The Journal of the British Homoeopathic Society

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I

1

t8<2>

CJf ^nnraal

OF THE

Itritisli InMDptJir |nmtii

O '^

NEW SERIES

VOL. I.

SESSIOISr 1892-1893

EDITED BY

RICHAED HUGHES, M.D.

Xon^on
JOHN BALE & SONS

87-89, GREAT TITCHPIKLD STREET, OXFORD STREET, W.

\ 1893

}

*1

CONTENTS.

Officers and Council.

list of Presidents.

Trustees.

Corresponding Members.

List of Fellows.

List of Members.

Liverpool Branch.

Local List.

Members Eesident Abroad.

Papers and Communications.

Summary of Therapeutics and Pharmacodynamics.

Index.

:o

r^i

EXCHANGES.

Allgemeine Homoopathische Zeitung

L'Art Medical.

The American Homooopathist.

The Clinique.

The Hahnemannian Monthly.

HomoDopathic Journal of Obstetrics.

The Homoeopathic Physician.

The Homoeopathic Eecorder.

The Homoeopathic World.

The Journal of Ophthalmology, Otology and Laryngology.

The Medical Century.

Medical Advance.

Medical Era.

Medical and Surgical Becord.

Minneapolis Homoeopathic Magazine.

The Monthly Homoeopathic Eeview. ^

New England Medical Gazette.

North American Journal of Homoeopathy.

Pacifiic Coast Journal of Homoeopathy.

Bevue Homoeopathique Francaise.

Bevue Homoeopathique Beige.

Southern Journal of Homoeopathy.

Zeitschrift der Berliner verein Homoopathische Aertze.

NOTICE.

This volume comprises the proceedings of the British
Homoeopathic Society during its Forty-ninth Session, 1892-93.

The Council does not hold itself responsible for the
statements, reasonings or opinions expressed in the various
Communications published in the Journal.

JOURNAL

OF THE

muMptMr

No. 1. JANUAEY, 1893. Vol. I.

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

36, Sillwood Boad, Brighton.

EDITOEIAL PEEFACE.

The British Homoeopathic Society was founded in 1844.
It was not till 1860, however, that it began to issue a period-
ical record of its proceedings. This publication was styled
** Annals and Transactions of the British Homoeopathic
Society and of the London Homoeopathic Hospital." It ha&
continued to appear ever since ; for though its contents first
saw light, from 1870 to 1876 inclusive, in The British Jour-
nal of Homoeopathy, and from 1885 to 1892 in The Monthly
Homoeopathic Beview, they were always reprinted in separate
form and sent to the members, who thus have a complete
set of the journal to the present time, forming twelve
volumes of 600-700 pages each.

Our present publication is the avowed and direct con-
tinuation of its predecessor, though under a different name.
It has assumed its altered title for several reasons. In the
first place, the London Homoeopathic Hospital has now
acquired such strength and individual life that it has begun ^
and intends to continue, to publish its own " Eeports " after

VOL. I. — NO. 1. 1

2 EDITORIAL PREFACE.

the fashion of other metropolitan institutions of the same
kind. Its name, therefore, disappears from our titlQ-page.
Again, the phrase "Annals and Transactions '* was chosen
(we apprehend) in order to warrant the use of past as well
as current proceedings of the Society. Of such liberty
we have no need at present to avail ourselves. We might
then have called our present issue simply *' Transactions of
the British Homoeopathic Society." But, in the first place,
we propose to give, in addition to the papers read before, and
the discussions held by, the Society, a summary of the phar-
macodynamics and the therapeutics of each quarter's jour-
nalism; so that "Transactions" simply will not cover our
matter. And then, secondly, we want to indicate the fact
that in substance as well as in form we are making a new
departure ; that the present series of the Society's publica-
tion is the fruit of a renewed life and energy on its part,
which it trusts will be felt by its members far and wide.

We have, accordingly, assumed the title of The Journal
OF THE British Homceopathic Society, following thereby
more than one well-known precedent. But we would have
it distinctly understood that we in no way seek to rival The
Mo7ithly Homceopathic Beview and The Homoeopathic World,
We occupy different ground from these our contemporaries ;
we give no news (save of the Society itself), review no books,
take no part in medical politics or controversies. We aim
only at providing the members of the Society with a record
of its work, and a series of excerpts from the journals which
lie on its table. If we can perform this task to their satis-
faction, our aim will be attained.

ON STAMMERING HEABT.

ON STAMMERING HEAET.^

BY R. E. DUDGEON, M.D.
Consulting Physician to the London Homoeopathic Hospital.

The cardiac affections I am going to bring under your
notice to-night are not very interesting because not danger-
ous. I have lumped them together under the name of
^* Stammering Heart,*' for I think that title best indicates
their character and importance. Though as a rule they
are not dangerous they are extremely disagreeable, and
often cause a great deal of anxiety and alarm to the
patient and the doctor.

What constitutes a stammering heart is irregular action,
without ascertainable organic disease, valvular or muscular.
I am not aware that the name "stammering" has been
applied to these affections, but they have been described
under other appellations. Thus Dr. Latham : ** "What can
be said of palpitations of the heart, and intermissions and
irregularities of its beats which come and go during a man's
whole existence, neither originating in any known disease,
nor terminating in any, nor abridging in any measure the
duration of life? They must mean something, but we know
not what. We may call them sympathetic, but it must be
in a very lax sense.** (Latham's Works, Syd. Soc, ii., 519.)

Probably modem pathology would not be content with
such an inconclusive statement. In place of talking vaguely
about sympathy, the up-to-date pathologist would have to
speak about the sympathetic and the vagus nerves as factors
of the phenomenon, or say something pleasant about the
increase or diminution of the inhibitory power of the cardiac
ganglia, or vaso-motor nerves. But after all, when we come
to consider the matter curiously, we shall have to confess
that the modem pathological explanation is hardly more
satisfactory than Dr. Latham's no-explanation, and does not
afford the slightest hint that could be of use for therapeutical
purposes.

' Bead before the Society, October 6th, 1892.

OS STAMMKBiyO HEABT.

Irregularity of the heart's action is not always without »
perceptible pathological cause. Pneumonia is frequently at-
tended by a very palpable irregularity, a fit of asthma almost
invariably shows it, an accumulation of flatulence in the*
stomach is a frequent cause of it, various valvular disease&
are known to be accompanied by it, and some kidney diseases,
are seldom without it, but the stammering heart differs from
all these.

As the analogous affections of the voice muscles are
divided by pathologists into two classes, stammering and
stuttering J so the irregularity of the heart's action I am
speaking of may be said to be of two kinds, stammering
and stuttering, Intermittence, regular or irregular, may be
termed stammering; other irregularities in which, so far
from there being fewer beats per minute, there are often
many more beats than in the normal state, I would call
stuttering. However, not to refine too much, I will call all
the irregularities of the heart's action, without demonstrable
pathological cause, " stammering heart."

The common typical variety of this affection is seen
in the intermittent pulse.

Fig. 1.

This is sometimes congenital. I will show now one of a.
series of sphygmograms I possess taken from a young lady at
different periods of her life. When I first noticed her irregu-
lar pulse she was about two years old ; she is now fifteen, and
she has never lost the stammer I first observed in her. It
changes its rhythm now and then, but never by any chance
becomes what may be called regular, except transiently, when
the circulation is hurried by great exertion or a febrile condi-
tion. When I first observed it it was of the character seen
in fig. 1 — a normal beat followed by a bigeminous beat —
quite regular in its irregularity. Some days after this the
little girl had an attack of jaundice, the pulse then became

ON STAMMERING HEART. O

-entirely bigeminous, i.e., the systole of the heart was suc-
ceeded before the pulse had attained its full length by an
abortive systolic action, causing the slight curve seen in the
middle of what appears to be a beat of double the normal
length. It is thirteen years since then, but the pulse during
all that period never deviated into a normal character, and
never, as far as I am aware, showed three successive normal
beats, wdth the exception to be presently noticed. I took a
sphygmographic tracing in April of this year when she was in
perfect health, and was nearly grown up to woman's estate,
and it was still irregular, though the irregularity differs

Fig. 2.

slightly from what it used to be. The latest sphygmograms
I have of her were taken in September last, when she was
evidently sickening for measles, with a cough and tempera-
ture of 103". The regular intermittence is very obvious.
When the fever attained its height two days afterwards,
temperature 104.2°, the intermissions became rarer, usually
every fifth or sixth beat, but occasionally the pulse would
beat quite regularly for a much longer period, as shown
in fig. 2. Here the pulse, which in the normal state ranged

Fig. 3.

from 70 to 80, was quickened to 126 beats per minute. Next
day the fever having subsided, the temperature became nor-
mal, and the pulse went down to 70, its normal abnormality
was restored, as shown in fig. 3.

Such cases, where there is never any return to a regular
normal action except in morbid conditions in a heart other-
wise presenting no sign of disease, are rare. On the other

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fA^ti [frit/'-Auy J t^Mi: X iiifc pulse sb:'ws> libf^ STAJiniier ftssnimn^

r'ts^. v^i'Ai^ <j\siy ^'j iajiDpffiiiic xi«tfEm£^j53^ He ^^sonie years

-'•^;iniii^^--.r ii^iart of this chArjw^ter xiscaIIt becomes

ON STAMMERING HEART. 7

regular if the circulation is hurried by exertion, wine or any
febrile attack. In this it differs from the irregularity attend-
ing heart disease, as that is usually unaltered when it is not
increased by such causes. An intermittency of the heart's
beats — though it is occasionally met with in cases of acute
disease, and then may" indicate a partial failure of power
requiring some cardiac tonic — when it is an habitual state
and especially when it preserves a sort of rhythmic regu-
larity and is not attended by wealmess of the heart's actidn
generally, is not to be looked upon as a morbid or even as
an important symptom. It is recorded of Talleyrand, whose
pulse intermitted regularly every fourth beat, that he as-
cribed his longevity and good health to the circumstance
that his heart had a rest every fourth beat which gave it a
decided advantage over hearts which went on pumping the
blood continuously and without pause. The idea that the

Fig. 6.

intermission is a rest during which the heart acquires fresh
vigour derives some countenance from the circumstance that
the next beat after an intermission is generally stronger than
the other. I submit one among many examples in my
possession which illustrates this : (fig. 6).

The same thing is observed even when the intermission
is not perfect, when indeed the abnormal pulse consists of a
normal beat followed by a weak or imperfect pulsation.
Still the next beat will be found to be stronger than the
strongest part of the abnormal beat.

Intermissions are usually not perceptible to the subject
of them, but this is not always the case. Sometimes a more
or less distinct momentary obstruction is felt during the
intermission. It is not pain, but a kind of stoppage is felt.
Sometimes the feeling is much more intense. Patients have
complained to me that it seemed as though the heart were
for an instant squeezed by a vice.

8

as afrAMMEBIS€k heabt.

The more irregolar variety of stammmng heart, which
I have called stuttering, is often accompairied hy diragree-
able sensatioiis, described by the subjects of it as palpita-
tion, flattering, holding back, squeezing of the heart, &c.

Pig. 7 is a sphygmograni from an old gentleman above
80, whose pulse I had opportunities of observiog for ^vecal
years, and during all that time it presorted aJmilaT^ ^gns of

Fib. 7.

irregularity, as much so when he was quite well as when he
was suifeiing from some alight attack of cold or dyspepsia.
In this case no subjective syn^toms connected wMi the
heart's action were preseat.

Fig. 8 is a sphygmogram taken from a lady weE on in
the seventies. I have many niore sphygmograms of this
pulse exhibiting almost every kind of stammer. The ex-
tremely irregular character will be maintained ibr months
and even years at a time, and then without ascertainable

Fig. 8w

cause the pulse will become quite regular and remain so, with
an occasional but rare intermission, for as long a period.
She has been xmder my observation for thirteen or fourteen
years, and I have never noticed that the heart stammer was
dependent on any particular indisposition, for though she was
often under treatment for dyspepsia, bronchial catarrh, and
pains in the back, the heart was ofken quite regular durino^
these attacks, and irregular when she was comparatively
well. As a rule she did not feel more dfficulty in walking
when her heart was irregular than when it beat quite
normally,

•^ay be thought that I am occupying your time un-

ON STAMMERING HEART.

necessarily in bringing before you an abnormal state of the
circulation that has little pathological significance, and
therefore must be destitute of practical importance. But
that is not quite the case. Patients are often alarmed to
find that their heart is acting so eccentrically, and doctors
who have not made a study of the phenomenon sometimes
confirm the patients' fears. Several striking instances of this
I have met with in practice. I will relate one of these in-
star omnium, A retired colonel, aged 60, who had served
for some years in India, and since his retirement lived on
his estate and devoted himself to country sports and public
speaking, used to come up to town and consult me. He
was a fine healthy-looking, I may say robust, man, and his
chief complaint was that he would be occasionally seized
with what he called palpitation of the heart, which would
last for several hours, and frightened him very much. I
first saw him in 1884, and he told me that he had been
affected in a similar way for four years, but that the fre-
quency and duration of his fits of palpitation had latterly
increased very much, so that he now had them on an average
every three days, and they would last for thirty-six hours at
a stretch. He had consulted maijy physicians, but to no
effect. With the exception of some slight gouty symptoms,
such as enlarged finger-joints and the occasional passage
of uric acid .concretions, varjdng in size from a pin's head
to a small pea, his health seemed to be good. I examined
his heart several times when free from ** palpitation," but
could find no signs of valvular or other disease. After two
years the " palpitation " became permanent, and on his next
visit to London he went to consult an eminent and titled
allopathic specialist, who gave a very unfavourable prognosis
and told him that it was absolutely necessary he should give
up all those amusements and occupations in which he de-
lighted. He was to ride no more to hounds, to give up
shooting, never to indulge in platform oratory, to live most
carefully and to take only carriage exercise or a slow walk
on level ground. After this consultation he came to see
me and told me what the great man had said. I said I
was of an entirely different opinion, and assured him that

10

OS BTA3UIEBI5G BEABT.

he had only a Htammering heart, which thoogh disagreeable
wftH lint (1nii((crouH ; that, tboagh it wotild be anadvisable to
takti any very violent exercise, he might still ride to hounds,
walk hrinkly up hill, shoot partridges and pheasants and
(•crnHidimny tipcak at public meetings on unexciting snbjects.
ViH. II will ^ivo you a good idea of what was tbe apparently
|)i'i iiiitnriit conditiiin of his heart's action at this time. Two
viino litlri' it w»H not improved. He acted on my advice
'Mill ocnliiiiird lu }:i>HlH>ut his usual employments and sports

/UV/VAAAAAWWiK

■iiji (iii> ]n•^•\\ to the stammer in his heart, which
ii<>L» I il ^iriiii [ had assured him, in the words of
il ^tii.1 "of no cuiisegnence." After this the

>'it t^Hiiliiiilty to right itself, and when I examined
t.r,.>iiitjii>{ i>{ IH\H the Bphygmogram I obtained

Iv iir.iiiiiki (lig. 10). That this return to normal

i>m|, iIiiu til uiiy improved state of the health was

iilMit liiiiii till! cii'uuuiHtance that it occurred while he

hMi iliu; liojii a rather severe attack of bronchial and

I with harassing cough, and he was also
I iiitbuli before mentioned in considerable

.tun "'-
iillMo.

'J'ldA in ii> illiiitli'iitcii the value of a knowled^ <^ this
<ii|iU"ii i>l' tho heart's action, for it is well known
ifllf tiiiyLhing has a more disastrous effect on the
it r.'.iitforl of a patient than a belief that his heart
)y dK' iiH'^d, If we are able to assure him thaA

ON STAMMERING HEART. 11

the irregular action which so distresses him is of hardly
any greater pathological importance than a stammer in the
apparatus of speech, we shall often succeed in changing a.
life of misery and dread into one of cheerfulness and com-
fort. It has more than once happened to me to find a poor
creature living in perpetual fear of making any exertion or
undergoing any excitement, whether pleasurable or painful,
lest some fatal catastrophe should occur. If we can convince
him that his fears have no foundation, and that he may da
pretty much as others do without fear of any bad conse-
quences, we shall have acted the part of a good physician
quite as well as if we had cured him of a serious disease by
"draporpill.''

The most extraordinary case of cardiac stammer that I
have met with in practice was that of a gentleman at the
head of his profession in the musical world whose heart,
though to all appearance perfectly sound, would take fits.

Fig. 11.

of stopping for from four to twelve and more seconds at a.
time. In its normal state the sphygmogram showed a
slow but pretty strong pulse of 42 in the minute, but with-
out warning the pulse would suddenly stop for a longer
or shorter time. On my first applying the instrument
there was not the faintest indication of a pulse, during the
short time (ten seconds) the paper took to pass through.
A few minutes afterwards the sphygmogram showed a
strong, regular pulse of normal character. Fig. 11 shows
the same pulse four years afterwards. There are two rather
weak beats, and then comes a pause which ran to the end
of the paper, and was prolonged a good way beyond. On
taking the sphygmogram two years later there was but one
beat on the whole length of the paper, the rest of it being^
occupied with the pause. The instrument applied a few
minutes later showed a perfectly regular and normal pulse.

12

ON STAMMEBING HEABT.

I conld not discover that this remarkable stammer was con-
nected with any particular condition of the health. It was
not worse during some severe attacks of bronchial catarrh
than when he was apparently in good health. This pecuh-
arity of heart's action did not hinder him [from performing
with ease the very onerous duties of his profession, and I
see that up to the present time he is as actively employed
as ever, though in age he must be considerably far on in the
sixties.

Fig. 12.

Wreden (Ziemssen's Cyc, xii., 784) relates a case of nearly
•equal retardation of pulse, but that was in a man dying of
cerebral abscess.

' The fluttering pulse met with in certain febrile affections
and in some indispositions not distinctly febrile is essentially
a stuttering pulse. In some cases the stutter will go on for
days, and the heart will then right itself quite suddenly. As
long as it lasts it greatly alarms the patient and his friends,
and the ordinary mode of treating it by pouring in enormous
quantities of alcoholic stimulants is often followed by disas-
trous consequences.

Fig. 13.

Fig. 12 is a tracing of the pulse of a gentleman in his
usual state of health. It is tolerably strong and perfectly
normal in character ; 77 per minute. Under the influence of
an attack of undeveloped gout (the gout did not appear until
some days after the pulse had regained its normal character),
the pulse took on the fluttering or stuttering character (fig.
l«'i), which it maintained (the tracing it will be observed is
utterly abnormal, and the velocity 1(>8 beats per minute) un-

DISCUSSION ON STAMMEBINO HEABT. 13

interruptedly for a fortnight and then suddenly resumed its
normal character and speed. I do not give this as an ex-
ample of stuttering heart pure and simple, for it no doubt was
caused by the latent gout which broke out later.

Ordinary attacks of palpitation are nothing more than
stuttering cardiac action. I have given a tracing of the
pulse in such an attack in the London Homoeopathic Hospital
Reports^ vol. i.

The action of the heart in attacks of asthma is often
of the stuttering or fluttering character, but as these, though
they may not be dependent on any organic heart disease,
are caused by an obvious morbid condition, they do not
properly belong to my subject.

Exciting causes of stammering or stuttering heart seem
sometimes to be tobacco smoking or tea and coffee drinking.

As the affection appears to be more a habit than a disease,
it is not very amenable to medicinal treatment. Smart
exercise, a glass or two of wine, digitaUs, strophanthus,
cactus and especially that much advertised preparation of
cactus called ** cactina pillets,** will sometimes rapidly restore
the rejpilar action of the heart, but as often it pursues the
uneven tenor of its way without heeding the remedies ad-
ministered. The best thing the doctor can do after ascer-
taining that the irregularity is unconnected with any obvious
disease of the heart or other organs, is to assure the patient
that the stammer or stutter of his heart is not dangerous,
and that he need not lay himself aside as an invalid obliged
to take precautions to avoid sudden death. The cases I
have brought before you prove that the cardiac stammer
may occur in the earliest infancy and the most advanced age,
that it may be continued or intermitting, and that it is not
dependent on any ascertainable condition of health.

Dr. Byres Moir thought the writer had mixed up a great
many different conditions and classified them under '* stammering
heart." He wished he could accept the statement that none of
them were due to organic changes, though he certainly agreed in
the suggestion that these irregular conditions were frequently due
to states that were only functional. But in later life when this

14 DISCUSSION ON STAMMEKING HEABT.

irregular action occurred he was sure, from many cases he had
watched, that it was due to organic changes chiefly in the heart's
wall. It would be interesting if they could get the full history of
many of the cases which had been mentioned, as he felt sure
many of them would die from heart failure. That day he had
seen a man in a dying condition, who for four years had suffered
from palpitations such as Dr. Dudgeon had described. For a few
hours he would have an irregular action of the heart, and it would
pass off, and perhaps for a month he would have no further
attack. Gradually it got worse and worse, and he was now
dying — a condition due to fatty degeneration of the walls. He
was quite sure, in cases in advanced life, when there had been no
irregular action before, some organic change was the cause. The
treatment Dr. Dudgeon recommended in the case of the colonel
was quite right. There was great danger in telling such patients
to lie up. It was the worst treatment they could get. The more
such persons could be encouraged to keep up a healthy exercise
of their full powers the better they would be. The last tracing
of the sporting colonel was a perfectly regular one, but that was
taken during an attack of bronchitis, and if there was any febrile
condition at all that would probably account for the regular
action. Another case was apparently what was now called a
x:ase of tachycardia, and that was entirely due to stammering
hei)irt, because it was a paroxysmal condition, and was not due
to any cardiac lesion so far as had been discovered, but was due
undoubtedly to the paralysis of the vagus. He saw a case some
time ago in which, by evacuating the stomach by a mustard
emetic, the attack was at once checked and the pulse fell from 200
to 72 in an instant. Those cases were the most dif&cult to treat.
There were, no doubt, many things which caused the intermit-
tency, as excess of wine or tobacco. One of his fellow students,
by smoking a certain number of pipes, could produce intermit-
tency. With children the case was different. He had con-
stantly seen children of all ages with irregular action from which
they got quite free. But when it came on later in Hfe he felt
quite sure organic changes would show themselves sooner or
later.

Dr. Dyce Brown quite thought with Dr. Moir that in many
cases of irregular heart there was organic disease. Still, there
were no doubt an enormous number of cases which were simply
functional, and it would be generally found in such cases there
was some decidedly neurotic history — either the patient, when
examined carefully, would show a neurotic temperament, or it

DISCUSSION ON STAMMERING HEART. 15

would be found that other members of the family had suffered
from neurotic disease. No doubt many of the cases due to
irregular action of the heart were perfectly curable, and did
get perfectly well, yet, if they persisted for years with hardly
any alteration, they indicated a very feeble nerve supply to
the heart, and such patients, if not cautioned against over exer-
tion and over-strain, might show serious symptoms of heart
failure. There was another extremely interesting class of cases
of irregular nervous action of the heart which Dr. Dudgeon
had not noticed, and which did not perhaps come within the
scope of his paper — those where there were very marked bruits,
but where there was no disease of the heart whatever. He had
observed cases, where through some nervous disturbance the
heart had begun to be irregular, and at the same time showed
very marked bruits, sometimes at the base, sometimes at the
apex, and sometimes at both, and after treatment these symp-
toms would entirely disappear, showing that the production of
the bruits was functional and nervous, and of the same character
as the irregular action of the heart. He generally made it a
rule, if he saw a patient of this kind for the first time, and
found no history of rheumatic fever or probable existence of
organic disease of the heart, to give a cautious diagnosis until he
had seen the results of a few weeks* treatment ; and in many
cases this had been justified by finding that not only the irregu-
larity disappeared, but the bruit entirely disappeared also. He
might mention one medicine exceedingly useful in nervous affec-
tions of the heart — lycopus.

Dr. Arthur Clifton said he was the more pleased with Dr.
Dudgeon's paper, because he had been in the habit of taking
sphygmographic tracings every week of patients. He had had
many cases similar to those brought forward to-night to which
he could give no name. He had merely called it by the name of
heart failure or want of nervous power. But whilst he used the
sphygmograph he was sometimes much confused by the indica-
tions given, but they served his purpose, not so much for diag-
nosis as for reference from time to time to see how the patient
was doing. From one of the tracings he should certainly have
thought that the man had aortic mischief, whereas Dr. Dudgeon
does not appear to have done so ; and there were two or three
other of the tracings which he should have set down to valvular
disease, where he had not. Of course, however. Dr. Dudgeon
was a far greater master of the subject than himself. He had
seen many cases similar to those brought forward which had

16 BiacTrasioN on scr^JcisBisGr heabt.

beea matorially and permaneniiy improved by rnediCTTTes — and
medicines diflferent from those nsnally rndifiared by Dr. DndgBon
— ^in heart diaeaae ; and soch medicines 1200, iram die £act of their
doing 90 nmch good, rather condrmed him in. his diagnosis. The
medicines he referred to were phosphorus and fgnatfa, and
these two medicines had di'me more good to such cases than he
had found from anv medicine he knew of.

Dr. CiLRVBAS thought with Dr. Moir it would have besL more-
interesting if Dr. Dudgeon, in reciting the cases, had also told
them exactly what was the resuh: of the physcal examination of
the heart by the stethoscope, and this would have confirmed or
otherwise the suspicion entertained by Dr. iToir that some or-
ganic lesion would have been found.

Dr, B, Hughes said the discussion thev had heard showed
that this question was one which constantly came before their
minds when they were examining cardiac cases : Is the trouble
in the substance of the heart or in its nervous supply? He
thought that almost every set of symptoms for which patients
came to them were referable to one or other of those cate-
gories, and very often might be assigned to either, and the
question must really be determined by the concomitant symp-
toms, the history' of the patient, and things of that kind.
There was no doubt the vagus did exert i^n the heart a con-
trolling influence, which if stimulated would make the heart
slow, and when cut off, as by division or paralysis, would set
the heart CfS beating as fast as it could go, and which if stimu-
lated irregularly would cause an irregular pulse, that would
Tie^'ertheless have no significance, and, as Dr. Dudgeon said,
would neither shorten life nor hinder one from activity. On the
Other hand, it was quite certain that if the muscular substance of
the heart itself failed from fatty degeneration or any cause that
weakens it, that too might show itself by irregularity of the
heart's action before there was any evidence, to the ear, of organic
(ViHeBAe, So that it might have a very evil significance or a very
liarmless one, and one must look at the concomitant symptoms.
Huch things as cedema of the feet (to which he attached great
in)p(;rtance in all cardiac cases) must help to guide them in their
conclunioDS, He would like to ask Dr. Dudgeon a question with
r^^gard to a remark which had impressed him very much. It had
h(!on said that where patients were conscious of intermission of
thoir hearts' boat the intermission was fimctional only, and was
duo to Homo extraneous cause, while in true intermission in
lioart diiicaBe the patients were not conscious of the failure of

DISCUSSION ON STAMMERING HEART. 17

the heart. If that were a true distinction it was a very valuable
one, and would aid much in determining the question which
always confronted them in these cardiac cases.

Dr. Madden thought there could be no doubt whatever, that
intermittent action, jper se, was essentially an affection of the
nervous system. It might arise in the brain, in the vagus or in
the sjmapathetic system, whether accompanied or not by organic
lesion. If accompanied by organic lesion, it might be secondary
to that, in consequence of the ill-nourished nervous system, and
not in consequence of the irregular state of the heart. They
constantly found organic disease of the heart without the symp-
tom of irregularity, and they constantly found irregularity without
organic disease. They were not necessarily connected, and the
important point for them to determine was whether there were
both or only one. His experience had certainly taught him that
irregularity was the least important of all heart symptoms as
regarded serious prognosis, and in a general way he had come to
the conclusion that heart symptoms of which patients were con-
scious were probably not due to heart disease, but to functional
derangement. The more this was impressed upon them the
more successful they would be in practice, especially in the way
Dr. Dudgeon had pointed out — ^in not frightening patients un-
necessarily. But even when there was slight — especially chronic
— cardiac weakness he must confess that entire rest and non-use
of the heart, or rather not exciting it to a little extra use, seemed
to him to be bad treatment, as the exercise of the heart as a muscle
was most important in strengthening it, just as it was in any other
muscular portion of the system. He felt sure that Dr. Dudgeon's
paper would be useful to himself and to others in the treatment
of heart cases.

Dr. GoLDSBROUGH could not help thinking that the cases of
purely functional affection of the heart, such as Dr. Dudgeon had
described, were extremely rare. There must be some organic
disturbance not observable by their ordinary diagnostic methods,
which was the exciting cause of the irregularity spoken of.
Were they not too apt to think of the heart as simply a muscle ?
whereas its innervation was a most compHcated piece of me-
chanism, and indeed the muscular structure itself could only be
kept in working order by the help of the nervous mechanism.
But was not this particularly the case with regard to the cardiac-
gangUa themselves ? If these were not kept in a good condition,
the heart muscle was likely to fail, and soon they found thin
walls and a very deficient and irregular action. He was in-

VOIi. I. — NO. 1. 2

18 DISCUSSION ON STAMMEBING HEABT.:

terested in Dr. Dyce Brown's remark with regard to the presence
of a hruit where no positive disease could be discovered. He
had seen one such case — that of a lady who was subject to severe
attacks of angina pectoris. She had never suffered from rheu-
matism or gout, but was of a highly neurotic temperament, which
he beheved she inherited from her father, who died in the street
from an attack of heart spasm. As a rule no organic mischief
could be detected by an examination of her heart, but he had
repeatedly noticed a bruit which he had attributed to a deficient
closure of the aortic valves on account of insufficient innervation,
and sometimes he had also noticed a mitral systolic which he
had attributed to the same cause. At other times these signs
were entirely absent. This lady suffered very much from intense
pain across the chest] from the attacks of angina, which seemed
almost to paralyse her for the time being. This pain had been
relieved frequently by the medicine which has been referred to as
a poison — namely, tobacco. It had been used several times with
very great benefit. One could go on talking about medicines for
a good while. There were several that had not been mentioned
— ^particularly one, lachesis, which was very valuable in attacks of
irregular heart.

Surgeon-Captain Deane (a visitor) said that Dr. Dudgeon's
paper had reference to a subject which for many long years had
puzzled army surgeons. Palpitation of the heart had caused,
and was still causing, an enormous amount of invaliding from the
British Army ; and when they had eliminated those cases which
were due to something palpable and tangible in the way of
anaemia, the results of rheumatic fever, and the cases of young
and badly developed soldiers being overworked and overstraining
themselves at drill, there was still a large proportion — more so
than the last speaker would perhaps think — of cases where there
was palpitation without any obvious cause. The men were in
health ; they were not anaemic, they had nothing the matter with
them ; they ate well. They went into hospital, and in hospital
they got worse. But if their tobacco was knocked off, the
palpitation stopped. Let the raan get out of bed, and put on his
tunic, and back came the palpitation as bad as ever. The case
of the Colonel, referred to by Dr. Dudgeon, interested him
greatly, because the disabihty passed off, and he would like to
know to what extent civil practitioners met with the cases turned
out of the army. They could not get rid of that stammering of
the heart in the soldier. He became useless and was invalided.
What became of such men ? He beheved with Dr. Moir that

DISCUSSION ON STAMMERING HEART. 19^

many of them developed organic disease of the heart, and before
they left the service they frequently showed signs of it in en-
largement of the heart, and perhaps a little murmuring sound.
The man who could give them a line of treatment which would
•enahle them to keep those stammering hearts in the army had a
^eat future before him. One of the first cases of stammering
heart which he ever had to treat on his own responsibility was a
soldier in Nepaul, who had been invalided for this condition,
though when examined (and he had over and over again ex-
amined his heart most carefully), there was not a sign of organic
disease in it. All of a sudden, without any rhyme or reason, his
heart went off at a gallop, and so it would be for hours. He was
then young and enthusiastic, and gave a half drop of aconifce in
an ounce of water. A small dose always brought that man's
pulse down to its normal beat. In India he had certainly
benefited that condition of stammering heart with small doses
of ordinary tincture of aconite. Still he confessed, as he was
brought face to face with stammering heart in the soldier, he
was nonplussed, and the custom in the army — ^he did not know
-what civil practitioners did — was to pass them on to somebody
else. There was no doubt that the stammering heart of the
soldier was caused by the unhygienic conditions under which he
lived, and by the foul tobacco he smoked — often on an empty
stomach. But when they had eliminated those cases which were
aggravated by tobacco, there was still a very considerable pro-
portion of cases where tobacco played no part, and of which, as
Dr. Dudgeon had said, there was no explanation.

Dr. J. E. Day remarked that the palpitation of puberty had
not yet been mentioned. Some years ago he met with a case of
that kind. The girl, about the age of puberty, had an extremely
rapid pulse. He did not know whether it would come under the
head of stammering heart — probably rather under the head of
tachycardia — but this girl's pulse continued for many days at a rate
of 120 to 130. There was no pyrexia, and there were no other
symptoms except this extremely frequent pulse. He took no
sphygmographic tracing, but the action apparently was regular
though very frequent. Were they justified in regarding an inter-
mittent pulse as of pathological significance? Considering that
men, all their lives through, might have this intermittent pulse,
and yet attain to extreme longevity, as was the case with the late
Professor Sharpey, he thought it was not necessarily so by any
means. With regard to remedies, he had lately had very satis-
factory results with strophanthus, the first decimal dilution, iu

20 PISCUSSION ON STAMMERING HEART.

cases of irregular heart, where dependant upon alteration in the
circulation brought about by an alteration in the position of the
body, resuming the vertical position from the horizontal, or again
assuming the horizontal from the vertical.

The President said that they could all of them probably call to
mind cases of irregularities of the kind spoken of by Dr. Dudgeon,
which had gone on for many years. In some cases the patients-
might be still living, and in others they might have died of some-
thing quite irrelevant. He had one or two such cases in his mind
at the moment. He thought they were all pretty well agreed that
the heart was a good deal more of a nervous than a muscular organ,
and that these irregularities depended upon disturbances of the
nerves of the heart and must be attacked from that side. He had
not heard any of the speakers refer to that kind of irregularity of
the heart which was observable sometimes in cases of advanced
nervous disease, such as when the patient had paralysis agitans.
He had himself seen one or two cases of the kind, and in fact he
had shown a tracing at one of the meetings of the Society a few
years ago. The man had paralysis agitans which was of such a
character that the voluntary muscles were in a state of constant
fine tremor, in fact there were very often clonic spasms of the
voluntary muscles, and the heart appeared to share in this, be-
cause, when the tracing was examined, it was seen to be not the
usual thing at all ; but the up stroke and the down stroke of the
tracing consisted of a very marked wavy line, as if the heart muscle
itself shared in the clonic spasm. The bruit, to which Dr. Dyce
Brown referred as being frequently present without obvious organic
lesion, had come under his (the President's) observation several
times, especially in cases of chorea, and he had put it down to an
abnormal kind of susurrus of the heart muscle. Under ordinary
circumstances the heart sound is tolerably uniform ; the susurrus
of the heart muscle takes place in a regular manner, but where
that regularity was disturbed they might have something very
like a valvular bruit. Certain it was that it passed away, and no
valvular mischief of any kind was found ; and frequently, where
the opportunity for post-mortem examination had occurred, no-
thing had been found amiss with the valves of the heart in chorea,
and cases, too, of an aggravated kind. There could be no ques-
tion but that Surgeon Captain Deane was entirely right in what he
had said about the abuse of tobacco in the army. He was quite
certain, from several cases he had seen in hospital practice of old
soldiers who had come with irregularity of the heart, that their
troubles had been originated and kept up by the use of tobacco>

DISCUSSION ON STAMMEBING HEART. 21

smoked the first thing in the morning on an empty stomach.
Dr. Day's reference to the rapid pulse of puberty was also very
interesting. That phase of disturbed innervation had doubtless
occurred in the practice of most of them.

Dr. Dudgeon, in reply, said he was very much pleased with
the manner in which his paper had been received. He thought,
however, that a good many of those who had spoken had mistaken
what the affection was of which he had spoken. They had
spoken of palpitation, and a good many had confounded this with
stammering heart. But palpitation of the heart was generally
an increased action of the heart without any stammering. He
had taken many tracings of patients suffering under palpitation,
and, as a rule, the palpitation consisted of an increased jerky
action of the heart without the stammering which had formed
the subject of his paper. Dr. Moir seemed to think that if he
had pursued the cases to the bitter end he would have found in
cases of stammering heart a fatty degeneration, or something of
that sort. But, unfortunately, his patients had not had the kind-
ness to put themselves upon the post-mortem table, because in
regard to none of the cases of stammering heart which he had
related had he had an opportunity of being in at the death. Only
one of those mentioned by him had died ; and that person did not
die under his treatment, but had, in fact, left his care for several
years. Dr. Moir remarked that the Colonel's regular heart
occurred during bronchitis when there might have been febrile
action. But it was not so ; because the heart remained regular
both before he had the attack of bronchitis and after the attack
of bronchitis was gone : so that he had an interval of perfectly
regular action. Therefore he could not say that the regularity
was caused by the disease from which he was suffering when he
saw him last, which was only an ordinary cold with some cough.

With regard to bruit. This he had not alluded to at all.
There was no question in any of the cases he had brought forward
of any bruit. In fact, as he had said, in all those cases when he
had the opportunity of examining them when the heart was not
stammering there were no physical signs whatever on auscultation.
He was perfectly aware that bruits would occur in the heart with-
out any existent disease, either valvular or otherwise ; but at the
same time it occuired in a pathological state. As far as his
experience went, either anaemia or something of the sort would
produce that bruit ; but then one could not say that the patient
was not suffering from disease. He was afraid the cases he
had brought before them were destitute of interest because they

22 DISCUSSION ON STAMMEBING HEABT.

.were not accompanied by disease, as far as he could make out.
He had not mentioned all the medicines that had proved useful
in irregular heart, because as a fact he had never found any
medicine of any particular advantage in the particular affection
which he had described. Sometimes the patients would seem to
be a little better for a glass of wine, or a dose of digitalis or
glonoin, or some medicine of that kind, but at other times the-
medicines given did not produce the slightest effect. It had been
suggested as a diagnostic point between irregularities of the heart-
due to organic disease, and those due to nervous affection, that
the irregularity of the organic affection was not felt, while the
irregularity of the nervous affection was felt. Now that was not
at all the case with the stammering heart. It was sometimes
felt very acutely, and sometimes was not felt at all. The ordin-
ary stammer of intermission might be felt, but it also might
not be felt. He was himself a victim of the disease — if it could
be called a disease, and sometimes his heart took a fit of inter-
mittency every third beat for months at a time. Yet he never
noticed it except when he put his head down on his pillow and
heard his heart beat, or, of course, when he put his finger on hi&
pulse; and on many occasions he had been quite surprised
at other people telling him that his heart was intermittent, as he
had not felt it. Perhaps those present would say that was not a-
nervous affection, but that, as he had, as Dr. Hughes knew, very
well-marked arcus senilis, it was a sign of fatty degeneration.
However, it certainly did not prevent his doing anything he
wished to do. Dr. Goldsbrough had said that there might b&
organic disease which the physician could not detect, for tha
physical signs were unknown, or of so slight a character that
they could not be detected. It might be so ; there might be
organic disease, but it was not perceptible, and so he must say da
non apparentibus et non existentibus eadem est ratio. Their very
honoured visitor had given them his experience of palpitation
in the army, and palpitation might be a very common affection
among the soldiers. Probably a good deal of the palpitation of
the soldier was due to anaemia, while a good deal was most likely
caused by the excessive use of tobacco and of stimulants, because
all those things rendered the heart very irritable and easily
excited. But that was not the stammering heart that he alluded
to, which would not prevent the soldier doing his duty. The^
palpitation of puberty was of the same character — a palpitation,
not a stammering. The sphygmograms in paralysis agitans,
alluded to by Dr. Blackley, he had himself observed several

ON THE MEDICAL TKEATMENT OF PLEURISY. 23

times.' There were various irregularities caused by diseases of
the kidney, diseases of the lungs, and various other diseases ; but
the irregularities he had brought before them were not, as far as
he could discover, attended with any morbid symptoms, and
even although morbid syinptoms might occur in other parts of
the body or other organs, these did not seem to affect the irregu-
larity one way or the other. He had already shown how a con-
spicuous example of the febrile state would completely annihilate
the irregularities or the intermissions for a time.

ON THE MEDICAL TEEATMENT OF PLEUEISY.^

BY MEDGLEY CASH, M.D.
Physician to the Torquay Homoeopathic Dispensary.

When our Secretary invited me to contribute towards the
discussion on the treatment of pleurisy, and when I had
looked over my note books for the last sixteen years to see
what available material I had to draw upon, I confess I felt
somewhat dismayed to find that I had nothing either original
or particularly interesting to bring before you, and had it
not been for the desire to do what I could, however little, to
support the movement for these discussions, I should have
felt constrained to have excused myself from the task.

Amongst the predisposing causes of pleurisy , probably the
first is a tuberculous habit of body. Pulmonary tubercle is a
fertile source of pleurisy, and a non-inflammatory attack in a
young person is often of sinister significance.

Dr. Wurmb, of Vienna, has suggested that this has pro-
bably to do with a pathological change in the blood, caused,
as we now suppose, by the tubercle bacillus. Similarly,
gout, syphilis, influenza and pyaemia may all act as general
causes for the disease.

Exciting causes may be traumatic, as in rib fracture, or
by the check of cutaneous perspiration in a chill, or by the

* Bead before the Society, November 3rd, 1892.

24 ON THE MEDICAL TBEATMEKT OF PLEURISY.

spread of inflammation by contiguity, as in pneumonia and
tubercle of the lungs — the latter thus being both a general
and an exciting cause.

Bemedies for pleurisy may be divided into these : —

(1) To abort an attack.

(2) To relieve pain and cough, and to control effusion.

(3) To remove accumulation of fluid — serous and puru-
lent.

(4) To promote convalescence and to keep up the patient's
strength.

1. To abort an attach, — For this purpose we have several
remedies, pre-eminent amongst which is aconite. Aconite
will frequently cut short an attack of simple inflammatory
pleurisy if used early enough in the disease. But it requires
to be given early. If after using it for a few hours the fever
still keeps up, it is useless to persevere with it ; some other
remedy must be chosen. It will probably be of less use, as
also it is less indicated, in pleurisy of tuberculous origin. It
failed with me in a case where pleurisy was secondary to
influenza, and yet was apparently induced by the patient
getting a chill when over-heated — the blood being clearly in
a deteriorated condition. Dr. Wurmb says {British Journal
of Homoeopathy, vol. i.), he never saw aconite directly pro-
mote the absorption of fluid, but as this absorption does
not occur while fever is maintained, then by cutting short the
fever, aconite gives indirectly most valuable assistance in
this direction. It is the great specific against inflammatory
fever and inflammatory pleurisy. What other aborti-
facients can we reckon upon besides aconite ?

Belladonna. — In Hahnemann's " Materia Medica Pura,**
translated by Drs. Dudgeon and Hughes, many well-marked
pleurisy symptoms are brought out under this drug. Trinks
thought well of it where aconite failed, and where the pain,
fever, and dyspnoea announced the still unchecked progress
of the malady, and he specially instances those constitutions
disposed to tuberculosis, and where therefore aconite may
not be sufficient. This is illustrated by the following case.
Aconite was given by me to a young man, but it failed to
relieve a small dry pleurisy near the apex of his right lung.

ON THE MEDICAL TBEATMENT OP PliEUEISY. 25

This disappeared under belladonna and spigelia. The failure
of aconite was accounted for when, eight months later, tuber-
cular arthritis manifested itself in the ankle, a younger
brother shortly afterwards falling victim to a similar attack.

Ar7iica comes in for traumatic cases. We may not get,
and must not expect always to find, the bruised feeling
which is given in the text books, but when injury has pre-
ceded and caused inflammation, this drug may be of much
service.

After the initial stage is over, and the disease fairly
established, we require remedies to conduct it along mildly,
to relieve pain and cough, and above all, to control the
amount of fluid effused into the pleural cavity. These
stages, though adapted for classification of remedies, are
often ill-marked clinically. The first stage runs imper-
ceptibly into the second. Often when called in we find
effusion has already occurred, and our efforts must be
directed to limit it.

Now, for this purpose, probably no medicine is so useful
as bryonia. While aconite comes in for the initial dry
inflammatory condition, its sphere, as we have seen, is
largely confined to this, but in bryonia we have a drug which,
while useful for the early stitch and dyspnoea, is specially
potent when inflammation has gone on to fibrino-serous
exudation, for it effects its absorption with the least possible
delay. Dr. Trinks' evidence is strong here (British Journal
of Honueopathy, vol. viii.), and I suppose when called in
first to a case of pleurisy, by far the most frequent prescrip-
tion in our school would be found to be aconite and bryonia
in alternation. For myself, I may say this is, in the main,
my usual practice, and many are the cases I have seen
beginning with a rigor or shiveriness followed by fever,
dyspnoea, pleural pain and cough, in which these two
medicines have wiped out the trouble, and restored the
patient to health within a few days. And whatever may be
«aid against the practice of alternating remedies as a rule,
we have in the setting-in of pleural inflammation such a
running together and overlapping of the first and second
stages that in many instances, as we cannot watch our

26 ON THE MEDICAL TREATMENT OF PLEURISY.

patients from hour to hour, we shall, I believe, do the best
for them by giving aconite and bryonia alternately at
frequent intervals. When, however, the dulness on per-
cussion and decrease of pain evidence the separation of the
inflamed pleurae by the effusion of fluid, the time for
aconite has passed by, bryonia only may be sufficient to
compass its absorption, but sulphur is the remedy in which
I have most confidence for the removal of fluid in the chest.
It seems to be well spoken of by homoeopathic writers in
general, not only in the fibrino-plastic pleurisies, but also
in the serous effusions of hydrothorax, whether this term
be used for a chronic collection of fluid remaining after
acute pleurisy or for dropsy gradually thrown out from a
failing heart, or due to a deteriorated state of the blood as
induced by kidney disease.

Speaking of sulphur. Dr. Wurmb says : ** Sulphur pene-
trates the entire organism, even in its finest and most
recondite portions. It increases the activity of vegetative
life generally, and of the processes of secretion and ab-
sorption in particular. It accelerates the interchange of
elements, and makes it more pervading ; in a word, it fulfils
all the demands upon which the removal of an abnormal
product is conditional. Upon these grounds we apply
sulphur to the removal of pneumonic infiltration, or serous
exudations, and of old as well as recent deposits in the skin,,
the parenchyma, the joints and the bones." (Wurmb's
"Studies of Pneumonia," 1857.)

As illustrative of the resolvent action of the drug, I cite
the following case which occurred to me some years ago.

T. C, aged 14, from Plymouth, staying at Hele Cross,,
near Torquay, came to my dispensary May 24th, 1881.

History, — Always been a healthy boy, but last winter
caught a cold, which resulted in an obstinate chronic cough.

Lifting a block of stone about three weeks ago, when
working in his uncle's stone yard, he strained himself.
Dyspnoea came on, which has increased ever since, but he
has no pain.

(The late Mr. J. H. Nankivell, when in Cornwall, has
shown (British Journal of HomcBopathy, vol. xxiii.) how

ON THE MEDICAL TREATMENT OP PLEURISY. 27

often attacks of pleurisy are set up amongst the miners by
the intense muscular exertion of straining at their work.)

T. C. was seen by a well-known doctor in Plymouth,
who sent him to Torquay as the best place he could come
to, but told his mother he was sure to die — nothing could
save him.

Present Condition, — Appears to be in great distress; there
is an extreme appearance of illness, with rapid panting breath-
ing. Percussion over the whole of the left lung absolutely
dull. No vocal thrill or resonance. Side of chest feels very
hot to the hand, perceptibly more than the right. Ausculta-
tion over the left lung : Breath sounds are very faintly
heard, and there is well-marked aegophony. Over the right
lung respiration is harsh and exaggerated. The heart beats
with its maximum apical intensity in the epigastrium, and a
Httle to the right of this. There is no visible pulsation in the
usual apex area, and the sounds are heard feebly there, while
loud in the epigastrium. Pulse 112, temp. 102.9\ He sweats
freely. Has a cough and expectorates mucus, no blood.
There is no external bulging of the chest walls. Appetite
and functions good, considering his condition, which is grave,
and he feels himself to be very ill. I ordered him one drop of
aconite Ix, and arsen. alb. 3x, alternately every two hours,
and to go home and to bed at once. The next day I saw
him at his house and found him lying on his left side;
respiration 32 per minute. Further examination confirmed
above report. He had slept well, and felt better, since he
came to this house, where the air is good. On the 26th he
was lying easily, and had slept well. Pulse 104 ; respira-
tion, 32 per minute. On percussion I thought the upper
part of the left lung posteriorly not quite so dull. Ordered
a linseed and mustard poultice to the chest, and aconite
Ix and sulphur 3x to be taken alternately every twa
hours. By the 28th he could breathe better. Sweats
heavily in his sleep. Eespiration 32, and pulse 96 per
minute- I thought there was more vocal resonance over
left lung, though no vocal thrill was to be detected.
On examining him on May 30th, I found the dulness in
statu quo. There was copious sweating, vocal resonance

28 ON THE MEDICAIj TREATMENT OF FLEUBISY.

louder, but fremitus poor. Breathing weak. The following
day I put a Southey*s trocar though the seventh costal
interspace below left scapular angle, but no fluid came.

On June 6th, I found, breathing better, and his face a
better colour. Slight improvement in percussion note. He
now got sulphur 3x, and digitalis ^, alternately every two
hours. The next day the pulse was a little over 80. Ee-
spiration 24 per minute. Heart resuming normal position.
Percussion note still further improved. Finds himself less
breathless on exertion. He looked better and was cheerful.
Appetite good ; functions regular.

By the 13th, apex beat was about normal position.
Sweats much less. Stronger, and able to walk a little out
of doors.

On July 5th, he walked two miles down to dispensary to
•see me, looking well and strong. A little dulness remained
over left base, where also breathing was shghtly deficient,
otherwise air entered lung well ; he had no . dyspnoea, and
scarcely any cough.

He came to see me at the dispensary on September
13th, looking very well and strong. Can walk for eight
miles without effort. No cough, no dyspnoea, and altogether
healthy ; pulse 84. Ordered to work in moderation.

In April, 1883, he came down again about some little
matter, and I really did not know him. He had grown into
a strong, broad-shouldered, muscular young man, enjoying
excellent health, and working as a monument mason. He
had called on his former doctor to report himself cured, but
when the latter heard what treatment he had been under,
he turned rusty, and showed him out of the house. Under
sulphur taken steadily for about three weeks, the effusion
in this case all but disappeared, though it could not be said
that the lung had completely cleared up for some time after
he had apparently quite recovered his general health. I
should like to have tried the effect of arnica had I seen the
case shortly after the strain to the chest, which probably
excited the inflammation in this boy, whose system was pre-
disposed to the complaint by a lingering cold. The time
for aconite was — as I now think — ^passed. And should I

ON THE MEDICAL TEEATMENT OF PLEURISY. 29

meet with such a condition in such a stage again, I should
feel inclined to give sulphur at once. The time also for
bryonia had passed. Earlier it might have controlled the
large eflfusion ; so also had there been pain to indicate
it, it might have been useful ; when I saw him, there
was no pain.

And this reminds me of a very different case. I
once was called to treat a tall delicate girl of 16, who
had exposed herself to cold one chilly night in March.
She had a small dry pleurisy in the right lung, with
friction sound ; high pulse and temperature, which at
ihe third day of my attendance still kept up to 103°*
There was never any effusion, but she had a harsh, gruff
cough, and the pain was so acute she was in terror to
breathe, and held her breath with such success that I
could hardly hear any respiratory murmur. She began to
wander, got flushed, and the skin was bathed in perspira-
tion. During four days I gave her aconite, bryonia, and
belladonna, with hot linseed poultices to the side, but did
not seem to myself to effect much till I gave her drosera.
(" Severe stitches in chest when sneezing or coughing ;
must press on chest with hands for relief.'' — Hering)
(" Stitching in muscles on coughing and breathing. . . .
almost arresting breath." — Allen.) This acted quickly, so
as to quiet the cough and much relieve her pain. She
got a critical epistaxis, and very shortly the cough, which
had been severe on waking, almost disappeared; the pain
left, and she became convalescent.

For the reUef of acute stitching pain — not necessarily
only neuralgic or myalgic — I have given ranunculus bul-
bosus and sceleratus.

Farrington in his ** Materia Medica," says : — *' We may
think of ranunculus bulbosus in inflammation of serous
membrane, particularly of the pleura or peritoneum ; when
there are acute stabbing pains in the chest, in the case of
pleuritis, and accompanied by the effusion of serum into one
or the other cavity. Accompanying this effusion we find
great anxiety, dyspnoea and distress, caused partly by the
accumulation of fluid, and partly by the anxiety from the
pains themselves.'*

30 ON THE MEDICAL TREATMENT OP PLEURISY.

Again, arnica has served me well for the removal of acute
pleural pain.

Under the head, '* The Belief of Pain,'' the use of local
applications falls naturally to be considered. I may say
shortly for myself, that along with internal remedies I use
external applications, and should be sorry to be without
them in treating pleurisies. Not only for the alleviation of
the acute side stitch, allowing increase of power and com-
fort in breathing ; for the lessening of the fever which severe
pain and dyspnoea alone will account for; for a sedative
action, therefore, upon the irritated nerves of the system,
both locally and generally, resulting in better sleep and more
ability to take food — for all this at the commencement of a
painful feverish complaint we must be often indebted to the
use of the hot linseed poultice, with or without a judicious
admixture of mustard. And when the stage of severe pain
is passed, when the presence of fluid or of plastic membranes
in the pleural sacs calls for removal, we may do much to aid
their absorption, and at the same time tone up and supple
the rigid uneasy muscles by gentle frictions of rhus, bryonia
or arnica liniments, and by supporting and protecting the
thorax with applications of oil on fir wool or flannel.

As a case in point I may mention a case now under
treatment where bryonia liniment has been of striking
benefit. Its use aided convalescence from a right-sided
pleurisy, causing perceptible increase in the respiratory action,
and removing the sensation of a stiff wall in the side.

"When, unfortunately, we have to do with a collection of
pus in the pleural cavity, we shall, I believe, be consulting
the best interest of our patient by removing it as quickly as
possible, and for this we must have recourse to paracentesis
thoracis.

Hepar sulph. has been credited as a useful remedy in this
condition. I should, however, prefer, first, to withdraw the
pus as by pneumatic aspiration, and then give some medicine
such as this or silicea to prevent its re-formation.

To promote co7ivalescence and keep up the patient's strength
I have recourse to arsenic, especially the iodide and the
chininum arsenicosum, to china tincture and to chininum

NOTES ON PLEUBISY AND ITS TREATMENT. 31

sulphuricum, which, besides their general strengthening or
tonic properties, have special curative action on the lungs ;
a generous diet, as by red wine and meat ; a pure, mild,
bracing air, by moor and sea ; the use of cod liver oil and
some of the maltine preparations, especially for the young
and tubercular. Of the prepared animal essences I have
found Bovinine useful, and Carnrick's peptonoids given in
hot milk, both to the young and to the old and feeble.

Cases of pleurisy must be considered as to their ultimate
'probability of developing phthisis, when lingering on in a state
of partial unsatisfactory convalescence. These cases do ex-
tremely well, as a rule, at Torquay. The mild yet gently
bracing atmosphere of our sunny hills sloping to the south,
the shelter afforded from the cutting E. and N.E. winds, the
very large average of sunshine all the year round — all these
surroundings greatly favour the removal of old pleural adhe-
sions and deposits, and by stimulating the respiration and
benefiting the general health, help to put a definite end to
long-continued danger of ultimate tubercular formation.

NOTES ON PLEUEISY AND ITS TEEATMENT.^

BY HEEBBRT NANKIVELL, M.D.
Physician to the Hahnemann Convalescent Homey Bournemouth,

When our Secretary asked me to read a short paper
on the treatment of pleurisy and empyema, I felt that
I was at a certain disadvantage in complying with his
request. The cases of pneumonia or pleurisy which have
occurred, in previously healthy people, in my practice
during the past twenty-five years have been very few
indeed — only five or six in all before influenza began to

' Bead before the Society, November 3rd, 1892.

32 NOTES ON PLEUBISY AND ITS TREATMENT.

increase the liability to this class of disease. I suppose that
this is really due to the same quahties of climate which tend
to produce amelioration in more chronic diseases of the
chest, for which Bournemouth and its neighbourhood have
long been a resort.

The relation of pleurisy to phthisis is a well marked
one.

(1) Pleurisy with effusion has long been recognised as a
cause of phthisis ; this is due to (a) the general interference
with the lung function when that organ has been com-
pressed for any length of time by the presence of fluid in
the pleural sac, or tied down more permanently by bands of
lymph, the result of pleural inflammation ; (fi) and further to
the more or less direct infection of the lung by contiguous
inflammatory processes, or by absorption of depraved effu-
sions, or by the irritation set up by imperfectly organised
false membranes, themselves liable to degeneration of
structure ; (7) by the depression to the general health ensu-
ing in the course of slow recovery from a debilitating and
incapacitating disease. According to circumstances, the
lung trouble may be primarily pneumonic, becoming caseous ;
or it may be primarily tubercular; or it may assume the
slower fibroid degeneration.

Case 1. — Miss H., aged 25, tall, delicate looking, had
been under medical care (allopathic) in 1876 for pain in
the left side. There was no fever. On examination, well-
marked dulness and oegophony were noticed on the left side
of the chest posteriorly. There was no marked cardiac dis-
displacement, and slight dyspnoea occurred only on exer-
tion.

Bryonia was exhibited ; absolute rest in bed and a dry
diet ordered ; the effusion steadily decreased, and in fourteen
days the physical signs had disappeared, including the
friction redux. She still remains in excellent health.

Case 2. — Mrs. L. had a severe attack of pleurisy with
serous effusion in 1871, at the age of 39. The serous
fluid was on several occasions aspirated ; the illness lasted
nearly twelve months. Four years afterwards a severe
haemoptysis occurred, and she was sent to Bournemouth.

NOTES ON PMIURISY AND ITS TREATMENT. 33

I found a contracted right lung with dryish crepitus in the
upper third ; there was a suspicion of crepitation in the
apex of the left. General health was greatly restored;
the lungs became drier, but there was always dyspnoea on
exertion. With variations in health, specially caused by
the approach of the menopause, this condition was main-
tained for seven years, and her hfe was enabled to be one of
considerable bodily and mental activity. In th6 autumn of
1882 at her own home, her health began seriously to
deteriorate, and a renewed attack of haemoptysis (from
which she had been free for seven years) was the immediate
precursor of a fatal issue.

Case 3. — G. W., aged 18, returning from an ocean trip
took cold off the Azores. He walked iato my consulting
room one day in 1874, looking thin, but bronzed and
healthy. On examination the left thorax was found in-
tensely dull, the intercostal spaces bulging, and the heart
pushed to the right side of the sternum. I was glad when
he got safely into his own bed. After a few days, aspiration
was performed and seven measured pints of pus were with-
drawn: the pus was healthy. In about a month a re-
collection had taken place ; an incision was made in the
axillary line and a tube inserted* After a time I wished to
make a posterior opening, but on passing a long probe into
the pleural cavity I found the false membranes so dense and
thick that I desisted. His health improved much, notwith-
standing that he belonged to a ** tuberculous " family; after
three years he went to Australia still wearing a tube in the
side. After two years* residence there, disease of a phthisical
character was set up in the right lung, and he died.

I have related these three cases as illustrating some
different tendencies, and results of pleural effusions in
relation to normal recovery or the future production of
pneumonic trouble as the case may be. There is, however^
another well established connection between pleurisy and
phthisis, and that is, where an intercurrent pleurisy is
estabhshed in the course of a phthisis. I have never known
an effusion to take place in these cases, the pleurisy is
always "dry," and generally obtains in the lower thirds of

VOL. I. — NO. 1. 3

34 NOTES ON PLEUBISY AND ITS TREATMENT.

tKe lungs posteriorly or laterally. It is almost always
of grave import, is accompanied by increased fever, and
the dry sounds are generally in the course of a few days or
weeks reinforced by moist crepitations, having their origin
in the lung tissue. I think it is Powell who remarks that
the causes of these intercurrent pleurises are due to the
deposit of caseous or tubercular matter in the peripheries of
the lung substance ; a slight roughness is thereby induced
first of all in the lung pleuron, and after a time as the
deposit softens, the moist sounds become established. I
believe bryonia is still the best remedy we have for controll-
ing this double condition.

In speaking of treatment, I have chosen to narrow my
subject somewhat; others will speak more directly of the
treatment of the disease in its initial stages, but the best
treated case of pleurisy may leave in the patient conditions
which more or less inevitably lead up to a termination of
life through the induction of fatal chronic disease.

1. The absolute removal of liquid effusions of any
character must be accomplished, and unless these be purely
■serous, they should be removed by surgical means.

2. The absorption, or organisation of false membrane is
«, most important desideratum. Medically, much may be
done by steady, courses of hepar sulphuris, mere, corros.,
and ars. iod. These courses must be reinforced by careful
hygiene and diet, building up the patient's physique, and
strengthening skin and nerves against ** taking cold."
Physiological rest should be for a considerable time most
strictly enforced, and the patient absolutely forbidden to
get fatigued or '* out of breath," and true physiological
exercise must also be enjoined by massage of the thoracic
muscles, by careful lung drill, and by the discriminating use
of very light dumb-bells and bar-bells, so that the damaged
and contracted lung may have every opportunity of ex-
panding. The question of climate, and especially of alpine
■climate, will have to be considered at this point.

3. Care should be taken that the very first indications of
true lung mischief be treated promptly and energetically;

NOTES ON PLEURISY AND ITS TREATMENT. 35

every day of their existence must be fraught with the
greatest danger to the patient's welfare.

Before closing this very imperfect paper, I will relate
shortly a case of diaphragmatic pleurisy that was under my
care last February. A severe attack of influenza had quite
prostrated a lady, aged 40 ; there were no complications, but
the debility was great. After ten days she was allowed to
walk to the sofa one evening, but soon after intense pain set
in, deep in the right thorax above the liver. No morbid sounds
could be heard either in front or behind ; the pain, which
was very intense, yielded to bryonia and gelseminum in a few
hours, and convalescence was apparently re-estabUshed. In
a week's time, in consequence of a slight imprudence, the
same pain recurred on the other side of the thorax, and
though at first no physical signs could be detected, in forty-
eight hours friction sounds, followed bydulness on percussion,
and cegophony were established anteriorly and posteriorly,
as well as on the axillary border. The pleurisy was of a
very curious character, and for several days slowly increased
in extent, involving fresh spots of about two inches in di-
ameter every two or three days till it reached a full half of
the thorax. The debility was extreme, and painful dyspnoea
considerable, but there was never much compression of the
lung, and the patient made an excellent though tardy
recovery, and there is now no indication of dulness, and
the lung expansion is excellent,

I shall be glad if the relation of this case educes from
members of the Society an account of their own experience
in similar ones.

36 THE TREATMENT QP PLEURAL EFFUSIONS.

THE SUEGICAL TEEATMENT OF PLEUEAL

EFFUSIONS.^

BY E. WYNNE THOMAS, M.D.
Surgeon to the Birmingham Hom,CBopathic Hospital.

You have already heard the subject of pleurisy treated
from a physician's point of view. It occasionally happens,
as you know, that inflammation of the pleura is followed by
the effusion into the pleural cavity of more or less fluid.
This is Nature's way of relieving the inflammation when the
disease has passed a certain point of intensity, but if the
case is seen early, and the constitution is sound, it is not
likely to happen often, because medicines, such as aconite
and bryonia, will generally cut short the inflammation.
When a considerable quantity of fluid has, however, been
poured into the pleural cavity, the question arises whether
this should be let out by a surgical operation, and it is my
part now to place before you the rules which experience has
led surgeons to lay down on this matter.

Let me tell you frankly that my experience, in such
operation, is very limited. I have performed a certain
number and variety of operations, enough perhaps to make
me judge of their comparative advantages, but I shall lay
before you the opinions of our chief authorities. I was
house-surgeon at University College Hospital, under Mr.
Erichsen, a good many years ago. Anaesthesia had been in
use about ten years, but the second great discovery, that of
antisepticism, was not to be made for another decade.
Those were evil days, and I look back with a shudder when
I think of the results of operations simply from surgeons
not knowing the importance of cleanliness. Those educated
in the last twenty years can little realise the change. At
that time surgeons shrank from opening the great cavities
of the body, such as the peritoneum, pleura, skull — and
rightly so, so great was the mortality. Now these opera-
tions are performed daily with confidence, knowing that if

' Read before the Society, November 3rd, 1892.

THE TREATMENT OP PLEUBAIi BPFOSIONS. 37

rigid care is taken to introduce no dirt, all will go well;
moreover^ many of our best surgeons have abandoned the
antiseptics of Lister as unnecessary.

Let me say a word about effusions in general. When a
membrane or other part is inflamed, the inflammation is
relieved by the transudation through the walls of the blood
vessels of a portion of some of the elements of the blood.
In the case of a mucous membrane it is thrown off from its
surface, and passes immediately out of the body. If a solid
part is inflamed, the effusion is into the tissues around, and
in the case of serous membranes, the fluid is thrown into
the cavity of the particular serous membrane affected.
These effusions, then, do not constitute the original disease,
but are its effects ; and when these fluids are retained in the
body they are often much more dangerous than the original
disease. Thus in relieving a pleuritis. Nature fills the
pleura with fluid which she cannot rid herself of, except at
much cost and risk — like firemen who, in extinguishing a
conflagration, drown the premises. "We may say it is an
accident that there happens to be no outlet for the fluid.
Now great progress has been made in the last fifteen years
in the successful treatment, by drainage, of effusions. For
instance, it has been applied to collections of fluid in the
peritoneum or its neighbourhood, as well as to parts after
•operation or accident, numerous instances of which will
readily occur to your minds. We should, I think, ask our-
selves whether, even if we could effect the absorption of the
fluid by medicine, we ought to do so. Formerly patients
were poisoned and invahded for years by the retention of
pus, who are now quickly restored to health by opera-
tion, and I ask whether pleuritic effusions are to be treated
on general principles or regarded as requiring special rules.
Probably, we might say, certainly, no good to the constitu-
tion can result from the re-absorption of an effusion which
has been stagnant outside the circulation for days or weeks.
If taken up by the lymphatics and poured into the blood it
cannot be utilised in the nutritive processes, but must be
excreted by the various organs — ^kidneys, bowels, skin and
lungs ; and I feel sure that if we could obtain reports of 100

38 THE TBEATMENT OF PLEUBAL EFFUSIONS.

cases in which a considerable effusion had been absorbed,,
we should see that the health was impaired for months or
years.

Pleuritic effusions are of various kinds, ranging from
serouiS to purulent, but even in those chiefly serous there
are pus cells, and often bacteria, and although the so-called
serous fluids may remain in that state for many weeks,
there is always a tendency in them to become more and
more purulent or even septic. In proportion as they are
purulent, so is the danger to the constitution of blood
poisoning, if absorbed, and it is impossible to make a rigid
division, although practically we distinguish them into
serous effusions and empyemata.

We begin, then, with the serous effusions. To deter-
mine, in any given case, which we have to deal with, the^
safest plan is to use the aspirator, and if the fluid is found
to be chiefly serous, we may, if we think well, proceed to
draw it off. In this,jthe closed method, it is essential that
extreme care be taken to ensure that while the fluid is re-
moved, no air is admitted into the pleura.

When we ask, at what period shall the operation be
done ? we find great differences of opinion. (1) A very large
majority advise that no operation should be done (i.) if the
inflammation of the pleura is still active ; (ii.) if the effusion
is small in amount. Now Castiaux advocates a very early
puncture even during the acute stage of the pleurisy, and
even if the fluid is small in quantity. He maintains that
this cuts short the inflammation. He operated thirty-seven
times, in all successfully, and says the convalescence was in
all the cases completed in a few days. Such a plan, if safe,
as it appears to be, has great advantages : (i.) you withdraw
the fluid before it has time to deposit its fibrin on the
pleura; (ii.) you prevent increasing compression of the lung;
(iii.) you at once restore to the lung its function, and (iv.) by
preventing the absorption of the fluid you avoid the risk of
poisoning the blood. Supposing there was a valve, by open-
ing which we could at once drain off the fluid, it would be
obviously the right thing to do. The operation as now
done amounts to little more. Why, then, lose these obvious*

THE TREATMENT OF PLEURAL EFFUSIONS. 39

advantages by trying to promote absorption? This is a
point I particularly ask you to discuss. Porritt warns us
against rashly proceeding to operate. He further says " a
recent effusion may give rise to urgent symptoms, even
commencing cyanosis, which may become less urgent after
further effusion, and tapping would in such a case only add
to the danger.'* Why should it, I ask? Suppose, too, the
farther effusion did not relieve. The large majority of
writers are for following the happy mean ; they wish to give
Nature a chance of re-absorbing the fluid herself with the
aid of diuretics, diaphoretics, purgatives, &c. Just think of
all these exhausting processes ! Apparently they do not
fear the consequences of interfering with the lung for
several weeks, and getting it possibly permanently bound
down by adhesions. All advise us to operate if the pleura
is nearly fall, or if there are signs of distress, such as
cyanosis, syncope, &c. Bowditch says, if the effusion is
stationary from two to four weeks, and the pleura half fall,
he would then operate ; also if the fluid reached to the
angle of the scapula he would operate after four weeks. He
would wait for subsidence of fever in acute cases. Clifford
Albutt says if the fluid rises above the angle of the scapula
he would tap after two or three weeks. Anstey in the
same cases would wait four weeks. Bowditch was very
successful. Out of 386 operations, he did not lose one.
Contrast this with Dupuytren's results, who only saved two
cases out of fifty.

Toussaint gives the following statistics : —

4 deaths out of 176 cases, operated upon between 1 and 20 days.
6 „ „ 80 „ „ „ „ 20 „ 60 „

1 11 >i • »> n i» »» 60 „ 120 ,,

showing that mortality rises in proportion as the operation
is deferred.

These statistics, combined with Castiaux', clearly show
that the operation is nearly free from danger, and seem to
point to the advantage of operating early^ Now I am quite
willing to admit that practically we are almost compelled
by our patients to adopt the waiting course, and I am not
prepared to urge operation when the effusion is a very small

40 THE TBEATMENT OP PLEURAIi EFFUSIONS.

one, because I fancy the chances of wounding the lung
hardly warrant the risk.

Where should the puncture be made ? Considerable dis-
cussion has arisen on this point, but the balance of opinion
is in favour of the eighth, intercostal space in the back.
The really important matter is to do it above the line of
the diaphragm.

There is a general belief that it is dangerous to draw off
too much fluid at one time, the rule being to watch the
patient, and instantly stop if any distress is produced;
further, not to remove more than sixteen ounces in a child,
and twenty-four in an adult. It must be drawn off slowly.
The operation has to be repeated several times if absorption
does not go on. Should the fluid become offensive, it must
be treated by the open method.

It hardly seems worth while to discuss the various
methods of performing the closed plan. As I have already
said whether we use the aspirator or the trocar with a
tube dipping into an antiseptic solution, the essential points
are that the instruments shall be absolutely clean, the chest
wall thoroughly cleansed, and no air admitted.

We next come to the purulent effusions.

Having ascertained by the exploring trocar that the fluid
is purulent, there is only one course to pursue, and that is,
at once to evacuate it, the only exception being in the
case of phthisical empyemata. It is generally agreed that
operations in such cases are out of the question, and only
hasten the end. It makes no difference whether the case
was originally purulent, or has become so, nor whether the
case is recent or chronic. Clifford Albutt, who is slow to
operate in serous cases, says, '*I, therefore, dishke and
reprobate all tampering with an empyema."

As to the method of operating, there are, as we may
expect, differences of opinion; a certain number, apparently
wishing to pursue what seems a milder plan, advocate the
closed plan. The majority are for thorough and open drain-
age. There are three plans mostly in vogue : (1) Evacua-
tion by an aspirator or trocar, on the closed plan ; this
seems to have answered frequently in the case of children*

THE TBEATMENT OF PLEUBAL EFFUSIONS. 41

The operation may have to be repeated. (2) The open plan
— that is, incision and the insertion of tubes, the orifice
being carefully covered with layers of antiseptic gauze on
Lister's plan. Good results have often been obtained in
this way, and no objection can, I suppose, be made to it in
the case of children and young persons. But the safest,
most scientific plan, and that adopted by the great majority of
surgeons, is pleurotomy, that is, an incision of two inches to
four inches through an intercostal membrane so made as to
allow of thorough evacuation of all the fluid, and then kept
open with free admission of air. By this plan even shreds of
membrane can be extracted, the one and only point for care
being that no fluid shall remain to become putrid. In doing
this an incision must be made down to the pleura, and then,
instead of incising with a knife, the closed points of Hilton's
forceps must be thrust through, and the blades opened so
that the pleura may be torn freely. By this plan one is less
likely to injure lung and artery, and also the wound is less
hable to heal too soon. Surgeons who have often operated
inform me that they do not adopt strict Listerism. The air
does no harm as long as the drainage is free.

One plan, viz., that of Dr. Morgan, I have seen remark-
ably effective. He passes a full-sized soft tube, the larger
the better, through the chest from the fifth space in front to,
say, the eighth behind.

Are ribs to be resected ? I know a surgeon who treats
his cases in children by always resecting the upper two-
thirds of a rib ; others prefer to cut out one to one and
a-half inches of a rib, but others, as Porritt, object to
the proceeding as being unnecessarily severe, and as bar-
barous. Porritt says, ** It is a barbarous procedure, whose
effects will tell upon the patient as long as he lives." Mar-
shall, on the contrary, says, ** It adds but little to the gravity
of the operation, for the bone is soon renewed and the chest
wall will be as strong as ever."

How are we to decide ? It seems best to be guided by
the local conditions, and to resect if sufiicient room cannot
be got without it. The operation is a very easy one, and is
shown to have been very successful. I may add here that

42 THE TBEATMENT OF PLEUBAL EFFUSIONS*

as a later operation done for the purpose of allowing the
chest wall to fall in when the lung does not expand, resection
of several inches of several ribs has been found useful. In
such cases an incision is made down in the mid-axillary
region, and another nearer the sternum ; the ribs are cut
across and drawn out, and then the periosteum removed by-
scissors, otherwise the bone is not renewed.

At what point in the chest wall is pleurotomy to be done ?
Here, again, we meet with differences of opinion, one party
selecting the fifth interspace below the nipple (on right),
others choosing some part in the back — seventh, eighth, or
even ninth space.

Mr. Marshall strongly advised tapping in the fifth inter-
space in front below the nipple, and gave the following
reasons for his choice, but it is not quite clear to me that he
was speaking of pleurotomy. He speaks of puncturing, not
incising. If the chest be opened near its inferior limit, when
the distended pleura is being emptied the chest walls fall in
and the diaphragm ascends, and its inflamed surface covered
with organised lymph will cohere with the costal pleura*
The opening, if in the seventh, eighth, or ninth space, will
often be closed by the diaphragm. A longer tube will be
required, and will keep up irritation. He adds that adhe-
sion between the pleural surfaces of the ribs, lung, and
diaphragm will be prevented. I suppose he means that
these adhesions are to be desired if the lung does not ex-
pand.

The usual point of selection is the seventh or eighth
space in the back outside the angle of the scapula, on the
ground that the thicker portion of the fluid gravitates there,
and shreds of membrane can be most easily removed. If
there be bulging of any part of the chest wall it is advisable to
open it there, but if the drainage is not effectual an incision
should be made in the usual place as well. The free
opening of a pleurotomy is less dangerous than paracentesis ;
oedema of lung never follows it ; the strain upon the lung is
less severe.

Should injections be used? Not until there is some
evidence of putridity or retention* The best is pure water,.

DISCUSSION ON PLEUBISY. 43

or if more active measures become necessary, a little alcohol
or salicylic acid may be added by means of a fountain syringe.
Alarming symptoms have occasionally followed their use.

I have now brought before your notice what seem to me
the most important points relating to the surgery of pleuri-
tic effusions. I have said nothing about the concomitant
use of medicines, because my time was limited, but I none
the less urge you to work at the same time with both hands.
While advocating the withdrawal of the fluid effused, I
recognise that the diseased pleura and lung must be restored
to their healthy state by the natural powers of the constitu-
tion, which can be greatly aided by medicine. I will now
conclude with a couplet of Porrijbt's —

When in doubt,
Let it out,

and to this I add —

To keep it in
Would be a sin.

Dr. Dudgeon said that he had practised in the pre-historic
days, when opening the thorax was never thought of, or was at
least, looked upon as a hazardous operation which must be left to
the mightiest of surgeons. He remembered a case of pleurisy,
with great effusion in the left side of the chest and great dyspnoea.
This was more than thirty years ago. Now no one would hesitate
to employ a drainage-tube ; but as a disciple of Hahnemann he
had perfect confidence that the medicine would relieve the effu*
sion. But he was mistaken. The lady he was attending had a
violent attack of vomiting, and ejected two or three pints of pus,
and thus the empyema discharged itself. In another case he
attended thirty years ago, the effusion was discharged between
the fourth and fifth ribs, and the child made a rapid recovery. In
dry pleurisy, he had heard no mention that evening of a medicine
which he had found very successful; viz., cantharis. He was
called to a lady a few days since, suffering from violent pleurisy
in the right side. She could scarcely draw a breath without
screaming. Temperature 102°; pulse 120 and upwards. He
gave aconite, but found she had had a bad night ; fever and pulse
still high. He then gave cantharis and aconite alternately* Next
morning the pulse was about 70. She had perspired profusely
during the night.

44 DISCUSSION ON PLEUBISY.

Dr. Clarke thought Dr. Dudgeon's experiences showed the
efficiency of medicines given in assisting the operations of nature
in getting rid of the pus. Dr. Hilbers had told him of a remark-
able case of pleurisy with effusion, which filled one side of the
chest. Arsenicum was given, and the effusion was absorbed. He
was glad to hear Dr. Cash speak of belladonna. About seven
years ago he was called upon to attend a lady, about 35, who was
exposed to a chill and was seized with violent pains in the side
which had lasted two days. Temperature 104°. Dulness at the
base with SBgophony. He gave her aconite and bryonia 1, but
the pain and temperature continued the same, and she now had
violent headache and throbbing arteries. He then gave bella-
donna, and the next day the pain had almost gone, and from that
time she became almost convalescent. One indication of bella-
donna was the inability to lie on one side. It caused, usually,
great sensitiveness. He had also found sulphur of immense
benefit in many cases. He had used it with one lady who had
haBmoptysis. She had attacks of catarrhal pneumonia ; violent
influenza of the old sort ; bronchitis ; violent pain in the left side,
and desire to cough. He gave her a few doses of sulphur, which
acted like magic, and the pleuritic trouble disappeared.

Dr. Clifton was glad surgeons could apply remedies when
physicians were in vain. The main purpose of physicians was
to prevent the effusion. He should not hesitate to call in the
surgeon to aid in the evacuation of the serous fluid, but by the
aid of three or four medicines he had been able to *' abort " or
control pleurisy. The medicines were belladonna, bryonia, and
veratrum viride ; the last when the temperature reached 104°,
and the tongue showed the characteristics of this medicine. By
the aid of these remedies he had generally been able to control
pleurisy. He had known hepar sulphuris, iodide of sulphur,
iodide of calcium, and arsenic used with effect.

Mr. Haeold Thomas instanced two cases which illustrated
the surgical treatment of pleuritic effusion — one, a young man,
aged 24, who contracted simple pleurisy in June, 1890. In three
weeks pus had formed, and the chest was aspirated; in two
days a small portion of the eighth rib was removed and chest
drained. After nine days the pleural cavity was washed out with
iodine lotion. The patient was much troubled with profuse night
sweats, which were controlled by meals of rump steak and Bass's
ale at midnight and 3 a.m. He laid great stress on the usefulness
of the midnight meals. The next patient, aged 49, was cured
after two aspirations with Potain's aspirator. Carefully com-
piled charts were exhibited.

DISCUSSION ON PIiEUBISY. 45

Dr. Hughes referred to Dr: Jousset's excellent clinical lec-
tures, in which it was shown that good recoveries were made
where cantharis was used. The same results might he obtained
from the use of similarly-acting medicines as seemed to be achieved
by the aspirator, the drainage-tube and other active measures;
though he agreed with Dr. Thomas that if there were purulent
matter it would be a sin to keep it in. Jousset cited a series of
experiments made on dogs by M. Laborde, which showed that the
action of bHsters had in many instances been really homoeopathic
to the case. He had also found sulphur effectual where there
^as effusion.

Dr. Dyce Bkown said they were all agreed as to the value of
aconite. But when aconite failed he had found baptisia answer,
though he could not explain why it was so. Arsen. iod. had also
been mentioned, but it was hardly efficient when the patient was
in a weak condition ; but when the temperature was not high,
arsenic acted beautifully. Belladonna sometimes operated won-
derfully. He agreed with Dr. Cash as to the value of sulphur.
He did not think he should begin with it so early in the case as
Dr. Cash did. When there were any signs of absorption he
should go on with medicines.

Dr. Mom said that it wad impossible to separate pathology
from treatment. Some cases were tubercular. There was a
striking article by Dr. Barrs, of Leeds, in which it was said that
out of seventy-four cases treated, there had been thirty-two
deaths ; but thirteen of these were cases of phthisis. When the
disease was tubercular half the patients died within five years.
Was the tubercle the result of pleurisy? In many children's
cases pleurisy was overlooked. With regard to the treatment,
they had to abort it when they could. In hospitals there were
many instances in which the chest, on the admission of. the
patient, was full of fluid. If there were urgent symptoms — if
within fourteen days there was too rapid an accumulation — he
used the aspirator. In chronic cases, when it was not urgent to
make a large aspiration it was quite enough to see what the
effusion was, and try the effect of apis and other medicines. Out
of seven or eight hospital cases of empyema he bad lost two.
One was tubercular— in another there was a septicsBmic con-
dition on admission. He agreed with Dr. Thomas that when a
tube could not be retained resection was the best.

Mr. Wright thought in a child of tender years it was not
necessary to resect the rib. There was ample space between the
ribs. In the more rigid chests of older people resection of the rib

46 DISCUSSION ON PLEURISY.

was more often necessary. One of Morrant Baker's india-rubber
tracheotomy tubes might sometimes be used for drainage, and the
flange end of it prevented its slipping in. He thought the chest
should be washed out as soon as possible. Fluid should not be
injected, but simply allowed to enter by hydrostatic pressure. In
some cases withdrawing a small quantity of fluid by an exploring
syringe has been followed by rapid absorption of fluid.

Dr. Neatby had found good results from apis, by which he
had succeeded in emptying the chest of fluid. Another remedy
was Koch's tuberculinum, which had been successful when the
fluid was sero-purulent and of scrofulous origin. Cases ought to
be watched after recovery for twelve months, particularly if there
was a suspicious tuberculous history. He had found a cyrtometer
made by Maw, Son, and Thompson useful in determining the
development of the chest physique. The patient ought to be
watched, and the effect of hill climbing observed. Care should be
taken to see whether there is diminution or alteration in the size
of the chest.

Dr. Jagielski gave his experiences of chronic and complicated
cases in dispensaries. There was great variation in the elasticity
of the thorax. Up to the age of 24 the expansiveness reached
three to three and a-half inches ; but after that age it went down
by one or one and a-half inches. The spirometer would indicate
the increase of cubic inches. As to chronic cases, massage had
been mentioned by Dr. Nankivell, but its effect depended upon
how it was administered.

Dr. GoLDSBKOUGH had found kali carb. very useful, and also
tincture of iodine. Pleurisy had been controlled in less than
twelve hours by bryonia. If there were no risks in an operation,
surely it was our bounden duty to recommend a patient to submit
to it.

Dr. Nankivell, in reply, observed that each of the readers of
papers, though they had been separated from each other by hun-
dreds of miles, had fortunately taken up different parts of the
same question. He could have wished, however, that Dr. Cash
had read his paper first, and that he had been sandwiched be-
tween Dr. Cash and Dr. Thomas. He agreed that cantharis was
a valuable medicine, either by itself or with aconite or bryonia.
The severe pain of pleurisy was apt to disappear a few hours after
the slightest effusion had taken place. But it would not do to
jump to the conclusion that it had then been controlled. Local
applications were also valuable. He recommended the application
of cotton wool covered with oil silk, and left on for twenty-four or

KEMOVAIj op a IiABGE OVARIAN TUMOUR, 47

forty-eight hours, or even longer. It acted speedily as a poultice,
and saved the patient a great deal of trouble.

Dr. Cash said that his object was to prevent effusion, and
at the same time prevent excessive inflammation. Dr. Dyce
Brown had recommended sulphur. He himself used aconite,
which he employed until the pulse indicated subsidence of the
fever. Belladonna was very useful, especially in tuberculous
cases. It was preferable even to aconite. Dr. Wright had
spoken of the benefit of withdrawing small amounts of fluid.
He would go even further; a small puncture would stimulate
the vital powers and set up absorption.

Dr. Wynne Thomas said the more he thought of it the more
he believed that effusion was not a disease. • He would not con-
sider (in the same way) expectoration as a disease. The earlier
the pleurisy was cut short the better. But when effusion is es-
tablished relief should be given at once, instead of waiting week
after week. He never used the spirometer.

ON THE SUCCESSFUL EEMOVAL OF A LAKGE
OVAEIAN TUMOUE, KNOWN TO HAVE
EXISTED FOE AT LEAST EIGHT YEAES.^

BY GEOEGE BTJEFORD, M.B.
Physician to the OyncBcological Department^ London Homoeopathic Hospital.

Dr. Abthtje Clifton, of Northampton, brought up to
town in September, 1892, a lady aged 52, for consul-
tation, with a view to determine the propriety of re-
moving a large ovarian tumour, which now was causing
considerable sickness and no little pain. I say advisedly
the propriety of removal, for, some eight years ago, the
patient had consulted Sir Spencer "Wells on exactly the
same point, when the tumour was much smaller, and
received from him the advice to undergo no operative
treatment, but to allow matters to remain as they were.
This advice was followed, until the embarrassing distension,
the acute attacks of pain, the recurring crises of vomiting

* Bead before the Society, November 3rd, 1892.

48 BEMOVAL OP A LARGE OVABIAN TUMOUR.

and the general impairment of the patient's health made it
desirable to review the situation, to determine whether now
operation were legitimate and desirable.

I found the lady with a large polycystic tumour occupy-
ing the pelvis and lower abdomen, and chiefly developed on
the right side. There were some solid elements plainly to
be made out in the right iliac fossa ; but the major part of
the tumour was fluctuant. As it was rapidly increasing in
size, I advised operation with a view of relieving her of the
more conspicuous symptoms, which were becoming more
and more intolerable.

The following week I performed ovariotomy, finding,
exactly as had been diagnosed, several cystic loculi, each
containing some pints of fluid, and a large doughy mass, the
inspissated contents of which refused to flow through the
ovarian trocar. I therefore turned it out whole and entire,
and with it the attached but emptied cysts which had been
dealt with earlier in the operation. Fortunately there were
no adhesions, and no bleeding. The pedicle was tied — an
ordinary ovarian pedicle springing from the right broad
ligament — the serous cavity flushed, a glass drainage tube
inserted, and the operation concluded in the usual way.

Arnica had been regularly administered for a week
anterior to operation ; but immediately thereafter, its place
was taken by bell, and mere, corr., given, alternately each
half hour for twenty-four hours. A troublesome flatulence
now called for special attention, and a course of nux vomica,
with the use of the rectum tube, was instituted. These
measures relieved to some extent, but not sufficiently, and
an aperient was administered again and again, in order to
unload the intestines of their gaseous accumulation, but no
purgation was effected, although the distension gradually
lessened. Nux was continued for some days, and afterward
china, as the convalescence became more advanced. Piles
were complained of during the later stages of the recovery,
although there was no local evidence of their existence;
but all unpleasant sensations subsided as the intestinal
evacuations became more frequent and more regular. The
patient was sent home five weeks after operation with the

THE OVABY AND ENDOMETEIUM CONSIDERED AS GLANDS. 49

abdominal incision well healed, and the general health
much improved.

Examination of the removed tumour mass showed it to
consist of a large dermoid cyst, with fatty fluid contents,
and of some three or four thin- walled cysts, containing
amber-coloured fluid. This condition is quite in keeping
with the patient's statements as to the existence of a
tumour for eight years, with its rapid increase during the
latter part of the time. Dermoids are notably of slow
growth, and the original tumour mass was doubtless the
dermoid cyst, large and dense, the contents of which could
not be evacuated by the trocar. The remaining cysts were
broad ligament cysts, probably of a much more recent
origin, and it was the rapid growth of these which caused
the notable enlargement of the tumour mass so distressing
to the patient. These cysts often grow with a rapidity as
remarkable as the enlargement of a dermoid is slow and
dilatory.. Abdominal section effected the removal of the
entire tumour mass, to the great rehef of the patient and
the restoration of her capacity for a useful and enjoyable
life.

ON THE OVAEY
AND ENDOMETEIUM CONSIDEEED AS GLANDS.^

BY EDMUND ALLEYNE COOK, L.R.C.P., &C.

I propose in this paper to consider, 1st, how far diseases
of the uterus and ovaries may be looked at as diseases of
glandular structure; 2nd, what influence abnormal nerve
action, has upon them ; and 3rd, whether by considering these
diseases as nerve irritation acting through glandular struc-
ture we may not get light on treatment.

In his observations on the nature of the ovary Tait says
(p. 276) ** the ovary then is a gland, developed as other

* Bead before the Society, December 1, 1892.
veil. I. — NO. 1. 4

50 THE OVABT AND BNDOMETBIUM CONSIDERED AS GLANDS.

glands, and formed of similar elements. Its peculiarity is
that its cell nuclei have special powers during a certain
period of life.'* And Johnstone, quoted by Tait (p. 326) says
'* in the ordinary acceptation of the term the endometrium
above the internal os is not mucous membrane, but belongs
to the so-called adenoid tissue, and that menstruation is for
it exactly what the lymph stream is for the lymph glands, or
the blood current to the spleen."

Here, then, we have views of the ovary and endometrium
which deserve consideration, for if these can be regarded
as glands in their functions, then circumstances which affect
the growth, well-being, and decay and disease of glands
generally will affect these. Wherever we find bone in the
human body its nourishment and diseases are the same;
wherever we find involuntary muscle it will be controlled
by similar nerves, its diseases amenable to similar treat-
ment ; thus when we find a medicine having an action on
the muscular fibre of the heart we may expect it to have a
similar power over the uterus so far as this latter is com-
posed of similar tissue, and vice versa, the action being
varied by function ; and observed facts tell us that whatever
will affect one gland in the body will affect similar glandular
.structure generally. The difficulty crops up at once of de-
fining what we mean by a gland. With grammarians the
adverb was a sort of sink — any word they could not classify
under other heads was an adverb. With chemists in old
times any matter they could not classify was ** extractive";
and with anatomists and physiologists any organ lacking a
class home seems to be a gland — sometimes it secretes, some-
times it does not — all the same it is a gland, only more so if
it secretes. With such an all-embracing faculty it is much
more difficult to say an organ is not a gland than to say it is
one ; but there are several views in which we can regard an
organ, and if we can in all of them say it has glandular
properties our belief in that special organ being a gland
becomes emphasized. If we find it secretes, if we find it has
glandular structure, if we find that the organ we consider
develops in the opposite sex into an organ which has all a
gland's properties of function and structure, then our idea is

rTHE OVARY AND ENDOMETRIUM CONSIDERED AS GLANDS. 51

confirmed. The ovary certainly secretes ova (a gland is not
necessarily bound to have a liquid secretion), and has its
origin from the same structure which forms the testicle in
the male, but that it has ordinary glandular structure would
not, I think, be commonly accepted ; nevertheless we may
reasonably view it as a gland. With regard to the endome-
trinm, it has evidently secreting power and ordinary glandular
structure. The part from which it develops becomes in the
male of no importance.

We find in almost all studies, that when facts are looked
at in various lights, analogies drawn, and theories formed,
the theories are found thoroughly to fit the facts from the
theorist's point of view only, and to fail from other points of
view — ^no one theory is perfect. This is especially so in
chemistry ; yet, there has scarcely been a chemical theory
advanced during the last thirty years, but we find the con-
sideration of it has brought out and emphasised facts which
otherwise would have remained dark, and progress in the
science has been derived from all : there has been no theory
but has been useful, provided it has been rigidly tested by
experiment and only adhered to so 'far as results warranted.
The bete noir of medicine has been that views or theories
have been adhered to when the facts reviled them. How
can we test this view of the ovary being a gland ? If it be
affected by disease, by medicine, by poisons as are other
glands ; if when it is affected other glands show sympathetic
affection, then we are strengthened in our idea ; and if we
find that medicines when applied to diseases of the ovary
because of what is known of their action on glands are able
to bring reHef, then we add to our knowledge.

We well know there are certain diseases special to glands
finch as Hodgkin's disease ; of the influence of these on the
ovary and endometrium there is, so far as I can find, no
record. But there are other blood diseases as mumps, or
scarlet fever, or smallpox, which have a special influence on
glands. This influence is most probably due to an animal
poison in the blood which poison is arrested at the gland
and causes swelling and inflammation. The curious in-
fluence of an attack of mumps on the testicle has its

52 THE OYABY AND ENDOMETRIUM CONSIDEBED AS GLANDS.

counterpart in its influence on the ovary, and when scarlet,
fever spends its venom on the tonsils, it also affects other
glands and very strongly the ovary, and the effect of small-
pox or rheumatism is similar. It is certainly very suggestive
that the reason these poisons act similarly on structures so-
widely apart, is because they are similar structures, the
difference of final result between the action, say, on the
lymphatics of the neck or the parotid, being explicable by
difference of secretion. If the poisoning is intense we know
the glands break down. Indeed, the inflammatory deposit
in any gland changes in three ways, it is absorbed and leaves
no trace, or it breaks down into pus and is discharged, or it
takes on a plastic organisation and remains, being then not
easily acted on by medicine. The tendency to absorption is.
greater, the greater the outlet ; the salivary glands have an
outlet in saliva, the ovary has none but in ova. The
poisonous material can easily get away in a liquid but
scarcely in an ovum ; therefore it can be easily understood
how the effects of the one poison remain in the ovary as a
chronic tenderness and enlargement, while the salivary
gland returns to its primal state ; again, it is a curious fact
that the gonorrhoeal poison will sometimes apparently pass
by the uterus and spend its effects on the ovary, but since
the endometrium regarded as glandular structure secretes a-
liquid and is subject to denudation there is at once a reason
for apparent difference of effect.

As an instance of the action of medicine on glands,
pilocarpine or mercury may be taken. Either will cause
salivation in consequence of their action on the nerve con-
trolling the salivary glands; but the action does not end
here, for the whole of the organs of the body known as
glands are deeply affected by these medicines, from the liver
to the smallest lymphatic gland, and if the ovary be a gland
and the endometrium gland structure, we should expect
these medicines to have a, powerful action upon them.
Regarding pilocarpine, there is no literature of its effects
on ovarian tissue, but mercury is known to have a deep
action on it, and to cause a leucorrhoeal discharge from
the endometrium which may well be comparable to that

THE OVABY AND ENDOMETBIUM CONSIDEBED AS GLANDS. 53

from salivary glands. Again, the effects of chill or cold on
well-known glands have their counterpart in the ovary, and
on the other hand there are the effects of removal of the
ovaries of cows during lactation. When this function is in
fall vigor, if the ovaries be removed, then the lacteal glands,
instead of ceasing to secrete after a certain time as in un-
jspayed animals, continue to give plentiful supplies of milk
without cessation ; and I have a strong conviction that the
ovary does not suffer primarily from any cause without
showing effects of sympathy (probably from similar nerve
control) on the other glands ; for instance, I have now had
many cases in which ovarian disease was accompanied by
swollen tonsils, the tonsils swelling more and getting more
tender with every aggravation of the ovarian trouble. There
are other circumstances besides the above showing the
intimate sympathy between the mammary glands and the
ovary, and Freund has shown that there is no more certain
mode of producing abortion than cupping the mammae
and passing an electric current through them. The lym-
phatic glands of the body swell under certain conditions ;
any irritation of the lymph channels will produce swelling,
poisonous or non-nutritive material travels up them and
then sets up irritation most easily, which subsides, becomes
chronic, or causes them to break down and djecay ; and if
we take the ovary as a gland simply, we can understand
how the gonorrhoeal poisons, or the poisons of the puerperal
states act in enlarging the gland and that permanently.
Tait states that when the uterus is enlarged by gestation the
ovary is so also, and refers to Henning's table of measure-
ments of ovaries under several conditions, and points out,
backed by this authority, how the puerperal woman has
ovaries increased in size beyond all other healthy states,
and that the left ovary is enlarged far beyond the right,
and he says that he has " no doubt this is explained by the
want of a valve in the left spermatic vein.'* " As the ovaries
rise in the abdomen with the pregnant uterus, their liga-
ments, their tubes and everything connected with them rise
in proportional degree " ; "it is therefore not to be wondered
At that any incident which interferes with the involution of

5^ THE OVABY AND ENDOMETRIUM CONSIDEBED AS GLANDS.

the uterus after paorturition should also affect the ovary. "^
"It is therefore practically a sub-involution of the ovary
with which we have to deal, and as in the uterus we have
hypereemia of the organ, gradually passing into chronic
metritis, so we have a similar process occurring in the
ovary."

