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Boston Medical Library 8 the fenway '
THE
MONTHLY HOMEOPATHIC REVIEW.
Edited by
ALFRED C. POPE, M.D. D. DYCE BEOWN, M.A., M.D
AND
EDWIN A. NEATBY, M.D.
VOL. XLIL
jB. OrOULO & SON, Ltd., 59, MOOBOATB STRBSr, K.C.
1898.
NOV 5 loi::
WCV 5191
LOMDOir:
8TBAKBB BBOTHBBS, IAD., ** THI BIBHOPaOAIB FBaSB," BUaOPMATB WITHOUT, E 0
Mflnthly Beriew, Dm. 1,
INDEX.
lU.
INDEX.
A.
rAOB
Abortion, Threatened Treatment
of 828
Acne Vulgaris, Dr. W. Eppe on 02
AT.TCXATfPHB, Dt. A. 8., OD Sup-
puratiTe ICastoiditie 712
American Institute of Hobmbo*
pathy 486
Antqpyrin Eruption 637
Appendicitis 636
Appendicitis, Dr. Day on 216
Appendicitis, Dr. BCoir and Mr.
E. Shaw on Ill
Appendicitis, Some Cases of, by
G. E. Shaw, Esq 26
AfisoLD, Dr., on Consultations
with HomoBopaths 186
Abhulpht, Dr., of Nice 768
Arsenic, Herpes Zoster following 369
Arsenic in Cholera 260
Arsenic,Peripheral Neuritis from 369 Associated Symptoms, by Dr.
Wilkinson 469
B.
Balfoub, Dr. G. W., on HomoBopathy, by Dr. George Black 671
BiLFOiTX, Dr. G. W., Personal Experience of an almost for- gotten Episode in Medical ffistory 618
' rAOB
Btrometrioal Preesuie as a Factor in Medicine, by Dr. Burwood 466
Bath Corporation and the Medi- cal Prof ession 78
Belladonna Poisoning 288
Bichromate of Potassium 602
Black, Dr. Gsobob, on Dr. G. W. Balfour on Homcsopathy 671
Black, Dr. GaoBas on Yisoum Album 832,478,636, 602
Blacklst, Dr. C. H., on Con- Bultation with Homceopaths.. 226
Blagklst, Dr. J. G., on Lym- phadenia 198
Blaxb, Dr. YiOTOB 494
Bournemouth Convalescent Home 633,638, 766
Bradford Medico-Ethical Society 193
Bbown, Dr. D. D., on Ergot in Threatened Abortion 823
BuBFOBD, Dr., on Hepatic Bnlargempnt, Complicated with Biliary Calculi 88
BuBFOBD, Dr., on Mental Per- turbation associated with Uter- ine Displacement « 348
BuBFOBD, Dr., on a New form
of Pessary 690
Do. Ovarian Cyst 207
BuBWOOD, Dr., on Barometrical Pressure as a Factor in
Medicine 465
Do. Some Influenza Expe- riences 148
IV.
INDEX.
Monthly flonuBopatlilc ReTiew, Dee. 1. 1898.
C
PAOS
Gactua GrandifloruB 601
Calcatta, Homoeopathio Medical
School of 368
Calcutta UniTerrity 317
Cantharides 628
Garoinoma 626
Cabfbab, Dr., on Ovarian
Dermoid Cyst •. 207
Caaee at the Bromley Hoepital,
by Dr. Madden and W.Thomas 366 Case, Dr. Midolbt, on Nen-
ralgia 666
Do. on Ingrowing Toe-nail 726
Causttcom 667
Cephalalgia, Case of 62
Cesarian Section , 247
Chloroform Poisoning 236
Cholera, Arsenic 260
Choreic Spasm, Case of, by Dr.
Maokechnie 60
Cider, Devonshire (Whimple) . . 669 CuLBKB, Dr. J. H., Consulta- tions with HomcBopaths .... 188 CuFTON, Dr. Gbobob .... 498, 766
Coffee 609
Comma, an Absent 610
Congress, British Homoeopathic
302, 821, 898, 418 Congress, 1898, Presidential
Address 898
Congress, Selection of Papers on
446, 447, 610 Consultation Question Bevived
66, 178, 223 Consultation with Homooopaths,
by Dr. Arnold 186
Consultation with Homoeopaths,
by Dr. J. H. Clarke IBS
Consultation with Homoeopaths,
byM.D 184
Consultation with Homoeopaths,
by an Open Minded General
Practitioner 123
Convulsions Cured by Carcinoma 663 Cough Befractory after Influenza 167 CowFXBTHWAiTB, Dr., Causti-
cum.......... 667
PAOS
Criticism, The Higher, by Dr. MacLachlan 82
Cbouohss, Dr. Alkxawdbb, Notes on Two Oases of Con- vulsions Cured by Circum- cision 66$
Cydopaediaof Drug Pathogenesy and Bepertory, by Dr. C. WesselhoBft 366
D.
Day, Dr. B., on Appendicitis 216
Diphtheritic Croup, Case of, by Dr. Munster 44
Dispensary, Birkenhead Homoeo- pathic 318
Dispensary, Folkestone Homoeo- pathic 66, 767
Dispensary, Torquay Homoeo- pathic &6S
Drugs, Modus Operandi of, Mr. Picken on 126
Drugs, Modus Operandi of. Dr. Proctor on 62
Dyspepsia, Chronic Case of, by Dr. Mackechnie 61
E.
Eczema, Case of, by Dr. Mac- kechnie 60
Epilepsy, Plumbic 606
Episode of Medical History, by
Dr. G. W. Balfour 618
Effs, Dr. W., on Aone Vulgaris 92 Ergot in Threatened Abortion,
by Dr. D. D. Brown 323
Ezophthalmio Goitre 634
Xonthly RoiiKSoiMiftble R&wimw, Deo. 1, 1897.
INDEX.
F.
rAOB
Federation of Britiih Homceo-
patliic Hospitals 368
Fern In New Ouinea 378
Foreign Bodies in the Stomach 506 Forward MoTement, The 705
(JoLDSBBOUQH, Dr., Notes OB
Inflnenza by 166
Gout and Allied Disorders by
Dr.Ord , 529,594,644
Gouty Diathesis in Childhood,
by Dr. Monster 654
GBXBH,Dr.y.,Hydio-nephrosis .
by 656
GynsDoological Surgery 247
HsBmatnria and Qoinine 126
H AHinDUinr, CM&oial Account of the Exhumation of the body of 385
Hahhscahs's Bemains 634
I>o. Tomb, by Dr. Hughes
191, 804, 382, 665, 758
Haxx, Dr. E., Hepatic Enlarge- ment, complicated with Biliary CalcuU 88
Hammer Toe and its Treatment, by Mr. D. Wright 264
Hay Fever and Nasal Asthma, by Mr. D. Wright 548
Hatwabd, Dr. J. D., Strangu- lated Umbilical Hernia 211
Hepatic Enlargement Compli- cated with Biliary Calooli.. .. 88
Hernia, Strangulated Umbilical 211
Herpes Zoster 809
Holiday Besort 448
PAOS
Homoeopathy 267
Do. in Cook*s County
Charity Hospital.. 57
Do. in Edinburgh 318
Do. inParis 67
Do. in Tasmania 68, 4t5, 490 Do. Is Professional Ap- preciation of. In- creasing 123
Do. In War Time .... 446
Do. The Prindi^ of, by
Mr.Picken....619, 660 Do. The Attitude of
HomcBopaths to .. 641 Homoeopathic Hospital Work . . 1 Hospital, Adelaide Children's 56, 298 Do. Devon and Cornwall
Homopopathic 860
Do. Leaf Cottage, East- bourne 187
Do. London Homoeopathic
286, 371, 703 Do. do. Aooount of The 243
Do. do. Post Gra«iuate
Course at the . 189 Do. Melbourne Homoeo- pathic 188
Do. Phillips Memorial,
Bromley 186
Do. Plymouth Homoeo- pathic 187
Do. Tunbridge Homoeo- pathic 494
Do. Distribution of Aid to 119 Do. Belief Funds, Distri- bution of 69
HuoHBS, Dr., Cydopwdia of Drug Pathogenesy and the Beperiory thereto, by Dr. C.
WesselhoBft 366
HuoHis, Dr., Manual of Thera- peutics ■ 188
Hydro-Nephrosis, by Dr. Y.
Green and Mr. D. Wright .. 656 Hydrochloric Acid in Sciatica . . 249 Hygiene of the Lying-in Boom, byDr. Storrar 47
VI.
INDEX.
Montbly HuinckKiptiihic RAview. Dec. 1, 1898.
I.
PAOB
Inflaenza 129
Do. Dr. Burwoodoa 148
Do. Dr. Dyoe Brown 169
Do. Dr. Goldabcough 166
Do. Dr. McLaohlan 132
Do Dr.MaoNiali 159
Do. Dr. Moir 152
Do. Dr. Roche 161
Inflnenzal Oondition following a Gynasoologioal Operation, byDr.Neatby 171
L. i
Lead PoiaoninK 568
Lichen, Case of 51
Loyalty 634
Lymphadenia 198 |
M.
MAciEBGHi9iB,Dr.,Ga8e Reported by 50
MacLaoht^w, Dr., on Influeitza 132 Do. on the Use of High Po- tencies 5
Do. on "Higher Criticism*' 82 Do. on Whitlow 269
HaoNish, Dr., on Some Pulmo- nary Remedies for Influenza Cases 159
Madden, Dr., on Cases in
Bromley Hospital 356
Do. on Puerperal Septicaemia 328
Magnesium Sulphate 372
Malaria, The Mosquito and .... 728
Malaria, Quinine and 561
MAjrsoir. Dr., on Malaria and the Mosquito 728
Ma-Beuses, The Training of ... . 'c77
Mastoiditis, Surpurative, Study of, by Dr. A. Speirs Alexander 712 |
Materia Medica, Improvement !
ofthe 706,768
Medical Council, Mr. Theobald ,
and the 573 |
MedicoEthicalGode, Fetters of a 558 1
Medioo-Ethical Society, The
Bradford 193
Metabolism in Thyroid Feeding 248
Mezereum and Mercuriua 495
MoiB, Dr. B., on Appendicitis III
Do. on Pulmonary Compli- cations in Influenza. . 153
Do. on Uterine Myoma .... 101
Morphia Poisoning 571
Mosquito, The, and Malaria. ... 728 MuKBTBB, Dr., on a Case of
Diphtheritic Croup 44
Mythological Therapeutics .... 449
N.
Nbatbt, Dr., on An Anomalous Condition following a Gyniecologioal Operation 171 Do. on Neurotic Cachexia . . 350 Do. on Uterine Myoma 101, 742 Do. The Operative; Treat- ment of 742
Neuralgia, Dr. M. Cash, on ... . 566
Neuritis, Peripheral 369
Neurotic Cachexia and its Treat- ment, by Dr. Neatby 350
O
Obxtuast :
Chance, R. L., Esq 60
Cockbum, Mrs 60
Danforth, Dr 572
Hart, Ernest, Esq 124
Ker,Dr 373
Marain,Mr 319
Morrisson, Dr 671
MulleT,Mr. G 252
Ockendon,MT 377
SteUler, Dr. Cornelia 638
Opium Poisoning 603
Ophthalmic Disease Sympathetic to Uterine Fibroid 278
Obd, Dr., on Oout and Allied Disorders 529,594, 644
Ovarian Dermoid Cysts 207
KoAtbly H<
Berfew, Dee. 1. li
INDEX.
VIK
P.
PAOB
PelTio Baflez, Osie of, by Dr.
W.GuhBeod lU
Pemphigiu, Cam of, by Dr.
Mackachoie 60
Periostitis of Mothar of Peari .. 242 Pemuuganate of Potash in
Opium Poiaottiiig 603
Pessary, A {few Form of Uterine,
by Dr. Bnzford 690
Pharmaoeutkal Association of Great Britain, The Hodmbo-
pathic 496
Fhosphoms Poisoning 671
Fhoephoms Necrosis 241
Physic 60
PiCKBir. Bfr. Bum, on the Prin- ciple of Homoeopathy. . . .619, 660 Plagne, Physinan to Treat the,
HomoBopathieally .... 234
Do. Therapeutics 227
Plumbic Epilepsy 606
Potassium Chlorate Poisoning.. 287
Potendes, Use of High 6
Pbootob, Dr. ,on Drug Action 63, 263 Prostate, Hypertrophy of the, by Mr. Wright 414
Q.
sand Malaria 661
Becorrent Laryngeal Nenre ... . 604 Bbbd, Cash, Dr., on Pelvic
Reflex 724
Be-proTing of Drugs 706
RsviEWs: Asthma : Is it Curable, by Dr.
KacNutt 667
British, Colonial and Conti- nental Homoeopathic Direc- tory, 1898 176
Diagnosis Chart of Coma, by
Dr. Huntley 116
Essentials of Homoeopathic
Therapeutics, by Dr. Dewey 627 Homoeopathic Journal of Sur- gery and Gyneeoology .... 218
paUb London Homoeopathic Hos- pital Beports, vol. Ti 173
Manual of Qsaito-Urinary and Yenflraal Diseases, by
Dr.Carleton 116
Medical Treatment of the
DrinkHabit,byDr.Kennedy 369 Pharmaoop4e Homoeopathique
Franqaise 280
Pioneers of Homoeopathy, by
Dr.Bradford 62
Pocket Dictionary of Hygiene, by Mr. Kingzett and Dr.
Homfray 628
Bepertory of the Cydopndia of Drug Pathogenesy, by
Dr. Hughes 417
Tallemuui's Treatment of Rheumatism and Stilf JoinU, by Dr. Shadwell .. 218 Teste and Studies of the Ocu- lar Muscles, by Dr. Maddox 692 Therapeutics of Neuralgias, by
Dr.Lutxe 762
Twenty-Two Tears* Expe- rienoe in the Treatment of Cancerous and Other Tu- mours, by Dr. Snow 483
Bickete, by Dr. B. Day 344
Bheumatism, Chronic, Hydro- Electric Treatment of 636
BhuB Toxicodendron, An Ana- logue of 496
BocHB, Dr., Clinical and Thera- peutic Notes on Influenza .. 161
S.
Salamander as a Drug 371
Sanitation in Australia, Pro- gress of 306
Scarlet Ferer Modified by In- fluenza, by Dr. Stonham .... 163 Sciatica, Hydrochloric Acid in. . 260 Scnrry-Rickete, by Dr. B. Day 344 Septicemia, Puerperal 328
Vlll.
INDEX.
Monthly HomoBopathie Beview. Deo. 1, 1896.
PAOS
Shaw, Mr. Ehox, On Some Gasee of Appendicitis, sub- mitted to Operation 26
Signatures and Similars. . . .487, 667
Sncpfsoir, Dr. T., on Dnct Oar- dnoma 626
Sinuses— on the Treatment of Old, by Mr. Dudley Wright.. 41
Social Evening 58
Society, British Homoeopathic 63, 117, 177, 220, 448, 484, 677, 698, 763
Sodium Salicylate 69
Do. Pathological Effect 189
Stannum Cases, Two, by Dr. M.Cash 48
Stomach, Bemoyal of the 666
SiONKAX, Dr., Two Gases of Scarlet Fever, Modified by Influenza 163
Stobbab. Dr. , on the Hygiene of the Ljring-in Room. 47
Stramonium in Influenza 264
Do. Poisoning 604
Surgical Gown 68
Symptoms, Associated by Dr. Willdnson 469
T.
Talbot, Dr., Boston, U.S.A. .. 816 Tasmania, Homoeopathy in 446, 490
Tatb, Sir Hbnby 872
Temperament, Diathesis and
Dyscrasia, by Dr. B. Thomas 680 Thbobald, Mr., and the Medi- cal Council 673
Therapeutics, Mythological 449
Therapeutics, Our Duty and
Besponsibility towards 613
Thomas, Dr. B., on Tempera- ment, Diathesis and Dyscrasia 680 Thomas, Dr. W., od Cases in
Bromley Hospital 36S
Do. on Ovarian Dermoid
Cysts 207
Toad as a Drug 371
Toe-nail, Ingrowing, by Dr. A. MidgleyCash 726
U.
PAOS
Union, An Interesting 368
Urethritis, Posterior Gases of,
by Mr. D. Wright 38
Uric-acidsemia, Oases of 60
Urticaria 62
Uterine Displacement associated
with Mental DiM&se 348
Uterine Myoma, by Dr. Neatby
and Dr. Moir 101
Do., The Operative Treatment of , by Dr. Neatby 742
V.
VeUs 609
VnsOHOw, Professor 697
Yimsum Album, Experiences with, by Dr. G. Black . . 332,
478, 636, 602
W.
Whitlow, by Dr. MacLachlan. . 269 WiLDB, Dr. Stawlbt, on a Re- fractory Cough after Influenza 167 WiLKiNBON, Dr., on Associated
Symptoms 469
WnjJAMB, Dr. Eubxtlus, Presi- dential Address at the British
Homoeopathic Congress 398
Wbioht, Mr. DxTDLBT, on
Hydro-Nephrosis 666
Do. on Hammer Toe 264
Do. on Hay Fever and Nasal
Asthma 648
Do. Surgical Clinique at the London Homoeopathic
Hospital 38
Do. Senile Hypertrophy of
the Prostate 414
*- = '-^*^r- ■
\^r)\/ 5 * :"]!
THE MONTHLY
HOMCEOPATHIC REVIEW.
HOMCEOPATHIC HOSPITAL WORK.
It has been customary with us, for some years, to welcome the new year with a retrospective glance at the progress oar therapeutic views have made in various directions during the preceding twelve months. On the present occasion, we purpose devoting the space, hitherto given to such reflections upon the past, to the considera- tion of a suggestion made at the last Congress for the further development of the opportunities, presented by oar hospitals, for cultivating therapeutics and for extending the knowledge so obtained among our pro- fessional brethren. Union is proverbially associated with strength, and we hope, by uniting more closely and distinctively those engaged in performing their respon- sible and useful duties in the wards of our hospitals, that we shall obtain a means of making the value of homoeo- pathy more clearly and more widely known than we possess at present.
Not unwatched by us, a movement has of late been made in medical politics for the co-ordination of the edacational, financial and cUnical resources of the great London hospitals. Of the waste involved in segregation, and the enormous gain secured to all by aggregati^
VoL 42, No. 1. ®**
HOMOEOPATHIC HOSPITAL WORK. ^T^^Jw^^TwBe!
there needs no argument to tell. On the other hand, we may well reflect on how much our own hospitals lose, in many directions, by their isolation, and how greatly they would gain in their influence upon the progress of therapeutics by a closer union and a better defined co-operation in their medical and surgical work, provided that such co-operation is based upon lines that are practicable.
Homoeopathy owes much to her hospitals. Where these are numerous, there our therapeutics flourish ; where they are few in number, there our views maintain a struggling existence. Of the first importance, therefore, in the polity of homoeopathy is the existence and spread of hospitals, and in a pubUc life where our ceremonial appearances are all too few, they constitute the outward and visible sign of our existence and importance.
If homoeopathy owes much to her hospitals, conversely the hospitatls owe as much to homoeopathy, the demon- stration of which is their raison d'etre.
The members of each medical staff are, almost without exception, united through the medium of the British Homoeopathic Society, and, whether we wish it or not, not one of our public institutions lives alone, but the public value and the therapeutic standard of any one are intimately bound up with the pubUc value and therapeutic standard maintained by other homoeopathic hospitals in other places. Hence, has arisen in the minds of some of our body the question: "Are we utilising to the full the great power which these, our institutions, members of a common body, could exert unitedly for the prestige and the furtherance of homoeo- pathy as an increasing factor in public life?" And having satisfied themselves that the answer must be in the negative, they have formulated a scheme whereby they hope to remedy this defect in our organisation, whether for offensive or defensive alliance.
This scheme was first sketched in a short paper by Dr. E. M. Maddbn, written for the current volume of the London Homceopathic Hospital Reports (which ought, ere this, to be in the hands of our readers), and con- stituted a strong plea for a Federation or Union of all British Homoeopathic Hospitals, the root idea being that ^embers of our hospital staffs should so combine as
SSSTSTS?*'' homceopathic hospital work. 3
to produce the feeling that they were rather xnembers of one large corporation, carrying out its work at different centres, than that they were isolated and altogether independent one of another as at present ; that all doing good work at any one hospital should feel certain that it would be known and appreciated at all the others, while the members of the staff of one hospital would be conscious that they equally shared in the successes of their colleagues at other centres, each feeling that he must do his own work so thoroughly as to be worthy of the corporation to which he belongs. Advantage was taken of the recent Congress at Clifton to call a meeting of the medical staffs of our Homoeopathic Hospitals, and they were unanimous in the view that these institutions have a national as well as a merely local value. They are not only admirable retreats in which to heal the sick, they are the outposts and the beacon lights of scientific medicine, so that they have a common base and a definite relationship. A second meeting, to formulate a programme and to construct an executive, is to be held during the first week in the new year, when the chief propositions for discussion are these : —
" To constitute the Federation by the establishment of a Common Council Board, consisting of delegates from each hospital."
" To suggest that a uniform scheme for reporting the essential details of cases be tabulated for all the hospitals, and that these records be permanently preserved for after reference and use."
" To provide for an annual summarised report of all the work thus done in the British Homoeopathic Hospitals ; and also for the detailed report of cases of special importance and interest."
*' To arrange a practical scheme by which the medical staffs of the provincial hospitals may receive any desirable assistance from the hospitals in the larger centres in the way of consultation, or operative measures, or in the exhibition of cases."
" Thai the Federation should also constitute a body for the promotion of homoeopathic principles by assisting in the establishment of Homoeopathic Hospitals in new centres, preferably in those where Dispensaries already «xi8t."
HOMCEOPATHIC HOSPITAL WORK. ^b^LFj^^^
Beview, Jan. 1, 1806.
It might readily be conjectured that the bulk of hospital work in England is done at the London Homoeopathic Hospital, this being the only hospital which issues professional reports of its cases. But according to the statistics compiled by Dr. Madden, nearly two-thirds of the cases treated in homoeopathic hospitals in England do not come within the scope of the London hospital work. The great majority of cases thus treated in our educational institutions are unknown to the public and the profession at large, except by sporadic appearances in the homoeopathic journals; and the absurd notion often heard expressed, even in London, that our hospital cases are all mild cases, stalks unabashed through the land. We think it would be of the highest value if a journal, similar in conception to the reports of the London Homoeopathic Hospital, could be so planned as to represent in due and fitting propor- tion the technical work of every homoeopathic hospital in England, and we throw out the suggestion to our London colleagues whether it were not possible so to broaden the scope of their annual publication as to represent in a more comprehensive volume the similar work done in sister institutions. It is impossible to rate too highly the effect which laudable emulation would have upon all.
As with individuals, so with aggregates, isolation is a penal infliction. The stress of professional interdict has been felt by every colleague throughout the land ; and a striking tribute it is to homoeopathy that it has flourished in spite of such ostracism. The Federation plan seems to amplify the resources of our hospitals in fraternally supplementing, as occasion arises, the needs of one by the aid of another. In such co-operation the London Homoeopathic Hospital naturally takes the lead ; and our other large hospitals at Liverpool and Birmingham might usefully be the foci of cottage hospitals in their associated districts, and render reciprocally any desired professional aid in the conduct of cases. Within our own fold professional culture ranks high, and every department of special practice is well represented ; and there is no longer the least need for patients to drift^ from either hospital or dispensary to old school practice in search of special or surgical aid. We trust that such a plan will be devised as will lay the
a^^T^S^ HIGH POTENCIES.
resources of our well-equipped hospitals open to the smaller institutions when these require co-operation. In special, or critical, or obscure cases it would be a seemly and graceful act for the staff of the larger hospital to assist, in consultation or by operation, the staff of the smaller one, and increasing interest and value would be lent to consultation days by the exhi- bition of uncommon or doubtful cases on the part of the provincial hospitals.
This movement, like all initiated for the advancement of homoeopathy, has our hearty sympathy. What the Federation scheme will actually accomplish depends on the amount of discreet and enthusiastic work put into it ; but that its basic principle — the union of units for individual expansion and aggregate advance — is right and practical, there can be no doubt.
THE USE OP HIGH POTENCIES IN THE HEALING OP THE SICK.*
By John McLachlan, M.D., B.Sc, Edin. ; P.E.C.S., Eng.
It was with considerable reluctance that I consented, at the request of the Committee, to give a paper on the above subject. The subject itself is full of interest as a jpjxrelj physical study, but it has often given rise to bitter controversy, in which the disputants have not always used "Parliamentary language," and good men have allowed themselves to become estranged by reason of such bitter contention. So strongly at times has the controversy raged that the perennial Scotch heresy hunts are tame in comparison. Por these reasons I rather fought shy of the subject ; but, having taken the matter in hand, I will do my best, and I would warn you all that I myself am a man of peace, and will not willingly hurt anyone's feelings. After all, the subject is essen- tially a practical one, and no amount of controversy can settle the point. Por my own part, I do not care one iota what potency a man may use provided always that he (1) has a reason or reasons (be they right or wrong) for what he does, and (2) uses only one medicine at a time. I may possibly revert to this subject before I close my paper.
* Presented to the British Homoeopathic Congress, Bristol, September 16th, 1897.
6 fflOH POTENCIES. "S^'^^^SJTlMef
Beriew, Jan. 1, 1686.
The use of high potencies seems to me to be but a very natural corollary from the main proposition {simHia similibtis curentur),{or if a given drug can produce such and such a state of suffering during its " proving" in a healthy man^ i.e., one whose vital force has no present tendency in the direction impressed upon it by the drug in question, how much easier must it be for this same drug to produce its effects in the sick man, whose vital force has already a present tendency to go in the same direction, and, therefore, how much less of the drug should be required. In the first case — that of the healthy man — it is like two forces acting along the same straight line in opposite directions, where the resultant is equal to the difference between them, and has the direction of the greater component.
Now the drug will always form the greater component^, and so it has first to bring the other force (health) to rest, as it were, and then impress upon it a force, causing it to move in the opposite direction (away from health). In the second case, that of the sick body, it is like two forces acting along the same straight line in the same direction, and the resultant, therefore, is "equal to their sum. Now, it is evident that a very much smaller force will be necessary to produce the same change of velocity in the second case than in the first, i.e., a much smaller dose will be required.
It has always seemed to me that Newton's third Law of Motion really underlies our great Law of Cure. This law, as you remember, states that : To every action there is an equal and opposite reaction, or, action and reaction are equal and opposite. Our allopathic friends use the " action " or primary effect of the drug, whereas we use the "reaction" or secondary effect; and the serious question arises whether we ought not really to be called allopatJis, and the allopaths to be called Homoeopaths. For observe the state of the case in Allopathy, using lines with arrow-heads to show the natural tendency of the disease, the primary effect of the drug (the action), and the reaction.
Disease tendency.
Contraria contrariis curantur (the " action ").
< .
The inevitable " reaction.*'
SSSSrSTSS*^ HIGH POTENCIES.
The '' reaction/' it will be observed, is in the $ame direction as that of the original disease tendency.
Now in Homoeopathy the state of things is slightly different.
Disease tendency.
Similia similibas curentnr.
The reaction.
The reaction is in the opposite direction to that of the original disease tendency.
Another point in favour of high potencies is this : We are taught that disease is not a material entity, but only a derangement of the spirit-like immaterial " vital force." If we therefore oppose to this deranged immaterial vital force massive material doses or low potencies, can we be said to be carrying out our principle siynilia similibus curentur, for we are opposing something that is immaterial with that which is material ? Again, in using material doses what proof have we, and how can we as scientific men know, that we have given the remedy homoeopathic to the case ? The feelings of the patient ? No ! For however convenient these may be in general every-day practice, yet they do not form a scientijic proof. In using massive doses the patient may feel better for two possible reasons : —
1. The medicine may really be the one homoeopathic to the case, and effect a cure in the usual way.
2. It may not be homoeopathic to the case, but may merely be working in some " other ** way, i.e., it may have no direct effect at all on the suffering part of the body, but may be simply making some other part of the organism ill, withdrawing attention, as it were, from the part really ill till Nature unaided works a cure ; just like the lizard, who, when too hotly pursued by an enemy, breaks off a part or the whole of its tail, and leaves that part to jump about and attract the attention of the enemy while it itself, the real lizard, makes good its escape. This is in reality the favourite method of old-school therapeutists, though, of course, very naturally they will not admit this.
In all probability, the aggravation produced (slight or otherwise) by high potencies is the best proof that the medicine is the correct one. We fead something
8 HIGH POTENCIES. "Sfwe'wfjTJflSB?
analogous to this in electrical science, viz., when we use the gold leaf electroscope to detect the existence and kind of electricity on any body. For the rule is — K when an electroscope is charged the approach of an electrified body causes the leaves (a) to diverge more, the approaching body and the leaves are similarly electrified ; (b) to diverge less (or collapse) the approaching body and the leaves are oppositely electrified, or else the approaching body is uncharged. Eepulsion, therefore, is the only sure test of electrification. This corresponds to the aggravation produced by the medicine. But collapse of the leaves does not necessarily indicate that the body to be tested is charged, for they may collapse if the body presented to the electroscope is an uncharged conductor. In like manner a feeling of ** betterness " on the patient's part caused by the use of material doses is no certain proof that the medicine given is the correct one.
Some object to the use of high potencies out of respect for the " atomic theory." To such I would say — You may safely leave the " atomic theory " and everything relating to chemistry to take care of itself. I often think that the atomic theory, as propounded by Dalton, has had its day. But, apart from that, what have we, as therapeutists, to do with matter. In the Physical Universe there are but two things, matter and energy ; to these two, either separate or. combined, we must trace all phenomena in the Physical Universe. Now, matter is indestructible i.e., there is ** conservation of matter," for on this fact chemistry is based. Again, it ie perfectly impassive, and can neither originate nor change anything. On the other hand, energy is associated with every change in the physical imiverse. It is the active part of the universe, and all change is due to it ; and, just as in the case of matter, there is also a " conservation of energy." Matter is that which has weight, and can thus be made evident to our senses by that property. Energy we cannot perceive by our senses, except in the act of transformation from one form to another. Now, as chemists, we have to do with matter beyond everything else ; but, as therapeutists, we have to do with energy, for the healing power, manifested by drugs, must be a form of energy. But this can never by any possibility be detected by the chemist (who has to deal with matter only). In fact, as I said a minute ago about energy in
SSriSlrj^nSS^ HIGH POTENCIES. 9
general, bo now I say about this special form of energy ; we can only perceive it in the act of transformation, i.e., in bringing about some change, as in the healing of the sick. The grotesque absurdity, therefore, of chemists trying to analyse our medicines to find out what is in them, and then when they can find no vuitter present (not enough, that is, to be detected by their comparatively crude apparatus) stating that the medicines can have no healing powers, is at once apparent. As well might one try to analyse a piece of a copper conductor in order to find out what electricity is.
[I ought to remark here, however, in paasing, that though formerly current electricity was supposed to flow through the substance of the condiictiwj wircy it is now a pretty well-established /act that the " conducting '' wire, though it guides, does not carry that form of energy we call electricity, the energy paths lying outside in the surrounding medium ; in other words, we may state, that the copper wires of the Atlantic cables do not carry the current at all, but that its path lies outside the wires altogether.] We can thus see that if we are to measure anything we must use appropriate units, and to try to estimate the healing power of medittines in grammes is as absurd as to express the height of a steeple in amperes.
1. The first case is one of that common and trouble- some complaint, eczema. In 1892, about three months after I came to Oxford, a young lady, 18 years of age, consulted me for this complaint. She had sutlored from the eczema since she was a baby, and al)out two years ago asthma was superadded to it. The eczema was worst in the hollows of the joints, legs, neck, and face, and in the right hand ; and, as she was learning the violin, the latter situation caused her a great deal of annoyance. It was worst in spring and autumn. It itched a great deal, especially about the neck, and this was worse in the evening, but more so still on undressing, when she itched all over, but this passed off when once she was warm in bed ; but there was much smarting after scratching.
The asthma was most marked at or about the time of the " monthly periods '* ; was most troublesome about 8 a.m., wh«n she frequently had to sit up in order to be able to breathe at all. It was very difficult to be
10 HIGH POTENCIES. "S^i^^TW^,!
Beyiew, Jan. 1, 1898.
qnite Bare whether or not the itching was aggravated or ameliorated by heat, but this difficulty may have been caused by her previous free use of arsenic (from allopathic hands). The medicine seemed to me to be either arsenicum or sulphur ; and I tried both of them diligently at various times and in various potencies^ though never going above the 200th potency. I had come to the conclusion that sulphur was almost certainly the remedy for her, and I was, therefore, very much disappointed at its very partial success, for the relief never lasted very long, there being constant and very annoying recurrences, I then wrote to a friend of mine in London, stating the case to him as briefly as possible. He kindly replied as follows : —
1. Asthma before menses — cupr. puis, sulph.
2. Asthma during menses — china, cupr. sulph.
8. Itching when undressing — ars. amm. m. cocc. dros. dulc. gamb. ham. hyper, mezer. nux. oleand. rhod. rumex. silica, siann. sulph. Therefore, sulphur is the only one remedy that corre- sponds to these, and it agrees fairly well with the other symptoms. Give one dose of sulph. m.?;i., (F.C.), i.e., the millionth potency, the highest yet made, and let it act a long time.
I sent her one dose of this potency, and told her not to be in any special hurry about coming to see me again. Six weeks later she was very much better, and the improvement continued to progress steadily though slowly for several months. All this time the only medicine she had was sac. lac. After that I gave her an occasional dose of the d.m., potency of sulph., she all the while steadily advancing towards cure. About a year and a-half from her first visit she ceased her visits, considering herself cured. Of course, a year and a-half seems a long time, but you must not forget that the disease had lasted 18 years.
The marked connection that often exists between asthma and eczema is peculiar, the two affections frequently alternating with one another — catarrhal inflammation of the skin with catarrhal inflammation of the lungs. I have known some rapidly fatal cases of catarrhal phthisis to follow cases of " cured *' eczema — cured by external applications. It is such knowledge that makes one very chary indeed about using external
SSSJTj^TS^ high potencies. 11
Beriew, Jan. 1,
" cnrative " applications in cases of eczema. Most old- school dermatologists, of coarse, sneer at such fears, and deny that there can be any possible connection. The reason of this is not far to seek, for once admit that fact, and the raison d'etre for their existence as ** specialists " at once disappears. Nature nearly always sends chronic diseases to the least fatal situation, e.g., eczema to the skin surface. But the dermatologist does his very best to drive it from that surface ; if, unfortunately, he succeeds, in some cases there may be no great harm done, but in others it may mean death, though, of course, the patient dies *' cured." I believe that in all cases where such '* cures," or suppressions, are made from without inward, even though they may escape immediate evil results, yet a depraved constitution in some form or other will almost certainly result, which will be trans- mitted to their children and their children's children. This way of looking at the matter is of the greatest practical importance, in considering the important question of pra-naUd medication. For such mal- treatment is, I believe, the origin of the " psoric " constitution. As I have elsewhere remarked, to treat a '* diseased skin " successfully, and safely, we must treat the body that has produced it ; the skin eruption is merely an effect — the outward and visible sign of an internal dynamic derangement. A perfectly healthy body must possess a perfectly healthy skin, and a diseased skin cannot possibly exist upon a perfectly healthy body ; there is a very wide difference between a disease of the skin and a disease on the skin. I doubt if the former can exist, per se. In the treatment of skin diseases, just as in other diseases, the " totality of the symptoms" must be our guide, and that includes everything that can be learned by every sense we possess about the patient and his disease, not only subjective symptoms, but objective as well, together with its cause and all that can be known of its pathology and patho- logical anatomy, so far as these can aid us in effecting a cure,
2. The next is an " eye case " in a lady, 66 years of age. She suffered from frequent attacks of sore eyes, especially the right one, and the allopathic oculist, who attended her before I was called in, used to keep her in a dark room for 10 weeks at a time, together with the
12 HIGH POTENCIES. ^S^^Jj'/wfjTJftSJ?
assiduous application of a zinc lotion and atropine drops. The eye trouble was a frequently recurring one, and was getting worse and more frequent every year. The attacks were often about March and April, and again perhaps in the fall. The cure in this case has not been so complete as in the previous one, as there have been one or two slight relapses since, though, curiously enough, much later in the year, and the eye that used to be the worse (the right) seems to be less liable to be attacked now. At the same time I thought it was worth while mentioning the case on account of the very marked improvement all round. The eyes during these attacks were very red, there was intense photophobia, and a great deal of very acrid, watery discharge. The surface of the cornea very rapidly became cloudy and opaque (like ground glass), though I do not remember ever being able to detect a definite ulcer at any particular spot. Very soon after the attacks came on blood vessels began to shoot across the surface of the cornea tlirough the opaque region, not so much at the lower segment of the cornea, but at the outer or inner side where the lids could not rub much — not like in ordinary panmis. As the eyes got better the blood vessels on the surface of the cornea shrivelled up, and the opacity disappeared to a great extent, though even when they are at their best there is a slight permanent opacity in the right eye — the eye that used to be the worst.
There was one very definite sj'^mptom that she did not tell me of for some time after I began to attend her, and after she did tell me it was some time before I recognised its full significance, viz., that during these eye attacks^ at any rate when the photophobia and pains were at their worst, she always had a peculiar rushing noise in her ears. If you consult that most excellent edition of Hahnemann's Materia Medica Pura, issued by the Hahnemann Publishing Society, you will find the above symptom under arsenicum, s. 176, " Roaring in the ears at each attack of pain," and then as a foot note, *' The occurrence of other symptoms during the pains is quite peculiar to arsenic." In the beginning of my treatment of this case, before I knew of the above symptom, the medicines I chiefly used were euphrasia and arsenic (not alternately, but at different times), though with the latter I did not go higher than the 30th potency. There was some
SlfaiJfj^^Si"* HIGH POTENCIES. 18
S0fiew. Jan. 1, 1808.
improvement undoubtedly, but it never lasted very long, and it was only when I used arsenicum m.m. (F.G.) potency that steady and permanent improvement began to show itself, and I think that for about a year and a-half I heard no more of my patient ; though, as I said, since that time there have been one or two slight relapses, though she has not had the ear symptom — except on one occasion slightly — since she received arsen. m.m.
8. Alopecia Areata, This is a case already reported in the Monthly Homoeopathic RevieWf but I introduce it here as being a very fair illustration of my subject, and also to bridge over the gap between my two previous cases and my next one, lest the drop from the millionth to the 200th potency prove too much for my hearers.
W. C, aged 11, was brought to the dispensary last August, suffering from the above complaint. He was said to suffer from " worms," his appetite was capricious, and after meals he suffered from a hardness and fulness in the region of the stomach (a not uncommon thing for boys). The bald patches were in the usual position, and of the usual appearance ; there were several large patches behind the ears and on the occiput. They were circular, sharply circumscribed, perfectly bald, of ivory whiteness, smooth and shiny like a billiard ball. The skin had the usual white, shining, atrophic appearance.
In this case the subjective symptoms were very meagre, so that one had to trust almost entirely to the objective. In Vol. I- of the Medical Counsellor (1879), Dr. H. N. Guernsey, writing about tinea decalvans, says : " When the denuded part or parts of the scalp present the appearance of cleamen^ whiteness^ and smoothness, phos. will pretty certainly be indicated by all the other symptoms, when a very few doses of this remedy in the 19 m. will be sufficient to set up such an action as to cure the patient and restore the hair as in health.*' Not having the above attenuation, I gave the boy one dose of the 100 m. In the course of three weeks there were distinct signs of a growth of hair on the bald patches, and by the end of two months it was almost impossible to male out the position of the patches, they being completely covered with a good growth of hair.
There are two theories as to the immediate origin of this disease : — •
(1.) It is believed to be due to some nerve disturbance,^
14 HIGH POTENCIES- ^SS^w^r^fSI"
Beview, Jan. 1, 1696.
leading to atrophy of the roots of the hair and some- times of the skin.
. (2.) The old idea was that the disease was due to a parasitic fungus (the Microaporon Audouini). This idea has now for the most part been given up, as the so- called contagious cases were probably cases of ringworm.
Does the fact that phosphorus cures this disease lend support to its probable origin in a "nerve disturbance"?
To be sure, the amount of phosphorus present could not be looked upon as a massive dose, nor could it in any way act as a " nerve tonic '* according to old-school ideas of the term. At the same time it should be remembered that what is wanted in such cases is not to supply the material (phosphorus) to the patient, but to give him the power to take up, or assimilate, the material already present, in a comparatively large quantity, in ordinary every-day food — in the form of phosphates. The same is true in regard to many other important medicinal agents, as iron, lime, sulphur, &c.
4. In August, 1892, a lady in her fifth pregnancy came to consult me concerning lactation. Her chief complaint was that hitherto all her children had refused to suckle her ; some of them would not even attempt it, and others, if they did try it once, after long persuasion, they would not be beguiled into doing it again. She said her milk was watery and blue, that it was apt to run away of iis own accord and disappeared altogether soon after she got up at the end of the usual month. She had a genuine desire to be a real mother to her children, and not merely to bring them forth, and it quite naturally, therefore, caused her many jealous pangs to see her child prefer a stranger (the nurse, who had charge of the bottle) to herself. She wanted to know if anything could be done to correct this abnormal state of affairs. I explained that while one could not be absolutely certain of putting the matter right, yet I believed that it was possible, and, in any case, that it was very well worth trying. I find that pregnant women make the most docile of patients if one explains to them the special object in view, and how it will in all proba- bility be to the benefit of the unborn babe. The minute details of the symptoms I need not go into further than stating a few of the leading points. Irfher non -pregnant state menstruation was rather profuse and lasted too
^BttlyHOTioBopj^ HIGH POTENCIES. 16
Beriew, Jan. 1, lfi86.
long, with white-of-egg-like acrid " whites "• during the last half of the menstrual month, and then there were such sulphur symptoms as pressure and burning on the top of the head, burning of the hands and feet, and a heavy, head, exhausting sleep. But for success in treat- ment I founded my hopes chiefly upon the teaching of Hahnemann (as I understand it) in regard to '* psora," or the previous suppression of chronic affections by external methods of cure, not in herself, for I could dis- cover no sign of such in the anamnesis of the case, but almost certainly in her parents or grandparents. The medicines I determined to give in the few months at my disposal — she was four or five months '' gone " when she consulted me — ^were sulph., calc. c, calc. phos., and silica, and in that order, giving each about a month to do its work. Sulph. was given in the d. m. potency, all the others in the 200th. I gave two or three doses during the first two days, and then let the medicine do its work undisturbed for the rest of the month. Under the circumstances, I did not see what else I could do. I have already explained why I gave sulphur. In regard to the other medicines mentioned, we find in the Guiding Symptoms under : —
Calc. Ostrear, — ** Profuse secretion of watery milk, which the child refuses to take." " Milk disagrees with the infant." "Milk has a disagreeable nauseating taste, the child will not nurse, but cries much." The same medicine has also galactorrhoia.
Calc. Phos. — " Child refuses the breast ; milk has a saltish taste."
Silica. — "Aversion to mother's milk, child refuses to nurse, and if it does nurse it vomits."
Gina, lach, nat. m., and rheum all record the fact that the " child refuses to, nurse."
The result was far beyond anything I had dared to hope, for not only could she suckle the child, while he on his part never showed any sign of refusing the breast, but in size, general build, and health he far surpassed all her previous children, and this was well shown at a later period, when he produced a crop of healthy teeth. He leaves the various babies used for the purpose of advertising the well-known infant foods far in the back- ground. She has had other two children (both girls) since then, and continues to be able to suckle them.
16 HIGH POTENCIES. "^S^'^/w^SuTios^
I do not have a great many midwifery cases, and only snch as are my own patients, but in all first cases I make it a sine qua non that they will pay me a visit every month or six weeks during their pregnancy, and when I explain why, they are perfectly willing to do so. There can be no time so appropriate for the eradication of evil constitutional tendencies and for building up a a sound constitution as the time when the body is in the actual process of formation. By adopting such simple means, I believe we would gradually sweep such scourges as phthisis, cancer, &c., from the face of the earth. I consider the subject of Pra-natal Medication well worthy of a very prominent place in any system of therapeutics.
5. This last case is chiefly of value to show how an allopath may at times unknowingly stumble upon & homoeopathic cure. It was a case first of gonorrhoea, then of syphilis. The young man had 3 or 4 hard chancres on his penis, in the neighbourhood of the corona glandis and frsenum. He came as soon as he noticed them, and I at once put him upon mere, sol., 12th potency, in infrequent doses, and, later, on the SOth potency of the same medicine. The sores were kept clean, but no medicated washes were used. They slowly healed, taking several weeks in the process, but there was never the faintest sign of any secondary skin eruption or other secondary symptom, unless bone pains in the occiput and loss of hair are to be regarded as such. The case seemed to be getting on beautifully when he began to suffer from very persistent and severe pains in the occiput — they began about six weeks after the chancres appeared, and a couple of months later the hair began to fall out. The pain was like toothache, he said, was worst at night, and was, on the whole, better when the head was wrapped up warmly. The scaJp in that region was sore to the touch, and the pain was aggravated by cold air. It was ameliorated somewhat by clasping his two hands behind his head so as to grasp the occiput, and then rocking his head from side to side. 1 tried on many occasions to give him relief, but failed. He would come in day after day, sit down on a chair in my consulting room, clasp his occiput, lean forward, and rock his head from side to side in great agony. He was
Setting worse, but, being a very staunch homoeopathist, le did not wish to consult an allopath, though his father
JESSSrSTiST' HIGH POTENCIES. 17
pressed him to do so. One Sunday afternoon his father invited him to come home to tea (he did not live with his father) » and had an allopathic doctor there to meet him. This doctor examined him and prescribed for him, and told him that he mast go on with the medicine steadily for months. My patient did not tell him that he was suffering from syphilis. He brought the prescription to me (I am very sorry now I did not keep a copy of it), but it contained iodide of potassium, guaiacum, and one or two other accredited anti-rheumatics. He asked me whether or not he should take it. I said by all means he might try a few doses of it, and let me know the result, but if he was distinctly better or markedly worse, in either case he ought to stop it at once. The result was that after a few doses the pain disappeared, and never returned again in the slightest degree. So that instead of going on with it steadily for months he did not half finish the first bottlefuL I believe the credit of the cure is due to iodide of potassium, for the symptom about rocking the head from side to side occurs in Lee's Repertory of Characteristics under iodide of potassium and no other medicine.
We learn from this case : —
(a.) The impartiality of Law, Law is no respecter of persons. If I, professing to follow the Law, yet do not conform to its requirements, it will not " stretch a point " just to save the credit of a member of the British Homceopathic Society. On the other hand, if an allopath, who sneers at our Law, unconsciously conforms to its demands, it will nevertheless promptly honour that obedience.
{b.) The absurdity of the methods of the Old School. This doctor, who is a shining light in the Old School, an F.E.C.P., &c., could have known very little about the real power of drugs or the principle on which to select them for any given case of disease, for, professing to be a follower of the impossible *'contrariacontrariiscurantur " rule, he nevertheless selects a drug according to the never-failing principle of similia similihus curentury with the result that he effects a speedy and permanent cure. What could be more absurd and unscientific than to mix four or five drugs together and tell the patient that he mast go on steadily with this mixture for months? Clearly he could have had very little conception of what
Vol. 42, No. t o
18 HIGH POTENCIES. "S^=5™??^«
Beview, Jan. 1, 1886.
he was doing. I suppose the reason for this allopathic absurdity is because they hope that before the three or four months are up, Nature herself will step in and effect the cure. A very convenient method certainly, but not scientific. If I find that a medicine has to be kept up steadily for a long time in order to give the patient relief, and that the trouble returns when the medicine is stopped, I know that I have not got the medicine homoeopathic to the case, and set about trying to find the appropriate remedy.
(c.) Then again comes the fatal error of a mixture of drugs — fatal to all exact observation — and the same applies to members of our own school who alternate or mix two or more drugs either in the body or out of it. The question is not whether Hahnemann alternated or did not alternate, but simply that such a method is unscientific and cuts at the root of all exact observation. I do not of course refer to that form of alternation which eimply changes a medicine because a change in the symptoms demands it; that is a necessary and perfectly proper thing to do. I have already remarked that I do not care one iota what potency a man paay use, but I do plead most earnestly in the interest of scientific medicine that from henceforth only one medicine be used at a time; if this is done I am convinced that the * potency question will look after itself. Hahnemann, we know, used massive material doses in the early days of homoeopathy and performed some startling cures, but then he had the good sense to stop the medicine, and did not tell his patients to go on with it for weeks or months irrespective of effects. Then, again, the medicines one is most tempted to alternate are those that have a very close resemblance to each other, and which are in most cases muttuil antidotes.
In drawing my paper to a close, let me remind you of John S. Mill's Canons of Inductive Logic, at least the ones that are more particularly applicable to our science.
1. The method (or Canon) of Agreement. When a number of cases observed agree in one point only but differ from each other in all other respects. This method gives only a very 7o?r degree of probability, though the greater the number of cases the more likely are the inferences to be correct. This is the method of the Old School therapeutist, and those of our own School
^Silfj^TiBa*" HIGH POTENCIES. 19
who use more than one medicine at a time. The degree of probability by this method is so low in any single case that it is a '' negligible quantity." The reason of its weakness is, as Mr. Mill himself points out, the ** plurality of causes** — that the same effect may in different cases be due to different causes.
2. The method of difference. This is the great method of experiment, and, properly conducted, gives absolute certainty. Only tico instances are taken, and they differ in one point only. In performing experiments, according to this method, it is absolutely necessary to vary only one circumstance at a time. This canon is not liable to any such weakness as the canon of agreement, for, as there is only one new circumstance at work, all the others remaining unchanged, that, and that alone, must be the cause of any change. This is the method of the experimental chemist. I wish I could say it was also the method of the scientific therapeutist — I mean the therapeutist who only uses one medicine at a time, under the guidance of the law, similia similibus currntur. But alas ! it is not, and cannot be ; not because of any fault on the part of the prescriber nor of the medicine used, but because we can never find two patients exactly the same in every particular. We have, therefore, to turn to —
8. The joint method of agreement and difference. Here tioo sets of instances are observed, the one set positive, the other set negative, differing in one important point {the medicine we give), but in several other points beside (the natural differences between different patients) ; and, as they thus differ in more than one point, one can never be quite sure, though, when properly conducted, this method gives a very high degree of probability.
I trust you will pardon me thus reminding you of a few salient points in Rudimentary Inductive Logic, in support of my contention that we ought to use only one medicine at a time.
Discussion.
Dr. Hughes : I have read Dr. McLachlan's paper with the good expectation which my knowledge of him always leads me to form about anything he writes, bat I regret to say that I have not had the satisfaction in it which most cf his com- manications have given me. Dr. McLachlan divides his
C— 2
20 HIGH POTENCIES. "S^fJSJTJSs!
argument into two. One section may be called theoretical argument in favour of high dilutions ; the other, the practical argument derived from the cases he cites. I have roughly divided his theoretical arguments into three. The first is, that it is easier to modify disorder than to disturb order, and, therefore, that high potencies are better than low in the treatment of the sick. But surely that is only an argument for attenuated doses. It is no argument for high potencies in preference to low, but for potencies — for dilutions — in preference to crude quantities. So I think we must put that on one side as having no bearing on the question he has raised. The second is this. We are taught, he says, that disease is a derangement of the vital force, that is, of an immaterial thing. The medicine should therefore be immaterial. When Dr. McLachlan says, ** We are taught," I think he must remember the old injunction that we are not jurare in verba magistri, even when the magister was Hahne- mann. It is but an after-thought of his at the most. All this about the vital force, the spirit-like force, the derangement of which causes disease, belongs to the fifth and latest edition only of the Organon, and there is nothing about it in the earlier editions, issued when Hahnemann was at his prime. And I must say that I think we are forbidden by modem science to follow him herein — that there is no evidence of the existence of a " vital force.'' We need not get into the spirit- like region at all, or call for immaterial drugs. We have dynamic disturbances, I quite grant, of the living substance — the protoplasm. It is that which we have to deal with, and we can deal with that best, I take it, by the energies of minute portions of medicinal matter. That meets by anticipation the third point. Dr. McLachlan says it is energy we want and not matter ; but surely a scientific man like Dr. McLachlan knows thoroughly well that there is no such thing as energy without matter; that energy means matter in motion. (Dr. McLachlan. No.) ISurely you must have something to be energetic if there is energy. Men, like Tyndall and others, who have led the science of our day, will tell us that all energy is matter in motion. There is no such thing as action apart from matter.
Dr. McLachlan : It is tlie evidence of energy ; it is not energy.
The Pbesident intimated that it would be more convenient if Dr. McLachlan replied after the discussion.
Dr. Hughes : That is my point. You cannot have energy without matter. Therefore you must not attenuate so far as to lose the presence of matter, however finely attenuated it may be. Those are the arguments, in brief, which I would
bSS^STu^So^ high potencies. 21
advance in reply to Dr. McLachlan's theoretical considerations. I come now to the practical. I have read these cases ; bat Dr. McLachlan knows, as well as I can tell him, that a few cases prove nothing. Disease is such a complicated thing, and the natural history of disease is so little understood, that whatever presumptions may be raised by two or three successful cases are merely presumptions, and nothing more. And the great defect of these oases, if he will allow me to say so, is that there is no evidence that the medicines given were homoeopathic to the disease. Let us take the first case. He gives sulphur, because a friend in London <' kindly replies as follows " : — ^Asthma before menses, three drugs, including sulphur ; asthma during menses, three drugs, including sulphur ; itching when undressing, a number of drugs, including sulphur. But what does he mean by replying thus ? Does he mean that any prover of cupr., puis., or sulph. when testing the drug on her own person, had a fit of asthma before her menses, or during her menses ? Or does he mean that any person poisoned by copper (people are not readily poisoned by Pulsatilla or sulphur) had an attack of asthma before the menses, not having this attack before? No, there is no evidence of any such pathogenetic power of these drugs. These are mere empirical suggestions by an individual whose name is not mentioned, and therefore I will not criticise him. There is no evidence that the drugs have ever caused the ailments they are given to *cure, and unless they have done so you may give them in the most infinitesimal doses possible, but you do not make them homoeopathic. Homoeopathy is carrying out the rule similia similibus ciirentur, and is not truly homoeopathic practice unless you do carry out that rule. (Hear, hear.) So with the next. In the third case phosphorus is supposed to be homoeopathic because Dr. Guernsey advised that it should be given. But Dr. Guernsey's recommendation does not make the drug homoeopathic. Phosphorus has never been known to cause alopecia areata in the way arsenic has caused it ; there are several cases of poisoning by arsenic in which that affection has been caused, but nothing of the kind in the extensive pathogenesy of phosphorus. There is therefore no evidence of homoeopathicity there. Again, the evidence of homoeo- pathicity adduced in the fourth case is, I suppose, that we find certain symptoms in Bering's book called *' Guiding Symptoms," which were found in the case before us. But Bering's " Guiding Symptoms " does not profess to be a col- lection of pathogenesy, but a collection of symptoms mainly clinical, with empirical observations, and with a number of suggestions of his own and others — ideas and fancies — the
22 HIGH POTENCIES. "^^J,XT«J!
Materia Medica Impura which Hahnemann protested against, and published his Materia Medica' Pura to supersede. I am sorry to say that those who call themselves Hahnemanians have largely gone back to the Materia Medica Impura instead of using Hahnemann's pure pathogenesy as their guide in practice. We come to the fifth case. That is not an example of the action of infinitesimals. I will first note, however, that we are told that iodide of potassium must have been homcBopathic to the case of syphilitic headache which it cured, because the patient, when very bad, rocked his head from side to side, and '<the symptom of rocking the head from side to side occurs in Lee's Repertoi-y of Characteristics under iodide of potassium and no other medicine." Well, here again, a single incidental symptom is to be taken as a guide for the treatment of such an obstinate disease as syphilitic headache, instead of the well-authenticated power of iodide of potassium to overcome such affections I Surely this is trivial. What authority has Dr. Lee for putting this symptom under iodide of potassium ? It reminds me of Gibbon's epigram : — ** Abulfeda vouches for this, but who shall vouch for Abulfeda ? " What empirical ground even has Dr. Lee for it? What evidence is there that people who have been cured of headaches by iodide of potassium have rocked their heads from side to side more than those not cured by it ? To conclude, therefore, I do not think that we can argue from such cases in favour of high dilutions. I think that foi: such action we want a number of cases in which the drug is selected according to the true Hahnemannian principle of similia similihus curentur, and in which the effects shall be so unmistakable, on a large scale, that there shall be no getting over them ; otherwise the presumption is against the high potencies. It is quite obvious that all the tests which we have for determining the presence of active medicinal substances gradually lose their force as you get higher and higher. At first you have colour, smell and taste. You gradually lose them as you attenuate. Then comes the chemi- cal test. At last you lose that. Then the microscopic test. At last you lose that. Then the spectroscopic. That gets less and less, and at last you lose that. Finally, all evidence whatever of the presence of drug-material ceases. You may have finer tests still, and may follow it up further than the highest point yet reached, but the whole evidence is that at last it must cease, and when you get up to Hahnemann's SQth, surely you have got far enough for all conceivable action of drugs. I would not allow a few individual instances, in which the homceopathicity of the medicine is very far from being proved, to outweigh such
ISS^fj^SrSSf^ HIGH POTENCIES. 28
eyidenoe as that. I think it is a pity that we should weight homceopathy iBJorioiisiy with these animaginable potencies. It is sufficiently heavily weighted and prejudiced already. We should not overweight it farther by adopting these impossible dilutions into our practice, and so make it less and less
Eracticable to convert our brethren of the Old School to a elief in the virtues of our system. (Hear, hear and applause.) Dr. Dtce Brown: A paper on ''high dilutions" at the Congress now and then is extremely valuable. With all due deference to Dn Hughes and his powerful remarks, we must remember that though the high dilution men are in a minority — ^yet, they are in a very considerable minority — they are men who have been educated as we have ourselves, who have had a large amount of practice, and who have the same powers of observation. It is an important fact to keep in view that they do cure cases, and sometimes very remarkable cases, with high dilutions when lower ones have been unsuccessful. For that reason I think it is so important to have a paper now and then upon that side of the question. (Hear, hear.) We ought not to have them all on one side. We should be glad to hear what can be said in favour of the high dilutions. In arguing upon the action of these high dilutions we are led into difficult ground. Dr. McLachlan speaks of the vital force ; Dr. Hughes pooh-poohs it and thinks it does not exist. There is no actual proof of it. But say what we will, call it what you like, it seems to me that there is something which is immaterial and pecuhar in the reaction of the body to high dilutions. We need not discuss the point whether c. m. or the millionth dilution (as in one of the cases was used) are illustrations of this or not. A sufficient illustration of the wonderful vital reaction — call it that, or vital force, or anything you like, but it is something different horn chemistry or from pure materialism — (Dr. Hughes : Hear, hear.) — is shown in the 80th dilution. If you admit the curative value of the dOth dilution I do not see where you are to stop. I should be very sorry to pooh- pooh any cases that are recorded as having been cured by dilutions considerably higher than the 80th, because if you once admit the 80th you admit the whole argument. There- fore, I think we must allow the existence of something — call it vital force or what you like — something very peculiar in the vital organism that reacts upon medicines that are absolutely inconceivable when you put them down in figures. Hence the value of an occasional paper upon this side of the subject. Of course, in a short Congress paper there can only be a very few cases given. But I think we should open our eyes and ears to take in all that can he said on the other side.
24 HIGH POTENCIES. "S^'iL^^TT!!^
BeTiew, Jan. 1, 1898.
provided it does not absolutely exceed our possibilities of conception. The only respect in which I think Dr. McLachlan might have strengthened his case is by not using such severe remarks upon the subject of the tangible dose. He takes for granted, on page 8, that the tangible dose is a total mistake ; that there is no proof that it is homoeo- pathic to the case ; and that it just works in some other way. It is a pity he weakens his case by thus maligning the lower dilution school. The homoeopathic dose is the dose less than will produce aggravation. How much less is a question to be determined by experience. The large majority of homoeopaths know that comparatively tangible doses do cure ; that they are chosen because they are purely homoeopathic, they cover the whole complaint, and therefore are purely homoeopathic. It is a pity, as I say, that Dr. McLachlan weakened his case by hinting the reverse. He says here what is very true — that ** in the treat- ment of skin disease, just as in other diseasoR, the totality of the symptoms must be our guide, and that includes everything that can be learned by every sense we possess about the patient and his disease, &c." I quite agree with him there. We, who use habitually what may be called the more tangible doses, select our medicines on that very principle. But, at the same time, we are glad to find that there are men who attain success by the use of very much more infinitesimal doses than we are in the habit of employing. I beg to thank Dr. McLach- lan for his paper. (Applause.)
Dr. E. B. BocHE : I think we must keep clearly before our minds that we must demand from all those who bring forward these cases that there should be a real homoeopathicity. (Applause.) That is the great point. I remember a little while ago, in London, raising the question, and it was simply thrown on one side by the person to whom I was speaking. A material was being dealt with that was questionable, entirely questionable, and I spoke of the importance of its being a medicine that had been proved, and that we should know what it was. The reply was, ** I don't care where it comes from." The next step from that is that there is no necessity for a clear proving. I maintain that there must be a proper proving of the very material we are to use as a medicine, never mind what the dilution of the moment may be. (Hear hear.) I can believe a man of repute who tells me that he ceui cure a disease with 200, if he has had sufficient experience, and has chosen the medicine that has been proved for the cure of the symptoms that have been assuredly produced by it in its provings. By way of illustra- tibn, I have. had it told me, by men of experience, that calc. 200 has cleared away a crop of warts, and so on. A young
itS^jSTSft"* HIGH POTENCIES. 25
Sefiew. Jmu 1.
lady said to zne the other day : '* I am bo much obliged to jou ; ever since you looked at my warts they have all gone away." (Langhter.^ I had not given her any medicine.
Dr. Obd : I should like to add to that the example of two schoolboys who agree to " wish " their warts away, and a few weeks afterwards they are gone. A characteristic of the high dilution people seems to be that going in for these potencies undermines what I may call their homoeopathic morality. They take less trouble in looking out for the homceopathic correspondence between the symptoms of the disease and the medicine, and in seeking agreement at all points. They are content to take some vague, ill-defined, and ill-substantiated symptom, which is not a true pathological symptom at all, and they also lai^ely use symptoms observed in disease. With re^urd to '* tnmscendentally " high potencies, the paper has enlightened me in that it has enabled me to more thoroughly understand where their strength resides. I have never been able to conceive how, when you put medicine in a bottle, and wash it out, and out, and out, by a machine, a thousand times or more, the remedy becomes so very much more powerful. But I see from this paper that outside the vital and material action of the medicine there is something remarkable in its influence which may be compared with electricity ; and Dr. McLachlan points out the very interesting fiebct that electricity does not exist in the wire which conveys it, but on the out^de of the wire. I can understand, there- fore, that the repeated washing-out of these bottles does not affect the strength of the medicine, because it resides on the outside of the glass, and I suppose what we want to remember is to be very careful never to dust them. (Laughter.)
The President : I think at this stage I may ask your permission to let me close the discussion, and to do it in a word or two of my own. I forget how many years our friend Dr. McLachlan has been in practice, but he is not what we would call a senior practitioner, and I think we must not break a butterfly on the wheel. Dr. Hughes's ponderous arguments are like the Nasmyth hammer, and brought down to crack Dr. McLachlan's little nut they inflict a heavy blow indeed. I would rather say to Dr. McLachlan, persevere in the line you have taken up, and time and experience will guide you aright. But in the meantime, I would recommend Dr. McLachlan to take the advice that I have mentioned in my address this morning, and not to rationalise too much, but observe accurately more and more, and then his results will be more worthy of being recorded. With regard to Dr. Boche's treatment of warts, if he will excuse my being flippant— one is apt to get flippant towards the close of the
26 APPENDICITIS. ^^'^JS^^SSTir^!
Congress afternoon — he really practised homoeopathy when he looked at that young lady's hand and administered a high potency. (Laughter.)
Dr. McLacblan: I am sorry you so misunderstood me. Dr. Hughes. If I had had three minutes before you began, in which to explain matters, I could have put things all right. I am not here merely as an advocate for high potencies. I was simply asked to write a paper giving my experience in regard to high potencies. I gave all the cases I had. You must not go away with the idea that I do not believe in low potencies and that I regard them as useless. However, there are two points which, in my opinion, are of far more importance than even the question of the potency. These two points are (1) the mode of choosing the remedy ; (2) a rigid adherence to the principle that only one medicine is to be given at one time. Of course, one necessarily follows from the other. Our aim is to choose the simillimum, i.e., the most like remedy, and in the very nature of things there can only be one most like. 1 strongly insist upon these two points, because I do not believe the question can be profitably discussed until they are settled. If they are settled, I quite believe the potency question will look after itself. As to the mode of choosing the remedy, what I always try to aim at is to follow those cases of Hahneman's mentioned in the beginning of his Materia Medica Ptira, and quoted by Dr. Dudgeon, with various comments, in the Honueopathic World, for August, 1890. The question of energy and matter I will not go into now. There is a great deal that might be said on it, but I refrain from troubling you further this afternoon.
The discussion then closed.
SOME CASES OF APPENDICITIS SUBMITTED TO OPEEATION.
By C. Knox Shaw, M.R.C.S. Eng., L.E.C.P. Lend.
Surgeon to the London Homceopatliic Hospital.
In the fourth volume of the London Homoeopathic Hospital Reports there appeared a paper of mine on " The Clinical Phenomena of Appendicitis, and their Relation to the Need of a Surgical Operation." Our hospital records then showed that since 1887, when reliable statistics can be first obtained, no fatal case of appendicitis or perityphlitis had occurred, and only two had been submitted to operation. Since 1894, when
IR^fSTS^* APPENDICITIS. 27
my paper was written, foarteen cases of appendicitis have been admitted, upon four of which I have been asked to operate. The following seven are all the cases of operation that have passed through my hands up to the present time, and in all the result has been eminently satisfactory. Extended experience has confirmed me in the conclusions I had previously formed after a careful study of such cases as I had seen, and of the work of others in this field of surgery. I know there are some who are still opposed to operation for appendicitis, but I think a careful consideration of the following cases must convince the most sceptical that operative inter- ference was amply justified, and that in the recurrent cases the patients were rescued from a state of chronic invalidism by means of the operation.
In hospital practice we see only the severer cases, and of course the ratio of operation to unoperated cases will be much larger than in general practice. It is perfectly certain that the vast majority of cases recover, and recover permanently ; and that, taking the simple with the severe attacks, the mortality varies from 5 to 10 per cent. But should an abscess form the danger is much increased, and the mortality at once ranges from 30 to 40 per cent. Operation may be needed in two stages of the disease, and as the technique somewhat varies according to the condition for which operation is undertaken, it will be better to consider it separately. We may be called upon to operate during an acute attack, or when the disease has assumed the recurrent form. The condition for which operation in an acute attack is needed is generally localised suppuration. I am not referring now to those rarer and very serious cases of perforative peritonitis which are, alas ! very fatal, and which oflFer one of the most serious problems of peritoneal surgery. They must be dealt with as are other cases of intestinal or gastric perforation, and will always have a large mortality. That they are, however, amenable to medicinal treatment I had a striking instance only lately, when, in consultation with Dr. Dyce Brown and Dr. Purdom, I saw a gentleman, aged about forty, in an advanced condition of perforative peritonitis. His condition was such that I considered any operation would inevitably hasten what appeared to be a rapidly approaching end, and yet, under the unremitting care
28 APPENDICITIS, "^ji^sr;^
Be¥iew, Jan. 1, 1886.
of Dr. Purdom, who never lost faith in his therapeutic measures, the patient made an excellent recovery.
Case I. shows the usual course of an appendicular abscess, and for this operation was undertaken on the ninth day of the disease ; probably it would have been wiser to operate earlier. Treves considers opera- tion most frequently needed about the fifth day. However high the temperature may rise — and it may reach 104° — it generally begins to fall after the first two days if the case is going to end in resolution. If the temperature keeps up and the local swelling becomes very tender, and the constitutional symptoms increase in severity, an abscess is probably forming, and the question of operation must be seriously considered. Fortunately, in Case I. the abscess was reached without opening the general peritoneal cavity, and this result is the more likely to be obtained if the operation is not undertaken too early. The size of the tumour in the right iliac fossa bears no relation to the question of abscess nor to the need of an immediate operation, for we see in Case II. that a swelling of very considerable size may entirely resolve.
The second class of case in which operation is needed is where the appendicitis assumes the recurrent or chronic form. Six of the seven cases were of this type. A perusal of them will show the kind of case in which operative interference may be justifiably employed. The conditions needing operation may be summarised as : —
1. Recurrent cases of some severity occurring at short intervals. Cases 11., III., IV., V.
2. Cases of a milder type, but which prevent the patient from following his employment, or where from his circumstances he may not readily be able to obtain medical assistance. Case IV., VII.
3. Cases in which a recent attack has been very severe, such as being accompanied with a discharge of pus per rectum. Case VI.
Case I. — Acute Appendicitis; jirst attack; localised septic peritonitis; operation; recovery.* Albert R. was admitted into Bayes "Ward, under Dr. Galley Blackley, on November 2nd, 1894. He had
• From notes made by Dr. C. E. Wheeler, Resident Medical Officer.
USSI'jSTISS!*^'' appendicitis. 29
never had any illness like the present. On October 24th he thought he strained himself when playing football ; and next day noticed pain in the right groin, which continued for three days, when, October 28th, he com* plained of tenderness in the right iliac fossa. The bowels, which had been acting daily, were last moved on October 30th. When examined, his right iliac fossa was found to be occupied by a tender, very resistant mass, measuring four inches by two-and-a-half; the area over it was dull on percussion, whilst the rest of the abdomen was tympanitic. He lay on his side with his knees drawn up and complained of severe paroxysmal pain. His tongue was coated ; his lungs, heart and urine normal. His temperature on admission at 10 a.m. was 100*4°, but it rapidly rose to 103-2°, his pulse being 120. He was ordered belladonna and nux vomica alternately ; glycerole of belladonna locally, and a diet of milk and barley water. The same evening his temperature reached 104*4° when he was sponged with tepid water and bryonia given. Next day he was in more pain and red streaks were noticed on the skin over the affected area. He was ordered veratrum viride in alternation with bryonia and a compress of veratrum viride (si.-Oss) . That evening, November 3rd, his temperature rose to 105.6°, and during the night he vomited twice. In the morning his temperature was normal, but his pulse remained at 120. On November 5th he had again vomited, the breath was offensive, the tongue thickly coated, and his bowels had not been moved since admission. In the afternoon I saw him and advised operation. During the afternoon he had two loose stools within an hour of one another.
On the morning of November 6th his temperature suddenly fell to 96°, and his pulse to 62. That after- noon operation was undertaken, and an incision was made over the swelling in the right iliac fossa and before the internal obhque muscle was completely divided, pus was seen at the inner angle of the wound. Along with the ofifensive pus some very foul gas escaped. The wound being cautiously enlarged an abscess cavity was entered and gently explored, but the appendix was not recognised either in the cavity or in its soft and purulent walls. Fearing to break down the protective adhesions and so set up a general infective peritonitis, the search was
30 APPENDICITIS. ^B^I^j^i^^.
abandoned. The cavity was carefully washed out with perchloride of mercury lotion and a drainage tube inserted, the whole being dressed with iodoform and cyanide of mercury gauze. He was ordered belladonna and mercuriuB cor. The wound was dressed twice a day, but it was a week before the discharge lost its oJOTensive character. For nearly a week the temperature remained subnormal, and the pulse ranged from 50 to 60. The condition was considered to be one of toxsemia, and on November 9th Dr. Blackley ordered the patient crota- lus 8. The case ran an uneventful course, and the patient left the hospital with a sound cicatrix, on Decem* ber 16th.
Case II. — Recurrent appendicitis; admitted for second attack; two relapses whilst in the hospital; operation dunng quiescent period : recovery,*
Hugh D., aged 8, was admitted into Bayes Ward under Dr. Byres Moir, on October 16th, 1894, with swelling and tenderness in the right iliac fossa. A month previously he had had a precisely similar attack, which had sub- sided under medical treatment outside the hospital. On October 9th he had another attack of pain and tenderness in the right iliac fossa, but no vomiting. B,emaining ill, he came up as an out-patient and was at once admitted. In the right iliac fossa was found an indurated mass, measuring about five inches from above downwards, and three inches across ; it was very tender to pressure. There was no constipation. He was ordered mercurius cor. 3x, and made a rapid recovery, and by the 26th the swelling was practically gone. On October 30th the temperature rose to 102.2°, the pulse quickened, the tongue became coated, and there was great tenderness and swelling in the right iliac fossa, with rigidity of the rectus muscle. He was first given belladonna 2x, and mercurius cor. 3x alternately, then veratrum viride Ix and veratrum viride as a compress. It was not until November 21st that all the right iliac swelling had subsided and the boy seemed comfortable and well again. On the morning of November 28th the temperature rose to 101.8° and all the old symptoms returned. The boy had been kept strictly to his bed since his admission to the hospital, with the exception of two days on the
• From notes made by Dr. C. E. Wheeler, Resident Medical Officer.
^S^rSraSt' APPENDICITIS. 81
coach and one walk roand the ward. By December 8th the symptoms had subsided once more, and after a consultation of the staff it was decided to operate.
Operation was undertaken on December 11th. A three-inch oblique incision was made running upwards and backwards, one third of the distance between the anterior superior iliac spine and the umbilicus, the centre of tbe incision being on this line. This incision follows the direction of the fibres of the external oblique muscle, and, as far as possible, an endeavour was made to reach the peritoneum by separating the bundles of muscle fibre, rather than by incising them. On opening the peritoneum the appendix was readily found as it was presenting directly forwards, its distal extremity being adherent to the parietal peritoneum at the lower end of the wound. These adhesions, and others to the small intestine and omentum, were divided, and the meso-appendix having been ligatured and separated, a silk ligature was lightly tied around the appendix close to the csecum, and the appendix amputated. The mucous membrane of the stump was destroyed with pure nitric acid, and then the edges of the serous coat of the appendix were brought together by a fine continuous sUk suture. The whole stump was then invaginated into the caecum and fixed there by three Lembert's sutures, by this means completely burying it within a furrow made in the caBcum. The wound was closed with silkworm-gut sutures, and gauze dressings applied. The appendix, which was of considerable size, was hypertrophied, especially the mucosa, and at the distal extremity of the canal there was marked stenosis.
The patient was ordered aconite and arnica. Nothing to note occurred until the 16th, when, as he complained of a little pain, the wound was dressed, and found to be healed ; there was a Utile tenderness over the csBCum, but no general tenderness nor distension. As his bowels had not been moved since the operation, and his tongue was covered with a thick white fur, he was ordered mer- curius dulcis, Ix, gr. x, statim, and bryonia, Ix, every two hours. In the evening he passed a large stool. On the 19th the temperature rose to 101^, due to a stitch abscess, but fell next day. On January 8rd he was taking ordinary food, and apparently quite well, but, acting on Dr. Moir's advice, he was kept quiet, and did not leave
82 APPENDICITIS. "'^^^SS'?^
Review, Jan. 1. 1896.
the hospital until January 16th, when he went to the Convalescent Home at Eastbourne.
Glass I. and II. were reported at length in the London Homoeopathic Hospital fieports to illustrate the paper previously alluded to.
Case HI. — Recurrent appendicitis ; third attack ; operation during quiescent period ; recovery,*^
Harold C, aged 14, was admitted into Bayes Ward under Dr. Byres Moir, on March 1st, 1895. In 1891 he had an attack of severe pain in the right iliac region, with diarrhoea and nausea, and he had been liable to occasional attacks of pain in that region since. In September 1894 he was for six weeks an in-patient of the hospital under Dr. Washington Epps, with a typical attack of appendicitis, all the usual clinical phenomena being present. He made a good recovery under bella- donna and mercurius cor. When admitted on this occasion he had been ill two days with his third attack, an apparently mild one. There was, however, tenderness and swelling in the right iliac fossa, which subsided under veratrum viride, 2x, and bryonia, 3x. On March 12tb operation was undertaken, the peritoneal cavity being exposed in the usual manner, the omentum was found adherent to the abdominal peritoneum ; the adhesions were broken down and the peritoneal cavity entered below. The appendix was freed with some difficulty owing to omental adhesions, there were also adhesions binding it closely to the caecum. When freed the appendix was ligatured and amputated, the mucosa destroyed with a drop of pure nitric acid and the peri- toneal end sutured. The meso-appendix, which was of fair size, was brought over the stump and sutured to the caecum. Silkworm-gut sutures closed the wound. The wound ran a perfectly aseptic course ; some anxiety was caused by a rise of temperature to 101° on the evening of the second day, but this was found to be due to an attack of bronchitis, which somewhat delayed convales- cence. He was discharged well, April 10th. This is the only operation in which the method of dealing with the stump of the amputated appendix varied from that described in Case II.
• From notes taken by Dr. C. E. Wheeler, Besident Medioal Officer.
iRlSSrjSTSf '' APPENDICITIS, 88
Casb IY. — Recurrent Appendiciti$ ; admitted after the $ixth attack ; operation during quie$cent period ; recovery.^
James B., sat. 90, was sent into the hospital on Jane Srd, 1896, by Dr. Murray, of Folkestone, for repeated attacks of peritonitis, having had six within thirteen months, the last being in April. He said that pain was first experienced in the region of the epigastriom, and then extended over the whole abdomen ; the pain was intense and accompanied with vomiting and constipation. The attacks usually lasted from one to seven weeks. The patient was married. He had jaundice when five years old, but enjoyed good health till five years ago, when he had his first attack of influenza. In March, 1895, he had a second attack, and two months after was seized with his first attack of appendicitis ; this lasted a week. Two months later a similar attack. He had another slight one in October and a severe one, lasting seven weeks, in December. At the end of February he had a slight attack, and a very severe one in April, from which he has not yet sufficiently recovered as to be able to go to work. In all the attacks, except the second, he has been constipated. In the last the vomiting continued a week. Dr. Murray had made a definite diagnosis of appendicitis, and sent him into the hospital with a view to operation.
When examined, deep pressure in the right iliac fossa gave a sense of resistance, and a creaking sensation could be distinctly felt. There was no marked tenderness at McBumey's point. The patient complained that when he turned on his left side he felt a dragging • sensation in the right iliac region. He was ordered nux Bx and sulphur 3x alternately.
On June 16th, under gas and ether, an oblique incision was made to open peritoneum. The appendix was found with some difficulty ; it was beneath the csecum, passing in a curved direction upwards, with its concavity towards the iliac fossa, the appendix being adherent in nearly its whole length to the psoas muscle. This fixation of the caecum and appendix would account for the dragging pain the patient complained of on turning to the left side. The appendix was severed from the caecum, after
* From notes taken by Hr. C. J. Prime, Resident Medical Offioer. VdL 42, No. 1. D
84 APPENDICITIS. '^^^fjir?^
ligature, and then enucleated from its deep adhesions. The stump was invaginated into csBcum. The wound was closed with silkworm-gut sutures.
The appendix was short and much thickened; the mucosa was soft and thick, and the serous tissue hyper- trophied. About one third of its length from the apex a perforation had taken place ; the appendix at its seat of perforation had become adherent to the psoas.
The temperature rose to 99® on the 3rd and 4th days, otherwise it remained normal or subnormal throughout. The wound was dressed for the first time on the 22nd| when it was found aseptically healed; the stitches were cut, but not removed till the second dressing on the 31st. The patient left the hospital on July llth. He was seen again in October, 1897, sixteen months after the operation, when he was found to be quite well ; he had had no illness since the operation, and he had a sound scar, with no tendency to hernia.
Case V. — Recurrent Appendicitis ; operation during quiescent period after fourth attack; recovery.*
Christine S., SBt. 15, was sent to the hospital by Dr. Hall, of Surbiton, when she was admitted into Duming Ward under my care, on May 22nd, 1897. She had enjoyed good health till August, 1894, when she had a severe illness, keeping her in bed three weeks. She complained of pain with great tenderness in the right iliac region; she also vomited. In August, 1896, December, 1896, and again in April, 1897, she had similar attacks, rather less severe than the first, and not attended with vomiting, but the bowels were constipated. During the last three attacks she was attended by Dr. Hall, and later by Dr. Hall and Dr. Wheeler, who described the attacks as being typical of appendicitis, fever, right iliac swelling, pain and constipation.
When examined, there was rigidity of the right rectus, tenderness at McBurney's point, increased resistance in the right iliac fossa, and on deep pressure an elongated hardish swelling, about the size of a little finger, could be made out.
Operation was undertaken on June 1st, the peritoneum being opened by the usual incision. The appendix was
•Prom notes made by Mr. F. A, Watkina, Resident Medical Officer.
IS^SSTu^' APPENDICITIS, 86
placed superficically, greatly inereased in size and buried m omental adhesions. There were signs of recent peritonitis. The adhesions being freed, the appendix was ligatured near its base and removed. The stump was touched with a drop of pure carbolic acid, sutured and then invaginated into the ciecum. The peritoneum was closed by a continuous catgut suture, and then the skin and muscles united by silkworm-gut suture, and gauze dressings applied.
The appendix presented the usual appearance found in catarrhal appendicitis; there was no stricture or concretion. The wound was dressed on June 9th, and found aseptically healed. The temperature only reached 99° on the 1st and 8rd days of the operation. She left the hospital on June 19th, eighteen days after the operation, wearing an abdominal belt. She was seen in October, 1897, when she was well and strong, and had a sound cicatrix. She had had no pain since operation.
Case VI. — Recurrent Aj^endicitis ; operation during quiescent period ; recovery.
On October 20th, 1897, I saw, in consultation with Dr. Vincent Green, of Wimbledon, Miss Dorothy C. »t. 18, when the following history was elicited. In 1892 she had a severe attack of peritonitis, for which she was laid up in bed a month, and remained delicate all the winter. Since this attack she has had, off and on, when run down or from some slight error of diet, attacks of abdominal pain. The abdomen has also, since 1892, been sensitive to touch and has been tumid and distended. The colic would be so severe that she must either lie down or lean over the back of a chair. She is very liable to get attack of indigestion. In the beginning of 1897 she had a slight attack of perityphlitis, keeping her at home a week. Whilst on a holiday in North Wales, in August last, she had a severe attack of peritonitis. A note from a medical man who saw her in consultation stated that she then suffered from appendicitis, that perforation and a limited abscess had followed on this occasion, and that the abscess had discharged through the bowel ; and further, an operation was advised. She made a slow convalescence and had not at the time of OUT eonsultaton returned to school.
D-2
S6 APPENDICITIS. ^^Sl^j^'!^
Be?iew, Jan. 1, 1896.
When examined, the abdomen was certainly tumid, but there was no thickening to be made out in the right iliac fossa ; there was some doubtful tenderness at McBumey's point.
Operation was undertaken in the early morning of November Ist, the abdomen being opened by the usual incision ; no muscular tissue was cut, the fibre separating readily. The appendix was easily found and traced into the subcsecal fossa, where its bulbous end was buried in adhesions. After removal the stump was invaginated into the caecum, the mucosa being first scraped away. The wound was closed by silkworm-gut sutures. The appendix was 8^ inches long, with thickened walls ; its canal was patent to within fth of an inch from its extremity, where there was a stricture. The extremity was bulbous, with a dilated cavity, and at its extreme end perforation seems to have taken place, and here the most firm and extensive adhesions were found. The mucosa was thickened and in places considerably injected. The canal contained fseculent mucus. The evening of the operation the patient was ordered belladonna. She was bright and free from pain, and on November 5th the bowels were relieved by an enema. The first dressing was done on the 9th, the wound being perfectly aseptically healed and three sutures removed, the rest being removed on the 11th. The patient was up on a couch on the 16th, and was sent to her own home on November 20th. The highest recorded tem- perature was 99*8° the evening of the operation.
Case VII. — Recurrent Appendicitis ; operation during quiescent period ; recovery,*
Mr. E. J. E., 8Bt. 27, was, on November 24th, 1897, sent to me by Drs. Burwood and Searson, of Ealing, for an opinion as to the propriety of operation. The patient, a well developed man, had enjoyed excellent health till the spring of 1893, when, whilst he was working in the woods and lumber camps of Canada, he was seized with severe pains in the right iliac region. He was admitted to the Homoeopathic Hospital, Toronto, under the care of Dr. Hall, when a diagnosis of typhlitis was made, and he was kept under treatment several weeks. In the
♦ Prom notes taken by Mr. P. Higrgring, Resident Medical Officer.
^S^^arSSt' APPENDICTTIS, 87
summer of 1894 he again had a slight attack, and off and on afterwards he had what he called frequent reminders of pain. In February, 1897, he had a severe attack again ; this time, he was away from hospital accommodation, in Southern Ontario, and under allopathic treatment. The pain was most acute, and for a few days he was so seriously ill that an immediate operation was contem- plated. Since then he has had a great many attacks of pain, and cannot work for long or take any long walks without pain coming on. He has been obliged to give up work, and has come to this country for advice. He has been keeping very quiet since he came home, and he is at the present moment quite free from pain.
A careful examination revealed nothing especial about the right iliac fossa beyond rigidity of rectus muscle, and some tenderness on deep pressure. Operation was advised on the history of the case. He was admitted into Bayes ward, under my care, and submitted to opera- tion December 7th.
The usual incision was made. The abdominal wall was thick, muscular and rigid. The caecum was bound down by adhesions. The appendix, which was very long and thin, was attached by firm adhesions to the caecum behind, and in front adhesions anchored it to the brim of the pelvis ; after curling behind the caecum, it passed directly backwards, to be attached very firmly to the peritoneum overlying the psoas muscle. Numerous adhesions were peeled off, and some were ligatured, there being more than usual haemorrhage. On amputation, the pouting mucosa was touched with pure carbolic acid. The stump was invaginated into the caecum. To gain better access to the appendix the wound was enlarged by a vertical incision downwards from the middle of the lower flbap. Silkworm-gut sutures were used. The operation was somewhat unusually prolonged, owing to the difficulty in freeing the adhesions.
Belladonna and mercurius cor. were ordered. The temperature rose during the first twenty-four hours to 100^, but soon fell to normal. The wound was dressed on the eighth day, and found aseptically healed. The patient will be leaving the hospital this week (December 20th).
88 SURGICAL CLINIC. ^^L^SSTlSfi!
Beview, Jan. 1, 1806.
NOTES FEOM MR. WRIGHT'S SURGICAL CLINIC AT THE LONDON HOMOEOPATHIC HOSPITAL.*
I. — Posterior Urethritis : Its Diagnosis and Treatment.
Gentlemen, — This patient has suffered from a slight gleet for many years as the result of an attack of gonorrhoea. He has been treated at other hospitals for this condition, and has had catheters passed to dilate a stricture which was said to be present. He says that he has a gleety discharge from the urethra, which at times becomes thick, and can be " milked '* out from the deeper parts. The urine is often cloudy. There is some smarting and stinging during micturition at the base of the bladder, and at times pain at the end of the penis. His general health is good so long as the bowels act regularly, but there is a tendency to constipation. Examination shows the penis small in size, with a much constricted meatus, which only admits a No. 5 English catheter. This passes the rest of the way easily without obstruction, but causes some pain as the deep urethra is entered. This pain lasts some time, but is relieved by making the patient hold the end of the penis in water comfortably hot. (This plan is a good one, and may be made use of to allay dysuria of cystisis and prostatitis, the patient holding the penis in hot water whilst he is micturating).
Examination of the rectum shows nothing abnormal in its mucosa, but the prostate is decidedly tender and perhaps a little larger than natural.
The first treatment to be adopted here is to slit up the meatus. Such a narrow meatus will keep up a gleet just as much as a narrowing of the deeper part of the urethra by a stricture will do the same, and with its cure the gleet will much diminish. The meatus can be incised towards the frenum with a meatotomy knife without an anaesthetic, and with very little pain to the patient if properly done. Some gauze must be inserted between the edges of the cut to prevent union, and in a week the parts will have healed, the patient being instructed to pass a bougie every day. Further 1 ment can then be adopted.
♦ One of the series of Post-srrBdnate Lectures.
SSS^j^fHS?*' SURGICAL CLINIC. 39
Bsfftev, Jan. 1,
The next patient is complaining of exactly the same symptoms as the former one, but in his case the meatus is normal, so we can proceed to examine him, as we should have done in the former case, had the meatus not needed treatment first.
The first thing to do is to apply the *' two glass test." The patient passes water into two separate glasses for examination. The yrine thus passed is found to contain long thread-like bodies (" tripper faden " of the German authors) which gradually sink to the bottom of the vessel. If the first sample only contained these, and the second was free, we can diagnose that the anterior part only of the urethra is affected, the posterior part being free. The first gush of water washes them out, and the second part is clear. You will remember that gonorrhcea starts at the meatus and spreads backwards, and may not affect the deeper parts, or may remain there after the anterior part is cured.
To diagnose a posterior urethritis, that is to say a urethritis of the prostatic inch behind the triangular ligament, we should first pass a catheter down to the bulb, u€,, about five inches do^vn, and wash out the anterior urethra through this. This is easily ac- complished by means of hydrostatic pressure, the fluid ruiming out at the meatus if the catheter be not so large as to quite fill it, as it cannot pass the compressor nrethrse muscle which surrounds the membranous portion and acts as a stop-cock at this point. The anterior urethra being thus cleansed, make the patient pass water again into two glasses. If the first is cloudy and the second clear a posterior urethritis is present, as the first gush has washed this part clean, and the rest that follows is unaffected.
It often happens that the second portion is also cloudy or contains pus. This means one of three things : First, that cystitis is present, which can usually be diagnosed by its special symptoms ; or, secondly, that pyelitis is present, which can also be diagnosed by its symptoms and microscopic examination of the urine ; or, thirdly, that the turbidity arises from mucus or pus originating in the posterior urethra and flowing back into the bladder. This is quite feasible, since the contraction of the compressor urethrse is stronger than that of the sphincter of the bladder, and the former prevents the
40 SURGICAL CLINIC. ^^L^jST^''
Review, Jan. 1, 1808.
discharge coming forward, and so it has to flow back- wards into the bladder, and thus mingles with the urine. In this case, after washing out the anterior urethra, the contents of the first glass only were cloudy, and the indications are plain that we have to deal with a posterior urethritis.
We will now pass a bulbous bougie to ascertain whether there is any stricture. These bougies are all the same size in the shank; but the bulbous part^ which is somewhat conical in shape, is made in different sizes. The meatus of this patient will admit a fairly large-sized one — a No. 8 English — and it passes as far as the triangular ligament easily. On withdrawing it no obstruction is met with. If there had been a stricture, the blunt part of the bulb, in withdrawing the instrument, would have caught in it. These instruments are much more certain in finding out a stricture than sounds, for the latter will often pass a stricture of large calibre, that is one which is not a tight one, without giving any sense of obstruction, but a bulbous bougie will catch in it as it is being withdrawn.
We may now conclude that there is no stricture, and that we have now only to deal with the posterior urethritis, which was diagnosed by the " two glass " test. Such cases are often extremely troublesome, and they may tax your knowledge and powers of treatment to the utmost extent. They usually need both local and internal treatment. Slight cases will often be cured by the alternate application of dry heat and cold to the deep urethra. This is done by using steel sounds, which are made hot by putting into hot water, and after one hot one has been passed a cold one should follow. This may be repeated several times at a sitting, and two or three sittings a week until the symptoms show a great im- provement, when less frequently will suffice. In passing these sounds do not use oil or vaseline as a lubricant^ but anoint them well with soap. This enables you to pass them easily in sufficiently moist, and, moreover, you will find^ that on withdrawing the sor" ^ ^, quantity of mucus will be clinging to it. Thus yoi ally cleanse
the urethra at the same time, and wit or vaseline
you will not accomplish this.
In more obstinate cases local me n will be
needed. One of the best applicationi solution of
iKSS^taTSa?** 8UB0I0AL CLINIC. 41
Btifkfw, J«B. 1, 188&
nitrate of silver. This should be made with an Ultzmann's catheter, which will deposit the lotion in the prostatic urethra. Begin by injecting about 6 or 10 minims of a solution of the strength of 6 gr. ad. ji. every other day, and increase this gradually, if need be, up to 40 gr. ad. ji. These stronger solutions should, however, be employed only twice a week.
It often happens that with this posterior urethritis there is some cystitis, and in such cases a vesical injec- tion of weak baro-glyceride lotion may be used at the same time.
So far as internal remedies are concerned, there are many which do gokxl, but the unfortunate part is that often, apart from the gleet, no other guiding symptoms are present. If tenesmus, strangury, &c., are present, cantharis is by far the best, but apart from this, iodide of sulphur, ferrum picricum, and capsicum are often of Bervice. I do not think I can give you any precise indications for your choice of these, but I would remind you that you can often gain a knowledge of the condition of the deep urethra by examining the mucous membrane of the anterior part by everting the lips of the meatus, and I think that if you find this part of a dull and more or less congested appearance, iodide of sulphur will most likely give benefit ; whereas, if it is pale, the ferrum salt will do good. Capsicum is usually best in alcoholics. Thuja is said to be good, but so far in my own practice it has been a failure for the chronic con- dition, and I never now employ it.
n. — On the Treatment of Old SintAse$.
Most of you have, ere this, found how difficult it often is to get a deep chronic sinus to heal up. I have found this also, but I think that I have also had con^derable success in certain cases by treatment upon definite lines. 1 have certainly been able to cure, in not a few instances, cases which have previously had much treatment with- out permanent benefit, and as the plan may be useful to you, I will show you how it may be carried out.
This patient has a sinus in the lumbar region, the result of an operation some years ago on the kidney. He says that it will not heal, and that a quantity of pus comes away. On probing, the sinus bleeds a little ; a thin probe goes in about two inches. No dead bone can
42 SUBQICAL CLINIC. "^^Z^T^
Beview. Jaa. 1, 16B6.
be felt. The walls of the sinas grate somewhat as the probe passes in, showing the presence of a good deal of fibrous tissae around. The first case in which I had a signal success in the kind of treatment I am going to relate, was one of a similar nature to that under treat- ment. The patient was a woman who had two calculi removed two years previously from the left kidney, and a sinus had formed after the operation and had refused to heal; a large quantity of pus came away, and so weakened and troubled the patient that she was advised by the surgeon who had done the operation to have the kidney excised. This she refused to do, and con- sulted me with a view to a cure without operation. I did not hold out much hope of doing this, but I was gratified when the sinus healed up rapidly as a result of the treatment adopted. I have treated many cases since then, and I must confess that I have not cured all. One thing I must tell you, that you need never expect to cure those cases dependent upon necrosed bone or other foreign body until the offending substance has been removed.
Now, if you study the pathology of a sinus you will readily have a clue to the method of healing it. To this end let us mentally lay open the sinus and see what we have to deal with. First there is around the part which immediately abuts on the skin a slight covering of epithelium. This is continued from the skin down into the sinus, but stops after a short distance. Next, the remainder of the floor is formed of more or less unhealthy granulation tissue lying upon a bed of dense fibrous tissue.
Now each of these elements have to be to some extent removed, or replaced by more healthy material, before we can expect healing. How is this done in other parts of the body ? If we compare this condition of things with an ordinary callous ulcer of the leg, such as we meet with every day in the out-patient department, you wiU see that the two conditions correspond practically in all particulars, and what cures one will, if applied in a proper way, more often than not cure the other. In the case of a callous ulcer we exert pressure by strapping to get an absorption of the underlying fibrous tissue, and this being accomplished we apply some stimulating
MajjaiTHo»««^ SUBOICAL CLINIC. 48
B«ri«w. Jan. 1.
application to the surface, having first cleansed it and got rid of all unhealthy elements as far as possible*
The same steps must be taken in the case of the sinus. First, then, how are we to apply the pressure to the walls to get absorption of the fibrous tissue ? This may be done in the following way, namely, by thoroughly dilating the sinus with graduated probes until you can insert a laminaria tent along its whole length. The tent may be left in a day or longer, and' you will then find that half your difficulty is over, for the walls of the sinus will by that time have been rendered soft and yielding. This may be repeated if required, and in some cases it is only necessary to dilate with the probes without doing more. The pressure thus applied will cause much of the fibrous tissue to be absorbed, and healing will commence. We must now cleanse the lining of the sinus as far as possible. This is a matter which might present some difficulties. Of course, you may inject various anti- septics which are often sufficient, but lately my plan has been to inject as much as the sinus will hold of elixir of lactated pepsin, which is prepared by Parke, Davis & Co.* This contains pepsin, pancreatin, lactic acid, maltose and hydrochloric acid, and the digestive action of these is exerted upon the unhealthy elements contained in the sinus walls. This is left in for half-an-hour or so, and then washed out and lotio rubra injected. The applica- tion is now completed. This may be repeated as often as is necessary, but I usually find that one or two dilatations, instillations of the digestive fiuid two or three times weekly, and daily injection of lotio rubra, previously washing out with some weak antiseptic on the days when the lactated pepsin is not used, is the best
• More recently I have preferred the f oUowiDg preparation : — Twktk Diastase gr. j, Pepsin gr. i, Acid Hydrochlor. mix., Aq. Dest. fl. J x. Mix the water and hydrochloric acid by shaking well ; then add the pepsin and taka diastase and again shake well and pass through the Paetenr Chamberland filter.
The pepsin and taka diastase are prepared by Parke, Dayis & Co. I find the above a good lotion to use as instillations in very chronic otorrhoea with grannlations in the tympanum.
Bonghly speaking this is a 1-5000 solution of pepsin, and the hydrochloric acid is present to the extent of 0.2 % as in gastric juice. It is not neoesaary to filter the solution for treating sinuses.
44 CASE OF DIPHTHERITIC CROUP. ^'^i^jS?^
Beriew, Jan. 1, 1886^
method to porsae. If the epithelial layer has extended any considerable distance into the sinus, it will be necessary to remove this. This may be done easily after the dilatation by scraping with a sharp spoon, or the application of nitrate of sUver or sulphate of copper, or cocaine may be injected, and the mouth of the sinus freshened up with a tenotome. Lastly, I should mention that to all my patients I give silica 8 trit. or nat. silicosim 2x dil. at the same time as the above treatment is being carried out. The above method is, I believe you will find, often as rapid in effecting a cure as completely laying open the sinus and allowing it to heal up from the bottom. At any rate it can be carried out by the patient, with occasional supervision by the medical man, and there is no necessity for lying up, an advantage which most patients will be glad to avail themselves oL
CASE OF DIPHTHERITIC CROUP SUCCESSFULLY TREATED.— ANTI-TOXIN USED.
By H. V. MuNSTEB, M.B., CM.
As every case of diphtheria treated by anti-toxin is of interest, as tending towards establishing or otherwise the usefulness of the treatment by this method, I submit the following case to the readers of the Review : —
Mabel H., set. 4, was seen by me for the first time on 19th October, at 10 p.m. Child was then labouring with loud stridulous breathing, accompanied with retraction of the lower ribs and strong efforts of the muscles of forced inspiration with each breath. Exami- nation of throat showed tonsils a little enlarged, but no soreness of the throat was complained of, and no false membrane visible.
Temperature not elevated. Pulse good. No cyanosis or lividity.
Ordered steam kettle at once, and put child on spongia ^ every hour.
As case seemed urgent, Dr. Purdom was called in the same night, but we decided to wait till morning and note the effects of treatment before contemplating any operation such as tracheotomy.
20th October. Child much the same. Retraction of ribs even more marked. As case was urgent. Dr. Pur-
SUSSrSriS^ CASE OP DIPHTHERITIC CROUP. 46
dom came again, and we decided to call in a local sargeon, who did not feel jostified in operating, bat advised an emetic, greater concentration of vapour from steam kettle, and free stimulation. Glands of neck enlarged, but as throat is still clear the case is regarded as simple croup. This treatment, along with spongia <^, and later aeon., gave some temporary relief to the breathing. Temp. 100.6^ F. m afternoon.
Digestive system in good order and child taking nourishment well and freely. Breath sounds distinctly audible at bases of both lungs, where some coarse crepitations can be heard. There is no dulness on percussion. Child perspires freely and sleeps a good deal.
2l8t October. — ^About the same. Temp. 101® F. Pulse 180 to 150, brom. 8x, sang. Ix, every hour alt. Bromine put into steam kettle instead of iodme.
22nd October.— Child complains of throat. On exami- nation both tonsils are seen to be covered with false membrane.
Merc. bin. 2x, brom. 8x h. 1 alt. Later on mere. cy. 8x was substituted for mere. bin. 2x.
At 4 p.m. Dr. Purdom saw the child. Temp. 102.7^ F. Great amount of loose rattle in throat, and of moist sounds at bases of lungs. Retraction of ribs marked. Pulse 160.
The case being now considered diphtheria and unlikely to recover, we injected 1,500 units of anti-toxin in right interscapular region.
At 10 p.m. child distinctly relieved. Temp. 100.6^. Pulse 160. Respiration still very stridulous. Merc, cyan. 8x gtt. ij. h. 2.
October 28. Much less rattle in throat. Still some retraction of lower ribs. Pulse 144. Pulse was almost absent on inspiration. Temp. 99.5^. Still membrane on both tonsils. Throat being swabbed with boro- glyceride.
At 4.30 p.m. Dr. Purdom again saw patient, and another injection was given in left interscapular region of 1,500 anti-toxin units. Red blush over site of yester- day's injection. Very few moist sounds at bases of lungs now. Temp. 100.6''. Pulse 150 at time of injection.
At 9.35 p.m. less retraction. Stridulous noise less marked. Relief seemed to follow injection ahnost at
46 CASE OF DIPHTHERITIC CROUP, "^SSi^SSTS?
Bariew, Jan. 1, 18B6.
once. Mother observes that child was very restless after both injections. Temp. 99^ F. Pulse 150. Child more eager for food.
Examination of urine reveals a good deal of albumen. No tube casts, but a few red blood corpuscles in deposit. Continue mere. cyan. 8x.
24th October. Child decidedly improving. Evg. temp. 99.4° P. Pulse 132. Child drowsy all day , but had slept little during previous night.
25th October. Still improving. Stridor not yet absent. Merc. cy. 8x.
26th October. Bespiration almost nozimal. Temp, normal. Pulse 124.
Merc. cyan. 3x, gtt. ij. Liq. strych. phos. ^^ gtt. j„ every two hours alt.
From this time on child steadily improved. Still a trace of albumen present in urine on 1st November. Attendance ceased soon thereafter.
There are several points about this case which call for a few remarks, and which appear to me to speak in favour of the anti-toxin treatment in general. Although the diagnosis of diphtheria was not confirmed by bacteriological examination, still there was very con- clusive clinical evidence that the disease was of that nature, the prolonged stridulous dyspnoea without any marked intermission, the false membrane on the tonsils, and the albuminuria all pointing strongly in this direction.
Until the anti-toxin was used the whole progress of the case appeared to be downwards, although the usual treatment by steam inhalation containing antiseptics, emetics, and homoeopathic remedies had received a fair and continued trial. Beyond a little pain at the time of the injections, no inconvenience was met with in the subsequent course of the case which could be attributed to the anti-toxin, save, perhaps, a general cutaneous rash, not unlike that of scarlatina, which appeared about two days after the last injection. The effect of the injections appeared to be rapidly beneficial, as seen by Ml of temperature and relief to the breathing, even although the anti*toxin was used so late in the case, for there was a history of the disease being present from 15th October.
One might be permitted to add that in considering the merits or demerits of a method of treatment, besides the
SSSSrJSTSl?^ HYOIBNB OP LYING-IN ROOM. 47
important consideration of statistics^ sorely the effects seen at the bedside when cases are carefully watched should carry some weight. When one sees cases going from bad to worse suddenly take a decided turn for the better, after a new and recognised method of treatment has been introduced, it surely is a strong presumptive indication that the treatment has been beneficial, and moreover that we are justified in giving — ^nay, even called upon to give trial to such treatment in serious cases which do not respond early to other methods. I imagine that by carefully watching cases, and by selecting the suitable remedy at the right moment, results will be attained which will be better than those to be got by adopting any one method universally. Many cases are serious from the outset, and by all means let an ti- toxin be used here ; but where cases are mild from the outset they usually respond at once to the usual homceopathic reme- dies, and here it seems to me unnecessary to resort to a painful, expensive, and cumbersome method like injec- tion of anti-toxin.
THE HYGIENE OP THE LYING-IN ROOM. By W. M. Stobrab, L.R.C.P. and L.R.C.S. Edin.
Senior Physioian to the North of England ChUdren's Sanatorimn ; PhyBician to the Soathport Hydropathic Hospital.
It has long been a dictum of mine that no woman's toilet equipment is complete without a deep sitz bath.
Nothing is more generally convenient for ablutionary purposes, and nothing more comforting and even remedial in many of the various ailments, not only of menstrual life but also of pregnancy. A hot or warm sitz bath can seldom do any harm, if not continued over 10 minutes, and most often it works a great deal of good.
These few remarks are preliminary to an account of how I usually treat my lying-in cases.
Supposing the labour to be a normal one, the patient, as soon as everything about her is clean and tidy, is lifted gently into a sweet clean bed. She is then enjoined to rest, and the nurse performs the usual attentions.
After about the first 24 hours I direct the patient to get up every morning and evening for about 15 minutes (never longer) and sit in a hot 90-95° sitz bath, oarbolised if need be, and be sponged down while in it and given a
48 CLINICAL NOTES. "SSiL^SH?^
Beview. Jan. 1, 1886.
comfortable wash. If necessary, bnt practically it is seldom required, the vaginal douche may be used just before coming out of the bath. Any clots there may be generally come away while sitting in the bath. The patient puts on clean linen and binders, and gets into clean sheets — the bed having been well made while she is in the bath.
This is done regularly night and morning (gradually reducing the temperature of the bath to about 80^ before coming out) for a week, when usually the patient strongly resents being kept in bed any longer. I try to keep her quiet for another week. I have followed this practice for eight or nine years, and have never had any mishap.
The pleasure of the bath, the perfeet cleanliness ensured, and, above all, the delightful restfulness which generally follows, have, often been expatiated on to me by grateful patients.
The consequence is, my patients do not come out of their lying-in chambers looking like &ail pale lilies, but usually as ruddy and hearty — if not heartier — than when they went to bed.
There is only one warning note to add. I have observed that women treated in this way generally con- ceive again at the very first opportunity.
Southport, October 10, 1897.
CLINICAL AND THEEAPEUTIC NOTES OP EECENT CASES.*
Eeported by Dr. Midoley Cash, Torquay.
Two Stannum Cases.
I. — Mrs. A., set. 48, wife of a clergyman, ordered
abroad by Dr. D P , who told her she was
threatened with Tubercviosis, and that the right lung was affected, tubercle bacilli having been found in the sputum. Severe night cough, spitting up much blood- streaked mucus, constant sweating, and considerable loss of weight had appeared lately.
• Notei of ,«;«■ aw invited for this depurtment They should be addzessed to " Dr. Ozd, Boumeiiumth."
MoaeUjJtoaoD^ CLINICAL NOTES. 49
B«fl0V, Jan. 1,
Being an old patient of mine, her haaband wrote to me in much alarm about his wife, and asking for remedies. I sent her stannum 8x ; 3 grains to be taken every three hoars daring the day and 8 drops of hyoscyamas at bedtime, to be repeated every two hoars through the night if awake and coughing.
In ten days he wrote that the medicines had certainly done his wife good, and it was remarkable to him '* how much more good the homoeopathic treatment does than the best allopathic."
The cough entirely ceased, she slept well, gained weight, and in six or eight months became comparatively strong and healthy.
n. — Mrs. B., set. 40. A tall emaciated worn-out woman» the wife of a labourer. Has been in ill health and anaemic for some years. Got a chill a week before she was seen and developed a pneumonic patch at the apex of the left lung. She was expectorating copiously a frothy blood-streaked mucus, the temperature being about a degree above normal.
Ant. tart., bryon., phosph., silic. and china were given in the 5 months that followed, with perhaps some amelioration of symptoms. At the end of this time I found her general condition lower. Examination revealed a cavity in the left lung, with tinkling and amphorid breathing. Expectoration profuse, stringy and foetid. Terebine inhalations improved the last- named symptom. A course of stannum was now pre- scribed— 2 or 8 grains of the 8x trituration being given three times a day. This was persevered in for five weeks. At the end of this time examination of the chest showed improvement. The cavity in the lung seemed drying up — <)nly a slight tinkle heard, and amphoric resonance fEonter. The expectoration and cough were much reduced. She now feels stronger, and is able to do some of her household work. In short the disease which was making rapid progress was arrested for the time. The patient lived for over two years afterwards, the stannum a second time during that period averting a farther attack, which threatened to be speedily fatal.
Vol. 42, No. 1.
Mnv 5 T^io
V
Notes of Gases treated by Dr. Mageechnie at the Bath Homoeopathic Dispensary.
Eczema. — Croton Tig,
Emma W., set. SO. Has eczematous patches at bends of elbows, which crack and weep, causing much irritation. The itching is worse at night and after food and after washing. Bowels costive with large difficult stools. Otherwise healthy, urine and menses as usual. During the first two weeks she received rhus, cantharis, and bryonia. The latter relieved the constipation, but the eruption continued to spread and appeared on the face, the irritation being constant. Croton Tig. 6x was now ordered. The itching remained the same and even increased the first week this was given, but the patches began at once to decrease in size, especially on the face. The following week the irritation had almost ceased, the face was clear, and but little remained elsewhere. Croton was continued, and the case shortly reported cured.
Pemphigus, — Rhus Tox.
George G., »t. 6 years. Has a bullous eruption on scalp, fkce, neck, wrists and other parts. This has existed for some time and is still coming out, the older bullae having dried up and leaving black crusts. Child well nourished and otherwise healthy. Considerable irritation and heat about spots. Ordered Bhus Tox. 8x. The irritation subsided during the first week. No fresh places occurred, except in the scalp where there was a fresh outburst, in other parts eruption was rapidly fading. To continue rhus. In six weeks the lad was cured, the scalp being the last part to recover.
" Uricacidcemiay — Qlonoiriy Lycopodium. Louisa S., 8Bt. 23 years, housewife. For some time had suffered from headaches at nape of neck, aggravated on stooping. The pain is throbbing and accompanied by flushings and heats. Bowels confined; she has blind piles. Urine now copious and free, but sometimes thick with pink deposit. She feels heavy and listless, and often has indigestion ; catamenia irregular, is worse at periods. Ordered glonoin 6x. In four days the headache was better and bowels relieved, and in a week pains had ceased. She was generally improved, but now complained of fulness and distress after food, with abdominal
SsS'jSTSS^ clinical notes. 61
BeYfew, Jan. 1, 1808.
flatulence and deposit of pink urates in urine. Lyeopodium 6x was now given. This relieved all the symptoms described. Patient now acquired a specific metritis and diecharge, for which she remained under treatment for three months, but there was no return of previous symptoms of uricacidsBmia.
Choreic Spasm. — Cuprum. Mary T., set. 48 years, a shirtmaker. For some time has noticed spasmodic jerks of her neck, which twist the head round. They are now very frequent, chiefly affecting sterno-mastoid muscles. Catamenia ceased for six years, but she still suffers from flushes recurring at irregular intervals. Her bowels usually discharge three or four loose stools per diem without griping. Ordered cuprum met. 8x trit. In a week there was no improve- ment, except that the bowels moved once daily and stools were formed. As she complained much of frontal headache, worse by stooping, with increased flushings, a dose of lachesis night and morning was ordered, to continue cuprum t.d.s. In a fortnight there was marked improvement. Jerking of neck much less, headache better, and flushes almost ceased. She now complained much of distension and flatulence after food. To continue cuprum, with an occasional dose of carbo. veg. for the flatulence. The cuprum was continued for some time longer, and in another month the patient was reported cured.
Chronic Dyspepsia — Pulsatilla. Alice B., aet. 22 years, domestic servant. Complains of dyspeptic pains and tenderness at epigastrium after food, of six years duration. There are no other symptoms obtainable, bowels regular, urine and menses normal. Ordered pulsafcilla 3x. In a fortnight she reported " much better." To continue Pulsatilla. Patient did not return for 11 months, when she sought relief for other symptoms, having had no indigestion meanwhile.
Lichen. — Arsen. lod. Ada G., 8Bt. 11 years. An eruption of papules com- menced a month ago and now covers body. Much itching at night. Appetite good, bowels regular. Treated for ten weeks by sulph., apis and graphites, there was no marked improvement, the rash coming in fresh places
E— 2
62 BEVIEWS, ^C5.XT?ai^
whilst fading in others. It also changed in character under graphites, becoming squamous, each papule widen- ing out to a scaley patch. A fluent catarrh also set in, and the itching at night continued. Arsen. iod. was now ordered. In three weeks the irritation ceased, and the rash appeared better. Ars. iod. was continued. Shortly after the eruption vanished, and the cure has remained complete.
Urticaria, — Urtica Urens, Harriett H., set. 22 years, a dressmaker. For some days has had an eruption of urticaria on arms, chest and' shoulders. Severe irritation, especially in bed, though it subsides after a time and she then sleeps soundly. Appetite good, no indigestion ; bowels rather confined ; menses normal. Ordered urtica urens 8x. The rash subsided in a day or two, and there was no return.
Cephalagia. — Pulsatilla . Alice D., set. 19, dressmaker. Complains of transient pains, shooting through head, frequently recurring. They are aggravated by movement, not by stooping, and occur more often during morning. She has a catarrhal herpes at the angle of the lips. Appetite poor, cannot eat a hearty meal, constant uneasiness in bowels, which move moderately. Her sleep is disturbed by dreams, she has dyspnoea on ascending stairs. Ordered Pulsa- tilla 3x. In four days she sent for more medicine, being much better. Shortly after she reported herself cured.
REVIEWS.
T/w Fiamers of Homceopathy. Compiled by Thom.vs Lindsley Bradfobd, M.D. Philadelphia : Boericke & Tafel. 1897. pp. 677. To the ready pen of Dr. Bradford, author of the Iloiruzopatliic Bibliography of tlu United States, the profession and the public is once more in debt. We shall all agree with the opening lines of his prefeice, where he writes, ** the memory of men who have been instrumental in relieving human suffering is worthy of being preserved," In this collection of short biographies. Dr. Bradford enables us to fulfil, or fulfils for us, this desirable end. The material at his disposal has been very varied, and very diflBcult in some instances to obtain. Many well-known names are found in the list, and many
SS^SrnS^ MEETINGS. 68
Bevfow, Jaa. 1,
which the readers will probably meet for the first time. It is strange that in some instances so little is to be found in homoeopathic literature concerning well-known men, and in one instance — that of Stapf — me only information was drawn from an old book in the Surgeon-General's library in Washington. Of Hartlaub there is only a page and a hill.
The history of Friedrich Hahnemann, unlmown probably to most of the recent converts to homoeopathy, forms an extensive but gloomy contribution to the work. The story ends in sadness and mystery. The struggles and difficulties of the early disciples of homoeopathy were such that only men of strong purpose, high moral courage, and firm conviction could have battled against successfully. That they should have done so much good work both in their practice and in their provings of drugs in the face of such opposition and persecution as these short stories tell of, is remarkable, and should call forth our gratitude to these brave men. Dr. Bradford has done good service to us all in bringing them once more, and in a collected form, before us.
The second part of the work is devoted to the early practitioners of homoeopathy not directly connected with Hahnemann himself and his work. It constitutes the larger part of the book, and includes such men as Quin, Bubini, Ldon-Simon (pdre), Tessier, W. Wesselhoeft, etc. A few laymen, eminent in their enthusiasm, are also immortalised. We can assure our readers that they might often pleasantly while away half an hour at the end of a tiring day's work by turning over the pages of Dr. Bradford's latest achieve- ment.
MEETINGS.
BRITISH HOMCEOPATHIC SOCIETY. The second meeting of the session was held at the London Homoeopathic Hospital on Thursday, November 4th, Dr. Edwin A. Neatby (President) in the chair.
Dr. Harold Y. Munster, 8, Oakfield Boad, Croydon, was dected a member of the Society.
The President referred to the death of Mr. Hugh Cameron, the last of the original members of the Society, and, in con- junction with Dr. Dudgeon, a friend of the late Mr. Cameron's for fifty years, moved that a vote of condolence be sent to his widow and fiucoily.
The following specimens were exhibited : —
(1). Oongenital malformation of the heart with explanatory diagrams. (Dr. J. H. Bodman.)
64 MEETINGS. "dlw=5r;!lSl'
(2). A speoimen of adhesive pericarditis. (Dr. J. H. Bod- man.)
(8). A dilated Fallopian tube from a case of double hydro- salpinx. (Dr. Edwin A. Neatbj.)
Section of Qeneral Medicine and Pathology.
Dr. GoLDSBRouGH read a paper on The Diagnosis and Treat- ment of Brain Disease : with special reference to the conditions requiring surgical interference. In the paper the author dia- cussed the most important principles of diagnosis which can be used as guides to treatment ; he entered into the considera- tion of symptoms and their bearing on localisation. He thought that etiology was a factor worth attention, and that a pathological inference was important. He then entered fully into the applications of these principles in the diagnosis and treatment of concussion, abscess, tumour, aneurism and meningitis. He intimated when drug treatment was likely to be beneficial, and when surgical aid was likely to be necessary. He quoted a case where trephining for meningitis had been successfully performed.
Mr. Dudley Wright followed with a paper on Some Aspei^ts of Intra-cranial Dssease Viewed from a Surgical Standpoint, Tha diseases discussed were meningitis, intra-cranial suppurations, thrombosis of cerebral sinuses, intra-cranial haBmorrha^e, tumour of the brain and its membranes, and congenital mental defects. The main points in the diagnosis of these varied conditions were carefully pointed out, and the indica- tions for operation emphasised together with the best methods available. The paper was illustrated by lantern slides.
A discussion followed, opened by Dr. E. B. Boche and Mr. Knox Shaw, and continued by Dr. Galley Blackley, Dr. Day, Dr. Moir, Mr. Ashley Bird, Dr. Molson, Dr. Buh- FORD, Dr. J. H. BoDMAN, Mr. Johnstone and Dr. NeatbVp Dr. Goldsbrough and Mr. Dudley Wright replied.
The third meeting of the session was held at the London Homoeopathic Hospital on Thursday, December 2nd, 1897, Dr. Edwin A. Neatby, (President,) in the chair.
The Secretary announced that Dr. James Watson, 259, Smithdown Road, Liverpool, had been elected a member of the Society through the Liverpool branch. The following specimens were shown : — (1). Diphtheria bacillus (stained). (Mr. Johnstone.) (2). Diphtheria bacillus growing as agar-agar jelly inocu- lated 12 hours for a sore throat. (Mr. Johnstone).
(8). Tracheotomy instruments, table, etc., bed arrange- ments for nursing a case of diphtheria after trr -^-^-^^omy. (Sister Marion, Barton Ward.)
£:i£yjSTaf'' MEETINGS, 56
(4). A BfJ^imen of appendix vermiformis removed for relap- sing appendicitis. (Mr. Enox Shaw.)
(5). Two skiagrams showing needle in the hand, removed by operation. (Mr. Enox Shaw and Mr. Dudley Wright.)
(6). A calculus removed by supra-pubic cystotomy. (Mr. Dudley Wright.)
(7). Uterine tumour removed by abdominal hysterectomy. (Dr. Edwm A. Neatby.)
Section of Subgeby and Gynecology.
Dr. E. B. BocHE read a paper on The Surgical Treatment of Diphtheria^ with especial reference to the methods and anatomical relation of tracheotomy. He described the various steps of the operation, and gave hints as to the avoidance of difficulties that arise during the course of the operation. In the paper he wished to emphasise the point that an effort should be made to simplify the operation in every way as regards instru- ments, and the necessity for assistance, and that abandoning all questions of an operation '* high or low," we should free ourselves of this neecUess and embarrassing limitation and so act as shall enable us safely to place the incision and insert the tube at the point we may judge to be the best.
Dr. BoBSBSON Day read a paper on The Serum Treatment of Diphtheria. He first gave four cases which he had success- fully treated with the serum, the diagnosis being verified by the bacteriological test. He then considered the cases treated in the London Homoeopathic Hospital and the Sydney Children's Hospital, tables of statistics being thrown by the lantern on a screen. He considers the statistics most con- vincing of the efficacy of the serum treatment.
Dr. Byres Moir followed with a short paper on The General Medical Treatment of Diphtheria. He first referred to the increase of diphtheria cases in the London Homoeopathic Hospital during recent years. Jn the hospital the remedy chiefiy used had been mercury in the form of the cyanide or biniooide. He thought we had not the same success as some other observers had obtained. He discussed kali bichrom., Phytolacca, bromine and ammonia. With regard to laohesis and crotalus he thought more rapid action ought to be obtained by their subcutaneous injections. He considered local treatment important.
The discussion was opened by Mr. Dudley Wbight and Dr. Madden, and was subsequently taken part in by Dr. Hughes, Dr. Blackley, Dr. Cabfbae, Dr. Dyce Bbown, Dr. Epps, Dr. Seabson, Dr. Bodman, Dr. Goldsbbough, Mr. Johnstone, Dr. Stonham, and Mr. Enox Shaw. Dr. Boohe, Dr. Day and Dr. Moib replied.
56 NOTABiLu. -^^s^^ssriUSS:
Renew. Jaa. 1, 1886,
NOTABILIA.
FOLKESTONE HOMOEOPATHIC DISPENSARY.
Many old-standing charities last year (1897) suffered in con- sequence of the numerous appeals which reached the public for speciid ** Jubilee " help. The homoeopathic dispensary at Folkestone has been one amongst the number, and rather than allow themselves to remain in debt the managers decided to adopt the time-honoured plan of getting up a sale of work early last month. In addition to the usual attractions, an exhibition of models of beds, etc., showing " patients " under treatment for various ailments, formed a feature of consider- able interest. This "exhibit," from the London Homoeo- pathic Hospital, had gained prizes at the Chicago World's Fair and elsewhere ; its points of interest were described and explained by an experienced and amiable nurse told off for the purpose by the above-named hospital. On another page we have advocated an exhibition of espiit de corps amongst homoeopathic institutions, and we are glad to notice this as a practical example of one (possibly minor but nevertheless real) way in which the strong amongst us can help the weak.
We congratulate the authorities, and especially our friend Dr. Murray, on the success of the undertaking, and hope the funds and the publicity gained will free the dispensary from financial anxiety, until the growth of the charity again requires an appeal for help. The proceeds realised a total of £160.
THE ADELAIDE CHILDREN'S HOSPITAL. OPENING OF ISOLATION WARDS.
The Allan Campbell Buildings, or the Isolation Wards and Bacteriological Laboratory, of the Adelaide Children's Hospital, to which we have before alluded, were formally opened on Saturday afternoon, October 16, by Lady Victoria Buxton, Patroness of the institution. The ceremony was witnessed by a large, influential, and representative assemblage. Among those present were : — His Excellency the Governor and Lady Buxton, Miss Mabel Buxton, Major Guise, A.D.G., His Honor the Chief Justice, Right Hon. S. J. Way, President of the Hospital, the Hon. Dr. Allan Campbell, M.L.C., after whom the buildings are named, Mr. Walter Howchin, Secretary of the Hospital, the members of the Board of Management, several of the medical gentlemen connected with the institution, and many others. The foundation-stone was laid on December 12 last year by Lady Victoria Buxton. The building has cost about £5,000.
£SS'JET5S^ notabiua. 67
fi«new, Jan. 1,
The PBEsmcMT said: The building was not merely an ornament to the city. It was devoted to the glory of Ood, to the benefit of the siok children of South Australia. He purposely used the word children without any quaUfications as to rich or poor. No matter whether the child lived in a hovel, a cottage, or a mansion, if there were a fear that it was suffering from infectious disease it could be brought to this institution for the purpose of being watched and treated — in the case of people of competent means treated by the family medical man or such other professional skill as might be required, and in the case of the poor man's child being treated by the best medical skill available in the colony like the other occupants of the Ghildren's Hospital, without fee or charge or any other reward to the subscribers of the institution than the satisfaction of doing good.
We feel great satisfaction in recording the completion of this institution, and congratulate our colleague Dr. Allan Campbell on the success which has crowned his efforts. Dr. Campbell could have no more worthy monument and his merit has well earned the distinction he has gained.
HOMCEOPATHY IN PARIS.
Toward the end of last year, an unknown friend sent us a copy of Le Journal (Paris), relating the commencement of a discussion in its pages on homoeopathy, initiated by Dr. Flasschoen. We have not heard the conclusion of this, and should be glad if our correspondent would again commuuicato with us.
HOMCEOPATHY IN COOK COUNTY CHARITY HOSPITAL.
Whensveb homoeopathy has had a fair chance to demonstrate its virtues it has always shown itself, as a system of internal medicine, to be superior to any other method with which it has been brought into competition.
The mortality-rate in the homoeopathic wards of Cook Comity Hospital is three per cent, less than the mortaUty-rate in the wards where the patients receive allopathic or eclectic treatment. The figures were made up after an examination of the hospital records covering a period of five years and the treatment of 50,000 cases.
The superior resulte of the homoeopathic treatment, if the entire number of patients received the benefit of it, would be equivalent to the saving of 800 lives per year, or, in the five- year period, 1,600 lives.
In the treatment of tetanus, of pneumonia, and of typhoid, the homoeopaths in Cook County Hospital have always had a
68 NOTABILIA. '"^^'SS"?^.
Reriew, Jan. 1, 1896.
record markedly better than that following other methods of practice.
The favourable results of the five-year period are still maintained. — Medical Era, November 1897. Chicago.
HOMCEOPATHY IN TASMANIA.
A WELL-ATTENDED meeting of homoeopaths of Launcestoni Tasmania, was held in the lecture room, Mechanics' Institute, last October, when it was decided to form a HomoBopathic League, having for its objects the furtherance of the spread of homoeopathy and the defence from any attacks made upon that system of medicine, and to organise and keep its adherents in touch with each other. A large number of members were enrolled in the room, and much enthusiasm was evinced by those present.
A NEW SURGICAL SHIRT OR GOWN.
Mbs. M. J. Webb, of Clifton, has favoured us with model samples of a shirt and gown designed by herself to admit of easily reaching any parts of the patient's body for dressings, etc., with a minimum amount of moving. The full-sized garments were exhibited at the Queen's Hall last year, and may be seen at Weiss's, 287, Oxford Street. The usual seams of such garments are almost entirely replaced by buttons, which, however, lie on the top of the patient and cannot cause pressure. The garments are put on in the usual way and unbuttoned at any part as required. They may be made of linen, flannelette, or flannel, and they appear to us to be of undoubted value in surgical, obstetrical, and some forms of medical work. We have not, however, had an opportunity of seeing and using the full-size garments themselves.
A SOCIAL EVENING.
The present staff of the London Homoeopathic Hospital and a number of the old Resident Medical Officers met at dinner on Wednesday, 15th ult., at Eettner's Hotel, Soho.
The object was not business but pleasure. After a good dinner, in a comfortable well-lighted private room, a pleasant programme chiefly of musical nature was carried out, Dr. Bur- ford, chairman for the year of the staff meetings, presiding.
The meeting famished its own entertainment, no outside artistes being present. Dr. Galley Blackley and Mr. Dudley Wright, who have often on similar occasions won applause, surpassed themselves. One of Dr. Blackley's songs, a humorous student piece, composed by himself, but based on
SSSS'STfa?" NOTABILU. 69
B«fjew» Jan. 1, 1886.
the Gennan, was encored. Dr. G. E. Wheeler gave a recitation and a " reading " of his own composition which £airly '< brought down the house." Dr. Leo Bowse, Mr. Spencer Cox, Dr. C. E. Wheeler, delighted the company with their musical efforts, both vocal and instrumental. Dr. Burford, in some amusing rhythmical lines, touched upon the salient features of the work and disposition of some of his colleagues, and suitable speeches were made by Dr. Blackley, Dr. Hardy
g Bournemouth), Dr. Leo Bowse, Mr. Knox Shaw and Dr. Dyce rown.
The evening was voted a great success, and it is hoped that it will be repeated annually or biennially.
THE DISTBIBUTION OF THE HOSPITALS' BELIEF
FUNDS.
On the 9th ult., at the Westminster Hospital, Mr. G. A. Cross read a paper on the ExUtiny Syate^m of Distribution ; e.g., of the Hospital Sunday and Saturday Funds, &c. The paper was read at a meeting of The Hospitals Association, Mr. A. Cosmo Bonsor, M.P., Treasurer of Guy's Hospital, occupying the chair. In our next issue we hope to give an abstract of this interesting paper.
DBPBESSING EFECT OF SODIOM SALICYLATE.
Db. W. B. Bice writes to the British Medical Journal, Nov, 20, 1897 : — " An old lady lately suffering from symptoms traceable to the uric acid diadiesis bad intense inflammation and nocturnal pain in the tissues surrounding the first joint of the great toe and in the heel, with general oedema of the right foot. These symptoms rapidly subsided under treatment with colchicum and alkalies. Subsequently vague shifting pains of a rheumatic nature developed, and she took 10-grain doses of sodium salicylate every four hours. This was followed after the third dose by symptoms of the most alarming prostration, mental and bodily. The pulse became weak and compressible, and fell to the remarkably small number of 85 beats a minute. Her temperature also became subnormal. On stopping the salicylate treatment the symptoms rapidly disappeared, and the pulse became 80 per minute."
THBOW PHYSIC TO THE DOGS.
Thk Post-Graduate recalls the following story of General Sherman : He had been under the care of a physician for some time, when one day the general said ; ** Doctor, I don't seem to be getting any better for all your medicine." ** Well," replied the doctor, jocosely, '< perhaps you had better take
60 OBITUABY. "^a^Sr"?^
Beview, Jan. 1, 18B6.
Shakespeare's advice, and 'throw physio to the dogs'." ** I would, doctor/' replied the sick man as he turned his head on the pillow, '* I would, but there are a number of valuable dogs in this neighbourhood." — Med. Argtu, Oct., 1897.
OBITUARY.
THE LATE MRS. COOKBURN.
All those who were closely associated with the London Homoeopathic Hospital between 1870 and 1890 will share the regret with which we announce the decease of Mrs. Gockbum, who, during the greater part of that period was the Lady Dispenser of the Hospital. Mrs. Cockbum, whose strength failed rapidly during the past twelve months, died on Sunday, the 12th ult., from an apoplectic seizure, at her residence on the North Hill, Highgate, in her 71st year. Joining the hospital some years after the death of her husband, Captain Charles Cockbum, her considerable natural ability enabled her rapidly to perfect herself in the technical knowledge necessary for her duties, and the admirable manner in which she filled her important office during the time when the hospital was in course of development from a small institution into a con- siderable one, the perfect order which, by a rare combination of firmness and tact, she maintained in the department under her charge, made her a valuable member of the lay staff. Mrs. Cockbum combined a great charm of manner, with much force of character, and was beloved by a large circle of friends. Li the hospital, as a public charity, she took the deepest personal interest, and she added to its funds some notable donations, the result of collections. Mrs. Cockbum was therefore one of the most excellent lay officials that any hospital could have, and her retirement some years since was regretted by all. The interment took place in Highgate Cemetery, on Wednesday, the 15th ult., the hospital being represented among the mourners by the Sepretary- Superinten- dent, Mr. O. A. Cross.
ROBERT LUCAS CHANCE, Esq.
Bt the death on the 24th of November of Mr. R. L. Chance, Birmingham loses one of her most successful and at the same time one of her most generous citizens. Every institution in the city, which contributed to promote the welfare of the poor and needy, has, at one time or other, and many during a long series of years, derived signal advantages from the soundness of his judgment and the liberal distribution of his wealth. To
I^^Tui^ OBITUAKY. 61
the individaal poor of the city and district he also rendered much peonniary help. That he might be able to do so jadicioosly, he for many years employed a secretary, the greater part of whose time was occupied in the investigation of the afi&drs of the numerous applicants for his assistance.
To the Birmingham Homoeopathic Hospital, Mr. Chance has been a warm and liberal benefMtor and a member of the Ck)mmittee since the days, now forty years ago, when it existed merely as a dispensary under the medical charge of the late Dr. Fearon. While Mr. Ohance's charity began at home, it did not stop there. On the contrary. Homoeopathic Hospitals in different parts of the country enjoyed the advantage of his interest in therapeutics and his liberality.
During the last few months of his life, when suffering from the weakness consequent upon long illness, he exerted himself in efforts to raise the funds for the enlargement of the Birmingham Homoeopathic Hospital. This enlargement included an operating theatre, accident wards, private wards, suitable administrative offices, and additional quarters for the nurses. In order to carry out these improvements, the sum of £5,000 was required. Towards this amount, £1,000 (a legacy from the late Alderman Avery) was in hand, and generous promises of substantial help (initiated by the munificent offer from the Earl of Dysart) were received, amounting to a further £1,500, leaving about £2,600 to be raised.
The offer of Earl Dysart — a donation of £800, provided that ten times that amount was raised before the Christmas of 1897 — was made when his Lordship attended the Birmingham Musical Festival held last October, in aid of the funds of the General Hospital. Mr. Chance at once gave £250, and he devoted much of his time during the last month of his life to writing letters to his friends soliciting donations towards this object, and succeeded in raising the amount necessary to enable the Hospital Conunittee to fulfil the condition of Lord Dysart's generous proposal.
Mr. Chance's fatal illness commenced as the result of the shock he sustained on hearing of the sudden death at Nice, last July, of his brother, Dr. Frank Chance, whose name is well known as that of the translator of Virchow's Cellular Pathology, and more widely still as that of a Hebrew scholar of the first rank.
How great is the loss of such a man to his friends and fellow citizens can with difficulty be expressed. It is indeed a severe blow to a large family and numerous friends, among whom he ever reckoned his workpeople and dependents.
62 CORRESPONDENCE. "^^^fSTifMSe!
CORRESPONDENCE.
THE MODUS OPERANDI OF DRUG ACTION.
To the Editors of the ** Monthly Homceopathic Revieic,** Gentlemen, — The reference by Mr. Baist Picken to some points in my address at Bristol, calls for an acknowledgment of the continued interest he takes in the attempt to elucidate the modm operandi of the homoeopathic cure on the particular line that he has taken up. The short time allotted to an address prevented any criticism of the theories of homoeo- pathic action mentioned, and it is not with the intention of commencing a discussion on the subject, but rather with the desire of courteously recognising Mr. Buist Picken's labours on our behalf that I offer the following few remarks.
The laws of wave interference, which our friend pushes to the extent of explaining not only the homoeopathic cure as a principle, but the action of the small dose and the permanence of the homoeopathic cure, would, if they were proved to be able to do all that he claims, entitle him to the highesi; con- sideration. But I am obliged to confess, even after reading his latest utterance, that I do not quite see my way to accept- ing them as an adequate explanation of the case.
Some of the phenomena connected with wave interference seem to make equally for explaining the action of opposites as well as of similars, but in any case, the principle itself belongs to that category of mechanical laws from which it has been my endeavour to separate the vital activities. If we could bring about a synthesis of chemical affinities and physi- cal vibrations, we might, perhaps, obtain a tertium quid which would be more likely to represent the unique qualities of living bioplasm. We already speak of vital chemistry, and it is the hope of many physiologists that in the play of chemical attractions and repulsions we shall ultimately be able to dis- cover the secret of vitality. To try to bring down the complex nature of perhaps the highest form of force that is known to actuate matter to the level of simple vibrations of a merely mechanical kind, must in my opinion only end in failure. As an analogy only, whilst we are glad to impress into our service all the help that physical science affords, I am afraid it will carry us but a short way. As I said in my address, '< life is so unique a thing, with its powers of growth and reproduction, its reaction to stimuli, its capability of exhaustion and recu- peration, and its association with feeling and thought, that I am inclined to think it doubtful whether any pardlel to vital processes will be found in the world of physics."
As a matter of fact the movements of the bioplasm in the cell are not in straight lines, and exhibit nothing of the nature of physical vibrations, and they do not perpetuate
JSteSrSlTM^ CORRESPONDENCE, 68
theniBelyes indefinitely, but are self-contained, and their behayioor is more consistent with a higher form of chemistry than of mere wave motions.
Mr. Buist Picken, in his advocacy of the principle of wave interference as an explanation of homoeopathic cure, would seem to have almost come to the belief that this principle was not merely an analogy but an expression of the actual facts of the case. But he knows quite well that it is possible to express the ideas of one science or art in the terms of another witiiout in the least confusing the two, and therefore it is hardly necessary to remind him that whilst using the instrument of analogy it is desirable not to confuse the idea of vitaUty with that of physicid yibrations. Keeping, however, the two con- ceptions quite distinct, I would ask him to continue his studies, and if he can clear up some of the difficulties on the physiological side, as they present themselves to medical readers, I for one shall be very glad to hear what he can say in elucidating the modus operandi of the homoeopathic cure by analogies drawn from the realm of physics, even if they are only analogies, between two essentially disparate sciences.
FaithfuUy yours,
Birkenhead, Pbtbr Proctor.
COLLECTIVE INVESTIGATION OF DISEASES. To the Editors of tlie *^ Monthly Hnmaopathic Review.*'
Gentlemen, — The New Year is a time for the formation of good resolutions, and I am anxious to call the attention of your readers to the ScheduLes which have been drawn up by the British Homoeopathic Society for the investigation of the five diseases: enteric fever, acute rheumatism, pneumonia, diphtheria and scarlatina.
Many have been applied for, but it is hoped that all will take part in this work, which will do more than anything else to show the superiority of homoeopathic treatment over all other methods.
Recent and reliable statistics are what are now required, and if all your readers would contribute their cases we should soon have the necessary material to hand. The best way to use the schedules is to have them at the bedside and fill them up as the case progresses, and not to leave them till the patient gets well. Used in this way they will be a help and source of interest to the doctor.
I shall be happy to send a set of schedules to all who may apply for this very useful New Tear's gift, which the British Homoeopathic Society offers to all who practise homoeopathy. Yours, &c..
J. BoBERsoN Day, M.D. Lond*
December 20th, 1897.
64 CORRESPONDENTS. "^b'^^w^jST?^
Beriew, Jan. 1, 1886.
NOTICES TO CORRESPONDENTS.
*^* We cannot undertake to return rejected manuseriptt,
AuTHOBS and Contbibutobs receiving proofs are requested to correct and return the same as early as possible to Dr. Edwin A. Neatby.
London Homcbopathio Hospital, Obeat Obmond Stbeet, Bloohsbuby.— Hours of attendance : Medical, In-patients, 9.30 ; Out- patients, 2.0, daily; SUBOICAL, Out-patients, Mondays, Tuesdays, Fridays and Saturdays, 2.0 ; Diseases of Women, Out-patients, Tuesrlays, Wednesdays and Fridays, 2.0 ; Diseases of Skin, Thursdays, 2.0 ; Diseases of the Eye, Thursdays, 2.0 ; Diseases of the Throat and Ear, Wednesdays, 2.0 ; Diseases of Children, Mondays and Thursdays, 9 A.M. ; Operations, Tuesdays, 2.30 ; Dental Cases, Thursdays, 9 A.H.
BOOKS RECEIVED.
A Manual of Genito- Urinary and Venereal DUea^es^ by Bakk Q-. Carleton, M.D. ; with Venereal DUcases of the Eyc^ by Chailes Deady, M.D. ; and Veswal Calculnjt and Urethrotomy^ by William Francis Homan, M.D. New York. Boerioke, Rungon & Emesty. 1895. — Difftretitial JDiagnotU and Treatment of Coma — A Chart. Arranged by Geo. A. Huntley, M.D. Huntley Bros. Weston-Super-Mare. — The JTomaopathie World. December. London. — Mediral Beprints. December. London. — The Cheviiat and Druggist. December. London. — TJie Calcutta Journal of Medicine. November. — Indian Homceo- jmthic Review, November. — ReU and> Raget (Prince and Peasant), Calcutta. November 20th. — Daily Telegraph. Launceston, Tasmania. October 22nd. — The Homoeopathic Eye^ Ear^ and Throat Journal, December. New York. — Tlie Medical Times. December. New York. — Tlie Neio England Medical Gazette. December. Boston. — Medical Century, December. New York and Chicago. — The Jlomceojfathie Physician. December. Philadelphia. — The Hahnemannian Monthly. December. Philadelphia. — The Ilomceopathic Recorder. November. Philadelphia. — Homoeopathic Envoy. December. Lancaster, Pa. — Medical Era. November. Chicago. — Revue Ilomosopathique Prancaise. November. Paris. — Allgemeine Homdopathische Zeitung, December. Leipzig. — Leipziger Popular e Zeitxchrift fiir HomSopathie, December. — Revue ITomaopathigue Beige. October. Brussels. — Rivinta Omiopatica. September-October. Rome.
Papers, Dispemuur Beports, and Books for Beview to be sent to Ihr. Pope, 19, , Watergate, Grantham, lincohwhire ; Dr. D. DroK Brown, 29, Seymour Street, Port- man Square, W.; or to Dr. Edwik A. Nbatbt, 178, Haverrtock ffill, N.W. Advertiae- mentR and Bnmness oommunicationfl to be sent to Mesira. £. Oould & 8o«. 69. Moorgate Btreet, £.C. '
K^J^ThtSn^ THE CONSULTATION QUESTION. 66
THE MONTHLY
HOMCEOPATHIC REVIEW.
THE CONSULTATION QUESTION REVIVED.
It is now nearly fifty years ago that the British Medical Association, at what the late Dr. Gonolly termed that *' tamaltaous " meeting at Brighton, passed a series of resolutions denunciatory of homoeopathy, and of those members of the medical profession who practised homoeo- pathically. Of these, the third stated that it was ** derogatory to the honour of members of the Associa- tion to hold any kind of professional intercourse with homoeopathic practitioners.'* The fourth described ''three classes of practitioners who ought not to be members of the Association, namely : first, real homoeo- pathic practitioners ; second, those who practise homoeo- pathy in combination with other systems of treatment ; and third, those who, under various pretences, meet in consultation, or hold professional intercourse with those who practise homoeopathy."
Several instances have been recorded in our Review, since these resolutions were passed, illustrating how surgeons, acting in accordance with their instructions, have been guilty of gross inhumanity, not to say brutality. Time passed on, and, as it did so, Nemesis appeared ! The Lancet had declared that, '' under no circumstances whatever" ought a non-homoeopathic
Vol. 42. No. 2. F
66 THE CONSULTATION QUESTION. ^^^i^fFSbflflSs!
practitioner to meet an avowed homoeopathist at the bedside of the sick ; while in 1861 this same journal stated that for any one to do so on "the plea of humanity," was **a libel on that sacred name!" In the coarse of another eleven years, the Lancet had learned enough of the effect of these resolutions upon the general public to discover that, as the result of carrying them out, " the profession comes to be charged with littleness, and jealousy and illiberality." Consequently,, upon this discovery it tells its readers that " to refuse to apply the forceps or to practise version for a patient in extremis, because she has the misfortune to be attended by a homoeopathic practitioner, would be unworthy of any medical man who has the power to do such things." (Lancety August 3rd, 1872.)
The question, whether, either in a medical or surgical case, a non-homoeopathic practitioner could properly meet, for the purposes of diagnosis, a legally qualified man practising homoeopathy, on which the article from which the foregoing dictum is quoted is a commentary, is described by the writer to be "one worthy of con- sideration." " It is so," the article continues, "because every right-minded medical man must wish to reduce to a minimum the differences which hinder professional intercourse between the members of a liberal profession, or which raise up barriers that the public cannot understand or sympathise with. The latter point is one of great importance.'' (The italics are ours.) Thus we see that public opinion has its influence even upon so case-hardened a morale as that of the man, who, eleven years previously, could assert that for a non-homoeopathic practitioner to meet in consultation, for the purpose of devising plans for the relief of suffering, " one who practised homoeopathically " on the plea of humanity, •* was a libel on that sacred name."
Nine years later, one of the most distinguished statesmen of the Victorian Era lay a-dying. The physician attending him was commonly reported to be a homoeopathist. A Fellow of the College of Physicians (a non-homoeopathist) was summoned in consultation. After some demur he obeyed the summons. Great was the consternation in Pall Mall and at the offices of the British Medical Association ! Meetings were held and resolutions passed. One, of the
iKteSf^TiSwI*** THE CONSULTATION QUESTION. 67
members of the Lancashire and Cheshire Branch of the Association, was summoned to re-endorse the previous resolutions of the Association condemning homoeopathy and ostracising those members of the profession who practise homoeopathically. A resolution to this effect having been proposed, was met by an amendment, brought forward by Dr. H. Lowndes and Mr. Hake, to the effect that every member of the British Medical Association was entitled to the freest exercise of his own individual judgment in regard to the question of meeting in consultation gentlemen who practise homoeopathy. After a long discussion, 23 voted for the amendment and 26 against it. The amendment, being lost by so small a majority, ** the previous question " was moved and carried nem. con., and a second resolution declaring it to be inconsistent with professional honour and honesty for practitioners of medicine or surgery to meet homoeopaths in consultation was withdrawn !
Until within the last few weeks nothing has since been heard of the 1851 resolutions of the British Medical Association. Consultations between medical men who practise homoeopathically, and those who do not, have been increasingly numerous, and have abundantly proved that the profession of medicine, at least in its higher ranks, is reverting from the version of ** Medical Ethics *' promulgated by the British Medical Association to the Christian version of Medical Ethics propounded by Professor John Gregory, of Edinburgh, in 1772, who says : ** It is a physician's duty to do everything in his power, that is not criminal, to save the life of his patient, and to search for remedies from every source and from every hand, however mean and contemptible. This it may be said," he continues, " is sacrificing the dignity and interests of the faculty. Bat I am not speaking of the private policy of a corporation or the little arts of a craft, I am treating of the duties of a liberal profession, whose object is the life and health of the human species, a profession to be exercised by gentlemen of honour and ingenuous manners, the dignity of which can never be supported by means that are inconsistent with its ultimate object, and that only tend to increase the pride and fill the pockets of a few individuals."
Now, however, the subject has again been broached in
F-2
68 THE CONSULTATION QUESTION. ^ite^l^wflS^lflSBL
the British Medical Journal (December 18th, 1897), by Mr. Jessop, of Leeds, the Senior Surgeon of the Infirmary of that city, in the following letter : —
" Consultation with Homceopaths.
<' Sib, — What is the attitude at the present time of the profession towards homoeopathy ? I ask this question, because I have been credibly informed that a London consultant, bearing a well-known name, an equally well-known Manchester consultant, and an eminent Bradford practitioner, have severally of late been acting in consultation with one who for many years has represented homoeopathy in a large manu- facturing town in Yorkshire. The relations between regular (sic) practitioners and those professing homoeopathy have been discussed again and again, but so far as I know not for a decade or more, and as we live in an age of change, it may be useful — it certainly will be interesting — if the opinions of some of the leading representatives of tbe profession upon the question could be ehcited. — I am, etc., T. R. Jessop.
" Leeds, December 6th."
The Journal of the following week appeared without any response being made to Mr. Jessop's appeal for *' licht, mehr licht.''
In the opening number of the New Year, Mr. W. Gilchrist Burnie, of Bradford, who, if not ** one of the leading representatives of the profession,'* is probably Imown to persons living in his immediate neighbourhood as a more or less estimable general practitioner, vouch- safed his assistance to Mr. Jessop in endeavouring to solve the knotty problem, which, considering that " we live in an age of change," had somewhat troubled him of late. The Bradford G. P. writes with a degree of confi- dence that Mr. Jessop must have felt to be reassuring. He says :
<' As to what is the attitude of the profession, as a whole, on this matter, there can, I think, be little doubt. That there will always be in a large profession a few who, if allowed, will meet homoeopaths and other {sic) irregular practitioners is, I think, also not doubtful.
'< The important point appears to me to be, what is the remedy ? And I venture to think the only at once plain and sufficient remedy is for the profession, as a whole, to decline not only to meet or act in common on a hospital staff with such practitioners, but also to decline to meet or act with any practitioner so meeting them.*'
ItSSH^^TS^ THE CONSULTATION QUESTION. 69
Mr. BuANiE seems to be under the impression that we do not '' live in an age of change/' and that as was the attitude of the profession in 1851 so it is now in 1898. If such is his view, he will have found by reading a letter, entitled *' A Plea for Tolerance/' appearing on the next page of the Journal, that there are members of the profession, whose therapeutic views we may assume to be akin to his own, whose notions are not so impermeable to the light of experience and the trend of public opinion as his own would seem to be. The letter is as follows : —
A Plea for Tolbbamce.
*' Sir, — Permit me to point out that the arguments used by Mr. Flehhino and a * General Practitioner ' (soond ones I certainly consider them) for admitting to branches the holders of ' medical aid ' appointments, would also justify ub in adopting — would compel us rather to adopt a more generous or tolerant attitude towards the homoeopathic section of the profession than has hitherto been our wont. In my opinion (shared, I trust, by a large number of your readers), our past conduct in this matter has been anything but creditable to our good sense, to say nothing of our humanity. I am utterly incredulous of the ill results predicted for oar patients and the ignominy for ourselves, from the practice of meeting homoeopaths in consultation. What can be more ignominious than our present position before the public, of declining to meet men who, equally with ourselves, have passed through the legal curriculum, and so earned a right to an opinion ? Why not credit these gentlemen with the possession of some tact, some desire to find a point of agreement with ourselves ? It is generally admitted that Hahnemann's influence upon our own methods of practice has been and is considerable ; and I could easily name a number of drugs which we have appropriated (not always with any acknowledgment) from the homoeopathic armamentarium. CoLERmoE, a profound thinker though not a doctor, said of Hahnemann that he was a ' splendid fellow ' and that his ttieory, though not exactly right, was by no means altogether wrong. Is not this commonly the case with theories, and a possible view of the one in question ?
** Our present boycotting attitude towards homceopaths amounts really to social persecution. But ' the blood of the martyrs is the seed of a church.' We have learned something from homoeopaths in the past ; why not learn more, if more is to be learned, and so prove to the world that our sole care ia that the truth alone shaU prevail. I am, etc., — A Membeb.
•« December, 21st, 1897."
70 THE CONSULTATION QUESTION. ^b^^fSS^m!
How striking is the contrast between the letter of " A Member " and that which bears the signature of Mr. BuRNiE, of Bradford ! The one is evidently the com- position of a man of observation, of generous instincts, anxious to enlarge his powers of professional usefulness and his opportunities for extending the exercise of them ; of a man who is weary of the galling pressure of the trades' union yoke which has been forced upon him, desirous of regaining the liberty to think for himself and to act in all things professional, as his conscience instructs him that he ought to do. The other is the outcome of a man who, like the Bourbons, has learned nothing and forgotten nothing — a professional fossil ! Though neither response to Mr. Jessop's appeal has come from ** one of the leading representatives of the profession," the writers none the less clearly express the views and feelings of the Forward Party on the one hand, and of that which, on the other, would still cling to the slough of absolute intolerance and ignorance into which the British Medical Association led their fathers fifty years ago.
We rejoice at this exhibition of a renewal of life among the general practitioners of the country, and feel sure that it will increase in vigour and extend in area far more rapidly and far more considerably than some fossilised members of the British Medical Association have any idea of.
In his letter to the Journal, Mr. Jessop refers to " an eminent Bradford practitioner " as having been ** acting in consultation with one who for many years has represented homoeopathy in a large manufacturing town in Yorkshire." This is perfectly true. But why should Mr. Jessop feel any surprise that it is so ? The gentleman in question freely expressed his opinion on the subject in 1877, and in a letter addressed to Dr. Wyldb written by him during that year, and published with his consent, he commences by saying: — ** For a long time, I have seen reason to regret more and more deeply the unfortunate attitude assumed by what is called orthodox medicine to the homoeopathic school, as well as to deplore the sectarian intolerance which has seemed to me sometimes to actuate the latter." He concludes the letter with the following sentence:— " It appears to me that if a homoeopathic practitioner should wish to see an
fiSS^ftbTSs!^'' THE CONSULTATION QUESTION. 71
allopathic, or vice versa, or if the patient attended by the one should desire a consultation with a practitioner of the other school, there are no reasons which ought to continue to prevent the one practitioner from meeting the other, and giving the patient the benefit of their joint advice. At least, I for one am in strong hopes that a sectarian animosity, which should never have arisen, may «ome to an end some day or other."
As from all we have heard of the writer of this letter, he is a gentleman who has the " courage of his opinions," we cannot understand Mr. Jessop implying, as he does, by writing the letter published in the Journal, a feeling of surprise that he should have met in consultation a gentleman openly and avowedly practising homoeo- pathically ! It is his right, and moreover it is his duty —as it is the right and duty of every member of the profession — to be guided by the dictates of his own experience Freedom of opinion, freedom of thought, and freedom of discussion must be permitted to all medical men. Once admit the justice of the principle laid down by Professor Gairdner, of Glasgow " No one ha$ a title to say to any one else, I insist that you believe so and so, or I will disown you as a professional brother " —and every hindrance to free professional intercourse is removed.
The more frequently the question, the discussion of which Mr. Jessop has revived once more, is brought forward and receives that " consideration " of which the Lancet said in 1872 that it was " worthy," the sooner will the profession be relieved from, the shackles of the mis- chievous and tyrannical trades' unionism with which it has been sought to impede its members in the free exercise of their duty to those who consult them, and to restrict their obligations to their professional brethren. If a physician who practises homoeopathically requests the assistance or advice of one who does not so practise, he does so for a purpose which he thinks may be helpful to . his patient. Whether the assumed advantage is looked for in diagnosis, prognosis or in treatment, the con- sultant is not called on to enquire. His opinion is sought, and is therefore regarded as being worth taking. Why should he refuse it ? It is said that, in giving an opinion upon a case under the care of a homoeopathic practitioner, a physician or surgeon, who did not believe
72 THE CONSULTATION QUESTION. **^£;rflS11?t»8!
in or know anything about homoeopathy, would be compromising himself, he would be giving his sanction to a therapeutic method which he professed to regard as erroneous. In investigating, conjointly with a homoeo- path, the nature of a disease, or the prospects of recovery from it, or in stating what, in his view, would be the most desirable course of treatment to be adopted, the non-homoeopathic consultant in no way compromises himself. He states his view, which is not necessarilly that of the practitioner who calls him in. If the opinions of both should turn out to harmonise, in one or other or on all three points ; or on the other, should they differ, the decision of the course to be pursued will remain with those most interested in the welfare of the patient. The late Dr. Drysdale, of Liverpool, writing on this subject, gives the following very apposite illustration of what we regard as the proper course to be followed. '* In a case of haemoptysis which I attended, in
the alarm of a fresh attack, Dr. was sent for, and I
arrived at the same time; we examined the patient together at the bedside, and discussed the case alone. The patient's friends were informed that we agreed as to the nature of the case, but differed about the medicines to be ordered, so we wrote our prescriptions. They
chose Dr. 's, and I retired from the case. This,"
adds Dr. Drysdale, ''is as it should be, and is strict medical etiquette; and allow me to observe" he con- tinues, *' the better informed of the public know that, and resent a breach of etiquette on the part of any of the profession, in conformity to trades'-union rules made by any illegal clique, whatever they may call themselves^ whether Ethical Societies or a British Medical Asso- ciation."
The history of all great truths has repeatedly shown them to have struggled through a period of determined opposition to their reception. But the time comes when this struggling gradually ceases, when knowledge increases, when prejudices abate, when the claims of experience make themselves felt, when enquiry and investigation, freed from the shackles of vested and personal interests, become generally and carefully pursued, and the truth shines forth with a irght so brilliant that its acceptance can no longer be resisted.
Progress in the general appreciation of the principle of
SS^F^bTiSs!**' BATH CORPOIUTION. 7*
drug selection — Similia Similibtis Curentur — has been no exception to the struggle in which all great and far- reaching truths have been involved. Bat we, who have endeavoured to promote its investigation and acceptance, have ever felt confident of its ultimate triumph over all prejudice. Tout I'ient a point a qui sait attendre. Yes, and we congratulate ourselves, as we see the barriers raised by prejudice and self-interest against the reception of the great therapeutic truth, the mode of applying which in the treatment of disease was first set forth by Hahnemann, breaking down one after another, slowly, indeed, but surely, that we have known how to wait. That, in earnestly and constantly expounding and illustrating it in hospital and dispensary^ in journal and in literature, in exerting ourselves in its development and facilitating its application, in defending it and its professional expositors from the assaults of ignorance and prejudice, and this ever with due regard to the true ethics of medicine, and without giving just cause of offence to any member of the profession, we have waited as it was right that we should wait. Pursuing the same course, we may rely upon it that the time — considering the importance of the truth itself, the strong and bitter feeling which its propagation has engendered, and the personal interests that may be supposed to be more or less injuriously affected by its general adoption into medicine — the time, we write, is not long before homoeopathy will meet with that con- sideration from the profession of which it is worthy.
THE BATH CORPOEATION AND THE MEDICAL PROFESSION. From an early date of the controversy excited by bomceopathy, one of the forces brought to bear against the effort to promote an understanding and appreciation of it has consisted in endeavouring to make the public believe that medical men, practising homtjeopathy, are not members of the profession ; that whatever they may have been once, when they adopted homoeopathy into their therapeutic methods they ceased to be so, they were no longer professional brothers but, as some 30 or 40 years ago. The Medical Times and Gazette expressed the relationship, " brothers-in-law." Bath has ere now distinguished itself by fruitlessly trying to foster this
74 BATH CORPORATION. ^SS?/w%**?^2S^
Review, Feb. 1, 1898.
kind of feeling. The late Dr. Newman, who practised homoeopathically in Bath for 35 years, and of whom, in noticing his career after his death, The Bath Herald said, *' During his life in Bath, he has been one of the most successful and best known practitioners in the West of England, having patients in every part of the district,*' encountered bitter opposition of tbis kind. He was proposed as a member of the Bath and County Club, and, through the medical opposition, was black-balled. Thenceforward, every medical man proposed met with the same fate. The cause of this being well known, Newman was again proposed and elected.
Once more to give practical evidence that a medical man practising homoeopathy is not a fit associate for any one, the Committee of the Baths at Bath, or rather we should say the Mayor of the city (the successor of the gentleman who so courteously received and hos- pitably entertained the members of the last Homceo- pathic Congress on the occasion of their visit to Bath) summoned to a conference the members of the medical profession pra<;tising in Bath inviting each personally, but omitting to include in his invitation those members who were known to practise homoeopathically ! Against this course of action Dr. Percy Wilde very properly protested in a note to the Mayor. We had, however, better give the Mayor's own account of the proceeding as we find it given in Keene's Bath Journal of the 8th ult. in a report of a meeting of the Baths Committee : —
'< The Mayor, in accordance with the intimation he made at the Council meeting, referred to the conference he had had with medical men of the city. It had become, he said, a somewhat delicate question, and he hoped no trouble was coming out of it. As they knew perfectly well the allopaths and homoeopaths could not exist together, if they took vinegar and oil because they could use them they must rub them together, and it was absolutely impossible to take allo- paths and homoeopaths and make them live one inside the other. Though it might have been an oversight on his part to have omitted the very small body of homoeopathic doctors, be did not mind saying that had he admitted them he was perfectly certain he should not have had any representative meeting of allopaths, for they had told him it was against the rules of their profession to sit in committee with the other body. It had been said that the Mayor should have had these invitations issued by the Town Clerk, but he thought they
SSSflSbTwS^ BATH CORPORATION. 75
-would allow him to tmj that he did what was oonsidered the professional thing. He went to the secretary of the Society, and through him he got these gentlemen together. In answer to a note he received from Dr. Wildb, he wrote that he oon- sidered the whole matter was a medical question and referred him to the secretary, Mr. Beaumont. In answer he was sorry Dr. WiLOE thought fit to write an impertinent and insulting letter. He could lay that before the Committee if desired, and he was sure they and others would back him up when he said that the writer called his honour into question. Beferring to the conference his Worship said the whole meeting was harmonious, and they were absolutely unanimous on one important point. They agreed that the whole body should be a Committee, that there should be an exeontiye Committee, and out of that two or three gentleman should be always ready to be at their beck and call, to keep their eyes open, and it they saw anything unsatisfactory at the Baths they should at once report to that Committee. They would then have the whole medical profession as a Committee to approach. He proposed that that Conunittee send an invitation to the gentlemen of the Medical Committee asking them if they would form themselves into a Committee, and from that appoint an executive or whatever they chose. As the allo- paths could not be expected to invite the homoeopaths to meet them he hoped that Committee would see fit to include them on whatever Committees might be formed."
As the Matob, who seems to be a very hypersensitive individual, appears to have resented Dr. Wilde's want of appreciation of his mode of summoning the members of the medical profession, and to have characterised his note in very unjustifiable language, we will here give the <5opy of the letter which Dr. Wilde published in the Bath Herald of the 10th ult. :—
" The Mayob a»d Dr. Wilde.
** Sis, — I beg to hand you for publication the letter which the Mayor is reported to have described as * impertinent and insulting.' It was addressed to Major Simpson, Queen Square, in reply to a letter received from Major Simpson, Bath and County Club, in refereoce to a question which I had addressed to the Mayor of Bath, at the Guildhall. I reproduce it from memory, but the words, I believe, are exact : —
"Sir, — I am in receipt of your letter which I observe contains no expression of regret. I decline to regard it as official for your own sake. This is a civic matter not a medical one. It is your honour which is in question not mine. Yours truly,
Percy Wilde.
76 BATH CORPORATION. ^S!J5^^=S?h*?^Si^
Reriew. Feb. 1, 1896.
'* I think that the intention of this letter is too perfectly obyions to require explanation. I did not wish to take the- Mayor at a disadvantage, and so wrote to him in his private capacity, indicating clearly what I realised would be the result of his action. Your obedient servant,
" January 10, 1898. Pebcy Wh^de, M.D.'*
At this meeting of the Baths Committee some uncertainty seems to have been felt as to whom. the Mayor would include in the term " Medical Profession,*' and the following interpellation was consequently made : —
** Mr. Waldron asked if the Mayor, in moving this resolution intended that the medical profession of Bath be invited ? The Mayor : I should put it in that way certainly. Mr. Waldron said that being the case it gave him the greatest pleasure to second it. They as a Committee could not for a moment consider to what branch of the profession gentlemen belonged. He could see the error the Mayor unfortunately fell into. Good gracious ! What could they think of men of the education and station of doctors tabooing and boycotting other doctors."
Mr. Thomas having stated that it was a mistake to suppose that the Medical Association included all the medical men in Bath, when as a matter of fact it represented only a bare majority of the doctors of the city, the Mayor was asked to reduce his proposition to writing, and the Chairman said that Mr. Watts had drafted the following : '' That the medical practitioners of Bath be asked to form themselves into a Committee to co-operate with this Committee in promoting the prosperity of the bathing establishments, and to appoint an executive Committee for that purpose with a small Sub-Committee to communicate with the General Purposes Committee." — Alderman Ricketts said he could not support it. In his humble opinion they must not have co-operation from any outside body whether medical practitioners or other persons. They should be ready to express their willingness to consider any communication that might be sent to them by the medical profession > but to ask them to appoint a Committee was not their business. He believed Mr. Beaumont actually spoke about the doctors taking the management of the baths^ Amongst the medical profession there were many
SS^f^rrtS^!^" BATH CORPORATION. 77
differences of opinion and some dissenters. He was told Dr. Wilde had a good average practice at the baths, and they should not do anything in the slightest degree to affect that practice. Was it to be supposed that if they invited them to form a committee homoeopaths wojuid be placed on it ? Mr. Alderman Bicketts further objected to the resolution, being somewhat anxious about inviting the interference of medical men. His experience of having members of the medical profession on the Town Council not having been, except in one instance — that of the late Mr. Alderman Freeman — very encouraging.
Aldernaan Taylor said his Worship had done exactly the right thing, but, having done the right thing, he hoped they would not do just the wrong thing that morning by adopting the resolution submitted to them. He was afraid if they asked the medical profession to appoint a committee there would be just that feeling which they wanted to get rid of — that some doctors had more authority or voice in the management of these waters than others. He thought having gone so far as they had and having given the medical gentlemen to understand that they wished to regard their suggestions with every possible consideration, they had done nearly enough. He was sure any suggestions from the medical gentlemen would always be received with courtesy and a desire to accede to the requests that they made.
Presently the consideration of the whole matter was adjourned for a fortnight.
The Mayor's speech, in expounding his admirable suggestion that the Committee of the Baths should make arrangements for having the advice of the medical profession in the city in their management, is in many points peculiar, especially so when he ventures into the regions of metaphor. ** It was," he is reported to have said, '' absolutely impossible to take allopaths and homoeopaths and make them live one inside the other ! " Literally, this is an " absolutely impossible " proceeding and most of us would regard it as an undesirable one, even were it possible. But what does it mean as a metaphor ? Here his worship is incomprehensible ! It would seem, indeed, that some members of the City Council have found it more or less difficult to maintain an existence with a member of. the medical profession residing " inside " their Municipcd . body ! What the Mayor
78 BATH CORPORATION. "SL^/w°fT?^S^*'
Itoview, Feb. 1, 1896.
desired that his committee should understand by his Somersetshire pleasantry we cannot divine ! His initial blunder, in taking steps to convene a meeting of the members of the medical profession, appears to have been in the method he took to ascertain who those were, who residing in Bath were members of the profession. Instead of going to an " official " source — to the Medical Register — he applied for information to an " officious " one — the secretary of the Bath and Bristol Branch of the British Medical Association. From him, he appears to have gathered ihat if he admitted to the meeting any homoeopathic doctors, he would not have any repre- sentative meeting of allopaths, for he had been told that " it was against the rules of their profession to sit in committee with the other body." The Lancet, however, has so far enlightened him, as to have assured him that there is no rule of the kind. We certainly never heard of such a rule, but can easily imagine that Mr. Beaumont's imagination provided him with one for the occasion. To have his instructions carried out, or modified (as he chose) by the Secretary of the Asso- ciation, instead of requiring the Town Clerk to carry out his orders as Mayor was, he considered, the pro- fessional thing to do, you know ! This is almost as good a joke as his discovery that it was impossible to make an allopath live inside a homoeopath or vice versa ! That any one so peculiarly constituted as to suppose that he was doing the correct thing in applying to the secretary of the local Medical Society to know who in Bath were members of the medical profession, and then to constitute him Town Clerk, pro re nata, should be unable to understand Dr. Percy Wilde's letter, and only capable of seeing in it something '^ insulting and impertinent," is not surprising. The only fact we can gather from the incident is, that when Dr. Percy Wilde refused to be suppressed by order of the Mayor of Bath, the said Mayor lost his temper, and, as is not unusual under such circumstances, said some singularly childish things the first time that he had an opportunity of doing so in public !
The newspaper from which we have quoted the extracts we have made, from its report of the meeting, makes the following comments upon it : —
" An important discussion took place at the meeting of the
2^3^=J~«?PJ|"« BATH CORPORATION. 79
B«Tiew. Feb. 1, 16M.
Baths Committee yesterday, respecting the attitude of the medical profession towards the baths. It was obvious that the committee fully appreciated the importance of the co- operation of the profession, but at the same time there was a ▼ery natural desire that the ordinary management of the baths should not be interfered with. The Mayob has certainly acted in the interests of the city by taking the initiative with the view of securing the sympathetic aid of the medical gentlemen practising in the city in the efforts of the Baths Committee to make Bath ever-increasingly attractive. It is, however, unfortunate that a note of discord has been struck owing to the omission to invite the homoeopathic doctors to the Matob's conference. They will not fail to observe that so fur from there being any intention to slight their branch of the profession, there is every desire to include them in any committee that may be formed equally with that of the allopaths.
'* Considering the importance of the subject the committee acted wisely in deferring further discussion of the matter until the next meeting. It is essential, as the Lancet suggests, that the question shall be viewed in all its aspects by the Corporation. The adjournment of the discussion will give an opportunity for an interchange of views between members of the committee, the medical profession, and others interested, and is therefore to be welcomed. Of course the success of the Baths is completely in the hands of the medical profession. The Mayob's object is to evolve a scheme which shall be a guarantee that the baths of Bath are properly superintended. This can of course only be accomplished by the cordial co-operation of the profession, and it will scarcely be secured by the adoption of such a vaguely worded resolution as was brought forward yesterday. Whilst care must of coarse be taken that the medical gentlemen are not permitted to usurp the functions of the committee, it must also be conceded that the proposed committee of medical men must be * consultative ' in something more than name.
" There is not only the administration of the waters, but, awaiting solution in the in[miediate future, is what has been termed the social side of the question. Medical men are naturally deeply interested in both aspects of the matter, and Mr. Beaumont's encouraging assurance that < the profession are prepared to do all that lay in their power for the benefit of Bath and the welfare of its baths ' is very reassuring. The subject is certainly one of the most important and far reaching in its consequences that has ever engaged the attention of the Baths Committee."
80 BATH CORPORATION. ^Re^ewfF?b^!t»^^
The Lancet having, on the Ist ult., expressed its approval of the meeting of those members of the medical profession summoned by Mr. Beaumont, the honorary secretary of the Bath and Bristol branch of the British Medical Association, on behalf of the Mayor, the editor of that journal was invited to express his views on the dilemma, in which the Mayor's plan of obtaining the advice of the medical profession of Bath had placed the Committee of the baths. Having noticed the objection which, as we have seen, some members took to the Mayor's proposal, that it might interfere with the independence of the Corporation in the management of the baths, the Editor writes : —
" Unfortunately, one circumstance gave a little excuse to those who hesitated to adopt the Mayor's suggestion. The whole profession of Bath, numbering some ninety practitioners, includes two or three homoeopaths. These were not included in the invitation of the Mayor to the profession. This circumstance has raised the whole ethical question of meeting homoeopaths, thus embar- rassing the Mayor and imperilling the success of his excellent scheme. The profession itself, we gather, is •divided on the question, part holding that the rules which regulate consultation with homoeopaths should obtain here, and part that the question is quite a different one. We are asked for our opinion, and we have no hesitation in saying that we regard the question as quite simple. The meeting of a homoeopath in consul- tation is quite a different matter from meeting him in a committee. For the latter purpose he is a member of the profession as much as any other practitioner, and entitled to a voice in a committee of the whole profession. In any such general committee the homoeopathic prac- titioner will always be in a hopeless minority. His sys- tem has had a hundred years to commend itself, and it Temains a fantastic fad of a small section of the pro- fession. But this fact notwithstanding, he is by law in the profession and entitled to all the amenities of it when they do not involve others in grave ethical difficulties, which cannot well arise out of any reasonable co-operation between the profession and the Corporation. In the circumstances arising at Bath we should advise the entire elimination of the distinction of regular (sic) and homoeopathic practitioners so as to facilitate the object
S^flSrSa^ BATH CORPOBATION. 81
of the Mator. If it falls through let it not be due to the fault of the profession,"
Notwithstanding the unabashed, ignorant hatred of homoeopathy which nervades this passage, there is present in it a very wholesome dread of the power of public opinion. As we have pointed out in the preceding article, the Lancet felt the influence of this dread when,, on the 8rd of August, 1872, the editor wrote, " Every right-minded medical man must wish to reduce to a> mininium the differences which hinder professional intercourse between members of a liberid profession, or which raise up barriers which the public cannot understand or sympathise with. The latter point is one of great importance."
Hid estimate of homoBopathy as ''a fantastic fad," while it is one which shows how great is his ignorance thereof, and indeed of the history of modern therapeutics, is much to be deplored in one who has so great an influence both for good and for evil, as has the editor of the Lancet, is at the same time one that we can well afford to smile at. It is the editor's notion, evolved from his inner consciousness, like the German professor's descrip- tion of a camel.
It is, in short, entire ignorance of what homoeopathy consists in, of what those who practise homoeopathically understand by it, that leads him to indulge his spleen in this contemptuous epithet. The correspondent of the British Medical JouimcUy whose letter we have reprinted in the preceding article, knows more than the editor of the Lancet. Says the writer : —
*' It is generally admitted that Hahnemann's influence upon our own methods of practice has been and is considerable ; and I could easily name a number of drags which we have appropriated (not always with any acknowledgment) from the
homcdopathio armamentarium We have learnt
something from homoBOpaths in the past; why not learn more, if more is to be learned, and so prove to the world that our sole care ia that the truth abne sludl prevail."
A *' fantastic fad " would not have had such an influence as this ; the working out of one in daily practice would not have afforded so considerable an amount of information, as the practitioner who wrote the letter admits that he has secured from it. But for this 8o-calied ^' frmtastic fad " the best and most useful hints
Tol. 4S,No.2. o
82 THE HIGHER CRITICISM. ^SJdSmfpCTl^
conveyed by all modern manuals of therapeutics from Dr. Ringer's onwards would never have seen the light.
At an adjourned meeting held since this article went to press the idea of regarding homoeopathic practitioners as not being comprehended in the term medical pro- fession seems to have been abandoned, and the following resolution was unanimously passed : —
*' The Baths Committee view with ^eat satisfaction the result of the Mayor's conference with the gentlemen of the medical profession practising m Bath, and now resolve io invite them to form an advisory body, to whom such medical questions connected yrith the management of the Baths, as may be deemed advisable, may be referred by the Baths Com- mittee."
In making the stand he has done Dr. Percy Wilde has earned the thanks of all those members of the profession who practise medicine homoeopathically. *' The present boycotting attitude towards homoeopaths " said a correspondent of the British Medical Journal, a month ago, *' amounts really to social persecution." Resistance to this sort of trades' union like tyranny — i^ the duty of all and in its result reflects upon the cdmfort of all. We congratulate Dr. Wilde on his success in defeating the assault attempted to be made on his professional position, and through him on that of all of us who practise homoeopathically.
THE "HIGHER CRITICISM.''
By John McLachlan, M.D., B.Sc. Edin., F.R.C.S. Eng.
Dr. Hughes, judging from his remarks on my paper <read at the recent Congress*), seems to think that its main object was to prove that high potencies are capable of healing the sick. Such was not my intention, for that has been proved (so far as such things can bie proved) long before I was born, and I assumed that these proofs were well known to the committee when they asked me for a paper on that special subject. My paper was a mere contribution to the already overwhelming proofs of the past. I am further sorry to observe that I misled Dr. Hughes in regard to the ** vital force." I did not need to go to Hahnemann's Organon for that idea, for I held it long before ever I knew there was such a book, and I believe
• MonthXy lloinaopathu! Review, January, 1898, pige s]
^riSr?FS!TiaSB!''*'THE HIGHER CRITICISM. 83
it to-day more firmly than ever ; call it what you will, there it is ; and I fail to perceive the distinction between Dr. Hughes' "dynamic disturbances," and Hahnemann's " derangement of the vital force." John Hunter believed just as strongly in the " vital force " as Hahnemann did, bat perhaps, tike the lattet, he may not have been in his "prime " when he did so. I cannot tell.
Modern science does tiot forbid our following Hahne- inann in this point ; ignorance of science may do so, and a few of the so-called scientific men, but those at the best are one-sided in their views, being heavily weighted by materialism, which has been and is the curse alike of medicine and religion. At the best, of course, the idea of a ^* vital force" is a mere hypothesis (scarcely rising, indeed, to the rank of a theory), and as such is incapable of proof or disproof ; but it in no way violates any of the known analogies of science, and unless it does, it is in no sense nnscientific. Science gives us many statements which have not been proved, but it does not follow on that i^count that they are worthless. Darwin's evolutionary hypothesis is incapable of proof or disproof, yet few ^ientific men doubt its truth. The hypothesis of a "vital force," better than any other hypothesis yet put forward, enables us to explain and connect observed phenomena, and as such it is an adequate .or working hypothesis ; and further than that it is fruitful, as it has led to many useful facts, and an hypothesis, even if false, if it does this is worth retaining. When it ceases to be fertile, by all means throw it aside like a useless tool that has served its day and generation.
Dr. Hughes says there is no such thing as energy without matter. How does he krurw } I grant it cannot be manifested, to our senses^ as at present constituted, without the presence of matter upon which, to act, but whether it can exist apart from matter no one can say. It is not, like elasticity for example, a mere property oi matter; if it were, then of. course it could not exist apart from matter, bat it is something as different from matter as it is possible to be. Energy does not mean matter in motion ; matter in motion has kiiletic energy, and it is by that means that it is measured, but it itself is something quite distinct.
I do not believe it is possible to attenuate a medicine so highly as to destroy all traces of the matter originally
84 THE HIGHER CRITICISM. ''bSSw^^mTiImw!
present; bat whether that be possible or not, that ia altogether beside the question, for it is energy, not matter, with which we are dealing. Now the special characteristics of energy are its easy transformability and transferability, and there is nothing absurd or impossible in the idea that the energy of the drug to heal can be transferred to the menstruum used for the purposes of attenuation. It is not so easy to get rid of matter as Dr. Hughes seems to think, and so much i& this the case that to the experimentel chemist such things as pure reagents and clean vessels are absolutely unrealisable ideals. Furthermore, the chemist can never be accepted as a trustworthy exponent of the divisibility of matter, since the question whether it is or is not infinitely divisible does not concern chemical science. The molecular weight of hydrogen is for convenience arbitrarily fixed at tioo^ and we asmme that there are two atoms present. We do not know ; there may be two millions for all we can tell. Further, the atom and molecule, of nearly all the metals at any rate^ are identical.
In regard to his criticisms on the '' cases " I gave,, much of it is very trivial and may be neglected. Dr. Hughes does not believe in what are known as clinical symptoms, and I do. No Materia Medica can ever hope to be complete, without them, nor can any complete Materia Medica be composed entirely of them; but there is surely the happy mean. Distinguish them from pathogenetic symptoms properly so called, but put them in. Some of the most trustworthy symptoms in the Materia Medica are only clinical as yet. Our provings, even the best of them, are woefully imperfect, and in the very nature of things must, as provings^ remain so. At the best they are mere finger-posts, pointing indeed in definite and trustworthy directions, but they do not cover every inch of the way, and very often leave very wide gaps indeed.
Dr. Hughes, with that air of calm and placid superiority which becomes him so well, sneers at the use I make of the observations of men now no more, but who, while alive, were just as competent to observe and reason as any of us. He seems to want us all to begin where Hahnemann began, and work it all up over again till we come to the « Cyclopadia of Drug PaiJwgene^^;'
SSS'STSk*" the higher cbiticism. 85
Beview, Feb. 1,
and then — ^bat after that the Delage. But that would be absurd ; life is too short for one thing, and why should we cast aside the clinical experience of the last hundred years, collected by many trustworthy men of whom the world was not worthy ? Much of it is the result of enormous labour and of careful observations on their part, just waiting for a little more, as it were, to clench the proof. We must at least allow to such men the same honesty of purpose and intelligence that we claim for ourselves. Just as well might he suggest to a locomotive engine builder of to-day that he ought to begin where Kobert Stephenson began.
Althoagh arsenic has caused alopecia areata, yet had I given it I would not have been carrying out the " rule " similia similibus curentury and there is no reason, there- fore to believe that it would have cured the case. Dr. Hughes is content with general resemblances, neglecting altogether the most important features, viz. : — the specific individtud differences between one case and another. Had the patches been dry, rough, and dirty looking, in all probability arsenic would have cured the case, bat the patches were clear, white, and smooth, and therefore I gave phos., and not merely ** because Dr. Guernsey advised that it should be given." Now although all cases of alopecia areata have certain close correspondences in general features (else they would not be examples of the disease in question) yet these are of little value to us in our efforts to find the simiUinium, the all important points being the specific individiuil differences. It is exactly the same in other sciences. When the chemist, for example, wishes to recognise and differentiate the members of an homologous series, e.g.^ the alcohols, or the different isomers of any one alcohol, 4?.^., amylic, he does so by noting the specific individual differences^ since the general properties would be of little, if any, value for such a purpose.
Dr. Hughes speaks of " the well-authenticated power of iodide of potassium to overcome " syphilitic heaaache. •* Well-authenticated " by whom? Is this "well- authenticated " observation clinical or pathogenetic ? Did the provers have evident syphilis ? If so, according to Dr. Hughes' own showing, we ought to place little, if any, confidence in their symptoms. Most of those, so far as I am aware, who make use of this '' well-authen-
86 THE HIGHER CRITICISM, ""^^g^Jw^^S"^^!
ticated power of iodide of potaflsium " give it mixed with half-a-dozen other things, and unless we have other knowledge to guide us (as I had in the case in que8tion> it. would be difficult to tell which of the six or seven drugs was the active agent. Again, is iodide of potassium the only medicine that can cure this variety of headache ? And if it is not, how are we to know when to give one or when to give another except by taking into account specific individual differences ? (The particular symptom in question is given in Allen's Enq/chpadia, vol. v., p. 884. Perhaps Dr. Lee got it there ; I do not know.)
Dr. Hughes says : " When you get up to Hahnemann's 80th, surely you have got far enough for all conceivable action of drugs/' I confess one would naturally think so ; but here again the only test of any practical value is the exyerimentnl one. No man's ipse dixit can suffice. In the cases I gave I had tried the 30th and 200th potencies again and again, but only to meet with repeated disappointments ; they were patiently tried, but were found wanting, and that was why the millionth was used in the cases in question. I am unable to say what special potency between the 30th and the millionth might have cured the cases, nor do I think the question is one of any importance.
Our primary mission is to restore the sick to healthy whether with ** unimaginable potencies " or '* impossible dilutions," not as Dr. Hughes seems to think to convert our old school brethren — certainly not, at any rate, by means savouring strongly of Jesuitism ; besides all this, a 8rd or a 6th potency (not to speak of a 12th or a 80th> is to the most of them even more impossible and un- imaginable than the millionth is to Dr. Hughes, even though the physicist may express the lengths of light waves in fractious of millionths of a millivietre.
But besides this, the potency question is one entirely for those who are converted — for the Children of Light only, not for those who are sunk in even more than Cimmerian (therapeutic) darkness. As well might one accept the dicta of an avowed atheist concerning the purely experimental truths of the Christian reUgion.
I am just as anxious for union as anyone, but not at the expense of principle. Maintain the truth at all costs^ yielding not a nail's breadth ; if union can be promoted
BSrtS^SbTSa** THE HIGHER CRITICISM. 87
in this way, so much the better, but maintain the truth. Union on any other terms is worse than open hostility, and those who, to salve their consciences, while promoting it, cry, •* Peace ! Peace ! " when there is no peace, are traitors to truth, and fit companions of a Machiavelli or a Judas Iscariot. At heart, the allopathic school is just as bitterly opposed to Hahnemann and homoeopathy as ever, and that, too, altogether independent of the potency question.
I am sorry if I left the impression that Dr. Dyce Brown refers to, viz., that I did not believe that a low potency or a mother tincture could cure disease. I have not the least doubt that they can do so. The reference in my paper is rather in the form of a rhetorical question, and to such no answer is usually required or expected.
Dr. Roche's experience must be very different from mine, for, so far as my experience and observation go, it is those who believe in the so-called high potencies and the " single remedy " that devote the most time and study to the Materia Medica. He must have come across bad samples, surely, or else he must have mis- understood. I cannot understand why any one who uses two or three remedies together, or in a imori alter- nation, could wish to study the Materia Medica. Under such circumstances to do so would be mere loss of time^ and as useless as trying to till a barrel with its bottom knocked out. Any domestic, or other cut and dried » " Manual of Therapeutics " would do just as well and cost much less labour.
Concerning the other speakers I need say but little ; their remarks, however, appropriate as after dinner speeches, were surely somewhat out of place at a meeting convened for the discussion of scientific subjects. At the same time I might observe that the *' point " of the President's witticism (surely unique in the history of the presideniicd chair) anent Dr. Roche's remarks concerning warts and their ways, appears to haTe been missed ; and, even though it was made at my expense, I would point out that ** high potency " should read *igh (eye) potency.
Oxford, Jan., 1898.
88 CHRONIC HEPATIC ENLARGEMENT. ^Re^^I^h^
CASE OP CHRONIC HEPATIC ENLARGEMENT, WITH ULTIMATE ACUTE SYMPTOMS (INFEC- TIVE CHOLANGITIS); COMPLICATED WITH BILIARY CALCULL ABDOMINAL SECTION: CHOLECYSTOTOMY, WITH DRAINAGE OF BILE CHANNELS: RECOVERY.
By Edgar A. Hall, M.B., and George Burford, M.B.
Previous Clinical History: By Dr. Hall. It is sixteen years since I discovered that my patient, Mrs. A., had an enlarged liver. At that time I was con- sulted on account of symptoms which led me to believe that the organ in question was at fault. These were : —
Pain in the hepatic region, in the epigastrium, and under the right shoulder ; nausea, flatulence, and a coated tongue; evacuations lighter in colour than normal ; complexion sallow, conjunctivae slightly bile-tinged ; urine appeared normal, non-albuminous, occasionally deposit- ing lithates.
On local examination I found the liver much enlarged. The enlargement was uniform and regular, and the liver- surface smooth; the percussion dulness extended, if I remember rightly, to quite a hand's-breadth below the ribs. There was some tenderness on palpation, but neither then nor since has severe pain been complained of.
Mrs. A — had always led an active life ; she was careful in diet, and very abstemious as regards stimu- lants. There was no valvular disease of the heart, and it was rather difficult to account for so decided an enlargement of the liver.
During the interval of sixteen years, up to the present, the condition of things has maintained an average course. There have been mild liver troubles from time to time, but they have always yielded pretty quickly to treatment.
It was only in September last that any marked change in the symptoms occurred. At that time the liver became more tender ; the enlargement was obviously increasing, and febrile symptoms now supervened, the temperature ranging from 99^ in the morning to 100-101^ in the late afternoon. Chilly sensations were also complained of, but there was no actual rigor.
I now suspected some inflammatory action in the liver or gall bladder, and possibly abscess, and as the
Montidy HoBUBOpathie B«viefw, Feb. 1, 1»06.
CHRONIC HEPATIC ENLARGEMENT. 89
new symptomB did not soon subside I asked Dr. Burford to meet me in consultation. The house was not new though well built, and as sore throats had appeared among the other residents quite recently, and the sanitation was open to suspicion, it was decided at the consultation to advise removal from the house, as the symptoms, distinctly septic in character, might possibly have originated from defects of drainage. The lady went to a southern watering-place, but without any benefit. After she had been there a short time I was asked to go down and see her, as the general condition was worse. I found the temperature had risen to 100^ in the morning, and 102 — 103^ in the afternoon ; there was great tenderness over the liver in the gall-bladder region ; the tongue was coated, and there was complete anorexia. Remedies were prescribed to relieve the symptoms, but with no improvement, and feeling that delay was dangerous I ordered her home again, with a view to early operation. The total mixed urine for lour-and- twenty hours was forwarded to the Clinical Research Association for detailed examination ; but no results were obtained which threw light upon the case.
On October 14th, at the second consultation with Dr. Burford, after careful examination under anaesthetic, it was decided that operative interference was imperative, and this accordingly took place within a few days.
Gallstones fad, nat,)fmm the case as narrated.
90 CHKONIC HEPATIC ENLARGEMENT. **°C'Jw^FXriS^^
Operation : By Dr. Burford.
On October 22nd, with the assistance of Dr. Wheeler and Mr. Johnstone, Dr. Hall anaesthetising, I opened the abdomen by an incision in the right linea semilunaris^ The surface of the liver was of normal appearance^ regular in outline, and showed no abnormal character on palpation. The edge of the liver was in the plane of the umbilicus, and extending the incision downwards, I came upon the fundus of the gall bladder, tightly packed with hard bodies. An aspirating needle was pushed into the gall bladder, but no fluid was sucked out ; and after complete isolation by sponges, the fundus of this organ was freely laid open. One after another, four large calculi were with some difficulty extracted ; and here I may say that Tait'scrocodile forceps were of the greatest service .^
The gall bladder was an elongated funnel-shaped tube,, between four and five inches in length, and containing scarcely a teaspoonful of bile. Digital examination revealed no further calculi in the vicinity, and the open- ing in the gall bladder was sutured to the upper part of the incision, as high as possible ; the skin was not included. The operation was completed in the usual way.
The convalescence was continuous and practically un- broken. The temperature immediately came down,, never rising afterward even once to its former pitch ; and long before recovery was complete, averaged a normal course. When the dressing was changed, on the third day, bile welled up freely from the gall bladder, and continued to discharge in some quantity daily, up to the time of the spontaneous closure of the aperture. The bowels were moved on the the third day, the evacuations^ then and ever since showing the usual evidence of the action of the bile. We thus gained early in the conva- lescence sufficient proof of the perviousness of the hepatic, cystic, and common ducts.
The pain and local distress, formerly troublesome and persistent, have entirely disappeared ; the liver dulness- has receded considerably ; the patient has a better colour and a good appetite, and has actually put on weight.
Remarks : By Drs. Hall and Burford. In all respects the operation has been most successful ;: it was evidently the proper course to adopt, and we feel assured that to it the lady owes her life. Several points. of e^>ecial interest offer themselves for consider-'^ --n.
SiSJflSuirSS^*' CHRONIC HEPATIC ENLARGEMENT. 9t
What was the relation of the chroziic enlargement of the liver to the formation and presence of the calculi ? Beviewing the total clinical history of the case, it seems most probable that the original and primary affection was an infective cholangitis of a low grade ; that the hepatic seizures noticed in the course of the case were exacerbations of this condition ; that in one of these seizures the nuclei of the calculi were simultaneously deposited from the bile in the gall bladder ; that the calculi gradually grew by accretion, no new ones being formed. This condition of things went on for some years, when finally an acute exacerbation of the infective cholangitis brought matters to a crisis. Of the septic type of symptoms during the last seizure, no one who saw the patient could have any manner of doubt.
Apart from the removal of the calculi, what was the permanent gain to the patient by this operation ? Briefly, the free drainage from the liver of septic bile, the excitant of the last pyrectic attack ; the resulting disinfection of the bile channels, and protection against any recrudescence of the cholangitis. And as a secondary but most important . sequela, the retrocession of the liver, whose bile passages were previously swarming with irritative bacteria. The constitutional improve- ment, too, based on the rectification of the liver condition, and the elimination of its septic elements, was most marked.
