently,  there  ensued  an  effort  to  re- 
move even  the  faintest  semblance  of  foundation  for  this 
charge. 

Propositions  were  made  that  the  name  of  homoeopathy 
should  be  dropped,  that  the  distinctive  title  should  be 
blotted  out  from  our  societies,  our  hospitals,  our  dispen- 
saries, our  journals.  With  this  end  in  view,  men  with- 
drew from  the  British  Homoeopathic  Society,  and  refused 
to  allow  their  names  to  appear  in  our  special  directories. 
This  trading  upon  a  name  is  but  another  view  of  the 
question  to  what  extent  a  professional  man  is  justified 
in  giving  the  public  the  information  that  he  is  possessed 
of  special  knowledge,  or  follows  in  his  practice  a  special 
line  of  treatment.  The  question  has  always  been  a 
difficult  one,  but  the  difficulty  is  not  confined  to  the 
homoeopathic  body*  The  etiquette  which  forbids  the 
medical  practitioner  adopting  the  modes  of  advertising 
usual  in  commerce  is  good,  as  far  as  it  restrains  the 
profession  from  using  these  means  of  publicity  for 
personal  advantage.  But  it  is  continually  evaded  among 
the  so-called  orthodox,  for  being  denied  the  straight- 
forward means  of  direct  statement,  they  have  been 
driven  to  underhand  means  to  attain  their  end,  such  as 
starting  specialist  societies ;  writing  specialist  articles 
in  pubUc  and  in  medical  journals  ;  publishing  on  their 
specialities  unnecessary  books,  which  uniformly  contain 


522  .AFTER  TWENTY  YEARS,     ^l^l^^!'^!^ 

their  names  and  full  addresses ;  starting  specialist 
hospitals  and.  dispensaries  with  which  their  names  are 
pablicly  connected.  I  do  not  say  that  the  specialist 
should  attach  to  his  name  words,  such  as  oculist,  gynsB- 
cologist,  dermatologist,  &c.,  but  it  seems  to  me  that  mea 
who  honestly  adopted  this  alternative  would  occupy  a 
higher  moral  plane  than  those  who  use  the  subterfuges 
which  I  have  described,  and  that  for  a  profession,  in 
which  such  practices  are  common,  to  charge  the  homoeo- 
path with  trading  on  a  name  is  as  comic  as  the  '^DevU 
reproving  sin." 

In  this  question  of  special  directories  I  think  those 
men  who,  practising  homoeopathy  and  beUeving  in  its 
truth,  yet  refuse  to  allow  their  names  to  appear  in  such 
publications,  have  by  such  action  clearly  put  their 
supposed  duty  to  the  profession  before  their  real  duty 
to  the  community  at  large.  For  were  these  directories 
to  cease  to  exist,  what  means  would  remain  for  the  public 
to  discover  what  medical  men  there  were  who  practised 
according  to  the  law  of  similia  mnilihus  eurentur  ?  and  I 
hold  distinctly  that  the  public  have  a  right  to  that  infor- 
mation. It  is  true  that,  to  a  slight  extent,  this  difficulty 
has  been  met  by  the  general  directories  inserting  homceo- 
pathic  literature  and  homoeopathic  appointments.  Bat 
we  do  not  all  hold  appointments,  nor,  fortunately,  do  we 
all  write  books.  I  have  previously  alluded  to  one  incon- 
venience to  which  I  myself  have  been  subjected  by  the 
non-issue  of  a  homoeopathic  directory  since  1889,  and  a 
timely  reminder  has  since  been  given  by  the  fact  that  a 
homoeopathic  practitioner  failed  to  receive  an  invitation 
to  this  Congress  in  consequence  of  the  accidental  omission 
of  his  name  from  that  very  directory.  It  is  a  matter  of 
daily  occurrence  with  all  of  us,  that  patients  are  com- 
pelled to  change  the  locality  of  their  residences,  either 
permanently  or  temporarily,  and  one  of  the  questions  we 
have  continually  to  answer  is  "  What  doctor  shall  I  go 
to  if  I  need  one  ?  "  Without  our  special  directory  how 
are  we  to  give  this  (in  some  cases)  vital  information  ? 
Hitherto  these  directories  have  been  trade  speculations 
of  various  chemists,  and  I  think  we  owe  them  a  debt  of 
gratitude  for  what  they  have  done  in  the  past.  But  we 
ought  not  to  be  dependent  on  the  question  whether  these 
*^ade  speculations  can  be  made  to  pay  for  the  con- 

mance  of  our  directories.    There  should  be  an  official 


SSS^SST'^*'     AFTBB   TWENTY  YEARS.  628 


Beriow,  Xng.  1, 1891. 


record,  and  for  this  we  need  no  new  association  or  reform 
union.  It  is  a  duty  which,  in  my  opinion,  the  British 
Homoeopathic  Society  might  well  take  up. 

How  are  we  to  increase  the  spread  of  homoeopathy 
among  the  public  ?  We  shall  only  do  it  by  reviving  the 
missionary  spirit  to  which  I  have  before  alluded. 

Five  years  ago  an  effort  in  this  direction  was  made, 
which  resulted  in  the  formation  of  the  Homoeopathic 
League,  which  has  since  that  time  done  considerable 
work  by  the  circulation  of  tracts,  and  by  the  provision 
(in  one  instance,  at  any  rate),  of  a  lecture  on  homoeo- 
pathy, but  even  in  this  effort  this  spirit  of  professional- 
ism has  had  some  influence,  and  it  has  been  insinuated, 
if  not  openly  asserted,  that  it  would  be  a  breach  of 
etiquette  for  a  practitioner  to  be  openly  connected  with 
this  movement.  Even  one  of  the  most  robust  homoeo- 
paths amongst  us  considered  it  might  well  be  left  to  the 
laity  themselves,  as  they  were  strong  enough  and 
advanced  enough,  with  the  helps  afforded  by  our  serial 
literature,  to  carry  on  the  work  successfully.  I  believe 
that  this  excessive  professionalism  has  crippled  and  con- 
siderably hindered  the  work  of  this  useful  body,  and 
would  have  done  so  even  more  but  for  the  fact  that  it 
had  amongst  its  professional  members  a  man  willing  and 
able  to  provide  the  admirable  succession  of  tracts  which 
it  has  issued. 

Here,  as  elsewhere,  to  obtain  the  best  results,  the 
public  and  the  profession  must  work  hand  in  hand.  And 
I  would  suggest,  especially  to  my  colleagues  in  country 
towns,  the  i^visability  of  utilising  the  resources  of  the 
league  in  the  delivery  of  popular  lectures  on  the  subject 
of  homoeopathy. 

But  though  this  activity  is  necessary  for  the  spread  of 
homoeopathy  among  the  public,  yet  I  quite  agree  with 
what  was  stated  in  1879,  ''  that  the  number  of  persons- 
in  this  country  who  prefer  homoeopathic  treatment  is 
immense,  far  exceeding  the  supply  of  practitioners  who 
can  give  it  them,  and  only  waiting  the  multiplication  of 
these  to  increase  at  a  still  greater  rate."  And  this  brings 
me  to  the  second  and  more  important  part  of  the  subject 
the  necessity  of  increasing  the  number  of  homoeopathic 
practitioners.  I  say  the  more  important  part,  for  it 
seems  to  me  to  be  a  senseless  and  almost  cruel  policy  to 


624  AFTER  TWENTY  YEARS.     ^'SSSrfSSITuS! 

increase  the  namber  of  believers,  withoat  at  the  same 
time  furnishing  them  with  the  opportunities  of  puttiog 
their  beliefs  to  a  practical  use. 

The  hindrances  in^hich  obtained  twenty  years  since  to 
the  medical  student  studying  homceopathy,  with  few 
exceptions,  obtain  still.  He  must  relinquish  the  hope  of 
appointments  and  the  emoluments  of  the  profession. 
He  is  still  generally  excluded  from  the  medical  societies, 
or  if  perchance  he  becomes  a  member,  remains  there  on 
sufferance  only.  Nor  is  there  as  much  to  tempt  him  in 
the  loaves  and  fishes  of  the  new  school  as  there  was, 
perhaps,  in  its  earlier  days. 

But  the  great  reason  why  we  fail  to  get  converts  from 
the  medical  students  is,  that  hitherto  vte  have  not  been 
able  to  give  them  sufficient  advantages  in  the  way  of 
instruction  to  compensate  them  for  what  they  wonld 
have  to  relinquish. 

To  furnish  this  desideratum,  since  homoeopathy  was 
introduced  into  this  country,  several  eflforts  have  been 
made. 

In  the  early  days  lectures  were  delivered  at  the  Golden 
Square  Hospital  to  medical  men  and  medical  students, 
and  at  various  times  also  special  lectures  have  been 
given  at  the  London  Homoeopathic  Hospital.  But  the 
greatest  attempt  in  this  direction .  was  the  scheme 
initiated  by  Dr.  Bayes,  in  1875,  in  founding  the  London 
School  of  Homoeopathy.  It  was  a  great  effort.  It  was 
well  supported  at  the  beginning,  both  by  the  public  and 
the  profession.  Admirable  lectures  were  delivered  by 
most  competent  men,  and  in  that  school  some  of  the 
younger  ones  amongst  us  learnt  most  of  their  homoeo- 
pathy. 

It  was  an  effort  that  deserved  success,  but  like  previous 
attempts  it  failed  in  its  most  necessary  element — ^the 
power  to  attract  students — so  that,  after  a  few  years  of 
waning  strength,  it  fell  into  a  state  of  coma,  waking  now 
and  then  to  give  utterance  to  intermittent  lectures,  and 
then  resuming  its  attitude  of  suspended  animation. 
Why  did  that  school,  like  its  predecessors,  fail  ?  Because 
it  had  the  radical  fault  that  it  was  neither  a  complete 
school  of  medicine,  nor  had  it  the  power  of  conferring  a 
diploma. 

Dr-  Bayes  was  quite  alive  to  these  two  weak  points, 
and  it  was  his  hope  and  ambition  to  found  a  complete 


r 


SSSf^jMTS^**    AFTER   TWENTY  YEARS.  525 

medical  school,  with  power  to  grant  a  diploma ;  but  he 
foimd  that  in  the  then  condition  of  things,  a  complete 
medical  school  was  impossible,  partly  owing  to  the  size 
of  the  hospital.  And  he  wisely  or  unwisely  attempted 
to  attach  to  the  school  the  power  of  giving  a  diploma  to 
qualified  men  who  attended  the  lectures  and  passed  an 
examination  in  the  theory  and  practice  of  homoeopathy. 

In  this  idea  he  was  opposed  by  some  of  his  most 
worthy  and  valued  colleagues,  who,  from  past  experience, 
prophesied  failure,  and  perhaps  in  some  degree  helped 
the  fulfilment  of  their  prophecy. 

It  is  reported  of  Napoleon  I.  that  he  said,  "If  you 
want  soldiers  you  must  breed  them,*'  so  I  say,  if  you 
want  practitioners  of  homoeopathy  you  must  educate 
them  ;  and  as  we  have  learnt  by  past  experience  that  it 
is  of  little  use  to  attempt  to  do  this  by  providing  them 
with  extra  academical  or  extra  professional  lectures — 
lectures  which  they  must  attend  in  addition  to  their 
ordinary  curriculum — it  follows  that  the  only  alternative 
is  that  we  must  have  a  complete  medical  school  in  which 
students  may  be  educated,  not  simply  in  the  theory  and 
practice  of  the  orthodox  school,  but  imbued  from  the 
veiy  beginning  of  their  career  with  that  better  knowledge 
of  tiierapeutics  which  we  owe  to  Samuel  Hahnemann. 

That  which  was  impossible  in  1875  may  prove  to  be 
within  our  reach  in  1891.  We  are  now  within  a 
measurable  distance  of  having  a  hospital  large  enough 
to  qualify  it  for  a  school  of  medicine,  and  I  must  strongly 
support  Dr.  Garfrae,  who,  in  his  address  to  the  British 
Homoeopathic  Society,  brought  this  matter  prominently 
before  them. 

I  consider,  therefore,  not  only  for  the  benefits  the 
hospital  will  confer  upon  the  sick  poor,  but  from  this 
necessity  for  a  school,  that  the  duty  which  lies  nearest 
to  us  at  the  present  moment  is  to  help  forward  to  the 
fall  extent  of  our  powers  this  scheme  for  its  enlargement. 
And  I  would  urge  on  those  who  have  the  rebuilding  of 
the  hospital  in  hand  to  keep  this  side  of  the  question  in 
remembrance.  Not  to  build  with  the  word  **  fiinality  " 
in  their  minds,  but  so  to  biiild  that  they  may  in  the 
fature  still  further  enlarge  it,  rendering  it  not  only 
<Sapable  of  giving  aiccommbdation  to  the  increase  of 
patients  which  will  surely  come  to  it>  but  of  making  it 

Vol.  35,  No.  8.  2  p 


626  APTEB  TWENTY  TEAB8.     ^S^^SSTm. 

a  worthy  and  a  fitting  home  for  a  medical  school,  m 
which  shall  be  trained  the  rising  generation,  sons  of 
homoeopaths,  both  medical  and  lay,  who,  relieved  from 
the  inconveniences,  the  injustices,  and  the  temptations 
their  fathers  have  bad  to  endure,  may  be  trusted  to 
worthily  uphold  the  cause  of  truth  and  progress  in 
medicine. 

In  establishing  such  a  school  as  we  have  been  speak- 
ing of,  there  enters  of  necessity  the  question  whether  or 
not  it  should  have  the  power  of  granting  a  diploma. 
Theoretically,  I  am  of  opinion  that  no  teaching  institu- 
tion should  be  also  an  examining  or  qualifying  body. 
Had  we  a  State  examination,  with  examiners  paid  by 
the  State  and  debarred  from  private  practice — if  thifl 
examination  were  thorough,  including  as  an  integral 
part  of  it  the  knowledge  of  homoeopathy — ^we  should  be 
the  first  to  recognise  and  admit  that  there  was  no 
necessity  for  any  school  granting  a  diploma.  But  whilst 
the  qualifying  power  is  entirely  in  the  hands  of  our 
opponents,  whilst  the  examiners  are  more  or  less  con- 
nected with  the  various  teaching  bodies,  and  candidates 
must  furnish  certificates  that  they  have  studied  a  certain 
number  of  years  in  a  recognised  school  of  medicine,  I 
am  afraid  it  is  more  than  possible  that  students  pre- 
senting certificates  from  our  school  would  be  heavily 
handicapped  in  the  race  for  a  legal  qualification,  but  we 
may  make  the  experiment,  and  if  we  find  that  our 
students  are  unfairly  treated,  then  I  think  we  most 
brave  the  law  and  grant  diplomas,  trusting  to  the  holders 
thereof  by  their  conduct  and  by  their  numbers  to  force 
the  State  to  give  them  legal  validity. 

For  many  years  it  has  been  in  my  mind  that  there 
was  one  way  in  which  my  Metropolitan  colleagues  might 
help  the  hospital  in  addition  to  begging  for  it.  I  mean 
by  the  establishing  of  local  dispensaries.  This  idea 
was  somewhat  discussed  in  a  paper  read  by  Dr.  Hay  ward, 
at  the  Leicester  Congress  in  1878,  and  it  also  came 
before  the  Board  of  the  Homoeopathic  Hospital  in  1886, 
when  a  scheme  was  propounded,  of  which  Mr.  Cross,  the 
excellent  secretary  manager,  has  kindly  given  me  the 
heads. 

There  are  points  of  ifference  in  principle  between  this 
scheme  and  that  whic    has  been  maturing  in  my  niind» 


S!S?[JSri!wS?**     AFTBB  TWENTY  YEARS,  627 

and  naturally,  perhaps,  I  prefer  my  own.  Mr.  Gross's 
scheme  was  to  establish  local  branches  of  the  hospital 
for  ont-patients. 

1.  Such  branches  in  densely  populated  parts  of 
London  to  be  established  under  the  title  London 
Homoeopathic  Hospital. 

wSl^^     I     Ont-patient  Branch. 

2.  The  central  mani^ement  to  rest  with  Central 
Board. 

3.  Local  committee  to  be  formed  to  collect  subscrip- 
tions  and  recommend  improvements  and  developments. 

4.  The  medical  staff  of  each  branch  to  be  appointed 
by  the  central  authority,  and  to  form  part  of  the  medical 
staff  attached  to  the  hospital  (of  course  the  local  men 
would  be  the  most  eligible). 

6.  The  patient  to  pay  a  registration  fee,  except  when 
recommended  by  a  subscriber. 

6.  The  expenses  to  be  paid  out  of  the  subscriptions 
and  registration  fees. 

7.  The  surplus,  if  any,  to  be  applicable — 

a.  For  a  contribution  to  the  central  hospital  in  Great 
Qrmond  Street. 

h.  For  honoraria  to  the  medical  staff  of  the  branch. 

From  these  headings  it  is  clear  that  centralisation  was 
to  be  a  leading  feature  of  this  scheme,  and  this  I  think 
was  a  mistake.  What  I  would  rather  propose  is  that  the 
homcBopathic  practitioners  in  different  neighbourhoods 
should  join  together  and  initiate  local  public  dispensaries. 
I  say  initiate,  for  I  am  convinced  that  in  this,  as  in 
other  movements  for  the  spread  of  homoeopathy,  the 
first  steps  must  be  taken  by  the  profession,  but,  for  the 
continuance  and  support  of  the  scheme,  they  should 
endeavour  to  form  a  committee  from  amongst  their 
patients,  which  committee  should  have  afterwards  the 
fall  control  and  management  of  the  dispensary.  On  this 
map  which  you  see  before  you,  I  have  indicated  by  the 
red  spots,  the  location  of  all  homoeopathic  practitioners 
known  to  me  in  London  and  the  suburbs,  and  by  group- 
ing  them  somewhat  in  the  manner  I  have  indicated  by 
file  coloured  lines,  you  will  understand,  if  the  local  men 

2p  — 2 


628  AFTER  TWENTY  YBAB8.     ^^S2l^^ft!S*ffl! 


Beview,  Anf^l,  UH. 


co-operate,  we  might  easfly  sustain  five  or  six  such 
dispensaries  in  connection  with,  bat  independent  of,  the 
Homoeopathic  Hospital.  By  some  such  plan  as  this, 
local  men,  whose  distance  from  the  hospital  prevents 
their  accepting  posts  on  its  staff,  would  still  be  able  to 
do  good  work  amongst  the  poor  in  their  own  neighbonr- 
hood.  For  thoagh  I  haye  not  stated  the  fact,  the 
inference  is  plain,  that  I  intend  each  dispensary  to  be 
officered  by  the  local  medical  men.  The  necessary  funds 
would  be  furnished  by  subscriptions  and  by  a  registra- 
tion fee,  not  large  enough  to  be  burdensome  to  any  bat 
the  yery  poor,  in  whose  case  the  fee  might  be  remitted 
at  the  discretion  of  the  medical  officer  or  on  the  recom- 
mendation of  a  subscriber. 

Of  course  I  know  many  practitioners  haye  already 
private  dispensarieB.  I  have  myself  worked  one  for  the 
last  20  years.  But  I  do  not  think  any  fear  need  be  felt 
that  these  public  dispensaries  would  in  any  way  interfere 
with  them,  for  they  would  appeal  to  a  lower  stratum 
than  that  from  which  the  priyate  dispensary  draws  its 
patients. 

Any  surplus  of  funds  would  be  sent  as  a  subscription 
to  the  hospital,  and  I  belieye  in  most  cases  there  would 
be  sufficient  to  entitle  the  medical  officers  to  send  in 
cases  which  they  should  consider  suitable  for  hospital 
treatment.  The  adyantages  that  would  be  deriyed  if 
this  scheme  were  carried  out  would  be  felt  in  three 
directions. 

In  the  first  place,  the  poor  (who  are  by  no  means  the 
least  appreciatiye  of  the  benefits  of  homoeopathy)  would 
haye  an  altematiye  at  their  own  doors  giyen  them  to  the 
present  allopathic  dispensaries. 

The  medical  officers  would  get  a  wider  range  of  prac* 
tice,  and  thereby  gain  knowledge ;  they  would  also  be 
brought  a  little  more  in  touch  with  each  *  other,  and 
cease  to  be  such  isolated  atoms,  as  many  of  them  now 
are. 

The  hospital  would  gain  in  funds,  for  I  do  not  think 
the  establishment  of  dispensaries  would  lessen  its  list  of 
subscriptions.  It  would  gain  also  by  haying  sent  into 
its  wards  cases  more  suitable  for  hospital  treatment  than 
any  hospital  depending  in  a  great  measure  on  the  recom- 
mendation of  subscribers  for  patients  can  hope  to  secure, 
and  here  I  would  make  an  appeal  to  the  subscribers  to 


SS^^TTSS!^     AFTER  TWENTY  YEARS.  629 

the  hospital,  with  regard  to  the  patients  they  recom- 
mend, that  they  shoold  not  send  in  trivial  cases,  or  cases 
that  only  require  rest  and  nursing.  It  is  true  the  house- 
sorgeon  has  the  power  of  refusing  unsuitable  cases ;  but 
it  is  not  fair  to  put  him  in  the  position  of  risking  offend- 
ing an  influential  patron  because  he  thinks  the  case 
miBuitable.  I  have  said  cases  better  suited  for  hospital 
treatment,  but  I  would  add  also  for  clinical  instruction ; 
and  if  we  are  to  have  a  medical  school,  that  will  be  a 
most  important  point. 

I  commend  this  idea  of  local  public  dispensaries  to  the 
hvourable  consideration  of  my  Metropolitan  colleagues* 

In  all  the  suggestions  that  I  have  made  to  you  I  have 
tried  to  keep  in  mind  the  cardinal  principle  of  the 
co-working  of  the  public  and  the  profession  ;  and,  if  in 
80  doing  I  have  seemed  to  cast  some  contempt  upon  pro* 
fessional  etiquette,  it  is  not  that  I  have  no  respect  for 
the  injunctions  of  that  code,  but  that  I  feel  that  those 
injunctions  must  give  way  when  they  conflict  with  the 
higher  duty  which  we  owe  to  the  public.  There  is  one 
of  those  injunctions  with  which  I  am  in  complete 
sympathy,  and  that  is  the  one  which  forbids  professional 
men  holding  or  using  secret  remedies.  For  when  they 
disobey  this  injunction  they  are  not  simply  violating  the 
laws  of  medical  etiquette,  but  they  are  failing  in  their 
duty  to  humanity ;  and  in  connection  with  this  part  of 
the  subject  I  would  speak  of  what  some  would  consider  a 
comparatively  small  matter,  and  that  is  the  practice 
porsued  by  some  bomoBopathic  chemists  of  putting  up  as 
secret  remedies  what  they  call  homoeopathic  specincs, 
which  is  a  description  both  untrue  and  misleading.  The 
result  of  such  practices  is  that  the  purchaser,  being,  as 
he  often  must  be,  disappointed  in  the  results  of  these 
quack  remedies,  goes  away  and  says  "he  has  tried 
homoeopathy  and  it  has  failed."  In  the  co-operation  of 
the  public  and  the  profession  in  this  matter  of  homoeo- 
pathy, it  is  essentiid  that  they  should  both  keep  their 
hands  free  from  quackery,  and  it  is  no  less  essential  that 
the  link  connecting  them,  the  homoeopathic  chemist, 
should  remember  that  he  also  has  his  part  to  play  in 
this  great  cause. 

Gentlemen,  I  have  said  that  the  tendency  of  the  times 
in  which  we  live  is  rather  to  diminish  than  increase 
class  privileges  and  the  power  of  close  corporations,  but 


580  AFTER   TWENTY  YEARS.     *'SSl^'!ST!2?' 


Beriew,  Aug.  1«  un. 


though  it  is  an  age,  democratic — ^revolutionary,  if  yon 
will — it  is  also  an  age  of  dreams  and  ideals.  And,  after 
looking  back  twenty  years,  if  we  have  the  temerity  to  try 
and  forecast  what  may  be  the  results  of  a  change  of 
policy  in  the  homoeopathic  body,  we  shall  not  be  withoat 
good  examples  in  other  fields.  It  is  a  safe  advice  of  the 
American  that  you  should  not  prophesy  unless  yoa 
know,  but  I  cannot  help  feeling  that,  with  an  increasing 
responsibility  for  human  life,  that  with  the  knowledge 
forced  upon  us  that  though  we  are  professional  men  ure 
have  not  ceased  to  be  citizens,  getting  rid  of  some  of  this 
professionalism  that  has  bark-bound  us  so  long,  we  shall 
make  an  intense  effort  to  supply  the  great  need  of  our 
time,  and  if  we  put  our  hearts  and  souls  into  that  effort 
we  shall  succeed  ;  and  I  see  in  the  future  not  simply  one 
medical  school  attached  to  this  hospital,  educating 
students  in  the  best  methods  of  therapeutics,  but  similar 
schools  at  Liverpool,  at  Birmingham,  at  Manchester,  and 
other  great  centres  of  population,  each  doing  its  part, 
and  doing  it  well,  by  sending  forth,  year  by  year,  men 
thoroughly  qualified  in  every  respect  to  practice  medicine. 
I  see  the  men  of  the  homoeopathic  school  still  pursuing 
the  noble  course  that  they  have  so  long  held,  increasing 
and  perfecting  our  knowledge  of  the  materia  medica,  and 
the  best  way  to  apply  it ;  but  no  longer  in  the  position 
of  providing  perfect  weapons,  and  having  no  soldiers  to 
use  them.  I  see  the  profession  generally  so  influenced 
by  force  of  numbers  that  it  is  compelled  by  public  opinion 
to  admit  the  equality  of  the  homoeopathic  practitioner. 
Then  with  the  still  increasing  knowledge  of  the  history 
of  disease  and  the  laws  of  health,  with  this  perfected 
power  in  therapeutics,  the  millennium  of  medicine  will 
not  be  far  distant,  when  a  premature  death  will  be  as 
great  a  scandal  to  society  as  a  case  of  starvation  is  now. 
This  may  be  an  ideal,  this  maybe  a  dream ;  but  remem- 
ber that  the  dreams  of  to-day  are  the  reaUties  of 
to-morrow,  and  if  we,  utilising  our  opportunities,  help  to 
the  best  of  our  powers  the  advent  of  this  time,  we  may 
with  a  clear  conscience,  when  the  time  comes  for  us  to 
lay  down  our  work,  say,  We  have  done  our  duty  as 
physicians,  we  have  done  our  duty  as  citizens,  we  have 
don«  our  duty  as  men.  "  I  have  gathered  a  posie  of 
other  men's  flowers,  and  nothing  but  the  thread  that 
binds  them  is  my  own." 


fiSa^Sfr?!^  OVARIOTOMY.  681 


BMiav,  Aug.  1, 1891 


OVARIOTOMY  AT  THE  BRITISH  HOMEOPATHIC 

CONGRESS  MEETING. 

July,  1891. 

Bt  G.  H.  Bubfobd,  M.B. 

A.  B.,  aet.  28,  was  sent  from  Eastbourne  by  Dr.  Croucher, 
for  removal  of  a  rapidly  growing  ovarian  cyst,  to  the 
hospital  on  July  8ra.  Ovariotomy  was  performed  on 
Wednesday,  July  8th,  before  a  large  and  distinguished 
tompany  of  visitors. 

The  cyst  was  monolocular,  and  contained  nearly  a 
gallan  of  fluid.  Some  omental  adhesions  were  ligatured, 
tiie  pedicle  tied  with  silk,  and  the  cyst  removed.  The 
peritoneum  was  next  flushed  with  a  weak  solution  of 
boroglyceride,  a  glass  drainage  tube  inserted,  and  the 
incision  sutured. 

The  patient  made  an  unusually  excellent  recovery: 
the  sutures  were  removed  on  the  seventh  day,  and  the 
patient  warded  on  the  eighth.  Her  present  condition 
could  scarcely  be  improved :  the  appetite  is  good,  the 
digestion  sound,  and  sleep  perfectly  natural. 

CLINICAL  NOTE. 
By  W.  Lamb,  M.B.,  CM.  (Edin.) 

Bryonia  Alba  80  in  Rheumatism. 

I  HAVE  been  induced  to  put  on  record  my  success  with 
hryon,  alb.  80  in  rheumatism  owing  to  my  intense  dis- 
satisfaction with  the  lower  potencies  as  recommended  by 
Dr.  Hughes  in  his  incomparable  Manuai  of  Pharmacody- 
namics. Indeed  I  have  been  singularly  disappointed 
with  bryon.  Ix  in  rheumatic  fever,  and  I  do  trust  that 
any  of  my  professional  brethren  whose  experience 
corresponds  with  mine  will  also  put  on  record  their 
failures. 

T.  W.,  railway  employ 6,  was  attended  for  rheumatic 
fever  and  recovered  very  slowly  up  to  a  certain  point. 
At  first  he  got  aeon.  Ix  niij.  and  bryon.  Ix  ntij.  alter- 
nately, and  not  progressing  as  I  would  like,  I  gave 
bryon.  ^,  and  doing  no  better  I  changed  to  several 
medicines,  amongst  them  sulphur.     But  as  he  did  not 


632 BEVIEWg,  ^'S^fSS^ 

progress  beyond  a  certain  point,  and  having  read  Bome- 
where  of  the  efficiency  of  the  SOth  dilation,  I  prescribed 
it,  and  I  was  extremely  gratified  to  find  that  at  once  his 
tardy  convalescence  was  converted  into  speedy  recovery. 

After  some  time,  having  been  at  his  nsaal  work,  be 
came  back  with  rheumatic  ophthalmia,  accompanied 
with  rheumatic  pains  in  his  back.  I  gave  bryon.  80 
again,  and  he  at  once  got  better.  I  may  add,  he  got  no 
local  application  for  his  eyes. 

I  have  used  bryon.  80  in  several  other  cases  of  rhen* 
matism,  both  acute  and  sub-acute,  and  find  it  most 
trustworthy. 

My  first  cases  of  rheumatic  fever  treated  by  aeon.  Ix 
and  bryon,  Ix  went  steadily  on  from  bad  to  worse,  peri- 
and  endo-carditis  supervening,  disheartened  me  veiy 
much.  One  case  recovered  satisfactorily,  another 
recovered  with  damaged  heart  and  is  still  alive,  a  third 
recovered  for  a  time  but  has  since  died  of  the  cardiac 
complication  under  an  allopath,  a  fourth  died  with  a 
hyperpyretic  temperature  of  108^  F.  If  my  unfortunate 
experience  is  unique  I  should  like  to  know  it,  and  would 
be  most  thankful  for  any  light  upon  the  subject.  Bat 
having  found  that  I  can  depend  on  bryon.  80,  I  think  iS 
is  my  duty  to  place  the  fact  on  record. 

40,  High  Street,  Dunedin, 
New  Zealand. 


REVIEWa 


Fever:  Its  Paitwlogy  and  Treatment  by  Antipyretia,  By 
H.  A.  Habe,  M.D.  PubUshed  by  F.  A.  Davis,  Philadelphia 
and  London. 

This  little  work,  of  some  200  pages,  is  a  careful  remmi  of  ifae 
action  of  antipyretics.  From  antipyiinf  through  the  ranks 
of  antifebrin,  thallin^  pJienacetine^  down  to  salicylic  acid  and 
cold  bathing,  the  anti-fever  forces  are  passed  in  review.  The 
conclusion,  however,  seems  to  be  that  cold  sponging  is  after 
all  the  best  and  safest  mere  reducer  of  temperature,  with  the 
addition  of  the  cold  bath  in  hospital  practice.  That  the  use 
of  antipyretics  is  not  without  danger  in  large  doses,  and  that 
the  disease  is  often  not  much  ixifluenced  by  mere  reduction 
of  temperature,  is  also  abundantly  manifested  in  these  pages. 


SS5?£S?n^'  BBVIBWB.  688 

The  redaction  appears  to  be  broaght  about  in  three  ways. 

By  diminution  of  tissue  waste  and  oxidation. 

By  diminution  of  heat  formation  by  direct  action  on  the 
nerve  centres. 

By  increase  of  heat  elimination,  as  by  sweating,  &o. 

Although  the  high  temperature  itself  is  a  danger  in  some 
cases,  it  should  be  remembered  that  it  is  only  one  symptom  in 
the  course  of  a  disease  like  typhoid  or  phthisis,  and  perhaps 
a  necessary  and  curative  process.  In  England,  at  least  m 
private  practice,  the  use  of  the  cold  pack,  followed  by  cold 
bath,  is  too  much  neglected.  Only  those  who  have  been  thus 
treated,  during  the  course  of  typhoid,  for  instance,  can  realise 
the  comfort  of  it ;  how  the  patient  longs  for  the  pack,  as  the 
one  luxurious  oasis  in  the  fever-stricken  desert  of  his  dreams. 

AnUpyrin  is  the  first  and  most  important  of  the  antipyretic^. 
It  delays  or  prevents  fermentation  and  prevents  putrefaction 
in  Uood.  In  moderate  doses  it  lowers  ordinary  healthy 
temperature.  It  lowers  febrile  temperature.  The  lowering  is 
due  to  lessened  production  as  well  as  decreased  dissipation  of 
heat.  It  has  no  effect  on  the  circulation  or.  respiration. 
Tissue  waste  is  diminished,  urea  diminished.  It  delavs 
reflex  action,  depresses  the  motor  and  sensory  tract  of  the 
cord  and  motor  and  sensory  nerves.  It  is  eliminated  by 
the  kidneys. 

In  certain  cases  5, 10  or  15  grains  are  a  poisonous  dose, 
setting  up  nausea,  vomiting,  ringing  in  ears,  cerebral 
congestion,  cyanosis,  duskiness  of  face  and  hands,  sweating, 
prickling  and  tingling  of  skin,  erythematous  patches  on  hands, 
feet,  face,  arms  and  chest ;  even  pemphigus  and  bullce  have 
been  noted.  A  hundred  cases  of  poisoning  are  recorded,  of 
which  six  were  fatal. 

There  has  been  noticed  a  serious  fall  of  temperature  from 
the  use  of  antipyrin  in  tubercular  cases,  and  in  typhoid  the 
gravity  of  symptoms  does  not  diminish  with  the  apyresis. 
It  has  no  antiperiodic  value. 

Its  use  in  migraine,  hemiorania,  in  allaying  the  pain  of 
gout  and  rheumatism  is  certain.  Germain  See  praises  its 
analgesic  powers  in  hepatic  colic,  in  tapes  dorsalis  and  in 
angina  pectoris,  replacing  morphia  in  many  cases  of  long 
standing. 

Antifehrin  is  a  depressant  of  the  heart  as  well  as  a  reducer 
.of  febrile  temperature.  Its  analgesic  are  even  greater  than  its 
antifebrile  virtues. 

There  is  a  curious  observation  by  Faust,  which  the  author 
says  *'  he  cannot  understand,  and  which  flavours  of  smilia 


584  BEviBWs.  "SS^^*?^ 


JEteviev,  Aug.  1,  IttL 


gimiltbuSf  viz.,  that  the  use  of  awtifehrin  immediately  after  the 
cold  bath  in  typhoid  fever  prevents  any  subsequent  chilliness 
and  quiets  the  patient.*' 

Its  poisonous  symptoms  are  nausea,  sweat,  cyanosis,  clonic 
convulsions  and  collapse. 

Thallin  is  a  powerful  antipyretic.  It  reduced  the  tempera- 
ture in  a  case  of  high  temperature  due  to  an  injury  to  the 
inhibitory  heat  centre  of  0  H  in  the  corpus-striatum.  It  is 
antiseptic  and  reduces  tissue  waste.  In  large  doses  it  produces 
congestion  of  the  kidneys  and  has  a  destructive  action  on  the 
white  blood  corpuscles. 

PJienacetine  has  a  similar  effect  on  the  nervous  heat  centres, 
and  a  depressant  action  on  the  spinal  cord.  As  an  analgesic 
in  cases  of  neuralgia  and  migraine  it  is  most  efficacious. 

SaUeijlic  acid  is  no  longer  used  as  an  antipyretic,  but  as  an 
anti-rheumatic.  Even  in  rheumatism  it  seems  doubtful  if  it 
does  more  than  relieve  the  pain. 

There  is  an  interesting  bbservation  that  the  oil  of  gaulthesia 
(salicylate  of  methyl)  may  be  inhaled  from  a  sponge,  and 
appear  in  the  urine  in  a  few  minutes.  Moreover,  inunctions  of 
the  acid  rubbed  up  with  vaseline  have  a  similar  effect. 

The  untoward  effects  of  salicylic  add  and  its  salts  inekde 
tinnitus  aurum,  delirium,  visual  hallucinations,  dimness  of 
vision  and  contraction  of  retinal  vessels,  motor  disturbances, 
hsBmaturia,  albuminuria,  urticaria,  petechial  exanthemata, 
oedema  of  face  and  eyes,  sweats  and  dea&ess. 

The  work  is  well  got  up  and  printed.  The  diagrams  of 
temperature,  pulse,  blood  pressure,  &c.,  are  so  numerous  as 
to  be  rather  bewildering.  There  seems  to  be  a  necessity  for 
further  proving  of  these  drugs  in  much  smaUer  doses  and  on 
the  human  subject.  There  are  very  careful  and  detailed  tables 
of  the  untoward  effects  of  antipyrin,  salicylic  acid,  &c. 

Altogether  the  essay,  to  which  was  awarded  the  BoyUton 
prize  of  Harvard  University,  is  one  of  great  interest;  the 
authorities  have  been  carefully  studied,  and  there  is  a  con- 
siderable amount  of  original  research.  As  an  example  of  the 
modem  mode  of  examining  new  therapeutic  agents  it  is  dis* 
appointing.  To  begin  the  study  of  a  remedy  by  finding  what 
weight  per  pound  will  kill  a  dog  or  rabbit,  to  follow  up  by 
injecting  large  doses  into  the  veins,  seems  but  a  coarse  and 
clumsy  method  to  those  who  are  accustomed  to  the  more 
delicate  experimental  researches  of  our  own  school. 


^rfUyHojnaKjNOiic  MEETINGS.  535 


Btfiew,  Ang.  1,  IflU 


MEETINGS. 


THE   BRITISH  HOMCEOPATHIC  CONGRESS. 

This  annual  gathering  of  medical  men  practising  homoeopathi- 
cally  took  place  in  London  on  Thursday,  July  the  9th,  and  hy 
the  kind  permission  of  the  Board  of  Management  of  the  London 
Homceopathic  Hospital  was  held  in  the  Board-room  of  that 
institation.  The  number  of  gentlemen  present  again  proved 
that  London  is  a  favourite  *'  fixture/*  and  that  for  holding  a 
saecessful  meeting  it  has  advantages  which  no  other  locality 
ean  present.  On  this  occasion  the  annual  assembly  of  the 
British  Homoeopathic  Society  being  held  on  the  evening  of 
the  8th,  together  with  an  opportunity  of  visiting  the  wards  of 
the  hospital  and  witnessing  some  operations,  proved  additional 
attractions.  The  cleanliness,  neatness  and  cheerful  appearance 
cf  the  wards  of  the  hospital  were  generally  remarked  upon. 
The  first  operation  was  performed  by  Dr.  Burford,  who,, 
assisted  by  Mr.  Knox  Shaw,  removed  a  unilocular  ovarian 
tumour^  Dr.  Burford  gave  a  short  history  of  the  case  at  the 
conclusion  of  the  operation.  Of  it,  the  detaik  will  be  found 
<m  page  581.  Mr.  Enox  Shaw  removed  a  cancerous  breast^ 
and  Mr.  Dudley  Wright  a  dermoid  cyst  from  the  abdominal 
wall. 

The  Congress  assembled  at  ten  o^clock  on  Thursday  mom- 
vugf  when  there  were  present  Mr.  H.  Habris,  of  London, 
President^  in  the  chair ;  Mr.  Hugh  Cakebon,  Dr.  Yeldhah, 
Br.  DuDaEON,  Dr.  Dyce  Brown,  Dr.  Gabfrae,  Dr.  J.  G.  Black- 
unr,  Dr.  Byres  Moib,  Dr.  J.  H.  Clarke,  Mr.  Enox  Shaw,. 
Br.  Bubford,  Dr.  Cooper,  Mr.  Dudley  Wright,  Dr.  Marsh, 
Br.  R.  Day,  Dr.  W.  Epps,  Dr.  Buck,  Dr.  E.  Blake, 
Mr.  W.  Cox,  Dr.  Bradbhaw,  Dr.  Powell,  Dr.  Subs-Hahnb- 
XASN,  Ihr.  GoLDSBORO,  Dr.  Jagielski,  Mr.  Gerard  Smith, 
Br.  Renner,  Dr.  Morrisson,  Dr.  Herring,  Dr.  Bennett,  and 
Br.  Blackworth  (London) ;  Dr.  Sandberg  (Brixton) ;  Dr.  Pul- 
lab  and  Mr.  Newbery  (Norwood) ;  Dr.  F.  Nankihsll  (Syden- 
ham);  Dr.  Cook  (Richmond) ;  Dr.  Madden  (Bromley) ; 
Br.  PuBDOM  (Croydon) ;  Dr.  Bubwood  (Ealing) ;  Dr.  McKilliam 

Slackheath) ;  Dr.  Bbycb  and  Dr.  Wolston  (Edinburgh) ;. 
'.  Bbysdale,  Dr.  Haywabd,  Dr.  C.  Haywabd,  Dr.  Gobdon. 
SiuTH,  Dr.  Mubbay  Moobe,  Dr.  Hawxbs,  Dr.  Simpson,  and 
Br.  Cappbb  (Liverpool) ;  Dr.  Pboctob  (Birkenhead)  ;  Dr- 
Bluvbebg  and  Dr.  Stopfobd  (Southport) ;  Mr.  Wilkinson  and 
Br.  Thobnley  (Bolton) ;  Dr.  Hughes  (Brighton^;  Dr.  Pebcy 
Wilde,  Dr.  McEechnie  and  Mr.  Nobman  (Bath) ;  Dr.  Bams- 
botham  (Leeds) ;  Dr.  Pope  (Grantham) ;  Dr.  A.  C.  Clipton 
(Northampton) ;  Dr.  G.  Clifton  (Leicester) ;  Dr.  Nicholson 


536  MBBTINQB.  ''^SL^SS^TSt 


Benmr.  Ang.  1, 18IL 


(Clifton) ;  Dr.  MuBRiiY  QB'olkestone) ;  Dr.  Cboxtoheb  (Si. 
Leonards) ;  Dr.  Kennedy  (Newcastle);  Dr.  Abbott  (Presioa) ; 
Dr.  H.  Nankiyeix  (Boumemouth) ;  Dr.  Hawkes  (Bamsgate); 
Dr.  Roche  (Norwich) ;  Dr.  Nibld  (Tunbridge  Wells) ;  Dr. 
liUTHEB  (BeliiEtst) ;    Dr.  Gn^BEBT    (Beigate) ;    Dr.  Oudribss 

SIxford) ;  Dr.  Hatle  (Bochdale) ;  Dr.  AiiExandeb  (Southsea); 
r.  Johnstone  (Maidstone) ;  Dr.  Bidpath  (Huddersfield) ;  Dt, 
BoDMAN  (Devizes) ;  and  Dr.  Gobdon  (Liverpool).  Dr.  Fbekcs, 
of  San  Francisco,  and  Dr.  Beaumont,  of  Minneapolis,  were 
Also  present  as  visitors.  Letters  or  telegrams  regretting  their 
inability  to  attend,  and  expressing  good  wishes  for  the  sucoess 
of  the  Congress,  were  received  from  Dr.  Fbost,  of  Boume- 
mouth, Dr.  Blackley  and  Dr.  Mont,  of  Manchester,  Dr. 
Dbummond,  of  Malvern,  Dr.  Gibbs  Blake,  of  Birmingham, 
And  Dr.  Both,  of  Divonne  les  Baics,  who  also  sent  his  kind 
regards  to  all  his  colleagues  in  England. 

The  Congress  was  opened  by  an  Address  from  the  President, 
Mr.  Habbis,  entitled  "  After  Twenty  Years  and  Twenty  Yean 
After,"  which  was  received  with  frequent  applause.  Itirill 
be  found  in  extenso  at  page  607  of  our  present  number. 

At  its  conclusion 

Dr.  Hughes  said  he  had  several  times  at  these  Congresses 
liad  the  pleasure  of  proposing  a  vote  of  thanks  to  the  President 
for  his  address,  but  never  with  greater  pleasure  than  he  fell 
in  rising  to  do  so  on  the  present  occasion.  He  felt  when  they 
-elected  Mr.  Harris  to  the  chair  last  year  at  Boumemouth  that 
they  would  have  a  good  address,  and  he  had  been  gratified  by 
hearing  one  so  full  of  energy,  so  well  conceived,  and  so  weU 
delivered,  as  that  which  they  had  just  heard,  one  whieh 
would  inspire  them  to  renewed  efforts  in  the  work  committed 
to  their  charge  of  labouring  for  the  advancement  of  homoeo- 
pathy, and  making  that  their  primary  and  most  sacred  duty 
as  professional  men.  He  quite  trusted  that  some  recognisable 
and  distinguishable  progress  in  homoeopathy  would  take  its 
•date  from  this  occasion. 

Dr.  Pope  said  he  had  very  great  pleasure  in  seconding  the 
proposal.  They  had  indeed  heard  a  most  admirable  address, 
one  full  of  spirit,  calculated  to  encourage  them  in  the  future, 
and  one  which  he  believed  would  do  permanent  good  to  the 
progress  of  homoeopathy  in  this  country.  They  must  all  as 
medical  men  remember  that  in  the  progress  of  homoeopathy 
lay  the  real  progress  of  medicine  as  a  practical  art.  Nothing 
within  his  remembrance  had  appeared  to  him  to  cast  a  greater 
reflection  ifjpon  what  was  termed  modem  medicine  than  the 
course  of  the  recent  epidemic  of  influenza.  That  such 
diseases  as  pneumonia  and  bronchitis  should  have  caused  so 


r^ 


Srfl^rCrSS^  MEETINOB.  537 

floriooB  a  mortality,  and  that  such  methods  of  treatment  as 
they  had  read  of  as  being  adopted  shonld  have  been  pursued 
1^  a  large  proportion  of  medical  men,  seemed  to  him  to  con- 
stitiite  a  very  gjrave  reproach  indeed  to  the  therapeutics  of 
the  present  day,  and  it  was  to  remove  this  reproach  that  they 
irere  anxious  to  push  forward  a  knowledge  of  homceopathy 
both  among  the  members  of  the  profession  and  the  public 
at  large.  He  felt  sure  they  would  join  cordially  with 
Br.  Hughes  and  himself  in  thanking  the  President  for  his 
itddress.    (Applause.) 

The  Pbbsident,  in  reply,  said  he  accepted  with  much 
gratitude  the  thanks  they  nad  been  so  kindly  pleased  to  giv& 
him.  It  was  not  without  a  certain  amount  of  trepidation 
that  he  undertook  the  duty  of  bringing  before  the  Congress 
what  he  felt  might  be,  in  some  measure,  disagreeable  facts, 
bat  if  any  blame  was  to  be  attached  he  hoped  they  would 
iUow  it  to  rest  with  himself  only.  He  trusted  that  nothing- 
he  had  said  would  in  any  manner  hinder  the  cause  of 
homoeopathy,  the  advancement  of  which  was  the  one  hope 
and  deare  he  had  before  him  in  his  professional  career ;  and 
he  did  most  emphatically  and  from  his  heart  say  that  if  they 
wanted  to  do  good  in  the  cause  of  homoeopathy  and  promote 
its  progress  they  must  make  it  their  life's  work.    (Hear,  hear). 

Ifr.  Enox  Shaw,  of  London,  next  read  a  Paper  entitled : — 
^  Observations  on  the  action  of  the  Iodide  of  Potassium  in 
tertiary  Syphilis."  This,  with  the  discussion  to  which  it 
gave  rise,  we  hope  to  publish  next  month. 

Dr.  BuBFOBD,  of  London,  then  read  a  paper  on  "  The 
]^iprocal  Belations  between  Surgery  and  Homoeopathic 
Therapeutics  as  exemplified  in  Pelvic  Lesions,"  the  subject 
being  illustrated  by  three  examples  of  tumours  recently 
SQccessfuUy  removed  in  the  London  Homoeopathic  Hospital. 
This,  with  the  discussion  upon  it,  we  hope  to  publish  next 
ihonth. 

After  hearing  the  paper  the  members  of  the  Congress 
adjourned  for  luncheon,  which  took  place  at  the  Holbom 
BoBtaurant,  the  members  of  Congress  being  the  guests  of  the 
British  Homoeopathic  Society.    After  luncheon, 

The  PfiEsmENT  conveyed  the  thanks  of  the  Congress  to  the 
British  Homoeopathic  Society  for  their  kind  entertainment. 
In  a  sense,  perhaps,  it  was  an  expression  of  thanks  to  them- 
selves, but  not  entirely,  for  he  VTas  sorry  to  say  that  not  every 
member  of  the  Congress  was  a  member  of  the  British  Homoeo- 

Cthic  Society.    (Hear,  hear.)    Those  who  were  not  ought  to 
.    (Hear,  hear.) 


638  MBETIN08.  "S^fiSr?^! 

Mr.  Knox  Shaw,  the  Preddent  of  the  Society,  replied, 
assuring  the  members  of  Congress  that  they  were  extremely 
pleased  to  see  them.  He  only  hoped  that  those  who  were  not 
members  of  the  Society  would  join,  and  so  make  the  fortii- 
oming  session  the  most  sucoessM  they  ever  had.  (Applause). 
Congress  reassembled  at  the  Hospital  at  two  o'clock,  wbm 
Dr.  Hayward,  as  Secretary  to  the  Hahnemann  Publishing 
Society,  read  the  following  report  of  the  meeting  of  that 
Society  held  the  same  day. 

The  meeting  of  this  Society  was  held  in  this  room  Qna 
morning.    At  this  meeting  it  was  announced  that  the  foods 
in  hand  i;^ere  £24  7s.    It  was  also  intimated  that  now  that 
the  Cyclopadta  of  Dinuj  Pathogenesy  was  near  completion  the 
Society's  work  can  and  should  be  prosecuted  with  vigour.    It 
is  now  evident  that  the  Cyclopadia  does  not,  will  not  and 
cannot  supplant  any  of  the  Society's  three  great  works,  viz. : 
the  Materia  Medica,  Physiological  and  Applied,  the  PathogenetK 
Repertory,  or  the  Clinical  Bepertory^  and  that  the  necessity  for 
the  Society's  Materia  Medica  with  its  Schema,  its  Repertory  of 
the  Pure  Pathogenetic  Symptoms,  and  its  Therapemtie  Repertory, 
with  its  collection,  tabulation  and  practical  application  of  the 
clinical  symptoms,  and  the  usus  in  morbis  is,  if  possible,  more 
evident  now  than  ever  before.    The  Secretabt  mentioned 
that  the  introduction  to  the  Therapeutic  Repertory  had  been 
prepared  by  Drs.  Drysdaie  and  J.  Gibbs  Blake,  and  that 
Dr.  Cooper  was  engaged  in  the  preparation  for  this  work  of 
the  chapter.  Diseases  of  the  Ear ;    and  that  Dr.  John  D. 
Hayward,  of  Liverpool,  was  engaged  in  preparing  for  the 
press,  for  the  Materia  Medica,  Physiological  and  AppUed,  the 
b.te  Dr.  Alfred  Drysdale's  MS.  of  Colocynth;  also  that  for  the 
Pathogenetic  Repertory,  Dr.  Jones,  of  Birkenhead,  was  enga^ 
in  the  preparation  of  a  re-issue  of  chapter.  Nose ;  whilst 
Dr.  Haywa^  was  engaged  in  a  similar  re-issue  of  chapter, 
Ears,  and  chapter.  Throat ;  and  there  was  promise  of  an  issoe 
of  chapter.  Larynx,    Bronchia  and  Chest.     Also  that  Dr. 
O'Connor,  of  New  York,  has  promised  to  get  the  help  in  this 
i^ork  of  some  of  our  younger  eoUeagues  in  America.    Appeal 
was  also  made  to  our  own  practitioners  to  join  hands  in  one 
of  the  works  of  the  Society.    The  three  works  offer  sjAeres 
for  the  tastes  and  abilities  of  all — ^those  whose  taste  does  not 
lie  in  the  Repertory  line  can  take  up  the  Materia  Medica,  and 
those  who  like  clinical  work  can  assist  in  the  Clinical  Repertory ; 
our  specialists  may  take  up  clinical  work  in  their  own  line : 
Mr.  Enox  Shaw,  for  instance.  Diseases  of  the  Eye;   Dr. 
'^urford.  Diseases  of  Uterus,  and  so  on,  just  as  Dr.  Cooper 
'  Diseases  of  the  Ear.    Let  each  try  to  be  something  more 
1  a  sponge — ^living  on  homoeopathy — ^let  us  feed  the  cow 


USSS^SSTS^  MKETIHGB, 589 

M  well  as  milk  her.  After  Bome  diflcossion  it  was  agreed  that 
the  symptomfl  of  Hahnemann's  Chronic  Diseases  shall  be 
included  in  the  Repertory ^  bat  that  they  shall  be  indicated  as 
sQch  by  some  distinguidiing  mark. 

The  Pbesident  then  asked  for  proposals  for  a  place  of 
meeting  next  year. 

Dr.  Ybldhax  proposed,  and  Mr.  Gamkbon  seconded,  the 
selection  of  London. 

Dr.  Blitmbbbo  proposed  Sonthport,  and  Dr.  Mubbat  Moobb 
seeonded  him. 

Dr.  Madden  proposed,  and  Dr.  Hughes  seconded  Manchester. 

Dr.  Hatwabd  proposed  Bath,  in  which  he  was  seconded  by 
Dr.  CuFTON. 

After  voting  upon  each  proposal,  the  majority  rested  with 
Sonthport. 

The  Sbgbbtabt  (Dr.  Dyoe  Brown)  then  read  the  report  of 
the  Congress  for  last  year. 

The  next  business  was  the  balloting  for  the  President  for 
next  year. 

The  PfixsmENT,  on  the  votes  being  ooonted,  said  he  had 
much  pleasure  in  announcing  that  they  had  elected  Dr. 
IUmsbotham  their  president  for  the  coming  year.    (Applause.) 

Dr.  Bamsbotham  having  expressed  his  thanks  to  the  members 
for  the  unexpected  honour, 

Dr.  Hughes  proposed  that  Dr.  BJiumberg,  their  able  repre- 
sentative of  homceopathy  at  Southport,  be  the  Vice-President 
for  the  ensuing  year,  and  that  Dr.  Stopford,  as  a  younger 
practitioner  in  the  same  town,  be  appointed  local  secretary 
(hear,  hear) ;  also  that. the  general  secretary  and  treasurer  be 
asked  to  continue  the  honorary  ofiSces,  which  they  had  so  well 
filled  in  the  past. 

Dr.  Hatwabd  seconded  and  the  proposition  was  carried 
uuuumously. 

Dr.  Dtce-Bbowk  proposed  that  the  Congress  of  1892  be 
held,  as  usual,  on  the  Thursday  of  the  third  week  in 
September. 

Dr.  Hughes  seconded,  and  this  was  also  agreed  to. 

The  PBEsmENT  then  announced  that  Dr.  Hughes,  as  the 
permanent  secretary  of  the  International  Convention,  had  & 
communication  to  make  to  the  Congress. 

Dr.  Hughes  said,  as  they  were  aware,  he  had  just  returned 
'  from  the  meeting  of  the  International  Homoeopathic  Convention 
in  America.  At  the  last  gathering  a  unanimous  vote  was 
passed  expressing  the  desire  that  the  next  should  be  held  in 
England,  and,  as  permanent  secretary,  he  was  desired  to 
communicate  ttiis  to  the  present  Congress.  The  course  they 
took  when  a  similar  wish  was  expressed  in  1876-7,  was  to 


^40  MEETINGS.  ^^SJS.aSM 

appoint  a  committee  to  consider  the  arrangements,  and  he 
therefore  proposed  that  they  appoint  a  similar  committee  on 
the  present  occasion.  If  he  might  he  permitted  to  do  so,  he 
would  nominate  Drs.  Dudgeon,  of  London,  Pope,  of  Grantham, 
Hayward,  of  Liverpool,  and  Clifton,  of  Northampton,  to 
oo-operate  with  himsdf  in  canying  out  the  necessary 
arrangements. 

Dr.  Dtce-Bbown  seconded,  and  the  motion  was  unanimously 
carried. 

Dr.  Hughes  also  placed  on  the  table  some  views  of  the 
homoeopathic  institutions  in  New  York,  Brooklyn,  and 
Philadelphia,  for  the  inspection  of  the  members. 

The  Gong^ss,  at  the  end  of  the  general  business,  proceeded 
with  the  discussion  of  Dr.  Bunord's  papier,  of  which  we 
propose  to  give  a  report  next  month. 

The  discussion  having  terminated,  Dr.  Bobebson  Dat  read 
1^  paper  on  *'  The  Supervision  of  Normal  Parturition."  This, 
with  the  discussion  that  followed,  we  shall  publish  next 
Month. 

At  the  close  of  the  discussion,  tea  was  kindly  served  in  the 
dining  room  by  the  lady-superintendent  and  assistants.  After 
this  much  appreciated  refreshment.  Dr.  Mub&at  Moobe  read 
a  paper,  entitled  ''  Notes  on  the  Climatology  and  Prevalent 
Diseases  of  New  Zealand,"  illustrating  it  by  specially  prepared 
maps.  This,  together  with  the  discussion  upon  it,  we  hope 
to  publish  in  a  future  number. 

The  debate  having  concluded,  a  hearty  vote  of  thanks  was 
presented  to  the  President,  and  the  members  separated  to 
re-assemble  at 

The  DnnoEti, 

which  took  place  at  the  Holbom  Bestaurant.  There  was  an 
exceptionally  large  company,  including,  in  addition  to  Hbxxe 
attending  the  meetings  of  the  Cdngress,  Dr.  Priestley, 
Mr.  Humdall,  Mr.  G.  A.  Boss,  Mr.  Edwyn  L.  Pope,  and 
others,  whose  names  we  were  unable  to  obtain,  together  with 
a  numl)er  of  ladies  were  present.  The  chair  was  taken  by 
tibe  President,  Mr.  Hsnet  Habbis.  The  arrangements  for 
the  dinner,  which  was  served  in  the  Venetian  Boom,  were 
admirable.  The  usual  brief  toast  list  was  gone  through 
afterwards. 

The  PBEsmsNT  proposed  as  the  first  toast  that  which,  with- 
out exception,  held  the  first  place  in  every  assembly  of 
Englishmen,  the  health  of  Her  Most  Gracious  Majesty  the 
Queen,  and  of  the  other  members  of  the  Boyal  Family. 
(Applause.) 


g^ArnSff"  MEETINGS. 641 

The  Pbbbidbmt,  again  rising,  said  it  was  the  custom  in  all 
meetings  of  homcBopaths  to  let  their  thoughts  revert  for  a 
time  to  the  man  who  was  the  founder  of  their  system.  He 
had  just  proposed  the  health  of  a  monarch.  He  had  now  to 
propose  iiie  memory  of  a  true  monarch,  though  dead,  a  man 
who  devoted  his  life  to  the  service  of  his  fellow  men,  and 
despite  persecution  and  obloquy  stood  firm  to  the  last,  and 
did  bis  very  best  to  promulgate  the  doctrine  which  he  felt 
was  pregnant  with  benefit  for  mankind.  Samuel  Hahnemann, 
perhaps,  did  not  receive  his  due  reward  during  his  hfetime, 
but  when  the  fame  of  monarchs  that  now  filled  the  world's 
ear  had  died  away,  the  fame  of  Samuel  Hahnemann  would 
remain  as  that  of  one  of  those  saviours  of  mankind  of  whom 
ihe  world  was  ever  proud,  a  fame  which  would  not  diminish 
as  time  went  on,  but  which  would  grow  and  increase  until 
even  those  who  now  refused  to  acknowledge  the  truth  of  his 
doctrines,  or  even  to  see  the  genius  of  the  man,  would  be 
proud  to  say  that  they  had  at  last  come  to  recognise  that 
Samuel  Hahnemann  was  not  only  a  reformer,  but  that  he 
was  a  true  man.  (Hear,  hear).  He  asked  them  to  drink  in 
silence  to  the  memory  of  Hahnemann. 

The  President,  on  rising  after  an  interval,  said  that  the 
next  toast  would  be  proposed  by  Dr.  Pope,  who  he,  amid  much 
laughter,  described  as  **  the  Pope  of  Homceopathy." 

Dr.  Pope,  who  was  received  with  applause,  said  he  did  not 
think  there  had  over  been  a  time  in  the  history  of  homoeopathy 
in  this  country  when  anyone  could  have  risen  to  propose  the 
toast  that  had  been  entrusted  to  his  care  with  greater  pleasure 
than  that  with  which  he  was  able  to  propose  it  on  this 
occasion.  The  toast  was  that  of  *'  Homoeopathic  Hospitals 
and  Dispensaries."  He  did  not  propose  to  trespass  upon  their 
time  by  giving  them  a  spqcial  report  of  each  institution,  but 
he  might  be  allowed  to  mention  one  or  two,  and  in  the  first 
place  the  London  Homoeopathic  Hospital.  He  was  glad  to  be 
able  to  say  that  this,  the  central  institution  for  the  teaching 
and  practical  illustration  of  bomoBopathy,  was  never  in  abetter 
state  than  at  the  present  time  (hear,  hear),  and  never  had  it 
a  more  efficient  medical  staff.  (Hear,  hear).  He  felt  sure 
that  anyone  who  was  present  in  the  wards  and  operating 
theatre  on  the  previous  afternoon  must  have  been  greatly 
interested  and  gratified  with  what  he  saw.  He  had  been 
particularly  glad  to  hear  that  in  connection  with  this  hospital 
a  dinner  was  to  be  given  early  in  the  following  week  in 
honour  of  Major  Vaughan-Morgan.  (Applause).  As  persons 
interested  in  the  welfare  of  that  institution,  there  was  hardly 
anyone,  if  indeed  there  was  anyone,  to  whom  they  were 
DQore  indebted  than  to  Major  Vaughan-Morgan.    (Renewed 

Vol.  35,  No.  8.  2  Q 


542 MEETINGS,       ^a^,^5rgsi! 

applause).  During  the  past  ten  years  very  considfirable 
improvements  had  been  made  in  its  financial  position  and 
general  management,  and  he  belisTed  that  these  were  all  mainly 
due  to  the  unceasing  care,  watchfulness  and  energy  of 
Major  Vaughan-Morgan.  (Hear,  hear.)  In  addition  to  that 
they  had  the  prospect  of  the  institution  being  re-erected  on  a 
larger  scale,  and  with  greater  provision  for  its  efficiency  than 
could  be  possible  in  the  case  of  a  building  adapted  from  two 
or  three  old  houses ;  and  here,  again,  it  was  owing  to  Major  and 
Mrs.  Vaughan-Morgan's  active  efforts  that  total  subscriptions, 
now  amounting  to  £29,000  out  of  the  £80,000  required,  had  been 
raised.  Every  homoeopath  in  the  country  was  interested  in  the 
welfare  of  that  hospital,  or  at  all  events,  ought  to  be,  and 
therefore  owed  a  great  debt  of  gratitude  to  Major  Vaughan- 
Morgan  for  the  manner  in  which  he  had  championed  its 
cause.  He  felt  sure  they  were  all  extremely  glad  to  hav6 
this  opportuixity  of  doing  him  honour.  There  were  other 
institutions  in  different  parts  of  the  country  as  to  which  be 
should  like  to  say  a  word.  Southport  had  one  which  had 
been  established  for  the  last  thirty  years  (hear,  hear),  a  very 
excellent  institution,  which  had  been  the  means  of  benefiting 
some  5,000  children,  and  altogether  had  done  an  immense 
amount  of  good.  The  liiverpool  Hospital  was  also  present  in 
their  minds  as  an  institution  built  and  furnished  at  the 
expense  of  a  wealthy  Liverpool  merchant,  who  felt  himself 
largely  indebted  to  homceopatby  for  benefits  received  by  him- 
self and  his  family,  and  who  founded  it  as  an  acknowledgment. 
At  Birmingham  was  a  well-managed  hospital,  which  began  as 
a  dispensary  forty  years  ago,  under  the  care  of  the  late 
Dr.  Fearon.  At  Bath  they  had  a  usefid  hospital,  which  had 
also  done  good  work,  and  to  which  they  all  wished  prosperity. 
At  Plymouth  there  was  another,  to  which  the  same  remarks 
appHed,  and  another  at  Bromley — a  memorial  to  a  much 
respected  homoeopathic  physician,  Dr.  Bobert  Phillips — ^whieh 
their  friend,  Dr.  Madden,  had  been  the  means  of  establishing, 
while  only  recently,  one  had  been  opened  at  Tunbridge  Wells. 
He  asked  them,  then,  to  drink  to  the  prosperity  of  all  these 
institutions.  Each  was  doing  the  work  for  which  it  was 
designed,  and  doing  it  well,  and  all  were  fulfilling  their  object 
in  such  manner  as  to  make  them  a  credit  to  the  system* 
to  illustrate,  and  in  order  to  spread  among  the  poor  the 
advantages  of  which,  they  had  been  established.  (Applause). 
Dr.  Haywabd  returned  thanks  for  the  toast,  and  speaking 
for  the  London  Homoeopathic  Hospital  he  assured  them  that 
all  those  connected  with  that  institution  would  feel  gratified 
by  the  kind  manner  in  which  the  toast  had  been  proposed 
and  received.    They  had  been  given  to  understand  that  when 


^SSS^STuS^  MEETINGS. 548 

the  new  bailding  was  erected  the  institution  was  to  beoome 
something  more  than  it  was  at  present,  and  that  they  were  to 
have  a  folly-equipped  school.  He  could  only  say,  might  the 
day  very  rapidly  come  when  this  would  be  an  accomplished 
fact.  Homoeopathy  at  the  present  time  stood  very  much  in 
need  of  the  authority  of  a  medical  school,  which  would  bring 
homceopathic  practitioners  into  the  world  without  the  necessity 
of  their  going  through  the  mill  of  an  allopathic  training,  for 
there  was  no  question  that  many  young  men,  the  sons  of 
homoeopathic  fathers,  who  had  shown  a  tendency  towards  the 
medical  profession,  disappointed  the  hopes  of  their  famiUes  by 
not  taming  out  homoeopathic  practitioners.  They  had  to  go 
through  such  a  mill  in  the  allopathic  school  that  very  few  of 
them  came  out  as  homoeopaths,  much  to  the  regret  of  parents 
and  to  the  loss  of  the  community.  When  they  had  a  London 
school  of  homoeopathy,  which  would  have  the  power  to  grant 
diplomas  and  bestow  full  qualifications  on  young  medical  men, 
they  would  have  a  great  power  for  good  in  favour  of  homoeo- 
pathy. Perhaps  he  might  make  special  mention  of  the 
Liverpool  Hospital,  as  he  had  something  to  do  with  its  being 
established,  and  which,  as  well  as  being  a  lasting  testimony 
to  the  munificent  charity  of  Mr.  Henry  Tate,  was  an  illustra- 
tion also  of  the  advantages  of  a  homoeopathic  hospital  to  the 
community.  The  Southport  Hospital  had  also  done  good 
work,  and  under  the  guidance  of  Dr.  Blumberg  and  the  rising 
practitioners  who  were  associated  with  him,  would  no  doubt 
continue  to  do  equally  good  work  in  the  future.  The  remaining 
institutions  were  in  a  flourishing  condition,  and  in  behalf  of 
one  and  all  of  them  he  would  say  that  they  were  extremely 
obliged  for  their  good  wishes,  and  they  would  endeavour  to 
continue  to  deserve  them. 

The  Pbesident  then  called  on  Dr.  Blumberg,  as  one  who 
had  long  rendered  valuable  service,  both  by  pen  and  practice, 
to  the  cause  of  homoeopathy,  to  propose  the  toast  of  Homoeo- 
pathic Literature. 

Pr.  BiiXJHBEBO  said :  Mr.  President,  ladies  and  gentlemen, — 
Some  persons,  perhaps  rather  paradoxically,  have  questioned 
whether  Gutenberg  really  conferred  a  benefit  on  mankind  by 
inventing  the  art  of  printmg.  And  indeed,  if  one  considers  the 
immense  amount  of  perfectly  useless  books  which  this  art  has 
produced,  one  certainly  cannot  call  it  an  unmitigated  blessing. 
Take  medical  literature,  for  instance.  If  all  the  books  and 
pamphlets  on  medicine  which  had  been  printed  up  to  the 
time  of  Hufeland  and  Hahnemann  could  be  thrown  into  the 
ocean,  the  loss  would  be  really  infinitesimal.  The  farrago  of 
cruel  absurdity  found  in  the  period  before  our  great  Beformer 
introduced  careful  induction,  logic,  and  common  sense  into 


'644  MEETINGS.  "SS^^iS^S* 


B0VMV«  Au^*  1«  18H* 


medicine,  is  perfectly  incredible !    With  him  a  new  en  of 
medical  literature  began.      (Cheers).     We  look  back  irith 
reverence  upon  his  works,  and  the  works  of  his  helpers  and 
disciples — Stapf,  Noack,  Gross,  Hartlaub,  Jahr,  Both,  HeiiDg, 
Trinks,  Hirschel,  etc.    In  England,  too^  the  new  system  of 
medicine  has  found  most  worthy  literary  champions;  most 
valuable  works  have  been  pubUshed  in  the  course  of  tiie  last 
fifty  years,  and  the  British  Jmimal  of  Homaopathy  did  more 
than  yeoman's  service  in  our  cause.   It  would  be  difficult,  say 
impossible,  to  match  it  for  perfect  fairness,  for  variety  of  infor- 
mation, for  deep  research,  and  for  lucidity  of  argument.    It 
was  a  sad  day  for  homoeopathy  when,  after  more  than  forty 
years  of  a  most  useful  and  splendid  existence,  it  ceased  to 
exist.    Let  us  exert  ourselves,  gentlemen,  to  resuscitate  it  if 
possible,  from  its  ashes.    (Cheers).    And  let  us  give  honour  to 
the  three  men — ^happily  with  us  this  evening — (great  cheers) 
whose  names  will  always  be  associated  with  this  great  publi- 
cation.    First,  my  friend  who  sits  next  to  me.  Dr.  Drysdale 
(great  cheers^,  whom,  with  his  permission,  I  will  compare  to 
Thomas  Carlyle,  combining  the  most  varied  and  profound 
knowledge  with  the  greatest  singleness  of  purpose,  a  lover  of 
truth  and  a  hater  of  shams.    Next  Dr.  Hughes  (great  cheers), 
who  resembles  Bacon  in  so  far  as  he  made  a  new  doctrine 
acceptable,  even  to  its  enemies,  by  his  careful  investigation^ 
his  logical  power,  and  the  clearness  of  his  diction ;  and  last, 
not  least.  Dr.  Dudgeon  (great  cheers),  whom  I  would  like  to 
compare  to  Swift,  wielding  the  keenest  pen  of  his  time,  ever 
getting  the  victory  by  apt  illustration,  by  the  most  feliciionB 
humour  and  wit,  a  joy  for  us,  and  the  dread  of  our  enemies. 
(Immense  cheering,  accompanied  by  the  singing  of  ''  For  he 
is  a  jolly  good  fellow.")    But  though  we  have  lost  the  great 
Quarterly  we  have  still,  Mr.  President,  ladies  and  gentlemen, 
two  more  popular  and  widely  read  periodicals  for  our  canse. 
I  mean  the  Homeopathic  Rerietc  and  the  Homoeopathic  WorU» 
(Cheers).    No  one  who  reads  them  can  doubt  that  they  are 
conducted    with    the    greatest    ability;    and    in    proposing 
'<  Homoeopathic  Literature,*'  I  cannot  do  better  than  couple 
it  with  the  names  of  their  editors,  Drs.  Pope,  Dyce  Biown, 
Neatby  and  Clarke.    (Great  cheers).    May  they  long  continue 
to  lead  the  battle  for  the  only  rational  system  of  medicine,  a 
battle  which  ultimately-— depend  upon  it — ^must  prove  vic- 
torious I    (Cheers). 

Dr.  Clarke,  who  was  then  called  upon  by  the  President,  said 

why  the  burden  of  the  response  to  this  toast  should  fall  on  his 

shoulders,  after  they  had  had  the  names  of  the  giants  of 

homoeopathic  literature  called  up  before  them,  he  could  only 

'  attribute  to  the  fact  that  for  six  long  years  he  had  borne  the 


iSgwrgnrag;^       MEETiNqs, 545 

"  World  "  on  his  shoulders,  and  so  might  be  supposed  to  have 
had  some  little  preparation  for  the  task.  After  Dr.  Blumberg's 
remarks  little  remained  to  be  said  about  homcBopathic  Kterature. 
He  might  mention,  however,  that  it  was  of  very  ancient 
date,  going  back  to  the  time  of  Hippocrates,  and  taking  in 
Shakespeare,  and  as  the  editor  of  Health  had  pointed  out, 
Milton  also,  before  it  reached  Hahnemann.  Since  Hahne- 
mann's day  homoeopathy  had  always  been  literary.  It  had 
never  wanted  for  literary  expression.  Hahnemann  himself 
was  a  mighty  literary  man,  and  after  him  there  were  scores 
of  others,  not  forgetting  Constantine  Hering,  who  had  given  to 
the  world  works  of  literature  not  confined  to  medical  subjects, 
and  not  forgetting  Dr.  Blumberg  himself,  who  as  they  knew 
was  a  poet  as  well  as  a  doctor.  (Applause).  The  world  was 
no  doubt  greatly  indebted  to  literary  men,  while  they  on  the 
other  hand  were  very  much  indebted  to  the  rest  of  the  world 
for  accepting  their  services,  and  in  thanking  them  for  the 
enthusiasm  with  which  they  had  received  this  toast  he  would 
also  offer  them  the  thanks  of  the  literary  men  for  the  manner 
in  which  their  services  were  appreciated. 

The  Pbesident  remarked  that  the  next  toast  was  a  very 
important  one,  including,  he  was  glad  to  say,  both  sections  of 
the  medical  profession,  and  it  could  not  have  a  better  proposer 
than  the  "jolly  good  fellow"  whose  name  they  had  so 
enthusiasticsJly  received — Dr.  Dudgeon.     (Applause). 

Dr.  Dudgeon  said  the  toast  which  had  been  entrusted  to 
his  care  was  that  of  the  guests.  They  were  always  glad  to 
see  as  many  guests,  strangers  to  their  Society,  and  even 
strangers  to  homoeopathy,  as  possible  on  these  occasions,  and 
especially  were  they  honoured  on  this  occasion  by  having 
among  their  guests  a  number  of  the  fair  sex  (hear,  hear  and 
applause),  whom  they  very  cordially  welcomed.  They  had 
not  previously  been  honoured  by  the  presence  of  ladies  at 
their  festive  gatherings,  and  they  were  extremely  pleased  to 
«ee  them,  for 

'*  Withoat  a  smile  from  partial  beauty  won. 
Oh  !  what  were  man  ?  a  world  without  a  sun." 

{Applause).  The  gentlemen  whom  he  was  specially  requested 
to  mention  in  connection  with  this  toast,  were  two  from 
distant  America,  Dr.  Beaumont  and  Dr.  French,  together 
with  Dr.  Priestley.  Dr.  Beaumont  came  from  Minneapolis, 
from  whence  they  had  a  guest  at  their  last  Congress,  in  the 
person  of  Dr.  Aldrich.  Dr.  French  came  from  the  still  more 
distant  quarter  of  San  Francisco,  which  he  believed  could  not 
be  reached,  travelling  at  the  utmost  speed  of  steamboat  and 
lailway,  in  less  than  a  fortnight.  He  could  only  say  that 
they  felt  extremely  honoured  in  having  two  gentlemen  from 


646  MEETINGS.  ^S^^'^T?^. 


Review,  Aug.  1, 191. 


such  distant  places  present  to  take  part  in  their  proceedings. 
But  the  third  gentleman  he  had  mentioned,  Dr.  Priestley, 
came  from  a  still  more  distant  quarter.  He  came  from  tbe 
allopathic  camp.  ^Laughter).  But  they  i7ere  more  than 
delighted  to  see  their  friends  the  enemy  among  them  (hear, 
hear),  although  he  could  scarcely  call  them  enemies  now, 
seeing  that  only  a  very  short  time  ago  he  received  a  beaatifolly 
emblazoned  card  stating  that  the  President  and  Council  of  a 
well-known  medical  society  requested  the  honour  of  his 
presence  at  a  conversazione — a  gratifying  evidence  of  the 
rapirrovhement  between  the  two  schools.  (Laughter).  He 
called  upon  them  to  drink  the  toast  with  all  honour,  coupling 
with  it  the  names  of  Drs.  French  and  Beaumont,  and  lastr 
but  not  least.  Dr.  Priestley.     (Applause). 

Dr.  BEA.UMONT  said  it  gave  nim  great  pleasure  to  be  among 
them,  and  he  thoroughly  appreciated  the  courtesy  and  kind 
attention  which  he  had  received  at  their  hands.  He  had 
been  very  greatly  interested  in  the  proceedings  of  the 
Congress,  and  particularly  in  the  address  of  the  President. 
(Applause).  He  had  been  given  to  understand  that  British 
medical  men  were  very  conservative  people,  and  he  must  say 
that  it  came  to  him  rather  as  a  surprise  to  hear  their  Presi- 
dent come  forward  and  state  his  real  views  in  the  able  address 
which  they  had  heard.  The  subject  of  medical  education  was 
one  in  which  he  was  especially  interested,  inasmuch  as  he 
had  just  gone  through  rather  a  severe  fight  in  establishing 
the  teaching  of  homoeopathy  in  the  State  University  of 
Minnesota.  They  had  a  large  tmiversity,  in  which  provision 
had  been  made  for  different  departments  of  instruction.  Law 
was  provided  for,  and  after  it  had  been  added  they  knew  that 
medicine  would  soon  follow,  but  they  were  at  a  loss  to  kaow 
how  homoeopathy  would  get  fisdr  and  equal  representaiion, 
and  they  were  resolved  to  accept  nothing  short  of  equality 
between  the  two  schools.  (Hear,  hear  and  applause).  The 
result  was  that  a  few  of  the  homoeopathic  physicians  of 
Minneapolis  and  St.  Paul  united  their  efforts  and  established 
a  medical  school.  They  obtained  a  charter  from  tbe 
State,  raised  the  necessary  funds  and  started  the  school. 
They  issued  pamphlets  in  the  spring,  and  in  the  fall  they  had 
eight  or  ten  students  pa3ring  them  for  instruction  in  homoeo- 
pathy. After  two  or  three  years  of  hard  work  the  subject  was 
ftgitated  in  the  State  legislature.  A  Bill  was  brought  in 
which  would  have  closed  the  doors  to  homoeopathy  entirely* 
but  of  course  they  had  able  workers  on  their  side,  and  in  the 
end  they  gained  the  day.  (Applause).  The  opposition  Bill 
was  lost,  and,  to  make  a  long  story  short,  they  had  now  a 
university  in  Minnesota,  in  which  there  had  been  from  the 


f^SST^  MEETINGS. 547 

start  fourteen  full  chairs  in  which  homoeopatliy  was  taught- 
(Applause).  They  were  in  the  same  building  with  the 
allopathic  school,  and  he  ventured  to  think,  using  a  vulgar 
expression,  they  were  able  to  keep  their  end  up  admirably. 
They  had  found  no  trouble  or  annoyance  when  cariying  on 
their  work ;  in  fJEwt,  the  authorities  of  the  university  would  not 
allow  it.  The  first  practitioner  in  either  school  who  dared  to 
introduce  any  sarcasm  in  his  lectures  would  be  immediately 
called  upon  to  answer  for  his  conduct.  In  short,  they  had 
egtabhshed  a  splendid  school,  and  in  the  whole  medical 
department  they  had  about  225  students.  Homoeopathy  had 
at  present  only  80,  but  the  number  was  increasing.  The 
corriculam  was  very  long,  three  years  of  nine  months  each  at 
the  start,  and  this  year  they  had  accepted  a  fourth  year  class^ 
estabhshed  by  the  American  Institute  of  Homoeopathy,  making 
four  years  the  full  collegiate  year.  (Applause).  He  ventured 
to  say  that  they  could  do  the  same  thing  in  England.  They 
had  an  admirable  hospital,  and  abundant  material.  They  had 
veiy  able  men  in  their  ranks  who  could  not  be  equalled,  not 
even  in  America  (laughter),  and  a  school  of  medicine  here 
under  the  title  of  "  Hughes,  Dudgeon  &  Co.,  Unlimited," 
would  undoubtedly  achieve  a  thorough  success.  (Laughter 
and  applause). 

Dr.  Priestley,  who  was  cordially  received,  also  responded. 
He  said  he  came  there  that  evening  as  a  guest,  and  he  must 
in  the  first  place  say  that  he  had  been  immensely  delighted 
with  the  entertainment  of  the  evening,  and  felt  proud  to  be 
in  such  an  assembly.  Although  classed  as  one  of  the  opposi- 
tion he  must  explain  himself  a  little.  Some  time  ago  he  was 
in  doubt  whether  he  should  come  over  to  the  homoeopaths  or 
stay  where  he  was  among  the  allopaths,  and  he  must  confess 
that  he  was  strongly  urged  to  go  over  to  homoeopathy.  He 
was  so  by  one  of  their  former  Presidents,  who  very  nearly 
captured  him,  and  would  have  done  so  altogether  had  it  not 
been  for  the  kind  assistance  of  their  present  President,  who 
enabled  him  to  drift  into  another  channel,  one  which  he  felt 
to  be  more  congenial  to  himself,  viz. :  sanitation.  He  had 
drifted  off  into  sanitation  pure  and  simple,  and  hoped  to  stop 
there  all  his  life.  He  felt  that  he  ought  to  take  this  oppor- 
tunity of  thanking  their  President,  who  was  occupying  the 
chair  that  evening,  for  the  great  assistance  he  rendered  him 
in  enabling  him  to  obtain  his  present  position.  Had  he  been 
guided  by  their  former  President  he  should  certainly  have 
become  a  homoeopath  in  the  ordinary  sense.  He  would  add 
that  he  felt  very  much  gratified  by  their  kindness  and  the 
manner  in  which  he  had  been  received.     (Applause). 


548  MEETiNas.  "S22:*?rfl2I' 


Beview,  Aug.  1,  UU. 


Dr.  Hates  C.  Frbngh,  of  San  Francisco,  California,  being 
called  for,  also  responded  for  the  toast.  He  remarked  that 
the  honoured  guest  of  the  recent  American  Congress,  and 
their  honoured  countryman,  Dr.  Bichard  Hughes,  would 
doubtless  have  informed  them  as  to  the  growth  of  homoeopathy 
in  the  United  States,  so  that  he  might  safely  leave  that  im- 
portant duty  in  his  hands.  Accustomed  as  they  were  daily  to 
look  upon  the  ivy-clad  monuments  of  ages,  it  might  not  be 
uninteresting  to  them  to  know  something  of  the  phenomenal 
growth  of  homoeopathy  on  the  Pacific  Slope.  Previous  to 
1848-9  it  had  not  become  the  home  of  the  Anglo-Saxon,  but 
to-day  they  had  more  homoeopathic  physicians  on  the  Pacific 
Coast,  alone,  than  there  were  in  all  the  British  Isles.  Nor 
had  it  been  altogether  smooth  sailing  for  them,  for  during  the 
past  year  they  had  had  a  legal  tilt  with  their  medical  opponents, 
from  which  happily  they  emerged  with  credit,  and  the  positive 
improvement  of  their  standing  before  the  law.  An  effort  was 
made  under  the  stronger  patronage  of  the  old  school  to  enact 
proscriptive  class  legislation  against  them,  but  it  failed,  and 
he  was  glad  to  be  able  to  say  that  it  developed  a  strong  senti- 
ment in  their  favour,  both  on  the  part  of  the  press  and  the 
general  public,  and  once  more  homoeopathy  was  triumphant. 
He  was  also  glad  to  report  that  the  Hahnemann  Hospital 
College  of  San  Francisco,  in  which  he  had  the  honour  of 
representing  the  chair  of  ophthalmology,  was  in  a  flourishing 
condition.  This  briefly  was  their  report  of  homoeopathy  on 
the  Pacific  Coast.  (Applause).  Here  let  him  say  that  he  did 
not  share  the  pessimistic  views  of  some  as  to  the  future  of 
homoeopathy  in  Great  Britain.  Great  as  had  been  their 
growth  in  America,  with  the  fine  literary  advantages  of  this 
country,  and  their  good  old  English  stock  of  persistency  and 
pluck,  they  were  bound  speedily  to  follow.  Dr.  French  then 
greatly  entertained  the  company  with  several  American  anec- 
dotes, finally  saying  that  some  years  ago  one  of  their  Irish- 
American  brethren  was  called  upon  at  the  Court  of  St.  James' 
for  a  toast,  and  gave  the  following,  with  which  he  would  now 

close : — 

*'  Here's  to  the  American  Bivle, 
Proud  borrid  of  freedom,  all  hail ! 
The  fowl  that  no  man  can  invaigle 
Nor  pat  salt  on  his  beautiful  tiul." 

(Laughter).    In  conclusion,  he  thanked  them  very  sincerely 
for  the  manner  in  which  his  health  had  been  received. 

Mr.  W.  H.  Cox,  in  response  to  the  call  of  the  President, 
returned  thanks  for  the  ladies,  and  said  that  on  behalf  of  the 
ladies  he  thanked  them  very  sincerely  for  the  manner  in  whieh 
the  toaf t  had  been  received. 


S^iSTTST'  MBBTlNflS.  549 

—  -  -     ■■  —    ■  -     -    _  ,      ,  ^ ^ ^ ^_      __  — ^ 

Dr.  Bamsbotham,  in  proposing  the  last  toast,  the  health  of 
the  President,  said  he  felt  sure  they  would  agree  with  him 
that  in  electing  Mr.  Harris  to  the  chair  the  Congress  did  itself 
as  much  honour  as  it  did  him.  (Hear,  hear).  No  one  could 
have  listened  to  the  address  which  he  had  delivered  that  day, 
and  marked  the  learning,  the  persuasiveness,  and  the  hope- 
fulness for  the  future  hy  which  it  was  distinguished,  without 
esteeming  it  a  great  privilege  to  listen  to  him.  There  was 
<me  feature  of  their  assembly  this  year  on  which  he  might 
especially  congratulate  their  President,  and  it  was  that  his 
occupancy  of  the  chair  had  been  marked  by  the  largest 
attendance  at  their  annual  dinner  of  which  they  had  yet  been 
able  to  boast,  reaching  the  very  respectable  total  of  101.  He 
had  always  understood  that  101  guns  constituted  an  imperial 
salute,  and  as  most  of  those  present  that  evening  were  great 
gnns  he  thought  the  gathering  marked  an  era  in  their  career. 
He  asked  them  to  drink  with  all  heartiness  the  health  of  their 
President,  Mr.  Henry  Harris.    (Applause). 

The  company  drank  the  toast  with  enthusiasm,  singing  : — 
*'  For  he's  a  joUy  good  fellow." 

The  Pjussn>SNT,'who  was  greeted  on  rising  with  renewed 
applause,  said  it  was  obvious  from  Dr.  Bamsbotham's  speech 
that  he  was  the  odd  one.  (Laughter).  If  his  occupancy  of 
the  chair  was  marked  by  the  fact  that  they  had  a  larger 
attendance  of  guests  at  the  annual  dinner  he  trusted  that  it 
might  be  an  augury  of  better  things  to  come,  and  though  he 
took  an  immense  interest  in  the  general  progress  and  welfare 
of  humanity,  he  had  in  more  fields  than  one  upheld  the  idea 
that  humanity  would  not  prosper  to  its  fullest  extent  unless 
the  whole  of  humanity,  both  men  and  women,  joined  in 
jmmoting  its  elevation.  Therefore  he  was  pleased  to  see 
that  in  one  other  respect  his  occupancy  of  the  chair  was 
marked  by  a  new  departure,  and  that  was  that  in  their 
present  Congress  they  had  invited  the  influence  of  men  and 
women  to  work  together  for  the  progress  of  their  cause.  He 
said  distinctly  that  much  as  both  medical  men  and  laymen 
might  exert  themselves,  a  vast'  deal  more  useful  work 
might  have  been  done  in  persuading  the  public  of  the 
benefits  of  homoeopathy  had  they  but  engaged  the  efforts 
of  women  in  their  cause  (hear,  hear),  and  he  knew  no  better 
method  of  bringing  women  into  this  important  field  of 
action  than  by  putting  them  on  a  position  of  equality  with 
their  lords  and  masters.  (Oh !)  Continuing,  the  President 
said  that  when  last  year  nis  colleajg;ues  placed  him  in  that 
position,  he  felt,  \nthout  any  self -depreciation,  that  they  had 
made  a  mistake.  (No).  If,  by  stirring  up  the  rather  stag- 
];iant  waters,  he  might  have  set  free  some  organisms,  which 


650 MEETINGS,  ''SSS;,^T?!mS! 

would  not  be  poisonous,  but  which  might  be  the  seed  of 
future  growth,  and  which  might  cause  a  more  rapid  spread  of 
homoeopathy  in  this  country  than  they  have  seen  hitherto, 
any  efforts  which  he  had  made  would  be  amply  repaid. 
(Applause).  He  could  not  speak  otherwise  than  seriously 
upon  these  matters.  Perhaps  it  was  not  in  his  nature  to  do 
so.  He  could  not  banish  from  his  mind  the  feeling  that  this 
question  of  homoeopathy  and  its  progress  was  a  question  of 
great  importance  to  the  community  at  large.  He  impressed 
upon  them  most  strongly  that  they  held  in  their  hands  a 
power  capable  of  conferring  upon  humanity  one  of  the 
greatest  possible  blessings  in  the  dehverance  from 
disease.  (Hear,  hear).  He  most  sincerely  and  thoroughly 
believed  that  let  medicine  in  general  progress  as  it  might,  let 
surgery  advance  to  its  utmost  extent,  they  would  not  attain 
to  the  highest  state  of  society  in  this  matter  until  they  had 
brought  about  a  general  belief  in  the  law  of  similars.'  He 
was  conscious  that  after  the  humourous  speeches  they  had 
heard  this  must  seem  to  them  rather  a  heavy  deliverance. 
But  he  could  pleaa  this  as  his  excuse — that  it  was  his  only 
opportunity.  Men  were  not  Presidents  of  Congress  more  than 
once  in  their  lifetime,  and  if  they  let  slip  that  opportunity  of 
impressing  upon  their  brethren  what  was  their  life*s  liuih, 
they  failed,  in  his  opinion,  to  discharge  their  duty  properly. 
(Hear,  hear).  He  was  firmly  convinced  that  one  of  the 
factors  of  human  progress,  moral  progress  indirectly,  but  more 
especially  physical  progress,  one  of  the  factors  which 
would  tend  to  make  a  healthy  nation,  therefore  a 
wealthy  nation,  and  therefore  a  prosperous  nation,  was  that 
which  they  held  in  their  hands  in  the  reform  of  the 
therapeutic  treatment  of  disease.  (Applause).  He  would  not 
detain  them  longer.  There  was  much  to  say,  but  time  failed 
them.  He  must  say,  however,  that  he  had  been  extremely 
gratified  with  the  reception  they  had  given  him.  It  was  with 
no  slight  amount  of  trepidation  that  he  dared  to  put  on  paper 
thoughts  which  he  knew  might  be  unacceptable  to  some 
amongst  them,  because  although  he  loved  a  fight  with  an 
enemy  worthy  of  his  steel  he  should  be  sorry,  indeed,  that 
there  should  be  any  split  or  disunion  in  the  homoeopathic 
camp.  (Applause).  What  he  wanted  to  see  was  that  they 
should  join  hand  in  hand,  stand  shoulder  to  shoulder,  and  fight 
this  battle  as  their  forefathers  had  done  in  the  past,  showing 
themselves  worthy  of  the  trust  that  had  been  conrnoiitted  to  them, 
and  if  they  would  do  that  he  had  no  doubt  that  in  the  not  far 
distant  future  homoeopathy  would  occupy  in  this  countiy 
as  good  a  position  as  it  did  among  their  friends  across  the 
water,  and  that  sooner  or  later  that  union  would  come  aboat 


Jg^fiSrST'  MEETINGS. 661 

which  they  all  desired — only  they  sought  to  attain  it  by 
different  methods — and  that  the  lamb  would  lie  down  with 
the  lion,  but  not  inside  him.  (Laughter).  They  must  not 
allow  the  homoeopathic  lamb  to  be  slaughtered  by  th& 
allopathic  Hon,  but  must  hold  fast  by  their  principles  until 
they  were  acknowledged  by  all  to  be  the  true  principles  of 
medicine.  He  had  no  doubt  that  by-and-bye,  when  their 
allopathic  friends  had  undergone  an  operation,  so  to  speak, 
upon  their  organs  of  mental  vision  they  would  see  this  fact 
clearly,  and  join  with  them  hand  in  hand — one  brotherhood 
and  one  sisterhood  for  the  common  weal  of  humanity. 
(Applause). 

This  concluded  the  toast-list,  and  the  singing  of  **Auld 
Lang  Syne  '*  brought  the  proceedings  to  a  close. 

BRITISH  HOMGEOPATHIC   SOCIETY, 

ANNUAL   ASSEMBLY. 

Thb  Annual  Assembly  of  the  Session  1890-91  was  held  on 
Wednesday,  July  8th,  1891.  Dr.  Dudgeon,  President,  in  the 
chair. 

After  the  reading  of  the  minutes,  the  President  called  on 

Dr.  Hughes,  who  gave  his  report  as  delegate  at  the  Inter- 
national Congress,  which  met  in  Atlantic  City  last  month. 
He  said  the  meeting  was  a  splendid  success.  There  were 
over  five  hundred  members  present.  There  were  five  days  of 
work,  and  three  hours  morning  and  afternoon  of  solid  work 
each  day.  The  arrangements  were  excellent  and  the  time 
was  very  well  occupied.  Whilst  there  was  great  liberality  of 
sentiment,  the  loyalty  to  homoeopathy  displayed  was  of  the 
most  encouraging  kind.  He  brought  back  most  pleasant 
recollections  of  his  visit.  He  spoke  of  the  homoeopathic 
institutions  in  the  States,  and  handed  round  engravings  of 
some  of  them.  The  Hahnemann  Hospital  and  Medical 
School  of  Philadelphia  was  the  finest  medical  institution  he 
had  ever  seen.  It  was  the  unanimous  vote  of  the  Congress 
that  the  next  meeting  should  be  held  five  years  hence  in 
England. 

On  the  motion  of  the  PsEsmsNT,  a  vote  of  thanks  was 
passed  by  acclamation  to  Dr.  Hughes  for  his  attendance  and 
report. 

The  Prestoent  then  delivered  his  valedictory  address,  which 
will  be  found  on  page  493. 

The  address  was  listened  to  throughout  with  the  liveUest 
interest,  and  at  its  close  a  vote  of  thanks  to  the  President 
was  moved  by  Dr.  Dbysdale,  seconded  by  Dr.  Mackechnib 
tod  carried  with  great  enthusiasm. 


-552  MEETINGS.  ^"S^^aTu^. 


BANQUET  TO  MAJOR  VAUGHAN-MORGAN. 

In  the  Whitehall  Rooms,  at  the  Hotel  M6tropole  on  Monday 
night,  July  18,  the  Board,  the  Medical  Council,  the  Medi<»l 
Staff,  and  Governora  and  subscribers  to  the  hospital  united  in 
•entertaining  Major  Yaughan-Morgan,  Chairman  and  Treasurer 
of  the  hospital,  to  a  banquet,  in  recognition  of  his  great  and 
long-continued  services  to  the  hospital  and  the  cause  of 
homoeopathy,  as  well  as  to  congratukkte  him  on  the  attain- 
ment of  a  total  of  £26,000,  for  rebuilding  the  hospital,  and  to 
place  in  his  hands  as  Treasurer  the  further  amount — ^£4,000 
— necessary  to  make  up  the  total  of  £80,000  requisite  for  the 
new  building.  The  Earl  of  Wemyss  and  March  presided  over 
a  large  company,  and  supporting  him  were  :  The  Hon.  Alger- 
non Grosvenor,  General  Beynon,  Sir  Robert  Palmer  Harding, 
Mrs.  Reed,  Mr.  Sidney  Gedge,  M.P.,  Mr.  0.  V.  Morgan,  M.P., 
iuid  Mrs.  Morgan,  Captain  Davies,  Mr.  and  Mrs.  Trapnuum, 
Colonel  Clifton  Brown,  Mr.  G.  Holt  StilweU,  Mr.  Allan 
E.  Chambre,  Mr.  Hugh  Cameron,  Rev.  and  Mrs.  Dacre 
<}raven,  Mr.  Campbell  Wynne,  Mr.  J.  E.  Hofiinann,  Mrs. 
Faskally,  Mr.  and  Mrs.  Hoffiiung.  Mr.  G.  A.  Cross. 

Following  an  excellent  dinner. 

The  Chairman  proposed  '*  The  Queen  and  the  Royal  Family." 
Under  ordinary  circumstances,  he  said,  he  should  have  said 
nothing  except  to  simply  ask  them  to  drink  the  toast  with  all 
the  customary  loyalty.  But  it  had  been  recently  said  of  Her 
Majesty — and  he  could  not  do  better  than  repeat  it — "  Her 
name  will  ever  be  remembered  as  a  noble  character,  and  as  ft 
lady  great  in  the  wisdom  of  her  counsels,  and  whose  reign  has 
conferred  lasting  blessings  on  England."  They  were  noble 
and  true  words,  and  worthy  of  the  occasion  on  which  they 
were  uttered,  and  did  as  great  honour  to  those  who  heard 
them  as  to  the  illustrious  Emperor  who  recently  spoke  them. 
.(Cheers). 

The  toast  was  loyally  Jionoured. 

The  Chairman,  in  rising  to  propose  the  toast  of  the  evening, 
**  The  health  of  Major  Yaughan-Morgan,"  was  received  with 
ioud  and  prolonged  applause.  In  the  first  place,  he  said,  he 
wished  to  lay  before  them  the  reason  why  he  presided  that 
•evening.  About  a  month  ago  he  received  a  letter  from  Lord 
Ebury,  their  President  (cheers),  stating  that  owing  to  bis 
great  age — which  he  (Lord  Wemyss)  had  no  doubt  was 
entirely  due  to  his  having  been  an  homoeopath  (cheers),  he 
^Lord  Ebury)  would  be  unable  to  preside  at  the  banquet 
Lord  Ebury  asked  him  to  preside  in  his  stead,  and  the  request 
was  couched  in  such  terms  as  left  no  possibiHty  for  him  to 


il»UUrH««Bogthi.  MEETINGS.  55S- 


Bavisw,  Aoff.  1, 1801. 


refuse.  Therefore  it  was  that  he  occupied  the  chair  that 
night,  and  that  it  had  devolved  upon  him  to  propose  the- 
b^th  of  their  gnest.  (Cheers).  Well,  he  thought  Major 
Morgan  and  they  also  would  expect  him  to  say  something 
more  as  to  the  position  of  homoeopathy  than  to  sing  their 
guest's  praises.  He  was  sorry  to  say  he  could  look  hack  over 
half  a  century.  (Laughter).  Oreat  changes  had  taken  place 
in  medical  practice  during  those  years.  At  that  time  it  was 
said  at  his  grandiather's  place  that  the  housemaids  kept  them* 
selves  in  tea  and  sugar  simply  by  selling  empty  medicine 
bottles.  Everybody  in  those  days  took  something  like  three 
draughts  a  day.  (Laughter).  It  was  thought  the  right  thing 
to  take  salts  and  senna  in  the  morning,  and  added  his  lord- 
ship-—possibly  from  experience — ^they  might  guess  what  an 
awakening  that  was  for  the  children  in  the  morning* 
(Laughter).  Carlyle  said  men  were  mostly  fools,  and  in  that 
respect  it  was  fortunate  for  the  medical  profession  that  men 
were  fools.  (Laughter).  He  confessed  to  have  been  a  fool 
for  many  years  himself,  as  far  as  medical  treatment  was  con- 
cerned. A  great  change  had  taken  place  ;  all  those  draughts 
were  at  an  end,  and  he  believed  it  was  due  to  the  successful 
practice  of  homoeopathy.  (Cheers).  It  was  Dr.  Quin,  who 
founded  the  hospital,  and  had  done  so  much  to  popularise 
homceopathy  in  London  and  elsewhere,  who  taught  him  thai 
salts  and  senna  in  the  morning  were  not  a  necessity  of  human 
existence.  (Loud  laughter).  This  he  ventured  to  think  had 
been  the  good  result  of  homoeopathy.  Their  medicines  had 
been  cribbed  without  any  acknowledgment,  and  leeches  and 
lancets  had  been  thrown  to  the  winds.  (Applause).  While 
such  was  the  position  at  the  present  moment  of  homoeopathy 
— ^that  it  had  produced  those  great  changes  in  medical  prac- 
tice, a  very  beneficial  change  both  by  example  and  precept — 
it  was  still  misunderstood  and  ignored.  Homoeopathic 
practitioners  were  looked  upon  as  the  pariahs  of  the  medical 
profession  ;  all  public  authorities  ignored  them,  and  they  had 
simply  to  fight  their  way.  More  than  that  they  could  show 
by  statistics,  when  they  looked  to  the  recent  visitation  which 
had  devastated  so  many  districts — ^that  mysterious  disease 
influenza.  So,  too,  when  they  looked  to  the  cholera,  they 
found  the  results  of  homoeopathic  treatment  would  compare 
more  than  favourably  with  any  other  treatment.  Mr.  Henry 
Harris,  President  of  the  Annual  Congress  of  Homoeopathic 
Practitioners,  in  the  excellent  address  delivered  by  him  a  few 
days  ago,  showed  that  the  treatment  of  influenza  by  homoeo- 
pathic doctors  was  far  in  advance  of  that  of  allopathic  prac- 
titioners. Returns,  he  said,  had  been  received  from  fifty-eight 
hmnoBopathic  medical  men,  and  of  the  6,900  cases  treated  not 


■564  MEETINGS.  "SSSL"^:??1SS' 


Beview,  Asg.  1,  IflU. 


one  had  been  lost.     (Cheers).     From  a  book  put  into  his 

handsi  he  saw  the  returns  on  cholera  were  still  more  strikiiig. 

A  gentleman  was  sent  by  Government  to  enquire  into  the 

treatment  in  various  hospitals.     In  his  report  he  said  he 

would  rather  be  treated  in  a  homoeopathic  hospital  by  one  of 

those  physicians  than  by  any  other  medical  man.    (Applause). 

Seeing  the  success  of  the  treatment — truth  was  great — it  did 

not  progress  as  it  should.     What  should  they  do  ?  Mr.  Harris 

said  they  must  assert  themselves.    He  said  the  same,  and  that 

they  should  insist  in  the  new  hospital  on  having  a  medical 

school  iu  which  they  could  show  the  difference  between  the 

systems  and  thus  assert  themselves.    (Loud  cheers).    These 

were  the  days  of  self  assertion,  and  everybody  pleaded  the  right 

to  assert  themselves.    That  surely  was  the  conclusion  of  the 

present  gathering.     Who  would  not  plead  guilty  to  the  soft 

impeachment  ?    Certainly  not  the  ladies ;  for  the  last  right  to 

which  a  woman  has  asserted  herself  was  the  right  to  leave 

her  husband  if  she  did  not  wish  to  live  with  him.    (Laughter). 

He  wished  every  practitioner  to  take  an  example  by  the 

assertion  of  rights  he  saw  around  him.     '*  Form  your  school 

and  build  your  hospital,  assert  your  right  to  enquiry  by 

public  authority  and  appeal  to  Parliament."    (Loud  cheers). 

If  that  was  of  no  effect  they  might  obtain  popular  support  by 

striking.     (Laughter).     Nearly  all  the  great  artistes,  including 

Madame  Albani,  Madame  Nordica  and  Madame  Patti,  believed 

in  homoBopathy ;  and  he  would  say  to  those  doctors  who  had 

the  good  fortune  to  attend  those  artistes,  that  they  should 

induce  them  to    strike  unless  the    public    recognised   the 

admirable    system,  or  until  Parliament  no   longer  turned 

a  deaf  ear  to  the  appeal  to  be  recognised  as  a   school. 

(Laughter  and  cheers).    He  was  preaching  on  behalf  of  a 

system  which  was  right  and  just,  and  which  if  more  widely 

diffused  would  confer  great  benefits  on  the  human  race. 

They  were  about  to  have  a  new  hospital  established  on  the 

site  of  the  old  one,  which  had  already  conferred  such  great 

benefits  on  those  patients  who  had  the  good  fortune  to  be 

treated  there.    The  enlargement  was  wanted ;   the  hospital 

had  now  90  beds,  but  if  there  were  120  beds  they  had  then  a 

right  to  call  upon  the  authorities  to  recognise  them  as  a 

medical  school.     They  were  not  so  now  for  the  reason  he 

had  referred  to,  but  they  could  put  themselves  in  the  right  by 

putting  the  authorities  in  the  wrong.    (Applause).    If  the 

new  hospital  was  as  airy,  as  clean,  as  well  managed,  and  the 

patients  looked  after  as  carefully — especially  the  children — as 

they  were  that  day,  when  he  had  been  to  the  hospital,  there 

was  every  prospect  of  having  a  most  successful  institution. 

Now  he  came  to  what  had  brought  them  together,  and  that  was, 


S^rgr^  MEETIKQ8- 656 

as  they  were  well  aware,  to  do  honour  to  the  man  to  whoee 
exertions  they  owed  the  excellent  results  achieved.  Those 
results  were  mainly,  if  not  entirely,  due  to  the  advice  and  ene^ 
of  Major  Morgan.  (Cheers).  That  he  had  not  known  Major 
Morgan  previously  had  been  his  great  loss.  He  regretted  that 
he  had  only  made  the  acquaintance  of  that  gentleman  that  day, 
but  he  had  heard  much  of  his  hberality  and  energy.  He 
knew  Major  Morgan  had  offered  for  five  years  £1,000  a  year 
to  any  hospital  which  would  set  aside  a  certain  number  of 
beds  for  homceopathic  patients.  That  was  one  of  his  good 
deeds,  and  during  the  fifteen  years  he  had  been  connected  with 
the  institution  he  had  rendered  it  the  utmost  service.  (Loud 
cheers).  He  had  developed  its  resources  and  increased  its 
usefulness  until  it  had  fallen  into  a  state  of  chrysalis  decompo- 
sition, to  revive  into  a  beautiful  and  fully-grown  butterfly. 
(Laughter).  As  his  acquaintance  with  Major  Morgan  had 
been  so  short,  he  could  hardly  deal  adequately  with  his  merits. 
But  in  a  letter  received  from  Lord  Ebury,  regretting  inability 
to  be  present,  the  noble  lord  had  paid  the  highest  possible 
compliment  to  Major  Morgan.  Lord  Ebury  stated  it  was  a 
real  grief  to  him  that  he  was  not  able  to  be  present  that  even- 
ing in  order  to  do  honour  to  a  man  who  had  been  one  of  the 
greatest  supporters  of  the  hospital,  and  one  of  its  ablest  coun- 
cillors. He  doubly  regretted  it,  because  it  happened  at  a 
moment  when  they  had  attained  the  object  of  all  their  desires, 
the  building  of  the  new  hospital.  (Continuing,  the  Chairman 
said  it  seemed  to  him  in  those  days  of  calls  upon  people's 
purses,  by  rival  institutions,  almost  a  marvel  that  any  man 
should  by  any  possible  amount  of  persuasion  or  attraction 
obtain  in  one  year  £26,000.  (Cheers).  Now  in  conclusion 
he  would  simply  ask  them  to  drink  Major  Vaughan-Morgan's 
health,  thanking  him  in  their  name,  and  all  the  patients  who 
had  passed  through  the  hospital  for  the  last  fifteen  years ;  and 
to  remember  that  the  most  practical  manner  in  which  they 
coold  show  their  appreciation  of  his  work  was  by  completing 
ihe  sum  which  was  wanted. 

The  toast  was  musically  honoured  with  great  enthusiasm. 

Major  MoBGAN  on  rising  to  respond  was  most  warmly 
greeted.  He  said  he  had  delayed  rising  until  that  moment 
in  the  hope  that  the  subscriptions  would  have  been 
announced;  that  was  the  programme,  and  he  trusted  that 
before  he  resumed  his  seat  he  should  know  the  result  of  the 
banquet.  His  first  duty  was  to  ask  their  indulgence  and 
consideration  for  the  peouUar  position  in  which  he  stood. 
He  would  not  use  the  hackneyed  phrase  *'  unaccustomed  as  I 
am  to  pubho  speaking,"  but  he  would  say  he  was  no  orator, 
and  following  such  an  able  speaker  as  the  Earl  of  Wemyss 


556 MEETINGS.  "SSfefiSTigg! 

and  March,  he  felt  he  was  at  a  great  disadvantage.  They 
could  not  all  he  orators,  and  his  life  had  been  one  of  activity, 
working,  in  fact,  rather  than  talking.  (Hear,  hear).  He 
had,  of  course,  to  thank  the  noble  Chairman  for  the  kind 
expressions  he  had  used  concerning  him,  and  for  the  kind, 
and  more  than  kind  manner  in  which  they  had  received  those 
remarks.  He  could  not  lay  claim  to  all  that  had  been 
attributed  to  him,  but  he  was  not  going  to  use  another 
hackneyed  expression,  viz.,  "  that  he  altogether  undeserved 
everything  that  had  been  said  " — ^not  because  he  felt  he  did 
deserve  it,  but  because  a  man's  co-workers  were  mach 
more  able  to  discriminate  what  his  merits  were  than 
he  could  himself*  (Applause).  His  personal  inclinations 
towards  public  dinners  were  not  very  strong;  indeed, 
he  had  always  had  an  inherent  objection  to  them. 
Therefore,  when  it  was  suggested  that  a  banquet  should  be 
given  he  declined ;  but  when  it  was  further  suggested  that  the 
object  was  not  only  to  give  him  a  compliment,  but  to  complete 
the  funds,  he  felt  he  could  no  longer  refuse.  (Cheers).  He 
could  not  altogether  acquiesce  in  tixe  statement  of  the  Chair- 
naan,  that  the  grand  results  achieved  were  mainly  due  to  him, 
because  he  had  been  enthusiastically  supported  by  his 
colleagues  on  the  Board  of  Management,  the  medical  staff  of 
the  hospital  and  outside  medical  men,  many  of  whom  were 
present  that  evening.  At  the  same  time,  there  were  outsiders, 
who  were  in  the  homoeopathic  profession,  who  might  have 
helped  more  than  they  had.  He  felt  he  owed  a  great  deal  to 
the  Committee,  who  had  organised  the  banquet.  If  they  had 
succeeded  in  obtaining  the  remainder  of  the  required  sum, 
they  must  have  greatly  exerted  themselves,  and  he  could  only 
say  that  Mr.  Cross,  their  Secretary,  deserved  every  recogni- 
tion, because  his  tongue  had  almost  become  blistered  and  his 
throat  choked  with  the  amount  of  talking  he  had  had  to 
do.  (Laughter  and  cheers).  As  far  as  he  was  concerned, 
he  was  not  going  to  strain  the  question  of  whether  he  was 
deserving  or  not.  His  own  conscience  told  him  that  he  had 
done  what  Lord  Nelson  said  every  Englishman  ought  to  do ; 
it  had  fallen  to  his  lot  in  his  humble  sphere,  and  he  hoped  and 
beheved  he  had  done  his  duty.  (Cheers).  He  could  fully  bear 
out  the  noble  lord  in  the  chair  regarding  his  statements  of 
the  horrible  doses  of  medicine  children  were  often  forced  to 
swallow.  The  whole  world  had  to  thank  Hahnemann  for  his 
discoveries.  If  it  was  permitted  to  the  spirits  of  the  departed 
to  hover  around  them,  and  to  know  what  is  going  on  in  this 
sphere,  what  must  be  the  joy  of  Dr.  Quin,  who  40  years  ago 
founded  the  hospital.  Since  that  time  250,000  patients  had 
passed  through  it  in  one  form  and  another.    Hundreds  of 


i£5£?S?TSS!*'  MEETINGS.  657 


Beriew,  Aug.  1. 1881. 


fives  had  been  saved  and  terrible  sufferings  mitigated.    That 
hospital  had,  however,  served  its  purpose.  The  time  had  come 
when,  through  new  discoveries  with  regard  to  bacteria  and 
bacilli,  &c.,  it  had  been  found  necessary  to  alter  the  structure. 
The  Board  of  Management  had  thought  it  desirable  to  establish 
a  new  hospital.  They  proposed  to  build  one  which  should  have 
all  the  good  quafities  of  the  other  hospitals.    (Cheers).    They 
thought  the  homoeopathic  medical  men,  who  had  a  very  hard 
time  of  it  now  and  then  from  their  brethren — should  at  least 
have  a  good  hospital  so  as  to  show  they  could  bring  about  as 
good  results  as  their  brethren.    They  did  not  refuse  in  the 
hospital  any  case  whatsoever  with  the  exception  of  contagious 
dis^kse.    It  did  not  matter  what  the  disease  was,  it  was  at 
once  taken  in,  and  he  was  going  to  say  "  done  for,"  but  as 
that  was  vulgar  (laughter)  he  would  say  "  and  the  patient 
cared  for."    (Cheers).    In  England,  however,  homoeopathy 
did  not  progress  as  it  should.    He  quite  agreed  with  the 
sentiments  of  the  noble  Chairman  on  the  point,  and  hoped  he 
wonld  carry  out  those  sentiments  by  joining  the  hospital  as 
one    of   the  Vice-Presidents.      Lord  Wemyss  could  be  of 
material  assistance  to  them  in  the  construction  of  the  hospi- 
tal for  he  (Major  Morgan)  had  ascertained  from  his  con- 
versation that  morning  that  the  Chairman    had  splendid 
constructive  abilities.    (Applause).    In  the  United  States  a 
very  curious  state  of  things  existed  as  compared  with  England. 
In  this  country  they  numbered  their  homoeopathic  prac- 
titioners by  hundreds.     In  the  United  States  there  were 
12,000  in  actual  practice,  and  a  great  many  homoeopathic 
medical  schools.    In  England  they  had  not  one,  and  all  their 
medical  men  were  converts.    In  a  country  hke  England  a 
man  usually  kept  to  the  creed  in  which  he  was  brought  up, 
therefore  if  they  could  establish  a  school  it  would  be  a  grand 
undertaking.    In  conjunction  with  Dr.  Bayes,  he  made  about 
ten  years  ago  an  effort  to  establish  a  school,  but  somehow 
or  other  it  failed.    Many  of  them  had  doubtless  heard  of 
Mr.  Andrew  Cam^e,  the  Pittsburg  millionaire.     Well,  the 
other  day  he  read  a  pamphlet  of  his  in  which  he  advocated 
the  distribution  of  a  man's  surplus  wealth  during  his  lifetime. 
He  was  much  struck  by  his  arguments,  especially  as  they 
were    enforced    by  practice.      They  had,  he  was  glad  to 
say,  examples  of  this  practice  also,  and  without  going  out  of 
their  own  sphere   he  could  mention,  as  a  case  in  point, 
Mr.  Henry  Tate.    In  common  with  others  in  the  room,  he 
also  tried  to  carry  the  idea  into  practice,  but  it  was  in  his 
case  by  only  smadl  degrees.    There  was  also  a  lady  amongst 
them  who  carried  out  this  principle,  viz.,   Miss  Duming 
Smith.    (Cheers).    In  alluding  to  the  principle  he  particularly 

VoL  85,  No.  8.  2  b 


668  MEETINGS.  "S^'^Sf!^ 


Reyiefir,  Aug.  1,  UU. 


did  SO  for  one  reason  that  he  entirely  agreed  with  the  principle 
which  Mr.  Carnegie  emphasised  ;  but  he  also  did  so  in  order 
to  inform  anybody  who  heard  him  that  if  they  felt  disposed 
to  hand  him  a  cheque  for  £10,000,  he  would  not  insult  them 
by  refusing  it.  (Cheers  and  laughter)*  Their  scheme 
contemplated  a  hospital  not  much  larger  than  the  present 
one,  but  if  they  had  another  £10,000  they  could  do  a  great 
deal  of  good  with  it.  (Hear,  hear).  In  conclusion  he  would 
quote  a  few  lines  from  Longfellow  on  the  text  that  a  manr- 
however  humble  his  sphere — could  in  that  sphere  do  a  great 
deal  of  good,  and  that  he  should  not  be  deterred  by  the  flBict 
that  his  sphere  does  not  allow  him  to  do  larger  things.  The 
lines  were : — 

"  Lives  of  great  men  all  remind  ns, 
We  can  make  oar  IWes  sublime, 
And  departiDg  leave  behind  us 
Footprints  on  the  sands  of  time. 