The facts stated I do not gainsay, but the deductions
from these facts are singular. The gland is stated to be
enlarged from blood congestion; the vein is the outlet for
blood from the enlarged gland ; there is no constriction
in its cahbre, not even a valve ; it is enlarged in proportion
to the other organs ; the uterus and ovaries rise in the pelvis,
and therefore their veins have a smaller weight of blood
to overcome, and yet we are told gravely that these condi-
tions are sufficient to explain an enlarged ovary. If it be so
then the laws of hydrostatics and hydrodjmamics are abro-
gated in this especial matter (not an uncommon thing when
a theory has to be fitted) . When we consider this matter
without bias we must see that were the veins smaller or
otherwise constricted that would be an unanswerable reason
for the enlargement of the gland, we should say our remedy
was to enlarge them, and nature does that — we are told that
the result of this action of nature is to cause enlargement of
the ovary ! ! Poor nature ! The whole problem is in what
way the uterus, tubes, ligaments, and ovaries enlarge, Why
they decrease in size, why the process sometimes stops at a
given moment. Tait well sees that the reason of all this is
one and not several, and could we fit any theory to the facts
it must and should explain all. He inclines to the idea that
the ultimate cause is some nerve control referable to a centre
or ganglion, but he enunciates no reason why the process
stops in one case, goes on to health in another, and to hyper-
involution in a third. With regard to the evolution and in-
volution of the uterus, we know very little about the matter ;
but we do know that once emptied of its foetal contents the
healthy natural course is for it to return in due time ta
nearly its original bulk, and any departure from this course
is a diseased condition whether it stops short or proceeds too
far, and must have some cause. A remnant of placenta, a

THS OTABY AND EKDOMETBIUM COKSIDEEED AB GLANDS. 65

nerve shock, a retention of natural discharges, exposure to
cold, gonorrhoea! inflammation, are all possible causes. In
diminishing in bulk the material disappearing goes partly
into the blood current and partly is discharged, and as the
nterus diminishes so also does the ovary; but this latter
has no possible means of discharging its surplus material
save into the blood current. So long as this surplus material
is healthy all will be well, but if it be poisonous it will act
on the ovary in Hke manner as it would on any other gland
and cause swelling, tenderness, and breaking down. So
long as there is a free discharge from the uterus after
parturition there is scarcely likely to be a stoppage in the
involution of the organ, but any spasm or doubUng on itself
preventing free outlet will at once cause the putrefying
poison-producing discharge to act on the nerve supply, it
may be in a similar manner as does the poisonous material
of a bruised wound which results in tetanus — it may kill
the nerve supply, or cause a tetanoid condition of the nerve.
In the one case you will have stoppage of involution, for if
the nerve be killed how can it act ; in the other an increased
action which may result in hyper-involution. There are
certain well-known discomforts of the sub-involuted state,
but the pregnant uterus at two or three months is at least as
heavy as the sub-involuted one, and as low in the pelvis,
therefore, since it causes no discomfort or even conscious-
ness of its presence, weight alone cannot be any element in
the discomfort of the sub-involuted state.

The strong influence of nerve action on gland structure
—no matter whether set up by muscular action of con-
tiguous parts, or by thought or emotion — is well known.
The dog standing in front of a butcher's shop, dwelling,
doubtless, with ecstatic thought on the delicacies on view,
has his sahvary glands affected beyond control. The effects
of anger, excitement or emotion in stopping the supply of
milk in a nursing mother, the effects of anger in disorder-
ing the liver, are instances of the effects of abnormal nerve
action on a gland ; and if the ovary be a gland, and the
endometrium glandular, we should expect that any nerve
action affecting them abnormally would have large effects in

L

^6 THE OYABY AND ENDOMETRIUM CONSIDERED AS GLANDS.

evidence. It is said a woman feels with her ovaries. The
seat of the emotions has been variously placed. Heart
rhymes with so many words that poets have placed it there.
The Tmrk considers it to be in the liver, and addresses his
intimates as, *' ! friend of my liver, corner of my liver."
Old David devoutly believed it was in the bowels, and some
of us who have had troubles in examinations think there is
truth in that. The German thinks melancholy emotions
connected with the spleen, and finally emotion has found a
location in the ovary. Certain it is that a woman with
tender ovaries is a creature vibratile, susceptible to much
emotional influence, and if you can allay the ovarian disease
you rehabilitate her nerves. We know that ovarian disease
will have vast influence in promoting epilepsy ; and a little
time back, a patient, aged 22, suffering with enlarged and
tender ovary, which gave trouble in peritonitic attacks at
irregular times, had some few days recovered from one of
these and had been for forty-eight hours absolutely free from
pain. Her ear needed syringing on account of a discharge,
and the opportunity of her freedom from pain and discomfort
was taken to syringe it. The operation was done with the
utmost gentleness, producing no pain in the ear but a giddi-
ness (which usually accompanied it). But with the giddi-
ness this time, there occurred first, a sudden feeling of con-
striction across the upper sternum ; second, a fierce pain
through the ovary which lasted twelve hours, with head-
ache ; there was some weeping, but no unconsciousness ; as
she expressed it, ** it seemed as though the ear were con-
nected with the ovary."

The intimate nearness of nerve action and sexual ereth-
ism is far too often overlooked. It can scarcely be needful
for me to point out how the sexual organs are influenced by
every variation of emotion. The way in which the cata-
menia will cease on nerve shock, how labour pains will
cease on an even expected arrival, how far fear will cause a
paralysis of the sphincter vesicae, all these without a particle
of sexual feeling, prove the subtle and delicate influence of
even a slight emotion. We know these things, and yet it is
not often we take into account as a cause of alteration and

THE OVABY AND ENDOMETRIUM CONSIDERED AS GLANDS. 57

disease of the sexual organ the subtle influence of sexual
feeling which must have a daily influence infinitely greater
than the other causes I have mentioned. A girl grows
up from girlhood to womanhood —

'* Standing with relactant feet
Where the brook and river meet,
Womanhood and childhood sweet,"

absolutely unconscious of what is dawning within her,
because of the absolutely abominable social pseudo-delicacy
which prevents her guardians approaching the subject ; and
as Euskin says, " She may fall and defile her head in the
dust if you leave her without help at some moments of her
life." Yet the social custom is to leave her without help,
often without fellowship ; leave her to find out for herself or by
the instruction of nasty people things that are essential to
her health she should know — ^how the good God has made
her. And then we wonder at the outcome, that we have
swollen ovaries, distended tubes, painful catamenia and all
the ills which civiUsed life makes women heir to. More than
that, in treating her ailments we do not keep sufficiently, if
at all, before our eyes those subtle overwhelmingly powerful
causes of her defects of body ; let us consider whether it is
not the fact that at this time of waking womanhood, she is
overpowered by natural animal instincts and mostly with no
more knowledge than an animal of what they mean. Now,
we know there are drugs which will rouse sexual erethism
in both sexes, origanum, ferrum mur., damiana, 6aw palmetto,
iodine are examples. Surely among these, if there be any
truth in the homoeopathic law, we can find means to
repress sexual instinct in obedience to civilised conven-
tionalities and amenities for the good of the individual. I
think evidence could be produced to prove that, unless the
female be a sort of sexless individual, in 80 or 90 per cent, of
the cases of gynaecological interest which come before us we
have as a root cause of abnormalities of function and form
past or present sexual erethism, and I do not think there is
a gynaecologist who professes to have found the consideration
of this a ground of treatment, and I do not think gynaecology
can be called scientific without its students give these things

58 DISCUSSION ON THE OVABY AND ENDOMETRIUM.

their due place, which is a large one. It would not become
me to take up your time with cases, but this I can state
that the drugs I have named are valuable aids in small doses
in allaying irritation of nerve. Take the case of a woman
having tumour of the breast, and bear in mind Freund's
demonstration of the influences of irritation of this gland on
the pregnant uterus ; then ask yourself whether it is probable
or possible any such irritation can exist in the mammsB and
not have its reflex action on the uterus and ovaries and
vulva, and although the woman will not complain (she has
nothing definite she cares to state) yet you will not cure her
except by chance unless you take it for granted such irrita-
tion exists, and give remedies for it ; and if you give damiana
or origanum in dilution you will, even if you don't cure the
tumour, get an amelioration of the general health. This I
know from practical experience.

The ovary and its treatment is the opprobium of gynae-
cology. If its surgical treatment was absolutely sure and
entirely satisfactory we should have less to regret ; but in
this organ, while operation frequently relieves, it as fre-
quently leaves matters in their unameliorated condition so
far as pain and discomfort are concerned, while it would be,
to put it mildly, inaccurate to say that the relief by medicines
fulfilled our expectations and desires. To look at the ovary
as a gland, and from this position to study its treatment,
may be imperfect, but already this point of view has in my
experience opened up some prospect of relief and is therefore
worth pursuing. If I could reasonably hope to get help by
looking at the organ as a nerve centre I should readily con-
sider its prospects, for while I admit that were the Homoeo-
pathic law perfectly applicable it might answer all purposes,
yet I know in our present imperfect application of it there is
something left to be desired.

Dr. Hughes said that some French physiologist had observed
that a woman was what her uterus made her. He agreed with
Dr. Cook in thinking that it would be more correct to say that a
woman was what her ovaries made her, because the uterus was
very little more than the receptacle of the ovary, in which lay

DISCUSSION ON THE OVABY AND ENDOMETBIUM. 59

the centre of sexual life. Undoubtedly, a woman for a long
period of her life was what her sexual system made her — ^in
most cases unconsciously. He agreed that the ovary was to be
regarded as a gland — he had always thought so, and it had
helped him to think so. Much help could be derived in the
treatment of obscure diseases of single women by remembering
the part which the ovary had to play, and applying remedies
accordingly. Help was then often given, though the patient
was ignqrant of the way in which she was helped. His list of
remedies for these troubles was somewhat different from Dr..
Cook's. He had no experience of damiana. But he had often
found origanum useful. Flatina was also serviceable in checking
morbid tendencies. Dr. Blake had told him that next to origa-
nmn, platina was the best medicine in these disorders. Another
remedy was lilium. These three drugs were the most effective he
knew.

Dr. Neatby mentioned one case of the connexion between
the parotid glands and the ovary. He had reported the case in
the Review. It was one of mumps. It was on one side only,
and was followed up by ovarian pain and miscarriage without
any obvious cause. There was no departure^in any other respect
from the usual course.

Dr. Dudgeon said that the ovaries were undoubtedly glands ;
but a definition of " gland " was required. In one sense every
organ might be said either to be a gland or to contain glands.
The kidneys were glands — the intestines contained glands. There
was a great analogy between the ovaries and the testicles in a
man. The former secreted one thing — ^the latter another. This
analogy assisted him once in curing diseased ovaries in a very
striking way. A lady complained of abdominal swellings. He
fomid both ovaries enlarged to the size of a fist. Not knowing of
any medicine which acted directly upon the ovaries he fell back
on the idea that graphites, which had a distinct action upon the
testicles, might do good. He used it and the tumours dis-
appeared. It was nearly a year before they finally vanished.
He had recorded the case in the British Journal of Homoeopathy,
His notion was that the glandular structure of the testicles had
a great analogy with the ovaries. Dr. Cook had referred to the
danger of girls being brought up in ignorance of their sexual
system. He knew of a striking example of this. A mother told
him that her daughter was suffering from curious symptoms.
The young lady was the daughter of a clergyman, and ver}'^
strictly brought up. He gave the mother a hint and the girl con-

•60 DISCUSSION ON THE OVARY AND ENDOMETRIUM;

fessed that she regularly masturbated. The girl did not know it
was wrong until her mother explained that it was — ^both morally
and physically. The girl had brought herself into a condition of
extreme nervousness, and suffered from extraordinary fits of
passion and of sulkiness, and was not the least like the other
children.

Dr. BuRFORD said they must not depend wholly on text-books.
It did not follow that because a man was a good operator he
was a good pathologist, and vice versd. In looking at the book of
a distinguished pathologist he found it stated that the ovaries
conditioned the function of menstruation. They had, however,
little to do with menstruation. Eemove them and the patient
will continue to menstruate. Mri Lawson Tait said the ovary
was a gland. It was so in a rough sense. So are the tonsils,
the red marrow. But it was not a gland in the sense that its
secretion was influenced by nerves or the blood supply, as in
the case of the salivary gland. It was shewn by the researches
of Polus that the ovaries contained all the glands which they evei"
contained at birth. The ova tended to diminish. Apart from the
stroma's development the number of ova diminished. If the
ovary and the uterus are glands much more so are the tubes,
though they did not secrete anything. The tubes and their
surroundings had far more influence pn uterine functions than
the ovaries. If you removed a woman's tubes with the adjacent
structures the function of menstruation, in 99 cases out of 100,
would be stopped beyond recall. The uterus and the vagina
found their culmination in the tubes. Suppurative lesions and
inflammatory lesions were really inflammations of the tubes.
The ovary was sometimes free from trouble, while the tube had
been the root of all the mischief. Compare the ovary considered
as a gland with the undoubted glands, e,g.y the breast. A tumour
•of the ovary in a girl was, in 99 cases out of 100, a sarcoma. In
the breast it was not a sarcoma. The two structures on the
gland theory were similar structures, largely knit together by that
nervous plexus which united all the sexual organs. So far as the
endometrium was concerned it was a gland because it secreted.
The theory advanced by Dr. Cook was still inchoate and embryo-
nic, but it was an excellent working hypothesis, from which good
results had followed. But he would not bind himself to the hard
and fast theory that the ovary was a gland. Experience showed
that we gained little by pathological observations, but a good deal
from observations of symptoms i

Dr. Morn thought the greatest triumphs were to be looked for

DISCUSSION ON THB OVAEY AND ENDOMETEIUM. 61

in the way of prevention. There was a great future before us in
that respect, and Dr. Cook's paper was full of suggestion of what
might be done in the future.

The Pbesident remembered Dr. Dudgeon's paragraph con-
cerning the action of graphites in ovarian trouble, and had found
it very useful, and had often prescribed it. But at the same time
it had not been proved to his satisfaction that the ovary was a
gland after all. As Dr. Burford had said, this was a subject which
required more working out. There was clinical reason for think-
ing it was not a gland. It did not answer to the cUnical test. It
there was one medicine more than another which had an effect
upon the glands it was iodine in its various forms ; but iodine had
no appreciable effect upon the ovary. He agreed with Dr. Cook
that the endometrium was much more of a glandular structure.
He concurred with what had been said about the importance of
avoiding false delicacy with regard to young girls.

Dr. Cook in reply to Dr. Dudgeon admitted it was not easy
to define ** gland." An illustration might be drawn from the
difference between the hands of a washerwoman, which are con-
stantly in water, and those of ordinary persons. In the washer-
woman's case the cuticle seemed always to have some secretion
which kept it moist. There was a swelling of the epithelial tissue,
and this illustrated a primary gland structure. The lining of the
membrane of the tubes was glandular for the same reason. They
secreted more because there was more mucous membrane in a
small space. Dr. Burford had said that he could not understand
why sarcoma occurred in the ovary and not in the breast. But
irritation of the mammae would set up irritation of the ovary, and
what affected the ovary generally affected the mammsB. He put
forward what he said as speculations only. It was the heretic
who doubted received doctrines who often led the way to dis-
covery.

L

62 THE DIURETIC ACTION OP " APOCTNUM OANNABINUM.

»»

^OBSEEVATIONS ON THE DIUEETIC ACTION OF
" APOCYNUM CANNABINUM," OE AMEEICAN-
INDIAN HEMP.i

BY BYEES MOIR, M.D.
Physician to the London Ho^noBopathic Hospital.

The root is the medicinal part of the plant, and the pre-
parations in use are : —

1. Tincture.

2. Triturations of the root.

3. An infusion (of 1 oz. of the fresh root to a quart of
water) .

4. Hunt's Decoction ; an American preparation.

5. Keith's Apocynin ; also an American preparation.
Apocjmin and Apocynein, active principles, were separated

by Schmiedeberg in 1883, and are said to resemble digitalis
in their properties.

This drug was, I believe, first brought to our notice in
Hale's **New Eemedies," where it is mentioned that in
America it had received the title of a " veritable vegetable
trocar," and in the same article Dr. Griscomb is quoted as
saying " that this agent has four different distinct operations
upon the system — causing (1) nausea and vomiting ; (2) this
is followed by increased alvine discharges, which are suc-
•<;eeded by (3) copious perspiration, and in many instances
(4) by diuresis." In Dr. Peter's proving with half a wine
-glassful of Hunt's " Decoction " three times a day, the urine
was diminished by a third. Dr. Marcy's provings were
made with the third dilution. Some diminution of urine
was noticed for two days, then decided increase with dull
^aching pains in the kidney. Many clinical cases are given
with splendid results, but the cause of the dropsy is not
often definitely recorded. Several were evidently due to
heart failure ; no mention of Bright's disease, as a cause,
is given.

In the Cyclopcedia of Drug Pathogenesy several new
provings are narrated, but the results on the quantity of

^ Bead before the Society, December 1, 1892.

THE DIURETIC ACTION OP " APOCYNUM CANNABINUM.*' 63

nriiie passed are quite indefinite, the amount being sometimes
increased, sometimes lessened. Its action on the heart is
well shown in the proving of Mr. Chapin (page 329). He
took the hot infusion in Joz. doses, and after the fourth dose
the pulse, which to begin with was 68 and regular, was
described by a medical friend as " full, slow, irregular, inter-
mittent, dicrotic ; at times feeble and readily compressed : "
slight darting pains in region of heart ; had to breathe
deeply from feeling of suffocation. The weakness of heart
and pulse lasted for some days.

The next important observation on apocynum that I
have found is Dr. Murray's " Graduation Thesis on Apocy-
num Cannabinum," pubUshed in the Therapeutic Gazette^
Sept. 16th, 1889. After saying that in America it has been
specially recommended as a diuretic in renal dropsy, he
mentions that Dr. Einger had tried it in Bright's disease
without getting any result ; and states that " so far as our
experience goes in this country, apocynum does not act as
a diuretic in the class of cases of dropsy in which American
authors have found it useful." He goes on to quote some
experiments, as to its physiological action, made by Dr.
Rose Bradford, who shows that its principal action is on the
heart, resembhng on the whole strophanthus more than
digitalis. He gives a case of mitral disease, under Dr.
Sydney Ringer, at University Hospital, in which it was used.

Case. — A woman, 38 years of age, with mitral regurgi-
tant murmur, oedema of feet and hands, cyanosis of face,
and great dyspnoea. The pulse on admission was 128 : and
16 ounces of urine were passed in twenty-four hours. Five
minims of the tincture was given every four hours ; increased
the next day but one to ten minims. On the fourth day of
treatment the pulse had fallen to 94, and 179 ounces of urine
had been passed in the twenty-four hours. The dropsical
fluid having been got rid of, the quantity of urine began to
diminish while the pulse maintained a normal average.

He also records a case of mitral constriction, in which
the good results obtained by digitalis were repeated, when,
digitalis having to be discontinued, apocjmum was given in
its place. He arrives at the conclusion that its action, as a

64 THE DIUBETIC ACTION OP " APOCYNUM CANNABINUM.*'

diuretic, is similar to digitalis — through the heart and not as
a local renal diuretic.

In our own hterature on the subject I have found very
few reports of the action of apocynum. In looking through
the volumes of the British Journal of Homoeopathy for the
last twenty years, I only found two reports of cases treated
by it. One was in vol. xxiii., 1865 ; an extract from the
American Homoeopathic Observer of a case of hydrothorax,
reported by Mr. H. M. Warren as cured by apocynum can-
nabinum, five drops of the tincture every two hours. The
other case was reported by the late Dr. Drysdale, in vol.
xxxviii., 1880, — a case of ascites and anasarca, without heart
disease, in which the diuretic action was most beneficial.

I will now record my own case, which shows the diuretic
action of apocynum : —

The patient, a man, aet. 67, had for two years signs of
heart failure, from fatty change, the pulse being quick,
irregular, and feeble. The apex beat of the heart was two
and a half inches below, and outside the nipple line ; over
this area a systolic bruit was subsequently developed, though
it was not present at the beginning of the illness. (Edema
of the legs came on gradually, with some swelling of the
lower part of the abdomen and genitals and an effusion of
fluid into the right pleural cavity. Under infusion of digitalis,
strophanthus and mercurius, the quantity of water passed
had varied from 23 to 50 ounces in the twenty-four hours.
Once, under infusion of digitalis, it had reached 63 ounces,^
but the oedema had steadily increased.

On the 20th of June, 1892, the note was — pulse is so*
feeble and irregular that it cannot be counted ; no dyspnoea.
The oedema has steadily increased. Measurement round the
calf of leg 18J inches. Bowels confined. Thirty-nine ounces-
of urine passed in twenty-four hours ; it is loaded with
lithates, and has a trace of albumen. Infusion of apocynum
was ordered, one drachm three times a day. Only one dose
had been taken before my visit on the 21st, but 57 ounces of
urine had been passed, and after this a steady increase in its
flow took place. 22nd, 107 ounces ; 23rd, 154 ounces ; 24th,
98 ounces ; 25th, 102 ounces ; 26th, 67 ounces ; 27th, 65
ounces ; 28th, 75 ounces ; 29th, 50 ounces.

THE DIURETIC ACTION OP " APOCYNOM

t. MOIR S CASE, SHOWING DIUBETIC ACTION OP APOCYNUM
CAKNAB.

6& THE DIUBETIC ACTION OF '* APOCYNUM CANNABINUM.

»»

By the 15th of July the whole of the oedema had disap-
peared, and the calf measured twelve and a half inches (pix
and a quarter inches less).. The apocynum was only given
for ten days, and as soon as improvement began, only once a
day.

On the 12th, after the apocynum had been discontinued
for a week, the urine excreted fell to 34 ounces, but in three
days again, when the medicine was repeated, the quantity
rose to 72 ounces. After this the oedema was quite kept in
check by the apocynum, but there was no great improve-
ment in the heart or pulse, and the patient died three
months later from heart failure.

I am indebted to Dr. Washington Epps for the foUovdng
case showing the diuretic action of apocynum.

A girl, set. twenty-one, was said to be suffering from a
weak heart, but there was no bruit. Dr. Epps saw her for
the first time on the 7th January, 1891, after an illness of
ten days. She had then a pulse of 140, feeble and irregular,
and w'as struggling for breath. He found double pneu-
monia, with effusion of fluid into the pericardium. Great
oedema of abdomen and lower extremities, the abdomen
being dull to the level of the umbilicus, and the skin of the
legs stretched almost to bursting.

He tried tincture apocynum cannabinum <t>, from one to
four drops every four hours, without effect ; also arsenic and
phosphorus.

On the 20th January the condition was much the same,
twenty ounces of urine having been passed in the last
twenty-four hours. One drachm of fresh infusion of apocy-
num in one ounce of hot water was ordered every four
hours. During the night three ounces of thick urine were
passed.

At midday on January 21st, ten ounces of clear urine
were passed, and from that time a steady improvement took
place, the quantity of urine passed was as follows : —

22nd, 100 ounces ; 23rd, 140 ounces
25th, 220 ounces ; 26th, 320 ounces
28th, 100 ounces ; 29th, 100 ounces

24th, 160 ounces.
27th, 160 ounces.
30th, 60 ounces.

By this time the dropsy had quite gone, and there had

THE DIURETIC ACTION OF " APOCYNCM CANNABINUM," 67

DE. EPPS CASE, SH:Q"WrN(J DIDItETrC ACTION OF APOCYHtJH
CANNAB.

JiSDiiT 20H1 2Ut SBnii SSrf mh 25tli SflUi S7th 28tb !tWi SOtli

68 THE DIUBETIC ACTION OF " APOCYNUM CANNABINUM.

II

been a corresponding improvement in the heart and pulse,
and the patient made a rapid recovery. For the first three
days the infusion was given the bowels acted from three to
six times ; then for two days twice a day, but were after-
wards costive.

Dr. Blackley has kindly allowed me to make use of the
following case exempHfying the action of apocynum as a.
diuretic.

A boy, set. fifteen, was admitted into the London
Homoeopathic Hospital for heart disease and dropsy. There
was a history of rheumatic fever seven months previously.
The heart was enlarged, and there was loud, mitral systolic,
bruit. He had ascites, and measured thirty-seven inches at
the umbiUcus. CEdema of legs and genitals was very marked^
On the day following admission, on account of the urgency
of the symptoms, he was tapped, 192 ounces being with-
drawn. In the last twenty-four hours ten and a half ounces,
of urine were passed. On the 7th May, he had passed
twenty-six ounces of urine in twenty-four hours, free from
albumen. He was ordered 5ii. of fresh infusion of apocynum
three times a day. Next day he had passed 158 ounces of
urine, and the swelling had gone down considerably. On
the 9th May it was noted that he had passed 202 ounces
of urine containing a trace of albumen. By the 13th, the
urine had fallen to seventeen ounces, and the dropsy had
nearly disappeared, with great improvement in the pulse
and heart. By the 26th May he was out of bed and left
the hospital on the 6th June, being free from dropsy and
able to walk about. He was re-admitted on the 8th July,
and died the next day from heart failure, but there was no
return of the dropsy.

This case is not satisfactory with regard to the action of
the medicine, as a great deal of the benefit was evidently
due to the tapping, but both Dr. Blackley and Mr. Spencer
Cox, who had charge of the case, were convinced of the
undoubted diuretic action of the drug.

In addition to Drs. Blackley and Epps who kindly lent
me the notes of the two cases I have just given, I wrote to
twelve other medical men asking them for their experience

THE DIDBETIC ACTION OF " APOCTNUK CAKNABINUM."

BLACKtET S CASE, SHOWING DIURETIC ACTION OP
APOCYNUM CANNAB.

May 5Ui 6tli Tth gth 9th 10th 11th llth ISth 14th IBth

70 THE DIURETIC ACTION OP " APOCYNUM CANNABINUM."

of the use of this drug, especially as a diuretic and with
regard to its action on the heart.

From these I had answers (with one exception). Seven
state that they have had no satisfactory results. Four use
the drug more or less largely, and from these I will first-
quote : — •

Dr< Arthur Clifton, who sent me a valuable synopsis as
the outcome of over fifteen years' experience of the drug, in
a dozen cases of ascites and anasarca ; mostly in patient&
over fifty years of age.

** In one-third of the cases, where the dropsy was
dependent upon or caused by cardiac disease, or by kidney
disease, per se, but associated with liver disease secondarily,,
the medicine did but little if any good, i.e., did not reduce
the dropsy*

** In the other two-thirdss, passive congestion and en-
largement of the liver were the primary causes of the
ascites, leading to cardiac dilatation and kidney inaction, —
the urine containing small amounts of albumen, but giving
no evidence of true Bright^s disease. In these the apocy-
num was all-sufficient in removing the water, stimulating
the kidneys to pass as much as two quarts in the twenty-
four hours. As well as the enlargement of the liver there
was often more or less jaundice with pale stools, the bowels,
being sometimes constipated, but more often slightly re-
laxed; the urine being scanty, high coloured and loaded
with lithates."

Though the kidneys have been so apparently over-
stimulated, Dr. Clifton has never known the reverse condi-
tion on leaving off the medicine.

The drug was used in the form of Boericke and Tafel's
concentrated decoction 5i. to siii. every four hours. He had
tried the matrix tincture in doses of from five to ten drops-
without good results.

Dn Alexander, of Plymouth, reports that he has used
the drug for years with the greatest success in cases of
oedema of the legs, and even of ascites, due to cardiac weak-
ness. He divides his cases into two classes. (1) In cases
with valvular lesions ; in these the relief to cardiac distress

THE DIUEETIC ACTION OF " APOCYNUM CANNABINUM.*' 71

was very great, and was attended by a marked diuretic
effect. The benefit was not always of long duration, re-
currence taking place with more or less rapidity according
to the gravity of the lesion. (2) In cases due to commencing
dilatation of the heart from feebleness of muscular contrac-
tion, or perhaps fatty infiltration ; the results here have
been more permanent. He thinks that the drug has some
specific action on the cardiac muscles, and though it may
not be distinctly homoeopathic, considers that it is a very
useful and reUable medicine. He uses an infusion in 5ss. to
5i. doses, which he finds acts better than the tincture.

Dr. Hardy, of Bournemouth, writes that apocynum " is
a drug in which I have the greatest confidence, and as a
diuretic in the anasarca of Bright's disease, and more
especially of cardiac disease (mitral valvular disease with
dilatation), it has no superior. For here, in addition to its
power of diminishing dropsy, I am sure it is also a * cardiac
tonic,' like digitalis, steadying the pulse and increasing
arterial pressure. (When digitaUs is failing I turn to
apocynum, and always with satisfaction). In pleural effu-
sions it has several times helped me greatly.** He uses the
matrix tincture, five to ten drops three times a day, but
whenever he has used the infusion in 5j- doses he has been
more pleased with it than with the tincture.

Dr. Percy Wilde, of Bath, states that he has never been
able to arrive at any satisfactory conclusions with regard
to apocynum, especially as to its action on the heart. He
gave me the notes of two cases : —

(1), Ascites in a man, aet. 43, whose liver was enlarged,
heart weak, and slightly dilated. Apocynum <f), tiiij., was
given four times a day, causing profuse watery evacuations.
The dose was reduced to mj., four times a day, but still pro-
duced watery stools, though less violently. There was no
diuretic effect, but the whole symptoms improved, and the
man was dismissed cured.

(2) . A female, set. 54, whose abdominal ascites was due
probably to liver, which was enlarged. The urine was very
scanty, but free from albumen. Apocynum had no effect ;
diuretin, no effect. Apis 3x relieved all the symptoms. He

72 THE DIUEETIC ACTION OF " APOOYNUM CANNABINUM.

t>

has used the liquid extract, but with no particular advan-
tages ; it caused nausea, and he had a solid extract prepared,
and gave it in the form of pills. He has also used the drug
in tachycardia and nervous palpitation with slight benefit,
but thinks that it is only under conditions of abdominal
plethora that it does good in such cases.

I have given you one successful case occurring in my own
practice, but my failures have been far greater than my suc-
cesses. For several years I used the tincture, but never ob-
tained any good from it. I then tried the fresh infasion in
5j. doses, with better results ; but I have just lately made a
trial of the drug in the wards in four cases of anasarca and
ascites for heart disease, and in not one of them was there
the slightest improvement from the use of it. In all of them
the failure of the heart was very advanced.

From the evidence I have brought before you to-night,
there can be no question about the powerful diuretic action
of apocynum, and also that it is very uncertain in its action.
The two reasons for this uncertainty I would put down to
(1) the unreliable preparations of the drug, (2) the selection
of unsuitable cases.

This is only a short paper, and I hope in another one,
before long, to be able to decide these points, and for the pre-
sent would only say that the best preparation of the drug is
the fresh infusion of the root : and that with regard to the
suitable cases not much can be expected from it in the
dropsy of an advanced case of Bright's disease or cardiac
disease, but that Dr. Arthur Clifton has given us the key for
the use of the drug, viz., ** cases in which passive congestion
and enlargement of the liver are the primary causes of the
ascites, leading to cardiac dilatation and kidney inaction
secondarily." In my own experience I have found little
evidence of a direct action on the heart, but there is enough
to show that it has a decided action, and I think that the
source of its action must be looked for as well in the stomach
and liver.

I will now only refer for one minute to the question,
whether the use of apocynum in ascites and anasarca is
homoeopathic ?

DISCUSSION ON "APOCYNUM CANNABINUM." 73

In Dr. Drysdale's paper he says, "The action of the
apocymun here may be fairly claimed as homoeopathic, act-
ing directly on the disordered capillaries and lymiphatics, and
not indirectly as a primary diuretic, for the dose, viz., four
drops of the tinctuve per diem, was too small for a diuretic.*'

In 1870, the late Dr. Douglas Hale read a paper before
this Society, entitled " The Drift of Modern Homoeopathy,"
implying that the modem practice of homoeopathy is drifting
away from the early precepts of Hahnemann, and brought
forward the use of apocynum in dropsy as an instance.

In the British Journal of Homoeopathy for 1870 there
is an answer to this charge by Dr. E. M. Hale, of Chicago,
who maintains that apocynum is homoeopathic to dropsy,
arguing that apocynum is primarily homoeopathic to pro-
fuse nrine with excitement of the kidneys, and secondarily
homoeopathic to scanty urine with congestion of the kidneys ;
these two conditions having been produced respectively in
persons from small and large doses. He appeals for the fol-
lowing law of dose, viz., " That opposite pathological condi-
tions are caused by the primary and secondary effects of
medicines ; that their effects may alternate ; and that a strict
adherence to the law of similia should oblige us to take cog-
nizance of this dual action, and select the dose in accordance
with such action."

Dr. Hughes was in favour of the soft " c " and the short ** y."
He had been disappointed with the drug in dropsy. He had only
given it in tincture. Perhaps Dr. Moir would give the proper
strength of the infusion.

Dr. Mom : One ounce to one quart.

Dr. Cook had used the drug once or twice, and had come to
the conclusion that it made all the difference whether or not it
was a fresh infusion from the fresh root. In a meadow cattle
would avoid buttercups, but in hay they ate the buttercups with
the rest of the grass. The drying seemed to produce some altera-
tion in the properties of the buttercup, and to effect the elimina-
tion of some active principle. A like result was observable with
respect to cascara sagrada, which was very different according as
it was old or not old. So fresh orange peel would not, but dried
orange peel would, produce evacuations. So with burdock applied
to the iareatment of eczema.

74 DISCUSSION ON "APOCYNUM CANNABINUM.

ft

Dr. BuBFOBD had only given the drag once, to a patient who
had a large abdominal tmnonr with swelling of the legs. The
dose was given in tincture, and the only effect was to doable the
amount of urine withoat affecting the total of albnmen. She
only passed more floid through the kidneys, bat the circumference
of the legs was not altered. With regard to pronunciation he had,
asked a distinguished classical scholar, who told him everybody
now pronounced scybalse with a hard c, and the same would apply
to apocynum. Dr. Moir's papers had struck out a new line, and
he agreed with Dr. Cook that we are much too content to follow
in the steps of our ancestors. There was every reason to beUeve
that it made all the difference in what condition the drug was
when it was administered.

Dr. Dudgeon said that Dr. Moir had asked whether the
employment of apocynum as a diuretic was homoeopathic. If
an infusion of one drachm was given and a diuretic effect was
produced it was decidedly allopathic. He did not suppose Dr.
Moir had seen apoc3mum given in dilutions produce any diuretic
effect. He had not had great success with it in any case of
dropsy. He had seen violent purging produced which did no
good to the patient. But diuretic action might be produced by
homoeopathic medicine in small doses. A gentleman had come
to him with a large abdomen. He found that the patient must
have had an attack of peritonitis. There was a fluctuation on
every side except in one part, and he imagined that the peri-
tonitis had caused some adhesions. Having had some experience
of a dilated bladder he introduced a catheter, but found that th&
bladder was not distended. He gave him some apis, and the
result was that the abdomen fell into its natural shape, and the
patient said that he had passed an immense quantity of urine.
This shewed the diuretic effect produced by a homoeopathically
acting medicine. Dr. Moir's large doses are allopathic. In one
case he had given some doses of citrate of potash, and the dropsy
disappeared. He gave 10 grains — two doses of 5 grains each.
This was not homoeopathic.

Dr. Lough, in a case of dropsy with albuminuria, had given
1 to 5 drops. He had never been able to report any result at
all with it. He had never used the infusion, but would do so in
future.

Mr. Knox Shaw thought from what he had heard in Dr.
Moir's papers that it was quite possible to ascribe a homoeopathic
action to apocynum in dropsy. Perhaps he might be allowed
to refer to a paper he read at the Congress on the action of iodide
of potash on tertiary syphilis. He had tried to show that the

DISCUSSION ON "APOCYNUM CANNABINUM." 76

medicine might be homoeopathic to tertiary syphilitic nodes. In
Dr. Peters' proving, after material doses of Hunt's decoction — a
strong remedy — the urine was diminished ; but with Dr. Marcy's
proving with the third dilution, the amount of urine was increased.
When proving with massive doses produced a given effect,
moderate doses would relieve the corresponding symptom in the
diseased state. But when a proving with a dilution revealed an
opposite action to that induced by the large dose you must give a
higher dilution if a curative action was desired. He had been
accused by an American journal of leading homoeopaths by a will-
of-the-vdsp for enunciating the theory. The basis of an admirable
paper might be laid if the varying effects of provings with material
and small doses of remedies known to be valuable were recorded.
Some drugs appeared to produce two opposite actions. It would
be interesting to know in each case in what dilutions it was
proved. It was often difficult to judge whether a particular result
was due to the drug administered. When he was House
Physician at Guy's a man came with an enormous ascites.
Mistura cinchonse was given him, and whilst taking it he began
to pass enormous quantities of water, and the ascites disappeared.
It was impossible to say that this was due to the remedy.

Dr. JaoieiiSei would hke to know whether any alkaloid had
been discovered in apocynum. All analytical results were of great
importance.

Dr. Neatby had been much disappointed with the drug in
renal dropsy; but he had much confidence in it in the cases
described by Dr. Chfton when there was commencing heart
failure, or a damaged heart due to diseased liver, or injury to the
lungs through long bronchitis, asthma or emphysema.

Dr. Cox had had several cases during his long residence in the
hospital, and the medicine struck him as of great value in most
cases of dropsy due to the heart and not to the kidneys. But the
infusion had to be given to get any result. The tincture produced
no result.

Dr. Epps said that in giving a drachm of the infusion not more
than li grains of the root was administered.

The Pbesident said the short papers had been exceedingly
interesting, and he wished they had them more frequently —
everybody had something to tell about individual medicines, and
much might be expected from collective investigation. It was
important to distinguish cases from one another. The medicine
did not act in all cases of dropsy. It was necessary to divide the
cases into renal, cardiac, lymphatic, and other cases of dropsy,
and old standing bronchitis and emphysema. Dr. Mdir's case of

76 LIVEBPOOL BBANCH MEETING.

a woman was favourable to the supposition that the drug had a
diuretic effect. But it was not always so. He had in the wards
a woman aet. 45. For the last eight years she had had attacks
of bronchitis resulting in emphysema. There was very extensive
anasarca. The abdominal wall had increased in thickness from
the amount of fluid. The urine was scanty, from about 15 to 25
ounces. Shortly after admission she was put upon an infusion
of the drug. During the last 48 hours the amount of urine rose
to about 22 to 26 ounces. She was now taking 3 drachms. She
began on one — then two — ^then three; but there had been no
material increase in the amoimt of urine, and there was still a
trace of albumen. The woman's condition was desperate. He
had given the tincture till he was tired, and he never saw the
slightest effect.

Dr. Mont, in reply, said it was unfortunately not possible
to get the drug fresh. Dr. Burford had said the drug had no
effect on albimien, though it increased the quantity of water ; this
was the experience of others. Dr. Dudgeon had spoken of small
doses being homoeopathic, and large doses not homoeopathic.
That was not homoeopathy — the essence of which was the similar
action. High dilutions had been found to increase the amount
of urine, and were homoeopathic to such cases as diabetes in-
sipidus. As to alkaloids two principles had been extracted, but
most preferred infusions and tinctures to the alkaloids. In
digitalis he found infusions acted better than the other forms of
administering the drug.

LIVEKPOOL BEANCH MEETING.

A Meeting was held in the Hahnemann Hospital,
Liverpool, on December 1st, at which Dr. Hawkes (Presi-
dent), Drs. Hay ward, Mahoney, J. D. Hayward, Gordon
Smith, C. W. Hayward, Green, Murray Moore, B. Thomas,
and Capper (Hon. Sec) were present.

Some preliminary business, to which reference has been
made in another part of the Journal, having been transacted :

Dr. Conrad Green gave details of a case of continued
fever which Dr. Hayward had attended with him in consul-
tation. The patient, a young lady, had inhaled a bad smell
while staying in the country. The early ssmaptoms were

lilVEHPOOL BRANCH MEETING. 77

enlargement of the glands of the neck : then frontal head-
ache, epistaxis and pain in the right side of the abdomen.
The temperature kept at about 102'' for some time : then
fell to nearly normal: but afterwards began to rise very
irregularly. There were continuous sweats throughout.
During the last few days the temperature had been normal^
after having been above the normal for eight or nine weeks.
Baptisia 'was given for about three weeks at the outset,
with other medicines in alternation according to symptoms :
calcarea carb. 6 and sulph. 6 were prescribed for three or
four days ; then at Dr. Hayward's suggestion tuberc. 6
(Koch), for a week; latterly ars. 3 and calc. c. 6 were
given for alternate weeks.

Dr. HAYWA.XID, commenting on the case, said that it
appeared to him to be a case of incipient phthisis, cured with
ars. 3 and calc. c. 6, and was specially interesting as it illus-
trated the good, effect of prescribing symptomatically, when
a prescription according to pathological changes had failed.

Dr. J. D. ECaywaed thought it was a case of typhoid
with relapse. He questioned whether the treatment could
be considered, as prescribed only in accordance with sub-
jective symptoms, since bapt. and ars. cause pathological
symptoms similar to typhoid.

Dr. B- Thomas described a case of gonorrhoeal rheu-^
matism, ^wlaich he had attended : and said that in obstinate
cases of rtieumatism, confined to one or two joints, it was
often wise to enquire carefully as to the possibility of this
cause o£ origin.

Dr. Sawkes exhibited a portion of the liver of a patient

he had. attended at the Hospital, and subsequently at her

own "tLome. Persistent vomiting ; the passage of urine dark

in colour manifesting the melanic reaction; and the light

colour of the alvine evacuations, were the most marked

peculiaxities of the case. The whole of the abdomen was

dull on percussion, and some difference of opinion existed

as to the cause thereof. The patient, who eight years

before had had her right eye removed for intra-ocular sar-

78 LIVEBPOOL BEANCH MEETING.

coma, gradually sank. At the post-mortem only a small
incision was permitted, but this disclosed the fact that the
liver almost filled the abdominal cavity. It was dark, nodu-
lated, and hard, and microscopic sections made by Dr. Chas.
Hayward established the view suggested by the urine, that
the case was one of melanosis. The only helpful medicine
was arsenicum, which seemed to mitigate the vomiting.

Dr, Hawkes also showed an ovary he had removed from
the right inguinal canal. The patient had suffered much
inconvenience since a confinement six years before, and
ordinary appliances had not helped her. The ovary, which
was oscillatory between the external ring and the upper por-
tion of the labium majus, was reached by an incision similar
to that practised in Alexander's operation. Adhesions were
dealt with, and the ligament ligatured. The wound healed
by first intention, save where a small drainage tube was in-
serted. The temperature, subsequent to the operation, did
not exceed 99T.

Dr. B. Thomas sent the patient into the Hospital, under
Dr. John Hayward, who, having diagnosed the condition,
transferred the patient to Dr. Hawkes' care.

The next specimen shown was a portion of an athero-
matous aorta. Dr. Hawkes stated that he had recently lost the
patient, whose malady had, towards the end, closely simulated
aortic aneurism. Two or three observers had been misled
by the physical signs, and he had incurred the displeasure of
the patient and friends, in that he had not told them earlier
of the existence of the alleged aneurism. During the last
week or so the pulses were unequal, but not the pupils ;
there was dulness to the right of the sternum, and a systolic
bruit was audible in the second intercostal space ; and a
peculiarly shrill cough was heard, not for the first time.
These symptoms, together with dyspnoea, pain, and restless-
ness, led to another practitioner being called in, who, on
hearing of a long standing pain in the chest, reflected
somewhat on the diagnostic skill of the family attendant.
A post-mortem revealed a greatly enlarged fatty heart. The

LIVEEPOOL BRANCH MEETING. 79

auricles were much dilated; their walls degenerated and
thin. The right auricle was found to occupy the position
assigned to the supposed anetirism, which was non-existent.

A discussion upon Health Besorts then took place, based
upon Dr. Hayward's recent paper on ** Grand Canary as a
Health Eesort."

Dr. Haywabd, in opening the discussion, spoke of the
fact, that patients of phthisical tendency could frequently
overcome and eradicate such tendency by placing themselves
under suitable atmospheric and climatic conditions.

Dr. F. MuRBAY MooEB said that he had intended to
compare the most favourable climate of New Zealand for
consumptives with that of the Canaries, but had not yet
had time to do justice to the subject. He feared that after
hearing what Dr. Hay ward had to say, there could be Uttle
comparison, but he had seen many cases do very well in
New Zealand. The advantage of the Canary Islands was in
the fact, that there was much less tendency to rain and
storms than in New Zealand, where winds especially are
very prevalent* He had had some doubt as to the water
supply in Gran Canaria, but Dr. Hayward had satislGied him
on that point. The advantages of New Zealand are that
there is a long sea voyage, and that a patient is among his
own countrymen, and can easily settle there. It appeared
that a great deficiency in the Canary Isles was a lack of
amusements, which is not the case in New Zealand. The
temperatures of the latter place are, however, 4° or 5°
colder in winter. There are great differences in the rainfall
in New Zealand ; the least is 25 inches per aimum, and the
highest 125 on the west coast. Thus in both groups of
islands the west coast is the moister. The summer temper-
atures are about the same in the two places ; but in New
Zealand there is a breeze which makes it easier to bear the
heat. Apart from the undoubted benefits of the sea voyage
the Canaries have the advantage of being near. There is
not so much to attract the eye in the Canaries, owing to the
comparative absence of foliage. Dr, Moore also spoke of
Tasmania.

80 IiIVEBPOOL BBAKCH MEETING.

Dr. J. D. Haywabd quite endorsed the remarks of the
previous speaker. He considered that it was absolutely
necessary that phthisical patients should be placed amidst
congenial surroundings, and there appeared to be a lack of
facilities for amusement in the Canaries. He had under-
stood from his reading that the climate of Guimar is really
the best ; and made reference to Dr. Yeo's work on health
resorts.

Dr. Mahoney maintained that climate has far less to do
with the cure of consumptives than is generally imagined,
and that the essential feature was to attend to the manner
of life, and general sanitation. He quoted cases, where an
open air life with exercise, without change of climate, had
proved very benelGicial. If cases cannot stand the climate of
England, and are sent away for a time, they frequently break
down on their return. This is not a cure, and we must
follow the Hahnemannian doctrine of ensuring a complete
cure.

Dr. Smith noticed the English health resorts, Ventnor,
Torquay, and Penzance. He mentioned that Dr. Williams,
who has had thousands of patients through his hands, advo-
cates Ventnor as possessing far the best cUmate.

Dr. Hawkes mentioned the importance of early morning
exercise in phthisical cases : but a respirator should be worn.
He had sent one patient suffering from haemoptysis to China,
and he had never looked back since his return. One patient
he sent to Crosby did very well ; and he also recommended
Formby, but the house should be built upon piles. He had
also sent patients to Australia, but had found indigenous
fevers deleterious there. He spoke of Davos, Mentone,
Bournemouth, and the Clyde ; and said he had been dis-
appointed in West Kirby.

Dr. Haywaed, in replying, said that there were many
disadvantages, as well as advantages, in a sea voyage. Of
our own cUmates that of Llandudno is a good example of a
dry sea climate ; but it is at the same time far too moist ;
and we cannot get a dry climate in England. The damp-
ness of our warm climates puts them out of the sphere of
health resorts for consumptives. In South Africa there are

SOCIETY NEWS. 81

many health resorts, but all suffer from heavy winds and
heavy rains. In parts of Teneriffe there is plenty of foUage.
With regard to amusements, there are theatres, public
buildings, and even an Enghsh club. There are no cold
winds in Gran Canaria. There is great advantage in our
own coasts that are sandy, in the air being dried by blowing
over the sandhills. Thus Southport has been highly spoken
of. W. Kirby has been greatly overrated, as it has a damp
cold air. He quite beUeved that the dry side of Teneriffe
might be very good.

SOCIETT NEWS.

At the opening meeting of the session, held on Thursday,
October 6th, the president (Dr. Galley Blackley) said that before
passing to the business of the evening, he had to thank the
Society for the honour done him in selecting him for the important
office of President. He felt sure that the kindness and generosity
which the members had always evinced to him in his capacity
as Secretary would also help and support him in his arduous
duties in the presidential chair. Members had received their
notice papers, and would see that the Council which was
appointed at the Annual Assembly had been far from idle. The
Council had had two meetings, and the result of their deUbera-
tions had been two appointments, which he was sure would be
received with approbation by every member of that Society. As
to the appointment of the Hon. Secretary, his feeling was that
if he (the President) had done well, it was in resigning the posi-
tion of Hon. Sec, which he had held for the last seven years, in
order to make way for so energetic and so evidently useful a man
as their late President. He had had his eye upon Mr. Knox
Shaw for some months before the end of last session, and came
to the conclusion that here was the very man to carry on the
-work of the Society, not in the somewhat humdrum way in which
it had been carried on recently, but so as to infuse new life and
new spirit into the work. He felt that the time was come
'when they needed a little vigour infused into their proceedings.

VOL. I. — NO. 1. 6

82 * SOCIETY NEWS.

The second appointment he was sure they would greet with
equal satisfaction, which was that, acting upon the authority of
the Annual Assembly, they had come to the conclusion to publish
the Transactions of the Society quarterly, as a separate quarterly
periodical, and Dr. Hughes had very kindly undertaken the
duties of Editor of those Transactions. Dr. Hughes' name alone
was one of the very best auguries for the future success of
those Transactions, and he considered that success was already
assured, and certainly, were any inducements necessary to out-
siders to join the British Homoeopathic Society they could now
oJBfer ample advantages. The Society he thought might feel quite
comfortable on the score of expense, as he believed the outlay
was not likely to be appreciably greater than it had been under
the late arrangement.

Letters have been received and presented to the Society from
Dr. Lambreghts, fils, and Dr. Boniface Schmitz, of Antwerp, ac-
knowledging in courteous terms their election, at the last annual
assembly, as corresponding members of the Society.

On Thursday, November 3rd, the following gentlemen, having
been duly nominated as candidates, were elected by ballot : — G.
Abbot, M.D., 11a, Standishgate, Wigan ; E. Bellis, L.E.C.P.I.,
4, Addison Terrace, W. ; Ashley Bird, M.R.C.S., Stanwell Eoad,
Penarth; H. d'Amim Blumberg, L.E.C.P., Warley House,
Southport ; W. F. Blyth, L.E.C.P., 99, Approach Eoad, Victoria
Park, E. ; T. E. Brotchie, M.D., 102, Great Victoria Street,
Belfast ; F. W. Clifton, M.E.C.S., 348, Glossop Eoad, Sheffield ;
C. P. Collins, M.E.C.S., Norham Lodge, Leamington; H. E.
Deane, M.E.C.S., Aldershot; J. Finlay, L.E.C.P., Greystone,
Eawtenstall, near Manchester; J. Gordon, M.B., 70, Upper
Parliament Street, Liverpool ; 0. T. Green, M.E.C.S., 33, Grange
Mount, Birkenhead; Vincent Green, M.B., London Homoeo-
pathic Hospital, W.C. ; J. Hamilton, L.E.C.P., 16, Eldon Square,
Newcastle ; J. D. Hayward, M.D., 15, Princes Avenue, Liver-
pool; J. C. Huxley, M.D., 91, Harborne Eoad, Edgbaston; J.
McLachlan, M.D., 38, Beaumont Street, Oxford; D. Moir,M.D.,
333, Oxford Eoad, Manchester; W. H. Eean, M.E.C.S., 36,
Vernon Terrace, Brighton; W. Cash Eeed, M.D., 8, Queen Anne
Terrace, Plymouth ; A. Eoberts, M.D., Princes Square, Harro-
gate ; W. Eoche, M.E.C.S., 36, Berners Street, Ipswich; G.
Scriven, M.D., 33, St. Stephen's Green, Dublin ; A. G. Wilkinson,
M.E.C.S., 28, Newland, Northampton ; C. J. Wilkinson, M.E.C.S.,

SOCIETY NEWS. ' 83

112a, Chorley New Eoad, Bolton; Eubulus Williams, M.D.,
Beaufort Eoad, Clifton; J. Wingfield, L.R.C.P., Alcester Road,
Moseley, Birmingham.

At a meeting of the Council, held on November 24th, the first
branch of the Society was formed by the Council granting the
petition of the Liverpool Homoeopathic Medico-Chirurgical Society
to become a branch of the British Homoeopathic Society. It is
to be hoped that this is merely the first of a series of influential
and active branches being formed in other parts of the country.
There is scope for the formation of local medical societies in two
or three counties. The benefits of meeting for the interchange of
thought and for the consideration of matters of interest in all
branches of medical work is invaluable to the advance and elucida-
tion of Homoeopathic therapeutics and to the professional well-
being of its exponents. The Liverpool Homoeopathic Medico-
Chirurgical Society has long been a power in the development and
organisation of Homoeopathy in the Lancashire district. It has
ahready a membership numbering sixteen, and it will now pro-
bably increase its strength and position by drawing to its meetings
those members of the parent Society who may be residing in
neighbouring towns.

All members of branches are entitled to attend and take part
in the meetings of the Society held in London, as well as those
of the branch to which they are attached.

On Thursday, December 1st, the following gentlemen, having
been duly nominated as candidates, were elected by ballot : — F.
H. Bodman, M.D., Oakland Eoad, Clifton; J. Buchanan, M.D.,
49, Stanhope Gardens, S.W. ; J. P. Cavanagh, L.B.C.P., 57, The
Tything, Worcester ;. E. P. Cox, M.D., 2, Lime Grove, Man-
chester; G. A. Craig, M.B., 63, ■ Soho Eoad, Birmingham; J
•Craig, L.E.C.P., Shelton House, Stoke-on-Trent; J. S. Craig,
^.B., 137, Steelhouse Lane, Birmingham ; J. Drummond,
L.R.C.P., Shenstone, Great Malvern; F. Hall, L.E.C.P., Oak
House, Bacup, Lancashire ; J. J. Mitchell, L.E.C.P., 1, Howard
Place, Stoke-on-Trent; T. D. Nicholson, M.D., 2, White Ladies
Boad, Clifton; A. J. Ockenden, M.E.C.S., 25, Eegency Square,
Brighton; A. Eoss, L.E.C.S., Vernon Place, Scarborough; E.
Gordon Smith, M.B., 164, Upper Parliament Street, Liverpool;,
W. 0. Steinthal, L.E.C.P., 128, Tweedale Street, Eochdale*

84: SUMMAKT.

The attention of members, especially those who have lately
joined, is drawn to the Library of the Society which is at the
London Homoeopathic Hospital. It contains a very good selec-
tion of works bearing upon Homoeopathy in all its departments,
and has in the reading case a number of current Medical Journals
of this country, of America, and of the Continent. Members are
allowed to take books home to read, and it is hoped that arrange-
ments will ere long be effected to make the contents of the
library more accessible to country members.

The new additions to the library are the last editions of
Norton's " Ophthalmic Therapeutics," Hughes' ** Pharmacody-
namics," and Ludlam's ** Diseases of Women," as well as the
Therapeutic Gazette and the British Medical Journal,

At a meeting of the Liverpool Homoeopathic Medico-Chirurgical
Society, held on December 1st, at the Hahnemann Hospital, it
was resolved that in future the Society should be entitled the
Liverpool Branch of the British Homoeopathic Society, and that
its meetings should take place on the second Thursday in each
month. It was decided that a branch subscription of two shillings
and sixpence be levied to meet local expenses. At the same
meeting Dr. Hayward, senior, was elected as the Liverpool
Branch representative on the Council of the Society.

SUMMAEY OF PHAEMACODYNAMICS ANI>

THEEAPEUTICS.

« GATHER UP THE FRAGMENTS, THAT NOTHING BE LOST."

September — November, 1892 .

In commencing a new series of the Annals of the British
Homoeopathic Society, the Council has thought it desirable
that, out of the many journals taken by or supplied in ex-
change to the Society, excerpts should be made for the
use of its members, embodying all observations pertinent
to their specialty which have appeared during the three

SUMMABY. 85

months previous to the issue of each quarterly number.
Homoeopathy being a method of utilising the action of
medicines in the treatment of disease, it is obvious that
the facts which come within its sphere are those of
pharmacodynamics and of drug-therapeutics. Our quarterly
summary will, therefore, consist of these. They will be
arranged in alphabetical order in one or other of these
classes, according as drug or disease is the peg on which
they hang, and will be indexed at the close of each volume.
This summary being compiled primarily for the use of
members of the British Homoeopathic Society, it should
not, we think, include the British Homoeopathic journals,
which every practitioner of our school in the country
ought to take and read. For the sake of completeness,
however, we propose to give a reference to any noteworthy
observations, pharmacodynamic or therapeutic, which have
appeared in these journals during the quarter, leaving details
to be followed up in their own pages.

PHARMACODYNAMICS.

icidom aceticum. — Dr. Owens has had very favourable ex-
perience with this acid in cancer. In external forms of the
disease he keeps the growth or ulcer moistened with the 2x dilu-
tion, giving the Ix internally ; in cancer of the stomach he relies
on the latter alone. He relates four cases, of which three seem
undoubted instances of the disease. — Medical Era, September.

icidum nitricum. — The virtues of this acid in menorrhagia
(which the author — or editor — writes **hemorrhagia"), already
exhibited by Drs. Ludlam and Claude, receive further confir-
mation in an article from Dr. S. O. Amerman in the American
SomoRopathist of Nov. 15th. The Ix dilution was given.

Arsenic. — A case of poisoning by this drug is recorded in the
Lancet of Oct. 22, in which the sulphide was deposited over one-
third of the endocardium of the left ventricle. The peritoneum
was generally congested and of a rosy hue, especially over and in
the region of the stomach.

Borax. — Lemoine has observed two cases of epilepsy in
which, under the administration of borax, a bluish-grey line was
observed on the gums resembhng that produced by lead (there
was no history of lead poisoning), and in both cases there was a

86 SUMMARY,

slight gingivitis, the gums being swollen and reddened ; in one-
case they were also tender, and in the other there was salivation.
— Therajjeutic Gazette^ September.

Cadmium iodatum. — Dr. F. O. Pease, in a proving of the 6x
trituration of this salt, developed great itching of rectum and anus,
felt during the day only. There was also constipation, frequent
desire for stool without result, or only scanty discharge of dark
brown offensive stools of clayey consistency. Tenesmus accom-
panied the stool and was also associated with the itching, which
it felt as if it would relieve. There was much bloating of
abdomen, with sense of fulness. Dr. Pease has verified these
indications in practice. — HoTnosopathic Physician, November, p.
503.

Camphor. — In an article on the treatment of cholera in the
Artzliche Bundschau (No. 34 of 1892), the following state-
ments are made about camphor (without, of course, any refer-
ence to Hahnemann or homoeopathy) : " Camphor comes first
among the older approved remedies. The spirit proved very
effective in the frightful epidemic during the Bohemian campaign
of 1866. Vari'ous persons who recovered stated that they could
not sufficiently praise the extraordinarily warming and enlivening
action of the camphor ; whereas * schnapps,' which had been
given them before in lieu of a better remedy, in no way lessened
the frightful algidity and dread of death, but rather increased the
nausea and conciousness of danger. After an hour the camphor
produced a comfortable sense of warmth, and after a day it
enabled them to urinate." — Therapeutic Gazette, September.

Cicuta. — A case of poisoning by this plant is recorded by Dr,
Stonham in the Monthly Homoeopathic Bevieio of September.

Cocculus. — Dr. E. P. Colby contributes a short study of this
drug to the Neiu England Medical Gazette of September. He
thinks that many of its symptoms point to Meniere's disease, and
are better explained by a labyrinthine influence than one exerted
on the crura cerebri. (His symptomatology, however, is of so
mixed a character that it seems to us impossible to draw sound
inferences from it). He describes, as conditions in which the
remedy is useful, one of ** deathly sickness " with vertigo, the face
being pale, pulse slow and weak, and skin clammy ; and the occi-
pital pain of ** tired spine."

Colchicum. — In the New England Medical Gazette of Novem-
ber, Dr. Sutherland has an interesting study of colchicum in rela-
tion to cholera, to which — from a review of its pathogenesy — ha
shows it to be more truly homoeopathic than any of our standard
remedies for the disease.

SUMMARY. 87

Ficns indica. — Dr. Banerjee, of Calcutta, communicates to the
Southeim Journal of Homoeopathy of September (which journal
is now edited by Dr* Eldridge C. Price, of Baltimore), a proving
on himself and nine others of the fruit of this tree. In eight out
of the nine it seems to have caused phosphatic urine, and in five
spermatorrhoea.

Hamamelis. — Dr. Lauder Brunton has a paper on the treat-
ment of haemorrhoids in the British Medical Journal of March,
1892, in which the sole medicinal treatment recommended is the
local use of hamamelis, of which he prefers the proprietary to the
pharmacopoeial preparations. — Therapeutic Gazette^ September.

Dr. Clarke contributes some new symptoms observed in a
patient with varicosis, taking the first dilution of the drug. —
Homosopathic World, October.

Hypericum. — Dr. McGilchrist, reportiog the surgical work
of the year in the Homoeopathic Medical Department of the
State University of Iowa, writes : ** After every operation the
wound is covered with a compress of absorbent cotton, wet with
hjrpericum (watery extract), a dry compress outside of this, and a
bandage over all. This dressing is not removed for several days,
unless soiled. Hypericum, ten drops in Ji. of water, is given in
teaspoonful doses once in fifteen or twenty minutes for four or
five hours ; then once an hour for twenty-four hours, when it is
discontinued. . . In nearly every case there was entire absence
of pain, due to the hypericum, and primary umon/' —Hahne-
mannian Monthly, September.

Kali bpomatum. — A case of acute poisoning in an infant
appears in UArt Medical for November. The chief symptom
was general urticaria. It was preceded by great agitation.

Lithium. — Dr. Brant writes : — *' I once had a case with the
following symptom j and only this one, as the lady was enjoying
good health with this exception ; * on inspiring, the air feels cold
down into the lungs.' I recollected having noticed that symptom,
so I went to work to find it. I spent several hours and found it
under lithium carb. One dose of the 30x relieved her entirely."
—Monthly Homoeopathic Beview, September, p. 550. [It is
a curious satire on repertory making, that no such symptom
appears in the pathogenesis of lithium. Who was Dr. JBrant's
authority ? Ed.]

Natrum sulphuricum. — Dr. Dahlke states that a bitter taste
in the mouth is characteristic of natrum sulphuricum. A woman
who, besides such a taste, complained of nothing abnormal, re-
ceived the second dilution, three drops per diem. The taste disap-

88 SUMMABYw

peared after a few days, but as long as she took the drops she
suffered from a morning diarrhoea, with rumbling in the bowels.
— Hdhnemannian Monthly , September, p. ^66,

Nux moschata. — A case of nutmeg-poisoning is reported in
the Therapeutic Gazette of September. — " The condition was one of
low muttering delirium, with occasional silly laughter, the most
constant hallucination being that she had two heads. From this
condition she could be aroused momentarily by shaking her or
speaking to her sharply, but she immediately relapsed into the
same state. There was also a sense of impending dissolution, for
she besought me piteously not to allow her to die* Her pulse
was 120, of good strength and volume." Vomiting had preceded
this condition. She had taken about three nutmegs in powder to
produce abortion. No uterine action was manifested- The re-
porter compares the action of the drug to that of cannabis indica.

Oleander. — V. Oefele, from the use of oleander in seventy-three
cases of cardiac disease, concludes that the leaves, cortex and fruit
have a therapeutic action which places the drug in the digitalis
group. Its effect is prompt and lasting. The pulse becomes
slower, more regular, and more powerful. Diuresis, with increase
of the urinary solids, is brought about, and the stools are more
abundant. The palpitation, oedema and dyspnoea of valvular
disease disappear. The diuresis is more marked than with any
other member of the group. Oleander has no such action on the
vessels as strophanthus, and may thus be given in atheroma. A
small daily dose is from 0.05 to 0.5 grm. of the crude drug.
— British Medical Journal^ October 22.

Phytolacca in Bheomatism. — Eheumatism of the right
deltoid, of twenty-seven years' standing, in a man of 62, was
removed by four doses of phytolacca, 3x, and there had been no
return of the trouble six months afterwards. — North American
Journal of Homosopathy^ September, p. 631.

Plumbum. — ^A case of lead poisoning, in which death occurred
from cerebral haemorrhage, is given from an Italian journal in the
Hahnemannian Monthly for October. Besides the arteritis it
causes, lead is said to set up a chronic diffuse meningo-ence-
phaUtis.

Podophyllum. — Drs. Wilson and Harper have both had a case
in which, under podophyllum prescribed for liver symptoms, old
cataracts have cleared away. The former gave a high, the latter
a low, dilution of the drug. — Hahnemannian Monthly, September.

Santonine. — A case of poisoning by a 5-grain dose in a boy
of 9 is reported in the Lancet of October 29th. The symptoms

SUMMARY. 89

were those of collapse with cyanosis, loss of consciousness, and
convulsive twitching of the limbs. Becovery ensued under
stimulants.

Silicea. — A serious case of vomiting cured by this drug — ^to
which repertory-searching led him — is related by Dr. Wolston in
the Monthly Homoeopathic Beview of November (p. 662.)

Stannum. — Observations of effects of vapour in workers
with tin are to be found in the HonuBopathic World for
September.

Succinum. — Dr. Morris Wiener reports that a proving of
amber on himself developed symptoms of hay fever, and that he
finds a 3x trituration remedial in the idiopathic disorder. — Homoeo-
pathic World, September.

Tarentula cnbensis. — Dr. W. J. Martin some tirae ago re-
ported great success with T. cubensis in diphtheria where the
initial symptoms are febrile and inflammatory, such as in less
toxaemic states would indicate belladonna. He now, after eight
years, renews his testimony to its value. *' So great is my confi-
dence," he writes, " in the power of this drug to cure diphtheria
of the variety I have tried to describe, ttiat I feel as though there
should be no deaths from this much dreaded disease, if re-
cognised at once, and T. cubensis, in the 6th, 12th or 30th
potency, immediately prescribed." — Hahnemannian Monthly,
September.

TabeFcnlinnm. — Dr. Jousset is using Koch's preparation,
internally, in the third to the sixth, dilution, where albuminuria
persists after the other symptoms of renal mischief have been
removed. He reports very good results. — L'Art Medical, Aug. —
Nov.

Dr. Bernard Arnulphy, who for some years past has been
practising at Chicago, relates his experience with this sub-
stance in tuberculosis. In chronic cases he has had but indifferent
success. In acute tuberculosis, however, he describes it as
liaving '*the most wonderful remedial action he has ever seen,"
^nd relates three cases which bear out his praise. He gives the
6x— 8x trituration, and advises the preparation to be freshly
made. — Medical Era, October,

THERAPEUTICS.

Alopecia areata. — Dr. H. M. Bunting relates a case of this
disease in which much itching of the scalp was present, cured in
three weeks by vinca minor 200. — Hahiiemannian Monthly^
September.

90 SUMMARY ,

»

(Dr. Bunting states that he cured this case in a, to him,
** thoroughly Hahnemannian manner." How this should be does
not clearly appear; for the itching of the scalp is a generic
symptom common to hundreds of medicines, while the specific
condition of baldness in patches does not occur even in the
somewhat apocryphal x^athogenesis of the plant supplied by
Rosenberg — GyclopcBclia of Drug Pathogenesy, iv., 419. — Ed.)

Aortitis, Chronic. — Dr. Elias C. Price (Southern Journal of
nom(BOi)aihy f September) records a case presenting the features of
this disease as described by Tessier and Jousset. Great benefit
resulted from a course of phosphorus 3x and convallaria <p , while
a drop of glonoin 1 would arrest the paroxysms (" choking," as
he called them) in a few minutes. The patient, who was 67 years
old, was carried off by influenza and pneumonia, and no autopsy
was made.

Aphonia. — Dr. Alex. Villers states that from a large expe-
rience with professional singers he finds arnica the best remedy
for vocal fatigue of untrained voices, argentum nitricum for that
of trained ones, and nux vomica where the inability to exert the
voice is part of a general '* laziness." — Homoeopathic Physician ,
September.

Bright's disease. — A case of plumbism is recorded in the
Hahnemannian Monthly for October, 1892, where, in addition to
colic, the patient showed great prostration, marked nausea,
oppression of breathing, waxy pallor of face, frequent and copious
urination. The urine was of low specific gravity, and by analysis
yielded much albumen. On giving up his trade he became well,
and remained so till his death by accident. The reporter cites
several observations of curative results following the adminis-
tration of plumbum in interstitial nephritis. — Hahnemannian
Monthly, October.

Chorea. — Dr. Marc Jousset relates a case of chorea, in which
antimonium crudum (3x trituration), given for anorexia and dis-
gust at food, caused such marked improvement in the movements
of the limbs that it was persevered with, and rapid recovery
ensued. — UArt Mddical, November.

Cornea, Ulcer of. — In a case of superficial ulceration of the
cornea, with intense photophobia, ulcer appearing as if covered
with a layer of gray pus, silicea 3 and 30 cured in a very short
time, — Deady, in North American Journal of Homasopathy, Sep-
tember, p, 632.

Diphtheria. — In L'Art Medical for September, Dr. Jousset
relates a case of laryngeal diphtheria, with albuminuria, which

SUMMAEY. 91

made a good recovery under spongia, which was given in the Ix
trituration every hour.

Dropsy, General.— In a case of this disease, of six weeks*
standing, lycopodium 15 induced diuresis within twenty-four
hours, also diarrhoea; and in three weeks effected a cure. —
Terry, North American Journal of Hommopathy, November, p. 759.

Enteritis membranosa. — ^Dr. J. B. Cocke relates a case of
this rare disease, where the presence of the false membrane was
established by microscopical examination by Dr. Sutherland.
Before passing it, severe attacks of colic were experienced, which
colocynth relieved (2x). The curative treatment consisted of
mere. coit. 3x and nux vom. 2x. Dnder these remedies the
attacks became fewer and slighter, and soon ceased altogether. —
New England Medical Gazette, November.

Epididymitis. — Dr. Allison Clokey reports a chronic case of
this affection, showing an enlargement almost hard as bone, with
pains shooting up the cord. Under aurum 6x this disappeared
lu six weeks. — North American Journal of Homceopathyy October,
p. 656.

Erysipelas. — In a case of this disease, appearing in the ab-
dominal parietes, and involving the scrotum, the latter was found
enormously swollen, dark, and superficially ulcerated. Delirium,
high fever, rigors, and dry blackish tongue, were present. Ar-
senicum 3x arrested the gangrenous process, and completed the
care in four weeks. — ^Terry, North American Journal of Homoeo-
pathy, November, p. 757.

Glycosuria. — L' Art Medical for November gives an account of
a thesis by Dr. Cartier on the toxic glycosurias, and especially
on that produced by uranium. He studies the glycosuria of
phloridzine (a glycoside found in the bark of the roots of various
fruit trees), of the acids (which cause also the diabetic coma),
of the narcotics (morphia, &c.), of the ** agents st^atogenes'*
(arsenic, phosphorus, &c.), and, finally, of uranium. It has, he
writes, for a constant property the production of glycosuria,
though the sugar is not very abundant ; there is always albumin-
uria also. It kills the animals experimented on in a few days,
after having induced torpor, paralysis, somnolence, and actual
coma ; all these symptoms are accompanied by emaciation, slow-
ing of respiration, and diminution of temperature. The liver and
kidneys are the seat, first of congestion, then of fatty change.
There is also gastro-enteritis, with ulceration of stomach (as
observed by our own E. Blake), and predominating proctitis.

Goitre, Exophthalmic. — Dr. E. H. Linnell contributes a

92 SUMMABY.

paper on this disease to the North. American Journal of Homao-
pathy for November, with three cured cases. In the first, lycopus
4x — 6x was the chief remedy; in the second, it reUeved the
symptoms, but had to be supplemented by ferrum and digitalis ;
in the third, iodine 30, with ignatia, did all that was required.

Hiccnp. — ^In a case of this affection, combined with pleuro-
dynia, ranunculus bulbosus Ix, prescribed on account of the latter,
cured both. — Monthly Homoeopathic Beview, September.

Laparotomy. — The value of medicines in aid of the success
of these operations is appraised by Dr. Burford in the Monthly
Homoeopathic Beview of November.

Madarosis. — Dr. John H. Payne relates a case of this affec-
tion, in which the eyelashes had been absent since infancy
(patient being now 18). The edges of the lids were thickened,
rounded and glazed, and itched much. There was eczema behind
the auricles, and a chronic nasal catarrh ; also, after washing face
in morning, a stiff glazed feeUng remained in the skin. These
symptoms suggested petroleum, which was given (dilution not men-
tioned) three , times daily. After two months, itching had gone ;
in another month the nasal catarrh was nearly well, and the lashes
had begun to grow, and this they continued to do till they, with
all else about the face, were in a normal state. — New England
Medical Gazette, October.

MyxoBdema. — A typical case of this disease, of three years'
standing, was admitted to the Eoyal Free Hospital, in July, to be
treated by hypodermic injections of thyroid juice. In consequence
of the difficulty experienced in obtaining the latter. Dr. Hector
Mackenzie was induced to try the effect of feeding the patient on
fresh thyroid glands. The result has been a very striking improve-
ment. The myxoedemafcous swelling has entirely disappeared, the
temperature has become steadily normal, the skin moist and the
speech natural. At first the thyroids of two sheep were given
every day, finely minced. This was probably more than was
advisable, because a remarkable acceleration of the pulse ensued,
which lasted until the thyroids were discontinued for a time. —
Lancet, October 16. In a communication to the same journal,
of October 29, Dr. Mackenzie gives details as to obtaining and
preparing the thyroids, of which he thinks one every other day
sufficient. His patient looks and feels perfectly well, and her
previously bald crown is now covered with thick hair. — In the
British Medical Journal of the same date. Dr. Mackenzie relates
his case in detail, and another is communicated by Dr. Fox, of

SUMMABY. 93:

Plymouth, showing similarly good results. "Small doses" of
the minced gland are recommended by the latter physician.^

Nenralgia. — Dr. Jousset relates in Zr'^r^ Medical of September
two cases of this kind. One was sciatica of six weeks' standing,
cured in one week by nux vomica, Ix trituration, which he con-
sidered indicated by lancinations of pain on movement. Bryonia
3, given for four days, had had no effect. The other was tic-
douloureux affecting the infra-orbital nerve, and dating from far
back. Under thuja 6 and 3 and coccus cacti 6 and 3, the attacks-
entirely subsided for the time. This was a favourite medication
of Tessier's, and both the present case, and some experience re-
ported of old by Dr. Escallier, seem to show that the thuja was the
active agent. (On what authority does Dr. Jousset state that the
pathogenesy of thuja shews " sharp lancinating pains on the level
of the upper jaws and in the teeth ; the face becomes suddenly
purple with the exacerbations of pain"? These symptoms are
not to be found in Allen's " EncyclopaBdia," even among tha
apocryphal contributions of Dr. Wolf. — Ed.)

PerinsBal Ri^dity. — In a pleasant paper on " The Perinaeum
in Norraal Labour" {Medical Advance j August), Dr. Winterburn
speaks warmly from large experience of the value of the free use
of lard for reducing rigidity of vagina and perinaaum. It should
be not only introduced, he says, but rubbed in. It will break
down the rigidity of the most obstinate perineeum, and prevent
rupture.

Pleurisy. — To the treatment of this disease Dr. Jousset de-
votes a clinical lecture in L'Art MMical, October. He continues-
to account cantharis the leading drug in its treatment, and
relates two hospital cases illustrating its efficacy. In the first,,
a copious effusion on the left side, of several days' standing,
causing absolute dulness and absence of respiratory murmur,
disappeared in three weeks imder the third dilution. From the
third day of treatment free diuresis occurred, and therewith the
dulness began to diminish. In the second, the effusion was-
enormous, and it was not till the eighth day of the treatment,
and the use of the mother tincture, that improvement set in,
here again with diuresis. Symptoms of acute oedema of the
sound lung now appearing, 400 grammes of fibrinous fluid were
removed by thoracentesis from the other, side, and the cantharis

>A history of the "Method of Treatment by Injectmg Physiological
Fluids" is given in L'Art M€dical for September. See also Therapeutic-
Gazette, September, pp. 609, 621.

94 SUMMARY.

continued. The patient, who had been admitted on May 8th,
went out entirely convalescent early in June. In illustration of
the homoeopathicity of the remedy, Dr. JLousset cites the experi-
ments on dogs of a M. Galippe; cantharidine, injected into the
veins, caused, besides its usual genito-urinary troubles, a ''double
sero-purulent pleurisy." A case is also related in which a dia-
phragmatic pleurisy came on during convalescence from typhoid.
There were such violent paroxysms of pain that on one occasion
morphia had to be injected hypodermically. Bryonia was given,
ten drops of the mother tincture during the day, and the malady
rapidly subsided.

Salpingitis. — ^Dr. Marc Jousset mentions a case of left salpin-
gitis presenting a swelling as large as an orange. Homoeopathic
medication (actsea, apis, cantharis, colocynth), with antiseptic
applications to the os uteri (why these?), caused the swelling to dis-
appear almost entirely, and a season at Croisic completed the
cure. — L'Art Medical j November, p. 377.

Scarlatina. — Dr. John N. Taylor relates (Southern Journal of
HomcBopathyj September) an experience decidedly favourable to
the claims of belladonna as a prophylactic against scarlatina.
He gave two drops of the Ix dilution every three hours to four
children whose brother had the disease pretty severely. Isolation
was impossible, and three out of the four showed symptoms of the
malady, but it was incompletely developed and ran a short mild
course. The fourth escaped free.

Tetanus, Traumatio.— Dr. Charles W. Smith reports a case
of this disease, of no slight severity, resulting from a lacerated
wound, in which complete recovery ensued under homoeopathic
treatment. Hypericum was first given alone, then in alternation
with nux vomica Ix, and subsequently the latter with hyoscyamus
till the termination of the case. — North American Journal of
Homceopathy, October, p. 683.

Urine, Suppression of. — Dr. Lamb, of Dunedin, records a
case of suppression of urine (cause not stated) in a child of two.
After ten days' steady diminution, and twenty-six hours' entire
absence, terebinthina 3 was given. After ten hours, a small
quantity was passed, sp. gr. 1004. Two days later, quantity still
being insufficient, cantharis 3 was substituted, with complete
cure. — North American Journal of Homoeopathy, September, p.
628.

[Several excerpts from German homoeopathic journals have to
be left over for next time. — ^Ed.]

k

JOURNAL

OF THE

nMoptMr

No. 2. APEIL, 1893. Vol. I,

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

36, Sillwood Boad, Brighton,

COLOCYNTH: A SUGGESTION FOR A EEVISEI>

MATERIA MEDICA.1

BY JOHN W. ELLIS, M.B. (VIC); L.R.C.P., ED.; F.E.S.
Honorary Medical Officer to the Hahnemann Hospital, Liverpool.

A PUBE and trustworthy materia medica is so absolutely^
necessary for the successful practice of medicine according
to the formula " Similia similibus curentur," — " Let lihes^
le treated by likes,'* that the pathogenic material at our
disposal cannot be subjected to too severe an ordeal of criti--
cism. When I consider how very carelessly many of the
experiments for ascertaining the influence of drugs upon the
healthy human organism have been conducted ; the total
absence in many cases of any allowance for the results of
expectant attention ; the introduction into the pathogenesy
of sjrmptoms noted during the administration of drugs to
persons suffering &om chronic disease ; the fact that in some
instances so-called drug-provings have been instituted by
individuals whose whole interest in the matter has been the
earning of a pecuniary reward — no doubt proportioned to the

* Bead before ihe British nomceopathic Society (Liverpool Branch) Januaiy
mh,18d8.

VOL. I. — ^NO, 2. 7

^8 COLOCYNTH.

multiplicity and variety of the symptoms produced by the
prover if not by the drug ; when I consider the many sources
of error which beset our system of drug-proving I cannot
but sympathise with one of our American colleagues who
recently characterised a considerable proportion of the patho-
genic material of oiir school as " bosh ! "

The only attempt on any large scale to grapple with the
difficulty of deciding what is and what is not to be considered
fis the pure result of drug action has been the recently con-
cluded noble work of Drs. Hughes and Dake, " The
Cyclopaedia of Drug Pathogenesy." By the elimination from
this work of the results of experiments made with dilutions
above the 6th centesimal, and of all symptoms appearing
after the administration of drugs to other than persons in
average health, we are now able to obtain a clearer picture of
the physiological and pathological effects of drugs; and
could we easily refer to the material there collected in
narrative form, there is no doubt but that pur prescriptions
would be given with a greater feeling of confidence than
under the old regime.

But the ** Cyclopsedia of Drug Pathogenesy '* is not, nor is
it intended that it should be, a handbook for the practitioner,
and no index to it can prevent the necessity for reference to
a materia medica where the symptoms of the various drugs
are arranged with a view to facilitate easy comparison — an
arrangement which has so far been best met by the Hahne-
mannian schema. Allen's Handbook, the best of the present
day works of reference, contains many symptoms which
mus^ be expurgated ; and the ** Materia Medica, Physiological
and Applied" is so far too incomplete, and, perhaps, too
extensive in arrangement for ordinary use ; and it seems to
me that we ought now to put our shoulders to the wheel and
produce a materia medica — the pathogenetic material of
which shall be confined to that contained in the ** Materia
Medica Pura*' of Hahnemann, the "Cyclopaedia of Drug
Pathogenesy," and any more recently published and trustr
worthy provings or experiments.

I have referred to the ** Materia Medica, Physiological
and Applied,'' of which so far only a single volume has been

COLOCYNTH. , 99

published. Though the general conception of this work
■cannot be sufficiently praised, I feel that as a book of refer-
ence — and that, I maintain, is what we want now — it stands
to what is Tvaixted for the consulting-room desk much in the
same relationship that " Ee5molds* System of Medicine '"
does to " Bristowe.'* To include, only the more important
drugs several volumes would be required, while to treat of
all those in use by the homceopathists, the completed work
would rival, if not surpass, the ten volumes of Allen's
Encyclopaedia . What we want for practical use is, it seems
to me, a book in a single, not too cumbrous volume, if
possible, -which shall contain the purified pathogenic material
arranged in schema form with a brief pathological ancj
therapeutic commentary on each drug, with a still briefer
reference to its natural and general history, together with
the mode of preparation and administration for medicinal
purposes. And if one volume will not contain all this, then
let us have the pure pathogenic material in one, and th^
remainder in another companion volume.^

Such a work would, in my opinion, do more to advance
the study of pure homoeopathy than any time and labour spent
in compiling from our periodical literature the oftentimes
very dubious results of the administration of drugs, more
or less homoeopathically selected, in diseases of, frequently,
very uncertain diagnosis — a work which, though strongly
advocated by our late colleague. Dr. Drysdale, would, I beheve,
tend rather to foster the spirit of empiricism everywhere so
rampant- Twelve months ago I was urged by the late Dr.
Drysdale to prepare a monograph on colocynth for the
** Materia Medica, Physiological and Applied,'* and the follow-
ing pages are intended rather as a sketch than a finished pic-
ture of that drug, introduced on this occasion to invite your
criticisms as to the possibility and probable utility of such
a manual of materia medica as I have advocated. In the

1 "WliUe these thoughts have been passing through my mind, I fin^ that
an American society has already commenced a revision of the materia medica
much, on the lines I have advocated. A sample of their treatment of the drug
Thuja occidentalis which includes all I desiderate above, and in addition a
comparison with its analogues, occupies 11 octavo pages of the Hah^ienianniari
Monthly for August, 1892, while the Fame drug in schema form with very brief
clinical notes only, fills nearly 14 large quarto pages of Allen's Handbook.

100 OOLOOTNTH.

pathogenic material arranged in schema form I have adopted
the plan of affixing a nmnber to each symptom indicating the
frequency of its occurrence in the whole of the provers, and
this was done principally with a view to ascertain how far
one might be justified in omitting all sjrmptoms not occurring
in at least two of the provers of any particular drug— -a pro-
ceeding which has recently been advocated by many students-
of the materia medica in the United States. I entered into
the work with a strong bias in favour of such omission — I
leave it as here presented fully convinced that by the admission
of all the symptoms of every prover we run great risk of
recording much that is fanciful, but that we can only refuse
admission to the symptoms not occurring in at least two-
provers at the risk of losing much that is really explanatorjr
of the pathogenic action of the drug— much that is valuable^
to us in practice. Let us turn for an illustration to the-
pathogenesy of colocynth in so far as the symptoms of the
lower extremities are concerned. These, as presented, are
34 in number, while if we limit the presentation to those
recorded by at least two provers we at once diminish these
symptoms to the number of 6, and some even of these are
most indefinite in character, while we find that many of the
uncorroborated symptoms represent evidence of similar
drug-action in different provers, but expressed in variety
of language.

Colocynth.

Foreign Names. — Fr. and Germ,, Coloquinte : Span, and
ItaL, Coloquintida : Dut, Koloquint : Arab and Pers.^
Hunzil. Abbreviation, Coloc, CoL

The bitter apple {Citrullus colocynthis, L,, N.O. Cucur-
hitacece) which furnishes the colocynth of medicine is a trail-
ing plant, in general appearance resembling the commoi>
cucumber, having angular hairy stems, bearing tendrils and
deeply lobed hispid leaves, from the axils of which arise in.
early summer sohtary, bell-shaped, yellow, moncecious flowers,,
which are each succeeded in the autumn by a yellow fruit of
about the size of an orange, with a thin, smooth, and leathery

• «>

COIiOCYNTH. 101

irind. The plant is a native of the Levant, Egypt, Arabia,
Palestine, the Cape of Good Hope, &c., and is also culti-
-vated in Spain, from whence and from Smyrna and Trieste
the dried, usually peeled fruit is imported for medicinal
purposes. Only the pulp of the fruit, carefully freed from
the seeds and rind, is ofi&cinal, and this pulp consists of a
spongy or paper-like material, of a yellowish-white colour,
with an intensely bitter taste, a character from which the
popular name of the plant has been derived.

The drug is used in homoeopathic practice both in the
form of a trituration of the pulp with sugar of milk, and as a
tincture, prepared by digesting the pulp in alcohol. Colocynth
appears to owe its medicinal property to a glucoside,
colocynthiTiy which is soluble in water and alcohol ; and it
also contains a resinoid material — citrullin, insoluble in
water.

Coloc3nith appears to have been used in medicine from the
^earliest ages of which we have any record. It was prescribed
hy Hippocrates, in the form of enema, in coxalgia from
taking cold ; Dioscorides recommends it in the same disease
but in the form of friction with the fresh juice, and in
paralysis, coUc, and toothache. It was highly esteemed by
the early Arabian physicians in such diseases as chronic
headaches, obstinate hemicrania, melancholia, articular pains,
:astlinia, and especally in colic and coxalgia. Paulus iEgineta
follows Dioscorides in recommending it in the form of friction
with the firesh juice in coxalgia ; Bhazes is said to have cured
many thousand cases of ischialgia (sciatica) by means of ene-
mata of colocynth and saltpetre. " Colocynth and Agaricus
were the principal ingredients in the famous Hiera Pachii
Antiochii, a secret remedy employed by the greatest physi-
•cians of antiquity in gout, paralysis, epilepsy, &c." (Watzke).
It was used by Bonetus and Timoeus in deficient catamenia,
and as an ecboKc. Among more recent writers we find that
Van Helmont and Zacutus Lusitanus have regarded it as an
excellent antisyphihtic remedy ; Junker used it in asthmatic
paroxysms, haemorrhoids and toothache; ^-ndDolberg praises
it in gout. But in a great measure owing to the ill effects
which followed the carelessness with which colocynth was

102 COLOCYNTH.

often administered (to such an extent that some counselled
that its prescription should only be permitted to old and
experienced physicians) it gradually fell into the category of
** good remedies out of fashion," and in the present-day
works on Therapeutics we find colocynth referred to simply
as a powerful gastro-intestinal irritant and hydrogogue
cathartic, rarely prescribed alone but usually in combination
with mercury or with other purgatives, and carminatives, and
then generally in conditions where it is deemed expedient to
quickly unload the bowels in cases of cerebral congestion,
ascites, &c.^ Though not generally alluded to in works on
materia medica, the drug is still used by certain classes of
women as an abortifacient and emmenagogue.

The Pathogenesy of Colocynth,

We owe our knowledge of the pathogenetic effects of
colocynth upon the healthy human organism to the follow-
ing sources :

1. Hahnemann's experiments with the drug upon him-
self, his son Frederic, and Drs. Stapf, Eiickert, Langhammer,
Gutman and Hornberg, which with observations on colocynth
by Zacutus Lusitanus, Schenck, AUbert, &c., and cases of
poisoning by this drug recorded by Staalpart van der Wiel,
Hoyer, Tulpius, Plater and Hoffmann, were recorded by him
in the sixth volume of the first edition of his Eeine
Arzneimittellehre (pubUshed 1821). This contained 17
symptoms produced in himself by colocynth, and 210 in
others. The second edition, vol. vi. (vol. i. of Drs. Dudgeon
and Hughes* EngKsh translation),^ contains 26 sjmiptoms
from himself, 195 from fellow-pro vers, and 29 firom authors ;
250 symptoms in all.

2. Experiments conducted for the Vienna Proving
Society by Drs. Arneth, Bohm, Fleischmann, FrohUch
(on himself and two girls), Gerstel, Hausmann, Mas-

' For an interesting historical account of Colocyntli, see the monograph on
this di'Ug by Dr. Watzke, in Metcalf's Homoeopathic Provings, from which
much of the above information has been derived.

' Materia Medica Pura : Hahnemann Publishing Society.

COLOCYNTH. 103^

chauer, Puffer, Eeisinger, Eothansl, Wachtel, Weinke,
Wurstl, Wurm and Watzke, the latter of whom edited the
results of the proving in a valuable monograph on colocynth
in the first number of the ** (Esterreichische Zeitschrift fiir
Homoeopathie," a translation of which appears in Metcalf s
Homoeopathic Provings (New York, 1853).

3. Experiments conducted for the Jena Proving Society
by Drs. Krumbholz, Martin, Mayer and Eunge, and published
inHona. Vierteljahrschrift, x. 1.

4. A monograph on colocynth by Hechenberger (Kolo-
cynthologie oder Beobachtungen iiber die vortrefflischen,
\ael zu wenig beachteten, Heilkrafte der Kolocynthis. —
Insb. 1840).

The Cyclopaedia of Drug Pathogenesy (II. 345) con-
tains in narrative form the provings in 2, 3 and 4;
it also contains a so-called proving by J. V. Mtiller, in
whom certain acute symptoms are supposed to have been
produced by a single dose (20 drops) of the fourth dilution ;
and a proving by Dr. Lembke, whose bona fides has been
rendered doubtful by recent researches on the part of Dr,
Dudgeon. The symptoms recorded by both these so-called
pro vers have been omitted from the following pathogenetic
material.

Pathogenetic symptoms in schema form.
Provers : 27 males, 2 females.

(The figures in brackets refer ^o the page and line in the Cyclopaedia of
Drug Pathogenesy, vol. II., where the preceding symptom occurs. The
absence of a figure denotes that the S3rmptom is from Hahnemann's
Materia Medica Pura, or that it is one of such frequent occurrence as to
need no special reference. Where a symptom occurs in both these works
only the reference to the Cyclopsedia is given.)

Mind.

Unusual weakness of the memory.^ (348, 45).
Depression of spirits.^ (350, 38).
Morose, fretful state of mind.^ (355, 47).
Disinclination for speaking.^ (355, 47).
Disinclination for bodily and mental exertion.^ (351, 6).

104 COLOCYNTEU

Head.

(General).

Confusion of the head*^ [as if after a debauch^ ; especially in

the sinciput^].
Vertigo^ [apparently arising in the left temple on turning

the head quickly^] .
Weariness and weight in the head.^ (360, 49).
Whole head painful, worse on stooping.^ (366, 8).
Headache as though sinciput and temples were compressed,

worse on stooping and in the open air, with pain in the

eyeballs.! (356, 14).
Burning pain in left orbit, temple, and nose with a feeling

as if the eye and nose were swelling.^ (349, 7).
Twitching pain from the right deltoid insertion through the

shoulder to the upper teeth, temples, and vertex.^

(350, 38).

{Frontal region J).

Weight in the forehead^ (349, 47 ; 351, 36), [on awaking at

night^ (351, 36)] .
Pressure in the forehead^ [left^ (351, 27) ; right^ (359, 8) ;

increased by moving the eyelids^] .
Aching in the forehead^ (356, 4), [worse on stooping^ (356,

4) ; worse while lying on the back^] .
Throbbing frontal headache^ (359, 50).
Burning pain in the skin of the forehead above the eye-

brows.!
Stitches above the right eye with itching of the scalp^

(349, 9).

{Temporal region).^

Bight temple* ; left temple*^ ; both temples.*

Pressive pain^ [worse while walking, but reheved by
sitting stilP (358, 47) ; worse by stooping^ (348, 48) ;
in both temples, with heaviness of the eyelids without
sleepiness, and which disappeared after cafe noir^
(346, 46) ; with twitching of the right upper eyelid^
(353, 20)] .

Boring.!

Digging.!

COLOCYNTH. 105

Out ting in left temple with itching of scalp^ (349, 39).
Tlirobbing.i (349, 39).

iVertex^).

I^ressure* (348, 24), [in the vertex and left eye, and then in

both eyeballs^ (348, 24)] .
Acliiiig, worse on stooping and from movement.^
Burning on left .side of the scalp.^
Soreness of the scalp at the vertex, as if the hair had been

dragged.^ (354, 50).

(^Occipital region).^
Pressure.^ (351, 29 ; 355, 2).

Eyes.

Pressure in the orbits towards the root of the nose.^ (354, 2).
frequent g.ttacks of pain and aching in (forehead and) eye-
balls.i (356^ 30),

in the eyeballs, increased by stooping, relieved in the

open air.^ (356, 15).

in the eyeballs with smarting in the eyes.^ (355, 46).
Pressure in the eyeballs which feel harder than usual.^

(351, 48).
Burning in the right eyeball.^
Shaorp cutting pain in the right eyeball.^
Pressure on both eyeballs.^ (348, 26).
Twitching of right upper eyelid lasting three days, with

headache.^ (353, 21).
Burning in right upper and lower eyelids and inner canthus.^
Stye.i (356, 46).
Shimmering before the right eye in the shape of a circle

with rays.i (351, 47).
A great white light at the side of and below the line of

vision of the right eye, which disappeared when the

eyes were turned towards it.^ (352, 6).

Babs.

Sarache in right ear.^
Shooting in right auricle.^

Shooting pain from the eustachian tube to the membrana
tympani, relieved by boring with the finger.^

106 COLOCYNTH.

Painful drawing behind the right ear.^

Noises in the head : tinnitus^ [ringing^ (347, 47 ; 351, 46),
roaring^ (361, 29) ; roaring and throbbing^ (349, 33;].

Face.

Pain in cheeks.^ [Pricking in the right malar bone,^ (349,36) ;

burning pain^ ; pressure in the malar bones^ (349, 5 ;

360, 39)] . •
Transient stitches in the upper jaw^ (347, 1).
Tearing on the left side of the face to the ear and into the

head.^
Constriction of left cheek, extending into the eye^ (349, 11).
Pimple on left cheek, discharging watery fluid.^
Feeling as if the upper lip were swollen, accompanied by

toothache.^ (347, 46).
Burning at the right angle of the mouth. ^
Pustule at the left angle of the mouth. ^
Burning of lower hp.^ (348, 27).

Mouth.

Toothache' [in upper teety (350, 26; 358, 49; 360, 43); in the
lower teeth^ (349, 46) ; in all the teeth for two days^
(345, 45) ; with twitching extending to the left arm^
(349, 40)].

Sensitiveness of the incisor teeth.^ (348, 20).

Swelled feeling in the roots of the lower teeth. ^ (349, 46).

Smarting inside the right cheek and side of tongue.^

Tongue white and rough, as though from tobacco smoking.^

Tongue rough, as though sand were strewn upon it.^

Sensation as if the tongue had been scalded.^ (354, 42).

Smarting at the tip of the tongue.^ (357, 21).

Burning at the tip^ (349, 12) and on dorsum of tongue.^
(349, 48).

Bitter taste. ^

Disgusting, putrid taste. ^

Scraped feeling in the palate.^.

Throat.

Dryness and roughness^ (349, 5 ; 355, 46) ; [with frequent-
hemming^] .

COLOCYNTH. lOT

Scraped feeling in the throat.* (350, 7 ; 354, 15).

Pricldng as from an awn of corn.^

Sense of compression.^ (355, 26).