Most remarkably, during the whole term of years this, lady has been under Dr. Hall's supervision, none of the cardinal symptoms of gall stones were present. The clinical course of the hepatic attacks, recurring from time to time, was such as happens in hosts of instances where there is never any suspicion of calculi. It is probable that the position of the lowest calculus, imbedded as it Mias in the mucosa of the neck of the gall bladder, acted as a plug, and that the constancy in size of this viscus, never being distended with bile, may account for the complete absence of attempts at extrusion.
The patient . had never suffered from malaria or typhoid.
We think this case of sufficient interest to publish in some detail, hoping it may contribute to the solution of similar difficult problems that may present themselves to our colleagues.
«2 • ACNE VULGARIS. ^Swl^f^SHftS?
ACNE VULGARIS.* By Washington Epps, L.E.C.P.
Physioian to the London Homoeopathic Hospital.
Ladies and Gentlemen. — Acne, one of the most troublesome of the less severe skin diseases — is the subject of the first of my lectures on dermatology. It is often most difficult to cure, and many a case goes from one dermatologist to another for treatment. The owner of a lovely face, acne disfigured, will do almost anything to obtain a cure, this the advertising patent medicine vendors know so well and to their profit. The present lecture will be devoted entirely to the common form of acne (a. vulgaris) and will not include acne rosacea.
Acne vulgaris is the fifth commonest of all the skin diseases, and occurs in about 8 per cent, of all cutaneous <;omplaints. It has also been called acneadolescentium, from its appearing between the beginning of puberty and manhood, and acne disseminata from the spots being separate, and having no tendency to run together.
Definition.
Acne vulp^aris consists of an inflammation of the sebaceous glands due to retained secretion, occurring chiefly in young people.
Acne is limited to the skin covering the cheeks, forehead, €hin and shoulders ; it occurs at puberty and disappears with adolescence. There is at first a thickening of the horny layer of the skin, with blocking of the sebaceous follicles causing comedones (acne punctata) ; this blocking of the ducts with thickened sebum causes inflammation and further thickening around the ducts (acne indurata) ; and lastly suppuration takes place in the sebaceous gland (acne pustulosa). This last stage, suppuration, may go on to the extreme limit and destroy the sebaceous gland, causing scars (acne hypertrophica). The four varieties, therefore, are A. punctata, A. indurata, A. pustulosa, and A. hypertrophica.
Acne cachectica, which appears in broken down subjects, and acne scrofulosa, occur on any part except the palms and soles. Both these varieties of so-called
♦ The flwt of twelve poet-graduate lectures on skin diseases. DeUvered Hay 6th, 1897.
SrtSSr^TwS^ AC^'E VULGARIS. 9S
acne are more a kind of follicalitifl and have no comedonea to start with.
Mr. Jonathan Hutchinson* gives a very clear definition of the differences between three somewhat similar diseases which affect the follicles of the skin, namely, lichen, sycosis and acne. He says : ** When the orifice of a hair follicle having no hair becomes the seat of chronic thickening, we name the little firm pimples thos produced ' lichen.' When a hair follicle, containing a hair, inflames and suppuration ensues, and the lining membrane is loosened so that it may be pulled away with the hair, we name the disease 'sycosis.' When the sebaceous gland (formerly the appanage of a hair now suppressed) becomes first distended with its own secretion and then inflamed, we name the condition 'acne.'"
Symptoms.
Acne does not occur until the advent of puberty, that is, when the glands of the skin are most active, and the hair glands are in full activity. This takes place with the other changes which occur at this period. The disease then begins about 16, and continues usually until about 26, that is until adolescence. As I have said it is limited principally to the face, chiefly to the forehead and cheeks, but it does not attack the scalp. It also, but less frequently, attacks the chin, neck, chest and back, and the shoulders, seldom, if ever, the nose and lips. These latter are the site of acne rosacea, which begins about 26 to 80, and lasts until the menopause.
The extent of the disease depends largely on the number of the ducts blocked — the number of comedones. £aich of these is the centre of a fresh area of inflammation.
The disease does not always run on to the three varieties. Many cases stop short at the comedone stage, others at the inflamed indurated stage, and others, especially in unhealthy cachectic subjects, run on to the pustular stage.
In severe cases the little abscesses are of considerable sise relatively, and are often composed of two or even three blocked follicles, which have suppurated and run together. These are the disfiguring spots that are too
• The Archives of Surgery, vol. 4, p. 44.
94 ACNE VULGARIS. ^"Se^^I^^Tim.
often followed by the scars and pits so mach dreaded by womankind. -
The disease' more often attacks fair {>eople, but many of the worst cases are in dark subjects.' It is especially severe in hairy people, persons with much flaflf, namely, many lanugo hairs, and also in those having thick greasy skins, i.e., those with over-active sebaceous glands.
It is needless to mention that, beyond the disfigurement and the tenderness of the pimples, the rash is of little consequence.
Pathology.
The comedo consists of (1) the black head of the so- called maggot, which is composed of hardened pigmented epidermic scales ; (2) the mantle, the shed lining of the sebaceous duct, and (3) the centre, the changed thickened sebum, containing one or more twisted or bent lanugo hairs.
Sabourand, of Paris, has lately figured in the journal of the Pasteur Institute, plates, which show a parasite common to seborrhoea, alopecia areata and acne. This point, the presence of a parasite common to seborrhoea of the scalp and also to acne, is of great importance in the treatment. Very often when these two diseases are present in the same subject, and this combination is far from uncommon, the cure of the acne is very often non- permanent until you have removed the co-existing seborrhoea which keeps up the acniform condition of the face.
Second. The parasites. These are thought by some dermatologists, as Unna, of Hamburg, to be the cause of the disease, and by others to be secondary and more or less accidental. It appears to me that these parasites are secondary. You must, however, have a constitu- tional condition which favours the growth of the parasite or parasites. Some authorities give one, others two and even three.
Unna says* the parasites found in acne are of two kinds, they are both found in the comedo. ** Of the micro-organisms which are very frequently found here, I would specially note the keratrophitic, oat-shaped * bottle bacillus ' and the diplococcus of seborrhoeic
• Ihrwat. ZeiUehr,, August, 1896, also British Journal of Derma^ toh}gy, vol. 8, p. 453.
^^^TehTSt^ ACNE VULGARIS. 95
eczema, both are chiefly limited to the head and' mantle of the comedo. . . . Inside, on the contrary, one always meets with a special form of bacillos ; this must attract most of our attention, for it is exceedingly probable that it is not only an accompaniment but the actual cause of comedo formation, and therefore of acne in general." Unna states that he has found these latter bacilli in every comedo and at the lowest part, showing, as he thinks, that the other forms of bacilli (the keratophitic bacillus and the diplococcus) are later arrivals. He thinks that the suppuration which takes place in acne is due to the presence of this bacillus and not to the accidental presence of the pyococcus.
Other authors, however, think that the presence of certain microbes is not sufficient to explain acne, that there must be a preparation of the soil, and that the skin of people without acne is as rich in microbes as that of those with it ; this Lomry shows 4tom microscopic examinations of scrapings of the skin in persons free from acne. In this Crocker agrees ; he states in his book on skin diseases that '' a parasite called the demodex folliculorum may be present, but has no pathological significance."
Whether these parasites really have any action in causing acne appears to be doubtful, but in the treatment it will be found that the application of a mild parasiticide will materially assist in curing. This may, however, be in preventing the entrance of or in destroying, these parasites, which, although not causing, may keep up the irritation, by flourishing in the epidermic scales and the sebum.
Diagnosis.
This, in most cases, is very easy. The points to note are:—
1- The age of the patient.
2. The dissemination of the lesions.
8. The position, the forehead, cheeks, upper part of the chest, etc, namely, the bust, as the sculptor would put it.
4. The chronicity, with exacerbations, i.e., fresh oatbreaks.
5. The anatomical seat of the lesion, namely, the sebaceous duct.
96 ACNE VULGARIS. "^""SS^Jn^^SST^l
Acne vulgaris must be separated from : —
(a.) Acne rosacea, now more commonly called rosacea ; this attacks the middle two-thirds of the face; aene» more the circumference of the bust. The rosacea patient is older, usually beyond thirty, and the sebaceou<s element, the inflammation resulting therefrom, is only an insignificant part of the disease. The general diffuse byperaBmia of the face and the dilated vessels are the reij disease. This hyperaBmia will be found due in most cases to disease elsewhere, uterine, gastric, want of temperance, &c.
(fc.) Syphilitic eruptions of an acniform type. The tendency of these to become grouped, the history of the disease, the age and condition of the patient, and gene- rally the polymorphic character of the eruption and the position, other than on the bust alone. Prognosis.
The cure of acne, like many other things, comes to him who waits — long enough. By this I mean that every case, almost without exception, will get well aa you verge on the 26th year or so. Few cases last beyond thirty. Treatment may, however, much shorten and ameliorate some cases, and in others even cure. Success depends, in most cases, on finding the real, the consti- tutional, cause, and — which is quite as important — in being able to remove it. It may be due to delayed, excessive or painful menstruation, masturbation, consti- pation, insufficient or unsuitable food, often seen in school-folks. I am quite sure in my own mind that an excess of both sugar and common salt will aggravate acne if they will not even cause the acniform condition.
Again, it appears to me that it is possible that indis- cretions in the lives of the parents of these young people, especially the fathers, may have somewhat to do with the predisposing constitutional condition favouring the development of acne.
Lastly, in many cases, the patient's surroundings and manner of living help considerably in the causation. I have long noticed among my out-patients the prevalence of acne among compositors, who spend long hours in hot, badly- ventilated workshops, often turning night into day.
The above is, perhaps, a long digression, and has nothing, perhaps, to do with {MrognoBis. I am, however, convinced that unless we are good all-round physioianB
S^jF^bTSSf^ ACNE VULGARIS. 97
«6 well as dermatologists, and recognise in many cases, if not all, the constitutional causes of so many skin diseases, we shall fail in our treatment. We may do much to relieve, but we shall not cure our patients until "ve get at the real cause.
Crocker says : " The apparently causeless cases (those in which one fails to find ttie cause) are the most obstinate and the most difficult to cure." Treatment.
First, the surroundings, as good air, cleanliness, baths, «ea-water spongings and bathing, suitable foods, exercise and gymnastics, reasonable hours, etc. These are all of the utmost importance. They need not, however, be more than mentioned, as they are apparent to every one.
Second. The internal treatment. Kippax, of Chicago, one of the few physicians who has written on the homoeo- pathic treatment of skin diseases, gives 37 remedies as indicated in acne, from antimonium crudum to veratrum ; some of these remedies, as granatum, nabulus serpen- taria, eugenia jamb., robinia, sumbul, we hardly know of, and others we seldom use. There are, however, certain remedies which I have found of considerable use in treating acne, somewhat in the following order : — Natrum mur., pulsatilla, sulphur, hepar sulphuris, belladonna, antimonium tartaricum and crudum, phos- phoric acid, bromide and iodide of potassium, arsenic iuid phosphorus, and perhaps sabina.
Natrum muriaticum. From what I have said under •causes, common salt, the chloride of sodium, should be of considerable use in treating acne. This I have found it. Many an obstinate case of acne have I relieved and cured with this remedy. Farrington says, page 661, natrum muriaticum acts '^ also on the sebaceous glands. These little glands are quite numerous in certain parts of tbe body, especially around the wings of the nose
and tbe cheeks Natrum mur. stimulates
these, the skin becomes oily in appearance." The indi- -cations are a mapped tongue with thirst, a chlorotic or anaemic condition, the patient is low spirited, is soon exhausted mentally and bodily, has a weak circulation, and so suffers from cold hands and feet, has a harsh, dry yellowish skin, suffers from amenorrhoea, the menses are checked or delayed. There is constipation, the stools are hard, difficult .to expel, and fissure the anus.
Vol. 42, No, 2. H
98 ACNE VULGARIS. "^t^I^^rS^T^^'
There is a particular form of hypochondriasis associated with weak digestion and constipation, also a special headache, /ran^aZ, worse in the morning and after mental exertion. This headache is often periodic, lasting from snnrise to sunset, and accompanied by chills and paroxysms of sneezing. These are the principal indications. One, however, gets to recognise a natrum patient at once. Natrum mur. is, as I have stated, one of the most helpful remedies in acne.
Pulsatilla. One need hardly give the indications for this remedy. It does not so much act on the skin as on the general condition of the patient. It is most useful in young anaemic girls suffering from amenorrhoea. It is more useful before than after twenty years of age. It& action is frequently helped by giving some preparation of iron at the same time at meals ; a favourite preparation of mine is Flitwick water. Another remedy which alternates well with Pulsatilla is sulphur, both should be given high, about the twelfth dilution. Natrum should also be given in the same potency.
Sulphur. This is a remedy which is needed in most skin affections, but from experience I find it most useful in the dry varieties. It should generally be given high. It acts well on the skin, and at the same time corrects the torpid liver and the resulting constipation sa frequently accompanying acne. It is also valuable in inherited acne, by which I mean, acne patients, the children of parents who have themselves suffered from acne and some other skin complaint, what Hahnemann, as I understand him, means by psora. If sulphur is given in moist eruptions, as chronic eczema, it should be given high (12-80), the lower preparations, in my hands,, generally aggravate.
Sulphur applied locally acts well in acne, either as sulphur water, sulphur powder shaken up in distilled water or rose water, or as dilute sulphurous acid. These should be applied after washing; they make a very pleasant face wash.
Hepar sulphuris acts on the skin very much in the same way as sulphur, the point of distinction is pustulation. It is of great use in pustular acne, especially when small abscesses form. The absce88e& heal more kindly and leave less scar.
SgSif^gn§5^"^ ^C-^E VULGARIS, 99
Belladonna. This remedy is usef al in the early stage, the erythematous stage ; it is then of distinct service. We all know and recognise its beneficial action in ery- sipelatous and erythematous conditions of the skin, the simple dermatitis. I don't think it of much use in long-standing cases of acne, these require deeper acting remedies as natrum, arsenic, phosphorus and sulphur.
Antimonium crudum and tartaricum. The cases requiring these remedies verge on sycosis, the face is more hairy than in simple acne, the pimples are pustular, and often have a central lanugo hair. With this condition of the skin you have the character- istic indigestion, the thickly-coated white tongue, accompanied by nausea, impaired appetite, slow digestion, flatulence, and the tendency to diarrhoea.
Phosphoric acid. This remedy is of use specially in boys and young men, who suffer from seminal emissions or are addicted to masturbation. At the same time order open-air exercises.
Bromide of potassium is also of use in the same class of case, especially in young men at puberty, when their whiskers are coming. It is more useful in dark than fair subjects, phosphoric acid suiting the fair youths. In girls, these two remedies are of service when the eatamenia are excessive and exhausting, in this differing from natrum mur. in which the flow is scanty and irregular. The bromide and phosphoric acid subjects are generally hot, florid, fuU-blooded persons ; the natrum mur. ones, cold, timid, pale, desponding, anaemic.
Iodide of potassium and iodium are seldom useful in true aene ; the cases needing these two remedies are more folliculitis, that is inflammation of the follicles of the hairs, without plugging, and the pimples are scattered all over the trunk and limbs, not confined to the bust as in true acne. The iodide of sulphur 3x, as suggested by Mr. Dudley Wright, is also of marked use in the same class of case.
Arsenic and phosphorus. The old dermatologist. Hunt, thought very highly of arsenic in acne, and in his work gave several cases of cure. When, therefore, you have a very obstinate case, give arsenic, it sometimes aets wellr The cases are always chronic and more rosacea than acne vulgaris, the induration is not confined to the follicle but wider spread. Phosphorus is of ^
100 ACNE VULCxAMS. ^CJ^L^^ST?^
Beriew, Feb. 1. 18B&
later school than arsenic. It acts in much the same way ; you have, however, more the symptoms of phosphoric acid.
Sabina and sanguinaria are two remedies occasionally of use in older women ; the spots are, however, acniform more than acne, and clearly reflex and secondary to some uterine or ovarian irritation. They have in my hands occasionally proved serviceable.
Third. The local, external treatment.
1. Palliation. Protecting the face from cold winds with veils. Steaming and soap. Washing the face with very hot water and soap ; exposing it to a steam blast or steam-kettle to soften the plugs and then gently pressing and kneading the pimples. Very sensitive skins should be washed with oatmeal water, or with the purest olive oil alone. This latter I have seen distinctly useful,
2. Extraction of the comedones. This must be done very gently, otherwise, if much pressure be used, the skin will be bruised and the inflammation and induration increased. After steaming the face the follicle should be opened with a blunt stilette and then gently squeezed or a comedo extractor used.
3. Puncturing the suppurating pimples. When done it should be done freely with a needle, or better with a puncturing stilette. Again, caution should be used that only gentle pressure be applied, otherwise bruising may eause hard, long lasting red knobs.
4. Cauterisation is sometimes of use in very obstinate pimples, either with carbolic acid or electrolysis, three milliamperes being used to destroy the hair follicle.
5. Shelling for scarring, i.e., removing the epidermis, is strongly recommended by some. Teuten, of Wiesbaden, has quite a reputation for improving the appearance of young women's faces by this means. The anaemic girls go to Sc^walbach ; the waters of this spp. cure their ansemia, but bring out a copious crop of acne spots ; by means of shelling the disfiguring pimples are very much lessened, and the general good looks much improved. A strong resorcin paste is used. Politzer, of New York, uses a strong paste of ichthyol for the same purpose. It is applied all night, acute dermatitis results, and shedding of the horny layer of the skin takes place. The shelling may be repeated
SSS'ShTiS?"''' UTERINE MYOMA. 101
Befiew, Feb. 1« 1808.
several times at intervals of several days. Unna's salicylate plaister would have the same elTect.
6. Parasiticides. First examine the scalp for seborrhoea. If there is any scurf or dandruff, the condition should be treated with some mild mercurial or sulphurous acid lotion together with brisk brushing.
Secondly. The individual spots should be treated. Binger recommends sulphurous acid applied to each spot with a small brush. This I have often found of considerable use. Another good application is a wash of powdered sulphur shaken up in rose water, with a little glycerine added. This, also, is of distinct service, as is a very mild preparation of oleate of mercury (1 per cent.) A 1 per cent, solution of formalin has also been advised by Hyde for the same purpose.
Lastly, for washing, use a mild soap, by preference one of the many super-fatted kinds. Use a soap that will not inflame the skin and cause thickening of the epidermis and thereby blocking of the follicles. The above are the many and varied means of attacking this troublesome disease from the constitutional, local and parasitic sides. By long continued treatment much good may be gained in nearly every case.
TWO CASES OF UTERINE MYOMA AND SOME LESSONS THEY SUGGEST.
By Edwin A. Neatby, M.D.,
ABfliatant Physician for Diseases of Women to the London Homoeopathic Hospital,
AND
Bykes Moib, M.D.,
Physician to the London Homoeopathic Hospital.
The natural history of disease for its own sake will always secure for itself patient and scientific students, but the therapeutist will seek to know what is known and knowable of its course for the practical benefit of his patient. As the young medical student must be familiar with the normal or physiological state of health before he is capable of judging of the importance of departures therefrom, so must the student of disease ascertain, as far as possible, the usual or natural course of an illness before he is competent to form an opinion
102 UTERINE MYOMA. ^'Se^^I^FT^X
as to the effects of treatment or to advance an accurate prognosis.
Even the worst enemy of homoeopathy wUl acknow- ledge that by its alleged do-nothing methods the eyes of the profession have been opened to the value of the vis medicatri^ natnrce. For " active treatment,'* ^.f/., of pneumonia, resulting in a mortality of from 20 to SO per cent., the masterly inactivity of ** expectancy" has, through the influence of homoeopathy, been substituted, with an improvement in the death rate of 10 to 20 per cent. Homoeopathic practitioners, then, have been instrumental in throwing a flood of light on the natural history of disease, even though it may have been unintentionally, for if they did not leave their cases to nature, they emboldened others to do so.
From the knowledge thus obtained the medical man is able to say that a disease like pneumonia will probably run a certain course, and will reach its crisis on one of a limited series of davs and, in all probability, in a healthy subject at neither extreme of life, result in easy recovery. He is able to point out and guard against the danger of collapse at the time of the critical drop of the temperature. Again, he knows the danger of nephritis in scarlet fever, and, especially during the desquamative stage, can warn the patient of his danger and adopt preventive measures. If in such cases he omits precautionary measures he does not act up to the light which he either possesses or ought to possess, and he incurs and is worthy of blame.
In other words, the doctor (as the term implies) must be a teacher. His knowledge enables him to foretell, to prophesy, not indeed by an inspired revelation but by a process of calculation based on an accumulation of fact, his own and that of others. He is bound to place such knowledge and before-sight at the disposal of his patient to indicate to him (or his representative) the probable or certain course and issues of his malady, and to guide him to the best way of escape if a way exist.
The steady but rapid increase of human knowledge is so great that even a Macaulay's school-boy could hardty keep pace with it. With this goes the fact of the gradual extinction of the ** good-all-round man.*' In few instances is the presence and advice of such a person more needed than in the class of cases which forms the
SSSSfSrSS!^ UTERINE MYOMA. 108
subject of this paper. When the combined wisdom of physician and surgeon cannot be secured in one person, it is essential that the two should meet and form a united
{'ndgment on the medical and surgical aspects of the case, ^ased on knowledge obtained from the bed-side, the natural history of similar cases, the operating table, and the pat-mortem room.
Let us see if these remarks — somewhat of the nature of truisms — have any bearing on, or receive exemplifi- cation by, two cases which have recently been under treatment in the London Homoeopathic Hospital.
On September 3rd, 1897, Mary 8., a short, squarely- built, single woman of dark complexion, set. 41, came to the out-patient department ; she could walk on the level, but could not get upstairs by herself, and could not lie down on the examining couch. She was at once admitted to the wards. The patient's own history is important in three particulars. Three years ago she had amenorrhoea for five months, after which the period was regular and somewhat excessive, but menstruation ceased in August, 1896» t.^., when the patient was 40 years of age. Twelve years ago the patient had an operation for uterine polypus. There was no history of acute illness except '' quinsey " twice.
On examination the abdomen was found to be enor- mously distended, measuring 50 inches in circumference. The greater part of it was dull, with a resonant area across the abdomen in the line of the transverse colon. There was &ee fluid in the abdominal cavity, but in spite of the fluid and tension solid masses could be felt, especially in the right iliac region. Vaginally the uterus was found to be drawn up, and there were some solid growths felt at the vault. No accurate conclusion was possible, but a solid, and probably myomatous, uterine tumour was diagnosed.
The legs and face and skin of abdomen were oedema- tous, and had been so for some two or three months. On the skin of the abdominal wall there were a number of bollse, from some of which serous fluid was oozing. The heart sounds were feeble and the mitral systolic was roii^hened. The apex beat was not located, but the heart seemed to be pushed up.
To relieve the pressure gradually a Southey's tube was inserted into the abdomen, and 144 ounces of serous
l04 UTERINE MYOMA. ^"S^L^iTT^,
Beviev, Feb. 1, 18P8.
fluid were drawn off. The quantity of urine was very small, not exceeding 12 ounces in 24 hours, but there was no albumen or sugar ; specific gravity 1020 ; copious urates. Apocynum and arsenic were first administered^ and • after two days they were replaced by strophanthuB. The patient had been getting about a little until she came into the hospital, but she rapidly got worse, anasarca increased ; she had an attack of faintness with some convulsive movements and unconsciousness on the 5th June, from which she rallied quickly. The next after- noon she became very blue, pulseless and convulsed, and died in a few minutes, in spite of ether and strychnine hypodermic injections and artificial respiration.
At the post-mortem examination a large multi-nodular cystic myoma was found, filling the abdomen and push- mg up the diaphragm. Across the upper part, as is shown in Fig. I., the transverse colon was closely adherent, and the enlarged left Fallopian tube is seen stretched across a nodule to the left and low down. There were a number of large cysts and many small ones; some of the nodules were solid fibroids — the majority were myomata, soft or cystic. Adhesions were very numerous, and it would have been quite impossible to remove the tumour by operation. After letting out the fluid of the cysts the solid matter weighed over 27 pounds.
The notes were taken by Mr. Watkins, late House Surgeon, and the photograph by the Eev. A. T. Gape.
The next patient* was Mrs. F., set. 43, but looking older, gray since 28, married 17 years and never pregnant. She was ansemic, but not extremely so, and dyspnoea on exertion was present, and had been noticed two or three months. Patient has had no rheumatic or scarlet fever, typhoid or diphtheria.
Menstrual life had been fairly normal, with the exception of, on one occasion twelve months ago," a severe flooding." The periods lasted seven days, and latterly have been excessive and occurring every three weeks.
She was admitted on November 27th ; the last period occurred on November 5 th and it had not recurred on on the 29th.
Patient stated that she had noticed enlargement of the
* From notes taken by Mr. P. Hlggens, House Surgeon.
DR. NEATBTS MYOMA CASES.
Fig. I. (Page 104.)
Fia. II. (Page 106.)
£5^^pSn*?§£"' UTERINE MYOMA. 106
abdomen three months or more ; twelve months previously she believes her '' stomach was quite flat."*
On examination a large, rounded central prominent
abdominal tumour was seen ; it extended well above the
umbilicus. It was smaller at its lower part, and the
bladder was drawn up in front above the pubes, and
when distended could be seen extending two-thirds of
the distance to the umbilicus. The tumour was globular,
smooth and elastic. It felt like a tense ovarian cyst,
but no definite thrill was obtainable ; if cystic the walls
were very thick. Vaginal examination threw much light
on the condition, and revealed the following interesting
and important facts : extending well into the true pelvis,
and to within about 1} in. of the vaginal orifice was a
hard, nodular, non-sensitive mass. This tumour nearly
filled the pelvis, was most prominent on the left side,
and pushed the uterus over to the right. This otgan
lay close to the right j^elvic wall, and was high up, almost
out of reach. The hard mass described could, when the
liladder was empty, be felt bimanually Ijring below the
globular abdominal tumour above mentioned. But
pressure with the external hand, both upon the abdominal
wad the pelvic tumours, was readily communicated to the
^^r in the vagina, whether resting on the tumour
^^ on the cervix uteri. When the abdominal tumour
^as drawn up by an assistant the cervix was raised from
*e finger, and when released it re-descended heavily
^Pon it. The evidence, therefore, of the close connection
^' fte tumours with the uterus and with one another
^^ tolerably complete.
The interpretation of the phenomena was plain and
pJ"iking. The pelvis was occupied by a hard fibroma of
^^8 standing, growing from the left side of the uterus
^^ pushing it over to the right. This tumour probably
J^'^owed into the left broad ligament. From near the
g^^dus of the uterus sprang another tumour, recent,
^ **• (possibly even cystic), rapidly enlarging and dragging
^ the bladder — a myoma very elastic, if not actually
^^taining fluid.
-^-*^he urine averaged about 40 ounces daily, specific ^^ty 1020 ; phosphates were present but no albumen.
p^^he had been under Dr. Ord's observation for a few^ weeks, who on S^^iying the increase in the size of the growth, sent her up from ^^^iiemouth for operation.
106 UTERINE MYOMA. •^S^iTwfFSl^flSSr
The cardiac condition is described on a subsequent page.
At a consultation of the staff operation was decided upon. The usual preparation by rest in bed, light but liberal diet, and thoroughly emptying the bowels, was carried out. On the morning of December 2nd the patient was anaesthetised by Mr. Lestock Eeid; ether was given, and the patient was admirably managed by the administrator; no rigidity, straining, retching, or contretemps of any kind occurring throughout. Mr. Johnstone gave his valued help at the operation. A long incision was made extending 1^ inches above the .umbilicus. The abdominal tumour was found to be so elastic as to lead to the exclamation that there was ** no doubt of its being cystic now " ; it was easily got outside. The intestines were carefully protected, and there being no tension they did not attempt to protrude. The broad ligaments were tied off outside the ovaries, (which were very large) and as this was done the pelvic mass was gradually raised from its hollow. After ascertaining the exact height of the bladder wall a transverse incision across the front of the tumour from one broad ligament to the other was made, about one inch above the afore- named viscus. The peritoneum was divided by this cut, and was stripped downwards together with the bladder. After a similar incision had been made behind, the uterine arteries could be felt pulsating and they were ligatured. By this time the hard pelvic fibroid was thoroughly raised from its bed, and only a small pedicle formed by the cervix had to be dealt with. As a precaution this was ligatured by transfixion and the cervix divided. The plug of mucus in the cervical canal was not disturbed, but the canal was closed by fine sutures, and the stump was allowed to drop to the fioor of the pelvis. The anterior and posterior edges of peritoneum were approximated and united by fine continuous sutures over the pedicle, leaving it retro-peritoneal. Except the stump of the broad ligament, no raw surface was left in the pelvis. A drainage tube was used.
Figure II. shows the relative size of the hard and the soft tumours, but the difference in the appearance of -the two does not come out well. The tumours are cut open in the photograph. Two dark spots in the upper tumour show the site of small cysts, about the si«e of a
iKilSJ'^rrSSf '' UTEMNE MYOMA. 107
JiiTiew. Feb. 1. UM.
filbert nut in the fresh state. The uterine cavity is to the left (in the picture) of the lower (hard) tumour, and is stuffed with cotton-wool to shew it up. The tumour weighed about six pounds. The photograph was taken by Rev, A. T. Cape.
During the operation it was noticed that the veins of the remnant of the left broad ligament had become very much distended.
The operation was followed by very little shock, the patient rallying well and passing urine naturally by the second day. After a few hours a most troublesome cough set in, which caused great abdominal pain. Vomiting ceased after 24 hours ; there was no distension at any time, and the urine did not contain albumen after the operation. The Keith's glass tube was left in two days, and a rubber one replaced it for 24 hours ; after that no further dressing was required.
The bronchial cough, with purulent expectoration, gave great distress and was difficult to relieve.
The heart sounds were as before the operation until about the 6th, when the loudest bruit was heard midway between the aorta and the apex.
On the 9lh, in the same situation, the bruit was noticed to be distinctly musical in character, but this high pitch was confined to a very small area. Cough improving, but the patient was weak and pale.
On the 10th patient was allowed to be propped up in bed by a bed-rest. The next morning she complained rather suddenly of pain in the left leg, especially the calf, and thrombosis of the femoral and saphena veins was discovered.
On the 18th the area of the musical bruit had extended, and it was thought to be exocardial ; the leg was doing well. After this the patient continued to convalesce, the musical bruit gradufdly disappearing and the swelling of the leg going down. She was kept very quiet in bed for some weeks, was lifted out on the 10th January, 1898, and left the hospital quite well.
Here are two cases sufficiently alike to admit of fair and advantageous comparison. Any difference in the two was in the first patient's favour, both as regards age and strengths Her case furnishes such an example
108 UTERINE MYOMA. ^^I^iTT^
Beview, Feb. 1. 1808^
as is not easy to obtain of the natural history of disease^ practically undisturbed by art. Twelve years before, a polypus was removed from the uterus, and this furnishes us with a probable date as to the duration of her tumour. At what period it became cystic we have no evidence,, except that it grew much more rapidly during the last year. It proved its innocence by leaving her fairly well and strong till within a few months of her death. It proved its noxiousness (though technically not malignant) by killing the patient in a simple mechanical manner. Pressure on heart, kidneys, and other viscera induced cardiac weakness and dilatation, renal inadequacy and anuria, uraemia, orthopnoea, convulsions and death. Operation fortunately was not to be thought of when she came under medical observation, and at the autopsy the numerous adhesions showed that the growth had probably long been inoperable.
The clear inference in this case is that the patient required some wise physician gifted with foresight to warn her of the future, and a surgeon to advise her aa to the possibility of the safe removal of the tumour. The patient waited until urgent symptoms developed because she was ignorant and unadvised.
The second patient was seen by Dr. Ord, who gave her the benefit of the prophetic power possessed by the educated and judicious physician. He saw that the prospects of the patient if left to nature were practically those of the first named case, and those who knew both patients could see that her chances were even lesa favourable. Case II. was diagnosed to be one of soft and possibly cystic myoma of the uterus. The evidence went to show that it was growing. It is a point to be borne in mind, and which we wish to emphasize both from the medical and surgical side, that such a condition demands prompt surgical interference. To wait until symptoms arise is to wait until the growth has made itself obnoxious through enlargement, through peritoneal irritation and adhesions, or through damage to the uterine appendages. In these and other ways the magnitude and danger of an operation are increased,, and the patient's chances are lessened through local causes. The same undesirable end may be attained through diminution of the patient's general resisting power. Annmia will tend to increase ; through malnutrition the
g^l^^bTtSS?**' UTERINE MYOMA. 109
heart muBcle will fail and dilatation be induced. Or the mere added work thrown on the heart by a massiye tumour will cause hypertrophy, to be followed later by failure of power. For local or general reasons — or both -—procrastination of operation means a courting of dis- aster.
As has been pointed out in the London Homoeopathic Hospital reports, increased tension at the radial pulse often accompanies uterine myomata. The bearing of this on the question of operation is real and direct. The significance of such increased tension arises from the secondary changes brought about by it in the heart and vascular system. After tension has existed for some time, hypertrophy of the muscular coats of the arteries is sure to follow, as well as of the wall of the heart, and later on degenerative changes which lead to a failure of the circulation.
In cases where there is marked anaemia low tension may be present, and with it a weakening of the myo- cardium with consequent dilatation of the heart and failure of the mitral and tricuspid valves. The danger of this failure is very much increased by the presence of a large tumour in the abdomen, and the interference which it gives rise to in the general circulation.
The first case was seen in the final stage, when after a long gradual failure death took place in consequence of enfeebled circulation. The second case was fast approaching the same condition.
At the consultation, one of the chief points in deciding for or against operation was the state of the heart. There was a loud systolic murmur heard best in the pulmonary area, but it could also be heard at the apex, and it was a disputed point whether there was mitral incompetence. After the operation the weakness and troublesome cough led to further dilatation of the heart, and the musical murmur was probably due to incompetence of the tricuspid valve, though at the time it was thought that it might be exocardial.
On page 108 we have implied that to treat these cases by radical surgical methods or to leave them to nature are the only practical alternatives. There is no question here as to the use of palliative medicinal means for there is no clinical evidence of drugs having any influence oa
lia UTERINE MYOMA. ^Si^t^5S?l?J&*!
soft myomata. Nor would one expeet much influence. A tumour of the uterus arising before the menopause and unaffected for good by its onset whether natural or artificial, is not likely to be benefited by drugs — ordinarily much less potent uterine agents than the menopause.
Though the cases here adduced do not show this fact, it is, nevertheless, well recognised that soft and cystic myomata are not diminished by the cessation of menstruation either natural or resulting from the removal of the uterine appendages.
Summary.
1. These observations refer primarily and chiefly to soft or cystic myomata, which require complete mental differentiation £rom hard fibroids.
2. The natural history of the former differs from that of the latter in being uniformly bad.
8. The effect on the heart may be summarised as follows : —
In addition to the actual interference with the circulation caused by the pressure of a large tumour, failure of the heart may result from long continued increased tension or from low tension ; the latter occurs more especially when there is marked ansemia.
4. Soft and cystic myomata are uninfluenced by the menopause ; it is in vain to defer treatment on account of its proximity.
5. Fibroids must be treated on their merits ; soft and cystic myomata have no merits, and must be summarily dealt with as soon as diagnosed. They require total removal, quite apart from the presence or absence of symptoms. The better the patient*s health the better her chance of recovery.
6. There is no clinical evidence that these tumours are influenced by medicines.
7. Haemorrhage is less severe in myomata (soft) than n fibroids (hard).
8. The two kinds of tumour may coexist in one patient as in both these cases.
9. It is desirable, on account of the different clinical course of hard and soft '' fibroids," that different names be used for the two varieties. The hard variety might conveniently retain the name of fibroma, and the soft that of myoma.
SSSS'^TSf** APPENDICITIS. Ill
HevJMT, Feb. 1, 1896.
A RAPIDLY FATAL CASE OP APPENDICITIS.
With the Lbssonb to be Drawn from it with reoabd TO Operative Interference.
By Byres Moir, M.D., PhjncUtt to the London Hom(Bopathio Hospital,
AND
C. Knox Shaw,
Snzgeon to the London Homoeopathio Hoipital.
(1) The following are from notes taken by Dr. Byres Moir^
Om the morning of the ISth of January I (1) was called to
see a little girl, aged six years, who, at five a.m., was seized
with violent pain in the abdomen, and vomiting. She
was a healthy, well-developed child, there had been no
Berions illness previously, but a history was given of
sharp attacks of pain with vomiting on three distinct
occasions, which passed off in a few hours, the last of
these being in September, 1897. On the 10th of January
she had a slight feverish cold, but appeared to be
perfectly well on the 12th, and there had been no
abdominal pain. When I saw her at 9.80 a.m. on the
18th, the vomiting had ceased, and the child had been
dozing, and no abdominal pain was complained of. The
pulse was 140 and the temperature 108.8^. There was
no distension of the abdomen, but decided pain
on pressure in the right iliac region, no swelling
could be felt. The tongue was furred, and the bowels
had acted on the previous day. The matter vomited
during the night was light yellow bile. The case
then had the appearance of an ordinary attack of
appendicitis, though pulse and temperature were
higher than one usually sees in these cases.
Belladonna Ix and mercurius cor. 3x were ordered, and
belladonna was applied locally. She was to have milk
and water in small quantities, and water to drink. In
the evening the child was found to have passed a fairly
quiet day ; there had been no return of the vomiting ;
the tenderness of the abdomen remained just the same ;
the bowels had not acted. The temperature had fallen
to 102.8®, and the pulse to 120. At my visit the next
morning I foxmd that there had been vomiting in the
night, in consequence of which Dr. Cox had seen the
cluld. She was now complaining of more pain, and I
found for the first time some slight general distension of
112 APPENDICITIS. ^S^l^w^Sr?!lSL'
Renew, Feb. 1. 18B6.
the abdomen. The temperature was 101.6^, her pulse 140. There had been no action of the bowels. There had been no return of the vomiting after Dr. Cox had seen her. The child was evidently not so well, but had no collapsed appearance. On account of the distension of the abdomen and the still rapid pulse, especially as the temperature had fallen, I thought it was time that the question of operative interference should be considered, and arranged with Mr. Knox Shaw to see the case with me in the afternoon. Just before we saw her there had been a copious vomit of dark green fluid, and the child was much worse, and showed for the first time evidence of collapse. The state at our examination is given in Mr. Enox Shaw's notes later.
The mother of the child, who had not been present at my first visit, had obtained by telegram, from the doctor who had seen the patient in previous attacks, a report that there had been no evidence of appendicitis. The question we first had to discuss at our consultation, in which Dr. Cox joined, was, what was the nature of the present attack ? In the first place I considered that the previous somewhat similar illnesses had been, in spite of the doctor's opinion, mild attacks of appendicitis. The statement of the mother being quite clear that the pain was always in the right iliac fossa. It was now evident, however, that we had a general peritonitis, and from its rapid progress this could only be due to a perforation, and from lack of other symptoms, perfora- tion of the appendix was considered to be the most probable origin. Immediate operation seemed to us the only advisable course, though from the symptoms of collapse already present, only faint hopes could not be held out as to its ultimate success. Another opinion was asked for and obtained without delay, but even in a couple of hours such a rapid change for the worse had taken place, that operation was considered inadvisable. At eleven o'clock the child sank. A post-moiiem was made the next day. On opening the peritoneum a quantity of sero-purulent fluid was noticed with flakes of lymph attached to the intestines. The appendix, a very long one, was fixed by adhesions to the peritoneum covering the psoas muscle; there was no localised abscess nor swelling. The appendix was not distended; its middle third wasi of a dark
S^'^rr^' APPENDICITIS. 113
liyid colour and in the centre of the free surface of this there was a very small punched-out perforation, not larger than a pin*s-head. From this there had evidently been a leakage of the contents of the appendix into the general peritoneal cavity. I have seen a good many cases of appendicitis, but have fortunately never met with one similar to this before. From the post-mortem- it is quite evident that an operation directly after my first visit would have given the only chance of a recovery^ At that time, however, I could see no symptoms which would have justified it. There were not even present the symptoms of general peritonitis, and during the first day vomiting and pain were both absent. The pulse and temperature, which in an adult would be of serious import, do not carry the same weight in a child. It was not till twenty- four hours had elapsed, that the symptoms of general peritonitis, which had been insidi- oasly progressing, became manifest. The case is a very instractive one with regard to the general question of operation in appendicitis. For we must remember that the danger of a possible perforation is present in every ease. If this occurs, as in this case, we have the risk of a septic peritonitis, of such a virulent type that the patient collapses before the classical symptoms of peri- tonitis are developed.
Mr. Knox Shaw remarks : I saw this very interesting case with Dr. Byres Moir at 6.80 on January .14th. The child was then extremely ill, with hollow eyes and pale and shrunken face ; she was lying on her back in a somewhat torpid condition, but was easily roused, and answered questions intelligently and brightly. The tongue was slightly coated. The abdomen was tympanitic and generally resonant, but there was no great meteorism; the chUd bore its abdominal manipulation well, there was general but not excessive tenderness. When asked to point to where the pain was, she always placed her hand over the right iliac region. No swelling or mass could be detected in the right iliac fossa or elsewhere. The bowels had not acted since the 12th, though there was a desire for them to do BO. An examination per rectum showed faeces, but nothing abnormal in the pelvis could be detected ; the examination caused the bowels to act. The breathing was quick, pulse small and rapid — 160 ; the temperature
VoL 42, No. 2. I
114 APPENDICITIS. ^"^*Ji^wfFr?!1»i"
was 103°. There was no very marked collapse, nor cyanosis, nor the cold sweats of advanced peritonitis. Yet the case was clearly one of serious peritonitis, and probably due to a perforation, or gangrene of the appendix. The question naturally arose, should we operate ? It seemed clear that the child would almost certainly die if left alone, and that in her present condition an operation offered only the barest chance of success.
However, whilst recognising the almost hopelessness of the task, I was prepared to operate, provided the mother clearly understood the extreme gravity of the situation. A further opinion was then obtained ; by this time the child had rapidly and steadily become worse, and when Dr. Moir saw her later he agreed with the opinion then expressed that the time for operation had passed. The child died forty-two hours after the onset of the disease, and thirty-six hours from first being seen by Dr. Moir. The lyosUinortem examination showed only too plainly that operation, to have had any chance of being successful, must have been undertaken on the onset of the symptoms. Experience shows that the character of the onset of the attack bears no definite relation to the severity or danger of its subsequent course, and so we are at once face to face with a great difficulty. Until we can find some definite signs or symptoms by which we may distinguish between the dangerous and the moderate cases, we must either perform a good many operations that may not be absolutely necessary, or occasionally lose a case like this. I think our main guide in these cases is very carefully to distinguish between localised and general peritonitis. A watchful eye must be kept for the onset of general peritonitis, and if we are at all suspicious that this is existent, then the question of operation must be seriously considered, and if we are sure of our diagnosis, urged. Mr. Frederick Treves well describes the position when he says : ** If the gravity of the patient's position be appreciated, it will be evident that a carefully made incision into the abdominal cavity can hardly add to his peril, while on the other hand it may be the means of saving his life.'*
There is another interesting point in the case ; from the previous history it would appear that the child had
X!^rX^ BEVIEWS, 116
had two if not three attacks, commencing in a similar manner to the present ; vomiting, right iliac pain and feverishness. The mother was most positive on this point, and that the attacks had yielded to a mild purga- tive. Against their being attacks of appendicitis we had the opinion of a previous medical attendant, who con- sidered that they were not due to the appendix nor to any form of peritonitis. Dr. Moir, however, thought that at the post-ifwrtem there was evidence of previous peritonitis. These cases of acutely virulent perforative peritonitis are usually primary attacks, a previous attack generally erects some protective barrier to a sudden bac- terial invasion of the peritoneum. Still they may occur after recovery from a mild attack, and this possibility adds weight to the opinion that a history of previous attacks, though mild, warrants an operation for the removal of the appendix during the quiescent period.
REVIEWS.
A Manual of Genito-Urinanj and Venereal Diseases, By BuKK G. Cableton, M.D. New York : Boericke, Runyon and Emesty.
This manual is really the joint production of three authors, for Dr. Carleton has associated with himself Dr. Charles Beady, who has written on venereal diseases of the eye, and Dr. Homan, who has contributed the sections on vesical calculus and external urethrotomy. The impression left after a perusal of its pages is that the book lacks in many places the stamp of practical personal experience — ^we have too little of what Dr. Carleton himself has found good. But this is too often the fault of homoeopathic text books, the inexperienced reader is left to flounder amongst an alphabetical list of drugs when be needs the practiced hand of the author to guide him in the selection of the most useful drugs. The chapters are of unequal value, that on pyehtis in particular being noticeable for its incompleteness. It is not quite clear why, in a manual of genito-urinary diseases, the description of diseases of the kidney should stop at its pelvis. The fullest and best chapters are those on the so-called venereal diseases, gonorrhoea, syphilis, and their allied affections. Here we seem to get at some of the author's experience. His descriptions of the various diseases are good and accurate. He is thoroughly cosmopolitan in his treatment, and gives, in iiddition to homoeopathic therapeutics, the recommendations of
1—2
116 KEviEws. "^*^2w=sr??;JSSr
Beview, Fbb. 1, 1806.
traditional medicine. From these sections we may get many useful hints. In addition to remedies mentioned when the various syphilitic disorders are described, a special chapter is devoted to the treatment of syphilis. The author claims Hahnemann as a supporter of the mercurial treatment of this disease. He is strongly of opinion that no mercury should be given in a case of syphilis until the secondary manifestations have appeared, the only exception being when the diagnosis is positive, as when a diancre appears on the hand or finger of the surgeon. In the primary stages he advises mere. sol. Hahn., mere, vivus, mere, proto-iod. In the late secondary and tertiary stage mere, bin-iod., mere, bichlor., cinnabaris and mere, dulcis, while iodide of potash, in appreciable doses, should be used for the late manifestations of syphihs. Dr. Deady has contributed four chapters covering fully the primarv and remote syphilitic affections of the eye, and has entered carefully into their therapeutics. A short and concise section on stone in the bladder, has been pre- pared by Dr. Homan. In describing the radical cure of hydrocele no mention is made of excision of the sac : injections of either iodine or carbohc acid, which are recommended, are known too frequently to fail. In varicocele Dr. Carleton follows Mr. Morris in preferring subcutaneous ligature, after a method practised by Dr. Keyes, to the open method of excision, more commonly followed in this country. At the conclusion of each section tiiere is a chapter on the special therapy of the organ just described : this is certainly a very valuable addition to the book. Thus we have a special tiierapy for the prepuce and glans, a special therapy for urethral and gonorrhoeal discharges : a special therapy for the scrotum, testicle and cord. The book is well printed and there is a good index.
Diagnosis Chart of Cama. By Q. A. Huntley, M.D. Weston*
Super-Mare : Huntley Brothers. We have received from Messrs. Huntley Brothers, of Weston- Super-Mare, a sheet which gives the differential diagnosis and treatment of coma in a tabular form, arranged by Oeorge A. Huntley, M.D. ^University of Vermont, U.S.A.) As it is very often extremely difficult when called to a case of coma to diagnose its cause, it may be useful to have at hand a tabulated list of the differentiating symptoms to refer to.
There are thirteen different kinds of coma in the list, viz.^ uremic, diabetic, apoplectic, alcoholic, opium, belladonnai asphyxia, congestive, epileptic, hysterical, syncope, coma from meningeal haemorrhage or from injury to head, and catalepsy.
Siy^ny MEETINQB. 117
Coma from carbolic acid poisoning, which has been so frequent of Ute, might Tery usefallj have been added. The symptoms of these different kinds of coma are arranged nnder ten head- ings. Thejare clear and definitCi and we have not much criticism to make on them. Under the heading papils the ^enns regular and irregular are used, which we suppose mean eqtukl and unequal, and would, we think, have been better so e^piBBsed. Under the heading paralysis we find it stated that in diabetic, alcoholic and congestive (sunstroke) cases there is no true paralysis in distinction to apoplectic coma where bendplegia or universal paralysis may exist. The value of this distinction must depend upon the depth of the coma. Paralysis must be complete in every case where the coma is very deep.
One symptom is very puzzling. Under the heading of odour of breath, and in the column giving the symptoms of asphyxia, is placed the symjptom, ''breath contains large amoont Go,." As Go, is an odourless gas we cannot see how it can be detected by the odour of the breath. Any super- fioity of Go, in the breath would be a difficult thing to measure in an emergency.
The last heading is that of treatment, and is entirely on aUopathic lines ; it seems fafrly complete, but we think that in opium coma the use of potassium permanganate should not have been omitted.
MEETINGS-
BRITISH HOMCEOPATHIG SOCIETY. The Fourth Meeting of the Session was held at the London Homoeopathic Hospital, on Thursday evening, January 6th. The President, Dr. Edwik A. Neatby in the chair. The following specimens were shown : —
1. Ovarian cyst, removed on account of pain. (Dr. Burford.)
2. Ovarian cyst, removed on account of htemorrhage. (Dr. Burford).
8. Gall-stones removed by cholecystotomy. (Dr. Burford.)
4. Nine inches of the colon, with caBCum, vermiform appendix, and a portion of the ileum, removed from a case of intussns- eeption in a baby five months old, with fatal termination. (Mr. Knox Shaw.)
Section of Matbria Medica and Thebapel^tics.
Mr. Edward Mahony, of Liverpool, read a paper on TJie Therapeutic Uite of ^owdes.
The author first quoted Hahnemann's writings to show that he distinguished between the use of nosodesandisopathy.
118 MEETINGS. "'S!iS:=ST?»?^!
BeTiew, Feb. 1, 188?.
and that the ** miasm" being highly dynamised, was consequently altered, and that the cure was effected by opposing a simiUimum to a simillimum. He urged that Hahnemann accepted four things : — The law of similarity, the law of potentization, the use of nosodes, and the origin of chronic disease in ** miasm." He considered ihe therapeutic use of nosodes to consist of the administration to the sick of the secretions of diseased animals, or of the pus or other morbid products of diseased conditions. He answered Dr. Bayard's objection that the cure in the use of nosodes is wrought by identicals by saying that potentization alters the nosode from idem to simillimum > And to Dr. Felliger's difficulty that one cannot be satisfied that the nosode is in the same condition as when first taken from the diseased individual, he replied that that is exactly what is wanted, and what potentization brings about. He next expanded and defended the proposition that the laws of Bimilarity and potentization lie at the root of the whole question. To the objectors of the use of clinical symptoms he quoted Hahnemann in support of their use. He concluded by asking what real therapeutic advance is there that is not in iis germ to be discovered in the Organony in the Chronic IH^iitses^ and the Materia Medica Pura,
Dr. Richard Hughes next read a paper On tht- mt of Nosodes in Homwopathic Practice, The author referred principally to hippozaenine and psorine, and drew attention to the diBcuesion on the action of the former initiated by Dr. Garth Wilkinson and Dr. Drysdale as far back as 1854. He also referred to Dr. Dudgeon's observations on psorine in his early lectures and severely criticised the source of the material used in Gross* four provings. He quoted Dr. Dudgeon's objections to the source of Hering's matter, and came to the conclusion that there was a considerable uncertainty as to what is really meant when psorine is used. Dr. Hughes next mentioned Dr. Gaillard's views that the acarus secretes a venom which he calls psorine, and to its absorption follows the secondary disorders known as psora. He would Umit the term nosode and the practice to the proved virulent products of specific disease, and would sweep away the manifold nastinesses of secretion with which morbid fancies have tried to load our pharmacopcBia. The author next discussed the source and the action of tuberculine, referring especially to ihe preparations of Koch and Heath. He quoted evidence of its uae both isopathically and homoeopathic
In the discussion that follo\i . Dudgeon, Dr- BLACKi-Er,
Dr. GoLDSBROUGH, Dr. Dyci yn, Dr. Jawiklski, Dr,
l^EWBEBY and Dr. Neatby took
lK^!^r^^' NOTABILIA. 119
NOTABILIA.
THE DISTRIBUTION OF AID TO HOSPITALS. At a meeting of the Hospitals Association, in the Board Boom, Westminster Hospital, on Thursday, 9th December, 1897, a paper on Exi9tinfj Si/stems of Distribution, was read by Mr. G. A. Cboss, the Secretary -Superintendent of the London Homoeopathic Hospital. Mr. H. Cof mo Bonsor, M.P., Treasurer of Guy's Hospital, occupied the chair.
After an admirable paper on the Work and Aims of the Hospital Saturday Fund, by Mr. B. B. Acland, Chairman of that fund,
Mr. Gross read his paper, firom which we give the following short extracts : —
" I must, at the ontset, express my deep sense of the great indebtedness of the hospitals and allied institutions to botli the Hospital Sunday Fund and the Hospital Saturday Fund for the benefits which they confer upon medical charities, and for the labour which has been expended by both funds to find bases of award which shall be absolutely and frigidly just and impartial. I am sure that in the process of award no tincture of prejudice or favour is allowed to exercise the smallest effect, and that any inequalities which may appear in the awards arise from the systems of assessment alone.
For here we have two capable and impartial bodies both working on totally different lines, both strenuously aiming at a distribution that shall be fair and equitable, and both achieving the most diverse awards. How far it happens that the very efforts they make to be right are the causes of their defects ; how far it happens that they seek a long way off, and with the aid of a telescope, what is lying at their feet, or examine with a microscope that, the true proportions of which ^e visible with the naked eye only, are among the questions I shall ask you to consider. But when we find one hospital wceiving from the Saturday Fund of JglS.OOO a larger award tiian from the Sunday Fund of ^240,000, it is clear that if the naetliod of one Fund is right, the method of the other must necessarily be wrong.
In arranging a true method of distributing a fund subscribed by the pubSc generally for the hospitals coUectively, there are some truisms which must belaid down and distinctly borne in mind. The awards must be made : — . ^* bi fair and equal justice to all and each.
^* Without the bias of any matters of opinion, either as to individual beneficiaries or as to theories of hospital administration. ^* 1^0 secure this, a purely arithmetical method is the only safe and reliable one.
120 NOTABILIA. ^''^^^n^
Review, Feb. 1, USR.
4. The awards should follow — or grow out of— the figures
from each hospital as supplied by that hospital.
5. Thej should be made wi^out any regard to privileges
to be obtained or exercised by the collectiog and distributing agency. Before proceeding to the award on these lines, certain conditions must be observed : —
(a) An enquiry must be made into the status and eligibility
of the hospital for an award.
(b) A proper testing and checking of the figures or other
information supplied must be undertaken.
Most of these are so obvious that it may appear a waste of time to enumerate them. But the danger of their being forgotten is less than the danger of their being too loosely interpreted and extended in practice, so as to bring in matters of opinion and theory. At the conclusion of my paper I hope you will admit that in a true system it is necessary not only to bear them in mind, but to preserve them in their integrity, so great is the tendency to interpret them in the light of special views and special doctrines.
Let me give two examples. Nothing is more desirable in hospital administration than economy. You wish to encourage it, and construct your system accordingly. But what is the test of economy ? Ten experts will give you ten different standards. If you choose one, ten good hospitals will come out with ten palpably disproportionate results. The fact is, economy is, within the walls of a hospital, a matter of fact ; outside those walls it is a matter of opinion. Tou have therefore to be exceedingly careful how your admirable desire to reward this undoubted virtue is carried into practice. Or take efficiency. What U efficiency ? We all know for our own institutions, but who can define it for any other? Yet the Saturday Fund awards partly on • efficiency,' and the Sunday Fund partly on * merits.'
I shall be asked what I would do as to needs, as to economy, as to merits, as to percentage of administration to expendi- ture. When you will tell me how to distinguish afieir off and by statistical returns between a righteous need and a need that might and should have been avoided, when you will enable me to decide what is an economical rate and what is not, when you will define what are really individual merits, and what is an excessive percentage of administration to expenditure (I do not mean in very obvious cases), then I will reply to the query. Till then it seems to me that all these considerations entice the distributor on to the wrong line, and merely obscure the issue.
The funds should not require privileges. The Saturday Fund asks the privilege of an annual subscriber, but without
g^fJSTS^'"' _ NOTABILIA. _ _ J21
;gTxaranteei]ig a specified annual snbecription. It does so in the interests of those who subscribe to the fund in small ■amounts. The plan seems to me less likely to help the hospitals substantially than to help those who contribute.
It would be hard if no privileges could be conceded, but ftey should not be a condition precedent to an award — there should be no bargain — the matter should be left to the imfett^red discaretion of the hospital authorities.
I now come to the main practical basis of a true method. Time will not allow me to do more than suggest the central idea.
It should be the actual charitable work done. This you arrive at to certainty by the beds constantly occupied. The figure cannot delude you or mislead you. It is the one hospital statistic on which you can found an award. You cannot go far away from it on account of theoretical principles of management, or needs or merits, or even •economy without danger to the accuracy of your allotment. Because your theories are not of equal application. You cannot in all cases assess merits or even needs, and economy is an indeterminate quality. Some of the beautiful ideas we hear of are simply impossible in hospital management, and if you begin to penalise or reward according to doctrinaire views, inequa]dties must result.
But if, adhering to a rugged simplicity, you ascertain the iotal number of beds occupied in the Metropolis, divide the total you have to award by that number, and arrive at the fair proportion to each bed, then if you award so much per bed occupied, say an average £5, you achieve all you can hope for either in the way of rewarding merits or discouraging extravagance. A hospital may have a high expenditure per bed. That does not affect you. You give M5. Another may have a low expenditure per bed. That does not affect you. Yon give a level £6. The £6 is worth more to the economically mana^gsd than to the extravagantly managed, — ^more to the hospital whose beds cost iSO per year than to the hospitals whose beds cost £100 per year. You are neither called upon to say which is economical nor which is the reverse. Bhould there be a too high expenditure it is neither penalised nor ^encouraged. According to the present method, it has a premium where the award follows expenditure.
No doubt some modifications would be necessary, but they should be as few and as exceptional as possible, avoiding the mistake of legislating for a number by reason of the peculiarities of a faw.
The great danger in all efforts to distribute public funds is the liability, as already said, to be swayed by matters of
1 09 -MAT A "DTT T A Monthly HomoBopatWo
J-^-fl NOTABILIA. Review, Feb. 1, 1898.
opinion, by the assumption of untried principles, or by mere fads.
There are many current theories of hospital administration ». and much impracticable criticism.
1. There is the ever constant suspicion that the adminis-
tration costs of a hospital are a sort of superfluous leakage which you must not recognise, still less encourage, which you cannot do witliout, but must not admit the necessity of.
2. Next there is the natural but by no means reasonable
bias in some minds, in favour of the large general
hospitals, especially if they have medical schools, it
being apparently assumed that a large hospital must
be better than a small one quo ad charitable work.
8. Then some hospitals have endowments, and here a w^ide
range of objections arise. Some say that there should
be no endowments. Others that there should not be
large endowments.
4. Latterly there is a new theory, that a hospital must have
merit if it organises an enquiry of a drastic kind into
the circumstances of its out-patients. I do not say it
is an improper thing to do. But I suggest that no
distributing agency should modify its award according
to the discretion that may be exercised in a hospital in
this regard.
These, and others like them, are disturbing influences. For
when once you have admitted degrees of qualification or of
disqualification on account of special theories or opinicms as
to hospital management you cannot consistently stop, but
must go on multiplying them.
I submit that all theories of general features of manage- ment are worthless and misleading as guides to a distribution^ and in proportion as you complicate your scheme of award by such theoretical considerations you defeat your own end.
Take a final illustration on the point of economy. Nothing is more praiseworthy than economy. Suppose that it is your function, by aiming to encourage economy and discourage extravagance, to decide practically whether a certain hospital is conducted economically or not. What do you mean by economy? It is not the spending of sixpence where yon ought to spend a shilling. It is to spend only what is necessary for a standard of efficiency, and to get your full value for what is spent. You can do inferior work at a parsimonious outlay, you can do a highly efficient work at an apparently high cost. Of the two, the latter is the truer economy. But if you judge by figures alone you must eondemnit. The figures moreover are merely a matter of
£5^r?errsi'*' notabilu. 12s
average. The hospital of 400 beds averaging a smaller cost per bed than a hospital of 150, may not be so economically conducted, certain standard expenses common to all hospitals* large or small, being spread over a large number of beds. You may say this proves economy from another point of view, as showing that large hospitals are better than smaller ones. But is that really so? Are the patients worse provided for in small hospitals than in large ? You may say ** Yes " or " No,** according to your personal views. Uy point is that economy is a matter of fact which you cannot derive from figures, in statistics it is a matter of opinion, it may be a matter of pure theory and is a source of complica- tion when you come to make awards.
It seems to me that in entering into such questions the Funds assume something of the duties of the donors and sub- scribers to hospitals, and that they should be contented with satisfactory evidence as to the proper constitution of the charity. It is possible to make mistakes from over-anxiety to do right. It is possible to attempt too much.
Finally, I would urge upon both Funds the desirability of accepting a suggestion made by Mr. Conrad Thies that a committee of hospital secretaries should be convened to dis- cuss the whole subject of methods of award, and to submit their recommendations to the councils of both Funds. I am sure that — as in the instance of the long-desired uniform plan of stating accounts — they would bring to their work not only absolute impartiality, but such an exhaustive knowledge of hospital affairs and administration as would enable them to construct an admirable scheme."
The proceedings terminated with a vote of thanks to both Hr. Acland and Mr. Cross, on the proposition of the chauman.
IS PROFESSIONAL APPRECIATION OF HOMCEOPATHY INCREASING ? The following suggestive letter appeared in the Bnthh Medi- cal Journal of the 28th ult., and, together with one quoted from the same source in our first article, constitutes a decisive answer in the affirmative to this question : —
** Consultation with Homeopaths. '* Sir, — I am ratlier surprised that any one at this time should again raise the question, < Should homoeopaths be met in consultation ? ' Are the homoeopaths bigoted or narrow minded ? If any should think so, let them read the intro- duction to Dr. R. Hughes' Manual of Therapeutics. I did so accidentally when a student, and was so pleased with it that I resolved to study it after I qualified. I wonder
124 OBITUARY. MonttlyHomoBopattic
Re\iew, Feb. 1, 1696.
if the extremest fancies that ever entered into the mind of a homoeopath are more chimerical than the grave and laboured speculations of the lights of our profession, -which are received with acclaim to-day and discarded to- morrow. Do we not use the remedies which thej have introduced or rescued from oblivion, and show us how to employ with advantage, and without acknowledging their source ? Do we not read of a new remedy introduced by Dr. So and So, when it has been employed by the homoeopaths since the time of Hahnemann, and oftener with more success by them, as they discriminate when it should be used, whereas those of the orthodox school employ it in all and every case, and being disappointed soon relegate it to the region of forgotten remedies, for example, potassium bichromate, cactus grandiflorus. Are our text books free from the teaching of homoeopathy? I would ask those gentlemen who have written to the British Medical Journal on this subject to study carefully the British Annual for 1887, Dr. Sidney Binger*s Handbook of Titer apeuiics, and compare them with Dr. Hughes' works, and tell us what opinion they oome to. A number of medical men have told me they have been indebted to the homoeopaths for some of the best hints they ever got, and I have learned more of the treatment of disease from some of these men than from those from whom much more was expected. I think the time has now arrived when doctors should be more bent on relieving human suffer- ing, and advancing their profession, than standing on their dignity, and should not be above learning from all or any source.
'< What about the new serum treatment ? Does it not savour of similia similibua curantur / I think a great number of us, oonsciously or unconsciously, practise a little homoeopathy, and I think it is not becoming in members of a liberd pro- fession, ' to denounce Hahnemann as a charlatan, while presenting their patients with a plateful of crumbs furtively swept from Hahnemann's floor.'
*' I have never met a purely homoeopathic doctor in consultation, but will be very pleased to do so.
I am, etc., An Opek-Minded General Praotitionbb."
OBITUARY
ERNEST HART, Esq., D.C.L. By the death of Mr, Ernest Hart on the 7th ult., after mamy years of suffering from diabetes, a sequel of which recently led
IS^rRr^^^^ OBITUARY. 125
to amputation of one leg, the profession of medicine has lost the ablest journalist ever connected with its press.
Bom in London of Jewish parents in 1885, the ability which distinguished him throughout life, was first marked at the City of London School, which he left as oaptain. Entering at Mr. Lane's school, attached to St. George's Hospital, he passed through the usual medical curriculum, and was admitted a member of the Boyal College of Surgeons in 1856. He subsequently joined the Medical School of St. Mary's Hospital, which afterwards he served as Ophthalmic and Aural Surgeon, and at the same time entered upon practice as a consulting surgeon in the City.
Journalism, however, and not practical surgery, soon proved to be his forte. At the age of 22, he was received by the late Mr. Wakley (in 1858) as an assistant in the conduct of the Lancet. Here he met with precisely the outlet for his energy that he was in search of ; and under the direction of % tlu>roughly congenial spirit he made rapid advancement in those aggressive, and what were often unscrupulous modes of attack for which the Lancet was at that period conspicuous. '' For reasons of a purely private nature *' we are told {Lancet Jan. 15) his connection with the journal ceased in 1866. Dr. Markham retiring from the editorship of the Uritinh Mediml Journal almost at the same time. Mr. Hart wae appointed as his successor, and in its management he found a sphere of work for which he was well adapted and a fitting outiet for his energy. That he has raised the Journal from being a comparative feeble representative of the needs, wants, and prejudices of the profession, to one of considerable influence is generally allowed. In directing attention to many sanitary subjects of the first importance, and in using the Juurmil to publish the results of his enquiries, there is no doubt at all that Ernest Hart did a really useful service to the profession of which he was a member, and the country of which he was a citizen. He has been, since 1872, a member of the Parliamentarv Bills Committee of the British Medical Association, and of his work in this capacity the Lancet says, *' it is safe to say that no question affecting the public health or the interests of the medi(^ profession escaped investigation during the quarter of a century for which be held office." Largely through his efforts the conditions of the medical offices of the Navy and of the Army have been materifJly improved. Acts of Parliament relating to Baby Farming, The Infectious Diseases Notification Act owe much of their satisfactory characters to his energy in collecting evidence. His researches into the etiology of epidemics of cholera and typhoid have contributed largely to our present knowledge of ilie history of ^ese forms of disease. We may indeed say.
126 CORRESPONDENCE. ^Ei^Jw^F^T^Ss:
that on whatever Bubject he wrote after carefal and thorough study of it, he wrote with every advantage to the profession.. One of the most useful manuals was entitled The Truth about Vaccination, a perfect storehouse of facts on the subject.
That he was a bitter and unscrupulous antagonist of homoeopathy all men know. When writing upon it, he wrote without the slightest knowledge of it — at least we hope so. For had he had any acquaintance with it, everything that we can remember to have seen in his Journal criticising or reflecting upon it must have been a deliberate and studied misrepresentation of it, and of those members of the profession who practise homceopathically. Hence, we trust that his dialectics were the frait of ignorance, the result of his early training in editorial work in the Strand.
By those who knew him personally, Mr. Hart has been described as being a good friend, a bitter foe, and a brilliant journalist ; a man of energy, enterprise and public spirit.
The Lancet of the 22nd states, that Dr. Dawson Williams, who for seventeen years has been connected with the Editorial department of the Journal, was on the 19th ult., by the Council of the British Medical Association, unanimously appointed Editor.
CORRESPONDENCE.
H.EMATURIA DUE TO QUININE.
To the Editors of tJu ** Monthly Homoeopathic Review.'' Gentlemen, — In the Therapeutic Gazette, April 15th, 1897, Karamitsas, of Athens, reports seven cases of hfematuria due to quinine (given for malaria), one of them being in a child and the others in men, six of the individuals being medical men. In all these cases haematuria could be produced at will by the administration of quinine. The patients passed through their malarial paroxysm without htematuria if quinine was withheld, but developed haBmaturia if the drug was given. The above statement is confirmed by other writers. Pam- poukis and Chomatianos, of Athens, have reported cases in which quinine caused hflemo-globinuria, the salt most fre- quently producing this symptom being the sulphate (probably on account of its more frequent employment than any other).
Yours truly,
R. Graham Wills, M.D.
THE MODUS OPERANDI OF DRUGS. To the Editors of the *'Mo7ithhj Homeopathic Beview^ Gentlemen, — ^Let me thank Dr. Proctor for his kind response to my appeal to him. If the students of the rationale
l^\^?^^8w?^'' correspondence. 127
of homoBopathy pursue the study in the fine spirit of Dr. Proctor's letter, they are not likely to miss the way to the truth they are seeking. There are always at least two routes to concrete truths — the interior and the exterior. Borne minds naturally choose the one route, as different minds are structurally compelled to keep to the other, few being so constituted that movement either way is for them about equally safe and easy. But as appearances en route are often very misleading, it is necessary for the diverse minds to be continually on guard against misunderstanding.
I would be obliged to Dr. Proctor if he would merely mention the phenomena of interference that appear to him to " make equally for explaining the action of opposites as well as of similars ; " also the difficulties on the physiological side of our subject alluded to by him at the end of his letter.
Farther reply at present is unnecessary, since the matter of Br. Proctor's communication is partly dealt with in an article I have already in print, and which will appear next month in the Honueopathic World, and in the North American Journal of Homceopathy.
Faithfully Yours,
W. BUIST PiCKEN.
THE MAYOR OF BATH AND THE HOM(EOPATHIC DOCTORS.
To the Editors of the '* Monthly Honueopathic Rerietc.**
CrEXTLEMEN, — A rumour that I am about to retire from practice having been widely circulated for some time past, and lately given great prominence to by a public statement of the ^ayor of this city, I am compelled to take notice of it.
7be Mayor, in a recent speech concfeming the desirability of admitting homoeopaths to a proposed medical advisory p^Qumttee on the subject of the mineral baths, said, '< He relieved there were only four homoeopathic doctors in Bath, *^d one of these was about to retire, so that Dr. Wilde and ^^ partner were the only two who really used the baths." I ^t once wrote to the local papers stating that I had not the ^^ intention of retiring, that I was constantly sending patients to the baths, both for the ordinary and the Nauheim ^eatment, and that as a former member of the Battis l^ommittee of the Town Council I was quite as interested in 1^ baths as any one ; I also intimated that the Mayor had ^^ midnformed by certain interested persons witib whom ^^^ ^^ was father to the thought.
128 CORRESPONDENTS. "?'^',=S?1'?2S'
Beview, Feb. 1, 1896.
The Mayor has since expressed his regret at having been so misinformed, bat as I do not know the extent to which this misinformation may have spread I shall feel much obliged if you will give this letter the publicity of your journal.
Yours truly,
Bath, Jan. 16. Geobob Nobman.
NOTICES TO CORRESPONDENTS,
*.• We camwt undertake to return rejected wunuseriptt. Authobs and Contributobs reoeiFing proofs are reqaested to correct
and return the same as early as possible to Dr. Edwin A. Neatby.
London Homosopathic Hospital, Gbeat Ormond Street, Bloomsbury. — ^Hours of attendance : Medical, In-patients, 9.S0 ; Oat- patients, 2.0, daily; SUBOIOAL, Out-patients, Mondays, Tuesdays, Fridays and Saturdays, 2.0 ; Diseases of Women, Out-patients, TuesfJavs, Wednesdays and Fridays, 2.0 ; Diseases of Skin, Thursdays, 2.0 ; Diseases of the Eye, Thursdays, 2.0 ; Diseases of the Throat and Ear, Wednesdays, 2.0 ; Diseases of Children, Mondays and Thursdays, 9 A.M. ; Operations, Tuesdays, 2.30 ; Dental Cases, Thursdays, 9 A.M.
Communications have been reoeived from Dr. P. Wilde, Dr. Nob- man, Dr. Wills (Bath) ; Dr. Bambbotham (Leeds) ; Dr. Pboctob (Birkenhead) ; Dr. McLaohlan (Oxford) ; Dr. Obd (Bournemouth) ; Dr. Dudgeon, Mr. Pigken, Mr.CBOss, Mr. Knox Shaw, Dr. Bubfobd, Dr.EpP8,Dr. MoiB,Mr. Wybobn (London) ; Dr. S.Wilde (Cheltenham).
BOOKS RECEIVED.
Common Settle Hofuceopatlnj, Murray Moore, M.D. Liyerpool : Thompson & Capper. — Facts ahaut Monte Carlo. London : Bos- borouffh Press. 1898. — Thn Jlomceoimthic World. January. London. — Medical Reprints, January. London. — TJie Chewht and Druggist. January. London. — Indian Ifowceopathir Beview.—Ileit and Maget^ Calcutta. December, 1897. — The North American Jemrnal of Homceo- pathy. January. New York. — The JIomaojMthie £ye^ Ear^ and Throat Journal. January. New York. — Xlte Medical Times. January. New York. — The Xew England Medical Gazette. December and Jan- uary. Boston. — The Ilahnemannian Monthly, January. Philadelphia. — The Ilomo'itpathic Physician. January. Philadelphia. — The ffovicpo- pathic Jiecorder. December, 1897. Philadelphia.— 7%<f Medical J'>a. January. Chicagro. — The ('Unique, December, 1897. Chicago. — Thr Ifomcfojtathio Envoy. January. Lancaster, Pa. — The Anteriean Medi- cal Monthly. November and December, 1897. Baltimore. — The Minntavitlis HonurojMUhic Magazine. December, 1897. — Pacific fbast Journal of HimteojHithy. December, 1897. 8an Francisco -^Medical Brief. January, be. Louis. — Rerw Jlomceopathiqve Pran<;aise. Decem- ber, 1897. Paris —i2/*rtt« JTomccopathiqne Beige. November, 1897. Bnusels. — Homoojwth ische Zeitung, November, December and January . Stuttgart. — Leipziger Popnldre Zeitschrift fiir IlomHopathie. Januanr. — Hommopat h ische Maandhl ad, December and January. Nederland.
Papen, Diflpensarjr Beporta, and Books for Bevi«w to be tent to Dr. Pops, 19, Watergate, Orantham, linoohuhire ; Dr. D. DrcK Browx, 29. Seymour Street, Port- ■aa Sqnarc, W.; or to Dr. Edwix A. Ksatbt, 178, Hareratock Hill, N.W. AdT«itiae- ■MBte and BoaiiMM eommamcatioiM to be lent to Mewrs. E. Gould k 8ov, W Mootfata Stnat, S.C.
wr5STr«8* INFLUENZA. 129
THE MONTHLY
HOMCEOPATHIC REVIEW.
INFLUENZA.
For failure to conform to type, enteric fever has long had a well-deserved notoriety, and it is not until recent years that a rival has appeared to diapnte its pre- eminence. Now for" multiplicity of form and aberrations from the typical, influenza must be acknowledged to hold the first place. From the eflfects of the '* poison/* or the ravages of the bacillus, scarce a tissue or an organ eeems to be exempt. The irregularity of its results is as striking as the evidences of its possible distribution ui the body. These features, together with the terrible waste of power and life, at once account for the volume of literature already accumulated, and for the fact that it is still increasing in bulk.
The papers we have secured from various contributors are both therapeutical and clinical. In the former, we have the views of representative men in general and constdting practice as to treatment, successful and tinsuccessful, both pf the ordinary course of the disease and of some of its complications.
Dr- GooDHABT, in AUbiitfs System of Medicine, vol. i., page 700, writes :—
''There is no specific yet at hand for this disease. This is qttite certain from the number of drugs that have
Vol- 42, Xc 3. K
190 INFLUENZA, ^e^l^^f^U^g^Sg
been regarded as almost infallible by one observer and another."
In pleasing contrast with the uncertainty and diversity of medicinal treatment among the ranks of orthodoxy, is the comparative unanimity noticeable among those who accept the rule of similars as a therapeutic guide — a oneness of mind the more remarkable that it has been arrived at wholly without collusion. It is due, of course, to the fact that, in the main, the prescriptions have been based on the rule '^ let likes be treated by likes.'' Even where minute symptomatology cannot be, or is not followed so as to secure a «{77iiZ2tmum, the great underlying principle of homoeopathy dominates the selection. If the condition is one of excitement, a stimulating or excitant drug is given ; if the disease is of an asthenic nature a drug producing adynamia is selected. A close similarity is thence observable in the treatment by many widely separated prescribers. The divergencies are explicable by the difference in type of cases in different times and places ; and also by the fact that no specific treatment of the disease is contemplated, but only, as one writer points out, a specific treatment of the individual case.
This is not the place to [go into the merits of the various drugs mentioned by our authors, or indeed to discuss the treatment of influenza. But there are one or two points which may be worth a moment's attention. Pr. McLachlan, in his essay, points out that aconite is not, as a rule, the most suitable anti-pyretic, even in the early stages of the malady, while Dr. Burwood advances it as one of the most useful of his influenza remedies. Accepting these statements as facts, we have the apparent contradiction of two careful and experienced observers coming to different, if not opposite, conclusions. The explanation must be found either in a difference in the cases referred to or a difference in the mode of administering the drug, and it is not improbable that the latter is the important factor. A perusal of the provings in the Cyclopadia supports the view that aconite may produce the restlessness which is described by the text-books as such, and is expressed by the terms "anxiety," "anguish," "internal uneasiness,'* "internal restlessness,*' &c., either with or without pyrexia. Similarly, fever may be induced without the
SStJrSShT?^^! INFLUENZA. 181
lestleBBnesd said to be '' characteristic " of aconite. Taking now a number of influenza cases of an average severity, where the asthenia is not marked early, a few ivillhave the restlessness and agitation '' characteristic " of aconite, with pyrexia; a much larger number have fiimple fever without that type of restlessness ; while tomrds the close, the restlessness is present even when the temperature is normal or subnormal. This last occurs chiefly at night.
Now the pharmacodynamics of aconite would lead us to expect that drug to relieve all three states ; while clinically, there is a seeming doubt as to its utility. Our own observations would lead us to believe that the uncertainty is due to a question of dose. There is clinical evidence to show that in pyrexia, with the* restlessness described, and for the restlessness without fever, aconitum is a aimUlimum and will relieve in any hypo-physiological dose, and possibly best of all in the higher dilutions. For the simple fever without '/anxietas " aconite is still useful, but it must be given in a low dilution. A gain in accuracy and precision is made by the close symptomatic choice of the remedy and an increase in the range of potency useful ; while, with the less accurate symptomatology, a widening of the range of applicability is obtained with a limiting of the effective dilution. In other words, the low dilution will benefit a much larger number of cases than can the exclusively high dilution, but the results may be less brilliant, less certain, and the cures less complete than those of the latter if ihe selection be guided by close symptomatology.
The uselessness of verbal similarity is well pointed out by Dr. MagLachlan in his remarks on the restless- ness, indicating respectively aconite, gelsem. and baptisia.
It is in matters of this kind that experience, coupled with careful comparative study of drug and disease symptoms plays so important a part, while verbal repertory prescribing is so disappointing.
Beturning a nos moutonsj there is yet one feature well signalised in the articles which follow, which will bear emphasizing here — ^viz : — the importance of not trifling with such a foe as influenza. It will certainly find out weak spots, as Dr. Roche so aptly puts it ; it will likely enough reveal latent tendencies; to old age it is
K-2
182 INFLUENZA. ^^r2Sh7J«?
especially mimical, and over fatigue, anxiety, a lowered state due to surgical or obstetric procedures render the patient specially prone to severe or unusual attacks of the disease. As a large proportion of pregnant women are said to abort if attacked with influenza, it is desirable, as far as is possible, to protect them irom infection, and the same of course is true of women recently confined, and of the subjects of surgical operation.
INFLUENZA : AN ESSAY.
By John M'Lachlan, M.D., B. Sc, Edin,; F.E.C.S. Eng.
Definition. — ^A continued fever, occurring in widely extended epidemics, and due to a specific cause. It is characterised by early catarrh of the mucous membrane of the respiratory tract, and, in many cases, also of the digestive tract; by quickly on-coming debiUty out of proportion to the intensity of the fever and the catarrhal processes ; and by the serious nervous symptoms. There is a strong tendency to inflammatory complications, especially of the lungs ; uncomplicated cases are rarely fatal except in feeble and aged persons. One attack does not confer immunity from the disease in future epidemics.
Such is the usual definition, though it seems to me that influenza partakes of the characters of the malarial rather than of the continued fevers. It may be described as a miasmatic-contagious fever.
Synonyms. — ^Febris catarrhalis; defluxio catarrhalia epidemicus ; catarrhus a contagio (Gullen) ; rheuma epidemicum ; cephalalgia contagiosa ; epidemic catarrhal fever ; tac ; horion ; quinte ; coqueluche ; ladendo (or la dando) ; baraquette ; g^nerale ; coquette ; cocote : allure ; follette ; petite poste ; petite courier ; grenade ; la grippe ; ziep ; schafhusten and schafkrankheit ; huhner weh ; bUtz-katarrh ; modefieber ; mal del castrone. There are also several names indicating its supposed origin. Thus, it has been called in Bus&ia ** Chinese catarrh;" in Germany and Italy, •*the Eussian disease;" in France, "Italian fever/'
** Spanish catarrh," and so forth. Such r few of its
names, some scientific, but mostly popuh i two at
least of the popular names have foimd tl widely
J
IKlS^SSW^ INFLUENZA. 188
BffTiew, Hnelk 1, 1«6.
into medicine and medical literature, almost to the exclusion of the terms by which science has sought to designate the disease ; these are '' influenza " and '' la grippe." Many of its names are now obsolete and meaningless^ so far as the present generation of medical men are concerned — such as peripneumonia notha (Boerbaave, Sydenham), peripneumonia catarrhalis (Haxham), pleuritis humida (StoU), &c. Its popular English names are by no means numerous, probably because Englishmen are neither quick to see in the disease a resemblance to some common circumstance or thing, nor are they disposed to make a joke about it ; thus they differ widely, on the one hand, from the Germans, and, on the other, from their volatile French neighbours.
The Germans find many resemblances. In the
laboured respiration and the character of the cough
they find a suggestion of a common epi-zooic affecting
tbe sheep ; hence Schafhusten (sheep cough) and
^chafkrankheit (sheep sickness), or because the cough
is like the crowing of a cock, and the disturbance of
respiration and the rapid prostration suggest some
resemblance to a common disease of the domestic fowl,
it has been called Huhner Weh (chicken disease,
^liooping cough) and Ziep, which is about equivalent
*o '*pip." They call it also, because of its rapid
"evasion, Blita-katarrh (lightning catarrh) and mode-
^^ber (the fever in vogue).
But the French make a jest of everything, and the
J^ore serious the subject the better the joke. Hence
^"?y have found a new name for almost every great
^Nemic of influenza, and each name more trivial than
}^^ last. As examples we may take tac (rot) ; horion (in
J^st» a blow) ; quinte, because the spells recur at intervals
^^ five hours (!) ; cocqueluche (a hood or cowl) from the
^^P Worn by those suffering from the malady, and so on.
^a grippe is from the Polish chrypka (Raucedo) ; some,
nowever, thmk that it is derived from afiripper (to seize).
Iiifluenza is of Italian dtrivation. It is said that the
^isease received this name because it was attributed to
. ^ ." influence '' of the stars, or from a secondary
•Jipiification of the word indicating something fluid,
^^^knt or fashionable.
134 INFLUENZA. ^^'SST?'?^
Beview, March 1, 1898.
Historical. — It is supposed to be referred to by Hip- pocrates, though he does not give an exact description. An outbreak in the Athenian army in Sicily (415 b.c), recorded by Diodorus Siculus, has been supposed to be influenza. As early as the ninth century several epi- demics of catarrhal fever, Italian fever, and the like were recorded. In the year 872 a.d, a cough, which spread like the plague, was recorded. In 876 there appeared in Italy a similar epidemic, which spread rapidly over all Europe, even affecting dogs and birds. In 976, Germany and all Prance suflfered from a fever of which the chief symptom was cough. Two centuries later (1173) a widespread malady, of which the symptoms were chiefly catarrhal, raged in Europe. A disease, resembling influenza in its symptoms, is alluded to in early Gaelic manuscripts under the name of creatan {ci'eat, the chest). The disease is also described in an Irish manuscript of the fifteenth century, under the name of fuacht and slaodan.
The first epidemic that prevailed in the British Isles^ of which any accurate description remains, is that of the year 1610. The disease came from Malta, and invaded first Sicily, then Italy, Spain and Portugal, whence it crossed the Alps into Hungary and Germany as far as the Baltic Sea, extending westward into France and Britain. It is said that not a single family, and scarce a person escaped it. It was attended by "a grievous pain in the head, heaviness, difficulty of breathing, hoarseness, loss of strength and appetite, restlessness, retchings firom a terrible tearing cough. Presently suc- ceeded a chilliness, and so violent a cough, that many were in danger of suffocation. The first day it was without spitting ; but about the seventh or eighth day much viscid phlegm was spit up. Others (through fever) spat only water and froth. When they began to spit, cough and shortness of breath were easier. None died except some children. In some it went oflf with a looseness ; in others by sweating. Bleeding and purging did hurt."
In 1557 we find another epidemic. It start( ?st-
ward from Asia, spread over Europe and then led
the Atlantic to America — in fact it circumnavi^ *ie
^ globe. It broke out in England after a vr y
season, when there was great scarcity of cor^ ^
S^fiSS^^!^ INFLUENZA. 185
month of September. It is tbns described, ** Presently there were many catarrbs, quickly followed by a most severe congb, pain in tbe side, difficulty of breatbing, and a fever. The pain was neither violent nor pricking, but mild. The third day they expectorated freely. The sixth, seventh, or at the farthest tbe eighth day, all who had that pain of tbe side, died; but such as were blooded on tbe first or second day, recovered on the fourth or fifth ; but bleeding on tbe last two days did no service. . . . Some, but very few, bad continual fevers along with it ; many bad double tertians ; others simple, slight intermittent. All were worse by night than by day ; such as recovered were long valetudinary, had a weak stomach and hypped." Thousands were attacked at the same moment. It was extremely fatal. In Mantua Carpentaria, a small town near Madrid, it broke out in August and so fatal was tbe blood-letting and purging which constituted the treatment at first, that of the 2,000 persons who were bled, all died.
In 1580 a great epidemic of influenza spread from the south-east toward the north-west over Asia, Africa, and Europe, and spread to England. Concerning it Dr. Short remarks " few died except those that were let hlood of, or had unsound viscera." Zuelzer informs us that the victims of this epidemic in the " Eternal City '* were not less than 9,000, and that Madrid was almost depopulated by it. This high mortality has been attributed to the bloodletting practised in the treatment of the disease. There was usually great sweating at the end of the attack, and this may have given rise to the name '< sweating sickness." The plague, measles, and small-pox prevailed also during the year 1580.
After a short rest the disease reappeared in Germany inl591, and from this date up to the year 1675 the epidemics were frequent. Two great men lived about this date viz. : — ^Willis and Sydenham — the former describes the 1668 epidemic, the latter that of 1675. About this period, too^ the disease began to be known as "influenza," the "influence" of the stars suggested itself, in connection with its sudden appearance and wide ^ribation, to the minds of the physicians of this date. WilUs writes that ** about the end of April (1658) suddenly a distemper arose, as if sent by some blast of the «tor«, which laid hold on very many together ; that in
186 INFLUENZA. ^^^^l^g^lT^sSS!
some towns, in the space of a week, above 1,000 people fell sick together."
Epidemics are recorded in Great Britain and Europe in 1688, 1698, and 1709. In 1729-80 a widespread epidemic swept over Europe. In five months it spread over Russia, Poland, Germany, Sweden and Denmark. In Vienna 60,000 persons fell ill of it. Pains in the limbs and fever marked its onset ; catarrh, oppression, hoarseness and cough followed. A petechial eruption was observed in some instances, between the fourth and seventh days. Zuelzer suggests that this may have been ** spotted fever." Copious sweating was often noted as well as nose-bleeding and bilious stools.
Two years later (1782-88) an epidemic starting from Saxony spread through many Continental towns and invaded Great Britain in the month of December. In Scotland at this time three forms of the disease were described, viz., 1. the cephalic, 2. the thoracic, 3. the abdominal. This epidemic may be said to have lasted four or five years. Concerning this epidemic John Huxham, of Plymouth, writes: — '* About this time a disease invaded these parts which was the most completely epidemic of any I remember to have met with ; not a house was free from it ; the beggar's hut and the nobleman's palace were alike subject to its attacks, scarce a person escaping either in town or country ; old and young, strong and infirm, shared the same fate." The epidemic reached Plymouth on February 10th, which was on a Saturday, and that day numbers were suddenly seized ; the next day multitudes were taken ill, and by the 18th or 20th of March scarcely any one had escaped it.
During the next 60 years or so some six or eight epidemics are recorded, generally mild in nature, though widely spread. In 1762, for example, in Germany nine-tenths of the population were attacked by the disease. Noah Webster found influenza prevalent in North America in 1781, and in 1782 one of the most remarkable epidemics of this disease appeared in Europe. It came from the '^purple East," from Asia into Bussia, and spread over Sweden, Germany, Holland, and France, Italy, Spain and Portugal. The crews of Dutch and Engliah ships were taken ill with the disease upon the high seas. In Vienna three-fourths of the population
SSSS^SSTSS? INFLUENZA. 187
Beriew, Kuefa 1, lan.
£ell ill of it with Buch Buddenness that it got here, for the first time, its name " Blitz-katarrh." Many out- breaks took place in Europe and America during the years 1788-90. Warren, of Boston, deecribes one attack in a letter to Lettsom, dated May 80th, 1790, wherein he records that George Washington had a severe and dangerous attack, but was then recovering. Other 'epidemics occurred in 1796, 1797 and 1798, continuing to prevail till 1808. In 1880 began a series of epidemics remarkable for their wide diffusion and the rapid succession with which they followed one upon another. The disease began in China, swept into Bussia, then through various Continental cities, and in June, 1831, it invaded England. After this there was a brief period of repose, but in December, 1837, influenza reappeared, and first, as so often before, in Russia. In London almost the whole population was attacked, and the mortality was enormous. Again, in 1847, a fjreat epidemic occurred; it prevailed in London for six months, and one-fourth of the entire population were affected.
No well marked widespread epidemic occurred after that of 1847-48 until 1889. This epidemic seemed to start in Central Asia and then spread to St. Petersburg about the middle of October, and reached Great Britain about the ^^i of December. From that date until the present June it seems to have been with us off and on ever since. ^ 1889 London was the chief centre of the disease ; fiuU in 1891. During the winter of 1891-92 influenza prevailed as an epidemic in every civilised country and "^ every qu8.rter of the globe.
CuNiciji Varieties. — The clinical divisions of to-day ^^ essentially the same as those adopted bv the Scotch %8icians in 1782.
^* Catarrhal^ affecting the respiratory tract and the P^rta in immediate connection with it. ,. 2' Gastric, marked bv sudden onset of vomiting and diarrhoea.
3, Nervom, marked by severe headache and backache, *^^ great depression.
oviiPxoMs. — A few of the more important symptoms
Kil ^ ^^*®^* "^^^ /erer is usually moderate, though
, lUitteB it may reach a high grade ; there are frequently
casA^ sensations followed by flushes of heat, in many
•^8 attended by profuse sweats (** sweating sickness")^
138 INFLUENZA. ^2SSi^2J"ST?SI."
Review, March 1, 1888.
In connection with the catarrhal form the coiigh is often one of the most distressing and obstinate symptoms ; it is spasmodic in character, and in some of the older epi- demics was confounded with whooping cough. It is apt to be worse toward evening and at night— as I know from bitter personal experience. It gives rise to pain and soreness in the muscles of respiration. In many epidemics the cough is not a prominent symptom, though it seems to be a marked feature af the present epidemic in Oxford. Another remarkable symptom is the dysp- ncea. I do not refer to that dyspnoea which accompanies bronchitis, capillary or otherwise, but to that met with where there is no discoverable lung lesion. It is most probably due to some interference with the function of the vagus at its root, i.e., of nervous origin.
There is, however, another possibility. We know that impulses are constantly passing up the vagus to stimulate the inspiratory centre ; these impulses are caused either by the state of the air in the air vesicles of the lung acting on the peripheral terminations of the vagus, or else by the composition of the blood in the capillary network surrounding these vesicles. Some eight or ten years ago I wrote a thesis suggesting that the comparatively large lymph-vascular spaces of the lungs were the incubating ground for the microbes which were supposed to be the cause of the specific infective fevers. In the beginning of 1892 a bacillus previously unknown to bacteriologists, was discovered by Pfeiflfer, and has been asserted to be the specific exciting cause of influenza. Solid particles in the air we know very easily gain access to the lymph vascular channels through the '^ stomata " in the endothelial lining of the vesicles. It may be therefore that the bacilli (supposing aU this to be true) during their incubation produce some material that has the power of benumbing the peripheral terminations of the vagus, and thus give rise to the dyspnoea, from the loss of the reflex stimulation to the inspiratory centre. One might associate with this paresis of the vagus^ the benumbing of other nerves, e.g. those of taste and smelU and hence the temporary loss of these special senses.
Chest pains, stitches in the side (not pleuritic) frequent sneezing, loss of the sense of smell and of taste, attend the development of the general catarrhal manifestations. .In connection with the nervous system we note the early,
wffcT^' INFLUENZA. 189
tapid, and great prostration of muscular strength : in inany epidemics this is one of the most remarkable features. The headache is often, no doubt, catarrhal in nature, but in many cases it has a far deeper origin, and is oft^n accompanied with stiffness of the neck muscles, with cutaneous hyperesthesia of head and neck.
Pains in the limbs are common — sore and bruised sensations, dragging and boring in the loins and calves, &c. Pains in the chest (pleurodynia) are common, as well as pains in the throat and nape of neck. Great hebetude and torpor have marked some epidemics. That of 1712 was called the " sleepy sickness," by reason of the prevalence of these symptoms.
Diagnosis. — This is not as a rule difficult. The march of the epidemic, the number of persons attacked, the prominence of the nervous symptoms, the rapidly developed debility and the character of the cough, nsually severe out of proportion to the physical signs, distinguish it from all other epidemic diseases. It has *o be distinguished from the *' simple cold " or non- specific catarrh. Some cases, too, bear a strong resemblance to beginning enteric fever, but influenza lackg the temperature-curve, the usually rapid pulse, the «plenic enlargement, and the eruption of enteric fever, ftnd the progress of the disease will in a few days clear np the most doubtful cases.
Treatment. — ^At this point we necessai'ily and decidedly part company with our friends, the allopaths. My own 1^ conviction, from long and extended observation, is *hat the allopathic methods of treatment are far more dangerous to life than the disease itself. Nor is the ^^ason far to seek. The allopathic policy is one of ^^ression and concentrated attack upon single ^naptoms — symptom treatment, in fact, in its most Solent and fatal form. Is the fever high ? Then ifc JJl^st be brought down at any cost, shutting his eyes to |h? fact that it is a mere symptom, and that to forcibly ^^% it down is equivalent to screwing down the safety- y^ve of a steam engine, while the fire, or source of the ^^®r, is left untouched, with the result that something ^^ gives way — some more vital organ is attacked. The ^?^e policy is pursued with other outstanding, isolated, ^8le symptoms. Is the catarrh troublesome? Then
140 INFLUENZA. ^Si^TSSh^SST
it must be treated specially and dried up, with the result that the disease centres upon some more vital part of the rebpiratory system ; and so on through the long and wearisome list of single symptoms. Yet from their tower of scientific straw, plastered and painted to look like granite, they sneer at us because, so they say, we treat symptoms, and in thus judging us they condemn themselves, for they who judge practise the same things, only more so. One is forcibly reminded here of a parable concerning a beam and a mote. But we do not treat symp- toms ; we merely make use of them as a traveller makes use of milestones and finger-posts, hills, trees, or other topographical peculiarities of the country through which he passes, in order that he may know his exact where- abouts, and as guides to lead him to his desired destination. The difference between these two modes of using symptoms is as great as it is possible to be.
In absence of homoeopathic treatment during an attack of influenza the best thing for the patient to do is to go to bed, between blankets if the muscular pains are severe, take light liquid nourishment, e.g., hot milk diluted one half with barley water ; if the cough is severe, dry and spasmodic, then set a bronchitis kettle going in his room to keep the air moderately moist. For the rest avoid all allopathic drugs, and take no thought for the temperature or anything else. I suppose this is all too simple and easy for our allopathic brethren to be content with, they must do something more than that.
** Polk mann do something for their bread,
An* sae maun death."
The above may be regarded as the general treatment of hijixienza, and which may be practised alike by homoeopath and allopath. »
We now come to the specific medicinal treatment. Do not misunderstand me ; there is no one specific for influenza, or any other disease, nor in the nature of things can there ever be. What we have to do is to find and apply the specific remedy for each individual case as it presents itself, though, as in all epidemic diseases, there will most probably be one or two medicines more frequently indicated than others. I will now name a few of the medicines which I have found more or less
£5S!?£S???r22' INFLUENZA. 141
useful in the various epidemics since 1890, giving the indications which seem to me (rightly or wrongly) to warrant their use in this special disease.
Aconite. — In discussing the claims of this medicine to a place in the therapeutics of influenza, I would first direct attention to Hahnemann's introduction in his Materia Medica Pura. There is one group of symptoms so characteristic of aconite that Hahnemann said: *' Aconite should not be given in any case which does not present a similar group of symptoms." These are the symptoms of the mind and disposition^ viz. : *' Best- lessnesB, anxiety and uneasiness of mvid and body^ causing tossing and sighing and frequent change of pos- ture ; forebodings, anticipations of evil, anguish of mind, dread of death, and even distinct anticipations of its occurrence/'
Now aconite does not seem to have any effect on organic substance — does not produce any marked or cbAracteristic change in the tissues or fluids of the body, and it cannot therefore in itself be sufficient to carry a patient safely through a complete course of pure acute inflammation of any organ or system. The only modi- fication to the above statement is in the case of measles,, where, so far as my experience goes, aconite is usually in itself quite competent to do all that is needed to be done, and I rarely give measles cases any other medicine.
In the action of aconite that localisation is wanting which is the essential feature of these inflammations. Its great use in such cases is in the very early stage of the inflammation, f.e., in the stage of general arterial exdtenient, which precedes its localisation in any one organ or tissue, and therefore even before the '' active hypertemia " stage and long before the stage of exudation. It must never be given merely to "subdue the fever," and then some other remedy added *^ to meet the case ; " nor is it to be alternated with other drugs for the purpose of "controlling fever." If the fever be such as to require aconite, then no other drug is needed, and if other drugs seem indicated one should be sought which meets the fever as well, for each drug has a fever after bis kind.
There is no resemblauce in the pathogenetic symptoms of aconite to the features of any dyscrasia, and for this reason it can never be required in any of the miasmatic
142 INFLUENZA. g^i^j^r^Syt^
fevers or dyscratic diseases — save perhaps as a rare and temporary intercurrent in some complication, or where the group of symptoms of the mind and disposition are present. Its action bears no resemblance to that of any poison, such as that which produces typhus or typhoid, intermittent or remittent or continued fevers. Our allopathic friends even have discovered that aconite is '* good for fever," and they have tried it in such fevers as typhoid with, I need hardly say, no beneficial result on the death rate of that disease. Some of our own men, with a total misunderstanding of the essential inner nature of the pathogenesy of aconite, and led fi way by a few unimportant and superficial similarities, have even recommended its use in ** ulcerative endocarditis ! "
What then is its use in an epidemic of influenza? It can hardly be of use in genuine influenza ; but it is of great use in those cases where one is in doubt whether the symptoms manifested are the result of a simple chill or to the specific poison of influenza. A few doses of aeon, 30 will speedily banish all doubt ; for if the case is the result of a simple chill and be taken sufliciently early aeon, will be all sufficient to effect a cure, but if due to the poison of influenza it will have no beneficial effect and some other remedy will have to be given,
Gelsemiuvu In the earlier epidemics of the present series — from about 1889 to 1892 — gelsem. and the somewhat similar remedy, baptisia tinct. were very frequently required, and occasionally eupator. perf. The difference between gelsem. and baptis. is chiefly one of degree, the former being the milder acting of the two, baptis. being the more deeply acting, and being, as it were, an advanced gelsem. Both have intense muscular soreness and prostration, both have drowsiness and nervous excitement with prostration, and both have an afternoon exacerbation of fever. In gelsem. we have the suffused redness of the face, causing a semi-intoxi- cated look, with general mental torpor and thick slow speech, not so much due to the mental torpor (as in baptis.) but rather to the depressing effects on the motor nerves. I have always regarded the intense occipital headache beginning in the nape of the neck and cervical spine and spreading over the head as a special indication for gelsem, as opposed to baptis. ; this headache is oftea
rS^JSS^iTI'^? influenza. 143
accompanied by stiff neck. The patient answers qaestions either slowly or imperfectly, as it all the functions of the brain were blanted — like a person well under the influence of liquor.
It is possible that gelsem. would have been the remedy also in some of the epidemics of the past when many of the cases were supposed to resemble " spotted fever *' e.g., in the epidemics of 1729-80 where we find such symptoms as great pains in the limbs, with fever, drowsiness, petechial eruptions between the 4th and 7th days^ copious sweats, bilious stools, &c.
The gelsem. fever seems to be rei;nittent or intermittent in its type. I believe also when we meet with cases of influenza in children, other things being equal, gelsem. is a remedy likely to be very useful, as it is generally in the remitting types of fever in children. The child is drowsy, with suffused redness of the face, is peevish and irritable when aroused, but this is quite different to the mental restlessness of aconite.
Baptisia tinctoria. — Much that I have written about gelsem. applies with equal, and even greater, force to baptisia — ^the fever, the drowsiness, the torpid semi- comatose conditions of the brain, the uniformly suffused red besotted face, the intoxicated look, the intense muscular soreness and prostration, the restlessness, because the parts rested on feel sore and braised, and the bed also feels as if it were too hard, and hence the patient moves often in his attempts to find- a soft place (in this latter respect it resembles arnica.) It is useful in those cases also which seem at their outset to have a close resemblance to ** typhoid fever,'* or perhaps I ought to say the " typhoid condition," as well as those cases in which the peculiar form of dyspnoea above mentioned occurs.
Eupatorium perfoliatnm (" Thoroughwort "or ** Bone- set.") This medicine is useful in cases where the bone paifis are specially prominent — ^intense aching in the limbs and elsewhere as though every • bone in the body was being broken. In such cases we have constant change of position by the patient even though the pains are not worse by repose ; he complains of a bruised, broken feeling all over the body. Both this remedy and bi4»ti8. havQ marked soreness of the eyeballs. I have not had occasion tq u^^.eupator. perf. a great deal,
144 INFLUENZA. ^S^^
though one did meet with appropriate cases occasionally in the earlier epidemics of this series, and the present type of influenza seems also to tend in that direction.
Nat rum muriaticum. — This very useful medicine is to be kept in mind for those cases where the loss of taste and smell accompany the catarrh (compare puls.)f together with hydroa or " cold sores " on the lips and cracks at the angles of the mouth* It will be still further indicated if the patient has been dosed with quinine, ammoniated or otherwise.
Arsenicum. — This is a remedy of great value in the aged and in children, and especially in the catarrhal form of the disease when we meet with the characteristic prostration and weakness, with its sudden onset and rapid advance, with burning heat and unquenchable thirst and restlessness. Further it is of great use in those cases where the gastro-intestinal irritation is a marked feature, giving rise to diarrhoea, and more especially if the diarrhoea should be brownish or coffee- coloured and provoked by every attempt to eat or drink. We are taught in a general way that arsen. should not be given too soon in a disease lest we increase the downward tendency {e.g., in typhoid fever), and that rhus. tox. may with advantage precede it. But, as in most cases, there is an exception to the rule, and that is in gastro-enteric inflammations, as in the cases now under consideration arsen. is often called for at the very beginning of the case, and nothing but benefit follows its administration when properly indicated. The restlessness is one of the characteristic indications for arsen. ; the patient cannot rest in any place, changes his position continually, and that too even though he is fatigued by so doing. The period of general aggravation is from 1 to B o'clock a.m.
There is at first sight a considerable likeness between aeon, and arsen., viz. : the restlessness, full bounding pulse, great thirst, hot dry skin, anxiety and fear of death ; but aeon., as we have seen, has practically no effect on the tissues or fluids of the body, whereas arsen. affects both profowndLy.
Arsenicum iodatum. — This is a remedy I have not used much, chiefly because the provings are so meaf[re. It is said, however, to be specially useful, and should
t!S^^S^?^' INFLUENZA. 145
Jtevftw, M««h 1. 18M.
therefore be kept in mind. In a general way tbe indioa* tions for its use (chiefly clinical, I believe) are the same as those of the oxide, but it is to be preferred when the symptoms indicating arsen. occur in marked stru* mons comtitationsa It is stated to be speeially usefal for influenza in horses^ as in 1880, when there was an epidemic of influenza affecting horses chiefly, in Canada^ and the United States, east of the Mississippi river.
Rhw tax. should not be forgotten, as it may occa- sionally be useful. It has the well known restlessness, which compels the patient to toss about, is worse on first moving but better from continued motion ; it compels bim to toss about in bed, and he is better for a short time in each new position, but very soon he has to change again. This tossing is not, like arnica and baptisia, because the bed feels hard, but because of the tearing pains in the muscles and fascisB. There may be copious eory2a with sneezing and dry cough, the cough bein^ worse from evening until midnight, and excited by cold drinks.
Arnica mont. is occasionally useful. Like the others, it has a restlessness. In this case the patient may be kept awake till 8 o*clock a.m. by heat, restlessness, and Constant desire to change [position, the bed feels too hard, and so he moves often m order to find a soft spot. The patient at the same time may be drowsy and stupid and very apathetic,
AUium cepa (the common red onion).— In cases where ve have profuse watery discharge from the eyes and nose, but without the great and rapid prostration characteristic of arsen« The tears are bland, but the nasal discharge is very acrid and watery, and accompany- ing these symptoms we may have a very painful laryngeal cough. It is interesting to note that the onion contains appreciable quantities of phosphorus and sulphur.
The Cough. — Should any special remedies be required for the cough — ^apiurt from those indicated by the general symptoms — sticta puL, phos., hyos., con«, dros., rumex, and ant» tart, are a few of the more likely ones.
Stietm C' Lungwcnrt ") has been used largely in i^uenza, where the cough was a prominent and 4istreesing symptom. It is dry, worse in the eyening.
Vol. 42, No. 8. L
146 INFLUENZA. ^"S^!S^???2S:
and night, and ctUoAva the patient neither to sleep nor lie down.
Phosphorus. — ^With the cough, we find rawness and soreness of the chest, with oppression at its upper part more especially, as if a weight were lying upon it. The cough is aggravated, by cold air and by lying on the li>ack or left side, and froip talking and laughiug.
HyoscyamuB. — An irritable, dry, nervous cough, which comes on as soon as the patient lies down, < but is better on rising or. sitting up (puis, is similar in this respect),
Cowittwi.— rTormenting night cough when first lying down ; there is hardly any cough during the daytime* It is spasmodic in character and simulates whooping cough. The patient is unable to expectorate, but must swallow what he coughs up.
Drosera, — ^A spasmodic, hoarse and deep sounding cough as soon as the head touches the pillow ; worse in the afternoon and evening, and again after midnight .
Rumex Crispus. — ^\^iolent, incessant, fatiguing cough, aggravated or excited by pressure on- the trachea or throat pit, by talking, and by every inspiration of cool air, or by any variation in the volume, rapidity or temperature of the inspired air. It is provoked by a tickling in the suprasternal fossa, and is accompanied by stitches through the left lung and rawness under the clavicles. It is worse in the evening and night, and from 2 to 5 a.m.
Antinwn. tarL~^ln bronchitis, with much loose phlegm but feeble expulsive power, i.e., in the threatening " paralysis of the lungs," especially in infants and the aged. The mucus is plentiful, loose and rattling, yet the patient cannot get it up, and may not even feel the need of coughing, because the sensitiveness of the reflex mechanism is being blunted by the venous condition of the blood. I'robably along with this we may notice a bluish tint on the red surface of the lips and the gradual development of a drowsy condition. When these symptoms are present the patient is in a very dangerous condition. Bary. carb. is complementary to ant. tart* in cases of impending lung paralysis in the aged.
Another medicine well worth keeping in mind is kali iod., as it is of great use in oedema pulmonum, accompanied with great, rattling of mucus in the chest.
it^^S^f^ JNPLUENZA. 147
with watery expectoration, looking like seap-Muds* In the «ase of children,. ipecac, often precedes the ant. tart, stage.
Let me point out (1) the value of steam in the atmos- phere of the room in cases of dry irritating cough ; (2) in the case of the aged it is most important to ayoid as far as possible any risk of '' hypostatic congestion " of the lungs. If the patient is able to bear it, he should" be propped up with pillows, almost in a sitting posture, so many hours each day, and failing that he should be turned frequently from one side to the other, thus calling in the aid, rather than permitting the hindrance, of gravitation to the circulation through the lungs. In regard to medicines, ant. tart, and kali iod. will likely prove most useful, together with the judicious use of stimulants e.g., whisky and water*
In regard to compUeatioM and $eqvla I have had little or no experience. At th^ time of writing I have two old ladies, one 79 f the other 88, suffering from bronchitis, which is poMibly the result of a recent attack of influenza ; but with this exception I have had no experience in complications, nor have I ever had a single death from this disease, nor any patient even within measurable distance — speaking humanly — of death, with the exception pf the first old lady above mentioned. Nor do I think that this experience is peculiar to me ; I believe it is the general experience of homceopathic practitioners of all the various grades of faith and practice.
In this respect homoeopathic treatment contrasts very markedly with old school therapeutics; for after all, though the old school may not be quite so repulsive looking as in the days when she was armed with, and made such free use of, the lancet, nevertheless it is to be doubted whether with her antip^etics, antiperiodics, purgatives, narcotics, hypnotics, stimulants et hoc genus omne, being at the same time so ably aided and abetted in this direction by the manufacturing chemist, it is to be doubted, I say, whether she is less dangerous.
I have intentionally said very little about potency. Most of the remedies named in the foregoing list work very well in the medium and lower potencies (Ix to 12) in influenza cases, though one may often go higher with advantage to the patient. As I have frequently said, so I would say. again, that I believe the potency question
L— 2
148 INFLUENZA. ^^^Sj^Sjlga!
waald look after itself proTided we woald always seleet the mott'like remedy and gire it iblone, only changing to another if we find the medicine is not the most like, or if a change of Symptoms demand it. By constant and daily practice at this one would speecffly form scientific habits of thonght tod practice, so far as prescribing is^ concerned. Another point which csbSfnot be too strongly insisted npon is, that having given a medicine, whatever the potency, shOtdd the patient show distinct signs of improvement, then it should be dbcontif^ued, or at least given very much less often, and theh as soon ^s the improvement ceases it may be agaiii given, or, if the symptoms have altered^ another mote appropriate one shocdd be selected. In this way one can gauge exactly how much medicine is necessary to co^e the patient, and thus avoid the risk (a very real One) of introducing com- plications from over-dosage — I mean that when given in excess of what is necessary to cure, the medicine may begin to prodti6e its owii eharacteri^e pathogenetic symptoms.
In the old sehool the practice is to give a$ large a dose as the patient can stand, and repeat it ad often as possible with the same proviso, Le*t the dose should ^'ti«^ be under the minimum lethal. In homoeopathy the rule is to give the smallest amount that will cure the patient ; anything more is clearly unnecessary and wasteful, and may he injurious.
As a '* pick-me-up " after an attack of influenza a few doses of psor. (8t>th, 200th or higher) will be found of great benefit.
Oxford, February, 1898.
SOME INFLUENZA "EXPEBIENOES."
By T. W. BuRwooD, L.E.C.P. lldin., L.R.C.P. Ireland, &c.
Since 1890, when the medical world Was really brought face to face with influenza as such — ^though I believe I had frequently seen sporadic cases which were a puzzle to me, and to which I could not attach a name — my experiences of the disease have been most varied and interesting. To those who have had to deal with it on a large scal^, its monster demon microbe has played such
S^SSSr?!^ INFLUENZA. 149
SevMV, XMch 1, IMS.
a variety of prftnks that one aad all mast aUow the disease to be one of the most '' tricky '^ that has had to be combated with.
In years gone by, when I heard of a patient hayihg influenza, I i»etiired him sitting wra^jped in blankets before a fire» his feet in a hot mustard foot-bath, and eating grael with '^ something" in it. His running nose and eyes required constant attention, the frequent secretion f r<»n which mikde great demands on the stock of pocket handkerchiefs at his disposal. Now nothing of the sort predominates ; but one whose ailments g^oeraUy take a neuralgic type gets severe neuralgia, it matters not where ; it may be in head ox eyes ; or the entire spinal column, with all its plexns of nerves, may receive the full fozce of the storm, and allow the pati^it no rest.
Should he be of a rheumatic type, he may suddenly get aching ip the limbs ; he is tortured in ail his qiuscles, his lumbar regions seldom escaping, cmd he feels almost unable to drag oue leg after the other.
Or he may be one whose digestive system is easily upset, and he may, without rhyme at reason, so far as he knows, be placed hor$ de comboJb with a violent attack of vomiting, or his intestinal tract may be i^ected and diarrhcea may be wid often is present.
Or he may have a 'Miver," and here the mischief often plays a fine game.
But where there is a tendency to pulmonary trouble we are more likely to have grave and serious consequences, and much anxiety to both doctor and patient. Should he, however, when he gets the slightest cold, be annoyed with hoars^iess, laryngeal irritation and constant tickling cough, only let the influenza poison gain an entrance at that weak point in his armour and he will have a very busy time night and day. If the patient be a female, in ninety cases out of every hundred, the attack comes on either during or just after the usual monthly period, and should the uterine sphere be her weak point, you may be sure the tempest w3X wake up ovarian neuralgia and other complications.
The peculiar vagaries of both pulse and temperature, such as are never seen in any other disease, are so typi* cal that a trained observer cannot fail to know where ^' he are!"
160 INFLUENZA.- l^^i^S^.^£Jf
Beyi0W. Maich 1, 1888.
A patient comes into yoar cotfsulting room, tlitows himself into a chair, tells you he ''cannot mak^ out what is the matter. The last few days he has been ailing with he does not know what, ba( anyhow hefeels as weak as a kitten ! " You take his pulse and find it beats 90 to 100, while his temperature may be quite sub* normal, or over 100^, with a pulse only 66 or 70. You at once send him to bed, and tell him ''to remain there until you uUow him to get up." Or you are sent for to see a patient who has *' gone to bed perfectly well — never better in all his life; he was awakened in the night with pains all over him," and after enduring agonies, sends for the doctor the first thing in the morning, who when he arrives finds him with a pulse of 140 and a temperature ot 104° — 105°, without a single complication to account for this sudden, outburst, and no complaint except his pains.
Both patient and friends are in a state of great alarm, and the only cool and calm person present is the homoeopathic doctor, who can with confidence assure- them all " the patient will be much better in the morning " and so he is !
I have just seen a boy of 14, son of an Indian oJ£cer^ with a pulse of 84 and pains in all his limbs ; every morning at 9 his temperature is normal ; he gets a cold » stage with shivering ; at 3 p.m. his temperature is 108"^ and he is prostrate ; at 9 p.m. his temperature is 98.4°. For some three months before this boy was born his mother had Indian fever very badly, and this, his -first attack of influenza; simulates the Indian fever most minutely. In my experiei^ce many scores of patients who have resided in malarial districts assert that what they are suffering from is simply Dengue fever. In all my cases I have never found a single one, whether simple or aggravated, in which the attack did not produce a state of depression and prostration out of all proportion to the severity of the symptoms.
In my experience during the first epidemic those attacked were adults, and not a single child was affected ; in the following year and subsequently the younger members of the community have not escaped. Not infrequently very young children are attacked ; they are unable to detail theu' symptoms, and the doctor with all his care cannot say what is the matter with them ; but"
IJ^SSf?^ influenssa; 161
Beview. March 1, 1886.
when the little patient is convalescent, the only conclusion to be drawn is — " it must have 'been influenza."
In years gone by, before I encountered this disease as such, how many cases I can look back on which were enigmas to me, and to which previous experience could give no name, but with oiir symptomatology and our remedies 1 battled successfully, because I treated the patient and not the disease, which '' disease" I now recognise as influenza.
In the matter of treatment my experience is of coui^se homoeopathic.
At the outset^ my Usual custom is to mix 12 drops of aconite Ix in 12 des^irt-spoonfuls of cold water, and order 1 dessert-spoonful every hour tor six hours, and after- ward every 2 hours until my next visit, and then every 8 hours until the temperature is normal*
After that my sheet-anchor is arsenicum, as its patho-» genesis covers the entire fleld, whether nervous, pulmo- nary, stomachic, intestinal^ or cardiac. My experience has shown that after arsenicum^ nux vomica completes the cure.^ The above three remedies of course refer to plain sailing cases With no complications.
Another experience, and I have had many of them, is even with a IbW pulse and sub-normal temperature aconite is not contra-indicated, as it covers more symp-* toms than any other medicine I know of« Should the case develop a low typhoid type> and aconite has failed after 24 hours, then baptisia Ix may be relied on with confidence. For the special neuralgias, gelseminum Ix^ 20 drops in a half tumbler of cold water, a teaspoonful every 5 or 10 minutes, acts like a charm. Belladonna has not been a satisfactory experience for the laryngeal cough, while rumex crispus Ix, spongia Ix or hyoscya* mus Ix have triumphed gloriously*
For the rheumatic type, after aconite Ix, bryonia Ix and rhus tox Ix have proved in every way satisfactory.
My experience in those cases in which the brunt of the mischief is spent in the uterine sphere, actea r* Ix comes in after aconite with splendid results. Even the cases where vomiting and diarrhoea are present, I seldom have found aconite fail, and if it has, then iris vers, comes to the rescue*
In all lung complications I adhere persistently to aconite, a dose every hour for six hours, and then
bryoxiia 4 or phosphorus S, iiceordiiig to cireamstam^y every hotir for the next six hoi^s, lyid bo on alternately, not atopping the aaonite until the tepiperature b^ been normal for 2i boors. In the bronchial eatarrbi when adTentiiious sonnds are beard all over tjie lung or in patches, mtb a musieal buzzing wiuch tb^ patient bears 80 distinctly thai; it keeps him awake listening to the concert, ipec, Ix is all I ever waited.
My experience in the adjuvawU used gives me much satisfaction. First thing on seeing a patient I order a hot bath at a temperature of 98^, all the time he is in the bath the hot water is to be allowed to run in until the temperature of the water has reached 2^ Fabr. higher than the patient's own temperature before he entered the bath, and after r^naining in for 20 minutes to return to bdd. If in two boors the temperature taken under the tongoe is above 100^, I order a cold body pftsk from the arm pits to. the hips, to be changed when dry and repeated until the temperature is normal. If the spinal patmi are severe, the eompress is made from 8 to 10 inches wide and sufficimtly long to reach from the nape of the neck to the end of the spine, instead of the body pack.
For the laryngeal cough, a compress of surgical lint wrung out of cold wat^ and covered with flannel is found to be most iootbing and comforting to the throat* If the headache is unbearable, frequently fomenting the forehead with a spcmge wrung out of hot water, and a cold cominress below the occiput will, according to my experience, seldom be applied in viun.
In the matter of diet, seeing the disease produces very early a feeling of extreme prostration, I invariably feed my patients generonsl^r from the onset, even with a high temperature. I consider the best of everything tiie wisest for my patients, and I see they have it; consequently when I have mastered the disease, I have no weary convalescence. My experience has led me to adopt a practice which I insist on in all cases. I tell my patients, as soon as I have made my diagnosis, to keep in bed until the temperature has been normal for 24 boors; at the end of that time, provided it remains normal, he may dress and sit in his room ; the next day he may go down stairs, and the following day, if the weather is suitable, he may go for a short walk.
UmaUy b; tba ^ad of a week he is ^hle to return to his bnanesB. Where therjB have been eerioas complieations, and in d^Qfbte eon^totions, a change of air is a desin^le finish*
hi all my ^ixperieaces dufiog the last eight years my medieiiial armatneBtaricmi has been strictly, and absdutely eonfined to ^^amcsopatbie remedies, with the satisfactory result of not having lost a eingle case.
As the M. H,. B^ may be read outside the profession, I hope that those of its sabecribers who live at a great distance from a bomoBopathjc physician m&y find what I have said ssefal. Thase experienees have been written .dojping the coarse of an inflaeni a epidemic, and while driving in my brougham from one patient to another, conssqpientiiy, witb freqiimt inierraptions, so if what I have aaid seems snatchy, jeirky, md disconnected, I crave the indulgence of my readers. At the sam^e time, I feel my eubject is a Protean one, and quite beyond the limits of a magyvmnft article.
Ealing, W,
PULMONARY COMPLICATIONS IN INFLUENZA. By BvBBs Mom, M.D.
PkysiioUn to the London fiomcBopathio Hospital. The present onUnreak of influenza has been proving very fatal to old people from lung complieations. These are met with in the forms of bronchitis, broncho-pneumonia, and lobar pneomonia, and present many points of interest both in diagnosis and treatments
The preliminary symptoms of aching head and limbs are often sli^^t, but there is usually a thickly coated tongue, withcompleteloss of appetite. The fever is usually slight, or temperature may be sub-normaL The cough is a marked feature ; it is hard, dry and racking, often in paroxysms resembling whooping cough, and very intractable to remedies. As a rule there is no ex{>ector ration, and when there is any it ip of a glutinous character. Bespiration is difficult, the air not entering the lungs freely. Over the posterior portion of the lungs sharp sticky rales can be heard. Sometimes a case may temunote fatally^ without any sign of consolidation being present. In other cases patches of solid lung sf(pe9ix here and. there, o^ sometimes extensive consoli'
154 influenza; ^^TgSg;ftSS!
dation of both lungs may supervene* If pleurisy occurs it often runs on into an empyema.
In cases where improvement takes place, the ezpecto-* ration becomes less glutinous and more free, and a large amount may be discharged ; if this does not take place, the heart begins to show signs of over-strain from the effects of constant straining cough and the inter* ference with the circulation in the lungs^
In the present outbreak I have not met with a case of the worst form of lobar pneumonia. In these the physical signs are often more like those of an extensive pleuritic effusion than of consolidated lung. The per- cussion note may be quite dull, breath sounds absent, and no vocal resonance to be heard. If an exploring needle is used no fluid except a little blood can be obtained. In February, 1892, when influenza wa& raging, I saw a gentleman of 66 who had previously been in good health. He had been seized the morning I saw him with difficulty of breathing and pain in the left side. There was dulness on percussion, but no breath sounds could be heard. By the evening he was delirious ; there was rattling of mucus, but no expj^ctora- tion. The next day both lungs were involved, and he sank in three days. The marked features in his case being the total absence of respiratory sounds over the posterior regions of the lungs, the rapid delirium, and the absence of any expectoration, the lungs being evidently blocked with a glutinous secretion.
Broncho-pneumonia, which is not usually met with in adults, is frequently met with as a sequela or in the course of an attack of influenza, and is very dangerous when the patient is over 70.
In the beginning of January I had to see a gentleman of 78 in a house where there had been several cases of influenza. He was evidently suffering from an attack of influenza, but not enough to make him take to his bed, of which, like so many old people who have had good health, he had a perfect horror. His temperature was normal, but the cough was most troublesome and racking, though nothing could be detected on the lungs, and none of the ordinary remedies seemed to relieve it.
After a few days, the peculiar sticky rales could be heard over the lungs, and a little glutinous expectoration ^as brought up. He was taking Uttle nourishment, and
^t^lSSSI?^ INFLUENZA.' 16&
Beview, Mftrch 1, 1898.
weakness was. increasing, but it was with great difficulty that he was made to lay ap and to sabmit to a nurse, by this time a patch of consolidation with moist crepitus had developed in the left lung, but expectoration was more copious, and with regular feeding he improved, and after a week seemed to be out of danger, but though the same care was taken and he had not left his bed, there was a recrudesence of the pneumonic trouble in the other lung, from which he sank in four days.
I have at present in the hospital • a man of 88, who- was admitted on the 9th February in what appeared to be a moribund condition. A fortnight before he com- plained of headache, lachrymation and nasal discharge, with cough and Wheezing. He continued at work till the 6th, but was then compelled to give in on account of the difficulty of breathing.
On admission there was great dyspnoea and lividity. Pulse 120. Temp. 100.2°. Frequent loose cough, with maco-purulent expectorations. Mucous rales could be' heard all over the chest, with a friction sound over lower part of left lung. There was no dulness to percussion* Heart sounds scarcely heard on account of emphysema. In this case the next day the cyanosis was less marked, and improvement has been rapid, due to the power of expelling a copious muco-purulent expectoration.
My chief object in putting these notes together is to obtain from others their experience in the treatment of shnilar cases, and especially on the two points of cough and expectoration.
For the cough I must say that I have been dis- appointed in the usual remedies. In the early stages the iy cough has more the characteristics of hyoscyamu^ or drosera, but these, in my experience, do little good. Besides these I have used aconite, belladonna, rumex, sanguinaria, lachesis, and many others, but without definite results.
In the pneumonic stage as met with in old persons antimonium tart, does not benefit as it does in children, and I have seen more good result from phosphorus, but I think the best remedy is as Dr. Blackley so strongly emphasised at the last meeting of the British Homoeo- pathic Society — ^iodide of arsenic.
For the heart failure strophanthus in 2-drop doses is very satisfactory as a stimulant.
156 INFLUENZA. ^^^rsssMBr
NOTES ON INFLUENZA. By Giles F. Goldsbbouoh, M.D.
ABsifltaat PhysioiMi to the London HomoBopftthio Hospital.
At the risk of boring the readers of the Eeview, the following notes on the well-worn subject of Influenza are presented as bearing on the prevalence of the disease, and the character of the cases occurring at the present time.
As far as the writer is able to speak for the South of London, the disease is very prevalent, but not in the proportions of the epidemics experienced during recent years. And what is more noticeable, owing perhaps, to more careful precautions being taken against infection, not many members of one family have been affected. Two is the maximum the writer has met with in any instance. Children too, this time, have as yet nearly all escaped.
As regards the character of the cases, they have been varied, but falling under the usual well-recognised type. The majority of cases, however, have not been so severe as have been experienced during the past five years; the fever has not run so high or continued so long. It cannot be said, however, that patients have finally recovered any more quickly than formerly, and among the chest sequelse, troublesome, dry broncmal catarrhs and bronchitis have been very conspicuous. The recurrence of the familiar type has served to illustrate again the value of one or two homoeopathic remedies, and for that purpose it is referred to here. A typical case may be cited emphasifiing the value of these remedies.
E. A. D., a strong, healthy man of 27, was quite well on the morning of January 28rd. During the day he suddenly became very ill, and was seen by the writer in the evening in the following condition. He was very prostrate, with intense headache and confusion of mind, aching and soreness all over the body. Temperature 101.6, pulse soft, very compressible, about 90. Bespira- tion difficult, witii sharp pain through the right side of the chest. Frequent, severe, shaking cough, loose, but no expectoration. Tongue coated with thick, white fur, and odour of breath verv foul. The patient was seen downstairs, and was cautioned as to the possibility of
SSS!Jf523fi??Sa INFLUENZA. 167
{ftinting on going upstairs. As a matter of fact, he did faint on trying to ascend the stairs. He was put to bed between blankets in a warm room, and had given him baptisia <f> gttj., and ant. tart. 2s gr. i. ; om. hor. alt. He was seen again on the afternoon of the next day and the ehange in his condition was remarkable. He was bright and cheerful, and greeted his medical man with a &m lumd-grip. The pains in the head and limbs had gone,, as also had the pain in the chest ; the cough was loose and easy. Temperature 99, pulse 70, regular, soft. Tongue [nearly clean. A request was made for solid food. There was no return subsequently of anj symptom of moment. The cough lasted rather over a week, and there Was want of appetite and a feeling of weakness, but the patient regained his ordinary health without other sequel.
It is scarcely possible to ^ think that had^ not the remedies mentioned been administered, the patient could have recovered from his severely-ill condition so quickly, and ^though this may bean exceptionally favourable case, and the fever and prostration may last from one to three days, it is a comparatively comnK)n ex^rience in the hands of the writer in the use of baptisia and ant., tart. The reason for alternating the two remedies is, that the pathogenesis of baptisia does not meet the chest symptoms of an incipient bronchitis or pneumonia such as those of an influenza usually appear to be. On the other hand, these are met by ant. tart, as in the case cited or by bryonia, and alternation is therefore perfectly justifiable. The chest condition produced by baptisia, it may be noted, is rather that of a paretic dyspnoea than an embarrassment due io congestion in tubes or air-cells. The picture of the other symptoms of influenza observable in the pathogenesis of baptisia render it the most completely homoeopathic remedy to the common type of the disease in the earliest stages, ranking higher tban aconite, gelsemium or veratrum viride.'*'
As regards after treatment, the bronchial catarrhs present a problem which in the experience of the writer is not yet solved. The most commonly used remedies by him are ipecacuanha and hyoseyamus prescribed
* Vide Cyelepttdia of Drtug Pathogenety^ vol. 1. p. 572.
158 INFLUENZA. Ig^faTgB!
according to the indications for each, and .adminierteriad in frequently-repeated doses with glycerine, or the spiritus chloroformi. For the after prostration he has found chin, sulph. yery useful, also strychnia, and stroph'anthus in heart failure.
. A few cases have occurred recently in which the disease seems to have spent itself in the stomach, the generalised condition presenting itself as an acute gastric catarrh. The writer has had three or four such cases during the past two months. He would hesitate to describe them as influenza, except for two well defined character- istics (1) . the otherwise, unaccountable origin of the disease not succeeding any error in diet or exposure to cold, and (2) the peculiar taste in the mouth and odour of the breath which have supervened after the acute symptoms have subsided. The gastric pain and tender- ness, ^witb vpniiting, and thicjkly-coated tongue have lasted twa or three daj^s, unaccompanied with fever ; the tenderness has continued longer with coated tongue and disgusting influenza taste, as already mentioned, and an absolute loathing of food. Ars, alb., ant. crud. and kali, bichrom. appear to be the best remedies for this condition.
Two marked effects of influenza on the nervous system have come more especially under the writer's notice. These are an orbital neuralgia, and mental depression. The neuralgia has usually, been of a severe type, the supra- and infra-orbital nerves being affected, with or without tehderness along the nerve-trunks, and some- times the eyeball has been very painful, the symptoms simulating those of acute glaucoma, although distinguised from this by the absence of increased tension of the eye-ball or sluggishness of pupil. Spigelia, colocynth, or arsenic in this order, seem to be the best remedies for this condition.
As regards mental depression, the case of a man of over 50, who had recovered from the acute symptoms of influenza, was somewhat remarkable. With the excep- tion of a coated tongue and some old cystitis which had been resuscitated by the occurrence of the influenza attack, he was nearly well, when one night he summoned all his family round him and assured them his last moments had arrived. He urged that the doctor should be sent for, whichrequest was complied with post-haste, but upon the doctor's arrival he found that there was
JKggf^SSMg INPLUENZA. 159
not the slightest ground for the apprehension ; it existed, indeed, in the man's mind only. . The family were immediately reassured, but the man's depression entirely passed off only after a few days' administration of aurum metallicum 8.
SOME PULMONARY EEMEDIES FOR INFLUENZA
CASES.
By T>. Mag Nish, M.A., M.B., CM. Edin. Aasistuit Physician to the London HomcDopftthio Hospital.
DuRiNo the present epidemic of influenza, A^eratrum viride, the green hellebore, is worthy of a trial. Its chief sphere of action is in the initial stages of pulmo- nary disease — the stage of engorgement and congestion.
According to Ringer, in large doses it causes a very rapid thready pulse, a cold clammy skin, nausea, vomit- ing and great muscular prostration. This description daring the present epidemic accurately corresponds to the condition of many of the patients during the preliminary stages. During this epidemic the fever is usually asthenic, with ** the very rapid thready pulse " so accu- rately described in the provings.
During the past four weeks over 20 cases have been under my treatment, and the type has been fairly uniform, viz.,. fever usually 101° to 102°, a pulse over 100> coldness of the body, great prostration, very ofl;en nausea and sometimes, especially in children, vomiting. On examination during the initial stages, the base of either lung is found on percussion to be slightly tympanitic or flat. A few fine crepitations are heard over, this area, the vocal resonance and fremitus are increased and occasional pain is complained of. At this stage veratrum viride Ix, one drop every hour, is most beneficial. As soon as the fever subsides, the veratrum viride should be discontinued, and the medicine homoeopathic to the condition given. In cases of lobular inflammation the pathological conditions vary rapidly, patches of dulness appear and disappear over the lungs at short intervals of time. In these cases, as long as the fever continues and the symptoms correspond, it is advisable to continue the veratrum viride. The rapid changes of the pathological condition preclude one giving
im MIFL0BNZA* SSfilfSS??^
mtwinft jCbqu 1, 1816^
a definite opinion of the efficacy of the drug. From many cases treated, the following may be cited . as an etample.
B. S. 8., female, mt* 8^ wa» visited on SSth January, 1898. There was a history of deliriimi during the nighty most troabkeome eoogh, and pain on the right side of the chest posteriorly. Patient complained of nausea, and had vomited once that morning. On examination, temperature 102.4^, pulse 140, small, easily cgmptda^ible, respiration 60^ very shallow. There was a dull note over the base of the right lung extending up to the sitth rib posteriorly, fine crepitations were present over this area, the voeieJ resonante and fremitus were increased. In the upper and anterior part of the lung the breathing was louder than usual, but no adventitious sounds were audible.
The left lung seemed to be normal. A Gamgee jacket was at once applied to the chest. Yeratrum viride Ix, one drop every hour.
On the 26th temp. 99^. Pulse 100. Besp. 80. Patient had passed k very good night. Cough trouble- some at intervals. The chest on examination was much the same. Ver. vir* Ix trij. 2 h. d.
27th. Temp. 98.4®. Pulse 80. Kesp. 26. Patient felt very well; cough much less; no pain in chest. An occasional crepitation heard over the affected area^ Note on percussion flat* Bep. bryonia Ix.
29th. Temp. 98.2°. Pulse 80. Besp. 24. Cough occasional ; still slight dulness over the right base ; no crepitation audible. Breathing now of the bronchial type, the inspii^atory and expiratory sounds being equal. Bep. bry. Ix.
81st. Temp, normal. Pulse 80. Bosp. 24. No cough; percussion note still impaired over the right base ; breathing bronchial. Bep. ars. iod. dx.
Feb 2nd. Ordinary temp. ; chest normal ; no cough ; patient well.
The case cited is a-dample of many uud^r treatment at the present time.
When liver symptoms are prominent, baptisia Ix, and chelidonium Ix are to be considered. In the pneumonia of old people associated with liver symptoms, baptisia Ix, one dropddses, is benefidial. Where in such cases the debility is theehief comiplaint of the patient,^
n:^!^^^?^ INFLUENZA. 161
liquor strychnine nitratis 8x, in one drop doses, has proved most useful in the disease, not only clearing up the lung, but also allaying the fever and restlessness. The forms of pulmonary disease at this time are most varied, still it is advisable to treat the patient primarily" on his symptoms, and secondarily on the pathological changes in the lungs.
CLINICAL AND THERAPEUTICAL NOTES ON INFLUENZA.
By E. B. RocHK, L.R.C-P. Lond., M.R-C.S. Eng.
The name " influenza/' as expressing a kind of ** bold/' has been familiar all my life, but it was only in 1890 that I learned that this was an appropriation, and that there was a proper proprietor of the name, with a definite character and history, who had come to demonstrate his existence and claim bis name. One wonders now at the complete disappearance for so many years of the disease, while the name lingered tacked on to colds with feverish symptoms, general pains, headache and languor. The main characteristics of influenza soon impressed themselves — sudden feeling of illness with cold chills, fever, severe headache, general aching of back and limbs, sneezing, coughing, sore throat, sickness, and sometimes diarrhoea. Rapidly spreading in all directions and coming under extensive observation, it was found that there were varying types — mainly nervous, pulmonary and gastric. This was mainly also the result of what has been established as the great feature of influenza, namely, the marked accentuation of whatever is the weak point of the individual attacked.
Besides these main types were cases where glandular enlargement, throat symptoms, cardiac excitement and failure were prominent. The sudden onset of the symptoms in a person quite well up to then, and with no suspicion of having taken cold, marks this disease.
Very little is known of the poison itself. It appears to be carried by the air, spreading from the East with great rapidity and varying virulence. It comes and con- tinues in all conditions of weather, but seems to move trith strong winds. The attack lasts four to eight days,
Vol. 42, No. 3. M
162 INFLUENZA. ^*"^5Sif?^
Review, Maroh 1, 1806-
and leaves the patient frequently affected with debility, languor, and depression of spirits quite beyond what might be expected. The great point of treatment, though difficult of realisation, is to place the patient at once in bed.
Aconite should be administered in frequent doses to promote free perspiration. After this, of course, the prominent symptoms will indicate the remedy.
Headache, belladonna or glonoine. Coryza and ocu- lar irritation, ars. Severe pain in the back and legs, with hard cough, bryonia* Bronchial extension, with yellow expectoration, kali bichrom. ; while deeper bronchial symptoms or broncho-pneumonia call for ant. tart, or phos. Gastric symptoms, with the harsh, irri- tating cough, are met by bryonia, while more hepatic conditions, with sickness and sore throat, call for mere, sol. Cardiac excitement is met by ignatia or cactus, and symptoms of failure by strophanthus or strychnine. The resulting weakness and nervous debility call for ars., nux., or gelsem. according to the predominance of the symptoms.
Influenza appears to be contagious in the feverish stage, though where it is epidemic this is difficult of proof. In a number of cases a measly rash has come out, mainly in children. This fact is important, and may be linked with the other fact of the occurrence of a similar rash after use of enemata in cases of prolonged con- stipation. The persistence of a severe and shaking cough is a frequent sequel, and the almost certain stirring up of the individual weakness, together with a most unusual degree of debility, teaches the patient that influenza is a disease sui generis. The frequency of grave nerve depression and melancholia must have forced itself on all observers with a considerable number of cases of insanity and suicide. The majority of the fatal cases, mainly from pulmonary mischief, are in those who, neglecting the early symptoms, try to keep about, neglect the warning, will not go to bed, and expose themselves to cold, and at the same time have a weak point to be assaulted.
The lower mortality of late epidemics is doubtless due to the public recognition of the importance of taking to bed as avoiding serious danger, lessening complica- tions, and hastening recovery. In the Eastern Counties
f^'^S^TFtSt' INFLUENZA.. 168
B«vMw, Much 1, 1896.
the disease was, as to this invasion, first epidemic in 1890, then in 1892 and again in 1894. There is now another epidemic. The t^ype is milder and less fatal—* less of the pulmonary and more of the gastro-bilioos form. I have seen nothing to indicate or favour the idea of any relation of influenza to enteric fever.
TWO CASES OP SCAELET FEVER MODIFIED BY INFLUENZA.
By T. G. Stonham, M.D. Lond.
Phyncian to the Eleotrioftl Department, London HomoBopathic Hospital.
Once more influenza is with us, and; as usual, is protean in its forms, thereby often affording us a problem in diagnosis. We have read how difficult it proved to be at King's Lynn to distinguish it from enteric fever, and more recently, how at Warwick Asylum a sudden out- break was for a time thought to be caused by wholesale ptomaine poisoning, until it was proved to be due to influenza of the gastric type.
Not only does influenza simulate other diseases, it also modifies them when they are present, and sometimes to Buch an extent that it becomes difficult to recognise them. We have lately seen two cases of influenza ^o-ezisting with scarlet fever, in which the course of the latter has been in several respects altered by the influenza symptoms becoming developed during the latent period of the scarlet fever which followed as these were abating. As the incubation period of influenza is probably very short — only a few hours — the two com- plaints must have been contracted almost simultaneously.
Case I.
B. B., aged 15. On Jan. 10th complained of a severe headache and sore throat, with pains about the body and a temp, of 101^. The patient was sent to bed.
Jan. 11th. The symptoms continued; the temp. 101° in the morning and 102° in the evening. Influenza was diagnosed as the probable cause of the illness.
12th« The fever and other symptoms remained about the same. No cough and no further development of the throat affection. No rash on any part of the body.
18th. In the morning the pulse was better the
1B4
INFLUENZA.
Monthly Hoinoeo|Mithie Beriew. March 1, 1896.
throat less painful the headache khd pains about the body gone. She seemed to be recovering in a normal way from an attack 6f Influenza. The temp., however, was as high as 101^. In the evening the pdtient blecame very unwell, with hot burning headache and dry hot skin; and a teinp. of 104° F.
14th. Temp: in the morning 102.6°, in evenmg 104.8°. A few discrete, r6,tbet dart-coloured papulfes on the face and forehead. The .sore throat had abated ; the tongue furred, but no strawberry appearance.
16th. Much the same, except that the temp, had fallen to 101^ in the morning, 103° in the evening ; na extension of rash.
16th. A genuine scarlet fever rash appeared on the trunk, while the dusky papules on tlie face had died away. Temp. 101° in the morning, 102.5^ at night.
17th. Desquamation in large branny, scales set in over the face and neck ; no extension of the scarlet rash on the trunk either now or subsequently.
HS^S^SS^?^ IKFLUENZi. 166
Be^iew, Mtfeh 1, 2818.
18th to 20tb. GradiuJ deferyesceoce occurred on the rdifiappearahce of the rash ; the face and neck desqua- mated most freely. On the evening of the 20th there was much pain in the left ear.
Subsequently. For the next few da^s the ear comi^- cation caused a considerable evening rise of temperature, which was lowered by a free discharge from the ear oia the 22nd. She was at first perfectlv deaf in the.left ear, but hearing gradually improved, till by Feb. 8th it became •quite normal again, though there continued for a time to be a slight disi^acge.
The urine was frequently tested for albumen, but none found. About the 26th Jan. desquamation commenced on the hands, and the convalescence proceeded normally.
The remedies used were gelsemium, bellad., pulsl, Thus., mere, cor., and arsenic.
Case II.
A. W., aged 18, was taken ill on Dec. 5th with the usual symptoms of influenza, — ^headache, fever, pains in limbs and shivering, and then, after a day or two's treatment by rest in bed and gelsemium subsided, so that on Dec. 0th he was so much recovered that he was permitted to go down stairs. But in the evening he became very feverish, and scarcely slept all night, with intense laryngeal pain and dyspnoea.
Dec. 10th. Temp .108^. He complained of great pain in the throat and larynx, but an examination revealed nothing but a slight redness, altogether out of proportion to the severity of the symptoms. He was quite aphonic ■and had much dysphagia. There were no other symptoms of note and it was feared that he might be going to have diphtheria. He was given aconite and epongia.
Dec. 11th. The laryngeal symptom much better, but he remained feverish. *
12th. No further development in throat. Epistaxis occurred. General feebleness and ill feeling. Temp. 101^.
18th. More epistaxis in the morning. In the evening the throat was more red but less painful. A vivid scarlet fever rash appeared on the face, neck and trunk. Temp. 102°.
166 INFLUENZA. lS2i'22^?^
BeTiew, Much 1, 18S6.
14tb. Temp. 99^. The rash was mach fainter and appeared to be dying away ; it was still limited to the trunk, face and neck.
15th. The rash remained in the same situation bat qnite faded. No throat symptoms now, and patient appeared to be convalescent. The face commenced to desquamate in rather large flakes.
16th. In the evening the temperature ran up to 104% and the red papular rash over the chest, abdomen and back again became very bright, but there was no extension in area. The tongue covered with a thick yellow fur.
17th. The rash fading and the temperature falling. From this time the rash quickly faded away, never having attacked the lower extremities at all, and only partially the upper extremities. The face, neck, and chest at once desquamated in large pieces, commencing on December 16th and being complete in a few days. Convalescence proceeded normally, and the hands began to desquamate about December 27; the feet did not desquamate at all.
The urine at no time contained any albumen.
The medicines used were gelsemium, aconite, spongia, lachesis, belladonna, arsenicum.
In both these cases influenza took place during the prodromal stage of scarlet fever, giving rise to an acute Ulness before the scarlet fever symptoms commenced, so that the rash, instead of appearing as usual on the second day of illness, appeared after an illness in one case of five, and in the other of eight days.
In both cases the rash appeared in an abnormal manner and was limited in extent, the lower extremities entirely escaping and the upper extremities being only very slightly aflfected.
In both cases the throat symptoms began, at the commencement of the illness and were most severe before the rash appeared, and in neither case did the tongue present its characteristic appearance.
In both cases a very free desquamation of the face and neck took place assoon as the rash subsided on the face, and while on the trunk it was still prominent.
Quite 10 days to a fortnight elapsed before it commenced elsewhere.
iSdSSriESK?!^!' INFLUENZA* 167
ON A REFRACTORY COUGH, OFTEN INFLUENZAL.
By Stanley Wilde, L.R.C.P., L.R.O.S., Edin.
One reads very liitle in our periodical literature of the successful treatment of coughs, and judging from personal experience, the reason is apparent. Most practitioners would, I think, acknowledge that eoxnf^ are a great bugbear to treatment. I refer to the ordinary catarrhal cough. You examine the chest in these cases and elicit no signs of bronchial disturbance ; you look into the throat and gain little from doing so. The voice is not husky, but the patient has a troublesome racking couch, which by a process of negative reasoning you refer to the trachea. It is these tracheal coughs, I believe, that give so much trouble, and are so rebellious to treatment. We are rich in remedies with distinctive indications, but this is where the difficulty comes in. Gross-examine patients as you will, you cannot obtain from them, in the majority of instances, any precise indications for any particular medicine. Their coughs are not worse at any special time (they often tell me that they '* just cot^ at any time'') ; they have not noticed that eating, or drinking, or speaking makes any difference, nor is the cough worse on movement, or on change of temperature, and so on and so on. I am speaking now of actual cases, and draw no fanciful picture.
I often wonder what the so-called ''Hahnemannian *' would do in such cases ! There is nothing to be done, under such conditions, but prescribe a remedy which has a special affinity to the part affected, and, as often as not, with non-success. One admires the fine differential individualisation by the late Carroll Dunham of such medicines as belL, causticum, phos., and runiex, but it is difficult to put it into practice, because patients cannot be got to have these fine distinctive symptoms to order, so to speak.
Recently a case of this kind came under my care, associated with influenza. The patient, a middle-aged man, subject to a harrassing cough, but now much intensified. An examination of the chest revealed nothing abnormal. The cough was violent and
m IKFLUENZA, t^^^^g^^fT^
spasmodic, with a copious expectoFfi-tion • of frothy mucus. I could ol^^t^Hi ^p special aggravations or ameliorations of the cough from the patient. After prescribipg yariiQus medicines without th^ least effect, I noticed one day at tWpatient^s bedside a glass of water, and asked wbfkt it eontaiaed. ^e tl^ep told me that it was cold water, ^bich, be sipped, because he thought it eased his cough ft little. On this slight hint I prescribed cauHieum 8x,. knowiQg that this medicine had the symptom ** cough reUeved by. a swallow of cold water," and with very decided relief. This simply goes to prove that the law of similars is all right if one can only get a £air chance to fit the remedy to the case. But the extreme difidci^lty of doing this in the treatment of coughs must he within the experienxse of the majority of practitioners.
Sedative? t^e sometimes effectual and even necessary. I call to mind an instance of severe tracheal cough where the patient was well-nigh exhausted from incessant cough and loss of sleep. Medicine after medicine bad been given with no effect ; and so one morning, on visiting the patient and seeing him quite prostrate, I gave hiiqi a tabloid containing ten minims of tinct. opii. Next day he told i^e he fell asleep shortly after J had left the .house, and awoke ^^ feeling a new man." Curiously, the cough became manageable after this, and the tabloid was not repeated.
In these c^ghs eodeia Ix in two 4rop doses is oftei^ very helpful, and the simple and old-fashioned mixture of glycerine or honey and lemou juice, which often soothes and acts as an expectorant, is not to be despised. To this mixture I often add a little vaseline with good effect ; and, as adjunctive treatment, the inhalation of steam frcw water containing a little vinegar, and the applicatiou ot a hot poultice ox fomentation to the windpipe aire freguexjitly bene^icalal.
But the fiiuMi remains that this type ,of cough, is difficult and finsatisfa^tory to treat ; and I have essayed this short article, not with any thought of conveying ioformation, but to elicit from others their experience in this troublespflp^ affection.
fSSi'^SSr?^ JMFLUENZA. 189
ON INFLUENZA.
By D. Dycb Brown, M.D.
Consulti&g Fbjsioiaii to the Loodoa Qomceopftthlo Hospital.
So much has been written on influenza that little remains fo be said on it, except one's personal experiences of the present outbreak of it. I avoid, therefore, all generalities in these short remarks, and confine myself to noting the main features of the .disease as I have seep it in its present recrudescence, and the treatment I have found most successful. In the first place I have found that the' serious chest complications have been the exception rather than the rule as in former outbreaks. Some laerious cases I have seen in consultation, but they .are the exceptions at present^ and have yielded satisfactorily to antim. tart. 8x, phosphorus 8 or 4x, and arsen. ioa. 8X; according to the well-known indications for these reqaedieSr There is always more or less catarrh of the respiratory apparatus, and this has yielded always to bryQuia 8 Qf Ix.
Bat the marked type of influenza at present is, in my experiezice, one where the poison expends its force on the nervous system ^d the digestive organs, the two often -combined i^ the same case. In some the temperature runs high, mth hardly any local symptoms to speak of, except the digestive catarrh. In these, I find aconite Ix and bryonia Ix each ajijternate hour admirable in most cases. But when the tongue is much coated in the centre, and clean at the edges, with complete aversion to food, I gave baptisia Ix in plaice of aconite, with very satislactc^y results. The digestive state may show thickly coated wl^ite tongue, utter loss of appetite, and nausea, whejp antim tart. 8x soon reUeves, and at the same time i|S beQeficial for the prostrate feeling which Mf^mpasneB tixis «tate ; and it is well followed by nux vomica. Or there may be a clear, red, dry tongue, with aausea or vomiting, when arsenicum Sx and beUadonita Ix quickly show an improvement. The axsedQioom here filso meets tlie sense of prostration. Oc<MunoBally i^ece is 4ia>r]^l^<£9'^ i:equiring ^lercurius cor. or arfien^ctuju^ or v^atr;ijuxi^ as tl^e sym^oms may indi- 4»te ; while in other cases, a troublesome fo^m of conslji*
170 INFLUENZA. SUSiTSSf?"^
Beriew. Miu«h 1. 1888,
pation occurs, seemingly produced by a temporary paresis of the muscular coat of the bowels. The bowels seem to be acting slightly, or even fairly^ when suddenly the symptoms of returning sickness, coated tongue, loss of appetite, with severe abdominal pain, or severe tenesmus lead to an examination of the abdomen, when the ascend- ing colon is found to be loaded and tender, requiring large and repeated enemas, which dislodge large hard fsecal masses. When such digestive cases have got " round the comer," nitric acid Ix, in 2 or 8 drop doses, eomes in admirably to complete the convalescence.
But in many cases, the main feature is the extreme sense of prostration, with few local symptoms, and little or no rise of temperature. As one patient described hi& feeling to me when I first saw him, ^' I feel three parts dead." This patient's temperature was normal. Besides the general prostration, one finds a great variety of neurotic symptoms — headache, generally of the neuralgic type, coming on intermittently or remittently, nausea, without marked gastric disturbance, craving for food, with constant '^ sinking," sleeplessness, restlessness, and very depressed spirits ; abdominal neuralgic pains, pain& of the same character in the chest walls, simulating pleurisy, weak or intermittent heart-action. Such cases are the slowest of all to recover, often leaving a long and tedious condition of weakness, bodily and mentally. In one case beginning as influenza that I saw in consulta- tion— an elderly lady — all the symptoms of pneumo- gastric paresis were present — rapid pulse, short, difficult breathing, sleeplessness, commencing engorgement of the bases of the lungs, enlarging liver, and commencing albuminuria.
In these neurotic cases, food is sometimes taken well, and craved for, while in others there is complete anorexia. Stimulants are very unequally borne, and sometimes not at all. In the therapeutic treatment of these patients, I find the only way is to be guided by the symptomatic indications, to cover the totality of the symptoms ; but in most cases the selection falls easily on arsenicum, belladonna, gelsemium, china, or chininiim nitricum, nitric and phosphoric acids, and aetiea. Sleeplessness is often a very troobleaome symptom,, requiring belladonna, gelsemium, or ignatia, coffea and i^hamomilla.
SS^'SSfl^lSi* INFLUENZA. 171
BcTtow. March 1. 1888.
It would be beyond the scope of these few observattona to describe in full the detailed indications for the various remedies I have named, while at the same time it would be unnecessary, as their pathogenesis is so well known in our school.
AN ANOMALOUS INFLUENZAL CONDITION FOLLOWING A GYNAECOLOGICAL OPERATION.
By Edwin A. Nbatby, M.D,
Thb surprises which influenza springs upon the hapless practitioner are so numerous that it behoves us all to make common property of a knowledge of its crooked ways. The tendency whieh this truly formidable malady evinced, especiaUy in the 1889-90 epidemic, to induce suppurative processes somewhat resembling pysBmic conditions, continues to receive all too many illustra- tions. Its disposition to discover weak points and to render active latent constitutional or local defects should put us most carefully on our guard and bring into play all our preventive resources. The case I am about to relate displays some of the eccentricities of the disease when brought into contact with a case of a semi-surgical character. Towards the close of last year I was requested by a colleague to see a patient of his for a threatening abortion of about the sixth month. Best failing to stop the process, and the lady becoming weak, it became necessary to complete the emptying of the uterus already in progress. This was done with the usual precautions as to asepsis.
The patient's state before the end of a fortnight was so good that she rather chafed at confinement to bed, and at the end of fourteen days, after an examination of the pelvic organs, she was permitted to get up. Except f(»r some neunilgic twinges about the head she felt "quite well." Suddenly, the same day (Tuesday), the temperature ro8e> bad headache set in, severe general achmg came <m, the muscles feeling as if beaten and bruised. The pulse was very little accelerated. The classical symptoms of influenza excited no alarm, and the ease being at an end gyneecologically. Dr. Moir took up the management. By Thursday the patient seemed
172 INFLUENZA. ^gaSiTg^r?f;^
extremely ill, and was sleeping very badly. Difficult and frequent micturition developed, and examination of the urine showed that cystitis was present, and after filtration of the urine albumen was still evident ; the reaction was alkaline and the sp. gr. about 1020. There was also great tenderness to touch, and some tenderness in the renal regions and loins, and Dr. Moir was of opinion that sqme degree of nephritis was present. Neither blood nor casts however were discovered.
To increase the complexity and anxiety of the case, on the Thursday considerable tympanitis had developed, and I saw the patient again on Saturday and Sunday. This had so much increased as to cause real distress with the breathing, and the tongue was dry, coated and indurated. The pulse also became for a short time hard and quick, but never frequent. Its greatest frequency was on one occasion 96, usually it was from 80 — 84 at the patient's worst. After the aforenamed Sunday morning (the sixth day), the symptoms gradually abated, and by the eighth day the abdomen had resumed its usually flat state. Before the lady became ill several members of her household and family had had influezuea, and the initial symptoms of the attack justified the diagnosis. It was when the irregular abdominal symptoms showed themselves that fears were entertained lest the influenza should have lighted up pelvic or ab- dominal inflammation, or whether a late septic condition, following on the abortion, had arisen. Pelvic examination, the infrequency of the pulse, and the known vagaries of influenza confirmed the original diagnosis, and the absence of vomiting acted as a '' saving clause."
The fever continued for nearly three weeks before finally becoming normal.
My object in relating this case is to reassure others placed in similar trying circumstances, but it may make the history more complete if I state that gelsemium was first given, followed by baptisia, which seemed exception- ally well indicated. BeUad. and cantharis followed, the latter being replaced later by mercurios cor. Poultices and the application of glycerinum belladonnsB gave considerable relief, and the use of peptonised in place of plain milk was followed by a diminution of the distention of the abdomen. Arseniate of quinine was finally administered, and the temperature fell after being up
b2J^7.2r?S2i' KEviEws. 178
Beview, JkUrefa 1, 1886.
as stated. The case mast be regarded as one of acute cystitis followed by pyelitis, probably only or chiefly on the left side.
I am indebted to the gentleman in charge of the patienty and to Dr. Moir for permission to publish the case.
REVIEW3.
Tfie London Homcsopathic Hospital Reports. Edited by G. BuBFOED, M.B., 0. Knox Bhaw, and Btbes Moib, M.D. Vol. vi. London. 1897.
The volume of the Reports before us opens with a full and clear account of the recently proposed Federation of the Homoeopathic Hospitals of the United Kingdom. Of this Yery promising proposal we gave an account m our leading article for January ; on this ground, and, further, because we understand that a meeting is about to be held to formulate a plan of operations to effect this very useful purpose in the course of a week or two We need say nothing further about it than to advise our readers to carefully peruse Dr. Madden*s essay and study the proposals made in it.
The next paper by Dr. J. G. Blackley, On Some Primary Anemias and their Treatment is instructive, interesting and useful. The opening sentence reads as follows : — '< Although the researches of Cutler and Bradford made it tolerably certain that iron had no action upon healthy blood, there can be httle doubt that there is good ground for the old and widely diffused belief in the virtues of iron as a remedy in anaamic conditions," With the observations of Gutler and Bradford we admit tiiat we are not familiar, but the experiments of Loffler, with iron upon healthy persons, do, we think, show that it must have an action upon the blood very similar to that which obtains in some forihs — and those the most common — of anaemia. He says " Iron is said to be a strengthening remedy, and in fact is employed chiefly or exclusively in morbid states, in which weakness is a prominent feature. But let us glance at our provings. A constant and invariable symptom was general debility, the sensation of weakness, of heaviness and prostration of the hmbs, of disinclination for corporeal or mental activity, fatigue, insuperable drowsiness— all signs of a diminution of the strength and feeling of strength. Verily " he adds, '^ It requires no excessive enthusiasm for tiie homoeopathic doctrine to see in these a striking proof of
174 REVIEWS. ^^^Sj^?ft2IS
its truth." Journal for Experimental Medicine, Berlin 1849, And British Journal of Homaopathy^ vol. viii., p. 258.
It is true that the means for examining the physical <5onstitution of the blood, which are at our command to-day were non-existent in 1849, but before explaining the employment of iron on merely empirical grounds and justifying its use by clinical experiment alone, a thorough proving like that of Loffler, with the addition of those sources of research which Dr. Blackley so fully makes use of in his bedside investigation, and which he has clearly set forth in his post-graduate lecture, an abstract of which appeared in our Review for 1897, ought to be made. Meanwhile, we not only have good reason from clinical experience^ for crediting iron with the powers to cure simple anaemias, but also scientific grounds for doing so.
Of the various forms in which iron is administered, Dr. Blackley prefers in protoxalate. The illustrative cases reported are interesting and suggestive, and their progress is demonstrated by investigations showing the improvement in the physical condition of the blood.
In idiopathic aneemia, Dr. Blackley shows the best results to have accrued from the exhibition of arsenical preparation, and demonstrates that in thus usmg arsenic we are carrying out the law of similars. Lead he also shows to be a homoeopathic rival of arsenic in this condition.
Three cases of aleucsBmic lymphadenia (Hodgkin's disease) are reported, but no improvement unfortunately occurred in
Mr. Knox Shaw contributes an mterestmg paper, from which much may be learned of the progress and difficulties of cataract extraction, based upon 110 carefully studied cases that had been operated upon by him.
A very interesting paper is that by Dr. Byres Moir on 4^hange8 in Circulation Leading to Breakdown in Middle Life. The cases which are reported to illustrate it are fully drawn and of great cliniciJ interest.
Mr. Dudley Wright reports, in the next paper, two cases, one of carcinoma of the pancreas with gastric complications, and the other of suppurative pancreatitis, in which both received, for a brief period, a certain degree of relief from extreme suffering by means of a surgical operation. They are undoubtedly interesting, but we cannot regard them as encouraging.
Dr. Goldsbrough's essay entitled Diagnostic Method in Disease of the Spinal Cord strikes us as one of the most instructive and usefal to the general practitioner in the volume. The method adopted is that worked out by
^t^'^SSr?'^ REVIEWS. 176
Baview, Mu^ 1, 18B6.
Sir William Gowers in his work on fiueaus of the yervous System^ and Dr. Goldsbrough applies it to the elucidation of an obscure case of spinal disease, taking the reader step by step in the unravelment of the varioas symptoms. It forms a most complete and valuable clinical lecture*
Dr. Boberson Day's report of The Department for Diseaui 4if Children is very full and equally interesting, and contains many therapeutic observations of value in the records of the cases he has presented.
The report on Thirty Cases of Diphtlisria with Special Reference to Treatment, by Dr. Henry Bodman, is very carefully done, and the conclusions have evidently been folly and impartially considered from the facts brought under his notice in the hospital wards. The inclusion of two cases that were moribund on admission in his therapeutic statistics' somewhat spoil his results, or,>j:ather, the accuracy of the lessons to be deduced from them. Moribund cases, however usdulfor pathological purposes, teach nothing therapeutically. In concluding his essay, Dr. Bodman writes: — <*The best treatment for diphtheria extant may therefore be summarised as follows: — (a) The administration of a homoeopathically selected remedy ; (6) the injection of a suitable quantity of antitoxin proportionate to the severity of the case ; (c) the local application of antiseptics to the ejected surfoce.
''There is no reason why homoeopathic and antitoxin treatment should not be applied together. The antitoxin treatment may be regarded as supplementary to the homoeo- pathic, for it probably supplies ready made that which we aim at producing in the body by the homoeopathic remedy. If this be so, it has the advantage of being independent of the capacity of the individual for reacting to a stimulus. Neither is there any reason why a belief in the efScacy of antitoxin treatment should lead us to abandon local treatment, for it is a useful measure, which may hasten recovery by removing the source of infection."
Dr. Edwin A. Neatby's contribution is a clear clinical demonstration of the conditions under which prolapsed, movable, or floating kidneys are met with ; the circumstances surrounding them, and the most approved methods designed for affording them relief.
This is followed by a clinical lecture by Dr. Goldsbrough on Chorea from a Therapeutic Standpoint, in which he gives a survey of the number and character of cases of chorea treated in the hospital during the last ten years, and of the treatment adopted* It will, we think, prove very useful in suggesting therapeutic ideas to the practitioner in his endeavours to
176 KEVIEWS. ,S^'SS^?!»JS!
Beirieir, March 1, 1896.
afford relief in cases of this often intractable and tedious disorder of the nervous system.
The concluding essay in this volume of the Hospital TteporUi is one on Syphilis. Congenital and Acquired^ by Dr. Boberson Day, who is in cfaskrge of the Children's Department, from which he has drawn the facts which have led to his conclusions. It is an instructive and useful contribution to^ the study of this, as Dr. Day truly describes it, *' poly-morphous
This volume fully mietiritains the high standard reached by its predecessors, and reflects the greatest credit upon the medical staff of our hospital, while it affords another demonstration of the value of the Institution as a source of instruction in therapeutics, medical and surgical, and in the study of disease^
British^ Colonial and Continental Homoeopathic Medical Directory^ 1898. Edited by. a Member of l&e British Homoeopathic Society and Dr. Albxamdsb Yjllerh^ of Dresden. London : Homoeopathic Publishing Company.
In spite of the feeling on the part of some of our colleagues that a homoeopathic directory is de trop, while a list of the members of the British Homoeopathic Society is printed in the Transactions of the Society, yet the support given to this Directory shows clearly that a large majority of our confr^es think otherwise. Owing to tfae withholding from l^e Directory of a considerable number of names, the list of homoeopathic practitioners in Great Britain cannot be perfect. Still, the little book is a valuaUe one for reference, and is as perfect as it can be under the circumstances. It contains besides a list of homoeopathic veterinary surgeons, of homoeopathic chemists, of all provincial towns in which are homoeopathic practitioners and chemists, of idl homoeopathic hospitals and dispensaries, with their officials and medical staff, of homoeo- pathic works published in 1897, and of homoeopathic journals. And last but not least in value in importance, a list of homoeopathic practitioners and chemists in all the British Colonies and on the Continent. We are often asked by patients going on the Continent for the names of homoe(^thic practitioners in the various towns they visit, and it is a great help to have this list, compiled chiefly by Dr. Villers, of Dresden, to refer to. We congratulate the editor on his careful and troublesome work so well done.
D. Dyce Broan-n, M.D.
2S5^r5S3bTw6? MEETINGS. 177
MEETINGS.
BBITISH HOMCEOPATHIC SOCIETY.
Thb fifth meetifig of the session was held at the London Homoeopathic Hospital, on Thursday, February 8rd, at a quarter to eight ; the President, Dr. Edwin A. Neatby, being in the chair.
The following specimens were shown : —
(1). Aneurism of the arch of the aorta (Dr. Byres Moir).
(2). Pericarditis and aneurism (Dr. Washington Epps).
(8.) Perforated appendix cmoi (Dr. Byres Moir).
(4.) Fibroid of ntems extruded from the cervix and removed by the ^craseur (Dr. Edwin A. Neatby).
Sbction of Gsmbral Mediodix AMD Patholoot.
Dr. Edwabd Blakb read a paper entitled, The Study of the hand for Indicatians of General Diuase,
The summary of this.valuable paper is too long to insert in our present issue, owing to exceptionid pressure on our space. It would be spoiled by abbreviation, and we hope to publish it next month.
Mr. F. A. Watuns next read a paper on the Honiaopathic Treatment of Pneumonia in Children under the Age of Five Years. The author said that pneumonia in children under the age of five was generally of the lobular type. He then described a case in a child, aged one year and eight months, lately a patient in the London Homoeopathic Hospital. With r^ard to diagnosis, he thought the greatest difficulty lay in distinguishing between the lobar and the lobular forms of pneumonia. He described both forms, and exhibited temperature charts of each variety. He mentioned bronchitis as a source of error in diagnosis. He next carefoUy detailed the points that enter into a case, and which affect the prognosis. He quoted statistics from allopathic sources which gave the mortality oi the disease in chUcben as varying from 40 to 60 per cent. In discussing treatment, he said that aconite should only be given in the early stages, that antimonium tart, was our sheet anchor, phosphorus was helpful when the lungs are drier and there is much consolidation, and that the iodide of arsenic was invaluable when the temperature had dropped, in order to promote resolution. He then presented a table of fourteen cases that he had observed whilst house- physician. The first eleven were cases of broncho-pneumonia, and all recovered. The last three were of the croupous form. No. 12 made a good recovery, No. 18 died on the eighth day, death being preceded by convulsions and a temperature of
Yol. 42, No. 3, X
•178 NOTABILU. IS^^^SI!^
Beylew, Mudi 1, 1886.
108.4"^. No. 14 was admitted moribund, and only lived five hoars.
The summary of the cases, presented in a tabular form, was most instructive, and will be published in full in the Journal of the Society.
Mr. Watlans stated that during the last five years 49 children under five years of age had been admitted with, broncho-pneumonia, and of these only six had died. Four of the fatal cases were admitted in a moribund condition, and two were complicated with croup. The mortality of broncho- pneumonia in the London Homoeopathic Hospital is therefore only 12 per cent.
A discussion followed, taken part in by Dr. Hughes, Dr. Newbeby, Dr. Mont, Dr. Blackley, Dr. H. Nankivell,. Dr. Stonham, Mr. Dudley Wbioht, Dr. Blake, Dr. Jones, Dr. MaoNish, Mr. Johnstone, Mr. Knox Shaw, Dr. Epps and the PBEsmENT.
NOTABILIA.
THE CONSULTATION QUESTION.
The appeal made by Mr. Jessop, of Leeds, to representative men of the profession to state whether the resolutions, agreed to nearly fifty years ago by the British Medical Association, not to meet in consultation medical men who practise homoeo- pathically, are still incumbent on those members of the pro- . fession who do not so practise, has not, during the past month, been anymore encouraging to some people than it was during January. Mr. Malcolm Morris, who is more distinctly, '•representative" than any one who has come forward to assist Mr. Jessop in his researches, expresses his views in the Practitioner in the following paragraph, on which we will make some comments.
'' Homceopathy and ' Allopaths.' ** Homoeopathy as a system is to my mind a delusion,, when it is not a deceit. Yet it is unquestionable that, in regard to therapeutics, we owe more to the homceopaihs than we are sometimes willing to admit. A consultation with a homoeopath can, as a rule, serve no useful purpose ; it is as if a Catholic priest and a Methodist minister were to be asked to confer as to the spiritual consolation to be administered to a dying sinner. But after all, as the judge reminded the overbearing counsel, that 'the court were at least vertebrate animals,* the homoeopaths may urge that they are members of the medical profession. This fact appears to be forgotten by some champions ofi
£gygS3Mg'' KOTABILIA. 179.
medical orthodoxy. At Batb, trouble has arisen in conse- quence of the exclusion of the homoeopathic practitioners from a conunittee of the medical profession of the town. And in a recent issue of the British Medical Journal^ the President of the Bradford and District Medtco-Ethical Society argues that members of that body are debarred from meeting homoeopaths in consultation under rules so-and-so» which he quotes. These rules are to the e£Feot that no member shall meet in consul- tation, other than a registered medical practitioner, or shall, consult professionally with any medical practitioner who conducts his practice otherwise than in an honourable and legitimate manner. Of course, if a homoeopath is unqualified, cadit quastio. But the assumption that a homoeopath cannot be considered as practising in an honourable and legitimate manner appears to me unwarrantable. Are pilules and honour incompatible ? And is a man to be held to practise illegitimately because his method of treatment is to the Greeks foolishness ? If so, there may be many within the straitest sect of orthodoxy who practise otherwise than in a legitimate manner. It is a curious coincidence that in the issue of the British Medical Journal containing the letter from the Bradford ' defender of the faith,' there is another from a well-known disciple of Hahnemann, who takes part in what may be called a public consultation on the treatment to be adopted in certain cases.
<'In the letter from the President of the Bradford and District Medico-Ethical Society to which reference has been made, < allopath ' is used throughout to denote the non- homoeopathic practitioner. I, for one, protest against this objectionable party nickname. It is an invention of the Hahnemannian sectaries, and it is surprising to see this question-begging term quietly accepted as a ' legitimate * designation by a representative of rational medicine. The scientific physician is neither a homoeopath nor an * allopath.' Like Moli^re, il prend son bien oii il le trouve, and, regarding not systems but facts, uses whatever method or instrument he thmks likely to serve his purpose."
The opening sentences of this paragraph strike us as para- doxical. ** Homoeopathy as a svstem is to my mind a delusion — ^when it is not a deceit." Then in the next sentence the readers of the Practitioner are assured : *' Yet it is unquestion- able that in regard to therapeutics, we owe more to the homoeopaths than we are sometimes willing to admit." Is it from a "delusion " or a '' deceit " that those who repudiate homoeopathy <* owe more than they are sometimes willing to admit " ? This reminds us of a statement made by Dr. Bur- ney Tec, when addressing his class at King's Oollege Hos-
N— 2
180 NOTABiLiA. ^s^^5.°^r?;si;
pital: <'I believe that the homoeopathists have, in many instances, called attention to the valne of drags which had been too much neglected." {Medical Times, May 17th, 1884). The observations which this elicited in the Hahnemannian Oration for 1884 are equally applicable to the sentences quoted from Mr. Morris's paragraph. Said the Orator on this occasion : ** This sentence is a distinct testimony to the truth of the principles taught by Hahnemann. It affords striking, albeit most unintentional evidence that there is doctrine in reference to therapeutics. Were it otherwise how could the homoeopathists have been able to call attention to the value of these drugs ? Beyond the method of Hahnemann, they had no means of ascertaining the therapeutic value of drugs which were not within the range of the knowledge possessed by the bulk of the profession. Homoeopathists have called attention to the value of drugs which had been too much neglected ; and they have been able to do so simply because they studied the physiological effects of these drugs — more Hahne- manni — and applied them in practice in the treatment of disease as the law of similars dictated.*' A system which has had such results as Dr. Bumey Yeo and Mr. Malcolm Morris have attributed to it, cannot have been a delusion, still less a deceit. On the other hand, it is perfectly possible — perhaps we should be justified in writing '* probable " — that Mr. Morris's conception of homoeopathy is '* a delusion."
*' A consultation with a homoeopath can, as a rule, serve no useful purpose " we are told. To this it is only necessary to reply that such consultations have been held to very useful purposes on many hundreds of occasions. Solvitur ambulando. But Mr. Morris says that ** it is as if a Catholic priest and a Methodist minister were to be asked to confer as to the spiritual consolation to be administered to a dying sinner." The comparison is an impossible one. The Catholic priest and the Protestant minister have a divine revelation to guide them, and upon the instructions given to them in it they place totally opposite interpretations. Medical men have no divine revelation to guide them; there is no orthodoxy in medicine. Experience is their only authority, and, as all must admit, experitntia falla^v. Hence the highest authorities in therapeutics are but fallible men, and very fallible they are, too, often enough. Still, when maJdng experience our guide, we find that the fullest recorded experience of the past 2000 years points with a uniformity that is so striking as to disarm doubt, that thie principle nmilia similibns curcntur is a true one, and that when medicines are prescribed in harmony with it disease is more likely to be promptly relieved and more completely cured, than when the relation between the drug
SSSSrSS^'SS' NOTABILIA. 181
B0fiew, Kneh 1, 16B6.
prescribed and the dieease to be oared is that expressed by the axiom, contraria eontrariU opponsndaf "the antipathio method," on the one hand, or *' the allopathic or heteropathic plan, the Riving of medicines which occasion phenomena altogether different or foreign (neither similar nor exactly oppoflite) to those of the disease/' on the other. Mr. Morris protests against the term ** allopath" to describe a non- homoeopathic practitioner as an objectionable party nickname. It is one for which we admit that we have no special liking. First, because it is more or less inaccurate ; the non-homoBopathic practitioner more generally depending for his remedies upon such as are antipathic in their relation to disease. And secondly because the non-homoeopathic practitioner scouts the veiy idea of there being "doctrine in therapeutics;" "a device of the enemy," the President of the Boyal College of Physicians termed it a few years ago. The same authority had assured the students of Ouy's Hospital, ten years previously, that he believed that " we know next to nothing of the action of medicines and other therapeutic agents.'' The homoeopathic practitioner on the contrary is fully assured that there is doctrine in therapeutics, that he is not obliged to depend upon chance for his knowledge of a drug, or when and how to use it in the treatment of disease, and therefore as the term « allopath " implies dependence upon a " principle," we think that those medical men to whom it is applied are not worthy of it — ^they repudiate all regard for any ttierapeutic principle, depending wholly upon empiricism, pure and simple, and that is undeserving of being described as a therapeutic " principle." A homoeopathic practitioner, on the contrary, prescribes medicine upon a well defined scientific basis whenever it is possible for him to do so ; the non-homoeopathic practitioner makes no attempt to do anything of the kind. II prend son hien ou it le trouve^ as Mr. Morris says, quoting Moli^re, and when he finds " wn him " in the writings of a homoeopath he is especially cautious to avoid noticing the source of his inspiration !
Another contribution towards the solution of Mr. Jessop's doubts appears in the Journal of the 6th ult. from Mr. Arthur Wiglesworth, of Liverpool, who, however, does not correspond to our ideal of one of " the leading representatives of the profession." Mr. W. claims, he says, '' some small right to speak on this subject because at a very early stage of my career much pressure was put upon me to induce me to become a homoeopathic practitioner^ I was introduced to a gentleman practising on Hahnemann principles, and I read much literature upon the subject." Then follows Mr. W.'s
182 >'OTABILIA. -Kl^SSSr^'
notion of what homoeopathy means. A notion which clearly shows that however much he may have read about it, he had digested very little. A- homoeopath, who practises as Jilr. W. says he ought to practice, cannot, he thinks, receive the right hand of professional good fellowship, or be met in consultation. '< But the matter is render^ «till worse by reason of the bastard homoeopathy which is practised at the present day." That is a homoeopathy which does not correspond with Mr. W.'s account of the genuine homoeopathy ! He says, however, that by bastard homoeopathy he means, <* a homoeopathy which is practised upon a supposititious idea of drug action upon a healthy subject, but which has never been put to practical proof." What sort of homoeopathy Mr. W. means by this we cannot imagine ! He then writes of men, who " practise with the principles of Hahnemann as adulterated with present day homoeopathy or allopathy according to the wishes or principles of their patients.*' This is bad enough, but we are told that worse remains behind. '* Allopathic drugs," he writes, '' are often prescribed as homoeopathic, when their action must be known to be purely the former." He then refers to a case of aortic aneurism for which two homoeopaths prescribed iodide of potassium in allopathic doses, and then enforces his illustration by saying that '* no amount of iodide of potassium will produce an aortic aneurism." This observation we do not think to be by any means original, and we can assure Mr. W. that we never heard of anyone who did suppose the iodide of potassium to have any such power. The only drug that has given any indications that it might prove useful in . aneurism is the chloride of barium, and in using it in a case of abdominal aneurism Dr. Flint of Scarborough '' obtained striking remedial effects almost amounting to a cure.". {Homceopathic Review, June, 1879, and Practitioner^ July, 1879^. Dr. Flint " accounts for its effects from the irritating influence on the arterial system whi(di baryta salts are found in experiments on animals to exert." (Hughes* Pharmacodynamics, p. 288). Dr. Howett, of Toronto, and the late Dr. Torry Anderson have since reported cases in which it was successfully used. The evidence that chloride of barium is homoeopathic to the aneurismal condition is slight, the clinical evidence of its utility is small. On the other hand, abdominal or thoracic aneurism is a necessarily fatal disease. Hence, the medical man who would use, if he could obtain, a clearly homoeopathically-indicated medicine in which he Tvaa justified by previous results in placing confidence, feels himself bound in such a case in falling back upon empiricism. Dr. G. W. Balfour's strongly
It^J^^Sir^^' NOTABILIA. 188
Bariew, March 1, 1899.
luged reoommendation of large doses of the iodide of potassium appeals at onee to any medical man having snch a case under his care.
The late Dr. Drysdale, when replying to Mr. Ellis Jones, who, at a meeting at the Liverpool Medical Institute in 1859, had said in effect, that homoeopaths were mere sectarians who were bound by certain dogmas, and by a restricted creed that confined them to a definite course that they were bound to follow, said : ^' Homoeopathists had no dogma or creed that must be believed in and followed independently of its proofs derived firom observation and experience alone. The homoao- pafehic theory was adopted by him and others as resting on these, and its exact place in medicine could be determined by experience alone — ^not only the past, but future experience — and homoeopathy not being held as a dogma, he admitted that that place might be modified by future experience. As an instance of the effect which future discoveries might have in determining the exact place to be held in medicine by the homoeopathic principle he noticed the "treatment of entozoa. Formerly the origin of these parasites was enveloped in profound obscurity, and it was not known whether they were in reality products of diseased action, and to be treated as diseases properly so-called, or mere foreign bodies which had obtained entrance into a person otherwise healthy or diseased. It was now known that they were not diseases properly so-called in any sense of the word, and, therefore, when it was necessary to expel them, it must be done in the same way as any other body by the means that are principally used for that purpose in common practice, though for any disorder accompanying their presence the specific medicine must still be used as before."
Mr. Wiglesworth's letter has been replied to in the Journal by Dr. J. H. Clarke, and a very excellent reply it is. The following is the text of it : —
Ck)N8ULTATI0N WTTH HoM(£OPATHS.
*♦ Sir, — In common with many others, I welcome the appearance in your columns of the letter signed ' An Open- minded General Practitioner,' as an indication that a better state of things in the domestic policy of the profession may be at hand.
** Your other correspondent (Dr. Wigles worth) has evidently taken some pains to understana what homoeopathy is, but I must ask your readers to go to Hahnemann's works rather than accept Dr. Wiglesworth as a competent interpreter of his doctrines. For I do not wonder that, with Dr. Wigles- worth's misapprehensions of them, he declined to become one of the body he imagines homoeopaths to be. But homoeopathy
184 NQTABILIA. ^a^SShif^
18 Qot whftt he paints it. For one thing, homiBopathy has na < speQifics for diseases/ It has a method, by meuis of which, a probable specific may be found for any given case of disease ; but the remedy in every case must be selected in accordance with the particular disease manifestations present. Gorrodv^ sublimate produces symptoms found in many cases of dysentery, and will cure cases, otherwise arising, in which these particular symptoms are prominent: bat ii will not cure all cases by any means, and it is therefore no ' specific for dysentery.' Bhus and bryony produce rheumatic symptoms, but neither the one nor the other is a specific for rheumatism. The pains produced by rhus are relieved by motion* and those produced by biyony are increased by motion, and each drug will only cure those cases in which the corresponding characteristics are met with. The great virtue of homoeopathy lies in this, that it supplies a methods by which the appropriateness of any remedy may be ascer- tained, beforehand in any case. This question of dose is a matter for experience to decide, and until the limits of the sensitiveness to drug influence of the human organism is ascertained, it is useless to dogmatise on this point.
** I should like to remind Dr. Wiglesworth that the practice of homceopathy is not quite as simple a matter as < falling off a log,' that there are many degrees of adeptship among those who accept the truth of the doctrine on which the rule of dmilia is based, and also that there are many degrees of similarity between drug effects and disease conditions, any of which may be utilised for therapeutic purposes.
'< With regard to the question of consultations between* allopaths and homoeopaths, I should like to suggest that the point be referred to the General Medical GovuiciL Shouldi the Council decide that it constitutes ' infieunous conduct in a professional respect,' that will practically settle the matter. On the other hand, supposing a registered practitioner of either school should be in need of professional help in any case, and shotdd be refused the same for doctrinal reasons,. I should like to know whether or not the Council would deem the conduct of the refuser to be * infamous.'
"I am, &c.,
" John H. Clabke.
" 80, aarges Street, Feb. 6th."
The British Medical Journal of the 19th ult. contains the following very interesting letter from a non-homoeopathic practitioner on the same subject : —
" Consultation ^ith Homceopaths.
*• Bir, — I vwture to think that the letter of your corre- spondei^t, 'An Open-minded General Practitioner,' fairly
S£S^525:W^ NOTABILIA. 185
BMri0w. Uuth 1, 1808.
expresses the views of many of the more enlightened members of the profession. That his letter should have appeared in your columns angors well for the fatore, and seems to herald an era of tolerance and even of goodwill towards men who are woridng honestly according to their convictions in therapea- tics. It is now too late in the day to characterise sneh prac< titioners as either ' fools or knaves.' They have graduated (some with distinction) in the regular schools^ and there are no grounds for the onchazitable assumption that they are actuated by other than honourable considerations.
« Looking at the situation from the standpoint of one conversant with the inner tBcia^ your correspondent suggests that the antagonism to homoeopathy, to say the least of it» is rather unseemly. The majority of those who stigmatise bomcBopathy as something akin to quackery, and its prac- titioners as 'irregular/ have extremely vague notions of the doctrine, and no experience of the practice which they denounce. Those who have carefully worked at the subject, as your correspondent has done, recognise the great acquisitions to our knowledge of therapeutics which have resulted from the labours of the homoeopathic school. The extent to which such knowledge has been utilised is set forth in the standard text books on treatment, but is clearly legible only to those who have studied homoeopathy. The real truth of the matter is that the so-called * irregular ' therapeutic method of one generation is placidly accepted as sound practice by the next. And so it is obvious that in the domain of therapeutics (the proverbial * backward boy ') there is no room for dogmatism. Let us, therefore, as members of a liberal profession, relegate penalties for heresy and schism to another tribunal, ' prove all things and hold fast that which is good.'
** I am, &o.,
" M.D."
This is followed by another letter, this time from a physician who practises homoeopathically in Manchester — Dr. Arnold, of Oxford Boad. We have only space for the concluding paragraph, which contains, as will be seen, some striking &cts as to the power of the infinitesimal dose.
''A man may be a consistent homoeopath without ever using or even believing in infinitesimals. At the same time the evidence in favour of the action of infinitesimals is practically overwhelming, and much of it has been provided by authorities whose orthodoxy Dr. Hime could not impugn. Darwin, for instance, in his work on InseeUvorom Plants describes the vigorous physiological reaction exhibited by the leaf glands of drosera rotundifolia to l-fiO,O0O,000th of i^
•186 . NOTABILIA. ^S^'Sj^f^'
Review, March 1,
grain of phosphate of ammonia. Naegeli's more recent experiments on the power of dilute solutions of metallic salts to inhibit the growth of certain vegetable organisms, such as spirogjrra, carry the proof of infinitesimal action far beyond Darwin's twenty- millionth of a grain, and should remind Dr. Hime that, in matters admitting of the experimental test, the ' cannot possibly believe ' attitude is foolish. It was adopted by certain very positive gentlemen who had a con- troversy with one Galileo, and its appearance in Dr. Hime's letter only shows how very thin is the scientific veneer on some of our latter-day scientists."
One incident arising out of this correspondence in the Journal is amusing. In the letter we reprinted from the Journal on p. 128 of our last number, the writer expresses the deep sense that he has of his obligations to Dr. Hughes* Manual of Therapeutics. Seeing this in the Journal^ the publishers naturally thought that the editor would desire that his readers generally should know where they might obtain the book, accordingly, they sent a carefully worded advertise- ment of it to the Journal ofiice. But no ; it was returned on the following day as being '< unsuitable to our columns '' !
A correspondent recommends a book in the pages of the Journal^ but the publisher of that book is not permitted to advertise it in the columns devoted to book announcem^ts 1
It reminds of a line in Tristram Shandy : — ^
" The world is ashamed of being virtuous. "
THE PHILLIPS MEMORIAL HOSPITAL, BROMLEY.
The ninth annual meeting of the above institute was held on the 17th ult., the President of the hospital, Mr. Walter Merton, occupying the chair. The report furnished the usual figures as to the number of patients and the state of the finances, all of which were encouraging. The most gratifying information of all placed before the subscribers related to the development of the rebuilding scheme. A most advan- tageous site had been acquired on a long lease, with option subsequently of purchase. By the end of last year the building fund had reached i62,794 as a jubilee commemoration, which added to previous amount raised by efforts of the conunittee, realised a total of £4,600.
It is estimated that this sum would not only, to a great extent, if not entirely, build and equip the new hospital, but it had already purchased the entire freehold and leasehold mterest in the present hospital, the future income from which would more than provide for all time the ground rent of £80 payable under the lease of the new site.
l£;;tSr2Sn!^' NOTABILIA. 187
THE PLYMOUTH HOliCEOPATHIC HOSPITAL. Th« Western Daily Mercury (Feb. 9th)b6^8 an account of a Sale of Work in aid of the above institution with the following words : —
'* Probably few benevolent insiittitions in the West of England have done as much good work in a more unostentatious and unobtrusive way as has the Homoeopathio Hospital and Dispensary at Plymouth ; eertainlv none have done so much pro bono publico with such little public recognition or support. Of more recent years in particular the medical staff and officials of the institution have considerably enlarged their sphere of usefulness, and have in many ways set commendable examples to kindred institutions ; yet the public generally have shown little inclination to recognise and help the workers. It was probably as much with a view to bringing more strongly before the inhabitants of the Three Towns the great usefulness and evident need of the institution, that the bazaar which is now being held in the Guildhall was conceived, as of -effecting the immediate purpose in hand — die clearing off of a deficit of something over £000. Necessary enlargements and alterations of premises, and a growing demand on the institution which has not been met by a corresponding increase in either subscriptions or donations, have been the cause of the present deficiency, which has been of steady growth, and which has taken several years to accumulate."
We quite agree that in some instances which we could name, if necessary, the managers of homoeopathic hospitals do not seek adequate publicity for their good work. Hospitals form the best method of spreading a knowledge of homoeopathy and of making its bene^ts available to the public. To bring them into prominent notice is an advertisement at once justifiable and necessary. We are glad indeed to see that an effort of this nature has been made by our friends at Plymouth. Homoeopathy at the Three Towns except in the matter of numbers, is exceptionally well represented in practitioners, and there can be no doubt that the good work the Plymouth Homoeopathic Hospital does will necessitate its still further enlaigement ; as it will surely create a demand for further practitioners familiar with homoeopathy, we hope it will also do a good deal toward supplying them. We are able to announce that the total amount of receipts from the sale is about £800.
THE LEAF HOMCEOPATHIC COTTAGE HOSPITAL,
EASTBOURNE. Tms little hospital has done good work for more than 10 years, and we are sorry to say that its funds are not in so good
188 NOTABILU. M^:SSST^.
a condition as may be desired. It seems only necessary to make the need known to have it supplied in sach an enlightened and wealthy a place as Eastbourne. Though we cannot address the Eastbourne public in our pages, we might perhaps suggest to the managers of the hospital that an '* advertisement " such as was so successful at Folkestone, might do good also at Eastbourne. At that town the nursing models proved very attractive, and would we hope be available for Eastbourne also.
The Leaf Cottage Hospital has eight beds and a cot ; 80- patients were admitted, of whom 50 were cured and 19 relieved,, the rest were unrelieved and under treatment.
THE HOMCEOPATHIC HOSPITAL, MELBOURNE.
We are glad to note the continuance and increase of the work done in connection with this hospitol. During the year ending June, 1897, the number of out-patients was 5,978— an increase of 1,868 ; the number of in-patients treated was 792, with a death-rate of 8.12 per cent. In the dental department the patients number 821 against 855 during the previous year.
Chloroform has been almost entirely superseded by ether.
The overdraft of £788 of the Maintenance Fund has been reduced to £125, and the overdraft on the Building Fund is also smaller than last year.
<'In 1876 the principle was adopted of receiving small payments from those in-patients who, although unable to fee a medical man, are able to pay a trifle per week. The amounts fixed are — for out-patients. Is. to 2s. 6d. per week ; for in-patients txom 5s. upwards, and, although a v^ large proportion receive gratuitous treatment, yet the principle has worked so well that its adoption has been a matter of satis- fihction to the management."
HUGHES' MANUAL OF THERAPEUTICS.
Aix readers of English homoeopathic literature will learn with pleasure of a new proof of the fact that Dr. Hughes' Manttal is still so well appreciated in other lands that a new translation of it — into Bussian — ^is to i^pear. The ** Society of Homoeopathic Physicians of St. Peterri)urg " have undertaken this interesting work, for which the author's consent has been obtained, and Dr. W. von Dittmann will be the translator.