Footprints  that  perhaps  another, 

Sailing  o*er  life's  solemn  main, 
A  forlorn  and  shipwrecked  brother, 

Seeing  shall  take  heart  again. 

Let  us  then  be  up  and  doing, 

With  a  heart  for  any  fate ; 
Still  achieving,  still  pursuing. 

Learn  to  labour  and  to  waic" 

Mr.  G.  A.  Cross,  the  Secretary-superintendent,  then  read 
the  list  of  donations,  amidst  great  enthusiasm.  The  total 
amount  subscribed  was  £4,800  2s.,  including  a  cheque  for 
£100  from  the  Earl  of  Wemyss  and  March. 

Major  MoBOAN  then  proposed  the  last  toast,  viz. :  "  The 
Health  of  the  Earl  of  Wemyss  and  March,'*  amidst  loud 
applause.  Before  alluding  to  the  subject  of  the  toast,  he 
wished  to  say  a  few  words  about  Lord  Ebury,  whom  they  all 
regretted  was  unable  to  be  there  that  evening.  (Cheers).  He 
was  well  known  to  them  as  a  most  amiable  man,  and  was 
now  in  the  last  decade  of  a  hundred  years.  He  had  been 
for  more  than  50  years  in  the  front  rank  of  homoeopathy. 
He  thought  the  fact  that  a  gentleman  at  his  time  of  life 
wishing  to  attend  a  banquet  and  expressing  grief  at  being 
unable  to  do  so,  must  be  taken  as  a  great  compliment  to 
them.  Lord  Ebury  had  always  done  his  utmost  for  the 
hospital,  and  his  last  act  had  been  to  secure  them  such  an 
able  Chairman  as  the  Earl  of  Wemyss  and  March.  (Cheers). 
Not  only  was  the  noble  Chairman  an  ardent  homceopathist, 
but  he  was  able  by  his  position  to  give  ''tone"  to  his 
opinions.  It  was  said  that  some  were  bom  great,  others 
achieved  greatness,  while  others  had  greatness  thrust  upon 
them.     He  could  only  say  the  noble  Chairman  was  bom 


SSS'STffi?*  NOTABUJA.  569 


Btriew,  Aug.  1, 1891. 


great  and  had  also  achieved  greatness.  (Cheers).  Lord 
Ebury,  they  had  heard,  was  a  splendid  specimen  of 
faomoBopathic  treatment ;  but  there  were  hundreds  of  others 
also,  and  if  they  wished  for  a  specimen,  they  coald  not  do 
better  than  to  take  the  noble  lord  in  the  chair.  (Applause). 
They  could  congratulate  him  on  being  a  homoeopathist.  As  far 
38  he  (Major  Morgan)  was  personally  corcemed,  he  was 
cQUTinced  that  had  he  not  been  a  homoeopathist,  he  would 
ere  now  have  been  in  another  world.  (Hear,  hear).  Without 
farther  preface,  he  would  ask  them  to  join  with  him  in 
drinking  to  the  health  of  the  Earl  of  Wemyss  and  March, 
and  thank  him  for  being  present  that  evening. 

The  toast  was  warmly  honoured. 

The  noble  Ghaibxan  m  response  said  he  cordially  returned 
thanks  for  the  kind,  but  somewhat  personal  speech  (laughter) 
of  Major  Morgan.  If  he  had  done  anything  of  benefit  to  the 
hospital  he  was  truly  glad.  (Cheers).  He  had  been  asked  to 
become  a  Vice-president.  Well,  he  was  not  an  idle  man,  and 
he  was  afraid  he  could  not  give  much  time  to  the  objects  of 
the  hospital,  but  if  he  could  do  anything  towards  the  new 
hospital  he  would  gladly  do  it.  (Cheers).  He  had  told  them 
a  short  time  ago  that  he  was  a  fool.  (Laughter).  Well, 
flome  said  fools  built  houses  for  wise  men  to  live  in.  For  the 
last  16  years  he  had  been  engaged  in  that  particular  folly,  and 
thus  if  he  had  gained  any  experience  in  construction  it  should 
be  gladly  placed  at  their  service.  (Cheers).  He  congratu- 
lated every  one  present  on  the  great  success  which  had 
attended  the  dinner,  and  on  having  completed  the  sum,  with- 
out which  he  thought  they  had  wisely  determined  not  to  lay 
a  single  brick  or  stone.  He  again  cordially  thanked  them  for 
the  reception  they  had  given  the  toast  of  his  health. 

This  completed  the  list  of  toasts,  and  the  guests  shortly 
afterwards  dispersed. 

During  the  evening  a  choice  selection  of  music  was 
rendered  hy  Mons.  Tivadar  Nach^z  (violinist),  Mr.  Francis 
Walker,  Madame  Guilia  Valda,  and  Mr.  Wilbur  Qunn.  Mr. 
I^an  Watson  cleverly  gave  a  recitation.  The  musical  pro- 
ceedings were  under  the  direction  of  Mr.  Raphael  Boche. 


NOTABILIA. 


SEQUEL  TO  A  CASE  OP  ACUTE  INTESTINAL 
OBSTBUCTION  CUBED  BY  LAPABOTOMY. 

In  the  Monthly  Homceopathic  Review ^  vol.  xxxiv.,  p.  476,  1890, 
is  reported  by  Dr.  Gilbert  and  Mr.  Enox-Shaw,  a  case  of 
acute  intestinal  obstruction,  treated  by  abdominal  section, 

2  b— 2 


560  OBITUABY.  "SS&.^fS?S5* 


Bflview,  Aug.  1,  tan. 


Tnth  a  suocessfol  issue.  A  man,  aged  81,  was  operated  on  by 
Mr.  Knox-Shaw,  in  April,  1890,  for  obstruction  of  a  week's 
duration.  The  patient  quite  recoyered  and  was  able  to  resume 
his  employment  as  a  footman.  A  year  later  he  was  seized 
with  his  old  symptoms  and  notwithstanding  an  operation  he 
Succumbed  to  the  attack.  By  the  courtesy  of  the  Besident 
Medical  Officer  of  the  General  Infirmary,  Worcester,  Mr.  Knox- 
Shaw  is  able  to  report  the  termination  of  this  yery  inteiestiiig 
case. 

It  seems  that  he  was  admitted  into  the  Infirmary  on 
June  1st,  1891,  with  obstruction  of  the  bowels  and  feculent 
yomiting,  the  obstruction  being  of  about  a  week's  duration. 
He  was  operated  on  a  few  hours  after  admission,  an  incision 
being  made  through  the  old  scar,  but  the  omentum  was  found 
so  adherent  that  the  opening  into  the  abdominal  cavity 
through  it  was  abandoned  and  another  incision  made  through 
the  right  linea  semi-lunans.  A  loop  of  small  intestine  was 
found  bound  together  about  two  feet  from  the  caput  casci,  and 
also  a  band  fi'om  the  old  wound  oyer  which  a  portion  of 
intestine  hung.  Both  obstructions  were  released.  About 
two  feet  of  the  intestine  was  in  a  state  of  actiye  peritonitis  and 
yery  congested.  The  operation  was  successful  and  his  bowels 
acted  yery  freely  within  half-an-hour  of  the  operation,  bat 
the  peritonitis  did  not  subside,  and  that,  in  conjunction  with 
a  very  weak  heart,  carried  off  the  patient  on  the  third  day. 

■ -   —  -        - —    -       -      -  ,  ^  —   ■     ■     M^       m  ,1  ■    ■   ■    ^M  I  ■!  ■  ^^„^^^_— . 

STATE  HONOURS. 

We  learn,  from  The  BrtUsh  Medical  Journal,  that  oar 
colleague,  Dr.  B.  London,  of  Carlsbad,  has  received  the  Cross 
of  an  Officer  of  the  Star  of  Boumania. 


OBITUARY. 


WILLIAM  MORGAN,  M.D.,  M.B.C.S.,  OF  CARDIPP. 

We  regret  to  learn  that  our  veteran  colleague  passed  away  on 
Thursday,  the  9th  of  July,  the  day  of  our  Congress  meeting. 
Dr.  Morgan  was  in  his  7drd  year,  but  had  been  in  good  health 
till  last  year,  when  he  met  with  an  accident  on  the  Taff  Yale 
Railway,  which  gave  him  a  shock  from  which  he  never  re- 
covered, and  since  then  his  health  has  been  gradually  £uling. 
He  was  a  native  of  Glamorganshire,  and  the  son  of  a 
clerg3rman.  In  his  profession  he  was  very  popular,  and  his 
genial  temperament  made  him  a  favourite  with  all.  He  will 
he  much  missed  in  Cardiff  and  its  neighbourhood  by  a  wide 


S^r^STS^"        CORRESPONDENCE.  561 

drde  of  friends.  He  praoiised  at  first  in  Brighton^  where  be 
was  physician  to  the  homoeopathic  dispensary.  Subsequently 
be  moved  to  London,  and  was  one  of  the  medical  officers  for 
out-patients  to  the  London  Homoeopathic  Hospital.  After 
removing  to  Cardiff,  he  started  the  South  Wales  Homoeopathic 
Institution,  and  which  he  remained  in  charge  of  till  the  last. 
Dr.  Morgan  was  the  author  of  several  popular  treatises  on 
homoeopathy,  some  of  which  had  a  wide  circulation.  He  leaves 
a  widow  and  two  daughters. 


CORRESPONDENCE. 


THE   NEW  HOSPITAL. 
To  the  Editors  of  the  *•  MowUdy  Homaopathic  Review,^* 

Gbntlehen, — By  the  donations  promised  or  paid  on  the 
occasion  of  the  banqueir  to  Major  Vaughan-Morgan  at  the 
Whitehall  Booms,  Hotel  M6tropole,  on  the  18th  ult.,  under 
the  Presidency  of  the  Earl  of  Wemyss  and  March,  amounting 
to  £4,800,  the  fund  for  rebuilding  this  hospital  has  been 
carried  over  the  total  originally  proposed — £80,000. 

This  sum,  the  largest  ever  contributed  to  further  the  cause 
of  homoeopathy  and  confer  its  advantages  on  the  poor,  oon-« 
^uded  by  the  largest  sum  ever  raised  at  any  festival  of  the 
hospital,  the  whole  having  been  promised  within  the  short 
space  of  twelve  or  fourteen  months,  provides  a  standing 
answer  to  the  suggestion  that  homoeopathy  has  ceased  to  pro- 
gress, or  that  the  public  estimation  of  its  worth,  or  the  public 
enthusiasm  for  its  development,  has  died  away. 

Although  munificent  sums  have  been  contributed  by  con* 
stant  supporters  of  the  hospital,  the  Board  of  Management 
gladly  recognise  that  so  large  a  sum  could  hardly  have  been 
raised  in  so  short  a  time  without  the  active  co-operation  of 
members  of  that  section  of  the  medical  profession  practising 
homoeopathy. 

This  co-operation,  in  response  to  repeated  appeals,  has  been 
forthcoming  from  every  member  of  the  medical  staff,  and 
from  medical  men  in  every  part  of  the  United  Kingdom. 

I  am  therefore  desired  by  Major  Vaughan-Morgan  and  the 
Board  of  Management  to  tender,  through  the  medium  of  your 
Journal,  their  cordial  and  grateful  aclmowledgments  to  those 
members  of  the  medical  profession  who  are  ti^us  represented 
in  this  fund,  and  who  will,  in  consequence,  be  represented  in  the 
new  hospital,  which  is  being  designed  by  the  architect, 
Mr.  Wm.  Pite,  of  Bloomsbury  Square,  and  which,  occupying 
the  site  of  the  present  building,  will  form  a  striking  testimony 


662 C0RRE8P0NDEKCE.        ^T^^IZT^- 

in  the  metropolis  to  the  reality  and  the  advantages  of  homoeo- 
pathic science. 

The  Board  cannot  tender  these  public  acknowledgments  to 
those  numerous  medical  friends  who  have  exerted  their  beet 
influences  for  this  new  hospital — ^many  of  them  having  local 
interests  and  local  institutions  to  consider — ^without  an 
expression  of  regret  that  a  considerable  proportion  of  the 
homceopathic  medical  body  have  refrained  from  recognising 
the  force  of  any  and  every  appeal  to  them  to  participate  in 
this  movement  (which  will  certainly  commence  a  new  epoch 
in  the  history  of  the  struggle  of  homoeopathy  for  its  proper 
status  in  medicine),  and  have  allowed  the  present  gratifying 
result  to  be  achieved  without  their  sligiitest  sign  of  effort  or 
of  interest. 

This  curious  apathy  has  made  the  more  distinguished  the 
activity  of  those  who  are  so  liberally  represented  in  the  fond, 
and  intensifies  the  gratefal  appreciation  felt  by  the  chairman 
and  the  board,  as  to  the  successfal  aild  hearty  co-operation  of 
medical  friends  in  the  metropolis  and  in  far  distant  parts  of 
the  kingdom. 

The  board,  however,  cherish  the  hope  that  should  they  find 
it  desirable  to  adopt  certain  propositions  now  being  urged 
upon  them  for  the  yet  farther  development  of  the  hospital 
(which  would  necessitate  an  additional  sum  of  £10,000), 
those  members  of  the  medical  profession  who  have  refrained 
from  co-operation  on  this  occasion,  may  yet  consider  that  the 
welfare  of  a  small  and  militant  body,  like  the  homoeopathic 
medical  profession,  depends  upon  absolute  unity  of  idea  and 
action,  and  that  individual  isolation  cannot  bring  about  the 
advancement  of  the  general  cause. 

Permit  me  to  repeat  once  more  to  the  medical  Mends  of 
the  hospital,  collectively  and  individually,  the  most  cordial 
recognition  and  thanks  of  the  chairman  and  the  board. 

I  am.  Gentlemen, 

Very  faithfully  yours, 

G.  A.  Geoss, 

Secretary-Superintendent.^ 

London  Homoeopathic  Hospital, 
Great  Ormond  Street, 

Bloomsbury,  W.C. 

To  tlie  Editors  of  the  **  Moivthly  Homceopathic  Beview.'* 

Gentlemen, — Having  devoted  my  Presidential  address  at 
the  Congress  held  in  1880  to  an  examination  of  the  con- 
dition of  our  Materia  Medica,  and  having  at  the  same  time 


BgffirSJSy^        COBBESPONDENCE, 563 

offered  some  suggestions  for  its  improvement,  I  naturally  feel 
a  lively  interest  in  any  movement  having  that  object  in  view. 
Hence  I  venture  to  ask  you  to  spare  me  a  comer  in  your 
journal,  to  congratulate  the  members  of  the  revising  committee 
on  the  excellent  work  they  have  done  in  the  production  of  the 
Cyclopadia  of  Ihnuf  FatJiofjenestj,  and  on  its  virtual  completion. 
It  is  no  small  achievement  to  have  brought  the  contents  of 
Allen's  ten  volumes  of  symptoms,  to  say  nothing  of  other 
provings,  within  the  compass  of  four  volumes ;  and  to  have 
reduced  the  n amber  of  medicines  from  650  to  about  half  that 
number.  We  owe  the  committee  a  deep  debt  of  gratitude  for 
the  large  amount  of  time,  thought,  and  patient  perseverance 
they  must  have  devoted  to  the  laborious,  and,  I  should  think, 
uninteresting  task.  None  of  us,  I  imagine,  will  feel  disposed 
to  sympathise  with  Dr.  Proctor,  in  his  regret — as  expressed 
in  your  last  issue — at  the  exclusion  from  the  Cijclopmlia  of  so 
many  drugs  that  find  a  place  in  Allen's  and  other  works.  If 
I  have  any  regret  at  all  in  the  matter  it  is  that  the  process  of 
rejection  was  not  carried  somewhat  further ;  for  it  cannot 
be  denied,  that  after  all  that  has  been  effected  a  good  many 
medicines  are  retained  that  have  no  title  to  be  admitted  to 
fellowship  with  recognised  homoeopathic  remedies,  as  well  as 
a  host  of  symptoms  that  it  is  difficult  to  believe  ever  had  any 
existence  except  in  the  imagination  of  the  prover.  This 
difficulty  will  never  be  got  over  until  many  of  our  medicines 
have  been  submitted  to  careful  and  exhaustive  re-proving. 
We  may  then  look  for  a  real  Materia  Medica  pura. 

Still,  considering  all  the  circumstances  of  the  situation, 
which  was  a  delicate  and  difficult  one,  more  could  not 
reasonably  be  looked  for  than  has  been  accomplished. 
Nevertheless,  one  may  be  allowed  to  express  a  hope  that 
in  any  future  editions  of  the  Cyclopadia^  the  pruning 
knife  will  be  applied  until  the  number  of  our  remedies  is 
brought  down  within  manageable  hmits.  All  we  require 
in  treating  ninety-nine  cases  in  a  hundred  is  a  selection 
from  our  grand  old  remedies  of  a  comparatively  small  number 
of  well  proved,  well  tried,  strongly  marked  medicines.  And 
this,  I  am  persuaded  from  extensive  observation,  is  all  that 
most  of  us  aim  at  or  require. 

In  the  meantime  let  us  be  duly  grateful  for  past  favours, 
and  patiently  wait  for  more. 

Yours  faithfully^ 

S.  Yeldham. 


564  CORRESPONDENTS.       ^'SSlL^Tffi* 


Bevi0W,AiiK.l,ttBL 


NOTICES   TO   CORRESPONDENTS. 

*«*  We  cannot  undertake  to  return  rfjeeted  mantueripts. 
Authors  and  Gontbibutobs  reoeivinf^  proofs  are  reqaested  to  oomct 

and  retnrn  the  same  as  early  as  possible  to  Dr.  Edwin  A.  NBiiTBT. 

London  Homoeopathic  Hosfital*  Great  Obmond  Street, 
Bloombburt.— Hours  of  attendance :  Medical,  In-patients,  9.30 ;  Oat- 
patients,  2.80,  daily ;  Surgical,  Mondays  and  Thursdays,  2.30  ;  Diseases 
of  Women,  Tuesdays  and  Fridays,  2.30  ;  Diseases  of  Skin.  Thurdays, 
2.30  ;  Diseases  of  the  Eye,  Thursdays,  2.30  ;  Diseases  of  the  Ear,  Satur- 
days, 2.30  ;  Dentist,  Mondays,  2.80  ;  Operations,  Mondays,  2. 

Communications  have  been  received  from  Dr.  Thomas  (Llandudno), 
Dr.  Yeldhah,  Dr.  Robebson  Day,  Mr.  Knox  Shaw.  Dr.  Washington 
Epps,  Dr.  Bubford  (London),  Dr.  Hughes  (Brighton),  Dr.  Murray 
Moore  (Liverpool),  Mr.  Crubs  (London),  the  Publishers  of  the 
British  and  Colonial  Druggitt  (London). 

We  greatly  regret  that  owing  to  the  conjunction  in  time  of  the 
Annual  Meeting  of  the  British  HomcBopathic  Society,  the  Congress  and 
the  American  latemational  CoDgpress,  we  are  compelled  to  postpone  a 
very  interesting  report  of  the  latter  by  Dr.  Hughes,  till  our  next  issuer 
The  papers  read  at  the  Congress  have  also,  for  the  same  reason,  to  be 
deferred.  Also  papers  by  Drs.  M.  Cash  and  Alexander,  which  ard 
in  type. 

BOOKS    RECEIVED. 

Modem  Materia  Mtdica,  By  H.  Helbing,  P.C.S.  1891.  British  and 
Colonial  Druggist.  London. — Text  Booh  of  Materin  Mediea  and 
Therapeuticfi,  By  A.  C.  Cowperthwaite,  M.D.  Sixth  edition.  Chicaga 
1891.— rA«  Drug-Proving  of  th^i  Future,  By  Richard  Hughes,  MJ). 
— ^Homoeopathic  League  Tracts.  No.  36.  Ilofnoeopathy  and  Blood- 
Letting.  London  :  J.  Bale  &  Sons. — The  Therapist,  June.  London. — 
The  llomcgopathi^  World,  July.  London. — T?ie  Chemigt  and  Bntggist, 
July.  London. — The  Monthly  Journal  of  Pharmacy,  July.  Landon. 
— AddreM  to  the  Inter natioiuil  HonnoBopathio  Congress  of  1891.  By 
E.  E.  Dudgeon,  M.D..  Honorary  President.  Papers  from  the  Anti-Vivi- 
section Society.  London. — Tlve  North  American  JoumaZ  of  Hommo- 
pathy.  June.  New  York. — The  Hahncmannian  Monthly.  July.  Phila- 
delpbia. — Tfic  Clinique.  June.  Chicago. — 77w  Homaopathic  Journal 
of  Obstetrics,  July.  New  York. — The  PhiladrJphia  Inquirer,  June 
17-23. — Tluf  Ilomasopathie  Physician.  July.  PMladelphia. — Southern 
Journal  of  HtyfntBonathy.  June.  New  Orleans. — Th4^  Medical  Record, 
June  13,  20,  27.  July  4  and  11.  New  York,— The  California  Homoeo- 
path. June.  San  Francisco. — The  Medical  Current.  July.  Chicago. 
^—The  Medical  Argus.  June.  Minneapolis. — IIomeBopathic  Entoy^ 
July.  Lancaster,  X/.S.A. — Kali  Cfiloricum,  A  Lecture  by  C.  S,  Mack, 
M.D.  Ann  Arbor. — The  Medical  Adrancr,  June.  Chicaga — The  New 
Yorh  Medical  Times.  July. — The  Medical  Era.  July.  Chicago. — 
Ret^ie  Uoma^opathique  Beige.  April.  Brussels.— ^viZ.  Gen.  de  l%ih^' 
peutiqtie,  June  and  July.  Paris. — La  Medicine  Hypodcrmique,  May. 
Fans. — Allgcm.,  ffovh.  Zeitung.  July.  Leipzig. — Populdre  Zeitsehrift 
fur  Horn oopathie.  July.  Leipzig. — Homasop€^hi^oh  Maandhlad.  Jnlylu. 
Gravenhage. — Riri»ta  Omicpatica,  June.  Bome. — Gazctta  Medica  JH 
Torino,  June  and  July.  Torino.    New  England  Medical  Gazette,  July. 

Papers,  Dispensary  Reports,  and  Books  for  Beview  to  be  sent  to  Dr.  Pops,  19, 
Watergate,  GrantUaxn,  Lixfcolnshire ;  Dr.  D.  Dycb  Bbowx,  29,  Beymonr  Street,  Port- 
man  Sqnare,  W.;  or  to  Dr.  Edwix  A.  Nbatby,  161,  Haventock  Ilill,  K.W.  Advertise- 
ments and  Bnsinem  communications  to  be  sent  to  Meoars.  E.  Gould  ft  Sov,  fi9« 
Moorgate  Street,  £.0. 


SSt^sST^**  IODIDE   OF  POTASSIUM.  565 


THE    MONTHLY 

HOMCEOPATHIC    REVIEW. 


I 

!  :o:- 


OBSERVATIONS  ON  THE  ACTION  OP  IODIDE  OP 
POTASSIUM  IN  TERTIAEY  SYPHILIS.* 

By  C.  Knox  Shaw,  M.R.C.S. 

If  there  is  one  fact  that  stands  out  clearly  amidst  the 
general  unbelief  in  the  action  of  remedies,  it  is  the 
nniyersal  acceptance  of  the  curative  power  of  the  iodide 
of  potassium  in  tertiary  syphilis. 

I  am  referring,  of  course,  to  those  late  manifestations 
of  syphilis  which  are  characterised  by  the  local  fibroid 
degeneration  surrounding  a  more  elastic  and  rather 
softer  matter  which  distinguishes  the  gummatous  deposit. 

Though  the  efficacy  of  the  power  of  the  iodide  is 
acknowledged,  yet  the  explanation  of  its  action  is  various 
and  unsatisfactory.  I  do  not  propose  to  discuss  the 
probabilities  of  the  theories  advanced,  but,  as  a  matter 
of  interest,  will  merely  mention  one  or  two.  "  The 
iodine  set  free  from  the  iodide  is  taken  up  by  albuminous 
substances,  and  the  entrance  of  the  iodine  molecule  into 
their  composition  causes  them  to  undergo  more  rapid 
metamorphosis.  Gummatous  deposits  appear  to  be 
especially  affected  in  this  way."  .  (Brunton).  "The 
beneficial  action  of  iodide  of  potassium  may  be  due,  in 
part  at  least  (when  mercury  has  been  given  in  the  earlier 

*  Bead  at  the  British  HomoBopathio  Gongress,  London,  Jul/,  1891. 
YoL  85,  No.  9.  2  s 


666  IODIDE   OF   POTASSIUM.   "^SSS^ 


Beview,  Sep.  1«  IflU. 


stage  of  the  disease) ,  to  its  again  liberating  part  of  the 
mercury  which  has  been  in  a  state  of  more  or  less 
dormant  combination  with  some  of  the  tissues." 
(Brunton).  Some  who  otherwise  cannot  explain  its 
action,  speak  of  it  as  a  ''  specific." 

Most  writers  on  homoeopathic  therapeutics  acknow- 
ledge the  power  of  the  iodide  to  remove  tertiary  deposits, 
but  are  unable  to  claim  this  action  as  an  illustration  of 
the  law  of  similars.  Dr.  Hughes  says  that  "the 
indications  for  its  use  must  not  be  looked  for  in  its 
pathogenesis !  Dr.  Trites,  in  his  article  on  Syphilis  in 
Amdt's  System  of  Medicine^  writes :  How  the  iodiiei 
act  in  tertiary  syphilis  is  an  open  question,  but  the 
action  is  certainly  dependent  upon  the  rapidity  with 
which  it  finds  its  way  into  and  out  of  the  blood.'' 
Dr.  Madden  in  the  British  Journal  of  Homosopathy^  vol. 
26,  p.  415,  expresses  the  opinion  that  ''  the  cure  of 
tertiary  syphilis  by  the  iodide  of  potassium  is  specific 
but  not  homoeopathic,"  and  himself  inclines  to  the  view 
that  the  new  growths  are  quasi-parasitical,  and  that  they 
are  removed  by  the  parasiticidal  action  of  the  drag. 
Dr.  Allen  too  is  unable  to  attribute  its  action  to  its 
homoeopatbicity  to  the  disease. 

As  far  as  I  can  judge  the  reason  for  giving  the  above 
opinion  arises  from  the  fact  that  in  the  pathogenetic 
action  of  the  drug  no  conditions  have  been  produced 
that  are  in  any  way  similar  to  the  manifestations  of 
tertiary  syphilis.  On  carefully  studying  the  article  on 
Iodide  of  Potassium  in  the  Cyclopaedia  of  Drug  Paiho- 
genesy,  it  is  very  evident  that  few  observations  are  there 
recorded  that  help  us  in  this  matter.  Bicord's  state- 
ment that  when  the  drug  had  been  given  in  strong 
doses  in  a  cas.e  of  cancer  of  the  face  he  had 
seen  a  rupia — ^like  rupia  cachectica — develop  on  the 
legs  and  forearms,  seems  to  be  the  only  inkling 
we  get  of  the  action  of  the  iodide  upon  the  deeper  tissues. 
The  amount  of  the  drug  used  in  all  the  cases  was  either 
frequent  small  doses  or  a  few  large  but  seldom  repeated 
ones.  I  was  therefore  content  to  leave  the  action  un* 
explained  until  I  read  Mr.  Hutchinson's  very  interesting 
book  on  Syphilis,  p.  304,  published  by  Cassell  &  Co.,  in 
1887,  when  I  came  across  the  following.  "  On  cases  of 
poisoning  by  the  iodide  of  potassium.  The  eruptions 
which  occur  in  connection  with  iodide  of  potassium  are 


ISSlSijS^^^iSn!^    IODIDE   OP   POTASSIUM-  567 

very  varioas  in  character,  and  some  of  them  closely 
resemble  in  appearance  those  due  to  syphilis.  Thus 
miBtakes  may  very  easUy  occur,  and  the  remedy  may  be 
poshed  in  the  hope  of  caring  symptoms  of  which  it  is 
itself  the  cause.  I  believe  that  I  have  known  more  than 
one  case  in  which,  where  this  mistake  was  made,  a  fatal 
result  followed.  For  when  the  depression  from  the 
iodide  has  reached  a  certain  point  and  been  continued 
for  a  certain  time,  the  system  recovers  with  difficulty  or 

not  at  all  when  it  is  discontinued It  is  a 

carious  fact  that  these  eruptions  on  the  skin  in  many 
cases  begin  immediately  after  the  first  few  doses,  now 
and  then  a  single  dose  is  quite  sufficient  to  bring  them 
out.     They  may  occur  at  any  age,  and  are  often  very 

severe  in  the  young An  acne  eruption, 

occurring  on  the  face  first  and  subsequently  on  the  body, 
is  by  far  the  commonest  of  the  iodide  eruptions,  but  is 
not  the  only  one.  The  eruption  may  be  vesicular,  or 
bullous,  or  flat-topped  tubers,  such  as  we  see  more 
frequently  after  the  use  of  the  bromide.  Speaking 
generally  I  know  of  no  rules  whereby  an  iodide  rash 
can  be  distinguished  from  the  bromide.^' 

Hutchinson  remarks  upon  the  idiosyncrasy  of  some 
persons  to  the  action  of  the  iodide.  In  some  a  grain  or 
two  will  produce  iodism,  and  in  others  drachm  doses  or 
even  more  will  produce  no  apparent  harmful  effect.  He 
has  known  cases  cured  by  a  third  of  a  grain,  and  others 
requiring  an  ounce  and  a  half  in  the  twenty-four  hours. 
Here  was  indeed  food  for  reflection  and  though  not 
exactly  establishing  the  relationship  between  tertiary 
syphiUs  and  iodide  of  potassium^  yet  it  opened  the  door 
to  the  probability  of  there  being  a  similarity  between  the 
disease  and  the  drug.  This  probability  was  further 
strengthened  by  the  publication  by  Mr.  Hutchinson  of 
two  plates  in  the  first  volume  of  his  Archives  of  Surgery, 
These  plates  ai'e  so  interesting  that  I  ask  you  to  study 
them,  and  I  venture  to  assert  that  if  any  one  here 
present  were  called  upon  to  diagnose  such  a  case,  his 
opinion  would  most  probably  be  that  it  was  undoubtedly 
the  manifestations  of  tertiary  syphilis. 

I  do  not  think  that  I  can  do  better  than  quote  the 
remarks  that  accompany  the  plates.  These  two  portraits 
''belong  to  the  same  case,  and  illustrate  the  most 
Exaggerated  form  of  iodide  of  poUusium  eruption  which  I 


568  IODIDE   OF   POTASSIUM.   ^^L^ST?^ 


Beriew,  Sep.  1,  ISBL 


haye  ever  seen.  I  do  not  think  that  there  could  be  any 
reasonable  doubt  that  the  huge  tuberous  masBee  here 
depicted  were  really  the  result  of  the  use  of  the  iodide. 
As  such  I  diagnosed  them  before  knowing  anything  of 
the  man's  antecedents,  and  subsequent  enquiry  con- 
firmed the  suspicion.  It  will  be  observed  that  they  are 
very  similar  in  all  local  characters  to  others  which  have 
been  not  unfrequently  observed  after  the  use  of  the 
iodides  and  bromides,  differing  simply  in  the  size  attained. 
The  explanation  of  the  very  large  size  of  the  growths  in 
the  present  case  was  to  be  found  in  the  fact  that  the 
dose  of  iodide  had  been  steadily  increased  as  the  eruption 
advanced. 

"  The  patient  was  a  man  aged  twenty-six,  who  was 
admitted  in  the  London  Hospital  much  in  the  same 
condition  shown  in  the  portraits.  The  latter  were,  indeed,, 
taken  on  the  day  after  his  admission.  He  died  from 
exhaustion  a  few  days  later.  On  enquiry  at  the  hospital 
in  which  the  man  had  been  treated  before  he  came  to  us, 
it  was  ascertained  that  he  had  been  admitted  there  on 
account  of  some  swelling  of  the  groin,  which  was 
diagnosed  as  syphilitic.  He  had  at  that  time  no  skin 
eruption  whatever.  Iodide  of  potassium  in  five-grain 
doses  was  at  once  ordered.  An  eruption  soon  began  to 
appear,  and  as  it  was  considered  to  confirm  the  diagnosis 
of  syphihs  the  iodide  was  increased  to  ten  grains  at  the 
end  of  a  week.  Ten  days  later  it  was  increased  to 
fifteen,  and  later  still  to  twenty.  He  continued  it 
without  intermission  from  July  the  23rd  to  October  the 
9th,  when  mercury  was  substituted.  The  eruption  had 
been  steadily  getting  worse  the  whole  time,  but  as  it 
had  been  throughout  considered  to  be  syphilitic  the 
specific  had  been  pressed. 

''  On  careful  enquiry  I  did  not  think  that  there  was 
much  reason  to  suspect  that  the  man  had  really  had 
syphilis.  He  lived  for  about  a  fortnight  after  the  iodide 
was  completely  left  off,  but  during  this  time  no  material 
change  occurred  in  the  eruption.  He  was  in  all 
extremely  feeble  condition  the  whole  time;  and  his 
death  was  from  exhaustion.  The  microscope  was 
carefully  used,  but  revealed  nothing  of  importance," 
Huchinson  further  suspects  that  not  a  few  cases  which 
have  been  classed  as  cutaneous  gummata  in  connection 
with  syphilis  have  been  really  examples  of  iodide  of 


^SSSr^TSf*'    IODIDE   OP   POTASSIUM.  569 

potassium  eraption,  and  not  only  is  it  necessary  in  the 
diagnosis  of  syphilitic  gummata  of  the  skin  to  first 
ehminate  iodide  eruptions,  bnt  the  same  remark  appUes 
to  the  various  conditions  which  have  been  grouped 
together  under  the  name  of  "  granuloma  fungoides." 

It  must  be  very  rarely  indeed  that  we  can  get  such 
evidence  of  the  action  of  large  and  oft-repeated  doses, 
and  I  have  tried  to  confirm  this  action  by  reference  to 
^ther  cases.  In  my  researches  I  have  been  very 
materially  indebted  to  a  work  by  Dr.  Prince  Morrow,  of 
New  York,  published  in  1887,  entitled  Dnig  Eruptions  ; 
and  I  would  commend  this  book  to  the  notice  of  the 
editors  of  the  Cyclopedia  of  Drug  Pathogenesy.  The 
chapter  on  Iodide  of  Potassium  shows  that  Dr.  Morrow 
has  made  very  extensive  investigations  into  the  subject, 
and  from  his  bibliographical  references  I  have  been  able 
to  trace  to  their  original  sources  many  of  the  articles 
therein  referred  to. 

I  do  not  intend  to  refer  to  the  manifestations  of  iodism, 
which  are  so  well-known  to  us  all,  but  to  pick  out  such 
cases  as  I  hope  will  throw  light  on  the  subject  of  this 
paper ;  nor  do  I  propose  to  weary  you  on  an  occasion 
like  this  with  tedious  details  of  symptoms.  If  the 
suggestions  of  this  paper  are  of  any  value  the  compilers 
of  our  Materia  Medica  will  naturally  refer  to  the  articles 
themselves  for  the  necessary  information.  So  may  I  ask 
your  attention  for  a  few  moments  to  some  interesting 
records  of  the  pathogenesis  of  the  iodide  of  potassium. 

In  addition  to  the  rupial  sores  described  by  Bicord,  he 
has  further  noticed  a  nodular  erythema  (Bullet,  de 
Therapeutique,  t.  xxiii.,  p.  162,  1842).  Celso  Pellizzari, 
in  a  paper  in  the  Archives  of  Dermatology^  July,  1881, 
p.  268,  on  some  phases  of  the  pathogenetic  action  of  the 
iodide,  reports  a  case  where  a  man,  aged  80,  was  for 
some  syphilitic  symptoms  ordered  fifteen  grains  of  iodide 
of  potassium  each  evening  and  some  mercury  during  the 
day ;  the  latter  he  soon  left  off,  but  he  continued  the 
iodide,  from  March  20th  to  April  14th  when  he  became 
very  ill  and  was  admitted  for  what  was  supposed  to  be 
glanders.  He  had  many  large  inflammatory  nodular 
masses  varying  in  size  from  that  of  a  nut  to  an  apple, 
seated  in  the  subcutaneous  cellular  tissue.  The  nodules 
were  round  and  situated  under  the  skin,  so  much  so  that 
the  latter  did  not  take  part  originally  in  the  morbid 


670  IODIDE   OP  POTASSIUM.  "Ig^^gS^ 

process.  Abscesses  formed,  but  healed  slowly  and  left 
cicatrices.  On  omitting  the  iodide  the  eruption  departed 
but  recurred  each  time  the  drug  was  repeated. 

In  the  same  paper  Professor  Pietro  Pellizzari  is  stated 
to  have  seen  a  patient  in  whom  the  iodide  produced 
inflammatory  masses  in  the  subcutaneous  cellular 
tissue ;  and  another,  a  lady,  in  whom  he  could  cause  the 
reappearance  of  nodules  at  any  time,  as  large  as  a  fist, 
by  giving  the  iodide.  Celso  Pellizzari  agrees  that  the 
rupioid  form  is  certainly  much  less  frequently  met  with 
than  the  urticarial. 

Besnier  (Annates  de  Derm,  et  Syph.  1882)  had  a 
patient,  a  man,  aged  40,  who  consulted  him  for  an 
eruption  on  the  palm  of  the  hand,  which  was  very 
difficult  of  diagnosis,  but  for  which  he  gave  him  two 
grammes  of  the  iodide  of  potassium  daily.  This  was 
followed  in  a  week  by  an  eruption  on  the  face  and 
thorax  of  veritable  tumours,  varying  in  size  from  a 
small  to  a  large  pea.  They  were  of  a  reddish  coppery 
hue,  flabby,  almost  fungous,  and  presenting  punctate 
depressions.  Incision  only  gave  exit  to  blood.  A 
similar  condition  was  observed  in  a  woman,  aged  65. 

Dr.  Valanur  observed  (Journal  of  Cutaneous  and 
Venereal  Diseases,  1884),  in  a  woman,  aged  49,  with 
mitral  disease,  who  had  been  given  for  four  days  two- 
and-a-half  grammes  of  the  iodide,  that  she  was  attacked 
with  acute  pain  in  her  buttocks,  thigh,  calf  of  leg,  and 
in  the  dorsal  region.  Then  there  appeared  upon  the 
parts  small  indurated  nodules  of  the  size  of  a  nut  of  a 
deep  red  colour,  and  readily  appreciated  by  palpation. 
During  three  days  they  developed  in  size,  one  or  two 
attaining  the  volume  of  an  egg.  The  iodide  was 
repeated  three  times,  and  after  each  repetition  the  same 
syinptoms  appeared. 

Talamon  (Joum.  de  Med.  et  Chir.  1885)  reports  the 
case  of  a  woman  in  whom  two  and  a  half  grammes  of 
the  iodide  produced  an  eruption  resembling  erythema 
nodosum. 

Hallopeau  (L*  Union  Medical,  1885)  observed  the 
development  of  painful  nodes  in  one  of  his  patients, 
which  was  repeated  every  time  he  took  the  iodide  of 
potassium.  The  tumours  were  oval  in  shape,  reddish  at 
the  surface,  and  painful  on  pressure ;  they  were  chiefly 


r 


S^B^Jt^SSu*   K)I>n>E   OF  POTABSTOM.  671 

■_  .         * 

sitaated  over  the  anterior  surfEUse  of  the  thighs.     She 
also  had  iodic  purpura. 

Dr.  Prince  Morrow  himself  lost  a  patient  from  iodide 
poisonings  where  tubers  were  developed,  but  there  was 
much  more  general  dermatitis  than  in  Hutchinson's  case. 

Dr.  Fox  says  {Trans.  Clin.  Soc.,  vol.  xi.)  that  he  has 
often  been  consulted  for  supposed  syphilis,  when  the 
disease  has  been  simply  an  iodide  rash.  Dr.  Morrow,  too> 
asserts  that  cases  of  iodide  poisoning  ''  have  been  mis- 
taken for  syphilis,  and  the  iodide  may  be  continued, 
possibly  in  increasing  doses,  for  the  very  condition  which 
it  has  caused." 

I  think  I  may  fairly  say  that  these  records  establish 
the  fact  that  there  is  in  the  pathogenetic  action  of  the 
iodide  of  potasmtm  a  condition  markedly  similar  to  the 
tertiary  manifestations  of  syphilis.  The  evidence  I  have 
adduced  is  not  biassed,  as  in  none  of  the  cases  was  an 
attempt  made  to  prove  the  drug  with  preconceived 
notions  as  to  its  action,  but  the  symptoms  occurred 
during  the  administration  of  the  drug,  and  in  most  cases 
the  action  was  verified  by  the  withdrawal  and  renewal 
of  the  drug. 

The  study  of  the  subject  brings  out  strongly  one  or 
two  very  interesting  points,  to  which  I  wish  for  a  moment 
to  draw  your  attention. 

One  is  summed  up  by  Dr.  Prince  Morrow  as  follows : 
*'  The  length  of  time  which  intervenes  between  the 
administration  of  the  drug  and  the  first  appearance  of  the 
eruption  varies  according  to  the  size  of  the  dose  and  the 
predisposition  of  the  individual ;  usually  it  is  from  the 
third  to  the  sixth  day ;  it  may  be  a  few  hours  or  several 
weeks."  There  seems  to  be  no  definite  relation  between 
the  size  of  the  dose  and  the  form  of  the  eruption  ;  this 
would  appear  to  be  a  matter  of  individual  constitution. 
It  is  very  striking  what  a  prominent  part  the  peculiar 
idiosyncrasy  of  the  patient  plays  in  the  development  of 
iodism.  The  pathogenetic  action  of  the  drug  may  be  pro- 
duced in  one  patient  by  a  grain  or  two,  and  in  another  very 
large  doses  are  needed  before  any  effect  is  visibly  excited. 
May  this  not  be  a  key  to  the  fact — surely  observed  by  all 
who  have  given  the  drug  therapeutically, — that  in  some 
cases  of  tertiary  syphUis  a  cure  can  be  obtained  by  a 
small  dose,  whilst  in  others  it  is  only  when  the  large 
dose  is  reached  that  any  benefit  is  obtained.    I  would 


572  IODIDE   OF  POTABMUM.    ^"SSl^aS^U^ 

venture  to  suggest  from  this  fact  that  there  is  a  direct 
correspondence  between  the  dose  of  the  drug  in  its  patho- 
genetic and  curative  action.  As  in  some  cases  the 
pathogenesis  is  induced  by  small  doses^  so  in  some  cases 
the  cure  is  obtained  with  small  doses.  But  as  in  other 
cases  large  doses  are  required  to  bring  about  any  patho- 
genetic action  so  there  are  cases  of  tertiary  syphilis 
which  can  only  be  influenced  by  large  doses  of  the  iodide. 
In  commending  this  very  imperfect  paper  to  your  kind 
consideration,  may  I  ask  for  an  expression  of  opinion  as 
to  whether  in  the  Ught  of  later  investigations  and 
observations  we  may  not  with  some  degree  of  probability 
ascribe  a  homoeopathic  action  to  the  action  of  the  iodide 
of  potassium  in  tertiary  syphilis. 

Discussion. 

The  Presu)ent  said  they  were  much  indebted  to  Mr.  Enox 
8haw  for  his  very  able  paper,  and  as  a  homcBopath  wishing  to 
bring  within  the  scope  of  the  homoeopathic  law  all  curative 
agencies,  he  felt  very  great  interest  in  his  attempt  to  show 
that  the  action  of  iodide  of  potassium  was  homoeopathic. 
There  were  two  or  three  experiences  met  with  in  their  dafly 
practice  which  they  had  not  yet  been  able  to  bring  within  the 
scope  of  their  law,  and  for  his  own  part  he  must  confess  that 
hitherto  the  action  of  ioduU  of  potassium  in  syphilis  had  been 
one  of  them.  But  it  was  a  question  which  they  might  now 
very  fairly  begin  to  consider  whether  they  could  not  claim 
this  action  of  iodide  of  potassium  for  homoeopathy.  He  would 
only  add  that  in  discussing  this  and  the  succeeding  papers, 
their  speeches  should  be  like  Liebig's  Beef,  concentrated,  and 
that  they  should  have  as  much  of  the  essence  and  as  httle  of 
the  verbose  as  possible. 

Dr.  Hughes  remarked  that  Mr.  Knox  Shaw  had  been  good 
enough  to  tell  him  that  he  had  him  somewhat  in  view  in 
writing  this  paper.  He  would  therefore  lose  no  time  in  rising 
to  say  what  he  had  to  say  upon  it.  He  thought  Mr.  Knox 
Shaw  had  done  well  to  bring  the  subject  before  them,  as  it  was 
of  course  desirable  that  they  should  face  any  apparent  excep- 
tion to  the  prevalence  of  their  law,  and  from  time  to  time 
reconsider  the  evidence  which  might  formerly  have  been  suffi- 
cient to  convince  them  that  any  given  course  of  procedure 
was  outside  the  region  of  homoeopathic  practice.  Mr.  Knox 
Shaw  had  brought  forward  a  number  of  very  pertinent  cases, 
and  if  his  thesis  were  this — that  there  were  features  of  tertiaiy 
syphilis  to  which  iodifie  was  perfectly  homoeopathic  and  which  it 
might  cure  after  the  homoeopathic  manner,  he  should  say  he  bad 


I^fSriX^    ^QPJPE   OF  POTASSIUM, 573 

entirely  proved  it.  If  he  were  to  speoify  still  more  minutely, 
and  say  that  in  tertiary  syphilis  affecting  the  skin  they 
were  probably  acting  homodopathically  when  they  gave 
iodide  of  potasdttm,  and  might  expect  a  cure  with  reasonably 
fimall  doses,  he  should  again  say  that  he  had  established  his 
point.  But  if  he  were  asked  whether  the  cases  which  had 
been  brought  forward  proved,  or  even  made  it  probable,  that 
iodide  of  potasdum  acted  homceopathically  in  the  gummatous 
deposits  in  the  viscera,  he  should  say  that  nothing  that  had 
been  broug^ht  forward  seemed  to  him  to  shsJce  the  conviction 
to  which  Dr.  Madden,  himself,  and  others  had  arrived  in 
times  past,  that  it  did  not  act  homceopathically  here,  but 
after  the  manner  of  a  parasiticide,  if  they  were  pleased  to  so 
term  it — he  should  say  rather  of  a  dissolvent,  melting-dowp 
these  adventitious  masses  of  tissue,  so  that  they  might  be 
washed  away  and  carried  out  of  the  system.  These  gummata 
were  entirely  different  from  the  affections  of  the  skin  they  had 
heard  described,  which  were  only  exaggerations  of  those  well 
known  to  occur  frequently  during  the  administration  of  iodide 
4if  potaesium.  On  the  question  of  doses  he  would  only  say 
one  word.  Mr.  Knox  Shaw  had  resolved  the  question  into 
<me  of  susceptibility,  and  thought  that  this  would  account 
for  the  necessity  of  giving  larger  doses  in  certain  cases. 
Well,  if  Mr.  Enox  Shaw  could  bring  them  forward,  say  half-a- 
dozen  cases,  in  three  of  which  the  real  gummata,  either  in 
the  viscera  or  in  the  bones,  had  been  dispersed  by  even 
1  or  2  grain  doses  of  iodide  of  potassium  in  a  reasonable  time, 
and  then  three  more  in  which  the  same  gummata  had  required 
a  15  grain  dose  or  more,  he  might  be  inclined  then  to  say 
that  it  was  a  matter  of  susceptibility.  But  when  the  fact 
seemed  to  be  that  to  disperse  these  tumours  they  must 
always  use  the  larger  dose,  he  thought  the  probable  reason 
was  not  the  susceptibility  of  these  patients  but  the  different 
mode  of  action.  (Hear,  hear).  Such  at  all  events  was  the 
impression  made  upon  his  mind  by  the  interesting  and 
valuable  paper  they  had  heard  read.    (Applause). 

Dr.  Pope  said  he  wished  to  endorse  most  fully  Dr.  Hughes' 
appreciation  of  Mr.  Enox  Shaw's  very  interesting  paper,  one 
of  the  most  interesting  papers  on  Materia  Medica  he  had  heard 
lor  some  time,  and  at  the  same  time  he  must  also  endorse  his 
criticism  so  far  as  the  gummata  were  concerned.  That  the 
iodide  of  potassium  acted  specifically,  that  was  to  say,  homcBO- 
pathically,  in  the  dispersal  of  gummata,  he  did  not  think 
Mr.  Enox  Shaw  had  proved  at  all,  and  the  mere  question  of 
the  large  doses  that  were  required  in  order  to  disperse  the 
true  gummata  seemed  to  him  to  show  that  the  theory  that 
Dr.  Madden  advanced  years  ago  was  so  far  as  they  were  con- 


674  IODIDE   OF  POTASSIUM.  ^^RjSJfSJTSn! 

cerned  more  nearly  accurate.  An  illustration  of  that  was  the 
case  reported  in  Dr.  Byrom  Bramwell's  very  interestipg 
clinical  lectures  of  about  twelve  months  ago  of  intra-cranial 
syphilitic  gummata,  giving  rise  to  paralysis  and  convulsive 
movements  of  the  right  arm  and  band.  That  patient  was 
given  80  grains  of  the  iodide  of  potasdunif  three  times  a 
day,  and  Dr.  Bramwell  remarked  '*  I  expect  if  the  lesion  is, 
as  I  suppose,  a  syphilitic  gumma  on  the  sur&ce  of  the  bnin, 
that  in  the  course  of  a  few  days,  when  the  system  gets 
thoroughly  saturated  with  iodide,  the  headache  will  subside, 
sleep  will  return,  and  the  localised  convulsions  will  dis- 
appear. The  essence  of  the  treatment  in  a  case  of  this  kind 
consists  in  rapidly  saturating  the  patient  with  the  iodide. 
At  least  80  grains  should  be  given  three,  four,  or  five 
times  a  day ;  if  you  want  to  obtain  brilliant  results  you  must 
give  large  doses."  As  a  matter  of  result  his  patient  was 
practically  well  within  a  fortnight.  The  iodide  coold 
only  be  said  to  exert  its  specific  influence  upon  lesions 
which  were  directly  syphilitic,  and  it  was  chiefly  the  gum- 
matous products  upon  which  its  specific  influence  was  exerted. 
In  the  case  quoted  the  gumma  was  carefully  diagnosed,  the 
dose  given  was  a  very  large  one,  and,  as  he  had  said,  the 
patient  was  well  within  a  couple  of  weeks.  Mr.  Enox  Shaw 
had  quoted  very  largely,  and  very  profitably  also,  firom 
Mr.  Hutchinson,  and  Dr.  Morrow  of  New  York.  There  was 
another  feature,  both  of  syphilis  and  of  iodide  of  potassium,  whidi 
was  very  well  worthy  of  being  kept  in  mind.  Many  of  them 
would  doubtless  recollect  Mr.  Langston  Parker,  of  Birmingham, 
well  known  as  a  syphilographer,  and  a  man  of  very  acute  and 
careful  observation,  and  a  very  large  experience.  (Hear, 
hear).  In  the  Provincial  Medical  and  Sunjical  Journal  of 
1862,  Mr.  Parker  gave  the  particulars  of  four  cases  of  hyper- 
trophy of  the  tongue.  The  surface  of  the  tongue  was 
lobulated  and  fissured,  and  he  described  the  appearance 
as  being  almost  that  of  a  cancer.  He  said  he  had 
selected  these  cases  from  a  mass  of  others,  and  bis 
examination  of  them  had  establidied  in  his  mind  the 
conclusion  that  this  appearance  of  the  tongue  was  due  to 
the  long-continued  use  of  iodide  of  potassium,  the  patient 
having  taken  several  grains  a  day  for  two  or  three  years. 
These  cases  he  (Dr.  Pope)  thought  confirmed  in  another 
direction  the  idea  Mr.  Shaw  had  given  them  with  regard  to 
Mr.  Hutchinson's  skin  cases.  Iodide  of  potassium  was  a  drug 
of  very  considerable  interest,  but  unfortimately  it  was  also 
one  which  had  not  had  the  advantage  of  being  carefdlly 
proved  upon  absolutely  healthy  persons.  They  had  indeed  a 
so-called  proving  by  Mons.  Houat,  but  this  was  simply  a  work 


r 


SSSJTsSTiSi?**  IODIDE   OF  POTASSIUM.  576- 

of  fiction,  and  therefore  valueless.  Then  they  had  a  proving 
by  Nenning,  who  was  a  thoroughly  confirmed  hypochondriac^ 
and  lived  in  an  atmosphere  of  symptoms,  while  the  only 
other  one  he  believed  was  by  Dr.  Colby,  showing  that  it 
produced  one  symptom  of  the  action  of  iodide  ofpotoidum  on  the 
throat.  Another  point  worthy  of  remembrance  was  that  in 
a  great  number  of  other  cases,  such  as  rheumatism  and 
diseases  generally,  the  action  of  iodide  of  potassium  was  upon 
the  tissues,  which  were  invariably  affected  in  the  course  of 
syphilis,  and  especially  upon  the  glands  and  the  mucous 
membrane  of  the  mouth  and  throat.  All  these  circumstances 
seemed  to  him  to  point  largely  to  the  fact  that  in  prescribing 
the  iodide  of  potassium  in  cases  of  syphilis  of  the  skin  they  were 
prescribing  a  medicine  which  was  homoeopathic ;  but  when  it 
was  given  in  a  case  of  true  gummata  upon  the  brain,  or  bone,, 
or  in  the  abdomen,  there,  on  the  other  hand,  they  were  pre- 
scribing a  chemical  or  parasitical  solvent.    (Applause). 

Dr.  Edwabd  Blake  viewed  the  paper  read  by  Mr.  Enox 
Shaw  as  a  most  valuable  contribution  to  scientific  medicine. 
Its  clearness,  its  conciseness,  and  its  excellent  delivery  were 
beyond  praise.  Dr.  Blake  thought  it  was  hardly  fair  that 
Mr.  Enox  Shaw  should  be  required  to  show  cases  cured  with 
small  doses  of  iodide  of  potassium.  The  patients  who  needed 
the  drug  come  to  us  commonly  in  a  different -attitude  from 
the  or&iary  class.  They  were  often  soaked  with  syphilis^ 
saturated  with  alcohol,  permeated  by  mercurials,  and  pro- 
foundly, depressed  in  body  and  mind.  In  such  patients  the 
sensibdities  were  deadened,  and  there  was  little  chance  of 
response  to  the  stimulus  of  the  mere  dilutions.  Mr.  Enox 
Shaw  was  quite  right  in  saying  that  death  might  ensue  from 
persistent  overdosing  with  jwtassic  iodide.  Dr.  Blake  had 
watched  an  undoubted  example.  A  guardsman,  of  about  forty 
years  of  age,  suffered  from  some  signs  of  cardiac  dilatation  with 
vertigo.  There  was  a  history  of  slight  sunstroke,  but  there  was 
no  evidence  of  organic  change  in  any  vital  organ.  The  patient* 
was  making  steady  progress  under  lachesis,  when  the  friends 
asked  for  an  allopathic  opinion.  The  aid  of  a  craniologist  of 
quite  European  fame  was  sought,  who  diagnosed  intra-cranial 
syphilis,  and  gave  massive  doses  of  iodide.  The  man 
immediately  grew  worse.  His  reason  became  impaired, 
dementia  set  in,  and  general  dropsy  soon  closed  the  scene. 
The  brain  was  examined  after  death,  and  was  found  to  be 
typically  healthy,  with  no  trace  whatever  of  syphilis,  past  or 
present.  There  seemed  little  doubt  that  this  man  died  from 
the  immediate  effects  of  over-drugging.  There  was  certainly 
a  good  deal  in  "  idiosyncrasy "  as  regards  iodine.  The 
thurtieth  centesimal  induced  in  some  persons  a  marked  coryza. 


576  IODIDE   OF   POTASSIUM.    *^JwTsSTt«! 

Dr.  Blake  had  been  dlBappointed  in  the  curative  influence  of 
iodids  over  acne,  till  he  ascertained  that  Dr.  Thin  had  pointed 
out  that  iodides  do  not  specially  affect  the  true  glands.  They 
cause  a  vesiculating  dermatitis — ^not  a  folliculitis.  This 
observation  of  Dr.  Thin  had  been  confirmed  by  the  micro* 
scopic  researches  of  Duckworth  and  of  Vincent  Harris. 
Dr.  Blake  had  shown  that  the  microphyte  of  dandruff,  when 
conveyed  from  the  scalp  by  means  of  the  finger  nail  to  a  gland 
affected  by  acne  punctata,  had  the  power  of  setting  up  a 
butyric  acid  fermentation,  with  the  formation  of  propane, 
thus  converting  the  punctate  acne  into  acne  pupulosa.  If 
vitality  be  impaired  a  local  sphacelus  took  place,  staphylo- 
cocci appeared,  and  the  case  then  became  one  of  acne 
pustulosa. 

Dr.  Dbysdale  said  when  he  first  took  up  the  programme  he 
felt  a  sense  of  disappointment  that  there  was  so  little  homoeo- 
pathy in  it,  but  on  looking  at  the  analysis  of  Mr.  Enox  Shaw's 
paper  he  was  bound  to  confess  that  he  had  touched  upon  what 
ought  to  be  a  most  interesting  question  for  their  consideration. 
The  difficulty  was  certainly  with  the  gummata.  They  could 
not  expect  to  have  in  provings  a  very  exsust  and  complete 
disease  reproduced.  (Hear,  hear).  It  was  not  so  in  the  case 
of  any  other  disease,  and  why  should  they  expect  it  in  this  ? 
There  must  be  something  in  the  inward  nature  of  the  process 
that  was  homoeopathic,  although  it  could  not  produce  a  whole 
and  complete  gumma.  They  undoubtedly  found  that  when 
they  got  a  case  of  internal  gummata,  such  as  that  of  Dr.  Byioxn 
Bramweirs,  the  larger  dose  was  more  effective  than  afiything 
they  knew  of  at  present.  He  did  not  regard  the  question  as 
settled  yet,  but  they  must  adnut  that  they  felt  more  security 
in  giving  the  16  grain  dose.  At  the  same  time,  he  confessed 
that  Dr.  Byrom  Bramwell's  observations,  in  that  paper  which 
they  had  all  read,  were  fax  too  dogmatic.  The  principle 
which  Mr.  Knox  Shaw  had  laid  stress  upon,  of  the  idiosyn- 
crasy of  patients — which  meant  the  contingent  susceptibility 
of  each  patient  (hear,  hear) — was  of  very  great  importance. 
He  thought  they  might  in  this  way  explain  the  necessity  for 
larger  doses.  When  there  was  a  poison  in  the  system, 
generally  speaking,  it  was  so — ^in  intermittent  fever  and 
several  other  diseases  they  found  that  the  very  infinitesimal 
dose  would  not  do.  It  was  useless  talking  about  it ;  it  flailed, 
and  they  must  give  larger  doses.  Therefore  upon  all  that  had 
been  said  he  was  inclined  to  the  belief  that  in  the  present 
instance  they  must  use  the  larger  dose  and  consider  it  homoeo- 
pathic.    (Applause). 

Dr.  Ybldham  would  like  to  state  the  result  of  his  expe- 
rience in  the  use  of  iodide  of  potassium.     He  had  used  it  in 


iSSSr^TSfr'  IODIDE   OF   POTASSIUM.  577 

ft  large  nnmber  of  cases  of  tertiary  syphilis,  and  he  had 
found  nothing  else  to  equal  it.  He  had  given  it  in  con- 
siderable doses.  Small  doses  he  thought  were  almost 
inoperative.  (Hear,  hear).  From  five  to  ten  grains  was  the 
dose  which  he  usually  gave.  He  must  say  that  he  had  never 
seen  anything  at  all  as  the  result  of  any  quantity  he  had 
given,  to  correspond  in  any  way  with  the  examples  which 
Mr.  Enox  Shaw  had  brought  forward  in  his  admirable  paper. 
The  only  effects  he  had  seen  that  were  what  they  might  call 
pathogenetic  effects  were  the  physiological  action  of  the 
medicine  on  the  throat  and  nasal  passages.  It  was  very 
common  to  find,  two  or  three  days  after  beginning  the  use 
of  the  medicine,  that  the  patient  suffered  with  catarrhal 
symptoms,  often  very  troublesome,  but  after  the  medicine 
had  been  continued  for  a  few  days  longer,  those  symptoms 
all  disappeared,  and  they  got  the  symptoms  of  the  curative 
action  of  the  medicine.  (Hear,  hear).  But  in  no  instance 
had  he  ever  seen  anything  at  all  like  the  gummata,  or  any 
other  of  those  secondary  or  tertiary  diseases  that  sometimes 
occurred. 

Dr.  Hatwabd  said  he  would  like  to  draw  attention  to  a 
point  which  appeared  to  him  to  have  escaped  notice.  Mr. 
Knox  Shaw  had  pointed  out  that  many  of  the  cases  he  had 
referred  to  were  not  the  giving  of  iodide  of  potassium  in  syphilitic 
cases,  but  absolutely  the  effect  of  the  iodide  of  potassium  in 
cases  that  were  not  syphilitic.  The  symptoms  were  therefore 
purely  pathogenetic,  and  it  appeared  to  him  that  they  did 
correspond  very  closely  with  a  great  deal  of  the  effect  that  they 
saw  in  tertiary  syphilis.     (Hear,  hear). 

Mr.  Knox  Shaw  said  he  would,  in  view  of  the  proximity  of 
luncheon,  reply  extremely  briefly  to  the  very  kind  consideration 
which  his  paper  had  received.  He  particularly  laid  down  that 
in  many  of  the  cases  he  recorded  the  skin  itself  was  not 
primarily  affected  (hear,  hear),  but  that  the  deposit,  as  they 
might  call  it,  arose  in  the  subcutaneous  tissues.  In  most  of 
the  cases  it  was  in  the  subcutaneous  tissues  that  the  disease 
first  developed,  and  secondarily  it  affected  the  skin.  So  that 
they  had  here  instances  of  the  iodide  of  potassium  acting 
deeper,  in  reality,  than  in  the  ordinary  skin  eruptions.  Of 
coarse,  as  he  had  said  before,  they  could  very  rarely  get  anyone 
who  would  submit  to  death  in  the  interests  of  proving  a 
medicine  (laughter),  and  it  was  only  very  rarely  that  they 
could  get  cases  where  a  man  would  heroically  attack  a  disease, 
and  heroically  go  on  attacking  it  and  defending  the  positioa 
taken  up,  as  was  evidently  done  in  some  of  these  cases.  The  case 
was  treated  in  the  first  instance  with  the  idea  that  it  was  syphilis, 
and  the  medicine  was  continued  when  indicated,  and  so  they 


678  NORMAL  PARTURITION.     *?5^°£??»S!' 


Banew,  Sep.  1,  IM. 


obtained  an  excellent  proving.  Dr.  Byrom  Bramwell  lud 
down  in  one  of  those  didactic  articles  which  he  wrote  Hiat  if 
the  patient  had  tertiary  S3rphiUs  and  they  gave  iodide  of 
potamum  there  would  be  no  iodism  ;  but  that  if  they  thought 
the  case  was  tertiary  syphilis  and  they  gave  iodide  ofpotasdum^ 
iuid  the  pathogenetic  or  physiological  action  of  the  iodine  was 
produced,  they  might  be  quite  sure  they  had  not  got  syphilis 
to  deal  with.  He  laid  that  down  very  strongly  indeed, 
especially  in  cerebral  medicine.  Dr.  Yeldham,  in  his 
careful  selection  of  his  remedies,  would  not  be  likely  to  pro- 
duce any  such  symptoms  as  they  saw  here,  because  he  would 
only  give  the  drug  where  it  was  indicated.  In  reply  to  the 
remarks  of  Dr.  Hughes,  he  felt  positive  that  he  could 
undoubtedly  produce  cases  of  tertiary  gummatous  syphilis 
which  had  been  cured  by  himself  with  two  or  three  grains  of 
iodids  of  potassium,  while  he  had  also  had  cases  in  which  he 
had  required  at  least  ten  or  fifteen  grains.  (Hear,  hear). 
He  was  quite  certain  that  he  could  bear  out  what  Mr. 
Jonathan  Hutchinson  said,  that  he  had  cured  cases  wilh 
one<third  of  a  grain,  while  others  needed  an  ounce-and-a-halL 
(Laughter).  So  he  believed  in  those  cases  there  was  some 
analogy  between  the  production  of  the  symptoms  and  the  cure 
of  the  disease.  In  conclusion,  he  begged  to  thank  them  for 
the  kind  manner  in  which  his  paper  had  been  reodved. 
{Applause). 


THE  SUPEEVISION  OF  NOEMAL  PAETUEITION.* 
By  J.  EoBERSoN  Day,  M.D.,  Lend. 

Assistant  Physician  and  Anaestlietist  to  the  London  Homoeopathio  Hos- 
pital ;  Visiting  Physician  Margaret  Street  Infirmary  for  Consumption, 

kCf  &c. 

**  Old  things  are  passed  away,  all  things  are  become  new." 

These  words  seem  exactly  to  describe  the  revolution 
that  has  come  about  in  obstetrics,  and  may  well  intro- 
duce the  subject,  and  as  disciples  of  Hahnemann  are 
peculiarly  appropriate  to  our  method  of  treatment. 

But  not  only  has  the  medicinal  treatment  changed, 
'but  all  the  surroundings  of  patients  are  now  altered. 
Hygiene  and  sanitiebtion  have  explained  much ;  antiseptic 


*  Read  at  the  British  Homoeopathic  Congress,  July,  1891. 


iS^^TSS^  NOBMAL  PARTUBITION.  679 

nursing  has  done  more,  till  the  mortality  of  the  puerperal 
state  is  reduced  almost  to  zero.  Each  branch  of  our 
profession  is  so  intimately  related  to  the  others,  that 
discoveries  in  one  directly  or  indirectly  benefit  all. 

Homoeopathy,  which  has  done  so  much  for  us  in  other 
special  departments,  has  not  been  behind-hand  in 
obstetrics,  and  there  is  every  reason  to  believe  will  do 
much  more  for  us  in  proportion  as  we  have  means  and 
opportunities  for  its  study.  But  as  in  the  case  of  sur- 
gery, obstetrics  must  always  to  a  large  extent  depend 
on  the  tocfttf  eruditus  of  the  physician,  and  also  on  the 
thorough  and  conscientious  carrying  out  of  antiseptics  ; 
and  it  is  only  when  these  and  all  other  considerations  are 
taken  into  account  that  are  likely  to  bear  on  the  welfare 
of  our  patients,  that  we  can  expect  the  best  results  from 
homoeopathy.  Indeed,  it  is  not  giving  homoeopathy  a 
fair  chance  to  disregard  these  very  important  adjuvants, 
and  when  this  is  done  we  must  expect  disappointment. 

But  I  shall  endeavour  to  limit  my  remarks  to  that 
I)ortion  of  my  subject  which  I  have  selected,  as  being 
one  which  will  be  of  interest  to  the  majority — ^the 
**  Supervision  of  normal  parturition." 

Latterly  it  has  been  my  habit  to  prepare  the  patient 
for  parturition  by  a  course  of  medicine  commenced  about 
the  sixth  or  seventh  month  of  pregnancy  and  continued 
during  the  remaining  period  until  delivery. 

I  give  dcUBa  roc,  Ix,  gtt.j.  dose  every  morning  for  one 
week,  then  eavlophyUum  Ix,  gtt.j.  dose  every  morning  for 
the  next  week,  and  then  back  again  to  actaa,  and 
continue  this  alternation  of  the  remedi(?s.  So  far  as  I 
have  observed  the  effect  has  been  to  render  labour  easier 
and>  I  think,  more  rapid.  In  some  cases  I  have  reason 
to  believe  the  labour  has  been  induced  a  week  or  ten 
days  before  term,  and  if  this  be  so,  although  it  is  always 
difficult  to  be  sure  of  these  dates,  it  may  explain  the 
greater  ease  and  rapidity  of  the  labour. 

Mr.  W.  H.  Bean,  in  a  paper  read  before  the  British 
Somoeopathic  Society  in  1884,  speaks  in  the  highest 
terms  of  arnica  given  the  last  three  weeks  of  pregnancy. 
He  gives  the  first  decimal  in  half-drop  doses  every 
morning.  He  says,  ^*  I  have  tried  it  in  a  large  number 
of  cases,  and  I  can  say  with  confidence  that  in  no  single 
instance  have  I  been  disappointed  in  it.  Two  most 
important  results  may  be  confidently  expected  from  its 


580  NORMAL  PARTUEITION.   "'^iJ^gSM! 

use,  supposing  the  condition  of  the  mother  and  the 
foetus  be  normal.  It  materially  reduces  each  of  the 
three  stages  of  labour  and  marvellously  minimises  the 
pain." 

He  quotes  three  cases,  one  a  girl  of  14,  a  second  who 
had  not  borne  a  child  for  15  years,  and  the  third,  a 
primipara  of  48,  all  of  whom  had  very  easy  times. 

He  uses  the  tincture  prepared  bom  fresh  plants  only, 
the  ordinary  tincture  having  failed.  In  conclusion,  be 
says,  **  arnica  possesses  a  power  over  the  uterus  the 
value  of  which  cannot  be  easily  estimated.  I  use  it  now 
in  nearly  all  my  cases,  and  the  larger  my  experience  the 
more  fully  I  am  convinced  that  the  obstetric  practitioner 
has  at  his  command  a  drug,  by  the  side  of  which  nearly 
all  other  medicines  sink  into  insignificance."  A  drag  so 
highly  eulogised  cannot  fail  to  commend  itself. 

During  the  early  stage  of  parturition  ignatia  Ix  suits 
well  the  excitable  state  so  commonly  resulting  from  pain 
and  loss  of  rest. 

As  I  wish  this  paper  to  be  as  practical  as  possible,  and 
to  give  a  true  and  exact  picture  of  the  modem  lying-in 
room,  it  will  be  well  to  name  the  requisites  for  the 
comfort  and  welfare  of  all  concerned. 

In  the  first  place  a  good  nurse  is  essential :  one  who 
has  bad  a  scientific  training  (if  I  may  use  the  word 
in  speaking  of  a  nurse)  as  to  the  nature  of  septic 
diseases  and  their  prevention.  Without  such  a  training 
a  nurse  cannot  be  expected  to  carry  out  the  minnte 
details  of  aseptic  nursing :  indeed,  it  would  be  useless 
to  expect  anyone  to,  without  understanding  the  rationdef 
to  do  so.  For  the  welfare  of  the  patient  a  good  nurse  is 
as  essential  as  a  good  doctor,  and  a  careless  nurse  may 
thwart  all  the  care  and  skill  of  the  physician,  and  may 
be  the  means  of  bringing  him  into  disrepute.  This 
point  cannot  be  too  strongly  insisted  on. 

It  is  my  habit  to  place  in  the  hands  of  the  nurse  & 
card  of  "  Eules  for  the  Use  of  Monthly  Nurses."*  These 
are  as  follows : — 

1. — The  nurse  will  have  charge  of  two  bottles,  labelled 
No.  1  and  No.  2.  No.  1,  corrosive  sublimate  in  strong  solu- 
tion (808  grains  in  4  ozs.  glycerine) ;  No.  2,  tincture  of  iodine, 
pure ;  also  a  pot  of  eucalyptus  vaseline  (1  in  8). 

—  -  ^' —  —  —     -  ■     -    ■ —  ■■    -  — —  -    ■  -  I ■ — ■^^^^*' 

*  Modified  f zom  Playfair. 


SS^STMSf*"*  NOBMAL  PABTURITION.  581' 

.  2. — A  small  basin  containing  a  (1  in  1,000)  solution  of  eor- 
lonye  sublimate,  made  by  adding  one  teaspoonful  from  bottle 
No.  1  to  one  pint  of  water,  must  always  stand  at  the  bedside, 
and  the  nurse,  after  washing  her  hands  with  soap  and  nail- 
hmsb,  must  well  rinse  the  hands  in  this  before  touching  the 
patient  in  the  neighbourhood  of  the  genital  organs,  whether 
for  washing  or  any  other  purpose,  before  or  during  labour,  and 
for  a  week  after  delivery. 

8. — All  sponges,  vaginal  and  enema  syringes,  catheters,  as 
well  as  bed-pans  or  slippers,  must  be  well  rinsed  in  a  similar 
flolution  of  (1  in  1,000)  corrosive  sublimate  before  being  used. 

4. — The  eucalyptus  vaseline  is  to  be  used  to  grease  all 
vaginal  tubes,  catheters  and  enema  tubes  before  being  used. 

5. — ^Twice  a  day  the  vagina  is  to  be  syringed  with  two  pints 
of  warm  water  (temp.  100^  F.),  to  which  two  teaspoonfuls  of 
tincture  of  iodine  (bottle  No.  2)  have  been  added.  The  exter- 
nal genital  organs  must  be  sponged  with  corrosive  sublimate 
solution  (1  in  1,000). 

6. — All  soiled  linen,  sheets,  diapers,  &c.,  should  be  at  once 
removed  from  the  room. 

N^B. — Southall's  sanitary  towels  are  strongly  recommended, 
and  also  a  sanitary  sheet  for  the  accouchement. 

Instead  of  the  strong  solution  of  corrosive  sublimate 
No.  1  I  now  use  a  more  convenient  preparation  of  cor- 
rosive sub.  tablets — one  tablet  being  added  to  a  pint  of 
water  makes  a  solution  of  1  in  1,000.  They  are  very 
portable,  and  keep  weU.  Or  powders  composed  of  cor- 
rosive sub.  gr.  X,  tartaric  acid  grs.  50,  and  ^  gr.  carmine 
may  be  used,  as  recommended  by  Dr.  Cullingworth,  one 
powder  making  one  pint  of  1  in  1,000  solution  of  per- 
chloride. 

SouthaU's  sanitary  sheets  are  invaluable.  They  should 
be  placed  before  the  fire  before  use,  when  they  swell 
up  and  become  soft  and  downy ;  one  is  generally  suffi- 
cient.   They  are  very  absorbent  and  cleanly. 

The  nurse's  dress  should  be  of  a  white  glazed  or 
starched  material,  and  of  course  be  put  on  fresh  for  each 
case.  Attention  to  the  hands  and  nails  may  be  thought 
superfluous,  but  success  can  only  be  insured  by  attention 
to  details,  and  the  nurse  (and  it  need  not  be  said  the 
physician)  should  be  in  the  constant  habit  of  using  the 
nail  brush.  It  is  well  after  washing  the  hands  in  hot 
water,  t^ter  drying  them  to  well  rub  in  lanoline  and 
calendula  ointment.  This  should  be  a  matter  of  habit, 
especially  as  most  antiseptic  solutions  are  somewhat 

YoL  35,  No.  9.  2  t 


582  NOBMAL  PABTUBinON.     ''tS^ 


BtfftoWi  Stp.  It  IM* 


irritating  to  the  skin  if  the  hands  are  often  in  them, 
especially  in  cold  weather.  Bole  2  applies  equally  to 
physician  and  nurse.  At  a  well  known  lying-in  instita* 
tion  not  far  from  here,  at  one  time  the  enthusiasm  for 
antiseptic  midwifery  was  carried  to  such  a  degree  that  it 
was  the  practice  to  deliver  the  child  in  a  cloud  of 
carbolic  spray.  This  we  know  now  to  be  superfluons, 
but  still  the  spirit  of  the  practice  was  good,  and  it  would 
be  well  if  all  who  practise  obstetrics  constantly  kept  the 
subject  of  antiseptics  before  them.  It  is  only  by  scrupn- 
lously  attending  to  all  the  details  of  antiseptic  nursmg 
that  immunity  from  puerperal  fever  can  be  insured, 
for  we  now  •kdow  this  to  be  an  entirely  preventible 
disease,  and  here  we  have  the  explanation  why  some 
men  constantly  meet  with  this  disease  in  their  practice, 
whilst  others  never  see  it. 

During  the  first  stage  of  labour  I  have  had  the  best 
results  from  chloral  hydrate  in  very  tangible  doses, 
following  Playfair*s  recommendation,  giving  ^iss  of  the 
8yrup=gr.  xv.  every  20  minutes  for  three  doses;  it 
lessens  the  pain,  produces  a  drowsy  state,  and  often  the 
patient  sleeps  between  the  pains,  only  waking  up  when 
they  are  severe.  A  fourth  dose  may  be  given  if  necessaiy. 
Good  progress  is  made  during  this  drowsy  condition,  and 
the  OS,  which  perhaps  at  first  seemed  rigid,  goes  on 
dilating.  The  chloral  possesses  another  advanfaftge,  ton 
should  an  anaesthetic  be  required  during  subsequent 
stages  less  is  required  than  if  no  chloral  has  been  given. 
This  may  or  may  not  be  due  to  decomposition  of  the 
chloral  in  the  blood  giving  off  chloroform  as  Oscar 
Liebreich  believed. 

Dr.  Edward  Janney,  of  Baltimore  {Hahnemann. 
Monthly  J  May,  1891),  speaks  well  of  gebemium  2x  m 
rigidity  of  the  os. 

Another  plan  which  I  have  found  very  useful,  and 
which  may  be  used  in  conjunction  with  the  above,  is  a 
hot  vaginal  douche,  temp,  from  100^-105°  and  rendered 
antiseptic  by  Creolin  or  Banitas.  The  stream  is  directed 
against  the  resistant  os,  and  the  douche  maybe  repeated 
if  necessary. 

As  soon  as  the  os  is  fully  dilated  or  dilatable  the 
membranes  should  be  ruptured  if  they  have  not  already 
ruptured  spontaneously.  Nothing  is  gained  by  waiting  if 
the  fact  is  fully  determined  that  Hie  os  is  quite  relaxedi 


TSSSH^HuiSn!^  NORMAL  PABTUBITION.  588 

indeed  the  membranes  are  occasionally  so  tough  that 
great  delay  is  caused  by  waiting  for  their  spontaneous 
rapture. 

The  method  I  adopt  for  this  purpose  is  extremely 
srmple,  and  much  safer  than  the  use  of  hair-pins,  quill 
pens,  <&c.,  which  are  commonly  resorted  to.  The  nail  of 
the  forefinger  of  the  right  hand  is  notched  with  a 
penknife,  and  the  sharp  point  thus  produced  is  quite 
sufficient  to  tear  through  the  membranes  when  they  are 
rendered  tense  during  a  pain.  The  progress  of  the  case 
is  now  greatly  facilitated,  and  by  the  escape  of  the 
amniotic  fluid  the  head  descends  into  the  pelvis.  The 
chief  danger  of  delay  now  is  when  the  anterior  lip  of  the 
cervix  gets  jammed  between  the  pubes  and  the  head. 
This  can  eaeoly  be  avoided  by  pushing  it  up  and  keeping 
it  so  during  one  or  more  ptains,  when  it  recedes  over  the 
head  and  gives  no  more  trouble.  It  is  during  the  second 
and  third  stages  of  labour  that  the  physician  can  be  of 
most  service;  during  the  first  stage  the  examinations 
should  seldom  be  made. 

Should  the  perinaeum  be  rigid  it  is  well  to  let  the 
nurse  foment  the  parts,  and  freely  lubricate  with 
eucalyptus  vaseline.  During  dilatation  of  the  ostium 
vaginsB  is  the  most  painful  period,  and  it  is  always  well 
when  this  takes  place  slowly.  The  A.G.E.  mixture 
administered  at  this  stage,  at  the  acme  of  the  pains,  has 
a  most  beneficial  effect,  and,  if  thought  desirable,  may  be 
pushed  to  the  production  of  complete  ansBsthesia.  A 
mixture  made  by  substituting  Eau-de-Cologne  for  the 
alcohol  is  more  pleasant  and  equally  efficacious. 

The  various  plans  for  supporting  the  perinsBum  are 
fully  described  in  the  text  books,  but  most  must  be 
expected  from  fomentations  and  stretching  and  lubri- 
cating the  parts.  Even  when  all  has  been  done,  and  the 
utmost  care  taken,  rupture  in  certain  cases  will  take 
place  to  a  greater  or  less  extent.  Lateral  incisions  have 
been  suggested  to  obviate  this,  but  if  the  rent  be 
properly  sutured,  union  by  first  intention  is  obtained, 
and  nothing  more  can  be  desired.  The  perinaeum 
should  always  be  examined  afterwards  to  see  if  there  is 
any  laceration,  and  if  there  is  the  wound  should  be 
thoroughly  cleansed  from  adherent  clots,  and  the  edges 
brought  together  by  two  or  three  deep  sutures  of  silk  or 

2  T— 2 


684  NORMAL  PARTURITION.     ""S^^eSlfMSS! 

gut  passed  well  through  the  perinseal  body.  A  diy 
dressing  is  then  applied  with  crystaUized  iodoform. 

It  is  astonishing  how  little  pain  is  caused  by  tms 
procedure,  the  parts  being  in  a  somewhat  anesthetic 
condition.  The  chief  discomfort  the  patient  suffers 
afterwards  is  from  having  the  legs  tied  together. 

This  little  operation  is  so  simple,  and  gives  so  little 
pain  if  done  at  once,  that  to  omit  it  and  leave  the 
perinsBum  ruptured  on  the  chance  of  its  uniting  c&a 
only  be  regarded  as  criminal,  considering  the  life  of 
subsequent  misery  which  has  by  this  neglect  been 
insured  for  the  patient. 

How  much  of  the  work  of  the  gynaecologist  would  be 
prevented  if  this  precaution  were  always  taken !  It  ia 
true  that  now  and  again  we  find  an  advocate  for  leaving 
the  rupture,  saying,  that  if  united,  with  the  next  preg- 
nancy it  will  tear  again ;  this  is  very  likely,  but  then  it 
can  be  united  again,  and  between  whiles  the  patient 
is  perfectly  sound. 

Should  there  be  great  delay  in  the  second  stage,  the 
head  advancing  and  receding  when  on  the  perinceum,  the 
patient  getting  worn  out  and  restless,  I  have  only  seen 
the  best  results  from  the  application  of  the  forceps.  Here 
we  have  a  powerful  and  most  valuable  means  of  con- 
trolling labour,  a  means  which  is  perfectly  safe,  but  too 
often  neglected.  There  is  a  limit  as  to  the  time  a 
patient  should  be  allowed  to  remain  in  this  stage,  and 
if  this  limit  be  exceeded,  subsequent  convalescence  ift 
retarded,  even  if  no  worse  results  follow.  The  state 
of  affairs  is  somewhat  comparable  to  the  condition 
which  exists  at  the  end  of  the  first  stage,  where  timely 
rupture  of  the  membranes  greatly  facilitates  progress, 
and  obviates  much  suffering. 

With  the  expulsion  of  the  child  our  thoughts  should 
be  directed  towards  the  state  of  the  uterus,  which  should 
be  carefully  followed  down  by  the  hand,  making  sure 
that  it  is  in  a  state  of  contraction,  which  state  must  be 
maintained.  The  hand  should  not  be  removed  from  the 
fundus  now  till  some  time  after  the  birth  of  the  placenta, 
depending  on  the  degree  of  contraction  and  the  amount 
of  haemorrhage  which  should  be  carefully  watched. 

The  expulsion  of  the  placenta  should  not  be  attempted 
until  about  twenty  minutes  after  the  birth  of  the  child. 
This  gives  time  for  the  closure  of  the  sinuses.    Traction 


}S!SS!^!!TS^  NORMAL   PABTUBITIQN.  685 

on  the  faniB  is  never  necessary,  and  should  be  strictly 
ayoided ;  the  method  of  expression  as  described  by  Grede 
is  always  sufficient  to  force  the  placenta  oat  of  the  uterus, 
and  in  most  cases  (by  bearing  down  efforts  of  the  patient 
at  the  same  time)  out  of  the  vagina  as  well.  Experience 
in  the  maternity  department  of  University  College  Hos- 
pital convinced  me,  and  subsequent  practice  has  only 
eonfirmed  the  opinion  then  formed,  that  the  often  heard 
of ''  retained  placenta  "  is  extremely  rare. 

The  method  of  expression  consists  in  driving  the 
placenta  out  by  vie  a  tergo.  After  about  20  minutes  from 
the  birth  of  the  child,  advantage  is  taken  of  a  pain,  when 
by  grasping  the  fundus  firmly  and  expressing  in  the  axis 
of  the  pelvis,  being  helped  by  the  bearing  down  efforts 
of  the  patient  the  placenta  is  bom,  without  the  intro- 
duction of  any  part  of  the  hand  into  the  parturient 
canal.  Should  the  contractions  of  the  uterus  be  feeble, 
the  hand  should  be  placed  in  a  jug  of  cold  water  for  a 
few  minutes,  then  q^iickly  wipe J  Ld  applied  to  the 
fondus.  This  will  almost  always  produce  a  contraction. 
It  is  not  necessary  for  the  physician  to  keep  his  hand 
on  the  fundus  all  the  time,  but  the  nurse  may  from  time 
to  time  relieve  him  of  this  duty,  for  duty  it  assuredly  is, 
and  by  its  observance  po^t  partum  haemorrhage  may  be 
prevented. 

Immediately  after  the  expulsion  of  the  placenta  a  hot 
calendula  douche  should  be  given,  strength  about  5i  to 
the  pint,  and  temperature  100*^  to  105°.  The  effect  of 
this  is  twofold,  it  is  wonderfully  soothing  to  the  abraded 
passages,  and  it  causes  powerful  contraction  of  the 
uterus,  and  will  effectually  control  any  hsBmorrhage. 
A  medicated  pessary,  containing  gr.  v.  to  gr.  x.  iodoform, 
is  then  inserted  to  insure  antisepsis. 

The  reaction  at  this  stage  is  best  met  by  hot  drinks 
and  arnica  8x,  and  keeping  the  patient  warm  with  hot 
bottles.  In  another  twenty  minutes  or  so  the  binder 
may  be  applied.  This  is  frequently  too  narrow,  but 
should  reach  from  the  crest  of  the  ilium  to  well  below 
the  trochanter. 

It  is  very  important  that  the  patient  should  not  exert 
herself  in  its  application,  and  to  avoid  this  it  is  best 
done  by  commencing  its  application  when  on  her  side, 
and  having  the  binder  rolled  up  as  is  done  in  changing 


686  NOBMAL  PABTUMTION.     '*^&?£??!gS? 


Bcnriew,  Sep.  1,  Utt. 


sheetB ;  the  patient  is  rolled  over  on  her  back,  and  no 
lifting  required. 

Hitherto  I  have  said  nothing  about  the  time-honoured 
ergot,  which  has  in  measure  become  associated  with  the 
lying-in  chamber.  It  is  certainly  a  very  powerful  agent, 
and  has  often  been  the  cause  of  much  harm.  Eyen 
amongst  the  old-school  practitioners  it  is  almost  re- 
stricted in  its  use  to  the  end  of  the  third  stage  of  laboor, 
indeed,  one  might  go  so  far  as  to  say  it  is  never  safe  to 
employ  it  before  the  placenta  has  been  delivered.  I  find 
now  it  is  rarely  necessary  to  use  it  at  all,  and  never  in 
the  form  of  the  liquid  extract,  which  is  a  nauseating 
and  disgusting  preparation,  and  liable  to  go  bad  on 
keeping.  If  the  labour  has  been  carefully  conducted  m 
above  described,  there  is  very  little  tendency  to  poit 
partum  haemorrhage,  the  uterus  having  had  no  oppor- 
tunity of  relaxing.  Should  it  occur,  however,  a  hot 
vaginal  douche  is  the  most  prompt  means  of  insuring 
uterine  contraction.  At  the  same  time  I  always  have 
by  me  ergotine,  10  minims  of  which  I  inject  into  the 
glutei.  It  is  a  permanent  solution  made  by  Huggett  and 
Co.,  and  contains  gr.  iij.  to  nt  x.  It  acts  more  promptly 
than  the  liquid  extract  taken  by  the  mouth. 

By  carefully  adhering  to  the  above  described  methods 
of  treatment,  the  very  best  results  are  obtained,  the 
labour  itself  is  reduced  in  time  and  the  pain  modified, 
and,  if  desired,  by  pushing  the  anaesthetic,  abolished ; 
convalescence  is  also  rapid  and  certain.  The  remedies 
at  this  stage  vary  with  the  symptoms ;  arnica  3x  eveiy 
few  hours  is  best  indicated  immediately  after  delivery 
and  for  the  first  few  days.  About  the  third  day  shoold 
there  be  any  appreciable  rise  in  temperature  aconite  or 
bell,  will  give  most  relief. 

I  am  sure  the  longer  the  patient  can  be  persuaded  to 
maintain  the  horizontal  posture  the  better ;  at  least  a 
fortnight  should  be  spent  absolutely  in  bed,  most  of  the 
third  week  lying  on  the  bed  or  couch,  and  the  fourth 
week  the  patient  may  come  down  stairs  and  finish  by 
taking  a  drive. 

It  is  always  well  to  explain  to  the  patient  the  reason 
for  this,  what  to  her  may  appear,  enforced  idleness. 
Bub-involution  by  these  precautions  is  avoided,  with  its 
attendant  miseries, — ^prolapse,  retroversion,  flexion,  etc. 

In  conclusion  a  word  about  the  diet.    The  patient's 


ISSS^^a^S^  NORMAL   PABTUBITION.  587 


appetite  is  always  the  best  guide  provided  there  is  no 
morbid  craving.  It  is  always  well  to  bear  in  mind  that 
a  person  in  bed,  and  doing  no  work,  has  not  the  appetite 
of  one  who  is  up  and  about.  The  old-fashioned  gruel 
has  almost  ceased  to  be  given,  except,  perhaps,  for  the 
first  day  after  delivery.  The  feeling  that  the  parturient 
woman  is  not  an  invalid,  and  simply  passing  through  a 
aeries  of  natural  events,  should  ever  be  uppermost  in  our 
thoughts  and  guide  us  in  our  treatment ;  the  diet  should 
therefore  be  light  and  easily  digested,  and  abundant, 
eepecially  the  liquids.  Stimulants  are  not  necessary, 
bat  positively  harmful,  as  they  tend  to  produce  and  keep 
up  pelvic  congestion. 

Discussion. 

The  PsBsmENT  remarked  that  if  it  were  not  for  the  carbolic 
qmy  Dr.  Boberson  Day  had  spoken  of,  it  would  seem  to  him 
timi  the  whole  tendency  of  his  paper  would  be  to  make  them 
regret  that  they  could  not  be  bom  again.  (Laughter).  To  be 
surrounded  by  so  many  scientific  apphances,  and  to  be  pro- 
tected with  so  much  care  from  their  earhest  hours  against  the 
approach  of  germs,  seemed  to  suggest  a  condition  of  things  in 
which,  if  they  could  not  bear  children  themselves,  they  must 
at  least  long  to  be  bom.    (Laughter). 

Dr.  Hawkes  (Bamsgate)  would  hke  to  express  his  very 
cordial  thanks  to  Dr.  Day  for  his  most  able  paper.  It  would 
be  exceedingly  helpful,  and  especially  to  those  among  them 
who  happened  to  have  their  lot  cast  in  rather  outlandish 
neighbourhoods  where  they  could  not  readily  get  the  help  of 
their  confrh-es  who  were  in  sympathy  with  them  on  the  subject 
of  homoeopathy.  He  was  reminded  in  listening  to  what  Dr. 
Day  had  said  as  to  the  use  of  drugs  during  the  progress  of 
pregnancy,  tbat  he  had  also  found  the  drugs  mentioned  of  very 
great  service  in  the  treatment  of  the  patient  during  a  couple 
of  months  beforehand.  The  results  had  been  so  marked  that 
he  had  made  careful  notes  of  them  in  his  obstetric  book,  and 
his  experience  was  quite  in  accord  with  that  of  Dr.  Day.  He 
remembered  having  some  years  ago  had  given  to  him  a  book 
entitled  Parturition  Without  Pain,  with  which  Dr.  Day  was  no 
doubt  SBuniliar.  It  was  a  small  book,  pubUshed  by  an  American, 
and  in  it  the  writer  advocated  the  great  value  of  the  dietetic 
treatment  of  the  patient  before  the  confinement.  Dr.  Day 
had  referred  to  the  question  of  dietary  afterwards.  He  lent 
this  book  on  several  occasions  to  ladies  who  were  approsu^hing 
their  confinement,  and  where  they  had  sufficient  strength  of 
mind  to  follow  the  suggestions  therein  given  their  cases  were 


688  NORMAL   PARTUBITION.     ^"^l^SHV^ 


Beview,  Sep.  1,  un. 


very  greatly  helped,  and  some  of  those  who  had'  preyioady 
suffered  long  and  painful  parturition  recorded  their  experience 
as  most  satisfactory.  The  advice  was  that  the  patient  shonld 
live  well,  principally  upon  fruit,  and  the  idea  which  the  writer 
advanced  was  that  there  should  not  be  any  great  amount  of 
mineral  matter  in  the  bone  of  the  foetus,  so  that  it  should 
come  quite  easily  through  the  passages.  This,  he  believed, 
had  been  realised  in  cases  which  had  come  within  his  own 
experience.  He  would  give  one  instance.  Of  course,  one 
swallow  did  not  make  a  summer,  but  he  could  give  a  number 
of  cases  if  necessary.  One,  however,  particularly  struck  him. 
It  was  the  case  of  a  lady  who  had  borne  four  children,  and  in 
each  case  had  experienced  very  long  and  painful  confinements. 
On  the  fifth  occasion  he  happened  to  be  called  in,  and  having 
just  had  the  book  in  question  lent  to  him  he  handed  it 
over  to  her,  cmd  took  the  advice  of  her  husband  about  it, 
with  the  result  that  the  patient,  being  rather  a  strong-minded 
woman,  read  and  carefully  followed  the  practice  laid  down, 
with  a  result  which  he  well  remembered.  He  was  dressing  on 
a  Sunday  morning  between  seven  and  eight  when  he  was 
called  to  the  house,  which  was  about  a  quarter  of  an  hour's 
journey  from  his  own.  The  lady  had  been  out  of  doors  the 
evening  before  and  had  been  in  perfect  health  all  through  her 
pregnancy,  and  the  confinement  was  over,  and  he  had  left  the 
house  before  half-past  nine.  Be  thought  that  was  an 
exceedingly  satisfactory  result,  and  the  patient,  from  her 
previous  experience,  thought  so  also.  On  three  subsequent 
occasions  when  he  had  the  opportunity  of  attending  her,  the 
same  result  followed.  He  also  agreed  entirely  with  Dr.  Daj 
as  regards  the  subject  of  the  nursing.  They  did  not  always 
have  the  selection  of  the  nurse,  and  sometimes  the  nurses  were 
anything  but  what  might  be  desired.  He  would  only  add  that 
he  was  thoroughly  in  sympathy  with  the  essence  of  the  paper, 
and  thanked  Dr.  Day  most  heartily  for  his  contribution  to 
their  proceedings.    (Applause). 

Dr.  Jagielski  also  congratulated  Dr.  Day  upon  his  excellent 
paper.  He  referred  to  the  value  of  such  an  institution  as  that 
for  the  instruction  of  midwives,  of  which  his  father  was  the 
director,  and  spoke  in  congratulatory  terms  of  the  starting  of 
such  institutions,  which  in  Prussia  had  been  in  existence  for 
fifty  or  sixty  years.  Here  in  England,  the  movement  was 
only  of  recent  growth,  and  he  did  not  think  that  as  yet  it  had 
developed  to  such  an  extent  as  the  importance  of  the  subject 
merited.  He  pointed  out  that  it  was  the  greatest  help  and 
relief  to  the  surgeon  to  find  on  his  arrival  at  a  confinement 
that  a  midwife  had  been  already  engaged  who  had  prepared 
everything  that  was  prescribed  in  their  practice,  and  therefore 


itoriSSfSTSSi?^  NORMAL  PABTTOITION.  589 

it  was  of  the  greatest  impprtanoe  that  midwives  should  have 
this  opportunity  of  qualifying  themselves  by  training  and 
examination  for  the  duties  they  would  have  to  discharge.  The 
speaker  also  alluded  to  the  excellent  results  of  using  arnica  in 
cases  of  confinement,  and  to  the  value  of  homoeopathic  treatment 
in  cases  where  abortion  was  of  frequent  occurrence,  and  in 
which  apis  had  served  him  in  good  stead. 

Dr.  WoLSTON  (Edinburgh)  said  he  should  like  to  touch  on 
^ne  or  two  points  raised  in  this  interesting  paper.  The  first 
was  as  to  the  breaking  of  the  membranes.  No  doubt  there 
were  some  cases  in  which  the  rupture  of  the  membranes  was 
exceedingly  advisable,  but  a  sort  of  rule  of  thumb  statement, 
that  the  membranes  should  be  broken,  he  certainly  could  not 
agree  with.  He  was  persuaded  that  the  preservation  of  the 
bag  of  membranes  was  of  immense  value,  particularly  in 
certain  cases.  To  allow  the  membranes  to  be  broken  early, 
and  the  head  to  come  down  upon  the  perinseum,  was  to 
prolong  labour,  because  a  hard  resLstiog  body  Uke  a  head 
down  upon  a  rigid  perinssum  would  not  have  the  same  effect 
in  dilating  it  as  the  bag  of  membranes.  The  latter  was  in 
reality  a  hydrostatic  bag,  and  water  as  they  knew  pressed 
equally  in  every  direction  according  to  the  force  employed* 
There  were  cases  on  the  other  hand  in  which  the  breaking 
of  the  membranes  was  of  the  first  importance.  Then 
as  to  the  using  of  the  forceps  in  suitable  cases,  he  (the 
speaker)  beheved  they  had  all  made  mistakes  in  their 
younger  days  in  not  having  used  the  forceps  more  frequently. 
In  those  days  they  were  hable  to  be  deterred  by  an 
element  of  fear,  whereas  they  got  over  that  disagreeable 
sensation  when  they  were  a  little  older.  Practically  he  had 
j)ut  on  the  forceps  in  every  third  or  fourth  case,  when  there 
had  been  any  delay.  Of  course,  in  a  rapid  case  they  were  not 
required.  But  no  harin  came  when  the  work  was  done  wisely 
and  well.  They  must  bear  in  mind,  however,  that  the 
presentation  of  the  head  must  be  carefully  made  out.  He 
remembered  having  been  called  in  in  consultation  in  a  case 
where  another  medical  practitioner  had  gone  to  work  in  this 
rapid  way,  put  on  his  forceps  immediately,  after  only  an 
hour  of  labour,  and  pulled  the  head  through,  with  serious 
consequences  to  the  patient,  who  only  recovered  after  several 
months'  careful  treatment.  In  that  case  the  practitioner 
had  tmdoubtedly  mistaken  a  posterior  for  an  anterior 
presentation.  They  must  therefore  use  them  with  caution. 
Thirdly,  as  to  the  binder.  He  believed  the  binder  as  usually 
applied  was  a  downright  abomination.  He  did  not  know  what 
other  members  of  the  Congress  thought,  but  he  knew  that  when 
he  had  taken  the  trouble  to  ask  patients  who  had  had  a  binder 
^ve  or  six  times,  and  then  had  been  induced  to  give  it  up  on 


690  NOBMAL  PABTUBITION.  ^"SS^^^S^^, 

{he  seventh,  they  always  eleeted  to  do  without  the  binder. 
There  was  no  possible  utility  in  the  binder  while  the  patient 
was  lying  in  bed  in  the  early  days.  In  his  judgment  it  only 
had  the  effect  of  pressing  down  the  womb  and  its  appendages 
deep  in  the  pelvis,  at  a  moment  when  it  should  be  left  free 
for  the  elastic  tube,  which  the  vagina  is,  to  support  it  in  its 
natural  position,  and  he  believed  that  a  very  large  number  of 
the  oases  of  chronic  metritis  and  retroversion  that  fell  into 
the  hands  of  the  gynsBCologist  were  the  result  of  the  binder 
having  been  put  on  too  firmly.  He  felt  convinced,  from 
twenty  years'  experience  of  never  using  the  binder,  that  patients 
got  on  more  comfortably  without  it.  The  time  to  put  the 
binder  on  was  the  fourteenth  or  eighteenth  day,  when  they 
were  rising.  Give  them  a  nice  binder  then,  and  they  would 
thank  you  for  it.  As  to  the  strength  of  the  solution,  he 
thought  that  one  in  a  thousand  of  corrosive  sublimate  was  a 
solution  on  the  strong  side.  (Hear,  hear).  He  knew  there 
had  been  eases  where  a  solution  of  that  strength  had  passed 
into  the  abdominal  cavity  with  very  serious  results  indeed. 
Personally,  he  thought  that  one  in  three  to  four  thousand 
was  amply  sufficient.  He  thanked  Dr.  Boberson  Day  most 
cordially  for  his  interesting  paper. 

Dr.  Dtce  Bbown  said  he  had  only  one  remark  to  make  on 
Dr.  Koberson  Day's  admirable  paper,  and  that  was  rather  in 
support  of  what  Dr.  Wolston  had  just  said.  He  must  say  that 
he  thought  it  was  a  mistake  on  the  part  of  Dr.  Boberson  Day 
to  advise  that  the  solution  of  corrosive  sublimate  should  be 
one  in  a  thousand.  A  number  of  cases  had  been  recorded  in 
the  old-school  journals  where  solutions  of  less  strength  than 
that  had  produced  very  serious  results  indeed,  and  he  thought 
that  when  they  wished  to  take  every  possible  precaution,  to 
assist  normal  labour  as  far  as  possible,  and  to  bring  the 
patient  through  in  the  most  perfect  condition,  they  should  not 
run  the  least  risk  by  using,  with  the  best  intentions,  a  solution 
which  might  have  such  lamentable  results  as  had  been 
frequently  brought  about.  He  sympathised  strongly  with 
Dr.  Wolston  in  saying  that  one  in  three  or  four  thousand 
was  quite  sufficient. 

Dr.  Marsh  said  they  had  been  given  some  very  good  advi<^ 
as  to  the  constant  use  of  the  nail-bruah,  but  even  after  this 
had  been  followed  they  would  often  find  blood  still  remaining 
at  the  quick  of  the  nail,  to  remove  which  he  would  like  to 
recommend  the  use  of  a  penknife  or  towel  as  well.  The  value 
of  the  binder  had  always  been  a  matter  of  opinion.  Those 
who  were  engaged  amongst  poorer  people  would  have  found 
the  binder  practically  useless.  It  was  nearly  always  up  under 
the  axilla.  He  used  the  binder  himself  out  of  deference  to  the 


2!!S^8STSS"*     NORMAL  PARTUBITION.  691 

n'odioes  of  patients.  Sometimes  he  had  it  put  on  for  the 
24  hours,  where  he  thought  it  would  be  useful,  but  he 
ttuNight,  if  it  were  left  to  himself,  he  should  not  trouble  about 
usmg  it  at  all.  As  one  of  the  previous  speakers  suggested, 
there  eertainly  seemed  more  to  be  said  in  favour  of  using  it, 
if  at  all,  when  the  patient  got  up.  As  to  corrosive  sublimate, 
he  was  not  much  given  to  its  use,  and  to  tell  the  truth  he  was 
rather  afraid  of  it.  A  medical  man,  not  a  homoeopath,  from 
the  York  Boad  Lying-in  Hospital,  told  him,  when  he  was 
down  at  the  mortuary  four  or  five  years  ago,  that  they  had 
had  four,  five,  six,  or  seven — ^he  would  not  speak  positively  as 
to  the  number — cases  of  inflammation  from  it,  and  gave  a 
complete  proving.  He  had  been  fearful  of  using  it  in  the 
strength  suggested,  on  that  account,  although  it  might,  per- 
haps, be  safely  used  in  a  higher  dilution. 

Dr.  BoDMAN  suggested  that  a  solution  of  Sanitas  or 
Oreolin  would  be  quite  as  efiiectut^,  and  very  much  better. 
(Hear,  hear).    Personally  he  never  used  corrosive  sublimate. 

Dr.  GoBDON  SioT^t  (Liverpool)  remarked  that  he  had  had  a 
considerable  amount  of  midwifery  practice.  When  he  first 
commenced  his  practice  he  knew  nothing  of  homoBopathy, 
bat  by-and-by  he  began  to  use  arnica  and  pulsatUla^  dx  in 
both  cases.  After  a  time  he  gave  up  arnica  in  favour  of 
puUatilla,  and  now  he  used  in  almost  all  cases,  for  the  last 
uumth,  usually  caulophyllum  in  the  morning  and  piUsatUla  at 
night,  the  third  decimal  in  both  cases.  He  had  noticed  that 
the  time  he  had  to  wait  now  at  midwifery  cases  was  not  half 
80  long  as  in  his  earlier  days. 

Dr.  BoBEBSON  Day,  in  replying  upon  the  discussion,  said  he 
brought  the  subject  forward  with  the  special  object  of  eliciting 
opinions.  He  thought  the  subject  of  obstetrics  had  not  been 
ftirly  treated  by  homoeopaths.  They  had  very  little  literature 
on  the  subject,  notwithstanding  that  it  presented  a  wide 
field  for  observation.  Beferring  to  the  remarks  made  by 
Dr.  Wolston,  he  quite  agreed  with  him  as  to  the  value  of  the- 
bag  of  membranes  in  the  dilitation  of  the  cervix  and  os,  and 
he  would  point  out  that  he  was  very  careful  in  his  paper 
to  use  the  words:  **it  should  not  be  ruptured  until  the 
oi  uteri  was  fully  dilated  or  dilatable."  After  this  stage  had 
been  reached  the  bag  of  membranes  ceased  to  be  of  any 
farther  value.  It  had  no  value,  so  far  as  we  knew,  in  dilating 
the  perinaeum,  this,  of  course,  being  done  by  the  progress  of 
the  head  subsequently.  With  regard  to  the  binder,  the  value 
of  its  use  was  a  matter  of  opinion.  They,  in  the  south, 
preferred  the  binder.  In  the  north,  and  among  the  Scotch, 
he  supposed  the  ladies  preferred  more  liberty,  and  objected  to 
SQch  restraint.    Two  or  three   gentlemen  appeared  to  b& 


592  TACHYCABDIA.  "^i?S^?SJ! 


Bevieir,  Sep.  1,  Un. 


under  a  little  misapprehension  as  to  his  remarks  conoaming 
the  use  of  corrosive  sublimate.  He  was  very  careful  to 
specify  that  it  was  only  to  be  used  externally.  He  was  folly 
aware  of  its  danger  as  an  injection,  and  he  never  allowed  it  to 
be  used  as  such,  having  pbserved  many  cases  of  poisomng 
following  therefrom.  They  would  obser^^e  that  in  the  roles 
for  midwives  which  he  had  passed  round,  its  prescribed  use 
was  entirely  limited  to  the  cleansing  of  utensils,  such  as  the 
bed-pan,  the  rinsing  of  the  hands,  and  so  on,  and  never 
AS  an  injection.  With  these  explanations,  he  beg^d  to  thank 
them  for  the  manner  in  which  his  paper  had  been  received. 

TACHYCAKDIA,  OR  EAPlD  HEART.* 

By  a.  Midgley  Cash,  M.D. 

I  AM  about  to  describe  a  somewhat  rare  case  of  gastro- 
oardiac  neurosis,  on  which  I  should  like  to  invite  discus- 
Bion,  especially  with  regard  to  treatment. 

Mr.  R..  aged  about  64,  consulted  me  early  in  October, 
1890,  with  the  object  of  seeing  what  homoeopathy  could 
do  for  him.  He  had  pretty  well  exhausted  allopathic 
resources,  having  tried  some  of  the  chief  lights  of  the 
profession,  from  one  of  whom  he  held  most  particular 
instructions,  both  as  to  medicinal  and  dietetic  treatment ; 

whilst  Dr. ,  of  Leamington,  and  one  or  two  doctors 

on  the  Riviera,  had  devoted  much  time  and  attention 
to  his  case. 

For  some  time  past  he  has  suffered  from  attacks  of  rapid 
heart's  action,  when  for  a  period  of  from  12  to  about  48 
hours  the  heart  will  fairly  run  away.  During  this  time 
the  pulse  at  the  wrist  is  uncountable,  if  not  entirely 
imperceptible.  The  hands  are  cold  and  often  moist,  a 
general  condition  of  shock  or  collapse  pervading  the 
whole  system,  an  anxious  pallor  overspreading  the  coun- 
tenance, voice  low  and  weak,  and  the  patient  lying  in 
bed  in  an  exhausted  condition.  On  examining  the  heart 
-mth  the  stethoscope,  I  generally  find  the  pulsations  to 
be  about  170  per  min.,  both  sounds  weak,  especially  the 
second,  but  although  weak,  there  is  no  murmur.  The 
apex  beat  is  exceedingly  feeble,  and  the  a<ition  of  th^ 
organ,  although  fairly  regular,  fluttering  and  powerless. 

The  great  exciting  causes  of  these  attacks  may  be  said 
to  be  two,  a  chill,  either  solely  or  through  the  stomach, 
and  sometimes  the  stomach  alone. 

*  Read  before  the  Western  Counties  Therapeutioal  Society. 


r 

I 


ggSi^gTSi!^  TACHYCARDIA, 69^ 

Ab  to  the  Stomach.  It  may  be  briefly  described  a& 
persistently  and  most  extraordinarily  acid.  There  seems 
to  be  an  unwonted  fount  of  acidity,  which  he  constantly 
describes  to  me  as  "boiling  up."  He  suffers  from 
almost  constant  acid  eructations  of  wind.  The  tongue 
dry  and  brown,  a  high  state  of  constipation,  urine  very 
acid  and  often  charged  with  lithates,  but  no  albumen,. 
and  almost  any  food  in  the  stomach  would  at  certain 
times  bring  on  an  attack. 