Constriction, causing frequent swallowing.^ (352, 45).

Sensation as of a foreign body in the throat, as though he

Iiad to swallow over a lump.^ (360, 19).
Sensation as of a ball, the size of the fist, rising up into the

pharynx, with oppressed respiration.^ (349, 24).

Appetite and Thirst.

IHminished appetite.*

Increased appetite^ (354, 13 ; 360, 12 ; 360, 44) ; [feeling of
emptiness in the stomach with voracious hunger,^
(354, 37) ; voracious hunger followed by heartburn,*
(360, 44)] .

Disgust before eating.^ (356, 28).

Thirst.3 (354^ 13 . 343, 2I ; 360; 12).

Stomach (for pains, etc., in epigastric region, see
Abdomen) .

Hiccnp.^

Eructations^ [empty^ (349, 30 ; 355, 30) ; of bilious fluid^ ; of

bitter, white, frothy matter^ (355, 39)] .
Heartburn.^ (360,44).
Nausea.^
Vomiting.^

■

Abdomen.

{General),

Sensation of coldness in abdomen.^ (346, 34).

Heat inthe abdomen.^ (360, 23 ; 349, 11) [rising towards the

chest and ending in sweat. ^ (348, 49).
Sensation of emptiness in abdomen.^
Ihstension of abdomen.® [tense and very sensitive to touch. ^

(352, 14).
Bombling in the abdomen.^
Pains (of uncertain location) :

Attended by a rush of blood to the head and face,.
followed by perspiration in those parts, which, after

108 COLOCTOTH.

the pain had ceased, felt as if cool air blew upon

them.^
Like an electric shock through the abdomen to anus.^

(354, 38).
As if severely clawed.^
After eating.2 (353, 12).
Worse from pressure.^ (348, 37).
Reheved by bending forward or pressure.' (359, 3).
Relieved by drinking coflfee.* (356, 18).
Relieved by evacuations.' (360, 23 ; 355, 15 ; 359, 3).
ReKeved by emission of flatus.^ (353, 7).

(Epigastric region).

Inflation of epigastrium.^ (347, 47).

Aching in gastric region with a sense of hunger.^

Pressure as if from a stone.^

Cutting in epigastrium.^

Spasmodic pains, griping* (350, 18 ; 353, 3) [rising to the

throat^ (350, 18) ; with tenderness^ (353, 3)] .
Burning pain.^ (350, 13).

(Umbilical region,)

Distension,* (348, 19 ; 356, 26).

Soreness and tenderness.^ (355,40; 356,10).

Shooting pains* [compelling him to crouch forwards^ ; from
umbihcus to loins and spine^ (356, 43)] .

■Cutting pains.' (361,28; 346,20; 356,25).

Griping, constrictive pains® [relieved by the emissi(?n of
flatus^ (362, 50) ; accompanied by a cutting pain deep
into pelvis and then upwards^ (351, 28) ; worse after
fruit^ (346, 50) ; with painful stitches in bladder and
subsequently in rectum, disappearing on the discharge
of flatus.i (346, 43)] .

(Hypogastric region),

"Sensation as if the intestines were gathered into a ball and

lying in the hypogastrium.^ (350, 48).
Pressure as if from flatus that will not come away.^
Aching after dinner, relieved by discharge of flatus and stooL^

(358, 45).
•Cutting pains* (346, 20) ; [increased by walking*] .

OOIXMJIHTH. 109"

frioi*' S'^P^^S^^ (348, 12) [relieved by strong preBsore';
Coos*'^*r j-ti»»^^"^ a-nd a senae of inflation.^ (348, 12)].
„-fi,£yrtar%a'<s -region) .
iffyP^.^^ jrigl^*' «>:E>I're88ing breathing.^ (351, 6).
pres^*^^a ('35^' ^^^ - [under the last ribs'; in the hepatic

X&& -J3. Ijel"!*-^ forward through the hepatic region and

p^atiol- ^«^

ows" ■- rie neaa.' (3Si,

(351, 37).

okook- ^"'ttiro"^'' -tlie head.' (351, 21).
ttieO . lef»liyE>oohondrimn.' (351,

fXl^^ -j^ i» ""STit, increased by presaure.'
l-eosi'"' ^-o rig^* Jli""-" "Rio"' 048, 25).
™wi»e ;o i» iliac region.'

BorioS ■Pf'\347,3* ; 356,31) [in both flanks altemalely.'

(3* ' * tli^ "'Pb with nausea and chilliness.'

:p,B<^'*" £ ^eakneasor paralysis of the sphincter.^ (352,3),

c riS**'**'^+ e:tfo'* to prevent the evacuation from coming,

[g^^^ ■v-.ei'^^^ *^eaching the night chair' ; as if weakened

g,vr»y tiu'^^^ diarrhoea'].

by '^"'^ tbe rectum.' (348, 22; 359,33) [with insufBcient-

Stitch-" Jua^^'^^^^-

° stop*- \^ a»us.' (353, 50).

— ^^tcVi*^^® e \^ftlteTnftting with vesical tenesmus.' (351, 18)1 .
rreoe^^^f 't^e »»^8= (354, 11 ; 346, 14 ; 360, 37). [with itching
\\.c^^°S° Q^ifioe of the urethra' (354,11).]

Vo. ^''^ ^^10 anus* [with burning along the sacral region'
"Btin^^ -1 g)] .

^ ni juacus (moisture) from the anus.' (348,21;

*=*?f2)-

^ Vliod hemorrhoids.'

gvJoUei^ ffom the anus* [in the case of Dr. Fleischmann

Ii»o^°!^ yjopiom continued for more than a year after-

t^'^, ,ifith sticking and burning pain in the small of

** back and anus — symptoms never before experienced

110 .COLOCYNTH.

Stool.

Loose stools^^ [with discharge of much flatus^] .

Pappy^ [with coldness in the whole body.^ (352, 48)] .

Watery.^

Copious, yellowish brown with a putrid smell.^

Thin, frothy, saffron-coloured, with a mouldy smell.^

Greenish-yellow diarrhoea.^

Oopious, yellow, and almost inodorous^ (355, 50).

Bloody^ [first watery and slimy, then bilious, and at last

bloody^ ; first fluid and fseculent, later almost of pure

blood with pieces of the intestinal mucous membrane,

with firightful tenesmus^ (365, 52)] .
Viscid and slimy.^ ,
Hard*^ [in small pieces^ ; as if he were passing stones^

(354, 32)].

Ueinaey Organs.

Frequent micturition.^ (350, 18; 358, 19).

Abundant discharge of urine.*

Urging to urinate, tenesmus, strangury* [with scanty dis-
charge of urine^ ; alternating with rectal tenesmus^
(351, 18)] .

Eetention of urine.^

Urine : of intolerable odour, became thick, gelatinous, and
viscid on standing.^

Copious, light brown, becoming cloudy on cooling and de-
positing a copious and sometimes sandy sediment.^
(360,13)..

Pale red, with light brown sediment depositing reddish
crystals on the vessel.^ (356, 33).

Copious, clear, and watery.^ (354, 7).

Itching in the orifice of the urethra [and in anus]^ (354, 12).

Prickhng in the orifice of the urethra after micturating.^
(348, 33).

A stitch like lightning from the point of the glans through
the abdomen to the leffcflank.^ (349, 14).

Burning in the orifice of the urethra after micturating.'
(359,31).

Aching pain at the end of the urethra after urinating.^

^OLOCYNTfl. .111

Sexual Organs.

Retraction of prepuce.^ (358, 42).

Retraction of testicles.^ (366,28).

Drawing pain in left testicle^ (345, 29).

Increased sexual impulse* (349, 27 ; 351, 46).

Frequent erections.^ (350, 8).

Priapism.! (366, 29).

Impotence, without deficiency of sexual desire. ^

Voluptuous dreams with seminal emissions. ^

Swelling of the vulva, with a sense of bearing down and heat

in the vagina.! (366,19).
Menses profuse and too early.^ (360, 17).

CiECUiiATORY Organs.
Palpitation* [felt through the whole body^ (349, 34) ; with

heat in the head^ (355, 12)].
Pulse quick and fuU.^
Pulse small and accelerated.^ (366, 25).

Chest and Eespiration.

Stitches in chest* [right'^ (354, 41 ; 361, 36) ; in the cardiac

region^ (356, 45) ; under left pectoralis (354, 41) ; in both

sides of the chest, with oppressed breathing^ (356, 13)] .
Twitching pain in intercostal muscles.^ (350, 26).
Orasping pa,in in intercostal muscles.^
Dryness and tickling in the larynx.^
Irritability of the larynx, the voice became rough and hoarse;

distressing dryness of the air passages with fatigue in

the affected parts.^ (345, 38).
Pressure in the middle of sternum, as though something lay

on the chest. ^
Tightness of the chest, with slow and difficult breathing.^
Oppressed breathing* [lung appears unable to expand^ ; with

a sensation of a ball as large as the fist rising up in the

pharynx.! (349,23)].

Neck and Back.

Pressure in nape towards occiput. ^

Stiffness in nape^ (354, 5); [felt on moving the head^ (354, 5)].

Drawing pains in the nape.^ (347, 25).

112 OOLOCYNTH.

Pain in left cervical muscles* [drawing* (359, 24) ; sharp^ ;

tearing^ (348, 16) ; in left stemo-mastoid^].
Stitch under right scapula during inspiration.^
Aching under the right scapula with tensive pain from thence

downwards.^ (352, 5).
Drawing in right scapular region.^
Sensation behind the right scapula as if the arm were

sprained.^
Sore pain in left scapula.^

Shooting pain between scapulae, worse on walking.^
Bruised pain in lower part of back.^
Shooting pain in right loin on inspiration, worse by lying on

the back.^
Throbbing in right lumbar region.^ (350, 1).
Burning pain in the loins.^ (366, 19).
Throbbing in left iliac region and right loin over the iliac

crest towards the buttock.^ (348, 25).
Burning pain in the small of the back and arms.^ (346, 39).
Pain in the sacrum* [pressive* (355, 8; 359, 14); as if beaten^

353, 15)] .
Aching in left sacro-iliac commissure.^ (349, 43).

EXTEBMITEES.

(General).
Weakness in all the joints, especially the knees and elbows.'

(351, 5).
Drawing pains in all the joints, especially the fingers and

toes.i (359, 15).

(Upper).

Twitching pain at the insertion of the right deltoid, extend-
ing through the shoulder towards the upper teeth, and
as far as the temple and vertex ; the parts, after its-
frequent recurrence, became sore to pressure.^ (350, 38),

Twitching in the left arm as far as the elbow, with toothache
on the right side.^ (349, 40).

Pain in the arms as if bruised.^

Pain in the shoulders* [aching in both^ (355, 11) ; drawing in
the right^ (345,45) ; painful tension in the right, worse
on movement^ (351, 42)].

COLOOYNTH. 11$

Stitches in the elbow and forearms.^ (354, 23 ; 355, 37).

Aching in the arm bones, especially beneath the head of the
humerus and above the wrist, worse by rest.^

StifEaess of the right forearm, with painfuhiess of the ex-
tensor muscles.^ (352, 28).

Numbness of right forearm.^ (348, 14).

Crampy pain in left forearm.^ (360, 45).

Tearing in left arm down to finger-joints.^ (347, 26).

Pain in the right palm so that the fingers were opened with
difficulty.^ (356, 48).

Pain in thumb^ [right^ ; left^ (353, 25)].

Drawing pain in finger-joints of the left hand.^ (347, 24).

Pain in right middle fingers.^ (356, 21).

Pain in left little finger.^ (358, 26).

{Lower).

Weakness of the legs as from fatigue.^

Weariness of the thighs, especially noticed when going up-^

stairs.^ (350, 11).
Burning pains in the bones of the lower extremities.^ (355, 5).
Tearing in both thighs, and in the left calf as far as the heel.^

C347, 27).
Drawing pain from left ilium to the groin and inner side of

the thigh. 1 (346, 1).
Pain in the right thigh when walking, as if the psoas were

too short.^
Stitches in the inner side of the left thigh from the ischiatic

tuberosity towards the knee, when walking.^ (357, 16).
Drawing pains in thighs' [outer side, while walking^ (357, 22);

inner side^ (359, 40) ; as far as the knee^ (353, 33)].
Weight in both knees.^ (353, 26).
Pain in the knee when walking^ (351, 41) [as if the joint

were tightly bound^].
Tearing in left knee, disappearing on walking.^ (353, 26).
Stitches in left knee.^ (355, 33).
Pain in patella^ [with heat and swelling so that walking

became painful^ (346, 12) ; passing oflf as walking was

continued.^ (353, 42)].
Pulsation in left popliteal space.^ (350, 2).

veil. I. — ^No. 2. 8

114 qOLOCYNTH.

Numbness down th6 outer side of the right calf, ultimately

extending into the great toe.^ (348, 6).
Numbness, beat, and swelling of left: foot gradually invading

the whole leg.^ (350, 32).
Pain in the hitherto painless varicose veins of the right leg.^
Cramp-like drawing in the left calf.^ (347, 2).
Sharp cutting on the iuAer side of the left calf, when at

rest.^
Pain in left tibia^ [drawing, extending to the ankle^ (364, 30);

tearing in night^ (349, 22) ; burning^ (353, 11)].
Tearing in the anlde^ [when sitting^ ; while walking^

(347, 7)]. .
Drawing in the right ankle^ (358, 50).
Aching in the left instep^ (354, 47).
Cutting pain, as though a nail were driven through the right

instep^ (354, 48).
Twitching in the dorsa of both feet towards the tibiae^

(356, 1).
Tearing on the dorsum of the left foot.^
Pain in the dorsum of the right foot, and a pale, painless
swelHng, the size of a pigeon's egg, at the outer edge of
the tarsus.^ (358, 2).
•Stitches in the dorsum of the right foot and great toe.^

(354, 19).
Stiffness in the left great toe.^ (346, 4).
Pressing and throbbing in the first joint of the great toe, as

if the boot were too tight^ (358, 34).
Sprained feeling in all the toes of the left foot, felt while

going upstairs.^ (359, 27).
Tearing in the sole of the right foot.^
Drawing pain in the inner ball of the left foot.^ (356, 44).
Stitches along the outer border of the left sole.^ (347, 2).

Skin.

Itching while in bed, causing restlessness and inability to

sleep. ^
Itching, especially on the chest and abdomen, in the morning

on awaking.^
Boils^ [face and back^ (345, 30) ; on the hands^ (356, 46)].

COLOOYNTH, 115

SIjEEP.

Restless sleep^ (356, 5 ; 353, 32).

Dreams^® [vivid^ ; horrible, exciting^ (355, 24) ; pleasant^
(351, 35) ; voluptuous^; voluptuous, with seminal emis-
sions^].

Pathological Action.

" Most pharmacologists of the present day," says Watzke,
** do not seem to consider it worth while to seem to know
anything specific about the peculiar powers of colocynth.
They content themselves with setting it down as * Furgans
acre vehemens' or ' Drasticum heroicum,' and with a few
words refer to its former dangerous employment ** (Monogr.
Coloc, Metcalf s Hom. Provings, p. 378).

And after the lapse of nearly half a century pharma-
cologists appear to know little more about colocjnith than
than they did in Watzke's time. ** Colocynth," says Einger,
"** produces diarrhoea, colic, and sometimes vomiting. The
diarrhoea is watery, and after large doses serous, mucous,
and bloody. In large doses it may excite gastro-enteritis
and peritonitis *' (Handb. of Therapeutics, 11th ed., p. 593.)
" Eohrig, from his experiments with fasting animals, is led to
place colocynth high among cholagogues. It makes the bile
more watery, but also increases the solid constituents. It
powerfully stimulates the intestinal glands " (Id.).

A study of the symptoms during life, and of the post-
mortem appearances after fatal poisoning by coiocjmth
(vide Cyclop. Drug Pathogenesy, II., 365, et seq.) indicates
that the drug acts primarily as a stimulant to the sensory
nervous system, affecting more especially the sensory nerves
of the gastro-intestinal tract. And experiments conducted
by Orfila and others on animals show that this action is not
merely mechanical, but is distinctly specific, for it occurs
whether the drug be administered by the mouth, injected
into the tissues, or applied to a raw surface of the body.
Moderate doses, by stimulating the sensory nerves of the
stomach and intestines, produce vaso-dilation and exalted
glandular activity^ resulting in an increase of the natural

116 COLOCYNTH.

secretion, and a softened or pappy stool. A larger dose
causes a still farther increase in the quantity, and an
alteration in the quality of the fluid secreted, which
becomes more watery, and at the same time acrid, giving
rise after its discharge to burning and smarting at the anus.
The increased stimulation of the sensory nerves results in
(reflected) motor irritabiUty, varying in degree from a slightly
increased peristalsis to the most violent tormina ; and the
same condition affecting the rectum produces intense
tenesmus. A fiirther continuation of the irritant effects of
the drug leads to vaso-motor paresis, the mucous membrane
becomes deeply congested, blood escapes from the over-
distended vessels, and the mucous coat becomes so softened
as to be easily detached. Gangrene of the bowel may take
place (as Hoffman ^ notes to have been of frequent occurrence
after medicinal doses of colocjmth for ascites), or the inflam^
mation, at first limited to the mucous coat and the sub-
mucous tissues, may extend through the muscular to the
serous covering, and fatal peritonitis may ensue. As is
usually the case in muco-enteritis of any severity, the con-
tinued over-stimulation of the intestinal motor nerves
eventually leads to an opposite .condition, a weakening and
finally paralysis of the muscular coat, the gut becomes easily
distended from an accumulation of gases, and tjrmpanites
results. In the dogs which were the subjects of experiment
by Orfila, the drug seemed to have a stronger afl&nity for the
stomach and rectum than for the portions of bowel inter-
vening ; but the results of post-mortem examination do not
show this to be the case in any marked degree in the human
body.

But while the pathogenetic action of colocynth does
undoubtedly centre on the sensory nerves of the stomach
and intestines, we find by the method of drug experimen-
tation almost pecuUar to our school — the administration of
small doses of the drug at tolerably frequent intervals to
healthy individuals — that colocynth has a wider range than
is indicated by the symptoms in cases of acute poisoning,

» Op. Omn, Gen, 1740, III., 332.

COLOCYNTH. 117

With or without increased intestinal activity, and sometimes
after the cessation of such activity, provers experience well-
marked irritation of a large portion of the general sensory
nervous system, and more especially of the trigeminus and
the sensory portions of the brachial, lumbar, and sciatic
plexuses. "Whether this irritation is due to direct (primary)
stimulation of these nerves, either centrally or peripherally,
or v^rhether it is the result of a stimulus reflected from the
gastro-enteric mucous membrane remains to be decided ;
but that the latter is probably the correct conclusion seems
home out by the great general resemblance between many
of the sjmaptoms experienced by provers of colocynth and
-well-known manifestations of gastro-enteric disturbance,
-such as the mental confusion, the various forms of headache
and facial neuralgia, the vertigo and tinnitus aurium (which
is most often produced by reflex excitation of the vaso-motor
nerves of the labyrinth), the dryness of the throat and
irritability of the larynx, the oppressed breathing, the pains
and stifEness about the neck, the brachial and intercostal
neuralgia, the sciatica and the articular symptoms. Even
the great increase in the secretion of urine, so characteristic
of the administration of colocynth in small doses, is a known
physiological result of stimulation of the vagus at the cardiac
end of the stomach — which produces a reflex dilatation of
the renal vessels.

Therapeutic applications.

The fact that any drug should have fallen into disrepute
among medical practitioners because of ill effects noticed to
follow its administration to the sick would be considered by
the student of homoeopathic medicine prima facie evidence
of its power for good in properly selected cases of disease;
and colocjmth is no exception to the rule of practice
"" Similia similibus curentur" It is just in the condition pro-
duced by its maladministration, and which led to its disuse
by the general body of the profession except as a purgative —
its tendency to cause violent colic and purging, and to set up
muco-enteritis, that colocynth has gained its. laurels in

118 OOliOCYNTH.

homoeopathic practice, and our literature contains many
records of its curative power in such conditions.^

From the pathogenesy of the drug, as well as from
practice, we find that the chief indications for colocynth in
muco-enteritis are : pain of a spasmodic (cutting or griping)
character affecting chiefly the umbilical and hypogastric
regions, generally relieved by stooping forwards and by pres-
sure, and usually accompanied by diarrhoea and flatulent
distension. The pains are also relieved temporarily by dis-
charge of stool or flatus, and are usually increased by food,
although we note that two of the provers found the pains,
greatly relieved «,fter taking coffee.

The diarrhoea for which colocynth is applicable may be
merely a loose, pappy stool, usually preceded by some colic
or pressure in the hjrpogastric region, and often attended
with much rumbling of flatus ; or it may be watery, or
bilious, or . even bloody ; and although in two provers the
pappy stools were accompanied by a feeling of weakness of
the sphincter which rendered retention of the stool, even for
a short period, so difl&cult that there was scarcely time for the
necessary " change of base " (Aloes), the characteristic rectal
condition attending the severer forms of colocynth diarrhoea
is one of violent tenesmus (Merc. corr.).

Nearly all our writers on colocynth refer to its value in
colic and diarrhoea due to emotional causes : this may be the
case, but this prescription is not deduced from the patho-
genesy of the drug,

Our literature does not seem to contain any records of
the use of colocynth in entero-peritonitis, but where this con-
dition has ensued upon muco-enteritis it is probable that
colocynth might be helpful.

The hard stools produced in some of the provers are evi-
dently due to a secondary action of the drug.

* The following is a typical illustration : ** Dr. Bohm cured radically with
colocynth, Srd dil., attacks of colic, with pressure at the stomach, flatulence,,
eructations, and mucous diarrhoea, in a man of 54, subject to haemorrhoids ;
the colic came on daily, and was brought on by taking food even of the
lightest description. The patient had undergone the water treatment at
Graeuberg for three years, with partial amendment. Soon after the first
dose of colocynth he was seized with a more violent colic than he had ever
experienced. Ten months after he had experienced no return *' (Watske'a
Monogi:aph).

OOLOOYNTH. 119

After muco-enteritis probably sciatica has been the prin-
cipal sphere in which colocynth has been found curative, and
not only by homoeopathic practitioners, but, as was referred
to in the history of the drug, it was one of the favourite and
most successful drugs used against this disease by the Greek
and Arabian physicians. It is distinctly homoeopathic to
sciatica and to neuralgia affecting the anterior crural nerve,
as is evidenced by the richness of our provings in these
symptoms. It is probably in sciatica and neuralgia depen-
dent upon rectal irritation, and in that of a rheumatic
character (note here the relation between chronic rheumatic
manifestations and digestive disturbances) that colocynth
-will be found most useful ; where the pain is shooting or
tearing, usually worse at night, and where it may be accom-
panied by numbness or cramp of the muscles of the leg.
Hughes remarks (Pharmacodynamics, 5th ed., 433) that he
has found colocynth curative only in recent cases of sciatica,
preferring Rhus or Arsenicum in those of longer duration.^

Although colocynth has been recommended (and the
recommendation copied by one author after another) in
morbus coxarius, it is not probable that it would be of any
value in pure hip-joint disease.

The headaches produced by (and therefore similar ones
would be curable by) colocynth are mostly frontal and
temporal in situation, and most frequently pressive in
character ; there is some tendency for the left side to be
more affected than the right, though the disproportion is
not great. In most cases the headache is increased by
stooping and by movement, and is frequently attended by
neuralgic pains in the eye-balls, orbits, and face. In those
provers in whom pain attacked the vertex the scalp became

* Dr. Bohm removed with colocynth 3 an Ischias postica which had
attacked a hearty, healthy man, of 40, without assignable cause, with violent
pain extending from the trochanter to the ankle, which had for 12 weeks re-
turned every week and lasted 20 or 30 hours with extreme intensity. Bhus
tox. had been tried without effect. The paroxysm returned once, but in
a feeble degree, and went away permanently under a continuance of the
colocynth " (Dr. Watzke's Monograph).

A young man about 20 had sciatica for several weeks. The pain was
lancinating, flashing along the track of the nerve whenever an attempt was
made to raise the limb. One drop of tincture of colocynth in water effected a
prompt and permanent cure (HempeFs Materia Medica, I. 457).

120 COIiOCYNTH.

tender, a symptom again foreshadowing a rhemnatic con-
dition. Whether colocynth will prove of service in pure
migraine, or whether good results will only follow its
administration in sympathetic headache, facial neuralgia,
and toothache (for all branches of the trigeminus may be
affected) from gastro-enteric disturbance must be decided
by experience. Lilienthal specially refers to its value in
^'bihous and gouty" headaches, and Watzke remarks that
''the hemicrania and prosopalgia which colocjmth cures
proceed from increased sensibility from rheumatic, gouty,
or gastric irritation — in organic disease from deeper causes
the eflScacy of colocynth is very doubtful."^

Colocynth has been referred to (by Allen) as a palliative
of the pain of acute glaucoma and iritis, and Hughes says
'*it has been found of serviqe in the violent pains in the
eye-ball which precede the development of glaucoma," but
Angell does not include colocynth in his list of medicines
useful in ophthalmic practice. Farrington refers to it, and
I think with more propriety, as a good remedy in gouty
affections of the eye, and in this condition compares it with
Staphisagria. Dr. Trites, in Arndt's System of Medicine,
II. 326, regards colocynth as " one of the sovereign remedies
in orchitis " (one prover had drawing pains in the left
testicle). Colocynth has been found useful in ovarian neu-
ralgia, while in that form of ovaritis accompanied by
general abdominal tenderness, Dr. Ludlam considers it
(after belladonna) more useful than any other medicine.
In the case of one of Dr. Frohlich's female provers there
were produced ** stitches in both flanks, apparently connected
with the ovaries,'' but without any other symptoms of

* Dr. Schiller records a case of severe headache where after the con-
tinuance of the pain for some time the left eye became quite blind, and the
other, though still useful, attacked with cutting, burning pain, with an acrid
discharge from both eyes. Two drops of coloc. ^ every three*hours removed
the headache completely within 24 hours, and had a sensible effect in
diminishing the pain in the eye. Under a continuance of the colocynth the
sight of the eye was preserved, and the patient completely restored in eight
days (Dr. Watzke's Monograph).

A hemicrania in a woman of over 60, occupying the left side, returning
periodically at five in the afternoon, and which had lasted several years was,
after fruitless treatment by allopathic means, somewhat alleviated by asarum,
and disappeared entirely and permanently imder a few days' use of colocynth
(Attomyr, Archiv. f. Hom. H. xi. 2, 144).

DISCUSSION ON COLOCYNTH. 121

disturbance of these organs: Cases of the dissipation of
ovarian tamonrs by the administration of colocynth have
been recorded, but the records are so vague that little
reliance can be placed upon them.

From the similarity of its arthritic symptoms to those
dependent upon the rheumatic or gouty diathesis, colocynth
deserves a trial in these conditions, while the dry, scraped
throat, the laryngeal irritability, the oppressed breathing,
the stiff neck, the intercostal neuralgia, and the sacral
aching with haemorrhoids so closely resemble similar
conditions in gouty or lithaemic subjects as to warrant the
expectation that colocynth will be found useful in the
treatment of such individuals.

Dose. — Colocynth may be considered one of the more
potent of our drugs, and the best results appear to have
been obtained by doses of the third to the sixth centesimal
dilution, either of the tincture or triturated pulp. Dilu-
tions lower than the third are liable to be followed by
medicinal aggravation of the symptoms.

Dr. Hawkes said he did not feel that he could give an opinion
as to the use of the terms *' pathological " and *' physiological " in
reference to the actions produced by drug provings ; he thought
it -was a question to be discussed. Eeferring to the proving of
drugs he thought that some were more true in their action in
disease to their pathogenesy than others, colocynth being one that
was not quite true. He was very much disappointed in its use in
colic cases, and much preferred bell., dioscor., &c. Neither did he
find it of inuch service in sciatica and neuralgia.

Dr. J. Murray Moore was much pleased with the paper, as
after Dr. Dudgeon's exposure of the fallacies of Lembke's prov-
ings, something ought to be done. He liked colocynth in the colic
that was relieved by pressure, and a cup of strong coffee. He re-
ferred to the distinct pathological and physiological effects of
some drugs, and read some extracts on colocynth from Bell's
** Diarrhoea."

Dr. Rowland Wilde said that whether physiological or patho-
logical effects were produced was simply a question of dose, in-
stancing constipation, which was differently affected according to
the different strengths of medicines.

122 DISCUSSION ON COLOCYNTH.

Dr. John Haywabd said that tho subject was one of special
interest to him, as Dr. Drysdale had asked him to prove colocynth.
He agreed with Dr. Wilde as to the use of the terms pathological
and physiological. Aconite given in large doses would produce
pathological effects ; in small, physiological. He thought that the
proving actions were pathological. As to colocynth, he thought
it a pity that there were no more provings of it, as amongst them
there were those of two women only. He used colocynth much
more frequently since he had studied it, and found it useful in
certain forms of colic and neuralgia ; the colic being worse at
night as most of the colocynth symptoms were. He mentioned
its use in most hospitals as a very efficient purgative.

Dr. Davidson mentioned a case of superior maxillary neuralgia
cured by colocynth.

Dr. Mahony thought that colocynth was more useful in cases
where pain was worse about 4 p.m. If we could only find out the
way in which the drug ajffected the nervous system, it would
probably prove very much more useful.

Dr. Herbert Wilde had found colocynth useful in sciatica,
but not in muco-enteric cases.

Dr. C. W. Hayward had found it very useful in right sided
sciatica.

Dr. Ellis, in responding, asked Dr. Hawkes whether he had
had any experience of the use of colocynth in gynaecological cases,
to which Dr. Hawkes answered in the negative. He referred to
many symptoms of colocynth as being merely clinical, and which
are therefore out of place in the pure pathogenesy. He thought
that the neuralgia of colocynth was of a reflex character. Colo-
cynth was probably of no use in neuralgia which was not sym-
pathetic with gastro-intestinal troubles. He did not consider that
the symptoms ** worse at night" and "worse at 4 p.m." were of
any significance. As to the use of colocynth in sciatica he had
had no experience ; but muco-enteric troubles were liable to be
increased by even the lower dilutions of colocynth.

ON GEBM GONTAQIO)?. 123

ON GEEM CONTAGION.!

BY STAMMEES MOERISSON, M.D.

These brief notes refer to the contagion of anthrax in
animals, but their bearing upon the human side of the
question will be apparent. In Dr. Klein's book there is
a reference to the pertinacity with which germs retain
their hold upon grass in an open field. To my mind, they
have a direct relationship to preventive inoculation, and
especially to vaccination. Some years back I nearly lost
an adult patient from blood poisoning consequent upon
heifer lymph vaccination; I have seen an infant die from
blood poisoning; and while I was in Montpellier four
soldiers died in the hospital from erysipelas caused by re-
vaccination. Hence the question of germ contagion is to
me of special interest.

A gentleman farmer in a West-Midland county has just
given me the following account of infection among cattle.
In June, 1888, three head of cattle were placed in a par-
ticular field. Three days after one of these wap taken ill,
and died within a few hours ; the other two animals became
irffected, and both died. Four head of cattle were placed in
this field in May, 1889 ; one of these became affected, and
died ; the others were closely watched, and upon a second
showing similar symptoms it was driven, evidently in great
pain, to a neighbouring butcher's to be killed. The butcher
said, " Try some Epsom salts." One pound of salts were
administered and the beast recovered ; the other two were
treated in like manner, and removed from the field, and they
escaped ; but the butcher lost two of his own cattle through
placing them where the infected animal had been. No
cattle were pastured again in the infected field till February,
1892 — ^nearly two years, when fourteen animals were placed
there. It was not long before one of these was seized with

» Bead before the Society, October 6th, 1892.

124 ON GEBM COKTAGION.

the old symptoms, and died. The others had been skinned,
but the farmer had recognised the contagiousness of the
complaint, so this carcase was buried some eight or nine feet
deep, and shrubs planted over the spot. The other animals
were removed from the field, and one poimd of Epsom salts
given to each. This was on a Monday. All the animals
became somewhat queer, probably from being so thoroughly
dosed, but the salts were repeated on the Wednesday, and
not one of them contracted the fatal disease.

An interesting point was, that on the day on which the
one was lost all the herd were observed feeding upon
turnips at noon, and three hours later the infected bullock
was lying dead. A second point of interest is, that during
the intervals between the periods mentioned, both sheep
and horses had been pastured in that same field without
taking any harm. A third point of interest is, that since
the last incident the upper portion of the field, where the
<;arcase was buried, has been railed off, and cattle have
been safely pastured in the lower portion. A fourth point
of interest is, that the butcher who skinned some of the
animals escaped being inoculated, but the butcher who
would have skinned the last animal that died, had it been
done, was shortly after this incident removed to a neigh-
bouring infirmary suffering from blood poisoning through
-another source.

The disease from which these cattle died was anthrax,
the highly infectious nature of which is now well known.

How was the infection first introduced, and by what was
it retained ? The farmer supposes that it may have been
due to an infected animal having at some time been buried
there, and contaminating the herbage.

Experimenters handling anthrax germs have to be
•extremely careful, both in regard to themselves and to any
animals in adjacent rooms. But my farmer friend was not
at first aware of the contagious nature of this disease, and
the record of his losses shows how readily maladies arising
from infectious germs may be passed on from one individual
being to another. With the method of treatment I have
only to deal thus far : — salts of many kinds are inimical to

HABITUAL CONSTIPATION. 125^

germ life ; probably the germs in these instances were con-
veyed to the stomachs of the animals; and the salts ad-
ministered to those that were saved when infected acted
destructively upon the germs before a sufficient time had
elapsed for the germs to seriously affect the system. An-
thrax germs multiply with great rapidity, and they enter
the circulation, destroying the blood cells and filling the
capillary vessels; hence the frequency with which their
effects prove fatal.

HABITUAL CONSTIPATION.!

BY EDWARD BLAKE, M.D.

The symptomatic method of treating this subject ha&.
been so well threshed out by our school that I will approach
the subject from the etiologic side. To do this properly, it
is needful to contemplate briefly the physiology of enperis-
talsis and the mechanism of normal defaecation.

In the year 1888,^ Dr. Hughlings Jackson put forth his
thoughtful " Nerve Theory of Normal Defaecation." He
predicted the existence of a motor (viscero-motor) centre,,
possibly in the medulla, and a controlling (viscero-inhibitory)
centre, probably in the dorsaP region of the cord. From the
former, he beUeves that polio-enteric or gray fibres pass,.
probably by way of the left vagus, to the bowels. These
cause intestinal contraction. From the latter, the dorsal
centre, he describes leukenteric, or white fibres, as proceeding
to the intestine direct. These latter possess the property of
keeping the intestines dilated. These two centres are, of
course, united by communicating fibres to secure harpaony
of action. When both act in unison, all is well. When one
set is paralysed we have constipation. From paresis of the
other, diarrhoea ensues.

> Bead before the British Homoeopathic Society, February 2nd, 1893.

* " Diseases of the Brain," British Medical Journal, July 14th, 1888.

' The researches of Professor Gaskell, of Cambridge, have since made it
certain that this centre is situated somewhere between the second thoracic and
the second lumbar roots.

126 HABITUAIi CONSTIPATION.

In childhood it is possible that the intrinsic muscles of
the rectum may have the power of voiding the lower gut ;
but as life advances, the rectal detrusors need more and more
to be reinforced by the diaphragm and by the parietal
muscles. As these lose tone, constipation becomes a habit.
Part of the splendid effect of nux vomica in overcoming the
costive tendency is due doubtless to its influence in increasing
the innervation of the abdominal muscular surroimdings.
It is probably through these centres that the hypnotic
influence acts. The main outlines of the Jacksonian theory
are supported by the valuable work of Gaskell,^ of Cambridge,
on *' Visceral and Vascular Innervation."

The scheme of Hughlings Jackson is no doubt correct as
far as it goes; and standing alone, it would serve to explain
many familiar phenomena, — such, for example, as ''mental'*
•<;onstipation and "emotional** diarrhoea. But it is not all.
In 1887 Mr. Bland Sutton, followed by Gaskell, demon-
strated that developmentally the alimentary canal precedes
in life history the neural canal ; that, in point of fact, the
spinal cord is developed from the food tube.

We can and must infer the existence of an automatic
motor nerve-centre in or near the intestinal canal, associated
with the nerve plexuses of Auerbach and Meissner. A centre
which is alert in health, at least during the waking hours.
A centre prone to be affected by many stimuli, but which,
when unstimulated and also after over-stimulation, possesses
the property of arresting the vermicular movements. Landois
and Sterling have shown that the integrity of this centre
depends immediately on a certain kind of blood, holding
certain gases in solution, and flowing at a definite rate
through the intestinal vessels. Upon the blood supply
doubtless depend, at least in part, the normal diarrhoea of the
newly-born and also the equally natural costiveness of the
aged.

There are many more natural movements of the intestines
than we are apt to suppose : all are probably contributory to
normal and healthy function. I will content myself with

* Journal of Physiology ^ Vol. VII., p. 1. 1886. Cambridge Scientific Inst.
Co., St. Tibbs Row, Cambridge.

9ABITUAL CONSTIPATION. 127

describing seven of the most obvious movements. Of these
some are automatic or passive, and some are voluntary.

Second method of intestinal movement. — If we look at the
abdomen of a healthy male adult at rest in the dorsal recum-
bent posture, we notice that the abdominal wall rises with
inspiration and falls during expiration.

Third method of intestinal movement — If we watch still
more carefully, we note that the recti abdominales constantly
throb with the impulse of the cardiac ventricles. The move-
ments of ordinary breathing are greatly accentuated during
such forced expiratory and inspiratory efforts as are involved
in walking, talking, sighing, sneezing, coughing, laughing,
vomiting, micturating and defaecating. These tend, on the
whole, to thrust the contents of the abdominal cavity down-
wards and backwards.

Fourth msthod of intestinal movement, — If we direct the
patient to contract the iliaco-pso8B, supplied, as you know, by
the anterior branches of the lumbaj nerves and the anterior
crural, the largest trunk from the lumbar plexus, derived
from third and fourth lumbar, with a fasciculus (inhibitory?)
from the second lumbar, we get an entirely different effect
on the intestines. They are now thrust forward and a little
upward. When all the parietal muscles, including the iliaco-
psosB and the quadrati, act together suddenly, then is the
favourable moment for hernia to be established.

Fifth method of intestinal movement. — In a natural state
when the posterior muscles come forward, the abdominal
recti, the obliqui and the transversales, supplied chiefly by
the lower six dorsal intercostals, act consensually and, by
contracting, push back the viscera and their contents. Both
the viscera and the vessels are now exposed to considerable
pressure between these opposing surfaces. They cannot
escape the squeezing process, for the levator ani is thrown
into contraction below, whilst above, the diaphragm, having
aheady descended, remains fixed during effort. Thus a
powerful compressing influence is exerted on the intestines,
on their contents and on the abdominal organs and vessels
generally. The receptaculum chyh is emptied, and for a time
lymph is driven back into the cerebro-spinal cavity and into

128 HABITUAL CONSTIPATION.

the lower extremities. Venous blood, too, is for the moment
delayed in the leg-veins, and is driven back on the tributaries
of the superior cava.

Dr. Lauder Brunton, in a paper read before the West
Lbndon Medico-Chirurgical Society, June 12th, 1891, spoke
of the important part played by the levator ani in normal
defsecation. He made some sensible remarks on the en-
couragement afforded to constipation by the height of the
ordinary closet-seat, which leaves the levator ani flaccid and
drooping. With a pouched state of that important muscle,
it is very difficult to expel a stool : this difficulty is overcome
in the normal crouching position of primitive man.

We can readily see why shouting, cycling, rowing, running
and hill-climbing must be potent factors in assisting the
portal circulation and thus preventing constipation. Lauder
Brunton has shown that mountaineering, perhaps more than
any other form of exercise, forcibly squeezes the sponge-like
Hver, stimulating its sluggish portal vessels and its own
intrinsic circulation.

Sixth method of intestinal movement, — ^When we travel,
we carry the intestines with us and thus they move in
relation to the surface of the earth.

Seventh method of intestinal movement, — We have
accounted for six common methods of movement. We may
add to these a seventh, which is a kind of natural succussion
of the spine. The trunk is jarred every time the heel is
placed on the ground. Whilst riding a horse, this jarring is
especially felt. It takes place in a train and in a carriage to
a less marked extent. If carried to excess, this vibration may
produce constipation, which, in many persons, follows a
prolonged journey.

Thus we see that there are, at least, seven sorts of move-
ment of the intestines. Two of these movements are always
at work, one of them during the waking hours at least. All
of them are in active play during the normal life of labour.
It is plain that everything which tends to modify any one of
these movements, may become a contributory factor in
bringing about a state of constipation.

We can quite well understand now why some lazy

HABITUAL CONSTIPATION. 129

people, especially those who breakfast in bed, may sufifer
from a torpid condition of the bowels. The habit of lying
later in bed, coupled with the fact of eating more, of doing
less and of being insufferably " bored," may serve to explain
in part why some persons are not so well on Sunday.

Constipation in the Young.

As the causation of constipation is so much bound up with
the questions of age and of gender, I propose to treat, under
separate headings, the three chief epochs of Hfe, and I will
afterwards devote a special section to the consideration of
the influence of sex on the regularity of the bowels.

Diarrhoea, normal in early life on account of the exceeding
hurry of metabolism, is a disease, and a very fatal one, at an
advanced period of existence.

I think Vogel was right when he said that nitrate of
silver is the specific for costiveness of the newly-born, when
that symptom occurs in connection with jaundice. If it fail^
then a capital combination is podophyllum 30 by day, with
aconite 3 at night. Mercury is indicated by red gum, itself
probably a septic rash, by adenoma, green stools (duodenitis),
copious frequent micturition with consequent intertrigo, and
the troubles of teething. Sulphur is also most valuable.
Nux vomica, so useful in adult life, is rarely called for during
babyhood.

I will pause here for one moment to suggest a reason why
convulsive fits form such a prominent feature during infancy
and why they are so intractable on occasions. The
tremendous activity of tissue-metabolism during infantile
life loads the blood with toxines, just as pregnancy does ; if
these are promptly removed as soon as they are formed, by
vigorous action on the part of the ordinary emunctories, all
goes well. But if, on the other hand, something interferes
with one or more of the four great sewers of the body, the
skin, the lung, the kidney and the bowels, then poisonous
products rapidly accumulate in the nerve centres. These,
acting on an irritable and unstable nervous system, wotdd
readily induce toxic convulsions.

VOL. I. — ^NO. 2. 9

130 HABITUAL CONSTIPATION.

I must admit that the constipation of later childhood is,
in many cases, due to sheer idleness or inattention. Unless
the call of nature be imperative, the duty will be postponed
through pre-occupation, inadvertency or petulance. There-
fore the child should be. educated from the first with regar.d
to the gravity of neglect of this plain duty ; and a daily visit,
with patient waiting, must be insisted on, at a definite hour.

Costiveness in boys, with prolapsus ani, may mean either
thread-worms, phimosis, or renal calculus. The first calls
for ignatia, podophyllum or sulphur ; each of these remedies
is greatly aided by some appropriate chalybeate. The two
latter will of course be met by surgical measures.

Constipation with either unilateral ptosis, chorea, sore
navel or enuresis nocturna should draw the attention of the
physician to the possibility of round-worm.

Men who have lived freely, and have abused athleticism,
present a familiar group of symptoms, which we have all
seen relieved by sulphur, hepar, sbscuIus, mercury or nux
vomica. We know well the athletic list of ailments, seen to
perfection in the so-called " gouty " subject. Pulmonary
vesicular emphysema, enlargement of the liver, especially of
the small left lobe, hsemorrhoidal troubles, fits of irascibility
alternating with gloomy forebodings. With this group is
usually associated the clerical or more correctly the athletic
i;hroat, follicular or granular pharyngitis and, in old cases, a
•condition of pharyngeal varicosis, which has been graphically
if not elegantly described by Mr. Lennox Brown as ** piles
of the throat." These people have, I am ashamed to say,
been sometimes condemned as consumptives, merely because
they spit a little blood, a process usually followed by a con-
rsiderable sense of rehef. Patients have come to me who
have been profoundly depressed by the wholly unnecessary
gravity of the prognosis delivered by my predecessor.
Nothing is more delightful than to see the complete revolu-
tion worked in these persons by a few cheering words,
associated with a strict dietary, i.e., abstinence from meat and
liquor. With the exception of lung education, complete
bodily rest should be insisted on. A type of the sad history
of many athletes is to be found in Charles Kingsley, who

HABITUAL CONSTIPATION. 131

died much too early in his career, of pleurisy following
extreme over-exertion. Such men, having the congested
liver which is secondary to tricuspid insufficiency, find them-
selves growing " bihous," yet they will not dock their dainties
nor take rest* They are goaded on by the deep-rooted Saxon
conviction that everjrthing may be cured by violent exertion,
if only you take enough of it ! Often urged on too by fooUsh
companions, the emphysematous, middle-aged man takes
more and more exercise, seeking in vain to remove by
exertion the symptoms which have been induced by violent
effort, with most calamitous results.

Hydropathy and rest improve these people. A vegetarian
dietary is a grand aid in restoring them. A glass of water
on waking, taken hot if the heart be thin and dilated, often
produces the needed evacuation. Mercury, nitric acid, nux
vomica, sulphur, bryonia or aesculus : may be thought of ;
also high dilutions of the hepatic stimuli may be administered
before meals. A drop of aconite in the form of mother
tincture or the first decimal dilution, given at bed-time in a
pint of very hot water, sometimes acts admirably. These
patients are prone to have acute pains in the great occipital
or second cervical nerve. This pain may be promptly
relieved by ten to twenty grains of the bromides, it is some-
times rapidly removed by five to ten grains of antipyrin. I
have seen it permanently cured by a course of sanguinaria
in the lower dilutions. At the same time, possible errors of
refraction and accommodation should always be accounted
for.

. Constipation is the bane of old age. We must not expect
to cure it. But we mend matters by looking carefully after
the teeth, removing septic material and replacing by art
that which is denied by nature. If appropriate exercise be
impossible, an attendant may work the knees up and down.
Then, whilst an attendant holds the ankles, the patient
should be requested to rise without the use of the arms —
counting the while to prevent rupture.

For colic of the aged, especially for the nocturnal form
associated with constipation, I have found plumbum metalli-
cum in the third trituration of signal service.

182 HABITUAIi COK8TIPATIOK.

There is a form of senile constipation, first described, I
believe, by Arbuthnot Lane, of Guy's, the author of some
admirable observations on the modifications of bony tissue
produced by age and occupation.

Old men sit much more than the young and they usually
sit in a particular way. The body is pitched forward, whilst
the hands grasp the arms of the chair. Owing to this*
peculiar posture, and to the natural senile atrophy of the
soft parts which surround the ischia, there is a progressively
increasing pressure on the coccygeal tip, which slowly curls
towards the front of the sacrum. I have met with this con-
dition when the tilted coccyx blocked the advancing fsecal
mass, acting just as a moraine does on the travelling glacier.
I have been able to mend matters by gently, yet firmly,
pressing the coccyx downwards and backwards.

Costive and corpulent old gentlemen sometimes derive
considerable benefit from dieting. Sugar, starch and alcohol
may be replaced by plentiful fruit and vegetables. They
improve nvith the use of •passive movements, of deep
abdominal eflfleurage, with the employment of de Watteville's
thick wire induction coil applied to the abdomen. The
occasional injection into the sigmoid flexure of a hot solution
of Epsom salts, by means of a long tube, sometimes brings
away a vast accumulation of scybala.

Constipation in Wovien,

Costiveness in girls, residing at a boarding school or
engaged in a factory, often arises from inadequate provision
of time and accommodation. Dr. Arthur Clifton, who has
had a large experience in such cases, tells me that he can
quite endorse the observations of Sir Andrew Clark in the
relation that coprostasis may bear to chlorosis. If anaemia
may arise from constipation by autotoxis, then neglect of a
regular relief is not quite such a venial oiBfence as some of
our veterans would have us believe.

It is certainly monstrous that a large boarding school
should depend on a single water closet, a few minutes only
being allowed for its use by the entire community. There is
a detestable custom in some schools, that if a girl ask to

HABITUAL GONBTIFATION. 133

leave the room for a relief of nature, she receives forsooth a
bad mark !

Spinal corvatore may lead to constipation as we all
know. I am not sure whether it is as well recognized that a
costive habit may lead to spinal curvature. On this import
tant point I will refer you to my authority — Mr. Warrington
Haward.

Mr. Warrington Haward, in an excellent article, on
"** Surgical Aspects of Constipation,*' in the Lancet for April
28th, 1888, gives the following case, with some remarks
which may interest you: "A young lady of nineteen was
brought to me on account of a lateral curvature of the spine.
There was a slight curve, the convexity in the lumbar region
being to the left.^ . The patient complained much of a dull
pain in the loins, especially on the left side. She stooped a
good deal, and was very easily fatigued. She was, moreover,
extremely thin and anaemic, had but little appetite, a coated
tongue, foul breath, and very cold hands and ieet. An
examination of the abdomen revealed a large faecal accumu-
lation in the sigmoid flexure ; and, on being questioned, she
admitted that the bowels were extremely constipated, often
acting only once a week. This is one case out of a series of
the same kind which have come under my notice. In them,
a supposed lateral curvature is merely the habitual position
assumed by young girls suffering from obstinate constipation
and loaded sigmoid flexm'e. Such cases," Mr. Haward goes
on to say, " are best treated by massagie, feeding and
aperients, under which the anaemia disappears, the bowels
recover their power, appetite is regained, flesh is made, and
the yielding of the spine comes to an end."

Constipation, alternating with lientery, should suggest
defective teeth.

Constipation, varied by mucous diarrhoea, may arise from
a vast number of causes, prominent amongst these being
retrorse uterine dislocation. It is a mistake to view piles as
constituting a proof of backward displacement of the womb.
They are much more suggestive of cervical hyperplasia. A

* This is probably a misprint for right. A loaded left abdomen would lead
to flexion towards the affected side. So would pain in left erector spinse.

134 HABITUAL CONSTIPATION.

very hot hazeline enema, the more copious the better, at bed-
time, tends both to cure the cause, and to relieve the results,
in both kinds of cases.

Constipation, associated with persistent pain in middle
cutaneous of thigh [a branch of the anterior crural from the
third and fourth lumbar, with connecting filaments to second
lumbar, see Dr. Murray on " Our Mistakes," Lancet^ May 7th,.
1892] , should lead at once to a search for rectal carcinoma.

Possibilities of fistula, fissure, piles, polypus and pocket
should be borne in mind. The existence of a forgotten
pessary shotdd be contemplated, whilst such foreign bodies
in the vagina as a cork, a stick or a jam-pot have been known
to explain otherwise inexplicable constipation.

8ea-side constipation may be relieved by iris versicolor
1 or 3x before the meals and aconite low at bed-time.

There is a form of constipation, which I do not remember
to have seen described. It is quite common in cases of old-
established pelvic stasis, and is very cm^able by a mechanical
manoeuvre. It is produced in the following way : Organisable
lymph is slowly poured out in the meshes of the connective-
tissue which surrounds the internal sphincter. This, in
process of time, forms a cylindrical ring, which can be
rolled between the finger and thumb, imparting to the touch
a sensation as if it resembled an umbrella ring of caoutchouc.
Dilatation by means of the two index fingers, after carefully
cleansing the bowel and using cocain, often effects a perma-
nent cure.

I had designed to bring before the Society cases illus-
trating the successful treatment of constipation by isolating
the particular element at fault, and artificially suppljdng the
special need. This, however, time forbids. I will content
myself with a single example.

A delicate lady, aged 40, during two years after spinal
meningitis, lost all power of defaecating. The lost art of
evacuating was completely restored by systematic morning
succussion. The colon was cuffed by the cupped hand. Thia
was effected by the patient herself.

DISCUSSION ON HABITUAL CONSTIPATION. 135

Dr. Clabke doubted whether much practical good was derived
from a too minute analysis of all the nerves brought into play ia
the relief of the bowels. Dr. Lauder Brunton had explained to
the world the action of the nerve-centres when Eve plucked
the apple for Adam. But no good advance was thereby gained
for either science or theology. Most of them had experience of
the successful use of the simillimun, without too careful an
analysis. Aconite had done good without any examination of the
relation between constipation and the general condition of the
patient. Some of the worst cases had yielded to alum and
alumina ; alumina was good when the stools were in hard, small
lumps. The longest case of constipation he had known was a
patient in the hospital who did not defsBcate for three months.
He had heard of a case of a whole year's constipation. It was an
Irish case. Natrum muriaticum was also useful in bad cases in the
sixth decimal dilution. A lady, of an age about the climacteric,
who had suffered from uterine hssmorrhage and had been under
many specialists, had ultimately found reUef from hydrastis.

Dr. Hughes's experience had been similar to Dr. Clarke's.
Dr. Blake's physiological hypotheses were interesting, but some-
what unpractical. But he agreed with his remarks about hygiene.
It was most important to ascertain habits to bring the patient
into a suitable condition. But Dr. Blake should not underrate
remedies. When they had done all that their fellow practitioners
of the old school could do, they had remedies to fall back upon
which acted marvellously ; sulphur, bryonia, nux vomica, opium,
among the old medicines, and hydrastis and collinsonia among
the new. Bryonia 30 had often set a young child's bowels at
work. After doing all that hygiene could suggest, it was
important to find the medicine which best corresponded to the
symptoms.

Dr. Mont thought Dr. Blake had thrown out excellent sug-
gestions. But could they hope, without medicines, to keep the
bowels regular ? They might, of course, resort to enemas. He
had found that medicines could not be relied on to take the part
of nature. There was, not long since, a case of peritonitis in the
hospital. The patient died, and there was found that ulceration
and perforation of the colon had been caused by a mass of
hardened faeces. It was not safe to leave such cases to nature.
The seats in closets were too high. In old people he had found
new masses of muscular tissue formed around the anus, and relief
in such instances was afforded by simple dilatation.

Dr. GOLDSBBOUGH was rather surprised that Dr. Blake did

186 DISCUSSION ON HABITUAL CONSTIPATION.

not mention opium in babies, which he regarded as one of the
leading medicines, especially if there was a tendency to convul-
sions. Nux vomica was also useful in babies, in the sixth or twelfth
dilution. He was also surprised no mention was made of hepar
sulphuris, especially when there was catarrhal jaundice. He had
reported one case in the HomcBopathio Beview. Hepar sulphuris
had produced a marked effect in a bad case of constipation with
jaundice. In chronic cases where there was ballooning of the
rectum, Dr. Drysdale, at one of the Congress meetings, had advo-
cated physiological rest. Mr. Harris had a case of retroflexion
of the uterus with pelvic stasis-^difficult menstruation — obstinate
ballooning of the bowel. She had been under treatment at Guy^s,
and when he saw her she was put into bed and given nothing but
bovril for 35 days. She then had a natural movement of the
bowels. He carefully watched the symptoms from day to day —
noticed the condition of the tongue, the bowels and the temperature.
The patient had another natural movement 9 or 10 days after-
wards. Another case was that of a lady three months pregnant.
The bowel was constipated. The patient was highly neurotic.
She was left alone without evacuation by enema. She got relief
every five or six days, although painful, a large stiff stool over
which she had no control. He could not find a simillimum to
that, though he had looked through the repertories. Plumbum,
coUinsonia, opium, had no effect. The attractive physiologi-
cal reasoning of Dr. Blake was hardly applicable to ordinary
practice.

Dr. Thomas said he had an old lady of 76 who had been
troubled with constipation since she was 20. For the last six
years resort had been had to enemas. She came to him in
October ; he began with sulphur, then opium, then alumina, 3.
She now had an action of the bowels every second or third day.

Dr. Dudgeon observed that when a constipated person was
afflicted by an acute disease — such as bronchitis for example —
which had no direct connexion with the bowels, it had often been
found that the constipation ceased although the medicines were
not directed to its removal.

Dr. BuR^OBD said that he had happened to be for the first
time at a meeting of the Royal Society, the object of which was to
raise a memorial to Owen, when Dr. Flower said that most of
Owen's work was not permanent. Certain anatomical observa-
tions had been controverted by Clarke. Then Johnson Symington
had advanced a third set of views. If in these circumstances
where observations, not theories, were concerned, three different

DIS0UB8I0N ON BABITUAIi CONSTIPATION. 187

yiews could: be held by those eminent men of science, we might
dismiss the question of finality. It had been said that no physio-
logical fact lasted more than three years. But this did not give
much aid with regard to effective treatment of anomalies which
constantly occurred, and could not be explained by physiology.
With Dr. Dudgeon he saw a case of strangulated hernia in which
the use of enemata produced a considerable stool. But after death
there was no doubt of the real condition of things. Of remedies
natrum muriaticum, 6, was among the most valuable. With
regard to absorption from the gut, when he was house surgeon at
Soho Hospital there was a case of cancer of the colon which led
to an enormous accumulation of fsBces. He gave enemata for 20
days. About the middle of the treatment the woman developed
septic pneumonia. There had been for many days absorption from
the gut. This explained the general condition. Young girls some-
times showed all the symptoms of spinal irritation, which were
relieved if they were sent to bed and the bowels relieved two or
three times a week. Massage and electricity are also useful. If
the paper were printed he hoped Dr. Blake would reconsider the
question of remedies, as they all looked upon him as one of the
patres conscripti in the homoeopathic treatment of disease.

Dr. BiBD remarked that one cause of infantile constipation
was constriction of the anus, which nurses removed with a greased
finger. How would homoeopathic remedies affect such condition?

The President approved the hygienic measures which had
been recommended. He had found singing, especially if the girls
were taught to take breath in the modern scientific way, a remedy
for constipation. Dr. Blake's paper was full of matter, and they
would all look forward to seeing it in print.

Dr. Edwabd Blake, in reply, said that he had listened with
great interest to the references to natrum muriaticum, a quite
mvaluable drug, possessing, like most of the salts of alkaline bases,
a strong elective affinity for the endometrium. It is a grand
remedy for profound hydrsemia with constipation, especially if the
mouth be dry and a vesicular rash invade the lip.

It is a fact that patients, with marked pelvic congestion, often
improve as regards their constipation when confined to the bed.
No doubt this is partly mechanical, the heavy and depressed
organs float upwards, the weight of the uterus being taken off the
rectum, the obstruction to the onward passage of the fsecal mass
is removed. Then of course the congestion itself is relieved, be-
cause the syphon-like vessels of the uterus are emptied through
their improved position.

138 DISCUSSION ON HABITUAL CONSTIPATION.

Dr. Blake proceeded to say : — ** I do not believe that the per-
sistent relaxation of the abdominal wall due to maternity is a
mechanical matter. It is a far more deep-seated affair. No
amount of supporting before or of bandaging after delivery will
prevent it. Ptomaine poisoning goes on in many women during
pregnancy aggravated by constipation, for as I have shown they
have not only their own toxines to dispose of, but also those of
the unborn child. Nature makes large provision for this in the
enormous foetal liver, and in glands devoted during this time to
special functions of metabolism, as for example the thymus which,
reaching its maximum development at two years of age, fades
away at puberty.

*' This epoch also doubtless sees the highest activity of the
adrenals. Witness also the enormous development of adenoid
tissue in the naso-pharynx in the case of the young, under the
irritation of inhaled bacteria and their proteid products.

" I have shown that when the functions of the adrenals are
paralysed by purulent products, the pigment changes first described
by Addison are seen.

"When their functions are suspended by arsenic, we see
Cheadle's disease. But the poisons which flow through the
suprarenal capsules affect also the thyroid gland and they then
may give rise to those pigment changes which have been described
by Drummond, West, Carrington, and some continental observers
as * thyroidal bronzing.'

" We see the same pouching of the abdominal wall carried to-
an extreme degree during the course of puerperal fever and in
typhoid. The causation is identical in both. Virulent toxines
have invaded the motor spinal roots, and the patient, if the
disease be not checked, falls a victim to true ascending palsy.
The paralysis attains its lethal point when the poison, reaching
the anterior roots of the fourth cervical, overwhelms the nucleus
of the phrenic.

" A collateral piece of evidence of the truth of the above
statement, is that at the same time that women become pouched or
* pot-bellied,' they also are prone to become flat-footed. This is
not due, as has been thought, to relaxation of the ligaments of the
foot, but in great part to paralysis of the flexor longus poUicis and,
in less degree, to paresis of the flexor brevis digitorum, both of
which muscles derive their nerve supply from the posterior tibial.

" The accuracy of this pathological position is attested by
the clinical fact that flat-foot, a serious item in accentuating the
constipation, by obviating exercise, may be removed by direct

A CASE OF SUPPURATIVE PEBICHONDBinS. 139

stimulation of the two muscles at fault, by means of the combined
current.

**I have not, in my experience, found that the neurotic-
and muscular elements predominate in the constipation of the
very young. Pot belly, nearly normal in babies, does not in
their case arise from defective innervation of the abdominal wall.
We know this from their proneness to colic, which I have shown
to lie in tonic contraction or tetanic cramp of the rectus abdominis.

" Primarily it is the mere anatomical accident of a shallow
pelvis and of undeveloped ilia.

"Their constipations are usually due to arrested glandular
action — ^they call for such remedies as aconite, mercurius^
podophyllum and hepar."

NOTES ON A CASE OF SUPPUEATIVE PEEICHON-
DBITIS, WITH CEDEMA OF THE LAEYNX,.
OCCUEEING DUEING AN ATTACK OF TYPHOID
FEVEE.i

BY MB. LEO BOWSE.
Resident Medical Officer^ London HonKsopathic Hospital.

Mr. Leo Eowse showed a specimen taken from a girl,
aged 14, who was admitted to the hospital under Dr. Black-
ley with typhoid fever. She came in at about the third
week of the disease, during the first week of September.
During the first two weeks of her illness the disease was of
the asthenic type, with a comparatively low and certainly
very irregular temperature. She got much better, and on
the 19tli her temperature became normal for the first time.
It did not remain normal more than a few hours, and went
up in the regular typhoid character till it reached again 104.**
The symptoms then pursued the usual course, but on the
28th there was some slight stridor noticed in her breathing,,
and she complained of having some sore throat. He ex-
amined her throat and found the tonsils slightly enlarged,

^ Bead before the Society, October 6th, 1892.

140 Discussion ON A CASE OF BUPFURATIYE PBBIGHONDBITIS.

and the pharynx just a little injected. She complained,
however, of no pain in swallowing. On the 30th, in the
morning, he was called to see her, and found that she had
a somewhat sudden and great dyspnoea ; this not yielding
to treatment, tracheotomy was performed, as death seemed
imminent. As soon as the operation was finished she
breathed very well and seemed to be doing nicely for a
few hours, but the purulent expectoration simply poured
out of the tracheotomy tube, and she died on the afternoon
-of October 1st, about thirty to thirty-two hours after the
tracheotomy was done, from cardiac failure due, he believed,
to bronchitis. Dr. Moir very kindly made a post-mortem on
the follovnng day, and this was the specimen he produced.

There was a great deal of oedema of the larynx occupjdng
the aryteno-epiglottidean folds to be seen. It showed very
much greater in a fresh state, the larynx being then com-
pletely closed. Another point of interest about it is that
there was evidently an abscess all round the cricoid cartilage,
a suppurative perichondritis, separating the perichondrium
completely from the cricoid.

The President stated that he saw the patient just at the
last — she having been admitted during his absence on his holiday.
It appeared to be a perichondritis akin in its character to the
periostitis which is so common after typhoid fever. The case
was a relapsing one, a fresh crop of spots having come out about
a week before her death.

Dr. Byres Moir said he never before remembered any case of
typhoid where tracheotomy had been necessary. "When he made
the post-mortem the whole of the upper part of the larynx
showed the existence of extensive oedema very plainly, so that
the opening of the glottis must have been quite closed : then in
cutting into the larynx, there was pus surrounding the cartilage,
and it was quite separated. What was peculiar in the case was
that the periostitis, which the President mentioned, was usually
sequela, but this occurred in the active stage of typhoid. — {Patho-
logical Specimen^ October &th, 1892).

EXTBA-UTEltlNE GESTATION. 141

ON A CASE OF EXTEA-UTEEINE GESTATION,
IN WHICH LAPAROTOMY WAS SUCCESS-
EULLY PEEFOBMED TO EEMOVE. A SUP-
PUEATING FOETUS FEOM THE PEEITONEAL.
CAVITY.^

BY GEOBGE BUBFOBD, M.B.
Physician to the Cfynacological Department, London Homosopathic Hospital,

At the present day, when the diagnosis of extra-uterine
gestation has been so carefully elaborated, that in place of
being a rare lesion, it is now detected with surprising fre-
quency, and when the successful operative treatment has also
been correspondingly developed, the narration of a recent
case where the diagnosis was exact and the treatment success-
ful will not be without special interest.

The patient was a married woman, 25 years old, with
a history of one labour some five years back, and a clear
account of regular menstruation from thence up to October,
1891. At this juncture the period suddenly closed, and she
became pregnant. The ordinary course of pregnancy appar-
ently supervened for three or four months, after which the
course of events was constantly interrupted by various
symptoms and crises, detailed later on. She was twice in
hospital for treatment of urgent conditions during the next
few months ; bi;t after ten months of patient waiting the
confinement seemed as far off as ever. She now came under
the care of Surgeon-Captain H. E. Deane, who directs the
hospital for soldiers' wives and children at Aldershot, and by
whom, the condition being detected, I was asked to under-
take the case.

In the history of this remarkable case of extra-uterine-
gestation, the events in the earlier stadium were so marked,
and their import so clear, that it is difficult to exonerate the^
supervisors of that period from failing to recognise the
extreme gravity of the condition. A patient, with a clear
history of four months' pregnancy, presents herself with a
swelling in the flank so painful and tender, that a three-

^ Read before the Society^ October 6th, 1892.

142 EXTBA-UTEBINE GESTATION.

weeks' residence in the hospital is requisite to subdue the
urgency of the symptoms. With the assurance of pregnancy
she is discharged from hospital, and a week later some of the
phenomena of labour set in, in the shape of labour pains,
followed by a discharge, in which is observed pieces of
" flesh " — probably decidual. This discharge lasted for five
days after the pains, attending which was a systemic collapsed
condition continuing for twenty-four hours. She revives
and is able to travel, and in three weeks* time these symptoms
repeat themselves — a sudden sense of violent movement in
the abdomen, a loss of consciousness, v^ith a reappearance of
the discharge, again containing '* fleshy" masses, and this
time lasting three weeks. The first stadium is now com-
plete, and we have here clearly deUneated the history of a
tubal gestation proceeding calmly, as is its wont, toward
the twentieth week. The tube has now become distended
to its fullest capacity ; an attempt is made to discharge the
foetus, in which attempt the tube is ruptured. Simul-
taneously the uterus takes on the function of labour, dis-
charging its contents as partially liquefied decidual masses,
together with the oozing of blood. A prolonged period of
unconsciousness attends this epoch : and gradually the
patient recovers, to have these phenomena repeated in a more
striking form three weeks hence. The extrusion of the
foetus from the tube, probably only partial the first time,
now becomes complete ; it is expelled into the peritoneum,
the uterus finally evacuates the remainder of its contents,
and goes through the process of involution, the completion
of which process is determined at the time of operation.
The extraordinary and striking anomaly, hitherto observ-
able in these crises, is the complete absence of the usual
evidences of intra-peritoneal haemorrhage, a complication so
usual, that in the majority of cases the patient's history goes
no farther, unless immediate operation be resorted to.

The early crises are over, and we have now to deal with
a foetus, detached from its vascular connections, lying as a
foreign body freely among the intestines, and commencing to
undergo retrograde processes.

Let us continue the symptoms through the second or

EXTRA-UTEBINE GESTATION. 143

post-ruptured stadium up to the time of operation. The
patient notices that her abdominal girth becomes less and
less ; a previously existing oedema of the legs now disappears,
and the milk, hitherto running from the breasts, now ceases
to be secreted. A backache, • with a bruised sensation, is
developed and persists, and recurring states of collapse, of
varying gravity and duration, repeatedly manifest them-
selves. Through one of these she was watched by Mr.
Deane, who summarises the events thus : " On the evening
of September 8th, she suddenly complained of a sinking
feeling, and became collapsed, with a feeble pulse ; she
rallied, but experienced the same condition next evening,
though her pulse was not so weak. She was not blanched,
but complained of great pain in the back and left side. The
next day she had regained her usual health." When I state
that exactly such an attack occurred in hospital, after the
administration of an enema, you will see in these citations
the account of recurring crises of shock, due to the presence
of a mobile and detached foreign body of some bulk in the
peritoneal cavity.

The first week in August a menstrual period supervened,
and the occurrence was repeated the first week in September,
lasting about seven days. The pulse and temperature were
never observed to be other than normal ; the appetite was
good, the capacity for sleep unimpaired.

Late in the history of the case the patient came under
the care of Mr. Deane, who, recognising the gravity of the
condition, kindly asked me to see her. We determined the
presence of a foetus free in the peritoneal cavity ; of an
emptied uterus ; and, recounting the history, we had no
difl&culty in unifying the series of events in the patient's
case which had culminated in the condition under observa-
tion.

After the storm now reigned a delusive calm. Here was
a patient of healthy aspect, of excellent appetite, of unim-
paired capacity for sleep, and possessing with it a normal
poise and temperature. There was no sickness, no constipa-
tion, no impairment of digestion. Save for a backache,
which, whilst reclining, was only moderate, and for an

144 DISCUSSION ON EXTBA-UTEBINE GESTATION.

occasional wave of pain and tenderness in the left side, and
for recurring conditions of collapse which were moderate in
their intensity, and not prolonged in their duration, there
were no symptoms indicating that we were dealing with
a present condition of great gravity, and with a patient
literally on the very verge of a catastrophe. That such
might be the case we had reason to expect; that such
actually was the case, operation proved. With a view of
averting any critical development, and with a desire not to
wait until the vital resources had been seriously impaired,
with the concurrence of my colleagues I operated. In the
abscess cavities, on the verge of rupture, into which the
tissues of the scalp and buttocks had developed, we recog-
nised the imminence of that deadly peril which our timely
action had averted. A little time longer, and that foetid
fluid would have been poured into the peritoneal cavity,
and probably one more would have been added to the
list of preventable deaths from which timely operation might
have been all-powerful to save.

Mr. Knox Shaw asked what evidence there was that the
cavity contained pus. He was extremely interested in the case,
but unfortunately was not present when the foetus was opened,
and he could not be sure that the yellowness which they saw was
not due to a condition of mummification or even adipocere. He
observed that the buttock had been opened, and he supposed pus
was found there, but he thought that in drawing attention to the
case it would be interesting to have it clearly stated where the
pus was found. The case was one of immense interest, and it
might be many years before they saw such a case again. It was
a case, as they saw it, in which the difficulty of diagnosis was not
very great — ^whatever it might have been in the earlier stages. It
appeared to him highly probable that in bygone times it would
have been believed that the foetus was germinated in the peri-
toneal cavity itself — ^that it was developed totally ex utero, and
was formed in the sac of the peritoneum itself, and was not
connected either with the broad ligament or the Fallopian tube.

Mr. EowsE, who had examined the foetus, stated that on
incising the buttock he had discovered a mass, exactly such as
one finds in caseous tuberculous disease, that is to say, no liquid

JSWAST UFK ISSCBA2ICB. Irl^

bofc a cbeesr masBy which had been for some time probably
iHATOriiitg - caseatiiBi; such a oooditiaa as was oftm seen ia
cnfafgrailflfos giands.

INFANT UFE INSXTE^ANCE. ^
Bt Fbask H. Sha:w»

SmrffBOH to ths Buduatan, Cottage SnpUal^ SL Lmmards-om^Sm.

I i TA KK no apology for brmgfng before this Society a
aafaject which is in no way connected with the art of healing,
conrad^red either from a medical or surgical aspect, beheviog^
in addressing my follow-members, I am appealing to men
who do not regard the administration of drags or the use
of Hie knife as the '^ be all and end all '' of oar position as
medical men.

I shall endeavonr as £aur as possible to regard my snbjeci
—that of "Infent Life Assurance "^^ — ^firom a medical> or
shall I say from a medical practitioner'^s point of Tiew> for it
is a many-sided sobject, and has a yast social bearing which
eamiot be altogether leffc oat of sight.

It is now five years ago since the Eev. Benjamin Waagh»
the energetic foander and director of the " Society for the
Prevention of Craelty to Children," startled the complacent
and easy-going British pabUc by stating the fact that at
least one thousand helpless little children were annaally done
to death for the sake of the insorance money due to their
mmatoral parents or gaardians, on giving satisfactory proof
to the Insorance Society of sach death.

A statement so appalling, so sweeping, called forth at
once, as was natoral, mach comment and criticism* and*
from those interested in the maintenance of the present
system of Infant Life Assurance, much abuse» But the
more the snbject is investigated, the more light that is

* Bead before the Society, Feb. 2nd, 18d8.
VOL. I. — NO. 2. 10

146 INFANT LIFE INSURANCE.

thrown upon it, the more those who are competent to give
an opinion and to add to the already existing and damning
evidence are questioned, the more painfully evident does it
become that Mr. Waugh has rather under than overstated
the facts of the case.

Here let me at once say, before I appeal to the evidence
that I intend briefly to lay before you, that those of us (and
I am convinced this will include all the members of this
Society, when they have given the subject the due consider-
ation it deserves, many doubtless having already done so),
who are anxious that the law as regards Infant Assurance
as it now stands should be speedily and materially altered,
are thereby bringing no charge against the industrial classes
of this country as a whole. It is only because there exists
in that class, as in every other class, a small but appreci-
able minority destitute of every virtue, destitute of what is
seldom lacking in the brute creation, namely, natural affec-
tion.

It is not a question altogether of depriving the British
workman of his rights. Let us remember it is the in-
dustrial class only that is permitted by law to gamble
with its offspring — the death certificate of an unwanted
<;hild against three, or six, or ten pounds from the Insurance
Societies. The game was long ago recognised as far too
tempting and dangerous for the wealthier portion of the
<;ommunity, and, by an Act passed in the reign of George
III., forbidden. It was the repeal of this law in the reign
of our present Queen, as far as the industrial classes are
concerned, that makes the evil now possible.

If there be a libel at all in the above statement it is a
libel upon the frailty of human nature. To say that ** One
in every thousand of the working classes is not to be
trusted " is not a hbel on the nine hundred and ninety nine.

It is, then, with this appreciable minority of the wage-
earning class — for one in a thousand comes to be an
appreciable minority if you put down the wage-earning
class as ten milhons — we have to consider ; chiefly the very
poorest or most dissolute portion. But for convenience I
will roughly divide them, and place them under the
following heads : —

I

INFANT LIFE INSUBANCE. 147

1. The indifferent.

2. Those parents devoid of natural affection;

3. The deliberate child destroyers.

4. Those who are parents or guardians of illegitimate

children.

1. The indifferent. — Perhaps not such a very large class;

wlio certainly would never become criminal, but for the

temptation held out to them. The balance would probably

be evenly held, but for the accursed gold that is thrown into

one side of the scales by the insurance agent. The methods

of this class to rid themselves of their children are nearly

al^vs^ays passive ; they let things go ; they don't send for the

doctor till too late, for it is the doctor's fee to pay, versus

six pounds to be paid to them, a loss against a gain ; or,

perhaps, they neglect to carry out the doctor's instructions,

or to give the medicine when they have sent for him. If the

<5liild had not assumed a financial value, its life might have

been saved ; it is just this fact which has handicapped it.

2. Those parents without any natural affection, — A sur-
prisingly large portion of the minority, a far more difl&cult
olass to deal with than the first, for their methods are coarser.
The unwanted child is ever standing between them and the
^wanted gold. The methods used to rid themselves of a
nuisance, and to give them the means of satisfying their lusts,
will be more determined and less passive. The children are
starved or improperly fed. They know, as well as we do,
that you may kill a child as effectively by improper food —
•such as an exclusive diet of bread, or biscuits, or by sour milk
— as by withholding nourishment altogether. In fact, they
are far too crafty to adopt the latter course. Medical aid is
never sought until the child is in extremis ; the medicine is
sxrre to be thrown down the sink, and the advice not followed.
The only reason for seeking medical aid at all is that the
^^ papers'^ may be all right. About these papers I shall have
a word to say directly. There is only one other method of
these parents or guardians without natural affection, that I
need mention, it is their unscrupulous use of soothing
syrups and powders. This method has, at least, this to
recommend it, that it is painless and merciful compared
with some of the means used.

148 INFANT LIFE INSUBANCE.

3. The deliberate child destroyers, — I need say but very-
little of these, they belong usually to the most dissolute ani
debased portion of society. The money, to them, would not
be the only inducement to rid themselves of the children, it-
would be only one more added inducement. Their methods
are chiefly poison and wilful exposure of the children, scantily
clad, during cold and inclement weather. And lastly :

4. The parents or guardians (baby-farmers, etc) of ille-
gitimate children,— '^et^een fifty and sixty thousand illegi-
timate, and therefore unwanted, children, are bom in this-
country every year — a population equal to that of a town
like Hastings. Far be it from me to say that many of these
helpless babes do not bring with them the fullest share of
a mother's love, but the fact remains that the majority of
them are a hindrance and a burden to their mothers,,
even before they are born into this world. Is it to be
wondered at, therefore, that these children should figure
largely in the death-roll of those let die, or deliberately killed
for the sake of the insurance money? For the more virtuous
portion of the community adds one more temptation to the
already overburdened souls of these unfortunate mothers, in
the shape of so many pounds, shillings and pence available
upon the death of the child.

Now about those " papers " I alluded to just now, the
Death Certificates, I am sure this question of giving death
certificates will come home to every medical man. It is one
most of us have to face in our dispensary, hospital, and the
poorer portion of our private practice. If I may draw for
a moment from my own personal experience, I can without
any effort call to mind more than one case in which I
have given a certificate tnat in the light of my present
experience I feel convinced I ought to have withheld. In
future I should look with the gravest suspicion upon any
case in which those who brought the child for treatment
(and it is not generally the mothers who bring the child-
ren, they are always said to be ill, or engaged) displayed
anxiety as to *' whether *the papers' would be all right
if anything happens," especially if the child so brought
be in extremis. The difficulty in detecting cases of neglect

INFANT LIFE INSUItANCB. 149

or wilful exposure is always increased when the children are
brought to us at the dispensaries or hospitals and not seen
At their own homes. That my experience is not peculiar, I
judge from the evidence of some of the medical men before
the committee of the House of Lords. To take two examples.

(257) Mr. Branson, M.E.C.P., said " The experience of
every man I have spoken to has borne out the same thing,
namely, the difficulty of giving certificates.*'

(268) Asked if medical men do give many certificates
which they ought not to give. The answer was " Yes, we
do/'

Mr. William Jackson Cleaver, M.B., M.C., of Sheffield,
«aid : —

**It is a very common idea in the profession that there is a good
deal of wilful neglect and child murder connected with insurance.
In years gone by I used to have a great number of very weakly
infants brought to me close upon their death, for whom I used to
give a certificate, not thinking there was anything wrong about
the case. It is only in the last four or five years that I have got
to know that those children had many of them been insured, and
I cannot help thinking that the reason why they have dwindled
away from my hospital is because of the great care I have exer-
cised in the last four or five years in questioning the mothers
before granting death certificates."

I have the report here of several cases in which children
have been poisoned, and deaths from ordinary diseases certi-
fiedy which I have no need to read.

The profession is, I believe, becoming more and more
alive to its responsibility in the matter of giving these certifi-
•cates in doubtful cases ; the knowledge of the evil use that is
made of them, makes us, I trust, all more careful.

And now one word as regards the methods in which the
<5liildren are insured. The old-fashioned custom of the
**firiendly-lead" in which the neighbours met in a public-
house, and the plate was passed round, between the songs
und glasses of beer, to collect the necessary funds to meet
the funeral expenses arising from a death in the home of a
fellow workman, has given way to the apparently more
fieemly efforts of the insurance agencies to meet similar

160 INFANT LIFE INSUBANCE.

emergencies. Eoughly speaking, these agencies may be
divided into two classes : —

(a) The friendly societies and burial clubs, " The Odd-
fellows,'* '* Hearts of Oak,'' &c.

(h). The collecting societies, such as the " Prudential,"
^* Pearl," &c.

The former are usually local and mutual, the latter purely
trading companies. I should like to emphasize this distinc-
tion, because in suggesting remedies to meet the evils of
infant life assurance it will be necessary to refer more par-^
ticularly to these distinctions.

I must tax' your patience for a few minutes, whilst I read
to you evidence given by experts, if I may call them so, be-
fore th(5 committee of the House of Lords, with its able
chairman, the late Archbishop of York, better known perhaps
as the Bishop of Peterboro*. The men called before that
committee cannot be accused of being mere enthusiastic sen-
timentalists. Parish doctors, or those attached to large
dispensaries and hospitals, are not usually led away by their
feelings. Coroners are not given to over-statements, and the
highest judges of the land are accustomed to weigh both their
statements and the evidence brought before them. Yet they
combine unhesitatingly in their condemnation of the present
system of infant life insurance, with one exception, and he
a coroner. This is what some of our medical men have to
say on the subject, and I quote their evidence as arranged for
one of the supplements of the " Children's Guardian."

Mr. Algebnon Hodson, L.E.C.P., M.E.G.S., of Brighton :

** I have formed a very strong opinion as to the connection be-
tween murder or * the putting away ' of children and insurance..
It is impossible, under the present state of the law, to bring home
this crime of wilful neglect and child murder to the parent. I
have in many cases been perfectly satisfied that a child has been
literally murdered, for I can call it nothing else. At the General
Hospital at Hove, Brighton, we have a very large number of cases
of marasmus, which is a wasting disease, in which we are perfectly
satisfied that the children are simply starved for the sake of the
insurance money."

INFANT LEFB INSURANCE. 151

Mr. John Bransom, M.E.C.S., M.E.C.P.Edin., L.S.A.Lond.,

of Eotherham:

"The general effect of infant insurance amongst the improvident
classes of the poor is to make them careless as to the treatment
of their children. It has generally demoralised them; their
natural care has been lessened by the inducement to neglect
which insurance holds out to them. It is only the flagrant cases
we can lay hold of ; nothing is more easy than to kill a child, but
nothing is more difficult than to detect the crime. When they
wilfully mean to compass the death of the child, as I know they
do in many cases, they can time it so as to kill it in a few days.
They become perfectly wooden and indifferent to the prospect of
the child's death. The thought which is constantly before their
minds is, * If the child dies I shall get so much money.' "

Mr. Heney Bueby Pullen-Bueey, L.E.C.P., M.E.C.S.,of

Liphook, Hants :

*' My opinion is strongly against the system of infant insurance.
Frequently I have been called to cases of moribund insured
children; they were dead within a few hours. They were all
cases in which a certain amount of medical attention would pro-
bably have pulled the child through. I was called in just in time
for them to get a certificate of death, and for nothing else. I do
not believe the law knows anything about these cases, or gets hold
of 6 per cent, of them. It is my distinct opinion that the insur-
ance money is an inducement to bad parents either to do away
with the child or to criminally neglect it."

Mr. John James Eitchie, M.E.C.S., L.E.C.P., Medical

Ofl&cer of Health of Leek :

*' My experience as medical officer of health confirms the view
that child-life assurance as at present carried on is unfavourable
to child life. The history of our experience at Leek may be
interesting and useful. There has been a burial society here for
upwards of thirty years, which has been well worked and proved
of great service to the inhabitants. For certain reasons the direc-
tors saw fit in the year 1876 to discontinue the insurance of lives
of infants under one year. At that time the infant mortality was
156 to 1,000 born, a little over that of England generally. In the
following year the mortality dropped to 109 — ^the lowest point
ever reached. As soon as the local society declined this class of
business, the branches of several large insurance offices took it up,
and vigorously canvassed for the same, and in the year 1878 the

162 INFANT LIFE INSURANCE.

mortality rose to 170 ; the average for the last seven years has
been 170, and during the year just closed it reached 186, while
that for the whole of England and Wales was 147.**

Mr. Fredk. Dunn, M.E.C.S., of Wolverhampton :

" When I held the appointment of Union Medical Officer, I
was struck with the frequency with which children suffering from
diseases of an asthenic type, such as atrophy, tabes, diarrhoea,
convulsions, etc., were brought to the dispensary at the last
moment, mainly with the object of obtaining *the certificate,'
such children being almost invariably insured. In reply to my
question : Why has not this child been brought to the doctor
sooner ? the general answer was : It has always been a delicate
child, but has got worse the last day or two. The truth of this
statement I had no means of verifying, but I noticed that
generally after one or two visits at the most the mother came
for the certificate. This I could not well withhold, having nothing
to go upon. I feel morally convinced that the child had been
allowed to 'go out,' or, at least, to become so ill as just only to
allow of its being rushed up to the doctor at the last moment
to cover themselves."

Mr. Sidney Babwise, M.B.Lond., M.E.C.S., of Blackburn:

" Child-life insurance is certainly,with the lowest class, an in-
ducement to neglect children. My practice has been entirely
with the pauper class. Outdoor paupers insure their children
in large numbers, and in my opinion the sum of £2 or £3 is
sufficient to upset the balance of motive in bad parents."

Mr. G. S. Eedmond, L.E.G.S., Gateshead, formerly Medical

Eesident Officer of Dispensary :

*' Over and over have I been called to cases too late to do any
good, but where it was only too apparent that a doctor was
sent for, not in the hope of rescuing the child from death, but of
saving the parents from punishment — their only anxiety being
evinced by the hackneyed inquiry, * If anything happens to it, I
suppose you will give me a certificate, doctor?' In many of
such cases I find the infants' lives insured."

Mr. W. Carey Jeffebies, L.E.C.P.Edin., of Brighton :

*' The fact that at last steps seem about to be taken to inquire
into the practice of insuring the hves of young children cannot
but bring a sense of relief and satisfaction to the minds of all

INFANT LIFE INSUBANCE. 163

medical men who have, in the out-patient department of the
hospital or in general practice, been brought in contact with a

large number of the children of the poor It is not

easy to define the reasons that excite the medical man's sus-
picions. It may be that he is struck with the fact that the child
might perhaps have been brought for treatment a little sooner ;
that a rather long interval takes place before it is brought again ;
or that there is always a full bottle of milk or other food near it
somewhere when his visit is expected. A second and generally
older woman than the mother is almost invariably present, who
asks questions and volunteers statements as to the child having
* screaming convulsions,' 'Can't keep its food,' etc., as if to
prepare the practitioner for what will soon happen. Meanwhile
the child wastes away, perhaps gets convulsions, and dies. The
certificate of death and insurance money are obtained, as the
medical attendant cannot say its death was not due to natural
causes, and there it ends."

It will naturally be asked " Why don't you as medical men
send more of your suspicions cases to the coroner? " And
I think the answer is : Experience has taught us that it is
useless to do so in the hope of getting the cases committed to
the assizes, for on suspicion alone they certainly cannot be
<;ominitted. Even when the evidence seems strong and the
coroner commits, it is often found that in the time that must
elapse between the inquest and the assizes the evidence in-
variably gets watered down and weakened. The first out-
burst of indignation on the part of the neighbours is over, and
in all probability they have been " got at *' by the friends of
the accused. But let the coroners speak for themselves.

Mr. John Troutbeck, M.A., B.C.L., Coroner for the City and

Liberty of Westminster:

" The result of my observation is that child life insurance is
prejudicial to child life. The features in cases of insured children
which attracted my attention were that they were badly and in-
sufficiently fed, and exposed to cold and rain, and found suffocated
in bed with their parents. I have found the parents come to the
inquest drunk ; sometimes from the proceeds of the insurance. I
sometimes find that they have told my officer that the child is
not insured, and when they are on oath they admit that the child
is insured. I do not commit for trial. In all these suspicious
cases it is very rare to get a verdict."

154 INFANT LIFE INSURANCE.

Mr. Maurice Frederic Carter, Coroner for the Forest
Division of the County of Gloucester :

** From my twenty- two years' experience as coroner, my opinion
is that the practice of child-life insurance is very prejudicial. It
is my distinct impression and belief that it tends to crime. I
always ask in suspicious cases that come before me if the child
is insured. I think, from my experience, that the familiarity of
the parent's mind with the death of the child being connected
with money has a tendency to deprave the mind of the parent.
I have never sent a suspicious case to the assizes, because I find
jurors will not find 'culpable* neglect ; they always attribute it to
the ignorance of the parents, and acquit where there ought to have
been a committal and trial."

Dr. George Thompson, Coroner of Oldham :

" As a coroner and medical man, I hold the opinion that child-
life insurance has a decidedly prejudicial effect. Children on
which I have held inquests in most cases were insured. I beheve
that in those cases infant insurance tends to the neglect and
death of the insured. In three years there would be about 150
cases, where the child was buried without investigation, that
ought to have been inquired into. I have not in many cases sent
for trial at the assizes, because it is almost impossible to get
evidence that people could be convicted upon. Insurance agents
never give me any help. I have never been told of a suspicious
case by one."

Very briefly as to the remedies to meet the above-stated
evils. First and foremost the total abolition of insurance
for all infants till they are two years old ; for pathologists
tell us it is more difficult, nay, almost impossible, in the
earlier stages of infant life to distinguish between starvation
and mal-nutrition due to disease or improper feeding on
the part of ignorant mothers.

And, further, greater encouragement and facilities should
be given to friendly and burial societies ; these are usually
local and mutual, the members are known to each other,
which naturally has a beneficial and controlling effect over
their actions : also, these societies often provide for sickness
as well as death, a most important point.

Again, a far more strict supervision should be kept over
the purely commercial insurance companies (the collecting

INFANT LIFE INSUBANCE. 155"

societies). Pestering and touting by their agents should be
altogether forbidden. The maximum sum for which a child
is insurable should be reduced to the same as the sum for
^wliich children are insurable in societies conducted by work-
ing men themselves. This, practically, from the Chief
Registrar's returns, is about a fourth of the sum insurable
in these collecting societies.

We, as medical men, may do much without waiting
for any Act of Parliament, by exercising greater care in
the giving of death certificates in all cases in which we
have any suspicion that the children have not had fair
play. In spite of what I said just now about the difficulties
of the evidence at inquests, send all doubtful cases with a
note to the coroner. This will insure, at least, some in-
vestigation on the part of the police, which may act as a
warning to other careless parents, and should you have in
your neighbourhood an Inspector of the Society for the
Prevention of Cruelty to Children, it would be well to com-
municate your suspicions to him also.

I cannot believe that with a full knowledge of the dangers
and evils attending infant life assurance, in spite of the fact
that a Bill has already been brought before Parhament and
failed to become law, means cannot be devised which shall,
v^hilst enabhng the working class to provide against sudden
and heavy expenses attendant on the death of their children,
also at the same time safeguard children of the minority
against their unnatural parents, who may scarcely be
called working classes.

In proportion as we have stood by the working classes
when we have thought they have been oppressed, so should
we have the courage to say them nay when they lay claim
to that which we believe it is to their best interest they
should forego.

Hio one is more aware of the very inadequate way in
which I have dealt with my subject than I am myself, but I
shall be content if I have aroused a greater interest in a
suhject in which we, as medical men, should take a special
interest, and in which I think we may lay claim to have a
large share of influence for good or for evil.

156 DISCUSSION ON INFANT LIFE INSUKANCE.

Dr. Mom said he was afraid that he had not been so vigilant
as he ought to have been. He had always assumed that much
of the marasmus he had discovered was due to the ignorance of
parents, and possibly not wilful neglect on their part. A child of
18 months old was brought to him last Tuesday. He was told,
in good faith, that the child had been fed on raw onions. They
•ought to get information from the neighbours in such cases.

Dr. GoLDSBBOUGH Said the question came home to him as he
had a great deal to do with people of this class. There was a
great deal of neglect, not wilful, on the part of mothers. Much
harm was done by the abominable system of insurance agents
calling at the houses of the poor. He had known men, who could
earn nothing in any other way, turn to insurance canvassing.
They got each new baby insured. The remedy lay in the extir-
pation of this system. Some children were not insured until
they were ill. Then the temptation began. The mother some-
times resisted. The agent did not take the trouble to inquire.
He had known the Insurance Company refuse to pay because the
child had been ill longer than insured. The mother blamed the
agent, but the Company did not blame the agent. He had made
a practice of telling people he should not certify should the child
die. He was afraid that coroner's officers were too often open to
metallic persuasion, and on being so persuaded they were ready
to say a child had died from natural causes. To deal with the
> cases satisfactorily, one must be either a medical officer of health
or a district, officer, so as to be able to get at the coroner himself,
instead of through his officer.

Dr. Bryant, of San Francisco, said that he had not been in
practice at home. But he was under the impression that child
insurance was not allowed in America.

Dr. Blageley said that in times gone by he was afraid he had
not been sufficiently wide awake either in the Hospital or in
private practice. When mothers were admonished for not hav-
ing done all they ought to have done, they were apt to say it
was the Lord's will. Mr. Shaw had struck a suggestive chord
in bringing the subject before them. If they could not secure
concerted action, they might each do something to prevent the
reckless continuance of such abuses. The daily papers were
very severe on doctors in these matters.

Mr. Shaw, in reply, said if all had been as careful as Dr.
Goldsbrough there would have been little need of complaint. He
hoped others would be more careful in the future. He was not

NOTE ON THE PBEPABATION OF APOCYNUM CANNABINUM. 16T

avT^are of the difificulties arising from the coroners' officers. In
the country they had not to do with the constable or the beadle,
but communicated directly with the coroner.

A NOTE ON THE PEEPAEATION OF APOCYNUM

CANNABINUM.i

BY EDMUND ALLETNE COOK, L.R.C.P., &C.

The root of this plant may be expected to undergo some-
changes in properties in the drying, similar to those which
certainly take place in the cascara sagrada, willow bark, and
other vegetable products, hence it would be better were the
medicinal preparations made from it in the &esh state. I
a45certained from the curator at the botanic gardens, Kew,.
that the root is grown there without any difi&culty in the open
air, and he kindly sent me a specimen. From the root I
made two preparations, an acetic and a weak spirituous pre-
paration, samples of each of which I presented to Dr. Moir-
for experiment in his wards. It is evident that in making
such preparations it is eminently desirable that as few
operations as possible should be used, and those the least
likely to cause chemical changes. The succus is an ideal
preparation when just sufi&cient of a preservative is added to
it, and any dilution should be mainly with water and without
heat. The above mentioned preparations were made by
adding to the thinly sliced root cold water, allowing to rest
24 hours, and then in the one case J acetic acid B.P., and in
the other sufficient spirit to make a mixture of spirit and
water of a gravity of .935 was added ; the exact strength of
spirit being of small moment provided there be enough to keep
the preparation and not enough to precipitate any active
matter. These liquids so prepared have a far more powerful
aroma of the root than any other I have seen, and so far as.
I have tried them are very active.

' Specimens presented to the Society, January 5th, 1893.

158 ANCHYLOSTOMUM DUODENALE.

ANCHYLOSTOMUM DUODENALE.^

BY DUDLEY WRIGHT, M.R.C.S.

Surgeon for DUfioses of the Throat and Assistant- Surgeon to the London

Homceqpathic Hospital,

The parasitic Nematode, Anchyhstomum Duodenale vel
DochmiuSf is the cause of a peculiarly progressive form of
anaemia, which is seen almost exclusively in hot countries,
more particularly in Egypt, India, and Brazil. In these
various localities, the disease is known under different
names, e.g., Egyptian, chlorosis; in India, Kala Azar; and,
in Ceylon, Beri-Beri. In Switzerland it gave rise to the
death of more than 100 of the workmen employed in the
St. Gothard Tunnel.

The parasite is a small round worm, with a stiff body and
s, head bent at right angles, which is provided with a round
mouth and three sharp teeth.

The female measures about half an inch in length, and
the male — which is more slender, and is distinguished by the
corolla-like expansion of the caudal extremity, from which
a double whip-like peni^ projects — is about half as long
again.

The female is extremely prolific, and discharges ova about
Tfijs inch in length, which, when passed from the bowel, do
not contain a manifest embryo.

The worms attach themselves firmly to the mucous
membrane of the duodenum and upper part of the jejunum.
They wound deeply, and suck the blood therefrom, caus-
ing sub-mucous ecchymoses, and, occasionally, haemorrhage
into the lumen of the bowel.

The symptoms caused are mainly those of anaemia, with
general debility and dropsy.

The parasites now shown were sent to me from Assam,
and were passed by a prisoner in the Ganhati Gaol.

The treatment out there consists, I believe, in adminis-
ttsring large doses of the extract of male fern.

The life history is said to be as follows : — The ova, on

^ ^Microscopical Specimen : Clinical Evening, March 2nd, 1803.

i^

j^<,/J5^, uu i/'-duc.-.

ANCHYLOSTOMUM DUODENALE. 159

being passed, gain access to mud or water, and in that
medium they produce slender worms which exhibit active
movements.* These require no intermediate host, but de-
velop into sexually mature animals when they reach the
human alimentary canal;

DESCEIPTION OF PLATE.