IKSSrSSITiM? ' C0BRE8P0NDENCB. 189
W6iiiiderBtaDdtfaatDr.Haghe8*jV/anua2o/'P/i«rmaco(ji/namic«, forwhicdi he ia probably most widely known all the world over is already rendered into the language of the Czare.
BoA manuals have been tzanslatod into Frenob, and a Spanish version is said to be in existence. Ifaay ^ears ago the Manual of Pharmacodynamics began to appear in one of the German joomals, bat as far as we know has not been published separately.
Finally, we believe, Dr. Hoghes has been asked to allow the Manual of Therapeutics to appear in a Hindustani dress.
This remarkable popularity of scientific works, extending over so many years, speaks for their usefulness in a way no words of ours, even if called for, could do.
THE SUMMER POST-GBADUATE COURSE AT THE
LONDON HOMCEOPATHIC HOSPITAL. The Educational Committee, we are informed, have again made arrangements to supply material for clinical study under the direction of the staff of the Hospital in the main as last summer. The aim of the course is practical-ness, if such a word be permissible. It is not to present an encyclopaedic digest of any subject or course of subjects. It is to present to medical men the salient clinical features of a subject or a case, illustrated so fur as is possible in corpore vili ; to make common property of the views of the hospital staff — ^physicians, surgeons and specialists — on diagnosis, prognosis, treatment, etc. Speak- ing now as representing the practitioner, we believe the course cannot be made too practical even at the risk of repetition, and that information on and management of everyday cases will be more valued than learned disquisitions on the technicalities of the specialist. For those who wish a thorough special course in any branch arrangements will be made by the Hon. Secretary of the staff, Dr. Washington Epps. As far as we have been able to ascertain, clinical lectures will be given daily, except Saturdays. One hour will be devoted to a lecture demonstation and for a similar space of time a member of the out-patient staff will exhibit his cases. In a later issue we hope to be able to present more details.
PATHOGENETIC EFFECT OF SODIUM SALICYLATE. Db. Richabdson Rice, of Coventry, communicates a report of the following case to the British Medical Journal (Nov. 20), iUustrating the profound prostration which may arise from the use of sodium salicylate : —
" An old lady lately under my care, suffering from symptoms traceable to the uric acid diathesis, had intense inflammation and nocturnal pain in the tissues surroimding the first joint
190 C0BRE8P0NDENCE. ^gSSi'SSSf?^'
Beriew, Mtreh 1, 189S.
of the great toe and in the heel, with general oBdema of the right foot. These symptoms rapidly subsided under treatment with oolchicum and alkalis. Subsequently vague shifting pains of a rheumatic nature developed, and £ gave her 10 grain doses of sodium salicylate every four hours. This was followed after the third dose by symptoms of the most alarming prostration, mental and bodily. The pulse became weak and compressible, and fell to the remarkably small number of 85 beats a minute. Her temperature also became abnormal. On stopping the salicylate treatment the- symptoms rapidly disappeared, and the pulse became 80 per minute. These symptoms could not be attributed to the ac^on ' of the colchicum, as I kept her on it for several weeks with- complete relief to all the symptoms.*'
ANNUAL HOM(EOPATHIC CONGBESS. The Oongress will this year be held in London on Friday^ June 3rd. Full particulars will be published in due time.
CORRESPONDENCE,
HAHNEMANN'S TOMB. To the Editors of the ** Monthly Hoinceopathic BevieicS* Gentlemen. — As you have probably learned from the last two numbers of the lievue Homceopathique Franqaise^ the negotiations with the hitherto owners of Hahnemann's tomb in Paris have (thanks to Dr. Oartier) reached completion, and the ground, with its honoured contents, is legally at the disposal' of his disciples, who are represented in this matter by the Ck)mmittee appointed for the purpose at the International' Congress of 1896. What shall be done with our trust is a matter for deliberation; but, ere we can arrive at any^ judgment, it is necessary to know what funds we shall have at our command. The following letter has accordingly been drawn up, and has received the approval and signature of all' the members of the Committee : —
" To
'' Moved by a sentiment of respect for the memory of the founder of Homoeopathy, the International Congress of his disciples nieeting m London in 1896 formed a Committee having for its aim the raising to Hahnemann a tomb-stone worthy of him, that which now marks the place of his mortal remains being rude and poor.
*• The Society Homoeopattuque Fran9aise, working in union with the International Committee, has at last, after fifty-five years of oblivion and neglect, succeeded in obtaining a dee* signed by the heiress of Hahnemann, whereby sh« authorise*
iSSSfSl^iaer CORRESPONDENCE. > 191
it to xaise a funaral monument over his grave and to maintain this in perpetnity. We propose to erect such a monument by international sabBoriptiony feeling sure that all who value homoeopathy will acknowledge that there is no burial-place on- earth which more loudly calls for such a gouvenir than that wherein repose the ashes of our illustrious Master. To this his glorification we invite the homoeopathists of the whole world. Will you aid us in our task by employing, as regards- your own country, such means as seem to you most suitable for making our project known and collecting subscriptions towards it ? And may we consider you (or will you find us another who will so act) as a corresponding member of our Committee, with whom we may put ourselves in regular communication ?
'< The date of the inauguration of the monument is to be the occasion of the meeting of the International Homoeopathic Congress in Paris, in 1900. The time before us is therefore short, and we shall be grateful if you will take the matter in hand as soon as possible. You will kindly address your answer to this letter to one of the members of the Committee, preferably the President or the Secretary.
<*With the assurance of our high esteem, believe us to remam,
" Yours very faithfully, *' Lbon de Bbasol, M.D., President,
8, Nicolaievskaia, Petersburg, Bussia. *' FBAM90IS Oabtieb. M.D., Secretary,
18, Bue Vignon, Paris, France. << BicHABD Hughes, M.D.^
86, Silwood Boad, Brighton, England. '* BusBBOD James, M.D.,
Cor. 18th and Green Sts., Philadelphia, U.S.A.* " Ajlbxandbb vok VujLEBa, M.D., 7, Liittichaustrasse, Dresden, Germany." This letter, in its original French, or its foregoing (hoe) rendering into English, will be sent to some society or leading physician in every country not represented on the Committee. The members of the Gommittee will themselves undertake the work desiderated for their own respective countries ; and I think I cannot better initiate my share of the task tJian by sending the present letter to our British homoeopathic journals. I will therefore, gentlemen, beg your insertion of it, and any commendation to your readers you may feel disposed to award, it ; and remain
Yours very faithfully
BiCHABD HUQHBS.
Brighton, Feb, 1898.
192 CORRESPONDENTS. t'S^^.SS^S^m^.
NOTICES TO CORRESPONDENTS.
•^* We cannot undertake to return rejected manvtcrlptf. AuTHOBS and Contbibutobs receiving proofs are requested to correct
and return the same as early as possible to Dr. Edwix A. Neatbt.
London Hom(eopa.thio Hospital, Gbeat Obmokd Btrebt, BLOOMSBUBT.—HourB of attendance : Medical, In-patients. 9.S0 ; Out- patients, 2.0, daily; SURGICAL, Oat-patients, Mondays, Tneedays, Fridays and Saturdays, 2.0 ; Diseases of Women, Out-patients, Tuesflays, Wednesdays and Fridays, 2.0 ; Diseases of Skin, Thursdays, ^.0 ; Diseases of the Eye. Thursdays, 2.0 ; Diseases of the Throat and Ear, Wednesdays, 2.0 ; Diseases of Children, Mondays and Thnndays, ^ A.M. ; Operations, Tuesdays, 2.30 ; Dental Cases, Thursdays, 9 A.1C.
Communications have been received from Dr. Hughes (Brighton) ; Dr. Haywabd (Birkenhead) ; Dr. Hawkes (Liverpool) ; Dr. Gibbs Blake (Birmingham) ; Dr. J. R. Day (London).
BOOKS RECEIVED
BrttUhf Colonial and Continental HomoBopathic Jdedical Directory for 1898, Edited by a Member of the British Homoeopathic Society and Dr. Alexander Villers. London : Homceopathic Publishing Co., KC—Saw Palmetto {Sdbal serrtUatd) : it» HiHory, Botany^ Pharma^ (^ology, Therapeutic ApplicatioHM^ etc. By Edwin M. Hale, M.D. Phila- delphia : Boericke & TafeL 1898.— TA^ Tallerman Treatment, hy Superheated Dry Air, Edited by Arthur Shadwell, M.A., M.D., Ozon. London : Bi^llidre & Co. 1898. — Why Your Businat Does Xot Increase : British Trade v. Foreign Competition, By Lieut.-Col. K. M. Fobs, L8.C. London : ** Mercantile Guardian " office. l%98.-^Transactions of the American InHitute of Hoviowpathy. 1897. — Therapeutics of Plague, By Mahundra Lai Sircar, M.D., D.L., CLE. Calcutta. 1898.— rA^? London Homagopathtc Hospital Beports, 1897. — Journal of the British /lomoBopathic Society, January. Bale, Sons & Danielsson, Ltd.— 2%tf IIomaopHhio Journal of Surgery and Oyntecology. January. New- York and Chicairo. — The Cliemiet and Druggist. February. London. — The Calcutta Journal of Titdicine. January. — The Indian Homao- pathic Beriew. November and December, 1897. Calcutta. — 77/ c Tiorth Afnerican Journal of Homaopathy, January. NeW York. — The Jlovueopathie Eye, Ear, and Throat Journal. Februaiy. New York.— Tfie Medical Times, February. New York.— 7%^? Medical lOentury, January and February. — Tlie New England Medical Gazette. January and February. Boston. — The Hahnemannian Monthly. February. Philadelphia. — The Homoeopathic Beeorder, January. Philaddphia. — The Homoeopathic Envoy, February. Lancaster. — The Hahnemannian Advocate, December, 1897, and January. Chicago. — The Minneapolis Homoeopathic Magazine, January. — Tlie Pacific Coast Journal of Homoeopathy. January. Ran Francisco — The Medical Brief. Feb- ruary. St. Louis. — Betue Homeeopathique Franqaise, December, 1897, and January. Paris — Betue Homoeopathique Beige. December, 1897. Brussels. — Allgemeine Hom^opathische Zeitung. February. Stuttgart. — Leipziger Populdre Zeitschrift fur Hovidopathie. February. — La Homeopatia, November, 1897. Bogota. — Birista Omivpatira. ^o▼em- ber and December, 1897. Borne. — Homesopathische Maandblad, Feb- ruary. The Hague.
Papera, Di^penaary Beporta, and Booka for Review to be aent to Dr. Pops, 19, watergmte, Grantham, Liacolnflhire ; Dr. D. Dtce Browx, », Sermour Street, Part- man Square, W.; or to Dr. Edwix A. Nbatbt, 178, Haverstook BBll, N.W. AdTOitiw- SoOT«S 8toBet*EC*"°"'^^***'*°* to be ewit to He«re. E, Ooulo * 8ov, M
S^r^SlvSw.*'' MEDICO-ETHICAL SOCIETY. 19$
THE MONTHLY
HOMOEOPATHIC REVIEW.
THE BRADFORD MEDICO-ETHICAL SOCIETY.
Medico-ethical societies have existed, as a part of the volantary organisation of the profession of medicine, for now some 50 years. The ostensible motive with which they were originally formed was excellent. It was intended that they should, by rules mutually agreed upon by the members constituting them, strengthen medical men in their duty, in so acting one towards another in the exercise of their profession, as they would desire that each should act towards the other* This, we say, was the ostensible motive of their formation. The actual object sought after by their rules was to compel the sacrifice of the right, aye, and more than the right, the duty of private judgment, on the part of all members to the rules which the majority might find it to their interests to agree to.
One of the earliest of these medico-ethical societies was that of Manchester. Conspicuous among its rules was one obliging its members to refuse to meet in con- sultation or render any professional assistance to a. medical man who was known to treat diseases homoeopathically. Very early in the history of this society the late Mr. Robekton, a surgeon of considerable
Vol 42, No. 4, 0
194 MEDICO-ETHICAL SOCIETY. ^SSiJ, ^SS^JflW?
reputation, not merely in his immediate neighbourhood, but throughout the profession, was requested by the late Dr. Edwald Phillips to meet him in consultation at the bedside of a patient — a near relative of Mr. Boberton's. Preferring to exercise his right of private judgment rather than submit to the yoke the Society sought to impose upon him, he went to Bowdon and met him. No sooner did the fact of his having done so become known in Manchester than this Society called him to account. The result of his arraignment we have forgotten, but our impression is that he resigned his membership. One of the members gravely informed him that to meet a homoeopath in consultation *' under any circumstances whatever" was, in a pro- fessional sense, to commit the '' unpardonable sin."
A similar rule, we believe, still obtains in all medico- ethical societies. For several years obedience to it was urged by the medical press. As we pointed out in our number for February, the Lancet in 1872 found it better policy to try and reduce to a viinimmii the differences which binder professional intercourse between the members of a liberal profession, and not to raise up barriers that the public could neither understand nor sympathise with. This has been the trend of feeling in the profession for many years past, and, as a consequence, consultations between homoeopathic and non-homoeo- pathic physicians and surgeons have become increasingly frequent, and the refusals of the latter to respond to the requests of the former, for a consultation, have been proportionally rare.
Mr. Jessop, of Leeds, as we stated in February, evived the question involved, in a letter to the British Medical Journal^ which we reported at page 68. Why he should have done so is an interesting question^ especially as we have been informed, on excellent authority, that he has met, in consultation, a medical man practising in Leeds, whose name appears in the Homtropathic Medical Directory J and also a gentleman who, having been house surgeon at the London Homoeopathic Hospital, acted as the locum tenens of the medical man in question. However, he did raise the question, and illustrated the necessity for ascertaiuing the attitude of the profession towards homoeopathy, at the present time, by stating that he had been credibly informed that a London con-
SSSSff^rSw?* MEDICO-ETHICAL SOCIETY, 195
saltant bearing a \7ell-kn0wn name, an equally well- known Manchester consultant, and an eminent Bradford practitioner had been acting in consultation with one, who for many years had represented homoeopathy in a large manufacturing town in Yorkshire. There was nothing very surprising in all this ; but the enquiry led to the publication, in the British Medical Journal, of some interesting letters, which, we hope, have revealed to Mr. Jessop that there are still some members of the profession of medi- cine who have such a sense of their duties as members of a liberal profession, that they can, and do, rise above regarding' these duties as being consistent with the ''private policy of a corporation or the little arts of a craft," and, in their endeavour to save life, ^* search for remedies from every source and from every hand, however mean and contemptible " such source and such hand may have been represented to them to be.
The Bradford Medico-Ethical Society, however, appa- rently regarding what they are pleased to conceive to be '' the dignity and interests of the Faculty " as something infinitely more important than *' the duties of a liberal profession whose object is the life and health of the human species," have, through their President, the Medical Officer of Health for the borough — and, therefore, we presume, a physician not engaged in the practice of medicine — a gentleman whose name is favourably known to students of Preventive Medicine, placed on record, in the pages of the British Medical Journal (January 22nd), an excerpt from these rules regarding consultation. These read as follows : —
81. No Member shall meet in consultation other than a regular r^^tered practitioner.
82. No Member of this Society shall meet in professional ^nsultatio^ an^ medical practitioner who conducts bis practice otherwise than in an honourable and legitimate manner.
88. No Member of this Society shall knowingly meet in professional consultation any consultant resident within a radius of fifteen miles who shall meet in consultation any sach irregular practitioner.
Commenting on the foregoing, Dr. Himb writes : —
** An honourable man could hardly belong to a society ^hieh has adopted the above rules, as understood by us, and
0-2
196 MEDICO-ETHICAL SOCIETY. ^i^^^Sij aSSK^ISJ?
Review. Apxil 1, 1S06.
at the same time meet homoeopaths in consultation. If it were supposed that there was any loophole for suoh a thing, I have not the least doubt the rules would be altered to specially prevent it."
Why could not an honourable man belong to a society having these rules, and, at the same time, meet homoeopaths in consultation ? There is no reference to homoeopathy in them, nothing in either which describes medical men who, in treating sick people, select their drug agencies on a homoeopathic basis. Bemarking on these rules, Mr. Malcolm Morbis writes : '' The assump- tion that a homoeopath cannot be considered as practising ' in an honourable and legitimate manner,' appears to me unwarrantable. Are pilules and honour incom- patible ? And is a man to be held to practise illegitimately because his method of treatment is, to the Greeks, foolishness ? If so, there may be many within the straitest sect of orthodoxy who practise * otherwise than in a legitimate manner.' " — The Practitioner, Feb., p. 122.
Since the foregoing paragi'aph was in type. Dr. Hime has stated, in the Journal of the 26th ult., that bis Medico-Ethical Society has altered this rule by adding words to it ** whereby homoeopaths are specifically stated the persons with whom members of the society might not hold consultation. One solitary hand was ** he writes '^ held up in favour of an amendment, authorising consultations with any registered practitioner. Even the seconder of this amendment did not vote for it."
The third rule is a curiosity. A member is by it pro- hibited from meeting in consultation " any consultant residing within a radius of fifteen miles, who shall meet in consultation any such irregular practitioner." This rule would absolve the '^ London consultant, bearing a well- known name, and the equally well-known Manchester consultant " from the penalty of daring to do their duty in spite of the orders of the Bradford Medico-Ethical Society, while it exposes the " eminent Bradford prac- titioner " to all the vials of their wrath which the Society can pour out upon him. Leeds, moreover, is only 9 or 10 miles distant from Bradford. What will the Society say to " the distinguished surgeon in our neighbouring city of Leeds " ? He is within the fifteen miles limit,, and we have seen that he, too, has been credibly reported-
WSiST/SS*" MEDICO-ETHICAL SOCIETY, 197
to have met in consultation two medical men, who may be presamed to rely upon homoeopathy to direct them in selecting their drug remedies, for one of them has his name in the Homoeopathic Medical Directory ^ while the other is a member of the British Homoeopathic Society.
The ''eminent Bradford practitioner" is, however, well within the Society's '^ sphere of influence/' and he appears to have been promptly '' brought to heel/' as we learn from a letter from the secretaries published in the British Medical Journal of the 12th ult. Having quoted from the letter of, as they describe him, ''the distinguished Burgeon in our neighbouring city of Leeds," and that of '* Dr. HiMB, the President of this Society," the secre- taries proceed to say that they have —
''Ascertained from Mr. Jessop the particulars of the xsonsoltation between an * eminent Bradford practitioner ' and a homoeopath referred to bj him. We have the greatest possible satisfaction," they continue, '< in being able to inform jou that the gentleman in question has written in answer to our enquiries, and states that he met the homoeopath in consultation inadvertently not knowing that he was such.
"We trust/' they conclude, "you will give the fullest possible publicity to this explanation. The statement as to want of orthodoxy among the profession here in reference to homoeopaths, made by so eminent a man as Mr. Jessop, has i^oen regarded here as a serious reproach by the profession, and "ve have lost no time in dealing with it, and request you at the earliest moment to publish this letter. — We are, &c.,
John Dunlop, L. 8. Mackenzie, Joint Secretaries Bradford and District
Medico-Ethical Society."
Have the secretariea quoted the whole of the letter that afforded them so much satisfaction? Did the ^riter of it express no opinion on the broad question at issue? Two reasons present themselves as suggesting that he would have availed himself of so excellent an opportunity of doing so. Firsts because it is impossible, ^ter all that has appeared in the Journal and Pravti- tioner^ on the subject that it is one which can remain Without further discussion; and Secondly, because the ^tor stated his views fully and clearly upon it, when he ^ote in 1877 to Dr. Wyld as follows :—
'* I have idways felt tiiat there was not sufficient reason why ine two schools of medicine, who could not help agreeing
198 MEDICO-ETHICAL SOCIETY. ^^^J.^^STift^W^
with each other on the fandamental facts of chemistry, anatomy, physiology and pathology, should refuse to meet at the bedside of the sick because they were not agreed as to treatment. I know, of course, that it is said diat the two modes of treatment are incompatible — that the one must counteract the other — that we cannot serve God and mammon, &c. It is just because I do not agree with this opinion, and because I think that a careful investigation of nature indicates the common ground upon which both modes of treatment stand, that I am now writing you this letter."
Had he, as he would have been more than justified in doing, admitted that he had met a homoeopath in con- sultation, and denied that he had ofifended against the 82nd rule of the Society, inasmuch as he had no reason to suppose that the gentleman he had met conducted his practice otherwise than in " an honourable and legiti- mate manner," the further discussion, which we believe to be inevitable, would have had a good sound basis upon which to proceed.
To have the courage of one's opinion, and to exercise one's right of private judgment, are privileges infinitely more precious than any that can by any possibility attach to the membership of a Society — aye! even of the Bradford Medico-Ethical Society. Especially has it become so since the meeting on the 16th ult., the result of which Dr. Hime communicated to the Joimial of the 26th ult. We would urge upon any member who is conscious of his duty to his profession and Society —
Fortem posce animum. While to all, who, let the consequences be what they may, scorn to allow " I dare not to wait upon I would,'' we recall the frequently realised prospect held out to them by Vikgil —
Foi^san ethac olim menwiisse juvahit.
ON LYMPHADENIA.*
By J. Galley Blackleg, M.B. Lond. Senior Physician London Homoeopathic Hospital.
Under the generic title "lymphadenia," it has been found possible to gather together a number of highly interesting diseases, in all of which ancemia is an early
• The third of a series of post-firradnate lectnres **Oii the patholonr and therapenttOB of the blood." *'
iKssJrssra^ on lymphadenia, 199
and prominent symptom ; diseases whose affinities and matoal relations have been, until recently, very imper- fectly understood. As early as 1845 Virchow, in describing Uukamia (weisses Blut), was fully aware of the connection between the leucocytosis and the hyper- trophy of certain of the hsematopoietic organs (spleen, lymphatic glands, &c.), but it has been reserved for modem pathologists to follow up this clue and thoroughly unravel the mystery of the connection existing between Buch apparently unlike diseases as lymphadenomsi (Hodgkin's disease), leucsBmia, splenic anaemia, and the ansemia of infants. In all of these it is found that the initial and essential lesion consists either in hyper- trophy of already existing lymphoid tissue, or at times in a genuine new growth of such tissue.
By lyniphctdenia, then, is understood, not a nosological entity but a pathological state characterised by anaemia, by hypertrophy of certain of the haematopoietic organs (spleen, red bone-marrow, lymphatic glands and lymp- hoid tissue generally), and, sooner or later ^ by augmen- tation of the leucocytes in the blood.
It is important to remember that the last-named and most striking symptom of the lymphadenic process, the leucaemia or leucocythaemia, has no independent existence, but is invariably accompanied by a neoformation of lymphoid tissue ; in other words, there can be no leucaemia without lymphadenia, although lymphadenia may be unaccompanied by leucaemia in all but the latest stages of the process. Leucaemia is^ in fact, only an episode, and all lymphadenias, whether complicated by leucaemia or not, form part of the same pathological entity.
In a large majority of cases the lymphadenic process commences either in the spleen or the lymphatic glands,. but it may be situated in the bone marrow, in the tonsils,. in the intestines, in the testicles, or even in the skin. When lymphadenia has for its initial seat an organ already provided with lymphoid tissue, there occurs simple hyperplasia of this, and microscopic examination of a hypertrophied gland, for instance, shows in the early stages a finely reticulated tissue with multitudes of small uni-nuclear leucocytes in its meshes ; in the later stages this reticulum loses its delicacy, becomes more dense, and the leucocytes become larger and fewer :
200 ON LYMPHADENIA. "S^'^SST^TSS?
Review, April 1, 1696.
if, however, lymphoid tissue is not normally present, small leucocytes with a single nucleus are first deposited, and then a fibrous stroma.
The best known examples of the lymphadenic process, although by no means common, are yet sufficiently fre- quently met with to enable most students to have the opportunity of seeing them once or twice in hospital practice. Named in order of frequency, they are Hodgkin's disease or " lymphadenoma," leucaemia or leucocythsemia, splenic anaemia, and the idiopathic anaemia of infants.
I. Hodgkin's Disease (An;emu lymphatica).
This interesting disease, named after Hodgkin, who first described it in 1832, and subsequently included in nosological tables, under the title '^ lymphadenoma," has been been latterly more aptly designated ''anaemia lymphatica," and will be found under this title in the latest edition of the '* Nomenclature of Diseases."
Of its etiology, little that is reliable is definitely known. It has evidently a marked preference for the male sex, and for ages ranging from 30 to 60. Trousseau enume- rates as exciting causes, chronic coryza, lachrymal tumour, otorrhoea and superficial lesions of skin and mucous membranes.
The pathological anatomy of the disease is very much what our account of the lymphadenic process would have led us to expect. When glands are excised and examined microEcopically in the early or soft stage they are found to consist of masses of small round cells, imbedded in a delicate fibrous stroma. In the latest, or hard stage, this stroma is seen to have increased in quantity and density, and the contained cells (leucocytes) have proportionately diminished, and have become largely multinuclear. In 75 per cent, of cases the spleen is enlarged, and this likewise is primarily soft. Where the bone-marrow is aiTected the changes are the same as those to be described presently under the head of leucaBmia. The tonsils are frequently hypertrophied, and lymphomatous nodules are found along the whole of the gastro-intestinal mucous membrane. Examination of the blood in large numbers of cases tends to show that, with the exception of a moderate amount of anaemia, absence of abnormalities is the rule. The number of
^jSSTfSSS" ON LYMPHADENIA. 201
leucocytes may be permanently increased, but not very much, and most of these are small and possess a single nucleus. In a few cases a true leacaemia has, in time^ been seen to develop, and this fact, in addition to others to be referred to later, have led German writers to speak of this disease as ''pseudo-leucaemia/' or, more strictly speaking, the " aleucsBmic ' Yorstadium' *' of leucsemia.
Symptoms. — The most striking, by far, is the enlarge- ment of the lymphatic glands, which are usually involved in the following order : —
(a.) Cervical glands.
j^. (Axillary „ '^ I Inguinal „
(c] Internal ,, After this comes the enlargement of the spleen, which can usually be felt below the hypoohondrium as soon as the superficial glands are visibly enlarged. Other external appearances are pallor or sallow hue of skin with pigmented patches, and ecchymoses or petechial haemorrhages in places ; nodular eminences on the skin, varying from the size of a hemp seed upwards, are also often found. The skin is generally dry, but occasionally the very opposite obtains, and drenching perspirations are frequent. Epistaxis, hsematemesis and melsena are also frequently met with; the bowels are usually tonstipated, but where this is not so the patient is troubled with diarrhoea.
Subjective symptoms are fairly numerous, and com- prise languor, palpitations, loss of appetite, digestive disturbances of various kinds, dyspnoea, ringing in the «ars, vertigo, headache and visual disturbances. Tem- perature is usually somewhat raised above the normal, but presents, in addition, alternations distinctly sugges- tive of the remittent type of temperature curve.
The most frequent complications are dyspnoea and stridor, paralysis from pressure on the recurrent laryngeal nerve, "gastric crises," jaundice and the advent of amyloid degeneration of internal viscera.
The usual duration of the disease is from one to two years.
The differential diagnosis is fairly easy ; from scrofu- lous or malignant glandular enlargements it is readily distinguished (a) by the fact that the subjacent glands are never attached to the skin and (6) by its spreading
202
ON LYMPHADENIA.
HontUy HomoeopAthie Review, April 1, 1698.
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to other and frequently distant glands. A semi- malignant form of lymphoma (lymphosarcoma) is characteiised by the presence of abundant uninuclear leucocytes (lymphocytes) in the blood, whereas in true sarcoma where the leucocytes are increased they are of the large multinuclear variety.
In the matter of treatment not much that is very encouraging can yet be said ; arsenic is the only drug that has given in allopathic hands even a semblance of uniformly beneficial results, and this only as the result of enormous doses and at the expense of setting up symptoms of neuritis, &c. The drug is certainly not homoeopathic to the lymphadenic condition, and the true simillimum for this last has yet to be found. The annexed tabular record of three cases recently treated in the wards of the London Homoeopathic Hospital, the first two of the aleucsemic type and the third of the mildly leucsemic variety, shows the results of the treatment, whether by arsenic or bone-marrow, to be equally unsatis- factory.
2. Leucjemia.
As pernicious anaemia is distinguished from severe Bymptomatic anaemias not only by the extent of the ansemia, but also by its permanent and progressive character, so in like manner we distinguish leucaemia from mere leucocytosis, firstly by its persistency, and secondly by its extent ; whereas, in extensive leucocy- tosis the number of leucocytes seldom or never rises above 50,000 or 60,000 per cubic millimetre, in genuine leucaemia it never falls below 70,000, and may rise until the number, in extreme cases, even equals that of the red corpuscles. Amongst the predispoiim/ causes of leucaemia may be enumerated repeated attacks of malarial fever, anaemia lymphatica, diseased tonsils with subsequent hypertrophy of the cervical glands, and lastly ablation of a hypertrophied spleen, which, contrary to one's natural expectation has been known to convert a simple leucocytosis into a persistent and grave leucaemia.
Pathological Anatomy.
The commonest types of leucaemic lymphadenia are
the myelogenous, the splenic, and the glandular, in all
of which the blood-forming organs are found infiltrated
with leucocytes. In the other and rarer t}7)es there is
-204 ON LYMPHADENIA. \^?.?j;.^^?r??;2l?
R^Tiew, April 1, isee.
either hyperplasia of lymphadenoid tissue generally, causing hypertrophy of tonsils, solitary follicles, Peyer's glands, thymus, or subcutaneous lymphoid tissue, or there is an actual new growth of lymphoid tissue causing true heterologous nodules to be deposited in the liver and kidneys. The most important changes, however, are found in the great blood- making organs. In the bone-marrow the fat cells disappear, their place being chiefly taken by the colourless marrow cells which have multiplied enormously and, to a less extent, by large nucleated red corpuscles. The spleen is enlarged, sometimes to an enormous extent, and on microscopic examination this is found to be chiefly due to proliferation of the lymphoid cells. Besides these there are found numbers of large white cells frequently enclosing ordinary red or nucleated red corpuscles.
The changes of the blood in leucaemia are chiefly seen in the increase of white corpuscles, but besides this we find the specific gravity lowered, ranging from 1,086 to 1,049 ; the alkalescence and coaguala- bility are both diminished, and the clot is found to be buffed and cupped. The red corpuscles may be normal in appearance, but marked poikilocytosis is occasionally seen ; where nucleated red cells are found they are generally of the normo-blastic type ; blood plaques are numerous. The changes in the white cells are many and striking; the numbers usually range between 100,000 and 1,000,000, but cases have been recorded where the white cells have actually exceeded the red corpuscles in number; the oxyphile (eosino- phile) cells are much increased in proportion to the rest, a^nd the natural amoeboid movements of the white cells are seen to be very sluggish. The predominance of large or small leucocytes has led to a rough classi- fication of leucaemic cases into lympamia (found in lymphatic cases) and spletuemia (in splenic cases,)"^ but in splenic and myelogenous cases, it is found that the leucocytes belong to the variety known as myelocytes, t and not to the ordinary large leucocyte with a poly- morphous nucleus found in all mere leucocytoses.
* " KleinzeUige '' and "groeszellige Leukaemia " of German writem
t After double staining, these appear as large spherical ceUs nearly
filled by large pale-stained nuclei immersed in neutrophilic protoplasm.
ISH^SSTfS^" ON LYMPHADENIA, 205
The symptoimtohgy of leucaemia comprises that of all profound ansemias with the addition of others due to the presence of the enlarged spleen and to a less extent of enlarged liver and lymphatic glands, though the last never occasion so much suffering as in Hodgkin's disease. The feeling of fulness due to the presence of the enlarged spleen is usually the first symptom to attract the atten- tion of the leucfiemic patient, and this usually increases until the distension and pain are a source of great discomfort to the patient. In extreme cases the enlarge* ment in an upward direction may seriously interfere also with the action of the stomach, heart or lungs. The most striking circulatory symptom is haemorrhage, which occurs in a large proportion of cases, most frequently from the nose and less frequently from the bowels, stomach, lungs or uterus ; into the skin, brain, joints, cellular tissue or peritoneum. The haemorrhagic tendency is so great that slight injuries may give rise to serious loss of blood ; the extraction of a tooth, or the puncture for paracentesis, has thus led to death ; whilst most cases in which excision of the spleen has been attempted have been fatal from the same cause.
What has been said with regard to treatment of the lymphatic form of anaemia is equally true of leucaemia ; no true simillimum for this or other lymphadenic conditions has yet been discovered.
8. — Splenic An^bmu.
This condition may fairly be looked upon as the a-leucaemic variety of splenic lymphadenia; the most striking symptom is the anaemia, which is very de- cided, the red cells ranging in number from 2,700,000 to 800,000 per cb. m.m. The haemoglobin is low in individual corpuscles, the corpuscular richness being often as low as 0.5, but the shape of the red corpuscles is preserved, and deformities are rare. The leucocytes oscillate in number between 30,000 and 60,000 per cb. m.m., but the number in individual cases is subject to great fluctuations; in purely anaemic cases the leucocytes are mostly of the large variety, consisting of a single large nucleus surrounded by hyaline protoplasm.
206 ON LYMPHADENIA. ^^^i.^^fSS!
4. — Anjemia Infantum Pseudo-lbuc^mia.
Von Jaksch was the first to recognise the existence of this affection, apart from the numerons symptomatic anaemias incidental to infancy, sach as those of rickets, of syphilis, of malarial poisoning, &c., &c., and the title adopted for it by him sufficiently indicates its position as a member of the lymphadenic family. According to VoN Jaksch the affection includes the following elements : —
1. Grave anaemia, the red cells frequently falling below 1,000,000.
2. Extensive leucocytosis.
8. Great variations in the size, form and staining powers of the white cells. 4. Deformed, degenerated and nucleated red cells.
The symptoms, in addition to those of anaemia, include marked swelling of the spleen, and, in a less degree, of the liver and lymphatic glands. The blood conditions in one of Von Jaksch's cases were as follows : —
Bed corpuscles = 820,000 White „ = 54,000
Haemoglobin = diminished.
The leucocytosis is marked and lasting, and the propor- tion of white to red corpuscles may rise to 1 — 20, 1 — 17, or even 1 — 12. Stained films show: — (a) Diminution of blood plaques ; (b) degeneration of red corpuscles (polychromatophilia), with irregularities of size and shape; [c) normo^blaats in considerable number; (({) many oxyphile and multinaclear leucocytes.
The (Ufff rental diagnosis is fairly easy if regard be had to the following four points : —
1. Bed corpuscles decreased.
2. Leucocytes polymorphous,
3. Liver not enlarged in proportion to the spleen.
4. Haemorrhagic symptoms are rare.
Prognosis is hopeful, recovery being common ; but how far the recovery of recorded cases has been due to treatment rather than to a natural tendency to a favour- able issue is fairly open to question.
R^SSSf AjSvSS!*'' DERMOID CYST OP THE OVARY. 207
TWO CASES OF DERMOID CYST OP THE OVARY.
I. Rapid Growth of an Ovarian Dermoid ten yeara after the Menopause, with disappearance of a pre-existing Fibroid. Ovariotomy: Recovery.
By G. M. Cabfbae, M.D., and George Burfohd, M.B.
II. Ovarian Dermoid Cyst, removed by Ovariotomy, followed by Tachycardia and Acute Insomnia: Re- covery.
By H. Wynne Thomas, M.R.C.S., and George BURFORD, M.B.
Fibroid Tumour of the Uterus icith HteniorrluKje, both disappearing after the induction of the Menopause, Dermoid Cyst of Ovary ^ with growth ten years after the Menopause. Ovariotomy : Recovery.
Clinical History: By Dr. Carfrae.
The patient was a single lady set. 62. She had been under my care at various periods for 20 years ; and at her first consultation she complained mainly of recurring head- aches, constipation, and menorrhagia.
Examination revealed a uterine tumour which I believed to be a fibroid ; it was sessile, about the size of a large orange, but not spherical, and attached to the posterior wall of the uterus. The symptoms continued of much the same character until 60, when the menopause came on. A definite improvement in general health now set in; the headaches disappeared, and the htemorrhage entirely ceased, and did not recur.
Early in 1696 the patient came to me complaining of bladder irritation, during the day only ; and of general nervous symptoms. Cantharis and terebinth brought relief to the vesical distress.
In September of the same year she spoke of acute pain in the abdomen, with a sense of fulness, and troublesome flatulence, for which I gave salol. She disliked examina- tion exceedingly, and as the distension seemed more or less due to flatulence, I did not insist on it.
In May and June of 1897 she again complained of distension, and the former headaches had returned. I
208 DERMOID CYST OF THE OVARY. ^R^^'^^fJ^?^
Review, April 1, 1898.
now made a local examination, and found the characteristic signs of an abdominal tumour, the growth was dull on percussion over its anterior surface, and was easily defined by palpation. Per vaginam^ the lower segment could be distinctly felt, though quite unattached to the uterus. The fibroid of former date, however, had completely disappeared. I diagnosed an ovarian unilocular cystic growth.
Shortly afterward I advised its removal, but as this was impracticable at the time, the operation was deferred until January of the present year.
Ovariotomy : By Dr. Burford.
On January 23rd, 1898, I performed ovariotomy on this lady, removing a fair-sized dermoid cyst, the size of a large cocoa-nut and containing fiuid fat, hair, bony plates, and an incisor tooth embedded in the cyst wall. The uterus was normal, and no growth remained. Although exceedingly neiTOUs about the operation, she bore the stress remarkably well, and was not even troubled by post-operative sickness. The pulse and temperature remained about normal, and the convalescence was unbroken, save for a certain amount of distress due to intestinal inertia, as the recovery proceeded. She was an exceedingly active woman, and her dietary had been largely of meat; and the change to a simple dietary and prolonged quiescence affected not the earlier but the later stage of the recovery.
Once this difficulty had been surmounted, she gained rapidly in health and strength, and returned to her friends with a practically new lease of existence.
Remarks. It was comparatively late in life ere this ovarian growth began to give trouble. During the menstrual epoch, the uterine fibroid with its associated menorrhagia were paramount : as the menopause came on the hflemorrhage entirely ceased, and the fibroid disappeared. Ten years after the menopause the dermoid had reached sufficient dimensions to cause distress. Not only for the relief of the symptoms, but for the protection of the patient against malignant development, we regard the operation as of signal service to her.
iSSSS^^iT^^ DERMOID CYST OP THE OVARY. 20^
Be*i«w, April 1. 1806.
Dermoid Cyst of the Ovary ^ removed by Ovariotomy: Prolonrfed Tachycardia followed by acute Insomnia and Cerebral Irritability : Recovery.
By H. Wynne Thomas, M.B.C.S. and George
BUEFORD, M.B.
The previous clinical history of this patient is brief. She was a single woman of 38, of fair health up till five years previously, when an acute attack of influenza seized her. Thereafter the period, previously lasting some four or five days, became scanty, lasting less than one day. She complained of pain in the right flank, and local examination showed the presence of a fair sized cyst, probably ovarian in origin, and lying in front of the uterus, which organ was closely applied to the posterior wall of the cyst.
She was received into the private ward of the Phillips Memorial Hospital at Bromley for operation, which was undertaken by Dr. Burford, Dr Madden ansBsthetizing, and Dr. Wynne Thomas assisting.
Ovariotomy : By Dr. Burford.
On February 12th, 1897, 1 performed ovariotomy on this patient, removing a large dermoid cyst of the ovary,, with the usual contents of hair, fat, and irregular bony plates. The fatty matter was cheesy in character, and would not flow through the trocar ; the cyst was therefore removed practically entire.
The same evening the pulse was 104 per minute, and the temperature 100^. But that the pain in abdomen was acute, the general condition was very satisfactory. Arnica was administered every two hours in hot water.
On the second day the retching and vomiting being troublesome, ipecac, was given. This effectually met the symptom, no sickness occurring after. The patient had a quiet night, but very little sleep. Temperature 101^; pulse 182.
The third day, as frequent faintness was complained of, digitaline was administered in ^ grain doses every tln*ee hours. Merc, dulcis Ix to open the bowels. During the night the faintness repeatedly recurred, and the sleep was in snat-ches of a few minutes ; very restless. Temperature 101^ ; pulse 124 per minute.
On the fourth day, the frequent faintness persisting, china was administered, at first alternately with and next
Vol. 42, No. 4. p
210 DERMOID CYST OF THE OVARY. *SSrtew. A^TifiSa?
in place of the digitaline. . The bowels were freely opened Milk, with lime water, was frequently given. Temp. 101^. Pulse 120.
On the fifth day the faintness continued ; the tem- perature was 98 ; the pulse ran up to 160. Brandy and Valentine's meat juice were given in addition to the milk ; the china was continued, and a few doses of mere. corr. interpolated, to check some rectal tenesmus.
During the night the pulse ran up to 170, and then hecame uncountable ; the temperature remained at 98^. Arsenicum was given at frequent intervals. Sleep in periods of a few minutes, with restlessness when awake.
The sixth day, the highest temperature was 101, and the most frequent pulse 164 per minute. Champagne was now administered, in addition to the milk and brandy. Arsenicum was continued. The bowels were still very troublesome, the motions being slight and sometimes offensive. During the night strophanthus was substituted for arsenicum, the total sleep amounting to 85 minutes.
Not until the fourteenth day did the pulse finally drop below 140 per minute, the temperature ranging from 98^ to 101^* Insomnia now became a serious difficulty ; although for some time the sleep had been broken and scanty, as the pulse regained tone the nights became more restless. The patient would become drowsy for half-an-hour, then suddenly awaken with a violent fit of restlessness, and endeavour to get out of bed. A variety of hypnotics was given, each without effect ; and after aconite, gelseminum, hyoscyamus inter alia had been fruitlessly administered, belladonna in the third centesi- mal dilution, as prescribed by Dr. Thomas, was effective. Ultimately, about a month after operation, the full <3apacity for naturc^l sleep returned.
The convalescence now proceeded apace, and the patient returned home, some seven weeks after the operation, in rapidly improving health. She has made continuous progress since then, and at the date of writing is proposing to begin bicycling.
Remarks. — The leading features during the convales- cence were tachycardia and insomnia, with intestinal irritability in the earlier stages. The heart trouble was severe and prolonged; and on its cessation Insomnia, with mental irritability, took up the running. Through-
S^^M'S^riS?/' STRANGULATED HERNIA. 211
out there were no aigns or symptomB of peritoneal involvement ; the local conditions were beyond suspicion. The complete restoration of the patient to vigorous health is the clearest proof of the functional character of these profound perturbations.
The snperrision of this most trying convalescence was Ably carried out by Dr. Wynne Thomas, whose judgment and resource were so repeatedly tested. Dr. M^den, as consultant, freely gave his valuable advice and assist- ance from day to day. And the nursing arrangements, skilfully controlled by the matron, Miss Hyde, con- tributed in no small degree to the ultimate satisfactory issue.
STRANGULATED UMBILICAL HERNIA : EXTEN- SIVE SLOUGHING OF COVERINGS, PROBABLY DUE TO ABUSE OF ICE-BAG : RECOVERY.
By John D, Hayward, M.D. Lond.,
Sorgeon Hahnemann Hospital, Liverpool.
It is probably the experience of every surgeon that occasionally, after an operation in which everything has been favourable both locally and constitutionally, the issue will be mysteriously unfortunate ; whereas, on the other handy in some cases a favourable result will occur, where such was not to be expected. It has seemed to me that such surprises are especially frequent and startling after abdominal operations, and particularly in those for strangulated hernia.
I have known death to occur after an uncomplicated operation for hernia, in which, neither at the operation nor at the post-mortem, could any local or constitutional cause therefor be discovered. As illustrations of the opposite class, I especially recall two cases. In one, which was that of a strangulated femoral hernia in a middle-aged woman, the loop of bowel was black in colour and grooved where it had been nipped ; as it was still shiny it w|ts returned, and an exceptionably rapid recovery resulted. The other case was that of an old man with a broken-down constitution and a strangulated inguinal hernia ; the bowel, although obviously damaged, was returned and, before the close of the operation, considerable quantities of liquid faeces came from th^
p— 2
212 STRANGULATED HERNIA. ''l^.^^JS??^!^
wound. It was considered less hopeless to leave things alone than to open the abdomen in order to look for the leaking bowel. Fsecal discharge came from the wound for a few days; but otherwise recovery was complete and uneventful.
I consider a recent case of recovery under similarly unfavourable circumstances worthy of a brief note, if only pour encourager les autres, especially as the compli- cation was probably induced by an item in the pre* operative treatment.
Mrs. B., aged 55, has had an umbilical hernia for the past 12 years. The patient is a florid, healthy woman ; she is extremely stout, indeed an ordinary roller towel will not meet round her for use as a binder.
The hernia first appeared after lifting some heavy articles, during which the patient says she felt something " give and crack.*' The protrusion never went back after its first appearance, but varied in size ; it was never smaller than a couple of fist^. She wore a hernial belt, with a large pad, to support the swelling and prevent further protrusion.
This rupture gave but little pain or trouble until two- months ago ; occasionally it would become larger, harder and somewhat painful, but a short period spent lying on her back, with gentle manipulation, would relieve this condition.
Early in October the tumour suddenly became very tense and painful ; but her doctor was able to relieve her by taxis, and she was kept to bed for three days.
On the evening of Friday, November 26th, 1897, she had taken a heavy tea and had been laughing immode- rately, after which she felt the rupture had become large and painful. Dr. Mahony (who attends her, and by whose kindness I became interested in the case) was sent for, and attempted reduction by taxis in vain. Vomiting soon set in and, from this evening on, no faeces or flatus was passed. Other attempts at manipulation were fruit- less ; and although the patient's general condition kept good the vomiting was so persistent that on the morning of the 28th operation was hinted at, but not viewed with favour by the patient or her relations. Dr. Mahony at this time mentioned the case to me, and, operation being refused, I suggested an ice-bag. I note this, in order to assume responsibility, because I am of opinion that my
ji^^^A^Ti^ STRANGULATED HERNIA. 218
not having fixed a period for the use of this appliance, led to a prolonged appUcation, which was responsible for a serioas complication later on. Vomiting became very frequent, and in the forenoon of the 80th it had become fsecal in appearance and odour. I was asked to visit the patient for the purpose of operation on the evening of this, the fifth day. The condition was evidently one of <;omplete strangulation ; there was a quantity of brown, offensive, faecal, vomited matter on view, and evidently no further time to lose. The patient's mental and general condition were remarkably good ; the tongue was brown and very dry, and it and the lips were covered with black sordes ; the pulse was good, but breathing was rather rapid and the breath offensive.
Dr. Mahony administered chloroform, which was excellently taken ; and, under adverse circumstances in surroundings, by the light of a candle, I performed herniotomy. A large umbilical hernia was present, about the size of the head of a child of eight years old. The skin over it was cold, was extremely congested and dusky, with two or three purplish patches. I then learned that the ice-bag, which had just been removed, had been employed continuously for 30 hours !
The operation was uneventful, the skin covering the sac was thin; on opening the sac large masses of omentum presented ; behind and surrounded by this was found a knuckle of dusky, but shiny, small intestine. This bowel was tightly nipped, and its return into the abdomen, with the gratifying *' slip and gurgle " did not occur until the umbilical orifice had been nicked with the hernia knife and some little force exerted. Some omentum was returned, but the bulk thereof was unre- tumable. I should have liked to have removed it all, but was afraid to prolong the operation, which so far had only taken a few minutes. However I transfixed, ligatured with catgut, and removed a piece the size of a goose's egg, which it had been necessary to handle in order to get at the loop of bowel ; the remainder was left in the sac to which it was adherent. No vessel required ligature; the wound was sewn up and drained, an attempt having been made to operate and dress asepti- cally.
The patient rapidly recovered from the chloroform, and in about 20 minutes from the commencement of
'214 STRANGULATED HERNIA. ^'^JiSj^STJ^Si!
Review, April 1. 1808.
proceedings she was chatting cheerfully. She had two large motions in the course of the night, and passed flatus and urine freely. She did not vomit after the attack, a half-hour or so previous to the operation.
Nothing but warm water was permitted by the mouth for the first 24 hours, after that Wyeth's beef juice and barley water were used for a couple of days.
All went well until the fourth day when the tempera- ture rose to 101, and it was evident that some of the skin and omentum were sloughing. Two stitches were re- moved, and on the next day the others were cut, leaving the wound completely open. A flap of black gangrenous skin at the upper end of the incision, the size of a crown piece, was snipped off with scissors, as was a considerable piece of gangrenous and foetid omentum. In the course of the next week, the whole mass of omentum, external to the umbilical ring, came away in softofiensive sloughs, which freely leaked oil. Charcoal poultices, iodoform, izal, corrosive and boracic compresses were used, and small pieces of gangrenous skin snipped off occasionally.
Despite the horrible state of affairs locally, the general condition improved daily. The bowels were opened once or twice each 24 hours, she took food freely, had no pain or discomfort whatever, was cheerful and slept all night, except when waked for the dressings. But for anxiety as to extension of the gangrene to omentum in the abdominal cavity, or as to leakage of discharge or diseased matter into the peritoneum, there was nothing to cause concern. Why this latter did not occur it is difficult to see, for the enlarged umbilical opening was at the bottom of this diseased mass. Active interference was avoided, for fear of actually precipitating such an occurrence. The tongue cleaned and became moist, and the temperature did not rise again above 100, while it was generally normal. She was troubled with a good deal of cough which had been present before the operation, but, strangely, this caused no trouble at the hernial orifice. By I)ec. 14, all the contents of the external sac had come away and the cavity had granu- lated up in another fortnight. Nature, therefore, has performed a radical cure, there being now no protrusion ; and, although she is to wear the pad for a month or two, the inflammation at the neck of the sac has so
nS^^xST'S^ STRANGULATED HEBKIA. 216
Beview, April 1, 18B6.
firmly closed it, that in time this may be safely dispensed with.
In a fair experience of operative hernia cases I have never previously known the sac with its contents and coverings to slough. In this case I believe that the low vitality of the distended skin covering the hernia and of the fat flabby omentum was injuriously affected by the prolonged use of the ice-bag. Theoretically, the ice-bag should often prove of use in facilitating reduction by taxis, what its practical value is found to be I am unable to say. Recently a gentleman of 85 called on me, com- plaining of foBtid vomiting having suddenly come on. I found a small inguinal hernia, of which he was unaware ; it was tense and had no cough impulse. I directed him to go home and to bed, to put an ice-bag on the lump, and I would visit him in an hour or two. At my visit the hernia was readily reduced, with relief to the symp- toms. This is the only case I recall where taxis seemed to be rendered successful by the ice-bag. In the Ught of my case reported above, I should be loth to use the cold application for more than an hour, or at most two.
I am indebted to Dr. Mahony for permission to report the case, as also for the following note : —
** As responsible for the internal medical treatment of this patient, I have only to add that she was, at the time of the operation, under the action of sepia ; and that she received, during the time of our combined attendance, mere, sol, thuja and nat. carb., each in a high potency, and as called for by the variation of the symptoms."
A CASE OF APPENDICITIS TREATED MEDICALLY WITHOUT RECURRENCE.
By J. RoBERsoN Day, M.D., Lond.
Physician in charge of ihe Department for Diseases of Children, at the London Homoeopathic Hospital.
It is the relapsing cases of appendicitis about which we most frequently hear, when they eventually find their way to the surgeon, having very often survived repeated attacks of the disease. Much less frequently do we hear of those cases where there has been but a single attack. There are some surgeons who maintain that relapses are the rule, and that sooner or later an operation will
216 APPENDICITIS. "SjiSi.^rrKSS:
Beview, April 1» 1898.
be required to effect a cure. We do not know the pro- portion which. exists between the primary.and the relap- sing: cases, and statistics on this point are greatly needed.
The following notes were taken at the time of the illness of Master T. K., age 16, who had a very severe primary attack of appendicitis. He made a perfect recovery, and has continued well ever since.
On March 14th, 1896, 1 was asked to see T. B., aged 16. The previous day he had taken his meals in a hurry, so as to ride his bicycle. I found him in bed, with a temperature of 101.4°, and pain in the hypogas- trium, but no tenderness. Appetite nil. Later in the day the temperature rose to 108.8^. He had no vomit- ing or diarrhoea. I gave baptisia Ix every three hours.
The same evening he had rigors, with profuse perspi- rations.
Early the next morning (March 15th) I saw him. He had slept very little, been very restless, and was in severe pain. He had vomited just before I arrived, and again while I was there— green, bile-stained vomit. His bowels also acted three times, small, brown-formed motions. Tongue moist. Urine painful on passing. Had slight rigc^rs at times.
The decubitus was characteristic, patient lying on his back with the legs drawn up ; the abdomen was tender and tympanic, but not distended. There was some special tenderness over the ilio-caecal region, and also over the left hypochondrium. The pulse was 102, full, soft, compressible.
. Later in the day. Dr. Moir and Mr. Enox Shaw kindly met me in consultation. There had been no vomiting since I left in the morning, but the abdominal tender- ness continued, especially over the caecum and at McBurney's point. The temperature was 104^. Bespi- rations were frequent and shallow. The medicine was changed to aeon. Ix and bry. 8x alternate hours ; and locally veratrum viride tepid compresses to the abdomen, 5j to aq. 5vj.
Diet : Non-particulate, e.g.^ clear beef tea, Valentine's meat juice, peptonised milk, the juice of oranges to allay thirst ; to be fed every two hours.
At 7 p.m. he was freer from pain and pulse was good.
On March 16th he was freer from pain, had slept a little, and his pulse, 88, was soft and compressible. He
1£S5^j5Sr!^' APPENDICITIS. 217
Refiew, April 1,
vomited twice in the night and once while I was there — a green vomit with mucus, but not offensive. The abdo- men could be examined with less pain. The bowels had acted three times in the night slightly. The same treatment was continued, but the diet was restricted to Valentine's juice, clear beef tea, veal or chicken broth, no milk or Benger's food.
He had a good deal of flatulence, and in the afternoon there was much urging to stool, chiefly flatus and a little mucus passing. The pulse was steady at 70, and temp. 100.6^. At 9.80 p.m. there was less tenesmus, and there had been no further action of the bowels. When at rest the abdominal pain was absent ; but on palpation the csecal region was still tender. Medicine changed to bell. Ix and mere. cor. 8x alternate 2 hrs.
On March 17th he was better. Had slept over 8 hours. Temp. 100.4^ this morning, and no vomiting or tenesmus. In the afternoon he vomited twice, the first time with a little blood. He was very restless during the day, so T gave ignat. Ix in alternation with the bell. Ix, and locally ordered belladonna and glycerine. Percussion showed distinct dulness in the right iliac region, and the pain was localised at this spot. In the evening he was much quieter, with a compressible pulse of 62 and a temp, of 99.4^; there was no return of vomiting.
March 18th. Had passed a good night, with 9^ hours sleep. Had no pain, except from flatulence occasionally. Temp, normal. Pulse 70, good.
March 19th. Passed a quiet night, and slept 4 hours 40 minutes ; three small motions, partly formed, passed with flatus. He has no real pain now or tenderness ; and the dulness in the right iliac fossa has diminished, and temperature is normal. Pulse good, 68.
March 20th. Passed a very good night, and slept nearly 6 hours. There was now a distinct fulness to be felt in the right iliac region, which when pressed was slightly tender, but it caused no actual pain. It con- tinued slightly dull.
March 21st. Progress maintained, passed a very good night. Appetite returning. Ordered raw meat sand- wiches and peptonised milk.
March 28rd. Declared himself " perfectly well."
Q1Q 'DWTVTt'C Monthly Homoeopathic
^•^^ '^^ ^ ^'^ *^ =>• Bftview, April 1, 18W.
March 27th. Made steady progress, and took solids Buch as chicken and fish. His temperature continued subnormal for some days. Sulph. 3 gr, i. three times a day was now given.
On March 80th he sat up for the first time ; he never had any more pain or tenderness, and convalesced steadily, leaving for Eastbourne on April 29th.
A few days ago (February, 1898), he walked into my consulting room, as fine a specimen of the (/e7iu8 homo as one could wish to see, over 6 feet in height and well proportioned. He has never had any return of his symptoms since.
REVIEWS,
Tlie Homtfiopnthic Journal of Surgei-y and Gt/nfFcologii, Medical Century Co., Chicago and New York. January. Vol. I., No. 1. This is the first number of a new homoeopathic journal devoted to surgery and gynaBcology, chiefly to the former, and we welcome the new comer, and wish it all success. As a frontispiece, there is an excellent portrait of our distinguished confrere^ Dr. Tod Helmutb, of New York, and in the body of the journal a very interesting sketch of bis life.
The issue of a new journal in America of this size and importance is a furtber indication of tbe go-abeadness of homceopatby under tbe guidance of ourfriends across tbe water.
The TaUerman Treatment by Superheated Dnj Air in Eheumatisin, Gout, Bheiimatic Arthritis, Stiff and Painful Jointa, Sprains, Sciatica and other A flections. Edited by Arthur Shad- well, M.A., M.B. Oxon., M.R.C.P. London: Bailliere, Tindall & Cox, 1898. The value of such a method as this, as indeed of any therapeutic method or course, can only be established or refuteid by experience. It has not fallen to our lot to see any cases which have derived benefit from it, but this is probably due to tbe extremely limited experience we have bad with the " dry hot-air bath." The testimony of this volume is certainly considerable and weighty, not tbe least part of which is found in tbe following lengthy quotation from the preface by Dr. Sbadwell. He writes : '* ^Vben requested to supervise the preparation of tbe volume I readily consented for three reasons. In tbe first place experience has convinced me of the value of tbe treatment ; in tbe second, I think it ought to be very much better known than it is ; and in the third I have no personal interest whatever. I originally
l£SSS'.SSn5£'' REVIEWS. 219
BflTiew, April 1» 189P.
approached Mr. Tallerman's inyention with the scepticism which becomes second nature to a medical man» but having tested it on my own corpus vile, I found that it did what it pretended to do, and then I saw a boy with a knee-joint full of fluid and wincing at every movement, gradually charmed off, within half an hour, into a smiling and painless indifference, which permitted the free handling and flexion of the limb without a murmur. Since then, I have repeatedly seen results produced in old and hopeless cases of rheumatic arthritis which I could not have believed on any lesser evidence than my own eyesight. The facts related in this volume amply corroborate my experience, and make it unnecessary for me to say anything more on that head. Attested as they are by many independent observers of high standing in the profession, they form a body of evidence which no one can affect to ignore or despise. They do not come from one or from a few clinujues, but from a large number of first-rate hospitals, not only in this country, but in Paris, the United States, and Canada. It is impossible to deny the weight of so large a mass of concurrent testimony."
Again, on page 4, Dr. Enowsley Sibley, of the North-West London Hospital, writes of the effects of the dry heat that *' locally (1) the heat produces dilatation of all the cutaneous vessels and free circulation through the parts ; it is impossible to say how deeply into the tissues this extends, but from the results it may be judged to be some distance, and at the same time there is a marked stimulation of the nutrition of the cutaneous nerves ; (2) there is free perspiration of an acid sweat ; and (8) relief from pain, however produced, is almost at once apparent, (ienerally (1) there is profuse perspiration and dilatation of vessels ; (2) increase of the rate of the pulse and force of the heart's action ; (8) increase (slight) of the respiratory movements ; and (4) an increase of the body temperature, often of two or three degrees Fahrenheit."
The records of the cases are well worth perusal, and the more so that they are not always records of success. Time may show in what class of cases good results are most likely to be obtained.
A small institute has been established where cases of a suitable nature are treated free of expense when the patients are quite unable to pay. We should be glad to know if there is any via media between charitable relief, such as this, and the very high fees at one time demanded (and as far as we know still charged) at the Welbeck Street Institute. If the benefits of the treatment are as represented, it is wrong that they should be restricted to the prince and the pauper.
220 MEETINGS. -^^"^i.^^rSSS
MEETINGS.
BRITISH HOMCEOPATHIC SOCIETY.
The fifth meeting of the session was held at the London Homoeopathic Hospital, on Thursday, February 8rd, at a quarter to eight ; the President, Dr. Edwin A. Neatby, being in the chair.
Section of General Medicine and Pathology.
Dr. Edwabd Blake read a paper entitled, The Study of ike Hand for Indicatums of General Disease.
Dr. Blake having shown what a large amount of informa- tion cDuld be gleaned concerning character, health, occupation, habit and method of life generally from a careful study of the hand, went on to describe the significance of colour in its bearing on disease.
He then spoke of the changes in skin-texture, especially as relating to the nails, showing the significance of white markings, longitudinal striation and of lateral furrowing. The first usually traumatic, the second a mere result of thinning, a process which occurs normally after middle life and abnor- mally after neuritis of various kinds ; cross-furrowing being a sign of metabolic arrest, seen after many serious illnesses.
Original observations were detailed as to the rate of nail- growth at differing ages, the average in man being 125 days. The growth of the nail sometimes forms a valuable element in diagnosis, diseases of the lower neuron being usually associated with arrest of ungual development. Hysterical imitation of degenerative disorders of grey matter, on the other hand, do not affect the nail-growth.
The coma of diabetes may be distinguished from the coma of ursBmia,* if there be a rash present on the forearm, in the following way : Purple macuUe indicating uraBmia, whilst a raised rash, yellowish-brown in colour, points to xanthoma- diabeticorum.
Brown spots on the wrist, occurring in the course of osteo- arthritis, lentigo rheumatica, first described by Dr. Blake in The British Journal of Hom^opathtj in 1881, was four years later re-discovered by Dr. Kent Spender, of Bath. It was incorrectly called by him '< xanthoma." The termination « oma " should of course be reserved for something in the nature of a tumour.
Dr. Blake then spoke of the geographical distribution of eruptions on the hand, showing that eczema elects the line of skin fringing the lunule, whilst psoriasis prefers the free border of the nail, thus forming a curious exception to the
jssssr^srss^* meetings. 221
dinical rule that whilst eczema loves the aspect of flexion, psoriasis prefers the aspect of extension*
It is often said that palmar psoriasis is always syphilitic* The word ** always " is not admissible in matters pathological. Psoriasis of the palm is sometimes arsenical* occasionally traumatic, and frequently due to trade irritation.
Mr. Jonathan Hutchinson has adduced such strong evidence that epithelial cancer may follow the internal use of arsenic, even after a long interval, that when we can estabUsh in a given case that it certainly is not arsenical, then a very patient and protracted triid of the higher dilutions of this drug should be made before resorting to surgical measures.
Syphilis, when found in its primary form on the hand, generally attacks the skin at Uie side of the nail. The chancre has no elective site, it only occurs there because a hang nail or a border cut usually exist in that locality, thus forming the needed chink in the armour for the penetration of the protozoal arrow.
Dr. Blake afterwards described the various diseases which are associated with some change in the form of the finger* tip, which is acuminated in osteo-arthritis and in acromegaly.
In acrom^aly the nail is narrow and over-lapped by exuberant skin, whilst in Marie's disease — pulmonary hyper* trophic osteo-arthropathy — the nail is broad and spreading and the finger tips clubbed. This state of things is not confined to Potts' disease of the spine ; it occurs also in congenital mitral disease, in traumatic neuritis, in tubercular phthisis, in some forms of broncborrhoea, and in hepatic abscess, when the pus escapes by way of the air passages.
Dr. Blake suggested that the finger clubbing might be due to veno-lymphatic stasis, showing most at the points of least resistance.
He then drew attention to the curious resemblance between the small ribbed nails and the stunted fingers as an acquired condition in acromegaly and the normal stall of the anterior hand of the larger anthropoid apes.
(Edma of one hand, if actUe, points to peripheral neuritis, either catarrhal, toxic or traumatic in origin ; if chronic , then vessels obstructed by adenomatous or other axillary tumour should be hunted for.
If both hands swell, then albumenuria, due to primary renal changes, or arising from diphtheria or saturnism, would be thought of.
Morning deadness of one hand is not necessarily cardiac. A common cause is pressure on a nerve-trunk during sleep, especially in a gouty person. If the symptom persist, digitalis
222 MEETINGS. "^"^:.%r;sS'
Review, AprU 1, 1886.
cures the greater number of cases. If it fail, ignatia, apis, and aconite may be thought of.
If neuritis, with sudden deadness of one hand, occur in an otherwise healthy woman, especially if amenorrhoea appear without pregnancy, alcoholism should be suspected.
Deadness of the little finger is common to leprosy and to general paralysis of the insane.
In the discussion following the reading of the paper. Dr. Dudgeon, Dr. H. Na2«kivbi.l, Dr. Blackley, Dr. Bybes Moib, Mr. Enox Shaw, Dr. Stonham, and the President took part.
Mr. F. A. Watkins next read a paper on the Hotn^opathw Treatment of Pneumonia in Children tinder tJie Aije of Five Years y a summary of which appeared in our last issue.
The Sixth Meeting of the Session was held at the London Homoeopathic Hospital on Tuesday, March Srd, the President, Dr. Edwin A. Neatby, in the chair.
Dr. Dewey, Dr. Eugene Porter and Dr. Pemberton Dudley were elected corresponding members of the Society.
Section op Surgery and Gynjeoolooy.
Dr. Gash Beed (Plymouth) read a paper entitled <' Clinical notes on Endometritis, chiefly the senile form," the paper was illustrated by a lantern demonstration of microscopic slides.
The first case he described was that of a lady aged 68, with a bulky, soft, easily bleeding uterus, the sound passing 3^ inches ; there was also profuse, offensive leucorrhoea. The uterus was dilated, and the endometrium curretted, and pure carbolic acid applied to the surface. The patient made a good recovery. Micro-photographic slides were exhibited of the case, and the opinion of Mr. Johnstone given that if the condition was not actually malignant, there was a malignant tendency.
The second was a lady, aged 86, suffering from metrorrhagia, due to endometritis in a virginal uterus*
A discussion followed, taken part in by Dr. Burford, Dr. Madden, and Dr. Neatby.
Mr. Gerard Smith then gave a practical demonstration of **The molecular physics of the X ray phenomena." The demonstration was liberally illustrated with most interesting experiments, especially with regard to fluorescence under the X rays, and at the close a vote of thanks was given to Mr. Gerard Smith.
fiES?wl^^ri?rJS^"' NOTABILIA, 228
NOTABILIA.
THE CONSULTATION QUESTION. The correspondence on the above subject in the British Medical Journal, which we noticed last month, has been continued. It has, however, drifted rather towards a dis- cussion on some features of the practice of homoeopathy than been directed towards the consideration of consultations between homceopathic and non-homoeopathic practitioners. This, indeed, was noticeable during February, when the Journal published a letter from Dr. Arnold, of Manchester, containing admitted facts illustrating the power of infinitesi- mal particles of matter to influence living organisms. A portion of this letter we printed at p. 185 of our last number. In the Journal of the 5th ult. Dr. Brazil, of Bolton, published a reply to Dr. Arnold, in which he says that he has been particularly struck with " the number of medical men who are coquetting with homoeopathy," That is to say, Dr. Brazil is surprised with the number of medical men who are enquiring into the meaning of the subject and as to the results which have accrued from treating £sease homoeopathically. He is astonished that in the domain of therapeutics there should "not be room for dogmatism," and that any one should advance such a proposal as to '* relegate penalties for heresy and schism to another tribunal," and at the same time urge members of a liberal profession to <' prove all things " (in- cluding homoeopathy among them) *< and hold fast that which is good." Dr. Brazil must, however, remember, as Mr. Jessop remarked, that this is "a world of change," and that we live in tunes when dogmatism regarding facts in nature must give way to experiment and yield, as Tyndall has said, to a " patient industry and a humble, conscientious acceptance of what nature reveals." But he adds as primary conditions of such an enquiry ** an honest receptivity, and a willingness to abandon all pre-conceived notions, however cherished, if they be found to contradict the truth."
Dr. Brazil, in directing his attention to Dr. Arnold's letter, says that he ** contends that Darwin's success in stimulating the leaf glands of drosera rotundifolia with ^^^^j^jJ-^-^^j^ grain of ammonium phosphate is an argument^ in favour of infinitesimal doses. A few days ago I measured one of these little glands, it was xT?bW inch in length by n^Vojy inch in diameter. If we assume that it weighs ^^^^^ of a grain then, (it is probably not one-tenth of that — the larger estimate will suffice for my purpose) and we prescribe for a man weigh- ing 150 lbs. in proportion we should have to give 50 grains, a decidedly allopathic dose.
224 NOTABILIA. "^^A^if^l^r
" But the fact is that medical science is but little concerned either to attack homoeopathy or to defend allopathy. We are not allopaths or any other paths ; we are practitioners of the science and art of medicine. Causes of diseases are so variousy and their pathology so different that the problems involved in their treatment are far too complicated to obtain a solution in any such bold general formulaB. Attempts to relegate treatment to any such so-called systems are not rival solutions of a scientific problem, but, as Dr. Pye Smith has aptly remarked, ignorant answers to an absurd question. Just as there is no one cause of disease so there can be no one system for its cure. The true principles proceed on other and far different lines, and he is the most enlightened physician who follows out his plan of treatment, not in deference to a general formula but in pursuance of a scientific reason.
'' For the physician who has grasped these principles homoeopathy falls naturally into its own proper place among obsolete medical theories, and the question of consultation with homoeopaths answers itself. There must be a common ground of agreement between the consultants or consultation is out of the question. Let orthodox medical men consult together, and let the homoeopath consult with his own confrere. ThrasyUus a ThrasyUo consilium petat.*'
Dr. Brazil's strictures upon homoeopathy are too absurd to have been derived from any other source than his inner con« sciousness. Imagination or assumption have evidently prompted them ; experiment and observations have had no part whatever in formulating them.
In the Jownal of the 12th ult. Dr. Arnold replies to. him in the following letter : —
*' Dr. Brazil's criticisms of my remarks on infinitesimal action would have, perhaps, been more to the point had he made himself acquainted at first hand with the authorities I quoted. Darwin does not say that ^^^^y^^^j^ of a grain of ammonium phosphate is required to stimulate each separate leaf gland of drosera, but that half a teaspoonful of water containing that amount of the salt, when poured upon a leaf of the plant, caused ' the inflection of almost every tentacle, and often of the blade of the leaf.' The amount of the salt brought into action on any one gland by this process must obviously have been very much less than the one twenty millionth of a grain. Dr. Brazil will have to re-state his rule of three sum — that is to say, if he does not see that his argument is faulty in itself even if his numerical data were correct.
«• The striking picture of an • organism bathed in unlimited supplies of a toxic solution ' seems to be a product of Dr. Brazil's inner consciousness; at any rate, it has no relation to any of Naegeli's experiments. Naegeli'p work is of great
^rfpriU.^*' NOTABILIA. 225
interest, among other things he found that one part of hydrated oxide of oopper was sufScient to render 1,000,000,000 parts of water toxic to spirogyra fehe amount of copper oxide, therefore, required to render the litre of water fatal to the organism growing in it was YOoi-Bisis *^ ^^ * gramme.*' reberoll(jodij' namxscke Erscheinungen in lebenden Zillen ivm Carl row yaegeli, H. Georg, Basel, 1898.
Dr. Blackley, of Southport, has also sent the following, commenting on Dr. Brazil's letter to the Journal. The major portion of Dr. Blackley's letter appeared in the Journal of the 26th. We here give it as it was sent to the Journal, Sentences omitted in the Journal are in italics.
Consultation with Hom(eopaths. To the Editor of the ** British Medical Journal,'*
SiB, — Your correspondent. Dr. Brazil, does not fully answer Dr. Arnold's letter in your number of March 6th.
If he will refer to Darwin's work on insectivorous plants he will find that he distinctly states that each gland of the Drosera BotundifoUa could not have absorbed more than aooo^oooo of ^ gnixi of the phosphate of ammonia. And yet this minute quantity caused distinct physiological action. This surprised Mr. Darwin, and rather troubled him, because he feared that nobody would believe his statements. Never- thelees, he published them and let them take their chance. G(tod honest ioul that he was !
But mil object in writing to you is not to vindicate what Dr. Arnold has written on this matter, as I am quite sure he can take care of himself. It is, however , to give some of my oicn experience of the action of small quantities in setting up disease in one ctse tJiat I Juive investigated very fully.
For some years before I commenced my curriculum of study I had suffered from that curious malady — hay fever. It came on in the summer and departed in the autumn. Nobody could tell me anything satisfactory about it. When I had qualified and had got fairly established in practice, I com- menced to investigate the cause of hay fever. I made slow progress at first, but, by patience and perseverance, I even- tually satisfied myself, by actual experiment, that pollen — the pollen of the grasses — was the cause of the attacks in England. These investigations were pubUshed as the first edition of my work on hay-fever in 1878. The Lancet and some otJier journals gave excellent revietvs of Hie book.
After a little time I set to work to determine the quantity (by weight and by number) of the pollen grains that would set up hay fever. After careful and repeated experiments I Sound that so small a quantity as ^^ioo^ of a grain, inhaled
(Tol. 42, No. 4. Q
226 NOTABILIA. ^S22;.\^S?7^
Revi«w, April 1, isee.
in each 24 hours, would produce mild, but very distinct, symptoms of the malady, and it did not usually take more than an hour's exposure to the atmosphere, at the commence- ment of the disease, before I was aware, from the symptoms, of the presence of pollen. Thus 4^0^00 of a grain gave me yery distinct indications of its presence. But rather less than 7^7 of a grain would sufiBce if inhaled in 24 hours, to keep up the disorder in its severest form, and a quarter of an hour's inhalation of such an atmosphere by a hay fever patient would give repeated and violent attacks of sneezing and other symptoms. Here it was not the question of curing disease by a small dose, but the question of producing disease by what even your correspondent will admit to be a very small — an infinitesimal — dose.
The whole series of experiments were undertaken in the interests of medical science and not to support anff particular theory. Ity however, gave me an excellent example of the powers of infinitesimal quantities.
In addition to the facts mentioned above, I have been, for the last fifteen years, engaged in a set of experiments on the subcutaneous injection of the active portion of the pollen grain. These have given much the same results, in the matter of dose and the matter of symptoms, as my other experiments. These have not yet been published^ but I hope soon to publish them.
In the whole of my investigations I have only had one object^ i.e., to get at the truth. I am as anxious to be right, as are any of my colleagues of the opposite school.
lam willing to be convinced if I am wrong. BtU I shall not be converted by abuse. Let us hope that a better day is dawning.
Chas. H. Blacklbt, M.D.
Southport, Mareh 14th, 1898.
During the three months throughout which this corre- spondence has been going on in the Journal, the Lancet has never referred to it, either directly or indirectly, but in its issue of the 19th ult., in an answer to a correspondent who has signed himself *' Hospital Medical Officer," the editor, on p. 885, makes the following statement : —
<* No one will deny that drugs vary in effect according as they are given in large or small quantities. For example, half-an-ounce of vinum ipecacuanhaB will induce vomiting, if taken ; but on the other hand, persistent vomiting is often completely checked by the administration of one minim of the same preparation every fifteen minutes. The reason why it is impossible to meet homoeopaths in consultation is owing to their ridiculous ' principles ' and their views on pathology.^
S^gSfrffriS^' HOTABIMA, 227
The principles of hoincBopaths are said to be " ridiculous " in the last sentence of this deliverance. In the first, the doctrine of the doable action of drugs, first annoanoed by medical writers in homoeopathic literature, is described as one which "no one will deny." In the second, this principle is illustrated by a therapeutic Hskct, the knowledge of whach is solely due to the study and practice of homcBopathy.
Mr. Herbert Spencer has said, <'0f the three phases through which human opinion passes — the nnanimity of the ignorant, the disagreement of the inquiring, and the unanimity of the wise— it is manifest that the second is the parent of the third. They are not sequences in time only, they are sequences in causation." Education p. 58. The Lancet has been for the last 70 years a conspicuous supporter of the *' unanimity of the ignorant," it appears, from the passage we have quoted, to be passing on to the second stage of development into which, as the Journal ha9 shown us, so many members of the profession have already passed ; trying to " prove all things," and then follow on by " holding fast that which is good."
THERAPEUTICS OF PLAGUE.
Db. Sibcab, of Calcutta, has sent us a copy of his article on plague, in the Calcutta Journal of Medicine. We have extracted a large portion of it, omitting sozoe of the lozig symptom-lists which are to be found in all the text materia medica books: —
<< The Plague, as it is now understood, namely, the Bubonic Plague, is perhaps one of the oldest, as it is one of the most dreadful, of diseases.
''From all the accounts that we have of the disease, we find it to be one which is attended with the largest mortality. In its mildest visitations that mortality has never been below 50 per cent. In its most virulent forms the mortality has been as high as 90 or even 100 per cent. In the plague which broke out on the banks of the Volga in 1879, there were in the village of Vetlanka 417 cases out of a population of 1700, and of these 417 cases 862 died, that is, 90 per cent. In some other villages <m the Volga, the disease was even more severe, indeed, it assumed the form of death itself, as not a single person that took the disease recovered. The fact of this high mortality shows that medical treatment has been of very li^le avail in arresting the progress of the disease or of helping recovery from it. And this is the testimony of all who have written upon it after a careful study of its history or from personal experience.
Q-2
228 . KOTABILIA. "C'll^.^rjJftSSf
Review, April 1, 1888.
*' Whether the treatment adopted by the old school, especially in olden days, did aggravate the disease and add to the mortality that woold have naturally resulted from it, is a question which demands serious attention from its importance. This much is certain that some of the judicious members of that school have admitted the injuriousness of that treatment. Thus Dr. Gavin Milroy, one of the greatest authorities on Epidemic Diseases, has said : * There is little on this head (curative treatment) in medical writings at all satisfactory or encouraging in respect of the recovery of the sick, but much that is admonitory as to the baneful effects of an over-active and meddlesome medication. • . . The perusal of recorded histories of cases of plague, as observed at Malta in 1818, and in Egypt in 1886, leaves the impression on the mind that the patients would have fared better had they been treated with light nourishing food and cordials frequently administered, together with simple saline or acid medicines, and without active purgation, blood-letting, and such energetic measures.'
" It is satisfactory to see in this connection that Dr. Dyson, - Sanitary Commissioner of Bengal and member of the Plague Commission, has, in his recently published list of requisites for Plague Hospitals and Segregation Camps, condemned the use of antipyretics, such as antifebrine, phenacetin, as they have been found to produce unfavourable results in plague cases. Plague is essentially a disease with adynamia of the gravest description as its pronounced condition, and therefore nothing should be done to aggravate that condition.
'* It should be remembered that we have as yet had na testimony from members of our own school. Indeed, homoeopathy has not yet had its trial in this disease. And this for the simple reason that there has been no occasion for it, neither in Europe where plague had ceased to exist before homoeopathy developed into a workable system, nor in America where the disease is happily unknown and we hope will remain so.
" We ought to make an exception to the statement we have made above, namely, that homoeopathy has not yet had its trial in plague. The exception is a solitary one, but a very remarkable one also. The late Dr. John Martin Honi^- berger, who says he learned homoeopathy at its very source, from ' the father of homoeopathy, the celebrated Dr. Hahne- mann,' made trial of its medicines with success in the plague which was raging at Constantinople in 1886. * In order to have some experience in this matter (of plague),' says he {Thirty-Jive Years in the East, vol. i,), * I tendered my services at once to the plague-hospital at .Pera (one of the Christian
^SS^'f^nS^" NOTABILIA. 73,9
Beriew, April 1, I89d.
suburbs of Constantinople), where the poor patients were left to their fate, as no medical assistance or any other aid was to be had. Without any authority or permission, I attended them at my own expense. I proceeded, to the satisfaction of all the attendants and patients, to treat the infected according to the homoeopathic principle, and my endeavours were mostly crowned with success. All this, effected by the most simple treatment, did not fail to procure me, in a very short tune, a great reputation, so that, after the extinction of the plague, and the abolition of all quarantine, I was in great request amongst the most respectable private families. But, before I proceed to prove the efficacy of the minute doses of homoeopathic medicines, I must first speak of a special remedy, which proved very efficacious, -employed as a prophylactic or curative ; and I dare to say, with respect to the plague, it might be considered as a specific. During my stay at Constantinople,'* he continues, "I frequently had an opportunity of making the observation that many individuals, especially Armenians, wore a string, to which was attached a bean, called Strychnos Faha St. Ifpiatii, as a preventative against the plague. Having been informed that this bean was aclmowledged to be an effective one, I administered it in minute doses, as a medicine, and that with the best success. The particulars will be mentioned in the course of this work.'
** The particulars here spoken of are, that two years after, ^n his way to Lahore, he himself caught the plague at Palee and cured himself with * the small pills of the above- mentioned Strychnos Faba St. Ignatii,' after the second dose of which be relates that * I began to perspire to such a degree that my mattress was wetted through. In consequence of this perspiration, I got rid of the fever and anxiety, and enter- tained the hope of being restored to health, although the pains in the groins still continued. The swelling of the glands remained for three weeks, as I did not employ any local remedy.*
** It is a pity that the worthy doctor has not mentioned, in his book from which we have quoted, what other homoeo- pathic medicines he had employed against the plague with success at Constantinople. Perhaps he did not think it necessary to do so, having found in ignatia almost a specific. Here we have a medicine, not suggested on theoretical grounds, but discovered by a happy accident, actually used and found beneficial. Dr. Honigberger's own case might have been a mild case of plague, but that it was a genuine case of the disease must be evident from the circumstances under which it occurred and from the symptoms given, and there is
280 NOTABttlA. "S^^.^rffTflSf
BeTiew, April 1, 1888.
no doabt that ignatia did succeed in cutting short the
** Now what of the score of remedies which have been suggested on theoretical grounds 7 Are they all, or any of them, likely to be useful in the disease? Are there any others in our materia medica which, on the principle of similars, may also be useful ? If the principle of similars be a natural law, then we ought to be able to select out of at least two-hundred well-proved drugs some which will meet cases of the plague.
'' Of the drugs mentioned by various authorities mentioned above, we would give preference to crotalus, lachesis, phos- phorus, and arsenicum, their importance being in our opinion in the order they are mentioned, and we would add to these cobra, mercurius corrosivus, carbo animalis, carbolic acid» and baptisia.
'' Crotalus deserves the first place in the most virulent types, especially when associated with a hsemorrhagic tendency. The following symptoms of the nervous, circulatory, and other systems as affected by this venom, show what an intimate resemblance they bear to the symptoms of the worst forms of the disease: Unusual obtuseness and stupidity; coma; languor and delirium; extreme prostration, sinking and faintness ; staggering and falling ; vertigo, with intense headache, especially in forehead above the eyes and in temples. Countenance deathly pale, and often expressive of calm indifference, with marked prostration and apparent free- dom from pain. Eyes half-open and staring. Nausea and vomiting of bile. Tongue much swollen and too large for the mouth. Constipation or diarrhoea with violent tlurst, with great anxiety, uneasiness andbuming throughout the body. Dry consuming fever, with dry tongue and intense thirst, pulse very weak and frequent, respiration difiScult and hurried. Haemorrhage from the bowels, gums, lungs, and indeed from every part of the body. Inflammation and swelling of both inguinal and axillary glands. We can confidently say that a case of plague which will present a majority of the above symptoms will be benefited, and, if not in eastremis^ will be cured.
'' LachaU closely resembles crotalus in the great prostration and septicnmic condition which it produces. The symptoms noticed under lachesis either from bites or provings will show that they analogise very faithfully with the symptoms of eases of plague. The tendency to haemorrhages is much less under it than under crotalus. The characteristics of the fever idso are different. There is under crotalus, singularly enough,.
sasygarag^^ notabiua. 231
profose penpiratioa daring the ehilly stage, which is wanting in lachesis. The lachesis patient ooarts the heat of fire from which he feels better, a symptom not found under orotajus. The predominance of action of lachesis is on the left side. Symptoms worse after sleep. Great loquacity.
*' Cobra is a more energetic poison than either crotalus or laohesie. Indeed, it is the most virulent of serpent venoms. Its action upon the nervous system is more profound than upon the blood. Hence it should have a place where the prostration is unuBuallygreat at the very outset, and there is imminent danger of failure of the heart. The following symptoms will deter- mine its selection : Intense depression of spirits accompanied by severe headache, which is aggravated by the least motion^ sii^fly relieved in the open air, more relieved by smoking, completely by alcoholic liquors. Considerable pain in fore- head attended by fluttering of heart. Headache all day, most severe and throbbing in afternoon. Prostrate and miserable in body and mind, with dulness of head, heavy aching over eyes md dry mouth. Torpor and listlessness pervade the whole system. Confusion of head and strong disposition to doce ; uneonscioiis of what is parsing, but at times showing much inquietude without making any specific complaint, at others lay moaning and dozing. Nausea and depression of vital energy to an unusual degree. Looks very pale and ill ; looks thin and haggard in face, dark circles around eyes. Tongue and mouth very dry, without thirst. Craving for stimulants which aggravate the state. Nausea, with very parched mouth, frequent inclination to spit rather adhesive saliva, yet constant desire to drink. Sudden, relaxed motion. Diarrhoea followed by constipation. Tired and sleepy. Oasping for breath all day. Audible beating of heart. Pulse firequent, remarkably irregular in rhythm and force. Heart pulsates after cessation of respiration. The cobra patient has even greater longing for fire daring the chilly stage than the lachesis patient. He cannot stay away from it, and feels better from the radiant heat. It is true that the disorganising effect of cobra upon the blood is less than that of lachesis, and much less than that of crotalus, but it is not altogether nil. Hence though in cases of plague where hflsmorrhages are a prominent symptom preference should be given to crotalus and even to lacheais, we must not forget cobra when the other symptoms correspond with it.
" The E^mptoms given above are sufficiently differentiative of these serpent venoms to help in their selection. But for a more detailed analysis of their distinguishing characteristics
232 NOTABILIA. ^^?^J%r?^"
Re\iew, April 1, 1»8.
we would refer the reader to Vols, xii., xiii., and xiy. of the €al. Jour. Med,
'' There is another serpent venom , the Elaps CorallinuSf which might find its use in cases of plague, especially where hsemorrhages prevail and the blood discharged is black and generally fluid though sometimes clotted. It strongly resembles crotalus in this respect, and may be used either at the very beginning, or when crotalus has failed.
''In the gravest, foudroyant cases, where death seems imminent, we would recommend hypodermic injections of the serpent venoms (of course in dilutions) as more efficacious than their administration by the mouth. We need hardly add that for purposes of injection we do not mean a mixture of the four venoms, but only the particular one which may be deemed appropriate to the case under treatment.
'* Phosphorus should have the preference in cases where the lungs are involved. Fever generally in afternoon or evening, first violent chill, so that he could not get warm, followed by heat with thirst, and internal chilliness, and after the latter had passed off, heat and perspiration all night. The fevers of phosphorus very often assume the typhus or typhoid character, become complicated with pneumonia and bronchitis. Always lies on the right side, lying on the left side causes anxiety.
'' It is a positive fact that many cases of slow arsenical poisoning can scarcely be distinguished from low, adynamic fevers of the typhus or typhoid character. On this foundation Arsenicum is used in our school for fevers of that description. Hence it is very likely that it will be found appropriate in some cases at least of the plague, especially of the gastric and intestinal variety, in which insatiable thirst, un- controllable vomiting and diarrhoea are present. Its appropriateness in particular cases can be easily found out by the experienced and inteUigent homoeopathic practitioner.
'' Fever at 2 o'clock in the night, increased warmth in whole body, sweat in face and on the feet, tension in hypochondria and epigastrium, producing colicky pain and anxiety. Typhus- like fever with extreme restlessness, alternating with stupor. Burning heat internally, with anxiety, after midnight, with inclination to uncover. Heat and restlessness the whole night, and pulsations in the head hindering sleep ; or nocturnal heat without thirst or sweat. Cold, clammy sweat ; offensive sweat over whole body. Sweat, when commencing to sleep, going off after sleeping a little. Sweat, with excessive thirst ; would drink all the time.
** In this connection we may state that, as mentioned by Dr.
if^ffiSlTlSa'' NOTABILIA. 233
Imbert-Gocirbeyre, ^ the anatomist, Jacques de Carpi, who was the first, it is said, to employ mercurial frictions in syphilis, is believed to be the inventor of the arsenical amulet. Accord- ing to Eircher, in his work upon the Plague, it is a potent means for drawing out the pestilential virus, its similar among animal poisons. Willis does not hesitate to commend this prophylactic procedure, theoretically as well as practically. It is said that Pope Adrian VI. was preserved from the plague by its means.'
** That amulets do act in numbers of cases it is impossible to deny. Bat how they do so, whether by simply acting upon the imagination, or by exerting some subtle physical influence, is more than our present crude philosophy can explain. What- ever the modus operandi, it is neither prudent nor philosophical to object to their use, especially when medicine has proved so acknowledgedly impotent that we are obliged to have recourse to the barbarism of quarantine and the cruelty of dragging away patients from their dearest surroundings. There would be no harm if everybody were to wear in these days of plague panic, an amulet of St. Ignatius's bean or of arsenic on the arm, or, perhaps, better of one on one arm and of the other on the other arm.
" We would recommend Mercurius Corrosivus where the involvement of the glands, and the gastric and intestinal symptoms form the prominent feature of the disease. It has the further recommendation of being a proved antiseptic to the plague baciUi, as of all other pathogenic bacilli generally. The homoeopathic practitioner need not be told that this antiseptic property will be displayed even in our dilutions when administered internally.
'* Carbolic Acid has almost all the chief symptoms of the disease, with the exception only of glandular enlargements. It may be used at the very beginning when the headache is very distressing, and in the course of the disease when septicsBmia becomes general, and the discharges become very foul and offensive. Even in our attenuated doses given internally it will be found to exert a remarkably antiseptic influence.*'
** The importance of Kali. Phos. as a tissue remedy, especially in affections of the nervous system marked by great debiUly and in all putrid and decomposing processes, was first pointed' out by Dr. Schiissler, of Oldenburgh, North Germany, in 1878. The subsequent proving of the drug under the direction of Dr. H. C. Allen, and clinical experience, would seem to have realised the anticipations of Schiissler. Drs. Boericke and Dewey, in their work on The Twelve Tissue Remedies of Schiissler remarks : "It corresponds to the hosts of conditions
284 NOTABILU. "^f^.^'SSTtJJJ!
Reriew. April 1,18P8-
known as neurasthamia, in which field it has won its greatest laurels. It is a restorative in muscular debility following acute diseases, myalgia and wasting of muBoular tissue, all dependent upon impaired innervation. Atrophic conditions in old people. In cases arising from rapid decomposition of the blood corpuscles and muscle juice, such as hemorrhages of a septic nature, scorbutus, stomatitis, gangrenous angina, phagedenic chancre, offensive carrion-like diarrhoea, adynamic or typhoid conditions, &c.' We have no experience with kali. phos. But if half of what Drs. Boericke and Dewey say, has been based upon positive clinical data, then the drug is likely to be a very useful one in plague, and we have na hesitation in recommending its trial when success with the remedies mentioned before has not been satisfiEictory.
'' As regards the dilutions in which the medicines are to be administered, we should prefer the lower, from the drd to the 12th decimal. There may be occasions for using the higher, but we would leave each practitioner to use his own dilutions.
'* In view of the danger of having the plague amongst us, we have thought it our duty to make the aforementioned suggestions on the treatment of the disease which is likely ta be useful. In the absence of personal experience we have been obliged to rely upon reported symptoms, especially those given so clearly and fully by Drs. Dyson and Calvert. As in all diseases, so in plague, individual cases may present peculiarities which will demand remedies other than those suggested above. Again in the course of treatment of particular cases, the necessity may arise for the exhibition of intercurrent remedies, and as far as we can judge, there is likely to be a call for Opiirn^ and one or other of the solanaceous narcotics, Belladonna , Hyosajamus, Stramonium for cerebral symptoms, of IpecaaianJtn, Antimonium, Crudum Antimomum Tartancum for gastric and pulmonary symptoms, of Hepar Sulphuris and Silecea for suppurations.
'' In this time of India's sorest need, not less urgent than wide-spread famine itself, we trust our colleagues throughout the world would be good enough to send in any farther suggestions that they may deem necessary, which we shall be glad to publish in tbis Journal for the benefit of our OQQUtrymen." ■^■q* — -
wanted : a physician to treat the plague homceopathically.
On another page we have recorded how much (or, unfor- tunately, how little) has been done to test the value of homoeopathy in the treatment of the plague. Analogy would
Sgy^gTg* _NOTABILIA. _ _285
raggest that it can do better than other methods, thoagh, with a steadily increasing spread of mortality, that is, perhaps, not saying mach.
We understand that some benevolent and inflaential saj^rters of homoeopathy have expressed a desire that one or more eompetent observers should be sent out to India to treat the plague on homoeopathic principles. Of the desira- bility of this proposal there can be no two opinions, and could it be carried out, there is little doubt that the world in general, and homoeopathic therapeutics in particular would be placed under an indisohargeable debt to the gentlemen who are prepared to give effect to their suggestions by practical support.
Before any definite steps can be taken towards obtaining fiKsilities lor such treatment as to ensure financial support, it is necessary to have suitable candidates in view for the req>onsible post. We may state that all expenses and a liberal salary are offered to a suitable man. Further informa- tion may be obtained from 6. A. Cross, Esq., or Dr. Edwin A. Neatby, The London Homoeopathic Hospital, Great Ormond Street, W.C.
A CASE OF CHLOROFORM POISONING.
In the British Medical Journal (November 20th, 1897), the ease is reported of a man who was found semi-conscious from taking chk)roform. The writer. Surgeon S. T. Beid, R.N. Surg., says : —
« Coffee was given, artificial respiration resorted to, and the electric current brought into play, also shortly afterwards ntxx of liq. ammonise were injected by a local medical man.
*« On the arrival of the ship's surgeon (8.80 p.m.) he found the patient deeply comatose, eyes suffused, face purple^ breathing very slow and shallow — sighing — character, pulse just perceptible (40 per minute). He injected tixxx of ether and gave an inhalation of nitrite of amyl, but finding no response to these he injected one eighth of a grain of strych- nine and placed the patient in reclining position with feet well up.
'* I arrived shortly after, having been sent for, and as the patient was still in the same state — fully dilated pupils, loss of conjunctival reflex, relaxed sphincters— we determined to push the injection of strychnine to the full extent.
" 9.15 p.m. Injected ^ gr. strychnine.
« We increased the electrical current from 80 volts to 40 V(dts, and the effect was very marked upon the respiratory jnusdes. Previously they had ceased to act, and respiration,,
^36 NOTABiLiA. ^ST^i.^^r^iss:
Heview, April J, 1886.
which was very shallow and diaphragmatic, now became quicker and deeper, and the chest wall, commencing about the sub- clavicular regions, began to move with normal rhythm. But it was noticed afterwards that this marked effect of the current was only on suddenly increasing the strength, and not a continued stimulus that could be depended upon to keep the patient alive while the chloroform was being exhaled from the lungs.
*' The nape of the neck was shaved, and one pole (from the arrangement of the battery it was impossible to tell which was the anode and which the kathode) was applied as near the respiratory centre as possible, the other at the ensiform carti- lage ; finally the current was increased to 50 volts.
** Artificial respiration was continued, and another injection of strychnine was given {^ grain at 9.40 p.m). Shortly after this the effect of the drug became evident, chest respiration became more marked, trismus, pupil contracted. Conjunc- tival reflex was obtained, and it was noticed that the patient vomited after each fresh injection of strychnine. But what was most interesting was to see the gradual counteracting influence of the chloroform over and above that of the strych- nine. The respiration again became shallow and diaphrag- matic in character ; the conjunctival reflex was no longer obtained, and the wedge of wood used to counteract the trismus fell out of the patient's mouth, while his aspect presented very little to suggest that he had had nearly one-third of a grain of strychnine injected, and a 50 volt current passing into him.
^' 10.80 p.m. Injected ^^ grain of strychnine.
** 11.30 p.m. Do. do. do.
*'The same course of events followed each of these injec^ tions of strychnine, but it was not till half an hour after the last injection that we got full evidence of the action of strych- nine. On occasions he would have muscular contractions which necessitated stopping the artificial respiration and even holding the patient down on his couch, but these were not at all excessive, and on reducing the electrical current, subsided almost completely. An hour after the last injection it was noticed that the strychnine still seemed to have strong influ- ence, appearing as though we had injected just sufficient to counteract the influence of the chloroform, for the pupil still remained contracted ; the conjunctival reflex was easily obtained, while the rigidity of the jaws subsided, and we had no other signs of excessive muscular contraction.
'* Twenty minims of tinct. digitalis had been injected with marked improvement of the circulation ; heart sounds were now heard distinctly, pulse was felt at the ankle, and there was marked improvement of the pulse at the wrist. The
iSSiS'A^SlT'JSS:'' NOTABILIA. 237
. April 1, li^S.
respiration had greatly improved, the chest muscles were acting well, the inspiration was deep and long, and the patient continued to improve, till shortly after 1 a.m. he became sensible, having been under the influence of chloroform for over seven hours.
" There were no other signs of the effects of strychnine ; he had a very quiet night, dozing peacefully ; his pulse was very weak, for which caffeine citrate was injected, and the next day he had sUght diarrhoea, bat the subsequent progress was very favourable.
" Remarks. 1. A stomach pump was not used at all ; he had vomited freely after he was discovered (6.80 p.m.), and when the stomach pump was obtained, there was no smell of chloroform in the vomit, but his breath was fully impregnated with the odour, and continued so for fully twenty- four hours afterwards.
'*2. The quantity of chloroform taken into the stomach must have been over 2 ozs., but the quantity absorbed into the system can only be judged by the amount of strychnine injected and the length of time the patient continued to expire the vapour.
'* 8. The tabloids of strychnine Were used, strength ^ gr. ; of these 22 were used, making the total just under the half- grain.
" Conclusions.
" 1. The great value of strychnine as a stimulant to the respiratory centre during chloroform poisoning in keepin<^ hfe going while the vapour is being exhaled, but the drug must be used boldly.
*' 2. The use of the electrical current in acting upon the respiratory centre at once, and by increasing the current rapidly, keeps the respiratory mechanism during the dormant stage of strychnine after injection.
** 8 With these two agents to hand one ought to be able to treat any case of chloroform poisoning.''
POTASSIUM CHLORATE POISONING.
P. Jacob {BerL klin. Woch.^ July 6th, 1897) records a fatal case. A patient, aged 89, was admitted almost comatose, thirty hours i^r taking about 26 gr. of this drug. The face, ears, fingers and toes were blue. There was much dyspnoea, and the pulse was thready. Camphor injections were given, and the stomach washed out with water to which sodium bicarbonate had been added. Venesection was performed on two occasions, and 1,000 c.cm. of normal saline solution was infused. Some considerable improvement was noted on
1238 NOTABILIA. "S^i.%T!2^
Beview, April 1, 1886.
the third day. 50 c.cm. urine of a brown red colour was drawn off, and was found to contain both albumen and blood. From the time of admission a marked metheemoglobinuria existed, but after the second day a distinct hsemoglobinuria. Six days after taking the poison the patient died suddenly and unexpectedly. Only an incomplete necropsy could be made fifty hours after death. The spleen was enlarged, the lungs deeply engorged with blood, and the kidneys swollen. The changes in the blood were interesting. There was a very marked leucocytosis at first. The red cells were paler than usual, and showed marked d^enerative changes. The leuco- cytosis gradually diminished, so that on the day of death the leucocytes did not exceed the normal, but the changes in the red cells gradually increased, so that eventually hardly a normally coloured red cell was to be seen. The red cells which escaped the destructive changes nearly all showed poikilocytosis. The author's observations thus agree with those of Beissand Kronig. The hyperleucocytosis is a reactive change. The author would go so &r as to say that the use of potassium chlorate, even as a gargle, should be entirely given up and forbidden. Even in smaJI doses it is a severe blood poison, and may produce a haBmorrhagic nephritis. — British Medical Journal, Nov. 1897.
A CASE OP BELLADONNA POISONING.
In the British Medical Journal^ of May 8tb, 1897, Dr. Duncan reports the following interesting case : —
M. W., a male, aged 46 years, was admitted on November 10th, 1896, at 9 a.m.y in a comatose and collapsed state. It was stated that he had three hours and a half previously taken a little over an oimce of glycerinum belladonnaB, in mis- take for " black beer."
The patient is a hawker, and had risen at 5.80 a.m. to go to market. On the previous night he had taken a little black beer for a '< cold," and had set down the bottle beside some others. Next morning he intended having a little more of the black beer, and took, as he supposed, the correct bottle. He measured out a Uttle over an ounce of the material which was labelled glycerinum belladonnse. He added a little warm water and some sugar to it and drank it off. This was about 5.80 a.m. He thought at the time that the taste was not the taste of black beer, and remarked so to his wife.
According to the account received he wheeled his barrow to the Citadel Station, which is about 200 yards from his house. He returned home, not feeling very weU, and his wife sus- pected that he had taken the wrong medicine. She at once
nS^^A^ST^ NOTABILIA. 239
gave him some salt and water in order to induce vomiting, but this was unsuceessful. She afterwards gave him some tea. He gradually got worse. She noticed that he could not take hold of things properly, and that he reversed the order of things. For instance, instead of putting the stall on the barrow he tried to put the barrow on the stall.
Dr. Maedonald was sent for, and arrived about seven o'clock. He was shown the bottle containing the belladonna, and was told that the patient had not vomited. Apomor- phine i grain was injected subcutaneously, and the patient vomited, in about three minutes, one or two mouthfuls of a brownish coloured fluid which had a faint odour of bella- donna. The patient was delirious, the delirium being of a noisy and active character. The pulse was very feeble. One- twentieth grain of sulphate of strychnine was injected subcu- taneously. He was then sent to the Cumberland Lifirmary. t
On admission he was found to be comatose. The jaws were firmly clenched, and there was a constant grinding of the teeth. There were jerking movements of the limbs, but chiefly of the tendons at the wrists. The body was warm, the temperature in the axilla being 98.6^ ; the pupils were widely dilated, and did not react to light ; only a small rim of the iris was seen. The breathing was somewhat stertorous. There was marked dryness of the mouth and tongue, which was seen on forcibly opening the mouth ; the skin was dry. The pulse was 112, and very weak. One-tenth of a grain of strychnine, along with a quarter of a grain of morphhie, was at once injected subcutaneously.
The patient remained comatose until 11.80 a.m., when he began to be restless and tried to get out of bed. He spoke then for the first time, and when questioned he could tell part of his name, but could not remember the other part of it. A busy and happy delirium had supervened, and he looked at times as if he were intoxicated with alcohol. He clutched at imaginary objects, and had evidently hallucinations of unseen agency ; the movements of the arms were very inco- ordinate. He kept picking at the bed clothes, and made movements as if he was tying knots.
He was at this time seen by Dr. Barnes, and a second hypo- dermic of morphine was injected, two-fifther of a grain being administered. In about 10 minutes the delirium ceased, he feu asleep and slept in one position, with hardly any move- ment except an occasional slight twitching of the arms, until 4.45 p.m. ; the breathing meanwhile was more regulcur ; the pulse at four o'clock, before he awoke, was 84. AftierwardB it was 126, and was very small in volume ; the pupils were still markedly dilated. On being asked his name he could tell it
940 KOT A TUT T A Monthly Homoeopathic
^^^ JSOi ABlIilA. Kevlew, April 1, ISW.
perfectly. He knew where he was, but could not remember when he came to hospital. He said he came here alone, that he had been in hospital since '* Wednesday/' which was six days before the date of actual admission, and that he had been in bed ever since. His speech was thick, and somewhat indistinct. On being asked to protrude the tongue he did so in a choreic way. It was white and moist. He asked for a drink several times. He was given milk, which he swallowed with apparently no difficulty. He expressed a desire to micturate, and passed for the first time after admission about 5 ounces of clear urine, of normal odour and colour, specific gravity 1012, acid, and containing no albumin. The muscu- lar co-ordination was quite good. At 6 p.m. he was drowsy, and had to be roused to conversation. At 6.45 p.m. he began to sweat, and his skin secretion afterwards remained normal.
He slept again until 9 o'clock. His memory now was much better. He could not, however, remember anything of the morning's doings until he was asked whether he remembered drinking anything. It then immediately flashed to his mind, and he gave quite a correct account of everything he did except that he could not remember having taken the barrow to the station. He said the first bad symptoms he felt were a feeling of dizziness, and his legs ** going from under him,'^ and then ** a mist coming over his eyes." He remembered nothing further until he awakened at 4.45 p.m. He slept at intervsJs during the night, but was greatly troubled with dreams. He awoke next morning apparently well.
The pupils were still dilated. The bowels moved twice whilst in hospital ; the motions were normal. The tempera- ture ranged from 98.6^ to 99.4^ until the morning of discharge on the third day after admission, when it was normal. He expressed himself as feeling as well as he did a fortnight previously. Neither flushing of the skin nor any appearance of a rash was observed during the whole time he was under observation. Since he has resumed his usual occupation, and has kept quite well.
Bemabes bt Mr. Duncan.
The case appears interesting to record (1) on account of the rapid recovery after such a large quantity of the poison had been taken. A considerable quantity must have been absorbed as the stomach would have no solid food in it, and as the poison would be diluted with the salt water and tea, vomiting not having been provoked until an hour and a half had elapsed ; even then only a mouthful or two of a fluid smelling faintly of belladonna was rejected. From inquiries which have been made at the druggists who made the glycerinum
£:£S'Ssre:" notabiua. 241
Baviev. AprU 1. 18^.
beUadonnie, it has been found that a little over an ounce of it contains about 8 grains of the active alkaloid atropine. As &r as I have been able to make out from the literature at my disposal, this case approaches next to the one reported by Dr. Eliot, and quoted in a Sf/stem of Jjegal Medicine by Hamilton and Godldn, in which 4 grains of the active alkaloid had bean taken without a fatal result.
(2) According to Binz, in his Lectures on Vliarmacology^ '' violent maniacal excitement " is put down by most authorities on belladonna poisoning as the first prominent symptom. This was noted chiefly by Pfuhl, Matthiolus, and his contemporary, Dr. Johannes Weyer. In this case the first prominent symptom was muscular inco-ordination. The patient's wife noticed that he could not lift things properly. She then noticed that he was getting weak in the legs, and that he then fell back exhausted. This was followed in a short time by excitement. The behaviour in this case coin- cided with Professor Eraser's views — namely, that the action on the spinal cord is first paralysing and then exciting ; also that from paralysis of the vagi the pulse rate .was increased during the time that the symptoms of belladonna poisoning were present.
(8.) The experiments of the Edinburgh Committee went to show that morphine is not antap^onistic to atropine, although atropine is to morphine, but one or two cases are on record where morphine by subcutaneous injection relieved the ^inptoms of atropine poisoning. One case is especially men- tioned by Binz where a boy had eaten the seeds of datura stra- monium, the alkaloid of which is in many respects identical with atropine. In this case death seemed inevitable, and as a last resource morphine was administered, with the result that the grave symptoms were arrested, and the boy speedily recovered. In the case now recorded there seemed to be un- doubtedly great benefit derived from morphine, as the delirium and hallucinations subsided almost immediately, and remained permanently in abeyance. The patient was also able to co-ordinate his movements in order to get out of bed to pass water.
PHOSPHORUS-NECROSIS OF THE TEMPORAL BONE.
We reprint some remarks on this subject by Dr. Wiirdemann m the BritiMh Medical Journal of November 27th, 1897 :—
''Phoqphorus-necrosis is described as a characteristic maxillary bone disease conmiencing after several years' contact with phosphoric fumes, occurring especially among
Vol. 42, No. 4. R
242 NOTABILIA. ^^^:a.^3?ftS!?
Beview, April 1, 18B8.
workmen in match factories, affecting 11 to 12 per cent, of those exposed to the fames. It very rarely affects persons with sound teeth, but occurs mainly in those whose teeth are carious ; where the teeth have been extracted and the alveolar process exposed excep* tionally predisposes to the disease. The earliest case was reported in 1845, being noticed in 1889, about eleven years after the opening of the match factories in Vienna. It is much less prevalent now than formerly, on account of better hygienic surroundings in the factories, im- proved artificial ventilation, the vaporisation of turpen- tine, and the rigid inspection to which the workmen are subjected. The red amorphous phosphorus is comparatively harmless, and is now generally used. The first symptoms are toothache, followed by pain in the jaw, swelling and tender- ness of the gums, and formation of abscesses discharging foetid pus through the cheek, roof of mouth, or even the aural cavity, leaving fistulous openings. The patient acquires a peculiar pasty appearance of the face and puffiness of the cheeks.
The usual complications are chronic bronchial catarrh, chronic gastro-enteritis, and constipation. The patients rapidly deteriorate in general health. The most rare com- plication is pointing of abscesses or continuation of the ostitis to the bones of the external auditory canal, which, as far as I can find, is described by only one author. After subsidence of the acute symptoms the bone is found to be necrosed. The disease is always chronic, and almost imper- ceptibly slow in the upper jaw, but in the lower is sometimes acute and attended by high fever. The lower jaw is most frequently attacked. The disease b^ns in the periosteum, is due to local irritation and ends in the death of the bone. The sequestrum adheres firmly to the underlying bone, becoming encrusted with a pumice stone-like material. The disease may affect only small parts of the jaw or even the whole bone.
'' The treatment advised by all authors is dietary, hygienic, and stimulant, together with tonics, antiseptic washes, and removal of the sequestrum by operation. Operations for removal of dead bone are generally very successful. Billroth cured 20 out of 28 cases. Of neglected cases, 85 to 88 per cent, die of complications and of sepsis.'*
PERIOSTITIS OP MOTHER-OF-PEARL.
Six cases of a very rare disease — the so-called periostitis of mother-of-pearl workers — ^have lately come to Berlin for treat- ment. Professor English, of Vienna, was the first to observe
^^^wffpril^ag^ NOTABILIA, 243
this disease some years ago, and later Professor GusBcnbauer (Billroth's saccessor) made a special study of it. In all about 25 cases have been observed, ail in children ; but the six cases which have lately come under Dr. W. Levy's treatment in Berlin are all adults. The symptoms are very painful swell- ings of the bones of the extremities, accompanied by fever, continuing for weeks and even months, but rarely leading to suppuration. After a certain length of time recovery takes place, but if the old work is resumed relapse is almost certain. The cause is thought to be the constant breathing of mother-of-pearl dust (consisting of about 95 per cent. carbonate of lime and 6 per cent, concholine, an organic substance) mixed with the water that is used in polishing, turning, &c. The connection of cause and effect, however, is not entirely clear as yet, for the attempts to produce a similar disease in animals, both by inoculation of the watery mixture and by filling their breathing air with mother-of- pearl dust have proved completely unsuccessful. — BrUish Medical Journal^ March 6th, 1897.
"WITHIN THE HOSPITALS."
The following article contains what is well known to most of our readers, but it will be read with interest by many, and will be useful as a record of what is thought of the London Homoeopathic Hospital by an eminent non-homoGopathic authority.
" In a notice which appeared in The HospiUil for June 80th, 1894, of the proposed plan of this hospital, it is stated, ' We shall look forward with much interest to seeing the completed plan.' That pleasure we enjoyed a few days ago, when we made a thorough inspection of the new buildings from roof to basement. Our inspection confirms the opinion already expressed that great credit is due to Mr. William A. Pite, the architect, for the marked success with which he has accomplished a difficult task. On a narrow site, with all the hampering restrictions incident to a crowded district of London, Mr. Pite has erected a hospital building which 4X>ntains wards which are as good as, or perhaps even better in some respects, than those of many recently erected hospitals in this country. He has evinced marked skill in setting back the building so as to give light and air to the out-patient department, and in the methods of lighting tiiat department from the rear which he has introduced. The building, now that it is completed, in view of the difficulties referred to, must constitute an object lesson for all who wish to study and understand modem hospital construction. We made a very
B— 2
244 NOTABILU. "Si^iJ.^ZS^^*
Beview, April 1, 1898.
few criticisms in dealing with the plan, but those criticisms have been reduced to msignificance by the changes the architect has introduced. Mr. Pite has evidently made a study of the most recent hospital buildings, and anyone who- wishes to benefit by the lessons which may be learnt from an inspection of the new Homoeopathic Hospital, must of course be familiar with the principles of hospital construction in their present completeness. We have inspected hundreds of hospitals and kindred institutions, but we never remember before to have realised that there are lessons to be learnt in the board-room. The board-room at Great Ormond Street is perfectly proportioned, and it affords evidence of the loving and intelligent observation brought to bear by the officials, the committee, and the architect in settling the plans of the present building. The feature of the room is the fireplace, an old one, parts of which came from Arundel Castle. It is of a composite character, and has been built up from materials derived from various sources, which were obtained after diligent search, and this mantel and fireplace now constitute as a whole one of the most striking features in a really beautiful room. There has been an evident endeavour to provide that everything in the new building shall be of the best, and from the ingenious arrangement for the bottles containing the drugs in the dispensary to the mechanical contrivance in the gas stoves in the kitchen on the top floor, by which a large saving of gas is secured, this rare foresight must afford satisfaction to the trained observer as he goes from floor to floor.
<'A Comfortable Hospital. '' The predominant impression conveyed to our minds by our inspection was that this is a comfortable hospital. Comfort- able, that is to say, from the fact that everybody, as far as we can judge, who works within the institution is dominated by the feeling that upon his or her individual shoulders rests the responsibility to discharge their duties so as to secure the provision of all reasonable comfort for all, and the maximum of efficiency in every direction. Each ward contains provisions in the duty rooms, and in the arrangements for the service of the dinners and other meals, which must add materially to the comfort of the patients by securing that the meals are served hot, and that they are presented to the patient in the form best calculated to be appetising and tempting. Then, again, the size and arrangements of the smaller wards containing nine beds are such that we incline to the feehng that war& of this size without screens for paying patients at, say, two guineas a week would be popular and satisfactory. The children's ward (an illustration of which we gave in Tfu
^^JS^:^!" XOTABILIA. 245
HfMpiutl of June 19th, 1897), is one of the most aitraoiive ^wards we have ever seen. A good friend of the hospital with artistic tendencies has designed and presented a large screen of plain glass which not only acts as a break at the entrance to the ward, but gives the whole room a special character which is striking and pleasant. Here, too, we find evidence of the thoughtful care which has been put into the arrange- ments for the comfort and well-being of the patients. Each child has its own clothes arranged separately and provided by the hospital. In those cases where the parents are too poor to adequately clothe the children, arrangements are made to allow each child to take out the suit used by it during the time of its residence in the hospital. These dotlies are made from remnants obtained from certain firms who are interested in the hospital, and have a special character, which might be generally adopted by hospitals with advantage. Each garment is made of pieces, the pieces being of different patterns, but so selected as to make the general effect of the clothes unobtrusive and good. The object of this plan is to take it out of the power of the parents to pawn the clothes when the children leave the hospital. Pawnbrokers will not take clothes so ^onstructedi and it is for this reason that we mention the matter here. Then, again, every child has its own towel, its own flannel, and its own brush and comb. The medicines are kept in a basket containing a separate division for each bed according to its number, and the poisons are safely locked up in a cupboard by themselves. The ward contains a portable cabinet with every requisite for tracheotomy operations, and the condition of the cots, the glass, and everything in the ward reflected great credit upon the nurses, who are deservedly proud of the spotless cleanliness, which is a great characteristic -of this institution, and which is apparent when all due allowance has been made for the smartness which one expects to find in a new building. The same result was noticeable in the operation-room and in the condition of the instruments and the various vessels and appurtenances, and may be said to constitute a feature which is to be met with almost every- where. The patients seemed to appreciate the comforts of their surroundLsgs, which is not always the case.
• * Some Ano3i alies.
** Where there is so much to praise, as in a case like the building we are dealing with, it is remarkable to find certain defects which can easily be remedied, the presence of which is mainly due to the often unconscious effects of old customs or traditions. Thus, despite the fact that a change may repre- sent a sum of iSSOO per annum, we were surprised to find that
246 NOTABILIA. *S?^J.^^S??f"JS^
Renew. April 1, 1888.
the committee of the HomcBopatbic Hospital still reqaires its patients to supply themselves with tea, sugar, and butter, a change of linen, with towels and soap, a brush and comb, and Is. for breakages. It is due to the marked efficiency and intelligent thoughtfulness exhibited throughout the New Homceopathlc Hospital that the authorities should make up their minds to abolish these requirements, and so place their hospital on a par with the most wisely administered hospitals in the country. Again, having so complete a children's ward, there is no excuse for permitting the adult patients in certain of the wards to be subject to the disturbing influence of suffering children, as is at present the case. Another objection to the presence of children in the adult wards is that this must necessarily consume some of the air allowance provided for the adults, and good wards of modem construction may be rendered unhealthy by a practice which tends to retard recovery, and is altogether indefensible where there is an adequate number of beds provided for children in a separate ward. Again, we are convinced that something may be done, despite the pressure of space, to remedy the untidiness of certain of the bathrooms, due to the presence of clothing and linen which are out of place there. Their presence may tend to render the hospital less hygienically complete than it otherwise would be. The communication between the mortuary and the hospital proper should be disconnected from the main building, as we understand it will be when the additions to the Nursing Home, now in course of construction, are completed.
" Genebal Featubes. We cannot justly conclude our notice of the Homoeopathic Hospital without expressing our appreciation of the whole- hearted and intelligent services which the present secretary- superintendent, Mr. G. A. Cross, has rendered to the institution. Such of the books as we had occasion to examine, especially those relating to the admission of out-patients, and the register of attendance of the medical staff, are excellent of their kind, and were accurately and neatly kept. We observed that only about 2^ per cent, of the out-patients admitted are free cases, the larger proportion being persons who pay Is. for a month's attendance, although a proportion are received by the presentation of governors' letters. The system on which this hospital is financed is notable too. There appears to be no attempt to appeal for an arbitrary sum, the amount of which seems often to be fixed for the reason that it is sufficient to excite sympathy and increase the amount of individual contributions. Mr. Gross and his committee wisely pursue the Spurgeon plan of setting forth clearly what money
JSSSS'a^.STISS'* notabilia. 247
B«7iew, April 1, 1898.
ihey reqaire and the purposes to which that money will be devoted. In this way they have succeeded in paying o£f the whole of the building debt, and are at the present time steadily working to provide the funds for the erection of the additions to the Nursing Home, and to secure an income from annual subscriptions sufficient, with that derived from other sources, to maintain the hospital in efficiency. They appear to recognise, as men of business, that if you have an invested capital it is legitimate and proper to obtain the sanction of the governors to realise a sufficient amount of that capital from time to time to meet the necessary expenditure, and then to ask the public to enable them to replace the capital so expended and to maintain the reserve fund at an adequate amount.
'* Finally, we found that the whole of the drugs, apart from crude drugs, are given gratuitously to the hospital by a large firm of druggists, Messrs. E. Gould & Sons, 59, Moorgate Street, E.G., honorary chemists. We examined the drugs, and found them of excellent quality. Possibly other secretaries may like to know of this fact, as there must surely be some other firms who, if properly approached, would be willing to do as much for a hospital in which they may be interested as is done for the Homoeopathic Hospital by Messrs. Gould & Sons."
CiESABIAN SECTION.
Fbok an article in the Vacific Coast Journal of Homceopathj we extract the following : —
Mrs. S. had a contracted pelvis, and her first pregnancy was terminated by prolonged labour, and finally craniotomy was performed. Her second pregnancy terminated in December, 1898, and 8i hours after the beginning of labour Caesarian section was performed. The child and mother did well. In March, 1897, about 10 days from the close of term Caesarian section was again performed on the same patient, this time in a hospital, which she was able to leave on the seventeenth day. The second operation was in some respects simpler than the first, and we might expect second and third operations to have a lower death rate than first operations, as they would come more promptly under the surgeon's care, and the exhaustion of prolonged labour would be avoided.
GYNiECOLOGICAL SURGERY.
Db. H. J. OsTBOM, of New York, has published an article on the above subject in The Medical Times for last December. He deals with the causes of failures, and points out that
OJ.Q VATAHTTTA Monthly Hom«»op»tiii«
Review. Afvll 1, ISK.
accurate diagnosis must precede treatment. With regard to vaginal as opposed to abdominal hysterectomy, Dr. Ostrom prefers the vaginal operation wherever possible, as being less severe, and attended with less risk of future hernia. Inflam- matory diseases of the true pelvis are better operated on through the vagina, but this is not the case if the peritoneum must be opened to reach the tumour. An ovarian abscess, pustulsB or extra-uterine pregnancy ruptured between the layers of the broad ligament can be easily and safely reached thorough the vagina, and needless risk is incurred by the :abdominal method.
Abdominal drainage may be successful in draining small areas, and sacs which cannot be removed, but with regard to p^eneral abdominal drainage there is no reason to expect it to be effective, and further, at the end of the operation the cavity should be surgically clean and therefore require no draining. In ligaturing, the arteries alone should be secured, otherwise the constricted nerves set up local disturbances, and also a mass of tissue is left unprovided with nourishment, and this often causes pelvic abscesses, etc.
Against the predetermined operation of morcellation he sets his face.
METABOLISM IN THYROID FEEDING.
Gluzinski and Lemberger {Ccntralbl, f.inii, Med., January 80th, 1897) have investigated this subject, with special reference to thyroid feeding in obesity. They point out that it is necessary to find out whether the loss of weight takes place at the expense of the fat of the body or of the protoplasmic tissues, such as the muscles, etc. There is a class of cases of obesity not due to excess in eating or to deficient exercise, as when it occurs as an hereditary affection, or in sterile women, or after ovariotomy, at the climacteric, etc. Here there is a disturbance in the cells of the protoplasmic tissues, in which oxidation processes take place. The authors have investigated the subject under the following conditions : (1) A sufficient number of calories were introduced with the food ; (2) the tliyroid treatment extended over a sufficient time ; and (8) a comparison was made between thyroid tablets and the fresh gland. Their researches were made in the case of a man, aged 28, moderately fat. and continued during twenty-seven days, which they divided in five periods. In the first seven days the nitrogenous metabolism was investi- gated and an equilibrium produced, in the second seven days thyroid tablets were given, in the third period of six days no tablets were given, but during the next four days
S5SSr5Sri«^ NOTABILIA. __ 249
fresh thyroid was administered, and finally doring the last three days no thyroid feeding of any kind was adopted Tables showing tiie elaborate analyses of the nitrogenoos income and output are appended. The authors arrive at the following conclusions : In a healthy man the thyroid tablets produced in seven days a loss of weight amounting to 400 g., the positive nitrogenous balance steadily diminishing. They attribute the fact Uiat the nitrogenous balance did not bec<nne negative to the circumstance that the thyroid substance had been injured in the preparation of the tablets, since fresh thyroid acts much more energetically. During four days only the above-named patient consumed fresh thyroid, and he lost 1,000 g. in weight, and the nitrogenous balance became markedly negative. It is calculated that one-fifth of his loss of weight took place at the expense of his muscles. Fresh thyroid acts energetically on albuminous dec(»nposition, but some of the efBciency is lost to the thyroid substance in the process of making tablets or in keeping it too long. The administration of the artificial products over long periods of time is, however, not without action on albuminous substances.
THE VALUE OF HYDROCHLORIC ACID IN SCIATICA DISCOVERED BY ACCIDENT.
A somewhat remarkable incident is recounted in the Semaine Medicale, of a patient having arrived at a successful method of treatment for himself, by a merest accident, an accident, too, which was founded on a blundering ignorance of chemistry. A man who had suffered for many years from sciatica was treated in an Algerian hospital by means of hypodermic injections of salt and water, but without much success. After he had left he bethought him that perhaps the salt was not strong enough, and that a stronger preparation of salt might be more successful. He therefore procured some '* spirit of salt " (Hydrochloric acid), and painted it on the knee, getting rid of his long attending trouble in a few days. Having occasion shortly afterws^s to attend the hospital for some other affection, he confided in Dr. Bourlier, professor of therapeutics, whom he saw, how he had managed to get rid of his sciatica. This gentleman thought the plan worthy of trial and employed it in several cases with invariable success. He then told his son, Dr. Maurice Bourlier, who was house physician, and he treated a number of cases with great satis- faction to himself and to his patients. A treatise has recently been published on the subject by Dr. C. Gennatas, of Montpellier, on the basis of a dozen cases of neuralgia of the
250 NOTABILIA. "^I'l'^.^^SfTiSJ!
Review, April 1, 11^98.
sciatio nerve, all of which were completely relieved by tbia means. The procedure is simple enough. Half an ounce of Hydrochloric acid is put in a small cup, and a brush is dipped in it and applied over the painful part of the nerve, three or four coats being painted on. The limb is then enveloped in cotton wool dressing. Of course the application causes a somewhat severe smarting sensation, but this is quite bearable. A few minutes afterwards the skin becomes reddened and hot, and sometimes buUte are formed which fill with fluid. These, even if they occur, disappear in two or three days. Usually the patient feels better even after a single sitting. The application can be repeated in from 24 to 48 hours, but not again for several days for fear of producing sloughs. Of course, too, where there are buUie they must be avoided in subsequent applications. No serious inconvenience is caused by the hydrochloric acid, such as was experienced when a similar procedure was attempted some years ago by Dr. Legroux with strong sulphuric acid, which was found to be liable to cause extensive sloughing of the skin. The twelve patients referred to were all reported as cured in from three to five sittings extending over a week to twenty-five days. It may be well to say the hydrochloric acid of the French Godax is very slightly stronger than that of our own PharmacopcBia. — Lancety Nov. 20, 1897.
SALINE INJECTIONS IN INFANTILE CHOLERA. Loin, of Brussels (Semaine MMicale, clxxvi), in children from six weeks to three months old, the subjects of infantile cholera resisting all sorts of treatment, has had recourse to subcutan- eous injections of normal saline solution in doses of 50 c.cm. morning and evening. After the first or second injection the frequency of the stools diminished, they began to regain their normal consistence and appearance, and in a few days the patients recovered. — British Medical JounuiL
ARSENIC IN CHOLERA. Db. R. B. Leach, of Minneapolis, presented to the 65tfa Congress of the United States, through Senator Davis, a memorial " praying that a test be made of the arsenization method of treating the disease of cholera." He bases his claim for a hearing on the great mortality of cholera, on the facts that the HafHdne treatment is tacitly admitted to be a failure, and that the spread of commerce at the present day makes the appearance of cholera in Japan and China now a matter of greater moment to the United States than at any previous time. He believes that it is not possible always, by quarantine, &c., to exclude cholera from the States, and he
l^A^pSrSS" NOTABILIA. 251
believes that the advantages of a mineral prophylactic such as arsenic are more conspicuous than an animal agent, because it is more manageable. In conclusion, Dr. Leach's memorial states: —
I submit the following syllogism of my theory, and append its similitude, as taken from the text-books of authorities of all *' schools " of medicine, and respectfully dedicate arseni- zation to humanity, as I beseech your honourable intervention in their behalf.
Inoculation with smallpox virus produces symptoms similar to smallpox (Lady Mary Wortley Montague, 1721.)
Inoculation with vaccine virus produces symptoms similar to smallpox. (Dr. Edward Jenner, 1775.)
Inoculation with smallpox virus is prophylaxis against smaUpox. (Lady Montague, 1721.)
Inoculation with vaccine virus is prophylaxis against small- pox. (Dr. Jenner, 1788.)
Inoculation with cholera virus produces symptoms similar to cholera. (Ferran and Haffkine.)
Inoculation with arsenic produces symptoms similar to cholera. (Farington, Virchow, and Leach.)
Inoculation with cholera virus is prophylaxis against cholera. (Ferran and Haffkine.)
Inoculation with arsenic (arsenization) is prophylaxis against cholera. (B. B. Leach, 1892.)
Inoculation with smallpox virus endangers the patient to diseases possibly worse than smallpox. (Historical.)
Inoculation with cholera virus endangers the patient to diseases possibly worse than cholera. (Q. £. D.)
Inoculation with smallpox virus ''went down" before Jeimer's vaccine. (Historical.)
Inoculation with cholera virus must succumb to its legitimate successor, quod erent demonstrandum.
The following comparative schedule of arsenic and cholera is drawn from Heinigke, Cowperthwaite, Herring, Farrington, Baue, Boberts, and Bartholow : —
Invasion Stage.
ABiiENIC. I CHOLERA.
1. Intense anxiety. | 1. Nerrotis disturbance.
2. G«aieral tremblin{r. i 2. Trembling.
3. Exhaustion from slight efforts. | 3. Debilitj : marked depression.
4. Fears to be left alone. | 4. Unaccoantable lowness of
spirits.
5. Binflfing, roaring in the ears.
6. Vertigo.
7. Headache.
& Qreat anxiety about the epi- gastrio region.
5. Noises in the ears.
6. Giddiness.
7. Headache.
8. Epigfastric uneasiness.
252
NOTABILIA,
Monthly HonuBOpatUo Ite%iew, AiNTfl 1, 1806.
1. Pxirging, vomiting. -2. Violent thirst.
5. Violent pains and cramps. 4. Exhaastion.
i). Trembling, cannot rest any- where.
6. Great anxiety at epigastrion*.
7. Stx)ol8 : Pieces of macnous,
dirty water.
8. Intense heat and burning in
the stomach.
9. Drawing, tearing, jerking in
the fingers ; toes drawn downward ; violent shoot- ing, tearing pains in the calves ; catting in abdomen.
Sta(fe of
1. Face hippooratio, shxnnken,
earthy, or livid.
2. Eyes sunken.
3. Lips livid.
4. Parchment-like skin ; clammy
sweat.
5. Pulse thread-like and weak. ^. Respiration short and anxious.
7. Voice hollow, weak, and
hoarse.
8. Sleeplessness, with great rest-
lessness.
9. Dry mouth ; suppressed urine
or nearly so.
10. Aggravated by cold.
11. Vomiting immediately after
drinking.
12. Intense heat in the stomach.
EvaciuUion Statje.
Severe purging and vomiting.
Constant thirst.
Painful cramps.
Prostration and collapse.
Trembling; great restlessness •
Sinking at epigastrium.
Stools peculiar ; ** rice-water :" character, watery ; modi- fied fibrin.
Burning in the stomach.
Cramps in fingers, toes, and calves of the legs and in the thighs, or in the abdominal muscles.
Collapse,
1. Features pinched, shrunken,
leaden, or livid.
2. Eyeballs sunken in their
sockets.
3. Lips especially livid.
4. Skin wrinkled, shrivelled,
bathed in cold sweat.
5. Pulse exceedingly thready
and feeble.
6. Oppression and craving for
air.
7. Voice weak ; extremely tM>.
8. Great restlessness and jactita-
tion, with weakness.
9. No saliva ; urine suppressed
or almost so.
10. Aggravations from oold.
11. Drinks quickly ejected.
12. Sense of heat in the epigas-
trium.
OBITUARY.
CHARLES FREDERICK WATTS. M.R.C.8. ENG.
We regret to learn" that Mr. C. F. Watts has passed away at the a$^e of 88. He has been in feeble health for some years, and died simply from old age at Redhill, where he was under the care of Dr. Gilbert, of Reigate.
Mr. Watts took the diploma of M.R.C.S. in 1838. He at first practised in London for two years, and then went to live at Thames Ditton, where he practised as a homoeopath for 21
[• We regret the delay in the appearance of this notice.— Eds. AT./T.iZ.]
bSSH^x^TS^!^ correspondence. 253
April 1, iSdS.
years till 1881, when he retired from practice, bat lived there till 1887. He then removed to Bedhill, where he died. Before commencing private practice he was house surgeon at University College Hospital. Mr. Watts was a quiet, reticent man, and was not much known to the profession, but was liked much by all who knew him. He, we believe, hardly ever sent out a bill for fees. His only literary production, so fioLr as we are aware, was a repertory of Hempel's Materia Medica. He leaves a widow.
DEATH OF MR. GEORGE MULLER, OF CLIFTON,
BRISTOL. It may not be reckoned out of our province if we notice the death of the venerable philanthropist, Mr. George Miiller, the founder of the Ashley Down Orphanage, at Clifton, on the lOtli ult., at the ripe age of 98. His philanthropic life and work is so well known that we do not require to describe it. He never asked for money, but it always came in freely, and in large sums. He believed in the efficacy of faith and prayer, and such was the wonderful record he had. His life and death, which was sudden, as he was found dead in his bedroom, have a special interest for homoeopaths. Mr, Miiller was a staunch homoeopath all his hfe, his physician being Dr. Eubulus Williams, of Clifton. He put his orphanage many years ago under the medical charge of Dr. Williams, who still carries on the good work, and who has thus had a unique oppor- tunity of showing the value of homoeopathic treat- ment in the various forms of illness, often of a severe and depressing type, which are to be found in the class of children who are received into orphanages. During the visit of the Congress to Clifton last year, Dr. Williams was good enough to conduct some of its members over the large institution.
Mr. Miiller's health had been failing of late, and at Dr. William's earnest advice to ease himself of part of his work, he did so, and, while considering the advisability of having an attendant to help him in dressing, &c., the end came thus suddenly.
CORRESPONDENCE.
THE MODUS OPERANDI OF DRUGS.
To the Editon of the ** Montklt/ Hotmnopathic Bevieiv,'*
Gemtlbmbn, — Although it does not seem to me probable that the real explanation of the homoeopathic cure of disease will be found in Mr. Buist Picken's physical theory, yet, as he invites me to point out where I think his explanations
254 COBBESPONDENCE. "^^1,^^?^
seem to make equally for the allopathic action of medicines, I will ask your permission to do so in a very few words.
To take the illustration of the wave motion of light and ^ound, we have in the first place the fact that for the perfect neutralisation of two undulations, the waves should be of equal shape, size and strength. Now, in therapeutics, this effect can only be obtained by equal doses of the same drug, but that is not homoeopathy. In the second place, these equal waves must crop each other at such an angle, or in such direct opposition, that they may interfere with each other. Now, it is only when vibrations in such case meet each other in opiwsiu phases on the undulation that neutralisation takes place. If they coincide in their phases they merely add to each other's strength.
This oppositeness, which is necessary for wave interference, seems to convey pretty well the allopathic idea of medicinal action, except that in the vital sphere we cannot get such opposite action by the same agent as is possible in physics ; we must employ medicines acting oppositely physiologically.
Consequently the idea of isopathy is involved in the very existence of wave motions of equal character, whilst the actual work done is of the nature of allopathy (more strictly Enanti- opathy) for the neutralization of wave motion is of the nature of simple, mechanical antagonism when minutely examined.
This is what was in my mind when I wrote in reply to Mr. Buist Picken, and it remains to me an objection which may be removed by him if he thinks it worth while. In any case I hope he will see where this particular difficulty lies, and credit me with the desire to accept his views as far as I can so as to make his analogy complete.
Yours, &c.,
February 20th, 1898. P. Proctor, L.B.C.P.
A STRAMONIUM CASE IN INFLUENZA.
To the Editors of the ** Montfdy Homeopathic Review/*
Gentlemen, — Your Influenza Number is a very interesting one. May an Ignoramus supplement it with an interesting Stramonium case ?
I went on Sunday afternoon to see A. B., who was very ill.
He was in bed, throwing himself about, talking nonsense, jerking his arms, laughing, starting violently when spoken to or touched. He vomited green matters, and complained of a violent pain in his head, <* right in the hairt of his heed," as he explained afterwards. His pulse was very full and very
B^f^rS^ CORRESPONDENCE. 256
fast, his head baming. Every few minates he asked for water ; but he said tliat it ivag blacky and diat everybody looked black.
In these days of Inflnenza, he got first what had been taken down for him : a couple of drops of Pyrogen 6. Under this the poise moderated; he became more quiet, ceased io demand water, and was able to describe the fearful pain, like no pain that he had ever felt before, right in the middle of his head. But everything still looked black, and again he vomited green and bitter stuff. For that he got one dose of Crotalus, which did not stop it ; while the symptom, " Every- thing looks black," was referred to Allen.
Stramonium turned out to be the medicine, covering the whole case perfectly — tossing, starting, jerking, fever, green vomit, pain in head, and the key-note, " Your fsiCQ is quite black ! " Luckily, I had a good supply of Stramonium 80 ; and under its influence he soon dozed off comfortably. The globules were continued, from time to time, all night. In the morning he seemed all right ! By mid-day he was up and sitting by the fire, without a single Stramonium symptom left. When his wife laughed at hun for behaving so oddly the evening before, he said that what he imagined was that he had a bran bag under each arm, and that he fitted his head into one, and, as that was not right, he took it out, and fitted it into the otdier.
At night there was a slight return of the pain, which yielded to Stramonium easily, though the skin on the top of the head remained painful to touch for several days. After this he was up every day, but not wisely ; since he had some fever till Thursday (as high as 101 of an evening), and some bronchitis ; on Friday the temperature was normal. I wish I could give temperature, or pulse, that first evening. I am afiraid (a touch of the wrist proclaiming fever), I only was con- cerned to find a remedy, and not to record a case !
By the way, no one mentions Pyrogenium for Influenza ; and I have so often cured colds and influenzas (in the first stage of chill just turning into fever ^ with that peculiar boiling in ones head and veins that everyone knows who has made acquaintance with the fiend^. Two or three doses will often completely avert an attack. Then another medicine that may come in handy for the bone pains is Natrum PIios, 1 have given it, because the acid saliva of influenza patients has three or four times taken all the lettering off my thermometer, which is at the present moment bare and difficult to read* Has any one else noticed this?
Yours obediently,
Jjondon, March 6th. A Beadeb.
266 CORRESPONDENTS. 'Be*lw5\^T'i?llS.T
To the Editors of the " Monthhj Homoeopathic Review.'*
Gentlemen, — Knowiog that you are interested in Jieiv (?) remedies, I enclose you a cutting from a U.S. paper of recent date.
*< Tincture of Horse Chestnut is proposed as an infallible remedy for hemorrhoids in doses of 10 drops daily. A marked improvement is said to take place after two doses and a cure effected within a few days." — Philadelphia Pott. Yours truly,
A. Stoddabt Kennedy. 45, Welbeck Street, Cavendish Square, W., March 7th, 1898.
NOTICES TO CORRESPONDENTS.
*^* We caniwt widertaUe to return rejected mauHMcripte, Authors and Gontbibutobs receiving proofs are requested to correct
and return the same as early as possible to Dr. Edwin A. Nbatbt.
London Homobopathic Hospital, Great Ormond Street, Bloomsburt. — Hours of attendance : Medical, In-patients, 9.30 ; Out- patients, 2.0, daily; Surgical, Out-patients, Mondays, Tuesdays, Fridays and Saturdays, 2.0 ; Diseases of Women, Out-patients, Tuesdays, Wedneisdays and Fridays, 2.0 ; Diseases of Skin, Thursdays, 2.0 ; Diseases of the Eye, Thursdays, 2.0 ; Diseases of the Throat and Ear, Wednesdays, 2.0 ; Diseases of Children, Mondays and Thursdays, 9 A.M. ; Operations, Tuesdays, 2.30 ; Dental Cases, Thursdays, 9 a.m.
CommunicationB have been received from Dr. J. D. Hatward. Dr. W^ioglesworth (Liverpool) ; Dr. C. H. Blacklet (Southport) y Professor Aldrich (Minneapolis) ; Dr. J. R. Day (London).
BOOKS RECEIVED
Xinth Annual Report of the PkUlips' Memorial HomtBopaihie Jfo*- pital and I>ixpenjtary for Vear ending Decevhhcr^ 1897. — the Ilomceo^ pathic World, March. London. — Tlie CTiemist and Druggist , March. London. — The North American Journal of Homatopathy. February. New York.,— TJte Medical Tinier. March. New York.— 2%« Ilmnoeo- pathic £gcy Ear, and Throat JovrnaL March. New York.— J%«' Ifahnemannian Monthly, March. Philadelphia. — The HonuBOpathir Recorder, February. PhUadeiphia. — The Hommopathic Phytdeian.- January. Philadelphia. — The Clinique, January and February. Chicasro. — TJte Ifahnemannian Adrocate. February. Chicago. — The Medical Era, February and March. Chicago. — The American Medi- cal Monthly. February. Baltimore. — Tlie Medical Brief. March. St. Louis.— y%<? Ilomceopathie Enroy, March. Lancaster, Pa. — The Minneapoli* Htmucopathie Magazine. February. — Indian Howeeopathir Rerifiiv, January. Calcutta. — The Calcutta Journal of Medicine, February. Calcutta. — Revue Ilomceopathique Frangaiec. February. Paris — Rerue Ilornctnjmthiq'ue Beige, January. Brussels. — Archir, fur HofnOopathic. March. Dresden — AUgemeine ffomSopathische Zeitung, March 8 and 17. heipKig,^Leipziger Populdre Zeittchrift fUr liomoojfathie. March. — Homwopathische Maandolad, March. The Hague.
Papers, DispetMary Beporta, and Books for Beview to be sent to Dr. Popk, 19, Watergate, Gia&tham, lincolnshire ; Dr. D. Drcx Bbowv, 29, SeTmoor Street, Port- man Square, W.; or to Dr. £nwi.v A. Kkatbt, 178, Haverstock Hill, N.W. Advertaae- menta and Bnainess cooimunioations to be sent to Mtawn E. Oodlo 9t 8ov, 60 Mooxga«e Street. B.C.
1 S*Sf£7«??SS."' HOMEOPATHY. 267
THE MONTHLY
HOMCEOPATHIC REVIEW.
-:o:-
HOMCEOPATHY.
Well nigh every communication to the medical press purporting to give a representation of homoeopathy, which has proceeded from non-homoeopathic practitioners, discloses so complete an ignorance of that which those members of the profession who practise homoeopathically understand by this term, that it seems to us desirable,, once again, to devote an article to considering what the ground is which the word homoeopathy covers. At the same time, the question of consultations between homoeo- pathic and non-homoeopathic practitioners, which ha& recently been under discussion in Bradford, is one quite independent of the truth or falsity of homoeopathy, however correctly it may be stated.
The rules of the Bradford Medico-Ethical Society, at the time when the discussion commenced, obliged a member not to meet in consultation any one who con- ducted his practice otherwise than in '^ an honourable and legitimate manner." To regard the selection of medicines for the treatment of disease in dependence upon homoeopathy, to prescribe such medicines in small, though^ as experience has proved, sufficient, doses as dis- honourable and illegitimate is, as Mr. Malcolm Mobris
Vol. 42. No. 5. B
258 HOMEOPATHY. ^"S^H^^J^^^
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wrote, " unwarrantable/' When the teaching of physi- cians, who while living have been, and of those still amongst us, who are regarded as men of light and lead- ing in therapeutics, has been and is like that of the present President of the Eoyal College, " that we know next to nothing of the action of medicines and other therapeutic agents," and who at the same time, with a full consciousness- of their ignorance, spend their days in writing prescriptions of medicines of the " action " of which they " know next to nothing," is it not contemptible for one medical man to say to another, and still more so for a medical society to say to a large body of well educated and experienced medical men — ** I insist that you believe so and so," (in this instance the ** so and so " is homoeopathy), " or I will disown you as a medical brother?" Sir William Gairdner admits that no one has a title to take up such a position, and a fortiori no Society has, for he added : ** There is no opinion so modern or so eccentric that he must perforce reject it." Therefore there is no opinion so modern or so eccentric that anyone holding it, and day by day acting upon it, can be refused the assistance of a consultation with one who does not entertain an opinion of either variety. The very notion of refusing to meet a homoeopath in consultation is an illustration of Fara- day's well known dictum that, on many very important matters, men's judgments and convictions are almost entirely at the mercy of passions, prepossessions, and even of pure ignorance. It is so in the case where con- sultation is refused to a medical man who practises medicine homceopathically.
The refusal of assistance to aid in relieving saffering is, by the order of the Bradford Medico Ethical Society, denied to a medical man, who avows that he believes in homoeopathy. With the "passions and prepossessions " that have determined this conclusion, we cannot hope to deal ; " pure ignorance " is, on the other hand, more amenable to the influence of knowledge, and this we will endeavour to supply.
Homoeopathy is a therapeutic doctrine, an induction of Samuel Hahnemann's from observed facts noted in the literature of medicine daring the 2000 years preceding his researches, commenced rather more than a century ago.
lJ^«Sr5STSS!^ HOMEOPATHY. 259
Mr. Simon in his Lectures on General Pathohgy (1850) writes: ''That which essentially marks the operations of science is the reduction of an infinite exterior diversity into systems and formulas expressive of mutual relation."
In the present instance, the object of the research was the ascertainment of the '* mutual relation" which exists between the action of drugs on healthy men and women on the one hand, and on diseased men and women on the other. The material for such a research was ready to hand. All that was required to make use of it was to be found in a medically cultivated intelligence, supplemented by unflagging industry in analysing the records of medicine. Disease has existed in all ages. Drugs have ever been used to promote recovery from it. Injuries too have, both designedly and accidentally, been inflicted on human beings by drugs as long as they have been in use. Scattered up and down in the literature of medicine since the days of Hippocrates, and more especially within the last 800 years, are records of cases cured by certain drugs, and reports of the phenomena producible in healthy persons by the same substances. From such a collection may be obtained precisely the kind of facts, needed for the determination of the mutual relation between drugs and diseases, requisite to determine its nature. It was from 43 drugs reported on by 800 observers — men of consideration in their day — examined in this manner that Hahnemann drew the conclusion that this mutual relation was expressed by the ancient but neglected Hippocratic formula, similia similibits curentur. In 1869 Dr. Dyce Brown made a similar collection from the works of Trousseau and Pidoux, Pbreira, Wood, Waring, Christison, Taylor, and Graves. The drugs examined by Dr. Brown are 40 in number. Thirteen of these had previously been studied by Hahnemann, while 27 are an addition to those he had derived from the literature of the past. If an observation of natural phenomena can be utilised by comparison and analysis, for the formulation of an expression of mutual relation, those recorded of 70 drugs may be safely employed to ascertain that which subsists between the disease- exciting and the disease-curing powers of drugs in general.
8-2
260 HOMEOPATHY. "^^^^^S^^^
What, then, do we find by studying these illustra- tions? Throughout the entire series of observations there runs one fact common to all — one phenomenon characteristic of all, one which is of the essence of all — viz., that the drug which bad been observed to cure a given disease, had, in every instance, been observed to produce a similar morbid condition in a healthy person. By the recognition of this principle, all the facts so collected become susceptible of classification.
Thus was demonstrated the fact — it is no theory — that aimilia similibus curentiir. That such a therapeutic maxim contained a therapeutic truth had been suspected, and more than suspected, by Hippocrates in ancient times, and among modern writers by Bouldac^ Detharding, Bertolin, Floury, Stoerck and Stahl. Hahnemann's great merit consists in that, while recognising the priority of his predecessors, he thoroughly established the validity of this therapeutic principle, and the vast extent to which it is capable of clinical appUcation, in his having made experimental researches into the action of so large a number of drugs as he did, and in having worked out a plan by which it might be put into practice.
It is this principle of drug selection that constitutes Homceopathy ; and howsoever it is carried into practice,. whether by Hahnemann's method or any modification of it, that practice is the practice of homoeopathy.
Oftentimes, indeed we might say generally, when a non-homceopathic practitioner essays to refute homoeo- pathy he pictures it as a mode of giving globules instead of boluses, or as the psora theory, or as the dynamiza- tion theory, or indeed as anything but what it is, any- thing except what it is understood to be by those who have devoted time and effort to its study and practice. Thus Dr. Wiolesworth, in his letter to the British Medi- cal Journal (Feb. 5) deUvers himself in this wise : —
'< True homoeopathic treatment — not the bastard homoeo- pathy now generskily practised — rests on the due observance of these two axioms: 1. That a drug which will induce a given disease in a healthy subject will, when that disease spontaneously arises, be a specific for its cure (giving rise to the formula similia dmilibus curantur). 2. The more minutely the drug is divided into doses the greater its potency for effecting a cure."
2SS2Sf5r?Sf^ HOMEOPATHY. 261
The first of these two axioms is a more or less correct definition of homoeopathy, the second has nothing what- ever to do with it.
Then we are informed, with some solemnity of style, *'Now either these principles — these theories — are true, or they are false." Pretty much the same may be said of all principles, all theories ! This statement is followed up by an assertion, which Dr. W. would have no little difficulty in proving. ** Investigation," he writes, *' scientific and practical, has denounced them as false as they are absurd by the vast majority of the medical profession, who are ever open to the reception and adaptation of scientific facts." Homoeopathy has never been denounced after any scientific or practical investiga- tion of it. Tract No. 11, published by the Homoeo- pathic League, entitled Official Trials of Honujsopathy^ Vol. I, p. 121, (Homoeopathic Publishing Company, 12, Warwick Lane, E.G.), gives a complete account of ,every supposed public enquiry into the practical value of homoeopathy during the last sixty or seventy years. In it Dr. W. will see that in making the assertion we have quoted from his letter, he has allowed his judgment and conviction to be entirely at the mercy of his prepossessions against homoeopathy, and of his ignorance of it.
Dr. W. is very indignant with what he is pleased to term "bastard homoeopathy." By this, he is good enough to explain, that he means " a homoeopathy which is practised upon a supposititious idea of drug action upon a healthy subject, but which has never been put to a practical proof." Dr. Wiglesworth would have made his meaning clearer if he had, while endeavouring to make himself understood, explained his explanation ! What is a '' supposititious idea of drug action upon a healthy subject, which has never been put to a practical proof " ? The records of the effects of drugs in disturbing
. the human health, collected together in the Cychpcedia of Drug Pathogenesy, have always seemed to us very real indeed !
Finally, Dr. Wiglesworth assures us that ** there is a great divergence of opinion concerning the second axiom,"
• which we have already quoted. We can assure him that there is no divergence of opinion upon this "axiom"; it is one which we never heard of before, one which has no connection whatever with homoeo-
262 HOMEOPATHY. "^^SJJw^SS^S^SaT
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pathy. Homoeopathy, as we have stated, is the selection, as medicines for the treatment of the sick, of substances which produce symptoms of disordered health in healthy persons like those the physician wishes to relieve or cure. Like everything else, homoeopathy may be put into practice perfectly or imperfectly, carefully or rashly, intelligently or ignorantly. The experience of the last hundred years has shown that to do so to the greatest advantage, one must possess the records of experiments upon the healthy with as many drugs as possible. That while the dose necessary to elicit the antipathic action of the drug must needs be as large, or nearly so, as is consistent with the safety of a patient's life, that which is requisite to develop its homoeopathic action must needs be small. How small this should be can only be stated in the very general rule, the quantity prescribed must be smaller than that which has been found necessary to produce the symptoms which led to its prescription^ This again will be modified by circumstances relating to the patient, such as age, sex, temperament,, habits, &c., the nature of the disease from which he suffers, and the drug itself. As to the limits within which the effect of a medicine will be influenced by the smallness of the dose in which it is given, we know nothing with certainty. The most suitable dose of a homoeopathically selected medicine can only be determined by individual experience. As Opie, the great artist, when asked by a pupil how he mixed his paints, replied, '' with brains, Sir;'' so the best dose in which to give a homoeopathically chosen medicine must equally be determined " by brains." Experience is, in this matter, our only safe guide. The late Dr. Abnold, Professor of Pathology at the University of Heidelburg, gave the following as the result of his twenty years' experience.
** After," he says, ** I was convinced of the truth of Hahne- mann's law of cure, I deemed it my duty to listen to the repeatedly expressed desire of the reformer and repeat his experiments exactly. As far as the doses were concerned, I did this with great unwillingness, and with great scepticism as to the results. Nevertheless, I saw not a few cases recover after the administration of medicines in the tenth, twentieth, and even thirtieth centesimal dilution. I observed not only qpeedy cure of acute disease, but also frequently a remarkable
iSS^fiSr^lSj?^ HOMCEOPATHY. 268
change in many ohronio oases. I grant readily that many of the cores which encouraged me in the commencement of my homceopathic experiments were not dae to the small doses of medicine ; bat that all the results are to be ascribed to the healing power of nature alone, I can by no means convince myself, even with all the forces of scepticism. I saw in not a few cases which had resisted the most different modes of treatment, cure take place after a small dose of a carefully chosen homoeopathic medicine. In not a few cases, however, I waited in vain for any curative result from the small doses ; but nevertheless, distrusting myself rather than the precepts of Hahnemann, I at first sought the cause of failure, not in the insufficiency of the dose, but in error in the choice of the medicine. This brought on me many cares and troubles, mitil I saw myself obliged to descend to lower dilutions. I was soon convinced that these yielded much more certain results, without the so-much -dreaded disadvantages. In this manner, guided by experience, I arrived step by step at the position that it is never necessary to administer medicine in any dilution or trituration higher than the sixth dec. (third cent.), and I have never had to complain of any hurtful collateral action, or any primary action, that disturbed the cure. But I must add, that it is only very seldom, and with very powerful medicines, and in very susceptible patients, that I ever go as high as the fifth or sixth dec. dilution, that in general I confine myself to the first or second dilution or trituration, though not unfrequently I find it necessary to go up to the third or fourth dec. dilution for these purposes. In the six lowest decimal dilutions and triturations, I consider that we possess a scale suitable to afford the corresponding doses for all the present known diseases.
'* In a period of ten years I have never found it necessary to go above the sixth dec. dilution, but I have often been obliged to give the specific remedy in stronger doses, such as several drops of the pure tincture, or one-fourth, one, or even several grains of the original preparation." ^^'
What now are the limits within which homoeopathy, intelligently practised, can be of advantage in relieving the sick ? Cases there are, and more especially parts of cases, where the administration of a palliative, an anti- pathic medicine, supplies the only relief that a drug can afford.
Whilst it is the duty of the physician, who knows by experience that, if he can find a remedy which is homoeo-
•Dfl# RationeU Specif itehe oder Idl&patkitche Heilverfahren, By Dr. Wilhelm AmokL Heidelbarg, 1851.
264 HOMffiOPATHY. *^i^^^S^^^
Beview, May 2, 1886.
pathic to bis patients* condition he mil do him the highest degree of good, to search for and to give that remedy ; if, on the other hand, the condition is one to which no medicine is known to be homoeopathic, it is equally his duty to resort to any measure, whether medicinal or surgical, that holds out a prospect of affording relief. Cases of this latter class are few in the extreme. Con- sequently, save in a few well defined instances, the frequency with which a physician, who knows that homoeopathy is true, resorts to some empirical or merely palliative expedient, will be found to be in inverse proportion to his familiarity with the Materia Medica.
Dr. WiGLBswoRTH, in the latter portion of his letter, again refers to what he terms " bastard homoeopathic practitioners," who accept the guidance of homoeopathy in some instances, and of allopathy, or, more correctly speaking, of antipathy, in others. The excuse made **is," he says, "that there is allied truth in both sys- tems. This statement," he continues, **is both absurd and untenable." It is neither the one nor the other. To attempt to cure disease by the aid of drugs, homoeo- pathy is alone of any value. To endeavour to relieve suffering, proceeding from incurable organic disease, while, in many instances, a homoeopathically selected remedy is all sufficient, in others it is not so. The pain of cancer, say of the rectum, cannot be relieved, in most cases, save by morphia ; the excruciating agony, which attends the passage of a gall stone, can rarely be mitigated by any other means. It is sad that such should be the case ; for while the suffering is lessened, the disease is uninfluenced by it.
Hence that similia similUms curentur directs the prac- titioner to his most efficient drug remedies in far more than ninety-nine per cent, of the cases that come under his observation, it is equally true that contraria contrariis <urantiLT points him to drugs which, in a few instances, will most completely enable him to give his patient that modicum of relief which is all that his condition admits of his receiving.
In conclusion, we may repeat what we wrote in this Review just thirty years ago : — " Homoeopathy is a .method of drug selection, and this alone. It consists in prescribing for disease a medicine, the physiological action of which is similar to the pathological process
b^^^iSSb^ on hammer toe. 265
tgoing on in the patient. Carry this principle into practice, howsoever we will, we practise homoeopathy. Those who have had the largest amount of experience in doing so are agreed, that most effectually to apply it, the physiological action of drugs must be ascertained ; that the remedy prescribed should be given uncombined with any other ; that the quantity ordered should be less than that required to excite its physiological
action Were every other view expressed
by Hahnemann shown to be erroneous, homoeopathy would still remain unassailed. This principle or law, and the method of practically applying it at the bedside, must be tested experimentally before it can be disproved. No amount of argumentation can show it to bo a wrong principle."*
ON HAMMER TOE AND ITS TREATMENT. * By Dudley Wmght, M.R.C.S. Eng., L.R.C.P. Lond.
Avsistant Sarg^eon and Surgeon for Diseases of the Throat and Ear to the London Homoeopathic Hospital.
The deformity to which the name of Hammer Toe is -given is one which, though somewhat common, is often present for a long time before it attracts the attention of the patient, or troubles him sufficiently to cause him to seek advice.
Though in some cases this condition appears to be hereditary, in so far as one or both parents or other relatives have been similarly afflicted, there can be no doubt that in the majority of cases it is an acquired defect.
In the normal foot the second toe is the longest, or at any rate projects a certain distance beyond any of the •other toes, and it is, therefore, upon the point of this toe . that the stress of pressure caused by short boots is likely to fall. In order to accommodate itself to the restricted space, flexion of the proximal interphalangeal joint takes .place, with the result that a tendency to hammer toe is produced, which in time becomes a permanent condition. The position of the toe is depicted below, and it may be remarked that though the deformity may be present in
• Monthly Homctopathic Revieto. vol. xii., April 1868, p. 199.
266 ON HAMMER TOE. "^^'iL^^STTSST
Review, May 9, IfittS.
any of the toes, it is far more commonly met with in the second than in any of the other digits.
Diagram showing the Position of the Bonee in Hammer Toe.
{The position of the epiphytial line U indicated by the shudittg, and
the arrow marks the direction of preuwre).
With the establishment of this deformity certain secondary changes take place in the structures involved. It is only reasonable to suppose that shortening of the flexor tendon occurs in accordance with the well recog- nised law that a muscle relieved from tension for a long period tends to shorten. The ligaments on the plantar aspect of the joint likewise probably partake in the same change. Attention has, however, been chiefly drawn to the lateral ligaments by the researches of Messrs. Shat- tock and Anderson, who independently and simulta* neously showed that the lowermost fibres of the lateral ligaments became shortened, and thus formed a bar ta replacement of the bones in their normal position.
From observation of a number of cases that I have operated upon, I am inclined to think that a change occurs in the head of the proximal phalanx, which, though slight, is of some importance in view of the correct treatment. This change is one which is sa commonly met with in other cases as a result of pressure upon the growing point of bones, viz., expansion of the part upon which the least amount of pressure is exerted.
It will be remembered that the phalanges of the small toes have their epiphysis — and therefore their point of maximum growth — situated at the distal end» In the abnormal position of the toe produced by the short boots the pressure is no longer on the extreme end of the phalanx, but more towards its under surface (in the direction of the arrow in the diagram). It can hence easily come about that growth will most likely be
IS^jS^t^S^ 0^ H^MMEB TOE. 267
more abundant at that part of the head in front of the point of pressure, and this may occur to such an extent that some amount of deformity is produced, whereby replacement of the middle phalanx in its normal position is hindered, although the other restraining causes, such as shortened ligament and tendon, be overcome. In connection with this point it may be noted that the deformity is usually acquired in early life, when the fast growing foot of the child is pressed upon by the boot which it has outgrown.
The symptoms produced are mainly due to the troublesome corn which develops over the site of the most prominent part of the toe. This is constantly pressed upon and irritated by the boot, and is a source of great inconvenience to the patient, often preventing long continued walking. It is this secondary trouble which usually brings the patient to the surgeon, and attempts to cure the corn without rectifying the mal- position of the toe are fruitless, in all but minor cases.
The treatment which was formerly adopted in these cases was amputation of the offending member. This is a proceeding which is not only unnecessary, but moreover may lead to further deformity in the great toe. If the second toe is removed, the great toe loses the support of its neighbour and tends to be pressed inwards. The result of this is the projection of the head of its metacarpal bone on the lateral aspect of the foot and the occurrence of a bunion which may prove even more troublesome than the original malady.
The plan of treatment usually now adopted is to divide the contracted ligaments and tendon subcutaneously , and to retain the toe in the corrected position with splints.
Now this form of treatment entails a considerable period of incapacity for the patient, often going into eight or more weeks, and from what I have seen of it, is not very infrequently followed by a relapse. This I believe in part to be due to the fact that in the planning of this operation two things have been overlooked. First, that the toe should be replaced in an over extended condition in order to prevent recurrence of the contraction of the parts ; and secondly, that the change in the head of the bone, which I have above indicated^ lias not been attended to.
268 ON HAMMER TOE. ^^^I'wfSJT^'
In view of these facts the following method is advised, and is the only one which I now adopt.
The usual precautions are taken to render the toes and foot aseptic, especially about the nails. A piece of indiarubber tube is tightly twisted round the root of the toe to be operated upon and retained by catch forceps. This will stop all bleeding during the operation and render the field clear for all manipulations. An incision is made over the flexed joint, this incision being in a vertical direction and may, with advantage, be made to include a small oval of skin containing the 'Corn which is situated here, this being removed. The joint is now exposed, and the soft parts should be thoroughly separated on all aspects from the joint, the instrument used for this, whether scalpel or scissors, being kept close to the bones so as to avoid injuring the digital arteries. This having been done, the joint is now pushed out through the wound and the ends of the two phalanges made to project by cutting through the articular ligaments. The cartilage-covered ends of the two bones are now shaved or sawn off. The whole £eld of operation is thoroughly cleansed, and the elastic tube removed, and the oozing of blood stopped by sponge pressure. One or two silkworm gut sutures close the wound and a gauze dressing is applied, the two ends of the bone being placed accurately in con- tact. Care should be taken before tightening the sutures that all exuded blood is expelled from the wound. A small gutta percha or zinc splint is placed under the toe and strapped on over the dressings, and the whole is now surrounded by cotton wool and a bandage applied. Healing usually is perfect at the end of a fortnight, when the dressings may be removed and the stitches taken out, but the splint should be retained for a week longer. At the end of this period union of the two bones will have resulted in a straight position, the deformity being corrected with a shortened toe — a point of some importance — since the digit no longer gets the pressure of the boot on its point, and hence recurrence is less likely.
I have now performed this operation of resection of the joint several times, and have not yet seen a recur- rence of the deformity, and can recommend it to all who may be called upon to treat this condition.
^Iwf^Tna*"^ WHITLOW. 269
WHITLOW.
By John McLachlan, M.D., B.Sc.,Edm; F.R.C.S. Eng.
Synonyms : Paronychia ; Felon ; Panaris (French) ; Panaritiam (German).
In general practice one comes across cases of whitlow not infrequently, and at times they caase a good deal of anxiety to the practitioner. Whitlow has been defined as an erynpeloB inflammation of the Jinger, and it certainly has many points in common with that variety of erysipelas known as celliditis. 1. The causes are the same. 2. There is usually great constitutional disturb- ance. 8. The inflammation is diffuse and tends to go on to suppuration and sloughing. 4. There is the erysipelas-like blush of the back of the hand and arm.
Classification. — We may classify the varieties of whitlow in various ways : —
1. Paronychia ungualis.
2. Paronychia cellulosa.
8. Paronychia osseosa, or rather, Periostei, (the maligna of some writers).
4. Paronychia tendinosa.
1. Ungualis. This is the simplest and most superficial form, in which we find a drop of pus between the dermis and epidermis ; this variety, as the name implies, is usually limited to the ungual phalanx, and is often at the side of, or round the root of, the nail, (a *' runaround'*). It corresponds, I believe, to the superficial xchitlow of Abernethy ; and, in its early stage, to the ^^ mere erythema'' of Christopher Heath, and in its later stage to the ^^superficial whitlow " of the same author. The pus may penetrate the true skin and so merge into the next form by direct extensionj or it may give rise to it from the absorption of its septic mutter. It may also affect the matrix of the nail, and thus lead to onychia J with temporary or permanent deformity of the nail. Whatever treatment may be adopted, I believe a poultice of boric lint is of great value, together with clipping away any dead cuticle. I mean by a boric pcmltice^ three or four layers of boric lint wetted with hot water and covered by oiled silk and cotton wool ; the essential nature of a poidtice is simply that it is a
^70 WHITLOW. "S^=S???Si'
B«viewp lUf S, 18S6.
means of applying heat and moisture, and the boric acid present in this case makes it antiseptic as well.
A form of superficial whitlow is sometimes seen occur- ring without any apparent cause and attacking one finger after another. The fluid beneath the cuticle is not always purulent, sometimes being merely albumi- nous and mixed with flakes of lymph. It never leads to any deep suppuration. It is most common in children and females, and is consequent upon general debility, or upon unknown epidemic or endemic influences being most frequently met with in the spring — ^perhaps ** sycotic ** in nature. It is described by French writers under the name of toumiole or panaris phlyctenoide. Clinical experience would seem to indicate that nat. sulph. ought to be very useful in this variety of whitlow.
2. Cellulosa. — The cellular tissue whitlow is usually the result of a poisoned wound, though it may some- times arise idiopathically, or it may be secondary to the superficial form. As a rule it arises either in the cellular tissue of the pulp of the ungual phalanx, or at the root of the finger. It may lead to necrosis of the terminal phalanx, or it may open into the sheath of the tendons.
3. Osseosa. — This variety usually leads to necrosis of a part of the terminal phalanx. It may arise (a) as a primary "acute necrosis," (b) secondary to the cellular tissue whitlow. Usually only a part of the phalanx, dies, the proximal end where the termination of the flexor sheath is attached and where the long flexor tendon is inserted as a rule escapes death, and thus the joint is preserved intact. The distal portion of the bone dies (1) because of the interference with the periosteal blood supply from the great tension, and (2) because of the absence of the tendon sheath on that part of the bone.
4. Tendinosa. — I doubt whether this variety — the true ** thecal abscess*' as it is termed — ever occurs as a primary affection ; but it may be (a) secondary to the osseous and cellular tissue varieties, (b) Caused by the surgeon opening the sheath of the tendon when incising a cellular tissue whitlow. By this means the synovial sheath is infected with septic matter, and the usual results are, spread of the inflammation, sloughing of the tendons, and a useless finger. In such cases when the little finger or thumb is affected (the synovial
^^J^^S^' WHITLOW. 271
sheathB of which are continuous with the common sheath at the wrist under the anterior annular ligament) the suppuration rapidly extends to the palm of the hand and to the forearm above the anterior annular ligament ; further the wrist joint itself may be opened and destruction of the whole hand result.
It must not be thought that I mean to imply that a tenosynovitis never occurs, for undoubtedly there are at least two distinct varieties, (a) Suppurative, which is usually traumatic and septic, (b) The lympby variety resulting from constitutional causes ; but then these forms of teno-synovitis would hardly be included under the head of* Whitlow."
Tbbatmbnt. — ^When I was a student the diagnosis and treatment of whitlow were exceedingly simple — for the surgeon. A patient is brought in to the out- patient clinic, suffering, we will suppose, from whitlow. The presiding surgeon asks one question, ** Did you sleep last night ? " The patient probably says " No." " Ah ! ," says the surgeon, '' whitlow in the sheath of the tendon : free incision down to the bone." But perhaps the patient affirms he did sleep last night, but it docs not make much difference for the Jiat still is — a free incision down to the bone lest it burrow into the sheath of the tendons. In this little operation two points were strongly insisted upon (1) to have something firm and unmovable (wood or stone) behind the patient's hand, so that it would be impossible for the hand to descend from the knife, though it might be drawn towards the patient ; (2) to eut in the middle line with the edge of the knife directed towards the tip of the patient's finger, so that as the hand can only be pulled towards the patient, and not depressed, the incision will be enlarged in the proper direction, and no injury done to the patient (?) or surgeon. Now if a student, being examined in his final " triple qual. " let us say, the subject under discussion being whitlow, did not give these cut and dried answers on the treatment of this affection, he would have stood in great danger of being " referred to his studies " for three months at least. I am ashamed to confess that once upon a time I believed and taught this method of treatment, being at that time sunk in the deepest depths of therapeutic darkness, knowing nothing of the real healing powers of drugs in such conditions, and ready
272 WHITLOW. ''f^I.^SS^^r
to sneer at anyone who ever saggested the possibility that drags covld be of use in sach an evidently surgicaL case.
Are we then never to use the knife in whitlow ? I would not go quite so far as to affirm that it should never be used though I have not used it for many years, and. if I had to use it, I would look upon the case as a failure, not of homoeopathy, but of my powers to apply it properly. One thing is certain, if the knife is to be used it ought not to be done in that blind and reckless manner usually recommended, for the sheath of the tendons must not be lightly opened into as the risks to the patient may be very serious. I have seen the sheath opened on various occasions but never yet saw it contain pus, nor the synovial lining even evidently inflamed. I have frequently seen fingers so disorganised as to be deemed worthy of amputation, and yet when the tendon sheath was laid open afterwards it was absolutely unaffected, being as smooth and shining as in health. If, however, a case is really doubtful, then give the patient an anaesthetic, render the limb bloodless by Esmarch's method, and dissect calmly and quietly through the doubtful part ; in this way the exact position of the pus can be ascertained with certainty, and all haphazard butchery (misnamed "heroic" surgery) avoided. A poultice of boric lint is of great value as already stated, elevation of the hand by means of a sling and entire functional rest to the limb absolutely imperative.
Therapeutics. — ^Various remedies have been credited with producing panaritium, or "a feeling as if* or a " tendency " to it. It is unnecessary for me to give a list of such, I will content myself with giving a few particulars (culled from various sources) of a few medicines which I have found most generally useful in practice, together with the names of one or two others which though I have used but little in practice, I have always in mind when I meet with cases of whitlow.
Anthracinum : Said to be useful in the worst cases of felon or whitlow, with sloughing and terrible burning. Compare its use in the worst forms of Carbuncle. Often useful where arsen. seems indicated, and fails to relieve.
Apis : I have never had occasion to use this remedy in whitlow. It has cured many cases of whitlow with burning, stinging and throbbing; especially useful ia
i^^M:!^rSSt'^ WHITLOW. 278
Beriew. May Z. l««.
" run-aroonds *' after abuse of sulphur, also in '' dissecting wounds." From its action upon serous membranes generally, it is likely to be useful in cases of teno-synovitis septic or otherwise, as well as in traumatic erysipelas with great oedema. Sulphur is its complement and follows it well.
Arsenicum : When gangrene is present, with a great desire to have the part wrapped up warmly. In its general indications it resembles anthracinum, though the latter remedy seems to be suitable for a more advanced and a more serious state of affairs. Hence anthrac. is given after arsen. fails to relieve the intense burning pains and other symptoms.
Fluoric acid : Cases of whitlow where this remedy is likely to be of use are relieved by washing or sponging with cold water, and aggravated by the application of heat. It seems to affect the fingers of the left hand rather than those of the right, and the pus tends to point on the dorsum of the finger. About a month ago I had a typical example of this variety, and where fluoric acid acted like a ^* charm." The ** pointing " on the dorsum is a real thing, and not a mere sympathetic cellular tissue abscess. It is possible that incisions are frequently made into the pulp of the ungual phalanx of the finger when the pus is really on the dorsum; this mistake arises from the sense of fluctuation yielded by the pulp of the swollen finger covered by its thickened cuticle, even when no fluid is present. Fluoric acid and silica are both useful in bonefeUms, but observe that silica is aggravated by cold applications and ameliorated by warmth — the reverse of fluoric acid. Fluoric acid is also useful in cases of onychia resulting in deformity of the nail, as often happens in cases of paronychia umiuaUs.
Hepar : Useful in cases where there is extreme sen- sitiveness to touch ; cannot even bear the weight of a poultice, though the heat of the poultice ameliorates ; patient likes to sit beside the fire. Parts affected often the right thumb or a finger, with violent throbhirif/ " gathering pain." Lachesis is complementary to hepar in this affection.
Lachesis : Besembles arsen. and anthrac. in its applications ; in cases of gangrene, or where the swelling is of a bluish or purplish hue. Felons with ** proud flesh."
Vol. 42, No. 5. T
274 WHITLOW. »?'i^''.°S-?Sf?S?
Review, May 2, 1668.
Ledum : For whitlows, the result of iDunctured wounds, needle pricks, hang nails (nat. mur.), splinters, &c. Affected part most comfortable when cold (fluoric acid).
Natrum sulph. : Whitlow beginning as a Uxstei-y and the pain is more bearable out of doors ; suppuration round the roots of the nails, caused by living in damp houses, cellars, &c.
Nux vomica : Patient is usually very cross, and prefers to sit by the fire and have the hand wrapped up warmly, and wants doors and windows shut. All his senses too acute. Thumb, right or left, most frequently affected.
Pulsatilla : The pains are accompanied with chilliness, relief from cool applications and the open air, aggrava- tion in the evening, from warm applications or from letting the limb hang down. Patient very tearful.
Silica : Whitlow, where the inflammation extends to the tendons, cartilages and bones; bone felons (see fluoric acid) and '* run-arounds." Like fluoric acid useful in cases resulting in deformity of the nail ; usually most comfortable when warmly covered. Fluoric acid is the complementary remedy. (Consult Allen's Encyclopcedia, under Silicea,)
Pathogenesy of Whitloic. — I do not suppose that any medicine, with the exception perhaps of fluoric acid, has actually produced whitlow, during its proving. One can hardly expect provers to be so energetic and self-denying as to persist with a proving until such painful organic lesions are produced. For this reason, therefore, we are chiefly dependent upon clinical symptoms and clinical experience when we attempt to treat whitlow by the method of Hahnemann, and not as mere surgeons. In saying this I do not mean it as a sneer at the surgeon, for to be a surgeon was once my own dearest wish, but that was before I knew anything about homoeopathy. At the same time, if ever I had to resort to purely sur- gical means in the treatment of this affection, I would regard the case as a '* failure." Doctors in general are but necessary evils, the surgeon probably most of all, but nevertheless both are necessary.
In other diseases it is the same as in whitlow. Take pneumonia for instance, one can hardly expect provers to go on with any given drug till it has actujJly produced a genuine pneumonia. It has therefore been suggested
It^!^;^^' WHITLOW. 275
that the lower animals should be used for this purpose , and by the continuous use with gradually increasing doses of the given drug to see whether it can produce lobar pneumonia, or any other well defined organic lesion. Such a suggestion cannot be too strongly condemned, both on humanitarian grounds and because it is unscientific, and can only find a place in a science, falsely so-called. Such a method could not by any possibility lead to any useful result, that could not equally well be attained by more legitimate means, so far as healing the sick is concerned. Suppose, for example, that six medicines can be proved in this way to have produced pneumonia, of what earthly advantage is it to know this, when we are face to fac3 with an actual case of pneumonia ? The mere physical signs of pneumonia are practically the same all the world over by whatsoever means produced ; the dulness on percussion, the increased vocal fremitus, the crepitations, fine or coarse, give no indications that will guide us to the appropriate medicine ; thus our half dozen medicines that have been thus proved to have produced pneumonia, simply become half a dozen harassing doubts at the bedside of an actual case. To be sure one might try them all in turn, taking twenty-four hours for each, and then by the time they were finished the patient would either be dead or the crisis passed. No ! leave all such rubbishy methods to the " Old School," the homojopathy of Hahnemann does not need them.
To treat any disease successfully, we must know, or at least do our best to find out, the specific individuul differences both of the different medicines and of our patient, before we can use medicines intelligently. This is only another way of putting Hahnemann's dictum. "In making this comparison, the more promine.nty tin- common and pectdiar features of the case are specially and almost exclusively considered and noted ; for these in particular should bear the closest similitude to the symptoms of the desired medicine, if that is to accomplish the cure.*' In other words, the specific individual differ- ences of the medicine must be similar to the specific individual differences of the patient. The lower animals can never give us this knowledge, and without it we are but little better than the allopaths. Leave us rather in ow fools* paradise, hugging to our hearts the pleasing
T— 2
^76 WHITLOW. ^^lw?Syg!SS:
delusion that only oney or at the most tico, medicines, can both produce and cure pneumonia. This will at least give us an appearance of confidence (born of ignorance it is true) at the patient's bedside, which if of no benefit to the patient cannot fail to impress the patient's friends — a most important point if a doctor wishes to "get on."
1. Anthracinum : The indications for this medicine are, I believe, only cliuical.
2. Apis : •* Inward burning about a hang-nail on the outside of the right fourth finger ; no redness where it pains inside, and not aggravated by pressure. Fine burning and pricking in the finger tips. Sensation a» if the finger nails were quite loose and as if he could shake them oflf."
3. Sulphur : Many hangnails on the fingers. Pain in the tips of the fingers in the morning, as if the nails had been cut too short. Pain on the flexor surface of the right middle finger as from a sticking splinter. Burning in the balls and tips of the fingers. At night, in bed, a semi-lunar painful drawing in the root of the nail of the right little finger. Tearing and drawing pains very marked. At night in bed tearing under the nail of the left thumb. Tearing sticking above the nail of the left ring finger, as if a needle were thrust in,, especially violent in the evening. Shooting in the tips- of the fingers at night. Stitches in the tips of the fingers. Crawling and prickling in the tips of the fingers very acute, worse on hanging the arm down.
4. Arsenicum : The indications for this medicine are chiefly of a general character.
5. Hepar : Indications chiefly general, though we find ** stitches in one finger as from needles."
6. Nux vom. : Indications chiefly of a general charac- ter, but we find ** Jerking sticking pain along the bone of the thumb, extending backward. Burning in the ball of the thumb on lying down after dinner."
7. Pulsatilla : Indications chiefly general. Also " Pain as if a panaritium would form on the side of the nail of the index finger. Violent stitches in the tips of the right fingers."
8. Fluoric acid : " The pains in the hands became exceedingly violent and the hand much swollen ; next day the fingers, and especially the thumb, were violently inflamed ; the hot bright-red skin on the tips was dis-
coloured, the last phalanx almost immoyable, with violent pains in the hands extending up to the shoulder, and fever; towards evening of the second day the pains become throbbing and the tips of the fingers more swollen ; on the third day the tips of all the fingers were white, and the thumb was enveloped by a white blister, upon which the nail seemed to rest, with constant tor- menting throbbing pains ; on opening the blisters there was discharged a thick brown very offensive fluid, which was vei7 acid; under these blisters was seen on the fingers the uninjured true skin ; on the thumb there was underneath a second blister, upon opening which com- mencing suppuration was found; the fingers healed rapidly ; the thumb continued to secrete a thin pus and was only healed after four weeks. Pain in the left index finger, as if in the bone, now and then during the day ; the whole finger is painful internally, particularly in the evening. Burning internally about the bone. A violent burning stitch in the fleshy part of the left thumb. Prickings in the ends of the index fingers, most in the left. Acute prickings, as with a needle, in the fingers. Now and then a pain resembling a contusion in the ends of several fingers, as it were in the bones. Painless sensation beneath the nail of the left thumb, as if some- thing were working gradually its way out, in the fore- noon."
9. Lachesis: Visible pulsation in a large portion of the ball of the left thumb, and frequently recurring jerking. A panaritium on a finger in which there had formerly been frequent jerking, preceded by jerking and pains, so that she could not bear the arm under the covering, frequently shooting upward and often down- ward into the arm, which was weak. Stitches in the tips of the fingers. Gnawing and crawling in the bones and flesh of the right third and fourth fingers ; also under the nails as though something were crawling about under them."
10. Ledum : A feeling in the nail of the left third finger as if raised up by pressure from beneath, together with prickling in the tip of the finger. Stitches as with needles beneath the right thumb nail. The periosteum of the phalanges is painful on pressing it.
11. Natrum sulph. : Violent burning in the tips of the fingers. Boring in the joints of the fingers (many
278 OPHTHALMIC DISEASE, ^''^^m^^''
Beriew. May 2, 1808,
drawing and pressing pains) sticking pain in the tip of the left thumb behind the nail, evening. Sticking pain in the tips of the fingers. Violent stitches in the left thumb, in jerks, almost like pulsations of the pain. Fine sticking pain in the points of the right thumb and forefinger, as if the veins were being pulled out, whilst knitting at noon, (tearing pain in various fingers, very frequent). Sticking ulcerative pain under nail of the right forefinger. Beating in the tip of the left little finger, like a pulsation, for several minutes.
12. Silicea : Pain as from a splinter in the flexor surface of one finger. Pain in the left index finger as if a panaritium would form. Sensation as if the tips of the fingers were suppurating. Feeling of numbness of one finger as if it were thick and the bone enlarged (tearing and sticking pain in various fingers), stitches in the ball of the thumb.
The above symptoms are taken from Allen's Encyclo- pedia. I regret that I am unable to make use of the Encyclojicedia of Drug Pathofienesy, the repertory to that work being as yet incomplete.
Oxford, April 1898.
' OPHTHALMIC DISEASE SYMPATHETIC TO UTEEINE FIBROID.
In the April number of The Homoeopathic Eye, Ear and Throat Journal of New York, Dr. Vilas, of Chicago, reports the following interesting case : —
The following case was brought to my office August 12th, 1893, by W. A. McDowell, M.D., Rockford, Illinois. I give the history (from a report of the case since made by him) as given to me at that time.
" Miss , aged 47 years. About fourteen months
ago, she began having pain in the left eye and on the left side of the nose. This pain grew worse rapidly, the eye becoming very red and swollen ; she could not bear the light because of the pain it caused. She consulted an eye specialist who treated her about three months, using both local and internal remedies, but with no relief whatever. The pain had now become so severe in the eye that she was forced to take opiates to get any rest at all, especially at night. On the advice of the eye
E^jS.TnSg?'** OPHTHALMIC DISEASE. 279
specialist who had treated her she went to Chicago and into an eye infirmary. She remained there under constant treatment three months, with no benefit what- ever. The treatment was very painful ; using her own words, 'worse than death/ She then went to her home, not far from Chicago, and remained a few weeks, trying whatever she thought might give her relief, such as poultices, hot applications, etc.
"Her friends now persuaded her to try another specialist in a neighbouring city. She did so, and there lived in his family, and was under his immediate care for nearly four months, but received no benefit."
It was at this stage of her case that she went to Dr. McDowell, giving the foregoing history, and saying in addition that she was fearful that she had a tumour. "For over a year," she said, "she had noticed an enlargement in the pelvic region, and of late it seemed to be growing ; had given her no discomfort, but as the growth was becoming more noticeable to her, she wished an examination and opinion."
An examination by him disclosed a uterine fibroid about the size of a coffee-cup. She put her case in his care, and he prescribed for her general condition, bearing in mind the fibrous growth. He treated her a month, and using his own language, " with very little, if any, improvement, using hot applications to her eye, which would afford temporary relief.'*
I again quote from Dr. McDowell's narrative : " She still suffered intense pain and the eye was swollen, very red and angry in appearance. She had now fully resolved to have the eye removed, and so expressed herself to me. Not feeling competent to say yes or no, I advised her to consult at least two competent men. She made choice of two, and did as I suggested. One gave no decided opinion, the other advised removal at once ' in order to save the other eye.' She came back to my office fully decided to have the operation for the removal of the eye on the next day. I now said to her, * I wish you to go with me and see Dr. Vilas, and let us hear what he has to say.' She consented and we went together."
Examination at this time by me confirmed the general condition of the eyeball as has been described, but I could detect no organic lesion. It was apparent, how-
280 BEviEws. "'ClJfSSrHSg
ever, that the eye troubles had arisen and progressed synchronously with the tumour, and I had seen similar manifestations with uterine disturbance. I therefore advised to remove the uterine tumour, confident of the result as to the eye.
** Acting on this advice," concludes Dr. McDowell, ** three days later Dr. Ludlam, at the Hahnemann Hospital, in Chicago, removed the fibroid tumour. The fourteenth day after the operation she rode in a carriage three miles, and in a few weeks had fully recovered.
'' Immediately after the operation for the removal of the tumour, all pain left the eye, and the redness and swelling began to disappear. Ten days later there was no trace of there having been any trouble with the eye, nor has it ever troubled her to this day, January 24, 1898.;;
REVIEWS.
Phannacopee Homceopathique Franqaise. Bedigee sous le patronage de la Soci^te Fran9aise d'Homoeopathie. Par H. EcaUe, L. Delpech, et A. Peuvrier, Pharmaciens a Paris, avec la collaboration de MM. les Doctenrs Mare Jousset et Vincent L^on-Simon. Demy 8vo, 408 pp., in paper wrapper. Paris : Librairie J. B. Bailli^re et Fils. 1898.
In a paper presented to the IntematioDal Homoeopathic Congress, held in Paris in 1889, M. Ecalle proposed the nomination of a commission of Pharmacology having for its chief object the preparation of a new homoeopathic Pharmacopoeia, one which should be more in accord with tbe progress of science than that hitherto in use. This proposal was favourably received by the Congress, who referred the matter to the Societe Fran9aise d'Homoeopathie, and the present work is tbe result.
The work is divided into two parts, the first dealing with the <' General Pharmacopoeia," the second with the *' Special Pharmacopoeia." The first five articles treat of vehicles, fundamental preparations, attenuations, globules, and dis- pensing and preservation of the medicines. Under '* Vehicles " are given full descriptions of the sources, methods of production and preparation, characters, tests and uses of alcohol, sugar of milk, water and glycerine. Commercial alcohol of 81° to 82° is directed to be redistilled. Rectified spirit of 88° to 90°, and the same reduced to 80^ and 70°
^^^^?S^SS^ REVIEWS. 281
B«view, MAf S, ItlBR.
respectively, according to requirements, are also recommended. Sugar of mUk is purified bj precipitation with alcohol. Water is to be slowly distilled after previous filtration. Glycerine of 80° B., having a density of about 1*27, is to be used in preparing the first attenuations of certain substances, and chiefly for alkaloids. Precautions are given in relation to the choice of products, their preparation and preservation, under ''Fundamental Preparations,'' and especially with regard to calcarea carbonica, mercurius solubiUs, causticum, &c., which are to be obtained by Hahnemann's methods.
Mother tinctures of fresh vegetable substances are directed to be prepared from indigenous plants. These are divided into two distinct categories; (1) those with a considerable amount of juice, and (2) those with a very small amount.
Indigenous plants with a considerable amount of juice are pounded in a mortar and submitted to pressure. To the juice thus obtained is added an equal weight of alcohol of 90^, and liquor No. 1 is thus produced and set aside. To the marc resulting from the preceding operation is added its own weight of the same alcohol ; this is macerated for 10 days and again expressed. The liquor No. 2 thus obtained is added to the first, the mixture allowed to deposit and filtered after decantation. It is claimed that by this operation a tincture is secured which is always similar in composition, and which will contain all the active principles of the plant. '* In effect, in the liquor No. 1 are those constituents of the plant which are soluble in water as well as those which are carried in mechanically, and in the liquor No. 2 all those which are soluble in alcohol." We cannot, however, admit this proposition as correct, since the very small proportion of alcohol used to extract the marc would be insufficient to exhaust it, at least in the case of some very juicy plants, of resins and other substances soluble in alcohol but insoluble in the juice, besides which, the loss in the process of expression would be proportionally great. Surely it is far preferable to percolate the marc with the whole of the alcohol used, as directed in the BritUh Homceopathic Pharmacopu:ia, if such extraction is attempted at all ; but the process of percolation is not mentioned in the work, a fact which we consider regrettable. Aconite serves as a type of this class of tinctures, while those of the second category are typified by dulcamara. These latter are said to have a very small amount of juice, but in the experience of British pharmacists the average loss of moisture from dulcamara is greater than that from aconite, when each is collected in the proper season.
The plants of the second category are crushed, reduced to a fine moist paste, covered with an equal weight of alcohol of 80^,
282 EEViEws. ^SSJ?/w^S???IS^
Beview, May 9, 18B6.
and after maceration for 10 days are decanted and filtered. Tinctures of exotic vegetable substances are to be made bj reducing the substance to a fine powder, and simple maceration in alcohol of 70°, in the proportion of 1-20 (1 grm. to 20 grms. we presume, though it is not so stated) for ten days. They are then to be filtered. The type of these tinctures is ipecacuanha.
The proportion of 1-20 has been adopted for all such substances indiscriminately to efifect the complete solution of the active principles of the plant, and ''because in this way the physician always knows the quantity of substance which corresponds to the quantity of tincture prescribed by him." Trituration is also ordered for some vegetable substances specified in the Special Pharmacopieia, such as ipecacuanha. Tinctures as well as triturations of animal substances are directed, the former by maceration in alcohol of 9QP in the proportion of 1-20. Moschus and corallium rubrum are quoted as types, the latter of those which are prepared in trituration only. There is not much that is new in the trituration process recommended ; the centesimal scale is followed, except in the case of very active substances, of which digitaline is a type. For these the first three decimal triturations are recommended in order to secure intimate admixture.
Under '' Attenuations" we have the theories relating to their action, and rules and precautions to be observed in their preparation, with the vehicles suitable for each class, one peculiarity being that for intermediate dilutions which are not preserved, a mixture of four parts of water with one part of alcohol is allowed. The starting point of attenuation is the mother tincture, in all cases where this is prepared, while in the case of triturated vegetable substances the crude drug is the starting point. Hence there will be unfortunately a still wider difference between the liquid attenuations and triturations of the same drug than that already existing in this country. For example, the first trituration of ipecacuanha will contain 1 in 100, while the first dilution of the same drug will be in the proportion of 1 in 2,000. We hope the physician will remember this in writing prescriptions.
It is stated in the preface that <' Hahnemann, who, for his time was a very distinguished and accurate chemist, has fixed in very precise terms the preparation of all the medicines which he experimented on ; our work is absolutely conformed to his indications, but we have added all the new medicines applied since then."
This statement is not supported by the method adopted for making the attenuations.
Hahnemann appears to have attached considerable importance
}£Sgt^£ynSr BEYIEWS. 283
to the fact that liquids were largely prescribed in drops, and his endeavours were directed towards ensuring the proportion of one grain (Nuremburg), or one drop, in 100 drops, whether the tincture was prepared so that either 10 or 20 drops of mother tincture represented one grain of the dry material, as in the case of non-indigenous plants.
In that of staphysagria, for example, where 10 drops of the mother tincture represented one grain of the seeds, 10 drops of the tincture were mixed with 90 drops of alcohol in order to obtain the first dilution (x^tt)-
If, as appears in several parts of the work before us, liquid vehicles are to be taken by weight, and the mother tincture being the starting point of attenuation, the first centesimal dilution will deviate to an enormous extent from Hahnemann's preparation.