A  constwtly  present  condition  of  highly  acid  dyspepsia 
thus  culminates  at  intervals  in  heart  attack,  either  by 
some  reflex  action  upon  the  sympathetic  nerve  hastening 
the  heart's  action,  or  else  by  reflected  power,  decreasing 
the  prohibitory  action  of  the  vagus ;  possibly  both  these 
causes  act  together.  For  20  years  he  has  been  a  hypo* 
chondriac,  and  a  close  student  of  his  own  case.  Has 
taken  large  quantities  of  medicine,  especially  of  alkalies 
and  antacids,  sodu,  bismuth^  and  magnesia^  and  his 
decided  testimony  is  that  they  made  him  much  worse  I 
and  that  the  attacks  were  more  frequent  than  formerly. 
Has  lost  much  flesh,  his  aspect  sallow  and  cachetic,  so 
much  so,  that  when  I  first  saw  him  I  suspected  cancerous 
disease,  probably  of  the  stomach,  but  could  find  no 
evidence  of  any  tumour,  and  though  he  had  formerly 
been  in  the  habit  of  vomiting  brown  fluid,  this  had  not 
been  the  case  recently ;  neither,  as  a  rule,  did  he  suffer 
from  pain  in  the  stomach,  other  than  what  was  obviously 
caused  by  acidity.  The  liver  is  not  enlarged.  The 
stools,  which  were  only  brought  away  by  enemas,  were 
of  a  dark,  frothy,  yeasty  consistence,  a  sense  of  great 
relief  following  their  discharge.  His  medical  attendants 
had  been  greatly  exercised  to  find  some  purgative  which 
he  could  bear,  so  as  to  cleanse  the  intestines  of  this 
offensive  matter,  and  so  relieve  the  system,  but  hitherto 
wiUiout  success,  for  though  he  himself  had  a  strong 
yearning  for  aperients,  and  a  steady  desire  to  try  every 
fresh  one  that  had  been  recommended,  his  uniform 
experience  has  been  that  whenever  taken  an  attack  of 
palpitation  is  sure  to  follow. 

Within  a  fortnight  after  my  first  visit,  one  of  his 
attacks  of  palpitation  occurred,  from  which  he  had  scarcely 
recovered  when  he  had  a  threatening  of  paralysis.  The 
articulation  became  difficult,  and  next  day  he  was  hemi- 
plegic  on  left  side.    Hughlings  Jackson  saw  him  with 


U94  TACHYCAEDIA.  ""iSS^SirTttS! 

me,  and  gave  a  good  prognoeiB  as  to  paralysifl,  but  could 
give  no  explanation  as  to  heart  attacks.  From  the 
paralysis  he  made  rapid  and  good  recovery.  From  that 
time  to  the  present  there  have  been  nine  of  these  heart 
attacks,  seven  of  them  with  the  osual  rapid  action,  pulsa- 
tions of  from  160  to  over  190  per  minute,  and,  in  addition 
to  these,  two  other  attacks  in  which  the  general  symp- 
toms were  much  the  same,  but  the  pulsations  remained 
quiet,  at  about  68  per  minute.  There  was  bilious  vomit- 
ing, and  the  chilliness  and  collapse  were  rather  more 
marked  than  in  the  usual  attacks. 

His  diet,  which  had  been  most  carefully  regulated, 
I  did  not,  in  the  first  place,  very  much  alter, 
with  the  exception,  however,  of  cutting  off  most 
farinaceous  substances,  including  potatoes,  and  only 
allowing  bread,  stale  or  crisply  toasted.  His  experience 
had  taught  him  to  avoid  alcoholic  stimulants,  as  these, 
even  including  whiskey,  increased  his  acidity;  warm 
water  and  nib  cocoa  were  the  fluids  best  tolerated,  a 
little  weak  brandy  and  water  being  occasionally  given 
during  the  collapse  stage  of  an  attack. 

As  to  Medicines f  he  seemed  to  do  very  well  for  some 
time  at  first  upon  lye.  6x  and  nux.  3x,  although  lye.  had 
to  be  suspended  when  the  paralysis  occurred,  and  coccuL 
Sx  was  given  with  nux. 

During  the  next  heart  attack,  which  was  preceded  and 
accompanied  by  a  great  amount  of  acidity,  pult.  was 
given  and  cactus,  which  relieved  the  severe  constriction 
of  chest.  Carbo.  veg,  and  bryon.  were  both  useful  at 
times.  For  acidity,  whioh  kept  recurring,  I  now  tried 
sulph.  dc,  8x.  Later  on  argent,  nit.  6x  and  capncum  was 
given  intercurrently  for  the  heartburn.  The  acidity 
proving  intractable  I  now  tried  calc.  carb.  for  some  days. 
Digitalis  and  stfXfphantkus  had  been  frequently  imd 
carefully  tried  by  his  former  medical  advisers  with  only 
negative  results.  Under  iris.  Ix  he  seemed  to  do  well 
for  some  days,  but  whether  this  was  "a,  case  of  post  hoc 
or  propter  Iwc  it  would  be  difficult  to  say.  Cactus  and 
musk  seemed  to  be  of  some  service  during  the  attacks  of 
rapid  palpitation,  but  I  cannot  say  that  anv  medicine 
appeared  to  do  much  good,  or  that  any  decided  ground 
was  gained  by  treatment. 

I  felt  particularly  anxious  to  make  the  skin  act  well, 
and  in  order  to  relieve  the  system,  and  for  this  purpose 


SSSJ^r^TSx?^  TACHYCABPIA, 696 

he  had  both  hot  water  and  vapour  baths.  For  thd 
latter,  being  of  a  mechanieal  turn,  he  had  an  ingeniooB 
arrangement  made  by  which  he  could  procure  a  very 
efifectiTe  Turkish  bath  in  his  own  bedroom,  and  copious 
diaphoresis  was  thus  maintained  at  intervals.  Still  the 
attacks  recurred.  The  latest  and  worst  being  indeed,  in 
his  estimation,  brought  on  by  a  hot  water  bath,  after 
which  he  was  positive  no  chill  could  have  been  taken. 

Another  case  of  rapid  heart  came  under  my  care  seven 
years  ago.  He  was  a  stdut,  large  gentleman,  a  retired 
lieutenant-colonel  of  from  66  to  70  years  of  age,  of  {hto* 
nouuced  gouty  constitution.  When  ^st  examined  I  found 
his  heart  working  steadily,  at  80  per  minute,  though  occa* 
sionally  I  could  note  a  double  beat,  or  stumble  in  its 
action.  He  would  get  great  palpitation  come  on  if  excited 
or  nervous — if  he  had  to  make  a  speech,  for  instance-^ 
but  he  could  walk  well  up  hill  and  shout  without  trouble. 
Plain  ordinary  food  he  could  digest  well,  but  any  condi- 
ment would  bring  on  an  attack.  He  had  suffered  from 
chalk  stones,  and  the  urine  was  often  lithiatic.  There 
was  no  faintness,  flatulency  or  pain,  but  he  would  get 
attacks  either  daily  or  three  and  four  a  week.  Coming 
on  about  8  p.m.,  they  would  last  the  night  and  some* 
times  the  following  day,  often  about  86  hours.  During 
them  the  pulse  would  run  on  to  180  per  minute,  and  a 
fluttering  would  be  detected  by  the  hand  laid  on  the  side. 
There  was  no  arcus  senilis.  The  bowels  tended  to  be 
loose.  Violent  exertion,  such  as  hopping  or  pressure, 
would  sometimes  stop  an  attack.  Gfen.,  nux  vom.,  moBch.^ 
colekic.  and  heU.  had  fedled  to  effect  much  improvement 
at  the  time.  Here  some  peculiar  condition  of  the  gouty 
habit,  or  some  stomach  irritaticm,  may  have  predisposed 
to  the  attack.  Simple  weakness,  as  of  fatty  condition  of 
the  heart  muscle,  was  scarcely  so  probable  a  cause.  This 
case  is  now  keeping  much  better,  but  the  paroxysms  still 
occur  from  time  to  time.  It  may  be  probably  best  classed 
as  a  purely  nervous  case  of  tachycardia. 

A  case  of  rapid  heart  is  described  in  the  BriL  Med, 
Journal  of  January  8l8t,  which  was  put  down  as  probably 
caused  by  the  shock  of  an  accident  inducing  some  cerebral 
disturbance  so  as  to  derange  the  normal  equilibrium  be- 
tween the  vagus  restraining  and  the  accelerating  sympa- 
thetic nerve  power.  Here  there  was  no  gastric  cause  in 
operation,  and  improvement  is  stated tohaveoccurred  from 


696  TAOHTCABDU.  "*S*S."S:r?^ 


Bevkm,  Sep.  1,  im« 


large  dosen  (SO  min.)  of  tinotore  of  beUadanna,  and  the 
application  of  the  interrapted  galvanic  current  to  the 
pnenmo-gastric  nerve, ''  one  pole  behind  the  neck  high  np, 
and  the  other  along  the  coarse  of  the  nerve  in  the  neck." 
This  treatment  \vitliin  a  fortnight  reduced  the  pulse  from 
something  between  190  and  200  to  120  per  minute. 
Physical  shock  was  evidently  the  factor  here.  In  the 
following  case  mental  shock  was  the  active  cause  of  the 
malady. 

Mrs.  E.,  the  wife  of  a  friend  of  mine,  an  allopathic 
doctor,  as  a  girl  was  hysterical,  but  got  quite  free  of 
this  as  she  gr^w  up.  No  neurotic,  history  in  family. 
The  catamenia  were  regular.  No  ansBmia.  Had  had  a 
fever  in  youth,  supposed  to  have  been  enteric.  A  quiet, 
unemotional  woman.  She  lost  her  first  child  very 
suddenly  at  six  months'  old.  It  died  instantly,  in  an 
attack  of  laryngismus  stridulus.  She  took  its  death 
very  quietly  apparently,  but  two  weeks  afterwards  had 
an  epileptic  fit.  Within  three  years  she  had  three  mis- 
carriages, and  two  years  later  began  to  get  heart  attacks 
of  rapid  action,  lasting  from  ten  minutes  to  ten  hours. 
The  heart  would  start  off  in  a  moment  without  any 
apparent  cause  and  run  on  up  to  200  beats  a  minate. 
No  pulse  could  be  felt  at  the  wrist.  The  attack  would 
terminate  suddenly  with  a  sensation  as  if  the  heart 
turned  over.  Her  affection  was  termed  epilepsy  of  the 
heart.  A  mitral  murmur  existed  prior  to  any  attack  of 
it,  worse  after  she  had  passed  through  a  number  of  them. 
No  gastric  or  other  symptom  co-existed,  and  nothing 
was  known  to  produce  an  attack.  Twelve  months 
before  death  she  began  to  get  petit  mal,  and  again  one 
time  of  grand  mal«  The  last  heart  attack  began  tvo 
weeks  before  death,  and  went  on  till  it  wore  her  out. 
She  became  cyanotic  and  died  in  syncope.  No  medicines 
touched  the  ailment.  Mental  shock  was  considered  to 
be  the  fons  et  origo. 

In  all  these  cases  it  appears  that  something  disturbs 
the  cardio- vascular  trophic  centres  in  the  medulla  ob- 
longata, especially  those  of  the  vagi  and  sympathetic 
nerves.  It  would  seem  that  the  inhibitory  action  of  the 
vagus  is  suspended  for  a  time.  This  disturbance  may  be 
due  to  shock — physical  or  mental — or  to  the  presence  in 
the  blood  of  uric  acid  or  other  poison.  But  whatever  the 
«ause,  the  resulting  condition  is  one  which  is  difficult  to 


u!S^^!T15S^  THE    SINGLE  KEMEDY-  597 

treat,  and  medicines  are  not  of  very  striking  utility. 
Most  can  be  done  by  the  removal  of  the  cause  where  that 
IB  possible.  When  a  gastric  attack  is  at  the  bottom  of 
the  trouble,  rapidly  emptying  the  stomach  of  acid  mucus 
or  bile  ^l  quickly  stop  the  runaway  heart.  And  when 
—as  in  my  first  case — ordinary  emetics  are  only  retained, 
and  vomiting  is  difficult  to  set  going,  a  ^  grain  ajx)^ 
morphia  which  I  injected  under  the  skin  gave  a  good 
result.  Vomiting  occurred  in  five  minutes,  the  patient 
shortly  fell  asleep,  and  woke  after  some  hours  with  the 
attack  over  and  the  heart  beating  at  its  normal  rate. 

That  medicines  should  fail  in  such  a  case  as  this  does 
not  seem  extraordinary.  Bather  would  it  be  surprising  if 
they  could  effect  much  in  the  way  of  quieting  the  rapidly 
working  heart  as  long  as  the  cause  of  this  was  still  acting. 
Conquer  the  acid  dyspepsia — not  always  an  easy  task — 
and  you  cure  the  heart  trouble.  When,  however,  pure 
nervous  causes  are  at  work  to  produce  tachycardia, 
medicines  might — given  homoBopathically — ^be  more  suc- 
cessful, as  indeed  we  frequently  find  them  to  be  in  cases 
of  functional  palpitation  of  various  kinds. 

Torquay. 

THE  SINGLE  EEMEDY  IN  DISEASE.* 

By  Sam.  Philip  Alexander,  M.D.,  CM.,  M.B.C.S. 

The  point  for  discussion  under  this  heading,  I 
take  it,  is  the  use  of  the  single  remedy  as  against 
the  practice  of  giving  drugs  in  alternation.  We 
all  agree,  I  have  no  doubt,  that  for  the  proper  appli- 
cation of  the  law  of  similars  the  use  of  the  single 
remedy  is  one  of  the  great  essentials.  In  my  own  prac- 
tice I  find  it  sufficient  for  the  bulk  of  cases  to  prescribe 
one  remedy  at  a  time,  and  only  to  change  it  for  another, 
as  indicated  by  the  varying  symptoms  and  stages  in  a 
given  disease.  Of  course,  in  some  cases — *'  chronics  " 
especially — the  properly  chosen  single  remedy  will  often 
cure  straight  away,  or  eventually,  if  the  remedy  is  per- 
sisted in,  without  having  occasion  to  change.  I  can 
recall  many  instances  in  support  of  this.  I  have  been 
especially  struck  lately  in  comparing  two  cures  I  have 

*  Baad  before  the  Western  Ooimties  Therapentical  Society.. 
VoL  55,  No.  9,  2  u 


698  THE   SINGLE  BEMBDT.  ^^bS^^^^!^ 

had ;  one  an  acute  case  and  the  other  chronic,  bat  both 
treated  with  the  same  drug.  The  acute  case  was  one  of 
violent  headache,  attended  with  maniacal  symptoms  and 
melancholia,  the  totality  of  the  symptoms  pointing  to 
calc.  carb.  The  other  case  was  a  baby  of  aboat  a  year 
old,  who  had  suffered  from  birth  with  diarrhoea  and 
vomiting,  perspiration  of  the  head,  mesenteric  enlarge- 
ment, and  all  the  usual  symptoms  and  signs  of  marasmus. 
In  the  first  case  calc.  carb.  6  cured  in  a  week,  whilst  the 
same  drug  in  the  same  potency  made  a  man  of  the  baby 
(so  to  speak)  in  six  months. 

I  find  it  a  very  good  rule,  where  the  indicated  remedy 
fails  to  benefit,  to  first  try  a  different  potency  before 
changing  the  drug,  in  acute  cases  going,  as  a  rule,  lower, 
in  chronic  higher.  A  few  days  ago  I  was  consulted  by 
a  young  girl  suffering  from  an  acute  attack  of  herpes 
zoster  of  the  upper  part  of  back  and  left  side.  The 
eruption  consisted  of  a  mass  of  vesicles  from  the  size  of 
a  pin's  head  to  that  of  a  pea,  and  was  accompanied  by 
neuralgic  pain.  Rhus  tox.  8  was  prescribed  and  taken 
with  little  effect  for  three  days.  I  then  changed  to 
Thus  tox.  Ix,  when  the  eruption  dried  up  forthwith, 
araenicum  Sx  completing  the  cure  by  removing  the  pain. 
As  to  high  potencies,  I  can  never  forget  a  case  I  used  to 
attend  when  in  Yorkshire. 

The  patient,  a  lady,  was  a  chronic  sufferer  from  stru- 
mous disease,  which  manifested  itself  in  almost  every 
conceivable  form,  more  especially  as  severe  double  oph- 
thalmia. A  symptom  peculiarly  distressing  to  her,  and 
from  which  she  frequently  suffered,  was  a  "  feeling  of 
grit  or  sand  under  the  eyelids."  Sulphur  80  always 
promptly  removed  this  feeling,  any  lower  potency  of  the 
drug  being  entirely  without  effect. 

And  now  as  to  alternation  of  remedies.  Whilst 
strongly  deprecating  the  method,  as  a  rule  of  practice,  I 
cannot  help  thinking  that  in  some  cases — acute  especially 
— ^we  can  do  more  for  our  patient  with  two  drugs  given 
alternately,  than  by  the  single  remedy.  BeUadcnfUh 
though  pretty  well  specific  for  scarlatina,  does  not  appear 
to  me  to  reduce  the  fever  so  quickly  given  alone,  as  when 
alternated  with  aconite.  This  applies,  too,  to  other 
acute^  diseases  attended  by  fever,  such  as  pneumonia, 
pleurisy,  bronchitis,  &c.y  in  which  aconite  given  daring 


iH^jSSTS^  THE   SINGLE   REMEDY.  699 

the  pyretic  stage  seems  to  help  the  action  of  the  more 
specific  remedy. 

Again  we  frequently  have  to  treat  a  mass  of  symptoms, 
which  it  is  almost  impossible  to  hit  off  with  one  drug,  or 
two  distinct  sets  of  symptoms  occurring  simultaneously 
in  the  same  patient.  How  frequently  when  treating  a 
ease  of  eczema  or  any  other  definite  disease,  are  we 
requested  by  the  patient  to  prescribe  something  at  the 
same  time  for  his  "  poor  stomach,"  or  liver,  or  to  "  put 
something  into  the  medicine  for  the  bowels,"  or  to  help 
the  sleep?  In  such  a  case,  I  expect,  the  most  of  us 
would  order  with  success  some  such  drug  as  lycopodium^ 
caffein,  &c.,  to  be  taken  at  bedtime  ?  This  is  really  to 
alternate,  and  yet  to  do  so  does  not,  as  a  rule,  interfere 
with  the  action  of  the  specific  remedy.  The  ideal  practice 
no  doubt  is  to  embrace  such  side  issues  and  additional 
complaints  in  the  totality  of  the  symptoms,  and  with 
the  single  remedy  fire  a  shot  at  the  whole.  How  many 
of  us  manage  to  hit,  I  wonder  ? 

The  stock  treatment  of  piles  with  ntuic  and  sulphur^ 
adopted  by  some,  certainly  seems  to  do  more  good  than 
the  employment  of  either  of  those  drugs  singly. 

Then  there  are  cases,  in  which  we  may  have  descended 
to  alternation,  where  I  am  confident  the  second  drug,  if 
it  does  not  actually  assist  the  action  of  the  proper 
remedy,  does  not  interfere  with  it,  but  acts  like  so  much 
additional  water.  I  have  seen  a  case  of  acute  rheuma- 
tism promptly  cured — mirabile  dicti^— with  hryonia  and 
rhus.  tox.  given  alternately !  (I  would  just  remark  that 
I  had  no  hand  in  this  prescription.)  That  two  such 
antagonistic  drugs,  thrown  into  the  system  together, 
diould  effect  a  cure  is  only  to  be  explained  on  the  prin- 
ciple of  the  '^  survival  of  the  fittest ;"  the  disease  selects 
its  own  HmiUimum^  and  discards  everything  else.  But 
the  great  argument  against  alternation,  and  one  which 
should  teach  us  to  steer  clear  of  the  practice  as  much  as 
possible,  is  the  obscurity  in  which  it  involves  us  as  to  the 
proper  estimation  of  our  results.  I  can  recall  at  least  two 
cures  in  my  own  practice,  following  upon  the  alternation 
of  drugs,  in  which,  to  this  day,  I  am  ignorant  as  to 
which  drug  to  apportion  the  credit.  One  was  a  case  of 
chronic  gastro-enteritis,  the  principal  symptoms  being 
vomiting  and  diarrhoea  after  food,  with  burning  pain  in 
the  stomach  and  severe  colic.     These  symptoms  seemed 

2U  — 2 


600  lembke's  pbovings.    ^^IZ^SSTSt 


Beyiev,  Sep.  1,  ISU. 


to  me  to  indicate  arsenicwm  and  colocynth.  Accordin^j 
the  two  drugs  were  given  in  alternation,  and  the  man 
who  had  suffered  for  months  was  well  in  a  few  days. 
Whether  one  or  both  drugs  did  the  work  I  cannot  tell. 

The  second  case  was  somewhat  similar,  occurring  not 
long  ago  in  a  lady,  whom  I  was  called  to  see  in  the 
country.  This  case,  however,  was  recent  and  typhoid 
in  character,  attended  with  liver  symptoms.  Baptisia 
doing  no  good,  I  hesitated  between  mere.  sol.  and 
verat.  alb.y  but  finally  gave  the  two  in  alternation* 
with  immediate  and  complete  success.  Possibly  the 
two  drugs  helped  in  the  cure  by  each  removing  their 
own  pecuUar  symptoms,  but  as  they  were  given  ia 
alternation  I  could  never  know  certainly. 

I  quote  these  cases,  not  to  defend  alternation  of  drugs^ 
but  to  show  how  instructive  a  study  of  the  practice  may 
become,  as  contrasted  with  the  more  precise  and  bett^ 
way — "  the  single  remedy." 

Tecumseh  House, 

Southsea. 


LEMBKE'S  PBOVINGS. 
By    B.    E.    DuDGEoiii,    M.D. 

Db.  Lembke,  of  Biga,  is  one  of  the  most  voluminoa» 
contributors  to  the  homoeopathic  Materia  Medica  since 
Hahnemann's  time.  To  the  pathogeneses  of  no  less  than 
thirty-six  medicines  he  has  contributed  provings.  These 
jprovings,  unlike  those  of  his  predecessor,  Gajetan  Nen- 
ning,  which  were  made  on  a  number  of  seamstresses, 
and  which  Hahnemann  did  not  hold  in  much  esteem^ 
were  all  made  on  himself.  A  cursory  glance  through 
them  will  convince  anyone  that  they  displajr  a  very 
remarkable  similarity,  especially  in  the  predominance 
of  symptoms  relating  to  the  joints  of  the  extremities. 
.There  is  seldom  anything  in  them  which  one  would  say 
Vas  characteristically  distinctive  of  the  action  of  the 
various  drugs  subjected  to  experiment.  As  a  rule,  they 
seem  more  like  the  ordinary  sufferings  of  a  person  with 
a  decidedly  rheumatic  diathesis. 

.     I  have  always  credited  Dr.  Lembke  with  an  honest 
'belief  that  the  symptoms  he  records  were  due  to  the 


ICooChly  HoBMBopathio 
Bariew,  Sep.  1«  1881. 


LEMBKfig  PB0VING8. 


601 


action  of  the  medicine  he  was  proving,  though  they  seem 
to  me  more  like  the  pains  and  aches  of  a  gouty  dyspeptic 
person,  evoked  probably  by  the  slight  derangement  of 
health  caused  by  the  drug,  which  though  not  intense 
enough  to  excite  its  own  characteristic  effects,  was 
sufficient  to  stir  up  the  latent  activity  of  the  provcr's 
constitutional  ailment.  But  an  examination  of  his 
recorded  symptoms  in  the  pathogenesis  of  the  sweet 
spirits  of  nitre,  a  medicine  for  which  he  is  the  chief 
sponsor,  leads  me  to  doubt  whether  Dr.  Lembke  is  as 
reliable  an  authority  with  regard  to  the  effects  of  the 
medicines  he  has  published  as  one  should  wish  him  to 
be,  and  whether  he  is  not  rather  what  Hahnemann 
called  Dr.  Nenning — "  a  symptom  manufacturer," 

What  has  staggered  my  confidence  in  the  trust* 
worthiness  of  Dr.  Lembke  as  a  prover,  more  even  than  the 
suspicious  similarity  of  the  symptoms  he  attributes  to 
the  different  medicines  he  professes  to  have  proved,  is 
the  absolute  identity  of  the  symptoms  of  two  alleged 
provings  of  nitri  spiriius  dtdcis,  said  to  have  been  made 
on  two  separate  occasions  at  twenty-two  years*  interval. 
In  order  to  show  this  identity,  I  subjoin  in  parallel 
columns  a  portion  of  each  of  these  so-called  provings. 

Spiritui  Kitri  DuLeU, 


28tb  April,  1^9,  8  a.m.,  10  drops. 

Soon  after  taking  this,  a  feeling 
in  tiie  head  as  if  vertigo  were 
«oming  on,  repeated  several  times ; 
when  seated  a  sensation  as  if  the 
iipper  part  of  the  body  swayed. 
The  pidse,  until  8.30  a.m.,  rather 
fnUer  and  slower  than  usnal.  In 
the  hands  nncertain  feeling,  like 
treinbling,  when  grasping  and 
holding  objects.  Some  aching  in 
left  knee,  and  later  in  right  fore- 
arm, 9.80  a.m.  About  4  p.m.  draw- 
ing on  dorsum  of  left  foot,  in  joint 
of  left  metacarpus. 

29th  April,  B.30  a.m.,  15  drops. 

Tearing  in  fingers  and  toes,  ])ain 
in  right  hip- joint,  7.30  a.m.  Aching 
in  top  of  left  thoracic  wall,  going 
and  coming,  unaffected  by  breath- 
ing and  movement  The  left  ear 
feels  stopped  up  without  pain  and 
swelling,  8  a.m. ;  this  lasts  an 
hour ;  was  probably  only  the  oom- 
menoement  of  a  bad  catarrh  which 
became  developed  the  same  day. 


18th  Nov.,  1871,  8  a.m.,  10  drops. 
Soon  after  taking  this  a  feehng 
in  the  head  as  if  vertigo  were 
coming  on,  repeated  several  times ; 
in  the  intervals,  when  seated,  a 
feeling  as  if  the  upper  part  of  the 
body  swayed.  The  pulse  until  8.30 
not  otherwise  altered,  than  that 
it  beat  fuller  and  perhaps  slower 
than  usual.  In  the  hands  an  un- 
certain feeling  when  holding  ob- 
jects. Some  aching  in  left  knee 
and  then  in  right  forearm.  About 
4  p.m.  on  the  dorsum  of  left  foot, 
in  left  wrist  joint. 

19th  Nov.,  8  a.m.,  15  drops. 
Tearing  in  fingers  and  toes. 
Aching  in  left  thoracic  wall, 
oomlng  and  going  several  times, 
during  which  breathing  or  move- 
ment were  without  influence 


602                         LEMBKE's  PB0VING8.  "S^X^W 

2nd  May,  7.15  a.m.,  25  drops.  22nd  Noy.,  8  a.in.,  26  dzops. 

Soon  after  taking  this  lieavi-  Soon  after  taking  this,  heaii- 

nees  in  the  occiput,  with  heat ;  ,  ness  and  heat  in  the  oooipat,  in 

through  the  back  sensation  as  if  the  baok  sensation  of  heat  rinng 

hot  water    ran  from  below  up-  '  from  below  upwards,  and  katiiLg 

wards,  lasting  i  hour.    Heat  in  i  about  20  minutes.    Great  heat  in 

the  face,  more  inwardly  than  out-  ,  the  fiice,  then  through  the  whole 

wardly,  then  in  the  whole  body ;  body.  Sweating  of  palms ;  highly 

sweat  in  the  hands,  and  greatly  '  swollen  bloodvessels  of  the  hands 

swollen    bloodvessels    in    them,  '  when  the  body  was  at  rest,  lasting 


about  10  minutes.  About9ajn. 
inward  ohilliness,  oold  hands,  fre- 
quent micturition,  urine  bright 
jreUow,  lasting  one  hour.  Shoot- 
ing on  tip  of  tongue.  Nothing 
more  was  observed  during  the  day. 


although  no  movement  had  pre- 
viously occurred,  lasts  ^  hour.  The 
pulse  during  the  past  ^  hour  some- 
times unequal,  the  beats  on  the 
whole  fuller  and  stronger.  About 

8  a.m.  inward  chilliness,  cold 
hands,  desire  to  urinate,  lasting 
till  10  a.m.  Drawing  in  muscles 
of  calves  in  the  left  tibia  at  9.45. 
Fine  shooting  on  the  tongue-tip, 

9  a.m.,  slight  nausea.  The  urine 
at  10a.m.  showed  nothing  peculiar. 

And  BO  it  goes  on  throoghout  the  whole  of  the  two 
provings,  almost  word  for  word  the  same  in  both,  a  few  un> 
important  alterations  in  the  phraseology  and  the  omission 
of  a  few  trivial  symptoms  constituting  the  only  difference 
between  the  two  accounts.  The  only  explanation  of  thia 
marvellous  coincidence  that  occurs  to  me,  is  that  Dr. 
Lembke  was  paid  so  much  per  column  for  his  provings, 
and  that,  not  having  any  new  proving  on  hand,  and 
perhaps  wishing  for  a  little  ready  money,  he  imagined 
that  by  changing  the  dates  he  might  serve  up  an  old 
proving  which  would  not  be  recognised  as  being  the 
same  as  that  he  had  contributed  so  many  years  ago. 
What  makes  me  think  that  Dr.  Lembke  was  paid  for  his 
provingB  according  to  their  length,  is  the  obvious  manner 
in  which  they  are  spun  out  by  repetitions  and  irrelevant 
remarks.  The  number,  too,  of  the  provings  he  has 
furnished — thirty-six  at  least,  perhaps  more,  some  of 
them  very  long — seems  almost  beyond  the  power  of  one 
man  to  have  accomplished  during  his  career  as  a  medical 
practitioner  presumably  in  active  occupation.  These 
provings,  or  most  of  them,  may  be  seen  in  the  Cyclopcedia 
of  Drug  Pathogenesy,  and  though  they  are  there  given 
considerably  condensed  and  pared  down,  they  will  still  be 
found  to  bear  out  the  criticism  I  have  given  of  them. 
If  this  be  the  true  explanation,  it  throws  a  doubt  upon 
the  trustworthiness  of  all  his  other  provings,  and  woald 
warrant,  if  not  their  entire  omission  from  our  Materia 


2S£?ST3n?^  BBVIEWS.  608 

Hedica,  at  all  events,  their  admission  as  doubtful  until 
some  satisfactory  evidence  is  afforded  of  their  genuine- 
ness. And,  indeed,  the  Materia  Medica  would  suffer  no 
great  loss  by  their  entire  omission,  for  as  a  rule  they 
consist  of  trivial  and  unimportant  symptoms  by  no 
means  characteristic  of  the  effects  of  the  drugs  such  as 
we  have  them  from  other  sources. 

REVIEWS. 


The  Drug  Proving  of  the  Future :  A  Contribution  presented  to 
the  International  Homaopatliic  Convention,  June  18th,  1891, 
hy  BicHABD  Huomes,  M.D.,  &c.  A  reprint  from  The 
Hahnemannian  MontJUy,  July,  1891. 

We  should  imagine  that  there  is  no  physician  more  highly 
qoalified  for  the  task  of  instructing  the  medical  profession  on 
the  subject  of  drug-proving,  of  how  most  accurately  and  at 
the  same  time  most  completely  to  ascertain  the  pathogenetic 
properties  of  drugs,  than  the  author  of  this  paper.  Widely 
read  in  medical  hterature,  of  a  long  and  large  experience  in 
the  use  of  drags  as  curative  agencies,  Dr.  Hughes  also  brings 
to  his  task  the  information  he  has  derived  from  seven  long 
years'  devotion  to  the  examination  of  the  records  of  the 
effects  of  drugs  upon  the  human  organism — effects  which 
have  been  produced  under  well  nigh  every  variety  of  circum- 
staDoe  and  by  doses  of  an  almost  equal  variety  of  magnitude. 
Sach  a  course  of  study  could  not  fail  to  show,  to  one  of 
Dr.  Hughes'  culture  and  breadth  of  mental  view,  how  the  most 
usefdl  and  thorough  investigation  of  the  properties  of  drugs 
can  best  be  made :  he  has  also  been  able  to  ascertain  the 
requirements  of  all  real  progress  in  this  most  important  branch 
of  medical  study,  the  drugs  of  which  we  need  fuller  informa- 
tion, and  others  of  which  the  very  little  that  we  know  accu- 
rately suggests  that  well  and  thoroughly  carried  out  provings 
of  them  may  make  them  fruitful  therapeutic  weapons. 

The  subject  of  provings  has  often  been  enlarged  upon  by 
men  who  have  been  hampered  by  hobbies.  To  one,  no  proving 
is  satisfactory  except  such  as  is  made  with  massive  doses,  to 
him  all  else  is  **  rubbish."  To  another,  none  is  of  any  service 
mdess  made  with  drugs  in  a  more  or  less  high  state  of  dilu- 
tion— ^and  so  on.  Dr.  Hughes,  on  the  other  hand,  shows  the 
necessity  ahke  for  single  large  doses  as  presenting  "  the 
image  of  acute  disease  in  its  course  and  duration,"  of  small 
doses,  gradually  increased  if  necessary,  repeated  and  persisted 
in  until  morbid  phenomena  appear,  continuing  them  until  the 
medicinal  disease  has  been  thoroughly  established  in  order  to 


604 BEVIEW8>  ''ggj^fgygg 

produce  pictures  of  chronic  diBeases ;  of  such  as  may  be  tanned 
infinitesimal,  which,  though  possibly  only  producing  effecto  in 
five  per  cent,  of  the  provers,  and  requiring  espeoal  care  to 
avoid  illusions,  do  in  such  a  proportion  of  subjects  as  he  has 
stated  give  results  which  the  crude  drug  does  not.  They  aie 
effects  dependent  upon  special  suscepibility,  and  present  as  a 
rule  those  minuter  features  of  idiopathic  cUsease  which  enable 
us  to  select  simillvna  instead  of  dmiUa  only,  enabling  us,  in 
short,  accurately  to  individualise  our  cases  when  prescribing. 

Dr.  Hughes  urges  the  importance  of  availing  ourselves  of 
all  the  modem  measures  for  conducting  physical  and  chemical 
examinations  during  a  proving ;  of  testing  the  health  of  a 
prover  by  giving  him  blank  powders  for  a  time  before  com- 
mencing a  proving,  as  a  check  to  subsequent  trials  made  with 
the  drug  itself,  and  to  distinguish  between  real  medidnai 
action  and  the  mere  spontaneous  perturbation  of  the  provei's 
health. 

The  paper  is  in  every  way  an  excellent  one;  and,  in 
presenting  it  at  the  "  International "  Congress,  Dr.  Hu^ieB 
reflected  great  credit  upon  homoeopathy  in  Great  Britain. 


Te.rt  Book  of  Hygiene  from  an  American  SUindpoint,  By 
G.  H.  BoH]fa,  M.D.,  Baltimore.  Second  Edition.  Phila- 
delphia and  London :  F.  A.  Davis.    1891. 

This  book  traverses  in  an  interesting  and  instructive  manner 
the  whole  range  of  Hygiene  and  Public  Health.  In  it  Dr.  Bohi 
has  incorporated  the  most  reliable  work  of  his  predecessors  and 
co-workers  in  the  field  of  sanitary  science,  both  in  this 
country  and  America.  The  chapters  on  Air,  Water,  Food, 
Sewage,  etc.,  are  representative  of  the  best  views  on  the 
subject.  We  notice  that  Dr.  Boh6  strongly  recommends, 
when  writing  of  house  sanitation,  the  Decceco  closet.  This  is 
a  comparatively  new  **  wash-out,"  but  we  are  disposed  to  agree 
with  him  that  it  is  probably  the  best  of  its  kind.  Contnry 
to  the  generally  accepted  English  opinion.  Dr.  Boh^  does  not 
advise  the  house  drain  being  trapped,  as  he  considers  this  no 
guarantee  to  prevent  pressure  of  air  from  the  sewers. 

Whilst  not  entering  very  fully  into  it,  the  chapter  on 
this  subject  brings  out  well  the  salient  features  of  Hospital 
Construction. 

The  chapter  on  School  Hygiene  (a  subject  about  which  the 
profession  cannot  be  too  well  informed)  is  clearly  written  and 
contains  sound  information.  There  is  much  to  be  done  for  the 
welfare  of  the  rising  generation  by  a  proper  hygienic  supervision 
of  schools.  And  no  one  has  a  better  chance  of  helping  those  who 
are  unable  to  help  themselves  than  a  school  medical  officer  who 


is  -well-Tersed  in  this  important  subject.  We  might  mention  in 
passing  that  in  the  table  of  contents,  chapter  viii.  should  be 
School  Hygiene,  and  not  School  of  Hjgiene. 

Dr.  Boh^  does  not  £Ebvoar  cremation  as  the  best  method  for 
the  disposal  of  the  dead,  as  he  considers  the  supposed  dangersr 
of  burial  grounds  to  be  much  exaggerated ;  and  he  lays  stress 
upon  the  medical-legal  objection  of  the  rttnoval  of  all  trace  of 
poisons  should  it  ever  be  necessary  to  examine  a  suspected  case. 

The  section  on  epidemic  diseases  enters  fully  into  the 
subject,  but  as  the  book  professes  to  be  written  for  sanitary 
officers  as  well  as  students  and  practitioners,  it  would  have 
been  profitable  to  have  devoted  some  space  as  to  the  best 
manner  of  investigating  the  causation  of  an  outbreak  of  an 
epidemic.  The  part  of  the  book  most  essentially  American' 
is  that  on  Quarantine,  which  has  been  supplied  by  Surgeon 
Wyman,  of  the  United  States  Marine  Hospital, 

Whilst  being  a  good  exposition  of  the  principles  of  sanitary 
science,  this  book  will  scarcely  compete  with  its  English 
rivals  amongst  the  students  of  this  country. 

MEETINGS. 


INTEENATIONAL  HOMOEOPATHIC  CONGRESS,  1891.* 

At  the  meeting  at  Basle  in  1886,  a  vote  was  passed  that  the 
next  quinquennial  gathering  should  take  place  in  the  United 
States.  This  desire  was  communicated  by  the  Permanent 
Secretary  to  the  Secretary  of  the  American  Institute — the 
great  national  body  of  American  homoBopathists — and  by  him 
to  the  meeting  of  the  association  held  in  1887.  It  was 
welcomed,  and  the  institute  undertook  the  organisation  of  the 
Congress  and  provision  for  its  expenses.  This  has  been  done 
by  converting — so  to  speak — ^the  annual  assembly  of  the 
Institute  into  an  open  and  international  gathering,  and 
charging  its  officers  with  the  business  and  its  subscriptions 
with  the  cost. 

Accordingly,  on  Dr.  T.  Y.  Kinne,  of  Paterson,  N. J.,  Presi- 
dent for  the  year,  and  on  Dr.  Pemberton  Dudley,  the 
General  Secretary,  has  fallen  the  main  burden  of  organising 
the  present  Congress;  and  the  success  we  shall  see  it  to 
have  attained  is  largely  due  to  their  endeavours.  Not  the 
least  felicitous  of  their  provisions  was  the  nomination  of  Dr. 
Talbot,  of  Boston,  as  President.      (Their  wish — so  gratifying 

■   ■     I        ■^-  .^  ■-■■■—  ■ ■-■  --—I     .1  ■■     ■    .■.-»■        -     ■  II  ■  I.  ■    ■  ■      ■■  ■■  I  ■ .  ■       ■    I  ■■   w  I  ■■   I  la 

*  The  meeting  at  Philadelphia  in  1876  was  called  the  "^  World  *■ 
HonuBOpathiQ  Conyention."  For  that  of  London  in  1881  it  was  decided 
that  the  phrase  **  International  Homoeopathic  Conyention  ''  should  be 
used.    This  time  it  has  been  determined  to  substitute  "  Congress.'* 


fl06  MBBTINOB.  "?S£.=t??S!r. 


SUyrww,  Ssfm  1«  UU* 


to  OS  in  England — that  Dr*  Dudgeon  ahonld  assnme  the  post 
was»  when  Ms  presence  was  found  impossible,  met  by  naming 
him  Honorary  President.)  Dr.  Talbot  proved  an  ideal  chair- 
man ;  and  his  business  capacities,  and  combination  of  courtesy 
with  firmness,  secured  order  and  despatch,  while  it  left  no 
rankle  or  sense  of  hardship.  Another  excellent  provision 
was  the  constitution  of  a  Committee  on  Business,  of  which 
the  President  and  Permanent  Secretary  were  ex  officio  members, 
which  met  eyery  evening  to  arrange  the  work  for  the  following 
day.  In  this  way  everything  was  carefully  plumed 
before-hand — ^the  order  and  grouping  of  papers  determined,  and 
the  leaders  of  the  discussions  on  them  selected.  Dr.  McClelland, 
of  Pittsburg,  was  the  agent  in  carrying  out  the  decisions 
of  this  conclave  ;  and  very  assiduously  did  he  fulfil  his  task. 

While  much  of  the  success  of  the  meeting  is  thus  due  to  its 
officers,  not  a  little  credit  for  this  must  be  assigned  to  the 
rules  under  which  the  proceedings  were  conducted.  Each 
day's  work  was  commenced  by  an  '*  Address,"  of  more  or  less 
oratorical  and  general  interest.  The  papers  prepared  could 
be  read  by  the  authors  or  their  deputies,  in  full,  in  part,  or 
in  abstract  as  they  pleased,  so  long  as  they  did  not  occupy  more 
than  fifteen  minutes.  A  member  (chosen  beforehand)  was 
then  called  upon  to  open  the  debate,  for  which  purpose  ten 
minutes  were  allowed  him,  and  the  subject  was  finally 
thrown  open  for  general  discussion,  speakers  being  limited  to 
five  minutes  each.  When  the  President  considered  that 
sufficient  time  had  been  spent  on  the  paper,  having  considera- 
tion to  those  which  had  to  follow,  he  called  upon  its  author 
^if  present)  to  reply.  This  plan  worked  admirably.  At  first, 
mdeed,  the  readers  of  papers  miscalculated  the  relations  of 
time  to  matter ;  and  had  more  than  once  barely  reached  the 
end  of  their  preliminary  considerations  when  their  fifte^ 
minutes  had  expired,  so  that  we  lost  the  very  pith  of  their 
remarks.  The  lesson,  however,  was  soon  taken  to  heart; 
and  judicious  omissions  and  summaries  enabled  later 
essayists  to  do  more  justice  to  their  themes. 

Finally,  all  praise  must  be  given  to  the  earnestness,  the 
good  spirit,  and  the  discipline  which  characterised  the 
assembly.  Its  proceedings  thus  passed  off  with  the  utmost 
smoothness — ^without  loss  of  time  or  temper  ;  abundance  of 
good  matter  was  presented  and  of  thorough  discussion 
carried  on.  It  was  unanimously  felt  that  no  pleasanter  or 
more  profitable  meeting  of  homoeopathists  had  ever  been 
held ;  and  Ssprit  de  corp9  among  us  cannot  but  be  advanced 
by  its  experiences. 

And  now  a  few  words  as  to  the  locality  and  personnel  of  the 
meeting. 


Saj^^ETSS*"  MBBTDfOS.  607 


Bnkw,  Sip.  1, 1891. 


1.  Atlantic  City,  where  we  aesembled,  is  a  summer  resort 
(m  the  ocean  from  which  it  deriyes  its  name,  about  60  miles 
soath  of  Philadelphia.  It  possessed  the  advantage  of  a  large 
hotel  which — at  this  season  of  the  year— oould  be  devoted 
entirely  to  the  Congress ;  of  coolness  ;  and  of  freedom  from, 
the  noise  of  tra£Sc.  The  two  latter  qualifications  were  keenly 
enjoyed  by  those  who  remembered  Philadelphia  in  1876  and 
London  in  1881. 

SL  As  many  as  498  practitioners  of  homoeopathy  registered, 
their  names  as  attendants  upon  the  Congress  (and  it  is 
probable  that  others  were  present  who  neglected  thia 
ceremony).  Of  these,  one — ^Dr.  Alex.  Yillers — ^was  from 
Germany;  one — ^Dr.  Hughes — ^from  England;  two — ^Drs.. 
Fisher  and  C.  W.  Clark — ^from  Canada.  The  rest  were 
Americans.  Among  the  latter  were,  save  Ludlam,  the 
Wesselhoefts,  and  Hale,  almost  every  one  known  to  fame. 
Hehnath  and  Allen  came  from  New  York ;  Talbot  and 
Satherland  from  Boston;  Baue  and  the  Jameses  from 
Philadelphia;  Holcombe  from  New  Orleans;  Wood  and 
HcLaohkn  from  the  University  of  Michigan;  McClelland 
from  Pittsburg ;  Foster  and  Woodward  from  Chicago.  The 
last-named  city  also  sent  us  a  rising  surgeon,  of  singular 
fire  and  energy,  in  Dr.  Pratt ;  and  a  lady-physician,  no  less  a 
person  of  mark,  in  Dr.  Julia  Holmes  Smith.  To  complete 
rtatistics,  it  may  be  added  that  over  500  visitors  were  present 
(chiefly  from  the  families  of  the  members),  so  that  the 
total  attendance  was  reported  as  1,058 ;  and  that  218 
Addresses,  papers  and  speeches  were  deUvered  during  the  five 
days  occupied  by  the  assembly. 

With  these  general  remarks,  we  proceed  to  give  a  detailed 
account  of  what  took  place. 

Tuesday,  June  16th. 

The  Congress  opened  this  evening  at  8  o'clock  with  a 
preliminary  meeting.  The  place  of  assembly  was  a  pavilion 
attached  to  the  hotel  where  most  of  the  members  had  taken 
np  their  quarters;  it  was  commodiously  arranged  with 
l)enches,  platform,  &c.,  and  hung  round  about  with  shields,  on 
which  were  inscribed  the  names  of  deceased  champions  of  our 
cause  in  all  countries.  The  Permanent  Secretai7 — 
^*  Hughes — took  the  chair,  no  other  officers  yet  existing. 
Addresses  of  welcome  were  then  presented  by  the  Mayor  of 
Atlantic  City,  and  by  the  President  of  the  Institute.  In  the 
course  of  the  latter  a  portrait  of  Hahnemann,  hung  above  the 
chair,  was  unveiled;  and  the  Master  was  eloquently 
apostrophized  by  the  speaker.  Dr.  Einne  was  next  called 
upon  to  present  the  report  of  the  Institute  as  to  the  officers  it 


•608  MEETINGS.  *^SS2J*2r?»S!' 


Beview,  Sep.  1,  IIHI. 


wonld  nominate  and  the  roles  of  proceeding  and  order  of 
business  it  Would  recommend  to  the  Congress.  These  being 
^ut  and  adopted,  Dr.  Talbot  was  led  to  the  chair ;  and  the 
Permanent  Secretary,  vacating  it  in  his  favour,  presented  him 
with  the  gavel  which  had  been  used  by  the  foregoing 
Presidents,  bearing  their  names  inscribed  upon  it.  Dr.  Taibot 
addressed  the  meeting  in  a  few  words  of  thanks,  and  of 
•encouragement  to  their  impending  labours ;  and  then,  in  liea 
•of  an  address  of  his  own,  read  one  which  (on  request)  had 
been  prepared  by  Dr.  Dudgeon.  It  was  entitled  **  The  Certa 
and  the  Dubia  of  Homoeopathy ;"  and,  it  need  hardly  be  aaid, 
was  warmly  received,  and  thanks  for  it  directed  to  be  cabled 
to  its  honoured  author. 

Wednesday,  June  17th. 

The  regular  meetings,  from  10  to  1  and  from  8  k> 
6  daily,  now  commenced.  On  the  upper  dais  of  the 
room  sat  the  President,  with  Dr.  Einne  as  Vice-  President 
on  one  side''',  and  the  Permanent  Secretary  at  his  table 
on  the  other.  On  a  lower  platform  were  Dr.  Pemberton 
Dudley  and  Dr.  T.  M.  Strong,  acting  as  Becording 
Secretary  and  Stenographer  respectively.  On  this  also  each 
speaker  took  his  stand,  so  as  to  be  seen  and  heard  of  all. 

The  morning's  work  was  Homoeopathic  Therapeutics,  bnt 
first  we  listened  to  an  address  from  Dr.  A.  S.  Couch,  of 
Predonia,  N.Y.,  on  ''  The  Ethical  Basis  of  the  Separate 
Existence  of  the  Homoeopathic  School.''  Dr.  Couch  is  a  bom 
orator,  and  both  matter  and  manner  on  this  occasion  were 
worthy  of  him.  The  essence  of  his  contention  was  that  loyalty 
to  the  truth  we  are  entrusted  with  requires  the  maintenance 
of  our  distinctive  position  and  the  persistent  assertion  of  oar 
claims. 

Dr.  Cowperthwait,  of  Iowa  City,  now  read  a  paper  on 
''  The  Influence  of  Homoeopathic  Therapeutics  on  Old-School 
Practice,"  for  which,  of  course,  recent  doings  in  the  camp  of 
traditional  medicine  gave  him  ample  material.  Coupled 
therewith  a  paper  by  the  venerable  Dr.  Lilienthal,  on 
*'  Homoeopathic  Therapeutics,"  was  presented  in  abstract  by 
Dr.  Hughes,  who  also  opened  the  discussion  on  the  pair.  Dr. 
Lilienthal's  main  thesis  was  an  urging  to  purity  in  homoBO- 
^atliic  practice,  and  this  Dr.  Hughes  warmly  supported, 
warning  against  the  temptation  to  a  shallow  and  lawless 
eclecticism.  He  was  followed,  in  the  same  strain,  by  Dr.  J.  C. 


* AU  Presidents  of  National  Societies  (including  Mr.  Harris  as  chairman 
«lect  of  our  Annoal  Congress)  were  tx  offielo  Vioe-Presidents  of  the 
International  Oonvention. 


iSSi^^TS^  MEETINGS. 609 

Morgan,  of  Philadelphia,  and  Dr.   T.  F.  Allen ;   and  the 
debate  was  then  closed. 

We  were  next  called  to  more  practical  considerations  by  a 
paper  from  our  own  Dr.  Edward  Blake,  entitled  *'  How  to 
Core  Back-ache."  It  was  read  in  an  abstract  prepared  by  the 
aathor ;  and  discussed  by  Drs.  Schneider,  Monro,  Sartain  (a 
Iftdy),  Owens,  Flora  Brewster,  Dudley,  Duncan  and  Hughes. 
A  main  point  made  was  the  need  of  searching  for  mechanical 
eauses  of  drag  or  pressure. 

Dr.  Komdoerffer,  of  Philadelphia,  then  brought  us  back  to 
^ilosophy  by  a  paper  on  '*  The  Belation  of  Homceopathio 
Therapeutics  to  Constitutional  Predispositions."  It  was 
oonoeiyed  on  so  large  a  scale,  that  its  allotted  time  was 
entirely  occupied  by  its  preamble  ;  but  its  aim  was  evidently 
to  enforce  the  necessity  of  taking  chronic  diatheses  into 
account,  even  in  local  or  acute  affections.  A  paper  by 
Dr.  Diederich,  of  Kansas  City,  on  a  cognate  theme,  having 
been  read  in  abstract,  the  discussion  on  the  pair  was  opened 
by  Dr.  Allen.  He  vigorously  supported  the  position  of  the 
essayists.  Chronic  disease  must  always,  acute  disease  must 
often,  be  treated  constitutionally,  with  regard  to  cachexise 
inherited  or  acquired ;  and  the  former  might  be  eradicated, 
and  the  latter  prevented,  by  such  medication.  He  was  followed 
by  Drs.  Morgan  and  Hanchett,  and  by  Dr.  Eomdoerffer 
in  reply. 

Dr.  Cowl,  of  New  York,  now  read  a  paper  on  the  "  Import 
of  Bacteriology  to  Homoeopathic  Therapy  in  General."  He 
advocated  a  certain  auxiliary  use  of  antiseptics,  of  which  he 
regarded  the  mlpho-carholate  of  sodium  as  the  least  foreign, 
and,  therefore,  the  least  inimical  to  the  organism.  The 
discussion  (which  had  to  be  adjourned  till  after  luncheon), 
was  opened  by  Dr.  A.  Yillers,  and  was  then  further  fed  by 
a  paper  from  Dr.  J.  N.  Mitchell,  of  Philadelphia,  advocating 
antisepsis  in  obstetrical  cases,  and  carried  on  by  Drs.  Dake, 
McClelland,  Mitchell,  Higbee,  Bushrod  James,  and  Custis. 
It  turned  mainly  on  the  question  between  antisepsis  and 
asepsis ;  and  differences  of  opinion  appeared  here  as  among 
all  who  treat  of  the  subject. 

The  afternoon  session  had  been  assigned  to  essays  and 
discussions  pertaining  to  Obstetrics.  These  were  initiated  by 
a  paper,  humorous  and  sensible,  by  a  lady  from  Connecticut, 
Dr.  Pardee,  who  found  her  only  critic  in  one  of  her  own 
sex,  Dr.  Millie  Chapman,  of  Pittsburg.  Dr.  Danforth,  of 
New  York,  followed  with  an  essay  on  '*  Puerperal 
Septicemia,"  which  revived  the  antiseptic  question,  and 
excited    a    vigorous    discussion,  ip    which    Drs.   Sanders,^ 


610  MEETIN08.  ^'TS&^S^Tml 

Holmes  Smith,  Bnshiod  James,  Allen,  Owens  and   Flon 
Brewster  took  part. 

By  this  time  the  afternoon  was  £Eur  advanced,  and  when  short 
papers  by  Dr.  Church  on  **  Decubitus  in  Dystocia  "  and  hj 
Dr.  Morgan  on  "  Prolapsed  Funis  "  had  been  read,  and  as 
briefly  discussed,  the  Congress  adjourned. 

Thursday,  June  18th. 

This  was  the  ''  Materia  Medica  Day,"  and  a  goodly  list  of 
papers  appeared  on  the  programme.  First  of  all,  howeTer, 
the  Congress  listened  to,  and  were  instructed  by,  an  address  by 
the  veteran  Dr.  Dake,  entitled  "  Practitioners  of  Homoeopathy 
always  the  Defenders  of  Medical  Freedom.*'  It  praised  the 
medical  liberty  enjoyed  in  England,  and  deprecated  the 
tendency  to  fetter  this  now  showing  itself  here  and  there  in 
the  United  States. 

Dr.  Hughes  then  came  forward  to  present,  on  behalf  of  Dr. 
Dake  and  himself,  a  **  Report  on  tiie  Cyclopaedia  of  Dmff 
Pathogenesy  "  now  close  on  its  completion.  Dr.  Woodward 
opened  the  discussion  thereupon,  followed  by  Drs.  Allen,  Mack, 
and  Dudley,  all  expressing  warm  appreciation  of  the  work,  and 
Dr.  Allen  stating  that  he  always  recommended  would-be 
students  of  homoeopathy — ^many  of  whom,  from  the  ranb 
of  the  old  school,  applied  to  him  for  advice — ^to  begin  by 
mastering  it. 

Next,  papers  by  Dr.  Conrad  Wesselhoeft  and  Dr.  Hughes, 
entitled  respectively  ''The  Demands  of  Modem  Science  in 
the  Work  of  Drug  Proving"  and  "  The  Drug  Proving  of  the 
Future,"  were  presented,  the  former  by  Dr.  Cowperthwait, 
the  latter  by  its  author.  Dr.  Allen  opened  the  discussion, 
telling  us — inter  alia — that  there  was  a  good  prospect  of  the 
endowment  of  a  physiological  laboratory  in  connection  with 
the  New  York  Homoeopatiiic  College ;  and  was  followed  by 
Drs.  Mohr,  Morgan,  Van  Denburg,  Dake,  Sutherland,  and 
Cowperthwait.  Dr.  Dake  roused  great  applause  when  he 
recalled  the  fact  that  it  was  84  years  ago  when  he  first  came 
before  the  Institute  to  advocate  ihe  sounder  methods  of  drug- 
proving  which  were  now  being  everywhere  accepted  and 
followed. 

The  subject  was  resumed  in  the  afternoon,  m  its 
pharmaceutical  branch,  by  papers  from  Dr.  J.  W.  Clapp,  of 
Boston,  on  ''The  Pharmacy  of  Triturations,"  and  from 
Dr.  Sherman,  of  Milwaukee,  and  Mr.  A.  J.  Tafel,  on  *'  The 
Pharmacy  of  Tinctures."  On  the  former  there  was  nothing 
to  be  said ;  but  apropos  of  the  latter  the  question  between  the 
British     and     Uie    (projected)     American     Homoeopathie 


ItSS^SmS^  MBKTnfM.  611 


Bsview,  Sep.  1,  UBl. 


Pharmacopoeia,  as  to  the  unit  of  strength  for  attenaation»  was 
raised  by  Dr.  Hughes,  discussed  by  Drs.  Duncan  and 
McClelland,  and  referred  to  the  American  Institute  (which  is 
preparing  the  latter  work)  for  re-consideration. 

Dr.  AUen  now  came  forward  with  a  paper  of  his  own,  on 
^*  Indexes  and  Repertories."  While  commending  the 
proposed  index  to  the  Cyclopedia,  he  considered  a  therapeutic 
repertory  also  necessary—one  that  should  fill  up  gaps  from 
•dmical  experience,  and  present  symptoms  in  three  aspects — 
viz.,  locality,  sensation  and  conditions.  He  thought  that 
Bonninghausen's  Pocket-book  best  supplied  such  need. 
Dr.  Mack,  the  Professor  of  Materia  Medica  at  the 
Homoeopathic  College  of  Michigan  University,  followed  with 
a  «*  Discussion  of  Dr.  Hughes's  Proposed  Index  to  the 
Cyclopaedia  of  Drug  Pathogenesy,"  '^  of  which,  with  some 
modifications,  he  approved.  The  two  papers  were  then 
debated  by  Drs.  Mohr,  Van  Denburg,  Eomdoerffer,  Church 
(who  suggested  a  ''  Beference  Bible  '*  as  the  model  for  a 
repertory),  Morgan  and  Hughes;  Drs.  Allen  and  Mack 
replying.  A  main  point  in  question  was  whether  modalities 
can  be  separated  from  their  symptoms,  and  sensations  from 
their  seats;  Dr.  AUen  advocating  this,  Drs.  Mohr  and 
Hughes  cautioning  against  the  abuse  of  such  practice. 

Dr.  Eldridge  Q.  Price,  of  Baltimore,  now  brought  forward 
the  plan  of  a  club  formed  in  that  city  for  **  A  Beconstmcted 
Materia  Medica."  It  is  based  upon  the  Cyclopadia;  and 
proceeds  upon  the  principle  of  retaming  only  such  symptoms 
as  have  been  experienced  by  two  or  more  persons,  giving 
these  precedence  according  to  the  number  of  those  who  have 
observed  them.  It  was  discussed  by  Dr.  Sutherland  (who, 
with  Dr.  C.  Wesselhoeft,  is  engaged  upon  a  similar  plan  based 
on  Allen's  Encyclopadia)^  and  Dr.  Daks. 

Last,  a  paper  by  Dr.  E.  M.  Hale,  ''The  Probable 
Homoeopathic  Uses  of  some  new  but  unproved  drugs"  was 
— ^in  the  absence  of  its  author — presented  in  brief  and 
criticised  by  Dr.  Hughes. 

A  paper  by  Dr.  Van  Denburg,  "A  Comparison  of 
Therapeutic  Methods,  based  on  a  study  of  Arsenic,"  having 
been  read  by  title  and  referred  to  the  Committee  on 
Publication,  the  Congress  adjourned,  feeling  that  a  good  day's 
work  had  been  done. 

Friday,  June  19th. 

The  address  of  to-day  was  by  Dr.  Talbot,  on  **  The  Duties 
and  Besponsibilities  of  Homoeopathic  Colleges  as  Leaders  in 

*  See  thlB  Journal  for  NoTember,  1890. 


612 josETiNgs,  ''S^fgrgSi! 

Medical  Prc^;ress."  It  was  brief,  though  pregnant ;  and  6» 
speaker  aaked  that  the  time  he  had  not  occupied  might  be 
given  to  others  who  could  speak  on  the  theme.  This  brought 
up  Drs.  S.  B.  Beckwith  and  Helmuth,  whose  reminiscences  of 
the  4soUeges  at  Cleveland  and  Philadelphia  respectively  dated 
from  1858 ;  and  they  strikingly  contrasted  the  state  of  things 
at  the  present  day  with  what  then  existed. 

We  now  passed  to  the  subject  of  the  morning — Gynecology. 
The  first  paper  read  was  one  by  Dr.  James  G.  Wood,  on 
**  Epilepsy  as  a  Hystero-neurosis"  (using  the  term  "  hystero" 
in  its  etymological  sense,  and  induding  the  o\'aries).  He 
related  three  cases  illustrating  the  thesis  implied  in  ms  title, 
one  of  which  was  cured  and  the  others  greatly  benefited  by 
operation.  The  discussion  was  carried  on  by  Drs.  A.  Villers 
and  Helmuth,  the  latter  of  whom  related  a  very  interesting 
case  of  menstrual  epilepsy,  the  aura  starting  from  one  of  the 
ovaries,  which  persistent  pressure  for  two  to  three  days  befoie 
each  period  completely  cured. 

Dr.  L.  A.  Phillips,  of  Boston,  now  discoursed  upon  '*  Aids 
to  Gynaecology  neither  medical  nor  surgical."  His  paper 
was  discussed  by  Drs.  Danforth,  Julia  Holmes  Smith, 
McClelland,  Morgan,  Schneider,  and  Flora  Brewster;  and 
many  practical  points  were  made. 

Dr.  Betts  next  came  forward  with  a  paper  on  '*  The  Scope 
of  Homoeopathic  Therapeutics  in  Gynaecological  Practice." 
He  stated,  as  the  result  of  extensive  inquiry,  that  he  could 
find  no  instance  of  uterine  neoplasmata  occmTing  in  the 
subjects  of  homoeopathic  treatment  from  their  youth  up— the 
inference  being  that  early  symptomatic  treatment  prevented 
the  development  of  these  growths.  Drs.  Johnson  (a  Udy), 
Dake,  Phillips  and  Bushrod  James  took  part  in  the  discussion. 

Dr.  Ostrom,  of  New  York,  followed  upon  "  Damaged 
Uterine  Appendages  and  their  Bemoval."  He  did  not  thnik 
pyo-salpinx  ever  amenable  to  internal  treatment.  One  o^dock 
having  now.  arrived,  discussion  was  deferred  till  the  afternoon ;. 
but  when  the  Congress  re-assembled,  no  one  was  found  to, 
speak  on  the  subject.  Other  gynaecological  papers  still 
remaining,  they  were  disposed  of  before  coming  to  the 
special  subject  of  the  meeting. 

Dr.  Lee,  of  Bochester,  presented  a  record  of  <' Forty-two 
consecutive  Laparotomies,"  all  of  which  recovered  bat  one. 
Dr.  Helmuth  congratulated  the  homoeopathic  school  on  the 
advance  of  its  surgery ;  .and  Drs.  Fiske  and  S.  B.  Beckwith 
^so  spoke. 

Dr.  Higbee,  of  St.  Paul's,  Minnesota,  read  a  paper  entitled 
"  Gynaecological  Surgery— when  to  operate" — discussion  on 
which  was  postponed,  and  eventually  never  came  off. 


JSS^^TS^  MEETIK08. 613 

This  brought  us  to  "  Ophthalmology,  Otology,  and 
Laaryngology  ;"  and,  though  the  afternoon  session  was 
prolonged  till  6.80,  the  time  proved  quite  insufficient  for  doing 
justice  to  so  large  a  subject. 

Dr.  McLachlan  began  with  ''  Similia  in  Eye,  Ear,  Nose  and 
Throat  Diseases."  (**  Similia,"  we  should  say,  by  a  frequent 
Ainerioan  usage  is  short  for  S.S.O.)  He  was  general  only  in 
his  statements,  but  warmly  commendatory ;  and  was  followed 
by  Dr.  A.  B.  Norton  in  the  same  strain,  the  latter  testifying, 
firasn  the  experience  of  the  New  York  Ophthalmic  Hospital, 
to  the  undoubted  power  of  our  remedies  (especially  cawtHcum) 
in  checking  the  progress  of  cataract.  Drs.  Bushrod  James  and 
MacDermot  bore  similar  testimony. 

Dr.  Hooker  followed  on  **  The  Surgery  of  the  Nose  and 
Naso-pharynx,"  which  was  discussed  by  Dr.  W.  A.  Dunn. 

Dr.  Ivins,  of  Philadelphia,  then  read  an  interesting  paper 
on  *'Hay  Fever."  He  gave  a  more  hopeful  prognosis  than 
18  generally  ventured  on,  his  main  remedies  being  allium  cepa, 
naphthaline  arn.  iod,  and  alb.^  and  arum  triphyllum.  Dr. 
Wright  opened  the  discussion,  and  was  followed  by  Drs. 
Morgan  and  H.  G.  Allen. 

Dr.  Hayes  French,  of  San  Francisco,  next  discoursed  on 
".Points  of  Diagnosis  in  Be^ractive  and  bther  Eye  Troubles," 
but  was  too  technical  to  excite  discussion  ;  which  was  other- 
wise with  a  paper  by  Dr.  Park  Lewis,  of  Buffalo,  *'  On  the 
study  of  Ophthalmic  Therapeutics."  As  speakers  on  this 
topic  there  rose  successively  Drs.  Wanstock,  McDermot» 
Eomdoerffer,  Dunn,  Hayes  French,  Norton,  and  Bushrod 
James;  all  bringing  forward  useful  matter,  which  will  be 
fomid  in  the  Transactions* 

Saturday,  June  20th. 

Dr.  Charles  Oatchell,  of  Michigan  University,  led  oft 
to-day  with  an  address  on  *'  Th$  Influence  of  Homoeopathy  on 
Beeent  Medical  Literature  and  Practice."  He  thought 
that — in  America  at  least— literature  had  been  much 
influenced  by  it,  but  practice  very  little. 

Dr.  Holcombe,  who  was  called  upon  to  speak  on  the  subject, 
said  that  old-school  practitioners  adopt  bits  of  homceopathic 
practice,  empirically,  but  never  acknowledge  the  law. 

The  subject  of  the  day  was  Surgery ;  and  the  first  paper 
was  by  Dr.  Horace  Packard,  of  Boston,  who  is  achieving  quite 
a  reputation  in  this  sphere.  It  was  upon  "  the  Present 
Belations  of  Antiseptic  Methods  to  Surgery,"  and  was  a 
strong  defence  of  Listerism.  It  was  read  in  abstract  only — 
ttie  author  being  absent ;  and  the  discussion  was  undertaken 
bj  Drs.  Lungren,  and  Sheldon  Leavitt.    Both  had  been  with 

ToL  35,  No.  9.  2  X 


614  MEETINGS.  ^'^SS^ 


BcvicWi  8cp«  1«  IflHa 


Lawson  Tait ;  but  while  the  fonner  was  well  satisfied  with 
the  cleanliness  and  hot  water  on  which  alone  that  soxgeoa 
relied,  the  latter  thought  he  had  seen  better  results  stiH 
when  actual  antiseptics  were  employed. 

Dr.  Helmuth  followed  with  an  able  paper  on  **  Carcinoma 
and  Sarcoma,"  based  on  a  collation  of  100  cases,  and,  likeaU 
this  great  surgeon's  writings,  ''  hewn  firom  life."  He  hsd  no 
doubt  of  the  value  of  honueopathio  medication.  For  tnia 
carcinoma  the  remedies  were  araetde  when  the  face  wis 
affected,  catUum  for  mammary  scirrhus,  hydrastu  ht 
uterine.  In  sarcoma  he  had  seen  excellent  results  from 
thujaf  internally  and  locally.  Dr.  McClelland,  who  opened 
the  discussion,  had  had  best  results  from  an*  tod.,  siUcuij 
and  calcarea.  He  related  two  cases  of  nodular  liver, 
apparently  cancerous,  which  recovered  under  an,  iod,  8x. 
Dr.  Owens  had  had  much  success  from  aeetie  acid  applied  to 
the  tumour  and  taken  internally.  The  subject  was  also 
spoken  to  by  Dr.  J.  N.  Henry  (who  commended  cale.  phoi.  as 
the  chief  anti-cancerous  medicine),  Dr.  S.  B.  Beckwith, 
Dr.  T.  E.  Sawyer  (who  had  found  most  relief  to  the  pains  of 
malignant  disease  from  the  higher  attenuations),  and  Dr. 
Fisher. 

Dr.  van  Lennep,  of  Hdladelphia,  now  gave  us  an  exoeOent 
paper  on  ''  Inflammations  of  Uie  right  iliac  fMsa,"  chiefly 
typhlitis  and  perityphlitis  (both  of  which  he  considered  to  be 
primarily  "  appendioitis  ") ;  which  was  spoken  to  by  Dr.  h 
£.  James.  The  remainder  of  the  surgical  programme  iras 
then  adjourned  to  the  afternoon. 

Before  we  resumed  it,  however,  we  listened  to  an  address  from 
Dr.  H.  M.  Lewis,  of  Brooklyn,  on  **  Training  Schools  fer 
Nurses;"  on  which  subject  Drs.  Julia  Holmes  Smith, 
Moffatt  Cook  and  D.  H.  Beckwith  spoke.  America  should 
be  a  paradise  for  nurses,  as  it  seems  that  trained  ones  recdye 
from  20  to  25  dollars  a  week. 

Surgery  now  began  again  by  a  p^ter  from  Dr.  Wilcox,  of 
Buffalo,  on  "  the  Surgery  of  the  Spinal  Cord "  (it  should 
have  been  **  column "),  which  excited  no  discussion ;  and 
then  Dr.  Pratt  came  forward  to  expound  the  "Qnfieial 
Surgery  "  by  which  he  has  made  so  much  stir  during  the 
last  five  years.  He  points  to  the  extreme  importance  of  the 
outlets  of  the  body  as  sources  of  reflex  irritation,  comparing 
them  to  the  ports  and  railway  stations  of  traiSic.  He  believes 
that  a  large  portion  of  chronic  disease  is  caused  by  such 
irritation,  and  is  curable  by  surgical  rectifying  of  the  orifices 
themselves.  His  success,  as  he  reports  it,  has  been  something 
phenomenal ;  and  the  volcanic  force  and  earnestness  with 
which  he  expounded  his  views  made  a  deep  impression  on  the 


SSSSTgnf^"^  MEETIKGB. 615 

audience.  The  discnssion  was  carried  on  by  Drs.  Monro. 
Helmnth  (who  had  had  little  experience  of  the  practice,  but 
wished  to  encourage  it),  Storke  and  Skiles ;  and  Dr.  Pratt 
replied,  avowing  himself  a  hearty  homoeopathist,  and  only 
advocating  his  practice  as  a  dernier  ressort. 

Dr.  Tesbt,  of  Utica,  closed  the  surgical  section  by  a  paper 
entitled  "  Are  Sinuses  and  Fistul®  Curable  without  Surgical 
Treatment  ?  "  a  question  he  answered  in  tiie  affirmative. 
Peroxide  of  hydrogen  and  balsam  of  Pern  appear  to  be  the 
local  agents  on  which  he  depends. 

Not  much  time  was  now  left  for  the  subject  of  the  after- 
noon, which  was  Diseases  of  Children,  but  we  had  papers  on 
''Infantile  Eczema,"  by  Dr.  Millie  Chapman,  of  Pittsburg, 
diflcnssed  by  Drs.  Orme,  Oilbert,  Morgan,  Hughes  (who 
questioned  the  existence  of  any  such  thing  as  the  "  psorinum'* 
mentioned  in  the  paper),  and  Henry ;  and  by  Dr.  Owens,  on 
''  Diet  in  Diseases  of  Children/*  to  which  Drs.  Edmondson, 
Custis,  Hooker,  Dudley  and  W.  T.  Morgan  spoke. 

Monday,  June  22nd. 

Sunday  was  of  course  a  day  of  rest ;  but  on  Monday  we 

xe-assembled,  and  completed  the  work  of  the  Congress. 

We  first  took  up  the  Beports  from  the  various  countries  in 

which  Homoeopathy  has  been  planted.      Dr.  T.   Franklin 

Smith  gave  that  of  America.   Dr.  Hughes  presented  those  sent 

for  England    by  Dr.    Stancomb,  for  India  by  Dr.  P.   C. 

Majumdar,  and  for  New  Zealand  by  Dr.  Murray  Moore, — 

adding,  later,  a  report  from  Bussia  by  Dr.  Bojanus.    Dr.  A. 

Villers  read  reports  from  Germany  and  Austria  by  Dr.  Th. 
^        Kafka,  Dr.  Elauber,  and   Dr.  Lorbacher.     Others  presented 

flimilar  communications  from  Dr.  Briickner  regarding 
I       Switzerland,  Dr.  Hansen  for  Denmark  and  Dr.  Gonzalez  for 

Mexico. 

No  discussion  having  been  excited  by  these  reports  (all  of 

which,  save  that  from  Switzerland,  were  favourable),  Dr. 
I       Wright,  of  Buffalo,  was  requested  to  deliver  his  address,  put 

down  for  the  afternoon,  on  "  Hofinpitals,  their  construction, 

maintenance,  management,  &c."    This  was  spoken  to  by  Drs. 

Talbot  (who  stated  that  there  were  now  five  hospitals  in 
I  Massachusetts  equally  divided  between  two  schools),  Bushrod 
I       James,  Hayes  French,  McClelland,  Stout,  Moffat,  Gilbert, 

and  Dudley — ^Dr.  Wright  replying. 
In  the  afternoon,  the  first  business    was    the  decision  as 

to  the  place  for  the  next  Congress,  which  was  unanimously 
[       determined  to  be  England. 

The  subject   of   hisanity     was   then     handled   by   the 

Superintendents    of  the  two    great  State  Asylums    under 

S  X— 2 


016 NOTABILUa  ^"SSJI^^sS^^. 

homoBopathic  management — Dr.  Simmons  Paine,  of 
Massachusetts,  and  Dr.  Talcott,  of  New  York.  The  fcmer 
spoke  chiefly  of  the  treatment  by  rest,  but  mentioned 
incidentally  that  none  but  homoBopathic  remedies  vere 
prescribed  in  his  institution,  and  hypnotics  never  given.  Dr.. 
Talcotc  made  a  like  statement  for  the  Middletown  Asylum, 
and  stated  his  death-rate  as  4  per  cent,  in  contrast  with  6  per 
cent,  in  the  old  school  asylums  of  his  State,  while  his  proportion 
of  recoveries  was  as  five  to  three.  Drs.  Fellows,  Morgan  and 
Wanstall  spoke  to  these  papers,  and  Drs.  Paine  and  Taleott 
replied. 

A  number  of  miscellaneous  papers  were  then  cleared  offt 
being  read  either  in  full  or  in  abstract,  but  no  discussion 
taken,  and  this  way  we  had  Dr.  Cooper,  of  London,  on 
"  Camphor  Bromide ;  "  Dr.  Salzer,  of  Calcutta,  on  "  Asiatic 
Cholera ;  "  Dr.  Qailliard,  of  Brussels,  on  "Psora,"  and  on 
"  Complex  and  Alternating  Bemedies ;  "  Dr.  Dearborn,  of 
New  York,  on  "  Lanoline  and  Agnine;  "  and  Dr.  Deschere,, 
of  the  same  city,  on  "  Diet  and  Homceopathic  Treatment." 
Two  more  were  read  by  title  only — by  Dr.  Clifford  Mitchell, 
of  Chicago,  on  '•  Spermatorrhoea,  &c.,"  and  by  Dr.  Vincent 
Leon  Simon,  of  Paris,  on  the  "Abuse  of  Coffee."  Lastly, 
Dr.  Storke,  of  Denver,  gave  us  some  account  of  the  climate  of 
Colorado,  and  Dr.  Stout,  of  Jacksonville,  spoke  of  that  of 
Florida. 

This  completed  the  programme,  and  after  the  usual  votes 
of  thanks,  and  the  singing  of  the  Doxology,  the  Congress  was 
dissolved. 
B.  H. 

NOTABILIA. 


NOTES    FBOM   AMEBICA. 

At  the  meeting  of  the  American  Listitute  of  Homoeopathy  on 
the  22nd  of  June,  Dr.  Dyce  Brown  was  elected  a  correspond-- 
ing  member  of  the  Listitute. 

'['  );c  :ic  :tc 

The  next  meeting  of  the  American  Listitute  of  HomoM)- 
pathy  was  appointed  to  be  held  at  Washington,  D.  C.,  in 
May,  1891. 

*  4c  4e  4e 

Dr.  J.  H.  McClelland,  the  senior  surgeon  of  the  homoeo- 
pathic hospital  in  Pittsburgh,  has  been  unanimously  elected 
President  of  the  Pennsylvania  State  Board  of  Health.  It 
should  be  remembered  that  this  Board  consists  of  physicians 
entertaining  all  kinds  of  therapeutic  views. 

^  JfH  Hit  a: 


iSSSt^^rrST'  NO^ABILU.  617 

m 

The  CUnique  (Giicago)  for  Jane  containB  a  letter  from 
Dr.  Ludlam,  who  has  recently  visited  this  conntry,  giving  in 
his  own  genial  style  a  very  appreciative  notice  of  the  London 
Homoeopathic  Hospital,  its  medical  and  surgical  staff,  nursing 
institnte,  treasurer  and  secretary.  Dr.  Ludlam  urges  upon 
his  colleagues  the  formation  of  a  nursing  institute  in  connec- 
tion with  the  Chicago  Hospital.  Referring  to  the  lady  super- 
intendent, Dr.  Ludlam  writes  :  *'  Such  lady  superintendents 
as  Miss  Brew,  with  whom  I  was  glad  to  renew  my  acquaint- 
ance, are  like  rare  bits  of  old  china,  one  to  the  set,  but  having 
found  her  counterpart  as  nearly  as  possible,  and  secured  her 
interest,  the  work  of  building  such  an  enterprise  would  be 
half  done  to  begin  vrith." 

#  lie  4:  sk 

-  The  editor  of  The  Medical  News,  published  in  Philadelphia, 
has  been  greatly  excited  by  the  meetings  of  the  Litemational 
Homoeopathic  Congress  at  Atlantic  City,  or  rather  by  the 
idotices  of  the  proceedings  of  that  body  pubhshed  in  the  news- 
papers. His  impotent  rage  expended  itself  in  a  leading  article 
of  some  length,  which  concluded  as  follows : — ''  The  moral  of 
it  all  is,  that  to  indulge  in  good-humoured  contempt  of  these 
pestiferous  doctrines  and  doctrinaires  ;  to  show  them  mercy, 
to  be  indifferent  to  them,  to  compromise  and  play  politics  with 
them,  is  to  be  poltroon  and  renegade  in  the  face  of  one's  duty 
to  science  and  humanity.*'  The  editor  of  the  Philadelphia 
Medical  Newt  is  happily  perfectly  safe  in  writing  this  sort  of 
stuff;  no  one  can  prosecute  him  for  doing  so,  for  a  country- 
man of  his  once  told  us  there  was  '*  no  law  in  the  United 
States  preventing  a  man  making  a  dam'd  fool  of  himself." 
60  he  can  go  ahead,  and,  after  his  own  long-winded  fashion, 
follow  Dogberry's  example  as  often  as  he  likes  I 

MAJOR  VAUGHAN-MORGAN. 

The  Philanthropist  and  The  Gentlewoman  for  last  month  con- 
tam  excellent  portraits  of  the  popular  and  highly  successful 
Chairman  and  Treasurer  of  the  London  HomcBopathic 
Hospital,  together  with  a  report  of  the  proceedings  at  the 
banquet  recently  held  in  his  honour.  We  subjoin  a  complete 
list  of  those  present : — The  Earl  of  Wemyss  and  March, 
President,  supported  by  the  Hon.  Algernon  Grosvenor,  General 
Beynon,  Sir  Robert  Palmer  Harding,  Mr.  Sydney  Gedge,  M.P„ 
Mr.  Octavius  Vaughan  Morgan,  M.P.,  and  Mrs.  Morgan, 
Captain  Davis,  Colonel  Clifton  Brown,  Dr.  Edward  Blake, 
Dr.  and  Mrs.  A.  H.  Buck,  Dr.  Dyce  Brown,  G.  Barratt,  Esq., 
Dr.  and  Mrs.  Galley  Blackley,  Dr.  Burford,  Dr.  Bennett, 
Mr.  A.  Ridley  Bax  and  Mrs.  Bax,  Dr.  and  Mrs.  Burwood, 
W.  Deane  Butcher,  Esq.,  A.  Bamet,  Esq.,  AlanE.  Chambre, 


618 NOTABD^>  ""^S^^SSX 

Esq.,  Miss  Cole,  G.  A.  Gross,  Esq.  (Secretaiy-superintendent), 
W.  S.  Cox,  Esq.,  Dr.  J.  H.  Clarke,  Dr.  A.  H.  Croucher, 
Mr.  and  Mrs.  W.  M.  Cross,  Miss  Coach,  Vincent  Cotteiell, 
Esq.,  Dr.  Cooper,  Bey.  and  Mrs.  Dacre  Craven,  Exu^ 
Cameron,  Esq.,  Dr.  Carfrae,  Dr.  Boberson  Day,  Mr.  and 
Mrs.  William  Debenham,  Dr.  and  Mrs.  B.  E.  Dudgeon, 
Mrs.  and  Miss  Drew,  Dr.  and  Mrs.  Washington  Epps,  Mis. 
Faskally,  Mrs.  Gregory,  Dr.  and  Mrs.  Gilbert,  Wilbur  Gudd, 
Esq.,  Miss  Harrison,  Dr.  and  Mrs.  Siiss-Hahnemann,  Mr. 
and  Mrs.  Stanley  Harding,  Dr.  and  Mrs.  Fall,  Mr.  H.  W.and 
Mrs.  Henderson,  Dr.  Harper,  Mr.  and  Mrs.  Henry  Harris, 
Dr.  and  Mrs.  Hawkes,  Mr.  and  Mrs.  S.  Ho&mng,  The 
Hawaiian  Charg^  d' Affaires  and  Mrs.  A.  Ho&iang,  Bemaid 
Henderson,  Esq.,  J.  H.  Hays,  Esq.,  Mr.  and  Mrs.  Malcolm 
Jonas,  Dr.  and  Mrs.  Jagielski,  Miss  Jones,  Mr.  and  Mrs.  C. 
A.  Kelly,  Mr.  Henry  J.  and  Miss  Elunt,  E.  H.  Laurie,  Esq.* 
Miss  Florence  Lewis,  Mr.  and  Mrs.  Septimus  Yaugfaan* 
Moigan,  Dr.  Byres  Moir,  Dr.  Cavendish  Molson,  M.  Tivadar 
Nachez,  Mr.  and  Mrs.  WiUiam  Pite,  Alfred  Bobert  Pite,  Esq., 
Mr.  and  Mrs.  W.  M.  Penfold,  Dr.  Powell,  Dr.  and  Mra. 
Pollar,  Mr.  and  Mrs.  B.  P.  W.  Beneau,  Mrs.  Beed,  Mr.  and 
Mrs.  Alfred  Bosher,  Baphael  Boche,  Esq.,  Miss  Bapley, 
Frederick  Bosher,  Esq.,  Mr.  and  Miss  Beed,  Dr.  and  Mrs. 
Benner,  Dr.  and  Mrs.  Sandbezgj  Mr.  and  Mrs.  Knox  Shaw, 
Mr.  and  Mrs.  J.  P.  Stilwell,  G.  Holt-Stilwell,  Esq.,  Dr. 
Gerard  Smith,  Miss  Thacker,  Major-Gen.  Thomson,  Mr.  and 
Mrs.  Leo.  Thomas,  Mr.  and  Mrs.  Edwin  Tate,  Mr.  and 
Mrs.  J.  Trnslove,  Mr.  and  Mrs.  Trapmann,  Madame  Guilia 
Yaida,  Dr.  George  Wyld,  Gampbdl  Wynne,  Esq.,  IviQ 
Watson,  Esq.,  Mr.  and  Mrs.  A.  Williams,  Miss  WiUiams, 
H.  T.  Wooderson,  Esq.,  Mrs.  Wooderson,  A.  Walker,  Esq.! 
W.  F.  Watts,  Esq.,  Mrs.  Watts,  Dr.  Yeldham. 

THE  BEV.  C.  H.  SPDBGEON  AND  SIB  A.  CLARK. 

BABT. 
A  London  contemporary  says :  "  The  announcement  that  Sir 
Andrew  Clark  was  '  not  available '  to  see  Mr.  Spurgeon  means, 
we  suppose,  that  Sir  Andrew  will  not  meet  Dr.  Eidd  in  con- 
sultation. The  same  question  arose  when  Dr.  Eidd  Tras 
attending  Lord  Beaconsfield  m  his  last  illness,  in  1881,  and 
on  that  occasion  Dr.  Jenner,  with  the  concurrence  of  Sir 
William  Gull,  also  refused  to  meet  him.  Dr.  Eidd's  offence 
in  the  eyes  of  the  profession  is  his  leaning  towards  homoeo- 
pathy. Not  that  he  is  a  homoeopath  out-and-out;  he  is 
rather  to  be  described  as  an  eclectic.  That  is  to  saji  he 
elaims  to  take  the  good  and  leave  tihe  bad  of  botib  systems. 
But  this  attitude  wiU  not  do  for  orthodox  medicine,  which 


SSJ^eSTiSg^  JIOTABUJA.  619 

regards  the  homodopath  trith  much  the  same  feelings  as  the 
BossiaQ  Emperor  does  a  Jew,  and  will  have  no  paltering  with 
the  evil  thing.  And  perhaps,  for  the  patient's  sake,  it  is  as 
well,  that  the  two  kinds  of  practitioners  should  not  meet  and 
practise  their  varioas  systems  upon  him  at  the  same  time/' 

Mr.  Spnrgeon,  as  might  have  been  expected,  seems  to  have 
done  quite  as  well  without  Sir  Andrew  Clark's  advice  as  if  that 
eommodity  had  been  *'  available  "  !  The  only  loser  by  the 
refusal  to  meet  Dr.  Eidd  was  Sir  Andrew  himsdf  1 

HOMOEOPATHY  IN   INFLUENZA. 

'*  There's  a  queer  thing  about  this  epidemic  which  is  that 
the  allopaths  are  losing  all  the  cases,"  said  an  overworked 
undertaker  to  a  News  reporter  yesterday  afternoon., 

The  undertaker  was  drawing  on  his  gloves  preparatory  to 
attending  a  «  4  o'clock  "  at  Forest  Lawn. 

"  Are  you  serious  or  jesting  ?  "  asked  the  reporter,  who  is 
an  allopath  by  predilection. 

"  Dead  in  earnest,"  was  the  reply.  We've  been  rushed  to 
death  for  a  month  and  we  haven't  buried  a  homoeopathic 
victim  yet.  If  you  doubt  what  I  say,  go  and  look  at  the  death 
certificates." 

The  reporter  proceeded  to  the  bureau  of  vital  statistics  and 
found  the  undertaker's  statement  pretty  well  backed  up. 

Inquiry  elicited  the  iaet  that  there  are  800  allopaths  in 
Buffido  to  60  homoeopaths — a  proportion  of  6  to  1.  To  bring 
up  the  proportions  and  eliminating  the  doubtfals,  the  reporter 
multiplied  the  homoeopathic  deaths  by  five,  which  would  give 
that  school  10  deaths  to  the  allopathic's  68,  given  an  equal 
number  of  homoeopaths  and  allopaths  in  Buffalo. 

'*  Why  are  the  homoeopaths  apparently  so  successful  ?  '* 
asked  the  same  reporter  later  in  the  day  of  Dr.  S.  N.  Brayton, 
of  Delaware  avenue. 

**  They  are  not  'apparently'  successful,  they  are  successful,'* 
was  the  reply. — The  Keystone^  May,  1891,  Buffalo,  New  York. 

LADIES  AT  THE  INTERNATIONAL  CONGRESS. 

On  of  the  most  interesting  features  of  the  Homoeopathic 
GooiYention  of  Atlantic  City  was  the  large  number  of  pretty 
women  doctors  in  attendance.  They  were  all  young,  the 
majority  of  them  being  apparently  xmder  thirty,  and  their 
fresh  faces,  attractive  costumes  and  stylish  hats  made  a 
blooming  oasis  amid  the  Sahara  of  wrinkled  male  faces  around 
them.  Among  these  fair  physicians  were  Dr.  Harriet  Sartain, 
a  daughter  of  the  celebrated  Philadelphia  artist ;  Drs.  Eliza 
M'Clure,  and  Mrs.  Bronson,  also  of  Philadelphia,  and  Drs. 
Millie  Chapman  and  Mrs.  Brewster,  of  Baltimore. — Dvhlin 
Evening  Telegraph* 


620  JIOTABILU.  "SiSil^S??^ 


Bavieir,  Sep.  1,  un. 


THE  KEYSTONE. 

The  Keystone  (Buffalo)  is  a  paper  pablished  monthly  in  the 
interest  of  the  Homoeopathic  Hospital  of  Bnffalo.  The  Jime 
number  contains  a  report  of  a  year's  work  in  the  hospital,  and 
the  journal  publishes  from  time  to  time  reports  of  interesting 
cases. 

In  England  the  method  of  forwarding  the  interests  of  hos- 
pitals by  means  of  a  monthly  journal  devoted  thereto  has  not 
hitherto  obtained.  In  the  case  of  the  Keystone,  success  seems 
to  have  attended  its  advocacy,  for  since  its  first  issue,  rather 
more  than  a  year  ago,  *'  the  gifts  have  more  than  doubled." 

Instead  of  our  London  Hospital  Saturday,  a  collection  is 
made  in  several  feustories  and  stores  of  the  city  by  boxes  for 
weekly  contributions  for  the  formation  of  a  "Workman's  Free 
Bed  Fund."  If  the  hint  is  worth  anything  the  Buffalo  autho- 
rities will  doubtless  esteem  imitation  of  their  methods  a  sincere 
flattery. 

The  Keystone  asks  its  readers  for  opinions  as  to  the 
ltd^'isability  of  discontinuing  the  word  homodopathic  in  the 
title  of  the  Buffalo  Homoeopathic  Hospital.  When  the  tmth 
of  the  homoeopathic  doctrine  is  universally  acknowledged,  and 
absolute  liberty  of  opinion  is  allowed  to  all  medical  men-— 
when  therefore  every  hospital  is,  or  may  be,  a  homoeopathic 
hospital,  then,  and  not  tiU  then,  the  distinctive  adjective  may 
be  dropped. 

RATIONAL  THERAPEUTICS  FROM  A  *'REGULAB" 

STANDPOINT. 

Db.  6.  A.  Fbeeman  contributes  the  following  interesting 
article  to  the  New  York  Medical  Tijnes : — 

*'  The  trend  of  thought  upon  the  subject  of  therapeutice 
among  the  more  conservative  members  of  the  Old  School,  ifl 
so  clearly  indicated  in  a  paper  contributed  to  the  Medical 
Ilecord,  May  16,  1891,  by  Dr.  S.  Henry  Dessau,  that  an  out- 
line of  his  argument  will  not,  we  think,  be  found  uninteresting. 
The  author  begins  by  emphasizing  the  necessity  which  exists 
at  the  present  time  for  a  more  correct  system  of  therapeutics. 
Such  a  system,  he  says  must  be  founded  upon  a  correct  under- 
standing of  the  relationship  between  the  physiological  action 
of  drugs  and  the  manner  in  which  the  causation  of  disease 
affects  the  healthy  state.  Here  has  been  the  wider  field  of 
investigation  in  recent  years,  and  such  immense  progress  has 
been  made  in  this  direction  that  many  ideas  held  concerning 
therapeutics  as  taught  by  former  leaders  of  medical  thought 
have  now  been  almost,  if  not  entirely,  abandoned.  Yet,  when 
we  look  about  us  and  take  a  mentaJ  survey  of  the  medical 
situation,  we  find  that  little  progress  has  been  made  toward  a 


SSSi^iWSr*  .WTABOIA.  621 

more  certain  means  of  core.  The  prinoipal  endeavour  has  been 
to  discover  the  causation  of  disease,  and  if  possible,  a  means 
to  remove  it.  In  this  direction  the  discovery  of  microbes  as 
the  specific  agents  of  contagions  disease  has  led  up  to  very 
important  results.  But  further  researches  in  this  field  will 
probably  show  that  our  main  dependence  for  the  successful 
treatment  of  disease  will  be  required  to  be  based  upon  the 
phyeiolotjical  action  of  remedies^  and  a  correct  application  of  such 
action  to  Ute  diseased  condition, 

*'  There  are  evidently  many  instances  of  diseased  action  iit 
which  our  attempts  at  therapeutics  can  not  be  directed  against 
the  removal  of  this  cause  which  has  fled,  but  more  properly  to 
a  restoration  of  the  normal  function.  In  view  of  what  has 
been  learned  respecting  the  action  of  ptomaines,  it  is  not  at 
all  improbable  th^t  germ  diseases  may  depend  for  their  suc- 
cessful treatment  upon  remedies  administered  upon  the 
principle  of  their  physiological  as  well  as  their  antiseptic  action. 

"  In  the  investigation  of  this  physiological  action  of  drugs, 
perhaps  the  most  important  fact  which  has  been  disclosed  is 
that  of  their  double  action — ^a  phenomenon  known  in  an  indis-* 
tinct  sort  of  way  from  the  earliest  times,  but  which  has  only 
quite  recently  been  studied  in  a  rational  manner.  Binger, 
Brunton,  Phillips,  Babagliati,  Boss  and  Sharp  in  England, 
Schultz  and  Peiper  in  Germany,  and  Bartholow,  Smith,  Beed, 
May,  Mayer,  and  numerous  others  in  this  country  are  some  of 
the  workers  in  this  direction.  The  testimony  from  all  sources 
goes  to  show  that,  in  all  carefully  conducted  and  recorded 
experiments,  tJie  primary  eject  of  a  drutj^  as  manifested  in 
physiological  disturbances,  is  the  direct  contrary  of  the  secofulary 
or  more  fully  developed  of  the  drug, 

"  I  have  long  thought  that  a  more  rational  therapeutics 
could  be  founded  upon  the  utilisation  of  the  primary  physio- 
logical action  of  drugs  when  given  in  their  minimum  quantity 
to  produce  this  effect,  eliminating  from  consideration,  of 
course,  all  chemical  antidotal  actions  that  drugs  possess.  To 
my  mind  it  presents  many  advantages,  chief  of  which  is  the 
simple  and  rational  principle  of  applying  the  uncomplicated 
action  of  a  drug  to  a  diseased  action,  which  is  of  a  like  uncom- 
plicated nature,  as  a  means  of  cure.  That  is  to  say,  we  obtain 
the  action  of  the  remedy  without  its  consequent  reaction, 
which  in  this  instance  would  be  the  equivalent  to  the  restora- 
tion of  normal  physiological  action. 

"  The  secondary  advantage  of  giving  a  remedy  with  little 
or  no  disagreeable  taste,  either  in  the  form  of  a  small  sugar- 
bf-milk  tablet  or  an  aqueous  solution,  is  not  to  be  slightingly 
regarded,  not  only  in  our  practice  among  children,  but  also 
with  adults  of  a  delicate  and  fastidious  taste. 


622  MOTABILIiL.  "SSSJ'SfflSl! 


B0fi0W(  Ssp.  1«  IBHa 


**  I  have  endeairoared  to  ahow  that  a  certain  class  ofdn^ 
affecting  the  nerves  and  another  the  specific  oigaos  and 
tissaesy  have  an  nndonbted  douUe  action,  the  pnmaiy  or 
initial  action  being  the  direct  contrary  of  the  seoondai^or 
complete  physiological  action ;  and  tiiiat  the  primary  aotiaw 
being,  so  to  say,  devoid  of  reaction  when  obtained  from  ut 
exhibition  of  the  minimum  dose,  can  be  scientifically  applifid 
for  its  direct  action  against  those  disturbances  of  the  eoonomy 
corresponding  in  their  effects  to  the  secondary  or  full  physio- 
logical action  of  the  drug  employed. 

«•  The  question  of  dosage  necessarily  becomes  one  of  the 
highest  importance,  and  it  behoves  us  to  turn  our  attentioii 
with  all  due  judgment  and  deliberation  to  a  reformation  of 
this  subject. 

"  In  these  paragraphs  we  behold  a  representative  of  medical 
orthodoxy  proclaiming  his  belief  in  a  rule  of  drug  action  which 
is  only  the  principle  of  simiUa  differently  stated,  aud  also 
calling  for  a  reformation  in  the  direction  of  small  doses  I  Let 
Dr.  Dessau  take  one  step  further,  and  learn  to  individiuUte 
his  remedies,  and  the  last  shade  of  difference  between  his 
practice  and  that  of  the  average  homcsopath  will  have  dis- 
appeared.  When  his  colleagues  shall  have  followed  him,  what 

then  will  stand  in  the  way  of  medical  union  ?  " 

Dr.  Dessau's  account  of  the  rule  of  drug  can  scarcely  he 
defined  as  ''  the  principle  of  dmUia  differently  stated."  It  ifl 
rather,  as  we  have  frequently  shown  when  reviewing  Dr. 
Sharp's  later  essays,  an  endeavour  to  explain  the  modm 
operandi  of  a  homoeopathically  selected  medicine.  Withoat 
the  guidance  of  the  principle  of  similia,  it  is  impossible  to 
individualise  remedies.  There  is  in  Dr.  Dessau's  vievs 
nothing  to  prevent  co-operation  with  homoeopathic  physiciAnfl, 
either  at  the  bedside  or  in  societies  ;  on  the  contrary,  any  one 
holding  them  and  refusing  such  professional  intercourse  is 
directly  opposing  the  progress  of  therapeutics.  It  is  not  men 
of  Dr.  Dessau's  stamp  that  prevent  a  union  of  medical  men  of 
all  shades  of  thought,  but  persons  like  the  editor  of  the  Phila- 
delphia Medical  News,  whose  references  to  homoeopathy  are 
mixtures  of  studied  misrepresentation  and  savage  inveetiTe. 
Unfortunately  they  are  the  men  who  at  present  have  the  ear 
of  the  profession.    Hence  it  is  that  we  must  still  fight  on. 

ANTAGONISTIC  ACTION  OF  POISONS. 

An  interesting  illustration  of  the  antagonistic  action  of 
poisons  is  given  in  a  letter  we  have  received  from  Hr. 
W.  Bushton,  addressed  to  his  brother  in  Tasmania,  by  Dr. 
Mueller,  of  Yackandawdah,  Victoria,  in  which  he  states  that 
in  cases  of  snake  bite  he  is  using  a  solution  of  strychnine  in 


840  pttrts  of  water  mixed  witti  a  littk  gljoeiine.  Twenty 
mmims  of  this  solution  are  iojeoted  in  the  usual  manner  of  a 
hypodermic  injection,  and  the  frequency  of  repetition  depends 
upon  the  symptoms  being  more  or  less  threatening,  say  from, 
tm  to  twenty  minutes.  When  all  symptoms  haTe  disappeared 
the  first  independent  action  of  the  strychnine  is  shown  by 
sUght  muscular  spasms,  and  then  the  injections  must  be 
discontinued  tmless  after  a  time  the  snake  poison  again 
reasserts  itself.  The  quantity  of  strychnine  required  in  some 
eases  has  amounted  to  a  grain  or  more  within  a  few  hours* 
Both  poisons  are  thoroughly  antagonisticr  and  no  hesitation 
need  be  felt  in  pushing  the  use  of  the  drug  to  quantities  that 
would  be  fatal  in  the  absence  of  snake  poison ;  but  of  about 
one  hundred  cases  treated  by  this  method,  some  of  them  ai 
the  point  of  death,  there  has  been  but  one  failure,  and  that 
arose  from  the  injections  being  discontinued  after  Ingrain 
of  strychnine  had  been  injected.  Any  part  of  the  body  will 
do  for  the  injections,  but  Dr.  Mueller  is  in  the  habit  of 
making  these  in  the  neighbourhood  of  the  bitten  part  or 
direeily  upon  it. — Pharmaceutical  Journal^  June  18th,  1891. 

Sm  WILLIAM  GULL  AS  A  SCEPTIC  IN 

THERAPEUTICS. 

Ih  the  last  volume  of  the  Guifs  Hoxpital  Reports,  recently  issued, 
Tol.  xlvii.,  1890,  there  appears  an  "  In  Memoriam  "  notice  of 
its  late  distinguished  Consulting  Physician,  Sir  William  Gull. 
The  paper,  though  unsigned,  bears  internal  evidence  of  being- 
written  by  one  of  the  hospital's  present  senior  physicians;  and. 
as  some  of  his  remarks  therein  may  be  said  to  represent  the 
views  of  the  militant  section  of  medical  nihilists,  they  may  be 
interesting  to  those  who  have  not  yet  lost  all  faith  in  drug- 
administration,  and  who  are  not  yet  wandering  in  the  slough. 
of  therapeutic  negation.  The  idea  of  holding  up  homoeopathy 
as  a  system  of  "  do  nothingness  "  is  amusing  in  its  conception 
and  yet  saddening  as  a  display  of  ignorance  of  its  principles. 

**  It  would  be  a  great  mistake  to  suppose  that  Gull's  excel- 
lence as  a  practical  physician  was  limited  to  power  of  diag- 
nosis, appreciation  of  the  patient  and  his  conditions,  or  facility 
in  acquiring  and  retaining  that  confidence  of  the  sick  man 
which  in  most  cases  is  essential  for  carrying  out  treatment, 
and  in  many  is  itself  a  help  to  cure.  He  was  generally 
supposed  to  be  a  sceptic  as  to  therapeutics,  and  his  treatment 
to  be  what  some  people  call  "  expectant "  and  others  **  do* 
nothing."  As  in  most  cases  of  general  reputation,  the  con- 
clusion, so  for  as  it  was  incorrect,  was  in  great  measure  due  to- 
the  very  man  whom  it  wronged.  If  a  physician  honestly  beUeves 
that  medicine  is  powerless  over  disease,  he  need  not  relinquish 


624  NOTABiLU.  **SSS:"2f?!2l? 


Beriew,  Sep.  1,  Ifltt* 


his  practice,  for  it  is  often  well  worth  a  patient's  while  to 
ascertain  whether  he  is  really  ill  or  not,  and  what  is  the 
nature  of  his  complaint ;  he  may  often  wisely  pay  for  the 
knowledge  of  what  is  likely  to  happen,  and  what  cannot  be 
cured  may  often  be  prevented.  But  although  n^ti?e 
practice  might  still  be  followed  for  the  sake  of  diagnosis  and 
prognosis  and  prophylaxis,  yet  an  honest  disbehever  in  thera- 
peutics could  never  prescribe  a  potion  or  a  pill  without  losing 
his  self-respect.  As  a  matter  of  fact.  Sir  William  Gull  ofieo 
prescribed  no  drugs  whatever,  and  his  prescriptions  when  he 
wrote  them  were  of  extreme  simplicity ;  ten  or  fifteen  diope 
of  tincture  of  steel  three  times  a  day,  sulphate  of  magnesia, 
and  carbonate  of  soda,  mineral  acids  in  infiision  of  gentian  or 
•orange,  aloes  and  compound  rhubarb  pills — ^these  were  his 
frequently  recurring  formukB.  To  these,  in  suitable  cases, 
were  added  quinine,  digitalis,  opium,  arsenic,  and  mercury  in 
moderate,  but  efScient,  doses.  He  was  never  tired  of 
exposing  the  absurdity  of  much  of  the  traditional  poly- 
pharmacy. He  would  show  how  much  harm  may  be  done  by 
the  vigorous  treating  of  half-understood  diseases,  and  he  once 
said  that  if  every  drug  in  the  world  were  abolished,  a 
physician  would  still  be  a  useful  member  of  society.  To 
appreciate  his  position,  we  must  remember  something  of  the 
unquestioning  ffidtb  in  bleeding  and  blistering,  purging  and 
physicking,  which  was  still  held  when  Gull  was  a  student 
The  physicians  of  the  first  half  of  the  present  century  seemed 
to  have  no  conception  that  many  diseases  naturally  tended  to 
recovery  if  not  interfered  with,  and  that  others  as  naturally 
tended  to  death,  however  treated.  Their  erroneous  notions 
of  physiology  and  patholc^,  their  not  yet  exploded  remnants 
of  medieeval  superstition,  their  almost  unsuspected  ignorance 
of  the  processes  and  even  the  detection  of  disease,  and  their 
boundless  credulity  in  the  action  of  remedies,  led  to  just 
i^riticism  in  the  minds  of  the  more  thoughtful  of  the  huty, 
and  to  something  like  negation  among  a  few  in  the  ranks  of 
the  profession  who  were  not  bound  by  the  fetters  of  tradition 
— such  as  Sir  John  Forbes  and  Dr.  Hughes  Bennett,  of 
J^dinburgh.  The  astonishing  fact  that  under  treatment  by 
Hahnemann's  sect  patients  did  not  always  die,  led  thoughtfol 
men  to  open  their  eyes. 

**  Gull's  treatment  of  fever  and  of  acute  rheumatism  were 
valuable  contributions  to  the  scientific  study  of  therapeutics ; 
iind  he  once  said  to  the  present  writer  after  his  retirement 
from  practice,  '  One  thing  I  am  thankful  that  Jenner  and  I 
have  together  succeeded  in  doing : — ^We  have  disabused  the 
public  of  the  belief  that  doctoring  consists  in  drenching  them 
with  nauseous  drugs.'     Nevertheless,  those  who  knew  Gull's 


SSa^STSB?*  OBITUARY.  625 


'•  Sep.  1, 1801. 


practice,  either  in  the  hospital  or  in  private,  are  well  aware 
that  his  scepticism  was  perfectly  reasonable,  and  his  thera- 
peutical fiuth  all  the  stronger  because  it  was  discriminating. 

The  popular  belief  that  he  did  not  believe  in 

medicines  did  great  harm,  and  did  him  injustice — injustice 
which,  as  usual,  was  not  quite  undeserved  by  the  sufferer* 
But  there  are  not  wanting  signs  of  a  new  era  of  meddlesome 
medication  and  reckless  polypharmacy.  The  generation  which. 
18  now  getting  old  was  brought  up  under  the  healthy  reaction 
from  the  old  tyranny  of  drugs ;  but  the  new  generation  ia 
fiuniliar  with  scores  of  new,  much  vaunted,  but  little  tested 
remedies,  most  of  them  uncertain,  and  many  dangerous  in 
their  effects.  The  practice  of  medicine  in  Germany,  and  to 
some  extent  in  America,  is  with  many  honourable  exceptions 
raahy  meddlesome,  and  sometimes  mischievous,  repeating  the 
old  blunder  of  assuming  that  every  disease  has  its  appropriate 
remedy,  and  too  often  treating  each  symptom  as  it  arises  with 
the  self-confidence  and  ignorance  of  a  homoeopathist. 

"The  worst  of  the  almost  daily  introduction  of  highly- 
vaunted  remedies  to  be  used,  abandoned,  and  replaced  by 
others  destined  to  Hve  as  short  a  life,  is  to  produce 
in  scientific  tempers  complete  scepticism  in  therapeutics ;  and 
the  worst  of  the  universal  scepticism,  which  clever  men  are 
apt  to  feel  or  to  affect,  is  to  encourage  relapse  into  pharma- 
ceutical credulity."  . 

A  LEGACY. 

The  Lyons  Medical  reports  that  a  very  wealthy  lady,  who 
died  recently  at  the  advanced  age  of  eighty-three,  made  the 

following  provision  in  her  will :  **  Je  16gue  au  Docteur  X 

en  reconnaissance  de  ses  soins  ^clair^s  et  d^vou^s  auxquels 
j'ai  d^  vivre  si  &g6e  tout  ce  qui  se  trouvera  dans  mon  bonheur 
da  jour."  When  the  article  of  furniture  thus  fantastically 
denominated  was  searched,  its  only  contents  were  found  to  be 
the  untouched  mixtures,  boxes  of  pills  and  other  medicaments 
(still  enveloped  in  paper  as  they  had  been  sent  by  the  chemist) 
which  had  been  prescribed  for  the  defunct  by  her  medical 
attendant  during  the  past  ten  years ! — Tlie  Lancet. 

OBITUARY, 

EDWARD  HENRY  MILLIN,  M.R.C.S.,  L.S.A. 

W£  much  regret  to  have  to  record  the  death  of  Mr.  Millin,  of 
Worcester,  on  the  2nd  of  August,  at  the  age  of  76,  after  an 
illness  of  several  months  duration.  He  was  bom  in  Santa 
Cruz,  Feb.  24th,  1815.  Before  commencing  private  practice 
he  acted  as  ship's  surgeon  for  some  years.  Iq  1846,  he  settled 
at  Hiill,  where  he  made  the  acquaintance  of  the  late  Dr.  Atkin» 


626  COEBEBPONBENCE.       "ISSmSTmSI 

and  through  his  mstrnxnentality  he  had  his  eyes  opened  to 
the  truth  of  the  law  of  similars.  After  deciding  to  praetise 
homoeopathy,  he  removed  to  Coventry.  There  he  practised 
with  success  till  1860,  when  he  resolved  to  settle  in  Worcester, 
in  which  place  he  remained  till  his  death.  Mr.  Millin  wm 
very  successful  in  practice,  and  was  greatly  belo^  and 
respected  by  all  who  knew  him,  while  his  uniform  coxiriesjto 
his  professional  brethren  in  Worcester  tended  much  to  soften 
their  prejudice  against  homoeopathy.  Mr.  Millin  leaves  a 
widow  and  chree  daughters. 

CORRESPONDENCE, 

WHAT  IS  A  HOM(EOPATH? 

To  tlie  Editors  of  the  ** Montfdy  Homeopathic  Review" 

Gentlemen, — I  have  always  been  surprised  at  the  concep- 
tion of  homoeopathy  which  my  allopathic  friends  possess,  bat 
their  opposition  to  my  methods  of  practice  still  remain  on  the 
same  ground,  and  not  one  of  them  will  give  up  this  curious 
idea  as  to  what  homoeopathy  is ;  I  have  now  made  a  discovery. 
I  have  found  that  their  accusation  is  quite  just,  and  that  there 
is  a  section  of  our  school  which  consists  of  men  who  hold  just 
those  opinions  which  I  have  stoutly  denied  as  belonging  to 
liomoeopathy.  What  am  I  to  do  ?  These  men  are,  I  am  tedd, 
the  only  true  and  conscientious  homoeopaths,  and  I  am  sailing 
under  false  colours  if  I  do  not  practise  as  they  do. 

I  have  been  studying  one  of  the  latest  books  which  are  used 
in  practice  by  the  "  conscientious  homoeopath,"  and  I  am 
quite  bewildered  by  it.  '' Boenninghausen's  Therapentio 
Pocket  Book  "  is  the  work,  and  though  I  believe  myself  to 
1)0  an  homoeopath,  yet  I  find  that  this  work,  and  others  like 
it,  would  be  utterly  useless  to  me,  it  is  an  enigma,  tiie  answer 
to  which  I  despair  of  finding. 

Diseases  are  not  referred  to  in  this  work,  and  there  are  veiy 
few  of  the  symptoms  of  disease ;  those  concerning  discbarges 
a>nd  excretions  being  almost  the  only  really  characteiistio 
symptoms  which  can  be  said  to  lead  one  to  any  diagnosis,  all 
the  rest  seems  to  my  uninstructed  mind  utterly  vague  and 
unpractical,  and,  more  serious  than  this,  it  seems  to  be 
ridiculous,  giving  to  our  opponents  the  very  strongest  grounds 
for  the  ridicule  they  express  for  our  opinion. 

As  an  example,  toke  the  sections  for  the  head.   Here  we  find 
several  vague  and  inaccurate  divisions,  first  *'  External  Head, 
followed  by  the  equally  useless  terms  **  (General  Sensations, 
^«  Sides  of  Head,"  "  Light  Hair,"  "  Dark  Hair,"  and  so  on. 
Under  each  of  these  headings  are  grouped  hundreds  of  drogSf 
with  no  word  to  say  what  these  dnigs  do  to  these  parts,  nor 


Vf 

tl 


SSS^STSS?^         CORRBSPONDBHCaB.  627 


Beriew,  Sep.  1, 1891. 


wbat  is  their  relation  to  tlie  head.  Take,  as  another  example, 
the  region  **  Chest/'  Of  what  use  is  it  to  be  told  that  there  are 
nearly  two  hundred  drugs  related  in  some  way  not  expressed 
to  the  "  Internal  Chest,"  and  then  that  these  same  drugs  are 
also  related  to  the  symptoms  of  every  other  part  of  the  chest, 
with  no  word  as  to  what  is  their  relation,  what  the  changes 
they  produce,  or  the  symptoms  exhibited  as  the  result  of  those 
chamges. 

The  chapter  on  **  Sensations  "  is  surely  one  which  might 
give  reasons  to  the  enemy  to  laugh  at  us.  I  have  every 
respect  for  the  descriptions  of  their  pain  and  sensations  given 
me  by  my  patients,  as  indications  of  the  particular  mental 
condition  of  the  patient,  and  as  leading  me  to  track  out  the 
seat  of  the  disorder,  but  I  could  never  have  any  proof  that  the 
sensations  they  describe  are  the  same  things  as  were  ex- 
perienced by  the  prover  of  drugs.  One  man  may  say  he  has 
a  "  sticking  pain,"  but  the  next  man,  be  he  prover  or  patient, 
may  eall  it  a  *'  stabbing  pain,*'  and  by  this  book  I  should 
have  to  look  under  two  different  heads  for  these  paius.  How 
on  earth  am  I  to  ascertain  from  a  patient  if  his  pain  be  or  be 
not  one  of  the  bewildering  list  of  stickings,  stabbings, 
jumpings,  crawlings,  drawings,  tearings,  twistings,  twingings, 
ticklings,  and  the  rest,  which  I  find  have  been  experienced  by 
provers  ?  A  sick  man  will  take  any  description  which  seems 
to  indicate  that  he  is  very  bad.  Such  descriptions  are  of  no  use 
clinically,  nor  are  these  vague  lists  of  the  sensations  of  provers, 
for  we  cannot  fit  them  to  the  case  of  disease  before  us. 