The figures are taken from some plates in a report on Kdla-
Azdr and Beri-Beri by Dr. Giles, Surgeon I.M.S., on diity in
Assam.

Fig. I. — Mature male rhabditis of Dochmius Duodenalis
viewed laterally.

M. Mouth.
• b^ Anterior bulb.
G. Central Ganglion.
b^. Posterior bulb.
H. Hepatic cells.
L. Lemniscus.
T. Testis,
i. Intestine.
S. Copulatory Spicule.
B. Copulatory Bursa.
Fig. II. — Shows the changes in the gastro-intestinal mucous
membrane.

" A portion of a vertical section of the upper part of the ileum
from a case of Anchylostomiasis, showing the space between two
villi filled up with blood clot, in which is embedded an immature
Dochmius (the worm is cut twice by the section, so that two
sections are seen). At the highest part of the blood clot may be
seen a deep erosion of the mucous membrane.**

160 FATAL CASE OF PEBFOBATIKG UIiCEB OF THE STOMACH.

A FATAL CASE OF PEEFOEATING ULCEE OF

THE STOMACH.

BY GEEARD SMITH, M.R.C.S.^

A GIRL aged 19, who died seven months after a severe
haematemesis, from which she had apparently completely
recovered (as she had resumed her work as a governess, and
had taken an active part in games), having one day eaten
something that caused vomiting, fell back during the attack
with an extremely severe pain in the stomach. She developed
symptoms of peritonitis, but not rapidly, and there was no
condition of collapse ; there was very rapid and remarkable
distension of the abdomen, with continued vomiting, but no
sjrmptoms of intestinal flatulence, except the distension ; as
the distension increased, the tenderness became less, until
there was little pain on pressure, unless very deep. There
was no haematemesis, and no action of the bowels nor
escape of flatus by mouth or anus ; the patient was evidently
sinking : an eminent surgeon made a diagnosis of volvulus,
without peritonitis, and advised immediate laparotomy, re-
marking specially the absence of tenderness on pressure.
Mr. Gerard Smith submitted to his judgment, but subse-
quently withdrew from the operation, feeling sure from the
history and symptoms of the case that there had been a per-
foration of the stomach, setting up peritonitis, notwithstand-
ing that there was little pain on pressure (the temperature
was steadily rising, and pulse getting wiry and rapid ; tem-
perature, 102' ; pulse, 120), and notwithstanding that there
was no haematemesis.

The operation was performed ; at the first opening of the
peritoneum there was a free escape of gas without faecal
odour ; the intestines were seen to be quite flaccid and
empty, far back in the abdomen ; there was abundant peri-
tonitis, and no twist or obstruction of the gut.

Death took place 20 hours afterwards, and the post-
mortem specimen now exhibited showed a very large old

* Pathological Specimen : Clinical Evening, March 2nd, 1893.

A CASE OF ABDOMINAL TUMOUB. 161

ulcer, as large as a five-shilling piece, firmly attached to the
pancreas, and completely perforated over its whole area ;.
this was intact, and had been in no way responsible for the
fatal illness, but there was another smaller perforating ulcer^
which had been as firmly attached to the under surface of the
liver. The edge of this had been recently torn off fi:om its
abnormal attachment ; being on the upper border of the
pylorus, the escape of stomach contents (except gas) had
been. slow, hence the collapse was not rapid; no doubt, the
attack of sickness had been the cause of the tearing away of
the attached edge of the ulcer.

The failure of the diagnosis, on account of the presence
of a deep layer of gas- between the intestines and the ab-^
dominal wall, is a warning ; and the fact that the girl had
recovered health and been able to take part in work and
games — ^lawn tennis, &c. — with 'so large an ulceration of the
stomach, perforated, but previously attached to subjacent
structures, seems very unusual and unexpected.

A CASE OF ABDOMINAL TUMOUE, PEOBABLY
MALIGNANT, AND ASSOCIATED WITH THE
EIGHT KIDNEY OE ITS BELATED STEUC-
TUEES.^

BY GILES F. GOLDSBROUGH, M.D.

A.S., man, 39, jobbing builder. Always sober and tem-
perate. No history of syphiUs. Had scarlatina with a
consequent nephritis and dropsy at six years of age. Eheu-
matism from getting wet at eighteen, otherwise he had been
quite well until the summer of 1890, when he accidentally-
fell twice during his work (June and July). No apparent
injury resulted until August when, after lifting a heavy
weight, he passed some bright blood in his urine. He did.

» Clinical EvenlDg, March 2nd, 1893.
VOL. I. — ^NO. 2. 11

162 A CASE OF ABDOMINAL TUMOUR.

not lay up, but consulted his doctor (allopathic), and was
under treatment until October, when he came under my care.
The hsematuria had become worse ; it was intermittent in
character, always bright red, and usually clotted, so that he
often suffered considerable pain in voiding urine. The
attacks would last several days, gradually subsiding, then
recurring again in a few days. "When the man came to me
he was very anaemic, and weak. I have no note of his tem-
perature at the time. He was under treatment for one or two
months without success, the medicines administered being
belL, ham,, am,, millefol, I then put him on a course of
china 1 and secale 6 alternately, which seemed soon to check
the quantity of blood, and the attacks became less frequent,
but they did not finally cease until about a year after his
coming under treatment, and he continued the medicines for
a month or two longer. His health gradually improved ;
he had been laid up for a week or so at a time, and did
odd jobs in the interval. I had not seen him from about
December, 1891, until the 9th of last month. He had not
felt well since his previous illness, and had not been able to
take continuous work. Was always languid and sleepy after
meals. Six months ago he commenced retching in the
morning, and subsequently had vomiting of frothy green
mucus ; also nausea on beginning to eat, aggravated by going
to the fire, or on stooping. A poor appetite, constipation,
and fulness of the abdomen, are other symptoms he has grad-
ually come to complain of. On stretching out in bed he has
been seized with cramp in the calf of the left leg.

Family History, — Father living in fair health, of a very
phlegmatic temperament. Mother died at 43 from consump-
tion (patient aged 12 at the time). Two brothers and one
sister died in infancy. One brother died at eight years from
marasmus, following a succession of abcesses, and one at 16
from epilepsy. An uncle on the mother's side died of soften-
ing of the brain, an aunt still lives in good health. A half-
sister of the patient I attended at 11 years of age for excessive
metrorrhagia, she is now about 20 years of age in good health.
There is no history of tumour or cancer in the family.

Present condition, — Height 5ft. 2in.; weight 7st.; pale

A CASE OF ABDOMINAL TUMOUR. 163

face, rather cachectic and anaemic. Eeddish sandy hair and
beard, stooping gait, teeth carious, tongue red and fissured.
Lungs normal. Heart normal, except that first sound at the
apex gives a sharp click. Pulse 78 in the morning, regular ;
90 in the evening. Abdomen on inspection is very full,
especially to the right of the umbilicus, and this prominence
•comes much more into view on stretching the body at full
length with the arms above the head. On palpation a hard,
slightly elastic, non-fluctuating, somewhat irregular tumour
is felt, growing, as it were, from behind forwards. It is
most prominent about midway between the umbilicus and
the edge of the abdomen, shading off shghtly to the left of
the former region with increasing hardness to the right.
The growth seems disconnected from the Uver, and extends
-downwards to within two or three inches of the iliac region.
Percussion gives the liver- dulness normal above; and a nar-
jow space towards the middle line between the liver and the
tumour below is clear. Also on the right side of the tumour
there is a small space clear above the crest of the ilium.
Complete dulness is noticed over the defined regions of the
tumour. There is no pain in the tumour, nor tenderness on
pressure, although the patient has complained lately of
feeling his clothes rather uncomfortable.

The temperature is normal in the morning, and rises to
lOO** F. in the evening. This has been tested on several
occasions. Urine normal ; specific gravity 1018 ; free from
albumen. The gastric symptoms complained of on Feb.
9th have disappeared under ars, and mere. He is now
taking hydrastinin 2x ; (gr. ii. bis die were ordered on Feb.
13th, and gr. v. on 27th).

Mr. Knox Shaw has seen this patient, and he will hence-
forth be placed under his care in the hospital.

Dr. Dyce Bbown could not quite agree with Dr. Goldsbrough
as to the non-fluctuating character of the tumour. His opinion
was that there was distinct fluctuation. He thought that there
were one or more cysts containing fluid, and that they were
evidently connected with the kidney.

Mr. Knox Shaw thought they might congratulate themselves

164 A CASE OF ABDOMINAL TUMOUB.

upon the interesting cases which the members had brought for*
ward. Not the least interesting of an interesting series of cases
was that of Dr. Goldsbrough. With respect to diagnosis he was
inclined to agree with Dr. Dyce Brown that there might be a
cyst, but sarcomata often gave a sense of fluctuation. The case
was clearly that of the kidney. There was a previous history of
hsematuria. In differentiating they had to consider whether it
might not have been caused by a calculus. The ureter becoming
entirely blocked, the hsematuria ceased. Thus there might be-
either hydronephrosis or cystic degeneration of the kidney. If
anything surgical had to be done it would have to be by an abdo-
minal excision. It would be impossible to remove the growth
through a lumbar incision. The operation would be a grave
one, and the result of the removal of a kidney for sarcoma was
generally such. The prognosis depended to a great extent upon
the diagnosis. If it was simply a cyst, it was not so grave. In
any case anxious thought would be required, for in all opera-
tions on the kidney care must be taken to enquire into the con-
dition of the other kidney, lest there should be suppression of
urine.

Mr. Gerard Smith said there was a cystic feel about it. If
it had been a woman he should have thought it was papilloma.

Dr. Blackley had examined the case, and although he-
thought there was a feeling of fluid, he was more inclined to
think it was a malignant growth. There might be a small cyst,,
but the rapidity of the growth was in favour of its being
malignant. The rest of the tumour was wonderfully solid. He
agreed with Mr. Knox Shaw that it would be impossible to*
remove it by a lumbar operation.

Abscess of the Abdominal Wall : a Sequela of TyphoiD'
Fever. — ^Dr. John Hayward, at the January Meeting of the
Liverpool Branch of the Society, drew attention to a case in the
Hahnemann Hospital, in which an abscess had formed just below
and a little to the right of the umbilicus, during convalescence:
from an attack of typhoid fever. He thought that the condition
bore some relationship to the necrosis occurring after typhoid : a.
sequela to which he claimed to have been the first to draw atten*
tion.

THE IDEAL TBEATMENT OF UBETHRITIS. 165

THE IDEAL TEEATMENT OF UEETHEITIS IN

THE MALE.i

BY EDWARD BLAKE, M.D.

Those who have been at the pains to keep themselves
at all au courant with recent continental views 9.S to
Gonorrhoea will admit that the mildest attack is not to be
lightly viewed.

Those again who have seen much of its treatment, will
scarcely be prepared to deny that at its very best it leaves
ranch to be desired.

That owing to a number of causes a really scientific
treatment cannot always be carried out in civil life is quite
true, but it may be remembered that when we have urged
a right course and it is not carried out, our responsibihty is
lightened, and the probability of subsequent reproach is
lessened.

I wish it to 'be understood that I attach enormous im-
portance to the internal use of appropriate drugs; but to
name them to my present audience would be a formality.

1. Perfect rest in the recumbent posture.

2. Abstinence from all alcoholic drinks and from meat
diet.

3. Success is so largely a matter of good drainage, that
if the meatus be congenitally small or artificially contracted
by old hypertrophic urethritis, it should be freely enlarged.

4. The canal having been rendered aseptic, the patient is
put under the influence of cocaine or of ether, and the
meatus boldly slit on one side of the mesial line down to
the root of the firaenum, and, if stricture be present, a series
of sterilized metalUc bougies are passed into the bladder.
The slitting may be done by means of the galvano-cautery,
or vdth Eeginald Harrison's most convenient probe-pointed
triangular knife, devised for this purpose. At the same time,
if the frsBnum be broad, it should be snipped through to pre-
vent pocketing, as pockets are apt to form nests of infection.

> Clinical Evening, March 2nd, 1893.

166 THE IDEAL TREATMENT OF UBETHBITIS.

No upward cutting is needed, nor are any sutures neces-
sary.

The- wound is kept open, and bleeding is arrested by
means of a pledget of lint dipped in hazeline, or with
Ehrle's styptic wool.

5. Make a careful search for intra-urethral chancre, and
dress it frequently with iodized phenol.

6. Till the acute purulent stage be passed, keep the peni&
immersed in some simple germicide solution. A mixture of
boric acid and borax answers very well.

7. Under all ordinary circumstances avoid direct in-
jections ; they are a fruitful source of deep-seated stricture,,
and are most pernicious.

Use a reflux syringe, such as Eeginald Harrison'&
Irrigator, introduce it very slowly indeed, and in a rotatory
fashion, the liquid running all the time to avoid carrying
pus back ; it should pass well behind the inmost point of
tenderness.

8. Differing cases require different solutions; Ichthyol
can be highly recommended, strength twenty grains to one
ounce of distilled water.

9. Never use any organic material in the form of a^
bougie or catheter when metal can be employed.

10. Never pass anything into the urethra without steri-
lizing both the tube and the instrument.

11. In using a strong solution of cocaine, prepare the
patient by giving two or three grains of quinine, as severe
fainting has followed the employment of solutions above
10%; with this precaution I have used cent, per cent,
solution.

12. All gleets call for patient scrutiny, under electric
illumination, with air ballooning.

13. Morning agglutination, shuddering during micturition,,
and the presence of mucous shreds or " pennons '* in the
urine, suggest granulating surfaces on the urethral mucosa.

14. Bear in mind the possibility of wart or polypus, the
latter very rare : also of congenital diaphragm ; the last,
however, is a pathological curiosity.

15. Sterilize the urine from within.

IKREGULAB ACTION OF THE HEABT. 167

By way of prevention, when circumcising the young, slit
down the meatus freely, for it is probably more important
to do this than to remove the foreskin.

According to one of our transatlantic brethren. Dr.
Wilhamson, stenotic meatus is usually present in mastm^-
bators.

CONTINUOUS lEEEGULAE ACTION OF THE
HEART, IN A LABOUEEE, AGED 42/^

BY BYEES MOIE, M.D.
Physician to the London Homo&opathic Hospital.

W. G., labourer, age 42. Admitted 8th February, 1893.
Complains of shortness of breath on exertion and tendency
to faintness.

No pre^aous illness except syphilis, 1872. Family history

good.

Present illness began twelve months ago by slight
attacks of faintness ; they did not last long and he took no
notice of them till three months ago. One night, about
three months ago, he was awakened in the night by an attack
of coughing which lasted for some time and left him in a
heavy sweat and very faint ; after this, the fainting attacks
got more frequent and more severe, though he never lost
consciousness. The cough also became worse. He also
now felt pain in the left side, going through to shoulder-
blade and up to the shoulder.

States that he has lost three stone in weight since the
beginning of the illness.

Physical signs. — Chest shape good, expansion good.

Percussion, — Eight side normal. Left side, comparative
dulness between first and third ribs, then resonant to cardiac
dulness.

^ Clinical evening, March 2nd, 1893.

lbs IKREGULAIi ACTION OF THE HEABT.

Breath sounds normal ; no adventitious Bounde.

Cardiac. — No increased dulness. Apex normal in
position ; at apex the sounds are confused, first sound
always reduplicated, second sound occasionally. Nothing
heard at base (beyond the reduplication), not in carotids, nor
subclnTians. No bruits.

The pulse beat is quite irregular, both in force and
rhythm ; difficult to count, but about 120 a minute. The
sphygmographic tracing shows considerable irregularity, a
distinct beat being followed by either one or two incomplete

D the 2iid of Klarch, four 01

There is no complaint about swallowing, or any laryngeal
trouble, anS except for the faintness, the patient says he
feels quite well.

Dr. Gould suggested that smoking might be the cause of the
irregular action. The maa smoked two ounces of shag a day.
He himself had been obliged to give up smoking twenty years ago
for the same cause.

Dr. Dudgeon said this case was similar to several which he

DISCUSSION ON IKREGULAR ACTION OF THE HEART. 169

exhibited on one occasion. The main interest was the long con-
tinuance of the irregular action. The pulse varied very much in
character. There was sometimes more, sometimes less, stammer-
ing. He had no doubt, although the case had lasted a long time
and though there was considerable weakness and emaciation, there
was no element of heart disease. He had not the slightest doubt
that, within a reasonable time, the patient might recover. But
sometimes these cases did not right themselves. Cases went on
in this tumultuous manner until death came rather suddenly.
Some serious disease might be expected to accompany these
symptoms. The chances were, however, that some day he might
recover. Even after five years he had known a heart suddenly
recover itself.

Dr. Blackley admitted that tobacco might have some effect
upon such a heart. He had had two or three cases within the
last two or three years, both of which Dr. Dudgeon had seen with
him. In one case — a man of seventy — the patient was a non-
smoker ; in the other case, tobacco was an element. Both lasted
a good while ; but both patients died within the twelve months,
and did not appear amenable to treatment. All the recognised
cardiac tonics were tried; strophanthus, digitalis and cactina
'• pillets."

Dr. MoiR said : This case comes under those Which Dr. Dudgeon
brought to our notice lately, viz., " Stammering Heart," and Dr.
Ernest Sansom has also just read a paper on the same subject.
The latter puts down syphilis as a cause of the irregular action,
and suggests that morbid changes, due to syphilis, may cause a
disturbance of the vagus. He could not accept the view that
tobacco was the cause of the irregular action. Dr. Gould had
said the man smoked two ounces a day ; but this was wrong, half-
an-ounce of shag a day was the man's allowance, and that had been
now stopped for some time. He was more inclined to put syphilis
as the cause. He would give a bad prognosis in such a case ; the
loss in weight he considered a grave symptom, and before long, if
the man continued going about, would expect a fatal termination.

170 SUBCOSTAL ABSCESS.

SUBCOSTAL ABSCESS; INCISION INTO LOIN:

EECOVEEY.i

BY J. GALLEY BLACKLEY, M.B.
Physician to the London Homoeopathic Hospital.

A YOUNG man, aged 20, had been an in-patient of the
hospital last June with what was diagnosed before admission
as pleurisy with effusion. When first seen by Dr. Blackley
the right chest was found to be dull posteriorly as high as
the tip of the scapula, and breath sounds over the dull area
were very faint. No aeogophony was heard however at the
upper limit of dulness, only some loud moist rales. Above
and in front the percussion note was clear ; on the left side
below the clavicle was a comparatively dull spot, and breath
sounds were much exaggerated all over, with some moist
crackling rales. Temperature was very high on admission,
being 105.4** at night, and 100" in the morning, and this con-
tinued for many days with but slight variation. About four
days after the patient's admission, a shallow circumscribed
swelling about the size of the palm of a good large hand and
slightly boggy in feel, was found in the right loin just below
the lowest rib. This was poulticed until fluctuation was
evident, and after a few days was freely opened by Mr. Knox
Shaw. On introducing the finger into the abscess cavity it
was found to pass downwards for about 2J inches, and up-
wards inside the floating ribs as far as the finger could reach.
A 12-inch silver probe was next introduced and passed freely
in an upward direction for about 10 inches, and evidently was
inside the ribs. About 10 ounces of laudable pus were
evacuated at the time of opening, and some ounces came
away daily for several days. The temperature within ten
days was subnormal, and the patient left the hospital cured
within a month. The lower lobe of the right lung speedily
cleared up ; and the chest, although expansion is somewhat
deficient over the site of the previous dulness, shows no signs
of the falling in usually found after empyema. Dr. Blackley

1 Clinical evening, March 2nd, 1893.

SOCIETY NEWS. 171

inclined to the idea that the abscess was in the posterior
mediastinum, and did not penetrate the pleural cavity.
Vertebral caries as another possible cause was practically
eliminated, as very careful examination both then and now
failed to reveal the sUghtest indication of a spinal origin for
the abscess.

Mr. Knox Shaw observed that the case was interesting chiefly
from the point of view of diagnosis. He could not say with cer-
tainty where the pus originated, but his strong impression was
that it was not pleural. On opening the cavity it did not behave
in the way usual with empyema. He came to the conclusion that
the pus existed between the pleura and the ribs. He thought
this opinion was probably right, otherwise the lung would have
shown evidence of old mischief, and there would have been some
falling in of the ribs.

SOCIETY NEWS.

At the February Meeting of the Society it was resolved that
a deputation consisting of its President, Treasurer, and Secretary
should present a congratulatory address to Dr. Wielobycki, a
former member, on his having attained the great age of one
hundred years. Dr. Wielobycki was originally elected a member
of the Society, on the nomination of Dr. Quin, on the 10th of
December, 1851. He seems to have been an active member of
the Society, taking frequent part in the discussions, and on
several occasions presiding over its deliberations in the absence
of the President, Dr. Quin. In 1852 he read a paper on " Neu-
ralgia," and in 1854 one on " A case of compHcated labour from
the locking of the heads of twins in their descent in the pelvis."

On February 13th, the ofificers of the Society, together with
Drs. Cameron, Jagielski, Epps, and Clarke, waited upon Dr.
Wielobycki and presented him with the following address : —

** Dr. Severin Wielobycki, — The British Homoeopathic Society
desires to congratulate you on the attainment of the great age of
one hundred years. When, after obtaining your degree of M.D.
in Edinburgh and practising for a few years in Canada on the
old system, you became a convert to Hahnemann's doctrine, you
settled in London as a practictioner of homoeopathy, and joined
the British Homoeopathic Society, of which you became an active

172 SOCIETY NEWS.

member, and to the Transactions of which you contributed a
valuable article on an obstetrical subject, which is preserved in
the twelfth volume of the British Journal of Homoeopathy.

** Though, owing to your great age and virtual withdrawal
from medical practice, you have long ceased to be a member of
this Society, we do not forget that you were the associate of some
still living members, and we have great pleasure in cordially
congratulating you on having attained a length of years seldom
accorded to man. Bom three years before the promiiLgation of the
homoeopathic therapeutic law by Hahnemann, you are doubtless
the oldest living representative of homoeopathy in the world.

** While warmly congratulating you on the remarkable health
and vigour that have hitherto attended you, we trust that your
life may yet be long spared to enable you to pursue the philan-
thropic work of promoting temperance by precept and example,
to which you have devoted yourself since retiring from medical
practice, and in which, notwithstanding your patriarchal age, you
still take a lively practical interest.

** (Signed) " J. G. Blackley, President.

*' K. E. Dudgeon, Treasurer.
** C. Knox Shaw, Secretary.
'* Hugh Cameron.
" Victor JagieijSki.
*' Washington Epps.
" John H. Clarke.
** London, February 13th, 1893.''

At the June Meeting of last year. Dr. Hughes suggested that
the Gresham University Commission now sitting should be
approached with reference to the necessity of authoritative in-
struction in homoeopathy being provided by the new University.
An account of this proposal, which was unanimously accepted,
will be found in the Monthly Homoeopathic Beview of July. A
memorial, based on its lines, was presented to the Commission,
and request was made that one or more of its signatories might
be heard as witnesses. The Commission, however, has adjudged
the question to be beyond its powers ; but will print the memorial
as an appendix to its Eeport. It will, we trust, meet the eyes of
some of the public, and will bring to their knowledge the crying
need that exists for provision of systematic instruction in the
principles and practice of our method.

On Thursday, January 6th, the following gentlemen, having
l)een duly nominated as candidates, were elected by ballot: —

SOCIETY NEWS. ' 173

Francis Sorell Arnold, M.B., B.C.Oxon, 332, Oxford Eoad, Man-
chester; Frederick Flint, M.D.Aberd., 8, Eamshill Eoad, Scar-
borough; William Ombler Meek, M.B.Ed., 256, Oxford Eoad,.
Manchester ; Peter Proctor, L.E.C.P., M.E.C.S., 17, Hamilton
Square, Birkenhead ; WiUiam Henry Eoberts, L.E.C.P.Ed., 63,
Lower Mount Street, Dublin; John Wilde, L.E.C.P., M.E.G.S.,.
Park House, Weston-super-Mare; Arther Llewellyn Williams,
L.B.C.P., 127, Moss Lane, East Manchester.

On Thursday, March 2nd, the following gentlemen, having
been didy nominated as candidates, were elected as members : —
S. Henry Woodgates, M.D.Glasg., Mona Lodge, Lyndhurst Eoad,
Exeter; Edward Eobert Bradley Eeynolds, M.E.C.S., Highcroft,
Shepherd's Hill, Highgate, W.; Charles Edwin Waddington,
L.E.C.P., 55, Queen Eoad, Manningham, Bradford.

We are receiving from our Exchanges words of commendation
and welcome upon the fresh departure of the Society in the
manner of publishing its proceedings. We hope that every
member will feel that it is his duty to maintain the high ideal at
which we aim by contributing something of his experience to the
work of the Society. With the large number of members that
the Society now possesses, there will be found no difficulty in
obtaining valuable information upon all branches of homoeo-
pathic therapeutics. The parent Society does not meet often
enough to receive all the communications that are due, so that it,
becomes imperative for some of the more active provincial mem-
bers to bestir themselves into forming branches for the better
development of our work.

The Southern Journal of Homoeopathy, commenting upon our
new issue, says: — '*To judge from the contents of the initial
number, the Joubnal of the British Homoeopathic Society will
be of interest not only to the members of this association, but it
will be both interesting and valuable to every medical man who
appreciates the experience and the literary productions of edu-^
cated physicians and surgeons, put together in the form selected
by Dr. Hughes. . . . There can be no doubt that with the*
aid which the English profession will furnish their accomplished
editor, the Journal op the British Homceopathio Society will
hold an enviable position in the world of periodical literature."

Dr. W. W. Van Baun, of Philadelphia, welcomes us with : —
« England has at last a homoeopathic journal the profession caiL
be proud of. Success and long life to it.''

174 SUMMABY.

The Clinique, in noticing the Journal, says : — ** This publica-
tion is a new and timely departure for a Society that was founded
in 1844, and which has been in successful operation ever since.
It has already issued its very valuable annals in twelve portly
volumes, and now proposes a serial that shall be up with the
times, and with the advanced position not only of the flourishing
Society itself, but also of the general interests of the profession
* over there.' That the enterprise is in the editorial charge of
our good friend. Dr. Kichard Hughes, estabhshes its character
and assures its success. Our readers should subscribe for this
journal from the start, and so help along the good work. It is
clinical and practical to the last degree."

Of our new venture the Hahnemannian Monthly writes : — " An
excellent publication, ably and carefully edited by one thoroughly

versed in the work A magazine, the character of

which is second to none, and which, if maintained, will present
a review of medicine and surgery no one can be without."

SUMMAEY OF PHAEMACOD YN AMIC S AND

THEEAPEUTICS.

" GATHER VP THE FRAGMENTS, THAT NOTHING BE LOST,"

December, 1892 — February, 1893.*

PHARMACODYNAMICS.

Aaram. — ^Johann C, aged 36, had for several years been sub-
ject to a head affection, that tormented him by day and night.
Melancholy, anxiety, with fear of impending serious illness. Then
occasionally great excitement and restlessness, vertigo, pressure
on chest and epigastrium. Face red ; blowing noise in place of
first sound of heart. Bell. 6x, on Sep. 25th. Oct. 5th. —
Improvement reported. Heart's action very excited ; eruption
of pustules on thigh. During past week had suffered much from
toothache. Aur. m., 3x, three times a day. Oct. 15th. —
Better in all respects. The medicine was continued. Oct. 15th.
— Quite cured, and able to resume his work. — Amberg, A. H, Z.,
29th September.

* With some arrears.

SUMMARY. 175

Belladonna. — On Sept. 23rd, 1890, at 5 p.m., two children
ate an unknown number of belladonna berries.

1. Franz Lehner, aged 2| years, one hour afterwards was
Tsry ill, sad and dejected ; complained of pain in mouth and
chilliness ; asked for sugar, lay down in bed and began to be
delirious. The whole skin was scarlet, burning hot ; head, hands
and feet in constant convulsive movement ; both pupils much
dilated, anxious expression, wild restless look, red inflamed eyes
and Uds, the whole face intensely red and puffy, burning hot, hair
matted with perspiration, mouth dry, tongue very red and swollen,
difficulty of swallowing, constant chewing movements, stiffness of
neck, boring of head backwards on pillow, continued jerking of
hands and feet as from electric shocks, great distension of abdo-
men, rapid pulse, palpitation of heart, beating of carotids, great
restlessness. This lasted all next day (24:th). 25th. — ^The red-
ness and swelling of body began to decline, only the face remained
bluish red and swelled, pupils still strongly dilated*, the convul-
sive movements of extremities and restlessness became weaker
and seldomer, the delirium and unconsciousness only ceased for
intervals ; had two diarrhoeic stools, two berries passed, after
-which the distension of abdomen diminished greatly. 26th. —
Temperature of head and body still very high, pulse still rapid,
twitchings became rarer, consciousness frequently returned, and
for longer periods ; in evening, increased heat and excitement.
27th. — Consciousness perfectly restored, still somd excitement,
heat and redness of face in evening, sleep quieter. 29th. — Well,
except great weakness.

2. Joseph Lehner, aged 5. Three quarters of an hour after
taking the berries, burning in mouth, pains in stomach ; at 7
p.m., great anxiety and restlessness, trembling of limbs, pale and
drowsy, with constant restfessness and movements of whole body.
At 2 a.m., vomiting with relief. 24:th. — 6 a.m., pupils much
dilated, gait unsteady and staggering, talks nonsense and cannot
express himself properly, violent fit of dry cough. He will not
lie down, and is always on his feet. 25th. — Still great restlessness,
constant walking about and wish to run away, whirling vertigo,
dilated pupils, is as if blind, when walking lays hold of chairs, &c.,
speaks continually in unconnected phrases ; sees pears, apples
and plums hanging, which he tries to catch hold of ; much per-
spiration on head, two diarrhoeic stools, in which were the skins
of the berries, no appetite: heat and excitement increased in
evening. 26th. — Eestlessness and excitement less, but the ver-
tigo and staggering gait, dilated pupils, with perspiration on head
and evening aggravation, continue. 27th. — Attack of chilliness

176 SUMMAEY.

and heat with tapid pulse, perspiration of head, deception of
sight, talking nonsense, great forgetfulness, constant restlessness
and evening exacerbation. 28th. — All symptoms gradually sub-
sided, appetite returned, but he is very weak, and though he had
slept well still staggered ; his mental powers returned slowly. —
W. Huber, Archiv. f, Horn., i., No. 8.

Camphor. — ^The Therapeutic Gazette of December calls atten-
tion to this drug as one '* in danger of passing into obscurity " in
ordinary practice, commending it not only as a diffusible stimu-
lant, but also as anti-diarrhoeic. In virtue of these properties,
and because " volatile oils and their derivatives act as internal
antiseptics," its repute in cholera is well warranted. It may be
given here in common red wine, which also '* inhibits the growth
of the cholera spirillum." It often relieves cardiac distress, with
or without organic disease to account for it.

Carbo Ye^etabilis. — An analytical study of the pathogenesis of
this drug, one of a series issued by the Medical Investigation
Club of Baltimore, appears in the Southern Journal of Homceo-
pathy for November.

Cooaine. — Dr. Piedvache contributes to L*Art MSdical of
Jan. a thorough study of the physiological action of this drug.
His conclusions are that it is not, as it has been styled, ** the
curare of the sensitive nerves," acting only on their terminal
Qxtremities; but that it affects the nervous centres generally,
&:st as a stimulant, and secondly as a depressant.

Colooynth. — A typical case of the sciatica calling for this drug
is reported by Dr. Hobart. The pain had commenced in the
stomach and left ovary, then shifting to the left leg, where it had
continued at intervals for a year. It was drawing, crampy and
throbbing. Colocynth 3x cured in four days. — Med. Era, Jan.,
p. 12.

Coniam in Cataract. — Dr. Talbot communicates to the
Medical Century of January two cases of cataract (so diagnosed
by oculists), in which the administration of Conium 3x seems to
have dispersed the opacity and restored vision. In the former
of the two general symptoms of the drug were present. [Dr.
Talbot quotes several symptoms from the pathogenesy of conium
as indicating its homoeopathicity to cataract. But surely these
sensations, coming and going during provings of the drug, can-
not be due to any substantive changes in the lens. — ^Ed.]

Crocus in Imaginary Pregnancy. — A woman supposed her-
self to be three months gone in pregnancy, and stated that she
had felt ** something living jumping about in her abdomen "
several times. Examination found no change in the uterus ; and

SUMMAEY. 177

after a third dose of crocus 15, there was no recurrence of the
movements. — Horn. Journ, of Obstetrics, &c., Jan., p. 25.

CupFum arsenicosam.—A severe case of the nausea and
vomiting of pregnancy, with great prostration and emaciation, was
rapidly cured by this drug, in the 3x trit. — N. Amer. Journ, of
Horn,, Jan., p. 53.

In the Horn, Becorder of Feb. 15th, there is a case of poison-
ing by C. ars. Besides the symptoms of local irritation and of
general collapse, there was tremulousness of the whole body (in-
cluding the tongue).

Digitalis. — Dr. Huchard, in giving this drug for cardiac dropsy,,
adopts a new method which seems to obviate many of the objec-
tions to it, and must find favour in our eyes. After a few days
of milk diet and absolute rest, he gives a single dose of the
crystallised digitalin, and then waits for six to fifteen days before
repeating it. — Therapeutic Gazette, Oct., p. 689.

Mr. Wyborn sends a note on the alkaloids of this plant to the
Monthly Horn. Review of Feb., from which it would appear that
Huchard's crystallised preparation mentioned above is impure,,
being nearly pure *' digitonin," which is ** useless as a remedy for
heart disease '' I

Dolichos pruriens. — Br. Mifflin finds the tincture of this plant,,
in 1 to 4 drop doses, give great relief to the itching of the skin
caused by the presence of bile in the blood, as in jaundice. —
Southern Journ. of Horn,, Nov.

Filix mas. — It is beginning to be found that the large doses-
of male fern in vogue for killing tape-worm cannot always b&
given with impunity. "The extract of male fern has a toxi©
property, acting principally upon the digestivq system and the
nerve-centres, and producing such symptoms as vomiting,,
diarrhoea, colic, cephalalgia, difficult locomotion, dilated pupil,
impaired vision, hurried respiration, motor paralysis, depression,
&c/' These are the conclusions of Katayama and Okamota
{Therap. Gazette, Oct., p. 710). The amblyopia seems to occur
only in weak and delicate subjects, or in those of poor health.

Graphites in Chronic Blepharitis. — Another case illustrative
of the curative power of graphites in chronic inflammation of the
edges of the lids is communicated by Dr. Edward Kirkland to the
N. Am. Journ. of Horn, for February (p. 116). It was of several
months' standing. Improvement was noticed within a week, and
continued without interruption to cure. The 3rd trit. was given
four times daily.

Gnarsa in Epiphora. — Dr. Parenteau confirms from his.

VOL. I. — NO. 2. 12

178 ' SUMMABY.

experience Dr. Claude's recommendation of guaraea in watering of
the eyes, where there is no mechanical obstruction to the out-
flow of the tears, but simply an excess of formation. He gives
the Ix dil. — N. Am. Journ, of Horn., 'Feb., p. 84.

Hydrastis. — Mrs. Z., landlady of an inn, aged 60, had for
months been ailing, and the treatment she had hitherto undergone
had been of no avail. She was first seen on the 30th July. She
complained of tenderness and pressure in gastric region, anorexia,
increase of sufferings by the liquid food she was confined to, as
she could take no solids ; vomiting of food, mucus, and stuff like
•coffee grounds, obstinate constipation, faintness and emaciation,
•earthy complexion. She had already been under three doctors,
who pronounced her disease to be cancer of the stomach. Ex-
amination showed a hard tumour the size of a pigeon's egg
betwixt xiphoid process and umbilicus, enlargement and tender-
ness of liver, pulse slow, hard, intermitting every fourth or sixth
beat, second sound of heart obscure, the arteries hard and rigid.
As the symptoms seemed to indicate carcinoma of stomach and
atherosis of heart and arteries, the prognosis was doubtful. As
no decided guiding symptoms were present, hydrastis 3x, one
drop every three hours, was prescribed on pathological principles.
The liquid diet was continued. Heard nothing of the patient
for three weeks, and then, Aug. 20th, learnt that soon after com-
mencing the medicine improvement had set in, pain and vomiting
had ceased, strength and nutrition had returned, she was again
busy in her household duties; could go upstairs without the
dyspnoea that had previously plagued her. She could eat meat
and other solid food with comfort. Continued hydrast. Seen a
fortnight later, she was in every respect well, though a small
remnant of the tumour could be detected by careful examination :
a few weeks later even this entirely disappeared. — Amberg,
A.h.Z., 29th Sept.

In the London Horn. Hospital Beports for 1892, Dr. Bur-
ford communicates much experience with the hydrastis de-
rivatives in menorrhagia and metrorrhagia. The alkaloid
" hydrastin *' has been resolved into ** hydrastinin *' and opianic
acid, and most of the Continental therapeutists have used "hy-
drastinin." Dr. Burford and several colleagues have used the
same preparation in the 1st, 2nd, and 3rd dec. triturations,
and report similar results, especially from the two lower poten-
cies. Dr. Burford says that '* there are few non-parturient uter-
ine haemorrhages that it will not immediately control, and few
contingent uterine conditions that its continual use will not more

SUMMABY. 179

or less benefit." Dr. E. A. Cook has furnished him with a note
on ** hydrastin." He uses an alcoholic solution of gr. xx. to the
pint (= one part in 350), and finds 2- to 5-drop doses of this (=
gr. Y^ to T^) " all-sufficient for the purpose of stopping haemor-
Thage." When the dose is too large, it sets up " a peculiarly
intensive headache, the head feeling as though the scalp would
lift, with giddiness on turning, and an intense irritability, always
provoked by any noise." Dr. Burford's experience with *'hy-
^astin '* is confirmatory of these conclusions.

Dr. Burford gives references to, and an outline of, the old-
school literature of the subject. In the Therapeutic Gazette for
October there is a further communication upon it by Dr. Gotts-
«halk. He finds gr. |- of " hydrastinin" the maximum dose, and
thinks that 20 drops of the fluid extract will accomplish the
same work, though less quickly and surely. The drug acts by
narrowing the vessels, and is useful whenever uterine haemorrhage
•depends on congestion or relaxation of the organ.

Hydrocyanic Acid in Infantile ConYulsions. — Dr. A. H.
■Croucher communicates to the Horn. World of Februarj^ a case of
this kind in which drop doses of the 1st dil. of the acid effected a
•satisfactory cure. (As the patient's age — 3| , 3 when attacks first
commenced — ^was beyond that of dentition, this case might rather
be called epilepsy. — Ed.)

Icthyol. — This substance — a distillation product of bitumin-
ous material, containing a large proportion of sulphur — has been
much employed of late by dermatologists. It seems now ascer-
tained that it acts by constricting the arterioles, and accordingly
finds use as a topical application for boils, erysipelas, &c. An
ointment containing from 20 to 50 per cent, is the usual form ;
but the " sulphicthyolate of ammonium " is soluble in water in
these proportions. — Therapeutic Gazette j Oct., p. 684:.

Lachesis in Sore Throat. — Mrs. B., aged 38, had for three
weeks suffered from pain in throat ; she felt as if the throat was
Ta\7, and as if a round lump stuck in oesophagus that she must
continually swallow down, but it immediately returned. At night
woke up with feeling of suffocation. She is best when lying on left
side with head raised. Believed by swallowing solid food, but
-empty swallowing aggravates. Throat very sensitive to external
pressure. Urine dark and turbid, bowels confined, worse in cold,
damp, windy weather. Appetite good, menstruation regular.
Much thirst, and longing for coffee. Laches. 30, 2 globs, every
evening, cured her in a short time. — Waszily, Archiv. f, Horn.,
i.. No. 8.

180 SUMMABY.

Lappa major. — Dr. S. A. Jones has an article on this plant m
the Horn. Becorder of January 15th. In it he mentions that a
colleague consulted him for what he called *' spermatorrhoea,"
but which Dr. Jones found to be an excessive deposit of amor-
phous phosphates. He had never, he said, observed this *' white
stuff" in his urine until he had made a proving of the burdock,
which he took in large doses, and which brought on an alarming
prostration ** like typhoid fever."

In the number for February 15th, Dr. Jones begins the narra-
tive of a proving of the plant.

LJlJum Tigrinam. — A woman, aged 33, had formerly suffered
from chlorosis. Had a child at full term two years ago, and a
miscarriage last year. For six weeks has suffered from violent
pains in abdomen, frequent urging to stool and to pass water — a
feeling as if all the genitals would be forced out. On examination^
uterus was found to be slightly swollen. Lilium tigr. 3x thre©
times a day removed all these symptoms in a week. — Amberg,.
A.h.Z,, September 22nd,

HeFoarius CoFPOsiYUS. — A case of poisoning from the con-
tinual handling of disinfectant solutions of this salt is recorded in
the N, Engl. Med, Gazette of January. The first symptom,
was the dysenteric diarrhoea of the drug, with proctitis ; then
vomiting and collapse. The use of the drug was discontinued^
and the patient became well again. On its resumption, .after
nausea and slight vomiting, fever ensued, temp. 103°, with severe
headache and partial stupor. A very offensive diarrhoea set in,,
with severe pain and much mucous discharge. Then came pain
and swelling of joints of hands, which on their inner aspect
became red and tender, as though denuded of cuticle.

Natrum muriatioam. — Miss P., aged 33, was last year treated
for a nervous affection of stomach. For a fortnight has suffered
from headache from the nape to above eyes. Pain over the eyelids
so that she can hardly open eyes. In the first days the pain
came on in forenoon, now she wakes with it in the morning;
it increases gradually till noon, then declines towards evening.
Towards the end of the attack the pain is concentrated in temples.
The right side is chiefly affected. Vomiting sometimes ensues.
Pain worst when lying, is aggravated by mental exertion ; sleeps
well, appetite bad. Much thirst and dryness of mouth, most at
noon. August 30th. — Nat. mur. 11, three times a day. Sept.
26th. — Eeports that the next day the pain was better. After
three days it was completely gone. — Dahlke, Zeitsch, d, BerL
Ver, xii., 52.

SUMMARY. 181

Mrs. E., aged 53, has suffered from childhood from chronic
conjunctivitis. Photophobia, lacrymation. The tarsi much
thickened and red. Warmth does good. Occasionally mist before
eyes. Skin of hands rough; sometimes there is a vesicular
eruption on them. Constipation. Natr. mur. 30, a dose every
third night. After fifteen days the eyes were wonderfully improved.
Photophobia, lacrymation and mistiness of vision gone, and the
red tarsi very much better. She got Natr. mur. once a week.
No more medicine required, and after a year no relapse. — Ibid.
Phellandpium in Phthisis. — Dr. Terry confirms the favour-
able repute of this drug in certain cases of pulmonary tuberculosis.
It appears to be '* pneumonic phthisis 'in which it does good ;
and the general symptoms melt away under its use in from four
to six weeks, leaving only the physical signs, to disperse which
other treatment is needed. He gives the mother tincture, or Ix
dilution, 2 to 5 drops three times a day.^^. Am. Journ, of
Horn,, Feb., p. 118.

Phosphorus. — Dr. Thornton has experimented, in the labora-
tory of the Jefferson Medical College, on the reputed antidotes for
phosphoric poisoning, and comes to the conclusion that perman-
ganate of potassium is the only one to be relied on. "It must
be used before the poison has become absorbed, and must be weU
diluted (.6 to 1 per cent, solution), or vomiting will result before
ihe chemical re-action has taken place in the stomach. It must
be given in excess, as much permanganate is reduced by the
organic substances in the stomach." — Tkerap, Gazette, Jan.

Physostigma. — In a case of neurasthenia in an old lady, with
great mental and physical debility, and rapid feeble pulse, the
3rd dil. of this drug had a marvellously ''tonic" effect. After
five days' administration she felt better than for six months past.
— N. Am. Journ. of Horn,, Jan., p. 56.

Sabal serrolata. — Dr. D. H. Bay, of Calcutta, relates two
cases in which urinary fistulsB have healed under the action of
the tincture of this plant. — Hom. Becorder, Nov.

An old-school practitioner, in the Chicago Medical Tvmes, bears
his testimony to the value of this drug in prostatic irritation and
enlargement. He claims that it will reduce the gland to its
normal size, and effect a permanent cure. — Ibid., Feb.

Scutellaria. — Dr. Gorton writes in the N. Y. Med. Times of
•* the valuable assistance he has derived from 1 minim doses of
the tincture of this drug in cases of neurasthenia." — Monthly
Hom. Bev., Feb.

Sepia in Polyarthritic Rheumatism. — Mr. S. was seized

I

182 BUMMABT.

on October 28th with acute articular rheumatism. The pains^
were chiefly in ankles and wrists. Temp., 38.2^ to 38.9°. Copious
perspiration of intense sour smell. Pains aggravated at night,
especially before midnight ; constant desire to change position.
Ehus 3 every three hours. After three days no improvement.
The pains are in almost every joint, change their seat frequently,
and extend into the body; are aggravated by cold and wet
weather, and by the shghtest draught of air. Urine dark. Oct.
31st. — Sepia 6 every three hours. Nov. 2nd. — Patient out of
bed and greatly pleased that he is so much better. Sepia con-
tinued less frequently. After eight days he was free from pain.
A slight stif&iess only remained, which went off without further
medicine. — Waszily, A,h,Z,j cxxvi., 56.

Sticta in Cou^h. — Dr. Malcolm Leal contributes his experi-
ence with this remedy, which he uses in the mother tincture.
The cough for which it is effective he describes as "dry, hacking,
or single concussive; worse at night; apparent cause, tickling;
apparent seat, upper trachea or larynx ; unaccompanied by pain,
though cough may seem to jar whole chest." — Am, Homo^ojpa-'
thist, Jan. 15th.

Sulphup in Pulmonary Catarrh. — A governess, aged 27,
sought advice on July 10th for a lung affection of long duration.
Frequently suffers from cough ; last winter had moderate haemop-
tysis. Now coughs much day and night, with yellow expectora-
tion, great dyspnoea, anorexia, looks very ill, has some fever,
menses regular, no hereditary taint. Dulness on percussion at
apex of right lung ; peculiar respiration and bronchophony before
and behind ; at apex of left lung posteriorly small r&les, leather-
creaking sounds on respiring in left scapular region and dry rhon-
chi extensively heard on both lungs. Sulph. 30 every three hours,
July 15th. — Much better in subjective symptoms, cough and
dyspnoea ; the catarrh of apex of left lung, the rhonchi and leather-
creaking sound gone. She now got Bry. 3 for a little time, and
was soon able to return to her work. — Amberg, A.h.Z,, Sept.
29th, 1892.

Teliurium. — Three cases by Dr. Shelton, confirming the^
value of this metal in spinal irritation, will be found in th©=
Monthly Horn. Beview of Sept., p. 548.

Thlaspi Bursa Pastoris. — A haematuria of weeks' duration,
in a subject of Bright 's disease, was entirely checked in forty-
eight hours by 5-drop doses of the tincture of this plant, after
the ordinary remedies had failed. — N, Am, Joum, of Horn.,.
Jan., p. 57.

SUMMABY. 18S

¥inca minop in Diphtheria. — The widow of an apothecary in
Munich enjoyed a great reputation for the cure of diphtheria by
means of a secret remedy, which she wished to sell for the modest
sum of 100,000 marks (£5,000). A sample of this wonderful
remedy was obtained and on examination proved to be vinca minor.
Of this the astute widow prepared for each case a fresh decoc-
tion, which she administered to the diphtheria patients by table-
spoonfuls. The remarkable success of this remedy in many
undoubted cases of severe diphtheria was certainly to be
attributed to its homcEopathicity to the disease, for we read in its
proving by Dr. Eosenberg that among other symptoms it caused
sore throat when swallowing, hoarseness, ulcers in the nose, with
obstruction of the nasal passages, flat ulcers on the buccal mu-
cous membrane. Hitherto this drug has been but little used by
homoeopathic practitioners, and its usefulness has been almost
confined to the cure of a case of plica polonica. It might be
worth while to give it a trial in cases of diphtheria, which is not
always so amenable to the ordinary homoeopathic treatment as
we could desire. — Moesex in Allg, horn, Ztg,, cxxvi. 56.

THERAPEUTICS.

Acute Hydrocephalus. — A case of what seemed to be this
disease, in a boy of 12, deUrium being very marked, presented
to Dr. Crosby's eye so strong a resemblance to poisoning by
cocaine, that he put two drops of a 2 per cent, solution into half
a tumbler of water, and gave a teaspoonful every two hours.
Delirium soon abated, and convalescence set in and proceeded
uninterruptedly. — Med, Era, Jan., p. 16.

Cancer of Stomach. — Dr. Winterburn relates a case gene-
rally diagnosed as, and apparently being, scirrhus of the pylorus.
Under Bryonia 30, chosen on account of the subjective symptoms,
and given every six hours, improvement speedily set in, and went
on to complete recovery. — Medical Advance, Nov.

Cancer of Tongue. — Dr. Eidpath contributes a case to the
Horn, World of December, where, in a subject of abdominal
cancer, the disease appeared in the tongue. Under Silicea Ix
all the symptoms disappeared, and they did not recur before the
patient's death.

Cholera. — A layman, who seems to have treated a good many
cases, reports his experience of the recent Hamburg epidemic
of cholera. He found arsenic the great remedy, camphor and
veratrum proving ineffective. The 6th dilution answered for

184 SUMMARY.

the slighter cases, but for those of more serious or advanced
character the 4x and 3x triturations were required. Of these
(excluding the slighter cases), he lost at the rate of 5 per cent,
only. — Leips, Fop, Zeitschr,, Nos. 23 and 24, 1892.

Dr. Hesse communicates his experience in the same epidemic
to the Allg. horn, Zeitung, He seems to have made most use of
camphor and veratrum, which latter medicine he has given in
drop doses of the mother tincture. He does not say how many
cases he treated, but gives his death rate at 20 per cent., in con-
trast with the 40 to 45 per cent, of the general mortality. — Bevue
Horn, Beige, Feb.

Cornea, Uloer of. — Dr. Alton G. Warner records a case of
sloughing ulcer of the cornea, with intense conjunctival injection
— ^which last, at any rate, was of a month's standing under old-
school treatment. A marked aggravation of pain and photo-
phobia every second day induced him to give chininum muriati-
cum 1st cent. Eapid improvement ensued, and cure within a
week. — N. Am. Journ. of Horn., Jan., p. 18.

Croup. — A girl, aged 7, was treated for croup by an allopathic
doctor, who thought the case hopeless, and as a last resort pro-
posed tracheotomy. On this the parents sent for a homoeopathic
practitioner, who found the child lying in an apathetic state, with
loud gasping and sawing respiration, violent fits of coughing,
which threatened suffocation; the larynx and trachea seemed
to be clogged up with mucus ; great desire for warmth, head
thrown back, temperature 40° C. He gave hepar 30 and spongia
30 in solution alternately every hour. In two hours all the suffo-
cative attacks ceased, and the cough was much diminished. The
child made a. perfect recovery. — Waszily, Allg, horn. Ztg.,
cxxvi., 53.

Diphtheria. — A man, aged 56, after feeling poorly for some
days got sore throat. Last night he had symptoms of suffoca-
tion of a dangerous character. When seen in the morning he
was hoarse, had dry, short cough, great prostration, desire for
cold drinks, profuse sweat in sleep, head must be elevated, worse
when he lay on left side, mouth and lips dry, constipation, drowsi-
ness, pulse small and intermitting. Phos. 6 every three hours.
Next morning the diphtheritic deposit was diminished to the size
of a bean [we are not told how big it was before], but heart's beats
and pulse very weak. Next day the throat was nearly well, but
he felt poorly after each dose. The phos. was then continued in
the 30th dil., a dose night and morning. After this, the cardiac
weakness continuing, and there being great chilliness, he got kal.

SUMMABY. 185

carb. 30, and afterwards cupr. 30, which completed the cure. —
Ibid,, 54.

A girl, aged 19, got diphtheria yesterday. To-day the mem-
branous deposit covers both tonsils, which are much swollen.
Externally the swelling is greater on the right side of neck. She
cannot bear to be in a warm room, in spite of the cold (it was
January) she must have the window open, must lie with head
high, is best on back, sleep restless before midnight, cold drinks
allay the throat pains; urine with red sediment. Lycop. 30, one
dose in evening. Next morning the membrane had entirely disap-
peared. She got for three more days lycop., and then was quite
well. — Ibid.

Eczema. — 1. S. P., a blonde lady, aged 27, suffered for half-a-
year from eczema of palm and between fingers ; the eruption on
the hand was dry, that between the fingers was vesicular. Aggra-
vation from washing. Leucorrhoea after menses. She got, Dec.
8th, sepia 30, one dose once a week. After four weeks the erup-
tion was much improved. — Hesse, Archiv, f. Hom.y i., No. 8.

2. F., a governess, had suffered for three months from dry-
eczema on both hands. Complained of heat of hands and flush-
ings of face. Sepia 30, once a week. Eeported on Dec. 5th
that she had only used three powders, which cured the eruption.
— Hesse, Ihid.

3. A custom-house officer, aged 30, had long suffered from
itching eruption on backs of hands. Six years ago was treated
bomceopathically for a scabious eruption on the body. On April
7th, 1891, he got sepia 30, once a week. Nov. 18th. — Came
under treatment for an acute affection which was cured by puis.
The eruption was then quite gone, April 11th, 1892. — Slight
gonorrhoea for a week. He got sepia 30, five powders, one every
night. May 7th. — Gonorrhoea gone, but the eruption on hands
returned. No medicine.— Hesse, Ibid,

4. S., a retired railway luggage guard, aged 67, sought advice
for a cutaneous disease of long standing. In his early youth he
had always suffered from papular and pustular affections. When
serving in the army he had eczema of the thighs, which the army
surgeon soon removed by a zinc ointment. It returned, however,
after some years, and was nearly limited to the thighs. It was
worst when he was about 34 years old. He had a great deal of
medical treatment of all sorts. It was at length cured, or dis-
appeared for sixteen years, he knew not by what remedy. In
March, 1889, the disease broke out again with increased intensity.
It was again treated with a variety of remedies, without any good

186 SUMMABY.

result. Seen Dec. Ist, 1891, he presented the following ap-
pearance : — His face and head (which had lost all its hair) were
inflamed and red, with moisture constantly exuding from them,
that had to be continually mopped up. His extremities were in
the same state, but only a few spots over the body. If any spot
became dry for a short time, a white glittering scaly skin was
formed on it, under which the moisture still formed. The patient
was in despair. Lycop. 3x every evening was prescribed. Dec.
14th. — ^No change. Prescribed graph., 6 trit., every evening.
Jan. 18th. — Still no change. Sulph. 30, one dose. Feb. 1st. —
Same state. The prescription now was natr. mur. 3x, to be
taken every morning fasting, in a cupful of hot water. This
treatment was continued till April 10th, when a considerable
improvement was observable. The natr. m., in hot water,
was continued till June 24th, by which time the patient was
quite free from his eczema, and the hair had again grown on
his head, not white, as it had been before he lost it, but dark
brown.— Billig, A, h, Z., Oct. 27th.

Epilepsy. — In a case of this malady of twenty-two years'
standing, originating in a disappointment in love, the fits
gradually increasing in frequency until — on coming under treat-
ment — they occurred twice or thrice daily, Dr. Winterbum
prescribed agaricus 30. The attacks at once became rarer, and
after four or five months she had no more. The only symptom
specially indicative of this medicine seems to have been ** great
flow of ideas and loquacity after the attack." — Medical Advance,
Nov.

Dr. W. M. Houston relates a cure of this disease, of three and
a-half years* standing, by cuprum met. 12, given because of the
convulsions invariably occurring at night during sleep. — Ibid.

Hastodynia. — In a case of pain after nursing, of stinging
character, commencing at the nipple and extending into the gland
about fifteen minutes after the child had been to the breast, a
number of remedies failed to relieve, but the tincture of sabal
serrulata (the " saw palmetto ") cured in two days. — Am, Ho-
moBopathistf Dec. 19th.

MetroFPhagia. — Mrs. O., aged 44. The catamenia, which she
had not had for eight months, came on and had now lasted four-
teen days. She felt particularly well to-day, and had walked out
when a violent flooding came on. She was taken home in a
carriage, and now lay in bed. Dark blood with large clots poured
from her, especially at every movement ; no pain. Yesterday had
much flatulent distress. She got Lycop. 30, two globs, on tongue.

BUMMABY. 187

After this one large clot came away, but nothing more. The
following day she was much better and rapidly recovered.--^
Waszily, Archiv,f, Hcnn., i., No. 8.

HyxoBdema* — Dr. Clarke reports, in the Horn, World for Oct.,
a case of this disease in which arsenicum, prescribed on account
of the concomitant symptoms, proved curative.

Nails, Degeneration of. — Dr. Batault relates a curious case
in which the nails of the fingers softened and stripped off in scales.
The extremities of the fingers were so tender that the coat could
not be buttoned. The patient had had syphilis seven years,
previously ; but anti-syphilitic treatment was useless for this^
affection, which continued to increase during three and a-half
years. Plumbum 30 was given night and morning, and after three
weeks pain and tenderness had ceased. No medicine was taken
for a month, and the nails improved in character. Under thuja.
30, given because of perspiration of hands and feet, this improve-
ment continued, but pain returned. Plumbum was now resumed,,
and in three and a-half months from the beginning of the treat-
ment the nails were perfectly strong. After three years there had
been no relapse. — N. Am, Joum, of Horn,, Feb., p. 87.

Nephritis. — Ernst Muller, farm labourer, aged 38, had been
seriously ill for ten weeks under allopathic treatment. When
seen on May 10th his whole body was oedematous and swollen
to such a degree that he could not move an inch in bed without
assistance. He got arsen. 30 every two hours. This was con-
tinued for ten days. The urine contained albumen to one-fourth
of its volume. May 20th. — No perceptible alteration. Arsen. 5x
every two hours. May 23rd. — Legs more swollen, but body and
arms less so. Continue medicine. May 25th. — Marked improve-
ment of all symptoms. Albumen in urine now one-eighth of its^
volume. Swollen much less. Patient was able to walk about
and his appetite much improved. May 28th. — Only slight swelling
at ankles, greatest towards evening. The urine only showed
a slight turbidity on June 17th ; the swelling had quite disap-
peared. June 26th. — Urine quite free from albumen. Appetite:
normal. His body appeared well nourished, only some weakness
remained. In another fortnight he was again at his work in the
fields. — Paul Lutze, A. h, Z,, Nov. 2nd.

Obstetrio Praotioe. — Dr. S. P. Alexander has a paper in the
Monthly Horn, Beview of Feb., relating his experience with ho-
moeopathic remedies for the disorders of the pregnant, partu-
rient, and puerperal states.

Pleurisy. — A boy, aged 6, had suffered since end of March

188 SUMMARY,

from fever which at first came daily at 10 a.m., now (June 30th)
at noon. There is first rigor, with blue lips and earthy com*
plexion, then heat with red face, then sweat. During the attack
complains of pain in body and head. The sweat is greatest on
liead. The whole lasts one and a-half to two hours. Before the
attack there is cough, with retching and vomiting of food. The
cough lasts through the attack. After it is over the child wants
to get up and eat. Appetite good. Bowels regular and sleep
sound. Is emaciated, very irritable. There is pleuritic exuda-
tion in right side up to angle of scapula. Gastric region tender
to touch. During the fever the whole abdomen is sensitive to
the slightest pressure. Has been under treatment since end of
March ; was for several weeks in hospital, was tapped there, but
as the effusion returned was dismissed uncured. Bryonia and
apis were given in alternation. June 16th. — Mother reports
that there has been no febrile attack for three days. The dul-
ness still extends to the same height. The medicines were
continued. August 8th. — No more febrile attacks. Effusion quite
,gone. General health normal. — Dahlke, Zeitsch, d. Berl, Ver.,
xii. 51.

Pneumonia, CaYity of Lung, Pleuritio Exudation. — August
O., aged 4, had been long treated by allopathic practitioners, who
pronounced the case hopeless. His illness dated from April 5th,
when he had pneumonia and pleurisy with effusion. When seen
►on May 29th he was very ill, had great dyspnoea, and could
scarcely stand. He coughed much and expectorated much yellow
sputa, with occasional vomiting. In the upper part of right lung,
before and behind, the percussion sound for a hand's width was
quite empty ; respiration bronchial, with metallic sound ; in the
lower part of right lung, before and at the side, empty percussion
;SOund and absence of respiratory sound ; behind, moderate dulness
and feeble vesicular respiration. Then the upper part of right lung
was pneumonic, with infiltration, suppuration and formation of a
cavity ; its lower part was occupied by pleuritic exudation. Pre-
scribed Sulph 30. June 4th. — Cough and general state improved.
June 12th. — Pain much less, respiration in right lung more distinct,
though there was still dulness, but anteriorly the pleuritic exuda-
tion was greatly increased, and the dulness on percussion extended
from above to below ; no respiratory sound perceptible. Arsen. 30
•every three hours. June 30th. — Fever and cough less. The pneu-
monia was gone, but the pleuritic exudation had increased and
extended up to the angle of the scapula ; it had caused a njarked
.scoliosis of the spinal column. Kali iod. 6x one drop every three

6UMMABY. 189"

hours, and a teaspoonful of cod liver oil at night. Under this
medicine the exudation diminished, the strength increased, the*
scoliosis declined. July 16th. — Exudation gone, but the scoliosis
remained. July 31st. — Improvement continues, the exudation
anteriorly diminished. September 6th. — Patient looked well, had
gained flesh, no trace of the scoliosis, only slight dulness in lower
part of thorax anteriorly. No trace remaining of pneumonic in-
filtration or cavity. — Amberg, A. h. Z,, Sept. 29thi

Pneumonia with Lumbrioi. — ^A girl, aged 7, of robust frame,
but with swollen, pasty, pale face. She had been treated for
pneumonia for a week by a practitioner who gave aeon., bry. and
phos. But so far from improving, her malady had assumed a
typhoid character. March 3rd, — She lies in a state of sopor with
occasionally bland delirium. Wakes up now and then with a
piteous cry and begins to cough. She then replies to questions
in a low voice, plays with her doll for a few moments, then falls
again into her soporose state and lies with half-shut eyes. When
awake she picks constantly at her nose and Hps, which are dry,
rough and red. Complains of right frontal headache. Percussion
shows dulness in right lung superiorly ; auscultation reveals in-
filtration and fine rales. Temperature 40° at night ; 38.9° morn-
ing. Complete anorexia, great dislike to sweets, tongue red.
Stools pea-coloured and thin, several times a day, sometimes
passed unconsciously. With the cough a httle viscid, rust-
coloured expectoration. Pulse small, quick. Urine turbid, fre-
quently passed. Ehus 30 every two hours. Warm compresses-
to chest, cold compresses to head. Next night slight perspiration,
which continued during the day. Cont. Rhus. 14th. — Cough
seldomer, sleep quieter, skin moist, diarrhoea several times a day.
Passed a lumbricus. Picking at nose and lips continues. She got
cina 30x and acid phos. 30 alternately every two hours. Passed
about twenty lumbrici. The resolution of the pneumonia went
on steadily. Cough seldom, with a little sputum coctum. Has
left off boring in nose, but still picks lips. Diarrhoea ceased. She
sits up in bed and plays. Temperature steadily dechned. She
got Sulph. 30. 19th. — Was nearly quite well. All the functions.
normal. — Mossa, Archiv,f, Horn., i., no. 8.

Psoriasis palmaris. — Dr. Cooper relates in the Horn. World
for January a case of this disease of some years' standing. He
gave Calc. carb. 3x, five grains to 5ij of water, five drops three
times a day, and a local application of calendula and vaseline.
Three weeks after finishing the medicine the hands — hitherto-
unchanged — began to improve, and gradually recovered their*
normal condition.

190 BUMMABY.

Pulmonary Tuberculosis. — In articles by Dr. E. E. Graham,
in the Oct. number, and Dr. H. S. Stark in the Dec.
number of the Therapeutic Gazette, much praise is given to
kreosote in the treatment of this disease — ^both writing from a
wide experience. The drug is given internally, in doses of four
drops three times daily, gradually increasing to forty or more.
By neither author is its germicidal power made much of, though
it is recognised. Dr. Graham thinks its chief use is to reduce
cough and expectoration; Dr. Stark attaches most importance
to its ** anti-fermentative power in the digestive tract," « by
which it favours nutrition and assimilation. Curiously enough,
in the same (Dec.) number of the Gazette appears a paper from
Dr. Longstreet Taylor, in which he says of kreosote, that '* it
upsets the digestive organs in the majority of cases, long before
it is being taken in sufficiently large doses to have any appreci-
able effect," and that after a conscientious and extended trial he
has given it (and guaiacol) up. This writer is, on his part,
•enthusiastic about the so-called ** Shurley-Gibbes " treatment,
which consists in the hypodermic injection of iodine and of the
chloride of gold and sodium, with disinfectant inhalations. The
testimonies he cites (in addition to his own) to its efl&cacy are
sufficiently striking; and as the drugs used are in no slight
liomoBopathic rapport with the disease, the treatment must com-
mand our interest.

Dr. Winterburn relates a case in which not only were there
all the rational and physical signs of pulmonary tubercle, but
the sputa revealed under the microscope the presence of elastic
fibres of lung tissue. Under silicea, sulphur and lycopodium
complete restoration to health took place. — Medical Advance,
ITov.

Soiatioa* — Mr. B., aged 45, robust and otherwise healthy,
has suffered for some weeks from a pain extending from sacrum
down through right lower extremity, following the course of the
anterior branches of the sciatic nerve. Ehus 6, one drop every
three hours, produced marked improvement in two days. The
medicine was continued four times a day. Three days later the
pain was only felt on moving. Caustic. 6, four times a day. After
two days more no pain, only some weakness and difficulty of
moving the leg. After a few days of caustic. 30 the affection
was quite cured. — Amberg, A, h. Z,, Sept. 29th.

Trismus. — Dr. Owens reports two cases of this affection, of
traumatic origin, in which physostigma 2x sufficed for the cure.
— Med. Era, Jan., p. 8.

JOURNAL

OF THE

fitifet lDMnpt|ir

No. 3. JULY, 1893. Vol. !•

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

36, Sillwood Boad, Brighton.

EHEUMATISM : SOME INVESTIGATIONS EE-
SPECTING ITS CAUSE, PEEVENTION AND
TEEATMENT.i

BY PEBCY WILDE, M.D.
Physician to the Bath Homoeopathic Hospital,

The great frequency of the disease is indicated by the
&ct that out of 15,552 cases admitted to St. Bartholomew's
Hospital during a period of six years, no less than 1,137
were cases of acute rheumatism, i.e., 7.31 per cent. This
does not include the large number of sufferers from the
chronic and acute forms of the disease, who were treated in
the out-patient department.

The danger of acute rheumatism lies in its remote, rather
than its immediate, effects. The mortality was only 1.32
per cent., but no less than 70.86 per cent, of these patients
developed heart disease as a result of the attack.^ It is

» Read before the Society, April 6th, 1893.

* In almost every case a blowing murmur was heard over the heart some
time during the acute stage, but these disappearing mxumurs are not included
in the above statistics. The liability to heart complications increases with
«ach attack; thus the percentage is 58.8 for first attacks, and this rises to 81.9
for third attacks. — Dr. Saml. West, Practitioner, 1888, p. 104.

VOL. I. — NO. 3. 13

194 BHEUMATISM.

when we consider the great frequency of this fever as com-
pared with others, and the large share which an impairment
of the heart's functions has in the mortality from all other
causes, that its dangerous nature can be justly appreciated.

In its sub-acute and chronic forms, rheumatism is re-
sponsible for a greater amount of pain and physical disable-
ment to the inhabitants of the British Isles than any other
disorder. If an estimate could be made of the pecuniary
loss which the country sustains as a result of the crippling
effects of rheumatism on its working population, it would
represent such a large sum that the consideration of means
for its prevention and cure would be regarded as a social
as well as a medical question.

The mortality and the suffering which attends it is
infinitely gi'eater than that of the combined effects of small-
pox and cholera, in the prevention of which so much public
money is very properly spent ; but the preventive treatment
of rheumatism is not at present regarded as a possible result
of the advance of medical knowledge. In respect to its cure,
I will only say that it was a study of the unfortunate
results attending the ordinary methods employed which led
me five years ago to a study of its nature and causes, with a
view to finding some more satisfactory method of combating
the disorder. As a result I was led to adopt measures for
the treatment of rheumatic fever which are the reverse of
those ordinarily adopted. While watching the results of
my earlier cases, it became evident to me that there were
methods by which rheumatism could be easily detected
long before its actual development, and that by very simple
methods of treatment the attack could not only be prevented,
but that the measures used for prevention were themselves
a cure for a large number of intractable disorders, due to the
.same coiiditions which produced rheumatism, but which are
jiot generally recognised as .associated with it. I hqtve
•delayed the statement of the results of this investigation
until the observation of individual cases had extended over
a sufficient number of years to enable me, not only to test
the results of treatment, but to examine the value of indi-
'Cations afforded by persons who, while in apparently perfect

RHEUMATISM. 195

health at the time the observations were made, exhibited
«igns which eventually led to the development of rheumatism
or its allied disorders.

Acute Bheuinatism,

The first question which suggests itself to us in the study
of acute rheumatism is : What is the nature of the fever ?
Is it a continued fever, attended with swelling and pain in
the joints as one of its most prominent symptoms, or is
the fever produced by the acute inflammation of the joints
themselves? The term "rheumatic fever" would pro-
perly represent the first condition, but " acute rheumatism "
would be a more precise mode of expressing the latter.

The "Encyclopaedia of Practical Medicine,'* published in
1834, tells us that " this disease is often designated by the
trivial name of ' rheumatic fever,' which impHes a constitu-
tional disease as well as a local." The continued adoption
since then of the term " acute rheumatism," to express
what is commonly known as rheumatic fever, would indi-
cate a general opinion in favour of the view that the fever
is the result of the local symptoms. From this naturally
follows the therapeutic induction, that if we cure the in-
flammation of the joints we can abate the fever, and that
whatever reduces the fever will be likely to limit the
rheumatic process and cure the disease. This view is not
an unnatural one, but it gathers very little support from the
results of clinical observation.

The following facts must be within the knowledge of
every practitioner who has watched the course and progress
of any series of cases of rheumatic fever : —

(1) The development of very high fever may take place
before the joints become affected.

(2) There is no direct relation between the degree of
fever and the number of the joints affected.

(3) Articular rheumatism may exist in a very large number
of joints without the existence of fever, and it is not un-
common in rheumatic fever for the joints to remain acutely
affected after the fever has subsided.

But further and very important evidence is afforded on.

196 BHSXJMATISM.

this point by the results of the use of salicylic acid and ita
salts in this disease. For many years the treatment of
rheumatic fever in our large metropolitan hospitals has
been synonymous with the use of salicylates ; we have in
consequence an amount of statistical evidence which proves
the undoubted power of this drug in controlling the fever
and in limiting the painful inflammation in the joints. But
we have also learned that although it is a powerful anti-^
pyretic, cases of hyperpyrexia are as common under its use
as they were under the older methods of treatment.^ We
find that convalescence is retarded, and that patients remain
in hospital longer than before. That, according to various
statistics, no less than 50 to 70 per cent, of the patients
treated develop heart disease.

I have stated only the most prominent of the facts which
may lead us to question whether the fever of rheumatism
can be regarded as a result of the local inflammation of the
joints, and this led me to consider whether remedies which
act as agents for subduing the pain or controlling the fever,
are of necessity the best that can be chosen for curing the
disease which gives rise to them. If we seek for further
guidance on the subject by making a study of the causes
which give rise to this particular form of fever, we are
brought into contact with many apparently contradictory
phenomena.

(1) The attack is most often due to a chill or exposure
to damp, but it may occur in persons who have for a long
time been confined to their rooms or to bed, when such
causes have not existed.

(2) It is common among men exposed to muscular fatigue,
but it occurs among delicately nurtured girls, who are not
placed under such conditions.

(3) It is commonest in youth and middle age, but it may
occur at a very advanced age, and it is noticeable that in its
chronic forms this disorder is most common among elderly
persons.

' See paper by Dr. Donald Hood, read before Medical Society of London,
Feb. 13th, 1888, in which the results of treatment of 9,850 patients at Quy's
Hospital before the introduction of salicylate treatment were compared with
1,145 cases treated by salicylates at Guy's and St. Bartholomew's Hospitals.

BHEUMATI8U, 197

The only condition amongst those usually stated to
which it is difficult to find an antithesis, is the influence of
cold and damp in combination in causing this disease.
Even here we have to remember that out of a certain
number of persons exposed to this condition only a small
minority will develop rheumatism. To establish a connec-
tion between certain conditions and the symptoms to which
we have given the name of rheumatism, leads only to para-
doxical results, because we are working without a knowledge
of the immediate causes from which these symptoms spring.
If we except the "nervous theory" of rheumatism, ascribed
to Canstatt and Seitz, but which is practically a modernised
version of the views of C alien, we may take it there is a
general agreement in favour of the existence of a poison
which is the direct cause of the symptoms of rheumatism.

Whether this poison is admitted into the blood in the
form of micrococci (Hueter), or exists there in the form of
a vegetable organism (Salisbury), or enters the system in the
form of a miasm, which resembles the effect of malaria
(Maclagan), or is lactic acid which has accumulated in the
blood or the excretion of which is prevented by the effects
of a chill — according to the views of Prout and adopted by
Todd, Bichardson, Fuller, and most modem writers, — it
appears probable that we shall be guided to a clearer under-
standing of this subject by considering the relation of causes
to this poison than by trying to directly connect them with
the symptoms it produces.

The symptoms of rheumatism are of a very marked and
definite character, and it appears a proper line of enquiry to
seek some substance which, introduced from without or
manufactured from within, is capable of producing symp-
toms on the healthy body resembling those of rheumatism.
I will venture, at the outset, to throw aside the considera-
tion of poisons introduced from without, as there is no
clinical evidence to support the theories which adopt them.

We know that the chemical laboratory of the human
organism is capable of producing poisons, instead of bene-
ficial products, as a result of derangement of its functions.
We can produce an impairment of function followed by

198 BHEUMATISM.

symptoms indistinguishable from a form of rheumatism, bjr
causing a person unaccustomed to great physical exertion to
•undergo excessive muscular fatigue. On the next day we
shall find that the muscles which have been especially
exerted are swollen, tender to the touch, and that every
movement causes sharp pain. We shall usually find also
that the reactions of the saliva and of the perspiration have
become acid instead of alkaline, just as we find them in
rheumatism. These symptoms are more temporary than
those which follow the effect of a chill in a "rheumatic
subject," because the disturbance of function in the healthy
subject more readily tends to rectify itself; but the charac-
ter of the symptoms is the same in both.

From the familiar experiment of the effects of muscular
fatigue on the muscle of a frog, we know that the result of
the over-stimulation of the motor nerve is to produce an
accumulation of lactic acid in the muscle, the effect of
which is to prevent the muscle reacting to the stimulation
conveyed from the nerve. Before this fatigue took place,
each contraction of the muscle was followed by an act of
perfect combustion, in which oxygen was used up and car-
bonic acid gas and water liberated. But under the
conditions produced by exhaustion the combustion is
incomplete, and lactic acid is produced as an intermediate
product of oxidation. If this lactic acid is washed out of"
the muscle by means of a weak solution of common salt,,
the muscle again responds when its nerve is stimulated.
It is usual to explain the defective oxidation by which the
lactic acid is formed by saying that all the available oxygen-
is used up. This view is not entirely correct, because if'
instead of washing away the abnormal product we gently
manipulate the muscle between the finger and thumb, we
can complete the oxidation of the acid, and the muscle wiU
again respond to stimulation. This tends to show that it *
is not the absence of oxygen, but of the power to liberate it,,
which is the cause of the imperfect combustion. This point
is of considerable importance, because while it is demon-
strable that the symptoms of muscular fatigue are due to the.
accumulation of sarco-lactic acid in its tissues, it is none

RHEUMATISM^ 199

the less true that fatigu^ of nerve, by preventing the
liberation of oxygen, may be, and is, a direct cause of the
production of this acid.

There is, therefore, no direct antagonism between the
nervous theories and the poison theories of this disorder.
The fault of the former theory is that it does not take into
account the many other causes which may produce defective
metabolism. We should not be right in saying that the
rheumatic pains from which a person who has undergone
over-fatigue suffers are directly due to lactic acid ; all that
we know of the direct effects of the excessive accumulation
of the products of tissue waste in the muscles is that they
cause a feeling of fatigue and loss of power, and this is not
of necessity followed by the pains I have described, as we
may gather from the study of athletic feats which require
the over-fatigue of muscles for many days in succession.

It is here that this enquiry brings us to the consideration
of two sets of conditions and symptoms. The first has
reference to the production of excess of products of the
lactic acid type in the tissues, the conditions causing it,
and the symptoms it produces. The second, to the manner
in which this condition may lead to the symptoms of pain,
inflammation and swelling of the affected parts, with or
without fever. The increased manufacture of these pro-
ducts involves so slight a departure from ordinary function
that the symptoms resulting may be so slight as not to
attract attention ; it is when this production is excessive
and continuous that it causes definite symptoms. The
conditions which give rise to the formation of lactic acid,
instead of carbonic acid gas and water, and of uric acid
instead of urea, are any which are capable of causing defec-
tive oxidation.^

* The type of chemical change here indicated is well illustrated by Dr.
Golding Bird. Starting with 1 atom of protein (which represents the ingre-
dients of all muscular and fibrous tissue), and adding to this 91 atoms of oxygen,
we obtain 1^ atoms of uric acid, 33 atoms of carbonic acid gas, and 30 atoms
of water. The uric acid from its insolubility may be the exciting cause of a
pathological condition, but if we add 6 atoms of oxygen and 4 atoms of water
to 1 atom of uric acid, we obtain 6 atoms of carbonic acid gas and 2 atoms of
urea, both of which are readily eliminated.

200 BHEUMATISM.

There may be a defect in the|Supply of oxygen owing to
the condition of the blood, or owing to impairment of its
circulation in the tissues. In respect to the defect of circu-
lation, it may be equally due to disuse or over-use of the
ipiuscle, to the influence of cold and damp, or to any cause
which depresses the activity of the peripheral or central
nerve centres. Thus the causes which appear conflicting
when considering the symptoms of rheumatism are found to
be acting in the same direction, when regarded as sources of
imperfect oxidation. This condition is the cause of many
troublesome ailments which the physician is called upon to
trcQit, and which remain intractable because the nature of
the ailment is not recognised. It is essentially a debility
which leads to the production and accumulation of acids in
the tissues.

Asthenoxia.

I shall speak of this condition as asthenoxia — a name
derived from the Greek words Aa-Oeveia, debility, and 0^u9, an
acid. It is not uncommon to find ** an acid condition of the
blood" described as an essential condition in gout and rheu-
matism, but this name does not imply the existence of this
condition ; on the contrary, I have examined the reaction of
the blood in a wide variety of cases, including many of rheu-
matic fever, and the blood has been invariably alkaline. Acid
products may be discovered in the blood in minute quan-
tities both in health and disease, bat the whole of my
investigations go to show that the acids are not conveyed to
the tissues by the blood, but are manufactured in the tissues
themselves, and that their destruction in situ is both the
ordinary physiological condition, and the one which should
be the aim of treatment.

When there is excessive accumulation of acid in the
tissues, symptoms are produced corresponding with the
action of a depressant poison on the system. A feeling
of weariness and indisposition to muscular exertion is
a prominent symptom. This symptom may be due to
physical debility or to neurasthenia, but in both these

JtHEUMATISM. 201

cases exertion will be followed by exhatstion. In asthe-
noxia, vigorous exertion will most often give relief.

There is this peculiarity respecting exercise — an ordinary
walk would cause fatigue, but cycling, riding or any form of
exertion which raises the heat of the body, and causes
vigour of circulation, temporarily removes the weariness
previously complained of. In some cases mental depression
is more marked than muscular inactivity. The patient
either worries over matters which would not otherwise cause
trouble, or recognises that there is no reason for depression,
but is still profoundly depressed.

The skin commonly presents symptoms which point
to defective circulation or disturbance of its innervation.
Instead of its natural transparency, it presents a dull opaque
appearance, and sometimes we notice that unhealthy pasty
look which is associated with the formation of comedones.
Irritation of the skin, especially about the eyes and forehead,
which sometimes passes into a low grade of erysipelas, is
invariably attributable to the condition of asthenoxia.
Another very frequent symptom is a remarkable sensitive-
ness of the skin to cold. That chronic and oft-recurring skin
eruptions are due to the condition of asthenoxia, and can be
readily cured by removing this condition, is a fact worth
noting, but I am not yet in a position to say more than
that when these conditions are found in conjunction,
measures should always be employed to remove the accumu-
lation of acid from the tissues. Asthenoxia often occurs in
association with anaemia, and renders this disorder very
intractable ; there is a reason for this to which I will presently
allude, and which shows that the removal of the acids from
the tissues should take priority over the remedial measures
used for improving the condition of the blood.

The effect of an excessive accumulation of acid in the
tissues sometimes causes dyspnoea which may be of a very
urgent character. This may be proved by the immediate
relief caused by methods used to remove the acid products.
The relation of asthenoxia to asthma is of considerable
importance in considering the treatment of the latter affec-
tion.

202 BHEUMATISM,

•

Before entering upon the study of the process by which
the acid products of the tissues are converted into a poison
capable of producing active inflammation, I will mention one
or two symptoms connected with the digestive system,
which, standing mid-way between asthenoxia and rheu-
matism, are not ordinarily traced to their cause, and which
prove VQry intractable to ordinary medicinal measures.

There is a form of gastrodynia which is associated with a
decided tenderness over the epigastrium, and which closely
resembles the symptoms of gastric ulcer, but it will be found
that the tenderness is more. diffuse and more superficial, It
does not readily yield to the treatment or dietetic measures
.used for gastric ulcer, or if it is relieved by the effects of
careful diet it readily recurs. An examination will often
prove that the patient is suffering from asthenoxia, and the
rapid and permanent improvement which follows the
removal of this condition will afford proof of the cause upon
which it depends. It is not uncommon to find a localised
tenderness over other parts of the abdomen, unaccompanied
by symptoms which would enable us to name a definite
cause, and sometimes accompanied by symptoms, such as
vomiting, which might lead to a very grave diagnosis. It
is the absence of symptoms associated with the graver
disorders, and the detection of the condition of asthenoxia,
which will enable a diagnosis to be made and rapid relief
given.

The Cause of Bheumatism,

A very extended series of observations confirms me in
the belief that the condition of asthenoxia invariably pre-
cedes the manifestation of rheumatism, but that it is a
disorder which may continue for months or years without
the production of symptoms which would be recognised as
rheumatic. It is necessary, therefore, to consider the
manner in which the acid products in the tissues may become
changed so as to produce the rheumatic poison. If we refer
to the results of overfatigue in the human subject, we find
that it is not until some time after the actual exertion that
the symptoms resembling rheumatism are produced, and
then only in a marked degree in those whose muscles are

BHEUMA.TISM. 203

feeble. The conditions presented, therefore, are an excess
of lactic acid in muscles reduced to a low state of functional
activity by the effects of over-fatigue. It is obvious that the
muscle is not in a condition to remove the excess of lactic
acid by combustion, and that some chemical changes must
take place. It appeared to me that the effect of lactic £|»cid
on tissue in a low state of vitality might be studied on the
muscles of a recently killed animal. If a portion of such
muscle be placed in a concentrated solution of lactic acid,
we shall observe that it is capable of entering into chemical
combination with the muscle without destroying its struc-
ture. The muscle becomes semi-transparent, and exhibits
an almost gelatinous appearance. The complete - chemical
transformation which has taken place is rendered evident by
the fact that if this muscle is kept for weeks exposed to the
air in a warm room, it will not undergo putrefaction or any
observable organic change. It will be observed that the
transparency of the preparation is increased by exposure to
the air, and that such exposure is almost necessary to com-
plete the chemical transformation.

Two fish which have been treated in this way and after-
wards exposed to the air in a warm room for two months
well illustrate this. In one of them the process of oxida-
tion was rapidly completed by immersion in a solution of
peroxide of hydrogen, with the result that the tissues are
preserved in their natural state and are permanently pre-
served. When the oxidation is left to the action of the air,
the tissues become more friable and less adapted for preser-
vation and anatomical preparations; but both specimens
represent the fact that acids such as are formed in the
tissues are capable of entering into chemical combination
with tissues when their vitality is lowered, without altera-
tion of the anatomical structure of the latter, and during this
process oxygen is used up, although destructive oxidation
vrith the evolution of carbonic acid gas does not take place.

It is of very great importance to a clear understanding of
the phenomena of rheumatism, that the process of oxida-
tion which takes place in animal tissue should be understood.
We are apt to think of oxidation as a process of combus-

204 BHEUMATISM.

tion attended with the evolution of carbonic acid gas ;
but there are conditions of incomplete oxidation, when any
carbonic acid formed is not given off, but re-absorbed, so
that the addition of oxygen serves to form a more acid
product than before.

Thus, if a piece of muscle which has been combined with
lactic acid be placed in a bottle filled with a weak solution
of permanganate of potash, and this bottle is connected by a
glass tube with another containing lime water, it will follow
that if the process of oxidation which takes place is
accompanied by the liberation of COg, it will pass along the
tube, and cause the formation of a milky precipitate in the
lime water. But the experiment may be watched for hours,
and it will be found that no gas of any kind is evolved by
the chemical processes taking place, in fact, there is a greater
tendency for the lime water to rise in the connecting tube,
showing that there is some exhaustion of the air in the other
bottle. The permanganate solution shows by its loss of
colour that it has yielded up its oxygen, but neither this nor
the COg has passed away, and the only alteration observa-
able in the muscle is an increase of its transparency.

While lactic acid in its pure state is rapidly oxidised in
the presence of an oxidising agent, we notice that when it
has entered into chemical combination with proteid matter
it is capable of using up oxygen to form a body, which I
show you, but into the complex chemical nature of which I
will not enter, but which has a more intense acid re-action
than lactic acid itself. While free lactic acid may be
regarded as a depressant to tissue functions, its combination
with proteid matter and with a quantity of oxygen insuf-
ficient to produce complete oxidation causes the formation
of an intensely acid product capable of acting as an irritant
to the tissue, and producing those symptoms which we
associate with the name rheumatism.

It will be understood, that by continually adding even a
weak solution of an oxidising agent we shall finally reach
the stage of complete combustion ; but I shall not make too
great a demand upon your imagination if I ask you to con-
sider that under the conditions which tend to produce the

RHEUMATISM. 203

accumulation of lactic acid in the human body, and the
causes which lead to the imperfect oxidation of this acid,
with the formation of the more acid product, the des-
truction of this intermediate body may not proceed faster
than its manufacture, and this may explain the condition
presented in cases of chronic rheumatism.

The previous experiment may be performed in another
way. The lime water is replaced by some coloured fluid,
and is connected with the other bottle by a fine capillary tube.
Here the coloured water will be seen to pass along the tube
in the direction of the bottle where the chemical process is
taking place. Its passage not only indicates that there is
no gas passing off from the bottle containing the acid muscle
and permanganate solution, but that there is no increase of
temperature as the result of the chemical action. Because
if the temperature of the solution was only raised by the
slightest degree, the effect would be to drive back the fluid,
which steadily rises towards it along the capillary tube.
This can be demonstrated by placing the hand on the per-
manganate bottle, when the fluid in the tube will immediately
flow back again, owing to the expansion of the air caused by
the shght heat conveyed to the bottle.

But it is quite possible to cause complete combustion in
this experiment by still further raising the temperature of
the bottle in which the process is being conducted. The
same result may be accomplished by adding a stronger solu-
tion of the oxidising agent. It is not only the quantity
of oxygen, but the energy with which it is supplied which
determines complete combustion. When we cause this
energy in either of the ways I have mentioned, phenomena
are produced resembling those of acute rheumatism. While
the process is taking place, intensely acid products are
formed which undergo combustion, and are given off in the
form of CO2 and water. But the process occupies some
time, and it is only when it is completed that the acid pro-
ducts disappear. While it continues, there is a decided rise
of temperature in the solution.

206 BHEUMATISM*.

The Cause of the Fever,

If in the light of these investigations we again approach
the question of the cause of fever in rheumatism, we have
before us the following data : —

(1) A person suffering from asthenoxia, whose tissues are
charged with excess of lactic acid, is exposed to a chill ; the
primary effect is to diminish the force of the circulation and
the amount of oxygen to the tissues, the secondary effect is
an increase of both.

(2) The result is to render chemical change in the tissues
more rapid — to cause, in fact, the rapid oxidation of the pro-
ducts of tissue waste. It is known that active chemical
change produces a rise of temperature, although it is a very
slight one ; thus if I add a solution of lactic acid to one
of carbonate of soda, active effervescence takes place and the
thermometer will show a rise of temperature equal to a frac-
tion of a degree, but if, instead of using carbonate of soda, I
employ a solution of permanganate of potash (i.e., an oxi-
dising agent), there is again brisk effervescence, and the
thermometer will show a very decided rise of temperature.
(The experiment was performed and the temperature of the
solution rapidly rose from 60*' F. to 140° F.)

It would be impossible to discuss here the relation of
the constant oxidation of lactic acid, or it would be more
correct to say, the chemical bodies which it represents, to
the maintenance of the body heat, or the general relation
which its more rapid oxidation bears to fever as a symptom ;
but this fact will be constantly observed : A patient who
suffers from an ordinary chill, with no symptom but fever,
or perhaps one of the forms of tonsillitis, or some other
slight affection which enables us to give a name to the
disorder, will usually exhibit (my experience is not sufficient
for me to say invariably) an acid state of the saliva and
perspiration, which will continue during the continuance of
the fever, but which will disappear when the fever abates^
The exception to this is that the acid reaction may continue
after the fever has abated ; in such cases it is iny experience
that convalescence is delayed, and I treat such patients for
asthenoxia, and directly the acid reaction disappears they

RHEUMATISM. 207

make rapid recoVei?y. The method of testing this point is
so simple that I prefer to wait for the accumulated experi*
ence of others before asking that my view should receive a
too extended application.

My own clinical observations leave no doubt upon my
mind as to the fact that if four persons suffering from the
same degree of asthenoxia each contract a chill, probably
only one of these would develop rheumatic fever ; and that
while the other patients would show a degree of fever out
of proportion to their inflammatory symptoms, that of the
rheumatic fever patient would be comparatively lower, al-
though the fever would be of longer duration. He exhibits
the symptoms of rheumatism because the functional activity
of the tissues is not sufficient to completely oxidise the acid
product, but permits it to enter into that combination with
the tissues which I have already explained.

The addition of permanganate of potash to lactic acid
represents the first three cases — a process of rapid oxidation
vsdth a high temperature is produced^ The addition of a
weak solution of permanganate of potash to muscle treated
with lactic acid represents the rheumatic case. With the
addition of heat produced by fever, active changes take
place which finally destroy the acid, but they are slower and
less vigorous than the former reaction.

Treatment of Bheumatism.

Prom the experiments we have made it will be seen that
the quantity of oxygen required to decompose the rheu-
matic poison is in inverse ratio to the amount of the heat
supply. These facts bring us to an obvious conclusion. The
fever which attends rheumatism, and the acute fevers from
which an asthenoxic subject sufifers, represent the destruc-
tion of a poison ; and the result of such attacks should
fee followed by an improvement in the general health, if the
process is helped by the physician, rather than that every
effort should be made to check the salutary process. It is
well known that all the ordinary antipyretic remedies, the
salicylates and quinine, serve to diminish tissue metabolism.
By offering a temporary check to the imperfect process of

208 BHEUMATISSf.

oxidation by which the rheumatic poison is formed, they may
effect an improvement in the external symptoms ; they
leave however the acid products undestroyed, and the vital
powers in a worse position than before to complete their
destruction. Convalescence is delayed, a greater tendency
is shown for the disorder to pass into the chronic form, and
relapses are frequent. This is precisely what our studies
would lead us to expect, and from the results of the use of
such drugs they receive their strongest confirmation. In
respect to the deplorable frequency of heart complications
under the use of salicylates, it appears probable that when
the tissues are charged with the rheumatic poison, and the
natural processes required for its combustion in situ are
checked, the poison is taken up by the lymphatics and
is thus conveyed to the heart.

While rheumatic fever is regarded as due to an acid
condition of the blood, little importance will be attached to
the necessity of its prompt removal from the tissues ; but
having proved that acidity of the blood is not a normal
occurrence in rheumatism, and that the poison is formed
and decomposed in the tissues, then the great importance
which I have learned to attach to its active destruction and
ready elimination will be appreciated.

Both in asthenoxia and rheumatism the presence of
acid products in the tissues, by depressing their vitality,
favours further production. Their removal, therefore, is the
first indication for treatment. It is obvious that all methods
which favour increased metabolism assist the destruction of
the poison. The most rapid method of increasing metabo-
lism is by raising the temperature of the body, by simulating,
in fact, the process which occurs in fever. The effect of
heat applied to the body is threefold : —

(1) It directly facilitates chemical change.

(2) It causes an active circulation, and therefore an in-
creased supply of oxygen to the superficial tissues.

(It is worth noting that while a rheumatic patient may
exhibit a very high temperature, the appearance of the skin
usually shows defective circulation in the superficial tissues,
which do not receive the full effect of the brisker circulation

BHEUMATISM, 209

paused by the fever. This explains why " natural " fever is
less effective in increasing metabolism than the application
of heat to the surface.)

(3) It aids the elimination of waste products by means of
perspiration.

In reference to this point it is important to observe that
the act of sweating is not in itself a cure for rheumatism.
Continued sweats are common in both acute and chronic
cases, and experience shows that they dp not give relief.
■ They are due to an almost paralytic condition of the vaso-
motor nerves, the result of the poisoned condition of the
tissues ; thus while it favours the elimination of waste pro-
ducts it also favours their production, with the result that
no benefit results to the patient. The application of
external heat in such cases gives immediate and appreciable
relief, and its subsequent result is to limit the amount of
sweating.

In cases of asthenoxia and the slighter forms of rheuma-
tism, a wide choice of methods for raising the body tempera-
ture is open to the practitioner ; but in acute cases, or when
there is some debility, we are practically restricted to those
which can be administered while the patient is in the hori-
zontal position. Bearing in mind the fact that the secondary
effect of heat is to diminish tissue metabolism, it is desirable
to use no greater amount of heat than is necessary to raise
the body temperature, and at the same time cause perspira-
tion. The raising of the body temperature without the act
of perspiration would cause discomfort to the patient. Hot
water baths are inadmissible in acute inflammatory condi-
tions, because they cause too much arterial excitement ; they
are valuable for the same reason in the chronic forms.

One of the most satisfactory methods, and one which
need never be omitted because of a difl&culty in obtaining
appliances, is the '* hot moist blanket pack." This differs
only from the " cold sheet pack " in the fact that a blanket,
wrung out of water at as high a temperature as possible,
takes the place of the cold wet sheet. It is important that
the blanket should be " moist '* and not ** wet," and it is an
advantage to use a hot-water bottle to the feet, and another

VOL. I, — NO. 3. 14

210

bHEnMATISU.

(made of india-rubber) to the back. The only objection to
this in the treatment of acute rheamatism is that it requires a
certain amount of lifting the patient or bis removal &omthe
bed. The same objection applies to the other methods in
ordinary use. To obviate this difficulty, and to remove that
sense of restriction which many patients find unpleasant
while packs are being given, I invented an appliance which
I have called '■ the Vaporarium." It consists essentially
of a metal cover, large enough to form an arch over the

patient while lying in bed, and to extend from the shoulders
to the feet, at which end it is closed. This cover is double,
so that a space of a little less than balf-an-inch is left be-
tween the outer and inner surfaces. This space is filled
with boiling water, and it ie the heat radiated from the
metal, in addition to that given off from the patient's body,
which forms the means of raising the body temperature.
As moisture is necessary, this is provided by simply wringing
a piece of flannel out of hot water and enclosing it inside the
appliance — practically it is laid upon the patient's body.

BHBXTMATISSf. 211

This appliance can be recharged without removing it from
the patient's body, but this is never necessary, as it will
retain its heat for a longer time than is required for any
single process. For convenience it is made in two halves,
and it is when these are used separately for a prolonged
vapour bath to the upper or lower part of the body, that the
advantage of being able to refill them, or keep a constant
stream of hot or cold water circulating through them, makes
itself apparent.