The tincture and dilutions of staphysagria being directed to be prepared with alcohol of 70°, the specific gravity of which may be taken as about 0.87, the volume of 100 grammes, would be about 115 cubic centimetres, and in our experience one grain by weight of such alcohol would correspond to at least 2.8 drops of average size.
The following calculation will illustrate the contrast between Hahnemann's preparation and that of the Pharma- cop6e Homoeopathique FrauQaise : —
Drug. <l> tinct. totj-
Staphysagria, Hahnmn., 1 gr. in 10 drops +90 drops = 100 drops,
„ Ph.Hoin. Fr. 1 „ 20 gr. or 46 „ x 100 „ =4,600 „ „ „ Igm.in20gm.or28cc. xlOO „ =2,800 cc.
The second part of the work contains three chapters dealing with (1) vegetable substances, (2) animal substances, and (8) mineral substances and chemical products. There is also an appendix treating of organic products (thyroidine, &c.), a full table of contents, and an index. The three alphabetical arrangements of these chapters are somewhat confusing, as one cannot, without referring to the index, or remembering whether the substance sought for is vegetable or mineral, readily refer to the desired article. One alphabetical arrange- ment would, in our estimation, be far preferable, and we commend this point to the consideration of the compilers in case of a future edition being issued.
The nomenclature of vegetable preparations consists of the Latin botanical names of the plants from which they are derived, and a similar rule applies to animal substances. For chemical products and minerals the nomenclature of the older continental pharmacopoeias has been retained, but with some Ulconsistencies. Thus the Latin adjectives used for similav salts vary considerably, and we have for calcium iodide
284 REVIEWS. "ffl:^5S?1«^
Review, May 2, 1898.
** calcarea iodata," for potassium iodide ** kali hydriodicum," and for sodium iodide '' natrum ioduretum." The adjective used to indicate bromides is " bromicum,'* instead of " bromatum.** Again, while " cuprum arsenicum " is used to denote arsenite of copper ''ferrum arsenicum " indicates arsenide of iron. Some modern exceptions occur like '' aci- dum cyanhydricum," **acidum fluorhydricum," and "kali bichromaticum," and the names of the alkaloids and some other chemical preparations have no Latin terminations, for example, " digitaline," ** es^rine," " cicutine (bromhydirate de)." We altogether fail to comprehend the reason for the following under *' zincum phosphoricum,** namely, ** syn, dnci phosphidum, phosphate de zinc, Angl. zincic phosphide^*' followed by a process for preparing the phosphate. Zincum phosphoratum, phosphide of zinc, was introduced into the British Homoeopathic Pharmacopoeia many years ago, but no mention is made of the phosphate — zincum phosphoricum. ''Cadmium sulphuratum,'* used as a synonym for cadmic sulphate, is also inconsistent.
" Nitrite d'Amyle *' would have been better placed under **Amyl Nitrosum," and **Trinitrine *' is better known as ** Glonoine.'' ** Cedrus Deodora " should be " C. Deodara," while " Brucea antidyssenterica " is probably a misspelling, as it appears correctly spelt in the table of contents. '^ Bella- dona" and ^'Oayacum'* are also peculiar. The printer's devil appears to have been busy with the English names : thus we find ''Common Chamomille*' (pp. 50 and 78), *' German Chemomile, Com fever ferr." (p. 78), '* Spotted Kemlock " (p. 90), *' Nairy Yam" (p. 97), " Sweet-scensed Lifs everlasting" (p. 112), " Sir John's Wort " (p. 120), and ** Stony scented Lettuce " (p. 128), besides others.
Among the newly introduced remedies we find avena sativa, boldo, cedrus deodara, galium moUugo, gnaphalium dioicum, kola, lonicera caprifolium, strophantus hispidus, teucrium, scorodonia, adonidine, antipyrine, cocaine, cotoine, duboisine, ergotinine, esculine, fuchsine, merourius chloro-iodatus, quas- sine, sparteine sulphate, thyroidine, and pancreatic, hepatic, cerebral and other organic extracts.
Under each head in the chapter on vegetable substances are given, as a rule, the synonyms, French, English, German, Italian and Spanish names, natural order, habitat, characters, preparations, and principal indications (therapeutic), and in some cases the flowering time and a caution against confusion of species ; also some properties generally attributed to par- ticular plants. Corresponding information is given in the chapter relating to animal substances. In that devoted to mineral substances and chemical products no chemical for^
S^SSrS.TnSf' BEviEws, 285
xnnlffi appear, but synonyms, foreign names, sources, methods of prodaction, characters and properties, preparations, princi- pal indications and, in the case of active poisons, the maxi- mom dose recommended.
No tests are given except those quoted from Hahnemann's writings.
The preparations of apis mellifica are, tincture of the entire bees, killed with alcohol and reduced to pulp ; tritura- tion of the living bees ; tincture of apium virus obtained by vigorously sliakmg the live bees in a bottle and afterwards allowing them to escape and dissolving the poison deposited on the sides of the bottle in alcohol of 90^ ; and trituration of the same by catching the insects with pincers and allowing them to discharge their poison on sugar of milk. Trituration is the only method by which the serpent venoms are treated. Tincture of sepia, as well as trituration, is ordered.
Of the metaJs, silver is directed to be prepared by introduc- ing the chloride into a platinum capsule containing water acidified with sulphuric acid and a sheet of pure zinc, treating vnth diluted sulphuric acid, carefully washing and drying the powder so obtained. Gold (although named " aurum foliatum ") to be precipitated from a solution of the chloride by means of ferrous sulphate ; copper to be precipitated by iron rods from solution of its sulphate ; soft iron of good quality is to be reduced to filings, ground to powder in a mortar, and sifted through a hair sieve ; mercury to be obtained by distillation from a mixture of cinnabar with iron filings or quick lime ; platinum by heating the double chloride of platinum and ammonium (platinum sponge), or by precipitation of the chloride by means of a solution of potash in alcohol (platinum blacky ; lead by precipitation from a dilute solution in nitric acid oy means of zinc rods ; tin by precipitating a boiling solution in hydro- chloric acid by means of carbonate of soda, transforming the precipitated stannic hydrate into insoluble stannic hydrate by the action of nitric acid, finally reducing with black flux and washing ; and zinc by redistillation, conversion into pure oxide in the wet way and reduction by hydrogen.
In the case of the acids the officinal preparation is taken as the starting point of attenuation regardless of the percentage of anhydrous acid contained in it. Thus the first attenuations of •* Acidimi Muriaticum '* and " Acidum Cyanhydricum " bear no relation to each other or to the rest of the acids in point of strength.
Of alkaloids, the third decimal trituration or solution is the «tronge3t homoeopathic preparation which can be prescribed by the physician, and it is urged that trituration is much
286 MEETINGS. ^'^^I^^SiTl^.
superior to dilution, because the physician always prescribes the dilutions and tinctures, not by weight, but in drops, and these vary in size according to the strength of the alcohol. The possible variation in their size is said to be in the proportion of 20 to 60. Besides this, the evaporation of the vehicle considerably augments the strength of those active solutions, a circumstance not always without danger. The following typical formula is given for the 8x dilution : —
Digitaline, crystallised 1 gramme.
Alcohol of 90° 650
Glycerine of 30° 860 „
First dissolve the digitaline in the alcohol and afterwards add the glycerine.
Arsenicum album is to receive special treatment. The opaque variety, being more soluble in weak alcohol, is to be selected. It is to be prepared both by trituration and by solution, using alcohol of 56°. While triturations of petroleum are tolerated, those of phosphorus are suppressed as being completely defective, and a special 8x solution is the only preparation authorised. This is made by placing a gramme of phosphorus in a bottle with 100 grammes of pure glycerine of 80°, melting the jphosphorus by the aid of hot water, shaking the bottle until the contents are quite cold and after mixing them with 900 grammes of alcohol of 96° shaking the whole vigorously for some minutes. No solution of sulphur is recognised, trituration being the only form prescribed for the first three attenuations. Trinitrine (glonoine) is not to be prepared or prescribed stronger than 1-100.
Apart from the imperfections we have pointed out, the work of the compilers appears to have been done thoroughly. It is, however, to be regretted that so little effort has been made to approach international uniformity ; in fact in certain directions a greater deviation than ever has been adopted, both from this desirable object and from the directions and aims of Hahnemann .
The work has been very nicely printed on excellent paper, but lacks a binding worthy of its importance.
MEETINGS.
LONDON HOMCEOPATHIC HOSPITAL,
The annual general meeting of the governors, donors and subscribers of the London Homoeopathic Hospital was held in the board room of the hospital on Thursday, the 24th of March, 1898, Mr. Stilwell (Chairman of the Board of Management) presiding.
S^r^-n*??^' MEETINGS. 287
Review, M&7 2, 1808.
Prayer having been offered up bj the Chaplain (the Bev. Dacbe Craven), and the Secretary- Superintendent having tead the forty-eighth annual report,
The Chairman (Mr. Stilwell) moved its adoption, saying : Ladies and gentlemen, — I rise to move that we adopt the report you have just heard read. Almost in the last sentence of that report we speak of a period of fifty years — no small period — ^which has seen the rise of this hospital, from a small house in Golden Square, to the present large and imposing building so admirably adapted in every way for the work which is carried on in it. We have during that time had many losses, of which one of our greatest has been that of our patron, during the last twelve months. The Duchess of Teck has been a supporter of this hospital, and a very kind help to us at all times. Whenever we asked for her assistance she most graciously gave it to us. She was present when the foundation stone of the new hospital was laid, and afterwards when it was opened on its completion, and by her gracious presence she made both events marked days in the history of this institution. We have also to deplore the death of the late Mr. Hugh Cameron, We all know that his name has been associated with this hospital from the beginning, through all the forty-eight years which had elapsed when he was taken from us by death. During the whole of that time his advice, his sympathy, and his help were very marked. I am sorry to have to mention Lord Emlyn's illness. He, I had hoped, would have been standing here and proposing the adoption of the report instead of me, but he is suffering from an attack of influenza, and has been advised to take rest in the hope of the restoration of his health. I am sure we all feel anxious that that result may be speedily arrived at. In looking at the report you will have noticed the extraordinary increase of patients — ^both in and out — during the last year. That has been the result, in the first place, of the appreciation of the work carried on here by the staff, and not only of our work, but of the way in which it is done. It has been the result, in the second place, of the fBLct that homooopathy is found by the poor to be very helpful to them. They find that their period of sickness is shortened, that their recovery is quicker, and that their strength is not undermined by treatment which has sometimes been called "heroic." It was with much pleasure that I heard of the grant from the Prince of Wales' Fund, which has helped us to the extent of £245 to reduce the debt which I hope some day to see wiped off in its entirety. We have also been much encouraged by the endow- ment of a new bed through the kindness of Mr. and Mrs. Bid- ley Bax. It has been named by them the *< Alfred Aubrey
288 MEETINGS. . "?iJ?'=SS?r^'
Reriew, May S. 18^.
Vernon Bax Cot.'* It is very cheering to be helped in thia manner, and I like the idea of naming cots or beds as a memorial of those whose memory we wish to perpetuate. The building of the Nursing Institute is now complete. It has cost us a good deal more than we ever expected to have to pay for it. Building materials, labour and many other things have gone up in price very much since we first talked of putting that building into order. As most of you know, we had an old building with a wall that was condemned, and we were bound to pull that wall down. When we had done so we had a small house with no staircase in it. Under the advice of our architect we took off the roof, we added a story, we built a staircase, more bedrooms and bathrooms, and we have now a very comfortable and well-arranged house, containing forty-six beds for the use of the nurses. This is more than the hospital requires for its purposes at present, but it gives us an opportunity of enlarging the staff of private nurses trained in the wards, and which is in itself a very good advertisement for the hospital. In fact, it is one of the best advertisements we have, for the nurses, who have the interests of the hospital at heart, go out to nurse invalids and sick persons, and by their means people get to know that there is such a place as the London Homoeopathic Hospital, and so are encouraged to contribute to our funds. The post-graduate lectures are a feature which has lately been introduced. The medical staff have arranged to carry on, during the summer session, daily lectures and demonstrations, embracing general medicine and surgery and and various special branches of each. This will be a great help to homoeopathy, as it is a way by which we can induce young men to come forward and learn what there is in homoeopathy, and see the excellent practice that there is at this hospital. I do not think we can too warmly thank those who are so kind as to give up their time to preparing and delivering these lectures, and I think that some special funds should be appropriated to the maintenance of these lectures, the expenses of apparatus^ and so on, and to a certain honorarium to the lecturers. I hope that during the next twelve months we shall see some- thing of that kind brought about. I would specially tender the thanks of the board and of this meeting to the Medical Staff. Their care and their work is constant. There is never a day when they are not in the hospital doing good work and helping those who are in pain and sickness, and we cannot too highly value the services they give us. To the Nursing Branch, too — to Miss Brew, the sisters and the Nurses — ^we desire to offer our best thanks for their continual
H^^^STf^^SSS^ • MEETINGS, 289
and kindly help, and I woald mention thai there seems at the present day a feeling of emulation among the nurses as to who can best assist in carrying out the work of the hospital. That is a thing that we, as a board, are most grateftd for. The fees received from private nursing are double in amount what they were last year, and we hope for a further increase in the current year. The scheme for the payment of nurses, and the payments for private nursing are fortunately bringing things to an equilibrium which is very satisfeMstory. I hope that state of equiUbrium once passed will result in a source of substantial income to the hospital, and in advantage to the nurses, as it will ensure their having constant work. Our thanks are due to our able and active Secretary-Superintendent, Mr. Gross, for the manner in which he, with his staff, has carried on the daily duties of his post. We must also tender our thanks to Messrs. E. Oould and Son, the honorary chemists, who very kindly supply us with drugs gratuitously. There is another point in the report which I must refer to. That is, that we have receiv^ the whole of the money — £48,000 — ^which the building has cost, and we have a balimce of about £840 over, a very satisfactory state of things. (Applause.) Our new hospital is paid for, it is freehold, and it is unencumbered. The collection of so large a sum as that shows the growing confidence of the public in the work carried on here, and it is noteworthy that those who know our hospital and the work carried on the best, are the largest contributors to this fund. The Board have shown their sympathy in the work by being very considerable contributors themselves ; my colleagues have personally contributed £8,762 to the BuUding Fund. (Applause.) With regard to other donations, the annual report which we have laid before you to-day will give particulars. We started to raise £80,000 for this purpose. I am afraid that if I had known we would have had to raise nearly £50,000, I should have despaired. Fortunately, we thought it was only £80,000, but the expenses increased beyond our anticipations, and we were £18,000 on the wrong side. However, we found that our constituents and supporters came forward in the most kind and generous way, and enabled us to pay off the whole. I hope that the kindness which has been shown to the management of this hospital will so far continue that we shall be able to raise the somewhat large sum of £10,000 to pay off deficits, and also to raise £2,000 annually in subscrip- tions, both of which will be necessary to the well-being of this hospital and to keeping it free from debt. Two or three friends of the hospital who have been told what is likely to be
V6L 42, No. 5. V
290 MEETINGS. _ , _"'S^M^^
done next year have kindly promised amongst them the sum of nearly £8,000. (Applause.) Such a fact as this makes us most hopeful of the future. Ladies and gentlemen, I now beg to move that this report be adopted. (Applause.)
Sir Henry Tyler said : Mr. Chairman, ladies and gentlemen, — I have very much pleasure in seconding the resolution so ably moved by the Chairman. There is only one remark I would make upon what he has said. I desire to go one better than he has done, for I hope that not only shall we be able to raise an extra £2,000 a year, but I hope that, now we have finished our building and obtained it free of cost and unencumbered, we shall raise such a sum as will bring us in an annual income of £2,000 a year extra, so that we can put ourselves on a suitable footing as regards endowment, as well as having an excellent building. I often ask myself how it is that homoeopathy is not more often adopted. Amongst the rich we have this difficulty. If it is recommended to them they ask their pro- fessional adviser if they shall adopt it, and he tells them that it is all a fraud and humbug, and they straightway have nothing to do with it. (Laughter). There are also diffi- culties among the poor, although they find great advantage in recovering from homoeopathic treatment more rapidly, and in not having to recover from the drugs administered under other methods of treatment. We can only attribute it partly to prejudice, of which there is a great deal, partly to igno- rance, and partly to stupidity. People will not trouble to think for themselves. It is like a poor man I saw at an insane asylum on one occasion. This man, a Boman Catholic, had had an epileptic seizure, but he was now perfectly sane, and could safely have been discharged. His great fear was that he would be discharged, because he said <' I have given my soul to the priest and my body to the doctor, and I am now devoid of all responsibility." (Laughter). People wiU not think for themselves. I am glad to see that we do so much good, and I hope we shall do a great deal more. (Applause.)
The Chairman having put the resolution to the meeting, it was carried unanimously.
The Ghahiman : You have had read in the course of the report a resolution that a sum of £2,000 out of the reserve fund should be appropriated to the payment of the expenses of the Nursing Home. I will call upon Captain Cundy to move this resolution, but first of all the Secretary-Superin- tendent will read the recommendation of the Board.
The Secretary- SuPERiNTBNDBNT then read recommendations from the board of management, and from the trustees, that
n:^!^S!t^'' MEETINGS. 291
the resolution be adopted by the governors, donors and subscribers.
Captain Gumdt said : Mr. StilweU, ladies and gentlemen, — the resolution I have to propose is based upon the two recommendations which yon have just heard read. It is to this effect : — '< That this general meeting of the governors, donors and subscribers of the London Homoeopathic Hospital hereby empowers and directs the board of management and the trustees of the hospital to appropriate for the use and service of the hospital a portion not exceeding £2,000 in amount, of the moneys of the invested funds, to be expended in payment of the costs of rebuilding and furnishing part of the Nursing Institute building so far as those costs exceed the amount voted for the purpose by the governors, donors and subscribers at their special general meeting on December 11th, 1896.*' Now really I should feel, were it not for my conviction that I stand in the presence of a most sympathetic audience, and that I have no brow-beating Bumble to contend against, somewhat in the position of Ohver Twist in Dickens' book — the boy who asked for more. We have had what would seem to the official mind the sufficient sum of £8,500 given into our hands for the purpose of rebuilding the Nurses' Home. We could not, however, make that do, and we ask you for £2,000 more. I feel sure that no eloquence of mine is needed in order that you shall agree cordially to this, for you have already had it amply stated both in the report and in the Chairman's speech that it was necessary. This Nurses' Home, which cost a good round sum when originally built, was used for a ^mporary hospital during the time that this hospital was being rebuilt, and when we came to take possession of it again, hoping that we should not have to spend much upon it, we found that one of its walls was condemned, and that it would be too small for the nurses we require for the extended hospital and for our private nursing staff. It was necessary, therefore, to expend a sum, which we estimated on fair grounds would amount to £8,500, in rebuilding it. When, however, we came to get actual tenders from various builders under the architect's plans we found it would be necessary to :ask for at least £2,000 more, and hence the resolution which I have ventured to put before you. We have watched most carefully, with a great deal of searching of heart, the cost of this Nursing Home. It stood for some time after the hospital was opened, on what looked like a piece of waste ground, and we were assured by the medical men that it was most unhealthy to leave that spot of ground as it was. Everybody was uncomfortable, because it was felt that we were not making
u-2
292 MEETINGS- ^"S^I^^vV^^
B«Tiew,Ma7S,18B«.
the best use of our property, for that waste piece of ground waa worth money. At last we plucked up courage, and the result is xhat there is certainly there a most commodious and suitable home for our nurses. (Applause.) We hope, ladies and gentlemen, that the result will be that we shall have a larger staff of capable nurses. We are getting that gradually, we have had a very great accession of desire for our nurses this jear shown in the proceeds of the nursing fees— the results beiug double what they were last year — and, as has been well stated, these nurses not only supply a want of our medical men in their private practice, but they also act as a most excellent advertisement for our hospital. (Applause.) I believe that our outside nursing has done more to gain friends for this hospital, and will do more in the future, than anything we have hitherto done. The nurses come into our houses, they show their skill, and, if you look at the testimonials we get from those in whose service they have been, you will see — for they are full of loving and tender expressions — that our nurses have not only done good to the bodies but have gained the hearts of those they have been nursing. (Applause.) Next month we hope this home will be in full swing. Mow, with reference ta the report which has been presented to this meeting, we seem to be rather going ahead in our expenditure, but as acting treasurer it has been my duty, montli by month, to attend the audit here, and although some of the expenses have caused me searching of heart, yet I can honestly say that we have passed nothing which we considered was not absolutely necessary for the well-being of the hos* pital. It is no use our having a hospital like this if we are not up-to-date in everything, and we must remember that this is a unique hospital, because it is the only homoeopathic hospital in London, and it is now, we believe, the school for homoeopathy. This is the great object which we have in view in inaugurating and carrying on these lectures which our medical staff are so kind as to give. For some time they gave these lectures without any honorarium at all — it was not their idea to ask for anything for the time and trouble they took — ^but we did not feel it right that they should give this extra time to educational work without having some sort of fee. If we are to expect to have medical recruits to carry on homoeopathic treatment throughout the country, we must have a school for these recruits, and I do not see any school which we can have except this hospital. We must, as our ranks get thinned by death, fill them up with men, competent as well as zealous in homoeopathic science. We must have a teaching centre for that purpose. I do not see any other way of getting
iKSSi}'5ST?SSJ"* MEETINGS. 293
BflTJew. Umj 2, 1886.
these recruits except by having a homoDopathic school here and by having these clinical and scientific lectures given by our staff. One other point and I have finished. In the report the old valuation of our property still, for the moment, appears. The figures should now, however, be somewhat as follows : — Our site instead of being put down at £5,000 is worth £10,815 ; the hospital is worth another £86,197 17s. 2d. ; and in site and hospital we have really got some £47,000 in freehold property. At the back of the hospital we have the Nursing Home, and round the corner we have some houses which are the freehold property of the hospital. I think I have now finished my task, and I await a seconder to my resolution.
Miss J. DuBNiKo Smith, in seconding, said : Mr. Chairman and gentlemen, — I have much pleasure in seconding the resolution which has been so fully explained by Captain Gundy. It does seem a large sum which has been required to build this Nurses' Home, but we all know how very great the expense of building is now-a-days. I went over the home a week or two ago, and I must say that I was very much pleased with the arrangements, which all seemed to be thoroughly complete, and everything was most airy, bright and pleasant. In this home the nurses cannot fail to be thoroughly healthy and well up to their work. We must remember that now-a-days we require good workers, and in order to get good work done, we must keep the workers in good health and give them plenty of fresh air. I am sorry that it is necessary to devote this further sum of £2,000 to to pay off the debt on the home and to pay for furnishing it. However, I understand that what is meant by 'Staking from the funds of the hospital" is that we do not add to our funds, but that if the legacies and donations we receive are large enough to allow it, we merely spend them instead of adding them to the reserve fund. I hope this will be the case this year. Of course, if legacies and donations are not enough to enable us to do so, we have to sell some of our invested funds ; but, as the Secretary explained to me, that entails the expense of commission, and the board wonld very much rather save that expense if they can. The Chairman referred to the great comfort of the patients, and the high appreciation that they feel for their treatment here. I have visited the wards on one or two Mondays, and a woman said to me only last Monday : — ''I wish I had come here sooner, I should have been saved a great deal of suffering and trial.'' It is a very great pleasure to hear such remarks as these, and to feel that everything is being done for the com- fort and well-being of the patients. I have very great pleasure in seconding this resolution. (Applause.)
294 MEETINGS. "S^w^SS??^
Bemw, Maj 2, 1886.
The Chairman put the resolatioD, and it was carried unanimously.
The Chairman : I now call upon the Bev. Mr. Carter to move the next resolution.
Bey. J. Carter said : Mr. Chairman, ladies and gentlemen, the resolution I have to propose embraces a very wide area. It is : — '< That the best thanks of this meeting be given to the Board of Management and House Committee, the Treasurer, Vice-Treasurer, Medical Staff and Lady Visitors." I happen to have been on several occasions in a position to* judge of the grand work that is done by all included in this resolution. More particularly I may mention the medical staff. I have often been struck by the great sacrifices the medical gentlemen must make in serving us. I know also the noble work which they do here, and the great amount of time which they devote to it. I am glad also to hear that the prejudice which existed against homoeopathic treatment is wearing away. If I could only speak as a representative of the views of those who have enjoyed the blessings of this hos- pital, there would go up to heaven one great burst of thank- fulness for the blessings received — (applause)— and I have often thought that those who take part in this work have their reward in the vast amount of good which they do — a reward that is not expressed by the lips, but one that is greater than anything that can be given here on earth, (Applause.) This resolution is one which speaks for itself, and I am very glad to propose it.
Mr. Martin Deed : I have much pleasure in seconding that resolution, Mr. Chairman. I consider that I owe a great debt of gratitude to homoeopathy and to this institution.
The resolution was put to the meeting and carried unani- mously.
The Chairman, responding for the Board of Management and the Treasurer, said : On behalf of the board of management, and of the treasurer, who, as I have explained, is not here to-day, I beg to offer our very best thanks to you for this vote. I assure you that in doing as we have done during the past twelve months we have looked upon it as a labour of love. That it has been a successful labour is so much the more satisfactory to us, and it is an encouragement to us to fiB.ce those difficulties in the future which we have just set plainly before you. Our difficulties we feel are to be met, and we are very hopefal that by a persistence in the course which we have followed during the last few years, and which has resulted in the present state of affairs, and by the help of those who have come to our aid in the past, we shall carry things through in the future to a very magnificent result.
!£*i?l£?S^'"° MEETINGS. 296
Reriew, May 2. l^OS.
(Applause.) It has been suggested that we should develop the hospital more and more, but I feel that we must first of all put our finances on a firm footing in the present buildings. So long as I am in the position which I now occupy I shall endeavour to keep within our income rather than anticipate any increase which we may look for hereafter. (Applause.) I thank you for your kindness on this occasion.
Dr. GoiJ>sBRonoH, responding for the Medical Staff, said : I could wish that some member of the staff holding a more onerous position than I do should have risen to express our thanks to you. I do so, however, with great pleasure. As a medical staff we do not work for thanks, as far as the expression of them is concerned. Still we cannot really do without them, and we are glad that this expression of thanks is made to us from year to year. There is one point I should like to refer to, and that is the cordial sympathy which exists between the board of management and the staff. I believe that that is a point of very great advantage to the hospital as a whole, and I hope that that cordial agreement which does exist will continue to do so, and will always be maintained. (Applause.)
The Bev. Daobb Craven, responding on behalf of the Lady Visitors, said : I have very great pleasure in returning thanks for the lady visitors. There are a very large number on the list — thirty, I believe — and some of them visit the hospital at different times of the year, and for various purposes. Some come to read to the poor people who are lying in bed ill, others bring flowers, others bring their musical instruments, their violins and violoncellos, and play to the patients. All their efforts are received with very great thankfulness by the patients, who have often told me that it is a very great comfort and help to them because there are many hours of the day when it is very monotonous, when they have nothing to do but to lie in bed and look out of the window or something of that sort. I must say, on behalf of the lady visitors, that I have heard them say that what makes their visits here so exceedingly pleasant is not only the gratitude shown by the patients, but the whole tone that pervades the wards. That excellent tone is entirely due to Miss Brew and the nurses she has trained.
Dr. Btres Moir said : I have much pleasure in proposing the re-election of the President (the Earl of Wemyss and March) and the Vice-presidents. Although things have gone so well with the hospital up to the present, the staff are not yet quite satisfied. For instance, as you know, diphtheria is increasing in London by leaps and bounds. When we had but few cases we were able to treat them in the wards, but of
TLKW^ritana Monthly Homoeopathic
Review. Hay % 1888.
late we have had too maDj. Last year the hospital beat its record. We took thirty cases in the twelve months, and of these we only lost three, two of whom were dying when brought in. I have much pleasure in proposing the re-election of the President and Vice-president.
Mr. DuDLBT Wright said : I beg to second that resolution, and in doing so to thoroughly endorse aU that Dr. Moir has said. We all on the staff have our hobbies. Dr. Moir wants a diphtheria ward ; the gyneecologists want a gynaecological ward ; and the surgeons want their suFgical wards increased. We all of us have a large number of patients on our books whom it is impossible to take in, as there ia no vacancy for them. That shows that not only is this hospital very popular, but that it already has become too small for its needs.
The Chairman : Before putting that resolution I would like to say one word of a personal character. I am delighted to hear what Dr. Moir says, and what Mr. Dudley Wright has affirmed, that there is this feeling amongst this staff of going ahead, yet we are bound to see our way as men of business before doing so. (Hear, hear.)
The resolution was then put and carried.
The Chairman : The next business is the re-election of the retiring members of the Board of Management, viz., the Lord Newton, Mr. A. Bidley Bax, Mr. Alan E. Chambre, Mr. T. D. Galpin, the Hon. Algernon Orosvenor, Mr. Edwin Tate and Mr. Hermann W. Tinn6, and of the auditors — Messrs. Prideaux, Booker, Frere and Co. — and the confirma- tion of the election of Mr. Dudley Wright and Dr. Boberson Day as new members of the board of management.
Mr. Knox Shaw : After what we have heard this afternoon from the movers of various resolutions, and from the report, there can be no doubt that this resolution will meet with your unanimous approval. Those of us who have intimate knowledge of the work of the board of management must feel that we could ill afford to lose any one member of the board which has guided us so well during past years, and which has brought the hospital to so successful an issue. In such a case it is impossible for us to do anything but re-elect the gentlemen whose names you have heard read out by the Chairman, and that we should confirm the election of Mr. Dudley Wright and Dr. Boberson Day. (Applause.)
Dr. Sanders : I have much pleasure in seconding this resolution.
The resolution was carried unanimously.
Sir Hbnrt Ttler : I have very great pleasure in moving the re-election of the medical staff and the confirmation of
iSS?Jri2LT5r?§w'"' MEETINGS. 297
the election of Dr. Lambert, Dr. Spencer Cox, and Dr. Leo Bowse.
Mr. A. BiDLET Bmx : I have much pleasure in seconding this resolution. All that has been said about the medical staff I thoroughlj endorse. If I may compare the hospital to a steam engine, I would say that the staff are like the steam without wluch the engine could not go. (Applause.)
The resolution was then carried.
The Seoretabt-Supebintenbent then read an abridgement of the report of the C!onyalescent Home at Eastbourne.
The Chaibman : I have to propose the adoption of the ninth annual report of the Convalescent Home, a summanr of which you have heard read. There is one point I would like to mention. I am sorry we are not able to tell you that we have got an increase in the size of the home so as to enable us to take in men as well as women and children. It is very desirable that we should be able to send men down to a home of our own. There is an arrangement by which we can send them elsewhere, but that is a very different thing to having our own home for men. I look forward to the time— not, I must confess, very hopefully at the present moment — when we may have a home built near the sea on the south coast.
Captain Cundt: I have much pleasure in seconding the adoption of that report.
The resolution was put and carried unanimously.
The Chairman : That concludes the business of the meeting.
Dr. BuRFOBD : It is painful to differ from the Chairman, but the business is not quite concluded. (Laughter). I have much pleasure in proposing a vote of thanks to Mr. Stilwell not only for his presence and his work on this occasion, but for the very satisfactory and successful fulfilment of his duties as Chairman of the Board of Management during the past twelve months, and for many antecedent twelve months. (Applause.) This hospital owns few older friends than Mr. Stilwell. The post of Chairman is no sinecure, and we have the greatest possible confidence in him as Chairman. It is an onerous and very responsible position indeed, and I am sure your gratitude will prompt some such token of respect as I am asking you to give. (Applause). Much of the good feeling with which the board and medical staff work is due to the Chairman, who is both Speaker and Home Secretary. (Applause.) There is no officer of the institution who deserves our thanks more. (Renewed applause.)
Mr. John Cabtbb seconded the resolution.
The resolution was carried by acclamation.
The Chairman : I thank you all most sincerely, and I thank Dr. Burford for the kind way in which he has brought forward
5i98 MEETINGS. ""S^lISlf?^'
Reriev. May S, 1806.
this resolution. It is a great pleasure to me to hear thai anything I have been able to do is appreciated by those with whom I have been working for the past twelve months, and for more than twelve months, as Dr. Burford has said. This is the first time I have been able to be at the annual meeting for three years. It is a great pleasure to me, and I thank you very much. (Applause). The meeting then separated.
THE ADELAIDE CHILDREN'S HOSPITAL.
This institution, which owes its existence and its development to the initiative and to the constant efforts in promoting the extension of its sphere of influence to our colleague, the Hon. Dr. Allan Campbell, M.L.G., has recently issued its twenty-first annual report. From the retrospect, with which the board of management commence their report, some idea will be gained of the valuable work being done by it.
'' In reviewing the past twenty-one years, the hospital has shown a gradual and uninterrupted growth. Few years have gone by in its history without witnessing either some permanent improvements to its buildings, or a concentration of effort in some specific direction towards perfecting its methods or broadening the usefulness of the institution. The original buildings, which, in recognition of the long and valuable services of the President, the board has decided to call ** The Way Buildings," were erected in 1878 ; the Ophthalmia Ward and central block were added in 1888 ; the Disinfecting Chamber in 1888 ; the basement was excavated and converted into Dormitories in 1889 ; the Sanitary Towers were built in 1898 ; the Angas Buildings were erected in 1898-4, and the Isolation Wards and Bacteriological Laboratory in 1897. Each of these additions has proved a distinct advantage, and has gradually brought the institution nearer that condition of perfect equip- ment for the treatment of diseases which is the main object toward which the board directs its energies.
''isolation wards and bactebiolooical labobatobt.
'' These important additions, which were in contemplation at the last annual meeting, have been erected during the past year, and were publicly opened by Lady Victoria Buxton a few days after the close of the year with which the present report deals. The building committee has been unremitting in its labours of oversight, and has made it a first consideration that the new wards and laboratory shall be constructed in accordance with the most approved scientific and sanitary principles. The new buildings supply accommodation for
is:^^:^^:^'' meetings. 299
about thirty cots, distributed over four wards, two of which will be used as Observation Wards for the reception of doubtful cases. The board recognises the great importance of protecting the public health by the isolation of cases of infection, and has made provision by which paying patients will be received in this department of hospital treatment. * « * ♦
'' The Bacteriological Laboratory has been designed with special reference to a school of instruction in this important branch of science, and the apparatus with which it is furnished has been selected by Dr. Borthwick and a European specialist, and include the latest scientific appliances for bacteriological investigations.
** The entire cost of these additions (including a detached cottage fitted up as a dormitory for nurses), when the bill of extras has been paid the contractor, will be about £5,568. Towards this amount the sum of £4,547 has been received. The furnishings, including the bacteriological apparatus, will cost a further sum of £86^, toward which £87 has been raised. The balance left, when added to the deficiency on building account, shows a total liability of £1,296.
'< In recognition of the signal service Hon. Dr. Campbell devoted to the initiation of this movement, and his success in obtaining funds for the buildings, the board resolved that these latest additions to the hospital shall bear the name of •The Allan Campbell Buildings.'
QUEEN VICTORIA HOME FOB CONVALESCENT CHILDBEN.
« The movement to establish a sanitarium in the hills for sick children, which originated last year with the * Sunbeam Society,* under the generous promptings of * Uncle Harry ' and the proprietors of the IlegUter and Observer, marks a further new departure in the benevolent aims of the community of South Australia. The institution is intended as a permanent memorial of the Diamond Jubilee of Her Majesty the Qaeen, and the committee appeals to the public to show their loyalty in contributing something, however small, towards this national object. The home, whilst afBliated with the Adelaide Children's Hospital, is under the supervision of a large and representative building committee, chiefly composed of residents in the hills. The foundation stone was laid by Lady Victoria Buxton, on July 10th last, in the presence of a unique gathering, chiefly composed of bright and willing * Sunbeams,* by whose zealous efforts the greater portion of the funds in hand have been raised. The present scheme is to erect, as soon as funds will allow, about two-thirds of the complete structure, and this will entail an expenditure of a
little over £2,000. The money in hand, after paying for land, fencing, planting, well-sinking, &c., amounts to £1,285, of which sum the ' Sunbeams,' have raised £882. The disastrous reasons that have occurred of late have militated greatly against the ingathering of funds for this object, and the committee does not feel justified in proceeding with the buildings ..until the money to pay for them is in hand.
" The proposed home will in no way conflict with any existing institution in the colony. Its intention is not primarily that of a convalescent home for patients recovering from acute diseases, but it will be largely utilised for surgical cases of a chronic nature, in which an exhausted constitution needs the healthy and natural stimulant of fresh mountain air to turn the balance in the life of a sick child towards recovery and health. The home is intended to benefit that clsLBB of little sufferers whose condition may well awaken our pity as they lie prisoners in their cots for months, or even years, with a slight improvement in their condition, and in whose interest provisions must be made in the home for direct medical oversight, with skilled clinical nursing.
^'MEDICAL.
'< The report shows that the gradual increase in the number of in-patients, which has been maintained for some years, still continues, the increase in this respect amounting in the past year to 80, while the average daily number of in-patients has increased from 59.66 to 62.1. There has been at times a great strain on the capacity of the hospital, and, when full, rather than turn serious eases away, temporary provision has been made, so that the number of patients in the hospital has often exceeded the cot accommodation. The 458 in-patient €ases that have been under treatment are classified under 120 different diseases, and of those discharged 264 were cured and 77 relieved. It is satisfactory to note that the number of deaths shows a low average, amounting in all to 15, and but few of these were the result of zymotic diseases. Forty cases of enteric fever were treated, and although this number was three less than for the preceding yeac, it is considerably above the average. No deaths occurred with the fever patients, and out of 19 cases of diphtheria received only one had a fatal issue. The remarkable decrease in the death rate of diphtheria patients is to be attributed to the use of anti-diphtheritic serum, the value of which as a specific has been clearly demonstrated. Diseases of the bones and joints (which are more or less chronic in their nature) reached the high figures of 64 for the year, and diseases of the eye 41. Both totals are largely in excess of the preceding year. The increase of ophthalmia among children, particularly in the northern
£;ayr^ST?i&"" meetings, soi
areas, demands acoommodation beyond that which the hospital can at present devote to sach cases.
•* The surgical operations have numbered 418, which is an increase of 90. This large increase has been occasioned ehieflj from the number of out-patients who have been subjected to operations of a minor kind that did not require residence in the hospital. In the dispensary department 6,160 patients have been seen by the medical attendants, and treated as out-door cases.
" BACTSBIOLOOICAL DEPARTMENT.
"This department, which is under the control of Dr. Borthvnck, assisted by the Resident Medical Officer and others, continues to do valuable work in a specific way. Aa a matter of routine every sore throat occurring among the patients and nurses is examined bacteriologically, and by thia means outbreaks of this disease in the hospital are undoubtedly prevented. In the same way unsuspected cases of diphtheria have been prevented from finding their way into the general wards.
" Careful examination of the throats of patients recovering^ from this disease has shown that the period of infectivity is much longer than was formerly supposed. In the interests of the public health the convalescents from diphtheria are detained until all fear of infection is gone. The period when they can be safely discharged varies, and can only be determined by bacteriological examination.
•' This department has also done a public service in the aid it has given to medical practitioners by supplying a bacteriological diagnosis m such diseases as diphtheria, typhoid fever, and tuberculosis, in which an early and positive diagnosis is of the greatest moment. This outside work is daily increasing, and with the greater conveniences and more ample appliances of the new laboratory, it is hoped that the department will have a still wider usefulness.
" The following is a summary of the work done during the year : — Examinations made — In-door patients, 887 ; out-door patients, 64 ; private practice, 62, particulars of which are as follows : — " Swabs and cultures examined for diphtheria . . . 417
Widal's test for typhoid fever 37
Sputum and other specimens examined for tubercle 51
Other examinations fas of pus, &c.) 8 "
The meeting at whicn this report was presented was held on the 2nd of November, 1897, in the Duncan Ward of the new Allan Campbell building, His Excellency the Governor (Sir T. Fowell Buxton, Bart., K.C.M.Q.) occupying the chair. Jn the course of an interesting address, His Excellency the
302 NOTABILIA. "^^l^lSa^T^.
-Governor said that ** he was confident that there was not a hospital anywhere which was more ablj served by its •committee and by the nurses who carried on the work of the institution. He was quite sure there could be no children in private houses or other hospitals who were better looked after, more lovingly tended, and more scientifically treated than were the children in this hospital." An expression which a careful study of the report assures us was abundantly justified.
The Bight Hon. S. J. Way, the Chief Justice, who occupied the chair during the latter part of the meeting, in consequence of His Excellency the Governor having been obliged to leave in order to fulfil another engagement, in replying to a vote of thanks to the occupants of the chair, said, ''the hospital received £1,000 per annum from the Legislature every year as A vote towards the support of the Institution, and if he were not trenching on politics he would say there was a very strong <;laim on Parliament on behalf of this institution. The bacteriological department was a benefit to the whole community, and it placed the hospital in advance of any similar institution in the colony, and, he believed, in the whole of the Australian colonies."
We heartily congratulate the Hon. Dr. Campbell on the excellent and valuable public work he has been the means of doing in Adelaide, and on the thorough appreciation which his labours for the public good have met with throughout South Australia.
NOTABILIA.
BRITISH HOMCEOPATHIC CONGRESS.
PREsroENT : Dr. Eubulus Williams, Clifton. Vice-President : Dr. T. W. Burwood, Ealing. Hon. Secretary: Dr. Dyce Brown. Hon. Treasurer : Dr. E. M. Madden. Hon. Local Secretary: Mr. C. Enox Shaw. Council: The President, the Vice-President, the Hon. Treasurer, the Hon. Secretary, the Hon. Local Secretary, Dr. Hughes, Dr. A. C. Clifton.
The Annual Congress of British Homoeopathic Practitioners will be held this year in London, at the London Homoeopathic Hospital, Great Ormond Street, W.C., on Friday, the 8rd of Jime, at 10 o'clock punctually.
The Presidential Address will be delivered by Dr. Eubui.us WttUAMs, of Clifton, at 10 o'clock.
Any strangers, ladies as well as gentlemen, who may desire to hear the President's Address, will be welcome.
After a short interval, to enable the treasurer to receive the members' subscriptions, Dr. J. H. Clarke, of London, will
SSi!2.^5S.T?SS5"* NOTABiLu. 303
Beriew, Hay <• 18W.
read a paper on The Doctrine of Signatures and the Law of similars. This will be followed by a discussion.
The members residing in London and suburbs invite the members of Congress to luncheon at the Holbom Restaurant, at one o'clock.
At two o'clock punctuallj, the Congress will re-assemble, and will select the place of meeting for 1899, elect officers, and transact any other business which may be necessary.
Dr. T. W. Burwood, of Ealing, the Vice-President, will then read a paper on Some Interestiuff Facts, not strictly medical, having an Important Bearing on Disseise and its Treatment, to be followed by discussion.
The third and last paper will then be read by Mr. Clement J. Wilkinson, of Windsor, on Associated Symptoms in both Provings and Diuase without obvious Pathological Basis, to be followed by discussion.
Afternoon tea will be provided at the hospital about 4 p.m.
The members of Congress, with their friends, ladies as well as gentlemen, will dine together at the Holbom Restaurant, at 7 o'clock.
The subscription to the Congress is ten shillings and sixpence. The dinner ticket alone, for guests only, will be seven shillings and sixpence.
Many of our colleagues residing in London and the suburbs have expressed a desire to receive as guests, during the •Congress, their confrkres from the provinces, with their wives, if possible. All, therefore, who are willing to do so, are requested to send their names to Mr. 0. Knox Shaw (the hon. local secretary), 19, Upper Wimpole Street, W. And, on the other hand, all who wish to avail themselves of this hospitality are requested to send their names to Mr. Enox Shaw. Gentlemen who thus offer their hospitality will kindly understand that they may invite personally those whom they would wish to have as guests, otherwise Mr. Enox Shaw will ajrrange for them. It is thus hoped that no one need go to an hotel unless he prefers to do so.
Should any one know of any colleague who has not received a circular announcing the Congress, the secretary will be much obliged by being informed of the omission.
The following are Precis of the Papers it is proposed to read : — ^Dr. Clarke's paper on The Doctrine of Signatures, and the Law of Similars. Provings, though the chief, not the only source of indications for the use of drugs. — The doctrine of signatores explained. — Many common uses of drugs traceable io this source. — Confirmation in homoeopathic provings. — The field of the law of similars a very wide one. — The limits of atilisable correspondence not yet ascertained.
804 NOTABiLiA. '"s^iFis;^^':
Review. Hay % 1898.
Mr. Wilkinson's paper on Associated Symptoms occurring in both provings and disease without obvious Pathological basis. Associated symptoms. — Examples under brjonia, causticum, colocynth, hyoscyamus, &c. — Suggested explanations. — The value of such association as an argument to support the law of similars.
Precis of Dr. Burwood's paper not received.
HAHNEMANN'S GRAVE.
Db. Cabtibb, the secretary of the SociitS Franqaise D^Homceo- pathUf announces, in the last number of the Rewie Homceo- pathique Franqaisey that the grave of Hahnemann at Montmartre is placed in a remote comer of the cemetery, against a wall, surrounded by other graves, all as dilapidated and neglected as that which contains his ashes. Under such conditions it was impossible to dream of erecting in such a spot the last monument to the memory of the grand old man of medicine. Such being ttie case he tells us that it is with great satisfaction that the society has been authorised by the Prefecture of the Seine to remove the remains of Hahnemann to the Cemetery of Pere-Lachaise, and that a perpetual concession, of suitable size for the purpose, has been obtained. The concession is situated on the border of one of the most frequented avenues of the historic section of the great Parisian necropolis in the midst of celebrities of all epochs.
If, writes Dr. Cartier, the adherents to homoeopathy throughout the world, medical men and medical societies, are willing to assist us in our work by a subscription, the International Committee, united with the French Homoeo- pathic Society, will have the amount necessary to raise a monument worthy of Hahnemann, one which will perpetuate for all time the name of the founder of homoeopathy, and will bear witness to the vitality of the doctrine itself.
The alteration of the site of the proposed monument, from an obscure comer in an inferior graveyard, to a prominent position in the grand cemetery of Pdre-Laohaise will, we are sure, be felt to be in the highest degree satisfactory and will prove an additional stimulus to all who desire to do honour to the memory of the greatest therapeutist of the century to gratify their feeling by assisting in the erection of this memorial.
Dr. Richard Hughes, of SiUwood Road, Brighton, we would remind the readers of the Review, has underUken to receive subscriptions in aid of this memorial.
S^rSSTS^'^' NOTABILIA. 805
AUSTBALIAN PROGRESS IN SANITATION.
At the annual meeting of the Australasian Association for the Advancement of Science, which took place in Sydney in January last, the Hon. Dr. Campbell, M.L.G., of Adelaide, as President of the Section on Hygiene and Sanitation, contributed a paper of great interest on <* Aspects of Public Health Legislation in Australia," from a reprint of which, from the South Australian BerfUter, we will endeavour to give our readers some idea of the advanced views in public hygiene which are being pressed upon the attention of our fellow subjects in far distant Australia.
In considering his subject, the Hon. Dr. Campbell first dwells upon the attention which hygiene claims from our legislators.
In urging the need of legislation, he said : '* Public hygiene really can have no practical existence without enactment. To minds trained to methodical reasoning it may seem an easy process to utilise the conclusions of a branch of science so experimental as that upon which public hygiene rests, and to secure their materialisation in law. But when it is remem- bered that these conclusions of science must filter through minds whose strong point is not the calm exercise of the reasoning faculty, the barrier to securing an Act of Parlia- ment is substantial, and the labour involved in overcoming it hard and oftentimes disappointing. But legislation has to be obtained. It is said that public opinion must be followed, but it is equally true that it must be created. It is the work of knowledge to create, and that is the work of this Association to-day. In seeking legislation the main factor after all is not so much public opinion, but the intelligence of the average representative of the people. He is a compound of many influences, and the subject of the most diverse motives. Nevertheless, he makes our laws, and determines the legis- lative limits of our aspirations for the public good. He must be approached with consideration. The clearest demonstrations of science will not compel his assent. We must exercise discretion, and clothe our advances in accordance with his habits of thought as a politician, and not as a savant or a philanthropist, although none knows better than I do that there is much in his labours that exhibits both practical wisdom and philanthropy."
This attitude of semi-indifference is considered as to a certain extent excusable.
*' In its scientific aspect it is itself largely only of yesterday, while the organisation of its principles under legislation involves considerable public expenditure, and at the same
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306 NOTABILIA. ^B^^^ZTTi'^"'.
time impinges upon individual liberty, of which he is very suspicious."
Compulsory legislature for the public health, Dr. Campbell argues, must be to a large extent necessary, acknowledging that ** it is only in so far as any system of compulsion among a free people can be rationally defended that it has any right to exist. Public health laws have the broadest possible basis. They touch every member of the community. Public health is equivalent to national well-being, and national well-being is certainly the welfare of the whole and not of a few. Its legis- lation prejudices no one in the end, and with whatever irksomeness its mandatory provisions may be received by some, no class and no individual of any class goes under in conse- quence. I claim on behalf of public health laws that, although they come within range of the spirit of a time which hankers after compulsory legislation for economic purposes, they are the one phase of that legislation which can call to its defence sound reason and a guarantee of fair play to tdl. Compulsion at any time can only be deprived of its apparent tyranny by its inherent reasonableness, and applied to the legislation I should like to see established, it simply means the parting with a partial and oftentimes injurious freedom for a fuller and a higher form of liberty." In showing this reasonableness he points out that, in the first place, ** pubhc health enactments are but part of the modem movement which is lifting the masses and ameliorating the struggle for existence. Philoso- phers have called it the altruistic movement, but the spirit of it is the lessening of human misery , and the enlargement of the possibilities of a better life to all.*' Secondly, that such legislature is of high economic value. Some of its problems can, he said, be set out in figures as clearly as the balance sheet of a business concern. *• Adam Smith," however, "tells us that industry is the true source of wealth, but steady toil lies at the basis of industry and health at the basis of toil. A healthy nation, also industrious, is on the high road to wealth. It is this condition that alone makes for a high standard of comfort ; and, as the social writer phrases it, renders possible the maintenance of a life worth living,"
Australia having no statistical records setting out the gains which an intelligent administration of public health is calculated to secure, he quotes from an address delivered at the Guildhall last June, by Sir Richard Thorne Thome, in which he showed that in the fifteen years ending 1895, public health legislature had been the means in the United Kingdom of saving 15,000,000 attacks of sickness.
The hon. gentleman then directed the attention of his audience to bacteriology, referring to it as the repository of
l^Wewf^THS^"" NOTABILIA. 807
the facts and generalisations that constitute the basis of the present day principles and practice of public hygiene. *^ Bacteria ** he said *' are living organisms, subtle and minute, bat no mystery attaches now to the conditions of their life or their management. They are ponderable bodies, subject to physical law, and there is no uncertainty as to the course they will pursue in any circumstances of important practical moment. If they are present in a liquid medium, they will precipitate or remain afloat, according to their specific gravities. If they lie upon a moist surface, they will not rise with the evaporating moisture. If they become dry, they will be disseminated only by such air currents as are of sufficient force to lift them into the atmosphere. This material property of germs, then, is a fundamental conception, and forms the basis of the chief practices of hygiene in connection with communicable diseases. It is a conception, too, that divests these germs of all mystery ; it is easily grasped by the public mind, while it is more than sufficient to satisfy the public judgment on the reasonableness of the means prescribed by public health legislation for their control and destruction."
In further pressing the study of the natural history of the microbe, he said that '' the power of these minute bodies or microbes to produce disease is beyond dispute. They attach themselves to different structures in the body, find for themselves a suitable soil, and multiply with amazing rapidity. The process is not identical in each kind, neither are the conditions on which their development is dependent the same in all ; but the fact that they are living, ponderable bodies, with a Hfe history singularly distinct, is applicable to all. It is not assumed that nothing now remains to be known regarding them, for that would not be true ; but so far as public health is concerned, every practical point is covered by the knowledge now acquired. These germs or microbes are the efficient causes of such widespread and well-known diseases as typhoid fever, diphtheria, tuberculosis, influenza, and many others, which every year in this bright land of Australia destroy so many lives. These microbes are known to be specific — they never lose their identity or produce a disease other than the one from which they have been derived. They are as separate in their natural history as species of animals and plants are. Their qualities of ponderosity, vitality, and specificity render them conveyable from one human being or animal to another.*'
Passing now to the second part of his subject, Dr. Campbell then described what Australia had accomplished in the
X— 2
808 NOTABILTA. "^^^Jw^SSTS"^
direction of public hygiene a«nd sanitation, and showed thai the colonists were
" MOYING IN THE BIGHT DIRECTION.
** In sanitary work Australia is certainly unable to boast of achievements such as characterise the movement in England and several leading Continental nations, or in some of the United States of America; but we may nevertheless take heart and rely in good faith upon the assumption that at least our steps are towards the rising sun. It is true that we have at our command all the scientific knowledge in the possession of these older countries, and the many reports issued by state health boards prove the presence amongst us of men conversant with every modem phase of scientific hygiene, and keenly alive to the necessity of progress. But here, as in many other state affairs, sanitarians must wait upon the people's representatives to afford them by legislation a plane of action. Every man, who may, in some degree, be acquainted with the outlines of the history of Australia, will be ready to admit that there is something to be said in extenuation of our backward position. The early days of colonisation were times of struggle. Sustenance for daily consumption was the immediate and most pressing necessity. So soon as settlement extended the question of communication and interchange came next, while the organisation of social order and defence from internal enemies followed. The city of Sydney, in which we are now met, may be taken as typical of the early days of settlement. The first settlers on these shores landed upon a virgin soil. They entered into the enjoyment of a delicious atmosphere, a mild winter, a delightful spring, and a fairly moderate summer. All their surroundings were undefiled, fresh from Nature's hand. For fifty years they paid little or no heed to hygiene or sanitation. They brought with them from the old country certain ideas and habits, and — however much England of a century ago began to leave these old ideas behind — the settlers here knew nothing better. Their descendants perpetuated the habits of the dark ages of hygiene. The increase of rural settlement, however, the growth of city life, the exhaustion and defilement of the water supplies, the pollution of the soil and the air, and the accumulations of filth and refuse, made deep and serious inroads upon the health and mortality of the people. They were compelled to pay some attention to the question of better sanitary surroundings. Sydney was founded in 1788, yet the sanitary arrangements sixty years afterwards were of tlie most primitive character. Up to 1850 the water supplies of a large and ever-augmenting population were obtained
wlSi^J^^St'' NOTABILIA. 809
from wells or some domestic catchment. The old cesspit existed unchallenged during that long period, and for some years afterwards in many places, while scavenging was practically unknown. The atmosphere was polluted by the presence of noxious trades in the very heart of the city. The creation and securing of wealth shut out every other consideration of a less material nature, and the people did not awake from their lethargy until death had found them 'ten thousand several doors for men to make their exits.' The new Corporation of Sydney under the Act of 1857, it is said, worked wonders for its welfare, although at the same time history admits that it was only about ten years ago' that an ample supply of wholesome water was found for all its citizens. However, if the leading requirements of every large community are enumerated it will be found that she is well abreast of any city anywhere. The capital city of Victoria followed much on the same lines, with the exception that in its water supply it anticipated this city by many years, while in its drainage system it has been as many years behind. Within the last three years a drainage system on the most modem lines has been inaugurated, and when completed will place Melbourne in the front rank of well- sewered cities. For many years Adelaide has had both water and sewage in excellent condition, and has been acknowledged by visitors generally to be the cleanest city in Australia.
^'WATEBy SEWERAGE, AND L. S. D.
'^ We cannot therefore be said to have remained inactive in securing improved sanitary conditions for our largest populations. If we take into consideration the large expenditure involved in carrying out the engineering works necessary to meet their requirements in respect to water and sewerage, it will readily be conceded that greater advances have been made towards better sanitary conditions than were to have been expected even a few years ago. There are good grounds for some degree of satisfaction when it is recollected that Sydney has expended £4,164,0<X) upon its water supply, and £1,892,000 upon its sewerage arrangements ; that Melbourne has spent £2,400,000 on its water supply, and on its drainage system, when completed, upwards of £5 ,000,000 ; and that Adelaide, small as it is, has on each of these works spent respectively the sums of £1,491,000 and £516,000. It may be said that a water supply and system of drainage are necessities of city life, and apart from the question of health would come into existence on grounds of convenience, or from business motives. Still, without them city life would be intolerable in the long run. Water supply and sewerage are
810 NOTABILIA. "-ai^lL^SS??^*^
Rex'iew. May 2, 1898.
fundamental requirements, and must exist if sanitary conditions are to be maintained. Whatever may be the details of an organised system of public hygiene these must exist as a basis. In the present condition of these cities there is certainly some ground for congratulation and future hope of still better things.
** WANTED — ^A BUBAL ABOUSING.
'^ I cannot speak so favourably of the condition of rural Australia. Some writers say there are elements of encourage-" ment in the existing state of things, and that it is not a vain hope to believe that broader hygienic ideals will yet take hold of the local governing authorities and lift the sanitary position of the country districts to a higher level. Meanwhile, it is to be feared that in the larger number of rural communities very primitive hygienic and sanitary conditions prevail. In many instances the functions of those Local Health authorities seem to be exhausted in the abatement of glaring and offensive nuisances. Municipal communities have been moving forward, but rural districts have been stationary. The hope of reaching these authorities lies in better and wiser legislation than we have yet had. There are at work in this country many agencies pressing towards a higher sanitary ideal. The mingling of health topics in our various systems of public education, the existence of centres of instruction, established by the St. John's Ambulance move- ment all over the colonies, the labours of scientific associations and popular health societies, the dissemination of useful information by the Press, the organisation of several forms of charities, especially hospitals and trained nursing institutions — all conspire to create and extend a mass of simple knowledge among the people that must inevitably bear practical fruit ; and let us also hope that by the same means the attention of our legislators will be arrested, and the necessity for the embodiment of a higher legislative ideal will speedily become apparent to them also."
Following this interesting account of sanitary progress in the cities and country districts throughout Australia, the Hon. Dr. Campbell dwelt on the hospitals of the several Colonies. Hospitals he regarded as being a most important means of educating the people in the value and necessity of sanitary work. They should teach the fact that *' isolation, ventilation, disinfection, drainage and pure water are any- where and everywhere the conditions necessary to secure safety from the most fatal diseases that afflict our race." That in their construction and practical working they should illustrate every advance in modem hygiene ; that they should
KS^^^2?r* NOTABILIA. 311
Eeriew, May »» IvJi
be true object lessons to those whom it is oar earnest desire to enlighten. He illastrates his remarks by reference to hos- pitals in Sydney, Melbourne and Adelaide.
He then dwelt on the value to the community of the trained nurse. In doing so he said : —
'* There is a kindred agency to that of the hospital — an agency full of promise, and one calculated to carry into effect the details of public hygiene in a manner impossible to be provided for by law. I refer to the use of trained nurses among the sick poor in their own homes. The law may com- mand, but men and women, however poor, are free agents, a&d if cleanliness in all their surroundings, as well as tlie early recognition of conimmiicable diseases, is to become a part of the daily experience of the poor, the intelligent and the trained must bring it home to them. Trained nurses are exactly the agents required for this service.'*
The chief advantage secured by the trained nurse in educating the people in the principles and practices of sanita- tion are thus described : —
" Their constant contact in a friendly way with the great body of the people, and more especially those who interest themselves least in hygiene, enables them to exercise not merely a beneficent, but likewise an educational influence on the poor, and at the same time, by the timely recognition and separation of infectious cases of disease, they confer a precious boon upon the rest of the community generally. We are not behind in Australia in charitable institutions, carrying on the same good work, but we have not yet risen to the full perception of the large advantageous possibilities to public health that lie in this new province of woman's work."
Experience in our towns and rural districts bears out very fully these views of the good influence of the properly trained •* district nurse ; " nurses such as are sent out by the Victorian Nursing Institute to our crowded streets and villages.
The Hon. J)r. Campbell has very precise and accurate views on the all-important question of the powers and responsibilities of the State or central authority on the one hand, and of the local authority on the other. In considering the methods and results of existing legislation in Australia, he says : —
" A.ct3 of Parliament, not being automatic, must be given effect to by some authority in whom the State vests powers for that purpose. The attitude of that authority towards the exercise of these powers will necessarily indicate its capacity and fitness for the function entrusted to it. If the adminis- tration is lax, indifferent, or altogether deficient, with the
312 NOTABILIA. ^'S^^^^^
Eeview, May 2, 186B.
appearance of protection, the public health becomes the sport of every infections disease that comes along."
He then refers to the Health Act in Victoria, pointing ont that it is admirably drawn, and makes most full and adequate provision for the attainment of the purposes of such a measure. But he goes on to say : —
'* The feature, however, that demands our attention at this moment is that all duties and powers are lodged in local health authorities with a central authority for supervising purposes. If legislation on these lines was capable of being made effective, Victoria, by virtue of its comprehensive and intelligent Health Act, and also the acknowledged public- spiritedness of its community, would make it so.*'
But the words of the last report of the Central Board of Health for the Colony of Victoria show clearly enough that it is not effective. Having quoted evidence to this effect from the report, he says : —
** Surely, if practical experience in the working of an Act is any guarantee of its real ef&ciency, these words are simply condemnatory. They at once suggest the question — Should local authorities be entrusted with the administration of a branch of the Public Health Act, which they so signally failed to put into effect ? It would seem that the law may be as perfect as the Mosaic economy, but it is no warranty of its success. There is such a thing evidently as failure, not because the tenor or aim of the law is defective, but because the State looks for intelUgence, sympathy, and action in those to whom it has committed certain powers and duties, while neither of them is forthcoming, nor, if experience is any assurance on the point, likely to be."
He further presses his point in this way : —
**It is a political blunder which sacrifices efficiency to a political theory of local self-government — a theory applicable to many public functions, but strikingly inapplicable, from the very nature of the case, to this portion of the public health administration. The conviction forces itself upon my intelli- gence that a more reasonable division of public health work must be drawn between the central and the local authorities in the immediate future of health legislation. No doubt this would be more easily achieved were not the question of public expenditure so prominent a feature in such a re-arrangement. But the State has already found its way to de&ay from the public treasury the expenses of public departments, such as education, because efficiency is reckoned of more account than local self-government. Other departments might be instanced on the same grounds, but none of them, not even education.
^^^"« NOTABILIA. 313
<xsciipies the same important rank in the general weal as the conservation of the public health.'*
We have felt precisely the same result in England. The Notification of Infectious Diseases Act is not general, it is dependent on the intelligence of local authorities. The only objection the persons who constitute these authorities have to the Act is, that they are by it compelled to pay to medical men supplying the information it provides for the munificent sum of two shillings and sixpence. As the chairman of the sanitary committee of one of these bodies, who refused to adopt the Act, said to a medical man, *' You may notify as much as you've a mind to, its the 'arf crown as I object to." To sponge upon a medical man at every opportunity seems to be engrained in a large proportion of the human race !
On the subject of Food Inspection, Dr. Campbell says that the work of inspection throughout the Australian Colonies is lamentably ineffective. On the cause of failure. Dr. Gresswell, the chairman of the Victorian Board of Health, when speaking of the necessity of reforms, said : — ** They must necessarily be slow, more especially where administration was local and not 45entraL 'Legislation,' he added, 'was being prepared in Victoria which he hoped would go far towards remedying most of the evils which so tenaciously clung to our meat and milk supplies.' This expression of views comes as a hopeful fore- cast, but unless the lines of the legislation suggested are •different from the legislation of to-day the same disappointing tale of failure will have again to be told."
The Hon. Dr. Campbell then alludes to the scourge of consumption, and looks forward to the time when it, too, will be brought under control as the course of typhus and of small-pox has been. " If, however," he says, ** a consummation so desirable is to be achieved, intelligent and ceaseless efforts must be directed by improved legislation. The tubercle bacillus is highly infectious, and the avenues by which it can reach the human subject are more numerous than in any other communicable disease. A person suffering from it may infect other persons; animals supplying milk, or whose carcasses are utilised as human food, are sources of infection ; and a whole series of domestic animals with which men and women are constantly in contact, although differing in degree, jure mediums for its conveyance to man.*'
In concluding his address. Dr. Campbell dwelt earnestly and intelligently upon small-pox and vaccination. ** Nothing," he says, *' seems to me to indicate more strikingly that in public health matters we lag behind the age than the attitude -which several colonies maintain towards compulsory vaccina- tion. The fact that the large populations of New South
314 NOTABILIA. "^ISw^SS?11^*
Bevicw, Ma7 2, 1868.
Wales and Queensland are practically unvaccinaied com- munities is a matter for surprise and misgiving. The protective pover of vaccination is now as well established as any fact in any of the most rigid of the inductive sciences. Barring the dread that disease may be conveyed by the use of humanised vaccine lymph — and as the ground for such fear is now extinguished by the substitution of sterilized calf lymph — no objection remains to the compulsory enforcement of vaccination. I have seen the ravages of small-pox among the unvaccinaied, and I assert unhesitatingly that no man — whether legislator or private citizen — if he has ever witnessed the terrible spectacle which so many of these persons under small-pox present, can be anything but a supporter of compulsory vaccination. Having suffered an attack of small- pox at the age of twenty, I took special advantage of my immunity as a student to see all that could be seen and learned respecting this disease in a large city hospital, from which it was then never absent. No ordinary malady presents such shocking features, and certainly legislators do not realise their weighty responsibilities to the people when they con- tinue indifferent to the disastrous contingency of an invasion of this very horrible disease. Quarantine is and has been serviceable, but it is no unusual thing to hear even chairmen of Public Health Boards remark that we are bound some day to witness its appearance in Australia. When it does come and gets beyond quarantine control, then pity will be felt for the unvaccinated. A parade of statistics seems to me to be imnecessary in pressing the urgency for effective vaccination. I may be allowed to summarise the position which it holds to-day in the following manner : — (a) Indisputable evidence is in hand to show that the mortality from small-pox, where vaccination has been practised, has been reduced 72 per cent. ; (b) in no other disease has an abatement of the death-rate from any cause, sanitary or otherwise, taken place to any- thing like the same extent; (c) its mode of action is no longer mysterious or supposed to be contrary to nature, but by the light which bacteriology and experiment have thrown upon it is shown to be one of several illustra- tions of a principle in nature by which immunity from certain diseases is secured; {d) prior to the introduction of vaccination small-pox was the scourge of infant and adolescent life ; in vaccinated communities to-day the adults chiefly suffer from it ; (e) it has been clearly proved by experiment that revaccination at a given age of fifteen or sixteen years restores the protection of adults ; (/) even when adults who have been vaccinated in infancy, and who have not been revaccinated, are attacked by small-pox, the disease runs a
^^^TySt'" NOTABILIA. _ 315
highly modified course — this was my own experience at the age of twenty , (//) the consensus of opinion with respect to the use of humanised lymph should he abandoned in favour of calf lymph. This, then, is the position of the vaccination question. For the security of the colonies the law throughout Australia should be assimilated on a compulsory basis. For this, I presume, we must wait the awakening of the legisla- tures that still lag behind."
The Vaccination Bill, now before the House of Commons, practically abandons ** compulsion." What is regarded as a compromise is substituted for it. One fine having been paid, a parent is to be freed from the obligation to protect his child from the small-pox infection. Lord Grimthorpe, who is equally well known among ecclesiastics, medical men and lawyers for expressing his views in exceedingly plain English, wrote the following letter to The Times of the 21st ult. upon this point : —
** Is not this new system of granting permanent permits for a few shillings (therefore wrongly called a fine), or allowing an ignorant set of people on a council to grant them gratis in the lump, for parents to small-pox their own children first and thence a whole town a brilliant specimen of modern cowardice and yielding to a small minority making a great noise?
" And why is it not at once extended to the keeping of mad dogs, as a still greater number of crazy sentimentalists want, who think all dogs must be mad already to take muzzles so contentedly as they do ?
** Indeed, why should not all * preservers of ancient rip^hts ' of making stinks and all other sacred and profane nuisances, and breaking all kinds of laws, be allowed to take out a licence once for all, or, as an * assessed tax,' renewable annually, by which the public might at least make a little money ? To be sure, the anti-vaccinators, like the infant-death-insurers, who violently rejected Archbishop Magee's Bill for controlling them, do save somebody a good deal of money by keeping down the population and keeping up the death-rate ' to the high standard of excellence of the old one,' as the celebrated Revised Version preface modestly said of itself."
Evidently recognising that the defective work in promoting public health is due to the initiation and responsibility resting in local authorities, the hon. gentleman concludes his most interesting and effective address by saying : — ** We un- doubtedly make the mistake of following England in her eflforts to establish a complete system of local self-govern- ment. I am not opposed to local self-government as a working principle, but I none the less regard the inclusion of
316 NOTABILIA. "S^'=5S??;^
Be\-iew, IdMj 2, 1898.
tbe administration of infectious diseases as outside its sphere. The light which science has thrown upon public hygiene is comparatively recent ; the principle of local self-government in England is very old. Yet in England recently departures have had to be made from the principle, especially in matters -of public health. Local self-government covers many things in the management of the common affairs of a community, but it has been clearly shown that it utterly fails to bring about in local authorities in Australia an appreciation of the objects legislation seeks to secure in the control of commu- nicable disease. The State must assume this responsibility. It alone possesses the means of organising the necessary skill, experience, and aptitude required to meet all the contingencies arising in the course of an outbreak of infectious diseases among the public and further of enforcing the law. The sooner the position is taken so much the sooner will the public see and appreciate the great work that is being done for them. The local health authorities will realise that they are not called upon to undertake responsibiUties which many of them have declared to be outside their functions. They will feel under such new conditions that the branches of the public health administration are equitably divided between the State and themselves, and with this conviction will they more heartily fulfil the duties appointed to them. In mutual co-operation the two authorities will work together, and will doubtless succeed in bringing about a condition of the public health of which every sanitarian will be proud. For the starting-point of all this we must rely upon the intelligence, the patriotism, and the earnestness of our legislators. I ■appeal for a comprehensive consideration of this question — realising that if they once see its urgency, and become roused to the sense of deep responsibility that lies witli them to introduce better and more effective legislation, it will speedily come about ; and, once accomplished, no service to their country will bring them greater satisfaction, and no labour they could give will reap for the community a handsomer or more permanent reward."
DR. I. T. TALBOT OF BOSTON U.S-A.
Every one who knows him, whether personally or by reputation, will rejoice to hear that Dr. Talbot, who spent last winter in Europe, returned home during November with his health greatly restored. He however relinquished the practice of medicine and resolved on devoting his time and strength to advancing the interests of the Massachusetts Homoeopathic Hospital, an institution which largely owes its
i£SS?rigr2?Sa*^ NOTABILIA, 317
prosperity and pre-eminent position in Boston to the work that Dr. Talbot has done for it from the day of its foundation.
In the twenty-eighth annual report which has just reached us we find the following arrangement has been made by the board of management : —
"The increase of the property of the hospital, and the consequent development of its activities, which is likely to be continuous and progressive, have constrained the trustees to consider the subject of changes in methods of administration to meet new responsibilities. They have arrived at the conclusion that the immediate care and management of the institution should be entrusted to an officer to be called * Tlie Director of the Massachusetts HomcBopathic Hospital/ with large powers and duties, involving serious responsibility. They have desired to place in the position a man of acknowledged professional distinction, and of large general experience. It will not surprise those who have any knowledge of the history of the hospital that the choice of the trustees has fallen upon Dr. I. Tisdale Talbot, who has been unanimously elected director of the hospital.
" To the well-deserved reputation and to the high attain- ments of Dr. Talbot as a physician, he adds a qualification for the position which is peculiarly his own. From the early and feeble beginnings of the hospital to the present day, no man has given more time, thought and unsparing energy to its support and success, and now that it has readied an honorable distinction as a charitable corporation, and that new fields of usefulness are opening before it, it may well and fitly be entrusted to the sympathetic care and oversight of one to whom it has been for so many years an absorbing interest.
'' The trustees express the feeling of all the friends of the Massachusetts Homoeopathic Hospital in wishing for Dr. Talbot a long and successful career as its director." An expression of feeling in which we, and all in England who have the pleasure of knowing him, most sincerely join.
UNIVEKSITY OF CALCUTTA.
It gives us much pleasure to announce that at the meeting of Convocation of this University in February, the honorary degree of Doctor in the Faculty of Law was conferred upon our learned colleague Dr. Mahendra Lai Sircar, C.I.E., the accomplished editor of the Calcutta ^ledical Journal, Vice- Chancellor the Hon. Mr. Justice Trevelyan officiating in its presentation.
318 NOTABILIA. "Cl'w^SE^?^
In bis address on the occasion, His Excellency Lord Elgin, the Chancellor of the University, in offering his congratulations to Dr. Sircar said : " I think that the University has chosen a very appropriate occasion for conferring on Dr. Mahendra Lai Sircar the honorary degree of Doctor of Law in recog- nition of his eminent service in the cause of scientific enquiry.
'' Certainly during the last year we have been able to observe convulsions of nature on a scale which is almost without parallel, and we know that millions of our fellow-subjects have been suffering from privation, from causes of which at least we may say that the investigator has much yet to discover and to determine. I congratulate, therefore, the University as well as Dr. Sircar on the occasion which has been selected for conferring upon him the honorary degree of Doctor of Laws." (Applause.)
HOMOEOPATHY IN EDINBURGH.
The Edinburgh Eveniwj Dispatch, of the 28rd ult., informs us that the homoeopathic dispensary, at the west end of the city, which for fifteen years or so has been annually increasing in the number of its applicants for relief, is to be converted into a hospital, for which a corner site in the Haymarket district has been secured. The Dispatch contains a sketch of the elevation of the proposed building, the appearance of which is very promising.
WIRRAL HOMCEOPATHIC DISPENSARY, BIRKENHEAD.
The Twenty-Second Annual Report of this Institution gives the following as the result of the year's work.
The total number of attendances was 4,668, and the total number of visits paid to patients at their own homes, (including consultations at the Medical Officers* own rooms) was 1,255.
The Treasurer's account shows receipts from all sources amounting to £159 4s. 8d., leaving a balance carried forward to this current year of £29 Is. Od. after the payment of all expenses.
The Medical Officers are Drs. Reginald Jones, Theodore Green and Dawson.
BSri^'STf^Si^ OBITUARY. 319
. Beriew, Iby 2, 188?.
OBITUARY.
MR JAMES MARSON.
The ChemUt ami Druggist^ of the 9th ultimo, has the following account of the late Mr. Marson, of Staflford : —
*'0n March 80, at Earl Street, Stafford, Mr. Jamea Marson, chemist and druggist. Aged 88. Mr. Marson was the ' fisbther ' of the trade in the borough. He was the son of a farmer and miller, and went to Stafford as an apprentice with Mr. Dawson, chemist and druggist, who occupied premises in the Market Place. He commenced business for himself in 1882, when he founded the business carried on at present in Greengate by his son. He wa3 then 22 years of age. He married at 27, his wife (who survives him) being at the time only 17. Although Mr. Marson carried on business as an aUopathic chemist, he was from the first a convinced homoeopath, and was no doubt the first homoeopathic chemist practising as such in England. He was taught the art of making triturations, globules, &c., by Dr. Davids, a young homoeopathic physician, son of the then Court physician to the Shah of Persia. Dr. Davids afterwards settled in Manchester. Mr. Marson was preparmg and selling homoeopathic medicines in 1887-89, and had a high reputation in the Midlands at the time, when H. Turner, the first homoeopathic chemist in Manchester, was a schoolmaster, and when both Messrs. Leath and Epps, who afterwards became fcCtnous in the business, were, we believe, connected with the publishing trade.
<: >^ >te :{: 4e
"He was the last survivor of those leading burgesses who signed the oath of allegiance to her Majesty when she ascended the throne in June, 1887, and the fac nimile of his signature appears in the recently-published volumes of the Royal charters of the borough. The late Mr. Marson was doubtless the oldest Freemason in the province. He was initiated in 1888, and installed W.M. of the Royal Ghartley Lodge of Fortitude in 1886. He was one of the founders of the ** First " Staffordshire Knot Lodge, formed in 1886, and in that year be was appointed J.D., and subsequently became Provincial Orand Director of Ceremonies. In religion he was a sturdy adherent to the Plymouth Brethren cause. Had he lived another month he would have been enabled to celebrate his diamond wedding. He leaves eleven children, besides his widow. Only a few days before his death Mr. and Mrs. Marson were walking out together. He was a skilled botanist, and had an extensive knowledge of ancient and modem languages."
320 CORRESPONDENTS. "fT^^fSr*!^
NOTICES TO CORRESPONDENTS.
*^* We caruwt undertake to return rejected viannitcripti.
Authors and Contribdtoiis receiving" proofs are requested to correct and return the same as early as possible to Dr. Edwin A. Nbatbt.
London Homceopathic Hospital, Great Ormond Street^ Bloomsbdry.— Hours of attendance : Medical, In-patients, 9.80 ; Out- patients, 2.0. daily; SURGICAL, Out-patients, Mondays, Tuesdays, Fridays and Saturdays, 2.0 ; Diseases of Women, Out-patients, Tuesdays, Wednesdays and Fridays, 2.0 ; Diseases of Skin, Thursdays, 2.0 ; Diseases of the Eye. Thursdays, 2.0 ; Diseases of the Throat and Ear, Wednesdays, 2.0 ; Diseases of Children, Mondays and Thursdays, 9 A.M. ; Operations, Tuesdays, 2.30 ; Dental Cases, Thursdays, 9 A.M.
Devon and Cornwall Homceopathic Hospital.— A report of this meeting is in type, but is crowded out at the last moment. WiU appear next month.
Communications, &c., have been received from Mr. Knox Shaw, Mr. Dudley Wright, Mr. G. A. Cross, Mr. Wyborn, (London) ; Dr. Rams both AM, (Leeds).
BOOKS RECEIVED.
■ The Homceopathic World. April. London. — TJie Clie^nUt and I)rvg» gist. April. London. — The Calcutta Journal of Medicine, February. — Tit e North American Jo^irnal of Homceopathy. March. * New York. — The Ilomceojyathic £ye, £ar, aTid Throat Journal, April. New York. — The Medical Times. April. New York. — Hie New England Medi- cal Gazette. March and April. Boston. — Twenty-eighth Annual Report of the Massachusetts Homceopathic Hospital, JBoxton. — The Hahnemannian Monthly, April. Philadelphia. — The HofnoeopatJiir Recorder. March. Philadelphia. — The Homwopathi^^ Envoy, April- Lancaster. Pa. — T!ie Medical Century, March. Chicago. — The Clinique, March. Chicago. — The Medical Era. April. Chicago. — TIte Hahn^- manvian Adrocate. March. Chicago. — The Homa'opathic Magazine. March. Minneapolis. — The American Medical Monthly. March. Balti- more.— The Pacific Coast Journal of Homoeopathy, February. San Francisco. — Tlie Medical Bri^f. April. 8t. Louis. — Rerue Homoeo- pathiqve Franqaise, March. Paris — Rerns Hommopathique Beige, February. Brussels. — Leipziger Populdre Zeitschrift fiir Homeopathic, April. — Allgemeine Hom&opathische Zeitung. March and April. Leipdg. — Homoeopath ische Maundhlad, ApriL Amsterdam. — Rirista Omio^ ptttica. January and February, Rome.
Papen, Dispensary Reports, and Books for Review to be sent to Dr. Pops, 19, Watergate, Grantham, Linoolnshire ; Dr. D. Dtcx Brown, 29, Sevmoor Street, Port- man Square, W.; or to Dr. Bnwix A. Nbatbt, 178, Haverstock Hill, K.W. Adyertiae-^ ments and Business communications to be sent to Messrs. E. Gould ft Sov. 6f^ Moorsate Street, E.G.
M^HZtXt' THS AXNVAL OONOBESS. 821
THE MONTHLY
HOMCEOPATHIC REVIEW.
-:o:-
THE ANNUAL CONGRESS.
Thb Ankual Houceopathio CSonobbss, as oar readers are faUy aware by this time, froxQ the circulars sent oat by the Secretary, and reprinted in oar last issue, takes place in London, on Friday, the 8rd inst. When it is held in the Metropolis there is aluvays a very full attendance of members, and we have every expectation that this year it will again be so. London possesses attractions that no other city does* Everything gravitates to London, the centre of the world in importance. Nearly every one now-a-days pays a visit to the " little village " once- a year at least, and our colleagues in the medical pro- fession, with their usual judgment and good taste, like to take advantage of a gathering of their canfreres to . '\ kill two birds with one stone." And they are quite right. There is something breezy and refreshing to every one who does not live in London, in the bustle, the active life, the multifarious amusements, the picture galleries,. and the exhibitions of all kinds, which is quite exhilarating. And we advise all who can, and who even at the last moment have not decided to come, to decide at once for the visit. We are sure that no one will regret doing so, and that the regrets will be with those who stay away. We have frequently before
Vol. 42, No. 6. T
'd^ -THE ANNUAL CONflBESS. "SSS,?^S??iS£
AeviflWi Jdkie 1« 18BB*
enlarged on the advantages that the Congress oflfers, and we are pleased to see that our esteemed contempoiury the Homoeopathic Worlds puts very clearly and forcibly one point, which we beUeve is forgotten by many. That is, that the Congress takes a unique place of its own. It has nothing to do with the British Homoeopathic Society, or with any other society. A man may be a member of one or other of these, or he may be a member of none, and yet he is eligible, for the Congress, if he is a fully qualified practitioner. It it thus a most catholic assem- blage, and ought to have very large support. But while London affords so many attractions to our visitors, in the height of the season, there is another motive to induce our colleagues to muster in full numbers, namely the importance of such a gathering in the metropolis. . Many eyes will be upon us, and many will gauge the progress and position of homceopathy in the United Kingdom by the manner in which practitioners of the New School come forward to such a representative meeting. It is, therefore, a matter of •duty on the part of every one who can possibly leave his work for a day to come and swell our numbers. In these days when the Old School policy is to quietly ignore us and give out that we are dead, and that only our ghost hovers about '' the dawn of scientific medicine," as SxB William Bboadbbnt was pleased to put it, we ought to be glad to embrace the opportunity of giving the lie to such statements by showing what satisfactory numbers we can muster to our annual gathering. Let them see that we are very much alive, and that we have no intention of being absorbed by them.
The arrangements for the Congress will, we expect, be very satisfactory. Many of the doctors in London and the suburbs have expressed their desire to offer their hospitality to their colleagues from a distance, and we have no doubt that this kindly feeling will be largely accepted, and taken advantage of, as it will much reduce the cost of a visit to London. The address of the Presi- dent, Dr. EuBULUS Williams, will, no doubt, be full of interest, though we do not as yet know the tenour of it ; while the three papers by Drs. Clabkb, Bubwood, and Wilkinson promise to be most interesting. Dr. Clabkb takes up a new line, in explaining the '' Doctrine of Signatures," expounding his views on its merits, and
eS3S?jS??mS* BBOOT W i30BTI0N; 828
ltovww.JaQel.lSML
."wfa'ai bearing ' it and hoindeopathy motaally. ha'ire; Whether we may agree with him or not, the '^fNllijeet 10 original and ihtereating, and will probfibly give rise to a Igood discussion. Pd. Bubwood's paper will» ^im: c^an «88ure our readevd/he one of exception^ inter6rtj and ^oite original. His subject has been the; reatdt <4 lyeari of obBervation, and is eminently praotieaU thoogh not bearing specially on homoeoimthy . But at Mch^a xneetr ing, subjects of importance in relation to aHiiSihools of practice are important for homcBopaths to study. If r. WhiUnsoh's paper is strictly homoeopathic, and t$ike$ np a rather abstruse question in therapeutics, which is .well worthy of study and elucidation* and we feel svxt that it will be a mastei^ful examination of the subject. The programme, in fa6t, is a very fresh and delightful one.
At lunch, the memb^s frrai Lonobn and its suburbs will have the pleasure ot eutei^taining; as tbdit guests^ 'their brethren from a distance, while the 'dtlinei: is mure to be a snccesd. We hope there will bci a larg^ muster of the fair sex, to honour us with their {ireEfQno^ at the festive dinner board.
The businessprooe^dings are to be held at the'London Homoeopathic HOspMal, by the kind permission of the Board of Managemelkt.
ON THE USE.6p ergot IN THREATENED. ABORTION.
By D. Dycb Brown, M.A., M.I).
Consolting Phyalciaii to the London Homcsopathio Hofpital.
That the use of homoeopathic remedies in the treatment of disease by members of the old school is steadily on the increase is patent to every one who is interested in homoeopathy, and who reads the old school journals. Examples of this we from time to time notice, and the advertising circulars of manufacturing chemists display a remarkable list of " new remedies *' — ^remedies which a few years ago were never heard of by allopaths, but wliich had been in use for ages by the homoeopathic school, which were brought into notice by them, and which can act on no other rule than that of similia similibm. And all this while the old school continuea
T— 2
&24 BEGOT IN ABOBTION* ^t^fj^nHmS!
to jeer at homtBopathy as being onsoientific and delunye^ while those who practise it are considered outside the pale of consultation with the ** orthodox " practitioner.
Bat the fact remains all the same that the practise ot the old school is becoming steadily more and more^ leavened with the ** accursed thing/ whether in igncK ranee, or ** secretlv for fear of the Jews." Hence the open recognition of the principle does not keep pace with the adoption of the treatment.
An interesting example of this I cut out from the Britiih Medical Journal of March 6tii, 1897, but allowed it to pass unnoticed, owing to press of work, till now* But though late in recording it, it is a pity to pass it by» It is a paper by Dr. Lombe Atthill, of Dublin, Ex-Master of the jEtotunda Hospital, entitled, ** Obsevations on the anticipation of Posi>partum Hadmorrhages, with remarks on the Action of Ergot in Pregnant Women." After stating his experience of the value of giving ergot for some weeks before labour to women who were liable ta> post-partum hemorrhage, instead of waiting to give it at the time of labour, he proceeds : —
'' Although foreign to this subject, I wish to state my expe* xience of the use of ergot in cases of threatened abortion ; in these, haemorrhage without pain is often the first symptom^, and that indicates that the ovum is partially detached ; whe» whoUy detached hsmorrhage as a rule ceases and the content* of tibe uterus are sooner or later expelled. But it is seldom thai we can say with certainty when it has become hopeless to save the ovum, and therefore it is our duty to persevere in our attempts to do so as long as possible ; and of all methods to this end; absolute rest in bed for a considerable time is without doubt the best. But it is most irksome to a patient,, specially a mother with probably young children needing her care, to submit to the restraint imposed on her by keepih|^ her bed for weeks, and many will refuse to do so ; indeed, some women become so prone to abort that it seems useless to try to enforce prolonged confinement to their room, and then it is obviously better that the ovum should be quickly got rid of.
** Such a case occurred to me some five and twenty years ago. About that time I had as a patient a delicate young married lady, who in the course of the preceding ten months had twice aborted at about the tenth week of her pregnancy, and on each occasion alarming hadmorrhage had occurred. I attended her on the second of these. She became pxegnant again within two months, and at the expiration of almost
jKSS^jSIImw?** laooT in ABOBTioir. 825
•^zaetlj the saniQ tim^ as on the previoaa ooeaaionii, luemor- ihftge jMt in, which she knew wm the forenmner of another miacarriage, I mw her a tew hours later. There were no^ jpainsy bat the os was patulonSt and her state identical with what it had been in the early stage of her previous illness. J ^ame to the condusion that she must* certainly abort, and I at once pat her on ergot and stiydminOt with the view of getting rid of the ovam rapidly. The dose of ergot was repeated every two hoars, and I watched this lady all day, hourly expecting that she woald have a recurrence of the hfldmorrhage which had so alarmed her and me on the previous eccasion. Bat instead of this the h»morrhage lessened; Bight came on, and she slept. Next day the os was not the size of a split pea. This lady went to the full term and ^ve birth, to her great joy, to a son, now a strong man 6 feet mgh.
''From that day on I invariably administered ergot to women threatened with abortion. In some it produced no effect whatever ; in a few it indaced uterine action, and the expulsion of the ovum followed. In the majority the threaten- ing symptoms disappeared, and pregnancy proceeded n(Mnnally ; but in not one of them did I regret having administered ergot, «nd I am satisfied that if the ovum is not blighted, that is, ceased to be a living body, that ergot acts as a uterine tonic, <and renders the organ in many cases fitted to undergo the forther changes which take place in it during utero-gestation ; but if the ovum is detached and blighted, then it becomes, as it were, a foreign body, and ergot is then likely to stimulate the uterus, and to expel its contents. This opinion is, of •coarse, based only on the results of my personal observation, but of its correctness I hfkve no doubt."
Here we have an important fact stated by a well-known jKithority, from his personal observation — of the correct- ness of which he has no doubt — that in the majority of cases of threatened abortion treated with ergot, the threatening symptoms subside, and the case goes on to term, and that where the ovum is expelled, it is because it is already so far detached as to be practically a foreign body, and beyond the reparative powers of the system.
The main fact to be noticed in these observations is that the same drug which is so well known to produce, in full doses, very marked contraction of the uterine mnscular fibres to the extent of causing labour pains and abortion in the early stages of pregnancy, and at the time of normal delivery of setting up labour pains when deficient, and even of doing so so violently as to endanger the life of the child, and finally, of producing firm con«t
826 ERGOT? IN ABOBTION. ^^^f^SS^wSu
traction of the nteras after delivery, with expulsion of 6lots in cases of actual post-partum hasmorrhage, or when this is feared from the previous history of the patient. But this remarkable fact is kept, as it were^r m the background, by the author's throwing dust in the eyes of his readers. Instead of noting such a fact as being a curious, an interesting, an instructive, or puzzling, one, which would put him into a difficult position with his '* orthodox '* brethren, he calmly gives theories in. the most misleading manner, saying that ^' ergot acts as- 1^ uterine tonic, and renders the organ in many cases fitted to undergo the further changes which take place in it during utero-gestation." This is precisely a warmed- up edition of the late Dr. Anstie's famous explanation of the action of drop doses of ipecacuanha wine in vomiting, namely, that in these doses ipecacu-' anha acted as a tonic to the vaso-motor nerves of the stomach. This was simply throwing dust in his readers' eyes, to prevent them observing and noting the essential fact, which was that the same drug caused and ctired similar symptoms in large and small doses respectively. So here it is again with Dr. AtthiU and ergot. The same drug causes and cures similar con- ditions, and to call such a drug a uterine tonic is, to say the^ least of it, suppressing half the truth. It is, as- logicians term it, an example of iuppresno veri, but we should never think of hinting that an honourable man would be guilty of mggeatio falsi, which is very closely allied to the mppressio veri. No drug can be called a '* tonic " to a particular organ, which is only such in & . non-pathogenetic dose, and which is the very reverse of a ** tonic " in fuU or pathogenetic doses. Half the truth . is suppressed in so stating the case ; the whole truth being than ergot has, like all other drugs, a double and reverse action in large and small doses respectively;^ that the very conditions it produces in full doses in the , healthy bod^ it cures in smaller doses in disease, and that thus it is an example of the law of similars. How long will our friends of the old school persistently shui their eyes to obvious facts, and to the inference which^. when once pointed out, stares them in the face 2 The . facts and the inferences from these facts have been stated by us off and on for a century, and still they have eyes., but see not.
^SSa^STSS" BBOOT IN ABOBTION. 837
.For my self 9 I can amply . cocsoborato Dr. Lombe Atthiirs obseryations and conolasions. During the period in my professional life when I cultivated obstetric pcBctice, ergot was invariably, I may say, the medicine I prescribed in threatened abortion ; and even when actual pains had set in, and the case seemed hopeless, its action was most marked in subduing the pains, stopping the discharge, and enabling the patient to recover enturely^ and go on to full time. I came to the same conclusion a^ Dr. Atthill has done, that it is practically only in cases where the ovum has so far separated as to be only a dead loreign body, that ergot fails. Of course I prescribed the drug in these cases because it was so homoepathic to them, and not from having discovered its power accidentally, as Dr. Atthill seems to have done. And herein lies our power and the value of our law of similars. We do not need to wait for a chance accident to reveal a &ct to us. We know it beforehand, and we have simply to put our knowledge to the practical test.
' Li connection with this subject, I have here to tell an interesting bit of medical history bearing on homoeo- pathy and the old school. It was a correspondence I had with the late Dr. Meadows, about the year 1866, when I was a homosopath in conviction though not qnite ready for open avowal. Though these letters were not private, yet I considered it only a point of honour, knowing the antipathy of the old school to anything savouring of homoeopathys not to make any use of them. Now, however, that Dr. Meadows has joined the majority, no harm can be done to his memory. I was then looking into the merits of a statement of Sir James Y. Bimpson's that chlorate of potash was successful in the treatment of habitual abortion; his theory being that oxygen gas was set free and super- o^^genized the blood. The theory seemed absurd, but aa a point of successful practice I wished to find out the experiences of leading accoucheurs. Among others. Dr. Meadows wrote that he had no good results from it ; but — and here comes the interesting point — ^he added, the medicine which he had found more successful than any other, though it would perhaps surprise me, was ergot in small doses. I replied that I was not surprised, as I believed many medicines were valuable in conditions the very reverse of what was supposed to be their usual
82&' PUEBPERAL SEFriCiBBflA. •^SJwfjSSTiTiWL
s^here^if •giyen in stnaO' doses. - To this i>r. Meaflows, relied that he was mnch interested in what I had said, - atid'he advised me to work oat the sabject and publish my i;esnlt8 and conclusions.' What Dr. Meadows' actual knowledge of the pnnriples of homcBOpathy amounted to I do not know, as our correspondence then ceased, I feeling that I could not 'write on the subject without con^mitting myself to homoeopathy, for which at that juncturq I was not fully prepared. The facts are interesting, as showing that so long ago as about 1866 Dr. Meadows was fully aware of the value of a pure
Eiece of homcBopathy, and employed it ; and now we ave Dr. Lombe AtthiU, thirty years later, testifying to the same truth — ^a truth which has been long familiar to hoinceopaths. Thirty years seems a long time for such slow progress, but the advance is nevertheless in evidence. Even Sir William Broadbent considers that we are actually at the ** dawn (!) of scientific medicine.'' As the . Scotch story has it, '^ he maun be a pious lad, he is thankful for sma' mercies," if he begins at this . time of day to see the dawn, while to the eyes of those who keep them open to see, the sun has been shining
brilliantly for a century.
t ' ■ "■• — t- ■ <' ■■ — • — ■ - ■ . - . ■ - ■ » ■ I ■ .
TWO CASES OP PUEEPEEAL SEPTICEMIA RAPIDLY CURED BY REMOVAL TO ANOTHER HOUSE.
By Ed. M. Madden, M.B.
Thb liability of almost all forms of sanitary defects to set up blood poisoning during the puerperal period is sufficiently established to need no further demonstration, and the common-sense deduction that the most essential part of the treatment of such a case consists in removing the patient out of the poison-laden atmosphere is frequently insisted upon in all recent treatises on mid- wifery, for all that, it is a mode of treatment which one very seldom hears of being carried out, and the anti- septic armamentarium is so powerful now-a-days, that I am inclined to think we are all disposed to feel perhaps over-confidence in our capacity to ward oflf, or destroy sepsis, when of external origin, by means of free vaginal or uterine germicidal douches, of which the solutions of iodine and of corrosive sublimate are probably the most trusted, and not without reason.
wi^SS^J^STSSS^ PUEBPXRAL BEMieXMlk. S29'
* l^e following easeB illustrate ttie immediate* sabBi- 4ence of all serious symptoms on removing the patientc^ from the houses in which the septicemia originated; and such typical examples will» I hope, persuade others to follow them in like circumstances.
Casb I. •
Mrs. M., age 28, a strong, hearty woman, was confined of h^ first child at mid-day on 18th June, 1889. The child was a large one, and necessitated delivery by for- ceps ; there was a small tear in the perineum, which was stitched at the time, aiid there was rather free hemor- rhage before the placenta was delivered.
From the first she had two or three vaginal douches daily, using sanitas in hot water, t part in 10.
Junel 14th. Morning T. 99.4. P. 100. Passed two large clots to-day, but was in very good spirits and slept well. Evening T. 100.4. P. 104. 1^ aeon. Ix., and arnica Ix., nt ij. every two hoars.
15th. Temperature and pulse almost exactly the same — ^no more clots, lochia normal.
16th. Morning T. 100.6. P. 104. Evening T. 101.4. P. 108. The milk coming in to-day was supposed to account for this slight fever, as everything else seemed normal. The bowels also were well opened without help.
17th. Morning T. 99.2. P. 98 ; and all seemed going on well, till at 1.80 p.m. she had a rigor, and the temperature ran up to 108.4.
As soon as I could reach the house I gave an intra- uterine douche of hot sanitas lotion and repeated this twice more the same day, although there was no reason to think that anything had been left in the uterus, and the lochia remained normal throughout. ^, lach. 4c., and arsen. 8x. By 7 p.m. the temperature had fallen to 100.4 and the patient had had a very free sweat.
18th. Morning T. 99.4. P. 100, and she seemed viery comfortable, had slept well and taken her food well. Repeat medicmes. Evening T. 100.8 P. 104, and although there were no local symptoms I thought I would be on the safe side, and repeated the intra-uterine douche at 7 p.m.
. 19th. Morning T. 99. P. 100. Evening T. 99.6. P. 96, and we hoped we were over the trouble^ ^ arsen. 8k. alone. ^ . - ^
880 ?UEBPERAL SKPTICiEMIA. ^'r^^jS!^!!!^
. 20th. Morning T. 99. P. 86. Evening T. 100.4. ?.100.
2l8t. Morning T. 100. P. 100» and the patient had a good deal of headache, but was in every other way normal. At 12, iiOQn, to-day she had another severe rigor, with T. 106.4. P. 160. I now introduced an iodoform pencil into the uterus and left it there and gave her china 4> and lach. 4c. in rapid alternation, and the fever again rapidly subsided with the usual heavy sweat. All this time the lochia remained normal, and ' there was no symptom of pelvic or peritoneal mischief' of any kind.
22nd. Morning T. 99.6. P. 112. But again at noon she had a rigor, with T. 104.4, and at 1.80 a second, with T. 106.4, and for treatment received aconite ^ nys. every half hour, and an ice cap applied to the head. This fever also went down in tiie course of a few hours with a heavy sweat.
It was now evidiant that she was threatened with ^ severe and prolonged attack of septicaemia, and it was also certain that it was not a case of auto-infection, and as neither I nor the nurse had been recently attending any septic cases, it seemed tolerably certain th^t the cause must be some sanitary defect in the house where she lay, which later examination proved to be the case^ the cellar drain being untrapped.
I therefore persuaded her husband to allow me to remove his^ wife to her mother's home, about two miles distant, and we made iJl the arrangements to do so on the following morning.
28rd. Morning T. 99.8. P. 120. At 11 a.m. we removed her as arranged to her mother's house, and the day being fine and warm she was taken in an open c&rriage and thoroughly enjoyed the drive. Evening T. 100.2. P. 100« ^.arsen. 8x6. Shrs.
And from this time she never once looked back, as a glance at her chart will show, her temperature never again exceeding 99.5, and by the 26th being normal all day long.
Gasb II.
Mrs. P., aged 88, was confined of her third child on April 10th, 1898. She waa attended by a lady doctor^ and except that the labour was very rapid and accom- panied by a rather heavy loss of blood, neither tl)e.
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mSS^SSST^mS^ PUEBPEBAL SEPTIQXMIA. 881
labour nor the first part of the puerperal period were in any way abnormal. The lady doctor saw her for the last time, I. believe, on April 80th, when she made a careful pelvic examination, and pronounced her to be perfectly well internally, which verdict I have no* doubt was quite correct. She had, however, been, feeling unwell and feverish since the 28th, on which day she had felt very chilly (though neither then nor subse** quently did she have any de&iite rigor), and found her temperatore raised at night. The only definite physical signs were a verv coated and brown tongue, and a slight bronchial catarrh with a very irritating convulsive cough. But she felt very unwell and very depressed, and had an. ahnost constant slight per^iration. The bowels were open naturally, and with normal stools every day ; lochia, and all pelvic conditions normal.
I was not asked to see her until May 2nd, but I waa* enabled to get from the nurse a record of the liemperatarea from the 29th of April.
At my first visit I found the condition above described^ and also learned that a pond near their house which had been dry for nearly all the winter had just got half full with the recent rams, and that at the same time as the imset of her own feverish symptoms there were four others in the house taken ill with sore throats.
I gave her arsen. a. Sx. and phos. 4x. the first day» and afterwards bry. Ix. and lach. 4. But when I found on the morning of May 5th that she had had another slight chill during the night, and her T. was 102 at 11 a.m., I strongly urged her leaving the house at once» and as no friend's house seemed quite available at the moment, I had her brought to my own house that same afternoon. That evening her T. was 99.8, and a glance^ at her chart will show that it never rose again, but went straight down to the normal the next day, and has stayed there ever since, while all her feelings of illness and depression vanished from the time she entered the himse. Of course this was not nearly so bad a caser in any way as the first, but I don't think anyone can doubt that it was of the same nature, and my firm impression is that her prompt removal from the source of infection saved her from what might well have proved a. serious and prolonged illness.
Bromley, IStii May, 1898.
S32 ^ viscuM ALBUM. '"S^SSTySSS!
; EXPERIENCES WITH VISCUM ALBUM.
By Geoboe Black, M.B. Edin.
^NE case of sub- acute rheumatism was reported by me in the April No. for 1896 of the Monthly Homaopathie Review. It is as follows :— Mrs. M., aged 24, a stout, leuco-phlegmatic woman, with red hair and light blue eyes, mother of two children, the youngest being five months' old and at the breaat. On Feb. 8rd, 1894, she had tonsillitis, which was relieved in two days by suppuration and discharge from left tonsil, ferr. phos. .fix and baryta carb. 4x. having been given. About a fortnight previously she had experienced an attack of rheumatism, preceded by shivering, in her ankles, shoulders, right hand and wrist, which were swollen. On March 18th she again had a shivering fit. Next day she felt a gnawing pain in ankles, commencing in the right, then going to left, next affecting the right knee, followed by the left knee, the right hip being invaded last. On March 22nd the ankles and knees were less swollen. Patient could not stand ; had to be lifted in and out of bed. Knees were not swollen and there was no redness, but they were stiff and acutely painful on movement. The right hip was very tender on pressure, ^md the skin reddened over the joint. Heart sounds •clear, somewhat accentuated over pulmonary and aortic <areas. Urine high coloured, no deposit. Pulse 108, temp. 101° ; aconite Ix ordered every two hours. Next day, pulse was 96 and temp. 99.4°. Both hips aire now ^affected. Urine clear ; has had no sleep.
March 24th. No sleep at night on account of pain in legs, which affects her when she tries to turn on .one side. A little sleep during day. Pain idways gets worse when . she becomes warm in bed. The left ^ee joint is swollen, without redness ; the pain is always worse on movement. Ptulse 104, temp. 99.8^; bryonia 8 every two hours. Next day pulse was 108, temp. 100°. No improvement ; lK)th elbows now affected, the right first. Yiscum album S every two hours.
March 26th. Had a better night, slept more. The ^wrists now affected, the ri^^t first ; it is stiff, puffy, and the skin reddened in a streaky fashion. Knees and . Ankles stiff and painful. Pulse 100, temp. 100°, rising
SSSTj^SiriS^ V18CUM ALBUir. 88ft
to Ids ftnd 100.4^ reflpectiyely at 10 p.m., when there was still a great deal of pain.
ICareh &7th. Entirely free from pain. It left her ai 1 a.m. in the following order : first ankles, then knees^ then elbows and wrists. Can move the legs to-day. Bight wrist yery stiff. At 9.80 p.m. had no retom of pain; swelling is leaving right hand, and wrist. Complains of an aching pain at the top of the head* Pulse 94, temp. 99^.
March 28th. A good night, sl^t well. About 10 p.m. pains retomed in right wrist and elbow, not severely — a naggingpain — ^which left again aboat 1 a.m. Can now move legs without pain. Swelling has left knees ; there is still a little in riffht ankle, also of right hand.
March 81st. Allowed out of bed.
April 2nd. Sitting up; complains of weakness.. Yiscum album changed to china 80, ter in die.
During illness the cardiac sounds were clear, and the milk slowly left breasts without trouble. The pains used to get worse about 5 p.m., and kept on generally till 1 or 2 a.m., when sleep ensued. She said of pain, ** it was just ais if all my veins were drawn up," and in hips, aa if she were " being drawn up in these parts and then suddenly let loose." There was transient pain in back on March 28rd only, probably due to her having been only two weeks free from menstrual discharge since coi]£nement, during which interval there was considerable leucorrhcBa.
I have used viscum album several times since in acute and sub-acute articular rheumatism, but I have nothing of a definite or satisfactory character to relate : in some instances of chronic rheumatism, however, in sciatica^ and in two or three cases of acute myalgia the results were encouraging.
Cash I. — Myalgia.
Miss F., aged 67, dark hair and eyes, medium height and stoutness, still quite " regular," consulted me on Feb. 6th, 1898, and complains of pain between the shoulders. The movement of the shoulders hurts her more than anything. '' When I get out of bed mornings I can scarcely dress myself, there is so much pain. When Tm lying in bed, after I have been lying some time, towards morning, then it begins." After she has
51 yiBcvuALBxm. "^SSa^^gg?^
i>eeh up and moviilg about for some time she doesn't feel it. '^ Now it is aching ; I can feel it is there. The •second joint of the right middle finger swelled up the wother day, bat this is now gone, it went away after a time. I had it about a week." Yiscum album 80, fiye 4rops on S. L. once, at 6 pjn.
• Tuesday, 7th. Better t in less pain than she has been •during this attack.
Friday, 10th. Complains of a tingling feeling coming *from the right shoulder forward under the axilla to the breast. Yiscum album 80, 12 drops in half a tumbler of water ; a dessert spoonful every four hours.
I met Miss F. out to-night. She was stepping along briskly, so much so that I scarcely thought it could be she. She said, ** Tou will be glad to know that I am •much better ; the pain is not gone yet, but it is deadened, and I feel a lot l^etter than I did."
Monday, 14th. '' I'm a great deal better. The pain is not quite gone, but I am a good deal better. I feel it for a couple of hours in the morning, but it is nothing •compared with what is was ; I can dress and all that now without singing out. I haven't felt the pain in my side since I began to take the medicine, but I feel it just where the pain was between my two shoulders." The swelling of the finger joints gradually subsided and there has been no return.
Case II. — Lumbago. Mrs. A, aged 80, dark brown hair, dark grey eyes^ stout, was seen on Tuesday, March Ist, 1898. She told me see went into town on Saturday evening, and after she came back and had taken off her things, she shivered. Sunday morning her back was very bad'; seemed like anyone tearing it to pieces ; she felt as if she wanted something to press against it. She complains much of her back to-day ; is obliged to get some one to help her before she can raise herself up. "When I move my left arm it seems to affect my back. Just to draw my foot up it pains me." The situation of the pain is the lumbar region and up along the spine. Temp. 98°, P. 72. Tongue clean. "I keep feeling starving, yet can't fancy anything "to eat." When she coughs it causes great pain iii the chest and back. Yesterday she expectorated some dark greeny-yellow phlegm. Yiscum album 8 every two hours.
. Bivi«ir,Jttiiel,
UomimasMc VISCUM ALBUM. 88b
. Wednesday, March 2nd. She can sit up in bed* hv herself to-day, and can tnm from side to side ; there m • mneli less pain in the back. •
Case III. — Lumbago, ' Mrs. M. aged 60, a thin, fragile woman, with silvery hair and brown eyes, has been safferiQg from catarrh of the bladder, whidh was improving under ferr« ph. and kali chl. On Sunday, the 28th Feb., 1898, I saw her, when- she complained that on the previous Priday and Saturday she felt cold and shivery, and couldn't get any heat into her. Saturday, she felt pain in the riig^ lumbar region, extending to the right buttock ^ to-day the pain has been much worse. It is very pamful to move ; the slightest movement aggravated the pain. Temp. 101^, P. 112. Face flushed, tongue grey-coated. There is much pain in the right lumbar region and down towards the right buttock. Viscum album 8 every hour.
Monday Feb. 2l8t. She can move a little better this morning Temp. 99^, P. 96. Continue. ' Tuesday, 22nd Feb. Temp, normal, P. 72. She says she feels better ; the pain in her back is almost gone ; she can turn and move about now with only the least sense of pain. '' It is wonderful," she added '' that I have so quickly got relief. I never knew anything like it before."
Cask IV. — RheunuUiim of Lumbar Aponeurosis.
Mrs. B., aged about 45, fair, of medium height and stoutness, sent for me on February 28rd, 1898^ and •complained that she was seized with poiin at the lower part of the back (sacral region) two days previously. Oouldn't turn either to the right or left. The pain was greatly aggravated by movement. She at once took aconite, which she has continued since, and applied hot salt and hot water bottles, which have to some extent relieved her. It still hurts her very much to move. The bowels have been painful, and her sides. When she was first taken, it was after exposure to damp, she became cold and shivered. The pain she describes as of a terrible clutching nature, as if her vitals were affected. At first she had to pass water very frequently ; not so frequently now. Temp. 99°, P. 72. Act. rac, <l> 4 drops in a tumbler of water ; a dessert-spoonful every two hours.
886 VISCUM ALBUM. "SSSi
Beriow. Jim* 1, Ml.
^ Thursday 24th. Not any better* Temp. Sg.^'', P. 80. Her eyes filled with tears, she complained much of pain on the slightest movement. . Yiscum album S every two hoars.
Friday. 26th. 'Had a better night, can move better and feels much better. ^ Temp. 100^, P.^ 72. Continue* The fever gradually diminished, and in two or three days she was downstairs, all pain having gone from her back.
I have used viscum album several times in the treatment of metrorrhi^gia, but I do not know that I have got a single encouraging result, and in the cases of retained placenta in which I have given it — three in number — the result had been nil.
Some Rheumatic C(ue$* •
On September 24th, 1895, I was consulted by
'Miss , aged 54, in whom menstruation was stiU
proceeding perfectly regularly. She complains that her joints have got worse and worse, they ache and gnaw» " the weight of my body on the joint causes it to be very sore. This morning I nearly fainted with it. I perspire so dreadful. Sitting' like this it don't ache, but if I were to sit up on this couch I couldn't be still & minute, it would begin to gnaw ; it's dreadful in bed — the whole knee seems on fire, it keeps me awake, I can't get off to sleep. While moving there is relief for twa or three minutes, but as soon as I am still the pain Sets in.*' The patellae have a lumpy, nodulated appearance and feel, and she complains of great pain all round left patella, which is very tender to touch, especially at mner aspect. The left knee is swollen in comparison with the right. She says ''You can hear my jointa 'scroop' as I go upstairs." Some of the metacarpo- phalangeal articulations became swollen. Urine ib normal in appearance^ Yiscum album 8,12 drops in i^ tumbler of water, a dessert-spoonful three times a day. The report I have, without any date, is, ** this relieved her, the next day she was better."
Mr. , aged 60, reddish hair, a weakly delicate
man of a badmorrhagic diathesis^ consulted me on February 2l8t, 1894, and complained that the previous week he didn't know where to put his legs, they ached so. He was standing in the garden in the .dam .
ISSS^J^SuSt" TI9CUM ALBUM> SSJ
"watchiTig Bome men working at the drains. Went into the greenhoase in his slippers. Was oat walking about on Sunday and felt nothing amiss. On Mondav on
Setting out of bed he felt his left ankle painful ; hobbled ownstairs, since then it has been painful, especially irhen he attempts to move it, and more particularly ^om side to side. Can't move it either side without pain, the up and down motion hurts him. The joint is swollen and tender on pressure, especially when the maJleolus is pressed against the joint. No other joint is affected. Yiscum album 8, 12 drops in half a tumbler of water, a dessert-spoonful every four hours.
Monday 26th. Downstairs. All swelling gone, can move it without pain in every direction.
Lumbago.
Mr. , aged 62, a cab proprietor, consulted me on
Wednesday, May 26th, 1898, and complained of having suffered from pain in the lumbar region since the previous Tuesday. It seemed to take him all in a minute while stooping ; he went out, but had to come back again ; it was very painful when he, attempted to itum. The pain when I saw him on Friday had partly ^ne from the back and was affecting the right hip. Viscum alb. 8 was prescribed, 12 drops in half a tumbler of water, a dessert-spoonful every two hours.
Sunday, 28th. The pain in the back is now much hetter, but it is gone to the hip and right side. Has got up twice to-day ; obliged to go to bed again in the morning, but was up in the afternoon, although in a :good deal of pain. Continue.
March 29th. The patient called upon me this morn- ing himself to say he was all right.
Sciatica,
I have already referred in a '^ Case of Sciatica of nine gears' standing cured by Carbon Bisulphide" to the amelioration in the patient's condition brought about by my first prescription of viscum alb. 8.
The patient consulted me on the 24th July, 1898. T4>r two or three years he had been unable to go to bed on account of his inability to lie down. The situation sjid direction of the pain were centre of right buttock, 4own back of the thigh to the popliteal space, then down
ToL42,No.«. t
888 VISCUM ALBU». ^SSlSrfitoSlflSi!
to the back of the leg, stopping short a little way ritofm the ankle. '' He feels the cords behind the knee ratb^ tight as if the leg were being drawn up." The ezprossiQa made use of by this patient is similar to that of the onf snflEering from sah-acnte articalar rheumatism, with ifa!^ exception that she speaks of '' veins." *' It was just as if all my veins were drawn right up." They probab]!" mean the same thing, but with the hazy anatomioa^ knowledge such people are possessed of it would hard^j be fair to expect anything more definite. On the 29tb July this sciatica patient reported *^ I have had 1} houn^ relief from pain since taking the medicine, this is mor^ than has ever happened to me since the commencement of my illness." I might have had a brilliant cure to plaM to the credit of viscum album had it not happened when m^ patient came again that I was out of the drug, or it might have been a providential arrangement by which I was enabled to substitute carbon bisulphide for viscuxn album, and so effect this patient's recovery. ?
In another case of sciatica associated with otorrhoea in which I used it after sulphur 80 failed to do any good^ and where it was to some extent beneficial, the symp** toms were : Pain in the left leg and foot, extending froca the centre of the buttock down the back of the thigh to the popliteal space ; then down the back of the leg to the inner ankle, where it stops short behind the internal malleolus. *' It burns very much but just at the heel it is as if one put a red hot coal against it; it aches all down the thigh and *t6e leg feels heavy as lead. The whole leg seems quite consumed with pain ; sometimes it is like little bubbles forming and breaking, and the^i it will beat and throb like a clock. The leg seems at times contracted, drawn up behind the knee." Yisoua alb. 8 was given on March 21st, and she reported on April 2nd that she was getting on nicely, when she ran out without any covering on her head and ears from a hot room and brought on an attack of inflammation oif the mastoid procefis.
Swelling of Right Knee.
On April 10th, 1894, 1 was consulted by Annie >,
aged 20, a blonde. About two years ago she fell and struck her right knee. Nothing appeared amiss at the time. Bather more than 12 months ago she felt as if
JSayj^StlSy^ VIBOUM ALBUM, 889
mne Utile bone had got out of place ; after that noticed* a swelling begin to appear, and this has got much worse flinoe. Can hardly walk now, the pain is so great; it horts more after she has been sitting a long time ; it aches frightfully. The joint is now swollen, two inches larger than the other ; last two months hardly able to wiJk ; the right calf is one inch less than the left ; sleeps well and eats welL The swelling of the joint is most observable at the inner aspect where it is tense and fall ; it is also swollen and tense above and below the patella. No tenderness to speak of on pressure. Not menstraated for two periods. Pals. 80 given, one dose.
May 19th. Felt mach worse the day after she saw me. CSoald scarcely walk three steps. She then of her own accord painted it with iodine till the skin cracked and she coald bear it no longer ; the pain got easier after a fortnight and she coald walk aboat better. On exami- nation I find the knee joint rather more swollen than it was. Circumference of right knee 16 in. ; left 12} in. Yiscum album 8, 6 drops in half tumbler of water, a dessert-spoonful three times a day.
June 2nd. She says : I can walk ever so much better upon it ; it does not pain me nearly so much. I do not get that aching pain which I used to have. Circum- ference 14^ in.
July 25th. Circumference of knee 14} in. Can walk much better than she could. Continue the viscum album 8, increasing the dose to 12 drops.
Some Ear Cases.
Before proceeding to give my notes of some of these cases I must apologise for their fragmentary and unsatis- factory character, partly arising from the fact that it is difficult to get people to persevere for any length of time where progress is, and must of necessity be,, slow. We are consulted by those who have suffered for years, and our remedies are expected to woric miracles, and too frequently, when nothing very striking happens in a month or two, they become weary in well doing and give up coming, and we lose sight of the case. This applies more especially to those who pay for their advice. Many of those who are seen by medical men gratuitously will come till further orders, and If, unfortunately for them and the medical attendant, they ;;
z-2
S40 VISCUM ALBUM. ^'^SiL^nSSV!^
happen to be of a nearotic type of constitution, the. organs and tissues of the body that are from time to . time affected unll shift like the varying views of a kaIeidoecope» and blessed are they whose patience fail not, and who, after many years, are still listening to the same old tune of terrible agony, played upon an instru* ment of many strings.
But again, in many of those diseases occurring as manifestations of the strumous diathesis, you have recovery up to a certain point, then the patient catches cold, the tonsils become swollen, or more swollen than they were before, the hearing becomes as difficult as ever, and their money seems to have been spent for nought, and your labour for that which profiteth not.
With these remarks b}' way of introduction, I will now proceed to lay before you some of the notes in my possession connected with the cases we have under con- ;£ideration.
Case I.
The first note of this case I am unable to find, but I believe it was some time in October, 1894, that Mr. J., a tall, dark haired man, a travelling butcher, consulted me on account of his hearing. Some years before, he was playing with his brother in a loft, and he gave him ^such a bang on the right ear that made it ring, and he has not heard since in that ear. It discharged^ for a long time after. At the time of his first consulting me I must have given him viscum alb. S, because the note made on December 26th is to this effect : Viscum alb. 3 ; .6 drops twice a day, a$ before, and the report is as follows : '' My hearing is better ; while some ladies were talking the other night I heard what they were saying ; this I have not done for five or six years." Speaking in an ordinary tone of voice he hears me very well to-day, even with my back to the light, so that he cannot see the movement of my lips. I now tested his hearing with this result : —
|
W. T. |
N. 8. |
T. F. |
|
|
night ear |
7i— 8in. |
2 yds. |
All over room as far as I could re- move from him. |
|
Left ear |
2 ft. |
8 yds. |
Do. |
I am sorry I cannot give the preceding record, nor nave I any subsequent note.
ga8b n.
On Monday, March 4thy I was consulted by Lizzie H.» aged 27, dark brown hair, grey eyes, of strumous consti* tution, who told me that when five years old she had scarlet fever ; '' both ears ran then, and I have always had a discharge since, and hearing has been much affected." Her speech is like one who is deaf.
W. T. N. S. T. F.
Bight ear 2} in. 18 in. 4 yds.
Left ear not a sound. Yiscum album 8 five drops three times a day. Monday, March 18th. —
W. T. If. S. T. P.
Bight ear 4^ in. 82 in. 4 yds.
Gasb m. Miss W., a well developed ffirl, of healthy looking complexion, age 21, with dark, bright eyes, dark brown hair, consulted me on October 24th, 1894, and said that about four years before she was in the show room of a large drapery firm here and noticed that she could not hear what the customers said. Her hearing has got worse since then, and she has funny noises in the head like a lot of water rushing into an empty cistern. At times it has been like thunder rolling. Never had any discharge from the ear that she knows of. Was four months in London, and went to the Golden Square Hos-
Sital. She was given medicine to sniff up the nose, but id not derive any benefit from it.
W. T. N. 8. T. F.
Bight ear ^ in. 2 ft. 4 yds.
Left ear i — | in. 1 yd.
Yiscum alb., 6 drops twice a day. Wednesday, Nov. 2l8t. Complains of great noises in the head — hissing, like a. train in the distance, or steam being let off. Sometimes also like a whistle. She tells me her mother is deaf, and a sister aged 17.
W. T. N. 8. T. F.
Bight ear 1^ in. 2 ft. 6 yds.
Left ear l| in. 2^8 yds. 6 yds.
She now complained of her throat, which I found
inflamed with some swelling of the left tonsil. For this
bell. 6 was given, and on Sunday 25th, the throat being
launch better, viscum alb. 3 was repeated as before. :0n
S42 VIBCUM ALBUM. "'SSL^iSS^ffi
B«vJ0«,Jiiiiei«18M.
January 6th she was suffering from nasal catarrh, and patr. sulph. 8x was prescribed. The last time I tested her hearing was February 26thy and the result was as follows : —
W^# T» N* Ba T« r»
Bight ear 6 in. 26 in. 4 yds.
Left ear . 4 in. 2 yds. 4 yds.
The result in this ease was nothing very brilliant, but such improvement as did take place was, I believe, due to the viscum album.
Casb IV.
On Monday, April 1st, 1896, a girl aged nine was brought to me by her mother. She was of medium height and stoutness, had brown hair, grey eyes, and reddish cheeks. The beginning of the previous year she ^suffered from scarlet fever, and had an awful discharge from her left ear, and it would swell up like an egg behind the ear. She also had a bad discharge from the nose while she had the fever. Since then her hearing has been affected.
W. T. N. S. T. P.
Bight ear. Normal in all respects, although the ear channel is so blocked with wax that the tympanum cannot be seen. ' Left ear ^ — J in. 5—6 in. 24 — 26 in.
On examining the left ear I find the channel free, except for the oozing of some discharge. At the lower part of the tympanum there is what appears to be a collection of pus : above this, thje tympanum presents a convex surface, and has a swollen, thickened, reddish appearance. Viscum alb. 8, 6 drops in half tumbler of water ; a dessert-spoonful three times a day.
Sunday April 28th. She could hear the bells of All Saints Church as she came up, which is better than she has done since her illness.
w. T. N. s. T. F.
Left ear 1 in. 19 in. 2^ yds.
There is much less congestion of the iympanum than there was. Continue; On June 14th, I have a note to this effect : — *^ Bowels have been relaxed for three weeks. Sometimes wiU go three or four times a day." To-day about 12 o'clock she complained of a dreadful pain in lier head, hea^. Could hardly keep it up; was sick
£3Si^£?irSn^ :«I8CUK ALBUM. &4S
and vomited. Been taking TiBcain alb. 8 till yesterday. Her appetite has been poor for some time.
I have no note beyond this date, and there is no reference to the copdition or state of her hearing.
Cash V. Alice B., aged eight, a pretty child, with aobom hair, and grey eyes, of stramous type of constitution, and with her milk teeth in a wretched state of decay, was brought to me <hi May 8rd, 1898, on account of the state of her hearing. She was taken to a doctor a year ago, but does not think she was any better after. She was not noticed to be deaf till a year ago,- and there was nothing ihat they knew of to account for it. An aunt is deaf. In her case it came on after scarlet fever. This child has had nothing of the kind. Had measles 2 years ago slightly. No discharge from her ears then. Her breathing is bad at night. She cannot breathe through her nose, and lies with her mouth open. Appetite is fiurly good. Her sleep is often disturbed, and if she is excited, she talks in her sleep. She often has a hissing sort of noise in the ears, as of steam being let off, especially at night. The tonsils are much enlarged, and are stredced with dilated capillaries. The mouth is very moist; there is a great deal of saliva all about, presenting a frothy appearance; there are watery bubbles all over; the anterior part of the tongue is fltudded with the red points of prominent papillao. The tympana presented, as far as I was able to make out, a healthy appearance.
W. T. li. S.
Bight ear 6 in. 4 ft.
Left ear 1 in. 17 in.
Yiscum alb. 3. One drop in a teaspoonful of water, ihree times a day.
Wednesday May 10th. She has had to be kept home from school two days on account of a bilious attack to which she is occasionally subject. Fancies the dribble from her mouth is not so much as it was. She was -very feverish on Thursday and Friday. Sleepy and heavy, and very hot ; did not eat much for two or three days.
W. X. Xf. B.
Bight ear 16 in. A long distance.
Left^ar 9 in. Sit.
84*^^ BCijRVY-KICKEm ^b2SS^%??2b^'
Beview,Jmiel,]aB8**
' On- Tuesday, May 28rdy I again saw her. BhO'^ni^ now anffering from an alveolar abscess, with swelling oC the snb'-maxillary and cervical glands.
W. T. N. S.
Bight ear 20 in.. Left ear 11 in. 4— 5 ft.
This was the state of things up to the time viscnn^ album waa left off, but it is right to say that under th& use of sil. 4x, bell. 8, snlph. 8, and cal. 6 the hearing had speedily improved, and on Wednesday, July Sth, it was :— r.
w. T.. Bight ear 86. in. Left ear 80 in. Upwards of a year after, this child's hearing was worse* than ever ; she had many enlarged glands in the neck^ and under the jaw. She was again given visoum alb* and her hearing improved, but I am unable to give details.
{To be contintLed).
SCUBVY-BICKETS, ILLUSTBATED BY TWO • CASES.
By J. BoQERSoN Dat, M.D. Lond.
Physidan for Diseases of Children to the London Homoeopathic Hospital.
ScuRVY-BiCKETS is a disease of considerable interest,, especially as it is a preventable disease. Attention waa first called to it by Dr. T. Barlow, who made it the subject of his Bradshaw lecture. ' It is fairly commonly met with in children a few months old, mostly from 9 to 18 months. It occurs with equal frequence amongat the children of the rich and the poor. The resemblance to scurvy is greater than to rickets, although it generally , occurs in rickety children.
The causes which produce, this disease are much the .same as those producing scurvy in tJhe adult, namely^ .improper food. It never occurs in breast-fed children, but always in those artificially fed. The subject qf artificial feeding of infants is always of interest, and a perenpial source of discussion. We shall always have to face the difficulty of artificial food for children, and
SS^j£??M^'' 8CURVY-BICKET8* 84fi
|tofi0V,Jiinei,l«6.
there is no doubt that some children thrive well on a food which will cause scnryy in others. • One of .the finest children I know was brought up entirely on humanised milk prepared by one of ouc large dairies ; it was most interesting to watch the little fellow steadily lay on weight, week by week, in a perfectly normal way.
On the other hand, we. occasionally meek with a child which is fed .in precisely the same way and it develops scurvy.
It has been satisfactorilv demonstrated that there ia some subtle property in fresh milk, and fresh food, which^ for want of a better term, we call the anti-scorbutio element. Destroy this element^ by heat, or other methods commonly in use for preserving foods and scurvy results. Bestore this element to the scurvy-stricken child and it recovers.
. . Compare this with the curative effects of lime juice and fresh potatoes on the scorbutic sailors., v
. Now, in the artificial feeding of children we are con- fronted with a serious difficulty at the outset ; if we feed .with raw or unsterilised milk we may give the children several grave diseases, e.g.y tuberculosis (from tubercu- 4ous cows), scarlatina, enteric fever or diphtheria ; if oo the other hand we sterilise our milk we protect the children from these diseases, but they then run the risk .of becoming scorbutic. In fact, we are on the horns of a dilemma.
Fortunately, we are able to supply this antiscorbutic element to the child in other ways than by the milk, which are safer, and, at the same time, equally efficacious.
Climate and general hygienic surroundings avail nothing in preventing this disease, which may invade the nursery of the rich where there is every luxury and modern invention. Both my cases came from healthy districts, and one from a large airy house with good garden.
The onset of the disease is suddenl The child becomes fretful, cries when touched, lies helpless, and the limbs hang as if paralysed. The aspect of child is remark- able, the healthy fresh tint is lost, and it becomes instead pale and earthy in colour. In the case of £. P., great swelling' of the right shoulder and shaft of th^
Imunerns and also of the left femur, were early and Terj obvious lesions. .The large bine veins whicn marbled the right shoulder^ at one time suggested a rapidly- growing sarcoma.
These swellings were acutely painful to touch and Barlow regards them as the charaoteristic lesion — ^they are due, as has been seen in the few poit^mortenu tbsA have been made, to sub-periostea! haomorrhages. They leave the bones permanently enlarged, ossification taking place as recovery follows.
^ In other cases the mucous membranes show a great disposition to bleed. The gums are spongy — ^this may be often seen, and is an early sign — simple pressure of the finger will cause blood to ooze out at the base of the teeth. Bleeding may come from the bowels, bladder or vagina.
HaBmorrhages may take place into the orbits, as was the ease with P. 0., and at times this is so great that it leads to proptosis.
The skin often shows marks of bruising, from slight pressure, and even handling the child may lead to sub- cutaneous haamorrhages — ^the bites of fieas assume a Satechial character — the muscles are wasted and very abby. Dentition is delayed and generally the symp- toms of rickets are also present, such as profuse perspi- ration about the head, with widely open fontanelles. There may be slight fever, but this is not usually high.
Case I.
Phyllis 0., aged ten months, the only child of healthy parents, weighed 10^ lbs. She was healthy at birth, but the mother soon had peritonitis and the child had to be weaned.
She was first seen Sep. 28rd, 1897, greatly wasted and flabby. Two weeks previously had a spontaneous hsBmorrhage into the right orbit, like a ''black eye." The same had happened before into the left. She cried when touched and bruised readily. There were two bruises on the back. The gums were not spongy, n(X was there any bleeding from the mouth or other purts..
She was put on a diet of milk and barley water and raw meat juice. Galcarea carbonica 6, one grain was given three times a day.
On Oct. 7th. Cod-liver oil was added to the above prescription.
miSi^^SSTSS^ BCUBVT-BIOKBTS. 84T
On Oct. 28th. Had gained 1 lb. 6 oas* in ten days.
On Nov. 4th. A fartiier gain of } lb., and had much 4Qore life.
On Dec. 2nd. Chapman's wheaten flonr and pmnea were added to the dietary.
Jan. 10th. the weight was 16 lbs. 10 ozs., and on Jan. 24th she was quite well.
Cass II.
Was a very marked case. Kathleen P., aged 11 months. Was the second child in the family.
The health of the other child was very good. For one month only she had the breast, after that was hand fed. Cows' milk and Mellin's Food for six months, and for .the last four months Savory and Moore's food .exclusively prepared with boiled milk and water.
At birth she weighed 8 lbs., but at the end of the month only 5 lbs. For the last two months she had lost ihe use of her legs and cannot bear to be touched — she screamed if moved. Had profuse perspirations about the head during sleep.
Her mother iirst brought her to me on Jan. 17» 1898.
The legs hung down as if paralysed. Muscles were very flabby ; there was a swellmg over the left femur at its lower end, which was very tender, and also a swelling -on the right shoulder. She had one tooth. Calc. C. 6, one grain e^ery three hours, and bovinine were ordered. Humanised milk prepared at home from fresh milk was substituted for the patent food. Grapes were allowed.
Feb. 7th. Had cut three teeth since the treatment was commenced. The swelling over the right shoulder snd upper part of humerus was much larger, and large -veins were seen marbling the surface. The right arm was powerless. The swelling over the left femur also had increased and was very painful. T. 99.4^.
I found a mistake had been made in preparing the milky and the child had again been given Savory and Moore's food.
Feb. 12th. The feeding question a great difficulty. The child had no appetite, had to be fed with a spoon. Blackish pieces were seen in the motions (? blood). The swellings over shoulder and femur had further increased. Bep. cide. e. 6, and cham. Sx pil. i. every 2 hrs.
Feb. 171h. Very meeh better. Takm liie nouriBh- ment well, and not Bitk any more. The swelling had
"848 CHBONIC MENTAL PERTURBATION, ^S^^j^SJTmw!
Beytew, Jane 1. 1806.
dumnished* As her weakness was so profound, and all inovements gave such pain she was simply wrapped in gamgee tissue to save the pain of dressing. A tea- spoonful of cream was now added to each meal.
Feb. 19th. Was Tery much better, and laying on : flesh.
Progress was now steady, only interrupted by an attack of measles on March 12th.
I was able to obtain, through the kindness of Mr. (Gerard Smith, a Roentgen Bay photograph of tiie enlarged limbs, which clearly demonstrated the profound changes the bones had suffered.
ON A CASE OP CHRONIC MENTAL PERTURBA- TION, ASSOCIATED WITH UTEBINE DIB- PLACEMENT,
By Geobob Bubfobd, M.B.,
PhjBioian for Diseasee of Women to the London Homoeopathio Hospital.
Elsewhwb I have adduced cases illustrative of the co- relation between disordered pelvic conditions and mental
r^rturbations in women.* In the Review for May, 1897, also cited an instance of mental disturbance following ovariotomy during pregnancy, and promptly and perma- . nently cured by actaaa. The case I have now to relate is in some respects more striking than any of these.
In September of last year I saw a girl, aet. 19, whose
physical condition was commonly that of acute nervous
irritability and tension, sometimes rising to a state of
semi-frenzy. This was varied by occasional moods of
: sullen obstinacy; and at night the proceedings were
. marked by the patient leaving her bed, walking to and fro
in the bedroom, and throwing up the window, with the
stated intention of leaving the room by this exit. For
some two years she had been diligently attended botii
day and night; and as both the mental condition and
, the physical unrest were increasingly difficult to manage,
. her friends felt compelled to consider the necessity of
putting her under restraint. Ere adopting this extreme
, measure they, at the instance of one of the above-cited
patients, sought my .advice.
J * Trantactiong of the Internatimal Congresi. London. 1896. ;
S!Sil'jS;i?MS?** CHBONIC MENTAL PBRTUBBATION. 849.
B0fiew,Jvu) 1.1808.
' I gathered from the mother that some years befoife, her two daaghters, then scarcely in their teens, had been' improperly^ approached by the rascally fifttfaer of some school friends* The younger daughter soon forgot the episode ; on the elder, the present patient, it made an al)iding impression. ** She had never been herself/' said her mother, '' since that time, and her temper and mental irritability had grown successively bad and worse." There was no definite history of masturbation, although the patient spoke of indefinite local irritation and discomfort. The period commenced at 16> had been fairly regular up to date, usually lasting some four or five days, moderate in quantity. Menstruation was accompanied by a decided' increase in the subjective phenomena.
I obtained the consent both of the parents and of the patient for examination under anadsthetic. This was administered by an expert, and I found the uterus of fair development, but acutely retrofiexed ; the sound passed easily. No other local abnormality, positive nor negative, was present. I replaced the uterus, and inserted a suitable pessary. I also prescribed stramonium 8x, thrice daily for the ensuing week.
Ac the end of seven days I again saw the patient. The transformation waa complete ; none would recognise in the modest, well-mannered girl who now came to see me, the morbid, uncontrollable, suspicious character of a week Ago. Sleep was now comparatively tranquil, and the demeanour of the patient during the day was one of progressive improvement.
After a further lapse of a few days she left town ; and I now prescribed for her a course of actsea 8x. In less than a week's time the parents received an urgent telegram from the country friends, begging that the girl should be sent for, as for the last day or two her manner had filled them with alarm. I saw the patient after her unwelcome return ; the old bad semi-maniacal condition had returned in its former force. Analysing the history of her stay in the country, I found that one day she had foolishly ridden a pony, without saddle, round the {Mkddock, and that on the ensuing day her troubles xe-commenced. This was too obvious a lead to be missed. I again had her anaesthetised, again I found the uterus retioflexed, again I restored the organ, and re-adjusted the pessary. Actaea was continued.
850 THE NEUBOTIC OAOHEXIA. ^tt^fjZ^l^tSmi
Seven months have now elapsed, and the history of the patient during this time has been that of continaons well being. '* My daughter continues well/' writes the mother ; '' we are most thankful for the new life, so to speak, that followed the treatment/'
Nor is this the only case in which I have been able by gynsBcological measures to obviate the dreadful altema* tive, for a girl, of confinement and seclusion in an asylum. I do not propound this course of action as a panacea ; but I do consider that in all cases where mental pertur* bation is obviously co-related with pelvic troubles, painstaking efforts should be made to eliminate these ere the patient be put into confinement. Nor is any other course fair to the alienist ; for the pelvic disorder persisting, the co-related mental troubles can hardly be expected to cancel themselves.
THE NEUROTIC CACHEXIA, AND ITS TREAT- MENT BY PULL FEEDING, ISOLATION, MASSAGE, ETC.
By Edwin A. Nbatby, M.D.,
Assistant Physioian for Diseases of Women at the London HomoBopathio HospitaL
Db. Weib Mitchell, the introducer of the method of treatment known by his name, is a neurologist. Bat in this country it has been quite as frequently carried out under the supervision of the gynaecologist, partly^ perhaps, because its chief advocate here has been Dr. W. S. Playfair. That the female reproductive organs suffer in neurotic women, however, is not questioned, and it is therefore not unnatural that some of these patients should find their way into the handa of physicians they think specially qualified to deal with their local ailments. The celebrated obstetric physician of King's College Hospital, in a farewell address* delivered on the occasion of his retirement from that office, said, " One subject, however, I cannot pass over, as it has always interested me much, that is, the possibility of treating systematically and successfully the strange and manifold neurotic symptoms which so often shipwreck the lives of women and reduce them to
• Lancet, Uaioh 19th, 1898.
SSSSSfjSrjS?** THE HEUBOTIO OAOHEXIA; 86t
a state of chronic inyalidism previonsly quite hopeless. That cases of this sort, unhappily so common, can be so often, when properly managed, restored to health is, in my judgment, one of the greatest gains to practical medicine in the last quarter of a century. This is^ perhaps, not strictly a gynsBcological matter, but it is often closely connected with " gjrnascology.
The sul^ect has attracted my attention e^er since the earliest appearance of Dr. Weir Mitchell's books on Nervous Diseases, and on Fat and Blood, in 1876, and daring most of this time I have had occasional experience of its benefit3. More recently — that isduringthe last three or four years — since the establishment of an admirably managed nursing home near me, I have had numerous cases, selected from my own practice and sent to me by colleagues, in which excellent results have been obtained. As would be expected, they have been chiefly women ; but one can have so-called '' hysterical " cases (though I dislike the term) even if not " strictly gyn»cological," (!) in men.
SxTiTABLB Cases. To avoid disappointment a careful selection must be made. In the first place, if a cure is to be promised, the patient must be free from organic disease. The most &vourable cases are pale, thin subjects, who eat badly and sleep little. They are hypersensitive to every external impression — ^heat or cold, noise, light, conversation, exertion, worry , &c. They have lost interest in life generally, and in themselves in particular; no effort is made to get well, for none appears worth while, and a state of querulousnesB and general discontent is liable to develop. Patient and friends mutually misunder- stand one another, and life becomes burdensome. . They have pains, either permanent or migratory, always aggravated by every fresh circumstance, and seldom ameliorated by any. The sufferings of such people are real enough to themselves although no physical cause may be apparent to the doctor. Highly- strung and highly-educated women, who have had a long course of physical fatigue, anxiety or worry, are not uncommonly BO affected ; but those who have long had slight ailments, with leisure to dwell upon them and opportunity to consider themselves at every point, are a most difficult class to deal with. Nothing ** agrees with " them, and they have already tried every form of medicine, diet,
S62 THB NBUEOTIC CACHEXU. ^i^^fjS^^SSt
Bevieiw, June 1, liM.
and treatment without avail 1 If'snch patients remaiit well nooriBhed^ — or apparently so— even the Weir Mitchell treatment will be severely tested. . ^
Another class of patients more satisfactory to deal with are those who have drifted into a weak and spirit- less condition after an illness. Here high feeding and massage are very powerfal and beneficial.
All these cases may fittingly be classed together under the heading of neurasthenia. • i
After a careful consideration of the case, if the oon-> elusion is arrived at that it is one likely to be benefited by a course of Weir Mitchell treatment, there are several other elements essential to success.
First among these is the necessity of securing the patient's confidence. Something of the trustful spirit which leads a patient to, say *^ I would let So-and-so take my head off, if he thought proper," is desirable. It denotes an easy mind. I have always found that it is best secured by taking the patient into one's confidence, avoiding all appearance of mystery, and explaining, in t)rinciple at least, the nature and objects of the treat- ment. Many of these neurasthenic patients have received the impression that they are hysterical, especially if they are women. In their minds this is synonymous with being, if not actually a sham, a malade imaginaire. Even were this the case, it is unwise to allow the patient to suppose that this is the doctor's view« Besides, it is always questionable whether, strictly speaking, there are any miaginary maladies. For '* if a person is ill enough to say he is ill when he is not ill at all, he must be very ill." That there is truth in this paradox no one can doubt. As one realises this, one's sympathy is drawn out — a fact quickly detected by the sensitive patient. It is easy to advance to her some plausible and even reason- able theonr explanatory of her condition ; to seize upon faults of the nervous, circulatory or digestive systems as a point JCappui for one's remarks and plans.
It is easy to impress upon these patients that they are weak, and that a part or the whole of the body is either over-worked or under-nourished, or both. It is then equally simple to assure them that rest and full feeding will do them good, and to enlist their co-operation in the form of willingness to be, for a time, as absolutely inactive and restful as possible. Inactivity and rest are
SSTSSf^ THE MEUBOTIO CACHEXU. 888
not ^nonymoTiB ; nothing condaoes more to reet of mind than an intelligent appreciation on the part of the patient of the doctor's object. Much chafing against details mil be avoided by a good understanding obtamed beforehand. Above all things, it shoold never enter into the mind either of the doctor or patient that the coarse is intentionally irksome, harsh or penal.
The invalid deserves, and shoold have, a patient hearing. Her views of her ease, her experience of past maladies, and treatment may be of nse to the doctor, and vnll certainly have the effect of gaining for him the patient's confidence. Any complaints of the effect of the treatment, or of faults on the part of the attendant, should receive most careful and loyal attention. For this purpose it is usually desirable to give the patient aaopportunity of speeJiing to the doctor in the absence of the nurse. She feels herself shut off from her friends and at the mercy, more or less (at the risk of spoiling the treatment), of the nurses ; the medical man is her only protector and friend, and is responsible both to the patient and to her relatives or guardians.
Hardly less important than the features we have been considermg is the next point. It is notorious how full of advice and suggestion are the friends of a patient — especially when they have allowed a case to drift until a strange doctor comes on the scene with a fresh pro- gramme. Then they rouse up and seek to secure credit k> themselves while discounting the suggestions of the new arrival. It would be wise absolutely to decline a. ease for Weir-Mitchell treatment unless a thorough nnderstanding is arrived at with the responsible guar- dians of the patient. The same full and frank explana- tion of the case and of the plan of treatment should be given to them as to the patient. It is often even more^ difiScult to make them see the necessity of isolation, etc., than to persuade the patient of its desirability. It is,, without question, asking a good deal of relatives to trust their dearest to the absolute unrestricted care of a medi- cal man, perhaps a stranger ; to hear nothing of, and to^ communicate nothing to them, save through the doctor or his agents. Unless the fullest confidence is first esta- blished the strain upon their trust ia apt to prove too much. Should it give way at a critical moment the
V6L 42, No. «. 2 ▲
864 TOE NEUBOTIC CACHEXIA. ^^^^H^fSSSlfmSi
fancceaa 6t the case may be invalidatedy and much waste of time and money be inyolved.
PiBT AND Bbgime. Although it ia impossible to lay down any rale which will apply to all patients, it may. ^rhaps be of use to any who may care to take up thi^ class of cases and this form of treatment to know, what has been successful in other hands. I usually begin with a few days entire rest in bed, piarmiiting no exertion of any kind. The nurses attend . to the patient's toilet, and he or she is not allowed to leave tha room — or if very weak the bed-— for any purpose. No reading or writing, of course no visiting, and very little conversation are permitted. The patient is induced to lead as far as possible a vegetative life. The diet varies with the case, and it is wise to find out a patient's idiosyncraciea beforehand^ to save after-friotion. Many patients, ^specially those of the fat, florid and flabby kmd, will eay they can take little or no milk. I have only met pne patient in a number of years with whom milk seemed wholly to disagree. It is a very different matter, resting quietly in bed, with no fatigue and no other diet, from the ordinary routine of life and a mixed and heavy or undigestible diet to which a pint or two of mUk are added. Here milk often disagrees. But with care as to quantity, dilution, etc., most patients ^t rest take milk well. It is better sometimes, when the tongue is white and teeth marked, and the bowels sluggish, to begin with cream and water, gradually adding milk. During the first few days sometimes weight is lost, and ^t is necessary to be careful that this loss is* not consider- able, or time will be wasted in making up lost ground, t^eighing every two or three days therefore is desirable..
Massage is begun after three to seven days interval, passive measures only being first dsed for half an hour once or twice daily. The times for meals, massage, etc.^ should be regularly planned, and the plan adhered to with as little variation as possible ; but no plan should be slavishly followed which is not giving good results. As the massage is increased so may the diet be, both in quantity and variety ; two quarts of milk daily, with added' cream, is enough to maintain in weight a person of average size when at rest. Additions to this in the shape of oatmeal porridge, eggs» brea4, fish, fowl, tripe, fat bacon.
THE NKUROTIG CAGHEXU. 366.
■ " ■ ■■^IW • II . -■■■■ _
sweetbread, Vegetables, and fruit i^ll go to inoreaad th^ weight, if the milk is continued in quantity^
After seven to ten days, exercises, at first passive and &en. with resistance, can be commenced. Special* Attention. should be paid to real or fancied weakness or defect.
Permission to read, write, or receive visitors is generally given after two or three weeks, at stated times and for definite periods. The increase of these various privileges or duties is determined by the way they are borne.
When the patient gets up, some occupation sliould be- prescribed for named times, e.g., wood-carving, fret- work, needlework, painting or drawing, and quite late on. Qiasic. A rest in the recumbent posture should be taken ^r each fresh effort and form of exercise, the rest at first being much in excess of the work.
Driviug, walking and cycling all come in after about' (oar weeks. For men, boxing and clubs are very useful. The practice of cycling has kept away many, I kuow,, from the doctor, some of whom learnt^ act as. a. part, of the Weir-Mitchell course, under my superintendence, and were previously always invalids. It is at firsV necessary to impose judicious limits, until the patient <»n properly gauge her strength.
After six or eight weeks a patient should be leading a fall and interested vigorous life, full diet, mental and bodily interests and occupation being adequately and equably apportioned. Some patients fail because they go back home and neglect all the precautions in the way of exercise, fresh air, etc., when they get outside the t^ular discipline of the institution life. The^ should be! warned of this. It often happens that a patient, when back in ordinary life, loses weight again. But it does not mean that he or she therefore loses strength or fimmess of tissue, but simply that health is maintained ; and forced feeding being left off the weight regains a more ordinary standard.
From one to two stones should be put on in about six* weeks, depending on the size and weight of the patient at the start.
Drugs arc not always needed, but the increased meta- bolism brought about by the treatment enables them tO' act with excellent effect when required* The bowels
3 A^2
856 BBOMLEY HOSPITAL. ^"SSlL^ST^S?
Be«i«w,JiiBel,in6.
usually act well, the abdominal massage being enou^ to secure this.
It would unduly prolong this paper were I to give cases, and very little would be gained* The chief results, obtained are relief from pain, real or *^ imaginary '* (7y improved appetite and sleep, increase of weight and strength. A fresh lease of, andmterest in, life are taken, due to the improved physical condition — the patient's outlook as well as his own aspect have brightened. A relative of one patient said to me, '* X has lost his stooping gait and weak apologetic manner ; I was astonished to see ^is erect, firm attitude and manly bearing." For five years this man had scarcely been at business one montk m four — from debility following influenza. He is totally ^han^ed and regularly at business. The habit of taking; exercise is a great gain, and the confidence which enables a man or woman to recognise themselves as strong, able to face all weathers and surroundings, without ** taking, thought for the morrow," is an enormotLs and lasting^ gain.
A FIELD DAY AT THE BROMLEY HOM(EOPATHia HOSPITAL.
A Pragtigal Illustration of the Wobsmo of thb*
Hospital Federation Scheme as it will Affect on&
Smaller Institutions*
By Drs. Madden and Thomas.
On Wednesday, 18th May, Mr. Enox Shaw, Senior Surgeon to the London Homoeopathic Hospital, and Consulting Surgeon to the Bromley Homceopathic Hospital, went down to Bromley, and reached the^ hospital at 8.15 p.m. He there saw in consultation with the local staff (Messrs. E. M. Madden and H. Wynne Thomas) the following cases : —
Case I. Harriet W.,8Bt. 84. Chronic tuberculous abscesfr in the left thighs communicating with a carious cavity in the head of the trochanter. She had had the abscess* opened and scraped in this hospital two years ago ; it was then of long standing, and it burrowed a long way down the thigh, evidently starting from disease in the trochanter. This was thoroughly scraped and drained.
lSlSS!^!i'SS^ BBOMLET HOSPITAL. 867
Sevtew. Jtua 1, IflM^
After this operation she got quite well for a Bhort time* «nd she was sent to the hospital at Margate, where it -soon returned, and it was found necessary to operate • upon her twice* For the last three or four months it had «gain became active, having, as a matter of fact, never -firmly healed from the first, and rendering her quite ^onfit for her work as a domestic servant.
Dr. Madden having given the anffisthetic, Mr. Shaw, -assisted by Dr. Thomas, cut down freely over the diseased 4>one, and goaged out and scraped away soft carious bone, until a caviqr of sound bone was made ; he then cut away or scraped the lining membrane of the old "Sinuses, and closed the wound with stitches in the hope that it will heal soundly by primary union, all diseased tissue being removed.
Case II. John E., let. 48, a carpenter, had fallen
ncross his bench last June and injured two or three of
his left ribs below the angle of the scapula, which he
^as told were '' fractured but not broken." He was
unable to work for six weeks and never quite got over
the pain. Last Christmas he had a bad chill which
brought on a cough, and he has been ill more or less
"Since, but not under medical treatment, until he was
-seen at home by Dr. Madden on Ist May, who found
ivell marked evidence of pleuritic effusion at the left
base, and advised his coming into the hospital. He
was aspirated on May 6th, and again on the 18th, on
^each of which occasion from 2 to 8 ounces of sero-
purulent fluid were extracted, with marked temporary
benefit to his pyrexia and general condition, but it was
felt that it would be wisest to open and freely drain the
pleura. Accordingly, after the patient had been
-aniesthetised, Mr. Shaw made a free opening into the
pleura between the seventh and eighth ribs, and found it
-necessary, in order to make room for a full sized tube,
to remove an inch of the 7th rib. In doing this, the
-pleura was found to be extremely tough and thickened,
-and the periosteum unusually adherent, giving evidence
-of recent severe injury. No large amount of pus escaped
— ^not above six ounces — the cavity being evidently
dimited by adhesions.
Case III. Maria H., et. 59, was ansBsthetised for ^he purpose of making a thorough examination of a ^owth, probably cancerous, in the upper part of the
j858 BROMLEY HOSPITAL. *^S^f^S?ifMS!!
, reetute, iflmh had caused hemorrhage and freqaeni small stools for 4 or 6 months* Preyious examinations had shown a rough, irregular growth, which felt as if it came through a ring of inyaginated bowel, and it was desired^ if possible, to ascertain its odfi^ and attachments, with a view to determine the possibility of its removal by operation. Examination showed that -the growth had
,been retracted within the sigmoid flexure, so that at first it eould only be felt indistinctly through the coats of the
. rectum, but it was afterwards possible to feel its \ow0t portion with the tips of two fingers introduced as high as possible into the rectum.
Mr. Shaw therefore gave it as his opinion that it isrte
not desirable to attempt its remoyal, but that colotomy
might very possibly at some future time become needful.
In addition to the above. Dr. Thomas had brought in
' from his out-patient clinique the following three casea for Mr. Shaw's opinion : —
Case lY.. A child, 8Bt. S months. The mother said that at birth the child had a swelling in the occipital region, about the size of the child's head. This was like a
. bag of water, and evidently a meningocele^ The child
. was admitted into the Children's Hospital, Great Ormond Street, where the tumour was removed, and the child sent home three weeks ago. Since then the head itself has rapidly enlarged, and now was enormously distended^ and presented a typical example of hydrocephalus^ while in the seat of the old meningocele is a small dusky swelling of the size of a walnut. The only treatment thought to hold out any chance of saving the child's life was trephining the skull and draining the ventricles,, though it is recognised that this is rather a forlorn hope. As the Bromley Hospital is not at present able to admit children so young, Mr. Shaw proposed to admit it into the London Homoeopathic Hospital for this purpose.
Case Y. M. S., set. 2i. This was a case of multiple tuberculous abscesses, some starting in bone, others not so. She had already undergone four or five operations for the purpose of opening and scraping away tuberculous matter and diseased bone. At the present time there are three sinuses leading to carious bone in the left foot and ankle,, and the question 'has arisen whether it is
Jiecessary to remove the foot. Mr. Shaw, howevei^
BXVIEWB. ' 869
advised again soraping the sinases and fixing the foot in an immoveable splint, as the joints themselyes did not appear to be involved.
Case YI. A young girl of 14, soffering from a chronic obstrnction involving the right nostril only, while anterior examination of the nostril gave no indication of the cause of it. Mr. Shaw, after careful examination with the rhinoscope and laryngoscope, pronounced the obstrue- tbn to be due to adenoids, and advised their being scraped in the usual way.
This concluded a very fair afternoon's work, and well illustrates one of the many ways in which it is hoped that the smaller hospitals will benefit by entering into closer bonds witii the older and larger institutions by the Federation scheme.
REVIEWS.
The Medical Treatment of the Drink Uahit. By A. Stoddab^ Eennxdt, L.B.G.S. and L.B.C.P., Edin. Ix>ndon : Bimp- kin k Marshall. Ekdkatoubs to cure the drunkard of his propepsity to abuse the use of alcohol by intoxicating himself with it have been numerous. Legislation has been invoked, and has inflicted penalties from '* five shilliugs and costs " to seclusion. Medi- cal measures have been tried; ''infallible cures" have been widely advertised, ** whose only success," as Dr. Kennedy says, '* has been of a financial nature to the benefit of tbeir promoters." In this pamphlet the author proposes the adop* tion of a course of treatment of which he says that, while not " infallible," it has proved more or less permanently useful in a number of instances ; oases, moreover, where the patients have, after treatment, been exposed to strong temptations to recur to the indulgence of their " besetting sin *' without having yielded to them. The course of treatment he has adopt^ is fully described, and is such as any medical man can adopt. We know nothing of its value from personal experience, and, as personal experience can alone gauge its value, we therefore refrain from expressing any opinion on this, the all important point.
This much, however* we can say, that in this little pamph-^ let Dr. Kennedy introduces it in a thoroughly rational manner ' — one entirely free from any of those exaggerated statements Which are ho closely allied to <' puffing ; " and we can there- !fore recommend its perusal to all who have opportunities
860 MEETINOS. '^^^STifuHL
within iheir readh of putting it to the test of practical etpe«; fience. .
His method is, he says» adapted to the pennanent core not of the drunkard having the power to resist temptation to indulge in alcoholic intoxication, and simply declining to ezer* cise that power, bat of the dipsomaniac, " where drunkenness is due to an irrenstible impulse entirely beyond the influence of an^ appeal to the moral and mental faculties," to cases of which the late Dr. Moxon so eloquently wroto, where " the beloved wife may join her hands imploringly; his pallid, starving children may look timidly up in his face ; he goes by to ruin himself and all, as you go through cobwebs on a firash September morning." Oases of which the most pfomi- nent symptom is a " craving " for alcohol, commonly arising from a sense of sinking at the epigastrium, a feeling whi<£ indulging the craving generally relieves for a time, but a form of relief invariably followed by the reaction that ever attonda upon the employment of antipathically indicated drugs, if only a few such cases as those described by Dr. Moxon, in the quotation we have made from his article in the CofUemporary Eeview (November, 1878), can be saved, a great benefit will have been conferred. Dr. Kennedy's plan of treatment is simple, and we believe entirely safe ; being so, we recommend his litUe brochure to the notice of our medical brethren.
MEETINGS.
DEVON AND CORNWALL HOMOEOPATHIC HOSPITAL.
Thb annual meeting of the supporters of this institution was held on the 25th of March, from an account of which, in Ths Western Morning New$^ we make the following extracts :— «• In their report the committee said : — The growth in the work of the institution has been maintained, and during the past year the amount done in most departments exceeded that of any previous year. The number of patients treated in the wards was 142, the largest number ever attained. The attendances at the out-patients' department and on patients at their own homes were well maintained, whilst the number of attendances of the out-patients largely exceeded that recorded in 1896. As shewn in the last annual report the work done in the accident or emergency ward shewed a large increase over that of 1896, but the number of cases treated during the last year shews a still further marked increase, being 848, or 98 more than the number in the preceding year. The special departments of the Hospital— those treating disease
—^ _^- — ' - = — *
cf tlie ear, thioftt, eje and nose, and of diseaflea peculiar 16 ivomen— are greatly appreciated, and the ireA done has beett largely on the increase. The dental department, which is fmdear the care of Mr, Louis Sexton, has also rendered 'tk large amount of good service. The experiment inaugurated in 1806 by the appointment of trained nurses to attend on patients visited by the medical officers at their own homes continues to be a great success. On account of the largd increase in the amount of work entailed by these nunring virits, your committee some months ago deemed it wise that the same should be done by their own staff, and not, iM heretofore, by an outside nurse engaged especially for the purpose. The alteration has proved most beneficial. Not only is the scope of the work greatly extended, but it is, in addition, done more efficiently and thoroughly than before. Oertain of the nurses perform the work in rotation, and the Kipportunity is thus afforded them of gaining valuable experience which will be of great benefit to them hereafter. To meet the increased calls on the nundng staff it has been found necessary to increase the same by the addition of another probationer* It is satisfactory to learn that not only have all the staff passed in ' first aid ' in connection with Hie St. John's Ambulance Association, but that the majority of them have also passed the examination in < home nursing.* Lectures in connection with the association have been given to the nurses by Dr. Yawdrey, the hon. surgeon of the institution."
As in most instances of the kind, additional funds are urgentiy needed. The balance against the treasurer is still eomewhat larffc, ** notwithstanding that in order to meet the debt on the building-renovation account, and to reduce the deficit on the current account of the past year, a bazaar was held early in this year, and as a result the building-renovation debt has been extinguished, and the current deficit somewhat reduced. It is proposed to meet the heavy balance still stand- ing against the institution as a consequence of increasing deficits by appropriating £500 from the reserve fund. But tiiere will be still need of more annual subscriptions and in larger amounts, more donations, and if possible a good endowment fund, and the committee earnestly commend the •consideration of this appeal to their friends and supporters who feel disposed and are able to help the institution in a more liberal form.
" Dr. Alexander read the medical report, which stated that in the in-patient department there had been a slight increase, 14d patients having been admitted into the hospital as agamst 141 in the previous year. Of this number 125 were either
862 jiSsrnffGS;
atvi«v,JiiiMl,
cued' or relieved, four were not relieved, one was disohazged at his own reqoesty one was inonrable, three died, and eight remained under treatment at the end of the year. In the pat-patient department the record of woric was no less satis** factory. There were 112 patients remaining nndsr treatment on Deoember dlst, 1686, and 8,Si88 patients were admitted during the year, maldng a total of 8,8W. Of this nnmber 2,606 were cored or relieved, in 488 cases the result conld not be ascertained, 187 were not relieved, 81 died, and 142 were remaining under treatment at the end of the year. Of the patients 848 were cases of accident or other sudden emergency <^-«n increase of 98, as compared with the record for the previous year. There were 18,506 attendances of out-patients at the dispensary — an increase of 286, compared with the previous year. There were also 8,619 visits paid to patients at their own homes by the medical officer and district nurse. In the department devoted specially to diseases peculiar to women, under the care of Ihr. Cash Beed, there had been 1,870 attendances during the year. Dr. Alexander continued to give his services on Tuesday mornings for diseases of the ear, throat, and nose, and on Thursday evenings for diseases of the eye. The latter department was of comparatively recent introduction, but the number of attendances of patients was increasing, and there was every prospect that it would prove as popular as other branches of the dispensary. The regular attendance given by the Jion. dental surgeocK Mr. L. E. Sexton, had now fully established this department of the hospital. The number of patients was increasing and the usefulness of the institution had been considerably extended thereby. The services also of the nurses appointed for district work were invaluable.
' ' Col. Armstrong, in the chair, in moving the adoption of the reports regretted thiftt they had been unable to balance their accounts without trenching on the reserve fund. Btill the institution was making progress. One of its most important features was the accident ward. The work done there had been most satisfactory. There was no institution in the centre of the town so well situated to deal with accidents as the Homceopathic Hospital. That fact should not be overlooked in their appeal to the public for funds. Though ttieir finances were not so flourishing as they could wish, they had a fine building, very different to the small establishment with limited means with which they started, and they might well be jMtisfied with the work accomplished. They could not too Jiighly praise the devoted attention of the medical staff to the patients, ^pplause.) •. ' < Mr. O. B, Barrett seconded the adoption of the reports, knd
ISSS^^SSf^SS^ kotabilia; »»
Btrongly ooonnetidBd the chimB of the institation to the paUic. The inoxeMing denuuidfl upon the aooident ward shewed the need of eaeh sn iiietitiition in the oentxe of alergepopoUktion. There was alwajB an open door for patients at their noepital in Lookyer-street, and he hoped the inetitation in the ooming- year wooM reoeiye a much larger meed of rapport firom the general pnblio than it had in the past/'
NOTABILIA.
PBDEBATION OF BMTIBH HOMffiOPATHIC
HOSPITALS.
A ifxxTXNO of the representatives, of the medical stafb of the Tarioos British HomcBopathic Hospitals was held in the board room of the London Homceopauiic Hospital, on May 5tb^ in aoeordance with a resolution passed at the Federation meeting at Clifton.
Dr. H. Nankivell (Bonmemonth) oooapied the chair, and there were present : I)r. Dyoe Brown, Dr. Oarfrae, Dr. Byres Moir, Dr. Neild (Tonbridge WeUs), Mr. F. Shaw (St. Leonards), Dr. Wynne Thomas (Bromley), Dr. Percy Wilde nSath), Ehr. Washington Epps, Dr. I^mbert, Dr. Leo Bowse, Dr. Boberson Day (London), Dr. Loagh (St. Leonardsk Dr. Pincott (Tmibridge Wells), Dr. Hawkes (Liverpool^ J>r. Neatby, Dr. Ooldsbrongh, and Dr. Marsh (London), witn Dr. Madden and Dr. Borford as secretaries.
The minutes of the previous meeting were read and confirmed.
Letters of regret at non-attendance and of concurrence with the objects of the meeting were read from Dr. Cash Beed and Dr. Alexander (Plymoutfi), Dr. C. W. Hayward (Liverpool)^ Dr. James Johnstone (London), Dr. J. W. HayWard (Liverpool), and Dr. Croucher (St. Leonards).
Dr. H. NanMvell proposed a resolution setting forth the constitution of the Federation, as in the subjoined draft. It was seconded by Dr. Hawkes, and carried unanimously.
Dr. Madden proposed : << That those present, together with any others afterwards nominated by the (Council, or delegated by individual hospitals, constitute the Central Council.'' This was seconded by Dr. Carfrae, and carried.
Dr. Neild then proposed : ** That the chairman, the iwo flecretaries, and three o&er representatives, chosen by the meeting, shall form an executive committee." This was seoondeil by Dr. Neatby, and carried.
S64 50TABILU. *£S&!53??!SiL
ltoTtew.Jual.iaa8.
{d)
The three representstiyes thus ohosen weie Dr. Peioj WMe, Mr.: Knox Shaw, and Dr. Neatby.
It was proposed by Iht. Burford, and seconded by Dr. Percy Wilde : '< That the exeoative committee be intrusted to pre- pare a scheme for the practical working of the Federation on ^he lines laid down in the draft scheme under the headings {2) ab c de^ and report, to a general meeting of hospital staffs iaJjmea.
This resolution was also nnanimoasly agreed to*
Various points arising out of the general working of the plan were discussed by Dr..Carfieae, Dr. Lough and others, as well as by the proposers and seconders of the various resolu- tions.
Subjoined is the draft scheme whidb was submitted to the •consideration of the meeting.
(1). It is suggested that the Constitution of the Federation embody:
(a) The representation of all British Homoeopathic Hos- pitals on
(b) a Central Council Board by one or more delegates from each hospital staff. The ofiScers of tiie Federation to be elected by the
GounciL
(2). For the practical working of the Federation it is suggested:
(a) That a uniform scheme for reporting the essential
details of cases be tabulated for all the hospitals, and that these records be permanently preserved for after reference and use.
(b) To provide for an annual summarised report of all the
work thus done in the British Homoeopathic Hospitals, and also for the detailed report of cases of special importance and interest.
(c) To arrange a practical scheme by which the medical
staffs of the provincial hospitals may receive any desirable assistance from the hospitals in the larger centres in the way of consultations, or operative measures, or in the exhibition of cases.
(d) That the Federation should also constitute a body for
the promotion of homoeopathic principles by assisting in the establishment of homoeopathic hospitals in new centres, preferably in those where dispensaries already exist. if) That a meeting of the medical staffs of the various hospitals be held annually in London, or in the Provmoes.
THE PBACTIGAL IMPOBTANCE OF HUaHES'
CYOLOPiBDIA. OP DBUCh PATHOGENESY AND
THE BEPEBTOBY THERETO.
Db* Gorbad Wssbblhovt, of Boston, zead a Paper iriifa ibm above title, a part of whiok we reproduce for our readera' benefit.
Among the soTuroes of information in regard to methods of using materia medioa are text-books on pathology and therapjentios. These teach ns little more than routine prescribing, by telling as what medicines are good for certain* diseases ; tiiey specify as well as possible a certain nmnber of sach medicines, but they cannot specify indications for remedies* as such indications actnaUy occur in practice ; these can only be found in a complete pathogenesy Uk^ fiiat of Hughes*, with the aid of a good repertoxy. (Booker of that kind are those of Hartmann* Baehr, Eafka^ Ooodno.)
There is another class of text-books, partly digests, partly compendia of materia medica proper (Farrington, Gowpertti- waite) ; these are all excellent in their way, aJso serving the purpose for which they were intended, provided always they ^tate the best ideas of other men, yet they are not, stricUy ^eakinjg;, sources o| original information, but rather the^ works of authors than of authorities, and hence not exactly fountain-heads of the true knowledge of materia medica.
What we need first, last, and all the time are books containing the records of original research, that is, of provings — ^the only reliable and safe base of therapeutics, whether in specialitiea or general practice. Now, Hughes' ''Cyclopasdia of Drug Pathogenesy " is such a work* It is not intended to replace^ but only to supplement Hahnemann's '' Materia Medica Pura '* A great deal has been added to the materia medica since Hahnemann's time; material has been collected, and stored away in periodical literature, awaiting the time when it could be put to practical use. Dr. Hughes has done this in a sdiolarly and conscientious manner, without any other xewvfd than, the consciousness of having feuthfully completed, the task intrusted to him. By thus supplementing Hahne- mann's work he has improved it by corroborating its contents^ or at least affording us the opportunity of doing so.
Neither is it intended to replace Allen's great work* Bpes^ing of these last two, a slight comparison is not out of v^ace here to show where thej differ fiom the work of Dr. Hughes. The latter contains original and unchanged;
M6 NQTABiLu, ^ssSr^snnssr
!■ I H IW^^aw^l H MIL. ^ .— ■'■■ ■ ■ ■
proving records,, while Hahnemann's " Materia Medioa Pnra/' and Allen's Enoyclc^pedia have their matter arranged anatomici^yi thereby already imparing the origin^ity and purity of the material. Snoh an arrangement undoubtedly &cilitates the finding of symptoms, but at the same time it distorts them by changing their place in the context. Also when you take these very remedies arranged anatomically and compare them with the original provings, you will be Surprised to see how their import has been changed in their irrangement into separate anatomical groups. ' The value of Hughes' book is enhanced on account of its VUJdng a critical choice in the selection of provings — a tnethod which Hahnemann and Alien do not adopt in the same degree. If you will read the introduction to the CydopaB^a, you will learn from it^that Hahnemann has used a great many provings whose authors and whose methods were uncertain, and that he included many clinical symptoms Ifrhicb were not the result of provings, but which were a transcript of cured cases, the symptoms of which were supposed to belong to the medicine to which the cure was attributed. Usefiil as this may be, it is not strictly speaking V pure materia medica " in Hahnemann's own sense. These
Erovings are all contained in the CyclopsBdia, but may easily e distinguished by their smaller, tvpe. Then there are the most reliable provings, whose authors, and methods are* Iqaown, while less reliable provings, or those made with excessively high attenuations, are omitted. Such information is not lost, but may be found in Allen's Encyclopedia. In Hughes' work, on the other hand, we find reduced to normal relations again that which was separated in Hahnemann's and Allen's works.
The Gydopcedia was prepared partly under the auspices of the British Homoeopathic Society, and partly under those of the American Institute of Homoeopathy, the beginning of the work dating firom 1882. There will be time to say only i» few words of how to study it : Take up almost any of the principal remedies there named, such as Aconite, Belladonna, etc., and read it through. If the anatomical schema should fatigue you, this narrative style would fascinate you like a story, and you would not care to lay it down until you had finished it. You would then already have retained much of it in your mind, partly because you observe a series of necessary consequences, and partly also because there is noticeable a repetition of effects. If you will then close the book and write down what you remember, you wiU find that materia medica is more interesting and less difiicult than you would suppose itom the ):eputation which it has gained
It^SS^SSm^ NOTIBILIA. 867'
r, Jane 1,
entirely from poor methods of studyiiig either the sehematic ammgementB or less reliable sooroes. Follow this plan with. <iiie or two remedies every week or every da^ if yoa have time, and you will not find it as difficolt to aoqoire a good share of: the materia medioa as it would be to learn anatomy or pathology. Yoa will soon become aware that the test of a^ good proving is the conformity and agreement between the. statements of the various proven ; if their results are not as rdmble as desired, each wlU tell a somewhat different story, or a very tedious, rambling, endless one, such as nervous invalids tell us. Now, if you have taken note of the most chataeteristic but congruent symptoms, ttien proceed at once- to miJce your <nm anatomical arrangmfunt of them. Some years • ago I read an article here which I called '' Every Man his own Bookmaker.*' I was not sure at that time as to whether* I had said anything to the point ; but I have become more and more convinced that it is best for each to make his own repertory. I say it for the reason that each one can make the best use of his own work which he understands. If I should make sa<di an anatomical arrangement or repertory, it would be of lees use to others than as if they had made it them* sdves out of funiliar material. But such a repertory for- private office use must of necessity be small ; still it would have the inestimable advantage of having introduced the aathor to, and familiarized him with, the huger and complete repertory of the Oyclop»dia now being issued. Without such - preparatory work the new repertory to the Cyelopsedia would be difficult to use.
Ihe arrangement of the new repertory is simple, but will require time and patience in its use. It is a complete refoenoe to Hahnemann's " Pure Materia Medica,'* to ** Chronic Diseases," to the ** Fragmenta de Firi^itf," and lastly to the four volumes of the Gyclopasdia itself. A desired symptom can readily be found in most or even in all of these works by following the reference. But that means work, and on that account many may not care to use it much ; for this same reason the Cyclopsdia has not been respected as it should have been. Yet, if the general practitioner would prove his right to exist by the side of the mechanical specialist he can do it in no other way. Again, as long as the field of gianeral therapeutics is but just beginning to be opened by better sources of original work and better books, constant niental application is a necessity ; and mainly, if we are convinced thai medidne can best be given according to the law of similars, there is no other way to demonstrate it except ti^ugh faithfiol application, study, and above all b^ the oultiyation of a certain degree of talent for the acquisition of
868; MOTABILIA. "^SSi
IteviBir, Jane 1,1
moh knowledge. — ^From New England Medical Gnuaett^^ December, 1897.
. [We onderstand that Pari II. of the index to the Cyctopadior ib to be ready, if possibky for presentation to the Ck)DgreB8 of Britiflh homoeopathic praotitioners in London on , Jmie ftxL Ebb. M.HJi.}
'■ THE HOMOEOPATHIC MEDICAL SCHOOL OF CALCUTTA.
Wk haye received the report of the above medical school fi>r tiie BesBion 1897-8, and are glad to see its continued progresa and prosperity, mider the rule of the Principal, Dr. M. M. Bose. The school is now entering its seventeenth year, a very fair time of trial, and to find that in each year continued and increasing prosperity and success are recorded, is very grati* fying» It is to he noted that this year, as in last, the number Qf students who come from long distances for instruction i» increasing, and this year Dr. Bose has to record that students, have come from other medical schools, and one is an M.A. of tixe Calcutta University, and the majority are from the upper and nuddle classes. Applications have been made for tho itdmission of female students, but this has been refused, owing to the want of proper arrangements for such a move. Still,, the fact is interesting, and shows the growing popularity of the school. Among the Licentiates, there were four Moham- meduis» which, Dr. Bose states, is a unique event in ita history. Besides the ordinary curriculum, arrangemente are being made for lectures on special subjecto, as insanity and nervous diseases, hygiene, skin, throat and larynx. Popular lectures on subjects of interest are given in connection with the school, as on plante, electricity, chemistry of bone, atmo- spheric air, and the human voice and its mechanical repro- duction. These seem to be appreciated and attractive. We Qongrntulate Dr. M. M. Bose on his energy and success, and he and the school have our very best wishes in their excellenUy , conducted propaganda of the truth of homoeopathy.
AN INTERESTING UNION.
A KABBiAaB is at all times an event of interest, usually how- ever the interest it gives rise to is limited to the family circles- and more intimate friends of the parties to the solemn contract. The position of those directiy concerned, however, • at times extends the interest excited over a wider area: of such a marriage we saw a notice in the Leeds Mercury of the 12th ult., of the grand-children of two members of th^ ittedical profession who, each in his own way, did in tiieir '
B&jSS'JrSS*' NOTABILIA. 969
Bevjew. June 1, 1888.
lifetime as much to extend a knowledge of homoeopathj «mong the profession and the public as any men of their ^7 — ^the late Dr. Sha^rp of Rugby, and the late Dr. Bamabotham of Leeds.
On the 12th ult., a grandson of the former, A. J. Sharp, Esq., M.D., B.8. Lond., F.R.C.8. Eng., of Whitby, son of the Bev. John Sharp, was married at St. Oeorge*s Church, Leeds, to the grand-daughter of the latter. Miss Mary Bamsbotham, eldest daughter of Dr. S.- H. Ramsbotham, of Leeds.
Most heartily do we wish that they may enjoy many years of happiness, usefulness and prosperity.
PERIPHERAL NEURITIS FROM ARSENIC.
Dr. CoLMAM relates the case of a girl, aged 12, who was
admitted to the Queen Square Hospital in December,
1997, with the following history : From September 27th
to October .28th, at another hospital (with the exception
of six days, when the treatment was discontinued
on account' of gastric disturbance) she was givto 16
minims of liquor arsenicalis three tim^s a day for the cure
of chorea. She left that hospital cured of the chorea and
apparently quite well. On November 10th she complained
that her legs were weak and tingled ; in another week there
was distinct ankle drop. When admitted to Queen Square
there was almost complete paralysis of all muscles of the
oxtensors below the knees, with well marked reaction of
d^eneration. There was also some weakness of the extensor
muscles in the forearm, with diminished faradic reaction bu(
no reaction of degeneration. There was no alteration of
cutaneous sensibility, but there was great tenderness of the
leg muscles. There was well-marked arsenical pigmentation
in the neck and groins. She had been kept in bed and treated
by massage and electricity, and she was rapidly recovering.
TThe case was of interest by reason of the delay that occurr^
between the cessation of the arsenical treatment and the onset
of the symptoms. It also showed that these somewhat heroic
doses of arsenic which were so highly vaunted in the treatment
of chorea were not unattended by serious risk. Several
instances of similar paralyses had come under his notice, and
in one, at any rate, recovery did not take place. — BrU. Med.
Joum. Jan« 1696.
HERPES ZOSTBR FOLLOWING THE ADMINISTBA-
TION OP ARSENIC.
]>K. Pbbcs writes as follows in Medical Reprinte for January
lSib» 1688:— «* It iis interesting to ascertain whether the
sghwinistration of arsenic for this hromic acne attending large
Vol. 42, Na 6. S B
870 woTABiLu. '^s%^^sa?sns£!
doses of bromide in epilepsy has a direct causative influence upon herpes zoster. Some writers have declared that the ^ association of herpes zoster and the administration of arsenie . is not one of direct aotiological relationship. I myself have seen some three hundred cases of epilepsy in which the bromic acne was partially controlled and removed by the administration of ordinary-sized doses of arsenic, but in no case did herpes zoster make its appearance. Hutchinson (Prince A. Morrow's Drug Erup- tiofu, page 78) has reported some fifteen oases, in which he suggests that arsenic was the sole cause found for the skin lesion » yet he draws a very modest conclusion as to its direct causative effect.
*' I desire to place upon record an additional case of herpes zoster in which the ordinary medical dose of Fowler's solu- tion of arsenic had been administered in a case of epilepsy which presented a profuse bromic acne.
*' P. W., a man, aged twenty-four years ; nativity. United States ; occupation, piano-maker ; duration of epilepsy, seven years. He had taken forty grains of bromide three times a aay, and in consequence, a very profuse bromic acne made its appearance upon the chest, face and back, which ran rapidly on to the pustular stage. After the administration of arsenic (two drops of the solution given three times a day for four days), in connection with the bromide (seven grains ttiree times a day) 9 he complained of a ' painftd rash ' on the chest and . back. His bowels moved two or three times during the day, and he had a general ill-defined feeling of lassitude. The rash had made its appearance in the axilla, which was ' pain- fully itching and burning.' Upon examination, a red papulo- vesicular rash was found just above the nipple on the left side of the thorax, in the axilla, and between the superior internal angle of the scapula and the vertebral column. In places the vesicles had ruptured, leaving a moist, scaly condition, often seen in this skin affection. There was a temperature of 101^, pulse 98, dryness of the mouth, and some slight head- . ache.
** He was placed in bed, the arsenic was withdrawn, and a powder of opium and prepared chalk was applied. Great , care was exercised lest the vesicles still remaining unruptured should be broken. As is ordinarily the case, the greater part | of the eruption ran its regular course of rupture, desicoation * and deatrization, and the patient was enturely wett^ in ten . days.
'* I report this case in order that additional data may thus be ooUected, and detennine, if possiblBi the^atiological relation- ' ship that exists between the administration of arsenic and
J^^STSSt NOTABIUA, 871
herpes zoster. If sach relationship ezists, I think it is quite nure. Indeed, this case might point more olearly to the oon- eomitanoe of this patient's skin lesion with the administration of arsenic than a seqaent ; but the rapid onset of the herpes zoster after the administration of arsenic, and the rapid recovery of the akin affection after the withd^wal of arsenic, leads me to think that it exists less as a coincidence than as a cansatiye factor.*'
THE TOAD AND THE SALAHANDEB AS DBUOS.
Hbwuett {Scimee ProgreUf July ; Lancet, July 81st) shows that the old practice of prescribing preparations of the toad as remedies for dropsy was not so absurd as might at first appear, br, as he has diown, a substance is secreted by the toad's akin fliat is very like dijgfitalin, and hence may have a favourable effect in cases of cardiac dropsy. It would appear that the active principles of the venoms of the toad and salamander are totally different substances from those of snake venom, the former being alkaloidal, while the latter are proteid in nature. Curiously enough, the venom of the toad and salamander is &tal to the animal which secretes it only in comparatively large amounts. The salamander appears to be remarkably refractory to certain poisons ; it is only completely " curarized " by 48 muligrammes of curare, while morphine is apparently quite inactive. It has been demonstrated by actual experiment that the salamander's blood and blood serum act as an anti* toxine toward curare. The article seems to show that the belief of the ancients in the venomous nature of tiie toad and salamander was not altogether devoid of foundation.
THE DEPARTMENT FOE DISEASES OP CHILDREN AT THE LONDON HOMCEOPATHIC HOSPITAL.
Lf this recently founded department during the first four months of ttiis year, there have been 128 new patients, and a total of 558 attendances. There has been a steady increase in the numbers of the patients since its establishment, soon after the New Hospital was opened. There will be a vacancy for a clinical assistant on the first of July. The post is for six months and the clinic is held on Monday and Thursday mornings at 9 o'clock. This post offers a unique opportunity to those who desire a special acquaintance with children's ' diseases.
The Hon. Secretary to the hospital staff at the London HomoBopathic Hospital, W.O., wHl be glad to receive the the names of those who may wish to apply or give any inform- ation on the subieet.
n— 3
872 • NOTABILtA. "SSSL.^^r^S
Beview, June 1, 18M
BIRTHDAY HONOUBB.
Ws Iiave noticed with much pleasure, that among the diBtingtiiohed men who have heen chosen for Boval Honoars is Mr. Henry Tate, the ever-generous philanthropist, who presented Liverpool with the Hahnemann Hospital, and is, now that he resides in the neighbourhood of London — occupying, we believe, the residence of the late Mr. Leaf, himself a generous benefactor of medical institutions connected with homoeopathy — ^a member of the Board of the London Homceopathic Hospital. We heartily congratulate Mr. Tate on Her Majesty's recognition of his generosity to his native city, and this country at large, and trust that he may long Uve, as Sir Henry Tate, to enjoy not only the distinction Her Majesty has conferred upon him, but the ** love, honour and troops of friends ** among the people of the country he has* id such various ways, so largely benefited.
MAGNESIUM SULPHATE IN TBOPICAL DYSENTERY, ^rrn reference to the article on this subject by Dr. Wyatt« Smith in the Brit, Med, Joum, of January 29th, Dr» -0. A. Johnston writes: "I should like to point out my ^experience in the treatment of dysentery with magnesium sulphate for the last six years. Since 1891 I came to the same conclusion as Dr. Wyatt-Smith, that the treatment of tropical dysentery (or acute dysentery of any kind) with ipecacuanha is not the radix dysenterica that it is said to be, so I tried at first Glauber's salt in small doses ; this I shortly rejected as the results were not encouraging, and at the end of 1891 1 began treatment with magnesium sulphate in small doseSy since which time I have had excellent results. Patients may come in passing fifteen stools a day containing blood and s}ime, but with the following treatment the average duration -of the dysentery is about two or three days, and this includes treatment of dysentery on field service, a disease formerly the rscourge of armies in the field.
" Treatment. — The patient is at once put on purely milk ^et, and is given 5 ij. of magnesium sulphate every four hours xsombined with aromatic sidphuric acid nt v. (to counteract jany severe griping the magnesium sulphate mav produce) till the flow of oile is well established, as seen in the stools ; then the mixture is stopped, and a quarter to a half of a pure gall nut triturated well with water is given every four hours. By the second or third day the dysentery has gone, and the patient starts his duties again on soft food for a day or so.
" About three or four years ago I recollect seeing an article in the Brit. Med, Joum, on a very similar line of treatment
SaSfj^Sy^Sff^ OBITUABY. £78
by a medical officer of. the Army Medical Service, I think* and concluded this treatment waA more used now than it appears to be. The magnesium sulphate in this form appears to me from its physiological action to be the ixugparsxcelUne^ for counteracting the pathology of dysentery, given even that the origo mali be the amceba of dysentery* as tiie free flow of bile is the best intestinal disinfectant, and this, aided by the other mild purgative and depletive action on the intestines and portal system (which these small doses have), gives the necessary antiseptic and, antiputrefactive flushing for the poUuted track. If necessary, local applications in the form of counter-irritants or fomentations over the large bowel can be .also given, but I have never yet had cause to use this plan. This treatment does not apply to cases of chronic dysentery.**
OBITUARY.
G. B. EBB, M.D. Edin,
It is with deep regret that we announce the death of one of the oldest and most esteemed of those members of the profession who have practised homcBopathically in this country — Dr. Ker, of Cheltenham — who departed this life on the 7th ult in the 78th year of his age.
Claudius Buohanam Eu was the second son of B. D. Eer, Esq., of Finnart, Oreenock, where he was bom on ihe 7th of February, 1821. He received his early education at the Oreenock Academy and afterwards in Glasgow. Having selected medicine as the profession of his life, he matriculated at the University of Edinburgh in 1841, graduating M.D. in 1844. During his undergraduate days he was intimate with the family of the late Dr. Francis Black, who had graduated in 1840 and had spent the following year in Paris, where he studied homoeopathy under Hahnemann's directions. Returning to Edinburgh, he lost no time in enlisting the sympathies of young Eer in the new tiberapeutic method, and succeeded in making a thorough convert of him. Three months after his graduation Dr. Eer commenced practice in Cheltenham, settling there in October, 1844 — fifty three years and a half ago. There he has, throughout that long period, sustained a high eharactet as a succ^ful physician, devoted to the intere&ts of ail who consulted him, a gentleman of unblemished honour, and a well known and universally respected personage in the society of this leushionable watering pkce.
The work of Dr. Eer's life was essentially that of the practising physician. Beyond contributing clinical papers to the British Journal of Honueopathy during his earlier years, and one on the Evidences of the Truth of HoHuxopaihy^^io
'874 OBITUARY. ''saiL^^s^sias!
Bevlcfw.JiiDe 1,1810.
which we shall refer presently — his litemry efforts were, it is much to be regretted, all too few. Neither did he often appear at medical gatherings, or take any active part — except on one occasion — ^in the public work of the profession ; his dislike to polemical discussions and to speaking in pabUc were, we believe, the chief causes of this abstention. At the same time, few men amongst ns have been moxe widely known amongst those who are the seniors of onr section of the profession, and no one was more beloved than was the kind and gentle Dr. Eer. In Cheltenham, too, he was equally retiring, taking no public part in the business of the town beyond serving on the Council of the Public Library in Boyal Crescent, of which, in 1868, he was one of the founders, and at the same time became also a member of its Council, a position he retained until his death.
The one public work, in connection with homcBopathy, which he took an active share in originating is, wiUi the prospect of our gathering at the Hospital on fViday next, of especial interest to remember. It is to Dr. Eer and the late Dr. Francis Black that we are indebted for having set our Annual Congresses agoing. The circular convening the first meeting was signed by them and addressed to each member of the profession known to be practising homoeopathically in the United Eingdom. It was held at the Queen's Hotel, Cheltenham, on the 12th and 18th of September, 1850; twenty*nine gentlemen responded to the summons of Drs. Black and Eer. Alas J of those twenty-nine Dr. Dudgeon and Dr. Clifton are the only survivors ; while of thirty-four who sent letters of apology for unavoidable absence, or expressing hearty concurrence in the objects of the Congress, Dr. Hamilton, Dr. Scriven and Dr. Eidd alone remain.
The late Dr. Willis, of Cheltenham, occupied the chair at the meeting on the first day, when Dr. Eer read a report of the propositions for the formation of an Annual Congress of Homoeopathic Practitioners in Great Britain and Ireland, a majority of whom had expressed their entire concurrence in the holding of such a meeting, and agreed to further its objects by every means in their power. The address at the opening of the Congress was delivered by Dr. Francis Black ; it was subsequently published in the British Journal of Homaopathyf vol. viii., p. 584. It was at this Congress that Dr. DiysdaJe first brought forward his splendid proving of the bichromate of potash, and that the late Dr. Madden read an elaborate paper on the treatment of uterine disease.
On this occasion, also, the movement was inaugurated which resulted in Hahnemann's statue being erect^ in Leipsic instead of, as had been previously determined, in Coethen.
Sgyj^STuSSa^ OBITUABY, B75
At the dinner, with wliioh the proceedinge closed, the late Dr. Chapman pretided.
Our Annual Congress has smee that day proved one of the noet nsefdl and interesting institutions, and it is pleasing to be able to associate its inaogoration witti the menu^ of two of our most esteemed ooUeagaes, Dr. Blaek and Dr. Eer.
That Dr. Eer was a physician of hiffh character, one determined to do the best for those who consmted him — ^however nnpopnlar with the profession that "best** miffht be— which experience and study had convinced him was tibe most con- dadve to the speedy, safe, and pleasant restoration of the health of his patient6--^8 made very dear by his admirable and oonvincing paper, entitled Evidences of the Truth of Homceopathy^ in the British Journal of Homctopathy^ vol. viii. In the intro- duction to the kind of evidence he brings forward, Dr. Eer describes the mental attitude assumed by man^r in the presence of a doctrine entirely new to them, a description which is as applicable to a very large number of the profession to-day as it was in 1850. *' There are some minds," he writes, " so constituted as to reject any amount of evidence brought forward to establish the truth of a new doctrine, if prejudice is enlisted against it. There are others who refuse assent to a proposition imless the proof recommends itself to their reason with all the cogency of a mathematical demonstration. The one applies himself to the perusal with his mind already made up on the question, determined not to be convinced, and so he remains unconvinced. The other is equiJly unsatisfied after his study, as he requires an amount of proof which cannot be given to him, and which, when it is a point of medicine we are endeavouring to establish, it is impossible to bring forward. To establiflh a fact in medicine is not an easy matter. It is well said by CuUen, that, in medicine, there are more false facts than fidse theories. We have therefore to exercise much judgment and discrimination in our investigation of a question in medicine which professes to be founded on facts. We have, in the first place, as far as may be, to satisfy our minds that the so-called facts are bond fide faciBf and afterwards we have to proceed to examine into the conclusions from these facts to ascertain whether they are properly deducible from them. Medicine is not a demon- strative science, and we are therefore obliged, when we examine a question belonging to it, to rest satisfied with an amount of evidence or proof short of what would content a mathematician. It is that which renders the study of new doctrines in medicine so difiicult, and necessitates very great judgment and caution in our investigations; for if we too readily give credence and our adherence
a76 oBiTUABY. "g^'cryiigg
Bevww, June 1, UBBl
to the , discoyeries so-calldd, which are every day beuo^ given to the world, we woold justly lay Ouiselves. under the imputation of a too great credulity, and of too readily leaving the beaten path to follow new things* And. again, if we wilfully shut our eyes and our ears against such discoveries, we close them against truth as well as error,, and so deny ourselves the chance or possibility of progress. It would be no easy task to define the limits which separate: credulity from scepticism. Like all extremes these two meet, and we are generally apt to fall into the one when we make too great endeavours to avoid the other. Each one for himself must guide his own investigations, and give or withhold belief as his judgment dictates — no general rule can be laid down for his guidance. To the liberal-minded and reasonable^ man, I cannot help thinking that the evidence in favour of the homoeopathic law here brought forward will have some weight, and I would beg to remind him that evidence may have very great weight without being conclusive. I sbalL have gained my object if he is induced by anything written iik these pages to examine carefully, and in a philosophic spirit, into the doctrine of medicine founded on the law nmiUa^ HmiLihm curentur. As to the result of such examination X have no misgivings." Dr. Ker's confidence in homceopathy as the basis of scientific therapeutics, appears in the following passage of the same article: — ''Our doctrine has beeik introduced with an overwhelming mass of evidence in its- support, and tin that evidence has been proved of no weight we cannot allow ourselves to attach much importance to the minor objections against some of the details of homoeopathic practice. It rests with them to controvert our arguments*. We have done all that is necessary to be done in establishing a new doctrine in medicine. Were it not for the periodical medical press, which exerts so pernicious an influence over a. large portion of the profession, many who would willingly follow the dictates of a liberal and philosophical spirit, and examine into and prove questions which are advanced by their medical brethren, however strange and contrary to all former experience they may appear, are deterred from doing BO by the fear of drawing on themselves the imputation of favouring quackery and of receiving castigation in consequence.'" The successful practice of medicine for more than half a century, in a town well known for the educated, cultured, and refined character of its population, enjoying during the wholes of that penod the respect and esteem of all its inhabitants, and the confidence and affection of a large proportion of them^ prove in the completest manner that Dr. Aer's confidence ia homoeopathy was abundantly warranted by the results thatha
SS^!^SrrSSt^ obitdaby. 87.7
BMinr. June 1,1896.
aehie^ed, tha^ in nrgini^ an earnest and impartial enqnirjr into ihe homoeopaihio doctrine on the. part of nis profeesional brethren, he; was bat enforcing npon them a duty of th& highest ethical importance, and that in pouring contempt upon all who are deterred by the sneers and threats of an ignorant, prejudiced, and intolerant professional press from carrying- out, to the fullest extent, the obligations they have assumed — to do the bett they can for aU who may consult them — he was amply justified.