If  we  are  to  pay  so  much  attention  to  symptoms  which 
do  not  in  any  way  aid  us  to  our  diagnosis,  and  to  remain 
content  with  symptom  collecting  without  tracing  the  symp- 
toms to  their  pathological  seat,  or  prescribing  for  the  diseased 
condition  ;  if  we  are  thus  to  do  all  we  can  to  escape  making 
any  diagnosis,  we  shall  always  be  open  to  the  ridicule  of 
our  opponents,  and  so  long  as  we  have  books  full  of  such 
absurdities  as  I  have  quoted,  we  deserve  to  be  ridiculed.  If 
this  school  of  symptomatology  had  been  exhibited  to  me  as 
the  true  path  of  homoeopathy  at  the  time  of  my  conversion  (I 
am  tempted  now  to  say  perversion),  I  would  never  have  looked 
fiurther,  but  I  was  at  the  first  outset  introduced  to  homoeo- 
pathy  by  men  who  went  upon  the  principle  of  diagnosing 
what  was  the  matter  with  the  patient  before  they  prescribed. 

I  was  trained  upon  Hughes'  Manual  of  Pharmacodynamics, 
which  has  nothing  in  common  with  this — to  me — new 
system ;  for  Hughes  determines  first  of  all  what  is  the  matter 
^th  his  patient,  and  then  proceeds  to  prescribe  for  him, 
giving  drugs  which  affect  the  part  disordered,  and  only  using 
^mptoms  as  they  point  the  way  to  the  diagnosis. 


628  OOBItEWONBENTS.       ^i^Sir^^ljSS! 


.  Should  we  not  recognise  tbe  fact  that  there  is  a  spht  in  obi 
Qtmp  ?  We  are  *'  Symptomatologists ''  and  *'  Pathologists," 
lud  these  two  are  becoming  more  opposed  to  each  other  as 
W0  go  on  ;  but,  which  are  the  homoBopathists  ? 

Yours  truly,  Hebehc. 

NOTICES   TO   CORRESPONDENTS, 

\*  We  cannot  undertake  to  return  r^eeted  manuseripti, 
Atjthobs  and  Coittbibutobs  receiving  proofs  are  requested  to  oonect 

and  return  the  same  as  early  as  possible  to  Br.  Edwin  A.  ^BiLTBi. 
<  London  Homoeopathic  Hospital,  Obeat  Obmond  Street, 
Bloomsbuby. — Hours  of  attendance :  Medical,  In-patients,  9.30 ;  Out- 
patients, 2.S0,  daily ;  Surgical,  Mondays  and  Tliursdays,  2.30 ;  Difleasea 
of  Women,  Tuesdays  and  Fridays,  2.30  ;  Diseases  of  Skin,  ThurdayB 
2.90  ;  Diseases  of  the  Eye,  Thursdays,  2.80  ;  Diseases  of  the  Ear,  Satur- 
days, 2.80  ;  Dentist,  Mondays,  2.30  ;  Operations,  Mondays,  2. 

Communications  have  been  received  from  Dr.  Dudgeon,  Dr.  TV.  Effs, 
Dr.  Pbiestley.  Mr.  Knox  Shaw;  Mr.  Dudley  Weight,  Mr.  Gebabd 
Smith,  Mr.CBoss,  Liq.  Gabnis  Co.  (London) ;  Dr.  Hughes  (BriirhtoiL) ; 
Mr.  Jump  (Folkestone)  ;  Mrs.  Cook  (Buffalo) ;  Dr.  Alex.  Yillebs 
(Dresden) ;  Mexican  Homosopathic  Institute. 

BOOKS    RECEIVED. 

The  Massenr*8  Vade  Mecum.  By  K  Donate  Jump.  Bristol :  John 
Wright  &  Co.  1891. — Annual  of  the  Unirereal  Medical  Seienee*, 
Edited  by  C.  E.  Sajous,  M.D.  Five  vols.  Philadelphia  and  London : 
F.  A.  Davis.  18U1. — A  Report  on  the  Jleevlte  of  HomcBopathic  Treat' 
ment  of  Cholera  in  Ma/rch-May,  1891.  By  Badh.  Grhosh.  CalcQtta.' 
The  Neto  JRevt/-dU's.  A  bi-monthly  epitome  of  progress  in  Homoeopathic 
Materia  Medica  and  Therapeutics.  Edited  by  Drs.  Gross,  E.  M.  Hsle, 
and  B.  N.  Tookes,  M.D.  Chicago.  May. — The  Lancet.  August  8th. 
London. — The  Ifornasopathi^  Warld,  April.  London. — IlospUtu  Gazette. 
July  25.  London. — Medical  Reprinte.  August,  London. — The  Chmid 
and  Druggist.  August.  London. — The  Monthly  Magazine  of  Phar- 
macy, August.  London.— T^  Philanthropist.  July  and  Aognst 
London. — The  Gcntlevjoman.  August.  London. — Nursrt'  Jtmmal, 
August.  London. — The  North  American  Journal  of  Ifomaopathy. 
July.  New  York. — The  American  IIommopathiM.  Augnist.  New  York 
•^The  New  York  Medical  Times,  August. — Thi^  Medical  Record.  Jnly 
and  August.  New  York. — Journal  of  Ophthalmology ^  Otology,  fe. 
August.  New  York. — The  New  England  Medical  Gazette,  August. 
Boston. — The  Hahnemannian  Monthly,  July  and  August.  Phi}adel> 
phia. — The  Jffomesopathic  Physician.  August.  Philadelphia.—^^ 
Clinigue.  July.  Chicago. — The  Medical  Advance^  July.  Chicaga— 
The  Medical  Era.  August.  Chicago. — The  Keystime.  Juna  Buffalo. 
—Homceopathic  Envoy.  August  Lancaster. — Southern  Journal  of 
ffnmtBopathy.  July.  New  Orleans.— 1%«  Medical  Argus.  July. 
Minneapolis. — Rexue  Homceopathique  Beige,  May.  Brussels.— i/v^/« 
Oin,de  Thirapeutique.  August.  Paris. — Allgem^.IIom.Zeitung.  August 
Leipzig. — Liepzig  Fopuldre  Zeitschrift  fur  Homoopathie,  Aognst— . 
Oazetta  Medica  Di  Torino,  August — La  Rcforma  Medica,  May. 
Mexico. — UomiKopathisch  Maandhlad.    Angfust 

'  Ttipers,  Dispensary  Bcports,  and  Books'  for  Bevlew  to  be  sent  to  Dr.  Popi,  19, 
UTatergate,  Grantham,  Lincolnshire ;  Dr.  D.  Dtcb  Bbowm.  S9,  Sevmonr  Street,  Port- 
man  Square,  W.;  or  to  Dr.  Edwin  A.  Nbatbt,  161,  Haverstock  Hill,  N.W.  Advertise* 
ments  and  Bnsinem  cammonicatioas  t9  ^  seat  to  Meairs.  £.  Oouu>  ft  flov,  0^ 
Moovgate  Street,  £.C. 


S^S^.ST'SSf*'  NEW  ZEALAND.  629 


liifiOT,  Oct.  1,  un. 


THE    MONTHLY 

HOMOEOPATHIC    REVIEW. 


•:o:- 


SOTES    ON    THE    CLIMATOLOGY    AND    PREVA- 
LENT DISEASES  OF   NEW  ZEALAND.* 

By  John  Murray  Moore,  M.D.,  M.R.C.S.,  F.R.G.S.,  &c. 

Mr.  President  and  Gentlemen, — In  submitting  to  this 
honourable  assembly  a  paper  on  the  Climatology  and 
Prevalent  Diseases  of  New  Zealand,  I  wish  to  anticipate 
«t  the  outset  an  objection  which  may  exist  in  some  of- 
jour  minds  that  the  subject  is  outside  the  range  of  topics 
associated  with  homoeopathy.  This  may  be  so;  but  surely 
the  therapeutics  of  climate  ought  to  be  studied  by  every 
well-informed  practitioner,  whether  homoeopathic  or 
non-homoeopathic.  And  I  should  think  that  the  com- 
munication by  a  confrere  of  the  results  of  his  personal 
•^perience  and  observations  made  in  so  interesting, 
valuable  and  remote  a  country  as  that  of  New  Zealand, 
would  be  more  interesting  than  reading  books  on  the 
.'Subject. 

Personal  residence  in  a  foreign  climate  for  some  years 
is  a  good  solid  test  of  its  value,  if  we  deduct  the  neces- 
sary ''  personal  equation ;  "  and  if  any  invalid  should  be 
:saved  from  loss  of  money,  time,  and  health,  and  his 
medical  adviser  from  disappointment  and  chagrin  by  the 
warnings,  advice,  or  suggestions  I  have  thought  out  in 

**  Raad  before  the  BritiBh  Homceopathic  Congress  in  London,  Jnly,  1891. 
YoL  35,  No  10  2  Y 


680  NEW   ZEALAND.  ^"SSiL^SL^SS! 


ReTiew,0etl.l8IL 


this  paper,  I  hope  this  half  hour  will  not  have  been  nn- 
profitably  spent. 

From  their  medical  attendant,  patients  not  only 
expect  now-a-days  all  sorts  of  instruction  as  to  diet, 
hygiene,  clothing,  house  drainage,  &c.,  &c.,  but  even 
exact  and  definite  information  about  foreign  climates 
which  the  busy  practitioner  has  neither  time  to  visit, 
nor  even  to  read  up,  so  great  is  the  flood  of  literature 
now  teeming  from  the  medical  and  general  press. 

It  was  with  a  view  of  adding  my  humble  contribution 
to  a  more  exact  knowledge  of  the  New  Zealand  climate, 
and  of  placing  that  grand  country  fairly  before  the  pro- 
fession and  the  public,  that  I  published  my  handbook, 
entitled  Netc  Zealand  for  the  Emigrant,  InvaRd  and 
Tourist,  through  Messrs.  Sampson  Low,  last  year. 

The  idea  I  had  formed  that  a  need  for  such  a  book 
on  this  particular  colony  existed  was  confirmed  by  a 
letter  from  Sir  Andrew  Clark,  Bart.,  the  eminent  con- 
sulting physician,  who  wrote  thus :  "  I  cannot  doubt  that 
an  accurate  and  comprehensive  account  of  New  Zealand 
climates  will  be  of  great  service  to  the  public  and  to  the 
profession.  To  intending  colonists,  and  invalids  espe- 
cially, a  book  of  the  kind  must  prove  of  inexpressible 
value,  not  merely  as  a  guide  to  seeking  what  is  right, 
but,  before  all  other  things,  as  a  guide  to  shunning  what 
is  wrong.  Mistakes  made  by  persons  seeking  climatic 
change  in  New  Zealand  are  frequent ;  and  I  know  of 
some  that  have  been  attended  with  the  worst  results."* 

Now  I  hope,  this  afternoon,  to  give  you  definite  ideas 
both  of  the  general  climate  of  New  Zealand,  and  of  the 
four  climatic  Zones — ^first  differentiated  and  mapped  out 
by  myself — aided  by  this  map  of  the  physical  geography 
of  the  Colony,  and  by  the  hand-maps  which  I  have  had 
printed  expressly  for  this  occasion. 

*In  a  subseqaent  letter,  after  a  careful  perusal  of  my  book,  he 
wrote  :  *'  I  am  exceedingly  pleased  with,  your  book  on  New  Zealand, 
and  expect  it  will  soon  occupy  a  first  place  among  the  handbooks  to 
that  country.  For,  in  the  extent,  yariety,  and  aoouracy  of  the  infor- 
mation it  oonveys ;  in  the  acuteness  of  its  observations ;  in  the  frank- 
ness and  impartiality  of  its  comments ;  in  its  dealings  with  the  drink 
trouble ;  in  &e  soundness  of  its  judgments ;  and  in  ^e  exoellence  of 
its  literary  form,  the  book  is  one  of  the  best  of  its  kind  with  whioh  I 
am  acquainted.  I  congratulate  you  on  the  happy  sucoees  of  yoor 
undertaking,  and  I  hope  that  with  restored  health  you  will  find  ample 
opportunities  for  the  exercise  of  those  abilities,  both  literary  and  pro- 
fessional, which  the  execution  of  this  book  proves  that  you  possess." 


Sgcggyaa!^        new  Zealand, 681 

Conceming  the  best  time  for  invalids  (and  tourists 
also)  to  leave  England  for  New  Zealand,  if  we  take  the 
average  length  of  the  voyage  at  six  weeks,  I  recommend 
them  to  leave  home  during  the  months  of  August,  Sep- 
tember or  October,  in  order  to  arrive  in  the  Colony 
during  the  antipodean  summer  months  of  October^ 
November  or  December. 

Concerning  routes:  Anyone  desiring  the  quickest 
possible  transit  to  New  Zealand  would  leave  Liverpool 
by  the  Saturday  Cunard  steamer  for  New  York,  cross 
the  United  States  with  the  Australian  mails  to  San 
Francisco,  thence  by  fast  steamer  across  the  Pacific,  and 
would  reach  Auckland,  New  Zealand,  on  the  thirty- 
foDrth  day  after  his  departure  from  home.  This  time 
will  be  reduced  to  thirty  days  when  the  Canadian  Pacific 
Railway  gets  its  new  mail  steamers  running. 

But  no  invalid  could  stand  the  fatigue  that  this  in- 
volves. Nor  is  the  Bed  Sea  transit  otherwise  than 
injurious  at  any  season  of  the  year.  The  hurry  across 
the  Continent  by  express  train  to  catch  the  Orient  or 
P.  and  0.  steamer  at  Brindisi,  or  Naples,  is  also  preju- 
dicial to  the  health-seeker. 

Of  all  the  routes  now  available  to  New  Zealand,  the 
long  sea  voyage  round  the  Cape  of  Good  Hope,  taken  by 
the  Direct  Mail  steamers  of  the  New  Zealand  Shipping 
Company,  and  of  the  Shaw  Savill  and  Albion  Line,  gives 
the  traveller  the  least  possible  risk  to  health  from  too 
rapid  changes  of  temperature,  while  the  table-fare,  cabin 
accommodation,  and  so  forth,  are  of  the  best  attainable 
quality. 

No  doubt  the  three  or  four  months'  voyage  in  a  well- 
found  sailing  ship  is  still  better  for  some  chest-invalids^ 
if  they  are  able  to  endure  the  monotony  and  are  pretty 
fiur  sailors. 

But  by  the  Direct  Mail  steamer  one  has  many  of  the 
advantages  without  any  of  the  drawbacks  of  the  long 
voyage  under  canvas.  On  the  fourth  day  after  leaving 
Plymouth  you  enter  warm  air,  and  are  gradually  {htc- 
pared,  day  by  day,  for  crossing  the  Line.  Calling  in  at 
Santa  Cruz,  Tenenffe,  is  a  pleasant  interlude.  By  the 
time  the  Cape  is  reached,  you  are  so  braced  up  and 
invigorated  by  the  voyage  that  the  inevitable  cold  and 
wet  of  the  south  latitudes  between  the  Cape  and  Tas- 
mania do  not  injuriously  affect  you.  Then  from  Hobart» 

2t— 2 


632  NEW   ZEALAND.  "'SSL^Sf!^ 


Beriew,  Get  1.  UH. 


sapposing  you  have  correctly  hit  upon  the  antipodean 
fiummer,  the  journey  to  the  Bluff  Harbour, .  the 
southernmost  part  in  New  Zealand,  and  so  up  the  east 
coast,  calling  at  all  the  chief  sea-ports,  until  you  reach 
Auckland — the  northernmost,  with  the  best  harbour  and 
most  picturesque  scenery  of  all — ^is  a  most  enjoyable  one. 
As  the  large  steamers  (of  4,000  to  5,000  tons)  do  the 
outward  voyage  in  forty-two  days,  and  the  homeward 
voyage  in  thirty-nine,  a  mere  tour  to  New  Zealand  and 
back,  allowing  five  weeks  to  explore  the  Colony,  need  not 
occupy  more  than  four  months ;  and,  I  may  add,  need 
not  cost  more  than  i£160. 

Invalids,  however,  must  spend  at  least  the  five  summer 
months — say  from  mid-November  to  mid- April,  to  obtain 
any  permanent  benefit. 

You  will  see  by  the  hand-maps  that  the  three  islands 
— ^North,  Middle,  and  South,  or  Stewart's — forming  the 
Colony  of  New  Zealand,  lie  in  curvilinear  form  from  N. 
to  S.  (rather  like  Italy  and  Sicily  reversed)  with  the 
concavity  turned  towards  the  west;  that  they  extend 
over  thirteen  degrees  of  south  latitude,  and  lie  between 
the  meridians  of  166°  to  178°  longitude  E.  of  GreenwicL 
The  length  of  the  Colony  is  about  1,100  miles,  and  its 
breadth  varies  from  six  miles  at  Auckland  up  to  160 
miles  at  Dunedin.  The  mountainous  character  of  the 
country  and  its  deeply-indented,  coast-line  (8,000  miles) 
— ^both  well  seen  on  this  physical  map — together  with 
its  position  in  the  track  of  the  south-west  trade  winds, 
occasion  the  general  climate  of  New  Zealand  to  be 
marine,  humid,  and  windy;  warm  in  the  north,  which  is 
nearest  to  the  equator,  and  cold  in  the  south,  which  is 
nearest  to  the  Antarctic  Pole.  The  mountain  ranges  are 
distributed  over  the  surface  of  the  North  Island  irr^- 
larly ;  but  in  the  Middle  Island  form  a  back-bone,  as  it 
were,  close  to  the  West  coast.  The  highest  mountain  in 
the  North  Island  is  Buapehu  (8,878  ft.)  near  the  centre, 
and  the  highest  in  the  Middle  Island  is  Mount  Cook,  near 
the  centre  of  the  range  of  Southern  Alps,  13,000  feet, 
surrounded  by  snow-crowned  mountains  of  from  9,000  to 
10,000  ft.  There  is,  then,  a  difference  in  the  arrange- 
ment of  plain,  plateau,  and  mountain,  and  therefore  of 
rainfall  and  wind,  between  the  two  chief  islands. 

In  the  North  Island  the  seasons  are  two  only— & 
summer  or  *'  hot  season,''  which  extends  from  November 


r 


SSSS'^n-SS;^  HEW   ZKALAND.  633 


SUnriBW,  Oct.  1, 1881. 


to  April  inclusive,  and  tapers  oflf  into  the  "  rainy  season," 
which  is  called  "  winter."  In  the  middle  of  the  Colony 
(Zone  II.)  the  four  seasons  blend  into  each  other ;  but 
in  the  southern  part  (Zone  III.)  spring,  summer,  autumn 
and  winter  can  be  better  distiaguished,  though  not  so 
clearly  as  in  England.  Each  season  of  the  year  is  more 
constant  in  its  duration  and  uniform  in  its  weather  than 
in  our  own  country. 

The  barometric  range  for  the  whole  year  is  only  a 
fraction  over  2°  Fahr.,  on  the  average  of  many  years' 
observations. 

Throughout  the  greater  part  of  the  North  Island  the 
climate  is  so  mild,  allowing  for  the  winds — for  de 
**gustibu8"  non  eat  disputanduni — that  a  healthy  man 
can  safely  sleep  out  of  doors  during  two-thirds  of  the 
year,  protected  merely  by  a  blanket  and  mackintosh. 

The  clearness  of  the  atmosphere  a  few  hundred  feet 
above  the  land's  surface,  the  constant  sunshine  even  in 
winter,  and  the  rapid  evaporation  of  moisture  from  the 
soil,  greatly  reduce  the  risk  of  taking  cold  from  a  wetting. 
Hence  we  can  understand  how  the  tourist  from  Europe, 
not  specially  hardened  by  Alpiae  mountaineering,  can 
safely  undergo  hardships  and  exposure  to  cold  and  wet 
in  climbing  mountains  in  New  Zealand,  a  tithe  of  which 
would  have  disabled  him  in  Europe.  For,  though  the 
weather  is  subject  to  sudden  and  sharp  fluctuations,  it  is 
free  from  great  extremes,  there  being  only  about  23^ 
di£ference  between  the  mean  average  temperatures  of  the 
warmest  and  of  the  coldest  months  of  the  year. 

The  Southern  hemisphere  being  colder  at  these  lati- 
tudes than  the  Northern,  the  climate  of  North  New 
Zealand  is  cooler  than  the  country  corresponding  to  it 
in  the  Old  World,  which  is  Northern  Africa ;  while  the 
South,  or  Stewart's  Island,  having  its  shores  washed  by 
Antarctic  current,  is  colder  all  the  year  round  than  the 
west  coast  of  France  at  the  level  of  La  Bochelle,  which 
is  warmed  by  the  Gulf  Stream. 

The  three  chief  elements  of  meteorology  which  go  to 
form  a  climate  are — I.  Temperature.  11.  Bainfall  and 
humidity.  III.  Winds.  It  is  necessary  to  dwell  upon 
these  in  ^ome  little  detail. 


684  NEW  ZEALAM).         *S^=ffir?Sl! 


Beview.OeLltUn. 


t  I. — Tehpebatubb. 

The  observations  of  sixteen  years  ending  1884  showed 
that  the  mean  temperature  of  Ithe  entire  North  Island 
was  for  the  spring  months,  66.4^ ;  summer,  65.4° ; 
autumn,  58.8° ;  winter,  50*^.  The  mean  temperature  for 
the  whole  year  was  57°,  the  same  as  that  of  the  cities  of 
Borne,  Montpellier,  and  Milan. 

Auckland,  one  of  the  two  chief  cities  of  the  North 
Island,  situated  on  nearly  the  same  parallel  as  Mel- 
bourne, Adelaide  and  Buenos  Ayres,  has  a  more  equable 
climate  than  any  of  those  places. 

The  mean  temperature  of  the  Middle  Island  for  the 
seasons  are:  Spring,  52.9°  summer,  61.5°;  autumn, 
64.6° ;  winter,  44.9° ;  and  for  the  whole  year  52°,  which  is 
a  little  higher  than  that  of  London,  viz.,  50°,  and  of  New 
York,  viz.,  51.7°. 

Thanks  to  the  Gulf  Stream,  Jersey,  in  the  Channel 
Islands,  though  lying  further  north  in  latitude,  has  the 
same  average  annual  temperature  as  that  of  the  Middle 
Island. 

Throughout  New  Zealand  the  night  temperature  is  on 
an  average  12°  colder  than  the  mean  day  temperature. 

The  mean  annual  temperature  of  the  towns  in  the 
Colony  has  been  noticed  to  be  lower  than  that  of  towns 
in  corresponding  Northern  latitudes  in  Europe,  but 
higher  than  that  of  towns  in  America  on  the  same 
parallels. 

The  climate  on  the  west  coast  of  both  islands  is  more 
equable  than  on  the  east  (and  is  more  moist  also),  there 
being,  for  instance,  18°  greater  range  of  temperature  at 
Christchurch  on  the  east  than  at  Hokitika  on  the  west 
of  the  Middle  Island  throughout  the  whole  year ;  the 
yearly  range  being  63°  and  46.9°  respectively.  This  is 
very  perceptible  to  residents  in  each  of  these  places, 
though  escaping  the  notice  of  the  visitor  passing  through. 
But  the  invalid  must  be  informed  that  per  contra,  fire 
times  as  much  rain  falls  upon  the  west  coast  of  this 
island  as  upon  the  east,  thus  rendering  that  more 
equable  district  undesirable  for  health-seekers,  becaose 
of  its  excessive  moisture. 

The  average  winter  temperature*  of  the  north  part  of 

*ThiB  temperature  is  a  degree  warmer  than  the  average  October 
temperature  at  Boumemotith  (1861-84),  and  at  Brighton  (1871-84). 


Moatfaly  HonuBopatMc 
BCTiow«  Oct.  If  18Bt« 


NEW   ZEALAND. 


635 


the  North  Zealand  is  58°,  which  is  11°  higher  than  that 
of  the  wannest  of  our  wintering  places — ^Llandudno,  42°; 
Torquay,  41°;  and  Penzance,  44°,  The  clearness  and 
purity  of  the  atmosphere,  its  freedom  from  fog,  mist  and 
smoke  greatly  enhance  the  power  of  the  sun's  rays  in  the 
winter  season. 

n. — Rainfall  and  Humidity. 

To  the  sufferer  from  any  pulmonary  disease,  perhaps 
the  most  important  element  in  a  climate  is  its  dryness  or 
humidity.  The  chief  distinguishing  feature  between  all 
the  Australian  climates  and  the  climatic  zones  of  New 
Zealand  is  the  excessive  dryness  of  the  former,  owing  to 
the  hot  winds  of  the  interior,  and  the  plentiful  rainfall 
and  well- watered  condition  of  the  latter.  In  New  Zealand, 
drought,  which  in  Australia  is  of  annual  occurrence,  is 
unknown.  Not  a  month  passes,  even  in  the  warmest 
summer,  without  rain.  It  is  stated  that  no  inhabited 
spot  in  the  whole  Colony  is  more  than  ten  miles  from  a 
river,  stream,  or  spring  of  good  fresh  water.  The  towns 
and  villages  are  well  supplied  with  water  of  fair  purity. 
Taking  the  year  1888  as  an  example,  the  latest  official 
figures  from  the  five  principal  meteorological  stations 
are  these : — 


station. 

Total 
Rainfall 
for  Year. 

Rainy 

Humidity. 

Gules  or 
High 

Mean 

Daya. 

Satorationts^lOO 

Winds 
on 

Temp. 

Auckland      

34.6 

174 

73  i 

26  days 

r,7.5 

Rotoma 

4U.1 

126 

(>s  X 

4    » 

r>2.6 

Wellington   

41.0 

186 

77  X 

106     „ 

54.4 

Christchurch  (Lin- 

coln^   

29.1 

128 

69  X 

27     „ 

51.6 

Dnnedin       

48.3 

157 

7r»  X 

19    „ 

49.7 

Average  humidity  of  the  fiye  stations — 72.4. 

During  this  year  I  find  recorded  three  earthquakes  at 
Botorua ;  three  at  Dunedin ;  eleven  at  Christchurch ;  six- 
teen at  Wellington  ;  and  none  at  Auckland. 

There  were  no  foggy  days  whatever  at  Rotorua ;  only 
one  at  Auckland ;  and  but  five  at  Dunedin ;  seven  at 
Wellington  ;  and  nineteen  at  Christchurch. 

Now,  as  the  average  humidity  of  the  English  health- 
resorts  is,  from  several  years'  observations,  81  per  cent. 


686  NEW   ZEALAND.  "^S^^Sf?^}! 


flvnew,  Oct.  1, 191. 


for  the  year — ^varying  from  78.8  at  Llandudno  up  to  87-8 
at  Osborne,  Isle  of  Wight — ^and  as  the  average  humidity 
of  the  colonised  part  of  South  Africa  is,  according  to 
Dr.  Fuller,*  60  per  cent.,  I  place  New  Zealand,  as  a  whole, 
intermediate  between  England  and  South  Africa  as 
regards  humidity.  But  local  topography  makes  very 
great  differences  in  this  respect.  For  a  long  series  of 
years  (eighteen)  the  average  annual  rainfall  at  Christ- 
church  was  only  25  inches,  which  was  just  that  of  Nice ; 
and  which  contrasted  very  strongly  with  the  rainfall 
recorded  of  Hokitika  on  nearly  the  same  parallel  of  lati- 
tude, on  the  west  coast,  namely  112  inches.  This  large 
amount  exceeds  that  of  Bergen,  in  Norway,  which  is  said 
to  be  the  wettest  town  in  Europe,  namely  80  inches.  (I 
visited  Bergen  in  August,  1889,  and  can  well  believe  this 
to  be  a  fact.)  We  should,  then,  seek  to  know  something 
of  the  meteorological  peculiarities  of  any  particular  town 
or  district  in  New  Zealand  before  we  can  safely  advise  or 
permit  a  chest  invalid  to  take  up  his  residence  there. 
That  which  attracts  the  farmer  and  grazier  is  often  most 
prejudicial  to  the  poitrinaire, 

III. — ^WiNDs,   Storms,  etc. 

The  wind  is  the  most  constant  and  most  notable  feature 
of  the  New  Zealand  weather.  The  stranger  who  lands 
at  the  capital  of  the  colony  when  what  is  facetiously 
termed  "  a  Wellington  zephyr  "  is  in  full  swing,  will  not 
see  a  lady  pedestrian  in  all  the  streets ;  will  see  good-sized 
pebbles  blown  about ;  and  must  exert  all  the  co-ordina- 
ting power  of  his  cerebellum  to  keep  his  balance.  It  is 
said  that  you  can  always  tell  a  Wellington  resident  from 
any  other  New  Zealander  by  his  instinctive  habit  of 
putting  up  his  hand  to  his  hat  at  every  street  corner,  no 
matter  where  he  is  !  This  city  has  a  splendid  deep-water 
harbour,  into  which,  or  out  of  which,  rude  Boreas  some- 
times prevents  large  steamers  from  entering  or  issuing. 
In  most  parts  of  the  Colony  a  calm  day  is  the  exception, 
not  the  rule.  But  the  winds,  which  are  generally  from 
one  of  the  three  points  of  the  compass — N.E.,  accompanied 
with  warm  mist  and  soft  drizzle  or  rain ;  S.W.,  dry, 
cold ;  and  S.,  accompanied  by  heavy  rain,  sometimes  bail> 

'*  South  Africa  as  a  Health  BeioH.    1886.    (W.  B.  Wliittingham, 
Iiondon). 


^t^^MrrrSi^         .  HEW   ZEALAND.  63T 


Beview,  Oct  1.  ISei. 


and  in  the  extreme  south  with  snow  occasionally — ^these 
winds,  I  say,  form  one  of  the  healthiest  features  of  the 
climate,  for  they  are,  as  with  us  in  Liverpool,  the  most 
efficient  scavengers  of  the  towns.  The  New  Zealand 
towns  are  not  kept  in  the  best  sanitary  condition  possible, 
owing  to  the  use  of  earth  closets,  insufficiently  supplied 
with  earth  and  too  seldom  attended  to,  and  the  want  of 
good  water  closets.  Though  water  is  plentiful,  the  house 
supply  in  towns  is  costly,  compared  with  ours. 

New  Zealand  is  happily  free  from  hot  winds,  dust 
storms,  whirlwinds,  cyclones,  blizzards,  and  has  only  an 
average  of  six  or  eight  thunderstorms  in  the  year.  Those 
invalids  who  have  experienced  a  Sydney  "  brick  fielder" 
or  a  Melboui-ne  *'  Southerly  burster  '*  or  the  terrific 
thunderstorms  of  the  Veldt,  in  South  Africa,  will  appre- 
ciate these  advantages  of  the  New  Zealand  climate  more 
particularly. 

Probably  from  the  constant  atmospheric  movement 
there  is  a  corresponding  activity  excited  in  the  human 
circulation,  and  in  the  brain  and  nerves,  which  enlivens 
even  the  most  lethargic  and  lymphatic  of  new  comers  to 
the  colony. 

It  has  been  noticed  that,  children  born  in  New  Zea- 
land, of  British  or  foreign  parents,  are  more  precocious, 
more  nervous,  restless,  daring,  and  excitable  than  their 
brothers  and  sisters  born  in  the  parents'  country  ;  and 
that  when  they  grow  up  these  characteristics  strongly 
develop,  especially  their  abounding  energy.  When  the 
British  visitor  sees  the  wonderful  developments  of  this 
young  country's  resources,  and  in  the  towns  music,  art, 
science  and  literature  carried  up  to  the  highest  level  of 
fin  de  Steele  culture,  he  cannot  but  feel  proud  of  his  race 
when  he  reflects  that  all  this  is  the  outcome  of  a  mere 
half  million  of  people — ^the  population  of  one  of  our  large 
cities.* 

The  Potjb  Climatic  Zones  of  New  Zealand. 

In  a  chain  of  large  islands  which  together  have  an  area 
of  104,000  square  miles,  and  extend  so  as  to  cover  a  space 
of  latitude  equal  to  that  of  Central  and  Southern  France, 
Italy,  the  Mediterranean,  and  part  of  Northern  Africa 
(were  it  placed  in  Europe),  we  may  expect,  and  we  do 

*632,3o2  by  tlua  year's  cenflus,  to  be  exact. 


«88  NEW   ZEALAND.  "^SSSL^Sr?^ 


Beview,  Oet  1, 18BL 


&aif  several  climates,  distinct  in  their  effects  on  the 
human  frame,  bat  shading  into  one  another  from  a 
meteorological  stand-point. 

I  have  been  the  first  to  study  out  the  actual  Climatic 
Zones  of  New  Zealand;  and  am  both  surprised  and 
pleased  to  see  that  no  destructive  criticism  has  been 
inflicted  upon  my  segregation  of  the  Zones  by  such  acute 
censors  as  those  of  the  Aihenaumf  British  Medical 
Journal^  Lancet,  and  Edinburgh  Medical  Journal.  The 
divisions  I  have  adopted  are  marked  in  black  lines  upon 
the  hand-maps.  (That  of  Zone  lY,  however,  is  drawn 
inaccurately,  and  made  too  thin  by  the  printer.) 

When  you  thoroughly  explore  New  Zealand  you  find 
that,  just  as  the  scenery  of  the  North  Island  reminds  you 
of  Greece  and  of  Southern  Italy,  and  that  of  the  Middle 
Island  and  South  Island  of  Switzerland  and  Norway,  so 
there  are  various  climates  recalling  those  of  Algeria, 
Italy,  the  Biviera,  the  South  of  France,  the  Channel 
Islands,  and  the  South  of  England.  Therefore  my 
division  is  a  natural  one. 

No.  I  Climatic  Zone. 

This  Zone  extends  from  the  North  Cape  of  the  North 
Island,  southwards  to  Napier  on  the  east  and  Patea  on 
the  west  coast.  It  has  a  deliciously  soft  warm  climate, 
with  a  mean  summer  temperature  of  66^^,  and  a  winter 
mean  temperature  of  53°.  Frosts  occur  only  at  night, 
in  the  sheltered  valleys  of  the  inland  districts.  At 
Whangarei  and  other  places,  guavas,  bananas,  oranges, 
citrons,  lemons,  and  the  largest  grapes  I  ever  saw  grown 
without  artificial  heat,  ripen  freely.  Although  within 
the  influence  of  the  sub-tropical  rainfall,  the  warm 
nor'easter,  bringing  in  what  is  called  **  muggy  "  weather, 
lasts  only  two  or  three  days,  and  is  succeeded  by  bracing, 
clear,  dry  weather.  It  is  diflScult  to  write  tame  prose  as 
I  recall  to  mind  the  balmy  softness  and  sweet  purity  of 
the  air  of  this  climate,  so  like  that  of  Greece. 

The  principal  towns  resorted  to  by  invalids,  who  natu- 
rally seek  society  and  not  the  isolation  of  country  farms, 
are,  from  north  to  south — the  Bay  of  Islands,  a  verdure- 
clad  Gulf  of  Sorrento ;  Whangarei,  built  partly  on  lime- 
stone formation,  where  the  orange  and  citron-groves  and 
vineyards,  amid  fine  volcanic  scenery,  form  a  pleasing 
entourage ;  Waiwera,   the  best  sea-side  resort  in  the 


SSSS^iS°;*!lffi*^  NEW   ZEALAND.  689 


fievfow,  Oel.  1, 1891. 


Colony,  twenty-six  miles  north  of  Auckland,  where  the 
attractions  of  hot  springs,  forest,  mountain,  river  and 
sea-bathing  are  all  combined ;  Auckland,  of  which  more 
presently ;  Tauranga,  a  miniature  edition  of  the  Bay  of 
Naples  or  of  Santa  Cruz  in  Teneriffe ;  Napier,  the  driest 
sea-port  in  the  Colony,  built  partly  on  limestone  hills ; 
and  New  Plymouth,  on  the  West  Coast,  the  most  bracing 
of  all  these  places. 

Auckland,  the  capital  of  a  large  province  containing 
150,000  inhabitants,  which  has  been  variously  named 
the  "  Naples,"  or  the  "  Corinth  "  of  New  Zealand,  has  a 
most  genial  climate,  the  winter  mean  temperature,  taking 
in  nights  and  days,  being  from  52°  to  57°.  Frost  does 
not  visit  the  city  at  all  during  an  ordinary  winter,  but 
outside,  there  may  be  in  June  or  July  about  4°  or  5°, 
just  enough  to  make  a  very  thin  sheet  of  ice,  which  melts 
by  noon.  House  fires  are  started  towards  the  end  of 
May,  and  discontinued  early  in  September.  We  called 
it  "very  cold"  when  the  thermometer  stood  at  40°Fahr. 
In  summer,  the  thermometer  stood  generally  about  75°  to 
77°  at  2  p.m.,  the  hour  which  I  found  by  my  observa- 
tions for  some  years  was  the  hottest  of  the  day.  Every- 
one complained  of  the  heat  if  it  went  up  to  85^.  Sun 
helmets  are  much  worn  there.  But  how  trMing  a  summer 
heat,  compared  with  the  110°  in  the  shade  of  Sydney 
and  Adelaide,  or  the  90°  and  100°  of  New  York !  When, 
however,  the  N.E.  wind  blew,  even  this  moderate  heat 
was  felt  relaxing.  This  Zone,  generally,  is  well  suited 
for  patients  sufifering  from  chronic  ulcerations  of  the 
throat  (except  tuberculosis  of  the  larynx),  chronic  bron- 
chitis, chronic  bronchitic  asthma,  chronic  pneumonic 
phthisis,  chronic  rheumatism,  and  organic  heart  disease. 
Even  cases  of  genuine  tuberculosis  may  be  safely  recom- 
mended to  Tauranga,  which  is  a  small  sea-port  on  the 
E.  coast,  situated  on  a  dry,  light  soil  of  pumiceous  sand 
and  gravel,  well  sheltered  from  wind ;  or  to  Napier,  where 
there  is  a  rainfall  of  only  87  in.,  or  less,  and  very  good 
society.  In  the  height  of  summer  the  invalid  can  move 
from  Tauranga  up  to  Botorua,  950  ft.  above  the  sea,  or 
from  Napier  to  the  country  hotel  of  Kuripapanga  at  a 
still  higher  elevation.  The  mean  annual  temperature  of 
Napier  is  58°,  and  it  stands  high  for  the  climatic  cure  of 
phthisis  in  the  estimation  of  the  New  Zealand  medical 
profession.    It  is  singular  that  at  New  Plymouth,  on  the 


640  .  NEW   ZEALAND.         "^l^^ST!^. 


Eenew,  Oct.  1,  IflBl. 


opposite  side  of  the  island,  half  as  much  rain  again  falls 
as  at  Napier  (namely,  58  inches),  and  that  this  other- 
wise healthy  sea-port  is  quite  contra-indicated  for  both 
phthisis  and  bronchitis. 

Inland  there  is  the  Thermal  health-resort  of  Te  Aroha, 
in  the  Thames  Valley,  126  miles  S.E.  of  Auckland  by  rail, 
where  there  are  valuable  sulphur  and  soda  springs,  ^hich 
are  stronger  than  those  of  Waiwera,  and  weaker  than 
those  of  Botorua.  I  shall  not  take  up  your  time  by  any 
detail  concerning  these  or  the  other  Thermal  springs, 
having  described  them  fully  in  my  book. 

There  is  a  great  variety  of  choice  in  this  Zone  for  the 
residence,  temporary  or  permanent,  of  the  invalid.  Each 
place  I  have  named  being  well  supplied  with  competent 
medical  men,  the  invalid  who  has  selected  that  place  will 
consult  the  resident  doctor  of  course,  for  all  additional 
information. 

Though  the  general  effects  of  the  climate  of  Zone  I.  is, 
after  some  years,  enervating  to  a  healthy  yet  nervous 
man,  requiring  him  to  take  a  sea  voyage,  or  move  further 
south,  yet  to  nearly  all  poitrinaires  it  is  a  grateful  and 
beneficent  region,  and  there  are  many  men  and  women 
living  there  now,  healthy  and  vigorous,  who,  according 
to  their  Home  physicians,  ought  to  have  died  long  ago ! 
For  chronic  liver  disease  and  for  chronic  neuralgia,  which 
is  aggravated  at  the  sea-side,  this  Zone  is  not  suitable. 

No.  II.  Climatic  Zone 

extends  from  the  southern  boundary  of  No.  L,  ^ 
lat.  39°  30',  southwards  across  Cook's  Straits  to  the 
parallel  of  43*^,  which  crosses  the  Middle  Island  from  the 
Hurunui  Kiver  on  the  east  to  the  mining  town  of 
Hokitika  on  the  west.  This  Zone  offers  a  colder  and 
more  variable  climate  than  No.  I,  and  is  better  suited 
for  a  healthy  emigrant  than  for  an  invalid.  Persons, 
however,  who  suffer  from  lax  cutaneous  action,  from 
torpidity  of  liver ;  or  irregular  action  of  kidneys ;  and 
those  who  are  acutely  sensitive  to  prolonged  hot  weather, 
will  find  residence  at  Palmerston  North,  Wanganui,  or 
even  Wellington,  with  its  wind  and  earthquakes,  more 
agreeable  than  in  the  warmer  North.  It  is  easier  slso 
for  healthy  persons  to  work  hard,  mentally  or  manually* 
in  Welhngton  than  in  Auckland.    In  this  Zone  frosts 


2^S?[nSw^    THE   EAB  AND   SCALP.  641 

occur  nightly,  all  through  the  winter,  bat  they  are 
neither  severe  nor  long  lasting. 

Grossing  the  Straits,  we  find  at  Nelson,  the  ''  Garden 
of  New  Zealand,"  a  climate  rather  too  warm  for  the  con- 
samptive  in  summer,  but  a  very  mild  and  suitable  winter 
climate. 

The  little  port  of  Picton,  at  the  head  of  Queen  Char- 
lotte Sound,  is  a  charming  sea-side  resort  all  the  year 
round,  and  ought  to  be  more  frequented  than  it  is. 
Tophouse,  60  nules  inland  from  Nelson,  though  the  hotel 
is  a  primitive  one,  affords  an  Alpine  summer  resort  at 
an  elevation  of  3,000  ft.  above  the  sea.  This  whole  Zone 
is  very  mountainous,  windy,  and  liable  to  earthquakes, 
of  a  slight  kind,  but  not  pleasant  to  the  nerves  of 
invalids.  But  I  do  not  know  in  the  whole  of  New 
Zealand  a  more  delightful  place  whereia  to  end  one's 
days  than  Nelson,  whether  for  quiet  scenery,  climate, 
society,  or  intellectual  resources. 

(To  he  continued,) 


THE  EAE  AND  SCALP ;  THEIE  SYMPATHIES. 
By  Robert  T.  Cooper,  M.A.,  M.D. 

On  the  16th  of  last  July  a  gentleman,  aged  about  fifty, 
whose  ears  I  have  been  in  the  habit  of  syringing  from 
time  to  time  for  the  last  ten  years,  came  to  me  with  the. 
left  ear  plugged  up  apparently  with  cerumen,  and  the 
entire  scalp  covered  with  eczematous  eruption.  The  top 
of  the  head  especially  was  covered  in  a  crust  in  which 
was  matted  the  scanty  supply  of  hair  that  remained  to 
him.  If  he  scratched  his  head  there  was  a  great  deal  of 
irritation,  but  not  otherwise. 

It  was  evident  the  case  was  one  of  seborrhoea  of  the 
:8calp,  and  such  being  the  case,  when  interrogated  by 
him  as  to  the  cause,  the  reply  I  at  once  gave  was :  "  You 
have  in  all  probability  been  using  vaseline ;  "  and  it 
turned  out  precisely  as  expected. 

This  is  about  the  fourth  time  I  have  seen  seborrhoea 
of  the  scalp  produced  by  vaseline,  and  have  also  seen 
the  same  consequence  from  a  petroleum  ointment,  used 
for  the  purpose  of  promoting  the  growth  of  the  hair. 

The  great  importance  of  this  case,  however,  arises 
ifrom  the  evidence  it  supplies  of  a  simultaneous  stimula- 


I 


642  THE   EAR  AiTD   BCALP.     ""^ISSL^E??^ 


Review,  OeL  1,  isn. 


tion  of  the  sebaceous  glands  of  the  scalp  and  of  the  (left) 
aural  meatus. 

It  is  such  a  common  thing  to  find  one  or  both  ears 
blbcked  with  ceramen  without  any  visible  alteration  in 
the  state  of  the  scalp  or  of  the  surface  of  the  skin  of  the 
face  or  neck,  that  in  the  presence  of  neighbouring 
exanthems  any  deductions  as  to  their  causal  or  sympa- 
thetic relationships  would  be  at  most  very  uncertain. 

But  in  the  above  ca^e  we  have  as  strong  evidence  as  it 
is  possible  to  imagine  that  the  eai*  and  scalp  affection 
were  but  parts  of  a  whole,  and  that  the  ear  in  becoming 
blocked  was  but  thrown  into  precisely  the  same  patho- 
logical condition  as  the  scalp.  And  my  reason  for  saying 
so  is  this :  I  had  seen  this  gentleman  in  the  middle  of 
the  previous  December,  and  had  then  cleared  out  the 
comparatively  small  amount  of  cerumen  in  his  ears,  and 
now  he  presented  himself  after  the  lapse  of  seven 
months  with  one  ear — the  left — completely  blocked. 

Now  as  I  had  had  the  opportunity  of  watching  this 
gentleman  for  over  ten  years,  and  as  his  ears  had  never 
required  syringing  oftener  than  at  two  years  interval, 
and  even  then  for  but  small  quantities  of  cerumen,  the 
conclusion  is  perfectly  justifiable  that  there  was  in  opera- 
tion an  unusual  cause  stimulating  the  meatual  sebaceous, 
t.e.,  the  ceruminous,  glands. 

This  case  therefore  ought  in  my  opinion  to  mark  an 
epoch  in  the  etiology  and  therapeusis  of  ear  disease. 
For  it  proves  what  I  myself.  Dr.  Galley  Blackley,  and,  I 
have  no  doubt  whatever,  a  great  many  others,  have  from 
time  to  time  suspected,  that  a  great  sympathy  eiists 
between  the  cutaneous  surface  of  the  scalp  and  that  of 
the  aural  meatuses,  and  consequently  of  the  middle  ears. 

A  patient  I  lately  saw  suffering  from  fronto-occipital 
headache,  alternating  with  severe  occipital  prurigo,  and 
whose  hearing  is  at  other  times  perfect,  gets  an  almost 
complete  deafoiess  of  both  ears  while  the  intense  itching 
of  the  scalp  and  nape  of  the  neck  lasts. 

It  would  appear  that  petroleum  or  its  presumable 
derivative  vaseline  (potentized)  ought  to  be  a  corrective 
of  undue  disposition  to  ceruminous  impaction,  when  of 
course  this  is  not  due  to  structural  imperfections. 

But  the  grand  lesson  from  such  a  case  is  to  pay 
very  close  attention  to  the  condition  of  the  scalp,  and  of 


SSSSfcSTSS!^      BHEUMAtIC  FEVER.  648 

the  state  of  the  skin  of  neck,  and  of  the  face  when  con* 
sidering  the  possible  causes  of  imperfect  hearing. 

It  is  well  known  that  the  mere  fact  of  wearing  a  nightcap 
will  often  arrest  the  progressive  enfeeblement  of  hearing 
in  those  advancing  in  life ;  and  it  is  very  common  to  find 
cases  of  deafness  where  the  slightest  breath  of  cold  wind 
blowing  upon  the  head  will  most  painfully  deafen  the 
patient.  Again  there  is  no  more  certain  way  of  acquiring 
deafiiess  than  sitting  in  a  drafty  office  where  every 
current  of  air  is  felt  to  chill  a  scalp  rendered  additionally 
sensitive,  from  its  being  perhaps  devoid  of  its  natural 
covering. 

There  is  no  doubt  that  much  of  the  increase  of  deaf- 
ness is  due  to  the  substitution  of  spirituous  and  watery 
preparations  for  oleaginous  ones  as  habitual  applications 
to  the  head. 

A  little  olive  oil,  or  beef  or  mutton  suet  pommade,  or 
perhaps  a  lanolin  preparation  is  very  much  to  be  pre- 
ferred to  the  quinine  and  cantharidine  preparations  so 
much  in  vogue,  but  so  dangerous  in  every  way  to  the 
maintenance  of  the  healthy  functions  of  the  surrounding 
important  organs. 


RHEUMATIC   FEVER  WITH  EXTREME 

HYPERPYREXIA. 

By  John  D.  H^iyward,  M.D.,  Lond. 

Cases  of  hyperpyrexia  are  not  so  common  but  that  a 
short  account  of  one  which  has  just  occurred  may  prove 
of  interest.  The  inevitably  fatal  result  of  this  complica- 
tion is  announced  in  the  reference  books  of  medicine ; 
and  I  am  unaware  of  any  record  of  the  recovery  of  well- 
marked  cases  under  homoeopathic  treatment,  though  I 
have  heard  of  several  which  have  succumbed.  The 
resemblance  to  sunstroke  and  narcotic  poisoning,  and 
the  profound  affection  of  the  central  nervous  system  and 
its  heat-regulating  control  are  well  marked  in  the  follow- 
ing case. 

Mrs.  C,  a  stout  lady,  aged  88,  of  active  habits  and 
general  good  health,  sent  for  me  on  the  morning  of 
August  the  17th  of  this  year,  complaining  of  feeling  un- 
well and  of  pain  in  one  finger  and  one  knee. 


644  RHEUMATIC  FEVER.      ''^L^fSJWS!! 


BevSeiw.  Oct  1«  un. 


Previous  history :  The  patient  is  one  of  a  niunerooB 
family,  most  of  the  members  of  which  have  in  childhood 
shown  signs  of  tabes  mesenterica  and  other  symptoms  of 
the  strumous  diathesis ;  she  is  the  mother  of  several 
children,  who  have  been  affected  with  caseating  cervical 
glands,  carious  fingers  and  masdllsBi  ozoena  and  similar 
iiroubles,  one  son  being  a  helpless  imbecile;  she  has 
^never  had  rheumatism,  nor  have  any  members  of  the 
family,  except  an  uncle  who  is  reported  to  have  died  of 
rheumatic  fever  with  cerebral  complications.  Mrs.  G. 
has  been  under  observation  for  many  years,  and  has  had 
no  serious  illness  ;  but  she  has  become  very  stout, 
although  active,  and  the  manageress  of  a  very  large  con- 
cern ;  she  has  been  rather  breathless  on  exertion,  and  the 
iheart  sounds  were  weak  but  otherwise  healthy ;  she  has 
been  troubled  with  indigestion,  and  has  biek  a  laige 
eater,  especially  of  animal  food. 

Present  illness  :  The  history  of  the  present  attack  at 
first  pointed  to  a  septicaemic  origin,  and  indeed  it  is  even 
now  possible  that  a  blood-poisoning  taint  was  present. 
The  patient  had,  more  than  a  week  ago,  been  visiting 
and  syringing  a  relative,  who  had  recently  been  confined, 
:and  who  had  very  offensive  lochia ;  this  woman  had  been 
dangerously  ill,  with  what  I  am  informed  had  been  certi- 
fied as  puerperal  fever.  Mrs.  C.  was  menstruating  at 
the  time.  In  addition  to  this,  there  is  a  history  of 
exposure  to  damp  and  cold  while  perspiring,  about  a 
week  previous  to  the  present  attack.  For  two  daye, 
before  my  first  visit,  patient  had  felt  poorly  and  shiver- 
ing, and  said  she  had  caught  cold. 

Present  sitate :  Patient  was  in  bed  complaining  of  pain 
in  the  right  second  finger  and  in  the  tendons  at  the 
back  of  the  left  knee.  The  finger  was  swollen  and  very 
-tender,  it  resembled  the  early  stage  of  a  whitlow ;  the 
imiddle  joint  was  the  most  painful,  and  no  solution  of 
the  continuity  of  the  skin  could  be  perceived.  The  knee 
was  not  hot.  red  nor  swollen,  but  was  acutely  sensitive 
to  touch  and  movement,  the  patient  became  hysterical 
•on  attempts  being  made  to  examine  it.  Patient  was 
excitable  and  herself  volunteered  the  blood  poisoning 
i;heory.  Temperature  99.6^.  Knee  and  finger  fomented, 
cand  rkubs.  tax.  prescribed,  the  painful  condition  being 
worse  in  bed  and  relieved  by  voluntary  movement. 


SSSSf^STSf  *       RHEUMATIC  FEVER.  645 

On  visiting  the  patient  in  the  afternoon  of  the  same 
day,  she  was  found  screaming  with  attacks  of  cramps  in 
the  legs  [she  was  rather  subject  to  cramps].  These 
cramps  were  better  when  she  sat  up  in  an  arm  chair, 
and  this  she  insisted  on  doing ;  they  remained  severe 
until  next  day,  when  they  gradually  became  less  frequent 
and  severe,  but  occasionally  occurred  for  two  days  more. 
Camphor  and  a  dose  or  two  of  cwp.  stdph.  were  adminis^ 
tered  and  then  the  rhus.  continued. 

August  18th. — Patient  better,  temperature  99^,  cramps 
less  severe ;  finger  and  knee  less  painful.  She  had  not 
slept  much,  but  seemed  progressing  favourably.  Bowels 
opened  by  enema. 

Dr.  J.  W.  Hayward  saw  the  case  with  me  in  consulta- 
tion at  this  and  several  subsequent  visits;  he  recom- 
mended crotcdus  alternately  with  the  rhus. 

August  19th. — ^Bestless  night,  temperature  99.6^.  The 
other  knee  and  both  ankles  were  now  painful  and  very 
tender ;  but  not  red  or  hot,  and  not  much  swollen ; 
patient  took  food  and  drink  readily,  indeed  all  through 
the  illness  she  took  food  well  and  often  complained  of 
not  getting  enough  to  eat  and  drink,  although  taking  a 
foir  amount.  Rkua  and  crotalvs  continued,  with  a  dose 
of  hyoscyamus  at  night. 

August  20th. — The    case    now   resembled    ordinary 

rheumatic  fever;    the  ankles,  knees,  wrists  and  the 

right  shoulder  being  affected ;  the  wrists  and  ankles 

were  swollen,  and  all  the  joints  were  painful  to  touch  or 

movement.    Temperature  101^.   Gontidue  rhiis  and  croU 

August  21st. — Temperature  100.6°.    Slight  dry  cough  ; 

no  pleurisy  or  pneumonia  to  be  detected.    Bryonia  given. 

Evening  temperature  102°.      Verat,  vir.  and  bryon. 

August  22nd. — Temperature  101.4°.    Bryon. 

August  28rd. — ^Mrs.  C.  very  much  better,  joints  only 

slightly  painful  or  swollen ;  she  could  move  herself  and 

lie  on  her  side  and  could  sit  up  for  examination ;  she 

expressed  herself  as  feeling  cheerful,  well  and  hungry. 

Temperature  100°,  pulse  90.    No  headache.    Continue 

bryonia. 

The  heart  had  been  carefully  examined  at  each  visit 
and,  although  weak,  was  apparently  unaffected.  The 
urine  could  never  be  obtained  owing  to  the  patient 
having  defective  control  over  the  bladder,  and  to  her 
being  so  heavy  and  so  sensitive  to  movement  that  the 

VoL  35,  No.  10.  2  z 


646  RHEUMATIC  FEVER.      ^ISS^oS!^ 

bed-pan  could  not  be  used.  The  urine  and  motions 
were  passed  into  napkins.  Patient  was  menstruating 
[before  usual  period]. 

On  the  evening  of  this  day  [23rd  August],  patient 
rapidly  became  worse,  and  on  my  being  summoned  to 
her,  the  temperature  was  found  to  be  104.6,  pulse  108, 
and  breathing  86.  Patient  had  become  rather  drowsy, 
and  the  pupils  contracted.  The  cardiac  region  was 
rather  tender,  and  a  soft  mitral  systolic  murmur  was 
present.  Patient,  for  the  first  time,  appeared  dangerously 
ill,  and  a  serious  prognosis  was  given.  Spigdia  was 
administered. 

August  24th. — The  heart  sounds  were  improved,  bat 
the  drowsiness  had  increased.  Through  the  night  she 
had  rambled  and  dozed  at  intervals ;  she  could  be  roused, 
but  did  not  recognise  nor  remember  well.  Pupils  con- 
tracted, react  slowly  to  light,  no  pain  or  headache. 
Temperature  105.4°. 

The  cardiac  region  had  been  poulticed  and  the  legs  and 
joints  wrapped  in  flannels  wrung  out  in  mustard  and 
hot  water.  In  the  afternoon,  temperature  being  still 
105°,  a  wet  pack  was  applied ;  during  its  use  she  became 
much  more  sensible,  looked  better  and  brighter,  and  the 
temperature  fell  to  103.6°.  Soon  afterwards  she  relapsed, 
and  the  temperature  was  again  106°.  Later  another  wet 
pack  was  employed,  but  she  became  more  comatose,  and 
after  its  removal  the  temperature  was  found  to  be  over 
105°.  Mrs.  C.  gradually  became  still  more  comatose  and 
Jibe  breathing  more  laboured.  Urine  and  loose  motions 
passed  involuntarily.  A  cold  bath  was  not  readily 
available  even  if  the  condition  of  the  patient  had 
rendered  its  emplojrment  possible.  The  skin  was 
always  dry  and  hot,  even  after  the  packs.  There  was 
sensitiveness  to  noise,  but  not  to  light.  At  no  time  was 
there  pain  or  tenderness  over  the  abdomen  or  on  breath- 
ing. Since  the  morning,  puUatilla  had  been  given  at 
short  intervals  on  Dr.  J.  W.  Hayward's  suggestion. 

At  10  p.m.  the  temperature  was  105.8°.  At  1  a.m. 
(August  25th)  it  was  107°.  Dr.  Gordon  saw  the  patient, 
and  apis  was  administered  for  a  few  doses.  At  2  a.m. 
the  temperature  was  108*6°,  and  just  before  death,  at 
8.30  a.m.,  the  thermometer  registered  111'4°  Fahr. 
after  one  minute  in  the  axilla.  The  temperature  was 
probably  even  higher  than  this,  and  it  certainly  felt  so 


B^^rcSTSl?^  CAMPHOR  IN  URINARY  DISEASES.  647 

to  the  teach,  half-an-hour  after  death ;  but  as  neither  of 
my  o¥m  clinical  thermometers^  nor  those  ofthenurses^ 
xegistered  above  111^^,  this  could  not  be  ascertained. 
The  temperature  under  the  arm  was  taken  with  several 
•different  thermometers,  and  in  one  of  my  own  the 
mercury  was  driven  to  the  extreme  top  of  the  capil- 
lary tube. 

The  case  is  probably  one  of  rheumatic  fever,  endo- 
carditis, meningitis,  and  hyperpyrexia.  It  is  of  interest 
on  account  of  the  early  resemblance  to  septicaemia, 
and  of  the  height  to  which  the  pyrexia  rose.  Note : — Of 
possible  interest  is  the  following  fact.  The  present 
reporter  having  visited  Mrs.  C.  twice  on  August  17th, 
on  the  morning  of  the  18th  his  wife,  who  had  been  con- 
fined twelve  days  before  and  had  not  had  a  bad 
symptom,  suddenly  began  shivering,  and  the  tempera- 
•tore  was  found  to  be  108° ;  in  the  afternoon  it  rose  to 
105"6°;  on  the  19th  it  was  102°  in  the  morning,  and 
rose  to  104*8*^  in  the  afternoon;  next  morning  it  wap 
normal,  but  rose  to  104^  in  the  afternoon,  gradually 
declining  to  the  normal  during  the  next  day.  Her  pulse 
was  between  120  and  160.  No  symptoms  except 
fainting,  headache,  and  weakness  were  present.  She 
.soon  recovered.    But  from  what  ? 

Liverpool. 

CAMPHOE  IN  UEINAEY  DISEASES, 
By  Joseph  Thornley,  M.D. 

The  following  notes  of  a  few  cases  of  urinary  disease 
treated  with  camphor  may  be  of  interest  to  the  general 
practitioner,  to  whom  a  medicine  which  experience  has 
proved  to  be  so  sure  and  powerful  is  invaluable.  In  those 
cases  in  which  strangury  was  the  most  prominent  symp- 
torn,  its  action  was  like  magic.  In  two  of  the  cases  the 
pain  during,  and  for  some  time  after  micturition,  was 
so  violent  that  it  was  a  source  of  terror  to  the  patient. 
Yet,  in  a  few  hours,  this  condition  was  entirely  removed 
by  the  aid  of  this  drug. 

Case  I. 

This  was  a  man  aged  40  years.  The  history  was  that 
while  on  a  railway  journey  he  was  seized  with  pain  in 
^e  left  lumbar  region  with  vomiting  following  the  attack 

2  z— 2 


648     CAMPHOE   IN   UBINARY   DISEASES.   ^^wfo^?wS^ 

of  pain,  and  with  suppression  of  urine.  The  case  was  diag- 
nosed as  one  of  renal  colic.  The  treatment  consisted  o£ 
hot  fomentations  applied  over  the  region  of  the  kidney 
and  extending  round  the  side  and  down  the  left  groin.. 
The  pain  in  a  few  hours  spread  along  the  entire  course 
of  the  ureter,  and  into  the  left  testicle,  which  was^ 
retracted  up  beneath  Poupart's  ligament ;  this  latteB 
condition  caused  very  violent  pain,  and  the  sickness  \^as. 
attributed  mostly  to  this  cause  by  the  patient  himself. 

Medicinally  I  administered  calc.  carh.  80  every  hours, 
and  gave  ice,  which  allayed  the  sickness  and  quenched, 
the  thirst.  The  hot  fomentations  gave  almost  instant 
relief  to  the  very  acute  pain,  and  it  was  noted  that  even 
during  the  short  interval  while  the  flannels  were  being 
changed  (although  this  was  very  short)  was  quite  suffi- 
cient to  cause  the  pain  to  return. 

This  treatment  was  continued  until  the  paroxysmi 
passed,  which  took  place  in  about  24  hours.  The  urine,, 
though  now  clear,  was  high  coloured  and  was  found  t4> 
contain  uric  acid  though  not  in  great  abundance. 

The  patient  now  remained  apparently  well  for  twenty- 
four  hours,  after  which  he  had  a  return  of  all  his  previous 
symptoms,  this  attack  lasting  three  days.  The  urina 
during  this  second  attack  contained  greater  quantities  of 
uric  acid  than  before.  He  now  suffered  from  strangury, 
the  pain  lasting  for  some  time  after  each  act  of  mictu- 
rition. For  this  I  gave  camphor  <t>  8  drops  on  sugar  every 
three  hours.  Within  an  hour  the  pain  was  relieved,  and. 
in  24  hours  had  entirely  gone  and  did  not  return. 

Case  II. 

A.  B.,  a  married  woman,  aged  80  years,  sent  for  me  to* 
visit  her  at  her  home.  She  complained  of  violent  pain, 
after  micturition,  with  constant  desire  to  pass  water,  and 
a  feeling  that  the  whole  of  the  urine  had  not  come 
away,  this  caused  her  to  have  what  she  called  "heavy 
bearing  down  pains  "  and  straining  to  force  more  urine 
away.  The  pain  she  said  was  like  a  knife  cutting  her,, 
and  it  was  so  severe  that  she  was  in  great  fear  of  the 
desire  to  urinate  coming  on.  I  ordered  her  to  foment  the 
parts  with  hot  water,  and  I  gave  her  cainphor  4>  8  drops- 
on  sugar  every  three  hours. 

Next  day  I  saw  her,  she  was  very  much  improved.. 
She  got  relief   after  taking  the  second  dose  of  the; 


IS^^S^nX^  CLINICAL   CASES. 649 

^camphoTy  and  had  continued  to  improve  ever  since,  the 
pain  now  after  passing  water  was  very  slight,  but  it  had 
not  entirely  gone.  Continue  the  camphor.  The  follow- 
ing day  the  pain  had  gone  altogether ;  I  ordered  her  to 
continue  the  medicine  three  times  a  day  for  a  few  days 
ionger.     She  had  no  return. 

Case  III. 

E.  A.,  aged  40,  a  married  woman,  complained  of 
having  much  pain  in  the  region  of  left  kidney  and  ureter, 
^nd  bearing  down  scalding  pain  on  passing  water.  I 
gave  her  camphor  <l>,  three  drops  on  sugar  every  four 
hours.  Next  day  I  saw  her  she  was  much  improved, 
the  strangury  had  entirely  gone,  and  the  pain  in  her 
side  and  back  was  very  much  better.  She  continued  to 
improve  from  day  to  day  until  she  was  quite  well. 

Since  the  above  cases,  all  of  which  were  very  acute, 
I  have  given  camphor  in  many  cases  with  charming 
cresults. 

I  gave  these  cases  to  show  how  great  a  weapon  we 
have  in  our  hands  for  combating  this  very  painful 
disease,  and  also  to  point  out  the  danger  of  neglecting 
.a  remedy  which  from  its  familiarity  we  are  in  such 
danger  of  ignoring. 

Bolton. 


CLINICAL  CASES. 
By   William   Lamb,   M.B. 

Case  I. 

Mrs.  D.  C.  C,  eight  and  a  half  months  pregnant,  com* 
plained  of  obstinate  constipatimi  all  through  her  pregnancy, 
having  to  sit  for  an  hour  before  she  could  extrude  a  few 
hard  round  balls.  Gave  plumb,  12  ntiij  t.  d.  s.  The 
next  day  after  taking  the  medicine  she  had  an  easy, 
natural  evacuation,  and  continued  so  up  to  time  of 
•labour.  After  labour  the  same  medicine  taken  on  the 
third  day  produced  an  easy  evacuation  next  day. 
^Nothing  done  except  medicine.  No  dieting,  etc.  I 
gave  the  12th  dil.  upon  Dr.  Ussher's  strong  advice  not 
tD  go  lower. 


L. 


660  CLINICAL   CASES.         ^?£SL^nT!^ 


Bevieir,  OeL  1,  IflBl. 


Case  II. 

G.  G.,  set  9,  was  suffering  from  neuralgia  (not  tooth- 
ache, his  teeth  being  all  sound)  of  this  peculiar 
character — that  as  regularly  as  the  clock  would  strike 
6  p.m.  his  pain  came  and  continued  until  he  fell  asleep 
after  tossing  upon  the  bed  exhausted.  He  would  awake 
free  of  pain,  go  through  the  day  without  any  intima- 
tion of  his  trouble,  but  as  sure  as  6  p.m.  came,  so  surely 
the  neuralgia  returned.  This  was  of  nightly  recurrence 
until  I  gave  cedron  2,  niij  2  hrs.  This  at  once  and 
permanently  removed  the  affection.  I  believe  malaria 
was  at  the  bottom  of  this  intermittent  neuralgia,  the  boy 
having  come  from  a  malarious  part  of  India.  The 
"  clock-like  periodicity  "  directed  me  to  the  drug. 

Cask  III. 

Mr.  E.  W.  G.  came  to  my  house  at  6  o'clock  one 
evening  suffering  from  catarrhal  ophthalmia^  with  such 
profuse  lachrymation  that  his  handkerchief  was  put  to 
his  eye  every  few  seconds.  I  prescribed  euphrana  ^  in 
fractional  doses  of  a  drop  every  two  hours,  and  locally  a 
lotion  of  euphr.  <^  1  in  10.  Next  day  he  came  to  my 
house  about  1  p.m.  without  any  appearance  of  ophthalmia. 
This  was  truly  magical. 

Case  IV. 

Mrs.  P.,  blonde,  suffered  all  through  her  pregnancy 
with  most  distressing  heartburn,  that  made  her  life  a 
misery.  I  gave  ptdsatilla  8x  ntij  for  a  dose,  and  was 
pleased  to  learn  when  attending  at  her  confinement,  that 
"  that  water  medicine  "  had  removed  her  heartburn  at 
once.  As  she  was  my  patient  previously  in  my  allo- 
pathic practice,  this  exhibition  of  what  homoeopathy 
could  do  made  her  a  complete  believer  in  the  new  thera- 
peutics. 

Case  V. 

Mrs.  C,  suffering  from  aphonia  so  complete  that  only 
the  lowest  whisper  was  possible,  was  treated  allopathic- 
ally  for  six  weeks  without  the  slightest  benefit.  As  it 
was  catarrhal,  I  gave  camticum,  8x  rriij  2h8.;  in  a  couple 
of  days  she  was  able  to  speak  in  her  natural  voice. 


r 


SSS^S^i^Jg?^       .  PELVIC  LESIONS-  661 


Bsview,  Oct.  1, 1691. 


Case  VI. 

Mrs.  S.,  on  being  asked  immediately  after  accouchement 
if  she  felt  all  right,  said,  **  Yes,  except  for  this  throbbing 
toothache  I  have  had  for  some  days."  Bellad.  30,  niij 
relieved  her  in  a  few  minutes,  one  dose. 

Case  VII. 

Mrs.  L.,  over  60  years  of  age,  sent  for  me,  as  she  was 
suffering  the  intensest  pain  in  the  stomach,  with  obsti- 
nate vomiting,  which  was  of  the  "coffee  grounds" 
character.  She  had  suffered  for  many  years  with  acute 
exacerbations  every  now  and  then.  She  had  consulted 
three  of  the  best  allopaths  all  of  whom  suspected 
"malignant  disease  "  of  the  stomach.  In  her  previous 
attack  her  allopathic  physicians  required  to  inject 
morphia  for  the  pain,  and  seemed  baffled  to  check  the 
vomiting,  one  of  them  confessing  he  had  exhausted  his 
armamentarium.  For  the  vomiting  I  gave  ipecac,  1,  ntij 
every  quarter  of  an  hour  at  first,  and  then  at  longer  inter- 
vals. They  were  truly  astonished  at  the  marvellous  efficacy 
of  the  "  drops."  For  the  pain  I  gave  atrop.  sulph.  from  the 
Ist  cent,  to  8rd  cent,  trituration,  1  or  2  gr.  doses  every 
few  hours.  This  so  relieved  the  pain  that  there  was  no 
need  of  hypodermic  injection  of  morphia.  She  got  quite 
well,  and  has  remained  so,  not  having  enjoyed  such  good 
health  for  a  number  of  years.  Diagnosis,  ulcer  of 
stomach. 

Dunedin,  New  Zealand. 


THE  EECIPROCAL  EELATIONS  BETWEEN  SUR- 

GERY  AND  HOMGEOPATHIC  THERAPEUTICS  AS 

EXEMPLIFIED  IN  PELVIC  LESIONS. 

By  G.  H.  Burford,  M.B. 

Awistant  PhyBician  to  the  Oyneoological  Department,  London  Homoeo- 

pathio  Hospital. 

A  HUNDRED  years  ago  the  only  natural  law  of  amplitude 
correlating  drugs  and  diseases  was  enunciated  as  an 
induction.  A  hundred  years  of  test  and  verification 
have  determined  the  practical  value  of  this  law,  and 
have  raised  it  from  the  barren  import  of  a  historical 


652  PELVIC  LESIONS.       ^S£?iL^S???2l* 


B«¥iew,  Oct.  1,  UN. 


incident  to  what  Goethe  phrases  as  *^  des  Leben's 
goldnen  Bamn."  But  no  law  of  iiature  is  dowered  with 
finality  or  exclusiveness,  no  sweeping  generalisation  but 
has  its  limits  and  its  complement :  and  the  condition  of 
our  knowledge  of  truth  is  that  such  knowledge  shall  be 
progressive.  As  yet,  however,  no  new  tnerapeutic 
induction  has  been  elaborated  which  bears  any  relation 
to  homoeopathy,  such  as,  e.g.,  that  of  the  second  law  of 
motion  to  the  first,  or  that  of  the  survival  of  the  fittest 
to  the  law  of  variation.  It  is  legitimate  to  enquire 
therefore  if  in  the  homoeopathic  law  we  are  to  see  the 
be-all  and  end-all  of  therapeutic  science:  whether  in 
"  similia  "  we  have  heard  the  final  deliverance  of  thera- 
peutics :  or  if  in  the  evolution  of  knowledge  we  may 
expect  yet  more  brilliant  discoveries,  yet  more  inspira- 
tions of  genius,  to  fitly  amplify  the  homoeopathic  law. 
How  much  this  law  needs  supplement  ere  it  can  success- 
fully displace  sacrificial  surgery,  and  in  what  degree 
surgery  has  been  supplanted  by  therapeutics,  are  the  hues 
of  enquiry  of  the  present  paper. 

MoDEBN  Surgery  Independently  of  Homceopathy. 

Any  therapeutic  scheme,  whose  aim  it  shall  be  to  rival 
the  work  of  surgery,  must  discover  to  us  a  power  in  the 
use  of  drugs,  a  celerity  in  operation  and  an  amplitude 
in  resource  as  yet  conspicuously  lacking.  There  is 
nothing  in  the  promise  or  the  potency  of  any  known 
natural  law,  or  any  certified  empirical  procedure,  which 
lends  countenance  to  the  statement  that  the  sphere  of 
therapeutics  is  conterminous  with  the  sphere  of  surgical 
removal ;  or,  differently  phrased,  that  the  therapeutics  of 
the  future  will  eliminate  the  sacrificial  surgery  of  the 
present.  For  let  us  form  a  clear  conception  of  the 
burdens  this  therapeutic  Titan  must  adequately  bear. 
It  must  remove  with  celerity  and  certainty  the  grave 
risks  incident  to  tumour  degeneration.  (Case  of  strangu- 
lated ovarian  cyst  successfully  operated  on  cited).  It 
must  devise  an  effective  means  for  removing  the  dangers 
of  suppurating  masses  when  in  contiguity  with  the 
peritoneum.  (Case  of  intra-peritoneal  abscess,  where 
surgical  interference  was  declined,  and  which  was  soon 
fatal,  cited).  The  appalling  results  of  extra-uterine 
gestation,  mth  its  immense  and  continuous  haemorrhage, 
must  be  obviated  in  some  way  without  the  use  of  the 


bS^^T^^      .pelvic  lesions.  653 


Keriev,  Oct.  1,  UBl. 


ligature.  The  drenching  haemorrhages  from  polypi  may 
be  staid  once  and  for  all  by  the  simplest  surgical 
procedure,  while  therapeutics  may  be  doing  its  ineffective 
best  at  a  time  when,  for  purposes  of  relief,  the  days  are 
golden.  The  rapidly  growing  and  fatally  tending  ovarian 
cyst  is  now  often  removed,  with  a  safety  of  result  and 
an  ease  of  convalescence  denied  to  any  therapeutic  treat- 
ment of  any  serious  lesion.  It  is  needless  to  detail 
for  you  the  vogue  of  surgery  in  the  removal  of  symptoms 
caused  by  impacted  calculi  of  gall-bladder  or  kidney,  in 
the  treatment  of  ileus  or  volvulus,  in  the  establishment 
of  anastomosis  of  intestine  in  cases  of  obstruction,  or  in 
the  surgical  treatment,  often  alone  quite  successful,  of 
tubercular  peritonitis.  If  diagnosis  be  an  unnecessary 
procedure,  and  symptomatology  the  only  basis  of 
successful  treatment,  the  fact  remains  that  before 
abdominal  diagnosis  was  elaborated,  or  abdominal  surgery 
hinted  at,  these  serious  lesions  existed,  and  in  spite  of 
homoeopathy  slew  annually  their  thousands  and  tens  of 
thousands.  In  the  palmy -days  of  symptom-study,  in  the 
first  fifty  years  of  this  century,  homoeopathy  elaborated 
a  recondite  method  for  dealing  with  such  cases.  The 
totality  of  symptoms  was  to  be  the  key  of  the  situation. 
After  fifty  years  of  assiduous  labour  it  became  evident 
ihat  homoeopathy  had  done  something,  but  not  all  that 
was  hoped  from  it.  It  had  relieved  symptoms,  it  had 
deprived  illness  of  many  of  its  pangs,  and  death  of  some 
of  its  terrors;  but  it  had  not  caused  neoplasms  to 
disappear,  or  recurrences  to  cease,  or  metastases  to 
vanish  in  any  appreciably  greater  ratio  than  before. 
Under  these  circumstances  modern  abdominal  surgery 
was  born.  Its  results  you  all  know.  And  when,  for 
non-infective  lesions  that  are  fatally  tending,  I  compare 
the  effects  of  removal  with  the  only  partial  relief  of 
symptoms  by  drugs,  I  am  compelled  to  admit  that  in 
this  field  therapeutics  have  been  signally  wanting  in  the 
success  that  has  attended  the  work  of  the  great  rival 
surgery. 

The  Influence  of  Homcbopathy  on  Surgical 

Pbocedubb. 

We  are  concerned  here  with  the  question.  What  change 
has  homoeopathy  effected  in  the  relations  of  surgery  and 
medicine?     Has  any  notable  re-distribution  of  cases 


664  PELVIC  LESIONS.        "^^L^nT^llS: 


Review.  Oct  1, 1891. 


been    effected,  and    the  medical    sphere    enlarged  by 
detachment  from  the  surgeon's  work  ? 

Here  certain  preliminary  considerations  come  in- 
The  basis  of  exact  science  is  the  possibility  of  perpetual 
verification.  As  therapeutics  is  not  an  exact  science,  it 
is  irrational  therefore  to  expect  invariably  the  same 
result  from  remedies  chosen  even  in  strict  accordance 
with  the  law.  Human  life,  and  at  present  human 
therapeutics,  are  worked  on  the  laws  of  probability  and 
average.  So  frequent  verification  of  results  must  suffice 
for  us  in  the  place  of  that  constant  verification  required 
by  exact  science.  But  further,  therapeutic  successes  of 
an  occasional  and  infrequent  type  are  not  to  be  denied 
on  account  of  their  rarity.  They  may  not  be  frequently 
repeated  in  even  similar  cases,  but  this  only  proves  that 
the  similarity  was  apparent,  not  real.  Thus  we  may 
admit  therapeutic  results  that  can  be  frequently  achieved^ 
and  those  that  can  be  but  rarely  repeated,  if  these  latter 
are  consiBtent  with  the  canons  of  eVidenc^. 

There  is  scarcely  a  department  of  surgery  where  well- 
attested  results  in  carefully  diagnosed  cases  have  not 
been  obtained  by  competent  observers.  In  the  great 
mass  of  reported  cures  the  diagnosis  is  open  to  serious 
objections,  but  I  will  adduce  others  to  which  no  excep- 
tion can  be  taken.  Dr.  Byres  Moir  has  under  his  care 
a  case  of  aortic  aneurism,  which  has  considerably 
lessened  and  finally  ceased  to  trouble  under  baryta  curb. 
The  patient  had  elsewhere  previously  a  prolonged 
hospital  experience  to  no  avail,  and  was  steadily  getting 
worse.  A  most  gloomy  prognosis  had  been  given,  but 
the  steady  improvement  under  drug  treatment  negatived 
the  asserted  imminence  of  dissolution. 

Dr.  Dudgeon  has  communicated  to  me  a  case  of  a 
lady  suffering  from  persistent  menorrhagia,  and  who 
had  undergone  operation  for  removal  of  ovaries  and 
tubes  in  the  hope  of  arresting  the  bleeding.  But  in 
vain ;  and  preparation  was  being  made  for  the  severer 
operation  of  hysterectomy,  when  it  was  suggested  that 
homoeopathic  treatment  might  be  tried.  Apis  was  the 
remedy  selected,  and  a  short  course  of  this  drug 
promptly  staid  the  hsemorrhage,  and  that  permanently. 

In  another  case  seen  with  Dr.  Hall,  at  Surbiton,  the 
results  of  treatment  were  quite  as  striking.    With  the 


n^H^^^T^^'         PELVIC  LESIONS.  665 

— 

assistance  of  my  fnend  Dr.  Garfrae  I  opened  the  abdo- 
men to  remove  a  suppurating  cyst.  Everywhere  the 
peritoneal  cavity  seemed  obliterated  by  adhesions ;  no 
serous  surfaces  were  to  be  seen ;  and  the  fingers  separated 
sheet  after  sheet  of  false  membrane,  before  even  the  cyst 
wall  could  be  clearly  made  out.  No  intestines  even  were- 
seen  during  the  operation.  In  consequence  of  these 
universal  adhesions,  a  small  part  of  the  basis  of  the  cyst 
was  left  behind.  Hepar  was  steadily  given  for  months ; 
and  a  year  after  the  primary  operation  I  again  opened 
the  abdomen  to  remove  the  remnant  of  cyst  wall.  A 
most  striking  change  had  occurred;  the  serous  cavity 
had  again  become  visible^  every  shred  of  membrane  had 
disappeared,  viscera  were  mobile,  and  all  traces  of  the 
intense  inflammatory  storm  had  vanished.  Hepar  was 
the  only  medicine  given  for  any  length  of  time. 

The  cure  of  haemorrhoids ;  the  disappearance  of  fistula ; 
the  reduction  of  prolapsus  ani  and  uteri ;  the  closing  of 
lachrymal  sinuses,  and  many  other  conditions  in  minor 
surgery  are  to  be  found  in  literature  as  observed  by  com- 
petent men.  But  their  relatively  infrequent  occurrence,  as 
compared  with  intractable  cases,  removes  these  from  the 
list  of  probable  events.  They  cannot,  even  in  cured 
cases,  be  prognosed  with  certainty ;  and  this  incertitude 
of  result,  together  with  the  relative  infrequency  of  the 
curable  type,  limits,  and  will  always  limit,  the  influence 
of  homoeopathy  on  surgery. 

Some  of  these  results  can  be  secured  with  much 
greater  frequency  than  others.  While  the  arrest  of  aneu- 
rism^ the  restoration  of  infiltrated  tongues  to  the  status 
quo,  and  the  cure  of  cystic  bronchocele  are  rarely 
achieved,  the  disappearance  of  enlarged  glands,  the  cure 
of  varicosis,  the  absorption  of  hordeola  and  more  rarely 
of  meibomian  cysts,  and  the  vanishing  of  young  and 
succulent  fibromata  come  within  the  range  of  frequently 
repeated  successes. 

And  in  the  after  treatment  of  operations,  these  remedies 
have  a  brilliant  sphere.  I  ascribe  much  of  our  success 
in  abdominal  sections  in  hospital  and  private  work  to  my 
uniform  practice  of  prescribing  bell,  and  mere.  cor.  during 
the  critical  period,  the  first  four  days ;  a  plan  I  have 
never  had  reason  to  alter. 


666  PELVIC   LESIONS.        *1S^°SS??ml 


Review,  Oct.  1,  Ifidl. 


On  the  Necessary  Limits  op  Therapeutics  in  the 
Treatment  of  Lesions  styled  Surgical. 

Although  an  operating  surgeon,  accustomed  to  deal 
mth  the  gravest  issues  of  life  and  death  in  cases  where 
therapeutics  have  failed,  I  confess  I  should  regard  with 
feelings  of  the  liveliest  apprehension  any  stagnation  of 
therapeutic  interest,  or  any  paralysis  of  therapeutic  effort 
in  the  direction  of  therapeutic  sufficiency.  To  regard 
therapeutics  as  all-sufficient  for  the  cure  of  cancer,  for 
the  removal  of  tumours,  for  the  absorption  of  calculi  or 
the  removal  of  remnants  of  inflammation,  is  a  position 
neither  warranted  by  experience  nor  justified  by  a  priori 
deduction.  If  the  theory  of  therapeutic  exclusiveness  be 
s,  counsel  of  perfection,  it  must  be  remembered  that  only 
stimulated  by  such  an  ideal  conception  have  the  advances 
of  therapeutics  been  made.  To  the  stimulus  of  this  idea 
we  owe  the  law  of  similia  itself ;  with  all  its  train  of 
results  in  limiting  inflammations,  retarding  suppuration, 
eliminating  diatheses  and  alleviating  symptoms.  Says 
a  distinguished  living  neurologist:  "  Only  by  such  a  worK- 
ing  hypothesis  have  facts  been  won  from  darkness  to 
light,  and  the  realm  of  knowledge  widened,  and  useful- 
ness increased."  And  if  we  failed  in  renewed  research 
and  experiment  in  the  force  and  sphere  of  drugs,  we 
should  have  the  insistent  voice  of  human  appeal  and 
public  sentiment,  which,  stimulated  by  surgical  triumphs, 
calls  on  therapeutists  to  justify  their  existence  and 
extend  their  usefulness  by  similar  brilliant  successes. 

Let  us  examine  with  scientific  care  the  issues  of  expe- 
rience as  defining  time  and  place  for  the  physician  and 
surgeon  respectively;  and  finally  let  us  consider  the 
scientific  basis  on  which  therapeutics  is  founded,  and  the 
necessary  limitations  which  they,  as  natural  laws,  possess. 

Li  the  issues  of  experience  as  regards  the  therapeutic 
treatment  of  surgical  lesions,  we  will  consider  well 
attested  facts  only,  available  as  scientific  evidence.  To 
save  time,  I  will  adduce  only  three,  of  whose  verity  I 
have  personally  assured  myself. 

Case  I. 

I  saw  in  the  country  a  few  weeks  back,  a  middle-aged 
ladv  suffering  from  an  ulcerating  scirrhus  of  the  breast, 
and  which  had  been  some  years  in  existence.    In  six  of 


^'Si^'^T^^'  PELVIC   LESIONS.  657 


.  Oct.  1, 1891. 


these  years,  however,  it  had  been  prevented  from  spread- 
ingy  the  discharge  almost  banished,  and  the  pain  reduced 
to  nil,  by  the  local  and  internal  use  of  arsenic  and 
hydrastis.  She  was  a  woman  in  authority,  with  many 
servants  imder  her,  "  none  of  whom,"  said  she,  **  have 
the  least  idea  that  there  is  anything  amiss  with  me/' 

Case  II. 

I  was  called  in  consultation  some  time  ago  to  see  a 
lady  with  obscure  abdominal  symptoms.  She  had  pre- 
viously been  treated  for  cancer  of  the  breast,  evidence  of 
which  existed  in  the  fact  that  the  lung  of  the  same  side 
was  infected.  But  of  the  earlier  lesion  scarcely  a  trace 
remained.  The  axillary  glands  had  disappeared,  the 
swelling  of  the  arm  had  gone  down,  the  pain  had  ceased, 
and  the  breast  itself  had  returned  to  its  normal  size  and 
density.  It  is  true  that  the  lung  was  infected ;  it  is  also 
true  that  during  the  time  the  patient  was  under  treat- 
ment, the  mammary  lesion  had  thus  been  controlled. 

Case  III. 

A  lady,  set  50,  seen  in  consultation  with  Dr.  Dyce 
Brown.  Here  there  was  a  huge  abdommal  swelling, 
with  history  of  recent  peritonitis,  the  base  of  the  left 
long  dull,  aphthsB  in  the  mouth,  pulse  120,  and  some 
constipation.  In  view  of  the  abdominal  deposit  and 
tumefaction,  a  diagnosis  of  exciting  cause  was  deferred, 
although  pretty  well  surmised.  After  a  series  of  cardiac 
and  gastric  crises,  the  patient  recovered  sufficiently  to 
leave  her  bed,  to  walk  about  the  room,  to  sleep  well,  to 
enjoy  her  food,  and  to  have  absolutely  no  pain.  The 
abdominal  tumour  now  being  more  defined,  exploratory 
section  was  made,  and  the  existence  of  sarcoma  placed 
beyond  question.  This  was  at  a  time  when  the  most, 
surprising  advances  had  been  made  in  general  bodily 
condition. 

The  existence  of  these  results  proves  merely  that,  in 
the  adduced  cases,  disappearance  or  Umitation  of  lesion 
followed  tjfie  use  of  certain  therapeutic  measures.  So,, 
as  a  single  exception  is  fatal  to  an  induction,  we  cannot 
accept  as  a  scientific  fact  that  lesions  carefully  diagnosed 
as  malignant  are  universally  outside  the  pale  of  drug 
influence.    But  from  the  rarity  of  this  occurrence  we 


668  PELVIC  LESIONS.        *?SSlw"o5??^ 


may  establish  the  generalisation  that  malignant  lenons, 
removable  by  drug  influence,  belong  to  a  type  rare  in  its 
occurrence,  but  possessing  no  differential  symptoma- 
*tology  from  those  which  are  incurable. 

These  results  obtain  attestation  in  a  new  and  most 
interesting  manner.  We  are  indebted  to  the  most 
enterprising  surgeon  of  the  day  for  the  following  faiCts  :— 

'*  I  have  seen,"  says  he,  "  a  myoma  disappear  after 
-an  abdominal  section  intended  for  its  removal,  where 
nothing  was  done  except  handling  the  txmiour,  with  the 
result  of  deciding  that  it  was  immovable.  This  experi- 
ence  has  been  recently  confirmed  abroad,  where,  in 
Vienna,  a  case  of  myofibroma  of  the  uterus  was  shown 
xmder  the  following  circumstances: — The  existence  of 
the  tumour  being  known,  a  laparotomy  was  performed, 
and  a  large  solid  tumour  found,  as  large  as  a  man's 
head,  solid  and  quite  immovable.  As  operation  was 
futile  under  such  conditions,  the  abdomen  was  closed. 
When  the  patient  was  examined  fourteen  days  later,  they 
were  astonished  to  find  the  tumour  shrunk  to  half  its 
former  size,  being  no  larger  than  a  child's  head,  and  it 
had  also  become  movable.  The  tumour  continued  to 
lessen  in  size  until  finally  it  became  no  larger  than  a 
:man*s  fist." 

"  I  know,"  says  Tait,  **  of  several  cases  in  my  own 
practice  where  such  disappearances  have  been  completely 
effected ;  unfortunately  I  know  of  a  much  larger  numb^ 
where  no  such  result  has  been  obtained." 

Tait  relates  another  case  where  a  cholecystotomy, 
an  operation  not  involving  parts  anywhere  near  the 
uterus,  resulted  in  the  diminution  to  one  third  of  a  large 
.fibroid  reaching  nearly  to  the  umbilicus. 

I  have  recently  watched,  with  Dr.  Madden,  a  case 
where  simple  exploratory  incision  was  suflScient  to 
terminate  a  series  of  hectic  symptoms,  and  at  the  same 
time  to  cause  to  vanish   a  large  pelvic  effusion,  the 

Jons  et  origo  nialL  And  Dr.  Madden  further  informs  me 
of  a  case  seen  some  years  ago  with  Lawson  Tait,  where 
cancer  of  the  gall  duct,  a  condition  precluding  anything 
but  exploratory  section,  had,  some  time  after,  quite 
vanished,  and  defied  the  gloomy  prognosis  given  after 

operation. 


S^r^TSt!^  PELVIC   LESIONS.  659 


On  the  Scientific  Basis  of  Thebapeutics  and  thbib 

Limitations  as  Nature  Laws. 

In  one  of  Herbert  Spencer's  most  philosophical  works 
is  the  following  striking  paragraph,  which  may  fitly  be 
transposed  as  the  cry  of  the  therapeutist :  "  Give  us  a 
guide,"  cry  men  to  the  philosopher.  "  We  would  escape 
firom  these  difficulties  in  which  we  are  entangled.  A 
better  state  is  ever  present  to  our  imaginations,  and  we 
yearn  after  it,  but  our  efforts  to  realise  it  are  fruitless. 
We  are  weary  of  perpetual  failures ;  tell  us  by  what  rule 
we  may  attain  success." 

Gentlemen,  I  must  here  reiterate  my  assertion  that 
the  law  of  similia  is  the  only  natural  law  of  amplitude 
hitherto  enunciated  in  therapeutics ;  and  that  like  all 
other  natural  laws  it  has  its  limits  and  conditions.  The 
essential  condition  of  its  operation  is  that  the  symptoms 
of  the  disease  shall  be  exactly  paralleled  by  the  symp- 
toms produced  by  the  drug.  Were  these  conditions 
exactly  and  thoroughly  in  harmony,  it  logically  follows 
that  the  drug  would  always  cure.  Pushing  the  hypothe- 
sis a  little  closer,  the  greater  the  similarity  the  nearer 
the  approach  to  identity ;  and  recent  experimental  obser- 
vations bear  out  the  validity  of  this  view.  Koch's  tuber- 
culin, or  as  potentised  by  Burnett,  is  a  sample ;  but  the 
most  striking  parallel  is  furnished  by  spectrum  analysis. 
Thus  the  D  lines  in  the  spectrum,  in  place  of  appearing 
as  yellow  bands,  are  simply  exactly  neutralised  and 
blotted  out  when  the  rays  from  sodium  vapour  traverse 
another  mass  of  sodium  vapour,  detached,  but  exactly 
similar,  to  the  first. 

Among  the  limitations  of  therapeutics,  the  first  is 
that  conditioned  by  the  necessity  for  the  drug  and  disease 
action  to  be  as  similar  in  manifestation  as  possible ;  and 
this  necessarily  implies  that  the  forces  which  express 
themselves  as  bodily  symptoms  shall  be  similar,  even  to 
identity.  But  we  cannot  know  bodily  forces  except  by 
their  manifestations,  their  intimate  nature  we  can  never 
know.  As  homoeopathy  thus  resolves  itself  into  a 
similarity  of  forces,  and  as  we  can  only  know  these 
forces  by  their  expression  as  symptoms,  we  often  find 
that  two  drugs  or  two  diseases  will  produce  symptom- 
series  nearly  exactly  similar,  but  of  widely  differing  real 
.nature.    See,  for  example,  the  mimicry  of  symptoms  due 


660  PELVIC   LESIONS.         "^^L^S??^ 


Review.  Oct.  1,  IfiBl. 


to  tissue  degeneration  by  those  resulting  from  functional 
neurosis.  Until  we  can  be  assured  then  not  only  of  the 
exact  harmony  in  symptoms,  but  also  of  the  harmony  in 
nature,  of  drug  and  disease  forces,  our  application  of  the 
law  must  often  be  erroneous. 

The  next  limitation  is  due  to  the  variations  in  the 
law  of  correspondence  correlating  disease  symptoms  and 
drug  provings.  The  similarity  between  the  effects  of 
certain  drugs  and  the  symptoms  of  certain  diseases 
almost  approaches  identity ;  examples  of  which  we  see 
in  arsenic  and  some  forms  of  cholera,  and  belladonna  and 
some  forms  of  scarlatina.  But  from  exact  parallels  snch 
as  these  the  variations  increase,  till  at  length  we  have 
collated  many  drug  provings  not  corresponding  in  their 
entirety  to  disease,  and  very  many  disease  effects  not 
paralleled  by  drugs.  We  know  no  drugs  nor  combinations 
of  drugs  that  have  as  their  effects  such  common  lesions 
as  fibroid  of  the  uterus,  cyst  of  the  ovary,  scirrhus  of 
the  breast,  or  sarcoma  of  the  kidney  capsule.  It  is  not 
legitimate  to  found  homoeopathic  practice  on  the  state- 
ment that  if  the  provings  were  carried  sufi&ciently  far, 
these  results  would  ensue ;  for  here  we  leave  the  safe 
ground  of  proven  result  for  the  uncertainty  of  specula- 
tion. A  proven  and  a  re-producible  parallel  between 
disease  symptoms  and  drug  provings  is  the  scientific 
basis  of  homoeopathy ;  but  the  moment  we  leave  this  safe 
ground  we  venture  into  regions  beyond  the  homoeopathic 
law  and  outside  its  sanction.  In  some  instances  a  limited 
analogy  has  been  established.  I  need  not  recapitulate 
Mr.  Knox  Shaw's  erudite  demonstration  of  this  morning, 
or  Hutchinson's  discovery  of  arsenically  produced  epithe- 
lioma, or  Berry's  demonstration  of  the  magnesic  and  cal- 
careous antecedents  of  bronchocele.  These  are  scientific 
facts,  and  justify  drug  exhibition ;  but  expectation  from 
analogy  does  not  carry  with  it  the  necessary  warrant  of 
homoeopathic  similarity.  I  do  not  say  that  it  is  not 
within  the  sphere  of  chemical  bodies  to  eventuate  in 
these  lesions,  on  the  contrary,  I  think  it  highly  probable, 
but,  as  yet,  because  we  lack  the  provings,  we  are  in 
exactly  the  same  empirical  mist  as  the  old  school ;  and 
our  results  in  the  treatment  of  neoplasms  are  little 
better. 

The  third  limitation  of  therapeutic  effect  arises  from 
the  oft  forgotten  fact  that  we  cannot  transcend  nature. 


m^S^TS^  PELVIC   LESIONS.  661 

When  we  introduce  drugs  into  the  organism  we  carry 
•therewith  no  new  force  which,  permeating  the  organism, 
•cures  in  its  integrity ;  but  forms  of  force  which  act  upon 
pre-existing  bodUy  energy  through  the  medium  of  mole- 
•cular  transformation.  And  the  effects  of  our  drug  are 
^fiimply  different  combinations  of  vital  energy,  limited  by 
ihe  possibilities  of  the  tissues.  Thus  we  cannot  produce 
absorption  where  there  are  no  lymphatics,  nor  hyp«r- 
lirophy  in  encapsuled  masses  with  no  blood  supply,  nor 
co-ordination  in  tumours  where  there  are  no  nerves,  nor 
•reproduction  of  organs  or  limbs  that  have  been  removed. 

Curative  processes  must  always  be  conditioned  by 
•certain  physiological  constants ;  and  to  determine  if  a 
given  lesion  is  within  or  without  the  pale  of  possible 
physiological  recovery  is  the  province  of  the  physician, 
-varying  from  age  to  age  as  new  successes  are  recorded. 

Gentlemen,  I  will  conclude  by  advancing  a  series  of 
general  propositions,  all  of  which  are  capable  of  demon- 
stration. 

1.  Neoplasms,  both  benign  and  malignant,  have  been 
♦observed  to  disappear  under  certain  conditions. 

^  2.  This  result  is  relatively  rare ;  and  cannot  in  any 
;given  case  be  with  certainty  prognosed. 

8.  The  absence  of  tumour  formation  in  drug  provings 
is  a  serious  bar  to  the  curative  use  of  drugs  in  cases  of 
meoplasms. 

4.  New  growths  are  often  the  outcome  of  a  complex 
-series  of  influences  resulting  from  temperament,  race, 
environment,  diet,  work,  and  mental  harass. 

It  is  unwise  to  expect  to  eliminate  a  result,  without  at 
tthe  same  time  taking  measures  to  neutralise  the  existing 
^causes  ;  which  so  long  as  the  relation  between  antecedent 
and  consequent  exists,  will  always  eventuate  in  bodily 
<defect. 

From  Homeric  times  the  work  of  the  physician  has 
l)een  viewed  as  a  measure  of  public  safety : — 

"  A  wise  physician,  skilled  onr  wounds  to  heal. 
Is  more  than  armies  to  the  public  weal." 

Discussion. 

Dr.  BoDMAK  said  he  did  not  remember  that  Dr.  Buiford 
•drew  attention  to  the  value  of  the  homceopathic  treatment 
on  preparing  patients  for  operations,  which  in  his  opinion  was 
wery  great.    As  an  illustration,  he  might  mention  the  case  of 

VoL  35,  No.  10.  3  a 


662  PELVIC   LK810N8.        ^"SSS^J^ST^ 


Beview,  Oct.  1,  ISBl. 


a  lady  who  consulted  him  for  a  litUe  growing  fibroid  in  the 
uterus.  She  had  gone  about  with  it  for  a  yeiy  long  time  up 
to  last  September,  when  she  consulted  him.  She  had  called 
in  a  surgeon  with  a  view  to  an  operation,  which  he  declined 
to  carry  out,  on  the  ground  that  her  general  health  and  condi- 
tion were  so  bad  that  it  was  impossible  to  operate  with  any 
expectation  of  success.  After  three  months  homoeopathic 
treatment  she  improved  so  much  in  general  health  that  the 
same  surgeon  saw  her  again  and  undertook  the  operation, 
which  was  most  successfully  performed ;  the  manner  in  which 
the  patient  recovered  and  gained  her  health  being  a  matter  of 
surprise  to  the  surgeon  and  all  who  saw  the  case  in  the 
hospital.  In  that  case  he  thought  the  preservation  of  life 
was  as  much  due  to  the  homoBopathic  treatment  and  the  skill 
of  the  physician  as  to  that  of  the  surgeon.  They  had  here 
an  illustration  of  the  great  use  of  homoeopathy  in  the  pre- 
paration of  patients  where  an  operation  was  inevitable. 
(Hear,  hear). 

Dr.  Goldsbrouoh  said  he  felt  sure  they  must  all  have 
listened  to  Dr.  Burford's  paper  with  a  great  deal  of  interest. 
He  had  always  regarded  the  physician  and  surgeon  as  twins* 
indeed,  almost  as  Siamese  twins,  and  he  was  a  httle  surprised 
to  hear  the  possibility  suggested  of  doing  away  with  either. 
It  seemed  to  him  that  they  had  to  work  hand  in  hand,  and  he, 
for  one,  as  a  general  practitioner,  was  glad  indeed  to  see  the 
revival  of  a  more  accurate  and  a  more  enthusiastic  surgical 
procedure  in  the  London  Homoeopathic  Hospital.  (Hear,, 
hear).  They  would  be  able  to  look  forward  to  some  of  the 
cases  referred  to  by  Dr.  Burford  having  fax  more  successful 
treatment  than  they  could  receive  by  merely  drug  medication^ 
Dr.  Burford  referred  to  the  almost  identical  correspondence 
between  drug  action  and  disease,  which  they  were  bound  to 
look  for  in  choosing  their  remedy.  True ;  but  they  did  not 
look  to  that  for  the  explanation  of  the  action  of  the  drug,  and 
it  seemed  to  him  that  they  had  to  study  more  minutely  and 
more  carefully  the  reaction  of  the  organism  in  itself,  the 
totaUty  of  the  patient's  state  against  the  action  of  the  drugs, 
if  they  were  to  get  success  in  the  early  manifestation  of  what 
finally  turned  out  to  be  surgical  lesion.  At  the  end  of  hi& 
paper  Dr.  Burford  referred  to  the  temperament  of  the  patient. 
It  seemed  to  him  it  was  thai,  which  they,  as  physicians,  had 
more  particularly  to  study.  If  by  any  unfortunate  chance  the 
lesion  turned  out  eventually  to  be  a  neoplasm,  or  any  other 
growth,  then  they  must  hand  their  patient  over  to  the 
operator  as  having  passed  beyond  the  efforts  of  the  physician. 
But,  in  the  meantime,  they  had  a  wonderful  field  of  investi- 
gation in  studying  the  causes  of  these  lesions  which  in  the  end 


^fgnraff^       P^imc  lesions. 668 

proyed  to  be  only  amenable  to  surgical  procedure,  and  in  the 
reaction  of  the  organism  against  these  causes  they  must 
find  their  principal  field  of  result.  To  wit,  how  should  one 
have  guessed  that  the  mere  opening  of  the  abdomen  and  the 
handling  of  a  tumour  would  have  caused  the  diminution  of 
that  tumour?  How  was  such  a  result  to  be  explained? 
They  might  term  it  the  reaction  of  the  organism,  but  it  was. 
in  this  line  of  investigation  that  their  efforts  must  be  directed 
if  results  were  to  accrue.    (Applause). 

Dr.  BocHE  said  one  thought  had  particularly  struck  him  in. 
listening  to  this  most  interesting  paper,  and  it  was  suggested 
by  Dr,  Burford  in  what  he  said  as  to  the  obiter  dictum  of 
therapeutics  and  these  surgical  proceedings.    Anyone  who 
had  taken  an  interest  in  surgery  for  a  number  of  years  would 
be  able  to  remember,  both  in  surgery  and  in  medicine,  tides. 
of  differing  opinion,  and  after  all  it  lay  with  the  rank  and 
file,  those  who  were  dealing  every  day  with  disease,  to  hold 
the  balance  between  the  opposing  sections  of  opinion.    They 
were  thankful  as  general  practitioners  to  have  in  the  front 
rank  those  who  were  at  least  holding  their  own,  and  doing  so 
as  it  were  on  their  observation,  with  the  great  and  wonderful 
advances  of  surgery,  especially  abdominal  surgery,  during 
the  past  ten  years.    Speaking  for  himself,  he  could  only  say 
that  in  his  time,  which  was  longer  ago  than  one  cared  to> 
remember,  when  he  was  house-surgeon  of   King's  College 
Hospital,  nothing  was  known  of  such  proceedings  as  they 
found  in  vogue  to-day.    They  were  entirely  new,  and  they 
must  be  thankful  that  their  hospital  was  sharing  in  the  great 
advance  which  had  been  made  in  that  department  of  medical 
science.    While  they  were  glad  to  find  that  line  being  pursued 
on  the  one  hand,  on  the  other  there  would  be  those  who 
would  adhere  very  strongly  to  the  course  of  depending  more 
entirely  upon  medicine ;  and,  the  balance  being  held  between 
the  two,  they  might  expect  as  time  passed  to  gain  additional 
knowledge  of  what  was  true  in  one  department  and  in  the 
other,   and  thus  come  to  abidingly  improving  conclusions. 
He  had  seen  cases,  just  as  Dr.  Burford  had  told  them,  which 
one  day  seemed  perfectly  hopeless  from  a  medical  point  of 
view,  and  yet  as  time  passed  circumstances  had  developed, 
points  had  been  cleared  up,  and  things  had  taken  a  course 
which  they  could  never  have  expected.     On  the  other  hand^ 
they  might  be  led  by  such  a  case  to  wait  and  wait  to  the 
dai^er  of  their  patient,  and  their  wisdom  lay  in  encouraging- 
those  who  would  bring  matters  to  such  a  state  of  certainty 
that  they  might  be  enabled  to  decide  in  cases  of  doubt  when 
they  might  safely  wait,  and  when,  for  their  patient's  good^ 
they  must  actively  and  promptly  interfere.    To  his  mind  it 

8A-3 


664  PELVIC  LESIONS.        "'S^^fK?^ 


Review,  Oct  1, 18BL 


seemed  that  at  the  present  time  they  had  arrived  ii  the 
position  of  doing  what  was  necessary  in  cases  where  they 
were  sure.  In  doubtful  cases  they  might  reasonably  wait, 
and  while  waiting  let  those  who  took  up  the  therapeutic  side 
be  as  active  as  possible,  so  that  grain  by  grain  they  might  be 
able  to  gather  that  full  and  complete  information  whidi  was 
necessary  to  bring  all  such  questions  to  a  satisfactory  con- 
clusion. He  hoped  they  would  see  these  operations  going  on 
as  successfully  as  they  had  done  of  late,  not  only  in  this  but 
in  every  other  department  of  their  profession.    (Applause). 

Dr.  Edwabd  Madden  remarked  that  without  attempting  to 
discuss  fully  so  able  and  philosophic  a  paper  until  he  had 
been  able  to  digest  it  at  leisure  in  the  printed  record,  he 
would  just  like  to  say  this — ttiat  while  no  doubt  the  elements 
of  the  therapeutic  action  were  as  Dr.  Burford  had  stated, 
they  still  looked  forward  to  extending,  or  perhaps  he  should 
rather  say  reducing,  those  elements  by  further  experience  and 
knowledge  of  drugs.  Thus,  while  they  were  told  that  it  was 
possible  for  nature  to  bring  about  a  cure  of  what  was 
apparently  a  foreign  substance  to  itself  simply  as  the  result  of 
an  exploratory  incision,  the  fact  of  course  proved  that  it  was 
not  really  a  foreign  substance  to  the  organism,  but  that  the 
changes  took  place  through  the  connection  between  the 
nerves  and  blood  vessels  of  the  tumour  and  those  of  the  rest 
of  the  body.  WhHe  that  was  so,  it  ought,  and  he  believed  it 
would,  become  more  and  more  possible  for  them  to  discover 
drugs  which  would  influence  the  organism  to  take  on  that 
reaction  without  the  necessity  of  the  exploratory  incision  or 
other  operation.  While,  therefore,  they  were  very  thankfol 
that  surgery  was  advancing  in  the  way  it  was,  and  that  they, 
as  homoeopaths,  were  able  to  share  this  progress,  he  stfll 
looked  forward  to  the  increased  knowledge  of  cbugs  reducing 
the  number  of  cases  which  they  had  to  hand  over  to  the 
surgeon.    (Applause^. 

Dr.  Hughes  said  ne  might  mention  one  important  matter 
bearing  on  the  paper,  with  the  main  drift  of  which  he  entirely 
agreed.  At  the  late  Congress  in  America,  Dr.  Betts,  of 
Philadelphia,  stated  that  he  had  consulted  as  many  as  possible 
of  his  fellow  practitioners  as  to  whether  they  had  ever,  in 
their  practice,  seen  any  neoplasms  in  the  persons  of  those 
who  had  been  under  homoeopathic  treatment  from  their  yoixtti 
lip,  and  the  answer  was^from  one  and  all,  that  they  never 
had.  Well,  one  must  not  build  too  much  upon  that,  but  the 
natural  inference  from  it  was  this — that  whenever  those 
patients  had  any  symptoms  of  things  going  wrong  with  them, 
those  symptoms  had  been  treated  homoeopathically  upon  the 
usuid  indications,  that  the  morbid  changes  had  thus  been 


fS^^S^n^^  PELVIC  LESIONS.  6651 


Seriew,  Oct.  1,  IWl 


overcome  while  they  were  still  fresh  adid  young,  and  so  never 
went  on  to  become  organised  in  the  form  of  new  growths. 
This,  although  not  scientifically  demonstrable,  was  sufficiently 
plausible  in  appearance  to  encourage  them  to  treat  homoeo- 
pathically  in  the  early  stages,  with  the  hope  of  efifecting  a 
cure  in  the  first  developments  of  disease.  But  at  the  same 
time  he  agreed  with  Dr.  Burford  that  when  once  the  changes 
had  become  organised  it  was  a  waste  of  time  to  treat 
them  medicinally.  They  might  succeed  in  one  case  out  of 
five  hundred,  but  in  the  other  four  hundred  and  ninety-nine 
the  sooner  the  patients  were  operated  on  the  better. 

Dr.  Hatwabd  said  Dr.  Hughes  had  touched  on  a  very 
important  point.  It  occurred  to  him  that  they  might  even 
r^ret  the  excellence  of  Dr.  Burford's  paper,  for  one  reason — 
that  such  excellent  results,  on  such  excellent  evidence,  of  the 
recourse  to  surgery  amongst  them  might  possibly  lead  them 
to  look  forward  too  much  to  surgical  assistance.  As  young 
men,  they  had  a  tendency  to  see  that  surgery  held  out  a  grand 
field  for  their  enterprise,  and  that  they  would  all  be  surgeons. 
He  believed  that  in  their  younger  days  they  were  all  really 
surgeons,  and  disposed  to  believe  that  surgery  was  the  thing. 
Gradually  they  had  come  to  see  that  the  constitution  needed 
other  treatment  besides  surgery.  Dr.  Hughes  had  hit  upon 
the  very  point — ^the  origin  of  the  necessity  for  surgery,  and  he 
quite  beheved  with  Dr.  Hughes  that  in  these  early  stages  was 
the  time  when  the  physician  might  render  potent  and  valuable 
aid.  He  (Dr.  Hayward)  thought  they  must  not  look  for  the 
production  of  the  neoplasm  by  medicine.  They  must  look  for 
the  general  condition  of  the  body  which  produced  the  neo- 
plasm. As  Dr.  Hughes  remarked,  the  homoeopathic  treat- 
ment of  patients  in  general  prevented  the  growth  of  these 
neoplasms,  and  the  need  for  the  intervention  of  the  surgeon. 
He  hoped  that  Dr.  Burford's  paper  would  be  taken  into  very 
careful  consideration,  and  that  it  would  not  lead  them  all  off 
into  surgery,  and  he  warned  the  younger  men  amongst  them 
not  to  think  of  all  becoming  "  Burfords  '*  because  surgery  was 
so  successful.    (Laughter). 

Dr.  BuBFOBD  said  he  would  not  venture  upon  any  lengthened 
reply,  but  would  content  himself  with  one  or  two  remarks  in 
reference  to  what  had  fallen  from  Dr.  Hayward.  If  ther^ 
was  one  thing  more  than  another  upon  which  he  prided 
himself  in  the  construction  of  his  paper,  it  was  that  he  had 
put  the  physician  first,  and  firsts  and  first  again,  and  left  the 
surgeon  out  in  the  cold.  The  direction  of  progress  which  he 
had  indicated  was  that  if  they  were  to  improve  their  thera- 
peutic measures  their  surgical  procedure  might  be  left  to  take 
care  of  itself.    He  thought  the  tendency  of  progress  so  far  a^ 


666  KEV1EW8.  "SS*=Sr?t^ 


Reriew,  Oct.1,1891. 


one  could  forecast  was  in  the  direction  of  therapeutic  rather 
than  sui^cal  increase  in  armamentum,  and  he  put  it  as 
plainly  as  he  could  that  it  was  to  the  physician  they  must 
look  rather  than  to  the  surgeon  for  .that  uniyersal  grasp  OYer 
neoplasm  of  this  description  that  at  present  they  failed  to 
possess.  In  view  of  the  shortness  of  the  time  he  had  nothing 
more  to  say  beyond  expressing  his  cordial  thanks  for  the 
very  gratifying  manner  in  which  his  paper  had  been  receiTed. 


REVIEWS, 


Beport  on  the  Influenza  Epidemic  of  1889-90.   By  Dr.  FaksonSi 

of  the  Local  Government  Board. 

Dr.  Parsons  has  presented  us  with  an  exhaustive  report,  fall 
of  statistics  and  facts  which  are  more  or  less  valuable.  It  is 
practically  a  compilation  of  facts  obtained  from  answers  to  a 
circular  note  from  medical  officers  of  health  and  others.  The 
mass  of  information  thus  obtained  is  enormous  and  hetero- 
geneous, useful  and  useless.  The  book  will  certainly  rank  as  a 
standard  work  on  the  Influenza  Epidemic,  and  will  afford 
valuable  material  for  future  investigators. 

Certain  conclusions  are  drawn  from  the  mass  of  evidence  by 
Dr.  Parsons,  and  for  the  benefit  of  those  readers  who  have  not 
time  to  read  the  book,  we  propose  making  a  few  abstracts. 