The effect of raising the body temperature in cases of
asthenoxia and rheumatism differs from that which fol-
lows it in fever arising from other causes. Its use in such
cases is usually followed by a marked fall of temperature,
which can be made permanent if the process is repeated
daily, or oftener if necessary. The effect is not that of an
antipyretic, but that of an agent which checks the inflam-
matory condition, and the fall of temperature is accompanied
by improvement in the physical signs. In cases of asthe-
no^a or rheumatism attended by a febrile condition but no
actual pyrexia, the effect of artificially raising the .body
temperature is frequently to cause a permanent increase of
temperature which may last several days. I do not mean
by this that a single tenjperature is maintained, but that the
daily rise and fall is higher than that of the preceding day,
and under the influence of daily applications of heat this
rise will continue for a certain number of days, when there
will be a sudden fall of temperature after the use of artificial
heat, and the temperature speedily falls to normal, at the
same time the reactions which were acid become neutral.^

No stronger indication could be afforded of the general
correctness of the views which this investigation led me to
adopt than the observation of one of these cases. The
effect, so far as the temperature chart is concerned, is to
produce a mild attack of rheumatic fever, but apart from

> It wiU be remembered that while the normal reaction of the perspiration
and saliva is alkaline, the first is mixed with the acid secretion of the seba-
ceons glands, and the latter with the acid mucus of the mouth, and that
therefore as we examine them clinically, the normal reaction may be said to
be neutral. But when either of the mixed secretions leaves blue litmus paper
tmchanged, we may take it that the pure saliva, or pure secretion of the
sweat glands, is alkaline.

212 BHBUliATISM.

the indications afforded by the thermometer there is nothing
to show a febrile state, on the contrary the patient feels
better each day, the symptoms formerly complained of abate,
and the whole appearance manifests improvement.

Although the aim of the treatment I have adopted for
some years is to convert all sub-acute and chronic cases of
rheumatism into acute ones, the expression must be taken
to represent the ssmaptoms exhibited by the temperature
chart, rather than those of which the patient is conscious.
The pain in the joints or the feehngs of general malaise
are always mitigated from the first day of treatment. It
would appear to follow from these results that in cases of
acute rheumatism, attended with marked pyrexia, the same
treatment would tend to increase the fever to a dangerous
extent. But it does not happen to be so in practice. The
reason of this appears to be, that as the fever is simply the
product of a more rapid process of oxidation, and as there
are limits to the degree to which this process can be stimu-
lated, depending upon the supply of oxygen, a natural safe-^
guard is interposed between excessive oxidation and the
production of such a degree of heat as would endanger life.^
"While in the early stages of acute rheumatism the artificial
raising of the body temperature is usually followed by a
slight rise, and the reverse happens during the latter part of
the attack, there is a variability in the temperature results
which are only explained if this factor is taken into account.

Against this treatment, the danger of hjrperpyrexia
may be brought. But all pathological and clinical evidence
points to the central nervous system as the origin of this
symptom. Experience shows that antipyretics and the use
of extreme cold, which check tissue metabolism, do not
reduce the fever in these cases, and that it will continue
to rise when all the vital powers are at their lowest ebb.

* Thus while the use of a hot pack will usually produce a rise of tempera-
ture of 2° F. in a person whose temperature is normal, the same applica-
tion will rarely raise the temperature more than half a degree if given to a
patient whose temperature is already 105' F. The first "pack" given to a
patient with acute rheumatism may cause a rise of 3° Fah. during its applica-
tion, but as the quantity of acid in the tissues is diminished, a rise of } to 1° F»
is all that is produced.

RHEUMATISM* 213

If it is due to the direct effect of the poison upon the
heat-producing centres, this will account for its comparative
frequency under the use of antipyretics, which arrest the
destruction of the poison, and its absence in the 107 cases
of rheumatic fever which I have treated by raising the
temperature of the patient.

Another source of anxiety which the practitioner may
have in adopting this method, is the propriety of doing so
when the patient is very debilitated or has a weak heart.
If this debility is due to the presence of unoxidised products
in the system, or is maintained by them, I can affirm from
the results of the use of this process many thousands of
times, that it is not only free from risk, but that it will yield
speedy and more permanent results than any tonic which
could be selected.

It is time to mention that although I have spoken only
of the use of heat, each of these applications is followed by
the use of tepid water to the surface of the body. This con-
sists in uncovering one limb at a time, sponging with water
at 75° F., and rapidly drying with a towel, which is not wiped
along the surface of the skin, but lightly and briskly rubbed
to and fro over it. It is then covered up and another portion
of the body treated in the same way, until the whole body
has received both the application of water and friction to the
surface 6f the skin. The object of this is obvious. Heat
forces tissue metabolism, but its after effect is to diminish
it. Cold^ and friction of the skin stimulate the natural
production of heat, and increase therefore oxidation in the
tissues. It would be possible, when the vital reaction is
good, to use no other agent but cold to obtain the object we
have in view by the use of heat, but the result would be
slower, and the great relief to pain which the method I adopt
gives would not be obtained. But so soon as the neutral
reaction of the perspiration shows that the acid products
have been removed from the tissues or reduced to a low ebb,
then the use of heat can be abandoned, and the " Cold

' As explained in my article on Thermo-therapeutics (Medical Anmuil,
1890), heat and cold are relative terms. The physiological effect of water at
75° F., following that of vapour at 106° F., is that of "cold," although it is
*' tepid " when considered in relation to the normal temperature of the air.

Q14 , BHEUMATISM.

friction " which IhaVe described, but carried out more vigor-
ously, becomes the main treatment necessary. This is done
by lowering th6 temperature of the water to 65° F., and
finally to 50° F., and using more prolonged friction.

I attach immense but not too great an importance to
this simple process, not only in the cure of asthenoxia and
rheumatism but also in other forms of debility, and in none
so much as persistent anaemia. By it all the good effects
of cold baths can be produced, without shock, risk or
danger, no matter how delicate the patient may be.

When the patient's cutaneous, circulation is so far
restored that ready reaction takes place, the third stage of
treatment may be commenced. This consists in the use of
exercise performed while the patient is in bed or lying on a
couch, the principle being that devised by Ling, in which
the effort made by the patient is resisted by the operator or
nurse.

Besults,

There is a natural difficulty attending the preparation of
statistics bearing on the treatment of rheumatism, because
the disease is naturally variable in its course and termina-
tion. In respect to the frequency of heart compUcations,
in the 107 cases of acute rheumatism I have mentioned, by
which I mean cases accompanied by continued fever, no
cardiac complications have taken place.^ I do not take this
as evidence that such complications will never occur jn
patients treated according to the methods I have described,
but that such a proportion as seven out of ten should
have heart complications is quite impossible.

As regards the pain and inconvenience caused by loss of
power during the acute attack, I think that the testimony of
my nurses is more eloquent than any statement I could
make. The treatment I adopt gives more labour to the
nurses than the administration of medicines at stated inter-
vals, but they are all of opinion that the actual labour of
nursing a case of rheumatic fever is far less under my

^ Since this paper was read the number has risen to 111, a record unique
in. the history of the disease.

BHEUMATISM. 215

xaethod than in ordinary cases, because throughout the
attack the patient is better able to assist himself, and suffers
430 much less pain.

In respect to convalescence and after effects, we have
learned to expect that the patient wUl be in better health
after the attack of rheumatic fever than before it. . .When it
is remembered that this acute attack is Nature's effort to
free the system of a depressing poison, there is nothing
extraordinary in this result, although it is contrary to
ordinary experience. One point we are careful to impress
on patients dismissed from the hospital, and that is to
return for examination in six months. If the symptoms of
asthenoxia are present, although the patient is in apparently
good health, we give treatment to remove this condition,
which usually occupies a week, and saves the patient from
an attack of acute or chronic rheumatism.

I claim that rheumatism is one of the most preventable
disorders as well as one of the commonest from which the
inhabitants of this country suffer. It is only necessary that
the physician should detect the very common condition of
asthenoxia, and employ the simple method I have described
for its removal. Let it be understood that I do not assert
that the discovery of this condition indicates that the
patient is " rheumatic," but it means that if this condition
is allowed to continue, rheumatism is one of the forms
of disorder from which the patient may be expected to suffer ;
but there are many others beyond those to which I have
already alluded.

The removal of the excess of acid may not take more
than three days, and in many cases the relief from its
depressing conditions enables the vis medicatrix naturce to
assert itself, and the condition does not return ; but when it
-depends upon a debility of circulation, of muscle or nerve,
we must only regard the patient as cured when these con-
ditions are removed.

While these investigations explain why physical methods
which have been held in certain estimation in the treatment
of rheumatism produce these effects by overcoming me-
chanical obstacles which hinder the cure of the disease.

216 tDISCUSSlON ON RHEUMATISM.

they do not prove that remedies are useless — on the con-*^
trary, they make it the more clear that all medicinal agents-
which act as specific stimuli to the tissues affected by
'rheumatism, or act by augmenting the general metabolism
of the body, must be of value in removing the cause of the
disorder. No object is to be gained by claiming too much
for one or the other. The method of physic and physical
methods are most powerful for good when they act to-'
gether, and both are useless unless properly selected and
judiciously administered.

Dr. Hughes said that he admired the ingenuity of Dr. Wilde*s
paper, and it was full of interest from the point of view of organic
chemistry. He was at first dubious as to its bearing fruit, for
whatever might be thought to be the chemical cause of the disease,
it was probable that for all practical purposes it would be lactic
acid under another name. As the paper went on, however, he
found the method indicated one that promised a helpful way of
treating rheumatic fever, which generally needed more than
dynamic remedies. Dr. Wilde's method supplied the need of an
extra-dynamic treatment, such as of old had been sought in
alkalies, lemon- juice, &c., and he felt that we ought all to be dis-
posed to try it. The action of our homo6opathic remedies in
rheumatic fever was very valuable, but hardly so much so as in
other pyrexiae, and hence the necessity of additional means of
treatment.

Dr. Edwaed Blake said that to begin to understand the
relations of the various forms of gout, of rheumatism, and
of the allied joint affections, it is needful to remember that :
(1) Neither gout nor rheumatism exists as a classic disease;
that is to say, there are no such pathological entities. (2)
There are no absolute anatomical characters to differentiate
between the chondro-synovitis of gout and that of rheumatism,
of puerperal fever and of the other arthropathies. It cannot be
too often repeated that the difference is clinical. It is etiologic
and not histological. Thus everyone admits that lead, alcohol
and traumatism may lead to the development of gouty chon*
dritis. He witnessed recently acute septic urethritis in a gouty
old gentleman of 72 pave the way to the production of an
undoubted attack of podagra.

He asked Dr. Wilde what evidence he could adduce that lactic
acid alone has the power to cause rheumatism? It is more

DISCUSSION ON BHEUMATISMt. 2l7

likely that every agency which can abruptly arrest metabolism
may lead to rheumatic fever. On the other hand, any agency
which slowly modifies metabolism may cause chronic rheu-
matism or osteo-arthritis, the differences between these two
being quite an artificial invention of the Bath School. Our
pathogeneses teach us that every poison known to man, every
drug in the pharmacopoeia, may induce symptoms resembling
those of rheumatism, and we ought to expect this, for they all
modify metabolism, or otherwise they are not poisons at all.
He said that he had previously drawn attention to the fact
that the agencies — ^mental, moral and physical-^which induce
joint disease in man, cause nerve disease in women and skin
disorder in children.

Dr. Blake was especially interested in the remarks made by
Dr. Wilde on the skin-changes of rheumatism. We are all
familiar with the erythema of rheumatic fever and of puerperal
septicaBmia, but in the chronic forms of rheumatism the derma-
toses are just as constant and quite as important. The chon-
dritic changes attract our notice, in that they not only impair
movement, but seriously mar the symmetry of the body; but
from the pathological standpoint the cutaneous changes are
more significant and more important. All the arthropathies
are preceded by variations of temperature and by modifications
of sensation. The earliest change is a fall of temperature,
associated usually with anaBsthesia. The second is a rise of
temperature, with hyper- assthesia and erythema. The third is
dysidl-osis, or else hyperidrosis. The last is cutaneous atrophy —
" satin- skin " — ^with certain changes in pigmentation, usually
xanthelasma of covered portions and melanosis of exposed areas.
A careful study of these modifications convinces us that in
the gouts and the rheumatisms we have to do with a great
variety of forms of peripheral neuritis, possessing fixed cha-
racters, and having each a distinct and definite toxic origin. The
cartilage and the bone changes are mere late results of neurotic
dystrophy. They bear no essential relation to the disease, there-
fore " osteo-arthritis " is an unfortunate and misleading term.

Dr. Cook said as long as Dr. Wilde contented himself with
facts he was in agreement with him, but with his theories he
entirely disagreed. When organic matter of any kind was brought
into contact with permanganate of potash or peroxide of hydrogen,
as an end product carbonic acid was always developed ; in fact,
there was only one organic product known which did not so
oxidise, viz., acetic acid. But when Dr. Wilde attempted to

218 DISCUSSION ON BHEUMATISM.

show that oxidation of fresh muscle produced extra acidity other
than carbonic acid the experiment was fallacious — ^there was no
extra acidity. The test was fallacious, for with the two pieces of
litmus paper the one fluid had removed the opacity of the paper
and the other had not, hence the tints appeared different and the
transparent paper more acid, but that was because the back-
ground was different. It was well known that lactic acid injected
into the body would not produce rheumatic fever — it is not the
cause of the pains, but some subtle organic compound other
than lactic acid probably operating in minute quantities produced
the symptoms. Dr. Wilde's theories were pretty, but not borne
out by facts. You may have lactic acid poisoning, but he believed
ptomaine poisoning is probably a cause of rheumatic pains. Acetic
acid as well as lactic acid causes muscle to become transparent,
and this proves nothing. The removal of acid products is nature's
remedy, and with this he agreed. Dr. Wilde's apparatus was
nothing more than a Turkish bath, and an increase of nature's
plan. In bad cases the hyper-pyrexia and the great perspiration
was but nature's plan for removal of poison, the quantity present
being greater the worse the case, and therefore the greater the
effort needed to remove it. When the liquid perspiration was
prevented condensing on the skin by outward application of dry
heat, much more heat was removed from the fever patient than
when it did so condense, and hence Dr. Wilde's appliances were
good. He agreed with the treatment, but not with the suggested
reasons for it.

Dr. Dycb Brown agreed with Dr. Cook that lactic acid was
not the cause of the symptoms known as rheumatism, and the
theory led to no practical result. If lactic acid were the cause
ought there not to be some symptoms before the explosion which
terminated in an attack ? If the elimination of the poison were
effected by the fever he did not see why those cases with profuse
perspiration and high temperature did not get well the quickest.
If elimination were the only thing to be aimed at, these patients
ought to have a short attack. He constantly tested the saliva of
patients with abnormal rheumatic symptoms, and in nine cases
out of ten he found it markedly acid. He could not agree either
with the theory or the mode of treatment proposed by Dr.
Wilde.

Dr. Dudgeon had seen cases of semi-acute rheumatism in
which the symptoms were often of a lingering charsicter. In
these cases the perspiration was commonly very profuse, and the
greater the perspiration the intenser the disease. When by the

PIBCUSSION ON RHEUMATISM. 219

action of medicines the perspiration is reduced the rheumatism
lessens pari passu. The rheumatic pain would return with the
perspiration and thus prove that relief came not through the
elimination of the acid through the perspiration, but that the
perspiration is developed along with the rheumatism.

Dr. Garfbae confessed that he could not see the advantage of
the Vaporarium described by Dr. Wilde over the ordinary bed
Turkish bath, a cradle and a spirit lamp ; he had followed this
mode of treatment very successfully. He thought the condemna-
tion of the salicylic acid treatment of rheumatic fever to be
exaggerated.

Dr. Madden wanted to know whether the sweating treatment
would be applicable in cases of hyperpyrexia.

Dr. Wilde replied that among his cases he had had none of
hyperpyrexia.

The President (Dr. Galley Blackley) was sorry to have to
confess that the theory of the lactic acid origin of rheumatism
was proved in practice to be untrue. He said that if one
examined with blue litmus paper a number of cases, in ninety-
nine out of a hundred the moist surface of the tongue would be
acid. The secretion of most of the mucous surfaces is acid. He
had used the wicker-work lamp bath with benefit. Every
modern investigation went further and further in the direction of
the bacillar origin of rheumatism, and he looked forward to the
time when the bacillus would be isolated and a toxine prepared
from it.

Dr. Percy Wilde, in reply, said that the discussion had
clearly proved that he had failed to make his views intelligible
to the meeting. He had tried to show them that lactic acid may
accumulate in the tissues to a large extent without the production
of any very definite symptoms, and when they did declare them-
selves they were not always those which we associate with the
word rheumatism.

To explain the conditions under which rheumatism was pro-
duced in those who suffered from this accumulation of acid
products in the tissues, he showed that lactic acid was capable of
combining with muscle (or other proteid matter) without causing
alteration of structure, and that no structural change followed the
subsequent exposure of the muscle to an oxidizing agent too weak
to produce complete combustion. ^ But under such conditions an
increase of the acidity of the proteid matter must take place.
Dr. Cook distinctly denied this, but in doing so he must have
forgotten that when oxygen was added to muscle in quantity

22d DISCUSSION ON BHEUMATISMr

sufficient to liberate all the carbonic acid gas, there would be left
behind uric acid and water, so that the residue would be intensely
acid, although the original muscle was neutral. But in the
experiment he had shown, the oxidation was not sufficiently
complete to drive off the carbonic acid gas, and therefore so much
as is formed goes to increase the acidity of the remaining product.
Dr. Cook appeared to have forgotten that both lactic acid and
uric acid were examples of acid produced by imperfect oxida-
tion. Dr. Cook had also apparently forgotten that there are
physical reasons why dry heat would not be used by any person
acquainted with the principles of thermal treatment for raising
the temperature of the body, and therefore when he said that
the appliance he (Dr. Wilde) had shown there was nothing more
than a Turkish bath, he made a mistake into which he hoped
the others would not fall. The exposure of a patient to the
fume of a lamp was not only the wrong way to obtain the result,
but a prejudicial and dangerous method. As moist heat was
required, and this could be obtained Iby the hot moist blanket
pack, he trusted that this would be used.

In reply to Dr. Dyce Brown's query as to why, if the fever
eliminated the poison, cases of rheumatism attended with high
fever and perspiration did not get well the quickest, he could only
express surprise that Dr. Dyce Brown doubted the fact. We all
know that cases of acute rheumatism terminate naturally in a
certain number of days or weeks, that sub-acute cases tend to
run a slower and more lingering course, and that chronic rheu-
matism is interminable. He had shown how all cases of
rheumatism might be made to take the course of acute cases,
without the pain and discomfort usually associated with the
word acute. The results proved that in acute cases instead
of seven out of every ten becoming permanently affected
with heart disease, 107 cases could be treated without this
occurring once, and that it was a usual remark with patients
that they felt better after the attack than before. If Dr. Dyce
Brown could not agree with a method of treatment which
accomplished such results, and the advantage of which could be
proved by the effects produced on the first patient on which it
was tried, he would be glad to have a better method pointed out
to him.

Dr. Wilde concluded by thanking the members for the
patience with which they had listened to a paper of such great
length — a fact which he only recognised when he looked at the
clock at its conclusion.

CASE OF TRAUMATIC OSTEITIS. 221

A CASE OF TEAUMATIC OSTEITIS OF THE

SKULL, SUBSEQUENT MENINGITIS WITH

DOUBLE OPTIC NEUEITIS: TEEPHINING :

EECOVEEY. 1

BY C. KNOX SHAW.
Burgeon to the London ffomosopathic Hospital,

Frederick W., an intelligent lad aged nine years, was ad-
mitted to the hospital on May 26th, 1892. About five weeks
previously, whilst at play, he had a severe fall, striking the
back of his head against a brick wall. He did not take much
notice of this at the time, but a fortnight afterwards his
mother noticed a swelUng on the back of his head. He now
complained of headache and of difficulty in reading. On the
16th of May, his headache continuing, he began to vomit,
and on the 19th he presented himself with Mr. D adleyWright 's
put-patients, when he was found to have a fluctuating swell-
ing in the mid-occipital region, vomiting, headache and
double optic neuritis. He had a slight convergent strabismus
^nd his pulse was 80. The symptoms continuing, he was
admitted to the hospital, when his condition was found to be
much the same as when last seen, but he was listless and
moping, his pulse was 84 and slightly irregular. Vomiting
and headache were marked symptoms, but there was no
paralysis nor twitchings nor convulsions, Though he still
complained of his sight he was able to read. He was ordered
belladonna Ix, three drops every four hours, and put on low
diet.

The boy was kept quietly in bed for three days, and the
vomiting ceased. On the 29th he was anaesthetised and an
elliptical incision made over the swelling on the occiput. An
abscess was opened : the pericranium was seen to be loosened
and the bone beneath was bare and rough. On a sharp
spoon being used to scrape away the rough bone, its texture
was noticed to be very friable and the bone permeated with

1 From notes made by Mr. Leo Bowse, Besident Medical Officer. Clinical
Evening, March 2, 1893.

222 CASE OF TRAUMATIC OSTEITIS.

pus which seemed to come from the diploe. A little further
scraping opened the cranial cavity, from which pus exuded.
A large trephine was now applied, and the whole of the soft-
ened parts were removed. Ljmaph and pus were now found
on the intra-cranial portion of the bone and the dura mater :
the latter bulged slightly into the wound and pulsated freely.
As the symptoms of the patient did not point to any localised
collection of pus and were compatible with a diffused menin-
gitis, it was not thought advisable to open the dura mater.
The parts were very carefully antisepticised and the wound
closed, leaving an angle open for drainage. The subsequent
history of the case was eventless. He had no vomiting, and
but little headache, and by June 7th the wound was quite
healed. He was out of bed on the 14th, but was kept in the
hospital till July 8th, by which time his optic neuritis had
subsided.

After leaving the hospital he went to a convalescent home.
At the present time he is very well and has complained of
nothing but a little headache when at school, but this I find
is due to a simple myopic astigmatism for which I have
ordered him glasses.

Bemarks : — This is a very interesting and instructive case.
At the time of the operation the boy stood on the brink of a
very serious and frequently fatal disease, and he probably
owes his escape to the fact that his primary injury was un-
attended by a wound, so that the severity of his septicity was
lessened. The first point we notice in the case is the slow-
ness of the development of the symptoms ; in injuries of this
kind the first fortnight is often symptomless, as in this case,
but then the headache, apathy, vomiting and optic neuritis
are gradually followed by the more serious symptoms of con-
vulsions, coma and death.

The sequence of events is accounted for probably in the
following way : the blow injures the peri-cranium and bone
and sets up a certain amount of osteitis, the inflammation
spreads to the diploic veins and thence to the inner table.
Lymph now forms between the dura mater and the bone :
the lymph, being very prone to suppurate, soon extends the
inflammation to the arachnoid, and a diffuse meningitis
follows.

CASE OF ELEPHANTIASIS ABABUM. 223

The case exemplifies the difference between a simple
traumatic inflammation with the formation of pus and a
similar condition where the pus has become septic. For in
this case we were saved the terrible pysemic condition which
accompanies septic wounds of the skull. It further shows
that in dealing with injuries of the skull we ought to treat
them in the same manner as we should osteitis in any other
bone, viz., by trephining to open the diploe, or even the
cranial cavity if necessary, to give vent to pus or any inflam-
matory material. If we had waited for more pronounced
symptoms to develop, the operation would have been delayed
too long to have been of any real service.

Mr. Jacobson has written very interestingly on this sub-
ject in his work, ** The Operations of Surgery," and this case
typifies nearly all the points he raises there.

Belladonna was the only medicine given to the boy, and
was continued the whole of the time he was in the hospital.

CASE OF ELEPHANTIASIS AKABUM.^

BY J. GALLEY BLACKLEY, M.B.
Physician to the London Homceopathic Hospital.

The patient was a woman, aet. 55, an Englishwoman born
in Kent, who, having never been out of England, and during
the greater part of her life having resided in or near Lon-
don, had severe elephantiasis of the right leg. Her family
and personal history were both good. She was in hospital
with acute rheumatism fourteen years ago, but the enlarge-
ment had then been in existence about fifteen years. It
began gradually and had gone on steadily increasing, although
her general health had been quite unaffected. Beyond the
difficulty of locomotion, the growth gave her no trouble.
The girth round the knee was now twenty-nine inches.

» Clinical Evening, March 2nd, 1893.

224 ON DENTITION,

Examination of blood and urine during her stay in hospital
about two years ago, gave negative results. Hydrpcotyle <f>
had been steadily given for months at a time, but
without effect. Massage had also been tried, but with
no permanent benefit. Photographs of the case taken by
Mr, Spencer Cox, when she was in the hospital, were
exhibited and showed that the progress since then had been
but sKght.

In reply to a question by Dr. Cook, Dr. Blackley stated
that the blood gave no sign of the presence of filariae.

ON DENTITION.!

BY GERAED SMITH, M.R.C.S.BNG.

The whole of child life is a time when the organism
is open to abnormal deviations, provided there be a causal
influence at work, either originating outside the body, as
in the case of chill or infection, or coming from within in
the form of some upset of a physiological process. Such an
internal causal influence is difficult dentition. (I am not
concerned here with normal dentition.)

It may be as well to briefly mention the nervous con-
nections of the teeth. Through the medium of the superior
cervical ganglion of the sympathetic, the teeth have anatom-
ical relations with the trifacial, pneumogastric, and glosso-
pharyngeal nerves; this ganghon sends a branch direct to
the jugular ganglion of the pneumogastric, and the ganglion
of the root of the pneumogastric; also to the petrous
ganglion of the glosso-pharyngeal.

The carotid and cavernous plexuses have intimate con-
nections with this cervical ganglion, and through them this
ganghon is connected with the ophthalmic branch of the
fifth, and the ophthalmic ganglion. These are not the only
ophthalmic relations of the teeth through the cervical

^ Bead before the Society, February 2nd, 1893.

ON DENTITION. 225

ganglion ; we have connections from the cervical ganglion
with the middle meningeal plexus, and hence with the optic
and inferior maxillary nerves ; the otic and casserian gang-
lions also are in relation with the teeth via the sympa-
thetic. These, although very imperfectly described, will be
enough to lead us to expect reflex affections of the stomach
and intestines, the sahvary glands and glands of the neck ;
the eyes, ears, larynx, and respiratory mucous membranes,
and the central nervous system, as the result of severe or
abnormal dental irritation.

The affections due to teething may be either local or
reflex ; the local affections, due to direct irritation of the
structures of the mouth and throat, are the well-known
excessive salivation, which scarcely needs to be considered
as a thing beyond a physiological process. But there is a
sense in which it may be useful to treat it. A very humble
nursery precaution may be taken in the shape of the ap-
plication of a piece of waterproof material to prevent the
constant chilhng of the front of the baby's chest by the thin
saliva.

But this process may go on to catarrhal stomatitis,
accompanied sometimes by enlargement of the submaxillary
or cervical lymphatic glands ; and, more rarely, aphthous and
ulcerative stomatitis may arise. The lesser trouble of ulcer-
ation of the fraenum linguae may also be troublesome ; these
affections are worth treating.

With regard to therapeutics, in my unregenerate days
two drugs were always useful. They are used by our
orthodox brethren on mferely empirical grounds, and with
su<$cess. Now I use them for better reasons ; they are
borax and chlorate of potash, and they will act well, as you
all know, in far smaller doses than allopathy uses. In
simple ulceration of the fraenum, kali chlor. will cure in
the 3x or higher triturations, and when there is aphthous
ulceration, or more unhealthy conditions, borax in the same
trituration seems to me to be useful. You will, of course,
remember how borax suits nervous, screaming children, who
clutch at their nurses and are afraid of falling out of their

VOL. I. — NO. 3. 15

226 QN DENTITION.

arms. Loose, pappy, offensive stools seem also an indica*
tion for borax.

If the frightened state is due to active cerebral con-
gestion, I think you will all agree that belladonna is better
than borax, the absence of fever being the ground for
selecting borax in these children.

In catarrhal stomatitis, kreasote and sulphuric acid are
good remedies. Kreasote I find useful in rather high
dilutions (high, I mean, for me), 6, for example ; sulphuric
acid I use lower, but this may be wrong, 3x being my
usual practice. I confess to having been badly served by
mere, sol., perhaps because I use it wrongly. I should be
glad to hear some discussion as to this drug.

When enlarged glands are prominent symptoms, silica
comes in. I have to make a confession here ; I am fond of
iodide of potassium in such troubles. This is not the
similar, but it does good.

The more severe sympathetic or reflex affections of
difficult dentition are, as you will agree, numerous, and in
a short paper I cannot do more than touch on them. I
speak more for the sake of starting a discussion than in the
hope of giving any real information. I think that con-
junctival blennorrhoea arises rather more frequently during
the eruption of the canines than with other teeth ; I think ,
that this is the reason for the popular term of the " eye
teeth." The popular idea that these teeth have longer roots
than others, and go near the eyes, has been added as an
explanation to the original reason for the term, and perhaps
there is some ground for the idea in a sense, for probably
the irritation may be felt first in the antrum of Highmire,
and spreads thence to the nasal and ocular mucous mem-
branes. The pain and photophobia, with non-purulent, or
almost non-purulent discharge, leads us to bell. I have not
used any other remedy, and shall be glad to hear of others.
I like the drug strong, three drops of Ix every two hours.
It is noticeable that the disorder is often unilateral, and
it is non-contagious.

Otitis is common ; the nervous connection with the otic
ganglion, and thence to the tympanum, would lead us to

ON DENTITION. 227

expect this. I think that you will generally find the mem-
brane dull and congested. I have so much faith in aconite
and Pulsatilla here, that if they fail, and the pain is not
abated, I always fear suppuration. I think that I have seen
membranes destroyed for want of paracentesis during teeth-
ing. I find a drop or two of a 10 % solution of cocaine in
the ear a great reliever of pain. The applicability of hepar
and siHca in cases of threatened suppuration is a question
worth discussion; I anl not sure but that hepar may
determine suppuration which otherwise might have been
avoided.

As to whether respiratory affections are often directly
due to teething is also a point on which I should like sug-
gestions. My experience is that bronchitis during teething
is so far more common in the cooler months, and in badly-
ventilated rooms at all times of the year, that chill or foul
air may be really the cause ; but no doubt the primary
irritation may be first felt in the larynx (I know children
who have spasmodic croup with many of their teeth, quite
apart from chill or unsanitary rooms, as do probably all of
us), and the primary trouble in the larynx may set up the
bronchitis. I have not time to enter into the therapeutics
of respiratory affections in dentition. I do not think that
the remedies are necessarily to be aimed at the special
cause, since our well-known bronchial and respiratory drugs
seem to act well, but no doubt I shall be corrected here. I
beheve that infants sometimes get bronchitis from the chill
of a wet chest from salivation, and I know that they avoid
such trouble if the chest is kept dry by waterproof sheeting.

With regard to diarrhoea, I have little time at my dis-
posal. The yellow or greyish stools seem the most common,
due to intestinal catarrh. I am sorry to have to desert
naercury here ; I fear that I use it ignorantly. As the
children have generally many chamomilla sjonptoms, fond-
ness for cold water; stools offensive, like bad eggs; child
^wanting to be carried about, — these lead me to a faith in
that drug. This is 'not a violent straining diarrhoea, with
often morning aggravations and occasionally prolapsus ani
as symptoms, which podophyllin cures. Colocynth in the
higher dilutions I have used for colicky diarrhoea. Calcarea

228 OK DBNTITIOy.

phos. 3x has served me well with flabby, shrunken children
with flatulent, thin, green stools. I need scarcely mention
mere. corr. and ipecac, in dysenteric diarrhoea, or arsenicum
when gastric irritation with thirst and purging are present.
Kreasote again is a favourite with me, and with many of us,
when we have vomiting and dark brown stools. The question
of diet I am glad to find I may leave to Dr. Neatby. It is,
of course, of the very highest importance in these cases. I
must apologise for the very short and scanty account of the
therapeutics of the diarrhoea of dentition. I do not care to
speak of more drugs than I have personal experience of, and
I must therefore expose the feebleness of my armamen-
tarium here.

Alumina for constipation, when there is difficult voiding
of even soft stools, I think we must all have used with
success ; bryonia, in rather strong doses, I rely upon for dry
hard stools, but I am not sure of its homoeopathicity ;
causticum is good for tough stools covered with mucus, and
calcarea carb. for fat, fair children with large, chalky stools.

I shall be glad to hear your opinion as to the frequent
origin of marasmus, with diseased mesenteric glands, from a
primarily catarrhal intestine due to dentition. I think that
the catarrhal irritation is often apt to pass into a condition
of follicular enteritis, involving subsequently the mesenteric
glands.

The most common affections of the skin are, I think,
what is called " red gum," which seems to be a very mixed
rash, prominent red papules, interspersed with patches of
erythema ; there is considerable variation in the size of the
papules ; they itch ; and there is often some desquamation
after their disappearance. I have seen a case in which the
close crowding of the papules, with much erythema, along
with trouble in the throat and foul tongue, rendered the
diagnosis from scarlatina none too easy. I like rhus tox. as
a remedy, and bell, if the erythema be greatly in evidence.
Weak carbolic lotions to relieve the itching, both in this
affection and in urticaria, are, of course, well known to all
of us. I have reason to be satisfied with bell, even in urti-
caria ; there is generally much erjrthema around the wheals.

ON DENTITION. 229

If gastric troubles are prominent with these rashes, I think
we do better to give remedies directed to them rather than
to the rash alone.

As to the eczema of dentition, it is a large subject. It
does not need much description ; beginning with redness,
induration and roughness of the cheeks, it would often stop
here, but for the intense itching which causes the child to
scratch the parts and make raw surfaces, which are then the
seat of deeper mischief ; it is over these raw surfaces that
the vesicles seem prone to appear, and if the effused gummy
fluid is allowed to dry and form crusts, which are subse-
quently scratched away, we soon have a serious condition
to deal with. The pustular form of eczema gives rise to
that profuse scabbing, forming sometimes a complete mask
to the face, which comes away and leaves raw surfaces ; the
neighbouring lymphatic glands are often affected. The
same remarks apply to the scalp eczema.

I think that we homoeopaths are saved from giving jn to
ihe popular errors as to the advisability of not attempting to
cure eczema during dentition ; it is a very convenient error
•for those whose therapeutics are incapable of meeting the
<;ase, as is also that other error about leaving diarrhoea alone
to run its course in teething. I am very fond of Unna's
.glyco-gelatine paint as an outward application, also of the
.weU-known white precipitate ointment. I should be glad
.to hear of a soap which may be trusted here ; for the want
.of one, I direct that only oatmeal water or hnseed water
shall be used. As to therapeutics, I can only mention my
friends, and shall be glad to be instructed : arsenic, seldom ;
rhus tox, in the vesicular stage, graphites in dryer forms,
also petroleum ; rhus has always served me well in intertrigo.
I should be glad to hear about tellurium ; I have had a few
xBases where it has served well, and of course we must not
.forget antim. tart, in the purulent form.

And now for the serious affections of the nervous system.
I think that we shall do well to be cautious in our diagnosis
here. The time of teething is also that of the very rapid
development of the nervous apparatus ; and, though teething
is often the determining cause, I think that we sometimes do

-. ., ...cd^tj^ .ui*t?cced to the spinal cord and

.V. -^^cwuiii-; cooth drugs. We meet with

, .A -^'okjui : from afifections of only single

• > v.^diii^ ot cue limbs, or grimaces during

. ...t,* .v.a\uisiou;j and coma. I do not think

. , . , .cuvulsions is generally so difficult to

.. ^ V. vuiy >^upposed. These muscular twitch-

-vl.<.5- o^cea j>igns of importance, and, as such,

.. . ..viu. I have generally been led to give

^ : ii; I ivteacies at the appearance of these

vv^ . ^'oai5>e, there be more serious signs of

.^ .>.:ou or irritation, when bell, comes in.

.X ..UNi, .dso have noticed that there is, even in

. . i.a^ iui5>wering to the muddled mental state

.. V V a ;^ ucrvtj i^torm is brewing ; a dullness of per-

. . 10 io\oi'st>, an acute hyperaesthesia; and in older

10 londency to incoherence or unfounded terror,

^\ ^oi.vt> to warn us of coming trouble. A warm

\ . . \ ^.:ul ;«i few doses of hyoscyamus will give a quiet

' \.s v^ ua bcoa able to recognise true "dental paralysis,"

. .. u' iutantite paralysis occurring during the second

. \'u uui^> bo classed under that title. In a few cases

-. ilv.ls diuing the first dentition which I have seen,

\ v^ !ui\o Ixjon symptoms which I should put down to

. v.'.vuKui polio-myelitis, and this could scarcely be due to

\^ vliu\L iutlueuoe of teething. But I shall be glad to hear

.'. .').u uoicti on this point.

V^ to therapeutics, the distinction between bell, and

I ai I lau viride has been one which has sometimes perplexed

iu\ when prescribing for the convulsions of teething. It is

^Kvint worth discussion. Hyoscyamus, also, is a drug often

... ;i;ivstod, and I shall be glad to hear your opinions upon

'v\.o three drugs. In less severe cases, not proceeding to

, oiiN ulsions, there being some pain in the head and evidence

,^ ;iddiness, such as clutching at the nurse's arms, or in

.a, I- children, staggering, gelsemium is a great remedy,

..i^uuu met., where there is also vomiting; ignatia in pas-

V .'.Mio> kicking children, who wake from sleep with a

N*.'

I

ON DENTITION. • il3l

scream; and finally, cicuta virosa, where there is facial
spasm and rigidity, whilst the limbs are relaxed, or not
convulsed. These are a few out of many, and again I must
explain that I am aware how small a hst this is, but I do
not care to speak of drugs which I have not used.

I have sometimes found that the diagnosis of worms has
been overlooked in cases of convulsions at this age ; it is a
point worth attention.

As to the question of lancing the gums, since so many
of the abnormal symptoms pass oflf when the tooth emerges,
it would seem that to lance the gums is common sense. I
am strongly in favour of lancing, if thereby it is certain that
the tooth can be set free from pressure ; and to secure this,
deep crucial incisions over the molars, and equally deep linear
incisions over the incisors, must be employed. The lancet
should, I think, feel the whole surface of the tooth, and the
lancing must be repeated if the cuts tend to heal before the
teeth emerge. I am open to correction in this opinion. I
know that many, to whose opinions I owe all respect, oppose
lancing.

I should put the determination of the question of lancing
as of prior importance to therapeutics, in practice.

The local affections due to primary dentition may be re-
peated in the second dentition, and demand similar treat-
ment ; but, as the child is now taking soUd food, we find a
good deal of constitutional upset due to the fact that eating
is painful. I have several times found cases of loss of appetite
and consequent debiUty, being treated by what are vaguely
called " tonic medicines," which were due simply to the
child not being able to explain that food was objectionable
because biting was painful; indigestion from bolting the
food is also not rare under these conditions. The treatment
is obvious, coming under the head of dietary, with which Dr.
Neatby will deal.

I am persuaded that in the press of general practice, we
often pass over many little troubles, due to the eruption of
the permanent teeth ; we find children irritable, weary, and
tinvTilling to play as usual ; sleeping badly, with a tempera-
ture slightly above the normal, and perhaps some sore throaty

233 ON DENTITION.

^nd teridernebs of the submaxillary and cervical glands.
Examination will often prove that the permanent teeth are
giving trouble. Lancing the gums over the new molars, ex^
traction of loose milk teeth and the application of a touch
of cocaine to the tender gums, with the administration of
chamomilla, gelsemium, kreasote, or ignatia, will often greatly
relieve these conditions. Bad temper and general contrari-
ness in a naturally gentle child is often due to the irritation
of permanent teeth. Folhcular tonsillitis, hypertrophy of
tonsils, are also sometimes due to the same cause.

The intestinal catarrh which is sometimes the accompani-
ment of second dentition, is the analogue of that of the
primary dentition, and, I think, tends more to take on a
chronic course, or at least, is more obstinate than that of the
primary dentition. I think that " Chronic gastro-intestinal
catarrh " or the "Mucous flux" of childhood, may be traced
back sometimes to the second dentition as its origin ; the
digestion and absorption of food is seriously interfered with,
and we cannot be too careful in our attention to the appar-
ently trivial signs of ill health during the second dentition. In
view of these possibilities, the primary intestinal catarrh is
treated much on the lines of that of the first dentition, but if
there be a more chronic state, I have found hydrastis, nux
and Pulsatilla my friends, though, of course, calcarea carb*
will often come in, and arsenicum for acute attacks during
the chronic illness. Again I am glad to leave the diet ques-
tion with Dr. Neatby.

I think that many cases of obstinate cough are due to
reflex laryngeal irritation from dentition, specially the second
dentition: indeed, you may have known such cases of in-
curable coughs in adults from the presence of carious teeth.
I have seen several such cases ; the therapeutic treatment of
such coughs is of little use unless the origin of the trouble is
removed ; in any case, drugs with both symptoms will act
better than those for the laryngeal symptoms only.

The headache, often with ocular symptoms, of the second
dentition I have found to be greatly relieved by gelsemium*

Time fails me to deal with the question of infantile
paralysis, which, I think, may be sometimes due to second

NOTES ON TEETHING. 233

dentition, and in this opinion I expect to be contradicted,
and I have not enough clinical proof to bring forward to
support it ; but it is one of those ideas one gets from the
impressions of cases in busy work. I like conium very
much as a remedy, and in later stages I have gained great
success from galvanism scientifically applied (if we may yet
dare to speak of therapeutic electricity as scientific).

Time also fails for dealing with chorea, and many other
affections which occur during the period of child life covered
by the second dentition, whether they be caused by it or not.
I must now conclude with my apologies for what is, I fear,
but a meagre account of a great subject : which I have treated
in a not very scientific way, though I hope that a useful dis-
cussion may arise from the fact that my paper is thus
imperfect.

NOTES ON TEETHING. 1

BY EDWIN A. NEATBY, M.D.
Assistant Physician to the London Homoeopathic Hospital,

ExTEEMES of all kinds are usually founded on error, and
this is not less true with regard to the views which have
obtained respecting dentition than in other spheres. At
one time almost every ailment occurring between the fourth
or fifth month and the third year of life was attributed to
teething. From this a not unnatural re-action took place,
and it was denied that any illness was due to the eruption
of the teeth. The truth lies midway between these ex-
tremes. It would probably be more correct to say that
dentition may modify almost every disease, may excite
attacks of ailments to which the patient is constitutionally
or otherwise predisposed or is frequently subject, or may
predispose to attacks which other circumstances excite.

* Bead before the Society, Jan. 5th, 1893.

234 NOTES ON TEETHING.

It is not my purpose to enter into any detailed account
of the subject which has been so fully and so ably discussed
in the paper we have just heard.

Mr. Gerard Smith has drawn attention to the nervous
connections of the teeth. I need not remind you that they,
the skin, and the mucous membranes of the alimentary
canal, are all derived from the same embryonic layer, the
epiblast.

The " feverishness " — speaking clinically — associated with
teething is of two kinds. The acute variety occurs when the
teeth are already piercing the gums, and precedes the com-
pleted eruption by a few hours or days. The slighter de-
grees have no special symptoms, while the more severe cases
are accompanied with, if not due to, cerebral hypersBmia.
The little patient lies almost unconscious, with flushed
face and occasionally jerking of the limbs. The temperature
may reach 104**, remaining at this height for 36 or 48 hours.
The whole attack lasts from three to seven days. These
cases occur oftenest in rickety subjects. The chronic cases
begin and end without any tooth immediately appearing,
and last from two to three weeks. There are night exacer-
bations and morning remissions of irregular amount. A
week or two after the subsidence of these attacks a batch of
three or four teeth may be " cut " close together.

That pyrexial attacks, both during teething and at
other times, ofken have a local and tangible cause, which
is liable to be overlooked, is well known. In children,
amongst the most common of these causes (as Dr. Edward
Blake has often reminded us) is " sore throat." I allude
to this only in order to refer to a circumstance which I have
not seen mentioned in books. There is clearly some con-
nection between throat inflammations and the skin — ^possibly
one of septic poisoning — as seen in some exanthems. Fol-
lowing sore throats, chiefly of the variety termed by
Trousseau " pultaceous," I have during the last two or
three years repeatedly met with desquamation of the epi-
dermis, very suggestive of scarlatina. This desquamation
may be either on the face and upper part of the chest
or on the hands. In the former situation the flakes are

KOTES ON TEETHING. 235

inuch finer than in the latter. That these cases are not
exanthematic I hold to be proved by the course of the
malady, and still more by the fact that the same attack
may repeatedly recur in the same individual both during
and after teething.

One of the most painful ailments associated with dentition
is ear-ache ; it is not infrequently followed by otorrhcea. I
imagine that this is often associated with inflammation of
the middle ear, which may either be due to extension of
inflammation of the fauces, or may be reflex. Perhaps
some of our members having a knowledge of otology can
tell us more of these cases, and of their prognosis. In my
experience the prospect is good. Even when repeated
attacks of otalgia, followed by otorrhcea, have occurred,
as often happens, hearing may be perfectly restored.

Besides the catarrhal and inflammatory conditions of the
intestinal tract, which I do not propose to dwell upon, there
are two other conditions occurring, of course, equally often
independently of teething, but which are materially in-
fluenced by the presence or proximity of that state. I refer
to vulvitis and nocturnal incontinence of urine. Both oi
these influences are reflex.

The association of rickets and dentition is very close,
but it is rather the rachitic condition which modifies the
course of teething than the converse. That rickets causes
retardation of dentition is universally recognised ; the other
frequently-made statement that the first teeth of rickety
children also decay early has recently been called in
question. My own observations lead me to agree with
recent writers, who state that decay is not early, but I
still regard this question as sub judice. To arrive at a
correct conclusion, we need carefully to exclude the presence
of scrofula, which certainly does cause premature decay.

The skin eruptions common during the period of dentition
form a subject full of interest, too wide to be entered upon
now.

" Convulsions " occurring during teething are, in my ex-
perience, much less common than most other ailments. In
deciding upon their frequency and relations, it is necessary

236 NOTES ON TEETHING.

to exclude — ^when one depends upon the testimony of mothers
— a number of contortions (due to pains of flatulence, &c.),
which are termed " inward convulsions.'* On the other hand,
it is important to differentiate the serious form of eclampsia
due to the syphilitic poison acting on the surface of the brain
or on the cerebral vessels. Convulsions deserve always serious
attention and care. Whether post or propter, convulsions in
infancy are more frequently than other ailments followed by
neuroses in after life. A large proportion of epileptics have
suffered from convulsions in infancy.

I can only briefly refer to the most important part of my
subject. A table I am drawing up from observations on some
300 cases is, unfortunately, unfinished. This table will show
the frequency of various teething ailments in relation to
feeding, to family history, and to other ailments of the
patients. I may state that I have been surprised to find what
a paramount influence upon dentition does feeding appear to
have. Too great care and precision in every detail cannot
possibly be adopted to secure appropriate feeding. Only a
year ago Mr. Gerard Smith, in his admirable paper on
*' Feeding," pointed out that even breast-fed infants may be
very improperly fed, through irregularity and over-frequency
of meals. I pass round two papers which have been to me
of great service in securing precision in feeding. One of
these is issued by the staff of this hospital and the other is
drawn up by myself. As might be expected, diarrhoea is
frequently the result of this ill-feeding : not less so is
bronchitis ; and of cases of convulsions, not less than 75
per cent, have been obviously improperly fed, and probably
the proportion is much higher.

Eespecting family history, the parents of patients suffering
from convulsions have quite frequently suffered from con-
vulsions, or other nervous symptoms. My observations sug-
gest a possible relationship between rheumatism in the
parent and intestinal disturbances in the child. This is not
yet established. I have been unable to discover any relation-
ship between the health of parents and skin affections during
teething, eczema, urticaria, prurigo, &c. Nor does feeding
appear to have so conspicuous an influence on this conditio^
as on many others.

DISCUSSION ON TEETHING. 237

As to after or separate ailments of the patient, the most
prominent lesson my incomplete table conveys, is that in a
very large proportion of cases, dentitional bronchitis is
followed by bronchitis in after years. Every attack of in-
fantile bronchitis is of importance, both from its prognostic
significance and its actual gravity. Eczema occmrs quite as
frequently amongst children who have had no difficulty of
teething as amongst those who had suffered at that time.
It more often is associated with bronchitis than with any
other tooth-trouble. The alternation between bronchial
attacks and outbreaks of eczema is familiar to you all.

Therapeutics. — There are just three remedies which, in
conclusion, I should like to ask you to notice. For the
simple irritabiUty, fretfulness, and restlessness of teething
children I have found agaricus Ix and 2x of marked service.
The presence of pruritus from urticaria or prurigo will
heighten the probability of the prescription being successful.

Passiflora incarnata for sleeplessness in the same sub-
jects, unless due to skin irritation, when no other remedy
is indicated I have found a most valuable empirical aid.
It is given in doses of 2-5 minims repeated at intervals of
half an hour or longer.

For some of those intractable cases of skin irritation due
to urticaria, &c., I have found J drop doses of nux vomica^
more successful than almost any other remedy, and I have
tried, after careful choice, a good many. Perhaps this is
another instance of the fact, interesting from a developmental
point of view, that many of our great nerve medicines are also
skin remedies, e,g, arsenic, bromide of potassium, and borax.

I may add to the remarks of Mr. Gerard Smith, that
lycopodium (12 or 3) has been of more service to me in con-
stipation than any other single remedy. I have found
incision of the gums entirely unnecessary.

Dr. Madden asked Dr. Neatby whether he had ever noticed
any tetanic symptoms after using the material doses of nux
vomica he had recommended.

Dr. Neatby replied in the negative.

Dr. Hughes said that Mr. Gerard Smith's paper had raised
several interesting pharmacological and therapeutic questions.

238 DISCUSSION ON TEBTHING.

Mr. Smith had mentioned the fear of falling downwards. Was
that any real indication for borax in stomatitis ? He could hardly
imagine that it would have any relation to such local affections.
Schreter had noticed that a child, while borax was applied to
his mouth, showed a fear of downward motion. It was quite
possible that it had an incidental effect upon the nervous system,
and this might be a good indication for borax in nervous dis-
orders in children. But the affection of the mouth from borax
was purely local, as might be seen in the first number of this
JouBNAii. In the instances given by Mr. Smith, borax cured
local and pathological symptoms without any effect on the
nervous system generally. He could not think it would be more
suitable because a child showed a dread of downward- motion.
He thought the reason why Mr. Smith had found borax more
useful than mercurius was that the whole blood and nervous
system was affected by the latter. When children had ulcerous
stomatitis the first decimal trituration of Kali chloricum acted
beautifully. He thought creosote was homoeopathic to stomatitis.
The long-continued use of creosote affected the mucous membrane
of the mouth and tongue. Its effects in this respect are to be
found in the Cyclojpmdia. A homoeopathic remedy iodide of
potassium was proved to be in enlarged glands by Cartwright in a
paper which he had written on the subject. The cervical glands
had swelled in three weeks xmder its influence. Mr. Smith said
that he had been disappointed in mercurius in the diarrhoea
of teething. That was because it was a reflex affection. That
was why chamomilla acted much better. It was his experience
that constipation had been best acted upon by the 30th dilution
of bryonia. He did not think hepaj could induce suppuration.
If that were the case they could not go on using their remedies.
One of the greatest comforts homoeopaths had was that their
remedies could not do any harm. When suppuration was
natural and inevitable the lower triturations of hepar would
forward it, whilst the higher triturations would every now
and then check it. But he thought it very unlikely that it
would cause suppuration where otherwise suppuration would
not supervene.

Dr. Dyce Bbown said with respect to the use of mercurius
in the stomatitis of children, if there was no other disorder it did
not succeed, but if there was any other disorder, say diarrhoea,
he found the value of mercurius. If there were stomatitis and
nothing else chlorate of potass was the only remedy. He could
not agree with Dr. Hughes that borax had only a local effect.

DISCUSSION ON TEETHING. 239

Dr. Hughes explained that he did not mean '' local " to ex-
dude dynamic.

Dr. Dtce Bbown said that in older children stomatitis and
active diarrhoea had been cured by chlorate of potass, which had
more than a local action on the whole mucous, membrane.
Mercurius in skin irritation, eczema, dried, rough skin, and in
pustules during teething irritation, was of immense value. As
to hepar, he quite agreed with Dr. Hughes, that not even the
low dilutions would produce suppuration. But the rule was a
correct one, that if you wish to promote suppuration, begin with a
low trituration ; but if you wish to prevent its going on, the higher
triturations were more successful. It was necessary, in the case of
bronchitis, to keep in view the reflex character of that from teething :
one should use medicines which either given with others or given
alone tended to relieve the reflex irritation, such as belladonna
or chamomilla. The latter he found of immense benefit. As to
bryonia in constipation he had acted on a hint from Dr. Bayes.
In children where the fasces were hard and painful to pass, bryonia
in the higher dilutions answered beautifully. In eczematous
irritations on the head and face, ** red gum,'' chamomilla and
viola tricolor were extremely useful. Gum lancing ought to be
discarded out and out. If the tooth was so close as to be actually
visible, there was no harm in lancing. But when that was not so,
harm rather than good was done in cutting down deeply. The
wound had to be kept open, and an unjustifiable amount of irrita-
tion was continued. If a cicatrix was formed it became more
difficult than ever for the tooth to emerge. Homoeopathic treat-
ment would be found to answer beautifully, instead of lancing, to
allay the irritation and enable the tooth to come through.

Dr. Madden thought that sometimes when a tooth wanted ex-
traction the irritation was caused by the food being swallowed
whole and not digested. The trouble was sometimes caused by
the organs of secondary digestion. Sometimes the suffering pro-
ceeded from the auto-infection of toxic material. Taking away a
decayed tooth or getting a new set of teeth would sometimes put
an end to a whole series of dyspeptic symptoms. He had always
lanced gums when he had been asked ; he had never known it
produce pain or do harm.

Dr. Blake remembered a Scotch lady coming to him who
had suffered pain in the great occipital (second cervical) nerves
for many years. He requested a dentist to remove from each
side a square piece of gum : this revealed beneath a completely
elaborated pair of wisdom teeth, and the long-established pain

240 DISCUSSION ON TEETHING.

disappeared. All absolute rules as to lancing gums were wrong.
There was often a little gastric catarrh with every tooth worry;
colic and green diarrhcea being common accompaniments of the
trouble. He objected to the word "reflex," which, like **hysteria,'-
covered a multitude of sins. Mr. Gerard Smith had asked about
petroleum. The late Dr. Blake, of Taunton, relied on it for
post-aural eczema. All skin diseases were primarily neuroses,
secondarily invasions. When the internal ear suffered it was due
to an extension from the throat. An infinite number of bacilli
were to be foimd in the Eustachian tubes. He had known a fit
of epilepsy connected in the case of a little child with a carious
state of teeth and sequent tonsillitis. He did not agree with
Dr. Hughes about the local action of borax. He had cured
stomatitis with borax 12 without local application. On this
point he agreed with Dr. Dyce Brown.

Mr. Wright, observing that Dr. Blake had alluded to the
extension of inflammation along the eustachian tube, said that the
possibility of its occurring from reflex action was shown by Dr.
Cook's experiment. Undoubtedly the majority of cases occurred
from inflammation and direct extension. Glycerine would
serve as well as cocaine, which would be unlikely to have any
local action, whilst glycerine with carbolic acid exercised a
soothing influence and relieved otalgia. Aconite tincture with
warm water would also relieve pain, and still more, veratrum
viride lotion. With regard to skin diseases, Mr. Smith had not
referred to sulphur applied internally and externally. Hyoscy-
amus was also useful in children's cases. Enlarged tonsils and
glands in children were often due to carious condition of teeth.
The eye tooth was connected directly with the antrum, which
might be affected by suppuration round the fang.

Dr. Dudgeon recommended the use of belladonna and chamo-
milla, as well as the aconite and Pulsatilla which Mr. Smith had
mentioned. In otitis no remedy was better than belladonna.

Dr. MoiR thought many diseases ascribed to the teeth were
due to rickets and improper feeding. Much, too, depended on
how the child was nourished in the uterus. The bib-bronchitis
mentioned by Mr. Gerard Smith was due to a mechanical cause.
There was generally some active influence besides reflex action.
There was not much use in lancing gums, nor did he think there
was any benefit from pricking gums. If one looked into the milk
teeth of the children of the present day, there were often large
cavities which tended to produce sore throat.

Dr. Day insisted on the necessity of a minute examination
of details. If they were neglected, the most carefully selected

DISCTO6ION OSX TSBTHXNG. 241

remedies would fail. Many remedies are quite pernicious to
children, many of whose sufferings were due to errors in diet.
Adjuvants to medical practice were essential, and occupied as
important a place as purely medicinal treatment.

Dr. Blackley agreed with Dr. Dyce Brown and other
speakers in condemning the use of the lancet. It did, perhaps,
no serious harm, but it did not do much good. As a student he
had been brought up to use it &eely, but had not used it pro-
fessionally for the last 20 years. During the last three years he
had had several cases of exanthemata with throat symptoms. He
had put them down to influenza. The ill-defined exanthem was no
doubt a form of influenza. There could be no question that iodide
of potassium was very efficient in inflammation of the cervical
glands. With regard to bryonia in constipation, he had generally
taken as his key note whether the child dribbled or not. If there
was previous dribbling it would not do much good. Mercury was
useful in skin affections. But there were two drugs which had
not been mentioned. Antimonium tartaricum and crudum and
sulphur were drugs which he used every week. Sulphur in the
form of ointment was serviceable in serous effusion. He did not
quite follow Dr. Blake's explanation of diarrhoea. He could not
give Mr. Smith any definite indications for the use of petroleum
and tellurium, as he rarely used them. He had tried them, and
found little encouragement to do so again.

Mr. Gerabd Smith, in reply, said he was thankful for the
many hints which he had received, and was glad that so many
had been down upon him for the use of the lancet. He supposed
that he had not been emancipated long enough, and the trail of
the serpent was over much that he did. Lancing he found to-
relieve pain, whether by local bleeding or local pressure. He
had followed precedent in using mere. sol. and borax. With
regard to irritation of the antrum extending to the eye, he meant
that suppuration about the root of the tooth would extend to the
antrum as the nearest mucous membrane. The same condition
which led to convulsions might give rise to epileptic symptoms.
But he doubted whether one was the cause of the other. The
teeth probably decayed earlier in rickety than in healthy children.
He did not know whether nux vomica was homoeopathic to
urticaria.

VOL. I. — NO. 3. IS

242 CASB OF ULCERATION OF THE TONGUE.

A CASE OP TEETIAEY SYPHILITIC ULCEEATION

OF THE TONGUE.^

BY DUDLEY WEIGHT, M.B.C.S.

Surgeon for Diseases of the Throat and Assistant- Surgeon to the London

Homoeopathic Hospital.

The patient, John D , aged 70, first came to the

Hospital in December, 1892, complaining of a sore on the
tongue, which had, so far as he knew, been present some
eight months. He gave the following history : — ^Fifty years
ago he contracted syphilis, having a well-marked chancre
and bubo. For the past 40 years he has had some soreness
of the inside of the right cheek, but never had any trouble
with the tongue until the present one.

He had been an excessive smoker up to 30 years ago. He
is a father of a family of 26 children, nearly all of whom are
now alive and healthy.

Eight months ago he had a very bad cold, and at this
time he noticed some soreness of the tongue. He received
medical advice for it, and, since it did not heal up, he was
advised to have the tongue removed both by his own private
physician and by a sujrgeon of St. Bartholomew's Hospital,
whither he had gone on the recommendation of the former
gentleman.

This he refused to have done, and he then came to the
London Homoeopathic Hospital, and was placed under my
care.

When first seen, there was deep and extensive ulceration
of the right side and tip of the tongue ; on the right side
there was also some scarring.

The parts around the ulceration were swollen and slightly
indurated, and there were one or two slightly enlarged glands
in the neighbourhood of the angle of the jaw. The breath
was foetid, and there was considerable pain shooting up into
the ear. Iodide of potash Ix niv. t.d.s. was ordered, together
with a lotion of chromic acid gr. ii. ad 5i.

In a week's time there was no improvement, so nitric

^ Clinical Evening, March 2nd, 1893.

MYXCBDEMA, 243

acid Ix nxii. t.d.s., and a lotion of eucaljrptus of the strength
of 5i. ad 3i. were prescribed.

This was on December 5th, and from that time to
February 27th the medicine was continued, each week show-'
ing a marked and rapid improvement : the ulceration cica^
trising, the pain abating in intensity, and the foetor dis*
appearing. After this date the patient caught a bad cold
from sitting in wet clothes, and a &esh induration and ulcera*
tion of the tongue was the result. The pain also returned,
and these symptoms still remain active (March 2nd). At
Dr. Pope's suggestion, the patient will receive fluoric acid
6, in the place of the nitric acid.

MYXCEDEMA. ^

BY EOBBBSON DAY, M.D.LOND.
Assistant Physician to the London Homosopathic Hospital,

This case is very typical of the disease, and as it shows
nearly all the sjmaptoms, I will briefly state the leading
features of the disease, which was first described by Dr. Ord :

Always adult females affected.

Excess of mucous tissues, " solid oedema."

Absence of thyroid.

Anaemic condition, from absence of this hsemopoietic
gland.

Hands spade-like (Gull),

Mental hebetude, slow speech.

Voice monotonous, leathery. •

Tardiness of co-ordination, difficulty of walking.

No albumen.

Mrs. H., aged 36. Dates her illness from birth of last
child, ten years ago. But since then she has had two pre-
mature confinements.

^ A Case presented at tl^e Clinical Evening, March ^nd, 1893.

244 MXY<ED£MA.

The illness began with feelings of chilliness and indiges-
tion. The feet and legs swelled and the breath got short,
she turned faint and giddy, and began to talk with thick
speech. She staggered about when walking as if from drink,
and her friends said she had dropsy in the face. Soon the
legs got very weak, and now it is a great effort for her to go up
and down stairs. The menses became profuse and continue
so ; now are very irregular, lasting a week or fourteen days,
with perhaps only three weeks interval. At the menstrual
period she has an aggravation of symptoms : the puffiness
of the face increases very much, she passes very little urine,
and all the tissues get swollen and her weight increases, she
becomes burdened with her weight. The menses are quite
painless and come on suddenly ; also at this time the teeth
get loose and she cannot clean them. She bleeds very
readily and wounds heal slowly. A burn on the arm re-
cently took a long time to get well.

During the illness, she has had a very dry skin, and can-
not perspire. The hair from being light, soft, and curly, has
become coarse, fallen out, and now is very scanty. Hearing
also became dull, so that she could not hear the carts in the
street, but hearing has improved now very much. The eyes
also got bad and she had to wear spectacles, but sight is
better now. She used to wake up numbed in the night and
could not feel her hands. She is very awkward with her
hands, in buttoning up clothes, &c., and she cannot sew or
wash.

She has got very stout and heavy — fingers enlarged so
much that she has been obliged to have her ring filed off.
The calf of the leg is 15J inches round, and the wrist very
big. She feels such a lump and so weak, she can scarcely
turn over in bed at times.

The teeth have decayed very much, and after going to the
dentist on one occasion the gums bled so much that they
had to be plugged.

Her memory is very bad, and she cannot read as she
used to do, will read the same passage over and over again.
She cannot repeat things from memory, gets confused. She
is very sleepy, and could sleep all day. She is never hungry.

THE MECHANICAL MANAGEMENT OF INFLAMED KNEE. 245

She can take a message but 'cannot think quick enough
to answer, and is very irritable in temper, but she used not
to be so.

There is no history of the disease in the family, and she
has four children, three healthy ; one has congenital heart
disease.

On some future opportunity I hope to show this patient
^gain, after she has been under treatment.

Dr. Clabee drew attention to a case of myzoedema lately
published in the Homoeopathic World cured by arsenicum in high
potency. Homoeopathy was capable of curing these cases if pro-
perly applied. Thyroid feeding or injection was not a cure.

A FEW HINTS ON THE MECHANICAL
MANAGEMENT OF INFLAMED KNEE.^

BY JOHN W. HAYWABD, M.P.
Consulting Physician to the Hahnemann Hospital^ Liverpool.

In diseased joints mechanical treatment is as much
called for as is medicinal — perhaps more. It is especially
needed in inflamed knee. Of the truth of this maxim I
have myself had personal experience, and experience is,
perhaps, the best teacher.

Of course, the main objects in view in the mechanical
treatment of inflamed knee are to keep the joint still and free
from pressure — ^that is, to procure rest to all the parts and
structures connected with the joint ; without this, medicinal
treatment is almost useless. Now, these objects cannot be
attained by simply keeping the patient in bed, for even
whilst there the body itself must be moved occasionally,
and every such movement causes motion in the knee, and
pressing together of its parts ; besides, it is very un-

' Bead before the liveipool Bnmch, April Idfch, 1893.

246 THE MECHANICAL MANAGEMENT OF INFLAMED KNEE.

desirable that such patients should be kept in bed, because
this confinement is injurious to the general health; some
rest in bed is, however, both necessary and advisable.

The knee is susceptible of two kinds of motion — flexion
and rotation — the latter to only a very limited extent ; and
to two kinds of pressure — longitudinal by the weight of the
body, and antero-posterior through the patella, both to a
severe degree.

The usual way to attain the objects in view is, of course,
to fix the leg in a Thomas's splint. This, when properly
adjusted, not only prevents all motion by flexion, but it
keeps off much of the pressure by the weight of the body,
and when nicely fixed and strapped, with a well-fitting boot
and the moulded stiff pads above and below the knee, even
rotatory motion is reduced to a minimum.

If the avoidance of flexion and rotation, and the pres-
sure by the weight of the body, were the only objects to be
attained, Thomas's splint leaves very little to be desired —
it accomplishes these ends almost to perfection; but, un-
fortunately, these are not the only objects in view, for it is
quite as necessary to prevent motion and pressure by way
of the patella — ^perhaps more.

Now, however carefully applied, Thomas's splint does
not entirely prevent the motion and pressure by way of the
patella, which are produced by the extensor muscles in front
of the thigh. This is made evident by placing the patient
on his back and causing him to attempt to lift; the leg
without the help of his hands ; when, by placing one's
palm upon the kuee both motion and pressure by way of
the patella are distinctly perceived. Every time, therefore,,
that the leg is raised — as in placing it on or taking it off a.
rest, or getting into or out of bed, or it is carried forwards —
as in walking or sitting down on a low seat, this motion and
pressure by way of the patella are, to a certain extent, pro-
duced, notwithstanding the wearing of a Thomas's splint ;
and if Thomas's splints cannot prevent them no splint can
itself do so. Now, motion and pressure by way of the patella
are not much less in themselves, and not much less hkely
to keep up inflammation in the knee, than are flexion and

THE MECHANICAL MANAGEMENT OF INFLAMED KNEE. 247

rotation and pressure by the weight of the body, and seeing
that they are of very frequent occurrence — ^that, in fact, the:
leg cannot be either lifted or carried forwards without their
being produced — and that on each occasion the articular
surfaces of the patella and femur and tibia are moved upon
each other, and pressed together by the weight of the whole
leg and foot, it seems imperative that means shall be pro«
vided for their prevention, quite as much as for the pre-
vention of flexion and pressure by the weight of the body.
Without such means, in fact, the mechanical management
of inflamed knee is only half provided for. How shall this,
be done ? Can it be effected by an addition to, an alteration
in, or a re-adaptation of, Thomas's spUnt ? I cannot myself
see that it can, for the splint has no fulcrum on the pelvis,
or independent of the thigh ; indeed, it is itself lifted by the
very muscles that produce the motion and pressure com-
plained of, aided by, of course, those coming from the
pelvis ; nor can I see any way of applying automatic power.
The motion and pressure by way of the patella are produced
by the mass of powerful extensor muscles on the front of
the thigh, acting through the patella as a fulcrum or pulley
over which they act every time the leg and foot are lifted or
carried forwards. If, then, this motion and pressure are ta
be prevented it must be by some means for lifting and
carrying forwards the leg and foot independently of the
muscles of the thigh, and such as will leave these abso-
lutely quiescent. This means, too, must be always present,
always at command ; and, as it cannot be effected automati-
cally, it must be under voluntary control, indeed, it must be
voluntary muscular power; it must, in fact, be by the
muscles of the arms ; the leg must be lifted and carried
forwards by the muscles of the arm instead of by those of
the thigh. Can this be done ? I think it can ; it can, in
fact, be easily and effectually accomplished by having a
piece of narrow webbing passed under the forepart of the
foot — say in the form of a stirrup — and hung from somb
convenient part of the dress in front, perhaps the brace
button, or it may be passed over the neck — the former for
use in the day time and the latter for the night — for it must

348 THS MECHANICAL MAKAOEMSKT OF INFLAICED EKEB.

be used in the night as well as in the day — or, as making it
less an eyesore, it may be carried up inside the trouser and
through the pocket. It must have a small crosswise handle
opposite the top of the thigh — ^perhaps in the pocket — to lay
hold of and lift and carry forwards the leg every time these
motions are required. By thus using the arm for hfting
and carrying forwards the leg and foot whenever these have
to be done, all motion and pressure by way of the patella
will, of course, be prevented, because the muscles in front
of the thigh wiU then not be caUed into action. If the
prevention of this motion and pressure be attempted by
tightening the pads above and below the knee in Thomas's
splint, the articular surfaces of the patella and femur and
tibia will be so pressed together as to be very likely to
aggravate the inflammation of the knee, at least, in recent
acute cases. In such cases every possible means should be
adopted to avoid pressure on the knee itself, either directly
or through the muscles. With this webbing, then, in addi-
tion to Thomas's splint, not only flexion and rotation and
pressure by the weight of the body, but also the motion and
pressure by way of the pateDa are prevented ; in fact, all
the mechanical requirements of inflamed knee are effectually
provided for, and rest to all the parts and structures con-
nected with the joint is secured.

Now, Thomas's splint requires to be very carefully and
accurately adjusted and fitted in each case. The ring
round the thigh must fit so that the ischium rests nicely on
it, and it must fit the thigh itself firmly. Unless the ring
fits the thigh itself nicely the pressure and chafing of the
fork will be very annoying, and even if ever so nicely
adapted, some time is required to become accustomed to
the inconvenience, and for the skin to become sufi&ciently
hardened to bear the pressure and friction. At least some
weeks' rest in bed should be aUowed for these, and during
this time the boot and pads must be leffc tolerably slack, and
the leg always lifted by means of the webbing. The total
length of the splint must be such that when resting on it
the heel shall not press on the boot ; if the splint be even a
very little short so that the weight of the body presses the

THE MECHANICAL MANAGEHBNT OF INFLAMED KNEE. 249

heel down upon the boot, then, at every step, the jarring
and pressing together of the articular surfaces of the femur
and tibia are all the greater in consequence of the knee
being kept absolutely stiff, and these are especially felt in
descending stairs and in walking quickly. If it be a little
too long the pressure of the boot on the instep will cause
intolerable pain, and perhaps inflammation of the foot.
Extension should on no account be attempted by traction
via the foot. Also, the pads above and below the knee
must be sufficiently wide apart to avoid their bearing on the
extensor tendon and on the ligamentum patellae ; and the
straps must be sufficiently slack, otherwise the pressure will
be very likely to aggravate the inflammation of the knee.
Also the pad below the knee, as well as that above, should
be made stiff and shaped so as to keep all pressure off the
ligamentum pateUsB. Again, as the splint has to be worn both
night and day, the straps and the boot should be slackened for
the night (at least, for the first few nights), otherwise the
swelling of the leg and foot brought on by the heat of the
bed will cause intense pain — -absolutely unbearable and
unnecessary suffering — and may indeed induce inflamma-
tion of the tendo Achillis, and perhaps of the instep. On
these points, gentlemen, I speak from personal experience.
When, however, the above-named points are attended to,
Thomas's splint, assisted by the webbing, not only meets
all the mechanical requirements of inflamed knee, but it
produces, perhaps, as little inconvenience and suffering as
such an apparatus must of necessity involve. The using
of a stick to bear part of the weight of the body when
descending and ascending stairs, and when walking quickly,
will further diminish the pressure by the weight of the
body, and thereby assist recovery. When first applied the
patient should spend some weeks in bed, in order that he
may become accustomed to the inconvenience and to
prevent any injury or accident from awkwardness in its
management.

When the whole knee is implicated — the cartilages and
bones as well as the surrounding structures, in deep-seated
structural disease of the knee — Thomas's splint is abso-

250 THE MECHANICAL MANAGEMENT OP INFLAMED KNEE.

lately necessary, and recovery can scarcely be looked for
without its use, but when it is more the surfaces and
surrounding structures that are inflamed — ^in recent mild
cases-:— though excellent, it is not essential* In these cases
a less heavy, less inconvenient and less expensive apparatus
may be used. It may possibly be sufficient if the knee be
kept (only) tolerably still, and pressure be (only) to a great
extent prevented, whilst appropriate medicinal treatment
is pursued. Motion by flexion can be fairly well prevented
by the use of a nicely padded, light, long wooden splint
reaching from the heel to the top of the thigh, and carefully
and firmly bandaged the whole length, except at the knee.
Every possible care must be exercised to avoid pressure on
the knee itself. To allow of this the knee should not be
included in the bandage. Two bandages should be used —
one to reach from the heel to just below the knee, another
from just above the knee to the top of the splint. Two
broad leather straps, shaped to the leg and nailed to the
splint, one just above the malleoli and the other at the top
end of the splint, to pass round the ankle and the thigh —
the former about three inches wide, with three buckles, and
the latter about four inches, with four buckles— will not
only give firmness and steadiness to the splint but will
also prevent the bandages slipping down. The lower end
of the spUnt must be well padded in order to protect the
tendo Achillis. A walking stick should be used to bear
part of the weight of the body, especially when ascending
and descending stairs, and when walking quickly. Motion
and pressure by way of the patella may be very effectually
prevented by the webbing already mentioned, used carefully
and both night and day whenever the leg has to be lifted or
carried forwards. This will also assist greatly in the pre-
vention of motion by flexion.

Provided the patient can remain mostly at home and at
rest, in mild cases, the above arrangements will keep the
knee sufficiently still and free from pressure to allow proper
medicinal treatment to cure the inflammation within a
reasonable time ; otherwise — that is, when the patient must
go about — ^it will, of course, be safer to fix the leg in a

DISCUSSION ON MANAGEMENT OF INFLAMED KNEE. 251

Thomas's splint and keep it there until all inflammation
has been subdued.

Dr. Gordon Smith thought that in all serious cases the
patient should be kept in bed, in addition to wearing a Thomas's
splint, so that the knee can be kept absolutely still. He con-
sidered Dr. Hayward's device very ingenious, and likely to prove
very effective.

Dr. Gordon said that he beHeved in applying a carefully
fitting Thomas's spHnt, and getting patients on their feet as soon
as possible. He considered Dr. Hay ward's suggestion a very
good one.

Dr. Gappeb said that as far as he was able to judge from
experience, Thomas's splint always acted practically with ad-
mirable efl&cacy. At the same time he thought Dr. Hayward's
improvement a very ingenious one, and Hkely to prove of great
service.

Dr. J. D, Hayward thought that Dr. Hayward was incHned
to exaggerate the effect of the pressure on the knee joint by way
of the patella. Any pressure exerted by the patella must be at
considerable mechanical disadvantage. The leg is raised rather
by means of the psoas and iliacus, than by the extensor muscles.
The extensor muscles do contract on raising the leg, but that is
chiefly due to an effort on the part of these muscles to fix the
knee. He thought the device might prove of some service as an
aid in the treatment of diseased knee joint.

Dr. J. Murray Moore mentioned a case in which jerking
of the hamstring muscles was met by the exhibition of ignatia.
He thought that Dr. Hayward's sHng was likely to prove very
useful in the treatment of fractured patella.

Dr. Ellis said that he agreed theoretically with Dr. John
Hayward's remarks with regard to the recti muscles, but muscles
are so accustomed to act in unison, that doubtless the recti act
at the same time as the psoas and iliacus in raising the leg, and
Dr. Hayward had probably found that this was practically the
case. Speaking without this personal experience of the splint,
he hardly saw the necessity for Dr. Hayward's improvement.

Dr. Charles Hayward said that acute cases of inflamed
knee seldom came under the surgeon's notice, but in his opinion
Buch cases should be always kept in bed, wearing a Thomas's
splint. With the long splint Dr. Hayward recommended, it
might be an advantage to have a slightly thickened sole on the
sound foot. When a patient is fit to go about on a Thomas's

252 DISCUSSION ON MANAGEMENT OF INFLAMED KNEE.

splint, the slight pressure exerted by the patella would not be
deleterious. In cases so acute that such pressure would be
deleterious the patient should be kept in bed.

Mr. W. D, Haywabd drew attention to the fact that as with
Thomas's splint the leg is kept straight, the traction by the
extensors is in nearly a straight line, which, of course, diminishes
the pressure by way of the patella.

Dr. Hawkes brought in two cases illustrating the treatment
of inflamed knee by means of Thomas's splint. The first was a
case of old synovitis, the patient being a plumber who had to
kneel a good deal ; and the second a case that had been
diagnosed as tubercular disease of the knee joint. The latter
had worn the splint for six months, and was comparatively
cured. Dr. Hawkes said that in such cases he usually made use
of a Macintyre splint to straighten the limb, before the applica-
tion of a Thomas's splint.

In reply, Dr. Hayward thanked the members for their re-
marks, especially Dr. John Hayward for drawing attention to
the fact that the leg is lifted and carried forward not only by the
extensor muscles of the thigh, but also by the psoas and iliacus^
which do not act through the patella. Also Mr. W. D. Hayward
for his reference to the fact above stated with regard to the
traction being nearly in a straight line. He also remarked that
some of the most important points had not been taken up in the
discussion, viz., these referring to the tight straps, pads and boot,
especially when left so during the night. These were points he
wished decidedly to emphasise, because of the absolute and
unnecessary torture they cause.

A CAS8 OF TUBEBOULOUS PHTHISIS. 253

A CASE OF TUBEECULOUS PHTHISIS CUEED
MAINLY BY TUBEECULINUM (HEATH.) ^

BY JOHN H. CUlRKE, M.D.
Physician to the London Homoeopathic HospitaL

James E., a carman, aged 40, was admitted into the
hospital October 17tb, 1892. The following notes are taken
from the case book of Dr. Vincent Green, junior resident
medical ofl&cer. The family history is exceDent, there being
no history of phthisis. The patient's present illness dates
from an attack of influenza three years ago, the attack being
followed by cough, expectoration, night sweats and emacia-
tion. These symptoms continued for a year until the
patient could hardly get out of bed on account of weakness.
He was in the North London Hospital -six weeks, where he
improved, but during the next six weeks he became rapidly
worse, having two sharp attacks of haemoptysis. When
admitted to the Homoeopathic Hospital he was emaciated,
suffered much fi'om dyspepsia, and had a poor appetite. He
had an irritative hacking cough, but not much expectoration,
but the sputum contained tubercle bacilli. At the apex of
the right lung there was a cracked pot note, tubular breath-
ing and abundant coarse crepitations. In the infra-clavi-
cular region there was some dulness, with prolonged
expiration and fine crepitations ; posteriorly, there was
audible prolonged expiration, with crepitations all over the
lung. At the apex of the left lung expiration was prolonged,
but there were no accompaniments. The heart sounds were
clear ; pulse 110. The patient complained of a feeling of
weight in the right chest, sleeplessness, and cough for several
days, and then he began to improve ; constipation was one of
his chief troubles.

On November 9th, as he still complained of the weight
in the chest, he was given Tuberculinum (Heath) 100, gt. iii.,
on the tongue, and this was repeated the following week.

By November 20th he had gained one and a-quarter.

^ A case presented to the Society February 2nd, 1893.

254 CHLOBOFOBM ANiBSTHESU.

pounds in weight ; the sensation of weight in the chest was
better, there was very little cough, no expectoration, no
night sweats, but he was troubled a good deal with flatulence.
Tuberculinum was repeated on the 30th, and again on Dec.
10th ; by this time he had gained another pound and a-half
in weight.

December 19th. — He complains of pains in the joints
without swelling ; there is a return of the sweats and cough,
with frothy white sputum. Under mere, vivus 12 the rheu-
matic symptoms perfectly subsided.

Tuberculinum was repeated on January 4th and 25th.

On February 2nd it was noted that he had gained four
and a-half pounds since January 18th ; he had no cough and
felt quite well. There was a prolonged expiratory murmur
and increase of vocal fremitus and resonance at the right
apex, but no abnormal physical signs at the left apex.

CHLOEOFOEM ANESTHESIA:
ITS ''ACCIDENTAL ASPHYXIA" AND MEANS OF

PEEVENTION. '

BY T. G. H. NICHOLSON, M.R.C.S.
AruBsthetist to the Hahnemann Hospital, Liverpool.

In engaging your attention for a short time on the above
subject, you will, of course, as I proceed, take it for granted
that I accept as far as it goes the pronouncement of the
Hyderabad Chloroform Commission, and look upon their
Eeport upon this question as something approaching finality;
and considering that the faculty has not got beyond specula-
tion, you will, I fancy, acquit me of blame, the more readily,
may be, if the fact of my doing so should result in any further
elucidation of the cause of the trouble which has engaged its
attention for some years past. The Indian Commission

' Bead before the Liverpool Branch, Feb. 2nd, 1893

CHLOBOFOBM ANiBSTHEBU. 255

has done mncli to enlighten us upon the subject of deaths
from chloroform, but I think we must look even further than
the Commission for the first cause, for I look upon the
cause assigned by them as really an effect, as I shall pre*
sently endeavour to shew. Having then detected the real
cause, let us do the next best thing, viz., seek a remedy for
a trouble that is, and will continue to be, forced upon our
attention and that of the public, with unpleasant frequency
until it is found. Now the better to enable you to form an
opinion as to the appropriateness of a method of prevention
which I am endeavouring to introduce, it may assist you if I
submit to your notice a few leading facts in reference to the
order in which chloroform exerts its influence. We are told
first of all, " that the vaso-motor system is very soon
involved," 2ndly, *' that the fall of the blood pressure be-
comes dangerous if pushed to the point of paralysis of the
respiratory centre," and lastly, *'that if the poisoning con-
tinues, the fall becomes much more rapidly dangerous, the
nutrition of the heart is profoundly interfered with, and the
deprivation of oxygen, produced by paralysis of the vagus,
causes it (the heart) to gradually cease to act." This quotation
refers to the inhalation of a poisonous or overdose, which the
Commission tell us is the invariable cause of deaths from
chloroform, producing as it does narcosis of the vagus and
interference with the respiration, culminating in spasmodic
constriction of the pulmonary and systemic arterioles, a
back rush of unaerated blood into the cavities of the heart,
and ultimate paralysis of its walls from over distension,
assuming that artificial respiration has not been resorted to
in time to re-estabhsh the respiration and circulation through
the lungs. Seeing then that an overdose is practically
synonymous with asphyxia, it would seem that our efforts
should be directed to the prevention of the possibiUty of an
overdose being taken, and this suggests the question "What
is an overdose? is it from the chloroform, or the chloroform
plus something else ? " and then how best to prevent it. As
to the first division of the question, let us keep in view the
fact that there are three factors that contribute to bring
about the condition that the Commission designates as

256 GHLOBOFOKH AKJ&6TH£8IA.

*^ accidental a^hyxia:'' Ist. A slowing of the circulation
with consequent partial arrest of the process of aeration,
corresponding perhaps to oppression of the vagus as distin-
guished from absolute narcosis. 2ndly. An abnormal accu-
xaulation of carbonic acid and hydrogen in the system,
to which presumably we are adding at each inspiration.
Srdly. Complete arrest of the function of the vagus and lungs,
followed by asphyxia through the deprivation of oxygen.
To the second division of the question, how to prevent it, I
would suggest that whatever will prevent undue slowing of the
circulation (which signifies a fall of the blood pressure, and
more or less interference with the normal rapidity of
aeration), without adding carbonic acid and hydrogen, must
tend to prevent vagus narcosis with its attendant asphyxia.

Now as a cardiac and respiratory stimulant we have in
oxygen a restorative of the first order, one that we should
never be without ; indeed, that we should seldom need in
the latter capacity alone, by adopting the method of in-
halation that I have initiated. It may be said of oxygen
that while it plays the part of a physiological antidote to a
condition liable to be induced during anaesthesia, viz.,
asphyxia, it does not chemically antidote chloroform. If
oxygen were a chemical antidote to it, we should not get as far
as to produce anaesthesia, let alone asphyxia, because being an
incompatible it could not be given at all. That it may,
under certain conditions, delay anaesthesia I am willing
enough to allow, but the reason of its doing so will be
found in an excess of either air or oxygen. If too much
air be given the chloroform is diluted too much, while, on
the other hand, an excess of oxygen excites a patient and
delays the action of the anaesthetic. The question, therefore,
resolves itself into a mere matter of determining the quantity
by or with which we can obtain the best effect of each ;
in other words, by which we may Umit the action of
our chloroform to the suspension of consciousness (which
is all that we require), at the same time maintaining
the respiration, circulation and aeration as near as may
be at the normal. From the very commencement of our
anaesthetic operations we absolutely, but unconsciously.

CHL<»OFOBM ANESTHESIA. 257

court disaster, safety seeming to depend entirely upon the
degree of nicety with which we can, as it were, poise onr
patient between safety and danger, owing to the indefinable
character of the Une dividing the two states. We must bear
in mind that not only is there, as we are told, a fall of blood
pressure due to ordinary chloroform inhalation, but that a
farther fall, please note, results from any interference with
the respiration, showing the necessity that exists for limiting
as far as possible the action of our anaesthetic. If we must
have slowing of the circulation, with all that it means, let us
have it from one source rather than two, and to effect this,
we must give oxygen to keep up the blood pressure, to
stimulate the heart and vagus with aerated blood, and to
prevent that abnormal retention of carbonic acid and
hydrogen in the system, which leads up to the condition of
asphyxia, and so greatly depresses the nervous systems of
our patients, as we see in the length of time it takes them
in many instances to come round. Now, if there was no
other advantage in the use of oxygen in this connection, it
is a distinct gain to be able to counteract the depressing
effect of our anaesthetic, and to facihtate the recovery of our
patients, and that it does so, I think scarcely admits of
doubt ; but such an effect can only be by virtue of its anti-
asphyxial and general tonic action upon the nervous,
respiratory, and circulatory systems. The extreme potency
of pure oxygen must be taken into account when crediting it
with retarding ansBsthesia. As a powerful excitant it merely
suggests the moderate use of it, or of just such a quantity
as will antagonise asphyxia, without interfering with the
action of the anaesthetic. As regards the length of time a
patient takes in getting " under," it has not by any means
been proved that a person would not be just as long in
getting under without oxygen, for we all know that the time
occupied varies in different cases according to susceptibility,
idiosyncrasy, and other circumstances, such as struggUng,
Tomiting, hysteria, or what not.

There is just another point in the Eeport of the Hyderabad
Commission to which I would like to direct your attention,
viz., " That irregularity in the fall of the blood pressure is

VOL. I. — NO. 3. 17

1
I

!258 GHLOBOFOBM AN£STHE8U.

always due to irregularity of, or interference with, the respi-
ration," but that this is not dangerous, "if" not excessive^
It is then added, " How this asphyxia is produced is for
physiologists to determine." Now, unless I am altogether
wrong, an elementary knowledge of physiology will enable
one to understand how it is, and I think the explanation will
be found in an uncounteracted or unneutraUsed deposit or
accumulation of carbon and hydrogen in the system, and
that mainly, for what is this but an interference with the res-
piration of a most active kind ? It is fortunate for us that
the system tolerates at all the presence of an excess of car-
bonic acid, and it is because it would appear to do so, that we
are able to get through any cases with safety, and here (our
various methods notwithstanding) comes in the unsatisfactory
aspect of the question — we never know the moment we may
cross the line of safety. Insensitiveness of the cornea
(corresponding to full anaesthesia) is said to be our guide to
stoppage of administration ; it may even represent the limit
of safe tolerance of the drug, but then we cannot stop it
altogether ; we have to go on piling up, so to speak, carbon
and hydrogen, watching the respiration meantime, and for
what ? only to see it slow off or stop altogether ! until, in-
deed, asphyxia threatens or is upon us. What says Dr.
Laurie? He says, " Administration should not be pushed
beyond full anaesthesia, because, if it is, the essential condition,
observe, which is normal respiration, cannot be main-
tained;" and this is true enough, for we continue the full
anaesthesia, as I have said before, without neutralising the
carbonic acid we are generating in excess, and he practically
admits that after corneal insensitiveness there is danger;
now what but oxygen can maintain normal respiration after
this stage is reached ? It would seem as though we could
not realise that there can be anything wrong until the respi-
ration gives out, but from what I have said I think it will be
seen that very much is wrong, commencing not only when
asphyxia sets in, but from the very initiation of our anaesthetic
proceedings. Now I claim for oxygen all that is claimed for
nitrite of amyl, and more, inasmuch as, unlike nitrite of amyl»
it does not merely help to circulate blood already loaded witU

CHLOBOFOBM AN^STHESU. 259

•carbonic acid (by paralysing the muscular coat of the contain-
ing vessels), but aerates and carries it along by virtue of its
own inherent stimulating and invigorating effect upon the
arterioles. It benefits the whole organism, it nourishes the
heart, raises the blood pressure, stimulates the vagus with
healthy blood, keeps the breathing regular, and does away
with a certain feehng of impotence that one is conscious of
while concentrating, as we are told to do, " all our attention
upon the respiration." It is said that our aim should be to
give chloroform in such a manner as that the blood pressure
shall fall regularly throughout the whole period of adminis-
tration, and that this can only be done by absolute regularity
of the breathing, but this absolute regularity is just what we
cannot command, and is the source of our trouble. Now
what will better contribute to absolute regularity of the
breathing than oxygen ? It cuts at the root of the trouble,
and prevents the condition that calls for the battery, nitrite of
amyl, and artificial respiration. Oxygen in a room is not
enough ; were we to empty a cylinder of it, a patient would
be little the better for it, so long as it could pass away through
ventilators, or be otherwise exhausted. It seems to me that
we are generating carbonic acid in excess, and that we should
give oxygen in excess to neutralize it, and to do this it should
be brought to the very nose of the patient, if we are to feel
sure that it is being inhaled in any appreciable quantity, or
to any purpose ; the inference from all which is, the necessity ^
of maintaining normal vagus stimulation, as distinguished
from irritation, because while the former, as with oxygen,
raises the blood pressure, the latter, as from an excess of
carbonic acid, lowers it. There is, to my thinking, some-
thing confusing in the interchangeable use of the terms
*' stimulation" and *' irritation,'' as though they meant the
same thing ; and I am of opinion that it would tend to a
clearer understanding of the whole subject, if we were to
think of " stimulation " in the sense that is attached to it in
the dictionary, viz., "as a quickly-diffused and transient in-
crease of vital energy and strength of action in the heart and
arteries," or, as I put it, a normal amount of nerve influence,
contributing to healthy function. Again, let us think of

260 XlHXiOBOFOBM AN^STHESU.

^^irriiatitm*^ as of something which produces an opposite-
condition of things ; in other words, as signifying an abnormal
degree of nerve stimulation or influence, leading or tending
to unhealthy function or result, as, for example, asphyxia.
We are told that electrical ** irritation*' of the vagus lowers
the blood pressure, and that asphyxia (produced by a poison,
and therefore an irritant) stimulates the vagus, slows the
heart, retards the circulation, and lowers the blood pressure ;
that it does, in fact, precisely the same thing that electrical
irritation does. In quoting the above, I do so by way of
illustrating the ambiguity alluded to.

Just a few words upon the subject of the heart, seeing
that it is with this organ that danger is in many minds still
primarily associated. The Hyderabad Commission tell us
that it is never affected by chloroform, except by over-dosing,
and that safety is guaranteed by regular breathing, and
this goes to prove the correctness of my theory, for I have
shewn how this over-dosing may occur, and be prevented, as
also the only method by which regular breathing can be
guaranteed. Where death occurs from pure nervous shock
inducing fatal syncope, or from valvular lesions, it cannot be
said to be due to, or as arising from chloroform, but as
occurring under it, which is quite a different thing, and
would suggest that a patient dying under such circumstances
'was not a fit subject for operation, and should not have
been placed in the position of incurring the risk.

Now as to the mode of administration. There is no
method (other than one which will ensure absolute regu-
larity of the breathing), that can assure immunity from
accident. It is not the inhaler, it is not the dilution of the
chloroform, it is not boldness, it is not even any amount of
experience and caution, because the trouble has its origin
altogether outside of these considerations ; and by way of
explaining what I mean, as also of affording food for re-
flection, I may say that of my three all but fatal cases, one
occurred at the beginning and the other at the end of an
experience extending over many years, as if to shew how
very little even experience and caution avails to avert this
particular form of danger. It cannot reasonably be supposed

CHLOBOFOBM ANiESTHESIA. 261

that in all the cases of death that we have heard of from
time to time, that there was timidity of administration, and
I have not been told that this was the cause of our two
'' accidents " in this hospital, and in making use of this
term I would not have it go forth that they were fatal
accidents. Had they been, I should have alluded to them
as deaths from, or deaths under chloroform, as they
may have occurred; but the term "accidents" I apply to
those cases of asphyxia in which we are successful in re-
suscitating our patients, and this it is said " can invariably be
done." But I think that this admits of some doubt, for .
artificial respiration has failed at the hands of presumably
very competent men, and the cause of death has been pro-
nounced to be asphyxia, and to say that it was not might well
be considered a piece of impertinence. Nevertheless, I believe
that our efforts at artificial respiration would in all cases be
successful if we could bring pure oxygen to bear upon the
rcase. And here will be seen the advantage of the method
of inhalation I am advocating. An inhaler of some kind
must be used, and the best form is that which will liberate
the chloroform vapour uniformly and steadily, rather than
in gushes (as with a napkin), and I was going to say admit
of a sufficiently free admixture of air, but experience has
convinced me that this is not enough, at least under the
atmospheric conditions which too often obtain in our large
cities. We need therefore hyperoxygenized air, for it is the
absence of this, or at any rate a deficiency of oxygen, that
lands us in the difficulty in which we every now and then find
ourselves.

I will now pass on to explain the method by which I
hope to prevent rather than meet the asphyxia that is in
naost cases sprung upon us so suddenly. It consists simply
in an admixture, during inspiration, of chloroform vapour
vdth hyperoxygenized atmospheric air, the oxygen being
regulated at the will of the manipulator as the condition of
the respiration and state of the pulse may indicate. The
advantages of the method are various and important, and
may be summed up as follows : — 1. That oxygen, by main-
tainii^ perfect aeration, can alone assure regularity both of

262 CHLOROFORM ANESTHESIA.

respiration and circulation. 2. That the function of the*
lungs being uninterfered with, narcotism of the vagus and
asphyxia cannot occur. 3. That the proper dilution of
the chloroform is effected by a steady and uniform rate of
evaporation. 4. That the action of the anaesthetic is limited
to the suspension of consciousness. 5. That watching the
respiration (in the sense of anticipating danger), is un-
necessary. 6. That the use of nitrite of amyl and artificial
respiration is superseded. 7. That a patient is rendered
independent of his atmospheric surroundings, however
adverse. 8. That the quantity of chloroform used is of
little ponsequence, regular respiration measuring the dose.
&. That by the method a feeling of confidence and security
takes the place of one of impotence (familiar under the old
system) , and moreover greatly facilitates the recovery of the
patient. 10. That the accidental element in chloroform
anaesthesia is eliminated.

It may be objected that the foregoing are merely as-
sertions of mine, that cases should be adduced in support
of them. Well, I will cite a few, roughly jotted ones it is
true, because to concentrate all the attention upon the
respiration, and take notes at the same time, is not exactly
an easy matter, but the last case (my own) was carefully
noted, and I will for the present refrain from any comments
upon it.

Case 1. — Gertrude Jones, age 7. Carious disease of bones of
the foot. Chopart's operation. Was slow in getting under owing
to admission of too much air, inhaler being large for the face and
too freely perforated with holes. Gave oxygen at intervals. In
half an hour after the operation the child was sitting up in the
bed and playing with its toys. No vomiting.

Case 2. — John Barton, age 60. Fistula in ano. Took the chlo-
roform slowly and was rather excited, the oxygen seeming to in-
crease the excitement and counteract the effect of the chloro-
form. Gave the anaesthetic alone, when he finally got under..
After a time noticed lividity of the lips and commencing pulmo-
nary oppression. Gave a few whiffs of oxygen, when this quickly
passed off, giving place to the proper florid hue. After the
operation, said he felt as well as he did half an hour afterwards,
and though there was a little bilious vomiting corresponding

CHLOBOFOBM ANJQSTHESIA. 263

with the period of pulmonary obstruction, he subsequently com-
plained of neither nausea nor headache. In this case the
chloroform from the same cause was too much diluted.

Case 3. — John Howden, age 31. Exploration of supra-pubic
sinus. Had had chloroform a week previously and said he tasted
it for three days afterwards. Took it again this time with
oxygen and said he felt no nausea whatever, nor had he a head-
ache afterwards.

Case 4. — Lena Hennessey, age 11. Eemoval of necrosed
maxillary bone. Gave oxygen and chloroform. Was under in
about ten minutes. Pulse full and regular; breathing ditto,
though very deeply under.