For some years Dr. Eer's heart had given evidence tha.t ii was unsound, but he never on this account slackened hift exertions in professional work, seeing his last patient on ^the- 6th May, his death taking place on we day following. Early in April he had an attack of influenza, but even then only desisted from his professional duty for a single day. Tlu» neglected illness weakened him very, much, and was followed by freqnent breathlessness after exertion. On the Friday evening ihis increased considerably, and he wrote a note requesting Dr. Stanley Wilde to come and see him on th» fDllowing morning. He went, but only to find his patient with a degree of pulmonary engorgement so considerable as to preclude all hope of his rallying from it, and he died during the evening of the same day. He was a man of remarkable- energy, and died '* in harness," as doubUess he would have- desirod to do.
Dr. Eer married, in 1856, the youngest daughter of General Sir David Leighton, E.G.B., of Charlton Eings, Gloucester- shire, who died in 1880, and by whom he had two sons and three daughters, who survive him.
ABTHUB JOHN OCEENDEN, M.B.C.S.
We regret also to record the death, at the age of 48, frovck cardiac sequel® of influenza, of Mr. Arthur Ockenden, of Brighton. Mr. Ockenden, besides being a sound preecriber on homoeopathic principles, was a good surgeon, accoucheur,, and* electrician, and will be much missed in these capacitiea by his local colleagues.
CORRESPONDENCE.
THE TBAINING OF MASSEUSES.
To the Editors of tlis ** Monthly Homceopathie Review,^'
GxxTLBMBv, — While the training of nurses has been maldnfi^ rapid strides of late years, the technical training of masseuses has remained very much at a standstill, and is not, on th& whole, what it ought to be in this countiy. . .
'878 OORBESPONDENCE. ' ^^^f^SJ^SSS!
One of the causes of this state of things is, that the pnblie are hardly yet aware that a high standard of knowledge is necessary for this nsefal branch of treatment ; and another, the delusion that anyone can become a skilled masseuse in a Tery diort space of time, which idea induced nambers of women wanting employment to rash to massage as the qoickest and easiest way of fitting themselves for earning a livelihood. Thus the market was flooded with incompetent workers, and disfftvour and ridicule were brought on the system.
Massage has now taken a recognised and definite position n the treatment of many diseases and surgical cases, and we are brought teyoe to fiB.ce with a serious question.
Will tibe practice fall entirelv into the hands of the Swedes, or will a more complete and thorough system of training be adopted in this country, enabling English women to compete with the Swedes ?
The defects of our training are as follows : It is muoh too flhort for the attainment of a thorough knowledge of elementary anatomy and physiology, and of good practical work.
The manipulations are taught on a healthy subject ; the pupils have no opportunity of seeing and handling patients.
At the Boyal Central Institute in Sweden, the course of instruction lasts two years for pupil masseuses, for masseurs three years, as they have to learn military exercises.
The curriculum includes anatomy, physiology, hygiene, pathology, added to which the students must understand dis- sections and attending in the operating theatre.
There is a large clinique where patients are sent from nervous hospitals, etc., and are treated by the pupils tmder the directions of a medical man.
The vast difference that exists between the systems of training is easily seen, and also how improvement is needed, if we are to enter the lists with a fair chtmce of success.
I am, yours truly,
H. B.
FEVEB IN NEW GUINEA.
To the Editors of the ** Monthly Homoeopathic Eemew,^'
Gentlemen, — The following letter from a missionary in New Guinea has been put into my hands, with a request for suggestions as to appropriate treatment for the very malignant form of fever therein described.. Thinking it may interest the readers of the Mon^ly Homaopathic BavieWf and poesiUy call forth a response aa to the therapeutical question^ I aend
ShSJ^j^i^S?** CORRBSPONDBNOB. 879
Rtfkm, Jum 1, UM.
it on to yon. Should axiT informatioii bearing on the subject appear in your pages, or be sent to me direct, I will see that it reaches the writer of the subjoined letter*
I am, gentlemen, Yours iaithAilly,
A. BvEXBB Alsxakder,
February 88nd, 1698,
Plymouth, May, 1898.
*' My Dear Friend.
« « « • «
" In February of last year, I arrived at one of my stations in time to witness the last combat with a fever that seemed strange to me. I did all in mv power to save the woman's life (a South Sea Islander's wife), but all the regular methods of treatment for fevers fedled utterly, and, after a most painful struggle, she succumbed. ** This being the first case I had seen of this particular
' Caver, I concluded tiiat she died from some female complica- tions, and there the matter ended.
'* In July or August, I was called to see a teacher here at my headquarters early one morning, and on putting my hand on his forehead, I immediately hi^ the conviction that he had on him the same fever as the above, but I did not then think it would be a hopeless case. I again tried evervthing to
- procure perspiration, but in a few days (six in all) he too fluceumbed.
" I then realised that in this particular form of fever, I had a monster to deal with that needed stronger measures than any other form of fever I had hitherto had to encounter, either personally, or in any patients. I read and re-read all I could find on fevers, Epoke to one and another who have had much experience of fevers in the tropics, but no ow could name it, neither suggest a remedy.
" Sunday, 18th inst., I was at an adjoining village, whither
' I had gone to attend two cases of fever on the Saturday, when one of my lads arrived to say I must return at once, as one of the women (South Sea) had gone down with fever. I lefl; my two patients, returned, and again recognised that I was face to &ce with the old monster, and there and then
began the old struggle, but only to be baffled as formerly.
4« • • 41
'^ On Tuesday last, I was called to go to two teachers who had }tsi gone down with fever (both men). One I recognised to be merely our ordinary malarial fever, the other I knew at <ince as the one that has always baffled me. This time I entered upon my duty feeling I must do my best in a hopeless task, but as I had the impression that he must die as the
880 CORREBPONDENCB. ^^^"Z??^
Beriew, June 1, ISBSr
others had done, I decided to follow only one coarse of treat- ment, and to study the case as dosely as my knowledge cQold take me. Here are the results of my observations^ Temperature when fever came on, 104.2° F. ; three hoora later, 105° (noon) ; and at sundown, 108°, with delirium. At 8 p.m. temperature had fallen to 105.6°, and at 4 a.m. to- 104°.
. " The whole of the following day it moved up and down between 108° and 105°; the next day it fell to 102°, and continued to fedl during the following night to normtd.
^* In all forms of malarial fever there is to be noticed a disagreeable smell, arising, I think, chiefly from the skin ; but in this fever, the body remains quite wholesome, whereaa the breath during the first twelve hours is unbearably foul> after which period, however, there is not a trace of foulness left, or I am unable to notice it. This has been true without exception in all the above cases. Likewise in the case of motions, in neither case have they exceeded, on an average^ over two in 24 hours, all of which have been more or less formed, and of a dull yellow colour. The desire to micturate^ however, seems to be constant, and almost every hour tba patient seeks relief in that way.
« The pulse varies from 60 to 70 beats per minute, and, in the case of present patient, he being the only one that haa not succumbed so feur, there has not been any profuse sweat.. In fact, with our ordinary fever of temperature at 108° or 104°, we get &r more in one bout than he has had all the week.
" To refer to the urine again — ^in every form of fever we get here the urine is one of the surest signs of how we stand a» regards fever or the contrary* Sometimes two or three daya before fever asserts itself the urine will become as dark aa strong tea, and remain so to the end or entire recovery of health. Jn these cases of which I now write the urine keeps its natural clear colour, the present case being no exception until after the first 48 hours, when the medicine began to make an appearance.
" The whole treatment internally for this so far successful case has been Henry's Fever Bemedy, Jyara Hari, in 120 m. doses every two hours, night and day, when the patient is not asleep. Bxtemally, a pile of blankets and massage, with frequent drinks of hot tea. The only difference in all these ranptoms^ with the foregoing is that the former all vomited their medicine more or less^ whilst the latter has not vomited once since the fever set in.
"March 4th. My patient died on the 2nd inst. But let me detail his case up to the end, seeing I have written the foregoing.
GORREBPONDEKCE. 881
"•'He continued to mend niitil the S4tb, when twice in 24 honrs he patted large quantities of blood and maoos, and what looked much like the Iming of the intestines, viz., long ilikes or shreds of a white shreddy substance. There was no pain, no smell, but a marked decrease in the pulse, which fell to 55 per minute, and very weak, but regular. There was very little pain on application of pressure to the abdomen ; but I at once changed his medicine, put him on ipecacuanha and sod» bicarb., stopped all soUd food, and put a thick flannel bandage over the abdomen, and fed him on fowl broth, arrowroot, and the yolk of eggs in tea. On the &7th he had « relapse of fever, temperature 103^, but the blood and mucus had ceased to be followed with diarrhoBa. I now began with starch enemas, and these relieved him very much.
. *' February 28th. Blood and mucus, pulse very quick and irregular; as well as I could count, I concluded it was at 90 per minute. Temperature down at 101.6°.
March Ist. Here came the climax as regards the perplexity of treatment. To put him on fever medicines meant a return of the blood and mucus stools ; to fiEJl back on ipecac, and flod«B bicarb, was to give the fever a free hand.
''March 2nd. Death stepped in to settle the struggle. Temperature rose, from 8 a.m« at 102.2° to 104° at noon. He then became violently delirious, and three people had all their work to keep him on his back. I have seen many a case of cleJirium, have had some had times myself, but never have I fleen anyone so desperate as this poor fellow. He seemed to have one idea, viz., to bite me, and it was only with the greatest effort that I could keep clear of him. He was afraid of me, and thus tried to shake me off. During the afternooui we had the greatest difficulty to keep his extremities warm ; the head remained up to his death intensely hot, but the legs and hands were deathly cold. In this respect only, plus the blood and mucus motions, did his symptoms differ from those of tiie others who have succumbed to the same fever.
'< Oan you follow the above ? I trust you may, and if you oan make any suggestions that will be of service to me in fiiture, I shall be immensely helped and pleased.
(Signed) ••
COLLECTIVE INVESTIGATION.
To the Editors of the ^* Monthly Honuxopathie Review.**
' OsNTLBiiBM. — ^The month of June will soon be here, and wHh it comes the time for returning the schedules for the collective investigation of disease.
882 CORRESPONDENCE. ^Sl^
Bevkrw, June 1, IBBS,
Will the gentlemen who have undertaken to fill up theae Bohedales kindly retam them on or before Jane 80. I shall be happy to send more schedules to any who may ap^ly.
It will be remembered the diseases under consideration are: —
Scarlatina. Acute Pneumonia.
Enteric Fever, Diphtheria.
Acute Bheumatism*
Yours fiedthfully
J. BoBBBSOK Dat. May 6th, 1898.
HAHNEMANN'S GRAVE.
To the Editors of the " Monthly Homoeopathic Review.^'
OEimjufBNy — You informed your readers in your May number that it was proposed, before erecting a new tomb over the remains of Hahnemann, to transport these remaiils themselves from their hitherto obscure resting-place to a suitable spot in Pdre Lachaise. As a member of the International Com- mission, I have just attended the ceremony of exhumation, and I think you will like to have an account of it.
I crossed the Channel last night, accompanied by the grandson of the master — ^Dr. Siiss Hahnemann — ^who was present as a youth at his progenitor's funeral, and most appropriately assisted at the present action. Our worthy colleague's fears'^ as to the genuineness of the body we were dealing with had been removed by the evidence we had brought before him ; and had any doubts remained, they would have been wholly dissipated by what transpired during the day. Dr. Cartier met us at the station, and after breakfast at his house, drove us to Montmartre, where we found Drs. Jousset, Lton Simon, Tessier, Boyer, Herrmann, Parenteau, and other noted Parisian homoaopathists. Proceeding to the grave^ Dr. Cartier commenced the proceedings by reading a statement of what had been done towards the ex- humation and translation of Hahnemann's body, and the ascertainment of its identity. Dr. V. Lton Simon ' followed, as President of the Soci6t6 Fran9aise d'Homoeo- pathie, with a eulogy of the deceased; and, by desire, I added a few words on behalf of his British disciples, expressing their sympathy with the work in hand. The coffin, which had been identified as Hahnemann's, was now brought to light and openedi and as it was known to have been embalmed, we indulged a sanguine hope that we might — ^though only in death— -gaze on Uie Master's fiice. To our
* Set Horn, Becorder for April, and Hahn^ Montkly for ICay.
]t0Vi0ir.JvMl,mB.
COJIBBBPONDEMOS*
888
disappointmenty bowever, ire found that this pari of ihd oorpaoy being nnoovered, had mouldered away, while the body, enshrouded in silk, was in &ir preservation. We found, nevertheless, on searching the coffin, unmistakable proo& of the body being Hahnemann's, in the shape of a paper bearing hifl name, of a medal shewing his bust, and of the wedding ling of his second marriage — ^which I am informed it is the German custom to bury in the husband's grave.
Our researches now being ended, the leaden coffin was again shut down, and, enclosed in a new wooden one, was conveyed to P&re Laohaise, where, in a beautiful and frequented spot, it was finally laid to rest, in the presence of the few d us who had leisure to proceed to the famous cemetery. We and others were then entertained at d^jeiiner by Dr. Lten Simon, and parted from our Parisian colleagues with renewed feelings of respect and affection, these to be still fiirther cemented, we trust, at the International Congress of 1900, and the unveiling of the monument to the Master in connection therewith.
And now, gentlemen, let me once more appeal, through your pages, for contributions towards erecting the contem- plated tomb. I have received but few, as the subjoined list will shew. The Continent has been beforehand with us — ^the last reports shoiring the receipt of 6,762 francs, of which less thiEm 500 are from English-speaking countries. America must not be expected to do much here, as she has her own monument already in hand ; but England, with her colonies and dependencies, ought not to shew a meagre front in the catalogue of subscribers. I trust I shall soon have to report a large addition to the names already inscribed in my receipt-book.
I am. Gentlemen,
Yours very fidthfnlly,
BioHABD Hughes. (Written at) Paris, May 24th, 189&
Subscriptions received. < s. d.
Dr. George Clifton 110
Dr. Arthur Clifton 110
Dr. Hayward 110
Hahnemann Epps, Esq 110
Dr. Mahendra Lai Sircar .« ... 0 10 0
Dr. Dudgeon 10 0
LadyCaird 110
Dr. T. Q. Stonham 1 1 0
Dr. Hughes 110
Dr. Edwin A. Neatby ...110
884 CORBEBPONDENTS. ^'aS^^ZS^nSt
NOTICES TO CORRESPONDENTS.
•^* We cannot undertake to return rejected manu$eript».
AUTHOBS and Goktbibutobs receiying proofs are requested to oorrect and retnm the same as early as possible to Dr. Edwik A. Nkatbt.
•LOITBON HOMOEOPATHIO HOSPITAL, GbEAT OBMOMD STBSET,
Bloomsbubt. — Hours of attendance : Medical, In-patients, 9.30 ; Out- patientSi 2.0, daily; Subgical, Ont-patients, Mondays, Thursdays, Fridays and Saturdays, 2.0 ; Diseases of ' Women, Out-patients, Tuesflays, Wednesdays and Fridays, 2.0 ; Diseases of Skin, Thursdays, 12.0 ; Diseases of the Eye, Thursdays, 2.0 ; Diseases of the Throat and Ear, Wednradays, 2.0 ; Diseases of Children, Mondays and Thursdays, ^ A.M. ; Operations, Tuesdays, 2.30 ; Dental Cases, Thursdays, 9 A.U. ; Orthopsdio Cases, Tuesdays, 2 p.m. ; Electrical Cases, Thursdays, 9 a.m.
Dr. Cboucheb, of St. Leonards-on-Sea, will visit Bezhill-on-Sea, Ingleside, 16, Albert Road, on Mondays and Thursdays, from 3 to 6 p.m. ^urinflf the summer months.
Ebbata.— P. 258 (May number), line 16 from the top, for **i8 liomoeopathy " read *' is, that homoeopathy is a fallacy." P. 268, line 18 from Uie bottom, for " The refusal of '* read " A request for."
Communications, &c., have been reoeiyed from Dr. Stanley Wilde ^Cheltenham).
BOOKS RECEIVED.
The Medical Treatment of the Drink Habit, By A. Stoddard Kennedy, Ii!B.C.P., &c. London : Simpkin fc Marshall. — I^e Journal of the Britiih Homeeopathie Society. April. London: Bale ft Sons, Oroat TTitohfield Street.— 7^ Honugopaihie World. May. London.— 7%« ChemiJtt and Druggist, May. London. — The Calcutta Journal of Medi- 4^ne. March. — T%e North American Journal of Homaopathy, ApriL Kew York. — The Homeeopathie Eye, Ear^ and Throat Journal. May. New York.— 7^ MedieOl Tim>ee. May. New York.— 7^ IVeio England Medical Gazette, May. Boston. — 7%e HomcBopathic Reeorder. April. Philadelphia. — The Homeeopathie Envoy. May. Lancaster, Pa. — T%e Medical Era. May. Chica?o.^7%« Hahnemannian Advocate. April. Chicago. — The Minneapolis Homeeopathie Magazine. April. — Pacific *Oea9t' Journal of Hommopathy, March and April. San Francisco. — The Clinique. ApriL Chicago.— TA« Medical Brief. May. St. Louis. — The Medical Century. ApriL New York.— i?<Tt«^ HovMsopathique Franqaiee. ApriL Paris — Revue Homotopathique Eran^aiee. March. Itrussels. — Homikwathische Zeitung. April and May. Leipng. — Revue Meneudle de Bibluhgraphie Medicale. ApriL ^BiiB.^Homeeopathisehe Maandhlad. May. T}ien»gxie.-^PopuldreBeitschrififiirHom^pathie, May. Leipaig^. ^
Pftpen, DispenMTf Beporto, and Booki fov Bcriew to be sent to Dr. Pops, 19, ^ttetnimte, Onurthani, linoolnshire ; Dr. D. Dtcb Bbowv, S9, Smrmoor Stnet, Boii- own Sqiuie, W.;' or to Dr. Edwiv A/Nsatbt, 178, HaTonCock Hul, N.W. AdTotue* nmta and Bnrinii ocmmniiioatioiw to be sent to Muwii. B. Oould ft Sov, Sf. IfiDorgMte Street, B.C.
S^SSST^Sm^ EXHUMATION OF HAHNEMANN. 885
THE MONTHLY
HOMCEOPATHIC REVIEW.
OFFICIAL ACCOUNT OP THE EXHUMATION OF THE BODY OP HAHNEMANN AT THE CEME- TERY MONTMAETRE AND OP ITS REMOVAL TO PtRE-LACHAISE,
itaiiflhfd hj the French HomcBopathlo Society aod the Bepreeentatiyee
<»f the International Tomb Committee, ptmBUt at the oeremonj on
May S4th, 18t8.
[Thb hearts of all homoeopathists, whose eyes rest on . these pages, whether patients or physicians, will throb in sympathy with the pathos and enthusiasm which they fonrtray. The glowing words of Dr. Cabtibb and, Dr. L^K-SiuoK' paint before our minds a vivid picture of the solemn but simple and touching ceremony around the grave of him whom we are proud still to call our Master. We are proud — for great as is the truth of homoeopathy, Hahnemann taught us even more than this. He taught us to observe, to experiment, to judge for ourselves.
The new spring life daseribed by our article carries a lesson with it — a type of ^trnthfulness and of resurrec- tion. We think of Hahnemann in his young days— a «ch(4ar, for at twenty we are told he was acquainted with Hebrew, Greek, Latin, French, Italian, English, alid
Ydl l«, No. 7. * 2 0^
EXHimATION OF HAHNEMANN. ^^K^^SyTiSSR
perhaps Arabic ; a scientist, witness his varied writings on chemistry, hygiene, &c., in the best medical journids of the day ; and a physician. In these, his pre-hom<BO-
Eathic days, he was successful, sought after and ^ onoured, at Dresden, Leipsic and Mayence. Good had it been for Hahnemann had he never been a physician — but bad for his posterity. We think of him paying dearly for his grand discovery — ^persecuted and driven from. Eqnigslutter, from Hamburg, from . Leipsic, and, skipping over his period of rest and succeps in Coeth^n and Paris, we follow him to his obscure and unnamed grave in Montmartre Cemetery. Is it too much to say that he spent his long life for others — for humanity rather than for himself ; that he lived and died a martyr to the convictions and teachings to which we' owe ao) mti6h? But as tiipe removes the prejudice against which he struggled, history, begins to record , the verdict o^ posterity. If he died uiohonoured, he lives, again in tens of thousands of his followers all over the world, and millions of sufferers have arisen to bless his name* . l^Atold numbers will rejoice that his grave has not been allowed to pass into oblivion, but that with the growth of his fame and the spread of his doctrines the age demand's that justice be done to him. No longer unhonoured, he takes his place amongst the departed heroes of that great nation which gave shelter to him . in his later years. The spring time has arrived for him once more.
' In the name of our confrereg in this country and of their many patients^-HAHNBMANN's debtors and admirers , -:-we congratulate our colleagues in Paris on the energy ' and loyalty they have shown in the work entrusted to t^em by their brethren the world over. We are thankful . for th& completeness of their success, and in particular - our- gratitude is due to Dr. Gabtier, on whose unwearied devotion so much has devolved. We look forward to the ^reat gathering which shall take place in Paris in • IdOO, when representatives from all parts of the globe will pay the grateful homage of all nations to the genius, the labours and the altruism of Samuel Hahnemann, i^erhap^ it is too much to hope that even those who fail * td tttidersiand and follow him will have the liberality, • gOQ4 tapte and judgment :to jo^ in honouring him ;so. soon. , But this will come — ^and more also.
SSS^J^TfaS** BXtttJMATION OP HAHNBMAKK. 887
The sabjoined report is translated from the official accoont published in the Revue Hofn^ Frc^aiee,—, Eds. Jf .ff.B-l
On Tuhsdat, May 24th, 1898, in the presenoe of the civil authority and of thirty-five other persons, the. solemn exhumation of the body of Sahubl Hahnbhann, founder of homoeopathy, took place. The ceremony be^n at half-past 8 o'clock in the morning by the arrival of the Commissioner of Police representing the civil authorities, who permitted the exhumation of the body of Hahnemann and that of his wife, in accordance with the arrangement made with the Baroness BoRimro'-' HAUSBN, the adopted daughter and heir of Hahnbmabv's widow. There were present : — ^ ' ' •
' Dr. Suss Hahnemann, grandson of Samuel Hahnb* mann, who came from England.
• Mr. CiiOQUBMiN, Yice«P^esident of the Transatlantic Ciompany, representing the BABONsssof B^onninoh^^sb^**
' The International Committee was represented by Dr. BicHABD Hughes of Brighton, and by Dr. FBAN9018 CABTiEifcy Secretary of the Paris Committee.
1?here were present also the following' doctors and chemists : L^on Simon, President of the French Homdeo* • pathic Society, Parbntbau, Conan, Joussbt Senior, Jousset Junior, Nimieb, Faure (J.B,), Ouinard, Faube (Elie), TissoT, Dezon, Nuouat, Botbb, Lovh, Ohanoerbl Senior, Chanobbel Junior, Gteoboes Tessibb, Tbichok» Pbuvbieb, Hbbrmamh, Vautier, Eoeniok, Girardeau, EcALiiB, and Bernard Arnulphy of Chicago..
Dr. Gannal, who was present at the embalming of the body of Hahnemann as an assistant to his father, 55 years ago, was also at the ceremony. Thirty-five persons in all gathered for the occasion, including five who were not medical men.
A telegram from Dr. De Brasol,. President of the Committee, addressed to the Secretary of the Committee was read at the beginning of the ceremoxiy.
''* Am not able to come, am with you in spirit at Paris, taking a , deep interest in ibis solemn occasion. It is oomfortingtbat due honour is at' last, being rendered to our Master. Wish kiccess to the work you have so energetically '
2 c-8
888' EXHUMATION OP HAHNEMANN, ''bS&^^STiSb^
imderfcakdii, and that in two years the tomb may be adorned by the beaatifol monument. — ^Dr. Bbasol."
Dr. Gabtibb was the first to speak.
** Gentlemen — In face of this open grave and before this coffin containing the body of Samuel Hahnemann,, our illastrioas Master, my duty is not to retrace the work of this man of genias, who has moved the world by bis ideas and bos doctrines. As Secretary of the International Oonunittee of this monument and French delegate, the only one able to act on the spot, I most give to you. who are present here and to all those who over the whole world are anxiously awaiting the result of to-day's ceremony, clear and decisive proof that we are in the presence of the precious remains of Samuel Hahnemann, and that the monument that we are to erect at Pere-Lachaise will undoubtedly cover the body of the founder of homoeopathy. This is necessary, became of recent polemics which have appeared on this sx^lect in different homoeopathic journals ; and which it la very important to correct by giving authentic proofs.
** The evidence may be summed up in two groups.
'' 1st. The information furnished by the register of the civil authority, and by the statements of tbe family and. of homoBopathists coiaoiding with the marks on the vault and on the cofflin :
'' 2nd. And finally the opening of Hahnemann's coffin, whose features ought still to be recognisable. We have to demonstrate that Hahnemann was buried in the grave of Lethx^bb, and that it is Hahnemann's body which is found on the opening of the first coffin. On the one liand, the books of the cemetery and of the registrar ; on the other, the information furnished by the grandson of Samuel Hahnemann, Dr. Stiss Hahnemann, who is here present; by Madame Bonninghausen, the adopted daughter of the late Madame Hahnemann, n4e d'Hebvillt, by Hahnemann's contemporaries, b^ those who have written on his life; all these testify that Chbistian Samuel Hahnemann died in Paris in 1848, and was buried in Lethijkbb's sepulchre, indicated by a perpetual grant, bearing the No. 824, of 1882, and 414 of 1884. On the left is the Hahnemann sepulchre, bearing the ' No. 281, in the year 1847.
iSS^^i^iSSr EXHUMATION OF HAHNEMANN. 889
'M^BBepolchrecontainB only the bodvof Hahnhmaioi's vidowi n^e Mj^lanis D'Hbbyilly, who. died in 1878.
''Certain homoeopaths have erroneood^ Bupposed that the body of Hahnemann was put into this sepalchre.
'' Gentlemen^ it is now open before yoa» it contains only one coffin whose description answers to the registered acconnt of Madame Hahnemann, nie D'Hbbyillt,
''The sepulchre Lethidre, where the body of Hahnemann reposes, has been reprodoeed in a print, in the Journal of Dr. Schwabe, the Homoopatkiichet KalendeTy in 1892, more recently |in the Hahnemannian Monthly of October, 1896.
" Since the drawing was made of the sepulchre, the zinc roof has been taken away, but you can see its identity with the drawing that I show you, by the iron railing and the shape of the tombstone. Finally, yon see,, as a convincing proof, in the comer of the tombstone, this inscription : ' C. P. 824/ (Perpetual contract 824). We knew also, through the cemetery authorities and through the account of the family and homoeopathic physicians, that Hahnemann's coffin was the last interred. The body of Oohieb was the first buried, the cemetery authorities possess no longer the date of his death ; the body of LBTHiiBE, who died in 1882, is in the middle, then the last one, that is to say the first beneath the stone, is the body of Hahnemann, buried in 1848. The number of Hahnemann's coffin inscribed in the register of Montmartre Cemetery is No, 1262, Ist ward {artxm^ di$$ement), 1848.
" Now, gentlemen, you are here to-day to verify these facts. We read distinctly on the first lead coffiii which presents itself, separated from the others by a layer of cement, immediately below the stone of the LsTHiisBE sepulchre, the following inscription, which has not been at all altered by the weather: *No. 1252, Ist ward {arrondissement) 1848.' Higher up, on the coffin, you can see a lead stamp (mark) as follows : —
* Bbeyet. ©'invention. Embaumement Oanndl.* " Now we know that HahnemanIi's body was embalmed by one of the first specialists of the day. - '
i ^^ The firm of Gahkaii still exists, 6, Bne de Seine; I had the oppourtunity of seeing Dr. Gannal, th» son and saeoessor^ who was his father's assistant «^ 4he embalming of Habnbmahm, Mid who still remembers the operation. The embalming was done, according to him, with sulphate of alumina (Gannal's process), although Dr. Suss Hahnemann, equally an eye-witnes8| asserts that arsenic was the agent employed.
''On GankaIi's books these words are still found: 8rd 7uly, 1848 : ' Embalming of Dr. Hahnemann, 2,000 fruics.'
" To-day Dr. Gannal is with us and desires to be present at the exhumation. I will now sum up in order the proofs of the identity of Samuel Hahnemann's body.
'^Ist/ Hahnemann ' was buried in the senulehre LETHiteE, and not in the Hahnemann's sepulchre, in aooordance with the statement of an eye witness. Dr. Stss Hahnemann, grandsoq of .Hahnemann, with the attestation of Macbime de Bonninohausen, adopted daughter of Madame Hahnemann, the widow, with the imtings of all those who have related Hahnemann's life.
'' 2nd. Hahnemann's coffin, in the LethiIirb sepulchre, is certainly the one bearing the No. 1252, 1st ward {arrandisaement), 1848.
"For, firstly, the No. 1252, visible on the coffin; corresponds with the number in the cemetery register ; secondly, the Bue de Milan, where Hahnemann died, at the present time in the 9th ward (arrondissement), belonged to the 1st ward of Paris in 1848. '
''8rd. Hahnemann alone died in 1848, and was buried in the Lethi]^be sepulchre, where two other bodies already lay buried, one in 1882, and the other at a still earlier date.
''4th. The stamp bearing the mark of Gannal's embalming is still another proof. •
'^ Finally, gentlemen, in order t9 dispel any remaining doubts, I obtained from the police authority consent to open the lead coffin. We are going to be present at a touching and unique spectacle ; we shall look upon the remains of hjn^ whp is our everyday guide-K)ur common Master. The futures of the illustrious Hahnemann, wh^
SSS!^!!SSSSk^ fiXHincAtnoM w hahnbicaiin^ 801
has slept lent tbed6 >65 yeaks, will see the light, for the UBttime," . _
' After the ' address of Dr. Cabtibr, Ml ^loqubvix spoke. - On 'behalf of Madame de BftimiNOHACssK, whom he represeniedat the ceremony, he thanked the Homcso- pathie Society, and in particular Dr. Cartibb, for the work of the homcebpathic physicians, in which, he said, Madame la Baronne de JBoNHiNaHAusBii takes the greatest interest. She rejoices to know that the remains of her mother, of whom she entertains a most-afEBction*. ate remembrance, will be plaeed with those of Doctor Hahnkmahk in the same grave in Pere-Lacbaise. .
Dr. SixoK, President of the French Homoeopathic Society then gave the following address :*--
''Crentlemen, — ^Thanks to the goodwill of Madame la Baronne de Bomkinohausbn, to the kindness of U. Gloqubhim, and. to the zeal of Dr. Cabtibr, we are able to honour the memory of Samuel Hahkemamm according to our dearest wish ; the French Homoeopathic Bodety offers them its sincere gratitude. It is ready to receivethe two coffins from the committee represented by Dr.' Hughes and Dr. Gabtibb. You may rest assured that we shilll carefully watch over this precious charge; Two generations have already passed, gentlemen, since our Master left this world, and to the grandchildren of his contemporaries the unexpected task falte of providing him a tomb less modest than the one in which he has rested until now. Strange tarn of events, which proves once more that man poposes and God disposes ; which also demonstrates again that Hahnemann's glory is pi'oolf against time !
***For firstly he lives again in his grandson, who follows faithfully in his footsteps ; and next his name is not likely to be forgotten, because instead of working for his own time and for himself, he has worked for all ages and fo^ humanity. ,
*^ Therefore, it is of little importance that the present age^ blind and ungrateful, has disowned and di»lained hun, posterity of which we are the vanguardi is ready to do him justice.
''Ha\lj HAH»B3tA»K!' We bow before thy venerated remains, to whieh^ more fortuiiate than our predecessors,
892 EXHUMATION OP HAHNBMAKN. ^bS^^TS^x
we can render the honours due*. Full of faith ixr^e future, we give our brethren rendezvous at thy mauiM>« leum at the Congress of 190Q. Thy tomb will appear to them more glorious, enlightened by the dawn of the nest century, which will certainly see the triumph et thy teaching."
After the earnest speech of Dr. Simon, who deeply moved the audience, Dr. Bighard Huohbs, of Brighton,, came forward and gave the following address in French :*^
" Gentlemen, — ^In obedience to the wish of my colleagnes, I say a few words in the name of the English' homceo* paths, and you will forgive me if I do not express myself as well as I should 4esire in your language.
'< England cannot boast of being either the birthplace or the burial place of Samuel Hahnemann ; she is nqt* however, wanting in her devotedness to his memory, any more than Germany or France. Her institutions show it. In the year when he died, she had already started the British Journal of Homaopaihy, and in the following year the British Homoeopathic Society was founded. Five years later the London Homoeopathic Hospital was opened, lately rebuilt at a cost of JS48,000, and .contain- ing now a hundred beds. The Joumcd bore up the flag of homoeopathy for 42 years: the Society and the Hospital. continue their work to this day. As a representative of them, and also of our present journals^ I come amongst you to-day, bringing their fraternal salutations to VArt Medical, to the French Homoeopathic Society, and to the Hahnemann and Saint Jacques Hospitals.
*^ You have heard from Dr. Gartier what we have to do and what has alreadv been accomplished. Our warmest thanks are due to m^i &s well as to the Society for which he acts, for having so well cleared a.way all obstacles from our path. To-day the disciples of our master can reclaim his precious body, look upon his features — so calm in the profound rest of death, and take him out from his obscure surroundings in order to deposit him among the
' kings of thought '
Who wage contention with th^r tifne'i decay ^ X And of the past are all that cannot pan away*''
IBiS^J^nfS?** J5XHUMATI0N OP HAHMBHANN. 8W
''Thuiis our task for to-day. To-morrow we Bhall make rtady to erect over these remains a monoment wortby of his merite and of: oar veneration for him, at the sight of which the world can ask, What was this man, to whom alEer more than 50 years, bis disciples have shown so much hononr ? It will ask ; and those who . know his worth already will make pilgrimage &om all the countries of Europe, from North and South America, from India» from Ausfaralia, and will rejoice to see the master thus honoured. They will return home, armed with a new courage to follow in the path which he opened up for the advancement of their art and for the benefit of their patients.
** French colleagues ! England joins with you in your desires and in your. work/'
Speech of Dr. Suss Hahnemann in French.
" As a representative of Germany uid of Hahnemann's family, I iam very happy that I am allowed to take part in this interesting ceremony. Fifty-five years ago I waa
E resent at the funeral of my grandfather, who was left ere without a name and without a monument for more than half a century.
''Thanks to the International Committee, and specially to Dr. Cabtisb, Samubl Hahnemann has found a resting place worthy of his name."
OPBNiNa OP THE Coffin.
After the. speeches were concluded the workmen proceeded to the exhumation of Hahnemann's co&n. In the presence of the Commissioner of Police the workmen raised the coffin to the surface by means of ropes ; it was placed on the boards which covered up the hole ,made by the previous exhumation of Madame Hahnemann. Dr. Gannal, who superintended the operations, discovered that the lead coffin of Hahnemann had been screwed down and not soldered, and he told the physicians that he feared the body might hot be well preserved. The workmen removed the screws which were not too rusty, and forced out those which were- worn out by age. The lead cover gaped at the end, and those who were present perceived Hahnemann*^
S94 JSXHtmATicor ov hahnehisn. ^^SmJ^^SS^^uml
feety wrapped up in cloths, resting against the sides of the coffin ; they appeared well preserved, but as ihey continued palling out the screws, and as the lid opened wider, it was noticed that there was water. in the coffin, «nd the fears that the body would not be well preserve increased.
At last the lid opened wide, and Hahnemann's body was seen, covered and wrapped np with silk bandages. The conformation of the body, outlined under the embalming bandages, was preserved; the body was slightly shrunken, but what most struck the onlookers was the short stature of Hahnemann. On asking those who knew him, we got the reply that the founder ot homoeopathy was, in fact, very short. The body was lying in water, the fluid not being produced by the embalming, but coming from the outside. The soil of Montmartre Cemetery was continually infiltrated, according to competent authorities, the water flowing along from the clay bottom ; but if the coffin, in 1848, had been soldered and not screwed, it would not have penetrated. Water in the coffin necessarily brought about the decomposition of the body.
The embalmer took great care, besides applying the silk bandages, to cover, the head and the hands with pieces of wool soaked in *' essence.** At the end of the half-centm*y, these pieces of wool appeared like larga sponges enveloping Hahnemann's head, and his hands which were crossea over his body.
Dr. Gannal removed from the face and hands the iremains of the wool and silk bandages, which were better kept than the rest.
The head was found to be a mere mass of decomposed tissue and bones. He searched for the glass eyes which liad had to be placed in the orbits.
Hahnemann's body was completely decomposed. There only was found a long tress of woman's hair twisted round the neck, probably Madame Hahnemann's hair.
In view of its being an impossibility to recognise Hahnemann's features, Dr. Gannal fortunately was able to produce for us several tdcens from the coffin, which .assured the identity of the body, and which we give in .detaiL
t^jSffTiS»!^ BX&UMATION 09 HAHMEMANK. 806
— ■-
Iflt. — Tm Wbddiho Bino.
Dr. Gannal examined the separated bones of the handy apd fimahed bj tUBOovering, on one of tthe metacarpals Hahnemann's wedding ring. This gold ring was shown to the spectators ; it was made of two small ones, which coold be separated by a penknife, and on one of them was engraved these words : —
** Samuel Hahnemann. Melanie d'HerviUy. Verbunden Coethen, 18 Janvier, 1836"
The ring was replaced on one of the bones of Hahnemann's hand oy order of the Commissioner of Police.
find. — ^The Gold Medal from the French Hom<eopaths.
At Hahnemann's feet was found a bottle corked with emery and sealed up. The police officer gave permission to break it ; it contained papers respecting Gannal's process of embalming, the gold medal from the French homoeopaths to their master, together with an autograph letter from the late Madame Hahnemann, which formed the final link in the chain of evidence of identity famished by the coffin. The gold medal, in an excellent «tate of preservation, represents on one side Hahne- mann's profile, by David of Angers, the sculptor of Hahnemann's famous bust, which is used as a model for his portraits. On the other side is the following inscription : —
'' A leur maitre, lee homceopathistes Franqaie. Similia SimUibue Curantur,**
This medal was struck in bronze. Dr. Boyeb had brought with him an exactly similar specimen to that found in the coffin. After having been examined by the company the gold medal was replaced therein.
Srd. — The Autogbaph of the late Madame Hahnemann.
Among the papers concerning the embalming, found i^tored in the bottle, was an autograph lett^ - from Madamer Hahnemann, which the Commissioner of the Po&e permitted* to be reproduced by photography. The anthentieity of the handwriting of Madame Hahnib^ jiAim wits attested by witnesses who had known the widow of the discoverer of homoeopathy. Monsieur
396 J5XHUMATI0N OF HAHNBBCANN. ^bS&
RericwrJnly 1*
Oloqubhin, representing the BoNNiKOHAUflEN family, and Dr. Hebrmann (of Paris), recognised the handwriting without the least hesitation. The facsimile of the letter is here reproduced.
.//*.. A^A- ^^ ^,^ uyU^^^y^ y,y^^^.
End of thb Cbbbmony at Monticabtbb.
By 10 o'clock the ceremony at the Cemetexy M<Mit- martre was oyer, having lasted an hour. and a half. The workmen replaced the lead cover ; the leaden shell was then put into a new wooden coffin on which they nailed the old plate (No. 1,263, Ist ward, 1848), also « tery large- new copper plate on - which the
^J^TlHSk!^ exhumation of HAHNEMANN. 897:
^'Samuel Hahnemann " was engraved. At this time the company withdrew, convinced of the identity of the body, but regretting the onsaccessfolness of the embahning.
Hahnemann's coffin, and that of his wife, were placed in a hearse, and ten persons accompanied it to the • Cemetery of Pere-Lachaise, amongst whom were Doctors S^ss-Hahnemann, Bichabd Hughes, Simon, Hbsrmann and Gabheb, and Monsieur Gloquemin*
At PftBE-LACHAISE.
By contrast with the retired spot in Montmartre, so small and mean, the new resting place of Hahnemann appears a veritable rehabilitation. The Chimin du Dragon at Pdre-Lachaise, where the founder of homoeo- pathy is now buried, is one of the most picturesque of roads, planted with a variety of trees, and having about it something at once grand and mysterious. Perhaps this name was given to it on account of a likeness to the ^aces which this mysterious and incomprehensible creature was supposed to frequent. At every turn in this renowned comer of P^re-Lachaise the mind lives again with all the grand and celebrated men that France has sheltered in science, the fine arts and war. Here music is represented by Bossini, Aubeb, Donizetti ; there the ] poets and celebrated writers. Bacinb lies almost beside Hahnemann; a little further on are Mols^be and Lafontaine. Science is represented by Oat-Lussac and Abago. The celebrated physician and neurologist. Gall, is a few steps lower down than Hahnemann. Lastly, on the same side are the tombs of the marshals of the First Empire — Net, Davout, etc. The Chemin du Dragon is the route usually . taken by tourists who visit this renowned cemetery — the chief in Paris — ^by thousands.
" What good fortjone ! " exclaimed one of the company, on arriving at this place. In fact, Hahnemann's tomb is just on the border of the Chemin du Dragon where two roads cross. In this way the site of the future monument can be reached bj three different routes.
Whilst the spectators admired this part of the cemetery and its adornment of spring verdure, the gravediggers pot Hahnemann's coffin into the grave. They placed the bock parallel with the road, in such a manner that the head of the great man will be found at the ngjat
998* PBBBIBENTIAL ADDBESSi ^^^fS^JjS?
hand dde of the .monument^ the feet at the left ; finally, * ate- little coffin eneloaing . the remains of Madame Hahnbhamv was placed at Hahnemann's feet. The Yioik* men immediately proceeded to cement the yanlt a£beri putting down the two coffins, and' coiser^ them with concrete in the presence of the on-iookers^ who onlyieft' the place after the grave had been perfectly closed and. filled up. .
A temporary railing and a crown will be the simple, ornaments over the precious remains of Hahnemann, until the day when, deeply moved, the homoeopathists ftom all parts of' the world will complete the work'4>f restoration in honour of their venerated master — a work the more brilliant because so long deferred.
THE PRESroENTIAL ADDRESS, BRITISH HOMEOPATHIC CONGRESS, 1898.
By EuBULus Williams, M.D.
Ladies, and Gentlemen, — ^When you did me the honour of electing me tp the dignity of President of this Congress * in September last, I scarcely realised the responsibilities which necessarily accompany sudh an honour, and I can only hope to satisfy your expectations with the assistance of your cordial help and support.
Difficulty assails one at the start, in selecting a subject for this address. Every path seems to have been trodden by my predecessors ; from every field of know** - ledge so much has already been gathered and so wisely arranged that one can only hope to follow as a gleaner, and gather up here and there what others have dropped* WjB, like our forefathers, are ever seeking after some new thing ; progress is our aim, forward is our watchwcnrd. ' To-day, the longing to alleviate the pains of suffering* humanity, and the desire to know that which will prevent much of this suffering, is keener than ever before ; and • yet, when we look back over the pages of history, and find that the Ancients, whom we be-littllB in our ignorance, were not so very far behind us, we are tempted to exclaim '* there is nothing new under the sun," and, that after a^l the thousands of years during which knowledge has beexi courts, her latest suitors have not won from her many more fiivoursjihan her younger and earlier lovers in the world^s history. .:
SSSSfj«5uSS£**^ PRESIDENTIAL. ADDRESS. 909^
:' Shis is the day of stndymg growth abd deyelopment. Eyokitian has become a oommon word in our langpage^. aiDd though I cannot hope adequately, to trace the eyolation of the science of medicine, I hope by, here. and there pointing to the page of history, to indicate sopcie of the phases thrbagh whidi tt has pas&ed sine^ it first emecgedfrom the darkness of ignorance and superstiticm- to the light of. the scientific knowledge of to-day — flight, which we flattei: oorselves is very; bright, but which* no* doubt, our. successors will find cUm and duU— still, clouded with much ignorance^ and possibly darkened by: some superstition.
: To the savage, the man who can heal is a god- In: his mind disease is a demoniacal visitation, and the/ physician who can exorcise the devil is stronger than the evil one^ and therefore to be revered as a diyine being ; also, it is considered well to propitiate his favour l^y ^ts. This . sentiment is still found among savage* races,, and. is probably a survival of the feeling which all men had ia the infancy of the human race, and was the oause, as civilization grew up, of that union of medic^le witix priestcraft ; . the one having power over, life and death in this life,; the other possessing power over life, and destructicm in the world to come ; and this accounts, for the intimate connection between religioji and medicine from the earliest till comparatively, receQt times. ]
:.Prob8l)ly, in pre-historio times, accident discovered to a few individuals, who had the wit to put two and two. together, even befoi^e they could count, that certain vegetable productions had the power of alleviating pa^n or curing an illness, especially if accompanied by prayers and incantations to the demons or gods who were suppq^d b) be punishing the victim. The prayer or. charm was, held to be the potent factor, though the medicine, when easily obtainable, was considered a useful, if not a necessary; adjunct. Charms were worn as a preventive against disease and. evil of all kinds till comparatively recent times, and^ indeed, to this day among individuals olthe most advanced and civilized racep;; and long after people had learnt the art . of . writing, it was thought aufiusient ^ to swallow the writtep. preppription . if thf^ dxuga-mentioned in it could not be obtained ; „and con- sidering th^ .^jqapo^ition of some of the prescriptions that come down to us, it was -probably far 4^tter *for the
400 PRESIDENTIAL ADDBESS. ^ iSSir, My i;
patient that he should swallow a little {M^yros and ink and much good advice, rather than the baneful con- coctions with which these tyros in the gentle art of liealing wbuld have hurried their patients but of the world.
Apart from conjecture and guesses at the remote past, the authenticated history of medicine is a long one. If we look at one of the ancient civilizations, and that not th6 most ancient, at Egypt, for instance, we find that as early as 4866 B.C., Teta, a king, wrote a book on anatomy, so that anterior to that time there must have been some knowledge of the human body, and possibly there were' some men who made a practice of dissecting; but the badly set limbs among some of the mummies which have been brought to light show that the knowledge of anatomy was very elementary, thougb for the purpose of preserving the body very ingenious devices must have been known to them for removing the brains through the nostrils. The heart, lungs, liver and intestines were also removed from the body before it was laid in the solution for preservation, the spaees made by the removal of these parts being filled witti aromatic spices uid disinfectants ; also frequently charms against evil and destruction were laid in as well as on the body. Though the processes of preservation of the mummy varied in different periods, we have every reason to believe that the art of embalming was known at least 4000 years B.C., and probably still earUer. Besides the book of anatomy already mentioned, we also know that during the reign of King Sent (4000 b.c.) ** the redaction of a medical papyrus was carried out.""^
We learn bom Ebers that in Egypt in the 18th ecntury b.o.,' there was a school of physicians attached to the coUege of priests, t It would seem to have been the custom at that time for the medical students to receive a preliminary training at one of the four great universities in that country. Only a few remain^ to the end of their course at Thebes; after ^passing the examination of a scribe the most gifted were sent to* Heliopolis, the most celebrated medical faculty of the world, whence they returned to Thebes~^at that time .— ^ t*
• •« The TSiOMr B. A. Wallis Budge, ^ S18* t"U«id»"voLi,p.82.Bbm. .
nS^^U^SSt^ PRESIDENTIAL ADDRESS. 401
the capital city — to practise their profeBsion, (Legend points to this same university of Heliopolis as the seat of learning where ** Moses became learned in all the wisdom of the Egvptians."}
They were pade physicians to the king and were consulted in all serious cases. Being attached to some priestly college, whoever needed a doctor sent to the Temple, and a statement was made of the complaint for wMcn the doctor was required.
It was left to the principal of the medical staff to select and send the man he thought best suited for the case, and the physician was paid out of the funds of the Temple. The patient paid or not, as he liked, to the Temple treasury.
Diodorus, writing in the time of Julius GsBsar, says : ^'The physicians have a public stipend and make use of receipti3 prescribed by the law, made up by ancient physicians, and if they cannot cure the patient by them they are never blamed; but if they use other medicines they are to suffer death, inasmuch as the law maker appointed such receipts for cure as were approved by the most learned doctors, such as by long experience had been found effectual, though Aristotle says * the Egyptian physicians were allowed after the third day to alter the treatment prescribed by authority and even before, taking upon themselves the responsibility.' *'*
From Diodorus also we learn that there was a rule that doctors should not demand fees on a foreign journey or a military service, when patients were treated free of expense.t
The physician then was an officer of the State and state paid, as were the priests of that time ; both also were holders of and derived the greater part of their incomes from private property, and were often membera of princely houses. The theological and the medical orders of the priesthood were the aristocracy of the . nation. The Egyptians regarded the human body as so sacred that even when the necessary act of cutting it before it was embalmed was performed, the man who gave the first cut with his sharp flint instrument was Idoked upon as an outcast and a pariah, who cotdd not even live and associate with respectable men,
♦ Pom : iiL 11. f Diodorua'i. 82.
Vol. 42, No. 7. 2 P
402 . PEBSIDENTIAL ADDBBSS. ^rS^mTu^
: but WM totced to live apiirt ; and thoujfh he doly
, performed the indispetisable duty, he was execrated and obliged to flee directly he had performed the operation. As early as the 13th century. B.C., not only do we get
' mention of the practice of surgery as distinguished from medicine, but we learn that there were specialists for the different parts of the body ; /^eaoh physician treats a single disorder and no more ;" some devoting themselves to the eye (the Egyptian oculists being very
. famous), ^'others undertaking to cure diseases of the head, others again of the teeth, others of the intestines, and some those which are not local,"* and the
. e^ibalmers, who in Genesist were spoken of as physicians, were a distinct order apart from those who
: ministered to the living. The artificial teeth found in the jaws of some of the mummies testify to the skill 6f the dentists, and some, have even gone so far as to assert there are traces of gold stopping to be found.:|^ Mid- wives assisted at the birth of diildren,§ though it was
' customary to call in the physician in difficult cases.H i Though at this time it was the custom to employ magic and religious formulae to cure the sick, as well as
. the remedies suggested by scientific skill, the physicians themselves being at the same time priests and the utterers
. of these magical formulsB, there are evidences that some among them had a distinct aversion to the employment
' of the magical art in conjunction with medicine, but to avow it openly and to practise it was to run the risk of incurring the indignation of the orthodox, and probable expulsion from the College of Physicians, if not actually
' to incur heavy punishment besides.
Vivisection was carried on, and comparative anatomy studied by a few devotees of the science^ and there are also indications that parts of the bodies of criminals were sometimes secretly dissected in the desire to know Uie siructure of the human frame ; but the saoredness with which the human body was r^arded by the Egyptians,
.and the necessity for preserving it as much like life as was possible, effectually prevented any systematic and adequate study of the human anatomy, and probably hB8 much to say to the very slow growth of surgery on the soil of Egypt.
• Herodotos ii., 84. f Oen. L., 2. 1 Bbera' " Egyptaan Prinoeas, i., 184. § Exodufl i., 15 T. II Bben, op. ait.j ii, note 48.
ltSS!!^S?!!lSS^ ^BESIDEtTTIAL ADDRESS. 40ft
Though y^esk in sargery, in medicine tiiey were more proficsettt, and it is curious to find in the Beflin museum a travellkig medicine chest from Egypt '' prettily and ^wmpendiously fitted up."^
It is i^BO interesting to note that in a papyrus of the 14th century b.c, '' Isis is to be called upcm to destroy the gernu o( disealse ; "t again, in Plutarch's -' Isis and Osiris/' the '* fumigatidns " mentioned as disinfectants 4ire very reasonable.!
From Herodotus we learn that not only was the study of medicine of very early date in Egyyt, but the medical ,men there were held in much repute, and were so widely famed that they were sent for from other countries. Cyrusy King of Persia, and his successor, Darius, both sent to Egypt for physicians.! Their knowledge of medi- cine was also celebrated by Homer in his Odyssey.H
Pliny tells us that in later times j7a«^mor£effi examixuv-
•tione began to be made in order to discover the nature of
\ maladies. H It would seem that the Egyptians considered
that the majority of disorders proceeded from indigestion
'and excess in eating, and so, as Herodotus tells us, ** For
three successive days in each month they purge the body
[ by means of emetics and clysters^ which is done out of
regard for their health, for they have a persuasion that
every disease to which men are liable is occasioned by
the substances whereon they feed."**
.. Among the Persians, too, a high value was set on the
medical art in a very early age. Pliny, indeed, maintains
^^ thatthe wfaoleof Zoroaster's religion was founded on the
science of medicine," and it is true there are a great msiiy
< meiitieal direction» in the Avesta. Among the detailed
*lfit of meifical fees we find that 'Hhe physician ishall
' treat a priest for a pious blessing or spell, the master of a
^ house for a small draught animal, and the lord of ia
district for a team of oxen;" so that among the
'■ Fersions the physician's fee depended, not oh his skill or
the time or care devoted to his patient, but on the
r neealth and 8b«dal standing of the sick man. Even in
• those days it was necessary for the physician to pass^a
; *^— .. ^ J ■ -, ^ ■ -^ — '■
f Ibid, vol. i, note 289.
lEben* '^IS^KTPtian Prinoess,'' vol. i., note 289.
{ Hero&ts«, iU\ 77. || R»wliiiBon*8 Kerodotos, ti.. note 8 1.
5 Ody«4y iv., 229. •* Pliny-six., t.
2 D-S
404 PliBBIDBNTIAL ADDRBSSt ''S^^'jtS^^MSt
kind of examination. ** If he had operated thrice successfally on bad men» on whose bodies he had been permitted to try his skilU he was pronounced ^ capable for ever/ if on the other hand three worshippers of the Diys died under his hands, he was pronounced ' incapable of healing for evermore. ' " *
It is to the Arabs, who derived it from Egypt and India, that Europe is indebted for its first acquaintance with the science of medicine, which grew up in the school of Salerno ; and a slight memento of it is still retained in the Ar^b symbols used by our chemists.!
The next step takes us across the Mediterranean to Greece, and there b.c. 460 we find the celebrated physician Hippocrates. He was supposed to be descended from the divine ^sculapius, who, if we may believe that Homer treated historical fact largely decorated with myth in his Iliad, probably really existed in an early period in Greece, and after his death was revered and worshipped as a god, temples being erected to him ; one of the most famous of which was at Epidaurus, where^ among the ruins, may still be seen the marble couches on which the patients waited in the precincts of the sacred building, till the priests of the temple could minister to their healing. .
If, too, we can trust Homer for the fact, there were in his time and earlier, military surgeons ; they ranked with the officers as leaders, and their profession of healing by no means prevented them taking their place at the head of their troops in battle. ' We are not in a position to know whether Hippocratea was the lineal descendant of JEsculapius, or whether it was mere repute on account of his following the same profession, as it was usual in those days for the sons to succeed their father, and for professional callings to be hereditary ; but his is a personality so prominent in the history of medicine that it cannot be overlooked.
In his day physical and metaphysical sciences were combined. As in Egypt the sciences of theology and medicine were closely connected, so in Greece we find that some theory of the universe and man's relation to
« Ebon' *<Eft7ptuui Princess'^ Tol. 9, bote 18* > t Jl»wUiuKm*s Herodotus, p. }87, Boto^
SSSSfwSrSS^ PRBSIDBKTIAL ADDBE88. 405
it was an indispensable part of a physician's mental oatfit
As it was held that the universe was made ap of the four elements— fire, earth, air, water, so it was supposed that there were four homoare in the living bod7--4)lack bile, yellow bile, blood and phlegm ; " out of the excess, or deficiency, or misproportion of these four humours there arise diseases ; by restoring the exact proportion of which diseases are cured."* And as he observed that nature generally restored the balance of health by the eipulsion of her ill humours, he was led to assist her by somewhat drastic treatment, if one may judge from his use of hellebore and other irritant poisons.
Hippocrates took a long step forward when he rejected supernatural causes of disease, and attributed it not to the ill-will of some god or goddess but to insanitary 4)ondition8.
Until quite recent times epUepsy was regarded as an evidence of demoniacal possession, and in the present day among the Dervishes it is looked upon as a purticnlarly holy state when induced by their extra- ordinary devotions ; but of epUepsy the Greek physician said, ** men regard its nature and cause as divine from ignorance. No one disease is either more divine or more human than another, but all are alike divine, for each? has its own nature, and no one arises without a aatunll cause."t
^ That in thus speaking he was far in advance of his times is shown by the fact that Origen, one of the early Christian Fathers, is far behind him in knowledge when he says, ** It is demons which produce famine, unfruit- lulness, corruptions of the air, and pestilence," t and to this day there are many who attribute great plagues and pestiknce to a punishment for wickedness rather than to a n^eet of sanitation and proper precautions against ibe spread of ii^ectious disease.
Hippocrates also appreciated the fact that reticence was a very desirable, if not actually a necessary qualification for the wise physician. He says, " What- ever in my professional practice or not in connection with, it I see or hear in the life of man which ought not
* BoflieU. *• Hiftory and Heroes of the Art of Medioine,*^ p. 30. t Quoted by BneseU, op. oit. X Quoted by Eiusell, op. cit
406 PJtSSIDBNTUL ADDKE88. ^bSSI^SS^
to be spoken of abroad, I will not divulge/ as redioning that all such should be kept secret.''* • There was a time before Hippocrates, when it was bdd that disease was only to be removed by the application (rf its contrary, e.g,, "if the skin is too dry, apply
Soisture, if too hot, apply cold;" but it was left to alen, the renowned physician of the 2nd century a.d.,. to enunciate the famous principle " contraria, contrariia curantur," though perhaps his gtaatest innovation in the practice of medicine was the importanoe he attached to the indications afforded by the pulse, of which he taiq[>ed %7 varieties.
This Galen, bom at Pergamos in a.d. 181 obtained honours in the schools of philosophy and then went to Alexandria, where he studied for some time in the great school of anatomy in that city. .
At 20 years of age he became physician to the Temple> in his native town, and when 84 years oid- be went to Borne and soon acquired great renown, as was evidenced* by the illustriousness of his patients and the largeness of his fees,, which even for tlkose days was enormous. One of his most famous cur^s was that of a philoBopher who was suffering from the effects of an overdose of theriaeum, and was cured hy Galen by tiie administra-- tion of the same medicine in proper measure.
This homcepathic treatment would «eem to have been* accidental however, for besides being c^iposed to hia famous principle, this learned physician ww sometimes as indiscriminate in his use of nostrums as tin voiest quack, if we may judge from some of his presciipliflBB^ For the cure of dysentery he offers no less ttian mat recipes of compound drugs f with disinterested impar- tiality.
There is, however, a much earlier recognition of the homoeopathic law, as indicating a rule for the selection of a remedy, in the lines of Antiphanes, about b.g. 404^ beginning —
'^ Take the hair, it is well written. Of the dog by which you'ie bitten, " etc. {
At the beginning of our era, the physicians in Bdme were mostiy of the slave elass, and although usefiil to
' ' • . ••
* Quoted bj RiitMUt op. eit t Euaaell, op. oit 88. t^uoted bj BuMeU, p. 81.
SSS^jSTuSS^ pmssidkntial addbess. 407
their mastera, were domineered over bj the powerfol magnates of the State ; the position of a medieal man im the. Great Roman. Empire being very different from that high standing of an earlier civilization, of which we have previooalj spoken.
The statos of the physician is not dependent on, neither does it necessarily advance with the increase of seientific knowledge ; in the early stages of history, as we have seen, it is rather ihe reverse, except for favoured individuals here and there like Oalen, who, however, found his position in Rome so intolerable, on the one hand, becaase his profession was looked down upon, by the powerful, and on the other, because he was execrated by his professional confreres for his popularity and success, that he would only remain for a few years at a time in the capital of the Empire.
The Romans in the period of their greatness, as is well known, made considerable use of various kinds of baths,, and utilised the mineral and thermal springs known to ihem for bathing purposes, but it is not so well known that a medieal friend of Cicero* was the first to employ the shower bath ; he also trusted much to diet and the proper use of friction and exercise.
To the Arabians we owe the earliest treatise on small-i pox,, by Rhazes, who wrote twelve books on chemistry, about the 10th century a.d. and, what perhaps was even more beneficial to the race, the introduction of mild aperients, such as senna and rhubarb, in place of the more drastic treatment of earlier physicians.
The spread of Christianity marked the period of aiedical eclipse.
The sun of science was once more darkened by dense clouds of superstition and its accompanying ignorance, and it is not until in comparatively modem times, some, time after 1162, when medicine was formally divorced from theology, that scientific knowledge again began to grow.
This enforced separation was to the credit rather of theology than of medicine, because it was owing to the mistceatment of the '' therapeutisB," as the medical priests were then celled, that the religious orders fell into disgrace with the people, and it became, necessary
« A«}l)si484^ 9ee Ittiw^ ^ 80-1.
408 PBEBIDBNTIAL ADDRESS. - ^S^Sirf jSJ^flW?
toi rescue the Tepotation of theology by finally and definitely separating the two sciences, and ** the practice of the healing art was from that time forbidden : to a priest.'** .
Thoagh the rank superstition which accompanied much of the early Christianity, its wonder-working relics of saints and innumerable miracles (most of which in ' the , present day can oidy be regarded as the childrcai of ignorance) was a foe to medical science and for centuries a great hindrance to its practice, yet it is to the Ghristiaa doctrine of charity that we owe the introduction of hos- pitals for the sick poor, yAiiGh in early times were insti> tuted by the monks, and this same spirit of charity has shown still more and richer fruit in the well-appointed hospitals and infirmaries of the present day.
It is due to heathen Bome to mention that, before the introduction of Christianity, it was regarded as the duty of the State to relieve and care for the sick poor.
To the same religious orders thanks are due for the preserration of medical as well as other literature, and for the culture which was unobtainable outside the monasteries in England in that age.
The common-place saying, the day is darkest before the dawn, finds its fulfilment in the history of medical science in England in the 14th century, when at the time of the Black Death the unavailing efforts of the physi- cians to arrest the spread. or cure the victims of the plague led to utter distrust of the doctors by the people, and the medical men themselves lost all confidence in their remedies. But the keen desire of the human race to live rose in revolt against this rest in fataliiy^ and men began to search diligently for means to avert the evil and for remedies to cure the disease. The old orthodoxy was powerless, and none were so consermtive in their practices or so faithful to tradition as thib medi- cal men ; but when the people's faith in them and liieir faith in tradition were shaken, then the stone was set rolling, slowly it is true, for the acquisition of more knowledge and the discovery of new things, and it has gone on rolling ever since in spite of clinging to time- honoured custom and an almost instinctive horror of innovation.
*BiU8elI,op.dt^Ii.99.
ItSS^SSSf'S^ PRESIBBNTUL ADDBX8S. 40$*
B9viMr,Jvlfl, WM.
FerhapBv the most ftdvaneed thinker in the medical world in the 17th century was the celebrated German . phyeieiany Paracelsas, who struck the first note of his emancipation from medical tradition at the very beginning of his career by publicly burning the works of Galen and Bhazes. Though as a man one cannot admire him> nor can one uphold the mercenary spirit which invaded the domain of his professional life^ yet in his bold seeking for truth by investigation and in experience, in a time when such were rare, he is worthy of honourable mention, and his advice to the physician may be quoted. He says : '* If a man wishes to learn much of disease let him travel far ; if he do so he will acquire great experience. Countries are the leaves of nature's code of law, patients the only books of the true physician. Beading never made a physician — <mly practice/'*
In Paracelsus, however, we are reminded of the Ancients, who tried to simplify everything in nature by reducing it to a numerical system. He maintained a threefold order in nature. As theologians held the doctrine of the Trinity, so he taught that everything in nature conformed to this principle, and that medicine consists of philosophy, astronomy, alchemy. A man is made up of three parts, body, soul and spirit; the world of three elements^ water, air, earth, to which tiiere correspond mercury, sulphur and saJt.t
In the next century Harvey's name is conspicuous. Unlike Paracelsus he was imbued with a profound respect for his teachers ; yet to him belongs the great merit of devotion to truth, and determination to follow it at all hazards. Though under the patronage of Charles I. we learn from Aubrey's life of the discoverer tliat '' after his book on the circulation of the blood came out, he fell mightily in his practice. It was believed by the vulgar that he was crack-brained and all the physicians were against him."
Lord Bacon, early in the 17th centuiy, advocated the eoUection and publication of authentic r^nedies, and moreover indicated the' weak spot in the medical science of his day. He complains that the medical faculty
« Quoted Iqr HiimU, p. 161. f Ibid.
410 PfflSSIBBNTIAB ADDREBS. ^^tS^^TSTSt
'''have no particular medicines which,, by a. specific property, me adapted topecaliar diseases/*
The necessity for specifics as a reliable and scientific method of curing disease is brooght out still more- strongly a lew years later by Robert Boyle, who at the 89me time advocates small doses and deprecates the . mixing of drugs; he held thatthe system of prescribing . i^cu^y ingredients in one recipe, though it might cure the patient, hindered the advancement of medicine, as the physician was then unable to judge of the effects of efbch separate ingredient, and so could not learn from ezperience as much as he otherwise might. It was. reserved to Sydenham to accidentally discover the first specific toward the close of the 17th century. . Though still clinging in practice to the evacuant treatment taught by Hippocrates, he was dissatisfied with it, and regarcUng it only as provisional, he felt after new truths, and sought ''to arrest the natural course of disease by the administration of specifics," so that when introduced from America by the Jesuits^ l^eruvian bark was shown to be the specific for ague, he was prepared to accept it as the first of his expected discoveries in a new field.
He was a follower of Hippocrates in that he held that nature must be studied by considering how nature^ let alone, would work, so that by treading in her footsteps the symptoms of disease might be subdued. He evidently departed somewhat from the common piractice of his time in advocating less interference with nature under the plea of assisting her. He said '' I often think we forget the good rule " festina lente," that we move more quickly than we ought to do, and that* more could be left to nature than we are at present in* the habit of leaving her. To imagine that she always wants the aid of art is an error, and an unlearned error too."
But he took a further step in advance of his: predecessors by indicating as an altemstive io wafohin^ and feUowing nature's methods, that spedfics mmt be jBapovwed and Jiaed, and pointed out that by the* mfittwd of treating diseases by qsecific r^nedies '^ wfr attack. the malady directly:"
He was regarded by the College of Physicians of his- day as half a lunatic; they froimed on hfan, and did
JSSSIujSSTun^^ PU8IBBNTIAL ADDBBSfiL 411^
ivbflit they rcoold to hinder hie sacceeB, and even ebdeavoared to expel him from tiiat illustriocui society. If to be ahuatid when alive and worshipped when dead . ia- <iiie of the orders of merit, tihen Sydenham must be placed among the honoured ones of the earth.
A century later the profession again shook its bead orer Jenner, when in, 1798, after 25 years of patient investigation in the meadows of his native valleys, he eame to London fall of his discovery of the potency of oowrpax inoculation to give immunity to man from small-pox, the terrible scourge of that time, which rannaoly claimed some 40,000 victims^ . Though his discovery was quite in. accord with the ^peculations of his master, John Hunter, who himself had bidden hi8f«pilaot''tUBk tat try," and if trae was to be the means of saving the lives of thousands of. men^ he failed to enlist, the sympathy or help of his. fiofeaaional brethren, and after three months of in- effectual work he retired again to the country, there to l^pare and. in the saane year to puUish his treatise. . Shortly after^however, as is well kiiown, the worth of. bis discovery was acknowledged, and to this day men and women all over the .world are reaping the benefit of bis toil in di^(M>vering and making known the beneficial effects of vaccination.
, In bis case it was not left to posterity to bestow well*^ yarned &me, for during his lifetinle he received from, the British nation a gift of Jl^l.0,000 which was not so very generous, considering his discovery had cost him. £6,000 ; and though the nation gratefully acknowledged that his labours had resulted in the saving 40,000 liveai imnually, it showed by its action that it paid better U> kill the king's enemies than to save lives to fight for him.. To the .work of the late Dr. Btissell, entitled History imd Hero€$ of ^ Art of Medicine, I am indebted for mnoh of the information made use of in this pi^r, and sawigh has been said to show that what the talented/ author kaa WDritten is true when he says, ** If we accept. uEogress we must say farewell to orthodoxy/'* and tlMt fEurewell to orthodoxy means pevseeution from ixm* tempavaries for all pioneers i. of truth, and it is often, feserved to subsequetit generations to revere and bless^ r — ^"^ ■ f ■ *ri •'• ■• f.- ■ — ' ' — ! ' — = T
41^ PRESIDENTIAL ADDBESS. ^'"^^
iUTl«w^Jiil7l.l8B8.
the social martyr for hid proeious gifts to suffering humanity, of the resalts of thought and study, and his courage in proclaiming honest conviction in the face of scorn and ridicule, if not, as in earlier times, at the risk of social ostracism or actual imprisonment
In such an assembly as this I need only mention Hahnemann as one such pioneer, who, by his discovery in therapeutics of the law ^*similia similibu8 ciirantur," and for the revolution in the practice of medicine brought about by him, is not unworthy to take his place by the side of those illustrious men already named.
But his life and work are too recent and too revolutionary to have won the world's praise as yet. His departure from the traditional paths was too great for orthodoxy to have caught him up so soon. For, to as followers in his footsteps, who also are somewhat in the shade with him, it is encouraging to remember that the heterodoxy of one age frequently becomes the orthodoxy, of the next, and to reflect that posterity may reward the man who is not only independent enough to. embark on original research, and has the boldness to depart from the beaten track in following the results of his studies, but who has the still greater courage to avow his departure from traditional opinions.
Such a man may earn for himself the derisive smile, if- not the openly expressed opposition of those who, lulled in the arms of orthodoxy, calmly drift through life, secure in the good opinion of their contemporaries ; but to whom posterity raises no monument to tell of some new scientific height achieved by laborious effort, and the overcoming, not only the inherent difficulties of an up- ward path, but the surmountingof the obstacles traditional bigotry plants in the way to arrest the progress of all who would forsake the beaten track, and would fain try to discover for themselves a new road to truth.
Far be it from^ me to despise tradition; where should we be without our valuable past ? Tradition is good-^ excellent — as a point of departure, not as a resting place. * This is an age of toleration. As civilization advances, so does a more tolerant spint prevail ; and this more genial atmosphere is even penetrating that most con- servative of corporations the medical profession; and the honours bestowed in this century upon Simpson, Lister, and a host of other wdl-known names testify to the tact
im^J^STW^ PRKBIDENTIAL AUBRESS^' 413
that now, in this age^ it is not always left to posterity to diflcover and reward a aoientific benefactor.
In such serioas matters as the spread of disease, and questions of life and death, it is well, nay, imperative ttiatwe shoald paUs^ before departing from traditions marked with the approval of time; bat a backward glance at the history of medical science warns us against too profound a trust in tradition, if, as we profess, progress is our aim.
One prophet has even ventured to foretell tiie status of the physician m the 20th century, and though we may not be able to follow the late Mr. Bellamy* in his- methods of attaining his ideal commonwealth, he haa indicated '^a consummation devoutly to be wished,'* which we all would welcome, and to the attainment of which every true lover of humanity would lend his aid, even though, as he says, it should lead to the extinction of the present genus of medical men, only, however, ** to open hew and finer fields of work '' to their successors in the profession.
. He prophecies that the advance of the science of sani* tiettion will tend to *^ the disappearance of conditions inimieal to health ; " that the economic independence of women advocated by him, and her '' physical rehabilita- tion wUl result in untold benefits to the race ; " and that "the people generally " will be " no longer in the state of ignorance as to their own bodies that they seem formerly to have been," so that in the future the dootora may look' forward to being ** merely specialists and experts on subjects that everybody is supposed to be well grounded in."
< He goes oil' ib state that with which we must ^Xk agree, that sectarianism has been a great hindrance^ in the advance of medical science, and only too truly he savs, in a backward glance at the present century, *^ You mil scarcely need to be* reminded that ill your day medicine, next to theology, suffered most of , all branches- of knoiriedger from the benumbing influence of dogmatic schools.^ The influence of such bigotry being to dis- courage original thought and retard progress.; ' The '90th 'century curriculum indicated by him leaves. ' little to be' desired.
' nf ..li .. ^— W-^-i r- ►
*-M.'4 PROSTATI* HYPEMROPHt. ^?gSSL
rJulyi.
^ ^' There B.te really uo eohditionB to limit the ^nrse ol phyBicians. The medieal edueation is the-faSest poBJ «ible, but the methods of practice are left to the doctor -and patient."
' And may not we also look forward, in the 20th centoryv %6 the tard^ recognition by the world of the great w<^k 'done by the discoverer of a scientific law in' therapentiefl; tand hope for an adequate appreciation by succeeding generations of the benefits conferred on the human rao^ by SAMUfiB Hahnemann.
;notes on the. treatment op senile jiyperteophy of the prostate, with special reference to thk use of j^icrate of iron, ,
By DuDMT WwoHT^ F.R.e.S. Bng:
^.spiBtant-Snri^n and Smgeoa for DiMMes of tiie Thioftt and Earr to the London HomoBopathio 'Hospital.
-SdMB time ago I communicated to the British Hesnoeo- ^pathic Society* a paper on the treatment of ..senile ' hypertrophy of the prostate, and laid special stcess upcm
i;he valne of ferram picratam in relieving many of the ^symptoms produced by this disease^.. Further experienioe
has served to confirm in large measure the statements I ^made therein.
The use of this drug was first suggested to me son&e
yearb ago by Dr. Robert Oooper^ and since that tine I -have used it laxgely, and h&va reason to be very satisfied
with the result. t hate found it especially suitable in ^he eMly stage
of prostatic enlargement, that is to say, within the fi^
12 mc^ths or so of the commencement of symptoms* bi -ftust;'I bdlieve that if used during this period we n^ay be •«bie; in a large number of cases, to prevent, or at a^y 'Tate retard, the further progress of the disease* Ttie -symptoms which I have found to be more espedaiUy -relieved by it are, in the first place, increased frequency
of micturition during the nighti Patients often ^oomplitin thftt they must get up several times to relieve
— -— ^V^ f) HI * »' ■ '■
- -^VdnriMi^ ef UU Mriiish JECowMBopathic Societu*, voL iy^ p. 434, in whidh an abetraot of my pAper will he f oiuid, Jhe original oommnni- oatlon having been Itst *^ '
'their bladder, and tfana their night's rest is dutdrbel.
^QSrisBymptom is almost immediately ameliorated. Agaia,
' rectal eymptoms are very markedly rdieired.
' My experience ehows that this drug does not pn)d«4ie
^constipation, as do most of the iron compounds. lis
action is rather the reverse, and in early prostatic eiises
. with considerable striMning to mioturate^ mthr seeondary
. prdapse of the rectum^^it gives grsatrelieL HeBmorriiQids,
also, as a complication of enlarged prostate, broagkt
■ about in the same way as, and usually aeeompaoyi^g
cl^e.prolapse, are likewise benefited by its use* . - ^
A. certain amount of residual urine is .not a centra-
indication. In one.caae, ten-ounces remained after the
patient had passed ^ater, and under tbe administration
i of thisdrug, without any accessory treatment, this ampuBt
.was reduced within two months to two ounces. I^
^another case, in which two ounces of residual urine wave
.preaent, after four weeks' -treatment the bladder was
.completely emptie4 at each act. .
I have never been able to satisfy miyself that the prostate has become smaller under the treatment. This, \ however, may, I think, be considered a minor point, ^ long as the symptoms produced, especially the amount of residuUl urine, are relieved. , It is. not possible in aigr givto case to accurately, gauge the amount of enlarge- ment present, and -rectal examination, though- giving considerable knowledge of tlie size of the lateral lobes of the gland, gives no indicatioh of the degree of enlarge- mefiit of the so-called middle lobe, which oftentimes is the inapediment to completely emptying the bladder. . .
Another symptom which this drag relieves, and which
often accompanies the nocturnal frequency of mictti-
' lition, is the smarting smd burning felt at the! neck of
the bladder. ' I do not allude to the acute j)ain and
burning which is present in cystitis, for I have not foutfd
' thi§ relieved by itj nor to the milder attacks which
'-characterise the sub-acute or chronic prostatitis tt
^ yocmger subjects which, like the last, are scarcely ever
benefited, bt^t only to the soreness and burning which
elderly *' proetatics " complain of. In such a condition
* tlieuse of buchu In in alternation witli the picrato is^a
4tttinet advantage. I should add that Dr. Cooper
' lyielieves the latter Is inost useful in dark-liaired peopfe.
' Tllia^may^be so, but'lMn equally certain tfaiai it relieves
"416 PROSTATIC HYPBBTBOPHY. ^bS&
Bartow. J«l7X«
fair-haired ones also. The doe6 I have usaally emplbydl is the 2x dilution. Lately I have tried the 3x with almost as mach snccess, and Mr. James Johnstone, who has nsed it in his clinic at the hospital Miis me that he has seen aggravation after the administration of the 2k dilution.
I would refer for a moment to the pathology of the senile prostate, particularly to its bearings on treatment- It must be remembered that the enlargement may be due to increase of any of the elements of the gland. In the majority, an increase of the connective tissue is the most marked, but flbro-myomatous masses may be present, .or the ^landula^ element may preponderate. Were we able to differentiate these various forms during life, treatment would probably be more likely to be effectual. The analogy of the fibro-myomatous masses to similar tumours of the uterus is suggestive, and it' is possible that these would yield to such a drug as cale. iodid. which, as Dr. Neatby has shown, exerts & beneficial action on uterine myomata.
There is a form of prostatic hypertrophy which is limited to a great extent to the posterior part of the gland, the urethral portion being free. Here, as would be expected, obstruction is not a marked symptom, the bladder being always completely emptied ; but patients suffering from this form, complain much of increased frequency of micturition, dragging and aching in the permadum, and rectal tenesmus and hsBmorrhoids. In such cases, catheterism will give little or no relief, and it is here, I believe, that as in the other cases mentioned, the picrate of iron will be of signal service.
It is obvious that all cases^annot be fitting ones for
the use of this drug, and amongst the unsuitable ones
will be those where enormous hypertrophy of the prostate
with great dilatation of the bladder are present. La the
same category may be placed patients who have much
• cystitis, with offensive alkaline urine, though I have seen
much benefit accrue from its use after the bladder has
been put into a more healthy condition by long continued
:daily waidiing out of the decomposing urine. In two
1 such carses I have drained the bladder for a fortnight Gt
. so by inserting a perinsBal tube (Hanrison's) through Hbm
i prostate into the bladder, and by this means have been
SXS^S^rX^ MVIBW8. 417-
BMvw.Jvlyl.
able to wash oat thoroughly every part of the viBcoB and also give it complete resf.
I would say a few words conoeming other methods of treating hypertropbied prostates. Of castration for this condition I haT^ihad no experience, but I have removed a portion of (he vas deferens in three cases.
In one« an elderly clergyman, who had symptoms of 6tone in the bladder, but in whom examination by sound and cystoscope failed to reveal any calculus, there was enlargement of both lateral lobes, , but espi&ci^lly j the right, which was tender. There had been some bleeding from the prostate^ Ferrum pic. relieved, but did not get rid of all the symptoms, and as there was a considerable rectal prolapse and hsBmorrhoids I operated upon these, and at the same time removed an inch of the right vas^ Drs. Madden and Thomas assisting. Six months later, by rectal examination, the right lobe was found tb be the same size as the left, which was also smaller than before, and was no longer tender, and he had lost all his bladder, symptoms. The right testicle was softer, but not smaller than its fellow.
In the second and third cases I operated upon patients of long standing hypertroj)hy. In one of them I renioved an enormous 'Calculus from the bladder by the supra pubic operation, and found a large post-prostatie pouch, the prostate itself standing up above this like a tangerine orange. ' Section of. the vas on both sides made no difference to his power in expelling urine, and he was forced to continue to live a catheter lif^. In the other case, within 24 hours of the removal of an inch of the vas on both sides the urine could be passed naturally, but unfortunately . this good/result did not last over a fortnight, the flow becojuing more and more obstructed, until finally the catheter was in constant demand. As a matter of fact, I did not look for very much improve- ment in either of these last two cases, but in earlier ones I think removal of a portion of the vas will prove a useful form of treatment. • - ■ •
REVIEWS.
A I{ep0rtory to the CyclopcRdia of Drug Patkogenssy. By Dr.
BMniABD HtJOHES. Btft II. Loudou : E. Gould A Son. 1898.
Wb 'welcome the publication of the second fasciculus of
Dr. Hiigbes*8 B/spertory. ) It contains the index to the symp-
VdU42,No.7. 2 k
its MKETiKos. "lffi°ss?y^
toms of Eyes, Ears, Face and Stomacb, and we are sore it will be gratefolly received by idl wbo desire to make a foil and satisfactory use of tbe four volumes of the OyclopadiaJ Considering tbe labour needed, and tbe otber occupations of the learned author, we cannot expect a very rapid succession of tbe future parts of this work ; but we must have patience till Dr. Hughes can find time to complete what is an enormous task, and one burdened with more than ordinary responsibility, as this is not, like most. other repertories, a mere mecbaoiical arrangement of the symptoms of the Materia Medica, but also a critical sifting of the pathogeneses of Hahnemann and his disciples. It would be premature ta attempt a detailed review of the work. That must be reserved till its completion.
MEETINGS.
ANNUAL HOMOEOPATHIC CONGRESS.
The Annual Congress of Homoeopathic practitioners was held on Friday, June 8rd, at the London Homoeopathic Hospital, Great Ormond Street, W.C. The proceedings opened at ten o'clock, a.m., when there was a good attendance, including a few ladies. The President, Dr. Eubulus Williams, occupied the chair.
There were present: — ^Drs. Black-Noble, Geo. Black, E. Williams, Dyce-Brown, Arthur Clifton, Bur wood, Storrar, J. W. Hayward, Pope, H. NankiveU, W. Wolston, Newbery, Powjell, Stonham, Lough, MacNish, Hamilton, E. Capper, Geo. Clifton, Hawkes (Biamsgate), A. H. Croucher, J.P., Bennett, E. B. Boche, Stopford, Dudgeon, A. Kennedy, Benner, PuUar, Galley Blackley, Mr. Jas. Johnstone, Prs. Carfrae, Proctor, Madden, Murray Moore, Mr. Enox Shaw, Drs. Hughes, Pincott, Frank Shaw, P. Wilde, Purdom, Gilbert, Neatby, Bamsbotham, Y. Green, J. H. Clarke, Cooper, Hayle, Jagielski, Norman, Pritchard, W. Epps, A. S. Alexander, A* H« Croucher, Wilkinson, Goldsbrough, Nicholson, B. Moir, H. Bodman, W. Boche, Finky, Mr. D. Wright, Drs. Gould, Mason, Murray, Cash Beed, Searson, Bnrford, ShirtliiF, Day, Scott, . Hawkes (Liverpool), Young, J. Jones, Sanders, Lambert.
The President read his address on the Evolution of thir Science of Medicine, and $t its close
Dr. Dudgeon rose and said : I ask your permission, Mr. Presi- dent, to propose a hearty vote of thanks to yourself for the beautiful discourse you have given to the Congress. I am sure the running current of applause which attended it showed how highly it was appreciated by the Congress. (Hear, hear.)
ggSyj^gyaf'' MBTTINqg. 419
We«re all, as members of the Congress, very mach indebted to Dr. Eabulos Williams for having oome all the way from Bristol to enlighten us and to give us saoh words of wisdom, which I have no doabt have created a great impression. In ancient times wise men came oat of the East, but now we see the West can produce men who speak words of wisdom. (Laoghter and applause.) I need not say any more, bat I am sore I speak the feeling of this Congress when I say we are very much indebted to Dr. Eubulus Williams for his very learned, and interesting, and instructive discourse. (Applause.)
Dr. Clifton : I must also ask permission to second tixe vote of thanks. Sir Walter Besant has said that London is the home of poets, philosophers, scientists, men of letters of eveiy kind, members of the legal profession, and medical practi- tioners. Another gentleman present, the editor of one of our monthly periodicals, who never argues with ianyone (laughter^, tells us that London is the centre of civilization to which all the light and greatness of this country trend. Now, I think we have had an illustration of it largely this morning, and I have been delighted to listen to the paper by Dr. Eubulus Williams. It takes my thoughts back so many years — to the time when Dr. Rutherford Bussell dealt with the same, or with a similar subject, and well I remember his rasping voice and his hard-sounding *' B's." But this morning we have had a similar discourse, in a very much more harmonious voice. I remember also how much we enjoyed it — being taken back out of the every-day matter of fact in which we are con- tinually going on, and what is sometimes called the more practical. And it is well to be taken back, and see what man has done in the past, and how steji by step progress has been made. With great pleasure I thank you, Mr. President, for your admirable address. (Applause.)
The Vice-President called on the company to express their thanks by acclamation, and said how delighted he had been to hear the address.
After the applause had ceased,
The Pbesident said : I am very much obliged to you, ladies and gentlemen, and I am very glad it is over. (Laughter and applause.)
The next business was to receive the subscriptions, and the ladies of the company departed, the President saying he was very sorry to have to lose their presence. After the subscriptions had all been paid.
The PREsmENT said he had pleasure in calling on Dr. GLABiqE to read his paper on The Doctrine of Signatures.
The discussion was opened by
Dr. DunoEONjWhosaid they had all listened with great interest
2 B-3
^0 MEETCTOS. ""SS^^S^TX
to the admirable paper read by Dr. Clarke, and the instances he had given of the signatures as guides to the coratiye remedies in certain diseases. But he tiboaght in the past the doctrine of signatures had been a very great failure. ^ In old works a great man^ remedies had been prescribed in consequence of their signatures. The orchid plant — the name of which is Greek for testicle, was so called because of some fancied resemblauce the root bore to that organ of the human body, and it had often been employed for diseases of the testicle, and as an aphrodisiac, but he did not think with anj great success, in fihct, rather with invariable fiEdlure. Another plant, the phallus impudicus, whose likeness to the male sexual organ led to its employment as an aphrodisiac, waa equally a failure and had long been abandoned. With regard to euphrasia, or eyebr^ht^ he thought it required a vivid imagination to perceive in it any resemblance to the eye unless perhaps the marking on the petals might be considered to have some faint likeness to the markings on the iris of some eyes. The names it had received in different countries indicate medicinal qualities which he feared ihej did not find in practice. In English the name is eyebright* He did not think it had much effect in brightening the eye, that is to sav, improving the sight, although they knew from experience that it had a good e&ct in catarrhal conditions of the eye, and he had found it useful in a severe and obstinate case of rheumatic sclerotitis. Its name in French was e4Ms$e lunettesf which seemed to indicate that it has the power to improve the vision, and Milton makes the angel Michael apply to Adam's eye euphrasia and rue for the purpose of enabling him to see better. But he (Dr. DunexoN) did not think it possiessed that propertjr of improving the sight in caseiB of amblyopia or amaurosis. In German the name is perhaps more appropriate, it is Augentrostf meaning *< comfort for the eye," and certainly it gives comfort in some cases of catarrhal ophthalmic and conjunctivitis. Other remedies which had been employed in consequence of their signatures were, for inistance rubia tinctoria, and^rhatania for hamorrhage on accountof their red juice resembling blood. Bhatania might be considered a good remedy for some cases of haemorrhagey but be .siqiposed ihei allopaths would say that was in consequence of its styptic properties and not on account of its red juice. There was. another remedy recommended, but they had not found it successful for stone of the bladder or the kidneys, namely, saxifrage on account of its supposed power of breaking up the stones among which it grows, hence itsnmxie. Certamly it grows amongst stones and displaces them, but ir}»6tber it breaks them up or not he did not know. Then these vai9.tbe pulmonariai whose name is derived from
SSS^J^S^JSS?^ MEETIKGS; 421
ft fancied resemblance of the miarldngs on its leaves to those observed on 'the surfftoe of the healthy lung, henc0 it ma held to be good for pulmonary diseases. Aristotodhia was and is still held to be an antidote to snake bites. ' There are two species, the names/ of both of which indicate its snpposed power over snake bites. One is the a. anguicida, the other a. serpentaria. . The latter is considered useful in cases of snake bite in so many different countries that it is probable some sort of signature has led to its employment, but what that signature was he could not tell. On the whole, then, he thought the doctrine of signatures formed no basis for them to judge of the action of remedies. Provings accord- ing to Hahnemannic method and clinical experience are the oidy certain and reliable sources of their Materia Medica, and gmdes to the selection of the remedy.
Dr.'PBocTOB remarked that in common with the rest of the members he was bound to say that he listened with pleasure to Dr. darkens paper. (Hear, hear.) However, he did- not suppose they, could fEurlyr consider it advanced medicine, (likugbter). As Dr. Dudgeon had pointed out they had a criterion for the determination of the actual remedial properties of medicine bv the provings, a process which was as muqh in advance of the doctrine of signatures as the sinking of an artesian well was over the divining rod, (Hear, hear.^ The doctrine of signatures had, no doubt, presented itselt to all their minds at one time or another as being a matter of great interest. It has a certain poetic quality. about it, and wh&t scientific value there might be it was attempted to determine in the paper by Dr. Clarke and by other writers. There was a small literature on the subject. He remembered reading a French book on it which developed the doctrine of signatures very largely and it was very good reading — ^it extended the subject very much more fully than Dr. Clarke had done that morning. After aU, the impression left on one's mind is this, they had had the doctrine of signatures for hundreds of years. But even Dr. Clarke would not pin his faith on any strict indication presented by any plant from that doctrine until it was verified by provings on the healthy body, and finally they were obliged to fall back on the Hahnemann method. (Applause.) At the same time there was a speculative, poetic, and perhaps philo- sophic interest in regarding the subject from Dr. Clarke's point of view. They must admit that the whole world; and the universe as a universe, has a unity of structure and con- stitution, and there are principles of analogy running through all nature, which sometimes throw unexpected light in dark places. His impression was — and he threw it out for con- sideration— ^that where the lower animals, which are wonder- fully gifted in detecting the qualities of food and drugs, ind
422 MEETINGS. "^BliSKrfj
Julyl.
seem to haye a speeial knowledge of medicine of iheir own, whether they are not led by the appearance of plants, and by their smell and taste, to determine ^m their deep iniBtinotive perceptions what the properties of the drug or food may be — m point of fact he would take it that the doctrine of aigna- tores was really a guide to the lower animals for them to determine the properties of a thing, and he would limit the doctrine of signatures to their use. (Laughter and api^lanse.) There is a Welsh proverb that a goat on the mountain side knows more botany than a professor, and he supposed he might explain the fact in the way here suggested. He remembered reading some time ago an interesting article bearing on that point. The negroes, in travelling through the forests in Africa, sometimes come across new plants, bearing fruits of the properties of which tiiey know nothing. To test the quality of the fruit they give it to a monkey, and they mark its effect. If the monkey lives, all right ; if it dies, then they know what to expect. (Laughter.) He took it there were two systems of dru^ selection here applied. The monkey applies the doctrine of signatures as far as he knows how to, and sometimes makes a mistake; the negro applies the Hahnemann method and experiments on a healthy body — ^in his case the body of a monkey, which is near enough to ours for practical purposes. (Laughter.) You will remember that on one occasion, when Darwin's doctrine of the descent of man was being discussed, Lord Beaoonsfield said he was on the side of the angels. He (Dr. Proctor) in like manner would ask them in this question of drug selection were they on the side of the man or of the monkey ? (Laughter and applause)*
Dr. Dtob Bbown said he must acknowledge that he had been extremely interested in Dr. Clarke's paper. He did not think Dr. Clarke intended them to understand that he would use this doctrine of signatures as a method of choosing medi- cines, but really intended to point out the curious resemblance between certain plants and the diseases on which they act — as throwing an interesting light upon a doctrine which at one time had great vogue in the medical profession. Their pro- fession ha^ its gloomy and grim side, and they were all better for having a veil of poetry and romance thrown over it — especially during such a meeting as that — they were glad to get out of the more serious and sober rut of many of the papers. It was sometimes an interesting thing, after having discovered the uses of remedies by Hahnemann's provings on the healthy individual, that they should find that many of those provings do correspond with the old idea of the doctrine of signatures. It was an interesting, romantic, and poetic way of looking at the matter, and he considered it delightful
SS^J^yngg^ MEETINGS^ -m
to hm¥B it BO brongbt before ihem, and it threw a cnrioofl side* i^t on homoeopathy. (Applause.)
Dr. Pbsct Wilde said her confessed he did not know whether he was on the side of the man or the monkey Qaughter), but his expetienoe of the doctrine of signatures had oeen in trying to diflooyer the reason why drags which were regarded as valuable in former times, fell out of use. In reiftding h^ generally came to such a statement as, ** this drug was said to be good for so and so, but it has no sensible qualities to justify this opmion, and it is now properly discarded."* Again and again they would find the statement in the pharmacopoeias of the latter end of the last century. The one published about 1775 contained this statement frequently and in connection with one drag mentioned by Dr. OlAxie, the **Shepherd*s Purse " — ^he ^lieved, speaking from memory, that it was one of the remedies thrown out. The Homoeopathic school had testored many of these drugs into practice, their method of dis- covering the virtues of drugs, preventing them from following the mistakes of the allopathic school. He looked at this doc- trine as an evil one, and as being one which misled men to use drugs wrongly, and to discard good remedies, and therefore he would be very sorry if any pressure was brought to associate the doctrine of signatures with the doctrine of similars. He was, none the less, much interested in Dr. Clarke's paper. (Applause).
Ihr. GoLDSBBouoH said he never knew exactly whether to take Dr. Clarke seriously in such a paper as he had read« Dr. Clarke had suggested they should maintain a child-like spirit. He agreed they should, in keeping their minds open to the appreciation of the new facts, but he doubted if it was a good thing to enter into an appreciation of a child-like doctrine. It seemed to him that the doctrine of signatures was a relic of their mental childhood which, as the President had said that morning, had been manifested by some great men in the past. He (Dr. Ooldsbrough) supposed that originally the doctrine arose as an after-thought. The ancients had no rule or guiding principle in the selection of drugs; they* tried every drag they could to find out its properties. They found out many valuable properties, and aft^wards they discovered that a particular cbrug manifested
* The work referred to is the yew DlMpenncUory^ pablished in 1753. This work, after desoribins: the virtaes ascribed to Shepherd's Purse, as a zemedj for diarrhoea and hsemorrhage, says : '* The sensible qualities of Shepherd's purse, discover little foundation for either of these opinion^. It has no peroeptible heat, aoriaionj, pungency or astzin* genqy ; the taste is merely herbaceous, so as to sufficiently to warrant the epithet given this plant by Mr. Bay, Fatuum,'* Very similar oon- clusions were reached oy modem pharmacologists respecting hama- heldB when it was first introduced into allopathic practice.
.424 MEETIKflS, ^S^j;fjSy?ta£
almost the .appearance of the disease for which it h^pened to be good, and so an adnmbration of doctrine was. sn^^ested as the result of this observation* If that is not an evideDce pf a child-like doctrine he did not know what was I StiU,. there y^ something in it— (hear, hear)— bat it seemed to- Ihjm that any possible value of the doctrine rested on a diffiarent basis altogether. . It was a psychological value, and suggested questions as to how far colour sensations and sensations of shape are related to other biological facts — for example, ih» syipptoms of disease. Dr. Clarke had put them on a wrong n^ental track in bringing the doctrine forward as he had^done^ and if he thought they would gain anything practical from such a consideration of it he was grievously mistaken* The whole doctrine, as presented by him, was simply a relic of mental childhood. (Applause.)
Dr« MuBSAT Moose thanked Dr. Clarke for enlarging on the scope of our knowledge of drugs by a paper on drug signature*. Instead of treating it contemptuously, they ought to welcome practical hints and suggestions. Dr. Clarke had done good service for homoeopathy ; for he had added to our knowledge of provings by making provings himself. But as. to a /'doctrine" of signatures, he (Dr. Moore) did not consider it worthy of the name of a '* doctrine '* — it was rather , a JbundlC: of old traditions — and now by their clever, and ingenious friend it had been revived for the purpose of discussion only. He was glad the scope of tlie Congress could enlarge to that extent. He was glad to see that Dr. Cooper was present, they had carefully considered hia communication, and there were some ingenious hints, in it. They [were invited bv Dr. Cooper to use hydrangea, a drug pf which he .kneyr nothing ; and was particularly glad to leam something in .diabetes,. and why? because, accprdin^ to the doctrine of signatures it is one of the thirstiest ^plants In the world* ' (Laughter.) The ledum palustre, we findi according to the rule of signatures is an excellent traumatic, ]because it has spear-shaped leaves ! So they were land^ into various strange and almost superstitious noti9ns, which tney could not possibly use as the> basis of drug selection. But any practical hint ascertained of actual plants not at j>re8ent in Qur Pharmacopoeia, they all, as progressive homoeopaths, would welcome. They could not despise information which was true,, and therefore he welcomed it as a sort of experimental subject ; but if they took it as a basis to prescribe, thej would be led to treat cases of paralysis agitans with the aspen» (laughter) by the tincture of the aspen willow^ and neurasthenia by that of the sensitive plant. . Dr. CooPEB said, as his name had been mentioned in con- nection with the matter, he hoped they would allow him a few
minutes to enter into the ;8fibjeet. There was a fear tha^ the matter under discussion was likely to lead to a great deal of strong feeling, and it was one which was not calculated to.be argued out so wqII at a meeting like that as in ^e pages ^of^ the journals, and by articles over which they would be able to. ponder for a longer time and to which they could giye more attention. But as Dr. Clarke had brought it forward, he was glad to be present, and to. say anything he could in (X)nnection with the matter. In the first place, in considering a subject of the kind, they had to some extent to define their, real position in medicine, and then they had not simply to go back to the old doctrine of signatures, but they had to consider in what way they could bring the doptrin,<p into a condition of utility, so that it would harmonise, with tbeir position* 80 far as their position in medicine was conoemedy they would find, if they looked at the matter calmly and dispassionately, that there still remained a lot to be done. They had arrived at this conclusion : that symptoms oonsti* tuted not only the indication for the prescription of remedies, but afforded them an actual knowledge of the action of a drug» By good proviugs they know the qualities of a drug, and they had definite indications for the prescription of remedies. On that pUtform homoeopathy was built up. Therefore, when they had got a knowledge of the action of drugs — a knowledge derived from provings upon the healthy body — when they could prescribe for disease in consequence of the indications thereby evolved they were on a platform from which no one could dislodge them. And here comes a great point ; notwith- standing their scientific basis there were difficcdties in the way. They had now accumulated Buch an enormous number of symptoms, it was difficult to collect these symptoms and apply them in diseases. In the next place, they found it extremely difficult to make such experiments on the healthy body as are required, and as modern science demands. The mere defini- ti(si of ' the word Health W9S obstructing them. They must look out for every means of facilitating prescription for disease, and the question was could they get help from signatures ? He coi^tended they had great grounds for utilising what may be termed signatures — utilising knowledge .gained in other branches of : science, in . botany, in biology, in vegetable physiology, in regard to plant life, and he thought by utilising such knowledge tiiey could more readily prescribe for disease. The mfltter could be easily ridiculed and set aside, but when they came to deal with it practically they found many phases in oonnection with plant-life helping them to valuable indica- tions in relation with disease. Dr. Cooper went on to speak of the properties of calendula officinalis. He had been in the liabit of using calendula internally for several years, and had
4SL6 MEETINGS, ^'1SS!^^;^1^
worked out many phases of its action. He spoke of the splendid ouratiTe ofEeot of calendula in a case of spinal irrita- tion, and in which he was led to use the drug through watch- ing the habits of the plant itself. He stated that he had gained a great deal of knowledge from the matter of signlttnraiA Dr. Cooper said he wanted to point out thai this matter was not eosmned to medicme alone. In Professor Nowack's work on Meteorological and Telluric Forecasts, the whole thing is worked out in regard to the weather (<< Chair"), and by watching the special features of one particular shrub {aln^tu ^recatorim), Nowack was enabled to foretell the doming on of a storm and other irregularities of the atmosphere. ('' Chairi chair.")
Dr. Madden said he was sure they were all indebted to Dr. Clarke for haying thrown a Uctle playful light on to a serious meeting. Like Dr. Goldsbrough he did notieel quite certain whether Dr. Clarke intended them to take the paper alto- gether seriously, and he thought and hoped not. (Laughter.) For surely it was coming down two or three steps to adopt a method of choosing drugs so manifestedly uncertain, and only right in a few cases, instead of relying on the abso- lute certainty of provings. To be of any real use to them a method of selection shoidd be universal, but neither Dr. Clarke nor any one else could contend that the resemblances to dis- charges or to organs were in any way reliable as indication of the means to use them as a remedy. It would lead them to use a cauliflower to cure warts or epitheliomatous tumours ! Such a basis of choosing drugs he did not think Dr. Clarke or any one else would wish them to adopt. In some cases he could imagine it might be a very useful memoria techntea to enable them to remember that a drug has a certain resem- blance to a particular organ or discharge, and it would be useful in this way, but he could not imagine it being seriously considered. (Applause.)
Dr. Pritchabd said it was interesting to know what the members thought of the subject, and while he was listening to the paper and thinking of the extremely interesting subject, and some of the drugs having to do with medicine, he thought of a few others. They were millefolium and hamamelis, both used as styptics, and being of a deep red colour ; and gamboge, which has a colour extremely like the discharge in diarrhoea. (Laughter.) A few others also flashed acrosa his mind. He thought, instead of using the doctrine of signa- tures for the choosing of remedies it would be more usefhl if applied to the choosing of material for provings. It was provings they wanted. (Hear, hear.) They could not get on with the present provings only. (Applause.) He never saw any provings coming from this hospital— the only person who
f.^-iyi,
UKsaaas. 427
gftTo ihem provings was Dr. Clarke. We want provings of new dmgs, and old provings pushed on to a greater extent. He did not mean to detract from old provings, nor depart from the totality of the symptoms, bat thought the experi- ment ought to be pushed further — ^for instance, a swollen joint produced as well as pains ; albumin and casts in the urine as well as pain in the back ; a rise of temperature as well as headache, &c, ; sugar as well as thirstiness, &c. He did not in the least undervalue the surgery of the hospital, which, he said, he was proud of ; but thought that we look to the medi- cal side to lead the world and ultimately to give surgery the second place, and it will only do this by closely following the doctrines of our great master ; and if it does this, it need not be afraid that any tada of the old school will produce better results. And this is more apparent in that anv good results that the old school may boast of are produced by approxima- tion to our methods. Modem research only maikes the truth of our guiding law more and more manifest.
Dr. BocHE had one word in suggestion, that was, the greater includes the less.
Dr. Nankivell thought Dr. Clarke had given them an interesting paper and one which had certainly given rise to the most interesting and amusing discussion he ever heard at a Congress. The doctrine of signatures was a relic of medifeval medicine, and as such, was interesting, but he faQed to see what possible assistance it could be to them in practice. It struck him, indeed, that this special doctrine had never produced a sinffle curative remedy. He believed the doctrine of signatures had arisen in some such manner as this: euphrasia was called << eye bright" because it was known to be useful for eye disease and trouble, and not because it was a little blue flower. According to the signature doctrine it should only be useful in diseases of blue eyes!
Dr. Clabxe : I thought someone would ask that !
Dr. Nankivell : I do ask it, and perhaps you have an answer ready. If there was anything in the doctrine of signatures, he said, was it not a very curious thing indeed, that there should not be more than half a dozen instances of it? As a Congress he thought they should say that this interesting question should be relegated to the background and left there. (Applause.) He was rather glad it had been brought forward ; it had given them a pleasant morning, but he thought they would not be very desirous of having it up again. (Laughter and applause.)
. Dr. Hatwabd said he was very fond of amusement sometimes, but he did not think that Congress was ^e place for it, and if in the future they did without such amusement
428 MEETIN08. "S^^^S^nSS:
it would be much to the . credit of the Congress. He joined with the-.others in thanking Dr. Clarke for* the amosemeni and thepleasant morning, and so far as a <little amusement was concerned he was glad to occasionally have it, but he did think thqr should have something really serious at Congress. It might do very well at the monthly meetings, but not at Congress. (Applause.)
The Chaibman asked if anyone else wished to speak. With regard to the doctrine of signatures, he would like to suggest that if any one thing was tcJcen into that room, and all- the members were asked to give an idea of what it resembled, no two would say the same unless it was by previous colliision. (Applause.) '
Dr. Clarke was then called upon for his reply. He expressed himself as greatly obliged to the members for the kind way in which they had received his paper (applause), and he assured Drs. Goldsbrough and Madden that when he wrote it he was never more serious in his life. When Dr. Dyce Brown asked him to write the paper several months ago he just thought for half a minute to see if there was any subject he could take, that would *'make their flesh creep," and within thirty seconds he thought he had one and gave the promise. At the same time he never wrote a paper unless be had something to say and believed it too ; and he adhered to all he had said that morning. In the first place, the whole doctrine of signatures was of course a verv crude affair, and he was not prepared to prove whether the doctrine was evolved as an after-thought, or whether it arrived first hand ; but he did not see, because they had now more advanced methods of dealing with things, that there was any reason to suppose that there was not some truth in it, and why they should not bring to bear their advanced methods in exploiting the doctrine for what it is worth. He did not want to exploit it for more than it is worth, but they ought to get out of it all the good there was in it. There was one reason why the doctrine did not come to a more successful development in olden times, and that was, that before Hsdinemann appeared no one knew how to give drugs. It was Hahnemann^ finding out how medicinal action might be brought about by intangible quantities of substances, that a number of old medicines had been brought back into ^e Materia Medica, — brought back by homoeopathy, and he (Dr. Clarke) thought homoeopathy would be the means of rehabilitating the, old doctrine. It would be found that there were a number of indications which might be traced to signatures. He could name hundreds, but he only indicated what he thought were sufficient. (Applause.) '
SSU^^Srai?^ mbbtihos. 42»
' At 12.85 the Congress adjourned to the Holbom BeBtaorttnt; where they were eniertftioed at luncheon in the Piscatorial Chamber by the members residing in London and the suhnrbs*. At the oondnsion of the repasty the Chaibm an proposed hearty thanks to the London members for the very kind and liberal entertainment they had provided.
Dr* PoPB said he had great pleasure in seconding, and he was sure they were all greatly indebted to them for ttie sumptuous luncheon. ^Applause.) i
Dr. Dtoe Bbown, on o^alf of his colleagues of London and district, said it gave them much pleasure to see the Congress in London, and to entertain them there, f Applause.)
The members re-assembled at two o*c1ock, and the minutes of the last Congress were read by Dr. Dyoe Brown and CQofirmed by unanimous consent.
Dr. Dtcb Bbown then stated that they had amongst them a gentleman from the United States. They genenJly had the pleasure of the company of several members of the probssion from the States, and they were always delighted to see. them. The more frequently they came the more hearty a weleome they would ' receive. (Applause.) That day Dr. Goldsmith, of Cincinnati, Ohio, was with them, and would be their guest at the dinner in the evening. (Applause.)
Letters of apology had been received from Dr. Arthur Boberts, who wrote, *< Deeply sorry I cantfot :be with you.*' Dr. Oibbs Blake wrote regretting that he was unable .to attend, and Dr. Douglas Moir, of Manchester, regretted that he was unable to leave that city.
The PsBsmsirr : The next business is to choose the place for next year's Congress. Has any one any proposal to make as to our destination ?
Dr. CuFTON : I would like to propose Leicester. (Applause.) It is a, very convenient centre, easily reached from east, westv north and south. You will have a very hearty reeeptioui and I thmk it likdy that you will meet with some of the more orthodox members of the profession. (Laughter.) We like to get ihem if we can. (Hear, hear.) )
' Dr. PowBLL seconded.
Dr. Qeoboe Cuftoh said, as one of the representatively of the homoeopathic profession in Leicester, • he strongly recom- mended them to go to that town. His colleagues would only be too delighted to assist him in giving the Congress a hearty welcome. By next year they woujd have four lines of nulway running into the town from all parts of the united worid, he might say— (a voice : Universe). Yes, Universe! (Laughter). If tb^ went to Leicester the homoeopaths there would be vety pleased, to see them* If possible, he would like tfaftt the Congress should be somewhat like it was at Bristol. Un-
foitnnately, he did not get there last year ; but if they could make it a two days' Congress, by going on the Thursday and extending it over the Friday, the friends at Leicester would be delighted to show them some of the lovely scenery of the Midland counties— Ghamwood Forest, etc. It is very interest- ing country, and people fond of geology would find plenty to interest them. There is also a great deal of architectural beauty, and many of his friends connected with architectural societies would be only too delighted to show them round.
Dr. Mason : I can only second the invitation. We shall be exceedingly pleased to see you.
Dr. Clifton remarked that last time the Congress went to Leicester some of the members could hardly get accommoda- tion, but during the last three or four years several new hotels had been built — ^Dr. Bubwood : SmsJl-pox, I suppose) — and they would be easily accommodated now.
The Pbssident : As there is no other place proposed it is, of course, carried unanimously. (Applause.) The next busi- ness is the election of President.
Dr. Clifton : Before we elect the President, would it not be wise to decide the date, or do we decide it afterwards ?
Dr. Dtce Bbown : It is regularly fixed to be the Thursday of the third week in September, except when in London, as to-day.
Dr. Clifton : I believe June or July would suit.
Dr. Dtce Brown said the date, according to the rule, would be the 15th September, as the 1st of September was a Thurs- day. They could not alter the rule except by vote in Congress.
Dr. Clifton : I think it would be wise to alter th^ rule, if we have power, now. If gentlemen have all been for their holidays and got back into full swing, they feel they cannot leave home, but after a hard winter's work, at the latter end of May or the beginning of June, we feel that a couple of days in the country would do us good (hear, hear), and I think it would be much wiser, and would suit the members better.
'Dr. Dtce Brown : As secretary, I should like to inform you that the matter was amply discussed for a long time, and some members spoke for the middle of the year, as you do now, but others expressed their opinion, and it was almost an unanimous opinion, and considering the interests of all firom the north and the south, and it was decided that the best time of the year, and die one which suited the holidays, was the third week in September. It was fully discussed, and it seems a pity to re-open the question. I may say, for myself, it would not be convenient in June — quite the contrary. But the third week in September is about the slackest time in the whole year. In certain places it may be a busy time, but we cannot arrange just to suit a single place ; we must look te
sagfj^grsr meetings. m
thfi general oonTeiiience. We found September wa^ the time of {he year which should be fixed, except when Congress meets in London. For myself, I shall oppose the re-opening of the question.
Dr. OoLnsBBOuoH pointed oat that the third Thursday in September next year is the 2l8t.
Jbr. Dtce Bbowm : Oh yes, I beg your pardon, I was looking at the wrong calendar.
Dr. GuFTON proposed that Congress meet next year in the first or second week in June.
Dr. Hatwabd seconded. I think, he said, it is a good opportunity to express our opinion and take exception tp the rule. We come to London in Juno, and seeing we have such a hearty and unanimous invitation we should take into consideration the wishes of our prospective hosts. There is no necessity to discuss the question if the President would put it to the vote to see if the majority would like June or September.
Dr. Maddsn : Is it worth while ? June is the middle of tb» London season, and the majority of the London members could not come away.
The PBxsmENT : Will anyone make a proposition that the rule be altered.
Dr. Clifton: I must make that proposition, taking all things into consideration. Li the third week in September the nights are cold and the days short, and coming into the country will not benefit you so much. For the good pf all I move that the rule be amended, and that June be this year the date of the Congress. Dr. Hatwabd : And I have pleasure in seconding that. Dr. Dtos Bbown : I move that the rule remain as it is. Dr. Pbootob : I venture to suggest that as we are indebted to the London contingent we ought to consider their feelings in this matter. I think it is a serious tiling to do — to re-open a question well considered and already decided upon. The Cooigress can always take its own power into its own hands, but I venture, to suggest on behalf of our London member^ that we bow to them and let that rule remain.
Dr. Mom said he was willing to support the resolution before the meeting.
Dr. Dtce Bbown : I find my amendment was the direct negative, and it is not necessary to put it — just simply the proposition and the alteration of the rule. The voting was in favour of the alteration by 30 to 6. It was then decided that the Congress be held in the second week in June next year. The election of President was carried out by ballot. The President said he. was glad to announce the result of
483 meetings; ^'nSS^j^^^mm
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the biiiliol. Dr. Byres Moir had been elected' bj a large majdritjr. • • • '
' Dr. Btbes Mont : I can only thank yon for the hononr you have done me, and express the hope that the next Congress tnll be a great success, which, as Dr. Clifton has put itforward, is sure to be the case. (Applause.)
Dr. Dtcb Bbown: 1 beg to propose as Vice-President Dr. Clifton, of Leicester. (Hear, hear.) It is our usual oustdm, having chosen the President, to select as Vice-Preddent the leading gentleman in the town in which Congress will' next meet, and it goes without saying who that is.' (Applause.^
Dr. BtTBFOBD : I have the greatest pleasure' in seconding that. It would be impossible to have a better Vice-President thttn Dr. Clifton, and when I further reveal a 'secret-^(crieA of "No,") — ^you don't know what I am going to say (Dr< Bur* wood : Yes we do,) — ^well, I will keep it a secret, but we could not make a better choice. (Applause.)
Dr. Geo. Cliftom: I am very. much obliged tathe company: (Laughter, and a voice, " Il's not been put yet*! *') - ..
The vote was unanimous.
Dr. Mont proposed Dr. Mason as local secretary. Dr. I>yoe Brown secionded, and the motion was carried ne9n, am*
The PsssroENT moved that the Secretary and Treasurer be continued as at present.
' Dr. Hughes seconded, and asked the meeting to cany it by acclatnation.
Dr. Dtcb Bbown promised to do his best in the future as in the past.
Th, Madden ^Treasurer) hoped his ** doctrine of signatures'* would be equal to all requirementSi and pointed signifioantly to the cheque book, amid laughter.
The next business was the appointment of the Council.
The President moved that the Council be the same — offioifdly and in this case personally — as at present.
This was agreed to. < Dr. Dtoe Bbown said it only remained to take *' any other
business " which members had to bring forward.
i Fedbbation of Hospitals. :
Dr. BuBFOBD said it would be interesting to the members of the Congress to know what had beeii done with regard to the iebeme for the federation of homoeopathic hoepitak. He was glad to say considerable headway had been made. Bwontly tiiey held a well*attended meetings at which were' many representatives of homoeopathic hosjntals, and an executive committee was appointed to present an interim repdrt at a specially called meetiiig. The first thing it id proposed to do is to make a preliminary visitation to every British hbmoeo-
pftihic hospital, so that it may be known how they can be best helped, and each hospital wonld be able to. suggest how to help to carry oat the soheme. Afterwards a meeting will be called, and a well-planned soheme drawn up. To the officers and committee it had been a matter of pleasure to obserye the unity and enthusiasm with which the suggestions had been received, and they hoped the most unbounded good would result as the final issue of their labours. (Applause.)
After the conclusion of the foregoing business, the President called upon Dr. Bubwood to read his paper entitled Barometrical Presmre as a Factor in Medicine, We hope to present this paper to our readers, together with the discussion which followed, in the next issue.
Dr. WnuBLiMsoK then read his paper entitled Associated Symptoms^ which was followed by a discussion, which will appear in our August number.
The meeting then closed.
Ths Gomorxss Dinnsb.
At seven o'clock the members of the Ck>ngress, with their friends, dined in the Venetian chamber of the Holbom Bestanrant. Grace having been said by the Bev. H. W. Hall, of St. Anne's Church, Grantham, and at the conclusion of dinner sung by the Celia Quartette —
The PuBsmENT proposed the health of the '< Queen and the Boyal Family,'* and remarked that all knew how ready the members of that feunily are at any time to sacrifice themselves for the benefit of any national cause. (Applause.)
The toast was received with musical honours.
The PuBsmsNT : The next toast is that of '* The Memory of Hahnemann." It is usual for the Chairman, it seems, to propose this, but I cannot make a speech, therefore I simply ask you to drink to the " Memory of Hahnemann."
The toast was drunk in silence.
Dr. Pope was next called upon, and said that having rendered honour to the memory of the greatest therapeutist of the century, one whose name, as Sir John Forbes said, " would be recognised by posterity as the exclusive excogitator and founder of an original system of medicine — destined probably in the remote if not immediate future to have a greater influence upon the Art of Healing than any promulgated since the days of Galen " — Shaving done this, it was most proper that they should drink heartily the toast he was called upon to propose, *'The Progress of Homceopathy," the progress of that therapeutic doctrine which is the basis of that original system. The apprecia- tion of the value and importance of homceopatby has bcfen in progress ever since the time when Hahnemann
Vol. 42, No. 7. 2 F
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first wrote the paper in HnfiBland's Journal^ in 1796, in whioh he defined it. To them, as members of that Congress who have daily experience of its yalae in the selection of remedies for the treatment of disease, to them the progress might seem to have been slow. But he would have them reflect (1) on the great difficulties which necessarily surrounded the introduction of a new therapeutic doctrine into the practice of medicine, (2) the enormous hindrances which Hahnemann's doctrine had had to encounter. There had been no true discussion of homceo- paihy from the first. When the question was introduced, ii was not the doctrine which was assailed. Hufeland — at onoe Hahnemann's admirer, friend, and bitter opponent — Shaving admitted that the principles enumerated by Hahnemann might doubtless serve to guide us to the discovery of uaefdl remedies, protested against his methods, because of what he termed tiie neglect of venesection, which he said nothing could replace, and for the neglect of which nothing could atone. And again, when it was discussed at the meeting of the London Medical Society in 1886, the first time it ever was discussed by a London Medical Society, and again two or thipee days later at Westminster — ^the last time that a paper was read before a non-Homoeopathic Medical Society — and discussed by Dr. Uwins and two or three more who had had real experience of the doctrine, and when it was stated at that meeting that aconite would be found sufficient to meet all the conditions under which blood letting w»s supposed to be required, Dr. Cluttsbbuck said it was something shocking to hear of an old and respected member of the society looking forward to the time when lancets would rust in their cases, and aconite be used instead. He moved a resolution that homoeopathy was unworthy of the consideration of that Society, and that it should never be mooted again, and that was the last time it was ever discussed in such a sodety by a person competent to lay the subject before the assembly. Again, in the journals discussion had been burked, and no opportunity had been given for anyone to bring the subject forward ; then the progress df Homoeopathy had been handicapped by a professional and social ostracism, which had rendered it essential that those who having had their attention accidentally drawn to it, and had adopted it, should be animated by that virile virtue — ^manhood, which Lord Bosebery, in his eloquent speech in the House of Lords that day fortnight, described as comprehending ** courage, righteous daring, and disdain of the odds we may have against us." There were very few men anywhere ,who could be said to disdain the odds against them, more especially when those odds resolved themselves into a risk of the means of livelihood. This had been another of
iEIS2I^jS?HB2!^ mbbtinos. 486
Beviair, Jvly 1,
ihe great hindranoes which homceopathiBta had had to «icDimter* Then again, all men, or at any rate a great many men were ready to ^ve a good deal for a quiet life, and there are plenty of people whose motto is ** anything for a quiet life.*' In illnstration of this, I would repeat what I said in the oonrse of an address I had the honour of delivering before the American Institute of Homoeopathy in 1879. On that occasion I said : *' The majority of the medical profession are simply and solely practitioners of an art, they go through their dttiy round, prescribe for and treat their patients as they have been taught to do ; they have little time for study, and so long as their patients get well) or are relieyed, in about the same pro- portion as those of their neighbours they are perfectly satisfied, and accept without question all that their fATourite periodical teaches tibem. It is because they have done so, that they have long since come to the conclusion that Homceopathy is a fiulure, or worse I They have made no enquiry into homoeopathic therapeutics, and being fully occupied, they have accepted the assurance, made by their favourite periodicals,that homoeopathy is no good." Under these conations, was it much to be wondered at that progress was not rapid ? On the other hand, was it not to be wondered at that the progress had been so rapid ae it had been.* Again, much as had been done honestly and honourably to promote the progress of homoeo- pathy, was it not, alas! too true that their efforts had to some extent been frustrated by some whose names had been associated with it — men who are known in the United States as '' cranks." Dr. Oatchell, on one occasion in the Medical Era of Chicago, wrote : '' In our profession there is no more pestiferous crank than the man who tries to load down homoeopathy with a lot of rubbish which belongs to it about as much as a barnacle belongs to a ship.*' He illustrated this with a reference to a man whom he had seen, and who had a delicate little vial nicely fitted with a wax cork, and labelled sol. And what did they think, he adds, was in it ? why, a lot of globules supposed to have been medicated with potentised sunsUne. (Laughter). It seemed difficult to understand how any man could regard such obvious nonsense as that as justifying him in refusing to enquire into a therapeutic doctrine which is supported by many thousands of mediciU men in all parts of the world, and has been so for a century. And yet the fact remains that it has that effect, and that it prevents an enquiry which is essential to the progress of homoeopathy. Dr. Lander Brunton, in his book on the Action of Medicines^ published last year, states that tvfaen he was a student, and that must be between thirty or forty years ago — thinking that homoeopaths were badly
2 p— 2
436 MEETINGS. "S«S:=JSS«S!
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treated, he proposed, to read a paper at a Students* Medical Society in defence of Hahnemann's doctrine. • In order to prepare himself for this work he read np what he called a homoeopathic text book. He does not give the titleof the bookoF mention anything more about it, and what he states he states from memory. He goes on to say that in the course of his reading he came across a section dealing with the treatment of stiU'bom children, and quotes the following passage : — « Take a small vial of some tincture — he forgot the name, and put four drops into a glass of water, l^en put four drops of this mixture on the child's tongue every five minutes until it recovers.*' (Laughter). " Well," he says, '* I thought one might go on ad infinitum with this, so I stopped writing my defence of homoeopathy." Whatever he intended, the conclusion Dr. Brunton evidently came to, was thai homoeopaths in general supposed that they could raise the dead I (Laughter). What the book was, Dr. Pope could not say, but he would like the opportunity of seeing it for the Bi^e of verifying the quotation. Notwithstanding that it preyented Dr. Brunton from writing a defence of homoeopathy, it did not, fortunately for his patients, prevent him from adopting homoeopathy into his practice, for three or four pages before the still-bom business he gives an illustration of how disease shpuld be treated. He speaks of a particular form of diarrhoea, one to which arsenic is peculiarly and notoriously homoeopathic, and he says — '^ The best remedy you could, use under these conditions is half-a-drop or a drop of ^t^. arsenic- aliif,'* This is a teaching of homoeopathy, and thus practically defends it. (Hear, hear.) Notwithstanding the closing of the doors of medical societies and medical journals to all discussion of homoeopathy, the closing of their advertising columns to all books regarding it «nd all appointments in homoeopathic hospitals and d^pensaries, notwithstanding the barricading of all avenues of professional advancement^ homoeopathy has progressed in professional appreciation and popular esteem. This progress had not. been in the way they would have wished to see it, but it had been m the way that he for many years had believed that the first steps would be taken — ^in an empirical rather than a scientific way. Medicines have been adopted as the outcome of some one's personal experience — some one whose experience was directed by homoeopathy, and they have been found to be useful in such and such cases without any reason being assigned why they could be expected to be so. This year the British Medical Journal^ had given evidence in its correspondence columns of the value which some ol the more intelligent general practitioners of the country attach to the practical results of homoeopathy as set
SSSJ^MTrS^ MEETINGS. 437
foirih in Dr. Hagbes' Priarmaeodynamies. (Applause.) This 18 evidence of the progress homceopathj has made among members of the profession. It was, he believed, the^ first occasion on which letters of the type of the three signed *'An Open-Minded General Practitioner/' "A Member," and "M.D.," which appeared in the Britisli Medical Journal for January and Febmary last, have ever appeared in the journal of the British Mc^cmU Association. But they all knew that supply follows demand, and the fact ttat these letters appeared convinced him that the editor had abundant reason to know that there was a demand for therapeutic information of the homoeopathic type, and consequently he felt bound to insert them. (Applause.) Then another indication of the progress of homoeopathy is to be found in the fact of Mr. Jessop's letter, inserted in the British Medical Journal for December, in which he asks for liie opinion of some of the leading members of the profession as to the question whether it was right that non-homoeopathic practitioners should meet with homoeopaths in consultation ; to which there was not one single response from a leading member. The only replies asserting that no such consultation should take place were from men of small consideration. The fact was there was no demand for the idea Mr. Jessop assumed to exist, and therefore, as a consequence, no supply was forthcoming. (Hear, hear.) This was the way that homoeopathy would progress — there would be no sudden revulsion, no great reaction in accepting the therapeutic principles they entertained. For the position to which homoeopathy had already been brought in this country they were indebted to no one man, but to many minds, to Bnany means. (Applause.) But if there were one man more than another or one liook more than another that had tended towards this result, he had no hesitation in saying that the man was Dr. Hughes, and the book his Phannaco- dynamics. (Applause.) It was in no spirit of depreciation, but with a true conception of their position and that of the profession at large, that Constantine Hering described Dr. Hughes' valuable ho6\s. as <' milk for allopathic babes *' and uncommonly good milk it is I (Hear hear.) He had no hesitation in saying that it was by the aid of such works that homoeopathy would advance amongst the general body of the profession. (Hear hear.) They were all anxious that homoeopathy should progress. Let them, then, strenuously exert themselves to support the various means to that end which they already possessed — their journals, their societies, their hospitals— let them strive to practise homoeopathy with that degree of scientific accuracy which would enable them to cure fti^ase more frequently and better than formerly, and by so
^8^ MEBTIH08. "Ig^^yg^
doing to inflaenoe the minds of their professional brethren in their immediate neighbourhood, and so impress the value of homoeopathy upon tihose gentlemen at present known to them as << Our friends the enemy." (Loud applause.) ' Dr. Pkbot Wuj>b, whose name was coupled with the toast» said there was one thing upon which those interested in the progress of homoeopathy could congratulate themselves, and. that was that Dr. Pope was present on that oeoaBioii — (applause) — and that they had been able to listen to has- masterly address upon the past history of homoeopathy. At the last Congress they were aU disappointed because Dr. Pope could not attend — ^they learned he was prevented through illness, and there was no one whose sympathies did not go out and hope that he would soon recover. (Hear, hear.) In' speaking of the progress of homoeopathy, Dr. Pope had spoken with that lucidity which they might expect from one who had always been in the front rank of homoeopathy, who had fought for it, and never at any moment shrank from sacrificing time and energy to the cause. (Applause.) And then as to the progress of homoeopathy. So far as he knew the homoeopathic school, at the present time it is the only body of practitioners who recognise that that thero is a science of medicine, and thereforo homoeopathy is for progress in medicine. It is left to tiiat school to place medicine on a scientific basis. (Hear hear.) By a peculiar irony of fi&te it was left to them as homoeopaths to sustain the honour of the medical profession. Thehomoeopathshadrotained- the old-fashioned principles, and they had never drawn the line between the duty of a gentleman, and that of a doctor. That line had been drawn by the members of the British Medical Association, and the result had turned upon them^ because when they have brought a system of ethics beforo the public, and when they have had discussion it has only brought disrepute on the members of the profession. The work before them in connection with the progress of homoeopathy is one which they have taken very seriously in hand. In the first place they thought they might so remodel their hospitals as to meet entirely the needs of the public. Now, it was much more difficult to found a hospital than a dispensary. The hospital question was a big one with the profession and public, and many efforts had been made to solve it. He thought the question arose in this way. Their hospitals were originally founded to meet the needs of the destitute poor, and were practically on the same lines as the poor law infirmaries. But owing to the success of the hospitol treat- ment and nursing, a large proportion of the people wonld rather, in times of sickness, go into the hospital than remain at home. The hospital question had arisen from the hd that.
ggyj^TirSa^ MBETINQ8, 489
thwe were people who wanted to enter the hoepital, but not aa reeipients of charity, and the proper Bolation of the question was to consider them as pnblio institntions, and adapt them to the needs and requirements of the public* This could be done by erecting hospitak in small towns to include any real poor, and the intermediaie classes who stand more in need of hospital treatment than any other classes. If that were done the hospital could be made practically self-supporting, and that would save the medical stadBT and others a great deal of worry and anxiety. Having established a hospital he believed they could carry out the policy of their therapeutic school and throw the paying wards open to all medical men. This had been adopted at the hospital at St. Leonards and at Bath, and had been found to work well. In that way they could show they were not a sectarian body, as they never had been. They simply claimed that the dierapeutic school has a place in medicine, and that there should be Uberty in opinion for the practitioners and for the public. By adopting the policy he had sketched out they would be settling a ^otty point and making the public understand the difference between their position and that of the narrow-minded policy of the rest of the profession. He had had a good deal to do in different ways with members of the "orthodox" profession, and he believed the ranks are not so solid or that the opposition to homcBopathy is not so great as many supposed. If they could only convince them that their interests would not suffer by adopting homcBopathy, he believed the difficulty would soon disappear. (Hear, hear.) In speaking of the progress of homoeopathy they should bear in mind the names of Pope, Dudgeon, Hughes, Dyce Brown, and many others he nmd not mention at that assembly. (Applause.)
Dr. BuBwooD said though that was an assembly of homoeo- pathic doctors he thoaght for once in a way they should desert their their colours and give an aUopatUo dose of welcome to their guests. (Applause.) It would be more in aocordanee with their feelmgs than a homoeopathic or infinitedmal one. He was exceedingly pleased to see so many visitors, and in sympathy with them they surely were, being at that gathering. They must have been patients, and if not already their patients, he was sure he hoped they might be, and if they were not but might be, he hoped when they were, they would do their very best to say as much as they could in praise of homoeopathy. For it is by homoeopathic patients that homoeopathy is to be pushed, not so much by the doctors themselves, but by the patients, who publish abroad all tiley know about it. (Applause.) He saw some before him whose names were as household words among homoeopaths, and who I taking a lively and intelligent interest in it. He hoped
440 MBETiNfls. "g^"3s;rj£
Bi&nom, Jvly 1, IflKw
they: would live long ta be homcBopaihs. (Applause.) Among tfaetu he saw Mr. Stilwell (i^pplause), Who had had their hos- pital in Great Ormond Street under his care far isaiiy years. Be was sure they would all drink Mr. StilweH's health, and he proposed that they do so. (Applaase).
Mr. Stilwbll returned thanks to the dootors for the manner in which they )bad drunk the health of the visitors. The hospital had be^ Mentioned by a previous speaker, and he could assure them that they were all striving for progress in that hospital. (Hdar, hear.) He was not- there that evening to defend the hospital, but he must express his thanks for the kindly mention and for expression of his feeUng that it should be borne in mind by all homoeopaths, and, as Dr. Burwood had said, by the patients. There was no doubt the hospital was the centre of interest for every medical man who is a homoaopath, and perhaps he might say for those who were not homoeopaths, but who sometimes stole their clothes. (Laughter.) ** We do not grudge them what they steal,*' he said, *< for it does us no harm and it might do their patients good, if they do not poison them with an allo- pathic dose of remedies we know so well how to employ." (Laughter.) Proceeding, Mr. Stilwell said he was adced by his neighbour, Dr. Goldsmith, of Cincinnati, to thank the company in his name, as the only representative of America in that room. . From what Dr. Goldsmith had told him he was sure homoeopathy was making steiBdy and real progress oa* the other side of the Atlantic, not only among the popu- lace, but also^mong members of the profession. Men's minds were being opeqad to the study of the principles of homoeo- pathy, and to the benefit which those who use it receive. He was very glad to hear that. He believed he had mentioned before that where there is one homoeopathic hos^tal in England there may be a hundred in America, and he under- stood tbat there were 11,000 practitioners in that vast country. That did not, he considered, put us to shame, because they all knew the difficulties under which we laboured here. They had no regular school as had the allopaths, and their teaching was conducted at hospitals by lecturers wha kindly give their services and energy for the dissemination of the doctrines. It was a very hopeful sign for the future of the art of healing according to Hahnemann. (Applause.) Before he left the subject of America he would say that from the eon* versation he had had with Dr. Goldsmith he had gleaned that there was a very strong feeling of sympathy between the* two English speaking races. (Applause.) He had always thought that to be the case — ^now he was sure of it. (Renewed applause.) lliere was nothing gave him more pleasure than to think that in the great hereafter England and Ameriea
would join hands across the ocean and contend together with diffionikes at home and abroad. (Applause.) Very mnch did he again thank them for the honour they had done him, as the t^resentatiye of the hospital, and for the kind way in which they had drank the health of the ladies and gentlemen who were the visitors. (Applause.) There were loud cries for " Ooldsmith " and a <' speech." Dr. Ooi:j>sBaTH, rising amid acclamation, said he had not expected to have to do anything more than sit in silence at that banquet. When a man ^d nothing to say, it was always best for him to stick to his text and say it. (Laughter.) He was in that fix now, except for one thing. Oertainly he wished to express his gratitude for the kind hospitalify which. they had offered him. Ooming such a long distance across the water, and being alone, it was pleasant to be so hospitably received and so cordially welcomed. The reference Mr. Stilwell had made to the feeling across the water was quite. true. (Applause.^ The step Chreat Britain took at the outburst of the war oetween the United States and Spain in declaring coal a contraband of war, and showing practical sympathy, gave America hope and settled the question, and did more to increase the brotherly feeling amongst] the people than anything else since the War of Independence. He knew the feeling would grow, and that the people would feel they are not two separate nations, but two branches of one great nation. (Applause.) Speaking wiUi reference to the homoeopathic school of medicine, Dr. Ooldsmith said they had privileges in America which were not enjoyed in England. He did not realise until that evening one difficulty they had always laboured under, and that was they had only one place, one way, in which they could learn or teach the theory of homoeopathy as the science of therapeutics. In America they had their medical colleges, and it was a great advantage to have lectures on the philosophy of homoeopathy, and this supplemented 4he work of teaching the homoeopathic Materia Medioa. They endeavoured to teach so that the students should go oat thorough homoeopaths, and know why they are homoeopaths, and could readily give a reanon for their fedth, and who are ready to study homoeopathy and materia mediea in.BUch a way that homoeopathy could be honourable and pn^ierly carried on. (Applause.) Homoeopathy was per moating the allopathic schools. Biecently he bought a book by Dr. Samuel Potter and he could turn to page after pa&;e all through that book in suggestive therapeutics which would prove this statement. All this made their work the lighter. In conclusion he merely repeated what he said before and tby^Vtt^ them very much, and in the name of those who
442 MEETINGS. "^^f^^ifuM?
wished they were present he wonld express the hope that some day they would be able to reciprocate. (Applause.) . Dr. Bahsbotham rose to propose tine next toast, that of the President. He said: — Ladies and Gentlemen, — I feel some difficulty in following the speakers who have gone beforet inasmuch as they have been able to shield themselves from criticism behind ttie personality of your president. This I am unable to do, and therefore I crave your indulgenoeinaddressing you directly. But in using that fiction of courtesy and addressing you through the chairman the speakers placed tiiemselves under his direct authority and control, from which I am glad to be emancipated, for in what I have to say I must unavoidably make remarks personal to our president, and I am therefore glad that he should be unable to stop me. The toast I have to propose to you is the health of our president (applause), a toast which is sure of your acceptance whether I can commend it to you or not. We listened with great interest to the president's address this morning, an address covering a very large field of survey and thought, expressed with a brief directness. He described to us what is evidently the evolution of medicine, and as he did so, it was impossible for us not to connect it with the evolution of our own particular department of medical science-— the evolution of homoeopathy. Dr. Eubulus Wilson is directly associated with the earlier traditions of homoeopathy^ traditions from which it would be well for us not to retn^ct or to derogate, still less to desert. (Applause.) The esteem in which he is held by what I may call outsiders is evidenced by the appointment that he has so long held, as physician ta Miiller's Orphanages, a position which gives him great advan- tages in dealing with one. department of our wodi — the study of epidemics — and in enabling him thus to add to our store of knowledge in such matters. As to the esteem in which he is hdd by the members of our own profession, we have ample evidence in the fact that he was elected first Flresident of the West of England Then^utical Society thirteen years ago, an office he has held ever since. To many of us the office of President of this, our only Congress, comes almost as the sole professional dignity of a lifetime. It is in truth the greatest honour we have to offer, but to Dr. Eubulus Wilson it comes not as the sole but as the crown of other honours professionally won. Let us drink to the health of our President. (Applause.)
The toast was received most enthusiastically, the company singing heartily <' For he*s a jolly good fellow.''
The Pbesident rose, amid applause, and said : Ladies and gentlemen,— I have to thank Dr. Bamsbotham for the kind and very cordial manner in which he proposed my health. I
gSSyj^gyar MEETIMQ8. 4IS
abo haye to thank you all for .the wa^ in wbioh yon received it. I am qnite snre no president will ever vacate the ohait with more pleasure or more gratitude than I do. (Loud ftpplanae.)
During the evening a well leleeted programme of mnaio was rendered by the Gelia Quartette, an excdlent combination pf male vinoes* Mr. Philip Pope was also to have favoured fhe company with humorous songs, but his directors had that day called him to the north, and he was therefore unable to be present.
BRITISH HOMCEOPATHIC SOCIETY^! \
The eighth meeting of the Session was held at the London Homoeopathic Hospital on Thursday, May 5th, 1898» Dr. Edwin A. Neatby, President, in the chair.
Sbotion of Medicine and Pathology.
Dr. Galijst BLACxiiBT read a paper On the Action of Some of the Principal Rctmatics. The author first discussed the action of iron, quoting the results obtained by Bemhard and Loffler fifty years ago, and showing that their observationa were confirmed by more recent workers in the field of hiematology. He mentioned Blaud*s pill and the saccharated carbonate of iron as being the most frequently used form of iron, but gave his preference to the protozalate first introduced by Professor Hayem, and referred to the results published by him (Dr. Blackley) in this Review.
Arsenic was next passed in review — a drug which lowers the number of red corpuscles. He considered the drug had undoubtedly great power in the pernicious form of ansBmia. The striking anaemia of lead poisoning was remarked, and in a case lately under his care he noted but little abnormality in the per centage of red corpuscles and haemoglobin, but poickUocytosis and variations in size were pronounced, and a few megalocytes were present.
. The author considered the effect of phosphorus upon the blood to be rather of a haemolytic than a dynamic stimulant^ and that in addition to changes in shape the number of red cells is much increased.
The anflemia caused by mercury was a prominent and con- stant aymptom.
Dr. blackley finally discussed a class of haemolytics par excdLence^ organic in origin, and mostly containing nitrogen^ such as nitro-glycerine, nitrite of amyl and nitro-benzoL tThesCy with naphthol, etc., cause a breaking up of the red corpuscles and diminish the power of combining with oxygeu in the haemoglobin. He considered the exact therapeutic future of these agents to be as yet undetermined.
Dr. Bughes, Dr. H. Nankivell, Dr. Ooldsbrough, X>r. Byres
444 MEETINGS. ^?L^J^?iS??1^'
Review, Jtdj 1, 19B8.
Moir, Dr. Neild, Dr. Carfrae, Mr. L. Eeed, Dr. V. Oredn, Dr« Purdom, Dr. Dyoe Brown and the President took part in the discassion that followed.
Dr. Btbes Mont then opened an interesting disoofision on Medicines of Use in Septic Conditions, with especial reference to alcerative endo-carditis. The discussion was taken part in by Dr. Epps, Dr. Goldsbrough, Dr. Nankivell, Dr. Carfrae, Dr. Blackley, Mr. Dudley Wright, Dr. Day and the President.
The ninth meeting of the session was held at the Londcm Homoeopathic Hospital on Thursday, June 2nd, 1898, Dr. Edwin A. Neatby, President, in the chair.
SSOTION OF SUBOERT AND GyNAOOLOOT.
Mr, James Johnstone, the Secretary, arranged a most interesting clinical evening, consisting of the exhibition of cases, specimens, and microscopic and X-ray demonstrations.
The following cases were shown :
By Dr. Burford : (1). Uterine fibroid, with cancer of breast and also floating kidney. (2). Vaginal hysterectomy for uterine cancer (with specimen). (8). Ovariotomy (with specimen). (4). Cystic enlargement of gall bladder, continuous improve- ment under berberis.
By Dr. Day: (5). Intracranial tumour; boy, age 4. (6). Friedrich's disease. Boy, age 5. (7). Pseudo-hypertro- phic muscular paralysis ; girl. (8). Intra-uterine amputation of forearm in a child. (9). Lymphangioma ofaxilla; girl, age 7.
By Dr. Goldsbrouoh: (10). Lower level or Jacksonian epilepsy, with paresis of left upper extremity ; woman, age 20.
By Mr. Jobnstone : (11). Tumour of breast (disappearance onder Phytolacca after diagnosis of cancer and advice of immediate removal).
By Dr. Nbatbt: (12). Abdominal tumour (malignant?). (18). Uterine fibroid, with cirsoid aneurism of uterine arteiy and commencing cardiac failure.
The following specimens were exhibited in the lecture room of the Hospital : —
• By Dr. Burford : (1). Uterus removed by vaginal hysterec- tomy for cancer. (2). Ovarian tumour removed by operation.
By Mr. Johnstone : (8)* Hydrocephalus, spina bifida and talipes valgus in a full time foetus, delivered without craniotomy (breech presentation).
By Dr. Moir : (4). Aneurism of first part of aorta, within the pericardium, from a man of 48. Heart weight, 2 lbs. (6.). Advanced calcareous changes in the mitral valve in a man of 80 years, with history of rheumatic fever 15 years before.
By Dr. Neatby: (6). Double dermoid ovarian cysts with multilocular simple cyst, removed from same patient by Operation. (7). Ovarian dermoid and papillomatous cysts
g^J^ffrST' NOTABILU. 446
removed from same patient post mortem, (8). Uterine fibroid^ showing hard and soft tomoors, removed by operation. (9). Uterine appendages and appendix vermiformis removed at one operation.
By Mr. Knox Shaw : (10). Gallstones removed by ohole* lithotomy.
By Mr. Wbioht : (11). Epithelioma of rectam removed by the trans-sacral route. (12). Papillomata of bladder removed by saprapabic cystotomy. (18). Vesical calculus, removed by suprapubic cystotomy. (14). Benal calculus, removed by nephro-lithotomy. (15). Salivary calculus, removed from sublingual gland.
Among ti^e microscopic exhibits were : —
(1.) Series of permanent microscopical preparations of the- b]ood.— Dr. Galley Blackley. (2). Badiograph of a foot with supernumerary toe. — Mr. Knox Shaw. (8). Some new haema* tological apparatus. — ^Dr. Galley Blackley. (4). Microscopical slides showing (a) Paget's disease of nipple, (b) Scirrhus carci- noma axillary gland from the same, patient. — Mr.Enox Shaw* (5). Microscopical preparations of streptococci, gonococci, etc.,. ulustrating the use of carbol-fuchsin as a differential stain. — Mr. Johnstone. ^6). Microscopical sections of diseased appendix vermiformis and slides of blood from patient with malignant abdominal tumour. — Dr. Neatby.
Mr. Gerard Smith gave an exhibition of new X-ray Fluo- rescent screen (presented to L.H.H. by F. Adair Roberts, Esq.) and an exhibition of the method of producing high vacuum in X-ray tubes, by the mercury fall pump. LivEBPOOL Branoh* At the closing meeting of the session held at the Hahnemann Hospital, Liverpool, Dr. John Hayward, Vice-President, in the chair, the following officers were elected for the ensuing session, 1898-1899 : — President, Dr. John Hayward ; Vice- President, Dr. Douglas Moir ; Secretary and Treasurer,. Dr. Watson ; Bepresentative on the Council of the Society, Dr. A. E. Hawkes.
NOTABILIA. HOMCEOPATHY IN TASMANIA,
The struggle has spread to Hobart, where it has evinced the same vigorous self-defence as was shown at Launceston — the boycotting there being described as '* a dismal failure." At a meeting held late in April at Hobart, an association of lay and medical members was formed '* for the furtherance of the cause of homoeopathy in Tasmania, and Uie spread of the trutiis of nmiUa simUUnu curantur,*' We wi£^ Dr. Gibson and Dr. Benjafield every success.
446 COBRBSPONDENCB, **B^yS3?iIwS
HOMOEOPATHY IN WAB TIME. Under this heading, the European edition of The New York Heraldf published in Paris (June 15) contains the following letter :—
. ** It is a pity that no one has yet made any suggestion rehr tiyely to the benefit which would accrue to ike American forces sent to warm climates through the use of homoBopathie treatment. The shock from wounds, the healing of these wounds, the biribi of the Philippines, the dread ydlow fever* all forms of malarial attacks find in homooopathic treatment miperior help.
** If the old school sanitary regulations do not admit of such therapeutic progress in the regular army, some one of the auxiliary societies might, under the protection of the flag* use such practice among. the many volunteers, who would with joy hail the innovation. The mortality lists would show fewer losses, and many more cures. Among the 12,000 American homoeopathic practitioners many would be found capable and happy to lend their services towards this patriotic end.
** Aldershot furnishes statistics of some value in relation to homoeopathic practice. As regards cavalry, Paris had its homoeopathic ambulances during the late war, both very honorably noted for the work achieved.
"Old BEsmBNT.*'
CORRESPONDENCE.
THE SELECTION OF PAPERS FOR CONGRESS-
To the Editors of the " Monthly Homaopathie Review J** Oentlebien, — I cannot forbear writing to you to express my astonishment that such a paper as the one read by Dr. Clarke should have been permitted to be read at such a Oan^ gress as our last. How could any one think that a paper of that nature could be anything else but a stigma to the escutcheon of homoeopathy ? We are taken by the regular practitioners to be cranks, if not fools, and if such a doctrine as that propounded by. Dr. Clarke is a doctrine which can go out as having been propounded at a Homoeopathic Congress, there is sonj^ just cause for their opinion of us.
May I ask you, Gentlemen, who is responsible for arranging for individuals to read papers at our annual Congress? Is ^ere 8uch a thing as a committee appointed, or is there not ? Or does the whole lot of the Congress, as it seems to the majority of us provincial, men especially, lie in the hands of its perma- nent secretary ? To allow a paper such as that was to be read immediately after the presidential address, says, at once that it is the chief paper of the* Congress ; consequently we can
j£jKr«ri??8!S?* CORRESPONDENCE. 447
only look at it that jast so far as Dr. Olarke is to blame, equally so far are the persons that allowed him to read it.
We proTinoials expect from the Homeopathic Congresses to gain some farther knowledge of what has been done in the homoeopathic world by the leaders, and especially by the leadjers of papers and the physicians of sneh hospitals as oars in London. Are we to go to the expense of time, trouble and money to hear nothing more osefnl to as than the doctrine of signatures ? If such be the case, I, for one, shall not attend any more Homoeopathic Congresses. I feel very deeply on this question, and at the Congress I stated my opinions to others, and I foand that they were shared by the majority of the members of that Congress. Consequently, though you may take this letter in a harsh manner, still it is a question which cannot be burked, and which for the sake of homoeopathy should not be burked ; we must know on whom the respon- sibility lies, that such a thing may not occur again. Southport, Yours truly,
June 14th, 1898. Bobebt Btopforp.
jn> the Editors of tJie ** Monthly Hnmaopathic Review,'*
Gbntlbmen, — ^In reply to Dr. Stopford*s letter in regard to the selection of Congress Papers, I beg to state that the douncil met towards the end of last year, and unanimously msde a list, in definite order, of gentlemen who were to be asked to contribute papers for the Congress of this year. Dr. Clarke's name was down among the first three. All the Council were present, except Dr. A. C. Clifton, who was unable to come. The Secretary has only one Yoice out of the seven members of Council. Had the Council resolved to ask for no papers, but to wait for ofiers, then a supervision of the papers might be carried out, but if a colleague is officially requested to write a paper, and the subject left, necessarily, to his own selection, it is impossible to " sit upon " the paper thus written by request. No one of any position in the pro- fession would submit to the possibility of his paper being rejected under such circumstances. Dr. Stopfonl will thus see that he is in a great mistake in supposing, as he says, that "the whole lot of the Congress, as it seems to the minority of us provincial men eeqpecially, lies in the hands of its permanent secretary." I am, besides, not the perma- nent secretary, but have had the honour of being annually lippointed. When I resigned in 1894, and was honoured by an unanimous request to withdraw my resignation, the Coun- cil was appointed for the purpose of relieving me of such responsibility as was thought unfair to rest on the shoulders of one individual. I was grateful for this kind help, and I now accept no further responsibility than devolves on a
448 CORRESPONDENTS. *SS2£L^j5!?mKl
Beriew, JvHj 1,
secretary who is only one of seven members of Cooneil* Dr. Stiopford, and the majority.he refers to, ha?e the remedy in their own hands.
I am, &e.f
D. Dtoe Bbown.
A HOLIDAY RESORT.
To tlie Editors of Hie ^'^ Monthly Homoeopathic Review.*'
Gentlemen, — In my wanderings last year in Switzerland, I came across a beautiful, but not sufficiently known spot, although now described in <* Baedeker." At the time, I said to myself I would let others know of it, and I think the best way is to ask you to place the address before your readers. I refer to the Hotel du Weisshorn, situated high up on the left (east) slope of the Val d' Anniviers, which runs fiom the south into the great Rhone Valley. The start is most convenienily made from Vissoye, a good path leading up through pine and birch trees. The hotel is about twohours from anywhereelse, but is connected by telephone and telegraph with Vissoye ; it ia 2,800 metres high, i.e. over 7,000 feet ; the air is clear, dry» fragrant and bracing ; shelter is at hand in the woods, and it is needed, for the power of the 8un*s rays, even late m September, was great. Plenty.of easy snow tramps are aoces* sible, the Bella tola, with a commanding view is scarcely three hours away, and tiie view of the Weisshorn is excellent. Olimbs can be made, and descents by two or three passes into the Zermatt Valley are safely practised. Although so high ihe air does not seem exciting, for I know of a mmUcal man who went there from St. Luc because he could not sleep at the former — a lower level. The hotel seemed well equipped, bat was almost shut up when I stayed there, and visitors go year after year.
Tours truly,
Edwin A. Neatby.
NOTICES TO CORRESPONDENTS.
Authors and Contbibutobs receiving proofs are requested to ccurrect and return the same as early as possible to Dr. Edwin A. Nbatbt. The " list of Books reoeived *' is unaToidablj postponed. Communications, &c., have been received from Admiral Sblwtk,.
Dr. Dyce Browh, Dr. Neatby. Mr. Kkox Shaw, Mr. Dudley Wbiobt
(London) ; Dr. Stopfobd (Southport) ; Dr. HuoHBS (Brighton) ;
Dr. Madden (Bromley) ; Manageb Ambzta Bazaab (Caloutta).
Fftpen, THMpenaarj Beporto, and Books for Beriew to be sent to Dr. Pops, 19, Watergate, Oraatbam, Linoolnflhire ; Dr. D. Dtos Bbowx, 29, Seymour Street, Port- man Square, W.; or to Dr. Bdwik A. Neatby, 178, HaTeratock mi, N.W- Advertiee- menta and BoaiiieH oommoaicatioiia to be eent to Meean. S. Oould * Sov, 89 Moorgate Street, B.C.
£5S^S!Tw5^* THERAPEUTIC MYTHOLOGY. 449
THE MONTHLY
HOMCEOPATHIC REVIEW.
THERAPEUTIC MYTHOLOGY.
Thb paper read at the recent Congress by Dr. J. H. Clarke, on what hg termed The Doctrine of Signatures, had, as is evident from the discussion, from the letter of Dr. Stopford, of Southport, published in our last number, from others in this, and from all we have heard of it in conversation since the meeting adjourned, precisely the effect that its author designed it to produce. When, said Dr. Clarke, in closing the dis- cussion, I was asked to write a paper for the Congress, ** I just thought for half a minute to see if there was any sub- ject I could take that would ' make your flesh creep,' and, within thirty seconds, I thought I had one, and gave the promise." It certainly has made our " flesh creep," to thitik that any physician, practising homoeopathically, could be found who could so far degrade homoeopathy as to pretend to bring to its aid a mediaeval superstition, a doctrine to which, as Dr. Dudgeon wrote fifty years ago, **it is impossible to attach any credence." The British Medical Journal (July 2), in an article criticising Dr. Clarke's paper, does us only the barest justice when remarking, ** Dr. Clarke's advanced views appear to have surprised even his brethren in Hahnemann, who hardly knew whether or not to take him seriously. Perhaps, like the fat boy in Picktmck, he only wanted to
Vol. 42, No. 8. 2 G
450 THERAPEUTIC MYTHOLOGY. ^Sxii?r°AT?*lS^
Be\iew, Aug. 1, 1868.
make their flesh creep." This, Dr. Clarke admitted, was his object in selecting the subject he did. When the Council of the Congress resolved to ask Dr. Clarke to prepare a paper for reading and discussion at the meet- ing on the 8rd of June, they did so recognising, as all who knew him would do, his capacity to write a useful and instructive paper, never suspecting for a moment that, though he is well known to entertain views on many subjects with which the great bulk of homoeopathic practitioners have not the remotest sympathy, he would so far disregard the confidence they had placed in him as to present an essay of the type that he did.
In the opening sentence of this paper, Dr. Clarke said, '' It would almost seem that it is to be the lot of homoeopathy to rehabilitate the ancient doctrine of signatures, developed and glorified by Paracelsus and possibly utilised by Hahnemann himself, and the older homoeopaths for suggestions as to the properties of drugs, the outlines of which were filled out by provings and clinical observations."
Having quoted this sentence, the editor of the British Medical Journal writes : *' That Hahnemann in his fine frenzy drew inspiration from the doctrine of signatures is probable enough, for the prophet of homoeopathy was, as Voltaire said of another prophet, capable de tout. Neither have we any diflSculty in believing that the glorious destiny of resuscitating the doctrine of signatures, which was well described by Dr. Ayrton Paris, as * the most absurd aud preposterous hypothesis that has disgraced the annals of medicine,' is reserved for homoeopathy."
On what ground does Dr. Clarke state that the doctrine of signatures was "possibly utilised by Hahnemann himself and the older homoeopaths for suggestions as to the properties of drugs, the outlines of which were filled out by provings and clinical observa- tions." ? He gives none whatever ; and nowhere could he find any in the whole of Hahnemann's writings! But to assert that he did so was necessary to aid in making our ** flesh creep " ; and further, to qualify the assertion by the word '* possibly " was desirable in order to provide himself with a way of escape, in the event of some one contradicting him, or of some opponent of homoeopathy, like the editor of the British Medical
iKi^An'STwe^'' THERAPEUTIC inTTHOLOGY. 451
Journal, taking adyantage of his assertion to cast ridicule upon homoeopathy. We assert, however, that it was not possible that Hahnemann should have utilised the doctrine of signatures for suggestions as to the properties of drugs. In the first place, Hahnemann lays it down as a principle of primary importance, that " in order to ascertain the actions of remedial agents, for the purpose of applying them to the relief of human saffering, we should trust as little as possible to chance, but should go to work as rationally and methodically as possible." Will Dr. Clarke or any other like-minded physician — if there be one — declare that the fact of the eiiphrasia having an '*eye blue flower*' — though, as Dr. Dudgeon said, "it required a vivid imagination to perceive in it any resemblance to the eye, unless perhaps the marking on the petals might be considered to have some faint likeness to the markings on the iris of some eyes " — is a rational reason for prescribing it in catarrhal ophthalmia ? No, Hahnemann insisted on the absolute necessity of drawing therapeutic conclusions from ascertained facts, not from imaginary dreamings. We are not left, however, to infer his views on the doctrine of signatures from the general principles he lays down, but on no less than three occasions does he give us his estimate of its value in that very decided and indignant phraseology which he was accustomed to employ when writing on any subject regarding which he had reflected much and felt deeply.
In his essay on The Three Current Methods of Treatment (1809) he describes " the rude experiences of domestic practice, the oracles of old herbalist books, or fantastic speculation {signature) " as being ** the gross sources whence remedies had flowed in abundance.'* Does Dr. Clarke suppose it possible that Hahnemann should have utilised a ^^ fantastic speculation " to supply him with suggestions as to the properties of drugs? {Lesser Writings of Samuel Hahnemann, p. 692.)
Secondly, — In his essay On the Value of the Specu- lative Systems of Medicine (1808) he writes : — ** How uninquiringly our writers of Materia Medica have adopted the statements proceeding from these impure sources is evident, among other things, from this, that they enumerate among the virtues of crude medicines, such as were originally derived from the mere supposi-
2 0-2
452 THEBAPEUTIC MYTHOLOGY. ^BSSJ^.^S^fiSeu
tions of oar superstitious forefathers, who had childishly asserted certain medicinal substances to be the remedies of certain diseases merely on account of some external resemblance of those medicines with something appreci- able by the senses in those diseases {signature), or whose efficacy rested only on the authority of old women's tales, or was deduced from certain of their properties that had no essential connexion with their fabulous medicinal powers." Op. cit. p. 670.
Thirdly. In the essay on the Examination of the Sources of the Common Materia Medica (1817), when commencing the consideration of the second source of the virtues of drugs, as ascribed to them in the Materia Medica, alleged to have a sure foundation, viz., their sensible properties, Hahnemann writes : '' I shall spare the ordinary medical school the humiliation of reminding it of the folly of those ancient physicians who, determin- ing the medicinal power of crude drugs from their signa- ture, that is from their colour and form, ascribed to the yellow turmeric the power of curing jaundice, and con- sidered hypericum perforatum, whose yellow flowers on being crushed yield a red juice (St. John's Blood) useful in hsemorrhages and wounds,. &c. ; but I shall refrain from taunting the physicians of the present day with these absurdities, although traces of them are to be met with in the most modem treatises on Materia Medica." Op. cit. p. 754.
Thus Dr. Clarke commenced his paper by a mis- representation of Hahnemann. It was not a studied misrepresentation, but a misrepresentation due to total ignorance of Hahnemann's views on the '* fantastic specu- lation " with which Dr. Clarke tried to make our " flesh creep " in his endeavours to rehabilitate it. To rehabili- tate or attempt to rehabilitate the ancient doctrine of signatures, or any other obsolete fantastic speculation, may indeed be the lot of Dr. Clabke, but it is not a part of the mission of homoeopathy to do so. Dr. Clarke would fain make our ** flesh creep " by persuading us that there is a very close connection between homoeopathy and '' the most absurd and preposterous hypothesis that has disgraced the annals of medicine." There is none whatever ; not a jot more than there is between Tenterden Steeple and Goodwin Sands ! This was fully demon- strated in the discussion when, with one exception, all
BSSSr^^i^ae^ THERAPEUTIC MYTHOLOGY. 453
who spoke repudiated the notions Dr. Clabke had wasted half-an-nour of the time of the Congress in his effort to make our '' flesh creep " !
That the paper, as a whole, was regarded as interesting and amusing by several speakers is true enough, but it was the kind of interest attaching to most papers dealing with the curious manners and customs of our forefathers, and the sort of amusement derived from a variety show. But, as Dr. Hatward said, while fond of a little amuse- ment, he did not think the Congress was the place for it. Dr. GoLDSBORouoH and Dr. Madden did not know whether to take Dr. Clabke seriously. Dr. Dudgeon said that in the past the doctrine of signatures had- been a great failure, and proceeded to show how great a failure it had been by naming about a dozen instances in which some fancied resemblance had been recorded between the plant and the disease it had been supposed to cure — but didn't. Dr. Proctor followed, and in a most striking and very humourous speech, suggested that as the lower animals seemed to be wonderfully gifted in detecting the (qualities of food and drugs, and seemed to have a special knowledge of medicines of their own, he would take it that the doctrine of sig- natures was really a guide to them, and to this use he would limit it. Dr. Percy Wilde looked at this doctrine as an evil one, and as being one which misled men to use drugs wrongly, and to discard good remedies, and therefore he would be very sorry if any pressure were brought to associate the doctrine of signatures with the doctrine of similars, an expression of opinion which was followed by loud applause from all parts of the room. Dr. Goldsborough regarded this so-called doctrine as a relic of their mental childhood, and as being originally an after-thought. If it had any value, that value was of a psychological character, and suggested questions as to how far colour sensations and sensations of shape are related to other biological facts. Dr. Clarke, he said, had put them on a wrong mental track in bringing the doctrine forward as he had done, and if he thought that they would gain anything from such a consideration of it, he was grievously mistaken. Dr. Murray Moore did not consider the doctrine of signatures worthy of the name of a " doctrine " — it was rather a bundle of old traditions, now, by their clever
454 THEBAPEUTIC MYTHOLOGY. ^^^fAJ^^Ss.
and ingenious friend, revived for the purpose of dis- cussion only. Dr. Nankivell said that the doctrine of signatures was a relis of mediaeval medicine, and, as such, was interesting, but he failed to see of what assistance it could be to them in practice. As a Congress, he thought that they should say that that interesting question should be relegated to the background and left there, a sentiment which was received with great applause.
Notwithstanding these expressions of opinion and the strong current of opposition to the views he had expressed. Dr. Glabke in his reply stuck to his original prophesy, and " thought that homoeopathy would be the means of rehabilitating an old doctrine ! "
When Sir Chakles Tregellis, " the king of Bucks/' at the beginning of the present century was beginning to train his nephew, Eodnby Stone, to enter the polite society of those days, he said " Have you any eccentricity, nephew? You have a pleasant catching laugh at all events. But an eccentricity is very bon ton at present, and if you feel any leaning towards one I should certainly advise you to let it run its course. Peter- sham would have remained a mere peer all his life had it not come out that he had a snu£f box for every day in the year, and that he caught cold through a mistake of his valet, who sent him out on a bitter winter day with a thin Sevres china box instead of a thick tortoise shell. That brought him out of the ruck, you see, and people remember him." Dr. Clarke's eccentricity to- day seems to be that he can, through homoeopathy, rehabilitate the ancient notion of signatures ! This it may be supposed will bring him out of the ruck of mere homoeopaths, and people will remember him ! The editor of the British Medical Journal among others, and indeed he ought to do so gratefully, for he has given him the only legitimate opportunity for ridiculing homoe- opathy and indulging in a sneer at Hahnemann that he has had for many years.
One thing, however, Dr. Clarke must have learned from this discussion and from the conversation he encountered during the day, viz.: that to pretend to rehabilitate, through homoeopathy, the ancient doctrine of signatures at a Homoeopathic Congress is not only not bon ton, but is to ensure a disastrous failure.
RS^jF^rS^ BAROMETBICAL PRESSURE. 455
BAEOMETEICAL PEESSURE AS A FACTOR IN MEDICINE.
Being some intbrbstino pacts not strictly Medical,
bitt haying an important bearing on disbase and
ITS Treatment.
By T. Wesley Burwood, L.K.Q.C.P. & L.M. Ireland, L.E.C.P. ife L.M., Edin.
Towards the end of the month of January, 1882, I was brought face to face with a puzzle which gave me much personal chagrin, though it eventually haa proved a source of much satisfaction, as it opened up a line of thought which to me has been very useful.
How frequently in the experience of all of us have our failures been fruitful for good.
I had been in regular attendance on a gentleman whose name is well known. He had been my patient off and on for some years for trivial ailments, and I flattered myself I knew everything it was possible to know about him ; he had been a most healthy man, never having had a serious illness since childhood. His habits were those of an English gentleman, and until a few months before his death, he might have been seen on horseback in " the Eow" every morning of his life when in London. He, however, towards the end showed signs of oedema in the feet due to heart trouble. There was no valvular lesion, though latterly marked dilatation was evident. There was no albumen in his urine and his present condition might be summed up as due to old age (84).
I had seen him one day about 6 p.m., he was jolly and jocular, with nothing to indicate anything like a sudden collapse, his respiration was normal and his pulse and temperature satisfactory.
To my surprise, when I called about noon the next day I found my patient dead !
On enquiring of the nurse, who was a woman of experience, what had happened, she said ; ' ' he went to sleep as usual between 10 p.m. and 11, but woke soon after one complaining of breathlessness, his heart beating very fast and irregularly, this went on until gradually he became pulseless, and he breathed his last at 6 a.m., five or six hours after first awaking."
466 BAROMETRICAL PRESSURE. *^SS1w.^lSTiml
When I left him the previous afternoon I told the friends I considered his condition highly satisfactory, and yet within 12 hours he was dead !
I felt my position acutely, as I feared lest the friends might consider I had not fully grasped the situation, and that my reputation was endangered, which however did not prove to be the case.
During the rest of the day I turned over in my mind -^very possibility that could have arisen, but derived no satisfaction from any of my cogitations.
Taking up the evening paper after dinner I saw an account of a " Terrible Gale/' which led me to wonder whether that had anything to do with my patient's sudden death. And this led me to the outcome of this paper.
Now I was not, nor am I, a meteorologist, but the facts are these, for four or five weeks before my patient died the weather had been what is commonly known now as " Anti-cyclonic," and on referring to the Charts published daily by the Meteorological Society I found the barometer had stood between 30.2 and 80.8 for nearly five weeks. But about midnight there was a sudden fall, the glass dropped to 29.1, and before the gale was over it had fallen to 28.5.
Now what does all this mean ? I am not going to give you a lecture on the barometer, we all know what that is, and few look at the instrument as it hangs in their entrance hall, excepting simply to see what the weather for the day is likely to be. To me it is that, but it is also a great deal more.
Now we all know when the barometer stands at 29 inches it means the atmospheric pressure registers 15 lbs. on every square inch at sea level, consequently when the glass indicates 80 inches there must be more than 15 lbs. pressure to the square inch, and more still as the mercury is forced up to nearly 81 inches, which latter point I have only seen once in 16 years' daily watching every morning and night.
Professor Darwin, in an article in the Fortnightly Review J says : " The barometer ranges through fully two inches. Hence, when the barometer is very high, every square foot of the earth's surface supports about 140 lbs. more than when it is low, and 140 lbs. to the square foot is 1,800,000 tons to the square mile."
B^fi^TiaML*'' BABOMETRICAL PRESSURE. 467
What then happened on this sudden fall takmg place ? My explanation is — my patient's heart had been beating strenuously for some weeks against all this extra pressure, and when this pressure was suddenly taken off, like a horse going up hill with a heavy load behind him, the traces suddenly breaking the horse gallops away free — ^the heart's action was increased, the over-loaded heart and lungs became oppressed, a clot was gradually formed in the cardiac cavities, and soon life became extinct.
I have during all these years of observation seen very many cases of one kind or another so affected, and I can assert, without fear of contradiction, that anyone interested in this subject will find notices of sudden death in the obituary of the morning papers after a sudden rapidly falling of the glass accompanied by a gale of wind or a hurricane ; and many of these are cases, which, no doubt, have been a puzzle to the medical men in attendance, when their patients have suddenly passed away without any apparent cause.
Tou may have a powerful heart bounding and thumping away, driving its blood with increased violence into th^ cerebral vessels, and should there be a weak, atheromatous spot, cerebral apoplexy is the result, and your patient, who goes to bed apparently quite well, is found lifeless in the morning.
This applies also to epistaxis, pulmonary and renal hemorrhages, angina pectoris, also in pruritus vulvae, and many other conditions.
This brings me to an interesting point, which has frequently been discussed, though I have never seen it mentioned in connection with my subject ; that w, why so many deaths take place in the night or early morning ? I believe this is due to conditions to which the barometer can testify.
Captain Greenstreet, B.N.B., a man of great intelli- gence, who made observations extending over many years and in every part of the globe, showed me the automatic readings from his aneroid, and said " that it mattered not in what part of the world he was, there was always a slight and sometimes great falling in the mercury between 8 and 5 a.m.," and my theory is, I think, substantiated thereby.
There is not a medical man of experience present but can call to mind patients so susceptible and sensitive.
458 BAROMETRICAL PRESSURE. ^SSJ^fA^l^Sw!
that before they get out of bed in the morning they aare able to tell that the wind is easterly, while others, who may not be affected by the east wind, will emphatically tell you there is going to be thunder, and you may rely on their prophecy coming true- That there is in some patients what I call " meteorological susceptibility " I can prove, as numbers of my patients keep an aneroid in their bedrooms, which they watch night and morning, and so regulate their action and mode of living accordingly.
My friend. Dr. Reed Hill, when he was Uving with me was so aware of this fact, that if he were disturbed in the night by a gale of wind he would say at breakfast, **we shall get a telegram directly from Mrs. So and So," and surely enough before noon that telegram came ; or I would say, ** we must look after Mr. So and So'b heart while this gale continues," and we invariably found it necessary, for the patients had had restless nights, with wakefulness and palpitation which nothing could account for.
Many years ago I was attending an elderly lady suffering from bronchitis and weak heart. During the progress of her illness the bar9meter ranged very high, and on coming downstairs after visiting her one day, I was met by the patient's son-in-law, a retired judge,
who enquired how Mrs. was? I replied, " She is
going on as well as she can, and as long as the barometer stands as high as it does there is no immediate danger, but if there should be a sudden fall we may expect disastrous results." In less than a week the mercury fell one night, a gale sprang up, and on going to the house next morning I enquired of the footman how my patient was, and was told she had had a restless night. On reaching her bedroom, I found the family watching her breathe her last.
That same morning between 5 and 6 o'clock I was called to see an old lady of 84, who had had a bad attack of dyspnoea, palpitation and diarrhoea in the night, and who died shortly before 9 o'clock the same morning.
That same afternoon at or about 8 o'clock the public were shocked with the news of the sudden death of Sir S. Northcote at the Foreign Office.
It may be interesting to the members if I recall to them the sudden death of Archbishop Benson in
bS^^S^TIS^ barometrical pressure. 459
Review, Ang. 1, 1888.
Hawarden Church, which took place daring a hurricane and a rapidly falling barometer.
In the spring of 1887 there were several letters in the *' Lancet " from different medical men, asking if any of their confreres could account for so many calls to patients suffering from diarrhoea, the attacks coming on on a certain Saturday. The same enquiry was repeated in the next week's issue. I may say, in passing, I looked carefully, and found no reply was ever sent.
On this same Saturday, when I went into luncheon, I found a telegram from a patient I had recently taken to Brighton, and before the meal was over I had another from a patient in Essex, and a third in Acton, and a fourth in Hanwell, all of them with sudden attacks of diarrhoea. For the next few days I was busy with fresh cases, all of which dated their ailments from about mid- day on Saturday ; some were men, some were women, all under different conditions as to health, locality and age. Nothing in the shape of indiscretion in diet could account for it. For three weeks previously the weather had been anti-cyclonic, the barometer standing from 30.2 to 80.6. On the Friday evening the glass showed signs of downward movement, and by mid-day on Saturday a gale of wind had come into activity, and with it quickened action of circulation, more blood was driven through their susceptible livers, more bile thrown out, peristaltic movement increased, and in all these cases mere, corrosivus quieted this internal disturbance and held the trouble in check.
Another instance in connection with this alteration in barometrical pressure occurred during a summer holiday in Switzerland. I was stopping with my wife and one of my daughters at Engleberg (3314 feet above the sea level), and at the same hotel I found a well- known West End physician who arrived 24 hours before we did. We hob-nobbed together and sat at the same table. On the third morning after his arrival he came to me after breakfast, asking me to prescribe for him for an attack of diarrhoea. On enquiry, he said ' they ' had given him bad salmon for dinner the day of his arrival, and this was the cause upsetting his sensitive liver. Others who sat at the same table, and who had been in Engleberg some days and partook of the same were not affected. My friend said he had taken rhubarb pills to
460 BAROMETBICAL PREB8UEE. ^r^^aSTl^S?
Review. Ang. 1, 199&
no purpose, bo he asked me what he shonld do, I said ^' leave physic alone, eat as mbubI, and drink only Cognac '* until the bowels are quiet."
I asked him how long he had taken to get from Harley Street, and whether he had rested en route. He said he had left Charing Cross at 11 a.m., and in the afternoon of the following day reached Engleberg. I suggested he should give the fish the benefit of the doubt, and that the diarrhcBa was most likely due to his rapidly rising to the elevation in which he now found himself. I explained had he quietly stayed at Lucerne 24 hours, which is only 1487 feet above the sea, and accustomed his heart to the altered pressure, it might have been altogether different.
Many visitors in Switzerland, to whom time is precious, rush away &om London to find themselves in Alpine heights before they hardly know where they are, and consequently are frequently attacked by the ''malade de montagne," which natives never experience.
Some years ago I had the widow of a clerg3rman under my care, who suffered from attacks of cardiac irregularity, palpitation and dyspnoea. She had no cardiac lesion. There never seemed to be any cause, as far as she knew, for the attacks, which were very distressing to herself and alarming to her friends. On one occasion I was sent for, and found her with a tumultuous, irregularly throbbing pulse, and much distress. The attack came on in the early morning, and when I arrived about noon she was very exhausted, and looked it. Her temporal arteries were working synchronously with her radial pulse and her heart. During this time we were passing through an equi- noctial gale. I at once gave her brandy, on the aimilia similibvs principle, and gave strict injunction as soon as the breathing was easier and the heart's action quieter to stop the brandy, and moreover to watch the barometer and give small quantities of stimulants only on a falling glass. Some weeks after this, one tempestuous Sunday morning about 11 o'clock, I happened to be passing the house and casually dropped in to see how the atmospherical disturbance was affecting her. I found a messenger had been already sent for me, but I had left home before his arrival. I was met at the door by one of the daughters, with tears
MMdyH^mma^mo bAROMETBICAL PBB88URE. 461
B«fiew, Aug. 1, laoe.
in her eyes and almost choked with her sobbing, saying, "I was only jast in time." I harried upstairs and ionnd the bed surrounded by members of the family all weeping. The patient was in a state of loquacious delirium, saying she was '' so happy," and with clasped hands, saying she was ** seeing angels ascending and descending." I enquired how long this had been going on, and was told she had awakened about 5 a.m., very distressed as usual, and had been ''rapidly sinking" ever since. Her pulse on my arrival was most regular and full, 110 to 120, and not the least like what I had noticed on previous occasions. I enquired how much brandy had been given, when a bottle of Martell's ^ ^ * was shown me, the contents of which, except a little at the bottom, had been given since she awoke. I told them there was no need for farther stimulants for the next 24 hours, and at the end of that time she would be her usual self. Needless to say the angels all dis- appeared, and on my next visit the following day she had recovered from the intoxication, which her too fond children had helped her to induce.
The old lady has since died of senile decay, finally expiring during an equinoctial gale last spring.
Another condition which I have found almost invariably affected by the sudden lowering of atmospheric
pressure is purpura haemorrhagica. Mrs. , a lady
nearly 60 years of age, has during the last five or six years been subject to purpura. She always knows when she is developing purpuric spots by the local pains, and these attacks are always more present during the period of a rapidly falling glass. On one occasion she suddenly became deaf in one ear duiing a gale of wind, and when I saw her I diagnosed haemorrhage in the tympanum, which was confirmed by a West-end aurist of great repute. In the summer of that year she took a house in an elevated position in the Lake district, and almost as soon as she arrived she suffered with palpitation of heart and fresh accession of spots. When she became accustomed to the elevation her cardiac action became regular, and the remaining part of the visit was happy and free from unpleasant symptoms, unless a gale of wind happened to arise.
Now in connection with ears, one often sees patients suffering from noises in the head, who will tell you that the
462 BAROMETRICAL PRES8UBE. ^S$Sw^A^*?fi^
degree of severity differs very much — some days very little, on others it is quite unbearable. If you suggest to them to watch the indication of the aneroid, they will tell you they are always better on a rising, and worse on a falling glass.
Another class of cases in which I have been very interested is epilepsy, and often have been astonished at the coincidence of epileptic attacks with rapid lowering of atmospheric pressure. In connection with this, I was surprised on one occasion to find the father of a young lady under my care had made observations for the last ten years in connection with his daughter's attacks, and he found she was always well during a rising glass, or a prolonged anti-cyclonic period, but she always had an attack when the mercury rapidly fell> and this usually in the early hours of the morning.
Another patient, a sweet lovely little chappie of 11 years, is always more free from his attacks during days and weeks of anti-cyclonic periods, but recently he had 19 fits in five days on a falling barometer.
On one occasion, in November, 1897, one Monday morning at 6 o'clock, four of my epileptic patients had attacks at the same hour, and this was 18 hours after my pocket aneroid had registered 81 inches at the end of Hastings Pier, but at the time of their attack, the glass had fallen suddenly to 29.6.
I am not at all inferring that all cases of epilepsy are due to this cause, for we know they are not. Still, as so many epileptics do have their fits in the early morning, I think I am justified in saying in all probability they are induced by rapid alterations in atmospheric pressure affecting the circulation in the brain.
DiPHTHBRIA.
Another feature and interesting fact in connection with this subject. In the prolonged anti-cyclonic periods which sometimes prevail for weeks together, there may be at the same time an absence of rain, and consequently our drains and sewers are lacking water, while the atmospheric pressure keeps down and imprisons the sewer gases.
Some years ago I demonstrated this in connection with an epidemic of diphtheria. I was enquired of by the Medical Ofl&cer of Health whether I had among my patients any cases of diphtheria or sore throats. I replied,
IS^f^Tia^*' BABOMETRIOAL PRESSURE. 463
"I had no more under treatment than usual after a prolonged period of drought, whether that drought was caused by an absence of rain in summer or by frost in the winter."
In studying carefully the meteorological phase of the epidemic, I found the outbreak took place on January 22nd. Five weeks previously, i.e., from 17th December, a period of 86 days, there had been no rainfall at all, consequently the drains were in a state of quiescence. Between these same dates the average height of the barometer was 30.80; this showed the atmospherical pressure was of very high range and spread over a long period. Consequently, when the barometer falls, this great pressure being taken off, the obnoxious imprisoned sewer gases are liberated and escape throu<^h faulty joints and defective traps and valves. Given a long period with a high atmospheric pressure, coupled with defective closets and drains, one can predict, almost to a certainty, when the glass falls there will not only be sporadic cases of diphtheria and diphtheritic throats, and follicular tonsilitis, but in districts where numbers of houses have their closets, etc., faulty, there will be in all probability an epidemic of the disease.
If at the time of the fall there is a gale of wind to blow away the miasm all well and good, but if there is little or no wind the gases are not easily dissipated, A falling barometer and a dead calm are very important factors, and in this case, on January 14th, the barometer began to fall, and continued doing so steadily during the 15th, 16th, 17th and 18th, which days I looked upon as the incubation period of the epidemic, as there was a dead calm on the 14th, very little wind on the 15th, and still less on the 16th and 17th.
Prom what I have advanced, I wish it to be distinctly understood I only find these conditions in the patient on a sudden and rapid falling of the glass. A north- east gale may be raging with fury, the glass rising all the time, and during its continuance the patient may be delightfully comfortable, but it is when the storm suddenly subsides and the mercury runs down the patient is distressed.
On a slowly progressive downward tendency of the glass the patient is not so much affected, as he has had
464 BAKOMETRICAL PRESSURE. "^SSSr^fSETSl^
Beview, Aug. 1, 1818.
time to accommodate himself, though unwittingly, to the altered circumstances hy which he has been surrounded.
Now with regard to treatment. This must be carried out, in my opinion, by each patient having the homoeo- pathically selected remedy suited to his own individual case, as much care being taken in the diagnosis of the medicine as ia the diagnosis of the disease. In the majority of the cases, at the time of the attack brandy or whiskey or ether, ia small doses, will be most beneficial.
The usual cardiac remedies, all of which are so well known to the members present, will, of course, be found useful.
In the intervals, general constitutional treatment will be necessary to so fortify the patient that he may be able to battle with the trouble to which his peculiar idiosyncrasy has made him liable.
I do not wish my medical friends to infer I consider all diagnoses are referable to alterations in atmospheric pressure. But I do say, where every other factor is carefully weighed and no satisfactory conclusion is arrived at, the probabilities are that the barometer will settle the difficulty, especially when the disturbance is functional rather than organic.
Professor Darwin, in the article before mentioned, which was published in February, 1887,: says, "It is found that earthquakes are indubitably more apt to occur when there is a rapid variation of the pressure of the air, indicated by a rise or fall of the barometer, than in times of barometric quiescence, and the connection between barometric variations and earth- quakes should make us reflect on the forces brought into play by the rise and fall of atmospheric pressure."
Now why should not the human subject be interfered with by these same influences ?
Our very familiarity with these changes may easily blind us to the greatness of the forces which are so produced, and I am convinced that many present, if they will take the same trouble and interest in it that I have done, will be equally satisfied.
Though there may not be enough to enlist the interest of the Congress in what I have advanced, I have found it very useful from an setiological point of view, as well as a help in diagnosis, prognosis and treatment.
SSfeSr^nrS?*** barometrical pressure. 466
DltOtJSWMf.
Dr. Nanjctvxzx considered that tbej were extremely indebted to l>r* Borwopd for the excellent and practical paper with which be had favoured the Congress. He had listened to it with the utmost pleasure. He did not think be had heard <Hie firom Dr. Burwood before. Why, he did not know» and he hoped they would hear more from turn in future (Applause.) The question of barome trical pressure was one which must always intexBst them as physicians. Of course, one has noticed that under certain conditions of the barometer h®morrhage from lungs ocHnes on much more frequently than at other times. Dr. Burwood had done right to show that it was the rapid feill which makes all the difference to the sufferer. A patient would get accustomed after a time to a high or a low baro- m^dtrical pressure, but when the vital equilibrium was easily disturbed was during a rapid barometrical fall. One noticed some such kind of influence in mountainous countries. Last year, when travelling in Switzerland, he ascended to a higher altitude than for some years he had been accustomed to. He went to the height of 5,700 feet, and there his rest was broken, he was troubled with frequent sleeplessness and had quite four bad nigh ts a week. Had he been a patient he suppo^^ed he would have been sent down, but being a doctor he did not go 1 At a still higher altitude of 7,100 feet, he fouud that out of seven nights he had six downright bad ones and was extremely uncomfort- able, and had disturbances of both cardiac and respiratory functions. He was none the worse in the mornings after, and could take a good deal of fairly severe exercise with comfort and ease during the day. Directly he descended to the valley the relief was absolute, and he never had a recurrence of these disorders, which were evidently due to the low barometrical pressure. He thought he perfectly agreed with Dr. Burwood, that in cases of functional difi&culty in the heart's action and also muscular incompetence that the trouble came on from rapid barometrical changes but it did not affect cases of valvular disease where the cardiac muscle remained in good order. It was where the muscles were weak that they must be careful how they sent patients to any height in mountainous districts — they were perfectly safe at 8,000 or 8,600 feet unless the patient was old and the ventricular powers were distinctly impaired. At these heights they got curative action in the heart cases from the improve- ment in nerve power, and in the nutrition of the ventricle. They were not to be afraid to send such cases up as high as they could safely go, i.e., as high as they could sleep comfortably in. But if they were sent higher there would
Vol. 42, No. 8. 2 H
466 BAROMETRICAL PRESSURE. "^B^^fASn^^
be too little rest and too heavy a strain from day to day, and they would return home worse rather than better.
Dr. Madden said they might surely not only learn what Dr. Burwood had told them, viz., to look out for squalls in patients when they encounter different atmospheres, but also to some extent to guard against them. If they had not the special apparatus to produce artificial pressure of the atmosphere ac all events they might try condensed oxygen and keep it ready for use under such circumstances. It was of compara- tively little use to know there was danger in the air if they did not know the remedy (a voice : '* brandy " and laughter), and the condensed oxygen would seem to be one of the best means of counteracting the effects described in those suffering from heart disease. (Applause).
Dr. Mont wished to ask Dr. Burwood if he had noticed that diminished pressure caused sleeplessness, in the same way as had been observed at certain altitudes in the mountains.
Dr. Hayle (Bochdale) said : We must all feel very much obhged to Dr. Burwood for his interesting paper. It is a very important subject, and a subject I have been especially interested in, as I have kept a daily record of the weather for more than 80 years. But it is also a very complicated subject, for I am sure that there are many things in the weather that may greatly affect sick people. Weather itself is a very com- plicated study. There are so many forces that combine to bring about the different states of the atmosphere, and many of these I am sure affect sick people quite as much as the rise and fall of the barometer. There is the magnetism of the earth and the effect of the moon, which we know acts on the earth, and much more on sensitive organisms like the nervous systems of sick people. Then the storms on the sun's surface also affect the magnetism of the earth. The presence of the sun in the day and its different relation to the earth at night affects the vitality of people. Of course, the sudden variations in the height of the barometer we know must affect heart cases and asthmatic cases very much, for we know what effects variations in altitude make in these cases. But I think Dr, Burwood has rather exaggerated the influence of this in his paper, for the number of sudden variations in the barometer is frequent enough to account for all the sudden deaths in these cases, and gradual falls and rises I do not think cause much disturbance Also, when the barometer has been high for a long time, as in an anticyclonic period, it seldom goes down suddenly, but generally gradually. These sudden variations in temperature are indeed very trying. Dr. Burwood thought that the greater mortality of people at night was probably due to the barometer genen^y being
SS^JTA^TSa*" BAROMBTRIOAL PRESSURE. 467
lower at night ; but I do not agree with this, because the average diurnal range is very small in England. Also people's own vitality is much lower about 2 a.m., even in health, so that that would account for more deaths at this time. Altogether, I think Dr. Burwood's paper very interesting and very im- portant, although I cannot agree with him on every point.
Dr. J. MxnuuT Mookb said he thought Dr. Burwood had done the Ck>ngress service in calling attention to a new element in disease conditions. Dr. Hayie had also done well to point oat that temperature, as well, affected disease, and that barometric pressure was not the only element. He (Dr. Moobb) had lived in different parts of the world, and had taken note of barometrical variation, and he could strongly corroborate some of the statements Dr. Burwood had made ; but as had been said, there was a diurnal variation even in a healthy man ; how much more so would there be in one diseased ! A healthy man is vigorous in the morning, and the lowest point is reached in the respiration, and the heart's action and the pulse from 2 to 4 o'clock a.m. Fortunately, our average range of barometric pressure did not vary more than three degrees in the United Kingdom. In the Southern Colonies and in Galifomia ii was much greater. He had noticed patients go off suddenly during and after a storm. Storms must be taken in account rather more by the physician. How often did they find it recorded that a man apparently in health had died in the midst of a storm ? and Dr. Burwood had given them a scientific and rational explanation of the matter. They should, he thought, pay greater attention to their barometers — (aneroids were on the whole the more accurate) — and they could make a better prognosis.
Dr. Dycb Bbowm joined in thanking Dr. Burwood for his paper, and said the matter he had brought forward was of extreme importance. It had never struck him until he, some time ago, had a conversation with Dr. Burwood, but a few days later he saw a remarkable corroboration of his views. There had been a long drought with high barometer and it had suddenly &llen, when we met, Dr. Burwood prophesied that there would be soon an outbreak of diphtheria, and sure enough this happened in a few days after. The^ all had come across cases where old patients cued suddenly m the middle of the night, when they had seen them a few hours before and con- sidered they were going on satisfactorily. It was very likely that a sudden falling in barometrical pressure might have been the immediate cause. (Applause).
Db. Jaoiblski said there was one practical point in the paper he admired, and that was the connection between barometrical pressure and the use of brandy. They had learned
2 H— 2
468 BABOMETRigAL PRESBURE. *Sl^^T^
from observation that in the morning about two o'clock the barometrical pressure was affected and the temperature falls to 96°, brandy was quite in place there. When a man went to work during the day, and came home 19 the evemng veiy tired, it was the proper time to advis# alooboL With regard to the lowness of the temperature in the early morning, caused by the variation in barometrical pressure, when it was very low, he thought that waa the proper indication for giving the patient some alcohol.
Db. Hughes: Would you use alcohol homoeopathieally ? (Laughter.)
Db. Jagielski : To get the full effect you give the full dose. (Benewed laughter.)
Db. Hughes : Has not alcohol a lowering effect ?
Dr. Jagiklsei : That is according to the quantity taken. I would decidedly not give the alcohol very much diluted with water ! (Laughter.)
Dr. Blacelet: I would like to suggest that the cause follows the effect, for when alcohol is taken the glass generally rises first. (Laughter.)
Dr. W. T. P. WoLSTON considered the paper most interesting, and thoroughly well worked nut. To most of them the subject was new, but anything which helped to make them better physicians, and to guard the lives of their patients was good, and its effect would be beneficial all round. If Dr. Burwood's theory was correct, it was important that they should be warned beforehand, and the weather reports from over the water would be of additional value. What Dr. Jagielski had said was true. In cases of cardiac feebleness, and asthma and the like, when they knew they had a feeble heart to deal with, it would be good practice to use a stimulant as a nighi-cap, or in the early hours of the morning, when a lowering glass is evident.