Epidemics  of  influenza  have  occurred  in  this  country  in 
1803,  1838,  1837-8,  1847-8,  1889-90,  1891.  Dealing  with 
the  history  of  the  epidemic  of  1889-90,  Dr.  Parsons  has  given 
lis  a  very  full  and  interesting  chapter,  tracing  out  the  Epidemic 
as  it  appeared  in  various  parts  of  the  world.  The  general 
course  of  the  epidemic  in  the  Northern  Hemisphere  has  been 
from  east  to  west  (t.^'.,  in  a  direction  contrary  to  the  prevailing 
surface  winds),  and  from  north  to  south.  In  the  Southern 
Hemisphere  its  course  has  been  from  south  to  north. 

It  follows,  as  a  rule,  the  lines  of  human  intercourse,  and 
does  not  travel  faster  than  human  beings,  parcels,  or  letters 
can  travel.  It  is  independent  of  season,  climate,  and  weather. 
Its  appearance  has  been  noticed  nearly  simultaneously  in  the 
north  and  south  hemispheres.  It  has  prevailed  in  the  cold  of 
Bussia  and  the  heat  of  India ;  in  the  moist  climate  of  the 
British  Isles,  and  the  dry  air  of  Egypt.  Several  sporadic 
cases  (generally  of  a  mild  type)  occurred  before  the  general 
outburst — the  droppings  of  a  thunder-cloud  before  the  storm. 
The  progress  of  the  epidemic  over  the  globe  (starting  from 
Bussia)  has  been  more  rapid  than  in  previous  epidemics. 

The  bacteriology  of  Influenza  is  not  yet  settled,  and  the 
germ  is  still  at  large  defying  the  detective  powers  of  nations. 


ISSSSrSSTJST'  REVIEWS.  667 


Pathologists,  too,  have  failed  to  make  anything  out  in  morbid 
anatomy.  Bifting  the  mass  of  evidence  as  to  the  etiology  of 
Influenza,  the  author  finds  that  the  epidemic  has  been  propa- 
^ted  mainly,  if  not  entirely,  by  human  intercourse,  though 
not  in  every  case  necessarily  firom  a  person  obviously  suffering 
^m  the  disease.  The  contagion  once  imported  into  a  locality 
way  propagate  itself  outside  the  human  body  in  such  media 
as  dunp  ground  or  air  contaminated  with  organic  exhalations ; 
but  the  i^t  of  adjoining  communities  suffering  at  different 
•dates  seems  opposed  to  the  notion  of  the  poison  travelling  far 
through  the  air.  The  rapidity  with  which  Influenza  develops 
into  an  epidemic  may  be  accounted  for  by  its  short  period  of 
incubation,  by  the  comparatively  general  susceptibility  to  the 
disease,  and  by  the  existence  of  numerous  slight  and  unrecog- 
nised cases.  It  is  possible,  the  author  goes  on  to  say,  that 
the  specific  germ  of  the  disease  may  multiply  in  appropriate 
media,  e.g.,  in  damp  organically-polluted  confined  air,  outside 
the  human  body.  Insanitary  conditions  (except  overcrowding 
and  impure  air)  do  not  seem  to  have  had  any  influence  over  it. 

The  chapter  dealing  with  the  prophylaxis  of  Influenza  is 
«hort  and  to  the  point.  Knowing  nothing  of  the  causation  of 
the  disease  we  cannot  scientifically  and  logically  suggest 
measures  for  its  prevention.  The  *'  isolation  *'  method  may 
in  suitable  cases  be  applied,  but  if  applied  generally,  clearly 
would  be  absurd.  [As  to  the  advisability  of  notifying  this 
-disease  under  the  Act  of  1889,  we  think  as  our  knowledge  of 
it  at  present  stands,  it  would  be  useless,  except  as  a  source  of 
income  to  general  practitioners.] 

Statistics  in  regard  to  the  Influenza  epidemic  of  1889-90  as 
it  affected  the  public  services  and  public  institutions  are 
interesting.  The  percentage  attacked  has  been  high  in 
industrial  and  reformatory  schools,  and  in  training  ships  ;  but 
has  been  low  in  priscms  and  lunatic  asylums.  In  the  General 
Post  Office  the  highest  percentage  of  Influenza  cases  was  in 
the  telegraph  department.  It  is  suggested  that  this  is  due  to 
the  ozone  given  off  from  the  batteries  used  in  producing  the 
•electrical  currents  !    Postmen  suffered  seriously  too. 

Chapter  X.  is  amusing,  but  is  from  the  pen  of  another 
medical  officer  of  the  Local  Government  Board — Dr.  B.  6. 
Low.  He  has  investigated  the  epidemic  in  Lincolnshire  and 
East  Yorkshire,  and  the  suggestion  is  made  that  the  epidemic 
began  in  Lincolnshire.  The  germs  travelled  over  from  some- 
where and  landed  at  Boston  or  Grimsby.  Finding  the  soil  of 
Lincolnshire  to  their  liking  (being  an  old  malaria  soil)  the 
germs  prospered  and  multipUed,  and  wandered  or  were 
carried  into  other  parts  of  Lincolnshire  and  elsewhere.    We 


«68 .  BEYiEws.  ^"ar?gS!?ggr 

may  notice  that  the  second  outburst  of  the  epidemic  in  1891^ 
began  in  Hull. 

As  to  the  horse-influenza,  if  statistics  go  for  anything,  it  is 
difficult  to  resist  the  idea  that  human  Influenza  is  derived 
from  equine  Influenza,  either  directly  or  indirectly.  They  haye 
much  in  common ;  and  where  the  one  is,  there  you  will  find 
the  other  is,  has  been,  or  will  be. 

While  the  Beport  was  passing  through  the  press,  a  second 
outbreak  of  the  Influenza  presented  itsdf,  and  Dr.  Parsons 
has  added  a  few  remarks  upon  it.  Its  mode  of  travelling  is 
the  same,  viz.,  by  human  intercourse.  It  is  almost  certain 
that  one  attack  of  Influenza  does  not  protect  against  another. 
Persons  attacked  with  Influenza  in  1889-90  epidemic  have 
suffered  again  in  1891.  The  type  of  the  latter  epidemic  is 
severer.  We  congratulate  Dr.  Parsons  on  the  result  of  his 
arduous  task,  and  we  will  congratulate  him  even  more  on  his 
second  edition  if  he  will  only  add  an  index. 


The  British,  Continental,  aiid  Colonial  Homoeopatldc  Medical 
Directory  for  1891 .  London :  Keene  &  Ashwell,  and  Homoeo- 
pathic  Publishing  Company. 

Another  edition  of  Eeene  &  Ashwell's  useful  little  directory 
has  at  length  been  presented  to  the  profession  and  the  public. 
We  say  ''  at  length,'*  for  returned  letters  and  reminders  from 
correspondents  that  they  had  changed  their  address  ''  some 
time  ago  "  had  led  us  to  realise  that  the  information  contained 
in  the  previous  edition  was  rapidly  becoming  unreliable,  and 
revision  was  much  needed.  That  we  have  had  so  long  to 
wait  is  probably  as  much  the  fault  of  the  homoeopathic  pro- 
fession, for  whose  convenience  the  directory  is  issued,  as  of  the 
publishers,  who  have  very  properly  awaited  the  support  which 
their  enterprise  certainly  well  merited. 

The  errors  and  omissions  pointed  out  in  our  pages  in  1889 
have,  we  believe,  been  corrected.  Some  of  the  information, 
however,  is  out  of  date,  and  it  would  have  been  wiser  to  send 
out  a  fresh  circular  for  confirmation  or  correction,  more  than 
twelve  months,  we  believe,  having  elapsed  since  the  issne  of 
the  last. 

However,  we  welcome  the  appearance  (A  the  Directory  and 
hope  it  will  be  regularly  published  in  future.  We  regret  still 
to  note  the  absence  of  some  names  which  ought  to  be  there. 
If  these  gentlemen  would  reflect  how  much  positive  incon- 
venience they  sometimes  cause  to  their  colleagues  and  their 
patients  by  thus  withholding  needed  information,  they  would 
forego  their  sentimental  objections  to  appearing  in  '*The 
Homoeopathic  Directory." 


S^fgnuSf  •  .   PKBI8C0PE. 660' 

Gedichte  ron  Qottfned  Raid,  Leipzig.  A.  Molleb,  1891. 
In  this  volume  of  German  verse,  by  Gottfried  Bahl,  the^ 
kindliest  critic,  we  fear,  coiild  find  but  little  to  praise.  Its 
contents  are  with  few  exceptions  love-poems  of  the  most 
common-place  description,  trivial  alike  in  thought  and 
expression,  and,  though  intended  to  be  expressive  of  vei^ 
fervid  emotion,  they  oidy  succeed  in  conveying  the  idea  that 
the  writer's  experiences  of  the  passion  which  has  moved  great 
minds  to  such  mighty  utterances  are  those  of  the  ordinary 
young  man.  There  are  no  traces  of  any  love  of  nature,  and 
even  in  the  later  poems  but  few  indications  of  the  high 
thought  and  feeling  which  lie  at  the  root  of  all  true  poetry. 
Herr  Bahl,  however,  by  no  means  lacks  confidence  in  his  own 
genius  and  in  the  verses  entitled  ''  Sendung,"  after  bidding  a 
condescending  farewell  to  '*  Emma/*  on  the  ground  that  she 
cannot  follow  him  in  his  flight  sunwards,  holds  out  the  con- 
solation that  he  has  made  her  immortal !  We  fear  that  tliis 
hope  and  the  wish  expressed  in  the  introductory  verses  that 
his  song  may  meet  with  "  Ruhm  und  Macht,*'  and  *'  Lieb  und 
Dank/'  are  alike  doomed  to  disappointment,  and  that  the 
writer  will  learn  that  the  title  of  poet  is  more  easily  claimed 
than  earned. 

PERISCOPE. 

Absenic. — A  lecture  {Drit.  Med,  Joum.)  by  Mr.  Jonathan 
Hutchinson,  recently  delivered  on  the  use  of  this  drug  in  some 
forms  of  skin  disease,  is  interesting  from  several  points  of 
view.  Belying  entirely  upon  the  clinical  method  for  ascer- 
taining the  conditions  in  which  arsenic  is  remedial,  Mr.  Hutchin* 
son's  experience  shows  how  unsatisfactory  a  method  it  is. 
Recent  observations  of  its  employment  have,  he  says, 
"strengthened  our  jEaith  in  certain  directions,  they  have 
limited  it  in  others,  and  they  have  impressed  upon  us  the 
great  need  of  caution."  Had  those  who  have  thus  indiscrimi- 
nately prescribed  arsenic  in  skin  disease  restricted  their  use  of 
it  to  oases  and  conditions  similar  to  such  as  the  drug  will 
excite  in  healthy  persons,  and  used  it  in  such  in  no  larger  a 
dose  than  was  necessary  to  secure  its  therapeutic  effect,  a  more 
useful,  because  more  decided,  definition  of  its  sphere  of  action 
would  have  been  deducible  from  their  observations,  and  to  lay 
stress  upon  the  ''great  need  of  caution"  would  have  been, 
unnecessary. 

Given  as  arsenic  commonly  is  in  skin  disease,  the  want  of 
cantion  in  dosage  ordinarily  displayed  furnishes  us  with  addi- 
tional knowledge,  or  confirms  that  we  already  have  regarding 
its  pathogenetic  properties.  Mr.  Hutchinson's  lecture  haa 
some  interesting  information  of  this  kind. 


670  PERISCOPE.         "^S^^JSSJI^ 


B«Tie«,  Oct.  1,  len. 


In  connection  with  a  liberal  administration  of  it,  Mr.  Hatchin- 
8on  has  ''  had  repeated  opportunities  of  observing  its  effects 
upon  the  palms  and  soles.  It  makes  them  bum,  itch,  and 
perspire.  In  the  instance  of  the  soles,  the  profuse  perspiration 
has  on  several  occasions  caused  the  epidermis  to  become 
todden  and  to  peel." 

In  referring  to  the  question  Is  arsenic  a  tonic  ?  Mr.  Hutchin- 
son suggests  that  it  probably  becomes  one  through  remoTing 
a  troublesome  and  irritating  diseasCi  and  he  adds,  "  of  this, 
however,  I  think  we  may  feel  quite  sure,  that  if  anenk  ia  to 
act  as  a  tonic,  everything  depends  on  the  smallness  of  the 
dose.  It  has  been  my  almost  invariable  experience  in  patients 
in  whom  we  had  pushed  it  for  the  cure  of  any  special  disease, 
that  they  were  very  willing  to  leave  it  off,  having  usually  felt 
languid  and  out  of  health  during  its  continuance." 

Mr.  Hutchinson  has  '*  formed  an  unfavourable  opinion  as 
to  the  influence  of  arsenic  upon  elderly  people.  •  .  .  More 
especially  is  caution,  I  think,  necessary  if  any  symptoms  of 
nerve  degeneration  are  present."  As  a  matter  of  every  day 
experience,  the  homoeopathic  physician  can  assure  Mr.  Hutchin- 
son that  there  are  few  medicines  more  useful  in  the  diseases 
accompanying  old  age  than  arsenic — but  here,  again,  every- 
thing depends  upon  the  dose.  A  homceopathically  indicated 
remedy  cannot,  either  safely  or  advantageously,  be  used  in  a 
dose  suitable  enough  for  one  that  is  Antipathic. 

"  Among  the  facts  which  have  been  thoroughly  established 
as  regards  the  possible  effects  of  arsenic,  we  may,  I  think,  now 
claim  that  it  is  an  undoubted  cause  of  peripheral  neuritis. 
•  .  .  .  During  its  medicinal  use  patients  not  infrequently 
complain  of  local  numbness,  more  especially  of  portions  of  the 
skin  of  the  lower  extremities,  numbness  and  tingling  of  the 
soles  of  the  feet  are  by  no  means  infrequent  symptoms." 

Herpes  zoster,  Mr.  Hutchinson  is  quite  convinced,  is  pro- 
4luced  by  arsenic,  *'  after  the  drug  has  been  used  for  some  time." 
"  If  arsenic  be  given  in  full  doses  for  long  periods,  although 
it  may  be  doubted  whether  there  is  any  reason  for  styling  it  a 
cumulative  drug,  yet  I  am  sure  that  its  employment  is  not 
without  danger.    There  are  certain  symptoms  which  ought  to 
lead  us  to  take  alarm.    If  the  patient  has  numbness  and 
tingling  in  the  palms  and  soles,  or  if  there  is  numbness  in  any 
particular  part  of  the  skin,  or  if  there  is  decided  loss  of  flesh, 
then  it  ought  to  be  suspended.    Irritation  of  the  conjunctiva 
is  of  course  a  well  known  symptom  of  disagreement,    t    •    • 
liability  to  diarrhoea,   and  in  a  certain  number  of  cases, 
extreme  irritabihty  of  the  bladder."     Such  symptoms  as  these 
occurring  in  the  course  of  a  disease  do,  caieris  paribus,  indicate 
arsenic,  while  their  arising  as  the  result  of  arsenical  over- 
dosing renders  the  suspension  of  the  medicine  essential. 


^t^'SmS^'  PEMSCOPE.  671 


Beview,  Oct.  1, 1801. 


As  a  result  of  over-dosing,  Mr.  Hutchinson  has  seen  arsenic 
appear  to  cause  or  to  increase  the  liability  to  epileptic  attacks, 
and  one  or  two  others  in  which  a  form  of  partial  paraplegia 
seemed  to  be  definitely  connected  with  its  use* 

In  writing  of  its  influence  on  persons  free  from  skin  disease, 
Mr.  Hutchinson  toys  :  ''Its  effects  upon  the  nutrition  of  the 
skin  in  such  cases  (supposing  the  doses  to  be  large)  are 
usually,  I  think,  that  the  skin  becomes  brown  and  muddy- 
looking  ;  it  is  also  dry  and  harsh  on  the  trunk  and  limbs 
generally,  although  there  may  be  perspiration  in  the  palms 
and  soles.  The  discolouration  may  be  attended  wich  actual 
pigmentation  and  may  increase  until  it  almost  resembles  the 
tint  of  Addison's  disease.  In  extreme  cases  not  only  is  there 
dryness  and  discolouration  but  scaly  patches  may  form  on 
the  knuckles,  elbows  and  knees  much  resembling  common 
psoriasis,  but  less  well  circumscribed.  A  much  commoner 
result  than  this  is,  however,  disturbance  of  the  nutrition  of 
the  skin,  not  over  the  body  generally,  but  over  the  palms  and 
soles  only.  On  these  parts,  in  addition  to  dryness,  corns  may 
form,  and  in  certain  very  rare  cases  these  corns  pass  on  into 
epithelial  cancer.  *' 

"  Certainly,"  says  Mr.  Hutchinson,  **  one  of  the  most 
remarkable  facts  as  regards  the  influence  of  arsenic  is  that  it 
appears  to  prevent  certain  affections  which  are  very  similar  in 
nature  to  those  which  it  causes."  This  observation  he 
illustrates  by  a  reference  to  its  control  are  *'  cases  in  which 
herpes  occurs  on  the  skin,  and  is  grouped  exactly  like  zoster, 
although  usually  more  limited  in  extent.'*  True  doubtless, 
but  hardly  "remarkable."  It  might  have  appeared  so  a 
hundred  years  ago,  but  during  that  time  the  same  fact  has 
been  observed  regarding  not  only  arsenic  but  many  another 
drug.  So  far  from  being  remarkable  it  is  but  an  additional 
proof  to  the  overwhelming  number  of  well  substantiated  proofs 
that  homoeopathy  is  true. 

Venesection. — During  the  last  nine  months  essays,  lectures, 
and  letters  have  appeared  in  the  medical  journals  which  have 
given  rise  to  the  suspicion  that  a  reaction  was  taking  place  in 
the  estimate  which  had  been  formed  of  the  worthlessness  of 
venesection  as  a  remedy,  and  the  injury  done  by  it  to  the 
patient.  An  examination  of  these  contributions  to  medical 
hterature,  however,  shows  that  there  is  no  tendency  to  re- 
instate blood-letting  as  the  ''  right  arm  "  of  medicine,  no  one 
now  suggests  it  as  an  antipyretic,  no  one  would  think  of  prac- 
tising it  in  every  acute  inflammation.  Still  less  do  the  quanti- 
ties of  blood  advised  to  be  drawn,  where  it  does  appear  to  be 
indicated  by  the  writers  referred  to,  approach  those  used 
during  the  first  half  of  this  century.  In  which  cases,  or  rather 


673 .PEMSCOPE.  "^[^fgrgiS^ 

under  what  circumstances,  then,  do  Dr.  Pye-8mith,  Dr.  Ogle, 
and  Dr.  Wilks,  of  Guys,  regard  that  old-fashioned  implement 
of  ''  healing  by  torture,"  the  lancet,  as  still  capable  of  being 
used  effectively  in  the  effort  to  preserve  or  prolong  life  ?  The 
indications  for  blood-letting,  Dr.  Pye-Smith  said,  "  were 
probably  the  recognition  of  the  anatomical  and  physiological 
condition  of  the  organs  at  the  time  venesection  was  proposed 
rather  than  the  consideration  of  the  pathology  of  the  dis^ise." 
In  other  words  this  revival  of  venesection  is  limited  to  the 
reUef  of  a  mechanical  impediment  to  the  freedom  of  the  circa- 
lation,  this  impediment  being,  as  Dr.  Ogle  states,  '^  a  con- 
gested or  overloaded  right  side  of  the  heart.''  This  dictum  is 
enforced  and  illustrated  by  Dr.  Wilks,  who  states  that  he  has 
employed  this  measure  thirty  times  during  his  professional 
career — which  must  now  be  approaching  fifty  years  of  hos- 
pital and  private  practice — strong  evidence  that  it  is  only  very 
exceptionally  that  a  physician  meets  with  a  case  demanding  it. 

In  the  same  number  of  the  lancet  as  that  in  which  Dr. 
Wilks'  paper  appears,  Mr.  Grey,  of  Putney,  gives  a  very  good 
illustration  of  the  kind  of  case  in  which  blood-letting  appears 
to  give  relief,  and  in  it  this  relief  was  obtained  by  only  two 
ounces  of  blood  flowing,  The  late  Dr.  Rutherfurd  Russell,  in 
a  paper  on  Some  Organic  Diseases  of  ths  HeaH,  published  in 
the  British  Journal  of  Homceopaihy^  vol.  xii.,  refers  to  cases 
evidently  dependent  on  the  0ame  cause — ^viz.,  an  over-distended 
state  of  the  right  heart.  ''Suppose,"  he  writes,  ''we  are 
called  in  to  a  man  45  years  of  age,  of  robust  muscular  frame, 
and  find  him  insensible  and  the  pulse  thumping  away  like  a 
sledge  hammer ;  suppose  on  applying  the  ear  to  the  chest  we 
detect  hypertrophy  of  the  heart  and  are  thus  convinced  that 
there  is  instant  danger  of  the  rupture  of  a  blood  vessel  from 
the  enormous  impetus  and  quantity  of  blood  that  is  driven 
into  the  vessels  of  the  brain,  in  such  a  case  shall  we  open  a 
channel  for  the  escape  of  the  destructive  stream  that  threatens 
every  moment  to  break  down  the  dykes  of  life  ?  Tliis  seems 
to  me  rather  a  question  of  hydraulics  than  of  pathology.  The 
relief  to  be  derived  from  blood-letting  can  scarcely  be  doubtful, 
and  the  only  counter  question  we  can  put  is,  have  we  in  our 
pharmacopoeia  remedies  as  cert^dn  and  as  speedy  as  blood- 
letting, and  will  blood-letting  prevent  their  use  ?  From  my 
own  experience  I  am  unable  to  answer  this  question." 

The  present  suggested  use  of  blood-letting  is,  then,  as 
Dr.  Butherfurd  Russell  wrote  forty  years  ago,  "  a  question  of 
hydraulics." 

Abnica  in  the  Alps. — The  arnica  flower  abounds  throughout 
the  whole  Monte  Rosa  group,  and  its  virtues  in  sprains,  bruises, 
and  such-like  accidents  common  in  Alpine  regions  have  long  been 


g^f<S°rS5f"  PRBISCOPE. &m 

familiar  to  the  monntain  population.  The  practice  among  them 
has  been  to  gather  the  yellow  daisies  at  midsummer,  dry  them 
in  the  shade,  and  pat  them  in  a  bottle  just  big  enough  to  hold 
them,  with  the  addition  of  spirit  more  or  less  rectified.  Closely 
corked,  the  bottle  is  thus  left  for  a  year,  after  which  the  liquid 
contents,  duly  strained,  are  fit  for  use. — Chemist  arul  DrugffUt. 

■  ■  —  ■*-  .  I  ,  . 

LARYNGOLOGY,  Etc. 

Lachesis. — Pathologiral  Indications. — Coryza  and  ozcena. 

Clinical. — When  the  sneezing  is  excessive  and  the  nasal 
catarrh  begins  with  sore  throat  (left  side)  or  there  is  obstruc- 
tion of  the  posterior  nares,  and  discharge  of  bloody  matter, 
sometimes  with  soreness  of  the  nostrils  and  lips.  During  the 
climacteric  period,  with  flushes  of  heat. 

MERcuBms. — Patlwloffical  Indications, — Coryza,  acute  and 
chronic.  Syphilitic  ozoena.  Hypertrophy  or  thickening  of 
the  Schneiderian  membrane.  Perforation  of  the  septum. 
Periostitis  of  the  nasal  bones. 

Clinical.  —Profuse  fluent  coryza  of  watery  corrosive  mucus, 
^uerally  worse  at  night.  If  the  catarrh  is  of  some  duration, 
it  is  better  indicated  when  discharge  is  greenish,  gluish, 
corrosive,  and  offensive,  and  foetid.  Generally,  the  nose  is 
red  and  swollen.  Nitric  add  will  complete  the  cure  if  there 
is  a  syphilitic  taint  in  the  system.  Ozoena,  with  soreness  in 
the  bones. 

Characterisdcs. — Lidination  to  perspire  in  bed,  and  no 
relief.  Coryza  worse  at  night.  Feels  bad  in  a  warm  room, 
bat  cannot  bear  the  cold  either.  The  mercurius  iod.  ruber  acts 
better  if  the  patient  is  syphilitic  or  scrofulous,  or  if  there  are 
polypoid  growths  in  the  nasal  cavities. 

Nafhthalin. — CUnicaL — It  has  been  found  a  valuable 
remedy  for  hay  fever,  many  inveterate  cases  seeming  to  have 
been  entirely  arrested ;  sneezing,  eyes  inflamed  and  painful, 
bead  hot ;  also  spasmodic  bronchitis  and  asthma ;  better  in 
the  open  air ;  soreness  in  chest  and  stomach  ;  has  to  loosen 
the  clothing.  (Dr.  J.  A.  Terry,  in  Jour,  of  OphthaL,  OtoL  and 
LaryngoL — Hahnetn.  Montfdy).  C.  W.  Haywabd. 

H^acoBRBAOE  Consecutive  to  Tracheotomy. — Dr.  Ad.  Maas 
{Deutsch,  Zeitschr.f.  Chirurg.,  8-4,  1890).  Report  of  a  case  in 
a  child  four  years  of  age.  .  Nineteen  days  after  this  operation 
Axrious  hsemorrhage  took  place,  with  fatal  result.  At  the 
autopsy  the  superior  wall  of  the  innominate  trank  was  found 
ulcerated  through.  Six  other  cases  are  mentioned  which 
were  fatal  through  ulceration  of  one  of  the  great  arterial  or 
venous  trunks  in  the  neck  by  extension  of  the  diphtheritic 
process,  or  consecutive  to  the  pressure  of  thecanula.     In  11 


674  PEKiscoPE.         "l^fSSrTm 

others  the  blood  poured  in  streams  £rom  the  tracheal  woond, 
coming  in  reality  from  the  lungs,  where,  however,  no  vascular 
lesion  could  be  found.  In  these  cases  the  htemorrhage  is  as 
furious  as  in  the  first  set,  but  it  is  not  always  fatal,  ceasing, 
as  a  rule,  gradually,  and  the  flow  often  being  intermittent. 
Broncho-pneumonic  patches  are  often  found,  but  in  some 
instances  no  lesion  can  be  demonstrated. 

Bblatiom  of  Nasal  and  Pbabtnoeal  Diseases  to 
Stuttering. — In  the  greater  number  of  151  stuttering  patients 
the  author  has  found  adenoid  vegetations  and  other  naso- 
pharyngeal disesaes.  He  believes  tiiat  the  stuttering  will  be 
cured  by  the  treatment  of  these  diseases.  (Eafemann, 
Daimsi,  1891.) 

ScBAPiNO  THE  Maxillabt  Sinus. — ^Eyssautier  (Daupkim 
Med.,  August,  1890).  A  lady,  87  years  of  age,  suffered  for 
18  months  from  a  discharge  from  a  sinus  at  the  level  of  the 
first  molar.  The  tooth  was  extracted,  and  foetid  pus  came 
away.  For  a  year  after  the  fistula'  discharged  purulent 
matter.  The  opening  was  then  enlarged,  the  second  molar 
extracted,  and  the  antum  washed  out  with  antiseptic  lotion ; 
the  mucous  membrane  was  also  scraped  with  a  small  curette 
and  the  surrounding  granulations  removed.  After  a  thorough 
painting  of  the  cavity  with  tincture  of  iodine  the  opening  was 
closed  with  a  tampon.  Four  days  afterwards  this  was 
removed,  and  recovery  took  place,  which  has  been  permanent. 

Case  of  Asthma,  with  Polypi  and  Htpsrtbopht  of  the 
Tubbinated  Bodies — Opebation — Cube.  (Cholmeley  and 
Spencer  Watson.  Lancet,  February  21st,  1891).  Patient 
Buffered  from  asthma  for  18  years,  and  had  received  no  benefit 
from  treatment.  The  nostiils  were  obstructed,  but  not  com- 
pletely. Mucous  crusts  covered  the  turbinates.  Free  appli- 
cation of  20  per  cent,  cocaine  relieved  for  the  time.  Clearance 
was  effected  by  means  of  the  snare  and  (under  cMorofom) 
the  ring-knife.  The  great  success  of  the  case  is  attribntea 
by  Watson  to  the  sudden  blow  to  the  morbid  habit  following 
the  very  thorough  clearance  effected  by  the  ring  knife,  as 
compared  with  the  successive  snaring  operations. 

D.  Wbiobt. 


SURGERY. 

EocH*s  Lymph  in  Subgicajl  Cases. — (Wilcox,  iWtA  Amn* 
Joum*  Hmmoju,  June,  1891).  Dr.  Wilcox  gives  the  follow- 
ing summary  of  thirteen  cases,  which  are  probably  a  &ir 
average  of  the  class  as  found  in  charity  hospitals  ;  eight  cases 
improved  and  five  did  not  improve.     The  improvement  was 


IS^JoSTS^"  NOTABILIA, 675 

frequently  the  most  marked  in  those  cases  which  received 
small  doses  and  had  light  reactions.  Small  doses  were  the 
rule  and  were  given  at  considerable  intervals.  It  was  im- 
possible to  say  why  one  case  improved  and  another  did  not. 
To  all  appearances  it  would  seem  that  Case  ii.  (lumbar  abscess 
from  spinal  caries,  discharging  sinuses  in  thigh  after  resection 
of  hip-joLut)  and  Case  ix.  (spontaneously  cured  spinal  caries^ 
recovered  resection  of  right  hip-joint,  commencing  disease  in 
leffc)  were  the  ones  especially  calling  for  the  treatment,  and 
vet  they  were  worse,  or  not  better,  at  the  end  than  at  the 
beginning.  On  the. other  hand.  Case  xiii.  (sinus  following 
dialing  of  femur  for  traumatic  ostitis)  in  which  the  disease 
dated  from  an  injury,  and  with  no  signs  of  tubercular  trouble 
elsewhere,  gave  one  of  the  best  results  obtained.  The  reactions 
varied  in  degree.  There  was  usually  a  fever,  accompanied 
with  flushed  face,  and  a  dull,  stupid  condition,  and  also  a 
general  feeling  of  illness  with  aching  in  the  muscles.  The 
urine  was  generally  diminished,  while  the  condition  of  the 
bowels  varied,  sometimes  being  constipated  and  sometimes 
loose.  Occasionally  the  reaction  did  not  come  on  until  the ' 
second  day.  The  injections  were  given  in  the  back  between 
the  shoulder  blades.  These  places  were  usually  very  sore  for 
a  few  days  afterwards,  but  never  suppurated. 

In  conclusion,  he  gives  it  as  his  opinion,  that  in  this 
substance  known  as  tuberculin,  or  more  commonly  as  Koch's 
lymph,  we  have  a  very  useful  remedy  for  a  certain  class  of 
Ibises.  It  is  difficult  yet  to  draw  the  line  and  state  definitely 
where  and  how  it  will  best  act. 

He  believes  that  the  violent  reaction  of  opinion  among  our 
old-school  brethren  is  due  to  their  sledge-hammer  method  of 
using  an  unproved  agent.  Proceeding  on  the  opinion  that  if 
a  little  was  good  a  great  deal  was  better,  they  did  violence 
to  nature  instead  of  helping  her.  Time  and  experience  will 
settle  the  question.  The  remedy  is  a  powerful  one,  and  one 
to  be  used  with  caution. 

NOTABILIA. 


HOMOEOPATHY  AND  THE  BELGIAN  SENATE. 

Otm  contemporary,  the  Revue  Horn.  Behje  (June),  gives  a 
reprint  from  the  Parliamentary  annals  of  an  important  dis- 
cussion respecting  the  teaching  of  homceopathy  in  the  Belgian 
Universities.  This  is  the  third  time  the  subject  has  been 
before  the  Senate. 

Taking  advantage  of  a  proposal  to  make  some  alterations 
and  fill  up  some  omissions  in  the  University  Examinations 


«76  NOTABIIIA.  ^'^l^?Sr^ 


Beview,  Od,  1,  IBBl. 


progtamme,  Senator  Terlinden  indicated  what  he  believed  to 
be  a  want  in  the  medical  curricnlmn — a  want  which  had 
existed  for  a  quarter  of  a  century.  In  so  long  a  time  opinioBB 
change  and  progress  is  made.  Monsieur  Terlinden  thought 
-iihat  a  great  step  forward  had  been  made  in  the  discoveiy  by 
Professor  Koch.  Unable  himself  to  decide  between  Eoch*8 
admirers  and  detractors,  he  nevertheless  observed  how  that 
•effects  upon  the  organism,  both  immediate  and  undeniable, 
tresulted  from  the  injection  of  so  minute  a  quantity  of  Koch's 
iluid  as  one  milligramme.  Indeed  it  was  hkely  that  still  further 
dilution  of  the  fluid  might  be  necessary.  The  effects  of 
thermal  waters,  of  sea  air,  of  vaccination,  and  of  post-mortem 
wounds  also  made  it  impossible  to  deny  the  power  of  infini- 
i^esimal  quantities.  He  thought  one  result  of  Dr.  Koch's 
discovery  should  be  the  recognition  of  homceopathic  medica- 
tion.   The  two  schools  should  walk  abreast. 

HomcBopathy  does  not  date  from  yesterday,  and  is  not  kept 
A  secret.  Hahnemann  said  that  **  when  the  saving  of  the 
lives  of  our  fellow  men  is  in  question,  to  be  ignorant  is  a 
««rime." 

For  more  than  a  century  **  animal  magnetism  "  was  treated 
with  contempt,  as  homceopathy  now  is  in  official  spheres — ^now 
it  is  recognised  by  the  Academy.  Qualified  medical  men  only, 
however,  are  allowed  to  use  it,  for  if  it  is  a  powerful  aid,  it  is 
also  a  terrible  weapon.  Shall  medical  students,  he  asks,  be 
left  to  instruct  themselves  in'  hypnotism  ?  The  answer  must 
Ibe  "  no,"  and  the  same  must  be  said  of  homoeopathy,  which, 
indeed,  some  who  do  not  believe  in  the  system  imf^ne  owes 
jdts  results  to  *'  suggestion."  M.  Terlinden  admitted  there  were 
probably  many  arguments  in  favour  of  homoeopathy  better 
than  those  he  advanced,  but  being  of  a  more  or  less  technical 
nature  he  left  them  to  others  for  discussion.  Another  popular 
reason  in  favour  of  the  public  teaching  of  homoBopathy  and  of 
its  practice  in  the  State  hospitals  was  the  claim  of  the  poor, 
who,  having  experienced  the  benefit  of  homoeopathic  dispen- 
sary treatment,  were  unwilling  to  give  themselves  over  to  the 
iOld  methods. 

After  referring  to  the  statistics  of  homoeopathy  in  the 
United  States,  he  appealed  to  the  Government  to  establish  a 
•chair  of  Honckoeopathy  in  the  State  Universities  and  in  the 
Veterinary  College,  and  to  set  apart  hospital  wards  for  those 
who  desire  or  are  willing  to  be  treated  by  that  method. 
Science,  he  maintained,  should  be  untrammelled,  and  said 
that  it  was  the  essence  of  the  higher  learning  that  all  opinions 
should  be  defended  and  discussed  in  the  various  Faculties. 

M.  Terlinden  adopted  the  suggestion  of  Dr.  Martigny  (La 
question  ham,  en  Bd^jique^  Brux.,  1879),  namely,  that  there* 


S^S^TS^  NOTABILIA, 677 

shoold  be  appended  to  the  subjects  taught  for  the  finalexami- 

nation  that  of  homoeopathic  therapeutics,  that  this  should  be 

an  optional  course,  and  that  the  diploma  should  state  whether 

'or  not  the  recipient  was  examined  on  this  subject.     This 

would  give  to  ''homoeopathic"  patients  a  guarantee  respecting 

iiheir  medical  man.    It  was  granted  that  the  Government  had 

the  power  to  establish  such  optional  courses,  and  to  recognise 

them  in  a  supplementary  clause  in  the  diploma,  and  M.  Ter- 

linden  hoped  that  by  next  year  the  Chamber  would  see  fit  to 

K^mply  with  the  recommendation  he  made. 

M.  SouPABT,  without  discussing  the'  question,  wished  to 

bring  out  one  point,  viz.,  that  it  would  be  advantageous  to 

leave  to  the  universities  more  autonomy  in  the  organisation 

'Of  their  courses  of  instruction,  the  law  only  regulating  the 

length  of  studies,  subjects  of  examinations,  &c. 

M.  le  baron  Submont  de  Volbbebghe  and  M.  de  Bublet, 
•'*  Minister  of  the  Interior  and  of  Public  Instruction,*'  both 
spoke  more  or  less  favourably  of  the  proposal  of  M.  Terlinden, 
M.  de  Burlet  remarking  that  he   understood   that  no  sub- 
stantive motion  had  been  made,  but  that  the  Government 
^were  requested  to  study  and  examine  the  subject  for  future 
'discussion.    He  stated  that  the  founding  of  optional  courses 
iRras  a  financial  question.     The  setting  apart  of  hospital  beds 
'Could  not  well  be  accomplished  by  law.     If  homoeopathy 
-spread  and  commended  itself  by  its  success,  he  thought  that 
recourse  tp  its  aid  would  be  had  by  the  authorities  without 
legislative  compulsion. 

Our  contemporary  adds  that  the  Municipal  Council  of 
Antwerp  has  taken  the  initiative  by  the  establishing  a  homoeo- 
•pathic  dispensary.  We  join  in  its  expressed  hope  that  next 
year  a  discussion  of  the  subject  may  be  followed  by  some 
arrangement  for  the  teaching  of  homoeopathy,  which  is  said  to 
"be  daily  gaining  ground  in  Belgium,  to  those  medical  students 
T?ho  may  desire  it.  This  would  probably  be  followed  sooner 
•or  later  by  the  establishment  of  hospital  accommodation.  We 
^wish  our  Belgian  colleagues  every  success. 

HOMCEOPATHY  IN  ANTWERP. 

In  the  Bevus  HoniceopatJaqvs  Beiges  Dr.  Lembreght  Jlls  makes 
ihe  important  announcement  that  the  Town  Council  of  Ant- 
werp, with  the  exception  of  one  vote,  unanimously  decreed,  at 
its  meeting  on  the  25th  of  June,  the  institution  of  a  public 
homoeopathic  dispensary.  This,  as  Dr.  Lembreght  points  out, 
was  a  measure  of  simple  justice  to  the  .poor ;  because,  while 
the  well-to-do  portion  of  the  citizens  of  Antwerp  were  able  to 
*choose  for  themselves  which  system  of  treatment  they  would 

VoL  35,  No.  10.  3  b 


678  NOTABILIA.  "^^SSlL^S-!^ 


B«view.Oet.  l.]»L 


adopt  in  illness,  the  poor  alone  had  no  choice,  but  were,  in 
seeking  gratuitous  medical  aid,  compelled  to  submit  to  allo- 
pathic treatment.  "  Thanks,"  writes  Dr.  Lembr^ht,  "  to  Qie 
energetic  initiative  of  the  Bureau  de  Bienfaisanre  and  of  the 
Administration  Cmnmunale  of  Antwerp,  the  first  public  bodies 
in  Belgium  who  have  had  the  courage  to  break  through  routine 
and  old  prejudices,  this  abnormal  position  is  to  disappear,  at 
least  to  some  extent,  and,  in  future,  the  necessitous  poor  will 
be  able  to  choose  which  method  of  treatment  they  prefer. 

*'  The  formation  of  an  official  homoeopathic  dispensary  is 
a  fact  of  first  rate  importance.  It  is  the  first  step  towards 
the  introduction  of  homoeopathy  into  the  hospitals  of 
Antwerp ;  for  if  the  poor  who  frequent  the  dispensary  have 
the  right  to  adopt  that  therapeutic  system  in  which  they  have 
the  greater  confidence,  why  should  not  the  sick  lying  in  the 
hospitals  enjoy  the  same  privilege?  Is  it  right  that  a 
patient,  treated  at  the  dispensary  by  the  homoeopathic  method, 
should  be  compelled  to  change  the  treatment  because  there 
happen  to  be  circumstances  obliging  him  to  seek  the  shelter 
of  the  hospital  ? 

"  After  years  of  struggling  we  now  see  the  removal  of  the 
insurmountable  barrier  which  has  hitherto  relentlessly  shut 
the  doors  of  every  public  hospital  against  the  homoeopathic 
physician." 

Dr.  Lembreght  concludes  by  rendering  especial  acknowledg- 
ments to  Dr.  Gits  and  Mr.  Alderman  Gits  for  their  exertions 
in  promoting  the  formation  of  this  new  dispensary,  and  for 
their  defence  of  homoeopathy  before  the  Council. 

We  heartily  congratulate  our  colleagues  on  the  important 
public  tribute  to  the  value  of  homoeopathy  that  they  haye 
obtained  from  the  Town  Council  of  their  city.  The  institution 
of  an  official  dispensary  ought  to  prove  of  material  assistance 
to  those  who,  in  the  Belgian  Senate,  are  endeavouring  to 
secure  provision  for  homoeopathy  being  taught  in  the  State 
Universities  ;  for,  if  municip^  officials  are  to  be  appointed  to 
treat  disease  homoeopathically,  the  State  ought  to  take  steps 
to  ensure  such  officials  being  properly  taught  how  to  do  so. 

NOTES  FROM  AMERICA. 

A  NEW  Medical  College — the  Southern  Homoeopathic  Medical 
College  and  Hospital— commences  its  first  session  on  the  5th 
inst.  in  the  City  of  Baltimore.  For  the  purposes  of  the  insti- 
tution the  Board  of  Directors  have  purchased  Calvert  Hall  at 
a  cost  of  £3,600.  £lxtensive  improvements  and  alterations 
have  been  made  in  it  in  order  to  adapt  it  to  the  teaching  of 
medicine,  surgery,  and  dentistry.    The  ground  floor  is  fitted 


S£5Sy<ST!SS^  KOTABILIA.  67» 

op  for  dispensary  purposes,  and  with  paihologioal  and  ehemi- 
eal  laboratories.  The  second  floor  provides  two  lecture 
theatres,  capable  of  seating  200  students,  together  with  two 
smaller  rooms  to  be  used  for  teaching  histology  and  dentistry. 
Here  also  is  a  large  room  formerly  used  as  a  chapel,  which 
will  be  devoted  to  a  library  and  meeting  room  for  the  Maryland 
State  HomcBopathic  Medical  Society.  Dissecting  rooms  will 
be  on  the  third  floor,  together  with  a  large  room  for  surgical 
and  dental  operations,  and  a  laboratory  for  the  dental  depart- 
ment. This  arrangement  is  to  be  regretted,  as  with  the 
present  knowledge  of  the  diffusion  of  septic  influences,  sur- 
gical operations  ot  no  kind  whatever  ought  to  be  allowed  to  be 
performed  in  such  close  contiguity  to  a  dissecting  room. 

Fifty  students  are  already  enrolled  on  the  college  register. 
The  college  was  incorporated  under  the  laws  of  the  State  of 
Maryland  in  May,  181K). 

We  wish  the  new  college  all  possible  prosperity,  and  are 
glad  to  learn  that  it  has  the  hearty  support  of  those  of  the 
citizens  of  Baltimore  who  have  done  so  much  to  make  the 
capital  of  their  State  a  great  educational  centre. 

This  demonstration  of  the  way  in  which  homoBopathy  is 
appreciated  in  the  Southern  States  has  not  been  secured  with- 
out much  and  long-continued  earnest  work.  In  an  elaborate 
notice  of  the  college  and  its  officers,  The  Baltimore  American 
(Aug.  16)  thus  alludes  to  the  progress  of  homodopathy  in  the 
State:— 

"HomoBopathy  was  first  introduced  into  Baltimore  and 
Maryland  by  Dr.  Swartz,  one  of  the  most  accomplished  and 
refined  of  physicians.  He  was  followed  by  Haynel,  McManus^ 
Middleton,  Baborg,  Schmidt  and  Martin,  all  of  whom  are 
now  dead.  Hammond,  Price,  Weiner  and  Heerman,  also 
pioneers  in  the  order  named,  yet  live  to  give  their  testimony 
as  to  what  hardships  they  endured  from  the  persistent  oppo- 
sition of  the  dominant  school  to  prevent  the  growth  of  & 
system  that  was  then  considered  a  radical  innovation  upon 
the  prevailing  methods  of  the  practice  of  medicine.  But  such, 
was  the  success  of  these  men  in  healing  the  sick  that,  not- 
withstanding the  untold  obstacles  and  opposition  which  they 
encountered,  homoeopathy  has  steadily  advanced  in  pro- 
fessional and  public  estimation  in  this  community  until  now 
it  has  such  a  firm  foothold  that  its  patrons  are  numbered  by 
thousands,  a  majority  of  whom  are  of  the  most  intelligent  and 
wealthy  citizens." 

The  State  of  New  York  has  instituted  a  State  License  to 
practise  medicine,  which  in  the  future  must  be  held  by  every 
practitioner,  whatever  may  be  the  source  of  his  degree  or 

8 


680  NOTABIUA.  *^^2SJ%?W£!? 


B«Tieir.  Oct.  1,  IWL 


diploma.  To  ensure  fiBdr  play  to  "  therapeatic  ereeds  "  the 
Legislature  of  the  State  has  provided  three  boards  of  examineis. 
These  are  chosen  by  the  Medical  Society  of  the  State  of  New 
York,  by  the  Homoeopathic  Medical  Society  of  the  State  of 
New  York,  and  by  the  Eclectic  Medical  Society  of  the  State  of 
New  York.  The  applicant  for  a  license  to  practise  in  the 
State  of  New  York  selects  the  Board  before  which  he  prefers 
to  appear,  and  is  examined  by  that  Board,  receiving— if  his 
examination  should  prove  satisfactoiy — ^his  license  from  the 
State  authorities.  The  several  boards  have  been  appointed, 
and  have  met,  electing  as  their  chairman  Dr.  Wey,  of  Elmin 
{an  allopath),  and  as  Secretary  Dr.  Wright,  of  BuffiJo  (a 
homoeopath). 

Referring  to  this,  Tha  Philadelphia  North  American  writes 
AS  follows : — 

'<  New  York  has  solved  the  problem  of  the  '  pathies '  in  the 
-ofdy  possible  way,  by  creating  three  State  bo^ords  of  medical 
examiners,  representing  tiie  three  distinct  schools  of  practice. 

"  This  solution  of  the  interminable  snarl  of  schools  of 
medicine  is  rational.  It  is  useless  for  anybody  to  sneer  at 
-*  the  schools.'  No  set  of  men  have  a  monopoly  of  knowledge, 
and  no  school  is  infallible. 

"  The  bills  so  far  offered  at  Harrisbui^  (Penn.)  never  had 
«  ghost  of  a  chance  of  becoming  laws,  for  we  do  not  live  in 
the  dark  ages  when  people  were  dragooned  into  any  system. 

*<  The  law  cannot  have  a  preference  for  any  system  of 
medicine  to  the  exclusion  of  any  other  based  on  research  and 
Actual  experiment  and  conducted  by  enlightened  men.  It  can, 
however,  provide  that  only  qualified  persons  shall  practise 
medicine,  and  leave  each  school,  under  common  standards,  to 
fix  the  ordeal  for  its  own  candidates." 

X:  4e  i|t  4e 

The  annual  announcement  of  the  Medical  School  of  the 
University  of  Boston  gives  the  following  account  of  improve- 
ments, completed  and  in  the  course  of  completion,  in  the 
opportunities  for  study  presented  at  this  school.  "The 
new  Dispensary  building,  affording  facilities  for  each  of  the 
twelve  departments,  with  rooms  of  sufl&cient  size  for  special 
idinics,  and  a  fine  lecture  hall  for  general  clinics,  will  be 
occupied  the  present  month.  The  extensive  additions  to  the 
Hospital,  now  being  erected  by  the  bounty  of  the  State, 
which  will  make  it  the  largest  general  hospital  under  homodo- 
pathic  management  in  the  world,  will  be  fully  completed 
early  in  the  ensuing  winter.  The  new  addition  to  Ae 
College  building,  sixty  feet  by  fifty-six  feet,  and  four  stories 
in  height,  contfuning  physiological  and  microscopical  labora- 
iories  fiilly  equipped,  each  able  to  accommodate  fifty  students 


SSS^^ErrSSS^  NOTABILIA.  681 


BciTtew,  Oct.  1,  IfiBl. 


at  the  same  time;  a  library  capable  of  holding  thirty 
thousand  volumes ;  a  pathological  museum  with  room  for  one* 
hundred  thousand  specimens ;  and  on  each  of  the  four 
stories  a  fine  lecture  or  reading  room  and  private  laboratory 
or  work-room, — ^these,  added  to  the  facilities  afforded  by  the 
former  school  buildings,  will  make  this  one  of  the  largest  and 
best  equipped  medical  colleges  in  the  country." 

A   FBAGMENT  FROM  THE  LATEST    HISTORY    OF 

HOMOEOPATHY  IN  RUSSIA. 

By  Db.  C.  Bojamus,  Senb. 

^  Incapacity  is  no  crime  ; 
Ignorance  may  be  forgiven. 
But  stupidity  neyer." 

The  Whist-Player. 

The  Pedagogical  Museum  of  St.  Petersburg,  where  lively 
debates'^  upon  homoeopathy  have  already  repeatedly  taken 
place,  has  lately  been  the  scene  of  a  lecture  read  under  the 
title  of ''  Homoeopathy  as  a  Doctrine  and  an  Error." 

This  lecture  was  read  on  the  20th  December,  1890,  by 
Dr.  Garriok,  who  formerly  held  an  appointment  at  the 
English  Embassy.  It  took  place  in  the  weU-fiUed  auditorium 
of  tiie  Museum. 

The  following  thesis  served  as  a  basis  for  the  lecture. 

1. — Hahnemann's  theory  of  similia  nmUibw  curantur  does 
not  stand  the  test,  and  is  not  confirmed  either  by  experiment 
or  observation  at  the  sick  bed. 

2. — The  results  of  treatment  with  infinitesmal  doses,  that 
is  to  say  with  homoeopathic  remedies,  or  by  inhalation  of  the 
drugs,  are  equivalent  to  the  absence  of  treatment. 

8. — ^Hahnemann's  Psora  theory  as  a  foundation  of  most 
chronic  diseases  is  false  and  remains  unproved. 

4. — The  efficacity  of  drugs  by  dilution  and  shaking  is 
diminished,  and  not  increased  as  Hahnemann  affirms. 

5. — ^None  of  the  theses  set  up  by  Hahnemann  can  be  raised 
to  the  dignity  of  laws. 

The  publication  of  the  report  of  the  lecture,  and  the  steno- 
graphic account  of  the  debates  had  to  be  put  off  till  the 
middle  of  April,  as  Dr.  Carrick  was  expected  to  fulfil  his 
promise  of  publishing  his  lecture. 

The  HonuBopathic  Messenger,  in  its  number  for  December, 
1890,  says  that  the  lecture  of  Dr.  Carrick  is  one  of  the  most 
untalented  and  trivial  libels  amongst  all  the  productions  of 

*  The  JtotUMy  Homaopathio  Beview,  1889,  p.  292  and  following. 


682  NOTABiLiA.  »S2a:"SE"?Si! 


Beffaw.  OeL  1.  im. 


this  class  of  literature.  The  lecture  is  entirely  devoid  of  any 
scientific  worth,  and  is  nothing  but  a  compilation  from  former 
libels  and  a  compound  of  trite,  worn-out  sentences  against 
homoBopathy.  It  is  easy  to  reconstruct  the  whole  lecture  by 
the  answers  of  the  opponents,  and  particularly  oy  the  refuta- 
tions of  Dr.  Brazol. 

In  the  beginning  of  his  refutation,  Dr.  Brazol  pointed  out 
to  the  lecturer  that  he  had  grossly  misconstrued  the  words  of 
Hahnemann,  who  speaks  of  the  action  of  clUna  upon  himself; 
and  lays  particular  stress  upon  the  &ct  that  cHna  taken  by 
him  when  in  good  health  had  called  forth  an  intermittent 
fever  peculiar  to  his  constitution — a  fever  from  which  he 
had  STiffered  in  former  years.  This  led  to  a  comical  incident. 
Dr.  Brazol  insisted  that  the  lecturer  should  name  the  work 
from  which  the  quotation  had  been  taken;  Dr.  Carrick 
answered  that  he  did  not  remember  from  where  he  had  taken 
it,  that  he  had  read  his  lecture  from  a  manuscript,  and  had 
left  it  in  an  adjoining  room  during  the  interval  which  had 
elapsed  between  the  end  of  the  lecture  and  the  beginning  of 
the  debates.  He  was  then  asked  to  show  the  manuscript,  and 
was  absent  so  long  that  it  seemed  as  if  he  had  taken  the 
example  of  the  opponents  at  the  fourth  lecture  of  Dr.  Brazol, 
who  had  quietly  escaped  the  debates  and  slipped  away.  He 
returned,  however,  and  was  obliged  to  avow  that  the  quota- 
tion had  not  been  taken  from  Hahnemann's  works,  but  had 
been  transcribed  from  the  work  of  one  of  his  antagonists, 
**  Therapeutics  of  the  Present  Period,"  by  Dr.  Bodger. 

Dr.  Brazol  went  on  iriBfuting  evei^  one  of  the  arguments  of 
the  lecturer,  proving  in  the  most  cuxsumstantial  and  evident 
manner  that  he  had  no  clear  conception  of  the  subject  which 
he  had  undertaken  to  discuss,  and  that  his  position,  ev^ 
Among  the  antagonists  of  homoeopathy  would  sdways  remain 
secondary  and  insignificant.  He  had  overlooked  the  fiE^t  that 
he,  as  well  as  most  of  his  predecessors,  whose  example  he  is 
following  and  whose  words  he  is  repeating,  attack  the 
theoretical  side  of  homoeopathy,  which  is  apt  to  alter  under 
the  influence  of  time  and  progress ;  to  destroy  the  practical 
and  experimental  side  of  homoeopathy  is  an  attempt  whidi 
can  only  proceed  from  the  brain  of  some  "  original "  who  is 
beyond  common  sense ;  to  be  the  copy  of  such  an  *'  original " 
can  only  appear  absurd  and  ridiculous.  If  Dr.  Carri^  had 
succeeded  in  fulfilling  the  task  he  had  undertaken,  he  would 
certainly  count  among  the  most  celebrated  men  of  his  time. 

Dr.  Brazol  opposes  the  following  antithesis  to  the  thesis 
stated  by  Dr.  Carrick. 

1. — The  law  laid  down  by  Hahnemann,  simiUa  similihw 
/nuatour,  is  absolutely  confirmed  by  physiological  experiments 


fS^J^STS^  NOTABILIA.  688 

and  by  observations  at  the  sick  bed;  farther,  the  experi- 
mental principle  of  the  action  of  drugs  and  the  pharmacology 
of  Hahnemann,  founded  on  this  principle,  are  indisputable ; 
it  has  been  controlled  by  repeated  experiments,  and  the  latest 
researches  have  proved  its  thorough  competence. 

2. — -The  results  of  treatment  with  infinitesmal  doses  after 
the  principles  of  homoeopathy  are  not  to  be  compared  with 
those  attained  by  the  absence  of  treatment.  Homoeopathic 
treatment  is  active  and  not  passive. 

8. — The  psora  theory  of  Hahnemann,  as  a  foundation  to 
the  greater  part  of  chronic  diseases,  does  not  belong  to 
homoeopathy,  being  a  pathological  theory,  but  may  serve  as 
an  important  guide  in  the  treatment  of  some  chronic  diseases. 

4. — The  action  of  a  drug  does  not  solely  depend  upon  its 
physical  and  chemical  properties,  but  also  upon  its  molecular 
condition.  Its  physical  and  chemical  power  may  be 
diminished  by  dilution,  and  its  dynamic  or  molecular 
power  increased. 

The  refutation  of  Dr.  v.  Dittmann  was  calm  and  moderate. 
He  began  by  pointing  out  that  the  practical  side  of  homoeo- 
pathy has  attracted  its  followers  for  nearly  a  century ;  thanks 
to  its  practical  advantages  homoeopathy  still  continues  to  gain 
ground,  to  extend  and  to  acquire  a  steady  position,  notwith- 
standing the  persecution  of  its  foes.  He  gave  statistics  of  the 
treatment  in  several  hospitals,  and  mentions  the  fact  that 
there  are  no  allopathic  physicians  in  those  parts  of  America 
where  the  yellow  fever  reigns ;  this  has  been  publicly  stated 
by  the  American  physicians  who  <;ame  to  the  Congress,  held 
in  London  in  1881.  He  quotes  certain  facts  taken  from 
chemistry  and  physics,  the  observations  of  Darwin  about 
Drosera  and  the  tubercle  bacilli,  which  act  in  such  a  fearful 
manner  and  can  only  be  seen  through  a  microscope  which 
-enlarges  them  by  a  thousand  times,  and  he  gives  these  ae 
proofe  of  the  efficacity  of  infinitesimal  doses. 

Dr.  Garrick,  in  his  answer  to  the  opponents,  plays  the  easy 
part  of  an  innocent  victim  sufifering  under  the  load  of  un- 
deserved accusations ;  he  protests  that  all  the  objections  of 
his  adversaries  are  false,  and  that  his  own  assertions  remain 
as  incontestable  after  the  debates  as  they  had  been  before. 
He  still  considers  Hahnemann  as  a  trader  of  secret  remedies ; 
is  convinced  that  chirui  does  not  produce  intermittent  fever, 
a  fact  he  has  personally  ascertained  at  a  quinine  factory  in 
Milan,  where  the  workmen  were  all  free  &om  intermittent, 
whilst  all  the  inhabitants  of  the  neighbourhood  suffered  from 
it'^ ;  (many  celebrities  have  confirmed  the  fact.)    He  does  not 

*  Hi»  knowledge  seems  as  light  as  a  feather,  his  comprehensioxi  as 
heavy  as  lead. — ^Author  of  the  Paper. 


684  NOTABILIA.  ^^^^/w^?5r?TSr 


i^Tiew,  Oct.  1, 1891. 


understand  his  antagonist's  assertion,  that  molecular  power- 
can  increase.|  The  statistics  given  by  Dr.  Brazol  he  said 
were  incorrect.  Arsenic  had  no  connection  with  cholera  (!) 
The  statistics  of  the  homoeopathic  treatment  of  the  cattle  p€»st 
were  false ;  Dr.  Garrick  knows  for  certain  that  in  England,  in 
1867,  fifty-six  cows  were  treated  homoeopathically  and  all  died 
He  concludes  with  a  few  malicious  remarks,  that  his  opponent. 
Dr.  Brazol,  might  have  been  more  polite  and  choice  in  his 
expressions  towards  a  colleague.  The  President,  in  his  con- 
cluding speech,  declares  it  impossible  to  sum  up  the  debates  ; 
the  chasm  between  both  camps  is  too  deep.  He  can  only 
express  the  hope  that,  for  the  welfare  of  humanity,  the 
adversaries  should  come  some  day  to  a  better  understanding. 

Dr.  Brazol  has  inserted  in  the  Homceopathic  PhytdcMn  (St^ 
Petersburgh)  a  supplementary  article  to  the  debates ;  as  there 
seems  no  chance  of  Dr.  Carrick*s  lecture  ever  appearing  in 
print,  the  following  passages  extracted  from  Dr.  BrazoVs 
article  will  give  the  reader  insight  into  some  of  the  prominent 
features  of  this  remarkable  lecture.  Dr.  Brazol  had  to  hear 
the  homoeopaths  of  the  present  day  called  a  band  of  free 
Eossacks,  in  the  sense  of  plunderers  and  marauders,  not  of  an 
honest  military  regiment ;  it  was  termed  a  shame  to  have  a 
word  to  say  to  them ;  Hahnemann  was  qualified  as  a  quack 
and  a  drunkard,  his  pathogenesis  as  symptoms  following 
intoxication.  **  It  is  natural,"  says  Dr.  Brazol,  "  that  such 
accusations,  such  want  of  conscience  on  the  part  of  the 
lecturer  stirred  up  feelings  of  indignation,  which  I  could  not 
repress,  and  that  my  answers  were  more  cutting  and  bitter,, 
than  could  be  pleasant  either  to  Dr.  Carrick  or  to  myself." 

After  Dr.  Brazol  had  most  emphatically  contradicted  the 
assertion  of  Dr.  Garrick,  that  ckhia  does  not  produce  inter- 
mittent fever,  and  given  him  the  most  palpable  proofs  that  he 
was  wrong,  the  lecturer's  answer  was  that  the  logic  with  which 
Dr.  Brazol  states  his  authorities  can  only  be  compared  with 
that  of  a  murderer,  who  being  accused  by  two  witnesses  of  the 
crime,  tries  to  prove  his  innocence  by  calling  in  20  witnesses 
who  had  been  absent  at  the  time  of  the  murder. 

When  Dr.  Garrick,  wishing  to  amuse  his  audience,  repre- 
sented in  a  ludicrous  light  the  symptoms  of  belladonna  and 
other  narcotic  remedies  taken  from  the  homoeopathic  pharma- 
cology, and  when  the  shallowness  of  such  an  attempt  had  been 
proved  to  him,  his  objection  was  that  he  knew  very  well  thai 
opium  produces  fearfrd  symptoms,  but  in  other  doses  than 

t  What  deep  knowledge  and  clear  comprehension  of  homoeopathy ! — 
Author  of  the  Paper. 


!£gS?f(STa5"''  NOTABIHA. 685 

homoBopathic  ones ;  therefore  he  does  not  even  know  that  the 
pathogenesy  of  drugs  are  results  of  large  physiological  doses. 

The  assertion  of  Dr.  Garrick,  that  the  symptoms  of  arsenic 
have  no  connection  with  cholera,  was  refuted  by  Dr.  Brazol 
with  a  number  of  proofs  taken  from  different  works  npon 
pharmacology.  He  concluded  with  the  words  of  Professor 
Virchow:  "  We  need  not  enter  into  any  further  details  to  show 
the  analogy  which  exists  between  the  state  of  the  intestines 
afler  poisoning  with  arsenic^  and  in  cholera/'  so  that  not  only 
the  symptomatic,  but  the  pathological  and  anatomical  relation 
of  arsenic  to  cholera  is  confirmed  in  the  most  evident  manner. 

Dr.  Brazol  points  to  the  fact  that  the  statistic  data  of  the 
homoeopathic  treatment  of  cholera,  which  he  compares  with 
the  allopathic  statistics,  are  taken  from  the  same  period  during 
a  cholera  epidemic  ;  these  statistics  have  no  connection  with 
the  assertion  of  Dr.  Garrick,  that  at  the  beginning  of  the  epi- 
demic everybody  died,  and  at  the  end  every  patient  recovered, 
even  if  such  an  assertion  had  been  correct.  Dr.  Garrick's 
remark,  that  he  does  not  understand  the  meaning  of  mole- 
cular energy,  is  too  ingenious ;  it  proves  the  absence  not  only 
of  medical,  but  of  general  knowledge.  Dr.  Brazol  concludes 
with  the  following  words ;  "  Some  of  the  members  of  the 
assembly  had  been  looking  forward  to  a  thorough  refutation 
of  homoeopathy  and  its  complete  defeat.  They  were  evidently 
disappointed  in  their  hopes  by  the  thorough  incompetence  of 
the  lecturer.  A  group  of  physicians,  with  whom  I  am  well 
acquainted,  gave  vent  to  their  disappointment  at  the  failure 
by  hisses  and  shouts.  Similar  manifestations  have  no  effect 
upon  us  ;  if  we  look  over  the  history  of  homoeopathy,  we  will 
find  many  fiercer  assaults  caused  by  the  intolerance  and  blind 
opposition  of  our  foes,  but  the  doctrine  of  Hahnemann  stands 
on  firm  ground,  is  endowed  with  a  vigorous  constitution,  and 
has  sufficient  vital  power  to  continue  its  life ;  neither  the 
hisses  nor  the  outcries  of  its  adversaries  will  ever  succeed  in 
crushing  it." 

The  event  which  has  been  reported  in  the  preceding  pages, 
that  of  a  lecture  against  homoeopathy,  accompanied  by  public 
debates,  appears  as  a  single  fact  in  the  history  of  homoeopathy 
in  Bussia.  The  painful  side  of  the  occurrence  was  the  whole 
tone  of  the  lecture,  its  aim  and  object ;  they  were  so  offen- 
sive as  to  excite  a  most  natural  indignation,  which  was  openly 
expressed  by  the  opponents.  It  is  evident  that  the  shock  of 
such  heterogeneous  elements  could  lead  to  nothing  but  to  a 
scandalous  and  ridiculous  explosion,  the  more  so  as  different 
machinations  had  been  set  to  work  and  clappers  prepared ; 
it  was,  therefore,  quite  natural  that  the  explosion  should  be 
accompanied   by    all   the    attributes   belonging  to  such  a 


686  NOTABIUA.  "^^=?£'?»!S!* 


Eeriew,  Oct.  1,191. 


demonstration  —  hisses,  shouts,  terms  of  applause  and 
•encouragement  on  one  side,  expressions  of  scorn  and  con- 
demnation on  the  other. 

When  a  scientific  question  has  been  a  topic  of  controversy 
for  nearly  a  century,  when  it  has  been  abused,  insulted, 
turned  to  ridicule  without  the  question  ever  having  been 
successfully  solved,  or  homoeopathy  uprooted  by  those  who 
have  attacked  it — a  whole  series  of  pamphlets  and  libels  may 
be  brought  forward  as  proofs — ^to  begin  over  again  in  the 
same  unworthy  style,  and  that  in  a  public  lecture,  only 
shows  a  total  want  of  comprehension  of  the  subject  nnder 
<discus8ion.  Buch  an  attempt  is  not  only  a  proof  of  ignorance, 
but  shows  an  extraordinary  degree  of  simplicity,  which  seems 
to  stifle  every  feeling  of  personal  dignity  ;  it  proves  the  truth 
of  the  sentence,  that  one  who  knows  nothing  of  danger  is  not 
afraid  of  meeting  it. 

Abstracting  the  fact  that  a  serious  and  scientific  question 
cannot  be  exposed  to  the  public  in  a  humounstic  form,  every 
lecturer,  undertaking  to  amuse  his  audience  by  humour 
and  sarcasm,  must  have  a  deep  knowledge  of  the  chosen 
subject  and  be  able  to  judge  if  the  question  itself  is  fit  to  be 
treated  in  such  a  light ;  he  must  also  be  sure  of  his  own 
talent  and  capacity  as  a  humourist.  One  who  has  nothing 
at  his  command  but  a  tremendous  stock  of  ignorance  and 
a  total  absence  of  Attic  salt,  can  only  appear  in  a  ludicrous 
light ;  it  is  therefore  quite  in  the  spirit  of  the  laws  of  analogy 
that  Carrick's  representation  of  homoeopathy  turned  to  a 
caricature ! 

After  having  exposed  our  opinions  about  the  aggressor,  we 
will  turn  to  the  opponent ;  nothing  can  be  objected  to  the 
serious  and  scientific  side  of  the  refutation,  but  we  cannot 
deny  that  the  tone  of  the  answers  was  the  inevitable  echo  of 
the  attack.  A  just  and  natural  indignation  is  expressed  in 
the  answers  of  the  opposition.  Can  it  be  otherwise,  when  one 
is  condemned  to  Usten  to  the  grossest  insults,  and  see  one's 
most  sacred  ideals  maimed  by  unworthy  hands  and  trampled 
in  the  mud  ? 

Accusations,  such  as  that  of  calling  Hahnemann  a  dronkaid 
and  his  ecientific  productions  the  vapours  of  intoxication, 
belong  to  those  insults  whicli  are  generally  visited  on  the 
person  of  the  accuser.  We  understand  those  feelings,  and  do 
not  attempt  either  to  criticise  or  to  make  things  better; 
we  will  only  permit  ourselves  one  question.  Would  it  not 
have  been  wiser,  or  as  one  is  apt  to  say,  more  pohtio — ^not  to 
expose  the  accuser  in  all  his  bareness  to  the  public  eye,  and 
not  to  show  him  in  a  Hght,  which  though  well  deserved,  is 
such,  as  he  himself  cares  the  least  to  exhibit  ?    If  the  outlines 


S2Si?5?rSS?**  NOTABILU.  687 


Bevlew,  Oct.  1,  ia>l. 


of  a  picture  are  too  sharply  marked,  there  are  always  meroifsl 
souls  at  hand,  who  hy  the  force  of  spiritual  relationship,  or  by 
that  of  having  received  free  tickets,  think  it  their  duty  to 
stand  up  as  champions  and  represent  the  accused  as  a  victim 
of  hatred  and  partiaUty.  This  is  a  very  convenient  shield ; 
both  moral  and  scientific  nudity  are  thus  screened  by 
the  mantle  of  compassion.  It  is  therefore  of  the  utmost 
importance  not  to  be  carried  too  far  by  indignation,  and  to 
keep  in  mind  the  words  of  Talleyrand,  <<  C'est  plus  qu*un 
crime,  c'est  une  faute."  The  judgments,  expressed  by  the 
newspapers,  refer  more  to  the  manner  in  which  the  per- 
formance took  place,  than  to  the  subject  of  the  lecture, 
although  in  some  papers  a  few  particulars  are  partially 
mentioned. 

On  the  whole,  the  sympathies  of  the  press  seem  more 
inclined  in  favour  of  homoeopathy  than  against  it ;  the 
manner  in  which  the  lecture  was  read  and  the  debates  con- 
ducted was  principally  censured.  This  is  in  accordance  with 
the  general  impression  of  the  public,  which  was  not  unfavour- 
able to  homoeopathy,  excepting  of  course  the  attacks  of  its 
acknowledged  antagonists.  The  flippant  and  unworthy  tone 
of  Dr.  Garrick's  lecture  was  met  with  general  disapprobation, 
it  was  openly  acknowledged  that  the  official  school  had 
suffered  a  positive  failure  in  the  person  of  Dr.  Carrick ;  he 
had  been  saved  from  a  complete  defeat  by  the  zeal  of 
Dr.  Brazol,  who  had  perhaps  gone  a  little  too  far  in  his  con- 
demnation ;  this  had  served  as  a  shield  for  Dr.  Carrick,  and 
had  given  him  the  benefit  of  a  slight  shadow  of  consideration. 
Such  is  the  opinion  which  has  been  transmitted  to  us 
repeatedly  as  well  as  the  following  judgment:  ''lam  no 
homoeopath,  I  know  nothing  of  homoeopathy,  but  I  am  able  to 
understand  that  a  scientific  question  cannot  be  treated  in  the 
low  and  flippant  manner  in  which  Dr.  Carrick  has  read  his 
lecture." 

Even  allopathic  physicians  have  rendered  justice  to  the 
scientific  worth  of  Dr.  BrazoPs  refutations. 

Amongst  all  the  different  opinions  pronounced  about  the 
lecture.  Dr.  Brazol  has  received  his  share  of  blame  for  having 
badly  chosen  his  expressions,  having  called  things  too  plainly 
by  their  names  and  given  a  tinge  of  personality  to  the  debates. 
KVithout  making  ourselves  the  pleader  of  Dr.  Brazol's  cause, 
we  consider  it  our  duty  to  prove  that  the  opinions  expressed 
by  the  press  and  the  public  are  wrong,  because  the  first  thing 
to  be  kept  in  sight  is  the  ground  upon  which  Dr.  Carrick  has 
built  his  lecture.  The  soil  which  has  brought  forth  nothing 
but  coarse  harlequinades  cannot  be  favourable  to  the  cultiva- 
tion of  a  scientific  subject.      The  person  who  has  taken 


688  NOTABiLiA.  ""SSL??!::??^ 


B0Tiew.  Oct  1,  vm. 


the  lead  in  the  proceeding  and  committed  the  blunder  is 
responsible  for  its  conseqaences.  Dr.  Brazol  was  forced^ 
certainly  against  his  will,  to  remain  on  the  same  barren 
ground;  he  could  not  even  amuse  his  audience,  not  being 
gifted  with  the  talents  of  a  clown ;  no  blame  rests  upon  bim ; 
it  is  no  more  his  fault  than  it  is  a  fault  to  soil  one's  fingers 
in  trying  to  save  a  costly  jewel  trampled  in  the  mud. 

COLLECTION  IN  AID   OF  THE    LONDON    HOMOEO- 

PATfflC  HOSPITAL. 

Undeb  the  auspices  of  the  Loyal  United  Friends,  the  third 
annual  procession  for  the  benefit  of  the  London  Homoeopathic 
Hospital,  Great  Ormond  Street,  took  place  on  Sunday,  the 
28rd  August,  when  divine  service  was  held  in  the  church  of 
St.  George-the-Martyr,  Queen  Square.  A  sum  of  about  £80 
in  previous  years  was  collected  in  aid  of  the  funds  of  the  hos* 
pital  by  the  working  men  of  the  neighbourhood  who  had 
received  benefit  at  the  hospital.  We  hope  that  the  success 
will  not  be  less  than  before. 

WILDUNGEN. 

Last  month  we  received,  too  late  for  insertion,  an  interesting 
letter  respecting  Wildungen  from  Major  Vaughan  Moigan. 
Wildungen  is  a  rising  watering  place  near  Cassel  in  Germany, 
and  is  situated  in  a  beautiful  valley  800  feet  above  the  sea- 
level,  surrounded  by  woods  and  hills  rising  to  2,000  feet. 
The  springs  are  four  in  number,  viz.,  three  celebrated  for 
their  action  in  all  urinary  diseases,  the  other  being  a  poweiM 
chalybeate.  The  *'  cure  "  at  Wildungen  consists  mainly  in 
drinking  one  or  other  of  these  waters,  the  Georg  Victor 
Quelle  and  the  Helenen  Quelle  being  the  most  frequently 
used ;  but  it  is  generally  supplemented  by  the  use  of  the 
baths,  the  activity  of  which  is  due  to  the  presence  of  free 
carbonic  acid. 

Major  Morgan  states  that  Dr.  Marc  has  quite  a  European 
reputation,  but  unfortunately  speaks  very  little  English. 
Dr.  Severin  speaks  English  fairly  well,  and  Major  Moi^an 
formed  a  high  opinion  of  his  ability. 

There  are  several  good  hotels  at  Wildungen  (the  best  being 
those  of  Mr.  Gocke),  the  charges  are  moderate,  and  the  food 
is  good. 

TRIGEMINAL  NEURALGIA  AND  IODIDE  OF 

POTASSIUM. 

In  a  recent  number  of  the  Neuroloffisches  CentraMaU  reference 
is  made  to  some  interesting  facts  related  by  Dr.  S.  Ehrmann 
as  to  the  occurrence  of  severe  facial  neuralgia  after  the 


^j^yBomcBOgjWc  NOTABILIA.  689 


Bewkfw,  Oct.  1, 18B1 


administoration  of  even  small  doses  of  iodide  of  potassium.  In 
the  first  case  mentioned,  the  patient,  a  strong  working  man  of 
thirty-five,  suffered  most  intense  pain  in  the  forehead  and  in 
the  teeth,  with  sensitiveness  over  the  whole  distribution  of 
the  fifth  nerve,  after  taking  fifteen  grains  of  the  drug.  A 
second  patient  after  taking  thirty  grains  had  much  pain  in  the 
region  of  the  upper  jaw,  with  pain  and  tenderness  in  separate 
branches  of  the  nerve,  and  also  oedema  of  the  eyelids  on  the 
left  side.  A  third  and  a  fourth  patient  also  suffered  from 
similar  symptoms  after  similar  doses.  There  were  associated 
in  all  the  cases  much  lachrymation  and  injection  of  the  con- 
junctiva, but  the  symptoms  rapidly  vanished,  and  did  not 
reappear  on  a  farther  administration  of  the  drug.  The  cases 
are  not  only  interesting,  but  important,  for  it  is  desirable  to 
know  as  much  as  possible  regarding  any  peculiar  effects  likely 
to  be  produced  by  a  drug  which  is  so  frequently  administered 
is  iodide  of  potassium. — Lancet. 


LARD  AND  VASELINE  CONSIDERED  WITH  REGARD 

TO  CUTANEOUS  ABSORPTION. 

We  extract  the  following  important  remarks  from  a  recent 
number  of  the  Feuillet  Medical.  It  is  known  that  physicians 
have  a  tendency  to  substitute  vaseline  for  lard  as  the  excipient 
used  in  the  preparation  of  ointments ;  but  does  absorption 
into  the  skin  take  place  in  the  same  manner  with  two  such 
different  substances  ?  Such  is  the  point  which  Messrs.  Adam 
and  Schonmacher  have  endeavoured  to  throw  hght  upon,  and 
the  results  of  their  experiments  have  appeared  in  the  Revue 
de  MMecine  YHerinaire.  In  the  first  place,  they  tried  whether 
fatty  bodies  are  really  absorbed  by  the  skin,  and  to  what 
extent.  For  this  purpose  they  prepared  an  ointment  of 
8  grammes  of  lard  and  variable  quantities  of  hydrochlorate 
strychnine,  and  they  applied  this  ointment  witJumt  friction  on 
the  diaved  head  of  a  dog.  Of  course,  in  this  position,  the 
dog  could  not  lick  it  off.  On  the  other  hand,  they  took  the 
precaution  of  examining  whether  there  happened  to  be  any 
scratches  on  the  surfiEu^e,  which  solutions  of  continuity  might 
account  for  any  absorption  that  took  place.  Moreover,  the 
animal  was  attentively  watched.  With  an  ointment  thus 
made,  containing  0.05  grammes  of  a  salt  of  strychnine, 
Messrs.  Adam  and  Schonmacher  observed  no  toxic  symptoms. 
With  an  ointment  containing  0.5  gramme  even,  there  was 
only  very  slight  inflammation  produced,  and  with  another 
experimental  ointment  containing  no  less  than  2  grammes  of 
st^chnine  salt,  a  dog  of  10  lb.  weight  was  attacked  with 
tetanic  convulsions  in  about  three  minutes,  and  died  in  the 


690  NOTABOiA.  "^5*!S-=?Sr?^ 


Beview.  Oet.  U  im. 


coarse  of  twenty  minutes ;  a  dog  weighing  72  lbs.  died  in 
like  manner  in  twelve  hours.  It  might  be  objected,  that  m 
shaving  the  dogs'  heads  some  abrasions  had  been  produced; 
but  the  authors,  having  made  purposely  such  an  abrasion  on 
the  head  of  another  Sog^  proved  that  death  did  not  occur 
more  rapidly.  When  the  same  experiments  were  made  wilh 
ointments  of  exactly  the  same  strength  made  with  vaseline, 
no  poisoning  occurred.  The  use  of  atropine  in  place  of 
strychnine  gave  precisely  identical  results ;  with  lard, 
mydriasis  was  produced;  with  vaseline,  nothing.  The 
authors  conclude  that  with  lard  ointments  absorption  does 
occur,  but  it  is  slight,  as  doses  a  thousand  times  as  large  as 
those  necessary  for  hypodermic  injections  are  requisite  to  kilL 
With  vaseline  ointments  there  appears  to  be  no  absorption 
whatever  if  the  surface  of  the  sUn  be  intact. — Magazine  of 
Phammcy*  ^ 

INGROWING  TOE-NAILS. 

Db.  Pubgkhauer  recommends  the  following  method  in  the 
treatment  of  in-growing  toe-nail :  A  forty  per  cent,  solution 
of  potawa  is  applied  warm  to  the  portion  of  the  nail  to  be 
removed.  After  a  few  seconds  the  uppermost  layer  of  the  nail 
will  be  so  sofii  that  it  can  be  scraped  off  with  a  piece  of 
sharp-edged  glass :  the  next  layer  i^  ttien  moistened  with  the 
same  solution  and  scraped  off ;  this  must  be  repeated  until 
the  remaining  portion  is  as  thin  as  a  sheet  of  paper,  when  it 
is  seized  with  a  pincette,  lifted  from  the  underlying  soft  parts 
and  severed  from  the  other  half.  The  operation  does  not 
require  more  than  half  an  hour's  time,  is  jwinless  and  blood- 
less, while  the  patient  is  delivered  from  his  suffering  witiJiont 
being  disabled  even  for  an  hour. 


HOW  TO  KEEP  NEEDLES  PROM  RUSTING. 

Db.    Robebt    H.    M.    Dawbabn  writes  to    the   New   Tork 
Medical  Journal : — 

**  It  would  be  an  interesting  point  to  determine  how  many 
(if  your  readers  are  agreed  r^Bu*ding  the  best  way  of  keeping 
their  various  surgical  goods  and  chattels  ready  for  instant 
use.  In  talking  with  other  surgeons,  I  find  many  opinions 
about  it. 

"As  to  needles,  for  instance,  I  think  the  majority,  after 
sterilizing  them  by  heat,  try  to  keep  them  dry.  Dry  sterilizing 
at  the  usual  temperature  is  apt  to  injure  their  temper  and 


SSSSr^ri^JSf*'  NOTABILIA.  691 


cause  sabseqaent  bending  during  nse;  boiling  or  steam,  to 
induce  flecks  of  rust.  Bust,  too,  results  from  occasional 
subsequent  exposure  to  air;  and  if  cotton  or  cloth  is  used 
this  attracts  moisture.  Should  a  film  of  vaseline  or  oil  be 
applied  as  a  protective,  this  causes  dust  to  cling,  and  requires 
firesh  cleaning  before  use.  Qlycerine  I  have  tried  and  found 
wanting.  In  it,  hygroscopic  as  it  is,  the  needles  do  not 
remain  entirely  untarnished.    They  finally  turn  black. 

"  For  the  past  year  I  have  been  pleased  with  the  results  of 
a  ne.w  plan — ^new  to  me,  that  is,  though  very  probably  not  to 
others.  This  is  simply  to  keep  ray  needles  in  alcohol.  For 
extreme  safety  against  rust,  I  use  absolute  alcohol ;  but  the 
commercial  article  will  probably  be  efficient.  At  least, 
some  needles  which  I  have  kept  in  common  alcohol  for  a 
month,  as  an  experiment,  are  as  bright  as  ever. 

*'  Upon  buying  the  needles,  I  immerse  them  in  benzine  to 
remove  grease.  Then,  after  running  them  through  a  towel,  I 
plunge  the  point  into  a  bit  of  cork  of  the  size  of  a  pea — ^to 
avoid  dulling  from  jolting — and  finally,  with  their  corks, 
they  are  put  and  kept  in  a  wide-mouthed,  glass-stoppered 
bottle  filled  with  absolute  alcohol. 

''After  use,  I  sew  through  a  thick,  wet,  soapy  towel 
repeatedly,  cleanse  the  eye  with  the  thread,  immerse  in  ben- 
zine, and  finally  replace  in  the  alcohol.  This  last  is  certainly 
an  d£cient  disinfectant,  besides  being  an  excellent  protector 
against  rust." 


CAFFYN'S   **CARNIS"  PREPARATIONS. 

We  understand  that  the  Liquor  Camis  Company  has  found  it 
necessary  to  extend  its  premises,  and  has  fitted  up  a  large 
new  flEMstory  for  the  production  of  its  raw  beef-juice  prepara- 
tions. This  is  the  only  manufactory  of  its  kind  in  Europe. 
Liq.  Camis  preparations  are  well  known  in  this  country,  and 
have  received  comment  in  our  pages  previously.  Since  their 
first  introduction  they  have  been  extended  and  improved.  The 
Liq.  Camis  itself  may  now  be  obtained  flavoured  with  celery, 
rendering  it  much  more  palatable  than  before.  More  recently 
a  beverage  for  use  hot  is  put  up  combined  with  extract  of 
malt  and  a  flavouring  of  cocoa.  A  jelly,  lately  introduced, 
would  be  a  favourite  preparation  of  Liq.  Camis  were  it  not  at 
present  a  little  overseasoned.  Suppositories  for  rectal  feeding 
complete  the  Ust  of  these  valuable  dietetic  articles.  The 
practical  value  of  raw  meat  juice  is  now  too  well  known  to 
need  enforcing  here. 


*692  COMUBSPONDBNTS.       "B^?oS?m 

NOTICES  TO   CORRESPONDENTS. 

%*  We  canmit  undertake  to  return  r^eeted  manntcripts. 

A.UTHOBS  and  Contributors  reoeiving  proofs  are  requested  to  correct 
and  return  the  same  as  early  as  possible  to  Dr.  Edwix  A.  Neatbt. 

London  Hohceopathic  Hospital,  Great  Ormond  Strebt, 
'Bloomsbury.— Hours  of  attendance  :  Medical,  In-patients,  9.30 ;  Ont- 
rpatients,  2.30.  daily ;  Surreal,  Mondays  and  Thursdays,  2.30  ;  Diseasei 
•of  .Women,  Tuesdays  and  Fridays,  2.30  ;  Diseases  of  Skin,  Thnxdays 
2.30  ;  Diseases  of  the  Eye,  Thursdays,  2.30  ;  Diseases  of  the  Ear,  Satur- 
days, 2.30  ;  Dentist.  Mondiays,  2.30  ;  Operations,  Mondays,  2. 

Communications  have  been  received  from  Mr.  Dudley  Wright. 
•(London) ;  Dr.  MORRISBON  (London) ;  Mr.  Knox  Shaw  (London) ; 
■Dr.  Cooper  (London) ;  Major  Y.  Morgan  (Lcmdon) ;  Mr.  Cross  (London); 
Murray  Moore  (Liverpool) ;  Dr.  Drybdale  (Liverpool) ;  Dr.  J.  D. 
Hayward  (Liverpool) ;  Dr.  Gibbs  Blake  (Birmingham) ;  MisB 
Collins  (St.  Andrew's);  Dr.  Hitchcock  (New  York);  Mr.  J.  Xelsox 
^King's  Lynn). 

Dr.  Drysdale  (of  Liverpool)  has  entered  into  inrtnership  with 
Dr.  John  W.  Ellis  (formerly  of  Hyde  and  Stoke-on-Trent).  Thar 
address  will  be  18.  Rodney  Street. 

We  are  requested  to  state  that  Dr.  S.  MoRBia80N*s  address  will  m 
future  be  Grafton  House,  Clapham  Common,  8.W.,  in  place  of  St 
Leonards-on-  Sea. 

BOOKS   RECEIVED. 

Scientifc  Medicine  in  its  Relation  to  Howueopathy.    By  Professor 
Theodor  Bakody.  M.D.,  of  the  Buda-Pesth  University.      Translated 
from  the  German  by  R.  F.  Bauer^  M.D.,  Philadelphia.    Boericke  tod 
T^eL      \%n,— Fifth  Annual  Report  of  the  Howueopathie  Lcafue,— 
The  Homeeopathic  Directory,    1891.    London  : — ^Keen  k  Ashwell,  Bond 
'Street. — Synoptis  of  the  Lire*  of  Victoria  C.  Woodhvfl  and  Tenetme 
(lafliH,  the  two  first  Lady  Bankert  and  Reformers  of  America,    By 
G.  S.  Darewin.    London.    1891.    J.  H.  Corthesy.— iiSfxva/  Health:  A 
Companion  to  Modem  Domestic  Medieine^     By  Henry  G.  Hanchett, 
M.D.    Carefully  revised  by  A.  H.  Laidlaw,  A.M.,  M.D.    Third  edition. 
Philadelphia.    The  Hahnemann  Publishing  House.    1891.— fa}kwr< 
Weekly  Sheet:   Being   Events  of  the  Day,  Illustrated,      London.— 
JHahnemannian  Ilimseopathy,    By  George  Logan  and  C.  T.  Campbell, 
M.D.    Ottawa.    1891. — The  Jlomaopathie  World,   London.    September. 
— The   Chemist  and  Druggist,     London.     September. — The  MontUy 
Magazine  of  Pharmacy,     London.    September.— !%/>  ^^orth  Awkcriean 
Journal  of  Homoeopathy,     New  York.    Axigjut,—The  Xeto  York  MeH- 
*eal  Times,     New  York.     September. — The  American  Honueopathist, 
New  York.    September. — The  Nino  York  Medical  Record.    September. 
— The  yew  England  Medical    Gazette.      Boston.      September.— I^ 
Hahnemannian  Monthly.      Philadelphia.     September. — 7%e  Homao- 
pathic  Physician.    Philadelphia.    September. — 7%e  Medical  Adtanee, 
<3uoaga     August — The  Medical  Era,     Chicago.      September.— TV 
(Jinique,     Chicago.     August— JAr    Argus.    Cleveland.     July.— TV 
California  UomoBopath.    San  Francisco.    August— TV  Homwopathie 
Enroy,     Lancaster,  I7.S.A.      September. — TV  Indian  Homteopathie 
Rerietc,    Calcutta.    June.— ^mZ/.  Gin.  de  Thirapeutique.    Paris.   Sep- 
tember.— Retue   Homseopathique   Beige.      Brussels.      Jj»lj,—Bitistn 
Omicpatiea,      Rome.      August  —  Liepzig    Populdre  Zeitsehrift  fSr 
Homoopathie,     September. — Gazetta    Mediea  Di  Torino,    August— 
Homaeopathiseh  MaandUad.    September. 

Tmptn,  Dispennry  Reports,  and  Books  for  R&tkiw  to  be  Mat  to  Dr.  Popb,  19, 
Watovste,  Grsathsm,  linoolnshire ;  Dr.  D.  Dtcb  Bbowv,  »,  fieymom  Street,  Fart- 
man  Square,  W.;  or  to  Dr.  Edwix  A.  Kbatbt,  161,  Havcntodc  nm,  N.W.  Advortise 
ments  and  Busmen  comtniinirations  to  be  sent  to  Heavt.  E.  Gould  ft  Soi,  <§» 
'Mooiiate  Street,  £.0. 


iSriSJf^nfM^        INFANT  FEEDING.  693 


THE    MONTHLY 

HOMCEOPATHIC    REVIEW. 


•:o:- 


INFANT  FEEDING.* 

By  Gerakd  Smith,  M.R.C.S. 

I  TAKE  the  term  "  infant "  to  include  the  first  year  of 
life,  the  period  of  rapid  change  and  active  tissue  meta- 
boUsm,  and,  though  I  must  disclaim  all  idea  of 
originality  in  what  I  have  to  say,  I  feel  that  the  subject, 
even  in  its  elementary  aspect?,  is  one  well  worth  our 
careful  notice. 

As  to  natural  suckling,  first :  we  do  not  always  regard 
this  function  as  one  which  we  have  under  our  jurisdic- 
tion, we  are  apt  to  neglect  our  opportunities,  and  to  miss 
the  chance  of  materially  helping  our  baby  patients,  for 
we  do  not  sufficiently  recognize  that  we  can  help  the 
mother  to  greatly  modify  the  secretion  of  milk,  and  to 
vary  the  quality  of  the  food,  by  the  advice  we  may  give 
her;  the  natural  feeding  also  is  our  guide  to  the  un- 
ravelling of  the  problems  of  artificial  feeding,  and  as 
such  demands  our  close  attention. 

Under  the  best  conditions  there  is  a  regular  and 
steady  growth  of  the  infant  of  from  two-thirds  to  one 
ounce  daily  for  the  first  five  months  of  life,  and  from 

*  Read  before  the  British  Homoeopathic  Society,  October  1st,  1891. 
Vol.  35,  No.  11.  3  c 


694  INFANT   FEEDING.  '^21SSL^iS!?W£!' 


Beview,  Nor.  %  Ifln. 


one-third  to  a  half-ounce  for  the  remainder  of  the  year ; 
these  figures  should  be  our  guide  to  estimate  the 
progress  of  nutrition. 

Perhaps  the  most  important  point  in  the  matter  of 
natural  feeding,  is  that  of  the  intervals  of  giving  the 
breast,  for  the  relative  intervals  have  a  great  effect  upon 
the  chemical  constituents  of  the  milk.  It  is  well  kno^m 
that  too  frequent  nursing,  and  irregular  intervals 
between  the  periods,  will  often  transform  a  previously 
normal  milk  into  a  fluid  utterly  unfit  for  the  nutrition 
of  the  infant.  The  relative  proportion  of  the  solids  to  the 
water  in  the  milk,  is  of  great  importance  to  the  infant ; 
the  shorter  the  intervals,  the  greater  the  proportion  of 
solids,  and  a  longer  interval  increases  the  proportion  of 
water.  Of  course,  the  more  condensed  milk  with  the 
greater  amount  of  solids  is  the  more  nutritious,  bat  the 
more  watery  milk,  though  less  nutritious,  is  more 
easily  digested ;  the  inferences  in  the  matter  of  illness 
in  infants  from  these  facts  are  obvious ;  infants  who  are 
vomiting  their  mother's .  milk,  or  having  diarrhoea  from 
undigested  curds,  are  greatly  benefited  by  increasing 
the  intervals  between  the  feedings,  and  so  increasing  the 
relative  proportion  of  water  to  the  solids  of  the  milk,  and 
infants  who  are  suffering  from  bad  nutrition,  on  account 
of  the  too  large  proportion  of  water,  may  be  aided  by 
shortening  the  intervals  of  feeding,  so  as  to  increase  the 
solids. 

As  to  the  amount  of  milk  taken  by  the  infant  from 
the  breast,  of  com'se  it  is  regulated  by  the  breast  itself; 
it  is  best  estimated  by  the  size  of  the  infant  stomach  at 
different  ages,  as  to  which  I  will  speak  presently.  The 
weight  of  the  infant  determines  to  a  great  extent  the 
amount  it  takes.  A  series  of  experiments  made  in  the 
Children's  Hospital  of  St.  Petersburg  gives  the  general 
result  that  the  greater  the  weight  of  the  infant,  the 
greater  the  gastric  capacity,  and  that  1-100  of  the 
initial  weight  should  be  taken  as  the  foundation  of  the 


S3SifrN^?T35i?^*      INFANT   FEEDING. 


695 


calculation,  to  this  being  added  15  grains  by  weight 
of  food  for  each  day  of  life  up  to  one  year. 

The  Table  No.  I.  will  give  a  general  rule  for  the  intervals 
of  both  artificial  and  natural  feeding,  these  intervals 
and  the  number  of  feedings  take  account  of  the  necessary 
longer  interval  of  rest  during  the  night,  which  comes 
about  naturally  in  all  normal  cases. 

TABLE    I. 
Genbbal  Rules  fob  Feeding. 


Age. 

Interralsof 
feeding. 

Number  of 

feedings 

in  24 

hours. 

Average 

amount  at 

each  feeding. 

Average  in 
24  hours. 

1st  week 

2  hours. 

10 

1  ounce. 

10  ounoes. 

1  to  6  weeks. 

2^  hours. 

8 

1  ^  to  2  ounces. 

12  to  16  ounoee. 

6  weeks  to 
6  months. 

S  hours. 

6 

3  to  4  ounoes. 

18  to  24  ounces. 

6  months. 

3  hours. 

6 

6  ounoes. 
8  ounces. 

36  ounces. 

10  months. 

'd  hours.      1          5 

40  ounoes. 

The  variations  that  take  place  in  human  milk,  are 
^eater  than  those  in  cow's  milk ;  the  human  subject, 
•especially  the  nursing  mother,  is  far  more  affected  by 
external  impressions,  and  the  nursing  mother  has  the 
thousand  mental  cares  and  worries  which  the  happy  cow 
escapes.  Indeed,  if  we  could  approximate  the  woman  to 
the  quiet  contented  state  of  our  cows,  we  should  hear  far 
less  of  the  mother's  milk  disagreeing  with  the  infants ;  a 
cow  is,  any  day,  a  happier  creature  than  a  nursing  mother. 

Human  milk  is  slightly  alkaline  in  reaction ;  has  a 
specific  gravity  of  from  1,028  to  1,084;  it  contains  water, 
87  to  88  per  cent. ;  fat,  S  to  4  per  cent. ;  albumenoids, 
1  to  2  per  cent. ;  sugar,  about  7  per  cent.,  and  ash  0.2  per 
cent.  You  will  find  this  rough  analysis  in  the  papers  I 
have  put  before  you  in  Table  U. 

Table  II. 

BouQH  Analysir  of  Human  Milk. 


Beactlon     ... 

Slightly  Alkaline. 

Specific  Gravity 

1028—1034. 

Water 

87—88. 

Ifa  V  ...        ... 

8—4. 

Albumenoids 

1—2. 

Sugar 

7.0. 

0.2. 

3C— 2 


696  INFANT   FEEDING.         ^SSSSL^SSJT^ 


Beview.  Nor.  S,  Iflftl. 


For  clinical  purposes  we  do  not  need  a  more  exact 
analysis  of  the  albumenoids  of  the  milk ;  it  is  a  general 
term  which  we  use  to  include  chiefly  casein,  and  an 
albumen  which  is  physiologically  the  same  as  the 
albumen  of  blood  serum.  The  chemistry  of  these  albu- 
menoids is  at  present  rather  obscure,  but  is  quite  exact 
enough  for  practical  purposes,  and  the  same  may  apply 
to  the  ash  ;  no  doubt  it  contains  various  salts,  but  it  is 
the  total  amount  which  concerns  us  in  estimating  the 
value  of  a  sample  of  milk  for  its  nutrient  power.  Milk 
is  the  result  of  the  activity  of  certain  cells  forming  the 
epithelium  of  the  mammary  gland ;  microscopically,  the 
cells  can  be  seen  distended  with  fat  globules,  as  in  the 
fat-cells  of  adipose  tissue,  and  the  fat  is  discharged  from 
the  cell  by  extrusion,  as  an  amoeba  discharges  its  waste 
food.  The  fat  in  milk  is  not  a  mere  extravasation  from 
the  blood ;  the  female  mammal  gives  off  far  more  fat  in 
her  milk  than  she  can  take  into  her  blood  in  food ;  in 
fact  an  increase  of  fatty  food  given  to  a  suckling  mother 
reduces  the  amount  of  fat  in  the  milk,  and  proteid  food 
largely  increases  the  fat  in  her  milk.  If  milk  be  kept 
warm  outside  the  body,  the  casein  is  increased  at  the 
expense  of  the  albumen,  hence  this  ingredient  also  is 
one  which  is  formed  apart  from  any  direct  exosmosis  or 
extravasation  from  the  blood. 

If  carnivorous  animals  feed  exclusively  upon  non- 
glycogenic  food,  milk  sugar  still  continues  to  be  formed 
in  due  proportion  in  their  milk,  so  that  this  element 
also  is  formed  in  the  gland  apart  from  the  blood  supply. 

There  is  evidence  then  that  milk  is  formed  in  the 
mammary  gland  by  direct  metabolic  activity,  and  that  in 
the  gland  the  three  great  classes  of  foodstuffs — ^proteids, 
fats,  and  carbohydrates, — ^are  thus  formed  out  of  that 
complex  substance,  protoplasm.  But  it  is  necessary  to 
observe  that  in  a  part  of  its  period  of  activity  the  mam- 
mary gland  does  eliminate  from  the  blood  various 
substances ;  in  the  colostrum  period  transudation  from 
the  blood  certainly  takes  place,  it  is  the  period  during 
which  the  gland  has  not  attained  its  full  powers  of 
secretion  from  its  own  cells,  and  irregular  health  in  the 
mother  may  prolong  this  period. 

We  have,  therefore,  to  guard  as  best  we  can  against 
the  causes  which  influence  the  human  milk  for  the  bad. 
As  quiet  and  as  restful  a  life  as  possible  is  necessary. 


^^^iSrP^SSi"'*         INFANT   FEEDING.  697 


B«view,  Not.  S,  1891. 


Women  who  imagine  that  the  claims  of  society  on  their 
time  are  greater  than  those  of  their  infant,  are  not 
justified  in  attempting  to  sackle  their  children,  as  the 
weary  work  of  attending  to  social  engagements  is  far  too 
great  a  strain  on  their  nervous  powers,  and  will  affect 
the  milk,  often  very  seriously.  I  prefer,  however,  to 
allow  the  mother  to  take  the  responsibility  in  these  cases, 
for  I  am  always  of  opinion  that  the  natural  source  is  the 
hest  for  the  infant  if  the  mother  be  healthy. 

Irregular  meals,  and  seasons  of  fasting,  are  serious 
drawbacks  to  the  mother's  powers  of  producing  good 
milk,  and  of  course  it  is  well  known  that  the  mother 
needs  a  plain  mixed  diet,  with  extra  water,  which  water 
cannot  be  supplied  so  well  in  alcoholic  drinks  as  it  can  in 
the  form  of  pure  water,  though  I  do  not  mean  to  say 
alcoholic  drinks  are  out  of  place  during  lactation ;  every 
case  stands  on  its  own  merits  in  this  respect,  and  no 
general  rule  can  be  laid  down  in  the  matter. 

The  influence  of  menstruation  upon  the  milk  is  a 
serious  point.  The  majority  of  healthy  infants  are  not 
seriously  affected  by  the  occurrence  of  the  menstruation 
in  the  mother  during  lactation,  and  other  infants  are 
only  affected  for  a  day  or  two.  In  such  cases,  there  is 
no  need  to  interrupt  the  natural  feeding,  but  where  the 
infant  is  seriously  affected,  and  the  bad  influence  persists 
far  into  the  following  month,  the  question  of  weaning 
may  come  up. 

Far  more  serious  is  the  occurrence  of  pregnancy 
•during  lactation.  Very  few  mothers  are  able  to  bear  the 
strain  of  supplying  food  for  three  lives  at  the  same  time — 
themselves,  their  infant,  and  the  unborn  foetus.  Their  milk 
degenerates,  their  own  health  suffers,  the  infant  is  starved, 
and  there  is  the  danger  of  reflex  irritation  to  the  uterus  to 
be  considered.  Pregnancy  should  be,  in  my  opinion,  a 
bar  to  the  continuance  of  lactation.  Fortunately  this 
settles  itself  very  usually  in  the  natural  way,  as  the  milk 
xseases  to  be  secreted  with  the  onset  of  pregnancy ;  but 
this  is  not  always  the  case. 

The  question  of  weaning  generally  settles  itself  by  the 
failure  of  the  quantity  or  quality  of  the  mother's  milk. 
Premature  weaning,  that  is  weaning  before  the  infant 
has  attained  the  power  of  digesting  starch  and  has  any 
teeth,  may  be  necessary  for  various  reasons,  but  I  think 


698  INFANT  FEEDING.        "SS&.^iSS??^ 


Berieir,  Nof?.  %  UU. 


we  are  too  often  in  the  habit  of  recommending  the 
mother  to  wean  nnneeessarily.  If  we  cannot,  by  altering 
the  mode  of  life  and  the  diet  of  the  mother,  so  change 
her  milk  as  to  bring  it  to  the  normal,  the  child  must*  be 
weaned ;  but,  as  I  have  before  indicated,  we  do  possess 
considerable  power  of  modifying  the  mother's  milk  by 
varying  the  intervals  of  nursing,  and  by  diet.  Proteid 
foods  increase  the  proportion  of  fats  in  the  milk;  the 
water,  which  is  the  only  part  of  the  milk  directly  derived 
from  the  blood,  is  made  to  vary  by  the  amount  in 
the  mother's  diet,  and  by  longer  intervals  or  the  reverse, 
of  nursing,  and  the  relative  proportion  of  solids  is  thus 
modified.  A  wet-nurse  is  the  next  best  to  the  mother's 
milk.  It  is  not  necessary  here  to  go  into  the  question 
of  the  wet-nurse  ;  the  rules  which  apply  to  the  mother 
are  the  same  as  apply  to  her,  and  we  should  always  be 
on  our  guard  against  the  foolish  tendency  of  the  em* 
ployer  to  overfeed  her,  and  so  derange  the  milk  supply. 

And  now  I  come  to  the  question  of  artificial  feeding. 
I  cannot,  for  want  of  time,  deal  with  it  in  any  way  bat 
in  outline.  We,  of  course,  wish  to  imitate  nature's 
methods,  to  give,  at  a  temperature  of  about  100^  F., 
sterilised  food,  by  means  of  an  apparatus  which  shall 
not  exhaust  the  infant's  strength  in  sucking,  food  which 
shall  imitate  the  mother's  milk  as  closely  as  is  possible. 
At  present  the  methods  of  artificial  feeding  are  very 
diverse. 

The  digestion  of  infants  is  liable  to  be  seriously 
interfered  with  at  three  periods  of  life :  during  the  first 
start  of  artificial  feeding,  again  at  the  time  of  teething— 
at  these  periods  experiments  are  made  to  find  the 
best  food — and  again  at  weaning  from  the  bottle.  The 
first  period  (the  first  onset  of  the  infant's  artificial 
feeding)  is  the  most  important,  for  the  gastric  apparatus 
is  then  at  the  time  of  its  most  rapid  development,  and 
is  taking  on  for  the  first  time  its  new  duties. 

The  first  point  of  importance  is  that  of  the  quantity 
at  each  feeding ;  we  take  the  size  of  the  infant  stomach 
at  each  age,  as  the  guide  to  the  average  amount.  At 
five  days  old  the  average  stomach  will  contain  1  ounce 
of  fluid  ;  at  one  to  six  weeks,  1^  to  2  ounces ;  at  three 
to  six  months,  8  to  4  ounces ;  at  six  months,  6  ounces, 
and  at  eight  to  twelve  months,  8  ounces.    As  a  rule  you 


r 


SSSSl^i^Tat^         INFANT   FEEDING.  699 


Beviaw,  Kov.  %  1891. 


will  find  that  parents  give  the  proper  contents  of  the  six 
months'  stomach  from  the  very  first,  and  I  believe  that 
the  distension  of  the  stomach  resulting  from  this  is  the 
cause  of  the  majority  of  digestive  troubles  in  infancy. 
Those  who  have  made  many  post-mortem  examinations 
on  the  bodies  of  infants  have  been  struck  by  the  great 
proportion  of  dilated  stomachs;  I  do  not  think  that 
the  stomach  under  natural  conditions  would  ever  be 
dilated,  and  in  Table  I.  on  the  printed  paper,  I  have 
given  a  list  of  feeding  times  and  quantities,  which  will 
be  found  to  be  of  practical  use. 

Nature's  method  is  a  sterilizing  one ;  adults  get  their 
animal  food  sterilized  in  the  majority  of  instances,  and 
our  infants'  food  should  certainly  be  sterilized.  In 
conducting  the  process  of  sterilization,  it  is  well  to 
remember  that  it  is  easier  to  kill  the  developed  bacteria 
than  it  is  to  destroy  the  spores ;  if  all  the  spores  present 
in  the  milk  are  first  matured  they  will  be  in  the  com- 
plete form,  and  more  readily  killed,  hence,  the  best  plan 
of  sterilization  is  to  warm  the  milk  to  a  luke-warm 
heat  for  an  hour,  and  then  raise  it  to  a  heat  of  about 
160?  F.  for  twenty  minutes.  Steaming  the  milk  is  the 
best  way  to  keep  it  at  this  temperature.  In  my  own 
norsery  I  have  the  milk  divided  i^to  as  many  portions 
as  there  are  to  be  feedings  in  the  day,  these  are  placed 
in  bottles  which  they  completely  fill,  and  these  bottles 
are  stood  together  in  a  large  tin  potato  steamer;  any 
other  large  covered  metal  kitchen  utensil  will  answer. 
A  little  water  at  the  bottom  of  this  steamer  is  allowed  to 
boil  for  twenty  minutes,  when  the  bottles  are  corked 
with  clean  cotton  wool  plugs,  each  one  being  opened  for 
a  meal. 

It  is  worth  noting  that  if  milk  be  boiled,  chemical 
changes  take  place  which  modify  it  in  a  way  which  this 
lesser  heat  does  not  bring  about;  milk  sterilized  at 
boiling  heat,  is  less  completely  digested  than  that  at  a 
lower  temperature,  and  less  than  that  of  quite  raw 
milk.  There  is  in  milk  a  ferment  capable  of  rendering 
starch  liquid  and  assimilable,  which  ferment  is  destroyed 
by  boiling ;  this  is  of  importance  in  the  case  where  the 
infant  has  progressed  to  starchy  foods,  prepared  with 
milk. 

Then  again,  the  lesser  temperature,  whilst  completely 


700 


INFANT  FEEDING. 


Moptfaly  HJowMBopiftic 
Bei^ew,  Not.  S,  UU. 


sterilizing  the  milk,  does  not  destroy  the  milk  sugar,  or 
coagulate  the  albumen  of  the  milk. 

TABLE   III. 
Differences  between  Human  and  Cows'  Milk. 


Reaction... 


WOMEN. 

Slightly  Alkaline. 


COWS'  as  usually  received. 
Slightly  Acid. 


'^^^^'■}    Small  proportion. 

Large  proportion. 

Coagulation     )    Not  peroeptible 
by  acids   ... )       in  test  tube. 

Marked  in    test   tube,  greatest 
with  pure  milk,  less  with  milk 
diluted  with  water,  and  when 
6  water  to  I   milk,  not  per- 
ceptible. 

Water     87—88. 

86—87. 

Fat 4. 

4. 

Albumenoids...     1. 

4. 

Milk  Sugar    ...     7. 

4.5. 

^xSIl...         ...       ...       U.iS. 

0.7. 

Bacteria Not  present. 

Present. 

Table  III.  will  give  you  a  summary  of  the  differences 
between  human  and  cows'  milk.  Having  treated  of  the 
sterilization  which  gets  rid  of  the  last  item  on  the  table, 
the  bacteria,  we  have  to  render  the  milk  alkaline  in  place 
of  acid,  and  this  is  best  done  by  adding  half  a  fluid  ounce 
of  lime-water  to  each  half  pint,  after  the  heating,  so  as 
not  to  deposit  the  lime  ;  we  then  find  a  large  proportion 
of  albumenoids  in  cows'  milk  as  compared  with  human, 
and  this  excess  is  of  coagulable  albumenoids.  In  human 
milk,  the  albumenoids  are  less  easily  coagulable  by  heat. 
The  simplest  test  for  the  amount  of  albumenoids  is  a  fev 
drops  of  acid,  acetic  or  hydrochloric,  and  by  the  table 
you  will  see  that  to  bring  the  coagulability  of  the  albu- 
menoids in  cows'  milk  to  the  same  condition  as  in  human 
milk  we  must  add  five  volumes  of  water.  The  fats  are 
the  same  in  cows'  milk  as  in  the  human,  but  the  neces- 
sary dilution  of  the  cows'  milk  to  obtain  the  correct 
proportion  of  albumenoids  has  reduced  the  fat  and 
sugar  far  below  the  human  standard  ;  hence  it  is  neces- 
sary to  add  fats  and  sugar ;  cream  is  the  best  form  of  fat 
to  use,  and  milk  sugar.  Equal  parts  of  cream  and  milk 
sterilized,  and  added  to  five  parts  of  water,  and  alkalized 
by  the  subsequent  addition  of  lime  water,  with  the 
addition  of  half  ounce  of  milk  sugar  to  each  half  pint. 


£SS2'^rrSSS^        INFANT   PEEDINO.  701 


BerJew,  Noy.  2, 1891. 


will  make  an  artificial  human  milk,  which  I  have  on 
many  occasions  proved  to  be  extremely  valuable  in  prac- 
tice. Each  feeding  should  be  warmed  by  adding  the 
water  to  the  sterilized  milk  and  cream,  warmed  to  a 
little  over  100^  F.  Babies'  bottles  are  now  sold  with 
thermometers  attached,  which  render  this  easy  of  esti- 
mation. 

But  the  great  expense  of  cream  in  our  city  life  renders 
this,  the  best  artificial  food  I  know  of,  too  great  a  luxury 
for  many  of  our  clients,  and  the  want  of  brains  amongst 
many  of  them  makes  the  probability  of  their  preparing 
the  food  properly  very  small,  so  the  many  forms  of  ready 
prepared  foods  in  the  market  find  a  ready  sale.  Before 
speaking  of  them,  I  have  a  word  to  say  as  to  the  use  of 
milk  sugar. 

Cane  sugar  has  generally  been  used,  it  is  said  to  be  a 
preservative,  and  in  the  condensed  form  as  in  condensed 
milk,  it  has  such  a  power ;  but  the  milk  must  be  diluted 
for  use,  and  then  it  has  very  active  fermentive  powers 
in  the  stomach.  Milk  sugar  being  found  as  such  in  the 
milk  of  all  mammalia,  there  must  be  some  reason  for 
its  existence.  Both  cane  and  milk  sugar  are  changed 
into  glucose  in  the  intestines,  but  there  seems  to  be  some 
difference  in  the  extent  to  which  they  can  be  used  as 
nutriment,  before  they  are  thus  converted.  So  far  as  is 
known,  cane  sugar  is  merely  a  reserve,  and  is  not  used 
directly  for  nutrition  ;  milk  sugar  is  probably  not  only  a 
reserve,  but  is  used  as  a  nutrient ;  milk  sugar  dissolved 
in  water  and  injected  under  the  skin  does  not  appear 
in  the  urine,  but  cane  sugar,  under  the  same  conditions, 
is  eliminated  unchanged  ;  milk  sugar  undergoes  no  direct 
alcoholic  fermentation,  but  in  the  presence  of  nitro- 
genous ferments,  is  changed  into  lactic  acid,  whilst  cane 
sugar  readily  undergoes  alcoholic  fermentation,  and  only 
very  slowly  and  imperfectly  is  changed  into  lactic  acid. 
Lactic  acid  is  of  great  importance. 

In  the  upper  part  of  the  intestines  of  milk-fed  infants 
there  always  exists,  under  healthy  conditions,  a  bacillus 
which  is  perhaps  the  immediate  cause  of  this  change 
of  the  milk  sugar  into  lactic  acid.  It  is  found  that  the 
presence  of  this  bacillus  acts  upon  the  milk  sugar  so  as 
to  transform  it  into  lactic  acid,  and  lactic  acid  is  fatal  to 
many  other  bacilli  of  hurtful  kinds.  On  the  other  hand, 
the  butyric  fermentation  of  cane  sugar  is  a  fertile  source 


702  IHFANT   FEEDING.         "SSSL^SSTS! 


Baiftov,  Nor.  1,  UU. 


of  digestive  troable  in  in&nts.  On  the  whole,  thea,  we 
are  not  justified  in  using  a  vegetable  sugar,  which  is 
foreign  to  milk,  when  milk  sugar  is  available. 