Case 5. — W. D. Walley. An anaemic infant of six months.
Eemoval of eyeball. Got under in about four minutes with
oxygen.

Case 6. — ^Woodderson, Walter, age 24. Got under in. ten
minutes with oxygen at intervals. There was some little ex;cite'-
ment, but got under thoroughly. Pulse and respiration regular
and full. Case, haemorrhoids.

Case 7. — Hales, Eichard, age 18. Incision of deep femoral
abscess. Got under in ten minutes with oxygen and chloroform.
Pulse and respiration normal. A little bilious vomiting but no
headache.

Case 8. — ^Thompson, Mrs., age 38. Eupture of perinaeum.
Gave oxygen and chloroform together. Was ** under" in about
twelve minutes ; respiration regular and full, pulse steady and
full. Was of a bilious and nervous temperament. Was under
about half an hour; a little vomiting but very slight headache.

Case 9. — Ainsworth, Eleanor, age 19. Extracting eight upper
stumps under oxygen and chloroform. Pulse and respiration
good. Some little headache after, and some vomiting, which
was worse the next day, and was attributable to a generally
disordered condition of the system. Consciousness returned
quickly.

And now for my own case. No. 10. Two or three important
alterations had been made in the inhaler. Commenced with
inhalation of oxygen. Pulse varying from 84 to 90, acceleration
accounted for in part by previous violent muscular exertion. In
three minutes it rose to 108 but was softer. Eespiration 14. In
ten minutes pulse 90 to 94. Vomiting for half a minute, pre-,
ceded by a fall to 70, after which pulse returned to 96. In four-
teen minutes vomiting again preceded by a fall to 60. In 21
minutes vomited for third time. In 30 minutes pulse varied from

264 DISCUSSION OK CHIiOBOVOBM AVJBBTHX8IA.

66 to 80. In 33 minutes stopped the chloroform and gave oxygen
only. In seven minutes later conscious, but some further
vomiting ; oxygen continued for five minutes longer. Bespira-
tion throughout regular and full, 13 to 16. Took about 5iii. of
chloroform. It will perhaps be noted that the fluctuations in
the pulse were somewhat eccentric, 84 to 90-108-90 to 94-70-96-
60-66 to 80, which I can only attribute to the immediate response
of the heart to the oxygen given, and not as indicating danger,
for as if to prove that regularity of the respiration is the main
thing to be aimed at, and is assured by this method, it was
remarked that " the respiration was regular and full throughout.*'
Now what more can we want ? As to the time a patient takes
to get ** under,*' none can be fixed ; we are not supposed to work
against time, nevertheless, I see no reason why a patient should
not be got ** under*' as rapidly when oxygen is used as he can
without it, because its inhalation need not be commenced until
full ansesthesia is induced, the period at which, according to Dr.
Laurie, danger commences, and as it is under the perfect control
of the manipulator it need not be given too freely.

Having now placed before you, illogically it may be, and
even incoherently, a few thoughts upon a subject which I
think you will agree with me is worthy of every consideration,
I have of necessity drawn upon the Beport of the Indian
Commission byway of shewing the fitness of the remedy that
I have been directing your attention to, but how far the
notions put forward will commend themselves to your
judgment I cannot of course say. If you can explain them
away, well and good ; but if you are of opinion that there is a
modicum of truth in what I have said, that it even has a
basis of physiology and common sense, I cannot think you
will do otherwise than encourage one to go onward and for-
ward, and as a body share with me any credit obtainable
from the inception of the method within the walls of this
institution.

Dr. Chables Haywabd thought that the best use of oxygen
was in cases of emergency, and in rousing a patient from the
effects of chloroform. He mentioned a case, reported from Paris,
where a mother and daughter were saved by artificial respiration
with oxygen, after three hours' liard work. They had been pro-
nounced past help by the surgeon at the hospital ; but the house
surgeon made the successful attempt.

LlVEBPOOIi BBANCH MEETINa. 265

Dr. Gordon Smith thought that Mr. Nicholson's method would
be useful in the case of old topers, and in similar cases in which
the organs were in such a state as to give no physical signs on
examination, but yet where chloroform could only be administered
with considerable risk. It would also be of benefit in cases, of
prolonged administration.

Dr. Murray Moore said that some patients took chloroform
well during parturition, even when they ordinarily suffered from
palpitation. Mr. Nicholson's method would be useful in such
a class of cases. Aftereffects of chloroform pass off more easily
than those of ether. Oxygen ought to prove of service in decom-
posing the carbonic acid in the lungs.

Dr. Mahony was glad that Mr. Nicholson accepted the con-
clusions that the Hyderabad Commission had adopted, as he felt
convinced that they were the right ones.

Dr. Hawees said that chloroform is an intoxicant, and does
not act by causing asphyxia. The anesthesia is not due to the
accumulation of carbonic acid in the lungs, but to the specific
effect of the chloroform.

LIVEEPOOL BRANCH MEETING.

The usual monthly meeting was held in the Hahne-
mann Hospital, on Thursday, March 9th, Dr. Hawkes
(President) occupying the chair.

The meeting was devoted to the consideration of clinical
cases, medical reports, &c.

Dr. Hawkes showed under the microscope some well-
marked granular casts in the urine of a pregnant woman
suffering from acute nephritis, for which no reason could be
assigned. He also exhibited four cases of considerable

interest.

(1) Mary E., aged 16, a patient who had just recovered

from purpura. She had taken a severe cold some weeks

previous to admission to the hospital. Spots came out all

266 XIVEBPOOIi BRANCH MEETING.

over her body about February 16tb, and on admission were
found to extend from head to foot. The spots were slight
on the forehead and chin, absent from other parts of the
face, but very well marked on the chest. Prior to the
appearance of the spots there had been profuse menor-
rhagia. Hamam. 1 was given, and then phosp. 6, the pro-
fuse menorrhagia having returned, but while the purpuric
spots rapidly declined the menorrhagia did not yield till
secale <f> (vfiii. — v. doses) was given every few hours. Secale
Ix. was of little service. The girl's family history was
unimportant.

(2) Isaac M., aged 50, who, besides suffering from gout,
was the subject of multiple fatty tumours, which existed in
each submaxillary region, on either side of the ligamentum
nuchse, and in each deltoid region.

(3) Thos. A., aged 50. This patient had a stroke on
August 15th last. He did not lose consciousness, and was
able to get home himself. In addition to paralysis of the
right arm and leg and the right side of the face, the right
leg was thrown out in walking. The patellar rfeflex was
exaggerated on the left side, and markedly so on the right.
After being in hospital about a month he complained of
pain in the hand, and decided symptoms of late rigidity
developed. These were manifestly helped by the inter-
rupted current with massage, and the patient had much
improved generally.

(4) Edward T. P., aged 48. Three years ago this
patient was thrown from a bicycle. A week after he had a
slight stroke,' and kept his . bed for a month. Some time
after he became aware that his arm and leg were powerless.
The leg improved, but the arm was still useless, and the
hand the seat of late rigidity. He walked at the time he
appeared before the meeting with a swinging gait, and the
patellar reflex was much exaggerated on the affected side,
but nearly absent on the other. He was improving under
electrical treatment.

Dr. Hawkes quoted Bastian to the effect that in lesions
of the cortex involving the whole thickness of the grey
matter, or this together with a portion of the subjacent

LIVEBPOOL BBANCH MEETING. 267

white matter, it has been found that secondary degenera-
tions occur only when such lesions implicate some portions
of the cortex within the Bolandian area. Lesions of any por-
tion of the internal capsule between the two nuclei of the
corpus striatum may give rise to descending degeneration.
Lesions in any part of the centrum ovale may give rise to
such degenerations.

Dr. Charles Haywaed brought in a young man upon
whom he had performed amputation through the thigh
some months ago. The patient was in good health, and
had grown considerably since the operation. He was
wearing a wooden leg that could be flexed at will by means
of a spring. The artificial limb was made slightly shorter
than the sound one, in order to prevent the habit of sweep-
ing the leg outwards in walking — a habit once contracted
not easily remedied when a more elaborate appliance comes
to be worn.

Dr. Capper brought before the meeting a little girl, 4
years of age, whose mother stated that she had complained
during the last few weeks of pains in the abdomen, which
were accompanied by vomiting, and alternating constipation
and diarrhoea. The abdomen was enlarged, and upon per-
cussion a large area of dulness was manifest, extending over
the hypogastric region, the left lumbar and both iliac
regions, but more towards the left side. No tumour could
be made out on palpation, and there appeared to be no liver
ot splenic enlargement. The child had been very delicate
soon after birth, and had suffered a good deal from diar-
rhoea. Dr. Capper had had the case under observation only
for a few days, but inclined to the opinion that the dulness
was due to the presence of a parovarian cyst, and this was
the general opinion of the members present.

Dr. Hawkes suggested that it might possibly be due to
a cystic kidney.

Dr. Capper also exhibited a very good specimen of
intussusception of the bowels, which had occurred in a child
5 months old. A considerable portion of the small intestine
had shpped into the caecum, which was almost involuted
upon itself, the vermiform appendix forming part of the
intussuscepted bowel.

268 CASE OF FBMPHiaUS IN A OHILD.

A CASE OF PEMPHIGUS IN A CHILD.^

BY J. ROBERSON DAY, M.D.LOND.
Asiistant Physician to the London HomosopcUhio Hospital,

F. K., age 15 mos., was admitted under my care at the
hospital on January 28, 1893. Both parents apparently
healthy. There are two other children in the family, and
both are healthy. The patient is the youngest. She was
brought up on the breast and bottle, and has only just been
weaned. She has always been deUcate, but born healthy,
and not till six weeks old did she show any rash. Has had
boils and snuffles since that time. On admission she had a
well-marked pemphigus rash scattered over nose, face, neck,
legs, hands and arms. The eruption always comes out first
as a bleb, and then leaves a raw surface. The voice is
hoarse, and marked snuffles are present.

Merc. V. 1, gr.j. every two hours, was ordered, and equal
parts of calomel and starch used as a dusting powder.

On February 4 it was noted that the dusting powder
had dried the blebs up, and only a few more had appeared.

More rash out on February 11. Merc. sol. 1, gr.j. t.d.s.,
was substituted for mere, v., and as the child was distinctly
worse this was on the 18th changed to canth. 3x niij. every
three hours. Notwithstanding treatment it was noted at
the visit on February 25 that more rash was out, and the
blebs were numerous. She was then ordered rhus Ix.

On March 4 she was admitted to hospital, and now is
improving under ars. a. 3x.

Bemarks. — This case I do not regard as syphiUtic, be-
cause there is no femily history and no eyidence in the
parents ; also because this is the youngest child, and the
other two are healthy, and not syphiUtic. Lastly, since
the specific mercurial treatment failed to cure.

Dr. Hughes said that these cases in children were very rarely
not syphihtic, and he was inclined to suspect this was the cause
of this case. He should otherwise have thought of arsenicum
as the first remedy for pemphigus.

> Clinical Evening^ Mareb 2nd, 1898.

A Discuasiasr on ttpbdid fbybb. 369

NOTES OF A DISCUSSION ON TYPHOID FEVEE/

Dr. Hawkbs introduced the subject, especially referring
to its etiology and pathology, quoting from Parkes, Blythe,
Allen and other authorities. He stated that Eberth and
Gaffky had isolated a bacillus from fseculent discharges of
typhoid patients. He exhibited a slide showing the bacillus
described by Klebs. Soils impregnated with filth afford
suitable localities for development. He referred to the
ground water theory and pointed out that sheets stained by
the urine or feecal discharges of the patient might become
dangerous on drying. It was stated that milk, the water
used in its adulteration, and ice long unmelted might
contain the germs of the disease. It was remarked that
the prognosis becomes more grave as the age of the patient
approaches 60, when the mortality reaches 34 per cent.
The diseases simulating typhoid were referred to and briefly
characterised. " Not typhus if 102'F.» be not reached by
fifth day" (Bljrthe). The ulceration was described and
sections of ulcer at tenth and twelfth day shown under the
microscope. Although Budd's dictum as to the appearance
of the intestine remains true, the spleen, heart and kidneys
are involved, and death from cardiac failure without other
serious lesion may occur. A slide showing section of fibroid
heart after enteric fever was exhibited. Blythe's view as to
the cause being a vegetable parasite, capable of completing
its cycle independently of the body, was referred to.

As to prevention. — Urine and faeces to be received into
vessel containing corrosive. Fsecal and urinary stains to be
dealt with similarly. Discharge to be buried away from
wells, or mixed with sawdust and cremated.

Treatment. — Dr. Hawkes employs hydropathic measures
for high fever. Baptisia in early stage, arsen. later. For
glandular trouble (intestinal) iod., mere. cor. For hsBmor-
rhage, tereb. 3x. He never obtained better results than
when in early dispensary days he used bapt., then liq. arseni-
calis (i-1 drop doses), and tereb. when needed.

* At the Liverpool Branch, April 18, 1893.

270 A DISCUSSION ON TTPHOID FEYEB.

Dr. Hatwabd said that in proposing a discussion on
typhoid fever, his object had rather been to elicit the results
of experience in the recent epidemic. He brought forward
three points : (1) As to whether a patient can take infection
through the respiratory organs ? (2) Whether typhoid stools
were infectious before decomposition? (3) Whether a
relapse was due to a re-infection with typhoid germs, or to
other causes.

As to treatment. — He asked for suggestions as to the best
treatment affcer the usual febrile symptoms in the early stages.
For example, when the glands are affected specially, such a
medicine should be used as would be Ukely to have a specific
action on the glands, such as mercury. If it is probable that
the decomposing products of ulcers passing off are hkely to
set up further infection, would not some antiseptic treatment
be thoroughly scientific? He also asked whether the
members considered that benefit might be produced by local
treatment, such as abdominal compresses.

Dr. GoEDON Smith said that with regard to the treat-
ment of the morbid condition in Peyer's patches, Dr.
Hughes suggests iodine as homoeopathic, as it has produced
similar conditions. In haemorrhages he had found tereb. in
sensible doses most valuable. With regard to relapses, he
did not think it necessary to have a re-infection, and
mentioned a case in which the whole train of symptoms
recurred after eating a currant bun. He questioned any
decided effect, by means of compresses, upon the morbid
processes involved, but said that they certainly reduced
fever, diminished delirium, and tended to give the patient
ease.

Dr. EowLAND Wilde said that next to the importance
of diet, he believed in that of thorough ventilation. With
regard to Dr. Hayward*s suggested treatment by antiseptics,
he mentioned the successful use of quinine in some cases,
after the trial of carefully selected homoeopathic medicines,
the efficacy of which might be explained on the antiseptic
theory.

Dr. GoEDON referred to the anti-pyretic treatment,
especially by means of the cold bath, as practised largely

A DISCUSSION ON OTYPHOID FEVEB. ^71

on the Continent and in New York. He instanced the good
results of this treatment* a death-rate of only four per cent,
occurring in some hospitals where it was used. He spoke
of the use of koumiss, and said that he continued the
restricted diet well into convalescence.

Dr. Bernaed Thomas considered the nursing the chief
matter of importance. He had found cold sponging of great
benefit, and referred to a case recently under his care, where
the temperature fell from 105.6° to 102.5°, with subsequent
improvement.

Dr. John Hatward said that he relied on bapt. followed
by arsen. in ordinary cases. He dilated on the symptoms
and cases benefited by arsen. He had seen more serious
cases recover in typhoid than in other cases in his experience,
and referred to the frequency of diphtheritic throats during
convalescence.

Dr. Mahony mentioned Valentine's meat juice. He
asserted the importance of differentiating our cases, and of
treating them with the remedy which agreed most with the
general symptoms and conditions of the patient.

Dr. J. Murray Moore referred to his colonial experience,
and stated that he had great confidence in arsenic, and used
it more frequently than any other drug in typhoid. He
believed that relapses were always due to indiscretion in
diet.

Dr. Ellis said that he thought rest so essential that he
would hesitate to allow a cold bath. He looked upon
arsenic as his sheet anchor, and agreed with Dr. John Hay-
ward's reflections on the relationship of this drug to the
disease.

In his concluding remarks Dr. Hawkes spoke of crotalus
in relation to typhoid, and of lachesis and mere. cyan, in the
treatment of diphtheritic cases.

273 TWO CASES OF AMPUTATION*

NOTES ON TWO CASES OF AMPUTATION.^

Db. Gobdon showed a female patient, aged 20, upon
whom an amputation of the foot had been perfonned. The
patient was of markedly strumous constitution. Six years
ago strumous disease manifested itself in the scaphoid, and
gradually extended to the os calcis and astragalus. She
was advised to have the diseased bone removed, but de-
clined operative interference, which was not permitted for
four years, during which time the lower ends of tte tibia
and fibula became involved. Two years ago the foot and
the lower ends of the tibia and fibula were removed by Dr.
John Hayward, and since then the patient has done very
well, and is walking about without a stick or any aid,
wearing a specially adapted surgical boot. During her
illness she was treated with calc. carb., silica, aurum Ix., as
indicated.

Dr. John Haywaed showed a patient upon whom he
had performed amputation through the lower and middle
thirds of the femur for suppurating disease of the lower end
of that bone, of three or four years' standing. The femur
was considerably implicated, but the operation was success-
ful, and the patient progressing well.

SOCIETY NEWS.

On March 13th, 1893, at the ripe age of 84 years, and after &
few days* illness from bronchitis, Charles Hills Mackintosh,
M.D. St. And., passed peacefully away. He had been a mem-
ber of the Society since 1868, and in active practice at Torquay
for nearly fifty years. Dr. Mackintosh never held oflfice in
the Society.

On Thursday, April 5th, 1893, the following gentlemen, having
been duly nominated as candidates, were elected members of the
Society by ballot: — Henry Arnold Eaton, M.B., C.M.Edin.,

> Liverpool Braaich, April 13th, 1893.

SOCIETY NEWS. 273

39, Surrey Eoad, Norwich ; George Reginald Jones, L.R.C.P.
Lond., M.R.C.S.Eng., 3, Iden Villas, Eastbourne ; William
Theophilus Ord, L.R.C.P.Lond., M.R.C.S.Eng., Lansdowne
Villa, Bournemouth; James Call Weddell, M.D., C.M.Edin.,
9, Park Terrace, Sunderland.

In consequence of the rebuilding of the London Homoeopathic
Hospital, in whose Board Room the meetings of the Society have
been held for many years, the Hospital authorities have placed
their temporary Board Room, at 35, Queen Square, Bloomsbury,
W.C., at the disposal of the Society. Henceforth the monthly
meetings will be held there.

At the April meeting Mr. Dudley presented some beautifully
preserved specimens of Cephalopoda (including Sepia), and Coe-
lenterata (including Corallium), obtained from the Gulf of
Naples.

On Thursday, May 4th, 1893, the following gentlemen, having
been duly nominated as candidates, were elected members of the
Society by ballot: — Samuel Brewer Brooks, M.R.C.S.Eng.,
L.R.C.P.Edin., Peachey Terrace, Nottingham; Andrew Moss-
forth Neatby, L.R.C.P., L.R.C.S.Edin., Mulgrave Road, Sutton,
Surrey ; Carl F. Fischer, M.D.Halle, L.R.C.P.Lond., M.R.C.S.,.
Eng., St. George's Club, Hanover Square, W.

At the May meeting the President showed for Dr. Proctor
(Birkenhead) some specimens of carbo-subhmatus, obtained by
burning camphor and submitting the result to a red heat, the
specimen showing finer division of the particles than ordinary
carbo-vegetabilis. The result is a very pure form of carbon.

Dr. John Murray Moore, Liverpool, has resigned his member-
ship of the Society.

On Thursday, June 1st, John Christopher Staley, L.R.C.P.I.,.
The Mount, St. Anne*s-on-Sea, having been duly nominated
as a candidate, was elected a member of the Society by
ballot.

VOL. 1. — NO. 3, 18

274 . SUMMAKY.

SUMMAEY OF PHAKMACODYNAMICS AND

THEKAPEUTICS. *

** GATHER UP THE FRAGMENTS, THAT NOTHING BE LOST:*

Mabch— May, 1893.

PHARMACODTNAMICS.

Acidnm flaoricam in Thyroid Disease. — A lady, aged
:about 30, complained of one side of her neck being larger than
the other. The left half of the middle lobe of the thyroid con-
tained a cyst the size of a walnut ; it felt firm and elastic, and
the structure of the gland was everywhere thickened, I thought
I would divide the treatment into two parts. First I would
bring down the swelling of the gland tissue, and then endeavour
to promote the absorption of the cyst. But this unhomoeopathic
manoeuvre did not succeed, for under the action of a daily drop of
ac, fluor. [dilution not stated], from Feb. 2nd to the middle of
March, by April 19th the swelling of the gland and the cyst had
both disappeared. — Yillers, Arch, /. Horn., ii. 156.

Acidum picricam. — Albuminuria had persisted, in a woman
of 27,. for ten days after her confinement. It was accompanied,
from the second of these days, by a peculiar headache. She
woke every morning with a dull pain in one or both eyes, and a
<ireeping sensation inside the skull. The pain increased in severity
gradually, extending through whole head and down nape, and
lasted all day. It was, at its height, pulsative, and was aggravated
by the slightest exertion of mind or body, even by turning the
■eyes. It passed off in the evening, and she slept well. After
several useless prescriptions, picric acid 12, four doses, aborted it
■at its onset, and it never returned. The albumen disappeared
without further treatment. — Horn, Physician, Feb.

Agaricus. — Dr. Shadle communicates a series of cases of
poisoning by different members of the family amanita — *'the

SUMMABT. 275

only mortal toadstool foe of man/* according to Mr. Julius Palmer
— ^which seem to show that atropine is their effective antidote.
The antagonism of muscarine and atropine is well known. —
Therapeutic Gazette, May.

Agraphia nutans. — In the Hahn, Monthly for March, our
own Dr. E. T. Cooper communicates his experience with this
plant — the common bluebell of the woods. He finds that a
tendency to free discharge from mucous membranes is a main
indication for it in throat and ear troubles ; that enlarged tonsils
with post-nasal growths may be reduced by it ; and that it is
unrivalled as a remedy in the mutism of childhood unconnected
with deafness. He gives single doses of the mothei? tincture.

Ammonium. — Dr. Clarence Payne finds stoppage of the
nostrils to be a valuable indication for ammonium carbonicum,
and coldness between the shoulder-blades for ammonium muriati-
cum, in catarrhs of the respiratory organs. — N, Amer, Joum, of
Horn., May, p. 282.

Antipyrin. — Moeller took 15 grains of antipyrin for headache.
Next morning he was surprised to find the joints of his fingers
swollen and, together with the backs of the hands, occupied by
erythema. The lips, the orifices of the nose, the auditory canal
and the conjunctivae were also reddened, swollen, and somewhat
painful. Moreover, there was a sharply circumscribed erythema
on the skin of the scrotum and glans penis, and on the corona of
the latter an ulcer developed, which healed without scarring in '
fourteen days. The rest of the exanthem disappeared in three to
four days. On repeating the experiment a month later, in ten
minutes he felt burning pain upon the lips and glans penis, and
an erythema speedily developed, with much itching and pain. On
the following morning ecchymoses had formed upon the dorsum
of the first phalanx of the thumb, and on the scrotum and the
folds about the anus were several excoriated spots. On the
corona glandis was a blister in folds similar to that of a burn, and
in spite of a protective dressing an ulcer formed, and was slow in
healing as before. — Therap. Gazette, April.

Apis. — Dr. Julia C. Jump was stung by a bee on the helix
of the left ear. There followed, in this order : (1) Sensation as
.though a thick stick was stuck through head from left to right. (2)
Swelling all over. (3) General urticarious eruption. (4) Severe
rigor, without sensation of cold. (5) Pain in kidneys and bladder,
without any urine being passed. (6) Dull pain in the entire
head, with weary and stupid feeling. She had now a gill of

276 BUMMABTv

hoUands and was put to bed. After a restless sleep she wokd
with pain and soreness in region of kidneys, bladder and ovaries ;
only after some hours was urine passed, scanty, hot^ and red.
Eruption had disappeared, leaving skin white, waxy, and puffy,
with extreme sensitiveness to touch and soreness on deep pressure.
There was sti&ess of joints and soreness of muscles as in rheu-
matism. It was a week ere she was restored to her normal
condition. — N. Amer. Joum, of Horn., May, p. 319.

Arsenio in Psoriasis. — ^The Climque of April contains an
interesting article by Dr. Halbert on experience gained in the
cutaneous department of the Hahnemann Hospital of Chicago.
In the discussion which followed when it was read as a paper
before the Clinical Society of that city, Dr. C. H. Evans related a
cure of a patch of psoriasis on the leg, of seventeen years' stand-
ing, during which time the patient had suffered many things of
divers physicians. The one subjective symptom was that the
spot burned night and day, and on the strength of this, arsenicum
6 was given, four doses daily. By the end of the third week the
heat was reduced by one half, by that of the fourth it had gone.
A week later the scales began to fall off, and a perfect cure soon
followed. After seven years there had been no recurrence of the
affection.

Arsenio in Canoer of Skin. — Lassar, at a meeting of the Berlin
Medical Society, presented two cases, and reported a third, in
which carcinoma of the skin had been cured by the use of arsenic.
Eowler's solution was used either subcutaneously or internally,
without any local treatment. Tonton (?), of Wiesbaden, reports
a similar result by the same treatment in a case of general sarco-
matosis of the skin. — Miinchener Med, Wochenschrift, Jan. 24,
1893. [This is the reference for Lassar's observation ; the other
(which we copy from the Hahn, Monthly for May), we cannot
trace. — Ed.]

Aurum in Ozasna. — Dr. Delap relates a case of this disease
— "atrophic catarrh" he calls it — in the Southern Journal of
Homoeopathy for January (p. 961). It began with a common cold
from exposure, but had gone on to necrosis of the bones. There
was no syphiUtic history. Cleansing local applications were used,
and aurum muriaticum 2 given internally. A severe headache
which was present, greatly aggravated by stooping, yielded rapidly
to the medicine.- Dead bone came away, and the patient became
quite well.

0UMMABY. 277

Auimm in Sarcocele. — ^A man had a hard enlarged testicle on
the right side, painful, particularly to touch. Clematis Ix aggra-
vated. The 6x dil. of the same drug, and iodine. 3x, had no effect,
and castration was recommended. Aurum met., 15th trit., was
now given three times daily ; the testicle gradually took its normal
^ize and became softer, and in six weeks patient was discharged
cured. — N. Amer, Jotim. of Horn., April, p. 249.

Caloarea in Polypus Napiom.— Dr. Milton Hammond relates
A few out of (he says) ** scores of cases " of this growth, which he
has cured with calc. carb, 30. — Southern Joum. of Horn,, March,
p. 1029.

Caldarea fluorioa in Throat Troubles. — In some '' Sugges-
tions founded on experience in the use of the Sehiissler Eemedies/'
contained in the N, EngL Med, Gazette for April, Dr. T. M. Barton
commends calcarea fluorica to relieve the tickling of the throat,
exciting cough, which is caused by elongation of the uvula.

Calendula, — Dr. Wilson Dods has' experimented With this
•drug, and finds that it is not germicidal. What good it does must
therefore be otherwise accounted for. — N, Am. JourH, of Horn.,
March, App., p. 39.

Camphor. — Dr. J. T. G. Emery communicates to the Amer.
HomoRopathist of March 1st four involuntary provings of camphor,
two from chewing the crude substance, two from tea-spoonful
doses of the tincture. Vertigo, drowsiness, sense of approaching
death, and subsequent nervousness, marked the first case; con-
vulsive attacks, with hysterical delirium, the second ; loss ,of
consciousness, followed by that of memory, and by impaired sight
for distance, the third ; violent cramp in the stomach, the fourth.

Cannabis indica.— Two more poisonings by this drug may be
read in the Monthly Horn, Bevieto for March, p. 169. The
patients, one a recent graduate in medicine, the other a dentist,
give a vivid account of their mental disorder.

Carbo YegetabUis. — Dr. PuUar relates some experiences con-
firmatory of the value of this remedy in adynamic bronchitis,
with threatening paralysis of the lungs. He gives the 6th cent,
trituration. — Monthly Hom. BevieWy April.

Cicuta in Convulsions. — Dr. Stonham follow^ up his case of

•cicuta poisoning, recorded in the Monthly Hom. Beview of

September, 1892, by one of cicuta cure in the same journal of

April, 1893 ; the convulsive symptoms being so similar as

immediately to suggest the remedy.

278 SUMMARY.

Creosote in tuberculosis. — Dr. Sommerbrodt praises creosote
in the treatment of scrofulous glands as warmly as do some
others in phthisis. He gives it in increasing doses, beginning (in
children) with a drop three times a day. It must be given after
meals, as the empty stomach will not tolerate it. — Therap,
GazettBf March.

Dr. Albu, who has used the drug in pulmonary phthisis for
five years in the Moabit Hospital of Berlin, considers that it has
no effect upon the tubercular process in the lungs, but is a useful
remedy in the symptomatic treatment of consumptives — perhaps,
the best we have. — Ibid., May.

Dr. Quint praises it in tubercular iritis. — Ibid,, p. 305.

Dioscorea. — Dr. Gentry finds bending head and shoulders,
backwards a characteristic indication for this remedy in colic.
[He speaks of it as ** the very picture of the provings." The
only trace, however, we can find of such a feature is in Allen's
S. 1021, and here it was lumbar, not abdominal, pain which
caused the backward flexion. — ^Ed.] — Amer. Homosopathist,
March 15th.

Diuretin. — This is a patent preparation, but no secret is made=
of its active ingredient being theobromine, the alkaloid of cacao.
Dr. Aldubalbe has tried it in all forms of dropsy : in those of
hepatic or renal origin its effects were slight, if any at all ; but in
cardiac dropsy the results obtained were excellent. About five
grammes must be given daily. — North Am. Joum. of Horn., May>.
p. 326.

Physiologically, theobromine seems to have no such action as.
digitalis and its congeners. Cohnstein, who has experimented
much with it, concludes that it belongs to the group of drugs
which act by direct irritation of the secreting elements of the
kidney. — TJierap. Gazette, May, p. 309.

Dolichos pruriens. — Dr. Jean de W^e, of Brussels^ has found
this medicine curative in two instances of the distressing itching
which so often accompanies jaundice. In the first case he gave
the mother tincture, in the second the 3x dil. ; either seemed
equally effective. — Eevtce Horn, Beige, March.^

Duboisine. — Eecent observations appear to show that in
duboisine we have a drug which may be of considerable value in

^ Dr. de W^e laments that he can find no article on this plant in the
Cyclopcedia of Drug Pathogenesy. If he will look at No. 6 of our rules of
working he will see that the scanty pathogenetic material we possess con-
cerning it was inadmissible. — R. H.

SUMMARY, 279

hystero-epilepsy. Cases have been recorded by Samuely and
Belmondo, in which it produced good results when no other
treatment did any good. Professor Pietro Albertoni has recently.-
recorded three similar cases in which the same treatment wa&
adopted with success. He gave from .0004 gramme to 0.5 milli-
gramme, and thinks that, judging from his own cases and thoset
of the observers mentioned, duboisine may be considered almost;
a specific against hystero-epilepsy. — Therap, Gazette, May.

Dulcamara. — A case of poisoning by this plant, medicinally
administered, is recorded by Dr. Kranz, of Wiesbaden, in the
Horn, World of ApriL

Exalgine. — A case of poisoning by this substance is related in
the Monthly Horn, Eeview for March, p. 172.

Glonoin. — An unusual case of acquired tolerance for this drug
is contained in the Therapeutic Gazette for May. It was given,
to induce its physiological effects,^ in a case of interstitial
nephritis (?). These were at first caused, as usual, by a drop of
a 1 per cent, solution. As they wore off, the number of drops>
and then the strength of the solution, was increased, till in less
than a year the patient was taking a dose equivalent to 6 gr. of
the pure drug. With the consentaneous use of the chloride of
gold and sodium — gr. ^^ to -^^ — the general symptoms, of which
vertigo and dyspepsia were the chief, had disappeared, and the
sp. gr. of the urine had risen from 1002 to 1018. [We have
queried the diagnosis here, because it seems to have been based
solely on the phenomena mentioned above. There was no albu-
men present, and nothing is said as to casts. — Ed.]

Granatum. — Dr. T. Hart Smith, having prescribed somewhat
substantial doses of tincture of pomegranate bark for worms,
found it produce (the patient was a child) spasms of the glottis.
He has since used the drug, in about the 2nd dil., as a remedy
for such spasms occurring in whooping-cough or elsewhere, and
has found it very effectual. —Sxte. Monthly, April.

Heloderma horridus. — This is said to be a poisonous lizard,
found on the banks of the Gila river, in New Mexico. Dr.
Kobert Boocock communicates some provings with the 3rd and
30th dilutions of the venom. It seems to be very virulent. — Horn,
Becorder, March and April.

Hydrastis. — Some fresh experimentation on the lower animals
with this drug and its derivatives is summarised in the Monthly
Horn* Beview for March, p. 173,

» For iUustrations of its use in this way ses Monthly Horn. Review for
March, p. 174.

280 gUMMABY.

Hyperioum. — Dr. E. P. Colby mentions a case of monolifonu
neuroma with consequent neuritis, rendering the whole hand
useless and very painful. Hypericum was the only internal
remedy administered, and after three weeks' use the tumours
upon the nerve-trunk could hardly be found. The neuritis had*
also perceptibly diminished. The patient was seen again later,
and was found so much improved that he was able to use a shovel
in gardening for several hours. — N. Engl. Med. Gaz., March.

Kali iodatum. — In the Lancet of March 4th is a case in
which grain doses of' thiB iodide; taken three times a day, caused
after six doses irritation in eyes, nose and throat, and after six
days a rash on the arms. On the seventh day this was found on
the legs also, and was ascertained to consist of irregular-shaped
blood extravasations.

Kalmia in Cardiao Headache. — ^Dr. ProU relates the case of
a boy of 13, who suffered from headache and weak memory to
such an extent that he was obliged to leave school. The cause
was found in an insufficiency of the cardiac valves, and kalmia 1
was given three times a day. In three days there was slight
improvement. The remedy was given twice daily in the 2nd dil.
The headache then occurred occasionally only. The 3rd dil. was
now substituted, and continued for seven days, when the head-
aches had wholly disappeared. Seven months after the boy was
found to have beenstudying without interruption. — Horn, Monats-
blatter, No. 1, 1893.

Lappa major. — Dr. G. M. Ockford relates a case of chronic
prolapsus uteri, cured by this drug in the 3x dil. A pessary had
been worn for years, and in its absence the uterus would protrude
from the viilva. After a fortnight of lappa it was removed, and
the uterus remained in position. The remedy was continued for
some weeks, and a year after there had been no return of the
trouble. — N. Am. Journ. of Horn., March, p. 177.

Provings of this drug, conducted by Dr. S. A. Jones, are
related in the Horn. Becorder for Feb., March and April.

Henyanthea. — Dr. S. A. Jones quotes a saying of the late
Carroll Dunham's : — ** If a woman ever tells you that she feels as
if she was crowded into a skin that is several sizes too small for
her, look up menyanthes, and you will probably find the rest of
her symptoms in that remedy." — Horn. Becorder, March.

(Enanthe crocata in Epilepsy. — Among his patients in the
Middletow.n Asylum, Dr. Talqott has many chronic epileptics.

aUMMABT^ 281

He has tried several homoeopathic remedies on these in the past,
but has obtained no definite amelioration. save with siHca, which
has done real good in cases where the attacks recur not oftener
than once a week, and are apt to. be specially severe about once a
month. Since using oenanthe, however,-^which he has done on a
large scale — ^he has noted much more decided results. The
attacks have become less frequent (by 40-50 per cent.) and less
violent, and the mental state before and after these, and in the
intervals between them, has been notably improved. The drug
was given in the mother tincture, 1-6 drops a day. — Beport of the
Middletown Asylum^ Jan., 1893.

Phosphorus in Parpura.— Dr. A. Speirs Alexander com-
municates to the Monthly Horn, Beview of May a case of purpura,
with hsBmatemesis and haematuria, in which rapid cure ensued
on the administration of phosphorus in the 6th dil.

Piper methysticum.— By the long-continued use of this drug
as an intoxicant, the skin of the inhabitants of the Sandwich
Islands is said to assume, particulaarly in the extremities^ the
appearance of icthyosis, associated with a certain degree of
atrophy, such as is observed in senile skin. There is an absence
of inflammatory symptoms. — BriL Med, Journ,, Jan. 28th,

Pulsatilla. — A schoolmistress, aged 30, thin, pale, with scanty
hair, complains of restless sleep, accumulation of saliva in mouth,
distended abdomen, occasional diarrhoea. She is growing thinner,
is always chilly and tired, the eyes are particularly weary. When
17 she had an Italian malarious fever, with rigors coming on at
2 a.m. The influenza of 1890, which attacked her, made her ill.
She was treated for a €nonth without benefit with nat. mur.,
sulph., cham. and nux v. She was not the least better, and she
had in addition bulimia with great yawning, and, in consequence
of her weakness, palpitation of the heart on any exertion.
From the moment when she began to take puis. 30, a dose every
day, she stestdily improved, and there remains nothing of her
malady except some sensitiveness to open air. — ^Villers, Arch. /.
Horn,, ii., 166.

Batania. — Dr. A. M. Gushing, taking some heavy doses of
the tincture of this plant to stop an obstinate mucous diarrhoea
(which it did), found it cause severe itching of the rectum. He
has since used it with rarely failing effect when threadworms
cause this trouble. Sanguinarinum nitricum, also, he finds
beneficial in itching and burning of the rectum unconnected with
ascarides. — Med, Century ^ March, p. 90.

282 BOMMABt:

Spi^elia. — ^A ^oman, aged 32, of robust frame, suffered from a
spasm of the stomach, coming on every evening at 8 o'clock;
after great exertion it comes on during the day. It goes off when
she goes to bed and falls asleep. She has also a sensation as if
the left side of the chest were larger and wider than the right;
this she only feels when lying down. Auscultation reveals an
obtuse murmur with the diastolic heart's sound. This murmur is
strongest under the third rib, near the anterior axillary line, and
in the supraclavicular space of the same side. She got for a
fortnight daily one drop of the 30th dil. of spigelia. On seeing her
two months afterwards she told me that she had only had one
more attack of spasm of the stomach. Auscultation showed per-
fectly pure heart's sounds without any murmur. — ^Villers, Arch,
f. Horn,, ii., 159.

Stannum. — Dr. W. A. Campbell reports a series of cases of
irritant poisoning, resulting from the ingestion of canned toma-
toes. Tin was found in large quantities in the contents of the
cans. A notable feature was the number of threadworms passed
in the stools, suggesting, as the reporter says, that the salts of tin^
and not only the powdered metal, are anthelmintic, — Therap.
Gazette, March.

Thuja in Osteo-sarcoma. — ^In a paper entitled ** Without
the Knife," published in the April number of the Hahnemannian
Monthly, Dr. Wallace McGeorge relates a case in which a large
tumour of the thigh, diagnosed as osbeo-sarcoma, was treated by
an old-school physician with the "fluid extract of arbor vitas
(Americana)." He gave at first one drop, then two drops, three
times a day, and after six months the tumour had completely
disappeared. (At the International Homoeopathic Congress of
1891, Dr. Helmuth spoke of several cases of sarcoma, which,
an operation having been decHned, he had succeeded in curing with
thuja similarly administered. — See p. 797 of the Transactions,)

Tuberculinum in Phthisis. — In the Horn. World of Aprils
Dr. Clarke relates a case of pulmonary phthisis in which ** the
consumptive process was completely arrested, and the patient
practically cured " by a course of treatment in which tuber-
culinum, prepared and given as Dr. Burnett recommends, seems
to have been the pre-potent agent. A partial proving of this
preparation (" bacillinum," "tuberculinum Heathii ") is extracted
in the same number of the World from the Horn, Becorder of
Nov., 1892.

Zincum. — Dr. d*Amore, of Naples, has experimented with

8UMMABY. 283

the oxide upon dogs, giving it in doses of grm4 ^ — 1 per diem*
Death occurred after 10 — 12 days* The animals presented the
following symptoms : — Eepeated vomiting without apparent
effort; extreme weakness; incomplete anassthesia; very pro-
nounced emaciation ; scanty urine ; haemoglobinuria, albuminuria^
and glycosuria; hypoglobulsBmia and leucocytosis, the haemo-
globin also being lessened. Zinc was readily found in blood and
urine. The tissue-changes ascertained by necropsy were of two
kinds — ^lesions of vascular origin, and those due to various de-
generative processes. They may co-exist in the organs with more
or less predominance of one or the other, depending, on the time
and the parenchymatous resistance to the drug. In general it
may be said of zinc, that its action is similar to that of phos-
phorus and of arsenic. The chief points of attack are the blood,
kidneys, and general nutrition ; in the liver and pancreas, as well
as in the kidneys, fatty degeneration is found.

THERAPEUTICS.

Aohillodynia and Gonorrhoaa. — Professor Albut, of Vienna,
announced in the Wiener Med. Presse of January 8th, 1893, that
he had lately met with six cases of severe pain in the insertion
of the tendo Achillis. These cases were attended by a small
swelling at the insertion of the tendon. The pains are very
obstinate, and are not alleviated by warm baths, cold compresses,
iodine or mercurial ointment applied externally. Professor
Albut inquires if others have observed this affection. Dr. A.
Welsch, of Augsburg, replies that he has seen three cases of it,
and they all occurred in patients who had suffered for a long time
from gonorrhoea. A swelHng of the point of insertion of the
tendon was always present. The pain was not always ahke or
constant, but increased as the gonorrhoea progressed, and
remained long after the discharge had ceased. ''These pains,"
says Dr. Welsch, " may either belong to those reflex phenomena
which sometimes occur in remote parts of the organism during
catheterisation of the urethra, or they may be referred to the
so-called gonorrhoeal rheumatism, confirming the opinion of many
of the older physicians that gonorrhoea is not merely a local
affection but a general malady (gonorrhoeal dyscrasia). Which
of these is the correct view I am unable to decide. In some cases
the gonorrhoeal infection may be merely a local disease, in others
it may become a general malady, owning to the wandering of the
cocci to distant parts." The remedy employed by Dr. Welsch is

284 3UMMABY.

the tincture of thuja ocddentalis externally and internally. He
applied compresses to the affected part moistened with a lotion
made with one part of the tincture to eight parts of water ; and
he gave internally four to six drops of the tincture three times a
day. He prescribed the same treatment in cases of pains in the
knee and hip of gonorrhodal origin. "Thuja/Vhe says, "acts
like copaiva balsam specifically on the. mucous membrane of the
urethra, bladder, ureters and kidneys, but has a much larger
sphere of action, as it relieves the accessory symptoms of
gonorrhoea^ which are chiefly localised in the joints and sheaths of
the tendons. Boerhaave and Huleland saw good effects from
thuja. Now-a-days its use is almost confined to our homoeo-
pathic colleagues,' who give it in diluted form. This is almost
enough to deter many from the employment of this plant, but
my motto is : ' prove all things ; and employ the best.' The
patient seeks relief from the physician, and if the physician
cannot help him he goes to Pfarrer Kneipp. Sapienti sat ! The
good effects of this tincture when applied to the base of warts are
well known ; it is also useful in condylomata and ulcus molle.
Very good results have been observed from its application in
erosions and ulcerations of the vaginal portion of the womb. I
have seen better and more rapid cures of cases suspiciously like
cancer from thuja than from any other remedy." This is a
brilliant testimony to the truth of Hahnemann's therapeutics
from an adherent of orthodox medicine. — Arch.f, Horn,, ii., 150,

Diarrhoaa ohronioa. — A clergyman, age 64, had suffered for
two years from diarrhoea. It came on after any exertion, after
eating bread or cake, and without any ascertainable cause, betwixt
2 and 4 a.m. Urging to stool came on with great intensity, with
rumbling in bowels and some pressure towards the right giroin.
He has great difficulty in resisting the call, particularly when it
comes on in the early morning ; it streams out, is very liquid,
inodorous, and contains a few ragged bits of fsBces. He has
slight piles, and previous to this malady his digestion was very
regular. Ehus 30, one drop twice a day, caused such an altera-
tion in three days that his bowels became quite regular, and ,
remained so for fourteen days, when, after drinking too much
white wine, the diarrhoea returned. The same medication for five
days cured him completely. — Villers, Arch.f. Horn,, ii., 155.

" Funk." — To anacardium, as a remedy for this mental con-
dition. Dr. Jones, on the authority of Carroll Dunham, adds
argentum nitricum. — Horn. Becorder, March.

BUMMABY. 285

Gonan*hGBa. — ^Two series of 150 cases of this disease were
treated at the venereal dispensary of the Hospital of the Univer-
sity of Pennsylvania. In the first serieSs mild injections (zinc and
hydrastis) were employed as soon as the disease had entered upon
the stationary period, and stronger ones later. In the second,
no injections were used until the subsiding period (^.6., about the
end of the third week), and then only the milder ones* The
number of cases in which posterior urethritis developed was, in
the first series, fifty-two ; in the second, twelve ; while epididy-
mitis presented itself thirteen times in the first, but four times
only in the second. The moral is plain. — Therap. Gazette^ March.
In the May number seven cases are related in illustration
of the new method propounded in the Lancet of Feb. 27, 1892.
They show it to be worse than useless. ** It only adds one more
to the long list of impracticable and visionary methods of treating
gonorrhoea, so much in vogue at the present day."

Leuoorrhoaa. — Dr. Southwick, who is well known as a gynas-
cologist, gives — in the Medical Century for April — indications for
belladonna, calcaxea phosphorica, helonin, kreosote, sepia and
stannum, as the leading internal remedies for this trouble. The
belladonna leucorrhcBa is recent ; thin, odourless, bland, not very
abundant ; increased by any cause producing pelvic congestion.
That of cstlc. phos. is profuse, milky and bland, with scrofula as
its basis. Helonin is indicated by a profuse yellow discharge in
ansBmic subjects, causing much itching. Kreosote comes in when
the leucorrhcea is profuse, watery and offensive, with much itch-
ing and burning ; sepia when it is milky, much worse before the
menses, and there is bearing down with enlargement of the
uterus, the complexion sallow, the skin unhealthy. Stannum is
much praised for profuse bland discharge of yellowish or white
mucus, with great debility and aching in the back.

Migraine. — Dr. H. Moser has a paper on the treatment of
this malady in the Horn, Monatshldtter, No. 2 of 1893. His
experience is, that one can never hope to cure a case without
getting the patient to give up coffee entirely ; that sanguinaria
and iris are the leading remedies ; and that niccolum, when indi-
cated, " will surprise." Its pain is most severe in the forenoon,
from 10 to 11, and may be so intense then that the patient cries
out in anguish. It appears first on the left side, then possibly
jumps over to the right. In the evening it disappears.

Hyxoadema. — Mackenzie finds that much less of sheep's
thyroid than was at first administered will suffice for these cases.

^ ^
J

286 SUMMABT.

The gland, or half a drachm of the extract therefrom, twice a
week, is as much as it seems advisable to commence with, and
the same amount once a week suffices to keep patients in good
health, after their primary recovery. — Lancet, Jan. 14.

Tuberculous Joints. — Dr. W. L. Morgan sends six cases to
the Horn, Physician for March, which, being diagnosed as tuber-
culosis of joints, recovered under homceopathic treatment. Calc*
carb. and phos., 30 to 200, were the leading remedies.

Varicose Ulcers. — ^The Horn, Becorder for March translates in
full Dr. Windelband's. article on the value of carduus marianus
here {Zeitschr, des Berlitier Ver. Horn. JErzte)» He has " records
of 145 bond fide cures out of 196 cases." He gives small doses of
the tincture or first dilution.

Dr. Jousset, in L'Art Medical for the same month, speaks as
warmly of clematis vitalba in this disease. He gives the 3rd
trit. internally, and uses locally an ointment made with the Ix.

JOURNAL

OF THE

nMnpthit

No, 4. OCTOBEE, 1893. Vol. I.

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

36, SUlwood Boad, Brighton,

PEESIDENT'S ADDEESS,^

BY J. GALLEY BLACKLEY, M.B.

Gentlemen, — Since the last annual assembly, when you
did me the honour of electing me to the post which I fill
to-night for the last time, many events of the first import-
ance to the well-being of this Society and of homoeopathy
generally have come to pass. It is well on occasions of
this kind that we should attempt a kind of scientific stock-
taking ; and as the events of this session have been of
surpassing interest, and will doubtless be destined to have
a far-reaching influence upon the future of this Society, I
propose to put before you as succinctly as possible what
these events have been.

Firstly, then, your Council met in July for the election
of a secretary and of an editor of its Journal. For the
first of these posts I had the pleasure of recommending
to the Council a gentleman whose name had occurred, I
make no doubt, to all those who had the pleasure of listen-
ing to his paper upon the " Future of the British Homoeo-

* Delurered June 29, 1898.
VOL. I. — ^NO. 4. 19

290 FBESIDENT*S ADDRESS.

pathic Society," a gentleman in every way fitted to infuse
new Kfe into the post which I now feel had been somewhat
perftmctorily filled by your late secretary — ^I allude to Mr.
Knox Shaw. The reception given by the Society to his
paper, and the discussion which followed it, were suiB&cient
evidence that we were ripe for reform of some kind — or
rather, I ought to say, for the bursting out into vigorous
growth of the little plant, which had for a good rnaay year^
been, only waiting for the fertilising showers which the
presence of an unusual amount of young blood in the Society
would sooner or later be sure to give. That this choice has
been in every way a fortunate one you hardly need to be
told, and the result is, that we have now our Journal, with
its supplement containing a full list of members with their
addresses and appointments; we have, at least, one vigorous
and healthy branch of the parent Society ; and we have a
real live Council, which has held no less than five meetings,
and has transacted a large amount of important business.

For the post of editor of the Journal there was one name
also which stood out pre-eminently from all the rest, if only
the bearer of it could be induced to add another to the long
list of burdens he carries on his shoulders. I allude, of
course, to Dr. Hughes, and I am sure it must be a source
of the liveliest satisfaction to us all that Dr. Hughes was
once more ready to place his time and his boundless energies
at the service of the Society and of the cause which he loves
so well.

From the very first it became evident that the tide
of new members which commenced to flow at the end of
last session would be maintained, for at our first meeting
we had no less than 28 new petitioijs for admission to the
Society ; at the second, 16 ; at the third, 7 ; at the fifth, 3 ;
sixth, 4; seventh, 3; and one each at the eighth, ninth, and
tenth ; and all these gentlemen, 63 in number, have been
duly elected members. The affiliation of the Liverpool
Homoeopathic Medico-Chirurgical Society, as a branch of
this Society, added three more members.

The new corresponding members you have just elected
will also help to confer lustre on our muster-roll.

pbesident's addbess. 291

, It is .rarely that a session goes bjr without' our having
to lament the loss of familiar faces, but it can be but seldom
that we have to lament the loss of. such a power amongst us
^s John James Drysdale.. Although resident at such a*
distance, and but rarely present in the flesh, he was in very
truth, to the last, with us in spirit. With the extent of
his work on behalf of homoeopathy, as well as in the
domain of pure science —with his many-sidedness, the
copious biographical notice in the Monthly Homoeopathic
Beview of last September has made you familiar ; but
it is only those who have lived in Liverpool, where he
lived and worked to the last, who can fully appreciate
the Idss we have sustained by. Drysdale's death. He was
a power amongst us who will not be replaced in our
time. Over and above his individual medical and scientific
work, brilliant as it was, he did, if possible, greater service
to the cause of homoeopathy by his unique gift of exciting
an enthusiasm for honest painstaking work in all those
about. him. It was impossible to be long, in Drysdale's
company without having promised to devote some of one's
leisure to the scientific exposition of homoeopathy. Not
the least, too, of his services to homoeopathy in Lancashire
were due to his gifts as a genial host, and (where once the
ice had been broken) as a thorough-going and trusty friend.

Dr. Mackintosh, though living in retirement at Torquay,
and not often present of late years at our meetings, was
well known to the older members of the Society, On the
rare occasions when he came up to the Annual Assembly,
his chief desire was to make the acquaintance of the younger
members of the Society, to whom he was always especially
kind and genial.

In Dr. Blumberg, of Southport, who died on the 5th
inst., we have lost a representative man, and one, moreover,
who might be reckoned as amongst the most scholarly
amongst us. He will be missed both in his local sphere,
and as being one of the few remaining members of that
gallant band of patriots from various countries who sought
and obtained an asylum on these shores after the general up-
ieaval of 1848, and most of whom, having adopted medicine
as their profession, have left their mark behind them.

S92 fbbsidekt's address.

Dr. Carl Fischer was a new member of the Society^
having been elected only at the May meeting. Immediately
after his election he went out to Chicago to attend the
World's Homoeopathic Convention, and died there last
week.

Of corresponding members, one of the best known thirty
years ago has disappeared, in the person of Dr. Charge^
a man who, perhaps more than any other, had done good
service for homoeopathy in France by his vigorous com-»
bative nature coupled with skill and acquirements of the
very first water.

The attendance of members at our monthly meetins^s
has given undoubted evidence of awaJ^ened interest in the
Society; on one occasion no less than 36 were present, and
the average for the first nine meetings was 24. This, for a
small Society like ours, the majority of whose members are
men living at great distances, is more than creditable.
Visitors have not been very numerous, the average being 1.1.
Besides the specimens shown on the occasion of the^^
clinical evening in February, some very interesting ones have^
been exhibited at our ordinary meetings. Perhaps the most
interesting were Dr. Burford's specimen from a case of
ectopic gestation, and Dr. Moir*s patient with paresis of left
sixth nerve and soft palate, and ansesthesia of left side of
face and gums.

The list of papers brought before the Society this session
will be found second to no other session both in their
character and the tone of the discussion, as well as in the
extent of ground covered by the various essayists. Dr.
Dudgeon's paper on stammering heart was a fitting prelude
to the others. Perhaps the second evening of the session
was on the whole the most interesting— an evening devoted
to a discussion upon the medical and surgical treatment of ^
empyema. Opened by men of such experience as Dr.
Herbert Nankivell, Dr. Midgley Cash, and Dr. Wynna
Thomas, one is not surprised to hear that the attendance,
was the largest of the session, namely, 36 ; and that 14
members spoke in the discussion. Dr. Cook's paper, on the
ovary and endometrium as a glandular structure, was, lika

pbebident's address. 293

everything proceeding from Dr. Cook's pen, marked by
strong originality.

An excellent paper, of a thoroughly practical kind, which
we should be glad to see more frequently, was Dr. Moir's
on the ** Diuretic Action of Apocynum ; " short as the paper
was no less than 13 members spoke in the discussion.

Dr. Blake's subject "Habitual Constipation " was handled
in a novel and somewhat original fashion, and in addition' to
purely medical treatment of this troublesome condition,
placed the members au courant in all that is new in the way
of modern adjuvants, massage, electricity, movements, &c.

Mr. Frank Shaw, in his short paper on " The Attitude of
the Medical Profession towards Infant Life Assurance,"
^ave an excellent example of the advantage there is for
medical men to step aside from purely medical work and
.give the world the benefit of well-directed efforts for the
benefit of the species, beginning, of course, very appro-
priately, with infant life preservation.

The ch'nical evening I have already referred to.

Dr. Percy Wilde's paper on the " Pathogenesis and
Treatment of Eheumatism " was a somewhat ingenious
attempt to revive the half-forgotten theory of the lactic acid
•causation of acute rheumatism. In the discussion which
followed, whilst giving the author full credit for his success
in the way of treatment, the general feeling was that the
hypothesis concerning the cause was what the Scotch would
call "not proven."

Dr. Alexander's paper, in May, was another of the
practical papers devoted to a single medicine, " Thuja in
relation to Aural Polypus and Allied Growths," and gave
rise to an interesting discussion.

Mr. Wright also read, on the same evening, his short
paper on "Roaring in Infants," destined to be read in
the section of Paedology at the World's Homoeopathic
•Convention in Chicago.

Dr. Cook's second paper this session, on " Antiseptics,
vrith especial Reference to the use of Ozone," was a most
fascinating lecture, and had the advantage of being extem-
poraneous. All present will look forward to an early oppor-

^4 pbesidei^t's addbess.

tunity for investing in an. ozone generator, and. so giving
their patients the full benefit of the virtues which lie its
allotropic oxygen.

Carrying out the line of policy adopted by the last
annual assembly, the first two numbers of the new Journal
of the Society, edited by the master hand and mind of Dr.
Hughes, are now in the hands of members. The Journal
tells its own tale, and has been pronounced on all hands aii*
unqualified success. Men who refrain from joining the
Society now, because they get nothing for their money,
must indeed be hard to please. The very complete classified
Supplement, containing names and addresses of members,
&c., is also very useful, and in the opinion of an influential
minority of the members of this Society fulfils nearly all the
purposes of a homoeopathic directory without having its
distinctive title. Whether this is really the case or not
remains to be seen. Some at least amongst us are of
opinion that a rose by any other name will surely smell
as sweet. Is it not the thing itself, rather than the name,
that the dominant school objects to ? I have always
thought it is. So long as we let it be known that we pre-
scribe even partially according to the law of simiha, so long
shall we be ostracised ; and it matters little, then, whether
we appear in a distinctive directory or a List of Fellows,
and Members of this Society. Those of our allopathic,
colleagues who are disposed to be friendly do not stop to
inquire whether our names appear in the Homoeopathic.
Directory or not. Whilst on the subject of publications,.
I might direct the attention of all members who have joined
since 1886 to the postrscriptuin on their notice paper, con-
cerning the republication of Part I. of the Cyclopaedia. As-
more than a hundred members have been elected since 1886
there must be a great many whose sets of the Cyclopaedia
are incomplete. I would urge upon all to seiid their names
at once to the Secretary, so that the republication may
proceed forthwith.

Outside the Society, and what immediately concerns
it, the events of the year, with two exceptions, have perhaps
been below the average in point of interest, but these two-

FBESIDENT*S ADDRESS. 295

events deserve special notice as being what is called epoch-
making. The first of these was the World's Homoeopathic
Convention, which commenced in Chicago on Monday, May
29, and lasted a whole week. The choice of so early
a date acted natm:ally as a barrier to the presence of very
many Englishmen, but our Society was after all re^
piesented by three of its members, viz., Drs. Molson,
Hiwkes, of Liverpool, and Fischer.^ Several papers written
by members were also sent over and discussed, and will,
in due time, appear in the Transactions of the Convention,
amongst them being one by Dr. Hawkes upon the " Posi-
tion and Progress of Homoeopathy in Great Britain and
Ireland since the last International Convention."

The second event, which happened as recently as Friday
last (June 23), is, so far as homoeopathy in England is
concerned, of far greater importance than anything which
has occurred for a generation past. I refer to the laying of
the foundation stone of the new London Homoeopathic
Hospital, which is at last a fait accompli. Graced by the
presence of the Patroness of the Hospital, that most genial
and deservedly popular of Princesses, who is not ashamed
even now coram populo to confess her faith in the method
of Hahnemann, and strengthened by the ever- needful sinews
of war, with an insignificant sum of £10,000 remaining still
to be raised, everything looks bright for the future of the
Hospital. Before two years are out we hope that all will
be in working order. With everything in the way of con-
struction, furnishing, and appliances of the very newest and
best, it will be strange if we do not attract students and do
more in the way of teaching than has ever been possible
in London before.

I see it has been the custom with most retiring Presi-
dents in their annual address to make suggestions as to the
future of the Society, and I would fain follow their example
in one or two respects. It has been frequently said that to
ns members the British Homoeopathic Society is the
medical society, the only possible one, and that therefore
our proceedings should embrace all that is usual in a
medical society's life. This I heartily endorse, but at the

296 FBEBIDSNT*S ADDBB88.

same time let ns not forget that the Society was founded
originally for the cultivation and spread of homoeopathy, and
that an exposition of the practical application of homoeo*
pathy in the cure of the sick should continue to he kept well
in the forefront. Let us not say we love surgery or gynse*
cology less, but that we love medicine (homoeopathic
medicine) more. It is also, let us not forget, our only
medico-ethical society, and although, speaking for myself,
I am agreeably disappointed at the very small amount of
such work which has devolved upon me as President, let
us always, by strengthening the hand of our President and
Council, enable them, where necessary, to put the foot down
and administer rebuke where it is merited. Let us not be
content merely to follow our allopathic brethren in such
matters, but let us ever set them an example in rigid appli-
cation of those first principles of medical ethics which should
come instinctively to the mind of all true lovers of their pro-
fession.

It has frequently been suggested from this chair, almost,
I think, from the very foundation of the Society, that we
should endeavour, as far as possible, to give opportunities in
our discussions for settling in some wise the all-important
question of the dose. This is a question which crops up
from time to time, is warmly discussed, and is then laid to
slumber for another spell. We do not seem to make much
progress. Perhaps I might suggest that one of our discus-
sions at an early date might be devoted to a consideration
of the treatment of different cases of the same disease at the
hands of different medical men by different dilutions of the
same drug. There is, I feel convinced, more in this than
appears on the surface, for the first questions which assail
the teacher are invariably the same — " How do you deter-
mine the dose ? '* and the next one, " How far can we
depend upon homoeopathic medication alone?'* On these
questions, and a few points which hinge upon them, I will
quote the remarks of one of my predecessors in this chair,
the late Dr. Bayes, merely remarking in advance that
though nearly twenty years have gone by since these words
were uttered, they remain as true and as much needing our
practical attention as they did in 1874 : —

PB£8ID£NT*S ADDBESS* 297

'' The solution of the much vexed question of the dose is
included in the proper appreciation of the great law. It is a
part of the art of therapeutics so accurately to adjust the
dose that the depressed and paralysed nerves shall be stimu-
lated exactly up to the health-point ; any dose which goes
beyond this retards cure by leaving a corresponding de-
pression. The working out of this enquiry affords a most
interesting field for careful experiment on the part of our
members, and it can only be satisfactorily carried out by the
conjoint efforts of many men and by the free comparison of
many individual experiences." Again : " It would tend
greatly to the advance of the legitimate influence within the
profession were we in a position to define its exact value in
the realm of medicine. The exjperience of many active
workers can alone enable us to prove the full extent of its
healing powers, and the limitations by which homoeopathy
is bounded in the treatment of disease. It may not be
premature to indicate that experience points to the two
following propositions. Firstly — that homoeopathy enables
us to restore the balance of functional action both to the
organs, to the circulation, to the nerve force, to cell growth,
and to metamorphosis of tissue. Hence the homoeopathic
method is apphcable to all diseases where loss of balance
between functional actions constitutes the disease, or is the
prominent cause of suffering. Secondly — ^by restoring func-
tional balance the homoeopathic method enables us to arrest
and destroy many morbid growths and many parasitic
diseases in an indirect manner, for if we are able to restore
perfect health to the containing or surrounding tissues, we
may, so to speak, starve the morbid growth or parasite.
The illustration of these two propositions affords much scope
for experiment. It will probably be found that surgical
interference, or the adoption of the antiseptic method in the
treatment of morbid and parasitical growths, in toxaemic
conditions, pyaemia, &c., will enable us to restore the sick to
health with a still greater facility and in a direct manner,
but nevertheless, a combination of the homoeopathic method
with those others will even here enable us still further
to expedite the cure."

298 fbesident's address.

One point more connected with the near future of the
Society and I have done. Some months ago I approached
our secretary ^rith a suggestion that as the termination
of next session would complete the fiftieth year of the
Society's existence, we ought not to let the occasion go by
without some special effort being made to celebrate the
Society's jubilee in a < fitting manner. This idea, was at
once warmly taken up by our energetic secretary, who im-
mediately suggested that for an occasion of the kind we should
certainly endeavour to get one of the original members,
to accept the presidency for next year. "We looked over the
list of members, with the dates of their elections, and found,
alas, that there was but a single one left of all that compact
little band who helped Quin to found the Society in 1844 ;
but this one was our dear old friend Hugh Cameron. Him
we now approached with a request that he would consent to
serve as president for next year, promising him all possible
assistance at the hands of two young and vigorous vice-
presidents. By this time you know the rest. Our dear old
friend has consented to sacrifice some, at least, of the well^
earned leisure of a green old age, and I think I may venture
to promise on behalf of all here present that it will not
be our fault if the session 1893-4 is not head and shoulders
above all its predecessors in the enthusiasm, at least, with
which we devote our energies to being, first physicians, then
homoeopaths.

And now, gentlemen, before I say good-bye, let me
thank you for your mivarying kindness and consideration
for myself whilst presiding at your meetings. I am proud
to say that I have been present at every meeting this
session, and that only on one or two rare occasions has the
meeting had to begin without me. Finally, let me thank
officers and council, who have one and all done so much to
make my post, if not absolutely a sinecure, at least a bed
of roses.

THUJA JN KBLATI0N TO AUBAL POLTPUSi 299

• THUJA IN KELATION TO AUBAIi POLYPUS

AND ALLIED GEOWTHS.^

BY A. SPBIRS ALEXANDEB, M.D., CM.

Physician, Ear, Throat and Nose, Devon and Cornwall
Homoeopathic Cottage Hospital,

One of the advantages claimed for homoeopathy is that
by its means surgical operations can sometimes be averted.
In the experience of most practitioners, cases from time to
time occur, where a surgical operation, though presenting
the readiest means of affording relief, may for some reason
or another be counter-indicated.. Among such opposing
circumstances may be mentioned, the situation of a new
growth, as rendering an operation dangerous or imprac-
ticable, or perhaps the nervous or debilitated condition of
the patient, which may induce both him and his attendant
to gladly accept the alternative of some less drastic method
of treatment than that of the surgeon's knife.

It is with the object of illustrating such an alternative
that I venture to address you this evening on the merits of
the well-known drug, thuja occidentalis, as an agent for
the treatment of aural polypus and other allied or analogous
neoplasms. I also hope to elicit some expression of opinion
on the part of my hearers as to the probable action of the
remedy in the few cases about to be related ; or, better still,
the history of any experience they may possess in the same
direction.

There is a disposition on the part of perhaps the majority
of aurists to regard polypus of the. ear as a merely local
disease, and therefore to treat it solely by local measures.
Hence it is usual to remove these growths by some suitable
surgical proceeding, such as the application of the cold or
galvano-cautery snare. That such treatment is often the
most rapid and effectual that can be adopted is doubtless
true ; yet if, as Hahnemann taught, " affections of external
parts proceed from an internal morbid state," ^ it would be

» Re^d before the Society, May 4th, 1893.
. « •• Organon," Sect. 187, p. 148.

800 THQJA IN BELATION TO AURAIi POLYPUS.

more scientific, more true to our principles, and more likely
to give a permanently satisfactory result, to treat the patient,
and not the disease.

Whatever merits surgical measures may possess, it will
he manifest that they were impracticable in the first case I
have to narrate, the anatomical relations of the parts in-
volved preventing the introduction of any form of snare.
Moreover, such measures were unnecessary, and the case
affords a proof that correct homoeopathic treatment may, in
certain instances, obviate the need of surgical operations.

Case I. — Mr. C. N., age 38, applied for treatment on
Sept. 2nd, 1892, on account of deafness and noises in the
left ear. He stated that a week or two previously, the ear
had been exposed to a blast of steam laden with coal dust,
after which the above symptoms had developed.

Examination revealed the presence of three masses of
exostosis springing from the anterior, the postero-inferior,
and the superior aspects of the meatus, and projecting into
the latter to such an extent a^ to leave only a small triangular
chink of its lumen patent. In consequence of this obstruc-
tion, no view of the membrana tympani could be obtained.
The cutaneous lining of the canal was slightly hypersemic
and swollen ; but the circumstances above mentioned pre-
vented any very accurate diagnosis being formed of the
changes that might be in progress internal to the exostosis.

Various palliative measures were adopted while waiting
for developments, but the case remained much in statu quo
till Sept. 13th, when a slight discharge of pus was observed
exuding from the chink between the bony tumours. Hepar
sulph. was now given internally, and suitable cleansing
measures instituted.

Here I pause, to observe that such treatment, though
it is the kind of rule-of-thumb means of dealing with many
cases of otorrhoea, cannot be commended as generally useful.
Many other drugs beside hepar have otorrhoea in their
pathogeneses, each no doubt possessing its own peculiar
and distinctive assemblage of symptoms. Where it is
possible to match one of such groups of symptoms to those
of the given case, the corresponding drug would probably be

THUJA IN SEI*ATION TO AUBAL POLYPUS. 801

the simillimum, and might therefore cure, irrespectively of
the pathological condition giving rise to the symptoms. In
ear cases, however, the discovery of the pathological con-
dition is generally of the greatest possible assistance in
guiding to the appropriate treatment, and may lead to the'
choice of the correct remedy, when sjrmptoms alone are
unavailable, or insufficient for that purpose. In other words,
it is desirable to take the entire objective, as well as subjective
aspect of the case into consideration, for the purpose of
diagnosing not only the malady, but also its remedy. That
such observation is necessary for the sufficient compre-
hension of a given case, is well illustrated by that now
narrated. Hepar sulph, had been prescribed chiefly because
it is known in a general way to control or modify the
suppurative process; but that such a principle was an
inadequate basis for its selection in this case, the sequel
will show. On Oct. 15th, the ear was again inspected, and
now for the first time a small polypus was seen pushing its
way through the triangular chink between the masses of
exostosis. It was bright red in colour, and bled easily when
touched with the probe. The subjective symptoms of deaf-
ness, roaring and commotion in the head persisted, and
were extremely distressing to the patient. These latter
were of course merely effects of a cause, and did not con-
stitute the disease itself, any more than jaundice is a disease
per se. They did not of themselves afford any such dis-
tinctive drug-picture as to indicate the simillimum, and
inasmuch as they are common to other abnormal aural
conditions beside polypus, it was necessary to recognize the
existence of the latter before the appropriate remedy could
be selected. But just as the subjective symptoms did not
constitute the disease, neither did the polypus do so. As
nasal polypus is not a disease of itself, but the outward
expression of one, viz., necrosing ethmoiditis, so aural
polypus is but that of the diseased process that gives rise
to it — in the present case otitis externa acuta. The sub-
jective symptoms, then, plus the purulent discharge and
polypoid growth, were the full external expression or
totahty of the symptoms and signs of that internal disease

302 THUJA IN EELATION TO AUBAL iPOLYPUS.'

which had to be cured, and, without that complete picture,
the weapon that should successfully contend with, and com^
pletely conquer the enemy, could not have been chosen.
-To find the simillimum, then, these had to be matched by
a disease-picture producible in the healthy body, by some
medicinal agent. Here a difficulty arose ; for, while several
drugs are accredited with the cure of aural polypus, none, so
far as I am aware, have yet been found to produce that
condition. An appeal had therefore to be made to clinical
experience — a resource whose value few will deny, and of
which most of us habitually avail ourselves. Such a pro-.
ceeding may be open to censure by some, as savouring of
Empiricism ; but the selection of a remedy for a given case,
on the ground that it 'has been known* to cure a precisely
similar case, is not empiricism in the obnoxious sense of
the term, if it can be shown that the drug acted beneficially
in virtue of its response to a recognised law. The drugs,
then, that have been accredited with the power of curing
aural polypus are calc. carb., lycopodium, mercurius, phos.,
sanguinaria, thuja and teucrium. Of these, thuja perhaps
possesses the weight of evidence in its favour ; though in
the strumous diathesis, calc. carb. would doubtless be the
more appropriate drug. Dr. Hughes reports a case of aural
polypus (to which I will refer more fully farther on) cured
by the internal administration of the former; and others
have obtained a like result in polypus of the uterus, larjnix,
etc. On Oct. 15th, thuja, in the 30th dilution, was accord-
ingly given to the patient before alluded to. On Nov. 4th,
the condition was unchanged, except that the polypus
appeared to have bulged out a little more through the
opening. Patient was directed to continue the medicine.
On Nov. 18th, he returned, and reported that a few days
before, after a great increase of the noise and turmoil in his
head, he had suddenly felt something " go oflf in his ear,*'
to use his own expression, the sensation being accompanied
by a slight discharge of blood from the meatus, that there-
after the noises had entirely ceased, and that hearing power
had at the same time returned.- ^

Examination of the meatus showed that the polypus had

THUJA. IN BELATION TO AUBAL POLYPPS.' 803 .

disappeared, some black, dried■^'up blood occupying its place;
The meatus was then syringed, and what appeared .to be the
shrivelled remains of a small polypus were washed out.
Hearing was found to be equal to that of the other ear, and
all subjective symptoms were gone. The chink between the
bony processes was too small to allow of the membrana
tympani being examined, but, a.s there were no signs sug-^
gestive of perforation, it was concluded that the poljrpus was
of extra-t5rmpanal origin.

Case It. — Gertrude S., aged 11, was seen on Sept. 6th,
1892, on account of deafness and purulent discharge from
the right ear. The discharge was of long standing, but no
definite history of its development could be elicited.

After the meatus had been cleansed by syringing, a small
pale polypus was found lying in the floor close to the mem-
brana tympani, which was intact. The child being ex-
cessively nervous, shrinking even from the touch of the
speculum, it was decided to try the effect of medicinal treat-
ment, before resorting to any operative interferenccw
Thuja 30 was therefore given internally, while boracic acid
was used locally for the purpose of cleansing the meatus.
Under this treatment the discharge gradually ceased, hear-
ing improved, and in two months' time, on Nov. 8th, inspec-
tion showed that the polypus had entirely disappeared.

This case may be taken as typical of others of a similar
character, in which I have found thuja useful. The situa-
tion of the growth in these cases has not seemed material,
in some being intra-, and in others extra-tympanal.

Likewise in cases of granulations of the middle ear, and
of otorrhcea, it has from time to time served me in good
stead, and, in some instances, after the failure of other means
of treatment. Besides the internal administration of the
drug, I may here suggest that it might probably be used
with advantage as an insufflation in the form of sugar of
milk saturated with the tincture and dried. This modifica-
tion of its use, however, I have not yet employed. As an
illustration of the action of thuja in some cases of otorrhcea,
the following may be adduced.

Case III. — Mr. M., a hale old man of 83, applied for

904 THUJA IN BELATION TO AUBAL POLYPUS.

advice on Oct. 19tb, 1892, an account of deafness of the
right ear. He stated that, after being exposed to a draught,
be had suffered much pain, which was relieved by the dis-
cbarge of matter. Examination revealed extensive rupture
of the membrana tympani, evidently resulting from an
attack of otitis media acuta. Hepar sulph. was given inter-
nally, with an insufflation of boracic acid.

On Nov. 16th, patient was again seen, but no material
improvement had resulted from the treatment. Thuja 30
was therefore substituted for hepar, and the insufflation
continued. This treatment was persisted in at intervals till
March 22nd, 1893, but without any appreciable effect.
Patient complained that he could not ta<ke the medicine,
because after each attempt he experienced a disagreeable
sensation in the ear and throat, as though all moisture in
those regions were completely dried up. There was no
cessation, however, of the otorrhoea. It seemed probable,
from these symptoms, that a medicinal aggravation had been
produced, and in order to test the effect of a higher dilution,
a few pellets of the thousandth were placed on the tongue,
the patient being requested to take no more medicine of any
kind before again reporting himself. On April 5th, he
returned, stating that the discharge had ceased entirely, and
that his ear and throat felt quite comfortable, though the
hearing had not returned.

Here, then, was an example of the apparent success of a
higher attenuation, after the failure of a lower one of the
same drug — a circumstance which may not be uninteresting
to those members of our Society who are still sceptical as to
the curative properties of any dilution higher than hand-
made two hundredths.

Case IV. — I shall now give a brief epitome of the striking
case already alluded to as reported by Dr. Hughes in the
Monthly Homceopathic Review for Sept., 1869.

Mr. A., aged 63, was seen by Dr. Hughes on the 23rd
March, 1869, and found to be suffering from a polypus, of
the raspberry-cellular variety, in the left meatus. Thuja 12
n. and m., was prescribed. This medicine was continued till
April 12th, when the polypus had assumed a blackish

THUJA IN BELATION TO AUBAL POLYPUS. 305

coloiir ; and on the 2()th, it had disappeared, though otorrhoea
and dea&OBS persisted. Merc. sol. 4 was then given, and
continued till May 12th, on which date the polypus was
discovered to have reappeared. Thuja 12 was accordingly
resumed for a month, and then replaced by the 30th dilution
of the same drug. Under this treatment the polypus in-
creased in size, at the same time fading in colour, till, on
June 22nd, it had become dead-white in appearance. On
July 8th, the polypus came away en masse, the otorrhoea
ceased, and hearing thereafter improved.

For the two next cases, I am indebted to my friend Dr.
Black, of Torquay.

Case V. — Mr. , aged about 45, above medium

height, corpulent, but fond of out-door sports, came to me
complaining of deafness in one ear, and of a discharge, partly
watery, partly bloody, that kept oozing from it. On waking
up in the morning, he found the pillow stained sometimes
'with blood, sometimes with watery-looking discharge. On
examining the ear with a Brunton's otoscope, I observed a
polypus of the mucous sort attached to the posterior wall of
the meatus, and projecting forward so as to obscure about
three-fourths of the tympanum. The surface was smooth
and glistening, and streaked with blood. I told him what he
was suffering from, and that I should give him some medi-
cine which had been the means of removing such growths in
the hands of others, although I myself had had no practical
experience of it. Although sceptical of the result, he took
along with him some thuja 30, of which he was told to take
five drops in a little water twice a week, and he left behind the
memory of a face lit up with a kind but incredulous smile.

A week afterwards I met him in the street, and he said
in passing : ** I have had no discharge from that ear since I
took the first dose of the medicine." " All right,'* I replied,
**rm glad to hear.it. Go on, and come to see me when
the month is up.** He presented himself at the end of the
month, and told me there had been no return of the
discharge, and his hearing was better. I examined the ear
hx which I thought the polypus had been, but could not see
a vestige of it. Thinking I had made a mistake, before

VOL. I. — NO. 4. 20

h

3.06 T3UJA IN RELATION TO AURAL POLYPUS.

saying anything I asked to look at the other ear. This. I
found as clear as a hell, so I told him his polypus was gon^e.
He said, " I thought it must, for I feel all right."

Case. VI. — Mrs. asked me to look at baby's navel,

as she thought it was not quite right. The infant was five
weeks old. On looking at it I found a fleshy-looking mass,
about the size of a small bean, projecting from the, um-
bilicus. It was somewhat conical at the apex, and had a
broad base. The child . was given thuja 30, two drops in
eight teaspoonfuls of water,. a teaspoonful three times a day.
I saw it again three weeks: after, when it had become
reduced in size to the head of a match. I do not recollect
seeing it again, and my impression is that, the mother told
me the child was all right.

It has been pointed out that thuja has not yet been
shown to have produced aural or other polypus in any of
its provers. In reviewing the foregoing cases, the critical
Hahnemannian may, therefore, well ask why the drug
effected the cure of such a growth, and if such a cure can
indeed be regarded as homoeopathic.

In order to solve these questions, the action of thuja on
cutaneous, muco-cutaneous and mucous surfaces generally,
and more particularly on that of the conducting apparatus
of the ear, may now be briefly considered.

Such action may be illustrated by the well-known effect
of the drug on the mucous lining of the urethra, several
provers while taking it having experienced genuine attacks
of urethritis, with its attendant symptoms of inflammatory
swelling, dysuria and purulent discharge. In others, con-
dylomatous patches about the anus, warty excrescences on
the corona glandis and on the lips, have been developed,
and some have reported the appearance of true papillomata
on the hands, &c. The latter, however, seem to have had
warts at some previous period of their lives, and may
therefore have had a predisposition to those growths which
thuja evoked anew.

Less well known, perhaps, are the catarrhal effects pro-
duced by this drug on the Schneiderian membrane, ai>d
what m9,y be regarded as its processes lining the Eustachian
tubes and tympanum.

r

THUJA IN BELATION TO AUBAL POLYPUS. ' 307

In the Gyclopcedia of Drug Pathogenesy, the nasal
symptoms recorded by various provers are as follows : —
•Obstruction of nose, from which a quantity of blood was
blown at evening; frequent sneezing; increased secretion
•of mucus from the nose ; stoppage of right nostril, alter-
nating with running ; in right nostril a feeling of soreness
or ulceration, — ^with other similar effects.

Likewise in the ear we find the following subjective
:symptoms induced :— Shrill ringing in the ear, which, after
a few hours, as suddenly changed to dull buzzing and
moaning, latter sensations gradually changing to a noise as
of a bubbling liquid ; feeling of stoppage in left ear, with
diminished power of hearing ; sticking from right velum
palati into internal ear ; painful stitchjes from depth of right
-ear through external , ear ; feeling as if the external organ
were filled with water, similar to the sensation felt when
one dips his head under water ; sensation as though some-
thing were squeezed out at both ears.

It will be noticed that no objective symptoms are men-
tioned in connection with the ear, but the effects recorded
both in that organ and in the nares suffice to indicate the
direction in which the drug acts. They jnay be fairly inter-
preted as the outward expression of hyperaemia of the mem-
brane lining those parts, and of increased secretion of
mucus from its glands. There is thus an anology between
the effect produced by thuja on the urethra, and that on the
nasal and aural mucous membrane, in both inflammation
and abnormal discharge resulting from its exhibition. On
the genital organs, and also on the skin, warty growths
have likewise been set up, and also cured, by its means.
From thence to polypus, there is but a step, both growths
being closely allied histologically ; and though thuja is not
known to have caused aural poljrpus, yet it is as easy to
conceive that it is as capable of curing it, as it is of curing
warts. Nor is it difficult to trace out the modus operandi of
such a cure. Given an aural polypus, it rests on and springs
from an inflamed base, drawing its nutriment from that
abnormally vascular region. Now, let the pedicle of that
polypus be ligatured, and what happens? It presently

308 THUJA m BEIiATION TO AUBAIt POLYPUS.

withers, dies, and drops off. And we may assume that thi&
is just what takes place in a case to which thuja is homoeo-
pathic. It acts on the inflamed base, dries tip the hyper-
semic vessels, cuts off the blood supply at its source, and the
polypus, no longer finding that nourishment which is neces-
sary to its existence, has no alternative but to succumb.

Thuja cureSy however, while the ligature or the ecraseur
only remove. In the former case the cause is got rid of,
and hence recurrence will be impossible ; but in the latter,
the general morbid condition and local hypersemia being^
unaffected, the polypus may be expected to re-appear at na
distant date.

Another explanation of the action of thuja in aural
polypus may be sought for in its reputed relation to the
sycotic diathesis. Hahnemann did, it is well known^
recognise a morbid condition, set up originally by the sup-
pression of a special form of gonorrhoea which he termed
sycosis. This affection, he says, " has been heretofore
treated with mercury internally, and externally by cauteri-
sation, burning, cutting, or ligatures. This violent external
treatment has been employed against the excrescences on
the genital organs. The excrescences first appear upon
those parts of the body several days, and often weeks, after
the infection by the act of coition has taken place. They
are accompanied with a sort of gonorrhoea from the urethra,
are sometimes dry and in the form of warts, but more fre-
quently soft, spongy, emitting a foetid fluid, sui generis, of
a sweetish taste (almost resembling that of herring-pickle),
bleeding readily, and having the form of coxcomb or a
cauliflower {brassica botrytes), . . . The natural and
immediate consequence of such violent treatment was that
the excrescences generally came out again, and were again
subjected to painful and cruel treatment. In case, however,
they did not re-appear in their original form, they broke
forth in the shape of more disagreeable and more dangeroua
secondary ailments."^

He then goes on to speak of the combined effects of
suppressed sycosis and the mercurial treatment. These are

* " Chronic Diseases," vol. i., p. 111.

THUJA IN BEIiATION TO AX7BAL POLYPUS, 80^

'*' excrescences formed in other parts of the body, either in
the shape of whitish, spongy, painful and flat elevations in
the cavity of the mouth, upon the tongue, the palate, the
lips ; or in the shape of large, elevated, brown, dry tubercles
in the axillaB, upon the neck, upon the hairy scalp, &c."^
This morbid condition is to be met by thuja, which, he
states, is homoeopathic to it.

Now, whether polypi, in their various orificial situations,
are to be considered analogous in aetiology to sycotic mani-
festations, as they are to some extent analogous histologi-
cally, is a question which has not yet been determined. If
they are, then the curative action of thuja in the examples
referred to is easily explained, and is to be found in its
specific relation to the sycotic dyscrasia underlying those
cases. It is to be observed, however, that there was no
history of sycosis, whether inherited or acquired, so far as
■could be ascertained, in the cases of aural polypus narrated
at the outset of this paper.

Case VII. — Before closing this subject, I should like to
refer to one more case of a somewhat different kind, but
analogous in some respects to polypus, in which thuja also
proved effectual. The case to which I refer is one of
papilloma of the eye-lid.

The patient. Miss C, in whom this occurred, applied for
treatment on December 29th, 1892. All that could be seen
externally was a slight bulging of the lower eye-lid, suggest-
ing the possible presence of a Meibomian cyst. E ver-
sion of the lid revealed a papillomatous growth, springing
from the palpebral conjunctiva in the situation indicated in
the accompanying sketch. When the eyelid was in its
usual position, the apex of the growth turned inwards and
•downwards, and lay between the lid and the eyeball.
When the lid was everted, and the base thus drawn down,
the apex rose into an erect position.

The patient very much objected to any surgical proceed-
ing, and it was therefore determined to give thuja a trial.
'This medicine was accordingly given in the 30th dilu-

' Ibid., p. 112.

310 THUJA IN EELATION TO AUBAL POLYPUS.

tion, a dose thrice daily, and a lotion of the mother tincture
in water was also used to bathe the eye. By the close of
the following month, a considerable diminution in size had
taken place, and on March 23rd, the little tumour was>
found to have shrunk to about one-fourth its original size.
This case is still under treatment, but as the growth is now
so greatly reduced in size that its final disappearance is
evidently but a question of time, I feel at liberty to bring it
before your notice.

There is yet another form of papilloma which, judging
by analogy, we may reasonably suppose to be amenable*
to treatment by thuja. I refer to that intractable and
dangerous, though fortunately somewhat rare disease,
villous tumour of the bladder. This growth, it is well
known, is papillomatous, and if papillomata in other situa-
tions of the body can be cured by thuja, why not this
also ? When recognised early — and in these days of cysto-
scopic examination this ought to be no difficult matter — I
suggest that this drug be tried both internally, and locally
as an agent for washing out the bladder. By such means ^
it seems possible that the disease might be successfully
dealt with in its inception, and surgical procedures thus
obviated. Happily for the patient, the latter alternative
does present a fair prospect of cure, as shown by a case
reported by Dr. Hector Cameron in the Glasgoto Medical
Journal for February of this year. For the removal of the
tumour, .in this instance, supra-pubic cystotomy was' per-
formed, and the pedicle ligatured and cut through, the
patient making a good recovery.

Do not let it be supposed that, in thus dwelling on the
merits of thuja, I have any intention of advocating its in-
variable use in the class of disease we have been discussing,
or of regarding it as a kind of patent panacea for polypus.
To do so would be contrary to the first principles of homoeo-
pathy, which require that every case should be treated on
its own merits, and in accordance with its own peculiar
symptoms. I hope, however, that enough has been said to
show that this drug is an active one in the cases to which
it is suited, and if the experiences recorded encourage any of

DISCUSSION ON THUJA IN RELATION TO .AUBAL POLYPUS- 311 "

my colleagues to test its virtues for themselves in corres-
ponding circumstances, my object in reading this paper will
have been attained.

Dr: Jageelski had had some experience of treating polypoid
growths and swellings of the mucous membrane of the nose, which
he considered due to an unhealthy dyscrasia. Since he had used
thuja he had never had the opportunity of seeing polypus in the
ear. In nasal cases he had found it reheve a most unpleasant
symptom, the pressure on the bridge of the nose. Thuja was
used both internally and externally, and a brush was passed
through the nostril. It was not necessary to use the dilutions —
but the drug itself might be used. He had treated seven or eight
cases in this way. He found that thuja alone did the work
well enough. He had known calcarea carbonica act locally on
the uterus in a patient suffering from polypus. He had also
cured a polypus protruding from the os uteri. He used thuja
several times at the root and the lip, and had the pleasure of
finding the growth shrink up entirely, without bleeding, or any
sign of the previous existence of the polypus. He had used the
30th, and locally applied the mother tincture.

Mr. Dudley Wright had appHed thuja several times, but had
never been satisfied that it was not the action of the spirits
of wine with which the preparation was made which caused the
shrinking; he had given up thuja, and used spirits of wine instead.
When thuja was given and boracic acid applied locally he was
not certain that it was not the boracic acid which cured the case.
If the drug was used, it should be used alone. It was impossible
to decide, if two drugs were used together, which produced the
effect. Sanguinaria had failed in aural polypus. In some cases
where neither sanguinaria nor thuja had done good, there was
diseased bone, and in those cases silica was the best remedy,
although some lotion should also be used to procure asepsis.
He had treated a case of papilloma of the larynx for seven months
with thuja, in various strengths, 30 to 12, but the child was none
the better. In another case there had been a certain amount of
improvement. Thuja was not of much value in laryngeal cases.
With regard to galvano-cautery, he thought the hot wire might
be injurious. With respect to nasal polypus and necrosing
ethmoiditis, he thought there seemed to be a general consensus
that no such disease existed, but that it was a natural process.

Dr. MoiB said that polypus had to be treated in each case
according to its history and progress. Multiple polypi in the

312 IHBCDSSIOH OH THUJA IN BEIATIOK TO AUBAIi POLYPUS.

nose xequired one treatment — pol3rpns in the uterine cavity
another. He had never seen a case of nasal polypus cured by
medicine, or read a report of such a case. Nasal polypi he was
accustomed to tear away with a snare, but they recurred. He
did not know whether electric cauteries produced better results,
though in the ear cases they produced striking improvement.
He had himself been treated by Dr. Cooper for polypus with
sanguinareous snuff, and the polypus disappeared in about three
days.

Dr. Dudgeon said that the well-known action of thuja in the
production and cure of condylomata suggested its use in the
somewhat analogous pathological structure of polypi. In condy-
lomata Hahnemann directed that the thuja should £rst be given
in the 30th dilution, and if it was necessary to repeat it, then in
progressively lower dilutions, viz., the 24th, 18th, 12th and 6th
dilutions. He also advised the excrescences to be touched with the
pure juice of the green leaves of thuja, using it with equal parts of
spirits of wine. It would probably be better to apply the fresh
juice without admixture with alcohol, as thereby we should avoid
the astringent or irritant action of the spirit.

Dr. Dyce Beown admitted that Mr. Dudley Wxight's
general argument was sound ; but the treatment of aural polypus
by external means had not been at all successful. If polypus can
so easily be cured in this way we should not hear of so many
operations, which are only resorted to because the disease was
unamenable to local treatment. He was disposed to agree with
Dr. Alexander.

Dr. Cook differed from Dr. Dyce Brown, and had not found
internal remedies of much use — at any rate in nasal polypus.
One popular treatment was a solution of boracic acid in alcohol,
given sometimes dilute, but with the strength increased as the
patient was able to bear it. The effect was to shrivel and dis-
perse the polypus. One defect in Dr. Alexander's paper was
that there was much said of the successful cases, but not a word
of the failures. He had attacked nasal polypus by one medicine
after another, but failed to touch it.

Dr. PiNCOT said he was asked to see a little child with
a polypus as big as a haricot bean protruding from the um-
bilicus. Boracic powder, after bathing with wEirm water, was
appHed, and in two days the thing had disappeared.

Mr. Gebabd Smith said there was often a growth of exuberant
granulations on the umbilicus of infants ; it was not a polypus>
but in three cases out of four, children got perfectly well after the
use of fuller's earth and cleanliness.

DISCUSSION ON THUJA IN BSItATION TO AUBAL POLYPUS. 313

Mr. Knox ^haw regarded polypus, not as a primary disease,
bat as a final development of a pre-existing malady. Surgical
procedure was the really more scientific, as they treated the final
development at once, and then were able to attack the pre-exist-
ing disease which caused the polypus. This was more especially
the case with nasal polypus, as he had hardly ever done any good
by treating nasal polypus, as polypus alone. Much good, how-
ever, could be done by treating subsequently the unhealthy con-
dition of the mucous membrane. He was speaking in reference to
grave surgical treatment of such cases. The principle was the
same, whether you applied boracic acid or spirits of wine, and
thus dried up the polypus, or used a cold or hot snare. The one
was a slow killing, the other a rapid guillotine.

Dr. BuRFOBD agreed with Mr. Shaw. The Germans some
time ago described this adenoma diffusum or adenomatous hyper-
trophy, of which the actual polypi are the last elements in
the course of events. Mr. Shaw had done well to distinguish
between the development of the lesion culminating in polypus,
and the absorption of the polypus itself. These were two distinct
processes. Dr. Alexander had alluded to the inflamed condition
of the base surrounding the polypus. It remained to be proved
whether remedies had any effect upon the polypus itself. The
conditions of absorption and other conditions were better applied
to the hypersBmic state of the adjacent parts than to the polypus
itself. In uterine polypus the notion was that the polypus
discharges and bleeds. This was not so. It was the parts
surrounding the polypus which bled, and when the haBmorrhage
was stopped the main cause of the disease had not been attacked.
In this connection he was more inclined to agree with Dr. Alex-
ander than with Mr. Shaw. There was much more to be gained
by prophylaxis than by the removal of the polypi in the final
development. In many cases polypi were multiple, and half-a-
dozen repeated operations would be necessary for their successive
appearances. If that tendency to recur was controlled by thuja,
then homoeopathy was valuable prophylactically with regard to
the absorption of tumours. We have still to learn that there were
considerable powers on the part of nature for the absorption
of these neoplasms, and one was very glad to hear of these
views of homoeopathic treatment to prevent the recurrence of
tumours.

The President (Dr. Galley Blackley) regretted that so few
had anything to say about aural polypus. He had never had an
opportunity of trying thuja in aural polypus, but he had seen it

814 DISCUSSION ON THUJA IN RELATION TO AURAL POLYPUS.

tried in one or two cases of papilloma. He had used an ointment
of the extract of thuja over and over again. He had heard of one
case of papilloma of the bladder, under the care of Dr. Bayes, in
which thuja only was given, with the result that the man got
well after having been reduced to a very serious condition by
persistent hematuria.

He said that Mr. Shaw and Dr. Burford had shown that
something could be done in the way of prophylactic treatment
before these growths become pronounced. Unfortunately facts
were not brought early enough before them. If a doctor were
told of a predisposition, the opportunity would arise of judging
the respective merits of medicine or the snare or other surgical
means. There was, he was convinced, a great deal of help to be
derived from thuja.

Dr. Alexander, in answer to Dr. Cook, who asked about his
failures in treating nasal polypus with thuja, reminded his hearers
that nasal polypus was not the subject of his paper. He had
never cured a case of that disease with thuja, but had heard of
cures by other medicines. Dr. Thomas Simpson had reported a
case of nasal polypus which so shrivelled up under calcarea 200
that no trace remained. He had himself treated a large number
of cases by means of the galvano-cautery snare, and in the
majority the removal of the growths was successful. When
their origin was recent, removal was often followed by recurrence.
The most successful cases were generally those of old standing,
where the growths had been long present, but the polypus-form-
ing process appeared to have become exhausted. The removal
of the polypi in such cases usually effected a radical cure. With
regard to the question of necrosing ethmoiditis, when he first
heard of the theory he was rather sceptical about it, but from
personal observation he had come to the conclusion that there
was a good deal of truth in it, and also in the doctrine of vertical
cleavage. Of the latter phenomenon he had actually seen several
examples, and frequently, when polypi were removed, spicules
of dead bone came away with them, while bare bone could
generally be detected with the probe. If a foreign body, such
as a sequestrum, were present in any situation in the body, the
result would be irritation, which led to suppurative changes and
granulations. A like result was found in the nose, in the produc-
tion of polypus from the presence of necrosis. The employment
of chromic acid for the extirpation of nasal polypi had been
referred to, but often produced extensive inflammatory swell-
ing, and was, therefore, objectionable. Mr. Dudley Wright had

BRONCHOPNEUMONIA OF.CHILDBEN. 815

objected to the use of boracic acid, but in the cases where it had
been used it was simply employed as a cleansing agent, and had
nothing to do with the cure of the aural polypus. He did not
see how prophylactic treatment could be adopted, as patients
were not seen till polypus had actually appeared, and its occur-
rence could hardly be anticipated. He agreed with Dr. Burford
that when thuja was applied locally, it acted by absorption into
the blood, and that when it cured, it did so in virtue of its being
homoeopathic to the dyscrasia. He was glad to hear of the
President's case of the cure of cystic papilloma, but asked if it
had been ascertained that it was a true case of papilloma of the
bladder. Had any fragments of the tumour been traced in the
urine?

The Pbesident replied that the case was so long before the
days of cystoscopy that he could hardly answer the question.

BEONCHOPNEUMONIA OF CHILDEEN.^

BY BERNARD THOMAS, M.B.