Db. Bubwood was received with applause on rising to reply. He was exceedingly pleased to know his paper had given satisfaction, though he was afraid there were some people would not find it of much use to them ; some men never wanted practical hints, but personally he was always glad of any hint when he could get one, especially if it was a benefit to a patient. Many gentlemen present, he knew, must have had patients who wtre a puzzle and have not been able to account for certain occurrences which the barometer could only decide. A man may suddenly have an attack of hsematuria, where no suspicion of either renal or cystic trouble existed, but on a lalling glass it has happened.
SlrtS^STS?** ASSOCIATED SYMPTOMS. 469
He agreed with Dr. Hayle. Blectrioal influenoes did affect aensiiiTe patients, but tbeee same inflaenoee were acoompanied by a falling glass and therefore altered pressure. He did not coosider the y^ part of an inch was worth oonsidering, although it happens more or less every night. Dr. Hayle had also mentioned that the thermometer may have something to do with it, but my paper does not consider variation in temperature but simply alteration in pressure.
With regard to Dr. Nankivell's remark in connection with cardiac cases in weak, dilated and flabby hearts, there was no question these patients suffered, as he, Dr. Burwood, had very firequently observed, and always found small doses of stimulants most useful, but over-anxious children might give too much, and so make the patient drunk.
With regard to sleeplessness, as mentioned by Dr. Moir, he. Dr. Burwood, had often found, after a boisterous windy night and a falling barometer, the patients had slept badly because of palpitation of the heart ; some even putting the cause to an extra cigar, or a Welsh rarebit for supper, though at other times neither tobacco nor food could be accused. Had their patients been told to watch the aneroid, their anxieties might have been allayed. So carefully had he studied this matter, that now it was part and parcel of his duty to see how fax the atmospheric influence had to do with the state of the patient.
As to ^ night-capping " a patient with dilute alcohol iu tumultuous weather, he considered the patient would be none the worse for it.
He again thanked the Congress for the reception they had given his paper, and hoped his friends might find it useful. (Applause).
ASSOCIATED SYMPTOMS.*
By C. J. Wilkinson, M.R.C.S. Eng., L.S.A.
In our daily pursuit of the $imillimum we have to listen to the patient's statement of his symptoms, and to examine his body for some objective signs which may reveal the cause and the pathological explanation of them. He has been but a poor observer of diseased nature who has not noticed that there are certain symptoms of which a patient complains 9vd sponte as an essential and integral part of his case, while there are other symptoms, the connection of which with his sufferings is so little obvious, that he is apt to leave them
* Bead before the British HoAoeopathio Congress in London, Jme, 1895.
470 ASSOCIATED 6YMPT0MS. "^SSSSr^S^^
BeritfW. Axig, 1. 1896.
onmentioned, as outside the sphere of his present complaint; and yet the association of these outlying and apparently accidental symptoms with those which are clearly of the very essence of his disease is, more often than not, a valuable indication or guide to the selection of the curative drug. Though these associated symptoms are of course jpresent in the provings of drugs, and are frequently mentioned as valuable guides in the choice of the true simillimum, I have been astonished that I have not found any systematic treatise upon the frequency and the meaning of their association. And yet it is clear, I think, that an explanation or rationale of the law of similars must be sought in some such direction as this.
For a successful cure by means of following this law, it is not necessary that the disease shall exhibit every symptom produced by provings of the drug used, but it is necessary that every symptom of the case to be cured should be found in the artificial disease induced in provers by the drug selected for cure. It is, indeed, a truism to us that the expectation of cure is in direct proportion to the accuracy of the simillimum. On the other hand, I think that most careful prescribers will have noticed that single symptoms may sometimes be relieved, the rest of the symptoms remaining untouched, by drugs which contain these single symptoms, but not the totality of symptoms of the case, in then* provings ; that is to say, the success achieved by the drug is still in proportion to its degree of similarity. It follows, then, that the covering of these outlying, but associated, symptoms of disease by like symptoms in the drug or iimiUimvm, is an essential part of a perfect prescription, and this makes the nature of their association in both spheres (disease results and drug pathogenetic effects) an important item in the questions that must be met before the true inwardness of the law of similars can be exposed and comprehended.
But, in the modesty of conscious ignorance, I do not propose to face sucn a tremendous issue as this. I prefer, rather, to mention a few instances of such associations of symptoms as occur frequently in the daily round, and are found also in the pathogenesy of drugs that are needed in the prescriptions of every diay associations of symptoms, however, the pathological
S^STiTSwk^ ASBOOIATED 8YMPT4W8. 471
basis of which involves ^ome speculation and may give rise to discQssioB. It may be that a statement of difficnlties, .and of possibly mistaken explanations, may result in some light being thrown upon the question in its entirety.
There is a form of cough for which we are frequently ealled upon to prescribe, and which has the following characteristics : There is irritation and soreness in the pharynx, and some soreness in the trachea ; there is aphonia, the voice showing a tendency to " cypher '* or to change its note in the middle of a word or sentence ; there is tickling extending from the larynx to the Eustachian orifice ; the cough is short and dry, that is to say, there is little or no phlegm expelled from the mouth, though some may be raised as far as the pharvnx, when it slips back again ; it is greatly aggravated by change from a warm into a colder air. It is a cough of small pretension, but the patient complains that he is shaken by it much more than the sound of it would lead one to infer. It shakes him f^eatly, so that he suffers from involuntary micturition from the impact of the cough upon the contents of the abdomen. This involuntary spurting of urine with a cough at once suggests the prescription of causticum, though it is a symptom which occurs also in the provings of scilla and of natrum muriaticum. It is a symptom of which the causa cansaus, the ultimate cause, is by no means clear. Let us for a moment consider the mechanism of cough- ing. ** In the act of coughing there is most often an inspiration followed by an expiration; but when the lungs have been filled by the preliminary inspiration, instead of the air being easily let out again through the glottis, the latter is momentarily closed by the approximation of the vocal cords ; and then the abdominal muscles strongly acting, push up the viscera against the diaphragm, and thus make pressure on the air in the lungs until its tension is sufficient to burst open noisily the vocal cords which oppose its outward passage. In this way a considerable force is exercised, and mucus and any other matter that may need expulsion from the lungs or trachea is quickly and sharply expelled by the out-streaming current of air."
" Now it is evident that pressure exercised by the abdominal muscles in the act of coughing acts as
472 ASSOCUTED SYMPTOMS. *^£^^iT?iSfl?
forcibly on the abdominal yiscero, as on the lungs^ inasmuch as the viscera forms the medium by which the upward pressure on the diaphragm is made, and of necessity there is quite as great a tendency to the expulsion of their contents as of the air in the lungs. The instinctive, and if necessary voluntarily increased contraction of the sphincters, however, prevents any escape at the openings guarded by them, and the pressure is effective at one part only, the rima glottidis."*
Now it is evident that the spurting of urine on coughing in such cases as we are now considering, depends upon some failure of the sphincter vesicss, whether it amounts to a partial paresis, or only to such an interference with its innervation as lengthens its reaction time, and prevents it from contracting early enough to prevent catastrophe. A glance at the provings of causticum shows that they abound in paralytic symptoms ; the face, the eyelid, the lips and tongue, and the muscles of the pharynx are all apt to suffer in this way, but the urinary muscles seem to be the subject of its especial selection ; we get a picture of loss of power in the sphincter, followed by loss of power in the detrusor, running on to vesical catarrh.
But what is the meaning of this association between a common enough result of '^ catching cold" and an affection of the third to the fifth sacral segments ? Is there anything in modern pathology which can be brought to explain it ? And yet precisely this association has been provided against in the provings of causticum.
I pointed ont elsewhere a few years ago that the visceral nerves controlling the calibre of vessels in the ovaries, the large intestines, bladder and uterus have their upper limit of origin in the spine, at the level of the fourth and fifth lumbar vertebrce, the highest point of origin also of the lumbo-sacral cord ; and I regard this as the explanation of those reflex pains in the sciatic nerve, which so frequently accompany or rapidly follow irritation in the viscera I have mentioned. A considera- tion of the pathogenetic symptoms of colocynth will show how fully this anatomical point explains the otherwise rather mysterious association of ovarian pain or rectal
• Kirke'fl HandhooJt of Physiology, p. 226.
lESSfrSTjSw?** ASBOCIATBD BTHPTOMS. 473
catarrh with pain m the hip or ankle, and even atrophy of the muscles in the thigh and leg.
There is a collection of symptoms with which we are often confronted which follows the ingestion of certain fishes (even when these are fresh), oatmeal (in some sensitive people), or the drinking of large quantities of cold water while the skin is sufficiently gorged with blood to leave the viscera comparatively ill supplied* The symptcMns are commoner in America, where iced water is a frequent beverage, than here. The trouble begins with a general sense of oppression, most marked in the chest; .there is cutting pain in the stomach accompanied by eructations of sour flatus, followed by waterbrash of a particularly sour nature. The tempera- ture rises to a considerable height, and there is vomiting of the contents of the stomach followed by large quantities of sour^ watery fluid. An urticarial rash appears very suddenly; so suddenly that it seems to be the result of the effort of vomiting ; the eyelids swell with effusion, the lips thicken, the skin presents numerous spots, papular, raised from the surface of the skin but flat in themselves, often at first themselves white, but surrounded by large zones of pinkish hypersBmia. Diarrhoea frequently sets in, with griping pain in the hypogastrium ; the stools are soft and papesoent, and have a peculiarly musty smell. The rash fades and diminishes, but fills up again every few hours, bringing a return of tremendous irritation. Now, it has long been recognised that these symptoms indicate the absorption of some albumose or toxin from the gastric and intestinal walls, but it is only during the last few months that the modus operandi of the albumose has been established ; it has been found to depress the action of fibrinogen, and so to lower blood-coagulability. Hence, the oedema of the eyelids, the swelling of the skin, and the discharge of fluid from both mouth and bowel may be regarded as so many serous haemorrhages from blood which is deficient in coagulability.
Now, this picture of symptoms, with its explanatory pathology, interests us at present mainly on account of the exquisite way in which both are covered by the provings of Pulsatilla. Not being myself a good subject for the action of Pulsatilla, I have not yet been able to prove, as I hope to do, that this drug in pathogenetic doses does
474 ASBOOIATED SYMPTOMS. "^SjL^SJTtS
BeTiew,Au9.1,in6.
actually lower the coagulability of the blood ; but this is more than probable, since I have noticed often that those who are most prone to such urticarial attacks — that is to say those whose coagulability^ if not always low» is subject to comparatively easy impairment — are of exactly the Pulsatilla temperament — *^ persons who, by the rela- tive predominance of the adipose tissue in their compo^ sition, by the whiteness of their flesh, the roundness of their forms, the mildness of their disposition, and their fitful moods, exhibit all the marked features of the female sex."*
Farrington (Clinical Materia Medica^^. 828) gives venous obstruction as the key noia^ Pulsatilla. ** Tou must remember," he says, ^ that the drug acts upon the vascular system, especially upon the right heart, and upon the veins and capillaries. Thus we find that whatever weakens the venous portion of the circulation, whatever retards the return of blood to the heart, must of course provoke just the class of symptoms for which Pulsatilla may be indicated." Undoubtedly Pulsatilla has this action in its provers, but I do not believe that this action alone will satisfy the requirements of its pathogenesy. Granted the action upon coagulability, many of the Pulsatilla conditions become comprehensible, especially the ansemia which Dr. Blake has already taught us to regard as an auto-intoxication or result of albumose poisoning.
These examples will perhaps illustrate as well as others the association of symptoms occurring in both patho- genesy and disease; but the list will be indefinitely extended in the mind of everyone. The tendency for symptoms curable by nux vomica to become worse between three and four o'clock in the morning is daily thrust under our notice, and the explanation of the symptoms, involving the digestive system, is a common- place one amongst us. But what of the cough and the hsemoptysis, with their same hour of aggravation ? What is the pathological explanation of it ? How shall we explain, again, the association of pleurodynia with herpes of the lip ? and yet, more than once, I have seen the two associated in practice and found ranunculus curative.
* Teste, quoted in Hoghes' Pkarmaeodynamiei.
^l^jSS^Tvm^ ASSOCIATED SYMPTOMS. 475
When a note is struck in an orchestra it will be foand that all strings and all brass instruments will vibrate to it which are tuned to notes in the common chord of the note struck. The notes which are evoked in this manner are known as overtones, and I think that the association of symptoms is somewhat analogous to this law of sound. And I regard this analogy as not being entirely fanciful, for the following reason. The note in music receives an arbitrary title after the earlier letters of the alphabet, but we know that its individuality or essence depends actually upon the number of vibrations or sound-waves which it sends out in'any given time. We can understand, too, that the string which is plucked to emit a given note, can be sub-divided into a practically unlimited number of parts ; furthermore, we can realise that the note does not stand alone for the result of the vibration of the whole string, but also for the vibration of all the aliquot parts of its entirety. We may state it also in this way — that the number of vibrations in a given time does not stand only for that number itself, but also for all the factors of which that number may be the product ; thus, a note which has 200 vibrations in the second does not represent only 200 vibrations, but also twice one hundred, four times fifty, ten times twenty, and so forth, and it is the presence of these factors which stimulates other instruments at rest in the room to vibrate in sympathy with them, and overtones are the result.
Now, our nomenclature of disease is either purely arbitrary, as in the use of such terms as mumps, measles, the yaws, &c., or it is based upon the name of the organ or part of the organ which is most obviously affected, as in such names as myelitis, ovarian cyst, and so forth. Of the actual nature of disease, as opposed to its phenomena, we still know very little. Of the number of its vibrations (so to speak) we are very ignorant. Of the different factors of which that number may be composed (to continue the metaphor) we know absolutely notlung. But regarding disease in this light, we are helped to understand how each factor may set up its own reflexes, and how by-products of disease of the nature of associated symptoms may result.
To consider disease thus curiously is to pre-suppose a pathology which transcends any which the microscope or
476 ASSOCIATED SYMPTOMS. ^'^^Si^^^umt
Reriew, Aagr. 1. UB6.
the test-tube has yet revealed to us — a matter at which imagination need not boggle, when we remember recent advances. And for us such a view has especial fascination.
The fact that associations of symptoms in disease apparently the most accidental, associations the most bafSing of explanation, are found associated also in the same sequence, subject to the same conditions of periodicity, of amelioration and aggravation, in the proving 6f the curative drug, leaves us no longer with similia gimilibus cursntur as a msixim of occasional utility, but raises the statement simiUasimilibys curantur as the formula of one of the great laws of nature.
DiSOtTSSION.
Dr. HOGBxs rose to thank Dr. Wilkinson for his very ingenious paper. At present he had very little to say in comment on the paper. It wanted readying and thinking about and comparing with their pathogenesis and their knowledge of the action of drags. The reference ta overtones in music was a most ingenious explanation, and it gave a reality to symptoms in disease which they were inclined to doubt or consider very bizarre or incomprehensive. They must not be led away, but let them accept the actual facts and scientific explanation would come. When they got so far they might fairly hope they were on the track of similar phenomena occurring in disease and drug action. (Applause.)
Dr. MuBBAT MooBE said he thought it was the most hom(BO^ pathic paper of the three to which they had listened to-day^ and they had to thank Dr. Wilkinson for working out the problems with such skill. From the precis he did think Dr. Wilkinson was going to trace the symptoms of bryonia and colooynth. Both these belong to the same natural order» but they would not think it from the symptoms. The present tincture is from a different species from that which Hahnemann made his provings from.
Dr. GoLDSBBOUGH Said he listened to the paper with great interest, and it reminded him of the fact that some years ago Dr. Wilkinson's predecessor read a paper on the same sub- ject, and he brought forward analogies of physical phenomena. He thought the} could reduce the law of similars to the practical point buggested by the paper. In treating patients, they had to think that there were connections between s>mptcn)B in a different way fiom simply connected organs, i.e., they saw the whole of one organi^m^— the patient was one^^and tbey had to treat him as a personality, as having
iSJSijSSTTSSlf^ ASSOCIATED SYMPTOMS. 477
one diseftse, rather than taldog oat iadiyidaal symptomB and making too maoh ci them.
Dr. FoLLAB said, from a homoeopathic point of view, he eonsidered it was an ideal paper. It presented the subject in aphilosophical way, and one wonld like to bear more of it. (Hear hear.) There was this about it, one would require to read it very carefully and think over it to discuss it fully. The suggestions were so good that one would like just to thank Dr. Wilkinson. The limitations of knowledge were so great, from the prescribing point of view, that they really &il6d to find an explanation of the range of medicine, except from some such suggestions as those here given. They often found that by curing one symptom by a medicine some condition they were not specially treating disappeared.
Dr. MoiB said there is a great deal to think over in the paper, and it looked as if they were coming to a time when a new theory would be revealed, and they would have to alter their views and take higher views of homoeopathic remedies than they had previously done. Dr. Wilkinson was workiug on right lines in bringing the matter forward.
Dr. Stomham said sometimes in looking for the symptoms in a patient one would hit on one symptom only and prescribe for that, and it was quite possible to cure the symptom by the use of a certain drug and yet leave the patient uncured and with all his other symptoms remaining. To borrow Dr. Wil- kinson's illustration, may we not say that in these cases, where an isolated symptom has been removed though a wrong drug has been chosen, a falee note has been struck, bat one in which there happeoed to be a coincidence between one of its overtones and one of the overtones of the note representing the true drug simillimum ?
Dr. Galley Blackley said the point which had interested him perhaps the most was that with reference to the question of ptomaine, or toxin-poisoning. He thought these offered a ready explanation of a good many of those inexplicable symptoms which do not lend themselves to immediate pathological classification. They knew that in some diseases, at least, there were several toxins at work — typhoid fever for instance, and in many suppurative complaints. The cough referred to in the paper might well be the effect of a toxin rapidly liberated. In influenza they knew it was so, and he ventured to think that it was very probable in the case of the cough in question, and which they all knew so well. It was constantly seeu in nervous cases, and there was httle improbability that it was due to paresis or inhibition of the function of certain nerves by toxins. The nomenclature of disease would, in fact, in the near future need entire revision,
478 VI8CUM ALBUM. "SSS^^STSSr
B«Ti«w, Aug. 1, 18BB.
and before long we shall probably speak of many diseases as simply what they are, i.e., toxin poisonings ^c, &o. This intoxication was, in reality, the pathological basis of the diseases ; what we know and recognise are merely the symptoms evoked by this process of intoxication.
Dr. Pbootob suggested that they would have to go a step farther, and say that when they had got a toxin they had not got a disease, but only the approximate cause of the disease.
Dr. Wilkinson said he did not think he need detain them beyond thanking them for the interest they had shown in a paper full of imperfections. He had intended to work oat some contrasts between colocynth and bryonia, but in that case, as in others, he was unable to get the necessary informa- tion for the pursuit of the argument. The main object of the paper, which had probably escaped many of them, was to point out the association of the symptoms of disease. This is one of the strongest arguments of homceopathy being more than an occasional principle, and one of the great laws of nature. Until homoeopathy succeeded in proving itself a law of nature, so long would the other side of medicine have some excuse for looking down on them. (Applause.)
This being the concluding paper of the Congress,
Dr. Hatwabd said, before they separated there was one matter they would wish us to join in and that was in according a vote of thanks to the President, for the way in which he had conducted the meeting. Their thanks were heartily due to him for his conduct in the chair. (Applause.)
The PREsmBNT : I thank you for your appreciation of my having done rather less than nothing. (Laughter and applause.)
EXPERIENCES WITH VISCUM ALBUM.
By George Black, M.B. Edin.
f Continued front page 844. J
Case VL
Miss M. of strumous constitution consulted me on Jan. 6th, 1896, and complained that since an attack of influenza four years previously, she had suffered from an offensive discharge from the left ear and been quite deaf.
" I cannot hear the clock tick when lying on the right side ; I could not hear if one spoke to me while I was lying thus."
SSS'^STSST VISCUM ALBUM. 479
Ravtow, Aug. 1, IdBS.
She was given salph. 80. One doser On March 9th, the left tympaham presented a reddened appearance in patches apon its surface, and the state of her hearing was as follows: —
W» X* lis o« X« ft
Left ear 2 in. 7 in. 2^ yds.
Tincture of viscum album 8, 6 drops twice a day. Sunday, May 19th, 1895.
W. T. N. S. T, P.
Left ear ^ in. 16—16 6 yds.
Cash VH.
Miss H., aged about 40, black hair, dark brown eyes, rather short and stout, healthy looking complexion, consulted me on Jan. 81st, 1898. She says she has been deaf in her right ear 12 years ; it came on after a low fever ; the left ear has been getting worse for three or four years. She can hear people talk when they 8pe£^ directly to her, but cannot hear the conversation in a room unless very loud, or a person addresses her. There are no sounds in the head or ears, and no throb- bing. Her general health is very good.
W. T. N. S.
Bight ear. Not on contact. Not at all.
Can hear a clock
when put close to
her ear, but not
a watch. Left ear 4 in. 15 in.
Viscum alb. 8, 12 drops in half a tumbler of water ; a dessert-spoonful three times a day between meals.
Monday, February 28th. " I fancy sometimes I hear the clock tick better and people's voices better."
Has frequently had slight earache just for a minute in the right ear once or twice a day, also occasionally in the left ear.
W. T. N. S.
Bight ear. Not on contact. Hears just like a
vibrating noise. Left ear 8—9 in, 66—58 in.
On examining the ears, I found the left tympanum of a pearly colour, rather crinkly in appearance, and with
480 viBCUM ALBUM. *^KI!^"frTS?
Review* Anf . 1, iSK.
one or two dilated eapillaries passing over the handle of the malleas. The right tympanum was in parts pearly looking, in other paxts a white band was obserred running round portions of it at its lower part, and again higher up, as if it were in a state of calcareous degeneration.
Casb vin.
Edith P., aged 25, a farmer's daughter, with dark hair, greyish-green eyes, pale face, and of medium height and stoutness, consulted me on Jan. 28rd, 1898, and said that she had been deaf ten years. She knows of no cause ; it did not come on after either measles or scarlet fever, as the latter she has not had, and the former only two years ago. She says she has a slight discharge from the left ear. None of the family are deaf. It seemed to come on very gradually. Tears ago she used to suffer from earache. She has been very well in health. Her throat has never troubled her.
|
W» T. |
H. 8. |
|
|
Bight ear |
7 in. |
11 in. |
|
Left ear |
2 in. |
6 in. |
U^ed to get singing noises in her head at one time, but not lately. On examining the ears with Brunton's otoscope, the meatus was found clear ; the patch of light fell to the left ; the head of the malleus and shaft were very clearly seen and presented a white appear- ance ; the tympanum looked as if collapsed ; in the left ear on the surface it seemed dull and moist. Yiscum alb. 8, 12 drops in half a tumbler of water ; a dessert- spoonful three times a day.
Sunday, Feb. 6th. Her friends, and she herself, think her hearing rather more acute, w. T. N. s.
Bight ear 9 in. 24 in.
Left ear 5 in. 14J in.
Continue. Thursday, Feb. 10th.
Bight ear 10^ in. 82 in.
Left ear 10| in. 27J in.
Continue.
Wednesday, March 2nd. She says " I can hear much better." She looks bright and cheerful. She thinks the
tS^SSTUSS^ VISCITM ALBUM. 481
medicine has made her feel giddy, and she has not taken the fall dose. One day she did not take any medicine and that day her head felt better. The left ear kept throbbing and she says her throat was swollen, and there was some difficulty experienced in swallowing. She can hear me talking very well to-day when I speak somewhat loudly ; this she has not done before. Her friends at home think there is great improvement.
W. X. II. o.
Bight ear 16 in. 72 in.
Left ear 34 in. 2^ yds.
She says she hears better when she is not tired. Con- tinue. March 80th. Still improving.
w. T. N. s.
Bight ear 20 in. 8 yds.
Left ear 48 in. 8 — 3 J yds.
Wednesday, April 27th. Hearing still further im- proved.
Bight ear 21—22 in. 4—5 yds.
Left ear 50 in. 4 — 5 yds.
Case IX.
Mrs. A. aged 80, the mother of three children, dark brown hair, grey eyes, stout, rather under medium height. On Tuesday, Feb. 15th, 1898, she consulted me about her left ear. She has heard very little in it since she was nine years old. It began with a violent earache. Had measles near about that time, and thinks it mav have come on after that. After the aching it discharged, and it has run more or less since ; the discharge is very offensive; she can scarcely bear the smell of it. Last Friday it started aching. The discharge stops as soon as the aching begins. It has been in a sort of grumble ever since till Sunday night when it became fearfully bad after coming home from church. It seems to come on in fits, quietens down a bit, and then comes on again. '' The pain is just as if some one were trying to screw my ear out. I always seem to want something warm on that side ; the outer part of the ear gets very cold. It seems to affect my nose too— that side of it getting like ice. My head seems quite heavy ; it is like a great lump." On examination, I find the tympanum
Vol. 42, No. 8. 2 X
482 VI8CDM ALBUM. "SSSr^^^TiS^
Beviev* Avg. 1, laW.
ruptared, and looking through the circular aperture of the rent, a dull red fleshy-looking mass presents itself to the eye. There is no tenderness on pressure over the mastoid region ; the worst pain seems to be just behind the lobule of the ear. " If I lie on the left side of my head, on lifting it up, it feels as if a ton weight were hanging from that side of my face." If the gathering is going to break she will hear a hissing, boiling sort of sound for an hour, then it will pop and she knows it has broken, and gets relief. It often does like that, going on for a month or two, then gathering and breaking.
Yiscum alb. 80, 12 drops in half a tumbler of water, a dessert-spoonful every two hours.
Wednesday, 16th. "I have felt better nearly all day till now again. It has come on since I came out. I slept better, only rather restless. When I did go to 9leep I seemed to get a nice sleep. After I have been asleep I seem to wake up with a start — feel so frightened and shake. It has not been like real pain to-day : a sort of grumbling feeling." It only came on severely since she came out. On examination I find the ear in a similar condition to what it was yesterday.
Monday, February 21st. I called two days after the above entry to see one of Mrs. A's children, and found Mrs. A herself busy at work, singing ; and looking quite bright and happy. She said all pain was gone, and it had not discharged. She never remembered such an experience before. Every attack of this sort she has had previously has invariably ended in an abscess and its discharge externally.
The nine cases just recorded may serve as samples of the results obtained by me in the treatment of affections of the ear by viscum album.
From the material at my disposal I could have fur- nished more, but these may suffice. With regard to the cases themselves I cannot help wishing they had been more satisfactory. No one can feel more than I, how much is left to be desired, but knowing the general hopeless- ness attending a good many of our efforts in this direction, it is well that attention should be called to a remedy that appears to exert a specific influence- upon the orgaii of hearing, and which will be found useful in
u^Ja^T"^'" beviewb, 483
the treatment of many troublesome and difficult cases of ear disease.
In those depraved constitutional types in which most of those cases occur, it is often difficult to prosecute for long any particular line of treatment. When matters are improving, and one is looking for some definite result, the patient develops some fresh illness, such, for example, as an attack of tonsilitis, and oar labour, for the time at any rate, is lost.
REVIEWS-
Twenty-two Years* Experience in the Trsatment of Cancerous and
Other Tumours. With an Introduction on the Increasing
Prevalence of Cancer and the Remedy for that Increase. By
Hbbbbbt Snow, M.D. (Lond.), Surgeon since 1876 to the
Cancer Hospital, Brompton. London: BaiUidre, Tindall
& Cox. 1898.
This, the most recent work from Dr. Snow's pen, reaches us
almost as we are going to press. The subject is one of such
importance, and even a cursory glance at the book shows it to
contain so much thoughtful and original material, that we are
glad to lose no time in bringing it to the notice of our
readers. Very briefly we may summarise some of its leading
ideas. Cancer is a product of civilisation, and is largely on
the increase. Statistics are given to prove the latter
statement. Allowance, so far as we have noticed, is not
made for improved diagnosis during the last two decades.
** Cancer is in no sense of the word a ' constitutional '
disease " (p. 26). Indeed, <* no cancer ever arises without an
oMmu exciting cause (italics ours) whether there have been
cancerous ancestors or not " (p. 14).
The contagiousness of cancer is dismissed summarily. <' No husband ever contracted the disease from his wife, or vice versa.'* Dr. Snow's experience of 22 years, during which he has paid special attention to cancer of all kinds, entitles his opinion to respect. We are, however, surprised that he can speak so dc^pnatically ; *' ever " is a strong word, and a much more limited experience, with less of the interest of a specialist, hardly leads us to think its use here in so unqualified a manner is warranted. With his view that locality, climate, etc., have little or no influence, we should more readily agree. Dr. Snow has been one of the most prominent men in associating the development of cancer with mental strain. His views have been widely adqpted, and it is to be hoped that some day they may bear fruit of a prophylactic nature. Connected with this
2 1-3
484 MEETINGS. ''S5S&^A^"?'?S!S!
Eerlew, A119. X. 18B6.
hypothesis is a therapeutic deduction — 'Hhe only drugs which arrest its career are neurotics having a special influence on the cerebral nerve centres/* He says this arrest may be " so complete and so permanent as hardly to fall short of cure/' under Cavourable conditions. The practical application of this hopeful view is the somewhat barren one that opium ranks first, cocaine second. Are these indeed the leading . << neurotics ** ? What of arsenic and phosphorus ? to mention only two others.
En passant we may note a statement new to us, though if it be a fact it ought not to have escaped our notice, and will be welcomed by our readers who Imow how to turn such knowledge to use : <' In monkeys cocaine produces the symp- toms of exophthalmic goitre."
Chapters on the proper surgical procedures, and on Dr. Snow's views respecting bone-marrow infection, are well worth reading ; indeed, this is true of the whole book.
Criticism might be offered on many points, but with the present imperfect state of knowledge of a positive. character it would be premature. The subject is of such importance as to demand the thoughtful consideration of all who have any opportunity of throwing light upon it.
MEETINGS.
BRITISH HOMOEOPATHIC SOCIETY.
Annual Assembly.
The first meeting of the annual assembly was held at the
London Homceopathic Hospital on Wednesday, June 29th,
Dr. Edwin A. Neatby, President, in the chair.
Dr. Norman Webster, of Guernsey, was elected a member of the Society.
Section of Maticru Medic a and Thbrapeutics.
A discussion on *' Gastric Hemedies " was opened by Dr. Stonham by a paper on Simple Dyspepsia. The author first surveyed the principal facts in the physiology of digestion. He then pointed out that a break-down at any point gives rise to the various symptoms grouped under the name of dys- pepsia. He referred to deficiency and alteration in the saliva, deficiency in the biliary secretion, and atony of the muscular wall of the stomach. The chief symptoms of dyspepsia were passed in review and their relationship to their remedies dis- cussed. The paper was a very full one, and the indications for the use of the different drugs completely gone into, but con- densation would do injustice to it.
A disouBdon followed, taken part in by Dr. Blaokley, Dr. Ord, Dr. N. Boehe, Dr. Moir, Dr. B. Boohe, Dr. Oolds- brough, Dr. Epps, Mr. Knox Shaw, Dr. Goldsmith, Dr. New- bery, Dr. Lambert and Dr. Neatby.
The second meeting was held on Thursday, Jane 80th, Dr. Neatby, President, in the obair.
Dr. Gash Seed, Dr. E. B. Boche, and Dr. Ord were elected Fellows of the Society.
Dr. J. J. G. Pritchard, of Dewsbnry, was elected a member of the Society.
The following officers were elected for the session 1898* 1899:—
President : Dr. Arthur Clifton.
Vice-Presidents: Dr. Burford, Dr. Epps.
Treasurer : Dr. Galley Blackley.
Council : Dr. Clifton, Dr. Burford, Dr. Epps, Dr. Blackley, Mr. Dudley Wright, Mr. Knox Shaw, Dr. Byres Moir, Dr. Goldsbrough, Mr. C. J. Wilkinson, Dr. Stonham, and Dr. A. E. Hawkes (representative of the Liverpool branch).
The following sections were elected : —
Materia Medica and Therapeutics: Mr. Wilkinson, Dr. Hughes, Dr. Epps, Dr. Ord, Dr. Dyce Brown.
Medicine and Pathology : Dr. Moir, Dr. Blackley, Dr. J 'ay, Dr. Epps, Dr. Goldsbrough.
Surgery and GynsBColo^: Mr. Knox Shaw, Mr. Dudley Wright, Dr. Burford, Mr. Johnstone, Dr. Neatby.
Library Committee : Dr. Blackley, Dr. Burford, Dr. Hughes, Dr. Neatby, Mr. Knox Shaw.
Mr. Knox Shaw, who had acted as Honorary Secretary to the Society for six years, presented his resignation to the Council the previous evening, and gave a report of the progress of the Society on the 80th ult. His retirement was most regretfully accepted, and early in July the Council elected Mr. James Johnstone as his successor.
During the evening Messrs. Downs Bros., of St. Thomas Street, made a display of surgical instruments, and Mr. Young J. Pentland, of Smithfield, and Mr. Kimpton, of Holbom, of medical books.
THE AMERICAN INSTITUTE OF HOMOEOPATHY. Thb fifty-fourth annual meeting of this body was held at Omaha, Nebraska, on the 2drd June. The President, Dr. A. B. Wright, of Buffalo, being in the chair, and after addresses of welcome to the members had been delivered by Dr. Wood, the chairman of the local committee of arrange- ments, by the Mayor of the City and the Governor of the
486 MEETisos. "Sa^PiST^g!
State of Nebraska, and suitably acknowledged by the Presi- dent, be delivered bis annual address, in which he dwelt on the constitution of the Institute, on medical expert evidence, on forestry, the completion of the Hahnemann monumeut at Washington, on training schools for nurses. He made the following remarks on the
MaTEBIA MBDtOA.
*' Now let us come to the item that is first in importance to this Society, and dear to the heart of every homoeopathist, our materia medica. In the early years of the American Institute its principal thought and work was on materia medica and clinical medicine. And good thought and good work it was. But the commendable work in the collateral sciences has absorbed so much of the time of our sessions that materia medica has been partially obscured and apparently relegated to second place. Yet tixe same men are working as ever, the committee on drug-proving liave done good work, and the materia medica conference has shown a faint renewed of interest in materia medica ; but the majority of the profession have not given it the attention which its importance demands. Yet how shall we effect a revival ? Only by increased activity in work. The lamented J. P. Dake agitated for several years a plan for a National Provers' College, but the scheme involved so much work and capital that it was impracticable.
** Drug-proving at the present time may be more satisfiebctory than that of twenty-five years ago. Through discoveries in chemistry and electricity, the use of new instruments of precision for physical examinations, eic, physical conditions and pathological changes, which could not be discovered at the time most of our provings were made, are now possible of being noted with great precision. With this assistance much chaff mi^ht be eliminated, and perhaps valuable symptoms added. We have such a perfect system of materia medica that the addition of any number of properly proved remedies cannot destroy its harmony. Our existence as a school of medicine depends on our maintaining and enlarging our materia medica. The demand is on us to do this as a material benefit to medical science. As we prize our materia medica, let us enrich it with additional reliable provings. so that when future generations of this Society make pilgrimages to Washington to see the classic bronze we have builded in honor of homcBopathy and its founder, thev shall take jusc pride in their loyal ancestors of the nineteenth century/'
During the week papers on a variety of topics bearing upon medical, surgical, and obstetric subjects were read and dis-
^jertow; Aug. 1,1896. NOTABILIA, 487
ooBsed ; the meetings adjourniaig; on the 80th to meet next year at Atlanuo City, New Jersey, having previoasly elected Dr. B. F. Bailey of Lincoln, Nebraska, as President ; Dr. Arthur B. Norton of New York ; and Dr. Sarah J. MiUsop of Bowling Qreen, Eentuoky, as Vice-Presidents ; Dr. Porter, and Dr. Kraft, Secretaries; Dr. Kellogg and Dr. Franklin Smith, Treasurers.
NOTABILIA.
SIGNATURES AND SIMILARS. A CUTTING we have received from the English Mechanic and World of Science, for July Ist, 1898, shows that the bruit of the play enacted at the recent Congress has travelled far. A correspondence seems to have been going on in the columns of that journal on the subject, the nature of which we divine from the reply elicited, shows that homoeopathy has suffered " in the house of its friends," more seriously than Dr. Clarke ever expected it would do. We make some extracts from the reply to the English Mechanic : —
**I do not quite gather from letter 41,200, in the issue of June 17th, if < S. S. C." really does suppose that the old for- gotten medical superstition of ' Signatures,' an attempt to revive which was made recently, as reported in this journal on June 10th, is identical with the other formula of ' Similars ' still used as a dogma to indicate the basic principle of homoeopathy.
'* If * S. S. C actually has made this extraordinary error, he has certainly completed for us the humour of the otherwise utterly insignificant episode; I must remind him that the society before which the paper setting forth the quaint old doctrine of < Signatures ' was read, and the body of medical men for whom he expresses such contempt, consist of medical men who have passed through precisely the same professional training, and hold the same degrees and diplomata, as every other legally-qualified doctor in the British Islea ; that their methods and scieutific knowledge are as up-to-date as those of the foremost of their orthodox brethren ; and that, until the point of selection of a drug for therapeutic use is reached, the homoeopaths work and thuik on much the same lines as aJl the rest of the profession. Can * S. S. C really think that this body of educated men would accept and base their practice upon that eccentric dogma of ' Signatures ' ? If he does so think, he offers a dehberate insult to men whose attainments are infinitely beyond his comprehension.
'* Of course, like others who are absolutely ignorant on the subject they so easily run into print upon, (<S. S. G.') supposes
'488 NOTABILIA. ^2S&
B«view, Ai«. 1, vm.
that the small quantity of medicine given forms an essential part of homoeopathy. Ooee more, and for the hondredth time, I assert thai kofnaapathy can be practised with doses of any nuig- nitude^ so far as qaantitj is concerned. Homoeopaths do not ciaim that they ase minute qoantities exclusively ; it is not the amount, but the molecular form or state of subdivision of the drug, which is essential. The only limit as to quantity is that less shall be given than will aggravate the disease symp- toms ; and even this is denied by some, who find that rapid alleviation of symptoms often comes directly afier a sudden increase due to the drug given, when this is really homoeopathic to the symptoms — ^i.^., it is capable, in health, of producing those symptoms which are found to be relieved by it in disease.
' *' I should never have imagined that anyone could so mix up the two terms * Signatures ' and ' Similars ' as to take them for the same definiticms ; but * 8. ti. C seems actually to have done this, and he writes, in letter 41,200, in the issue of June 17th, in a way which suggests that he thinks the recently- exhumed mummy doctrine of * Signatures ' is a dogma actually supported by the homoeopathic school. It may be well, perhaps, to supplement the paragraph which appeared in the * Scientific News ' columns of this journal on June 10th (why it could possibly have seemed worth the space I cannot in the least understand), and which recorded one eccentric idea in one paper, which was scarcely regarded as of any importance at the meeting, so that in the large and representative assembly there was found only one member to support the author of the paper (the Annual Congress of Homoeopaths in London^ ; and to add that in the British Isles there exist perhaps naif a dozen more of that opinion. The thing is merely a perplexing personal notion held by the reader of the paper in question, who wishes to revive as a serious opinion the old doctrine, or medical superstition (as it appears to me) of ' bignaturen,' which, with a host of dogmata equally curious, has been forgotten for a long period of time.*'
4i Ht * «
''Some Essentials.
'' First of all, and the verj heart of homoeopathy, is this. The conviction that there is, m the human physical constitu- tion, a vis medicatrix natura, or a strong * tendency towards recovery from illness,' a ' recuperative power,' and that it is by working with not against this force, that disease is best alleviated. Where is the absurdity here ?
'* Next, and the outcome of that main principle — that the s^mptonvs-of disease — our working data — should be regarded
ll::S^Sr!lSSSf^ j^otamlia, 489
as the indications of the working of that reouperatiye force in its fight against the disease action, and therefore that the symptoms are not necessarily evidences of movements to be opjm§d by drugs which will suppress, stifle, or conceal them, but are generally such as should be so treated by medicines that the physical movements (a really fitting term is difficult to find) shall be rather aided, even sometimes increased, by the use of drugs capable of producing similar efiects. We must ' push where Nature pulU,'
<' The considerations underlying homoeopathy are mainly, in addition to the above vital articles of belief: —
'* A medicine, to act curatively, must enter the blood-stream ; otherwise it cannot reach the special organ a£fected.
<* A medicine, to enter the circulation, must paas, by osmosis, through the infinitesimally thin membranous walls of either the absorbent or capillary blood-vessels of the stomach or other mucous sur&ce.
'* This osmosis must mean that the molecules of the drug have to penetrate between the almost unimaginably minute intervals between the cells forming the membranous walls of the vessels. Therefore, extremely minute subdivision of the drug must be secured.
"Every substance which, when taken into the body, produces perceptible effects on it, does so by virtue of a special * power of elective affinity ' it possesses ; and these affinities are proved best by the effects of the drug taken in fall doses m health*
" That the symptoms thus produced by a drug are the evidence of its particular sphere of action, its ' patho-genetic ' or symptom-producing action.
'* And that this action, being in each instance the analogue of some similar group, or combination of disease symptoms, is the indication which points to its use in the treatment of disease — i.e.y the * Patho-genetic ' sphere, is identical with the ' Therapeutic.'
*' And, perhaps, as important as any : That the organs and tissues which in health are specially affected by a drug, are intensely more sensitive to that drug's influence when disordered or diseased. Will ' 8. B. C* please note ? The belief is, that the diseased organ is more sensitive and receptive to the drug, by many ten thousaud fold, than it is in health, and wUl benefit by a correspondingly attenuated drug.
'< Finally. — That there are four available tests to prove the
presence of a drug, and that the three first may utterly fail to
show that a trace even of the drug exists ; and then the
-fourth, more delicate by fEur, will prove that the drug is there,
by the curative effects it produces. The four tests are —
490 UOTABILIA. "SSSL=lS?r^
Beview, Aug. 1, 1806.
*' 1. The microseope and toaoh.
^^ 2. Ghemieal testa.
*' 8. The crude irritant e£fectB on stomach, &c., which are Joroed to cast oat the drug, and to prevent its entering the circulation (as purgatives, emetics, &c.) And,
*' 4. The physiological test of the extreme sensitiveness of some diseased organ to the action of the drug.
'' ' S. S. G.' wants the third form of test— the most uncertain and crude of all. Before he will take a drug to iielp him in illness, he would prefer to bring disorder on some part which was, up to then, in healthy condition, rather than to accept the benefits of the fourth test« That is the test he could well try, out of the medicine-case ; but he must remember that it is the disordered organ which alone would respond to the test, and that it would do by getting better or
well. No amount of verbal discussion can equal that test.**
* * * ♦
If S. 8. G. desires to be further enlightened as to the views of the founder of the homoeopathic system, and of every practitioner of homoeopathy since his day — except two — on the notion of '* Signatures," we refer him to the leading article in this number of the Review, p. ^49.
HOMGEOPATHY IN TASMANIA.
The history of homoeopathy in our colonies bids fair to closely resemble that which has characterised it in Great Britain. Violent opposition at the commeaoement, rapidly followed by determined ostracism, both social and professional, of aU medical men who openly acknowledge their confidence in it as the scientific basis of drug-selection, in the treatment of the sick, whenever drugs are calculated to cure disease. Then has followed a revolt both of patients and doctors. They decline to endure such ostracism ; and, as the most effeotive protest against it, steps are taken to make the meaning of homoeopathy, the results of following it out in practice, and its advanti^es known wherever men can read and think.
Such has been its history here since 1827, when the late Dr. Quin came to practise in London. Such has been its history in Tasmania, since it was first heard of there in the early sixties. Lately the opposition of the profession has, under the direction of the British Medical Association, become unendurable. The result is, as we noticed briefly last month, the establishment of the Homoeopathic Associa- tion of Tasmania and the issue by it of a monthly paper .published at Elobart and designated The Tasmaman Homao- pathiv Journal, of which we have received a copy. A cireular
Sw^fSSTSa' NOTABILIA. 491
issued by the Association defines as the objects of the Asso- ciation—
1. To demonatiate the scientific basis of homoeopathy.
2. To maintain and uphold the absolute right of every legally qualified medical practitioner (as all homoeopaths in Tasmania are) to employ any system of medicine he may think best without thereby incurring any loss or diminution of professional status.
8. To promote the interests of homoeopathy by the inter« change of ideas, and reading of occasional papers relating thereto, and to keep the adherents of homoeopathy more in touch with one another.
The Tasmanian Homaopathic Joumaly in its leading article* states that *' its appearance is the consequence of a necessity of the times," and proceeds to describe the circumstances whidi have rendered it a necessity. It commences by stating that '* So far as legal qualification is concerned, the medical faculty in Tasmania has hitherto stood upon an equal footing. jNo one is entitled to practise for fee or reward in this colony unless his name be on the register of a legally constituted * Court of Medical Examiners,' and no one can have his name placed on the register of that court unless he can produce a British diploma, or a colonial or foreign diploma, proving that he has received a medical education equal to that prescribed by the Boyal College of Surgeons in England. This is the safeguard which the law of Tasmania provides for the protection of the public against charlatans or quacks. The law does not recognise any particular system of medicine, but leaves every duly qualified practitioner to treat his patients according to his best judgment, with the most modern scientific remedies at his disposal.*'
The editor then gives the position which has been forced upon medical men openly practising homoeopathically . * ' Some years ago— back in the sixties — homoeopathy first attained a sound footing in Tasmania, and the faculty of that day endeavoured to make a stand against it. They did succeed in keeping it out of the general hospital, but, in practice, public opinion was strongly against them. Good men came here from the other colonies, delivered lectures on the new school of therapeutics, the sympathies of the public went out to them, and it was soon evident that homoeopathy had come to stay. A few years later special homoeopathic pharmacies were established in Hobart and Launceston ; they had their branches in the leading country towns, and the adherents of homoeopathy increased and multiplied exceedingly. Since then there has been little friction between the systems. Excepting in one or two cases, practitioners of both
492 NOTABILIA. "SS^flSr?S£
schools have met in friendly consultation, giving their best efforts in the cause of suffering humanity, and> we may be excused for saying, with the best results. Recently a change has < come o'er the spirit of their dream.' A branch of the ' British Medical Association ' has been established in Tasmania, and the first result has been that the allopaths have given formal notice to their homoeopathic brethren that they must decline to meet them in consultJEition^ must refuse even to administer chloroform for them in opera- tions, and that they are to be boycotted in other directions. Well, ordinary human nature might properly resent this kind of dictation, and we presume homoBopathic physicians and lay homoeopaths are not superior to ordinary human weakness. The first result of the action of the practitioners of the older school has been the formation of a Tasmanian Homoeopathic Association, in which North and South have cordially joined hands ; the second result is the publication of our Number One, and we sincerely trust the next result will be the establishment of Homoeopathic Cottage Hospitals in Hobart and Launceston* and afterwards in provincial towns wherever they may be necessary. The public will then be able to judge by authoritatively tabulated results as to the merits of the two systems."
He then states that '< the object of the Association and of this journal will be to demonstrate the scientific basis of the system known as homoeopathy, and to advance this particular school of medicine."
After a brief definition of homoeopathy, he gives a short outline of Hahnemann's career, a quotation from a lecture by Dr. F. F. Moore, of the University of Harvard ; and concludes by saying that ** M that is asked is, that medical men will ' give the subject careful and unprejudiced investigation, and openly and candidly acknowledge the truth to be found therein.' So far back as 1846 the professor of pathology in the University of Edinburgh declared his conversion to homoeopathy, and in a telling speech said : — ' Let us then eitend to our homoeopathic brethren the right hand of fellowship, that the reproach of bigotry and intolerance may be removfd from us, that the truth may be advanced, and the day hastened when medicine will know no schools, but be represented by one body, working with renewed strength and vigour, and with the one aim of advancing medical science and the best interests of humanity.' This is sound advice, which the medical faculty in Tasmania, if wise, will do well to follow."
We heartily desire that our colleagues in Tasmania will fully succeed in their efforts at achieving complete freedom
ssjsiriErrss?** notabilia. 493
of opinion in the pnictioe of medioine in their colony, and hasten the time when the generous sentiments so eloquently oxpressed by Professor Henderson will be completely realised in their midst.
We are glad to notice that the new Association is heartily supported by the Colonial Press. As an illustration we quote a paragraph from The Launceston Examiner (May 21)«
'< HoM<BOPATHio League. — ^A meeting of this Association was held on Thursday evening last, at Mr. Henry Bitchte's ofiBce, when it was unanimously decided to amalgamate with the recently formed HomcBopathic Association in Hobart, the whole to be called the Homoeopathic Association of Tasmania, with centres in Hobart and Launceston, and in all probability branches on the .North- West and West Coasts and other districts. The amalgamated Associations promise to become in the future a strong organisation, as members are flocking in from all parts, the objects being to demonstrate the scientific basis of homoeopathy, to advocate that all legally qualified medical practitioners shall hold the same professional status, whatever system they may employ, and to keep the adherents of homoeopathy in touch with one another. At the meeting the establishment of a Homoeopathic Cottage Hospital in the near future was warmly advocated."
HONOURS TO MEDICAL MEN. DB. GEOBGE CLIFTON.
A NoBTHAifPTON paper of about the middle of July makes public the following news, which has been an open secret with a good many for some time. We quote the paragraph in its entirety, and join heartily in our contemporary's con- gratulations.
<* Many congratulations to Alderman Dr. Clifton, of Leicester, on his selection for the Mayoralty of Leicester for the coming municipal year. ' Alderman Clifton is one of the best known men of Leicester. He is brother to Dr. A. C. Clifton, of Northampton, and, like him, is an ardent homoeopath. It is nearly sixteen years since Alderman Clifton was first elected for the old North St. Margaret's Ward, Leicester, on the death of Mr. John Holmes. Nine years later, in November, 1891, he was raised to the Aldermanic Bench, as a fitting tribute to his very valuable services in both the Council Chamber and the Committee-room. Having the responsibility of a large professional practice, he has necessarily been unable to devote as much time to the work of the Committees as members with ample leisure. As chairman of the Lunatic Asylum Committee, however, he has still contrived to roAder
494 NOTABILIA. ''S?S'^^AT?f3«f
services which it is by no means easy to overrate, and by which he has contributed materially to the efficiency and development of the institution. The Alderman has also from time to time taken an active part in the work of the sanitary, watch, sewage, and other departments, and has altogether placed his slall and time ungrudgingly at the command of the ratepayers. The Mayor-elect, accordingly, has signally earned his promotion, and may furthermore be confidently trusted to maintain the best traditions of the civic chair. The seleo- tion of Dr. Clifton was made on Wednesday night, at a private meeting of the Leicester Town Council, when the proposal of Alderman Lennard was unanimously agreed to."
DR. VICTOR BLAKE.
A coRBESPONDENT seuds the following cutting from a local paper of which the name is not given. We congratulate our colleague Dr. Victor Blake on his rapidly acquired position, and trust his professional career may be not less successftd and distinguished : —
** Hearty congratulations to Dr. Victor Blake, member of the British Homoeopathic Society, on his election to the important and honourable position of County Alderman for the Isle of Wight. Dr. Blake is a young man, and a comparatively new comer to the Island, and it speaks well for his enterprise and ability that he is already a county alderman, a member of the Ventnor District Council, a surgeon- lieutenant in the volunteers, a prominent member of the local cricket club, and a gentleman connected with various other departments of Ventnor Ufe, besides being an esteemed member of the medical profession."
TUNBRIDGE WELLS HOMOGOPATHIC HOSPITAL
AND DISPENSARY.
Thb report of this institution for 1897, which we have just received, tells us that during the year 86 patients have been received mto the Hospital, these with 7 in the Hospital on the 1st of January, 1897, give a total of 92 for the year. There was one death among these, but the remaining 91 were discharged greatly relieved or cured. 2, 508 dispensary patients have been under care, 2,208 visits have been made to patients at their own homes, and 794 patients have received attention by the Honorary Dental Surgeon.
Consulting Physician, Dr. Burford; Consulting Surgeon, C. T. Knox Shaw, Esq. ; Physician, Dr. Neild ; Surgeons, J. 0. Pincott, Esq., and P. Capper, Esq., M.B.
li^^S^STuSSt" NOT^ILIA. 496
HOMCEOPATHIC PHABMACEUTIO ASSOCIATION
OF GREAT BRITAIN.
We are glad to hear that this Association, of which we had not heard for several years, was revived, at a meeting held in Harrogate, last April. The President is Mr. Pottage of Edinburgh; Treasurer, Mr. J. C. Thompson, F.L.S., of Liverpool ; Secretary, Mr. F. Foster, of Scarborough. The next meeting is to be held in London, when Mr. Foster will read a paper on Tablet Making.
AN ANALOGUE OP RHUS TOXICODENDRON.
Dr. Dtce Bbown has received the following interesting letter from Admiral Selwyn : —
"Dear Dr. Dyce Brown, — I know you are interested in anything that may turn out to be a new and valuable homoeo- pathic remedy, so I send you an extract from the Journal oj ths Society of Arts, June 17th, 1898, p. 669.
"No. 19 Semecarpus coriacea, Flora Brit, India, vol. ii, p. 82.
" In Singalese * BaduUa ' a common tree found over most of the hill country above 4,000 feet. This wood is sometimes used for tea chests in Ceylon, but it is considered too bad owing to the risk there is of getting any of the milk (Singalese ' Badulla Eiri ') on the skin as it at once sets up a violent inflammation. May not this be a remedy for eczema 7
" Very truly yours,
" J. H. Selwyn. " 186, Gloucester Terrace, Hyde Park, W., June 28rd, 1898."
MEZEREUM v. MERCURIUS. Thb Medical Era (Chicago, 1898) gives an interesting paper by Dr. Hanehett on mezereum. We quote it in full :
" During the past few months I have had such satisfactory results, In four or five clinical cases, from the use of meze- reum where I had febiled with mercurius, that I have become somewhat enthusiastic over the drug. I am well aware that mezereum is a medicine little referred to in many of our Materia Medicas, and very little used by most of our practi- tioners. In my own practice, while I have always had the drug in my case, I have seldom prescribed it until recently. A few months ago a patient came to me from a remote part of the State for treatment. The symptoms were somewhat peculiar, although I thought it a mercurius case. After fedling
496 soTABiLiA. '^saSr^aysnar.
wiih mercurius I carefully cast about for a medicine more suitable to the case which mercury had failed to help. I found this remedy in mezereum. In this case, and the other cases in which it has proven such a friend, the symptoms were some- what peculiar, and in closing this paper I will relate them in brief.
*< I hope that the members of this society have had even "ft wider and more satisfactory experience than I have had myself, and that by your discussions I may learn more of the drug, and add new symptoms to my small tested list. As you are all aware, mezereum is a vegetable^ the spurge-olive.
<'My special reason for taking the- subject mezereum v. mercurius, is to contrast the two drugs, and to try and show that many cases, which at first appear to be mercurius cases, are really maladies which have been aggravated by mercurius and which, in many instances, may be helped or cured by mezereum. Hence, I will almost say that mezereum, in a way, is antidotal to mercurius, while many of the general symptoms seem to be the same.
*< In the first place, I believe mezereum will cure more of those cases, which we may call a cross between syphilitic and mercurial poisonings, than any other drug. Mercury has, through all time, been given so freely and frequently for all syphilitic trpubles, indiscriminately, that each of us has often seen a condition hard to distinguish from a poisoning from mercury grafted on to a syphilitic constitutional disease. It is in this class of cases that I have found mezereum so useful. In these cases I had often given nitric acid, and as I remember my teaching in college and most of my reading since, nitric acid has been given as the great remedy to follow the abuse of mercury. It was after the failure of nitric acid to help my patient that I found and feared I had this mixed condition of sjphiHtic trouble with mercurial poisoning. While the symptoms for nitric acid are quite clear, and there seem- ingly should be no mistake as to its use. following a mercurial case, yet sometimes the distinction is so nice that it is hard to be sure, before trial, that nitric acid is our remedy. I cannot say that the mezereum symptoms are better marked than those of nitric acid, but I can merely state that with the following symptoms, I have found mezereum to do wonders.
'' Mezereum is a drug which I believe is used in all schools of practice, and I have seen it stated somewhere that in tin^ wonderfully advertised Hood's Sarsaparilla, mezereum is one of its main ingredients, and much depended upon to correct the syphilitic and scrofulous diathesis. I do not pretend to say that mezereum may not be the original remedy in many oases of syphilis instead of mercury, or any other drug for that
SSSSf^TTfig^' NOTABILIA. 497
toMet ; but I do Miev^ thai H i« m<M often ttdkd for where meicnfins bae spoiled the eem for a good meat erf. Some of oar writers give it pre-eminenee in the iiiilctenee it has apoa nodes and nototnrnal bone pain<f. Hahnemann, in some of hi0 writings, states thai! it will prodooe severe pains in the cranium, and also that it prodnees intense paiBS in the long and flat bones, especially in elaviole «id thigh. One writer states that it is one of the best remedies in rbeumatio periostitis. The pains of meeereum are qniek and shifting ; they may be sharp or doll, but when affecting the bones, the patient complains of the pain being apon the surface c4 the bone. Here is where it differs from meronrios. The meroarial pain is deep-seated, and seems to penetrate the very marrow. It does not cause (he excessive salivation of mercurins, nor does it affect the mucous tissues as deeply. The teeth seem too long ; this is one of its marked symptoms and should be italicized; not that the teeth feel sore as they may feel under mercorius, nor that they feel loose in their sockets as they do under mercurius, but the patient constantly complains of their being too long. If you ask him if they feel loose he states that they do not, that they feel very firm, but very long. Neither do the gums become sore and recede to the extent that they do under mercurius. They recede somewhat but are not inclined to be as spongy, neither are they inclined to suppurate as they may under mercurius. There is said to be a case on record where extreme necrosis of the jaw, produced by phospboms, was cured by mezereum, and it has been prescribed with success in many cases where the bones were considerably affected.
« Mezereum belongs to the cerebro-spinal group, and affects especially the sentient nervous system. It acts freely upon the abdominal viscera. It increases their secretions fireely, producing copious watery stool. It produces griping, cutting pains, nausea, as well as a general gastro-enteritis. As stated above, it acts directly upon the periosteum of all bones, and especially on the tibia. This condition is found in the case of the patimt referred to in the outset of this paper. It is simihur to mercurius in that its pains are usually worse at night. It has been said to cure violent toothache coming on every evening. In truth, it seems to have a peculiar adap- tation to the jaws and teeth. It differs firom mereurius in &at the mercurius pains are apt to be worse while the patient is at rest. The mezereum pams are worse when the patient moves.
** I ha^ fbund It usefdl in cholera-in^suitum, where the einii had been dosed wiith calomel and was of a syphilitic diatihe^s— a sorarwny child With enhorged glands and sallow
Vol. 42, No. 8, 2 K
498 NOTABILIA. >%Sl'=ir7!2£
Beyiew. Aug. 1, 198.
colour. After the stools the reotom remained prolapsed and was inclined to become strangulated. Mercorius has this same condition without the strangulation.
" In some of these cases referred to, I have found nervous rheumatism with flying pains and neuralgia. The symptoms are generally, as in mercury, worse at night, and one of the great distinctions between tiie two drugs, mezereum and mer* curius, is found in the character of the skin eruptions. The mercurial eruptions are generally flat and of a dark copperish colour. The mezereum eruptions are more like vesides coming to a head, apt to be white at the apex. This copper colour, sometimes, I noticed, about the base in the form of a. littie circle. When this vesicle would break it would simply leave a thin scab and disappear without the dark-coloured coppery appearance.
'*As I have emphasized above, my patients complained of the pains being sharp and stitching and flying about from place to place. The condition of mind is not of that deep gloom and morose disposition of merourius. While my patients seemed to understand the gravity of the disease^ from which they were suffering, yet they did not brood over it as I have often seen in so many cases of syphilitic disease,, where I have rapidly and readily cured them with the mercurial preparations.
'* Another characteristic difference which I have observed^ and which I think the writers on this medicine note, is thai tiie mercury patient may sweat freely but is not relieved by the perspiration, while the mezereum patient is usually relieved by perspiration. The mezereum perspiration is not of that peculiar sticky and clammy sweat, which we so commonly see in mercurius. I may also add that while mercury produces many skin affections they are generally of a secondary stage. Mezereum often primarily affects the cutaneous surfaces. Mezereum we may class among the skin remedies. Many of our writers claim it has cured shingles and pityriasis. Mezereum causes intolerable itching and irritation of tbe skin. It also irritates the genito-urinary organs much as cantharides does. In two of the cases where I have recenUy used it, there is a blenorrhea of the urethra in the male, and the urethra and vulva in the female. In one case I found it to correct a very acrid and disagreeable leucorrhea, so acrid indeed that it caused rawness, soreness and swelling of the parts. The entire vagina seemed red and inflamed and extremely sore and swollen. Mercurius also has some of these same symptoms, but the acrid discharge in mercurius seems to be more from a deep ulceration of the mucous surface and not of the general or diffuse inflammatonr
SSSS^HrrKT NOTABILIA. 499
Bariew. Aug. 1, leea
oondidon for which I would think mezeFenm adapted. In these conditions we get the same shooting, radiating and shifting pains that we find in other parts and organs of the body above referred to.
'* Mezereom is recommended by some as a good headache remedy. As a matter of fact, these abased or neglected cases of syphilis are apt to have the peculiar mezereum headache. A headache of compression, or a sensation as if the skull were screwed or bolted together tightly, and that the bony encase- ment of the brain was too small. One of my patients com- plained of periodical nose-bleed. This nose-bleed relieved the peculiar headache. I noticed that my patient's symptoms were aggravated by damp weather. I think this is a symptom which our Materia Medicas give to it, and wherein it agrees with meroury, which is apt to be worse from dampness and damp weather. It is said to be a good remedy for suppressed emptions, especially where the case has been abused by a too free use of mercury. One of my patients complained of much pain in the eyes, of a neuralgic nature ; this was probably caused by neuralgia of the ciliary muscles, and I think it has quite a sphere of action along this line. Undoubtedly my colleague, Dr. Moriarty, our efficient and scientific oculist, can tell us much of its use in this direction. Two of my patients were suffering from a catarrhal trouble of a scrofidous or syphilitic nature, and possibly as the result of mercurial poisoning. As the other troubles grew better by a general oonstituticmal recovery, these catarrhal affections disappeared.
•'Case L
*' A woman about 27 years of age came to my office a few months since, stating that she had been suffering from a private disease which her husband had brought to her. She lived in a remote city in this State. She said she had suffered from the trouble for several weeks before she knew what her disease was. She consulted her fEunily physician, who at once began what he called 'heroic' treatment. The ulcerated surfaces about the genital organs were cauterized, and she was given large doses of calomel. This calomel treatment was continued for several weeks until her system became thoroughly saturated with the mercury. She b^an to have the peculiar bone-pains, both characteristic of the disease and of mercurial poisoning. Her mental symptoms were not marked, unless it may he said, paradoxically, by a lack of mental symptoms. While she was a woman of intelligence and refinement, she did not seem to worry over the gravity of her condition. She did not brood over her family relations. While she felt worse at nighty die slept fairly well. She had taken calomel within
2 K— 2
60? KOTABiLiA. '^g^.'ssyng
the first week or two of her treatment, to complete salivation. However, when I saw hc^r, the gums had healed, although somewhat receded, but her teeth felt too long and she refsrrod to this symptom frequently. She said they were not nre, nor did they '* feel on edge.*' She complained of great pain in the clavicle and thigh bones. The lower limbs were more or less covered with the peculiar vesicular eruptions before referred to, with white tops and copper-coloured rings about the base. There was little, if any, ulceration about the vagina, but an acrid and burning leuoorrhea. As you may imagine, I naturally gave her nitric acid at first, thinking that she had already too much mercury. She reported during the first week, daily, at my office, but under the action of this medidne I could see no unprovement in the trouble ; I think she rather grew worse. I began to study her case more carefully, and concluded that mesereum was her remedy. I gave it to her first in two-drop doses of the mother tincture, three or fimr times daily, wb^ I saw a radical change for the better. I soon followed this with the second decimal dilution of the same drug. The improvement continued. I went on higher until finally the cure was completed with the 6th and 12th. I have occasionally heard from her, and she states that she is perfectly well and happy. The drug, seemingly, had a magical effect, and removed fdl doubt from my mind of her recovery being a mere coincidence. I feel sure that it was a cure made by the use of mezereum.
" Oasb II. << A man about 28 years of age consulted me a few months since, stating that in earlier life he had had syphilis ; that he had taken a thorough course of treatment for it, as he sup- posed. On questioning him as to the kind oi treatment and how it had affected ^m, he said that the medicine must have been very strong, for it had salivated him, and that his mouth had been very sore. He said that his teeth were so loose that he could almost shake them in their sockets, and went on giving the full history of mercurial poisoning. His hair was thin, having never fidly returned after falling out some time before. Much of the scalp was covered with a whitish eruption, the vesicle breaking and leaving these little white scabs with dark rings around the base. Alcmg the ahio-bones the periosteum was rough and uneven, in places being very much thickened. Nodes and mucous excrescences were to be seen. He emphasized the fact that while his mms had healed and his teeth were firm, yet they lelt very long, so long that they even bothered him in eating. I put him at oBoe vpon mezereum tincture, five drop doses every five honzB. Within a week he said he felt decidedly better, and
It^SSTSm^ NOTABILU. 601
the appAaranoe of his head and face was decidedly improved. As is my oastom in using this medicine, I raised about a decimal each week until I had him taking the sixth dilution. This completed the cure. I have seen him repeatedly since, and from his general appearance no one would know that he had ever suffered firom syphilis. The bone-pains had all disappeared and the roughness on the tibia was largely gone.
** Oase m.
"I mention this case because it illustrates what this medicine has done for me in a few cases of bowel troubles with small children. A child one year old, teething, had suffered for some time with intestinal irritation and diairiicBa ; almost or quite a dysentery. After the straining at stool the tectum became prolapsed, and could be put back only with great difficulty, being almost strangulated. The child had a history of ii^erited syphilis, and during its treatment for bowel trouble had been given calomel freely. I gave the child the 8x dilution of mezereum eveiy three hours, with a complete recovery from the dysentery and a general improve- men in constitutional symptoms. The child has grown and developed to a marked degree since its sickness.
** What, then, is Uie general summing up of the sphere of usefulness of this, I fsar, too much neglected drug ? What do we find from a contrast between mezereum and mercury? First and foremost, it is that mezereum is not only an excellent remedy in the treatment of constitutional diseases of a syphilitic nature, and those which have many of the symptoms accompanying this disease, but emphatically, those cases of a syphilitic and scrofulous dyscrasia which have been abused by so-called * heroic * doses of mercury.
''Let me urge those who have not used mezereum in syphilitic cases, where they have been overdosed with mercurial preparations, and where you do not get benefit from nitric acid or any other medicine, to give mezereum a trial. Or, for that matter, give mezereum when you first take your case, with the above marked symptoms as key notes."
CACTUS GRANDIFL0RU8.
Tbx Chmnut and Druggist, in a report of the proceedings of a recent meeting of the North British Branch of the Pharmaceutical Society, gives a summary of a paper by Dr. Gordon Sharp, on "True and False Cactus GrancUflorus." In this he expressed the opinion that plants often used by druggists in the preparation of the tincture of cactus grandi- florus were spurious, owing to botanists carelessly calling cereus by the name caetu$. Dr. Sharp further thought that
602 NOTABILIA, •*Si&^Sr?^
B«Ti«w, Aug. 1, Ifin.
both oerens and opantia were alike worthless, and should be discarded by both pharmacist and physician. Dr. Sharp's history of the therapeatio use of the plant is amusing. He ascribed " the reason of cereus being employed as a heart tonic to the fact that Spanish settlers on the Pacific coast, who got their information from the original occupiers of the soil, employed cereus in dropsy, and that, as many dropsies had their origin in heart affections, the transition from the treatment of dropsy to the treatment of heart affections was an easy one. Cereus opuntia was no more efficacious than the demulcent drinks known to us, such as barley-water, gruel, and others, used in the treatment of dropsies."
We never heard before of *'the Spanish settlers on the Pacific Coast " who employed cactns as a ** heart tonic," nor of any traditions of its value in heart disease having been handed down by them. The first time that the cactus was ever heard of in the practice of medicine was through the medium of a pamphlet, by the late Dr. Bubini, of Naples, entitled Cactus Qrandiflorus : Its Pathogenesis on the Healthy Human Being and Confirmed on the Sick. A translation of this, by Dr. Dudgeon, appears at p. 629 of the twenty-second volume of the British Journal of Homaopathy. It gives a catalogue of the symptoms of disordered health produced by Dr. Bubini*s experiments. It was from these that its value in certain cardiac affections was inferred.
It is from that variety of the plant used by Dr. Bubini in his experiments that the pharmacist ought to prepare his tincture. A good description of it appears in the course of the pamphlet (p. 580 loc. cit.) In Naples it flowers early in July, and though originally from Jamaica and the coasts of Mexico, thrives well in the open air of that mild climate. The plant used by Dr. Bubini was the night-blooming cereus grandiflorus, and may be easily obtained, partially prepared in alcohol, from the West Indies. This has been found to yield a perfectly satisfactory preparation, and to be thoroughly reliable in practice when indicated homoeopathically ; given on any other basis it is probably no more efficacious than Dr. Gordon Sharp's illustration, '< barley-water."
THE BIOHBOMATE TBEATMENT OF GA8TBIC ULCEB. At Aberdeen, Dr. Ashley Macintosh read, for Dr. McHardy (Cullen), notes of a case of chronic gastric ulcer treated by bichromate of potassium. The patient was a woman, aged 41, who had suffered severely from gastric ulcer for twenty years. Bichromate of potassium, in f^ grain dose, increased after four days to ^ grain, every six hours, was administered
SSSS'^nrSSS* notabilu. 608
B«Tiew, Ang. 1, 1896.
for about a month, when the entire groap of gastric symptoms had sabsided, and the patient rapidly gained in weight. The drag did not seem to have any effect on the aniemia, or directly on the heematemesis. Vomiting, previously a most distressing symptom, ceased after the first dose of the bichro- mate. The drug was thought to owe its effect to a local action on the stomach, and to be of benefit only in chronic gastric cases. — Brit. Med, Joum.^ April, 1898.
A CASE OF OPIUM POISONING TREATED BY PERMANGANATE OF POTAriSIUM.
Db. Don sent the following case to the BriU Med. Joum., April 23rd, 1898: —
<* I was recently called to Mrs. S., aged 64 years. She had swallowed by mistake half an ounce of laudanum 60 minutes previous to my seeing her. On my arrival, at 8.45 a.m., she had just vomited from the effects of a mustsjrd and water draught I found her collapsed and very drowsy ; her skin was cold ; pulse very weak and thready ; and both pupils contracted lo the size of pin heads. I gave her at once a hypodermic injection of one-twentieth of a grain of hydro- chlorate of strychnine, this had the immediate effect of strengthening the pulse. I then made a solution of potassium permanganate by breaking up three 2-gr. pills in three pints of water. From my previous knowledge of the patient I knew it would be useless to try to pass a tube into the stomach unless she was unconscious, a stage I did not wish her to arrive at. Accordingly I had to employ this method of lavage of the stomach. I made her swallow half a pint of the solution (1 gr. in 10 ounces) every five minutes, and between the doses induced vomiting by irritating the fauces. At the end of 20 minutes I made her swallow a pint of the solution and retain it in the stomach. She then felt better, and the drowsiness was not so great. Two hours after the accident the pupils were normal and the pulse strong, but great sleepiness still remained. At twelve noon she took 4 grains of permanganate of potassium dissolved in half a pint of water, and the same again at 2 p.m. I gave instructions that she was to be kept awake till 6 p.m., and milk and water in equal parts to be given at frequent invervals. Next day the patient felt quite well, but complained of dryness of the throat and mouth from the parching effect of the permanganate solution ; she ate well, and felt no other inconvenience from her unfortunate mistake."
604 NOTABILU. 'SSSSr?A3?lfllB!
A OABE OF 8TBAM0NIUM POIBONINO.
Db. B. H. Bhaw reports the following case in the Brit. Hed^ Jaum., April 22, 1898 :—
*< On January 9th at noon, Mrs. H., aged 68, took a tea- sj^nful ot an antiasthmatical powder in mistake forliqtuHiee powder. At 12.45 p.m., when sitting down to dinner, sha conld not understand a dry feeling in her month, whl^ sipping water did not affect in the least ; at the same lime her sight became blurred, and she experienced a peculiar sensation of 9weIIing in her eyes ; lifting the glass to moisten her lips she exclaimed at the weight of it, and feeling herself getting worse A% told her husband to go tor the doctor, and from this time remembered nothing till about 6 or 7 p.m. When I saw her at 2 p.m. her condition bore a remarks bio resemblance to a case of delirium tremens ; her face, however^ which was markedly pale, was not expressive of suspicion or anxiety, nor was there any clammy perspiration, the skin beinc; perfectly dry. Her eyes were bright and staring, the pupils dilated but not excessively, and absolutely insensible to light. The flow of ideas was very rapid, and her speech so fast that only at times could any sense be made of what she said. Mirthful delirium and hallucinations were very prominent, but illueions and delusions were marked absent. Although she often attempted to rise she seemed unable to do so from inco-ordination of the lower extremities. Sensation^ however, was perfect. The power of swallowing at first seemed absent, but if she was prevented from returning whai was placed in her mouth she swallowed it. Breathing was quiet, but the pulse was very rapid, thready, and compressible^ After using the stomach pump freely nitrite of amyl and digitalin (hypodermic) was administered, and shortly after- wards pilocarpin (i gr.)* Recovery after the use of the latter was remarkably rapid."
DIPFERFNCB IN VULNERABILITY OF FIBRES OP THE RECURRENT LARYNGEAL NERVE.
Im a clinical lecture given last November at the Que«a's Square Hospital for the Paralysed and Epileptic, and reported in the British Medical Journal, Bir Felix Bemon, M.D.» F.R.O.P., made some interesting remarks with regard to the greater vulnerability of the nerve fibres supfdying the abductor murcle of the vocal cords over those supplying the adductors. From his own observations he has demonstrated that in ordinary respiration the cords move scarcely if at all, but remain fixed in a position of considerable but not extreme abduction, the glottis being of the ehspe of an isoscelea
£3S?f5STSa^ NOTABILIA. 606
triaagld, ihe mdM of which hardly move during the respiratory phases, the width of the opening being in an adult abont 18^ m.m. As the oadaverio position of the cords only kAves an opening of 6.7 m.xn. this graater abduction during life must be due to a reflex tonus in the abductor musele (erioo-arytenoid posticus) kept up by impluses from the pneumogastric in the lungs.
Dr. Bissien Bussell has succeeded in splitting up the Be- current Laryngeal Nerre throughout its periphenJ course into three bundles of fibres — one supplying the abductor muscle, one the adductors, and the third which seems to produce no motor effect in the larynx.
If the Becurrent laryngeal Nerve be completely divided there will be complete pwalysis of both abductor and adductors of the same side, but if the injury to the nerve be not complete, as is often the ease in disease, there will be shown a greater vulnerability of the abductor. So constantly is this the case that it may be taken as an axiom that in slowly progressive organic lesions of the motor nerves of the larynx, whetiier at their origin in the bulb or in their course, it is always the abductor muscles which are primarily and chiefly afleoted. And as a corollary to this, when recoveiy takes place, it is the adductors which first recover. This difference in vulnerability is to be ascribed to the existence of bio- chemical differences between the antagonistic group of muscles, and it has been shown by Dr. Orabower, of Berlin, that the nerve endings of the motor fibres to the adductor muscles are of a much more elaborate and complicated character Uian those to the abductor. Thus, while there may be loss of abduction on one side, the adductors may still act, and the clinical importance of the above lies in the fact that there may be serious disease affecting a recurrent laryngeal uerve, such as aneurisms, etc., and yet no loss of phonatin or other symptom to call attention to the larynx.
The same may be the case in a more central disease affect- ing the nucleus of origin of the motor nerves in the bulb, « .y. syphilitic disease or tabes. As in many of these diseases abductor paralysis of a vocal cord is often for a long time the (Hily symptom, an early laryngoscopic examination becomes in all suspected cases of great importance. In their long course the motor nerves to the larynx are exposed to many hazards. The foUowing is a list of the bulbar and bulbo-spinal as well as the peripheral diseases in which they may be involved.
BuiiBAB AND Bulbo-spinal Affections.
Hiemorrfaage and softening, syphilitic processes, tumours, diphtheria, progressive bulbar pandysis, amyotrophic lateral
8oleroBi8, desBeminated oerebro-spinal sclerosis, syringonyeliA, tabes dorsalis.
PsBiPHEBAii AmonoNS. Acute rheumatic iufluenoes ; toxic influences (lead, arsenic, infectious fevers) ; tumors in post cavity of skull, foramen lacerum or foramen jugular ; pachymeningitis ; traumatism (cut throat, stabbing, injury during operadons, &o.) ; tumours of neck (goitre, peritracheflJ glands, &c.) ; aneurisms of arch of aorta, innominata, subclavian, carotid; mediastinal tumours; pericarditis and pleurisy ; tuberculosis and pleuritic thickening of apex of right lung; chronic pulmonary affections (chronic pneumonia, anthracosis, &c.) ; oesophageal carcinoma. In any of these affections unilateral laryngeal abductor paralysis may long be the most prominent and often the first symptom of the serious affection with which the patient is threatened, and this is especially true of such 43ymptoms as bulbo-spinal syphilis, progressive bulbar paralysis, tabes, goitre, aneurisms of the aorta and cancer of the oesophagus.
OABE OP PLUMBIC EPILEPSY.
Db. Rowland, of Bromley, writes in the Brit, Med. Jaum, of April 16th, 1898 :—
'* I received a police call on the evening of February 10th to see a lad, aged 14, who had been brought to the station in a fit. I found him sitting, supported in a chair, in a state of unconsciousness. The history given by the father, who was present, was that about half an hour previously the lad, while returning home from work, complained of feeling giddy, suddenly screamed out and fell, and was brought to the station by his father with the help of a constable. I found the muscles rigid, the teeth fiimly clenched, the eyelids closed, the left more firmly than the right ; the eyeballs were turned up, the pupils equal and of medium size. The pulse was regular and of fair tension. There was pallor of the cheeks and lips, and along the edge of the gums in both jaws a well-marked blue line. The laid*s clothing smelt strongly of paint. He had been assisting his father, a painter, for the past six months ; he had been very energetic at the work, and had once or twice suffered from colic, for which his mother had given him salts. He had never suffered firom ' tremblings ' or paralysis. I directed the patient to be laid down, and noticing him turn on his side and curl himself up, I concluded that the fit was passing off, and ordered him to be taken home in a cab. Later on in the evening I saw him at his home. He had passed urine and faces under him in the mterval ; he was still unconscious and rigid, but seemed
gggs^^rrar notabilu. so?
inclined to sleep, oorliDg himself ap in the bed. Tempera- inre 99.4'' ; pulse 88.
" Next morning the patient was quiet, but still comatose and rigid. He had passed a restless night, screaming, grinding his teeth, and throwing himself about, so that he was with difficulty kept in the bed. The temperature was 100°, the pulse 92. I prescribed potassium bromide gr. xt. in water every four hours, but administration by the mouth was extremely difficult, owing to the rigidity. In the afternoon, ite the coma and rigidity continued, and the temperature was going up, I called Dr. Price in consultation. We were agreed as to the serious nature of the case, and gave a guarded prognosis to the parents. Potassium bromide 5 ss. with syrup of chloral 5 ij. in water 3 j. was injected per r&ctwn. Chloroform was administered until the muscular spasm was relieved. The patient was ordered to be fed by nutrient suppositories, and the services of the district nurse were secured. At 10 p.m. I repeated the bromide and chloral injection, and again administered chloroform until the muscles were completely relaxed. I placed calomel gr. ij. on the back of the tongue. A specimen of the urine drawn off by the catheter was found to be free from albumen. The temperature was 101.4'', the pulse 100.
"Next morning (February 12th) the patient was still comatose, but the muscles were lees rigid. He had again passed a restless night. The nurse succeeded in giving two ounces of milk and a dose of the bromide mixture by the mouth. The temperature was lOl'^, and the pulse 112.
** About 8 a.m. on February 18th he opened his eyes for the first time. Thus he had been in the status epilepticus close upon sixty hours. All day long he lay quiet and dozed, taking no notice of anything, but took his nourishment and medicine when offered to him. In the evening the tem- perature had fallen to 99.6"^. He spoke for the first time on the morning of February 14th. Convalescence was now established, and he made an uninterrupted recovery.
** He went out for the first time on February 2l8t, having been on a course of potassium iodide four days previously. An examination of the fundus oculi showed no optic neuritis, and there was no impairment of vision.
" The above symptoms were undoubtedly due to lead poisoning. There was no family history of epilepsy. The mother said that the boy had been a great help to his father in the painting, and had done as much work as a man, keeping long hours, and had been careless in the matter of keeping his person and clothes free from the paint. He will not return to the painting business.
508 NOTABILU. "SSX^fTS^
Berfew, Astig. 1, ISW.
" The ease is of some interest on aoeonnt of the complete reooveiy. It is well recognised that cases of acate satnroine encephalopathy are of extremely grave prognosis."
FOBEIGN BODIES IN THE STOMACH— THE HUMAN OSTBICH.
In the Journal of the American Medical Association, March 5th, 1888, Dr. A. H. Meisenbaoh has pnUished the case of a man, aged 23 years, terming himself *^ the homan ostrich,'^ who had for nine years followed the ''profession" of swallowing glass, metal, &c. He snfFered no discomfort until the end of that period, when he comi^ined of pam in the stomach. When he was standing a mass of abont the siae of the hand could be felt in the umbilical and hypogastric regi(ms, which could be raised and which descended with an impulse. When recumbent, as he turned from his back od either side, the mass moved toward that side. A skiagram showed a shadow in the umbilical region. Gastrotomy was performed, and 118 articles, besides about an ounce of brdcen glass, weighing in all 1 lb., were removed. The articles were : 27 stf^ples, 16 screws (1 in. and 1^ in.), 62 nails (2 in. and 1^ in.), 21 cartridges, 2 pocket-knife blades, and 2 in. of brass chain. The patient recovered, but an attack of pneumonia of the right base followed the operation. Dr. Meisenbach attributes this to the X rays, to which the patient had been exposed on several occasions for long periods. X-rays dermatitis is now well known, and deep-seated injury has also been claimed as an effect ; but the retenticm for so long a period of this extraordinary collection of foreign bodies in ttie stomach without injury, and even without symptoms^ is remarkable.
A similar but fatal illustration of the accumulaticm of foreign bodies in the stomach has recently occurred at St. Bartholomew's Hospital. At the inquest held on the 21st ulto., Arthur Whitaker, cabinet md^er, said the deceased was his wife, and for the past three years she had suffered from pains in her stomach. In May she became so ill that he brought her to the hospital. — The Conmer : Da you know of her ever having swallowed anything such as pins or fruit stones ? — No, sir. — Dr. Gilbert Smith, house surgeon, said the cane was a very remarkable one to the doctors. The deceased was specially dieted, and it was arranged to perform an operation. On Saturday night her condition became very serious, and she died a quarter of an hour after. A post mortem examination revealed a remarkable condition of things. There was a large nmnber of cherry and other fruit
ISSSIf^rSS*' NOTABILIA. 609
«knies, pins, and pieees of siraw in the nomftolL — k Jaryman : How many stones do you think there were ? — Several hundred. These set op ulceration of the intestines, which caused death. — The Ooroner : She mast have been swallowing these tor years. — Certainly. — A bottle containing some of the etooes, mostly cherry and plam stones, some pins, and straw, was handed roand to the jnry, who retnmed a ferdiot in accordance with the medical evidence.
COFFEE.
Mb. Jonathan Hutgbinson (Archwes of Surgery), says that he has long been in the habit m prescribing coffee as a medicine in certain states of great debility. He regards it as a remedy quite nniqne in its osefolness in snstaining the nertons energy in certain oases. Apafrt from its general utility, and its well-known value as an antidote to opium, he has found it of especial service after operations where ansssthetics had been used, and in states of exhaustion where alcohol had been pashed and a condition of semi-coma followed. In these latter cases he has sometimes prescribed it as an enema when the patient could not swallow, and with the best effects. In many cases where death may seem close at hand, such an expedient as this may even be the means of a permanent restoration to health. Tea and coffee seem to be much ahke in many respects, but the latter is greatly preferable as to its sustaining power. It would be a great advantage to cor working classes, and a great help towards the farther development of social sobriety, if coffee were to come into greatly increased use, and if the ability to make it well could be acquired. As an example of the difference of effect of tea and coffee upon the nerves, the writer notes, what he believes many sportsmen will confirm, that it is fax better to drink cofiee than tea when shooting. Tea if strong or in any quantity, especially if the individual be not in very robust health, will induce a sort of nervousness which is very prejudicial to steady shooting. Under its influence one is apt to shoot too quickly, whereas ooffise steadies the hand and gives quiet nerves.
VEILS. The mania, or fashion perhaps it might better be called, among ladies of covering the face with a veil is almost universal. Crape as a mourning veil has been proven to be so markedly unhealthy that it is now generally discuffded as a mourning covering to the face.
Br. 3. At Wood, cl Chicago, has recently made teats as accurate as possible to ascertton if any danger to the eyes
510 CORRESPONDENCE. "^^^^S^T?^!
would be likely to be p2X>daoed by the wearing of veils. For tbis parpose he selected a dozen typical specimens of the article and applied the ordinary tests of ability to read while wearing them ; and the tests show that every description of veil a£Fects more or less the ability to see distinctly, both in iiie distance and near at hand, the most objectionable being the dotted sort. Other things being equal, vision is interfered with in direct proportion to the number of meshes per square inch, as tiie texture of the material also plays an important part in the matter. Thus, when the sides of the mesh are single, compact thread, the eye is much less embarrassed than when double threads are used ; the least objectionable veil, on the whole, being that which is without dots, sprays, or other figures, but with large and regular meshes made with single and compact threads. Dr. Wood pertinently rem^ks that, while eye troubles do not necessarily result from wearing veils — ^for the healthy eye is as able as any other part of the body to resist legitimate strain — ^weak eyes are injured by them. — Medical Times (New York). ^___
AN ABSENT COMMA. An action was recently brought against an American news- paper by an advertiser of a patent medicine for damages alleged to have been caused by a slight error, which looks Uke a practical joke of the printer's devil. Among the testi- monials to the marvellous efficacy of the remedy, one grateful sufferer was made to testify to the following effect : ' I am now completely cured, after having been at the gates of death merely Uirough taking half a dozen bottles of your medicine.' The omission of a comma after the word ' death ' converted this declaration of simple faith into a statement not likely to increase the sale of the nostrum. The case is a warning to those persons — too numerous among doctors as among other people — ^wbo have a soul above punctuation. — Brit. Med. Jaur., April 80th, 1898.
CORRESPONDENCE.
THE SELECTION OF PAPERS FOR THE CONGRESS-
To the Editors of the *^ Monthly Homaopathic Review.'*
Gentlembn, — It is to be hoped that Dr. Stopford's letter in your last number will do some good, and rouse to a sense of their responsibility those gentlemen whose duty it is to obtain papers for the Congress.
Surely the Council are to blame for putting themselves into such a position that they cannot refuse or amend papers. I
£!£S^.2rrSS^ COBRBBPONDBNOB. 611
Itoview.Ang. 1,1888.
wonld ask what is the use of a Gonnoil but to see that good papers aie forthcoming?
Another point I would like to raise : Why are the best papers aJways put off to the end of the meeting, when members are getting restless and anxious to have a ** consti- tutional," or to see the sights before dinner-time ? I can only account for it by supposing that the best papers are usually provided by the younger men, and that the order of reading^ is arranged on the principle of seniores priores. Dr. Wilkinson's paper was one that might have come directly after the luncheon hour, or after Hie President's address for thai: matter, as well as either of the other papers. It was the only one that had anythmg to do with homoeopathy, and yet it was practically shelved.
We may, I think, look for better times next vear. With Drs. Moir and Oeorge Clifton on the Council it will be surprising if some vigour is not put into that apparently nearly moribund body.
I am, Gentlemen,
Yours, etc., '
Dudley Wright.
To the Editors of the ** Monthly Honueopathic Review,**
Gentlemen, — I entirely endorse the spirit of Dr. Stopford*s letter in your last issue. I was present at the Congress, and heard as much as I could endure of Dr. Clarke*8 paper, and then went out, only to hear a chorus of dissatisfaction from other members, many of whom came long distances to be present at what should have been a meeting for mutual instruction and edification.
Evidently a burlesque was intended by Dr. Clarke, but a more unfitting season could not well have been chosen, and the natural result has followed — annoyance amongst our members, and an opportunity given to our friends, the allo- paths, to blaspheme, which they have not been slow to take advantage of.
I feel it incumbent upon me to disclaim all sympathy with such utter nonsense, which would only have been endurable had it been found in the ancient papyrus library recently^ unearthed in Egypt.
I also agree that a grave responsilility rests upon some ** person or persons " for permitting what we must regard aa a most unfortunate accident to have happened.
I am, Ac,
J. BoBBBSON Day.
86, Queen Anne Street, W. Jviy Uih, 1898.
519 OOSBBSPOMDBNTS. BBTtow.A»» iTiMe.
NOTICES TO CORRESPONDENTS.
•^* We cannot undertake to return rttjeeted manuscripts.
Authors and GoNTmiBUTOBS receiTing proofs are reqaeBtod to oorreci and retnrn the same as early as possible to Dr. Edwin A. Neatbt.
London Homckopathig Hospital, Great Ormond Street, Bloomsburt. —Hoars of attendance : Medical, In-patients. 9.30 ; Ont- patients, 2.0, daily ; SURGXGAL, Ont-patients, Mondays, Thursdays, Fridays and Saturdays, 2.0 ; Diseases of Women, Out-patientB, Tuesflays, Wednesdays and Fridays, 2.0 ; Diseases of Skin, Thursdays, 2.0 ; Diseases of the Eye, Thursdays, 2.0 ; Disease^ of the Throat and Ear, Wednesdays, 2.0 ; Diseases of Children, Moniiays and Thursdays, 9 A.M. ; Operations, Tuesdays, 2.30 ; Dental Cases, Thursdays, 9 A-M. ; Orthopsedio Cases, Tuesdays, 2 p.m. ; Electrical Oftses, Thursdays, 9 a.m.
Communications haye been received from Mr. Dudley Weight, Dr. R. Day (London); Dr. Burwood (Ealing); Dr. Wilkinhon < Windsor); Dr. Black (Torquay); Dr. Eldbidqe Pbice (Baltimore, Ind.)
Errata.— On p. 442, lines 8 and 26 from the bottom, for Wilson read Williams.
BOOKS RECEIVED.
7^i)enty'Two Years' Experience in the Treatment of Cancerous and other Tumours. By Herbert Snow, M.D. London : Baillidre, Tindall and Co. 1898. — 7\e Homcsopathie World. June and July. London. — The Chemist and Druggist, June and July. London. — ybrthampton Mercury. July 16th. — Calcutta Journal of Medicine. March, April and May. — Indian Medical Review. April and May. — Indian Messenger. Calcutta. May. — The North American Journal of HomcBOpathy. June and July. New York. — Presidential Address hifore the HomeeopathU Medical Society of the State of New York. By Eugene H. Porter, A.M., M.D. — ITomaopathie Eye^ Ear, and Throat Journal. Jone and July. Ne?7 York.— TAo Medical Century. June. New York.— 7%^ Medical Times. June and July. New York.— 2^ New England Medical Gazette, June and July. Boston. — 7%^ JBtahnemannian Monthly. Maj, June and July. Philadelphia. — The Homaopathio Recorder. May and June. Philadelphia. — The Homceopathle Envoy. June and July. Lan- caster, Pa. — The Clinique. June. Chicago. — The Medical Era. June. Chicago. — The Hahnemannian Advocate. May and June. Chicaga^ Minneapolis Magazine. May and June.— »2%« Pae^ Coaet Journal of Homosopathy. May. San Frandsoo. — The American Medical Monthly, June. Baltimore.— TA^ Medical Brief. SxiXj. 8t. Louis.— iZ^m^ HomcBopathique Prangaise. June. Paris. — Revne Homopopathigue Beige. April and May. Brussels. — Rivista Omiopatiea. March and JLpnl. Borne. — Allgemeine HomSopatkisehe Zeitung, June and July. heipng.-^Populdre Zeitschrift fUr IfonUhwathie, July. Leipsig. — Momeepathische Maandblad, July. The Hague.
Pkpen, XMneiiHUT Reports, and Books for Reriew to be sent to Dr. Popx, 19, Wategate, UnaMmm^ LfaMolnshiie ; Dr. D. Dtob Bbowx, W, Seymour Street, Pori- siisa8qQsm,W.; or toDr. Eownr A.NBATBT,176,Havfatockmi,N.W. Adjeitiae- jMPts sad Bnsfaess oommmueations to be sent to Mbsin. B. dorrto isbiT, W, ■toorssM Btreett B.C.
S^r^tTfSwl*" OUR DUTY AND RESPONSIBILITY. 618
THE MONTHLY
HOMCEOPATHIC REVIEW.
OUR DUTY AND RESPONSIBILITY TOWARDS THERAPEUTICS.
There is a legend that when Spenser was buried in Westminster Abbey the poets of his day — a day when poets were many and great — cast each his ode, with the pen which had written it, into the still open grave. The news of the exhumation and re-interment of Hahnemann's honoured dust has set us thinking what of worthy work this generation of his followers has to offer to his memory.
Clearly his is a memory which we honour ourselves in honouring practically, his an example which we should follow. Setting aside the honour which attaches to patient observation and to brilliant deductions from the facts observed, there remains the honour due to the pioneer, to the man who took the first step, '' the step which costs.'' Man is gregarious, a social animal ; Hahnemann braved and bore for many long years the obloquy which threatens the man who steps out of the rank to proclaim disturbance to the accepted order of things. He suffered slights and contumely from those
Vol. 42, No. 9. 2 L
514 OUR DUTY AND RESPONSIBILITY. *^?rf^5?J!1»^
whose vested interest in the old order he imperilled. From those who hated him, he bore open and covert injury ; from those whom he trusted, misconception and misrepresentation. His, for certain (though we remem- ber no sign of it in his writings), were the chills of doubt whether he might still trust his own senses in the face of a storm of opposition ; his was the fever of resentment against a blind incredulous world which withstood him» in part active with malice, in part passive through indifference. All these causes of depression were upnon Hahnemann throughout a life of unusual mental activity and unusual length.
Such considerations added to the central consideration of the enormous scientific value of the work which he did, might stimulate a generation which will be known in history as builders of monuments and givers of testi- monials '; especially when it is also a generation which has learnt, at least in part, that the noblest memorial to a great man is the appreciative continuation of his great works. But if we waive all such considerations as being matters of sentiment (a very poor reason, be it said in passing, for waiving them) there remains the plea that if the work of a man is good and tends to pro- gress, it is worthy of development for the work's sake, independently of any feeling of gratitude to the original worker.
What, then, was the great work of Hahnemann? Surely this, that he taught us how by careful observa- tion of the action of drugs upon the healthy we may best choose remedial agents for similar symptoms in the sick — in a word, he taught the proving of drugs as a guide to the curative simillimum. This was the very gist and centre of Hahnemann's life work ; it was the main- spring of the mechanism by which he maintained that disease should be combated. Without provings there is no homoeopathy.
The provings of Hahnemann and his immediate dis- ciples are a model of what such things should be ; they are a monument of self-denying, painstaking work, in which the power of observation and the care of record are wonderful. They represent the best work of that nature which those times could produce. Had Hahne- mann's provings been such as might be madfe now, or
SS^iStt^* 0^» I>UTY AND RESPONSIBILITY. 615
even each as might have been made fifty years ago, they woald have been at least temporarily lost to the world as incomprehensible. A re-discoverer would have been necessary when the world had ripened to their meaning.
Whatever may be thought of medical progress since the day of Hahnemann, there is no doubt that the means of precise and accurate observation have immensely improved. The sphygmograph, the stethoscope, the ophthalmoscope and laryngoscope, the aural and vaginal speculum have each of them opened new fields, not only for the detection of disease, but also for the com- parison of the results of disease with the results of drug patbogenesy. The culture of these fields in their former use has been, and is, unremitting and highly successful ; but what has been done to cultivate them in the latter of these two directions? Analysis, as applied to the excretions of the body, has been exalted by patient work to a high art ; what use has been made of it as a means of rendering more accurate the discovery of the simillimum? It must be conceded at once that the answers to these questions, if truthful, will not prove flattering either to this generation or to its immediate predecessor. The whole science of pathology, to use the term in its widest sense, is essentially the growth of the last half century. What have we done to apply it to the working of the law of similars? Has the science of proving ministered its '' possible " to the art of healing ?
It will not be necessary, perhaps, to enter thoroughly into a categorical answer to the questions we have raised. The full answer is only too obvious to our readers, and it involves a confession of duties omitted. The light established, with so much toil, in the face of so much bitter opposition, by Hahnemann and his personal followers, which so many have tried to put out, but in vain, is still shining. The pity is that so little is being done, either by reproving of the old drugs according to the many new methods now possible, or by thorough provings of new drugs, to render that light one undeniable in the world of science, a light which might dissipate the darkness which envelops so many of the recesses in the limbo of pain and disease. The original light has long enough been contemplated from every point of view ; the spectroscope of criticism and
2 L— 2
516 aUB DUTY AND RESPONSIBILITY. ■^BSiKl.^t^flfiS
appreciation has been applied sufficiently to its every ray ; its bands have all been lettered and numbered ; its capacity has been gauged and gauged again ; enough has been written concerning it to make our literature (did it only consist of provings throughout) an almost complete enchiridion for the overthrow of Death himself. What is wanted now is more oil. Toward the supply of this there is an apathy and indifference of which we cannot be proud.
From the aspect of a true believer in Hahnemann's law it is no difficult task to show that this neglect is wrong from the point of view alike of morals, of policy, and of science.
It is wrong from the point of view of morals. The man who said ** I owe nothing to posterity, for posterity has done nothing for me," may or may not have stated a brilliant paradox ; he was certainly not a satisfactory guide to conduct. We are ourselves posterity ; " the heirs of the ages," we are debtors to the progress of the past, and it is the duty of the good citizen to see that the patrimony handed to him by his forebears shall be passed on to his own children the better for his tenancy. Faith, whether in the dogmas of religion or of science, involves responsibility and duty. ** Faith without works," in every sphere of intellectual life, " is dead." If it is incumbent upon the convert to homoeopathy to follow the law of similars, it is also incumbent upon him to extend the sphere of its known operation. The laws of nature, to the student (and it is bad for those of us who are not still students), are not satisfied by the mere observance that may suffice towards the law of man. The mind which is actively following out a law of nature cannot say, *' At this bound, at that last footfall of the last worker, I pause, I refuse to go further." The very fact of intelligent capacity, binds the conscience to pro- gress. The moral atrophy which results from such a mental attitude, does not stop its course with the capacity which is unexercised.
Neglect is wrong from the point of view of policy. As we have seen above, where there is no advance degeneration is inevitable. It is in an age of unrest and of tireless competition that the law of the survival of the fittest has been formulated. The iteration of dogmas
E^i^^iTTS^'' OUR DUTY AND RESPONSIBILITY. 517
Renew. Sept. 1, 18H6.
does not advance science ; it is no matter for the prayer- wheel of Thibet. The early rising dairy-farmer (that converted high dilationist), does not content himself with the ceaseless milking of his cows ; he has observed that, unfed, they run dry and are soon unprofitable ; he acts accordingly. There is no spontaneous conversion of nothing into matter ; ex nihilo nihil Jit, From our bodies, our brains and our books we can get no more than we put into them. If our art is to improve, it will not be by accident, or by the half-reported details of accidental poisoning, but by hard unremitting work of the nature we have indicated. Even from the mere guinea-cological point of view, we cannot afford to fight with an armament which is still capable of improvement. For the sake of our reputation as a school, it is now pressingly incum- bent upon its members that they should give sonie practical evidence of the truth that is in them.
Neglect is wrong from a scientific point of view. A Frenchman, name unknown, said at a British Association meeting, a few years ago, ''It is not enough that a statement of fact should be true ; the question is, is it pregnant ? " This is a variant of the modern formula that the measure of vitality is its adaptability to its environment. Science concerns itself not at all with statements of fact merely as such, but with the bearing of such upon other facts. To justify its continued statement, a law or fact in science must be for ever tracing out and demonstrating its own vital relationship with other laws or facts as they arise ; nay, it must give fair promise that it has within it, but deducible, other laws and other facts which shall claim relationship with discoveries yet unborn. If the world of science is to be won to a recognition of Hahnemann's law (and there are signs that such a recognition is increasingly possible) the pour parlers for it must be stated in the terms of to-day's science; the relationship of Hahnemann's law to other already recognised laws must be established beyond the reach of cavil.
Into the manner in which a proving of to-day should be conducted we do not at present propose to enter. We are at this time content if we have persuaded our readers of the necessity for them.
518 AN ALMOST FORGOTTEN EPISODE. ^22l^S?^*iiM
Beview, Sept. 1, 1808.
PERSONAL EXPERIENCE OF AN ALMOST FORGOTTEN EPISODE IN MEDICAL HISTORY.*
By George W. Balfour, M.D., F.R.C.P. Edin.
In saying a few words of introduction from the chair of this section, over which I have the honour to preside, it has struck me that a few words from personal experience in regard to a now almost forgotten episode of medical history might prove both interesting and instructive. There are not many now alive who remember the lime when blood-letting was the panacea for almost every ailment, and when patients could be no longer safely bled they were certainly leeched or cupped. There must be few survivors of the time when one of the earliest lessons in surgery was to distinguish between an ordi- nary blood clot and one which was buffed and cupped, or who were taught that in uncomplicated pneumonia such confidence was to be placed in blood-letting that " the only essential action of the prognosis was the day of the disease on which the treatment was commenced," as it sometimes failed when delayed more than two or three days from the commencement of the disease.^ Yet such were the earliest lessons in medicine which I received, lessons which were daily exemplified in the wards of the old Royal Infirmary.
When within a year of my graduation I made my way to Vienna with the view of studying homoeopathy, which had just made a convert of one of our ablest professors (Henderson), I occupied my time at first in improving my knowledge of percussion and auscultation under the world-renowned Dr. Joseph Skcda, and you may imagine my astonishment when I found that in his wards the severest cases of pneumonia were treated with poultices and regulated doses of extractum graminis (hay tea), and with nothing else unless much pain was complained of, when a few grains of Dover's powder was superadded.
It was truly astonishing to behold in bewildered amazement a pneumonia melting away under the magic influence of the decillionth of a grain of phosphorus,
• The foUowing remarks, wliich constituted the Address delivered at the opening of the Section of Medicine at the recent meeting of the British Medical Association in Edinborgh, are reprinted from the BritUh Medical Journal, July 80th, 1898.
SSS^^TTmo?^ an almost forgotten episode. 519
Beview, Sept. 1, 1808.
bat it was indeed a reductio ad abaurdum to find this magic influence emulated by the virtues of hay tea, and to be told by Skoda that pneumonia was a disease which tended not to dissolution but to resolution.
The *o/ioiov vrdOos, known to Hippocrates as one of many theories available to guide and to explain the treatment of disease under certain circumstances, was raised to a paramount position by Hahnemann, who enunciated the doctrine that by it alone could disease be not only cured tuto, cito, ft jucundey but silently and at once extinguished. In this respect homoeopathy was the eighteenth century analogue of our modern antitoxin treatment. Remedies were selected not for any healing virtues they were supposed to possess, but because of the power they were believed to have of exciting a disease similar to that they were supposed to cure. A crude dose of such a remedy could not, as you may well suppose, benefit a patient, but by superadding a medicinal disease to that he already suffered from was bound to make him worse. This was called medicinal aggravation or exacerbation, and, to prevent any risk of this, Hahnemann invented a most elaborate system of preparation by which all the noxious qualities of the drug were gradually removed and nothing but its healing virtues left. The first step in this preparation was necessarily dilution, by which the active and noxious properties of the drug were gradually eliminated ; at the same time by a series of rubbings and handshakings the already spiritualised remedy had its dynamic power so developed, that, when adminis- tered in a fitting dose, the disease for which it was appropriate melted quietly away without any previous exacerbation. In spite of all this elaborate care, and in spite of the terrors of medicinal aggravation for ever before their eyes, there was still the widest dis* crepancy in regard to the doses employed by even professed homoeopathists, for while some employed drop doses of the mother tincture at reasonable intervals (Schmid), others used nothing lower than the 800th or 900th dilutions (Grosse), and sometimes only permitted the patient to smell one globule damped with this dilu- tion once during an illness of four or five weeks' dura- tion, so powerful were these high dilutions supposed to be, so mild and certain in their remedial action.^
620 AN ALMOST FORGOTTEN EPISODE. ■'iS2[2i^
Eeview. Sept. 1. 18B8.
The enormous discrepancy between these doses may be faintly imagined when you reflect that the 80th dilu- tion contains in each drop 1 decillioiith of a grain of the original drug, and that to bring about this attenuation each grain of the drug has to be dissolved in an ocean of 14 septillion cubic miles of diluted alcohol, a quantity equal to many hundred spheres, each with a semi- diameter extending from the earth to the nearest fixed star.'
Fleischmann, of the Vienna (Gumpendorf) Hospital, was not an extremist, and the dilutions he employed were seldom higher than the third or fourth, yet for one fresh from a school where it was taught that '* in the case of inflammation no one would think of trusting the safety of the patient to any other remedy than blood- letting,"^ it was a sufficiently startling experience to observe cases of true sthenic pneumonia not only entrusted to these infinitesimals, but making excellent recoveries under their use. Naturally the first and most obvious idea was that there really must be some occult virtue developed by the various triturations and sue- cussions, and some truth in the homoeopathic aphorism similia similibus curantur. Fortunately the excellent results obtained by Skoda with his hay tea sufficed to dispel these clouds of mysticism, while the success of Dietl in the same class of cases in another hospital with simple aqua colorata showed that there was nothing specific even in hay tea, and but confirmed the unmis- takable conclusion that, as Skoda put it, pneumonia tended not to dissolution but to resolution, and that the large blood-lettings thought necessary for its treatment were, to say the least, uncalled for.
Among some even in Vienna the idea prevailed that this singular result was due to the presence of a less sthenic type of pneumonia. I need not say that this idea was not shared by Skoda, nor by his colleague, Dr. Bittner, a benevolent-looking old gentleman of by no means a truculent aspect, but a great stickler for the old faith, who had no difficulty in bleeding his pneumonic patients freely with very considerable success, and when he could no longer bleed them he always cupped them ; he applied to them those now forgotten instruments of torture, the cucurbitula cruenta, so that when his
SSS^fSfTSlS** AN ALMOST FORGOTTEN EPISODE. 521
Baview, Sept. 1, 18BB.
patients did arrive at the post-mortem theatre they were always readily recognised.
Thoagh 80 much stress continued to be laid upon the necessity for blood-letting in the Edinburgh school, it had ceased to be carried to such an extreme as in the immediately preceding generation. I have been told by an old gentleman that he heard Professor Gregory in a clinical lecture boast that he had bled a man into convulsions/ adding that the students had rushed terror-stricken from the ward, and that he himself had been disconcerted for a moment. Fortunately the patient recovered, and Gregory's boldness and success were so rapidly blazoned abroad that, though long before the days of railways and telegraphs, within a week it was heard of at Geneva. In a series of MS. clinical lectures still extant, Gregory narrates the still more remarkable case of Betsy Moffat, who during an attack of pneumonia had suffered much from blood- letting, tartar emetic, and other perturbative treatment ; at last she was found at visit insensible, her pulse 104 and feeble, and a rattle in her throat like one dying. Even Gregory admitted she could not be further bled, but by dint of stimulating her with hartshorn and sack whey he was able to apply a few leeches to her head, and before he left the ward he was able to take 4 more ounces of blood from her arm, blood which, as Gregory tells us, was still buffed and cupped. It must be a relief to you, I think, as well as an astonishment, to learn that this patient did not die, but on the contrary was able to be discharged exactly one week after her last blood-letting.^
Gregory was a very able man and no fool ; he quite recognised the danger of large blood-lettings, especially in weakly patients ; he considered the remedy unsafe, but he thought it less dangerous than the disease, and in this opinion he was supported by the pathology of his day.
Towards the end of the seventeenth century the researches of Bonetus into human morbid anatomy confirmed the statement first made by Laelius a Fonte in regard to the presence of hepatisation in the lungs of those dying from pneumonia. By-and-by the further experience of Valsalva, Morgagni, and Lieutaud showed that the lungs of all who died with symptoms
622 AN ALMOST FORGOTTEN EPISODE. **BSwJ4.^?2wfe
of pneumonia were always either in a state of red or grey hepatisation, were either, as was supposed, filled with coagulated blood or were in a state of suppuration, the result of effusion of blood into their tissue. GuUen, impressed with the idea, based upon the presence of red or grey hepatisation in all fatal cases, that pneumonia was always fatal by the rupture of a vessel within the lung, connecting this with Hoffmann's' theory that all inflam- matory action was due to spasm of the small arteries, and regarding blood-letting as the only certain resolvent of spasm, was led to advocate free blood-letting — usque ad deliquium — as the only cure for pneumonia. For the first time in the history of medicine, phlebotomy as a treatment for pneumonia was removed from the domain of empiricism and placed upon the thoroughly scientific basis of an apparently indisputable pathology. When we recall the remarkable relief that followed venesection, ■the quiet restful repose of a patient who but a few moments previously had been sitting up gasping for breath and complaining of intense pain, we cannot wonder at the reluctance displayed by the profession when asked to cast aside a remedy so powerful to relieve and believed to be so certain to cure. And if we put ourselves in the position of the men of that generation, we almost cease to wonder that wise and able men yielded themselves to the fascination of infinitesimals which seemed capable of replacing so pleasantly and efficiently a remedy so powerful, but attended by so many serious drawbacks.
On my return from Vienna I read to the Medico- Ghirurgical Society of this city a report of what I had observed in the wards of Skoda with an account of 392 cases of pneumonia, treated on what might be termed the expectant principle, and showing a mortality of only 64, or 1 in 7J, equal to 13.7 per cent. I pointed out that the Vienna cases were certainly not less sthenic than those in Edinburgh, that they had the disadvantage of being daily unceremoniously auscultated, percussed, and lectured over, which was not the custom in our infirmary in those days, and that they had not the advantage of having been freely bled, yet their mortality was only 13.7 per cent.^ In the reports of our own infirmairy during the five years and three months from July let, 1839, to September 30th, 1844, there are
S^r^tTww!^'' ^N ALMOST FORGOTTEN EPISODE. 623
recorded 258 cases of pneumonia who escaped the lecturing, and had the advantage of having been freely bled, and of these 91 died, a mortality of 1 in 2.78, or 35.9 per cent., showing a proportion of recoveries of nearly 3 to 1, or over 20 per cent, in favour of those who were not bled, to say nothing of the time gained by their more rapid recovery,* or of the less exhausted condition in which the patients were left, whereby they were sooner fit to return to the duties of active life. I urged upon the Society the importance of giving the eclectic system of treating pneumonia a fair trial, throwing out the suggestion — made to me by a distinguished Austrian physician — that possibly some change in the type of the disease might underlie the apparent change in its relation to perturbative treatment. My words fell on deaf ears, and the conclusion arrived at may Tery well be summed up in ihe wordR of cme of the ablest physicians of the day — Dt, John Gairdnfr: ^'Nothing was better established than the good effect of blood-letting in Edinburgh, what- ever might be the case in Vienna. . . . Of the benefits of early blood-letting he entertained no doubt whatever ; they were positive, immediate, unequivocal, and admitted by almost every physician whose experience and judgment entitled him to consideration; and if Dr. Balfour, or anyone else, could shake his conviction in the truth of this opinion, he would also succeed in producing in his mind a general distrust of medical evidence in all cases of every description, since in no case whatever can we have evidence which is stronger or more satisfactory.'*'"
I need not pursue the subject further. The eclectic treatment passed gradually into the hands of the general practitioner, and within less than ten years the late Professor Bennett wrote : *' It is admitted that the practice of bleeding in acute inflammations has, within a recent period, undergone a great change ; that whereas it was formerly the rule to bleed early, largely, and often repeatedly, now such bleeding is rarely practised, and is not necessary.""
After this we had the war of opinions in regard to whether this change was due to a better knowledge of the natural history of the disease and of its pathology, or to an actual change in the type of disease, which had become less sthenic in character, and no longer required
524 AN ALMOST FORGOTTEN EPISODE. ^^^Z^bSSlT^^"
the same heroic remedies. But into this I need not enter; it forms part of the history of medicine, and the object of this short sketch is to point out the importance of a knowledge of this subject.
If at the end of last century the profession generally had been fully alive to the fact that since the days of Pythagoras, a contemporary of Hippocrates, there has never been wanting a body of eclectic physicians, many of them the most renowned physicians of their day, who shunned perturbative medicine, and guided their patients safely through the most acute diseases without having recourse to any so-called heroic practices," it seems unlikely that even the skilful special pleading of GuUen would have sufficed to establish blood-letting as a treatment upon a foundation apparently so stable. And in the absence of the factitious contrast between the supposititious curative action of heroic medicine and that of infinitesimals, it seems equally unlikely that Hahnemann's wildly improbable ideas as to the prepara- tion and powers of infinitesimals would have taken any hold on the profession at all.
We are now on the threshold of new discoveries, and of quite a new pathology, which is indeed but a higher development of ideas that have long been slumbering in the professional mind — the connecting links being Dwight, Raspail, Hallier, and Pasteur — but which seem likely now to attain a development of the highest im- portance for the well-being of mankind. It is well, however, in the light of the past to remember that disease may be recovered from under many different forms of treatment.
The practical certainties of our art in all ages have been sufficient for the welfare of mankind," and we must be careful never to subordinate to any vague ideas of what may possibly be curative of disease that which is, after all, the paramount object of our art — the relief of suffer ipg.
References.
^ AliB0U*8 Pathology and Practice of Medicine, 1844, p. 280. ^ British and Foreign Medieal Review, Ootobler, 1846, pp. 568 and 569. 'Simp- son, Homauipathy, Utt 2hnetx and if ft Tendenete», p. 285. ^MarshaU Hall, Rtnearches on Loss of Blood, p. 272. *See Additional Mevtorial to the Managers of the Moyal Injir^nary, Edinburgh, 1803, pp. 457, 468. • Edinburgh Medieal Jour^ial, September, 1865, p. 213. ' The influence of Hoffmann's views upon Cnllen's practice is well seen in the jirefaee
Sl^SnrSS^ ^N ALMOST FORGOTTEN EPISODE. 625
The foregoing interesting account of an almost for- gotten episode in the history of medicine in Edinburgh suggests a certain amount of comment. The late Professor Henderson suppUed so complete an answer to the doubt which Dr. Balfour throws upon the directly curative influence of small doses of homoeopathically selected medicines in the treatment of pneumonia, and the late Dr. Drysdale drew such marked attention to Professor Henderson's essay, in a paper published in 1867, in the Britiih Journal of Honweopatky, entitled Remarks on Dr. Balfoufs Introduction to the Study of Medicine (the title of the book containing the gist of the address the author read at the meeting of the British Medical Association in Edinburgh the other day), that we are surprised that Henderson's criticism has been so completely ignored by him. That an adequate reply would have been impossible we are fully aware, but that some sort of an answer should not have been attempted when reviving an interest in the incidents narrated by Dr. Balfour, is calculated to excite astonishment.
Dr. Balfour, within a year of his graduation, went to Yienna, with a view, as he says, *' of studying homoeo- pathy, which had just made a convert of one of the ablest of our professors (Henderson)." Occupying his time at first with improving his knowledge of percussion and auscultation under Skoda, he was astonished beyond measure at finding the severest cases of pneumonia treated with poultices and regulated doses of hay tea, and nothing else, save a few grains of Dover*s powder when much pain was complained of. In bewildered amazement, he subsequently saw this same pneumonia melt away under the magic influence of the decillionth of a
to his First Lines. ^ Edinhurgk Medical aJid Surgical Journal^ vol. Ixviii., p. 897. ^ " The part of the statementd of those witnessing suoh practioe whioh I was most inolined to distrust was the assertion that the conyalesoence of the patients thus treated was asuallj more rapid than that of patients with inflammatory oompUints treated by fuller eTaonations. But on watching the progress of oases of the kind I have been satisfied that the observation is oorrect." (A^lison, Edinburgh Medi4idl Journal, Nov., 1852, p. 507.) ^^ Edinburgh Medical Jour ml, AugUdt, 1847, jp. 141. ^^ Edinburgh Medical Jour}ial, Maroh, 1867, p. 770. ^See Haematophobia, Eidinburgh Medical Journal, September, 1858, p. 214 ; and An Episode Medical History, Edinburgh Medical Journal, December, 1894, p. 577. i«Cabanis, Du Degri de Certitude de la Mideeine, Paris, 1808, p. 65.
526 AN ALMOST FORGOTTEN EPISODE. *BSSJl,^?ifMB^
grain of phosphorus ; presently, as a reductio ad absiirdum^ he saw this magic influence of phosphorus emulated by hay tea ; and Anally, after having been taught in Edinburgh '^ that in uncompUcated pneumonia such confidence was to be placed in blood-letting that 'the only essential action of the prognosis was the day of the disease on which the treatment was commenced,* as it sometimes failed when delayed more than two or three days from the commencement of the disease ; " after such instruc- tions as this, to be told by Skoda that ** pneumonia was a disease which tended not to dissolution but to resolution," was most bewildering. That such is the case is doubtless true, and the mortality of pneumonia at that day may therefore be well ascribed to the injurious nature of the measures enforced to cure it! These were for the most part venesection, blistering and nauseating doses of tartar emetic. Professor Henderson had in the Monthly Journal of Medical Science in the year 1841, as he wrote some years later {British Journal of Homopopathyf 1862), '' incidentally pointed out, in a paper on The Anatomy of Pneumonia, a peculiarity in the effects of inflammation of the pulmonary air-cells — the true anatomical seat of pneumonia. On minutely examining the inflamed parts after death, it was not difficult to perceive that, as the inflammatory exudation increased, the parts affected became gradually paler and less loaded with blood, until, on the inflamed cells becoming fllled with the viscid substance, so much pressure was exerted on the blood-vessels, between the fibrous investment of the lobules on the one hand and the exuded matter which distended the cells on the other, that the diseased portion of lung became actually bloodless, or very nearly so, the deep red colour of the earlier stages of the pneumonia giving place to the straw or drab, or sometimes bluish-grey colour that distin- guishes completed hepatisation. As soon as this stage arrives, if the earlier stages of the inflammation be not going on in other parts of the body, the pneumonia, as an active inflammatory process, is literally put out — ex- tinguished by mechanical force; for it is undeniable that an excess of blood, in vessels dilated beyond their ordinary size is necessary to the existence of such a process. That compression is capable of producing the effect I have mentioned on the inflammatory process is
^SJfte^tTwee!*'' ^N ALMOST FORGOTTEN EPISODE. 527
well known from what has been observed of the conse- qaences of the effect of bandaging in erysipelas of the extremities, and of strapping in acute orchitis. In neither of those diseases, however, are the facilities for an effectual pressure on the vessels at all to be compared with those which exist in the minute vessels of the lungs, when every little mesh of capillary blood vessels may be said to be exposed on all sides, and in detail, to the immediate pressure of the exuded matter in the air cells, on whose surfaces they are spread ; while counter- pressure is close at hand on the exterior of each cell, in the form of other distended cells of the same group, and on the exterior of every little lobule, or group cf cells, in the form of the fibrous covering which they possess."
This explanation of Skoda's teaching by '' one of our ablest professors " ought, at the least, to have bten referred to on such an occasion. It is, however, a point of much less importance than that in which Dr. Balfour explains the to him startling experience of observing '^ cases of true sthenic pneumonia not only entrusted to these infinitesimals, but making excellent recoveries under their use," by assuming that their recoveries were simply 80 many illustrations of Skoda's dictum that '^ pneumonia tended not to dissolution but to resolution," when not interfered with by blood-lettings and the various measures then usually taught as essential to recovery. He goes further ; referring to the temporary relief to the dyspnoea and pain of pneumonia so frequently following on venesection, he *^ cannot wonder at the reluctance displayed by the profession when asked to cast aside a remedy so powerful to relieve and believed to be so certain to cure." And then again he says : " If we put ourselves in the position of the men of that generation, we almost cease to wonder that wise and able men yielded themselves to the fascination of infinitesimals which seemed capable of replacing so pleasantly and eflSciently a remedy so powerful, but attended with so many serious drawbacks." Why ''seemed capable"? Is it not a fact that, before '* yielding themselves to the fascination of infinitesimals," the '* wise and able men " referred to proved, out of their personal experience, that such infinitesimals were *' capable of replacing pleasantly and efficiently a remedy so powerful but attended with so many serious drawbacks." Dr. Henderson, e,g,, one
628 AN ALMOST FORGOTTEN EPISODE. ^^SSlJl.^tTi^
of the '* ablest professors " of the day, not satisfied with simple recovery from pneumonia being only 2 per cent., more frequently met with when that disease was treated homoeopathically than when it was allowed to run its course, the patient being protected only by good nursing, as evidence of the positively remedial power of infini- tesimal doses of homoeopathically selected medicines in the treatment of pneumonia, made a series of researches not only as to the mortality under different plans of treatment, but as to the duration of the disease under each. These researches are fully detailed in a singularly able paper, by Professor Henderson, in the British Journal of Homoeopathy for 1852, entitled Pneumonia under Homoeopathic^ Allopathic and Dietetic Treatment. The principal parts of the same essay also appearing in the Professor's brilliant reply to Professor Simpson's notorious tirade against homoeopathy — Homoeopathy : its Tenets and Tendencies — which he entitled Homoeopathy Fairly Represented in Reply to Homoeopathy Misrepre- sented. In this paper he examines a series of cases of pneumonia occurring in his own practice and in that of M. Tessier of the Hopital Ste Marguerite, in Paris, these being all that had come under the observation of either physician since either began to practise homoeopathically, until the time when the essay was prepared, and he compares the results of the treatment with those of that which followed the practice of M. Dietl, in Vienna, the cases submitted by the latter being also unselected.
Henderson and Tessier's cases were 50 in number ; of these 8 or 6 per cent, died ; the duration of the illness in those who recovered, reckoning the time until complete restoration had occurred, was 11.66 days.
M. Dietl in 129 cases gave no medicine and drew no blood ; of these 14 or 7.4 per cent, died, while the duration of the illness of those who recovered showed an average of 28 days for each case.
To deduce the efficiency or otherwise of a plan of treatment merely by the proportion of recoveries under it is superficial and more or less misleading. This is Dr. Balfour's plan, and seeing that the recoveries from pneumonia under homoeopathic treatment were 6 per cent., and those from the same disease when no medicine was given was 7.4 per cent., he immediately jumped to the conclusion that homoeopathic treatment
SSSSr^STS^'' CK)UT AND ALLIED DIB0RDBB8. 629
ftnd the giving of no medicine were as nearly as possible one and the same thing ! Bat ** the wise and able men " of whom he speaks were not satisfied with this superficial view of the matter. True, the recoveries in both series of cases were numerically nearly alike, but investigation proving that under homoeopathic treatment those who recovered did so in eleven days and two thirds, while the group entrusted to simple nursing and a carefully regulated dietary required 28 days in which to recover y was surely enough to account for '* wise and able men " becoming fascinated by the measures which they found to secure such results. They showed that although expectant treatment might be entitled to be regarded as tutOy that which was homoeopathic proved to be cito etjucunde in addition.
From a further close comparison of details, Dr. Hen- derson concludes that the facts prove that '^ homoeopathi- cally selected medicines cure and save life in a different way from that in which unassisted nature does in this disease ; they tend to cut short the disease by preventing exudation, or restraining it within very narrow limits both of extent and degree."*
Every homoeopathic practitioner knows from personal experience how true this is ; and yet one of the most widely accepted authorities on the nature and treatment of pneumonia has within the last few years said : —
'' Theoretically it might appear feasible that we should be able from our own resources to influence the course of the disease — to prevent, for instance, the stage of pulmonary engorgement from passing into that of hepa- tisation ; but for my own part I do not hesitate to say that no sufficient proof has yet been afforded of any such powers to arrest or abate the pneumonic process.'*!
THE EARLY RECOGNITION OF GOUT AND ALLIED DISORDERS.
By W. Thbophilus Ord, M.R.C.S. Eng., L.R.C.P. Lond.
Fellow of the British Homoeopathic Society.
Without a clear conception of the origin and progress of those conditions which produce gout and its many allied
• HomcBopathy Fairly Hep relented in Reply to Homoeopathy Mis- represented, p. 74. t Dr. Conpland, Br'vtUh Medical Journal, September, 1891, p. 692.
Vol. 42, No. 9. 2 m
530 GOUT AND ALLIED DI80RDERB. ^^^^^STIm.
disorders, their early recognition and satisfactory treat- ment is improbable. Oar success, as homoeopaths, in relieving and caring this great group of diseases has not hitherto been equal to that we have long attained in other morbid states. The failure of carefully selected homoeo- pathic remedies in acute and chronic gouty conditions is a matter of common observation amongst us. I suggested the reason for this in a paper on ** Hindrances to the Action of the Homoeopathic Specific," at the Leeds Congress in 1895, which appeared in the Review in the January and February following. Since then further study and clinical experience has convinced me that this matter deserves more careful and thorough consideration amongst us than it has hitherto received. Indeed, if we are to keep abreast of the times, a clear conception of the facts as now ascertained, and used with greatly increased success by our confreres, has become a necessity for us. The fresh light recently thrown upon gout and its allied disorders in their origin and progress from childhood to senile decay, has enabled clear and scientific lines of treatment (alike medicinal, dietetic, and hygienic) to be formulated for all stages of the disorder. As I hope to show, in a future paper, much of this medicinal treatment is largely based (unwittingly no doubt) on our great law of cure, but if our better methods of drug selection were applied greater success might yet be attained. That the way is open for us all to proceed on these lines it is my object to point out. But first we must define our terms, and so I propose to enumerate the diseases comprised in the great group of '' gout and allied disorders," with brief reference to the reasons which have led recent authorities to so regard and group them.
MuRcmsoN's Discovery of ** Lithjemll." The modern view of gout and allied disorders is really the outcome of the "lithsemia," first described by Murchison in 1874. He defined it as follows : " When oxidization is imperfectly performed in the liver there is a production of insoluble lithic (uric) acid and lithates f urates) instead of urea." He gives a long list of common symptoms resulting from this condition, most of which can be recognised as characterising the many maladies which we shall presently refer to. As diseases resulting from lithsemia, Murchison gives urinary calculi, oxaluria,
R^^iT?"^^ GOUT AND ALLIED DI80BDEB8. 531
Bertow, Sept. 1, 193.
biliary calcali, Bright'a disease, stractural disease of liver, arfcerial sclerosis and others. Although arising from the same cause, he tells us that true gout differs from lithaBmia in being characterised by deposits of crystals of urate of soda in joints and other parts, and although every gouty subject has suffered from lithasmia, every lithaemic subject does not necessarily suffer from gout.*
In his article on Gout in Quain's Dictionary of Medicincy Dr. Roberts gives an instructive list of premonitory symptoms often met with in gouty subjects, " or even," he adds, " in persons who have never actually suffered from declared gout, but which distinctly depend upon the lithaBmic condition. These .... frequently give warning that the gouty condition is in process of development, and if duly recognised enable the patient so to regulate his mode of living as to ward off the disease." t Together with the digestive symptoms usually recognised, he gives palpitation of the heart, catarrh of the throat and respiratory passages, violent fits of sneezing or asthmatic - attacks, headaches, giddiness, irritability, languor, drowsiness, neuralgias, profuse perspirations, and '' certain skin affections."
An American physician (the late Dr. Dowling) is quoted by Hale t as saying, " There is no denying the &ct that a large portion of the ills to which man, and woman, too, are heir, results from the presence in the blood of an excess of waste material in the form of lithic acid. Many of the cases of so-called neurasthenia — the new name for the fashionable and flattering disease, nervous prostration or exhaustion — are cases of lithaemia which can be cured .... by proper diet, the avoidance of stimulants and drugs," &c.
These few quotations from recognised authorities will serve to show the large number and varied nature of the disorders allied to gout ; due in fact to the same causes, and which we should endeavour to discover and correct at the earliest possible period in each patient. More recent researches have made this possible for us in many
* For an admirable rSgumS of Murohison's views, see our colleague, Dr. Edwin Hales' Practice of Medicine, also Fagge's Practice of Medi- cine, under " Hepatio Dyspepsia.**
t Qaain*s DiotUmary of Medicine^ 1st edition, vol. L, p. 650.
X Practice of Medicine ^ p. 478.
2 M-2
582 GOUT AND ALLIED DISORDERS. ^^bSSS^.^^TSISl
Beyiew, Sept 1. 1886.
cases in which previously we could never have perceived the real trend of apparently simple symptoms.
BeCOGNITION of LiTHJEMIC AND Fre-GoUTY TENDENCIES
IN Childhood.
Deficient power of eliminating and excreting the waste products of digestion and tissue metabolism is the cause of gout and allied disorders. So long as these matters are got rid of without accumulation in the system, no symptoms are produced, and health is maintained. What these products are — whether uric acid or other matters — though certainly of importance, does not immediately concern the practical physician. The tendency to their deficient excretion is often hereditary, and so it is oftenest exhibited in the children of gouty or lithsemic parents. It is aggravated, by unsuitable diet, but in severe cases will reveal itself under any diet. Thus we hear of chil- dren who pass urates, and even uric acid crystals, no matter how they are fed. In these the hereditary tendency is unusually strong, and true gouty deposits, though very rare, are not unknown. Henoch* mentions minute uric acid infarcts and urates as causing dysuria with screaming, retention of urine, nocturnal incontinence, and scanty urine staining napkins, as symptoms of Uthiasis in infancy. In early childhood frequent biliary disturbances, with drowsiness, scanty dark urine, peevishness, and chronic tendency to eczema, constant nasal catarrhs, chronic bronchitis, asthma, and constipation with white stools, are now being recognised as early manifestations of the conditions we are con- sidering. Indeed, when not obviously due to other causes, the constant recurrence of these symptoms in children indicates an accumulation in the system of effete matters which, in normal constitutions, are completely excreted, and are probably the same or allied to the uric acid and other matters which produce gouty symptoms in later life. Two proofs of this view can be given ; (1) that the conditions cannot be cured except by similar treatment (medicinal, dietary and hygienic) to that which relieves lithsemic states in later life ; and (2) that such children (unless properly treated) usually prove their tendencies
• DUeases of Children, vol. i., p. 174.
£dSJr^!Tww!** ^<>UT ^ND ALLIED DISORDERS. 533
by rheumatic, gouty, or other significant disorders in adult life.
In childhood, as at all ages, the products of defective excretion tend to manifest their presence in parts and organs whose vitality from any cause is lowered. This may be by hereditary influences, as in those whose parents have had skin, bronchial or arthritic troubles ; or by acquired weaknesses as in children who have had acute bronchitis, catarrhs, chills, etc. ; also from defects of environment, or from the lowering effects of zymotic diseases. In any such organs the retained poisons will there most probably exhibit their presence in a persistent tendency to some one or other of the disorders enume- rated.
Disorders Alubd to Gout at Puberty and Early Adolescence.
At puberty and in early adolescence the results of deficient excretory powers are more commonly seen and more easy to recognise than in infancy and childhood. When hereditary influences are less strong a healthy childhood may be followed by an outburst of lithsemic symptoms at this period of life. The critical age of puberty, as a time likely to bring to light constitutional defects and tendencies, is universally known. As with each advance in life, a change in the forms of these pre-gouty manifestations is now seen. Some which rarely occur in earlier life now become common. As striking examples of these, we have — (1) periodical sick- headaches or bilious attacks, (2) acute febrile rheumatism, and (8) epilepsy. Eczema is much less common, but psoriasis begins to be seen. Various gastric and mental disorders may appear in girls with commencing menstruation. Asthma, chronic bronchitiu, and constant nasal catarrhs are common.
It may appear strange to some to attribute these maladies to such a cause, but all modern clinical experience tends to confirm the fact that retention of litbaBmic matters is the predisposing condition in nearly all these cases, and that those in whom excretion adequately gets rid of the products of digestive and tissue metabolism escape these troubles. Further, a recognition of the fact and attention to the corre- spondingly suitable treatment is necessary, not, perhaps, to relieve each recurring symptom, but to prevent the
534 GOUT AND ALLIED DISORDEBS. "SSil.^ST^ialf
Beriew, Sept 1, 1K8.
recurrence and care the tendency. The exciting causes of acute rheumatism, with its often resulting endo- and peri-carditis, are chills from exposure and over exertion. But without a retention of effete matters, which in after life may be recognised as true gouty poisons, a simple chill would probably not produce rheumatic fever.
Bilious headaches, with or without vomiting, are common after puberty, especially in girls, with whom commencing menstruation increases tissue metabolism, with greater tendency to retention of urates, etc., and other consequent functional disturbances. The connec- tion between so called ^* bilious attacks *' and lithaemia (or uric acid retention) will be presently explained. It is doubtful if epilepsy is due to the same cause, but I have frequently verified the observation that such fits usually occur at times when the blood is most heavily charged with these impurities, and have found the fact of the greatest value in treating such cases. In my experience, to ignore the predisposing condition is usually to fail, in spite of most careful homoeopathic prescribing.
Gout and Allied Disobders in Adult Life.
Those who have suffered from various lithaemic or pre-gouty conditions will now tend to develop either true gout, with deposits, or the more chronic forms of rheumatism with articular deformities. Muscular rheumatism, often as lumbago, now becomes common. Crystals of urate of soda may be deposited in almost any part, as well as in joints, tendons and fascisB. Asthma is still common. There are many who escape these troubles until middle and later life, especially females, in whom they occur oftenest after the menopause. But there are three apparently innocent symptoms which, in my experience, seldom fail to point out the true gouty dyscrasia which will presently produce graver results. These are — (1) Frequent and intractable nasal catarrhs ("colds in the head"), and
(2) Severe headaches, (these are with high tension pulse, and are commonest in sedentary brain workers), and
(3) Periodical hepatic crises (" bilious attacks.") When not due to any local or other obvious cause in persons whose constitution and habits are suggestive of retained urates and other effete matters, they afford conclusive evidence of coming more serious troubles. In early
^S^JS^lTS^ oout and allied disorders. 685
middle life those who have previously escaped these symptoms may thus reveal a gouty tendency. Intestinal gout, with chronic or organic liver disorders, gall-stones, renal colic and oric acid calculi, with gravel and passage of '' cayenne pepper" uric acid crystals are frequently met with. But the most serious of all results of this chronic poisoning appearing in middle life is increased arterial tension leading to chronic interstitial nephritis, and possibly to one form of diabetes. Gouty eczema and psoriasis are now common. Apoplexy and the remoter consequences of high arterial tension, with atheroma from arterial sclerosis, aortic degeneration and cardiac failure, also angina pectoris and the whole train of symptoms indicative of senile decay are the final consequences of the condition we have been considering. The majority of such patients may escape actual gout, but their disorders are none the less the final and fatal results of long years of defective excretion and overplus ingestion. This condition has been well described and illustrated by instructive cases by our colleague, Dr. Byres Moir, in a recent paper, Changes in Circvia- tion leading to Breakdown in Middle Life.*
Such is a brief and imperfect sketch of the earliest symptoms which can be recognised as indicating the gouty or uric acid diathesis, as the older '^ lithaemia " of Murchison is now called. I have endeavoured to outline thus the great chain of disorders that dogs many of us almost from the cradle to the grave, all due to the continuously acting cause of defective elimination and excretion of the morbid products of digestion and tissue metabolism.
In a subsequent paper I hope to give the results of recent researches as to the nature of the poisons concerned, with some explanation of the various symptoms produced, according to the several parts of the body in which they are most prone to accumulate. In my own practice, I have found a clear conception of these matters of invaluable aid in obtaining permanent results from treatment, both by remedies selected in accordance with the law of similars, as well as by dietetic and hygienic measures.
{To be continiLed).
• London Homaopathic Hospital Reports^ vol. vi., 1897.
686 VISCITM ALBUM. '^SS^.^gS???^
Review, Sept 1, 1998.
EXPERIENCES WITH VISCUM ALBUM.
By Geobqb Black, M.B. Edin.
(Continued from page 483).
Fragmentary Pbovings.
I MUST now ask your attention to an attempt which I and three others have made to increase the sum of oar knowledge regarding the pathogenetic effects of viscum albam.
E. L. H. F., aged 20, well built, rather above medium height, and of more than medium stoutness, with fair hair, and grey eyes : some dilated capillaries are seen passing across the sclerotic in an irregular line. There are numerous acne spots on the forehead. Had whooping cough, measles and scarlet fever as a child. Menstruation regular, lasts about two days. Bowels regular. On examining the ears with Brunton's otoscope, I found many dilated capillaries in the ear channel, and more particularly just within the external auditory meatus. Here they were massed together so as to produce at parts an almost uniform redness. Deeper in, towards the tympanum, they were fewer in number. There were a few small and indistinct capillaries seen on the arm of the malleus : the head was white and the rest of the tympanum was of a normal colour and free from capillary engorgement.
Sight normal. Hearing ditto. Can hear a watch tick six yards one foot away with each ear.
Nov. 26th — ^Dec. 2nd, 1896 : At irregular intervals took doses of the 2x tinct., ranging from 6 to 20 drops.
Dec. 3rd — 8th. Similarly of Ix.
Dec. 8th, 9th, 10th, 12th, 13th and 15th. Doses of from 1 to 12 drops of the <^, taking on the last day 30 drops in all.
Wednesday 16th. About 11.80, just as she was going to sleep, her heart gave two severe thumps, and then went off beating at a tremendous rate. After a minute or two it slowed down again and became pretty much as usual, ** then I had a sort of trembling in my limbs ; my teeth chattered, and I got generally shaky : this lasted about an hour. After the palpitation and the trembling were over, the face was flushed." This morning she feels shaky, and last night she felt as if she had had a
SSSiJrs^nSg!'' viscum album. 587
beating ; had pain in the back between the shoulders — sort of aching — ^nothing sharp. To the left of the sternum and just above the breast, had a sort of aching, which was more apparent on breathing hard. Just feels it a little now on drawing a breath. Directly she woke up, she felt pain in the sacral region, aching and burning in character; not affected by movement— that continues now, 10.80 a.m. Last night urination was more frequent. ** I couldn't keep any part of my body quiet ; a leg might jerk, then an arm, but one or other would keep on jerking till it was over. The jerks became smaller and smaller till it was over." Seven years ago she had a similar sort of jerking come on after she went to bed ; it used to last much longer than this. This morning she feels jerky to herself. " If I were to turn quickly, it would seem to give me a jerk, and if I were to take anything up, or put a foot forward, it would seem to twitch." Got up twice to pass water while the trembling was on ; it seemed to cease a little each time ; then came on again." All last night, before the trembling came on, the water passed was very light in colour, the amount was ordinary each time, but the quantity on the whole was greater: Three or four days ago, there seemed to be an increased amount of saliva in the mouth. This has been each day since. Her teeth have bled. She has felt squeamish before breakfast and dinner to-day.
December 18th, 19th, 21st, 22nd. Took viscum a. 8, from 15 to 80 drops for a dose, the largest amount taken in one day being 40 drops.
December 28rd. Five drops of the 80th.
Thursday, January 7th, 1897. ^'I didn't get any palpitation last night before the twitchings came on, but I had some funny symptoms ; the twitchings lasted three hours: sort of — well I feel cold, then I suddenly get funny ; it's a sort of hot feeling, but I'm not actually hot. After that I was awfully hot and had intense headache, throbbing as if everything were banging about." "When was that?" "After the jerkings." "What time?" "About 3 a.m." "Had you gone to bed feeling well?" "Yes." "Anything unusual for supper ? " " Yes, I had a very big supper." " What did you have?" "Ham and cheese. I went down on the sea road with my brother, and I simply felt starving." " Were you conscious of dreaming ? " " No,
638 viscuM ALBUM. ^^l.^STiftUt
Beview, Sept 1, 1816.
I didn't dream at alL" ''Had you gone to sleep?' " NO) I had only just got into bed ; these flashings came on, then the jumpings, which lasted three hours.'* " Where did they begin? " " In my legs, I think, but they scarcely seem to have any commencement in a particular part ; I seem jumping and twitching all over. The whole bed seems to shake; my teeth only chattered when I got out of bed. No palpitation while the trembling was on, nor before, nor after. I always feel as if I'm going to do something dreadful while the tremblings are on, and after ; it's exactly what I used to have and as I felt seven years ago. I took valerian root then and that cured me." " Nothing frightened you vesterday ? " " Well, nothing to cause that I should think, out my brother leaned over the sea wall and I was afraid he would fall in ; he seemed to be going in and I caught hold of him, but I didn't feel frightened at the time, nor thought of it after to be frightened about it. I got out two or three times to pass water ; it was rather pale. I didn't get much sleep, because after I did fall asleep I kept waking up, and I felt if I stayed in bed I should just be the same."
Monday, February 1st. She complains now of still feeling shaky, as if just getting better from a bad illness. Feels worse on getting up than on going to bed ; head feels bad — sometimes top, sometimes forehead, dull aching, and at other times neuralgia ; it makes her head and face sore ; the pain is sharp, especially felt during the evening and after doing any work ; also feels weak. She has experienced sharp pain in the ovarian regions, coming and going for two weeks. If she moves in bed, or her mother, with whom she sleeps, moves, she becomes shaky, and the ovarian pains are worse. No frequent urination, no uterine pain. Last period was longer in duration, less in amount, and pain about the same. In the sacral region there is aching. No con- stipation. Appetite ravenous.
Some months after, she made the following statement as to her condition : *• Throbbing pain at the top of my head, which seems to spread over the whole of my head and makes me feel almost distracted. Shooting pains in my head and different parts of my body, especiaUy on the left side of my chest. A rather sharp pain in my left side lasting for about a quarter of an hour at a time.
SSiSff^SrrSg:^ VlflCUM ALBUM, 639
Palpitation of the heart, with a feeling as if I had lost my senses. Sense of great weight between my shoulders, and sometimes pain. Sometimes a feeling of great coldness in my back ; at other times a feeling of burning heat, low down in my back (sacral region). Sometimes a feeling as if a film were over my eyes. A feeling as if I should bite some one if I did not keep my teeth clenched. A wretched feeling as if I should do some- thing awfully wrong if I did not keep myself very much under control. Sometimes when I am out I feel as if Bome one were dragging me down from the waist, and directly after, I feel as if the upper part of my body were floating in air. I often have a feeling of nausea and giddiness. I keep waking in the night and thinking of the most horrible things imaginable, but I soon get to sleep again by trying very hard to think of something pleasant. When I wake during the night I am always very hot, with the exception of my knees, legs and feet, which are very cold."
Saturday, Feb. 5th, 1898. The above description corresponds in many particulars with this lady's condition now. She is haunted by the same feelings — terribly real to her and productive of the greatest misery — that she has so graphically delineated above. Her condition is certainly one calling for the greatest commiseration. She is highly intelligent, well edu- cated, and most able in the discharge of her duties as nurse. She strikes one as strong physically, and strong mentally, and possessed of will power a long way above the average. She has been with me and other medical men in circumstances that would have tried the strongest nerves, yet she did her duty and never manifested the slightest emotion. But for all that she says she is utterly wretched — that she thinks she will go out of her mind — feels as if she would have an epileptic fit, and says she would feel far happier in an asylum. This I think arises from a feeling that is very present to her mind that she will do some terrible deed, and that if there she would be protected and watched, and the responsibility of looking after herself would at any rate be shared by others along with herself, if it didn't entirely devolve upon them. AH this state of mental and physical wretchedness she declares emphatically has arisen since she took viscum alb. with
640 VI8CUM ALBUM. •"SSS^.^^ST?^'
B«view, Sept. 1. isea.
a view to proving it, and to it, and it alone, she attributes her misery. Her mother says, "I believe it was in her system, but that horrid stuff has brought it all out." I ought to say that my own mind is not clear on the subject. There is no doubt, I think, that the severe shakings, the nervous twitchings and tremors that she experienced while taking the % were due to the medicine, and perhaps the second severe attack may also be attributable to the same cause, but it should be remembered that between three and four months previous to her beginning to take the medicine her father died after a comparatively short illness. This caused her a severe mental shock at the time, and would doubtless leave its impress behind. Then again, in reference to the sacral aching she has complained of and still suffers from, it ought to be mentioned that while she was on Dartmoor with a patient suffering from hysteria bordering upon, if not actually associated with, mental alienation, she fell, in pursuing her one day when she had run away from her, in a sitting posture, and for some nights was unable to turn in bed without pain, and was conscious of it for some weeks after. She assures me, however, that it was gone for some weeks before beginning to take the viscum alb. Her sister is of a neurotic type of constitution, and suffers from migraine. These facts I thought it right to mention in connection with this proving, and before passing on to that of others.
Second Provino.
Mrs. , aged 37. Mother of three children, black
hair, hazel eyes, medium height and stoutness, placid disposition. Menstruation regular. While at school from 14 to 16 was greatly troubled with rheumatism in the joints of the first tvro fingers, chiefly of each hand, and in the wrists. After that she had a ganglion on the back of the left hand, it made the hand and wrist weak, it was about an inch long. She also got swellings, like large peas or small marbles, on the outer aspect of the left hand. Once when 12 or IS years old she suffered very much from rheumatism in the right shoulder joint. Had scarlet fever, small pox, and whooping cough between 6 and 9 or 10 years. Had influenza in 1888. Menstruation has been fairly regular, inclined rather to
KS^fsSTrSr ^8<^^M ALBUM. 541
be after, than before the time. Had excessive menstrua- tion for aboat six months after birth of second child.
December 14th, 17th, 18th, 19th, 2l8t. Took one dose a day of the 8rd dilation, 10 to 80 drops. Experienced jerking and twitching of muscles. Shooting pains in the left ovarian region, and on movement lumbar pain and stiffness.
Thibd Peovino.
Thursday, November 5th, 1896. Constance S., aged 27, of medium height and stoutness, brown hair, greyish (blue-green) eyes, teeth good, lost four top and two under.
Had influenza and bronchitis last winter. Two years ago she suffered from anaemia and had oedema of left leg. She was told by the doctor that her heart was weak and that she was ansemic. With rest and treatment, of which iron and digitalis formed a part, she got right. Had whooping cough, measles and scarlet fever as a child. Been nursing five years. Began to menstruate when 17. Not been very regular. Only menstruated once in three months for 2^ years ; duration, as a rule, one day. Her last period was two days with an interval of three months. Very light in colour and very small in quantity. " I feel very faint. I feel if I weren't to sit down every now and then I should faint. For two hours I have great pain " (in the hypogastric region) . "* The pain pre- cedes menstruation. I can always tell it is coming by this pain. I'm all right in bed, but up I feel faint." Very little pain in the back. All her life, with the exception of a few months ago, she needn't to wear any- thing. Bowels regular, has had an action every day. No pain. No urinary trouble. The water is usual in amount and there is no pain. When she had oedema the urine was tested and found all right. Sometimes gets a pain in the left side when she has walked or run much ; situation — above the haunch bone. P. 76, regular B. 20, both while sitting.
Chest — ^Development fair, respiratory sounds normal left side ; not quite so satisfactory at right apex. No difference could be detected between the two lungs on percussion. Expansion not so good at left apex. Car- diac sounds clear at all areas. T. 98 in the mouth.
Ears. — Membrana tympani normal in appearance. Can hear the tick of my watch with each ear at a distance of 8 feet 7 in.
542 VI8CUM ALBUM. "S^=CETt2S?
&0Ti0Wf SepL 1, 1806>
Eyes. — They are greenish, bluey-grey in colour. She can read D = 1.75 (6.8") at the distance of 5 feet 8 inches, with effort, one or two words she failed to make out — especially marked with the B. eye. This she says seems weaker. Can read D — 2.25 with perfect ease.
About 4 p.m. she had jBive drops of viscum alb. 8x given on saccharum lactis.
Saturday 7th. In no way different. Viscum alb. as above at 4 p.m.
Sunday 8th. Feels in no way different. Viscum alb. 8x 12 drops on saccharum lactis at 4.20 p.m.
Monday 9th. On asking if she had anything to report she said *' I don't know that it had anything to do with the medicine, but I have had some shooting pains over the region of the left ovary, and a sort of dead aching for half an hour after." She thinks she felt the same sort of pain seven or eight months ago after walking rather far. Yesterday she walked rather fast and rather a long way. It came on after she got home and after she had sat down. Felt nothing of it while walking. The urine has remained quite the same. She dreamt all night. If awake she seemed to be dreaming and if asleep slie was dreaming. '^I was doing this place up (my consulting room) giving douches and cooking and making beds and messing about. Very worried and could not get things right— doing ward work, doing my beds and so on, and was worried because I could not get the place to look tidy. There were lots of bottles in the windows and the more I cleared the more came." Appetite good. Viscum alb. 3x., 15 drops on saccharum lactis.
Tuesday, 10th. She says " I could not sleep all night till 4 o'clock this morning on account of pain in my right leg. It began in the hollow behind the knee (popliteal space), passed down the centre of the calf, then curved round towards the edge of the tibia ; it seemed to shoot for a few minutes, then it kept aching. I could not keep it still. It twitched at times but ached all the time till this morning. I feel a pain very similar to that when I am unwell. It always seems in the calf of the leg then. I kept moving from one side to the other and kept moving the leg about, as this seemed to ease it for the time. It ached a little this morning after I got
it^Sif^StTS^ VISCUM ALBUM. 543
ap." Now the pain is gone and she feels well. No medicine given to-day.
Wednesday llkh. ** My leg ached last night/' she says, *' just the same. It was the same part that was afFeoted and when it stopped aching it felt very hot for a time ; it came on after I had been in bed a little while ; it began with little shoots of pain, then a doll aching and when it stopped aching it burned for some little time after. I went to bed at 10 o'clock, and I must have been in bed a quarter of an hour when it began ; it began in the same place exactly. The burning was in the centre of the calf. It ached a long time, but not so long as the night before. I couldn't stay still; when it aches like that I keep changing the position of the leg, putting it to a fresh or cold part of the bed ; it doesn't stop the aching, but it seems to be a sort of relief in some way." No medicine.
Thursday 12th. '' Had a slight return of the pain last night after being in bed a little while ; it affected me in the same leg and in the same way, but didn't continue long." Yiscum alb. 8x 20 drops on saccharum lactis.
Friday 13th. No return of the pain last night ; slept well, felt nothing amiss at all ; feels better to-day from having slept.
Friday, November 27th. Five drops of viscum alb, 2xon saccharum lactis. She was " unwell " yesterday ; thinks her period has come this time at a considerably shorter interval than she is accustomed to.
Saturday 28th. Nothing to report. Yiscum alb. 2x 15 drops on saccharum lactis at 6 p.m. ''What have you felt ? " '* Fearfully tired last night as though I had been working very hard and hadn't rested." " Was that in the evening ? " "Yes." "Did you feel anything else?" *' I couldn't sleep ; I wasn't in any pain. I found this morning I was unwell again." " Is that unusual with you ? " " Yes, like this it is." " Do you ever remember being so before ?" " No, never." " How long had your period left you ? " " It left on Thursday." " I'm never more than two days ; this time I was only one." " Have you just been so one day lately ?" ** Yes." " Anything else ? " " Only that my eyes feel sleepy, difl&cult to keep them open ; as though the lids were too heavy. Nothing more." No medicine.
Monday 80th. " Is that stopped yet ? " " Not quite. I still feel very tired."
644. YI8CUM ALBUM. "jSJS^f^SfflSr
Wednesday, December 2nd. Period stopped yesterday. For two or tiiree days felt tired and weary as if she could shut her eyes and not talk to anyone. Feels quite - well to-day. Yiscam alb. 2z 20 drops on saccbarum lactis*
Tuesday, December 8th. Since last entry Constance S. has had viscum alb. Ix. 5 drops taken at twice on sac- cbarum lactis then 16 drops divided .into three doses. From these she has nothing to report. To-day I gave her one drop of viscum alb. <f> on s. 1. at 4.80 p.m.
Wednesday 9th. Feels languid, got little sleep because of toothache ; been to the dentist to-day.
Thursday 10th. Once in the night and several times this morning she has had a feeling in the hypogastric region, like she experiences when she is going to be unwell, Bhe has it now at 2.40 p.m. It is a hot feeling and a constant aching — a wearing ache — she complains of an aching like toothache going on all the time in the left groin, " Not a lot but yet enough to make you feel weary." . There is some aching in the left ovarian region, and some tenderness on pressure. Her tooth pained her a lot last night. Viscum. alb. <^ 6 drops on saccharum lactis at 4.80 p.m.
Friday 11th. Feels much better to-day^ Had some aching in left ovarian region this morning but it is quite gone now 4.30 p.m. Viscum alb. ^ 10 drops in water.
Saturday, 12th. Says she felt dreadful pain in the region of the left ovary, and down to about an inch above the fold of the groin ; it woke her up about 8 a.m., and the pain continued for an hour — a fearful aching. •* I never had such a pain I think. I felt very sick after this pain had left and cold-shivered. The pain was so great I didn't notice any sickness till it was gone. It never stopped all the time it was on me. Long before that came I had the pain in my chest, it ached and stopped and came again." She points to the sternal region between the mammae, and says : '* it went right across ; it came and went and came again and each time it did so it was more severe. I felt very sleepy, as though I couldn't wake up this morning. It went away for a little while, and when I drew a deep breath it seemed to come again. It didn't suit me to lie on my left side, it made the pain in my side (ovarian region) worse, as it seemed to affect the bone at that side (hip
SSJSr^rrSS^' viscum album. 545
B«Ttow, Sept. 1, 1888.
joint), it seemed as though the bone ached. I never had such an aching pain there before, it was a pain yoa couldn't have put up with long without doing some- thing." She says she felt in such a temper when the pain was on that she wished she hadn't drank the medicine. P. 96 at 8.S0 p.m.
Monday 14th. She had no viscum alb. Saturday or Sunday. Says she had some aching in the left side yesterday. This morning about 11 her nose bled. No viscum to-day.
Tuesday, 16th. No return of the bleeding. Last night she says her skin felt very dry, and as if she had a most brilliant colour all over. *' I think it was the kind of feeling people must have when they have scarlet fever." Viscum alb. 4> 6 drops at 8.30 p.m.
Wednesday, 16th. No symptoms of any kind. 4 p.m. 10 drops of viscum alb. <l> in water.
Thursday I7th. "I have had no pain but great twitching in my hands and legs for a long time — just like a person with chorea. I'm sure if I had had any- thing in my hand it would have gone. Began to feel it after I had been in bed some long time " (nearer one o'clock she thinks) " first my left hand jumped then both legs, my heart seemed to beat very fast. When I held the left hand with the right it seemed to stop it a little. Then I had a tendency to pass more urine, had to get up once — I never do get up — passed more than I would ordinarily at one time, also passed more in the morning than usual." Then she felt a sharp pain, a succession of stabs which came a little distance above the root of the left breast and passed down towards the nipple. To her it seemed j ust like a person in chorea. There were five or six children in the ward of the hospital, she once had charge of, suffering from this disease, they used to smash the cups, and she feels sure she would too if she had had anything in her hand. She says she had similar jerkings one night before, but they were much worse last night. She didn't think at the time it was anything more than the usual jumping of a person falling asleep, although it was different from anything she had had before. The left arm and the left leg were the worst. She says it lasted two or three hours. When she lay on the left arm it stopped it a little. There was also some jumping
^ol. 42, No. 9, 2 N
546 VI8CUM ALBUM. "^SiS^.^iT^lSL"
Review, Sept. 1, 1806.
or jerking of the muscles of the epigastrium and abdomen. She says she feels as if the jumping might come on a^gain in the left arm. Her teeth chattered. No medicine given to-day.
Saturday, December 19th. Felt pain in the left leg, in the calf, last night in bed, it ached more or less all night she thinks. She says '' I couldn't make it out. My left arm twitched a little in the night but not very much. Went to bed at 11, and hadn't been very long in bed when the twitching commenced. It didn't last move than half an hour."
Monday 21st. Had a few jumps in left leg and arm last night for about one hour from about midnight till 1 o'clock. *' I noticed the urine discoloured, it had a kind of milky-whitey look aiter it had stood," it was a sediment. Hadn't to get up to urinate. About the same time had some slight stabs of pain at the upper part of left breast. Had no pains at all on Sunday night. No medicine.
Tuesday 22nd. Had a headache yesterday and to-day her nose bled. Viscum alb. 3x, 10 drops at 4.80 p.m. To take 10 more at 7.30 p.m. in water.
Wednesday 28rd. While sitting this afternoon she has experienced an aching pain at the upper and outer aspect of both calves, going down about half way ; ''it is such a funny pain. I have to keep moving them, and that is just how it happens in bed." Thinks it came in the right leg first. *' I can't keep them still when I am sitting; I have toke<-p on moving them all the time." Hasn't felt anything like this in her legs before. Had it from 3.30 : now 6 p.m.
Saturday 26th. On Wednesday evening, 7.80, she took 10 drops of viscum alb. 3x. This morning, 8.30, 10 drops, the same evening 10 drops more. Friday the same, and 10 drops were again given this morning. " Had a twitching in my arms and legs on Friday for one hour about 12.30 a.m. Began in left arm ; it was not very severe — very restless in bed ; did not know it till morning, except to a certain extent, then I found all the bedclothes on the floor except the little corner of a sheet, and I was very nearly there myself. No wonder I was miserable," she said, " before I was wide awake enough to know what had been going on I had unbuttoned all my night dress, of which I have a habit when I feel a bit
^S^J^^S^'' VI8CUM ALBUM. 647
warm. I must have felt hot and ancomfortable. Thurs- day night I noticed some spots come up red on my chest and one or two on my neck, left side. They came on my face, under my chin and on my chest ; they were red and hard without heads." The one on her face now is a papule ; it is red in colour and feels shotty under the finger. She says she has never known herself to have spots, not even in the spring. She also experienced an aching sensation in the hypogastric region, as if she were going to be unwell. Yiscum alb. 8x, 10 drops in the morning.
Monday, 28th. " Felt very well till midnight, then I began to suffer from severe pain in the left ovarian and hypogastric regions ; was very faint several times, every time I began to move. I tried to reach to some smelling salts that were on the table, and I must have fallen for I found myself on the floor instead of in bed when I came to, and i was * unwell ' this morning. Very unusual for me. I never was like this. Was very faint all morning and the pain continued in my side till 20 minutes to 2 o'clock, when it got better than it was, but I feel it a little now, 5 p.m. I never had such pain ; it takes a lot to make me cry, but I did last night. I never cried on duty, and when I have felt faint and ill I always kept up. I can't describe the pain — just like a fearful aching, I never had such an awful pain."
Has had an aching in the left ovarian region at the time her periods come on for five or six years ; not very much, and sometimes she has had an aching as if her period would come on when it was not so — often had that feeling — has had it while taking this medicine more than she ever had before. It is always the left side that is affected. Her periods never came on like this in her life. P. 88 — 92. There is tenderness now in the left ovarian region and down towards the groin.
Friday, January 1st, 1897. Every night since Mon- day she has had the pain come on again ; it has wakened her up in the night sometimes and she has not been able to sleep till the morning. The parts affected have been the same as before, and the pain the same. When up and about she feels better.
On Wednesday the period was gone ; was quite well all the day, and all the night ; it came again on Thurs- day morning, but did not last any time ; to-day it is
2 N--2
648 HAY FEVER. "SSS,=^S??!^
B«yiew, Sept. 1, 1898.
much more and she has felt very tired, as if she were fit for nothing, and her head and legs have ached very much. The back has not ached. No trouble with the water or the bowels. She never had an experience like this in her life.
CTo he continued. J
NOTES ON THE TREATMENT OF HAY FEVER AND NASAL ASTHMA.
By Dudley Wright, F.R.C.S. Eng.
Assistant-Sargeon and Surgeon for Diseases of the Nos'^ and Throat to the London Homoeopathic Hospital.
It is not overstating the case to say that the scientific investigation of Dr. Blackley, senr., paved the way for the successful treatment of hay fever. His labours gave us a knowledge of the exciting cause of the complaint, and though our knowledge has extended since the first publication of the results of his experiments, it was his work which gave the initial impetus, and indicated the lines upon which the extension should proceed.
A pollen -laden atmosphere being the immediate exciting cause, we have to look for predisposing causes in the individual affected, and these we find in a morbid condition of at least two different systems of the body, viz., the nervous and respiratory.
As regards the nervous system, the condition may be classed as a *' neurotic habit." Though, perhaps, carrying but little information with it, and even acting as a cloak to our ignorance ; yet, until a better is found, this term may be conveniently used to express an unstable condition of the nervous system, which admits of slight stimulation applied to a disordered part, producing an energetic response.
Next, concerning the respiratory system, we have to look to the nasal mucous membrane as the part affected, and it will be found in nearly every case that a condition of hypertrophic rhinitis is present. This hyper- trophy affects most the lower turbinates, which are at times so much increased in size as to form a veritable nasal obstruction. At other times, however, and this is by no neans uncommon, it is only under the pressure of some form of stimulation that the lower turbinates
SS^"r£ggT^^ HAY FEVER. 649
become enlaxged, and then, by means of the erectile tissae with which they are so plentifully supplied, a large volume of blood passes into them, and causes them to assume the form of swollen and deeply congested masses of mucous membrane. At the same time, the plentiful supply of blood leads to an increased production of mucus, and this being formed quicker than it can be got rid of, accumulates in the nasal passages and further adds to the obstruction.
Having thus a knowledge of the pathology of the complaint, we are more in a position to successfully combat it. Taking first the exciting cause, it goes without saying that if a person finds that certain flowers cause an attack, such noxious plants should be avoided. It is often, however, impossible to do this. The pollen floating about at large and settling on the sensitive mucous membrane of those predisposed to attack will rapidly excite symptoms. To guard against this, various forms of shields have been invented, all of which have the purpose of preventing the pollen from reaching the mucous membrane, but like most things of a similar character, after being used for a short time they are discarded by patients as being cumbersome, or attracting too much attention. We are fortunately able now-a-days to do enough for our patients to warrant their discarding these instruments, as will be shown later.
In the next place, the " neurotic habit " must receive attention, and it is here that remedies find their sphere. Dr. Blackley testifies to the value of the iodide of arsenic, and there is no doubt that this is a valuable agent, though in my hands arsenic itself has proved of more service. This should be administered over a long period, and always for a few weeks before the period when the attacks are expected, for patients can often tell to a day the date of their onset.
During the attack, euphrasia 4> is very valuable, and should be frequently repeated.
And now as to local condition of the nose. It is here that treatment has lately scored such signal success. The object of such treatment is to reduce the swollen masses of mucous membrane, to prevent its engorgement, and to render it less sensitive to outside influences. This can all be easily accomplished by means of the
550 HAY FEVER. "S^^^.^^gnftag
galvano-cautery. The method of applying this is as follows : —
The nasal mucosa should be first of all tested by means of a blunt-ended probe for any particular sensitive areas. It will often be found that touching a portion of the septum opposite the lower turbinate, about i to J of an inch from the meatus, will produce the symp- toms of an attack. Indeed, patients will sometimes say- that by exerting pressure from outside the nose inward towards this spot they can bring on similar sensations. If such a spot be found it will have to receive a touch from the cautery point, but it is not advisable to do this at the same time as the turbinates are treated, otherwise during the healing process there is a risk of adhesion of the two surfaces taking place.
Having made our examination, we may now apply a 10 per cent, solution of cocaine to the mucous membrane by means of a pledget of wool, and in doing this it is well to be careful to see that the wool is not over- saturated with the solution, otherwise this will flow backwards into the throat and produce an unpleasant feeling there, or even some symptoms of cocaine poison- ing, for hay fever patients appear to be particularly susceptible to this.
The nasal mucosa is rendered insensitive in from five to ten minutes, and on removing the plugs of wool it will generally be noticed how much reduced in size are the lower turbinates to which they have been applied. This shrinking action of cocaine is one of its advantages over the more recently discovered eucaine, for it enables the next step of the operation to be more efifectually per- formed, the object of which is to produce a wound so that the scar formed by its ultimate healing may bind down the mucous membrane to the underlying bone, and so prevent the periodical swelling and engorgement which is one of the chief features of the disease.
This is best accomplished by puncturing the tissue of the lower turbinate in several places by means of a fine- pointed canterizer, the electric current being turned on immediately the point comes in contact with the mucous membrane, and pressure being at the Bame time exerted 80 that the point may burn its way in until the bone is reached. If the above directions have been fully carried out the operation is quite painless, and three or four such
JS^^STS^ HAY FEVER. 561
punctares may be made on either side, care being taken that the septam is not burnt, lest adhesion take place daring the subsequent healing.
The superficial eschar produced in this way is of far greater extent than the deep one, and it has the further effect of producing a certain amount of atrophy of the mucous membrane which will conduce to its ultimate insensitiveness, a matter of no small importance, seeing that the affection is in large part due to its hyper* sensitiveness.
Within two weeks healing will have taken place, and for the first two or three days after the operation the patient may experience the ordinary sensations of a cold in the head. During the healing process no local treat- ment is necessary ; but at the end of this period it is as well to examine again the state of affairs to see if a further cauterisation is necessary, as it often is. In fact, it id not unusual to have to repeat the operation three times, in order to obtain the maximum amount of reduction of the swollen tissues.
I have often had patients tell me after I have performed this operation, during one of these attacks of hay fever, that they have experienced immediate relief, and that the symptoms have not returned even though they have been in situations which would have formerly certainly brought on an attack, but I have found that it has been frequently necessary to repeat the procedure in the following year, after which the immunity from further attacks has extended over a considerable period of years.
I have hitherto only spoken of enlarged lower turbi- nates in connection with this complaint ; but it occa- sionally happens that we find polypi growing from the middle turbinate associated with this. Such cases must be treated upon the same principles, and the polypi removed, though it is well to be more guarded in giving a prognosis in such cases, for they far more commonly show a tendency to relapse than the more simple ones.
Now as regards so-called '* nasal asthma." This con- dition is one which affects a similar class of patients, though they may not suffer from hay fever. The usual symptoms are those of an ordinary asthmatic attack, commonly coming on suddenly at night, waking up the patient out of sleep. For the time the symptoms are
662 HAY PEVEB. "SS^^^^SET^
Review, Bept 1, 1688.
often very urgent, though slight attacks occur lasting only a few minutes, and occasionally during the day- time slight suffocative seizures trouble the patient.
The reason for their occurrence at night-time is probably owing to the more dependent position of the head, inducing a state of congestion of the lower turbinates, and a further element is added by the fact that the mucus collecting in the nasal passages, and not being expelled as it would be during the day-time, tends to become inspissated and obstruct the passages. Mouth breathing now becomes essential, and this evokes dryness of the whole of the upper respiratory tract, which, to my mind, may be looked upon as the prime factor in the pathology of the complaint. Such patients commonly have chronic bronchitis and emphysema added to their other troubles later on in life if the condition is not attended to earlier.
The treatment of such cases is the same as above detailed for hay fever. The condition of the nose must be carefully attended to, and any hypertrophy of the turbinates reduced by the galvano cautery, and it is in this particular complaint that iodide of arsenic is most indicated. A large number of these patients have a diRtinctly gouty history, and if such be the case the ordinary anti-gouty treatment will probably do more good. Dr. Pope informs me that he stops such attacks at once with naphtbalin given in S or 4 grain doses of the 1st decimal trituration. The suggestion for this use of the drug he believes he obtained some years ago from a paper on Naphthalin in Hay- asthma , by Dr. Terry of Utica, in the State of New York. A single dose on awaking has usually proved sufficient to check an attack.
In all cases deep breathing exercises with the mouth closed should be insisted upon, as the carrying out of these does much to increase the potency of tbe nostrils and fully dilate the lungs, and the general effect of such exercises upon the circulation and body metabolism is extremely beneficial.
It would be interesting to consider the question of how these reflex symptoms are produced by mere enlargement of the turbinates, but this is beyond the scope of the present paper.
lESSSSffSnTwee!*' CONVULSIONS IN INFANTS. 663
TWO CASES OF CONVULSIONS IN INFANTS CURED B? CIRCUMCISION.
By Albxandbr H. Croucher, M.D. Edin.
Haying recently had under my care two cases of convulsions occurring in infants suffering from pbymosis, it occurred to me that a few short notes of them would not be without interest. Both infants developed convulsions within a short time of birth, and in each there was apparently no obstruction to the flow of urine, but adhesions between the glans and the prepuce were marked. The convulsions ceased in each case shortly after the operation of circumcision.
It would no doubt be of advantage to the community if every male child with a long prepuce and phymosis, were circumcised, and that those suffering from a tight foreskin only, with no excess of prepuce, had the preputial orifice enlarged, the adhesions between the foreskin and glans separated, and the foreskin retracted.
The persistence of phymosis is the cause of much unnecessary suffering among children, and neurotic reflex affections are often induced which excite a prejudicial effect on a considerable number of men during the whole of their lives.
Complete retraction of the prepuce is necessary, in order to prevent the retention under it of the secretion of the numerous sebaceous glands in the mucous membrane of the corona and glans penis, and for purposes of cleanliness.
The collection of this sebaceous secretion, and the resultant inflammation, act as a peripheral irritant through the terminal branches of the internal pudic nerves. The results of the irritation are more or less severe according to the temperament and condition of the child ; there may only be peevishness, much scream- ing, and little sleep, or much graver issues, such as convulsions, may occur.
Of course it is not always easy to convince the parents (of phymotic children) of the necessity of circumcision, unless they themselves see some obvious morbid process going on. Before giving notes of the two cases men- tioned above, it may be useful to briefly give a risume of some of the complications and morbid processes which
564 CONVULSIONS IN INFANTS. ^SSlS^^S?i^!«^
Eeview. Sept 1, 1808.
have been known to arise from, and have connection with, this congenital malformation.
1 . Phymosis with Retention of Calculi in Preputial Cavity, — In the Lancet of September 22nd, 1882, are the notes of a case, where a man, set. 85, suffered with retention of urine ; circumcision was done because of the tightness of the contraction, eleven calculi of various sizes fell out weighing in all 70 grains, which for the most part consisted of triple phosphates. In the same journal of May 15th, 1880, is the record of a case occurring in a child, 8 years old, where a preputial calculus weighing 50 grains, and of the size of a sparrow's egg, was removed ; it was a phosphatic concretion.
2. Extravasation of Urine. — Two cases of this compli- cation are recorded by Mr. William Thomas in the Lancet of August 21st, 1886.
8. Purulent Cystitis. — A case is recorded in the Medical Times and Oazette of 1872.
4. Enuresis. — Nocturnal and diurnal has often been relieved by circumcision.
5. Reflex Paralysis of different parts of the muscular system. — Cases of this have been reported by Brown- Sequard and others.
6. Warts. — In the British Medical Journal of April 10th, 1886, Dr. Dabbs reports two cases in which circumcision was performed ; the children had warts on their hands and fingers. They very soon disappeared after the operations, which were not done for that object.
7. Epilepsy has been cured by circumcision. The Paris Medical, of December, 1887, has notes of a case where a child set. 8 years and a quarter, was first attacked by epilepsy in 1884, the attacks, which occurred once a week at first, increased in violence and frequency until in 1885 he had one daily, which lasted 8 or 4 minutes. The child began to lose both speech and intelligence. Circumcision on account of phymosis was performed. The week following the operation there were two attacks, but they were the last, and in a short time the cure was complete, the child enjoying good health moving and speaking freely,
8. Hernia. — This is a frequent result of phymosis, due to the straining required to force the water through the narrowed preputial orifice.
sKSlw^fenfTS^'* CONVULSIONS IN INFANTS, 555
Renew, 8ept. 1, 1888.
9 Vesical Calculus and Bladder Troubles have been simulated by this malformation, and the symptoms removed by circumcision.
10. Hip-joint Disease. — In the Lancet^ August 2nd, 1879, there is an interesting paper by Mr. Bichard Barwell, On Certain Points in the Etiology of Hip-joint Disease. In this paper strong arguments are adduced as to the causal relationship between phymosis and hip- joint disease.
11. Cough and Convulsions. — ^A case is reported in the Lancet, of April 27th, 1889, where a child, aged five years, '' had had a constant dry hacking cough for the previous two years. It was always worse at night, and kept him awake for several hours, coming on in paroxysms, and often accompanied with convulsions." Both troubles were relieved by circumcision.
12. Masturbation. — Phymosis and the attendant irri- tation has often been the inciting cause of this pernicious habit.
I will now briefly relate two cases of convulsions occurring in infants under my care.
Gasb I.
B. K. was born hurriedly on April 10th of this year. The first place he made his acquaintance with was a water closet. However, he appeared to have sustained no serious injury, beyond a slight bruise on the fore- head. He remained well until a fortnight after his birth, and then I ceased attendance. Five weeks later, the mother consulted me about the infant. The day after I ceased attendance convulsions began, his eyes turned up, he had strabismus, his legs were drawn up and his bands clenched ; there were general clonic spasms. These attacks lasted one or more minutes, and got so much more frequent that on June 9th he was having 12 or more attacks daily. On June 12th he was circumcised ; he had one severe seizure 20 minutes after the operation, it proved to be the last, and he is now in excellent health.
Case II.
A. T. C. was bom on April 80th of this year. He was a healthy infant, but was fretful, and seemed uncomfort- able ; this was not put down to any particular cause, but there being phymosis, it was intended to circumcise him
556 TWO CASES OF NEURALGIA. ^^SS^I^^SJIKSS
Review, Sept 1, 1898.
as soon as he was settled with his feeding arrangements. However, the performance of the needful operation was accelerated ; for on May 5th, at 1.80 p.m., the child had a convulsive seizure of short duration ; another attack occurred a few minutes later, in fact he hardly seemed to emerge from it, for there was a continued laryngeal stridor going on. At 8.80 p.m. circumcision was done ; he had three or more convulsive attacks, and the stridor was continuous till 4 a.m. on May 7th, when the last convulsion occurred ; the stridor continued for most of that day and then ceased. This patient when six weeks old had a very severe attack of bronchitis, and for four days his life was despaired of. Dr. Boberson Day kindly came from London to see him and gave his valued advice, and the patient pulled through. I may mention that an inguinal hernia developed itself during this bronchitic attack, but has not troubled since.
It is also satisfactory to mention that although when vaccinated at the age of three months the arm **took well," and there was a good deal of erethrism ; no return of convulsions occurred.
In Case I. I may add that an inguinal hernia also occurred after the operation, but from no obvious cause.
Eastbourne.
TWO CASES OP NEURALGIA.
By A. MiDGLBY Cash, M.D.
Mrs. p., aged 60, in course of influenza attack began to feel slight stabbing in left parietal eminence. This increasing in severity I gave her gelsem. No relief. Pain increased. Thinking it might be caused from pure debility, as she was greatly reduced by long continued illness, arsen. 8x was then tried. She now suffered 19 hours of acute agony, during which pain spread over the left side of the head, it was " boring and often seemed like something screwing into the skull, the area of its greatest intensity was about size of crown piece, and from this it seemed to radiate over whole of side of head. No fever : face pale and wan, pain increased by touching place, or movement. Several external remedies which she had formerly found useful were tried with
^^J^in^' REVIEWS. 567
effect of aggravating the pain, and a glass of hot port wine increased it so that she became aimosti frantic. A hypodermic injection of morphia seemed inevitable, bat first I mixed her some spigelia Ix. in water and gave a teaspoonful every hoar. This touched it, at the first dose great relief was felt, and when I saw her some hours later, she had had some quiet sleep. All acute pain gone, and only an occasional twinge was felt.
Miss C, aged 56, a stout, semi-hysterical invalid, sent for me for a severe attack of facial neuralgia, affecting the left side, chiefly in the jaws and temple. The pain was ''jerking." Hot applications gave no relief, but cold certainly caused some amelioration of pain. The cause was evidently dental, several loose and decayed teeth being in lower jaw. Pulsatilla was indicated, and I gave it in 3x, a dose every two hours. Shortly after commencing the medicine she had a severe paroxysm of pain, the worst she had yet felt ; thereafter she experienced great relief, and at the next visit had nothing further to complain of.
REVIEWS.
Asthma : Is it Curable / With Addeiula : Bn<fht*s Disease and its Treatment f and Relaxed Throat and Uvula versus Bronchitis. By G. A. MaoNutt, M.D., M.R.C.S., L.R.O.P. Dundee : William Kidd, 189«.
This little brochure by Dr. MaoNutt, of Dundee, is very interesting. Asthma is in all hands a troublesome disease to core, and often very difficult to alleviate to any great extent, as it is so dependent on climatic influences. Dr. MacNutt's oases, of which he relates fifteen, are certainly most remarkable in success. They were all severe cases, and many of them had been looked upon as incurable under long- standing allopathic treatment. Our author lays great stress on the connection between asthma and the digestive system, and careful dieting forms a very important part of his treatment. His oases of Bright's disease, of which he gives three, were also most successful, and his remarks on diet are excellent. The medicine he mostly trusts to in this disease is the arsenicum iodidum.
The last set of cases are those which had been long treated as bronchitis by others, but which turned out to be nothing of the kind, but only cases of relaxed throat and hypertrophied uvula. He gives eight cases of this mistaken diagnosis
668 NOTABILIA. "S^f^SnfTS^
which were rapidly and completely cured hy suitable treatment. As a contribution to our clinical experience these cases are all very yaluable, and we commend the perusal of this brochure to our colleagues. Though published in Dundee, it is to be had from Messrs. Kimpton in Holbom. It has long been a matter of regret that a city of the size and importance of Dundee should have for years been without a homoeopathic physician, and we are glad that this anomaly no longer exists, and that Dr. Maonutt is so energetically working this large field.
NOTABILIA.
THE FETTERS OF A MEDICOETBICAL CODE. Dr. Mack, formerly the Professor of Materia Medica in the Homoeopathic Medical Department of the University of Michi- gan, contributes the following interesting conversation with a former fellow-student to the North Ainsrican Journal of Homceopathy for July : —
** Fetters — Why, Freeman ! Where did you come from ? I thought you lived in Denver.
**' Freemmt — So I doj and am on my way there now. Train leaves at 5.80.
** This meeting was in the dining room of the West Side Railway Station in Chicago. I had not seen my friend Fetters since we were hospital internes together, after gradua^ tion from the Sydenham Medical College in Philadelphia a dozen years ago. After graduation he settled in Philadelphia, where he has somewhat distinguished himself as a student of bacteriology and a writer upon the subject. He is at present one of the Sydenham faculty. We were very intimate in student days, and during our residence in the hospital. I settled in the West and until this meeting had had no com- munication with him, excepting that he wrote me a note of bantering criticism, astonishment and reproof when he learned four years ago that I ha^l actually as^ociated myself by practice and by name with homoeopathy. The whole tone of his note WAS such that I made no reply to it. And here we were sitting down to lunch together while waiting to get out of Chicago.
** Fetters — Well, this is luck. I've thought of you often, and have wondered how in the world you ever came to take up with homoeopathy. Do you practise it only, or are you one of those who claim to practise * both ways ' ?
** Freeman — What do you mean by practising both ways ?
** Fetters — I mean do }ou sometimes use rational practice, and do you use empiricism ; or do you ignore all the modem research and discoveries that don't lead up to homoeopathy »
^t^'SSrr^" NOTABILIA. 559
Beview, Sept. 1, 1896.
and do yon disregard the accumulated experience with practices which seem to do good l^ut have nothing to do with homoeopathy ?
<* Freeman — I have great respect for rational practice and use it frequently. I also have respect for empiricism, and use it when 1 think I can't do better.
*' Fetters — Good for you. I'm glad that you're not so taken up with homoeopathy as to lose sight of everything else. I have nothing against homoeopathy — I was brought up on it, and for aught I can see the homoeopaths (if they don't tie to homoeopathy alone) do as well with their patients as any of us. But what I don't see is what reason you have for calling yourself a homoeopath when you practise rational medicine and empiricism as well as homoeopathy. Gjme, now, can you really give me any good reason for it ?
** Freeman — Indeed I can — the very best of reasons ; and if you are willing to listen, you are just the man I'm looking for, for I am brimful upon that particular subject.
'* Fetters — That's right. I like enthusiasm, if it is well directed— and yours is well directed if you can give any earthly rt^ason why a man who practises rational medicine and empiricism as well as homoeopathy should call himself a homoeopath. Fire away, and be quick about it, for it's near my train-time.
" Freeman—Th& point is this. The particular cure of which simitia is the law outranks, in a sense, any other cure which one can intelligently attempt with drugs — it transcends the possibilities of rational practice and cannot be intelligently attempted in empiricism. Seeing this, and seeing, too, that a
** Fetters — Hold on. You are going too fast. What do you mean by saying that the cure of which similia is the law transcends the possibilities of rational practice ?
*• Freetnan — I mean precisely what I say. Let me define that particular cure of which similia is the law : it is ' such modification of the quality of vital processes and their effects that, whereas these processes and effects are abnormal, they shall become normal as the immediate result of the medicine used.* By immediate in this definition I do not refer to time — I simply mean that there is no drug effect mediate to, or precedent to, the cure. In rational practice one cannot attempt to immediately transform vital processes from abnormal to normal, for the data to any rational practice must be in themselves knowable, and vital processes are not in themselves knowable. Vital processes can be known only in their effects ; so, too, of the dynamic properties of a drug (those properties by reason of which the drug acts immediately upon the
660 NOTABILIA. ^^gSSS^.^^S???^
Review, Sept. 1, 1806.
vital processes) they can be known only in their effects. Now, while we cannot in rational practice attempt the cure I have defined, we can attempt it under guidance of a law of nature (if such there be), stating what relation between the effects of diseased vital processes and the effects of a dynamic drug as a pathogenetic agent indicates that drug as capable of effecting that particular cure. Do you see what I mean ?
** Fetters — Yes, I think I do. As vital processes are known only in effects, and as the properties by reason of which a drug acts immediately upon vital processes are known only in effects, you would look to a law of nature for a statement of the relation between the effects of disease and the patii(^enetic effects of a dynamic drug capable of immediately transforming from abnormal to normal the vital processes back of the disease efifects.
** Freeman — That's it exactly. I believe that similia similibus curantur is that law of nature. Now you know, as well as I, that those whom you call regular physicians are, as a body, opposing in every way they can the spread of homoeo- pathy. They would gladly consign it to oblivion, while I believe that the cure of which similia is the law transcends any that can be attempted in rational practice, and, in a sense, outranks any other cure that can be attempted with drugs. In the circumstances I feel called upon to identify myself by name with homoeopathy, so that, whatever my practice in a given case may be, I shall be known first, last and all the time as an adherent to and advocate of homoeopathy. Do you understand now why I call myself a homoeopath, though I practise rational medicine and empiricism as well as homoeopathy.
** Fetters — Of course I do ; it's perfectly clear, and the thing that's made it clear is your definition of that particular cure of which similia is the law. I never before heard that that cure is different from another, but I see that it is entirely different.
" Train-starter — The train is now ready for Marshfield, Pitts- burg, Harrisburg, Baltimore, Washington, Philadelphia, New York and Boston. The train stands on track No. 5.
'* Freeman — Here's your umbrella — don't forget it, and don't forget what I've been telling you.
*• Fetters — Indeed I shall not. I've enjoyed your talk immensely. That definition lets you out in great shape.
** Freeman — I'm glad you like it. I'm going to send you a Uttle book.*
* PrinHpleM of Medicine, by Chas. S. Mack, M.D. Published by tlie W. T. Keener Company, 96, Washington Street, Ohicagro.
** Freeman — Will you read it.
" Fetters— Indeed I will.
** Freeman — AU right. I'll send it. Good-bye.
'• F«ttm— Good-bye.
" Off moved the train.
" From the day of the above conversation Fetters has, in the bottom of his heart, believed that the homoeopaths are ihe best all-roand men in the medical profession, and that those who call themselves regulars are part of the time shutting their eyes to, and the rest of the time actively antagonising, that which is best in medicine. At times Fetters has even felt an impulse to identify himself by name with homoeopaths, but he is fettered by an iron-clad code which he could not throw ofif and retain his position in Sydenham College. Besides, he is a bacteriologist and does not want to practise medicine. He says to himself, * If I were in practice, I'd throw o£f this miserable code and be free as Freeman is.' "
QUININE AND MALARIA.
Thb Standard, of the 16th uit., published the following interesting and suggestive conmiunication from a West African correspondent on some of the conditions of health in the tropics. The use — or rather the misuse — of quinine and arsenic are important factors of life in these malarious climates, while the purely empirical manner in which they are given and taken is particularly noteworthy — the choice of one or other appears to have no relation to the characteristic phenomena of the fever in each patient, but on extent of his means for obtaining the one or other !
** The theory recently propounded by Professor Koch, with regard to the use of quinine in tropical and malarious countries, is somewhat alarming, coming from a professional man of such eminence. If it had been advanced by a younger, and a comparatively unknown, savant, it would probably be treated with little or no respect. Now, however, that the subject has been brought forward so prominently, it is to be hoped that it will receive, from those qualified to investigate such matters, the consideration it deserves. According to Professor Koch, the treatment of malarial fever by quinine has been so overdone as to cause in many cases the even more pernicious black-water fever. Whether quinine is, or is not, the cause of black- water fever, there can be no doubt that it is frequently given in very large doses, and is often taken far more indiscriminately than it should be. The drug first came into great prominence as the specific for malarial fever. A
VoL 42, No. 9. 2 0
562 NOTABILIA. ''g^l^gri!;!^
few jeais ago, in many oases, it had to take a second place to arsenic — not that it was inferior, but because its cost put it out of the reach of many. Now it can be obtained at such a reasonable price that it has to some exteat displaced arsenic, and nobody going to the Tropics has any reason now to consider the relative expensiveness of the two drugs. It is in many instances not only taken in large doses, but also as regularly as food, with the object of impregnating the system, and thereby rendering it proof against the ravages of malaria. Whether such a course succeeds or not, the person who takes quinine in this wholesale manner feels at ease, since he is under the impression that he has done aJl he can in what is generally accepted as the right direction. For it must be remembered that at present there is no check on the promiscuous use of quinine by those who know very little about all its properties. The writer, who has had many years' experience in malarious countries, and enjoyed numerous opportunities of observing the treatment of malaria, is, however, emphatically of opinion that the object desired by the habitual consumer of quinine is not attained. Those who saturate their systems with the drug die in the same way as those who do not, and, as a matter of fact, close observation goes to prove that the regular use of quinine is almost entirely confined to persons comparatively new to malarial regions, and that, if the consumer survives, the tendency is to leave it off as experience is gained. Taken in excess, quinine can be a poison, like everything else, and often produces cinchonism. A subject getting a bad attack of fever, who is already debilitated by the use of quinine, and in many cases also by anti-pyrin aud anti-febrin, is weakened still more by the effects of the fever, and increasingly heavy doses of the remedies are resorted to. Is it any wonder, therefore, that in the great majority of cases whrre death occurs the actual cause is assigned to 'failure of the heart's action ' ? In partial support of this argument, it may be pointed out that the mortality in certain portions of West Africa, for instance, is greater now than formerly, although the conditions of life have been vastly improved. If Professor Koch's theory be correct, the fact that quinine is so much more within reach of everyone, and as a result is far more used, may be some explanation. Besides being cheaper, the drug may now be obtained in forms that render it less distasteful. Thus, tabloids are not so unpleasant as the soluble form of quinine, and, if sugar-coated, have no taste at all, while they are more easily carried about. Again, it has been found that women are unable, for various reasons, to take quinine in the same wholesale way as men. And yet
^S^J^n'SSt NOTABILIA. 663
the mortality amongst women on the West Coast of Afrioa is infinitely less, in proportion, than that of the other sex.
'* Malarial fever in pernicious climates, in subjects not accustomed to the habitual use of quinine, has, where no complications have existed, been coped with by doses not exceeding thirty grains in the twenty-four hours, and that in cases where the temperature has risen to one hundred and four and one hundred and five degrees ; while in cases of remittent fever, where quinine has proved ineffectual, arsenic given regularly in moderate doses has often proved successful. Apart from the quantity of quinine which may be in a person's system, perhaps unknown to the medical attendant, in ordi- nary cases of fever on the West Coast, fifty, sixty, or seventy grains, or even more, in twenty-four hours is no uncommon quantity to be administered, even to a new subject. But on this point one fact must be conceded — viz., that the progress of malarial fever on the West Coast of Africa is more rapid than in many other malarial regions, and drastic measures are necessary. But, as the mortality has increased notwith- standing, the problem suggested for solution is, why do some hve and some die when all cUmatic and other conditions are apparently equal ? For example, putting aside the question of quinine, why is it that, as before stated, women stand the West African climate better than men ? During the appalling mortality on the Gold Coast within the pist four years, there was hardly a death amongst the women living out there, while every kind of man was dying — men new to the Tropics, men almost born in them, men who had been accustomed to them for years, men who had battled with the ravages of West Africa itself for upwards of ten years. Uow is it that, with all the advantages given to Government officials in the way of unlimited free medical attention and exceptional leave privileges, the death and invaliding rates amongst that class have been far in excess of those of the mercantile community, who invariably have, owing to their vocation, to live in tlie more unhealthy portions of the towns, and to reside on the West Coast for longer terms ? Why should the death-rate be higher amongst certain classes of Government officials than others ? These peculiarities are not mere accidents, any more than, as Professor Koch says, * It is certainly not an accident that black-water fever occurs almost exclusively in men, and only exceptionally attacks women and natives.'