Much  error  exists  as  to  the  supposed  evil  effects  of 
lactic  acid.  It  is  a  necessary  substance  for  the  proper 
digestion  of  milk,  and  a  far  larger  amount  of  it  may  be 
taken  than  is  present  in  ordinary  food  with  great 
benefit  in  cases  of  fermentive  diarrhoea.  But  I  would 
not  say  that  the  glucose  formed  from  cane  sugar  is  in 
any  way  more  hurtful  than  the  same  substance  formed 
from  milk  sugar.  It  is  on  the  road  to  the  change  from 
sugar  to  glucose  that  the  evils  arise  in  the  case  of  cane 
sugar.  There  are  many  foods  on  the  market  containing 
glucose,  ready  made,  which  prove  assimilable  by  infants. 

As  to  the  various  prepared  and  patent  foods,  they  may 
be  classed  under  different  heads : — 

1. — Condensed  milk  with  a  very  large  proportion  of 
cane  sugar. 

2, — Condensed  milk  without  sugar,  sterilized  milK 
food,  as  Loefiund's. 

8. — Peptonized  milk  foods. 

4. — Condensed  milk  with  cereals,  and  the  starch  un- 
changed, such  as  Nestle*s. 

5. — Powdered  dried  milk,  and  cereals,  the  milt 
partially  peptonized,  and  the  starch  partially  changed 
into  soluble  starch  and  dextrine,  as  Carnrick's. 

6. — ^A  cereal  food  with  the  whole  of  its  starch  con- 
verted into  glucose — ^Mellin's  Food. 

In  the  first  food,  the  condensed  milk,  we  have  on 
dilution  a  food  which  has  the  albumenoids  and  ash  in 
about  the  right  proportions,  the  sugar  also  as  to  amount 
about  right,  but  it  is  cane  sugar,  and  the  fat  is  ver}' 
much  under  the  proper  standard  ;  it  has  also  a  neutral 
reaction. 

The  production  of  animal  heat  is  so  important  to  the 
infant  that  we  are  not  surprised  at  the  large  amount  of 
fat  and  sugar  in  its  natural  food ;  a  great  excess  is 
required  as  compared  with  the  foods  of  adults,  and  no 
artificial  food  meets  the  wants  of  the  infant  which  has 
not  this  proper  excess.  Also  I  think  that  a  slight  excess 
of  fat  over  the  requirements  of  nutiition  has  a  great 
effect  for  good  in  the  process  of  defsecation.  To  this 
condensed  milk  food  it  is  therefore   necessary  to  add 


SSSi^N^ra?*        INFANT  PEEDINO.  70S 


Bflvifliw,  Not.  S,  IflU. 


cream  to  supply  the  fat,  and  the  reaction  must  be  made 
alkaline  with  lime  water  or  carbonate  of  soda. 

The  second  form  of  food,  sterilized  milk  without 
sugar,  on  dilution  gives  a  food  much  reduced  in  fat, 
sugar,  and  total  solids,  and  we  have  to  deal  with  it  as 
with  raw  cows'  milk. 

The  third  form  of  food,  peptonised  milk,  comes  under 
the  head  of  pre-digested  foods ;  under  ordinary  circum- 
stances, we  do  not  wish  the  normal  functions  of  digestion 
to  remain  in  abeyance.  This  pre-digesting  is  contrary 
to  nature's  teaching,  and  we  are  often  in  danger  of 
putting  into  the  infant's  stomach  too  great  an  amount  of 
digested  albumen.  The  healthy  infant  should  do  its 
own  digestion,  though  the  conversion  of  the  sugar  into 
glucose,  if  complete,  does  no  harm  to  the  infant  in 
artificial  foods,  and  partial  pre-digestion  may  be  resorted 
to  with  benefit  in  cases  of  illness. 

The  fourth  food,  containing  unchanged  starch,  is  one  of 
a  class  which  may  be  digested  sometimes  by  strong 
infants,  by  the  help  of  the  starch-liquifying  ferment  in 
milk,  but  a  large  proportion  of  the  starch  passes  through 
the  intestines  unchanged,  and  will  be  found  in  the  fseces 
of  all  infants  fed  on  these  foods.  Starch  is  a  substance 
entirely  foreign  to  human  milk,  though  infants  after  six 
months  of  age  may  digest  it,  as  their  salivary  and  pan- 
creatic secretions  are  suflBciently  developed ;  even  in 
infants  before  that  age  there  is  a  slight  power  of  trans- 
forming starch  into  glucose,  but  we  may  safely  take  it 
that  though  every  new  power  is  meant  for  use,  yet  it 
should  not  be  fully  taxed  during  its  period  of  develop- 
ment, with  the  full  work  which  it  will  easily  accomplish 
at  a  later  period,  and  a  function  will  always  develop 
finally  more  power  if  it  is  not  thus  overtaxed  at  the 
earlier  period. 

In  the  fifth  foods  we  have  the  starch  still  present,  but 
partially  changed  into  glucose,  and  the  milk  is  partially 
digested,  thus  sparing  the  functions  of  digestion  from 
work  partially.  The  objections  to  these  foods  are  the 
same  as  to  the  last  form,  but  less  in  degree. 

Finally,  we  have  Mellin's  food,  in  which  the  whole  of 
the  starch  is  converted  into  glucose,  the  final  product  of 
the  normal  digestion  of  the  milk  sugar.  This  is  the 
best  food  I  have  met  with.  My  personal  experience  of  it 
at  home  has  been  very  satisfactory.   The  analysis  on  the 


704  INFANT   FEEDING.         "^SS^^C^mST. 


printed  paper  shows  Mellin's  food  as  dilated  with  nulk 
and  water,  and  speaks  for  itself.  As  a  close  imitation  of 
human  mUk  I  have  found  it  useful  as  the  infant  grows 
to  gradually  educate  the  sugar  transforming  powers  by 
the  gradual  addition  of  milk  sugar  to  the  food,  and  lat^ 
on  to  add  gradually  free  starch  as  the  infant  develops 
the  power  to  deal  with  it. 

TABLE   IV. 

Analysis  op  Mellin's  Food  with  Cows'  Milk. 

Water    ...         ...        ...        ...        ...      85.34. 

Sugur    ...        ...        ...        ...        ...      6.95. 

J/  ft  U  •••  •••  •■•  •■•  •■•  Oa 

Albamenoids  ...        ...        ...        ...      4.45. 

^XBu  •••  ■••  •■•  •••  •••  \fm  %  mim 

No  Starch,  Food  entirely  soluble. 

Discussion. 

Dr.  Dudgeon  said  he  could  endorse  Mr.  Smith's  praises  of 
Mellin's  food,  which  he  had  found  very  satisfactory.  He 
differed  from  Mr.  Smith  in  his  recommendation  of  mixing 
lime-water  with  milk  indefinitely.  He  had  seen  diarrhoea 
traceable  to  this,  and  stopped  by  its  discontinuance.  He  did 
not  think  the  acidity  of  cows'  nulk  was  of  importance.  Child- 
ren, like  adults,  may  thrive  on  a  great  variety  of  aliments ; 
but  it  was  well  to  have  a  standard,  and  he  thought  the  Society 
was  indebted  to  Mr.  Smith  for  bringing  the  subject  forward 
so  ably. 

Dr.  Frank  Nankivell  endorsed  the  recommendation  of 
Melhn's  food  in  early  infancy.  After  six  months  he  found 
Chapman's  wheat  flour  very  good  for  strong  children. 

Dr.  Dyce  Bbown  thought  that  most  nursiug  women 
required  *'  stout,"  but  the  effect  on  the  baby  was  the  best 
guide.  When  menses  recurred  during  nursing,  there  was  no 
need  for  ceasing  nursing,  as  long  as  mother  and  baby  were 
well,  and  not  suffering  from  it.  Pregnancy  during  lactation 
was  so  rare  that  one  seldom  had  to  give  advice,  but  if  it 
should  occur,  lactation  should  cease.  Mr.  Smith's  recommen- 
dations were  excellent,  when  the  child  was  healthy.  The  diflS- 
culty  in  feeding  arose  when  milk  could  not  be  digested  in  any 
form.  In  such  cases,  peptonised  milk,  Benger's  food,  or 
barley  water  with  a  few  drops  of  Bovinine  or  Valentine's  meat 
juice  in  it,  answered  well.  Hards'  food  and  Bevalenta  were 
very  valuable,  and  much  Uked  by  babies.  He  mentioned  one 
case  where  Bevalenta  saved  the  child  after  aU  other  food  had 
failed.  The  Aylesbury  Dairy  Company's  '*  artificial  human 
milk  "  he  had  seen  very  successful  in  such  cases. 


SSSS^JLrsrSS?^^      infant  feeding.  705 


Beriew,  Nov.  a,  1891. 


Mr.  W.  S.  Cox  wondered  if  it  were  possible  to  instil  some 
of  these  truths  into  the  minds  of  mothers  among  the  poor. 
They  seemed  to  give  their  children  chops  and  beer,  or 
anything  that  was  going,  the  appalling  effects  of  which 
treatment  was  seen  in  the  infants  admitted  to  the  wards. 
These  children  almost  invariably  improved  on  the  hospital 
diet. 

Dr.  CiiiFTON  (Northampton)  said  the  remarks  of  Mr.  Smith 
hardly  applied  to  his  patients,  who  are  largely  factory  women. 
Nursing  during  menstruation  generally  does  tell  on  mothers 
and  children,  though  it  may  not  appear  to  do  so  at  the  time. 
He  often  traced  diarrhoea  in  infants  to  it.  Nursing  durin^^ 
pregnancy  causes  women  to  fall  away  and  gives  rise  to 
obstinate  constipation.  He  had  seen  as  much  ancemia  the 
last  four  years  as  he  had  in  the  twenty  years  previous,  and 
also  attended  with  obstinate  constipation. 

He  did  not  find  alcohol  required.  Plenty  of  milk,  cocoa,  and 
water  are  all  that  are  necessary.  Gold  water  is  food  for  infants ; 
especially  if  they  are  constipated.  He  always  advocated  the 
free  use  of  it.  With  regard  to  stomach  capacity,  he  doubted 
if  Mr.  Smith  took  into  account  the  difference  between  the 
living  stomach  and  the  dead ;  and  milk  did  not  stay  in  the 
stomach  long.  ''Sterilizing"  food  was  impossible  among 
the  poor.  Referring  to  the  effect  of  condensed  milk  in 
producing  rickets,  he  did  not  find  that  it  did.  When  the 
milk  is  deficient  in  fat,  if  cream  is  put  to  it,  it  often  gives 
diarrhoea.  He  found  two  or  three  drops  of  cod  liver  oil,  and 
shaking  them  well  together,  answered  admirably.  Mr.  Smith 
had  rightly  mentioned  the  periodical  weighing  of  the  child  as 
the  best  test  of  its  progress  ;  but  he  had  learned  one  equally 
good  from  an  old  nurse,  namely,  looking  at  its  buttocks. 

Mr.  Hurndall  thanked  the  President  for  the  courtesy 
extended  to  him  as  a  visitor,  whereby  he  was  permitted 
to  take  part  in  the  discussion  upon  the  important  subject 
so  ably  introduced  by  Dr.  Smith ;  and  he  appreciated 
the  opportunity  of  offering  a  few  remarks  the  more,  as 
Dr.  Smi^'s  subject  was  one  ahke  interesting  to  the  medical 
and  to  the  veterinary  professions.  In  some  respects  the 
difficulties  each  had  to  combat  in  flEMsing  the  problem,  how 
best  to  rear  the  young,  were  very  similar,  especially  as 
regards  the  various  forms  of  diarrhoea  affecting  the  very 
young.  In  considering  this  peculiar  pathological  condition 
as  it  affects  animals,  probably  bovines  suffered  more  than 
any  othei',  and  it  had  often  furnished  a  fruitful  subject  for 
earnest  consideration  in  his  own  mind  why  calves  were  so 
frequently  the  subjects  of  obstinate  diarrhoea,  and  like  Dr. 
Smith  with  children,  so  he  had  come  to  the  conclusion  that 


706  INFANT   FEEDING.         ^S^.l^;T?2S' 


Beview.  Nov.  %  1801. 


more  often  than  not  the  food  given  to  the  mother  was 
responsible  for  this  oft -repeated  condition.  Until  this 
evening  Mr.  Hurndall  had  been  under  the  impression  that 
children's  stomachs  and  digestive  organs  genexaliy  eonld  be 
trained  by  practice  to  bear  the  administration  of  raw  cow's 
milk,  and  he  gladly  took  this  opportunity  of  thanking 
Dr.  Smith  for  the  very  lucid  explanation  he  had  given 
whereby  it  was  made  clear  to  his  (Mr.  Humdall's)  mind  that  it 
was  far  safer  in  the  interests  of  the  child's  health  so  to  alter 
the  contituents  of  the  cow's  milk  as  to  make  it  as  nearly  as 
possible  like  the  woman's.  There  was  a  lesson  to  be  learned 
from  Dr.  Smith's  arguments  which  might  be  in  turn  usefully 
applied  to  nursing  animals. 

The  subject  of  cows'  milk  as  used  for  human  food  was  one 
of  intense  interest.  Dairies,  as  at  present  managed  in  ail 
large  centres  of  population,  were  simply  a  disgrace  to  our 
sanitary  laws ;  there  was  no  wonder  that  zymotic  disease  was 
rife  in  our  midst ;  Mr.  Hurndall  had  repeatedly  drawn  the 
attention  of  medical  men  to  this  matter,  and  he  was  glad 
once  more  to  have  the  opportunity  of  doing  so.  It  was  well 
known  that  milk  was  one  of  the  most  favourable  vehicles  for 
conveying  the  germs  of  disease  from  place  to  place,  and  until 
the  law  stepped  in  to  enforce  strict  cleanliness  in  all  things 
affecting  milk,  so  long  would  disease  be  spread  through  this 
medium ;  he  earnestly  commended  the  consideration  of  this 
subject  to  all  medical  men  with  a  view  to  secure  their 
influence  and  co-operation  with  members  of  his  own  pro- 
fesssion  in  bringing  about  a  change  for  the  better  in  this 
direction.  Mr.  Hurndall  would  assure  one  gentleman  who 
had  spoken,  that  cows  did  not  menstruate,  but  probably  a 
misapprehension  had  arisen,  inasmuch  as  cows,  after  parturi- 
tion were  periodically  the  subjects  of  asti^ua  until  such  time 
as  the  sexual  appetite  was  appeased,  and  during  the  periods  of 
4estnis  a  glutinous  discharge  coloured  with  blood  passed  from 
the  vagina  which  had  possibly  led  some  persons  to  con- 
clude that  cows  underwent  the  function  of  menstruation. 
Mr.  Hurndall  did  not  beheve  that  the  milk  of  the  really 
healthy  cow  contained  bacteria,  and  when  present  he  believed 
these  organisms  were  introduced  in  transitu ;  it  might  be  that 
the  organisms  described  by  Dir.  Smith  as  bacteria  were  really 
those  which  are  present  in  tuberculous  animals,  of  whidi 
unfortunately  we  have  a  tremendous  number  among  our 
herds,  particularly  highly  bred  herds  like  the  Bate's  shorthoms» 
in  this  country,  and  this  is  another  subject  which  in  the 
interests  of  the  health  of  the  community  at  large  calls  aloud 
for  stringent  investigation,  especially  when  discussing  the 
value  of  milk  as  a  food  article  for  young  susceptible  children. 


ftS3SS.^iS;T?S}"*         INFANT   FEEDING.  707 


Review,  Nor.  %  1691. 


In  conclusion,  Mr.  Hurndall  desired  to  thank  Dr.  Smith  for 
his  interesting  and  instructive  paper. 

The  President  asked  if  he  correctly  understood  Mr.  Hubn- 
DALL  that  milk  was  supplied  to  us  from  cows  which  were 
pregnant. 

Mr.  HxTBNDALL  Said  certainly  it  was  so. 

Dr.  MoiB  endorsed  Mr.  Cox's  remarks  on  the  impossibility 
of  feeding  the  infants  of  the  poor  properly.  It  was  impossible 
to  keep  bacteria  out  of  milk,  and  it  was  safer  to  give  artificial 
food  entirely.  The  point  brought  out  by  Mr.  Smith  on  over- 
feeding was  most  important.  Some  mothers  had  said  to  him 
that  they  nursed  their  children  every  half-hour.  He  agreed 
with  Dr.  Dyce  Brown  that  barley-water,  with  perhaps  a  little 
cream,  was  an  excellent  food  where  milk  was  not  tolerated. 
Mellin's  was  certainly  one  of  the  best  foods.  He  had  traced 
illness  to  milk  from  cows  kept  entirely  on  oil-cake  all  the 
winter,  never  being  let  out  from  the  cow-shed  for  three 
months. 

Mr.  Dm)LEY  Wright  thought  changes  were  made  in  cows^ 
food  at  different  times  of  the  year.  They  were  given  grains 
when  they  went  off  grass,  and  this  caused  diarrhoaa  in 
children.  An  important  thing  was  the  kind  of  bottle  used  ; 
they  should  have  no  tubes.  Goats'  milk  was  useful  at  times. 
It  is  very  important  to  choose  a  wet-nurse  carefully.  She 
should  be  healthy  and  have  a  healthy  family  history,  and 
her  own  child  should  be  the  same  age  as  that  of  the  one  she 
is  engaged  for.  The  breasts  should  be  full,  and  the  child 
should  be  evidently  satisfied. 

Dr.  Madden  said  the  form  of  the  bottle  was  important,  not 
only  from  the  point  of  cleanliness  but  also  from  the  desira- 
bility of  having  the  child  take  all  the  food  at  once  whilst 
warm,  and  not  be  allowed  to  keep  the  end  of  a  tube  in  its 
mouth  and  suck  every  now  and  then  from  a  bottle  beside  its 
cradle.  He  discussed  the  question  of  sterilisation  and  the 
importance  of  the  question  of  tuberculosis,  pointing  out  that 
they  were  quite  distinct  from  one  another.  Mr.  Smith's 
formula  differs  from  that  of  the  Aylesbury  Dairy  Company  in 
the  omission  of  any  attempt  to  remove  curds.  His  experience 
was  the  same  as  that  of  I)r.  Clifton,  that  no  advantage  was  to 
be  gained  from  alcohol  by  a  nursing  mother.  Stout  for  the 
mother  was  on  a  par  with  castor  oil  for  the  baby ;  they  were 
both  old  nurses'  traditions,  and  he  advised  against  both. 

Dr.  Galley  Blacklet  has  seen  much  of  children's  diseases 
in  Liverpool,  and  the  effects  of  bad  feeding.  He  read  a  book 
by  Dr.  Thomas  Inman  on  infant  feeding.  Dr.  Inman  advo- 
cated feeding  infisuits  in  marasmus  with  whiskey  (one  to 


708  ,     NEW   ZEALAND.  "SSSL=5!:f?^ 


Benew,  Nor.  %  JMU 


twenty  of  warm  water),  giving  nothing  else  for  three  or  four 
days.  The  child  knows  when  it  has  had  enough,  and 
apparently  gains  flesh. 

The  FfiEsmENT  (in  the  chair)  referred  to  his  experience  at 
the  Evelina  and  Children's  Hospital,  where  a  large  proportion 
of  patients  were  suffering  from  errors  of  feeding.  He  approved 
of  Mellin's  food,  but  he  had  noticed  that  at  first  it  seemed  to 
cause  diarrhoea.  He  was  of  opinion  that  alcohol  was  not 
needed  by  nursing  mothers.  It  had  been  said  that  some 
babies  could  not  take  milk.  He  suggested  barley-water  mixed 
with  veal  broth  as  the  best  thing  in  these  cases.  The  great 
difficulty  with  peptonised  food  was  to  disguise  the  bitter  taste. 
Begarding  Bevalenta,  he  recalled  a  remark  of  Dr.  Favy*s  that 
Bevalenta  was  a  very  dear  way  of  buying  ground  lentils.  He 
had  seen  two  cases  of  sloughing  of  cornea  in  children  fed 
exclusively  on  boiled  bread — ^bread  boiled  in  water.  One  child 
is  now  dead,  and  one  is  permanently  blind.  At  a  consulta- 
tion on  one  case  it  was  said  the  condition  was  more  like  that 
described  as  being  common  among  ''  skilly  '*-fed  prisoners. 

Mr.  Gerard  Smith  (in  reply)  said  starch  might  be  useful 
before  the  age  of  six  months  as  a  separator  of  curds.  It  does 
not  do  to  remove  all  the  curd.  He  asked  at  what  age  Dr. 
Clifton  gave  cold  water  ?  [Dr.  Clifton  gave  it  from  a  month 
upwards].  Beferring  to  cows'  milk,  he  said  certainly  it  yielded 
more  curd  than  children  could  digest.  Egyptian  cows  gave 
milk  which  was  much  more  digestible,  the  cows  not  having 
been  so  carefully  bred  to  produce  casein.  He  had  noticed 
the  diarrhoea  following  Mellin's  food,  but  it  was  only  for  a 
very  short  time.  He  did  not  underrate  the  action  of  the 
whiskey  in  Dr.  Blackley's  cases. 

NOTES    ON    THE    CLIMATOLOGY   AND    PEEVA- 
LENT  DISEASES  OP   NEW  ZEALAND.* 

By  John  Murray  Moore,  M.D.,  M.E.C.S.,  F.E.G.S.,  Ac. 

(Continued  from  page  641.) 

No.  III.  Climatic  Zonb 

includes  the  remainder  of  the  Middle  Island  from  lat.  48^ 
southwards,  and  the  South  or  Stewart's  Island.  The 
climate  is  more  like  that  of  the  British  Islands  than  any 
other  zone,  with  important  local  modifications.  We  may 
leave  out  of  consideration  the  inland  lakes,  except 
Queenstown  on  Lake  Wakatipu,  the  Windermere  of  New 


i£SS?^iS;TXJ"'  new   ZEALAND.  709 


Iteriaw,  Nor.  2. 1891. 


Zealand,  and  the  west  coast  Sounds,  which  are  not  yet 
inhabited.  But  for  examples  of  habitable  places  illus- 
trative of  this  Zone,  we  will  take  Christchurch,  Bealey, 
Queenstown,  Dunedin,  and  Invercargill. 

Christchurch,  the  "  Cathedral  City,"  or  '*  City  of  the 
Plains,"  as  it  is  called,  is  the  important  capital  of  the 
province  of  Canterbury  where  the  largest  plain  in  New 
Zealand  exists,  on  which  very  fine  wheat  is  grown.  The 
winds  from  the  S.W.  and  W.  in  summer  lose  their 
moisture  in  passing  over  the  lofty  range  of  the  southern 
Alps,  and  become  so  heated  in  passing  over  this  plain 
that,  by  the  time  they  reach  Christchurch,  situated  at 
its  eastern  edge,  and  shut  off  from  the  cooling  influence 
of  the  sea  by  the  Lyttelton  hills,  the  inhabitants  suffer 
from  a  slight  imitation  of  an  Australian  hot  wind,  for  a 
few  days  in  the  year.  On  the  other  hand,  in  winter 
these  winds  pass  over  the  snow-clad  Alps  and  blow  very 
cold  in  Christchurch.  But  the  spring  and  autumn 
weather  in  this  city  is  perfect.  Some  cases  of  asthma 
do  well  here,  for  the  dryness  of  the  air  is  remarkable ; 
but  I  cannot  recommend  any  consumptive  or  bronchitic 
person  to  this  part.  Indeed  I  remember  distinctly 
that  a  bank  cashier,  who  had  had  a  cavity  in  his  phthisi- 
cal  lung  completely  healed  up,  and  had  enjoyed  life 
thorou^y  in  Auckland  for,  I  think,  four  years,  collapsed 
shortly  after  the  bank  removed  him  to  Christchurch. 

Bealey,  a  mountain  station  on  the  road  to  Hokitika, 
2,104  ft.  above  the  sea,  and  Queenstown  1,070  ft.,  have 
very  pleasant  cool  summer  climates,  54^  and  64^ 
respectfuUy.  The  former  is  the  coldest  metereological 
station  in  New  Zealand,  there  being  in  winter  20^  of 
frost,  and  the  average  for  the  whole  winter  (for  18 
years)  being  46^.  The  latter  is  a  capital  sanatorium  for 
invalids  convalescing  from  fevers,  exanthemata  or  any 
acute  pulmonary  disease  contracted  in  Dunedin  or  anj^ 
other  sea-side  town  in  this  Zone.  Queenstown  is  the 
most  healthy  and  enjoyable  summer  place  of  residence  in 
the  colony,  being  on  a  grand  lake  full  of  fish,  not  Uable 
to  sudden  storms  (therefore  safe  for  boating),  and  sur- 
rounded by  mountains  that  can  be  ascended  without 
either  danger  or  hardship.  It  has  a  winter  mean 
temperature  of  40^,  the  same  figure  as  that  of  Green- 
wich, Oxford,  and  Manchester  (1861-84.)  This  Zone« 
especially  the  Dunedin  section,  affords  a  pleasant  and 

ToL  35,  No.  11.  3D 


710  NEW    ZEALAND.  *^SSS,^C??SJ! 


bracing  change  from  the  heats  of  the  North  Island,  though 
the  transition  in  a  week  from  a  shade  temperature  of  80^ 
to  one  of  60°,  or  even  to  47°  at  night,  as  I  found  it,  causes 
in  some  sensitive  persons  a  functional  derangement  of 
the  kidneys  by  the  sudden  check  given  to  the  cutaneous 
perspiration.  This  is  soon  righted,  and  if  the  invalid 
returns  north  not  later  in  the  summer  than  March,  he 
will  keep  in  good  health.  I  do  not  advise  any  patient 
suffering  from  chest  complaint  to  go  to  Dunedin ;  but 
for  some  cases  of  dyspepsia  and  liver  inaction  caused  by 
the  heat  of  other  Zones,  the  climate  is  beneficial. 

No.  IV.  Climatic  Zone 

is  marked  by  a  circle  (which  the  printer  has  made  rather 
too  large)  in  the  centre  of  the  North  Island.  It  is  the 
nearest  approach  in  New  Zealand  to  the  *'  high  altitude 
climate  "  of  climatologists,  and  as  such  deserves  the 
separation  from  Zone  No.  I.  that  I  have  made.  This 
Zone  consists  of  an  extensive  inland  plateau  3,000  square 
miles  in  extent,  with  Lake  Taupo  as  its  centre,  and 
having  an  average  elevation  above  sea-level  of  about 
1,200  ft.  Standing  round  this  lake  are  all  the  volcanoes, 
both  extinct  and  active,  of  the  North  Island.  The  highest 
of  the  extinct  ones  is  Mt.  Buapehu,  8,878  ft.  high  ;  and 
the  active  one,  Ngauruhoe,  is  near  it,  7,481  ft.  It  was 
in  this  district  that  Mt.  Tarawera  broke  suddenly  oat 
into  eruption  on  the  night  of  June  10th,  1886,  an  event 
which  is  of  tremendous  significance  in  the  topographical 
history  of  New  Zealand,  having  destroyed  the  Sinter 
Terraces,  which  were  the  great  attraction  of  New  Zealand, 
and  foreshadowing,  it  may  be,  still  more  destructive 
events  in  the  future.  BtU  this  outbreak  may  give  quiet 
and  peace  to  the  local  disturbances  of  the  earth's  crust 
for  many  years  to  come. 

The  soil  being  of  pumice,  lava,  scoria,  friable  earth, 
and  sand,  the  rain  that  falls  in  this  Zone  soon  evapo- 
rates. The  light,  clear  atmosphere,  more  rarefied  than 
at  sea-level,  and  much  more  free  from  gales  (see  page  636), 
particularly  suits  asthmatic  and  emphysematous  cases, 
which  are  worse  at  sea-level,  and  those  neurotic  persons 
who  during  hot  weather  suffer  from  insomnia  at  the  sea- 
coast,  or  in  the  valleys. 

This  Zone  contains  the  Hot  Lake  District,  where  the 


SSSS'iSrrJSSi"*  NEW   ZEALAND.  711 


,  Not.  8, 1801. 


famous  and  very  numerous  thermal  sulphur  and  other 
springs  are  found. 

Having  condensed  in  my  fifth  chapter  all  the  informa- 
tion up  to  date  given  hy  the  medical  pamphlets  on  the 
enbject,  the  reports  of  Sir  James  Hector,  and  my  own 
personal  experience,  I  need  not  enlarge  on  this  subject, 
further  than  to  state  that  the  world-wide  reputation  of 
these  baths — for  they  are  too  rich  in  acids  and  salts  to  be 
imbibed — in  the  cure  of  rheumatism,  gout,  rheumatic 
gout,  sciatica,  and  other  neuralgias,  functional  local 
paralysis,  scrofulous  diseases  of  the  joints,  amenorrhoea, 
general  chronic  eczema,  psoriasis,  ringworm,  and  secon- 
dary syphilides,  is  amply  warranted  by  facts  withm  my 
knowledge.  On  the  other  hand,  no  patients  suffering 
from  far  advanced  pulmonary  phthisis;  from  chronic 
Bright's  disease;  from  spinal  caries;  from  myelitis;  from 
cerebral  softening ;  or  from  organic  valvular  disease  of 
the  heart,  should  be  sent  there.  The  definite  and  cate- 
gorical information  now  supplied  in  this  chapter  now 
enables  the  medical  attendant  in  England  to  select  for  a 
patient  who  is  intending  to  take  the  voyage  to  New 
Zealand  the  particular  spring  or  group  of  springs  that 
will  best  suit  his  disease.  But  in  all  cases  the  local 
balneologist  must  be  consulted  how  to  use  it,  or  them, 
as  the  case  may  be. 

And  now  I  must  speak  of  the  diseases  which  are  cured, 
or  alleviated,  or  not  benefitted  by  these  four  climates, 
and  by  the  sea-voyage.  The  most  important  and  most 
frequent  of  these,  for  which  New  Zealand  is  sought,  is 
pulmonary  consumption.  Now,  I  strongly  urge  patients 
who  are  far  advanced  in  the  second  stage  of  phthisis  ; 
patients  suffering  from  phthisis  florida  or  hssmorrhagic 
phthisis ;  and  those  affected  with  laryngeal  phthisis,  not 
to  go  to  New  Zealand.  If  they  are  "  bad  sailors,"  as  it 
is  termed,  even  the  sea- voyage,  usually  the  most  bene- 
ficial element  in  the  whole  trip  to  the  Antipodes,  will 
injure  them,  for  in  my  experience  as  ship's  surgeon,  I 
have  found  consumptive  passengers  quite  as  liable  to 
sea-sickness  as  healthy  persons,  and  serious  haemorrhages 
from  the  lungs  are  often  superinduced  by  the  vomiting 
and  straining.  I  have  seen  such  patients,  alas !  land  in 
Auckland  but  to  die  amongst  strangers  and  far  from 
their  homes,  within  two  or  three  months  of  their  arrival. 
I  would  limit  my  recommendation  of  New  Zealand  as  a 

3  D— 2 


712  NEW   ZEALAND.  "^L'^^S??:^ 


Beriew,  Nor.  S,  18B1» 


*'  cure "  for  consumption  to  well-diagnosed  cases  of 
genuine  tuberculosis  in  its  first  stage ;  chronic  pneu- 
monic phthisis  (of  which  most  cases  of  so-called  con- 
sumption consist) ;  chronic  unresolved  pneumonia  with 
emaciation,  chronic  pleurisy  with  adhesions;  chronic 
bronchitis  with  purulent  sputa,  and  simple  (not  tuber- 
culous) chronic  laryngeal  iilceration.  In  all  such  cases 
the  powers  of  primary  digestion  should  be  in  fair  con- 
dition. Then,  again,  to  obtain  benefit  from  any  of  these 
climates  the  patient  must  be  able  to  take  some  exercise, 
even  if  it  is  only  driving  in  the  open  air.  The  colonial 
houses  are  mostly  wooden,  often  damp  and  insufficienth^ 
warmed  in  winter,  but  far  too  hot  and  "  close  "  in  the 
height  of  summer.  Also  the  patient  should  have  the 
faculty  of  cheerfully  adapting  himself  or  herself  to  new 
surroundings,  new  neighbours,  and  so  on.  If  the  con- 
sumptive visitor  must  work  for  his  living,  let  him  go 
round  the  farms  and  seek  employment,  rather  than  follow 
any  indoor  trade.  Many  lives  have  been  saved  by  this 
constant  living  in  the  pure  air  of  the  country,  and 
especially  when  horseback-riding  has  been  the  means  of 
locomotion.  It  is  far  preferable  to  driving  in  a  buggy  or 
dog-cart,  for  the  roads  get  worn  into  deep  ruts  and  cross 
channels  in  the  rainy  season,  and  the  jolting  becomes 
excruciating  to  an  invalid,  as  well  as  dangerous  after 
dark.  On  the  other  hand,  the  worst  thing  a  consumptive 
visitor  can  do  is,  as  soon  as  he  begins  to  feel  better,  to 
attempt  too  much  sighUseevng  and  exploration.  The  most 
essential  rules  for  him  are  to  eat  regularly,  and  to  care- 
fully avoid  over-fatigue  and  getting  wet.  New  Zealand 
being  full  of  natural  wonders,  being  absolutely  free  from 
wild  beasts,  snakes,  malaria,  and  venomdus  insects 
(except  the  rare  Katipo  spider) ;  and  travel  through  the 
wildest  Maori  districts  being  perfectly  safe,  the  invalid  is 
apt  to  forget  himself  in  his  enthusiasm,  and  become 
a  tourist,  with,  perhaps,  even  mountaineering  ambi- 
tion. 

One  word  as  to  stimulants  in  New  Zealand.  I  advise 
invalids  not  to  attempt  to  drink  the  same  amount  or 
kind  as  at  home.  The  stimulating  air  of  the  Colony 
renders  it  unnecessary  for  them  to  take  port  wine,  stout, 
or  whiskey.  The  lightest  of  the  Australian  wines,  light 
Colonial  or  lager  beer,  and  efiervescent  teetotal  drinks 
(such  as  Zoedone)  are  quite  sufficient.   The  new  whiskey 


Jt^^^^n^'  NEW   ZEALAND.  713 


Beview.  Nov.  2,  ISBl. 


sold  everywhere  is  most  deleterious,  and  cannot  be  too 
carefully  avoided. 

Of  high  alpine  sanatoria,  resembling  those  of  the 
Engadine,  the  Andes,  or  Colorado,  New  Zealand  pos- 
sesses none,  though  Zone  No.  IV.  gives  some  of  their 
advantages,  combined  with  the  vast  resom-ces  of  the 
thermal  springs. 

But  I  could  point  out  at  least  nine  localities*  in  the 
Colony  where  an  enterprising  capitalist,  who  understands 
its  management,  could  erect  a  hydropathic  establish- 
ment, or  family  hotel,  which  would  become  a  great 
success,  because  of  its  meeting  a  real  need  in  New 
Zealand. 

The  general  effect  of  the  climate  of  No.  I.  Zone  upon 
the  consumptive  and  bronchial  sufferer  is  sedative ;  that 
of  Zone  No.  U.  is  sedative  on  the  east  coast,  and  tonic 
on  the  west ;  that  of  Zone  IV.  is  both  tonic  and  slightly 
stimulant.  (I  am  here  using  Dr.  Lindsay's  terms,  which 
are  accepted  by  medical  writers  on  climate.)  Zone  III. 
is  to  be  avoided  altogether.  If  we  accept  Hirschberg's 
conclusions  as  to  the  values  of  certain  climates  in  phthi- 
sis, I  should  place  New  Zealand  as  a  whole,  with  the  limi- 
tations I  have  now  given,  fifth  in  order  of  merit — 1st, 
Upper  Egypt;  2nd,  Tunis;  3rd,  Sicily;  4th,  Gulf  of 
Naples;  5th,  New  Zealand;  6th,  Corfu;  7th,  the  Kiviera. 
The  sea-voyage  commences  the  improvement,  in  cases 
suited  to  it,  which  the  climate  develops,  extends,  and 
often  renders  permanent.  But  the  consumptive  must  be 
warned  beforehand,  that  residence  in  New  Zealand,  not 
merely  wintering  there,  is  the  only  hope  of  permatient 
cure  if  he  has  already  reached  the  second  stage  of  the 
disease.  Our  November  fogs  and  March  winds  have 
killed  many  a  patient  who  has  rashly  ventured  back 
home,  thinking  his  lungs  a  proof  against  our  harsh, 
treacherous  and  most  uncertain  climate.  For  myself, 
though  never  consumptive,  I  have  to  thank  the  New 
Zealand  climate  for  completely  banishing  those  attacks 
of  bronchitis,  catarrh,  and  ulcerated  throat  that  I 
suffered  from  previous  to  1879.  The  sea-voyage  of  seven 
weeks  also  cleared  off   entirely  from  the  blood  that 

*  In  tlie  North  Island,  Great  Barrier  I.,  Howick,  Waitakerei.  Mana- 
snkiu  Gorge ;  in  the  Middle  Island,  Pioton,  Bealey,  Qneenstown,  Lake 
Te  Anau. 


714  NEW   ZEALAND.  "Sj&^^SfS?^.! 


Beview,  Not.  S,  18B1. 


tendency  to  carbuncles,  from  which  I  soffered  during  the 
summer  and  autumn  of  that  year.  Of  all  agents, 
medicinal  or  otherwise,  pure  sea-air  has  the  most  sooth- 
ing effect  on  functional  palpitation  of  the  heart ;  and  this 
benefit  is  experienced  to  the  full  on  the  voyage  to  New 
Zealand  by  the  direct  mail  steamers. 

For  any  individual  who  has  a  predisposition  to  apo- 
plexy, meningitis,  or  insanity.  New  Zealand,  as  a  whole^ 
is  unsuitable  as  a  residence. 

Diseases  Prevalent  in  New  Zealand. 

I  HAVE  now  to  notice  some  of  the  diseases  we  find  at  the 
present  day  in  the  Colony,  which,  however,  presents  no 
malarious  fevers,  or  any  other  heed  end^nic  disease 
due  to  its  80x1,  climate,  or  vegetation.  Hydrophobia  is 
unknown,  and  sunstroke  is  very  rare.  True,  the  Maoris 
suffer  from  rheumatism,  and  from  true  phthisis,  due  to 
their  wretched  food  and  reckless  habits  of  sleeping  on 
wet  ground.  They  are  slowly  dying  out,  as  the  inevitable 
result  of  an  imperfect  civilization,  the  vices  of  which  are 
acquired  before  the  virtues.  The  Colonial  Government 
strenuously  endeavour  to  arrest  the  decay  of  the 
aboriginal  tribes  by  providing  huts,  food,  clothing, 
medicine,  doctors,  and  so  on,  but  the  race  is  melting 
away,  though  the  Maori  has  more  largely  intermarried 
with  the  European  than  has  any  other  native  race. 
The  children  of  half-castes,  however,  as  a  rule,  either 
die  prematurely,  or  are  sterile  when  they  marry. 

Leprosy,  ascribed  by  the  Maoris  to  eating  a  certain 
fish  found  in  Lake  Taupo>  and  syphilis  exist  among  the 
natives,  also  scrofula  in  all  forms,  chronic  rheumatism, 
and  numerous  forms  of  skin  disease. 

But  I  must  limit  my  remarks  to  the  diseases  that 
prevail  among  the  colonists,  referring  you  to  my  Xllth 
chapter  for  fuller  details. 

1. — Insanity  n 

At  first  sight  mental  diseases  would  seem  to  be  very 
prevalent  in  New  Zealand,  1,684  lunatics  remaining  in  the 
seven  public  lunatic  asylums  at  the  end  of  1888,  out  of  a 
total  population  of  610,000,  being  a  rather  large  propor- 
tion. But  we  find,  on  comparison,  that  New  Zealand  ranks 
third,  and  not  first  or  second,  among  the  Australasian 


H^J^^^t:^^'  NEW   ZEALAND. 715 

Colonies,  in  a  table  drawn  up  in  1885 ;  for  while — 
Victoria  had  one  lunatic  for  297  of  the  general  population 
New  South  Wales        „       874    „  „  „ 

New  Zealand  „       401     „  „  „ 

In  the  official  returns  are  included  many  lunatics  who 
are  shipped  oflf  by  their  relatives  to  this,  the  remotest 
part  of  the  British  Empire.  Their  mental  state  is  not 
improved  by  the  voyage,  and  the  stimulating  atmosphere 
of  New  Zealand  aggravates  their  malady.  In  1885, 
England  and  Wales  had  more  lunatics  (one  to  889  of 
the  general  population)  than  New  Zealand.  But  there 
is  an  undue  amount  of  mental  derangement  among  New 
Zealand  residents,  due  to  (1)  drink,  (2)  depressing 
mental  emotions  and  speculation,  (8)  solitude,  (4)  spirit- 
ualism, (5)  religious  excitement.  As  regards  the  first  of 
these  causes — drink — about  1,500  lives  per  annum  are 
lost  directly  or  indirectly  through  alcohol,  being  about 
one  for  every  public-house  in  the  colony.  The  social 
customs  of  the  New  Zealanders  need  some  reformation 
in  this  respect,  though  I  must  state,  in  all  fairness,  that 
"  Young  New  Zealand  "  is  temperate  on  the  whole. 

2. — Typhoid  Fever 

is  deplorably  prevalent  in  the  towns,  owing  to  the  want 
of  sub-soil  drainage  and  of  water-closets,  and  the  in- 
sanitary state  in  which  the  inhabitants  keep  their  back 
yards.  If  any  of  my  audience  have  been  in  Australia  or 
New  Zealand  they  will  know  what  a  "  dunnikin " 
("  dinna  ken ' ')  means,  and  can  substantiate  my  statement. 
But  this  disease  is  very  prevalent  in  all  New  Zealand 
towns  in  the  later  summer  and  in  the  autumn  months, 
and  the  mortality  in  Auckland  was  each  year  from  16  to 
22  per  cent.  I  have  notes  of  40  consecutive  cases  (24 
males  and  16  females)  of  which  only  one  died, — an  over- 
worked schoolboy,  in  whom  meningitis  set  in  on  the 
fifth  day  of  the  disease  and  carried  him  off  on  the  fourth 
day  of  my  attendance.  The  disease  attacks  all  classes. 
The  Earl  of  Onslow,  the  present  Governor  of  New 
Zealand,  had  only  been  a  few  months  in  Wellington, 
before  his  eldest  son  and  the  military  aide-de-camp  were 
seized  with  it,  and  nearly  lost  their  lives.  On  the  other 
hand  typhus  fever  is  an  unknown  disease  in  New 
Zealand. 


716  NEW   ZEALAND.  *^SS^^Sf?^* 


Beriew,  Nor.  2, 18B1. 


3. — Entozoa 

are  very  common  in  young  people  and  children.  In  the 
country  this  parasitic  disease  is  to  be  accounted  for  by 
the  contamination  of  the  streams  by  the  excreta  of  sheep, 
dogs,  and  pigs,  which  contain  the  ova  or  half-way  forms 
(scolex)  of  some  intestinal  worm ;  and  in  the  towns,  the 
water  of  the  house-tank,  collected  from  the  rain  which 
falls  on  the  roof  made  of  shingles  or  of  corrugated  iron, 
is  apt  to  be  infested  with  the  embryos  of  tsenia,  ascaris, 
or  lumbricus,  derived  from  the  domestic  cat,  or  the 
sparrows  which  abound  everywhere.  It  is  a  rare  thing 
to  find  a  filter  in  any  New  Zealand  household;  if  it  were 
common,  much  of  this  disease  would  be  avoided. 

4. — Carcinoyna, 

in  the  form  of  epithelioma  of  the  lip  or  uterus,  and  in 
the  form  of  schirrhus  of  the  mammsB  or  cervix  uteri,  is 
rather  frequent  in  the  Colony.  I  have  seen  cases  of 
undoubted  schirrhus  and  of  fungus  haematodes  in  women 
at  as  early  an  age  as  85.  The  patients  from  country 
districts  who  came  from  remote  parts  of  the  province  to 
consult  me  in  Auckland,  resided,  I  found,  in  valleys, 
damp  in  winter,  and  liable  to  floods ;  and  they  had  been 
subject  both  to  privations  in  their  early  colonial  days, 
and  to  very  hard  work  ever  since  that  period.  Neglected 
simple  ulceration  of  the  os  and  cervix  uteri  showed  a 
greater  tendency  than  in  England  to  degenerate  into 
carcinoma. 

6. — Premature  Caries  of  the  Teeth 

is  a  marked  phenomenon  of  residence  in  Auckland  and 
some  other  towns,  in  both  adults  and  children.  It  is 
attributed  to  the  softness  of  the  drinking-water,  which  is 
deficient  in  lime.  The  Maoris,  however,  as  a  rule, 
have  very  good  teeth.  The  dentists  seem  to  do  a 
thriving  business  everywhere  in  New  Zealand.  Cases 
of  neuralgia,  dependent  on  this  caries,  are,  of  course, 
very  plentiful  in  towns  where  this  is  prevalent,  and  I 
cannot  say  that  the  above  explanation  entirely  satisfies 
the  mind  where  we  see  the  natives,  in  the  same  localities, 
retaining  their  molars  to  a  good  old  age. 

The  exanthemata  run  a  mild  course  in  New  Zealand. 
In  such  a  mild  climate  as  that  of  Zones  I.  and  11.  more 


^"^n^^TS^"  ^EW   ZEALAND, 717 

complete  day  and  night  ventilation  is  possible  than  in 
England,  and  infection  is  thus  limited  by  dilation  of  the 
poison. 

Acute  inflammatory  diseases,  such  as  acute  rheu- 
matism, are  milder  in  their  nature,  and  yield  more 
readily  to  the  appropriate  homoeopathic  remedy  than 
at  home. 

I  will  now  quote  three  cases  occurring  in  my  own 
practice  in  New  Zealand  of  more  than  common  interest. 
They  are  eases  of  (1)  melancholia,  (2)  cataract,  (S)  hyda- 
tids of  uterus. 

Case  I. 

Mrs.  B.,  a  widow,  aged  57,  sent  for  me,  August  16th, 
1884.  I  found  her  labouring  under  the  delusion  that 
**  she  was  too  wicked  a  sinner  to  live,"  that  she  ought  to 
die,  and  refusing  all  food  with  the  object  of  starving 
herself  to  death.  On  questioning  her  four  daughters, 
who  were  nursing  her,  I  found  that  she  had  suffered  a 
similar  attack  of  melancholia  ten  years  before,  in  1874, 
after  the  death  of  her  husband,  from  excessive  grief  at 
her  bereavement.  She  had  been  in  good  bodily  health 
before  this  second  attack,  and  no  definite  cause  could  be 
assigned  for  it.  The  skin  was,  I  found,  rather  hot,  and 
the  pulse  eighty-four ;  she  was  absolutely  sleepless.  As 
the  family  refused  to  have  her  committed  to  the  General 
Asylum,  which  was  always  overcrowded,  and  decUned  a 
professional  nurse,  I  had  to  arrange  for  domestic 
nursing,  which  is  not  sufficiently  strict  in  such  cases. 
The  four  daughters  took  it  in  turn  to  watch  her  night 
and  day.  I  prescribed  aiinun  muriaticum  5  and  gel- 
semiam  <f>  at  bedtime.  She  would  take  food  from  me  and 
from  no  one  else,  and  so  she  got  nourishment  only  at  my 
daily  visits.  But  her  delusions  gradually  cleared  away,  and 
by  September  15th  she  was  conscious  once  more.  All 
that  had  passed  since  the  beginning  of  her  attack  of 
insanity  was  a  blank.  She  had  forgotten  it  more  com- 
pletely than  a  dream.  On  the  24th  November  she  was 
threatened  with  a  return  of  the  melancholia,  which 
ignatia  and  m^rc.  corros.,  given  in  alternation,  cleared 
away  speedily.  From  that  time  till  my  departure  in 
September,  1888,  Mrs.  B.  remained  perfectly  well 
and  sane. 


718  NEW   ZEALAND.         "SSSL^ST?^* 


Eciview,  Not.  2, 1801. 


Case  U. 

The  first  case  of  cataract  which  I  treated  homoeo- 
pathically  on  the  plan  suggested  by  my  friend,  Dr.  Bur- 
nett, was  of  special  interest  to  me,  and  though  un- 
finished, I  hope  it  may  interest  you.  On  June  20th, 
1881,  a  rosy-faced,  healthy-looking,  stout  woman,  aged 
59,  Miss  P.  by  name,  consulted  me  about  her  faihng 
sight.  She  stated  that  one  year  previously,  while  cutting 
down  creepers  in  the  ''  bush,"  as  the  forest  is  called  in 
New  Zealand,  a  thorny  branch  had  sprung  backwards 
and  struck  her  left  eyeball  full  in  the  centre  of  the 
pupil.  Some  local  redness,  pain,  and  inflammation 
followed,  which  had  been  speedily  subdued,  but  the  sight 
became  dimmer  and  weaker  from  that  day.  She  cannot 
now  see  the  middle  of  any  large  object  plainly,  cannot 
see  the  divisions  of  the  window-panes ;  cannot  see  the 
full  moon  on  a  clear  night,  nor  her  own  features  in  the 
mirror ;  she  can  but  distinguish  light  from  darkness. 
On  examination  with  the  ophthalmoscope  I  found  a  soft 
lenticular  cataract  blocking  up  the  greater  part  of  the 
left  lens,  no  other  lesion  in  that  or  in  the  other  eye. 
The  sight  of  the  right  eye  was  weakened  by  the  double 
strain  that  had  been  put  upon  it  during  the  twelve 
months  of  increasing  blindness.  As  she  had  no  other 
derangement  of  health,  I  thought  the  case  a  hopeful  one 
for  a  steady  homoeopathic  treatment,  and  prescribed 
aecale  comatum  8.  If  one  searches  the  records  of 
epidemics  of  ergotism,  for  instance,  that  recorded  by 
Meyer,  in  1861,  cataract  will  be  found  to  be  among  the 
toxic  effects.  (See  Allen,  vol.  viii.,  p.  557 : — "  After  the 
epidemic  an  unusually  large  number  of  cataracts  occurred 
in  young  people,  twenty-three  of  whom  gradually  became 
blind.  ...  Of  the  cataracts  two  were  hard,  twelve  soft, 
and  nine  mixed  "). 

On  July  18th«  the  report  is  encouraging.  She  can 
now  perceive  the  full  moon  as  a  reddish  disc  of  Hght ; 
continue  secale.  August  17th — still  fmther  improve- 
ment— the  moon's  natural  colour  can  now  be  perceived, 
the  flame  of  a  kerosene  lamp  distinguishable  from  that 
of  a  candle,  which  was  not  so  before.  The  cataractous 
lens  is  plainly  seen  to  be  clearing  from  its  edges ; 
continue  aecale.  From  September  17th  to  October  25th,. 
the  treatment  was  interrupted  by  an  attack  of  bronchitis. 


jafii'TSTrffi?""  NEW   ZEALAND.  719 


,  Not.  2, 1801. 


which  was  arrested  by  arsenicuvi  and  ipecac.  She  then 
got  secale  80,  and  cannabis  sativa  1  on  alternate  weeks. 
November  21st — the  lens  is  visibly  clearer,  and  the  sight 
still  farther  improved;  chelidonium  1  and  cannabis 
sativa  1  on  alternate  weeks.  On  March  25th,  1882,  nine 
months  from  commencing  treatment,  Miss  P.  coald 
distinguish  her  own  features  in  the  mirror,  and  some 
objects  in  my  consulting  room  which  had  been  hitherto 
invisible  to  her.  AprU  26th — the  improvement  being 
apparently  stationary,  I  prescribed  j[j/io«.  30.  Jime 
24th — same.  August  26th — still  more  objects  could  be 
defined,  and  colours  could  be  distinguished ;  chelidonium 
and  phos.  8  in  alternation.  She  had  to  discontinue 
attendance  because  of  the  bad  state  of  the  roads  between 
her  farm  and  Auckland  in  winter,  but  she  promised  to 
write  to  my  chemist  for  the  medicines,  and  I  heard 
afterwards  that  she  had  done  so;  but  I  did  not  hear 
whether  the  cataract  ever  quite  disappeared. 

Case  III. 

Hydatids  of  the  uterus  are  sufficiently  uncommon  to 
make  the  following  case  of  some  interest.  These  para- 
sites infect  the  Australian  settlers  more  than  the  New 
Zealanders;  but  among  the  shepherds  of  the  middle 
island,  who  live  for  months  exclusively  on  mutton,  cases 
of  this  disease  sometimes  occur. 

Mrs.  W.,  aged  65,  the  Maori  widow  of  a  deceased  armj- 
officer,  Capt.  W.,  sent  for  me  September  11th,  1881. 
Her  former  medical  adviser  had  told  her  she  "  had  cancer 
of  the  womb,"  and  she  was  greatly  alarmed.  She  looked 
pale  for  a  Maori,  but  scarcely  cachectic,  and  was  losing 
flesh  and  strength  rapidly.  On  examination  I  found  the 
uterus  enlarged  to  the  size  of  the  fourth  month  of 
pregnancy;  the  cervix  was  not  fixed,  nor  were  there 
ulceration  or  rugosities  of  the  os  uteri.  From  the  os 
issued  a  profuse,  foetid,  purulent  discharge,  the  foetor  of 
which  was  not,  however,  the  peculiar,  sickening  foetor  of 
cancer.  I  ordered  vaginal  injections  of  hot  water  in 
which  Condy*s  fluid  was  mixed,  and  prescribed  thtrja  1 
and  secale  1  in  alternation.  On  the  third  day  of  treat- 
ment she  passed  an  extraordinary  string  of  bladders 
joined  together  by  a  kind  of  skin.  For  two  days  they 
were  passing,  and  with  complete  relief  to  all  her  distress. 
She  made  a  rapid  recovery,  and  remained  well  until  I 


720  NEW    ZEALAND.  ^S22i^Sr?l2J* 


Beneur,  Nor.  %  ISU. 


left  the  colony.  They  were  hydatid  cysts,  but  how 
they  got  into  the  uterus  is  a  puzzle.  Graily  Hewitt 
asserts  that  they  form  in  the  liver,  and  burst  through 
the  peritoneum  into  the  uterus  or  vagina.  He,  with  all 
his  vast  experience,  has  only  seen  one  case. 

Now,  I  fear  that  the  facts  and  figures  which  I  have 
found  it  necessary  to  lay  before  you  in  the  course  of  this 
paper  have  made  it  dull  and  dry,  and  I  thank  you  for 
the  patience  with  which  you  have  listened  to  it.  Though 
I  have  described  several  diseases  prevalent  in  the  colony, 
let  me  assure  you  that  there  is  very  little  serious  disease 
that  is  not  imported  from  other  countries.  That  terrible 
plague,  small  pox,  is  kept  out  by  effective  calf-lymph 
vaccinations,  and  very  little  is  heard  of  scarlet  fever 
of  a  bad  type. 

The  truth  is  that  there  is  no  highly-civilised  country 
in  the  world  that  is  more  healthy  to  live  in  than  New 
Zealand,  if  a  man  will  avoid  excess  in  everything. 
Longevity  in  New  Zealand,  in  people  who  are  not 
diseased  when  they  go  there,  is  the  rule,  not  the  excep- 
tion. Take  a  few  examples.  A  trio  of  sisters,  whose 
united  ages  amount  to  234  years,  have  long  survived  the 
*'  three  score  years  and  ten,"  and  two  of  them  have  passed 
through  several  illnesses.  The  handwriting  and  intellect 
of  an  old  Scotch  gentleman,  now  in  his  94th  year,  are  as 
clear  as  that  of  a  young  man.  The  hale  old  gentleman. 
Sir  William  Fox,  thrice  Premier  of  the  Colony,  to  whom 
I  have  dedicated  my  book,  has  lived  a  life  of  political 
excitement  and  close  official  work  for  forty  years,  but  at 
82  enjoys  his  cold  bath  every  day  in  the  year,  and  can 
distance  many  a  youth  in  walking.  Once  I  attended  a 
centenarian,  *'  Old  Kelly  of  the  Wade,"  as  he  was  called, 
aged  then  102.  He  is  said  to  have  been  liberated  from 
a  Sydney  prison  at  the  mature  age  of  60,  and  has 
certainly  lived  42  years  in  the  Colony. 

Statistics  prove  incontestably  that  New  Zealand  is 
both  more  prolific  and  more  healthy  than  either  the 
parent  country  or  any  of  its  sister  Colonies.  While  the 
mortality  of  1889  for  England  and  Wales  was  17.9  per 
1,000,  and  that  of  Tasmania,  the  healthiest  of  the  Aus* 
tralasian  Colonies  was  (in  1887)  15.45,  the  death-rate  of 
New  Zealand  was  9.4.  In  1888,  when  the  excess  of 
births  over  deaths  in  England  was  57  per  cent.,  in  this 
prolific  colony  it  was  231  per  cent.    Married  but  child- 


SJto^l^T?^*"'  MANUAL   OF   THERAPEUTICS.  721 

less  couples  often  have  their  hearts  gladdened  with 
offspring  in  New  Zealand.  In  1887  there  were,  in  a 
population  of  608,000  people,  192  twin  burths  and  one 
triplet.  It  has  been  noticed  that  old  people  in  feeble 
health  who  emigrate  to  this  Colony,  renew  their  bodily 
frajnes,  their  vivacity  and  energy  to  a  wonderful  degree, 
and  lose  all  the  nostalgia  that  at  first  depressed  their 
spirits.  0 

The  invalid  who  finds  any  of  these  four  climates  I  have 
described  suited  to  his  ailment,  and  therefore  adopts  the 
Colony  as  his  home,  will  find  life  easier,  happier,  and 
more  exhilarating  than  in  dull  and  misty  Albion.  The 
hours  of  business  are  shorter,  and  out-door  recreations 
are  more  numerous  and  enjoyable  than  in  the  old 
country.  For  the  reading  man  or  woman,  intellectual 
resources  are  abundantly  provided.  And  if  able  to  travel 
through  the  forests,  or  by  the  lovely  lonely  lakes,  the 
invalid-tourist  will  find  all  the  finest  scenery  of  Europe 
reproduced,  but  with  such  unique  New  Zealand  charac- 
ters super-added  as  to  for  ever  endear  that  grand  country 
to  one  who  has  lived  there  by  a  charm  that  neither  time 
nor  distance  can  weaken. 

The  brighter  Britain  of  the  South  provides  a  comfort- 
able home  to  the  toiling  emigrant,  abundant  surprise  and 
enjoyment  to  the  tourist,  and  renewal  of  Ufe  to  the  weary 
invalid.  Let  us  then,  gentlemen,  thank  Heaven  that  this 
magnificent  sanatorium  forms  a  part  of  the  British 
Empire,  and  a  portion  of  the  glorious  heritage  of  the 
An^o-Saxon  race. 

MANUAL  OP  THERAPEUTICS. 

Introduction. 

The  two  most  important  parts  of  the  homoeopathic 
movement  are,  first,  the  perfection  and  arrangement  of 
the  Materia  Mcdica,  and  second,  the  principles  that 
should  guide  us  in  the  application  of  the  homoeopathic 
law  to  the  practice  of  medicine. 

The  first  part  has  had  considerable  attention,  and 
needs  to  be  well  advanced  before  the  second  part  is 
capable  of  effective  treatment.  Homoeopathy  is  suffering 
from  the  too  easy  adoption  of  empirical  remedies  as  well 
as  the  too  ready  adoption  of  allopathic  palliatives. 
The  introduction  to  the  ManiKil  of  Therapeutics  shows 


722  MANUAL   OF   THERAPEUTICS,     ^^^^s^!^ 

how  the  attempt  is  to  be  made  to  put  forth  an  authori- 
tative compendium  of  the  pre&ent  state  of  the  practice 
of  our  best  practical  men,  which  should  be  of  great 
service  in  keeping  beginners,  and  solitary  practitioners 
especially,  from  too  readily  deviating  into  palliative  and 
empirical  practice,  and  indicates  a  method  by  which 
the  principles,  referred  to  above  in  the  second  part, 
can  be  applied. 

Assuming  the  truth  of  the  homoeopathic  law  it  would 
appear,  at  first  sight,  that  nothing  more  should  be 
required  for  the  perfection  of  medicine  than  a  perfect 
Materia  Medica  and  a  complete  Index  thereto.  No  doubt 
this  was  the  idea  in  the  mind  of  Hahnemann  when 
expounding  his  system  in  the  Organon. 

From  numerous  causes  (some  of  which  will  be  con- 
sidered presently)  it  was  found  that  the  application  to 
practice  of  the  homoeopathic  law  could  not  be  properly 
taught  unless  it  could  be  fitted  to  the  ordinary  methods 
of  nosology  and  pathology. 

The  first  obstacle  to  this  was  the  inherent  diflSculty  of 
adapting  the  homoeopathic  law  to  any  known  system  of 
nosology,  or  even  the  incompatibility  of  any  therapeutic 
system  with  the  logical  outcome  of  the  homoeopathic  law- 

Hahnemann,  as  we  all  agree,  rightly  rejected  the  urns 
in  morhis  as  the  basis  on  which  a  complete  systematic 
knowledge  of  the  specific  action  of  medicines  could  be 
founded.  And  he  maintained  even  that  the  knowledge 
gained  by  past  experience  of  the  specific  curative  effects 
of  drugs  through  empirical  use  of  them  in  disease  could 
not  be  arranged  and  stored  up  for  future  use  on  any 
known  system  of  nosology,  because  not  one  of  these  is 
sufficiently  minute  and  discriminating  to  enable  us  to 
recognise  with  certainty  the  exact  counterpart  of  any  case 
of  disease  which  was  cured  by  a  particular  drug  empiri- 
cally ;  and  also  because  the  number  of  varieties  of  con- 
crete cases,  or  even  species,  of  disease  with  the  same 
pathological  'or  nosological  name  is  so  great — being  in 
fact  practically  infinite — ^that  there  hardly  ever  occur 
two  cases  of  illness  exactly  alike.  Individual  cases  of 
disease  are  thus  like  pictures  in  the  kaleidoscope — infi- 
nitely varied,  and  never  likely  to  occur  again.  Instead 
of  building  a  system  of  specifics  on  such  a  shifting 
foundation  as  this,  according  to  the  hitherto  time- 
honoured  plan  of  experience  in  disease,  Hahnemann, 


i£HSS.^^rr5ffi^*    MANUAL  OF  THERAPEUTICS.  723 


Reriew,  Nov.  2, 1801. 


having  discovered  the  law  of  specifics,  took  as  his  basis 
the  unchangeable  actions  of  drugs  or  the  elementary 
morbid  states  produced  by  drugs  on  the  healthy  body ; 
and  thus  the  practical  application  of  the  homoeopathic 
law  assumed  the  form  of  adapting  these  medicinal  actions 
to  similar  elementary  morbid  states  occurring  in  indi- 
vidual cases  of  disease.  As  all  concrete  diseases  consist 
of  more  or  fewer  of  these  elementary  morbid  states, 
differently  combined  in  different  persons  at  different 
times,  it  follows  that  a  medicine  seldom  corresponds 
homcBopathically  to  the  entire  concrete  disease,  and  thus 
a  different  medicine,  or  a  series  of  medicines,  may  be 
required  in  each  iudividual  case  of  nominally  the  same 
disease.  Hence  there  might  seem  to  be  no  scope  for  any 
help  at  all  from  clinical  experience  ;  and  we  can  under- 
stand why  Hahnemann  and  his  earlier  disciples  at  first 
objected  to  all  classifications  of  disease  and  all  diagnostic 
nomenclatures,  and  to  all  indications  furnished  ah  iim  m 
morbis.  The  publication  of  cured  cases  was  also  dis- 
couraged, as  likely  to  lead  away  from  the  constant 
refereijice  to  t}xQ  Materia. Medica  as  the  sole  source  for 
the  proper  indications  for  the  specific  remedy.  This  was 
spoken  plainly  out  by  Hahnemann  in  his  two  celebrated 
cures  with  hryonia  and  with  Pulsatilla,  in  the  preamble  to 
the  Materia  Medica  Pura  (vol.  i.,  English  translation). 
Nevertheless,  as  time  went  on,  the  publication  of  cases 
cured  homceopathically  continued  and  multipUed ;  and 
as  such  cases  are  little  else  than  materials  for  a  special 
system  of  therapeutics,  the  question  of  such  a  system  (of 
therapeutics)  continually  recurred.  Moreover,  as  it  was 
found  that  the  arrangement  of  these  cases  according  to 
the  nosological  classification  of  disease  by  no  means 
destroyed  the  specialisation  and  individualisation  re- 
quired by  homoeopathy,  even  Hahnemann  eventually 
gave  way,  and  ultimately  withdrew  most  of  his  objections 
to  Hartmann's  Therapeia,  and  himself  added  indications 
ex  U8U  in  inorbis  to  his  Materia  Medica,  though  always, 
as  it  were,  under  protest  and  on  condition  that  the  pure 
symptoms  should  always  be  referred  to  for  the  ultimate 
choice  of  the  medicine. 

Amongst  the  reasons  for  the  necessity  of  taking  into 
account  the  usus  in  viorbiSf  we  may  give  some  of  the 
more  prominent.  It  is  more  or  less  necessary  for  the 
interpretation  of  the  Materia  Medica  itself;  for,  from 


724  MANUAL  OF  THERAPEUTICS.   "^^K.^iSTJUS!" 


Beview,  Nov.  2,  1891. 


the  fragmentary  and  disjointed  form  in  which  many  of 
the  symptoms  appear  in  our  Materia  Medka — and  to  a 
great  extent  must   necessarily  do  so — it  is  often  Tery 
difficult  to  discover  to  what  elementary  morbid  states  in 
real  disease  the  groups  of  symptoms  in  our  Materia 
Medica  correspond.     The  employment  in  disease  of  a 
newly  proved  drug  must,  to  a  certain  extent,  be  tentative 
at  first ;  but  when  once  the  homoeopathic  adaptation  of 
the  pure  symptoms  to  those  of  a  case  of  disease  results 
in  cure,  we  have  immediately  invaluable  information  as 
to  the  proper  sphere  of  the  medicine's  action,  and  an 
interpretation  of  the  symptoms  which  it  would  be  absurd 
to  forego  through  a  pedantic  adherence  to  an  alleged 
logical  outcome  of  the  homoeopathic  theory — that  the 
correspondence  of  the  pure  symptoms  is  all-sufficient  in 
each  case — and  that  no  two  cases  are  ever  alike. 

Besides,  as  noticed  by  Dr.  Hughes  {Knowledge  of  the 
Physician f  p.  77),  the  pathogenetic  effects  of  drugs  in  our 
provings  are  not  necessarily  conterminous  with  their 
curative  powers.  "They  may  fall  far  short  of  them, 
through  inadequacy  of  provings  and  absence  of  poison- 
ings ;  or  they  may  outrun  them,  from  the  multitude  of 
trivial  sensations  the  drug  may  elicit  without  definite 
character  or  localisation."  Hence  the  necessity  of  test- 
ing by  the  tims  in  viorbis. 

Also  with  regard  to  the  specific  contagions,  miasmatic, 
and  some  constitutional  diseases  in  their  concrete  forms, 
no  drug,  if  proved  even  to  a  fatal  issue,  can  produce  their 
exact  simile;  and  therefore  the  test  of  actual  use  in 
disease  is  necessary  to  determine  if  their  qualitative 
action  is  homoeopathic  to  the  morbid  state  which  pre- 
vails in  these  diseases. 

It  must  be  remembered,  also,  that  physiology  and 
pathology  are  not  now  in  the  state  they  were  in  Hahne- 
mann's day,  but  are  so  far  advanced  as  true  sciences  that 
they  afford  a  true  basis  for  the  description  and  classi- 
fication, not  only  of  diseases  but  of  the  effects  of  drugs. 
In  the  words  of  Dr.  Clotar  Miiller  (Brit.  Jour.  Hom.y 
xviii.,  185),  "  There  really  exist  a  number  of  diseasefr 
w^hose  symptoms  are  circumscribed  and  constant,  and 
whose  origin  and  course  may  be  defined  and  summed  up 
in  certain  categories  so  that  their  homoeopathic  treat- 
ment may  be  worked  out  exhaustively  once  for  all  and 
£xed  with  the  help  of  the  iisus  in  morbis.    Among  these 


B^^^^^^Tf^    MANUAL   OP   THERAPEUTICS.  725 

we  reckon,  for  example,  some  inflammations,  acute  and 
chronic  exanthemata,  syphilis,  gonorrhoea,  external  local 
diseases,  &c." 

The  necessity  of  utilizing  cUnical  experience  being 
generally,  if  not  universally  felt,  the  best  mode  of  doing 
so  has  been  discussed  for  many  years  by  the  members  of 
the  Hahnemann  Publishing  Society,  and  various  plans 
have  been  brought  forward  at  the  meetings  of  our  Con- 
gresses and  have  been  published  and  commented  on  in 
the  Journals.  At  the  Congress  held  in  Birmingham  in 
1888,  a  committee  was  appointed  to  put  the  work  in 
hand,  to  enrol  a  sufficient  nimiber  of  joint  workers,  and 
to  finish  the  first  instalment  by  next  Congress.  The  plan 
adopted,  subject  to  such  modifications  as  were  found 
necessary  in  working  out  the  details,  is  substantially 
described  in  the  Monthly  Homoeopathic  Review^  vol.  xvii.> 
p.  524,  and  vol.  xxvii.,  p.  661. 

It  is  thought  desirable  that  the  pathology,  aetiology, 
semeiology  and  diagnosis  of  diseases  should  be  omitted, 
because  these  are  easily  accessible  in  any  good  text  book 
of  medicine.  If  they  were  added  they  would  either  crowd 
out  the  clinical  experience  or  make  the  book  too  bulky. 

The  aim  of  this  manual  is  to  provide  a  compendious 
resume  of  the  clinical  experience  of  the  homoeopathic 
school,  and  to  add  practical  memoranda  on  other  points 
of  treatment. 

The  classification  of  diseases  adopted  is  that  of  the 
revised  nomenclature  of  the  Royal  College  of  Physicians, 
because  it  is  known,  and  is  in  the  hands  of  all  qualified 
medical  men  in  Great  Britam.  The  order  of  the  nomen- 
clature corresponds  in  the  main  with  our  repertories,  and 
will  be  adhered  to  with  few  exceptions.  The  alphabeti- 
cal index  will  serve  for  our  work,  with  some  variation 
and  revision,  but  the  running  number  will  be  retained. 
The  nomenclature  is  too  meagre  for  our  purpose,  but  it 
is  possible  to  interpolate,  in  the  appropriate  places,  any 
number  of  names  necessary  to  indicate  varieties  of 
disease  depending  upon  any  nosological  deficiency  (3/. 
Horn.  Revieto,  vol.  xv.,  p.  822). 

The  therapeutics  of  each  disease  will  be  given  in  four 
sections.  Section  1  will  consist  of  the  name  and,  if 
necessary,  the  definition  of  the  disease,  and  its  varieties 
and  complications. 

Vol.  35,  No.  11.  3e 


726  MANUAL  OF  THERAPEUTICS.    ^^SS^.^T^mS! 


The  names  of  the  medicines  will  be  arranged  in  three 
classes  or  categories : — 

Class  1. — Those  medicines  which  are  indicated  by 
experiments  on  the  healthy  and  confirmed  by  experience 
in  actual  practice. 

Class  2. — Those  medicines  which  are  specific  in  action 
but  only  empirically  known  as  such. 

Class  8. — Those  medicines  which  are  indicate  by 
their  pathogenesy  but  of  which  we  have  no  evidence  of 
confirmation  by  practice. 

The  meaning  of  Class  1  is  obvious,  and  no  remarks 
are  called  for.  Class  2  will  contain  those  specifics  whose 
curative  powers  in  particular  diseases  were  discovered  by 
empirical  use,  but  which  have  not  yet  been  found  to 
produce  a  morbid  state  similar  to  the  disease  in  question. 
Further  investigation  will,  we  anticipate,  cause  these  to 
be  transferred  to  Class  1.  Examples  of  this  class  are 
loditim  for  goitre,  mercury  for  syphilis,  quinine  for  mala- 
rial fevers,  and  colchicum  for  gout,  besides  a  number  of 
other  drugs  that  for  generations  have  been  in  common  use. 

Class  3. — When  we  consider  that  a  very  small  part  of 
our  vast  Materia  ^fe(lica  is  in  general  practical  use,  and 
that  a  large  part  of  it  has  not  yet  been  tried  in  disease 
at  all,  it  is  clear  that  progress  in  the  enlargement  of  the 
field  of  homoeopathic  medication  depends  upon  the  utili- 
sation of  these  stores.  Besides,  the  physiological  experi- 
mental school  is  continually  making  and  publishing 
experiments  with  old  and  new  drugs.  The  results  of 
such  experiments  will  find  a  place  in  Class  3,  unless  they 
confirm  the  use  of  those  in  Class  1  or  cause  the  trans- 
ference of  the  drugs  of  Class  2  to  Class  1. 

With  this  Manual  in  his  hands  the  practitioner  will  be 
able  to  add  any  fresh  drugs  that  may  be  experimented 
upon  and  which  develop  symptoms  like  those  of  the 
disease.     A  space  will  be  left  for  this  purpose. 

Section  2  is  the  most  difficult  to  work  out,  and  the 
plan  must  be  more  elastic  than  that  of  other  sections.  It 
will  contain  the  result  of  clinical  experience  in  the 
various  stages,  varieties  and  complications  of  the  disease, 
verified  as  far  as  possible  by  reference  to  published  cases. 
It  will  give  the  doses  of  the  medicines  and  any  informa- 
tion that  experience  justifies  as  regards  the  succession  or 
alternation  of  medicines.  But  it  should  avoid  putting 
together  hypothetical  groups  of  symptoms  a  priori,  and 


a^f^^rnS^'    MANITAL  OF  THERAPEUTICS.  727 

the  Materia  Medica  should  be  referred  to  for  the  dififer-. 
entiation  of  the  xnedicineB.     In  this  section  only  those 
pure  symptoms  should  be  given  which  are  indicated 
beforehand  in  the  choice  of  the  remedy  and  confirmed 
by  the  result. 

^  The  material  for  this  section  will  be  personal  expe- 
riences and  clinical  cases  extracted  from  the  homoeo- 
pathic^fiterature  both  European  and  American. 

We  think  the  plan  originally  adopted  by  the  makers 
of  Clinical  Guides  is  erroneous.  This  apparently  was  to 
copy  out  all  the  symptoms  of  a  cured  case  as  the  homoeo- 
pathic indications  for  the  medicine  used,  without  regard 
to  the  presence  or  not  of  these  symptoms  in  the  Materia 
Medica.  The  hypothesis  being  that  any  symptom  cured 
whilst  taking  a.  certain  drug  showed  its  power  to  produce 
that  symptom !  For  further  remarks  on  this  erroneous 
inference  see  Month.  Horn.  Review,  vol.  xv.,  p.  658-4. 

Section  3  will  consist  of  all  aids  to  successful  treat- 
ment with  non-medicinal  means,  and  any  details,  if 
necessary,  of  tbie  use  of  drugs  mentioned  already  in 
Class  2  of  Section  1.  The  former  comprise  diet  and 
regimen,  exercise  or  rest,  warmth  or  exposure,  baths  of 
various  kinds,  changes  of  climate,  spas,  health  resorts, 
&c.  But  the  use  of  non-homoeopathic  medicines  as  pal- 
liatives or  auxiliaries  requires  careful  consideration.  In 
the  Presidential  address  to  the  Homoeopathic  Congress 
of  1852,  one  of  our  colleagues  said  :  "  The  occurrence  of 
urgent  symptoms  requiring  the  temporary  employment  of 
allopathic  means  in  the  usual  powerful  doses,  has  been 
pointed  out  by  Hahnemann  in  the  Orgaiwn*'  (p.  169).* 
Now,  though  Hahnemann  does  not  specify  the  particular 
<:ase8,  or  draw  an  exact  line  where  such  helps  are  to  stop, 
yet  he  has  been  understood  to  limit  them  to  a  very 
narrow  circle,  and  to  look  unfavourably  on  such  of  his 
disciples  as  ventm*ed  to  abuse  their  liberty  in  that 
respect.    As,  however,  this  is  a  matter  that  can  only  be 

*  And  more  forcibly  in  a  published  letter,  as  follows  :  "  In  cases  of 
sudden  disease  threatening  speedy  death,  in  persons  previously  healthy, 
as  experience  shows,  with  perfect  justice  and  complete  consistency,  no 
medicine  can  be  admitted  which  promises  help,  after  the  lapse  of  some 
time,  by  its  secondary  or  homceopathic  action ;  but,  according  to 
common  sense,  antipatMo  medicines  only  can  be  given,  which  in  large 
and  frequently  augmented  doses  change  the  morbid  state  into  t£e 
desired  opposite,  and  thus  bring  back  the  patient  to  health." — JBrit, 
J^ourn,  nf  Horn,,  vol.  x.,  p.  332. 

3  E— 2 


728  MANUAL  OF  THERAPEUTICS.     ''SSl^Nr^Sl! 


Beriew,  Nov.  2,1801. 


determined  by  experiment,  and  will  doubtless  yary  with 
the  greater  progress  towards  perfection  of  the  homoeo- 
pathic method  itself,  it  is  plain  that  perfect  freedom 
mast  be  left  to  the  practitioners  of  homoeopathy  as  a 
scientific  body,  to  ascertain  by  experience  in  what  cases 
the  use  of  allopathic  auxiliaries  is  justifiable  and  neces- 
sary, and  cannot  be  settled  by  any  a  priori  dictum. 

We  think,  however,  that  the  physician  should  be  quite 
satisfied  that  the  palliative  is  the  best  treatment  at  the 
time  possible,  and  that  it  is  not  adopted  as  the  one 
giving  least  trouble. 

This  section  also  will  serve  to  expose  the  false  repre- 
sentations of  our  practice  still  prevalent  in  the  allopathic 
school  by  distinctly  stating  our  position  in  this  respect. 

Section  4  is  purposed  to  facilitate  reference  and  is 
merely  an  alphabetical  list  of  the  homoeopathic  medi- 
cines given  in  the  foregoing  sections.  It  will  not  be 
necessary  at  all  when  the  disease  under  consideration  has 
very  few  medicines  enumerated  in  Sections  1  and  2. 

The  physician  may  refer  to  this  section  only  when  he 
wishes  to  differentiate  two  or  three  medicines  by  the  aid 
of  a  Repertory  and  the  Materia  Medica, 

In  the  case  of  a  disease  that  has  many  sub-divisions 
Section  4  will  come  at  the  end,  but  each  sub-division  will 
have  Sections  1,  2  and  8  especially  devoted  to  it. 

Finally,  in  using  this  Manual  we  must  always  keep  in 
mind  that  the  choice  of  the  medicine,  the. ultimate  out- 
come of  the  whole  science  and  art  of  medicine,  can 
seldom  if  ever  rest  on  clinical  indications  alone,  but 
must  be  guided  b  the  correspondence  of  the  totality  of 
the  symptoms  of  the  patient  with  the  pure  symptoms  in 
the  Materia  Medica.  Even  when  we  are  guided  to  a 
group  of  medicines  by  their  having  proved  curative  in 
any  disease,  the  differential  diagnosis  between  the 
different  medicines  in  that  group  should  as  far  as 
possible  rest  on  the  pure  symptoms ;  and  it  may  happen 
often  that  an  untried  medicine  may  correspond  better 
with  the  actual  symptoms  of  the  case  before  us  than  any 
of  the  merely  clinically  indicated  group,  in  which  case  it 
is  to  be  preferred. 

It  is  hoped  that  the  preparation  of  this  Maniml  will 
promote  the  practice  of  medicine  according  to  the  law  of 
similars,  and  that  enough  has  been  said  to  prevent  its 
being  used  only  as  an  empirical  guide. 


SSSS'JJrrSl?*'        RELIEF   OP   COLIC.  729 


Beriew,  Not.  2, 1881. 


EAPID  RELIEF  OP  COLIC  PROM  ACONITE.' 

By  Stanley  Wilde,  L.R.C.P.,  L.R.C.S.  Edin. 

A  FEW  nights  ago  I  was  hastily  summoned  to  a  lady  who 
was  in  great  pain.  The  patient,  a  spare  married  woman 
of  nervo-bilious  temperament,  was  rolling  about  the 
bed,  evidently  in  great  agony,  and  in  a  state  of  much 
mental  as  well  as  physical  perturbation.  The  pain, 
which  she  described  as  if  she  would  burst,  was  referred 
to  the  descending  colon.  The  abdomen  was  not  tym- 
panitic, but  the  descending  colon  appeared  puffed  out, 
und  there  was  fsecal  matter  at  the  sigmoid  flexure. 
The  patient  is  subject  to  attacks  of  incarcerated  flatus, 
und  has  hitherto  always  taken  heUadonna  on  her  own 
account  with  marked  relief  and  subsequent  emission  of 
flatus.  In  this  instance  it  had  failed  to  produce  the 
usual  effect. 

I  at  once  gave  her  five  drops  of  aconite  Ix  (made  from 
Fleming's  tincture),  and  before  I  could  resort  to  other 
measures,  that  is,  in  not  more  than  two  minutes,  she 
looked  at  me  in  astonishment  and  said,  '^  I  can  feel  no 
pain,  it  has  ceased."  I  was  as  much  surprised  as  the 
patient  herself. 

'     The  cessation   of  pain  was  not  accompanied  with,  or 
JbUotced  by,  any  emission  of  flatus. 

The  patient  passed  a  good  night,  sleeping  well,  and 
not  needing  a  second  dose  of  medicine. 

Cheltenham, 

October,  1891. 


THE  TREATMENT  OP  CHRONIC  ENLARGEMENT 
OP  THE  TONSILS  BY  MEANS  OP  THE  GALVANO- 

CAUTERY. 

By  Dudley  Wright,  M.R.C.S., 

Assistant  Snrgeon  to  the  London  Homoeopathic  Hospital. 

As  there  appears  to  be  some  misapprehension  as  to  the 
scope  and  limits  of  the  above  form  of  treatment,  it 
would  not  be  altogether  out  of  place  to  give  a  short 
account  of  the  method  of  operating,  and  to  point  out, 
as  far  as  is  possible,  the  various  lands  of  cases  which 
particularly  lend  themselves  to  this  method. 


730  ENLAKGEMENT  OF   TONSILS.    ^^^f^S!^^ 

In  the  first  place,  it  is  necessary  that  we  should  be 
careful  to  fix  well  in  our  minds  the  rationale  of  all 
galvano-caustic  operations  in  which  the  result  aimed  at 
is  similar  to  that  in  the  form  of  treatment  now  under 
consideration.  The  principle  which  underlies  them  is, 
briefly,  this: — After  the  subsidence  of  the  limited  in- 
flammation caused  by  the  application,  fibrous  tissue  is 
formed,  and  the  subsequent  contraction  which  this 
undergoes  leads  to  a  reduction  in  the  bulk  of,  and  an 
atrophy  of,  the  elements  proper  to  the  tissue  or  organ 
under  treatment.  From  this  it  will  be  readily  under- 
stood that  the  deeper  in  the  substance  of  the  morbid 
mass  this  inflammation  and  subsequent  contraction 
occurs,  the  more  general  will  the  reduction  in  size  be,  and 
the  more  complete  the  cure. 

In  such  a  structure,  then,  as  the  tbnsil,  it  is  impor- 
tant that  we  should  aim  at  producing  this  inflammation 
in  the  more  central  part,  thereby  bringing  about  that 
universal  shrinking  which  is  so  essential  to  the  success 
of  the  treatment. 

Before  going  further  we  might  remark  that  many 
other  forms  of  caustic  applications  have  from  time  to 
time  been  employed.  Nearly  all  have  had  their  day, 
and  have  deservedly  fallen  out  of  use.  One  only  claims 
our  consideration.  Chromic  acid  has  been  used,  not  so 
much  for  the  tonsils  as  for  reducing  the  swollen  hyper- 
trophied  tissues  over  the  turbinate  bones  of  the  nasal 
fossae.  For  this  it  was  once  held  in  high  favour,  but 
since  the  introduction  and  gradually  spreading  use  of 
the  galvano-cautery,  it  has  lost  ground  in  the  esteem  of 
rhinologists,  and  nowadays,  in  a  competition  with  this 
latter  form  of  treatment,  it  is  considered  to  make  a  very 
poor  second. 

Compared  with  the  galvano-cautery,  chromic  acid 
exerts  its  influence  over  a  wider  and  more  indefinite 
area,  and  for  this  reason  alone  it  should  take  a  much 
lower  rank ;  and  when  we  add  to  this  the  consideration 
that  its  application  is  often  attended  with  no  small 
amount  of  after-pain,  we  are  no  longer  surprised  at 
seeing  it  find  a  restmg  place  in  the  limbo  of  rhinological 
therapeutic  agents. 

The  apparatus  required  for  the  carrying  out  of  this 
treatment  are  as  follows: — ^A  battery  with  connecting 
cords,  cautery  handle  and  two  or  three  more  burners. 


l&Sir^S!!Tw^  ENLABGEMENT   OF   TONSILS.  731 

and  a  tongae  depreasor,  or,  better  BtiU,  a  form  of  oral 
speculum,  made  by  Meyer  k  Meltzer,  which  will  prove 
to  be  of  the  greatest  service  in  dealing  with  children. 
One  of  Scball's  portable  plunge  batteries  will  be  found 
very  convenient.  The  following  figure  repreBents  the 
kind  which  I  use,  and  I  can  speak  very  highly  of  it  for 
all  forms  of  cautery  work.  It  possesses  the  advantage 
of  being  capable  of  use  as  a  means  of  electric  lighting  by 
simply  connecting  the  cells  in  "series"  instead  of 
*'  parallel." 


Fignre  I.  Batteiy, 


732  ENLARGEMENT   OF   TONSILS.   ^^Sl^JS??^ 


Bevlew,  Nor.  2,  IBU. 


One  of  the  burners  is  fixed  to  the  handle,  and  this  in 
its  torn  to  the  connecting  cords,  and  by  raising  the 
handle  of  the  battery  so  as  to  bring  the  fluid  to  act  on 
the  carbons  and  zincs  the  whole  is  in  working  order. 

The  form  of  burner  terminating  in  a  single  point — the 
first  represented  in  the  figure — will  be  found  most  useful 
for  ordinary  purposes.  The  current  should  be  just  strong 
enough  to  produce  a  dull  red  heat,  and  the  point  should 
be  passed  a  short  way  into  the  substance  of  the  tonsil 
before  the  current  is  allowed  to  pass,  this  being  effected 
by  pressing  the  knob  on  the  handle. 


Figure  of  platinum  points  and  handle. 

It  is  my  custom  to  paint  the  tonsil  two  or  three  times 
with  a  10  per  cent,  solution  of  cocaine  just  before  the 
operation.  Formerly  I  used  a  20  per  cent,  solution  as  a 
spray,  but  I  found  this  was  often  followed  by  unpleasant 
symptoms,  so  that  I  have  entirely  given  up  the  spray  in 
favour  of  the  brush.  The  cocaine  will  often  cause  a 
marked  decrease  in  the  size  of  the  tonsil,  and  it  is  in 
these  cases,  as  will  be  pointed  out  further  on,  that  this 
form  of  treatment  is  specially  indicated.  Three  or  four 
punctures  in  each  tonsil  will  be  sufficient  for  a  single 
sitting,  and  any  prominent  granulations  on  the  pharyn- 
geal wall  should  at  the  same  time  be  touched  by  the 
cautery. 

The  after  treatment  is  very  simple.  There  is  only  a 
slight  feeling  of  discomfort  for  the  first  twelve  hours,  and 
this  is  usually  lessened  by  the  use  of  a  Hazeline  gargle 
(5i.  ad  Oj.)  and  an  occasional  glycerine  jujube.  All  hard 
and  irritating  food  should  be  forbidden  for  two  days.  In 
from  five  to  seven  days  the  inflammation  is  sufficiently 
subsided  to  allow  of  fresh  punctures  being  made.  Several 
sittings  will  probably  be  needed  before  the  mass  will  be 
sufficiently  reduced. 

We  now  come  to  the  question — In  what  cases  is  this 
method  of  treatment  most  suitable  ? 


SS^'iSTf'S?^    ENLABGEMENT   OF   TONSILS.  733 


Itevieir,  Nov.  2, 1891. 


In  answering  this,  it  is  well  to  bear  in  mind  the  one, 
and  probably  only  drawback  to  this  method,  viz.,  the 
length  of  time  taken  to  effect  a  cure.  And  in  all  eases 
in  which  it  is  decided  to  adopt  operative  treatment,  the 
patient  should  be  made  to  understand  fully  that  whereas 
tonsillotomy  is  a  rapid  and  generally  a  sure  process,  this 
is  essentially  a  slow  one. 

There  is  no  doubt  that  it  may  be  considered  quite  free 
from  the  risk  of  haemorrhage,  and  also  that  inasmuch  as 
no  large  raw  surface  is  left  there  is  no  chance  of  a 
patient,  whose  health  is  in  a  low  state,  becoming  infected 
with  diphtheritic  or  other  poisons ;  for,  though  these  two 
•complications  are  rare  after  tonsillotomy,  they  should  be 
always  remembered. 

Moreover,  there  are  two  forms  of  diseased  tonsils, 
which,  to  my  mind,  are  particularly  suited  to  this  treat- 
ment ;  they  are,  first,  that  in  which  the  enlargement  is 
due  chiefly  to  an  increased  vascularity  of  these  struc- 
tures, and  as  a  consequence  of  this  a  diminution  in  size 
occurs  directly  the  cocaine  is  applied  ;  secondly,  that  in 
which  the  tonsil  presents  a  peculiarly  ragged  and  pitted 
appearance,  due  to  the  dilatation  of  the  lacunae,  for  in 
*this  form  attempts  at  amputation  generally  end  in  tear- 
ing rather  than  iQ  making  a  clean  cut  through  the  mass. 

To  sum  up,  we  might  place  our  indications  under  the 
following  heads : — 

1.  In  all  patients  who  are  liable  to  have  severe  haemor- 
rhage from  slight  causes,  and  particularly  those  suffering 
from  true  haemorrhagic  diathesis. 

2.  Those  in  whom  the  enlargement  is  due  to  increased 
vascularity  or  a  cavernous  structure,  rather  than  simple 
hypertrophy. 

3.  In  cases  of  the  "  ragged  '*  form  of  tonsil. 

4.  Under  this  last  head  we  might  class  those  patients 
who  stand  in  awe  of  the  knife. 

In  conclusion,  I  would  say  that  the  form  in  which  the 
tonsil  is  evenly  enlarged,  and  of  a  tough  and  unyielding 
nature,  owing  to  increased  connective  tissue  formation,  is 
particularly  unsuited  for  treatment  with  the  galvano- 
■cautery. 

Leinster  Square,  W. 


734  BEVIEW8.  "SSi"5S;"?SS! 


.  Nov.  S,  18B1. 


REVIEWS. 


Annual  of  the  Universal  Medical  Scietices :  a  Yearly  Rejfort  of 
the  Proffi-eHK  of  Hie  General  Sanitary  Sciences  tlirotufliout  the 
World.   Edited  by  Chables  E.  Sajous,  M.D.,  and  70  assoc- 
iate editors.    Illustrated  with  chromo-lithographs,  engia- 
vings  and  maps.    Five  vols.     1891.    F.  A,  Davis,  Phil- 
adelphia and  London. 
The  fourth  annual  issue  of  this  now  well-known  work  has 
been  for  some  time  before  the  public.     That  a  work  of  such 
magnitude  should  have  reached  a  fourth  issue  is  a  sure  indica- 
tion that  it  is  a  success.    Had  it  not  met  with  a  wide  and 
general  appreciation  it  must  ere  this  have  proved  an  extensive 
and  expensive  fedlure.    In  other  words,  a  large  number  of 
busy  practitioners  have  found  it  a  sound  commercial  invest- 
ment to  lay  out  some  three  guineas  a  year  on  these  volumes. 
The  scientific  and  literary  members  of  the  profession  form  too 
small  a  proportion  of  the  whole  themselves  to  support  the 
annual.     The  editors  and  publisher  may  therefore  enjoy  the 
satisfaction  which  they  certainly  deserve  of  having  produced 
a  work  of  practical  utility  to  the  general  body  of  fighters  in 
the  great  battle  against  sickness,  chsease  and  death.    It  is  not 
every  book  or  periodical  hanng  this  object  which  can  be  said 
to  accompUsh  its  mission. 

Commenting  on  previous  issues,  we  have  quoted  from  the 
chapter  on  Therapeutics — ^unfortunately,  generally  a  relatively 
short  one.  On  this  occasion  we  have  made  a  few  extracts  on 
another  page  which  will  give  those  of  our  readers  who  are 
unfamiliar  with  the  work  some  idea  of  its  nature.  Every 
possible  branch  of  '*  the  general  sanitary  sciences  ''  is  repre- 
sented, and  it  is  seldom  we  refer  to  its  pages  without  carrying 
away  some  useful  or  interesting  information.  The  plan  of  the 
work  has  been  this  year  rendered  practically  perfect  by  the 
addition  of  a  reference  list  of  journals  at  the  end  of  each 
volume. 


PERISCOPE. 


MATERIA  MEDICA  AND  THERAPEUTICS. 

Aristol  is  a  new  iodine  derivative  of  thymol,  which  has 
been  introduced  as  a  substitute  for  iodoform ;  it  is  said  not  to 
be  absorbed  by  the  system,  and  therefore  is  regarded  as  non- 
poisonous.  It  is  made  by  the  addition  of  a  solution  of  iodine 
in  potassium  iodide  to  a  soda  solution  of  thymol.  From  this  a 
voluminous  red-brown  precipitate  results,  containing  45*8  per 
cent,  of  iodine.     T?ie  Lancet  (July   18th)  states   that  Dr, 


sssiirifrra^"       pemscope. 735 

Heinrich  Stem,  of  New  York,  having  used  amtol  in  two 
cases  of  bums  and  scalds,  speaks  highly  of  its  influence  in 
promoting  early  and  rapid  recovery.  In  the  first  case,  the 
injury  was  a  bum  of  the  fore-arm  of  the  fourth  degree  ;  the 
slon  and  subcutaneous  tissues  had  been  destroyed.  The 
parts  turned  hard,  dry,  and  eschar-like,  the  surrounding  skin 
became  contracted  and  folded.  Anstol  and  vaseline,  in  the 
proportion  of  one  to  ten,  were  at  once  applied.  The  eschar 
separated  completely  by  the  fourth  day,  and  under  the  con- 
tinuous use  of  the  ointment,  suppuration  was  limited,  and 
granulation  and  repair  were  completed  in  less  than  a  month. 
In  the  second  case,  a  child  of  four  years  old  fell  in  a  bath  of 
hot  water,  and  blistering  resulted  nearly  all  over  the  body. 
The  largest  blisters  were  punctured,  and  arUtol  and  vaseUne 
in  the  above  proportions  were  applied,  and  recovery  was 
complete  in  the  course  of  about  two  weeks. 

The  Lancet  (August  29th)  brings  to  our  notice  a  still  more 
recent  substitute  for  ^  iodoform.  The  chemical  name  of  this 
new  antiseptic  novelty  is  '*  iso-butyl-ortho-cresol-iodide  " ;  as 
this  is  a  trifle  too  long  for  conversational  or  telegraphic 
purposes,  it  has  been  styled  '*  europhen."  It  occurs  as  a 
yellow  amorphous  powder,  with  a  shght  odour  resembling 
safiEron.  It  is  insoluble  in  water  and  glycerine,  but  dissolves 
in  oil,  alcohol,  ether,  and  chloroform  more  readily  than 
ftristoL  It  has  a  somewhat  resinous  feel,  and  adheres  to  the 
skin  or  mucous  membrane  and  to  the  smrface  of  wounds 
quite  as  well  as  aristol  and  better  than  iodoform.  Its  specific 
gravity  is  less  than  a  fifth  of  that  of  iodoform,  so  that  a  given 
surface  would  require  five  times  as  much  iodoform  us  europhen 
to  cover  it ;  neither  does  it  cake  so  easily  as  the  former. 
Ointments  and  solutions  of  eumplien  must  be  prepared  in  the 
cold,  and  solutions  require  filtration,  as  an  insoluble  iodide 
tends  to  form,  which  sometimes  causes  them  to  assume 
a  gelatinous  consistency.  It  is  not  poisonous.  It  has  been 
prescribed  with  satis^tory  results  in  both  soft  and  hard 
chancres,  in  mucous  patches,  and  in  tertiary  ulceration,  by 
means  of  a  one  or  two  per  cent,  ointment.  Hypodermic 
injections  of  from  one  to  two  grains  of  europhen  dissolved  in 
oil  repeated  daily  from  twenty-four  to  forty  days  completely 
cured  three  cases  of  secondary  syphilis  without  any  other 
medicament.  In  general  it  was  found  that  europhen  acts  only 
when  brought  into  contact  with  secreting  surfaces,  whereby 
it  is  decomposed  and  iodine  liberated.  When  applied  to  dry 
surfaces  it  appears  to  be  inert,  except,  indeed,  that  if  an 
ointment  of  greater  strength  than  two  per  cent,  is  used,  it 
acts  as  an  irritant,  and  sets  up  eczema.  Its  destructive 
power  on  micro-organisms  is  quite  equal  to  that  of  iodoform. 


736     ,   PERISCOPE.         "S^fi^S^^aSi! 

Antiseptics  in  Disease. — At  the  British  Homoeopathic 
Congress  of  1878,  Dr.  Galley  Blackley  read  a  paper  in  which 
he  suggested  tliat,  in  some  forms  of  disease,  remedial 
measures  would  be  found  to  be  curative  simply  in  virtue  of 
their  antiseptic  properties  ;  and  others,  while  being  antiseptic, 
were  also  homoeopathic,  as  arsenic  to  typhoid  fever,  and 
-corrosive  subhmate,  which  bore  the  same  relations  to  dysentery. 
For  the  most  part,  however,  medicines  of  an  anidseptic 
order  have  been  found  not  to  limit  their  destructive  properties 
to  germ  hfe.  Lately,  on  the  other  hand,  two  illustrations  of 
their  successful  use  have  been  pubUshed  which  are  well 
worth  reproducing  here.  The  first  appeared  in  a  lecture  by 
Dr.  Burney  Yeo,  in  Tlic  Lancet  (April  11th  and  18th),  in 
which,  after  referring  to  those  who  had  preceded  him  in  the 
treatment  of  typhoid  by  antiseptics,  he  describes  his  method : 
*'  Into  a  twelve-ounce  bottle  put  thirty  grains  of  potassic 
<ihlorate  and  pour  on  it  forty  minims  of  strong  hydrochloric 
-acid.  Chlorine  gas  is  at  once  rapidly  liberated.  Fit  a  cork 
into  the  mouth  of  the  bottle  and  keep  it  closed  until  it  has 
become  filled  with  a  greenish  yellow  gas ;  then  pour  water 
into  the  bottle,  little  by  little,  closing  the  bottle  and  well 

shaking  it  at  every  addition  until  the  bottle  is  filled 

To  twelve  ounces  of  this  solution  I  add  twenty-four  or  thirty- 
six  grains  of  quinine  and  an  ounce  of  syrup  of  orange  peel, 
and  I  give  an  ounce  every  two,  three,  or  four  hours,  according 
to  the  severity  of  the  case.  I  have  for  some  years  past 
treated  all  my  typhoid  fever  cases,  except  the  very  mild  ones, 
which  have  not  appeared  to  me  to  need  any  active  medical 
treatment,  on  this  system.  They  have  not  been  very 
numerous,  but  they  have  been  consecutive  cases,  and  they  have 
-all  done  well." 

Dr.  Yeo  refers  to  Dr.  Wilks,  of  Ashford,  in  Kent,  who 
reports  (Brit.  Med.  Jour,,  1870)  having  treated  171  cases  of 
typhoid  during  fourteen  months  with  sulphurous  acid  in  doses 
of  from  three  to  twenty  minims  every  four  hours  without  a 
death ;  and  to  the  record  of  Mr.  Eesteven,  of  Brisbane,  who 
gave  from  five  to  ten  minims  of  eucalyptus  oil  in  an  emulsion 
in  220  cases,  and  had  only  four  deaths.  In  1886,  Dr. 
Pearson,  of  Seymour,  Cape  Colony,  reported  in  TIte  Lancet  a 
series  of  one  hundred  cases,  with  only  one  death,  in  which  he 
gave  fifteen  minims  of  chlorinated  soda  solution  every  three 
hours. 

The  other  instance  of  the  successful  use  of  an  antiseptic 
occurred  in  the  practice  of  Mr.  Turner,  of  Sussex  Gardens, 
who,  in  The  Lancet  (July  18th),  reports  having  treated  215 
•cases  of  influenza  with  twenty  grains  of  salicin  in  powder, 
^veryhour,  without  a  single  death.    "If,"  he  writes,  "it  be 


?E5S2'^?^25"'  PERISCOPE.  737 


Be?i0w,  Not.  8, 1881. 


given  in  such  doses  as  twenty  grains  an  hour  for  ten  or 
twelve  consecutive  hours,  the  blood  must  become  thoroughly 
saturated  with  it,  and  therefore  (owing  to  its  antiseptic 
properties)  a  very  bad  medium  for  the  multiplication  of  germs^ 
or  microbes  of  any  sort." 

Absenical  Poisoning. — In  an  inaugural  dissertation  pre- 
sented to  the  Medical  Faculty  at  Breslau,  Dr.  Conrad 
Alexander  made  known  the  results  of  his  experience  on  the 
production  of  arsenical  paralysis  ;  in  other  terms,  on  the  pro- 
duction of  paralysis  in  cases  of  poisoning  by  arsenic.  We  have 
only  space  to  report  the  conclusions  arrived  at  in  this  httle 
work.     They  are  as  follows : — 

1st.  The  symptoms  in  cases  of  arsenical  poisoning  in  man 
point  to  the  fact  that  they  are  attributable  to  the  action  of 
this  agent  on  the  peripheral  nerves  and  muscles,  and  are  due 
to  the  production  of  multiple  neuritis. 

2nd.  In  certain  instances  it  is  possible,  in  rabbits,  to  pro- 
duce permanent  paralysis  by  means  of  arHmicy  which  paralysis 
is  especially  located  in  the  posterior  limbs,  and  is  accompanied 
by  a  high  degree  of  atrophy  of  the  muscles. 

8rd.  In  paralysed  animals,  degenerated  and  atrophied  nerve - 
fibres  are  to  be  found  in  the  small  muscular  nerve-branches, 
and  in  the  nerves  of  the  sub-cutaneous  connective  tissue, 
accompanied  by  swelling  of,  and  hsBmorrhage  into,  the  peri- 
neurium. The  spinal  cord  of  animals  so  paralysed  is  per- 
fectly normal. 

4tii.  Paralysis  in  these  animals  is,  therefore,  dependent 
upon  degeneration  and  atrophy  of  the  peripheral  nerves  and 
muscles. 

5th.  Experimental  observations  seem  to  warrant  the 
assumption  that  arsenical  paralysis  in  man  is  similarly  pro- 
duced. 

6th.  The  muscular  atrophy  produced  in  animals  poisoned 
with  arsenic  is  not  of  neurotic  origin,  but  is  entirely  inde- 
pendent of  the  nervous  system.  ci  BVty 

7th.  The  muscular  atrophy  in  animals  poisoned  by  arsenic 
is,  in  the  case  of  rabbits,  not  a  fatty  degeneration,  but  a 
<<  coagulation  necrosis,"  which  is  generally  accompanied  by 
the  formation  of  calcareous  deposits. 

8th.  Degeneration  of  nerves  and  muscles  is,  in  all  cases  of 
paralysis  occurring  in  animals  poisoned  with  arsenic^  probably 
due  to  the  production  of  '<  disturbed  action  in  the  capillaries 
of  the  nerves  and  muscles." 

With  regard  to  the  second  conclusion,  given  above,  we 
have  noticed  in  patients  taking  considerable  doses  of  arsenic, 
especially  in  patients  suffering  from  monomania,  that  in  the 
iBourse  of  a  few  days  a  stiffiiess  of  the  lower  limbs  ensues,  and 


738  PEM8C0PE.  ^SSS:=,Sri'^ 


Review,  Nov.  2,  ISH. 


a  difficulty  in  raising  the  leg  in  walking,  a  state  wliich  would 
undoubtedly  terminate  in  paralysis  if  the  medicine  were  not 
stopped.  It  will  be  seen  by  the  foregoing  statements  that 
Dr.  Alexander  has  restricted  his  observations  to  the  effects  of 
ursenic  in  producing  paralysis,  and  does  not  consider  any  of 
the  other  effects  of  arsenical  poisoning. — Burgoyne's  Monthltj 
Magazine  of  Pkarmary,  dx.  A.  C-  P. 


LARYNGOLOGY,  Etc. 

POSTKRIOB   BhINOSCOPT,    AMD   A   MeTHOD   OF   BeTB ACTING   THR 

Soft  Palate. — Dr.  Lubet-Barbon  {Arch.  Internat.  de  Largn,  ffr 
HhinoL  et  d'Otoloffie)  employs  first  a  mixture  of  equal  parts  of 
cocaine  and  powdered  sugar  in  the  place  of  the  ordinary  cocaine 
solution.  This  is  blown  into  the  posterior  nares  by  means  of 
a  suitable  insufflator.  The  upper  surfeu^e  of  the  palate  is  thus 
covered  with  the  powder  and  completely  anaesthetised.  A 
retractor — Hopmann's  or  Moritz  Schmidt's — ^is  then  intro- 
duced, and  traction  on  the  soft  palate  slowly  and  steadily 
made.  When  thus  performed  the  patient  experiences  a 
minimum  of  discomfort,  and  does  not  make  any  of  the 
gagging  and  swallowing  movements  which  generally  render 
this  operation  ineffectual. 

A  Means  op  Combatting  Glottic  Spasm  following  Appli- 
cations TO  THE  Larynx. — Dr.  Kayser  {Tlierap.  Monastttheftf, 
October,  1890).  To  avoid  this  spasm  he  advises  the  patients 
to  breathe  five  or  ten  times  as  deeply  as  possible  with  short 
intervals  immediately  before  the  application.  By  this  means 
a  hyper-oxygenation  of  the  blood  is  brought  about,  which 
enables  the  patient  to  hold  his  breath  some  thirty  or  even 
sixty  seconds.  The  application  is  made  directly  after  the 
last  inspiration,  and  should  spasm  occur,  it  will  have  nearly 
passed  away  by  the  time  that  the  ne^  of  taking  a  fresh 
inspiration  is  felt. 

The  Local  Use  of  Menthol  and  Oil  of  Eucalyptus  in 
Affections  of  the  Middle  Eae. — Dr.  Adolph  Bronner 
(Arch.  OtoL,  American  Edit.,  Vol.  xx.  No.  1).  The  author 
treated  many  cases  of  swelling  of  the  mucosa  and  a  few  of 
sclerosis  and  obtained  much  benefit  in  the  former,  and  in  the 
initial  stages  of  the  latter  prevented  encroaches  of  the 
disease,  "hi  the  first  class  of  cases  he  prescribes  a  snuff  of 
boric  acul  with  two  per  cent,  of  moithol  to  be  used  in  small 
quantities.  He  then  inflates  the  mid-ear  with  the  vapour  of 
mefnUwU  using  a  twenty  per  cent,  solution.  This  is  placed 
in  an  antiseptic  capsule  containing  pumice  stone,  which  is 
connected  to  one  end  of  a  Lucae's  modification  of  Politzer  s 


^SSS^^JTSSS^  PERISCOPE.  739 


Refrtew,  Nov.  2, 1891. 


bag.  The  air  enters  through  the  capsule,  becomes  charged 
with  the  vapour,  and  is  then  gently  injected  into  the 
eustachian  tube  by  means  of  the  catheter  which  is  connected 
with  the  other  end  of  the  bag.  This  is  continued  for  a 
minute  or  two,  and  the  swelling  of  the  tube  often  subsides 
materially  during  the  application.  If  the  tube  is  impervious 
to  air,  a  bougie  is  used,  being  previously  dipped  in  menthol 
oil.  Oil  of  eucalyptus  may  be  added  to  the  menthol.  The 
author  lays  stress  upon  tlie  favourable  results  to  be  obtained 
from  prolonged  use  of  this  remedy. 

Opbbation  fob  the  Belief  of  Deafness,  Noises  in  the 
Head  and  Ears,  and  Vertigo  due  to  Chronic  Catarrh  of 
THE  Drum  of  the  Ear. — Dr.  Sexton  {Arch,  OtoL,  Vol.  xx.. 
No.  2).  Dr.  Sexton  performs  certain  operations  on  the 
middle  ear  and  mcmbrana  tympani  for  the  relief  of  the  more 
distressing  symptoms  of  chronic  middle-ear  disease,  especially 
that  dependent  on  thickening  of  the  mucous  lining  of  the 
drum  and  adhesions  within  the  tympanic  cavity.  The 
operation  consists  in  removing  the  drum  and  the  malleus 
and  separating  the  incus  from  the  stapes,  rarely  removing  the 
latter  bones.  The  results  obtained  have,  on  the  whole,  been 
very  satis&ctory,  the  tinnitus  often  entirely  ceasing  and 
hearing  power  markedly  increased.  The  operation  is  done 
imder  an  ansBsthetic,  and  the  entire  drum  removed ;  the 
chief  object  in  after  treatment  being  to  prevent  its  repro- 
duction, which  is  not  always  an  easy  matter.  After  the 
operation  several  patients  complained  of  tingling  m  the 
tongue,  or  loss  of  taste  on  the  side  of  the  tongue  corres- 
ponding to  the  ear  operated  on,  evidently  due  to  the  division 
of  the  chorda  tympani  nerve.  The  rationale  of  the  operation 
is  that,  inasmuch  as  the  deafness,  tizmitus,  etc.,  are  due  to 
the  sclerosis  and  progressive  ankylosis  of  the  ossicles  which  is 
going  on,  the  removal  of  the  drum  and  malleus,  and  separa- 
tion of  the  incudo-stapedal  joint  will  produce  an  amelioration 
of  the  symptoms  and  improvement  in  the  hearing  power  by 
allowing  a  freer  and  more  natural  movement  of  the  ossicles. 
In  any  case,  though  there  may  be  no  actual  improvement, 
the  gradual  increase  of  the  deafiiess,  which  is  such  a  constant 
feature  of  this  disease,  is  prevented  by  removal  of  the  means 
by  which  that  increase  is  produced.  It  is  hardly  necessary  to 
add  that  the  operation  is  done  throxujh  the  meatus,  and  not  by 
trephining  and  removing  portions  of  the  temporal  bone. 

Dudley  Wright. 


740  PERISCOPE.  ^2S?Z 


Beriew,  Nor.  2, 1891. 


OPHTHALMOLOGY. 

Lv'ciPiENT  Cataract  :  its  Etiology,  Tbeathekt  axd 
Pboonosis.    By  8.  D.  Bisley,  M.D.,  Philadelphia. 

Absorption  of  Immature  Cataract  bt  Manipuultiox, 
WITH  Instillation.     By  B.  Ealish,  M.D.,  New  York. 

Dr.  Risley's  paper  is  published  in  fall,  and  Dr.  Kalish*s  in 
abstract,  in  the  August  number  of  the  Ophthalmic  Renew,  and 
both  are  evidence  of  the  search  after  some  means  of  arresting 
or  causing  absorbtion  of  incipient  cataract.  Naturally  neither 
observer  has  any  faith  in  the  action  of  remedies  upon  the 
degenerated  lenticular  tissue,  but  it  is  worth  considering  any 
accessories  to  treatment  which  will  mitigate  the  miseries  cKf 
the  partial  blindness  caused  by  immature  cataract. 

Dr.  Bisley  says  that  '*a  wider  experience,  with  the 
resulting  opportunity  for  independent  observation,  has  con- 
vinced me  that  in  a  considerable  number  of  these  afflicted 
persons  a  more  hopeful  prognosis  can  be  prudently  given. 
In  many  cases  the  apparently  progressing  opacity  of  the  lens 
can  be  arrested,  in  others  the  rapidity  of  its  increase  greatly^ 
retarded,  thus  maintaining  a  useful  accuity  of  vision  for  a' 
longer  time,  and  fedling  in  this  the  treatment  instituted  will 
place  the  eye  in  a  more  favourable  state  for  operative  inter- 
ference." 