Stipendiary Medical Officer to the Northern Homoeopathic Dispensary,

Liverpool,

The introduction of so familiar a subject requires per-
haps a word of explanation. The frequent, I may say
almost epidemic, appearance during the winter and spring
of bronchopneumonia at the north dispensary district, the
difficulties sometimes attending its proper diagnosis and
treatment, and its too often fatal termination, have led me
to choose it as the subject of my paper.

True lobar pneumonia has a specific cause and well-
defined characters — in the most literal sense of the term it
is therefore a specific disease. This is far from being the
case with bronchopneumonia. One observer (Osier) has
described it as a pulmonary lesion whidh may affect any
part of the lung. This gives an explanation to the meaning
of the indefinite course, diverse symptoms, and the no less

^ Bead before the Liveipool Branch, May 11, 1893i

316 BBOHCHOPNEUMONIA OF CHILDREN.

Yaried gross pathological features of the disease. It throws
some hght on the fact that various micro-organisms, not
excluding the redoubtable bacillus tuberculosis, have been
assigned as causes of lobular pneumonia. We may say,
briefly, that bronchopneumonia is nothing more than an
acute catarrh of the alveoli produced by the usual causes
of inflammation.

I have previously said that the gross pathological appear-
ances diflSer in many cases. Both lungs are usually affected,
and the consolidated lobules may be scattered throughout
the lung substance, aggregated together into patches, or
confined almost to an entire lobe. Patches of collapsed
lung often accompany these consolidations, as well as
emphysema, which, however, is most often found along the
anterior border of the lung. Lastly, an area of consoli-
dation near the surface may give rise to pleurisy.

Although the naked eye changes are so various, a micro-
scopic examination of a consoKdated lobule always shows us
the same thing. The alveoli are filled with catarrhal cells,
proKferated from* the epithelial lining. One might say it
was a continuation of a similar process in the tubes, where
the disease so often originates.

From recent observations it seems probable that micro-
organisms play some part in the production of this disease.
Its occurrence as a sequel or complication of whooping cough,
measles, pyaemia or other germ disease seems to point in
the same direction. The lungs, enfeebled by defective blood
supply, fever, or the exhausting fits of whooping cough, form
a ready nidus for the microbes, which soon gain ground in a
tissue too weak to resist their action.

The most susceptible age for bronchopneumonia seems
to be from one to five years, and less frequently in older
children; old people are also liable, but not to the same
degree as children. Among the poorer people who live in
damp cellars or filthy courts, who are constantly breathing
an unwholesome air, and whose children are frequently
neglected, the disease is not only more prevalent but, as
might be expected, more severe than among the better-
favoured classes.

BRONCHOPNEUMONIA OF CHILDBBN. 317

Bickets is nndoabtedly a predisposing condition, the
softened ribs and weakened muscles of the thorax prevent-
ing proper respiration, and the general state of malnatrition
which is present aiding in the susceptibility to this, as well
as other, diseases. A rachitic subject affected with broncho*
pneumonia has not the fall advantage of the lung areas which
remain healthy, and so the disease is likely to run an un-
&vourable course. Tuberculous constitutions, or those with
a feunily history of phthisis or other tuberculous disease, are
liable either to develop a rapidly fatal form of broncho-
pneumonia, or to recover and at a subsequent date to fall
victims to consumption.

Of the exciting causes, bronchitis affecting the larger or
smaller tubes is the chief, and it is for this reason, more
especially, that measles and whooping cough are the most
frequent precursors of bronchopneumonia^ My own expe-
rience leads me to think that pertussis is the more frequent
cause of the two. But besides these, the other well-known
conditions which are accompanied by, or give rise to bron-
chitis in young children, as dentition, chill, intestinal
catarrh, may lay the foundation for this disease. Lastly,
diphtheria, scarlatina, typhoid, septic fevers have sometimes
bronchopneumonia as a complication.

Bronchial symptoms and physical signs, indicating more
or less catarrh usually, but not invariably, precede the onset
of the disease. When this is the case they are soon followed
by an exaggeration of all the symptoms : more hurried breath-
ing, higher fever, and a cough which, instead of being loose
and rattling, becomes short, more hacking and often painful.
The temperature varies from 102''-105'* in the evening, with
morning remissions of several degrees. The chart often
shews an intermittent character, the morning temperature
falling below normal. In some cases, however, the onset is
sudden, or announced by convulsions, a large area of lung is
attacked at once, but the subsequent course will usually
indicate the true nature of the disease.

In a fully developed case the face is flushed or pale and
livid, the expression anxious, the alsB nasi work vigorously.
The child is inclined to lie quiet, and submits passively to

318 BBONOHOPNEUMONIA OF OHILDKEN.

examination; all his efforts being concentrated on respira-
tion, he is too occupied even to cry out. The respirations,
varying from 50 to 80, or even more per minute, are shallow,
often noisy and difficult, and if bronchitis of the larger tubes
accompanies the condition, loud sonorous rales are heard even
at some distance from the patient. In the movements of
the thorax, in advanced cases, one notices that the accessory
muscles are called into play, and the lower intercostal spaces
and epigastrium fall in with each inspiration. Pleurisy,
when present, is not an early feature ; it may be recognised
by the painful character of the cough and the physical signs
of friction or marked dulness, with loss of* breath sounds
and fiBgophonic resonance. Children generally swallow their
sputum, but when it is brought up, either by the forcible
cough of pertussis or by the act of vomiting, it is at first frothy
mucus, sometimes blood-streaked, and in the later stages
mucus and pus. When bronchitis co-exists, however, the
expectoration may continue yellow throughout. The above
characteristic symptoms may not be so evident in slighter
cases, or in those where there is little bronchitis. More-
over, meningitis or some other disease may mask the
presence of any pulmonary condition, hence the importance
of the physical signs which, unfortunately, are not so definite
as in lobar pneumonia.

The percussion note may be resonant all over the chest,
or there may be patches of impaired resonance. Anteriorly
the note is often hyper-resonant from the presence of
emphysema. The dull areas may be either due to collapse or
consolidation; but if the former is the case the breath sounds,
instead of being augmented, are impaired in intensity and
sometimes inaudible. Auscultation gives us breathing either
puerile, harsh, or, over consolidated areas, bronchial, either
tubular or blowing. The breath sounds are often masked
by accompaniments both moist and dry, which, when heard
through consolidated lung, have a pecuhar ringing or con-
sonating character. When these consonating rales are
discovered, although we may not be able to determine any
definite impairment in the percussion note, we may be sure
that there is some bronchopneumonia present. We must

BBONCHOFNEUMONIA OF CHILDBEK. . 319

remember that when we are examining a Imig with broncho-
pneumonia .we may expect to fiod the physical signs of
consolidation, collapse, emphysema and bronchitis. One
marked character of the physical signs is that they vary, at
different times in their position and character. First one set
of lobules are attacked, then, while these are clearing up,
another is affected — perhaps in some more • distant portion
of the lung^and so on.

The successive involvement of various portions of lung
accounts for the insidious course of the disease and the. no
less gradual decline and protracted convalescence. As the
pyrexia begins so it ends, falUng by a very decided lysis,
but one marked by remissions and intermissions. The
disease itself may last from one to several weeks, its course
depending on the amount of lung involved.

The complications of bronchopneumonia may be either
pulmonary, affecting the lung and directly due to the con-
dition present as bronchitis, emphysema, pleurisy, em-
pyema, bronchiectasis ; or due to the spread of the poison
to a remote organ — auto-infection, e,g,y meningitis in a
tuberculous case ; or lastly, to debiUty produced by the
disease, as diarrhoea, otorrhcea, &c.

With regard to tubercle, it is always an important
question whether any given case be tuberculous or simple,
so that pulmonary tuberculosis may exist either primarily
(acutej, or secondarily (chronic). It is said that if there is
much lividity, high fever, and on auscultation universally
scattered rales and harsh breathing, the case is one of tuber-
culosis. An unfavourable family history, the occurrence of
meningitis as a complication, have also to be considered in
this connection as pointing to the probability ; but perhaps
the only certain diagnostic point is the discovery of tubercle
bacilli in the sputum. On the other hand where the disease
runs a prolonged course, when the temperature will not
subside after some weeks of illness, when there are no signs
of the clearing up of the affected areas, when night sweats
and haemoptysis supervene after the more acute stage has
passed, the case is one of phthisis engrafted on the simple
form of bronchopneumonia.

330 BBONCHOPNEUMONIA OF OHILDBBN.

Many anthorities assert that capillary bronchitis and
bronchopneumonia are one and the same disease. It seems,
however, more probable that the latter is only a further stage
of the former. A case of capillary bronchitis is seldom with-
out some bronchopneumonia, and bronchopneumonia seldom
without some capillary bronchitis. The difference is more
one of degree than kind. When inflammation of the lobules
follows an acute attack of capillary bronchitis we are made
aware of the fact by a rise of temperature to 103** or 104°,
by the change in the character of the cough, by the greater
degree of dyspnoea and by the physical signs of consolidation.

It is often very difficult to distinguish true pneumonia
from the lobular form of the disease. In the latter, in some
cases, the onset is sudden ; but usually the subsequent course
of the disease and the temperature is different. There may
be pleurisy in both conditions, but in the croupous variety
it is an early symptom and the pain is usually of a severe
character. The expectoration when attainable will aid us,
and physical examination may elicit the fact that a portion
and not the whole of a lobe is implicated.

Other pulmonary conditions such as pleurisy and em^
pyema can be eliminated by a carefal consideration of the
symptoms and physical signs. Typhoid fever, meningitis
and other acute illnesses, which may exist either indepen-
dently or in conjunction with bronchopneumonia, have also
to be considered, but the history of the case and the pre-
dominance of the chest symptoms, both subjective and
objective, will help us to arrive at a correct diagnosis.

With regard to prognosis, it is never advisable to take a
gloomy view of a case, as even the most severe and appa-
rently hopeless cases recover. The younger the child the
more serious is the outlook, — an infant under two, that is to
say during the period of dentition, having a poor chance of
recovery. The underlying diathesis, rickety or tuberculous,
on which the disease is grafted, is another factor of great
importance both as to life and as to the subsequent health
of the patient.

The following case is a good example of a severe and
prolonged attack of bronchopneumonia in a boy aged 3 : —

BBONCeOPKECMONIA OF CHILDRBM.

321

William Clydesdale, aged 3, was first seen on April 8, 1893.
One montli ago had measles, followed by whooping cough, from
which he is still suSeriug. BroDchitis developed about a
week ago.

Family history. — A younger sister died of consumption of the
bowels, an elder of phthisis at puberty.

General appearance. — The child was poorly developed; rickety,
with small cheat, protruding forehead, pale face and prominent
abdomen. The skin was dry, temperature 99.2°; tonguo moist,
white fur. Pulse quick and small, over 120. Bespirations hurried,
shallow, with loud wheezing ; expiration followed by a short sigh.
The lower intercostal spaces were drawn in with inspiration.
Percussion hyper-resonant anteriorly, resonant posteriorly. Aus-
cultation. — Numerous rales, especially at the bases.

On April 10, the temperature had risen to 103.8°, tongue had
thick, white fur. There was frequent thirst. A greater degree
of dyspncea, and exaggerated movement of accessory muscles and
aJte nasi. Posteriorly at left base dulness on percussion, and also
some impairment at the right base. Bales distinctly louder and
more consonating at bases. The following day diarrhoea was
noticed.

Dulness, tubular breathing and consonating crepitations at
left apex posteriorly, and left base anteriorly and posteriorly,
were noted on April 12.

VOL. I. — NO. 4.

322 BBONCHOPNEUMONIA OF CHILBKEN.

On April 17 both bases showed marked dulness posteriorly.
The breathing was distinctly tubular at the right base.

By April 20 the dulness was less marked posteriorly, and
breathing was not tubular. Crepitations were still abundant ; the
tongue was cleaner. Frothy expectoration noted for first time.

On April 27 the patient had an attack of otorrhoea. The tem-
perature was then 101.4°.

From May 1 to 5, the temperature was remittent. The left
apex and right base still showed signs of consolidation.

The patient recovered from the acute attack about May 12,
but was still very weak. The breathing was better and the fever
had subsided. There still remained some dulness at the right
base and over left apex. The breathing was harsh, and there
were still some crepitations.

The treatment adopted was that recommended further
on in this paper. The medicines used were ant. tart. 3x,
trit. for the first few days, followed by phosphorus 3x and
at a later stage arsenicum 4x ; two drop doses of veratrum
viride ff> were given when the temperature was high. During
the fourth week the medicines used were arson, iod. and calc.
carb., together with cod liver oil.

The general treatment of these cases consists in putting
the patient to bed in a warm room, carefully avoiding any
draught, for which purpose, if necessary, a curtain may be
placed around the bed. A bronchitis kettle is useful in
many cases, both in rendering the breathing easier and also
in helping to loosen the expectoration. Poulticing is only
admissible in the earlier stages, or in mild cases. A jacket
poultice,, as often recommended, only interferes with the^
respiration, especially when there is much dyspnoea ; the
muscles have usually enough to do without lifting a heavy
poultice up and down, and for this same reason care should
be taken that the child, although sufi&ciently covered, is not
in any way bound or wrapped up tightly in blankets or
shawls, as is so often the practice among the poorer people.
Cotton wool may be placed over the chest loosely, and it
should be changed every day.

Ice bags have been highly recommended, but they are
only admissible when the patient can be carefully watched,
and the applications frequently changed. In a dispensary

BRONCHOPNEUMONIA OF CHILDREN. 323

practice it is therefore impossible to apply them, even with
the help which is received from the district nurses, of whom
I am glad to take this opportunity of saying we owe a great
deal for the care and attention which they give to our
patients. Most cases of bronchopneumonia call for the
administration of stimulants, for there is always the danger
of cardiac failure, from the extra work which is thrown upon
that organ.

Not the least important stage of a case is that of conval-
escence. It is well during this period to keep two aims in
view. In the first place, to restore the strength of the
patient by strengthening diet, change of air, &c., if possible,
and in the second place, by the aid of well chosen medicines
and cod liver oil, to lessen the chances of tuberculous deposit.

With regard to homoeopathic medicines, I do not wish to
take up the time by mentioning all the possible remedies,
but will content myself by simply mentioning a few, which
I have found the most useful.

Ant, tart, only in early stages, when there is not much
pyrexia, but a great deal of bronchitis.

Arsenicum. — Although it does not correspond to the
pathological condition, I have found it very useful in those
severe cases where there is high fever, adynamia, dry tongue,
fiordes on the teeth, frequent thirst for small sips of water.

Phosphorus, I. need hardly say, is a very useful medicine,
ajid very efficient in most cases.

Veratrum viride 1 have used in two or more drop doses
of the mother tincture, where the temperature is very high,
the pulse very quick.

Hepar, sulph. — When the expectoration has become
muco-purulent — towards the decline of the disease.

Arsen, iod. and Calc. carb, during convalescence ; the
former especially in cases suspected to be tuberculous.

I do not wish it to be thought that these medicines
should be given empirically ; as in other diseases so in bron-
•chopneumonia, the remedy should be chosen which most
-effectively covers the symptoms and conditions present.
Por here as elsewhere the law of similars holds good.

824 DISCUSSION ON BRONCHOPNEUMONIA OF CHILDBEN.

Dr. Hatwabd agreed with the remarks of Dr. Thomas, with
regard to poulticing, as the weight of a poultice often adds to the^
difficulty of breathing. The treatment of bronchopneumonia is a
feather in the cap of homoeopathy, its statistics are so good that*
we feel that no other treatment can be so successful. Dr. Thomas,
had not mentioned aconite — ^very useful when there is much
restlessness and tossing about. He would feel more confidence
in postponing the use of arsenic, in favour of the more marked
pathological remedies, such as phosphorus, bryonia and anti-
monium tart., which all bring about pathological effects similar to
the disease. The symptoms of veratrum-viride are much the.
same as those of aconite ; but the skin is not quite so dry, and
the restlessness not so marked. He thought that calcarea carb.
was more likely to be called, for than arsenic, iod. at the stage of
commencing tuberculosis. •

Dr. Gordon Smith considered the use of kali. bich. in certain
cases beneficial.

Dr. Herbert Wilde asked Dr. Thomas what proportion of
those cases that develop into phthisis he would consider bacillary^
He had not discovered bacilli except in one case, out of many he
had examined. He found phosphorus more reliable in these
cases than any other drug.

Dr. Capper agreed with Dr. Thomas as to the hopeful prog-
nosis, even in very severe cases. Bronchopneumonia was one of
the most prevalent diseases in dispensary practice, and he had
had experience in a large number of cases. They frequently get
better after lingering for weeks. With regard to poultices, he was
inclined to use them occasionally, and had certainly seen benefit
from them. He found arsenicum and phosphorus by far the most-
useful medicines, arsenic so well meeting the adynamia so often
manifested. He mentioned the value of ipecacuanha in certain
cases, and also referred to spongia, iodine and calcarea phosp.
He thought aconite only useful in the earliest stages, or when
new patches of inflammation were commencing to be developed
in the course of an attack.

Dr. John Hayward agreed with Dr. Capper as to the sphere
of aconite. He had found ipecacuanha very useful. He had
lately been converted from the use of poultices, as they are fre-
quently left on until much harm is done by cold air circulating
between them and the skin. He usually ordered camphorated
oil to be rubbed into the chest. It had probably some reflex
-effect, and undoubtedly did good. He considered broncho-
pneumonia one of the most fatal diseases in fat children. He>

DISCUSSION ON BBONOHOPNBUMONIA OF CHILDKEN. 325

referred to the value of quarter-grain doses of ammonia carb.,
administered every hour as a stimulant, alcohol often increasing
the cyanosis. Ammonia carb. had also an elective action upon
the lung, and he frequently administered it in alternation with
the specific remedy.

Dr. Green agreed that hope should never be abandoned in
these cases. Gases of this disease helped much to convince him
in his early studies of homoeopathy. Solanium acet. was of
much value in asthmatic cases. He seldom employed poultices,
but sometimes used a thin one without much weight, a mustard
leaf or hot cloths. He had often found brandy of service. With
regard to the pathology, theoretically there would be inflamma-
tion in the alveoli, but not in the bronchioles. The structure is
almost identical,, and this probably never really happens. He
regarded the use of camphorated oil as something more than a
placebo.

Dr. Ellis said that he was glad to hear Dr. Wilde speak so
well of phosphorus. Although antimonium tart, appears more
homoeopathic to catarrhal pneumonia, he had found its use dis-
appointing. He agreed with Dr. Gapper as to the occasional
efficacy of poulticing, as he had seen cases much improved when
they had been employed by patients without his instructions.
Stimulation by turpentine stupes was very useful. He thanked
Dr. John Hayward for his hint with regard to ammonia cajrb.
He had used it in his early days of practice, but had lately neg-
lected it. One lesson he had learnt from the late Dr. Drysdale,
was the bad effect of too much stimulation, and consequently
ultimate depression. He was not so much inclined to be san-
,guine as to the prognosis. Very many cases of phthisis began as
bronchopneumonia.

Dr. Gordon said that hfe experience of the disease was not a
particularly happy one. He would have been more interested if
Dr. Thomas had given the medicines used day by day in the case
he narrated^ There was no question as to the value of phos-
phorus. Antimonium tart, did not prove of so much benefit as
might be expected. Yeratrum alb. came in well in some cases.
With regard to poulticing, he thought that the friends of patients
ought to be indulged in this respect if they wished it ; otherwise
the doctor would be blamed in the event of a fatal result. He
had found one drachm of eucalyptus oil to two ounces of oHve oil
very useful as an inunction.

Dr. Gharles Hayward considered two drops of veratrum
viride a very strong dose for a child. He had used solanium

326 ON ANTISEPTICS.

acet. for adults with very disappointing effects. He had found
carbo veg. and ammonia carb. much more useful. Where anti-
monium tart, failed, calcarea carb. frequently succeeded.

Dr. ELaywabd thought that probably the evidence against>
antimonium tart, in such cases was on account of the exhibition
of too low a potency. The best results were obtained from the
sixth centesimal.

Dr. ELaweeb said that iodine should be thought of in cases of
emaciation, or where harsh breathing became a prominent symp-
tom. He had found phosphorus the best remedy, but it should
be used in pilules, and in the third centesimal. Antimonium tart-
he had found disappointing in all strengths. Hughes recommended
arsenicum, and he had found it valuable. He had almost dis-
carded poultices. Sulphur was useful in chronic cases. He
asked Dr. Thomas whether he had noticed that bubbling rales
lead to a bad prognosis. He did not often use bryonia in catarrhal
pneumonia. Lycopodium he had found disappointing. Broncho-
pneumonia of pertussis was often helped by coccus cacti and
cuprum. The physician should always be on the watch for pleu-
ritic effusion, and be ready to aspirate if necessary..

Dr. Thomas, in reply, said that he had seen benefit from
poultices in early stages, and in mild cases. He had not used
ammonia carb. as a stimulant, but had seen no bad effects from,
the use of brandy. In answer to Dr. Charles Hayward, he said
that he had tried veratrum viride Ix, to reduce the temperature^
but without good results.

ON ANTISEPTICS : WITH ESPECIAL EEFEEENCE

TO THE USE OF OZONE.^

BY EDMUND A. COOK.

I PEOPOSB that we should exchange our opinions upon*
the subject of antiseptics generally, and should devote a-
little attention to ozone in particular. Of course a great
deal that I have to say is already known to most of you, but
if we exchange our opinions, if we discuss a matter such as
this, which though old has many points which may be new
to many of us, we may each derive some benefit, although

* Bead before the Society, June 1, 189S.

ON ANTISEPTICS. 327

•we may disagree on many points. The antiquity of the
subject is simply beyond historical knowledge ; because
there can be no doubt that the earliest literature, the
earliest laws we have, contain many elements which
show that the writers of these laws had an intimate
knowledge of antiseptics. This was shown, for instance,
in the ideas underljdng the Levitical directions which were
distinctly antiseptic, when it was ordered that the blood
should be taken without the camp and the refuse be buried,
and in the rite of circumcision. And we know quite well
that without these ordinances disease would have super-
vened quite rapidly. And we find that even in modem
times there is a process for the disinfection of sewage mat-
ters which is called the ABC process. Years ago when
that process came out I asked the patentee, Why on earth
he called the process the ABC process, and he said ** I
will tell you. I got it entirely from the Bible, from the
ideas given there in the Levitical directions as to the dis-
posal of refuse and sewage."

Of course we cannot pretend to anything new. The
germ theory of disease which has been sprung upon us
as new and fashionable in medicine is really only the old
fashion sprung up again, like the crinoline and other mat-
ters. A century and a half ago there were men insist-
ing with great vehemence upon the truth of all or most of
the ideas which are current in our midst to-day. The
germ theory was in fact the same as the one of the
present day, only it did not take rapid hold of the minds of
those who heard it, and, therefore, by and by it dropped out
of fashion. Then, again, in mediaeval times we seemed
to have gone back, and when Sydenham, the prince of
English physicians, arrived upon the scene, people appeared
to have gone back to utter ignorance of most antiseptics.
Still there was a glimmering of reason and common sense in
their proceedings, for they strove to imitate nature ; when
they noticed that the disease caused excess of heat in the
patient they strove to encourage this high temperature;
they had noticed disease growing better after a sweat, they
strove to promote perspiration — truly in an ignorant and

328 ON ANTISEPTICS.

crude manner and utterly oblivious to the fact that fresh air
had anything whatever to do with the matter, and, there-
fore, they excluded that. Sydenham reformed the whole
medical treatment, and produced an era in the medical
profession, running counter to every prejudice and rousing
every opposition which vested interests could provoke. In
modem times we have improved and do not treat people by
exclusion of fresh air.

Of course now we know everything, " we are the people
ajid wisdom shall die with us." Everything is a microbe
which is not the product of a microbe, and every disease
under the sun is the product of a microbe in one or
other shape or form. This of course was taking things
to an extreme, and no doubt with the re-swinging of the
pendulum in this matter they would by and by think
that everything was amicrobic and that disease might be
caused by disinfection. Each medical observer believed
that by this theory there was something to kill in the
pursuit of his vocation, and each scientific observer seemed
to think that the perfection of killing in scientific matters
was obtained when everything was killed — only the thing to
be killed was not himself. I venture to demur to this. Let
him put forward the not altogether original proposition that
the struggle for existence was eternal — eternal in the sense
of penetrating all claims of existence, and an imperative
law of nature emphaisised by the fact that nothing would
nourish us but what had had Hfe.

But, regarding with respect only our own life, we find
even on that view forces — ^vital forces — arrayed against us
and for us, and at the present stage of the conflict it was
not- exactly wisdom to act so crudely as to destroy all
and sundry in our efforts for self preservation. The true
interests of self preservation would teach us otherwise.
Take, for example, the parasites found in plants. A plant
is infested by one parasite, and if we look further we
shall find there is yet another there whose function is to
prey upon the first, absolutely aiding the higher organi-
sations by so doing. But we in our ill-judged application
of antiseptics slew one and all ; we got the idea into our

ON ANTISEPTICS. 329

minds that a substance was a good antiseptic because it
destroyed all life with which it came in contact ; our methods
were carried on without regard to whether we were slay-
ing our aids and friends or our enemies.

It was now fully recognised that the white amoeboid cor-
puscles of the blood were microbe destroyers and they can
only act best when individually in the best state of health.
Every medicament which debilitates them acts in favour of
the microbe, and no matter how deadly it may itself be to
the microbe, cannot be a proper antiseptic on account of its
debilitating influence on the phagocytes. Take, for example,
the action of corrosive sublimate; its dose (allopathic) is
from 1-16 to 1-32 gr. It is of all popular antiseptics one of
the most deadly. We are told to use it in puerperal cases in
the proportion of 1 to 1,000, and to use as an injection per
vaginam of about 1 pint. Now 1 to 1,000 will be 1 gr. to
about 2^ oz., and after injecting a pint it will be almost im-
possible not leave behind at least 1 oz. ; that is to say by the
use of this antiseptic to prevent microbic life we administer
to the woman J gr., equal to eight fair* doses of this poison,
and then we consider we are scientific ! If the woman
before the administration was not liable to microbic infection
the absorbed poison will so debilitate the corpuscles that
she will be a prey to any microbe which floats, and if you
point to statistics proving great improvement in recoveries
since the use of this treatment, I would rejoin, so much
the worse ; for they have been in spite of it. I would put
forward the proposition that in any human being when the
phagocytes were in vigorous health they were all-suiB&cient
to deal with microbe life, when they are in feeble health the
microbe gains ground — ^that, in fewt, as they talk of a vis
medicatrix natura, I might insist on a vis antisepsis naturce.
Therefore anything which debiUtates the amoeboid cor-
puscles did absolute harm when they sought to do good.

We attack microbic or septic material (1) in the air, (2)
in the body, (3) on the surfia.ce of the body, and speaking
generally the average medical man believes, and certainly the
average lay man beUeves, that if he set up a noxious odour
sufficient to overpower a smell which he believed septic, we

330 ON ANTISEPTICS.

might take it for granted we were safe. Instances will occur
to all of you. I will instance the case of a street urinal
where some antiseptic would be found, it might be chloride
of lime or carbolic acid. It was absurd to think that
chloride of lime when it came into contact with urine served
any useful purpose as a disinfectant in the quantities used.
When chloride of lime comes into contact with urine it
begins immediately to decompose the urea, and as this
latter is in excess there is no chance of any destruction
of septic material — or if carbolic acid be used the result
would be no better. Lauder Brunton writing of carbolic
acid says : The results of experiments made in this way
were very surprising. It was to be expected that carbolic
acid would readily destroy the spores, but this was not the
case. A 1 per cent, watery solution had almost no effect on
them even after fifteen days' exposure. A 2 per cent, solution
slightly retarded their growth, a 3 per cent, killed in seven
days. Bear these proportions in your mind and then see
what application is made of this substance. When a noxious
odour was likely to occur, or when septic material existed, a
man came round with a canister similar to a large pepper
box, and dusted a small portion of powder over a grating or
heap of matter. The powder contained about a quarter
available carbolic acid, the rest being inert matter, — the
percentage proportion to septic material being about 1-10,000 ;
and this was thought sufficient to disinfect in spite of propor-
tions proved necessary to do any good.

If we apply antiseptics to fever of an infectious character
in the body, we think we have done enough if we lower
the temperature ; and on the surface of the body the treat-
ment of wounds is considered correct, if we can freely smell
the antiseptic. Now, in all septic life, as in all life, there
are (1) the vitality, (2) its environments essential. If a
wound were treated in a moist atmosphere, whether with
or without antiseptics, it would require far more care
than in a dry atmosphere, for an environment of moisture
was the very best for gro^yth of septic germs. There
were places on the earth where wounds never did welU
there were others where wounds never did badly, and the

ON ANTISEPTICS. 331

<lifference was due to presence or absence of moist heat.
Por instance, there was a place south of Los Angeles in
Southern California having on its east high snow-capped
mountains, and during certain months the wind came down
from the mountain summit losing in the cold region all its
moisture by congelation ; descending gradually into warmer
regions it licked up every particle of moisture in its way,
and with its gradually increasing temperature being more
and more greedy for all it could get ; the result being that
when it came to the plains it was so dry that men living
there and striving to write with a lead pencil had to keep
another in a vial of water by their side so that when the one
got too dry and hard to write it might be changed for the
wet one ; that fresh eggs laid exposed to the atmosphere
quickly lost so much moisture from the inside that a hard
mass was left, and respectable hens had got the reputation
of laying them hard boiled ; that men wishing to light the
gas needed no matches, but simply turning on the tap ran
the hand through the hair and then held the finger near the
pipe, when an electric spark did the needed lighting. In
such an atmosphere, wounds could not but heal ; but mark
the combining causes, dryness, and the fact that every
movement generated electricity, and electricity ozone —
nature's own disinfectant ; and the ozonised air being
breathed as well invigorated the phagocytes, and microbes
had no chance. Note well the fact that the ozonised air not
only affected for good the open wound ; but by its powerful
oxydising properties, combined with its diffusion, its inhala-
tion was of immense benefit.

If you would realise the full extent of the problem on a
large scale, picture yourself on the. top of St. Paul's with the
crowded mass of living material for more than a hundred
square miles beneath you; men and women with their
exhalations, with the exhalations from sewage material and
myriads of animals, with the smoke impurities, all gathered
together in one vast whole ; where for weeks together some-
times there was not wind sufficient to lift the overhanging
pall of fog, and then think, if you can, that the man with
the disinfecting pepper box can further any good purpose ;

332 ON ANTISEPTICS.

and more, when yon have in that seething mass hospitals for
cure, surgical wards for operation ; is it any wonder you lose
cases — ^is it not a marvel you cure any? I have said that in
my belief nature's own antiseptic is this ozone. The diffi-
culty has been hitherto where to get it and how to apply it,
because you know that no sooner does ozone come into con-
tact with organic matter than it is decomposed. Ozone
is the product of the action of the electrical discharge on
oxygen ; it renders the oxygen active, it condenses it in
bulk ; the specific gravity of ozone is known to be greater
than that of oxygen as three to two.

The question was how they were going to produce this
matter in such quantity as to render it effectual. Hitherto, all
ozonisers for the last decade or two had been such as to demon-
strate the presence of ozone in a small way, so that if they ap-
plied the nose closely they could smell it. Up to within recent
times those were the only ozonisers practicable at all. Now,
when I tell you that ozonisers are produced capable of making
ozone to such an extent that it was proposed to do away with
all other means of bleaching, you will see at once that it could
be applied to disinfection. Whether or not it would be a
commercial success, it ought to be perfectly possible to apply
it to ordinary hospitals. Sir B. Ward Eichardson some
years back stated that ozonising the air of wards was
distinctly the best way of aiding recovery of the sick. With
the ozoniser he used, he found there was apparently some
irritation of the bronchial tubes in certain cases. I obtained
the ozoniser Dr. Eichardson used, and used it to the best
of my ability ; I put it in a sick room and got quite as much
ozone as it would yield, and in no case did I find irritation
of bronchial membranes. The only way, in these days, of
producing ozone was by means of the electrical current,
wherever an electrical current could be got ; and the ordinary
house supply was practically the best. Practically the
simplicity of the whole business was such that there was no
excuse, so far as trouble and expense went, against it being
adopted in every hospital ward which was supposed to be
scientifically conducted. I have with me various ozonisers
which have been invented by Mr. Andrioli. The principle of

DISCUSSION ON ANTISEPTICS. 333

these ozonisers is one and the same in all ; they consist of
a glass plate on one side of which is a sheet of tin foil, on
the other a plate studded with numerous points. The one
side of the plate is connected with one pole from an induc-
tion coil or transformer, the other with the opposite pole ;
when the current passes, the discharge takes place by glow
(not spark) from every point, and the air or oxygen passing
over the points produces quantities of ozone. The ozonisers
now shown have a secondary battery of about two amperes
current, but they would be far more effective with a house
supply. I believe that even with the secondary battery we
can, with these ozonisers in our wards, derive a benefit far
exceeding the cost and trouble which is needful to procure
it.

Mr. Hanbuby (Visitor) remarked that the easy production of
ozone was a matter of great importance commercially, that his
firm had taken an interest in the matter from a conception of the
great use to which it could be put as a disinfectant and deodoriser,
and from its general application to medical purposes. Mr. Andrioli
had manufactured many forms of his apparatus, all involving,
however, the same principle, viz., the discharge of electricity of
great intensity silently, and as a flow discharge. He had applied
this to inhalers of various patterns and some of these might be
seen upon the table. Doubtless the application of ozone to
disinfecting rooms and aerating wards of hospitals had a great
future before it, and he would be most happy to show any gentle-
man interested the larger apparatus in full work, producing large
quantities of ozone.

Dr. Bybes Mom said Dr. Cook had brought forward an inter-
esting subject, but he was disappointed that he did not go on to
demonstrate the advantage to London of collecting ozone, and
distributing it all over London from a central station. He
thought he was quite right in what he said with regard to its
properties. It was nearly twenty years ago when the subject was
brought before the society and in the British Journal of Homo&-
ojpathy, in 1874, by Dr. Scott, exactly on the same lines as Dr.
Cook. Air impregnated with less than one in three millions of
its bulk of ozone purified its own volume of air loaded with the
effluvia of 4 oz. of highly putrid meat, demonstrating the strongly
disinfectant power of ozone in all cases where infection depended

334 DISCUSSION ON ANTISEPTICS.

on decomposing organic matter. Air containing only . — ? — -th
of its own bulk of ozone possessed a distinct ozonic smell. This
was advanced at the time to show the power of decomposing
organic matter. This question of ozone was brought forward with
a view to its influence on outbreaks of cholera, influenza, and such
epidemic diseases ; but nothing deflnite has so far been determined
as to whether ozone does influence these outbreaks or not. Country-
air, with a fair proportion of ozone, was said to be favourable to
vegetation, but air strongly impregnated with ozone was said to

destroy — or at all events retard — the growth of plants.

Dr. Dudgeon said one great advantage attending the use of «
ozone, if it possessed the antiseptic qualities described by the
reader of the admirable paper, was that it did not seem to do
any harm. All the other antiseptics that they were acquainted
with were more or less dangerous in their application. No doubt
perchloride of mercury was a dangerous antiseptic when applied
in any but very minute quantities. The great Lister, who made
his fortune and received his baronetcy in consequence of having
invented the carbolic spray, declared at the Berlin Congress that
he was ashamed that he had ever done such a thing. Carbolic
acid was often injurious to the patient — ^which might be endured,
as patients are made to suffer; but it occasionally injured the
operating surgeon, and that could not be tolerated at all. The
only question about ozone was whether it could be generated in
such quantities as to be employed as a disinfectant by the in-
genious little apparatus they had seen that evening. If they
could ever get an ozoniser, as had been explained, on the top of
St. Paul's, to disinfect the whole of London, that would be a
great triumph of art ; but it remained to be seen whether it could
be produced on a sufi&ciently large scale to be effective in un-
wholesome localities.

Dr. Clifton said that with regard to earth as an antiseptic, for
many years he had employed it as a dressing to varicose ulcers of
the legs, and found that, with the earth changed two or three
times, it was a great benefit. Were they to understand that in
what they called ozonised fluid there was no good ?

Mr. Knox Shaw regretted that his knowledge of chemistry
prevented his doing full justice to the reader of the paper, and
entering into a learned controversy as to the chemical part of the
subject he had brought before them. But as a practical surgeon^
one who was always anxious to hear and learn anything that
would advance one in one's method of treatment, he would offer a
few remarks. The principles brought before them were those o£'

1^

DISCUSSION ON ANTISEPTICS. 335

aerial disinfection ; and from Sir Joseph Lister, who was one of the
greatest exponents of surgical disinfection, they had gathered that
after all it was not in the air that they must look for the source
of the danger in their surgical operations, and that was why he
gave up the use of the spray ; that he had formerly looked to the
carbolic acid to destroy the germs that were floating in the atmo-
sphere, and so prevent them falling on the wound, whereas he
had now discovered that it really did not so very much matter
about using spray at all, as they could not with any success
attempt to kill the germs in the air. So that though it might be
an excellent plan to supply what was lacking in the atmosphere
in the way of oxygen, the oxygen being consumed by the human
beings around them, it was a different thing when they came to
apply it practically to the treatment of Surgical wards. He had
hoped that Dr. Cook would have enlightened them a little more
as to this. He believed that there were certain forms of disin-
fectants which rather based their claims to use upon their being
ozonised. He thought Kingzett, in his " sanitas " produced by the
oxidation of turpentine, claimed it to be an oxidising agent with
a certain proportion of peroxide of hydrogen, and therefore an
ozoniser. They would still be obliged to carefully steriHse their
dressings and instruments if they relied entirely on ozone in their
room for operating. Many persons had owed their death to the
excessive use of perchloride of mercury. Could ozone be used
locally in the lotions ? He would ask Dr. Cook to give those who
were surgeons a little inkling as to how they should manage their
cases if ozone were to fulfil all the expectations he wished them
to believe as likely to come from its general use.

Dr. Hughes expressed his profound sympathy with the end
Dr. Cook had proposed to himself in his excellent paper. It was
to do away with the poisonous germicides hitherto in use, sub-
stances injurious to host as well as to guest, and to substitute
nature's own antiseptic, in its most concentrated and active form
of ozone. The only question in his own mind was whether ozone
was truly germicide, i,e,, destructive of the vitaUty of the bacilli
of specific diseases like charbon and relapsing fever, and not
merely a checker of putrefaction and other septic changes. He
would be glad if Dr. Cook could resolve this doubt.

Dr. GoLDSBROUGH doubted if they were all so fully im-
pressed with the importance of the subject as they ought to be.
There were several considerations which arose to his mind upon
which he would Hke Dr. Cook's opinion. They had first the im-
yarlant question as to the quantity of ozone. What was its

SK DIBCU8SI0N ON ANnHEPTICS.

effdot ? If produced in quantity and applied to certain surfaces
of the body there would be some pathological changes seen, so
that there might be danger in its use as an antiseptic. The ques-
tion as to quantity then was a very practical one. He (Dr. Golds-
brough) took it from Dr. Cook that as he considered ozone to be
nature's own antiseptic, it was so by virtue of the production of
free oxygen or pure air. Dr. Goldsbrough remembered visiting
Professor Hamilton's laboratory at Aberdeen, when the professor
mentioned — ^in regard to the cultivation of bacteria — ^that if the
cultivating media were taken down to the sea-shore, the bacteria
could not be produced or propagated. Was this due to the in-
creased amount of ozone wafted from the sea, or to what might
be termed a normal standard of purity in the atmosphere, contain-
ing a certain amount of ozone in relation to its oxygen ? Dr.
Goldsbrough thought the safe ground to go upon was to ascertain
the standard of the purity of the air which would prevent the
cultivation of bacteria, and this would pave the way for the appli-
cation of ozone in cases of surgical procedure. The surgeon did
not want any putrefactive changes to take place in or near his
patient, and his great object was to create an environment where
these changes could be avoided. Another point of great import-
ance in relation to the employment of antiseptics was the state of
vitality of the patient, and here the question of homoeopathic
medication was closely allied, and the use of medicines in all
cases where antiseptics were called for was a right use.

The whole subject was more or less surrounded with uncer-
tainty, and yet we seemed on the verge of a great advance, which
would be aided by the steps taken by Dr. Cook.

Dr. Day said that that day he had learned a thing which he
did not know before, and he thought it was appropriate to the
subject under discussion ; viz., the use of charcoal in the arrest
of putrefaction. A patient of his told him that he had been in
the habit, for many years past, of using charcoal in the larder to
arrest the putrefaction of meat in hot weather. This charcoal
lasted for an almost indefinite period, and it proved most effica-
cious in entirely preventing bad smells, and game that was
quite high was rendered eatable after being cooked with a piece of
chai'coal enclosed in it. He had been thinking whether it would
be desirable to surround septic ulcers, &c., with bags of charcoal
in a dry form, or, on a larger scale, by surrounding the patient
with troughs or other receptacles filled with charcoal, which
would have the triple advantage of safety, simplicity and
economy. For this purpose charcoal should be used dry, and not
moistened as in the form of the charcoal poultice.

DISCUBSIOH ON AMTiaEPTICS* 337

Dr. Thomas thought the good they got from the use of ozone
was in the readiness with which it parted with its oxygen, and
natore's best antiseptic was plenty of fresh air, which contained
plenty of oxygen. There was one method which had not been
mentioned, by which they could apply oxygen locally, and in an
easy form, and that was by the use of peroxide of hydrogen. He
had tried it in one or two cases of imhealthy ulcers, and had
found it of the greatest benefit in stimulating the parts, and
bringing about healthy action ; and until they could get oxygen
more easily he should suggest that peroxide of hydrogen might be
used locally in the case of wounds.

Dr. BuBFOBD, after expressing high approbation of the cha-
racter of Dr. Cook's address, said Dr. Cook sometimes became
the victim of a scientific imagination. They had had elaborately
presented to them thab night that ozone would do this, that it
might do that, or that it ought to do the other. They had had
presented to them the superstructure of theory, requiring as its
corr^latiye a more developed basis of experiment. He had missed
that record of experiments and that series of interrogations of
nature which would have carried much more permanent convic-
tion to them than what they had had, valuable as it was, of Dr.
Cook's own intense personal convictions. He took it that some
points which had been supported, would not have been supported
had they had a more scientific observation in the way he had
indicated. He must not be supposed to be detracting from the
unaninK>us appreciation accorded to the view of importance of
antiseptics, and the whole value of ozone from the point of view
that it was a safe antiseptic. But he would point out that they
had arrived at a newer and better way ; viz., that as prevention
was better than cure, to prevent bacteria from increasing was far
better than the use of any antiseptic ever discovered. The best
scientific demonstrators of this were Tait and Bantock, who, with
most satisfactory results, paid no attention to antiseptics at all.
With regard to the illustration of ozonising London from the top
of St. Paul's, people might be found in the future to object to
compulsory ozonisation, as they now objected (and rightly) to
compulsory vaccination. In conclusion, he trusted that next
year they would have the pleasure of listening to Dr. Cook again
on the same subject, but with the counterpart of this evening's
address, i.e., a series of original experiments and observations
on the antiseptic powers of ozone.

The Pbesident (Dr. Blackley) said he thought all of them
were at one with regard to the necessity of doing away with a

VOL. I. — ^NO. 4. * 22

388 DISCUSSION ON ANTISEPTICS.

great many of the powerful antiseptics that had been used for so
long, and there was undoubtedly a great opening for soniething
that would act beneficially, without in any way prejudicing the
health of the patient. He had himself, for a good many years,
been accustomed to use peroxide of hydrogen, and he had been
extremely pleased with it. Several speakers had suggested that
they wanted more precise information as to the application of
ozone, and whether it was an applicable remedy for disinfection.
That, he took it, was really the thing they would like very much
to know. Of course, dry ozone was all very well for the purpose
of counteracting the germs floating in the air of a sick ward,
although even there they would like a little information as to
whether the air of a perfectly dry ward was as easily disinfected
as if there was moisture present. Peroxide of hydrogen was a
substance easily made use of, and if ozone was — as it appeared to
be — more powerful still in its effect, they would be glad if Dr.
Cook would tell them if it could be used in a similar way to the
peroxide solution. Of course, permanganate of potash had a great
reputation as giving off nascent oxygen ; but its cost, if it is to be
effective, was enormous. He had heard of a small fever hospital,
where the estimated cost of properly disinfecting the dejecta of
the typhoid cases was estimated at something like £10,000 a-year.
Many speakers seemed to have missed one point, viz., that ozone
was more than pure air ; ozone was something more than pure
<i)xygen, or even nascent oxygen. It was oxygen in a very active
form, and as such was very acceptable. Dr. Burford had been
talking about his ideal antiseptic. They had air which was
septic, and if Dr. Cook or Dr. Burford could tell them how to
make it aseptic, they would be leading them a great way.

BOABIKa IK INFANTS, 839

"KOAEING" IN INFANTS.*

BY DUDLEY WRIGHT.

Surgeon, Diseases of the Throat, and Assistant Surgeon, London Honumpathic

Hospital,

I AM fully aware that in choosing the name " roaring "
to describe the disease I am about to speak of, I have not hit
upon a very happy word. I know well that it is bad, both
on account of the fact that I am thereby naming a disease
by one of its symptoms, and also that, inasmuch as it is the
name used to designate a particular disease in horses — a
disease somewhat different in nature from the one under
consideration, confusion and misconception therefrom are
liable to result. I have, however, been almost compelled to
adopt this name, since, for reasons to be mentioned hereafter,
the cause of the disease is not sufficiently clearly defined to
justify one in adopting a nomenclature based on pathologi-
cal grounds.

Dr. Eobertson, of Newcastle-on-Tyne, it is true, in writ-
ing on the disease in the Journal of Laryngology — which
treatise, by the way, is the only one on the subject I have
been able to find in medical literature — calls it " posticus
paralysis in infants ; " but though it is probable that the pecu-
liar symptom which is almost the only objective feature of the
malady is due to bilateral paralysis, or more strictly speak-
ing, paresis of the posterior crico-arytenoideus, still, since
this point has not been determined, owing to the difficulty
in making a laryngoscopic examination in infants, I do not
think we are justified in using this term. Dr. Eobertson
recognises this and, therefore, uses it only provisionally, and
I, likewise, am quite willing to accept a more fitting one
whenever suggested.

Chronic roaring in horses I mention solely for the sake of
showing that it is in most cases — ^for the term has rather a
loose application — somewhat allied to, though differing in
degree from, the one under consideration.

* Bead before the Society, May 4, 1693.

S40 BOAfilKO IK INFANTS,

By examining the figure shown in Fleming's work on
*^ Chronic Boaring in Eoi?«6b/' it will be seen that the roar*
ing is due to a more or less complete paralysis of the left
vocal cord, the muscle most affected being the crico-ary-
tenoideos posticus of that side, which in the figure is seen
to be wasted and converted into a shrunken mass of fibrous
tissue, whereas its fellow is clearly defined and manifests
even some amount of hypertrophy.

This paralysis has been caused by pressure upon the left
recurrent laryngeal nerve, dnd this pressure is usually
exerted by enlarged bronchial glands, but can, of course, be
caused by any tumour in any part of the course taken by
that Aerve. As a result of this paralysis the cord assumes
the cadaveric position, and hence forms an obstruction to
the entrance and exit of the air, dyspnoea and stridor being
the result, the latter accompanying both the expiratory and
inspiratory acts, and being more marked the greater the
volume of air passing the obstructed point, and hence ac-
centuated during violent exercise, &c.

In infants, however, the paralysis is probably bilateral
instead of unilateral, and further, is limited to a single pair
of muscles^ the posterior crico-arytenoidei — the abductors
of the vocal cords. A corresponding important difference in
the objective symptoms exists in the fact that stridor only
accompanies the act of inspiration.

The following three cases met with amongst the patients
of this hospital — two having been under Dr. Moir, by whose
kindiiess I had many opportunities of examining them, and
the third one of my own patients — will give you a fairly good
picture of the disease.

The first case, that of a little boy, aged 4 years, was
brought to the hospital in December, 1890, for marked
stridor, accompanied by some dyspnoea* There appeared
to be a suspicion of a syphilitic history, the mother having
had a rash and sore throat, and the child likewise had had
an eruption which appeared on the buttocks as well as other
parts of the body. The rash had disappeared at 6 months
of age, at which time the child was vaccinated. The present
difficulty in breathing came on at 9 months of age. It

BOABIN& IN INFANTS. 341

commenced gradually, and reached its acme in about a
month, and remained in a stationary condition for three
years. The noise was always present, even when asleep,
aoid it was so loud that people living two floors above could
distinctly hear it.

The child had been treated at the Children's Hospital for
some time but without apparent benefit. On admission there
was a good deal of wasting. Dyspnoea was marked and
breathing noisy; there was a depression at the ensiform
cartilage and lower ribs with each inspiration. Examination
of chest showed no abnormal area* of dulness in front. The
area of heart's dulness was diminished. There was tubular
breathing over the upper end of the sternum with bronchial
breathing on eabh side over the situation of the bronchi.
Breathing at apices normal. Behind, beyond tubular breath-
ing over the course of the bronchi, there was nothing of
importance found. The trachea was slightly deviated to the
right in the neck, and all the extraordinary muscles of
respiration were brought into play, and the jugulars were
much distended. The glands on either side of the angle of
the jaw were slightly increased in size. Examination of
larynx was not possible. The abdomen was slightly enlarged,
the area of liver dulness being increased upwards, but no
enlargement of the spleen was found. During his stay in
the hospital, which was short, there was no great change.
The temperature did not rise except at the end, when
measles developed and the patient was discharged. It was
noticed that the breathing was much more noisy during
sleep. Treatment consisted in the administration of binio-
dide of mercury 3x, gr. 1 1. d. s., and belladonna Ix, mj. p. r. n.

Six months later, the child was re-admitted with symp-
toms of meningitis, which proved fatal within three days.
It was noticed that the breathing had entirely lost its
stertorous character, but that the cough was slightly
"croupy.*'

At the post-mortem examination-, inflammation of the
meninges was present, but no tubercles. The pleurae weve
itormal, and beyond some coUa^^se of the middle lobe of the
right lung, these organs appeared healthy; The thymus

342 BOABma ts infants.

was very large. The larynx and trachea were removed, but
on examination they showed no gross lesion to account for
the noisy respiration.

The second patient of Dr. Moir's was an infant aged 2*
months. There was a distinct syphilitic history in the family,
and the child itself suffered from snuffles, flattening of the
bridge of the nose and mucous tubercles. The disease lasted
until the child was 9 months old and then disappeared, the
treatment being mainly the biniodide of mercury. The notes,
of this case are unfortunately scanty, and no remarks are
made of the actual symptoms present.

The third patient was one of my own aged 14 months,,
who was brought for the noisy breathing which had been
present almost since birth. No distinct history of syphilis^
could be obtained, the child had had bronchitis but no other
illnesses. The noise, which was like a loud snore, was pre-
sent only in the inspiration, the voice was normal in quality
and quite powerful. Examination of the larynx was not
possible. Auscultation showed that the noise was heard
most distinctly over the thyroid cartilage. Examination of
the chest gave a negative result. The patient was ordered
biniodide of mercury, 3x, gr. 2 t. d. s. This was on January
20, 1890. On February 8, the child was brought back very
much better, and on February 22, his third visit, thirty-^
three days from commencement of treatment, the noise had
completely disappeared and the breathing was natural.

Dr. Kobertson, in the paper referred to, gives details of
three cases and mentions three others, six in all. His treat-
ment consisted mainly in the administration of bromides,
intubation of the larynx and removal of post-nasal adenoids-
when present. The three cases of which details are given
recovered or greatly improved within a month or two, and
none were immediately fatal. No mention of syphilis was
made.

We have then here a distinct disease attacking young
children varying in age from a few weeks to eighteen months
and causing chronic inspiratory dyspnoea and marked stridor
in breathing. The disease moreover attacks children in bad
health, especially those who are the subjects of congenital
syphilis.

BOABING IK INFANTS. 843

The peculiar noise made is similar to that present in
cronpi it is only heard during inspiration, it is worse during
sleep, and is never entirely absent at any time during the
course of the disease ; further, the voice remains unaffected*
The disease is, as I have said, chronic in character and
tends to persist many months or years if untreated. Had it
been possible in any of these cases to have examined the
larynx, our knowledge of the cause of these symptoms
would be complete, and we could say with certainty whether
the vocal cords were at fault or not ; but hitherto the
opportunity to do this has not presented itself.

In order to arrive at a knowledge of the nature of the
disease we are compelled to adopt a process of exclusion,
to put out of court those which we can prove it not to be,
and then see what is left to choose from. Let us do this.

1. Croup. — Ordinary croup, understanding thereby a
croupous inflammation of the mucous membrane of the
larynx, it certainly is not. The length of time present is
quite sufficient to preclude this ; moreover, I do not think
we should ever find a case of croup in which the obstruction
to the breathing had become so great as to cause the
amount of stridor noticed in our cases, and yet leave the
voice intact. The same appUes I think to chronic sub-
glottic laryngitis, in which, moreover, the stridor is present
both during inspiration and expiration.

2. Spasm of the larynx or laryngismus stridulus need
not be confounded with the disease under consideration.
The power to cough, the clear voice and the length of time
over which the disease extends again afford a distinction.

3t Growths of the larynx^ especially papillomata, are
commonly met with in children, and might easily give rise
to similar symptoms ; but inasmuch as such growths occur
on or around the vocal cords, the voice would in all proba-
bility be affected at some time or other during the course
of the disease.

4. I think likewise we may exclude growths pressing on
fhe trachea from without, such as enlarged thyroid or thymus
or other glands. The thyroid has never been noticed larger
.than natural, and in the case in wliich the thymus was found

344 boabuvo nr infaitts.

ailarged at the post-mortem it exerted no abnormal pressure
on the trachea ; besides this, pressure from without would
not cause inspiratory dyspnoea and stridor only, but both
inspiratory and expiratory.

It is to an unnatural position of the vocal cords that I
think we must look for the explanation of the disease, and
that abnormal position brought about not by spasm but by
paralysis. The only muscles which in a state of paralysis
could bring about this condition of affairs are the crico-
arytenoidei postici. A bilateral inactivity of these muscles
will produce all the symptoms enumerated, to wit, in-
spiratory dyspnoea and stridor and the maintenance of a
clear voice, and I think that we may assume that this is
the correct explanation. But into the question of how that
paralysis was brought about in the various cases I cannot
enter, and will only remind you that it may be caused
by pressure either on both recurrent laryngeal nerves or on
the trunk of one vagus nerve, or by changes in the spinal
accessory root and nucleus. We must also remember that
inflammation and adenoid growths of the naso-pharyngeal
region may reflexly bring about a similar result.

Inasmuch as there are several ways in which this con-
dition may be caused, I do not think that in every case the
origin of the disease will be the same. We can alwajrs
easily satisfy ourselves whether a morbid condition of the
naso-pharynx is the exciting cause, but for the diagnosis of
the others mentioned, extreme refinement is necessary, and
I do not think this always attainable. That syphilis plays
an important part I can quite believe, and the fact that
the three cases mentioned improved so rapidly under mere,
biniod. lends colour to this view.

I have nothing more to say with regard to the treatment
of such cases than that attention should be paid to the local
condition of the pharynx and naso-pharynx, and that if
adenoid vegetations be found they should be removed.
The administration of the biniodide has been so satisfactory
that we may almost trust to it alone to work a cure*

Occasion might arise, owing to the intensify of the
dyspnoea, for the performance of tracheotomy. Under the

BIBOUBBION ON BOAMNG IN IDTFANTS. 345

circumstances I should think that intubation would be a
fiar preferable procedure, and we have seen that it was fol-
lowed by good results in Dr. Bobertson's hands.

Mr. Cox had seen two of the cases, and thought that paralysis
did not altogether explain the symptoms. It seemed to him that
something more might be said for the tracheal pressure theory.
They were certainly very interesting cases; in one of them it
appeared that tracheotomy would be required immediately, yet
the case went on for days without producing iny marked exhaus-
tion. He considered that the undoubted benefit obtained from
the exhibition of mere, biniod. pointed rather to the presence of
enlarged glands than to paralysis.

Dr. Alexandeb referred to a case of chronic hoarseness of
twelve months' duration in a child of 5 years of age, which
had resisted medicines that appeared to be indicated, such as
causticum, carbo. veg. and phos. He had examined the child
repeatedly with the laryngoscope, but had failed to discover any
neoplasm or noticeable departure from the normal condition in
the vocal cords. He asked Mr. Wright if he thought it likely
that the hoarseness in this case might be due to a latent con-
dition such as he had described in his examples of '* roaring."

Mr. Wbight in reply said that he should have mentioned
that the biniodide treatment which had uniformly given such
good results originated with Dr. Moir. With regard to the case
mentioned l3y Dr. Alexander, he thought it was probably one of
paralysis of one vocal cord due to pressure on the recurrent nerve.
In all the eases of " roaring " there was never any impairment of
the voice, i.e., the power of adducting the cords was intact. In
Dr. Alexander's case he thought the cause was probably enlarge-
ment of the bronchial glands, with resulting reflex hoarseness.
In cases of pressure upon the recurrent nerve one vocal cord is,
or in rare cases, by reason of a mechanism at present not fully
understood, both are, completely paralysed, i.e., both abduction
and adduction are more or less completely prevented, hence the
voice is affected, and there is rarely any marked stridor, the cords
remaining in the cadaveric position, and thus a fair sized space
is left. Thus there can scarcely arise any difficulty in distin-
guishing between cases of recurrent and abductor palsy. At the
same time it must be remembered that both conditions may be
brought about by exactly similar causes.

846 THB TSEATHBNT OF OHBOKIO OOPHOBO-BAliPINGITIS.

THE TKEATMENT OF CHEONIO OOPHOEO-
SALPINGITIS (CHEONIO INFLAMMATION OF
THE UTEEINE APPENDAGES).^

BY D. DYCE BBOWN, M.D.
Consulting Physician to the London HomoBopcUhic Hospitaly

AND GEORGE BURFORD, M.B.
Physician to the OyncBcological D^parPment, London Homoeopathic Ho^taU

I. By D. Dycb Brown, M.D.

In having the honour of, acting with my friend Dr.
Burford, opening the discussion on the above subject, I
would draw your attention to the request that we have re-
ceived from the Honorary Secretary, that we should not
write 9^ paper, nor an essay ^ but simply and shortly introduce
the subject, and give lead to the discussion. I make, there-
fore, no apology for my remarks being short, and for not
entering into an account of the symptoms of the disease or
diseases included in the specified text, nor of their pathology,
further than is necessary for the discussion.

The essential questions are — (1) Shall we adopt thera-
peutic treatment thoroughly and throughout? (2) Shall we,
if this fail to cure, give up the case as hopeless of cure? or
(3) shall we recommend operation ? (4) What are the cases
where we should decline to recommend an operation, even
though for long we make little progress towards cure, by
therapeutic means? (5) What are the cases where we
should not hesitate to advise operative procedure ?

In considering these points, we should remember on the
one hand, that persistent and careful therapeutic treatment
in structural diseases of other organs does result in cure by
homoeopathic medication, after having been given up by the
old school, and that it is at the best a confession of weakness
to resort to operation. On the other hand, in considering
the advisabiUty of surgical procedure, we must not resort to
it with a light heart, but keep in view — (1) That the operation

' Read before the Society, June 28, 1898.

THE TBEATMENT 09 CHBONIC OOPHOBO-flAIiPINaiTIS. 347

may be fatal ; (2) That it is not, as in ovariotomy, kill or cure,
but that it may kill, and when it . does not, may not cure.
(3) That the woman, after, operation, is precluded from
marriage and child-bearing, and is mutilated in these impor-
tant organs for life ; and (4) That the forcible and premature
cessation of the catamenia may be followed by all the evil
systemic effects of premature menopause which are so well
known. These considerations I do not name to frighten one
from advising the operation in cases markedly caUing for it,
but only to be kept in mind, to prevent our advising such a
course without grave consideration. In the title of this dis-
cussion, cases of what are sometimes called " pure neurosis "
are not named or included. But we can hardly exclude them,
since certain operators advise oophorectomy in cases where
the neurotic disturbance both locally and generally is the
only disease, and where no evidence of structural disease can
be made out. But I maintain that we never, I may say^
meet with a case of pure neurosis. There is always a certain
amount of chronic congestion, engorgement, or inflammatory
action existing in cases where no structural disease can be
found, and where the prominent features are distinctly
neurotic. And, moreover, even where structural alteration
can be detected, it is in many cases of a comparatively slight
nature, while the main features of the case are essentially
neurotic. I therefore propose to include these neurotic cases
in mj' remarks.

In reply then to my first query, shall we adopt therapeutic
treatment thoroughly and throughout ? I think there need
be no hesitation in answering yes. In nine-tenths of the
cases we meet, therapeutic means should be adopted fully,
thoroughly, and for a prolonged time. My own experience
is that by so doing, cases which by certain surgeons would
have been relegated to the knife have got well, or so far well
as, with care and watchfulness on the patient's part, to enable
her to go about and enjoy life. A prolonged time of careful
treatment should then be always adopted. In the tenth case,
when we may feel rather hopeless of therapeutic cure, owing
to the structural lesions we may have discovered, we should
still give every chance to therapeutic means, in the hope of

348 THB TBEATHXVT OT CHBONIC OdPHOBO-BALPINGITIS.

preventing operation, and so doing credit to the advanced
methods of homoeopathy. I give at the end three cases
illustrative of this contention. (2) Shall we, if we fail to
cure by therapeutic means, give up the case as hopeless ? or
shall we (3) recommend operation ? To this I would answ(»,
If the case still shows no evidence of marked structural change,
and the symptoms, though obstinate, are essentially neurotic,
we should not advise operation, as it is in these very cases
that the least satisfactory results are obtained. They are
often left as bad as ever, or nearly so, and the game is not
worth the candle. We should continue to persevere with
every possible mode of adjuvant treatment, in the hopes of
ultimately succeeding. But on the other hand, if structural
disease is manifest, and has become more so, in spite of treat-
ment, then operation should be resorted to. This distinctly
answers my fourth query, — ^What are the cases where we
should decline to recommend an operation, even though little
progress is made towards cure by therapeutic means ? They
are those where no structural disease, or only a very slight
amount of it, is detected, and where the case is as nearly
as possible a pure neurosis. Such cases show bad results
after operation, matters being left practically in statu quo,
A case of this kind was sent up to this hospital to Dr.
Burford. At a consultation, it was decided that, being a case
such as I have described, operation was unadvisable. The
doctor who sent the case was much annoyed, and wrote
rather sharply on the matter. She was discharged, and he
sent her, I heard, to Dr. Bantock. Perhaps Dr. Burfard
may allude to this case, and if the doctor who sent the csise
is present, perhaps he will tell us the result. Fifth and
lastly, what are the cases when we should not hesitate to
advise operation ? These are when the amount of structural
disease is so manifest and serious as to virtually preclude
the hope of miedicinal cure, when the neurotic and general
symptoms are subordinate to the local ones, when the pati^it
is precluded from the amount of pain from standing or
wcdking, and when there is rise of temperature at night. In
such a case we should advise, at least, exploratory incision,
leaving iit to be seen whether the parts are so matted with

THE TBEATMENT OF CHBONIC OOPHOBO-BALPINOITIS. 349

adhesions as to render farther proceedings nnsafe, or whether
the parts can be safely removed. This doubt, which can only
be solved by exploratory incision, is one of the difl&cult points
in such operative procedure. On the whole, I consider
oophorectomy to be an operation which should seldom be
resorted to, and then only in cases where nothing else can be
done, and where such structural disease exists as to render
the woman a complete invalid.

As to the treatment, therapeutically, of such cases, it is
impossible in the limit assigned to these remarks to go fully
into it. The selection of the remedies depends entirely on
the individual case. All I can do is to name those that I
trust most in, viz., actsea, ignatia, belladonna, aconite, lilium,
sepia, sulphur, calcarea, pulsatiUa, bryonia, mercurius corr.
and biniod. Locally hot fomentations and pelvic compress,
the latter either in front or all round, acetic acid to spine,
and hot injections ; also and very important, tepid hip baths
for ten minutes at a time.

I shall now add a few cases illustrative of my remarks. I
have, I may say, only come across (1) one case where operation
was thoroughly satisfactory ; (2) two cases where there was a
partial improvement, for which the patient was thankfal, but
not such improvement as, in my mind, could be called satis-
factory as a result of operation and its risks. (3) I have met
with two cases where no benefit has followed oophorectomy,
and have known of others indirectly. The first was operated
on by a well-known and skilful operator of the old school,
and the second was operated on by Dr. Burford. He may
allude to this case, which he kindly asked me to undertake
some time after the operation. This patient still menstruates
regularly but with much pain, although both her ovaries were
removed. Her general neurotic state is slowly but steadily
improving under therapeutic means, so that from not being
able to sit up in bed, she has just returned from a trip to
the seaside, and has gone off again to Norfolk. I have little
doubt of curing this case entirely, but it is now over two
years since the operation was performed. (4) Cases cured
and much benefited by therapeutic means only : —

V

350 THB TRBATHEMT OF OHRONIO OdPHOBO- SALPINGITIS.

Case 1. — Mrs. A., the subject of peri- and parametritis with
inyolvement of the right ovary and tube, firm pelvic adhesions,
rendering the uterus immovable and tender ; constant discharge of
pus through the uterus, coming probably from the Fallopian tube,
great tenderness on pressure on the ovary and in the vagina,
pain in whole of right half of pelvis and down thigh and leg,
preventing her lying with ease with the leg straight out,
occasional rises of temperature at night, loss of health, inability
to sleep, and inability to be in the erect position without much
pain. She was nearly cured, when she got a chill when up out
of bed on a cold day, and had a relapse of her former symptoms.
This lady was under my care for two years, and then got
completely well. She reported herself at Christmas last as quite
well, and able to go about with ease. I had not then seen her
for over a year.

Case 2. — Mrs. B. had, after a confinement, a parametritic
abscess, which burst into the rectum. She regained her health
so far, but the discharge of pus per rectum continued. When I
saw her, her health was much affected, she had constant pelvic
pain, preventing her attending to her household duties. The
uterus was very slightly movable, the roof of the vagina on the
right side was hard and tender, and the right ovary was tender
and enlarged. Under silica 6 and a daily hip bath this lady
reported herself after three months as practically well, able to go
about her duties, eating and sleeping well, and with an entire
cessation of the rectal purulent discharge.

Case 3. — Mrs. C. had been under the care of a fairly well-
known obstetrician in Scotland, who had, from what I heard of his
treatment and advice, mistaken the case, supposing it to be only
neurotic. I found her with a high temperature, great pelvic
pain, sleeplessness, unable to stand or even sit up in bed without
pain ; her left ovary and tube much enlarged and tender, great
tenderness on vaginal examination, and night perspirations. I
diagnosed oophoro- salpingitis, with probably pyo-salpinx, and told
the husband that probably operation would be necessary. How-
ever, he was anxious to see what therapeutic measures would do.
I prescribed aconite, bell., hot fomentations and hot injections,
and advised her being placed under the care of another local
doctor. Mr. C. reported a month after that his wife was so much
improved as to be able to sit up out of bed, had not much pain,
and was eating and sleeping well. I have heard since that she
is fairly well, requiring care, but able to go about the house again.

Case 4. — Mrs. D. came to me with a history of pelvic inflam-

THE TBEATMENT OF CHBONIO OOPHOBO-SALPINQITIS. 351

mation, which had been treated in a decidedly rough allopathic
manner. Sho was unable to walk without pain, and could not
even get ease in bed without the leg being drawn up. The pain,
even in bed, kept her from sleep. Much pain in defaecation and
at the period. On vaginal examination the uterus was immovable,
and the roof of the vagina hard and tender. Her right ovary
and tube were enlarged and tender. She had been advised to
have operation for removal of the right ovary. This I advised
against, as unless the uterus were removed as well no good could
be done, in my opinion. She was anxious to see what homoeopathic
treatment would do. With rest in bed for a fortnight, then on
the sofa, compresses and hot injections, bell., sepia, sulphur,
mere. corr. and actaea, she got so free of pain that she slept well,
and ate well, and was gradually able to walk a moderate amount
without pain. The adhesions remained of course, but the ten-
derness in the right ovary and on vaginal examination was
reduced to a minimum, while the ovario-tubal swelling diminished
to a marked extent, the pelvic hardness as felt in the vagina
became markedly softer, and the uterus slightly moveable. The
patient then went home to the North of EnglQiud. This case
shows how much can be accomplished by homoeopathic thera-
peutic means.

Many cases of minor degree could be given, where cure
was accomplished, and in others such a degree of improve-
ment, as to lead the patients to consider themselves prac-
tically well, so long as they were content to lead a quiet life,
and avoid fatigue.

Lastly, as I said, cases of oophorectomy may prove fatal,
an element in the decision not to be forgotten. I add one
fatal case : a young lady was sent to me vnth constant pelvic
dragging pain, preventing her walking without much pain, or
in fact, doing anything but lying up. Her general health
was in consequence considerably affected. On vaginal ex-
amination, the left ovary could be easily felt much prolapsed,
and very tender to touch. The pelvic pain was evidently
due to this and this only. Therapeutic treatment was here
hopeless, and a pessary would have been useless, even if it
could have been borne. She was operated upon, but suc-
cumbed to peritonitis. One must thus not forget the possi*'
bility of a fatal issue.

352 THB TBBATICBMT OF CHBONIO OOPHOBO^SALPINGITIS.

n. Bt Geobge Bubfobd» M.B.

There are three distinct clinical types of chronic lesions

of the adnexa, differing also in pathological characters. They
are: —

(1) The type resulting from a general tropho-neorosis

where a toxadmia or fiknaemia induces chronic changes in the
abdominal sympathetic. Ovarian phenomena, inter alia,
ensue, and finally ovarian changes of the cirrhotic type.

(2) The type resulting from some reflex traumatism,
usually a chill, or a wetting. Chronic pelvi-peritonitis
ensues, probably secondary to tubal catarrh ; tubes and
ovaries are impacted in the midst of dense adhesions, which
contort and constrict the adnexa, entirely crippling their
physiological functions, and inducing constant and distress-
ing pain.

(3) The type resulting from some septic poison, either
gonorrhceal or from fermentative absorption, where changes
of much the same character as in the former type exist, with
also clear evidences of a pyretic stage. This variety has as
its distinguishing chnical feature an oscillating condition of
health, with a very marked tendency to easy and prolonged
relapses.

Of the second type, the traumatic, and the third type, the
septic, I may remark that they lend themselves fairly easily
to remedial measures in most cases, but that a moiety exists,
proof against the permanence of drug relief, where nothing
but removal of the affected organs will bring permanent
gain, and protect against that easy liability to relapse which
is the chief, as it is the most disquieting, feature of these
pelvic states.

For some years past I have been at intervals engaged in
original work in the investigation of a hitherto undescribed
morbid condition, examples of which have come under my
notice with increasing frequency. My study has been to give
cohesion and sequence to an amorphous group of symptoms,
to trace a natural history and a clinical course, and to record
the effects of various modes of treatment in breaking up the
cycle of disease phenomena. If therefore I give you now a

THE TREATMENT OF CHBONIC OOPHOBO-SALFINaiTIS. 853

miniatore sketch of my views, it is with the hope that your
own varied experience may supplement points on which my
sources of information are somewhat defective ; as well as
supply the wholesome test of criticism to the results I have
already elaborated^

No greater fallacy vitiate^ the judgment of the clinician
than the assumption that the intensity of symptoms must
have its counterpart in. a corresponding pathological change
in the affected tissues. And, turning our attention to the
feminine reproductive apparatus, ** nowhere in the body is it
more true that the intensity of pain is in many instances
in inverse ratio to the pathological condition sought for to
account for it.*' In no part of the body are nerve reflexes
more easily evolved, in no part of the body is nervous
equilibrium more unstable, from no other source are nerve
impulses radiated over the whole organism with greater
frequency and force. The physiological interpretation of
this is that the function of reproduction is one of the very
oldest in the scale of nature; that every addition in the
course of evolution has had to be co-ordinated with this
pre-existing function, and therefore a definite nerve corre-
lation has been established between it and every higher
faculty of a later date.

Here, then, is a clear reason why the occurrence of
puberty so profoundly influences all other elements in the
organism ; and the disarrangement of its mechanism, or its
development in a debilitated organism, so readily affects and
is shared by every other function of the body corporate.

My clinical studies of morbid conditions during repro-
ductive life have occupied themselves with increasing fre-
quency concerning an abnormal course, in which a general
type of disease can be distinctly made out, while every
quantitative variation is presented in individual cases. A
young lady, mostly of the upper or middle class, enjoys fair
health during her early years. Often she is plump and in-
clined to stoutness, is liable to adenoid hyperplasia, and
her frequent slight ailments show a certain vulnerability of
constitution. The incubus of puberty is now laid upon her,
a heavy draft upon the resources of an organism never more
VOL. I. — NO. 4. 23

354 THE TREATMENT OF CHBONIO OOPHOBO-BALPINGITIB.

than a minor quantity. The new periodic funotion is halting
and irregular, a suflScient proof of the difficulty of its co-
ordination by a relatively feeble organism. The period from
the first is of the dysmenial type ; for a few years the patient
struggles on, until some slight affection, a wetting, a strain
on lifting, or a time of insufficient nourishment at school,
causes a pain in the flank, or some similar local distress
which is exacerbated at the period, and continues in a
lessened degree during the whole interval. This, con-
joined with the dysmenial pain, constitutes a status doloris
which once established ebbs and flows, but is rarely entirely
lacking for any length of time.

Local physical examination at this juncture may reveal
absolutely no deviation from the normal, or merely some
version or flexion or ovarian prolapse, the simple restitution
of which affects the general condition but in the slightest
degree.

This is but the initiation of the patient's woes. Con-
stant and intractable lumbar backache gradually develops,
and the whole spine becomes tender and painful, the points
of maximum intensity being over the upper lumbar and
last dorsal and lower cervical vertebrse, the latter area being
a notable seat of pain in well-marked cases. Up the cervical
spine the pain is traced, and becomes continuous vdth an
occipital or occipito- vertical headache, of daily advent.
Asthenopia so marked as to practically prohibit any pro-
longed effort at near vision, is present in every case. An
apepsia with an appetite defective, faddist, and finally
deplorable, is followed by dyspepsia of the flatulent or
irritative type. Marked constipation invariably exists,
further enhanced by the effort at evacuation being fre-
quently painful. The capacity for sleep is so defective that
hypnotics are freely taken to induce even an attempt at somno-
lence, and the experience of the night is a constant rest-
lessness, followed by a troubled and dreamful slumber. A
capacity for taking alcoholic stimulant is developed, so that
I have known a young lady swallow as a nightcap a
modicum of spirit such as a confirmed* toper would deno-
minate stiff, and this with but little apparent effect. The

THE TREATMENT OF CHBONIC OOPHOBO-SALPINGITIS. 355

hands are attenuated and chill, the feet stonily cold, the
hair prematurely gray, the pupils frequently dilated, and the
tout ensemble is a state of lU^ which confines the sufferer
almost entirely to her room, every effort being the precursor
of aches and pains, languor and exhaustion.

I have cited here a well-marked case, taken from life ;
but any and every stage and degree of this morbid entity
exists, according to the patient's degree of vitality and
powers of resistance. Some cases are so slight that they
can scarcely be affiliated to this category ; others, more
developed, forecast only too definitely the tendency of their
debilitated vitality ; while yet others seem to have suffered
all the assaults which the slings and arrows of outrageous
fortune can make upon them.

Taking a broad view of phenomena, we have here to
deal with a trophic neurosis of a new type because con-
ditioned by a latter-day set of influences. We have as the
prime element in this clmical picture a type of constitution
styled by Niemeyer '* vulnerable." Upon this organism,
whose resources hitherto have been fairly equal to the
demands of juvenility, comes the stress and strain of pu-
berty ; and the halting, irregular, and painful performance
of this new function sufficiently attests the difficulty of its
co-ordination by the bodily powers. This is the first serious
crisis in the course of development — a crisis which comes at
a time when, forsooth, the moderate energies of the budding
girl are absorbed by the intellectual cramming of the high
school, or depressed by a defective regimen or an increasing
limitation of out-door life, and the feeble remnant is entirely
swamped by the imperious demands, of the newly-developed
functions.

The whole after-history is one long-continued protest on
the part of the organism against the thrusting upon it of
the vocation of the reproductive life, the demands of which
it is utterly unable to fulfil.

The nerve centres primarily controlling the uterine, tubal
and ovarian activities lie in a spinal tract between the
planes of the last dorsal and second lumbar vertebrae.

The ganglia here situate are kept in a constant state of

356 THE TBEATMENT OF CHBOKIC 00FH0B0-8ALPINOITIS.

irritation by the afferent vibrations engendered by imper-
fectly performed functions, and the effort to meet the dis-
proportion between fully developed organs and defective
vital power to work them. In the course of time the con-
stant irritation of these nerve centres is not only felt as
local pain, but is radiated to every part of the cerebro-spinal
and sympathetic system by virtue of that intimate nerve
interaction already spoken of. The withdrawal of a definite
amount of available vigour from the other vital necessities-
soon tells unfavourably upon the assimilative agencies. The
circulation of anaemic and toxsemic blood still further adds
to the incumbrances of the body corporate. Lessened nerve
supply brings about dyspepsia, and dyspepsia again even-
tuates in a still further deterioration of the nutrition of the
nerve centres. And so the vicious circle is constructed, and
ultimately there is slowly developed a typical example of the
lesion described by neurologists as spinal neurasthenia.

Treatment,

I have failed in my pourtrayal if I have not made clear
and vivid to you the various elements and the various stages
of the disease process under consideration. The background
on which the morbid picture is painted, is the type of
organism which can fairly pass muster so long as but limited
demands are made upon it. How much the urban mode of
life, the restrictions upon girls' physical development, the
assiduous deploying of their energies upon brain work of
various types, and the hereditary tendency to reproduction
of prominent nervous tensions in parents again in children ^
— these are elements which have to be worked out in each
individual case. Briefly, when a young lady is brought to
me in the early stages of defective health due to the de-
mands of the early years of puberty, I always order complete
cessation from intellectual work, hfe in the country under
strictly natural conditions, and the limitation of energies to
the establishment and consolidation of the physical growth
and development of the body. The appropriate therapeutics
find here their happiest sphere, as the fundamental defects
are those of nutrition and assimilation. A senseless plan it

THE TBEATMENT OP CHBONIC OOPHORO-SALPINGITIS. 357

is to endeavour by drug action to induce a menstrual period
in an organism, which has ceased its spontaneous perform-
ance ; unless by strengthening and invigorating those bodily
forces which have the process as their direct natural out-
come.

In stages later still, where irritative reflexes are com-
mencing, such as sickness, or other form of dyspepsia, and
the characteristic spinal pain, and defective circulation,
much good may ensue from applying Chapman's ice bag to
the spine, rectal feeding, or massage. Each case requires
its own line of treatment, together with the therapeutic aids
so plentifully at your disposal. Bat I would earnestly
<;aution you in these cases never to employ massage without
also insisting on a forced feeding. Without this, the massage
does much more harm than good, adding to, rather than
lessening, the exhausting influences the patient has now to
bear.

In chronic and inveterate cases, the last resort is the
artificial induction of a premature climacteric. The scientific
basis of this procedure is easy to demonstrate. The disease
circle in advanced cases maybe broken at various points. It
may be broken by so notably quickening the powers of
assimilation that the nutritive currents increase the visrour
and lessen the atonic irritability of the nerve gangUa pri-
marily aflfected. Or it may be broken by removing any
-detent such as an unhealthy environment, or improper or
defective food, or an exhausting or too prolonged intellectual
avocation. Or it may be broken by removing the prime
cause of the depraved health, the charges made upon the
system by the continuance of the periodic reproductive
phenomena. Obviously there may come a time when even
this is of no avail, when the spinal neurasthenia, the defective
nutrition, the vital collapse, shall have so lowered the re-
cuperative powers that there is no response to the removal
of the prime cause in their occurrence.

I can only say that such cases I believe are very rare. I
have never yet seen a case where considerable and lasting
benefit did not follow the surgical induction of the climacteric.
How are those cases to be accounted for when, after removal

358 THE TBEATMENT OF CHBONIC OOPHOBO-SALPINQITIS.

of the ovaries, menstraation still persists ? In one of two»
ways: either because every shred of ovarian tissue, the
whole Fallopian tube, or a large area' of the ovarian arter7
are not tied and removed ; or because again, the constantly
irritated utero-ovarian ganglia are now no longer controlled
by the local condition, healthy or diseased.

Cases in which Abdominal Section fob Kbuovaii of the Utebine

Appendages has been Pebfobmed fob Local and

Genebal Mobbid Conditions.

Case A. — ^Tropho-neurosis to maximum degree; removal of appendages on
both sides. Result — In statu quo ; no menopause ensuing.

Case B. — Periodphoritis on left side ; removal of left appendages only*
Result — Much improvement.

Case C. — ^Prolapsed hypertrophied ovaries ; removal of both sets of appen-
dages. Result — Greatly improved.

Case D. — Commencing atrophic cirrhosis ; constitutional debility ; removal
of both appendage sets. jRest^Z^— Much local improvement, meno-
pause instituted ; general health poor.

Case E. — Gk)norrhoBal affection of vagina, uterus and adneza ; marked noc-
turnal pyrexia ; great iliac pain ; removal of both sets of appendages.
Result — Complete cure ; menopause.

Case F. — Copious watery uterine discharges ; much local pain ; greatly im^
paired locomotion ; removal of left appendages only. Result — Marked
improvement.

Case G. — Tropho-neurosis, with acute local spasmodic pain ; removal of both
sets of appendages. Result — ^Very considerable improvement; meno-
pause.

Case H. — Chronic pelvi-peritonitis, from catarrh of tubes ; gonorrhoeal? Appen-
dages entirely buried in dense exudation ; right ovary alone removed.
Result — In statu quo.

Case I. — Chronic pelvi-peritonitis, gonorrhoeal ; pelvis completely blocked
by dense masses of adhesions; appendages impossible to isolate..
Result — Some general improvement.

Case K. — Cirrhosis of ovaries (alcoholic) ; removal of both adnexa. Result —
Moderate improvement.

Case L. — ^Advanced tropho-neurosis, much local and general distress ; remova
of both sets of appendages. Result — In statu quo; no menopause
ensuing.

Cases of a Similab Chabacteb undeb Genebal and Thbbapeutic

Tbeatment Mebely.

Case A^ — ^Very advanced tropho-neurosis ; a chronic invalid ; veiy slight^
benefit from protracted treatment.

Case B^ — Commencing tropho-neurosis, with ovarian prolapse. Improve-
ment tardy ; general health below par.

Case C^ — Advanced tropho-neurosis; some improvement imder treatment,,
but easily relapses ; chronic, invalid,

DISCUSSION OK CHBONIO OOPHOBO-BALPINGITIS. 359

Case D^* — Gomniencmg tropho-neurosis, with gastric reflexes; considerable
improvement under treatment ; relapses.

Case E*. — Chronic pelvi-peritonitis, with marked tropho-neurosis ; some degree
of improvement by treatment.

Case F'. — Marked tropho-neurosis; chronic invalid; scarcely able to get about.
Improvement— fiiZ.

Case G*. — Chronic cirrhosis of ovaries ; chronic invalid ; no permanent im-
provement by treatment.

Case H>. — Conmiencing tropho-neurosis; no improvement under prolonged
treatment.

Case I>. — Chronic pelvi-peritonitis, with probable impaction of appendages ;
former diagnosis ** hysteria."

Case K^— Tropho-neurosis, with marked dysmenia ; some improvement
under treatment.

Case U, — Gk)norrhoeal disease of appendages ; condition of health very
variable ; unable to follow avocation regularly ; dependent on her own
exertions. Present condition : health very defective.

Case M*. — Advanced tropho-neurosis, with great dysmenia ; chronic invalid ;
some improvement under treatment.

Case N^ — Advanced tropho-neurosis, with much local distress ; chronic
invalid.

Case O^ — ^Marked tropho-neurosis, with gastric reflexes ; improvement alter-
nating with relapses ; progressing.

Case P^ — Tropho-neurosis, with gastric symptoms and local distress. Im-
provement tardy.

Mr. Knox Shaw felt diffident about taking part in the discus-
sion, but during the past year he had been consulted by two
patients who caused him to reflect somewhat on the subject under
review, and had aroused in him an interest in a class of diseases
he saw very little of. These two cases made him wonder whether
after all we, as surgeons, were justifled in making such a holocaust
of the ovaries and tubes ad had lately become prevalent, and
whether we were on the right lines in atta^cking the ovaries them-
selves as the fons et origo mali. He asked attention to the follow-
ing cure. Miss W., age 38, consulted him in November, 1892, owing
to an inability to read or work without distressing pain, and com-
plaining of a burning feeling and fulness of the eyes. The
symptoms were so severe that continuous application of her eyes
to work was an impossibility. She was a myope, and a lens of
6 D gave her normal acuity of vision. Her difficulty arose from a
considerable degree of exophoria, or insufficiency of the internal
recti, causing a tendency of the eyes to diverge. This state existed
in distant vision, aad was increased in accommodation. We must
remember that the position of equilibrium in the ocular muscles is
'^ the resultant of the varying amounts of innervation which are
supplied to the muscles, aad which are distributed among them in

360 DISCUSSION ON CHBONIC OOFHOBO-SALPINGITIB.

proper proportions." In other words, it depends on a very
complex nervous function. All well know how in certain indivi-
duals, known as the neurotic, or of a neuropathic predisposition,
aberrations of nervous force play an important part in the develop-
ment of the symptoms of which they complain. In his experience
he should say that where one found suffering due to disturb-
ance of the motility of the aye, one almost invariably found a
definite neuropathic history, and that successful treatment was
best obtained, not by treating the eye alone, but by taking into
careful consideration the concomitant neurotic condition. Let
us now see what was the past history of the patient. She had
never been very strong. In. 1889 she suffered from writer's
cramp ; one of Duchenne's ** functional impotences," an inability
to execute an act, needing, as in the use of the eyes, a carefully
adjusted innervation of a number of muscles. Having recovered
from this, she became a victim to that cataclysm of symp-
toms associated with chronic oophoro-salpingitis, for which, in
February, 1892, she had both her ovaries removed by Dr. Fenton.
When Mr. Knox Shaw saw her .ten months afterwards she was
still suffering much from backache and pain in the side, and her
"period" had not long ceased, so that au artificial menopause
had not been induced. Now she had the ocular breakdown.

The next case. Miss M., age 44, was seen this April, complain-
ing of pain at the back of the eyes, with smarting and a bad
strained feeling. She could not use the eyes for long, and at
night not at all. In the right eye she had a very trifling degree
of hyperopic astigmatism (+ 0-5 D) and in the left eye a less
degree (+ 0*25 D) of simple hyperopia. But she had, when testing
the equilibrium of her ocular muscles, a marked excess of con-
vergence or esophoria, due to insufficiency of the external recti.
Enquiry revealed that for many years she had been a great invahd
and quite unable to walk from the symptoms centering round a
chronic oophoro-salpingitis. Four years ago both ovaries and
tubes were removed by Dr. Bantock, and she seems to have
derived some benefit from the operation, but she still suffered
much from backache, and was not able to do more than three
hours' teaching a day.

These patients' lives are rendered miserable by a series of symp-
toms which are generally found to be out of all proportion to the
discoverable pathological lesion, and which condition probably
exists in many without exciting any such symptoms. Are we
not justified in assuming that it is not so much the diseased
ovary that is the most important fsiCtor in the development of the

DISCUSSION ON CHUONIC oophoro-salpingitis. 361

symptoms, but the disposition to neuropathic manifestations that
exist, in the patient in whom the ovarian disease is found ? In
what he was inclined to consider as somewhat analogous cases, it
is not every case of abnormal equilibrium of the ocular muscles
that causes distress to the patient. There must exist in the
patient that preternatural affection of sense and motion, now
commonly known as the neurotic temperament.

It would appear to him, therefore, to be as illogical to fre-
quently remove the ovaries in these patients as it is to follow the
advice of some of our American coiifrlres and tenotomise in a
wholesale manner the ocular muscles of the class of patient to
whom he had just referred.

Dr. Cook said that the remarks of the first speaker were
mainly valuable as indicating the difficulty of applying thera-
peutic methods to the treatment of ovarian disease and the need
of great patience on the part of those treated. Dr. Dyce Brown's
patients seemed content to go on with a tedious treatment of two
or more years, and to be satisfied then with an amelioration, not
a cnre ; in general, patients would not so long cling to one mode
of treatment. Dr. Burford's suggestion, that at puberty the
organism of many girls, taking on new and most onerous duties,
was found of deficient strength for its increased load and thus
failed in its weakest part, was interesting and suggestive. He
agreed that the failure of operation to relieve symptoms might
in many cases be attributed to delay — delay which permitted
nerve disorganisation to progress so much that no operative
procedure could remedy the matter. Still, he was met by the
difficulty that in such weak constitutions as Dr. Burford had
depicted, the mischief began at puberty ; yet we could not suggest
that that, or soon after, was an appropriate time for surgical
remedies. We had to give some time to medicinal action, and
that delay might render nugatory all surgical' interference under-
taken later. Certainly there was great scope for fresh energy in
finding the appropriate treatment and medicine in young cases,
and at the same time it appeared clear that there came a time
at which nothing but surgery would avail. To suggest that a
woman who never could lead a proper marital life, or become a
a mother, was rendered a worse case by being deprived of diseased
ovaries under appropriate precautions, was absurd. Various
causes contributed to the prevalence of such cases ; clearly a
female animal in natural conditions, soon after sexual functions
became possible, was prompted to indulge them. This could
never be permitted in civilised life among women, and the re-

362 POLYPUS FBOM DSaBXEBATION OF THE CEBYIX UTEBI.

Btramt — the unnatural restraint — ^induced, often daring life-long
years, could not but have a mischievous physical influence, and
the weaker the organism the greater the harm. Medical men
must recognise fully this condition of things and its influence,
and point their remedies to allaying this special excitement, and
thus giving greater mental control.

Dr. jAGiEiiSKi had observed very often the reflex phenomena
brought on by anomalies in the sexual organs, and had demon-
strated the fact of these parts being the cause of the reflex
phenomena in the brain, throat, head, and other parts by
seeing these reflex phenomena produced in the patient by a
digital pressure, vaginally in and around the uterus. Eeferring
to massage, he regretted disrepute was brought upon it by cases
requiring it being relegated to non-medical hands, instead of
being treated by medical men who gave special attention to the
subject. The great point in the value of proper massage was to
prevent subinvolution, inflammatory thickening, and flexion and
version, by a proper combination of massage, electricity and in-
ternal treatment. This wiU check much misery and prevent the
so-called chronic mischief in gynaecology for which now operation
alone appears to be the radical remedy.

POLYPUS FEOM CYSTIC DEGENEEATION OF

THE CEEVIX UTEEI.^

Db. Hawkes showed to the Society a small uterine
polypus which he had removed from a patient aged 62, who
was admitted into the Hahnemann Hospital, Liverpool, on
May 2nd, 1893. Examination revealed a small polypus
growing from the anterior lip of the os uteri.

The small polypus was removed on May 4th, the
patient having complained of more ** dragging" than one
would have associated with such a small growth. The
narrow pedicle was merely snipped through with scissors.

On examination it proved to be the outcome of cystic

* Pathological specimen, Liverpool Branch. May 11, 1692.

HOM(£OPATHY IN RUSSIA. 363

degeneration of the cervix uteri. Relief followed this
simple expedient, and the patient returned home a few days
afterwards. It has been pointed out that under certain
circumstances congestion and hyper-distension of the
glands of the cervix occur, leading to a cystic condition.
These cysts, through hypertrophy of the subjacent tissue,
are forced forwards in the form of polypi.

HOMCEOPATHY IN RUSSIA.

At the Annual Assembly of the Society on June 28th,
Dr. von Dittmann, of St. Petersburg, was present, and on
the invitation of the President (Dr. Galley Blackley) made
some remarks on the position of homoeopathy in Russia.
He said that homoeopathy was making slow but steady
progress in the Russian Capital. Although homoeopathy
had a hard battle to fight, a more friendly state of feeling
was beginning to arise between them and the Allopathic
School. The official medical authorities in Russia had
great power; but homoeopathy was supported by some
patients of high rank, and the Emperor himself sympathised
to a certain extent with their system. He had given no
official recognition to homoeopathy, but was rather friendly
than the reverse. He (Dr. von Dittmann) had himself had
the honour of being presented to the Czar, to whom he had
appealed on behalf of a sanatorium which he had opened
near St. Petersburg, to which opposition was excited. The
Emperor had given a large sum for a homoeopathic hospital.
They had also secured the adhesion of some eminent prac-
titioners, among whom was Dr. Brasol, who was doing very
well. Public lectures have been given, which were attended
by hundreds of people. No doubt there was some noise and
disturbance at these meetings, and the big newspapers were
opposed to homoeopathy, but they were making progress,
and he hoped before long to have a homoeopathic hospital in
St. Petersburg. There were homoeopathic chemists who

364 HOMCEOPATHY IN INDIA.

sold a considerable quantity of homoeopathic medicine.
Funds were being collected, and in about ten months they
hoped to raise about ^£2,000 a year for the hospital. In a
couple of years they hoped to give gratuitous support to the
patients in the hospital. A large number of Greek priests
understood homoeopathy, and dispensed homoeopathic medi-
cines, especially in the large number of districts where there
were no physicians. They had also published translations
of homoeopathic treatises, and people would travel hundreds
of miles to receive homoeopathic treatment.

Dr. VON DiTTMANN further added that since 1881, when
he had the honour of taking part in the London Congress,
three new homoeopathic societies had started, at Kiel and
Odessa. They consisted mostly of laymen. Dr. Brasol
travelled a great deal and delivered lectures in halls hired
by the different societies.

HOMCEOPATHY IN INDIA.

In addition to Dr. von Dittmann, Dr. Majumdar, of
Calcutta, was also a visitor at the Annual Assembly. In
speaking of the state of homoeopathy in Calcutta and India
generally, he said that homoeopathy was introduced into
India by missionaries. One of his countrymen afterwards
took it up, and converted Dr. Sircar, who had brought it
forward at the Calcutta University. Since then little
progress had been made, and there were few practitioners.
He was converted to the system when he was a graduate,
and since then about a dozen members of his college had
followed his example. But there was at first no means of
spreading the system in India. Five or six years ago a
school was started and more progress was being made. A
hospital was opened last year, and there were greater facili-
ties for learning the system practically. There were thirty
or thirty-five beds, and ten or twelve separate rooms for
<3holera patients. In the last year or two there had been no

APHONIA PBOM PAEALYSIS OP THE LEFT VOCAL OOBD. 365

cholera cases — they had exported the disease to Europe.
In many places there were no homoeopathic physicians, and
scarcely any at Bombay. There were some comitrymen of
his practising at Calcutta, where also there were many
homoeopathic pharmacies. There were no practitioners at
Madras; but the missionaries were spreading the system
throughout the country, and lay practitioners were also
extending homoeopathy.

APHONIA FEOM PAEALYSIS OF THE LEFT VOCAL
COED SIMULATING PHTHISIS.^

Db. a. E. Hawkes demonstrated the chromogen reaction
in the urine of an anaemic girl who had been under his care
in the hospital, and recorded the case.

Eose F., aged 20, was admitted into the Hahnemann
Hospital, Liverpool, on April 22nd, 1893.

She was quite well nine weeks prior to admission, when
she caught cold. Her family history was said to be satis-
factory. Her catamenia were usually too free. She had
aphonia on admission, but no cough.

Auscultation and percussion showed no serious pul-
monary signs. There were, however, loud haemic murmurs
heard under the clavicles, on each side of the sternum, and
all over the cardiac area round as far as the left scapula, and
even to the spine, as well as in the vessels of the neck. The
temperature was normal. The urine was free from albumen,
but as the test was being applied a rose-red coloration was
observed indicating the presence of a chromogen.

It may here be remarked that this rose-red coloration is
obtained by adding impure nitric acid, that is, nitric acid
containing some nitrous acid, to a suitable sample of urine.
Dr. Herschell in the Practitioner , May, 1893, page 361, ex-
pressed the view that ** the red pigment is dependent in
some way or other upon the faecal accumulation in the

* Liverpool Branch, May 11, 1893. ~

366 APHONIA FROM PABALYSIS OF THE LEFT VOCAL COBD.

ascending colon,- and secondly that the finding of such a
pigment in the urine may be a valuable indication that such
a retention of faecal matter exists." His paper should be
read, and his references followed up, by those interested in
the subject. But to continue : On May 3rd a lar5nigoscopic
examination made by Dr. Charles Hayward showed that the
aphonia was due to the left vocal cord being fixed in a semi-
inspiratory position. This paralysis was thought to be due
to the recurrent laryngeal nerve having been involved in
some pleural thickening.