'*A possible explanation is that while men are more exposed to the sun and rain and other such influences than women, the great majority of men, or those in charge of them, do not realise sufficiently the dangers of such exposure. The question of clothing, for example, is most important. The
2 0—2
564 NOTABILIA. ^^g^SSr.^CJTTSS!
BeTiew. Sept 1, 1886.
old idea of wearing nothing but linen, and very little of that, is by degrees giving way to the more sensible one of wearing light woollen clothing in the Tropics. The best protection from the sun and rain is required, for, the principle being admitted tbat both are dangerous, it is essential that care be taken to minimise the attendant risks. Moreover, the system of requiring men to go to work (some in the sun) for three or four hours, return to their proper breakfast at eleven or half-past, and resume work about one o'clock — all the hottest hours of the day — ^is a tax upon the constitution to which women are never subjected, and members of the mercantile commun ity but rarely. These and other apparently small matters may not entirely account for the peculiarities referred to, neither do they dispense with the urgent necessity for coping with the larger question ; but, as long as those peculiarities exist, it is as well to ascertain the cause of them. Instruction in a school for Tropical medicine, such as has been suggested, would be a step in the right direction. But the lines upon which that tuition is to be given must be clearly settled in the first instance, and if it be found and recognised that a drug which is a specific in some cases is injurious in others, or in most instances requires to be used with greater care and cau- tion, and, further, that a check upon the promiscuous use of such a drug is essential, then it follows that the hitherto accepted theory of ' piling in ' quinine at all costs is wrong. The subject is as urgent as it is important. England owns many Colonies with vast resources, the development of which is retarded by the mortality involved, while the cost of human life in holding them is deplorable ; and it is to be hoped that those who have to treat malaria, or assist in the efforts of coping with it, will not too lightly disregard the emphatic warning given by Professor Eoch in the words, ' It is certain that the treatment of black- water fever with quinine must absolutely cease, and that malaria patients who have had one attack of black- water fever must have quinine given to them with extreme caution ; but that it is still better to give them some other remedy instead.* "
Since the foregoing was published the following letter on the same subject has also appeared in The Standard : —
** Malabia and QuiNmE.
** To the Editor of The Standard.
** Sir, — As a medical man who has had some experience of malaria both on the West Coast of Afiica and in tropical America, allow me to confirm the opinion exprepsed in your article of to-day, that large and long- continued doses of quinine will cause symptoms resembling those of malarial
^K^JSSST^ NOTABILIA. 665
Review, Sept 1, 18B9.
fever. In small or reasonable doses, however, quinine is, of course, highly beneficial in ordinary tropical fever.
*' The fact is, I think, that large and small dose^ of drugs have in many (if not in all) cases opposite actions, and this is probably the secret of tbe theory similia similibus curantur, *' I am. Sir, your obedient servant,
•' W. H. Cbowtheb.
" August 16/'
HAHNEMANN TOMB FUND.
Amt. already anno anoed £9 18 0 i Dr. Logan, Ottawa, Canada 110
Dr. MoNish, London ... 1 10 Dr. Dyce Brown, London 110
Dr. Hawkes, Ramsgrate ... 1 I 0 | Dr. £. Madden, Lon^lon ... 110
Dr. Pullar, London ... 1 1 0 i Dr. Byrea Moir, London 1 1 u Dr. £. B. Roohe, Nor^ch 1 I 0
James Epp^ Eiq 110 £20 8 0
Dr. Washington Epps,
London 1 1 U
B. Hughes.
REMOVAL OP THE STOMACH.
A CASE in which the entire stomach was successfully removed occurred some months since in Switzerland. The following record of it appeared in the Surgical Era for January (Chicago). The editor writes as follows : —
" Partial, almost complete, excision of the stomach has been done in a number of cases with a successful result, but complete ablation of the organ has now been done with the survival and well-doing of the patient.
*• We are indebted lo the New York Medical Record for a carefully written report from which we learn that on Sep- tember 6, 1897, Dr. Carl Schlatter, privatdocent at the University of Zurich, did remove the entire stomach from one Anna Landis, aged 62, and that at the date of the report, December 9th, 1897, she was alive, well and working. That the entire stomach was removed is shown by the microscopical examination of the specimen, which showed oesophageal structure at one end and duodenal at the other. The operation was performed for a carcinomatous growth, occupying most of the gastric cavity and confined entirely to the organ. The tumour was palpable between the left hypochondriac region and the umbilicus, and as large as two fists. The diagnosis of cancer was made, and, as the patient was unable to retain any nourishment whatever and was losing flesh rapidly, operation was decided upon.
*' Under morphine-ether ansBsthesia and strict antisepsis the abdomen was opened in the middle line from the
566 NOTABILIA. ''SSa;.°^^f?gi'
ensiform process to the umbilicus. The stomach presented as a bard mass which was freely movable and readily lifted out of the peritoneal cavity. As a gastro-enterostomy was impossible, Dr. Schlatter decided to attempt the removal of the entire organ, or, failing in that, to do a jejunostomy. The operator proceeded to isolate the diseased organ by incision and suturing between forceps, until only the oesophageal and duodenal attachments were left. These were then divided between clamps. It being impossible to bring the cat extremity of the duodenum to the stump of the oesophagus the open duodenum was closed and a loop of bowel fifteen inches below brought up to, and anastomosis effected with the oesophagus by three lines of suturing, i.e., of the mucous membrane, of the muscular and serous coats and a reinforcing Lembert suture over all. There was small loss of blood and the patient left the table in good condition after an operation lasting nearly two and one-half hours.
** While it is to be noted that the conditions present, the mobility of the viscus with its contained, circumscribed neoplasm, were eminently favourable for total extirpation and such as are rarely to be met, it is clear that the indications were met boldly and brilliantly by the operator and an epoch marked in the surgery of the stomach. Dr. Schlatter has achieved deserved celebrity ly his unique operation.
** The post operative coarse of the patient has been more surprising than the operation itself. Small quantities of liquid food were given on the second day and from the tenth day on * fairly large quantities of food ' were taken and generally well retained. On the tenth day the patient suffered from nausea and vomiting * apparently superinduced by having witnessed a change of dressing in a neighbouring surgical case ! '
^*The ancient and accepted expression of 'turning the stomach ' will have to be given up. There were several attacks of vomiting during convalescence. Nov. 25 the patient is reported as feeling quite well and able to walk about comfortably. There was a steadily progressive increase in the weight of the patient after removal of the cancerous stomach. At first pepsin and hydrochloric acid were given to assist in the digestive process, bat were soon given up as valueless. Chemical analyses of the stools showed no marked difference from those of health, and with the exception of diminution of the quantity of chlorides excreted there was nothing abnormal in the urinary secretion after the operation. The patient's food it should be noted, was prepared with less salt than that of the other patients. In the recorded cases of almost
iota] ablation of the stomach in the human subject, post mortem examination has shown that the small portion of gastric structure left has undergone dilatation or pouching to some extent, so that more or less of a reservoir existed for food, and as it is remarked in the report that at one time this patient vomited thirty ounces it is possible, and probable, that the portion of intestine above the oesophageal junction has taken on the function of a reservoir.
" From study of the record of this remarkable case the salient points of which are presented above, we conclude, contrary to previously accepted notions, (1) that the stomach is not a necessary organ ; (2) that in the absence of the stomach digestion and assimilation of ordinary foods may be thoroughly performed by the intestines ; (8) that decomposition of the intestinal contents is not prevented by the gastric hydrochloric acid; and (4) the principal functions of the stomach seem to be those of a reservoir lor the reception and preparation of food and to regulate the temperature of solids and liquids as ingested."
THE DOCTRINE OF SIGNATURES. The following amusing illustration of a popular application of the notion which Hahnemann termed a ''fantastic speculation," and the appropriate remarks of the coroner, appeared in an evening newspaper on the 11th ult.
At an inquest on a child in London yesterday the mother stated that all her children had been down with the measles. She kept them warm and gave them saffron tea.
The Coroner : Why did you give them saffron ?
Witness : Because my mother gave it to me when I had measles.
The Coroner: And that was, I suppose, because your grandmother gave it to her. I can't understand you mothers giving your children saffron. It is an old washerwoman's tale. I suppose it was originally recommended by some quack because it was the colour of measle spots.
A Juryman : But saffron is the usual thing to give children for measles.
The Coroner : Yes, but it's all nonsense. It reminds me of the old story told of one of the kings of England — I forget which — who was taken ill with scarlet fever. The Court physician ordered him to be placed in a bed the hangings and drapery of which were scarlet. Strange to say, the king recovered, and the lucky medical man was made a baron and given much land. (Laughter.)
A Juror: And the next one who tried it had his head chopped off, I suppose ? (Renewed laughter.)
The Coroner : History is silent on that point.
568
NOTABILIA.
Monthly HomcMpathie Renew, Sept. 1, IflW.
TORQUAY DISPENSARY.
The following medical report for 1897 has been received :
Patients remaining from 1896 121
Admitted during 1897 596
|
716 |
|
|
Cured |
266 |
|
Believed |
267 |
|
No Change |
16 |
|
No Report |
,47 |
|
Deaths |
'6 |
|
On Books |
126 |
716
The honorary medical officers are Dr. Midglej Gash and Dr. Edgelow.
CHRONIC LEAD POISONING.
Eabohbb {Correspondena-Blatt. f, Schtceiz, AerzUy May let, 1898) reports two oases of lead poisoning. (1) A painter, aged 60. In 1896 he had colic and paresis of the upper extremities, less marked in the forearm than in the shoulder muscles, especially the deltoids. This was cured. In August, 1897, he suffered from renewed colic, tremors, and violent pains in both arms. There was paresis of the muscles supplied by both radial nerves, which, however, disappeared, leaving only paralysis of the extensors of the ring lingers. The paralysis and atrophy affected chiefly the scapulo-humeral muscles ; the deltoids, pectoralis major, rotators of upper arm (especially infraspinators and teres minor), and the levator scapulsB being almost absent. Such a case is chiefly interesting from the point of view of differential diagnosis, the muscles affected being the same as in Erb's type of progressive muscular atrophy. The author also reports an undoubted case of the latter, and then compares the two. At the height of the paralysis and atrophy due to lead, the two were ver^ similar, and the differential diagnosis could not be made with certainty. The shoulder muscles were first affected in both ; in both atrophy was the most marked symptom and fibrillary tremors were absent, and there was no R. D. in either. The following facts were in favour of lead paralysis (a) lead poisoning was certainly present; {b) the deltoids were markedly affected, muscles which are attacked very seldom and then late in the disease in Erb's pwidysis ; (c) the temporary paralysis of the forearm muscles ; {d) the
iSS^^^^T^^ NOTABILIA. 569
Bariew, Sept. 1, 1888.
moscles affected corresponded as a whole to Bemak*s brachial type of lead paralysis, though the slight implication of the forearm was exceptional. The diagnosis was cleared up by recovery following treatment in December, 1897. (2) A solderer, aged 85, who, besides tjpical lead poisoning combined with general muscular weakness, had ceaseless fascicular contractions producing no locomotor effect in the dorsal muscles of the hand and in the lower extremities, especially the calf muscles. These fascicular contractions are called by Schulze ** myokymia," and have no connection with degeneration. They may be present in other diseases, and are purely of a functional neurotic character. This patient had other neuroses, a limitation of the visual field, and weakness of normally developed muscles. The presence of these neuroses in this case is interesting as illustrating the fact that lead poisoning plays an important part in the etiology of the neuroses, especially hysteria. — Brit. Med. Joum., July 30th.
DEVONSHIRE (WHIMPLE) CIDEB.
WmLE it is well known that there are fashions in medicine in the old school, though fortunately not in the homoeopathic school, it is no less true and curious that there are fashions in food and beverages. For example, port wine, which at one time was so largely consumed and prescribed, went out of fashion for years, and came to be considered as next to poison, while now it is revived again, widely recommended by doctors, and largely drunk. So with cider. At one time, it was con- sidered a most sound and wholesome beverage, as one suitable for daily use, and still more as a drink for those of gouty habit and its allied evils. And it is pretty well known that in cider- producing and cider-drinking counties, gout, lithiasis, and allied troubles are practically unknown, or, at all events, are much rarer than in parts where wine and beer are chiefly consumed. For a long time, the fashion of cider-drinking has gone out, and one seldom hears of it being used, or prescribed by doctors. It has for many years been the professional dictum (practitioners following like a flock of sheep the opinions of one or two authorities) that fresh fruit of all kinds, and especially apples are to be tabooed in gout and gouty states of consttiution, on account of their acids. We have long believed such a view to be quite a mistaken one, and have acted on this belief with the greatest benefit to the sufferers, to say nothing of their enjoyment in being allowed such a delightful addition to their strict diet. We believe
570 NOTABILIA. "SSJl.^fSn*"?^
Bevlew, Sept 1, 1886.
that the gouty acidity is benefited immensely by the addition to the food of the wholesome vegetable acids of fruit. And of none can this be said more truly than of ripe apples. One unfortunate result of the tabooing of fresh fruit in gout» lithiasis, &c., has been the difficulty of getting good cider. When one asks for *' cider " one often gets stuff not fit to drink, and containing much more alcohol than is natural to cider. This, as we have said, may be the result of the small demand for it in recent years, or it may perhaps be, to a certain extent, the cause of it. But the fact remains. Pure cider, non-alcoholized artificially, and carefully prepared from the finest apples, is not only a most wholesome drink as a beverage, but, being made from apples, is a valuable food in gouty states — we had almost said a valuable medicine. It ought to contain not more than 8 per cent, of alcohol— hardly more than the celebrated temper- ance drink, ginger ale, is said, on the best authority, to contain. So that in drinking pure cider, those gouty patients who are permitted to take a little alcohol, (and most of them are allowed whif^ky) will find there just the small modicum which is permissible, while those who are not rabid teetotalers will hardly be aware there is any alcohol at all in cider, as far as their comfort and well-being are concerned. Few but extremists in temperance will refuse, on medical advice,- to take a beverage such as pure cider, which is so beneficial to their complaint. It is on these grounds that we draw the attention of our colleagues to the *^ Whimple " cider. Here we have all that is desired. It is perfectly pure, prepared with the utmost care to produce a really pure drink, made from the choicest apples of the district, a district which is famous for its fine apples, and only containing 8 per cent, of alcohol. As a result of this care and selection, the *' Whimple" cider is quite delicious to the palate, and so ** clean to the mouth." We have tasted samples of the five varieties, and can thus speak from personal know- ledge. The ** Woodbine Blend," being dry, is perhaps the finestof all, while the »* Whimple Pomona" and the "Fair Maid of Devon * * are nearly, if not quite, as good. The * * Sweet Alfred * ' is a little sweeter, but is a delicious beverage, and more effervescent than the others. The cheaper brand " Whimple Specialite" — extra dry— is excellent also, though the other brands are more delicate. There is now no excuse for not prescribing cider when it can be got so pure and agreeable, and we strongly recommend our colleagues to try it as a beverage instead of beer or wine, and to test its value as an article of diet in gouty patients. The proprietors are Messrs. Henry Whiteway and Co., Whimple, Devon.
SgSS^fgfnX':^^ OBITUARY. 571
PHOSPHORUS AND MORPHINE POISONING.
ScHBEiBER {Centralbl. /. inn, Med., June 11th, 1898) mentions that potassic permanganate has been recommended as a remedy against both acute phosphoras and acute morphine poisoning, and in some such cases it has given very good results. The oxidation products of phosphorus and morphine are non-poisonous, at least in the doses in which they are then likely to be present in the stomach. The only disadvantage of potassic permanganate is that the potassium salt is poisonous, and therefore cannot be given in large doses. The author has made experiments to ascertain whether the sodium salt, which can be used in larger doses, would answer as well. Thus, 2.75 g. of potassic permanganate killed a rabbit, whereas the same dose exercised no poisonous action upon anoUier similar animal. Sodium permanganate is, however, not harmlcKS ; the maximum dose for a medium -sized dog is 4.5 g. Strong solutions are especially to be avoided, as they act as corrosives to the gastro- intestinal mucous membrane, and produce fatty changes in the liver and heart, and also renal irritation. The good efifects obtained by the sodium salt were shown to be not inferior to those of the potassium salt. Although experiment shows that the administration of the antidote suffices, yet the stomach should be previously washed out with a two per cent, sodium permanganate solution. This should be done even if the poison has been taken some hours previously. After this, half a litre of the same solution is taken, or it may be passed through the tube into the stomach. The washing out should he repeated again in a few hours. If washing out is not possible, apomorphine should be injected, as emetics administered by the mouth interfere with the permanganate. Where the emetic must be given by the mouth, half a litre of sodium permanganate is given immediately afterwards, and then another half litre after the vomiting. The usual remedies must not be omitted if there is any evidence of absorption having taken place from the stomach, because permanganate is of little service after the poison is absorbed. — Lnt. Med, Journ,
OBITUARY.
STAMMERS MORRISSON, M.D. Philadelphia, M.R.C.S. Eng., L.R.C.P. Lond., & L.M.
We regret to have to record another loss by death in our ranks.
Dr. Stammebs Mobrisson, of Clapham, passed away at Bex- hill on the 28rd of July, in his 56th year. Dr. Morrisson had
572 OBITUABY. ^224=^22??^
Review, Sept. 1, 19B8.
been in bad health for a long time, and those of his coUeagaes who saw him professionally had no hope of his ultimate recovery. Dr. Cronin, of Claphaln, saw him regularly, and others with him in consultation, and though often being near death*8 door during the winter, he made a remarkable rally, yet none of his medical advisers expected his recovery. Dr. Groucher attended him at the last. Dr. Morrisson was bom in 1842, went through his medical studies at University College, and was house-surgeon at the hospital for a time, afterwards settling in practice at Brixton and Glapham, where he carried on a successful career for 80 years. He made a number of contributions to the homoeopathic journals, one of the most interesting and important being his proving of lycopxu virginicus. He also published several brochures on consumption and other diseases. He had a singularly gentle, unobtrusive, and kindly manner, which, with his devotion to his work, made him endeared to his patients and friends. He spared no pains or fatigue in the care of his patients, and in fact kept on working when he was physically unfit for it by his ill -health. His patients and friends will miss him much. Dr. Morrisson leaves a widow and two daughters to mourn his loss.
DR. H. W. DANFORTH, MILWAUKEE.
OuB American eichanges notice with deep feeling, as one of the saddest circumstances of the Hispano-American war in Cuba, the death, or as the Medical Era quite justifiably terms it, << the unholy slaughter,** of this promising young surgeon, while attending a wounded soldier.
Dr. Danfobth was a graduate of the Homoeopathic Medical College of Chicago of 1888. He had been in Cuba for wdl- nigh two years as physician to General Oomez, but had returned to this country to regain his health, which had been badly shattered by exposure and insufficient food. Upon the declaration of war he was called to Washington by President McKinley, and by virtue of his practical acquaintance with Cuba and the conditions of the island was given special plaoe with the army of invasion. It was here, before Santiago, while attending to a wounded soldier, that he was shot down by a Spanish guerilla and the army was robbed of an efficient surgeon and dlirector.
This sad occurrence is thus described by a correspondent of the New York Sun, who was a witness to the deed : —
"To-day, July 2nd, Col. Cajrivas, a guerilla, is still lurking along the line of the road, his men hiding in trees and shooting at the wounded as they pass by. While I was
B^^S^nr^* CORRESPONDENCE. 573
crossing a stream this morning, leading a male bearing a wounded Bough Bider, five sbons were fired at us. The mole was killed, and Dr. Danworth, a sargeon in the cavalry, was wounded, a ballet passing through his head and inflicting a mortal wound. A few moments later two other wounded men were shot at the same crossing."
The Medical Era thus writes of him : —
'* Though still a young man he had already attained considerable distinction, particularly as a surgeon. He was popular with his associates, a close student, a thorough patriot, and had h«* been spared would have proven of great usefulness to the army medical service "
CORRESPONDENCE.
MB. THEOBALD AND THE MEDICAL COUNCIL. To the Editors of the ** Monthly Homoeopathic Review,*'
Gentlemen, — The fact that I have been deprived of my diploma by the Boyal College of Surgeon«>, and have been "Disqualified" by the General Medical Council, has been several times referred to in your journal ; and I presume that many of your readers will be interested in knowing what progress I am making in my efforts to obtain restoration from both these bodies. When I was condemned, I learnt firom an official since, that in two years I might expect my diploma to be returned. More than four years have elapsed and this is still refused. Under these circumstances, it appears to me that the College has come to a final and irreversible decision to treat me as an outcast for ever, and my only hope of regaining my professional standing is by an appeal to the law courts, and a judicial decision as to the legEdity of the whole proceedings. This I am anxious to do. I am fully persuaded that I have a very strong case for legal appeal, but for this I must be supported. And in the first place I ask my own medical brethren to do so. I require support for two purposes : 1st, the publication and circulation of my documents ; 2nd, providing the sinews of war for the law- fight.
Now I am informed that many of my own colleagues hesitate to support me because they think the question at issue to be Matteism. This is not the case. This was the ostensible ground on which action was taken, but I am persuaded that if I had not been a homoeopath the clemency of the College would long ago have been exercised on my behalf. My real offence is that I am a homoeopath.
574 CORRESPONDENCE. ^S^i.^Ti^
Let me put out a few facts that indicate this.
1. The unexampled duration of the penalty. Any man of good character coming under the legal danger of these hodies for a venial offence, speedily admitted and corrected, with promise not to repeat the offence, would be very soon pardoned. No conceivable circumstance of aggravation exists in any case except this fact that I am a homoeopath.
2. The College in deliberating on my case used as evidence against me chemical analysis. My practice is assumed to be fraudulent because certain remedies which I have employed yield no positive result to chemical analysis. Evidently this is evidence that may be used against plenty of remedies constantly used by homoeopaths.
8. My counsel, Mr. Acland, in his speech to the G. M. G.» pointed this out, and by way of a reductio ad absnrdum of this kind of evidence, said : *• Why, gentlemen, if you condemn Mr. Theobald because he uses medicines of this Hnd, you may condemn every homoeopathic practitioner in the kingdom. You must strike them all off the register." This precious suggestion was received with a '^hear, hear,'* from one member at least of the 6. M. G., whose '* hear, hear," was echoed by the sympathetic laughter of the rest. There was no rebuke from the chair for this levity — ^no protest from any sober-minded member. Evidently the notion of emptying the Register of its homoeopathic element was not at all unacceptable to the Council.
4. This was not the only incident of the kind. I quote the following from the report in the Lancet, December 8th, 1894. Mr. Acland was speaking : —
** The statute to which the Council owed its existence made it perfectly clear that a name could not be erased on the ground of the person having adopted any theory of medicine.
** Dr. Heron Watson : Tlieory !
*' Mr. Acland : And practice.
•*Dr. U. W. : No! no!
*< Mr. A. : I respectfully submit that theory is nothing at all unless it is to go into practice.*'
So you see that one member at least (the *' hear-hearer '*) on the G. M. 0, commits himself to the portentous absurdity that a man may lawfully hold a theory of medicine which he is not allowed to practise. He will, if possible, evade the application of the protective clauses of the Medical Act by this contemptible subterfuge.
6. Very strong anti-homoeopathic bias has been shown most conclusively by the absolute indifference of the College to the petition in my favour pretented last year, signed by 66
b!^!S^^'' correspondence. 576
medical men of good standing and position. I suppose no plea for restitution has ever been so weightily supported, nor has any petition presented by even a much smaller number of medical men been refused. The opportunity of snubbing a large body of homoeopaths was too tempting to be resisted.
We all know what kind of animus io regard to homceopathy is prevalent in the profession. And this animus is not confined to the small fry, incapable of rising above vulgar prejudice. It is shared by the most eminent men — the class of men that are selected to occupy seats in the governing bodies. And it seems to me clear that this is the real obstruction in the way of recovering my legal rights.
I have been 42 years in the profession, practising homoeo- pathy in a quiet, unsensational way. Not a whisper of scandal has ever assailed me. My reputation among those who know me certainly stands as high as that of any member of the B. C. S. or G. M. G. The incriminated book has been withdrawn from circulition. I have done all that is possible to '< purge " my offence, such as it is, and I really cannot think it very aggravated. To most persons it is invisible.
Quite apart from homoeopathy, it is intolerable that medical discipline should be thus administered, and even from this point of view I can scarcely believe that the law will endorse it. But the whole process has, from beginning to end, been unlawful. The very bye-law quoted against me — that against secret remedies — ^no longer exists ; it has been abrogated. And even if it were still in force it is guarded by a limiting clause, which, in the opinion of competent lawyers, exempts me from its application. So that I am condemned by the doubtful qpplicatwn of an extinct statute.
I cannot occupy your space with further detail. Fullest particulars will be contained in the documents which I wish to publish. I am anxious to send a copy of my indictment of these bodies to every Member of Parliament, and to all the principal journals in the country. Unaided I cannot do this. I have no hesitation whatever in asking to be assisted in what I am sure is a matter of large public interest. No loyal citizen can be indifferent to official action by which penal laws are strained, and cracked, and even broken, in order to feed rancour of the professional antipathies. And I feel confident that in resisting these bad deeds I shall be solidly supported, first by my own colleagues and their friends, and afterwards by the general public.
I am, Sir,
Yours very truly,
B. M. Theobald.
676 CORRESPONDENTS. "BSSSl^aSfTlM
BorieWi Sept. If ]fiB6>
NOTICES TO CORRESPONDENTS.
*^* We cannot undertake to return rejected vuinuteriptJi.
Authors and Contributors reoemng proofs are requested to correct and return the aame as early as possible to Dr. Edwin A. ]S eatby.
London Homcbopathic Hospital, Great Ormond Street » Bloomsbury.— Hoars of attendance : Medical, In-patients. 9.S0 ; Out- patients, 2.0, daily ; SURGICAL Out-patients, Mondays, Thursdays^ Fridays and Saturdays, 2.0 ; Diseases of Women, Out-patients, Tuesdays, Wednesdays and Fridays, 2.0 ; Diseases of Skin, Thursdays. 2.0 ; Diseases of the Eye, Thursdays, 2.0 ; Diseases of the Throat and Ear, Wednesdays, 2.0 ; Diseases of Children, Mondays and Thursdays, 9 A.M. ; Operations, Tuesdays, 2.30 ; Dental Cases, Thursdays, 9 a.m. ; Orthopaedic Cases, Tuesdays, 2 p.m. ; Electrical Cases, Thursdays, 9 a.m.
Communications have heen received from Mr. Dudley Wbigbt^ Mr. BuiST Picken (London) ; Dr. Wilkinson (Windsor) ; Dr. Obi> (Bouinemonth) ; Dr. Black (Torquay).
BOOKS RECEIVED.
Journal of th£ Britith Hofiiaopathic Society, July. London. The Hftmaopathic World, August. London. Tke Chewut and DruggUt. August. London. Calcvtta Jovmal of Medicine. July.
North American Journal of Homcei^Mithy, Auprust. New York. Himaiipathic Fyc^ Ear and Throat Jovmal, August. New York. Tlte Afedical Times. New York.
The 3V(/* England Medical Gazette, August. Boston* Tile Hahntwannian Monthly. Augfust. Philadelphia Howaiopnthic Recorder. July. Philadelphia. The Howcpopathic Enmy August. Lancatter, Pa. The Clinique. July. Chicago.
Ilahnemann Mediral College and Hospital Thirty-Xinth Annnal Anmyuncewent. Chicago.
The Medical Era. August. Chicago.
The Hahnemannian Adrocate. July. Chicaga
Thf Medical Century. August Chicago.
The Minneapolis Htmaopathic Magazine. August.
The Medical Brief. August. Bi. Louis.
The Pacific Coast Jonmal of Homwopathy. July. San Francisco.
Reviie Homaiopathiqve Frangaise. July. Paris.
Rt tue Mensyelle de Bihltographie Medicale. July. Paris.
Allgemeinc How^.'pathiJtche Zeitung, August. Leipsig.
Lei]), iger Popular e Zeitschriftfiir Homdi»pathie, August.
Rivista Omutpatica, May at d June. Rome.
Papers, Dispenrary Beports, and Books /or Beriew to be nent to Dr. Popm, 19, Watergate, Oranthaxn, Lincolnsbiie ; Dr. D Dtcb Bb« wk, 29, Sermonr Stareet, Portman Square, W. ; or to Dr. Edwik A. Nbatby, 178, Haverstock HiJl, N.W. AdvertisezneiitH and Business commmucations to be sent to Measm. E. Gould & Sox 59, Hoorgate Btroet, E.C.
i^w^o^T^t^ BRITISH HOM(EOPATHIC SOCIETY. 677
THE MONTHLY
HOMOEOPATHIC REVIEW.
THE BRITISH HOMCEOPATHIC SOCIETY.
At the closing meeting of the British Homoeopathic Society, held in the mid-summer, Mr. Knox Shaw, who had been for the last six years its honorary secretary, resigned his ofGice, and took occasion to present to the members an interesting report of the work of the Society during his term of secretaryship. This report will, we presume, appear in due course in the Journal of the Society ; the progress of the British Homoeo- pathic Society is, however, of interest not only to its members, but to all and several who are concerned with the advancement of homoeopathic therapeutics. For this reason, we think a few remarks on the progress of the Society will be welcomed by some not present at the annual meeting, and not receiving the Journal of the Society.
The status of homoeopathy does not consist merely of the number of names attached to a medical society, or appearing in a medical directory ; the scientific culture, the clinical experience, the technical knowledge of the exponents of this system of medicine, all bulk largely in elevating the medical and scientific tone of the individual members of the homoeopathic section of the medical profession, and in making them successful practitioners of the art of medicine. To this end well-equipped hos- pitals and well organised medical societies are necessary. Nothing is more striking amongst our body, during the last decade, than the extraordinary development of our hospitals and medical societies. Nothing, in our opinion.
Vol. 42, No. 10. 2 P
678 BRITISH HOMCEOPATHIC SOCIETY. ^Re^Jw^cSrif?^
presents more convincing evidence of the vigour of the small but steadfast band of men who have thrown off the shackles of medical trades-unionism to fight the battle of liberty of thought and of freedom to practise medicine according to their individual knowledge and experience than this fact. From this standpoint we have watched with great interest the remarkable expansion of the London Homoeopathic Hospital, and the development of the many provincial hospitals devoted to homoeopathic therapeutics; and now the Secretary's report of the progress of the British Homoeopathic Society during the last six years stimulates an ever watchful interest in its work. Not that the Society is an aspiring and precocious infant. In May, 1894, we referred fully to the celebration of its jubilee, and then noticed that it was entering on a new life and was adapting itself to more modern requirements. As to the necessity of a good medical society for those who are interested in homoeopathy, and the need for all who are united by this therapeutic tie becoming members we can add nothing to what we said then. Medicine and surgery are not stationary arts, their very progressiveness make the constant interchange of personal experiences a necessity to the man who would be thorough, and he must be an extraordinary being who cannot learn something, or even impart something, by meeting and discussing subjects of practical importance and professional interest with his colleagues. From Mr. Knox Shaw's report we learn that up to the summer of 1892 the Society conducted its meetings much in the same way as it had done for many, many years past, but that in that year, after much deliberation, important alterations were made in the laws of the Society, with a view to the " further advancement and extensiou of its work." His modesty prevented him saying that these alterations were the outcome of a paper read by him, on his retiring from the President's Chair, on The Future of the British Homoeopathic Society, A new and enlarged Council, with extended powers, and containing Members as well as Fellows, set to work.
Mr. Enox Shaw went on to say that ** daring the summer of 1892 the Council was busy with its work of reorganisation, and secared the services of so able a litterateur as Dr. Huohbs as editor of its Tramactions. At the commencement of the Sfession 1892-1898 there were 116 active members of the
SS^r<StTX^*'' BRITISH HOMCEOPATHIO SOCIETY. 579
Society, and as evidence that the homoeopathic body was ready for reorganisation, 66 new members joined the Society during that Session ; and daring the past six years a total of 111 members have been added to its roll.
^' In November, 1892, the Liverpool HomcBopathic Medico- Chini^cal Society — an old-standing homoeopathic society — applied to the Council, and was duly registered as the Liver- pool Branch of the British Homoeopathic Society. This important branch has steadily increased in numbers, and has risen from a membership of 15 to one of 81.
" Li January, 1898, the Jaumal of the Society appeared, and its sterling value as a homoeopathic medical periodical soon caused it to have a circulation outside the membership of the Society, both in this country and America. With the journal was issued, as a supplement, an annual classified list of officers and members of the Society.
^< At the Annual Assembly in 1898 the method at present in vogue for the election of the Officers and Council was adopted, and a new law defining the qualifications of members for the Fellowship was passed.
'< In April, 1894, the Society reached its jubilee, and with its President, the late Mr. Camebon, the only surviving founder of the Society, in the chair, celebrated the occasion by a well-attended banquet.
''At the annual assembly of 1894 the Council proposed certain new bye-laws, which were adopted. The most important addition was the division of the work of the Society into sections, three sections being formed, each with its chairman and secretary, viz. : — Materia Medica and Therapeutics, Medicine and Pathology, Surgery and Gynaecology. The varied and interesting papers, which have been the result of this division of labour, testify to the wisdom of this new step. Under the new bye-laws the old plan of ' private and public business ' was done away with.
"In 1896 the section of Medicine and Pathology, upon the direction of the Council, undertook the formation and distribution of schedules for the collective investigation of certain diseases. The returns are slow in coming in, but when they are complete they will form a most valuable contribution to the statistics of homoeopathy.
" During the same year the Council appointed a Committee -of the Society, under the guidance of Dr. Burford, to index British Homoeopathic Literature. The staff of collaborators are steadily at work at this important task.
" In July, 1896, the Council appointed a Sub committee to arrange for the entertainment, at a banquet at the Hotel •Cecil, of the members of the International Homoeopathic
2 P-2
680 , STUDY OF TEMPERAMENT. **a^5|Jw°^'^'^2^
Review, Oct. 1, 18B6w
Congress, then visiting London. Towards the end of 1896 the Council ordered the re-arrangement of the library of the Society, and instructed the librarian, Dr. E. A. Neatby, to prepare a catalogue of the books, this catalogue to be issued, in quarterly instalments, free to each member, as a supple- ment to the Journal, and the final part was issued with the July number. They further arranged for increased facilities for the loan of books to country members, and for the early publication of a catalogue classified according to subjects.*'
'* At the Annual Assembly of 1897 Dr. Hughes was able to announce that the first part of the repertory to the Cyclo- paedia of Drug Pathogenesy was nearly ready, and the Society thereupon undertook to subscribe for 260 copies, and to distribute them and future numbers without charge to
members ; two parts have already been delivered.
* * « #
<< During the past six years 66 meetings of the Society and 29 meetings of the Council have been held. During this period 121 papers have been read, and 5 clinical and microscopical evenings have been arranged."
We have thought such a record worthy of a somewhat full quotation : it clearly shows the position of the British Homoeopathic Society to-day, and though, in 1892, we feared that the aspirations of the Society might not be attained, the result of six years hard work has justified the optimistic spirit that animated the majority of the members. The Council have appointed Dr. James Johnstone, who has proved himself to be, by his management of many of the clinical and micro- scopical evenings in recent years, a very competent organiser, honorary secretary of the Society. We feel that in his hands the work of the Society will be carried on in a thoroughly scientific and progressive manner.
THE STUDY OP TEMPERAMENT, DIATHESIS AND DYSCRASIA AS AN AID TO TREATMENT.*
By Bernabd Thomas, M.B., CM.
The study of constitution has a special interest for those who favour the treatment of disease by the law of similars, for it deals with the individual and his morbid or special tendencies; and takes into account the
♦ Presented to the Liverpool Branch of the British Homoeopathic Society, April 14th, 1898.
bSSSJ^^Tmw*^** study op tempebament. 581
existence of certain proclivities or peculiarities, made known to U8 by the appearance, manner and history of the patient. The sabject of this paper is, however, a practically inexhaastible field of enquiry, and it is, therefore, unnecessary to state that I have only attempted to write an mtroduction, which will, I hope, suggest material for consideration at some future time.
We find little reference in the more recent text books of medicine to diathesis and temperament, nor do we hear much concerning these conditions in our student days. On the other hand, we are early impressed with the importance of bacilli and their toxines. This must not give rise to a wrong conception of etiology, for not only must the seed be there, but the soil must be capable of receiving it ; moreover the nature of that soil will modify, preyent or hasten its growth. In other words, there must be a proclivity to a special disease on the part of the individual, besides the accident of germ infection. And similarly in those diseases which have another exciting cause than the ubiquitous microbe, there is the same tendency among one or other to resist, to modify, or to succumb.
Before proceeding further it is necessary to define some terms which will be employed in this paper. Jonathan Hutchinson, in his lectures on "the Pedigree of Disease," says : —
" The term temperament is applicable to the sum of the physical peculiarities of an individual, exclusive of all definite tendencies to disease. Different temperaments are to be assumed to be hkely to give some degree of peculiarity to morbid processes when such have been induced by other causes; but they do not themselves involve any special proclivity. When most strongly marked, temperament is still consistent with the pro- longed enjoyment of perfect health."
The same authority says of diathesis. **It is any bodily condition, however induced, in virtue of which the individual is, through a long period or usually through the whole life, prone to suffer from some peculiar type of disease. Some diatheses are inherited, others are acquired. Of some the effects are permanent or constant, of others they are transitory, or recurrent after long intervals of health.
582 STUDY OF TEMPERAMENT. ^"u^l^oStT^
^' To distinguish between temperament and diathesis,. we may say that the former is a matter of physiology, and the latter of disease, and that the former term is applicable only to peculiarities which are a part of the original organization of the individual, whilst the latter may be acquired as well as inherited." *
'* It is important not to confuse diathesis with dyscrasia,. for the latter term implies the * peculiar and immediate effects of disease.' " *
Lastly cachexia expresses an extreme degree of bodily debility consequent upon advanced and severe disease.
The condition of the constitution of an individual may be denoted by these four degrees of health and disease* A temperament alone indicates perfect health. A dia- thesis stands in a somewhat intermediate position ; it indicates the tendency, though in many cases what we now call diathesis may at some future time be recognised as ''latent disease." A dyscrasia, and in a greater degree a cachexia, are obviously morbid conditions. Arranged in the order of severity we thus have (1) a temperament, (2) a diathesis, (8) a dyscrasia, and (4) lastly, a cachexia.
Various attempts have been made to classify the different constitution and diatheses. It is usual, it is interesting to note, for theorists to be satisfied with grouping these into three divisions. Professor J. Engel " gives three erases or dyscrasise, according to the relative amount of fibrin, albumen and serum in the blood. (1) The fibrinous crasis, including all acute inflammatory diseases ; f2) the albuminous crasis, including all chronic inflammations, hyperplasias and new growths ; (3) the serous crasis, including all dropsies and degenerations. These divisions seem to indicate stages in, and not differences of, morbid processes.
Grauvogl ^ mentions three constitutions (diatheses) ; (1) the hydrogenoid, (2) the oxygenoid, (3) the carbo- nitrogenous.
Hahnemann regarded psora, sycosis and syphiUs as sufficient to explain the existence of all chronic diseases. These three dyscrasiae corresponded more especially to sulphur, thuja and mercurius respectively.
This drug correspondence to constitution leads me to remark that those versed in homoeopathy would under-
SL^SS^cSTi^lSf"'' STUDY OF TEMPERAMENT. 588
Review, Oct. 1, 1888.
fitand the significance of terms such as the following : — the mix temperament ; the calcarea curb, diathesis ; the mercurius dyscrasia and the arsenic cachexia. But this aspect of the subject we will defer for the present.
Temperament.
The time-honoured division of mankind into four temperaments cannot be passed by unnoticed. The Sanguine temperament is characterised by vascular activity. It is shown by a florid complexion ; sandy hair, straight and coarse ; blue eyes ; firm flesh ; full, quick circulation and a mind impetuous and excitable. Ailments of the circulatory and respiratory systems and inflammations are said to predominate. Diseases run an acute course and terminate quickly in death or recovery.
The Nervous temperament is characterised by nervous activity and excitability. The head is large ; the hair flaxen and inclined to curl ; blue eyes ; fair nkin ; firm flesh ; the body inclided to be slender ; quick and fine circulation ; quick and excitable mind. Nervous diseases predominate, head complications and nervous symptoms are common in other affections.
The Bilious temperament. The outline of the body and countenance is angular ; the hair, eyes and skin are dark ; circulation strong and vigorous, and the mind steady and unexcitable. We may add that the com- plexion is often sallow or slightly icteric. The individuals with this temperament are disposed to take life seriously ; they are even inclined to be pessimistic, while the sanguine are more given to optimism. The bilious temperament denotes a liability to bilious and gastric derangements and complications.
The Lymphatic temperament is shown by a tendency to fatness and softness of flesh ; roundness of outline ; pale complexion ; light, straight hair; grey eyes ; slow, weak circulation, deficient energy and a mind slow and sluggish. There is a liability to diseases of mucous and serous membranes, to dropsies and oedemas. Diseases run a slow and retarded course, and there is little tendency to reaction. Dr. Hayward, in a paper on " Cachexia of Young Children,"* to which I am in great part indebted for these descriptions, remarks that in infancy the nervo- sanguine temperament is the most prevalent, and that
684 STUDY OF TEMPBRABfENT. ^X^-lJw^oTi'^wS!
more children of this type die than any other. This may be due to the greater activity of the nervous and vascular system during early growth and development. It is my impression that the majority of adult males conform most nearly to the bilious, and females to the lymphatic or lymphatico-nervous temperaments. It is the exception to meet with an individual who has the qualifications of a single temperament ; more usually we have a com- bination, as nervo-sanguine, lymphatico-bilious, &c.
Jonathan Hutchinson looks upon these temperaments as arbitrary, and of little clinical value. He says, " I cannot but think that what has been called temperament divides itself naturally into these two parts, race and diatheaia.'*^ Here we may agree that the complexion, whether light or dark, is a racial distinction, and has little to do with a person's proneness to modify disease* Complexion is determined by the quality or quantity of pigment, and also by the fineness or coarseness of the skin ; it does not depend essentially on the degree of vascular or nervous activity. It cannot be denied, however, that some persons have more vascular activity, some more nervous excitability, and that others are sluggish or bilious. The chief fault of the above descriptions of temperaments is that they are a little too detailed and too precise to be easily adapted to any given individual. But it is of practical importance and interest to notice, in selecting the appropriate remedy, the conditions or special drug temperaments which aid us, more especially, perhaps, in chronic cases.
As two types of the nervous temperament, we have nux vomica and ignatia ; the former for men, the latter for women and children. Farrington says of nux vomica, ** It does not necessarily follow that you must not use nux if the constitution is not what I am going to describe ; but it does follow that it acts better in the constitution about to be mentioned. Nux is best adapted to rather thin, spare people ; it does not act so well in the fleshy. Especially is it indicated if the patient is rather irascible and quick to action on his motives. He has a nervous temperament ; the face is rather sallow or yellowish. There is a sort of false plethora that gives the patient at times red cheeks on the yellow back ground. Generally, too, you will find that the patient suffers from any strain on the mind, particularly if this
2^SJr<2ri!^*"'' STUDY OF TEMPEBAMBNT. 585
overstrain of the mental powers is intensified or rendered more injorious by sedentary habits." This masterly description conveys, I think, an admixture of the bilious -with the nervous temperament*
The following account of sepia, from the same author, seems to indicate that it should be useful in lymphatic women of a bilious tendency, and we may add to it that it is recommended, more especially, for the dark eom- plexioned. ^* Sepia, has been found to act well in men, and more often in women, who are puffed or flabby, less frequently emaciated, who have a yellow or dirty yellow- brown, blotched skin; who are inclined to sweat, specially about the armpits, genitals and back ; suffer from hot flushes ; headache in the morning, and awaken stiff and tired."
As types of the more purely lymphatic, we may mention Pulsatilla and sulphur.
Hahnemann says of Pulsatilla, '' the medical employ- ment of the drug will be more salutary when in the maladies to which this plant corresponds, as regards bodily evils, there is at the same time a timorous, fearful state of mind and tendency to inward depression and quiet grief, or, at least, to pensiveness and resignation, especially if in health the patient was kindly and pleasant <or even of a light and changeable disposition). It therefore especially suits the lymphatic constitution, and is consequently but little appropriate to men, quick at their course of action and energetic in their movements, even though they appear kindly disposed."
Sulphur " is especially adapted to persons of rather light complexion (although the dark-complexioned may also yield to its influence), who are easily angered. It is one of our mainstays in the treatment of the negro. Whether this is owing to the rapid growth of scrofula in that race or not I cannot say. It is also suited to persons who are subject to skin affections, particularly to those who have a harsh rough skin, which very readily breaks out with eruptions of various descriptions varying from a simple erythema to a positive eczema. There is apt also to be an offensive odour from the body (perhaps originally due to uncleanliness, for the sulphur patient is not fond of water), but this is not removed by washing ; hence you must consider it also an abnor-
586 STUDY OF TEMPERAMENT. ^'S^^STifwWL
mality of the skin. The patient is rather of coarse fibre^ his hair is harsh and coarse."^
Both ferrum and aumm are recommended for the sangnine temperament and for persons with a florid complexion, but a further delineation of their characters is wanted.
Among other drugs, a few of which it is only necessary to briefly describe, we may contrast the temperament of aconite with that of agaricus.
Aconite is especially applicable to the plethoric, or those leading sedentary lives, dark hair and eyes, and persons of rigid fibre.
Agaricus to those with light hair and lax skin and muscles, and in old people with indolent circulation.
Alumina for dry, thin, withered subjects, or old people ; this drug is somewhat similar in this respect to conium.
Causticum suits those with dark hair and rigid fibre^ thus somewhat resembling aconite.
Graphites for persons inclined to obesity, particularly females with a disposition to delayed menses and constipation.
Secale is a contrast to sepia, in that it is more suitable to tall, scrawny women of lax muscular fibre, and to the feeble and cachectic, also to very old and decrepit persons.
Silica may be compared for points of resemblance and contrasted for its differences to calcarea carbonica.
Thuja, which we have seen is recommended in sycotic conditions, is suitable to dark complexioned people with black hair, dry fibre, and not very fat, but of lymphatic tendency and lethargic nature.
These by no means exhaust our list of drug tempera- ments, but they will serve suflSciently as examples. It is necessary to understand, however, that it is no part of this paper to dispute their validity. They have been found, we may suppose, by provings on persons of these temperaments who have reacted more quickly, or they are the result of clinical observation ; but whether the one or the other does not concern us now. That they are a useful addition to our means of finding the simillimum is undeniable. The question is how are we to make use of them ? I would answer that we should use them in much the same manner as the antipsorics.
SSS^fStMSe*"*' STUDY OF TEMPERAMENT. 687
either alone for chronic diseases, where indicated, or as intercurrent remedies to supplement the action of more superficially acting drugs. And perhaps we may be right — though this is always debatable ground — to give them in the higher dilutions, 6, 12, 80, 200th, &c., and at long intervals. Thus, supposing we are treating a patient of the nux temperament for subacute rheumatism, we may make use of bryonia, of rhus tox, of any other remedy, but an occasional dose of nux will help on the cure, although one would not think of this drug as a specific for rheumatism. Such a case occurs to my mind at present.
Diathesis*
We have now to consider those special tendencies to disease which are known as diatheses. There is the difficulty already mentioned of distinguishing diathesis from dyscrasia. Thus, there is no ground for believing the existence of a syphilitic diathesis. Congenital syphilis is a dyscrasia, for the new-born infant inherits the actual disease and not the tendency to it. '' A child inherits syphilis in precisely the same way that it inherits small-pox." ^ Again, the malarial diathesU is an acquired tendency from a previous attack, and is not to be confounded with malarial cachexia, the constitutional change resulting from ague saturation.
There is a condition known as the oxalic a^d diathesis, which is probably only a form of dyspepsia. It is more commonly found in men of good position, who are accustomed to good living and sedentary habits. It is accompanied with the symptoms of atonic dyspepsia, with the presence of oxalates in the urine, and with a peevish, irritable and often melancholic state of mind. For this condition Dr. Begbie* recommends non-saccha- rine diet and nitro-muriatic acid. We can hardly, in view of the definition of diathesis, call this more nor less than a form of dyspepsia, seeing that there is no special tendency to a particular type of disease, except perhaps the possible accident of the formation of an oxalic acid calculus.
Diatheses are not, as a rule, easily recognised, they are more often learned from a study of the family history (hereditary diathesis), from the personal history (acquired diathesis), or from both. At least two well-
688 STUDY OF TEMPERAMENT. ^^piJlL^oT???^!
marked constitutions are exceptions to this, in that they present obvious physical characters. Of the two varieties of struma about to be mentioned, I feel it probable that there is some disease already present which interferes with nutrition and produces a condition of delicacy and debility, which prepares the way for more evident scrofulous or tuberculous manifestations.
After a description of these, a reference will be made to the tonsillar dyscrasia, which, as you all know, repre- sents the physical changes brought about by mechanical obstruction to respiration in the naso-pharynx and fauces, but which, however, bears some relation to struma, and sometimes precedes it.
The Scrofulous Diathesis has long been recognised by two types: (1). The sanguineous or serous is thus described " There is a general want of muscular develop- ment, for although the figure may be sometimes plump and full, the limbs are soft and flabby ; the skin is fair and thin, showing the blue veins beneath it; the features are very delicate ; often a brilliantly rosy colour of the cheeks contrasts strongly and strikingly with the surrounding pallor ; the eyes, grey or blue, are large and humid, with sluggish pupils sheltered by long silken lashes ; hair fine, blonde, auburn or red ; teeth white, and often brittle ; there is frequently a fulness of the upper lip and alsB nasi; the ends of the fingers are commonly broad, with convex nails bent over their extremities. Such persons usually possess much energy and sensibility, with elasticity and buoyancy of spirits ; they often possess, too, considerable beauty. In this variety, with the same delicacy, the skin and eyes are sometimes dark."
2. The Phlegmatic or Melancholic. ** The skin, pale or dark, is thick, muddy and often harsh ; the general aspect, dull and heavy ; hair, dark and coarse ; the mind is often, but not always, slow and sluggish. Children, especially those in whom the diathesis is strongly marked, are often distinguished by the narrow and prominent chest, the tumid and prominent abdomen, and the paste-like complexion. The limbs are wasted ; the circulation languid ; chilblains are common on the extremities ; the mucous membranes particularly, and above all the digestive, are liable to morbid action ; the breath is often sour and foetid ; the tongue is furred, and
SSS^Jf^nTiSs*** STUDY OP TEMPERAMENT. 689
the papillsB towards the apex red and prominent ; the bowels act irregularly, and the evacuations are unusually offensive ; the digestion weak ; the appetite variable and capricious/' (Sir Wm. Savoy,)
Of these two, the sanguineous, or, as it is often distinguished, tuberculous diathesis, is more liable to visceral tuberculosis, especially to phthisis. I think it corresponds most nearly to the genius of iodine, but we also find points of resemblance to aurum, Pulsatilla, calcarea carb., and I think in some measure, agaricus. The phlegmatic, or more purely scrofulous diathesis, has a greater liability to bone diseases, joint diseases and skin affections. It suggests sulphur, also mercurius, hepar and silicea. I need not mention in both diathesis the utility of hygienic treatment and cod-liver oil.
The TomiUar Dyscrasia is a condition of childhood, or early puberty, produced by the obstruction to respiration caused by the hypertrophy of the tonsils or by adenoid vegetations ; often both conditions exist together. Children, before the age of puberty, are nose-breathers, and hence any nasal obstruction has greater effect on the respiration than in the case of adults. Moreover, these lymphoid structures are normally larger and more active before, and tend to atrophy after, puberty. This constitution is characterised by snoring and buccal respiration, the speech is thick ; there is sometimes stammering and often a greater or less degree of deafness. The mouth is open, the upper lip is short, thick and protruding, alsB nasi drawn in, the face pointed, but flattened laterally. The chest is small and narrow, while the respiratory movements are limited and imperfectly performed. The mind is usually slow, there is a vacant expression, and often a lack of intelligence.
Undoubtedly baryta most nearly of any of our drugs corresponds to this condition. There is the hypertrophy of lymphoid tissue, especially the tonsils, the liability to attacks of tonsillitis and also the slowness of mind which is so often associated. With regard to the local removal of the vegetations and tonsils ; when the period of puberty is near and immediate interference unnecessary, it is but to wait, to counsel gymnastic exercises, which will improve the capacity of the thorax, and to see if the condition itself will not improve and the glands atrophy.
590 STUDY OF TEMPERAMENT. ^R^J^oStTfas:
We will now briefly consider a few diathetic conditions which are not so plainly manifest by observation alone.
Gout is one of the most important. Here hereditary tendency is marked, and in those predisposed the least indiscretion will promote a paroxysm. Although a •disease of middle or advanced age, it has been known to occur in early manhood or even before puberty, where the hereditary tendency was a strong one. Treatment is principally dietetic, and the avoidance of sedentary habits. As a medicine in the goutily disposed, I should place most reliance on nux vomica, and next to that on lycopodium.
The Hcemorrhagic diathesis is rare. Hereditary influence is important, but, oddly enough, although most frequent in males it is transmitted through the female members of a family. Jonathan Hutchinson^ says it has a distinct affinity to gout, which usually figures in the pedigree. I have fortunately had no experience of the complaint — for I can conceive of no more distressing condition to treat — but would accept phosphorus as the best established remedy.
The Rheumatic diathesis is ascertained from the history, and, where such exist, the evidences of former attacks. Here I am speaking of the acute or subacute disease. We know that it is to a certain extent hereditary ; we know also that some individuals have one attack after another from seemingly trifling causes; and we also know that there is a relation between acute arthritic rheumatism, myalgia, chorea, endocarditis, pleurisy, etc. I call to mind one little patient who had an attack of acute rheumatism, followed by chorea, and this finally by another attack of acute rheumatism ; all within a few months' time.
Prophylactic treatment is the obvious avoidance of the direct existing cause. As a drug I would suggest actea racemosa.
A Catarrhal diathesis is often mentioned. It has some similarity in aetiology with the afore-mentioned. But I think catarrhs are more frequently produced by change of temperature than by damp or a wetting. It is denoted by a tendency to inflammations of the skin, or mucous membrane, of a catarrhal nature, from apparently slight causes. Certainly there are people who are more sus- ceptible in this way. They are often subject to cold
B^^Jo^^SSt^ 9TUDY OF TiSMPERAMENT. 591
hands and feet ; the circulation is slow, and they have a somewhat lymphatic tendency. The result of exposure may be dermatitis, coryza, diarrhoea, &c. For the diathesis Pulsatilla seems most indicated ; for the actual attack we have our usual remedies, such as aconite, bryonia, arsenicum, dulcamara, &c. I think senega should also &ai a place. Hering says of it that it is useful '' for the phlegmatic, also for fat children predis- posed to catarrh, or to the sluggish who react from colds indifferently."
Dysceasia.
The diatheses are in many cases so intimately linked with the dyscrasiae that this paper would be incomplete without some mention of them. It will only be possible to select some examples.
The condition of rickets in its later stages is mani- fested by obvious bone changes well known to all. The rickety cranium must be distinguished, on the one hand from chronic hydrocephalus, where the head is more spherical, and the eyeballs are displaced downwards; and, on the other hand from congenital syphilis, where we have the hot-cross-bun-like or natiform skull. I have also found it remarked that the hair on the scalp in rickets is generally thin, and that the skin becomes thick, opaque, and covered with downy hairs. We know further that rickety children are prone to suffer from convulsions, laryngismus stridulus, &c., and also that there is special danger from whooping cough, measles, bronchitis, or broncho-pneumonia. The subsequent effects of rickets are the bone deformities resulting in pigeon-breast, kyphosis, genu vulgum and varus, &c.
General treatment, consisting of a proper dietary and hygiene, is essential. Our most efficient constitutional remedies are those containing phosphorus {i.e., phos- phorus, phosphoric acid, calcarea phos., &c).
Scorbutus or scurvy is manifested in children by an earthy pallor, emaciation, spongy gums, tenderness and swelling of the legs, referable to hasmorrhage beneath the periosteum, oedema of the feet and separation of the ends of the long lines, indicated by crepitus. In adults we have the petechias or purpuric spots, usually situated at the base of a hair ; the ecchymosis or actual haemorrhage ; the spongy gums, and the tense, brawny swellings which are most frequentlv found in the
592 STUDY OF TEMPERAMENT. ^ RiS^SHlSS"
popliteal space, at the bends of the elbows, under the angle of the jaw and front of the tibieB. The face is sallow and bloated ; there is oedema of the feet, and the patients are breathless and liable to attacks of syncope. Treatment consists in corrected diet and lime-juice. Of medicines the muriates seem to act best. Farrington recommends chlorine, natrum mur., and ammon. mur. (the latter has caused an analogous condition.) We might also add acid mur. on pathogenetic grounds.
In the dyscrasia of osteo-arthritis we have first the evidences of disease in the joint changes. We notice that the phalanges and metacarpus deviate to the ulnar side ; the joint at the base of the index finger is often much swollen ; the ulna sometimes projects at the back of the wrist. The hip, which is often alone aflfected, shows its implication in a characteristic manner, first by pain and stiffness, next by shortening and eversion. The knee and jaw are sometimes involved. When it begins in those more advanced in life one joint only is often affected, and undergoes extensive change. In the young adult many joints are involved, but at first less severely. Besides these changes there is also more or less atrophy of the muscles, the interossei, the muscles at the lower end of the femur, and the deltoid being more particularly involved. The constitutional effect is marked by anaemia and debility. There is also noticed in advanced cases a peculiar velvety softness of the skin of the hands.
The disease is incurable. To modify the pains — and one can do little more — ^^I place most reliance on colchicum, arsenicum, and rhus.
The cachexia produced by advanced phthisis is unmistakable. In the first place the emaciation is noticed, and this is often more marked about the body and limbs than in the face. We notice an anaemic condition, with the hectic flush of the cheeks, or some- times, cyanosis, which may mask this condition, either in those acute cases where a large area of lung is involved, or in the more chronic where the right side of the heart is dilated. Further, on inspection of the chest, we notice the alar contour, the flattened infraclavicular regions, the ribs, which can easily be counted, the protruding scapulae, and the atrophied deltoids. Besides these, we notice the clubbed finger ends, and the red
ite.'iSr^f.TSS'"' STUDY OP TEMPERAMENT. 693
margin of the gums, and the freqaent presence of xanthelasma.
The cancerous Cachexia is marked by emaciation ; by a peculiar sallow complexion with a yellowish earthy tint ; a careworn, gloomy expression ; debility and languor ; anaemia and its accompaniments ; and irregular fever. The cachexia is most marked in gastric carcinoma. Arsenic is undoubtedly the drug which most corresponds to this condition.
Among other dyscrasise and cachexia we may mention the constitutioniA changes produced by myxoedema (cachexia strumipriva), cretinism, Graves' disease, acromegaly, pernicious anaemia, lymphadenoma, leucocyt- haemia, Addison's disease, and many others, includmg those caused by the various poisons, as alcohol, lead and mercury. Most are characterised by a form of anaemia which varies somewhat according to the particular disease present, so that the countenance is itself, in some measure, an indication of the special morbid disturbance. But too much time would be occupied by a satisfactory consideration of so many conditions.
To sum up, we find first certain temperaments which, apart from the disease with which our patient is suffering, we must take into account in treatment. Next, the diathesis is important both for prophylactic and thera- peutic reasons. Lastly, the dyscrasias and cachexias are treated by the specifics (where such exist) for the diseases which have given rise to these conditions. These remedies must be used, whether indicated by the special symptoms or not, on the grounds of the general condition.
Lime-juice for scorbutus, mercury and the iodides for syphilis, cod liver oil for struma, form the treatment advocated impartially, or almost so, by both schools. For ourselves, we might add iodine for the tuberculous, sulphur for the scrofulous, phosphorus for the rachitic, the use of baryta for the tonsillar, the muriates for scurvy, and so on.
In conclusion, we have two great classes of remedies, the first corresponds to the direct result of the determin- ing or exciting cause, unmodified by any special diathetic or constitutional tendency. Drugs of this class, although equally useful even in combating grave morbid con- -ditions, are nevertheless superficial or local in their
Vol. 42, No. 10. 2 Q
594 GOUT AND ALLIED DISORDERS. '^'S^l^o^^.
action. The second class corresponds to the constitu- tional condition, acts more profoundly and generally on the system. The first is necessary to the treatment of acute diseases (for example, aconite in inflammatory pro- cesses), and may be all that is required. The second is of use in chronic diseases, and also occasionally in acute, in order to effect a more speedy and permanent cure.
BiBLIOGSAPHY.
1. Th/' Pedigree of Disease, by Jonathan Hutchinson, F.R.S., 1884.
3. TJw Doctrine of Dyscrasia, by Dr. J. Engel. Brit. Journ. of Horn,, vols. iv. & V. (1846-1847) ; an extract from vol. i. of the Zeit- schrift der k. k. Gesellsckaft der Aerzte zu Wien,
^. Text-houJi of Homosopatky, by Dr. v. Granvogl.
^. The Cachexia of Young Ckildren, by J. W. Hayward. Brit. Joum, of Horn., vol. xvi., 1858. (Read before the Liverpool Homoeo- pathic Medico-Chirnrgical Society).
*. FarringtorCs Cllnieal Materia Medica,
*. Contrihutions to Practical Medimne, by Dr. James Begbie, M3., F.R.8.E., &c., Edin., 1862. See Brit. Joum. of Horn., vol. xri., 1863, and others.
THE EABLY EECOGNITION OF GOUT AND ALLIED DI80BDEES.— IL
By W. Thbophilus Ord, M.B.C.S. Eng., L.B.C.P. Lond.
Fellow of the British Homoeopathic Society.
The Origin and Formation of Uric Acid.
Having outlined briefly* the leading disorders produced by gouty poisons from childhood to old age, we may next enquire what is known as to the substances which, when retained in the system, produce these results. The one to which Haig and others attribute all these effects, and of which we perhaps hear most at the present time, is uric acid. Although it is well known that a small and variable amount of uric acid can always be detected in the urine, there is much uncertainty as to the true rdle played by uric acid in these conditions, owing to the difficulty of its detection in the blood. That it is found in the blood in distinctly gouty persons (i.e., those sub- ject to attacks of ordinary gout) was proved by Garrod many years ago, and is universally admitted. It has also been proved to exist in the blood in conditions in which oxidation is interfered with, such as pneumonia,
* For previooa paper see Monthly Ifomaopathic Review for September.
n^^o^nS^ GOUT AND ALLIED DISORDERS. 595
emphysema with cyanosis, etc. Also in diseases of the liver, spleen and kidneys uric acid is usually present. In certain conditions- also in which there is an increase in number of the leucocytes it seems to appear in the blood in excess. But in the many functional disorders which, according to Haig, are caused by its presence, analysis has failed so far to detect uric acid. It seems probable that, as Dr. Moir recently suggested,* Dr. Haig's views will probably be modified as our methods of analy- sis of blood improve. It is, however, quite possible that these discrepancies between his theory and analytical results may be removed, for at present the detection of uric acid in small quantities of blood is most difficult and uncertain.
Dr. Luff, on the contrary, maintains that uric acid never occurs in the blood in health, and in gout only when the kidneys are affected. He thinks that it is formed only in these organs, and that when their func- tion is impaired it is thence re-absorbed into the circu- lation. Most authorities now deny that it is formed directly from food, as Haig supposes, a few going so far as to assert that diet has nothing at all to do with its production. Haig's view is that it is produced exclusively from the extractives occurring in nitrogenous diet, such as xanthin, hypoxanthin, leucin, etc., and also that the caffeine compounds contained in tea and coffee are immediately converted into uric acid on absorption into the blood.
Personally, after carefully weighing the evidence, I suggest as the most probable explanation, and the one that covers most of the facts, a modification of the theory put forward by Dr. Levison of Copenhagent ; it is based chiefly upon the experiments of Horbaczewski and others in blood and urine analysis. According to these observations, which have been frequently verified, increased excretion of uric acid always occurs after excessive formation and disintegration of white blood corpuscles. This increase of leucocytes occurs normally after meals, but especially after ingestion of nitrogenous diet. The substance chiefly set free by the destruction of leucocytes is nuclein, and this is liberated in the spleen
* Lnndmt Htmaeopat'h'ic HogpiUil Reports, vol. vL, 1897, p. 47. t The Uric Acid DiatheaU. Cassell and Co., p. 34.
2 Q- 2
596 GOUT AND ALLIED DISORDERS. ^"kSUJ^oT?*^!
Keriew, Oct. 1,
which, as we know, enlarges after a meal. Nuclein is also formed in the body by disintegration of the albuminous substances of its tissues. Nuclein can readily be prepared from fresh spleen pulp, and can be converted into uric acid in a weak alkaline solution by treating it with blood at 40^ C* Although this is a laboratory experiment, it is of so simple a nature that we may conclude that the same process occurs when nuclein is carried from the spleen into the general circulation. Further, clinical as well as laboratory experience teaches us that the excretion of uric acid becomes increased or diminished by all factors (diseases, drugs, muscular exertion, etc.) which give rise to a more rapid or slower disintegration of the cellular elements of the body, and especially of the leucocytes. This is also true of the production of nuclein.
Further investigations may modify this view, but it is certainly more likely to prove correct than the comparatively unsupported ideas of Haig, whilst it equally accounts for all the facts which he has so ably brought forward in his book on uric acid.t
It is probable that a too implicit reliance on laboratory experiments accounts for the contradictory views put forward by other observers. It is impossible to imitate in test-tubes the complex physiological processes which determine the production and behaviour of these substances in the body. In the present state of our knowledge, theories founded upon such experiments can only be accepted if supported by a mass of clinical experience and facts evident to every practical physician. It is because the view of the production of uric acid from nuclein, as explained above, seems to me to satisfy these conditions to a degree that no other theory approaches that I advocate it as probably the correct one. Uric Acid not the only Gouty Poison.
There seems good reason for supposing that there are other poisons besides uric acid concerned in the production of these many symptoms and disorders. Few observers as yet agree with Haig in supposing this io be the only one. In true gout, with deposits of urate of soda, uric a<3id may be the only factor involved ; it is obviously the most important one. But in earlier life^
• The n-ic Acid DiatheiU, p. 22. t Ur\e Acid in tJie Cuusatwn of Disease, — OhurchiU.
n^^^SrnS^ GOUT AND ALLIED DISORDERS. 597
Review, Oct. 1, 18B8.
although uric acid may yet be proved to be the prime cause of the disorders produced, it seems more reasonable to suppose that other poisons must be present. Abnormal matters in the blood, that have been detected by analysis so far, are given by Y. Jakschi,* as urea, xanthin and hypo-xanthin (closely allied to uric acid), traces of volatile fatty acids, lactic acid, fatty matters (lipemia), biliary acids, cholestrin, toxic alkaloids and ptomaines, and acetone. These have all been detected in various morbid states, not especially in those under consideration. Their eflfects are but little known, even those of urea, which V. Jakschi asserts does not occur in excess in the blood during uraemia. Whether further research will prove that these substances, or others yet unrecognised, share with uric acid in the production of the various pre-gouty affections of which we are writing, remains to be ascertained. We may consider it probable that there are other complex substances which, by their occasional presence and varying amounts, account for the great variety of symptoms and disoitiers recognised as indicating the gouty diathesis, especially in early and middle life. Even supposing, as Haig does, that uric acid is always the predominant factor, we may suppose that the presence of other unknown poisons influences and determines the variety of symptoms by which uric acid manifests its effects. This probably accounts for the fact that many persons go through life saturated by gouty poisons, and die ultimately from their effects, without ever having true gout or any deposit of urates in their tissues, the deposition of these salts having been perhaps inhibited by the presence of some other substances which are absent in the blood of those subject to deposited crystals.
Admitting the variety and complexity of the gouty poisons, we can understand how these, acting upon the different constitutional weaknesses of various organs, both inherited and acquired, will cause one person to have asthma or nasal catarrhs, another eczema, a third periodical bilious attacks, others articular or muscular rheumatism, whilst some suffer from epilepsy, diabetes, albuminuria, or uric acid calculi, etc.
* Clinical D'uignwfU^ 3rd edition, pp. 79-90.
698 GOUT AND ALLIED DISORDERS. ^"u^lJ^o^H^^
Classification of the Parts Involved in the Production of Gout and Allied Disorders.
Accepting then uric acid as the most important factor in the production of these gouty and pre-gouty conditions, and admitting the existence of others of which we know hardly anything, before we can intelligently apply rules for treatment of these conditions we must ascertain in what parts of the body the poisons are most prone to occur in excess, what symptoms indicate their presence in these parts, and what causes determine their selection of the parts involved.
A number of facts and considerations, which it would be tedious to enter into at length, have caused me for practical purposes to classify the parts involved into four divisions, the importance of which will at once appear. Haig and others* acknowledge the differences between these spheres of influence. These are :
(1). Normal Storage Organs. (Liver, spleen and kid- neys).— In these surplus gouty matter seems to be temporarily stored when produced more rapidly than it can be excreted.
(2). The Blood. Which conveys, distributes, deposits and reabsorbs gouty matter through the body.
(3). Organs of Surplus Storage in Early Life (chiefly portions of joints, muscles, connective tissues, certain mucous membranes and glands). — These are affected by excess of gouty matters without deposition of urate of soda, so acting as additional storage organs and pro- ducing various disorders when overcharged.
(4). Organs of Deposition of Urates in Later Life (chiefly cartilages, ligaments, tendons, fascise, also intestines, arterial coats, and many other parts). — Those in which true gouty deposits of urate of soda are most prone to occur, producing symptoms of ordinary gout.
This arrangement is not so artificial as it may first appear, and I have found it of great value in understand- ing the true bearing of many symptoms which otherwise would be incomprehensible. For example, when excre- tion of uric acid and other gouty matters falls below their production, a long period, even years, may elapse
• Thus Lauder Brunton says (Cavendish Lecture, British Medical JournaL June 20tli, 1891), 'There are certam parts of the body in which the uric acid, wherever it may be generat^, has a tendency to be stored up, and this is especially the case in the spleen and the joints, which may be regarded as dustbins for uric acid."
R^^^'^ri'TSfi^'' OOUT AND ALLIED DISORDERS. 599
before evident symptoms appear, although the system is unconsciously accumulating material for an inevitable crisis. What becomes of this matter? A study of this arrangement enables us to understand where storage is taking place. Again, in treating these conditions, the object to be aimed at is to eliminate gouty matter out of the system, but it is easy to suppress and apparently relieve symptoms by merely causing a transference of gouty matter from one set of organs to another. So no permanent care is effected, and presently other disorders arise.
All remedies which relieve gouty symptoms (whether homoeopathically or otherwise) probably act in one of two ways, either (1) by driving gouty matters out of the blood, and from parts where symptoms are produced, into other storage organs, hence causing increased accumula- tion of poisons in the system; or (2) by increasing excretion, clearing the blood by true elimination, and re-dissolving gouty matter from storage organs, thence discharging it by the kidneys. The first method gives temporary relief, the second is more truly curative. As I hope to show later on, with the commoner drugs it is easy to see under which heading they group themselves, both from their provings and from clinical experience.
Symptoms Produced by Excess op Uric Acid and other Gouty Matters in various Groups of Organs. I. — Organs in which gouty matters are normally stored. The liver and spleen, those two great glands by which purification of the portal blood stream, and renewal of the blood corpuscles are respectively performed, intercept, store, and perhaps aid in producing surplus gouty matter which cannot be immediately excreted by the kidneys. Although as previously suggested, it seems probable that uric acid is formed by the passage of nuclein into the blood stream (this nuclein resulting from the destruction of surplus leucocytes in the spleen), it seems equally probable that the other yet unrecognised poisons, which as weU as uric acid cause the various gouty symptoms under consideration, are bye-products produced in destruction of effete matters entering the liver by the portal circulation. Thus in performing its functions after a meal the spleen enlarges, and so less markedly does the liver. We know nothing of the effects of excessive storage in the spleen, unless the
600 GOUT AND ALLIED DISORDERS. ^^^L^Sl^mm^
Review, Oct 1. 1808-
permanent enlargement in chronic malarial poisoning has some such origin. But with the liver it is very different. This is the great blood purifier, and the orgaa which we should expect to give most trouble when over- charged, as indeed it does. When embarrassed by a greater quantity of effete matter than it can effectively dispose of, the liver gradually accumulates these waste products of a too liberal or rich diet which, helped by insufficient exercise, clog the organ, hindering proper purification of the blood, and when charged beyond its capacity causes the overplus to pour into the circulation. Thence result, biliousness, indigestion, constipation or diarrhoea, and various symptoms of functional liver derangement. These are preliminary to lithsBmia and more distmct pre-gouty manifestations.
Thus the liver is our great storage organ, the spleen probably storing nuclein to form uric acid, and further embarrass the liver directly it becomes overcharged and discharges it into the blood. Probably the kidneys also act as storage organs. Those who follow Luff in supposing uric acid to be only formed in them would certainly think so. It seems possible also that the medulla of bones, having such important functions to perform in the production of blood corpuscles, may also aid in storage of gouty matters. Whether or not these other organs are concerned in storage, the fact that the liver is the great performer of this function is evident from the clinical experience of all observers for many years* and it is upon this organ that from a practical point of view our attention must be concentrated. It may be added that chemical analysis of liver, spleen and kidney tissues discloses a far greater proportion of uric acid than is found in any other tissues of the body.
The immediate effect of abnormal accumulation of gouty matters in the liver seems at first to be two-fold. (1) Diminished discharge of bile, causing constipation and light-coloured stools ; and (2) imperfect purification of the blood, causing loss of appetite, malaise, drowsiness, furring of the back of the tongue, and other familiar symptoms. These premonitory symptoms last for a day or two, when nature usually relieves the condition in one of three ways ; (1) by discharging uric acid, etc., into the blood, causing a distinct train of symptoms to be presently described ; (2) by a profuse discharge of
ilSSSS^ST^!^'' oout and allied disorders. 601
B«Tiew, Oet. 1, 1W6.
bile through the common bile dnot, prodacing diarrhoea and bilious stools ; or (8) by a regurgitation of effete matter backwards into the stomach in the form of a bastard bUe, causing bilious vomiting and usually sick headache. This is often accompanied by a discharge into the general circulation as in (1). The relief following these processes is usually immediate and complete, and the normal balance of health is restored often in a few hours, only to be followed in a few days or weeks bjr a repetition of tiie disorder if the same diet be persisted m. Hence the periodicity of sick headaches, biliousness, and bilious diarrhoea in such subjects.
I find on enquiry that the great majority of those who come to us in later life for various gouty troubles, have suffered when young from some such periodical attacks, usually sick headaches or bilious vomiting. A few days ago a gentleman, aged 65, consulted me, of typical gouty type, with high-tension pulse and other significant symptoms. As a young man he had been a martyr to headaches with biuous vomiting, which so increased in frequency that he was on the point of giving up his business on account of them. After having consulted many physicians with no permanent benefit, he was cured in the following significant way, through the wise advice of an old country woman. Immediately on an attack commencing he gave up all food and drink except bread and water, on which he lived for two days. After this brief abstinence he resumed his ordinary diet and had no attack for two months. Then a slight attack was relieved by one day's bread and water diet. After this, several months' freedom resulted, and only twice subsequently had he to resort to this dietary, being permanently cured. The explanation is simple. The two days holiday he gave his liver, enabled it to com- pletely clear off, not only the overplus but probably the accumulated gouty matters of many months past, and to continue its work invigorated by rest and purification. No doubt the liver was then assisted by other organs giving help in the work of storage, from the effects of which he has since had many other gouty symptoms, and has now permanent tissue changes in arteries and elsewhere which are probably incurable.
In most persons, after some years of periodical bilious attacks and discharge of gouty matters, these tend to
602 VI8CUM ALBUM. ^*pSJj^?S?^2f
Be^dew, Oct. 1, 1806.
cease, other parts probably relieving the pressure on the liver by assisting in storage. But persons of fall habits florid, and with large teeth (of the usually recog- nised gouty diathesis) often find relief in another way. The liver acquires the habit of continuously relieving itself by daily excessive discharges of bile, causing two or three bilious, loose, and very offensive stools per diem, which serve to keep such persons in apparently vigorous health, until gout attacks them in later life. If these discharges are checked in any way, liver congestion and often gouty attacks tend to appear at once. Alcohol, especially acid wines and beers, seem to assist the liver and promote free bile excretion, though hastening — as they are well known to do — the inevitable day of reckoning.
There is one important clinical observation connected with these liver conditions, the significance of which will presently appear. During the day or two of pre- monitory symptoms preceding these typical attacks, the urine is always high coloured and diminished in amount. During the attacks it is usually for a few hours loaded with urates, and after them it is limpid and clear and greatly increased in quantity.
Symptoms denoting excess of gouty matters in the blood and other parts will be considered in another paper,
{To be continued),
EXPERIENCES WITH VISCUM ALBUM.
By George Black, M.B. Edin.
(Continued from page 648. J
Fourth Proving.
This refers to myself. I am 43 years of age, of medium height, and spare habit of body; my hair which was brown is now considerably mixed with grey ; my eyes are what is usually called grey. I am a total abstainer, and have been for 27 years. I have also not touched butchers* meat, poultry, game or fish for eight months.
At 4.15 p.m. on Friday, November 6th I took 5 drops of viscum alb. 3x on s.l.
Saturday, November 7th. For about an hour after I experienced a dull aching in the head. During the night
^v'?^.^rS?TrC"' VISCUM ALBUM. 603
I dreamt a great deal, but have no recollection now what my dreams were about ; they were not, however, of an unpleasant nature. 4.15 p.m., viscum alb. 3x, 5 drops on S.I., and at 11 p.m. 5 drops more. I experienced a similar but longer continued sense of fulness in the head — a sort of dull aching — to that which I felt yesterday. I went out by train in the afternoon to visit a patient in the country and walked about three miles. Returning by train in the evening I became aware of a sensation in my left ear which partially interfered with my hearing. Sounds seemed to some extent muffled. This continued in a lessened degree during the evening, but on testing my hearing I found that the tick of my watch was audible five yards away. I also noticed when my arm was resting on fche ledge of the carriage window, and my cheek resting upon my hand, that there was a pulsation in my right forefinger. I also experienced some momentary shoots of pain along the right ramus of the lower jaw near the chin. I feel well and have a good appetite. No action of the bowels yesterday, but to-day all right.
Sunday 8th. I remained up reading and writing till after midnight. On getting to . bed I was somewhat sleepless and restless ; my brain active and my imagina- tion busy. About 1 a.m. I got off to sleep, but was roused up shortly after having had a seminal emission, the result of an erotic dream. To-day, with the excep- tion of feeling somewhat sleepy in the afternoon while reading in front of a good fire, I have felt all right. Once or twice last night I noticed that my mouth filled rather suddenly with saliva. My left ear is all right to- day. I ought to mention in connection with this feeling in my ear that while the train was standing at the station a coldish current of air came against that side of my head and face from one of the windows which was open. At 4,30 p.m. to-day I took 12 drops of viscum alb. 8x on s.l.
Monday, 9th. Last evening in church I experienced, while standing up, sharp stabs or shoots of pain under the false ribs of the left side, and a sense of constriction at the upper part of the left lung, especially marked on taking a deep breath. I observed that the urine passed last night was this morning turbid, and that a pink deposit adhered to the bottom and sides of the vessel. During the time I have abstained from flesh meats my
604 VISCUM ALBUM. "^L?SS???SI^
Reriew, Oot. 1. 18B6L
urine has been remarkably free from lithates, although formerly it was a common enongh occmrence to find these in the urine. My mouth felt disagreeable last night after supper of porridge and milk. After I was in bed my mouth again filled with water. I was awake many times in the night and seemed to be dreaming all through. To-day I feel all right. At 4 p.m. I took 15 drops of yiscum alb. 8x on s.l.
Tuesday, 10th. Went in the evening to the station. Afterwards took the chair at a lecture on " Buskin " and spoke for a few minutes. My mind seems clear and sharp. My spirits are good, and my appetite capital. Last night I slept well and was not conscious of dream- ing so much. I felt one sharp shoot of pain on the anterior aspect of the right fore-arm, just below the bend of the elbow ; it didn't last any time. I have felt seme aching this evening in my back, but as I have been lifting the children, it may be due to that. Bowels all right. No further turbidity of urine. No medicine.
Wednesday, 11th. Last night I slept very well. To- day I was out driving during the forenoon and felt all right ; the day was dull and misty. Scarcely could see anything in the morning ; towards noon it cleared some- what, but the sun never struggled through ; the wind was N.W., the ground softening, the frost going. To- night, while I was sitting thinking, about 9 p.m. I was seized with severe pain in my right shoulder joint. I became aware of it on attempting to move after being in the same position for some time with my hands thrust into my tirousers pockets, and looking at the fire. On withdrawing my right hand and attempting to move it I experienced, especially on elevation, a severe pain in the joint about the anterior and outer aspect. After moving the arm backwards and forwards, and up and down, it seemed easier, but after a period of rest, sitting as before, it came on again. At 10 p.m. I could just feel the slightest indication of pain on drawing the arm back as far as I could, and again on projecting it forwards.
Thursday, 12th. I had slight pain this morning on getting up in my right shoulder, a much modified state of the same as I had yesterday. I have not felt anything of it since. Viscum alb. 3x, 20 drops on s.l. at 4.30 p.m.
2Si^r<STS^ VI8CUM ALBUM. 605
Friday, 18th. After I had taken the dose of medicine yesterday I went ont to visit some patients. While flitting in the house of one I felt symptoms of a head eold setting in. My nose began to run. On getting home I found my P. 96, my face hot and flushed. A considerable quantity of flatus passed, having a very offensive odour. This state of things continued during the evening. At night there was a copious action of the bowels, the stool being very offensive. During the night there was some muscular twitching of the right leg — the lower part of the calf, some neuralgia pain in the right temple. To-day no pain but coryza bad.
November 26th. At 6 p.m. five drops of viscum alb. 2x. About 6.80 eructated a good deal; towards 6 p.m. slight numb sort of feeling in the head which passed quickly. 10 p.m. after reading on getting up from my chair experienced sharp momentary pain in left pectoral region. Hot feeling at night during micturition.
November 27th. Slept well. In the morning on turning felt slight stiffness in the lumbar region. Took food as usual. Gold N.E. wind blowing. No pain to-day while urinating. At 4 p.m. 10 drops of viscum alb. 2x on s.l. At 5 p.m. after writing for some time I experienced pain on the outer aspect of the right shoulder on elevating it. On passing flatus I perceived a similar offensiveness to that previously noted. Bowels moved last night ; stool large and somewhat difficult to pass. To-day, stool easy. About 10.80 p.m. on going out after sitting I was conscious of a dull pain under the left false ribs which I felt while walking, and now about 11.30 I am still conscious of it. I am also at the present moment conscious of a dull aching pain at the lower part of my right lung, especially on stooping or bending forward or backward.
Saturday, November 28th. I went to bed about 11.45 p.m. After I had been lying a short time I had a sharp twinge or shoot of pain about the centre of my right thigh posteriorly. It appeared to me from the feel of it like a neuralgic pain of the sciatic nerve. After the lapse of some time I experienced a similar but milder twinge in my left thigh, and at a corresponding position. There was also a slight momentary prick in the cardiac region which was not repeated. I was rather wide
606 VISCUM ALBUM. " Be'vl^w^oTyfTSJ^
awake for an hour or more and kept wondering what part of me would experience the next twinge. By and by there was a sharp twinge of pain in the left tibia. My back, across the lumbar region, has felt stiff and rather weak to-day, particularly the right side. Soft stool this afternoon. At 5 p.m. I took 15 drops of viscum alb. 2x on s.l. Now 8 p.m. I feel my right shoulder somewhat painful and there are occasional twinges of pain in my right forefinger. The weather to-day has been cold and stormy, with threatening of snow. Wind N.E.
Sunday, 29th. Last evening I began to experience pain of an aching character in my right knee joint ; it was painful to move and tender to touch ; each time I awoke I was conscious of it, and I still feel it (10.80 a.m.) when I move my leg, particularly on drawing it inwards and moving it outwards again. I also had some shoots of pain during the night at the upper and posterior part of my left thigh. After getting into bed I lay down on my right side, but was soon conscious of a feeling of weight and oppression about the heart, such as I never remember to have experienced before. It was accom- panied by a gripping sort of feeling as if a hand were squeezing the heart. After ten or fifteen minutes there was a relaxation of the constriction and a lifting of the load or weight that seemed resting upon me. This con- tinued for a few minutes, during which the sense of relief was very great and a warm feeling seemed to over- spread the cardiac region, but the respite was of a short duration, the feeling of weight and heaviness returned, and along with it the gripping sensation, and continued until I fell asleep. My wife tells me I got a good deal over on my back with my head drawn back and my mouth open and snored so loudly that she had to wake me up. One of the times when she awoke me I was dreaming of some place being on fire, but cannot now recollect more distinctly about it. 1 p.m. My right knee is still painful when the leg is extended. While I was sitting reading about 2 p.m. I felt a twinge of pain, momentary in duration, in my left ear. There have been several momentary stitches of pain, apparently superficial, in my thighs while I have been sitting read- ing, 3.30 p.m.
Monday, 30th. While in church last night, I felt
^SS^'^JTSf " VISCUM ALBUM. 607
Beriew, Oet. 1, 1808.
several sharp stinging twinges of pain above Poupart's Kgament, on the right side, inner aspect. The same thing recurred after I had gone to bed, and was very painful for some time. On putting my hand down to ascertain the exact position, it seemed to come from the internal abdominal ring, and shoot downwards along the cord to the right testicle which was drawn up tight against the external ring. I had no doubt in my mind that it was a neuralgia of the cord that had been set up ; it continued for some hours during the night, not bad enough to keep me entirely awake, but I passed a restless^ sleepless night on the whole, and was frequently roused up, and on each occasion I found that the pain was there. By morning it was gone, and I feel nothing of it now, 11.20 a.m. The rheumatic pain is quite gone from my right knee, and although the east wind is as keen as ever I don't feel anything of it.
Wednesday, December 2nd. On Monday I had a dry sensation at the back of my nose which descended to the larynx, and in the evening I found considerable difficulty in reciting at the dinner of the Caledonian Society at Exeter. My voice seemed uncertain, which made me feel uneasy when I stood up ; however, I managed to get through. Next morning I was suffering from a naso- laryngeal catarrh, and there was a quantity of thick disagreeable phlegm about the posterior nares and larynx. Each time on drawing a deep breath there was a tendency to cough, and to-day there is the same sort of feeling. I have been terribly down in the dumps to-day. Slept badly last night, but was in no pain.
Tuesday, December 8th. Since the previous entry the catarrh has been gradually subsiding, but it appears to have hung about me a much longer time than usual, which may be due to the fact that I have taken nothing for it lest it should interfere with the action of the vis- cum alb. Subsequent to the entry on the 2nd, I took part in a large concert at Newton Abbot ; my voice felt somewhat uncertain, and my breath seemed as if it might fail me, but I got through all right. One night, after lying down in bed, there was some wheezing of a sonorous character which, however, passed away in a few hours. About 6 o'clock this evening, I experienced some ringing in my left ear ; it lasted only a few moments and went again. Since then I have had a few shoots of
«08 VISCUM ALBUM. '"'^J^TT^I^
pain in my left temple. 7.40 p.m. My heart gave a throb just now, and then seemed to pause, it might be for the interval of an ordinary beat, and then go on again. 8.40. Sharp, sudden, momentary pain in the right side of my neck about 2 in. above the clavicle, while writing. 9 p.m. Flatus passed, having the same offensiveness already noticed, and from which I have been free since leaving the medicine off. In my notes, there is no mention of what was taken on the 7th. I beheve it was the ^ ; at any rate, I know I began this by taking a single drop, and my next entry gives the dose as 4.
Wednesday, 9th. I had some vivid dreams last night, but the substance of them is forgotten. I have felt better in spirits to-day. At 4.45 p.m. I took 4 drops of viscum alb. <t> on s.l.
Thursday, 10th. Several times during last evening I experienced shoots of pain in the middle of the left thigh posteriorly. Yiscum alb. <f> 6 drops on s.l. at 4.80 p.m.
Friday, 11th. Sat up till 1 this morning; went to bed ; slept very well till between 6 and 7 o'clock, when I had an erotic dream, with a threatening of a seminal emission, which, however, was averted by a strong effort of the will and sitting up in bed. To-day, with the exception of feeling my eyes weak while driving in the sun, I have been all right. Appetite good. I have once or twice felt a sort of tightening sensation as of tension in the brain ; it has not been painful, but just as if strung up.
At 10.80 a.m. 6 drops of viscum alb. (^, and at 4.80 p.m. 8 ditto in water.
Saturday, 12th. I felt nothing unusual during the evening. Sat up reading and writing till 12.80 a.m. then went to bed. 1 lay on my left side, but presently became aware of a curious feeling about the heart ; it was not painful, but rather of the nature of a tickling sensation, which, however, became so uncomfortable that it was impossible to remain as I was, with any prospect of sleep, so I turned on to my right side, and shortly after fell asleep. I have a recollection of turning in the night from side to side, and feeling stiff and heavy while doing BO. I had no feeling of discomfort on waking, and no stiffness. My head feels perfectly clear ; appetite first rate. At 10.80 this morning I took 10 drops of viscum
^^f^JTSS?^'^ VIBOUM ALBUM. 609
alb. <t> in water. So far, 12.45 p.m., I feel no effect from it whatever, unless a sense of well being, clear headedness and good appetite can be attributed to its influence. During the night I experienced some pain in swallowing saliva, I do not feel it now, 1 p.m., nor had I any pain while swallowing my breakfast. I also had a sharp but evanescent pain at the left side of my throat, about the region of the tonsil. Easy stool last night 6.S0 p.m. At 4.45 p.m. I again took 10 drops of viscum alb. 0 in water. About half an hour after taking it I had an uncomfortable feeling in my head while speaking to a patient, a sensation as if one didn't know what was going to happen ; it passed off when I got up and moved about. Flatus passed has a most disagreeable cadaveric sort of odour.
Sunday, 13th. Went to bed shortly after midnight, and became conscious after I had lain down of a stinging stitching sort of pain at the left side of the rectum, but low down in the neighbourhood of the anus. The pain came and went Uke a succession of stings or shoots, and continued probably a quarter of an hour ; the pain always came back to the same spot each time. During the night, on turning upon my back, I was conscious of a tearing sort of pain in the abdomen — the part affected seemed right across from one hypochondrium to the other — ^it was tolerably severe, but I don't seem now, at 2 p.m., to recall it with much distinctness. About 7 in the morning I began to experience twinges of pain of the nature of sciatica. The urine passed this morning was copious and pale yellow. To-day I have had a more copious flow of saliva in my mouth than anything I experience in a general way.
Monday, 14th. I took no viscum alb. yesterday, partly because of the bad night I had, and not wishing further to upset myself. I went to bed at 11.30. During the day I felt nothing amiss. I slept well at night, and had no pain or other inconvenience of any kind. When I awoke there was an unpleasant taste in my mouth, and my tongue was coated almost to the tip with an ochrey looking fur. At 10 a.m. viscum alb. </», 10 drops in water. Offensive flatus passed ; slight singing in my right ear of momentary duration. Aptitude for mental work. Appetite good.
Vol. 42, No. 10. 2 B
610 TISOUM ALBUM. ^*dL^SS^«
Tuesday, 15th. Slept well in the night. Had some slight .twinges of pain which I am miable now to localise. Last night while out walking my heart gave an uncomfortable throb ; it did not occur again. 10.10 a.m., 15 drops of Yiscum alb. </> in water. 8.30 p.m. Slight and transitory screwing-up sensation in my head. 10 drops more of <l> in watey. 4.10 p.m. Twinges of pain left side of neck while writing, behind the jaw.
Wednesday, 16th. Was unable to take any more medicine last night on account of being out. Recited several pieces in the afternoon ; mind clear ; memory all right. At first I was rather breathless, but it seemed due to nervousness. Last night during sexual congress I had a rather bad attack of palpitation of the heart. It quieted down after, and I slept all right. Felt somewhat languid on waking. 10.45 a.m. 15 drops of <^ in water. 8.30 p.m. ditto. When I went out at 5 p.m. on going up a slight ascent I felt drawing pains at the back of the left thigh in the region of the sciatic nerve. Pain in the lumbar region on stooping. 9.15 p.m. 5 drops more of <l> in water. Shortly after I experienced pain in region of right tonsil on swallowing saliva, and again when taking oatmeal porridge and milk for supper I had the same pain each time I swallowed. The food passing into the stomach seemed to cause considerable commotion (borborygmi). There was a feeling of uncertainty, too, as if something might happen ; such as a flagging or failure in the action of the heart. On getting up and moving about this passed oflf. P. 58, regular. Soreness of left pectoral muscles on raising the arm ; it was diminished on moving my arm up and down for some time. I felt it again to some extent on throwing my arm outwards. Momentary stinging pain in right ear and ditto in right upper eyelid. Muscular twitching about the right elbow, going on for some moments. Offensive flatus passed.
Thursday, 17th. While at breakfast this morning I became conscious of dulness of hearing in my left ear, which continued for about half an hour, after which I seemed to lose consciousness of it. 10.80 a.m. Viscum alb. <f> 15 drops in water. 3 p.m. Some muscular stiffaess experienced in lumbar region on first moving after sitting. 4.30 p.m. Viscum alb. <f> 15 drops in water. In the evening I experienced several sharp
^Sgag^f<gnr?ag"^ visqum album. en
twinges of pain deep in the right ear ; in a few minutes the pain was gone, and it has not again returned up to the present time, 10.45 p.m. 9 p.m. Viscum alb. 4> 10 drops in water. I went out shortly after taking this, and while walking, and especially going up hill, with each breath I took there was a sense of tight- ness and soreness in the muscles of the left pectoral region ; the deeper the breath I took the more apparent was this sense of tightness and constriction. I also felt it on expiring in a forcible manner. It is considerably gone now, but on taking a deep breath I can still feel it. I have had now, about 11 p.m., some sharp stitches of pain in my left ear. I have also had occasional sharp twinges of pain at the left side of occipital bone. I again feel some discomfort on swallowing saliva about the region of the right tonsil. I have felt cold and chilly at times to-day — occasional shivers running over my back. Friday, 18th. While I was sitting writing last night between 11.30 and 12 o'clock, there was a sound as of the wind in the trees or passing through chinks in the door ; it was still and quiet when I came in, and bright moonlight ; there seemed no movement in the air that could have produced this sound, but whether it was from without or something in my own head I cannot say. I got to bed after midnight, feeling very cold, although I had been near a good fire. Cold shivers kept frequently passing over my back, especially the lumbar region. After I lay down I experienced a sharp twinge of pain in the ball of the left great toe, and after a while a similar sharp shoot in the ball of the right great toe. I had frequent sharp shoots of pain in the left half of the occipital bone. This morning, while out walking, I had some sharp stitching pain in the centre of the left thigh posteriorly. 10.30 a.m., viscum alb. <^, 20 drops in water. My wife says this morning that she noticed the sort of drumming sound last night when she was in my room previous to the time noted. I asked her if she heard it this morning, and she said '* No.'* Then I asked her to call one of my nurses ; she came and said she could hear nothing, but I still believe it was the wind, as I did not hear it elsewhere, and I again hear it in my own room at 3 p.m. I have experienced several shoots of pain on the left side •of the occipital bone, and a soreness of the left pectoral
2 B-2
612 VISCUM ALBUM. ^SS^^SST^
Beview, Oct. 1, ISW.
muscles on moving the arm. Appetite good. This morning I had a spasm of the glottis ; it came on with a dry sort of sensation in my throat, followed by e£fortB to swallow, then a sort of complete block, necessitating frequent deglutitionary eflforts — ^my eyes filling with water, and my throat feeling most uncomfortable — speak- ing being out of the question for a short time. This after- noon, although close to a bright fire, I feel very chilly — ^my hands and feet being cold and a general sense of chilliness being felt all through me. Felt a sting of pain above my right knee while sitting reading ; also similar stings of pain in front of left leg. 4.30 p.m. 20 drops of viscom alb. <t> in water. Slight stings of pain in various parts of my body — cold creepy feelings passing frequently over me — pain in the right testicle — sharp twinges of pain in my left ear while at tea. Sharp stitch of pain back of upper arm ; stitch of pain under left breast while standing reading; twinge of pain (superficial) outer aspect of right thigh. 11.20 p.m. sharp and severe stitch of pain on left side of vertex while writing ; sting of pain upper part of left great toe ; twinge of pain back of left thigh.
Saturday, 19th. Went to bed at 12.80 a.m. Ground covered with snow. While turning in bed during the night I did so stiffly, as from a rheumatic condition of the lumbar muscles. Slept well and felt refreshed when
I awoke, 11 a.m. viscum alb. </» 25 drops in water. Since then I have had some transitory pain in different parts of the body ; a stitch in the chest below the left breast and again above the right knee. I have also felt con- siderable stiffness of left thumb on dorsal aspect on adduction and abduction, and along the metacarpal bone. Sting of pain at right scapula. Lumbar stiffness felt on rising from sitting 2.80 p.m. Momentary pains ex- perienced coming and going while sitting reading at lower and anterior part of right thigh ; seemingly superficial 5.80 p.m. A rather sharp sting of pain while sitting reading at left side of upper lip, repeated several times. 8 p.m., 25 drops of viscum alb. <l> in water. Shortly after stab of pain under left false ribs. While sitting talking to a patient at 9 p.m. sharp sting of pain was felt at upper part of left calf. Shortly after taking the medicine there was an urging to urinate, and at
II o'clock, after supper of porridge and milk, I was
B^^oTu^St"" VISCUM ALBUM. 613
seized with a sudden desire to pass water, some urine dribbling from me before I could reach the urinal. About 9 p.m. I had an uncomfortable feeling about the head — an inward sensation — a kind of numby feel as if one scarcely knew what might happen next. Creepy chilly feeling in left side, lower and outer part of chest. Creepy shivers in the lumbar region. Easy stool. Hot offensive flatus passed 11.80 and 11.46 p.m. About 10 p.m., while at my father's, had another spasm of the glottis. Those in the room wondered what was the matter with me ; I couldn't speak for some moments.
Sunday, 20th. Very cold when I went to bed after midnight ; warmed up after a while and got off to sleep. Awoke in the early morning with desire to urinate, and got out and passed water. Slept all right ; felt refreshed on waking. Cold bath as usual, very frosty night. Had a few shoots of pain while in church — ^here and there — left ear among other places. No medicine taken this morning. While in church in the evening momentary muscular twitchings were experienced. Several jumps in the region of right scapula. Bather painful aching in the muscles of lower dorsal region while sitting in church, relieved by movement and soon gone. Sudden twinges of pain lower part of right thigh and left supra- orbital region. Curious feeling in left ear ; hearing in that ear seemed dull, and with every inspiration through the nostrils it was as if the air were drawn into the ear and caused a sort of wheezing sound. On putting my finger into the left ear to make sure that it was not produced by the nose, I could hear nothing. It soon passed off.
Monday, 21st. Slept all right ; no urging to urinate ; no muscular or neuralgic pains to-day about the body ; at any rate so far, 5.16 p.m.
Tuesday, 22nd. Was out the greater part of last night in a hot and stuffy room. My head felt oppressed — a dull aching. It was wet and stormy during the night, and I got wet returning home, but changed as soon as I got in. Sat up reading till midnight. Before going to bed had an action of the bowels, which was constipated and much more difficult than while I was taking the viscum alb. The stool was succeeded by an itching at the anus, which continued for about 20 minutes, an was rather troublesome after I had lain down in bed.
614 VI8CDM ALBUM. ''"S^L't'Sn?^^
Review. Oet. 1, ISBB.
have also experienced some shoots of pain — last night in the left lower ribs, to-day, right inner ankle. I alsa have to-day pain in the muscles of the left side of my neck. On looking before me I have no pain — ^none when I raise my head and look at the roof, none when I turn my head to the right, but immediately I turn my head to the left I am conscious of pain which goes on increasing in intensity the farther round I try to get it. This con- dition of stiff neck was one with which formerly I used to be familiar, but I do not remember having suffered from it since I became a vegetarian. 12.45 p.m. Sting of pain anterior part of leg above ankle while reading* Twinges of pain several times in succession lower and anterior part of right thigh, while reading and writing. Hot stinging pain at left shoulder blade while reading ; continued several moments. 4 p.m. Momentary sing- ing in left ear. While sitting by the fire this afternoon readhig, my left leg gave a somewhat violent jump, and shortly after, I had a sharp pain seize me in the right buttock, rather high up ; it felt very like a twinge of sciatica ; it was central in position ; it passed off when I got up and moved about. Twice this afternoon, while sitting reading, I had an attack of spasm of the glottis ; the first began with a dry sensation at the left side of my throat, followed by frequent deglutitionary efforts- and cough to try to relieve it. The other attack waa worse, and began on the right side of my throat. No- medicine taken to-day.
Wednesday, 23r((. There is still a renmant of the stiff neck remaining, but it is not nearly so bad as it was yesterday. While sitting writing I have experienced twinges of pain in the region of left sciatica nerve, and a momentary twinge of pain in the left supra-orbital region, 7.30 p.m.
Thursday, 24th. Slept very well last night; felt considerably depressed in spirits yesterday. While sitting writing and reading this forenoon I had several single, sharp, momentary twinges of pain at lower part of right thigh posteriorly ; these seemed on the surface, but I had also one twinge of pain duller in character at lower part of left thigh, and which seemed to be in the sciatic nerve itself. While moving about I feel nothing ; it is only when I come to sit and remain quiet. Ncv medicine.
SS^^rrSSf • VIBCUM Al»tM. 616
Oct. 1, 11
Saturday, 26th. Yesterday I h^ a severe, sharp, aching pain during the greater part of the day round the outer border of the right axillary region towards the scapula; it is gone to-day, but was pretty bod when I went to bed last night. Previous to that I felt a similar, but less well marked, soreness in the left pectoral region, especially marked during deep breathing. This is now gone. On the left side of my neck there is a large papule, or small blind boil, which is tender to touch ; area of redness about the size of sixpence.
Sunday, 27th. I have had a very persistent acute aching at the left side of the anus for hours together to-day, especially marked this evening while returning from church, when it affected my left thigh, causing a sort of acute drawing sensation in it. It felt almost as if it might be the beginning of an abscess in that region. I have also felt one or two rather sharp twinges of pain of a neuralgic character, and a dull pain at the lower part of right orbit which came, increased somewhat in severity^ and gradually died away. The lump on my neck is subsiding. Loudish singing noise in my right ear repeated half a dozen times in two or three minutes. Sort of crackling sound in left ear while straining at stool, which was difficult.
Friday, January 1st. I think it was the same night as the previously recorded symptoms that I went to bed between 12 and 1 o'clock, and after lying down experienced a curious general tremor through my body, as if all the muscles were in a state of fibrillary contraction ; not a single involuntary jerk, nor the continued twitching of the muscle or a portion of one, but a general state affecting the whole body. It lasted till I fell asleep.
Conclusion.
I have endeavoured in the foregoing pages to bring together the material at my disposal relating to this interesting plant, and so to arrange it that the reader may form an independent judgment of its nature as a remedy, and the sphere of its action.
When one makes a special study of anything it is natural to find it grow upon him, and perhaps the tendency is to exalt it to a position above that which it deserves, and give it an importance it is not entitled to. Such may perhaps be the verdict of my brethren with
616 YIBOtJM ALBUM. ^'^Jw^ST?!^
regard to viscom album. At the same time, there is the possibility that this drug, so interesting in its associa* tions, so venerable in its antiquity, may have been pushed aside and forgotten for other and newer claimants to professional favour, and such I am persuaded has been the case. Believing that this neglect is unmerited, and that viscum album is capable of much wider application in the treatment of disease than anything which now obtains, I have sought to arouse a greater interesji in it, and I plead for its more extensive trial.
I have never before attempted anything in the nature of a proving (any physiological experiences I have formerly had have been accidental and unintentional), and how far I have succeeded in the present instance others must judge ; all I can say is that, on my part, and that of those who assisted me, an honest endeavour was made to find out what the drug was capable of doing, and to note down from day to day such departures from our usual health as might fairly be regarded as pathogenetic effects of the drug we were taking.
How tax such may have been the case it is impossible for me to say. There is no such thing in this world as a perfect constitution, and, consequently, aches and pains are not always to be regarded as the outcome of the drug we are trying to prove. Then again, when the mind is on the alert, we may bear, see and feel things, which if we were not in a state of expectancy, might pass unnoticed. But here again I say to myself, " Others into whose labours we have entered, and from whose work we are deriving guidance and instruction every day of our life, were men and women of like passions with ourselves, and if they have been correct in their obser- vations why not we ? "
It seems as if one could not doubt the poisonous nature of this drug, at any rate upon some constitutions, and its capability of setting up its physiological action in men and animals, and yet in view of the conflicting statements that are made, there is a good deal that wants clearing lip.
We are not told the quantity of viscum taken by the two girls to procure abortion, and which was followed by such deplorable results, but in the case of the boy who was found by Dr. Dixon like one intoxicated, with suffused countenance, livid lips, and all the rest of it, it
S^rggySBf'^ ^I8C?UM iXBUM. 617
is stated that an emetie brought up eight partly masti- cated berries of mistletoe. Whether these were all the boy had eaten we do not know, bat we have his own statement to the effect that after swallowing the berries he began to feel giddy, and remembered nothing more.
The writer in The Lancet seems to doubt the verdict of the jury in the case he reports, and appears to regard it as unlikely that death could have resulted from the eating of the misletoe berries, and in Plant Lore, Legends and Lyrics, by Bichard Folkard, Junr., we are told that '' fresh misletoe berries (not exceeding nine in number) steeped in a liquid composed of equal proportions of wine, beer, vinegar and honey, taken as pills on an empty stomach before going to bed, will cause dreams of your future destiny (providing you retire to rest before 12) either on Christmas Eve, or on the first and third of a new moon.'' It is not made particularly clear as to whether the number (9) in this witch's prescription, to which the berries were limited, was because it was con- sidered a safe quantity to administer ; the probability is that its significance was numerical rather than patho- genetic. Sir John Golbatch appears to have administered large quantities of the drug, and yet we do not hear from him of any cases of poisoning occurring in his practice. Whether much of the powder he administered was unab- sorbed, or his method of drying and preserving it deprived it of its activity, I cannot say ; his treatise, unfortu- nately, breaks off just when he has obtained a tincture of the plant, ''which he thinks will be more powerful than the infusion and powder he has hitherto made use of," and I do not know of any published results detailing his experience afterwards. When we read of ProU having symptoms recurring frequently during a period of two years from a maximum dose of 40 drops, and recollect that Dr. Parke gave half drachm doses three times a day, and Dr. Wilde as much as 40 drops to a child, it makes one wonder how such seemingly para- doxical statements are to be accounted for.
Making every allowance for individual susceptibility, there is still much that with our present knowledge of the drug remains uncertain.
The information regarding it may be summed up in three words: — Ist. Miraculous. 2nd. Traditional. 3rd. Scientific.
618 VISCUM AU8UM. ^'S^'S^^^
The Miraculous. Examples of the miraculoas may be found in the statement made by Albertus Magnns, that it would open all locks ; by Aubrey, who tells of the awful effeots which resulted to some ill-advised folk, who» without due ceremony, cut the mistletoe from an oak at Norwood to sell to the London apothecaries (and who for their pains fell lame, lost the sight of their eyes and broke their legs) ; and the Swedes, who think that a knife with an oak-mistletoe handle will ward off the falling sickness.
The Traditional^ in tlie statement of the Druids that it would heal all diseases and antidote every poison, ajid that of the old herbalists, that it was panacea for apoplexy, palsy, and the falling sickness.
The Scientific, or more recent and definite knowledge possessed by us of the principles to which it owes its activity, the directions in which that activity manifestB itself, and such results as have been tabulated of & precise and trustworthy character relative to its power over disease.
It seems strange, when one thinks of it, that a drug with such a history as this, should not have received more attention from the profession at large ; it is doubly strange that no exhaustive proving should have been undertaken so as to determine once for all its position in our Materia Medica. Many drugs, much less deserving^ have had justice done them, and their place assigned, whilst this one, with all its miraculous powers, and with all its traditional virtues, still remains comparatively unknown.
Should my efforts contribute to throw light upon this subject,' or to arouse interest in it amongst my brethren at large, I shall feel amply repaid, because I believe that with greater knowledge of its virtues there will come amelioration of human suffering, and the consequent joy and happiness that are ours when we feel that we have been instrumental in diminishing, in however slight a degree, the sum of this world's misery and pain.
bSSS5<2?TS!S^' principle op homceopathy. 61»
THE PRINCIPLE OF HOM(EOPATHY.
By W. BuiST PicKEN, Esq.
The explanation of homoeopathic therapeutics, what- soever it may be, must exhibit the homogeneity of the homoeopathic law to the general laws of nature, because the operation of the homoeopathic remedy, howsoever obscure, is certainly directed by natural and specific law.
In the degree, therefore, that any theory of similia is thus evidently one with our knowledge of the universe generally, in such degree is there at least probability of truth in it.
Of course all medicinal action is according to natural law ; and here the inconsequent thinker may object that the criterion of truth I have jast advanced is of common application to all systems of theory — as indeed it is. But applied to the different medical systems, we get in the case of homoeopathy a result quite unique. For while the latter runs parallel with the others as regards the particular laws of relation between each drug and the organism, in it alone is there one great general law relating all drugs to the organism in the same way — the practical law of similia. Whether the drug be of mineral, vegetable, or animal constitution, the law is the same. Being a general law, outworking itself through many and diverse particular laws, it is thus of higher grade than these, as by its correspondencies may be seen.
Now it will be conceded by all students of the theory of homoeopathy which I have had the honour to present to the homoeopathic school of medicine, that its oneness with the known laws of nature is indeed remarkable. In correspondential phenomena of water, air, light, chem- istry, electricity, magnetism, mind, the same principle has been shown to be active. What this principle in itself is I have not hitherto attempted to demonstrate, having limited my exposition of the theory of homoeo- pathy to its general laws. Moreover, as my aim through- out has been to offer a science of homoeopathy in unim- peachable unity with accredited science generally, and in terms of the same, an exposition of first principles for which we have no received terminology could not have helped so much as hindered the end in view. In this paper I shall for the first time deal explicitly with the principle of homoeopathy.
620 PRINCIPLE OF HOMCEOPATHY. ^"i2!^L"oT?l2^
Review, Oct. 1. 1896.
Underlying the laws of what (for lack of better termi- nology) I have called " interference-absorption/' there is a unifying power, a principle, for which we have as yet no descriptive name. The facts of homoeopathy are its cures ; these occur under the general law of sdmilia ; this again is an expression of a deeper principle, the source of all the correspondencies or analogies of the homoeopathic law. For this principle we have no name, nor shfidl I try to coin one for it here. The existence of the principle itself is proved by its expression in the correspondential phenomena of motion from matter to mind. A theory formed of these correspondencies certainly appears to be buUt on the principle of nature in question. And since no other hypothesis as yet advanced is measurably so homogeneous to received science generally, it has at least verisimilitude enough to command such attention as maybe necessary to carry my imperfect exposition of it to conclusive negation or affirmation.
Thinkers who cannot disprove the theory, but who meet it with inconsiderate denial, are reminded that if it be true in essence, howsoever defective in form, their persistent rejection would only exempUfy the old infirmity of the scientific mind in denial of what is true only because it is new.
By one of my critics I have been accused of incapacity, if not unwillingness, to see truth in any other theory than the one associated with my name. Perhaps this article will be an adequate reply to a charge so grave.
Another critic, whose honourable objections to my theory of homoeopathy have appeared in this journal, merits dijBTerent attention, which I regret having had so long to delay.
Dr. Proctor {Review, April, 1898) a little surprises me in saying he does not think '' the real explanation of the homoeopathic cure of disease will be found in Mr. Picken's physical theory." I should have thought my paper in the February issues of Th^ North American and the Homoeopathic World sufficient to prevent the theory from being characterised as a physical one. Indeed, a major contention of my exposition of homoeopathy all the way through has been the spiritual nature of it. Not to go back to articles in which this was specifically maintained, and the contention defended from first principles, I take
SdSSfStTiM^.''" PRINCIPLE OF HOMOSOPATHY. 621
from the February one the following refutation of the alleged physical nature of the theory under discussion. "Neither positive nor passive, the homoeopathically small dose has no action properly its own. It does not oppose force with force, the equation of which may be regarded as a problem in physics, nor so balance chemical action and vital reaction that their equation is to the organism a sum of plus in its physiology. The typically homoeopathic dose acts spiritually, i.e.y the converse of materially. It may be said to have a spiritual, impersonal action, of which the material reaction is physiological. It elicits normal organic motion by renunciation of itself for its 'otherness/ precisely as the typical * soft answer turneth away wrath.' Every kind of ' soft answer * will no more turn away wrath than will every small dose of medicine cure. In both cases the positive, contrary, repulsive force is renounced for the negative and attractive ; but in both cases also this negative must bear a specific relation to the disordered correlative. It must by impersonal action call forth similar action, the two con- verging and combining in restored unity. This pecidmr operation of the homreopathic remedy, more than its properties of attenuation, altlwu^h these are naturally concomitant, marks its spirituality."
If that excerpt should not convey to Dr. Proctor or any other of my readers a sense of the spirituality of my theory of homoeopathy, let the fallacy of this inter- pretation be shown. In any case it is clear that the theory is not propounded as a physical one. Strictly speaking, there is absolutely nothing wholly physical or wholly spiritual. The physical and the spiritual are inseparable ; in mass or molecule, of matter or of mind. The spiritual pertains to the interior pole, and the material to the exterior pole of a bi-polar unity. And the determination of anything as merely material or purely spiritual is only a convenience of thought ; even as such amounting to nothing more than a statement of how the two principles for us are polarized. The whole history of philosophic thought proves this.
It is somehow extremely difficult for most thinkers to remember that truth is dual, and for them to think accordingly. Yet only thus may the discovery of truth become relatively easy and sure by processes of a
«22 PRINCIPLE OF HOM(EOPATHY. ** rJ^J^oTJI^JS!
-dialectical nature. Hegel has once for all demonstrated ihe truthfulness of that assertion — ^but how many of us can make head or tail of Hegel ?
Dr. Proctor objects to my theory of homoeopathy, because it " seems to make equally for the allopathic action of medicines," and because it appears to him to be contradicted by certain facts of biology. " To take the illustration of two wave-motions of light or sound," says Dr. Proctor, " we have in the first place, the fact that for the perfect neutralisation of two undulations, the waves should be of equal shape, size and strength
In the second place, these equal waves
must cross each other at such an angle, or in such direct opposition, that they may interfere with each other. . . . . This oppositeness, which is necessary for wave interference, seems to convey pretty well the allo- pathic idea of medicinal action, except that in the vital sphere we cannot get such opposite action by the same agent as is possible in physics; we must employ medicines acting oppositely physiologically."
Dr. Proctor's difficulty, it seems to me, is a natural -consequence of his idea that the science of the vital realm and its laws is ** essentially disparate " from that of the physical realm and the laws thereof. When he says that the principle of interference itself ** belongs to the category of mechanical laws," from which it has been his endeavour to separate the vital activities, he is not, I believe, thinking of the principle at all, but only of its manifestation as the law of interference in mechanics ; moreover, he has, for the time being, certainly lost sight of the unity of all things, likewise of the operation and results of the evolutionary principle in nature. His confusion arises from the prevalent misconceptions with ret^ard to the nature of life. It is little understood that the universe, as a unity, is a living organism, just as a man is ; and that what we distinguish from other forms of force as life is really the distinction of a higher mode of motion from lower modes of the same in lower evolution- ary states. The mineral world exhibits types of motion which are sub-vital ; developed out of these we see in the vegetable world the higher order of forces properly termed vital and sub-sensuous; from these again are developed the next higher order of forces constituting the quality of motion called sensation, which is sub-mental ; and from
ttSS^foSTlSe?'* PBINCIPLE OF HOMOSOPATHY. 623
the latter is finally developed the ultimate types of motion named mental.
Motion, or mind, has by the evolutionary processus completed a cycle of evolution from the unconscious to self-consciousness. In other words, unconscious motion has awakened to self-consciousness in the mind of man.
Motion, life, sensation, intelUgence — four graded orders of motion, each higher one in turn developed out of the preceding lower order, and sustained by the same : all organised into indissoluble unity in man, who must necessarily be subject to all the laws of the orders of motion which constitute him. This being irrefutably so, there can be no science of life essentially disparate from any sound science of physics.
Dr. Proctor will probably now understand how I agree with him when he writes thus : — '' To try to bring down the complex nature of perhaps the highest form of force that is kaown to actuate matter to the level of simple vibrations of a merely mechanical kind, must in my opinion only end in failure." Undoubtedly ; if by bringing down the vital force to the mechanical level be meant elimination of the ultra-mechanical develop- ments of the organic energy. But we must bear in mind that as Nature develops a new type of force she integrates with it the preceding types. Motion, life, sensation, intelligence, are not only integrated into unity, but as constituents remain inviolate. The electrical, the chemical, and the mechanical systems of laws are in evolutionary relations within man and without ; they act on him, and are reacted on by him, individually and collectively. This idea of organic unity — unity of man and of the universe, is the master-key to the great problems of mankind — ^individualistic, socialistic, com- mercial, scientific, philosophic, theological, &c. Applied to the subject under present consideration its power is immediately convincing. We easily understand why it is that physical diseases may be cured by psychical means, and psychical disorders by physical means ': — €,ff., the cure of acute fear of death by aconite, of deep despair by arsenic ; cure of neuroses, inflammation of tissues, fever, even tumours, by pare will. By innumerable facts like these is demonstrated the unity of the com- pound systems of forces which constitute the human organism; while the principle of the convertibility of
624 PRINCIPLE OP HOM(EOPATHY. ^nSil^JStT?^
Beview, Oct. 1, 1898.
forces explains the rationale of therapeutic action of forces at one end of the scale on those of the other end. We thus see why motion is so highly communicable from one system to another, and how each drug will manifest its injSuence at either end of the scale according to the polar conditions of its use.
The anatomical, physiological, mechanical, chemical, electric, magnetic, and spiritual laws (the seven great orders of forces, in evolutionary sequence), having a typical action towards unity (or the maintenance of the organism) are thus in varying degrees all available for the induction of therapeutic effects in every system of the organism. The further apart any two systems are — the anatomical and the spiritual being at the extremities of the scale — of course the less effect can the one have directly on the other ; and obviously the system of forces in the middle of the scale must have in general the most direct action towards both ends. This is just what we find in drug therapeutics, which belongs to the middle order of organic forces. As, however, higher forces pervade and control the lower, when adequately directed, so it comes about that a tumour (which reaches to the anatomical end) may be cured by will, although rarely achieved because of the general undevelopment of therapeutic will-power.
Since, then, pain, inflammation, fever, &c., may be cured by appropriate uses of water, heat, light, drugs, electricity, magnetism, thought, emotion, will, therefore I conclude that the forces of the organism and of nature are a unity. It follows that while all the seven systems of forces have a variable general therapeutic value, each must have to its major degree such functions and values in relation to particular pathological phenomena. This truth I cannot elaborate here. But it is of immense importance in the study and practice of general therapeutics.
Having, I trust, clearly enough indicated the theoretical and practical evil of regarding the sciences of physics and biology as essentially disparate, T return to the statement that for the perfect neutralisation of two undulations of light or of sound, " the waves should be of equal shape, size, and strength." This condition of (mechanical) equality of opposing undulations has been cited as an objection to the interference-absorption
E^^w''(V?T?S?*' PRINCIPLE OP HOM(EOPATHY. 626
Review, Oct. 1, 1808.
theory. The objection might be valid if it were appli- cable to inter-relations of organic and inorganic forces as it is to inorganic forces of the same order intev'se. But, as Dr. Proctor has remarked, equaUty of forces in mechanical interference is not correspondential to homoeopathy. The correspondence which I have utilised in my exposition of theoretical homoeopathy, is that of ihe phenomenon, not of what may be called the noumeuon, of the motions in question. It is the phenomenon of destruction of light by light, of sound by sound, which is correspondential to the axiom of homoeopathy, that like cures (or destroys) like. When we come to investi- gate the invisible motions constituting the phenomenon, the correspondence is found to be at least as exact, but it is of course a noumenal, not phenomenal correspondence. And here I urge careful consideration of what is implied by this correlation of those terms, the latter signifying appearance as against the reality signified by the former — thus the manifold phenomenal differences growing out of a noumenal identity.
Symptoms are phenomena, and it is symptoms which are destroyed in homoeopathic therapeutics, not the forces constituting them. And as it is by direction of symptoms that the homoeopathic law is applied, it must be interference as a phenomenon which is the true correspondence of similia.
If the idea of isopathy be involved in the very existence of wave motions of equal character, as Dr. Proctor says, while ** the neutralisation of wave motion is of the nature of simple, mechanical antagonism when minutely examined," there is in this nothing antagonistic to my theory of homoeopathy.
The correspondencies as phenomena being self-evident, I proceed to show that as noumena parallel correspon- dencies exist.
Looking beneath the phenomenon of interference in sound or light to the motions which cause it, we find negative and positive vibrations passing from a par- ticular dynamic to a correlated static state. The waves are not in all respects equal (mechanically), since one is negative and the other positive. It is thus that they directly come to rest. Being positive and negative they are (mechanically) similar only, but complementarily so»
Vcl. 42, No. 10. 2 8
626 DUCT CARCINOMA. "^"^UF^SH^^
and have thas a polar equality , which is not to be con- fused with " isopathy."
The true isopathic element of the case under notice is in the equal periodicities of the motions. This equality, however, is the same whether it be interference or its opposite that is produced by two wave motions. The isopathic law is common to all drug action — positive, passive and negative — being the law of absorption generally. Series of isopathic waves in polar correlation produce no dynamic phenomena. Their independent motions that were qualified to manifest themselves as heterogeneity with concomitant dissipation of energy, in polar combination exhibit unity with concomitant con- servation of energy. In the phenomena of sound and light the static state is changed into the dynamic. And as interference is the direct restoration of the static state, the law of interference is thus seen to be an expression of the principle of equilibrium, or harmony. For the union of two motions in polar correlativity is direct, or interior, equilibration of the forces constituting them — '- the attainment of static harmony, or the re-ordering of pathological molecular motions to the normal or physiological.
rTo be continued, J
DUCT CARCINOMA.
By Thomas Simpson, M.D.
A LADT consulted me about a hard swelling around the right nipple which gave her much concern, seeing that pains of a shooting, burning nature kept her awake half the night, and a sanious fluid exuded continually from the nipple. She rismembered that her mother had died at the age of 55 from an affection somewhat similar, and was naturally anxious to know what steps should be taken to avert, if possible, so dire an issue.
I reassured her by saying I believed that an operation might possibly be averted by carefully-prescribed medi- cines.
I gave her conium 6 (from its action on glandular structures having been proved extensively over a prolonged period of time). In 14 days her general health had improved, and her weight slightly increased ; the sallow hue of her face was less pronounced. Appetite
^t^SSnS^ REVIEWS. 627
Tteviefw, Oet. 1, li
improved, sleep better, discharge from nipple less. Encouraged by these signs of possible arrest of the retro- grade progress I continued the conium in the 12th -dilution, and to gratify her importunity an ointment of -conium P. B. was applied.
These methods manifestly relieved her still further of the discomfort and distress which naturally accompanied a gradual increase in the extent and the hardness of the tumour which previously obtained, and the haemor- rhage from the nipple. One month later the marked diminution in the severity of the symptoms was so pro- nounced as to inspire hope, and so to improve her health.
Garbo animalis 6 was next prescribed and boric lint applied, because the symptoms seemed stationary; following this the state of her health improved, and the local symptoms subsided, especially the sanious discharge and the sleeplessness from pains. The 12th dilution next prescribed seemed to act with greater effect than formerly, all the signs of the disease (objective and sub- jective) remitting manifestly, and in five months from the first interview the appearance of the breast had regained its natural form and the discharge had entirely ceased.
Comment is unnecessary, excepting to urge a trial of well-indicated remedies in even pronounced forms of malignant disease, as well as in suspected and incipient forms of it, which so often come before us.
REVIEWS.
J'^ssentials of Hotnceopathic TfierapeiUics ; being a Quiz Compend
of the Application of HomceopcUhic Remsdi^s to Diseased
States, By W. A. Dewiby, M.D., Professor of Materia
Medica in the University of Michigan HomoBopathic
Medical College. Second edition. Revised and enlarged.
Philadelphia : Boericke & Tafel. 1898.
The first edition of this work was published in October, 1894,
and a notice of it appeared m our pages in 1895. We have
little to add to our then expressed opinion.
From the point of view of memorising, the '' Quiz *' form has many advantages. Most of the faults of the book are due, not to the compiler, but to the present state of our Materia Medica. That a second edition has been called for is a good sign and an indication of the vigorous growth of the homo&opathio school in America. There, a new generation of students and
2 8-2
628 NOTABILIA. "<S.*&?SK^
Renew. Oet. 1.1806.
junior practitioners is constantly arising, and such a work as this is of especial value to them. Were the questions alone given and the answers left to the student to supply by searching the archives of materia medica and therapeuties, the book would be worth possessing. Indeed this would not be a bad way to use it, the student afterwards comparing his answer with those of the authority.
We notice a number of the so-called tissue remedies are referred to — chiefly of course on clinical grounds.
A Pocket Dictionary of Hygiene. By 0. T. Euygzett, F.I.C, and Dr. Homfbey, B.Sc. London : Bailli^re, Tindall&Gox. 1898. '* OuB chief object has been to supply medical and sanitary officers with a pocket dictionary for reference in connection with their work.*' This sentence occurs in the preface to this waistcoat-pocket vocabulary. It is always well to know an author's object, when he has one, in order to arrive at a jost conclusion as to the success of a work from his own point of view. Let us give our readers a few examples : ** Adipose, fatty ; anhydrous, without water ; anodyne, a drug which alle- viates pain ; antisepsis, a state or condition free fratn sepm or jmtrefaction as attained by tlie use of antiseptics '* — ^which sub- stances are next defined. (We thought this state was that of asepsis.) '' Cardiac, pertaining to the heart; febrile, relating to fever ; toxic, poisonous: virulent, strongly poisonous ; " etc., etc., etc.
We select instances such as the foregoing, because they are short and easy to reproduce. There are longer definitions and explanations and with none of them, short or long, have we any serious fault to find as regards accuracy. But in most cases the information afforded is presumably well known to medical officers of health and sanitary officers. Either the ^< object " with which the authors started was an unwise one, or they have signally failed in reaching it.
NOTABILIA.
CANTHARIDE8 A TONIC TO TBE KIDNEYS.
On reading the above heading our homoeopathic readers ^vilI open their eyes wide, and then subside like the " Heathen Chinee ** into a smile that is <' child-like and bland," while our allopathic friends will likewise open their eyes wide, but smile, as they have it in Scotland, ''on the wrong side of their mouth." But such, we are told, is the action of cantharides by Octavius Beven, M.D., D.P.H., of Balham, in
iS^'^rrSSf" NOTABILIA. 629
Beriew. Oct. 1, !«'*.
a communication published in the British Medical Jotfntal of September 17th.
A.ccording to views generally received and enunciated in all works on materia medica, pharmacology and poisons, cantharides is perhaps the most powerful known irritant to the kidney, causing acute nephritis, htematuria, great pain, and strangury, to say nothing of its similar power on the bladder in caasing cystitis, and its usual symptoms. But Dr. Beven's view of things is, to put it mildly, novel, and perhaps hence- forth we shall find cantharides among the " new remedies *' of advertising chemists as a "tonic" to the kidney, and valuable in hsematuria and chronic albuminuria. But we shall best do justice to Dr. Beven by extracting his communication
.RIDES AS A HAEMOSTATIC IM H.l^MATURIA AND ITS
USE IN Albuminuria.
neficial effects of cantharides, taken internally, in
ctions of the kidneys, do not seem to be generally
■nee no apology is needed for bringing before the
notes of the following case : —
N., aged 68, a joiner, had always enjoyed perfectly
1 until the beginning of August, 1897, when he
arge quantity of blood with a few clots by the
.0 pain, however, was experienced. He was ordered
, and ergot, which stopped the haemorrhage. It
owever, directly the patient got about again. Sub-
.11 the haemostatics mentioned in the Pharmacopceia
logwood, galls, oak-bark, alum, iron, ergot, tannin,
, etc. — were tried with little or no benefit. Last
he went up to one of the London hospitals, where
n by a distinguished surgeon, who could not find
a either of the bladder or kidneys. He was recom-
3mostatics, and if he derived no benefit from these,
I of the kidneys was suggested to him — a course he
wouiv agree to on account of his age. For five months he
took lar^ doses of the prescribed haemostatics three times a
•day, but his condition both bodily and mentally became worse
and the haemorrhage increased.
« It was in this state that he came under my care at the beginning of May, ten months from the commencement of his illness. The urine on microscopical examination showed •quantities of blood corpuscles and a few casts. No enlarge- ment of the kidneys could be detected on palpation, and no pain whatsoever was experienced. I prescribed tincture of cantharides, ntv, three times a day, and regular exercise. In twenty-four hours all the haemorrhage had stopped, and the urine became quite clear. I then omitted the cantharides, but
680 NOTABILU. ''"SS^^^ST^
in ten days there was again a little blood in the urine, whioh immediately cleared up after a couple of doses of the mixture^ As a precautionary measure, I ordered a dose to be taken occasionally, with the result that no blood has been paased since. 1 omitted the cantharides entirely a fortnight Stgo, and put him on a preparation of iron to combat his an»mia.
*' The effect of the cantharides was marvellous, in that it stopped in twenty-four hours the hsemorrhage, which so far from yielding, had increased under the usual haBmostatics prescribed fbr a period of ten months. Best had nothing to do with the cessation, as I told the patient to be out of doors as much as possible.
** The diagnosis I dare not venture upon. To the tonie effect of small doses of cantharides on the kidney I ascribe the successful result. This drug also brings about a very striking diminution in the amount of albumen in the urine of patients suffering from ' large white * kidney, if given in small dos* s ; whether this diminution is permanent I am at present unable to judge.
** OcTAvius Bbvbn, M.D., D.P.H.
" Balham."
It will be observed that Dr. Beven states that "the beneficial action of cantharides, taken internally, in certain affections of the kidneys, does not seem to be generally known." We quite agree with him, if he adds "in the old school.'* But if he does not already know it, as we shrewdly suspect he does, we may inform him that it has been the leading medicine in homoeopathy ever since Hahnemann 'a immortal discovery of **8imilia dnnUbm *' as the great law in therapeutics, in the treatment of the very cases which Dr. Beven describes, and also in acute nephritis. He will find this fully in all homoeopathic works, though we have our suspicions that his knowledge of such works is more than he ventures to say, and that he has, as we now see, made good use of information thus acquired. He will also find, in Dr. Ringer's Manual of Therapeutics a full account of the therapeutic powers of cantharides in nephritis, hfematuria and albuminuria. But this one expects in a work so full of homoeopathy ; also in Dr. Lauder Brunton's Pharmacology ^ he will find, in the " Index of Diseases," that same drug recommended, at least in the first three editions. We have not seen any later one. One hardly wonders that Dr. fieven states that the curative effects of cantharides on the kidney do not seem to be generally known. The fact is that such treatment is so glaringly homoeopathic that its adoption would naturally frighten weak-kneed members of the medical ** Trades Union." How any one can shut his eyes to the fact
£Sltl!'<St"Tffif NOTABILU. 681
B«Tiew, Oct. 1, 1608.
of a drug which is so well-known to produce inflammation of the kidney and bladder, with haBmaturia, and yet is markedly eurative of these same states, when given in small doses, being other than a perfect example of the law of similars, is to us astonishing. In hot, it is most difficult to believe that it is not clearly seen. And what can be more absurd than, ignoring this remarkable fact, and saying, as Dr. Seven does, *' To the tonic effect of small doses of cantharides on the kidney 1 ascribe the successful result." This is simply throwing dust in the eyes of his readers, in order to escape the honest and manly admission ^at here at least is an example of the homoeopathic law and practice. His sentence is simply a second edition of Dr. Anstie's famous *' explanation " in the Practitioner of the action of drop doses of ipecacuanha in curing sickness, that it was not homceopathy, but that it showed that ipecacuanha in these small doses was a tonic to the vasomotor nerves of the stomach. Such a mode of speaking is contemptible when a great question of therapeutic law is the real issue. We are continually having to report examples of the adoption of homoeo- pathic treatment in the old school, as recorded in their own journals, given either without any attempted explanation or suggestion of the palpable relation between the drug and the ^sease, or else, as in Dr. Beven's paper, obscuring, as well as possible, the issue by writing of such drugs as *' tonics " to the organ in small doses. When will this sort of thing cease ? It vuist cease some day, and such papers as Dr. Beven's are perhaps the early signs of the <' dawn of scientific medicine," which Sir William Broadbent assures Qs is beginning to be visible. One word in conclusion, as to the dose employed by Dr. Beven. He gave five minims of the tincture of cantharides. Dr. Binger gives one minim, and still smaller doses would answer as well, as homoeopaths well know. But the fact of five minims having cured and not aggravated is an illustration of what we have had repeatedly to point oat, namely, that a homoeopathic dose is one which (I) is of a drug which has the relation of '*similia " to the disease ; and (2) which must be smaller than will aggravate the symptoms. How much smaller is a question of experience. If Dr. Beven continues to find five minims always successful, let him keep to it, as then it is equally homoeopathic to one minim, as Dr. Binger advises, or to still smaller doses such as are usually employed by homoeopaths. So let not Dr. Beven shelter himself under the idea that because his dose is not infinitesimal it is not homoeo- pathic. He only gives us a good illustration of what we have to point out so often to our old-school friends, that the
632 NOTABILIA. "Cfr.°0?n!^SS
homoeopathic dose is one ivhich cores ivithoat aggravation.
^ >|c « 4e *
The views of the editor of the British Medical Journal and our own differ widely not only as to the value of homoeopathy, but as to what is '* common fairness." While he is willing to give publicity to one observer's announcement of the useful- ness of a drug, to his fanciful explanation of its action, and to his remarks about the ignorance of the profession on these points, he is averse to sJlowing another observer to advance facts or theories of a conflicting contradictory nature. For our enthusiastic colleague, Dr. Arnold, of Manchester, addressed a letter to the editor of the Bridsh Medical Journal, which letter was received but not published. Our contempo- rary has evidently forgotten that magna est Veritas et pravalebit. Dr. Arnold's letter reads as follows : —
'* To the Editor of the British Medical Journal,
'* Sir, — In the British Medical Journal of September 17th is an interesting account by Dr. 0. Beven of a case of hiema- tuna and albuminuria, which, after proving refractory to various methods of treatment, was finally put right by small doses of cantharides. Dr. Beven says : ' The beneficial efifects of cantharides taken internally in certain affections of Che kidneys do not seem to be generally known.' This is perfectly true, so far as regards the majority of the profession. May I ask you in fairness, however, to let me point out that the use of cantharis in such cases as Dr. Beven describes has been a commonplace of homoeopathic practice ever since Hahne- mann's time, the choice of the drug being, of course, based on the fact that hematuria and albuminuria with casts are, as evenrone knows, among the most prominent symptoms caused by toxic doses of cantharides.
*' I am, &c.,
**F. S. Arnold, M.B."
As if with a presentiment that his letter to the Journal would never meet Dr. Beven's eyes through the columns of that paper, Dr. Arnold took the precaution of writing direct to that gentleman. Dr. Beven will never again be able to preach and practice crypto-homoeopathy in ignorance, as our readers will see on perusing our colleague's remarks, which we are allowed to reproduce.
Sir, — To one who recognises in homoeopathy a therapeutic principle of great value and wide applicability, your account of a case of haematuria and albuminuria treated by can- tharides, in the current number of the British Medical Journal is interesting, and, if you will pardon my saying so, also somewhat amusing.
S:5iS'(2n-S?'^ NOTABILIA. 633
You say ''The beneficial effects of cantharides, taken internally in certain affections of the kidneys, do not seem to l>e generally known." So far as the majority of the profession is ooncemeid you are perfectly right. You are, perhaps, aware, however, that the use of cantharis, in such oases as you describe, has been a commonplace of homoBopathic practice ever since Hahnemann's time, and that the homcBopaths base their use of the drug in such cases on its power to cause in toxic doses hsematuria and albuminuria with casts. Your explanation (?) of the beneficial action of cantharides in your case, as due to <' a tonic effect of small doses of can- tharides on the kidney,'' reminds one of the '< explanation " put forward to account ifor the cure of certain cases of nausea and vomiting by small doses of vinum ipecac; viz., that ipecacuanha in small doses has '' a tonic action on the nerves of the stomach," and of a still more classical " explanation " of drug action by one of MoliSre*s characters, and carries one just about as far. Do you really believe that the fact that large doses of cantharides will cause haematuria and albumi- nuria has nothing to do with the other fact that small doses of cantharides will remove those symptoms in a case of disease. Is it logically conceivable that the two facts are not in some causal relation to each other. Similarly with the facts that large doses of colocynth cause, while small doses cure, a certain kind of colicky diarrhoea, and that large doses of jaborandi cause profuse perspiration while small doses will absolutely check the drenching night sweats of phthisis, aod hundreds of other similar pairs of i&cts. To look upon these as isolated phenomena instead of as instances of a general principle ; to shut one's eyes to the gross improbability of the view that the toxic action of the large dose and the precisely opposite curative action of the small dose are unrelated facts ; to assume the existence of a « tonic action " rather than admit that there is any relation between the two, all this is surely an excellent example of what has been well called <' the credulity of incredulity."
I am, Sir,
Yours faithfully,
F. S. Arnold, M.B.
*'0. Beven, Esq., M.D."
BOURNEMOUTH CONVALESCENT HOME.
On another page will be found an important letter from Dr. Nankivell, giving an account of the improvement and enlargement of the Hahnemann Convalescent Home. This nstitute is so well known and of such wide-spread utility that
634 NOTABILIA. ""^^H^T?^
Beview, Oct. 1« 1896.
we feel sure it will meet with the generous support it deserves. We are very pleased to know of this forward movement, and for the sake alike of the sufferers relieved there, and of the cause of homoeopathy, we wish it every success.
HAHNEMANN'S REMAINS.
The Medical Era (September, 1898) publishes and supports a resolution of the Homoeopathic Medical Society of German- town, that steps be taken to learn if it will not be possible to have the remains of Hahnemann transported to America, and placed beneath the National Hahnemann Monument now being erected in the capital city of the United States. The resolution gives no argument in support of this, but the Era remarks : —
*' It is eminently appropriate that Hahnemann's remains should repose in American soil. It is in America that homoeopaUiy has made its greatest growth. But for the immense development of Hahnemann's system in our land, its position to-day in the world of medicine would, in point of numbers, be almost insignificant. America, with its twenty colleges, its numeroas journals, its many local societies and its great National organization, should become the repository of the mortal remains of the immortal Hahnemann."
LOYALTY.
Mr. Malcolm Mobbis, in the Practitioner for September, in the course of some notes on tbe meeting of the British Medi- cal Association, writes : ** Among the many good stories which I heard was the following, which, though probably not new,, is worth repeating : A distinguished physician, on the medical establishment of the Court, being on one occasion called to an exalted personage, had a notice posted up mtimating to all whom it might concern, that Dr. — having been summoned to Balmoral to see Her Majesty, will be unable to lecture to- day ! The effect of the announcement was rather spoilt by the fact that some one, with an inopportune display of loyalty^ had written underneath —
* God save the Queen! ' "
EXOPHTHALMIC GOITRE. Dr. Halbert, of Chicago, writes, in The Clinique as follows : ** When I began the study of this disease I was prejudiced by the prevailing statistics as to its incurability ; the pathology was not then fully settled, and surgical excision of the cervical sympathetic ganglia was about the only treatment
S:S^!^TS^' NOTABILIA, 685
then aceepied, though fortunately not accredited as a cure. Later came the experiments and apparent relief from the thyroid preparations only to be discarded after awhile as not only ineffective but absolutely harmful. No one had held to the homoeopathic remedy with any degree of confidence or encouragement. My experiments and study during the past ten years have convinced me not only of its curability, but of the invaluable benefit from the persistent use of the indicated remedy.
'* Of the remedies most serviceable to me I would mention ferrum phos., arsem'oum iodide and lycopus. The first is most useful in cases of anemia, or chlorosis, in young girls ; the second when there is a history of primary or secondary specific trouble, the strumous diathesis, or more particularly a fibrous increase in the gland together ynih adenoid enlargements in other glands. The best remedy on general principles is lycopus. This I almost always give in the tinc- ture, five drop doses four to six times daily. The other remedies I have almost invariably employed in the third decimal potency an equal number of times daily. The reme- dies must be used, with slight intermissions, for two or three years according to the severity of the disease.
"Lycopus virginicus, it will be found, has a primary action upon the heart producing in the end a cardiac erethism and a resultant stasis of the general venous system. Its direct involvement of the nervous system is in the form of a vaso-motor perversion permitting the decided structural changes from a prolonged impoverishment and irritation of the sympathetic ganglia. Its characteristic symptoms are the cardinal ones of this disease; that is, exophthalmud goitre and tachycardia. Added to these we find the alimentary disturbances, diarrhcBa, gastritis and hepatitis ; these are invariable concomitants of exophthalmic goitre. In place of this remedy I have oiten found colchicum decidedly valuable during the early attacks of the bowels and when the nausea, even to the odour and name of food, is present.
** We must always remember that the disease is pre-eminently one of the nervous system. Its gradation of symptoms begin with polyuria, diarrhoea, hepatitis and then gastritis. Preceding this we generally find a history of sexual perversion and some genital involvement. When the disease becomes fixed it is principally an irritation and perversion of the functions of the cervical sympathetic ganglia.
'' I have had many cases in my private and clinical prac- tice, and in a great majority of them have been successful with the above remedies."
636 NOTABILIA. '"^^rSr^'i^
Review, OeL 1. 1998.
THE TREATMENT OP CHRONIC APPENDICITIS BY MERCURY.
HoRwiTZ {AmiaU of Surgery, January, 1898) reports four cases of chronic appendicitis, in each of which operation was clearly indicated, and had heen advised by several eminent surgeons. This was refused by all the patients, each of whom came under the author's care for secondary syphilis, and was put on '* tonic " doses of protoiodide of mercury. Case 1, male, aged 44, had had nine attacks of appendicitis, one quite recently. There was a tender indurated mass in the right iliac fossa. Soon after the mercury treatment was begun he had a fresh acute attack of appendicitis, when the mercury was given up for a time. After the cessation of the acute symptoms it was resumed, with the result that not only the syphilitic symptoms disappeared, but also the appendicitis and constipation. ' Four years have passed since then, and there has been no return of the appendicitis. Case 2, male, aged 81. Three attacks of appendicitis ; has dyspepsia and chronic constipation. He had a slight acute attack of appendicitis after a year's treatment with protoiodide of mercury. Since then (two years and a half) has no trouble with the appendix. Case 8, male, aged 28. Five attacks of appendicitis ; doughy, tender mass in right iliac fossa. Protoiodide of mercury given. Health improved, and since then (three years and a half) appendix has given no trouble. Case 4, male, aged 88. Two attacks of appendicitis, and suffers from dyspepsia and constipation. Signs of chronic appendicitis in right iliac fossa. Protoiodide given up till now (one year and a half). Has had two attacks of appendicitis while under treatment, though none since last June. The author says it is remark- able for the chronic form of appendicitis following acute attacks to subside under small doses of mercury, and, though these cases are too few to arrive at definite conclusions, he thinks it well worth while for others to test the treatment in all cases of chronic appendicitis where operation is refused. — Brit, Med, Joiim,
THE HYDRO-ELECTRIC TREATMENT OF CHRONIC RHEUMATISM.
Chauvet of Royat {Arch. d'Elect, MM., April 16th, 1898) strongly supports Nevison's views as to the value of the elec- tric bath in chronic rheumatism. He either uses pure Boyat water, or adds 2 per cent, lithium chloride to it. The current is produced by a battery of 60 Leclanch6 cells, and is employed at an intensity of from 16 to 80 milliampires. The
jss^r^nrsgf" notabilia^ m
electrodes consist of charcoal covered with flannel, and each sitting lasts from ten to thirty minutes. The author records 14 cases of rheumatoid arthritis and 1 of gout treated in this way. In 8 the results were most satisfactory ; in 2 the hatha were beginning to do good when they had to be discontinued owing to the supervention of local or general excitability. In both these cases the patients were from the first nervous and apprehensive. In the remaining 4 cases no improvement was noted, and it is to be remarked that in all of them Heberden's nodes were present. The author thence infers that the treat- ment is not indicated where this particular deformity is found to exist. In any case, however, it does no harm, and during its continuance there is an absence of the acute exacerbations which are so common in rheumatoid arthritis. There is a remarkable improvement in the suppleness of the joints, and in successful cases the author claims that the hydro-electric method is more rapid in its effects than any other which he has tried. — Brit. Med. Journ,
ANTIPYRIN ERUPTIONS.
W. Weohselmann {Deut. vied. WocJi., May 26th, 1898) emphasises the difficulty sometimes experienced in recognising the antipyrin rash. It may spread universally over the body or be limited to more or less definite areas. In the latter case the parts about the mouth, anus, eyelids, the extremities, especially the backs and palms of the hands, the fingers and toes are most often affected. When limited in this way it may be attributed to syphilis. The rash consists of raised, well-defined red spots, round or oval in shape, upon which vesicles quickly appear. Healing takes place with a laminated desquamation or crust formation, and pigmentation frequently remains behind. The diagnosis is often made more difficult by the patient denying that it can be due to the use of any drug. The rash frequently does not appear after the first dose, but only after the antipyrin has been taken for some time, so that the patient hardly beh'eves it possible that it is due to the drug. The author gives details of five illustrative cases. He says that the rash is not so often seen as the use or misuse of antipyrin would lead one to expect. The size of the dose has little effect in producing it. The pigmentation is due to the rapid recurrence of the rash in the same part. Perhaps the drug is here excreted by the sweat glands and salivary glands rather than by the kidneys. In some investigations the presence of antipyrin in the urine could not be established. — Brit. Med. Joiuti, July 2nd.
688 OBITUARY. ^?Sl5?S!»?p?Sif
Beirtow, Oet 1, 1896.
OBITUARY.
DR. CORNELIA STETTLER.
Early in August one of the London papers announced the death on the steamer Frudn'eh dsr Grosse of a ladj doctor from Chicago named Cornelia Lettler (sic). At the time, we feared that this could be no other than our well-known American colleague whose name heads this paragraph. These surmises have been confirmed by an In Memoriam article in the Cliniqm, by Dr. Julia Holmes Smith (Aug. 15th) 1898).
Dr. Cornelia Stettler became known to many of our English •colleagues at the last International Congress held in London, where her intelligent interest in the Congress and the work of her English colleagues, her ready and comprehensive grasp of medical subjects, her courtesy and brightness won for her the appreciation and esteem of those who met her.
Cornelia 8. Stettler came of an old Dutch family of New York, whose faithfulness and pertinacity she inherited. Early left a widow, with a young daughter to care for, she decided to ^opt a medical career, and graduated in the Hahnemann Mescal College of Chicago in 1891. For some time before her sudden death she had acted as clinical assistant to Dr. Ludlam, while conducting a private practice at the same time. She was specially interested and skillful in gynecology and obstetrics. For four years she was corresponding secretary of the Clinical Society of Hahnemann College ; she was also a member of the Illinois Homoeopathic Medical Society and the American Institute of Homosopathy. Dr. JuUa Holmes Smith writes of her personal qualities in the highest terms.
The death, occurring suddenly on the voyage to Europe on July 28, is vaguely described as due to '* cardiac paralysis.'*
With the friends of Dr. Stettler, and especially with her daughter, we express our earnest sympathy, and join with Dr. Ludlam and his colleagues in regretting the premature demise of so able and promising a fellow- worker.
CORRESPONDENCE.
HAHNEMANN CONVALESCENT HOME. BOURNEMOUTH.
To the Editors of the ** Monthly Honueopatliic Review.'*
Gentlemen, — Great additions have been made during the present summer to this Home. The roof has been removed throughout, and a full story added to the building. The
E^SSr5?!7£S^*' CORREBPONDENOE, 689
Oommittee will thus be enabled, if the funds are sufficient, to increase the number of beds from 27 to 88, and to grant a very large increase of cubic space to each patient. Better accommo- dation will also be provided for the nurses and for the domestic staff, so that we may expect that the administration of the Home, which will remain in the hands of Miss Hill, will be earned on with even more energy and thoroughness than before.
The prominence which has been given of late years to the value of open air treatment of phthisis, has led the Oommittee and Medical Staff to the conclusion that the erection of ample balconies on the South Front was an urgent necessity, and they have consequently entered on a large, and hitherto unprovided for, expenditure for this purpose. A two-tier balcony is now in process of erection which will correspond to the ground and first story levels. It will face due south, and be protected by glass from east and west winds. On the north, of course, it will be sheltered by the building itself.
A lift is also to be erected, which will be used in the service of the Home and in the carriage of patients. The eost of this has been very generously defrayed by an anonymous friend.
Altogether an expenditure of £2,500 has been incurred on the structure itself: of this sum, roughly, £1,200 only are in hand, and no provision has been made for extra furnishing. It may be readily seen that much and generous help is still needed. Direct contributions to the Building Fund may be paid to the Treasurer, the Bev. F. Young, Fremantle, Marlboro' Boad, Bournemouth, or to the National Provincial Bank of England, Bournemouth.
But help may also be extended to us by assisting the bazaar which is to be held in the Mont Dore Assembly Booms, Bournemouth, early in November next. It is desired to make this bazaar commensurate with our need, which is great : and suitable articles of sale of every sort, useful and ornamental, will in the meantime be received by Mrs. Nankivell, Penmellyn, Bournemouth, the convener of the Oommittee of Ladies, or by Mrs. Hardy, West Chevin, Bournemouth.
Our Home is a charity for the three Kingdoms : its doors are open to all suitable cases that are sent to us on subscribers' recommendations ; and not one per cent, of those received belong to this district in the first instance. We therefore urgently claim your help in this our need.
Herbert Nankivell,
Chairman of Oommittee. Sept. 15, 1898.
640 CORRESPONDENTS. "b^Iw^STiI^
NOTICES TO CORRESPONDENTS.
•^* We cannot nndertahe to return rejected mannscriptM.
AUTHOBS and Contributobs receiving' proofs are requested to correct and return the same as early as x)ossible to Dr. Edwin A. Nsatbt.
London Homcbopathic Hospital, Gbeat Obmoxd Street, Bloomsbury.— Hours of attendance : Medical, In-patients. 9.30 ; Out- patients, 2.0, daily ; Surgical, Out-patients, Mondays, Thursdays, Fridays and Saturdays, 2.0 ; Diseaset* of Women, Out-patients, Tuesrhiys, Wednesdays and Fridays, 2.0 ; Diseases of Skin, Thursdays. 2.0 ; Diseases of the Eye, Thursdays, 2.0 ; Diseases of the Throat andl ^ar, Wednesdays, 2.0 ; Diseases of Children, Mondays and Thursdays, 9 A.M. ; Operations, Tuesdays, 2.30 ; Dental Cases, Thursdays, 9 a.m. ; Orthopaedic Cases, Tuesdays, 2 p.m. ; Electrical Cases, Thursdays, 9 a.m.
Communications have been received from Dr. Barrett, Mr. Theo- bald (London) ; Dr. Abnold (Manchester) ; Dr. C. W. Haywabd, Dr. J. D. Haywaud, Dr. Simpson (Liverpool).
BOOKS RECEIVED.
Textx and Studies of the Ocular Muscle*. By Ernest E. Maddoz, M.D., F.R.C.8. England. Bristol : J. Wright & Co. lS9»,—DUiionary of Hygiene- By C. T? Kingssett, F.I.C., and D. Homfrey, B. So. London : Bailli^re, Tindall & Cox. 1898. — EstentiaU of HomatojMthic Thera- peutics, By W. A. Dewey, M.D. Philadelphia : Boericke & Tafel. 1898. -^ Chloroform, ifj< Ahwlutely Safe AdmiriiHration. By Robert Bell, M.D. Glasgow : Robert L. Holmes. — The. Homceopathie World, Sep- tember. London. — The Chc^nut and Druggist. September. London. — The Practitioner. August. London. — Calcutta Journal of Medicine. June and August. — Hnmasopath ic Eye, Ear and Th roat Journal. Ne *■ York. — The New England Medical Gazette. September. Boston.— TTft/' Howaeo- pathic Envoy. September. Lancaster, Pa. — The Howo'rtpathie lieeorder. August. Philadelphia.— T/w Medical Era. September. Chicago.— Tlie Hahmmannian Advocate. August. Chicago. — The Clinique. June and August. Chicago. — The Minneapolis Homcsopathic Magazine. August. Minneapolis. — 77*^ Pacific 0)a^ Jtmrnal of Hommopatky. August. New York. San Francisco. — The Medical BHtf. September. Bi. Louis. — Tlie Medical Times. September. New York. — The Homceo- pathie Envoy. September. Lancaster. — YVm* Thsmanian Homteopathic Journal. July and August. Hobart — Bevue Homceopathique Beige. June. Brussels. — Bivista Omiopatiea. July and August. Rome. — Journal Belqe d'Himiotopathie. July and August. Brussels. — Homafo- pathi^ch Mnandhlad. August. Nederland.— -4r^A/r. /fttr Hofn&opathie. September. Dresden. — Leip^iger Populdre Zeitschrift fUr Homeopathic. September. Leipzig.
Papers, Dispensary Reports, and Books for Beview to be sent to Dr. Pops, 19, Watei^ate, Orantbam, Lincolnshite ; Dr. D. Dyck Bbo\^-x, 29, Seymour Street, Portman Square, W. ; or to Dr. Edwin A. Nbatby, 178, Haverstock Hill, N.W. AdvertiHements and Business communications to be sent to Messrs. E. Qoitld & Sox, B©, Moorgate Street, E.C.
^StTifSnTiMa'* ATTITUDE OF HOMCEOPATHS. '641
THE MONTHLY
HOMCEOPATHIC REVIEW.
:o:
THE ATTITUDE OF HOMCEOPATHS TO HOMOEOPATHY.
The progress of a new science which has not yet received universal recognition depends upon the conduct of its adherents. The opposition of unbelievers and the indifference of the ignorant are secondary in importance to the attitude of those who have embraced its truths.
In writing and speaking of the progress of homoeopathy amongst the profession and laity enough has been said of these secondary causes and too little of the former. It is possible for those who are professedly homoeo- paths, and who daily profit by the knowledge homoeo- pathy has brought them, to hinder the progress of homoeopathy by the attitude they assume towards it* Knowledge is a sacred trust, for the use of which we are responsible not only to our neighbours but to posterity. It is a searching question how far each of us, who aa medical practitioners assume the role of homoeopaths,, is faithful to this trust.
We are not concerned to write a sermon on the subject, important as it is. A few examples of the* harm that may be done unconsciously to enquirers after the truth will illustrate our meaning. The two extremes of optimism Bj[xd. j^cssimism in our attitude to homoeopathy:
Vol. 42, No. 11. 2 T
642 ATTITUDE OF HOMEOPATHS. ^^r^SL^v^**?'*^^''
Review, Nov. 1, 18B6.
are equally dangerous in their effects. As illustrating the former, we give a case that recently came under our observation. A lady brought her husband for advice to s, well-known homoeopath, introducing him with a statement to this effect : that twenty years before she had suffered from a terrible cough from which she was* never free for five minutes. All the resources of old-school practice had been exhausted in vain. At last she determined to try homoeopathy. The doctor she saw gave her one powder in his •consulting-room. This at once stopped the cough, which never returned. She, therefore, desired advice for her husband, who for many months had coughed incessantly, whilst ordinary treatment seemed useless. The lady was well known to the narrator, nor was there iiny doubt as to the honCi fides of her statement, which was corroborated by her husband. She evidently expected a similar miracle to be worked by homoeopathy for him. His case, however, proved to be one of old standing chronic bronchitis, an instantaneous cure being evidently impossible. This was very properly explained to the patient, much to his wife's disappoint- ment. But encouraged by the assurance that with patience and perseverance a cure could be effected, treatment was commenced, and in a few weeks the cough had gone, nor has there been any return of bronchitis since. Both he and his wife are now staunch homoeo- paths.
That such sudden and almost miraculous cures are sometimes effected by a single dose of the correctly indicated remedy need not be denied. But these are distinctly rare, and exceptions to the usual results of homoeopathic treatment. Very real harm is done to the cause we advocate by quoting such cases as if they were the usual effects of our medication. That we ahould always aim at such results is true, but that we should encourage patients to expect them is equally untrue. By such optimism many, who by more reason- able statements might be won to our cause, are discouraged, and with some justice consider themselves to have been deceived, and tell their friends that homoeopathy is a delusion. If the case of chronic bronchitis given above had fallen into the hands <Jf such an optimist, we can imagine that he would
mUSi^KSJ^l^'S^ ATTITUDE OF HOMCE0PATH8. 648
probably never have consulted a homoeopath again. We are convinced that a large number of would-be homoeo- paths are lost to our cause by such injudicious methods, and what is more serious they spread distrust of homoeo- pathy amongst their friends. It is in this respect that 'many of the popular explanations of our treatment in pamphlets and books are also greatly to blame. Do not let us belittle homoeopathy, but do not let us pretend that we can always work wonders in its name.
Pessimism — ^the opposite extreme to that we have considered — is equally a dangerous attitude and equally an untrue one. Fortunately, it is more rarely seen amongst homoeopaths than optimism. Our observation suggests that pessimists are the weak-kneed amongst us ; those who have slipped into routine, often semi-allopathic methods of prescribing. These cannot get their patients along without the frequent use of purgatives, and have given up all belief in the value of homoeopathic treatment in constipation. Such a physician, who enjoys a wide reputation as a homoeopath, and for whom we have personally a high regard, was recently consulted in the following case. A lady had for 18 months suffered from dropsy, from no evident cause. Under old-school treat- ment this had been diagnosed as a tumour, and her abdomen had been opened for its removal, only to disclose ascites and nothing more. She now required tapping every fortnight, and was rapidly losing strength — her doctor declared that nothing more could be done for her. She was urged by friends to try homoeopathy. The case undoubtedly was not a hopeful one, and the physician in question declined to undertake it, giving the patient and her husband to understand that homoeopathy could do nothing for her, and that she could not be in better hands than under the care of the old-school surgeon, who was continually tapping her. Fortunately, in their extremity, the advice of another homoeopath of less pessimistic views was sought, and by his treatment the ascites was successfully relieved, no further tapping required, and the patient restored to comparative health for two years, when she left the locality and passed out of observation.
It must be conceded that to decline treatment in such a case is to incur a grave responsibility, and to cast an undeserved slur upon the principles we uphold. Another
2 T— 2
644 GOUT AND ALLIED DISORDERS. ^SI^^I^nST^IS^
injury is done to the cause by such practitioners. Patients quickly conclude that the difference between old-school practice and a homoeopathy that has frequently to seek refuge in purgatives and other similar devices is a very slight one. Consequently it is allegiance to their doctor and not to homoeopathy that induces them to imagine themselves to be homoeopaths. When they visit other localities, or have to change their medical attendant, they usually lapse back into allopathy. Numbers of would-be adherents to homoeopathy are lost to the cause by these methods.
We think, then, that our attitude as practitioners to the cause of homoeopathy is of supreme importance, and we advocate neither an impossible optimism nor an intemperate pessimism, but a just and truthful estimate of the measure of success that may be reasonably looked for in every case presented to us. This should be coupled with an attitude of encouragement and hopeful- ness towards those desirous of testing our methods, even in cases which at first sight appear to present little likelihood of cure. Our literature abounds with instances which justify the wisdom of such an attitude.
THE EAELY EECOGNITION OF GOUT AND ALLIED DISOEDERS.— in.
By W. Thbophilus Ord, M.E.C.S. Eng., L.E.C.P. Lond.
FeUow of the British Homoeopathic Society,
II. — Sy^iptoms Produced by Excess of Uric Acid akd OTHER Gouty Matters in the Blood.
The quantity of uric acid present in the blood is most variable, fluctuating often from the point of saturation to complete clearance in so short a time as probably half-an-hour, especially in those who have plenty of available storage, and whose kidneys are uninjured. In others, it may remain always at or near the point of saturation — by which is meant that proportion beyond which no more can be held by the blood without deposi- tion in abnormal parts. Haig has discovered that the - symptoms produced by excess of uric acid do not depend only upon the actual quantity present in the blood, but also upon the proportion existing between the quantities
^SJr.^rMa^ <3F0UT AND ALLIED DISORDERS. 645
of uric acid and urea present. Thus the more urea in the blood the more uric acid can be held in solution without producing symptoms of excess. And vice versa, when urea is low a quantity of uric acid will produce discomfort which, if the proportion of urea were higher, would give no symptoms. Haig considers the normal proportion as about' 1 to 85. If uric acid exceeds this, or urea falls below 35 to 1 of the former, symptoms tend to be produced and deposition to occur in some storage parts.
The causes producing excess of these gouty matters in the blood are innumerable, but all act in one or more of three ways — (1) by excess being produced and poured directly into the blood as formed. This is true whatever theory as to its mode of production be accepted ; (2) by excess being given out by the storage organs, either through their being over full, and thus obliged to relieve themselves, or by some alteration in the blood which tends to dissolve out their stores ; and (3) by hindrance to excretion of uric acid through the kidneys. Of these the first is evidently dependent chiefly on diet, and that hereditary tendency or diathesis of which we have spoken. Nitrogenous foods and sugar are the great offenders in a mixed diet. Of the second cause, according to Haig, the prime factor involved is th« alkalinity of the blood- An increased alkalinity favours absorption from the storage organs, a low alkalinity prevents this and tends to deposition. TJiis blood condition also depends upon diet, as also does the reaction of the urine. There can be no doubt that Haig is correct in stating that the degree of acidity of the urine is a guide to the degree of alkalinity of the blood at the time it was excreted. Now vegetable diet is known to diminish acidity and even •cause alkalinity of the urine, it consequently increases the alkalinity of the blood, and hence its value in dis- jsolving out and eliminating stores of gouty matter in the system. Nitrogenous food in excess has the opposite effect, increasing the acidity of the urine and diminish- ing the alkalinity of the blood, hence locking up uric acid in the storage organs, besides increasing its produc- tion. The same is true of beer and acid wines, whereas vegetable acids, fruits, and cider increase alkalinity and reduce storage, being thus of great value in gout And allied disorders. Strange to say, although these
646 GOUT AND ALLIED DISORDERS. "^SSSrfNSTif^
effects of diet are daily proved in the experiences of thousands of physicians, there are certain laboratory experimenters (chiefly in Germany) who, being unable to confirm these facts in their test-tubes, have the face to deny them and assert that diet is comparatively of no consequence in gout.* Even Luff, in our own country, opposes Haig in his views as to the effects of increased alkalinity of the blood and of vegetable diet. But as his experiments and views chiefly concern true gout with deposits of sodium bi-urate, they are not so conflicting as at first sight may appear. And Luff, although denying that the alkalinity of the blood increases the solubility of deposits of sodium bi-urate in trite gout (which as explained before are only one special form of the many gouty and allied conditions we are considering), admits that *^ the saline constituents of vegetables exercise a remarkable inhibitory power over the decomposition of sodium quadri-urate "t (hence pre- venting gouty deposits), also that the solubility of sodium bi-urate (the form in which he considers uric acid to be present in the blood in gout) is increased by vegetable salts. Luff also says that the opposite is true of " the saline constituents of meat." Thus both observers practically agree as to the value of a vegetable dietary, only Haig insisting that it is due to their influencing the alkalinity of the blood, while Luff prefers to attribute the effect to their ** saline con- stituents." Probably both are correct. Many of the supposed disagreements between the views of Haig and Luff disappear when we remember that the latter writes chiefly of true gout with deposits of urates of soda, whilst it is Haig who has done such splendid work in bringing vast series of allied disorders into one field of view and explaining their common cause in his work on uric acid.
It may here be convenient to mention that after a prolonged study of the matter, I am convinced that Haig has gone in advance of the facts in his theory of the formation of uric acid directly from food. Consequently, he is mistaken in forbidding tea, coffee, beef-tea, chicken and meat extracts, with eggs, in his dietary for gout and
♦ Vrir Arid Diathe»ix, pp. 28, 29, 85. t J/r<//r-a^ ^l///iWtf/, 1898, p. 254.
^S^Jv^h^f^ ^OUT AND ALLIED DI80KDEB8. 647
allied disorders. Also his method of estimating the ario acid present in various foods has been considered imreliable, and is now supplanted by a more certain process. The third weak point in hia work is the assumption that uric acid alone is the cause of all these conditions, and his ignoring the existence of other blood impurities which undoubtedly have also much to do with this train of disorders. But bearing these three probable errors in mind, his work* is of profound value to every practical physician, and I strongly advise all who are unacquainted with it to obtain a copy and study it carefully. Next to the law of similars I believe it to> contain the most valuable working hypothesis that ha& yet been presented for our assistance in combating disease, and there is no disageement between the two ; indeed, the one assists the other.
Vaso-Motor Contraction op Arterioles, the Great Effect of Uric Acid in Excess in the Blood.
Vaso-motor contraction of the arterioles and capillaries is the great and far reaching effect of uric acid in the blood. All the important symptoms produced by its excess can be traced to this action, which, of course, produces increased blood tension; this throws extra work upon the heart, which in later life becomes enlarged and ''gouty." Hence increased arterial tension, with its many effects, is the invariable accompaniment of all gouty conditions and allied disorders. It can always be detected in the pulse (by finger or sphygmograph) before and during a uric acid storm (or attack of uric^acidaemia),. such as headache, bilious attack, anginal attack, asthma, epilepsy, and many other disorders I have referred to. In true gout increased tension can always be recognised, and its ultimate results in albuminuria, gouty heart and senile decay are well known. Such contraction in the kidneys hinders their excretion, the urine becoming scanty and high-coloured. Thus, as mentioned previously, diminution and concentration of the urine is also an invariable precursor of any such attack, whilst after- wards when the excess of uric acid and other gouty matters has been excreted (during the crisis) the arterioles relax and the kidneys freely excrete, diuresis setting in
♦ Urh' Ae'ul in the Canseation of Disease^ by Alexander Haig. ChnrcbilL 128. 6d.
648 aOUT AND ALLIED DISORDERS. ^^S:,^vSJ"?^S^
Review. Nov. 1, 188&
with abundant limpid urine. This diuresis is always accompanied by a feeling of well-being and increased vigour, the blood having been cleared of impurities. From this we can understand the malaise and weariness which precedes a uric acid storm, and is associated with diminished urination. Indeed, without such excess as may lead to attacks of uric-acidaemia, it is an observation common to all of us that mental and bodily vigour are most marked during hours of free diuresis, and the opposite obtains when excretion is scanty. Thus clearing the blood of uric acid and other gouty matters frees the circulation, and probably quickens combustion and metabolism throughout the body.*
It will now be clear that the chief symptoms produced by excess of eflfete gouty matters in the blood are those depending on contraction of the arterioles and capillaries and the resulting increased blood tension. It may be useful to briefly consider the commonest eflfects, according to the organs exhibiting them.
The Brain. — ^Headache, incapability for mental work, drowsiness, mental depression and epilepsy. The uric acid headache is usually " throbbing " and " bursting," worse by motion, and especially by jars. These con- ditions are most pronounced in brain workers and thick- necked persons. In others, almost any kind of headache may be met with. That associated with hepatic crises and vomiting is often occipital, and sometimes relieved by bending the head backwards. Probably frontal and temporal headaches are the most common. Drowsiness, vertigo, stupor and disinclination for mental effort are also common examples of the same conditions.
The Skin and Body-surfaces. — The capillary contraction produced by excess of gouty matter in the blood shows itself here by a lowering of the surface temperature, which can readily be proved by comparing a thermometer placed under the tongue with one placed in the rectum. During or before a gouty crisis (of whatever type) a difference of three or more degrees can often be detected. When it has passed and the circulation being freed, the capillaries relax, the difference sinks to one degree or less. This causes also dryness of the skin and chilliness, with cold extremities.
Urie Acid in Di*raH\ Haig, p. 155.
S^^fl^rriSe"'' GOUT AND ALLIED DISORDERS. 649
• The Kidneys. — This effect has been explained as causing diminished urine from vaso-motor contraction of the arterioles, and may finally result in albuminuria.
Heart and Lungs. — It is usually not until late in life that true gouty heart occurs," except in Bright's disease. The immediate effects of excess of uric acid and such matters in the blood of an otherwise healthy person <;annot be detected in the heart except by slight short- ness of breath on exertion, or palpitation. Anginal attacks may occur suddenly from this cause. Diminished aeration of blood, its increased impurity, and perhaps some specific poisoning effect on the smaller bronchioles often causes slight dyspnoea, bronchial catarrh and genuine asthma. Nasal catarrhs also are a very common evidence of a temporary excess of gouty matter in the blood.
Muscular System. — Lassitude, disinclination for mus- cular exertion, rheumatic pains, cramps and early fatigue are commonly noticed at these times.
Liver, Stomach and Intestines. — ^The effects of this Condition on the liver have been noted in my last paper.* On the stomach and intestines the diminished vascularity from vaso-motor contraction lessens absorption and secretion. Hence nutrition will be hindered, digestion interfered with, and constipation with flatulence from putrefaction of intestinal contents will often be observed.
III. — Organs of Abnormal Storage of Gouty Matters,
WITHOUT CRYSTAIiLINB DEPOSITION OF UrATEH.
We have examined the effects of uric acid and other gouty matters when in excess in the normal storage organs (liver, spleen, etc.), also the symptoms produced by similar excess circulating in the general blood stream in various organs. Also we have seen how the liver relieves itself of such excess. It remains to explain what symptoms are likely to occur when the blood relieves itself by depositing such poisons in other parts, which hence may be called abnormal storage organs. Many of the organs which exhibit symptoms given above as indicating excess in the blood, also perform the function of abnormal storage. Whether they do so or whether all symptoms disappear by a clearance of the
* Monthly HomaopatUie Jlevlcw for October.
660 POUT AND ALLIED DISORDERS* ^^vS^JL
Review. Nor. i, ]
blood-stream will obviously depend on two factors. First, if there is room for a farther sapply to be absorbed by the normal storage organs (so relieving the blood) ; and, secondly, whether the kidneys succeed in elimination of the excess by the urine. If the normal storage organs are full and the kidneys are blocked (through vaso-motor contraction) the excess must go- elsewhere, and hence deposition takes place in the abnormal organs. When this has occurred the symptoms- will no longer be immediately relieved by clearing the blood, but will persist for a longer or shorter time after- wards, and will tend (if unrelieved) to produce perma*> nent pathological changes in these parts. Thus during a uric acid storm the excess may pass into some muscles, producing muscular rheumatism. The crisis will be relieved, £ree diuresis may occur, with general cessation of other symptoms except the rheumatism, which may persist for days or weeks. To clear the blood of uric acid, etc., is one thing, to clear a set of muscles of effete matter is another. The one may be done in a few hours, the latter is a much slower process. It may be, as many have supposed, although Haig doubts it,, that lactic acid is the cause of muscular rheumatism. But this does not affect the question materially, as lactic acid is probably one of the impurities which, with uric acid and others, we are considering. Whatever we may call the substance, its behaviour is on the lines indicated. No doubt in the muscle tissue itself some chemico- physiological changes may take place after deposition.
It is evident therefore that when the blood is over- charged, and the normal storage organs can retain no more, any further excess of gouty matter, unless it is at once excreted, must manifest its presence elsewhere. And since excretion by the kidneys is at a minimum,. such symptoms are very liable to be produced by any exciting cause which may tend to invite deposition in a special part. Chills and over-exertion act as exciting causes, and thus beside the muscles, joints are very frequently affected. In these facts we have the expla* nation of acute febrile rheumatism. Bheumatic fever, with acute articular pains, is the commonest example of the condition we are considering. The joints offer a capacious storage space, and the rapidity with which excess of uric acid and its congeners seize upon these
l£!^r^r?wS^ <W)UT AND ALLIED DISORDERS. 651
organs, and the grave symptoms so produced, are matters of common observation.
Many cases of chronic eczema seem due to the same eause. Elimination by the kidneys being hindered, relief is attempted by the body surface, and the normal acidity of sweat (always increased when excess of impurities is present in the blood, as, for example, in rheumatic fever) encourages the deposition of litbsemia matters in the skin. Gouty eczema, and many forms not usually recognised as gouty, can only be cured by treatment directed to eliminating gouty matters from the system. Indeed, in true gout, crystals of sodium bi-urate can often be obtained from the sweat. It seems^ probable, therefore, that the skin shares, with other parts, the office of an abnormal storage organ. Probably the obstinacy of many chronic skin diseases to purely homoeopathic treatment is due to this cause, and the lack of recognising the necessity of assisting our remedies by other special methods.
The mucous and sub-mucous tissues of certain parts, especially of the respiratory tract, seem also to invite storage in some constitutions. The frequency of nasal catarrhs as evidence of an over-charged circidation has been mentioned, also of asthmatic attacks. There are other more chronic conditions that affect these mucous membranes and are due to the causes we are considering* The commonest of these are chronic post-nasal catarrh,, hay fever, chronic pharyngitis and laryngitis (so frequent in distinctly gouty persons), bronchial catarrh (especially noticed on rising) which often results in chronic bronchitis and emphysema. These conditions are usually attributed only to their exciting causes — chills, draughts, pollen grain, and what not. But though these act as germs, the soil must be prepared before they will germinate. It is the presence of excess of uric acid, etc., stored in these tissues (perhaps selected for storage through acquired or hereditary weaknesses) that renders them liable to produce such symptoms. In others, whose tissues are not vitally depressed by the presence of these poisons, such exciting causes have no effect. I have frequently noticed how often these attacks are accompanied or preceded by distinctly uric acid headaches, and how common hepatic crises (periodical bilious vomiting) are amongst them. Also the attacks
652 GOUT AND ALLIED DISORDERS. ^b^1L^nT?*?SS!
Beiriew, Nov. 1. 1998.
themselves frequently appear periodically. The hyper- trophic rhinitis, described as usually present by Mr. Dudley Wright in his recent helpful paper on Hay Fever and Nasal Asthma* I would look upon as probably due to the cause suggested.
In these conditions, especially when treatment has long been unsuccessful^ I have found that a practical recog- nition of the gouty diathesis and lithsemic storage, with the use of remedies and diet suitable for eliminating these blood poisons, will result in rapid cure. Notably in chronic sore throat (follicular pharyngitis) in such persons, and the more distinctly gouty throats common in later life, anti-uric acid treatment has done wonders many times in my hands when ** symptom covering" had completely failed. Such cases, which formerly had been a bugbear, as so difficult to relieve, I now welcome as comparatively easy and sure to succeed. In fact, the increased success in difficult and obscure cases that the guidance of these facts has brought me, stimulates the attempt to press them upon my colleagues. As to the special remedies (chiefly homoeopathic) that are of most use for this purpose, and also the dietary which so greatly assists their action, these must await a future communica- tion. A thorough acquaintance with the pathology of gout and allied diseases and their early recognition, as here very imperfectly described, is essential to the successful use of such methods.
The frequency of tonsillitis and chronic enlargement of tonsils has probably a bearing on this question of storage. Even in childhood sore throat with swelling of tonsils is a common precursor of rheumatism and cardiac affections. Very probably the constant throat trouble produced by the slightest chill in those with large tonsils, is due to a sudden accumulation in them of gouty matters which the circulation is endeavouring to get rid of. Also in later life quinsy has suddenly disappeared on the development of acute gout in the toe,t a fact readily
* Monthly Jlom/xopathic Ilev'ieu\ Sept. 1898, p. 548.
t firitWi Medical Journal^ April 30th, 1898. Quoted in HnnKEopnthic Wot Id ^ September. In this article — (" Beneficial Eflfects of one Disease as Regards Another '*)— some facts noted strikingly confirm the opinions given above. Headache is recorded as changing to backache, and palpi- tation to gastralgia, also migraine, spasmodic asthma, and angina pectoris, sncceseively displace one another in one patient. Similarly glycosuria and eczema, and eczema and asthma are sometimes inter* changeable.
SdSJJfNoTriwe^*' ^^^^ ^^^ ALLIED DISORDERS. 663
explained if the tonsils are regarded as abnormal storage organs.
That the kidneys may for years be saturated with uric acid and gouty matters is well known. Eenal calculus is one result, the commoner, perhaps, is albuminuria and Bright's disease. Also the ordinary diabetes of middle life is often caused by retention of similar matters, probably in the liver or pancreas. That there is a true neurotic glycosuria we need not deny, and this is the usually fatal form observed in earlier life. Nearly all the cases of real or partial cure of diabetes in middle life are those in which dietetic and other treatment has (perhaps unintentionally) effected a riddance of effete matters and a prevention of their storage in the system. Without this medicines are of little use. Ordinary diabetic diet is one of the most efficacious measures for effecting this purpose.
Bheumatoid arthritis, allied to both rheumatism and gout, yet distinct from either, is probably due to the causes we are considering. But so little is really known as to the origin of this mysterious disease that little more can be safely asserted. Some cases are un- doubtedly benefited by treatment which diminishes uric acid storage and increases its elimination.
IV. — Organs in which True Gouty Deposits op Bi-URATE OF Soda occur.
This constitutes ordinary gout, chiefly met with in middle and later life. Actually any organ may become the seat of these crystalline deposits, most commonly joints, tendons, and fasciae are affected. These are now known to consist of bi-urate of soda, which is very sparingly soluble in the blood and hence deposited in crystalline form. It is produced by decomposition of the quad-urate of soda, which is the common soluble form by which other symptoms are produced. Why so few people comparatively should develop true gout, seeing how many suffer from other complaints of similar origin is not clearly known. Luff, however, has shown that this decomposition, with consequent gouty deposits, is increased by the saline constituents of meat and hindered by the saline constituents of vegetable diet.
654 GOUTY DIATHESIS IN CHILDHOOD. ^^^fNSTiJwK
The symptoms and sequelas of true gout are so well known that nothing further need be said about them. My object in these papers has been to show the vast series of disorders which are now found to be caused by the same conditions, and of which true gout is only one and the final development.
A CASE EXEMPLIFYING THE GOUTY DIATHESIS IN CHILDHOOD.
By H. V. MuNSTER, M.B., CM.
Whilst the readers of the Monthly Homoeopathic Eei-iew are having the important subject of ** Gout and Allied Disorders " brought so thoroughly under their notice by Dr. Ord, it appears to me a suitable moment for recording in the pages of that journal a case which exemplifies, very forcibly to my mind, the gouty diathesis of childhood. The case, as made up from crude jottings, is somewhat as follows.
Erick D., aet. 7, is a smart looking little fellow, whose looks at first glance do not pity him, to use a familiar expression. His mother, however, who first brought him under my notice on 1st September, complains tliat he is very thin and gets more so ; that he is restless at night, grinds his teeth, perspires very freely, and always has offensive breath and a coated tongue in the morning. On enquiry we learn further that his stools are some- times chalky in colour, that his bowels are never loose, but rather confined, that he passes a rather small quantity of urine which sometimes deposits crystals resembling cayenne pepper. Also that there is frequently undigested food in the motions, that these are very offensive, the odour sometimes adhering to the patient for a considerable time. Also that mucus has at times been seen to accompany the motions.
The family history reveals the fact that gout has been a frequent scourge on the mother's side of the house. The child's father would seem to have had specific infec- tion some 16 or more years before patient's birth.
Physical examination of the child with every care discloses nothing abnormal in the organs of the body, heart, lungs, liver, spleen, bowels, &c. Emaciation is very marked, and the child's body contrasts with his
lS^fNSri!wS^** GOUTY DIATHESIS IN CHILDHOOD. 656
face, his face being ^' the best part of him.'' The urine« however, is noteworthy. As before mentioned, the quantity is small, sp. gr. 1081, reaction acid, contains urates at times and occasionally uric acid crystals.
The personal history ascertained regarding the child was that he had always been thin, had been under several doctors, but without benefit. By one he was prohibited starchy food, and by another was ordered to eat fat in large quantities. This latter plan had been adopted just previous to my seeing him, and the result had been far from encouraging. In fact his mother said the fat seemed to go through him unchanged.
He was now put upon the biniodide of mercury, 3 deci- mal trituration, about 8 grains thrice daily. Instructions were given also to administer a pill containing half-a- grain of calomel once or twice a week.
Sept. 2. Pill given last night acted this morning, and brought away a lumpy motion containing undigested lettuce and a good deal of mucus. It was very offen- sive. Instructions were now given to have the child weighed regularly, to let him take exercise freely short of fatigue, to be warmly clad, to have a hot bath followed by cold sponging once daily, and the diet was regulated carefully so as to exclude all sweet things, to prohibit any excess of starchy food, and to moderate very strictly the amount of fat consumed. The more easily digested and nourishing articles of diet were carefully selected. The same medicines to be contintied.
Sept. 9. Looks much better. Urine sp. gr. 1027, Motions very foul and free after the pills. Child relishes the new diet very much, whereby he is allowed some light flesh such as fish or chicken for his morning and evening meals as well as the midday meal (dinner). His appetite is wonderfully good. Continue medicine,
Sept. 16. Getting the pills once a week now. These eause a free motion always, and thereafter for some days the colour of the motions continues good. By the end of the week they become chalky again in hue. Patient looks about the same. Urine sp. gr. 1023, B. acid, no abnormal constituents, sugar, albumen, &c. Weight 2 St. 11 lbs. Bp.
Oct. 7. Weight, 2 st. 12J lbs. with the same clothes, showing a gain of IJ lbs. Looks- much better. Tongue
656 HYDRO-NEPHROSIB. ^^v^e^w^N^Tt^
quite clean. Motions now appear to remain healthy in colour. Urine much more copious of late.
In fact, at this stage the child seems to be fairly on the road towards normal growth and development^ though the medicines have been ordered to be continued another fortnight, and the same line of diet to be observed throughout life.
One might call the case one of mucous disease of the intestines secondary to disordered function of the liver ; but I am disposed to hark back, and ask the reason why in this child there should be this inactivity of the hepatic functions with its consequent results of mal-assimilation ? I think the answer will at all events partly be found in the gouty heredity on the child's mother's side. The case is of value also as showing the good effects of systematic regulation of diet and general hygiene com- bined with medicinal treatment.
The high sp. gr. of the urine when the child first came under observation would seem to point to excess of urea from tissue waste. The improvement in this was very marked under treatment, as also that in the state of the digestive tract.
A CASE • OP HYDRO-NEPHROSIS, DUE TO COMPLETE OCCLUSION OP THE URETER, PRESENTING UNUSUAL SYMPTOMS. NE- PHRECTOMY SUCCESSPULLY PERPORMED.
By Vincent Geebn, M.D., CM. Edin.,
And Dudley Wbight, P.R.C.S. Eng.
Assifltant Sur^reon and Surgeon for Diseases of the Throat and Ear to the London Homoeopathic HospitaL
"VVe think that the following case presents certain features which render it worthy of publication.
Prederick M., aged 23 years, first consulted Dr. Green in December, 1896, for pain in the left lumbar region. He had enjoyed excellent health until six months pre- vious to being first seen, when, after partaking of a hearty Sunday's dinner, he was suddenly seized with a violent pain in the left side, accompanied by nausea and . slight retching. The pain persisted for two days, and then subsided gradually.
jlS^Sa^^^T^'' HYDRO-NEPHROSIS. 65T
Since that time similar attacks had recurred every -week, starting on Sunday evening or Monday morning, and lasting one or two days. The attacks completely incapacitated him, and some relief was obtained from sitting in a stooping posture. During the attacks large quantities of urine were passed, and this also seemed to give some relief. The urine he passed was always clear and free from deposit on standing, and contained neither pus, albumen, blood, nor sugar. The patient is a fair- skinned, spare, and rather anaemic individual. He is a large eater, especially so on a Sunday, adding on that day half a glass of whisky to his customary daily two pints of beer.
Examination showed deep-seated tenderness in the left costo-iliac space, together with a slight swelling in the kidney region of that side.
From December, 1896, to April, 1898 — the date of his admission into the hospital — the patient was seen on many occasions by Dr. Green, and several drugs were prescribed, and of them the only one which gave any decided relief was berberis in the Ix dilution. The attacks, however, continued with considerable regularity, and the patient was brought to the hospital with a view to operative treatment and examined by Mr. Wright, who distinctly felt a tumour in the left renal region.
After admission Dr. Epps kindly took charge of the case previous to surgical measures being taken. The rest in bed and regular diet appeared to be beneficial, for the attacks of pain were less intense, and the swelling apparently disappeared. Occasionally an extra large meal was given, and usually this produced an attack, and then occasionally the tumour reappeared. During the attacks the bowels were constipated, other- wise they acted regularly.
A consultation was held and operative treatment decided upon, and the patient was transferred to one of Mr. Wright's beds.
On June 9th Mr. Wright operated — gas and ether anaesthesia. Incision four inches long, a finger's breadth, beneath last rib on left side and parallel to it. The various layers of muscle and fasciae were divided and peri-renal fat exposed. The kidney was found tucked up under the last rib, soft and lobulated, and somewhat enlarged, the pelvis being evidently distended. Palpation
Vol. 42, No. 11. 2 u
658 HyDRo-KBPHKOsis. "?JSlJ,fN;nf;S£
showed that but little kidney substance was left, the organ being converted into a loculated sac containing fluid. The wound was now enlarged to about 5^ inches in order to facilitate exploring both kidney and ureter, the latter being followed down as far as the lower edge of the psoas muscle, its upper part being found dilated ; no stone could be felt either in the kidney or ureter. The pelvis of the kidney was now incised, and about i^ii of clear fluid escaped. The finger inserted into the opening found nothing but a loculated sac. A catheter was passed down the ureter and was stopped by some obstruction at about 1^ inches.
It was now evident that one was dealing with a hydronephrosis due to obstructed uret^er, and as but little kidney substance was left, it was decided to remove the organ. The ureter was divided between two ligatures below the obstruction, and the vessels ligatured at their entry into the hilum by transfixing the pedicle, a small abnormal renal vein leaving the cortex and joining the renal vein was ligatured separately. Silk ligatures were used in each case. The structures having been divided the organ was removed. The parietal wound was closed with silk-worm gut sutures, a large drainage tube being: left in.
The operation caused but little shock, and the patient passed a fair night. On the night of the operation the temperature rose to 100.2**, but fell the following morn- ing to 99.6°, and the next day to 99^, and after that remained normal. The dressings had to be changed the day after the operation owing (to oozing, and the tube was removed at the same time and not replaced. After that the dressings were not removed until the stitches were taken out ten days later. The patient made an uninterrupted recovery, and was allowed up on the couch on the 11th day after operation. The urine passed since operation amounted at first to 27 oz. in the 24 hours ; on the sixth day it rose to 85 oz. ; on the 18th day to 47 oz. ; and on the 19th day to 60 oz. After this it varied between 40 and 60 oz., showing that if there had been any . secretory power in the kidney removed, the other had fairly well taken over its duty. The patient was discharged on the 22nd day after operation, wearing an abdominal support.
iSrt^Wv^riSS?^" HYDRO-NEPHROBIP. 669
Examination of the removed organ showed that it wa» about twice the size of a normal kidney. It was con- verted into a loculated sac, the walls of which were formed partly by the dilated pelvis and partly by degene- rated cortical sabstance. The ureter presented a com- plete cicatricial obstruction about 1} inches from its junction with the pelvis, it being impossible to pass even the finest probe through the obstruction. Note by Dr. Vincent Ghreen. Although the diagnosis of hydro-nephrosis was per- fectly clear, I must confess that I did not grasp the exact significance of the periodicity of the pain and its relation to the Sunday feasting. The operation, however, afforded an explanation. The channel for escape of the urine was so narrowed, that any large increase in the renal secretion such as would be induced by a heavy meal, accompanied by libations of whisky, gave rise to acute tension behind the block, and consequent pain.
The therapeutics of the case bear out what has been my previous experience in this class of case, that berberis stands unrivalled in the treatment of renal colic. It should be given low, one or two drops of the mother tincture at intervals of an hour.
Note by Mr, Wright, The above case illustrates one of the causes of hydro- nephrosis. Organic stricture of the ureter is not a common lesion, and the majority of cases of hydro- nephrosis are due to some other cause. I am quite unable to assign a reason for the appearance of stricture in the present instance, though it is evident that it has been produced by some ulcerative process within the canal. The absence of any history of the passage of gravel, or of haematuria, appear to negative the suppo- sition that lodgment of a small calculus was the primary cause, though it is possible that the first attacks of pain were due to passage of a stone which made a temporary stay within the canal and was finally voided per urethram without being noticed.
It certainly seems highly probable that, as Dr. Green suggests, the regular weekly attacks of pain were due to the extra secretion caused by increased food and drink partaken of on Sundays; though, as Henry Morris has pointed out, a distended colon may cause pain by^ pressure upon a displaced or abnormal kidney.
2 u-2
660 PRINCIPLE OF HOMCEOPATHY. "SJSL^f^STnSS
Since it has been demonstrated that in the case of urethral stricture, a reopening of the canal can be made with perfect success by grafting the part below the stricture into the pelvis of the kidney, the question naturally arisca whether it was good surgery to remove the kidney in the present case. I think that considering th(> fact that the organ had lost the greater part of its secreting structure, its removal was certainly called for.
THE PEINCIPLE OF HOM(EOPATHY.
By W. BuiST PicKEN, Esq.
{Continued from ]}afje 626).
Should anything more authoritative be required in refutation of the supposed isopathic nature of inter- ference, I would refer the reader to Professor Tyndall's exposition of the subject.