The  class  of  case  which  Dr.  Bisley  hopes  to  influence  are 
simple  uncomplicated  cataracts  with  no  disease  of  the  uveal 
tract  or  choroidal  or  retinal  changes.  To  quote  him  again, — 
"  The  improvement  of  vision  noted  in  almost  all  the  cases 
successfully  treated  was  in  no  case  due  to  the  absorption  of 
the  opacities  already  fanned  in  the  letis,  but  to  the  improved 
condition  of  the  choroid  and  retina,  and  the  clearing  up  of  the 
vitreous  webs  and  the  granular  or  sand-like  deposit  so 
frequently  discovered  in  the  anterior  part  of  the  vitreous 
body  when  studied  with  a  convex  glass.  Even  in  those  cases 
where  the  treatment  failed  to  arrest  the  advancing  opacity, 
the  patient  was  nevertheless  made  more  comfortable  by  it» 
and  the  general  condition  of  the  eye  improved.  The  treat- 
ment adopted  was  to  require  as  complete  rest  as  possible  from 
all  work  at  a  near  point.  The  use  of  smoked  glasses  when 
necessarily  exposed  to  bright  light,  and  the  local  employment 
of  mild  \eashes  and  astringents  to  the  conjunctival  sac, 
together  with  the  moderate  use  of  mydriatics,  preferably  a 
solution  of  liomatropine.  Internally,  iodide  of  potassium  or 
iodide  of  irim,  and  bromide  of  potasdum  or  lit/dum,  etc.,  if 
headache  were  a  marked  symptom.  If  these  were  not  well 
borne  the  clilorides  were  substituted,  or  in  many  cases  were 
used  in  alternation  with  the  iodides.  As  soon  as  it  was 
proved  feasible  any  existing  error  of  refraction  was  very  care- 


^t^iSrr^^        PEBiscopE.  741 


Btnew,  Not.  2. 1881. 


fdUy  corrected,  and  the  correcting  glasses  required  to  be  worn 
constantly,  suitable  correction  for  a  near  point  being  allowed 
for  all  necessary  work.  The  experience  with  these  patients, 
and  many  others  in  advanced  life  in  whom  mydriatics  have 
been  used  over  long  periods  more  or  less  regularly,  has 
served  to  convince  me  that  there  is  an  unwarranted  dread  of 
the  use  of  mydriatics  in  patients  who  have  passed  beyond  the 
middle  period  of  life.  With  but  few  exceptions  they  were 
used  not  only  without  harm,  but  with  great  comfort  and 
benefit.  When  the  mydriatic  solution  did  not  seem  longer 
indicated  I  have  frequently  used  weak  solutions  of  eserine.  .  .  . 
In  many  of  these  cases  it  was  very  gratifying  to  see  the 
sharpness  of  vision  improve  week  by  week  jjuH  passu  with 
the  improved  nutrition  of  the  eye." 

Dr.  Ealish  advocates  more  active  treatment,  consisting 
"  in  instilling  into  the  eye  two  drops  of  a  solution  of  equal 
parts  of  glycerine  and  a  one  per  cent,  solution  of  boric  acid  in 
rosewater.  The  surgeon  then  stands  behind  the  patient,  and 
over  the  closed  lids  places  his  middle  finger  on  the  nasal  side 
of  the  eyeball,  the  index  and  ring  fingers  resting  on  either 
side  of  it.  The  three  fingers  are  then  passed  with  slight 
pressure  towards  the  temporal  side  of  the  globe,  and  this 
stroking,  always  in  the  same  direction,  is  repeated  twenty  to 
thirty  times  a  minute  for  ten  minutes.  Then  a  second 
instillation  is  made,  followed  by  a  second  similar  period  of 
stroking ;  and  this  by  a  third  instillation  and  like  period  of 
stroking,  which  completes  the  manipulation.  The  treatment 
may  be  repeated  daily,  and  the  period  of  stroking  may  be 
lengthened.  It  may  be  continued  for  three  or  four  months^ 
but  should  be  suspended  as  soon  as  it  ceases  to  improve 
vision.  The  only  explanation  of  the  improvement  offered  is 
that  the  manipulation  quickens  the  intraocular  circulation.*' 

Dr.  Tatham  Thompson,  in  the  Boyal  London  Ophthalmic 
Hospital  Reports,  December,  1890,  records  a  case  in  which 
after  Foerster*s  operation  for  the  artificial  ripenintj  of  cataract, 
the  lens  cleared  up  so  that  only  a  trace  of  granular  opacity 
was  left,  and  with  presbyopic  correction  the  patient  read 
moderate-sized  print  with  comparative  comfort.  The  opera- 
tion referred  to  consists,  in  immature  cataracts,  in  performing 
an  upward  iridectomy,  and  then  triturating  the  cataractous 
lens  through  the  collapsed  cornea. — OphtJiabnic  Review, 
August,  1891.  C.  Knox  Shaw. 

DISEASES  OP  CHILDREN. 

Thb  Capacity  of  thb  Stobiach  in  Infancy. — In  order  to 
determine  the  quantity  of  food  to  be  allowed  to  artificially  fed 
infants  at  one  meal,  Dr.  L.  E.  Holt  has  measured  the  capacity 

Vol.  35,  No.  n.  3p 


742  PEMSCOPE.  "SSS-^SS??^ 


Baview,  Nor.  2, 1801. 


of  the  stomach  in  142  in&nts  with  the  following  result. 
Starting  at  birth  with  a  capacity  of  about  one  ounce, 
the  stomach  increases  in  size  at  the  rate  of  one  ounce  a 
month  during  the  first  three  months,  reaching  at  this  time 
one  half  the  capacity  seen  at  one  year.  From  then  to  eight 
months  its  growth  is  much  slower,  being  on  an  average 
about  half  an  ounce  a  month.  From  eight  to  fourteen 
months  the  rate  of  growth  is  still  less,  being  on  the  average 
one  third  of  an  ounce  a  month.  Approximately  at  the  ages  of 
one,  three,  six,  and  fourteen  months,  the  capacity  is  respec- 
tively one,  four  and  a  half,  six,  and  nine  ounces. — Xetc  York 
Medical  Times^  May,  1891. 

Cholera  Infantum  akd  Sumuer  Complaint. — In  the  Medical 
Kra  for  May,  Dr.  Wilson  Smith  draws  attention  to  the 
essential  difference  between  cholera  infantum  and  summer 
diarrhoea  of  infants.  Cholera  infantum  affects  the  whole 
nertous  system  as  well  as  the  intestinal  tract,  and  post- 
mortem shows  but  few  lesions  of  the  intestinal  mucous 
membrane.  It  is  quick  in  its  results  either  for  better  or  for 
worse,  aud  needs  few,  but  prompt,  remedies.  Two  symptoms, 
viz.,  free  watery  purging  and  vomiting  occurring  again  and 
again,  either  simultaneously  or  in  close  succession,  constitute 
the  prominent  and  distinctive  features  of  cholera  infantum. 
It  has  but  one  cause,  and  that  is  due  to  the  presence  of 
ptomaines  in  the  milk.  There  are  brain  symptoms,  dilated 
pupils,  hot  head,  cold  extremities,  drowsiness,  suppression  of 
urine ;  child  generally  lies  quiet,  makes  no  expression  of 
pain  except  roUing  the  head.  The  remedies  chiefly  useful 
are  belladonna^  croUm,  apL^,  veratnim,  podophyllum^  and 
.sulphur. 

Summer  complaint  affects  the  intestinal  tract  alone,  and  post- 
mortem shows  the  intestinal  mucous  membrane  reddened, 
thicker  than  normal,  and  the  glands  of  the  intestines  are  often 
broken  down,  leaving  follicular  ulcers.  The  complaint  is  slow ; 
its  chief  cause  is  error  in  diet ;  the  symptoms  are  intestinal — 
the  child  cries  and  screams,  draws  feet  up  from  pain,  followed 
by  frequent  discharges  from  the  bowels  ;  is  restless,  abdomen 
hot,  quieted  by  carrying.  The  character  of  the  discharge  and 
the  manner  of  expulsion  are  the  principal  guides  to 
selection  of  the  remedy,  which  may  be  one  of  a  large  number. 
Dr.  Smith  has  had  success  with  a  decoction  of  mare's  tail 
beans ;  the  indications  being,  stools  small,  excoriating, 
greenish  or  yellowish  green,  blood-streaked,  offensive  odour 
and  considerable  tenesmus.  Great  attention  should  be  given 
to  the  diet,  Nestle*s  and  Mellin*s  artificial  foods  being 
recommended. 


t^J^rX:"'  PERISCOPE.  743 

Treatment  op  Diphthebitic  Croup  by  Vapour  op  Calomel. — 
Dr.  George  Clinton,  of  Brooklyn,  New  York,  in  a  paper  published 
in  the  April  number  of  the  New  York  Times,  discusses  the  rela- 
tive merits  of  tracheotomy  and  of  a  new  treatment  introduced 
by  Dr.  Job  Corbin,  of  New  York,  in  those  cases  of  diphtheria  in 
which  the  disease  has  spread  to  the  larynx.  After  pointing 
out  the  necessity  for  a  very  early  performance  of  tracheotomy 
to  give  any  chance  at  all  of  a  favourable  result,  and  the 
exceedingly  few  cases  which  prove  successful  even  then,  he 
proceeds  to  describe  the  method  of  practice  which  has  given 
him  quite  a  new  hope  in  these  cases.  As  soon  as  the  first 
«ign  of  hoarseness  shows  that  the  larynx  is  becoming  affected 
the  child  is  placed  in  its  crib  and  surrounded  by  a  tent 
arrangement.  On  the  floor  are  placed  two  bricks  with 
sufficient  interval  to  admit  a  spirit-lamp  between  them,  and 
inverted  over  the  lamp  is  placed  a  tomato  can  through  which 
a  number  of  holes  have  been  perforated  to  admit  of  sufficient 
air  to  feed  the  spirit  flame.  A  powder  of  pure  calomel, 
consisting  of  thirty  grains,  is  then  sprinkled  over  the  bottom 
of  the  can.  A  dense  white  vapour  is  at  once  evolved,  which 
fills  the  canopy  and  is  inhaled  by  the  child.  In  aggravated 
cases  the  powder  is  repeated  every  two  hours,  and  the  interval 
lengthened  as  the  cough  becomes  loosened  and  less  frequent. 
By  this  means  Dr.  Clinton  has  saved  many  cases  where  from 
his  previous  experience  he  is  sure  that  tracheotomy  would 
have  failed.  He  insists  that  the  treatment  should  be  applied 
early — as  soon  as  the  first  signs  of  laryngeal  complication  can 
be  detected. — New  York  Medical  TimcB,  April,  1891. 

T.  G.  Stonham. 

CrANTOE  OP  Mebcuby  in  Diphtheeia. — From  time  to  time 
cases  of  cure  by  this  drug  are  recorded  in  the  journals,  afford- 
ing further  confirmation  of  the  value  of  the  rule  of  similars — 
furnished,  too,  by  those  who  ignore  or  oppose  it — and  not  less  of 
the  prejudice  of  those  who  adopt  our  therapeutics  unacknow- 
ledged. Dr.  Buelle  reported  that  he  had  obtained  good  results 
by  the  internal  administration  of  mere,  cyanat,  in  the  cases  of 
seven  children,  aged  from  two  to  four  years,  who  were  all 
cured ;  in  an  eighth  case,  in  which  the  treatment  failed,  it 
was  begun  late.  Improvement  began  at  once,  and  was 
marked  by  the  third  day.  Dr.  Ruelle's  formula  is  mere.  cyan. 
0*05  g.  alcohol  at  80''  8  g.,  distilled  water  192  g.  One  tea- 
spoonful  every  hour. — Brit.  Med.  Jown.,  Oct.  10,  1891. 

SucKLiNo  AND  Menstbuation. — The  following  summary 
(from  the  Annual  of  the  Univ.  Med.  ScL)  of  investigations  on 
this  subject  made  in  Lower  Austria  may  be  read  with  interest 
in  connection  with  the  discussion  at  the  British  Homoeopathic 

3f— 2 


fJAA  -KT  AT  &  UTT  T  &  MontWy  Homieapathir 


Ueview,  Nor.  2, 1891. 


Society  reported  on  another  page.  Daring  a  period  of  5^ 
months  careful  account  was  taken  of  52  cMldren  suckled  by 
women  in  whom  menstruation  had  appeared,  and  38  milk 
analyses  were  made.    The  conclusions  arrived  at  were  : — 

1.  '*  The  increase  of  weight  in  children  suckled  by  men- 
struating women  is,  in  many  cases,  extraordinary." 

2.  *'  The  average  increase  in  weight  is  greater  during  and 
directly  after  the  appearance  of  menstruation  than  before.'* 

8.  "  The  condition  of  the  child  during  menstruation  in 
the  nurse  is  all  that  could  be  desired.'* 

4.  "  During  the  so  much  dreaded  menstruation,  but  a 
single  child  became  dyspeptic ;  the  dyspepsia,  however,  did 
not  interfere  with  a  normal  gain  in  weight  in  this  child." 

5.  **  The  milk  analysis  showed  on  the  average  less  difference 
between  the  specimens  of  milk  of  a  non-menstruating  and  a 
menstruating  woman  than  between  the  specimens  of  milk 
taken  from  an  individual  at  morning,  noon,  and  evening." 

Normal  menstruation  (and  not  menorrhagia  or  metrorr- 
hagia) is  referred  to. 

TUBEBGULAR    INFECTION    THBOUGH    THE    NUBSE*B   MiLK. The 

infection  of  human  beings  through  tuberculous  milk  ha& 
been  repeatedly  shown.  The  following  case  suggests,  if  it 
does  not  establish,  the  etiological  relationship  referred  to. 
An  infant,  set.  five  months,  developed  tubercular  abscesses 
(confirmed  by  microscope).  The  infant  had  been  nursed  for 
four  weeks  by  a  woman  suffering  from  phthisis  with  abundant 
expectoration.     (Ibid.) 

Stomaoh-washino. — Booker  has  employed  this  treatment  in 
200  cases  of  gastric  and  intestinal  derangement.  He  uses  a 
soft  catheter,  No.  8,  9  or  10,  attached  by  a  short  glass  tube 
to  a  common  rubber  tube  two  feet  long  and  fitted  with  a 
funnel.  The  catheter  is  passed  down  to  the  stomach,  one  or 
two  ounces  of  tepid  water  are  poured  down  the  tube,  which  is 
lowered  and  converted  into  a  syphon.  The  washing  is  con- 
tinued until  the  water  flows  away  clear.  Belief  ensues  after 
the  first  washing.  Even  when  diarrhoea  without  vomiting  is 
present,  relief  is  obtained  by  preventing  the  passage  of  curds 
into  the  bowels.  Heart  disease,  serious  bronchitis  or  other 
pulmonai'y  trouble,  and  the  excitation  of  vomiting  counter- 
indicate  the  treatment.     (IhuL)  Edwin  A.  Neatby. 

NOTABILIA. 

HOMCEOPATHY  IN  ANTWERP. 

In  our  last  number  we  noticed  the  establishment  of  a  Homoeo- 
pathic Dispensary  in  Antwerp  by  the  Town  Council  of  the 
city  as  a  part  of  their  arrangements  for  the  medical  care  of  the 


Monthly  HoauBopatUe  ,  vnT  a  hit  t  a  7 4fi 


Review,  Not.  2, 1881. 


poor  under  the  management  of  a  Committee  of  the  Council 
styled  the  Bureau  de  Bienfaisaiwe.  The  medical  staff  of  the 
Bureau  numbers  45  out  of  the  125  medical  men  of  the  city. 
These  gentlemen,  on  hearing  of  the  decision  of  the  Council 
endeavoured  to  organise  a  strike.  As  the  homoeopathic 
physicians  in  Antwerp  are  but  five  in  number,  two  of 
them  being  gentlemen  advanced  in  years,  and  consequently 
limiting  their  professional  engagements  as  far  as  possible,  the 
gentlemen  who  proposed  to  strike  felt  sure  of  being  able  to 
compel  the  Council  to  abandon  their  proposed  dispensary. 
They,  however,  omitted  to  take  into  their  calculations  the 
Amount  of  enprit  de  corps  of  the  Council  in  the  first  place,  and, 
in  the  second.  Dr.  de  Mets  and  his  confreres  expected  to  find 
that  all  the  medical  men  in  the  service  of  the  Bureau  were  as 
stupid  and  narrow  minded  as  themselves,  while,  as  a  matter 
of  fact,  only  thirty -two  out  of  the  forty-five  consented  to  join 
in  "  /a  ffrere  generah,''  Finding  that  the  Council  were 
determined  to  constitute  a  homoeopathic  dispensary,  the 
allopaths  then  endeavoured  to  get  the  word  "•  homoeopathic  '* 
struck  out,  suggesting  that  a  homoeopathic  physician  should 
be  added  to  the  ordinary  staff.  The  Council  insisted  that 
those  of  the  poor  who  desired  homoeopatliic  treatment  should 
have  as  much  opportunity  of  knowing  where  they  could  get  it 
as  those  in  easy  circumstances  already  had,  and  resolved  on 
retaining  the  distinctive  appellation  by  24  to  5. 

Full  reports  of  the  discussion  at  the  Council  Meeting,  and  of 
that  at  the  meeting  of  the  allopaths,  are  given  in  the  city 
newspapers,  IjC  Precurseur  and  U  Opinion. 

The  rule  establishing  the  dispensary  was  agreed  to  on  the 
25th  of  June.  At  the  Council  Meeting  of  the  5th  ult.,  the 
results  of  its  re-examination  by  the  Court  of  Aldermen  and 
by  the  Commission  of  Hygiene  were  discussed.  M.  Alderman 
Git,  the  Chairman  of  the  Commission,  reported,  in  a  speech  of 
considerable  length,  on  the  decision  which  had  been  arrived 
at.  The  medical  officers,  he  said,  had  protested  that  the 
estabUshment  of  a  homoeopathic  dispensary  gave  an  official 
recognition  to  a  medical  doctrine,  while  those  who  gave 
it  were  not  competent  for  the  task.  He  replied  to  this 
that  they  had  no  intention  of  giving  a  higher  sanction 
to  this  than  they  did  to  any  other  doctrine,  and  that  the 
sole  object  they  had  in  view  was  to  arrange  for  homoeo- 
pathic consultations  to  which  the  poor  might  have  the 
opportunity  of  resorting ;  this  they  considered  it  was  their 
duty  to  do.  To  decide  that  homoeopathic  consultation  should 
be  provided  for  the  poor  was  not  a  doctrinal  act,  but  simply  a 
useful  administrative  one.  "  That  in  a  large  town  such  as 
ours,  where  homoeopathy  is  held  in  very  great  esteem  among 


7  Aft  urnrp  A  T>TT  T  A  Monthly  HainoeoiM.tlii» 


persons  in  easy  circumstances,  the  poor  alone  should  not 
hitherto  have  been  able  to  have  themselves  treated  by  this 
method  is  not  equitable,  neither  is  it  humane  or  democratic." 
Commenting  on  the  argument  that  had  been  raised  that 
the  poor  were  indifferent  about  the  matter,  he  referred 
to  a  petition  that  had  been  sent  to  and  read  before 
the  Council  from  the  workmen's  society,  l)e  Werkersr 
to  the  private  dispensaries  in  Brussels  and  to  that  of 
Dr.  Campenhoul  in  Antwerp.  Referring  to  a  petition 
presented  by  the  medical  staff  of  the  BureaUj  in  which 
they  denied  that  homoeopathy  had  any  scientific  basis,  this  he 
said  was  a  mere  assertion  made  by  men,  very  few,  if  any,  of 
whom  had  read  The  Oiyanon  of  Hahnemann.  It  was  also 
objected  that  the  Universities  had  not  recognised  homoeopathy^ 
and  that  the  number  of  behevers  in  homoeopathy  was  very 
small.  The  latter  fact  was  at  once  explained  by  the  former, 
and  in  view  of  it,  it  was  surprising  that  any  had  studied  and 
adopted  homoeopathy,  while  it  argued  a  real  courage  to  leave  a 
university  and  commence  again  a  new  course  of  study ;  the 
struggle  to  live  was  too  great  and  too  general  to  admit  of  many 
doing  so.  He  quoted  £rom  a  speech  of  Dr.  Flasschoen  pro- 
testing against  the  ostracism  with  which  homoeopathy  was 
treated  in  France,  also  appealing  in  the  name  of  progress,  of 
humanity,  and  public  health  for  its  being  taught  at  the  uni- 
versity and  introduced  into  the  hospitals.  Remarking  thai 
this  ostracism  was  coming  to  a  conclusion,  he  quoted  from  the 
speech  of  Senator  Terlinden  in  the  Belgian  Senate,  to  which 
we  referred  last  month,  when  he  urged  that  the  fact  of 
homoeopathy  not  being  taught  in  the  university  constituted  a 
defect  in  the  institution,  and  added  that  '^  when  the  question 
waa  one  that  affected  the  lives  of  our  fellow  creatures,  to 
ignore  its  existence  became  a  crime."  Having  quoted  from 
the  speech  of  M.  Burlet,  the  Minister  of  the  Interior,  on  the 
same  occasion,  who  said  that  if  homoeopathy  spread  and  com- 
mended itself  by  its  success,  he  thought  that  recourse  to  itfr 
aid  would  be  had  by  the  authorities  without  legislative  com- 
pulsion, M.  Git  said :  *^  Well  then,  gentlemen,  is  not  this 
absolutely  our  position  ?  Our  Bureau  de  Bieiifammce,  struck 
by  the  development  of  homoeopathy  among  those  in  easy  cir- 
cumstances, has  it  not  done  wisely  in  taking  the  initiative  in 
introducing  freely  and  without  any  evasion  opportunities  for 
the  poor  to  obtain  homoeopathic  treatment  ?  "  He  concluded 
by  expressing  his  confidence  that  the  Council  would  approve 
of  the  proposal,  that  the  medical  staff  would  withdraw  their 
opposition,  and  that  after  a  little  while  a  calm  would  follow 
the  unjustifiable  agitation  that  had  occmTed. 

M.  le  Dr.  Desguins,  who  opposed  the  proposed  dispensary,. 


^t^'^^^TS^  NOTABILIA.  747 


Bariew,  Nov.  2,  IWl. 


expressed  a  universally  felt  desire  that  the  dispute  should  be 
brought  to  a  conclusion.  He  objected  to  the  homoeopathic 
dispensary  b^use  it  implied  a  recognition. of  homoeopathy. 
However  much  the  Council  might  protest  against  such  a  con- 
clusion being  drawn,  it  was  one  that  everybody  would  make. 
He  denied  the  qualification  of  the  Council  to  pronounce  upon 
a  question  of  medical  science,  and  asserted  that,  in  estabhsh- 
ing  a  dispensary  for  the  practice  of  homoeopathy,  they  were 
doing  so.  In  setting  up  a  special  service  for  homoeopathy, 
they  were  at  the  least  recognising  it  as  of  equal  value  with 
traditional  medicine,  and  that  it  was  a  rational  and  efficacious 
method ;  it  determined  thus  a  scientific  question,  and  did  so  in 
a  sense  directly  opposed  to  medical  authorities,  who  were  quali- 
fied to  determine  it.  The  Council  ought,  he  said,  to  restrict 
itself  to  administering  the  law,  and  as  the  law  did  not  recog- 
nise the  term  homoeopath  and  allopath,  no  other  proof  of 
qualification  for  its  service  should  be  required  than  those  of 
Uie  possession  of  a  diploma  and  good  character.  Dr.  Desguins 
fully  recognised  that  in  proposing  this  innovation  the  members 
of  the  Bureau  believed  that  they  were  doing  a  useful,  liberal 
and  humane  work,  but  that  their  zeal  had  led  them  too  far, 
and  concluded  by  desiring  a  new  rule  to  be  drawn  up  which 
should  exclude  the  word  homoeopathic. 

M.  Git  replied  that  while  Dr.  Desguins  had  opposed  the 
words  homoeopathic  and  allopathic,  he  had  not  opposed  homoeo- 
pathy !    (This,  interpolated  Dr.  Dehguins,  was  a  mistake.) 

M.  De.  Vos  said  we  are  told  by  the  doctors  that  we  are  not 
qualified  to  express  an  opinion  on  homoeopathy.  We  are  not 
pretending  to  do  so,  we  simply  turn  to  account  for  the  benefit 
of  the  poor  a  system  which  exists,  and  which  is  preferred  by 
a  considerable  section  of  the  people.  "  Each  of  us,"  he  said, 
"  if  taken  ill,  has  the  right  to  seek  relief  or  cure  from  the 
method  of  his  choice,  and  by  which  he  has  been  previously 
relieved  or  cured — ^why,  then,  should  the  same  opportunity  be 
denied  to  the  poor  ?  No  one  could  deny  that  since  the  time 
of  Hahnemann  homoeopathy  had  not  only  maintained  its 
reputation  but  had  greatly  extended  it.  Such  was  not  the 
usual  course  of  anything  worthless." 

M.  Van  De  Walle  agreed  with  Dr.  Desguins,  because 
homoeopathy  could  not  be  used  exclusively  in  all  cases,  and 
urged  that  the  word  homoeopathic  should  be  removed,  that  a 
special  dispensary  should  not  be  established,  but  that  a 
homoeopathic  physician  should  be  added  to  the  staff  of  the 
Bureau,  and  a  department  at  the  pharmacy  of  the  Bureau 
should  be  fitted  up  for  homoeopathic  medicines. 

M.  ToNNELiEB  said  that  they  had  been  declared  by  the 
doctors  incapable  of  estimating  the  scientific  value  of  homoeo- 


748  NOTABiLiA.      "ssa^srs^ 


BfiivMir,  Vof.  2,  ISn. 


patby.  Possibly  so;  but  tbey  were  equally  incapable  of 
estimating  tbat  of  aJlopatby.  Tbe  doctors  asserted  that 
homoeopathy  had  no  scientific  basis :  but  homoeopaths,  who 
had  studied  it,  declared  that  it  had.  The  Academy  of 
Medicine  had  repudiated  it,  but  the  Academy  of  Medicine  was 
exclusively  composed  of  allopaths.  We  could  not  attach  im- 
portance to  a  decision  of  which  those  who  gave  it  were  at  one  and 
the  same  time  judges  and  partisans.  Whatever  might  be  their 
incompetence  to  decide  a  question  of  science,  they  were  quite 
able  to  arrive  at  a  conclusion  on  one  of  results  obtained  by 
the  homoeopathic  method.  He  could  not  understand  how  it 
was  that  those  who  pretended  that  homoeopathy  was  mere 
charlatanry  should  still  be  content  that  a  homoeopath  should 
be  added  to  the  staff  of  the  Bureau  provided  he  kept  his 
colours  out  of  sight.  This  endeavour  to  prevent  homoeopathy 
being  heard  of  seemed  to  him  and  to  many  others  to  reduce 
the  question  at  issue  to  one  of  '*  shop/' 

M.  Gits,  in  reply  to  Dr.  Desguins,  referred  to  recognitions 
of  homoeopathy  that  have  been  officially  given  in  France 
Italy,  Spain,  the  United  States,  Australia,  etc.  To 
M.  de  Walle,  he  replied  that  to  keep  the  word  **  homoeopathy  " 
out  of  sight  would  be  wanting  in  candour,  in  the  first  place ; 
and,  in  the  second,  the  nomination  of  a  homoeopatli  on  the 
general  staff  would  depend  upon  the  good  pleasure  of  the 
members  of  the  Durenu.  If  it  happened  to  be  packed  with 
allopaths,  they  would  be  able  to  neutralize  the  determination 
of  the  Council. 

After  a  brief  speech  from  Dr.  Desguins,  endeavouring  to 
minimise  the  recognition  of  homoeopathy  in  other  countries 
as  stated  by  M.  Gits,  (in  the  course  of  which  he  betrayed  his 
ignorance  of  the  state  of  medicine  abroad  by  saying  that  in 
America  any  man,  however  unqualified,  could  get  a  qualifica- 
tion for  one  hundred  dollars).  M.  Sp^e  moved  the  order  of 
the  day,  and  this  was  carried  by  24  against  6,  the  effect 
being  the  establishment  of  the  Communal  Homoeopathic 
Dispensary  of  Antwerp. 

On  the  evening  of  the  10th  of  October,  a  meeting  of  a  large 
number  of  the  medical  men  of  Antwerp  was  held  to  consider 
the  course  to  be  pursued  by  the  medical  staff  of  the  Bureau. 

The  secretary,  Dr.  de  Mets,  read  a  report  of  the  proceedings 
of  the  last  meeting  of  the  medical  staff,  when  it  was  decid^ 
that  they  could  not  continue  the  struggle  alone,  as  indepen- 
dently of  homoeopathy  their  particular  grievances  had  been 
satisfied,  but  the  question  of  homoeopathy,  was  one  which 
concerned  the  entire  medical  body.  Should  a  general  strike,  as 
one  of  the  councillors  termed  it,  of  all  the  medical  officers  of  the 
Bureau  take  place  ?     This  had  been  considered.     Thirty-two 


S^^'#rr;?S?""  KOTABILU.  749 


Beview,  Nov.  2, 18B1. 


advocated  a  strike  in  order  to  compel  tlie  hom(Bopaths  to 
withdraw.  By  this  measure  the  work  of  the  hospitals  would 
be  disorganised.  They  thought  also  that  though  thirty-two 
was  a  considerable  number,  still  it  was  insufficient,  and  that 
to  be  successful  at  least  four-fifths  of  the  Bureau  staff  should 
join,  and  this  would  require  thirty-six.  These  were  the  facts 
on  which  they  had  to  decide  the  course  to  be  pursued. 

Dr.  Tebwaone  then  spoke.  Would  the  Council  annul  the 
rule  they  had  so  recklessly  voted  under  the  influence  of  an 
Alderman  whose  father  was  interested  in  the  matter  ?  '•' 
This  Alderman,  in  his  speech,  abandoned  any  locus  standi  by 
Acknowledging  himself  incompetent  to  decide  the  essence  of 
the  question  at  issue.  To  the  public  this  was  mere  blustering, 
but  for  us  it  is  nothing  less  than  a  piece  of  audacity  con- 
-cealing  his  ignorance  of  positive  science. 

The  Council  were  supported  by  two  letters,  one  signed  by  five 
homoeopaths,  a  number  which  is  reduced  to  three,  because 
one  of  the  five  has  retired  from  practice,  and  another  treats  his 
patients  according  to  their  inclination ;  and  by  another  from 
the  working  men's  society.  These  do  not  justify  the  proposal 
•of  the  Bureau  either  in  the  light  of  science  or  in  that  of  the 
rights  of  the  democracy.  The  opinion  of  a  well-kno'wn 
senator  was  also  quoted;  but  another  illustrious  senator, 
Professor  J.  Crocq,  had  said,  in  a  letter  to  him,  "  At  the 
beginning  of  the  century  it  was  permissible  to  experiment 
with  these  homoeopathic  dreams  ;  but  now,  in  the  presence  of 
the  progress  made  by  pathology  and  physiology,  this  was  no 
longer  possible ;  it  is  for  this  reason  that  homoeopathy  is 
never  mentioned  in  a  medical  congress — it  has  no  fouyulation 
in  jmsitive  science,*'  Such  a  condemnation  at  once  ex- 
tinguished, he  said,  the  absurd  subterfuges  uttered  by  our 
professional  adversaries. 

We  witnessed  some  odd  things  at  this  council  meeting. 
Thus  M.  Gits,  short  of  arguments,  tried  to  reinforce  himself 
by  appealing  to  the  socialists,  whom  he  opposes  whenever  he 
can;  and  to  the  Catholic  minister,  whom  he  spits  upon 
whenever  he  has  an  opportunity.  This  will  give  you  some 
idea  of  the  grandeur  of  the  defence  of  homoeopathy  made  by 
this  alderman  and  of  his  intellectual  condition.  One  coun- 
cillor held  the  medical  profession  up  to  ridicule.  The 
moment  for  doing  so  was  badly  chosen,  as  the  council 
afforded  much  more  cause  for  laughter  than  the  doctors.  We 
had,  indeed,  in  this  meeting  a  spectacle  of  men  declaring 
themselves  incompetent  to  discuss  a  subject  on  which, 
nevertheless,  they  talked  for  hours. 


*  Dr.  GitP,  the  father  of  Alderman  Gits,  is  a  homoeopathic  physician. 


750  NOTABIUA.  "SSSlrXTSS! 


M.  Tonnelier,  being  a  nonentity  both  in  politics  and 
science,  we  will  not  waste  time  on  him.    (Cheers.) 

The  question  so  succinctly  stated  by  our  estimable 
colleague,  V.  Desguins,  was  not  understood  by  the  Council. 

With  regard  to  the  questions  the  Bureau  was  competent  to 
decide,  such  as  regulating  the  consultation  hours,  the  number 
of  doctors,  &c.,  satisfaction  was  given;  but  on  the  point 
which  most  intimately  concerns  us,  because  it  affects  the 
higher  interests  of  science  and  the  respect  which  is  due  to  it, 
we  have  received  satisfaction  only  in  words.  They  declare 
that  they  do  not  officially  sanction  homcBopathy,  and  then 
they  officially  instal  it  in  a  dispensary.  It  is  as  though  a 
person  struck  us  and  at  the  same  time  professed  his 
friendship  for  us. 

This  is  the  state  of  the  question  on  which  we  shall  pre- 
sently take  a  decision — one  of  great  importance  and  gravity. 
We  must  yield  our  personal  feeling  in  the  feu^e  of  scientific  and 
professional  dignity.  If  we  lay  down  our  arms  now,  our  doing 
so  will  only  be  momentarily.  Our  outraged  scientific  dignity 
must  be  atoned  for,  and  will  be  so  some  day  or  other. 
(Cheers). 

A  long  and  animated  discussion  followed,  in  which 

Dr.  Rop  expressed  himself  as  certain  of  ultimate  triumph 
because  their  cause  was  that  of  science  and  of  justice. 

Dr.  Van  de  Wiele  said  that  homoeopathy  ought  never  to 
have  been  introduced  into  the  administration — but  they  found 
themselves  with  a  fait  accompli  before  them.  He  deprecated 
a  strike  on  account  of  the  responsibihty  it  placed  upon  them, 
and  thought  a  milder  measure  would  suffice,  and  proposed  a 
commission  to  watch  the  progress  of  the  struggle,  and  urged 
that  a  physician  should  be  added  to  the  Bureau, 

Dr.  Rop  thought  that  Dr.  Van  de  Wiele's  proposal  would 
prove  illusory. 

Dr.  Rochet  suggested  an  address  to  the  Council  protesting 
against  the  dispensary. 

Dr.  Descamps  advocated  the  continuance  of  the  struggle. 
The  declaration  of  an  implacable  scientific  war  against  the 
homoeopaths. 

Dr.  Heetoghe  said,  shall  we  admit  that  120  physicians,, 
united  in  a  good  cause,  are  to  make  terms  with  four  homoeo- 
paths ?  If  we  act  steadily  together,  we  shall  extricate  our- 
selves from  them.   Let  us  then  possess  a  scientific  conscience. 

Dr.  Terwagne  replied  that  to  undertake  a  courteous  dispute 
with  homoeopaths,  to  argue  with  them  on  the  ground  of 
statistics,  would  be  to  be  made  dupes  of.  Medical  statistics 
were  valueless.  The  strike  which  had  been  referred  to  would, 
it  must  be  remembered,  leave  the  sick  without  medical  care. 


JSS^^rrSS?"'   .  KOTABILIA.  761 


Beriew,  No?.  2, 1891 


''  In  spite,"  he  added,  ''of  all  the  outrages  against  us,  all  the 
cruel  thrusts  which  have  lately  been  made)  at  us,  we  shall 
never  be  found  indifferent  to  that  feeling  of  humanity  which 
lies  at  the  bottom  of  the  heart  of  each  of  us.  Though  we  do 
not  obtain  an  immediate  result,  our  campaign  will  not  have 
been  fruitless.  The  Administration  did  not  wish  to  listen  to 
us.  We  have  done  our  duty  in  endeavouring  to  enlighten 
them.  We  separate  now,  and  say  to  them  :  '  Une  foiSf  c*est 
hien !  Mais  ne  recommeticez  pas ! '  In  short,  it  is  necessary 
that  they  should  know  that  to-morrow,  if  the  interests  of 
science  require  it,  we  are  prepared  to  renew  our  efforts.  With 
these  views  I  propose  the  following  Ordre  du  Jour: — 

"  '  The  medical  men  of  Antwerp  united  in  a  general 
assembly,  on  October  10th,  1891. 

" '  Considering  that  the  votes  of  the  Communal  Council  on 
the  regulation  of  the  medical  service  for  the  poor  recognises  a 
special  medical  system,  a  system  officially  discountenanced 
by  all  the  universities,  by  aU  intelligent  men,  and  rejected  by 
medical  congresses  by  reason  of  its  incompatibility  with 
positive  science ; 

"  *  Considering  that  the  Council  were  incompetent  to 
discuss  the  question,  and  ought  to  have  maintained  an 
absolute  neutndity  upon  it ; 

'''Considering  that  this  vote  will  lead  to  the  forcible 
introduction  of  the  privileged  system  into  other  medical 
services,  dependent  upon  the  Hotel  de  VilUy  hospitals,  dis- 
pensaries, etc.,  energetically  protest  against  the  pretensions 
of  the  Council,  and  reser\*e  to  themselves  to  select  a  more 
opportune  moment  to  renew  their  opposition  to  an  unjusti- 
fiable privilege.  They  decide  further  to  appoint  a  commission 
to  study  the  orgtmisation  of  a  syndicate  of  physicians.'  " 

This  ordre  dxi  jour  was  then  unanimously  agreed  to,  and  a 
copy  of  it  was  ordered  to  be  sent  to  the  Council  and 
the  press. 

Some  one  proposed  to  send  a  letter  protesting  against  the 
speech  of  M.  Tonnelier,  but — as  this  was  more  easily  pro- 
posed than  written — it  was  unanimously  resolved  that  for  the 
medical  men  of  Antwerp  to  take  this  gentleman  into  their 
consideration  would  be  to  confer  too  great  an  honour 
upon  him. 

M.  Tonnelier  has  since  addressed  a  letter  to  Dr.  Terwagne, 
one  which  the  doctor's  reply  proves  him  incapable  of  answer- 
ing.  This  correspondence  appears  in  L' Opinion  of  the  22nd  ult* 

Since  the  foregoing  was  written  we  have  heard  with  much 
pleasure  that  Dr.  Lembreghts,/77«  has  been  appointed  3/^/<rn{. 
and  Dr.  Boniface  Schmidt  ^Udecin  Adjoint  to  the  new  dispen- 
sary.    The  institute  opens  to-day. 


762  NOTABiLiA.       .  •'S^^^SfySi! 


Review,  Nor.  f,  lan. 


Thus  it  will  be  seen  that  the  Communal  Homoeopathic 
Dispensary  of  Antwerp  has  come  into  existence  in  a  some- 
what stormy  fashion.  The  struggle  for  fair  play  for 
homoeopathy  in  that  city  has  but  begun.  Men  who  are 
capable  of  talking  so  much  nonsense,  who  are  so  entirely 
ignorant  of  homoeopathy,  who  fear  the  spread  of  a  knowle^ 
of  it  among  the  people  so  much,  and  hate  it  in  proportion,  and 
who  show  such  an  amount  of  passion  when  they  find  them- 
selves compelled  to  compete  with  it  in  relieving  the  sick,  as 
M.  Terwagne  and  his  colleagues,  will  doubtless  continue  the 
struggle,  and  as  allopaths  generally  have  done,  will  probably 
show  themselves  perfectly  dead  to  any  sense  of  honour  in 
their  choice  of  weapons.  Hence  our  medical  confreres  in 
Antwerp  must  be  ever  on  the  watch. 

CHANGES  AT  THE  LONDON  HOMCEOPATHIC 

HOSPITAL. 
We  learn  that  Dr.  Carfrae  has  recently  resigned  his 
position  of  Physician  to  the  department  for  the  diseases  of 
women  at  the  London  Homoeopathic  Hospital.  We  believe 
that  our  distinguished  confrere  has  been  actively  connected 
with  the  hospital  for  a  period  of  some  twenty-eight  years.  At 
the  last  meeting  of  the  medical  staff  a  resolution  was  passed 
expressing  the  regret  they  feel  at  the  termination  of  Dr. 
Carfrae's  period  of  active  work  in  the  hospital,  and  the  hope 
that  he  will,  as  consulting  physician,  stiU  show  his  kindly 
interest  in  the  institution,  and  render  them  the  valued 
assistance  which  his  lengthened  experience  as  physician  to 
the  hospital  quahfies  him  to  give. 

Owing  to  his  continued  indisposition.  Major  William 
Vaughan  Morgan  has  felt  it  necessary  to  transfer  to  oiher 
shoulders  the  burden  of  the  duties  of  Treasurer  to  the 
hospital.  We  are  glad  to  know  his  loss  will  be  made  up  to 
the  hospital  by  the  assumption  of  the  treasurership  by 
Sir  Robert  Palmer  Harding,  already  well  known  as  a  friend 
B.nd  helper  of  the  hospital. 

Mr.  J.  Pakenham  Stillwell,  member  of  the  Board  of 
Management,  has  been  elected  one  of  the  Vice-Chairmen. 

Mr.  Rowland  Wilde,  M.B.,  CM.  Edin.,  has  been  appointed 
Junior  Resident  Medical  Officer,  Mr.  H.  W.  Cook,  M.B.,  B.S., 
having  been  transferred  to  the  senior  post  vice  Mr.  W.  S.  Cox, 
resigned. 

LONDON  HOMCEOPATHIC  HOSPITAL  REPORTS. 

This  new  departure  in  the  history  of  the  metropolitan  centre 
of  homoeopathy  which  has  been  for  some  time  desired  and 
finally  resolved  upon  by  the  medical  staff  is,  we  understand. 


^S^'H^St'  NOTABILIA. 758 

now  practically  a  fait  accompli.  The  work  is  **  in  the  press," 
and  may  almost  any  day  be  in  the  hands  of  the  subscribers. 
The  scanty  information  given  in  the  tables  pubhshed  for  the 
benefit  of  the  public  by  the  Annual  Report  of  the  Hospital 
has  not  supplied,  and  indeed  could  not  supply,  any  adequate 
idea  of  the  professional  work  done  in  the  wards  and  out- 
patient department  of  the  Hospital.  The  new  Beports  will, 
we  hope,  meet  this  want.  We  look  forward  with  much 
interest  to  the  appearance  of  this  fresh  evidence  of  the  vitality 
of  the  institution  and  of  homoeopathy,  so  often  stated  to  be 
and  wished  to  be  moribund. 


THE  H.  P.  S.  AND  ITS  MANUAL  OF  THERAPEUTICS. 

The  constant  aim  of  the  Hahnemann  Publishing  Society,  as 
most  of  our  readers  know,  has  been,  by  means  of  its  publica- 
tions, to  render  more  available  for  the  practitioner  the  vast 
mass  of  material  at  the  disposal  of  the  student  of  Materia 
Medica.  Its  annotated  Materia  Medica^  and  its  elaborate 
British  Tiepertonjf  have  been  endeavours  along  this  line.  If 
the  success  of  this  last  work  has  been  only  partial,  up  to  the 
present,  it  has  been  the  fault  rather  of  circumstances  than  of 
the  plan  and  merits  of  the  work.  The  Materia  Medica  itself 
being  incomplete,  and,  especially  of  recent  years,  in  a  tran- 
sitional state,  its  Index  is  necessarily  incomplete  also. 

On  this  account  it  was  decided  to  suspend  this  (repertorial) 
branch  of  the  work  and  push  on  with  what  may  be  called  the 
clinical  department.  The  publication  of  a  Manual  of  Thera- 
peutics  was  determined  upon,  and  we  are  able  to  place  its  first 
chapter — The  Introduction — before  our  readers  (see  page  721). 
The  scope  and  objects  of  the  Manual  are  therein  fully  described, 
and  we  hope  much  interest  will  be  aroused  in  this  important 
work.  The  authors  to  whom  we  owe  this  scientific  introduc- 
tion, write  us  as  follows,  and  we  hope  their  appeal  will  meet 
with  a  hearty  and  well  sustained  response : — 

''Our  colleagues  are  invited  to  criticise  the  plan  of  the 
Mamud  of  Therapeutics^  and  volunteers  are  invited  to  take  up 
sections  of  the  work  and  to  abstract  from  the  periodical  litera- 
ture of  all  countries  well  reported  cases  of  diseases  treated 
homceopathically . " 


HONOURS  FROM  MICHIGAN. 

Db.  Dtce  Bbown  has  been  elected  an  honorary  member  of  the 
Homoeopathic  Medical  Society  of  Michigan. 


764  OBITUARY.        "s!:^.i:°^r?:2^ 


Review,  Not.  S,  1801. 


OBITUARY. 

DR.  ROTH. 
We  have  learned  with  much  sorrow  from  lite  Times^  of  the  28rd 
ult.,  of  the  death  of  o\xr  warm-hearted,  euergetic  and  accom- 
plished friend,  Dr.  Roth,  of  Divonne — better  and  more  widely 
known  in  years  gone  by,  as  of  Wimpole  Street  and  Brighton — 
which,  it  is  stated,  occurred  on  the  20th  ult.  from  his  haying 
been  accidentally  bamed  wliile  taking  a  vapour  bath.  Ou 
this  occasion,  we  can  do  no  more  than  express  our  heartfelt 
regret  at  the  sad  event,  and  our  deep  sympathy  with  his 
sorrowing  widow  and  the  members  of  her  family.  Next 
month,  we  shall  hope  to  be  able  to  give  some  account  of  his 
career. 

CORRESPONDENCE. 

KEENE  &  ASHWELL'S  HOMGEOPATHIC  DIRECTORY. 
To  tfie  Editors  of  the  **  J^Ionthhj  llomceopathic  Revieic.^' 

Gentlemen, — This  Directonf  has  been  found  fault  with  for  its 
want  of  accuracy.  But  whose  fault  is  this  ?  I  have  ascertained 
that  Messrs.  Keeue  and  Ashwell  sent  circulars  to  all  the 
homoeopaths  they  knew,  with  the  result,  notwithstanding  two, 
three,  or  four  applications,  that  no  notice  was  taken  of  the 
circular  by  a  great  many  of  our  colleagues.  It  is  not  fair, 
therefore,  when  the  publishers  take  every  pains  to  ensure 
accuracy,  that  they  should  be  so  treated,  and  then  found 
fault  with  for  inaccuracy.  We  say  nothing  of  those  who 
wilfully  keep  their  names  out  of  the  list.  I  presume  they  are 
satisfied  with  their  reasons  for  so  doing.  But  this  is  no  fault 
of  the  publishers.  Those  gentlemen  have  the  satisfaction  of 
knowing  that  they  contribute  to  the  fact,  to  which  the  last 
President  of  the  Congress,  in  his  address,  drew  attention,  viz. : 
that  there  are  fewer  names  in  the  Directoty  than  used  to  be, 
and  this  statement  has  been  published  for  and  wide  in  the 
newspapers. 

If  our  colleagues  wish  to  see  an  accurate  Directory  they 
must  work  with  the  publishers,  and  take  the  trouble  to  send 
back  the  circulars  duly  filled  up,  or  when  a  new  name  has  to 
be  added,  to  send  vohmtarily  a  statement  for  publication. 
The  publishers  issue  the  DirecUmj  at  a  pecuniary  loss,  and 
we  owe  them  much  graditude  for  the  care  tliey  take  to  ensure 
accuracy,  and,  in  fact,  for  publishing  it  at  aU  at  a  loss  to 
themselves.  It  shows  an  amount  of  public  spirit  and 
interest  in  homoeopathy  which  should  be  met  in  a 
co-operative  spirit.  As  to  the  foreign  part  of  it,  it  is  most 
difficult  to  prevent  inaccuracies  in  speUing  names,  and  we 
venture  to  suggest  that  if  a  Directory  were  published  on  the 


^SJf^T^^Sf'         CORRESPONDENCE.  755 


Gontinent,  the  mistakes  in  English  names  would  be  far  more 
numerous. 

Personally,  as  Hon.  Secretary  of  the  Homoeopathic 
Congress,  I  have  an  interest  in  the  accuracy  of  the  Directory. 
I  cannot  be  expected,  in  sending  out  the  circulars  annually, 
to  remember  those  who  wilfully  or  carelessly  have  not  their 
names  in  the  book.  I  generally  get  an  amanuensis  to  copy 
the  names  as  they  are  in  the  Directory,  and  I  decline  to  hold 
myself  responsible  if  those  whose  names  do  not  there  appear 
receive  no  circular. 

There  will  be  a  new  edition  of  the  Directory  published  by 
Messrs.  Eeene  &  Ashwell,  74,  New  Bond  Street,  next  year, 
and  it  is  to  be  hoped  that  a  better  response  will  be  given  by 
our  colleagues.  Meantime  as  to  the  Congress,  I  would 
request  that  all  who  wish  to  have  a  circular,  and  whose 
names  are  not  in  the  Directory,  would  send  io  me  their  names, 
addresses,  and  professional  titles,  as  soon  as  possible. 

Yours,  etc., 

D.  Dyce  Brown. 

THE  PHESERVATION  OF  NEEDLES. 
To  the  Editors  of  the  "  Monthly  Homoeopathic  Review.'' 

Gentlemen, — In  reference  to  your  note  in  last  month's 
Ilet'iew,  dealing  with  an  effective  way  of  keeping  surgical 
needles  aseptic,  I  wish  to  indicate  a  sUght  modification,  which 
is  found  in  the  practice  of  the  best  Continental  operators. 
This  is  in  the  use  of  chloroform  as  a  medium  in  which  the 
needles  permanently  lie.  It  is  quite  free  from  the  objection 
to  alcohol,  in  that  it  is  not  hygroscopic  ;  and  in  practice,  it 
answers  extremely  well. 

When  in  Vienna,  I  noted  the  practice  there  was  to  use  car- 
bohc  glycerine  as  the  medium  for  preservation.  This  only 
works  satisfactorily  when  the  needles  are  nickel-plated,  and 
the  coating  constantly  renewed.  So  soon  as  the  nickel  in 
any  spot  is  worn  off,  galvanic  action  is  set  up  between  it  and 
the  steel  beneath,  and  the  abraded  area  further  increased. 
The  carbolic  glycerine  being  very  hygroscopic,  the  oxidation 
is  aided  and  abetted,  and  the  needles  grow  rusty  and  rough. 
With  chloroform  as  a  medium  for  preservation,  these  troubles 
are  avoided. 

To  render  needles  aseptic  after  operation,  brushing  them 
well  with  soap,  and  afterward  sterilising  by  boiling  in  weak 
soda  solution  for  five  minutes,  is  a  plan  carried  out  under 
high  auspices  in  Berlin. 

Yours  truly, 

Queen  Anne  Street,  W.  George  Btjbfobd. 


766  C0B8E8P0NDENTS.        "SS^^iSr?^ 


Beriew,  Nov.  S,  191. 


NOTICES   TO   CORRESPONDENTS. 


\*  We  cannot  wmhrtahe  to  return  r^ected  9taHH4eript$, 

Authors  and  Contbibutobs  reoeiving  proofs  are  requested  to  correct 
and  return  the  same  as  early  as  possible  to  Dr.  Edwin  A.  Neatby. 

London  Hom<eopathic  Hospital,  Great  Ormond  Street. 
Bloomsbuby.— Hours  of  attendance  :  Medical,  In-patients.  9.30  :  Oat- 
patients,  2.30,  daily ;  Surgical,  Mondays  and  Thursdays,  2.30  ;  Diseases 
of  Women,  Tuesdays  and  Fridays,  2.30  ;  Diseases  of  Skin,  ThurdajP 
2.30  ;  Diseases  of  the  Eye,  Thursdays,  2.30  ;  Diseases  of  the  Ear.  Satur- 
days, 2.30  ;  Dentist,  Mondays,  2.30  ;  Operations,  Mondays,  2. 

Dr.  MoBGAN,  of  Clifton,  has  taken  into  partnership  Dr.  Barro\^% 
late  of  Hey  lake,  Cheshire. 

We  understand  that  there  is  a  vacancy  for  a  house  surgeon  (qualified) 
at  the  Birmingham  Homoeopathic  Hospital. 

Dr.  J.  C.  PiNCOTT  and  Dr.  Neild.  of  Tunbridge  Wells,  hare  by 
mutual  friendly  agreement  dissolved  partnership.  They  continue  io 
practice  in  that  town. 

Communications  have  been  received  from  Dr.  Dbysdale,  Dr.  Moorb 
(Liverpool);  Dr.  Clifton  (Northampton);  Dr.  Gibes  Blake  (Bir- 
mingham); Dr.  MOBOAN  (Clifton):  Dr.  Stonham  (Ventnor);  Dr.  Bni- 
ford,  Mr.  Dudley  Wbioht.  Mr.  Hu  end  all,  Mr.  G.  A.  Cross  (London) ; 
Dr.  Lambreohts  (Antwerp) ;  Dr.  Bollen  (Port  Adelaide,  S.  Australia). 


BOOKS    RECEIVED. 


nutonj  of  Ch'cvmeiftion  from  the  Earliest  Timet  to  the  Prv$tnt. 
JforaJ.  and  PhyHcal  B^aitontt  for  its  Performance  ;  viifh  a  History  of 
JSunurhi^m,  Jlermaphrodhm,  etc..  and  of  the  Biffervnt  Operation* 
practiced  upon  tJte  Prvpnvc,  By  P.  C.  Remondino,  M.D.  Philadelphia 
and  London.  F.A.Davis.  ISIU. — The  Jlom/gopathio  World,  London. 
October. — TJie  Chemht  and  DniggiH.  London.  October. — The  Monthly 
Jfagaztne  of  Pharmacy,  London.  October. —  VanonVfi  Werkly  Shcf^t*. 
London.  October. — 'The  Xorth  American  Journal  of  JIanuropathy, 
New  York.  September. — The  JVew  York  Medical  Time*,  New  York. 
October.— T^^j  Mcdhal  Ilecord.  New  York.  October.— 7%^  Xetc 
England  Medical  Gazette,  Boston.  October. — The  Ilahncmannian 
Monthly.  Philadelphia.  October.  —  !77«?  Homceopathle  Physician, 
Philadelphia.  October.— 77/<!  Clinique,  Chicago.  September.— Jftr 
Medical  Era,  Chicago.  October.— ^Vw  California  Homeeopath,  San 
Frandsoo.  September. — Tlw  Homeopathic  Envoy.  Lancaster,  Pa. 
October.— 77«<  Indian  Jlomoiopathic  Hevisw.  Calcutta.  July. — ItevHr 
Homwopathique  Beige.  BruxcUes.  August.— i?WZ,  Gen.  de  Tkha- 
jteutique.  Paris.  October.— Leipzig -Populdre  Zeitsehrift  fur  Homikt' 
pathie,  October. — La  Homceopathie.  Bogota.  August.— i2*mf a  Omio- 
pati^ja,  Rome.  September.— (^ar/'ff a  Medica  di  Torino.  October, 
Ilomojopath  isch  Maandhlad .    October. 

Papers,  DispenMur  Beports,  and  Books  for  Beview  to  be  sent  to  Dr.  Pops.  19, 
Watovate,  Grantham,  Linoobwhire ;  Dr.  D.  Dycb  Bbowk,  29,  Befmoiir  Steeet,  Pact- 
man  Square,  W.;  or  to  Dr.  Edwix  A.  Nbatbt,  161,  HaTentock  IBll,  N.W.  Advertise- 
ments  and  Businem  communicatioos  to  be  sent  to  Messrs.  E.  Oould  ic  Sox,  Ut, 
Moonrate  Street,  B.C. 


SSS'S",'"?S}"'  GASTRIC   ULCER.  757 


Btrinr,  Dae.  1, 1891. 


THE    MONTHLY 

HOMOEOPATHIC    REVIEW. 


■:o:- 


GASTEIC  ULCER.* 
By  H.  Wynne  Thomas,  M.R.C.S.  Eng.,  L.R.C.P.,  Lond. 

The  subject  I  have  chosen  for  my  paper  is  "  Gastric 
Ulcer,"  for  the  simple  reason  that  during  the  last 
18  months  I  have  seen  and  had  under  my  care  a  number 
of  such  cases,  and  I  hoped  by  the  preparation  of  this 
paper,  and  from  remarks  which  will  follow  in  dis- 
cussion from  members  present,  that  I,  and  others  here 
to-night,  may  be  better  able  to  treat  this  affection  in 
future. 

I  propose  briefly  to  sketch  an  outline  of  the  etiology  of 
this  disease,  its  diagnosis,  and  the  most  important 
methods  of  treatment. 

By  gastric  ulcer  I  mean  to  confine  my  remarks  to 
simple,  chronic  perforating  ulcer. 

This  disease  is  characterised  during  life  by  pain  in  the 
stomach,  and  usually  associated  with  vomiting,  haemorr- 
hage, and  disturbance  of  the  digestion ;  and  terminating 
either  in  cure,  or  in  death  from  hemorrhage,  perforation 
or  marasmus.  Its  essential  anatomical  character  con- 
sists  in  a  circumscribed  loss  of  substance  of  the  coats  of 
the  stomach  or  duodenum  extending  for  a  variable 
depth  through  their  tissues. 

*  Bead  before  the  British  Homoeopathic  Society,  November  5th,  189  K 
Vol.  35,  No  12.  3  G 


758  GASTRIC   ULCEB.  "SS&?iS"?^ 


Beytow,  Dec.  1, 191. 


Galen  (130  a.d.)  mentions  ulcer  of  the  stomach,  and 
Oelsus  laid  down  rules  for  its  treatment  which  are 
generally  accepted  even  now.  In  1880  Cruveillier  first 
separated  simple  ulcer  of  the  stomach  from  cancer,  and 
in  1 853  Virchow  promulgated  the  theory  which  is  still 
generally  accepted,  that  it  is  caused  by  derangement  of 
the  circulation  in  the  gastric  vessels. 

Gastric  ulcer  is  ct  specific  variety  of  ulcer,  which  is 
met  with  only  in  the  stomach  and  duodenum,  usually 
single,  although  two,  three,  and  even  more  have  occa- 
sionally been  found.  In  shape  the  ulcer  resembles  a 
funnel,  the  loss  of  substance  being  greater  on  the  mucous 
surface  than  in  the  external  layers;  its  periphery  is 
usually  circular,  its  edges  being  sharply  cut,  as  if  a  piece 
of  the  stomach  had  been  removed  by  a  punch.  When 
recent  it  is  characterised  by  absence  of  all  rnfiammiatory 
infiltration  in  the  neighbourhood,  but  more  often  its 
edges  are  thickened  and  hard,  although  the  tissues 
immediately  surroundmg  the  ulcer  are  quite  healthy. 
The  base  of  the  ulcer  presents  different  appearances 
according  to  the  depth  to  which  the  destructive  process 
has  advanced  ;  the  floor  may  be  formed  by  the  muscular 
coat,  or  if  the  ulceration  extends  deeper  than  this,  it 
forms  a  hole  which  is  considerably  smaller  than  the 
opening  in  the  mucous  membrane,  and  at  the  bottom  of 
which  may  be  seen  the  peritoneum.  The  latter,  after 
rupture,  may  still  form  the  floor  by  adhesion  to  the 
neighbouring  organs.  The  size  is  variable,  the  average 
being  that  of  a  sixpenny-piece,  but  there  have  been  cases 
recorded  of  five  and  six  inches*  in  diameter. 

Ulcers  are  found  in  the  majority  of  cases  along  the 
lesser  curvature  and  posterior  surface  of  the  stomach, 
sometimes  in  the  anterior  sutfaceybut  much  more  rarely. 
Brintont  found  that:  out  of  220  cases  there  were — 

86  in  posterior  surface. 

56  in  smajler  cm'vature, 

82  at  pylorus. 

10  in  anterior  surface. 

13  in  ant.  and  post,  walls  at  same  time. 
5  in  greater  curvature. 
4  in  cardiac  pouch. 

♦  Ihytwldt'  Syiiem  of  Med, 

t  BritUh  and'  Fm-eign  Medical  and  Chir,  Beview,  Jan.,  1856,  p.  l.'>9 ; 
Feb.,  1856,  p.  f>9. 


JSSSS'^TJffi*^        OA8TMC   DLCEB.  769 


tteview,  Deo.  It  1801. 


So  that,  fortoiiately,  they  occur  eight  times  as  often 
on  the  posterior  wall  as  in  the  anterior  Not  infre- 
quently two  ulcers  are  found  in  the  same  stomach 
exactly  opposite  each  other,  one  on  each  surface,  and  as 
they  generally  seem  of  different  dates,  it  is  supposed 
that  the  walls  coming  together  while  the  stomach  is 
empty,  the  one  has  caused  the  other ;  ulcers  are  also 
found  in  the  duodenum,  and  occasionally  at  the  lower 
end  of  the  oesophagus. 

Cicatrization  may  take  place  in  any  stage  of  the  ulcera- 
tive process  even  after  complete  perforation,  if  blocked 
by  adhesion  to  surrounding  parts.  The  cicatrices  of 
the  smaller  ulcei's  generally  have  a  radiate  appearance 
produced  by  the  surrounding  mucous  membrane  being 
drawn  into  folds  towards  the  somewhat  depressed  cicatrix. 
Larger  ulcers  give  rise  to  cord-like  cicatrices  which 
produce  more  or  less  narrowing  of  the  stomach,  stenosis 
of  the  pylorus,  hour  glass  contractions.  I  came  across  a 
very  good  specimen  of  the  latter  while  at  work  in  the 
disscctmg  room. 

Grastric  ulcer  manifests  a  decided  tendency  to  extend 
and  eventually  perforate  unless  stopped  by  cicatrization. 
When  perforation  does  take  place  it  would  always  be 
followed  by  fatal  peritonitis  were  it  not  that  while  ad- 
vancing towards  the  peritoneum  the  latter  becomes  irri- 
tated, a  localized  peritonitis  takes  place  and  the  inflamed 
spot  becomes  glued  to  the  neighbouring  parts,  whatever 
they  may  be,  either  pancreas,  spleen,  liver,  etc.  The 
active  movements  of  the  stomach  naturally  tend  to 
prevent  adhesion,  and  this  is  particularly  so  between  the 
anterior  wall  of  the  stomach  and  the  abdominal  wall, 
hence  the  much  greater  danger  of  ulcers  in  this  situation; 
in  fact,  in  a  great  number  of  the  deaths  from  peritonitis 
from  this  cause,  it  has  been  found  afterwards  that  the 
ulcer  was  situated  in  this  part  of  the  stomach.  Some- 
times the  ulceration  continues  into  other  organs,  through 
the  diaphragm  or  larger  vessels  and  even  external  fistulte 
have  sometimes  been  found. 

Some  years  back  a  girl,  age  20,  was  admitted  into  St. 
Thomas's  Hospital*  in  a  state  of  collapse,  moist  sounds 
were  detected  at  the  left  apex,  gangrenous  bits  of  lung 
were  expectorated  with  a  very  foetid  mucus.     There  was 

•  JRrit.  Med.  JnL,  Febniary,  1879,  p.  576. 

3G-2 


7C0  GASTBIC   ULCEB.  "^iSjJ=?S?'?'^ 


Beview.  Dee.  1,  lOd. 


no  history  of  blood  spitting  and  she  only  occasionally 
vomited.  At  the  2>ost  mortem  an  ulcer  in  the  stomach- 
levas  found,  communicating  with  a  fiat  abscess  between 
the  liver  and  diaphragm,  and  this  oi)ened  into  the  left 
lung ;  a  few  tubercles  were  discovered  at  the  apex.  This 
shows  how  one  may  be  led  astray  in  diagnosis,  as  the 
ulcer  was  never  suspected  before  death. 

Murchison  has  collected  25  cases  of  gastro-cutaneous 
fistulse,  of  which  12  were  from  simple  ulcer  of  the  stomach,, 
and  the  others  being  from  cancer  or  perforating  wounds ; 
one  remarkable  case  was  that  of  a  woman  who  for  four 
years  kept  a  penny  pressed  into  a  sore  left  by  a  seton 
until  it  produced  a  hole  opening  into  the  stomach. 

Death  may  take  place  from  haemorrhage  arising  from 
erosion  of  some  large  vessel,  the  vessel  being  a  branch 
of  the  coronary  artery  of  the  stomach  or  pancreatic 
branch  of  the  splenic  artery.  In  The  Medical  Times  a 
case  is  recorded  where  death  took  place  from  ulceration 
of  the  splenic  artery  itself.  It  is  surprising  that  death 
does  not  oftener  take  place  from  bleeding,  but  I  think 
that  as  the  ulceration  approaches  a  blood  vessel  the  same 
process  of  localized  inflammation  is  established  in  the 
vessel  as  takes  place  in  the  peritoneum ;  a  clot  forms  for 
some  distance  on  each  side,  and  so  ulceration  may  actually 
go  on  completely  through  the  vessel  without  the  loss  of 
a  drop  of  blood  if  the  clot  be  firmly  attached  to  the  walls 
of  the  vessel,  but  any  violent  movement  or  distension  of 
the  stomach  or  increased  force  in  the  circulation  is  liable 
to  displace  the  clot,  in  which  case  bleeding  may  go  on 
indefinitely. 

The  fact  that  this  variety  of  ulcer  is  found  only  in  the 
stomach  and  its  immediate  neighbourhood,  mainly  in  the 
duodenum  and  lower  part  of  oesophagus  has  led  to  an 
attempt  to  explain  the  immediate  causation  by  the  cor- 
rosive  action  of  the  gastric  juice.  Virchow  pointed  out 
that  as  long  as  the  circulation  is  maintained,  the  alkaline 
blood  will  neutralize  the  acid  as  soon  as  it  penetrates 
the  tissues.  He  supposed  that  the  affection  began  with 
some  morbid  change  in  the  blood  vessels,  some  obstruc- 
tion in  either  an  arterj-  or  vein.  This  might  be  caused 
by  embolism  and  thrombosis  from  disease  in  the  coats 
of  the  vessels,  and  in  support  of  this  theory  Pavy  found 
that  in  animals  parts  of  the  stomach  from  which  the  cii*- 
culation  had  been  artifically  cut  off  had  luidergone  diges* 


^t^'^mSH^"  (USTMC   ULCER.  761 


BevJew,  Dec.  1,  imi. 


tion.  Paiinum  injected  small  pellets  of  wax  into  the 
arteries  of  the  stomach  of  dogs  and  found  afterwards 
ulcers  very  closely  resembling  those  found  in  the  human 
stomach. 

Wilks  and  Moxon  suggest  that  ulcers  may  be  of  nervous 
•origin,  just  as  ulcers  of  the  cornea  are  found. 

And  Dr.  Decker,  in  the  Lancet  of  1887,  vol.  1,  page  1100 
•advances  evidence  of  the  cause  being  traumatic,  i.e.  from 
hot  drinks.  He  thinks  that  the  contact  of  hot  thickened 
liquids  with  the  mucous  membrane  of  the  stomach  excites 
hyperaemia,  which  becomes  localized,  leads  to  venous 
stasis  and  haemorrhage  in  a  limited  area  and  to  sub- 
iiequent  necrotic  change.  He  points  to  the  frequent 
occurrence  in  cooks  who  taste  dishes  while  very  hot.  He 
made  some  experiments  on  two  dogs  by  pouring  very  hot 
liquids  down  their  throats.  In  one  he  found,  on  making 
a  2)08t  moi-tem,  a  patch  of  hyperaemia,  with  hsBmorrhage, 
between  the  mucosa  and  mtiscidansy  near  the  lower  curva- 
ture, and  in  the  other  a  deep  ulcer  of  characteristic  shape 
.and  position.  Two  patients  under  my  care  at  the  present 
time,  both  sufifering  from  undoubted  ulcer  of  the  stomach, 
•confess  to  taking  tea,  soup,  milk,  etc.,  very  hot,  and  one 
says  that  her  friends  frequently  remark  how  very  hot 
she  can  take  her  food.  This  may  be  a  secondary  cause 
in  some ;  but  it  seems  to  me  difficult  to  understand  why, 
if  in  itself  this  be  a  primary  cause,  ulceration  should 
be  limited  to  a  single  spot  instead  of  a  large  surface. 

Now,  the  primary  cause,  I  am  convinced,  can  be  traced, 
in  the  majority  of  cases,  to  tight  lacing.  As  I  have 
already  mentioned,  if  the  circulation  be  so  obstructed 
that  a  clot  can  form  in  an  artery  and  the  blood  supply 
from  parts  of  the  stomach  be  thus  cut  off,  then  the  gastric 
juice  can  eat  into  the  dying  tissue.  Ulceration  occurs 
chiefly  between  the  ages  of  17  and  25  in  girls,  especially 
servants,  who  very  commonly  ai'e  suffering  at  the  same 
time  fromamenorrhoea  and  anaemia,  the  blood  itself  being 
impoverished.  From  the  situation  so  common  in  the 
lesser  curvature,  and  from  its  singularity,  it  must  be  due 
to  a  local  cause  (for  if  due  to  a  dyscrasia  why  should  it  be 
solitary),  and  tight  lacing  would  and  must  embarrass  the 
-circulation  in  the  stomach  when  distended.  The  arrest 
of  the  circulation  need  not  be  for  long  to  permit  the 
formation  of  a  clot,  and  this  would  be  facilitated  by  the 
condition  of  the  blood.     Often  in  such  girls  there  is  a 


762    >  GASTRIC  ULCER.       ^^SSSL^Sr?^ 


Reriev,  Dee.  1, 1891. 


Budden  and  excessive  inflation  of  the  stomach  from  food  or 
flatulence,  producing  faintness,  and  here  yon  would  have  a 
stomach  distended  to  its  utmost,  and  bound  down  by  the 
corset,  and  then  comes  the  faintness  and  formation  of  a 
clot.  That  is  the  age  when  lacing  is  tightest  and  the 
growing  body  has  not  adapted  itself.  Men,  too,  often  wear 
belts,  and  excessive  flatulence,  with  feeble  circulation 
may  affect  them.  Girls,  and  men  too,  often  have  to  stoop 
for  long  hours  together  at  their  work  or  trade,  so  im- 
peding the  circulation.  Basmussen*,  of  Copenhagen,  who 
has  had  great  facilities  for  making  autopsies,  on  cases  of 
gastric  ulcer,  which  disease  is  very  common  in  that  city, 
says  that  it  is  not  uncommon,  after  death,  to  find  a  groove 
on  the  stomach  extending  from  about  the  middle  of  the 
lesser  curvature,  obliquely  towards  the  greater  curvature. 
This  is  marked  by  a  distinct  thickening,  and  is  often 
continuous  with  a  similar  groove  on  the  liver.  He  also 
mentions  a  number  of  cases  where  the  groove  is  found 
with  a  immber  of  scars,  and  in  some  cases  actual  ulcers. 
The  hospital  from  which  the  cases  are  taken  and  which 
is  reserved  for  the  incurable  and  aged  poor ;  he  finds  scars 
representing  old  ulcers  in  7  per  cent,  in  men  and  30  per 
cent,  in  women  over  40,  the  largo  majority  being  in  the 
same  position  as  the  groove  caused  by  pressure  fix)m 
tight  lacing. 

Of  the  symptoms  of  gastric  ulcer  one  ofthe  most  import- 
ance and  generally  the  earliest,  is  pain ;  this  may  vary 
very  greatly  in  intensity,  from  mere  feeling  of  weight  in 
the  stomach,  in  some  cases,  to  severe  boring,  burning 
pain  ;  as  a  rule  it  comes  on  in  from  2  to  20  minutes  after 
food  and  remains  until  gastric  digestion  is  over,  when 
the  pain  subsides,  usually  in  from  1  to  2  hours.  Of 
course,  if  the  ulcer  be  situated  in  the  duodenum  the  pain 
will  not  come  on  until  the  contents  of  the  stomach  begin 
to  pass  out  of  the  stomach.  I  had  a  very  interesting 
case  of  this  kind  just  twelve  months  ago,  November  21, 
1890.  Mrs.  D.,  aet.  38,  had  for  ten  days  been  suffering 
from  pain  and  fulness  at  times  in  epigastrium ;  appetite 
poor;  tongue  clean;  looks  anepmic.  R  lycojyod.  6- 
Four  days  later  pain  in  epigastrium  worse,  especially 
at  night,  great  tenderness  on  pressure.  Benger's  food 
and  arsejiicum.  8x. 

*  ///vY,  Mrd.  Jh!..  Janunrv.  1S87.  page  742. 


g^^'ri^n??gf  ^^  GASTBIC   ULCER. 763 

26th. — Pain  no  better,  now  always  worst  1^  or  2  lioiivs 
after  taking  the  food.    Ridge's  Food.    Liq.  Foivleri  iii j . 

28th. — Steadily  getting  worse. 

I  now  decided  that  the  pain  was  from  lower  down  than 
the  stomach,  most  likely  the  duodenum,  and  so  ordered 
kreochyle  that  would  be  absorbed  from  the  stomach  and 
little  remaining  to  travel  the  intestine.  I  also  gav(^ 
kali  Inch.  3x.  After  that  she  improved  wonderfully,  said 
she  had  no  pain  after  the  meat  juice,  although,  at  first, 
if  she  took  milk  it  came  on  again.  She  soon  made  a 
good  recovery.  Twice  before,  at  intervals  of  some  years, 
she  had  had  similar  attacks  which  had  lasted  months. 

The  pain  of  gastric  ulcer  is  naturally  mcreased  by 
indigestible  articles  of  diet,  and  is  generally  relieved  hy 
vomiting.  In  some  cases,  however,  the  pain  is  relieved 
by  eating,  and  in  rapidly  fatal  cases  pain  is  not  in- 
frequently very  slight  and  at  times  absent.  This  I  tako 
to  be  in  cases  where  a  large  slough  is  forming,  and  has 
not  been  thrown  off,  and  so  protects  the  nerve  endings, 
of  the  raw  surface  underneath  which  would  be  the  sen- 
sitive part.  Pain  is  increased  by  pressure,  and  the 
patient,  if  a  female,  is  even  content  to  forego  the  fancied 
advantages  of  her  stays  rather  than  endure  the  pain  the 
central  piece  of  whalebone  in  these  ingenious  aids  to- 
disease  often  produces.  As  a  rule  a  severe  attack  of  pain 
is  reheved  by  Ijring  down,  no  matter  what  may  be  tht^ 
situation  of  the  ulcer ;  pressure  is  always  most  painful 
over  one  particular  spot,  but  that  spot,  when  found,  is 
no  indication  to  the  exact  seat  of  the  ulcer,  as  far  as  1 
have  been  able  to  make  out.  Besides  pain  in  the  epi- 
gastrium, is  a  gnawing  pain  in  the  back,  limited  to  a 
single  spot  between  the  8th  and  9th  dorsal  vertebra\ 
Another  important  symptom  rarely  absent  is  vomitiniij, 
the  contents  of  the  stomach  being  evacuated  with  1)ut 
little  retching  and  relief  to  the  patient.  In  a  case  sus- 
pected of  ulceration  it  is  very  important  to  examine  tht* 
vomit  carefully  for  blood,  as  at  first  hsemorrhage  is  so 
slight  as  not  to  attract  the  patient's  attention. 

The  third  great  sign  is  htematemesis.  This  may  vary 
viery  much  in  amount ;  at  times  the  blood  distends  the 
stomach  and  intestines  and  the  patient  dies  without 
even  vomiting.  But  more  often  soon  after  a  meal  the 
patient  begins  to  feel  an  unusual  fulness  and  weight  in 
the  stomach;  she  feels  faint,  and  vomiting  of  blood  takes. 


764  GASTBIC   ULCER.         "S^^Sf?^ 


Beview,  Dec  1,  isn. 


place ;  if  the  amount  is  only  moderate,  and  has  been  in 
the  stomach  some  time,  it  is  dark,  like  coffee  grounds ; 
but  if  a  large  vessel  be  opened  up,  a  pint  of  bright  red 
blood  may  be  the  result.  Some  blood  is  generally  passed 
per  lectum,  possibly  the  same  day  or  a  day  or  so  later, 
usually  as  a  black,  tarry  motion,  but  if  in  quantity  may 
be  loose  and  red  in  oojour.  MelsBua  may  be  the  first 
sign  that  hsemorrhage  is  going  on  in  the  stomach,  and 
if  the  evacuation  be  tarry  the  bleeding  comes  from  the 
stomach  and  not  intestines,  as  haemorrhage  from  the 
latter  is  always  red.  Constipation  is  very  common  in 
these  cases  from  the  fact  that  on  account  of  the  pain,  the 
patient  is  led  to  take  very  little  but  slops,  and  from  the 
vomiting  little  is  left  to  pass  through  the  bowels ;  but  if 
the  ulcer  be  situated  in  the  duodenum  diarrhoea  is  not 
infrequent,  for  the  ulcer  is  a  source  of  irritation  and 
stimulates  peristalsis. 

Perforation  and  passage  of  the  contents  of  the  stomach 
into  the  peritoneal  cavity,  is  the  most  serious  complica- 
tion of  gastric  ulcer.  Sometimes  this  is  the  first 
indication  of  the  hitherto  latent  disease.  This  is  generally 
known  by  sudden  violent  pain  in  epigastrium,  spreading  all 
over  abdomen,  relaxed  abdominal  muscles,  absence  of 
abdominal  respiration,  great  tenderness  rapidly  followed 
by  tympanitic  distention  of  bowels,  and  death  within 
thirty-six  hours. 

In  January  last  I  made  a  post  mortem  with  Di*. 
Madden,  by  order  of  the  coroner,  in  a  case  of  sudden 
death  from  this  cause. 

The  patient,  a  girl  of  19,  was  housemaid  in  Bickley. 
For  a  month  or  six  weeks  had  looked  pale,  her  appetite 
was  good,  but  for  some  weeks  previous  to  her  death  had 
had  slight  mdigestion,  but  no  sickness  at  all  till  a  few 
hours  before  her  death,  when  she  vomited  some  mucus 
streaked  with  blood.  The  only  thing  she  complained  of 
was  cramp  in  her  legs,  which  generally  came  on  when  in 
bed  and  several  times  made  her  scream  out.  On  the 
Sunday  she  went  to  church  and  also  for  a  walk,  on  the 
Monday  she  scrubbed  a  hall  and  during  that  afternoon 
she  vomited  for  the  only  time  and  felt  faint.  She  went 
to  bed  and  felt  much  better  on  lying  down ;  that  evening 
at  eight  o'clock  she  had  some  gruel,  which  she  kept 
down ;  at  twelve  o'clock  had  some  milk  and  soda  and 
felt  better ;  but  was  very  faint  if  she  tried  to  walk  about 


g^rJK°ngy°  GASTRIC   ULCER. 766 

and  complained  of  pain  in  her  stomach ;  however,  she 
went  to  sleep  ;  at  four  o'clock  on  Tuesday  morning  she 
said  the  pain  was  better  but  she  was  very  ill.  She  went 
off  to  sleep  again  and  at  six  o'clock  the  other  servants 
becoming  alarmed  sent  for  Dr.Madden^who,  on  reaching 
the  house  about  half-past  six  found  her  dead.  At  the 
i)f)Bt  niaiiem  an  ulcer,  which  would  easily  admit  my 
forefinger  was  found  in  the  posterior  wall  of  the  stomach 
and  a  quantity  of  liquid  food  had  escaped  into  the 
peritoneal  cavity. 

The  diagnosis  of  this  disease  is  at  times  clear,  at  others 
most  difficult,  especially  in  sickly  chlorotic  girls  and 
women  with  menstrual  disorders,  who  complain  of  car- 
<Iialgia  and  indigestion,  but  those  cases  of  hysteria  and 
neuralgia  are  most  difficult.  One  very  important  sign 
against  ulcer  is  absence  of  any  connection  between  the 
taking  of  food  and  the  vomiting,  and  I  think  much  time 
nnd  trouble  will  often  be  saved  by  treating  all  doubtful 
oases  for  a  time  as  if  there  was  an  ulcer  present  by  strict 
abstinence  of  all  food  but  broth  and  milk ;  if  in  a  short 
time  little  benefit  is  gained,  ulcer  may  be  excluded. 

Electricity  is  at  times  useful  in  clearing  up  a  doubtful 
case.  If  pain  disappears  within  a  few  minutes  after  the 
application  of  a  constant  current  from  a  battery  of  20- 
40  cells,  then  the  pain  is  cardialgia,  real  ulcer  is  not 
affected  by  the  current. 

Among  other  diseases  likely  to  be  mistaken  for  ulcer 
is  cancer  of  the  stomach,  but  here  a  tumour  can  generally 
t>c  made  out  if  there  is  much  pain,  hsematemesis  is  a 
late  symptom  and  rarely  profuse,  by  this  time  cachexia 
has  developed,  and  on  examination  of  the  vomit  by  a 
microscope  special  cells  can  be  made  out.  This  disease 
occurs  after  80. 

Bommelaere  lays  great  stress  on  the  amount  of  urea 
excreted  in  these  two  conditions,  in  ulcers  the  percentage 
is  normal,  in  cancer  very  much  decreased. 

Byrom  Bvamwell  thinks  that  the  increase  of  the 
epigastric  reliex  on  one  side  over  the  other  should  be  a 
sign  of  some  value. 

As  regards  prognosis,  in  ordinary  cases  it  must  be 
good,  for  at  autopsies  healed  ulcers  are  found  quite  as 
often  as  open  ulcers.  Profuse  hfemorrhage  must  of 
course  increase  the  danger. 


766  GASTRIC    ULCER.  ^?iS!L?S:??^ 


Review,  Dec  1,  ISM. 


In  a  case  I  published  in  the  Mmithly  Hotnceopatiiic 
Jleriew,  in  December  of  last  year,  the  patient  vomited 
about  1}  pint  of  pure  blood,  Hhe  having  had  no  food  by 
the  mouth  for  thirty-six  hours ;  and  yet  at  the  past 
otiortem,  fourteen  days  later,  two  ulcers  were  found 
soundly  healed,  in  spite  of  the  fact  that  for  five  days 
previous  to  her  death  she  had  almost  constantly  most 
severe  vomiting  and  retching.  This  shows  that  after 
profuse  loss  of  blood  the  ulcers  heal  rapidly  and  soundly. 
If  the  ulcer  should  perforate  the  peritoneal  cavity,  the 
ease  almost  invariably  ends  fatally. 

Treatment. — Most  important  is  rest  in  l^ed,  and  I 
think  the  most  satisfactory,  and  I  am  sure  the  shortest 
way  is  rest  to  the  stomach  also.  For  three  or  four  days 
feed  the  patient  by  the  rectum,  either  with  peptonised 
foods  or  nutrient  suppositories.  A  very  good  food  is 
Leube's  food :  4 — 8  oz.  scraped  and  finely  chopped  beef; 
1 — 2  oz.  fresh  finely  chopped  oxen  s  or  pig's  pancreas ; 
and  add  warm  water  to  the  consistence  of  thick  gruel 
and  inject  slowly  with  a  long  tube ;  in  this  way  half-a- 
pint  or  more  can  be  retained  ;  or  some  of  the  meat  juices 
of  which  there  are  so  many  now  in  the  market,  but  of 
which  I  prefer  kreochyle  or  bovinine.  Beef-tea  and  eggs 
are  not  absorbed  readily  by  the  rectum. 

At  the  end  of  that  time,  begin  by  giving  small  quanti- 
ties of  liquid  food  by  the  mouth  ;  milk  and  lime  water  or 
j)eptonised  milk  5ij  or  ^iij  at  a  time  ;  many  people  obj^t 
to  milk  when  peptonised,  but  its  taste  is  much  improved 
])y  the  addition  of  Vichy  or  soda  water.  Buttermilk  is 
an  admirable  food  to  those  who  do  not  object  to  its  taste. 
Koumiss  is  also  good,  but  I  muqh  prefer  a  very  good 
preparation  of  milk  called  aerated  milk  ;  this  is  first 
sterilised  and  then  carbonic  acid  gas  forced  in  as  in 
ordinary  soda  water  ;  this  will  keep  in  a  cool  place  for 
weeks ;  it  is  sent  out,  in  syphons,  at  the  rate  of  6d.  a 
syphon,  manufactured  by  the  Stansted  Park  Dairy, 
Bishopsgate,  and  is  much  liked  by  patients.  At  the  end 
of  a  week  or  ten  days  lightly  boiled  eggs  and  milk, 
crumbled  biscuit,  powdered  rice,  or  Nestle's  infant  food 
may  be  added,  and  then  meat  broths,  young  fowl,  sweet- 
bread, &c. ;  but  for  some  time  brown  bread,  oatmeaU 
pastry  and  acid  fruits  should  be  forbidden. 

In  regard  to  medicinal  treatment.  There  are  some 
drugs  which  definitely  produce  ulceration  of  the  stomach 


SS2S^ST?SJ"*       gastric  ulcer.  7(57 


Bartow,  Dee.  1. 1801. 


and  daodenum,  notably  uranium  nitricuvi,  with  which  Dr. 
E.  Blake  made  some  valnable  experiments  some  years  ago^ 
an  account  of  which  is  published  in  the  Hahnemanv 
Materia  Medica^  part  2.  He  produced  definite  ulceration 
in  the  stomach  and  duodenum  in  some  rabbits,  and  in 
others  localised  inflamed  patches  which  would  doubtless 
have  gone  on  to  ulceration  if  the  animals  had  lived,  and 
this  was  not  from  any  local  action,  as  some  of  them  were 
treated  by  subcutaneous  injections  of  the  drug.  This 
drug  I  have  used  in  some  cases  with,  I  believe,  decided 
benefit  to  the  patient.  Arsenicum  has  vomiting  after 
food  without  nausea,  burning  and  gnawing  and  eroding 
pains  in  the  stomach.  BelL,  and  especially  atrajn/i,  is 
often  very  useful  in  these  oases,  and  especially  those 
hysterical  cases  with  pain  in  the  back,  etc.,  which  so 
closely  resemble  gastric  ulcer.  Argentum  nit.  is  spoken 
highly  of,  but  I  have  not  myself  been  successful 
with  it.  Phosphorus  is  another  good  medicine* 
For  the  burning  pain  in  the  stomach  a  few  drops  of 
chlorqform  shaken  up  with  jiv  of  water  and  5j,  given 
occasionally,  I  have  often  found  give  great  temporary' 
relief. 

Of  course  the  general  antemia  and  amenorrhoea  must 
be  treated,  and  for  this  pids.  and  some  form  of  iron  I 
generally  find  most  useful,  and  I  have  not  found  that  in 
giving  these  together  that  the  one  counteracts  the  good 
effect  of  the  other  as  Farrington  says  in  his  Clinical 
Materia  Medica.  For  an  attack  of  haematemesis  I  have 
foxindipecac. or  hamavielisy  or  both,  most  useful  in  checking 
the  bleeding.  Small  pieces  of  ice  to  suck  and  ice-bag 
locally,  but  whether  the  latter  really  checks  hsemon-hage 
I  am  not  sure.  Stimulants,  I  think,  should  be  avoided, 
as  the  flagging  circulation  tends  to  produce  coagulation , 
and  blocking  up  of  the  mouth  of  the  vessel. 

If  one  is  sure  that  perforation  has  taken  place 
abdominal  section  and  washing  out  the  abdomen  is  the 
only  chance  of  saving  the  patient's  life,  although  the 
percentage  of  recoveries  so  far  has  been  very  small. 

Discussion. 

Dr.  DuDOEON  said  a  medicine  he  had  found  most  efficient 
in  a  case  of  ulcer  of  the  stomach,  or  at  least  in  a  case  pre- 
senting all  the  symptoms  of  it,  was  cupnon  acet.  The  patient 
got  perfectly  well.     Kidi  hirhmm,  he  had  seen  of  great  use  in 


768  OASTBIC   ULCER.  "^i^^SP^^SI'' 


Bevjew,  Dec.  I,  U»l. 


cases  of  suspected  gastric  ulcer.  Dr.  Drysdale  and  himself 
had  observed  in  workers  in  factories  where  it  is  made,  ulcers 
in  various  mucous  membranes  resembling  the  ulcers  of  the 
stomach. 

Dr.  Pope,  affcer  expressing  the  pleasure  he  felt  at  hearing 
so  elaborate  a  paper  on  so  important  a  subject  as  gastric 
ulcer  read  by  the  son  of  an  old  and  valued  member  of  tlie 
Society,  referred  to  the  causes  of  this  form  of  disease,  and 
thought  that  Dr.  Thomas  had  omitted  to  mention  one  of  the 
most  frequent — ^viz.,  bad  teeth  or  no  teeth  at  aU.  The 
scarcely  masticated  food  acted  in  such  cases  as  an  irritant  to 
the  mucous  membrane  of  the  stomach,  in  some  instances 
occasioning  erosions  and  ultimately  ulceration.  He  mentioned 
the  case  of  a  servant  he  had  sent  into  the  hospital,  who  had  a 
mouthful  of  rotten  teeth,  which  he  had  in  vain  endeavoured  to 
induce  her  to  have  extracted.  With  the  rest,  milk  diet  and 
suitable  medicine  received  at  the  hospital,  she  returned  to  her 
village  home  greatly  improved  in  healtli.  Her  father,  a 
Lincolnshire  labourer,  insisted  on  her  having  animal  food, 
iind  this  was,  of  course,  followed  by  a  return  of  all  the  symp- 
toms. The  village  doctor  then  came  in  and  added  indigestible 
physic,  which  made  matters  worse.  Another  course  of  rest, 
milk  diet  and  arsenic  improved  her.  In  this  way  she  had  gone 
on  for  a  year  and  more  ;  lately,  however,  she  was  persuaded 
to  have  her  teeth  removed,  and  once  under  the  influence  of 
chloroform,  a  dozen  rotten  stumps  were  removed  and  she  is 
now  in  fair  health  and  able  to  take  light,  nourishment  in 
sufficient  quantity  and  without  pam.  Another  case  Dr.  Pope 
'quoted  as  showing  the  tendency  of  this  gastric  erosion  to 
recur.  In  this  patient  emaciation  and  feebleness  were  most 
marked — and  here,  too,  anenir  proved  effective,  togetha* 
with,  of  course,  an  exclusively  milk  diet,  in  restoring  him  to 
health.  In  the  large  majority  of  cases  arsenic  was  the  most 
homoeopathic  of  medicines — the  burning,  localised  pain,  the 
speedy  vomiting  after  food,  together  with  the  emaciation  and 
cachectic  look  being  its  chief  indication.  This,  with  the 
hichromaU*  of  potash — of  the  sphere  of  which  Dr.  Thomas  had 
given  them  a  good  illustration — and  uranium  were  the  most 
'Clearly  indicated  of  medicines.  An  excellent  illustration  of 
the  particular  kind  of  real  ulceration  in  which  uraniiim  might 
be  expected  to  do  good  was  given  in  the  number  of  the  Rfvi4fw 
for  last  February.  The  case  was  one  of  an  extreme  character 
— with  severe  pain,  vomiting  and  hsemorrhage — ^and  never- 
theless was  rapidly  relieved  and  ultimately  cilred  by  uranium. 
The  interesting  feature  of  this,  therapeutically,  was  that  in 
prescribing  this  drug  Dr.  Gorham  took  his  indication  from 
Dr.  Edward  Blake's  experiments  upon  rabbi^  only.     Out  of 


MoBjUrj^jBogtUc  GASTRIC   ULCER.  769 


BeHem,  Deo.  1, 1801 


eleven  rabbits  gradually  poisoned  with  nitmte  of  uranium  nine 
showed  post  mortem  evidence  of  distinct  and  well  marked 
ulcers  towards  the  pylorus.  The  proving  upon  human  sub- 
jects had  not  been  sufficiently  heroic,  so  far,  as  to  produce  a 
single  symptom  of  gastric  ulcer.  This  case  showed  that  in 
examining  the  pathogenetic  properties  of  a  drug  we  could  not 
afford  to  lose  sight  of  any  source  whence  information  might 
be  gained.  He  thought  that  with  such  a  grand  and  far- 
reaching  remedy  as  arsenic  was,  paUiatives  of  the  cliloroform 
or  any  other  type  would  be  found  unnecessary. 

Dr.  Hughes  said  the  last  time  gastric  ulcer  was  brought 
forward  was  when  Dr.  Meyhoffer  read  a  paper  on  the  subject 
at  the  Manchester  Congress  in  1B75.  Milk  diet  and  arfjentum 
nit.  were  his  remedies.  He,  Dr.  Hughes,  had  seen  ulcer  in 
many  servants,  but  in  his  experience  housemaids,  and  not 
cooks,  were  most  generally  affected.  He  suggested  that 
pressure  of  trays  might  cause  it.  There  was  usually  much 
ansemia,  and  to  this  art/mt.  nit.  was  homoeopathic  as  well  as 
to  the  ulceration. 

Dr.  Edward  Blake  considered  gastric  ulcer  to  be  a  much 
more  common  disease  than  might  be  imagined.  When  a  gas- 
tralgia  in  a  chlorotic  girl  resisted  ordinary  remedies,  it  wa& 
pretty  sure  to  be  the  result  of  an  ulcer.  Had  just  seen  a 
medical  friend  remove  a  persistent  pain  at  epigastrium  com- 
bined with  ansBmia,  by  means  of  carhmate  of  iron.  Dr.  Blake 
feared  that  the  tight-lacmg  theory  would  hardly  do,  as 
fiEMhionable  ladies  laced  a  good  deal  tighter  than  housemaids, 
but  ulcer  was  not  fomid  to  be  common  with  them.  He  viewed 
gastric  ulcer  as  a  local  necrosis  of  neurotic  origin ;  it  yielded 
to  nerve  remedies  such  as  arsenic,  vranium,  silver,  &c.  No 
respectable  explanation  of  its  occurrence  in  servant  maids  had 
yet  been  given.  One  must  go  to  their  life  history  for  an 
explanation.  These  girls  are  usually  the  children  of  agri- 
cultural labourers — victims  of  pre-natal,  post-natal,  and 
hereditary  innutrition.  It  should  be  remembered  that,  until  the 
recent  agitation  of  Joseph  Arch,  Hodge  was  the  worst 
nourished  animal  in  England.  For  example,  wages  were  at 
one  time  notoriously  low  in  Dorsetshire.  Francis  Ghsson, 
bom  in  that  county  in  1596,  first  described  rickets,  and  for 
that  condition  he  coined  the  quasi-classic  term  <<  rachitis."  It 
was  long  known  as  '*  the  Dorsetshire  disease."  Closely  allied 
is  its  cousin  struma.  Gastric  ulcer  is  doubtless  related  nearly 
to  the  perforating  foot-ulcer  of  so-caUed  scrofulous  subjects, 
now  recognised  to  be  a  neurosis,  as  the  homoeopath,  who  cures 
it  with  a  high  dilution  of  fdlica,  might  weU  suspect. 

The  country  girl,  who  sometimes  looks  so  ruddy,  is  rarely 
robust.    On  coming  to  town  she  is  suddenly  deprived  of  light 


770  OA8TBIC   ULCEB.  "^SSJfSS'TlSS! 

and  air.  Kept  in  an  undergTonnd  kitchen,  often  reeking  witb 
sewer  gas,  she  is  either  underfed  or  goiged  with  heavy  meat, 
and  is  said  to  be  greatly  addicted  to  the  abase  of  vinegar. 
She  becomes  either  hysterical  or  chlorotic,  and  she  fedls  an 
easy  prey  to  any  form  of  neurosis.  He  quite  agreed  with 
Dr.  Thomas,  that  most  gastric  ulcers  would  heal  without 
drugs  if  the  patient  were  put  to  bed  and  absolutely  deprived 
of  food  jiMT  orem. 

Respecting  as  to  the  use  of  the  enema,  three  times  a  day, 
the  rectum  and  the  sigmoid  flexure  should  be  well  washed  out 
with  warm  water,  beginning  with  small  enemata,  as  we  bear 
in  mind  the  valuable  researches  of  Dr.  Burford  on  this  veiy 
vital  point.  Then,  with  the  hips  well  raised,  a  very  long 
tube  quite  full,  to  exclude  aU  air,  should  be  passed  as  jGar  as 
possible  and  slightly  withdrawn.  An  ounce  or  two  of  pep- 
tonised  food  mtfiout  salt  is  allowed  to  flow  very  slowly  into  the 
intestine  by  raising  the  end  of  the  enema.  A  firm  broad  belt 
should  be  tightly  applied  round  the  buttocks,  and  the  patient 
enjoined  to  lie  on  a  warm  pillow  with  the  head  low  for  half- 
an-hour.  Dr.  Blake  thought  that  the  decayed  teeth,  noticed 
by  Dr.  Pope  as  a  cause  of  ulcer,  were  rather  a  result,  witli 
gastric  ulcer,  of  one  common  cause  of  defective  trophoneurosis, 
than  a  first  cause  in  themselves. 

Dr.  Mont  wished  to  draw  attention  to  the  difficulty  of  diag- 
nosis. He  thought  there  were  few  things  more  difficult  thim 
to  say  which  a  patient  had,  gastric  nicer  or  gastritis.  Among 
the  causes  alcohol  should  be  mentioned,  especially  among 
men.  In  one  case  due  to  this,  perforation  took  place  without 
a  previous  symptom.  A  very  severe  case  was  leaving  the 
hospital  that  week,  in  which  patient  has  got  weaker  and 
weaker,  till  she  lay  in  a  comatose  condition  for  three  days ; 
from  that  time  steady  improvement  took  place. 

Dr.  GoLDSBRouGH  agr^  with  Dr.  Moir  as  to  the  difficulty 
of  diagnosis,  but  it  was  necessary  to  give  the  patient  the 
benefit  of  the  doubt.  He  remembered  Dr.  Hughes  speaking 
of  artjentum  nit.  in  gastric  ulcer  subsequently  to  the  occasion 
he  mentioned.  Dr.  Goldsbrough  mentioned  at  that  time  that 
Hftf.  nit.  had  great  flatulence  in  its  pathogenesis.  This  Dt. 
Hughes  corrected,  mentioning  that  though  that  symptom 
might  be  a  valuable  indication  for  the  drug  it  was  not  found 
in  the  pathogenesis.  Dr.  Goldsbrough  had  been  disappointed 
in  the  use  of  arn.  nit.  in  gastric  ulcer.  Bismuth  seemed  to 
have  a  specific  relation  to  the  pain,  also  ferrum  aceticum  to 
the  pain  and  vomiting.  But  midoubtedly  the  chief  remedy 
was  arfttnir.  Dr.  Goldsbrough  came  from  the  neighbourhood 
of  Dorsetshire,  where  the  air  was  very  relaxing,  and  he 
remembered  the  diet  of  the  working  population  consisted  oC 


R252ii'iST?SfJ***  GASTRIC   ULCER.  771 


BflTiew,  Dec.  1,  lijei. 


bread,  bacon,  a  few  vegetables  and  tea.  A  diet  well  calculated 
to  promote  ancemia  and  ulceration. 

Dr.  Jaoislski  said  as  Koumiss  had  been  mentioned  ho 
would  say  that  it  is  not  only  a  food,  but  a  digestive  at  the 
same  time.  It  answers  in  all  points  for  Uiis  disease.  ArffctU. 
nU,  has  been  a  remedy  for  the  complaint  from  the  earhest 
times.  As  to  the  pain,  he  had  found  that  gastralgia  caused 
pain  at  the  back  between  the  sixth  and  eighth  vertebras,  and 
if  you  put  one  hand  at  the  back  and  one  at  the  epigastrium 
the  patient  complains  of  pain  like  a  hot  poker.  This  pain  is 
not  found  in  ulcer.  For  immediately  cahning  the  nausea 
Konmiss  is  the  best  remedy. 

Dr.  BuBFOfiD  said  that  the  theory  of  neurotic  origin 
mentioned  by  Dr.  Blake  had  quite  displaced  Virchow's  theory. 
He  mentioned  that  there  were  perforating  ulcers  in  various 
parts  which  must  be  correlated  to  the  perforating  ulcer  of 
stomach.  Perforating  ulcers  of  the  extremities  in  locomotor 
ataxia  were  of  neurotic  origin. 

The  desire  for  hot  drinks  in  ulcer  patients  showed  a  lack  of 
nervous  energy.  With  regard  to  pain,  it  was  quite  possible  for 
pain  to  be  absent  until  perforation  occurred.  Nor  did  it  in 
any  way  depend  on  the  size  of  the  slough,  and  he  mentioned 
a  case  in  point.  In  cancer  cases  there  is  absence  of  hydro- 
chloric acid  in  the  vomited  matter.  As  for  operation  in 
cases  of  perforation,  he  mentioned  that  the  record  was  one  of 
f&ilure  in  all.  On  the  other  hand,  those  left  at  home  without 
operation  all  died. 

Mr.  DuDLXT  Wright  thought  there  was  a  tendency  to  set 
down  all  diseases  to  nerves,  but  he  was  more  inclined  to 
ascribe  gastric  ulcer  to  venous  stasis.  He  claimed  cooks  as 
the  most  liable  to  gastric  ulcer.  He  beheved  it  was  partly 
due  to  their  [addiction  to  alcohol.  The  posterior  wall  is 
liable  to  be  attacked,  as  on  lying  down  the  erosion  is  more 
likely  to  occur.  In  rectal  feeding  cocaine  is  a  useful  addition 
where  there  is  much  rectal  irritabihty. 

Dr.  Cooper  referred  Dr.  Thomas  to  a  case  reported  in  Tfie 
Lftncet,  in  which  a  patient  suffering  from  ulcer  was  poulticed, 
and  a  red  spot  occurred  over  the  point  where  the  ulcer  was 
situated.  He  regretted  that  Dr.  Thomas  had  not  devoted 
more  attention  to  the  medicinal  aspect  of  the  disease.  It  is 
commonest  between  the  ages  of  18  and  22,  and  again  at  the 
climacteric.  His  experience  was  that  housemaids  were  more 
prone  to  it  than  any  other.  There  was  anfemia  and  pain  in 
the  left  ovary.  Arnen,,  cat-b.  t\,  hUm.  are  useful;  dXdO  actea 
and  bryojiin.  Besides  this,  ferr.  curb.  8x.  acted  well,  or 
Flitwick  water  in  teaspoonful  doses  In  a  case  at  climacteric 
adhesion  took  place  at  posterior  wall  of  stomach.    The  patient 


772  THREE  A-TYPICAL  CASES.      ^'S^^ISJTfir 


B«Tie«r,  Iloc  1, 1891. 


baa  recovered.  He  thought  sufficient  prominence  had  noi  been 
given  to  neuralgia  of  the  stomach.  He  mentioned  a  case  in 
which  a  pad  dipped  in  chloroform  applied  over  the  solar  plexii5% 
gave  permanent  relief.  A  severe  case  of  gastralgia  in  a  man 
he  cured  by  fpmpotcder  8x.  trit. 

Dr.  Thomas  (in  reply)  said  when  in  Birmingham  some 
years  ago  he  saw  three  cases  of  cancer  of  stomach  in  which 
the  hydrochloric  acid  test  was  tried,  but  without  any  decisive 
result.  The  cases  of  ulcer  he  had  seen  were  not  at  all  badly 
fed.  He  thought  it  curious  that  the  stomach  should  be  so 
much  more  frequently  affected  than  any  other  part  if  all  per- 
forating ulcers  were  to  be  regarded  as  of  the  same  kind,  unless^ 
due  to  some  local  cause  such  as  he  had  mentioned. 


THREE  A-TYPICAL  CASES. 
By  G.  H.  Burford,  M.B. 

Assistant  Physician  t^  the  Gynecological  Department.  London 

Homoeopathic  HospitaL 

I  PREFER  the  German  term  a-typical  to  the  usual  English 
adjective  anomalous.  It  better,  in  this  paper,  conveys, 
the  desired  idea  that  the  clinical  histories,  in  varying' 
degree,  depart  from  the  usual  and  ordinary,  that  theii* 
details  have  a  greater  range,  and  that  some  of  the  facts^ 
traverse*  those  usually  observed. 

Case  A. 

This  was  seen  in  consultation  with  Br.  Edgar  Hall,  at 
Surbiton,  and  the  aspects  of  the  case  were  so  unusual  as- 
to  constitute  a  pathological  difficulty. 

The  patient  was  a  well-built  single  woman,  about  40 
years  of  age,  who  previously  had  nothing  to  record  beyond 
the  usual  course  of  average  health.  Ten  days  anterior 
to  my  visit  she  had  a  period,  in  no  way  differing  firoui 
those  ordinary  with  her — a  relatively  scant  discharge,  a 
moderate  degree  of  pain,  and  no  notable  urinary  difficulty. 
Immediately  on  the  cessation  of  this  function  she  under- 
took some  heavy  lifting,  and  straightway  experienced 
acute  pelvic  pain,  with  a  sensation  expressed  '*  that  she 
must  put  her  hand  to  the  vulva  to  prevent  something 
coming  out."  She  betook  herself  to  bed,  and  from  the 
horizontal  position  gained  some  relief. 

The  following  day  sudden  and  notable  htematuria 
supervened.     The  urine  was  tinged  bright  red,  but  there 


nSt^J^SITSn^      THREE  A-TYPICAL  CASES.  77S 

r 

was  no  mineral  sediment  or  pus  therewith.  Coincident 
\dth  the  altered  renal  secretion  was  considerable  dysuria^ 
which  was  present  both  day  and  night.  The  pelvic  pain 
continued,  and  was  felt  in  the  sacral  area,  the  bearing- 
down  sensation  in  front  persisting,  but  less  intensely. 

After  a  few  days,  as  the  symptoms  had  only  slightly 
abated,  Dr.  Hall  kindly  asked  me  to  see  the  patient  with 
him,  with  a  view  to  accurately  determining  the  pelvic 
condition.  It  was  necessary  to  anaesthetise  the  patient, 
so  sensitive  was  she  to  local  examination.  Under  chlo- 
roform, administered  by  Dr.  Hall,  I  ibund  a  virgin  uterus, 
somewhat  retroflexed,  but  fairly  mobile.  The  left 
parametrium  and  the  pouch  of  Douglas  were  entirely  free, 
but  in  the  right  paxametriam  was  some  arching,  and  a 
distinctly  detectable  boggy  sensation,  absent  on  the  other 
side.  Rectal  examination  showed  this  more  clearly  as  a 
loosely-defined  swelling,  about  the  size  of  a  Tangerine 
orange.  A  catheter  introduced  into  the  bladder  brought 
away  about  an  ounce  of  brownish  urine.  ■* 

Hot  applications  and  tincture  of  hamamelis  internally 
were  found  of  no  avail.  Leiter's  coil  with  iced  water 
was  then  applied  over  the  pubes,  and  iron  administered 
in  place  of  hamamelis.  This  in  a  short  time  stopped  the 
haemorrhage,  and  the  patient  began  to  feel  very  well. 
After  the  urine  had  been  quite  bloodless  for  two  days, 
the  coil  was  removed,  and  the  patient  allowed  to  lie  on  a 
couclu  In  a  few  hours  great  local  distress  was  experienced, 
the  dysuria  recurred,  and  severe  pain  over  the  pubes  was 
complained  of. 

Various  remedies  were  now  successively  tried, 
chimaphila  with  most  result.  The  urine  beginning  to 
deposit  muco-pus,  the  bladder  was  washed  out  with  a  warm 
solution  of  boracic  acid  ;  this  gave  great  relief.  Deposit 
examined  microscopically  showed  pus  chiefly,  with  a  few 
altered  blood  corpuscles,  but  no  trace  of  kidney  structure. 
The  patient  continued  to  do  well,  and  ultimately 
quite  recovered  her  usual  health. 

The  question  arises,  what  was  the  exact  naturo 
of  the  lesion  existent  in  this  case?  The  symptom- 
series  is  almost  dramatic  in  its  vividness.  An 
ordinary  period  of  uterine  engorgement  is  commencing 
to  subside.  Before  the  return  of  the  pelvic  circulation 
to  the  status  qitOy  a  well  defined  traumatism  occurs. 
This    is    followed,  not    by    a    recurrence    of    uterine 

VoL  35,  No.  12.  3  H 


774  THREE  A-TYPICAL  CASES.      ^S2?I?2S*?^ 


B€Tiew»  Dee.  1,  Un. 


haemorrhage,  as  is  usual,  but  by  local  pain,  a  senarof 
dislocation  of  the  pelvic  viscera,  and  later  on,  by  a  slight 
but  continuous  haemorrhage,  escaping  into  the  bladder 
and  not  into  the  vagina.  Coincident  with  this  is  found  a 
recent  boggy  effusion  into  the  right  broad  ligament.  The 
pain  continues ;  the  sense  of  pelvic  discomfort  lessens  in 
some  degree  whilst  in  the  horizontal  posture;  the 
haematuria  shows  for  some  days  no  sign  of  abating.  On 
its  cessation,  and  with  the  commencement  .of  bodily 
movement,  there  occurs  a  sharp  attack  of  cystitis. 

These  signs  and  symptoms  may  be  read  as  the  clinical 
history  of  a  small  pelvic  haematoma,  but  not  of  the  usual 
kind.  The  absence  of  all  peritoneal  symptoms  indicates 
its  site  as  extra  peritoneal.  The  presence  of  a  right  broad 
ligament  effusion  confirms  this.  But  how  account  for 
the  vesical  haemorrhage  r  Three  alternative  hypotheses, 
in  the  absence  of  exact  pathological  data,  generalise  the 
symptom  series  described. 

I.  That  the  effusion  in  the  right  broad  ligament  found 
its  way  in  the  direction  of  least  resistance  along  the  planes 
of  cellular  tissue,  and  was  bounded  in  part  by  a  small 
area  of  bladder  wall,  through  which  a  vent  was  established. 

Against  this  may  be  urged  that  there  were  no  physical 
signs  of  this  continuity,  and  that  the  pathological  course  r;i 
here  depicted  is  not  usual. 

II.  That  at  least  two  haematomata  occurred  at  the 
time  of  traumatism,  the  major  one  as  before  described, 
the  minor  one  under  or  in  the  fibres  of  the  bladder  wall. 
An  easy  solution  of  continuity  would  account  for  the 
vesical  bleeding* 

III.  That,  coincident  with  the  pelvic  extravasation, 
but  quite  dissociated  from  it,  there  occurred  an  actual 
fracture  of  veins  just  under  the  bladder  epithelium.  The 
deferred  initiation  of  the  haemorrhagic  signs  is  thus  most 
easily  explained. 

I  am  inclined  to  regard  some  combination  of  hypotheses 
II.  and  III.  as  the  correct  solution  of  this  rare  and  most 
interestmg  type  of  lesion. 

Case  B. 

This  is  one  of  the  most  singular  and  eventful  cases 
of  its  kind  hitherto  included  in  my  experience.  The 
physiological  sequence  of  the  symptoms,  the  surpri&ing 
recuperation  under  treatment,   and  the  revelations  of 


a^SS^^'      THREE  A-TYPICAL  CASES.  775 

exploratory  incision,  these  contribute  to  invest  the  case 
with  uniqueness  and  interest. 

Miss  Y.,  aged  50,  had  heen  for  many  years  under  the 
supervision  of  Dr.  Dyce  Brown,  and  in  the  early  spring  of 
1890  left  England,  with  the  sanction  of  her  medical 
adviser,  for  temporary  residence  in  France.  Her  health, 
about  the  time  of  departure,  was  particularly  good,  and 
no  uterine  or  pelvic  trouble  was  then  existent.  About 
two  months  after  commencing  life  in  France,  this  lady 
sat  for  some  time  on  a  stone  seat,  to  sketchy  in  a  castle' 
yard.  She  was  attacked  the  same  evening  with  a  violent 
chill,  followed  by  acute  abdominal  pain,  which  tended' 
after  the  lapse  of  hours  to  increase  rather  than  lessen. 
Medical  aid  was  summoned  from  Paris,  and  the  patient 
was  carefully  watched  and  nursed  through  the  earlier 
stages  of  a  severe  attack  of  acute  peritonitis.  Progress 
seemed  slow,  and  as  soon  as  she  could  with  safety  be 
removed  she  was  brought  to  England,  after  a  most  diffi- 
cult journey,  and  at  once  placed  under  the  care  of  Dr. 
Dyce  Brown. 

The  continued  effect  of  the  illness  and  the  journey  had 
brought  the  patient  nearly  to  the  gates  of  death.  8h^ 
was  denied  nothing  that  skill  or  experience  could  suggest, 
and  the  progress,  though  slow,  was  assured.  After  two 
or  three  weeks  Dr.  Dyce  Brown  was  leaving  town  for 
some  time,  and  kindly  asked  me  to  take  charge  of  the 
case.  When  I  saw  the  patient  with  him,  there  was  a 
huge  abdominal  swelling,  solid  and  resistant  frcto  side 
to  side  up  to  the  umbilicus,  and  above  that  level  great 
tympanitic  distension  from  a  displaced  alimentary  canal. 
Aphthae  had  appeared  in  the  mouth,  the  tongue  being 
usually  red  and  moist.  The  pulse  varied  from  108  to  120 
per  minute,  and  the  temperature  oscillated  slightly 
about  99^ 

A  careful  thoracic  examination  showed  slight  dulness 
over  the  base  of  the  left,  and  somewhat  more  over  the  base 
of  the  right  lung. 

All  the  secondary  symptoms  were  present  in  full  force. 
An  easily  induced  emesls,  spasmodic  explosions  of  cough, 
occasional  attacks  of  colic,  and  inconsecutive  sleep  varied 
the  events  of  the  day. 

In  spite  of  this  formidable  array  the  patient's  condition 
tended  gradually  to  improve.  The  progress  of  con- 
valescence was  marked  by  three  series  of  crises  of  a  most 

3  u— a 


776  THBEE  A-TYPICAL   CASES.     ""^SlSLSt^?^ 


Beviev,  Dee.  1,  Ifln. 


interesting  and  soggestiTe  character.  A  gagtric  crms 
was  developed  earliest,  and  took  the  form  of  explosiTe 
and  almost  intractable  vomiting.  The  slightest  stunolos 
seemed  sufficient  to  evoke  an  emesis  ;  a  cough,  the 
swallowing  of  bitter  things,  slight  physical  discomfort, 
any  of  these  would  inevitably  bring  on  a  paroxysm.  The 
diet  was  daily  altered  in  quantity  and  nature,  the  patient 
requiring  constant  variety  in  nutriment.  Arsmicum 
was  the  most  potent  remedy,  and  after  a  time  the  stomach 
ceased  to  markedly  trouble. 

The  next  crisis  was  regpiratorf/.  A  dry,  distressing 
constant  cough,  markedly  aggravated  at  night,  prevented 
sleep,  destroyed  all  remnants  of  appetite,  and  made 
serious  inroads  on  the  patient's  vitality.  Not  every  night 
had  so  bad  a  record ;  about  every  third  night  there  was  a 
prolonged  struggle  against  this  troublesome  condition. 
Codeia^  given  in  minute  quantities,  was  of  paramount 
service,  and  under  its  influence  the  cough  soon  subsided, 
and  occasional  recurrences  were  remedied  by  it  equally 
well. 