There was much oedema of the right leg, and consi-
derable pain in the right side of the abdomen, where some
swelling ( ? cellulitic) was discovered. Examination of the
blood shewed the red corpuscles to be about 3J millions per
cubic millimetre. The corpuscles were of various shapes
and sizes ; the white corpuscles were relatively increased.

By May 8th the swelling and abdominal pain were
better, and the chromogen reaction was much less marked.

On the 13th it was noted that she was much better, and
that there was no suspicion of cellulitis. Her voice re-
mained the same, but the chromogen reaction was still less.

By May 23rd she could walk about the ward, th e oedema
having gone.

She was much better on June 2nd, but the right leg
swelled a little after she had been long up.

The chromogen reaction no longer appeared when nitric
acid was added to the urine. The haemic murmurs had
become much less marked.

On June 26th the patient left the hospital, all the
troublesome symptoms, except of course the aphonia, having
disappeared.

On her admission the slight cough, the aphonia, the
oedema, and the general appearance of the patient, some-
what closely simulated advanced phthisis, but further exa-
mination soon dissipated the notion. The medicine mainly
used was arsen. iod. 5 x.

A CASE OF ACUTE TUBERCULOSIS. 367

NOTES ON A CASE OF ACUTE TUBEBCULOSIS.^

BY A. F. HAWKES, M.D.
Physician to the Hahnemann Hospital, Liverpool.

Prepaeations showing tuberculosis of the lungs, spleen,
mesenteric glands and intestines were shown to the Society,
taken from the following case : —

E. G., a little girl aged 4 years, was admitted into the
Hahnemann Hospital, Liverpool, on April 19th, 1893, with
many of the symptoms of enteric fever. She had begun to
be ill, it was said, eight days before admission, when vomit-
ing and purging occurred. On admission her temperature
was 103.4** F. ; pulse 144, somewhat dicrotic ; and respira-
tions 36 per minute. Her tongue was dry, brown, and
thickly coated ; there was marked tympanites with tender-
ness, and some spots were visible on the abdomen; both
bases of the lungs were found to be congested on examining
the chest; the diarrhoea continued. It was, however,
noticed that the child shrieked a good deal, and belladonna
was suggested instead of baptisia, which she was taking.
On April 21st flapping of alee nasi was noted with hectic
flush on the cheek and some tendency to herpes on the nose.
Her temperature, respiration and pulse remained much the
same. There were pneumonic signs at both bases. The
next day the pulse was 168, temperature 102.2'. There was
an aphthous condition of mouth ; the child moaned a great
deal. On April 23rd loud moist rales were heard at the
bases; the pulse was 180, temperature 104°. The child
was pallid and restless, but there was less tympanites. A
few spots were still visible on the abdomen. She passed
frequent greenish stools. Apparently the milk was un-
digested, although peptonized. The child died after being
in hospital four days ; during this time she had given to her
baptisia, belladonna, phosphorus and mercurius cor., but
without effect. The post-mortem showed a tuberculous
condition of the left base, tubercles in the spleen, tubercle

* Specimen presented to the Liverpool Branch, May 11th, 1833.

868 SOCIETY KEWS.

of the mesenteric glands, and tuberculous ulcers in the
ileum ; a well marked intussusception was also discovered.

Dr. Hawkes pointed out the difficulty in the early-
diagnosis of these cases from typhoid fever, and emphasised
the misleading features in the case : the temperature, con-
dition of the tongue, the diarrhoea and the abdominal spots.
He quoted Fagge to the effect that such errors — ^if such an
unjust term is made use of — are excusable, especially if the
patient comes from a dark and dirty cellar as this one did.

SOCIETY NEWS.

The Annual Assembly, which brought session 1892-1893 to a
close, was held on June 28th and 29fch in the Lecture Eoom of
the College of Organists, Bloomsbury, under the presidency of
Dr. Galley Blackley.

Before proceeding to the election of officers, the President
announced that the coming session would be the jubilee of the
fouodation of the Society^ and in seeking to celebrate the occa-
sion in a befitting manner the Council had decided to suggest to
the Assembly the election of Mr. Hugh Cameron as president for
the ensuing year. Of that band of sturdy homoeopaths who
gathered round Dr. Quin, in 1844, to found the British Homoeo-
pathic Society, and who became its original members, Mr.
Cameron alone remains ; and it was thought it would be a
gracious act to ask him to become our President for the jubilee
year.

On a ballot being taken, Mr. Hugh Cameron was unanimously
chosen to fill the post of President, the choice of Vice-Presidents
falling upon Drs. Madden and Goldsbrough.

After ten years' service to the Society as Treasurer, Dr.
Dudgeon begged to be relieved of his office. The meeting ex-
pressed its gratitude to Dr. Dudgeon for the able assistance he
had given to the Society, and being assured that Dr. Dudgeon
was firm in his wish to retire, proceeded to elect the retiring
President — Dr. Galley Blackley — to the office of Treasurer.

The Council was completed by the election of the following
Fellows of the Society, Drs. Dudgeon, Hughes, Byres Moir and
Neatby ; and the following Members, Mr. Henry Harris and Dr.
Washington Epps.

SOCIETY NEWS. 369

The Liverpool Branch of the Society at the last meeting of
its session elected Dr. John William Ellis as President and Dr.
A. E. Hawkes as Vice-President, Dr. Edmund Capper being re-
elected Secretary.

At the Annual Assembly the Honorary Secretary moved on
behalf of the Council, seconded by Dr. Byres Moir, an alteration
in Law XVIII. (6) with a view to simplifying the election of officers
to the Council at the Annual Assembly. This having been carried
ne7n. con,, the section of the law referred to will now read thus :
— ** (6) At the last meeting of the assembly the officers of the
Society shall be elected for the ensuing year. The President,
Vice-Presidents and Treasurer, who shall be Fellows of the
Society, shall be the first officers elected. Four Fellows and two
Members shall next be elected, to form with the above, the
Branch Eepresentatives, and the Secretary, the Council of the
Society."

At the same meeting Mr. Dudley Wright proposed an altera-
tion to Law XII. by leaving out the words " with the addition of
having been in practice for seven years, five of which must have
been devoted to homoeopathy," and to omit " they also." The
new Law to read thus : —

XII. ** Fellows must possess the usual qualification of Mem-
bers ; must have been Members of the Society for at least two
years, and have also contributed at least three original communi-
cations. The new Fellow shall, on election, pay an enrolment
fee of one guinea."

To this Drs. Hughes and Dudgeon moved an amendment to
leave out " two " and insert " five." This having been carried,
the main question as amended was put to the meeting and
carried.

Law XII. will now stand thus : — ** Fellows must possess the
usual qualifications of Members, must have been Members of the
Society for at least five years, and must have contributed at least
three original communications. The new Fellow shall, on elec-
tion, pay an enrolment fee of one guinea."

Acting under the provisions of Law XII. (c), which states that
** Any member who, in the opinion of the Society, has at any time
distinguished himself in science or literature, may be elected a
Fellow by a majority of at least three-fourths of the members
present at the Annual Assembly," the Society, at its Annual
VOL. I. — NO. 4. 24

870 SOCIETY NEWS.

Assembly, elected Drs. John William Hayward and Herbert
Nankivell Fellows of the Society.

At the same time, the Society added to its roll of Correspond-
ing Members the names of that distinguished surgeon, Dr. Tod
Helmuth ; the able collaborator with Dr. Hughes in the
" Cyclopaedia of Drug Pathogenesy," Dr. J. P. Dake; and the

Editor of the " Eevue Homoeopathique Beige/* Dr. Martiny.

^ ^^— ^^^^■— ■—

In acknowledging the announcement of his election, Dr. Mar-
tiny writes to the Secretary of the Society : — .

'* Bruxelles, 8 Juillet, 1893.

** Monsieur et honor6 Confrere, — Je suis r^ellement flatty de
rhonneur qui m'a fait la British Homoeopathic Society en me
nominant membre correspondant de la Soci^te.

**Veuillez ^bre I'interpr^te de mes sentiments de gratitude
aupr^s de M. le President et des membres de votre Soci^te.

"Eecevez, Monsieur et honor6 Confrere, Tassurance de mes
meilleurs sentiments.

*' J. Mabtiny."

Dr, Tod Helmuth says : ** I thank the Society for the honour
of its membership, and venture to express the hope that, at some
not far distant date, I may be able to assist in its usefulness."

The Secretary has also received the following letter from Dr.
Dake : —

*' Nashville, Tenn.,

" August 2nd, 1893.

** Dear Sir,— I am in receipt of your letter informing me of my
election as a corresponding member of the British Homoeopathic
Society. I desire to say that I appreciate the honour, as well as
the privileges, of such membership, esteeming your Society as
one of the foremost agencies for the propagation of medical
reform. With many of your members I have the pleasure of a
personal acquaintance, which I value most highly. Convey my
thanks to your Society, and accept the same personally. — I am,
very sincerely yours, " J. P. Dake."

Since the last issue of the Joubhaii, the Society has lost, by
death, three of its members.

Dr. Carl F. Fischer, who died after a few days' illness in
Chicago last June, was only elected a member of the Society this
year, having retired from an Australian practice, and settled
in England.

In July, Dr. Edward Wynne Thomas, of Birmingham, passed

REPORT OF THE COUNCIL. 371

:away. His membership dated from 1864, and only this last
Session he took part in the discussions of the Society.

Dr. Harmar Smith, who became a member of the Society in
1861, died on the 7th of August at an advanced age, at Bourne-
mouth. Though at one time an active member of the Society, he
had, since his retirement from practice, taken but little part in its
deliberations.

Allusion is made in the Presidential Address to an announce-
ment that has appeared in the monthly circulars sent to mem-
bers, sayiujg that Messrs. Gould & Son are willing to re-issue Part
1 of the Cyclopaedia of Drug Pathogenesy, at a cost of 3s. 6d., if
a sufficient number of members will subscribe to the part. There
must be a considerable ijumber of members whose set is incom-
plete, and they should take this opportunity of obtaining the
missing part. The Secretary of the Society will be pleased to
receive the names of intending subscribers.

Frederick Wilham Giles, M.B.Dur., M.E.C.S.Eng., of the
Hotel Continental, Cannes, and John Bums Southam, M.E.C.S.
Eng., L.S.A., of 29, Talbot Street, Southport, having been duly
nominated, were elected members at the Annual Assembly.

At a meeting of the Council held July 13th, Dr. Hughes was
re-appointed E^tor of the Journal, and Mr. Knox Shaw, Honorary
Secretary of the Society.

REPORT OF THE COUNCIL.

Bead at the Annual Assembly ^ June 28th, 1893,

By an addition to Law XXVIII . made at the last Annual
Assembly, the Council has to ' present a report of the work and
progress of the Society.

The Council has had five important and well-attended meetings
during the year, at which a considerable amount of business has
been transacted. At the close of the session it has to congratu-
late the Society on a year of unexampled activity and prosperity,
sixty-six new members having joined since the opening of the
session. The Society has to deplore the loss by death of one of
its Fellows, Dr. Drysdale, of Liverpool, a veteran worker in the

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REPORT OF THE COUNCII. 373

<5au8e of homoeopathy, who had been a member since 1857 ;
Dr. Mackintosh, of Torquay, whose membership dated from
1868 ; and now within the last few weeks Dr. Blumberg, a
member since 1875, whose work in Southport is so well known.
One member has resigned. The membership of the Society is
now one himdred and ninety-six.

An important branch, numbering fifteen members, has been
formed in Liverpool by the afi&liation of the Liverpool Homoeo-
pathic Medico-Chirurgical Society. The coming session being
the Jubilee of the foundation of the Society, the Council is
desirous of celebrating this event by still further increasing the
roll of members, and relies upon every member aiding it in its
efforts to include within its membership the few who have not yet
realised the value to homoeopathy of a large and united Society.

A new departure has been made by the issue of the Trans-
actions, under the editorship of Dr. Hughes, in the form of a
quarterly Journal ; the reception of this both among the members
and the homoeopathic body in America is encouraging.

The meetings have been better attended than usual, and the
papers, as the Journal will show, have been valuable, varied, and
instructive.

The Treasurer's balance shows the finances of the Society to
be in a satisfactory condition. There have naturally been ex-
penses connected with the increased activity of the Society which
Are not likely to be repeated.

374 STTMMABY.

SUMMAKY OF PHAEMACODYNAMICS AND

THEEAPEUTICS.

"GATHER UP TSE FRAQMENTS, THAT NOTHING BE LOST."

June — August, 1893.

PHASMACODTNAHICS.

Argentum Nitrioum in Chorea. — Dr. Gross, of Eegensburg,
finds argentum nitricum — 2nd to 4fch trit., probably decimal —
more effective in chorea than any of our ordinary remedies, and
relates four cases illustrative of its power. — Allg. Horn. Zeit., voL
Ixiv., No. 24.

AFgentnm Nitrioum in Pseado-Membranous Enteritis. —

Dr. F. Pritchard relates a case of this kind, recurring paroxys-
mally, in which, after several remedies had been given in vain,
argentum nitricum, in the 6x trit., effected a rapid cure. — Hahn.
Monthly, July.

Arsenioum lodatum in Aphonia. — Dr. W. S. Pearsall re>
ports two cases of aphonia, with flabby relaxed condition of
laryngeal mucous membrane and imperfect approximation of.
vocal cords during phonation. Ars. iod., given in one case in the
30th, in the other in the 2x, proved curative. — N. Am. Joum, of
Hom», June, p. 394.

Atropine Poisoning. — Dr. Gunderlach records a case of this
kind, in which gr. f of atropine with gr. } of cocaine, in solution,,
were swallowed by mistake. Morphine and physostigmine did
something for the pulse, but the breathing continued slow (5-6)
and shallow, and the patient seemed sinking, when about two drops-
of the 1st dil. of glonoin were injected subcutaneously. Kespira-
tion almost immediately became deeper, fuller, and more rapid,
gradually rising to 12-16. Pulse, which had been 150-165, coinci-
dentally became slower, and much stronger and fuller. The effect
gradually passed off after one to two hours, when the injection was
repeated ; after each " new life seemed inspired, and the effect of
each was better than the preceding." — Amer. Horn., Aug 1.

SUMMAEY. 375

Aurum in Keratitis and Iritis.— Cases of acute parenchy-
matous keratitis and of syphilitic iritis are reported by Drs.
Boyle and Deady, in which aurum did everything that could be
desired. In the first, the metal was given in the 4x trit ; in the
second, the chloride in the 3rd dil. There was here great mental
depression. — N, Am, Joum. of Horn. ^ June, p. 395.

Borax in Epilepsy. — Dr. Clara E. Gary relates two cases
which seem to show that the good effects of borax in epilepsy,
lately vouched for by old-school physicians, can be obtained from
the Ix trit. There were no distinctive symptoms in these cases.
— N. Eng, Med, Gaz,, June.

Caloarea iodata in Fibroids. — Dr. Sarah J. Millsop relates
two cases of fibroid tumour, one interstitial, one extra-uterine,
in which very great reduction in size occurred from the use of the
iodide of lime. The 2x potency was used. — Horn, Journ, of Ob-
stetrics, dc, Nov., 1892.

Calendula. — Dr. E. K. Ghosh sends from India some interest-
ing experiences with calendula. It does not, he finds, prevent
suppuration, but it checks this process when already set up and
heals the wound. He dresses ulcers with the tincture-trituration,
and seals them up. It is especially valuable when they are slough-
ing. The same preparation is used with the best result as a
snuff for ozaena, even of syphiUtic origin. — Horn, Becorder, July.

Dr. Bishop, a convert from the old school, relates cases which
satisfy him that calendula is quite as efficient as the bichloride
in septic and suppurating wounds, without its disadvantages. —
Ainer. Hom(»ojpathisty Aug. 15th.

Caasticum. — ^The Soci^t^ Francaise d'Homoeopathie having
desired M. Pistruszinski, pharmacien, to make an analysis of
** causticum," prepared according to Hahnemann's instructions,
he has done so, and reports that the resultant liquid is alkaline,
giving no precipitate under tartaric acid and platinum bichloride,
but imder oxalate of ammonia shewing plainly the presence of
lime. [This, Hahnemann says, his preparation should not do;
and the examinations which Dr. Black, nearly thirty years ago,^
caused to be made of the causticum prepared by British chemists,
revealed potash only and no lime. — Ed.] — Bevice Horn. Francaise,
July.

Cedron in Neuralgia. — Mr. S., age 31, had suffered neuralgic
pains since an attack of intermittent fever two years previously.

* See BriL Joum, of Hom,y xxiv. , 471.

376 SUMMABT.

They were " of periodic recurrence, *' and from time to time
appeared in all parts of the body. Cedron Ix removed them in
three weeks, and they had not recurred for seven months when
the report was made. — N. Am. Journ. of Hom.^ June, p. 393.

Cicuta. — This drug proved rapidly curative in a case of idio-
pathic tetanus, of rheumatic origin. The 3x dil. was given. — Allg.
Horn, Zeit., Nos. 13-14, 1893.

Cimicifaga. — Dr. Talbot communicates his experience with
this remedy. Its great action, he thinks, is on muscular tissues,
and hence on the uterus. It reheves the effects of over-fatigue,
strain, and first use of the muscles after long inaction — as when
fractures have occurred. The muscular pains of pregnancy are
relieved by it, and parturition rendered materially easier. — N.
Engl. Med. Gazette, June.

Daboisine in Restlessness of the Insajie. — ^Prof. Spendel

has been trying duboisine in insanity. He finds that it has no
action in melancholia, paranoia, or simple insomnia, but excited
insane persons whose rest is disturbed by motor unrest become
quiet in five minutes after a dose of the drug ; the muscles relax ;
and after twenty minutes sleep comes on that lasts two to six
hours. He recommends beginning with half-milligramme doses
(i.e., gr. y^), and gradually increasing to one milligramme. — N.
Am. Journal of Horn., Aug., page 542.

Ergot in Hssmorrhage. — In a cHnical lecture on Haemoptysis,
reported in the Clinical Beview of June 28th, Dr. Henry Green
states that he has lost all faith in ergot ; and that at the
Brompton Hospital the drug is rarely used, one only of . the
physicians occasionally prescribing it in cases believed to be
capillary.

Gratiola in Dyspepsia. — This rarely-used but well-proved
medicine has rendered Dr. Tessier " incomparable service *' in
some forms of dyspepsia. His indications for it are: afflux of
blood to head, with heat and somnolence; great distension of
stomach ; lassitude and somnolence after meals, constriction of
throat, dysphagia for hquids, constipation, constriction of rectum.
— Bevue Hom. Francaise, Aug., p. 296.

HepoP in Pyo-salpinx. — " I have in mind a case I was called
upon to see with Dr. Deffendorf, of WiUiamston, some years ago,
in which we had a well-defined example of pyo-salpinx, the pus
making its escape into the uterus — a typical case for laparotomy.
The consent of the patient could not be obtained, and her condi-

SUMMAEY. 377

tion also prevented a demand for an operation, but under the
persistent use of hepar sulphuris, which seemed, not only from the
pathological conditions, but from the totality of the symptoms as
well, to be indicated, the patient was soon relieved of all her
troubles, and she is now enjoying good health." — Dr. Phil.
Porter, in Horn, Joum, of Obstetrics^ dx., Nov., 1892.

Hydrastis in Epithelioma. — Dr. Daudet reports a case in
which digital examination, together with the constitutional state
and appearance of the patient, and the foetid character of the dis-
charges, led him to the diagnosis of epithelioma of the cervix
uteri. He prescribed hydrastis 12, a dose three times a day.
Two days later, a copious, foetid, blackish haemorrhage set in, and
in three or four days more the tumour came away in blackish
matters having a sickening odour. All local symptoms disap-
peared, and the patient became quite well. — Bevtie Horn. Fran-
caise, July, p. 291.

Iodine in Pneumonia. — Dr. McMichael relates two cases
in which right-sided pneumonia, which was hanging fire under
ordinary remedies, rapidly subsided when iodine was given. He
believes the remedy to be as nearly specific as may be. In left-
sided pneumonia it is comparatively ineffective. — N. Am. Joum.
of Horn., Aug., p. 530.

Dr. Calderwood relates three cases illustrating the efficacy of
the same medication, and in all the inflammation was on the
right side. — N. Engl. Med. Gaz., July.

Lachesis in Wens. — Miss H., age 32, dark and plump, had
two wens on right vertex ; one vascular, and about half the size
of an ordinary nutmeg, the other white, and a httle smaller. The
former often had pains in it, as from thrust of a sharp instrument ;
the pains sometimes ran towards the left eye. She had besides
left ovarian troubles and many nervous symptoms that led to
lachesis, under which the vascular wen disappeared; but it had no
effect on the other. — N. Am. Joum, of Horn., Aug., p. 529.

Lachesis in Celinlitis. — ^In a case of cellulitis of leg and
thigh, following compound fracture of tibia, skin of affected parts
reddish purple, general condition that of impending septicaemia,
and temp. 105-5°, — ^lachesis 12 was given. The temp, fell to 99^ in
four hours, and uninterrupted recovery ensued.— -^^. Am. Joum,
of Horn,, June, p. 393.

Lachnanthes. — Dr. Ghosh, of Calcutta, relates a case which
seemed to be phthisical, in which, after the failure of iodide of

378 SUMMABT.

araenic, he was led by the accompanying stifEaess of the neck to
give lachnanthes. The 3x dil. did nothing, but under three-drop
doses of the mother tincture improvement ensued in a week and
went on to complete recovery. He has since used it in three
similar cases '* with good results."

He gave the remedy also in eight cases of stiff-neck. In three
only did it prove curative, and in these there was concomitant
cough — without chest symptoms. All three patients, moreover,
perspired freely in hands and feet ; and their stiff-neck and throat
cough (with burning of palms and soles) came on or increased
whenever such perspiration was checked. — Horn, Becorder, June.

(Enanfhe Crocata. — This obviously homceopathic remedy for
epilepsy is being taken up, of course without acknowledgment, in
the old school. The Am. HomcBcypathist, of August 15th, cites two
testimonies to its efficacy from the Chicago Medical Times,

Phosphoras in Epithelioma of Tongue.— Dr. T. F. Allen
reports a case of disease of tongue in a young man of 30, with no
syphilitic history, for which other authorities had advised imme-
diate extirpation, and which he could not but pronoimce epithe-
lioma. The patient's constitutional symptoms led him to give
phosphorus. Improvement began immediately, and after two
months, when the report was made, the tongue was almost wfell.
— N. Am, Joum, of Horn,, July, p. 467.

Sangainaria in Migraine. — Dr. S. G. A. Brown relates a case
of the sanguinaria headache, which is interesting in that the
I'emedy proved effective in the mother tincture. The malady had
lasted for three years ; and, after a two days* use of sanguinaria o
had not recurred for eight months. — N. Amer, Joum, of Horn,,
June, p. 392.

Silioea. — Dr. Windelband reports a yet more successful expe-
rience with this drug than we have on record, including tuber-
culous joints, exostosis and caries, besides abscesses. It is note-
worthy that he seems always to employ it in the 3rd trit. —
i^eitschr, des Berliner Vereines Horn, Aerzt.y xii., 1.

Sticta in Cough. — Dr. Youngman reports some further cases
iu proof of the great efficacy of this medicine, given in the mother
tincture and Ix dilution, against coughs. He sums up thus : 1st,
Stiota is indicated in harsh, racking, incessant, ** unprofitable"
oough, of spasmodic type ; 2nd, It is particularly adapted to
w^urotic, rheumatic and gouty individuals ; 3rd, It is more valuable
iu aubaoute and chronic cases ; 4th, It is more suitable to old age ;

SUHMABT. 379

5th, It allays irritation, soothes irritable tissue, removes hyper-
sensitive conditions of the respiratory mucous membrane, and
promotes sleep. — Hahn. Monthly, June.

Thlaspi bursa pastoris. — ^Dr. Julia Button communicates
some experience with this drug. She gave it in a case of climac-
teric metrorrhagia, — ^15 drops of the tincture to half-a-glass of
water, a teaspoonful every hour. It controlled the haemorrhage, but
caused a severe constrictive headache ; patient said it seemed as
though her skull would crack if she did not move her head with
great care. Glonoin reheved this, but the haemorrhage recurred.
Finally the Ix dil. was substituted, and this controlled bleeding
without producing headache ; and the trouble had not returned
for six months when the report was made. — Horn, Journ. of Obste-
trics, d'C, May.

Tabercnlinum. — ^Dr. Chas. N. Eoberts reports a case of what
seemed meningitis, in a child of 2 ; the urine was also foimd
solid with albumen. Helleborus, apis, calc. carb., were doing Httle
for the patient; but tuberculinum 200 (Boericke and Tafel)
initiated rapid improvement, which proved permanent. — Horn,
BecordeVy July.

Yerbascam. — An article on the preparation known as "mullein
oil " is contained in the Horn. Becorder for August, giving the
history of its use — ^internally for enuresis and other urinary
troubles, locally for deafness and earache.

THERAPEUTICS.

Aone. — A discussion on the treatment of this complaint took
place at the meeting of the Hom. Medical Society of the County
of New York. Dr. Arcularius has most confidence in cicuta in
the pustular form, and calcarea carbonica for the papular variety,
especially in women with catamenial derangement. Dr. Deschere
finds kali bromatum, a grain three times a day, very effective in
simple acne in nervous subjects. — N. Am. Jour, of Horn., Aug.,
p. 140 of appendix.

Cholera. — Another candidate for homoeopathicity to this
malady, beside the colchicum of Dr. Sutherland mentioned in
our January No., is the agaricus phalloides, brought forward by
Dr. A. K. Crawford in the Medical Century for August.

Croup. — Dr. Deschere thinks that in this disease our remedies
are usually given too strong, and the trouble aggravated. He now

380 SUMMABY.

never uses anything below the 30th, and finds aconite in this
dilution act marvellously. — N. Am, Joum, of Horn., Aug., p. 140
of appendix.

Glauooma. — ^Taking the hint given by the way atropine will
sometimes stir up a latent glaucoma, Dr. Parenteau has adminis-
tered the attenuated drug internally as a homoeopathic remedy
for increased tension of the eye, and with very satisfactory results.
— Bevue Horn, Francaise, June.

Puerperal PeYer. — In a valuable paper on puerperal fever in
the Horn, Journal of Obstetrics for July, Dr. Custis says, speaking
of its medicinal treatment : ** First of all comes rhus. I never
saw a case where it was not called for sooner or later. So con-
stant has been this experience, that I anticipate the condition by
giving it in the absence of other directly indicated remedies, or
when the temperature remains stationary, not improving under
the medicines previously prescribed.'*

Snakebites. — ^Dr. U. W. Eeed brings to our notice a plant
called ** Sisyrinchium '* — of the ** iris family,*' he says, which is in
repute among the American Indians as a local application for
snake -bites. He relates two cases in which rattlesnakes were
the offenders, and where speedy and unlooked-for recovery ensued
on applying a tincture of the roots, and giving it in fractional
doses internally. — Horn, Becorder, June.

Dr. Alt, of Munich, has performed experiments on dogs, which
seem to shew that the snake-poisons are eliminated by the
stomach, and only after re-absorption therefrom produce their
toxic effects, so that early washing out of this viscus renders them
innocuous, or at least mild in their operation. — UArt Mddical,
June.

INDEX

To the Trcmsactions, etc., of the Society.

PAOE

Abdominal Tumour, probably renal : (G. F. Goldsbrough) . . . . 161

Abscess of Abdominal Wall : (J. D. Hayward) . . . . . . 164

, Sub-costal : (J. Galley Blackley) . . . . . . . . 170

Alexander, A. S. : On Thuja and its Relation to Aural Pol}'pus . . 299

Amputation, Notes on Two Cases of . . . . . . . . 272

AnchylostomumDuodenale: (Dudley Wright) .. .. .. 158

Antiseptics, with especial reference to the use of Ozone : (E. A. Cook) . . 325

Aphonia, A Case of : (A. E. Hawkes) . . . . . . . . 865

Apocynum Cannabinum, Diuretic Action of : (Byres Moir) . . . . 62

Apocynum Cannabinum, Preparation of : (E. A. Cook) . . . . 157

Balance Sheet . . . . . . . . . . . . . . 372

Blackley, J. Galley : Sub-costsJ Abscess .. .. .. .. 170

Elephantiasis Arabum . . . . . . . . ^ . 223

President's Address . . . , . . . . . . . . 289

Blake, E. : Habitual Constipation . . . . . . . . . . 125

The Ideal Treatment of Urethritis in the Male . . . . . . 165

Bronchopneumonia of Children : (B. Thomas) . . . . . . 315

Brown, D. Dyce : The Treatment of Chronic Oophoro-Salpingitis . . 346

Burford, G. : On the Successful Bemoval of a Large Ovarian Tumour. . 47

Successful Laparotomy for Extra-Uterine Gestation . . 41

The Treatment of Chronic Oophoro-Salpingitis . . . . 352

Cash, Midgley : The Medical Treatment of Pleurisy . . . . . . 23

Chloroform AnsBsthesia, its Accidental Asphyxia and means of Preven-
tion : (T. G. H. Nicholson) . . . . . . . . . . 254

Clarke, J. H. : A Case of Tuberculous Phthisis Cured mainly by Tubor-

culinum (Heath) . . . . . . . . . . . . 253

Colocynth : a suggestion for a Bevised ^latcria 3Iedica : (J. W. Ellis) . . 97

Constipation, Habitual : (E.Blake).. .. .. .. ..125

Contagion, Germ : (S. Morrison) . . . . . . . . . . 123

Cook, E. A. : On the Ovary and Endometrium considered as Glands . . 49

The Preparation of Apocynum Cannabinum . . . . . . 157

On Antiseptics, with especial reference to the Use of Ozone . . 326

Council, Keport of . . . . . . . . . . . . 371

Day, Boberson : Myxcedema . . . . . . . . . . 243

A Case of Pemphigus iu a Child . . . . . . . . 268

Dentition : (Gerard Smith) . . . . . . . . . . 224

(see Teething)

Diuretic Action of Apocynum Cannabinum : (Byres Moir) . . . . 62

Dudgeon, K. E. : On Stammering Heart . . . . . . . . 3

382 INDEX.

Editorial Preface . .

Elephantiasis Arabum : (J. Galley Blackley) . .

Ellis, J. W. : Colocynth : a suggestion for a Revised Materia Medica

Endometrium and Ovary considered as glands : (E. A. Cook) . .

Extra-Uterine Gestation, Laparotomy for : (G. Burford)

PAGE

1

223

97

49

141

Germ Contagion : (S. Morrison) . . . . . . . . . . 123

Glands, On the Ovary and Endometrium ccmsidered as : (E. A. Cook) . . 49

Goldsbrough, G. F. : Abdominal Tumour, probably Benal . . . . 161

Hawkes, A. E. : Notes on a Case of Acute Tuberculosis . . . . 367

Polypus from Cystic Degeneration of the Cervix Uteri . . . . 362

A Case of Aphonia . . . . . . . . . . . . 865

Hayward, J. D. : Abscess of Abdominal Wall ; a Sequela of Typhoid

Jj w V6f •• •• •• «• •• •• ■• XOic

Hayward, J. W. : A few Hints on the Mechanical Management of In-
flamed Knee . . . . . . . . . . . . . . 245

Health Resorts, Discussion on . . . . . . • . . . 79

Heart, On Stammering: (K. E. Dudgeon) .. .. .. .. 3

Continuous Irregular Action of : (Byres Moir) . . . . . . 167

Homoeopathy in Bussia . . . . . . . . . . . . 363

India . . • . . . . . . . . . . . 364

Infant Life Insurance : (F. H. Shaw) . . . . . . . . 145

Kidney, Probable Malignant Tumour of : (G. F. Goldsbrough) . . 161
Knee, A few Hints on the Mechanical Management of Inflamed :

(J. W. Hayward) . . . . . . . . . . . . 245

Laparotomy for Extra-Uterine Gestation : (G. Burford) • . . . . 141

Life Insurance, Infant ; (F. H. Shaw) . . , . . . . . 145
Liverpool Branch Meetings . . . . . . . . 76, 265

Moir, Byres : On the Diuretic Action of Apocynum Cannabinimi . . 62

Continuous Irregular Action of the Heart . . . . . . 167

Morrison, S. : On Germ Contagion . . . . . . . . . . 123

Myxcedema : (Roberson Day) . . . , . » . . . . 243

•

Nankivell, H. : Notes on Pleurisy and its Treatment. , . . . . 31

Neatby, E. A. : Notes on Teething . . . . . . . . . . 233

Nicholson, T. G. H. : On Chloroform Anaesthesia . . . . . . 264

Oophoro-Salpingitis, the Treatment of Chronic Non-Cystic : (D. Dyco

Brown and G. Burford) . . . . . . . . . . 346

Osteitis of Skull ; Trephining : (Knox Shaw) . . . . . . 221

Ovarian Tumour, Successful Removal of : (G. Burford) . . . . 47

Ovary and Endometrium considered as Glands : (E. A. Cook) . . . . 49

Ozone, On Antiseptics, with especial reference to the use of: (E. A. Cook) 326

Pemphigus in a Child : (Roberson Day)
Perichondritis, Suppurative : (L. Rowse)
Phthisis cured mainly by Tuberculinum : (J. H. Clarke)
Pleurisy, Medical Treatment of : (Midgley Cash)
Notes on its Treatment : (H. Nankivell)

268

139

253

23

31

INDEX. 383

PAGE

Pleural ESusions, Surgical Treatment of : (E. Wynne Thomas) . . 36

Polypus from Cystic Degeneration of the Cervix Uteri : (A. E. Hawkes) 862

Preface, Editorial ^ . . . . . . . . . . . 1

President's Address : (J. Galley Blackley) . . . . . . . . 289

Rheumatism : Some Investigations respecting its Cause, Prevention, and

Treatment : (Percy Wilde) . . . . . . . . . . 193

Boaring in Infants : (Dudley Wright) . . . . . . . . 339

Rowse, L. : Suppurative Perichondritis during Typhoid Fever . . 139

Shaw, F. H. : Infant Life Insurance . . . . . . . . 145

Shaw, Knox: A Case of Traumatic Osteitis of the Skull, subsequent

Meningitis, with Double Optic Neuritis : Trephining . . . . 221

Smith, Grerard : A Fatal Case of Perforating Ulcer of the Stomach . . 160

On Dentition . . . . . . . . . . . . 224

Society News .... . . . . . . 81, 171, 272, 368

Stammering Heart : (B. E. Dudgeon) . . . . . . . . 3

Stomach, Fatal Case of Perforating Ulcer of : (Gerard Smith) . . 160

Teething, Notes on : (E. A. Neatby) . . . . . . . . 233

(see Dentition)

Thomas, Bernard : Bronchopneumonia of Children . . . . . . 315

Thomas, E. Wynne : The Surgical Treatment of Pleural Effusions . . 36

Thuja and its Belation to Aural Polypus : (A. S. Alexander) . . . . 299

Tongue, Syphilitic Ulceration of : (Dudley Wright) . . . . . . 242

Trephining for Traumatic Meningitis : (Knox Shaw) . . . . . . 221

Tuberculosis, Notes on a Case of Acute : (A. E. Hawkes) . . . . 367

Typhoid Fever, Suppurative Perichondritis during : (L. Bowse) ... 139

Abdominal Abscess,' a Sequela of : (J. D. Hayward) . . . . 164

Notes of a Discussion on . . . . . . . . . . 269

Urethritis, The Ideal Treatment of : (E. Blake) . . . . . . 165

Wilde, Percy : Bheumatism : Some Investigations respecting its Cause,

Prevention, and Treatment . . . . . . . . . . 193

Wright, Dudley : Anchylostomum Duodenale . . . . . . 158

A Case of Tertiary Syphilis of the Tongue . . . . . . 242

Boaring in Infants . . . « . . . . . . . . 339

INDEX

To Summary of Pharmacodynamics and Therapeutics,

PAOC

Achillodynia 283

Acidam Aceticum 85

„ Fluoricum .. .. 274

„ Nitricum . . . . 85

,, HjdrocyaDiciun . . . . 179

,, Picricum 274

Acne 879

Agaricus 274

Agraphia 275

Alopecia 89

Ammoniuin 275

Antipyrinum 275

Aortitis . . . . . . 90

Aphonia . . . . 90

Apis •• «• •• •• •• «iO

Argentmn Kitricuin . . . . 874

Arsenicum . . . . 85, 183, 187, 276

„ lodatum .. .. 874

Atropinum 874

Aurum . . . . 91, 174, 27G-7, 375

Belladonna 175

Borax 85, 875

Bright's DiseaBO 90

Bronchitis 277

Cadmium . . . . > » • • 86
Calcarea Carbon ica . . 277, 286

„ Fluoricu 277

„ lodata . . . . 277, 875

Calendula 277, 875

Camphor 60, 176, 277

Cancer of Skin 276

„ Stomach . . . . 188

„ Tougue . . . . . . 183

„ Uterus . . . . . . 877

Cannabis Indica . . . . . . 277

Cantharis . . . . . . . . 93

Carbo Vegetabilis . . . . 176, 277

Carduus . . . . . . . . 286

Cataract . . . . . . 88, 176

CausticUm . . . . . . . . 875

Cedron 875

Cholera 86, 183, 379

Chorea . . . . • • 90

Cicuta 66,277,376

Gimicifuga

Cocainum

Cocculus

Colchlcum

Colocynth

Conimn

Convulsions

Creosote

Crocus

Croup

Cuprum Arsenicosum

Diarrhoea

Digitalis

Dioscorea

Diphtheria

Diuretin

Dolichos

Dropsy

Duboisinum

Dulcamara .

Eczema

Enteritis Membranosa

Epididymitis

Epilepsy

„ Hystero-
Erysipelas . .
Ergot
Exalginum . .

Ficus Indica
Filix Mas . .
"Funk" ..

Glaucoma . .
Glonoin

Glottis, Spasm of
Glycosuria . .
Goitre

Gonorrhoea . .
Granatum . .
Graphites . .

PAGE

.. 376

176, 183
.. 86
.. r86
.. 176
.. 176
.. 277
190, 278
.. 176

184, 379
.. 177

.. 284
.. 177
.. 278
90, 188-4
.. 278

177, 278
91, 177

278, 376
279

185

91, 874

91

186, 280

279

91

876

279

87
177

284

880
279
279

91
91, 274

91
279
177

INDEX.

385

Gratiola
Guarsea

PAGE

376
177

Hamamelis . .

Heloderma . .

Hepar Sulphuris . .

Hiccup

Hydrastis . • , ,

Hydrocephalus, Acute

Hypericum . .

Icthyol
lodium

Kali Bichromicum

,y lodatum
Kalmia

Lachesis

Lachnanthes

Laparotomy, after-treatment

Lappa

Leucorrhcea

Lilium

Lithium

Lycopodium

Madarosis . .
Manganum . . . ,
Mastodynia..
Mercurius Corrosivus
Metrorrhagia
Migraine
Myxoedema . .

Nails, Degeneration of
Natrum Muriaticum
„ Sulphuricum
Nephritis . .
Neuralgia . .
Neuritis
Nux Moschata

• ♦

87
279
279, 876

* 178, 279, 377
• * 183
87, 280

.. 179
.. 377

.. 87
.. 280
.. 280

179, 377
.. 377
.. 92
180,280
285
180
87
91

92
280
186
180
186
285
187

187
180

87
187

93
280

88

Ohstetric Practice, Remedies in. . 187
CEnanthe Orocata . . . . 280, 378

Oleander 88

Osteo-sarcoma . . . . . . 282

Ozsena 276

Perinaeum, Rigidity of
Phellandrium
Phosphorus..
Phthisis Pulmonalis
Physostigma

93

181

181, 281, 378

. . 181

181, 290

Phytolacca «•
Piper Methysticum
Pleurisy
Plumbum . .
Pneumonia..
Podophyllum
Polypus Narium
Pregnancy, Remedies in

„ Imaginary

Prolapsus Uteri..
Psoriasis Palmaris
Puerperal Fever
Pulsatilla . .
Purpura

Sabal Serrulata

Salpingitis ..

Sanguinaria

Santoninum

Sarcocele

Scarlatina

Sciatica

Scutellaria

Sepia

Silicea .. .. 89,

Snake-Bites

Spinal Irritation

Spongia

Stannum

Sticta

Succinum

Sulphur

Tarentula Cubensis
Tellurium . ,
Tetanus
Theobrominum
Thlaspi Bursa Pastoris
Thuja
Trismus
Tuberculinum
Tuberculosis of Lungs
„ Joints

Ulcers, Varicose . .
Uranium . .
Urine, Suppression of

Verbascum . .
Vinca Minor

Zinoum

PAGE

88
281
93, 187
. 88
.188-9
. 88
. 277
. 187
. 176
. 280
. 189
. 380
. 281
. 281

181, 186
94
378
88
277
94
176, 190
181
181
90, 183, 378
380
182
91
89, 282
182, 378
89
182

89

182

94

278

182, 379

282

190

82, 282, 379

89, 190, 278

.. 286

.. 286
.. 91

.. 379
.. 183

., 282

LAWS

OF THE

BRITISH HOM(EOPATHIG SOCIETY

(INSTITUTED IN 1844)

IPrtntelr for t(re Society

Xondon

JOHN BALE & SONS

87-89, GREAT TITCHFIELD STREET, OXFORD STREET, W.

J893

CONTENTS.

Constitution of the Society ...

• • • • • • •

PACK

... 3

Branches ...

.. 5

X Cliw VV 9 ••• ••• ■•• ••• ••

... 5

Honorary and Corresponding Members

... 6

Transactions

... 6

Ordinary Meetings ...

... 6

Extraordinary Meetings

... 6

Annual Assembly ...

... 7

Offences and Penalties

... 8

The President and Vice-Presidents

... 9

The Council

... 10

Treasurer ...

... 10

Honorary Secretary...

... II

X!^£lL/wiS ••• ••• ..t ••• •«

... 12

Bye Laws : —

Ordinary Meetings

... 13

Library

... 14

Committees

.. 15

LAWS AND REGULATIONS

OF THE

BRITISH HOMCEOPATHIC SOCIETY.

INSTITUTED IN 1844.

CONSTITUTION OF THE SOCIETY.

I. This Society has for its objects the advancement and exten-
sion of the principles of Homoeopathy.

II. The Society shall be divided into Fellows, Ordinary,
Honorary, and Corresponding Members.

III. The Officers of the Society shall consist of a President,
two Vice-Presidents, a Treasurer, Council, an Editor of the
Transactions and an Honorary Secretary, all of whom — except
the Editor of the Transactions and the Honorary Secretary, who
shall be elected by the Council — shall be elected annually, and
be re-eligible ; but no President or Vice-President shall hold his
office for more than two years in succession.

IV. All Elections shall be conducted by Ballot.

V. Ordinary Members must be Medical men, residing in the
United Kingdom, registered by virtue of a diploma obtained
after personal examination, under the provisions of the Medical
Act, 1886; they shall pay on admission a fee of one guinea,^ and
an Annual Subscription of one guinea to the funds of the Society,
and have a right of voting when present at the meetings. All
Members residing out of the United Kingdom, or who shall be
prevented by illness, or any cause that is satisfactory to the
Society, from practising their profession, shall be exempt from
their annual payment during such time.

> See Law X.

VI. Every person desirous of becoming a Member of the
British Homoeopathic Society must be proposed by two Members.
The name, professional qualifications, and place of residence of
the Candidate shall be specified by the proposers. The proposal
must be in the following form : —

We, the undersigned, attest from our personal acquaintance with

(Qualifications) , that he has

fulfilled the requirements of Law V, ; and that he is a proper person to

become a Member of the Society.

(Signed by two Members.)

The proposal must be publicly read by the President of the
Meeting, and shall be suspended in a conspicuous part of the
Society's room during two Meetings before the Candidate is
ballot ted for.

VII. Before proceeding to ballot for any Candidate, the Secre-
tary shall read from the Medical Register for the current year the
qualifications under which the Candidate is registered ; or, in
the event of his registration having been effected since the pub-
lication of the Register for the current year, shall produce the
Candidate's receipt for his registration fee, or his diploma.

VIII. A majority of four-fifths of the Members present must
be in favour of the Candidate for his Election.

IX. Every person elected a Member shall, on his admission,
pay the fee and subscription according to Law V., and subscribe
to the following obligation :—

By subscribing my name to the Laws of the British Homoeopathic
Society, I publicly declare that I will endeavour to promote the
honour and welfare of the Society, and advance the doctrines and
practice of HomcBOpathy, and that I recognize and will observe
the Laws and Regulations of the Society,

{a,) New Members will be expected, as the turn of each comes
round, to read to the Society a Dissertation or Paper, the title of
which shall be announced at the Meeting previous to that at
which it is to be read.

X. Members residing more than ten miles from the General
Post Office shall be considered Provincial Members, and pay no
admission fee.

BRANCHES.

XI. For the further advancement and extension of the Society,
Members may form themselves into separate bodies, to be styled
Branches. Each Branch shall be free to govern itself as its
Members think fit, but no Branch Law shall be valid which has
not previously received the 'sanction of the Council. Each
Branch shall pay its own expenses, and no Branch shall be
deemed for any purpose the agent of the Society, or have the
power to incur any obligation on its behalf.

FELLOWS.

XIL Fellows must possess the usual qualifications of Mem-
bers, must have been Members of the Society for at least five
years, and have contributed at least three original Communica-
tions. The new Fellow shall, on election, pay an enrolment fee
of one guinea.

(a.) A Member desirous of becoming a Fellow must petition
the Society through the President, who must certify that the
Member has fulfilled the conditions in the preceding law, en-
titling him to present his petition, before it can be taken into
consideration.

(b,) The election of a Fellow shall be determined by a majority
of two-thirds of the Members present, after the petition has been
read from the chair, and affixed in a conspicuous part of the
Society's room during two Meetings.

{c.) Any Member, who in the opinion of the Society has at any
time distinguished himself in science or literature, may be elected
a Fellow by a majority of at least three-fourths of the Members
present at the Annual Assembly.

HONORARY AND CORRESPONDING MEMBERS.

XIII. Honorary Members must be either Medical men retired
from the active exercise of their profession, or men engaged in
auxiliary scientific pursuits, and who take an interest in the
advancement of Homoeopathy; they shall have the right of
attending the Public Meetings and taking part in the Medical
discussions.

XIV. Corresponding Members must be Medical Men of some
recognized University, College of Surgeons, or Licensing Body,
and engaged in the practice of Homoeopathy out of the United
Kingdom. They shall not be subject to any payments; nor
shall they have the right to vote.

TRANSACTIONS.

XV. The Transactions of the Society shall be published
quarterly in London, and shall be under the direction of an
Editor, who shall be responsible for their proper issue.

Once in every year a list of the OflScers, Fellows, Members
and Corresponding Members with their addresses shall be pub-
lished separately as a supplement to the Transactions.

ORDINARY MEETINGS.

XVI. The Ordinary Meetings of the Society, at which five
Members shall form a quorum, shall take place once a month,
during the Session, which shall extend from October to June
inclusive. But the Society shall have the power of prolonging
the Session, if required.

EXTRAORDINARY MEETINGS.

XVII. An Extraordinary Meeting may be called by the Pre-
sident ; or on the requisition of five Members.

ANNUAL ASSEMBLY.

XVIIl. An Annual Assembly of the Society shall be held in
London, in the month of April, May, or June, each year, for the
purpose of taking into consideration matters pertaining to the
interests of the Society, and of Homoeopathy in general,

(a.) The Annual Assembly shall consist of Meetings on two
successive days, and on a third if necessary. Five Members
shall form a quorum.

{b.) At the last Meeting of the Assembly, the Officers of the
Society shall be elected for the ensuing year. The President,
Vice-Presidents, and Treasurer, who shall be Fellows of the
Society, shall be the first Officers elected at the Annual Assembly.
Four Fellows and two Members shall next be elected, to form
with the above, the Branch representatives, and the Secretary,
the Council of the Society.

(c.) At the Annual Assembly, any Member may propose a new
law. The proposition must be in writing, and seconded : it
must be read from the chair, imd affixed during two Meetings in
a conspicuous part of the room, before it can be discussed ; and
three-fourths of the Members present must be in favour of the
proposition before it can pass into law.

(d.) No Member shall bring forward a motion involving a
material change in, or repeal of, any of the existing laws, without
the consent of a majority of two-thirds of the Members present ;
the proposition shall then be reduced to writing, and seconded ;
it shall be read from the chair, and affixed in some conspicuous
part of the room for two successive Meetings ; and cannot pass
into law without a majority of four-fifths of the Members
present.

(^,) On rejection of such motion, no resolution affecting the
same law, or of a like tenor, can be brought forward during the
same Assembly.

8

OFFENCES AND PENALTIES.

XIX. If any Member has cause of complaint against another,
he shall be entitled to claim the protection of the Society by first
stating his case to the President. The President, if he deem the
matter a fit subject for inquiry, shall, with two Members of the
Society (the person complaining and the person complained of
each choosing one), investigate the grounds of the accusation,
and determine whether the matter can be settled by an amicable
adjustment, or whether it shall be referred to the Council ; who,
in conjunction with the aforesaid parties, shall decide— whether
the question in dispute can be adjusted, — whether the offending
party shall Be admonished by the President, — or whether, finally,
it shall be brought under the consideration of a full Extraordinary
Meeting of the Society, as conduct deserving a public reprimand
in the presence of the whole Society, or expulsion of the offending
Member.

XX. Any Member who shall intentionally infringe the Laws
and Regulations of the Society, or shall by speaking, writing,
printing, or otherwise, do anything to the detriment or dishonour
of the Society, shall be liable to expulsion under the obligation
signed by him on admission.

XXI. Any person who shall announce by placard on any pubHc
place, or shall publish in any advertisement or circular letter, his
mode of practice or place of abode, or shall sell, or cause to be
sold, any secret remedy or nostrum, or shall pubHsh any pamph-
let or book in which cases of cure are detailed and the remedies
concealed, is not admissible as a Member ; and, moreover, if any
Member shall commit any of the above offences against the
Society, he shall be liable to expulsion.

XXII. Any Member assuming a professional title to which he
has no right, or to which he is not entitled by the customs or
usages of the profession, if continuing to do so after being
admonished by the President, shall be liable to expulsion.

XXIII. Whenever any Member, by the infringement of the
foregoing laws, or by any other act, shall, in the opinion of the
President and Council, have rendered himself liable to expulsion,
the Secretary shall notify the same to the offending party ; an
Extraordinary Meeting of the Society shall be convened for the
purpose of taking the matter into consideration, at which Meeting
the accused party shall have an opportunity of explaining. The
question shall be decided by a majority of the Members present,
the votes being taken by ballot.

XXIV. Expulsion deprives a Member of all the privileges of
the Society, and his name shall be struck off the list of Members.
The vote of expulsion shall be entered upon the Minutes, and a
copy of such Minute shall be forwarded to the Member expelled,
and to the Members generally.

XXV. A Member omitting to discharge his debts to the
Society before the close of the Annual Assembly, shall be liable
to have his name erased from the list of Members.

THE PRESIDENT AND VICE-PRESIDENTS.

XXVI. The President, or in his absence one of the Vice-
Presidents, shall preside at all Meetings, and conduct the business
of the Society according to the forms prescribed.

(fl.) The President of the Meeting shall announce from the
chair the subject of the evening's discussion, signify any vacancy
occurring in the Office-bearers of the Society, and report pro-
gress in case of adjournment of any Meetings.

(b.) On all occasions of voting, the President of the Meeting
shall receive from the Secretary the report of the Ballot, and
communicate the result to the Society.

(c») The President of the Meeting shall have a casting vote in
addition to his vote as a Member.

lO

(d.) The President shall keep possession of the Seal of the
Society, and a£Sx it to the Diplomas and acts of the Society.

(e.) The President shall countersign the petition for Diplomas,
in testimony that the Member or Fellow petitioning has fulfilled
the necessary conditions.

(/.) The President is ex-oficio Chairman of all Committees, but
with the option of declining attendance; whereupon one of the
Vice-Presidents shall preside.

THE COUNCIL.

XXVII. The Council shall consist of the President, two Vice-
Presidents, the Treasurer, together with four Fellows and two
Members, to be elected annually, and to be eligible for re-
election ; and a Fellow or Member to be nominated annually by
each Branch. Three Members of the Council shall form a
quorum. The Honorary Secretary shall ex-officio attend all
Meetings of the Council.

The business of the Society shall be managed by the Council,
who shall meet not less than four times a year ; shall elect the
Honorary Secretary and the Editor of the Transactions ; shall
direct the publications of the Society, and shall annually prepare
a report of the work and progress of the Society, to be presented
at each Annual Assembly.

TREASURER.

XXVI I L All moneys shall be paid into the hands of the
Treasurer, and the appropriation of the funds of the Society shall
be subject to the decision of the Annual Meeting.

{a,) The Treasurer shall take charge of and pay to the Bankers
all the funds of the Society, and shall prepare a financial state-
ment to be laid before the Annual Assembly.

(6.) The Treasurer shall keep a cash-book of all his receipts
and payments.

II

HONORARY SECRETARY.

XXIX. The Honorary Secretary shall keep a book, in which
every Member attending the Meetings of the Society shall enter
his name*

(a.) He shall also keep a book of incidental expenses, for the
re-imbursement of which he shall receive an order from the
Treasurer.

(d.) He shall keep a record of all Transactions and Minutes
of Private Business, and read them at the next Meeting, when
they shall be laid before the President of the Meeting for
signature. He shall also keep a record of the following points
in connection with Pubhc Business : i, Names of Visitors and
their Introducers. 2, The title of the Paper or Papers which
may be read, together wtth the names of those who take part in
the discussions, and the remarks of the several speakers.

(c) He shall inscribe in a book provided for that purpose,
all new Laws and Regulations passed at the Annual Assembly,
before the subsequent Annual Meeting.

(d,) In case of Voting he shall distribute the balls, bear round
the ballot-box, attended by a Member as a Teller, and report
upon the Ballot to the President of the Meeting.

(e,) He shall send to all Members of the Society timely notice
of all Meetings, Ordinary and Extraordinary, and of the Annual
Assembly.

(/.) When sending out the Notice of the First Meeting of
each Session, he shall remind each member that his Annual
Subscription has become due, and also regarding any arrears.

ig,) He shall send to each Candidate for admission into
Membership, a letter containing extracts from Laws IX., XX.,
XXL, XXI I., and XXIII., and informing him that on admission
he will be required to sign a Declaration that he will abide by
the Laws of the Society.

(h.) On admission of a new Member he shall see that he
subscribes the obligation regarding the keeping of the Laws of
the Society, and that he is provided with a copy of the said
Laws.

12

PAPERS.

XXX. New Members, each one in his turn, will be expected
to prepare a Paper to be read before the Society, the title of
which shall be announced at the Meeting previous to that at
which it is to be read.

XXXI. All Papers read before the Society become thenceforth
the property of the Society, and shall be deposited in the hands
of the Hon. Secretary.

The Author of a Paper read before the Society, wishing to

publish it himself, must obtain the sanction of the President and
the Council.

(a.) No Member shall publish, or furnish any materials for
publishing, any transactions of the Society, without the authority
of the President and the Council.

BYE-LAWS.

ORDINARY MEETINGS.

I. The Business of the Society shall be divided into Private and
Public.

II. The Hour of Meeting for private business shall be seven
o'clock p.m., and the time shall not be prolonged beyond eight,
except by a vote of the majority of the Members present.

The Order shall be as follows : —

The Minutes of the private business of the preceding
Meeting read and confirmed.

Notice of new motions.

3

4

5
6

III

New Petitions for admission read.

Candidates for admission balloted for.

Miscellaneous business.

New Members called in, and the laws signed.

Motions brought forward at former Meetings discussed.

Each Member is entitled to introduce a Visitor [during
the public business] to the Ordinary Meetings of the Society,
on delivering his name in writing to the President of the
Meeting, who shall have the power to invite him, if a Medical
Man, to take part in the discussion.

14

IV, A book shall be kept by the Secretary, in which Members
introducing Visitors shall see that they sign their names
previous to admission.

V, Public business shall commence at eight o'clock, p.m., and
shall not be prolonged beyond half-past ten, except by a vote of
the majority of the Members present.

The Order shall be as follows : —

1. Visitors announced.

2. Minutes of preceding Meeting read.

3. Subject of the Paper or Communication to be read at

next Meeting announced from the Chair.

4. Communications from correspondents and translations

read and discussed.

5. Paper read and discussed.

6. Meeting closed.

LIBRARY.

VI, That a Librarian be appointed, to take charge of the
books, periodicals, and papers belonging to the Society, and
that such books and periodicals (not being current numbers) and
papers as may be taken from the Library by Fellows and
Members shall be entered by the Librarian in a book kept for
that purpose. All such books to be returned within a month,
and periodicals within a week, of the time of their being taken
away,

VII, Any work soiled or injured must be replaced at the
expense of the Member so injuring it.

VIII, A book shall lie upon the Library table, in which each
Member may propose the purchase of such works as he may

15

think suitable for the Library ; which book shall be laid before
the Library Committee at their next meeting, and without their
order no book shall be purchased.

COMMITTEES.

IX, Committees shall be appointed by the Society, and shall
consist of not less than five Members, of whom three shall form
a quorum.

(a.) The President shall be Chairman ex-officio of all Com-
mittees, Vide Law XXVL

BYE-LATATS.

SEGTIONS-

I. The work of the Society shall be divided into the follow-
ing sections : —

(a) Materia Medica and Therapeutics.

(b) General Medicine and Pathology.

(c) Surgery and its special branches of Gynaecology.

II. Each section shall be controlled by a Committee of five
Members elected at the Annual Assembly, who shall choose
two of their number as Chairman and Secretary respectively.
The Honorary Secretary of the Society shall be ex-officio a
member of each committee.

III. Each section shall, as far as possible, have allotted to
it three evenings in rotation during the session. The Chairman
of the section shall be responsible to the Honorary Secretary
for the production of papers on the evenings allotted to it.

ORDINARY MEETINGS.

IV. Ordinary Meetings shall commence at a quarter to
eight, and shall not be prolonged beyond half-past ten, except

14

by a vote of the majority of the members present. The order
of business shall be as follows : —

(a) The minutes of the preceding meeting read.
{b) New petitions for admission read.

(c) Candidates for admission balloted for.

(d) Miscellaoeous business.

(e) Visitors announced and introduced.
(/) Specimens, cases, &c., shown.

(g) Papers read and discussed.
(h) Meeting closed.

V. Each Member is entitled to introduce a Visitor to the
Ordinary Meetings of the Society, on delivering his name in
writing to the President of the Meeting, who shall, have the
power to invite him, if a medical man, to take part in the
discussion.

VI. A book shall be kept by the Secretary, in which Mem-
bers introducing Visitors shall see that they sign their names
previous to admission.

COUNCIL MEETINGS.

VII. The Council shall meet at least four times a year at
seven o'clock on the evenings of the ordinary meetings of the
Society.

LIBRARY.

VIIL That a Librarian be appointed, to take chaise of the
it!»d<^^ periodicals, and papers belonging to the Society, and

15

that such books and periodicals (not being current numbers)
and papers as may be taken from the Library by Fellows and
Members shall be entered by the Librarian in a book kept for
that purpose. All such books to be returned within a month,
and periodicals within a week, of the time of their being taken
away.

IX. Any work soiled or injured must be replaced at the
expense of the Member so injuring it.

X. A book shall lie upon the Library table, in which each
Member may propose the purchase of such works as he may
think suitable for the Library ; which book shall be laid before
the Library Committee at their next meeting, and without
their order no book shall be purchased.

COMMITTEES.

XL Committees shall be appointed by the Society, and
shall consist of not less than five Members, of whom three shall
form a quorum.

(a) The President shall be Chairman ex-officio of all Com-
mittees. Vide Law XXVI.

OFFICERS AND COUNCIL

OF THE

Bdtfeb Romoeopatblc jSocletig,

ELECTED AT

THE ANNUAL ASSEMBLY, JUNE, 1893.

IprejBtlrent.
HUGH CAMERON.

EDWARD MADDEN, M.B.
GILES F. GOLDSBROUGH, M.D.

SreajBurer.
J. GALLEY BLACKLEY, M.B.

lEtbrarian.
E. A. NEATBY, M.D.

douxtal.
J. GALLEY BLACKLEY,M.B.

HUGH CAMERON.

R. E. DUDGEON, M.D.

WASHINGTON EPPS.

G. F. GOLDSBROUGH, M.D.

HENRY HARRIS.

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

RICHARD HUGHES, M.D.
(Brighton).

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

BYRES MOIR, M.D.

E. A. NEATBY, M.D.

C. KNOX SHAW.

ICibrarj dtommttttB.

J. GALLEY BLACKLEY.
G. BURFORD.

R. HUGHES.
E. A. NEATBY.

C. KNOX SHAW.

StCXZtBX^.

C. KNOX SHAW,

PRESIDENTS OF THE SOCIETY

(FROM ITS FOUNDATION).

1844-78 FREDERICK HERVEY FOSTER QUIN, M.D.

1879 ROBERT ELLIS DUDGEON, M.D.

1880 STEPHEN YELDHAM.

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

1884 DAVID DYCE BROWN, M.D.

1885 JOHN HAMILTON MACKECHNIE, M.D.

1886 MATHIAS ROTH, M.D.

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

1890 ROBERT ELLIS DUDGEON, M.D.

1891 CHARLES THOMAS KNOX SHAW.

1892 JOHN GALLEY BLACKLEY, M.B.

1893 HUGH CAMERON.

TRUSTEES OF THE SOCIETY.

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

CORRESPONDING MEMBERS.

ELECTED

1861 Dr. LEON SIMON, 5 Rue de la Tour des Dames, Paris.

1863 Dr. QUAGLIO, Munich.

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

1863 Dr. LADELCI, Rome.

1870 Dr. IMBERT - GOURBEYRE, Clermont-Ferrand,

France.

1875 Dr. LUDLAM, 1823 Michigan Avenue, Chicago.

1875 Dr. TALBOT, 66 Marlborough Street, Boston.

1875 Dr. ALLEN, New York.

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

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

Paris.

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

1878 Dr. CLAUDE, Rue Caumartin, Paris.
1878 Dr. sircar, Calcutta.

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

1892 Dr. BONIFACE SCHMITZ, Rue des Capucines,

Antwerp.

1893 Dr. TOD HELMUTH, 299 Madison Avenue, New York.
1893 Dr. J. P. DAKE, Nashville, Tennessee.

1893 Dr. MARTINY, Rue D'Arlon 45, Brussels.

1893 Dr. WINDELBAND, Koniggratzerstr. 88, Berlin,

1893 Dr. SULZER, Liitzowstr. 88, Berlin.

FELLOWS OF THE SOCIETY.

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

MEMBEBS OF THE BBITISH HOMCEOPATHIC SOCIETY.

Founded 1844.

EXPLANATION OF THE ABBREVIATIONS.

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

T. — Treasurer. L. — Librarian.

C. — Member of Council. S.— Secretary.

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

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

GENERAL LIST OF MEMBEES.

SLECTED

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

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

1888 Ai^EXANDER, Archibald Spiers, M.D., C.M.Glasg. ; Physi-
cian to the Devon and Cornwall Homoeopathic Dis-
pensary and Cottage Hospital; 6, Sussex Terrace,
Plymouth.

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

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

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

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

Edin., M.R.C.S.Eng. ; 3, White Ladies Road, Clifton.

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

1864 IBell, Vernon, M.D.Edin., L.R.C.S. and L.M.Edin. ;
Highland Gardens, St. Leonards-on-Sea.

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

4, Addison Terrace, Notting Hill, W.

V.
BIiBCTBD

1890 Bennett, Henry, L.E.C.P., L.E.C.S., L.M.Edin., L.A.H.,
• L.M.Dub. ; 323, Holloway Eoad, N.

1892 BiBD, Ashley, M.E.C.S.Eng., L.S.A. ; Gulverlands, Stan-
well Eoad, Penarth, Glamorganshire.

1871 *BiiACKTiEY, Chables Harrison, M.D.Brux., M.E.C.S.Eng. ;

Arnside House, Old Trafford, Manchester. (V.-P.
1881-2, 1886-7.)

1872 ♦BiiACKLEY, John Galley (2Veaswrer),M.B.Lond.,M.E.C.S.

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

1866 *Blake, Edward Thomas, M.D.Aberd., M.E.C.S.Eng. ;
Berkeley Mansions, 64, Seymour Street, Hyde Park,
W. (V.-P., 1887-9.)

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

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

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

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

L.M. ; Physician to the Bristol Homceopathic Dis-
pensary ; Linden House, Oakland Eoad, Clifton.

1860 Bradshaw, William, M.D.Aberd., M.E.C.S.Eng,, L.S.A. ;
122, Holland Eoad, W.

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

L.F.P.S.Glasg., L.S.A.; 25, Peachey Terrace, Mel-
bourne Street, Nottingham.

1892 Brotohie, Theodore Eainy, M.D., C.M.Aberd. ; 102,
Great Victoria Street, Belfast.

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

Physician to the London HomcBopathic Hospital ; 29,
Seymour Street, Portman Square, W. (P. 1884.
V.-P. 1883. C. 1892.)

1872 Bryce, William, M.D.Edin.; 31, Charlotte Square,

Edinburgh.

BLXOTBD

1889 BuBFOBD, Gbobob, M.B., G.M.Aberd. ; Physician tp the
GynsBcological Department, London Homceop^hic
Hospital ; 20, Queen Anne Street, Cavendish Square,
W. (C. 1892.)

1879 BuBNBTT, James Cobipton, M.D.Glasg. ; 2, Finsbury
Circus, E.G.

1892 BuBNS, Alfbed Huqh, L.E.C.P.I., L.S.A.Lond. ; Ham-
slade, Sweyn Eoad, Margate.

1873 BuBwooD, Thobias Wesley, L.R.C.R, L.M.I. , L.R.C.P.,
L.M.Edin. ; Strathmore, Florence Road, Ealing, W.

1876 *BuTCHEB, William ' Deane, M.R.C.S.Eng. ; Clydesdale
Villa, Osborne Eoad, Windsor.

1844 *Camebon, Hugh (President), M.R.C.S.Eng. ; 62, Redcliffe
Square, S.W. (V.-P. 1865-6, 1871.)

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

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

1892 Cappeb, Pebcy, M.B., C.M.Edin. ; 9, Monson Road, Tun-
bridge Wells.

1861 *Cabpbae, Geobqe Mann, M.D.Edin. ; Consulting Physi-
cian to the GynaBcological Department, London
Homoeopathic Hospital ; 4, Hertford Street, Mayfair,
W. (P. 1888-9. V.P.-1882-3.)

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

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

1873 Chalmebs, Andbew Cbichton, M.D., L.R.C.S.Edin.;
305, Glossop Road, Sheffield.

1877 Chubchill, Samuel, M.D.Aberd., M.R.C.S.Eng. ; 1,
Cheriton Terrace, Eolkestone.

vu.

EUEGTED

1880 '^CiiARKE, John Hknby, M.D., C.M.Edin. ; Physician to the
Londoii Homoeopathic Hospital; 30, Clarges Street,
W. (V.-P. 1888).

1861 *Clifton, Abthub Crowen, M.D. (Hon.) New York,
M.R.C.S.Eng. ; Physician to the Northampton
HomcBopathic Dispensary; 65, Ahington Street,
Northampton.

1892 CiiiFTON, Frederick William, M.R.C.S.Eng., L.R.C;Pl,
L.M.Edin. ; 356, Glossop Road, Sheffield.

1873 Clifton, George, L.R.C.P.Edin., L.M., L.F.P.S.Glasg. ;
48, London Road, Leicester.

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

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

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

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

Collins Street East, Melbourne, Australia.

1869 *CooPER, Robert Thomas, M.A., M.D., M.Ch. T.C.D. ;
Physician for Diseases of the Ear, London HomcBO-
pathic Hospital ; 30a, George Street, Hanover SquiBi,re,
W. (V.-P. 1889-90.)

1893 CoRBETT, Herbert Henry, M.R.C.S.Eng. ; 19, Hall Gate,

Doncaster.

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

Oxford Road, Manchester.

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

1892 Craig, George Alexander, M.B., C.M.Aherd. ; Physician
to the Birmingham Homoeopathic Hospital ; 63, Soho
RoEui, Birmingham.

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

1892 Craig, John Smith, M.B., C.M.Aherd. ; 137, Steelhouse
Lane, Birmingham.

,^^ /^^ -"*- "^ '^^^ \. .r . rJtiiiiu ; Surgeon

^ '.-..•« i»^. . ^^:a5*:?i Boqpcxml; to the
^^ ««^.-; r.^^akf^rsarr : aad to the

.^ I. !>!>*>tirj&i: xo the Hastily and

....*.^*A^'v V uLiAM, M.B.C.S.Eng., Iii,CJP.
), ;>u«»t: ?'irliAment Street, LiverpooL

.c..««itbu£(^ H.D.Lond.y M.B.G.SJEhifu
>.««.^ L.S.A.; Assistant Physiciiiai joid
o xM London Homoeopathic HoqiitiLl:
: Ja^rdens, Hampstead, N.W.

• '..^V4.j».- Iiii^wABD, M.B.C.S.Eng., Ii.S.A. ; Snr-

^ ..1, av^T^Ktal for Soldiers' Wives and Children,

s^ , , uii^. .Vldershot ; Army Medical Staff, Aldts*-

. x ir^j^, M.D, St. And., M.B.C.S.Eng.,KB.C.P.
. . , v>Aiji^?Id,> Sydney, New South Wales.

.,x, \ .ix, M.B.C.S.Eng., L.B.C.P.Edin. ; Shen-
. .. >, -ciia Mahrem.

X V. .xiiKT Ellis (Council), M.D.Bdin., L.B.C.S.

V oa;>ultdng Physician to the London Homoeo-

.. * loo^pital ; 53, Montagu Square, W. (P. 1879,

V -F. 1874-5, 1881. T. 1883-93. S. 1846-48.)

X ,\viiv Arnold, M.B., C.M.Edin. ; 2, Eldon
, ,, \ewcastle-on-Tyne.

. »\ WiLXOAM {President, Liverpool Branch), M.B.,
s\ \;i.. L.R,C.P., L.B.C.S.Edin. ; Honorary Medi-
.\, vs.i to the Hahnemann Hospital, Liverpool;
. \.\ .v> Street, LiverpooL

N\ .X viwiTON (Council), L.B.C.P., L.M.Edin. ;

\ \ s S. Mug. ; Assistant Physician to the London

. X vuhio Hospital ; 89, Great Bussell Street,

IX.
SI^ECTBD

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

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

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

1893 Flint, Fbbdbbic3K, M.D., G.M.Aberd., M.R.C.S.Eng. ; 8,

Ramshill Road, Scarborough.

1885 Fbobt, Geobqe, L.R.C.P.Lond., M.R.G.S.Eng. ; Assistant

Physician to the Hahnemann Convalescent Home;
Surgeon to the Bournemouth Homceopathic Dispen-
sary ; Clovelly, Suffolk Road, Bournemouth.

1888 GiLBEBT, Sydney, L.R.C.P., L.R.C.S.Ediii., L.A.H., L.M.
Dub. ; Roseneath, Reigate, Surrey.

1893 tGiLES, Frederick William, M.B.Durh., M.R.C.S.Eng. ;
Hotel Continental, Cannes, France.

1881 *Goldsbrough, Giles Forward (Vice-President, C), M.D.,
G.M.Aberd.; Cedar Lodge, 133, Coldharbour Lane,
S.E. • '

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

1886 Gould, Edward Gardiner, L.R.C.P.I. ; Woodlawn,

Leigham Court Road, Streatham, S.W.

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

1892 Green, Vincent, M.B., C.M.Edin. ; 10, The Common,
Ealing, W.

1876 Guinness, Arthur, M.D.Glasg., F.R.C.S.I., L.M.Dub. j

Physician to the Oxford Homoeopathic Dispensary;
Acacia Lodge, Oxford.

1877 Hahnemann, Frederick Leopold Robert, M.D.Leipzig ;

14, Highbury Crescent, N.

1876 Hall, Edqar Atheling, M.B., C.M.Edin. ; Physician to
the Surbiton, Kingston and Norbiton HomoBopathic
Dispensary ; Laurel Villa, Victoria Road, Surbiton.

X.

XIjXCTBD

1892 Hall, Frederick, L.R.C.P., L.E.C.S.I., L.M. ; Oak
House, Bacup, Lancashire.

1847*tHAMiLTON, Edward, M.D. St. And. ; 16, Cromwell Place,
8.W. (V. P. 1866-6. 1878-9. T. 1848-1881.)

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

1894 Hardy, James Ebenezer, M.B., C.M.Edin. ; 183, Bath
Street, Glasgow.

1859 Harper, James Peddie, M.D.Edin., L.R.C.S.Edin. ; 43,
Hertford Street, Mayfair, W.

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

1878 Hawkes, Alfred Edward {Vice-Pres., Liverpool Branch),
M.D.Brux., L.R.C.P., L.M., L.R.C.S.Edin. ; Physi-
cian to the Hahnemann Hospital, Liverpool ; 22,
Abercromby Square, Liverpool. (P. Liverp. Br. 1892.)

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

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

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

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

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

1886 HiLBERS, Hermann Gerhard, B.A.Camb., L.R.O.P.,

L.R.C.S.Edin., L.F.P.S.Glasg. ; 49, Montpelier Road,
Brighton.

1887 Hill, William Reed, M.B., C.M.Edin.; 29, Crouch

Street, Colchester.

ELECTED

1861 *HuGHEs, EiCHABD {Editor, C.) M.D.(Hon.), L.E.C.P.Editi.,
M.K.C.S.EDg. ; Physician to the Brighton HomcBO-
pathic Dispensary; 36, Sillwood Eoad, Brighton.
(P. 1887. V.-P. 1885-6. S. 1879-84.)

>

1892 Huxley, John Charles, M.D., C.M.Aherd. ; 91, Harbome

Eoad, Edgbaston, Birmingham.

1882 Jagielski, Victor Apollinaris, M.D.Berlin, M.R.C.P.
Lond. ; Physician to the Infirmary for Consumption,
Margaret Street; 54, York Terrace, Begent's Park,
N.W.

1894 Johnstone, James, F.R.C.S.Eng., M.B., CM., D.P.H,
Aberd. ; 47, Sheen Road, Richmond.

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

1893 Jones, George Reginald, L.R.C.P.Lond., M.R.C.S.Eng. ;

3, Iden Villas, South Terrace, Eastbourne.

1866 Jones, Jambs, M.D.Edin., M.R.C.S.Eng., L.R.CP.Lond. ;
Physician to the Reading and Berkshire Homceo*
pathic Dispensary, Holybrook House, Castle Street,
Reading. . i

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

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

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

1875 tKiTCHiNG, Charles Watson, M.B.Lond.; M.R.C.S.Bng,,
L.S.A. ; 6, Church Street, Cape Town, 8. Africa. '

1872 tKYNGDON, BouGHTON, L.S.A. ; Sydney, N6w South Wales.

1893 Lambert, James Rudolf Paul, M.B., C.M.fldin.; Resi-
dent Medical Officer to the London Homoeopathic''
Hospital ; London Homoeopathic Hospital, Great
V Ormond Street, W.C. -'^

xu.

1891 Lough, Geobqe John, L.B.G.P.I., L.M. ; Assistant Sur-

geon to the Buchanan Cottage Hospital, and Assistant
Ophthalmic Surgeon to the Hastings and St. Leonards
Homoeopathic Dispensary ; 35, Wellington Square,
Hastings.

1850 Mackbchnie, John Hamilton, M.D. St. And. ; Physician
to the Hahnemann Dispensary, Bath ; 15, Catherine
Place, Bath. (P. 1885. V.-P. 1872. S. 1867-69.)

1893 MaoNish, DAvm, M.A., M.B., C.M.Edin. ; Strathmore,
Florence Boad, Ealing, W.

1886 MoEhiLiam, Bobebt, M.D., C.M.Aberd. ; 1, Bennett Park,
Blackheath, S.E.

1892 MoLachlan, John, M.D., CM., B.Sc.Edin., F.B.^.S.Eng.

38, Beaumont Street, Oxford.

1876 *Madden, Bdwaed Monson (F.-P., Coundt), M.B.Edin.,
M.B.C.S.Eng. ; Physician to the Phillips Memorial
Hospital ; Burlington House, Bromley, Kent.

1892 Mahony, Edward, M.B.C.S.Eng., L.S.A. ; Honorary

Medical Officer to the Hahnemann Hospital, Liver-
pool ; 30, Huskisson Street, Liverpool.

1885 Maesh, Thomas Chaeles, L.B.C.P.Edin., M.B.C.S.Eng.,
L.M. ; Assistant Physician to the London Homoeo-
pathic Hospital, and Visiting Physician to the
Margaret Street Infirmary for Diseases of the Chest
and Throat ; 56, Fitzroy Street, Fitzroy Square, W.

1885 Mason, Heney, M.D., C.M.Glas., M.B.C.S.Eng.; 52,
London Boad, Leicester.

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

1893 Meek, William Ombleb, M.B., C.M.Edin. ; 256, Oxford

Boad, Manchester.

1893 MiLLEB, Bobebt Gibson, M.B., C.M.Glasg. ; 10, Newton
Place, Glasgow.

1892 Mitchell, John James, L.B.C.P.Lond., M.B.C.S.Eng.
1, Howard Place, Stoke-on-Trent.

1882 *Moie, Byees {Council), M.D. and C.M.Edin.; Phy-
sician to the London Homoeopathic Hospital; 16
Upper Wimpole Street, W. (V.-P., 1891, 1892.)

xm.

EltECTBD

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

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

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

1877 MooBE, John Mubray, M.D., CM., L.M.Edin., M.K.C.S.
Eng., M.D.New Zealand ; 51, Canning Street, Liver-
pool.

1867 MoBGAN, Samuel, M.D. St. And., M.E.C.S.Eng., L.S.A. ;
Consulting Physician to the Bath Homoeopathic
Hospital; Physician to the Bristol Homoeopathic
Dispensary ; 16, Oakfield Koad, Clifton.

1890 MoBBissoN, Stammebs, M.D.Phil., M.E.C.S.Eng., L.E.C.P.

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

1882 MuBBAY, John, L.E.C.P., L.E.C.S., L.M.Edin.; 15,
Trinity Gardens, Folkestone.

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

1888 *Nankivell, Hbbbebt, M.D.Edin., M.E.C.S.Eng. ; Phy-
sician to the Hahnemann Convalescent Home,
Bournemouth ; Penmellyn, Bournemouth.

1893 Neatby, Andbew Mossfobth, L.E.C.P., L.E.C.S.Edin.,
L.F.P.S.Glasg. ; Physician to the Sutton Homoeo-
pathic Dispensary ; Mulgrave Eoad, Sutton, Surrey.

1886 *Nbatby, Edwin Awdas {Librarian, Council), M.D.Brux.,
* L.E.C.P.Lond., M.E.C.S.Eng.; Assistant Physician

to the London Homoeopathic Hospital ; 178, Haver-
stock Hill, Hampstead, N.W.

1885 Nbild, Fbedebick, M.D.; C.M.Edin., L.E.C.P.Edin. ;
Physician to the Tunbridge Wells Homoeopathic
Hospital and Dispensary; Belvedere House, Tun-
bridge Wells.

1891 Newbbby, Willl/^ Ebedebioe Hoyle, M.D., CM.

Toronto, L.S.A.Lond. ; 109, Cazenove Eoad, Stoke
Newington, N.

1892 Nicholson, Thomas Dickenson, M.D., C.M.Edin.,

M.E.C.S.Eng. ; Physician to the Clifton Homoeo-
pathic Dispensary; 2, White Ladies Eoad, Chfton.

XIV.
ZLSOTBD

1880 Noble, James Black, M.R.C.S.Eng., L.R.C.P., L.M.Edin. ;
167, Kennington Park Boad, S.E.

1876 NoBMAN, Geoboe, M.E.C.S.Eng., L.S.A. ; Physician to
the Hahnemann Free Dispensary, Bath; 12, Brock
Street, Bath.

1892 Ookenden, Abthub John, M.E.C.S.Eng. ; 25, Begency

Square, Brighton.

1893 Oed, William Thbophilus, L.E.C.P.Lond,, M.E.C.S.Eng.;

Greenstead, Madeira Eoad, Bournemouth East.

1886 PiNOOTT, James Cole, M.E.C.S.Eng., L.E.C.P., L.M.Edin.;
Surgeon to the Tunbridge Wells HomoBopathic £[os-
pital and Dispensary; Calverley Parade, Tunbridge
Wells.

1862 *PoPE, Alfbed Crosby, M.D.Phil., M.D. (Hon.) New York,
M.E.C.S.Eng. ; Watergate House, Grantham. (P.
1881. V.-P., 1873-4.)

1879 Powell, Alfbed John, M.D.Erlang., M.E.C.S.Eng. ;
Sewardstone Lees, Anerley Eoad, S.E.

1868 tPsiTCHABD, JosiAH, M.E.C.S.Eng., L.S.A. ; 63, Eichmond
Eoad, Montpelier, Bristol.

1893 Pboctob, Peteb, M.E.C.S.Eng., L.E.C.P.Edin„ L.S.A. ^^
17, Hamilton Square, Birkenhead.

1884 PuLLAB, Alfbed, M.D., C.M.Edin. ; 78, Beulah Hill,
Upper Norwood, S.E. /

1884 Pubdom, Thomas Eadie, M.D., C.M.Edin., L.E.C.p!,
L.E.C.S.Edin. ; 26, Park Hill Eoad, Croydon.

1893 Eamsbotham, Samuel Henby, M.D.Edin., M.E.C.S.Bhg. ;
16, Park Place, Leeds.

1892 Eean, William Henby, M.E.C.S.Eng., L,S,A. ; 36,
Vernon Terrace, Brighton.

1862 Eeed, Eobebt Ehodeb, M.D.Clev., M.E.C.S.Eng. ; Mar-
ket Square, Lynn Eegis, Norfolk.

1892 Ee&d, William Cash, M.D., C.M.Edin. ; Physician to'^ihid^
Devon and Cornwall Homceopathic Dispensary and
Cottage Hospital ; 8,X3ueen Anne Terrrace^ Plymouth.

XV.

JUjECTED

1872 tBEiD, Lestock Holland, M.E.C.S.Eng., L.E.C-I^-I^oiMi- ;
Bowmanville, Ontario, Canada.

1885 Eenneb, Charles, M.D.Wiirzburg, L.K.C.P.Lond.j
M.E.C.S.Eng. ; 186, Marylebone Eoad, N.W.

1893 Eeynolds, Edward Eobert Bradley, M.E.C.S.Eng. ;
Highcroft, Shepherd's Hill, Highgate, N.

1892 Egberts, Arthur, M.D. St. And., M.E.C.S.Eng., L.S.A.,

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

1893 Eoberts, William Henry, L.E.C.P., L.E.C.S^Edin.,

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

1878 EocHE, Eleazer Birch, L.E.C.P.Lond., M.E.C.S.Eng.,
L.M. ; Physician to the Norwich Homoeopathic Dis-
pensary and Hon. Medical Ofl&cer to the Orphans'
Home, Norwich ; 27, Surrey Street, Norwich.

1892 Eoohe, William; L.E.C.P.L, L.M., M.E.C.S.Eng.; 38,
Bemers Street, Ipswich. /

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

1891 Eoss, William, L.E.C.P., L.E.C.S.I., L.M. ; Physician to

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

1892 EowsE, Edward Leopold, L.E.C.P.Lond., M.E.C.S.Eng. ;

114, Upper Eichmond Eoad, Putney, S.W.

1880 Sandberg, Arthur Gregory, M.D., Verm. (Hon.),

L.E.C.P., L.E.C.S., L.M.Edin. ; 161, Brixton Hill,
S.W.

1893 Sanders, Horace, L.S.A. ; 77, Camden Eoad, N.W.

1892 Scriven, George, M.D., B.Ch.Dub., L.M. ; Physician to
the Dublin Homoeopathic Dispensary ; 33, St.
Stephen's Green, Dublin.

1866 Scriven, William Barclay Browne, A.B., M.B.Dub.,
M.E.C.S.Eng., L.M.; Physician to the Dublin
Homoeopathic Dispensary ; 33, St. Stephen's Grefen,
Dublin.

XVI.
EEJCCTEO

1885 Shackletok, Hsnby, A.B., M.D.Dub., M.E.C.S.Eiig.,
L.M.R.C.P.I., L.M. ; 12, West Hill, Sydenham, 8.E.

1883 "^Shaw, Chables Thomas Knox {Secretary, C), L.B.C.P.
Lond., M.B.C.S.£ng. ; Surgeon and Ophthalmic Sur-
geon to the London Homoeopathic Hospital ; Surgeon
to the Buchanan Cottage Hospital, St. Leonards;
Ophthalmic Surgeon to the Hastings and St. Leonards
Homoeopathic Dispensary ; Consulting Surgeon to the
Tunbridge WeUs Homoeopathic Hospital ; 19, Upper
Wimpole Street, W. (P. 1891. V.-P. 1890.)

1885 Shaw, Frakk Hsbbebt, M.B.C.S.£ng. ; Surgeon to the

Buchanan Cottage Hospital, and to the Hastings and
St. Leonards Homoeopathic Dispensary ; 33, Warrior
Square, St. Leonaids-on-Sea.

1888 Simpson, Thomas, M.D. St. And., M.B.C.S.Eng. ;
Physician to the Hahnemann Hospital, Ldverpool,
and to the Bootle Homoeopathic Dispensary; 10,
Crosby Bead, Waterloo, Liyerpool.

1859 ^Smart» John Cass, MJ>^eid., Ext. L.B.C.P.Lond.,
M.B^C.SJEIng., L.S.A. ; Combe Hay, near Bath.

1886 Smith. Gkrari>» M^C.S.£ng. ; Craigholm, Upper

Clapiott, N^.

l^>i Smith. Bobskt Gordox, M.B.> C,M,Aberd. ; Physician to
tb0 llahui^maim Hospital, Liverpool; 164, Upper
INa^U^ou^ut S^r^^t, Liverpool.

(H^ ^VTHAMi^ JoHx Bi:o(s> M.B.C.S.IIng., L.S.A. ; Benar
YWwx l>ol\v\\Metett> N. Wales.

((i^ 8^^'t^cik'Vi, llKMHiiaftT GuBssox, M.DJBnix«, KRCP., L.M.
iJ».Uu.. M.BX\S.Eug. ; 28, Park Square, Leeds.

\\^ ^i^jiXJUX^ JoHX Christophsb Gbobqb, L.B.C.P.L, The
]dc>vuxt, St. Aune*s-on-Sea.

tH9^> Sevanwmh, £i&n£ST Hekby Mubly, M.B., G.M.Edin. ; 2,
Loww' Moira Place, Southampton.

i8^i S'VUiKTHAii, Waltbb Ouveb, L.B.C.P.Lond., M.B.C.S.
Eug., L.S.A. ; 128, Tweedale Street, Bochdale.

iB&^ tBTi^HSi^s, Samvsii Sandebs, M.B.C.S.Eng. ; Stedcombe
Mauor, A^monter, Devon.

XVll.
ELECTED

1889 Stonham, Thomas George, M.D.Lond., M.R.C.S.Eng. ;
Claremont, Belgrave Road, Ventnor.

1892 Stopford, Robert, L.R.C.P.I., L.M. ; Physician to the
North of England Children's Sanatorium ; 76, Hogh-
ton Street, Southport.

1887 Storrar, William Morrison, L.R.C.P., L.R.C.S.Edin.
L.M. ; Surgeon to the North of England Children's
Sanatorium ; 37, Hoghton Street, Southport.

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

1892 Thomas, Bernard, M.B., C.M.Edin. ; Stipendiary Medical

Officer to the Northern Homoeopathic Dispensary,
Liverpool ; 40, Oxford Street, Liverpool.

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

1891 Thomas, Harold Wynne, M.R.C.S.Eng., L.R.C.P.Lond. ;
Resident Medical Officer to the Phillips Memorial
Hospital, Bromley ; 65, Pd»rk Road, Bromley, Kent.

1893 Thompson, Charles, M.R.C.S.Eng., L.S.A. ; 226, Stam-

ford Street, Ashton-under-Lyne.

1855 f TucKEY, Charles Caulfield, A.B., M.B.Dub., L.R.C.S.I.,
L.M. ; Charleville, Kew.

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

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

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

1858 tWAUGH, Dr., Brisbane, Queensland.

1893 Weddell, James Call, M.D., CM., L.M.Edin. ; 9, Park
Terrace, Sunderland.

xvm.

ELEOTBD

1861 tWHBELER, Henry, L.R.C.P.Lond., M.R.C.S.Eng. ;
Auburn Eoad, Hawthoiiie, Victoria, Australia.

1893 WiLDB, Frederick George Stanley, L.R.C.P., L.R.C.S.,
L.M.Edin. ; logleside, Bayshill, Cheltenham.

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

1893 Wilde, John, L.R.C.P.Edin., M.R.C.S.Eng., L.S.A. ;
Park House, Weston-super-Mare.

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

1891 Wilde, Rowland Stanley, M.B., C.M.Edin.; Park

House, Weston-super-Mare.

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

Newland, Northampton.

1892 Wilkinson, Clement John, M.R.C.S.Eng., L.S.A. ; 112a,

Chorley New Road, Bolton-le-Moors.

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

127, Moss Lane, Manchester.

1892 Williams, Eubulus, M.D. St. And., M.R.C.S.Eng., L.M. ;
2, Beaufort Road, Clifton.

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

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

Glasg., Chloroformist to the Dental Hospital, Bir-
mingham; Aubyn House, Alcester Road, Mosely,
Birmingham.

1889 WiTHiNSHAw, Charles Wesley, L.R.C.P., L.R.C.S.Edin.,
L.M. ; New Cross, S.E.

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

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

V

1877 WoLSTON, Walter Thomas Prideaux, M.D.Edin.,
M.R.C.S. ; 46, Charlotte Square, Edinburgh.

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

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

XIZ.
BliECTKD

1889 Wbight, Dudley D'Auvbbgnk, L.R.C.P.Lond., M.R.C.S.
Eng. ; Assistant Surgeon and Surgeon for Diseases
of the Throat to the London HomoBopathic Hospital ;
32, Wimpole Street, W.

1864: *YfYU), Geobge, M.D.Edin. ; Eieldhead, Wimbledon
Park, Wunbledon. (V.-P. 1876.)

18^9 *Ybldham, Stephen, M.R.C.S.Eng., L.R.C.P.Edin. ; Con-
sulting Surgeon to the London Homoeopathic Hos-
pital; Highfield House, St. Nicholas Eoad, Upper
Tooting, S.W. (P. 1880. V.-P 1861-64 ; 1877).

LIVEEPOOL BEANCH.

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

MEMBERS.

Ellis, J. W., President. Hawkes, A. E., Vice-President,

Capper E., Secretary.

DAvrosoN, F. W. Meek, W. 0.

FiNLAY, J. T. Mitchell, J. J.

Gordon, J. N. Simpson, T.

Green, C. T. Smith, R. G.

Hall, F. Southam, J. B.

Hayward, C. W. Stopford, R.

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

Hayward, J. W. Stuart, P.

Jones, T. R. Thomas, B.

Mahoney, E. Thomas, E. J. H.

Williams, L. E.

LOCAL LIST.

AldershoL
Deane, H. E.

Ashton-under-Lyne,
Thompson, C.

Azmonter.
Stephens, S. 8.

Bacup,

HaU, F.

' Bath.

Mackechnie, J. H.
Norman, G.
Smart, J. C.
Wilde, P. E.

Belfast.
Brotchie, T. E.

Birkenhead^
Green, C. T.
Hayward, J. W.
Jones, T. E.
Proctor, P.

Birmingham.

Blake, J. G.
Craig, G. A.
Craig, J. S.
Huxley, J. C.
Thomas, E. W.
Wingfield, J.

Bolton-le-Moors.
Wilkinson, C. J.

Bournemouth.

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

Bradford (Torks).
Waddington, C. E.

Brighton^
Belcher, H.
Hilhers, H. G.
Hughes, E.
Ockenden, A. J.
Eean, W. H.

Bristol {see Clifton).
Pritchard, J.

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

Cheltenham.
Ker, C. B.
Wilde, F. G. S.

Chester.
Thomas, E. J. H.

Chislehurst.
Wolston, C.

Clifton, Bristol.

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

XXI.

Hill, W.K

Purdom, T. E.

Dolvryddelen iX. Walch
Sontham, J. B.

Corbett, H- H.

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

Burwood, T. W.
Green^ Y.
MacXish, D.

EoBiboume.
Crouchca-, A. H.
Jones, G. B.

Edinburgh.
Bryce, W.
Wolston, W. T. P.

Exeter.
Woodgates, H.

FolkesUme.

Chmcfaill, 6.
Murray, J.

(Haegaw.

Hardy, J. £.
Miller, E. G-

GrojKikamu
Pope, A. C.

Harrogaie.
Bobsiis. A.

Hastings.
LoTi^ G. J.

Ipstcick.
Eoche, W,

Tucker, C. C.

King^s Lynn.
Beed,B.B.

ZieamingUm.
Collins, C. P.

Leeds.

Bamsbotbam, S. H.
Stacev, H. G.

Leicester.

Clifton, G.
Ma£on, H.

lAverpool.
Capper, £.
Davidson, F. W.
Ellis, J. W.
Gordon, J. N.
Hawkes, A. £.
Haywaid, C. W.
Hayward, J. D.
Mahony, £.
Moore, J. M.
Simpson, T.
Smith, B. G.
Stuart, P.

xxii.

Thomas, B.
Williams, L. E.

London (N.).

Bennett, H. (Hollotvay),

Hahnemann, F. L. E. {High-
bury).

Newberry, W. F. H. {Stoke
Netvington).

Eeynolds, E. E. B. {High-
gate).

London {N.E.)

Blyth, W. F. {Victoria Park).
Smith, G. {Clapton).

London {N.W.)

Day, J. E. {Hampstead).
Jagielski, V. A. {Regent's

Park).
Neatby, E. A. {Hampstead),
Eenner, C. {Marylebone).
Sanders, H. {Camden Town).

Lojidon {S.E.).

Goldsbrough, G. F. {Camber-
well).

Harris, H. {Camberwell).

McKilliam, E. {Blackheath).

Nankivell, F. {Sydenham).

Noble, J. B. {Kennington).

Powell, A. J. (Anerley).

Pullar, A. {Norwood).

Shackleton, H. {Sydenham).

Withinshaw, C. W. {New
Cross).

London {S.W.).

Cameron, H. {South Ken-
sington).

Cronin, E. F. {Clapham
Common).

Gould, E. G. {Streatham).

Hamilton, E. {South Ken-
sington).

Morrisson, S. (Clapham Com-
mon).

Sandberg, A. G. {Brixton).

Yeldham, S. (Tooting).

London (B.C.).
Burnett, J. C.

London {W.)

Bellis, E. (Noiting Hill).

Blackley, J. G.

Blake, E. T.

Bradshaw, W. {Kensington).

Brown, D. D.

Burford, G.

Carfrae, G. M.

Clarke, J. H.

Cooper, E. T.

Cox, W. S- {Kensington).

Dudgeon, E. E.

Harper, J. P.

Marsh, T. C.

Moir, B.

Shaw, C. T. K.

Wood, H. T.

Wright, D. D'A.

London {W.C.)
Epps, W. (Bloomsbury).
Lambert, J. E. P. {Blooms-
bury).

Malyem.
Drummond, J.
Femie, W. T.

Manchester.

Arnold, F. S.
Blackley, C. H.

XXlll.

Cox, E. P.

Bawtenstally Lanes,

Meek, W. 0.

Finlay, J. T.

Moir, D.

Williams. A. L.

Beading.

Jones, J.

Margate.

Burns, A. H .

Beigate,

Nottingham,

Gilbert, S.

Brooks, S. B.

Bichmond (Surrey),

Newcastle,

Johnstone, J.

Eaton, H. A.

Hamilton, J.

Bochdale,

1

Hayle, T. H .

Northampton,

Steinthal, W. A.

CHfton, A. C.

Boss, W.

St, AnneS'On-Sea (Lanes)

Wilkinson, A. G.

1

Staley, J. C. G.

Norwich,

Eoche, E. B.

St, Leonards-on-Sea,

Bell, V.

Oxford.

Croucher, A. E.

Guinness, A.

Shaw, F. H.

McLachlan, J.

Scarborough.

Penarth (Glam.).

Flint, F.

Bird, A.

Boss, A.

Plymouth,

Sheffield

Alexander, A. S.

Chalmers, A. C.

Eeed, W. C.

Clifton, F. W.

Vawdrey, T. G.

•

Southampton.

Putney,

Stancomb, E. H. M.

Eowse, E. L.

Southport,

Bamsgate.

Blumberg, H. d'A.

Hawkes, E. J.
1

Stopford, E.

Storrar, W. M.