** If through any cause," says this authority, '' one ■system of ethereal waves be any even number of semi- undulations behind another system, the two systems support each other when they coalesce, and we have more light. If the one system be any odd number of semi-undulations behind each other, they oppose each other, and a destruction of light is the result of coalescence." Again, with reference to absorption of motion by Corti's organ, Professor Tyndall says it is not essential to response from any one string of this organ that the unison be perfect, as a certain degree of response occurs in the immediate neighbourhood of unison. Each of two strings, not far removed from each other in pitch, can cause a third string, of intermediate pitch, to respond sympathetically. And if the two strings be sounded together, the " beats " which they produce are propagated to the intermediate string. This, of course, does n<rt refer to interference, but the signification is the same. For it must be remembered that it is interference- absorption with which I have all along been dealing. This brings us at once to primary categories. Because no drug effect can be produced or induced without absorption of drug motion. It is, indeed, the mode of absorption, its conditions and consequences, which we
^SJ^NorrSS?** PRINCIPLE OF HOMCEOPATHY. 661
Beriew. Nov. 1, 1898.
are now studying. As I have elsewhere shown, absorp- tion may be effected in positive, passive or negative relations. Absorption and polarity are therefore first principles in therapeutic science. It is hardly necessary to add that they form the foundation of my science of homoeopathy.
In spectroscopic analysis, which presents beautiful illustrations of interference-absorption, the fallacy of the mechanically isopathic idea is further explained. The real equality is clearly seen to be that of periodicity of molecular motion. Periodicity, polarity — these are the essentials. Mechanical equality is a consideration irrelevant to the production of spectroscopic interference. To say that it is relevant to the production of 'perfect (complete) interference is not to raise any real objection to the interference-absorption theory of homoeopathy. Simply because in the sub- vital orders of motion only sub-vital phenomena are possible. Mechanical or chemical absorption of any kind must exhibit a mechanical or chemical equivalence, just because it is merely mechanical or chemical. And let it be observed that the departure from mechanical equality as a condition of interference, which we have seen in the case of Gorti's organ and of spectrum analysis, is only the thin edge of the wedge. As motion advances to the forms of life, sensation and intelligence, the distance from the mechanical conditions enlarges to a degree quite beyond our range of vision. In the human organism the correspondencies between the specific phenomena of the dynamic and static states of motion in mechanics are the phenomena of states of health and disease. In health, the sub-conscious organic motions are in a state of unity, with conservation of energy,, which is the correspondence, in relation to consciousness, of the merely mechanical static state. In disease, this organic unity, or equilibrium of all the forces of the organism, is less or more broken, and the correspondence to the mechanical state is seen in the pathological motions which sooner or later emerge into consciousnesa as disunity, with dissipation of energy.
Motion has four typical forms corresponding to the four great kingdoms of nature : — angular motion typified in the mineral world, circular motion in the vegetable world, spiral in the world of sensation, and vortical i»
662 JPBIKOIPLE OF HOMCBOPATHY. *'SSSiw^Cv"?'?i2?
Bftview, Nov. 1, IMS.
that of intelligence. These systems of motion are organised in man ; consequently he exhibits them all in perfection. Nothing below man can do this. In merely mechanical or chemical motion there is no retnm movement by which impressed motions can become " self-contained " — no development of motion such as constitutes the primitive cell. It is in the order of forces next higher to the chemical that for the first time in evolutionary sequence appears the circulatory type of motion which initiates life and is ultimated in man. And now it is just as easy to see why and how impressed organic motions become self-contained as it is to see why And how this is impossible in the case of inorganic bodies. With the second evolutionary order of motions mineral matter is raised to protoplasm, which becomes a new focal centre of reaction to the forces of the universe which are for ever playing upon all things according to their degree of receptivity. With the principles of the •conservation of energy, of the convertibility of forces, of association, the principles of growth and development now combine in organic transformation of mineral motions and matter into those of life, sensation, and ultimately intelligence. Thus is explained, very simply and very truly, the ultimation into health of a degree of similia absorption that in mechanics would yield relatively slight interference.
In the case of the interference of light by the tourmaline crystal, the laws of mechanics alone are concerned ; in that of the same kind of interference by the electro-magnet we see the former particular laws transcended, and the interfering crystals made to transmit the light as if in the mechanical position of transmission. But in the latter case the ethereal and molecular conditions continue to allow the transmission of light only so long as the initial influence of the magnet is maintained by it — the principles of growth and development being necessary to continuation and ultimation of such changed ethereal and molecular motions.
Interference, then, being essentially the interior equilibration of molecular motions in polar relation, a change from diversity, with concomitant dissipation of energy, to unity, with concomitant conservation of energy, it is evident that in each order of motions the
ISSewfNov"? w£!** PKINCIPLB OF HOM(EOPATHY. 668
laws of interference will manifest their common principle according to the mode of the several orders. On the mechanical plane the unity will take place mechanically; on the chemical plane it will occur chemically ; on the electrical plane, electrically ; on the vital, vitally ; and on the moral, morally.
" As a matter of fact," observes Dr. Proctor, " the movements of the bioplasm in the cell are not in straight lines, and exhibit nothing in the nature of physical vibrations, and they do not perpetuate themselves indefinitely, but are self-contained, and their behaviour is more consistent with a higher form of chemistry than of mere wave motion."
This is, of course, in fine accordance with the fore- going exposition of interference-absorption. The sequence of organic transformation of motion from the mechanical mode is into the chemical, thence through the electric and magnetic into the vital ; hence the passage of the <;hemical impression through the sphere of sensation to self-consciousness, as also the reflex movement from consciousness through sensation back to the chemical and mechanical modes of the mineral order in the organism.
I have at present neither time nor space for an exposition of the principle of similia in its various modes. But if the laws from it be elucidated in the lower and the highest of the series, the unity of principle should be seen.
Sufficient for my purpose has been said, I think, of the lower modes. In concluding I would offer some guiding observations with regard to the investigation of the correspondencies of the homoeopathic law in the moral mode. Being at the upper end of the scale of laws manifesting the principle of similia, we must look for •differences in the phenomenal aspect of things corres- ponding to the differences of the mode. Instead of •dealing with forces positively material and negatively spiritual, we have now to do with forces positively spiritual and negatively material. For the ubiquitous .and all potent ether, which is the fountain of all the physical forces, we have the omnipresent and omnipotent love which is the fountain of all the moral forces of the spiritual universe. This correlation of forces may
664 PRINCIPLE OF HOMCEOPATSY. ^S^Sr^^SJ^^
Beview, Nov. 1, 188B.
surprise some reader, being probably new to him. It is however, irrefragably true.
As we have seen, the essential nature of medical aimilia is interior (or molecular) equilibration of polar forces, with conservation of energy, for which the following formula may serve : positive and negative — unity, with conservation of energy. The formula of contraria is positive and positive, or negative and negative = disunity, with dissipation of energy. In the case both of similia and of contraria there is opposition . of forces, but in the former it is complementary, con- stitutive of unity, or static harmony ; in the latter it is antagonistic, entailing disunity, or dynamic discord.
The philosophy of the axioms, " force is no remedy," and "a soft answer turneth away wrath," is the philosophy of homoeopathy. As regards the first axiom the imity of law with similia is so obvious that anything in the way of exposition would be superfluous. The mechanics of the soft answer turning away wrath are not so evident.
Anger is a passion which is always a form of love. It may be an extreme action of love, self or other, or it may be an inversion of some form of love. The force i& in every case essentially a love force.
In the psychological, as in the medical sphere, external forces may assume positive, passive or negative relations^ By the former mode equilibration is effected destruc- tively, if at all. Murder may be incidental to the positive method. In the passive relation equilibration is obtained under the ordinary operations of the laws of action and reaction — the opposing forces come to Bit equilibrium or static harmony (as relationship), in which the reacting force persists, but is modified by the force^ acting upon it. This condition of things is exemplified^ in the struggle of men individually and collectively when, neither side submitting, they ** come to terms."' The negative mode of equilibration is essentially trans- cendental, whether it be in the case of drug relation to the human organism, or in that of the inter-relations of mankind. In both cases the method and expectation of common-sense are transcended, and an exalted experience becomes the basis of a higher science and philosophy.
I have said that anger is a form of love. This state- ment may at first sight appear paradoxical. Upon
b^^ST?'^'' principle of homoeopathy, 665
Beview, Nov. 1, 1896,
examination it will be seen to be simply and directly true. All the purely social forces are forms of love — in state normal, extreme, or inverted. Love, therefore^ must be competent to cure such disorders as it can cause, if the homoeopathic law be the operation of a^ general principle. But, like the drug remedy, love must assume the homoeopathic relation, both as regards polarity and posology. In a typical case of anger one form of love is in extreme action, another in deficient action; in positive hatred the latter form becomes inverted. Like begets like, and thus the tendency of anger or of hatred is to beget anger or hatred. This is- the law, and the application of it which appeal to com- mon sense, from the ground of common experience. As, however, like may beget like in respect of hatred, or inverted love, so by the same law may normal love beget normal love in the subject of the inversion of it. Rela- tively few individuals are qualified, by intuition or experience, to apply the law of love in this way, hence their experience and philosophy are at first sight trans- cendental nonsense to the man of common sense and ordinary experience. The advanced few, who know this higher truth and apply it, gradually propagate their experience and knowledge to the advancing many,, according to the general laws of evolution.
When two inverted love-forces meet, they augment each other, exhibiting disunity with dissipation of energy, correspondentially to the meeting of water or other physical wave motions whose phases are the same. The increase of mechanical, sonorous, luminiferous, and passional manifestation in these circumstances is due to polar resistance of motion. For it is a case of positive and positive, negative and negative, mutually aggra- vating dynamic disorder, resisting the physiological tendency to rest in positive and negative unity, or (physiologically) static harmony.
Now, in the case of the soft answer turning away wrath, this polar resistance is absent. But this is not all. While the inverted love-force suffers no augmenta- tion by resistance, it is interiorly equilibrated by a similar force moving in opposite phases. The anger- force is absorbed by the soft answerer as light is absorbed by a black substance. It is then by him transformed and radiated as a higher love-force, which the recipient
<666 PRINCIPLE OF HOMOEOPATHY. ^S^^^iSf?^
BeTiew, Kov. 1, 1886.
reflects, as a coloured substance reflects corresponding rays from the sun.
The principle of homoeopathic posology may be easily discerned in its correspondential manifestations of the social world.
To be negative, the homoeopathic dose must be ** small." In general, its efficiency is heightened by some degree of attenuation. In the most intractable disorders it is sometimes found that the organism will respond only to a very highly attenuated remedy.
Now attenuation signifies refinement, or spiritualisa- tion. To spiritualise love is to transform it from a lower, self-quality to a higher, not-self quality. Thus in the posological view the correspondencies of similia are obvious.
As all diseases amenable to drug treatment may be reduced to two classes, namely, positive and negative, so ;all love disorders may be classified into those two orders. The positive state of the disordered love-force is characterised by dangerous expansion, the negative by injurious contraction. Anger typifies the former state, grief the latter.
By renunciation of opposing anger, the disordered love-force is absorbed, (as Ught is absorbed by a black substance), and by sympathetic vibration a similar force of opposite polarity interiorly equilibrates the dynamic discord. By like sympathetic action on the " otherness '* of grief states, a harmonising motion is in the same manner initiated, and by accumulation changes the static disorder into dynamic harmony. Here we see .how beautiful is the operation of the law of extreme sensitiveness to impressions of opposite states. The -organic tension which is concomitant to pathological states goes far to make reaction possible from forces so mechanically slight as that of the typical homoeopathic remedy. The correspondencies in tension of a stretched band of india rubber, of a bent piece of finely tempered steel or glass (the latter perhaps the most elastic material known) the chemical condition of unstable equilibrium — these and like examples of reactionary tendencies, which have abundant correspondencies in the moral order of forces, but slightly adumbrate the organic potentialities of reaction that lie open to the touch of the homoeopathic infinitesimal.
l^^^rr^ CAUSTICUM. 667
And now, with all those complex natural correepon* dencies in view, reaching from primitive matter to self- conscious mind with irresistible significance, it would seem that we must either accept their plain teaching, or in this matter altogether renounce the functions of our intelligence.
CAUSTICUM.*
By A. C. COWPERTHWAITE, M.D.
Professor of Materia Medioa in the Chicago Homceopathio Medical College.
Causticum is one of the neglected remedies of our materia medica. It is a remedy possessing great power and value and yet one which is seldom called into use by the average physician.
This peculiar substance is a product of the distillation of equal parts of freshly slacked lime, sulphate of potash and water. Its mechanical nature is uncertain, but, even if its exact constituents are unknown it is essentially a potash preparation, possessing many distinctive qualities of the potash salts which it resembles more closely than any other class of drugs.
It acts especially upon the motor nervous system, giving rise to paralytic conditions, more particularly of the face, larnyx and bladder. It also has a remarkable action on the mucous membrane, especially those of the respiratory tract. It shows its power in diseases in which there is great weakness; a genuine potash indication which we find running all through the potash salts. The causticum patient has, too, the timidity characteristic of potash ; full of painful fancies in the evening; the child is afraid when alone in the dark; apprehensive. When closing the eyes frightful images appear. The patient is constantly sorrowful with weeping. The face is a correct mirror of his condition. It is sallow, sickly looking and expressive of his melancholy. Memory is weak, he is giddy with a .sensation of weakness in the head. The sight is dim as irom a fog over the field of vision. But more important
* Reprinted from the Medical Era,
668 CAUSTICUM. ^Swi^fNSHw^
than all these symptoms is the paralysis of single nerres, as of the face, the tongue, lips, the eyelids, one arm or one leg or the laryngeal muscles, the bladder, etc.
In the paralysis of the face, the patient trembles when he rises from his seat ; the parts feel numb, death-like and cold. This trembling belongs to all the paralyses of causticum, but is not characteristic solely of this drug, for we find it in baryta, phosphorus, mercurius, zincum, plumbum, and other drugs of the kind.
Causticum has cured stammering caused by imperfect control of the tongue. The paralysis of causticum may accompany deep-seated diseases of the brain or spine or may be excited by rheumatism or exposure to cold. It may also arise from checked eruptions. The paresis of causticum is further indicated in children who are scrofulous and totter and fall while walking. I have had what I consider a remarkable experience in the treatment of facial paralysis with this drug.
Some years ago I published the reports of a large number of cases of facial paralysis with the use of causticum 80. I recall to mind now a number of cases of facial paralysis brought on by exposure to cold winds where the genuine paralysis was present and had remained for several days, cured within a very few hours with the aid of causticum. This drug is also a favourite remedy in the treatment of laryngeal and chest diseases, and most efficient in the treatment of aphonia, whether catarrhal or not, but associated with great weakness of the laryngeal muscles which sometimes refuse their service and the patient is required to use the gi'eatest effort to articulate a word.
Causticum is my favourite remedy for aphonia except when it is purely catarrhal hoarseness, which is sometimes confounded with aphonia, but where phosphorus and other remedies are of greater value.
It is also a useful remedy for cough, especially where there is an inability to expectorate and loosen the phlegm ; apparently they cannot cough deep enough to get relief, this being due to a paralytic condition. In addition to the cough, however, if causticum is indicated we usually have present great rawness under the sternum, with burning and soreness, which, to my mind, is very characteristic of this drug. Of course we get rawness
^^'^rfX"" CAUSTICUM. 669
Beview, Nov. 1, 18B8.
under the sternum in several drugs, and unless the different indications were for eausticum, it is possible that rumex, nux, or some other remedy might be of greater value.
Like many other remedies eausticum has a roaring and buzzing in the ears, which is a purely nervous symptom of this drug. A patient who had this symptom in conjunction with earache found instant relief from the drug. We are too prone now-a-days to resort to local treatment for conditions of this kind, whereas, if we would only study our patient and our drug, we could very likely remove many of these symptoms for which we now send our patients to a specialist. This symptom of roaring and buzzing in the ears may be a concomitant of rheumatism or catarrh of the ear and throat, and may also be indicated in the excitement of Meniere's disease.
In atrophy of the bladder eausticum is often of excellent service, especially when the urine is retained from cold after labour, and also when urination has been so long postponed that the fundus of the bladder refuses to contract. In involuntary urination this drug is very beneficial to children who are so troubled at night, and also to those who are usually worse during <iold weather. It is my favourite remedy for nocturnal enuresis, except where Pulsatilla is well indicated.
Another condition I would speak of especially, and that is where the patient has a spurting of urine every time he coughs. I have had a great many cases of this troublesome complaint and so far as I can now remember I have never had eausticum fail me. I call to mind now A case that came to me about a year ago where a lady had been suffering with a chronic bronchitis for years, her greatest annoyance being that every time she coughed her urine would spurt, and it kept her constantly wet. Causticum not only cured that condition, but absolutely cured the whole case and the woman still remains perfectly well. The same condition often occurs when the patient sneezes, blows the nose or anything of that kind.
Another example of the debility of causticum appears in the nursing woman, in whom every exertion or loss of sleep endangers her supply of milk. This depresses her, making her very melancholy.
670 cAusTicuM. ^g^^i^w^j^^nas:
There is another nervous phenomenon of this drug which I do not consider or say much about, but which must not be overlooked, and that is its use in con- vulsions. Usually the patient begins with what might be termed chronic symptoms, being uneasy at night, anxious, restless, must sit up, throws the head about and finally, exhausted, falls asleep. The legs and arms are in constant motion during sleep. During the day the patient may have epileptiform spasms, complains of anxiety about the heart, making him restless. During the spasms he drenches himself with urine. I think this is the most important indication in spasm. The convulsive movements are usually more on the right side. Gausticum is also used in spasmodic symptoms of the abdominal region. It causes cutting, quick and cramping pains which cause the patient to bend double like colocynth, which remedy it follows, well comple- menting that drug, and establishing the cure after colocynth has only given relief.
In menstrual colic there are also darting pains in the back, and the menstrual flow is h'able to cease entirely at night and continue during the day after the usuaJ time.
I ought to mention in connection with the paralysis of this drug that which affects the deltoid where the patient cannot raise his hand to his head. It is my experience that this symptom is secondary to rheumatism, and so it is also very likely that many of the local paralytic symptoms of causticum are due in the first place to rheumatism. Sometimes the drug is useful in rheumatism where there is no paralysis, the joints being rigid, the tendons shortened and sometimes the joints ill-shaped, as in arthritis deformans.
The pains affect particularly the articulation of the jaw, and are worse from cold and better from warmth.
My experience with causticum is that it is a remedy that acts well in both the higher and lower potencies. The best results I have obtained with the 80, and yet I might perhaps have had equally as satisfactory results from the 3x, as this has proved of great service to me many times in the conditions which I have enumerated.
SS^^KoTrS^ DR. BALFOUR ON HOMCBOPATHY. 671
Qeviev, Nov. 1, 1896.
DR. GEOEGE W. BALFOUR ON HOMCEOPATHY, By George Black, M.B. Edin,
*' We must be careful nerer to suboidinate to any Yague ideas of what may possibly be oarative of disease that wbioh is after all tbe paramount object of our art — the relief of suffering.*' — Br. George W. Balfour, B.M J., July 80th, 1898.
"The first and sole duty of the physician is to restore health to the sick. This is the true art of healing." — ^Hahnemann, Organnn of Medicine^ § 1.
In his address delivered at tbe opening of the section of medicine at the annual meeting of the British Medical Association, Dr. George W. Balfour made some interesting statements in regard to homceopathy, un- folded a chapter of his life not generally known, and enunciated a principle in medicine for the guidance of his fellow practitioners.
The statements made in regard to homoeopathy show Dr. Balfour to be perfectly familiar with the subject upon which he speaks, which is more a great deal than can be said of the majority of old-school practitioners who have either written or spoken about it.
Here is no travesty of homoeopathy, but a plain, straightforward, unvarnished statement of what it is. The writer's knowledge of his subject is, however, used in an effort to bring the system with which he deals into contempt. If this were done by argument it would be easy enough to show its fallaciousness, but another method is adopted better suited perhaps to the agnostic attitude of the great majority of his audience. The preparation of homoeopathic remedies is so presented as to appear a reductio ad abiurdum; the differences existing amongst professed homoeopaths with regard to the dose is made to accentuate this position. The whole thing is finally made to appear ridiculous by comparing the old and new treatment of such a disease as pneumonia ; the result of which comparison is that, according to Dr. Balfour, there was little or nothing to choose between Professor Fleischmann's at the Gumpendorf Hospital, at Vienna, by means of small doses of phosphorus, Skoda's by means of hay tea and Dietl's with aqua colorata.
There is little doubt that the audience he addressed was in no way able to form an independent judgment on the statements that were made, inasmuch as most of those
672 DR. BALFOUR ON HOMCEOPATHY. ^Sriiw^No^i^
Benev, Nov. 1, 18B6.
who heard him knew little or nothing of the subject of which he spoke.
If trath were that after which the allopath seeks homoeopathy would not be as a sealed book to so many, and the blundering, distorted views of the subject, which are from time to time presented in their journals, would meet with the contempt they deserve.
In colleges and training schools of theology on the library shelves the student will find books dealing with all forms of belief or with no belief at all ; the desire being that the man shall be thoroughly instructed in all matters pertaining to the subject he has on hand, and shall have ample opportunity of examining its pros and eons, and so be able to form an independent judgment regarding it.
If a spirit at all approaching this obtained in the medical profession, the editors and conductors of journals would open their pages to every phase of thought and every variety of treatment that offered our poor suffering humanity an increased chance of recovery, but instead of this no writer who is familiar with homoeopathy is allowed space to ventilate the subject or present it in its true light, and, strange as it may appear, the greater the qualification of the writer for his task the less chance has he of being permitted to -express himself.
If the public generally were aware of the unfairness, the undignified and ungentlemanly conduct of those who know better, and those who ought to know better, it would open their eyes to a state of things they little dream of, and if the ordinary practitioner knew the pains that are taken to keep him ignorant and to present him with incredible stories of homoeopathy and homoeopathic practitioners, his sense of right and wrong — of fairness and common justice — would be so shocked that he would demand that this sort of thing should cease.
It matters not how much uncojiscious homoeopathy enters into one's practice ; so long as the man does not know what he is doing all is well, and it matters not how much conscious homoeopathy there is provided it is called by some other name.
One of the writers belonging to the second class of whom I am speaking may tell you at the top of a page
SSSSSr^STiS?** I>R- BALFOUR ON HOMCEOPATHT. 678
that '' ipecacuanha is a mild, tardy, bat certain emetic," that '* it produces repeated vomiting anaccompanied by much nausea or prostration," and at the bottom that ** few remedies are so efficacious in checking some kinds of vomiting.'* But then if you only do not acknowledge that this is homoBopathy it is all right. So with aconite, " whose virtues," the author wrote in 1871, " are only beginning to be appreciated," and speaks of it as *' to be the most esteemed for its power, little less than marvellous, of controlling inflammation and subduing the accompanying fever." Unfortunately for him, 41 years before he penned these words Samuel Hahnemann had written, ''I would speak of fevers, called purely inflammatory, in which the smallest dose of aconite, without recourse to any of the remedies acting in an antipathic manner, causes a prompt removal of the inflammatory action, and leaves no consecutive effects behind." In like manner we find our author, when speaking of belladonna, say that *' a full dose, in any of its forms, produces great dryness of the tongue and roof of the mouth, extending down the pharynx and larynx, inducing consequently some difficulty in swallowing, with hoarseness and even dry cough ; " and a little further on we read that belladonna is employed in several inflammatory diseases of the throat ; its good effects are most apparent when the throat and tonsils are acutely inflamed and much swollen." In 1881 Hahnemann wrote, " How often do not the more acute ^ases of quinsy, especially where there is external swelling of the neck, become fatal in the hands of those practitioners through repeated venesection, leeches, blisters, gargles, poultices, refrigerants, diaphoretics, purgatives and various other modes of torturing the organism, whereas health might have been restored in a few hours by means of one single dose of belladonna ! " So also with regard to mercury 'Uhe soluble prepar- ations act as purgatives, increasing the secretion from the mucous lining and the contractions of the muscular coat of the intestines," and on the opposite page *^ there is a form of diarrhoea common in children which is admirably treated by small doses of bichloride of mercury." But I need not trouble my readers with further quotations from the same source. That this is homoeopathy pure and simple anyone who knows any-
Vol. 42, No. 11. 2 X
^74 PR. BALFOUB ON HOMffiOPATHY. 'ttif^^JTTtSS
thing of the matter is perfectly aware ; the strange thing is that it should have been accepted without protest in quarters where it was, but then the name that is such a terrible bugbear to the allopathic mind was not used and- so the conscience of so-called orthodox medicine was appeased. But what a conscience this is !
Surely this sort of thing must speedily end. There is a length beyond which it cannot go : the game will be up, the farce played out. Either the eyes of the profession will be suddenly opened to what has been going on in its name during all thos§ long years, or the voice of public opinion, always so much in advance of that of vested interests, will make itself heard so unmistakably, that to gainsay it will be impossible.
We learn from Dr. Balfour's statements that he had been impressed by Professor Henderson's conversion ta homoeopathy and speaking of him as '' one of our ablest professors " says he proceeded to Vienna to study the system.
At that time Professor Fleischmann was ons of the physicians at the Gumpendorf Hospital, and " fresh from a school where it was taught " (writes Dr. Balfour) that '^ in the case of inflammation no one would think of trusting the safety of the patient to any other remedy than bloodletting, it was a sufficiently startling experi- ence to observe cases of true sthenic pneumonia not only entrusted to these infinitesimals, but making excellent recoveries under their use."
** Naturally," he says, " the first and most obvious- idea was that there really must be some occult virtue developed by the various triturations and succussions, and some truth in the homoeopathic aphorism simUia similibus curantur.'* Then follows the part of this- address intended to hold homoeopathy up to ridicule. ** Fortunately the excellent results obtained by Skoda, with his .hay tea sufficed to dispel these clouds of mysticism, while the success of Dietl in the same class of cases in another hospital with simple aqua colorata showed that there was nothing specific even in hay tea, and but confirmed the unmistakable conclusion that, as Skoda put it, pneumonia tended not to dissolution but to resolution, and that the large blood-lettings thought necessary for its treatment were, to say the leasts uncalled for."
SSS^fNoT^iTiS^"* I>R- BALFOUR ON HOMCEOPATHY. . 675
There appears to have been no doubt in Dr. Balfour'd mind as to the cases treated by Fleischmann being cases of genuine pneumonia. Referring to the paper he read on his return before the Medico-Ghirurgical Society of Edinburgh, he says, '' I pointed out that the Vienna cases were certainly not less sthenic than those in Edinburgh ; that they had the disadvantage of being daily unceremoniously auscultated, percussed and lectured over which was not the custom in our infirmary in those days, and that they had not the advantage " (sic) *' of being freely bled, yet their mortality was only 13.7 per cent.
** Inthereportsof our infirmary during the five years and three months from July Ist, 1839, to September 30th, 1844, there are recorded 253. cases of pneumonia who escaped the lecturing and had the advantage " (aic) '^ of having been freely bled, and of these 91 died, a mortality of 1 in 2.78 or 85.9 per cent., showing a proportion of recoveries of nearly 3 to 1 or over 20 per cent, in favour of those who were not bled, to say nothing of the time gained by their more rapid recovery or of the less exhausted con- dition in which the patients were left, whereby they were sooner fit to return to the duties of active life."
It appears that Dr. Balfour was prepared to give the eclectic system, as he calls it, of treating pneumonia a more extended trial. He urged the importance of doing this upon his audience, but his words fell on deaf ears.
The attitude of the profession in those days towards anything outside the beaten track, no matter how bene- ficial it might have proved in the treatment of disease, is well exemplified by the statement of Dr. John Gairdner. ** Nothing was better established than the good effect of blood-letting in Edinburgh." (This notwithstanding tlie mortality statistics with which he had just been furnished) " whatever might be the case in Vienna . . . . . Of the benefits of early blood-letting he enter- tained no doubt whatever ; they were positive, immediate,, unequivocal, and admitted by almost every physician> whose experience and judgment entitle him to considera- tion ; and if Dr. Balfour or anyone else could shake his conviction in the truth of this opinion, he would also succeed in producing in his mind a general distrust of medical evidence in all cases of every description since
2 x-2
676 DR. BALFOUR ON HOMOEOPATHY. "SJrtlwfNSHJwS!
in no case whatever can we have evidence which is stronger or more satisfactory/*
There is nothing like doing a thing well while you are at it, and one cannot help admiring the courage of the man who felt himself able to maike such a remarkable pronouncement. To express oneself thus must be to have the assurance of a lesser deity. How strange it must all have seemed to this individual, if he continued long enough in the flesh, to behold the gradual change in opinion wrought by homoeopathy which resulted in the complete abandonment of a practice by which he laid so much store.
I had taken it for granted that this salutary change was due to homoeopathy and had resulted from the labours of Hahnemann and his coadjutors, but the other •day I came upon an explanation which was entirely new to me and will be interesting, I daresay, to some of my readers. In his Plea for a Simpler lAfe, Dr. George Keith says : " The change from a severe system of treating disease by depletion in all its modes came in with a great social change, especially as regards the upbringing of the young. In my young days this was rather trying. Home discipline, as well as that in the -schools, was harsh, even with the upper classes. The boy must do as he was bid without delay and without protest or it was the worse for him. Pleasure for its own sake was at a discount. In Scotland, at least, the extreme doctrines of Calvin held sway, and a severe sway it was. Beaction came at last, and along with other changes came that of the treatment of disease, first by modifying the old methods and very soon by adopting others at the opposite pole." One is left in doubt as to whether it was reaction from the doctrines of Calvin that did away with blood-letting or that the abandonment of this practice and the revolt from the other were but the outward expression of a change that had taken place in the heart and mind of the people. He says, *' the change fell in with the spirit of the times," and he fears goes with it still.
Dr. Balfour was a young man when he read the paper to which he refers, and one can easily understand how the snub administered to him in the words "every physician whose experience and judgment entitle him to
SSSS^NrrrS*** DB. BALFOUR ON HOMCEOPATHY. 677
fieriew. Nov. 1, 1886.
cotmderation " shoald have acted as a deterrent in farther pursuing the subject.
Lonely is the pathway of the searcher after truths stout and strong must be the heart that follows where she leads.
He urged upon the Society the importance of giving the eclectic system of treating pneumonia a fair triaU but the Society would none of it, and from his previous utterances one concludes that the odium medicum v^eiS too strong for him to give the matter a fair trial and that lie, too, presently let it drop.
There is one part of this paper which is of the utmost importance because of the morality involved in it. The wonder is that no one present called in question the statements that were made. The paper was written by a man familiar with homoeopathy, and was evidently intended to cast ridicule upon it. He goes to Vienna that he may study it on the spot and see the system at work under the eye of a master. While following Fleischmann a glamour seems over him, which, how- ever, is speedily dispelled by the excellent results of the hay tea treatment and that of Dietl, but the curious thing is that when he compares statistically the results of treatment, although he had expressly gone to study homoeopathy, and the paper was written with a view to its condemnation, not the slightest mention is made of the results of the man whose work he went to study. Instead of dealing with Fleischmann's statistics, of whose existence he was perfectly aware, he maies a comparison between Skoda's and those treated in the Edinburgh Boyal Infirmary.
The amazing thing is how such a glaring discrepancy was allowed to pass at such a meeting without either enquii-y or protest. He must certainly have presumed much upon the credulity and ignorance of his audience to take so bold and glaring a course of inconsistency and unfairness.
Fortunately, for the sake of justice, the means are not wanting to show this in its true light.
In his book entitled, An Inquiry into the Homoeopathic Practice of Medicine, published in 1845, Professor Henderson says: "Dr. Fleischmann, of the Homoe- pathic Hospital of Vienna (maintained by the Austrian Government), has lately given to the public a statistical
678 ;DR. BALFOUR ON HOMCEOPATHY. *'S'iSiwfN^TJ»&
report of the diseases treated in that institution since its foundation in 1832, and among them we find no less than 800 cases of acute pneumonia, 105 of peritonitis, 224 of pleurisy, 29 of endocarditis and pericarditis.*' Here is one of the tables : —
Mortality in Cases ojf Pneumonia treated AUopathically. Authorities. No. of Cases. Deaths.
Grisolle 804 ... 43
Briquet 864 ... 85
Edinburgh Infirmary 222 ... 80
Skoda 19 ... 4
Total ... 909 212
Mortality 23.82 per cent., or nearly one out of every four.
Mortality in Cases of Pneumonia treated Homa'opathicaUy, Authority. No. of Cases. Deaths.
Fleischmann ... 299 ... 19
6.70 per cent., or about one death out of fifteen cases.
These figures, and those respecting the other diseases mentioned, speak with an eloquence greater than words, and, however ignorant his audience may have been of such facts, one cannot help feeling that they were known to the writer, and that for purposes of his own they were suppressed.
In the Monthly Homoeopathic Review for September, 1870, there is an interesting account of a discussion which took place at two meetings of the " Dialectical Society " in connection with an address delivered by Dr. Wylde on Homaopathy : Its Reception by the Public and by the Profession.
The following statistics were presented to the meeting, taken from an allopathic work by Dr. Bouth, and admitted to be accurate by Dr. Dietl, of Vienna, and Dr. Bennett, of Edinburgh : —
Homoeopathic AUopathic
Treatment. Treatment.
Percentage of Deaths. Pneumonia ... 5.7 ... 24
Pleuritis . Peritonitis . Dysentery ., Typhus AH diseases
3 4 3 15 4.4
13 13 22 19 8.5
^^MoTnSS^" I>R- BALFOUR ON HOMCEOPATHY. 679
One of the speakers, who, nevertheless, would not ill any way admit the claims of homoeopathy, declared that "he perfectly admitted that the old system of* Medicine was in many respects faulty, and he had known in his early practice many children dying of too much physic ; while for himself he thought he might in hid early days have killed one hundred by over drugging."
Supposing Dr. Edmunds to have been speaking seriously, and there is nothing in his statement to make us suppose that he is not, he is certainly to be congratulated on his courage in making this remarkable admission. But how wondrously pig-headed a man must be to make a statement of this kind, to be shown that such a thing is impossible by another system, and yet to declare that he cannot in any way admit its claims.
It resembles the attitude of Dr. Balfour, who with the ghastly statistics of pneumonia treated by blood-letting staring him in the face, yet talks of the cases that had the advantage of it ! One wonders if to some, language has lost its meaning, and the intellect become so warped that truth fails to find an entrance.
It was admitted long ago by Sir John Forbes that '* Hahnemann was a genius and a scholar, and destined to aflfect the practice of medicine to a greater extent than any man since the days of Galen."
Anybody who knows anything of the matter is aware that this is perfectly true — that by the consummate ability, the energy, labour and genius of this man the practice of medicine has been so affected that hundreds of thousands of lives that otherwise would have been sacrified have been spared, and that to-day all over the habitable globe men are benefiting by his labours, although, as yet, no acknowledgment has been vouch- safed from many of those who have profited so largely by what he has done.
When shall this acknowledgment come, and how ? Of the ** when " all we can say, is that it is not yet. To attempt anything more would be to enter the realm of prophecy, and here we should probably fare no better than Dr. Balfour himself.
"How "it is to be accomplished maybe matter of -conjecture. In his essay on " Dr. Marshall and Military. Hygiene " the author of " Eab and his Friends," one of the greatest ornaments of our profession and masters of
680 BB. BALFOUR ON HOM<EOPATHY. *%^^*?1^
Baview, Nov. 1, IflML
our language ; speaking of the remarkable improvement that had taken place in the army, sa^lB, it, is to be attributed under God *' to that mighty agent, which is in our day doing such wonders, and which wUl yet do more and greater — the Spirit of the Age — Public Opinion" — which, in passages of great eloquence he describes as ** the very breath of the power of God,"^ '' viewless, impalpable, inevitable, untamable as the wind ; vital, elastic, all-penetrating, all encompassing as the air we breathe," which " cannot be letted " which has '' gladdened and cheered all who believe that truth is strong, next to the Almighty," that '' it is a tide that has never turned," that ''answers the behest of no waning and waxing orb," that *' has its flux and reflux, its ebb and flow, its darkness and bright light, its storm and calm," but which ultimately will move on and up, overcoming every obstacle that tries to act as a barrier to its progress.
Spesd^ing of the same power, Maurice says: ''It is vague, indefinite, intangible enough no doubt ; but is not that the case with all the powers which afifect us most in the physical world ? The more men advance in the study of nature the more these uncontrollable, invincible forces make themselves known."
That this impalpable power has been at work in the progress of homoeopathy no one who has made himself ^miliar with the march of events during the last century can for a moment doubt.
Since the time that Hahnemann gathered together the loose threads of homoeopathic practice scattered throughout the Uterature of our profession from Hippo- crates downwards, and wove them with the golden thread of genius into that rule similia similibus curentur^ which has become the guiding principle of thousands of medical men all over the world, from that time till now, the profession at large has been moulded and influenced by public opinion and permeated by the principles of that school until it is difficult to know in the ordinary practice of to-day where allopathy ends and homoeopathy begins.
It is perhaps too much to expect that vested interests would lead the way, but little by little that impalpable influence— public opinion — has made itself felt, and every attempt to crush homoeopathy or prevent its
^S^Jlo^rS^^'' ^»- BALFOUR ON HOM<EOPATHY. 681
development has inyariably been followed — ^as all such' attempts in every sphere of life are — ^by fresh activity and increased growth.
Many seem to forget that homoeopathic practitioners^ do not exist in order to please themselves, they exist because there is a demand for their services ; and so long as people desire thus to be treated every law of liberty demands that no one shall interfere with the exercise of a just right.
It is nothing short of impertinence when multitudes- of people desire a particular method of treatment for others to say '' you shall not have it, because it differs- from what I consider right."
'< This is true liberty, when free bom men Having to advise the public may speak free."
This also is true liberty when a man may without let or hindrance practise what he preaches, provided in the doing of it no one suffers hurt.
That this liberty was denied to Hahnemann anyone acquainted with his life is perfectly aware.
In the year 1796 he published his Essay and New Principle for ascertaining the Curative Powers of Drugs^ with a few glances at those hitherto employed.
In 1801 he wrote his View of Professional Liberality at the commencement of the Nineteenth Century^ and no- doubt the words which follow are the expression of what took place with regard to himself.
" No sooner has a colleague made a suggestion that must be for the general good, put forward a perhaps useful propo- sition, discovered something profitable, than instantly the professional jealousy of his colleagues falls foul of him in order to bury in oblivion, or if possible to destroy the novelty by spoken or written depreciation, insinuation, sophistries or even injurious aspersions, and all because it did not originate with themselves.
'* How much this egotistical professional jealousy prevents the shooting forth and vigorous growth of our divine healing art, which is still in the condition of an undeveloped bud, must be evident to every non-professional person.'*
'^ Without friendliness and good-fellowsbip among its pro- fessors it will remain but a bungling art for another century.*'
'< Just as theological polemics have never produced a desire^ for truth, a perception of the high object of our existence or genuine virtue and devotional feeling — just as the personal
682 DR. BALFOUR ON HOMOEOPATHY. ^^viil^vS^'l^
Heview^ Nov, 1, IflBB.
squabbles of literary men have never succeeded in develop- ing the love of art, the true aesthetic feeling, enlightened taste and artistic skill — in like manner it needs no great sagacity to understand that the mutual detractions of medical men can have no other result but the depreciation and obscu- ration of their art which is without that the most obscure of all arts.
''As soon as I stepped forth among my colleagues, not "without nearly twenty years of preparation, not without many long years of Pythagorean silence, to contribute here and 1;here something to the improvement of our art, I found that I had lost my accustomed peace and quietness, and had fallen among a crowd of professional brethren who (with few excep* tions) regard nothing impartially : I was maligned. And how easy it is to persecute, to malign an art which has hitherto been founded on ever changing maxims, in which by the force of authorities, learned, empty terminology, sophistry, scho- lastic, stereotyped dogmas and imaginary experience, black was made to appear white, just as anyone pleased, especially where the judgment was perverted by depravity of heart, egotism and illiberality.
'' It is undoubtedly true that truth penetrates even through the thickest clouds of prejudice, but the often too tedious conflict of the opposing elements conveys a disagreeable, a discouraging impression to the mind.'*
Although nearly a hundred years have passed since these words were uttered, how true they remain to this day!
How many during the century that has elapsed have had to complain with Hahnemann that as soon as they stepped aside from the beaten track they found their peace and quietness disturbed !
Why should such a thing be possible in a profession like ours ? There can be no true liberty amongst any body of men where the members are not permitted to bring forward for discussion any subject bearing directly upon it. Nor is there anything but bigotry displayed when a method of treatment, whose published results entitle it to the most earnest and patient investigation, is either shelved or ridiculed each time it happens to be mentioned.
There are probably many who are prepared to deny these statements, and who will tell you they are ready to enquire into anything that has for its object the relief of suffering and the healing of disease.
bS^^^^o^Ta!^'' I>R. BALFOUR ON HOMCEOPATHY. '683
fienew, Kot. 1, lbP8.
I only wish I could believe that such were the case ; that there was in our profession any number of men belonging to the allopathic branch of it willing to give to a homoeopath the same patient hearing they yiould to another, or that the homoeopathic section would accord to them.
When this time comes homoeopaths will have gained what they have long been asking for, and a new era will have dawned upon us, but the time is not yet; and whatever may be said to the contrary, truth is not what the majority of the medical profession desire, and the position of the homoeopathic practitioner to-day in this country (with shame be it said) is little different from what it was in Germany at the time that Hahnemann -wrote.
" He who ascends to mountain tops, sliall find The loftiest peaks most wrapped in clouds and snow ; He who surpasses or subdues mankind, Must look down on the hate of those below. Though high above the sun of glory glow. And far beneath the earth and ocean spread, Round him are icy rocks, and loudly blow Contending tempests on his naked head, And thus reward the toils which to those summits led/'
So wrote Byron in Childe Harold, and his words are as true to-day as when first they were penned.
Here is an example from a well- remembered incident in my own life. Some time after I had come to this town (Torquay) it was thought desirable to resuscitate its Medical Society, and I, along with others, was invited to a preliminary meeting. The matter, being thought desirable, was agreed to, members were enrolled, and, after a time, meetings were held regularly in one of the rooms of the Torbay Hospital. The president for the year was a man for whom I have considerable respect, and with whom I am perfectly friendly. He is a frank, open, brusque sort of individual, who does not owe any •homoeopath a grudge, but simply looks upon him as a poor, deluded mortal. He will, however, meet with him 3Jid do anything in his power to help him.
On one occasion, after I had begun to practise homoeo- pathically, I received notice from the secretary of a paper to be read by this gentleman, the title of which Arretted my attention. It ran thus : Some Unexpected,
684 DR. BALFOUB ON HOM<EOPATHY. ''SSSl^CJT^
fieTiew. Nov. 1, 18BS.
Resvlts of Treatment. Thinking tbat these resalts were only '' unexpected " because of the writer's ignorance of homoBopathy, and that to anyone acquainted with tiie Materia Medica Pura or Allen*s Encychpadia the explanation would not be far to seek, I went to the meeting. My surmise was correct. Some four or half a dozen drugs were dealt with, ipecac., opium, bell, and arnica beiug of the number. Among the unexpected things related of ipecac, if my memory serves me rightly, was a severe paroxysm of asthma that had followed its employment, bell, had caused an erysipela- tous rash, opium the death of someone and arnica such dreadful distress in several instances that his hearera were advised to shun it as they would the arch-enemy of mankind himself.
Having said his say and told his stories he asked others to contribute their quota whether in support of what he had advanced or against it. When several of those present had spoken I rose, but I had scarcely uttered more than a sentence or two before an ominous silence reigned in the room and I became aware that I was speaking to a hostile assembly. By some subtUe sense you are instantly made aware that you are out of touch with your audience, and that your task of enlightenment is superfluous, inasmuch as there is no desire on the part of those present to be enlightened. It really is amazing, and if one had not witnessed the same thing many a time it would be difficult to believe that immediately anything savouring of homoeopathy (it may be only the mention of the giving of a medicine in the 8x attenuation) is allowed to fall from the speaker's lips that moment you are conscious that your words are falling upon deaf ears. I endeavoured to explain the phenomena which the president had described, and I said that so far from being afraid of arnica, I reg^urded it as a most valuable medicine, and was constantly in the habit of using it.
I told them that I did not hesitate to give it to old and young as well as middle-aged — that my parturient cases all got it, and that I had given it to my own child when he was only six months old. Now if trtUh had been that which was sought after, my statement would have called forth a desire for fuller information, but instead of this, some time after I received a letter from the
i52J?'^r?^"'' DR. BALFOUB ON HOMCEOPATHY. 686
Bvpiow, Nov. 1. 1806.
secretary, saying that at a meeting of the society held on such and such a day — of which meeting I received no notice — it was agreed that no homoeopath should be a member of that society. The deplorable thing to me is that honourable men see nothing incongnions in such conduct, and are found lending themselves to it. May the day not be far distant when this sort of thing shall be impossible, and ** when man to man the warl o'er shall brithers be and a' that."
A MiSSTATBMENT.
It is surely absurd of Dr. Balfour to say that " Remedies were selected not for any healing virtues they were stipposed to possess, but because of the power they were believed to have of exciting a disease similar to that they were supposed to cure." Is the healing virtue of a medicine lost because you administer it according to the dictum that likes are best treated by likes? Surely not. When the therapeutic lamp burned low in the old school and the wiser and more observant among its professors ceased to believe in the remedial power of the drugs they were, nevertheless, in the habit of employing, who was it that kept the light burning ? Who was it that never doubted the healing virtues of drugs ? Who but the followers of Hahnemann, whose reward has been to see their remedies of ten, twenty, forty, fifty, nay, of a hundred years ago brought into ''general" use, heralded by a blare of trumpets from some one of the arch-cribbers that have from time to time adorned the annals of ** orthodox " medicine, but without a word of acknowledgment as to the source whence their infor- mation has come.
CONCEBNING DILUTION AND ATTENUATION.
A presentment of the methods adopted in the preparation of homoeopathic remedies is given by Dr. Balfour in his paper in such a way as to make it evident that he is familiar enough with the work of this school, although the whole thing reads as if it were intended to excite the ridicule of his hearers and give them a laugh at the expense of homoeopathy.
Perhaps when Dr. Balfour has thought more deeply, and enlarged the sphere of his vision by examining some of the wonders of nature by which he is surrounded, he will attain to a spirit of greater reverence, and the
686 DR. BALFOUR ON HOMCEOPATHY. ^ttertiwfNSrfifiWBT
hilarity he would excite in others will fade out of his own heart.
When I was a student the germ theory of disease was laying hold of the minds of the more thoughtful in the profession, and the greatest surgeon it was ever my lot. to know was at work in season and out of season, spending many hours of every week in the wards of the old Edinburgh Infirmary, inculcating this doctrine and demonstrating the value of antiseptics in warding oflf the ill effects of operative interference.
At the same time and in the same infirmary another able surgeon was at work, whose power as a diagnostic elicited the admiration of all who came in contact with him, but who exhibited the same incredulity towards the germ theory of disease that Dr. Balfour does towards the attenuations of homoeopathy, and I remember as if it were but yesterday, his holding up a piece of macintosh to the light, displaying a multitude of minute interstices,, and with a twinkle in his eye, ask the present occupant of the chair of clinical surgery if he thought they (the germs) could get through these.
It has often seemed strange to me that considering, all that is happening round about us every day, men with any pretension to scientific attainments should make such a fuss about the infinitesimals of homoeopathy.
Which of them, I wonder, can say whether it is a 80th atmospheric attenuation or a one-thousandth that a child who has not had measles absorbs when one who has it contaminates the air of a schoolroom ? and if one form of matter in a high state of attenuation ia capable of producing a specific disease, what should hinder that another form of matter in a similar state of tenuity should be the means of its cure ?
After all it is not the number of molecules or the largeness of an atom that constitutes its power for good or evil, but the inherent virtue that is latent in it.
The latest utterance of science is to this effect : " In life I see the promise and potency of all forms of matter."
What Sir William Crookes has declared is becoming more apparent every day to those who believe that matter is but the medium by which the spiritual essence, of whatever sort it is, manifests its power.
Sri^rNoTrSw?*'' I>R- BALFOUR ON HOMGEOPATHY. 687
- Not the quantity of a thing matters, but the quality — that inherent something which gives it its distinctive characteristics.
Who will say how much of the poison of small-pox or scarlet fever is necessary to start an epidemic ? Is the strength of it equal to a mother tincture or does it only represent the decillionth of a grain of the original poison ?
How much of a flower is given off in its perfume ?
How much of a fox is left behind in the ether that dogs can scent it over a wide expanse of country ?
A friend once told me that he had a female butterfly of a particular species that was only found amongst the heather some two miles from his house and that one Sunday morning as he was going to church he put this butterfly in a cage on the sill of the window and found on his return that there were several males of the same sx>ecies hovering about outside.
Who can estimate the importance of atmospheric changes in the production of disease ? ' Far more marvellous to me than the fact that drugs, no matter to what extent they are potentised, should yet remain powerful remedies in the treatment of disease is this, that from the union of a sperm and a germ cell there should be evolved a being of whom our great dramatist said : —
« What a piece of work is man ! How noble in reason ! How infinite in faculty ! In form and moving how express and admirable ! In action how like an angel ! In apprehen- sion how like a god."
To think that from such a union, of whose possibilities the finest powers of the microscope can furnish us with no clue, concerning whose very nature we are left in doubt, there should be evolved a Shakespeare, a Milton, a B}a*on or a Gladstone, with all the commanding and varied powers of intellect that these names suggest — to- me this is infinitely more wonderful than that an infinitesimal, used homoeopathically, should be capable of arresting the progress of disease.
When men think less about material quantity and more about the quality — the original imparted living principle which, as some one has said, is '* the essential mould, idea or type from and by which the material expression is developed," little wonder will be expressed at the curative action of the decillionth part of a grain
"688 DR. BALPOUR ON HOMCEOPATHY. ^^SSSSt^nSTmSS!
of the original drug, or for thai matter of any attenua- tion that can be made.
When it is realised that man is an embodied spirit ; ^hen it is understood that God has given to each plant its own peculiar virtue ; when it is sufficiently impressed upon us that all the mighiy forces at work to-day are of . an intangible kind and silent in operation — ^that of one of them that has been compelled into man's service and imade the means of binding together the whole civilised world, annihilating space and time, the very nature is unknown — when these things are understood, then the way will be made clear for understanding the action of infinitesimals in the treatment of disease.
Nay, one might even go farther and say that it will then be looked upon as absurd to attempt to treat forces that are intangible by remedies in the gross.
When the nature and structure of the human body : are considered ; when the smallness of the cells in which all the ultimate processes of life and development take place — instead of regarding it as absurd to employ remedies that have been rendered subtle by the means already specified, wonder will be expressed that a cure was expected in any other way.
All the more recent ** triumphs " of the old school have been along the lines of homoeopathy or isopathy* so that to-day we have the employment of preparations -^of the organs and tissues of the body for diseases affecting those structures, and of disease products in the treatment of disease, as well as of drugs known to have produced conditions similar to those for which they are administered, and my own impression is that all the mischief that has arisen in the second class to which I have referred has been due to the largeness of the dose given by men unaccustomed to the action of the homoeopathic law.
There is but one matter more calling for attention in connection with this paper, and that is the statement with which it closes, viz., that '' The Paramount object of our Art is the Belief of Suffering."
This statement of Dr. Balfour embodies the essence of allopathic treatment. It is the relief of suffering — no matter at what cost — that is to be thought of. How •different is this from the simple grandeur of Hahnemann ! " The first and sole duty of the physician is to restore
B^fNo'^MS^*' ^^' BALFOUR ON HOMCEOPATHY. 689
health to the sick." No word there that savours of tinkering. The sentence is the clear utterance of a master mind in regard to the true art of healing.
How different is the conception of the physician's duty by these two men ! — ^how small and insignificant the one — how grand and noble the other.
A child is crying : it is in pain, it may be from teething or some other cause. The paramount object of our art is the relief of suffering; the mother has heard that laudanum or somebody's soothing syrup will do this ; she gives it and her infant dies.
The professional packman will try to be careful not to give a poisonous dose while he is putting into practice the paramount object of his art, viz., " the relief of suffering," but he may have to acknowledge when he is. older, that perhaps the death of a hundred innocents lies at his door by reason of over-drugging.
A foolish mother in feeding her child gives it tho breast or the bottle whenever it cries, she has heard that the paramount object of the healing art is '* the relief of suffering." She thinks it is suffering and, acting upon this thought, she lays the foundation of future misery.
How many are there, who, for some temporary gain, lose something infinitely more valuable.
Pain is not disease : it is but an accompaniment of it — one of Nature's many voices speaking to those who have ears to hear — to stifle it is but poor workmanship whether the hand that does it is professional or other- wise ; far better a thousand times, in all curable diseases, to let the pain continue till the cause producing it is removed.
For anyone professing to be a teacher of his fellows to give utterance to such a doctrine is pitiful enough-^ for a whole roomful of men to swallow it is more pitiful still.
But this pronouncement is, I have no doubt, a faithful reflection of the ideas entertained by that section of the profession to which Dr. Balfour belongs, and until a truer conception of the work to which they have been <saUed obtains, and a better formula is enunciated, so long will their treatment remain the hitty-missy thing it has always been, even in those palmy days when men ^* had the advantage of having been freely bled." Vol. 42, No. 11. 2 Y
680 UTERINE PESSARY. ^SS^f^SJllJ^w!
ON A NEW FORM OF UTERINE PESSARY, EQUALLY SERVICEABLE FOR RETRO- FLEXION, PROLAPSUS, AND CYSTOCELE.
By George Burford, M.B.
PhyBidan for DiseaBes of Women to the London Homooopathic Hospital.
FiYE years ago I gave much time and attention to the trial of Schultze's figure-of-eight pessary for retroflexion. I had heard this device commended in the Vienna Frauen-Elinik ; I had been dissatisfied with the Hodge and its modifications in certain obstinate cases of pos- terior displacement, and in the figure-of-eight I found a mechanism essentially different in plan from that of the lever pessary. Their distinctions may be briefly recounted.
The Schvltze Figure-of-eight.
Take a circular flexible pessary, twist it once across its equator, and a shape of the figure eight results ; the loops may be made into a smaller and a larger by a little after-manipulation. Thus is formed the Schultze pes- sary; when in sitn, the cervix lies in the smaller loop, while the larger lies free in the vagina, parallel to the kolpic axis, and retained by the tone of the tissues.
The modus operandi of this pessary, as set forth by Schultze, is that it in no wise acts by stretching the posterior cul-de-sac or the lax utero-sacral ligaments ; but that, given sufficient uterine tone, inclusion of the cervix in the smaller ring confines this organ well back in the cul-de-sac, and the fundus uteri consequently remains well to the front.
The Hodge or Lever Pessary completely disregarded the cervix as a point d'appiii, and acted directly on the posterior cul-de-sac and the utero-sacral ligaments. By upward thrust and lateral expansion the posterior connections of the cervix were tightened, the cervix itself held in tension backward, and the fundus lay more or less to the front. The problem with a Hodge always was (1) to secure the maximum amount of expansion of the posterior cul-de-sac with (2) no intolerance of the mechanism on account of tension of the vaginal walls. j
The Hodge I had already found of little use in many cases of atonic retroflexion. After a prolonged trial of the
iKS^J'^VoTri^S^ UTERINE PESSARY. 691
figure-of-eight, I concluded that this also was not fitted for the effective handling of some posterior displacements^ although in many cases it gave good results.
Becognising the different principles underlying the two mechanisms, and seeing nothing in the detail of each that was mutually exclusive, I cast about for some time for a form which should incorporate the essentials of the two. After some preliminaries I devised a pattera which I have since constantly used, and with the results of which I have been well satisfied. I call this device the " segmented-ring pessary."
The ^^ Segmented'Ring Pessary,'' The twofold object this fulfils is (1) the fixation of the cervix posteriorly in one of the segments — this is the Schultze plan ; (2) the expansion of the posterior cul-de- sac and tension of the utero-sacral ligaments — this is the Hodge characteristic.
I first replace the uterus, with the patient in the Sims position; then selecting a size suitable to the vaginal dimensions, I insert the segmented ring pessary, taking care that the cervix fits well into that segment which is upper and posterior. The upper arc of the pessary expands the cul-de-sac and makes tense the utero-sacral ligaments ; the cervix is retained well upward and backward in the vagina by the crossing of the bars.
I have been well satisfied during these five years with the action of this single form of pessary in various conditions of uterine and vaginal displacem^ut.
2 Y— 2
692 KET^iEWs. "S^l=C.-?'?SJ?
Review, Nor. 1, 1886;
.' Not alone in retroversion or flexion, but also in prolapsus it finds fitting use. If there is a fair perinaeum, this pessary is of the most conspicuous service in prolapsus or procidence. Four years ago a lady from the West consulted me, in whose case I found the greater part of the uterus protruding externally. Fortunately she had a fair amount of perineal support. I restored the uterus and placed a segmented ring- pessary. The relief obtained was immediate and complete. After three years the patient called to report progress. Not a day's discomfort had she experienced during this time ; she still wore the pessary without the least inconvenience, and its retentive power was all that <;ould be wished,
. In any tendency to prolapse of the anterior vaginal imll, or in the more marked condition of cystocele, I liave found this pessary of special and peculiar service ; providing always that the perineal body is fairly good. Were I restricted to any single form of pessary for general use, this is the foim of support I would unhesi- tatingly select.
I have brought this device to the notice of certain of my colleagues in various parts of the country, and as I find its use extending, I think it desirable to give the foregoing outline of its genesis and utility.
Messrs. Mayer and Meltzer, of Great Portland Street, have made this instrument for me from the first ; it is figured and described in their catalogue, and they have my instructions as to constructive detail,
REVIEWS.
Tests and Studies of the Ocular Muscles, By Ebnkst E. Mad- Dox, M.D., F.R.C.S. Bristol : John Wright & Co., 1898.
Db. Maddox has for ma^y years made the subject of the ocular muscles a special study, and in 1869, and again in 1894, we reviewed in these pages books written by him on Ophthalmological Prisms and the Decentering of Lenses. We therefore took up with interest his latest work on the ocular muscles, and we have not been disappointed in its perusal. It contains original observations by the author, as well as a careful resumJ of the worb of others in this direction. No one €an read it without being struck with the many original and practical suggestions it contains. We must confess that oa
iSS^'^rnST' MEETINGS. 693
Beriew, Nov. 1, 189S.
the action of individaal muscles much is written that is theo^ retical and not quite easy of comprehension, and that could only be adequately discussed by one who had made as deep a study of the subject as Dr. Maddox. In the chapter on the anatomy of the globe and its socket, special attention is drawn to the check ligaments, their relation to Tenon's capsule, and their bearing on tenotomy; the latter is a practical point which has not been sufficiently noticed. In the chapter on the '* ocular motions," which concerns itself principally with the rotation of the sphere, some new terminology is used. There is a very interesting section on the conjugation of the two eyes and the important associated innervation necessary for convergence and accommodation.
The chapters on strabismus, ocular paralyses, and sup- pressed squint, the latter meaning what used to be termed muscular asthenopia, or by Dr. Stevens, heterophoria, are of most practical use, and contain nearly all that is to be said on the subject. The author's directions for the ** exclusive test '* for detecting manifest squint are very clear. For measuring squint he favours the perimeter method, or the tangent strabis- mometer of his own designing. We have used both these methods with much satisfaction. Latent squint, or hetero- phoria, is always an interesting subject, and is fully and carefully considered by Dr. Maddox ; we know of no better method for its detection than the rod test and tangent scale arranged by him. His advice is that deviations which cause evident symptoms should first have their error of refraction corrected, and if that fail either orthoptic training, stronger prisms, or operation. The orthoptic training he recommends is by means of Javal's stereoscope, a method we have always found difficult to persuade patients to carry out ; he does not seem to favour the regular exercise of the ocular muscles with prisms. But either method requires a good deal of patient perseverance on the part of the sufferer. The book will well repay careful study.
MEETINGS.
BRITISH HOMCEOPATHIC SOCIETY. The first meeting of the session 1898-99 was held at the London Homoeopathic Hospital, Great Ormond Street, on Thursday, October 6th, 1898. The President for the year, Dr. A. C. Clifton, of Northampton, took the chair at eight o'clock.
Presentation to Mr. Enox Shaw. In opening the proceedings. Dr. Clifton said : << Before I proceed with my Presidential address, I must depart from the- usual course and perform a very agreeable and important
694 MEETINGS. *SS£'=i?r?^
Bariew, Nov. 1, 18B6.
fanction. Daring the lifetime of the Society it has had many secretaries, who, by reason of their personality, diligence and knowledge have largely contributed to its growth and well- being, and if time permitted, it would be due to their memory And worth to mention them individually, but unfortunately that is not the case this evening. Its last Secretary, as you are aware, was Mr. Charles Thomas Enox Shaw — alias * noxious ' by telegram — a designation in that respect adopted by himself, whether out of regard for medicied ethics or other- wise, deponent sayeth not, but a designation certainly erro- neous in relation to this Society and its several members, after six years of active and honorary service, during which time, to his great honour, he lengthened the cords and strengthened the stakes of the Society. Gentlemen, the executive of this Society have thought the present opportunity ought not to pass without presenting Mr. Enox Shaw with a testimonial of their esteem, and their appreciation of the services which he has rendered to the Society.'*
Addressing Mr. Knox Shaw, Dr. Clifton said : —
<* Dear Mr. Knox Shaw and Ex-Secretary, — It is my privilege and great delight to present you with this illumi- nated address, setting forth in small measure the appreciation by this Society of your valuable services. It will, I feel sure, be a source of gratification to you to receive this testimonial to your worth and work, and that in future years your chil- dren will be proud of knowing how highly you were esteemed hj us."
The following is the text of the address : —
'* The Fellows and Members of the British Homceopathic Society desiring to record their sincere appreciation of his services, present this address to Mr. Charles Thomas Knox Bhaw upon his retirement from the office of Honorary Secretary after six years of unremitting and self-sacrificing labour.
*' By his enthusiasm, his exceptional skill in organisation, and his self-denying devotion to its interests, the Society has gained new life, as shown by the doubling of its membership and the high tone of its proceedings. In addition, Mr. Enox Shaw, by his uniform tact and unfiling geniality, has secured for himself the hearty esteem and personal friendship of his cmifrh-es. This address is accompanied by the warmest good wishes of the Society, and by the hope that, though regretfully relieving him of his arduous labours, the Society may count npon his undiminished interest and support. " (Signed,)
A. 0. Clifton, President.
J. Galley Blacklby, Treasurer.
James Johnstone, Secretary."
^l^J^^'T^' MEETINGS. 696
Mr. Enox Shaw, in replying to the address, said, it was not <often he bad been so completely taken by surprise as be bad been that evening. He fonnd it almost impossible to express, •on the spur of the moment, in any really adequate manner, bis sense of the kindness shown by bis old friend the President in presenting the address. He felt bow little be deserved all the flattering things be bad said about him. He (the speaker) was only one of the many in the Society who had worked for it during the last few years ; and without the loyal help and support of his colleagues, assistance always rendered most cordially, bis labours would have been as nought. There were many ways, he said, of advancing the Imowledge of homoeopathic therapeutics. Some could write, others read papers ; be himself felt he might be able to do something by reorganising the British HomcBopatbic Society, and so be considered it to be bis duty to take up that work. His six years' work bad been of great interest to him, and be should always look back with pleasure to bis official connection with the Society. He bad made many friends and received a great many acts of kindness. He should always value the address as the outward expression of approval of and sympathy with his aspirations for the Society. Though he was seated on the other side of the table, be was not going to lessen his interest in and zeal for the work for which the Society existed. He was afraid that his old habits had caused him to usurp some of the duties that evening of his able successor, Mr. Johnstone, who he felt sure would receive the same courtesy that had iblways been extended to himself. Words did but too feebly express his feelings that evening, or rather, be felt unable to make proper use of them, but be would assure those present, one and cdl, how heartily and sincerely he thanked them for the cordial greeting awarded to him, and for the gracious manner in which the President bad made the presentation.
PsEsmsNTiAL Address.
Db. Clifton then gave his Presidential Address, which was entitled, The British Homceopathic Society — Its Baison d*etre; The growing of Souls. After thanking the Society for the honour conferred upon him Dr. Clifton said that he considered the Society existed for the distinct purpose of promoting growth of soul in all its members in relation to their special ^sailing as physicians and surgeons practising homoeopatbically. By the term *^ soul " in brief be meant '' that part of man which constitutes bis intellectual, mental and moral being, whereby be thinks, reasons, feels, suffers, and wills ; and which most men of thought and reflection recognise more or less as part, and even the greater part of themselves.
€96 MEETINGS. "S^^^^r??^
Beyiew, Nov. 1, 1896.
Dr. Olifton then gave a short Hsume of the present position of the HomcBopathic Society and of homoeopathy generally in this country, pointing out both losses and gains, and concluding there was no ground for discouragement in its rate of progress. He based the subject of his address proper on a quotation from the address of Dr. Quin, the founder of the Society, at its first annual meeting in 1846^ emphasizing these words as expressing the object of the Society at the present time, *^ The acquirement of knowledge, the augmentation of your means of combating disease, and the extension of the principles you advocate/' If these were the foundation principles of the Society it could not be a sectarian society. The work of the London Homoeo- pathic Hospital as the offspring of the Society was then passed in review, with comments and suggestions for its develop* ment. The work of the hospital and Society had been well and truly done, but Dr. Clifton desired to open up '' fresh fields and pastures new,*' in which the work bequeathed to this Society from the Hahnemann Publishing Society would receive a further development. This he regarded as of a '< higher character" than the work already being done. He laid down no principles for the guidance of the Society on the subject of the development of the '< Materia Medica," but warmly commended the movement already begun by the section in charge of that subject, and eloquently urged all members in their collective capacity ''to lay aside every impediment " and take up this work with heartiness and zeal. Dr. Clifton then addressed words of encouragement and counsel to both the younger and elder members of the Society, and concluded by saying that '' we still have a long way to go in pursuance of our object before we can stay our hands. We are somewhat in the same position as the British and Egyptian Armies were a short time ago in the Valley of the Nile, with enemies in front and on both flanks. H we earnestly and steadily pursue our march as British soldiers, and with the well^organised commissariat that we have, our Khartoum is assured and Hahnemann avenged in a higher and nobler sense than was Gordon."
Liverpool Branch.
The session of the Liverpool Branch of the British Homoeo- pathic Society was opened on Thursday, October 6th, by an address from John D. Hayward, M.D. Lond., M.R.C.S., President of the Branch. Dr. Hayward's address was entitled " Personal Experiences in the Prevention of Phthisis."
The newly-appointed secretary of the Liverpool Branch is Dr. James Watson.
S^.'i?^;T5S^'"' notabilia. 697
Beriew, Not. 1« 1888.
NOTABILIA.
PROFESSOR VIRCHOW.
The most important event in the medical world of London, during the past month, has unquestionably been thcf appearance in the metropolis of the venerable Professor of Pathology in the University of Berlin to deliver the Huxley Lecture at the opening of the Charing Gross Medical School, and the reception afterwards accorded to him at a public dinner given in his honour at the Hotel M6kropole.
Professor Virchow is, without a doubt, the grand old man of pathology. Born in 1821, taking his doctor's degree in 1848, and from that day to this a constant and incessant worker, not only in pathology, but in several other branches of science, for many years an active politician, being sometime the leader of the opposition in the Reichsrath, and on one occasion provoking, by the vehemence of his attack, the distinguished German statesman who has lately passed away (the man who is said, when reflecting on his great career, to have declared : " Nobody loves me for what I have done ; I have never made anybody happy, not myself nor my family, nor anybody else ; but how many have I made unhappy") — provoking him to challenge his opponent to a duel — an act of criminal folly which the great pathologist had the courage to decline ; and now at his advanced age performing, as the British Medical Journal says, " the mental and physical feat of coming a thousand miles to pronounce a lengthy oration before a strange audience and in a foreign tongue " — an oration which prompts the same observer to remark: — <<But the rarest quality of all was the venerable lecturer's freshness of mind; the broad-minded scepticism which lay at the root of all his great discoveries was still evident, but showed no sign of the incrustation by prejudice, which is too often the attribute of those who have left the ranks of the fighters to sit over them in judgment."
The lecture itself dwelt, most appropriately, with his life work — the development of Cellular Pathology and its fruits. The entire lecture is published in the medical journals of the 8th ult. and in The Times of the 4th ult. From the latter we extract the following interesting account of the original investigations which led up to his discovery of Cellular Pathology.
" The greatest difficulty in the advance of biology has been the natural tendency of its disciples to set the search after the unity of life in the forefront of their inquiries^.
698 NOTABILIA. "^^.^ZfT?^
Reriew, Nov. 1, 1888.
Hence arose the doctrine of vital force, an assumption now discarded, but fitill reveftling its influence from time to time in isolated errors. No satisfactory progress could be made till the idea of highly-organised living things as units had been set aside ; till it was recognised that they were in reality organisms, each constituent part of which had its speciiJ life. Ultimate analysis of higher animals and plants brings us alike to the cell, and it is these single parts, the cells, which are to be regarded as the factors of existence. The discovery of the development of complete beings from the •ova of animals and the germ-cells of plants has bridged the gap between isolated living cells and complete organisms, and has enabled the study of the former to be employed in elucidating the life of the latter. In a medical school where the teaching is almost exclusively concerned with human beings this sentence should be writ large : — * The organism is not an individual, but a social mechanism.' Two corollaries must also be stated — (1) that every living organism, like every organ and tissue, contains cells; (2) that the cells are composed of organic chemical substances, which are not themselves ahve. The progress of truth in these matters was much retarded by that portion of Schwann's cell-theory which sought to establish the existence of free cell-formation, which really implied the revival of the old doctrine of spon- taneous generation. This belief was gradually driven out of the domain of zoology, but in connection with the formation of plastic exudates found a sanctuary in that of pathology. I myself was taught the discontinuity of pathological growths — a view which would logically lead back to the origin of living from non-living matter. But enlightenment in this matter came to me. At the end of my academical career I was acting as clinical assistant in the eye depart- ment of the Berlin Hospital, and I was struck by the fact that keratitis and corneal wounds healed without the appearance of plastic exudation, and I was thus led to study the process of inflammation in other non-vascular structures, such as articular cartilages and the intima of the larger vessels. In no one of these cases was plastic exudation found, but in all of tliem were changes in the tissue cells. Turning next to vascular organs, and in particular those which are the common seats of exudation processes, I succeeded in demonstrating that the presence of cells in inflammatory exudates was not the result of exudation, but of multiplication of pre-existing cells. Extending this to the growth in thickness of the long bones — which was ascribed by Duhamel to organisation of a nutritious juice exuded by the periosteal vessels — I was thus eventually able
gSSl2L'.^^«rrSS2"* NOTABILIA. 699
to extend the biological doctrine of omnis cellula e cellula to pathological processes as well ; every new formation presup- posing a matrix or tissue from which its cells arise and the stamp of which they bear." "
One important lesson Yirchow derived from this pathological study was, as he said, '' the key to the mystery of heredity ; " ■and he continued, '< the humoral theory attributed this to the blood, and based the most fantastic ideas upon this hypo- thesis ; we know now that the cells are the factors of the inherited properties, the sources of the germs of new tissues and the motive power of vital action. It must not, however, be supposed that all the problems of heredity have thus been Solved. Thus, for instance, a general explanation of thero- morphism, or the appearance of variations recalling the lower animals, is still to be found. Each case must be studied on its merits, and an endeavour made to discover whether it arose by atavism or by hereditary transmission of an acquired condition. As to the occurrence of the latter mode of origin, I can express myself positively. Equally difficult is the question of hereditary diseases ; this is now generally assumed to depend on the transmission of a predisposition which is present, though not recognisable, in the earliest cells, being derived from the paternal or maternal tissues. But the most elaborately constructed doctrines as to the hereditariness of a given disorder may break down before the discovery of an actual causa viva. A notable example of this is found in the case of leprosy, the transmission of which by inheritance was at one time so firmly believed in that 80 years ago a law was nearly passed in Norway forbidding the marriage of members of leprous families. I myself, however, found that a certain number of cases at any rate did not arise in this way, and my results were confirmed by the discovery of the leprosy bacillus by Armauer Hansen. In a moment the hereditary theory of the disease was overthrown and the old view of its acquirement by contagion restored. Precisely the same happened a few decades earlier with regard to favus and scabies. Another instructive condition is that known as Heterotopia in which fragments of tissues or organs are found dwelling in a situation other than that which is normal to them. This is particularly the case with certain glands, such as the thyroid and suprarenal, but is also known with cartilage, teeth, and the various constituents of dermoids. It no doubt occurs by process of transplantation, the misplaced tissues developing no new properties, but merely preserving their normal powers of growth. The attempt to generalise from this fact and to attribute all tumour formation to this •cause carries the idea beyond its proper scientific limits.'*
700 NOTABILIA. "S^^f^"?^
Very interesting too was the following account of
PARASITISM AND INFECTION,
'< With regard to the subject of parasitism, the progress of scientific observation was retarded for centuries bj th& prevalence of the assumption made by Paracelsus that disease in general was to be regarded as a parasite. Pushed to its logical conclusion this view would imply that each independent living part of the organism would act as a parasite relatively to the others. The true conception of a parasite implies its harmfulness to its host. The larger animal parasites have been longest known, but it is not so many years since their life history has been completely ascertained and the nature of their cysts explained, while an alternation of generations has- been discovered in those which are apparently sexless. Very much more recent is the detection of the parasitic protozoa^, by which the occurrence of the tropical fevers may be explained. As yet we have not complete knowledge as to their life history,, but we hold the end of the chain by which this knowledge can be attained. The ilite of the infectious diseases are, however,, the work of the minutest kind of parasitic plants, bacteria, the scientific study of which may be said to date from Pasteur's immortal researches upon putrefaction and fermentation . The observation of microbes under exact experimental conditions and the chemical investigation of their products opened up the modern field of bacteriology, a science among the early triumphs of which were the discoveries of the bacilli of tubercle and Asiatic cholera by Robert Koch. In connection with this subject three important landmarks require comment. One is the necessity for distinguishing between the cause and the essential nature of infectious diseases, the latter of which is determined by the reaction of the tissues and organs to microbes. Secondly, there is the relation between the smaller parasites and the diseases determined by them. This may be summed up in the general word (introduced by Professor Vir- chow himself) infection.' But to assume that all infections result from the action of bacteria is to go beyond the domain of present knowledge and probably to retard further progress. The third point is the question as to the mode of action of infection. It is only the larger parasites whose main effect is the devouring of parts of their hosts ; the smaller act mainly by the secretion of virulent poisons. The recognition of this latter fact has led to the brilliant work of Lister on the one hand and to the introduction of serum-therapeutics on th& other."
After some observations on antiseptic surgery, during which he alluded in most enthusiastic terms to the work of Lord Lister, who he was proud to be able to greet as an old friend,.
B^^J^oTr^' NOTABILIA. 701
'when, amid great applause from the distiDguished audience, the Professor turned to Lord Lister and shook him warmly by the hand.
The lecture concluded with the following observations on •'abtificial immunisation.
** It remains for me to say a word concerning the other great problem, the solution of which the whole world is awaiting with anxious impatience. I refer to the problem of immunity and its practical corollary, artificial immunisation. It has already happened once that an Englishman has succeeded in applying this to the definite destruction of at least one of the most deadly infectious diseases. Jenner's noble discovery has stood its trial as successfully, except in popular fancy, as he hoped. (Cheers.) Vaccine is in all hands ; vaccination is, with the aid of governments, spreading continually. Pasteur also laboured with determination ; others have followed him, and the new doctrine of anti-toxins is continually acquiring more adherenis. But it has not yet emerged from the conflict of opinions, and still less is the secret of immunity itself revealed. We must become well accustomed to the thought that only the next century can bring light and certainty on this point.''
We feel all the more pleasure in thus drawing attention to the presence and reception of the distinguished Berlin Professor, inasmuch as our Bevieio (vol. v., p. 182) contained a full critique of his pathological views, when they were first introduced to the English-speaking members of the profession through the translation, by the late Dr. Chance, of his great and purely original work. Die Celhdarpathologie in ihrer Begr'undung auf FhysiologUche und Pathologuche Gewebelehre\ and again, in the succeeding volume for 1862 (in a leading article entitled Minima) the writer gave an elaborate present- ment of Virchow's views on the nature of disease. The researches of the Professor, as set forth in this and other of 'his essays, afford important confirmation of some of Hahne- mann's views, and do much to explain certain of the con- clusions resulting from the clinical application of homoeopathy.
For example, on no point was Hahnemann clearer or more decided than that drugs have an elective affinity for certain ^arts of the organism. Virchow, in his sixth lecture, when discussing ** specific affinities," says : ** I rather cherish the 'tsonviction that particular substances, which find their way into the blood, are able to induce particular changes in individual parts of the body by their being taken up into them in virtue of the specific attraction of individual parts for individual sub- Btances.' We know, for example, that a number of substances ■are introduced into the body which possess special affinities for
702 KOTABILIA. "yiS^'^r?"^
Beriew, Nor. 1, 189S.
the nervous Fystem, and that among this number again there are some which stand in a closer connection with certain very definite parts of the nervous system, as, for instance, with the brain and spinal cord, or sympathetic ganglia, and others^ again with particular parts of the brain, spinal cord, &c. On the other hand, we see that certain materials have some special relation to definite secreting organs, they penetrate and pervade them by a kind of elective affinity, that they are excreted by them, and that when there is a too abundant supply of such materials, a state of irritation is produced in these organs."*
Again, Virchow's researches have done not a little to explain the mystery of the action of the infinitesimal dose. The writer of the article Minima to which we have referred says : — '' After a candid and careful perusal of tbifl eminent German pathologist the following propositions present themselves to the mind.
** 1. The human frame is built up of an infinite number of ultimate elements, each of which manifests all the character- istics of life, individual existences mutually dependent, yet each having its own special action.
** 2. These vital elements are cells, so small that the aid of the most powerful microscope is required for their examination, yet they are in their individual and social states of the utniost importance as a whole, as well as for the development and cure of morbid conditions, which morbid conditions can, moreover, be induced by the most minute and subtle irritating forces.
<< 8. The application of such means of irritation to one single cell can give rise to a morbid condition which may be propagated farther and farther by a species of catalysis, the irritant itself (a particle of miasm for example) being infini- tesimally minute. ,
*' 4. As the minute contents of microscopic cells can be morbidly affected by very subtle irritating forces, so also can the same cells in their morbid states be therapeutically influenced by infinitely small portions of those substances for which they have an affinity.
*'5. The cell contents during the performance of these functions are subject to very delicate changes of arrangement .wherein an alteration in the polarity of the particles takes place, a circumstance of great importance in its bearings upon the probable electro-dynamic action of subtle medicinal sub- stances and of impalpable poisons."!
• Cellular PatholiHfy^ tranalAted by Frank Chance, M.B. Cantab.. 2nd edition, p. 626. ' ' ^
t Iloimxopathic Review, vol. vi., page 323*
S^'^^rSJ?" NOTABILIA. 70S
Beriew, Nor. 1, 1806.
As farther demoBstrating the character of the lessona resulting from Virchow's researches, the writer of this paper quotes him as saying in one of his works — Gessaminelte Ahharul- lungen zur mssenschaftlkhen Medicin^ Frankfort, 1856, p. 47 — ** The minimum of a very energetic inciter may have very great and Usting effects, since the primary catalytical action may be propagated farther and farther. * This/ he continues^ ' is one of the facts which demonstrates the possibility of so-called homoeopathic effects. ' ^
Thus the work of the therapeutist, when accurately and carefully accomplished, for whom the most satisfactory labora- tory is the hospital ward, becomes confirmed in its details of procedure in the laboratory of the pathologist, when that, too,, is accurately and carefully performed. The researches of students of pure science, the results of observations in physio- logy and pathology, and in physical science, have of late years largely supplemented clinical experience in confirming many of the views promulgated by Hahnemann, views which appeared so improbable in the light of the knowledge of the time when they were advanced.
The great German pathologist has contributed — all unin- tentionsJly, we know full well, but none the less certainly — in adding to our evidence of the truth of many of the obser- vations of the great German therapeutist. Still further evidence of the same truth will, we believe, be yet derived from the same source.
A NEW DEPARTURE AT THE LONDON HOMCEOPATHIC HOSPITAL.
The Board of Management of the London Homoeopathic Hospital, acting on the representation of the medical staff, have decided, temporarily at least, to appoint a third resident medical officer. With the lapse of time and the increase of knowledge, the work in such an institution as the metropolitan centre of homoeopathy naturally becomes heavier.
In the present instance an additional innovation has been made in the appointment of a lady to the new post. Her duties will, we understand, be mainly limited to the gynaeco- logical department. Miss Neild, an Edinburgh diplomee, daughter of our much-esteemed confrere at Tunbridge Wells is the first to fill this new position. We have long wondered that the Board did not take a step of this- kind, and that no- medical woman in this country had added to her «* orthodox '*^ attainments the knowledge and practice of homoeopathy.
704 COBBESPONDENTS. "S^^ZIT?2£!
Beview, Not. 1. 1896.
NOTICES TO CORRESPONDENTS.
•^* We cannot undertake to return rejected manuscripts.
Authors and Contributors receiying* proofs are requested to correct and return the same as early as possible to Dr. Edwin A. Neatby.
London Homckopathic Hospital, Great Ormond Street, BLOOMSBURT.—Hours of attendance : Medical, In-patients. 9.80 ; Oat- patients, 2.0, daily; Surgical, Out-patients, Mondays, Thursdays, Fridays and Saturdays, 2.0 ; Diseases of Women, Out-patients, Tuesdays, Wednesdays and Fridays, 2.0 ; Diseases of Skin, Thursdays, 2.0 ; Diseases of the Eye, Thursdays, 2.0 ; Diseases of the Throat and Ear, Wednesdays, 2.0 ; Diseases of Children, Mondays and Thursdays, 9 A.M. ; Operations, Tuesdays, 2.30 ; Dental Oases, Thursdays, 9 A.M. ; Orthopsedio Cases, Tuesdays, 2 p.m. ; Electrical Cases, Thursdays, 9 a.m.
BOOKS RECEIVED.
An Abridged Therapy-Manual for the BiO' Chemical Treat ment of Disease. By Dr. Med« Schuessler, of Oldenburg ; 25th edition, in part re-written. Translated by Louis H. Tafel. Philadelphia: Boericke and Tafel. 1898. — Therapeutics of Faeud and Sciatic Keurahjia, with Repertories and Clinical Cartes, By F. H. Lutze, M.D Philadelphia : Boericke & Tafel. 1898.— T/ttf Problems of Homoeopathy Solved; an Essay in Arborivital Medicine, Second edition. By Robert T. Cooper, M.A.. M.D. London : John Bale, Sons & Danielsson, Limited. 1898. — The HomoBopathic World. October. London. — The Cftemist and Drug- gist. October. London. — The North American Jowmal of jHomoeopathy. September. New York. — The ffoTnaopathic Bye, Ear and Throat Journal, October. NewYoik.—I7ie Medical T^mes. October. New York.— TA« Medical Century, September. New York. — Homoeopathic Journal of Obstetrics^ Guna:cology and Pedology, September. New York, — The Xew England Medical Gazette, October. Boston. — The Hahnemannian Monthly, October. Philadelphia. — The Homesopathic Physician, September. Philadelphia — Tfie Homasopathie Recorder, September. Philadelphia. — The Hahnemannian Advocate. September. Chicago. — TJie Clinigue. September. Chicago. — Journal of Orijicial Surgery. October. Chicago.— TA^j Medical Brief, October. St. Louis,- 2%tf Pacific Coast Journal of Homoeopathy, September. San Francisoo. — The Minneapolis HomxBopathic Magazine. September. — The HomoBO' pathic Envoy, October. Lancaster, Pa. — Revue Homoeopathique Prangaise, August, September, October. Paris.— iZ<?rvtf Homeeo- pathique Beige. July. Brussels. — Allgemeine Hom^opathiscJie Zeitung, September. Leipzig. — Homotopathisch Maandblad. September and October. The Hague.
Papera, Dispensary Beports, and Books for Reriew to be sent to Dr. Pops, 19, Watergate, Orantbam, Lincolnshire; Dr. D. Dtcb Bbowx, 29, Seymour Street, Portaman Square, W. ; or to Dr. Edwih A. Nkatby, 178, Haverstock Hill, N.W. AdTertuementa and Bnsiiieu communications to be sent to Messn. E. Goitld & Sok, lamited, 69, Moorgate Street, B.C.
S^JISJ^SSTSf*' THE FORWABD MOVEMENT. 706
THE MONTHLY
HOMOEOPATHIC REVIEW.
THE FORWARD MOVEMENT.
In an early chapter of his work, entitled A Manual of Pharmacodynamics, Dr. Hughes has given to the world a olear, concise, and most interesting account of the sources of the materia medica at the disposal of the homoeopathic practitioner. The work of Hahnemann himself, forming both the foundation and a large portion of the structure of the pharmacological edifice, is pourtrayed in its strength and its weakness. Following hard after the master came his disciples, Habtlaub and Thinks, and then Stapf, all of whom published pathogenetic material or records of materia medica pura, to be found in part or complete in the library of the British Homoeopatliic Society. Next came the Austrian re-provings, begun in the early forties. Many of these provings were con- ducted with large doses of strong preparations, with the object of developing ** the full physiological action *' of the drug. Other European countries and individuals have from time to time done something to increase our pathogenetic knowledge — works of great merit, but too numerous and scattered to mention in detail here. Finally, following Dr. Hughes' order, come the labours
Vol. 42, No. 12. 2 z
706 THE FORWARD MOVEMENT, ^"^l^^^^^
Review, Dec 1, !8B6.
of our American confreres, from Hebing to Hale, sup- plying a store of therapeutic wealth second in importance to those of Hahnemann only. These were the materials ready to the hand of the student and the prescriber ; the therapeutic stones as dug from nature's quarries, rough gems awaiting the polisher and the setter. A very little attention bestowed on this mass of crude materials,, whether by looking over the shelves of a good homoeo- pathic library or by reading the descriptions already alluded to, speedily demonstrates its enormous extent and its diversity. From quite early this material has been subjected to criticism — dating even back to the time of Hahnemann himself, who spoke with doubt of the work of one Nenning, now abundantly familiar to the student of our materia medica. It has undergone a double process — one, that of refinement or revision, the other that of classification.
The first-named process had for its object the purifi- cation of the crude materials under consideration and was begun, as we have said, by Hahnemann. Some three and a half decades ago. Dr. David Roth, of Paris^ did a good deal of work of this kind, published in the 19th and 20th volumes of the British Journal of Hom<topaihy, After a careful examination he comes to the conclusion that '* not single symptoms, but hundreds, aye, thousands, figure in the Materia Medica which do not at all pertain to the pathogenesy of the proved substance." What Dr. Roth and others have proved in a few instances, the majority of students of our materia medica have believed to be true in many others. These searching investigations and this scepticism — what we may call ** the higher criticism *' in a pharmacological sense — have resulted in a much more reliable, if somewhat curtailed, armamentarium. All this class of work has necessarily been of a destructive type.
The second-named process — separate in principle from the foregoing, though often associated in practice with it — was of a constructive type. Efforts of this kind include all works which seek to render available for use and reference in daily practice the mass of crude (♦^ven if purified) material. Books like Hughes' Pharmacodynamics, countless lectures on materia medica and therapeutics in journals of all nations, repertories, from Boenninghausbn's pocket-book
S!S5^5STS^ THE POBWABD MOVEMENT. 707
■ -•
to Gentby's monamental volumeB, Allen's Encyclopadia, Baue's Therapeutic Hints, and other works on thera- peutics, general and special, and last, but not least, the Cyclopadia of Drug Pathogenesy — these and numerous others, of which these are representatives, are of the constructive variety. The labour, time, thought, ingenuity, and money spent in this class of work is simply enormous, and demonstrates what an immense amount of attention the homoeopathic body has paid to materia medica and therapeutics. It hats been a labour at once of love and of necessity ; without it the science and art of rational therapeutics would long since have ceased to exist. In passing, we may ask. Has all this labour been in vain ? and emphatically we answer, " No." It has enabled homoeopathic practitioners, with material mostly more than fifty years old, encumbered with vague or obsolete phraseology, to keep abreast of the most successful and brilliant results of modern orthodox medicine, and ahead of all that, under the SBgis of ortho- doxy, is of a mediocre character. This has been attained, and homoeopathists are proud and thankful for it — ^but they are not satisfied. There have for long been yearnings after a fresh class of work, illustrations of which are to be found in Hale's New Remedies, and still more in the Materia Medica: Physiological and Applied, and quite lately in Mr. Wilkinson's admirable work, made public at the British Homoeopathic Society. These are more than a purification and re-arrangement of the old, they are the supply of new material. The old lines in principle are still the guiding lines, but the details are new, in the light of modern investigation.
The cry for new material is no necessary disparage- ment of the old. How good much of the old is, is only a source of surprise and admiration to those who know most about it. It is not disloyality but fidelity to HAHNEMiNN and his teaching that we should seek to add to the temper of the weapons he left us, and even to their number and kind if need be. The vigorous child he gave to the world could not remain just as he left it, or it would become a stunted dwarf ; it has grown and developed, and must do so or die.
So recently as three months ago in a leading article we raised our voice in favour of a bold, earnest and sustained
2 Z-2
708 THE FORWARD MOVEMENT. ^n^^uS^^^
Beview. Dee. 1. 18B&
forward movement in the matter of the " proving " of drags in a thoroughly accurate, scientific, and as far as may be, exhaustive manner on the ordinarily healthy human subject. Work such as this has been done by Mr. Wilkinson, who presented an able paper to the British Homoeopathic Society. These and other influences have been at work in the minds of many thoughtful practitioners of homoeopathy, and the feeling operating below the surface for an indefinite length of time found voice in the discussion at the last meeting of the British Homoeopathic Society, a report of which will be found on another page. It is our impression that the sense of a need in our work has been silently gaining force in our midst for some time ; inarticulate at first, perhaps now becoming expressible. There is a constant desire in the scientific mind not only to observe facts, but, as Dr. B. T. Cooper has well expressed it, ** to seek to bring the phenomena which we have observed within the realm of natural law." Applying this to the subject before us the craving — ^vaguely realised by some, perhaps — is that we should be able better to correlate pharmacodynamics with the ascertained pathology of disease. Let us illustrate our meaning by referring to the subject of the pathology of the ansBmias.
The systematic examination of the blood in accordance with the methods of modern hsBmatology will become de rigueur in all future provings and re-pro vings of drugs, at least in those which are known to affect the blood to any appreciable extent, and every available opportunity should be seized by pathologists to examine the blood in cases of poisoning. Even the scanty accounts we have at the present moment, when hematology may be said to be almost in its infancy, are most valuable, and at once point out to us, as followers of Hahnemann, the direction in which these drugs may be made use of as curative agents. In the case of iron, the oldest of haamatic remedies, the effects upon the blood both in provings and poisonings are marked and constant — diminution of fibrin, increase of coagulation time, decrease of iron in the ash, marked increase of leucocytes, obvious anaemia visible to the eye, with its attendant symptoms of "general debility, weakness, heaviness and prostration, disinclination for mental and corporeal activity, fatigue, and insufferable drowsiness " — about as close a picture
BSSS^f^TJSf*" THE FORWABD MOVEMENT. 709
of chlorosis as we are likely to obtain from any single drug.
In the case of arsenic, the evidence of correspondence between physiological effects and U8tu in morbiSf though scanty, is quite as striking. The ansemia of slow arsenical poisoning is traditional, and finds its antithesis in the high colour and embonpoint of the Styrian arsenic- eater. Its effects in diminishing the number of the red corpuscles without causing disintegration of the same is shared by few other drugs, and quite prepares us for its helpfulness in the treatment of some of the severest forms of anaemia ; whether the distorted shapes and great variations in size of the red corpuscles, common to all the grave anaemias, will be found to have their counterpart in the effects of provings and poisonings^ remains to be seen. Experience in other directions, more especially in the sphere of neurology, leads us to think that it will prove to be so.
We do not mean to advocate pure pathological prescribing, for we recognise that just as the subjective symptoms of a patient form part of his case, so the minute symptomatology of a drug must form an essential element in the corresponding simile. But in a day when the secrets of nature in disease have been laid open by the aid of instruments of precision we shall prove ourselves bad stewards of the therapeutic truth committed to us if we do not seek similarly to lay open the secrets of drug stction by all the means at our command. Bacon in his interesting explanation of the ** elegant, instructive fable " of the Sphinx, {i.e. science), writes, ** All the riddles of Sphinx, therefore, have two conditions annexed, viz., dilaceration to those who do not solve them, and empire to those that do." The homceopathic body has now to choose between '* dilacer- ation " and " empire." Should it remain content to sit still and pursue only that form of study which becomes closely related to sloth, and to give forth only theses which ** smell of the lamp," the former awaits it. To secure the latter — " the empire over nature, and the empire over man" — ^homoeo- therapeutics, with its golden guiding principle, must advance with the march of science in other departments. Only after labour comes rest. The upward march may be ** torturing, severe and trjring," and " may strangely perplex and harass the
710 THE FORWARD MOVEMENT. ^^^S^T^
Beriew, Dee. 1, IflOS.
human mind/' but the victory ie assured. Then the vanquished problems, like the carcase of the Sphinx, may be *' laid upon an ass, for there is nothing so subtile and abstruse, but after being once made plain* intelligible and common, it may be received by the slowest capacity " — even by those who have long opposed the truths we defend.
The British Homoeopathic Society has declared in favour of " empire." If its eflforts be loyally seconded by its members there can be no doubt that the result mil be a much more complete, accurate and pure materia medica.
The committee appointed by the Society will doubtless pay special and careful attention to all details in the method of experimentation, to ensure the confidence and goodwill of all unbiassed persons. It is not the place in this article to discuss those details. To a few leading essentials we may be permitted to allude.
Of first importance is care to avoid positive errors — e.g.y (1) the ascription of a prover's idiosyncrasy to a drug ; (2) the incorporation of symptoms of disease in a drug- pathogenesy; (3) the adoption of cured symptoms as pathogenetic (Dr. D. Roth, Brit. Joum. of Horn., vol. 19, p. 626) ; (4) the inclusion of mechanical or gross chemi- cal effects ; (5) the use of false terminology — anatomical, pathological or theoretical.
Not less necessary is it to steer clear of negative errors ; these are (a) omission of symptoms, especially of the finer shades; (6) the omission of conditions influencing a symptom.
Some of the positive errors are difficult to avoid, because ideal health is unattainable, but to secure accuracy as far as may be, actual patients must be inadmissible as experi- menters. With the same object an adequate period of probation is necessary, extending if possible in women over two menstrual epochs. During this stage a record of daily life with its varied phenomena must be kept with as much care as during a proving. By this means an experimenter may be trained to appreciate the points of importance to be observed during the subsequent period when taking the drug. If to this be added the story of the past life and ailments, a safe ground of comparison will be created.
Jte^ewrSTiTiSB^*' THE FORWARD MOVEMENT. 711
Negative errors will be minimised by '' making haste slowly/' i.e., by extending the experiment over a pro- longed period of time, by adopting a wide range of potency and a large number of provers of each drag.
The elaborate argument of Carrol Dunham proves <if proof be needed) that infinitesimals may provoke symptoms ; that they are more likely to furnish the finer shades of drug characteristics ; that they are best administered first. So excellent are Dr. Dunham's remarks that we will make a quotation from his classical Science of TherapeiUics (p. 140.) "... to obtain an exhaustive proving of a drug we should begin with small doses, gradually increasing the quantity until unequivocal symptoms appear. We shall thus, if we continue our experiments a suitable length of time, obtain peripheral symptoms, and these small doses will not have so influenced the system as to prevent our obtaining by subsequent larger doses the other varieties of effects .... A considerable space of time should be devoted to our first experiments with small doses. Finally, after an interval of non-medication, larger doses should be taken until we have exhausted the whole dynamic action of the drug . . ." What is included under the term " small doses " is subsequently discussed by Dr. Dunham. We can only state here that it includes the infinitesimals.
In conclusion, let us remember that in union lies our strength ; the younger men cannot do without the mature judgment and ripe experience of their seniors, and we feel sure, moreover, that they have both good sense and good taste enough not to wish to do without them. Equally the elders cannot do without, and the cause of homoeopathy cannot progress without, the enthusiasm and freshness of the juniors. There is work for all, and let us hope all are for the work. By patient perseverance in well-doing, the honour may be ours of effecting much to secure the ultimate prevalence of the truth, for which we have all done and sacrificed some- thing.
712 BUPPURATIVB MASTOIDITIS. '^"^^^SS^mSi
Review. Deo. 1, 18B8.
AN INTRODUCTION TO THE STUDY OF SUPPURATIVE MASTOIDITIS.*
By A. Spbibs Alexander, M.D., CM.
Hon. PhyBioian for Diseaaes of the Eje, Ear, Nose and Throat, Devon and Cornwall Homoeopathic Hospital.
The subject of mastoid abscess is one that for some years past has been increasingly engaging the attention of aurists, both in this country and on the Continent. By means of the improved methods of operation now in vogue, many sufferers from this disease are constantly being relieved, and not a few lives have been saved.
Without going too minutely into the subject of suppuration of the middle ear and mastoid process, I propose to sketch the main features of these associated conditions ; to describe the modem operations for the relief of the latter ; and to enquire to what extent homoeopathic treatment may modify their progress, or obviate the need for surgical interference.
Speaking broadly, mastoid suppuration is of two varieties — the acute and the chronic. Both are secondary diseases, resulting from primary suppuration of the middle ear. The latter is, in its turn, usually set up by extension of inflammatory processes travelling up from the pharynx via the Eustachian tube.
It i9 to be borne in mind that the tympanum is not a closed cavity, but communicates with the outer air by means of the last-named structure — ^the Eustachian tube — and by this channel micro-organisms are enabled to enter from without, and there can be no doubt that infection is often conveyed in this way, with its resultant suppuration. In this connection it may be of interest to note that Broca and Lubet-Barbon, of Paris, report that, in addition to the strepto-coccus, pulmono-coccus, pneumo-bacillus of Friedlander, and staphyio-coccus, they, on one occasion, found the B. coli communis in a specimen of a pus from the middle ear which they examined.
Such cases of suppuration — of the acute variety — are frequently met with during the course of diseases in which the pharynx is affected, notably in scarlatina,
♦ Prewnted to the meeting of the Weetem Counties Therapeuti ca Society, at Plymouth, 26th October, 1898.
SS^r^TiSw!*''' BUPPDRATIVE MASTOIDITIS. 7] 8
measles, influenza, nasal and post-nasal catarrh. When appropriately treated during the acute stage, such cases can usually be radically cured ; but from neglect, or inefficient methods of treatment, they frequently drift on into a chronic condition, resulting in the well-known cases of otorrhoea^ften in children — so constantly presenting themselves for treatment, both in private and dispensary practice, the parents often stating that their medical attendant had assured them that the running was best left alone, and that the child would grow out of it in time.
Another condition very commonly associated with chronic suppuration of the middle ear is post-nasal vegetations. The catarrh accompanying this ailment no doubt leads in the first place to extension up the Eustachian tube, and suppuration often follows. In many cases the pus makes an exit for itself by bursting through the membrana tympani, usually in the postero- superior quadrant, a perforation being thus produced, and finally, the acute stage having passed away, chronic otorrluBa results.
In view of such consequences, it is of the utmost importance that early removal of all post-nasal vege- tations should be effected. The writer has had numerous cases of otorrhoea, associated with post-nasal growths, in which the first step towards permanent cure has been the removal of the latter.
So much, then, for the usual origin of tympanic suppuration. One of its results has also been referred to, namely, perforation of the membrana tympani, as a mode of exit for the pus. This is, however, by no means the only complication that may arise, nor the only direction in which the pus may travel, whether in acute or in chronic cases. The course we have now to consider is that followed in either stage of the disease, the only difference being in degree rather than in kind, the effects of chronic suppuration being naturally much farther reaching than those of the acute.
Before proceeding to the consideration of mastoiditis, in order to elucidate the subject, the anatomy of the region concerned may be briefly described.
The tympanum is a small cavity, measuring about 15mm. from before backwards, 12mm. in height, and 2mm. in depth. It is bounded by bony walls on all
714 8UPPUKATIVE MASTOIDITIS. **fiL^Jw^fSr?lSS
sides, except externally, where it is closed by the membrana tympani, and anteriorly, where it opens into the Eustachian tube. For our present purpose it is unnecessary to describe particularly the chain of ossicles connecting the membrana tympani with the labyrinth. More important is it to consider the accessory cavitiee of the tympanum, these being chiefly concerned in the subject before us.
At the postero-superior region of the tympanum, there is situated a little opening, which is the orifice of a cHnal passing in a backward direction, and called the adUti8 ad antrum. The passage possesses a most im- portant bearing on the subject of mastoiditis, as it is the means of communication between the tympanum and antrum, a small cavity lying just behind and above the tympanum, and opening, in its turn, in the adult, into the mastoid cells. These structures thus form one continuous channel, consisting, from before back- wards, of the tympanum, aditus ad antrum, antrum, and mastoid cells. They are all lined by one unbroken layer of mucous membrane, and it will be at once apparent that an easy course for infection to travel backwardfl is thus provided. Given a case of suppura- tion of the middle ear, whether acute or chronic, there are two methods by which the mastoid cells may become involved — first, by the passage of pyogenic micro- organisms through the aditus to the antrum, leading by their presence and multiplication to an infective mastoiditis; or, secondly, by gravity, the pus flowing backwards through the same channel, as the patient lies in the dorsal decubitus. In cases where the aditus is large and open, pus can flow freely backwards and forwards between the antrum and tympanum, and where there is a ruptured membrana tympani, it finds free exit into the meatus externus by this means. In such cases, little more inconvenience is felt than that incidental to the discharge of pus from the ear, with its attendant deafness. In cases of acute otitis media, however, it not infrequently happens that the inflammatory process extends to the antrum and mastoid cells very early in the attack, before tympanic suppuration and consequent perforation have occurred. All the usual symptoms of acute inflammation are at once produced, intense pain in and behind the ear, with redness and swelling of the
lti!S^f52Ti8»!^ SUPPURATIVE MASTOIDITIS. 716
skin covering the mastoid process, an accelerated pulse and rise of temperature. If the patient be seen at this stage, mach can be done to abort the attack, and so prevent impending supporation. On March 9th of the present year, a young man in this condition presented himself for treatment. For the relief of the acute pain, which had kept him awake all night, hot fomentations to the mastoid were prescribed, dilute spirits of wine were dropped into the meatus, and aconite Ix given internally every two hours. Under this treatment, in some 48 hours, the inflammation had been greatly subdued, the pain and all attendant symptoms had subsided, and in a few days more the patient was perfectly restored to health. Left to itself, there can be little doubt that this case would soon have developed into one of suppurative mastoiditis.
As an illustration of the latter condition, in its acute form, the following case may be instructive : —
On March 20th, 1898, the writer was sent for to attend Miss L., 8Bt. 40. For two or three days she had been suffering from intense earache. She presented all the typical signs and symptoms of otitis media acuta and mastoiditis. The membrana tympani was deeply in- jected and turgescent, while the mastoid process was reddened, much swollen, and very tender to the touch. Linseed poultices externally, and aconite internally, were prescribed, but without much relief. It soon became evident that the stage of suppuration had been reached, the swelling of the mastoid persisting, and the bulging forward of the membrana tympani increasing. To relieve tension and give exit to pus, paracentesis tympani was now performed, an incision being made in the postero-superior quadrant of the membrane, while hepar sulph. 3x was given internally. Very little pus appeared at the time, but gradually it increased in quantity, and, in proportion as it did so, paia subsided, the swelling of the mastoid decreased, and finally dis- appeared. For the purpose of cleanliness, the meatus was now syringed with warm boracic lotion. This had the effect on one or two occasions of temporarily closing the opening in the membrana tympani, its closure being followed on each occasion by a return of pain, and of the swelling over the mastoid.
716 SUPPUBATIVE MASTOIDITIS. ^"^I^^^!?^.
Bevi0w. Dec 1, 1886.
Another form of acute sappurative mastoiditis is one seen more frequently in children than in adults, arising during the course of a chronic suppuration of the middle ear, with perforation of the membrane. The consequent otorrhoea may have been going on for weeks or months, when, perhaps, as a result of exposure to cold, an acute exacerbation occurs. The opening in the membrana in such cases then closes, swelling of the mucous membrane lining the tympanum and adjacent cavities takes place, and the opening of the aditus ad antrum thus becomes blocked. The pus in the latter cavity, no longer finding exit into the tympanum, accumulates, the tension of the surrounding walls is raised, acute pain results, and the pus gradually burrows its way through the cancellous bone, lying between the antrum and the external wall of the mastoid process, finds its way to the surface, and finally bursts through the skin, thus forming a mastoid fistula. It has been remarked that these cases are more frequently met with in children than in adults, and the reason is to be found in the circumstance that in young children there is usually only one cell present in the mastoid bone, namely, the antrum. As years advance, other cells become hollowed out in the surrounding bone, com- municating by minute openings with the antrum, and with each other, till at length the whole of the mastoid process down to the tip is occupied by a series of these cells. Hence, in adults, in suppurative mastoiditis, the latter become receptacles for pus, and, therefore, there is not such a rapid burrowing of the latter to the surface as in children, where there is only the antrum to contain the developing or retained pus.
Cases of this kind, when first seen, are generally beyond medical treatment, and prompt surgical mea- sures are called for, both for the relief of pain, and to minimise the danger of burrowing towards the lateral sinus, situated posteriorly in the mastoid process, or to the dura mater above it. In former times, it was customary to perform Wilde's incision for this condition. This consisted in a long curved incision through the skin and subjacent tissues just behind the auricle. The theory of this proceeding was that relief of tension was secured, and exit given to any pus that might be present under the skin. The operation is, however, of little
iS^5rriSa^ SUPPURATIVE MASTOIDITIS. 717
Talue, as the fistula resoltiBg from the burrowing of pus through the bone always remains, and unless healed, becomes a permanent source of danger to the patient. At best, it merely anticipates nature, which provides an escape for the pus by the bursting of the skin over the mastoid process.
A case of this kind was brought to the out-patient department of this hospital in March, 1897. The patient was a child of 1 year and 10 months, and was said to have had a discharge from the right ear for some months. When first seen the running had ceased, and the skin over the mastoid process was red and shining, and so greatly swollen as to push the auricle outwards and forwards. The swollen area was distinctly fluctuating and evidently full of pus.
The child was admitted to the hospital as soon as possible — on the 26th — but before it could be brought in the abscess had broken, and the pus discharged. A fistula had thus formed spontaneously, and from this the discharge of pus continued.
On the 29th, under chloroform ansBsthesia, an incision was made through the fistula, the skin reflected, and the bony walls of the fistula were then thoroughly curetted granulations and carious bone being removed, and the fistula followed up till the antrum was reached. A con- tinuous track was thus formed, leading from the external wall of the mastoid process behind, through the antrum aiid aditus, to the tympanum in front. Thorough irriga- tion of this tract having been carried out, the external wound was packed with iodoform gauze, and silica 6 given internally. The dressing was renewed daily for some weeks, and under this treatment the discharge gradually ceased, and the fistula healed entirely. (Patient exhibited, presenting cicatrix behind ear and healed membrana tympani.)
Having discussed the usual forms of acute mastoiditis, we can now consider the more chronic varieties, with the operative or other measures necessary for their relief.
Like the acute form, the chronic is due, in the first instance, lo suppuration of the middle ear. The com- munication between the latter and the mastoid cells has been described, and the manner in which those cells may become filled up with pus. While the aditus ad antrum
718 SUPPUBATIVE MASTOIDITIS. ^^^ewfS^l^S^
remains patent, and in the absence of other complica- tions, the pus constantly being secreted by the unhealthy mucous membrane lining those cells finds free exit into the tympanum, and thence through the usually ruptured membrane into the meatus. If now it were practicable to irrigate the antrum and mastoid cells thoroughly with some suitable antiseptic lotion, through the tympanum and adituB, together with appropriate remedies given internally, it might be possible, by such means, to cure many of these cases.
The anatomical structure of the antrum, however,, militates against this practice seriously, because, its floor being on a lower level than the aditus, it is impracticable to free it entirely by means of irrigation of its purulent contents. Hence the persistence with which some cases of otorrhoea resist medical treatment, and the local measures of irrigation and insufiSation. Notwithstanding this difficulty, it is always best, in the absence of any urgent symptoms, to persevere with such treatment for some time before reporting to operative measures, many cases yielding completely to it eventually, even those that may have been going on for several years, and in which it is fair to assume that the antrum, if not the mastoid cells, may be involved.
The treatment which, in the writer's hands, has been most successful in such cases is the thorough insufflation of the middle ear with boracic acid powder, accompanied by periodical lavement with warm water, and the administration of either Pulsatilla, hepar sulph., silica, or calc. carb. The choice of the appropriate medicine must be determined entirely on the merits of the indi- vidual case, and for this purpose the diathesis of the patient, with any concomitant symptoms that can be ascertained, must be taken carefully into consider ation» An objection that has often been raised to the insuffla- tion, or dry treatment, is that it may, by blocking up the aditus ad antrum, lead to retention of pus in the antrum and mastoid cells, and so to the danger of sinus phlebitis, or subdural abscess. In the writer's expe* rience of aural cases, however, extending now over a good many years, both in private and hospital practice, such complications have never been known to arise as a consequence of this mode of treatment.
^SSfSSTiSSs!**'* SUPPURATIVE MASTOIDITIS. 719
(Patient — a boy of 14 — shown, with chronic suppura- tion of both middle ears, and loss of membrana tympani on both sides, cured by above measures.)
But when these measures have been tried exhaustively without avail, when all obstacles to the exit of pus, or sources of its formation have been removed, when polypi and granulations have been dealt with, or a possibly carious malleus and incus disposed of, and when perhaps the patient has suffered from recurring attacks of sub- acute mastoiditis — under such circumstances the aspect of matters is changed entirely. Tbe last-mentioned circumstance — recurring attacks of mastoiditis — may be taken as a danger signal, indicating not only that the mastoid cells have been invaded by pus formation, but that their walls are almost certainly in a carious condition. When this is the case, the patient's life is undoubtedly threatened, and no life insurance office would be likely to accept the risk of it. The sufferer is in the position of one dwelling on the crater of a volcano, perhaps long quiescent, but ready to burst out in the fullest fury at a moment's notice. The danger in such cases lies in two directions. First, the carious process may extend backwards towards the lateral sinus, in which phlebitis is then likely to be set up. The next step is the formation of a thrombus in the sinus, witli its attendant obstructive consequences, and finally tbe thrombus may suppurate, and pyaemia result. Secondly, the thin lamina of bone forming the roof of the antrum may be attacked, and the dura mater lying in contact with it being infected by pyogenetic micro- organisms, a subdural abscess is set up, and the process may, and does, not infrequently, eventually lead to the formation of a cerebral absce&s, with its usually fatal consequences. Under these circumstances, opening of the mastoid process is imperatively called for, and must be performed if the patient's life is to be saved.
Before passing on to the description of the appropriate operation, it may be well to refer to one other form of middle ear disease usually associated with more or less caries of the antrum and cells, and in which the opening of the latter may be called for, before a radical cure can be effected. The condition alluded to is that of a chronic otorrhcea, associated with perforation of Shrapnell's membrane. Such cases obstinately resist local and
720 SUPPURATIVE MASTOIDITIS. ^^fSSTweS
medicinal treatment, the explanation being, that the perforation and purulent discharge result from caries of the attic, and often of the entrance to the antrum, if not of the mastoid cells themselves. It was for the relief of this condition, that Stacke devised the operation known by his name. This, however, will be considered a little later.
For the modern operation for opening the mastoid process we are indebted to Schwartz, of Halle. The method adopted by him being that chiefly practised by aurists both abroad and in this country, it will be unnecessary to refer in detail to others which have fallen into desuetude. The operation now carried out has been designed to avoid as much as possible three grave dangers which are met with in its performance. These are the lateral sinus, as it courses through a deep groove in the posterior half of the mastoid process ; the dura mater, which is separated from the antrum by a lamina of bone, little thicker than a piece of paper ; and, lastly, the facial nerve, which passes through its canal in the inferior half of the posterior wall of the meatus auditorius. The distance which intervenes between the posterior wall of the meatus and the lateral sinus is variable, but on an average is from 12 to 15mm. Sometimes, and particularly in children, it is much less than that, and, indeed, Hessler records cases in which the sinus was found in front of the antrum. The upper limit of the operation is the linea temporalis, a line running horizontally backwards from the roof of the zygomatic process and just above the meatus. Between these three points — the linea temporalis above, the posterior wall of the meatus in front, and the lateral sinus behind— there is usually an area of about 12 to 16mm. through which it is safe to cut into the bone. TYhen these rules are followed, and the operation per- formed with due caution, it is quite possible to avoid injuring any of the above-mentioned structures. A good deal of practice and experience are, however, necessary to insure confidence and eafety, and even skilled surgeons have been known to cut through, not only the facial nerve — thereby causing permanent facial paralysis — but even to open the external semi-circular canal which lies in close proximity to it. Should the lateral sinus be opened, the consequences are not bo
IKSilfSn'Se!^ BUPPURATIVB MASTOIDITIS. 721
serious, as the bleeding can be controlled by thorough plugging with iodoform gauze, and the operation resumed on another occasion. Professor Hartmann, in his book on Diseases of the Ear, states that he performed the operation a hundred times on the anatomical prepara- tion, before carrying it out in vivo.
The instruments used in the operation are scalpel, wound hooks, periosteum retractor, chisels and hammer, sharp spoon or curette, and probe. I am under the impression that the gouge is a good deal in use in this country, and McEwen and Barr of Glasgow advocate the dentists' burr. There can be no doubt, however, that the chisel in skilful hands, and with the bevelled edge held parallel with the bone, is a most satisfactory and efficient instrument, and can be perfectly controlled. The burr is very useful in removing sharp points of bone, and in smoothing off the conical walls of the incision, at the close of the operation.
In cases of acute suppurative mastoiditis, it is usually sufficient to open into the antrum, and, the various steps of the operation till this cavity is reached being common to it and to the more radical measures required in chronic cases, the former may be first described. The skin behind the ear having been sterilized, an incision is made down to the bone, in the groove immediately behind the auricle, and extending from the linea temporalis above (which can generally be felt under the skin) to the tip of the mastoid process below. Hsamor- rhage having been arrested by pressure forceps, the periosteum beneath either flap of the wound is raised from the bone by a sharp retractor. The lips of the wound being then held apart by a hook on either side, in the hands of an assistant, the whole of the surface of the mastoid process is now laid bare, and in front, the posterior wall of the external meatus can be seen, and serves as a guide for the first incision into the bone. This incision is to be made with a chisel about 5mm. broad, held parallel with the meatus, and about 2 or 3mm. behind it. The upper extremity of this vertical incision should correspond with the superior border of the meatus. A small metallic hammer, its head loaded with lead, is convenient for striking the chisel. A second cut is next made at right angles to the first, extending backwards horizontally from its upper edge, just under the linea
Vol. 42. No. 12. 8 A
722 8U»URATIVE MASTOmiTIS. "^Sr^D2f?M!
temporalis. It has been mentioned that this line marks the upper limit of the excavation, but, as the tegmen tympani is generally a little higher, it is safe to go a little above it. The third incision runs parallel with the second, horizontally backwards from the lower extremity of the first cut. Lastly, the posterior ends of the two horizontal incisions are joined by a vertical cut, and, in making the latter, the chisel should be held obliquely, so as to avoid driving it vertically downwards into the lateral sinus. The bone enclosed by these incisions is now chipped away in successive layers, and the excavation gradually deepened with narrower chisels, the operator always bearing in mind that the antrum is situated a little behind and above the upper border of the tympanum, and therefore guiding the chisel slightly upwards and forwards. As he proceeds, he explores the depths of the cavity with a bent probe, and when the antrum has been opened, its bent extremity can be hooked forward into its cavity. A communication has thus been established with the tympanum from behind, and free drainage secured. The cavity having been thoroughly cleansed and dried, the cutaneous wound is sutured, and the excavation packed with iodoform gauze. Tbe first dressing can be left for eight days, when the cutaneous wound will be found in most cases to have healed, and the stitches can be removed. The parts beneath will have to be packed with fresh gauze daily, till the whole wound in the bone has filled up.
In cases of chronic mastoiditis, or where the lateral sinus is to be opened, the operation, till the antrum is reached, is precisely the same as above described, with one additional proceeding. This consists in drawing the auricle well forward, till the cutaneous meatus comes into view, and then, as it lies in the bony meatus, it is to be cut through transversely. This having been done, it is then to be split longitudinally, the posterior half being afterwards sutured to the posterior lip of the skin incision, so as to form a lining for the back wall of the wound. The remainder of the meatus should be detached from the bone beneath it, when the tympanum comes into view, or the membrana tympani, if still intact.
In chronic cases, there is usually extensive caries of the mastoid cells, and these may be filled with pus right down to the tip of the mastoid, and backwards to tba
E^rSnTiS?*" SUPPURATIVB MASTOIDITIS. 723
lateral sinas. It is therefore necessary to cat away, or curette, all the affected parts in these regions, a large conical cavity being thus formed. It is here that the danger of wounding the sinus and dura mater is encountered, but, with due care, this can generally be avoided.
In cases of this kind, it is also now found judicious to remove the bridge of bone covering the aditua ad antrum, that is, the upper half of the posterior wall of the tympanum and meatus. Two dangers here present themselves. First, the external semi-circular canal lying in the floor of the antrum ; and, secondly, the facial nerve, in its canal passing through the inferior half of the posterior wall of the bony meatus, as it descends towards its exit through the stylo-mastoid foramen. The first can be avoided by passing a bent probe through the aditus, the bone above it being then chiselled through till the probe is met with. The facial nerve is not likely to be wounded, if not more than the superior half of the back wall of the tympanum be cut away.
The foregoing measures having been completed, a long sulcus is seen to result, extending continuously from the posterior border of the mastoid excavation, forwards into the opened tympanum. All granulations and sequestra having been scraped away, the wound is closed, as before described. Dressing has to be carried out for several months, till by degrees, the wound heals, and a cutaneous lining is secured, covering the walls of the wound from behind forwards, right into the tympanum.
For the treatment of cases in which it may appear that the carious process is limited to the attic, Stacke, a former assistant of Schwartze, practised opening of the antrum from before backwards, by cutting through the posterior wall of the tympanum. When this was done, it was often found that the mastoid cells also were involved, so that the wound had to be extended back- wards. On this account, no advantage is to be gained by Stackers operation, and it is just as well to perform the full operation at once, cutting from behind forwards.
The subjects of sinus phlebitis and suppuration, sub- dural and cerebral abscess, have been already alluded to, as consequent on suppurative mastoiditis, but, as they are somewhat beyond the scope of this paper, and their consideration would occupy too much time on the
3 A~2
724 A CASE OP PELVIC REFLEX. ^e*!f/w°i£n^8^
present occasion, it will be better to defer it to some future opportunity.
(Several preparations of the temporal bone, made by the writer, in Dr. Jansen's laboratory, in Berlin, were then shown. They illustrated — ^as dissections — the various steps in the operations for acute and chronic mastoiditis; also exhibiting the semi-circular canals, and the facial nerve, laid bare by the removal of the inferior half of the posterior wall of the meatus and tympanum.)
Plymouth, November, 1898.
A CASE OF PELVIC REFLEX. IS OOPHORECTOMY JUSTIFIABLE?*
By Wm. Cash Rebd, M.D.
Hon. Physiciaiif Gynaecologioal Department, Devon and ComwaU HomGeoiMkthio Hospital.
On returning from a holiday (?) in Berlin, where I had been attending Professor Martin's very remarkable clinic, I found the subject of the following remarks in our hospital. She had been sent thither by Dr. Midgley Cash, of Torquay, who had had her under care for a short time at the homoeopathic dispensary.
E. H., aged 18. Family history : Patient is one of 12 children, the others being healthy and well. Her parents are living and are fairly strong. She enjoyed good health also until about 14, when menstruation began. For six months or so the function was carried on painlessly. Since then, however, it has been accompanied by very great pain, which is increasing in severity. The dis- charge is not excessive, but is offensive. Leucorrhoea also exists. The site of the pain which begins a week before the " period *' commences, and continues through- out, is in the hypogastric, the sacral, and the right ovarian regions. The hands and feet are always cold, and the face gets flushed towards evening. Patient has been under treatment at home and at various hospitals for 2J years, and has twice undergone curettage of the uterus, besides other local treatment, without benefit.
* Being the substance of some remarks made by the writer »t a meeting of the Western Counties Therapeutioal Society, held at Plymouth, October 26th, 1898.
S^iiSffSTulSr' A CASE OF PELVIC REFLEX. 726
For the last two years she has been confined to her bed almost entirely, and for a still longer time has not been able to stand or walk alone. She says this disability is attribatedy by one of her previous medical attendants, to an attack of ** blood poisoning " from which she suffered.
Sach, in oatline, is the history of a distressing case, and the patient has come to us ** to have the ovaries removed/' This is the emphatic wish of her parents (not her doctor) and the imperative demand of the patient herself.
On examination, under an anesthetic, the cervix is found to be conical ; it looks forwards. The os uteri is small. The uterus itself is freely movable, and the right ovary is definitely enlarged ; the left is not enlarged.
In view of the foregoing, the following treatment was ^sarried out then and there.
Dilatation free and ample. Discission of cervix (after Martin) 1 cm. on each side, the cut being kept from healing by gauze soaked in tinct. ferri perchlor. Finally, the uterus was packed with iodoform gauze. As the patient emerged from the chloroform narcosis, there were free movements of her limbs in all directions, thus negativing the theory that true paralysis existed.
Remarks. — ^At once, on a review of this case, I mentally resolved not to remove the ovaries, and this in view of the following considerations.
1 . D.iubt as to the extreme severity of the dysmenor- rhoea, in view of the condition ascertained to exist. Watching carefully since the patient has been in hospital has confirmed my doubt.
2. The girl has been ill practically since puberty, and the pelvic organs have already received too much attention from *^ surgical art," and infinitely too much on the part of the sufferer, who has acquired a morbid habit of introversion, and, concurrently, a decreasing will power, with an increasing and now overweening impression that grave pelvic disease exists.
8. There is no evidence of true paralysis, or that the paresis which exists is other than that incident to pro- longed muscular inactivity.
4. The vaso-motor changes, as evidenced by cold feet,
726 NOTES ON INGROWING TOE-NAIL. *^S^
BAview. Dte. 1, 18BS.
" flttflhea/' &c., are part and parcel of the same nerve " degeneration."
5. A patient at 18 is incapable of jndging as to the effects, proximate and remote, of oophorectomy, and the parents, who are *' worn oat" with the case, are as little able to judge from their point of view. , 6. Thoagh the right ovary is enlarged, there is no evidence of organic structaral mischief therein.
In effect, finally, the phenomena are not chiefly peri- pheral, but central.
As a corollary to the above, I may add that at a sab- sequent interview with the mother, I learned I was not the first, nor even the second doctor, who had declined to operate radically. Fnrther information, too, elicited at the same time, went to prove that the position I had taken was logical, diplomatic, and above all the only just jone. Finally, I would advise any of my colleagues placed in a similar position, and with similar precedenta, to decline also to perform, this ** irretrievable experi- ment."
NOTES ON INGROWING TOE-NAIL.
By A. MiDGLBY Cash, M.D.
This term is somewhat of a misnomer. It is not so much that the growth of the nail is any way altered as that the soft parts at the sides of the nail become from some cause too closely pressed against the edges. Tight boots and shoes is a common enough cause, especially when an attempt is made to use those which are too short for the foot. Again, a very common cause is the cutting of the nails down at the corners. In such ways over-pressure is brought to bear upon the soft parts at the sides of the toe ; ulceration is started, granulations are formed along the edge ; these come to overlap the nail, and an extremely trying and painful condition of things is thus established. Both sides of the toe may be in this condition, though most frequently the outer side is the worst, or it may be the only one to be affected. More or less lameness follows, no shoe. or boot can be worn, and the patient becomes nervously fearful of movement or touch to the foot.
A variety of methods of treatment have been advised^ In my student days nothing but operation WM considered
^SSSi^SThlS^ NOTES OM INGBOWING TOB-NAIL. 727
— a most painfol prooeeding requiring the thorough administration of an aniesthetic for its performance. The nail was usually split down its centre, the two halves being forcibly detached from their bed with forceps.
With a little trouble and patience, however, this rather barbarous proceeding need very rarely be practised. The method I have followed, and which has given me satisfactory results, is as follows : — First, with a pen- knife or scalpel, scrape the nail firmly and evenly from tbe root to the free edge — the middle third only. By this means it is kept thin at its centre part, and being more flexible, the objectionable lateral pressure is diminished. In bad cases it may be desirable to reduce the thickness of the nail till it is little thicker at its free edge than a sheet of paper.
Then, at the sides, where active mischief is going on, and where overlapping ulcerating tissue exists, the first indication is to interpose some suitable substance between the ulcer and the edge of the nail. For this purpose I like the silver foil conunonly used by chemists for wrapping up powders. Take a piece three or four folds thick, about half-inch wide, and slightly longer than the full length of the nail. Keeping back the painful granu* lations with a fine probe introduce the strip of foil between the nail and the sore and pack it carefully in, so as to intervene the full length of the fissure between the nail and the soft parts. If the other side is effected treat this in a similar way. Then taking another piece of silver foil three or four folds thick introduce this under the free thin edge of the nail along its whole length, and with a director press it in as deeply as the patient can bear it, so as to raise the nail from the soft parts beneath. This is painful at first, but it is borne better and better every day as the process is repeated — some- thing more being gained each time. If the nail is very hard and horny, I have applied to it compresses satu- rated in carbolised glycerine, which have a soothing and emollient effect.
The granulations, thus kept away from the irritating pressure of the nail, soon begin to shrink and heal. I find it useful to dust over them and into the fissure powdered iodoform, which corrects fee tor and favours cicatrization. When the ulcer is healed patients should be instructed still to keep the nail carefully scraped as above described ,
728 MOSQUITO AND MALARIA PARASITE* ''b^
R«Tiew, I>ee. 1, 1«&
and also to keep it cat square and not at all short at the comers. This will throw the growth away from the edges and towards the middle, and tend to prevent a recurrence of the trouble, for a relapse is not unlikely without care, especially in members of certain families where predisposition exists to this complaint.
An unpromising looking case came to me recently in a lad of 16. Both great toe nails were sunk in a bed of angry granulations, exquisitely tender. With care and gentleness I could not at first succeed in peeling these back from the hard edges, and things looked so bad that I feared there would be nothing for it but to remove the nails in whole or in part. He had had to give up his work as a carpenter, as standing or walking had become impossible.
I kept him in bed a few days, and every second day scraped and treated the nails as above described. In a week he was able to be up, and walked a little in the garden without pain, and it was evident an operation would be avoided. In three weeks he returned to his work again practically cured, and I left him with orders to keep the nails thin and never to wear any but very easy shoes.
Torquay.
THE MOSQUITO AND THE MALARIA PARASITE *
Dr. Patrick Manson (President of the Section) in the course of a demonstration of the malaria parasite said : Ladies and Gentlemen, it was only a very few days ago that I received intimation that I might probably be asked to speak to you about one of the more recent advances in our knowledge of the malarial parasite. Unfortunately at the time I was ill, and as a consequence I fear that, what with bad health and want of time, my demonstration and exposition may be somewhat meagre, faulty, and unsatisfactory. However, I trust to your indulgence, and I hope I may be successful in giving you a lucid account of what is really a marvellous story.
[*From the British MediraZ Journal (September 24th) weraprintthe above addrefls by Dr. Patrick Manson, deUvrnd at the annual meeting of the British Medioal Society in Edinburgh. The address is of mnoh general interest, and we think many of our readers may be glad to have it brought again to their notioe.]
SjSJfSTirS!?** MOSQUITO AND MALARIA PABA8ITE. 729
Gyolh of thb Malaria Pabasitb in the Circulation.
In order that my hearers may have a clear idea of what I am going to say about the life-history of the malarial parasite outside the human body, it is advisable in ease some of you may not be familiar with the recent advances on the subject, to give first a short expo$^ of the leading facts of the life-history of the parasite inside the human body. I will be very brief, and not occupy your time with details which you may easily get from most modern text-books. Unfortunately, [ have left my lantern slides behind me, and I must trust to the chalk to illustrate what I am going to say.
If you examine the blood of a patient suffering from ague and select a time just before the stage of rigor, you will find in a proportion of the blood corpuscles a disc of protoplasm, varying in size according to the species of parasite, dotted all over with black specks of the characteristic pigment of malaria. This is a malarial parasite. If you examine the blood of the same patient during rigor, you will find that these black pigment particles become concentrated more or less in the centre of the blood corpuscle, and that the surrounding pale protoplasm has been broken up into a number of spherules. Later on, if you examine the blood during the stage of pyrexia, you will find that the spherules have escaped from the corpuscles into the liquor sanguinis, and many of them have been absorbed by the leucocytes ; a few, however, have contrived to enter the blood corpuscles. Later still, during the stage of apyrexia, you will find that these intracorpuscular spherules increase in size, acquire amoeboid properties, become pigmented, and by degrees, as you approach the stage at which we began our examinations, these pieces of pigmented protoplasm attain the size that we originally started with. Such, roughly speaking, is the cycle of the malarial parasite in the human body — that cycle of the parasite that subserves the multiplication of the parasite in the human body. There is nothing in this, however, that gives us any idea or suggestion as to the way in which the parasite manages, as all parasites must do, to pass from one host to another. The Flagellated Body.
If you examine the blood of malarials some time after the blood has been removed from the human body, you
730 MOSQUITO AND MALABIA PARASITE. ^"^^SS^
will find occasionally a Tery pecaliar and sfariking organ- ism known by the name of ''the flagellated body.'' This body can only be seen in blood some time after H has been removed from the human body. It is never to- be seen in blood immediately after its removal &om the circalaticm — an important fact. This flagellated body consists of a more or less regular, central sphere dotted over with pigment, and, proceeding from the periphery of the central sphere, 2, 8, 4, 5, 6, or more actively* moving, lashing filaments — flagella. If you keep up your observation yon will find that after a time many of these flagella break away from the central sphere, and become free and swim through the liquor sanguinis.
Thboby of its Function ; the Eole of the Mosquito cjonjectured.
Now, fixing my attention on the fact that this peculiar^ octopus-like creature, this flagellated body, only comes into existence a considerable time after the blood has left the human host, I concluded that there was probably a purpose in this circumstance — that, in fact, it waa intended to subserve the necessities of the organism exhibiting it, I concluded that, because it came into existence after the blood had escaped from the human body, the purpose of this flagellated organism lay outside the human body. But, as it was impossible for the latent fbrm from which this organism originated, and which is easily recognised, to escape from the human body by itself, it was necessary, in order to get it outside the human body, to invoke the assistance of some extraneous agency. It is unnecessary for me to give you here the various reasons and speculations which led me up to the conclusion that that agency was the mosquito. Doubtless I was influenced towards this conclusion by my previous experience of this insect as an agency for the evolution of the filaria sanguinis. Some people have doubted my statements as to the capacity of the mosquito for acting as intermediate host of the filaria. In. case there should be any sceptic on this subject here, and as an object lesson to convince you of the power of thia insect in spreading disease, I have placed under the microscope in tbe other room two specimens showing the filaria sanguinis in the thoracic muscles of the mosquito. One specimen shows the parasite in a mosquito whidk
\
SSSSfSTuiSBB!^ MOBQDITO AND MALABTA PARASITE, 781
has fed on filariated blood about twenty-four bours before. You can distinctly see the worm lying between the fibres of the thoracic muscle. The other specimen is also a section of mosquito's thorax, in which you will find the filaria at the end of six days or a week after the insect had fed^ the parasite being much increased in size and variously developed. It is a valuable object lesson for any sceptics who may doubt the power of the mosquito for taking care of pathogenic organisms.
I concluded, then, that the mosquito was the liberating agent of the malaria parasite as well as of the filaria, and that the flagellated bod^ sucked, in its latent form, so to speak, into the mosquito stomach developed there- in ; that the flagella broke free from the central sphere, as we know they do on ordinary blood slides, and that in virtue of their locomotive faculty they traversed the blood in the mosquito's stomach, penetrated the wall of the mosquito's stomach, entered some cell and there started the extra-corporeal life of the malarial parasite. Originally this was theory pure and simple — theory, however, that was justified, I think, by many facts as well as by analogy ; theory which has now been thoroughly borne out by subsequently and carefully- observed facts.
Boss's Observations.
I was unable myself, from various circumstances, to undertake observations in foreign countries with the idea of establishing the truth of this theory; but fortunately my friend Surgeon-Major Bonald Boss, I.M.S., who had already done much work in blood pathology, was so struck with the probabilities of the hypothesis I had expressed, that he undertook to work out the subject on his return to India, now some three years ago.
The first part of the theory he very quickly proved. He found that, true enough, on the malarial blood entering the mosquito's stomach, ex-flagellation almost immediately followed, and that it followed in a propor- tion of instances very much greater than occurs in malarial blood spread in the ordinary way on the microscope slide. He found that at least 70 per cent, of the crescent form of the parasite, one of the latent forms of the flagellated body, was transformed into the flagellated body. He found also that the flagella all
782 MOSQUITO AND MALARIA PARASITE. ""hSSJ?
1>ee. 1,181a.
broke away. Bat he utterly failed to find what became of the flagella. They disappeared, and he did not know where they got to. He searched the tissues of hundreds of insects, but he could find no evidence whatever of the flagella having entered them.
Discovery of the Pigmented Body in the Mosquito.
About a year ago, Boss, who had hitherto been work- ing with one or two species of mosquitos only, by chance came across what he called a '' dapple- winged " mosquito, a species entirely different from any with which he had previously experimented. This dapple-winged mosquito, of which, unfortunately, he was only able to procure four specimens, he contrived to feed upon the blood of a patient suffering from that form of malaria which is known as the summer-autumn fever, and which is characterised hy the presence of the crescent body in the blood. Two to four days after these insects had fed he dissected them. In one he could find no unusual appearance, but in the three others he encountered a very remarkable body. He noticed, embedded in the tissues of the stomach wall, certain peculiar, oval, minute, pigmented cells. The fact of the presence of pigment in these cells arrested his attention. The optical characters of this pigment were such that it seemed to be in every way identical with the pigment which is so characteristic of the malarial parasite. He also observed evidence of growth. In fact. Boss was sure that he had now encountered the extra-corporeal form of the malarial parasite. About the same time, by accident, he found one specimen of what is known as the grey mosquito, a common species in the tropics, feeding upon a case of ordinary tertian malaria. This mosquito he captured and kept for a few days, and afterwards dissected it. In this insect, too, he found similar pigmented bodies embedded in the walls of the stomach.
MacCullum's Observations on Haltbridium.
Here, however, fact and theory seemed to diverge. It was difficult to reconcile the presence of pigment in these cells with the absence of pigment in the flagella which, according to my hypothesis, are the infecting agencies. The pigment always remains in the central sphere, or what may be regarded as the residual portion of the flagellated body ; it does not enter the flagella. How
iS^fSSTSw"* MOSQUITO AND MALARIA PARASITE. 788
then accoont for it in Boss's bodies if they be the developing malaria parasite? Fortunately at this janctare help came from America, help which apparently reconciled theory and fact. MacGallam, of Johns Hopkins University, observed that in halteridiam an intra-corpuscolar parasite of birds closely allied to the malaria parasite of man, as I shall presently explain, the purpose of the free flagellam is to impregnate certain halteridia, and, as it were, prepare them for entering on a new phase of existence. In watching slides of blood containing halteridiam he observed parasites escape from the blood corpuscles and assame a spherical form. Certain of these spheres emitted flagella which, breaking away, accamalatod about other spheres which did not emit flagella, and finally entered them. Whereupon, after a time, the impregnated spheres changed shape, and acquired locomotive powers ; became, in fact, travelling vermicules, containing the entire substance of the original halteridinm sphere, including its pigment. They exhibited great powers of penetration, passing indifferently through red blood corpuscles and white blood corpuscles, and moving with freedom and activity about the field. Depend upon it, this locomotive penetrating power exhibited by the pigmented halteri- dinm vermicule has a purpose. Observe that it comes into existence only after the blood containing it has left the body of the bird. What more likely, then, than that this purpose is the attainment and penetration of the walls of the stomach of some special kind of mosquito that has ingested it ? It is pigmented. Hence, arguing from analogy, I would suggest the pigment in Ross's pigmented bodies found in mosquitos fed on human malarial blood.
This explanation I think is admissible, although, I confess, it cannot be said that absolute proof is as yet forthcoming.
Boss's Observations in Bird Malaria.
So far Boss's investigations had gone. He had succeeded in interesting a number of people in his work, and fortunately he succeeded in interesting the Indian Government. The Indian Government took him by the hand, relieved him of military duty, sent him into Cal- cutta, and placed him in a well-equipped laboratory with
734 MOSQUITO AND MALARIA PARASITE. ^'tSS^^S^,
inBtractions to work at this mosquito-malaria hypothesis. When Bobs arrived in CalcuttlBb in porsoance of these instructions, it was an unfortunate time of year for his purpose. It was not the malarial season, consequently he had a difficulty in procuring human subjects for observation and experiment. With characteristic energy, however, and not to lose time, he turned to bird malaria, and resolved to devote a few months, at all events, until he could get a sufficient number of human malariais, to studying the analogous parasites of birds. You know that birds, particularly in warm climates, are subject to what I might call plasmodial infection ; that their blood often contains parasites strictly analogous to those characteristic of malaria. There are two important species that have been studied. One of these is called halteridium, by Labbe, a well-known French authority. The characteristic of this species is that it extends along- side the nucleus of the bird's blood corpuscle, and forms sporulating appendages at the end of this halter-shaped sort of jugum. The other, very much like halteridium, eporulates in a somewhat different fashion. It is a more concentrated parasite, so to speak, occupying rather the centre of the oval blood corpuscle, and in order to obtain room displacing laterally the nucleus. It is called pro- teosoma.
Now both of these parasites resemble the malaria parasite in their structure. They are both intra-corpus- cular, and they are both composed of pale protoplasm carrying a large number of grains of black pigment. They also, like the malarial parasite, sporulate and they form flagellated bodies ; so that in every way they seem strictly analogous, and closely allied to the malarial parasite.
Discovert of Pigmented Bodies in Mosquitos Fed on Sparrows Affected with Proteosoma.
Boss gave particular attention to proteosoma. He found that by feeding the grey mosquito on sparrows, larks, and crows containing this parasite, he could with the utmost certainty get a crop of pigmented cells, resembling those he had similarly raised from human malaria, in the stomach of these insects. These experiments he repeated a vast number of times — not .one or two insects, but hecatombs of mosquitos he
BSSSSrSTlSa^ MOSQUITO AHD MALAHIA PARASITE. 736
sacrificed in this way in the cause of science. I forget his exact figares, but of 245 grey mosqaitoe fed on sparrow's blood containing the proteosoma parasite, 178 (or 72 per cent.) showed the pigmented bodies in the walls of the mosquito's stomach. He fod an equal number of mosquitos on human blood, on the blood of birds devoid of this parasite, and in various other ways, and of 249 mosquitos thus fed not one showed these pigmented cells in the walls of the stomach. These experiments seemed very conclusive. I was particularly struck with one experiment which he details. He collected a number of mosquito grubs from a drain near •his laboratory, and he put them in a bottle, and allowed them to remain there until the mosquito was evolved from the pupa. Then he fed some of these mosquitos on a bird in whose blood the proteosoma was particularly abundant. Ten mosquitos he fed in this way, killed them, dissected them, and examined their stomachs, and on an average he found that the stomach wall of «ach mosquito contained 100 pigmented cells. He took another batch of ten of the same mosquitos, and fed them on a sparrow whose blood was but moderately affected with the proteosoma. He dissected their stomachs, and enumerated the pigmented cells he found there, with the result that the average was only 29. Ten he fed on sparrows in whose blood the proteosoma was not present, and these he also dissects and carefully examined with high powers of the microscope, and in not one did he find any evidence whatever of the presence of pigmented cells.
Of the care and accuracy of Boss's observations I can give personal testimony. The preparations of these thirty dissected mosquitos' stomachs were sent to me, and I found under the microscope the pigmented cells, which there was no difficulty in finding, with the result that my count practically tallies with Boss's finding. I could state many more experiments, but these suffice to establish the fact that the grey mosquito fed on sparrow's blood containing proteosoma almost invariably contained the pigmented cell, and that grey mosquitos fed on sparrows whose blood did not contain the proteosoma did not contain pigmented cells. The inference cannot be avoided that somehow or other the mosquito subserves
736 MOSQUITO AND MALARIA PARASITE. ^b!!h^!
Dee. 1,1688.
the proteosoma, and that the pigmented cell is an eyolutionary form of proteosoma.
Thrir Position and Development.
After thoroughly establishing this fact Boss set to work to find out something about the history of these pigmented cells in the stomach wall of the mosquito, and to endeavour to locate their position exactly. If you examine a mosquito's stomach with the microscope you will find that the wall is made up of several layers. The outer layer is composed of ramifications of the air vessels of the insect. Beneath this you will find two layers of muscular fibres, longitudinal and circular. These cross each other at right angles, producing a soii of rectangular pattern. Below these you will find a structureless sort of membrane which does not stain easily, and below this again, and forming the lining membrane, the mucous surface, so to speak, of the mosquito's stomach, what might be called the epithelial layer, composed of several strata of cells. Boss found that the pigmented proteosoma cells do not occur, as might have been supposed, among the soft epithelial cells lining the inner surface of the stomach, but that they lie either on the outer surface of the homo- geneous layer covering this, or between the meshes of the muscular fibres. You see them lying between the muscular fibres which they dissociate somewhat in the same manner as trichina spiralis dissociates the muscular fibre of the pig and other quadrupeds. When the parasites grow, as they do by-and-by, to a large size, they gradually protude as a sort of waxt-like object on the outer surface of the stomach, so that finally, after six or seven days, the stomach of an affected mosquito acquires something of the appearance here represented. A. number of wart-like bodies — which are really what Boss calls the " proteosoma coccidia " — protrude into the body cavity of the insect.
Boss has not succeeded as yet in finding the earlier or first-day phase of the proteosoma in the mosquito's stomach wall ; but on the second day there is no difficulty in finding the parasite. It is an oval body some 6 or 7 micromillimetres in diameter ; through the homogeneous protoplasm of which it is composed you will find scattered some twenty particles of intensely
S!5i5Jr5S.TiS5f*^ M08QUIT0 AND MALARIA PARASITE. 787
black pigment. The outline is very distinctly and sharply defined. By degrees the little parasite grows, so that on the third or fourth day it attains a diameter three or four times this, becoming, in certain instances, granular, and exhibiting occasionally vacuoles, and other obscurely indicated marks of structure. By the fourth or fifth day it is more spherical, and has attained a considerable size, sometimes a diameter of 60 to 70 micromillimetres. The wall of the proteosoma coccidium is now thick and dense, and has a capsular appearance, and dim indications of structure can occasionally be made out. One particularly striking appearance is to be seen ; there is a sort of concentric arrangement of granules recalling what we may some- times see in show specimens of diatoms.
So far Boss had got with his work when his report (for permission to use which I am indebted to the Secretary of State for India) was written. According to Government instructions, it had to be sent in at the end of three months. Since then he has made remarkable progress. Of this progress I have learned from letters and telegrams.
Formation and Diffusion of '' Gbrminal Bods."
Boss found in certain mosquitos, particularly in those mosquitos in which the protruding proteosoma coccidia had ruptured, diffused through the body cavity, and also in the tissues of the insect, certain peculiar bodies, which he afterwards called germinal rods. They are exceedingly minute, spindle-shaped, somewhat flattened bodies. He found these in enormous numbers. He could not at first understand whence they came. After a time, however, he discovered that by dissecting the stomach of the mosquito in salt solution, and by exercising a little pressure on the cover glass, he succeeded in rupturing the proteosoma coccidia, with the result that enormous numbers, myriads, of these germinal rods were extruded from their interior. Thus he accounted for the presence of these bodies in the body cavity of the insects. They were the progeny of the coccidia. He also supposed that they became diffused throughout the insect by entering its blood. They have no very manifest locomotive power of their own, and consequently they could not wriggle their way through the tissues.
Vol. 42, No. 12. 3 b
788 MOSQUITO AND MALARIA PARASITE. ^'^iJ^]
Dm. 1,108.
He therefore concluded that they must be carried through the tissucB by means of the blood. To test this lie pricked with a fine needle the back of a mosquito at a time when he knew that the germinal rods must have formed in the proteosoma coccidia, and when he knew that these coccidia had in the main ruptured. He obtained a minute droplet of the characteristic white blood of insects, mixed this with a little salt solution, and placed it under the microscope, and therein he found innumerable germinal rods. Later he endeavoured to make out what next became of these rods, what was their purpose and destiny.
Their Prbsbncb in the Venbno- Salivary Glands.
In dissecting the tissues of the insept he, by accident, stumbled across a peculiar gland connected apparently with the proboscis. This gland consisted of a number of plump, clearly«defined cells, . arranged along a branching duct. He found that there were at least two such glands, one on either side of the insect's head, and he was astonished at finding in the clear, plump, cells composing the glands enormous numbers of the proteo- soma germinal rods. He found them arranged in bunches, as it were, producing in the gland cells an appearance something like the groups of bacilli in the lepra cell. Dissecting them out, and studying them microscopically, he found that the long ducts of the glands uniting terminated in a common trunk opening into the proboscis of the insect.
Experimental Communication of Proteosoma Disease BY Mosquito Bite.
Ross concluded from this, or rather speculated on the strength of the facts, that very likely this was the route by which the proteosoma germ left the mosquito. Possibly, he thought, it might be the way or a way by which the parasite was introduced into a fresh host. No sooner had the thought occurred to him than he proceeded in a characteristic way to test it by experi- ment. He got mosquitos that had fed on proteosoma- infected sparrows, and kept them five or six days until he knew the germinal rods had been formed, and were occupying these veneno-salivary glands, for such they undoubtedly are. He then let the insects loose again on
SSSSr^TwBB!^* MOSQUITO AND MALARIA PARASITE. 789
sparrows in whose blood careful microscopic examination had shown there was no proteosoma. Later on the mosqaitos bit the sparrows, and then after some days Boss pricked these long-suffering sparrows and examined their blood. He had the gratification of finding innumerable proteosoma in the blood corpuscles.
This is a wonderful and most suggestive result. I believe it, for I have confidence in Surgeon-Major Ross's intelligence and in his honesty. He is an extremely truthful observer, and would be the last to overstretch any fact that he may have observed. He speculates — yes, but when he is speculating he tells you he is doing so: when he states a fact you may rely upon its accuracy. Much of the information I have just given you came to me by telegram ; unfortunately, therefore, I cannot enter into minute detail, for one does not expect to find scientific men investing largely in telegraphic messages, even when communicating impor- tant facts of science ; but substantially I have not the least doubt that my presentment of the subject is correct,
Bbabino of Boss's Observations on the Malaria of
Man.
That this is the last word on the subject of the extra* corporeal phase of the malarial parasite I do not believe. I think that malaria may be acquired in this way — that is, by the bite of the mosquito ; but that that is the only way I cannot venture to assert, in fact I do not think. For observe ; malaria, we know, multiplies indefinitely outside the human body, independently of man. In fact, malaria is most prevalent in places where man is not. Therefore, this extra-corporeal condition of multiplication must demand something more than a short cycle of from man to mosquito and from mosquito to man. My impression is that it requires an infection of mosquito by mosquito ; possibly, as in tick disease or as in silkworm disease through the insect's ova, possibly through the larva. Boss's facts supply us, gentlemen, with an explanation of the former sort. They do not tell us how the parasite multiplies indefi- nitely through generation after generation. Still, it is a most important addition to our knowledge, and I am sure that it will lead to a full solution of the entire
8 B-2
740 MOSQUITO AND MALARIA PARASITE. ^n^^J!iS^!^Ml
problem and to very many advances in this important subject. It may be objected that what holds good for proteosoma may not hold good for Plasmodium malariaa ; but the similarity of the parasites is so great that one cannot resist the conclusion that their histories are also similar. Moreover, Boss has distinctly shown, as already mentioned, that certain species of mosquito do elaborate pigmented cells when fed on human malarial blood.
I am sure you will agree with me that the medical world, I might even say humanity, is extremely indebted to Surgoon-Major Boss for what he has already done,, and I am sure you will agree with me that every encouragement and assistance should be given to so hard-working, so intelligent, and so successful an investigator to continue his work. His observations tend to the conclusion that the malaria parasite is for the most part a parasite of insects ; that it is only an accidental and occasional visitor to man ; ^that not all mosquitos are capable of subserving it ; that particular species of malaria parasites demand particular species of mosquitos ; that in this circumstance we have at least a partial explanation of the apparent vagaries of the distribution of the varieties of malaria. It seems to me that when the whole story has been completed, as it surely will be at no distant date, in virtue of the new knowledge thus acquired, we shall be able to indicate a prophylaxis for malaria of a practical character, and one which may enable the European to live in climates now rendered deadly by this pest. Other practical issues will occur to anyone who thinks of the importance of an accurate knowledge of the life-history of this as of any other parasite.
Future Lines of Study.
What we want now is a complete study of the various species of mosquito in malarial and other lands, and of their behaviour in regard to the various forms of malarial parasites. It is only a question of a little time and of a little money. A few thousand pounds devoted to an investigation of this nature would prove an investment yielding a most liberal return to the country that makes it, and to none more than Great Britain.
B^^?5nrw9^* MOSQUITO AND MALARIA PABASITE. 741
Lateb Obsebvations.
Note. — Letters received from Ross subsequently to the delivery of the foregoing confirm and expand what is therein stated. Many (30) successful experiments on the communication of proteosoma to healthy birds indicate an incubation period of from five to nine days. The intensity of the mfection so conveyed gradually increases during several (4) days^ until finally as many as from five to ten or more parasites are to be found in every field of the bird's blood. These artificial infections are much more severe than those acquired naturally ; the birds may die from them. Boss further states that he has succeeded in communicating sparrow proteosoma to the crow. He also refers to another interesting observation — one which tends to confirm Mannaberg's view of the origin of the crescent body in human malaria. He finds that the large non-sporulating form of proteosoma— that from which the flagellated body is developed, does not begin to appear in artificial infections until three or four days after the sporulating forms are observable ; and he further states that it is easy to follow the formation of the body by the conjuga- tion of the associated parasites in multiple infections of blood corpuscles. He has devoted a great deal of attention to the peculiar black sausage-shaped bodies (represented in plates exhibited). Like the other forms in mosquito proteosoma infections, these occur only in mosquitos fed on proteosoma-containing blood. They are frequently present in great profusion, and, like the '* germinal rods," escape on rupture of the enclosing capsule into the body cavity, becoming subsequently diffused through the blood and tissues of the insect. Although Boss made several attempts to get these bodies to develop, hitherto these attempts have failed. The black bodies are not altered if kept in a moist chamber for weeks ; they do not develop in the stomach of mosquito grubs fed on mosquitos containing them. That is to say, they resist decomposition and digestion, but, though thus refractory, there can be little doubt that they have a significance in regard to the life-history of proteosoma ; possibly they are of the nature of resting spores, and demand some very special condition for their further development.
742 UTERINE FIBROIDS. ^"^I^SS^T^
THE OPERATIVE TREATMENT OF UTERINE FIBROIDS, ILLUSTRATED BY CASES.
By Edwin A. Nbatby, M.D.,
Assistant Physician for Diseases of Women to the London HoniGBopathio Hospital.
Rather more than a year ago I had the honour of presenting to the British Homoeopathic Society, as a presidential address, a paper on fibroids, dealing with the subject from a double historical point of view.* The surgical treatment of these growths was outside the scope of that paper, and save that some suggestions were made as to indications for operation, it was not alluded to. A feeling was present in my mind at the time that some- thing might well be written on the subject of the mode of operating on uterine myomata, but it was not yielded to by myself, in the hope that some one more able and experienced might undertake the task. Twelve months of waiting have not brought forth the article I should like to see, but I do not regret having delayed putting pen to paper. For the year has not been without fruit in the way of valuable experience which has served to confirm the views which have been shaping themselves in my mind for the past three years. During the past year I have had the opportunity of witnessing the work of a number of well-known English operators, as well as Professor Salin in Stockholm. But to none of these do I feel so much indebted as to my colleague Dr. Burford, from whose example and teaching I have learned much, and from whom I have on many occasions received hints which have contributed to the perfecting (in the sense of completing) my ideas. To Dr. Johnstone I owe my thanks for much help in carrying out many of my recent operations.
It will be understood, however, that I am not attempt- ing to give the views or experience of these operators^ but only to state what has been forced upon me by my own personal observation and experience.
My remarks will resolve themselves into
A COMPARISON
between " the old operation " as it is shortly caUed — i.e.^ the fixation of the stump in the abdominal waU, and the retro-peritoneal treatment of the same.
* Journal of the British Homceopathic Society, January, 1898.
l£3JS:^TSa^ UTERINE FIBROIDS. 748
Now, I am not forgetfal of the fact that it is a difficult thing to institate a jast comparison between any two methods. The common plan is to compare a yery large number of cases — oftentimes by different operators — and strike a mortality balance, in the hope that the numbeV of the cases will atone for the frequeni want of parallel in the comparisons. This plan will not be mine for the reason that I wish to bring forward only my own experience, and that experience is far too small to enable me to produce statistics convincing by the weight of numbers. I am ready, consequently, to admit that there may be, to the reader, a certain weakness in the proof adduced, to crave his indulgence when I ask him to allow some weight to the opinion I have formed — an opinion based on more evidence, of course, than can be put on paper, evidence obtained in critical moments at the operating table, and in many an anxious hour at the bedside.
The Operations Described. k.—The " Old Method:*
My earliest hysterectomies were all done on this plan which is familiar to all those who have seen much abdominal work or done any. In a few words — it consists in opening the peritoneal cavity, separating the adhesions (if any) , raising the tumour from the pelvis (if necessary), and cutting off the circulation from the tumour by encircling it at the most favourable position for forming a pedicle, by a constricting appliance. The upper part of the broad ligament may or may not first be ligatured and divided. After constriction, the tumour is transfixed by stout pins beyond, i.e., on the distal side of the encircling ligature (rubber tubing in my cases) and the tumour is cut away. The chief time is spent in trimming the pedicle thus formed, to reduce it to a reasonable size and shape. In the case of sessile tumours and those bulging into the broad ligament, this is a considerable, tedious and even formidable procedure.
The most important stage is that of suturing the peritoneal surface of the stump on the proximal side of the ligature to the peritoneum of the abdominal wall, drawing the pedicle well down to the lower angle of the wound. By this means the pedicle is made extra- peritoneal, union between the two serous layers taking place in from 24 to 86 hours. Drainage is used for from two to four days.
744 UTBBINE FIBROIDS. ^^^'L^JST?^
Berlew, Dee. 1, 18M.
The transfixing pins lie on the skin of the abdominal wall surrounded by the dressings, which are changed night and morning at first, and once daily after the removal of the drain material.
Mummification of the part beyond the ligature takes place — ^superficially at any rate. The drier the stump, the less smell there is. The slough is helped away by scissors, etc., during the second week. Some necrosis of the pedicle on the proximal side of the Ugature also occurs, and this is a possible source of infection. When the transfixing pedicle pins have been cut away the remainder of the stump sinks into the abdomen — a deep and wide sinus leading down to the slough, which separates gradually by the end of the fifth or sixth week. The patient can be discharged in the seventh week as a rule. At this date the wound is often incompletely healed.
B. — The Retro-peritoneal Method.
After extricating the tumour from the pelvis and extruding it as far as may be from the abdomen, the upper part of the broad ligament is tied off on each side. If the ovaries are sound, one should be left. A long pressure forceps may be placed on the broad ligaments close up to the uterus, and the remainder of the ligaments can then be tied off and divided down to the vicinity of the uterine arteries. These are then to be secured. This may be done by separating the layers of peritoneum forming the base of the broad Ugament and passing an aneurism needle round the arteries, or by including the broad ligament in the ligature (using a sharp needle for the purpose). If preferred, these arteries may be secured by forceps and tied after the tumour has been cut away. As soon as the circulation is thus cut off, a transverse incision is made along the front of the tumour, about i inch above the bladder margin and a peritoneal flap is reflected ; a similar flap is then made on the posterior surface. These flaps are, of course, continuous at the margins of the uterus (or tumour) with the broad ligament on eskch side. They are reflected as far as is necessary, and the tumour is cut away. As little interference as possible with the cervical canal or uterine cavity is desirable, a few stitches only being placed in the stump to close it. The inner surface of the flaps and the stump are examined m a good light and bleeding points (if any) are secured.
TtSSSJfSnW** UTERINE FIBROIDS. 745
The cat edges of the broad ligament are stitched by a ^ne running suture, and the edges of the flapn (made by dissection) also. Lembert's method is best, if there is time. A narrow row of stitching occupies the pelvic floor, little or nothing in the shape of a stump being seen. Whatever there is, is behind the peritoneum. No drainage is needed. The sutures in the abdominal wall are removed in the second week, the patient gets up in the third, and walks out of the hospital or home at the end of the fourth week.
Before instituting any verbal comparison I will narrate some cases, classifying them, perhaps somewhat arbi- trarily, in three series, viz. : — (1) fatal cases ; (2) unsatisfactory recoveries ; (8) complete successes.
Fatal Gases. A. — Old Operation.
M. D. 8Bt. 44, Single, (notes by Mr. Higgins) transferred to me by Dr. Goldsbrough. Came into hospital July 19th, 1897, for the weight and discomfort of a large abdominal libroid associated with some monorrhagia and anaBmia. Patient was carefully prepared for operation for 10 days, urea tested quantitatively repeatedly, about S60 grains daily being averaged. The total of urine was about 40 ounces daily and the bowels acted freely.
The tumour was difficult to raise from the pelvis and the broad ligaments were partly deligated prior to the formation of a pedicle. The operation lasted nearly two hours, time being spent in (vainly) endeavouring to arrest hemorrhage in the pedicle without the (elastic) ligature, and without tying the uterine arteries. Drainage was used. The pulse rose at once to 120, and in 20 hours to 140, the patient dying within 48 hours. She recovered consciousness, but did not recover from the shock of operation. Throughout, the patient was very restless, complaining greatly and constantly of pain, much aggravated at the time of vomiting, which was frequent. The temperature steadily rose with the pulse in this case. Flatus passed per rectum and the nutrients were well retained ; slight epigastric distension occurred. Only 30 ounces of urine were passed in 44 hours.
B. — The Retro-peritoneal Method. 8. S., November, 1896, set. 60, sent to me by Dr. Shirtliff, now of St. Leonards-on-Sea ; was admitted
746 UTERINE FIBROIDS. "^^SSL^SST?^
Beriew, Dee. 1, 1886.
to hospital on aocoont of a growing tumour of uteras* Menorrhagia had existed for some years and latterly metrorrhagia and offensive intermenstraal discharge. The tumour, which reskched to the pelvic brim, had only been recently discovered. The diagnosis was uncertain, but on opening the abdomen, multiple myomata were found. The operation was performed in the way described and lasted over two hours ; a drainage tube was used. No accident or complication occurred to prejudice the case. The patient died near the close of the fifth day.
Within 86 hours the pulse rose to 160 and remained between 140 and 156 until her death.
The temperature remained under 100^ until a few hours before death. Taken two hours before the end came, it was 103°.
After the first night there was no measurable quantity of sleep except the third night.
There was very little sickness or abdominal distension^ but constant restlessness and some embarrassment of respiration. Flatus passed freely throughout.
The pain complained of was slight.
This patient never recovered from the shock of the prolonged operation. If sepsis supervened it merged imperceptibly into the condition of shock, and was indicated by no symptoms other than the frequent pulse. It should be stated that sugar was twice found in the urine after the operation although not before.
" Unsatisfactory Rbcovbries." A.— The Old Method.
E. 0., set. 40, sent to me by Dr. Byres Moir, was under treatment eight months in the out-patient department of the London Homoeopathic Hospital. Her tumour reached the umbilicus, and its presence caused some pain and pyknuria, but it was the anaemia due to haemorrhage which made operation imperative. The bleeding had been excessive for several years, and latterly was not controlled even by complete rest in bed at the period. The kidneys were healthy and no sugar was found in the urine.
The operation was done on January 29th, 1896, in the way already described, drainage being used. The notes, very carefully taken by Mr. Lestock Eeid, state that " hardly a drop of blood was lost during the operation." There was nothing to lead one to expect any complica-
SSteSySTiS?*" UTERINE FIBROIDS. 747
tion, and for the first six days^ except pain which kept her awake, all went well. On February 4th delirium set in, and next day pleural friction was heard at the left base. Two days later the pedicle pins were removed and on the 9th patient had a good night without delirium. But on the 11th more pleural pain was felt, effusion had taken place also, and temperature and pulse were high. (T. 108^—104°; P. 120—140). This lasted nearly a week. Very troublesome, offensive, involuntary diarrhcea also set in. A fresh patch of pleurisy occurred still later, again with delirium, but by the 28rd the fluid was becoming absorbed and more friction and breath sounds audible. The last pleural rub was heard March 10th. After this thrombosis of a vein at the back of the right leg occurred. A description such as this gives no idea how ill the patient really was, and we were surprised at one time that she recovered. Discharged in the 10th week.
B. — The Retro-peritoneal Method.
H. H., 8Bt. 42, married, attended my out-patient department for several months. The tumour was about the same size as the last, i.e., reached the level of the umbilicus ; haemorrhage was considerable and persistent, and the heart was losing strength. On this ground I again advised operation — it had been declined before* There were haemic bruits and some dilatation. The pulse before operation was quick. The urine was healthy and the quantity good.
The operation was performed on 1st October of this year. No drainage was used. The first night the nurse's notes state " Sleeping frequently a few minutes at a time ; has complained of pain on and off» still has been quiet." On the second day, " Very good day on the whole, very little pain, no sickness, great thirst." There was no reference to operation pain after this.
I have classed this patient as an ''unsatisfactory recovery " because the pulse-rate gave me anxiety for the first fortnight, remaining from 108 — 120, and also because on the twelfth day a rigor took place, the temperature rose to 104^ F., and a slight tender swelling was found to the right of the cervix. This attack was accompanied with some pain in the left iliac region. The temperature came down in three days and nothing came of it, and the local swelling
748 UTERINE FIBROIDS. "^"S^iL^^SrVr^
Beriew, Dm. 1, 1606.
disappeared. Patient had some offensive diarrhoea from the sixth day, and on and off for a fortnight this caused some exhaustion and kept up the ansBmia. She left the hospital on the 81st October — four weeks and three days after operation, in good condition. (For the notes of this case I am indebted to Dr. Moss.)
" Complete Successes." A.— The Old Method.
The notes of B.A., set. 34, single, were taken by Dr. Chapman, then house-surgeon. The tumour was a large one reaching nearly to margin of right ribs. The size and weight of tumour constituted the chief trouble, micturition was somewhat frequent and occasionally difficult. Operation on Feb. 1st, 1897, no difficulty, pedicle easy to make, drainage used.
Pulse rose to liiO in 36 hours and remained about 120 for one day, then gradually came down, pulse and temperature keeping well together.
As to pain — 4 hours after the operation was over, patient had so much pain and restlessness that a suppository of morphia, gr. J, was given ; next day. nurse's notes say ** severe abdominal pain " ; "a great deal of pain all day " ; next night " kept awake by pain " ; '* restless and moaning " ; morphia given hypodermi- cally by house-surgeon ; next day " less pain " ; no further mention of pain from operation. There was a good deal of suppuration round the stump which was trimmed on the 8th and 10th days, and the rubber tube removed on the 13th, together with rest of pedicle. Dis- charge continued free until the beginning of the second week in March ; the wound was completely healed during the seventh week, at the end of which the patient left the hospital.
B. — The Retro-peritoneal Method.
Dr. Bennett, of HoUoway, sent to me in October last a single lady, mt. 39. She was very ansemic, the pulse showed by the sphygmograph signs of failing tension. Operation was advised and performed on the 18tb Oeto- ber. Patient complained the first night, at intervals, of abdominal pain, especially with the sickness (four times), but she slept two hours, in short spells ; next day, " not nauch pain." 2nd night, 8^ hours of sleep, "a good night until 6 a.m," then vomited and caused abdominal pain." 3rd day, *' not complained of abdominal pain."
SdSyrgrnsj!^ uterine fibroids. 749
Urine was passed naturally once on the 8rd day, but the catheter was used again for two days. Bowels opened early on 6th day.
The pulse reached 110 for a few hours the day after operation but soon descended to 100 ; after the 4th day it was under 90.
Stitches removed at two sittings, 7th and 10th days.
Patient was lifted out of bed at the end of a fortnight and tried her feet a week later ; left the Nursing-Home four weeks after operation. There were no drawbacks.
The Operations Compared.
For simplicity and speed the old operation must receive the commendation due to it. In a straightforward case but little skill or judgment is required for its perform- ance ; when adhesions or other complications are present the difficulty of operating is increased in direct ratio in both forms of operation. Now the length of time con- sumed in an operation may in some cases be of supreme importance ; where it is questionable whether the patient has strength for the shock an extra 20 or BO minutes spent under the anaesthetic may turn the scale against the patient. Here the time advantage presented by the old method must receive its due weight.
But the simplicity of that method is due to its crudity ; a large mass of tissue — part tumour, part uterine or broad-ligament tissue is crushed together in a constrict- ing ligature sufficiently powerful to produce distal gangrene — dry or moist according to its tightness.
Such a principle in general surgery would be scouted as unsound and inadmissible, and I have always felt it to be a violation of one's surgical instincts. Moreover the distortion and dragging on the parts associated with retaining the pedicle by force in the abdominal wound is productive of severe pain. The amount of pain com- plained of after the retro-peritoneal method where there is no strain on the tissues is very much less. There is another circumstance which should be noted — the old operation is of less general usefulness than its rivals there being many cases in which it is hardly suitable where the broad ligament is occupied by a large growth and the tumour projects into the pelvic cavity, and below the cervix which is " absorbed," as it were, into the body — in short, wherever it is unusually difficult to form a pedicle, there the old operation is unsuitable if
760 UTERINE FIBROIDS. ^B^I^^?1St
Befview, Dec 1, 180B.
not altogether impracticable. On the other hand, where a small pedicle makes the old operation easy and (rela- tively) satisfactory, there the new method is also excep- tionally easy and safe.
This is, perhaps, a matter of minor importance, for a surgeon should not start with his mind made up to do any particular operation — only to decide after opening the abdomen as to the most suitable. Unfortunately an operator who seldom practises the retro-peritoneai method, rarely decides in its favour when the difBculty presents itself. It may be bad to have a bias either way, but it seems better to be prejudiced in favour of a method which is always suitable than in favour of one which may any day fail one.
Cceteris paribus the shock is greater after the old, than the new method.
Finally, drainage is rarely needed by the new method, and the abdominal wound is not weakened by the pedicle.
On all points, therefore, save in the matter of time, the retro-peritoneal method is superior to the old operation.
It will, of course, be manifest that the few cases I have space to quote cannot illustrate all the points to which I allude in comparing two operations and their subsequent history, but my statements are facts I have observed or opinions I have myself formed or endorsed.
^ Fatal Cases Compared.
In the nature of things there cannot be much to be said of this series — it matters little to the operator under which method he loses his case, and to the patient nothing under which she dies. While still alive, however, her comfort is of the highest importance to herself and her friends. The fatal cases I have quoted are fairly representative as regards pain — the severity of course varying with the amount of tension put on the tissues. It may be a doubtful advantage that the patient lives longer under one method than another, if she finally dies, but I think cases live longer under the retro- peritoneal operation. If life be prolonged more oppor- tunity is given for efforts to save the case, and in some instances for the transaction of important business. The frequent dressing required in the old operation, and specially with drainage, is a distress to the patient.
bI^^^SSTiS^ utebine fibroids. 761
*' Unsatisfaotoby Becovbbibs" Compabed.
It is after the first week that most of the complications arise among unsatisfactory cases which nevertheless get well. The prime difference between the old and new operations in cases doing well for the first week is this : under the old the danger of sepsis begins or notably increases after the first week, while with the new it lessens or disappears. In neither case is peritoneal infection likely to occar at this date. In the old the sloughing pedicle is for many days a source of danger, a danger especially great at the time of removal of the pedicle-pins. Abdominal symptoms are not conspicuous, unless it be diarrhoea. Pleurisy, patches of pneumonia, bronchitis, delirium, splenic enlargement, pericarditis, nephritis, or renal inadequacy are real sources of anxiety. They are the more grave that they are evidences of systemic poisoning, and that a toUe causam treatment is almost impossible. The case quoted under this heading is a severe one — an extreme one indeed, and I am far from suggesting that such is a usual sequence of the old method.
More ligatures are buried in the tissues by the new method, and it is from these that difficulties of a local character are liable to arise. I believe that a local inflammatory condition of this nature will explain the rise of temperature which came on during the second week of the case I have quoted (H. H.). Collections of pus occasionally form around the stump, and if .allowed to burrow may cause troublesome sinuses ; I have not had such misfortunes so far in any cases. Another complication probably more common with the retro- peritoneal method is thrombosis of an iliac vein with its attendant danger of detachment of a clot. As the cellular tissue between the peritoneal layers of the broad ligament is more interfered with by the new method there is more liability for irritation to extend to the coats of the iliac vein. In one of my patients this came on about the tenth day and interfered with convalescence. Whenever the tumour grows out into the mesometrium and has to be shelled out this danger is present in either operation. But as such cases are less suited to the old method, a disproportionate liability may be forced, as it were, upon its rival.
762 BE7IBW8. "t^ifSSff^SJr
BeTiew, Dec. 1, 18B0.
" GoMPLBTB Successes " Compabbd.
It is, perhaps, here that the most striking difference between the two methods is seen.
In the old. — Apart from the pain of the early days — an experience not readily forgotten by the patient — there are daily dressings, perhaps daily screwing up of the serre noeud, removal of pedicle pins, slow separa- tion of the slough, an ugly scar and a weak spot in the ventral wall, and a sojourn in hospital for seven or eight weeks.
In the new. — After the ansesthetic vomiting is over,, the pain is almost nil, urine is passed naturally almost at once. There is no dressing until the stitches are removed between the 7th and 10th days. Recovery i» as uneventful as after a successful and straightforward ovariotomy. The patient may safely be lifted out of bed at the end of a fortnight and may walk a week later^ leaving hospital at the end of four weeks. Add to this the greater freedom with which the patient may, from the beginning, be moved about, and the immense supe- riority of the new method per se is strikingly obvious.
REVIEWS.
The TJierapeutics of Facial and Sciatic Neuralgias ; tptth Reper^ tories and Clinical Cases. By F. H. Lutze, M.D. Phila- delphia : Boericke & Tafel. 1898. Db. Lutze 6 little book is one which has sprang out of careful work ucdertaken, at first, for the benefit of himself and his own patients. For this reason it is one likely to be of use to others. It is on the well-known pattern, where a long list of drugs is given in alphabetical order, and the various pains supposed to be caused or cared thereby are stated categorically* These symptoms are distinguished by varying typography, but we have discovered no clue to the meaning of the different tvpes. If we may sappose them to mark clinical confirma- tions in his own experience their value is enormously enhanced. The ptatement at the close of each symptom-list of the aggravations and ameliorations is very usefal. Over 150 remedies are mentioned in the index, and to enable the bewildered physician to select the one remedy required, a repertory at the end of each section (facial and sciatic) is added.
Although we have not implicit confidence in all the authorities quoted, we are sure that if our readers would only take the troable to use Dr. Lutze*s book (or, still better, make
iSS^fgniSr MEETINGS. 768
one for themselves) they will be gamers in a two-fold sense. They would cure more patients and have less need to resort to gross sedatives ; still more important, they would acquire a growing confidence in their remedies and in the homoeopathic rule. Any effort which encourages men to study the materia medica, and to individualise their cases, meets with our approval and support.
The clinical cases cited are a relief to the reader ; they are always interesting, and often striking and instructive, and one in the introduction should prevent laxity in diagnosis, wad undue optimism.
MEETINGS,
BRITISH HOMCEOPATHIO SOCIETY. Thb second meeting of the present Session was held at the London Homoeopathic Hospital, on Thursday, November 8rd, 1898, Dr. A. 0. Clifton, President, in the chair. Hahnemann Mbmobial. Dr. Burford reported that oi\ a recent visit to Paris he had called on Dr. Gartier, the secretary of the movement for re-instituting a memorial of Hahnemann at Pdre la Chaise. Dr. Cartier informed him that the memorial fond was languishing, only 10,000 francs having been promised out of a necessary 18,000. Dr. Cartier was anxious that the memorial should be finished by the time of the International Congress in Paris, in 1900. Dr. Burford endeavoured to ease Dr. Cartier's anxiety a little by a promise to bring the matter under the notice of British homoeopathists. Unfortunately, the French sculptors would not begin the work until they had cash in hand.
bmtOVBMENT OF THB MaTBBIA MeDIOA.
Three papers were then read by Dr. J. W. Hayward of Liverpool, Dr. Madden, of Bromley, and Mr. Wilkinson,, of Windsor, respectively, on the work to be undertaken for the improvement of the Materia Medica.
Dr. Hayward adopted as his title : '' The Systematic and Scientific Development of the Material now at Our Disposal," and he pointed out that such development could never issue from simply a presentation of the pathogenetic material such as that we possessed in Hahnemann's Materia Medica Pura and the Cyclopaedia of Drug Pathogenesy. Neither would the Combined Index to these two works, which was being prepared, fulfil this purpose. Dr. Hayward advocated the plan of the " Materia Medica, Physiological and Applied," but confessed that it was too elaborate either for execution or practical service, and he proposed some simpler treatment of the materials along the lines of this work.
VoL 42, No. 12. 3 C
764 MEETINGS. "^i&,fgST^
Dr. Madden dealt with " The Necessity for Systematic and Scientific Be-proving of both Old and New Drugs." The basis of his argument was the immensely wider field covered by symptomatology in the present day than when most now weU-used drugs were originally proved. Hence the necessity for the reproving of these. In the old days sub- jective symptoms were most important, because the means at the disposal of physicians for obtaining reliable objective ones were very meagre, and pathology as a science was largely speculation. Such was not the case in the present day, and Dr. Madden advocated re-proving, with the special aim of adding objective results to those already known of the effects of drugs. All means of scientific or clinical research should be pressed into the service.
Mr. Wilkinson's title was '* Prolegomena of Modem Provings", and the basis of his argument practically the same as that of Dr. Madden. Subjective symptoms were good, useful, and necessary, but objective symptoms were more necessary than any. Mr. Wilkinson went into detail as to the organisation of new provings, the spirit in which they should be undertaken, and the precautions necessary to secure accurate results. He pointed out that the ''individual norm" of the prover was of the highest importance in estimating objective drug effects, especially with those drugs which were already known, and the effects could to some extent be anticipated. This '' individual norm,*' accordingly, should be always ascertained and recorded before the proving was begun.
Should a prover know what drug he is taking? was a question Mr. Wilkinson asked, and after careful consideration, answered in the afiirmative. Ignorance did not lessen the likelihood of auto-suggestion, and the prover, ignorant of the drug he was taking, would be deprived of the power of questioning his own symptoms.
Much advantage would accrue if the minds of several men were concentrated on one drug; and the essayist did not think men need fear interruption of their daily work on under- taking provings of drugs.
An interesting discussion followed the reading of the papers in which Drs. Clarke, Ord, Dyce Brown, Hughes, Fisher (Chicago), Pullar, Qoldsbrough, Burford, Neatby, Messrs. Knox Shaw and Dudley Wright, and Dr. Moir, took part. Eventually a committee was formed, consisting of the President and Secretary of the Society with Messrs. Wilkinson and Ord, to report at the next meeting of the Society as to what arrangements could be made with a view to promoting the object of the discussion.
ggSi^l^lgrna^^ NOTABILIA, 76^
NOTABILIA.
DB. GEORGE CLIFTON.
At the time of the last Annual Homoeopathic Congress (June) it was an open secret that our good friend, George Clifton, of Leicester, would in due time be elected to the Mayoralty of that town at the next vacancy. It is probable that this faet had something to do with the selection of Leicester, at Dr. Clifton's invitation, as the place of its next meeting.
On the 9th ult. the election took place, and Alderman George Clifton became Mayor of Leicester by a unanimous vote.
The mover of the resolution alluded in laudatory terms to Dr. Clifton's work, both professional, municipal, and philanthropic. Special allusion was made to his efforts in the ''almost sacred cause *' of the work for the *< Prevention of Cruelty to Children " ; also to the time of the small-pox epidemic in the town. The mover of the resolution also said of Dr. Clifton that '< In addition to all his other duties be has devoted himself to the department connected with the Fever Hospital, but it is in connection with our lunatic asylums that Dr. Clifton has mainly discharged his municipal duties. For seven years he has been chairman of that committee, and when you remember what an important work has been cast upon our municipality by having the care of those who are mentally afflicted you will realise what a good thing it is we have had in our midst one specially gifted and specially trained, and willing to devote himself to presiding over the administrations of that very large department of municipal work. I know that the friends and relations of the patients are indeed grateful for the presence of the doctor there, and that his work has been highly prized by everyone who is acquainted with it. (Applause.) There has been no show during all those 16 years, no excitement in the work tbat Dr. Clifton has undertaken. It has been 16 years of hard, plodding, hum- drum work, of pegging away at the daily and weekly duties that came round to him, and the public outside ought to know of tbe quiet, unobtrusive work that has characterised Dr. Clifton during all those years."
In thanking the Town Council for the honour put upon him, Dr. Clifton said : — '* I trust that the municipal year on which we are to-day entering may be one of peace within these walls, and prosperity to the good old town of Leicester. The records of our town show that 40 years ago to-day a representative of the medical profession — one of the ablest men of his day, a wise physician and an accomplished gentle- man— was appointed to this chair, I refer to Dr. Noble.
3 c— 2
766 UOTABILIA. "2^^2«S!
(Applause.^ Nine years ago also you honoured the medical profession oy choosing another good and worthy representa- tiye to fill this chair in the person, of Dr. Lankester — (applaase) — and you have again to-day chosen another member of the same profession, one who perhaps is not orthodox in all things, bat still one who has endeavoured to uphold the dignity of that profession, and who has ever put .first and foremost the daty of serving his fellow-men by nsing the knowledge he has acquired for the relief of suffering humanity. In the discharge of my official duties during the coming year you may sometimes doubt my judgment and wisdom, but I hope you will never doubt my honesty, and my desire to serve by all means in my power to maintain the good government of our town, and my efforts to uphold the best traditions of this Council. (Applause.) In all our detiberations I shall ask you to remember the words and sentiments expressed by a Leicester- shire worthy, Lord Macaulay, in his 'Lays of Ancient Bome ' :
** Then none were for a party, Then all were for the State. Then the great man helped the poor. And the poor man loyed the great. Then Romans were like brothers. In the brave days of old."
(Applause.) As the President of this Chamber, I shall endeavour to conduct its proceedings with strict impartiality, and I trust that, however divergent the views that may be expressed by members, it will be bome in mind that each one is here by the same constitutional right and authority, and that fairness and courtesy will be shown by all.** (Applause.)
We offer our cordial congratulations to the chief magis- trate of Leicester, and to our confrere, the elected President of the next Annual Congress of Practitioners of Homoeopathy, and wish him success in all his undertakings.
HAHNEMANN CONVALESCENT HOME, BOURNE- MOUTH. A SHORT time ago we inserted in our correspondence pages a letter from Dr. H. Nankivell, of Bournemouth, respecting the needs of the above-named institution, and the desirability of enlarging it, and of adding balconies for the open-air treat- ment of chest cases.
In aid of the fund for these objects a grand bazaar was held on the 2nd and 8rd of November, under the patronage of H.R.H. Princess Christian, H.R.H. the Duchess of York, the Countess and the Dowager Countess Cairns, the Lady Kath-
H^^^jB^St'" NOTABILIA, 767
leen Eliot, the Lady de Tabley, and other distinguished personages.
No pains were spared to make the event a success. The bazaar was held at the Mont Dore Hotel Assembly Booms (which were artistically decorated), kindly lent for the purpose.
The stalls contained a varied and valuable collection of useful, artistic and attractive goods, including : —
Oil and water colour paintings, artists' proofs and photographs, baskets and embroideries, pottery and Swiss wood carvings, stationery and perfumery, household linen, glass and china, toilet requisites and drugs, groceries, jams, cakes, &c., &c. The exhibition of hospital models formed a special and interesting section. of the Bazaar. These ingenious models were prepar^ by Sister Marion (of the London Homoeopathic Hospital), and have received prizes in England and America.
In the Winter Gardens, adjoining the Assembly Boom, short entertainments were given by Mr. Sidney Gandy, a thought reader and ventriloquist, assisted by Miss Inglefield
On Thursday evening, November 8rd, there was a Special Magic Lantern Exhibition, under the direction of the Bev. E. P. W. Eliot and Dr. Nankivell.
H.B.H. Princess Christian much regretted that as her time in November was fully occupied, she was unable to come and open the Bazaar. She heartily wished success to the sale, the object of which has her warmest approval. H.B.H. the Duchess of York sent some of her work to the Bazaar, ** Hoping thus to show her true interest in, and appreciation of, the object for which it is held."
Our Bournemouth friends are to be congratulated, not only on the influential patronage they received, but on the financial success of the Bazaar, which should serve as a model of excellent and economical management. The profits, above and beyond expenses, which only amounted to £77, reached the handsome sum of £628 17s. 9d.
FOLKESTONE HOMCEOPATHIO DISPENSABY.
Wb have just received the eighth Annual Beport of this insti- tution, from which we are pleased to learn that its funds are now in a more satisfactory condition. The old premises at Grace Hill have been given up to allow of alterations to the neighbourhood, and new ones more convenient have been secured at 11, The Parade, on the Bayle.
The sale of work, to which we referred at the time it was held, brought in the sum of £129.
Dr. J. Murray, the Medical Officer, paid no less than 514 home visits in the year.
768 C0BBE8P0NDBHCE. ^"^^^ST?^
Review, Dec. 1, 1898.
DR. BERNARD ARNDLPHY. Those of ns who are sendiDg patients to the Eastern RiTiera this winter will he glad to know that Dr. Bernard Amulphj, who for a nomher of years has heen working in the Hahnemann College and Hospital of Chicago, U.S.A , has returned to Nice, at any rate for the present, and will attend to any case commended to him.
HAHNEMANN TOMB FUND.
AmouDt already aonounoed
Dr. Proctor
Dr. Mnjaxndar
Surgeon-Major Deane
G. Kdox Shaw, Esq
Dr. Black Noble
B. HnoHES.
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CORRESPONDENCE.
THE IMPROVEMENT OF THE MATERIA MEDICA. To the Editors of the ** Monthly Homoeopathic Review.^' Gentlemen, — At the last meeting of the Britiph Homoeo- pathic Society some of the members who took part in the discussion sef med to hanker for more scientific data in the provings of medicines, chiefly with a view to render our materia medica more acceptable to students of pharmacology. It would no doubt give a savour of modernity to the present- ment of medicines if it were possible to append to each proving such data as sphygmographic tracings, ophthalmoscopic appearances, estimation of the amount of various excretions, and in short all ascertainable objective phenomena described in the latest phraseology of the schools. But I venture to doubt whether such additions would greatly enhance the value of our materia medica from a practical standpoint. I do not wish to depreciate in the least the advances that have been made in diagnosis and etiology, or in the knowledge of pathological changes. On the contrary, I think it is extremely important that we should be au courant with all the latest developments of medical science. And we have ground for congratulation in the fact that the surgeons and gynsecologists of our London hospital are as fully equipped in their depart- ments as the most distinguished specialists of the dominant school. For whatever differences may exist amongst us regarding the scope of homceopathy, I suppose we are all agreed that a certain proportion of cases are beyond the stage of medication, and can be efficiently dealt with by surgi(^ methods alone. It seems to me, therefore, that a wide and catholic spirit is the only philosophic altitude in view of ihe
SlSSiJf^TJSr" CORRESPONDENCE. 769
fBbct that the oare of disease fulfils itself in many ways. The extraction of an impacted gall-stone by sargical means is, in my opinion, quite as laadable an achievement as the core of some chronic disease by high attenuations of the homoeopathic remedy. In the healing art there ought not to be a narrow outlook in any direction, for we are surely on a higher plane than monopolists.
When, however, we come to the question of presenting the materia medica in a form that may prove most attractive to the highly trained and orthodox young gentlemen from the laboratory, I must join issue with those whose chief aim seems to be to approximate our methods as much as possible to those of the old school. What have they done for the real advancement of therapeutics, with all their experimenta- tion on the animal kingdom, from the mollusca upwards ? The truth is that they have only emerged from primeval darkness under the borrowed light of homoaopathic teaching, and, instead of gratitude, we get ostracism and misrepre- sentation. We might say with Shylock, ** Sufferance is the badge of all our tribe.*' Moreover, we must recollect that the enduring value of homoeopathy has been amply demon- strated on quite other lines, and some of us are content — nay, proud — to follow in the footsteps of its illustrious pioneers. The lines of homoeopathy and allopathy are, indeed, so essentially divergent that there would appear to be no meeting place except on the neutral territory of empiricism, and if it were practicable to inter homoeopathy in that common ground, I can imagine that the obsequies would attract a large and representative gathering of the ** pharmacologists."
Instead of vainly hankering after the good opinion of the old school, would it not be the wiser course on our part to grant that the phenomena involved in the curative action of our remedies are at present beyond scientific explanation, at least, in terms that would satisfy the requirements of pharmaco- logists whose conceptions are based on the crude methods of the laboratory, The phenomena in question have simply to be accepted as ultimate facts in therapeutics, attested by competent and trustworthy observers during nearly a century of clinical experience. If this view of the matter does not accord with the ideas of the ** scientific " school, so much the worse — for the ideas. It would obviously be futile, for instance, to attempt to set forth in physiological terms, the rationale of the action of a high attenuation of stramonium, or anacardium, or platina in reducing to comparative harmony the jangled chords of a mind out of tune. And, yet, I know as a clinical fact in my own experience, that such are the possibilities of medication.
760 CORRESPONDENTS. "'^I^SSTSS!
B«Tiew. Dec. 1, 1606.
These things are entirely oat of the range of the so-called soientifio physician, and constitute a barrier between the two schools which no concessions on our part are likely to remove. It seems clear that whatever may be the fatnre developraentff of therapeutics, the unique strength of the homoeopathic method will assuredly rest upon its apprehension of the real significance of mental and subjective symptoms, rather than upon any more material grounds.
Yours truly, Alfbbd Pullab, M.D. Ed. London, November 14th, 1898.
NOTICES TO CORRESPONDENTS.
•^* We cannot undertake to return rejected manu^eriptJt. Authors and Contbibdtobs receiving proofs are requested to oorreot
and return the same as early as possible to Dr. Edwin A. N batbt.
London Hom(eopathio Hospital, Great Orkond Strbet^ Bloomsburt.— Hoars of attendance : Medical, In-patients. 9.30 ; Out- patients, 2.0, daily ; Surgical, Out-patients, Mondays, Thursdays,. Fridays and Saturdays, '2.0 ; Diseaseo of Women, Out-patientSr Tuesdays, Wednesdays and Fridays, 2.0 ; Diseases of Skin, Thursdays, 2.0 ; Diseases of the Eye. Thursdays, 2.0 ; Diseases of the Throat and Ear, Wednesdays, 2.0 ; Diseases of Children, Mondays and Thursdays,. 0 A.M. ; Operations, Tuesdays, 2.30 ; Dental Cases, Thursdays, 9 A.M. ; Orthopaedic Cases, Tuesdays, 2 p.m. ; Electrical Oases, Thursdays, 9 A Jf .
BOOKS RECEIVED.
RenalThsrapeutict, By Clifford Mitchell, A.M., M.D. Philadelphia: Boericke & Tafel. 1898.— On the Study of the Hand for Indications of Local and General DUeoMe. By Edward Blake, M.D. London : Olaishtr and Ball. — Dijf orders of the Sewnal Organs of Man. By Dr. Ourletno. New York : Boericke & Co.— Journal of the British Hommtpat.hu\ Society. October, 1 898. — Tht^ Homceopathie World, November. London. — The Calcvtta Journal of Medicine, May and June. — The Chemist and Druggist, November. London. — South Australian Register, Septem* ber ioth.— r//^? North American Journal of Homceopathy, October.. New York. — Th4^ HomcBopathic Eye and Ear Journal. November. New York. — The Medical Times. November. New York. — Th- New England- Medical Gazette, November. Boston.— 7^^; Hahnemannian Monthly, November. Philadelphia. — The Horn ofopat hie Recorder, November. Philadelphia — The Homeopathic Envoy. November. Lancaster, Pa^ The Medii-al Era November. Chicago. — The Hahnemannian Advocate. Nov«»mber. Chicago. — The Minneapolis Homeopathic Magazine, Octo^ h&r.— The Leicester Daily Post November 10th.— T^a Medical Century. October. New York and Chicago.— Jft« Clinique. October. Chicago. — The American Mfdical Monthly. October. Baltimore, — The Paeifio- Coast Journal of Homceopathy. October. San Frandsoo. — The Medical Brief, November. St. Louis. — Retu-e Homeeopathique Prangaise. November. — Homeopath ische Maandhlad, November. Nederland. — AllgemeineHomdopathiMclie Zeitung, October and November. Leiprig*
Papera, Dispensary Eeports. and Books for Beyiew to be sent to Dr. Pore, 19^ Watergate, Granaam, Linootnabire ; Dr. D. Dtcb Bbowk, 89, Seymour Street*. pOTtman Square, W. ; or to Dr. Edwiw A. Nbatby, 178, Haveretodc Hill, N.W, Advertwanents and Buamees communications to be sent to Measn. B. Gould ft Sosr» Limited, 60, Moorgate Street, E.C.
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