But  the  most  distressing  crisis  was  c^n/toc.  Shortly 
after  the  initiation  of  the  respiratory  troubles,  cardiac 
phenomena  commenced,  and  were  equally  embarrassing. 
After  midnight,  the  patient  would  complain  of  great 
oppression  at  the  chest,  sleep  was  effectively  banished, 
and  anxiety  with  restlessness,  continued  in  increasing 
degree  for  some  time.  The  pulse  was  not  markedly 
quickened,  retaining  its  usual  average  of  120  beats  per 
minute.  A  sense  of  impending  misfortune,  a  total 
inability  to  lie  down,  a  restlessness  of  body  and  mind 
were  the  most  prominent  subjective  phenomena.  Various 
therapeutic  measures  were  put  in  vogue,  but  those  most 
serviceable  were  the  administration  of  hot  coffee  during 
the  paroxysm,  and  strychnine  nit.  1/200  for  a  short  time 
during  the  interval.  This  effectually  controlled  the  heart 
perturbation ;  and  the  manifestations  lessened  in  intensity 
in  a  striking  degree  in  a  few  days,  and  then  ceased. 

The  physiological  significance  of  these  symptoms  cannot 
be  missed.  They  were  originated  successively  in  the  three 
great  areas  of  distribution  of  the  vagus  nerves,  i.e.,  the 
heart,  the  lungs,  and  the  stomach.  The  crises  were 
respectively  gastric,  respiratory  and  cardiac.  Now  the 
sympathetic  nerve  plexuses  of  the  abdomen  inosculate 
iar  more  freely  with  the  pneumo-gastric  nerves  than 


a^iSJflS^.TSSi*'*'^      THREE  A-T»ICAL  CASES.  777 

with  any  other  branch  of  the  cerebro-spinal  axis.  Beflex 
irritation  proceeding  from  so  great  an  abdominal  area  of 
lesion  would  naturally  discharge  along  its  connections 
with  the  vagi,  and  reflex  vomiting,  reflex  bronchial 
irritation,  and  reflex  cardiac  inhibition  occur,  which  was 
actually  the  case. 

A  period  of  calm  now  supervened,  and  the  easy  course 
of  convalesence  charmed  us  all.  The  abdomen  grew  less 
tense  and  less  bulky.  The  cough,  once  so  annoying, 
diminished  down  to  an  occasional  mild  explosion.  The 
heart  crisis,  with  the  sense  of  oppression  formerly  so 
appalling,  now  ceased  to  trouble.  The  appetite  though 
variable  was  fair,  the  sleep  was  reasonably  sound  and 
almost  continuous ;  the  consciousness  of  pain  was 
materially  lessened,  and  the  reviving  spirits  of  the 
patient  afifbrdcd  to  her  proof  positive  of  her  recovery. 
The  lung  deposit  had  cleared  up,  the  percussion  dulness 
vanished,  and  there  were  no  signs  of  metastatic  involve- 
ment of  any  other  organ. 

The  patient  left  her  bed,  and  her  room.  The  general 
improvement  was  maintained,  but  withal  there  was  noticed 
a  recent  and  marked  increase  of  abdominal  girth,  pari 
imssii  with  the  systemic  betterment.  An  exploratory 
operation  was  advised  and  carried  out.  The  abdomen 
was  opened  just  below  the  umbilicus,  and  a  large  irregular 
adherent  mass  of  cancerous  tissue  exposed.  The  abdomen 
was  accordingly  closed,  removal  of  the  lesion  being 
impossible,  and  the  patient  recovered  from  the 
transient  effects  of  the  exploration.  But  the  invasion  of 
the  growth  continued,  the  symptoms  became  more  severe, 
and  the  unfortunate  lady  died  within  a  few  weeks  from 
this  time. 

The  clinical  individuality  of  this  case  is  striking  and 
singular.  At  a  given  period,  the  integrity  of  the  pelvic 
organs  is  placed  beyond  doubt  by  a  careful  local  examina- 
tion. Three  months  later,  a  slight  inflammatory  stimulus 
— that  of  chill — ^evokes  a  peritonitic  storm  both  furious 
and  protracted.  In  the  course  of  time,  much  of  the 
exudation  is  absor1)ed  ;  but  it  is  then  found  that  during 
the  illness,  more  stable  elements  and  withal  more 
dangerous  than  inflammatory  plasma  have  been  added 
to  the  intra-peritoneal  contents.  A  neoplasm  has 
obviously  developed  ;  it  steadily  increases  in  size ;  but 
concurrently,  tlie  general  condition  of  the  patient  im- 


7T8  THREE  A-TYPICAL  CASES.      ^.SS^fSSTS! 

proves,  the  appetite  returns,  the  normal  capacity  for 
sleep  exists,  and  locomotion,  which  had  been  impossible 
for  months,  is  resumed.  Exploratory  incision  determines 
the  malignant  nature  of  the  lesion  :  the  lethal  characters 
of  cancer  suddenly  appear  :  and  shortly  after  their 
initiation  the  patient  succumbs.  The  idiosyncrasies  of 
this  clinical  history  are  ^considered  together  with  those  of 
Case  C- 

Case  C. 

Madame  X.,  a  lady  of  40,  and  of  Spanish  extraction* 
tras  seen  in  consultation  with  Mr.  Deane  Batcher  at 
TN^ihdsor.  This  patient  was  of  an  active  disposition,  and 
devoted  to  out-door  life,  up  to  some  two  months  back ; 
when,  on  crossing  from  France,  the  passage  was  ex- 
tremely rough,  and  she  became  exceedingly  sick.  After 
landing,  the  sickness  did  not  abate.  It  continued 
acutely  for  two  or  three  weeks,  with  no  marked  fluctua- 
tion ;  at  the  end  of  which  time  it  slowly  decreased.  The 
emesis,  in  short,  was  most  probably  that  of  peritoneal 
irritation. 

Some  abdominal  swelling  was  noticed  a  twelvemonth 
ago,  but  as  it  was  not  attended  by  further  symptoms,  it 
gave  no  anxiety.  But  the  continuous  ill-health,  after 
reaching  England,  determined  the  seeking  of  medical 
advice.  A  professor  of  clinical  medicine  in  the  metropo- 
lis  was  consulted,  and  he  reassured  the  anxious  friends 
by  a  favourable  prognosis  of  hepatic  trouble.  About  six 
weeks  afterward  Mr.  Deane  Butcher  was  hurriedly 
sunmioned  to  the  lady,  as  she  appeared  to  be  in  extrenm^ 
She  was  cyanosed,  with  acute  dyspnoea,  and  possessing 
a  most  obvious  abdominal  fluctuating  tumour,  which 
prevented  the  recumbent  posture.  Eestoratives  were 
administered  and  accessory  attentions  put  in  vogue,  and 
the  patient  revived.  As  much  of  the  distress  arose  from 
abdominal  tension,  the  cyst  was  tapi>ed  at  its  most  pro- 
jecting point,  and  half  a  gallon  of  fluid  withdrawn.  This 
was  followed  by  great  relief,  and  the  patient  rallied  con- 
siderably. 

Four  days  later,  the  fluid  in  the  abdomen  had  again 
collected  ;  and  as  the  symptoms  of  distress  were  return- 
ing, the  cyst  was  again  tapped  and  three  pints  of  dark 
red  fluid  came  away.    Tielief  again  ensued ;  and  I  saw 


ItaS^uTuM^     THREE  A-TYPICAL  CASES.  779 

the  patient  the  next  day  with  a  view  to  more  permanent 
operative  relief  if  practicable. 

I  found  the  patient  presenting  all  the  signs  of  em- 
barrassed respiration.  She  was  propped  up  in  bed, 
unable  to  turn  without  considerable  dyspnoea ;  her  respi- 
rations were  shallow  and  quick,  her  alse  nasi  dilating, 
her  aspect  sallow  and  livid.  Abdominal  examination 
showed  a  fluctuating  swelling,  reaching  up  to  the 
iimbihcus,  uniformly  dull  on  percussion,  the  dulness 
shading  off  on  the  left  side.  Vaginal  examination 
showed  the  cyst  to  dip  deeply  into  the  pelvis,  displacing 
the  uterus  to  the  left  side  and  front.  This  latter  organ 
was  somewhat  enlarged,  but  not  notably. 

The  thorax  presented  signs  quite  as  grave  in  their 
imx)ort.  The  right  pleural  cavity  was  uniformly  dull  up 
to  the  fourth  rib ;  above  this  level  a  resonant  note  was 
obtained,  below  this  upper  limit  of  dulness  neither  voice 
nor  breath  sounds  were  to  be  heard,  and  the  apex  beat 
was  displaced  to  just  outside  the  left  nipple  line.  The 
left  lung  showed  no  notable  marks  of  lesion. 

As  there  was  still  a  considerable  amount  of  fluid  in 
the  abdomen,  and  as  no  exhaustive  diagnosis  could  be 
framed  until  this  masking  element  had  been  removed  ^ 
I  tapped  the  cyst,  per  abdomen,  and  withdrew  a  further 
quantity  of  thin  red  fluid.  A  number  of  disseminated 
nodules  were  thus  bared  to  palpation,  and  the  solid 
elements  in  the  abdominal  swelling  bulked  largely  in 
its  mass.  From  the  uterus  there  issued  a  slight  but 
jconstant  hemorrhagic  discharge,  and  the  odour  Lorn 
tlie  bed  was  characteristic. 

The  diagnosis  did  not  lend  itself  to  doubt,  and  a  very 
<i;rave  prognosis  was  given.  In  view  of  this  both  the 
patient  and  friends  were  extremely  anxious  for  such 
temporary  betterment  as  would  allow  a  pilgrimage  to 
Lourdes,  but  in  a  fortnight  after  consultation  the  patient 
)>ecame  collapsed  and  suddenly  sank. 

Conclusions. 

I  have  narrated  these  two  cases  in  detail,  that  I  might 
demonstrate  the  existence  of  a  Latent  Period',  or  Pre- 
Hymptamatic  stage,  in  malignant  lesions  of  the  abdominal 
viscera.     The  clinical  sequences  here  are  similar  up  to 


780  THREE    A-TYPICAL   CASES.    '^SSirfSSU^ 

identity.  The  patient  enjoys  average  health,  according 
to  her  ase  and  wont.  Suddenly,  like  a  bolt  from  the 
blue,  symptoms  arise  which  in  severity  and  protraction 
are  altogether  disproportionate  to  the  mildness  of  the 
exciting  cause.  The  symptoms  abate,  the  urgency  sub- 
sides, but  the  average  health  of  the  itatm  quo  is  never 
regained.  It  soon  becomes  obvious  that  the  tout  ensemUc 
is  of  serious  import ;  and  the  physical  signs  of  a  neo- 
plasm are  now  to  be  demonstrated.  This  tends  to 
increase  directly  as  the  systemic  improvement ;  the 
better  the  general  health,  the  quicker  the  early  stiages  of 
growth  of  the  malignant  mass.*  Soon  the  vigour  of  the 
constitution  becomes  minimised ;  systemic  infection  with 
the  toxic  products  of  carcinoma  begets  a  degree  of 
toleration,  and  the  struggle  between  constitutional  vigom* 
and  deadly  parasitism  is  ent^i'ed  upon  with  a  result 
certain  if  deferred. 

The  historical  sequence  of  events  during  the  Latent 
Period^  or  Pre-sympUwiatk  stage,  may  be  thus  set  forth. 
So  soon  as  germ  epithelium — that  layer  of  epithelium 
immediately  situate  on  basement  membrane — ceases  to 
develop  in  the  usual  way,  but  with  cells  and  nuclei  alike 
proliferating,  forms  a  heterologous  cell  collection,  the 
life  history  of  cancer  begins.  The  cells  increase  and 
multiply  with  a  rapidity  proportionate  to  the  blood 
supply  of  the  locality.  Every  effort  is  made  by  the  local 
tissues  to  homologate  the  new  growth  ;  but  this  latter, 
being  devoid  of  those  ambassadors  of  reciprocity,  nerves, 
no  relations  other  than  parasitic  ones  can  be  established. 
The  neoplasm  grows  at  the  expense  of  the  local  pabulum ; 
the  presence  of  the  foreign  mass  dispossesses  and  dis- 
locates normal  cell  elements ;  and  a  perpetual  nerve 
irritation  is  engendered  by  its  presence  in  its  immediate 
neighbourhood.  The  mass  grows ;  the  tone  of  the  local 
tissues  becomes  less  and  less ;  and  the  constant  and 
increasing  trophic  disturbances  gradually  reach  such  a 
point,  that  a  very  moderate  inflammatory  stimulus  pro- 
duces effects  out  of  all  proportion  to  the  intensity  of  the 


*  In  ovarian  non-malijy'nant  tninonrs,  on  the  contrary,  the  growth  of 
tbe  cyst  is  often  qnickest  in  the  later  stages,  and  slow  in  its  initiation. 
I  operated  recently  upon  a  lady  in  whom  the  cyst  had  doubled  in  size 
in  a  fortnight. 


^SS^^SrSJf^  CLINICAL  AND  THERAPEUTIC  NOTES.  781 


Review,  Dec.  1,  imi 


<3aa8e.    The  latent. period  is  now  over,  and  the  period  of 
manifestation  has  commenced.* 


CLINICAL  AND    THEEAPEUTIC    NOTES. 

By  Db.  a.  C*  Clifton. 

About  twelve  years  or  so  ago  a  paper  of  mine  appeared 
in  the  Monthly  Homoeopathic  Review,  under  the  above 
title,  in  which  I  sought  for  more  light  and  help  in  the 
treatment  of  acute  gout,  lumbago  and  tonsillitis,  inas* 
much  as  my  therapeutic  measures  had  not  for  the  most 
part  yielded  satisfactory  results. 

Dr.  Edward  Blake  and  Dr.  Nicholson  kindly  replied  in 
the  pages  of  the  same  journal ;  the  information,  how- 
ever, which  they  afforded  me,  was  mainly  pathological 
in  character,  while  I  rather  desired  symptomatic  and 
clinical  indications  as  a  more  certain  guille.  Neverthe- 
less I  was  grateful  to  those  gentlemen  for  their  sugges- 
tions, which,  moreover,  were  of  some  service  to  me. 

Since  that  time  I  have  been  more  fortunate  in  the 
treatment  of  acute  gout,  and  lumbago,  but  not  of  ton- 
sillitis, each  of  which  I  will  now  touch  upon. 

Ist.  Acute  Oout. — Several  cases  of  this  nature,  and 
severe  in  character,  I  have  had  under  my  care.  In 
addition  to  heredity,  the  exciting  cause  has  generally 
been  mental  worry,  and  next  in  order  depressing  climatic 
environment,  rather  than  error  in  diet,  or  physical 
indolence.  The  patients  were  somewhat  anasmic,  with 
soft  and  flabby  muscles,  were  low  spirited,  had  a  weak 
I)ulse,  with  internal  chilliness,  aversion  to  be  uncovered, 
yet  with  heat  and  dryness  of  the  skin,  and  great  sensi- 
tiveness to  touch  anywhere  ;  and  in  each  case,  notwith- 
standing pathological  indications  to  the  contrary,  on  the 
line  of  anaemia,  general  debility,  enfeebled  circulation, 
&c.  Aconite  one  to  two  drops  of  Ix  every  four  hours  for 
two  or  three  days,  was  of  marked  benefit ;  the  next  stage 
was  to  some  extent  one  of  internal,  but  not  external 

♦Since  writing  the  above,  Dr.  Arthur  Clifton,  in  a  private  com- 
nuinication,  informs  me  that  a  farther  experience  of  twenty  years 
enables  him  to  adhere  firmly  to  the  views  he  enunciated  in  the  MoHthhj 
ffotmropathit*  i/^av/' 1(7  at  that  date.  The  most  constant  and  the  motit 
prominent  phenomena  in  the  Latent  Period  he  finds  to  be  constipation, 
ft  refiex  neurosis  the  direct  outcome  of  the  instable  local  nerve  con- 
•dition  characteristic  of  this  period. 


782  CLINICAL  AND  THERAPEUTIC  NOTES.  ^^5ffi; 


Bcrisif,  Doe.  1, 1801.* 


heat,  or  much  dryness  of  the  skin,  and  rather  with 
desire  to  be  uncovered,  thirst  for  small  quantities  o( 
jfluid,  especially  for  acid  drinks,  together  with  general 
restlessness  and  irritability — and  although  there  was 
much  debility  it  was  less  than  in  the  former  stage,  and 
here  arseniaim  8x  every  fotir  or  six  hours  for  a  few  days 
was  largely  beneficial,  the  remaining  symptoms  were 
also  speedily  removed,  and  the  patients  restored  to  their 
ordinary  health  by  nux  vomica  or  Pulsatilla  in  one  drop 
doses  of  the  matrix  tincture  three  or  four  times  daily. 
Let  it  moreover  be  noted,  that  these  medicines  were 
selected  rather  from  the  totality  of  sj^mptoms,  in  the 
first  and  second  stages  especially,  than  from  pathologi- 
cal indications,  except  so  far  as  the  exciting  cause,  viz., 
mental  worry. 

Three  other  cases  under  the  same  nomenclature  I  have 
treated  presenting  different  symptoms ;  the  patients  were 
essentially  of  gouty  diathesis,  had  gouty  concretions 
about  the  small  joints,  and  although  low  spirited  and 
irritable,  this  condition  or  manifestation  was  different  to 
the  cases  in  which  arsenic nm  had  been  given,  for  here 
they  were  more  loudly  "cantankerous"  and  difiicult  to 
please;  complained,  moreover,  of  sinking  in  the  stomach, 
often  wanting  food  and  alcohol ;  had  a  weak  and  quick 
pulse  of  96  to  108  per  minute.  Two  out  of  the  three 
patients  had  haemorrhoids,  and  one  an  enlarged  prostate. 
In  each  of  these  cases,  while  a  few  doses  of  two  or  three 
other  medicines  were  given,  staphisagria  Sx  was  the  main 
remedy  which  quickly  restored  them  to  health. 

2nd.  Lumbago. — Here  Dr.  Edward  Blake  gave  me 
several  pathological  hints  for  consideration.  I  could  not 
accept  them  all  as  correct,  and  now,  without  debating 
that  point,  I  say  that  what  I  mean  by  the  term,  is 
characterised,  and  mainly  limited  to  pains  in  the  lumbal* 
muscles  or  fascise,  generally  the  result  of  getting  wet  or 
sitting  in  a  draught,  for  the  most  part  appearing  suddenly,, 
made  worse  by  movement,  especially  the  act  of  sitting 
down,  rising  up,  and  stooping,  oft-times  relieved  by 
external  warmth  and  rest,  and  but  seldom  attended  with 
febrile  or  other  disturbance  except  on  the  first  day  or  so. 

When  I  made  enquiry  before  concerning  the  treatment 
of  this  malady,  my  cases  had  not  been  cured  as  a  rule 
under  a  fortnight  ;  since  then,  although  I  have  had 
many,  they  have  been  cured  in  from  four  to  seven  days,. 


5£!SS^S*.'**?S^^  CLIKICAL  AND  THERAPEUTIC  NOTES.  788 


B«vi0w,  Bee.  1^1891. 


by  aconite  Ix  three  drops,  or  even  matrix  tincture  one 
drop  every  three  or  four  hoars  for  a  day  or  so,  and 
followed  by  dmifwga^  matrix  tincture,  one  drop  every  few 
hours.     Two  were  cured  by  aconite  alone. 

Three  cases,  somewhat  relieved  by  aconite,  derived  no 
good  from  cimifugay  and  because  the  latter  was  by  no 
means  indicated. 

A.  B.  was  a  plethoric  man»  who  largely  indulged  in 
animal  food  and  malt  liquor,  had  frequently  suffered 
from  dyspepsia,  headache,  giddiness,  and  shifting  rheu- 
matic pains,  with  a  broad,  red  and  beefy  tongue,  loss  of 
appetite,  constipated  bowels,  and  high  coloured  urine. 
Here  kali  bichromicum  8x  quickly  cured  him. 

C.  was  a  lady,  40  years  of  age,  who  had  previously 
suffered  from  dyspepsia,  abdominal  flatulence,  constipa- 
tion, too  frequent  and  profuse  catamenia.  Here  some  of 
these  symptoms  existed  with  the  acute  lumbar  pains, 
and  lycopodium  6x  quickly  cured  her. 

D.  was  a  gouty  man>  fond  of  old  port,  very  irritable 
and  hot  tempered,  but  yet  desponding ;  his  pulse  was 
thin,  weak,  and  irregular;  he  frequently  craved  food,  and 
something  of  this  kind  warm ;  he  had,  moreover,  some 
prostatic  disease ;  his  lumbar  pains  were  very  severe, 
and  much  worse  as  a  rule  at  night.  In  this  case  staphy- 
Hagria  3x  every  three  or  four  hours  soon  relieved,  and  by 
continuing  it  for  several  weeks  there  was  a  most  marked 
improvement  in  the  prostatic  disease. 

In  reviewing  the  cases  now  presented,  both  of  acute 
gout  and  lumbago,  and  in  the  light  of  somewhat  critical 
examination,  at  the  time  of  how  far  the  medicines  con- 
tributed to  the  cure,  or  alterations  and  corrections  of 
diet,  change  of  climatic  conditions,  cessation  of  mental 
worry,  together  with  rest  and  warmth,  I  am  convinced 
that  the  medicines  prescribed  were  the  main  factors 
leading  to  the  cure,  and  although  in  acute  gout  aconite 
and  arsenicum  were  of  essential  service,  mostly  on  the 
neurotic  side,  and  in  lumbago,  aconite  and  cimifuga,  the 
main  curative  agents,  and  may  largely  be  relied  upon, 
yet  I  say  the  more  we  individualise  our  cases,  and  take 
in  "  the  totality  of  symptoms,*'  and  so  differentiate  the 
cases,  the  greater  will  be  our  success. 

8.  TonsiUitis. — Here  I  regret  that  I  am  as  dissatis- 
fied with  the  result  of  my  therapeutic  measures  as  ever, 
notwithstanding  the  suggestions  by  tlic  gentlemen  who 


784  CLINICAL  AXD  THERAPEUTIC  NOTES,  ^^gSS^fSTgwi! 

tried  to  afford  me  help  at  the  time  alladed  to.  I  read  of 
other  practitioners  of  homoeopathy  snccessfally  coping 
with  this  malady,  bat  whether  I  prescribe  aconite,  apis^ 
belladonna,  baryta,  tjuaiacum,  hepar,  tnerairius,  or  other 
remedies,  in  dilutions  from  the  SOth  centesimal  down  to 
the  lowest,  from  pathological  indications  or  totality  of 
symptoms  I  am,  nevertheless,  intensely  dissatisfied. 
The  disease  has  generally  gone  on  to  suppuration,  lar^y 
reflecting  upon  my  skill,  and  what  is  far  worse,  bringing 
discredit  upon  homoeopathy. 

Leaving  now  my  former  enquiries,  and  subsequent 
experience  bearing  upon  the  same,  I  will  touch  upon 
viome  other  forms  of  diisease. 

1st.  Sciatica. — This  term,  you  are  aware,  is  for  the 
most  part  sharply  characterise  and  restricted  to  severe 
pain  in  the  sciatic  nerve  and  its  branches.  Althougli 
diathesis  is  one  factor  in  the  case,  and  a  very  important 
one,  the  more  immediate  and  exciting  cause,  traumatic, 
climatic,  &c.,  has  largely  to  be  reckoned  with,  and  taken 
into  account. 

The  two  worst  cases  I  have  met  with  had  been  under 
allopathic  treatment  for  some  time,  and  beside  the  usual 
remedies  on  that  line,  Turkish  baths  with  shampooing 
had  been  resorted  to,  and  the  latter  process  so  vigorously 
carried  out  as  to  set  up  inflammation  in  the  nerve  or  its 
sheath.  Bearing  upon  this  point,  I  believe  that  when 
drugs  aie  used  locally  and  topically,  for  this  and  similar 
nerve  affections,  in  the  very  early  and  acute  stage,  they 
should  only  be  stncared  on  the  part  affected,  in  the  form 
of  ointment,  or  used  as  lotions  on  lint  or  spongio-piline, 
and  only  in  the  last  stage  of  the  disease  should  sham- 
pooing or  galvanism  be  adopted.  In  the  cases  that  have 
<3ome  under  my  own  observation,  I  have  but  seldom  used 
anything  topically,  beyond  hot  fomentations  or  poultices 
of  chamomile  and  poppies,  and  these  not  very  often  ;  at 
the  same  time,  and  in  very  severe  cases  of  agonising 
pain,  I  have  prescribed  ointments  of  aconite,  belladonna, 
hamamcliH  or  re  rat  mm  ciride,  which  have  given  marketl 
relief. 

The  medicines  from  which  I  have  seen  the  greatest 
good,  have  been  aconite,  arsenicum,  belladonna  and  vera- 
trrnn  riridc,  in  the  Ix  to  6x  attenuations;  the  higher  have 
for  the  most  part  failed  me.  The  clinical  indications  for 
these  remedies  are  mainly  neurotic,  and  with  the  excep- 


bSS^SSTS^  clinical  and  therapeutic  notes,  785 

tion  of  the  last  are  old  and  well  known  to  yon,  so  that  I 
now  pass  them  over,  and  briefly  refer  to  veratrum  viiide; 
this  has  been  prescribed  with  great  benefit,  in  conditions 
bordering  upon,  or  even  constituting,  actual  inflamma- 
tion of  the  nerve  or  its  sheath,  rather  than  a  neuralgia 
in  the  strict  sense  of  the  term.  The  exciting  cause  has 
generally  been  pressure  from  a  hard  seat,  or  from  sham- 
pooing, and  where  arnica  has  been  indicated,  and  used 
without  avail ;  the  pains  as  a  rule  were  very  severe,  con- 
stant, and  of  a  burning  character,  and  slightly  relieved 
by  rest  and  warmth  ;  in  addition  to  the  local  symptoms, 
there  was  much  arterial  excitement,  with  a  pulse  as 
quick,  but  at  the  same  time  more  thin,  hard  and  wiry, 
than  either  of  the  other  medicines  named,  and  charac- 
teristic of,  and  this  peculiar  pulse  of  veratrum  viride  is  a 
symptom  which  largely  dominates  or  leads  to  my  selec- 
tion of  the  drug,  from  the  fact  that  in  many  other 
inflammatory  cases  I  have  moreover  found  it  charac- 
teristic, leading  to  the  cure,  and  as  a  rule  the  Ix  dilution 
in  drop  doses  has  been  most  beneficial. 

Other  medicines  are,  of  course,  sometimes  called  for 
in  this  form  of  disease.  Kali  bichromicum  has  in  two 
cases  been  eminently  useful  when  the  pain  was  worse  on 
first  movement,  like  unto  rhus.  Worse,  moreover,  in  the 
early  morning  and  by  walking,  and  attended  with 
similar  symptoms,  as  noticed  under  the  same  medicine 
for  lumbago.  Phytolacca,  too,  has  sometimes  been  of 
service,  but  here  I  am  not  sure  whether  the  cases  should 
pathologically  be  designated  as  sciatica  or  periosteal 
rheumatism,  because  the  pain  was  as  much  in  the  femur 
as  in  the  sciatic  nerve  and  its  branches,  and  was  more- 
over worse  at  night  in  the  warmth  of  the  bed.  One  had 
previously  suffered  from  rheumatism  and  one  had  a 
syphilitic  history,  the  exciting  cause  in  each,  however, 
was  excessive  walking  and  prolonged  standing  at  work. 
The  matrix  tincture  in  drop  doses  four  times 'a  day  soon 
cured  them.  Actaa,  hryonia,  cohcynth  and  rhuSy  I  have 
sometimes  used,  but  while  they  have  appeared  to  relieve 
some  symptoms  I  have  not  seen  unmistakable  signs  of 
cure  from  their  administration.  TeUiuium  has  been 
prescribed  several  times,  and  very  hopefully  in  cases 
presenting  its  characteristic  sciatic  nerve  pains,  but  I 
have  seen  but  little  good  from  it,  except  once,  and  there 
it  clearly  had  a  most  marked  beneficial  and  curative 


786  CLINICAL  AND  THERAPEUTIC  NOTES.  ^"^SS^St^^i. 

action.  Avivionium  muriaticum  and  gnapltaUuniy  have 
been  highly  commended  by  some  practitioners,  bat  I 
have  only  used  them  on  two  occasions,  and  can  say 
nothing  definite  and  satisfactory  in  relation  to  them. 

Coccygodyniii. — Although  this  is  a  malady  of  no  serious 
import,  it  is  yet  characterised  by  great  local  pain  and 
suffering  to  the  patient  when  sitting,  and  sometimes  in 
the  act  of  defaBcation.  Of  course  no  well  educated  and 
thoughtful  homa'opathic  practitioner  will  admit  that  he 
has  favourite  remedies  for  this  or  any  other  form  of 
disease,  nevertheless,  I  confess,  that  I  nearly  always 
prescribe  hyper icum  or  kali  bichramicuvi  in  these  cases, 
and  with  great  success.  Hypericum  Ix  when  it  has  been 
the  result  of  a  fall  and  blow  to  the  coccyx,  or  to  the  use 
of  forceps  by  an  accoucheur  during  childbirth,  while 
kali  bichromicum  6x  has  done  most  good,  when 
the  rheumatic  diathesis  been  more  manifest. 

Hcemorrhoids. — Here  for  many  years  I  have  tried  most 
of  the  remedies  recommended  locally,  in  the  form  of 
ointments,  suppositories,  and  liquid  injections  to  the 
rectum,  especially  iescvlus^  hamanielis,  hydrastis  and 
verbascnm;  one  or  other  of  these  drugs  have  often 
afforded  some  relief  to  the  pain,  but  as  the  same  remedies 
were  also  prescribed  to  be  taken  into  the  stomach,  I  have 
found  it  impossible  to  decide  how  far  the  local  measures 
were  beneficial ;  at  one  time  I  thought  highly  of  the 
latter  but  for  some  time  have  become  convinced,  they 
are  of  only  little  avail,  and  I  have  fallen  back  mainly 
upon  medicines  to  be  taken  in  the  ordinary  way,  and 
chosen,  moreover,  though  not  entirely,  from  pathological 
indications,  and  more  especially  in  relation  to  diathesis, 
and  here  the  remedies  I  have  found  most  efficacious 
have  been  the  old  and  well  tried,  such  for  instance  as 
<:alcarca,  graphites,  lycopodium,,nux,  pulaatiUa,  sepia  and 
sulphur;  while,  however,  I  say  this,  I  am  as  firmly 
convinced  that  local  applications  of  the  same  remedies 
are  sometimes  helpful.  jEscuIus  2x  has  been  of  signal 
service  in  several  cases,  and  of  course  haniamelis,  but 
instead  of  the  6x  to  Ix  dilution  which  I  formerly 
prescribed,  I  have  since  found,  one  to  three  or  more 
drops  of  the  matrix  tincture,  three  times  a  day,  of  more 
quick  and  lasting  benefit. 

rTo  be  continued, J 


sH^jS^TSSt^  INYOLCNTAEY  PBOVING  OP  APIS.       787 

INVOLUNTARY  PROVING  OF   APIS. 
By  R.  E.  Dudgeon,  M.D. 

On  the  2nd  November  I  ate  at  breakfast  a  small  quantity 
of  honey  which  had  been  brought  up  from  the  Isle  of 
Wight  about  two  months  previously,  and  in  which  were 
a  considerable  number  of  dead  T}ee8,  which  had  been  all 
that  time  in  the  honey,  and  which  were  removed  only 
when  the  honey  was  placed  on  the  table.  I  was  perfectly 
well  at  the  time,  and  in  every  other  respect  my  diet  was 
precisely  similar  to  what  it  had  been  for  weeks.  In  the 
course  of  the  day  I  noticed  that  my  thighs  felt  un- 
commonly warm,  and  they  were  more  sensitive  than 
usual  to  touch,  otherwise  I  felt  no  peculiar  sensations 
in  them.  On  undressing  to  go  to  bed  about  midnight,  I 
found  that  both  thighs  were  covered  with  a  bright  red 
smooth  rash,  and  they  were  considerably  swollen.  I 
slept  all  night  soundly,  and  the  following  morning 
observed  that  the  thighs  were  in  the  same  state,  and 
that  the  redness  extended  round  the  back  over  the  nates. 
I  again  ate  of  the  same  honey  at  breakfast.  During  the 
day  the  heat  of  the  thighs  increased,  as  also  the 
swelling,  and  there  was  besides  itching  and  fine  pricking, 
ds  from  a  needle  in  them.  The  swelling  was  decidedly 
greater,  and  the  sensitiveness  to  touch  increased.  At 
night  on  undressing,  I  observed  that  the  swelling  was 
very  considerable,  and  had,  together  with  the  redness, 
extended  down  to  the  ham  and  below  the  knee  on  its 
inner  aspect.  The  redness  above  had  not  extended, 
though  its  colour  was  brighter,  and  it  terminated  abruptly 
at  about  an  inch  below  the  bend  of  the  thigh.  It  was 
evidently  more  intense  also  over  the  nates,  and  where- 
ever  the  redness  was  there  was  swelling,  which  caused 
deep  hollows  in  the  limb  if  it  pressed  against  anything 
— as,  for  example,  the  wooden  arm  of  a  chair.  I  took  no 
more  of  the  honey  after  this. 

4th  Nov. — The  rash  much  the  same,  tenderness  much 
increased  after  walking ;  the  skin  felt  too  tight  for  the 
thigh,  and  soft  cotton  drawers  which  I  wore  felt  as  if  made 
of  prickly  horsehair,  so  greatly  increased  was  the  sen- 
sitiveness of  the  skin.  With  all  this  there  was  no  pain, 
no  disturbance  of  the  digestion,  no  diminution  of  appe* 
tite,  and  during  the  whole  time  no  abnormal  condition 


788       INVOLUNTARY  PBOVING  OP  APIS.   ^''S^S^l^. 

of  the  urine,  except  that  it  was  rather  scantier  and 
darker  in  colour  than  usual,  and  deposited  a  considerable 
amount  of  lithates. 

6th  Nov. — The  condition  of  the  thighs  and  back  was 
luialtered  on  rising.  I  had  a  good  deal  of  work  to  do 
and  much  walking  and  standing.  The  tight  hide-bound 
feeling  of  my  thighs  and  the  horsehair  sensation  caused 
by  my  drawers  were  much  more  marked,  and  towards 
the  end  of  the  day  the  skin  on  the  insides  of  mj^  thigh(^ 
was  quite  painful,  burning  mingled  with  pricking.  On 
undressing  at  night,  I  found  that  though  the  redness 
had  not  extended  the  oedema  had  spread  down  both  legs 
to  the  ankle,  and  they  pitted  on  pressure  everywhere. 
I  observed  also  that  bright  patches  of  redness  about  the 
size  of  my  hand  had  appeared  at  the  back  of  the  upper 
arms  and  a  little  beyond ,  towards  the  scapulae.  It  seemed 
to  me  that  the  colour  of  the  rash  on  the  thighs  had 
altered,  it  was  no  longer  bright  scarlet,  but  was  of  a 
purplish  hue.  I  did  not  sleep  so  well  the  last  two  nights, 
as  it  was  difficult  to  get  a  comfortable  position  for  the 
thighs. 

6th  Nov. — Colour  of  the  eruption  on  the  thighs  still 
further  declining  in  brightness,  oedema  of  legs  below 
the  knee  the  same  or  even  greater.  The  sensations  iii 
the  affected  parts  not  so  much  of  heat  as  as  of  horripila- 
tion over  the  thighs.  Towards  evening,  having  had  t<> 
go  about  a  good  deal  during  the  day,  the  oedema  of  the 
legs  was  greater,  and  extended  over  ankles  down  to  dorsum 
of  feet.  The  swelling  in  the  hams  rendered  it  uncomfort- 
able to  bend  the  knees.  I  felt  an  occasional  dart  through 
the  cardiac  region,  sometimes  a  sensation  of  burning  in 
throat,  and  strangely  enough  throughout  the  whole  attack 
I  had  a  slight  taste  of  honey  in  the  mouth.  I  slept 
tolerably  well,  though  occasionally  disturbed  by  itchin*:: 
of  the  skin  where  the  rash  was. 

7th  Nov. — I  was  called  out  early  to  visit  a  patient,  and 
when  returning  home  about  half-past  eight  was  suddenly 
seized  with  diarrhoea,  passed  motions,  liquid  brownish- 
yellow,  apparently  containing  a  good  deal  of  mucus  and 
accompanied  by  tenesmus ;  the  seccmd  motion  not  so 
watery,  of  peculiar  fish-like  odour.  Swelling  of  thighs 
very  much  less,  redness  darkest  at  the  upper  e<j^e. 
lEdema   of   legs   diminished.      Bed  patches  on  arms 


2?5S5^ STifw^*'    INTOLUNTARY  PROVING  OF  APIS.       789 

unaltered.  Heat  of  thighs  much  diminished  ;  they  itch 
someTvhat,  and  there  are  occasional  horripilations  over 
them.  At  night  on  undressing  found  the  ankles  much  more 
swollen  and  red  patches  on  the  inner  aspect  and  for  three 
or  four  inches  up  leg.  The  only  morbid  sensation  felt  in 
the  skin  was  intense  tickling,  like  insects  running  oyer 
it,  which  kept  me  awake  some  little  time.  During  the 
day  I  had  very  frequent  horripilations  over  back  and  legs, 
wherever  the  rash  was. 

8th  Nov. — Swelling  of  thighs,  legs  and  ankles  much 
diminished.  Skin  still  discoloured,  but  more  brownish-red. 
Still  some  oedema  of  lower  part  of  legs,  but  the  thighs, 
knees  and  calves  have  almost  regained  their  normal  di- 
mensions. During  the  day  passed  a  large  quantity  of 
pale  urine.     Stool  normal. 

9th  Nov. — (Edema  of  lower  part  of  legs  (the  only  parts 
now  swollen)  less,  still  pitting  on  pressure  over  shin-bone. 
Colour  of  affected  parts  paler,  urine  still  profuse,  pale. 
For  two  or  three  days  I  have  noticed  a  sort  of  clonic 
spasm  or  jerking  in  the  extensor  muscles  of  left  toes, 
which  draws  them  suddenly  up,  and  though  not  painful 
is  very  disagreeable.  This  continues  to-day  at  times. 
The  horripilation  less  frequent.  The  skin  where  the 
eruption  was  feels  harsh  and  is  very  tickly ;  scratching  it 
is  very  pleasant  and  relieveis  the  itching.  The  patches 
of  colour  on  the  inner  ankles  are  hardly  visible,  but  the 
patches  on  the  back  of  the  up^ier  arms  are  still  there, 
though  not  so  bright. 

10th  Nov. — Slept  profoundly.  On  rising  this  morning 
I  was  glad  to  notice  that  my  legs  had  resumed  their 
normal  shape,  but  on  going  to  bed  at  night  I  found  that 
the  ankles  were  oedematous. 

11th  Nov. — Itching  much  less,  slight  discolouration 
where  the  erythema  was,  no  trace  of  oedema ;  skin  feels 
harsh  and  rough,  as  though  it  would  desquamate. 

12th  Nov. — Desquamation  over  all  parts  of  skin  where 
the  erythema  was ;  parts  still  discoloured ;  some  itching. 

24th  Nov. — The  skin  wherever  the  rash  had  been  is 
still  rather  darker  than  the  rest  of  the  body. 

Remarks, — That  the  above  disagreeable  affection  was 
caused  by  the  poison  of  the  bees  diffused  through  the  honey, 
I  think  is  obvious  from  that  particular  honey  having  been 
t}ie  only  change  in  my  diet  that  had  taken  place.  I  had 
been  eating  honey,  but  from  a  different  source  and  con* 

Yol.  35,  Ko.  12.  3  I 


790        IXVOLUXTARY  PBOYIKG  OF  APIS.  ^'^Sl 


It 


taining  no  dead  bees,  forseveraliiiommgspreYiouBljwit^- 
out  observing  any  bad  effects.  My  daaghter  partook  of  some 
of  the  same  honey  as  that  which  poisoned  me  without 
developing  any  symptoms,  but  I  observed  that  she 
helped  herself  from  the  unbroken  comb,  which  was,  of 
course,  free  from  bees,  whereas,  I  ate  what  had  dropped 
from  the  comb,  and  which  contained  many  dead  bees. 
Besides,  my  daughter  being  very  subject  to  nettle-rash 
may  not  be  sensitive  to  bee-poison  taken  in  this  way. 
My  health  during  the  whole  time  was  perfect,  and 
though  I  had  a  great  deal  of  running  about  and  several 
anxious  cases  to  attend,  I  did  not  feel  any  unusual 
fatigue,  either  of  body  or  mind.  Hie  exact  symmetry  of 
the  erythema  was  remarkable.  The  thighs  were 
coloured  in  precisely  the  same  way  and  were  swollen  of 
the  same  size.  The  patches  of  red  on  the  back  of  the 
arms  were  of  the  same  size  and  shape,  and  when  the 
erythema  appeared  on  the  ankles  it  assumed  exactly  the 
same  form  on  both.  The  colour  disappeared  in  precisely 
the  same  way  in  all  the  corresponding  parts,  and  the 
swelling  went  off  at  the  same  rate  on  either  limb.  When 
the  oedema  began  to  subside,  the  urine,  which  had  been 
scanty  and  high  coloured  while  the  swelling  was  in- 
creasing, became  copious  and  light  coloured  while  it  was 
declining.  There  was  never  any  albumen  or  unusual 
morbid  constituent  in  the  urine  all  the  time.  The 
duration  of  the  attack  was  altogether  10  days,  and  even 
now,  20  days  after  the  commencement  of  the  affection, 
the  discoloration  of  the  skin  where  the  erythema  had 
been  is  still  distinct.  At  first,  not  suspecting  the  cause 
of  the  affection,  I  took  some  doses  of  belladonna^  but  as 
soon  as  I  discovered  the  cause  I  took  no  more  medicine, 
but  watched  its  development  with  interest.  I  never 
made  any  alteration  in  my  habits,  went  out  in  all 
weathers — ^as  usual,  without  a  great-coat — took  my 
cold  bath  in  the  morning,  and  ate  and  drank  (water)  as 
usual.  The  only  inconvenience  I  suffered  was  the 
extreme  heat  of  the  rash  for  several  days,  the  tenderness 
of  the  skin  for  two  days,  the  occasional  pricking,  and 
latterly  the  itching.  The  size  and  weight  of  my  legs 
and  the  hide-bound  feeling  caused  by  the  great  swelling 
and  stretching  of  the  skin  made  walking  not  so  com- 
fortable, but  I  did  not  do  less,  perhaps  rather  more, 
walking  than  usual  during  the  attack* 


^SSSJrSSTS^   HOMCBOPATOY  IN  ANTWERP.  791 

HOMCEOPATHY  IN  ANTWERP, 

In  our  last  two  numbers,  we  gave  some  account  of  the 
recent  interesting  and  successful  endeavour  to  establish 
a  homoeopathic  dispensary  as  one  of  the  municipal 
charities  of  the  City  of  Antwerp.  The  proceedings 
throughout  the  discussions  seem  to  us  to  admit  of  our 
making  some  little  commentary  upon  them,  which  may 
prove  useful  in  future  similar  struggles  to  place  homoeo- 
pathy in  its  true  position  before  the  public. 

The  Town  Council  of  the  City  of  Antwerp  decreed  the 
<5reation  of  a  homoeopathic  dispensary  to  which  the  sick 
poor  who  desired  to  do  so  might  resort.  The  opposition, 
which  was  conducted  by  Councillor  Dr.  Desguins, 
denied  the  competence  of  the  Council  to  pronounce  any 
opinion  upon  the  value  of  homoeopathy  as  a  scientific 
method  of  treatment.  Is,  we  should  like  to  know. 
Dr.  Desguins  any  more  competent  to  do  so  than  either 
of  his  colleagues  on  the  Council  ?  Has  he  ever  studied 
homoeopathy  ?  Has  he  ever  tested  it  ?  We  believe  that 
he  has  done  neither.  Dr.  Terwagne,  who  at  the  medical 
meeting  supported  this  contention,  said  he  had  appealed 
to  Professor  Crocq,  of  Brussels,  who  replied  that  whereas 
at  the  beginning  of  the  century  it  was  permissible  to  experi- 
ment with  what  he  termed  homoeopathic  dreams,  that 
now,  in  the  presence  of  the  progress  made  by  physiology 
and  pathology,  this  was  no  longer  possible,  and  that 
homoeopathy  had  no  foundation  in  positive  science.  It 
would  be  a  very  simple  matter  indeed,  in  short  it  has 
been  repeatedly  done  by  Dr.  Blackley  and  others,  to 
show  that  recent  physiological  enquiries  have  amply 
supported  some  of  the  most  disputed  of  the  points 
contended  for  by  homoeopathiats.  Dr.  Gaillard,  of 
Brussels,  proved,  some  years  ago,  that  Professor  Crocq, 
however  great  an  authority  he  may  be  on  pathological 
questions,  knew  nothing  about  homoeopathy — proved 
himself  to  know  nothing  by  what  he  wrote  concerning  it. 

Before  men  like  Dr.  Desguins  and  Dr.  Terwagne 
presume  to  place  themselves  before  the  public  as  judges 
of  the  scientific  basis  of  homoeopathy,  the  public  have  a 
right  to  demand  of  them  the  presentation  of  their 
credentials,  testifying  to  their  competency  as  witnesses. 

The  members  of  the  Town  Council  of  Antwerp  did  not 
express  any  opinion  of  the  character  of  the  scientific 

.    31— « 


792  HOMOEOPATHY  IN  ANTIVEBP.     ^^StJoSSTim! 

basis  of  homoeopathy.      Like  Dr.  Desguins  and   Dr. 
Terwagne,  they  had  not  studied  it.    Neither  did  they 
express    any  opinion   of   the    scientific    basis    of   the 
traditional  treatment  of  disease  taught  in  the  schools.. 
They  knew,  as  every  one  knows,  that  the  two  methods 
differed  widely  in  their  mode  of  operation,  and  they 
knew,  what  every  one  who  makes  a  little  enquiry  may 
know,  that  they  differ  greatly  in  their  results,  and  that 
this    difference  is   in  favour  of   homoeopathy.     They 
further  knew,  of  their  own  personal  knowledge,  that  in 
Antwerp,  while  homoeopathy  was  held  in  high  esteem 
among  a  number  of  persons  in  easy  circumstances,  the 
poor  alone  had  no  opportunity  of  being  able  to  take 
advantage  of  it.     They  knew  further  from  the  resuIts^ 
obtained  at  a  private  dispensary,  from  a  petition  pre- 
sented   by    a    working-men's    society,   and    from    the 
statements  made  by  M.  Tonnelier,  a  representative  of 
the  working   men,    that   the    poor   were   desirous    of 
having  the  advantage  of  homoeopathy.    Dr.  Desguins 
and  Dr.  Terwagne  would  probably  deny  the  competency 
of  the  working  men  to  express  an  opinion  on  the  question. 
But  a  working  man  is  as  capable  of  appreciating  the 
results  of  treatment  in  his  ovm  person  and  in  the 
persons  of  his  daily  associates,  as  are  those  in  easy 
circumstances.    Both  judge  by  results.    Neither  harks 
back  to  enquire  how  or  why  such  results  occur ;    all 
they  know,    and   all   that    it    is    necessary  for    their 
guidance     that     they     should     know,    is     that    the 
results  of  homoeopathy,  tested  on  an  enormous  scale,, 
have  showntbatiltnessesare  shorter,  convalescence  ismore 
I^erfect,   and  mortality  greatly  diminished,  than  is  the 
case  when  patients  are  content  to  trust  themselves  to  the 
traditional  treatment  of  the  schools.      Dr.  Terwagne, 
indeed,  told  his  confreres  in  distress  at  the  success  of 
homoeopathy  that  statistics  were  valueless.    This  was 
X>r.  Terwagne's  euphemism  for  saying  statistics  always 
tell  in  favour  of  homoeopathy  !     The  value  of  statistics 
depends  upon  a  variety  of  circumstances ;  but  when  they 
relate  to  a  considerable  number  of  cases  of  the  same 
disease,  occurring  in  the  same  locality,  and  during  the 
same  period  of  time,  and  treated  in  public  hospitals  where 
the  only  difference  in  treatment  is  the  mode  of  selection 
and  dose  of  the  medicine  used,  they  are  valuable.     Take, 
the  following  instance  as  an  example  of  statistics  which 


SiteiJf STiTiawI*^    HOMCEOPATHY  IN  ANT^VERP.  793 

.are  perfectly  trustworthy  and  eminently  instructive. 
During  1887, 1888  and  1889  Melbourne  was  visited  by 
an  epidemic  of  typhoid  fever.  There  are  three  hospitals 
in  the  city,  the  Melbourne  with  318  beds ;  the  Alfred  with 
144 ;  and  the  Homoeopathic  with  60.  During  these  three 
years,  the  Melbourne  received  1,182  cases  of  typhoid^ 
181  of  which  or  15.3  per  cent,  proved  fatal ;  the  Alfred 
liad  998  cases  with  a  mortality  of  1S5  or  13.5  per  cent, 
and  the  Homoeopathic  admitted  654  of  whom  49  or  8.8 
died.  Of  the  total  admissions  to  the  Melbourne  and 
Alfred  Hospitals  typhoid  fever  supplied  12.79  per  cent. 
<0f  the  whole  number  admitted  to  the  Homoeopathic 
Hospital  during  the  three  seasons  typhoid  furnished 
.36.37  per  cent.  Thus,  not  only  was  the  mortality  5.65 
per  cent,  less  under  homoeopathic  than  under  any  other 
form  of  treatment,  but  the  recoveries  &om  it  in  the 
Homoeopathic  Hospital  were  so  much  more  rapid  that 
this  institution  was  able  to  receive  three  times  as  many 
patients  (in  proportion  to  the  number  of  its  beds)  as  were 
the  Melbourne  and  the  Alfred. 

Similar  statistics,  equally  reliable,  are  on  record,  and 
^all  point  to  the  same  result — ^the  superiority  of  homoeo- 
pathy from  every  point  of  view  over  the  kind  of  treatment 
that  Dr.  Terwagne  would  alone  allow  to  be  scientific. 
It  is  useless  for  Dr.  Terwagne  to  set  aside  such  statistics 
JAB  valueless ;  intelligent,  common-sense  men  refuse  to 
regard  them  in  that  light. 

One  feature  of  this  dispute  is  especially  worthy  of 
jattention,  and  particularly  so  in  view  of  the  resolution 
Dr.  Byres  Moir  has  given  notice  that  it  is  his  intention 
to  propose  at  the  British  Homoeopathic  Society  on 
Thursday  evening. 

When  early  in  the  struggle  the  allopaths  in  Antwerp 
saw  that  they  must  be  worsted  in  it,  they  proposed  a 
<5ompromise.  They  offered  to  receive .  as  a  confrere  on 
the  staff  of  the  Bureau  de  Bienfaisance  a  homoeopathic 
physician,  and  suggested  that  a  special  pharmacy  should 
be  set  apart  for  his  use,  urging  that  this  would  fulfil  all 
the  objects  the  Town  Council  had  in  view  in  instituting 
a  homoeopathic  dispensary.  Their  object  was  to  suppress 
.the  word  "homoeopathic."  The  Town  Council  would 
iiot  listen  to  the  suggestion ;  and  why  not  ?  Mr.  Alder- 
.man  Gits  wished  to  retain  the  word  in  order  that  the 
^or  mig&t  be  able  to  obtain  homoeopathic  treatment 


794  'HOH(EOPATHY   IN   ANTWERP.     ^^JSfiL^iSTtSJ* 


Beriew,  Dec  1,  UPl. 


withont  any  eyasion,  and  he  argued  that  to  keep  the 
word  homceopathy  out  of  sight  would  exhibit  a  want  of 
candour  in  the  first  place,  and  in  the  second  if  the  Bureati 
happened  to  be  packed  with  opponents  of  homoeopathy 
the  nomination  of  a  known  homoeopath  would  be  rejected, 
and  the  purpose  the  Council  had  in  view,  that  of  giving 
opportunities  for  relief  in  sickness  to  the  poor  equal  to 
those  possessed  by  the  rich,  would  be  frustrated.  M, 
Tonnelier  said  that  he  desired  to  retain  the  disputed 
word  in  order  that  the  poor  might  know  which  doctor 
would  treat  them  homoeopathically  and  which  would  not. 
He  also  expressed  his  astonishment  that  men  who 
pretended  to  regard  homoeopathy  as  quackery  should  be 
willing  to  receive,  as  a  coyifrhre^  one  who  practised  it, 
"  provided  he  kept  his  colours  out  of  sight."  linplying 
that  it  was  not  homoeopathy  that  the  medical  men 
disliked ;  but  it  was,  that  the  public  generally  should  come 
to  know  that  the  superior  results  in  the  treatment  of 
disease  at  the  homoeopathic  dispensary  arose  from  this 
treatment  being  based  on  homoeopathy,  that  they  were 
afraid  of. 

On  the  other  hand,  Dr.  Desguins  protested  against  the 
new  dispensary  on  the  ground  that,,  in  setting  up  a 
special  service  for  homoeopathy,  they  were,  at  the  least, 
recognising  it  as  of  equal  value  with  traditional  medi- 
cine, and  declaring  it  to  be  both  rational  and  efficacious* 
This  is  doubtless  perfectly  true ;  and  it  would  be  ex- 
tremely unjust  were  homoeopathy  regarded  in  any  other 
light.  As  M.  de  Yos  said,  '*  No  one  could  deny  that, 
since  the  time  of  Hahnemann,  homoeopathy  had  not 
only  maintained  its  reputation  but  had  greatly  extended 
it.  Such  was  not  the  usual  course  of  anything  value- 
less." Those  who  have  a  knowledge  of  homoeopathy, 
and  have  tested  it  practically,  regard  it  as  having  proved 
to  be  not  merely  of  equal  value  with  traditional  medicine 
but  infinitely  superior  to  it. 

M.  Van  de  Walle  regarded  the  use  of  the  word  homoeo- 
pathic as  objectionable  because  homoeopathically  selected 
medicines  were  not  sufficient  in  all  cases.  8ome  caseR 
require  mechanical  treatment,  as  in  injuries;  others 
demand  operative  interference,  as  in  ovarian  tumours  ; 
others  again  require  antidotes,  as  in  poisonings ;  some 
extremely  painful,  and  at  the  same  time  incurable  cases, 
need  narcotics  to  render  the  last  days  of  life  compara- 


SJ^wf^^rSw!^     HOMCEOPATHY   IX   ANTWERP.  795 

tively  easy.  This  is  all  perfectly  true ;  but  in  all  other 
instcmces  the  .homoBopathically  indicated  remedy  is  all 
sufficient  not  only  when  any  remedy  is  at  all  useful,  but 
in  numberless  instances  where  no  relief  at  all,  or  but 
comparatively  little,  can  be  obtained  from  medicine  pre- 
scribed on  any  other  principle.  These  constitute  nearly 
the  whole  of  the  medical  cases  that  can  be  advantaged* 
by  medicine.  In  surgery  again,  though  an  operation 
may  be  required  to  cure  the  patient,  the  cure  is  both 
more  rapid  and  more  complete  when  homceopathically 
indicated  remedies  are  used  to  meet  the  contingencies 
of  the  operation,  than  where  they  are  not.  Surely  this 
is  justification  enough  for  enabling  a  sick  person  to 
distinguish,  by  the  use  of  a  distinctive  word,  whei'e  he 
is  likely  to  have  to  the  full  the  benefit  of  the  advantages 
derived  from  an  intelUgent  knowledge  and  practice  of 
homoeopathy ! 

Some  argue  that  the  use  of  the  word  homoeopathic 
carries  with  it  the  idea  of  personal  superiority.  Dr. 
Desguins,  on  the  other  hand,  looks  upon  it  as  indicating 
personal  inferiority !  Whether  it  is  looked  at  in  the  one 
light  or  the  other  depends  upon  the  knowledge  of 
homoeopathy  possessed  by  the  one  who  looks.  But  in 
reality  the  fact  of  a  physician  letting  it  be  generally 
known  that  he  practises  homoeopath}'  is  not  a  personal 
matter  at  all.  Homoeopathy  is  no  secret ;  opportunities 
for  knowing  all  about  it  and  how  to  practise  homa>o- 
pathically  abound  on  all  sides.  Some  physicians,  indeed 
the  large  majority,  reject  these  opportunities,  others 
embrace  them.  The  public  having  a  general  knowledge 
of  the  results  of  homoeopathy  desire  to  avail  themselves 
of  the  services  of  the  latter.  How  then  are  they  to  know 
what  institutions,  what  medical  men  to  apply  to  unless 
a  distinctive  word  is  used  to  point  them  out '?  It  is  not 
a  question  of  the  superiority  of  Dr.  Jones  to  Dr.  Smith, 
but  of  one  method  of  using  drugs  as  remedies  over 
another ;  a  method  which  all  can  practise,  if  they  choose. 

The  division  of  the  medical  profession  into  two  camps, 
as  it  virere,  is  very  undesirable  on  many  grounds,  but  the 
onus  of  its  existence  rests  entirely  with  the  majority  of 
its  members.  In  no  medical  society,  journal,  school, 
hospital,  or  dispensary,  connected  with  general  medicine 
can  homoeopathy  be  set  forth,  taught  or  practised  at  the 
present  time;    while  the  very    raisou    d'etre   of  such 


796  HOM(EOPATHY   IN    ANTWERP.    **^£5rjSS!T^ 

institutions  as  have  been  fonnded  by  those  who  believe 
in  homoeopathy  is  the  public  setting  forth,  teaching  and 
illustrating  of  it.  Hence  the  use  of  the  distinctive  word 
is  essential.  We  also  see,  from  the  Antwerp  discussions, 
that  the  public  consider  themselves  to  have  a  right  to 
know  the  therapeutic  views,  at  least  in  a  general  sense, 
of  those  they  consult,  and  undoubtedly  they  have  such  a 
right.  If  they  have  not,  why  have  we  been  at  such  pains 
to  instruct  them  as  to  what  homoeopathy  means  and 
what  have  been  found  to  be  the  results  of  adopting  it  ? 

It  is  not  the  least  interesting  point  in  the  dispute  at 
Antwerp  that  it  was  not  merely  a  question  of  freedom  of 
opinion  in  medicine  that  was  at  issue.  It  was  not,  as  at 
the  Jubilee  Hospital,  a  question  whether  a  member  of 
the  staff  should  practise  homoeopathy  if  he  chose — the 
Antwerp  doctors  have  been  so  far  educated  as  to  admii^ 
that  right,  and  were  prepared  to  receive  a  homoeopathic 
colleague,  if  not  with  open  arms,  at  any  rate  because  they 
felt  doing  so  to  be  the  lesser  of  two  evils !  It  was  not  a 
question  of  the  right  to  practise  homoeopathy,  but  one 
of  the  propriety  of  making  it  known  far  and  wide,  that, 
at  one  of  the  municipal  medical  charities  of  Antwerp, 
homoeopathy  was  practised.  This  is  a  considerable  step 
in  advance,  and  one  that  is  very  welcome. 

An  official  post  has  now  been  created  in  Belgium 
which  can  only  be  held  by  a  physician  familiar  with  the 
principles  and  practice  of  homoeopathy.  Meanwhile,  no 
provision  exists  for  teaching  the  one  or  illustrating  the 
other.  This,  we  doubt  not,  will  be  rectiiied  before  very 
long ;  for  it  is  of  course  necessary  that  persons  occupy- 
ing official  positions  should  be  adequately  instructed  in 
the  duties  attaching  to  them.  We  trust  that,  following 
the  course  of  the  Austro^Hungarian  Grovemment  with 
regard  to  the  University  and  Hospital  of  Buda-Pesth, 
that  of  Belgium  will,  in  the  interests  of  their  country 
and  of  therapeutics,  create  a  professorship  of  Homoeo- 
pathic Materia  Medica  in  the  University  of  Brussels, 
and  provide  wards  attached  to  the  chair  in  the  hospital  to 
enable  the  teaching  from  it  to  be  clinically  illustrated. 

It  is  important  to  notice  that  the  active  partisans  of 
traditional  medicine  only  regard  the  present  arrangement 
in  the  light  of  a  trace.  What  they  are  pleased  to  term 
their  "outraged  dignity"  is  to  be  avenged  some  day! 
That  i)ersons  outside  the  professional  ring  should  have 


S'5SJf52TSS"*     HOMCEOPATHY   IN   ANTWERP.  797 

the  audacity  to  have  an  opinion  upon  the  relative  value 
of  methods  of  treatment,  that  they  should  have  formed 
this  opinion  by  examining  results,  and  that  they  should 
exercise  this  opinion,  is  ''  an  outrage  "  !  If  they  desired 
to  know  anything  about  homoeopathy  they  should  have 
applied  to  the  Academy  of  Medicine— composed  entirely 
of  men  who  know  nothing  about  it,  and  are  bitterly 
prejudiced  against  those  who  practise  it !  But,  unfor- 
tunately for  the  so-called  "scientific  dignity"  of 
M.  Terwagne  and  his  friends,  the  Town  Council  agreed 
with  M.  Tonnelier  that  they  could  not  attach  much 
importance  to  a  decision  when  those  who  pronounced 
it  were  both  judges  and  partisans.  Consequently, 
^I.  Terwagne  brushes  M.  Tonnelier  aside  as  a  **  non- 
■cmtity  "  !  This  would  be  satisfactory  to  the  opponents 
of  homoeopathy,  were  it  not  that,  as  a  matter  of  fact, 
neither  hard  words,  nor  such  as  are  insolent,  break  any 
bones ;  so,  no  harm  is  done  by  indulging  in  them. 

But  those  who  are  professionally  responsible  for  the 
-success  of  the  new  dispensary  must  make  a  note  of  the 
spirit  and  temper  displayed  by  M.  Terwagne  and  his 
associates.  We  have  all  learned  here,  and  doubtless  the 
f^ame  conclusion  has  been  long  since  arrived  at  in  Belgium, 
that  however  honourable  in  all  other  relations  of  life  a 
medical  opponent  of  homoeopathy  may  have  shown  him- 
self to  be,  he  is  not  one  whit  less  likely  to  resort  to  the 
most  dishonourable  and  self-degrading  measures  to  check 
the  spread  of  the  therapeutic  method  he  has  set  himself  to 
•ilestroy.  They  must  remember,  too,  that  had  there  been 
a  sufficient  proportion  of  the  Bureau  staff  willing  to  join 
in  a  general  strike  we  should  never  have  heard  of  that 
**  feeling  of  humanity,"  which,  with  but  too  transparent 
^n  insincerity,  is  assigned  as  the  motive  prompting  the 
staff  to  ^'  momentarily  "  acquiesce  in  the  establishment 
of  a  Municipal  Homoeopathic  Dispensary.  Dr.  Hertoghe's 
exclamation  "  shall  we  admit  that  120  physicians,  united 
in  a  good  cause,  are  to  make  terms  with  four  homoeopaths? 
If  we  act  steadily  together  we  shall  extricate  ourselves 
from  them,"  conveys  a  word  of  warning,  to  which  our 
^colleagues  will  do  well  to  take  heed.  That  every  artifice, 
every  species  of  cunning  which  bitter  hatred  and  reckless 
unscrupulousness  can  devise  will  be  resorted  to  in  order 
to  prevent  the  success  of  the  dispensary  is  too  much  in 
iiecordance  with  events  which  are  historical  to  be  doubtful. 


^98 BEVIEW8.     •  "SS&fggT;^ 

Oar  colleagaes  mnst  be  ever  on  the  vatch  for  trickery, 
they  must  expose  every  atl^mpt  of  the  kind  \dthoat 
hesitation,  accepting  no  explanation,  but  act  upon  facts 
aa  they  find  them  and  as  they  occur.  It  is  a  bitter 
warfare  that  they  are  engaged  in.  Their  enemies  are 
exasperated  by  defeat  and  capable  of  adopting  any 
method  which  may  convert  their  defeat  into  victory ! 

Dr.  Hertoghe  may  well  be  astounded  that  four  homoeo- 
pathic physicians  should  have  had  such  an  influence 
upon  public  opinion  as  to  have  withstood  successfully 
the  assaults  of  120  allopaths.  Let  him  read  the  story  of 
Goliath  ^nd  David  !  It  is  not  always  the  ''big  batallions  "^ 
that  determine  victory !  A  good  cause  has  occasionally 
a  power  exceeding  that  of  mere  numbers.  The  very 
fact  of  four  representatives  of  homoeopathy  having  been 
able  to  send  one  hundred  and  twenty  allopaths  to  the 
right  about,  solely  through  the  results  of  their  work — 
is  a  strong  testimony  of  the  power  of  homoeopathy  over 
disease,  and,  at  the  same  time,  reflects  the  highest  credit 
upon  the  skill  of  those  whose  representation  of  homceo- 
pathy  in  Antwerp  has  brought  about  the  establishment 
of  the  Dispensary. 

In  congratulating  Drs.  Lembreght.^  and  Dr.  Boniface 
Schmidt  on  their  appointments,  it  gives  us  especial 
pleasure  to  remember  that  the  former  was  during  one 
year  a  pupil  of  the  London  School  of  Homa'opathy. 
We  heartily  wish  them  success,  and  trust  that  the  results 
of  their  work  may  be  such  as  to  increase  the  knowledge 
and  influence  of  homoeopathy  throughout  their  countrj'.. 

REVIEWS. 


TiCi'h'c  Ijecture^  on  die  Structure  of  Ute  (  entral  Xenoiot  Stf}<teui 

/or  Physicians  and    Studenta,      By   Dr.   LuD^io   Edixger. 

Second  edition,  revised,  with  188  illustrations.    Translated 

by  Willis  Hall  Vittum,  M.D.    Edited  by  C.  Eugene  Riggs, 

A.M.,  M.D.  Philadelphia  and  London :  F.  A.  Davis.   1890* 

By  means  of  this  volume  (pp.  280)  Dr.  Edinger's  well  known 

Vorlesunffcn     iiber    den     Ban     der      Xervosoi      i  'entralonjane 

are  rendered  available  to  English  readers.     The  translation 

is  from  the  second  German  edition,  published  in  1889.    The 

work  is,  as  its  title  indicates,  purely  anatomical,  and  is  a  plain 

recital  of  well  ascertained   &cts.      On  controverted  points^ 

Dr.  Edinger  gives  either  the  most  received  views  or  the  result 

of  his  own  repeated  and  careful  observations.    Tlie  second 


XjS£i'iST?eJ"'  MEETINGS.  "iW 


Beriew,  Dee.  1, 1891. 


chapter  is  in  some  ways  the  most  valuable  of  all,  foiTning  an 
admirable  groundwork  for  what  follows ;  it  consists  of  the 
embryology  and  comparative  anatomy  of  the  brain.  The 
information  is  so  clearly — ^we  bad  almost  said  simply — ^given, 
and  the  text  so  well  illustrated  by  numerous  woodcuts,  that  it 
can  be  readily  followed  even  by  a  reader  possessing  only  a 
slight  previous  knowledge  of  the  subject.  A  peculiarity  of  the 
engravings  is  that  the  blocks  used  for  the  German  edition 
have  been  employed  here,  the  explanatory  terms  thus  being- 
in  German,  necessitating  constant  translation  (as  foot  notes) 
into  English.  The  work  tliroughout  is  fully  illustrated.  The 
last  chapter  contains  a  well  executed  review  of  the  com- 
plicated structure  of  the  Pons. 

Although  the  author  considers  his  work  merely  ''  an  intro- 
duction to  the  study"  of  the  anatomy  of  the  bi*ain  it  is^ 
sufficiently  full  for  all  the  practical  uses  of  the  well  educated 
practitioner.  For  such,  and  for  the  student,  Dr.  Edinger'^ 
work  ought  to  rank  as  a  standard  text-book  both  in  England 
and  America.  The  enterprising  publisher  is  to  be  congratu- 
lated on  his  discernment  in  introducing  such  a  work  to  the 
English-reading  profession. 

MEETINGS. 


BRITISH  HOMCEOPATHIC  SOCIETY. 

The  Second  Ordinary  Meeting  of  the  Session  took  place  on 
Thursday,  November  5tli.     A  paper  was  read  by  Dr.  Wynne. 
Thomas,  junr.,  on  **  Gastric  Ulcer.'* 

The  PBEsn>ENT  showed  a  specimen  obtained  from  a  man^ 
aged  27,  admitted  into  the  hospital  under  Dr.  61ackley» 
for  symptoms  of  pyloric  carcinoma.  Abdominal  section  was 
performed  on  November  2nd  with  a  view  to  the  removal  of  the 
growth  by  pylorectomy  and  subsequent  union  of  the  stomach 
to  the  jejunum.  It  was  found  that  owing  to  the  extent  of  the 
gi*owth  and  the  adhesion  of  the  transverse  colon  to  the 
stomach  removal  would  be  too  serious  an  undertaking, 
^astro-enterostomy  only  was  therefore  performed,  decalcified 
bone-plates  being  used.  The  patient  unfortunately  sank  from 
exhaustion  thirty  hours  after  the  operation.  The  specimen 
showed  that  in  that  time  perfect  apposition  of  the  parts  had 
taken  place  and  that  the  union  was  quite  watertight. 

Mr.  Dudley  Wright  showed  a  Temporal  bone  removed  from 
a  patient  admitted  to  the  hospital  for  caries  of  that  bone. 
Thrombosis  of  the  lateral  sinus  and    subsequent    pyaemia 
had  proved  fatal,  in  spite  of  the  evacuation  by  trephining  of 
a  quantity  of  pus. 


800  MBETIXGS.  ^"S^ 


Beviev,  Dec  1«  IfiBl. 


The  Paesidknt  asked  to  be  allowed  to  delay  the  reading  of 
Dr.  Thomas'  paper  a  few  minutes  whilst  he  referred  to  the 
death  which  had  taken  plaee  since  their  last  meeting  of  a  past 
President,  and  an  old  and  valued  member  of  the  Sociii^, 
Dr.  Mathias  Both.  He  was  sore  the  Society  would  wish  to 
send  their  sympathy  and  condolence  to  the  widow  in  her 
sorrow.  Dr.  Cooper  moved  that  a  vote  of  condolence  be 
passed,  and  the  expression  of  the  Society's  regret  uid 
sympathy  be  sent  to  Mrs.  Both.  Dr.  Dudgeon  feelingly 
seconded  the  proposal,  which  was  carried  unanimously. 


WESTERN   COUNTIES  THEBAPEUTICAL  SOCIETY. 

Meeting  held  at  Torquay,  5th  June,  1891. 

Present : — Dr.  A.  M.  Cash,  of  Torquay ;  Drs.  W.  Cash 
Reed  and  A.  S.  Alexander,  of  Plymouth ;  Dr.  S.  P. 
Alexander,  of  Soutbsea :  Dr.  Nonnaii,  of  Bath ;  Drs.  E. 
WilUams,  F.  H.  Bodman  and  T.  I).  Nicholson,  of  Clifton  ; 
Dr.  Black,  of  Torquay,  as  a  visitor. 

Dr.  W.  Cash  Reed  then  read  a  paper  on  "  The  Right  Place 
of  Aperients  in  Practice,"  after  which  there  was  a  ^cussiou. 

This  interesting  paper  we  hope  to  insert  in  our  next 
iHSue. 

Dr.  A.  S.  Alexander  mstaneed  a  case  of  acute  constipation 
with  tension  of  abdomen  and  severe  pain  reUeved  at  once  by 
ftulr,  fjlyvyrrhizcc  ( 'o. 

Dr.  Nicholson  thought  Dr.  Reed  had  very  well  defined  the 
place  of  aperients.  He  had  seen  several  cases  where  aperients 
had  apparently  averted  a  fatal  termination  or  quickly  cleared 
up  an  anxious  complication.  He  referred  to  cases  of  children 
with  continued  or  remittent  fever,  furred  tongue  and  anorexia, 
which  resisted  homoeopathically  indicated  drugs,  and  were 
cliarmed  away  m  a  most  speedy  manner  by  dosing  with 
uuKjneHw.  He  mentioned  the  necessity  of  regular  evacuation 
in  old  pedple,  and  spoke  of  the  vahie  of  mercury  in  serious 
cases  of  cardiac  disease  with  dropsy. 

Dr.  Eubulus  Williams  praised  oleum  ricini  as  generally  the 
most  trustwortliy  aperient  when  needed. 

Mr.  Norman  recommended  J iq. -senna  leyuminosiP  in  con- 
stipation, especially  in  ovarian  disease. 

Dr.  A.  S.  Alexander  had  found  eollim.  ^,  two  drops  for  a 
dose,  a  good  aperient  in  pelvic  congestion. 

Dr.  S.  P.  Alexander  agreed  with  the  recommendation  of 
rnlUmoiwtj  and  mentioned  linseed  tea  and  frame  food  bread 
as  of  value. 


g^^rSfraf"^  NOTABILIA. 801 

NOTABIUA. 

SALE  OF  WORK  AT  THE  LONDON  HOMOEOPATHIC 

HOSPITAL. 
The  nursing  staff  of  the  Hospital  have  throughout  show^n  a 
lively  interest  in  the  Institution,  and  especially  in  the 
endeavour  to  raise  funds  for  the  New  Building.  Many  of  the 
nurses  have  been  able  to  collect  from  patients  and  friends, 
sums  which  have  been  a  welcome  addition  to  the  fund. 

The  latest  effort  has  been  the  organisation  of  a  Sale  of  Work 
which  took  place  in  the  Board  Boom  of  the  Hospital  on  the 
4th  and  5th  ult.  Arranged  and  carried  out  entirely  by  the 
sisters  and  nurses  this  enterprise  did  much  credit  to  their 
energy,  devotion  and  taste.  The  prettily  decorated  room, 
and  the  well  filled  stalls  proved  attractive  to  many  of  the 
patients  and  their  friends,  and  to  other  friends  of  the  hospital. 
Serving  both  for  decoration  and  as  an  attraction  to  pur- 
chasers were  a  number  of  good  etchings  and  engravings  and 
pretty  water-colour  drawings,  the  gift  of  kind  neighbom-s,  the 
students  of  the  '*  School  of  Art,"  in  Queen  Square. 

A  most  commendable  feature  was  that  everything  had  been 
marked,  as  nearly  as  could  be  ascertained,  at  its  proper  value, 
especially  the  clothing  stall,  which  was  duly  appreciated  by 
the  poor  of  the  surrounding  district. 

After  all  the  expenses  were  paid  the  sisters  and  nurses  had 
the  satisfaction  of  paying  to  the  Treasurer  the  sum  of  JSIOO.. 
They  certainly  deserse  our  congratulations  on  the  success  of 
their  uudertalung. 

PRESENTATION  TO  DR.  AND  MRS.  BLUMBERG. 

Ws  have  much  pleasure  in  joining  our  congratulations  to 
those  of  Dr.  Blumberg's  patients  and  fellow-townsmen  on  the 
occasion  of  his  silver  wedding.  An  interesting  gathering  took 
place  in  September  to  present  our  colleague  and  Mrs.  Blumberg 
with  sundiy  tokens  of  goodwill.  The  ceremony  took  place  at 
the  residence  of  Mrs.  Oxley,  The  Thorns,  Queen^s  Road, 
Southport.  It  took  the  foinn  of  the  presentation  by  a  number 
of  patients  and  friends  of  a  silver  centre  bowl  and  stand,  a  set 
of  silver  salt  cellars,  a  case  of  silver  dessert  spoons,  and  a  case 
of  fish  servers  and  knives  and  forks.  Accompanying  these 
was  a  tastefully  illuminated  address  in  the  following  terms : 
— *•  18th  September,  1891.  The  undersigned  offer  their  con- 
gratulations to  Dr.  and  Mrs.  Blumberg  on  the  occasion  of 
their  silver  wedding,  and  beg  their  acceptance  of  the  accom- 
panying pieces  of  plate.*'  Then  followed  the  names  of  over  100 
signatures.  It  should  be  stated  that  the  amount  of  each  in- 
dividual subscription  was  strictly  limited,  otherwise  the  presen* 


802  NOTABUJA.  ^*"b2J£^,i>ci;i«. 

tation  might  have  been  of  mnofa  more  imposing  proportions. 

The  Yen.  Abchdeacon  Clabks,  in  making  the  presentation, 
remarked  that  25  years  "was  a  good  long  time  in  the  life  of 
a  man  or  woman,  and  a  silver  wedding  made  people  feel  older. 
The  Archdeacon  had  known  Dr.  Blnmberg  28  years,  and  it 
was  not  the  first  time  he  had  spoken  at  a  presentation  to  the 
Doctor.  During  that  time  he  had  always  esteemed  him  most 
])ighly  as  a  medical  man.  On  one  occasion  he  had  been 
instrumental  in  saving  the  life  of  one  of  his  (the  speaker's) 
children  when  in  a  hopeless  condition.  The  Yen.  Archdeacon 
believed  that  it  had  come  to  pass  that  there  was  not  now 
either  the  same  odium  tfiertlofficwn  or  odium  medicum  as 
formerly.  Medical  men  of  the  two  schools  would  now  meet 
as  friends,  and  he  was  inchned  to  think  that  each  had  learned 
something  from  the  other. 

'  The  Rev.  R.  Stephenson  also  spoke  in  eulogistic  terms  of 
Dr.  Blumberg's  skill  and  kindness  in  his  profession.  He  had 
also  known  Dr.  Blumberg  in  connection  with  the  Literary  and 
Pliilosophical  Society  where  he  had  spoken  cleatly  and 
powerfully  on  certain  subjects,  and  maintained  his  views  widi 
a  courtesy,  firmness,  and  politeness  wliich  should  be  an 
example  to  every  Christian  gentleman  in  the  art  of  controversy. 

Mr.  B.  BooTHBOTD  having  spoken  in  support  of  the  presenta- 
tion, 

Dr.  Blumbebo,  in  acknowledging,  said  he  could  not  find 
words  in  which  to  express  his  own  feelings  and  those  of  his 
wife  for  the  many  kindnesses  they  had  received,  and  for  that 
most  splendid  and  undeserved  present.  Alluding  to  Arch* 
deacon  Clarke's  remarks  about  age,  he  said  he  felt  more 
attached  to  life  the  older  he  grew.  When  he  first  wenttoreside 
in  Soathport  it  was  prophesied  that  he  would  not  hve  a  year. 
But  he  was  there  to  falsify  all  such  prophecies.  The 
thing  which  gave  him  most  pleasure  in  recollecting  was 
the  foundation  of  the  children's  Sanatorium.  Through  this 
he  hoped  that  when  he  came  to  leave  tliis  world  he  would  be 
able  to  say  non  omtUs  moriar.  Having  heartily  thanked  his 
friends.  Dr.  Blumberg  sat  down,  and  the  proceedings  were 
brought  to  a  conclusion. 

On  the  following  day  a  garden  fete  was  given  by  Dr,  and 
Mrs.  Blumberg  to  the  children  and  nurses  of  the  Sanatorium. 
Nearly  70  children,  led  by  the  matron,  were  present. 


DEATH  OF  LADY  EBURY. 

W' E  regret  to  have  to  announce  the  death  of  Lady  Ebary, 
after  a  long  illness,  and  at  an  advanced  age,  on  the  2l8t  of 
November.     Lord  Ebury  has  been  for  so  many  years  so 


S^SZTSST'  NOTABnjA.  803 

_  _  -  -  -^11 

identified  with  the  cause  of  homoeopaUij,  and  with  the  Homoeo- 
pathic Hospital,  that  we  feel  sure  all  homceopaihs  will  sympa- 
thise with  his  lordship  at  this  time  of  affliction. 

MEDICAL  PRACTICE  IN  CONNECTICUT. 

The  following  reply  was  sent  to  a  doctor  inquiring  of  a  State 
official  if  he  wo<ild  he  allowed  to  practise  in  Connecticut  by 
restoring  his  name  and  the  college  from  which  he  was 
graduated: 

'^  Sir :  Anybody  can  practise  medicine  in  Connecticut. 
You  do  not  need  to  register ;  you  do  not  need  a  medical 
diploma ;  you  do  not  need  to  know  the  difference  between 
opium  and  peppermint ;  you  do  not,  indeed,  need  to  know 
anything.  You  can  simply  come  and  Uve  here  and  begin  to 
practise.  The  laws  of  Connecticut  will  sustain  you  in 
collecting  your  fees  for  professional  services,  if  you  render  any 
which  you  choose  to  caU  such.  But  if  you  undertake  to  carry 
me  or  my  trunk  to  the  depot  for  pay,  you  must  get  a  Ucense 
If  you  peddle  matches  or  peanuts,  you  must  get  a  license.  If. 
you  collect  the  swill  from  your  neighbours  to  feed  your  pigs,  you 
must  get  a  license.  If  you  want  to  empty  your  cesspool,  you 
must  get  a  license.  But  you  can  practise  medicine  in 
Connecticut  tcithotU  a  liceme, — Hartford  Post,  August  19, 
imi.—The  ClUvique,  (Chicago). 

NICOTINE  PSYCHOSIS. 

AccoBDiNG  to  Dr.  Schroff,  Wiener  Med,  Presse,  the  primary 
effect  of  tobacco  upon  the  system  is  excitation,  the  secondary, 
depression.  It  affects  the  entire  muscular  system,  the  heart 
as  well  as  the  vasomotor  system.  The  disease  called  nicotin- 
osis  mentalis  is  a  primary  insanity,  having  a  regular  course 
and  characteristic  symptoms.  Among  the  latter  are :  a  feehng 
of  extreme  debility  and  impotence,  with  early  hallucinations, 
delusions  and  suicidal  tendencies.  The  patient  at  first  feels 
ill,  is  restless,  easily  excited,  sleepless,  indifferent  to  usual 
occupations  and  more  or  less  depressed ;  afterwards  hallucina- 
tions of  sight,  hearing  and  of  general  sensation  set  in  with 
much  palpitation  and  pain,  about  the  heart.  Later  in  the 
course  of  the  disease  the  hallucinations  become  more  exag- 
gerated ;  he  has  visions  of  angels,  heaven  and  hell,  is  excitable 
and  boisterous.  The  paroxysms  and  excitement  are  periodi- 
cal, lasting  two  weeks  or  more,  with  intervals  of  quiet.  In 
the  beginning  of  the  disease  the  patient  is  gloomy  and  rest- 
less; later  on,  and  as  it  becomes  chronic,  he  is  more  quiet  and 
leeble-minded.  Patients  sometimes  recover  in  the  early  stages, 
but  never  in  the  later  ones.  Dr.  Ejellberg,  of  Upsala,  has 
investigated  the  effects  of  tobacco  in  inveterate  smokers  and 


^ KOTABILIA,  ''Ig^^,  1^.  ^  ,^ 

finds  that  they  are  of  a  distinctly  injarions  chaiacter.  Nioo- 
tinosis  mentis  is  a  primary  disease  which  helongs  to  the 
groap  of  mental  intoxications.  Dr.  Kjellbeig  also  speaks  of  a 
preliminary  stage  lasting  aboat  three  months,  which  is  charac- 
terised by  general  malaise,  uneasiness,  insomnia,  depression 
often  of  a  religions  tendency.  He  divides  the  establidied 
disease  into  three  stages :  (1.)  The  patient  is  sabject  to  halln- 
cination,  fixed  ideas,  with  tendency  to  suicide,  depression^ 
attacks  of  fear  and  outbursts  of  anger.  He  talks  little,  but 
logically ;  the  nutrition  is  impaired.  (2).  Exaltation  of  a 
pleasant  type  is  present,  followed  after  two  or  three  weeks  by 
depression  which,  in  its  turn,  is  succeeded  by  a  slight  fnAni«<*^l 
condition.  (3.)  The  inten^als  between  the  attacks  are  shorten 
the  patient  very  restless  and  the  intellect  and  memory  im- 
paired. He  observes  what  is  going  on,  but  is  taciturn  and 
indifferent.  The  prognosis  is  good  before  the  third  stage,  bat 
after  that  unfavourable.  The  treatment  consists  mainly  in 
abstinence  from  the  use  of  tobacco,  with  nutritious  diet. — 
^fe^^.  Reprints. 

A  CASE  OE^OLSONrNG  FROM  THE  EXTERNAL 

I'SE  OF  TOBACCO. 
Dr.  AucHfe  reports  the  following  curious  and  interesting  case 
to  the  Wiener  Medizinisehe  /'/y*w'.     The  patient  was  a  man 
suffering  from  pediculi  pubis.      He  took  200  grammes  of 
tobacco  and  boUed  it  down  in  two  litres  of  water,  and  tlien 
proceeded  to  "rUb  in"  the  mixture  over  his  entire  body. 
After  this  performance  he  did  not  wipe  himself,  but  sat  in  the 
wind  and  dried.     This  was  done  in  the  morning,  and  at  about 
half-past  one  in  the  afternoon  he  repeated  the  experiment.   At 
three  o'clock  he  was  suddenly  seized  with  violent  nausea  and 
dizziness ;  his  face  grew  dark,  cold  perspiration  streamed  from 
his  body,  which  assumed  an  extreme  pallor ;  and  his  hands 
and  feet  trembled.     The  patient  felt  as  though  intoxicated, 
and  seemed  to  be  looking  through  a  fog,  being  unable  t^o 
distinguish  the  contour  of  any  object.     His  pupUs  were  en- 
Lurged,  but  reacted   to  the  light.     He  could  hear  well,  but 
said  he  felt  as  though  cotton  were  stuffed  in  his  ears.   Vomit- 
ing occurred  from  time  to  time.    Besides  this,  the  heart  s 
action  was  much  slower  tlian  normal,  and  the  radial  pulse, 
small,  thready,  and  scarcely  perceptible.    These  conditions 
lasted  for  about  three  hours,  after  which  ihey  gradually 
abated.   The  next  day  the  patient  only  complained  of  a  sevei^ 
headache,  which  a  long  sleep,  however,  relieved. 

This  case  proves  that  tobacco  used  externally  can  give  rise 
to  the  same  toxic  symptoms  as  when  taken  internally.  The 
reporter  of  the  case  fails  to  state  whether  the  pediculi  were 
affected  or  not. — 3f «/.  lleprint^. 


^S^^STu^?^  OBITUARY.  805 


OBITUARY. 


MATHIAS  ROTH,  M.D. 

In  our  last  number  we  briefly  referred  to  the  sad  catastrophe 
which  had  so  suddenly  deprived  us  of  our  old  and  valued 
friend  and  colleague,  Dr.  Both.  On  this  occasion  we  are  able 
to  notice  his  long  and  useful  career  at  greater  length. 

At  the  British  Homoepathic  Society,  on  the  occasion  of  the 
ordinary  monthly  meeting  on  the  5th  ult.,  Dr.  Coopsb  moved 
and  Dr.  Dudgeon  seconded  a  proposal  that  the  Society  should 
express  its  sympathy  with  Mrs.  Both  and  her  family  in  their 
bereavement  in  a  letter  of  condolence  with  them.  This,  it  is 
needless  to  add,  was  unanimously  agreed  to. 

Dr.  Both  was  bom  at  Kaschau,  in  Hungary,  in  1818.    He 
was  the  youngest  of  five  children,  and  was  born  two  months 
after  the  death  of  his  father.    Having  completed  his  medical 
studies  in  Vienna  he  took  his  degree  at  Pavia  in  1889,  and 
settled  down  to  practise  in  Kaschau  in  1841.     When  the 
revolt  of  Hungary  against  Austria  took  place  in  1848,  Dr.  Both 
zealously  embraced  the  patriotic  side,  and  when  the  Austrians, 
after  their  defeat  at  Tallya  in  the  begiiming  of  1849,  hurriedly 
evacuated  Kaschau,  they  left  behind  them  near  a  thousand 
wounded  Austrian  and  Hungarian  soldiers.    The  medical  men 
of  the  town  imdertook  the  charge  of  these  soldiers,  and  Dr. 
Both  went  on  a  mission  to  the  seat  of  the  revolutionary  govern- 
ment at  Debreczin  to  obtain  the  post  of  inspector-general  of 
hospitals,  and  to  get  funds  and  requisites  for  the  treatment  of 
the  wounded.    On  his  arrival  at  Debreczin  he  heard  that  the 
Foreign  Minister,   Count  Bathyany,  wished  to  obtain  the 
services  of  some  one  who  could  speak  French  and  English  to 
go  on  a  secret  mission  with  despatches  and  instructions  to 
the  agents  of  the  government  in  Paris  and  London.     He 
offered  himself  for  this  dangerous  post,  and  his  offer  was 
eagerly  accepted.    But  in  traversing  a  part  of  the  country 
still  ill  possession  of  the  enemy,  he  was  arrested  and  thrown 
into  prison,  where  he  remained  until  the  revolution  was  crushed 
by  the  Bussian  invasion.    He  was  then  exiled,  and,  being 
unable  to  return  to  his  practice  in  Kaschau,  he  came  on  to 
London  in  October,  1849,  and  with  the  assistance  of  some 
friends  set  up  in  practice.     He  soon  turned  his  attention  to 
Ling's  system  of  medical  gymnastics,  which  was  introduced 
into  England  by  Professor  Oeorgii,  under  whose  instructions 
Dr.  Both  soon  acquired  a  competent  knowledge  of  this  ex- 
cellent method.    He  practised  it  with  great  success,  first  m 
Old  Cavendish  Street  and  afterwards  in  more  spacious  premises 
in  Wimpole  Street.    He  wrote  several  books  on  the  subject^ 

Vol.  35,  No.  12.  3  k 


806  OBITUARY.  "S2£L^*?T^ 


Reriew,  Dec  1,  lan. 


and  became  surrounded  by  a  large  and  lucrative  practice,  from 
which  he  retired  a  few  years  ago  to  a  siuall  property  in 
Divonne,  in  the  department  of  Ain,  close  to  the  Swiss  frontier. 
His  death  there,  which  occurred  on  the  20th  October  last,  was 
caused  by  an  accident.  When  taking  a  vapour  bath  at  the 
neighbouring  hydropathic  establishment,  he  wanted  to  give 
himself  a  cold  douche,  but,  by  mistake,  turned  on  the  hot 
water  which  scalded  him  so  severely  that  he  remained  un- 
conscious for  two  days  and  died  four  days  afterwards.  It  is 
consolatory  to  think  that  in  spite  of  his  severe  scald,  during 
the  short  interval  of  consciousness  that  preceded  his  death 
he  suffered  no  pain,  and  passed  away  peacefully,  murmuring 
his  wife's  name. 

Dr.  Both's  activity  was  not  limited  to  his  practice  of  the 
Swedish  movement-cure.  He  took  a  warm  interest  in  sanitary 
matters,  and  spared  neither  time  nor  labour  in  efforts  to  arouse 
interest  in  them,  and  to  promote  the  physical  development  of 
the  poor.  To  give  these  efforts  a  definite  and  practical 
direction  he,  in  li^57«  orgam'sed  the  Ladies'  Sanitary  Associa- 
tion ;  the  object  df  which  wai  to  diffuse  among  the  poorer  classes 
a  knowledge  of  the  laws  of  health,  by  disseminating  among  them 
simple  and  clearly  written  tracts  on  such  subjects  as  "  The 
Worth  of  Fresh  Air,"  **  The  Advantage  of  Warm  Clothing," 
**  The  Sick  Child's  Cry,"  "  Washmg  the  Children,"  &c.  In 
founding  this  Association  he  had  the  co-operation  of  Lady 
Mount  Temple,  formerly  Mrs.  William  Cowper,  Lady  Ebury 
and  the  Countess  de  Noailles.  Many  difficulties  were 
encountered,  and  through  the  untiring  eneigy  of  our  deceased 
colleague  surmounted.  Of  these,  not  the  least  was  the  fact 
that  he  believed  that  disease,  when  healed  medicinally,  was 
most  quickly  and  successfully  remedied  by  drugs  that 
produced  similar  conditions  in  healthy  persons.  His  lecturing 
on  behalf  of  the  Association  gave  The  Lancet  an  opportunity 
for  one  of  its  hysterical  outbursts  on  homoeopathy.  The 
Association  was  '*  warned  "  that  they  would,  by  sanctioning 
the  lectures  of  a  *'  well-known  homoeopathy"  alienate  the 
medical  profession,  and  throw  a  doubt  over  their  abi^tyta 
conduct  or  understand  sanitary  matters."  They  were  informed 
that  it  was  an  error  to  suppose  that  "  the  sanitary  conduct  of 
a  homoeopath  would  be  the  same  as  that  of  a  medical 
practitioner  of  any  other  school."  The  pretentious  humbug 
who  wrote  this  paragraph  further  told  the  Association  that 
*'  The  whole  system  of  homoeopathy  is  founded  on  a  baseless 
system  of  physiology,  the  principles  of  which,  introduced 
amongst  our  population,  would  be  as  fatal  to  health  as  any  of 
the  evils  to  which  they  are  at  present  subject !  "  Then  comes 
the  tlu^at !     The  ladies  are  told  that  if  they  continue  to  ally 


SSSI'STJSf""  OBITUABY.  807 


Beview,  Doc.  1>  1891. 


themselves  with  the  ''homoeopathic  delusion  "  The  Lancet 
''  will  have  no  hesitation  in  urging  on  our  medical  brethren  to 
withdraw  from  any  co-operation  with  them."  However,  the 
Sanitary  Association  took  not  the  slightest  notice  of  Thr 
Lancet's  fulminations,  but  continued  to  derive  advantage  from 
Dr.  Both's  assistance,  not  only  in  lecturing  for  them  but  in 
every  other  way  in  whicli  he  could  render  any.  The  result 
has  been  that  it  has  proved  a  great  success,  is  still  flourishing 
and  doing  a  large  amount  of  useful  work. 

Dr.  Both  exerted  himself  most  strenuously  in  endeavouring 
to  introduce  scientific  physical  education  into  schools.  Hin 
first  appeal  was  made  in  a  published  letter  to  Lord  Granville 
in  1854.  In  1862,  during  the  International  Exhibition,  he 
exhibited  scientific  means  for  rational  physical  education. 
Somewhat  later,  at  the  request  of  the  committee  of  the  United 
Service  Institution,  he  lectured  before  the  members  of  that 
body  on  Scientific  Physical  Training.  On  the  same  subject 
he  lectured  and  gave  courses  of  instruction  to  school  teachers ; 
and  ultimately  the  London  School  Board  was  induced  to  adopt 
his  methods  of  physical  training  to  a  limited  extent.  When 
he  retired  from  practice  he  had  the  satisfaction  of  knowing 
that  60,000  girls  in  the  schools  of  the  London  Board  were 
being  instructed  in  the  elements  of  physical  education. 

The  Society  for  the  Prevention  of  Blindness  was  also  pro- 
moted and  largely  sustained  by  him.  Its  basis  of  operation 
is,  like  that  of  the  Ladies*  Sanitary  Association,  the  diffusion 
among  all  classes,  but  particularly  among  th^  poor,  of  a  know* 
ledge  of  the  causes  of  blindness  and  the  means  of  preventing 
them. 

These  philanthi-opic  objects  are,  as  it  were,  left  by  Dr.  Both 
to  the  fostering  care  of  those  who  loved  and  admired  him 
when  he  was  living  amongst  us,  and  in  no  way  can  they 
l)etter  show  the  reality  of  their  regard  for  him  than  by  exert- 
ing themselves  to  sustain  them  in  full  efficiency.  The  Society 
for  the  Prevention  of  Blindness,  especially,  needs  help  both  in 
work  and  in  subscriptions  to  continue  it. 

He  was  a  warm  supporter  of  the  disposal  of  the  dead  by 
cremation.  At  his  own  request  he  was  cremated  at  Zurich. 
He  attended  and  took  an  active  part  in  Hygienic  Congi-esses 
in  Fitmce  and  Italy.  In  1882  he  published  a  translation  of 
Brandt's  J'reatwent  of  Uterine  Diseasen  hy  tlie  Movement  Cure, 
which  only  this  year  has  been  discovered  by  eminent  specialists 
to  be  a  most  successful  and  rational  method.  In  addition  to 
these  labours  he  took  a  warm  interest  in  homoeopathy,  which 
he  had  practised  in  Hungary,  and  which  he  always  adopted  in 
his  own  family.  He  was  a  Fellow  and  a  regular  attendant  of 
the  British  HomoDopathic  Society,  of  which  he  was  at  one 

3K— 2 


808  OBITDABY.  "?*SJ^2irSS! 

time  the  President,  and  was  always  to  be  seen  at  the  meetings 
of  the  British  and  International  Congresses.  Those  who  par- 
ticipated in  the  meeting  of  the  International  Homoeopathic 
Congress  at  Basle,  in  1880,  will  not  forget  the  able  service  he 
rendered  to  the  Congress  by  his  polyglot  acquirements.  He 
was  a  constant  attendant  of  the  meetings  of  the  International 
Homoeopathic  Congress  at  Paris  in  1889,  when  his  British 
colleagues  were  delighted  to  meet  him  again,  alas  I  for  the 
last  time. 

Dr.  Both  was  one  of  the  most  lovable  men  it  has  ever  been 
our  fortune  to  know.  He  was  enthusiastic  in  every  work  he 
undertook  for  the  good  of  his  fellow  creatures,  and  he  brought 
to  the  philanthropic  societies  he  founded  and  aided  a  rare 
organising  power.  He  seemed  to  infect  every  one  with  whom 
he  came  in  contact  with  a  portion  of  his  own  enthusiasm. 
This  was  especially  noticeable  in  the  Ladies*  Sanitary  Associa- 
tion and  the  Society  for  the  Prevention  of  Blindness,  both  of 
which  institutions,  under  his  surveillance,  published  a  large 
number  of  useful  works.  He  likewise  took  an  active  part  in 
the  Homoeopathic  League,  and  as  a  member  of  the  committee 
gave  valuable  aid  to  their  labours. 

In  addition  to  various  books  published  by  Dr.  Both  on  Thr 
Movement  Cure,  on  PnrahjsiH,  and  on  Spinal  Curvaturet:  to 
pamphlets  on  the  therapeutics  of  various  Continental  healtli 
resorts,  with  others  on  education  and  hygiene,  he  was  a 
frequent  and  valued  contributor  of  papers  to  the  Biitiah 
Journal  of  HowcBopathj  and  to  our  Reriew, 

A  gold  medal  was  awarded  to  him  by  the  Council  of  the 
International  Health  Exhibition  of  1884  for  his  exhibit  of 
numerous  models,  drawings  and  books,  all  illustrative  and 
descriptive  of  dress,  made  in  accordance  with  physiological 
requirements,  of  chairs  and  desks,  constructed  so  as  to  be 
adapted  to  the  structure  of  the  body,  and  of  the  positions 
taken  up  in  going  through  Ling's  exercises.  Hygienic  societies 
in  Paris,  Berlin,  Milan  and  elsewhere  on  Uie  Continent 
acknowledged  the  importance  of  Dr.  Both's  contributions  to 
practical  hygiene,  by  awarding  him  medals  and  electing  him 
as  one  of  their  corresponding  members. 

In  private  life  Dr.  Both  was  the  most  agreeable  and  hos- 
pitable of  hosts,  and  one  met  at  his  house  many  distinguished 
men  who  valued  his  friendship,  such  as  Kossuth,  Elapka, 
Pulszky,  Ernst,  Engel,  Leitner,  Louis  Blanc  and  many 
others.  In  short,  many  foreigners  distinguished  in  literature, 
ai-t,  music  and  pohtics  made  his  home  their  house  of  call,  and 
many  pleasant  evenings  were  spent  there  by  his  numerous 
and  now  sorrowing  friends.  Though  Dr.  Both  had  retired 
fi'om  active  practice  to  enjoy  a  well-earned  repose  in  his 


^SS^STfSI?^  OBITUARY.  809 


•ehanning  little  villa  in  France,  we  shall  not  fail  to  miss 
him  sadl5^,  for  he  never  ceased  to  take  a  warm  interest  in  all 
that  concerned  homuoopathy  and  his  old  friends  in  this 
country.  In  all  the  accomplishments  which  tend  to  make  a 
man  a  snccessfdl  practitioner  and  an  estimable  colleagne,  he 
has  not  left  a  superior  behind  him. 

He  was  a  man,  take  him  for  all  in  all, 
We  shall  not  look  iqion  his  like  again. 


S.  LILIENTHAL,  M.D. 

We  have  heard,  with  much  regret,  of  the  death  on  the  8rd  of 
October  of  Dr.  Lilienthal,  for  many  years  a  well  known  and 
active  physician  in  New  York. 

Hahuel  Lilienthal  was  a  native  of  Munich,  having  been 
bom  there  in  1815,  and  took  his  degree  of  M.D.  at  the 
University  of  that  city  in  1888.  At  the  close  of  the  following 
year,  he  emigrated  to  the  United  States  of  America.  In  1847, 
when  practising  at  Lockport.  N.Y.,  he  made  the  acquaintance 
of  a  homoeopathic  physician,  whose  success  in  a  case  of  scarlet 
fever  that  was  regarded  as  hopeless  induced  him  to  watch  the 
progress  of  other  cases  treated  homoeopathically.  The  results 
in  these  cases  impressed  him  so  forcibly  that  he  determined  to 
study  the  system  through  which  they  were  obtained.  This  he 
(lid  and,  after  healing  disease  in  accordance  with  its 
principles  for  seven  years,  he  settled  in  New  York,  and  in 
1857  was  appointed  Associate  Editor  of  the  NorHi  American 
'hmmal  of  Homceop4nhy,  From  1872  until  six  years  ago,  he 
conducted  this  well-known  '^  Quarterly  "  alone.  At  the  New 
York  HomoBopathic  Medical  College,  he  lectured  on  '*  Clinical 
Medicine  and  Diseases  of  the  Nervous  System.*'  In  1887  he 
retired  from  practice,  and  went  to  reside  in  the  midst  of  his 
family  in  San  Francisco.  Here,  however,  he  could  not  rest 
without  work,  and  engaged  in  consultation  practice,  while  his 
literary  contributions  to  the  Ilahtwrnannian  MonUihj  and  his 
old  journal  (which  since  his  departure  from  New  York  had 
become  a  *'  monthly  ")  never  ceased  until  his  death. 

Besides  being  a  physician  of  very  wide  learning  in  every 
department  of  science  bearing  upon  the  art  of  medicine,  Dr. 
Lilienthal  was  one  of  the  most  genial  and  lovable  of  men,  and 
as  such  those  who  were  present  at  the  Norwich  Congress  in 
1885  will  remember  him.  A  regular  attendant  at  meetings  of 
the  American  Institute  of  Homoeopathy,  none  ever  received  a 
heartier  welcome  from  all  his  colleagues  than  ''  Dear  old  Sam, 
as  he  was  affectionately  called.  Atheroma  of  tbe  coronary 
arteries,  which  had  been  the  cause  of  frequent  attacks  of 
^nmniia  pectoris  for  nine  years  past,  was  the  cause  of  death. 


810  CORRESPONDENCE.       ^^^iL^?CT?Sr 


Bevieir,  Dae.  1«  1»1. 


CORRESPONDENCE, 

THE  HOMCEOPATHIC  DIRECTORY. 
To  tite  Editors  of  ike  ^*  Mutvthltj  Homceopathic  Beview." 

(tentlbmen, — As  a  hoiUGeopathic  practitioner,  whose  name 
does  not  appear  in  Messrs.  Keene  and  Ash  weirs  Director}-, 
will  you  permit  me  a  little  personal  explanation  hy  way  of 
reply  to  Dr.  Dyce  Brown's  letter  in  your  Novemher  nmnber  ? 
When  Messrs.  Keene  and  Ashwell  sent  their  first  circular  a 
few  years  ago  intimating  they  were  on  the  point  of  puhlishing 
a  directory,  and  soliciting  information  for  it,  Messrs. 
Thompson  and  Capper's  little  book  was  still  in  existence, 
and  my  name  was  in  that.  I  wi'ote  to  the  former  gentlemen ,. 
saying  that  I  did  not  consider  there  was  room  for  two 
homoeopathic  directories,  that  one  must  stifle  the  other,  and 
therefore  I  did  not  wish  my  name  to  appear  in  theirs. 
Accordingly,  it  did  not  appear.  I  had  no  intimation  of  any 
kind  whatsoever  from  Messrs.  Keene  and  Ashwell  that  they 
were  to  bring  out  a  new  edition  of  then*  directory,  or  I  should 
have  sent  my  name  for  insertion.  It  lias,  however,  been  on 
the  roll  of  the  British  Homoeopathic  Society  all  the  time,  and 
if  Messrs.  Keene  and  AshweU  had  sent  a  circular  to  every 
name  there,  I  should  have  received  one.  Since  the  present 
du-ectory  superseded  Messrs.  Thompson  and  Capper's,  it  has 
been  a  matter  of  inconvenience  to  me  several  times  that  my 
name  has  been  left  out.  Yet  1  cannot  consider  that  I  am  ta 
blame  for  suggesting  a  spirit  of  co-operation  in  preference  tO' 
that  of  competitionf  in  the  simple  matter  of  the  issue  of  a 
liomocopathic  directory. — Youra  faithfully, 

Nov.  14.  Giles  F.  Goldsbkou(«. 


THE     HOMCEOPATHIC    DIRECTORY     AND 
"  PROFESSIONALISM." 

'To  the  Editors  of  the  "  Monthhj  HonmopaMc  Revieic.'" 

Gentle&ien, — It  seems  that  the  Homoeopathic  Directory  is 
regarded  by  the  public  and  the  profession  as  the  test  of  the 
advance  or  retreat  of  homooopathy ;  if  this  be  so,  all  who  have 
not  yet  placed  their  names  upon  it  ought  to  do  so,  though  of 
course  it  is  not  any  test  at  all  of  our  numbers,  nor  are 
our  numbers  the  test  of  the  advance  of  our  particular 
practice.  Mr.  Harris  spoke  in  terms  of  condemnation  at  our 
congress  on  **  Professionalism,"  which  is  the  force  preventing 
many  men  from  placing  their  names  on  this  public  list.  I  do 
not  think  that  it  is  an  imhealthy  thing,  for  any  savour  of 
public  advertising  is  sure  to  lower  our  standing,  but  it  would 
be  well  if  there  were  more  of  the  tnier  professionalism  which 
would  lead  men  to  join  the  British  Homoeopathic  Society.   The 


ftJriSSf^iTwBl!**^         CORRESPONDENCE.  811 

list  of  members,  which  is  privately  circulated,  is  my  Homoeo- 
pathic directory,  and  the  men  in  it  are  to  me  homoeopaths. 
But,  with  regard  to  this  ''  professionalism,"  I  think  that  some 
of  onr  seniors  do  not  give  allowance  for  the  difficnlties  of 
janiors.  The  profession  to  them  is  the  means  of  realising  the 
fatile  hopes  for  future  eminence  and  preferment  which  youth 
generally  possesses  for  a  short  part  of  their  earlier  career  in 
medical  practice  ;  and  when  a  man  gets  introduced  to  homoDO- 
pathy  by  chance,  he  is  driven  by  the  impulse  of  the  scientific 
'Spirit  to  adopt  it.  Of  course,  there  is  always  the  usual 
sophistry  about  **  the  happiness  of  following  one's  convictions,' 
or  "  the  satisfaction  of  having  it  in  our  power  to  relieve  sick- 
)ies8  in  cases  where  we  failed  before,"  and  so  on.  But  the 
real  truth  is  that  the  adoption  of  this  system  is  inevitable  to 
anyone  who  really  gets  a  scientific  grasp  of  it,  and  in  adopting 
it,  he  throws  away,  once  for  all,  those  foolish  hopes  of  ultimate 
preferment  in  his  profession ;  and  he  brings  upon  himself  the 
accusations  which  are,  after  all,  very  hard  to  bear,  of  having 
failed  to  follow  the  genuine  professional  ideals,  and  having 
brought  disgrace  on  his  own  name,  and,  worse  still,  on  that 
which  his  children  must  bear. 

I  am,  yours  obediently, 

Hebetic. 

NOTE   ON  DR.    MOORE'S  -  HYDATIDIFORM  MOLES 

OF  UTERUS,  &c." 

M.  H.  n.,  vol.  85,  No.  7,  pp.  458  to  469- 

To  Hie  Editors  of  the  *^Monthli/  Hojnccopathic  Review J*^ 

Gentlemen, — ^In  my  paper  on  "  Hydatidiform  Moles  of  the 
Uterus,  with  an  Illustrative  Case,"  in  the  July  Review  of  this 
year,  it  was  mentioned  that  the  patient,  Mrs.  C,  from  whom 
the  vesicular  mole  had  passed,  was  pregnant  at  the  date 
when  the  paper  was  writtten  (May  7th).  It  is  interesting  to 
know  the  sequel.  Mrs.  C.  went  to  her  full  term,  and  on 
August  10th  gave  birth  to  a  healthy,  well-formed  female 
infemt,  free  from  any  cutaneous  or  other  abnormaUties,  after  a 
very  easy  and  short  labour,  the  second  stage  lasting  only  45 
minutes. 

She  has  been  able  to  nurse  the  baby  at  the  breast  from  the 
second  day  without  the  least  inconvenience,  and  the  little  one 
thrives  vigorously  upon  Nature's  supply  of  nutriment.  The 
mother's  complexion  is  so  greatly  improved  that  one  would 
scarcely  recognise  her  as  the  same  individual  who  presented 
the  hydrsemic  appearance  noted  on  p.  455  of  my  paper  in  the 
Review. 

Liverpool. 


812 


COBBESPONBEXTS. 


JELeview,. 


NOTICES  TO  CORRHSPOINI 


NTS. 


z-eq  nested  to 


•**  Wf  cannot  vrnJertaJte  to  rctHrn  rvjvct^'^    ^n^MHieript*^ 

Adthosa  and  Contributobs  receiving  proofs  ar 
and  return  the  same  as  early  as  possible  to  Dr. 

London   Homceopathig    Hospital,   Great        Obmoad   8i^ 
Bloomsbuby.— Hours  of  attendance:  Medical.  IxB.-iM:ktients.  9.::{0; I 
patients,  2.30.  daily ;  Sargrical,  Mondays  and  Thnr-0<lAys,  2M .-  Dim - 
of  Women,  Taesdays  and  Fridays,  2.3(i :  Dieeases     of   Skin,  Ths^i^ 
2.30  ;  Diseases  of  the  Eye,  Thursday.^,  2.30  :  Dise&06«*  of  the  Ear,  Sif 
days,  2.80  ;  Dentist,  Mondays,  2.30  ;  Operations,  4Coaxd»y«,  2. 


Communioations  have  been  received  from  Dr.  I>  i:rx>oEO>'.  Dr.  (Jau 
BROUGH,  Dr.  PuRDOM ,  Mr.  Gerard  Smith.  Mr.  Kzsc^ox  Shaw  (LxmAim 
Dr.  A.  C.  Clifton  (Northampton) :  Dr.  H.  Wvn*xe  TB:oaiAfi  (Brorali* 
Dr.  Frank  Kraft  (Cleveland,  Ohio ). 


BOOKS    RECEIVED. 


Tlw  Greatvr  J)i»anvK  of  the  Li  err.     By  J.  C.  Bvirr%et.z,  MJ).   Londiw 
Homoeopathic  Publishinjr  Company.        '  »■         pu'i 

Deserijttict  Catalogurof  ihr  I/onmnianH  Public/*  ^^'^  ^^^^'   *^^^ 
delphia. 

TIu;  Jlowmopathic  World.    London.     Oetoljor. 

Mc'di^iU  Reprints.    London. 

Tlie  ChemlH  and  Druggie.   London. 

Monthly  Journal  of  Pharmac If.    Loudon. 

The  ^'fu}  York  Medical  Times,    October  and  NovenaDer. 

The  Xorth  Arnvrican  Journal  of  Homa-opathij.    Kewr  xoik.  wwoer 

Tlw  New  York  Medical  Record.     November. 

TJie  Awrrican  HomafojfathUt.    New  York.  .       „„j  A^f«K.r 

The  New  England  Medical  Gazette,  Boston.  September  ana  ^^^' 

The  ITahnemnnnian  Monthly.    Philadelphia.    Octol>er. 

TJw  Ilomofopathie  Physician.    Philadelplj^     :s^ovem«>er. 

Medical  Advance.    Chicago.    »September  and  Ocrtober.     ^^^^  ^^^ 

Smthern  Journal  of  Hoinasopathtj.    New  Orle^^^^- 
October.  '  . 

Tlic  Homeopathic  Envoy.    Lancaster,  r.S.A.   :So^^^ 

Tj  Union  flomceopathique.    Antwerp.     October. 

Retue  llomeeopathique  Beige.    Brussels.    Septax^f**^^  «qi 

Bulletin  Communal  de  la  Ville  d'Ativent.    No.  1 1^- 

Bull.  Gin.  de  TJicrapeutique.    Paris.    Novembe*--   ^    ^pmber. 

Lefpzuj'Populdre  Zeitschnft  f&r  Ilommpafhie.        ^  ^ 

Ritijsta  Omiopatica.    Rome.    October. 

Gazetta  Mcdiea  di  Torino.    November. 

JJomteojhUhlsvh  Ma-andblad.    November. 

Im  J/omeopatia.  Bogota.     September. 


{.  to  Dr.  Pon,  U^ 

L««^oar  Street,  Port- 
«rW.  AdvAtfiM. 


Pftpers,  Dispensary  Reports,  and  Books  for  Rovit^w  t^  %^    ^^!!^^^o"'  S^w**  ^o*- 
WatCTgate,  Omntham,  LiScolnkhire ;  Dr.  D.  Dyce  Bbou^  «S     jS^^J^-^*  Adwrtiie- 


^'f-.- . 


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